When to Worry and What To Do
By Molly Hedrick, PhD, Psychologist & New England Lead, Bradley REACH, Gary Regan, LICSW, Clinical Director, Adolescent Partial Hospitalization Programs, Bradley REACH, Juliana Chen, MD, Chief Medical Officer, Cartwheel, Stacey Swasey, LICSW, Cartwheel
Teachers, school social workers, counselors, and psychologists are the frontline in improving children’s mental health. Schools see children every day and have a deep understanding of their social, emotional, and academic progress. But precisely because schools see children so often, it can be hard to know when to worry, and where to find resources when you are worried.
When To Worry
Changes in mood and behavior are often the first red flags that there is an issue. These can manifest as struggles with:
daily functioning
school absenteeism
substance use
At the more severe end of the spectrum, these changes can lead to self-harm and suicidality. In a Multi-Tiered System of Support (MTSS) school supports are often the first line of defense. The level of concern should obviously increase if these initial supports don’t lead to improvement.
Communicating with Families
When sharing concerns with families, the starting point should always be listening and relationship-building. Strive to learn family and student perspectives (particularly for tweens and teens) and continually seek their input as you provide recommendations.
Psychoeducation is vital. Families come with different levels of experience and understanding about mental health. Consider and be respectful about cultural factors in terms of how mental health and asking for support may be perceived.
Finding Support
Even when parents, students, and schools have all acknowledged the need for more help, accessing quality providers can be a challenge. Telehealth can help with making care more accessible. A growing number of school districts across the United States have now brought telehealth into their MTSS.
Most people are familiar with outpatient teletherapy. But it’s worth knowing that many more levels of care can be delivered virtually including;
specialized outpatient
intensive outpatient programs (IOP)
partial hospitalization programs (PHP)
medication management
It’s often reassuring for families that evidence shows that virtual treatment for mental health shows no difference in clinical outcomes compared to in-person care.
When you’re really worried about a student, consider higher levels of care including IOPs and PHPs. Parents often are not familiar with this level of care, so it’s important to communicate that getting intensive, coordinated, interdisciplinary support early can often prevent crisis visits to the ED or avoidable inpatient stays. Taking time out of school to focus on mental health, as you would for any other medically excused absence, can also be a worthwhile investment. Families and schools can often self-refer to these programs without an evaluation in the ED.
For acute safety concerns, utilize the ED or call 911.
Collaborating
Successful outcomes depend on close collaboration between providers, schools and families, especially around the time of intake/admission and graduation/discharge. Schools can play a role by identifying contacts early on, and by getting family releases early. Advocate and share your voice. If you don’t hear back, keep trying. Your perspective is so important to students’ long-term outcomes.
Lastly, know that improvements can sometimes take time, and require long-term support from schools, families and outside providers. It really does take a village. And don’t forget that providing this kind of support is hard; remember to put on your own oxygen mask first.
DISCLAIMER:
The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment.
If you or your child are in crisis or experiencing mental health problems please seek the advice of a licensed clinician or call 988 or Kids Link in Rhode Island.
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