CSP 517 - Mental Health Toolkit Final - November 13 2018

Mental Health in the Schools

Information for Parents

By Emily Addington, Christina Boos, Cindy Hoang, Britni Kay, & Tracy Tran

Contents
What is Mental Health?............................................................................................................. 3
Positive Psychology and Wellness……………………………………………………………………………. 3-5
Statistics - Why Address Mental Health Early?………………………………………………………… 6
Red Flags and Risk Factors……………………………………………………………………………..…………. 7-10
Common Diagnoses and Concerns………………………………………………………………………….. 11-21
Depression……………………………………………………………………………………………………… 12
Anxiety…………………………………………………………………………………………………………….. 13
ADHD………………………………………………………………………………………………………………. 14
Autism Spectrum Disorder…………………………………………………………………………….. 15-16
Oppositional Defiant Disorder………………………………………………………………………. 17
Eating Disorders……………………………………………………………………………………………. 18
Substance Abuse………………………………………………………………………………………….. 19
Non-Suicidal Self-Injury………………………………………………………………………………… 20
Suicidal Ideation and Behavior……………………………………………………………………. 21-22
Cultural and Diversity Factors…………………………………………………………………………………….. 23-25
Taking a Systems Approach to Mental Health…………………………………………………………… 26-27
The Role of the School in Children’s Mental Health…………………………………………………. 28-30
Specific Roles in School-Based Mental Health………………………………………………………….. 31-33
Legal and Ethical Issues………………………………………………………………………………………………. 34-38
Steps in Addressing School-Wide Mental Health………………………………………………………. 39-44
Using a Multi-Tiered Approach……………………………………………………………………… 39-41
1

School Policy……………………………………………………………………………………………………. 42-43
Screening…………………………………………………………………………………………………………. 44-45
References……………………………………………………………………………………………………….. 46-49
Appendices………………………………………………………………………………………………………. 50-53

2

What is Mental Health?

Mental health involves many aspects of a child’s wellbeing. It includes the emotional,
psychological, and social aspects of a child’s life that influence how he or she thinks, feels, and
acts. The relationship between these aspects of mental health impact how your child handles
stress, forms relationships, and makes life choices (U.S. Department of Human Services, 2017).
Maintaining strong mental health allows your child to realize his or her full potential, cope with
normal stressors of life, and work more productively (World Health Organization, 2018). Mental
health has a strong impact on your child’s success both in school and beyond.
Positive Psychology and Wellness

“Positive Psychology is the study of the conditions and processes that contribute to the
flourishing or optimal functioning of people, groups, and institutions” ( Gable & Haidt, 2005).
❖ Positive Psychology has sparked a movement in schools, called P ositive
Education (Seligman, 2009).
○ This movement promotes the importance of teaching mental health skills in the
schools in addition to traditional academic instruction.
○ This way, education can incorporate parents’ desires to ensure that their
children are healthy and happy at school, in addition to achieving academically.
❖ Positive Psychology is related to (Seligman & Csikszentmihalyi, 2000):
➢ Wellbeing, contentment, and satisfaction (about the past)
➢ Hope and optimism (for the future)
➢ Flow and happiness (in the present)
❖ The goal of Positive Psychology is wellness.
➢ “Wellness is the maintenance of overall quality of life and the pursuit of optimal
emotional, mental, and physical health. Wellness is not the absence of disease,
illness, or stress but the presence of purpose in life, active involvement in
satisfying work and play, joyful relationships, a healthy body and living
environment, and happiness” (Substance Abuse and Mental Health Services
Administration, n.d.).
❖ Parents can help promote Positive Psychology by helping to foster wellness in
their children. The PERMA model below will demonstrate a few ways to get
started.
3

❖ The PERMA model lists the building blocks of wellness and how parents can
work on these steps with their children.

(Adapted from Positive Psychology Center, n.d.).
❖ The 8 Dimensions of Wellness can be used by parents to ensure their child is thriving in
all areas. Parents should explore ways to support their child in each of these eight areas.
(Substance Abuse and Mental Health Services
Administration, n.d.)

4

❖ Why are Positive Psychology and Wellness important to you and your child?
➢ Increases in well-being are likely to produce increases in learning.
➢ Positive mood produces better attention (Seligman, 2009).
➢ Adults and students with higher levels of well-being (Seligman & Csikszentmihalyi,
2000):
■ Perform better at work and in school
■ Have more satisfying relationships
■ Have better physical health and live longer
■ Have greater self-control
■ Have better coping abilities
■ Are more prosocial
➢ Optimism is a key contributor to well-being. Some of the benefits of optimism are
(Seligman & Csikszentmihalyi, 2000):
■ Prevention of some symptoms of depression and anxiety
■ Better performance in school, sports, and work
■ Reduced risk of dropping out of school
■ Better physical health outcomes
Further Resources for Families:

❖ For Wellness Strategies you can use with your child, visit
https://www.samhsa.gov/wellness/strategies.
❖ View 10 positive psychology practices for boosting wellness here:
https://www.psychologytoday.com/us/blog/anxiety-zen/201409/ten-positive-psychology-
practices-boosting-happiness
❖ View 5 ways to practice positive psychology here:
https://positivepsychologyprogram.com/positive-psychology-examples/

5

Statistics - Why Address Mental Health Early?

❖ Mental health disorders are the most common health issues faced by
school-aged children in the U.S. (Child Mind Institute, 2016).

❖ Only 7.4% of children receive any sort of mental health services over the
course of a year (Child Mind Institute, 2015).
➢ The average delay between onset of symptoms and intervention is 8-10 years
(National Alliance on Mental Illness, n.d.).
How does this Impact School and Learning?
1 in 10 young people have a mental health challenge that is severe enough to
impair how they function at home, school or in the community (Kessler et al., 2005).
Only 40 percent of students with emotional, behavioral and mental health
disorders graduate from high school, compared to the national average of 76 percent
(Association for Children’s Mental Health, n.d.).
Anxiety disorders such as social phobia can make students twice as likely to
drop out or have to repeat a year of school (Child Mind Institute, 2016).
ADHD, mood disturbances, anxiety, and disruptive behavior at

age 6 are correlated with math and reading achievement at age 17 (Child
Mind Institute, 2016).
6

Red Flags and Risk Factors

Understanding red flags and risk factors related to mental health can help parents look out for
potential issues their child may be experiencing. Knowing early warning signs that are commonly
associated with mental illness in children and adolescents is crucial for preventative care as it
serves as a basis to assist early detection and intervention.
Risk Factors:
Risk factors that are characteristics seen in children or their environments that may be
associated with an added potential for mental health problems. Certain risk factors are linked
with higher risk for alcohol abuse and other substance use, criminal behavior, unplanned
pregnancy, poor academic performance/school dropout and violence (Fertman, Delgado &
Tarasevich, 2014). If a child experiences several risk factors, this does not necessarily mean that
they are experiencing a mental illness--it simply means that they may be higher risk than
children who experience fewer risk factors.
Individual Attributes:
● Low self-esteem or issues with body image

● Cognitive and emotional immaturity
● Difficulties in communicating
● Medical illness
● Genetic predisposition (when mental illness runs in the family)
● Substance use (particularly if the use is frequent or if the child is dependent on the
substance to function)
● Chemical imbalance in the brain or body
● Lack of coping skills
● Incomplete or irregular brain development
Social Circumstances:
● Loneliness or bereavement
o Social and family isolation
● Neglect or family conflict
o Conflict among parents
o Family dissolution
o Attachment issues (inability to form healthy attachments to significant adults)
● Childhood trauma
o Exposure to violence
o Physical abuse
o Sexual abuse
o Or many other types of possible traumatic experiences
● Low-income/poverty
o Homelessness
o Malnutrition
7

o Sleep disruption
o Lack of access to healthcare
o Lower levels of parental supervision
● Low education level
o Difficulty learning
o Low grades
o Acting out in class
o Receiving serious disciplinary sanctions such as suspensions or expulsions
● In adults or older adolescents, stress at work or unemployment
Environmental Factors:
● Low access to basic services (such as healthcare, for instance)

● Injustice and discrimination
o Populations that are stigmatized (for example, children with racial minority
backgrounds or children who identify as LGBTQIA+)
● Social and gender inequalities
● Exposure to war, natural disaster, other large-scale catastrophic events
● Stressful life events
● In adults and older adolescents, lack of employment opportunities

Red Flags:
Red flags are seen as warning signs or symptoms that indicate a precursor to mental illness.
These symptoms are typically seen as small alterations in the child’s feelings, behavior or
thinking which happens before the illness has fully developed. Red flags serve as an alarm
system for those around to act. They are a step up from risk factors in that they indicate not just
that your child is more likely to experience a mental health issue, but they they may already be
experiencing it. Early detection can lead to intervention which can help prevent, delay, or reduce
the severity of mental illness (American Psychological Association, 2018). If parents do start to
notice these red flags, addressing and talking about these issues openly is a good start. Parents
can also decrease the chances of harm by removing weapons such as knives, pills and guns
from the house. Furthermore, parents play the crucial role of listening to their child and
motivating them to reach out to someone when they need extra support. Parents are
encouraged to reach out to their child’s school counselor or school psychologist. They can help
provide services and support within the school setting, and they can also help families identify
and reach out to mental health agencies in the larger community.
Exhibiting Feelings of:
● Hopelessness
○ Your child may be feeling hopeless when they does not look forward to the
future or have not developed any future plans.
○ Common phrases associated with hopelessness:
■ “There’s just no point.”
8

■ “Why bother?”
■ “Things won’t ever get better.”
● Helplessness
○ Your child may be feeling helpless when they feel trapped or unable control
situations in their own life.
○ Common phrases associated with helplessness:
■ “There’s nothing I can do.”
■ “I just wish I could escape.”
■ “No one ever lets me do what I want to do.”
● Sadness
○ Your child may be feeling sad when they feel less joy or happiness in life, or
when they seem less excited about things they once enjoyed.
○ Common phrases associated with sadness:
■ “I don’t want to do this anymore.”
■ “Nothing is fun for me anymore.”
Changes in Behavior:
● Noncompliance
o Behaviors or reactions that are outside the norm for others your child’s age.
o Consider your child’s developmental age when determining whether a behavior
is extreme enough to be a red flag. Ask yourself, “Is this behavior expected at
this age?”
● Aggressive or violent outbursts
o Inability to control temper.
o Tendency to use force or violence to achieve a desired outcome.
● Increased risky behaviors or showing less concern for safety
o Engaging in unsafe sexual activity.
o Experimenting with drugs and/or alcohol.
o Driving recklessly.
o Sneaking out of the house at night.
● Suicidal ideations
o Thinking and talking about suicide.
o Developing plans for suicide.
o Sharing plans of suicide with others.
o Expressing regrets about being alive.
● Non-suicidal self-injury
o Can include damage caused by cutting, scraping, biting, burning, picking,
scratching, stabbing, severing, constricting, hitting, gouging, or inhaling.
o Typically peaks during adolescence.
Academics:
● Difficulty concentrating
9

● Difficulty with problem-solving

● Poor academic performance or lower grades
Physical Changes:
● Excessive tiredness or drowsiness

● Sleeping problems (sleeping too much or too little)
● Eating problems (eating too much or too little)
Social Interaction:
● Social withdrawal or isolation

● Inability to connect with others
● Delusions, or lost sense of reality

10

Common Diagnoses and Concerns

Children and adolescents can exhibit a wide range of mental health concerns, and can even
meet diagnostic criteria for a number of mental health disorders. Mental health issues can be
internalizing or externalizing in nature:
Internalizing Problems Externalizing Problems

Maladaptive feelings or behaviors Maladaptive feelings or behaviors
directed inward. Examples include directed outward, toward the child’s
nervousness, withdrawal, and feelings environment. Examples include
of worthlessness. aggression and deceitfulness.
While the list of potential areas of diagnosis and concern is long, parents should be aware of the
most common ones seen in children and adolescents. They should understand the nature and
signs of these concerns, along with resources for seeking help should they see them in their
child. This section will review some of the most common mental health issues seen in
school-aged children and adolescents. These include:
● Depression
● Anxiety
● Attention-Deficit/Hyperactivity Disorder (ADHD)
● Autism Spectrum Disorder (ASD)
● Oppositional Defiant Disorder (ODD)
● Eating Disorders
● Substance Abuse
● Non-Suicidal Self-Injury (NSSI)
● Suicidal Ideation and Behavior
11

Depression
What is Depression?

Depression is a serious mood disorder in which an individual typically feels pervasive
sadness, emptiness, hopelessness, or worthlessness. Adults with depression often
demonstrate diminished interest in activities they once enjoyed, significant weight loss or
gain, and changes in sleep patterns. In some cases, they may begin to think about or attempt
suicide (American Psychiatric Association, 2013). Children seem to also display similar feelings
associated with depression. Children with depression may sometimes appear to have a
decline in energy, and they may have difficulty concentrating which often leads to a decline in
school performance. Other symptoms that a child or adolescent may display include
complaints about aches and pain and feelings of being irritable or bored.
How Common is it? How Early Can it be Identified?

About 7% of the U.S. population experiences Depression can develop at any age, and may
depression at any given time. Females may be diagnosed as early as preschool.
be affected roughly twice as much as males Preschoolers may display signs of extreme
(National Institute of Mental Health, n.d.). irritability, low energy, inability to focus and
express feeling pain or stomach. The
prevalence of depression is highest among
those ages 18-25 (National Institute of Mental
Health, n.d.).
Other Related Mental Health Issues Resources for Families

Children with depression may be at increased Depression helplines:
risk for these other mental health concerns https://www.mentalhelp.net/articles/depressio
(American Psychiatric Association, 2013): n-hotline/
● Anxiety American Academy of Child and Adolescent
● Substance abuse
Psychiatry - Depression Resource Center:
● Eating disorders
https://www.aacap.org/aacap/Families_and_Y
● Bipolar disorders
outh/Resource_Centers/Depression_Resourc
e_Center/Home.aspx
12

Anxiety
What is Anxiety?

Anxiety is defined by excessive, often unrealistic, feelings of worry or fear. These feelings are
usually accompanied by changes in behavior. Everyone experiences anxiety to some degree,
but people who experience severe or persistent anxiety may have an anxiety disorder
(American Psychiatric Association, 2013). Many different types of anxiety disorders have been
identified, including…
● Generalized anxiety disorder (GAD)
● Social anxiety disorder (social phobia)
● Panic disorder (PD)
● Specific phobias
● And more
In children and adolescents, anxiety may look like refusal to play with new children, clinginess
to parents or teachers, and unwillingness to try new things. Children may refuse to start
conversations, be less likely to be part of the discussion in class, and be less willing to raise
their hand to ask for help when needed. Children may also try to avoid anxious situations by
missing school and using excuses of feeling sick, while some actually develop stomach aches
and pain as a result of their anxiety.

For more information about these specific types of anxiety disorders, please see this resource
produced by the National Alliance on Mental Illness (NAMI):
https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders

Everyone experiences anxiety to some Most symptoms of anxiety disorders are
degree, but about 8% of children and present before age 21. Some physical change
adolescents and 18% of adults experience an that is linked to anxiety includes; difficulties
anxiety disorder (National Institute of Mental breathing, rapid heartbeat, diarrhea, nausea,
Illness, 2015). Females are at increased risk blushing and shaking (National Institute of
for anxiety disorders (Anxiety Disorders Mental Illness, 2017).
Association of America, 2005).

Children with anxiety or anxiety disorders Anxiety and Depression Association of
may be at increased risk for these other America (ADAA): https://adaa.org/
mental health concerns (American Psychiatric Child Mind Institute - Anxiety in Children:
Association, 2013): https://childmind.org/topics/concerns/anxiety/
● Depression.
● Substance abuse.
● Other types of anxiety disorders.
13

Attention-Deficit/Hyperactivity Disorder (ADHD)

What is ADHD?

ADHD is characterized by inattention, hyperactivity, and/or impulsivity. There are three main
types of ADHD (American Psychiatric Association, 2013):
● Predominantly inattentive
○ Inability to stay focused or concentrate in class
○ Struggles to follow instructions
○ Does not appear to be listening in class and at home
○ Has a hard time with organization
○ Often loses track of things and forgetful
○ Is easily distracted
● Predominantly hyperactive/impulsive
○ In constant motion, runs and climbs
○ Interrupts teacher/ classmates by blurting out answers
○ Hard time waiting or taking turns
○ Difficulty with quietly engaging in activities
○ Difficulty with sitting still and often need verbal prompts
● Combined type
○ Displays both inattention and hyperactivity/ impulsive

Roughly 5% of children in the United States ADHD is usually identified during the
have been diagnosed with ADHD. Boys are elementary school years. By definition,
diagnosed twice as often as girls (American symptoms need to be present before age 12
Psychiatric Association, 2013). in order to be ADHD. Children can be
diagnosed as early as 4 years old (American
Psychiatric Association, 2013).

Children with ADHD may be at increased risk Children & Adults with
for these other mental health concerns Attention-Deficit/Hyperactivity Disorder
(American Psychiatric Association, 2013): (CHADD) National Resource on ADHD:
● Issues with conduct or behavior, http://www.chadd.org
sometimes meeting criteria for
American Academy of Child and Adolescent
oppositional defiant disorder (ODD) or
Psychiatry ADHD Resource Center:
conduct disorder (CD).
● Substance abuse. https://www.aacap.org/aacap/Families_and_Y
● Specific learning disabilities. outh/Resource_Centers/ADHD_Resource_Ce
● Autism spectrum disorder. nter/Home.aspx

14

Autism Spectrum Disorder (ASD)

What is Autism Spectrum Disorder (ASD)?

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can look very different
from person to person. People with ASD exhibit the following, to varying degrees (American
Psychiatric Association, 2013):
● Problems with social communication or interaction.
○ Communication
■ Difficulty in verbal and nonverbal communication and do not
understand or properly use; spoken language, eye contact, facial
expression, tone of voice and gestures
○ Social interaction
■ Hard time recognizing emotions and intentions of others
■ Difficulty in recognizing one’s own feelings and expressing emotions
■ Often experience feeling overwhelmed in social situations
■ Difficulty in knowing when to take turns during conversation and with
gauging appropriate personal space
● Repetitive behaviors and/or unusually limited interests.
○ Repetitive behaviors
■ Body movements
● Flapping, rocking, spinning, running back and forth
■ Motions with objects
● Shaking sticks, flapping levers and spinning wheels
■ Ritualistic behaviors
● Lining up objects, repeatedly touching objects in a specific
order
● Resistance to change/ preference for unvarying routine
○ Unusually limited interests
■ Very narrow or extreme interests in certain topics
■ Staring at lights or spinning objects

The prevalence of ASD is highly debated. Most agree that ASD can be diagnosed as
Estimates range from 1 in 59 (CDC, 2018; early as 18 months (CDC, 2018). Some
Autism Speaks, 2018) to 1 in 100 (American research has shown that it can be diagnosed
Psychiatric Association, 2013). Boys seem to even earlier, at 12 months (American
be affected four times more than girls (CDC, Psychiatric Association, 2013).
2018; American Psychiatric Association,
2013).

Autism Speaks: www.autismspeaks.org
15

Children with ASD may be at increased risk National Autism Center:

for these other mental health concerns http://www.nationalautismcenter.org/resource
(American Psychiatric Association, 2013): s/for-families/
● ADHD. Autism and Beyond at Duke University:
● Anxiety.
https://autismandbeyond.researchkit.duke.ed
● Depression.
u/resources
● Sleep problems.
● Intellectual impairment.
16

Oppositional Defiant Disorder (ODD)

What is Oppositional Defiant Disorder (ODD)?

Oppositional defiant disorder (ODD) is a disorder seen only in children in adolescents in which
the individual exhibits abnormal levels of anger, defiance, or vindictiveness (American
Psychiatric Association, 2013). All children exhibit these behaviors to some degree, but they
are not indicative of ODD unless there is a persistent and pervasive pattern. Symptoms of
ODD may look like (American Academy of Child and Adolescent Psychiatry, 2013)
● Frequent temper tantrums
● Active refusal to comply with adult requests
● Strong sense of anger or resentment
● Revenge seeking
● Blaming others for misbehavior
● Deliberate attempts to bother or upset people

About 3.3% of children experience ODD. ODD can be diagnosed as early as the
Boys are diagnosed more often than girls in preschool years, and generally no later than
childhood, but there are no gender adolescence (American Psychiatric
differences by adolescence (American Association, 2013).
Psychiatric Association, 2013).

Children with ODD may be at increased risk Stanford Children’s Health - Oppositional
for these other mental health concerns Defiant Disorder:
(American Psychiatric Association, 2013): https://www.stanfordchildrens.org/en/topic/de
● ADHD fault?id=oppositional-defiant-disorder-90-P02
● Conduct disorders
573
● Anxiety disorders
Child Mind Institute - Oppositional Defiant
● Depression
● Substance abuse Disorder Basics:
https://childmind.org/guide/oppositional-defia
nt-disorder/
17

Eating Disorders
What are Eating Disorders?

Eating disorders are characterized by pervasive disturbances in eating or eating-related
behavior. These disturbances serve to impair the person’s consumption or absorption of food,
resulting in significant impacts on their health and/or daily functioning. Types of eating
disorders include (National Institute of Mental Health, 2017)...
● Anorexia nervosa, in which the person substantially limits their food intake.
● Bulimia nervosa, in which the person engages in a pattern of eating large amounts of
food followed by compensatory behavior such as vomiting, using laxatives, or
exercising excessively.
● Binge eating disorder, in which the person engages in episodes of eating large
amounts of food in a short time while feeling a loss of control.
How Common are they? How Early Can they be Identified?

The prevalence of eating disorders varies by Eating disorders can develop at any age, but
the type (National Institute of Mental Health, they peak from adolescence into early
2017): adulthood (American Psychiatric Association,
● Anorexia nervosa: 0.6% 2013). The median age of onset is 18 years for
● Bulimia nervosa: 1% anorexia nervosa and bulimia nervosa, and 21
● Binge eating disorder: 2.8% years for binge eating disorder (National
Institute of Mental Health, 2017).

Children with eating disorders may be at Eating disorders helpline:
increased risk for these other mental health http://www.anad.org/our-services/eating-disor
concerns (American Psychiatric Association, ders-helpline/
2013): National Eating Disorders Association -
● Anxiety
Parent Toolkit:
● Obsessive-compulsive disorder (OCD)
https://www.nationaleatingdisorders.org/pare
● Depression
● Body dysmorphic disorder nt-toolkit
● Substance abuse
18

Substance Abuse
What is Substance Abuse?

Substance abuse is defined by a person’s dependency on alcohol or other substances in
order to function. This dependency often manifests itself in (SAMHSA, 2015):
● Inability to make informed and reasonable decisions.
● Neglect of financial, familial, or other responsibilities.
● Engaging in risky behavior apart from using the substance itself.
Over time, people engaging in substance abuse tend to exhibit tolerance and withdrawal
(National Institute on Drug Abuse for Teens, 2017).
● Tolerance: Increased ability to endure the physical effects of a drug, so that more of
the drug is needed in order to achieve the desired effect.
● Withdrawal: Unpleasant, sometimes deadly, physical symptoms when the drug is
removed from the person’s system.
Parents can prevent their children from engaging in substance use by (Phoenix House, 2012):
● Explain to your child what is and is not allowed, and the consequences of engaging in
behavior that is not allowed.
● Spend time together as a family.
● Enroll your child in and encourage their participation in extracurricular activities.
● Give your child strategies for saying “no,” then practice them together.

It is difficult to determine the actual The onset of substance abuse can vary
prevalence of substance abuse. By the end of substantially. In fact, it has occasionally been
high school, roughly half of teenagers have identified in elementary school children
used illicit drugs at least once (U.S. (SAMHA, 2015).
Department of Health and Human Services,
2016).

Children engaging in substance abuse may Methods to Prevent Your Child from Using
be at increased risk for these other mental Drugs and Alcohol:
health concerns (American Psychiatric https://www.phoenixhouse.org/news-and-vie
Association, 2013): ws/news-and-events/simple-methods-to-prev
● Depression
ent-your-teen-from-using-drugs-or-alcohol/
● Anxiety
National Institute on Drug Abuse for Teens:
● Post-traumatic stress disorder (PTSD)
https://teens.drugabuse.gov/
National Helpline:
https://www.samhsa.gov/find-help/national-he
lpline
Alcoholics Anonymous: https://www.aa.org/
Narcotics Anonymous: https://www.na.org/
19

Non-Suicidal Self-Injury (NSSI)

What is Non-Suicidal Self-Injury (NSSI)?

A person engages in NSSI when they deliberately harm themselves in a physical manner
without the intending to do so in a life-threatening manner. Those who engage in NSSI inflict
tissue damage to their bodies by cutting, burning, scraping, biting, or hitting, for example
(Stargell et al., 2018). Most people engaging in NSSI do so as a way of escaping stressful
emotions or as a way of feeling less “numb”; NSSI is rarely done with suicidal intent (Stargell
et al., 2018; Miller, 2011). However, NSSI can unintentionally lead to serious injury and even
death.

15-30% of high school students have NSSI peaks in adolescence (Stargell et al.,
engaged in NSSI at least once (Stargell et al., 2018). It is much less common in childhood
2018). There are many misconceptions that and adulthood, though not unheard of.
only females engage in NSSI, but recent Roughly 1.5% of 5-10 year olds engage in
research suggests that up to 35% of those NSSI, and the adulthood rate is about 5%
who engage in NSSI are male. Youth who (DeAngelis, 2015).
identify as lesbian, gay, or bisexual may be at
significantly higher risk (DeAngelis, 2015).

Children engaging in NSSI may be at Cornell University Self-Injury and Recovery
increased risk for these other mental health Research and Resources:
concerns (Stargell et al., 2018; Miller, 2011): http://www.selfinjury.bctr.cornell.edu/resourc
● Depression
es.html
● Anxiety
S.A.F.E. Alternatives: https://selfinjury.com/
● Eating disorders
● Borderline personality disorder
● Suicidal ideation and behavior
20

Suicidal Ideation and Behavior

What is Suicidal Ideation and Behavior?

Some children and adolescents experience thoughts of suicide. Many never act on these
thoughts, some make plans to act on them but do not carry them out, and others make plans
to act on them and do carry them out. Suicidal ideation and behavior falls on a continuum:

Suicidal thoughts → Suicide-related communications or behaviors → Suicide attempts → Suicide
(Miller, 2011).

Suicide is the second leading cause of death Rates of youth suicide have increased
in youth ages 10-24 (Miller, 2011). In a CDC steadily since the 1950s (Miller, 2011).
survey of high schoolers conducted in 2017… Incidence of suicidal ideation and behavior
● 31.5% experienced persistent feelings of peaks from ages 14 to 16, then declines.
sadness or hopelessness (and this trend However, this issue is not
has been increasing since 2007). age-limited--anyone can experience suicidal
● 17.2% had seriously considered thoughts at any age, even young children
attempting suicide. (Miller, 2011).
● 7.4% had attempted suicide (Centers for
Disease Control and Prevention, 2018).

Should parents learn that their child is
Children engaging in NSSI may also exhibit considering suicide, they must get help as
these other mental health concerns (Nock et soon as they possibly can. Parents should
al., 2009): also remove weapons, guns, pills, knives from
● Mood disorders the house. It is important that they not leave
● Anxiety disorders their child alone until they can be assessed
● Impulse-control disorders by a qualified mental health professional.
● Substance abuse Following that assessment, family members
● And many others are encouraged to closely monitor their child
and to seek help from school faculty and from
mental health professionals in the community.

Suicide Prevention Lifeline: 1-800-273-8255,
https://suicidepreventionlifeline.org/
Suicide Prevention Resource Center:
https://www.sprc.org/settings/family-members
-and-caregivers
Child and Adolescent Suicidal Behavior, by
David Miller (Book)
21

Statistics
● 90% of those who have died by suicide had an underlying mental illness (National
Alliance on Mental Illness, n.d.).
● Males’ suicide attempts are typically more fatal than females’ (Miller, 2011).
● The two most common methods of suicide attempts are drug overdose and wrist
cutting (Miller, 2011).
● Rates of suicide are higher in rural than in urban areas (Miller, 2011). This may be due
to a lack of access to mental health resources.
● Only about 5% of people who complete suicide leave notes behind (Miller, 2011).
● The majority of youth suicides occur in afternoons and evenings, because this is the
time of day when they are most frequently left alone (Miller, 2011).
With this information about common diagnoses and concerns in mind, parents should feel more
empowered to…
● Recognize symptoms in their children

● Locate resources related to various mental health concerns
● Reach out to school-based mental health service providers for help
● Seek out additional community resources should their child require them
The parent-child relationship provides major opportunity for catching the first signs of mental
illness and identifying supports to prevent them from becoming worse. Parents should
understand various mental health issues seen in children and remain vigilant for signs of them in
their own child. Should they see these signs, they should not hesitate to reach out to the school
mental health team, who is both qualified and equipped to address these issues.

22

Cultural and Diversity Factors

As a parent, it is important to
consider the cultural factors at play
in your child’s environment. To
effectively improve a student’s
mental health, it is important to
consider their ethnicity, beliefs,
and values. Schools must
understand the environment in
which the student grew up in order
to get sense of the issues they
face. As parents, you can help the
school understand what your
family is like at home and how the
school can adapt to best support your child. Various factors related to ethnicity, beliefs, and
values will impact on every child differently and may take some time for others to understand.
Severe mental health issues may delay a student’s ability to connect with their community and
form important relationships that would otherwise greatly benefit them. It is important that
parents remain vigilant for different signs of mental health issues in order to help their children
as soon as possible should they ultimately arise.

Different Things
to Consider when discussing culture:
● What are some common practices/beliefs at home?
● What do you value at home?
● What ethnicities do you and your family identify the most
with?
● How can you share these different cultural differences with
the school?
● How does this impact my child at school?
● What can the school do to help learn about diversity?

23

Understanding the campus’ culture is an important first step in understanding the student
themselves. A study in Canada looked to study the campus culture to find what was needed to
be focused on concerning mental health and the different implications of culture. They
developed a “video voice” that was a documentary like measure to help counselors to find out
individual needs and experiences in the community. The students would take the recorders and
document their experiences to a camera instead of a physical person interviewing them. The
video voice was shown to “empower students to build on their existing capacities to increase
power and control, to assess their mental health culture, and to explore positive coping
strategies for mental health promotion” (Giamos, et.al, 2017). This can be a great idea to pitch to
your school to help your children feel more comfortable expressing themselves! Learn about
your school’s policy regarding cultural learning and how your child is able to express their own
culture without being afraid of opening up to their peers or adults on school campus.

Different beliefs gathered in a small environment like a school campus may cause conflict to
arise between students. It is important to consider your child’s mental health standing during
these arguments or even events of bullying. Being able to spread awareness of the different
religions and beliefs in a school setting can set up expectations for behavior towards others with
opposing views. It is important to remind your child to treat others with respect even when they
disagree with their beliefs. Building a safe environment where students can share their home
experiences with religion and being able to tie it back into their lesson in class is imperative to a
school’s culture. Allowing students to succeed in their academics by tying in experiences in
previous understandings can help a student thrive in their academics and learning processes.

24

You can ask your child things like:

● What do you value in your life?
● How do you think others are different from you?
● How would you like others to treat you when they find out
about your differences?
● How would you treat them?
● Why do you think it’s important to be nice to everyone even if
they don’t believe in the same things as you?

Build a conversation with your child and begin to develop ideas
together!

Values are something every student carries with them to school that have been instilled in them
from the home environment or through their life experiences. Going back to the idea of respect,
it is vital to promote understanding of different values and mindsets each student bring with
them to school to create a wonderful dynamic of ideas and personality. As a parent, you can use
the questions discussed above to talk to your child and develop a conversation of
understanding to promote understanding and respect to other students. Encouraging the
student to keep their own values and not falling into peer pressure and conformity allows the
student’s confidence to grow and in return developing a better mental state. Giamos (2017)
mention positive initiatives on campus that allow students with similar values to join campaigns
or events that increase their awareness to bettering themselves with developed techniques.
This is a great way to help a student grow in their community by doing community hours with
peers that they can connect and bond with. Consider pitching different cultural events ideas to
your school if there aren’t any in place! Creating lasting relationships that can in return be their
support group can help build resilience in your student’s academic career.

25

Taking a Systems Approach to Mental Health

What is a Systems Approach?
A systems approach, also known
as a systemic approach, involves
understanding problems within a
child’s context. This approach
requires viewing each child as
part of a larger system. When a
child has a problem, therapists
should look not only at the child
him or herself, but also at the
systems at play in their
environment. In other words, the
therapist should view the child
from a holistic perspective, with
each different context (or system)
of the child in mind (Margolies,
(2018). For example, when a
school-based mental health
professional works with a student
at school, they should resolve
problems not only by working with Source: https://images.search.yahoo.com/search/images
the student individually, but also by
examining the student’s systems. These Families affect their members’ thoughts,
might include their school, their family, and feelings, and actions. Individual family
their larger community. The many systems members make up a dynamic unit that must
that impact a child’s mental health can be work together to function properly. In order
seen in the graphic at the top of this page. to be as supportive as possible, family
members must respond to each other’s
What is the Family’s Role in a Systems needs and expectations. A change in one
Approach? person’s functioning within the family unit
Looking at the graphic above, you will will likely change other members’
notice that the first and most central system functioning as well. For example, if one
is that of the child. The next most central parent’s work schedule changes, the family
system, closely surrounding the child, is that may be forced to respond by altering the
of their family, friends, and social networks. other parent’s work schedule. If a child has
A child’s family is the closest form of support to stay after school for a tutoring program,
a child can have. This is why families play parents might have to rethink pick up times,
an important role in a child’s mental health.
26

which can affect work schedules and other counselors, or the school psychologist. It is
family functions in the home (Kerr, 2000). important to collaborate with your child’s
Every family member plays an important role school to ensure they are getting the help
in the family unit. Changes in the family they need not only in school, but also
dynamic can lead to changes in the outside of school.
individual child, including their mental Maintaining a positive relationship
health. In this sense, parents and families with your child at home is another way to
can be highly influential in supporting their foster support and provide a safe
children’s overall mental health outcomes. environment for your child. Providing a safe
By remaining supportive and aware of the and supportive environment in the home will
effects they can have on their children, help promote more effective
parents can ensure that their children communication. It is important for all of the
maintain a strong sense of mental health. systems that a child is involved with to
communicate effectively. When all systems
How Can You Get Involved When it Comes communicate effectively, support can be
to Your Child’s Mental Health? provided from all aspects of your child’s life.
Should your child be experiencing issues It is especially important for schools and
related to mental health, you as a family can families to work together (Systems
play an important role in their resilience and Theory/Therapy, 2017).
recovery. It sounds simple, but a major way
you can help at home is by simply being For more information regarding how to talk to
supportive. Family therapy can lead to your child about mental health and how to
communicate with your school team effectively,
significant outcomes for the child and for
see the handouts: 3 Easy Steps On How To Talk
the family as a whole, but parents can still
To Your Child About Their Mental Health and
be supportive of their child’s mental health Five Steps For Effective Collaboration in the
without participating in formal therapy. appendix.
Educating yourself about the specific mental
issues your child is experiencing can be
highly beneficial. You can do this by talking
to your child’s teachers, the school

27

The Role of the School in Children’s Mental Health

How can schools help?

Schools play a big role in helping your children maintain a good mental health in their academic
careers. Some different ways that schools have found success in promoting mental health can
be through:

1. Keeping a safe environment for discussion
2. Checking in with students on how they feel on campus/at home
3. Promote the campus mental health help center for students to drop-in
when they need help
4. Have meaningful posters around school to promote mental health
awareness

It is always important to keep a safe environment for children to express any events that might
occur on campus. Make sure your child has a good relationship with at least one adult on
campus who they can connect to and talk about such events with confidence. Promoting and
28

keeping the students aware of their campus’ mental health center gives them a place to go to
where a school counselor is able to talk to them if they have no existing relationship with any
other adult. Schools should also develop conversations and awareness through beautiful
posters that can attract students to learning more about mental health and where to go to for
help.

The National Alliance on Mental Illness (NAMI) also stands with schools promoting mental health.
It frequently hosts presentations for students on school campuses to provide them with
information on mental health issues and how to ask for help if they see signs in themselves or
others. These presentations are free and school campuses can reach out to NAMI to request
these presentations to help students understand mental health and destigmatize it. It is often
best for students to get a firsthand understanding of mental health and how it may impact their
lives. NAMI sometimes brings in different speakers who have personally experienced various
traumas. This may give students a more personalized experience as opposed to being lectured
by a single person. Interactive activities are provided, along with pamphlets and resources that
students can keep, giving easier access to help and information when they need it. Your child’s
school is responsible for building a strong campus community and for keeping your children
safe. NAMI’s services can help with that. Take advantage of all
the free resources schools are providing for you and your
children to keep up with mental health issues and education!

There are many ways that schools can start implementing good
mental health awareness on campus; for example, being trauma informed schools. According to
the Los Angeles Unified School District website, all of their schools are trauma-informed which
means that all adults on campus can provide help or refer help for students who feel physically,
socially, emotionally, and/or academically unsafe. This is an important aspect to keeping
students safe on campus to help promote finding help when students feel like they are not
comfortable in their environment. By promoting that our campuses have trauma informed staff
members, students can be educated to reach out to any adult on campus that they may feel the
most comfortable with to receive and get help. This may encourage students to reach out to
more adults to help them compared to one designated and stigmatized office room. As a parent,
there are different workshops on campus that are also trauma-informed to help parents get an
understanding of not only trauma education but also the types of education and trainings that
staff members receive as a part of their training.

Although it is a great idea to have trauma-informed schools across the nation, not every school
is educated in trauma. As a parent you can help through different outlets such as PTA meetings
in which you can advocate for your student’s mental health through different resources such as:

● NAMI Ending the Silence for Students: 50-minute presentation designed for middle and
high school students that includes warning signs, facts and statistics and how to get help
29

for themselves or a friend. Research has shown that NAMI Ending the Silence for
Students is effective in changing middle and high school students’ knowledge and attitudes
toward mental health conditions and toward seeking help

● NAMI Ending the Silence for School Staff: 1-hour presentation for school staff
members that includes information about warning signs, facts and statistics, how to
approach students and how to work with families

● NAMI Ending the Silence for Families: 1-hour presentation for parents and primary
caregivers that includes warning signs, facts and statistics, how to talk with your child
and how to work with school staff

30

Specific Roles in School-Based Mental Health

A school is like a giant machine. All parts of the machine have to be well oiled and work
together in order to make the machine as a whole work effectively. A school’s “parts” are made
up of the many staff members that are involved in bettering the school environment to foster
student learning. When it comes to a child’s mental health, staff take a collaborative team
approach and work together to address students’ mental health concerns. Below is a list of
team members and a description of their roles when it comes to the mental health of students. It
is important to note that not all schools will look the same, have the same team members, or
have the same responsibilities, but this list provides some general responsibilities of certain
team members.
School Psychologist
School psychologists help support students’ ability to learn and teachers’ ability to teach. They
are experts in mental health, learning, and behavior and work to help children succeed
academically, socially, behaviorally, and emotionally. School psychologists collaborate with their
team to create a safe, healthy, and supportive learning environment (National Association of
School Psychologists, 2018). The following are more potential responsibilities of a school
psychologist:
● Prevention issues from happening before they occur, and intervention when they do
● Involvement in screening processes (see the section on Screening later in this toolkit)
● Provision of mental health services, such as individual and group counseling
● Assessment of students to determine whether they are experiencing significant issues
that may impact their educational performance
● Planning, implementing, and monitoring school wide prevention efforts
● Consulting and collaborating with families and other school community professionals to
help make sure your child receives mental health services appropriate to their needs
(Splett et al., 2013)
School Counselor
School counselors help promote academic achievement, career development and social and
emotional development (American School Counselor Association, 2018). Here are ways a
school counselor helps your child:
● Provision of academic guidance and support

● Collaboration with parents to meet student needs
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● Collaboration with other staff involved in the school support team

● Assistance to families attain appropriate services a student may need
● Assists in mental health needs (screening, counseling) (American School Counselor
Association, 2018)
Teachers
Teachers are responsible for creating a safe and productive learning environment to promote
students’ academic, emotional, and behavioral success. When it comes to a children’s mental
health, teachers can help by doing the following:
● Recognizing warning signs of mental health issues students might be experiencing and
referring them to the school counselor or school psychologist
● Collaborating with parents about their child’s needs and concerns
● Building relationships with students and acting as a positive role model
● Implementing interventions or accommodations in the classroom
● Collaborating with the school team to ensure that students who are struggling with
mental health problems receive comprehensive support
● Recognizing and praising students’ strengths (Yahyaei et al., 2012)

School Nurse
The school nurse promotes students’ health and safety and can also provide mental health
support. The following are ways a school nurse can help support students’ mental health:
● Conducting screenings for mental health concerns

● Promoting students’ sense of self management, self-advocacy, and learning
● Providing direct medical care to students
● Promoting a safe and healthy school environment
● Providing education about health needs
● Connecting and communicating with the school, families, health care providers, and the
community to ensure students’ health needs are met (The American Academy of
Pediatrics, 2016)

Administrators
School administrators play an important role in overseeing the daily operations of the school.
This is important for the mental health of the students because ensuring that the school is
running smoothly will help ease stress and other anxieties that students may experience if the
school environment is not adequate to meet their needs. Here are other duties of school
administrators:
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● Serving as a link between students and the local community

● Hiring and evaluating teachers
● Creating and implementing mental health policies such as discipline, harassment, and
suicide assessment policies
○ Ensuring that all staff members are aware of these policies and enforcing them
● Setting goals and objectives for the school
● Communicating with parents, students, and community members (What Is School
Administration?, 2018)
Parents
Perhaps the most important person when it comes to a child’s mental health is you, the parent.
As a parent, you should feel empowered to help support your child’s mental health needs both
at home and at school. Here are some tips for parents to work with your child’s school in order
to support their mental health needs:
● Educate yourself about mental health and the different types of treatment available
● Communicate with school staff about challenges your child may be experiencing at
home or at school
● Be an active member of the student support team
● Communicate with teachers, counselors, school psychologists, and other school
administrators to ensure your child’s needs are met
● Advocate for services and supports your child may require
● Work with teachers in providing consistency between the school and home environment
● Make your child’s strengths known (Tartavosky, M., 2017)

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Legal and Ethical Issues

Schools hold great potential for addressing your child’s mental health needs and preventing
them from developing more serious mental health concerns. As a parent, you should be
informed about the various laws and issues of professional ethics at play regarding
school-based mental health. This section intends to keep parents aware of their rights and their
children’s rights regarding privacy, consent for services, and working with mental health
providers outside of the school.

Family Educational Rights and Privacy Act (FERPA)

Who Can Access My Child’s Educational Information?
● The Family Educational Rights and Privacy Act (FERPA) is a federal privacy law that
protects the privacy of student records kept by schools. These records may include
students’ grades, attendance, counseling notes, standardized test scores, and more (U.S.
Department of Education, 2018). Essentially, any records maintained by a school that are
directly related to an individual student qualify for protection under FERPA (Jacob,
Decker, & Lugg, 2016).
● A student’s records can only be viewed by those with a legitimate educational interest in
the student. This may include their current teacher, counseling staff, or administrators.
Student records must be kept in a secure location and should be accessible only by
relevant staff (Jacob et al., 2016).
● Parents have a right to inspect and review their child’s educational records up until their
child turns 18. Once the student turns 18, these rights transfer over to them. They can
also request that specific changes be made to these records (U.S. Department of
Education, 2018).
● For more information about students’ and families’ rights under FERPA, visit the U.S.
Department of Education’s webpage at
https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html.

FAQs: Consent and Assent

Does the School Need My Consent Before Working with My Child?
● Overall, the answer is yes. Upon initially meeting with your child, the school can gather
relevant information about their needs and situation before reaching out to you to obtain
consent. If the school wishes to continue providing individualized services, they are
typically required to reach out to you after the first one or two sessions (Jacob et al.,
2016).
34

● However, there are some exceptions to this in the state of California. Below are two
California statutes regarding children’s right to consent for their own mental health
services, one from the Family Code and one from the Health and Safety Code. Children
need to meet criteria under just one of these codes in order to consent for their own
services without consulting their parents (National Center for Youth Law, 2010).
○ According to California Family Code, if your child is age 12 or older, they can
consent to school-based counseling services provided that…
■ They are mature enough to participate, AND
■ They would present a serious risk or harm to themselves or others
without counseling or are an alleged victim of incest or child abuse.
○ According to California Health and Safety Code, if your child is age 12 or older,
they can consent to school-based counseling services provided that they are
mature enough to participate.
● Except in urgent situations, the school will likely seek out your consent before continuing
services. (Jacob et al., 2016). Should emergency services be provided without obtaining
parental consent, parents should be notified of the provision of those services following
the event (Plotts & Lasser, 2013).
● If your child is over the age of 18, they can legally provide consent themselves and no
longer require parents to do so (Jacob et al., 2016; Yell, 2016).
● For more information about consent in California, visit www.TeenHealthLaw.org.

What Does Informed Consent Really Mean?
● There are key three elements to informed consent:
○ Knowing (Understanding exactly what it is you’re consenting to).
○ Competent (You must be legally and practically qualified to give consent).
○ Voluntary (Your consent must not be given under pressure from another party).
(Jacob et al., 2016).
● Informed consent for school-based counseling services:
○ In school-based counseling, your child would meet with a school-based mental
health professional either individually or in a group with other students and
participate in evidence-based counseling practices.
○ In order for consent to truly be informed, parents should be provided with this
information:
■ The reason for which the school recommends counseling services
■ Proposed goals for counseling
■ Anticipated frequency and duration of services
■ Proposed techniques or methods to be used
■ Anticipated benefits of counseling
■ Potential risks of counseling
■ Alternatives to the proposed services (Plotts & Lasser, 2013).
● Informed consent for school-based mental health assessment:
35

○ In school-based mental health assessment, your child would be assessed by a

credentialed and qualified evaluator, such as a school psychologist, for the
presence of a mental health condition that impact their educational performance.
If the assessment reveals that your child possesses such a condition, they would
be eligible to receive special school-based services should your family agree to
them.
○ In order for consent to truly be informed, parents should be provided with this
information:
■ The reason for which the school recommends assessment
■ Areas in which the school suspects your child may have a disability
■ Legal timelines for the assessment process
■ Proposed assessment tools to be used
■ A copy of your parent rights, or procedural safeguards (a long legal
document outlining your rights as a parent when it comes to assessment,
qualifying for services, implementation of services, classroom placement,
and more)

Does My Child Need to Give Consent as Well?
● Legally, unless your child is over the 18, they are not eligible to formally give
consent--this must instead be done by their parents.
● With that said, from an ethical standpoint, schools typically try to obtain student’s assent
for services. Assent from a student under 18 means that, although they cannot legally
consent to it, they are in agreement with the service plan (Jacob et al., 2016). While
assent is not required for services, it typically makes students feel that their perspectives
are valued, increasing their motivation to participate. It should be noted that a student’s
assent should not be sought unless their decision can be honored; in other words, the
school should not ask for your child’s assent in cases in which a “no” answer means that
they would still be required to participate (Plotts & Lasser, 2013).

Once I Give My Consent, Can I Take it Back?
● Yes. Parents and students over the age of 18 have a right to withdraw their consent for
services at any time (Jacob et al., 2016; Yell, 2016).

FAQs: Confidentiality

As a Parent, Do I Have a Right to the Information That My Child Shares with School
Staff During Counseling Sessions?
● From a legal standpoint, parents have access to all records and information that the
school has about their child. As such, parents do have a legal right to the information
shared by their child in the context of counseling, provided that their child is under the
age of 18 (Jacob et al., 2016).
36

● With that said, from an ethical standpoint, it is typically discouraged for a school to
share this information freely with parents. There are a couple of reasons for this. Firstly,
doing so can damage the sense of rapport with and trust of the adult providing their
counseling services. This may ultimately make them share less than they otherwise
would in counseling, or worse, no longer participate at all. Additionally, sharing every
tidbit of information with parents may cause unnecessary alarm. In many cases, students
are able to work through these issues on their own. This is often more therapeutic for
students in that it helps them feel a greater sense of control and efficacy over their own
lives, which better prepares them for the next time they encounter a problem (Plotts &
Lasser, 2013).
● School staff typically will not share every detail of what is discussed in counseling with
students’ parents. However, they might make periodic phone calls home or send home
progress reports with general information about skills they have been working on during
counseling time, such as social skills or reframing thoughts in a more positive manner.
This is generally considered best practice, as parents are still involved in the periphery of
their child’s counseling experience, but students still feel comfortable sharing information
during counseling that they would not necessarily want to with their parents.
● Even if your school is in the practice of only sending general progress reports home or
sending no progress reports at all, you still have a legal right to request all counseling
records kept on your child at any time (as long as your child is younger than 18). This is
typically discouraged for the reasons explained above, but it remains your legal right
(Jacob et al., 2016).

Under What Circumstances Could My Child’s/Family’s Confidentiality Be Broken?
● At the outset of the counseling relationship, the student is told that there are three main
circumstances under which their confidentiality may be broken, all for safety reasons:
○ The student reveals that they plan to hurt themselves.
○ The student reveals that someone is hurting them.
○ The student reveals that they plan to hurt someone else (Merrell, Ervin, &
Peacock, 2012).
● Confidentiality may also be broken if the student requests it. For instance, if a student
struggling with how to disclose their sexual orientation to their parents would like their
counselor to help them do so, it would be acceptable to break confidentiality (Jacob et
al., 2016).
● Finally, in rare situations, school staff may be subpoenaed to testify to what was
discussed in counseling in a court of law. This causes a legal-ethical bind for counseling
staff, many of whom will fight to provide a summary of the information discussed as
opposed to fully sharing all of the student’s counseling records (Jacob et al., 2016).
● In the event that confidentiality needs to be broken, the student will be involved as much
as possible in determining who to tell, how to tell them, and whether they would like to
tell them themselves or have school staff do it (Jacob et al., 2016). Depending on the
reason for breaking confidentiality, the school may need to involve you as parents, law
37

enforcement, or government-run social services such as Child Protective Services or the

Crisis Assessment Team. Breaking confidentiality would only be done with the
purpose of keeping your child safe. Your school mental health team should be there to
support families in the rare case that outside parties must become involved.

FAQs: Outside Services

What if the School Staff Do Not Have the Necessary Qualifications to Support My
Child?
● All school staff are ethically obligated to work only within the bounds of their
professional competence. This means that, should they encounter a student situation
they are not professionally qualified to address, they link the student with someone who
possesses the proper skills and experience (Plotts & Lasser, 2013).
● Your child’s school should have developed relationships with various mental health
service providers in the community. School staff should be able to help your family
identify the services and organizations that best fit your child’s needs, then help you
reach out to in order to initiate services (Fertman, Delgado, & Tarasevich, 2014).

Can My Child Receive School-Based Services in Addition to Outside Services?
● Absolutely. In many cases, the school will provide a student with mental health services
even when he or she is also working with an outside service provider (Fertman et al.,
2014).
● Typically, in these cases, the school requests that the parents consent to a release of
information. This is a legal document allowing the school and the outside provider to
communicate about the child’s concerns, goals, and progress (Fertman et al., 2014).
There are many benefits to consenting to a release of information in that different teams
can communicate while working on different goals, they can keep their information
straight regarding the child, and they can consult with one another about how best to
proceed with services. It also allows the child to receive comprehensive services free
from unnecessary repetition and can potentially create more accountability on behalf of
each team. Parents have every right to determine whether or not they would like to
consent to a release of information. Like consent for school-based services, this consent
should be informed, competent, and voluntary (Jacob et al., 2016).

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Steps in Addressing Schoolwide Mental Health

Using a Multi-Tiered Approach
The most dynamic way to approach addressing school-wide mental health issues would be to
utilize the three tiers in Multi-Tiered Systems of Support approach.

Tier 1:
To help educate about Mental health, Tier 1 would be focused on school-based preventions and
universal interventions that can encompass about 80% of the campus in order to educate
students about their mental health. This can be accomplished through different posters around
school that can encourage mental health to get students talking about the issue without
alarming them with graphic images. The key points to Tier 1 are:

● Using Data-based Decision Making
● Developing a Simple Set of Behavioral Expectations
● Teaching Behavioral Expectations
● Acknowledging Appropriate Behavior
Along with Tier 1, screeners should be given campus-wide to identify

‘at-risk’ students. Screeners can be seen as the first step towards
progress monitoring since information gathered can be used as baseline
data. Progress monitoring with mental health interventions is a crucial part
to improving the child’s treatment outcome. It is part of the evaluation
process, in which data is systematically collected during treatment
39

implementation (Borntrager & Lyon, 2015). Some of the more widely used tools for monitoring
are; collecting data during observation (in multiple settings), using reliable and valid screening
assessments. Assessments and feedback can also be made available online.

Tier 2:

The Tier 2 would target at-risked students who are about 15% of the school population. These
students can be found in Tier 1 using early identification of students with mental health and
behavioral concerns such as acting out in class, arguing with their teachers, or refusing to do
work. Tier 2 would then have targeted school interventions with community support such as
restorative circles to help them talk about their struggles and help find them the right support
they need to do well in their academics. These interventions would include most of the
school-employed health professionals on the team to help students who struggle in Tier 2 to
eventually come back to Tier 1 as a universal population target for the school campus. Our goal
is to help students in a way that reduce their risks and improve academic and emotional
outcomes. In order ensure success, intensive progress monitoring should occur.

After a child has been identified as ‘at-risk’ and interventions have been chosen to implement, it
is vital for the team to have a monitoring system in place. Monitoring a child’s progress will give
the school psychologist, counselors and parents valuable information on whether or not the
child is responding well to counseling or other mental health services. Progress monitoring has
the potential to significantly improve treatment outcome. It serves as a feedback mechanism
which suggest the continuation or a change in the course of the current treatment. Following up
with a child’s progress helps to guide treatment and cues the school psychologist or counselor
when adjustment or continuation in treatment is necessary (Puddy, Roberts, Vernberg, &
Hambrick, 2012). The main areas of progress monitoring focuses on; symptoms, functioning and
overall well being of the child (Fertman, Delgado & Tarasevich, 2014). Giving every student the
equal opportunity to success can help the student achieve well and progress without obstacles
in life.

Tier 3:
The last Tier 3 are focused on students with severe/chronic problems which should make up
about 5% of the school population. These students would require intensive community
interventions with school support along with intensive school interventions with community
support. The child can be monitored by teachers, parents/ caregivers, therapists, counselors or
school psychologists. Parents can play a crucial role by monitoring their child at home by doing
40

periodic check-ins or by filling out different assessments. The child can also play a part by
completing self-monitoring tools. Self-monitoring tools are either rating scales or questionnaires
that help to depict the child’s current progress and feelings about the interventions.
Furthermore, these tools are an alternative way for the child to express his/her thoughts and
needs. School psychologists, counselors, psychologists usually distribute these monitoring tools
to students and families.

These students are closely monitored with one-on-one meetings to help them target specific
needs that may interfere with their learning environment. The school mental health professional
may want to hold meetings that may include parents, teachers, counselors, and anyone who can
participate to help the child progress through school in different environments such as the
classroom or at home. Progress monitoring can take place during formal observations in the
classroom at school or during counseling session, and can also be in a natural setting like the
playground or at home. In essence, a child can be monitored at home, in school or in the
community (Fertman et al., 2014). There are different symptoms and reactions in different
environments of the child so it is important to get as many aspects of the child’s life as possible.
Data gathered during Tier 2 interventions will help to determine whether or not the intervention
is effective and if so, it also tells us in which environment. Lastly, progress monitoring after
interventions will provide data of the overall success of treatment and helps to predict if the
treatment has a long term effect. Follow-ups should be systematic, frequent, simple/easy to
understand and user friendly (Puddy et al., 2012). Therefore, progress monitoring in multi-tiered
systems of support helps create a structure to match intervention with unique student needs,
while addressing mental health issues with different populations of students who may need
different levels of intervention and prevention to help create a better mental health environment
overall.
41

Steps within a Multi-Tiered Approach: School Policy

What is Policy? (Fertman, 2014)
❖ School District Policy: The rules that reflect school values and outline the responsibilities
of school employees in keeping students safe.
➢ Some components of district policy address bullying, academic honesty,
discipline and dress-code.
❖ Mental Health Policy: A component of school district policy. It addresses students’
social, psychological and emotional well-being.
➢ Some components address suicide, threats, harassment, crisis response, and
substance use.

What Does Having an Effective Mental Health Policy Accomplish? (Fertman, 2014)
1. Ensures the school’s compliance with laws.
2. Specifies exactly what the response to mental health concerns and incidents will be and
which staff members have which roles.
3. Promotes the importance of mental health in schools.

What Should a Mental Health Policy Include? (Fertman, 2014)

42

Why is This Important for Parents to Know, and How Can They Impact School Mental
Health Policy? ( Mental Health Colorado, n.d.)
❖ It is really important that parents advocate for policies related to their child’s education.
School improvements may require various policy or law changes at the local level. To
drive policy change at a local level, parents might start by:
➢ Attending public school board meetings to communicate your ideas and
priorities.
➢ Reaching out to other elected officials such as mayors or members of congress
to communicate your ideas and priorities.
➢ Help to elect officials that share your priorities. This includes reaching out to
candidates prior to elections to assess how committed they are to improving
mental health supports in schools.
Resources for Parents:

❖ Visit your school’s or district’s website to find their specific parent involvement policies.
➢ Here is a sample policy from Jim Thorpe Fundamental Elementary School in
Santa Ana, California: https://www.sausd.us/domain/6000
❖ Visit the California Department of Education and California State PTA websites to learn
more about parents’ rights when it comes to getting involved in their child’s education:
➢ CDE: https://www.cde.ca.gov/ls/pf/pf/
➢ PTA: https://capta.org/focus-areas/lcfflcap/priority-areas/parent-involvement/

43

Steps Within a Multi-Tiered Approach: Screening

What is Screening?
● Screening is a quick process used to identify how schools can support students more
adequately (Jacob, Decker, & Lugg, 2016). It involves collecting data from a large group
of students in order to identify those who might benefit from additional support (Yell,
2016). By way of screening, schools can ensure that all s tudents receive the support they
need to be successful before s ignificant problems arise (Merrell, Ervin, & Peacock, 2012).
This is especially helpful given that for almost any mental health condition, the earlier
that intervention is provided, the better the outcome (Essex, Kraemer, Slattery, Burk,
Boyce, Woodward, & Kupfer, 2009).
● Screening is not used to definitively determine whether a student has a certain issue, but
rather to identify students who would benefit from more assessment to find out whether
they do (Miller, 2011).
● Screeners are most effective when given to all students in the school population. Based
on the results, schools can further evaluate the needs of the students who the screener
identifies may be at-risk for a problem. These students may need some extra mental
health supports while at school that the rest of the student population does not
necessarily receive. Screeners can also identify students who may be past being at-risk
for a problem and are already experiencing it to a more severe extent. Schools should
further evaluate the needs of these students as they would those of the students who
the screener identified as being at-risk. They may require more intensive mental health
supports at school or other services from outside mental health providers (Jacob et al.,
2016).

For What Kinds of Problems Might Schools Screen?
● Historically, screening has not been an approach used very often by schools. Recently
though, schools have begun to screen more frequently for a wider range of issues.
Screening can be used for many types concerns, from problems with multiplication, to
exposure to trauma, to suicidal thoughts and behaviors (Miller, 2011).

Is Consent Required for Screening?
● School-wide or class-wide screening does not require consent from parents (Jacob et al.,
2016; Yell, 2016).
● If a screening tool has a reasonable expectation of eliciting personal or family
information from students, parents should be notified before the tool is administered.
This way, they have an opportunity to withdraw permission for the screener to be given
to their child (Jacob et al., 2016).
● Should a screening process identify that a student would benefit from more
individualized services, consent is typically needed before those services can be
44

provided (Yell, 2016). For more information about parental consent, please refer to the
“Legal and Ethical Issues” section.

If a Screener Identifies My Child as “At-Risk,” Will They Be Labeled as Mentally Ill by
School Staff?
● No. School staff should have training in screening in order to understand that the results
of screeners are only preliminary in nature (Jacob et al., 2016). Screeners are designed to
be overly sensitive to possible problems--so sensitive that, often, students identified as
“at-risk” during screening are later found to present no real concerns whatsoever.
● Additionally, the results of screeners will only be shared with relevant school officials
rather than the entire school staff as a whole. Privacy should be honored in the
administration and scoring of screening instruments (U.S. Department of Education, 2018;
Miller, 2011).

Can My Child’s School Screen for Issues That They are Unable to or Not Qualified to
Address?
● From an ethical standpoint, many people believe that schools should only screen for
problems that they can reasonably address given their resources. It could be considered
irresponsible for a school to screen for signs of, for instance, non-suicidal self injury, if
their staff is not competent to intervene with regards to that particular issue (Miller, 2011).

References

45

American Academy of Child and Adolescent Psychiatry (2013). Oppositional defiant disorder.
Retrieved from
https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Childr
en-With-Oppositional-Defiant-Disorder-072.aspx.
American Psychiatric Association, (2018). Warning signs of mental illness. Retrieved from
https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders
(5th ed.) Arlington, VA: American Psychiatric Publishing.
American School Counselor Association. Role of the school counselor. Retreived from
https://www.schoolcounselor.org/administrators/role-of-the-school-counselor.aspx
Anxiety Disorders Association of America (2005). Anxiety disorders in women. Retrieved from
https://adaa.org/sites/default/files/ADAA_Womens_R1.pdf
Association for Children’s Mental Health. (n.d.). Problems at school. Retrieved from
http://www.acmh-mi.org/get-help/navigating/problems-at-school/
Autism Speaks (2018). What is autism? Retrieved from
https://www.autismspeaks.org/what-autism.
Borntrager, C., & Lyon, A. R. (2015). Monitoring client progress and feedback in school-based
mental health. Cognitive and Behavioral Practice, 22( 1), 74–86.
http://doi.org/10.1016/j.cbpra.2014.03.007
Centers for Disease Control and Prevention (2018). Autism spectrum disorder: Data and
statistics. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html.
Centers for Disease Control and Prevention. (2018). Youth risk behavior survey data summary
and trends report 2007-2017. Retrieved from
https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf
Child Mind Institute (2016). Children’s Mental Health Report. Retrieved from
https://childmind.org/downloads/2016%20Childrens%20Mental%20Health%20Report.pdf
Child Mind Institute (2015). Children’s Mental Health Report. R etrieved from
https://childmind.org/downloads/2015%20Childrens%20Mental%20Health%20Report.pdf
DeAngelis, T. (2015). Who self-injures? Monitor on Psychology, 46(7), 60. Retrieved from
https://www.apa.org/monitor/2015/07-08/who-self-injures.aspx.
Essex, M. J., Kraemer, H. C., Slattery, M. J., Burk, L. R., Boyce, W. T., Woodward, H. R., & Kupfer,
D. J. (2009). Screening for childhood mental health problems: Outcomes and early
identification. Journal of Childhood Psychology and Psychiatry, 50(5), 562-570. doi:
10.1111/j.1469-7610.2008.02015.x
Fertman, C. I., Delgado, M. M., & Tarasevich, S. L. (2014). Promoting Child and Adolescent Mental
Health. Burlington, Massachusetts: Jones & Bartlett Learning.
Gable, S. L., & Haidt, J. (2005). What (and why) is positive psychology? Review of General
Psychology, 9(2), 103.
International Journal School and Cognitive Psychology. The five step collaboration cycle: A tool
for the doctors office. Retrieved from
https://www.omicsonline.org/open-access/the-five-step-collaboration-cycle-a-tool-for-the
doctors-office-ijscp-1000144.php?aid=60365
Jacob, S., Decker, D. M., & Lugg, E. T. (2016). Ethics and Law for School Psychologists, 7th
Edition. Hoboken, New Jersey: John Wiley & Sons.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US
children: Variation by ethnicity and insurance status. American Journal of Psychiatry,
159(9), 1548-1555.
46

Kerr, Michael E. (2000). The Bowen Center for the Study of Family. One family’s story: A primer
on Bowen Theory. Retrieved from http://www.thebowencenter.org.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime
prevalence and age-of-onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
Magalnick, H. & Mazyck, D. (2016). Role of the school nurse in providing school health services.
Pediatrics, 137(6). doi:10.1542/peds.2016-0852
Margolies L., PsychCentral (2018). Understanding Different Approaches to Psychotherapy.
Retrieved from
https://psychcentral.com/lib/understanding-different-approaches-to-psychotherapy
MedicineNet, Inc. (2018). Mental health in children. Retrieved from
https://www.medicinenet.com/mental_illness_in_children/article.htm#mental_illness_in_
children_facts
Mental Health America (n.d.) Talking to adolescents and teens: What to do and where to go.
Retrieved from
http://www.mentalhealthamerica.net/conditions/talking-adolescents-and-teens-what-do-a
nd-where-go
Mental Health Colorado (n.d.). School mental health toolkit. Retrieved from
https://www.mentalhealthcolorado.org/wp-content/uploads/2018/04/School_Mental_Hea
lth_Toolkit_Interactive_Final.pdf
Miller, D. N. (2011). Child and Adolescent Suicidal Behavior: School-Based Prevention,
Assessment, and Intervention. New York, New York: The Guilford Press.
Merrell, K. W., Ervin, R. A., & Peacock, G. G. (2012). School Psychology for the 21st Century, 2nd
Edition. New York, New York: The Guilford Press.
National Alliance on Mental Illness. (n.d.). Mental health by the numbers. Retrieved from
https://www.nami.org/NAMI/media/NAMI-Media/Infographics/Children-MH-Facts-NAMI.pd
f
National Center for Youth Law (2010). California minor consent laws: Mental health services.
Retrieved from
http://teenhealthlaw.org/wp-content/uploads/2015/10/CaMCConfMentalHealthChart12-10.
pdf
National Institute on Drug Abuse for Teens (2017). Tolerance, dependence, and addition: What’s
the difference? Retrieved from
https://teens.drugabuse.gov/blog/post/tolerance-dependence-addiction-whats-differenc
e
National Institute of Mental Health (n.d.). Major depression. Retrieved from
https://www.nimh.nih.gov/health/statistics/major-depression.shtml
National Institute of Mental Health (2017). Eating disorders. Retrieved from
https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml.
National Institute of Mental Illness (2015). Anxiety disorders. Retrieved from
https://www.nami.org/NAMI/media/NAMI-Media/Images/FactSheets/Anxiety-Disorders-FS
.pdf
Newcomb-Anjo, S. S. G. C., Barker, E., & Howard, A. (2017). A person-centered analysis of risk
factors that compromise wellbeing in emerging adulthood. Journal of Youth &
Adolescence, 46(4), 867-883. doi:10.1007/s10964-016-0603-2
Nock, M. K., Hwang, I., & Sampson, N. A. Mental disorders, comorbidity, and suicidal behavior:
Results from the National Comorbidity Survey replication. Retrieved from
47

https://dash.harvard.edu/bitstream/handle/1/4133811/Nock_Disorders_Comorbitity.pdf?se
quence=2&isAllowed=y.
Phoenix House (2012). Simple methods to prevent your teen from using drugs or alcohol.
Retrieved from
https://www.phoenixhouse.org/news-and-views/news-and-events/simple-methods-to-pre
vent-your-teen-from-using-drugs-or-alcohol/
Plotts, C. A., & Lasser, J. (2013). The counseling role in school psychology in School Psychologist
as Counselor: A Practitioner’s Handbook. Retrieved from
http://apps.nasponline.org/resources-and-publications/books-and-products/samples/N121
0_Chapter_1.pdf
Positive Psychology Center (n.d.). PERMA theory of well-being and PERMA workshops. Retrieved
from
https://ppc.sas.upenn.edu/learn-more/perma™-theory-well-being-and-perma™-workshops
Positive Psychology Program (n.d.). Positive education: Happy students & positive psychology in
the classroom. Retrieved from
https://positivepsychologyprogram.com/positive-education-happy-students/
Puddy, R., Roberts, M., Vernberg, E., & Hambrick, E. (2012). Service coordination and children's
functioning in a school-based intensive mental health program. Journal of Child & Family
Studies, 21( 6), 948-962. doi:10.1007/s10826-011-9554-0
Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction (Vol. 55, No.
1, p. 5). American Psychological Association.
Seligman, M. E., Ernst, R. M., Gillham, J., Reivich, K., & Linkins, M. (2009). Positive education:
Positive psychology and classroom interventions. Oxford Review of Education, 35( 3),
293-311.
Splett, J. W., Fowler, J., Weist, M. D., McDaniel, H., & Dvorsky, M. (2013). The critical role of
school psychology in the school mental health movement. Psychology in the Schools,
50( 3), 245–258. https://doi-org.libproxy.chapman.edu/10.1002/pits.21677
Stargell, N.A., Zoldan, C. A., Kress, V. E., Walker-Andrews, L. M., & Whisenhunt, J. L. (2018).
Student non-suicidal self-injury: A protocol for school counselors. American School
Counselor Association, 21( 1) 37-46.
Substance Abuse and Mental Health Services Administration (2015). Substance use disorders.
Retrieved from https://www.samhsa.gov/disorders/substance-use.
Substance Abuse and Mental Health Services Administration (n.d.). The eight dimensions of
wellness. Retrieved from
https://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness
St. Vincent’s Hospital, Fairview. Systemic Psychotherapy / Family Therapy. Retrieved from
http://www.svhf.ie/systemic-family-therapy.html
Systems Theory / Therapy. Retrieved form
https://www.goodtherapy.org/learn-about-therapy/types/systems-theory-therapy
Tartavosky, M. (2017) Tips for parenting with a mental illness. Retrieved from
https://psychcentral.com/lib/tips-for-parenting-with-a-mental-illness/
The American Academy of Pediatrics (2016). Role of the school nurse in providing school health
services. Volume 121. Issue 5. Retrieved from
pediatrics.aappublications.org/content/137/6/e20160852
United States Department of Education (2018). Family Educational Rights and Privacy Act
(FERPA). Retrieved from https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html.
48

United States Department of Health and Human Services (2016). Drug use in adolescence.
Retrieved from
https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/index.html.
United States Department of Human Health and Services. What is mental health? R etrieved from
https://espanol.mentalhealth.gov/basics/what-is-mental-health
What is School Administration? Retrieved from
https://learn.org/articles/What_is_School_Administration.html
World Health Organization. (2018). Mental health. Retrieved from www.who.int/mental_health/en/
World Health Organization. (2014). Risks to mental health: An overview of vulnerabilities and risk
factors. Retrieved from
http://www.who.int/mental_health/mhgap/risks_to_mental_health_EN_27_08_12.pdf
Yahyaei, D., Foroushani, Z. J., & Mahini, F. (2012). The school role in lively education and
student’s mental health. Procedia Social and Behavioral Sciences, 47, 1408–1412.
https://doi-org.libproxy.chapman.edu/10.1016/j.sbspro.2012.06.834
Yell, M. L. (2016). The Law and Special Education, 4th Edition. New York, New York: Pearson.
49

Appendix A:
3 Easy Steps For Talking To Your Child About Mental
Health
Step 1: Step 2: Step 3:
Notice the Symptoms Start the Conversation What to do, Where to
go?

You notice that something Pick a good time to have a What to do: After a
just doesn’t seem right, conversation and create a conversation with your
your child’s behaviors space that is safe to talk. In
child is going to depend on
seem different than others a non-judgmental way let what your child has told
in their peer group, or you your child know what you. Some of your child’s
notice the following changes you have problems might require
symptoms for more than a observed in them (school professional help, others
week: feeling sad, work seems to be may be situational or
hopeless, sensitivity to suffering, their mood temporary and just require
sound, sight smell, or seems to have “darkened”, your emotional support
touch, feeling overly they don’t seem to be and advice.
worried, loss of interest in hanging out with their You’ll want to consider:
things they used to enjoy, friends as much, etc.) and What kinds of symptoms is
problems with let them talk to you if they
your child expressing, and
concentration, loss of want to. how long the symptoms
appetite or overeating. Things not to do: Minimize have been going on.
(This list just names a few how they are feeling, let Where to go: School
of the symptoms your child your emotions rule your support staff can help
may be experiencing if response, do not tell your evaluate your child and get
they are having mental child what they should do, them the services they
health problems.) don’t argue, make need. Another option is
excuses, or compare them going to your family
to their siblings. doctor.

50

Appendix B:
Five Steps for Effective Collaboration
Five Steps For Effective Collaboration
1. Communication
This starts the process of connecting. With open communication, the partnership can begin. You and your child’s
school should have an open communication between your child’s needs/behaviors at home and at school. This
provides consistency between the home and school environment and will help resolve problems with more
accuracy.
2. Empathy
Empathy is the ability to understand and share the feelings of another. Empathy requires listening and
understanding the ideas, concerns, feelings, and thoughts of the other person. School personnel such as the school
psychologist should be able to understand your concerns for your child, and at the same time, you should be
understanding of where the psychologist’s thoughts are at too. To express empathy, one can reflect back what they
heard to make sure they are communicating effectively.
3. Respect
Respect needs to be mutual when collaborating with your school team. All members of the team should be
respectful and in turn, respected. A school psychologist will respect that you are the parent and know your child
best. In turn, you should respect the psychologist as a professional and value their opinions. Without respect, the
collaboration quickly breaks down.
4. Mutual Goals
When it comes to the goals and desired outcomes for your child, all members of the team should agree. No
decision should be made about your child that you do not agree with. When people are working towards the same
51

goal together, there is a greater likelihood that the goal will be met. Of course, the ultimate goal is to provide help
for your child, but the decisions as to which services are to be put in place should be mutually agreed upon.
5. Trust
Trust is defined as assured reliance on the character, ability, strength, or truth of someone or something. As a
parent, you are trusting the team to implement services that will help your child’s mental health needs. At the
same time, the team is trusting you to tell the truth about your child’s needs. As a parent, you need to trust the
relationship and partnership you have created with the team. Trust, the last step in the cycle, keeps the cycle going
around and around. When trust breaks down, the cycle stops.

52

Appendix C:
The Parent’s Checklist for Supporting Mental Health
Parents should feel empowered to enhance their children’s mental health. To generate the most
positive outcomes for your child, try to mark off as many boxes as you can on this checklist.
❏ Take care of your child’s physical needs--such as sleep, nutrition, and regular
healthcare--to the best of your ability.
❏ Let your child know that you’re there for them.
❏ Talk openly about mental health issues before they arise.
❏ Practice wellness strategies with your child.
❏ Understand various individual, familial, community, and cultural factors that may be at
play regarding your child’s mental health.
❏ Familiarize yourself with risk factors related to mental health issues.
❏ Remain vigilant for red flags that may indicate your child is experiencing some difficulties
with their mental health.
❏ Understand common mental health issues that arise in childhood or adolescence, and be
aware of resources available to treat them.
❏ Communicate with your child’s school about any mental health concerns you have
regarding your child.
❏ Be aware of the mental health team that may support your child while they’re at school,
which may include the school psychologist, the school counselor, teachers, the school
nurse, and administrators.
❏ Develop open lines of communication with the staff directly involved in supporting your
child’s mental health.
❏ Understand the legal and ethical issues related to addressing your child’s mental health
needs in the school setting.
❏ Advocate for school-level, district-level, or even state-level policy changes that may
improve the mental health outcomes of your child and their peers.
53

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Mental Health in the Schools

Positive Psychology and Wellness……………………………………………………………………………. 3-5

Statistics - Why Address Mental Health Early?………………………………………………………… 6

Red Flags and Risk Factors……………………………………………………………………………..…………. 7-10

Common Diagnoses and Concerns………………………………………………………………………….. 11-21

Autism Spectrum Disorder…………………………………………………………………………….. 15-16

Oppositional Defiant Disorder………………………………………………………………………. 17

Eating Disorders……………………………………………………………………………………………. 18

Substance Abuse………………………………………………………………………………………….. 19

Non-Suicidal Self-Injury………………………………………………………………………………… 20

Suicidal Ideation and Behavior……………………………………………………………………. 21-22

Cultural and Diversity Factors…………………………………………………………………………………….. 23-25

Taking a Systems Approach to Mental Health…………………………………………………………… 26-27

The Role of the School in Children’s Mental Health…………………………………………………. 28-30

Specific Roles in School-Based Mental Health………………………………………………………….. 31-33

Legal and Ethical Issues………………………………………………………………………………………………. 34-38

Steps in Addressing School-Wide Mental Health………………………………………………………. 39-44

Using a Multi-Tiered Approach……………………………………………………………………… 39-41

School Policy……………………………………………………………………………………………………. 42-43

What is Mental Health?

Positive Psychology and Wellness

(Adapted from Positive Psychology Center, n.d.).

Further Resources for Families:

Statistics - Why Address Mental Health Early?

How does this Impact School and Learning?

ADHD, mood disturbances, anxiety, and disruptive behavior ​at

Red Flags and Risk Factors

● Low self-esteem or issues with body image

● Low access to basic services (such as healthcare, for instance)

Exhibiting Feelings of:

● Difficulty with problem-solving

● Excessive tiredness or drowsiness

● Social withdrawal or isolation

Common Diagnoses and Concerns

​Internalizing Problems Externalizing Problems

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

Attention-Deficit/Hyperactivity Disorder (ADHD)

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

Autism Spectrum Disorder (ASD)

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

Children with ASD may be at increased risk National Autism Center:

Oppositional Defiant Disorder (ODD)

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

How Common are they? How Early Can they be Identified?

Other Related Mental Health Issues Resources for Families

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

Non-Suicidal Self-Injury (NSSI)

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

Suicidal Ideation and Behavior

How Common is it? How Early Can it be Identified?

Other Related Mental Health Issues Resources for Families

● Recognize symptoms in their children

Cultural and Diversity Factors

You can ask your child things like:

Taking a Systems Approach to Mental Health

ADHD, mood disturbances, anxiety, and disruptive behavior at

Internalizing Problems Externalizing Problems

❏ Talk openly about mental health issues before they arise.