MENTAL HEALTH TOOLKIT

A Guide for Parents and Guardians to Navigate their Student’s

Mental Health Needs

Compiled By: Kendra Canham, Emily Chen, Julia Hohl, Kathleen

Huerta, Yesenia Millan
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TABLE OF CONTENTS
What is Mental Health? …………………………………………………. 3-4
Positive Psychology and Wellness …………………………………. 5-7
Red Flags, Risk and Protective Factors ………………………….. 8-10
Statistics- Why Address Mental Health Early?...................... 11
Common Diagnoses………………………………………………………..12-18
Cultural and Diversity Factors………………………………………..19-20
Taking a Systems Approach to Mental Health……………….. 21
The Role of the School in Children’s Mental Health………. 22-24
Specific Roles in School-Based Mental Health …………….... 25-26
Legal and Ethical Issues ………………………………………………… 27-28
School Policy…………………………………………………………………. 29
Screening………………………………………………………………………. 30
Progress Monitoring……………...…………………………………….... 31
Multi-Tiered Approach………………………………………………….. 32-34
FAQ ………………………………………………………………………………. 36-37
Tools and Checklists …………………………………………………….. 38-40
References…………………………………………………………………….. 41-44
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WHAT IS MENTAL HEALTH?

Mental health is not simply the absence of mental illness; it includes our emotional,
social, and psychological well-being. There are a number of factors that contribute to
mental health, such as life experiences, family history, and our brain chemistry (CDC,
2018). With good mental health, ideally, students can maintain close friendships, motivate
themselves academically, and display moderate emotional stability. Also, children and
adolescents should feel comfortable with their friends, seek help from adults when
needed academically and emotionally, and successfully negotiate disagreements with
others.

MENTAL HEALTH AT A GLANCE IS...

1. The successful performance of mental functions.

2. The ability to think clearly, feel a variety of feelings, and behave in appropriate
ways.
3. The maintenance of fulfilling relationships with other people and the completion of
productive activities.
4. The ability to change and cope with adversity. (Fertman, Delgado & Tarasevich., 2014).
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Mental Health for Students

● Academic Engagement: Striving to do their best in
school, good attendance, homework completion
● Social Skills: Desires to see same-age friends regularly; has at least one
close relationship outside of the family with a peer
● Self-Regulation: Motivates self to do their best, rarely hostile, may
negotiate with the parent, but limited arguing; calms down quickly on
their own when distressed.
(World Health Organization, 2018).
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POSITIVE PSYCHOLOGY AND WELLNESS

Positive psychology is the scientific study of what makes life most worth living (Peterson,
2006). In simpler terms, it is a solution-focused way of thinking. A positive psychology
mindset may involve focusing on gratitude, compassion, and resilience. Other elements of
positive psychology, like hope and optimism, are associated with goal attainment, better
self-regulation, and overall healthy wellbeing (Gallagher and Lopez, 2009). Positive
psychology can be key to maintaining good mental health and overall wellness.

Wellness is a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity (Peterson, 2006). Wellness is also a feeling of contentment
with one’s current life situation, as well as a feeling of competency when change is needed.
Wellness is a broad term, encompassing physical, mental, and social health. To achieve
this, one should be physically exercising, eating well, and sleeping eight-ten hours each
night.

Additionally, mental health needs can be addressed through a self-care plan, which school
counselors are happy to help all students develop. In fact, the topic of self-care is
incorporated into classroom lessons as a tier-one service. In order to further bolster a
students’ mental health and wellness, caregivers ought to frequently check in with their
students and encourage conversations about how they are feeling. Young people are
extremely social beings, and their friendships have big impacts on their development and
wellness. Students should feel comfortable at school around their peers. Social skills can
be developed through group-work in classrooms, interactions at break and lunch, and
after-school activities. Wellness is paramount to a student’s overall success!
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POSITIVE PSYCHOLOGY AT HOME

Simple activities to practice with your student to promote wellness!

● GRATITUDE: Thankful for all that we do have rather than focusing on what we
do not have.

Example: Saying “thank you” to others, counting your daily blessings, writing
a letter of gratitude.

● SAVORING: Focus on all sensations associated with an experience (emotional,

social, physical)

Example: When eating a meal, gaze at the food, and think about where it
came from and the journey it took to reach your plate, slowly eat the food, let the
flavors sit in your mouth, appreciate the nourishment gained from the meal.

● MINDFULNESS: Awareness of own thoughts and thought-processes, focus on

the present moment

Example: STOP: S - stop, T - take three breaths, O - observe, P - proceed

positively. When faced with a stressful or overly stimulating situation, pause and
pay attention to how you feel and proceed according to what is best for you.

Positive psychology can easily be practiced at home on a daily basis. These

simple interventions can boost mood, increase productivity, and calm one’s
emotions.
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WELLNESS PROMOTION
Parents and guardians can help their students maintain a state of wellness through
the PERMA model (Seligman, 2018).

P Positive Emotions: joy, gratitude, or hope

E Engagement: interest, motivation, or absorption in challenging

activities

R Relationships: friendships, familial, or romantic

M Meaning: seeing and serving a purpose in life

A Accomplishment: wanting success or mastery, may be academic,

athletic, or social for students

The PERMA model can be applied at home much like it is within schools. Parents
can model a positive perspective to their students, fostering optimism. Students should be
encouraged to try new, challenging tasks and with parental support, they feel competent
when doing so. With guardians’ guidance, students should also be able to navigate social
circles frequently, building intimate connections outside the family. Also, help your child
find meaning in life through various avenues, be it religious, cultural, spiritual, other
(Pascha, 2016).
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RED FLAGS AND RISK FACTORS

Understanding and learning about developing symptoms or early warning signs can
help prevent or intervene on a mental illness. If several of these symptoms are occurring
with your child, it is recommended to follow up with a mental health professional.

Red Flags

Warning signs that your child might have a mental health condition include:
(American Psychiatric Association, 2019)

● Mood changes.
○ Look for feelings of sadness or withdrawal that last at least two weeks or
severe mood swings that cause problems in relationships at home or school.
● Behavior changes.
○ These include drastic changes in behavior or personality, as well as
dangerous or out-of-control behavior.
○ Fighting frequently, using weapons and expressing a desire to badly hurt
others also are warning signs.
● Difficulty concentrating.
○ Look for signs of trouble focusing or sitting still, both of which might lead to
poor performance in school.
● Unexplained weight loss.
○ A sudden loss of appetite, frequent vomiting or use of laxatives might
indicate an eating disorder.

● Physical symptoms.
○ Headaches and stomachaches
● Physical harm.
○ Self-harm, such as cutting or burning yourself. Children with a mental
health condition also might develop suicidal thoughts or attempt suicide.

● Substance abuse.
○ Use of drugs or alcohol to try to cope with their feelings.
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Risk Factors

A risk factor is something that can increase the

likelihood of developing a disorder or condition. A
child’s biology, psychosocial attributes, and
environment may put them at greater threat for
experiencing mental health illnesses.

Please note: 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 at higher risk.

Biological
● Genetics
○ Do certain mental disorders run in the family?
■ If so, family history of mental illness may increase the likelihood of
your child developing one as well.
○ Chromosomal and/or chemical abnormalities
○ Brain damage

● Gender
○ Some mental illness disorders are more prevalent for males than females
and vice versa

Psychosocial
○ Living in poverty
○ Low socioeconomic status
○ Homelessness
○ Low parental education level
○ Conflict between parents
○ Childhood trauma
■ Sexual abuse
■ Emotional abuse
■ Physical abuse
■ Exposure to domestic violence
○ Neglect

Environmental
○ Exposure to natural disasters (hurricanes, tornados, tsunamis, etc)
○ War
○ Discrimination (due to race, gender, sexual orientation)
○ Gang violence
○ Availability of resources such as healthcare services and clean water
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Protective Factors
Although, you have learned about risk factors that increase the likelihood of
mental health issues, keep in mind that there are also protective factors. A protective
factor can be defined as a characteristic at the biological, psychological, family, or
community level that reduces the potential for mental health concerns and problems
(Fertman, Delgado & Tarasevich, 2014).

Individual Attributes
● Positive physical development
● Academic achievement
● High self esteem
● Emotional self-regulation
● Good coping skills and problem-solving skills
● Engagement and connections in two or more of the following contexts: school,
with peers, in athletics, employment, religion, culture

Family Factors
● Supportive relationship with family
● Adequate socioeconomic resources for the family
● Family provides structure, limits, rules, monitoring, predictability
● Frequent shared activities with parents
● Family or parental guidance on how to solve problems or cope
● Support outside the family: grandparents, aunts/uncles, churches, community
organizations

Environmental Factors
● Safe and positive school environment
● Safe living conditions
● Safe community
● Physical and psychological safety
● Access social activities (sports, after school programs, etc.)
● Access to religion or spirituality resources
(Youth.Gov, 2019)
(Fertman, Delgado & Tarasevich, 2014)
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STATISTICS
Why Address Mental Health Early?

Mental health disorders are the most common diseases of

childhood. (Child Mind Institute, 2016).

How many children are we talking about?

49.5 %
Estimated to have a diagnosable mental
illness
22.2 %
have mental illness with severe impairment
sometime before they are 18
7.4%
of children in the U.S. receive mental health services.
(Child Mind Institute, 2015)
How does this impact my child at school?
● 1 in 10 adolescents have a mental health problem that challenges how they
function at school.
● Children struggling with mental health and learning disorders are at risk for
poor outcomes in school and in life.
● Mental health and learning disorders are tied to higher dropout rates.
○ Dropout rate is 38.7%
● Dropout and mental health disorders predict prison.
○ 70.4% of youth involved in the juvenile justice system meet criteria
for a psychiatric diagnosis, and 68% of state prison inmates have not
completed high school. (Child Mind Institute, 2016)
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COMMON DIAGNOSES
Children and adolescents can be afflicted by numerous mental illnesses. Some students
may even meet diagnostic criteria for certain disorders. This can be extremely
overwhelming to both students and their caregivers, but a diagnosis may allow for proper
treatment and services to be allocated for a student. The following information breaks
down the most common mental health issues identified in school-aged children:

● ADHD: Attention Deficit and Hyperactivity Disorder

● Depression
● Anxiety
● Substance Abuse
● Eating Disorders

Schools can provide a plethora of interventions to aid students who are afflicted by
mental health problems. Some common interventions include 504 plans and IEPs; these
must be qualified for, but a school psychologist can be very helpful in determining the best
path for your students.

At a glance, a 504 plan ensures a student with a disability has equal access to an
education, including accommodations to their learning environment. An IEP, or
Individualized Education Plan, lays out accommodations for students with disabilities who
need instructional alterations in the classroom. More information regarding specific
disorders and possible interventions and resources, along with student support teams, will
be discussed in the following pages.
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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)

ADHD is a persistent pattern of inattention and hyperactivity-impulsivity that
interferes with functioning or development (American Psychiatric Association, 2013).
There are 3 types of ADHD presentations:
1. Predominantly Inattentive 2. Predominantly Hyperactive- Impulsive 3. Combined

Diagnostic Criteria:
6+ Symptoms of Inattentive & Hyperactivity-impulsivity
Must have been present for at least 6 months in 2 or more settings

SYMPTOMS INCLUDE:

Hyperactivity & Impulsivity Inattentive

● Excessive fidgetiness
● Difficulty remaining seated when sitting is
required
● Feelings of restlessness (in adolescents) or
inappropriate running around or climbing
in younger children
● Difficulty playing quietly
● Difficult to keep up with, seeming to
always be "on the go"
● Excessive talking
● Difficulty waiting turns
● Blurting out answers too quickly
● Interruption or intrusion of others
● Failure to provide close attention to detail
● Difficulty maintaining attention in play, or
home activities
● Seems not to listen, even when directly
addressed
● Fails to follow through (eg, homework,
chores)
● Difficulty organizing tasks, activities, and
belongings
● Avoids tasks that require consistent mental
effort
● Loses objects required for tasks or activities
● Easily distracted by irrelevant things
● Forgetfulness in routine activities

How common is it? Resources for Families:

About 5% of children in the United States have
ADHD. It is often seen diagnosed twice as often in
boys than girls. (American Psychiatric Association,
2013)
School Interventions
IEP or 504 Plan
This ensures that students receive individualized
plans in order to meet their needs.
● Caring for Children with ADHD: A Resource
Toolkit for Clinicians, National Initiative for
Children’s HealthcareQuality (NICHQ)
https://www.nichq.org/
● Children and Adults with Attention-
Deficit/Hyperactivity Disorder (CHADD)
www.chadd.org
● American Academy of Child and Adolescent
Psychiatry ADHD Resource Center:
https://www.aacap.org/aacap/Famili
es_and_Youth/Resource_Centers/ADHD_Re
source_Center/Home.aspx
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DEPRESSION
Depression is a serious mood disorder characterized by the presence of a sad, empty, or
irritable mood, accompanied by somatic and cognitive changes that significantly affect the
individual’s capacity to function (American Psychiatric Association, 2013).

Diagnostic Criteria: 5 or more of the Resources for Families:

following symptoms within two weeks:
● Depressed Mood most of the day, Depression helplines:
nearly every day.
● Markedly diminished interest or https://www.mentalhelp.net/articles/depr
pleasure in almost all activities essio n-hotline/
● Significant weight change (not due
Suicide Hotlines:
to dieting), or loss of appetite
● Insomnia or hypersomnia nearly National Suicide Prevention Lifeline
every day
● Feelings of restlessness or lethargy Information for Parents, written by Nurse
Practitioners:
● Fatigue or loss of energy nearly
every day https://www.napnap.org/sites/default/file
● Feelings of excessive guilt or s/userfiles/for_providers/MentalHealthGu
worthlessness ideHandouts/NAPNAP_Information_on_D
● Limited ability to think concretely; epression_For_Parents.pdf
indecisiveness
● Recurrent suicidal ideation or
attempts

How common is it? Treatment in School:

3.2% of children aged 3-17 meet
diagnostic criteria for depression.
Prevalence increases with age; diagnosis
under age 12 are rare (American
Psychiatric Association, 2013).
504 plan - May allow for extra time on
assignments and other special
accommodations
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ANXIETY
Anxiety disorders are characterized by intense feelings of worry, fear and distress
in situations that are non-threatening or in a manner that is disproportionate to the actual
risk. The feelings cause significant problems in normal functioning in the individual’s life.
Types of anxiety disorders include General Anxiety Disorder (GAD), social anxiety, panic
disorder and phobia ( National Institute of Mental Health, n.d.).

Diagnostic Criteria: What it might look like in children:

● Presence of excessive anxiety, fear and
worry that occurs more often than not
for at least six months.
● The feelings are difficult to control and
may shift easily from one thing to
another.
● Anxiety and worry are accompanied by
3 of the following physical symptoms:
○ Restlessness
○ More fatigued than usual
○ Impaired concentration
○ Irritability (both external or
internal)
○ Difficulty sleeping or eating
● Refusal to play with new children
● Clinging to parents/guardians and
teachers
● Excessive worry/concern over tests,
homework, assignments such as not
being able to sleep a week prior to test
● Excessive worry about loved ones
getting hurt or ill or natural disasters
● Difficulty concentrating in class
● Difficulty staying in their assigned seat
● Difficulty getting up in the morning to go
to school
● Increase in tantrums
● Does not want to separate from
parent/guardian
● Freeze or panic when called on in class
or doing presentations

How common is it? Resources for Families:

About 1 in 8 children in the United States have
diagnosable anxiety. Anxiety from separation
can begin when the child is 18 months. GAD
can be observed as early as seven years old.
(Anxiety and Depression Association of
America, n.d.).
School Interventions
- Educating students on self-
regulation/coping skills
- IEP or 504 Plan
This ensures that students receive
individualized plans in order to meet their
academic needs.
Anxiety and Depression Association of America
(ADAA): adaa.org
Tips for beating test anxiety:
https://childmind.org/article/tips-for-beating-
test-anxiety/
(Child Mind Institute, n.d.).
Ask an expert about your child’s anxiety:
https://childmind.org/topics-a-z/ask-an-
expert/ (Child Mind Institute, n.d.).
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SUBSTANCE ABUSE
Substance use disorders involve a collection of cognitive, behavioral, and
physiological symptoms indicating that the individual continues using a substance despite
significant substance-related problems. Some common substances include alcohol,
marijuana, tobacco, stimulants, and opioids (American Psychiatric Association, 2013).

Diagnostic Criteria: Resources for Families:

● The disorder developed during or
within 1 month of substance
intoxication
● The involved substance or
medication is capable of producing
the mental disorder
● Disorder is not better explained by
another independent mental health
disorder
● Disorder does not occur exclusively
during the course of intoxication
● Represents clinically significant
distress or impairment, including
health problems, disability, and
inability to meet responsibilities at
work, home, or school
Substance Abuse and Mental
Health Services Administration
hotline: www.samhsa.gov/find-
help/national-helpline
Behavioral Health
Treatment Services Locator:
https://findtreatment.samhsa.gov/
Support Group- National
Alcohol and Substance Abuse
Information Center:
www.addictioncareoptions.com/

How common is it? Treatment in School:

● Over 20 million adults in the United
States suffer from substance use
disorders IEP or 504 Plan
● Teenagers are particularly This ensures that students receive
vulnerable to substance use individualized plans in order to meet their
disorders because their brains are needs.
still developing
● A majority of individuals who start Tier-1 school-wide intervention programs
using drugs or alcohol before age 18 to educate students and staff about
end up developing the disorder by substance use disorders, create a safe
age 20. For example, 15.2% of those space, and provide resources.
who start drinking by age 14 will
eventually develop an alcohol
dependence. (National Institute on Drug
Abuse, 2014).
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EATING DISORDERS
Eating disorders are identified by irregular eating or eating-related behaviors and
thoughts that alter an individual's physical health and psychosocial functioning (American
Psychiatric Association, 2013). Common eating disorders include: Anorexia Nervosa (AN),
Avoidant/Restrictive Food Intake Disorder, Binge-Eating, Bulimia Nervosa, Pica, and
Rumination Disorder.

Diagnostic Criteria: What it might look like in children:

● Anorexia Nervosa
○ Intense fear of gaining
weight/being fat despite
significantly low body weight.
● Avoidant/Restrictive Food Intake Disorder
○ Eating or feeding disturbance due
to lack of interest in food or eating,
avoiding food based on sensory
characteristics, and a concern with
aversive consequences of eating.
● Binge-Eating Disorder: 3 or more of the
following symptoms must be present:
○ Eating rapidly
○ Eating until uncomfortably full
○ Eating large amounts of food when
not hungry
○ Eating alone to avoid the shame of
how much one is eating Feelings of
guilt, disgust, and depression after
eating
● Bulimia Nervosa
○ Overeating and then vomiting,
using laxatives, fasting, or
exercising excessively to prevent
weight gain.
● Pica
○ Constantly eating non-nutritive
food such as soap, paper, chalk
● Rumination Disorder
○ Re-chewing, re-swallowing, spitting
out food repeatedly over a period
of at least 1 month
● Behavioral:
○ Frequent trips to the bathroom
○ Eating alone or refusing to eat
○ Wears baggy clothes to hide body
○ Hovers over chair instead of sitting
down properly
○ Considered a “picky” eater
● Emotional:
○ Excessive concerns and complaints
about their body image
○ Experiencing episodes of anxiety,
depression, embarrassment,
worthlessness
● Physical:
○ Sudden spikes in weight gain or loss
in a short amount of time
○ Abdominal pains
○ Thinning and dry hair, dry skin
○ Callus on knuckles from self-induced
vomiting.
(National Eating Disorders Association, 2018)

(American Psychiatric Association, 2013)

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How common is it? Resources for Families:

● Anorexia nervosa: 10:1 female-to-male
ratio with a 0.4% prevalence
● Bulimia nervosa: 1%-1.5% prevalence, 10:1
ratio between females and males
● Binge-eating: 1.6% for females, 0.8% for
males
● Pica & Ruminating disorder: unclear on
prevalence, but individuals with disabilities
are more affected with severity of the
condition
● Eating disorders can develop at any time,
as early as elementary school, and is most
common in adolescence and early
adulthood
● The following websites provide a support
system and guide for parents that need
extra assistance understanding their child’s
eating disorder, and helping them cope with
the treatment and recovery process
○ https://www.nationaleatingdisorder
s.org/parent-toolkit
○ https://www.feast-ed.org
○ https://anad.org/our-
services/eating-disorders-helpline/

(American Psychiatric Association, 2013)

School Interventions
● IEP or 504 Plan ensures that students
receive individualized plans in order to
meet their academic needs.
● Healthy body image education.
● Tier-1 school-wide intervention programs
informing students and staff about eating
disorders, debunking myths, creating
acceptance
 19

Cultural Diversity Factors and Implications

Cultural Diversity is understanding that ethnicities, beliefs, values, customs, attitudes, and goals
vary among different groups of people. The more we learn to recognize, acknowledge and
celebrate each other’s cultures, the better we can eliminate stereotypes and biases. Families are
the primary caregivers of children and the more informed and trained you are in mental health, the
quicker you can identify if a child is experiencing a mental health condition (National Alliance on
Mental Health, 2019).

As parents, you have raised your children based on specific cultural factors you have adapted from
your own families. Think about how your family copes with mental health issues. Here are some
questions that can help guide your reflection:

● How would you describe mental health?

● Is there a specific mental illness that runs in the family?
● What are some of your approaches to these mental health illnesses that would be helpful
for your child’s school community to be aware of?
● Are there reasons why you may hesitate to get help?

Answers to these questions are not universal. Western medicine and treatment for mental illness
is also not universal across cultures (Alegria, et al., 2011). Therefore, it may be useful to use an
integrated approach when working with diverse children and families. Schools must consider how
different cultures view the mental health stigma and incorporate ways to anticipate the needs of
their population.
 20

Understanding Mental Health and Culture at Home

At home, you can help reduce the mental health stigma by dismissing any guilt or shame a child
might have for having feelings of depression, anxiety, or other mental health disorders. If a child is
dwelling on negative thoughts, rather than asking them to “tough it out,” offer extra support and
talk with them to work through their emotions. A checklist for topics that you can discuss with
your child to facilitate conversations about their mental health can be found in appendix A.

There is a free 6-session course offered through the National Alliance on Mental Health (NAMI)
that helps parents become more aware of mental health conditions, ways to help kids
experiencing mental illnesses cope, and what the treatment and recovery process may be. It is led
by parents and caregivers that have personal insight on having a child with a mental illness and it is
also taught in Spanish (NAMI, 2019).

Also, you can work with your child to better understand their beliefs and values, which then
fosters their understanding and acceptance towards the varying backgrounds that their peers
might have. This will help promote a better overall culture at your child’s school, which is crucial
for their social-emotional development.

In order to better understand your child’s beliefs and values, you can ask them questions like:

● What do you think is important in your life?

● How do you think others are different from you?
● How should you treat people who are not the same as you?
● How do you want others to treat you, if they are different from you?
● What is your school doing to celebrate differences?

Together, you and your child can identify the values that are prevalent in your home and work to
promote respect towards the mindsets and values that other students may have.
 21

SYSTEMS-APPROACH to Mental Health

When it comes to student mental health, there are several different perspectives to use as
a tool to look at each particular case and together, they form the systems approach.

The systems approach involves understanding the child within their context. When a child
has a problem, we need to see them from a holistic perspective. Instead of only evaluating
the child, we need to take into account the different parts of that child’s life.

→ What is the family’s role in the systems approach? Parents, as seen from
the graph below, are part of the child’s microsystem, which has immediate, direct
influences on the child’s life. Thus, parents are an important piece of the whole
puzzle and have a significant impact on the child’s mental health.

→ What is the educational systems’ role in the systems approach? The

educational system your child is a part of influences their development and mental
health. The school system consists of local, state, and federal standards that dictate
classroom lessons and expectations. The educational system is a part of the
exosystem, a piece in the systems approach model that has an indirect effect on
your child’s experience.

When any one factor of the system changes, all other elements must also
adjust to maintain a “state of balance” in order to ensure the overall well-being of
the child (Johnson & Johnson, 2003).

→Educators, parents, and mental health professionals can use this approach to
better answer questions such as: What is the problem? Why has the problem
developed? How can we fix it?

The Ecological Systems-Approach:

Bronfenbrenner’s Ecological Theory of Child Development

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HOW DO SCHOOLS PLAY A ROLE?

With the rise in mental health awareness, campuses are implementing and expanding
programs to further promote positive mental health among students. Examples include:

1. School-Based Mental Health Support Teams: Consisting of trained staff members

and volunteer students who meet to discuss the needs of the campus’s population.

2. Tier-One Interventions: Teachers and trained professionals, such as counselors,

present relevant information about mental health, warning signs, and self-care.
Schools can display mental-health posters and have mental health awareness days.

3. Counseling: School counselors are well-versed in the field of mental health and
offer individual and group counseling sessions for persons dealing with mental
health issues that cannot be addressed through tier-one support.

“The evidence seems to support the claim that these school-based services have a
positive impact on students’ social and emotional well-being as well as on their academic
achievements” (Haynes, 2008).

Additionally, schools are responsible for maintaining a safe environment where students
and staff feel comfortable engaging in conversations about mental health. Students
should feel encouraged to disclose any events that they feel might be a threat to their
personal well-being. Staff should check-in regularly with students to make sure their
academic and social-emotional needs are being met (Fertman, Delgado & Tarasevich,
2014).

School is a unique environment in that a child spends so much time there, so it is

imperative that school personnel are not only well aware of mental illness warning signs,
but also know how to properly support mental wellness. Students should always be well-
informed of the mental health resources that are available to them, including at least one
adult they can talk to on campus.

If your student’s school does not have adequate support in place, some resources that you
can use to advocate for their mental health can be found in appendix B.
 23

STEPS IN ADDRESSING SCHOOL-WIDE

MENTAL HEALTH
During the week, students arguably spend the majority of their time in schools, which
means school staff and personnel are the first people to notice when there are behavioral
changes in your child that may indicate a shift in their mental health.

Ideally, schools will make mental health a priority in their comprehensive wellness goals
for all of their students. This means that schools will not only focus on your child’s physical
health, such as nutrition and exercise, but will also create ways to foster positive school
culture and healthy social-emotional, self-regulation skills for your child.

To do so, schools will follow federal and state laws along with district and school policies
in order to ensure the best ethical practices are in place for your student.

While all students benefit from mental wellness and social-emotional learning, schools
will do screenings to assess for students who need additional mental health support and
interventions. This multi-tiered approach allows the school to effectively address the
variety of needs that exists among different students, while monitoring the progress that
they make.

Through a collaborative effort, school administrators, teachers, you, and your community
will work together to ensure the overall wellness of your child.
 24

Specific Roles in School-Based Mental Health

When it comes to addressing students’ mental health, school staff take a collaborative
team approach in order to consider a multitude of perspectives. This approach reflects the
idea that no single person holds all the answers to mental health wellness for students and
individuals must consult with others in order to find the best solutions. Below is a list of
student support team members and a description of their roles within the school, as well
as their potential contributions to addressing student mental health:

School Psychologists

School psychologists help facilitate students’ ability to learn and teachers’ ability to teach.
They collaborate with families, teachers, school administrators and other professionals to
help children with mental health, behavior, learning, and social needs. They work to close
achievement gaps and provide therapeutic support in order to assist with students’
mental health and social emotional development (National Association of School
Psychologists, 2019). Some other services psychologists provide are:

● Prevent issues from happening before they occur, and placing the appropriate
interventions when they do
● Conduct psychological and academic assessments and screenings
● Identify at-risk students and school vulnerabilities
● Provide mental health services, such as individual and group counseling
● Support diverse learning needs
● Implement school-wide behavioral support by working with school staff, parents
and community agencies
Retrieved from: (National Association of School Psychologists, 2019.)

School Counselors

School Counselors are a critical part of the education team. They help students in all areas
of academic achievement, career development and social-emotional development
(American School Counselor Association, 2019). Here are some ways school counselors
can help your child:

● Apply academic strategies to maximize student achievement

● Deliver in-person services such as counseling, appraisal and advisement
● Collaborate with school staff and parents to meet students’ needs
● Teach students problem solving skills so they are better prepared to face issues
 25

that arise in their adolescent years and beyond

● Use data to analyze student progress and assess counseling program in order to
ensure its effectiveness for students
● Assist families with receiving the appropriate resources they need

Retrieved from: (American School Counselor Association, 2019).

Teachers

Teachers are the “first-responders” when it comes to students’ well-being. They are
responsible for creating a healthy, safe and productive environment for students to learn.
Some ways that teachers can help student mental health are:

● Recognize warning signs for mental health disorders in students and get them the
help they need by referring them to a school counselor or school psychologist
● Reduce stigma around mental health by encouraging students to express how they
feel in healthy ways
● Ease student anxiety within the classroom
● Implement classroom behavioral interventions by setting rules and boundaries
● Reinforcing positive behaviors and focusing on students’ strengths (Zhao, 2016).
● Building positive relationships with students and serve as a role model
● Communicating with parents to stay up to date on student progress

Parents

As a parent, you want to know that your child’s mental health is a priority, both at home
and at school. Here are some things you can do to work with your child’s school to ensure
they are receiving the help they need:

● Be honest, direct and specific when talking to school staff about your child’s mental
health to make sure they are clear about what your child needs. Do not hold back
information that would prevent the school from understanding your child’s needs.
● Ask questions about what teachers and other school administrators are seeing in
your child while at school. Some children present their mental health differently
while at school than they do at home, and vice versa.
● Inquire about resources that the school offers such as individual/group counseling
or outside referrals
● Collaborate with the school to create a successful support team for your child
● Know the law; make sure your child is receiving the care they qualify for
● Educate yourself about mental health

Retrieved from: (NAMI, 2019).

 26

Legal and Ethical Issues

Parents should be aware of their own rights and their children's rights regarding
mental health in the schools. There are many laws in place in order to protect your child's
educational and civil rights. This section will inform parents of their rights and their
children's rights which include privacy, consent for services and laws in regard to mental
health.

Confidentiality

Mental health professionals, including counselors and school psychologists, must protect
any information shared by the child. Confidentiality is an agreement not to disclose any
information.

Confidentiality is based on ‘need to know’ not what school personnel want to know
(Fertman, Delgado & Tarasevich, 2014). A student is informed that everything that is
revealed within the counseling session shall remain private UNLESS

■ The student reveals that he/she is planning to hurt themselves.

■ The student reveals that he/she is being hurt by someone else.
■ The student reveals that he/she plans to hurt someone else.
(American Psychological Association, n.d.)

Although confidentiality is an obligation to students, parents’/guardians’ have legal and

inherent access to be guiding voices in their children's lives (Fertman, Delgado &
Tarasevich, 2014). It is recommended to value confidentiality among your child and the
professional for your child's best interests. This ensures that your child is able to build a
trusting relationship with their counselor and can feel confident enough to share what
they may be facing. If a counselor feels like they need to involve you, the parent, they will
do so. Educators also have a duty to warn parents when there is danger.

Family Educational Rights and Privacy Act (FERPA)

Federal law provides protections for family and students rights during any involvement
with the educational and social service systems.

● What is FERPA?
○ FERPA is a federal law that allows parents the right to have access to their
children’s education records, the right to seek to have the records amended,
and the right to have some control over the disclosure of personally
identifiable information from the education records (U.S. Department of
Education, 2018).
 27

○ Parents only have access to these records up until the child turns 18.

Protection of Pupil Rights Amendment (PPRA)

● What is PPRA?
○ Federal law requires that schools obtain written consent from parents
before sharing information regarding evaluations.

If your child has a disability, he/she is entitled to certain rights under these laws:
● Individuals with Disabilities Act (IDEA)
○ IDEA is a law that makes available a free appropriate public education to
eligible children with disabilities throughout the nation and ensures special
education and related services to those children.
○ Individualized Education Program (IEP)
■ Individualized plan that ensures a child that is identified with a
disability receives specialized instruction and related services.
● Section 504
○ Section 504 is a civil rights law that prohibits discrimination against
individuals with disabilities. Section 504 ensures that the child with a
disability has equal access to an education. The child may receive
accommodations and modifications.

(U.S. Department of Education)

 28

SCHOOL POLICY
Students spend so much time on campus; it is imperative that school personnel are
highly trained on mental illness warning signs.

School policy lays out important guidelines for educators; there are protocols to be
followed in the event of a crisis. Similarly, policies align with a school’s vision statement,
which most likely addresses supporting the whole child or developing a student’s
academic, social, and behavioral skills. Goals as such require more tier-one support in the
realm of socio-emotional health. Classroom lessons about emotion-regulation, conflict
resolution, and self-care are essential to support the whole child.

The Mental Health in the Schools (2015) Act or H.R.1211 advises schools to apply a
public health approach to mental health services, meaning try and maximize the benefit
for all. This specific Act calls for trauma-informed, age-appropriate, culturally-inclusive
mental health services. It also maintains that each school must have a partnership with a
local community agency that specializes in mental health services.

Examples of School Policy Regarding Mental Health

Policy Statement:

“At our school, we are committed to supporting the mental health and wellbeing of our
students and staff. Our culture is supportive, caring, and respectful. We encourage
students to be open and we want each student to have their voice heard. We know that
everyone experiences different life challenges, and each of us may need help to cope with
them. We understand that anyone and everyone may need additional emotional support.
At our school, positive mental health is everybody’s responsibility. We all have a role to
play.”

Policy Scope:

This policy is a guide to all staff, including teachers, and non-teaching staff. It outlines our
approach to promoting student mental health and wellbeing. It should be read and
understood alongside our other relevant school policies.

Policy Aim:

The aim of our policy is to demonstrate our commitment to the mental health of our staff
and students.

Adapted from High Speed Training (2019)

 29

MENTAL HEALTH SCREENING

What is a mental health screening?

A mental health screening is a brief process which is helpful in identifying children

and adolescents who are at risk of having disorders and are in need of mental health
services. It is a very brief process, which is in the form of survey, regarding feelings,
concerns, etc. There are universal screenings which cover all mental health as well as
individual screenings on issues such as depression, suicide,etc. The primary purpose of
screening is to identify the need and further assessment. One thing to note is that, mental
health screening instruments are never used to diagnose. They are instead used to inform
parents/caregivers of concerns which need further assessments. If a further assessment is
needed, children would receive a mental health diagnostic assessment. This is extremely
helpful for school psychologists and counselors to help those students who go
undiagnosed or without further assessment (Fertman, Delgado & Tarasevich, 2014).
Please keep in mind that the child must make the decision and agree to the screening.

You can refer to an example of a mental health screening on Appendix C.

Free and confidential screenings are also available at https://www.helpyourselfhelpothers.org

What is a mental health diagnostic assessment?

A mental health diagnostic assessment is a more extensive and comprehensive

examination of the psychosocial needs identified during the mental health screening. The
assessment is based consequences and behaviors related to life stressors in the life of the
child and families. A licensed mental health professional is required to conduct the
assessment. The purpose of this assessment is to define the child’s concerns and develop a
comprehensive treatment plan (Fertman, Delgado & Tarasevich, 2014).
 30

PROGRESS MONITORING

Student progress monitoring is a practice that helps both educators and parents
use student performance data to continually evaluate the effectiveness of their
interventions in order to make more informed decisions. (Safer & Fleischman, 2015).

Progress monitoring will occur only after a screening identifies students who
require targeted and/or intensive support, and a diagnostic assessment is used to select a
specific intervention.

•These progress monitoring plans are used to assess whether or not students are
making satisfactory steps towards their goals

•Before a student can begin progress monitoring, a baseline must be

established

•These progress monitoring measures are very similar to screening

measures, but they are analyzed much more frequently (daily, weekly, or monthly)

•If the data collected indicates that a current intervention is not helping a
student make progress towards their goal, the intervention can be changed or
adjusted
(McIntosh & Goodman, 2016).

What can progress monitoring measure?

● Student Behavior Needs
● Student Academic Needs

Example of Student Academic Progress Monitoring Graph (National Center on Response to Intervention,
2012):
 31

MTSS APPROACH

What is MTSS? Multi-Tiered Systems of Support (MTSS) is an integration of a multitude of

tiered systems into one coherent, strategically combined system meant to address
multiple domains in education (McIntosh & Goodman, 2016).

→Examples of these domains include academics, social-emotional, behavioral instruction,

and more.

Who is involved in MTSS?

● Administrative Leadership
○ Strong and engaged site leadership through intentional planning
○ Strong educator support system through professional development
● Integrated-Education Framework
○ Fully integrated organizational structure through collaboration
○ Strong and positive school culture design with compelling goals
● Family and Community Engagement
○ Trusting family partnerships by providing engaging opportunities
○ Trusting community partnerships through engagement and invitation
● Inclusive Policy Structure and Practice
○ Identifying and removing barriers for students
○ Providing district-level professional learning (SWIFT Education Center, 2016).

(Region10, 2019)
 32

MTSS and Mental Health

TIER ONE: 80% of the student population served

● Classroom Lessons:
Tier one classroom lessons are preventative in nature; they are provided for
the entire school population. Teachers are often trained in positive-psychology and
wellness promotion which can be incorporated into their classroom climate.

● Posters Around Campus:

Posters around campus may promote positive psychology, optimism, or
hope. Similarly, warning signs of mental illness may be made visible so students are
reminded to watch out for their friends.

● Schoolwide Presentations:
A school counselor, school psychologist, or other mental health professional
may come into the classroom to give a presentation about mental health warning
signs, self-care, and other useful information. An assembly, like for Red Ribbon
Week (substance abuse awareness), may be held on campus in an effort to
disseminate knowledge to the entire student body in an engaging manner.

● Mental Health Screenings

It is recommended that all students be screened for mental illness; this way,
students who are at-risk can be identified early and provided with adequate
support.

TIER TWO: 15% of the student population served

● Meet with Counselor

Generally, students who have been flagged through a screening or
recommended for services by a teacher are included in tier-two interventions, like
meeting with a counselor. Sometimes these students are at-risk and more
information is needed to serve them adequately, this would be obtained through a
one-time counseling session.

● Group-Counseling
Often, at-risk students may be asked to participate in a restorative circle or
other small group counseling session to address their concerns.

TIER THREE: 5% of the student population served

● Individual Counseling
Ongoing, one-on-one counseling sessions are offered for students with
chronic/severe mental health concerns.
 33

● Community Agency Referral

Students with severe mental illnesses may require services beyond a
school’s scope; in this case, a counselor can provide resources for the family about
where to turn for help.

MTSS Mental Health Diagram

 34

FREQUENTLY ASKED QUESTIONS:

1. How do I tell if my child is acting like a typical moody teenager or is seriously

dealing with a mental illness?

Common mental illnesses in young people, such as depression and anxiety, will be
evident by a marked change in an individual’s behaviors and moods that lasts for
longer than two weeks (APA, 2013).

2. Is mental illness hereditary?

Children of parents with mental illness are often at a greater risk for experiencing a
similar mental health problem; however, research in the genetics linked to mental
illness is not well developed and inconclusive. For example, children with
depressed parents are 2-3x more likely to develop depression than their peers, but
this statistic is highly variable, as are others (Genetics Home Reference, 2019).

3. Can a child consent to receive counseling on their own?

No, legally a child under 18 must be given parent or guardian consent to

participate in individual or group counseling (ASCA, 2016). However, a child’s
assent is usually sought by the counselor. Meaning, a counselor will explain the
purpose and procedure of their meetings, allowing the child to voice any concerns
and informally agree to participate. This fosters a mutual respect between student
and counselor.

4. Once I give consent, can I change my mind?

Yes, parents of children under the age of 18 have the right to withdraw their
consent at any time. However, it is suggested that you speak with your child about
how they feel before you make any decisions regarding their counseling (Fertman,
Delgado & Tarasevich, 2014).
 35

5. Will a student support team be able to help my child with all of their mental health
needs?

Ideally, a student support team will do their best to help your child with their
academic and social-emotional needs. However, it is in the school counselor/
psychologist’s best practice to know their limitations and refer your child to a
counselor or psychologist outside of school when the issue expands outside their
scope of training. Certain school districts will have a list of recommended mental
health providers that your child can go to if they need additional services.
Communicate with your child’s school counselor/psychologist if you or your child
feel that additional help is needed. Also, keep in mind that it would be beneficial to
allow consultation between your child’s outside mental health provider and school
counselor and/or psychologist in order for them to work together to ensure the
best treatment and interventions for your child (Fertman, Delgado & Tarasevich,
2014).

6. Are there any classes offered to learn more about mental health?

The National Alliance on Mental Illness (NAMI) offers a free 6-session program
online or in person for parents, caregivers, and any other family members that care
for youth. It is taught by other parents that have first-hand experience living with a
child with mental illness which offers an extra level of support and understanding
in coping with mental illness. You will learn more about impacts mental health
conditions have on the family, available treatment options, how to advocate for
your child’s rights at school and important ways on how to take care of yourself as
well (National Alliance on Mental Illness, 2019). Additional info can be found in
Appendix B.
 36

Mental Health Resources for Parents

In this section, we provide some general information that parents and caregivers can use to help
navigate the sometimes confusing and complex world of child mental health.

Important Phone Numbers

Seek immediate assistance Crisis Text Line

if you think your child is in danger
of harming themselves or others.
You can call a crisis line or the
National Suicide Prevention Line
at 1-800-273-TALK (8255).
Text HOME to 741741
A free 24/7 hour support with a
Crisis Counselor via text.

THRIVE 2-1-1 Orange County

Is an app which provides parents with a Dial 211 or visit www.22oc.org
resource, regarding mental health. It is a FREE, 24-hour emergency hotline
https://www.adolescenthealth.org/About- linking you to thousands of local health and
SAHM/Healthy-Student-App-Info.aspx human services resources

Resourceful Organizations

National Institute of Mental Health Mental Health Association of Orange County

NIMA’s website provides guides and brochures A social services organization, which provides
directed at parents regarding mental health. many services for residents.
http://www.nimh.nih.gov/ https://mhaoc.org/

Western Youth Services National Federation of Families for Children’s

Organization which provides mental health Mental Health
services for children, youth and families. Provides an extensive amount of resources for
www.westernyouthservices.org parent such videos, guides,tips, etc.
https://www.ffcmh.org/resources

Finding Treatment Resources

Help When You Need It SAMHSA- Substance Abuse and Mental

http://helpwhenyouneedit.org/ Health Administration
This website helps search where to Helpful website for persons searching
find local mental health services near you. treatment facilities.
https://findtreatment.samhsa.gov/
 37

MENTAL HEALTH TOOLS AND CHECKLISTS

APPENDIX A:

A Parent’s Guide to Supporting Their Child’s Mental Health

There is a lot to know and do in order to support your child’s healthy development, so
allow this checklist to serve as a guide to beginning conversations about mental health
with your child.

❏ Ask your child how they are feeling today

❏ Ask your child if they are worried about anything
❏ Discuss the importance of sleep and good nutrition for health
❏ Understand cultural factors that can influence your child’s mental health
❏ Familiarize yourself with your own family’s history of mental health/illness
❏ Remain vigilant for warning signs seen in your child or their friends
❏ Discuss possible warning signs with your child so they are better prepared to
identify mental health issues
❏ Talk to other parents in your area about the importance of mental health
❏ Let your child know you are there for them frequently and available to talk
❏ Encourage your child to seek help from school personnel when needed
❏ Communicate with your child’s school if you feel like your child needs mental
health support
❏ Get to know the members of the school staff that may help support your child’s
mental health while they are at school, such as the school counselor, psychologist,
teacher, etc.
 38

Appendix B

Here are some resources and programs you can use to advocate for better mental health
care at your student’s school:

National Alliance On Mental Health (NAMI) Ending the Silence for Students is a 50-
minute presentation designed for middle and high school students that informs students
of warning-signs of mental health issues and what steps they can take to seek help for
themselves for their friend.

NAMI Ending the Silence for Staff is a 1-hour presentation that teaches staff facts on
student mental health, how to identify signs of mental health issues in students, and how
to approach students and families to discuss mental health concerns.

NAMI Ending the Silence for Families is a 1-hour presentation for adults with children.
The presentation informs individuals on how to discuss mental health with their child, the
statistics regarding mental health in youth, and how to work collaboratively with schools
to better their child’s overall mental wellness.

For each of the NAMI presentations, the organization will come to your school free of
charge. To host a presentation in your community, contact your local NAMI affiliate
through the organization’s website: nami.org. Studies show that these presentations have
improved overall mental health awareness for middle and high school students.

Families with children who are experiencing symptoms of mental health conditions can
also find support through NAMI Family Support Group. For more information and to find a
support group near you, visit: Find Support
 39

Appendix C

Here is an example of a mental health screening form:

 40

(Source: http://www.bhevolution.org/public/screening_tools.page)
 41

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