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UCLA School Mental Health Project
Center for Mental Health in Schools
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Continuing Education: Unit II
|Objectives for Section A|
|A Few Focusing Questions|
|Initial Problem Identification|
|Connecting a Student with the Right Help (4 parts)|
|Screening to Clarify Need|
|Screening: A Note of Caution|
|A Few Comments on Screening/Assessment & Diagnosis|
|Client Consultation and Referral|
|A Few Comments on Client Consultation & Referral||Triage|
|Initial Case Monitoring|
|About the DSM|
|Test Questions, Unit II: Section A|
Move on to:
Unit II Section B
After completing this section of Unit II, you should be able to:
explain what is involved in the process of identifying and processing students in need of assistance for mental health and psychosocial problems and identify five specific facets of the process
know of and be able to use at least two instruments for screening psychosocial and mental health problems
What is the school's role in the initial identification of students who may have psychosocial and mental health problems?
Once a student is identified as having problems, what screening activity can a school do to help clarify the nature and severity of the problems?
What are the purposes and processes of client consultation, referral, triage, and initial case monitoring?
Initial Problem Identification
Support staff identify many mental health problems when students come to their attention during attendance and dicipline rviews, assessments for special education placement, and related to crisis interventions, or as a result of others (staff, parents, students) raising concerns about a given youngster.
In this last respect, part of their job may be to educate teachers, peers, parents, and others about appropriately identifying and referring students.
And, of course, some students come seeking help for themselves.
How should you handle all this?
If there are accessible referral resources at the school (e.g., a school psychologist, a counselor, a social worker, a school-based health center with a mental health professional) or in the community, the answer may be to help a student connect with such an individual -- assuming it is not something you can handle without making a referral.
Of course, when other professionals are not available or when a student will not follow-through, your only choice is to decide whether to do something more yourself.
If you decide to proceed, you will want to assess the problem for purposes of triage and consulting with the student and concerned others.
What's a parent to do?
Joan, the nurse for Cates Elementary School, first encountered Matt Johnson when he was sent to her by his teacher because he said his stomach was upset. As best Joan could tell, there was no reason to think the problem was serious. She let the boy rest a while and then sent him back to class. Over the next two weeks, he was sent to her three more times with varying minor somatic complaints. At this point, she decided to call Matt's home.
Matt's mother was not surprised to hear from the school. Mrs. Johnson had been to school for several teacher conferences during the month because of her son's poor classroom functioning and behavior. She told Joan she thought Matt's trips to the nurse's office probably were a way of getting out of class. It was a pattern the mother had seen before, both with Matt and her other child. Mrs. Johnson stressed that a recent doctor's exam had not turned up any physical problems. She also noted that Matt's teacher had told her to monitor his homework more closely and discipline him more consistently for misbehavior. But when she had tried to do so, Matt's rebellious behavior increased. She wasn't sure what to do. In a voice that was partially a plea and very much a challenge, she asked Joan: Do you have any suggestions?
What has been your experience with situations of this type?
Contents of Section A
Connecting a Student with the Right Help
The process of connecting the student with appropriate help can be viewed as encompassing four facets:
|TEACHER: Yes, Chris, what is it?
CHRIS: I don't want to scare you, but my
Dad says if I don't get better grades
someone is due for a spanking.
This, then, becomes the focus of initial assessment -- which essentially is a screening process. Such screening can be used to clarify and validate the nature, extent, and severity of a problem. It also can determine the student's motivation for working on the problem. If the problem involves significant others, such as family members, this also can be explored to determine the need for and feasibility of parental and family counseling.
Contents of Section A
Screening: A Note of CautionFormal screening to identify students who have problems or who are "at risk" is accomplished through individual or group procedures. Most such procedures are first-level screens and are expected to over identify problems. That is, they identify many students who do not really have significant problems (false positive errors). This certainly is the case for screens used with infants and primary grade children, but false positives are not uncommon when adolescents are screened. Errors are supposed to be detected by follow-up assessments.
Because of the frequency of false positive errors, serious concerns arise when screening data are used to diagnose students and prescribe remediation and special treatment. Screening data primarily are meant to sensitize responsible professionals. No one wants to ignore indicators of significant problems. At the same time, there is a need to guard against tendencies to see normal variations in student's development and behavior as problems.
Screens do not allow for definitive statements about a student's problems and need. At best, most screening procedures provide a preliminary indication that something may be wrong. In considering formal diagnosis and prescriptions for how to correct the problem, one needs data from assessment procedures that have greater validity.
It is essential to remember that many factors that are symptoms of problems also are common characteristics of young people, especially in adolescence. Cultural differences also can be misinterpreted as symptoms. To avoid misidentification that can inappropriately stigmatize a youngster, all screeners must take care not to overestimate the significance of a few indicators and must be sensitive to developmental, cultural, and other common individual differences.
A Few Comments on Screening/Assessment and Diagnosis
When someone raises concerns about a student with you, one of the best tools you can have is a structured referral form for them to fill out. This encourages the referrer to provide you with some detailed information about the nature and scope of the problem. An example of such a form is provided at the end of this section.
To expand your analysis of the problem, you will want to gather other available information. It is good practice to gather information from several sources -- including the student. Useful sources are teachers, administrators, parents, sometimes peers, etc. If feasible and appropriate, a classroom observation and a home visit also may be of use. You will find some helpful tools in the accompanying materials.
And you can do a screening interview. The nature of this interview will vary depending on the age of the student and whether concerns raised are general ones about misbehavior and poor school performance or specific concerns about lack of attention, overactivity, major learning problems, significant emotional problems such as appearing depressed and possibly suicidal, or about physical, sexual, or substance abuse. To balance the picture, it is important to look for assets as well as weaknesses. (In this regard, because some students are reluctant to talk about their problems, it is useful to think about the matter of talking with and listening to students -- more on this in Section II-B.)
In doing all this, you will want to try to clarify the role of environmental factors in contributing to the student's problems.
Students often somaticize stress; and, of course, some behavioral and emotional symptoms stem from physical problems.
Just because the student is having problems doesn't mean that the student has a pathological disorder.
The student may just be a bit immature or exhibiting behavior that is fairly common at a particular development stage. Moreover, age, severity, pervasiveness, and chronicity are important considerations in diagnosis of mental health and psychosocial problems. The following are a few examples to underscore these points.
|Age||Common Transient Problem||Low Frequency Serious Disorder|
|0 - 3||Concern about monsters under the bed||Sleep Behavior Disorder|
|3 - 5||Anxious about separating from parent||Separation Anxiety Disorder (crying & clinging)|
|5 - 8||Shy and anxious with peers
(sometimes with somatic complaints)
|Reactive Attachment Disorder|
|5 - 8||Disobedient, temper outbursts||Conduct Disorder
Oppositional Defiant Disorder
|5 - 8||Very active and doesn't follow directions||Attention Deficit Hyperactivity Disorder|
|5 - 8||Has trouble learning at school||Learning Disabilities|
|8 - 12||Low self-esteem||Depression|
|12 - 15||Defiant/reactive||Oppositional Defiant Disorder|
|12 - 15||Worries a lot||Depression|
|15 - 18||Expreimental substance abuse||Substance Abuse|
Contents of Section A