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UCLA School Mental Health Project
Center for Mental Health in Schools
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Continuing Education: Unit II

Addressing Barriers to Learning
New Directions for Mental Health in Schools

Section B Continued

Primary Prevention and Treatment

As already noted, many school nurses can and want to be more involved in programs to prevent and correct mental health and psychosocial problems. Among the functions some already are carrying out are

mental health education
2. psychosocial guidance and support
3. psychosocial counseling

Mental Health Education
Educative functions range from disseminating mental health information to actual course instruction related to positive social and emotional development and wellness.

Every school needs to disseminate information that helps protect, promote, and maintain the well-being of students with respect to both physical but mental health. School nurses already play a major role in disseminating health related information. It does not take much imagination to see how important it is that such activity encompass mental health. This includes providing highly visible information related to prevention and correction:

During the instructional day, the curricula in many classes touches upon matters related to positive social and emotional development and wellness. In addition, some schools actually have incorporated mental health as a major facet of health education. And school staff are involved each day in dealing with matters related to mental health and psychosocial concerns.

Related to these matters, efforts should be made to capitalize on the school nurse's strengths by facilitating ways for her or him to play a direct role with students as part of a school's efforts to provide comprehensive health education and an indirect role by participating in developing the capacity of other staff to address these matters.

In addition, nurses can play a role in a variety of open-enrollment programs designed to foster positive mental health and socio-emotional functioning. They can also help establish strategies to change the school environment in ways that make it more inviting and accommodating to students. This involves participation in staff development, but even more, it requires working with school staff to restructure the school so that it effectively promotes a sense of community. Examples include establishing welcoming programs for new students and families and strategies to support other transitions, developing families of students and teachers to create schools within schools, and teaching peers and volunteer adults to provide support and mentoring. Intervening at this environmental level also encompasses working with community agencies and businesses to enhance the range of opportunities students have with respect to recreation, work, and community service.

Effective open-enrollment and prereferral intervention programs and environment change strategies can minimize the number of mild to moderate problems that develop into severe ones. This reduces the number in need of specialized interventions and helps reserve such help for those who inevitably require them.

Note: As a follow-up aid for you and your school, included in the accompanying materials is a resource packet entitled Where to Get Resource Materials -- prepared by the Center for Mental health in Schools at UCLA. This packet provides references to sources for materials, curricula, fact sheets (see example at end of this section), and various other forms of assistance for mental health education.

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Contents of Section B

Psychosocial Guidance and Support
Each day many students require a small dose of personalized guidance and support to enhance their motivation and capability for coping with stressors. Others who are involved in therapeutic treatment (e.g., personal counseling, psychotherapy, psychotropic medication) need someone who understands the treatment and can deal with related concerns that arise at school.

Personalized guidance and support is best provided on a regular basis in the classroom and at home. There are great benefits to be gained from any role the nurse may play in helping teachers function in ways where they directly provide such support or do so through use of various activities and peer support strategies. Nurses also can play a role in mobilizing and enhancing support from those in the home.

Specialist staff also is a logical person for a student to contact if something is amiss between what is happening at school and the student's therapeutic regimen. And s/he is a good person to interface with a student's personal counselor or therapist and to act as a school-site case manager so that there is coordination between the school's efforts to teach and treatment practices.

Guidance and support involves a range of potential activity:

Note: Special considerations and concerns arise related to students taking psychotropic medications. As a follow-up aid for you and your school, included in the accompanying materials is a resource packet on this topic entitled Students and Psychotropic Medication: The School's Role -- prepared by the Center for Mental health in Schools at UCLA.

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Psychosocial Counseling
Some student's problems will be more than you should try to handle and you will make the best effort you can to connect them with the right help.

There are many, however, who could benefit from your counseling -- once you have equipped yourself for the task and if you can create the time.

Good counseling builds on the type of caring which is fundamental to all helping relationships. It also encompasses the basics of any good working relationship -- and a bit more. Some basics are highlighted here. You will want to learn more and a good next step is to read some of the works referenced at the end of this unit.

In general, counseling requires the ability to carry on a productive dialogue, that is, to talk with, not at, others. This begins with the ability to be an active (good) listener and to avoid prying and being judgmental. It also involves knowing when to share information and relate one's own experiences as appropriate and needed. Some thoughts about engaging students in a productive dialogue are outlined on the following pages.

Counseling also requires the ability to create a working relationship that quickly conveys to the student

All this enables the counselor to elicit a student's concerns.

Then, the process requires the ability to respond with

Think about the students you have found it easy to talk with.
What made the dialogue go so well?

Think about those students you found it difficult to engage in a dialogue.
What are some ideas that might help next time
you encounter such a student?

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A Few Thoughts About Engaging Students in a Productive Dialogue

A few are so nonverbal that referral probably is indicated. Many, however, are just reluctant to talk.

How to Facilitate "Talk"

Quite often, one has to start building a relationship around relatively nonverbal activities, such as responding to a structured set of interview questions dealing with common concerns. In some cases, having students draw themselves or significant others and telling a story about the picture can break the ice and provide some leads.

In general, the focus is on enhancing motivational readiness to dialogue by creating a sense of positive value and expectation for counseling, personal credibility for the counselor, and permission and protection for engaging in exploration for change.

Some specific things to do are

In addition, for groups

How to Keep Talk Going
In general, the focus is on maintaining motivation.

Some specific things to do are

In addition, for groups


A group of adolescents agreed to advise
school and community professionals
on what they and peers needed
in order to feel helped.
The most basic thing they stressed was:
"Let us talk about the things
that are really happening
in our lives -- friends, sex, drugs."
"We need people in schools
who care and will listen."

Some Points About Counseling and Student Motivation

Most counseling at a school site is short-term. Some will be informal -- brief encounters with students who drop-in or are encountered somewhere on campus. All encounters have the potential to be productive as long as one attends to student motivation as key antecedent and process conditions and as an important outcome concern.

(1) Motivation is a key antecedent condition. That is, it is a prerequisite to functioning. Poor motivational readiness may be (a) a cause of inadequate and problem functioning, (b) a factor maintaining such problems, or (c) both. Thus, strategies are called for that can result in enhanced motivational readiness (including reduction of avoidance motivation) -- so that the student we are trying to help is mobilized to participate.

(2) Motivation is a key ongoing process concern. Processes must elicit, enhance, and maintain motivation -- so that the student we are trying to help stays mobilized. For instance, a student may value a hoped for outcome but may get bored with the processes we tend to use.

With respect to both readiness and ongoing motivation, conditions likely to lead to negative motivation and avoidance reactions must be avoided or at least minimized. Of particular concern are activities students perceives as unchallenging/ uninteresting, overdemanding, or overwhelming and a structure that seriously limits their range of options or that is overcontrolling and coercive. Examples of conditions that can have a negative impact on a student's motivation are excessive rules, criticism, and confrontation.

(3) Enhancing intrinsic motivation is a basic outcome concern. A student may be motivated to work on a problem during counseling but not elsewhere. Responding to this concern requires strategies to enhance stable, positive attitudes that mobilize the student to act outside the intervention context and after the intervention is terminated.

Essentially, good counseling reflects the old maxim of "starting where the student is." But more is involved than matching the student's current capabilities. As suggested, attending to a student's motivational levels is also critical. Thus, it is the counselor's responsibility to create a process that will be a good fit with the student's capabilities and motivation.

The less one understands the background and experiences that have shaped a student, the harder it may be to create a good fit. This problem is at the root of concerns about working with students who come from different cultures. It is, of course, a concern that arises around a host of individual differences.

As discussed in the unit on working with others, efforts to create effective working relationships require a breadth and depth of knowledge, skills, and positive attitudes. Counseling aims at enabling students to increase their sense of competence, personal control, and self-direction -- all with a view to enhancing ability to relate better to others and perform better at school. When a counseling relationship is established with a student, care must be taken not to undermine these aims by allowing the student to become dependent and overrely on you. Ways to minimize such dependency include

And be sure to avoid " The Rescue Trap."

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