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.
Note: As a follow-up aids for you and your school, included in the accompanying
materials are two resource packets prepared by the Center for Mental Health in Schools at
UCLA. One is entitled Screening/Assessing Students: Indicators and Tools and the
other focuses on Substance Abuse. Both include instruments you can use and provide
further discussion of what to look for in screening. Examples of some tools from these
packets are included at the end of this section.
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Screening to Clarify Need
Most of the time it will not be immediately evident what the source of a
student's problems are or how severe or pervasive they are. As you know, the causes of
behavior, learning, and emotional problems are hard to analyze. What looks like a learning
disability or an attentional problem may be emotionally-based; behavior problems and
hyperactivity often arise in reaction to learning difficulties; problems with schooling
may be due to problems at home, reactions to traumatic events, substance abuse, and so
forth. It is especially hard to know the underlying cause of a problem at school when a
student is unmotivated to learn and perform.
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.
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Contents of Section A
Screening: A Note of Caution
Formal 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.
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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.
Remember:
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 |
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
