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- Encourage schools to screen all students for mental health issues including trauma, depression, anxiety, and other disorders as appropriate.
- Consider also screening for families, with attention to relevant privacy considerations, who have experienced COVID-19 during the pandemic, as it may contribute to traumatic responses.
- Review state and county-level data to better understand the mental health issues that are most common locally.
- Determine which students and families have experienced increased distress during the pandemic via screens. For example, vulnerable populations may include: students or families who had COVID-19, LGBTQ students, or students that are housing insecure. Note: it may be worth incorporating a trauma screen specifically for these populations, and others.
- Address social and racial injustices that occurred during the pandemic (consider the guidelines from the American Academy of Pediatrics Suggestions on Addressing Structural Racism) and screen students who may have been impacted.
- Ensure screeners are developmentally, culturally, and racially appropriate.
- Where appropriate, use screeners to understand social determinants of health; home is not always the safest place for children and youth and understanding housing, food insecurity, and exposure to issues including domestic violence is important in understanding students’ recovery needs.
- Consider also understanding students’ protective factors.
- Communicate with families and guardians which screeners will be used, the rationale behind each screener, and if significant, feedback about their child’s screening results.
- Screeners should not be used for diagnostic purposes, rather to understand which students may need more support. Examples of Screeners include:
- PHQ9- depressive symptoms for teens.
- Universal screeners.
- Guidance for Trauma Screening in Schools.
- Utilize applications that allow students, particularly middle and high school age, to report concerns about mental health issues and suicidality related to other students anonymously. Research supports these applications as interventive for suicidality and other mental health issues. Example: Sandy Hook Say Something.
- Plan for distress around the return to in-person instruction. Organize conversations focused on returning to the classroom and adjustment to in-person learning which can be woven into school-level academic plans.
- Encourage mental health staff to participate in returning to school meetings to help process issues as they arise.
- Provide families with an outline and understanding of the resources and services available.
Prevention and Intervention
- Ensure there are appropriate ratios of counselors, school psychologists, etc.
- At minimum, ensure ratios established pre-pandemic. Lower ratios may be needed based on screening outcomes.
- 250:1 school counselors to students.
- 500:1 school psychologists per student.
- 750:1 school nurses per student.
- Increase intervention resources, especially in the first six months of return to in-person instruction and in school year 2021-2022.
- When students are referred via screening, implement a strategy for mental health professionals to further assess and identify which services are appropriate.
- Encourage continued use of guidance counselors and school psychologists for individual counseling as appropriate.
- Create and implement evidence-based interventions such as CBITS (Cognitive Based Intervention for Trauma in Schools) and/or Bounce Back into intervention repertoire. Also consider Coping Cat for non-traumatic anxiety. Other interventions should have a strong evidence base in pediatric mental health.
- Train counselors, school psychologists, and other staff who have not previously trained in CBITs.
- Consult local licensed psychologists and child psychologists to assist with training and collaborative consultation as needed.
- Implement a plan for office hours/check in hours for families who have students involved in intervention services at the treatment level.
- If not already in place, implement a crisis intervention team. This may be further established at the school level. Crisis teams should be able to evaluate and activate in case of major concerns such as suicidality.
- Consider district’s ability to fund and carry out parental training in mental health, such as Youth-Mental Health First Aid or Psychological First Aid
- Consider optional screening for teachers upon return to understand need and promote mental health services.
- Update or create employee assistance programs intended to help school staff deal with personal problems that might adversely impact their work performance, health, and well-being, where possible.
- Offer support groups as teachers return and adjust to in-person instruction and kick-off 2021-2022 school year, understanding that educators may also have experienced trauma, grief, and mental health difficulties during the pandemic.
- To the extent possible, provide teacher training in mental health, such as Youth-Mental Health First Aid or Psychological First Aid.
Trauma-Informed Disciplinary Practices
- Ensure discipline practices are trauma informed and consistent across schools.
- Focus should be on a positive, reward-based system with the avoidance of expulsion and suspension that forces to digress from in-person instruction unless entirely unavoidable.
- Teachers and mental health professionals should expect that some amount of difficult behavior and adjustment back to in-person instruction will occur. Protocols should be in place to address this in a tiered discipline manner.
- Refer to the National Association of School Psychologists resources for appropriate discipline.