Have you ever felt like a fish out of water? As educators and doctoral students, we found this expression to be true when we were attending the annual Neuroscience Research Symposium held on our university's medical campus. We were invited to attend a luncheon with the guest speaker, a leader in psychiatric research and depression, which was followed by a group discussion. We were the only educators present, and everyone else were medical students who were specializing in an area of neurobiology. When it was our turn to share our research, we discussed our desire to help fellow educators reach out to students that suffer from mental health conditions.
We may have felt awkward initially, but by stepping out of our educator comfort zone, we were able to begin partnering with medical professionals to educate teachers, administrators, and families on ways to support students with mental health concerns. Our team collaborated with an area high school whose administrator was also interested in supporting and strengthening her faculty's knowledge of their students' mental health challenges. We set up five workshops—two during the fall semester and three during the spring semester—and provided an information table during a parent-teacher event. Outlined below are the steps we followed in building our partnership, along with some of the barriers and insights that emerged.
Step One: Understand Your School's Policies and Procedures
Our first workshop revealed that many of the teachers were unaware of the district's policies and the building protocols for responding to student behavior that seems related to anxiety or another mental health concern. Teachers did not understand their role or responsibilities in this process. Inviting educators, administrators, and medical professionals to an open forum for discussion allows them to address issues and implement changes along with providing teachers with support and clear guidelines. Educators are not physicians and cannot make a diagnosis, but teachers must value their observations. Armed with tools to effectively document changes in behaviors, they become empowered to better collaborate with other school faculty and to communicate their concerns with students and their parents.
Step Two: Understand Signs and Symptoms
In our initial session with teachers, we utilized a poster activity, consisting of five questions that focused on identifying some of their current strategies and challenges when supporting students with mental health concerns (Figure 1). This activity generated our baseline for our future workshops.
Figure 1: Poster Activity Questions
What would you like to gain from PD activities on child/adolescent mental health?
What are some of the challenges you face in supporting your students' mental health?
What are the most common mental health and behavioral challenges you face in the classroom?
What are some effective strategies you have employed in the past?
What are some of the biggest challenges in working with the parents of your students?
Students who experience anxiety and depression may have academic challenges and can easily fall through the system. Anxiety disorders alone affect approximately 8 percent of children and teenagers, and the disorders affect their lives at both home and school (NAMI, 2015). The ability to identify the antecedents of a student's behavior and assist in discerning whether the behavior stems from a mental health issue is extremely important. Causes for the same behavior can vary widely among children (Dikel, 2014). By providing teachers and parents with training in recognizing potential signs and symptoms of mental health problems while also providing accurate and efficient documentation, educators are better able to create proactive strategies to support those students, and parents have data to assist healthcare providers in making an accurate diagnosis.
Figure 2: Clinical Features of Anxiety
Avoidance—reluctance to attend school, parties, camp, sleepovers; hesitancy in talking to new people
Somatic symptoms—headaches, stomach aches, pain out of proportion to physical findings
Insomnia—difficulty falling asleep or regularly waking in middle of the night
Excessive need for reassurance—frequent and extensive reassurance needed for multiple fears
Poor school performance—inattention, difficulty completing tasks in a timely manner
Explosive/oppositional behavior—triggered by specific anxiety stimulus
Eating problems—eating too little or too much to cope with anxiety
Step Three: Provide Protocols for Observation and Documentation
Our team then provided the teachers with document logs that listed behaviors consistent with how anxiety and depression often present at school along with space to record time of day, frequency, duration, and location of those behaviors. We also discussed the importance of collaboration among all school staff that might interact with the student. We asked them to compare their documentation of the behavior along with any known changes in the child's personal circumstances or relationships.
Figure 3: Excerpt from Anxiety Documentation Log
Observe & Support: Proactive Tools for Mental Health in Schools-table1
Observed Behavior | Frequency | Duration | Location | Time of Day |
|---|
| Displays argumentative, defiant, negative or disruptive conduct; or picks fights more than usual | | | | |
| Complains of headaches, stomach aches, or pain disproportional to physical condition | | | | |
| Avoids participation, /talking or socializing with others, presenting in class, or making friends | | | | |
| Feels pressured to be perfect, worries about succeeding in school, or needs frequent reassurance | | | | |
| Feels anxious, worried, fearful, irritable or fidgety; can't sit still | | | | |
Once school staff has shared their observations and concerns, establish a primary contact person to follow up with the parents or guardian. (This primary contact is often the person conducting the initial conversation.) By using documentation logs and guidelines for communication (Figure 4) the educators can begin conversations with families that discuss specific examples of behaviors and possible triggers, and then connect them to mental health resources in the community.
Figure 4: Guidelines for Communicating with Students and Their Families
Review the documentation logs and information collected
Make a plan for key topics you wish to discuss, questions you have, and goals for the conversation
Request meeting with parents in person if possible
Broach the subject with sensitivity (For example, "I've noticed some patterns / changes in John's behavior and I wanted to reach out to see how we can better support him at school."
Prepare the discussion environment– Ensure privacy– Minimize distractions and interruptions– Allocate ample time
Use open-ended questions to guide the conversation
Provide parents with copies of your documents for them to take to the counselor, therapist, or doctor
Provide parents with a primary contact person at the school for follow-up
Be Proactive and Supportive
Meeting the needs of students with mental health challenges is an ongoing process for educators. Our collaborating school administrator reported that, because of our partnership, teachers and staff now have the tools to intervene in a timely manner with students who exhibit signs of anxiety and stress. In addition, the school team is better able to communicate concerns with families and connect them to outside support agencies. As our pilot school continues to increase its awareness of mental health, our team will begin this collaborative process with two new schools in the St. Louis area during 2018.
The largest contribution that educators and parents can make to a child's mental health is their ability to observe, document, and provide support. With limited face time with a child to evaluate and screen for mental health problems, a health care provider often relies on reports by the parents, teachers, and child to accurately diagnose and treat the conditions. By understanding how mental health disorders present in children along with how to document behavior patterns, educators can deploy proactive strategies that may help to prevent a crisis and better support families when they make the decision to seek healthcare for their child.
