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Resources for Clinicians

Last updated August 2020

Frequently Asked Questions
Do I have to get parental/guardian consent to consult to a school about a child?

Engaging with parent(s)/guardian(s) before any consultation is always preferable, but when impossible (i.e., lack of response from parents, etc.), a child and adolescent psychiatrist can observe a child in a classroom and then consult to the teacher or school staff. Although the child and adolescent psychiatrist cannot interview or evaluate the child, or write a report indicating that a child “appears” to have any diagnosis, the child and adolescent psychiatrist may provide recommendations to the teacher, school counselor, administrators and/or other school staff (i.e., speech therapist, occupational therapist, etc.) about preferred strategies for working with the student’s behaviors or symptoms observed in that classroom.

What do schools usually seek in a consultation by a child and adolescent psychiatrist?

The child and adolescent psychiatrist must always clarify what a school requires when it requests a consultation. Schools seek either (a) an individual evaluation for a student about a potential education disability and appropriate interventions, or (b) consultation on a wider school system need (e.g., managing bullying, responding to school threats, etc.).

(a) Individual evaluations: After parental/guardian consent is obtained, schools usually want the child and adolescent psychiatrist to:

  • Review records;
  • Interview staff, the student and parent/caregiver;
  • Write a report summarizing observations and recommendations; and
  • Possibly participate, in person or by phone, in a meeting with a child’s education team.

The child and adolescent psychiatrist can help by clarifying:

  • Whether the student has a diagnosis (rule-out diagnoses are not helpful);
  • Whether that diagnosis/condition interferes with academic or social-emotional education progress; and
  • If the student would benefit from specialized instruction beyond counselling.

Families must understand that the student’s education team will make decisions about the student’s educational disability (e.g., social-emotional disability due to depression or anxiety), interventions and the appropriate school setting or placement. The child and adolescent psychiatrist can make recommendations, but the educational team will make ultimate decisions about the student’s needs, appropriate interventions, and educational setting.

(b) System consultations: The child and adolescent psychiatrist may often provide:

  • Recommendations for resources such as school-wide programs, books/websites, etc., on relevant topics such as social/emotional learning, or creating a positive school environment; or
  • Information at parent-teacher organization meetings or for professional development of school staff on issues such as identifying mental health concerns, barriers to early identification and treatment of mental health issues, or the mental health treatment referral process.
What do schools most value in reports from a child and adolescent psychiatrist about a student?

Schools want to better understand why a child has difficulty functioning in the classroom so reports should address the following:

  • First: A diagnosis helps the school identify if a child has an educational disability. The inclusion of the specific symptoms impairing a child helps clarify targets for intervention.
  • Second: Describing interventions for those specific symptoms can support teaching and learning. For example, the ADHD student who gets distracted quickly and loses items would benefit from sitting closer to staff or having staff check in to review information/directions, such as simply having pencils/paper available at school. Any intervention recommended should be both feasible in that student’s educational setting and benefit the other students in the classroom. For example, having a one-minute timer ring so that the teacher can reinforce a student is not feasible in most classroom settings. Moving a distracted child may benefit other students by reducing distractions. Having materials available may increase instructional time for all students by preventing time spent looking for pencil/paper.
  • Third: Public schools are required by law to generally provide education in the least restrictive environment (LTE).  Providing schools with recommendations of appropriate interventions for a student alongside nondisabled students helps ensure schools comply with LTE requirements and may be more appropriate than recommending a child attend a specific alternative program or school.
What is the difference between the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA)?

FERPA

  • At the federal level, FERPA and its implementing regulations protect most “education records” by classifying them as “confidential” and limiting their disclosure.1
  • FERPA applies to all educational agencies and institutions that receive funds under any program administered by the U.S. Department of Education. 
  • An educational agency or institution that is subject to FERPA may not have a policy or practice of disclosing the education records of students, or personally identifying information derived from such records, without the written consent of a parent or eligible student, meaning a student who is eighteen years of age or older. 
  • FERPA broadly defines the term “education records” to mean all records that are directly related to a student and are maintained by an educational agency or institution or by a party acting for an educational agency or institution.  Applying this definition, all mental health data that a public school district maintains on a special education student, including records of any mental health services provided under an individual education plan are “education records” for purposes of FERPA. 
  • Similarly, all mental health data that a school nurse receives or maintains on a public elementary or secondary school student fall within the definition of “education records.”  This is true regardless of whether the school district employs the school nurse or contracts with an agency that provides nursing services to students, and regardless of whether the services occur on or off school property. 
  • When contracting with a nursing agency, however, school districts would be well advised to include a provision in the contract confirming that the agency and its employees are required to comply with FERPA and any applicable provisions of state law.  The contract should also contain a provision confirming that no physician-patient or similar privilege will arise out of the nurse’s work with any student. 

HIPAA
           

  • HIPAA is a federal law that was designed to protect the privacy and security of individually identifiable health information that is maintained by a “covered entity.” 
  • This regulation requires “covered entities” to safeguard the privacy of health records and to limit the disclosure of such information without patient consent.  The law defines a “covered entity” to mean a health plan, a health care clearinghouse, and a “health care provider” that transmits health information in electronic form in connection with a covered transaction.2
  • A “health care provider” is any person or organization that furnishes, bills, or is paid for health care in the normal course of business.2
  • Many physicians do not seem to recognize that the HIPAA Privacy Rule permits covered health care providers to disclose private health information about a student to a school nurse for treatment purposes without parental consent.3
  • For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who administers medication to the student or provides other care to the student at school.  Physicians who are aware of this rule may still construe the physician-patient privilege to preclude them from disclosing private health information about a student to a school nurse without parental consent. 

References:

  1. http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5&node=34:1.1.1.1.33
  2. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
  3. U.S. Dept. of Health Hum. Services and U.S. Dept. of Ed., Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to Student Health Records, at 4 (Nov. 2008). 
What is the difference between and Individual Education Plan (IEP) and a 504 plan?

Download this table (PDF)

School Service Plans for Students with Psychiatric Disorders

School Service Plans for Students with Psychiatric Disorders

504 Plan

Individualized Educational Program (IEP)

Purpose

To ensure that all students have equal opportunity to learn, even if they have a disability; focus is student’s opportunities as compared to other students in that school

To remediate symptoms of a student’s disability; student’s unique needs are the focus

Criteria to receive this plan

Student has an impairment that limits a major life activity, but may not require specialized instruction

Student has a disability which interferes with educational progress, and which requires specialized instruction

Who develops this plan

Teacher, administrator (often the school’s designated “504 coordinator,” school counselor and usually parent, student) (if appropriate)

Educational team, including staff certified in special education; may include evaluations by school psychologist, social worker; parent may bring friends, advocates, own evaluators to be part of team

What is usually provided

Changes within classroom or school building to enable student to
complete curriculum expectations

Changes within classroom setting(s) to provide student different instruction, and may substantially alter what is required of student

Example of what is provided

Student is allowed more time to complete tests; Student may be provided device to hear better

Student may leave regular language arts class and receive specialized reading program; student may be exempted from course requirements

Which staff deliver services

Usually regular education staff

Staff with specialized training (special education teachers, speech therapists, occupational therapists, etc.)

Where the student receives
services

Regular classroom with regular peers “to the maximum extent appropriate”

Wide ranging, from regular education classrooms (inclusion) to pullout for special education classrooms, to offsite day school programs, to 24 hr/day residential schools

Review of the plan

Plan reviewed at least every year

At least every year plan is reviewed, and every 3 yrs the student is retested to see if still qualifies

Disciplinary actions

If “manifestation hearing” indicates student’s impairment or disability caused misbehavior, then student cannot be suspended/expelled; school is not required to provide free, appropriate education for suspended or expelled students

If “manifestation hearing” indicates
student’s disability caused misbehavior, then student cannot be suspended/expelled; if student is suspended or expelled, school must still provide free, appropriate education

Appeal resourses

School may alter 504 Plan immediately should circumstances indicate need; “notice” may be provided verbally; family may appeal to the Office for Civil Rights if perceive school is discriminating against child because of a disability

School must provide “prior written notice” before changes in educational plan or placement are made; family may appeal decisions or plan to local then State departments of education


Clinical Research

Overview of Services

  • Green JG, et al. 2013. School mental health resources and adolescent mental health service use. J Am Acad Child Adolesc Psychiatry, 52(5):501–510 .
  • Sanchez AL, et al. 2018. The effectiveness of school-based mental health services for elementary-aged children: A meta-analysis. J Am Acad Child Adolesc Psychiatry, 57(3):153–165.
  • Dray J, et al. 2017. Systematic review of universal resilience-focused interventions targeting child and adolescent mental health in the school setting. J Am Acad Child Adolesc Psychiatry, 56(10):813–824.
  • Hoover Stephen S, Sugai G, Lever N, and Conners E. Strategies for integrating mental health into schools via a multilayered system of support. Child Adolesc Psychiatric Clin N Am, 24:211-231.

Suicide Prevention

  • Paschall MJ and Bersamin M.  2018. School-based health centers, depression, and suicide risk among adolescents. Am J Prev Med, 54(1):44–50.
  • Joshi SV, Hartley SN, Kessler M, and Barstead M. 2015. School-based suicide prevention: Content, process, and the role of trusted adults and peers. Child Adolesc Psychiatric Clin N Am, 24:353-370.
  • Katz C, et al. 2013. A systematic review of school-based suicide prevention programs. Depression and Anxiety, 30:1030-1045.

Bullying/Climate

  • Gase LN, et al. 2017. Relationships between student, staff, and administrative measures of school climate and student health and academic outcomes. J Sch Health, 87(5):319-328.

Disaster/Threat Assessment

  • Cornell D, et al. 2018. Student threat assessment as a standard school safety practice: Results from a statewide implementation study. School Psychology Quarterly, 33(2):213-222.

Substance Use

  • Beningfield MM, Riggs P, and Hoover S. 2015. The role of schools in substance use prevention and intervention. Child Adolesc Psychiatric Clin N Am, 24:291-303.
  • Hennessy EA and Tanner-Smith EE. 2015. Effectiveness of brief school-based interventions for adolescents: A meta-analysis of alcohol use prevention programs. Prev Sci, 16:463-474.

Trauma

  • Hoover SA, et al. 2018. Statewide implementation of an evidence-based trauma intervention in schools. School Psychology Quarterly, 33(1):44-53.
  • Hydon S, Wong M, Langley AK, Stein BD, and Kataoka SH. 2015. Preventing secondary traumatic stress in educators. Child Adolesc Psychiatric Clin N Am, 24:319-333.

Prevention/Wellness

  • Milin R, et al. 2016. Impact of a mental health curriculum on knowledge and stigma among high school students: A randomized controlled trial. J Am Acad Child Adolesc Psychiatry, 55(5):383–391.
  • Lai K, Guo S, Ijadi-Maghsoodi R, Puffer M, and Kataoka SH. 2016. Bringing wellness to schools: Opportunities for and challenges to mental health integration in school-based health centers. Psychiatric Services, 67(12):1328-1333.
  • Bostic JQ,et al. 2015. Being present at school: Implementing mindfulness in schools. Child Adolesc Psychiatric Clin N Am, 24:245-259.

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Additional Clinical Resources

AACAP Practice Parameters

Considered resources for experts, mental health professional and physicians, AACAP's practice parameters were developed to guide clinical decision making. They show the best treatments and the range of treatment options available to families living with childhood and adolescent mental illness. Considered resources for experts, mental health professional and physicians, AACAP's Practice Parameters were developed to guide clinical decision making. They show the best treatments and the range of treatment options available to families living with childhood and adolescent mental illness.

Practice Parameters Psychiatric Consultation to Schools

Practice Parameters for the Assessment and Treatment of Children and Adolescents with Language and Learning Disorders

School Mental Health Resources

Special Education

School Accommodations

Trauma in Schools

Disaster Preparedness in Schools

Treating Youth at Risk for School Violence: Risk Management Considerations for Psychiatrists

Treating a youth who has increased risk for violent acts can be challenging. Psychiatrists have an important role in the assessment and treatment of at risk youth. While there is no stereotype or profile of the violent youth offender, there are specific areas for heightened concentration when assessing and attempting to determine the potential violent action a young patient may take.  Please click here to download your copy of this article.

School Resources for those impacted by disasters   

Suicide Prevention in Schools

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Videos
School Mental Health Training Videos

 

Mental Health in Schools- a perspective from school counselors, teachers and students

Mental Health in Schools

School Based Telemedicine Health
Dealing with the Death of a Student or School Staff Member

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Books

For more bibliotherapy resources, visit Living with Mental Illness: Books, Stories and Memoirs.


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