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Missouri School Counselors and Counselor Educators. (2015). School counselor referral Guide. A school counselor's guide to the referral process. https://dese.mo.gov/sites/default/files/guid-respon-serv-referral-process-guide.pdf

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Crisis Prevention and Intervention in School Counseling 

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Crisis Prevention and Intervention in School Counseling 

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School Counselor Stephanie

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Crisis prevention and intervention in school counseling is a topic that every counselor should know inside out. Crisis prevention is the key to teaching students how to keep themselves safe, while crisis intervention allows the school counselor to take all necessary steps to support a student in crisis. This post will give you all the resources you need to learn about and set up best practice crisis prevention and intervention protocols in school counseling.

Crisis Prevention & Intervention: My Story

I work with a very high crisis population. To give you an idea, we had 255 student crises at my school last year. So, this is what I do and I have a lot of experience with it. Unfortunately, for the last 10 years, we have seen an unprecedented explosion of student crisis across the nation. If you are interested in the causes behind this tragic trend, I highly recommend the book, The Coddling of the American Mind; it really is a must-read for everyone who works or raises children!

Crisis Prevention & Intervention: A Definition

Let's begin by defining what exactly constitutes a student crisis. Basically we are talking about any situation where a student feels there is/was/may be physical harm to self or harm to another. At my school, we call these the "3 hurts":

They want to hurt themselves physically- such as Self injury or Suicidal ideation.

They want to hurt another physically- such as threats of violence to another student/staff member or having Homicidal thoughts.

Someone threatens or hurts them or another physically- such as Bullying or CPS issues.

Crisis Intervention: Guidelines to Follow

It is important to have a protocol for handling student crises, that way you are prepared and ready to go when a crisis walks into your office, as it most definitely will if you are a school counselor (SC). You want to be able to focus all your attention on the student in crisis in front of you, and NOT on wondering or researching what you are supposed to be doing in a crisis! So, here are a few basic guidelines to follow in a crisis:

Talk immediately to the student and the parent/guardian.

Document, document, document.

Consult with your administration and co-counselor- do NOT work on a crisis alone.

If you need a crisis protocol, I have included a link below to my School Counselor Stephanie website where you can find a list of steps to follow for each of the different types of student crisis. To access this protocol, click this link and then scroll down to access my "Crisis Intervention Steps and Resources" downloadable.

Crisis Intervention: A Warning about Suicide Screeners/Assessments

It is best to avoid using suicide screeners/assessments in schools. Here are the reasons for this:

They increase the school and staff liability if a student is hurt.

A suicide screener or mental health assessment is a clinical tool that should be administered in a clinical environment by a clinician.

If you administer a schoolwide screener, are you prepared if hundreds of your students make a mental health outcry? Do you have the mental health staff immediately available to thoroughly investigate each outcry and complete all the crisis intervention steps? If not, you make the school system and yourself very vulnerable to a lawsuit if a student is hurt.

Here is an ASCA article on this topic: https://www.schoolcounselor.org/magazine/blogs/november-december-2013/suicide-contracts,-assessments-and-parental-guardi

Instead of using screeners or assessments in schools, it is best practice to communicate the facts that the student tells you directly to their parents/guardians.

Crisis Prevention: Lessons and Groups

Crisis prevention in group counseling and guidance lessons looks very similar. The reason for this is that school counseling interventions typically follow the Rti model:

Tier 1 Intervention- guidance lessons

Tier 2 intervention- group counseling

This means that the intensity and the frequency of the intervention support (in this case, crisis prevention), is just increased at Tier 2 group counseling.

Guidance Lessons

The entire student body should see you regularly in guidance lessons, so they know who you are and how to get to you in a crisis. Begin every guidance lesson with the following crisis prevention reminders and information:

How to see the counselor (request forms for non-emergencies)

The "3 hurts emergency" and how to get help

All school staff=mandated reporters

Tips to prevent the "3 hurts"

Then, teach a quick minilesson on crisis prevention as part of every guidance lesson. Possible minilesson topics could be healthy coping skills, stress and anger management, child abuse awareness, and more! Here is a link to my curriculum of guidance lessons where each one offers crisis prevention activities and info.

Counseling Groups

Increase the frequency and intensity of crisis prevention at the Tier 2 group counseling level. You can do this by:

Practicing mindfulness with the Bounding into Grounding activity from Sending Students Soaring: Trauma-Informed Group Counseling Guide.

NEWSY & NOTEWORTHY

In a few weeks, I'll also be uploading an end-of- year counselor task checklist with some accompanying resources. Follow me at this link to know when it is available.

LOOKING AHEAD

This brings me to the end of my May post. Please leave a comment because I'd love to hear what kinds of crises you are dealing with at your school! You can catch up with me again in June for my monthly counseling post that I share during the first weekend of every month! My June post will be all about tips for interviewing and landing that dream counseling job!!!

In the meantime, you can find out about my latest promotions, free stuff, or counseling adventures by following me on my School Counselor Stephanie Instagram, Facebook, or Pinterest pages!

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School Counselor Stephanie - School Counselor Stephanie

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Crisis prevention and intervention in school counseling is a topic that every counselor should know inside out. Crisis prevention is the key to teaching students how to keep themselves safe, while crisis intervention allows the school counselor to take all necessary steps to support a student in crisis.

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National Eating Disorder Association

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Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

DIAGNOSTIC CRITERIA

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

2. Intense fear of gaining weight or becoming fat, even though underweight.

3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA
Emotional and behavioral

Dramatic weight loss

Dresses in layers to hide weight loss or stay warm

Is preoccupied with weight, food, calories, fat grams, and dieting

Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

Makes frequent comments about feeling "fat" or overweight despite weight loss

Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

Denies feeling hungry

Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)

Cooks meals for others without eating

Consistently makes excuses to avoid mealtimes or situations involving food

Expresses a need to "burn off" calories taken in

Maintains an excessive, rigid exercise regimen - despite weather, fatigue, illness, or injury

Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive

Seems concerned about eating in public

Has limited social spontaneity

Resists or is unable to maintain a body weight appropriate for their age, height, and build

Has intense fear of weight gain or being "fat," even though underweight

Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight

Postpuberty female loses menstrual period

Feels ineffective

Has strong need for control

Shows inflexible thinking

Has overly restrained initiative and emotional expression

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Menstrual irregularities-amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a "true" period)

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body (lanugo)

Thinning of hair on head, dry and brittle hair

Cavities, or discoloration of teeth, from vomiting

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Poor wound healing

Impaired immune functioning

HEALTH CONSEQUENCES OF ANOREXIA NERVOSA

In anorexia nervosa's cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it's incredibly important to understand the many ways that eating disorders affect the body.

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Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat.

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School Counselor's Role in Addressing Eating Disorders 

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School Counselor's Role in Addressing Eating Disorders 

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American Counseling Association

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The School Counselor's Role in Addressing Eating Disorder

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Psychology Today

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Panic disorder is effectively treated with medications and therapy. Appropriate treatment by a professional can help lessen or prevent panic attacks by reducing the symptoms or the fears related to having an attack. Relapses may occur, but they can be treated effectively.
Therapy
Cognitive-behavioral therapy (CBT) teaches patients to see the links between their thoughts, beliefs, and actions. By changing distorted thought patterns that maintain anxiety and by exposing the person to anxiety-provoking symptoms or situations in a gradual manner, CBT can help create mastery over anxiety and panic symptoms. Therapy may help those with panic disorder to:

Understand their distorted views of life stressors, such as other people's behavior or life events.

Learn to decrease their sense of helplessness by recognizing and replacing panic-causing thoughts.

Learn stress management and relaxation techniques to help when symptoms occur.

Practice systematic desensitization and exposure therapy, in which they are asked to relax, then imagine the things that cause the anxiety, working from the least fearful to the most fearful. Gradual exposure to the real-life situation also has been used with success to help people overcome their fears.

Medications
Several medications have been found to be effective for relieving panic disorder. Antidepressants are one class of medications that must be taken for several weeks before symptoms begin to disappear.

Selective serotonin reuptake inhibitors, or SSRIs, work in the brain via a chemical messenger called serotonin. SSRIs commonly prescribed for panic disorder include Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa). SSRIs are also used to treat panic disorder when it occurs in combination with obsessive-compulsive disorder, social phobia, or depression. Patients may initially experience nausea, drowsiness, diarrhea, or sexual side effects when they first take SSRIs, but over time, symptoms subside. An adjustment in dosage or a switch to another SSRI may also correct the problem. Clients should discuss all side effects or concerns with their doctor so that any needed changes in medication can be made.

Benzodiazepines, including alprazolam (Xanax) and lorazepam (Ativan), may be prescribed for patients to help with more acute symptoms of panic disorder. These drugs alleviate symptoms quickly and have fewer side effects other than drowsiness, but frequent use may lead to dependence on the medication. They are not recommended for patients who have alcohol or substance abuse issues.

When taking medications, it is important for patients to be educated about potential side effects, the rationale for the type of medication prescribed, and other drugs or substances that may counteract or interact with the effects of the medications. Before stopping to take the prescribed drug, or if the medication does not seem to alleviate symptoms, the doctor should be consulted.

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Panic disorder refers to sudden and repeated panic attacks-episodes of intense fear and discomfort that reach a peak within a few minutes-during which time the individual experiences physical symptoms such as chest pain, heart palpitations, breathlessness, vertigo, or abdominal distress, sometimes accompanied by the fear of losing control or dying, according to the DSM-5.

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Psychiatric Times

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There are notable clinical successes in treating common emotional disorders using cognitive-behavioral approaches based on precise theoretical models. In anxiety disorders, the underlying fear beliefs are tested in behavioral experiments to substantially reduce symptoms; in depression, mood is lifted by reevaluating negative views of the self and limiting excessive rumination.

With psychosis, similar psychological processes are active in the experience of delusions and hallucinations. For example, persecutory delusions are conceptualized as threat beliefs that are the patient's attempts to make sense of his or her personal experiences, while hallucinations are problematic when they are interpreted by the patient as representing powerful and destructive forces. Hence, in cognitive therapy for psychosis, fearful thoughts are carefully reevaluated; withdrawal from social contact and activity is gradually reversed; and feelings of hope, control, and self-worth are fostered. Patients with psychosis are given time to talk about their experiences and, importantly, strategies are developed from this collaborative discussion.

In this one-on-one therapy, distressing experiences take center stage. The first generation of cognitive-behavioral therapy (CBT) for psychosis, when added to standard care, has demonstrated efficacy in treating patients with delusions and hallucinations. ¹ Although the first-generation CBTs are a significant step forward in treatment approaches, efficacy is moderate. Newer developments in CBT for psychosis are aligning interventions more closely with the transformation in the theoretical understanding of individual psychotic experiences. ² This may well be analogous to the CBT for anxiety: initial approaches showed moderate effect sizes, which were greatly increased by the development of disorder-specific and theoretically driven cognitive therapies. ³ Ongoing innovation in CBT for psychosis has garnered the interest of clinicians and researchers across the globe who are becoming increasingly involved.
The initial stages of intervention
A nonjudgmental "voyage of discovery" attitude helps a clinician engage the patient. It needs to be conveyed to a patient that his problems are being taken seriously. The CBT therapist should listen empathically and regularly provide brief summaries to make sure that he has correctly understood what the patient is saying so that he can move the discussion forward.

The distress caused by the experiences is commented on (eg, "it must make you very anxious" or "believing that the neighbors are trying to harm you must feel very intrusive and be upsetting to you"). Patients are engaged in therapy for the explicit aims of reducing distress, increasing confidence, and reengaging in activity. The clinician plays a collaborative role: drawing up a list of goals with the patient, discussing what will happen during the sessions, and regularly asking the patient for both positive and negative feedback.

Anticipating problems with engagement because of mistrust or auditory hallucinations can typically prevent misunderstandings. Immediate concerns (eg, suicidal thoughts, difficulties in getting to therapy sessions) should be dealt with before a full assessment. Challenging delusions in the early stages of therapy is not productive; the more difficult task of listening and trying to understand the patient's perspective will prove more beneficial. It can also be extremely helpful to occasionally focus on positive aspects and achievements of the patient. Patients with psychosis often present with low self-esteem, difficulties with trust, and fears about others viewing them as "mad"; the clinician who shows positive regard can help circumvent these negative self-views that can hinder engagement.

The initial aim is to develop an individualized understanding that accounts for distressing delusions and/or hallucinations. The ideas used in therapy are based on empirically tested cognitive models of psychosis. ⁴⁻⁷ The identification of factors underlying problems is developed using detailed in-session recollections by the patient of recent difficulties (eg, the last time he heard a voice or had a paranoid thought); structured diaries kept by the patient outside of sessions; and assessment of his life experiences, including stresses and current activity. The clinician keeps in mind the psychological ideas and models and will think about the following:

* What is the patient's emotional state: is he showing a worry style or sleeping poorly?

* What evidence makes the patient believe that the delusional thoughts are accurate?

* Is the patient having puzzling and confusing experiences?

* How does the delusional belief build on the patient's ideas about the self and others?

* What are his beliefs about the hallucinations?

* How do the delusional thoughts or interpretations of hallucinatory experience make sense given the patient's previous life events?

* Are there negative images?

* What is the reasoning style concerning these experiences?

* Are there behaviors (eg, avoidance) that contribute to the persistence of the thoughts?

* What is the patient doing during the week?

The answers to these questions are proposed to the patient for his opinion (eg, "I may have this wrong, but could it be that given the things that have happened in the past that your first reaction now is to think that others will be bad to you?" "Might it be that not sleeping is making things feel worse?" "It sounds like you worry a lot and doing this makes your concerns feel even worse?"). Gradually the therapist and patient develop a shared understanding, with the focus on what is maintaining the current problems and what can immediately be changed. The past and initial onset of problems are brought into the discussions when appropriate (and to varying degrees).

The Figure illustrates the onset of paranoid experiences that result from a spiral of stresses (isolation →drug taking →poor sleep) and lead to an odd perceptual state. A paranoid interpretation of the odd state is understandable given the context of long-standing social anxiety, a tendency to worry, and hasty reasoning. The reaction of avoiding situations leads to the failure to receive disconfirmatory evidence, and the paranoid fear becomes entrenched. Sharing this formulation with the patient to describe his subjective experiences may help him understand what is happening. Patient accounts are used to emphasize elements of the formulation. ⁸

It is important to note that cognitive therapies were developed in a tradition that interventions should be assessed for their efficacy and therefore formal measures of symptoms are routinely taken to monitor treatment effectiveness (eg, the Psychotic Symptom Rating Scales). ⁹ If change does not occur, the clinician needs to change course: weekly therapist supervision is advisable and close links with treating teams need to be maintained.
Interventions
Making sense of psychotic experiences illuminates many potential therapeutic paths. For example, the clinician may work on reducing negative beliefs about the self, limiting the time spent worrying, improving sleep, reducing drug taking, and increasing engagement in positive activities before addressing the delusional belief. There is evidence that simply improving sleep and reducing worry using CBT techniques developed for emotional disorders leads to reductions in psychotic symptoms. 10,11 This kind of work moves the intervention into an active phase beyond simply talking and it raises the patient's confidence in the clinician.

Delusions. A number of strategies can be used for delusions ( Table). If anomalous experiences are assessed as central to delusion formation-odd experiences that lead to odd ideas-they are targeted. The nature of the anomalous experiences can be explained to the patient (eg, "Part of the difficulties seem to come from when you feel as if the world is unreal. This is called derealization and is something people often experience when they are feeling miserable. Would you like me to find out if there is any good reading on this experience?" "It seems a large part of the difficulties are these terrible feelings of anxiety you get when you step on to the bus, is that right? Perhaps these terrible feelings are the central problem and you would feel more comfortable around people if those sensations weren't so strong?").

A functional analysis is carried out to identify the triggers and reactions to the anomalous feelings. The patient is encouraged to respond differently to the triggers, to reduce the occurrence of the anomalous feelings (eg, if the feelings occur when the patient is irritated by someone's behavior, assertiveness techniques might be taught). Or the person may be encouraged to cope differently with the anomalous feelings, to prevent a vicious circle of overreaction and anxiety that leads to more unusual experiences. At this point, asking about images that support the delusions may be useful. ¹² Another strategy is reviewing, reality testing, or modifying delusions. Patients are shown how to verbally review their delusional thoughts and to develop alternative explanations for the delusions (weighing up the evidence for and against).

However, beliefs are often best changed via experience, and behavioral experiments can be used to alter delusional beliefs. Hierarchies of tests are constructed, predictions are made, and the results of tests are considered. This work has to be done very carefully in agreement with the patient. Often it is best to put the alternative belief (eg, the patient will not be attacked, the voices cannot do what they threaten) to the test. In some cases, patients will not wish to consider alternative explanations for their experiences or to doubt the basic premises of their beliefs, or the beliefs are not possible to test. In these instances, it is necessary to work within the delusional system. For example, focusing on the most troubling aspects of the delusional system (eg, showing that the persecutor has less power than the patient thinks) or helping the patient return to positive functioning by improving his coping skills (eg, using flash cards with information for use in social situations).

Hallucinations. A central technique when working with hallucinations is to consider the patient's interpretations of his voices. Interesting theoretical studies have shown that relationships that patients have developed with their voices often mirror real-world experiences. ¹³ The basic cognitive model is that it is the interpretation of events, not simply the events, that determine emotional reactions. For example, the patient may believe that the voices are out to get him and that the voices can carry out any threat. The belief that the voices have such power is reviewed and tested out, just as for a delusional belief.

Trower and colleagues ¹⁴ describe how they focus on beliefs that the voices have power and control and that the person must comply and on beliefs concerning the identity of the voices (eg, the devil) as well as the meaning attached to the voice experience (eg, that it is a punishment for previous behavior). The therapist talks with the patient about what is the most helpful attitude and relationship to the voices and how to achieve this while acknowledging that it takes time for changes to occur. Perhaps the patient can be engaged with the voices only for a set period each day, and then he can focus on something he would rather do or accomplish. Sometimes an analogy is made with having a noisy next door neighbor or a bully in order to think how best to react to voices.

Often the triggers for auditory hallucinations are periods of anxiety or inactivity. Therefore, an individual's triggers for voices are identified and alternative ways of acting or structuring the day are developed (eg, if the voices only occur when the person is lying awake in bed at night, it might be appropriate to increase activity during the day and ensure the person is only going to bed when very sleepy).

It can also be helpful to enhance a person's coping strategies when hallucinations do occur. Some people find it helpful to wear headphones or to read, hum quietly, or seek company when voices occur. Another helpful strategy is to provide information written by other voice hearers. This can help the patient realize that he is not alone and can show him ways to adapt to the hallucinations. A promising new strategy to target the depression associated with voices is to develop competitive positive memories to use when voices occur. ¹⁵

Emotional concerns and activity. Throughout therapy there is ongoing work to improve the patient's self-esteem; reduce depression, anxiety, and worry; increase activities; and structure the week (including paying attention to regular and more healthy meals). Finally, the therapist and patient try to prevent relapse by identifying vulnerabilities and early warning signs and rehearsing compensatory strategies.

Overall, it should be clear that CBT draws on a range of techniques that are applied on the basis of individual formulations of a patient's difficulties. However, the unifying factor is the assumption that a patient's experiences should be taken seriously and that the patient can be helped to make psychotic experiences less threatening, less interfering, and more controllable.
Future direction
There is still much to do in the development of CBT for psychosis. The key treatment techniques for each individual psychotic experience (eg, paranoia, grandiosity, hallucinations, anhedonia) need to be identified. Approaches targeted to negative symptoms are only now emerging. 16,17 CBT techniques for psychosis differ depending on whether the focus is on preventing episodes, reducing relapse, increasing speed of recovery from an acute episode, or reducing persistent delusions and hallucinations. 18,19 Issues regarding comorbid alcohol and drug abuse need to be considered and the therapy adapted to specific demographics. 20,21

We are entering an exciting period of finding out how best to address psychotic symptoms. Identifying the moderators and mediators of CBT for psychosis will refine treatment and enhance patient outcomes. Although self-help and internet-delivered interventions are still in their infancy and require further research, we've come a long way in our understanding of how to approach and treat patients-we've realized that it is preferable to openly discuss psychotic symptoms with the patient.

Acknowledgment- Dr Freeman is supported by a UK Medical Research Council Senior Clinical Fellowship.

Disclosures:
Dr Freeman is Professor of Clinical Psychology, department of psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, United Kingdom, and is a Fellow of University College Oxford. Twitter: @ProfDFreeman. He reports no conflicts of interest concerning the subject matter of this article.
References:

1. Wykes T, Steel C, Everitt B, Tarrier N. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull. 2008;34:523-537.

2. Freeman D. Improving cognitive treatments for delusions. Schizophr Res. 2011;132:135-139.

3. Clark DM. Developing new treatments: on the inter-play between theories, experimental science and clinical innovation. Behav Res Ther. 2004;42:1089-1104.

4. Freeman D, Garety PA, Kuipers E, et al. A cognitive model of persecutory delusions. Br J Clin Psychol. 2002;41(pt 4):331-347.

5. Morrison AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother. 2001;29:257-276.

6. Chadwick P, Birchwood M. The omnipotence of voices. A cognitive approach to auditory hallucinations. Br J Psychiatry. 1994;164:190-201.

7. Beck AT, Rector NA, Stolar NM, Grant PM. Schizophrenia: Cognitive Theory, Research and Therapy. New York: Guilford Press; 2008.

8. NHS Foundation Trust: Institute of Psychiatry. Paranoid thoughts. 2012. http://www.paranoidthoughts.com. Accessed October 30, 2013.

9. Haddock G, McCarron J, Tarrier N, Faragher EB. Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychol Med. 1999;29:879-889.

10. Myers E, Startup H, Freeman D. Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial. J Behav Ther Exp Psychiatry. 2011;42:330-336.

11. Foster C, Startup H, Potts L, Freeman D. A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. J Behav Ther Exp Psychiatry. 2010;41:45-51.

12. Schulze K, Freeman D, Green C, Kuipers E. Intrusive mental imagery in patients with persecutory delusions. Behav Res Ther. 2013;51:7-14.

13. Birchwood M, Gilbert P, Gilbert J, et al. Interpersonal and role-related schema influence the relationship with the dominant "voice" in schizophrenia: a comparison of three models. Psychol Med. 2004;34:1571-1580.

14. Trower P, Birchwood M, Meaden A, et al. Cognitive therapy for command hallucinations: randomised controlled trial. Br J Psychiatry. 2004;184:312-320.

15. van der Gaag M, van Oosterhout B, Daalman K, et al. Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia-spectrum patients with persistent auditory verbal hallucinations: a randomized controlled trial. Br J Clin Psychol. 2012;51:158-171.

16. Grant PM, Huh GA, Perivoliotis D, et al. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry. 2012;69:121-127.

17. Klingberg S, WÃ¶lwer W, Engel C, et al. Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study. Schizophr Bull. 2011;37(suppl 2):S98-S110.

18. Morrison AP, French P, Stewart SLK, et al. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ. 2012;344:e2233.

19. Gumley A, O'Grady M, McNay L, et al. Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychol Med. 2003;33:419-431.

20. Barrowclough C, Haddock G, Wykes T, et al. Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. BMJ. 2010;341;c6325.

21. Rathod S, Kingdon D, Phiri P, Gobbi M. Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users' and health professionals' views and opinions. Behav Cogn Psychother. 2010;38:511-533.
Additional Reading
* Freeman D, Freeman J, Garety P. Overcoming Paranoid and Suspicious Thoughts. New York: Basic Books; 2008.

* Hayward M, Strauss C, Kingdon D. Overcoming Distressing Voices. London: Constable & Robinson; 2012.

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There are notable clinical successes in treating common emotional disorders using cognitive-behavioral approaches based on precise theoretical models. In anxiety disorders, the underlying fear beliefs are tested in behavioral experiments to substantially reduce symptoms; in depression, mood is lifted by reevaluating negative views of the self and limiting excessive rumination.

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American School Counseling Association

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ASCA Toolkit: Crisis Planning and Response During a Pandemic/Virtual School Counseling

While school counselors are key to providing grief and crisis support whether in a virtual or brick and mortar setting, some of the ways material and information is delivered may be different in a virtual world.

School counselors cannot complete this work and deliver services to students in a silo. Crisis planning and response - whether the crisis is a sudden school closure in general or an individual student crisis during the school shutdown - requires a school and community conversation. Talking through the virtual crisis and grief response with administrators and the school crisis team is vitally important. Consider these tips:

Ensure a plan is in place before a crisis occurs.

Communicate the plan with all school staff to ensure everyone is clear about how the process will work.

Reach out to community organizations and partners to fill in service gaps.

Work with administrator about how support to staff during the crisis.

Ensure the school website, and perhaps your own personal email signature, includes important information, crisis lines and resources.

Regularly check in with students and families. This isn't just a job for the school counselor but administration and other staff as well.

Remember to practice self-care.

For additional guidance regarding supporting students, read the National Center for School Crisis and Bereavement's Supporting Grieving Students During a Pandemic - A guide to using the Coalition to Support Grieving Students materials.
The School Counselor Role
Safe school and crisis response literature suggests several important crisis prevention and response preparedness practices in which school counselors should engage, including:

providing individual and group counseling

advocating for student safety by recommending school personnel put consistent procedures, communication and policies in place

providing interventions for students at risk of dropping out or harming self or others

supporting student-initiated programs

providing family, faculty and staff education programs

facilitating open communication between students and caring adults

participating in district and school response team planning and practices

promoting trauma-informed practices

partnering with community resources

In short, school counselors are a vital resource in preventing, intervening, and responding to crisis situations. Source: ASCA Position Statement: The School Counselor and Safe Schools and Crisis Response
Crisis and Grief Response Resources
Crisis Planning Pandemic-Specific Resources Trauma Grief Hotlines
The following hotlines may be helpful for students in crisis while not attending school due to COVID-19.

Childhelp National Child Abuse Hotline
(800) 422-4453

Disaster Distress Helpline - SAMHSA
(800) 985-5990

Girls & Boys Town National Hotline
(310) 855-4673

National Center for Missing & Exploited Children
(800) 843-5678

National Domestic Violence Hotline
(800) 799-7233

National Parent Helpline
(855) 427-2736

Rape, Sexual Assault, Abuse and Incest National Network (RAINN)
(800) 656-4673

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Crisis Planning and Response | American School Counselor Association (ASCA)

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ASCA Toolkit: Crisis Planning and Response During a Pandemic/Virtual School Counseling While school counselors are key to providing grief and crisis support whether in a virtual or brick and mortar setting, some of the ways material and information is delivered may be different in a virtual world.

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Child Mind Institute

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National Institute of Mental Health

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National Institute of Mental Health (NIMH)

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Learn about obsessive-compulsive disorder, including signs and symptoms, risk factors, treatments and therapies, and links to other resources to learn more.

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Child Mind Institute

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

What is conduct disorder?

Conduct disorder is a mental health condition that can affect children and teenagers. Kids who have conduct disorder seem to enjoy hurting people and doing bad things. They are unkind and often violent, and they don't care about other people's feelings. This behavior goes beyond normal teasing, bullying, or acting out.

Extreme bullying, hurting animals, and lying for no reason are all signs of conduct disorder. In younger kids, conduct disorder starts with pushing, hitting and biting. In older kids, conduct disorder can come with more extreme violent behavior and crimes like stealing, destroying things and setting fires.

All kids act out sometimes, so conduct disorder is only diagnosed when this extreme behavior shows up over a long period of time and isn't caused by the child's environment.

What are the symptoms of conduct disorder?

Symptoms of conduct disorder include:

Not caring about social norms of good behavior

Ignoring the rights and feelings of other people

Enjoying causing harm, lying or manipulating people

Committing physical or sexual violence

Hurting animals

In younger kids: lying for no real reason, stealing for the fun of it, and extreme bullying

In older kids: picking fights, lying, cheating, stealing, destroying property, and physically or emotionally abusing others

How is conduct disorder diagnosed?

Conduct disorder is different from just bad behavior or acting out, which most kids do at some point. Kids must show symptoms of conduct disorder for several months at a time to be diagnosed. Before diagnosing a child with conduct disorder, a professional will also try to figure out if their extreme behavior could be a reaction to problems at home. To be diagnosed, a child's enjoyment of causing pain must seem to come from something inside them.

What are the risk factors for conduct disorder?

Several things put kids at higher risk of developing conduct disorder:

Having a parent or sibling with conduct disorder

Having a biological parent who abuses alcohol or has depression, ADHD, bipolar disorder, or schizophrenia

Experiencing abuse or neglect

Being bullied or having friends who encourage negative behavior

How is conduct disorder treated?

Conduct disorder is hard to treat but treatment can work if the child's family, friends and teachers get involved. Treatment works better if it starts when the child is young.

In therapy for conduct disorder, the child learns healthier ways to interact with others. At the same time, the child's family and support system learn ways to communicate with the child. Children with conduct disorder usually stay in psychotherapy or behavioral therapy for a long time.

In younger children, therapy for conduct disorder usually involves teaching parents how to encourage good behavior. In adolescents, therapy may also focus on the child's relationships with friends, other kids, and adults at school (like teachers and principals).

There is no medication specifically for conduct disorder. But kids with conduct disorder sometimes have other disorders as well, like depression or bipolar disorder. Treating those other disorders with medication can help therapy for conduct disorder work better.

This guide was last reviewed or updated on February 23, 2023.

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Quick Guide to Conduct Disorder - Child Mind Institute

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Conduct disorder is a mental health condition that can affect children and teenagers. Kids who have conduct disorder seem to enjoy hurting people and doing bad things.

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American Academy of Child & Adolescent Psychiatry

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Oppositional Defiant Disorder

No. 72; Reviewed January 2019

All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life.

In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child's day to day functioning.

Symptoms of ODD may include:

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his or her mistakes or misbehavior

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

The symptoms are usually seen in multiple settings but may be more noticeable at home or at school. One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age. Biological, psychological, and social factors may have a role.

A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present, such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder), and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder.

Treatment of ODD may include:

Parent Management Training to help parents and others manage the child's behavior

Individual Psychotherapy to develop more effective anger management

Family Psychotherapy to improve communication and mutual understanding

Cognitive Problem-Solving Skills Training and Therapies to decrease negativity

Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers

Medications may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety, and mood disorders.

A child with ODD can be very difficult for parents. These parents need support and understanding. Parents can help their child with ODD in the following ways:

Always build on the positives, give the child praise and positive reinforcement when s/he shows flexibility or cooperation.

Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if s/he decides to take a time-out to prevent overreacting.

Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."

Set reasonable, age appropriate limits with consequences that can be enforced consistently.

Maintain interests other than your child with ODD, so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.

Manage your own stress with healthy life choices such as exercise and relaxation. Use respite care and other breaks as needed.

Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or other qualified mental health professional who can help diagnose and treat ODD and any coexisting psychiatric condition.

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Oppositional Defiant Disorder No. 72; Reviewed January 2019 All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents.

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Understood.org

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At a glance

IDEA is the nation's special education law.

Schools must find and evaluate students thought to have disabilities - at no cost to families.

To qualify for IDEA services, a child must have a disability and need special education to make progress in school.

To get special education services for a child, you have to follow a legal process. The most important law for this process is the Individuals with Disabilities Education Act (IDEA).

IDEA is the nation's special education law. It gives rights and protections to kids with disabilities. It covers them from birth through high school graduation or age 21 (whichever comes first). Parents and legal guardians also have rights under the law.

IDEA places two big responsibilities on states and their public schools.

Schools must find and evaluate students who may have disabilities, at no cost to families. This is known as Child Find. If a child has a qualifying disability, schools must offer special education and related services (like speech therapy and counseling) to meet the child's unique needs. These are provided through an Individualized Education Program (IEP). The goal is to help students make progress in school.

Second, schools have to give parents a voice in their child's education. At every point in the process, IDEA gives parents specific rights and protections. These are called procedural safeguards. For example, one safeguard is that a school must get consent from parents before providing services to kids.

The reach of IDEA goes beyond traditional public schools. It includes public magnet and charter schools. The law also provides early intervention services to infants and toddlers up to age 3. Finally, IDEA may impact some students in private schools.

About the author

About the author

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

Reviewed by

Reviewed by

Myrna Mandlawitz, MEd, JD has worked for over 20 years as a consultant/lobbyist on special and general education.

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Individual with Disabilities Education Act (IDEA)

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What is the Individuals with Disabilities Education Act (IDEA)? IDEA is a federal law that lays out children's rights in special education. Here's how it works.

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Understood.org

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A 504 plan is a blueprint for how the school will support a student with a disability and remove barriers to learning. The goal is to give the student equal access at school.

504 plans are formal plans that schools develop to give kids with disabilities the support they need. That covers any condition that limits daily activities in a major way.

504 plans often include accommodations. These can include:

Changes to the environment (like taking tests in a quiet space)

Changes to instruction (like checking in frequently on key concepts)

Changes to how curriculum is presented (like getting outlines of lessons)

Accommodations don't change what kids learn, just how they learn it. The goal is to remove barriers and give kids access to learning.

While it's rare, 504 plans can provide modifications. Unlike accommodations, modifications do change what a student is taught or is expected to learn. Students might get fewer homework assignments, for instance. Or they may be graded in a different way than their classmates.

The process for getting a 504 plan is different, and simpler, than the process for getting an IEP. But it varies from school district to school district

With 504 plans, schools look at information about a student from a few different sources. One source might be a medical diagnosis. Schools might also look at the student's grades, test scores, and teacher recommendations.

Families or schools can request a 504 plan through the school district's 504 coordinator. This person may also be the IEP coordinator. (Ask the principal if you're not sure who to contact.) The request must be in writing. The school will then hold a meeting to decide if the child qualifies and what supports are appropriate.

Legal rights under 504 plans

The 504 process has fewer protections than the special education process. But families can still play an important role by staying involved and making sure kids with disabilities get the same education as kids who don't.

Key takeaways

504 plans are designed to help kids with disabilities learn alongside their peers.

A 504 plan isn't the same as an IEP.

There are fewer safeguards in the 504 plan process than in the IEP process, so it's important to be proactive.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Melody Musgrove, EdD served as director of the Office of Special Education Programs (OSEP) in the U.S. Department of Education.

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A 504 plan is a blueprint for how the school will support a student with a disability and remove barriers to learning. The goal is to give the student equal access at school. 504 plans are formal plans that schools develop to give kids with disabilities the support they need.

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American Psychiatric Association

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American Psychiatric Association

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National Alliance on Mental Illness

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Schizophrenia is a serious mental illness that interferes with a person's ability to think clearly, manage emotions, make decisions and relate to others. It is a complex, long-term medical illness. The exact prevalence of schizophrenia is difficult to measure, but estimates range from 0.25% to 0.64% of U.S. adults. Although schizophrenia can occur at any age, the average age of onset tends to be in the late teens to the early 20s for men, and the late 20s to early 30s for women. It is uncommon for schizophrenia to be diagnosed in a person younger than 12 or older than 40. It is possible to live well with schizophrenia.

Symptoms

It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include a change of friends, a drop in grades, sleep problems, and irritability-common and nonspecific adolescent behavior. Other factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis. In young people who develop schizophrenia, this stage of the disorder is called the "prodromal" period.

With any condition, it's essential to get a comprehensive medical evaluation in order to obtain the best diagnosis. For a diagnosis of schizophrenia, some of the following symptoms are present in the context of reduced functioning for a least 6 months:

Hallucinations. These include a person hearing voices, seeing things, or smelling things others can't perceive. The hallucination is very real to the person experiencing it, and it may be very confusing for a loved one to witness. The voices in the hallucination can be critical or threatening. Voices may involve people that are known or unknown to the person hearing them.

Delusions. These are false beliefs that don't change even when the person who holds them is presented with new ideas or facts. People who have delusions often also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.

Negative symptoms are ones that diminish a person's abilities. Negative symptoms often include being emotionally flat or speaking in a dull, disconnected way. People with the negative symptoms may be unable to start or follow through with activities, show little interest in life, or sustain relationships. Negative symptoms are sometimes confused with clinical depression.

Cognitive issues/disorganized thinking. People with the cognitive symptoms of schizophrenia often struggle to remember things, organize their thoughts or complete tasks. Commonly, people with schizophrenia have anosognosia or "lack of insight." This means the person is unaware that he has the illness, which can make treating or working with him much more challenging.

Causes

Research suggests that schizophrenia may have several possible causes:

Genetics. Schizophrenia isn't caused by just one genetic variation, but a complex interplay of genetics and environmental influences. Heredity does play a strong role-your likelihood of developing schizophrenia is more than six times higher if you have a close relative, such as a parent or sibling, with the disorder

Environment. Exposure to viruses or malnutrition before birth, particularly in the first and second trimesters has been shown to increase the risk of schizophrenia. Recent research also suggests a relationship between autoimmune disorders and the development of psychosis.

Brain chemistry. Problems with certain brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neurotransmitters allow brain cells to communicate with each other. Networks of neurons are likely involved as well.

Substance use. Some studies have suggested that taking mind-altering drugs during teen years and young adulthood can increase the risk of schizophrenia. A growing body of evidence indicates that smoking marijuana increases the risk of psychotic incidents and the risk of ongoing psychotic experiences. The younger and more frequent the use, the greater the risk.

Diagnosis

Diagnosing schizophrenia is not easy. Sometimes using drugs, such as methamphetamines or LSD, can cause a person to have schizophrenia-like symptoms. The difficulty of diagnosing this illness is compounded by the fact that many people who are diagnosed do not believe they have it. Lack of awareness is a common symptom of people diagnosed with schizophrenia and greatly complicates treatment.

While there is no single physical or lab test that can diagnosis schizophrenia, a health care provider who evaluates the symptoms and the course of a person's illness over six months can help ensure a correct diagnosis. The health care provider must rule out other factors such as brain tumors, possible medical conditions and other psychiatric diagnoses, such as bipolar disorder.

To be diagnosed with schizophrenia, a person must have two or more of the following symptoms occurring persistently in the context of reduced functioning:

Delusions

Hallucinations

Disorganized speech

Disorganized or catatonic behavior

Negative symptoms

Delusions or hallucinations alone can often be enough to lead to a diagnosis of schizophrenia. Identifying it as early as possible greatly improves a person's chances of managing the illness, reducing psychotic episodes, and recovering. People who receive good care during their first psychotic episode are admitted to the hospital less often, and may require less time to control symptoms than those who don't receive immediate help. The literature on the role of medicines early in treatment is evolving, but we do know that psychotherapy is essential.

People can describe symptoms in a variety of ways. How a person describes symptoms often depends on the cultural lens she is looking through. African Americans and Latinos are more likely to be misdiagnosed, potentially due to differing cultural perspectives or structural barriers. Any person who has been diagnosed with schizophrenia should try to work with a health care professional that understands his or her cultural background and shares the same expectations for treatment.

Treatment

There is no cure for schizophrenia, but it can be treated and managed in several ways.

Related Conditions

People with schizophrenia may have additional illnesses. These may include:

Successfully treating schizohprenia almost always improves these related illnesses. And successful treatment of substance misuse, PTSD or OCD usually improves the symptoms of schizophrenia.

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What is Schizophrenia? | NAMI: National Alliance on Mental Illness

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Discover the symptoms, causes, diagnosis advice, treatment options and related conditions of schizophrenia.

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Project IDEAL

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Because of the federal laws and regulations that govern the education of students with disabilities, a process has evolved over time that governs the special education referral process. The purpose of this module is to provide an overview to the "Special Education Process" so that the learner may understand the global procedures for providing a student with disabilities a free and appropriate education (FAPE).

PHASE ONE: Recognition

All students begin their educational careers with needs. For many, it is the need for guidance by a professional educator who can expand their knowledge and understanding of the world around them. While each student brings a different level of knowledge and skills to his or her first class, the individual's needs are typically met by a highly-qualified educator. However, there are children who have unique needs that are atypical for children of their age and may not be within the expertise of the general education classroom teacher. It is during this time that the teacher (or parent, administrator, or counselor) recognizes a consistent need or problem exhibited by the student. The recognition of a discrepancy in the student's academic, social/emotional, behavioral, and/or physical ability and his or her age may signal the need for additional academic or behavioral supports.

During this phase, it is important to call a meeting with the parents or guardians. The teacher should provide examples of the student's work and/or anecdotal classroom notes regarding the student's needs. In the meeting, the teacher and the parent/guardian should explore the following:

Is the issue a recurrent problem or new? The parents will be best able to present invaluable insight into the knowledge, skills, and needs of their child. The teacher should document when they recognized an issue.

Is the issue constant? All children may exhibit unique needs or problems at some point but it may only be an isolated episode for that day. The teacher should document any issue that is constant, providing dates and information about the behavior of concern or skill deficit exhibited by the student.

Is the issue appropriate for children of this age? How many kindergarten students have been seen crying the first days of school? This behavior is a typical occurrence and should not be confused with an atypical behavior. The teacher should have a strong understanding of the cognitive, behavioral, and physical development levels of typical students they teach.

It is possible that the problems that are being exhibited by the student may be "solved" with the careful execution of a cooperative plan of action between the teacher and the parents. The teacher and the parent should document their plan of action, strategies utilized with the student, and progress. The teacher should continue to collect student work samples and keep assessment data relevant to the student's unique needs. It is critically important that the teacher document all actions and strategies used in the classroom and the impact on the student.

The student's parents/guardians should be kept informed of any changes in the student's progress. If the teacher, after a period of time, determines the problem cannot be controlled with simple classroom interventions, then the teacher should notify the parents/guardians that they will be asking for outside help from a school-based pre-referral team.

PHASE TWO: Pre-referral

The pre-referral step in the special education process is more formal than providing simple and temporary accommodations for students. Pre-referral intervention is to identify, develop, and implement alternative education strategies for students who have recognized problems in the classroom before the student is referred to special education. Pre-referral intervention is typically conducted by a Student Centered Team (also called early intervention team, intervention assistance team, student support team, teacher assistance team, or instructional support team). The pre-referral team usually consists of the teacher, the parents/guardians, an administrator, other general education teachers, nurse, guidance counselor, and any other adult involved in the education of the student. The general education teacher provides background information regarding the problem exhibited by the student and the team works together to develop possible solutions.

Because of changes to IDEA in 2004, many states and independent school districts have begun using a more formal and systematic pre-referral process called response to intervention (RTI).

"RTI is a model designed to address the needs of all children through a continuum of services, which include:

High-quality instruction and tiered evidence-based or practice-based intervention strategies aligned with individual student needs;

Frequent monitoring of progress to make results-based academic or behavioral decisions; and

Application of child response data to important educational decisions (such as those regarding placement, intervention, curriculum, and instructional goals and methodologies)" (TEA, 2007).

RTI provides three levels of intervention for students who are experiencing problems. Generally, the first level (sometimes referred to as Tier 1) is focused on utilizing high-quality general education instruction in the core curriculum with all students. RTI theorizes that around 80% of all students will respond positively to core curriculum and behavior systems. The second level (or Tier 2) provides targeted group instruction or some form of group remediation to improve performance. The RTI model believes that second level services will improve performance for approximately 15% of all students. If performance does not improve in the second level, then students are moved to the third level which consists of intensive, individualized interventions.

Whether the school uses pre-referral teams or the more formal RTI process, the intent is to provide interventions that will help the student achieve success without entering special education. However, if these interventions do not improve the student's performance, then the student will be referred for an assessment to determine possible eligibility for special education services.

PHASE THREE: Referral for Special Education Evaluation

If, after interventions in the general education classroom, the student continues to experience difficulty, school personnel may refer the child for a special education evaluation. Referrals for determination of eligibility for special education services may be initiated by:

School personnel (including general education teachers, special education teachers, counselors, administrators, etc.);

Child's parent(s) or legal guardian(s);

Any other person involved in the education or care of the child.

The official referral begins the formal process of determining eligibility for special education services. Once a referral is provided, the school must obtain consent from the parent(s) or legal guardian(s) to begin the evaluation phase of the referral process.

PHASE FOUR: Special Education Evaluation

IDEA requires that students referred for special education services receive a nondiscriminatory multi-factored evaluation. The school district is required to complete the evaluation within 60 days of the referral date. The evaluation is to be conducted by a multidisciplinary team that will consist of individuals who can bring different perspectives and expertise to the evaluation. Some examples of team members include:

Educational Diagnostician (also called Psychometrist) or School Psychologist: These professionals are qualified to conduct all types of educational assessments including intelligence (IQ), achievement, behavior, etc.

Special Educators: These individuals are qualified to conduct some types of achievement and behavior evaluations as well as informal observations.

General Educators: These individuals provide documentation of the problems of the specific student.

Parent(s) or Legal Guardian(s): The parents or legal guardians provide valuable insight into the student's behavior and personality in other environments.*

Related Service Providers (Physical Therapist, Occupational Therapist, Audiologist, Orientation and Mobility Specialist, etc.): These specialists provide information pertaining to specific areas of concern that have been assessed.

Medical Doctors (including psychiatrists, ophthalmologists, and optometrists): Depending on the disability of the student, medical records can also be used in the determination of eligibility for special education services.

* Parents of students with developmental disabilities must decide whether to complete the legal process to become the legal guardian once their child reaches 18 years old, the age of majority. According to Texas state law, this process is separate from the required school transition planning process.

The evaluation must be comprehensive and use evaluation tools and strategies that are technically sound and accepted. Most students receive a battery of formal evaluations that measure:

Intelligence

Achievement

Behavioral

Disability-specific issues

Medical

However, informal observations and documentation of the student's past work should also be used during the eligibility determination meetings. Assessments may not be biased in regard to race, culture, language, or disability. The materials and procedures must be administered in the language and form most likely to provide accurate information on what the child knows and can do.

PHASE FIVE: Eligibility (FAPE)

IDEA states that each child is entitled to a Free Appropriate Public Education (FAPE.) Special education services are one way to accomplish that requirement for some students with disabilities. Within 30 days of the completion of the evaluation, the individuals that took part in the process thus far will meet to determine eligibility. In simple terms, a student is considered eligible for special education services if (1) the child has a disability as defined by IDEA which negatively impacts his/her educational performance, and (2) the child needs special education services in order to benefit from education.

Not all students are determined to be eligible for special education services. There are multiple reasons why a student may not qualify for special education services including not having a disability that negatively impacts his or her education. However, these students may need help to access the academic curricula. In these situations, the school will need to work out a plan to provide other services for the student.

If the team determines that the student is eligible for special education services, then a formal Individualized Education Program (IEP) team will be formed to develop a plan of special education services for the student.

PHASE SIX: IEP Meeting (IEP and LRE)

The Individualized Education Program (IEP) is a legal contract between the parents and the school district that describes the special education services to be provided by the local education agency which is the local school district. While IEP documents vary, the basic parts of an IEP include:

A student profile that provides background information about the student. The profile will include strengths and weaknesses of the student, information regarding performance in the classroom and on formal assessments, and the reason he or she is receiving special education services.

IEP initiation and duration dates: the goals expressly stated in an IEP begin on the date, stated in the IEP meeting, and are in effect until the date stated in the IEP. These IEP goals are reviewed, monitored and updated based on student progress. For most students, IEP goals are in place for one academic year.

A statement of "special instructional factors" (such as the need for assistive technology, braille, or transition services). If the student requires any of the special instructional factors, they should be addressed in the IEP.

A statement of special transportation needs;

A statement of opportunities to participate in nonacademic and extracurricular activities with their non-disabled peers

A statement of the frequency and method of reports of goal attainment for parents or guardians.

Benchmark pages are included and focus on specific areas that need special education services (such as reading, math, PE, etc.). The benchmark pages include: Present Levels of Academic Achievement and Functional Performance (PLAAFP) statements,

Measurable Annual Goals,

Evaluations used to measure annual goals,

Benchmarks to be achieved to meet the annual goals,

Special education and related services needed to achieve the annual goal (includes frequency of services, amount of time, location, and responsible agencies).

A Behavior Intervention Plan (BIP) if the student's behavior is a concern and a functional behavioral assessment has been done or needs to be conducted,

For students 16 years and older; the plans and activities for the student's transition from high school will be addressed

The signature page which provides a statement of least restrictive environment (LRE) and has the signatures of all members present at the meeting.

The benchmark pages are the "meat" of most IEPs and can be developed by any member of the team. Typically, these pages are developed by the special education teachers in collaboration with the parents, general education teachers, related service providers, and behavioral specialists.

In some school districts, the IEP meeting may be referred to as the ARD meeting. ARD stands for Admission, Review, and Dismissal. The IEP team (also called IEP committee or ARD committee) is formed for the purpose of 1) developing the IEP, the formal plan of special education services; 2) overseeing the implementation of the plan, 3) evaluating the effectiveness of the plan annually, and 4) developing future plans as needed. The IEP team can also meet as needed when unique issues present themselves during the academic year (such as with behavior issues).

The IEP team is composed of the following:

The parent(s) or legal guardian(s) of the student with a disability;

At least one general education teacher of the student if the student is or may be participating in the regular education environment for any classes;

At least one special education teacher of the student or a special education provider of the student;

A representative of the local educational agency (LEA) who is (1) qualified to supervise the needs of the student, (2) is knowledgeable of the general curriculum, (3) is knowledgeable about the availability of resources of the public agency, and (4) has the authority to commit agency resources; This person is frequently a principal or assistant principal of the student's campus.

An individual who can interpret the instructional implications of evaluations (typically an educational diagnostician, school psychologist, or specially-trained special education teacher);

The student, when appropriate; and

Other individuals asked to attend at the discretion of the school or the parent who have knowledge or special expertise regarding the student (such as related service providers and/or family members or family friends maintaining a close relationship with the student). Parents also have the right to invite an advocate if they so desire.

Depending on the age of the student, other individuals may be included in the meeting including rehabilitation or transition service providers or early intervention representatives.

PHASE SEVEN: IEP Implementation

Once the IEP is developed and signed by members of the IEP team it is the responsibility of the entire IEP team to ensure that the IEP is implemented. The IEP team may meet as frequently as needed to discuss the implementation of the IEP. School personnel are required to provide documentation of the mastery of benchmarks and annual goals. The IEP document is a "living" document and can be altered during the school term if needed. The IEP goals and benchmarks provide the objectives for the education of the student and prescribe what services will be provided by the local school district and school campus to achieve those objectives. However, it must be understood that school agencies are not required to meet all the goals within the school term, but they must provide evidence of a "good faith effort" toward achieving the goals.

PHASE EIGHT: Reevaluation

Each year, the IEP team is required to meet for the dual purpose of evaluating the implementation of the current IEP and to develop the next annual IEP. During these annual meetings, the IEP team should discuss the positive and negative elements of the special education services provided and determine, based on any new assessment data, what services should be provided in the upcoming school year.

While the IEP is redeveloped each year, the IEP team does not have to conduct the battery of assessments each year. At a minimum, the IEP team is to determine if formal evaluation is required every three years. However, the IEP team can ask that formal evaluations be conducted more frequently if needed.

There are times when, after the reevaluation takes place, it is determined that the student does not need special education services. One example of this might be young children who are provided speech and language services and have developed the ability to speak without problems. In this case, the IEP team will need to file appropriate documentation to support the fact that the student no longer is eligible for services and the IEP team will disband for this student.

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Special Education Referral Process - Project IDEAL

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Overview to the “Special Education Process”; the global procedures for providing a student with disabilities a free and appropriate education.

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People often don't get the mental health services they need because they don't know where to start.

Talk to your primary care doctor or another health professional about mental health problems. Ask them to connect you with the right mental health services.

If you do not have a health professional who is able to assist you, use these resources to find help for yourself, your friends, your family, or your students.

Emergency Medical Services, 911

If the situation is potentially life-threatening, get immediate emergency assistance by calling 911, available 24 hours a day.

988 Suicide & Crisis Lifeline

If you or someone you know is suicidal or in emotional distress, contact the 988 Suicide & Crisis Lifeline. Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals.

Call or text 988 or chat 988lifeline.org.

Find Treatment with SAMHSA

SAMHSA's Behavioral Health Treatment Services Locator is a confidential and anonymous source of information for persons seeking treatment facilities in the United States or U.S. Territories for substance use/addiction and/or mental health problems.

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People often don't get the mental health services they need because they don't know where to start. Talk to your primary care doctor or another health professional about mental health problems. Ask them to connect you with the right mental health services.

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(Petersen, 2019)

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(Patel, 2020)

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Eating Disorder Professional Development for Educators 

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Eating Disorder Professional Development for Educators 

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National Eating Disorder Collaborations

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Education professionals play a large and ongoing role in the influence of young people.

Educator Resources

The NEDC has developed a range of resources to assist education professionals working in schools to understand eating disorders, promote health and wellbeing within their schools, recognise and respond to eating disorders, and support students who are undergoing treatment for an eating disorder.

Follow the link below to access the Eating Disorders Info website, created by the NEDC for young people.

www.eatingdisordersinfo.org.au - A mobile friendly website specifically created for young audiences.

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Education professionals play a large and ongoing role in the influence of young people. The NEDC has developed a range of resources to assist education professionals working in schools to understand eating disorders, promote health and wellbeing within their schools, recognise and respond to eating disorders, and support students who are undergoing treatment for an eating disorder.

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National Eating Disorders Association

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Anxiety Disorder Fact Sheet (For Schools)

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Anxiety Disorder Fact Sheet (For Schools)

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Kids Health

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What Teachers Should Know

Anxiety disorders are among the most common mental health problems of childhood and adolescence.

Anxiety disorders cause people to feel excessively frightened, distressed, or uneasy during situations in which most people would not feel that way. Left untreated, anxiety disorders can impair students' ability to work or study and may affect their personal relationships. In the most severe cases, anxiety disorders can make going to school incredibly difficult.

The most common anxiety-related disorders affecting kids and teens are:

Generalized anxiety disorder. With this common anxiety disorder, children worry excessively about many things, such as school, the health or safety of family members, or the future in general. These students also may have physical symptoms, such as headaches, stomachaches, muscle tension, or tiredness. Their worries might cause them to miss school or avoid social activities.

Obsessive compulsive disorder (OCD). Children with OCD have excessive preoccupying thoughts (obsessions) and repetitive actions done to try to relieve their anxiety (compulsions).

Specific phobias. These are unrealistic and excessive fears, such as a fear of dogs or enclosed spaces. Phobias usually cause people to avoid the things they fear.

Social anxiety disorder (social phobia). This anxiety is triggered by social situations or speaking in front of others. It is an intense fear of being judged in social situations or performance. A less common form, calledselective mutism, causes some students to be too fearful to talk at all in certain situations.

Panic disorder. A panic attack can happen for no apparent reason. With a panic attack, a person has sudden and intense physical symptoms that can include a pounding heart, shortness of breath, or dizziness caused by the body's normal fear response.

Posttraumatic stress disorder (PTSD). This results from a past traumatic event/experience.

Separation anxiety disorder: High level of distress when separated from a caregiver.

Students with an anxiety disorder may:

have trouble concentrating in class or completing classwork

feel self-conscious and avoid certain situations

have physical symptoms, such as a racing heart, fast breathing, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs

take medication to help reduce anxiety

miss class time due to problems coping at school, or needing to talk with a school counselor or therapist

What Teachers Can Do

Students with anxiety disorders may have difficulty completing their work. Teachers can help ease anxiety levels by:

talking with parents or guardians to learn about strategies that work at home

allowing students extra time to do work

checking that their assignments are written down correctly

giving them daily schedules

modifying assignments and reducing workloads when necessary

promoting relaxation techniques and allowing for breaks throughout day

encouraging school attendance, which may require shortened school days and modified class schedules

allowing them a safe space and ability to go speak with a counselor, if needed

easing anxiety in the classroom by pairing with a peer

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Anxiety Disorders Factsheet (for Schools)

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Anxiety disorders are among the most common mental health problems of childhood and adolescence. Anxiety disorders cause people to feel excessively frightened, distressed, or uneasy during situations in which most people would not feel that way. Left untreated, anxiety disorders can impair students' ability to work or study and may affect their personal relationships.

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PositivePsychology.com

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CBT Techniques: 25 Cognitive Behavioral Therapy Worksheets

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Here's a list of 25 cognitive behavioral therapy techniques, CBT interventions, and exercises. Try these worksheets in your own practice!

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Counselor Keri Blog: Resources to Spark Student Growth

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Anxiety is tricky, right? It can be a hard topic for kids to understand, especially when they're experiencing the physical effects of worry. But psychoeducation is an integral part of helpings kids deal with anxiety - it's harder to overcome things we don't understand, after all! Keep reading to find some of my favorite resources and activities to help kids understand what anxiety is.

Help Kids Understand Anxiety

1 - Smoke Alarm Analogy

Age: All ages

To explain what anxiety is, I use the smoke alarm analogy. Smoke alarms are really helpful for alerting us to danger when there's a fire and we need to get out of the building. But sometimes smoke alarms go off even when there isn't a big danger, like when we burn popcorn or toast. It makes the same sound for big emergency fires or little non-emergency fires.

Anxiety does the same thing. Anxiety tells us there's a big danger, even if the situation is actually not that big. It feels like a big danger because anxiety sends the same signals. The good news is we can learn skills to tame that anxiety emergency alarm (no more burnt toast alarms!).

2 - Hey Warrior

Age: Elementary & Middle School

I saw this book recommended on Instagram by fellow counselor, Gretchen, from Speckled Moose Counseling. I was hesitant to order from Australia because I'm spoiled on Amazon Prime, but it was 100% worth the extra shipping cost! This book does a fantastic job of explaining what worry is, where it comes from, and how kids can be warriors over their worries.

3 - Gremlin Girl

Age: Middle & High School

When I was planning for a classroom guidance lesson on anxiety, I wanted to find a way to break the ice and show my students that talking about anxiety is okay! So, of course, I went straight to their favorite source of entertainment: Youtube. I found this great mini-series called Gremlin Girl. The episodes depict anxiety as a Gremlin that pops up and has a lot to say. This video about waiting for text message responses is my favorite from the series so far:

My students loved this and were all quick to say how relatable it is! This was just a simple way to open the door to a conversation about anxiety while letting students see that others sometimes share the experience.

Find more activities to help kids understand anxiety:
Worry Warriors Group Counseling Curriculum Worry Workbook

How do you help kids understand anxiety? Fill us in below!

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Help Kids Understand Anxiety: Psychoducation to Help Kids Who Worry

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Anxiety is tricky, right? It can be a hard topic for kids to understand, especially when they're experiencing the physical effects of worry. But psychoeducation is an integral part of helpings kids deal with anxiety - it's harder to overcome things we don't understand, after all!