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American School Counselor Association Ethical Standards for School Counselors

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American School Counselor Association Ethical Standards for School Counselors

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Home - American School Counselor Association (ASCA)

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Strategies for Learning and Teaching: Special Education Support Services

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Strategies for Learning and Teaching: Special Education Support Services

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Working to deliver a better special education service

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What can I do as a teacher or school to encourage healthy eating habits and to be active? | SA Health

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How primary school teachers and schools can help children and teens to develop healthy eating habits and to be active.

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Get basic information on the Individuals with Disabilities Education Act (IDEA), the federal special education law, in this one-page fact sheet. You can read the fact sheet below or print it out to take to IEP meetings. You can also share it with school, district or state education officials when you're advocating for your child. (Click on the download link below to print the fact sheet.)

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Get basic information on the Individuals with Disabilities Education Act (IDEA), the federal special education law, in this one-page fact sheet. You can read the fact sheet below or print it out to take to IEP meetings. You can also share it with school, district or state education officials when you're advocating for your child.

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The Difference Between IEPs and 504 Plans

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The Difference Between IEPs and 504 Plans

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. And the disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And the disability must interfere with the child's ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team must include:

The rules about who's on the 504 team are less specific than they are for an IEP. A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

* The child's parent or caregiver

* General and special education teachers

* The school principal

* The child's parent or caregiver

* At least one of the child's general education teachers

* At least one special education teacher

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document. A 504 plan generally includes the following:

* Specific accommodations, supports, or services for the child

* Names of who will provide each service

* Name of the person responsible for ensuring the plan is implemented

* The child's present levels of academic and functional performance - how the child is currently doing in school

* Annual education goals for the child and how the school will track progress

* The services the child will get - this may include special education, related, supplementary, and extended school year services

* The timing of services - when they start, how often they occur, and how long they last

* Any accommodations - changes to the child's learning environment

* Any modifications - changes to what the child is expected to learn or know

* How the child will participate in standardized tests

* How the child will be included in general education classes and school activities

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations. Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

How to resolve disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

* Mediation

* Alternative dispute resolution

* Impartial hearing

* Complaint to the Office for Civil Rights (OCR)

* Lawsuit

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

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

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

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IEP vs. 504 Plan: What's the Difference?

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Students with Disabilities & Section 504 of the Rehabilitation Act of 1973

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Students with Disabilities & Section 504 of the Rehabilitation Act of 1973

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At a glance

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education services to eligible students.

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education and related services to eligible students. But not every child who struggles in school qualifies. To be covered, a child's school performance must be "adversely affected" by a disability in one of the 13 categories below.

1. Specific learning disability (SLD)

The "specific learning disability" (SLD) category covers a specific group of learning challenges. These conditions affect a child's ability to read, write, listen, speak, reason, or do math. Here are some examples of what could fall into this category:

SLD is the most common category under IDEA. In the 2018-19 school year, around 33 percent of students who qualified did so under this category.

2. Other health impairment

The "other health impairment" category covers conditions that limit a child's strength, energy, or alertness. One example is ADHD, which impacts attention and executive function.

3. Autism spectrum disorder (ASD)

ASD is a developmental disability. It involves a wide range of symptoms, but it mainly affects a child's social and communication skills. It can also impact behavior.

Various mental health issues can fall under the "emotional disturbance" category. They may include anxiety disorder, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression. (Some of these may also be covered under "other health impairment.")

5. Speech or language impairment

This category covers difficulties with speech or language. A common example is stuttering. Other examples are trouble pronouncing words or making sounds with the voice. It also covers language problems that make it hard for kids to understand words or express themselves.

6. Visual impairment, including blindness

A child who has eyesight problems is considered to have a visual impairment. This category includes both partial sight and blindness. If eyewear can correct a vision problem, then it doesn't qualify.

Kids with a diagnosis of deafness fall under this category. These are kids who can't hear most or all sounds, even with a hearing aid.

The term "hearing impairment" refers to a hearing loss not covered by the definition of deafness. This type of loss can change over time. Being hard of hearing is not the same thing as having trouble with auditory or language processing.

Kids with a diagnosis of deaf-blindness have both severe hearing and vision loss. Their communication and other needs are so unique that programs for just the deaf or blind can't meet them.

10. Orthopedic impairment

An orthopedic impairment is when kids lack function or ability in their bodies. An example is cerebral palsy.

11. Intellectual disability

Kids with this type of disability have below-average intellectual ability. They may also have poor communication, self-care, and social skills. Down syndrome is one example of a condition that involves an intellectual disability.

12. Traumatic brain injury

This is a brain injury caused by an accident or some kind of physical force.

13. Multiple disabilities

A child with multiple disabilities has more than one condition covered by IDEA. Having multiple issues creates educational needs that can't be met in a program designed for any one disability.

Having a disability is not enough to qualify for special education. The disability has to have an "adverse effect" on a child's education.

Key takeaways

Each of the 13 disability categories in IDEA can cover a range of difficulties.

Dyslexia, dyscalculia, and written expression disorder fall under the "specific learning disability" category.

"Other health impairment" can cover ADHD.

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

Rayma Griffin, MA, MEd has spent 40 years working with children with learning and thinking differences in the classroom and as an administrator.

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See a list of the 13 IDEA disability categories. Find out which disabilities can qualify kids for special education.

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Individuals with Disabilities Education Act

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Additionally, the IDEA authorizes:

In the law, Congress states:

The stated purpose of the IDEA is:

to ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living;

to ensure that the rights of children with disabilities and parents of such children are protected;

to assist States, localities, educational service agencies, and Federal agencies to provide for the education of all children with disabilities;

to assist States in the implementation of a statewide, comprehensive, coordinated, multidisciplinary, interagency system of early intervention services for infants and toddlers with disabilities and their families;

to ensure that educators and parents have the necessary tools to improve educational results for children with disabilities by supporting system improvement activities; coordinated research and personnel preparation; coordinated technical assistance, dissemination, and support; and technology development and media services;

to assess, and ensure the effectiveness of, efforts to educate children with disabilities.

Learn more about the IDEA Statute and Regulations.

Search the IDEA Statute and Regulations.

On November 29, 1975, President Gerald Ford signed into law the Education for All Handicapped Children Act (Public Law 94-142), now known as the Individuals with Disabilities Education Act (IDEA). In adopting this landmark civil rights measure, Congress opened public school doors for millions of children with disabilities and laid the foundation of the country's commitment to ensuring that children with disabilities have opportunities to develop their talents, share their gifts, and contribute to their communities.

The law guaranteed access to a free appropriate public education (FAPE) in the least restrictive environment (LRE) to every child with a disability. Subsequent amendments, as reflected in the IDEA, have led to an increased emphasis on access to the general education curriculum, the provision of services for young children from birth through five, transition planning, and accountability for the achievement of students with disabilities. The IDEA upholds and protects the rights of infants, toddlers, children, and youth with disabilities and their families.

In the last 40+ years, we have advanced our expectations for all children, including children with disabilities. Classrooms have become more inclusive and the future of children with disabilities is brighter. Significant progress has been made toward protecting the rights of, meeting the individual needs of, and improving educational results and outcomes for infants, toddlers, children, and youths with disabilities.

Since 1975, we have progressed from excluding nearly 1.8 million children with disabilities from public schools to providing more than 6.9 million children with disabilities special education and related services designed to meet their individual needs.

Today, more than 62 percent of children with disabilities are in general education classrooms 80 percent or more of their school day, and early intervention services are being provided to more than 340,000 infants and toddlers with disabilities and their families.

The Rehabilitation Act of 1973, Section 504 addresses protections for students with disabilities. Section 504 is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the department.

OCR enforces section 504 in public elementary and secondary schools.

Section 504 states: "No otherwise qualified individual with a disability in the United States... shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance...."

OCR also enforces Title II of the Americans with Disabilities Act of 1990, which extends protection against discrimination to the full range of state and local government services, programs, and activities including public schools regardless of whether they receive any Federal financial assistance.

OCR shares in enforcement of Title II of the Americans with Disabilities Act with the U.S. Department of Justice.

For more on the Americans with Disabilities Act, visit www.ada.gov.

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About IDEA - Individuals with Disabilities Education Act

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The Individuals with Disabilities Education Act (IDEA) is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.

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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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How to Help a Child with an Anxiety Disorder

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How to Help a Child with an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety.

Credit... Getty Images

By

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesn't necessarily declare itself with attention-getting disruptive behaviors; in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Adults may also assume that anxiety in a child is just a phase to be outgrown. A certain amount of anxiety is a normal aspect of development for young children - consider separation anxiety, for example - and it can even be protective, since children need to learn to keep themselves safe and anticipate certain kinds of dangers. But when worrying or avoiding possible threats gets in the way of a child's functioning or a child's enjoyment, it should be a signal to parents that help is needed, not just watching and waiting, not arranging the child's life to avoid the occasions of anxiety.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, "To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence." These children can get missed, she said, because they may seem to be functioning well; many don't have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

Consider the child whose anxiety about speaking in public gets in the way of participating in class. The child may be silent out of a fear of being laughed at or otherwise rejected, Dr. Merikangas said, but to the teacher, it may look like the child is just not interested. Environmental modifications can really help these children thrive in school, she said; for example, working in small groups with children they know.

The new report, released in September, summarizes the evidence that early temperament in children predicts their later behavior patterns around anxiety; toddlers who show what are called "behaviorally inhibited" behaviors, which parents are likely to perceive as extreme shyness, or anxiety around new people, are more likely to develop social anxiety later on. That doesn't mean that shyness is pathological (as with all varieties of temperament, there's a wide range of function), but it does suggest how important it is to help a child with this temperament who develops difficulties.

The tendency toward anxiety - and toward some specific forms of anxiety, like phobias - may persist throughout childhood and adolescence and into adulthood. And anxiety is closely tied to depression, Dr. Merikangas said. Although there have been reports that anxiety rates among American teenagers have soared, she cited evidence that the international rates of the underlying disorders had stayed consistent from 1998 to 2013; there is no global "epidemic" of clinical anxiety disorders, she said.

But with rates of suicide and suicidal ideation on the rise, it's particularly important to provide information to schools and to parents about recognizing anxiety and getting children help.

Dr. Harold Koplewicz, the president of the Child Mind Institute, said that when anxiety disorders in children are left untreated, anxiety can inhibit their lives, making standard daily activities difficult, from attending school to sleeping in their own beds, and lead to many extra visits to the school nurse or the pediatrician.

But beyond that, he said, "people underestimate that this is a gateway disorder." If children don't get help with these disorders, they may be at risk to develop other mental health problems; the child with severe separation anxiety may develop panic disorder, he said; the child with untreated general anxiety may be at greater risk for depression.

Dr. Merikangas was a co-investigator on a national study of mental disorders in adolescents, which has shown both that anxiety disorders were the most common mental health problems in adolescents in the United States, and also the problems that showed up earliest in those children's lives - the mean age of onset for anxiety disorders was 6. But many adolescents had never received treatment. That makes it essential to get the word out, Dr. Merikangas said, that anxiety is "one of the most treatable symptoms and syndromes, we can really change their lives with minimal intervention."

"All these disorders are remarkably treatable," Dr. Koplewicz said. There are highly effective behavioral and psychosocial therapies, including cognitive behavioral therapies, to help children cope with the demands of daily life. For children who don't respond to psychosocial therapies, he said, medications can be added.

But perhaps because anxiety is a normal response, parents often believe that even severe and disabling anxiety symptoms are just a phase, and on average, there is a two-year lag between the time children develop anxiety and the time they get help. "It's bad for these children's brains," he said. "Having your brain's thermostat miss-set is not good for your brain."

"Anxiety can manifest itself along a continuum," said Rachel Busman, the senior director of the anxiety disorders center at the Child Mind Institute. The report shows that there is some overlap with physical illnesses, such as chronic headaches or stomach aches, often coordinated with school. "That could be a kid's way of saying, 'I'm anxious,'" she said.

And when a child who is having a lot of difficulty with separation gets into the classroom, Dr. Busman said, that child may start throwing things, or running and hiding, and that "bad behavior" may represent the fight or flight response of anxiety. "We've also seen kids who have intense social anxiety and their way of managing it is to be class clown," she said.

Treating children with anxiety always means working with their parents. Jerry Bubrick, senior clinical psychologist at the anxiety disorders center of the Child Mind Institute, said that when children are little, it's normal for parents to operate in "fix-it mode," blocking the staircase so a toddler doesn't tumble down, averting problems before they happen.

As children get older, parents normally pull back, helping children find solutions of their own. "But anxious parents of anxious children remain in fix-it mode," he said, helping their children avoid the situations that make them anxious. Therapy involves exposing children to those situations and helping them develop strategies to manage them; with treatment, Dr. Bubrick said, parents can "let the child experience the anxiety and learn to tolerate and overcome it on their own."

"If you see things you're not sure about, talk to the preschool, talk to the pediatrician, be open to the idea that maybe there is anxiety," even in a young child, Dr. Busman said. Separation anxiety can be a problem even in children who are able to go to school, she said. Parents should pay attention if a child can't be left with a babysitter, a child can't sleep alone at home."These are the kids, they go into the bathroom, and they're like, are you still there?" she said. "We do see really young anxious children."

"If your child is suffering distress and dysfunction, reach out to your pediatrician," Dr. Koplewicz said. When you get to a mental health professional, "make sure you ask the right questions," he said, including asking whether that person has specific experience with treating anxiety and how long the treatment is expected to take.

"You want a professional who understands what they're doing and can explain to you what they're doing."

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How to Help a Child With an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety. By Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York.

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A Study on Prevalence of Anxiety Disorders Among Higher Secondary School Students

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Inside Higher Ed | Higher Education News, Events and Jobs

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More than half of the college students who visited their campus counseling centers during the 2015-16 academic year reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors.

This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services. This year, 51 percent of students who visited a counseling center reported having anxiety, followed by depression (41 percent), relationship concerns (34 percent) and suicidal ideation (20.5 percent). Many students reported experiencing multiple conditions at once.

Since 2009, when anxiety overtook depression as the No. 1 concern among college students, the number of students experiencing anxiety has steadily increased.

This survey was conducted between September 2015 and August 2016. In total, 529 counseling center directors representing that many institutions responded to the survey, with an even split between public and private institutions. The majority of respondents came from four-year colleges, but community colleges, professional schools and art schools were also included.

In an effort to reflect the makeup of their student bodies, counseling centers have diversified their clinical staff members. Of new hires, 62.2 percent are white, 15.3 percent black, 7.5 percent Latino and 10 percent Asian. This compares to current clinical staff, who are 70.9 percent white, 10.1 percent black, 7.3 percent Latino and 7.9 percent Asian.

"Student populations have become more diverse," said Micky Sharma, president of the AUCCCD and director of counseling and consultation services at Ohio State University. "Counseling services work to create a staff that represents their student bodies."

At Ohio State, for example, the counseling center now offers clinical services in nine different languages to meet the needs of their international students, who make up about 12 percent of the student body, Sharma said.

Regardless of race, ethnicity, gender or sexual orientation, "anyone could show up with anxiety or depression or a relationship issue," Sharma said. "A university counseling center is charged with providing help for everybody."

Another key finding in the survey is that 41.6 percent of counseling centers hired additional staff members in the last academic year, compared to about 26 percent in 2011 and 36 percent in 2016.

College counseling centers continue to grow to match the demands of their students, according to David Reetz, the lead researcher and coordinator for the 2016 survey and director of counseling and psychological services at the Rochester Institute of Technology.

"More students are seeking services because we continue to be more and more aware that a student's health and well-being have a lot to do with their success in their academic programs and the quality of their student life experience," Reetz said.

In fact, of the students surveyed, about 72 percent who used counseling services said it helped their academic performance in some way.

As more students continue to seek out mental health services and campus counseling centers try to keep up with new hires, the question of student wait times becomes key.

For the first time, this year's survey asked counseling center directors about average wait times for students based on the number of business days between when the appointment was scheduled and when it occurred.

The survey team found that, on average, students waited between six and eight business days for counseling services. However, as might be expected, institutions with a lower ratio of professional staff to students saw shorter wait times.

Reetz noted that the wait-time average is a "tricky number," given that some students opt to schedule their first appointment farther out to accommodate their own schedules.

"Students don't necessarily want to be seen right away," Reetz said, adding that, generally, "the more staff a center has, the shorter that wait time is between initial contact and first appointment."

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Anxiety and depression are the primary concerns for students seeking counseling services

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Survey of campus counseling centers finds increased demand for services, as well as additional positions and more diversity in hiring.

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October 2010 | Volume 68 | Number 2
Interventions That Work Pages 46-51

R. Marc A. Crundwell and Kim Killu

Rita's story illustrates the essential features of clinical depression in children and adolescents: a persistent sad or irritable mood, loss of energy, decreased interest in daily activities or previously enjoyed activities, persistent feelings of worthlessness or guilt, withdrawal, and, possibly, recurrent thoughts of suicide. Children and adolescents with depression may also show appetite changes resulting in weight gain or loss, disturbed sleep patterns, increased defiance or oppositional behavior, and impaired concentration.

Recognizing Rita

Although depression is classified as an adult disorder-and depression in very young children is rare-middle to late adolescence is the most common age when symptoms first appear or a first major depressive episode happens (Burke, Burke, Regier, & Rae, 1990). Lewinsohn, Hops, Roberts, Seeley, and Andrews (1993) randomly sampled adolescents within a U.S. community and discovered that the average age of onset of major depression was 14. Sadly, the earlier the onset of depression in children and adolescents, the more protracted and severe the course of the disorder usually is (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984).

As Figure 1 (p. 48) illustrates, research and clinical experience show that depression manifests itself differently in children than in adolescents in terms of what teachers see in the classroom (Kashani, Rosenberg, & Reid, 1989).

Figure 1. Characteristics of Depression in Children and Adolescents

When depression is recognized early and when professionals provide treatment, young people can experience improved mood and function better in school and life. Thus, the stakes are high. School personnel play a pivotal role in identifying depression-and intervening. Teachers, administrators, and other school staff must also be knowledgeable about depression because the disorder can seriously impair academic and interpersonal behavior at school (Hammen & Rudolph, 2003).

Depression is significantly correlated with poor academic grades, and students with higher ratings of depression are less likely to graduate from high school (Forehand, Brody, Long, & Fauber, 1988). Cognitive issues may include low tolerance for frustration and negative patterns of thinking. Depressed students often give up more quickly on tasks they perceive as daunting, refuse to attempt academic work they find too difficult, and quickly doubt their ability to independently complete academic tasks or solve problems. Memory, speech, physical and motor activity, and the ability to plan may also be affected. Many depressed children and adolescents are lethargic, speak laboriously, and have difficulty completely expressing thoughts and ideas.

Rita's case illustrates three other issues with regard to recognizing depression. First, the essential features of depression are as recognizable in youth as they are in adults, and the same diagnostic criteria are used for both age groups (Mitchell, McCauley, Burke, & Moss, 1988). Second, irritability is more common in depressed youth than in depressed adults. Third, teachers often overlook children with depression because symptoms like a sad mood or fatigue are more internal and subjective than the kinds of disruptive behavior shown by kids with more externalizing disorders, such as attention deficit disorder. Depressed young people often don't ask for help at school because of negative thinking patterns: No one cares about my feelings, nothing can be done to help me, and so on (Cash, 2003). Younger students often lack the necessary language skills and self-awareness to report-or recognize-their own depressed state.

Helping Students with Depression

Because depression can have broad negative effects on students' academic work and comfort in school, schools need to provide a variety of accommodations and instructional strategies to increase these students' success. Figure 2 (p. 50) shows strategies that can benefit children and adolescents battling depression.

Figure 2. Strategies to Help Students with Depression

Give frequent feedback on academic, social, and behavioral performance.

Teach the student how to set goals and self-monitor.

Teach problem-solving skills.

Coach the student in ways to organize, plan, and execute tasks demanded daily or weekly in school.

Develop modifications and accommodations to respond to the student's fluctuations in mood, ability to concentrate, or side effects of medication. Assign one individual to serve as a primary contact and coordinate interventions.

Give the student opportunities to engage in social interactions.

Frequently monitor whether the student has suicidal thoughts.

Develop a home-school communication system to share information on the student's academic, social, and emotional behavior and any developments concerning medication or side effects.

The best approach is often individualized. Here we describe an approach school personnel might use to help Rita.

As Rita's teacher Mrs. Shannon became worried about her, she shared her concerns with Rita's parents. They were relieved that the school had contacted them and were encouraged by the school's willingness to collaborate with them to address Rita's downward spiral and make decisions about ways to help her. With their cooperation, Mrs. Shannon and the school's guidance counselor brought together a team to provide interventions for Rita. This team brought in the school psychologist, who first strongly recommended that Rita's family physician evaluate her to determine whether further referral to a child psychiatrist was appropriate.

The school's intervention team, the school psychologist, and Rita's parents together developed an individualized plan of accommodations and instructional strategies to help Rita cope. After determining some appropriate interventions, the team met with Rita to discuss these possibilities and get her feedback; they knew this would increase the chance she would buy in. All the players involved agreed to meet monthly to review Rita's response to the interventions, ensure that their actions were helping her, and make any modifications needed.

Establish a Touchstone Teacher

Rita and a teacher from the resource room in her school, Ms. Hunt, began meeting weekly to help Rita develop specific goals for how she could manage better academically, socially, and in terms of behavior. Ms. Hunt was chosen because, as a resource teacher, she had flexibility to meet with Rita and could coordinate services with all of Rita's teachers. They met each Monday morning to review any work that Rita completed over the weekend and to set goals, targeting four areas in which depression typically affects students most strongly: work completion, work submission, social interactions, and physical activity.

The team considered it important that Rita take an active role in setting and achieving goals. This would help her learn self-management skills, which would later serve her in managing her depressive symptoms, accomplishing difficult tasks, and achieving personal goals (Cooper, Heron, & Heward, 2007). On Fridays, Rita again met with Ms. Hunt to review the week's progress toward her goals and discuss any assignments for the weekend. She also informally checked in with Ms. Hunt before lunch and at the end of most days.

Ms. Hunt became a nonthreatening liaison between Rita and her other teachers. Rita's teachers met weekly with this resource teacher to communicate clear guidelines and expectations for Rita's coursework. Thus, Ms. Hunt could help Rita coordinate her work across subjects and follow through on a self-management checklist of in-class assignments. Getting kids to use such self-monitoring tools has been found to improve on-task behavior in the classroom (Wood, Murdock, Cronin, Dawson, & Kirby, 1998); homework completion (Trammel, Schloss, & Alper, 1994); and academic performance (Wolfe, Heron, & Goddard, 2000).

As a result of their fluctuating moods, depressed students often have difficulties organizing work and persisting. Proactive strategies like monitoring progress and providing frequent feedback on whether students are meeting teachers' expectations are essential.

Teach Study Strategies

Rita's classroom teachers monitored her mood and energy level closely, periodically giving her a short break when her energy appeared to flag or her frustration peaked. They developed a system for Rita to initiate a break on her own. She moved to a quiet area of the classroom or left class to sit in the school counselor's office for 10 minutes; after this break, Rita returned to the task at hand.

The school considered the impact of side effects from Rita's antidepressant medications. Rita was allowed to keep water or juice on her desk to combat "dry mouth." She was seated close to the door in each class and given permission to leave the room quietly as needed to use the restroom.

Instructors also broke Rita's schoolwork into discrete tasks and helped her develop and manage a time line for when to complete each task based on her mood and energy levels. This enabled Rita's teachers to shorten or modify work. Teaching students with depression to recognize their typical mood and energy fluctuations throughout the day and take a break before returning to the task at hand increases their self-management.

Students with depression often find studying for tests a struggle because their disorder hampers independent study and concentration. Rita was given access to recorded class lectures that she could review outside class to assist her with taking notes and organizing class material to focus on relevant information. Teachers coached Rita in learning and study strategies to increase her independence in the classroom, including making outlines, doing conceptual mapping, and using mnemonic devices (memory skills can be dulled by depression [Brigham & Brigham, 2001]). Depressed students benefit from teacher-developed study guides for tests that enable them to focus on the most important material.

Within the general education classroom, Rita's teachers integrated specific interventions into the classroom routine. Typically, after the class started doing individual work, the classroom teacher would review with Rita the assignment and expectations. Throughout class, the teacher would frequently check on Rita's progress and give feedback on her performance. At the end of class, she would review Rita's work and provide her with any necessary materials or help she needed to complete the task.

Promote Social Interaction

Students suffering from depression often experience social difficulties and problems maintaining friendships as a result of mood fluctuations and their tendency to perceive relationships and interactions negatively. To foster an accepting, social environment for Rita, her teachers included cooperative group activities in the classroom and carefully selected whom to place in Rita's groups to increase the likelihood she would enjoy some positive interactions. Group work also let her share cognitive responsibilities, alleviating the stress depressed learners often feel about engaging in and completing learning demands independently (Perkins, 1993). Rita's teachers monitored her peer interactions and contribution to the group to ensure that she was participating.

Because students with depression often stop attending group activities they previously found engaging and view interactions with others negatively, it's important to intervene and schedule activities for these youth. Rita's parents and school staff collaborated to enroll her in an after-school program that focused on teaching social skills, and they arranged for individual counseling with the school psychologist. They worked to ensure that Rita took part in physical activity for a short period every day.

Communicate with the Student's Family

Brentwood School developed a home-school communication and tracking system that facilitated better communication between the school and Rita's family. Such communication systems increase depressed learners' participation in school activities by drawing on their personal experiences, letting parents know about classroom events and deadlines, offering a venue for problem solving, and reporting on progress (Davern, 2004).

Ms. Hunt noted Rita's daily progress toward goals and provided feedback on her mood and interactions through a home-school communication notebook. This notebook also enabled the family to keep Brentwood up-to-date on events at home, Rita's treatment, and other helpful information.

Confront the Issue of Suicide

Because Rita had mentioned suicide, it was imperative that school personnel monitor her suicidal thoughts or intentions. For many students, it's important to develop a "no-suicide contract"-an agreement between student and school in which a student promises that if he or she experiences suicidal impulses, the student will inform a health care professional, family member, or teacher rather than engage in self-injurious behavior. In Rita's case, Rita, her parents, and Ms. Hunt signed a contract that indicated the key people Rita should go to if she experienced such thoughts and the procedures and process that would be followed. If Rita told school personnel she was having suicidal thoughts, they would immediately contact Rita's parents, and her parents would take her to an emergency room for a psychiatric evaluation.

Replicating This Approach

Rita's case study reflects an ideal approach in a school where high levels of collaboration exist. Although many schools have worked hard to become more collaborative in their approach to working with students like Rita, in many places teachers will not find this level of support and collaboration. Teachers who find themselves in a school with less support and collaboration may not be able to implement as complete an approach as that discussed here, but they could implement many of the strategies noted.

For example, any teacher could initiate Monday morning meetings with a student struggling with a mood disorder to discuss the coming week, develop goals, and talk over how the student might keep up social interactions. A classroom teacher could support a student like Rita by providing a list of daily in-class assignments, coaching the student in organizing and initiating these tasks, and setting up a schedule to monitor progress and provide frequent feedback. Any teacher who sees one of her students facing mood fluctuations like Rita's could make task-by-task accommodations or modifications to meet that learner halfway, supply the kind of study supports discussed, and flexibly provide intermittent breaks throughout the day.

Depression in children and adolescents has significant implications for students' academic, behavioral, social, and physical well-being. School personnel must educate themselves on the characteristics and effects of depression, so they can provide the most effective interventions. Educators are responsible for not only meeting the academic needs of depressed students, but also ensuring their safety and welfare.

References

Brigham, R., & Brigham, M. (2001). Current practice alerts: Mnemonic instruction. Reston, VA: Council for Exceptional Children.

Burke, K. C., Burke, J. D., Regier, D. A., & Rae, D. S. (1990). Age at onset of selected mental disorders in five community populations. Archives of General Psychiatry, 47, 511-518.

Cash, R. E. (2003). When it hurts to be a teenager. Principal Leadership, 4(2), 11-15.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education.

Davern, L. (2004). School-to-home notebooks: What parents have to say. Teaching Exceptional Children, 36(56), 22-27.

Forehand, R., Brody, G. H., Long, N., & Fauber, R. (1988). The interactive influence of adolescent and maternal depression on adolescent social and cognitive functioning. Cognitive Therapy and Research, 12, 341-350.

Hammen, C., & Rudolph, K. D. (2003). Childhood depression. In E. Mash & R. Barkley (Eds.), Childhood psychopathology (pp. 153-195). New York: Guilford Press.

Kashani, J., Rosenberg, T., & Reid, J. (1989). Developmental perspectives in child and adolescent depressive symptoms in a community sample. American Journal of Psychiatry, 146, 871-875.

Kovacs, M., Feinberg, T. L., Crouse-Novak, M. A., Paulauskas, S. L., & Finkelstein, R. (1984). Depressive disorders in childhood: I. A longitudinal prospective study of characteristics and recovery. Archives of General Psychiatry, 41, 229-237.

Lewinsohn, P. M., Hops, H., Roberts, R. E., Seeley, J. R., & Andrews, J. A. (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 133-144.

Mitchell, J., McCauley, E., Burke, P. M., & Moss, S. J. (1988). Phenomenology of depression in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 12-20.

Perkins, D. N. (1993). Person plus: A distributed view of thinking and learning. In G. Salmon (Ed.), Distributed cognition: Psychological and educational considerations (pp. 88-110). Cambridge, England: Cambridge University Press.

Trammel, D. L., Schloss, P. J., & Alper, S. (1994). Using self-recording, evaluation, and graphing to increase completion of homework assignments. Journal of Learning Disabilities, 27, 75-81.

Wolfe, L. H., Heron, T. E., & Goddard, Y. I. (2000). Effects of self-monitoring on the on-task behavior and written language performance of elementary students with learning disabilities. Journal of Behavioral Education, 10, 49-73.

Wood, S. J., Murdock, J. Y., Cronin, M. E., Dawson, N. M., & Kirby, P. C. (1998). Effects of self-monitoring on on-task behaviors of at-risk middle school students. Journal of Behavioral Education, 9, 263-279.

Author's note: All names are pseudonyms.

R. Marc A. Crundwell is a school psychologist with Greater Essex County District School Board, Windsor, Ontario, Canada; marc.crundwell@gecsb.on.ca. Kim Killu is associate professor of special education, School of Education, University of Michigan-Dearborn; kimkillu@umd.umich.edu.

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October 2010 | Volume 68 | Number 2 Interventions That Work Pages 46-51 R. Marc A. Crundwell and Kim Killu Rita's story illustrates the essential features of clinical depression in children and adolescents: a persistent sad or irritable mood, loss of energy, decreased interest in daily activities or previously enjoyed activities, persistent feelings of worthlessness or guilt, withdrawal, and, possibly, recurrent thoughts of suicide.

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Students with Depression Help Them Find Their Way Out

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Students with Depression Help Them Find Their Way Out

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Bipolar Disorder in the Classroom

A powerful guide that offers hope, encouragement and new perspectives for educators as they tackle tough classroom situations. This book shows the educational impact of the illness and gives educators the tools to help their student find success.

The Student with Bipolar Disorder: An Educator's Guide

Teaching children with bipolar disorder can be both rewarding and challenging. This free downloadable brochure gives a concise overview of helping students with bipolar disorder.

Teacher Training: Four Part Webinar Series

The Webinar Series: Listen to our 4 part teacher training webinar series presented to the teachers of the state of Nebraska in association with ESU 13.

​Bipolar disorder can have many effects on a student in the classroom. Symptoms of both depression and mania can interfere with learning and make it difficult for the student to pay attention, stay on task, remain focused, and maintain motivation. In addition, cognitive effects may be seen in multiple areas including executive functioning, memory, and organizational skills. Bipolar disorder can also affect the child's ability to correctly process facial expressions and the emotional meaning of language. This can cause conflict with peers and staff, making social interaction a challenge.

?Isn't this just a behavioral issue

?How can I help a student with bipolar disorder in the classroom

?Do children with bipolar disorder qualify for an IEP

?What accommodations may be helpful

?How can I improve my classroom environment

​Children with bipolar disorder frequently have difficulty processing sensory stimulation. Analyze your classroom from the perspective of your student. Sitting by the pencil sharpener or a noisy air conditioner may overly tax this student as he or she tries to process these noises. Overhead lighting should also be examined. If your student is overly stimulated by these bright lights, consider turning a section of lights off and using a dimmer area for this student. Ask your student about things in the classroom that bother him. Making minor adjustments can make a major difference!

Can kids with bipolar disorder also have learning disabilities?

Can a child with bipolar disorder also be gifted?

Where can I get more information?

This essay by Tracy Anglada was originally published on the web and later included in the appendix of two of her books, Intense Minds and Swivel to Success. It shows the school day from the perspective of a student with bipolar disorder and demonstrates how a little understanding and help can go a long way in making a difference for a child.

My School Day without Help

As technology advances we get a glimpse into the workings of the brain which in turn gives an improved understanding of brain disorders. This download shows brain abnormalities which have been associated with childhood onset bipolar disorder. For a more complete discussion of these abnormalities and how they may impact the child, see the book "Swivel to Success"

Brain Abnormalities Associated with Childhood Bipolar Disorder

Dealing with Cognitive Dysfunction Associated with Psychiatric Disability is a very useful handbook made available by the New York State Office of Mental Health

Cognitive Dysfunction Handbook

LEVEL OF STABILITY/ FLEXIBILITY IN SCHOOL

Bipolar disorder is an illness that doesn't stand still. The symptoms of the illness can range from severely ill to stable. This chart helps teachers and parents clarify how to best meet the needs of the child during various stages of the illness.

Level of Stability/Flexibility in School

Students with bipolar disorder may have multiple sensory sensitivities. This checklist will help you evaluate your classroom environment and make modifications to address the needs of those who are hyper sensitive to noise, lighting, temperature and odors.

Examine Your Classroom Environment

Accommodations are frequently necessary in the classroom setting for students with bipolar disorder. While these should always be tailored to the individual needs of the student, here are some possible accommodations to help.

ACCOMMODATING STUDENTS WITH MOOD LABILITY

A very useful brochure from schoolbehavior.com about students with "mood lability" which includes those with depression and bipolar disorder.

Accommodating Students with Mood Lability

It can take months to recover from an episode that requires hospitalization. Special considerations must be made when a student is received back to school after a hospital stay. This article by Tracy Trudeau gives insight into this important transition.

A tool to help your students identify moods, express themselves, and learn social and emotional skills in the classroom and beyond. Gain insight into your student through technology and find the support you need.

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Bipolar Disorder in the Classroom A powerful guide that offers hope, encouragement and new perspectives for educators as they tackle tough classroom situations. This book shows the educational impact of the illness and gives educators the tools to help their student find success.

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Behavior Disorders: Definitions, Characteristics & Related Information

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Behavior Disorders: Definitions, Characteristics & Related Information

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Attention Deficit Disorder Association (ADHD)

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Attention Deficit Disorder Association (ADHD)

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ADDA - Attention Deficit Disorder Association

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National Alliance on Mental Illness: Rio Grande Valley

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National Alliance on Mental Illness: Rio Grande Valley

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NAMI Rio Grande Valley is the local affiliate of the National Alliance on Mental Illness ​, an association of hundreds of local affiliates, state organizations and volunteers who work in our communities to raise aware and provide support and education to those in need.

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Our work has resulted in positive change. We have educated millions about mental health conditions and reduced barriers to treatment and services. As a result of Mental Health America's efforts, many Americans with mental health conditions have sought care and now enjoy fulfilling, productive lives in their communities.

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Promoting Mental Health Awareness in Texas

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This resource center is designed to equip you with knowledge, resources, and a sense of hope for the future - for yourself or someone else you care about.

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Find Resources or a Provider | You're Not Alone | Mental Health Texas

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Mental Health Texas provides learning and treatment opportunities for those coping with mental health conditions and those who support them.