Editor’s note: This essay is an entry in Fordham’s 2021 Wonkathon, which asked contributors to address a fundamental and challenging question: “How can schools best address students’ mental health needs coming out of the Covid-19 pandemic without shortchanging academic instruction?” Click here to learn more.
As schools move to fully reopen, our first inclination may be to focus on the learning gaps that students have developed during the pandemic. But the psychological and emotional well-being of all members of a school community must also remain in the foreground. Establishing school as a space that is both physically and emotionally safe is essential. All students and teachers have experienced unprecedented disruption to normal patterns of interaction, and many have had to cope with uncertainty or substantial hardship. They will need support as they transition back into a full-time academic environment. In addition, many students will be managing grief, anxiety, or other emotional responses to recent events that will require long-term monitoring and an ongoing response.
Amid the instability of the 2020–21 school year, school leaders identified students’ mental health as one of their top concerns. However, most educators do not feel confident in their ability to identify students who might require additional mental health supports. Furthermore, many schools lack a clear, coherent system for addressing students’ mental health needs. Roughly 40 percent reported that they currently address concerns on a “case by case basis.”
The time for ad hoc responses is over. Having a distinct plan in place as students and educators reacclimate to the classroom environment will be integral to ensuring the well-being of students.
Recommendations
Our recommendations fall into four major types of action:
- Triage: Perform formal or informal triage to identify what students need to support their learning, and establish a referral system to connect students with school- and community-based mental health resources.
- Trauma-informed practices: Expect students to have difficulty with the transition back into classrooms. Establish generalized supports that can benefit all students, specifically trauma-informed relational practices and a robust framework for social and emotional learning that promotes emotional well-being and social connectedness.
- Targeted intervention: Monitor for behaviors that indicate a need for targeted intervention. Support school-based mental health professionals in implementing an evidence-based mental health program, such as Cognitive Behavioral Intervention for Trauma in Schools (CBITS), for students who have experienced significant trauma or who have been diagnosed with serious mood, anxiety, or other behavioral disorders.
- Faculty support: Attend to the mental health needs of faculty and staff by providing appropriate resources, developing a culture of emotional openness and vulnerability, building structures to support social engagement, and helping individuals develop their self-care practice.
Rationale
Triage
Students have experienced the pandemic in different ways. While some students may not have weathered significant anxiety or personal hardship, others have experienced traumatic personal events. This is most common among low-income students and students from racial and ethnic minorities, whose families are far more likely to have suffered economic hardship, illness, and death.
Students who have been physically separated from their school or community may feel isolated or neglected, including those who are vulnerable in their homes as a result of the volatility or abusive behavior of a family member. Many students, and particularly Black students, may also be contending with anxiety, fear, or confusion in a climate of anti-Black racism and police violence.
Knowing the state of any one student’s emotional well-being is difficult, unless they voluntarily disclose that information or, perhaps more likely, exhibit stress-induced behaviors like misbehaving (externalizing) or shutting down (internalizing). And educators must be ready to support all students, without treating them all the same. Mary Walsh, a professor of counseling and developmental psychology at Boston College, has estimated that even among students who have experienced trauma during the period of the closure, only about one-third are likely to develop serious issues, such as PTSD. Monitoring students for behavior changes will be important, but Walsh cautions against pathologizing students, suggesting that “If we put the right protective factors in place, kids have enormous resilience.”
The American School Counselors Association and the National Association of School Psychologists recommend collecting data to inform a psychological “triage” approach to allow schools and districts to identify students who need mental-health supports most. That includes students who have lost someone close to them, whose families have experienced financial distress or dislocation, who have previous mental-health concerns, and who have a history of trauma, including membership in a community with a previous history of educational disruption (such as natural disasters or mass casualties).
The next step is to connect students to appropriate services. Selecting those services should not be done on a case-by-case basis. Rather, staff need to have a clear understanding of what is available to best respond to student needs well in advance of any incident. A clear process for referrals can make this step more efficient and maximize the impact of this response.
Project Aware Ohio has detailed a comprehensive referral protocol to help schools and districts identify gaps in current procedures:
- Establish a problem-solving team for referrals. If there is no preexisting team with capacity to manage referrals, team members will need to be established and the team’s purpose, responsibilities, routines, and evaluation procedures articulated.
- Determine a procedure for managing referral flow. Adopt a standard referral form, determine a process for submission, and communicate this process with the school community. If referrals will be made to community agencies, identify key contacts.
- Develop a system for the team to gather student background information. Establish norms for collecting data from triage screenings, behavioral observations, and interviews with family and school personnel.
- Establish a secure record-management system. Determine where data will be stored and ensure that access is limited to appropriate team members.
- Map available resources and interventions. Create a database of school- and community-based resources and available interventions. Establish community partnerships, when appropriate, to fill gaps and discuss how the referral time will address barriers to access.
- Create decision rules to determine appropriate interventions based on this information. Establish guidelines on how students will be identified for the different tiers of intervention that are available and a plan for evaluating whether interventions are effective or should be discontinued.
- Develop a system to monitor and evaluate intervention effectiveness. The team should establish procedures for tracking whether interventions are occurring, whether they are effective, and how to request and share information and feedback between the involved parties (such as students, families, school personnel, and community partners).
Trauma-informed practices
Trauma is a psychological or emotional response to “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening,” according to the Substance Abuse and Mental Health Services Administration. Many students and families have personally experienced trauma related to health and economic consequences of the pandemic. And the period of disruption itself may have been traumatic for some. Viewing these events as presenting multiple potential traumas can help guide school policies, practices, and interactions among staff and students.
The adoption of trauma-informed practices in schools has steadily gained steam over the past several years. Dr. Howard Bath, a clinical psychologist and expert in developmental trauma, has identified three key pillars of trauma-informed care: safety, connection, and managing emotional impulses.
Ensuring students feel safe is essential. Even in the absence of a distinct threat, the brains of traumatized children tend to remain in a state of alarm, with energy focused on ensuring safety rather than engaging in growth-promoting activities. Creating consistent, reliable, and predictable environments in which students feel they have a degree of power and choice can help establish school as a safe place where they can relax their guard and trust the adults that they interact with regularly.
Trust and the perception of safety cannot occur without the second pillar, connection. Positive relationships with caring adults have great therapeutic value and may help to counteract negative associations from past experiences. Educators can foster such relationships by attending to, validating, and creating space for the strengths that students bring to the classroom. This also supports students’ seeing themselves as competent, worthwhile individuals.
Maintaining compassionate connections is complicated, however, by the difficulty traumatized individuals often have in self-regulation and managing emotional impulses. Responses to trauma are frequently observed as behavioral responses. In a school environment, where establishing strong routines and behavioral norms is a necessary part of creating a physically and emotionally safe space, trauma may prevent students from complying with all expectations for behavior right away. Students will need time to adjust, and disobedience may simply be a function of students’ challenges to regulate themselves.
Educators need to keep this in mind, rather than categorizing behavior as willful disobedience. Rather than assuming negative classroom behaviors (such as outbursts, defiance, or shutting down) are intentional and responding in a punitive fashion, trauma-sensitive educators help students “co-regulate” by modeling and explicitly teaching students how to manage their emotional impulses. Connectedness with peers is also an important protective factor, both for students dealing with trauma and those with other mental health conditions. Explicit social and emotional learning instruction can help facilitate these relationships.
Targeted intervention
Though adopting trauma-informed practices as generalized supports is beneficial, for some students, that won’t be sufficient support. A subset of students will have had direct traumatic experiences or be suffering from mental health conditions. They will need intensive interventions above and beyond generalized trauma-informed care in order to be ready to learn.
School leaders cannot assume these students will receive appropriate treatment outside of school, since approximately one-third of all adolescents who receive mental health care are served only in the setting of their school. This is particularly true for students who identify as members of a racial or ethnic minority or who come from a low-income household. Responding appropriately to these students’ needs will take the involvement of all staff members with mental-health training, including school counselors, psychologists, social workers, and nurses. Schools with enough specialized staff can offer individual and group-based interventions, such as Cognitive Behavior Intervention for Trauma in Schools (CBITS). Multiple studies have demonstrated that students who participate in a CBITS program experience significant improvement in self-reported symptoms of post-traumatic stress compared to a control group. For schools with fewer trained staff members, establishing care plans and scheduling frequent check-ins with at-risk students and their families can also support students with mental health needs, according to the Suicide Prevention Resource Center.
Regardless of the intervention approach, it is important to ensure that administrative and instructional staff all have a shared understanding regarding the importance of these interventions. And it is critical to remember that there will always be some students whose needs are too urgent or intensive to be served within the school setting. Intensive interventions should be handled in collaboration with external partners.
Attend to staff needs
No mental healthcare plan would be complete without considering the needs of the adults in the building, especially those in student-facing roles. The past year—full of sleepless nights, radical changes to instruction, long hours, unexpected childcare duties, and worries about safety for their students and themselves—has taken a toll on educators. A Louisiana study found that the prevalence of clinically significant symptoms of depression had almost doubled among early childhood educators. And in another study, approximately 85 percent of teachers reported that their mental health had declined compared to the previous year.
The recovery period already threatens to be a pressure-cooker for teachers. They are burdened with the expectation to make up for months of lost learning while also accommodating students’ heightened social and emotional needs. Proactive planning can help educators feel supported in their work and decrease instances of burnout that may lead to turnover and ineffective instructional environments.
Developing an organizational culture in which frank and open conversations can occur about staff emotions and mental health takes time, but schools and districts can nonetheless teach strategies and create structures that lay the groundwork for a healthy and open workplace.
First and foremost, schools should ensure that staff members have appropriate access to mental health care, such as counselors or therapists. Adequate coverage must be available so that staff have the ability to take the time they need to address their healthcare and personal needs. These basic supports can be bolstered by building in intentional opportunities for staff to connect with each other, whether by having periodic check-ins, developing mentorship relationships, or creating opportunities to socialize or decompress with other adults in the school community. To ensure educators take advantage of these supports, it can be productive for leaders to model emotional vulnerability and help-seeking behaviors. That helps staff to view these practices as indicators of strength rather than weakness.
It is also important to encourage stress-management strategies, such as healthy eating, exercise, adequate sleep, and relaxation techniques, including by weaving them into school culture. In particular, mindfulness practices have been shown to be effective in helping teachers manage occupational stress. There are a variety of models and resources that organizations can adopt depending on their unique circumstances. The Cultivating Awareness and Resilience in Education (CARE) professional-development program, which teaches mindfulness techniques, has been shown to improve teacher well-being, efficacy, burnout, and stress. Freely available resources such as Diana Tikasz’s excellent Pause-Reset-Nourish framework can also be helpful.
Above and beyond these practices, leadership should pay particular attention to staff members who seem to have difficulty coping with the challenges of their role and offer support as needed. Educators working in areas of high poverty or high trauma may be at risk of developing secondary traumatic stress (STS), in which they experience trauma due to hearing about the traumatic experiences of their students. While similar to burnout in terms of its external expression, STS is often not alleviated by a change in occupational environment. Particular educators may be more susceptible, including those who have experienced trauma themselves, are highly empathetic or inexperienced, or who work in communities that have experienced elevated levels of poverty, crime, or tragic events. The organization Support for Teachers Affected by Trauma offers a free training program to help educators recognize symptoms and engage in protective strategies.
As the adage goes, you need to put on your own oxygen mask first before helping others. Once we’ve done that, we’re better equipped to get through this turbulence together.
Reading List
American School Counselor Association and National Association of School Psychologists. (2020). “School Reentry Considerations: Supporting Student Social and Emotional Learning and Mental and Behavioral Health Amidst COVID-19.”
Baicker, K. (2020). The Impact of Secondary Trauma on Educators. Stress-Busting Strategies for Educators, 15(13).
Bath, H. (2008). The Three Pillars of Trauma-Informed Care. Reclaiming Children and Youth, 17(3), 17-21.
Dinnen, H., Cody, M., Jordan, E., & Meehan, C. “Referral Pathways Protocol for Mental Health Supports.” Project AWARE Ohio, Ohio Department of Education.
Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105-113.
LearnWell (2020). “Addressing K–12 Students’ Emerging Mental Health Needs.”
Minahan, J. (October 2019). Trauma-Informed Teaching Strategies. Educational Leadership, 77(2), 30-35.
Naff, D.B., Williams, S., Furman, J., & Lees, M. (2020). “Supporting Student Mental Health During and After COVID-19.” Richmond, VA: Metropolitan Educational Research Consortium.
Romer, N., von der Embse, N., Eklund, K., Kilgus, S., Perales, K., Splett, J. W., Sudlo, S., Wheeler, D., (2020). “Best Practices in Social, Emotional, and Behavioral Screening: An Implementation Guide. Version 2.0.” School Mental Health Collaborative.
Stiegler, K., and Lever, N. (2008). “Summary of Recognized Evidence-Based Programs Implemented by Expanded School Mental Health (ESMH) Programs.” Center for School Mental Health, University of Maryland School of Medicine.
Substance Abuse and Mental Health Services Administration. (2014). “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.” HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
