InvisALERT Solutions – ObservSMART

Engagement in the School Based Clinic Setting: Challenges and Opportunities

The early phase of mental health treatment called “engagement” marks the beginning of an emerging collaboration among provider, child and family. During engagement, clients develop important senses about their providers: Do I like this person? Can they help me? Does it seem like they care about me? Clinicians develop their own set of senses about clients: Is this someone I can really help? Is this client seriously committed to getting better? Is this case interesting or appealing? It is during engagement that a history is shared and areas for work are prioritized and agreed upon mutually. It is also during that time that the boundaries of treatment are set, tested at times, but ultimately established. For these reasons, engagement is a critical time in the treatment relationship.

All of these aspects of engagement pertain to clients who have demonstrated some interest in seeking help, as have many families who have sought help for their children in school-based clinics. In the school setting, too, there are parent populations who do not actively seek treatment for their child or family. In these cases, engagement involves challenges beyond those described above. Factors such as denial, avoidance, fear of stigma, excessive psychosocial or economic stressors, parental substance use or mental illness all complicate the engagement process. It is difficult for any family to hear their child is struggling at school, and when additional barriers to engagement exist, other measures are needed. A program within a school-based clinic provides some flexibility to reach out to families repeatedly, allowing them time to assimilate information about the services available. It is also essential to clarify repeatedly that the program and agency are separate entities from the school. This is crucial because at times families have received what they perceive to be a barrage of calls and complaints about their child from school administrators or teachers. Helping the family view the school-based clinic as separate, confidential, and supportive of the child’s functioning at school is important. Meeting with families off-site in locations such as at Head Start, in the community or in the family home are ways to connect on a level that may be more accessible and friendly.

Fortunately, most children easily and readily engage with program staff. They are exposed to the clinical staff daily from the onset of the school year, and the program offices appear inviting with toys and materials. The issue of engagement is not usually a challenge in gaining the child’s cooperation, but rather in collaborating with teaching staff around scheduling and best times to remove a child from class for treatment. Classmates can grow curious. They want to know why a particular child “gets to go play with you” and why they are not allowed. Being prepared with an answer that is appropriate to a young child’s understanding and preserves the privacy of the client/family is important.

A challenging aspect of engagement in the school setting is the development of a collaborative and mutually satisfying relationship with partners in the school – faculty and administration. Particularly when the school-based clinic is new or re-establishing itself with new school personnel, identifying “who we are and what we do” on a regular basis is essential. There should ideally be clarity and a mutual desire for the existence and successful operation of the school-based clinic from top administration to supportive staff. Reviewing and revisiting themes of how to identify children in need of mental health counseling beyond the expertise of Pupil Personnel staff, when and how to refer families, and why it’s important to use the school-based clinic for consultation should occur on an ongoing basis. Utilizing faculty meetings or other forums when all school personnel convene is optimal. Allowing faculty to ask questions about the school-based clinic in an open manner always, in this writer’s experience, results in an increase in both referrals to and consultations with the program.

Establishing clarity early on in the clinic-school partnership about the boundaries and limits of the program helps offset future misunderstandings and disappointments. For example, helping the school understand that family participation and consent to treatment is mandatory and that children are otherwise unable to be served encourages school personnel to become partners in the engagement process with families. Highlighting the difference between mental health treatment and constant crisis intervention is also important in order to avoid misuse of the program as a receptacle for misbehaving children. Marketing the program’s clinical services as offering both mental health counseling to children and consultative services to faculty in order to support their management of behavior challenges makes the most sense. When excessive clinical time is occupied by tending to children who have been removed from the classroom, the program cannot function optimally. Teasing out with faculty and administration those issues that are really disciplinary and require administrative intervention versus those that require mental health support on a regular basis allows for optimal collaboration.

In the fields of social work and psychology, the clinical supervision process enables the clinician to meet and discuss with a supervisor on a regular basis areas of work that are challenging. There is an implicit understanding that to reveal areas of challenge or even countertransferential experiences is a positive way to work through aspects of the clinical work that stagnate. The field of teaching offers a different culture relative to the worker-supervisor relationship. While teachers are offered some administrative support and are backed by strong unions, the implicit message is that teachers need to figure out a way to independently handle problems as they arise. Therefore, faculty tends to hold on to problems and attempt to manage hard situations, avoiding asking for help until the situation reaches a crisis level. When teachers are encouraged to consult with the school-based clinic from both clinic staff as well as from their own administrators, engagement among clinic, school and families is best.

There are additional ways that the school-based clinic works to engage both clients and school partners. In terms of clients, the participation by a larger agency that maintains excellent relationships with outside resources to provide financial and supportive services can be particularly beneficial. The school-based clinic participates in programs that offer families additional supports: a pajama program, a back-to-school clothing and school supplies drive, camp scholarship funds, and other miscellaneous donations throughout the year. Families experience this concrete support as extremely helpful and as clear evidence that the agency is interested in their wellbeing. For faculty members, the support offered by clinic staff is often helpful in an immediate way. Implementing a successful behavior plan for a disruptive child or offering a teacher useful strategies in dealing with a certain situation allows a teacher to understand the potential success of the program, value it more highly, and be more inclined to collaborate in the future.

In conclusion, successful engagement relies upon consistent communication and clarity on all levels in a school-based mental health clinic. Schools are busy places and the constant bustle of children and demands of the day make such communication a challenge at times. It is the job of the program manager to ensure that communication and clarity remain a priority, and this is achieved by arranging regular meetings with school administrative staff and faculty. Program staff must be adept at approaching faculty, being direct and clear about the collaboration, and revisiting issues when miscommunication and misunderstandings arise. Together, school personnel, families and school-based mental health clinicians can work cooperatively to improve functioning of children with behavioral, emotional or mental health issues.

SCOPES: Supporting Children’s Opportunities and Parent Empowerment in Schools.

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