Virtual Counseling

Access to mental health support for children can be extremely challenging. As we all know, mental health services are not cheap. And it tends to be the families with the least resources that struggle the most to find the money to pay for such services. Thankfully many school psychologists are trained and comfortable providing services like this. Sometimes there is a school social worker who would also be a good resource for these students, especially the younger ones.

As the students become older (6th grade and above) they tend to isolate themselves more. It becomes more challenging for them to reach out at all if they are in need. Sometimes just the real face-to-face part of it makes it completely aversive. Luckily, we are finally living in a time where mental health services can be accessible through a mobile phone or computer. It is a new way of practicing mental health so many are skeptical and options are limited, however, I have firsthand experience that it is absolutely perfect for people like myself.

I personally have significant issues with anxiety and I am currently a stay-at-home mother so my schedule is not my own. When I return to the workforce it would not be likely to change in that aspect. I am no longer in need of counseling, but I really love that this option is available to me now.

I was a skeptic. I wondered how someone could possibly provide therapeutic services without seeing and observing during a session. And in some respect, those things can be lost, making the therapeutic process a bit more challenging. Many of the services offer a video chat or messaging services, which can be extremely helpful in times where emotions are high and typing would be cumbersome. My skepticism faded very quickly. It can be extremely helpful to be able to message your counselor as things are happening. I didn't have to wait a whole week or so and try to remember everything I wanted to talk about. The somewhat immediate feedback also helped me implement strategies quickly and more effectively because that waiting period didn't exist. I could show my face or remain fairly anonymous. It honestly provided me with a sense of more control than the traditional set up for therapy.

I bring this up because our youth will only become more reliant on technology to provide services. And it is our job to try to meet them where they are comfortable enough to share. This might mean having an open door policy, providing therapeutic supports in the school setting, or (if parents are willing and able to pay) using virtual counseling.

TalkSpace was the one I went with. The prices for what you were able to get out of it were the most reasonable for me. I did a lot of research on these and this one also had the best reviews. At the time there were approximately three options. There are likely more now as this begins to catch on. But don't hesitate to do your research and find options that might work for your students. This could be a resource that changes their life.

Interventions, Accommodations, & Modifications

There often seems to be a lot of confusion about what exactly interventions, accommodations, and modifications are so perhaps a brief description of each is in order.  

Intervention: An intervention is a specific skill-building strategy implemented and monitored to improve a targeted skill (i.e. what is actually known) and achieve adequate progress in a specific area (academic or behavioral).  

• Intervention is not simply additional time for instruction or re-teaching, unless the re-teaching is being done in an alternative manner. 
• Require a targeted assessment, planning, and data collection. 
• Should be evidence-based and monitored regularly to determine growth and to inform instruction. 
• Differ from accommodations and modifications in that they teach new skills to help students overcome specific deficits or maladaptive response. 
• Examples of research-based interventions can be found in many places: interventioncentral.org is one good resource for several areas. 

Accommodations:  Provides augmentation so that the student is able to perform or demonstrate knowledge without the barrier of their disability. 

• Does not alter what the student is expected to learn, but makes learning accessible and allows them to demonstrate what they know. 
• For example, a shortened test provided to a student who has difficulty focusing. They are still responsible for understanding the same concept, but it is distributed to them in a manageable format. 
• Accommodations are basically physical or environmental changes. 

Modifications:  fundamentally alter or lower the standard or expectation of the course, standard, or test. 

• If a student is taking a shortened test, but is still responsible for demonstrating the same targeted skill as peers then this is not a modification.
• Involves lowering the level of the materials presented. 
• Grading is subject to different standards than general education, often based on IEP goals.

Accommodations level the playing field. 

Modifications change the field you're playing on.

Back, Then Gone, Then Back Again: Throwing All of Myself Into Every Hat

This blog is one that I wanted so much to do while working as a school psychologist, but as one could observe by skimming the list of posts...I was a bit, well...terrible at it. Not terrible at the writing, but terrible at keeping up with it. I had a goal to post at least once a month. I did not do this.

What is difficult about writing a blog while working as a school psych is that literally at the end of the day my brain just can't do it anymore. I put 100% of myself into my work when I am at work and 100% of myself into home & family when I am there. So to do the blog I would often have to sacrifice home/family time, and quite frankly I just didn't want to do that.

I had a lot of people tell me to keep up the writing and sharing once I decided to take a leave of absence to care for my son (that was also the moment of truth; when I finally learned how people really appreciated what I do). I had very much intended to keep writing. To keep learning and researching and keep up with the profession.

Now for the truth of it...keeping up with the profession while on the outside looking in was honestly enough work for me once I left. I'm sure I disappointed some people by "disappearing", and for that I am sorry. But once I had the opportunity to take off my 'career hat' I breathed such a sigh of relief that I wasn't ready to put it right back on immediately. It's not that I don't absolutely love what I did. I love being a school psych. I love helping everyone working with kids to enable them all to succeed (and sometimes that means just being a support for the teachers and staff). But as much as I absolutely love the profession...burn out is a real thing. Compassion fatigue is a very real thing. I worked for 5 years in a very challenging area and it wore me out. And honestly, I don't think it matters where you are. Every psych faces challenges. Reason being, we work with kids, we work with adults, we work in the field of education, we have a passion to help, and we have to work with limited resources. Being in a helping profession can be exhausting (physically, mentally, and emotionally)! So, yes, I took a LONG break from really engaging actively in the field once I left. I was spent. And I wanted to put myself into being a mom as much as I put myself into being a school psych.

Now my son is getting older and needing my attention less and less. He's growing up. It is bittersweet indeed. Next year he'll be a school age child (sniff). But I am so unbelievably grateful for this experience. I will never ever regret making this choice.

That said, it has been 1 and a half school years that I've been unemployed (I really hate that word as it implies that I could not get a job, but this is not the case. I actually had a lot of opportunity, but none in the area where we wanted to settle our family for our forever home) as a school psych. Once I am able to return to the field it will be 2 or more. If I thought selling myself was hard before, it will probably be even harder now. But I am prepared for that. On the bright side, having my child be more independent means I can now get back into doing things that relates to the field here and there as well as work in some volunteer work. So I'm going to work my way back first through my writing and research.

One of my favorite activities as a school psych was bringing easily digestible research-based information to teachers in a way that they could get as much information as needed in the shortest amount of time. I started writing a newsletter every two months that was never any longer than two pages. Teachers LOVED it. It was good information and they could read it in 5 minutes or less. It was my way of helping them when I was spread thin and couldn't always be there.  So, this is how I want to structure my blog posts as well, although some of them might become lengthier than others.  I hope there are some people out there who find the information useful. If not, well...at least I enjoyed doing the research!!

So I'm back...again...we will see how long I can stick with it this time before disappearing into another 'hat' again. Until then...happy reading!!

Youth in Crisis: Suicide Prevention & Intervention

The Hard Reality 

In today’s world our youth face tremendous life pressures that put them at risk for a myriad of self-destructive behaviors.  Many of our youth lack coping skills or healthy coping skills that can prevent devastating consequences like suicide. Although youth suicide rates have dropped since 1992, it still remains as the third leading cause of death among 10-19 year olds.  

Completed suicides are only part of the picture. Other forms of suicidal ideation and behaviors are much more common and typically are exactly the kind of behaviors to watch for. Prevention and intervention in this area should not be taken lightly. It is estimated that for every youth who dies by suicide, 100-200 youth attempt it. Within a typical high school classroom it is likely that at least three students have attempted suicide in the past year. (Poland & Lieberman, 2002) 

There are many risk factors that indicate red flags as long as people are educated about them and how to respond. Youth who are contemplating suicide frequently show warning signs of their distress. Parents, teachers, and friends are in a key position to pick up on these signs and get help. Most importantly never take these warning signs lightly or promise to keep them secret. It is better to err on the side of caution. There are some cases where one might just think a student is just asking for attention. Give it to them. I cannot stress this enough. All behaviors have a purpose. The key is to find ways to give them the right kind of attention. In most cases the individual is looking for signs that someone cares or is reaching out for help. Always take it seriously. However, don't overreact either. There is a fine balance here for the helping professionals. If in doubt, refer to whomever in your school is the most trained in mental health supports for students. This is typically your school psychologist, but could also be your school counselor or social worker. 

Suicide Warning Signs 

Many suicidal youth demonstrate observable behaviors that signal their suicidal thinking.  These include: 

·  Suicide notes.  These are a very real sign of danger and should be taken seriously. 

·  Threats. Threats may be direct statements (“I want to die.” “I am going to kill myself”) or indirect comments (“The world would be better without me”, “Nobody will miss me anyway”). Indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork.  Younger children and those who may have some delays in their development may not be able to express their feelings in words, but may provide indirect clues in the form of acting-out, violent behavior, often with threatening or suicidal comments. 

·  Previous attempts. If a child or teenager has attempted suicide in the past, there is a greater likelihood that he or she will try again.  

·  Depression (helplessness/hopelessness). When symptoms of depression include strong thoughts of helplessness and hopelessness, a child or adolescent is possibly at greater risk for suicide.  

·  “Masked” depression. Sometimes risk-taking behaviors can include acts of aggression, gunplay, and alcohol/substance abuse. While some youth may not act “depressed,” their behavior suggests that they are not concerned about their own safety. 

·  Final arrangements. This behavior may take many forms. In adolescents, it might be giving away prized possessions such as jewelry, clothing, journals or pictures. 

·  Efforts to hurt oneself.  Self-injury behaviors are warning signs for young children as well as teenagers. Common self-destructive behaviors include running into traffic, jumping from heights, and scratching/cutting/marking the body. 

·  Inability to concentrate or think clearly.  Such problems may be reflected in classroom behavior, homework habits, academic performance, household chores, even conversation. If a student starts skipping classes, getting poor grades, acting up in class, forgetting or poorly performing chores around the house or talking in a way that suggests they are having trouble concentrating, these might be signs of stress and risk for suicide. 

·  Changes in physical habits and appearance.  Changes include inability to sleep or sleeping all the time, sudden weight gain or loss, disinterest in appearance or hygiene. 

·  Sudden changes in personality, friends, behaviors. Parents, teachers and friends are often the best observers of sudden changes in suicidal students.  Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important, and avoiding friends. 

·  Death and suicidal themes. These might appear in classroom drawings, work samples, journals or homework. 

·  Plan/method/access. A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan. The greater the planning, the greater the potential for suicide. 

What to Do 

Youth who feel suicidal are not always likely to seek help directly. This is why it is important for parents, school personnel, and peers to be able to recognize the warning signs and take immediate action. When a youth shows signs they may be considering suicide, the following actions should be taken: 

• Remain calm. 
• Ask the youth directly if he or she is thinking about suicide. 
• Focus on your concern for their wellbeing and avoid being accusatory. 
• Listen. – This cannot be stressed enough. 
• Reassure them that there is help and they will not feel like this forever. 
• Do not judge. 
• Provide constant supervision. Do not leave the youth alone. 
• Remove means for self-harm. 
• Get help: School staff should take the student to the designated school mental health professional or administrator. Peers should not agree to keep the suicidal thoughts a secret and instead should tell an adult. Parents should seek help from school or community mental health resources as soon as possible.