Continuity of Care: Therapeutic Strategies at School
By Carissa Torres Razo, aka School Psych Mama
Truth be told, and as contrary to the title as it seems, I am not very confident in my counseling/therapy skills as a School Psychologist. Student throwing a chair? Cussing out the teacher? Refusing to do anything? I’m here for you- along with a reinforcement inventory and self-monitoring point system. But for the students with true Generalized Anxiety Disorder? Clinical Depression? I’m a little more insecure in my own skill set. So, I get the Release of Information signed by parent and I call the therapist and eagerly listen to their wisdom and how we can support the client/student in school. After all, school is where they spend most hours of their day and where a lot of stressors for mental illness can occur. However, I am consistently surprised and disappointed each time I speak to my clinical counterpart. I can come up with strategies I think will be effective, but why confuse and overwhelm a student who is already struggling by giving them another set of grounding techniques, language, and cues to learn? I’m no clinician, but here is my list of what to consider and communicate to the school staff so they can support your client at school.
Any tools used must be readily accessible at a school. Or easily provided by parent. I was recently told by a private psychologist she is using ice as a grounding technique and teaching the child to focus on the sensations of the ice melting in her hand when she becomes anxious. Fantastic. But does she keep ice with her all day? Do we interrupt several staff and walk across campus to the staff lounge to get her ice each time she needs it? And wouldn’t that hurt her hand after a while? I get it, I really do. But this hasn’t been the easiest to transition to school. While we are making it work for this particular child, another sensory-based strategy would have been easier and more accessible for us to transition into a school setting.
I come from a behavioral background so I like things to be discrete, operationally defined, measurable, and easily understood step-by-step. You are teaching breathing techniques? AWESOME. How many breathes does the client/student take? For how many minutes? What is the count in and the count out? I can give my own answers to these questions, but I want to do what is already being taught. And I don’t want to confuse and overwhelm a student already struggling to cope. I need the details. This helps me feel confident using the strategy and communicating the procedures to other staff to ensure they are consistent in implementation.
Schools love visuals (most of the time). Largely because visuals allow for a clear and consistent routine no matter the staff member present. This includes multiple teachers, administration, paraeducators/aides, and even substitute staff. Schools have a funny way of demanding and building routines while constantly changing and never being consistent (hello, 45-minute fire drills that disrupt the entire morning). I can easily use the steps in your grounding technique and turn it into a visual schedule, a self-monitoring system the student uses alone at his desk, or a visual cue for the staff to use when they observe the student escalating. A therapist may not have, use, or need visuals but they are very helpful at school. A therapist doesn’t need to provide them either (unless you are using something specific, in which case, please share and fax it over). The school can design and make them (and we also share!) but we need the details get started.