“A social system tends to draw our attention to the very points at which attempts to intervene will fail.” Jay W. Forrester
Even the best school districts have students that they find very difficult to serve. These are the kids who manifest emotional, social and behavioral difficulties. They participate in destructive behavior [vandalism, substance abuse, truancy, violence, etc.] and generally are not learning. Attempts to intervene effectively often seem to backfire. The ‘state of the art’ approaches have failed to provide any help to these kids.
There are four levels of defined intervention possibilities for the prevention and remediation of psychological disorder in children. An inverted pyramid starts with:
Universal Prevention Intervention
- Involves all school personnel, students and families – 100%
- Is concerned with balanced and rational messages
- Is specifically designed to overcome distorted thinking about self and others
- Includes ritualized methods of intervening with experiences of conflict
- Involves the entire culture of the school
Universal prevention efforts include all methods of ensuring that all children are receiving balanced and rational messages about self and others. This effort requires that the message senders understand the basic fundamental assumption of “you are what you think!” and become mindful of what they themselves are thinking particularly in times of distress and are capable of modifying their own actions and the messages emanating from those actions through ritualized responses and ‘mindfulness’. Generally, this level is met through the inclusion of a social emotional curriculum and rituals designed to habituate the staff and students to ways of respond in times of distress or aggression. A ‘crisis intervention’ program designed to be attributionally sound [i.e., send messages of recovery and personal responsibility] is one of the ritualized interventions. In its fullest sense, universal prevention is honed through a restructuring of culture so that all educational personnel and family members are habituated to sending balanced and rational messages.
Selected Prevention Intervention
- Involves targeted groups of students who are at risk*
- The percentage of students varies by neighborhood – each school in the district may have a different makeup
- Involves specific interventions to avoid future experiences of conflict
- Involves special classes or groups
* Student at risk are not manifesting atypical behaviors. They are selected based on specific risk factors.
- Constitutional handicaps: e.g., perinatal complications, organic handicaps, and/or sensory disabilities;
- Skill development delays: e.g., low intelligence, attentional deficits, reading disabilities, lack of cognitive strategies and/or poor work skills and habits;
- Family circumstances: e.g., low social class, psychological problems in the family, large family size, child abuse, stressful life events, family disorganization, communication deviance, family conflict, and/or poor bonding to parents;
- Ecological risks: e.g., neighborhood disorganization, extreme poverty, racial injustice, and/or unemployment.
Children who are developing under these circumstances are more likely to identify themselves as ‘different’ and therefore are open to distorted beliefs about themselves and others. The prevention efforts are to ameliorate these ‘differences’ and help the child build balanced and rational constructs about themselves and others regardless of the differences. Thus, a school that serves an area where most families are in severe poverty is likely to need to have heavy involvement in both universal and selected prevention efforts.
Indicated Prevention Intervention
- Involves children who are manifesting problems in living although not to the extent that they require remediation.
- This group is often identified by special education which is generally about 13%
- Inclusion of some socially disadvantaged student may increase this percentage.
- Involves specific interventions to avoid future experiences of conflict
- Involves special classes or groups
The interventions are designed to mediate the thoughts, feelings and behaviors that are interfering with growth and development. Many special education students will be in this group as well as students who are in the ‘Child Find’ process.
This is a group that most school districts are most competent to address, although most fail to effectively address the issues of the child with emotional disturbance.
Remedial Intervention
- Involves students who are labeled as having psychological disorders
- Involves students who have been arrested and/or are violent
- Involves interventions that take place in the school and family home
The interventions with this group of students have historically taken place outside of the school. However, several mandates have been placed to include services to these children in schools. IDEIA 2004 has placed emphasis on serving this group. The President’s Freedom Commission Report entitled “Achieving the Promise: Transforming Mental Health Care in America” has also emphasized the role of school in dealing with psychological needs.
In fact, one report, Treating and Preventing Adolescent Mental Health Disorders, WHAT WE KNOW and WHAT WE DON’T KNOW A RESEARCH AGENDA For improving the Mental Health of Our Youth says the following about the role of schools.
Schools have long been recognized as an important context for adolescent mental health development and service delivery. In fact, schools have been described as the de facto mental health service deliver system for children and adolescents, with between 70% and 80% of those that receive any form of mental health service obtaining such services from within the school setting (Burns et al., 1995). Higher prevalence rates of mental disorders and higher rates of comorbidity have been found among children and adolescents receiving services within the special education services of school than in specialty mental health clinics or in substance abuse clinics (Garland et al., 2001).
More than any other setting, schools provide access to adolescents for assessment and intervention. Student functioning, at least in terms of cognitive functioning needed for successful academic achievement is tracked regularly, and behavior is assessed by multiple observers (teachers). At the first sign of problems, interventions could be initiated, rather than waiting until serious disorders develop and the adolescent is brought to a psychiatrist. Preventive interventions designed to target large populations of adolescents are particularly well suited for the school setting.
Unfortunately, …the current state of mental health services in school is poor.
Schools, within their responsibility to educate, have been thrust into the position of providing the primary cognitive and psychological care for children with even severe and persistent problems in living and gradually this responsibility is becoming a mandate. NOTE: Pennsylvania Department of Education’s Special Education Performance Grant: School-Based Behavioral Health Services 2006-07.
DISCUSSION
While school would like to rid themselves of the responsibility for children with severe and persistent psychological problems the likelihood of that happening is small. All forces are moving to integrate a failed mental health system into the school proper. Schools that accept this integration haphazardly are likely to pay a heavy price.
There are ways that schools can approach the problems systematically and actually reduce the occurrence of psychological disorders and increase academic skills through a teaching process. The instinct is naturally drawn to the most problematic students, but the solution lies in the prevention of disorder, not its remediation. However, both prevention and remediation must be predicated on an entirely different construct than the present ‘mental health’ paradigm; and the resultant treatment is neither medical nor magical.
It is based on the logical construct that “You are what you think!”. If you change what you think, you will change both your emotional and behavioral responses. Changing thinking is a teachable process. Educators long the de facto keepers of the psychologically distorted and soon to be the responsible parties are in a unique position to change the culture of ‘victim’ into a culture of heroes. The focus is on Social Competence and the process is an educational one.
Districts have different needs, resources and priorities. While the model is most effective if done in total; districts can choose what areas of concern to address based on their own values. The Institute for Cognitive Behavior Management can help school districts design and implement an intervention strategy that best meets their needs. If the district is unsure where to start, the Institute staff can develop program audits or needs assessments that are user friendly to establish the parameters of the issues as perceived by the educational staff. From there a program can be designed with the model elements most significant to the district and products [evidence-based can be provided and theoretical and practice implementation provided.