Educating the Student with Mental Health Conditions

Educating the Student with Mental Health Conditions Behavior Disorders/Emotional Disability and Educational Implications Robin M. Fierer-Wilson, EdS RCCSEC School Psychologist

Topics to be covered: • IDEA and Emotional Disturbance/Disability (ED) • Characteristics of Students with Emotional Disability • ED versus “Socially Maladjusted” • Specific Emotional Disabilities • The Role of Schools • Response to Intervention for ED

IDEA and Emotional Disability • A condition exhibiting ONE or more of the following FIVE characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: • Inability to learn that cannot be explained by intellectual, sensory, or health factors • Inability to build or maintain satisfactory interpersonal relationships with peers and teachers. • Inappropriate types of behavior or feelings under normal circumstances • A general pervasive mood of sadness or depression • A tendency to develop physical symptoms or fears associated with personal or school problems

Characteristics of Students with ED • Typically exhibit mood disorders (depression, bipolar), anxiety disorders, or other psychiatric disorders • Co-occurrence of emotional disturbance and behavior disorders is common • Particularly vulnerable to environment changes such as transitions and to a lack of positive behavior support during transitions • Behavior and intensity is episodic and subject to change over time • Often behavior serves to direct attention away from underlying issues, such as depression • Behavior may be internal or external (e.g. acting out vs. withdrawn)

Behaviors Exhibited by Children with ED • Hyperactivity (short attention span, impulsiveness) • Aggression or self-injurious behavior (fighting, throwing things, cutting) • Withdrawal (not interacting w/ others, excessive fear or anxiety) • Immaturity (inappropriate crying, temper tantrums, poor coping skills) • Learning difficulties (academically performing below grade level)

ED versus “Socially Maladjusted” • Students who are deemed “Socially Maladjusted” are NOT eligible for special education services under IDEA • “Socially Maladjusted” has no clear Federal definition, thus no universally recognized agreement of its meaning • Additionally, no clear process for determining ED versus Socially Maladjusted • Body of research exists supporting different definitions of Social Maladjustment (Achenbach, Bower, Clarizio, Forness, Merrell & Walker) – a non-exhaustive list of authors, not specific citations

Traditional View of “Socially Maladjusted”(Merrell & Walker, 2004) • Student meets the Diagnostic & Statistical Manual of Mental Disorders (DSM) criteria for Conduct Disorder or Oppositional-Defiant Disorder • Engages in antisocial and delinquent behavior within the context of a deviant peer group (typically seen by older children) • Maintains social status with deviant peer group by engaging in antisocial and delinquent behavior • Problem behavior is “willful:” child is making a “choice” to do it and could stop if desired • Student with SM does not have internalizing/emotional problems or mental health problems • Student with SM believes that behavioral rules should not apply to them or that they should be able to self-select own rules of conduct • Students with SM are shrewd, callous, streetwise, and lack remorse

Legal Cases of Eligibility and Ineligibility • Fauqueir County Pub. Sch., 20 IDELR 579 (August 11, 1993) • The parents of a nine-year-old wanted their daughter classified as ED so she could receive special education services. The hearing officer found that the child did exhibit rage and behavioral problems at home and was categorized as “asocial”, but she was making significant progress in school. Eligible or Ineligible • The officer also found her to be well adjusted in the school setting. Therefore, the child was benefitting from the regular education program and, therefore, not eligible for special education services.

Eligibility versus Ineligibility • Hansen v. Republic R-III School District, No. 10-1514 • Larry Hansen’s son is a ninth-grade student in the Republic R-III School District (“Republic”) and has been diagnosed with conduct disorder, bipolar disorder, and attention deficit hyperactivity disorder. Hansen has (1) been suspended numerous times for threatening classmates and teachers, (2) made suicidal comments on multiple occasions, (3) consistently performed poorly in his classes and standardized tests. At the end of his fifth-grade year, Hansen’s father initiated proceedings under the IDEA for sped services for Hansen. Eligible or Ineligible

Hansen v. Republic cont. • Initially, Republic determined that Hansen did not qualify under IDEA for special education services. Hansen’s father challenged the decision, but the Due Process Panel agreed with Republic that Hansen did not qualify. • Hansen’s father sought judicial review of the panel’s decision, and the district court agreed with Hansen’s father that his son was disabled as defined by the IDEA. • Republic then appealed the matter to the Circuit Court of Appeals, arguing that Hansen did not meet the statutory definition of a “child with a disability”, arguing that he was “Socially Maladjusted”. • The Circuit Court of Appeals agreed with Hansen’s father, stating that the student “…consistently struggled to pass his classes, failed the standardized test for advancement to seventh grade, and suffered academically because of his diagnosed bipolar disorder.”

Specific Emotional Disabilities • Anxiety Disorders • Umbrella term that refers to distinct disabilities that share core characteristic of irrational fear: generalized anxiety disorder (GAD), Obsessive –compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias (heights, insects, etc) • Anxiety disorders are the most common psychiatric illnesses affecting children and adults (Anxiety Disorders Association of America)

Bipolar disorder (formerly referred to as Manic-Depressive Disorder • Causes dramatic mood swings from overly “high” and/or irritable to sad and hopeless and then back again, often with periods of normal mood in between. • Severe changes in energy and behavior go along with these changes in mood. • For most people, mood swings and related symptoms can be stabilized over time with a combination of medication and psychosocial treatment.

Conduct Disorder • Refers to a group of behavioral and emotional problems in children and adolescents. • Kids with this disorder have extreme difficulty following rules and behaving in a socially acceptable way, which may include some of these behaviors: • Aggression to people and animals; • Destruction of property; • Deceitfulness, lying, or stealing • Truancy or other serious violations of rules • National Alliance on Mental Illness. (2010). What is mental illness: Mental illness facts. http://tinyurl.com/3ew3d

Reactive Attachment Disorder • Disturbed and developmentally inappropriate social relatedness in most contexts to a marked degree, beginning before age 5 evident by (1) or (2): • (1) Persistent failure to respond appropriately to most social interactions (highly inhibited/ambivalent, hyper vigilant, contradictory responses such as approach-avoidance) • (2) Attachments categorized as inappropriate or indiscriminate, such as excessive familiarity/comfort with strangers or lack of selectivity in choice of attachment figures (indiscriminate). • Not accounted for by developmental delay (e.g. mental retardation) and does not meet criteria for a PDD • Pathogenic care of at least 1 type (neglect, abuse, repeated changes of primary caregiver)

Role of Schools in Children’s Mental Health • Schools provide a logical venue/opportunity to bring students, educators, families and community together • Building a “System of Care” or a partnership of service providers to support student success with a multidisciplinary team approach or “Wraparound Planning Process” • The Comprehensive Community Mental Health Services Program for Children and Families is a Federally funded program that provides grants to local communities (SAMHSA - http://www.samhsa.gov/)

Wrap-around Planning Process • Proven to be an effective process for designing individualized service plans for children with ED and their families • Teams include school personnel, family members of student, and other service providers involved with child (e.g. case worker, counselor, clergy) • In the three-tiered model (RtI/PBIS) the Wraparound Planning process can address the complex needs of students in the top of the triangle (RED): the 1% - 5% needing intensive and individualized behavioral interventions

Wrap-around Plan Example Justin: • Six years old, beginning kindergarten • Had been kicked out of several childcare centers for biting, kicking, and hitting. Also destroyed property and had temper tantrums that would last for hours. • Mother took him to the local medical school, where they diagnosed him and came up with a treatment plan. • Mother also took him to the community mental health clinic, where they provided a different diagnosis and treatment plan.

Justin continued… • The school provided a third “diagnosis” (eligibility determination) and plan. • When mother chose ONE plan to follow, the other two systems labeled her as “resistant”. • The Wrap-around Plan promotes a coordinated, community-based approach to care for children and adolescents with serious mental health challenges and their families. • “A system of care is not a program, it’s a PHILOSOPHY” (Dr. Gary M. Blau, Chief of the Child, Adolescent, and Family Branch at SAMHSA’s Center for Mental Health Services (CMHS)

RtI and Students with E/BD • Students identified as having E/BD may receive support at any Tier (I, II, or III) • It must be determined what level of services will provide the highest chance of success for the student – both behaviorally and academically • E/BD students will likely receive Tier III behavioral support, including an extensive functional behavioral analysis and interventions

Academic Systems Behavioral Systems • Intensive, Individual Interventions • Individual Students • Assessment-based • High Intensity • Intensive, Individual Interventions • Individual Students • Assessment-based • Intense, durable procedures • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Universal Interventions • All students • Preventive, proactive • Universal Interventions • All settings, all students • Preventive, proactive Designing School-Wide Systems for Student Success 1-5% 1-5% 5-10% 5-10% 80-90% 80-90%

Council for Children with Behavior Disorders(CCBD): Position statement on RtI and Behavior • All teachers and school personnel should be provided with the tools to implement scientifically-based academic and behavioral interventions. • Schools that implement RtI should be committed to providing PBIS and should integrate RtI and PBIS to ensure students’ academic and behavior needs are addressed. • *A functional behavior assessment and behavior intervention plan are suggested for any student exhibiting behavior that leads to restrictive disciplinary actions. RtI interventions should not be substituted for a spec. ed. evaluation referral for a student suspected of having E/BD. • Failure to refer a student suspected of having a disability and continued use of suspension and expulsion in the name of RtI are inappropriate strategies for addressing a students emotional/behavior problems.

CCBD position statement continued… • General education teachers should receive support staff, resources, and training in appropriate scientifically based academic and behavioral interventions regarding RtI. • *While collaboration between general and spec. ed teachers will enhance services at every level of a tiered system, spec. ed teachers should not be expected to reduce services to identified students with disabilities to assist general ed teachers in implementing RtI. • Parents should be actively involved in RtI and informed of the student’s progress or lack of, throughout the process

Please feel free to email me with any comments or questions! Robin Fierer-Wilson fiererrm@rccsec.org

Educating the Student with Mental Health Conditions