Blended Mental Health- A Flexible Safety Net for an Uncertain Time

By Duncan Young, CEO, Effective School Solutions

At this very moment, districts across the country are wrestling with a series of fundamental questions about what schooling will look like in the next 12–18 months. Will school be back in session? What changes to the school’s physical environment and operations will need to occur? If schools do go back in session, what is the risk of additional future closures? And finally, what will the state of student mental health be, and how can every district ensure that a flexible, powerful mental health safety net is in place to support students? For this last vital question, many districts are increasingly exploring the idea of Blended Mental Health, a form of mental health delivery that seamlessly combines in-person and virtual services.

COVID 19 and the Mental Health Challenge

Before diving into the details of Blended Mental Health, let’s first better understand the ways in which the COVID-19 crisis will affect the mental health of students. During this time of school closure, educators and clinical staff are reporting an uptick in mental health challenges among students. Academic stressors, family stressors, and most importantly social isolation are all key challenges for young people, especially those who relied on the structure and social connections of school as a mental health support. For these students, school was a “safe space” to which they no longer have access. Conversely, for school avoidant students, the return of school will create its own set of challenges. These students, who may be functioning well during periods of school closure, will be at higher risk of struggling to re-acclimate into the school environment. For all students, the pandemic serves as a sort of universally shared form of trauma that on balance is likely to increase the frequency and intensity of mental health challenges.

Blended Mental Health- A Primer

Because of the uncertainty of what back to school will “look like” in the fall, and the possibility of additional intermittent school closures, districts need to prepare and implement flexible, powerful mental health safety nets that are equally effective in supporting students both in-school and at home, in the same way that they are providing blended delivery models for academic programming. We call such a model Blended Mental Health. A good example of Blended Mental Health in action is found in our own organization, Effective School Solutions. We have traditionally delivered in-school intensive clinical services to students with emotional and behavioral challenges, but when school closures occurred were able to immediately “toggle” our care to a 100% virtual model. Here are some of the things we have learned along the way that we hope districts will find helpful.

Tip #1: Make sure you have the right in-person care occurring

To define what a Blended Mental Health continuum looks like, districts first need to make sure that they have the right continuum of in-person supports in place. We recommend the use of a Response to Intervention (RTI) or Multi-Tiered Systems of Support (MTSS) model for intervening and designing a mental health continuum. (ESS has designed and implemented such a continuum and a companion needs assessment, which you can find here.) In working with dozens of districts, we often observe that internal capabilities around Tier 2 mental health support (moderate and more episodic types of support such as Student Assistance Counselors, Guidance, etc.) are often strong, but higher levels of care (Tier 3 support) are often lacking, with out of district placements often taking the place of a true internally delivered Tier 3 support. It’s important that a district mental health continuum ensure that all three tiers are represented, and that each tier is sufficiently staffed, as many more students will likely require support when back to school occurs.

Tip #2: Prepare and Make a Checklist

Once the right in-person continuum is in place, districts should begin the process of ensuring that all the prerequisite steps are in place for a seamless and immediate shift to virtual support if school closures occur. Some of the questions that districts should consider include:

• How will the types of care in the in-person model translate to virtual delivery? (Our experience has been that individual and family therapy translate very easily, whereas treatments like group therapy- while powerful- require more planning and coordination to implement)
• What technology platform will be used for virtual care, and does it have the correct privacy and security capabilities and settings?
• What is your state’s requirement for gathering consent for the delivery of telehealth services?
• Will the goal of each therapeutic interaction change? For example, when we first implemented virtual support, we substituted true individual therapy with a series of therapeutic “check ins” that were a bit less structured and shorter in duration, with the goal of using early sessions simply to get students comfortable with the forum.)
• What guidelines and communication do you need to have for parents with respect to setting expectations and ensuring that there is privacy and confidentiality in the home environment?

Tip #3: Don’t Be Afraid to Throw Away the Script

During periods of school closure many students, particularly those with mental health challenges, are going to struggle with basic needs. Their home environment might be stressful, there may be a lack of availability of food and other basic resources in their home, and they may be struggling with social isolation. Sometimes, students may just need simple connection vs. a highly structured therapeutic sessions, and this is OK. Our clinicians, early in the school closure period, spent a lot of time just connecting with students and learning more about their at-home interests. (It’s safe to say that many students’ pets have made frequent guest appearances during therapy sessions!) Other clinicians have worked with families in high-poverty areas to get them access to food and other basic resources. During the stress of a pandemic and school closure, it’s important to be comfortable occasionally “throwing away the script” and taking on a whatever-it-takes attitude to address whatever student need is presenting itself.

Tip #4: Adjust Therapeutic Delivery

It’s important for clinicians to recognize that delivering successful virtual therapy requires an additional set of skills and practices above and beyond the delivery of in-person therapy. For example, clinicians need to spend more time preparing the physical space that they are in to ensure confidentiality and lack of distraction, and need to remind students ahead of time to do the same on their end. We recommend that our clinicians do “dry runs” with students before a first therapeutic session to make sure all potential technology snags are worked out. For more tips on virtual therapeutic best practices check out our companion article that takes a deeper dive on this subject.

Tip #5: The Family Connection is Even More Important

We believe that incorporating a strong family therapy component into a student’s mix of treatment modalities is vital. This becomes even more important during times of school closure. During school closure, the parent reinforces their role as a vital partner in supporting the therapeutic process. They may need to take a more active role in getting the student to participate in treatment, and the therapist and parent can work together to help students manage the new and emerging stressors that students may experience during times of school closure. As an example, when we are doing in person services, we normally would see 5–10 individual student interactions for every one parent interaction. During times of school closure, we see that ratio being closer to two to one, or even one to one. Parents may be struggling with their own mental health, or at the very least increased levels of stress, and interactions with a therapist about their child can often have an ancillary benefit for them.

In summary, we believe that the concept of Blended Mental Health will be vital to providing students with a flexible mental health safety net in what promises to be an uncertain period of time in the upcoming months. Working together, we are confident that we can get our at-risk students the support they need.