Introducing C.O.P.E.- A Mental Health Action Plan for Back to School

By Jerry Barone (Chief Clinical Officer), Dr. Coleen Vanderbeek (Director of Clinical Programming) and Duncan Young (CEO)

School districts across the county currently face a tremendous amount of uncertainty as they plan different approaches for returning to school in the fall. Should school be in-person, virtual or offered via a hybrid approach? How does a district balance the risk to student and teacher health with the very real negative consequences of continued disruption in schooling? And finally, once we return to school, how do we support the mental health of students, many of whom have been struggling for many months with a toxic combination of social isolation, environmental stress, and increased anxiety- in short, a collective trauma shared by a whole generation of young people?

While the first two questions are rightfully ones that districts are focused on right now, as the beginning of the school year approaches, the key questions districts must answer around mental health will gain in urgency. These can seem daunting, as many districts lack an effective mental health safety net to begin with. Fortunately, there are a specific set of concrete steps that districts can take, which we have encapsulated in the following framework which we call C.O.P.E.

Each step in the C.O.P.E. Framework- Communicate, Orient, Phase, and Extend- has a specific set of checklist items which provide districts with an actionable roadmap for how they can support student mental health. Let’s delve into each element of the framework.

Communicate and Plan

One of the major needs that districts will have around re-entry is the need to clearly communicate mental health as a priority, to acknowledge the struggles that students and staff might be facing, and to let them know that it’s “OK to not be OK.”

The key concepts for the Communicate and Plan section of the framework focus on this goal through building consensus among multi-disciplinary teams where all involved parties are having conversations around mental health and related supports for teachers, students and parents that need to be in place for the return to school.

Key checklist items include:

• Establish a multi-disciplinary Mental Health Steering Committee (i.e., Leadership, Educators, Clinicians, Students, Caregivers, Stakeholders, etc.) dedicated to planning for the ongoing mental health needs of students in relation to COVID-19 and school re-entry
• Develop an action plan to strengthen mental health gaps within all three tiers of their RTI Framework for teachers, students and families- divide this action plan into at least two phases, e.g. one for the first 90–120 days after school starts, and a second for the remainder of the year
• Develop a clear communication plan regarding mental health support systems that includes both an upfront communication from district leadership about supports being put in place, and ongoing updates.
• Schedule a back to school “virtual assembly” to communicate mental health supports to all stakeholders
• Develop psycho-education and SEL content that can be used in the virtual assembly and ongoing communications, focused on areas like mindfulness, resiliency, trauma, and distress tolerance
• Review discipline and attendance policies and consider revision in light of the unique circumstances of the coming school year

Orient All Staff Members

Equipping all teachers with the right toolkit to navigate school re-entry will go a long way in helping students acclimate back to their home school environment come the fall. This content should focus on topics like the identification of mental health warning signs as well as developing an understanding of trauma and how teachers can support students who have experienced trauma. A foundation of empathy and understanding as to the challenges students will face upon their return is vital, as is a sound program of professional development for staff.

Key checklist items include:

• Develop a plan to provide specific professional development content for teachers focused on navigating students return to school during COVID-19
• Develop professional development content focused on mental health signs and symptoms and trauma that students may display, along with appropriate referral methods for students
• Create a guidebook of mental health resources that teachers can access to support their own mental health; recommunicate any information on existing mental health supports (e.g. Employee Assistance Programs) available to teachers

Phase Clinical Care

We recommend that districts adopt a phased approach in providing clinical care to students during the back to school environment. Phase 1 consists of the first 90–120 days after school re-commences in the fall, and should prioritize flexibility and reach above all else. After all, during the back to school environment there are a lot of unknowns both in terms of the number of students who will be experiencing challenges and the types of challenges they will experience. Clinical staff should be deployed not just to reach students with previously identified needs, but should take on broader roles focused on screening, referral, and delivery of shorter-duration treatment for students who present with need and who may not have been on anyone’s radar screen previously. We think of clinicians deployed during this phase as “Mental Health Swiss Army Knives”, able to respond rapidly to a wide assortment of challenges, many of which may have been unforeseen.

Phase 2 occurs once a new equilibrium has been found- at that point clinical staff can be re-deployed in more permanent program structures to serve students with either intensive or more mild to moderate mental health needs.

In both phases, student safety and supervision are paramount, and districts should make sure that they have reviewed and refreshed their crisis assessment and referrals protocols.

Key checklist items include:

• Add a mental health screening process to identify students that are at high-risk of needing mental health support upon their return to school- this could include an online screener, a student survey, or clear communication of a referral process to teachers who may observe student challenges
• Evaluate the status of existing mental health programming (both intensive Tier 3 programs and Tier 2 programs for students with more mild to moderate challenges); ensure that program format has been adapted to reflect the back to school model
• Examine ways to redeploy existing clinical resources or add resources as part of a Phase 1 plan to increase screening and treatment options for students in need
• Ensure that mental health programming models have adequate personnel and content to focus on areas like trauma, bereavement, substance abuse and anger management (issues that may have been triggered by COVID-19)
• Ensure that there is a virtual capability for all therapeutic programming that can be activated if necessary
• Review and refresh crisis assessment and referral protocols

Extend Mental Health and SEL Into Classroom and Community

Extending evidence based psycho-education and social-emotional learning into the full academic milieu can go a long way towards creating a whole-school culture that prioritizes mental health and social-emotional well-being. These types of supports can also serve as a great way to regulate student mood and behavior in the face of many of the new and unfamiliar school-based routines that students will face. Also, this extension should go beyond the academic setting and include content for parents and families as well.

Key checklist items include:

• Structure regular time in the school schedule (e.g. bi-weekly to monthly) for classroom meetings/lessons in which school-employed mental health professionals “push in” to deliver psycho-education and SEL lessons focused on areas like mindset, behavior standards, bereavement/loss, affect regulation, coping/calming skills, learning strategies, self-management skills, social skills
• Develop the content to support these lessons
• Adapt all “push in” content to be able to be delivered in in-person, hybrid, or virtual scenarios
• Establish protocols to address ongoing staff needs (e.g., burnout, bereavement, illness), related to loss or stress from the pandemic (e.g. stress related to financial, personal, social, physical/medical issues, or not being able to say goodbye to students and staff members not returning to school)
• Develop a parent support series to assist parents with mental health concerns as their child navigates their return to school; schedule monthly virtual parent support groups to deliver this content to parents

In summary, all districts can make a meaningful difference in the mental health and wellness of their students during the upcoming back to school period. With a systematic, checklist-driven approach we can help all students “C.O.P.E” with the uncertainty they will be facing.