Optimizing Your District’s Mental Health MTSS for Crisis Recognition and Response

  • District leaders and clinicians should examine the crisis screening events that have occurred over the last several years, with an attempt to identify patterns and opportunities for improvement.
  • School-based Crisis Counselor(s) and back-up Counselors must be identified and receive proper initial training and ongoing professional development.
  • Screening Tools must be examined and selected (e.g., The Columbia Suicide screening tool and/or a proprietary crisis screening tool).
  • State “Duty to Warn” regulations should be reviewed to ensure that crisis counselors know under what conditions threatened individuals and/or law enforcement professionals should be notified.
  • The district’s “fit to return” letter should be reviewed and revised if needed, especially regarding the clarity and specificity of the assessing provider’s recommendations.
  • A method for parent notification and consent for screening must be developed, along with a procedure for proceeding in an emergency if the parent cannot be reached.
  • A communication protocol for providing the student, parents, and designated school personnel with recommendations upon completion of the screening must be developed.
  • A written summary format that includes the student’s presentation, the clinician’s findings, and the clinical recommendations should be developed. This summary will be completed and shared with the crisis team and the parents. In those cases where no further intervention is recommended, a process for deciding whether the student should report back to class that day should be clarified.
  • A process for coordination of care is needed for those instances when a student is referred to a crisis center or hospital for further evaluation. A “Clearance Letter” that includes all recommendations and requested accommodations should be designed for discharging providers to complete prior to re-entry.
  • A re-entry process should be established for all students regardless of the level of care (including no care) that was recommended. Without a well-defined process a student’s care and/or safety plan can be fragmented, and the likelihood of another crisis is increased.
  • Following re-entry, each student referred for a crisis screening should be reviewed on a weekly basis by designated administrative and clinical leadership until such time as the student’s condition is stabilized. Adherence to treatment recommendations, mental health symptoms, and academic performance are among the appropriate topics to discuss.
  • Once a comprehensive Crisis Assessment, Response, and Re-Entry “Fit to Return” protocol is created or revised, a plan for training (and continually re-training) all staff must be developed, along with a process for informing parents and guardians about all aspects of the process.
  • Regular staff training on recognizing mental health issues, on de-escalation strategies, and on approaching students from a trauma-informed perspective should be conducted.
  • Information about crisis incidents/assessments should be aggregated and reviewed on at least a quarterly basis by designated clinical and administrative leadership.
  • Provide a safe, positive, and affirming school environment.
  • Learn how to recognize signs of changes in mental and physical health among students, including trauma and behavior changes. Take appropriate action when needed.
  • Provide a continuum of supports to meet student mental health needs, including evidence-based prevention practices and trauma-informed mental health care.
  • Expand the school-based mental health workforce.
  • Support the mental health of all school personnel.
  • Protect and prioritize students with higher needs and those at higher risk of mental health challenges, such as students with disabilities, personal or family mental health challenges, or other risk factors such as adverse childhood experiences (ACES), trauma, and poverty.



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Effective School Solutions

Effective School Solutions

Reinventing K-12 Mental Health Care. Effective School Solution partners with school districts to help develop K-12 whole-school mental health programs.