So What Are Educationally Related Mental Health Services?

Since the state of California decided to repeal AB3632, which previously governed the provision of mental health services to students with IEPs in California, there has been a lengthy time period of changes and adjustments as school districts have had to figure out how to provide the services that were previously under the purview of the Department of Mental Health.  Now that the dust has somewhat settled, many parents are hearing a relatively new term for the services that previously were referred to as "AB3632 services"  - - "Educationally Related Mental Health Services" or the acronym "ERMHS."

At the most basic, ERMHS should encompass the same types of services that were previously available under AB3632 within a student's IEP, with the exception of "medication management" services.  This means that ERMHS may include residential placement or intensive outpatient therapeutic services like family therapy / counseling, individual therapy / counseling, and/or group therapy / counseling.  At this time, school districts are responsible for providing these services themselves, the same way that school districts are responsible for other related services such as speech and language therapy or occupational therapy.

Because school districts have always had the responsibility of providing "counseling" services as a related service (or what is called "Designated Instruction and Services" or "DIS" services), there is some confusion about the possible overlap between ERMHS and "DIS Counseling."  Here is a definition of each:

Counseling as a Related Services (DIS Counseling) is defined as counseling services provided to a student’s behavioral and emotional needs that affect their ability to benefit from their special education program and are manifested primarily at school.

Educationally Related Mental Health Services (ERMHS) is defined as services provided to a student whose behavioral and emotional needs are documented to be more intense in frequency, duration or intensity, affect their ability to benefit from their special education program, and are manifested as school, at home and in the community.

From these two definitions, it appears that there is a distinction between these two services.  Counseling as a related service is related to situations when a student presents with behavioral or emotional needs specifically within the context of the school setting.  ERMHS on the other hand is related to the provision of more intense services to address more significant behavioral and emotional needs that occur across settings, including outside of the school.  This would appear to mean that a school district must consider not only the behavioral and emotional needs that manifest in the classroom, but also those that manifest in the home and community.  If those behaviors and emotional needs manifesting in other settings impact the student's ability to access an educational benefit, then ERMHS may be warranted.

Given that ERMHS are intended to be intensive therapeutic services that address a myriad of significant emotional and behavioral problems manifesting across settings, one would assume that in many cases ERMHS may need to be provided outside of the school day in order to achieve the level of intensity of therapy that would be required and to effectively provide services like family therapy.  In many school districts in California, ERMHS are being made available outside the school day - in the student's home or through contracts with non-public (private) mental health clinicians.  Inevitably, however, in other school districts the same issues that already arise with regards to the provision of any related services - issues driven by administrative policies, contractual issues and convenience of the school district rather than by the needs of students.  Thus, there has recently been a push in many schools to assert that ERMHS can only be provided during the school day, and that since it is being provided at school it is ultimately the same as or duplicative of DIS counseling services.  While in some situations DIS counseling and ERMHS may be meeting the same needs and both may not be necessary, every child should be viewed as an individual in consideration of this issue, and there may be situations where an individual child requires both DIS counseling at school to address emotional and behavioral issues that specifically arise in the classroom and ERMHS outside the school day to provide parent training and family therapy, intensive clinical individual therapy where techniques like cognitive behavioral therapy can be applied, and appropriate group counseling services.

As school districts continue to adjust to their new responsibilities with the change from AB3632 to ERMHS here in California, it is essential that parents be aware of their rights and continue to advocate for their child's individual needs.  Many school districts have unfortunately given erroneous information to parents - such as broad statements that all students in residential placements will have to return to local schools because school districts are no longer required to fund residential treatment facilities as a student's educational placement.  At the heart of the issue, the substance of what should be provided and when it should be provided has not changed (with the exception of the provision of medication management as noted above).  IEP teams are still charged with determining whether a child requires mental health services as part of their program in order to receive a FAPE.  When placement decisions are being made, residential placement is still a setting on the "continuum of educational placements," and IEP teams still must consider whether a student requires such a setting in order to access an educational benefit. 

Switzer Learning Center

Yesterday, I visited and toured the Switzer Learning Center, a Nonpublic School (NPS) (for more about NPS placements - read our previous blog post from April 2009) in Torrance, California. Switzer if a specialized school for students grades 3 through 12 with learning disabilities, emotional disabilities, attention deficit disorders and behavioral disorders. It is an extremely small school, with currently around 92 students total.

Overview of the Program:

Switzer incorporates a clinical treatment program and behavior management throughout the school program. All students at all grade levels are on a behavior program that is based on reinforcement for positive behaviors, meaning that the students earn points for appropriate behaviors in each period of the school day. Additionally, the school keeps data on both negative or inappropriate behaviors and positive or "involvement" behaviors for every student, and utilizes a computer program to track progress and compare the student to the overall population of the school. The clinical treatment component also includes DIS counseling services for all students on a weekly basis, and availability of the counselors in the moment on an as needed basis.

There is one elementary school classroom, with students ranging from third through sixth grade, and one middle school class, with students from sixth through eighth grade. The high school classrooms are separate from the lower grade levels. The high school program includes six periods per day with the students changing classes and teachers for each class, similar to a traditional high school schedule. High school students can also be dually enrolled, either in a public high school in their home district, at the Southern California Regional Occupational Center (SCROC) in Torrance.

Other Things to Note:

Switzer is a good option for students who have behavior difficulties related to their disability.

It provides modified and individualized instruction within grade level curriculum standards, and also utilizes a specialized reading program, SRA-reading, to provide specialized intervention.

The behavior system is very positive and seems to be implemented consistently.

Switzer offers a diploma-bound curriculum, but does not provide the necessary classes and credits for a student to go straight into a 4-year university.

For more information about Switzer, visit their site directly at www.switzercenter.org. We can also help you with specific information about Non Public School placements.

Manifestation Determinations: Suspensions and Special Education Students

If your special education student gets suspended from school they have certain rights that a general education student may not have.

First, a special education student can be suspended or removed to an alternative placement for up to 10 school days for the entire school year due to a violation of student conduct. If your child is suspended for more than that or the district is attempting to move him to an alternative placement for more than 10 days then the district must first hold a manifestation determination meeting within 10 days of the decision to move the student. To review so far - the district can decide that they want to suspend for more than 10 days or even decide that they want to move your student but they can NOT actually do it until they conduct a manifestation determination meeting.

What is a manifestation determination? It could be like an IEP or it could be more like an expulsion hearing - depending on your district. Under the law the district, parents, and all relevant members of the IEP team review all relevant information in the students file, including their IEP, relevant observations, and information provided by parents to determine whether the conduct in question was caused by or had a direct and substantial relationship to the child's disability or if it was the direct result of the district's failure to implement the IEP. If either of these apply then the violation was a manifestation of the child's disability. If neither of these apply then it was NOT a manifestation of the child's disability and the suspension or move to an alternative placement goes forward UNLESS you appeal the result by requesting a hearing. If your child is removed to an alternative setting the district is still required to provide him with a FAPE.

If the violation is a manifestation of my student's disability what happens next? The IEP team must then conduct a functional behavioral assessment and implement a behavioral intervention plan or if a behavior intervention plan was already developed they must review the plan and modify it to address the behavior. The child also gets to stay at his or her current placement unless the parents and the district agree to a change in placement.

Are there circumstances where this doesn't apply? Of course there is. The district can remove the student to an interim alternative educational setting for not more than 45 days regardless of whether or not the violation was related to the student's disability in the following circumstances: 1) the student carried or possessed a weapon on school premises or a school function; 2) the student knowingly possesses or used illegal drugs or sold or solicited the sale of a controlled substance while at school or at school function; or 3) has inflicted serious bodily injury upon another person while at school or at a school function. The interim setting is still determined by the IEP team.

What if my child is not eligible for special education? In that circumstance they may still be protected if the district had knowledge that the child was a child with a disability before the behavior occurred. The district will be deemed to have such knowledge if the parent expressed their concern in writing that the student was in need of special education, if they requested an evaluation or if the teacher of the child or other personnel expressed specific concerns about the behavior to the director of special education or other personnel.

Can the school call the police? The laws that govern special education students do not do prohibit the district from reporting a crime to the appropriate authorities or prevent law enforcement or judicial authorities from exercising their responsibilities.

Residential Placements

What is a residential placement? When is it required? Who pays for the room and board cost? This blog will cover a basic overview of residential placements. Because often is is the student with mental health needs that need a therapeutic program like a residential school, this blog is part of our series for Children's Mental Health Awareness Day.

Residential schools can provide students with much needed consistency and intensity in their program, and can provide a therapeutic environment that may not be available in other settings. They exist on the "continuum of placements" under the IDEIA and state special education laws. Generally, residential placements are very restrictive settings, are very expensive, and are burdensome on the family unit, as the child has to be out of the home. Therefore, they are only appropriate as a consideration of the IEP team in situations where it is shown that they are required for that student.

Overview and Definitions:

A "residential placement" is a facility in which the student essentially lives at the school site and is in 24 hour custody. Residential schools are a type of therapeutic placement, and they provide a therapeutic component to address the student's mental health needs in conjunction with addressing the core educational curriculum and academics.

Students require residential placements for a variety of reasons and in a variety of situations. Residential placement is deemed appropriate when the therapeutic and residential components of the program are necessary in order for the student to receive an educational benefit. If placement in a residential program is necessary for the appropriate provision of special education and related services to the student, the program (including both therapeutic and educational components) must be provided at no cost to parents. Students who require residential programs are those for whom the educational needs and emotional needs are "intertwined" or "inseparable" from emotional needs, and a determination is made by the IEP team that the child requires therapeutic and habilitation services in order to "benefit from special education."

Some Basic Examples:

Student with extreme behavioral difficulties, who has been unable to learn appropriate behaviors in the school and community settings, or who is unable to generalize learned behaviors across settings to the extent that they are not able to benefit from the general education campus placement.

Students who require intensive 24-hour supervision and interventions to address aggressive, assaultive, destructive or self-injurious behaviors.

Students whose mental health needs are so significant that they impact their ability to participate in the school environment, attend school regularly, and function on a regular campus.

Students who have not made any progress in their emotional and behavioral goals in a less restrictive setting, and who require interventions across settings and in a therapeutic environment in order to benefit.

Payment for Residential Programs:

If a residential program is required for the student to receive FAPE, then it must be provided at no cost to parents. This does not mean, necessarily, that your school district will be paying the entire cost. Rather, states are permitted to have specific procedures and mechanisms in place to deal with funding for residential schools. In many states, there are cost-sharing arrangements between school districts (or "local education agencies" - LEAs), the state department of education (or "state education agencies" - SEAs), and / or other local or state government agencies. For example, in California, there are state-specific cost provisions that require the Department of Mental Health to fund the residential and therapeutic components of the program, if the child is eligible to recieve mental health services under the state's AB3632 provision.

Ultimately, it is the school district's responsibility to provide individual students with a free appropriate public education (FAPE). And the bottom line, therefore, is that if the student requires residential placement to recieve a FAPE, the District bears the burden of ensuring that it is provided at no cost to parents. There are certainly instances where a child may not qualify for eligibility under AB3632 or whatever program/agency the state has for mental health services, but still requires residential placement as part of their educational program. In those situations, the District must fund the placement, including the residential component, because to fail to do so would be a denial of FAPE to the student.

Eligibility under the category of Emotional Disturbance ("ED")

Mental health issues, as described in the previous post, are important components of the special education maze for many special needs kids. While mental health concerns arise in every eligibility category, there is one obvious category where they are a centralized concern, and that is the category labeled "Emotional Disturbance".

To qualify for eligibility for special education and related services as someone with an emotional disability, a student must exhibit one of the following five criteria "to a marked degree" over "a long period of time".

These criteria are:

(1) An inability to learn that cannot be explained by intellectual, sensory or health factors.
(2) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
(3) Inappropriate types of behavior or feelings under normal circumstances.
(4) A general pervasive mood of unhappiness or depression
(5) A tendency to develop physical symptoms or fears associated with personal or school problems.

What is "to a marked degree" over "a long period of time"? Well, to keep things interesting, the IDEA does not define these terms for us. To provide some guidance, the Office of Special Education Programs ("OSEP") has stated that a "generally acceptable definition" of "a long period of time" is a range of time from two to nine months - assuming preliminary interventions have been implemented and proven ineffective during that period. Letter to Anonymous, 213 IDELR 247 (OSEP 1989). As to the requirement that the behavior be to a "marked degree," OSEP has stated that this refers to the "frequency, duration or intensity of a student's emotionally disturbed behavior in comparison to the behavior of his peers and can be indicative of either degree or acuity or pervasiveness." Letter to Anonymous, 213 IDELR 247 (OSEP 1989).

My child meets this criteria, so now what? If your child meets the criteria for ED, then he or she should receive special education and related services that are appropriate for his or her unique educational needs in this area. If your child is not receiving services to meet these needs, then that means it is time for the IEP team to come together to discuss these unique needs, keeping in mind that "educational" needs can include BOTH academic and non-academic areas - so don't be afraid to explain how the emotional disability affects the needs of your child in both of these areas. The bottom line is that your child's IEP should reflect a program that is appropriate to meet your student's unique needs and enable him/her to receive an educational benefit.

How do I get Mental Health Services? Special education students in any disability category may receive services from county mental health programs. To receive these services, it all goes back to the basics of special education- FAPE - if mental health services are appropriate [the "A" in FAPE] to meet your child's unique educational needs [the "E" in FAPE], then those services must be provided at no cost to the parent [the "F" in FAPE].

National Children's Mental Health Awareness Day

Today, May 7, 2009, is National Children's Mental Health Awareness Day. This year's theme is "Thriving in the Community," and the awareness campaign has a special emphasis on how high school youth who receive the services they need are more likely to have positive outcomes, such as better grades, and less likely to have negative outcomes, such as involvement with the juvenile and criminal justice systems.

So many students who receive special education and related services require mental health services to address behavioral, social and emotional needs. We see a wide range of these issues, from kids who need school based counseling services to address their social skills deficits, to kids who require outside therapies to address their mental health needs, to kids who require residential placements because of the severity of their needs.

Here in California, we have what is referred to as AB3632 services, which are services and supports provided by the Department of Mental Health when a child on an IEP requires mental health services in order to access their curriculum. Read more about AB3632 here: http://www.dmh.ca.gov/Services_and_Programs/Children_and_Youth/AB3632.asp

Mental health issues need to be destigmatized-especially for kids and within the special education system. Why is it that parents are so reluctant to accept special education eligibility if the "category" is Emotional Disturbance (ED)? It's because of the stigma attached to these types of disabilities, the stigma that follows the child and unfortunately leads to misunderstanding by teachers and others who then often just assume "this is a bad kid." These issues can only be addressed by increased awareness on a large scale within school systems and communities.

One problem with mental health disabilities is that there are kids who are never identified as having a disability, but are merely "labelled" as being a disipline problem, so they never recieve the supports and services that they need. It is so true that if kids recieve the supports and services they need, they are more likely to have positive outcomes and less likely to end up on the juvenile or criminal system. As advocates, parents and educators, we have a "window of opportunity" to push for interventions and services for these students so that they can succeed and become productive participants in society.

Another equally concerning problem, however, is the overidentification of students as having "ED." In many instances, students with other disabilities, such as Learning Disabilities, Autism, etc, have related mental health needs, like anxiety or depression. Sometimes these needs are exasperated in situations where these children have not recieved the appropriate educational interventions or supports, and so they are flailing in a program where they are overwhelmed or feel "stupid." More awareness and education needs to take place to truly help parents and educators understand the existence of mental health needs that are related to other disabilities. The core disability may not be ED, but the child still may require mental health services in order to meet their needs.

There are also issues with systemic problems within school systems in terms of placing and servicing children with an "ED" label. Organizations all over the country are attempting to fight the "schoolhouse to jailhouse pipeline" by advocating for systemic changes in how students with emotional and behavioral difficulties are served within the special education system. (read: http://www.splcenter.org/news/item.jsp?aid=282) Too often, these kids have been "wharehoused" into special day classes without true individualization of their programs. Too often, comprehensive behavioral evaluations have not been conducted, or behavior plans have not been based on positive interventions, or haven't been approrpiately implemented. These systemic issues need to be addressed if the educational system is truly going to meet the needs of these kids, increase their positive outcomes and decrease the negative outcomes. An interesting article about these systemic issues can be found at the Southern Poverty Law Center's website at http://www.splcenter.org/legal/news/article.jsp?aid=189&site_area=1.

National Children's Mental Health Awareness Day is a good step in the right direction for addressing the issues that face children with mental health needs. Awareness, community education, decreased stigmatization, and systemic change are all necessary to truly begin to meet the needs of these kids so that they really can thrive in their communities.

Two Schools in Two Days

A2Z is often invited to open house events in Southern California to learn about and tour local non public schools. As these opportunities are made available to us, we will post to let you know about schools in your community and how they may be appropriate for your child.

Last week, I had the pleasure of touring two different schools in Los Angeles County: The Pacific Schools & Aviva High School

1. The HELP Group's Pacific Schools



Where: 15339 Saticoy Street, Van Nuys, California

What makes it unique: The Help Group's Pacific Schools are actually made up of 3 specialized programs: Pacific Ridge, Pacific Harbor and Project Six. In the Pacific Ridge and Pacific Harbor program, which are therapeutic day programs, the class size averages about 10 students with 2 adults. Various services, including family therapy, psychiatric services, counseling, speech and language services and Occupational Therapy are available on site. The Pacific Schools serve elementary, middle and high school aged students.

• Pacific Ridge is a day program serving children and adolescents with special needs in the areas of emotional, behavioral and neurological challenges.
  

• Pacific Harbor is for students who internalize their feelings, such as depression and anxiety, and may display mild behaviors. This program is also appropriate for students with emotional disturbances that require more intensive and comprehensive mental health services.
  

• Project Six is a residential treatment center for adolescents with emotional and behavioral challenges.
  

Is it appropriate for your child? The Pacific Schools may be appropriate for your child if he/she has emotional disabilities, behavioral disabilities, autism spectrum disorder, significant behavioral challenges or internalizing disorders. It provides a safe environment for students who were previously bullied at a typical school due to their differences, and who now show internal or external behaviors.

What I love about this school: The staff at the Pacific Schools place a strong emphasis on finding individualized incentives that are of interest to its students and using those things to help the student access his/her education. For instance, if your child is interested in playing instruments, sewing or guitar hero, these things would be made available as an incentive. For each program, there were "reward lounges" where students could play games, watch TV or use the computers. The importance of incorporating a child's interests into his/her program was a universal message across all three programs at the Pacific Schools. I believe that it was for this reason that the Pacific Schools had a personal touch where the personalities of the children were very evident.

2. Aviva High School




Where: 7120 Franklin Ave., Los Angeles, CA 90046

What makes it unique: Aviva High School is one of the few all girl, non public schools in Los Angeles County. Aviva also has a residential treatment program that has 42 students enrolled in the high school. Aviva provides a range of on-site clinical and educational services. Aviva also offers a mandatory 6 week summer school program designed to enrich and broaden the students' reading, writing, and math skills and prepare them to pass the California HIgh School Exit Exam (CAHSEE). Aviva High School has a maximum enrollment of 84 students. The maximum student:teacher ratio in class is 6:1. Over 95% of its students go on to post secondary programs, including universities and junior college.

Is it appropriate for your child? Aviva High School is appropriate for girls in grades 7 through 12 who need special academic, emotional, or behavioral support to maximize their educational potential. If your daughter requires a dual enrollment program, then Aviva may be the appropriate placement for her.

What I loved about this school: It was very clear that the staff at Aviva were dedicated not only to its students, but were also dedicated to working on improving the bureaucratic system that can often be an impediment to special education students. The staff at Aviva have forged relationships with individuals in the LAUSD system that are in charge of making important decisions, and are working with them to try to evoke a change in the system. This passion was not only present at the administrative level of Aviva, but was also apparent through the teachers, aides, and even hallway monitors at the school.