I'm Back! Developing A Transition Plan for Students with Disabilities Who Return to Rural School Districts from Mental Health Treatment Facilities
Nichols, Joe, Davis, Tina, Rural Special Education Quarterly
Rural school districts often face the dilemma of students with disabilities returning from mental health facilities without sufficient accompanying information needed to facilitate a transition into the educational setting. The compounding factors in this dilemma are the lack of rural mental health professionals and the proximity of mental health facilities to rural school districts. In order to develop a transition plan to address this dilemma, a mental health facility and twenty-five rural school districts collaborated in constructing The Cognitive/Behavior Management Transition Plan (CBMTP). This individualized plan details the roles of mental health professionals, parents, and educators in assisting the transition of students with disabilities into the rural school environment.
Many in rural school districts are encountering situations in which students with Individualized Educational Programs (IEP) are removed from the school setting and transferred to mental health facilities, located in distant locations, for evaluation or treatment. The students' removals result from a variety of reasons, with the most common being depression, drug use, or violence (Berns, 2001). Assignments to mental health facilities can result from court orders, referrals from social service agencies, or by parent referrals. Irrespective of the reason for the removal from the school setting, within a matter of a few weeks or months, most students are back home and expecting to resume educational activities in their local school district. The problems arise when students return with no accompanying information from the mental health facilities that inform school districts of assessment results or treatment plans.
When students with disabilities return from treatment facilities to resume educational services, school district personnel pose many questions. Are the students dangerous to themselves or others? Are they "cured?" What behaviors are we to expect? Has medication been prescribed that might affect school behaviors? Have IEPs been addressed while students were in the treatment facility?
Statement of the Problem
The dilemmas encountered by rural school districts receiving information regarding students who have been treated in mental health facilities are articulated by Dr. Annette Hux, a public school superintendent in the rural Bootheel Region of Southeastern Missouri, and a former teacher in a program for emotionally disturbed children:
Our school district is located about seventy five miles from Paducah, Kentucky and Jonesboro, Arkansas. Paducah is the home of the NBC affiliate and Jonesboro the ABC affiliate on our local television cable. When the shootings occurred in school districts located just outside these two cities, we became keenly aware of the fact that rural schools were not immune to violence. After these incidents occurred, my district and most others in the Missouri Bootheel have pretty much adhered to a zero tolerance approach to school violence and threats of violence.
One might think that the greatest problem we would face in a rural environment would be access to treatment for students who demonstrate a need for mental health services, but that is typically not the case. Usually either the juvenile court system or social service agencies arrange for these services and do so in an expedient manner. Our greatest problem is receiving information from the mental health facilities that have supposedly treated these kids. Most facilities are in excess of two hundred miles from our district, leaving us little chance of direct conferencing regarding students. We are often told that information cannot be shared due to FERPA or the facility's confidentiality protocols. We have had students return to us without any accompanying information in regard to their diagnosis or treatment plan. This is a difficult issue for schools and students alike, but is especially difficult when students have IEPs and an expectation of uninterrupted educational and related services exists.
As a special education teacher, my first concern was the returning students' ability to come to school and function both socially and educationally. Additionally, I had serious questions regarding how their IEPs were addressed while they were in treatment. As a superintendent, my main concern is readmitting students who have demonstrated behaviors that could endanger their peers and personnel in our school district. The concern magnifies when no information accompanies the child from the mental health treatment facility. (A. H. Hux, personal communication, March 2, 2002).
This concern of rural mental health follow-up care is consistent among rural special education teachers and school personnel regarding students with disabilities who return from treatment facilities. Olson (2000) noted, "... the situation is similar in rural areas across the country. Ninety- five percent of the nation's most rural counties do not have a single psychiatrist, 68 percent lack psychologists, and 78 percent do not have social workers" (p. 66). Facilities are often reluctant to release information surrounding the child for fear of compromising confidentiality issues. School districts are reluctant to readmit the students fearing situations may arise regarding their safety, the safety of their peers, and the safety of their staff.
Mental health professionals stress the importance of a transition plan for students who have been assessed, treated, and released from mental health facilities. Transition teams should include psychiatrists, physicians, parents, and educators. This team should have the capacity to act quickly in order to coordinate the essential mental health services children need after discharge in order to reestablish them in their community and school (Dush, Ayers, Curtis, & Worthington,2001).
Background of Problem
In recent years there have been revolutionary changes in the mental health services that impact the public school system. According to Murray (1997), current estimates suggest that due to a changing society, twenty-five percent of this nation's adolescents are at risk of serious mental illnesses that may threaten their life or the lives of others. Crespi and Steir (1996) observed that increased needs of mental health treatment services and preventive services for adolescents are escalating. Rural dwellers find those services difficult to access within a close proximity.
The mental health issues many children bring to schools often overwhelm school counselors. Most rural school districts do not employ school psychologists, but most employ guidance counselors. While the guidance counselors are prepared for crisis management, they have limited preparation in addressing serious mental health issues. Culbertson (1993) noted that school psychologists represent only five percent of the total number of clinically trained mental health professions, and one can reasonably assume that these trained psychologists do not often reside and practice in rural areas.
According to Canter and Dryden (1993), Georgia special education directors reported that independent contractors provide assessment services to more than one-half of the state's school districts. Canter (1998) also expressed concerns with school districts' abilities to address issues of depression, suicide potential, and substance abuse. If the school is unable and/ or unqualified to provide appropriate counseling and psychotherapy for its students, referrals to private facilities not only become essential, but are legally mandated through the Individuals with Disabilities Education Act (IDEA).
Children with mental health issues have many treatment options depending upon the severity of the situation. Mental health professionals strive to provide care according to treatment plans developed by multidisciplinary teams. According to Nastasi, (1998), the goal of the profession is to restore maximum independent living as rapidly as possible using appropriate levels of care for an illness. School district personnel encountering children with mental health issues need to be functional members of multidisciplinary teams who assist students with their transition from segregated assessment and treatment to functional independence. Due to the distance between the treatment facility and the school district, the physical presence of district personnel in multidisciplinary staffings is often difficult to arrange.
Weist (2000) suggests that evidence is emerging that rural school mental health programs will broaden their scope in the years to come. Critical to the success of those programs will be establishing standards for needs assessments and allowing school districts the latitude to design effective programs.
A mental health assessment and treatment center sought to establish and facilitate positive networking relationships with its rural public school district constituencies located in Arkansas and Missouri. In order to provide an efficient and more effective continuum of care for students with disabilities with mental health issues, the treatment center sought to create a protocol that would articulate facility-school transition services after assessment, treatment, and dismissal from the facility. The goal was to establish a networking system that identified transition services and personnel responsible for those services for students with disabilities returning to school after mental health assessment or treatment.
In order to secure information from rural school districts that would assist the facility in developing a student transition protocol, twenty-five rural school districts were surveyed with a written document. The survey document was constructed by the facility's special education instructor, educational coordinator, and a university professor with input from a facility social worker, a facility physician, and a facility mental health counselor (See Appendix A). Items contained on the survey were a result of complaints raised by constituent school districts who had determined that inappropriate or lacking information accompanied the return of children with disabilities after assessment and/or treatment from the facility.
The respondent districts were each located in a rural demographic setting and each had a total school population of less than one thousand pupils in grades pre-kindergarten though grade twelve. The survey was mailed to the counselor in the senior high school of each district with instructions for it to be completed collaboratively with input from the district's building level administration, special education instructors and counselors. All participants involved in the completion of the needs assessment survey were identified by position.
Needs Assessment Survey Response
Nineteen districts responded to the initial survey
within three weeks of its mailing. Three districts responded after a follow-up phone request was made. Three districts declined to respond to the survey.
The survey document (See Appendix A) allowed written input from school districts after an initial response to the following four questions:
1. Does our facility provided adequate information to ensure safe and efficient transition of your students after assessment or treatment in our facility? If the answer is "no," what recommendations do you have for improvement?
2. Is there adequate communication between the special education teacher in our facility and the district's special education teacher? If the answer is "no," how can communication be improved?
3. Will your district provide a transition team member to attend meetings at our facility (or by telephone conference) prior to a student's dismissal from our facility?
4. In developing a transition plan, what specific components need to be included that will assist you in providing a continuum of care in an efficient manner?
Results of Needs Assessment Survey
From the twenty-two school districts who responded to the survey, all expressed concern regarding the adequacy of information provided from the facility which would ensure successful transition. While each district stated that the facility provided information regarding the addressing of IEP objectives, concerns over medications, aftercare, and safety were consistent among all districts responding to the survey. A specific concern noted by eighteen districts was that little prior notice was received informing them that a "high maintenance child" was returning. Nine districts expressed concerns regarding the behavioral impact of medications taken by returning students.
All districts stated that adequate communication took place between the facility's special education teacher and district special education teacher, but thirteen expressed a concern regarding the facility's ability to address IEPs in a fashion that would enable the students to transition into the school setting and be prepared to continue as if they had not been removed. Twenty-two districts expressed that insufficient evidence accompanied returning students to support the notion that school-assignments were completed during a lengthy period of treatment in the facility, while one district stated that they received sufficient evidence to support students' work in the facility setting. Regular education instructors who worked with students with disabilities, through a special education resource teacher, mostly expressed the school-assignments concern. One school district specifically stated that there was a strained relationship between its resource room teacher and regular education staff and the possibility that the district would accept the work as completed in the treatment facility (without sufficient evidence) was practically nonexistent.
The districts each stated that they would provide personnel to serve on multidisciplinary teams to formulate transition plans for students reentering school from the mental health facility. Four schools indicated that they could only ensure participation by telephone conference due to the unavailability of substitute teachers in the area of special education. The remaining nineteen districts indicated that they would send a returning student's special education teacher, counselor, and/or principal to serve on the multidisciplinary team.
Each respondent district indicated that four items of information was needed from the mental health facility for inclusion in a transition plan. They were as follows:
1. A statement from the facility's physician indicating that students are not dangerous to themselves or others within the school environment
2. A detail of the student's mental health treatment plan which states the roles of the family, school personnel, and mental health professionals
3. A list of students' medications and possible side-effects that might impact the school environment
4. A compilation of students' work which was completed during the period of treatment
Cognitive/Behavior Management Transition Plan
As a result of the feedback provided by school districts on the needs assessment survey, the mental health facility constructed a Cognitive/Behavior Management Transition Plan (CBMTP). The purpose of this plan was to assist students with disabilities and the school districts located within their domicile in successful educational and behavioral transition from facility to school.
The contents of the CBMTP were designed to be structured by the child's multidisciplinary team whose members included the child's primary physician in the facility, facility psychologist, facility social worker, facility special education instructor, the child's parents, and representatives from the child's school district.
This plan was primarily designed from the recommendations provided by school district personnel and included the following:
1. A statement by the mental health physician in regard to the child's mental wellness, ability to accommodate the school environment, along with limitations of the child within the school environment;
2. A detailed plan of aftercare, if needed, which articulates the role and function of each provider;
3. A statement by the physician which details prescribed medications, their possible side-effects and how those side-effects could impact the child, his peers, and school personnel in the educational setting;
4. A portfolio of work that is aligned with the goals and benchmarks of the child's IEP that demonstrates the educational progress that was or was not made during treatment.
Transition Program Evaluation
In order to assess the efficacy of the CBMTP, an evaluation form was constructed. This form was constructed to be completed each school district that participated in the CBMTP Program. The evaluation was designed to be completed after the first month of a student's return to school. The following questions were asked on the form:
1. Did the school district receive sufficient information from the facility's physician regarding the child's ability to accommodate the school setting?
2. Was sufficient information provided to the school district in regard to medications the child was taking and the possible side effects of the medications?
3. Have personnel from the facility fulfilled roles described in the child's transition plan?
4. Have personnel from the facility articulated concerns (if they exist) to the school district in regard to the child's aftercare?
5. Did the student's portfolio provide an adequate demonstration of the educational work that was completed during the child's treatment period?
6. Was the IEP properly addressed during the child's treatment period?
CBMTP: Program Efficacy
After the first six months of implementation of the CBMTP Program, three of the twenty-two rural school districts that participated in the initial project have had students placed in the mental health treatment facility. Each of the three districts has initiated the CBMTP process for their returning students. Two of the school districts conducted teleconferences to initiate the CBMTP while one district sent the appropriate school personnel and parents to the treatment facility for the program initiation conference.
Each of the three districts has reported favorable results from this process. Feedback reports from school districts indicate the following:
1. Physicians' statements provided insight into the safety of the school environment when the students reenter from the treatment facility. These statements provided a clear focus of what can and cannot be tolerated by the child and the extent to which medications may impact the child's behavior.
2. The role of all role players involved in the students' transition from the treatment facility to the school setting has been well defined. The districts no longer feel as if they are working in isolation in the reentry and transition process. Treatment facility personnel involved in the aftercare portion articulated in the transition plan have performed their roles as articulated.
3. School assignments (as articulated by the IEP) have been well coordinated. The special education personnel employed by the treatment facility have had dialogue with school district special education teachers during the treatment process and have returned samples of student work which indicate progress toward the benchmarks articulated on the IEP.
After the first six months of program initiation, none of the students involved in the process has had to return to the treatment facility for residential services. Each has been able to accommodate the school setting as articulated by his or her CBMTP.
Rural school districts often feel disadvantaged when their students with disabilities and regular education students require assessment or treatment in mental health facilities located several miles away.
Often times, students are removed for these services by courts and social service agencies, and the school district is 'left in the dark' as to the emotional health of the child as well as how effectively the child has been educated during this time of assessment or treatment. As a result, rural school districts need to take a proactive approach to this dilemma rather than reacting to the unknown variables surrounding the returning student.
School districts should inform to juvenile court officials and social service agencies that a protocol of aftercare needs to be articulated when a child is leaving a mental health facility and returning to resume educational activities. Legal authorities and social agencies must understand that students with disabilities, through mandates of IDEA, may require services that are not readily accessible in rural settings. In order for all role players to act in the child's best interests and be simultaneously legally compliant, an organized and systematic plan that includes school personnel needs to exist.
A treatment plan should accompany each returning student that details a current mental health status and the roles of identified professionals and family members who will administer the treatment plan. This type of arrangement will significantly address the barriers that exist between rural school districts and remotely located mental health facilities.
To ensure efficacy in transitioning students from facility-to-school, an evaluation of the process and role players should be completed. This evaluation would best take place on a case-by-case basis rather than on a collective basis. This would ensure that neglected transitioning practices would not go unnoticed for an extended period of time.
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Joe Nichols, Ed. D., Assistant Professor
Department of Educational Leadership, Curriculum and Special Education
Arkansas State University
PO Box 2781, University, Arkansas 72401-1930
(870) 972-3062 email@example.com
Tina Davis M.S.E., Special Education Instructor
St. Bernard's Behavioral Health Center
2712 E. Johnson Avenue, Jonesboro, AR 72401
(870) 932-2800 firstname.lastname@example.org…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: I'm Back! Developing A Transition Plan for Students with Disabilities Who Return to Rural School Districts from Mental Health Treatment Facilities. Contributors: Nichols, Joe - Author, Davis, Tina - Author. Journal title: Rural Special Education Quarterly. Volume: 22. Issue: 3 Publication date: Summer 2003. Page number: 35+. © American Council on Rural Special Education Fall 2008. Provided by ProQuest LLC. All Rights Reserved.
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