Inside Recess!
Bringing Counseling Interventions
into the Schools
Kyle Kershner LPCC-S NCC LICDC-CS
and
Christy Danzuso LPCC-S NCC
Sojourners Counseling Services LLC
Objectives
◊ Understanding the benefits and challenges of providing
mental health services in an office and a school.
◊ How HIPPA impacts therapy in the school
◊ The importance of building a team
◊ Counseling techniques for children that can be used
both in offices and in schools will be explored
◊ Understanding the benefits and challenges
of providing mental health services in an
office and a school.
Discussion:
What do you see as the potential benefits to counseling in the
schools? In an office?
What do you see as the potential challenges to counseling in the
schools? In an office?
Challenges
Benefits
- Easier for families
- Parents’ involvement
- Interaction with Teachers
- HIPPA
- Real life situations
- Schools more picky when to take a child out; scheduling
changes from week to week
- Removing travel time for
appointments; less school time is missed
- Teachers can help assist when it is best to take a child out for a session
- Can utilize mental health knowledge to be an advocate for the student
within the school system
- Transportation issues are avoided
- Assist with crisis situations
- In some cases, stabilizing one aspect of the clients life is the biggest goal;
school can be that place
- Schools can get help with difficult kids without the financial burden or the
possibility of grant restrictions/unavailability.
- Provides a more comprehensive treatment for clients that struggle in school
as well as at home
- Collaboration with agency that can assist immediately; no wait list
- May be the only way for some kids to get the counseling they need
- Clinicians must learn how to fit within the school setting
mentality
- Community response due to lack of understanding or the
stigma of counseling
- School vs. Counselor ways of thinking—behavior,
consequences and discipline
- Having an adequate and consistent space to provide
counseling
Benefits
- Family involvement
Challenges
- Avoidance of services needed due
stigma of counseling
- Counselors schedule can be more
consistent
- Lack of transportation or other
issues prevent family from getting
- Office space that allows for more
to appointments
counseling techniques to be used
- Finding times that fit work
- More opportunity for colleague
schedules
collaboration
- Finding child care for siblings
- Confidentiality is easier to maintain
- Inconsistent sessions; drop outs
- Comprehensive treatment can be
more difficult to provide
Quotes from real people
“ I so appreciate you; this is the best thing that’s happened
to this school! There is such a need.” Teacher
“ I wish I could go to counseling everyday! It helps me to
learn ways to calm down think before acting and control my
anger.” Elementary Student
◊ How HIPPA impacts therapy in the
school
Release of Information
Feels more like a
flowchart:
Generic Release –
talk to anyone
Specific Release –
either you list everyone
but the janitor, or you
have to have the ROI
translator with you.
Student Confidentiality:
HIPAA and FERPA in the School Setting
How does HIPPA (The Health Insurance portability and Accountability Act of I996) Impact School Practices?
)
• HIPAA - the Health Insurance Portability and Accountability Act of 1996, protects the privacy of patient
information. HIPAA limits the disclosure of what it calls “protected health information” maintained by health
care providers (including medical and mental health providers).
• “Protected health information” includes individually identifiable health information in any form, including oral
communications as well as written or electronically transmitted information.
• Implications for school personnel: Without a signed consent by the parent or legal guardian, the school staff
will not be able to share records, specific health status, conversations with students, mental health
counseling information, etc. with school based counselor.
• If a school’s education records are not covered under FERPA (generally the case for private elementary and
secondary schools); they may be subject to HIPAA as a covered entity if they transmit health information
electronically. In this scenario, the school is a covered entity and student health records are protected health
information under the Privacy Rule.
Privacy Rule protects all “individually identifiable health information” held or transmitted by a covered entity or its
business associate, in any form or media, whether electronic, paper, or oral.
•
•
•
•
•
Student name
Name of student’s parent or other family members
A personal identifier (SSN#, student number, etc.)
Other direct identifiers (date of birth, place of birth, mother’s maiden name)
Information that alone, or in combination can be linked to a specific student
Student Confidentiality:
HIPAA and FERPA in the School Setting
(cont.)
What is FERPA?
• FERPA - FERPA, the Family Educational Rights and Privacy Act, is a federal law that protects the privacy of
students’ personal information held by educational agencies or institutions that receive federal funds under
programs administered by the US Secretary of Education.
• FERPA limits disclosure of information in educational records maintained by the school and applies to school
personnel.
• Applies to all public and private schools that accept federal funds.
• FERPA allows health care professionals treating in the school environment to discuss the student with
teachers, counselors, nurses, and any others who may be involved in the direct education of the student
without consent.
• If a person or entity provides health services directly to students and is not employed by, under contract to, or
otherwise acting on behalf of a school, then the resulting health records are not deemed to be part of the
education record covered by FERPA, even if the services are provided at the school site.
• Implications for school personnel: Without a signed consent by the parent or legal guardian, school personnel
cannot share written educational records with school based counseling staff. Any oral communication,
however, can be shared.
What are the education records?
• Records directly related to a student maintained by an educational agency
• Student health records at the elementary and secondary level (immunization record, physical exam, health
screening results, etc.)
• Nurses and Practitioners of the Healing Arts notes (documentation) in the official student file
• Special Education records
*some information gathered from School Based Counseling Alliance and Center for Adolescent Health & the Law
How are HIPAA and FERPA different?
Key points
•School based counselors need to balance their ethical obligation to maintain
confidentiality with their legal duty to report suspected abuse and protect the
student from ongoing and future harm. Federal law requires mandated reporting,
which is to immediately report suspected child abuse, and provides immunity
from both civil and criminal liability when done in good faith.
•In connection with a health or safety emergency, if knowledge of the information
is necessary to protect the health or safety of the student or others, then
information can be shared to the appropriate entity without consent.
•Schools may share directory information which includes name, address,
telephone listing, date and place of birth, etc. The scope of what directory
information can be released depends on individual school district policy.
•School personnel can share information with school officials and school
personnel who have legitimate educational interest in the information.
◊ The importance of building a team
Who is on the team?
Counselor
Parents
Child
Teachers
Principal
Guidance Counselor
Intervention Specialist
etc
Take into consideration:
◊ All the team members want what is best for the child
◊ We may all have different goals for the child / different areas we
are responsible for
◊ We are all effected by the attitude / behaviors of the child
◊ We are all effected by the attitude / behaviors of each other
◊ Counseling techniques for children that
can be used both in offices and in
schools will be explored
◊ Elementary School Interventions
◊ Middle School / High School Interventions
Elementary School Interventions
Stress Balls
•
•
•
•
•
Sensory issues
Anger management
Anxiety/worrying
Body focused repetitive
behaviors (such as
excessive nail biting,
picking, etc)
ADHD/ADD
Homemade Stress Balloons
No Cook Play Doh Recipe
You need:
• 2 cups plain flour (all purpose)
• 2 tablespoons vegetable oil
• 1/2 cup salt
• 2 tablespoons cream of tartar
• Up to 1.5 cups boiling water (adding in increments until it feels just right)
Roll Play Doh into ‘worms’ to make it easier to stuff the balloons.
Flour
Rice
Bird Seed
Sensory Bags
•
•
•
•
•
Sensory issues
Anger management
Anxiety/worrying
Body focused repetitive
behaviors (such as
excessive nail biting,
picking, etc)
ADHD/ADD
How to make a sensory bag
•
Zip lock bags (I double bag mine
to make it less likely to break)
•
Fill bag with hair gel
•
Add food coloring and/or glitter if
you choose
•
Add sensory items such as
confetti, pom poms, googly eyes,
buttons, beads, glass gems, etc.
•
Use duct tape to tape the bag all
around the edges to seal
Feelings
Game
Key:
Happy
Mad
Sad
Scared
Worried
Excited
Good Friend OR Bad Friend
Bully
Shares
Nice
Doesn’t listen
Breaks the rules
Likes to play with me
Mean
Caring
Bossy
Makes fun of others
Hits, kicks, pushes
Listens
Doesn’t take turns
Takes turns
Helpful
Follows the rules
Good Manners
Doesn’t make fun of me
Middle School / High School Interventions
Sequencing
Mu
ic
Steven Curtis Chapman – Cinderella w/o words
TobyMac – Extreme Days
Poetry / Laments
Plumb – I cut
Steven Curtis Chapman – Heaven is the Face
Chess
Attention
Impulsivity
Problem Solving
Thinking Ahead
Empathic Thinking