Newton Public Schools____________________________________________________
Student Services
100 Walnut Street, Newtonville, MA 02460
(617) 559-6022
Schools as Health Service Settings: One District’s Efforts Toward This Goal
David Gotthelf, Ph.D., NCSP, HSP,
Coordinator for Therapeutic Services; Newton Public Schools
There has been an increasing awareness nationwide that schools and school psychologists need
to provide higher levels of mental health services. While many school districts continue to
employ school psychologists primarily as evaluators, many more recognize the need for direct
service to students and families, along with regular consultation with teachers, staff, and
administration. Indeed, with the acceptance of RTI as a framework for academic intervention, so
has this been accepted as a method to provide a multi-level set of services designed to address
the mental health needs of all students.
NASP has reviewed the issue of school-based mental health services on the following website:
www.nasponline.org_advocacy_overview_sbmh This article covers who can provide such
services, including school psychologists, social workers, and counselors, as well as the use of
community mental health services within the school setting. Additional key issues include how
and when such services should be delivered and to whom, i.e. both students and families, as well
as how referrals are made.
One of the challenges in providing direct services is ensuring sufficient staffing in each school.
Meeting evaluation, direct service, and consultation demands can be daunting at best given the
staffing guidelines schools generally follow in hiring staff. Special educators and teaching
assistants are often expected to manage the emotional needs of the students assigned to them—an
expectation that is both unrealistic and at times inappropriate. Provision of trained mental health
staff at a reasonable cost is clearly the right policy, but can this combination be realistically
achieved?
One response to this challenge is the provision of doctoral level clinical interns to work with
school-based psychologists. Such interns generally have experience and training that would
provide schools with a level of service meeting general standards and needs. Moreover, an
increasing number of university training programs are recognizing that the mental health needs
of children in schools are not only equivalent to what would be encountered in a clinical setting,
but in many ways can be more effectively addressed in the experiential context of a school.
Despite what appears to be an obvious mandate, there are many questions to be answered and
hurdles to overcome before school districts can be recognized as mental health service settings.
Each state has its own set of regulations regarding the training and internship experiences of
students in order for them to be eligible to take the state licensing exam and ultimately be
accepted as a health service provider. In addition, state licensing boards have the option of
setting even higher policy standards in terms of what a health service setting should provide.
Such has been the case in Massachusetts, where very few school districts have ever been
recognized by the state licensing board as a health service setting. There are a number of reasons
for this. One issue is the level of training and degree the supervising psychologist must have, i.e.
doctoral level interns going for licensure would need a supervisor who is a licensed health
service provider. Or could this be managed by having an overseeing supervisor who is an HSP
but have a site supervisor who may not have such credentials but is nevertheless qualified to
supervise. And how would this be determined? Additional questions include:
1. Can the supervising psychologist be onsite, i.e. is the psychologist school-based rather
than centrally based?
2. Are the responsibilities of the psychologist truly broad-based, i.e. not simply involving
evaluation but including direct service and consultation?
3. Are the hours required for the intern sufficient?
And last, but not least, is the issue of compensation. Doctoral internship programs, particularly
those recognized by the APA, generally require a stipend. Most school districts in
Massachusetts, however, do not provide stipends because of the plethora of both non-doctoral
and doctoral level school psychology intern candidates coming from programs that do not
require this.
So, with all of this in mind, is it worth making the effort to become a health service setting? We
in the Newton Public Schools examined the criteria, looked at our resources, and decided it was
indeed worth it. The school district is in a suburb immediately to the west of Boston, and despite
its deserved reputation as a community and school system with a high level of resources, we
have seen a significant increase in the mental health needs of our students. Indeed, one of the
ironies of having a reputation as a strong provider of special education services is that families
with children having special needs desire to move here, creating an ever increasing need for
mental health services.
The Massachusetts Psychologist Licensing Board is the gatekeeper for mental health service
settings, and has a reputation for setting very high standards. Nevertheless, we felt we could
meet those standards. In brief, here are the nine criteria that needed to be met, and how each was
addressed:
1. The health service setting must be a defined entity (e.g. clinic, hospital, school counseling
center.): We felt that NPS should be considered a defined entity. Each of its 21 schools
addresses not only the educational needs of its students but gives equal attention to their
social/emotional/mental health needs. Each school has designated areas where mental health
needs are addressed; staff also address mental health needs within the “milieu” i.e. the classroom
and the playground. In addition to these designated areas, the school district provides specialized
programs designed to address the mental health and behavioral health needs of identified student
populations, including students diagnosed with depression, anxiety, acting out behaviors, and
ASD. NPS also has three 45-day stabilization programs for students who are in social/emotional
crisis and in need of more intensive clinical intervention.
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2. If the health service setting is embedded in a non-health service institution, the health service
setting must be a substantially separate entity that presents itself to the public as a health service
facility and must be identifiable as such: We felt that this criterion was not applicable, as the
Newton Public Schools should be identified as a defined entity, as described in Criterion 1.
3. The health service setting must have a place for maintaining confidential records: Each of our
schools has a secure place for maintaining confidential records. There is also additional space
available for confidential records in its central office building.
4. The health service setting must comply with HIPAA regulations (and/or FERPA for academic
settings): We noted that the Newton Public Schools complies with FERPA regulations, and that
our compliance is regularly reviewed by the city’s legal services department.
5. The health service setting must have a protocol covering emergencies and after-hour
coverage: Newton Public Schools has two designated on-call staff to cover emergencies
occurring during school and after school hours. Mental health staff have been trained in PFA,
suicide and threat assessment, and trauma management. The school district also has a working
relationship with Riverside Community Care regarding students who may need hospitalization.
Lastly, NPS has school-based teams well as a citywide safety/crisis management team trained to
deal with mental health emergencies. Yearly trainings are provided to team members and mental
health staff to keep them current in emergency management.
6. The health service setting must provide supervision by qualified licensed professionals and
qualified licensed professionals must be on-site: Newton Public Schools has 22 DESE licensed
school psychologists, of whom 18 are doctoral level and 10 are licensed Health Service
Providers. All are school-based, i.e. they can provide on-site supervision. In addition to licensed
psychologists, the school district also employs licensed social workers and mental health
counselors. Psychologists in Newton provide a wide range of comprehensive clinical and
therapeutic services, including neuropsychological assessments, individual and group counseling
using evidence based treatment such as CBT, and consultation/direct service with parents,
teachers, and administration.
7. For facilities in which research is a major component of the mission, the health service setting
must have clients who are not participating in research protocols, and other clinical services
which are not part of research protocols must be available to all clients: This criterion was not
seen as relevant to NPS as a health service setting.
8. The health service setting must have a referral network for services that are not provided by
the health service setting (e.g. medication): NPS has a contractual relationship with Riverside
Community Care, our regional mental health agency, which provides after hours child and
family services as well as medication services. We are in fact working with this agency to see if
we can jointly provide clinical experiences to our doctoral level interns.
9. For facilities in which research is a major component of the mission, the health service setting
must have a protocol for ensuring continuity of care for clients who withdraw from research
projects: Although this criterion was not seen as relevant to NPS, it was nevertheless pointed out
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that transition plans and services are provided to all students who are in need of such services,
including transitions to adult services and state agencies such as DDS, DMH, DCF, and MRC.
With these nine criteria addressed along with a second letter more specifically addressing the
licensing credentials of the staff, the Massachusetts Licensing Board immediately granted the
school district status as a health service setting. This was met with welcome surprise and
astonishment by the area training programs, not to mention the school districts in the area, but
the real challenge is not that Newton met the criteria, but whether other school districts could
marshal the resources to match what NPS has done: pay a top salary to attract and keep doctoral
level HSPs, have psychologists building-based, and have a job description that is truly clinically
oriented.
Newton still has several hoops to jump through. We are in the process of getting APPIC
membership as a match site, and following this we will be applying to the APA for a grant
providing stipends to interns for at least the coming year. But this is with the realization that the
school district will need to ultimately provide such funding for succeeding years.
In the meantime, it will be important for school districts and university training programs to
work together in examining the current criteria for health service settings and together with their
state school psychology association meet with their respective state licensing boards. MSPA has
indeed already been a part of such efforts, and the NASP Trainers of School Psychologists has
also recognized what we have done and how this can be duplicated nationwide. The hope is that
with such efforts we can provide the level of mental health services our students and their
families need.
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