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Abstract

In this series, we highlighted the importance of addressing the mental health needs of students with disabilities. The purpose of this final article in the series is to briefly summarize each article’s recommendations for addressing children’s mental health needs and to provide a compelling rationale for adopting those recommended practices. The rationale is introduced through a series of “why” questions, and those questions are then answered in sections addressing professional ethics and advocacy ethics. By focusing on practices, policies, and professional standards related to mental health among students with disabilities, school professionals adopt vital roles, responsibilities, and opportunities to assure access to school-based metal health supports.

The first article presented a six-step approach for integrating mental health services in the development of an individualized education program (IEP; Etscheidt et al., this issue). First, the need for school-based mental health services (SBMHS) is established through an evaluation that confirms the need for mental health support services. Second, the evaluation data are presented in the Present Level of Academic Achievement and Functional Performance section of the IEP. Third, annual goals are developed for all areas adversely affected by the child’s mental health status. Fourth, specially designed instruction (SDI) and related services interventions (RSI) are planned for each goal area. Fifth, plans for progress monitoring a student’s response to the SDI and RSI are developed and reported. Finally, the SBMHS must be implemented as planned and revised if progress toward the goals is not satisfactory. The second article in the series presented two case studies (Clopton et al., this issue) that illustrated how each of the six steps is completed in the development of an IEP for a young child and for an older student with disabilities.

In the third article, Hsieh and Donegan-Ritter (this issue) described the difficulties and challenges faced by early childhood teachers in addressing the mental health needs of young students with disabilities. In addition to offering specific student-based strategies and teacher interventions, the authors proposed early childhood mental health consultation (ECMHC) to maximize professional expertise in addressing a young child’s mental health needs.

“By focusing on practices, policies, and professional standards related to mental health among students with disabilities, school professionals adopt vital roles, responsibilities, and opportunities to assure access to schoolbased metal health supports.

We then presented a fourth article emphasizing the importance of home-school collaboration in the development and provision of mental health services to students with disabilities (Tucker & Matson, this issue). Expanding the multitiered systems of support to provide a continuum of mental health supports to students requires the integration of schools, families, and communities in a continuum of care. Several high-leverage practices to promote home-school collaboration were proposed that actively and intentionally include the student and family in identifying mental health needs and supports.

Why: To Meet Our Professional Standards and Responsibilities

To conclude this series, we frame the professional ethical principles, practice, and policies required of special education professionals addressing the mental health of students with disabilities. We then examine our professional responsibilities to adopt an ethic of care and advocacy in special education educational policy and practice.

The Council for Exceptional Children

The Code of Ethics of the Council for Exceptional Children (CEC; 2015) requires professional special educators uphold and advance several principles that directly align with addressing the mental health needs of students with disabilities. Special education personnel are responsible for “maintaining challenging expectations for individuals with exceptionalities to develop the highest possible learning outcomes and quality of life potential in ways that respect their dignity, culture, language, and background” (CEC, 2015, p. 1, italics added). In this work, professionals promote “meaningful and inclusive participation” in schools and communities while “protecting and supporting the physical and psychological safety of individuals with exceptionalities” (CEC, 2015, p. 1, italics added). The relationship between quality-of-life potential, psychological safety, and student mental health is recognized by mental health service providers and advocates.

Mental health issues can interfere with students obtaining the “highest possible learning outcomes and quality of life potential” (CEC, 2015, p. 1). One in six children in the United States has at least one mental health disorder, yet approximately half of those children did not receive mental health treatment (Whitney & Peterson, 2019). Recent research suggests an increase in these numbers during the COVID-19 pandemic (Creswell et al., 2021; Ford et al., 2021). Mental health issues negatively impact school attendance (Egger et al., 2003; Finning et al., 2019; Gubbels et al., 2019), school completion (Gubbels et al., 2019), and academic performance (Deighton et al., 2018; Masten et al., 2005; Wickersham et al., 2021). Moreover, there is evidence of a “cascading” effect of early mental health issues in that early externalizing problems (e.g., verbal or physical aggression, oppositional behavior, or hyperactivity) negatively affect academic competence, which in turn is related to later internalizing problems (e.g., anxiety, depression, or withdrawal; Masten et al., 2005; Moilanen et al., 2010). There is also a link between poor mental health and high-risk behaviors (e.g., substance abuse, suicidality) and, ultimately, a shorter life expectancy (Keyes & Simoes, 2012; Walker et al., 2015). Fortunately, evidence-based treatments exist for improving mental health in children and adolescents (e.g., Lee et al., 2012; Michelson et al., 2013; Oud et al., 2019; Ung et al., 2015).

Questions to Consider

• Why should school teams adopt this six-step approach advocated by Etscheidt et al. (this series) in “Securing School-Based Mental Health Services Through a Six-Step IEP Approach?”

• Why would local districts invest in professional development initiatives designed to advance the six-step approach?

• Why would educational policy makers at the local, state, and national levels support an approach that could result in an increase of students receiving school-based mental health services and a need to reexamine service delivery practices?

• Why should local districts amplify efforts to detect mental health needs as early as possible in a child’s educational career, as proposed by Hsieh and Donegan-Ritter (this series) in “Supporting Young Exceptional Children’s Mental Health in the Early Childhood Classroom,” including investing in screening tools and teacher training?

• Why should funds, research, and training to enhance early childhood special education teachers’ knowledge and skills in using evidence-based practices be expanded?

• Why should local, state, and national policy makers support and fund cross-disciplinary training to provide early childhood mental health consultation?

• Why should special education policy shift from one that views parental participation as a right to be afforded to one that embraces parental involvement as best practice in addressing students’ mental health needs and improving student outcomes as advocated by Tucker and Matson (this series) in “School-Based Mental Health and the Vital Role of Collaboration for the Success of Students with Mental Health Needs?”

• Why should the traditional roles of parents providing care and school providing education be diffused and blended?

Identifying students’ needs for SBMHS and providing evidence-based supports to address them is the ethical obligation of educators and mental health services providers (Chenneville & Schwartz-Mette, 2020; Mathur et al., 2017) Perfect and Morris, 2011). Etscheidt and colleagues (this issue) not only provided a six-step process for developing an IEP that includes SBMHS for students with mental health issues, they provided support for the need for such a process, including recent case law (e.g., Castro Valley USD, 2015; Ross Valley SD, 2014). Adopting the process may not only assist our students with mental health issues but also support the development of a practice that is consistent with our ethical obligation to support students in meeting their learning and quality-of-life potential. Adopting the process should also support the development and maintenance of a school environment conducive to psychological safety.

Psychological safety is a construct discussed in the literature on organizational behavior (e.g., Edmondson & Lei, 2014; Frazier et al., 2017), specifically in the area of organizational learning (e.g., Schein, 1993). The construct focuses on one’s perception of the safety of taking interpersonal risks in a given environment. Research indicates a relationship between psychological safety and performance and learning (Hunt et al., 2021). Specifically, when individuals feel psychologically safe, they are more willing to “speak up” by giving feedback, sharing ideas, asking questions, and admitting when they have made mistakes (for a review of the role of psychological safety in transformational leadership, safe team climate, knowledge sharing and reflection, and performance, see Edmondson & Lei, 2014). Schein (1993) suggested the essential elements of an environment that is psychologically safe include (a) providing practice opportunities, (b) overcoming fear associated with making errors by providing support and encouragement, (c) coaching and rewarding efforts in the right direction, (d) establishing norms that permit errors, and (e) rewarding innovative thinking and experimentation. As a result, it is our ethical duty to provide safe space for students to learn the academic, social, and behavioral skills they need to have the highest quality of life possible.

Appropriately delivered SDI focused on social-emotional learning (SEL; Elias, 2009) is consistent with these essential elements. Students with SEL needs require interventions to support positive behavior (Mitchell et al., 2019). If a student’s SDI supporting SEL occurs in a school that has implemented SEL as a part of a multitiered system of support, the focus will include emotion recognition and management, positive goal setting and achievement, empathy, positive relationship development and maintenance, and responsible decision making (Collaborative for Academic, Social, and Emotional Learning, 2018). As an instructional intervention, SEL has improved both academic and social/emotional/behavioral skills for students (Espelage et al., 2016; Taylor et al., 2017). Moreover, schoolwide SEL programs have a positive effect on the five core social and emotional competencies (e.g., self-awareness, self-management, social awareness, relationships skills, and responsible decision making), increase prosocial behaviors and decrease behavior problems in students, and improve student attitudes towards themselves, others, and school (Durlak et al., 2011; Schonert-Reichl, 2017). Although there is a lack of research on the relationship between these outcomes and feelings of psychological safety, one might posit a connection exists. For example, Espelage et al. (2016) found middle school students with disabilities who received SEL instruction reported being more willing to intervene in situations involving bullying than those in a control group.

Psychological safety not only “reduces threat to mental health in the social environment” but also helps with mobilizing personal resources (Ostapenko et al., 2021, p. 319). The safety of students from threats to positive development and mental health ensures educational environments fulfill the needs of all students (Slusareva & Dontsov, 2019). Mitigating risks to student mental health “is possible only if a psychologically safe inclusive education environment is built” (Slusareva & Dontsov, 2019, p. 241).

The CEC Standards, fortified by empirical research, establish that a child’s quality of life is enhanced by constructing psychologically safe educational environments. Such environments help mitigate the effects of student mental health issues through the provision of social/emotional/behavioral supports and the additional strategies presented in this issue.

National Association of School Psychologists

The National Association of School Psychologists (NASP) position statement (2015) addressing mental health services for children and adolescents proposes “universal mental and behavioral health promotion in schools, early identification and intervention, targeted supports, and interagency collaboration” to enhance students’ “academic, behavioral, and interpersonal outcomes” (p. 1, italics added). Multitiered, coordinated, culturally competent, and effective mental health services involve a continuum of supports from universal to individually directed services. In 2020, the NASP Professional Standards expanded these responsibilities to include using “assessment data to select and implement evidence-based mental and behavioral health interventions” that “integrate behavioral supports and mental health services with academic and learning goals” to help students “develop effective social-emotional skills” (p. 6, italics added). A “continuum” of mental and behavioral health services is established through effective home-school collaboration (NASP, 2020, p. 6, italics added).

The importance of early identification of risk and/or disability and subsequent early intervention cannot be overstated. As noted previously, consideration of social-emotional development and skills, as well as mental health, is an important piece of any screening and/or evaluation, including during the early childhood years. Hsieh and Donegan-Ritter’s (this issue) article on supporting the mental health of young, exceptional children indicated that behavior concerns and mental health diagnoses, along with disciplinary actions such as suspensions and expulsions, are on the rise during the early childhood years, with additional concerns noted for those identified with disabilities. Considering the difficulty in determining developmentally expected rather than developmentally deviant behavior at a young age (e.g., Wakschlag et al., 2018, 2019), gathering information across multiple informants and using reliable and valid assessment methods and instruments that measure context, quality, and developmental level are important (Dirks et al., 2012). Furthermore, those working with young children should not only have a strong background in development and the willingness and ability to collaborate with other relevant professionals but should also be aware of and be able to apply knowledge of evidence-based interventions and models (e.g., pyramid model, infant and early childhood mental health consultation) that address mental health concerns and challenges during the early childhood years (Giardano et al., 2017; Hsieh & Donegan-Ritter, this issue).

An important aspect when assessing and determining needed intervention(s) is the meaningful inclusion of parents. Parental participation is required when considering special education eligibility and services, as stated within the Individuals with Disabilities Education Act (2004), and it is especially pronounced during the early childhood years due to the need for family-centered assessment, planning, and services. However, partnering with families of young children is important even outside of the special education process, as noted within the Division of Early Childhood’s (2014) recommended practices and further described in Hsieh and Donegan-Ritter’s (this issue) article. Communicating with families not only allows for all relevant parties to stay informed of any concerns, assessment, and/or intervention but also promotes the sharing of information across all parties that have important information on the child across various contexts and settings. Parental involvement has been consistently shown to increase academic achievement and student outcomes (Boonk et al., 2018). Parent involvement in students’ learning has been recognized as essential to a child’s education and is positively associated with a student’s academic performance and engagement (Oswald et al., 2018).

“The CEC Standards, fortified by empirical research, establish that a child’s quality of life is enhanced by constructing psychologically safe educational environments.

The NASP Position Statement aligns with additional strategies promoted by Hsieh and Donegan-Ritter (this series), including the exploration of a continuum of mental health supports and the development of social-emotional skills in young children with disabilities. Adopting these supports reflects the educators’ commitment to meeting professional and ethical responsibilities.

Adopting the six-step approach, supporting early childhood mental health collaboration (ECMHC), and shifting special education policy from a view of parental participation as a right to a view of parental involvement as best practice will assist professionals in meeting their responsibilities in addressing students’ mental health needs.

Why: To Adopt an Ethic of Care and Advocacy

Adopting an ethic of care and advocacy is important in special education educational policy and practice. Through actualizing an ethic of care, school becomes an extension of a system of care responsible for student well-being. Owens and Ennis (2005) define caring as mutual patterns of recognition, development, protection, and empowerment that teachers must establish in their classrooms. Noddings (1984, 1992) proposed that care should be at the heart of the educational system, with a nurturing, caring teacher and the cared-for student. Care has entered educational policy agendas through the integration of care into school practices and in broadening the value systems used in those practices (Sevenhuijsen, 2003). The “relocation” of care to schools represents a “responsive public administration” in special education (Sevenhuijsen, 2003, p. 182). Included in a system of care, school practices are child centered and family focused: “Rather than have service providers determine what families need and the strategies used to address them, families should be viewed as the primary decision-makers and should be recognized as equal partners in efforts to plan and implement any services for children” (Cook & Kilmer, 2004, p. 656). Tucker and Matson (this issue) argued for the use of high-leverage consultation practices as a way educators can improve the system of care for students with disabilities. Through focused collaboration with families, students, and outside providers as part of the IEP team, families and students may feel more connected to the special education process, resulting in positive outcomes for all involved. Furthermore, culturally competent school practices that are tailored to meet individual needs and build on the student’s strengths also improve the system of care (Cook & Kilmer, 2004). High-impact consultation practices throughout the special education evaluation and subsequent services may also lead to improved listening and addressing the needs of minoritized students (Tucker & Matson, this issue).

The ethic of care is actualized through advocacy. Advocacy has long been characterized as the process of “giving voice to those without voice or whose voices are not heard” by conceptualizing social needs, empowering those involved with mental health service provision, and identifying systemic complexities and barriers (Gray et al., 2020, p. 2). Through professional advocacy, teachers and educational leaders can expand their role beyond policy implementation in the classroom to influence educational policy development: “The knowledge and skills educators gain through advocacy can build a bridge between policy and practice and inform support and effective educational policy” (Derrington & Anderson, 2020, p. 14). Unfortunately, the research on the role of front-line educators (e.g., teachers, school psychologists, social workers) in shaping policy is underdeveloped (Derrington & Anderson, 2020). Educator advocacy can take place within the school building, school district, or more externally with state departments of education and state or federal policy makers (Bradley-Levine, 2018).

Uniquely situated to speak on behalf of students to community stakeholders and state and local policy makers, teacher professional advocacy informs the public about current issues in schools and the education profession: “Educators have sound, reality-based ideas for reforming schools. They have insider knowledge about which new services to establish and which existing ones to expand or improve” (Bond, 2019, p. 77). Educator advocates can provide pragmatic solutions for systems changes due to their daily intersection with current educational policy, students, and families (Bradley-Levin, 2018; Weber et al. 2020). Specifically, teachers advocate for their students in the classroom through fostering a democratic environment, building positive relationships, teaching and modeling critical thinking, and empowering students through high-impact instructional practices that meet the needs of all students in the classroom (Pantic, 2017; Picower, 2012). Such classroom practices set the stage for advocacy outside the classroom. Teachers can share their practices along with data to support effective practices with community stakeholders who might also advocate for these practices and both state and local policy makers (Picower, 2012). Similarly, educational leaders and administrators must meet their professional obligations by keeping “issues of advocacy at the forefront of their work priorities” (Crawford, et al., 2014, p. 483). Advocacy requires a belief in equal educational opportunities by leaders who challenge the public educational status quo through involvement in advocacy activities both inside and outside of school (Anderson, 2009).

Yet many educators do not understand how to interact and influence policy makers or why it is important for them to participate in the decision-making process (Roberts & Siegle, 2012). Educators, as leaders and advocates of the profession, must build personal relationships with state and local policy makers to influence legislative change. Such advocacy activities involve communication with policy makers at the local, state, or federal levels; monitoring school board and state-level agenda; tracking legislative change; and participation in professional organizations (Devore, 2015). As policy advocates, educators can influence colleagues, administrators, policy makers, and other stakeholders to improve the learning context (Eckert et al., 2016). To do so, educator advocates must develop skills, including development of effective messages, social media engagement, and the ability to translate their knowledge and experience to information that is important and accessible for state and local policy makers (NASP, 2016; West & Shepherd, 2016).

As educators and stakeholders initiate advocacy activities, it may be helpful to turn to a common list of effective strategies. First, advocacy is all about relationship building (Rogers et al., 2020). Educators view relationships with students as a vital method of advocacy in the classroom (Picower, 2012) and can utilize these skills to begin to develop relationships with legislators, school board members, and other influential community members. Communicating with stakeholders and policy makers is also a key strategy, but many educator advocates find communicating their advocacy messages intimidating (Heinowitz et al., 2012; Rogers et al., 2020). NASP (2016) provides some key ideas to developing successful advocacy messages, such as forming messages specifically for a targeted audience. While building relationships, advocates should learn what their audiences know so they can frame messages specific to audience needs. Advocates should structure the message to be clear and concise, including a definition of the problem (e.g., students with mental health disabilities are often not receiving the mental health services they need to access their education), a proposed action (e.g., states could create programs to encourage the training of school-based mental health professionals), and the benefit of the proposed action (e.g., students will received the services they need to be more successful in school and in postsecondary opportunities; NASP, 2016).

When educators are strong advocates within and outside their classrooms, positive systemic changes take place, and the system of care is improved. This can be especially important for marginalized students, who the educational system often ignores, overlooks, or harms (Bradley-Levine, 2018; Picower, 2012; Tucker & Matson, this issue). Unfortunately, a prominent barrier for this work is the lack of training. Most educator preparation programs do not include advocacy training (Heinowitz et al., 2012; Rogers et al., 2020; Weber et al., 2020). Educator preparation programs must improve advocacy training opportunities for educators. This does not mean that teachers and school administrators must learn and practice advocacy at a state legislative session or federal committee hearing, but rather, programs must point out that advocacy occurs at all levels of engagement with policy, from classrooms to state and federal capitol buildings. Educators should be given the tools for a range of advocacy efforts so they can choose the efforts that best suit their advocacy objectives. With more educator advocates working at various levels, it is possible to expand the system of care to benefit all students.

Through actualizing an ethic of care, classrooms become an extension of a system of care responsible for student well-being. Educator professional advocacy promotes the ethic of care and ensures educational environments are responsive to meeting the needs of all students, including those with mental health needs. As an ethically bound and legally protected activity, advocacy must include promoting intervention at both the individual student level and the broader systems level (Oyen et al., 2020). As active social change agents, advocates address both student-centered issues and systemwide, professional issues. Promoting mental health interventions in daily school activities represent student-specific issues (Duncan & Fodness, 2008), whereas critical advocacy in education involves advancing legal and sociopolitical movement (Scott et al., 2009). Advocacy in multiple contexts is required to secure SBMHS and to meet our professional and ethical responsibilities.

“By adopting the strategies and practices presented in this series, educators and mental health providers have met their professional responsibilities to secure mental health services for students with disabilities who critically need those supports.

Conclusion

In this series, we presented several articles to assist professionals in addressing the mental health needs of students with disabilities. We then asked: Why should school teams adopt these practices, why would local districts invest in professional development initiatives designed to advance these practices, and why would educational policy makers at the local, state, and national levels support these practices, which could result in an increase of students receiving SBMHS and a need to reexamine service delivery practices? We concluded by offering two compelling reasons for adopting these practices and strategies: (a) to meet our professional standards and responsibilities and (b) to adopt an ethic of care and advocacy in special education educational policy and practice. By adopting the strategies and practices presented in this series, educators and mental health providers have met their professional responsibilities to secure mental health services for students with disabilities who critically need those supports. We hope that the series is helpful to educational professionals in securing SBMHS for students in our schools.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Susan Larson Etscheidt

Kerri L. Clopton

Susan Larson Etscheidt, Nicole R. Skaar, Kerri L. Clopton, and Stephanie L. Schmitz, College of Education, University of Northern Iowa, Cedar Falls.

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Our Professional and Ethical Responsibilities to Support Student Mental Health

Abstract

Why: To Meet Our Professional Standards and Responsibilities

The Council for Exceptional Children

Questions to Consider

National Association of School Psychologists

Why: To Adopt an Ethic of Care and Advocacy

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iDs

References