|
|
| The Collaborative: EXPLORING THE CONFLUENCE BETWEEN EDUCATION AND MENTAL HEALTH There are many missed opportunities when it comes to the treatment of children with emotional, educational, attentional and behavioral difficulties. These children can be better served by a carefully constructed collaboration between their parents, educators and therapists.
The therapeutic isolation of a weekly, hour-long, one-on-one session with the child and therapist is not an effective approach as it could be because it is not broad enough in scope or as inclusive as it might be. It is historically dependent on parental second-hand reporting of the complex environment of school and home and therefore less likely to work along with other related participants in the child’s life. It is in the absence of direct face to face interaction, negotiation and communication between and among relevant participants that the missed opportunities occur. A multidimensional, responsive and careful collaborative effort can mitigate these isolation pitfalls from all involved disciplines.
These missed opportunities, from a psychotherapeutic perspective, to significantly change behavior, motivation, and emotional functioning of these children using the isolated model is a result of several factors. There are equally burdensome struggles from the parental and educational perspectives as well.
1. The therapist often becomes involved late in the situation, i.e., gets called when the child is oppositional at school and/or at home, has gotten a series of poor grades, has tantrums when frustrated and has negatively internalized attempts at redirections. In other words the situation has become a crisis and expectations for quick resolution are high.
2. It often takes several weeks to develop a strong working relationship with a child, especially when asking the child to address something he/she is likely to want to avoid.
3. If medication has been initiated and has made significant improvements the secondary effects are likely to persist.
4. The child may have additional problems, such as, lowered frustration tolerance, social skill difficulties, a negative self-image and other co-existing disorders such as anxiety, depression, and learning disabilities.
5. The child may be confused by the different approaches used by the various adults involved and they're differing and sometimes opposing perspectives.
6. There can be redundancy and lack of cohesiveness in the redirections and behavior management styles of the involved adults.
There is a more comprehensive way to treat these children, and at the request and encouragement of some of the parents of my clients, I began to explore other ways to enhance and expand on therapy sessions specifically by meeting with school administrators, parents, classroom teachers and other educational specialists. As one of my client’s parents said in exasperation, “No one holds the whole picture.”
Therapists, educators and parents, in fact, all seemed to be attempting to solve some of the same problems but from very different perspectives. Educational professionals tend to support and remediate. Psychotherapeutic professionals tend to explore understanding and behavioral reactions and provide recommendations. The complexities of family systems tend to lead toward reactivity to behavior. These different perspectives can create very different environmental or emotional stressors for the child resulting in different reactions in the various environments and confusing the situation even more. Thus, the child can react very differently while in the different environments. Schools are increasingly overtaxed and under funded and burdened by the pressures of curriculum and testing. Therapists have to consider the implications of the school situation since children spend a significant amount of their waking hours in school and parents are trying to juggle increasingly complex lives. If there is duplication of effort could collaboration ameliorate some of this?
Developing a collaborative approach, which involved all the major participants in the child’s life, seemed to have a greater potential for success. It became my goal to develop a system that worked more effectively and efficiently with the whole child in that child’s real world of home, social situations and at school. A carefully constructed collaboration system is needed to create, around that child, a team tailored to his/her individual needs that crossed the boundaries from home to school.
Roadblocks to Collaborative Success
Parents, educators and therapists want to do what is best for these children. Constructing a functioning collaboration process is not, however, without problems or obstacles. People come to problems and solutions from vastly different perspectives. In fact, I have witnessed some intense disagreements based on differences in perspective.
Far too often parents have told me that the school “just doesn’t understand” or they are “unwilling to help.” That is most often the exact opposite of the truth and speaks more to the despair and isolation of the parent of a child not succeeding than unwillingness of an educator. In fact, a teacher’s job satisfaction is often directly tied to the success of their students. No doubt some educators make negative and incorrect assumptions about parents as well.
There may be fundamental misunderstandings, misinformation, and poor communications between this mosaic of participants. Coordination may be very difficult from a logistics perspective alone, as in, problems with schedules. Compensation may be problematic since insurance companies never reimburse mental health or medical providers for this important effort. Parents may have to pay for this time or attempt to play the middleman role themselves. Conflict can occur in the face of limited resources, frustration due to lack of progress, legalities, cultural differences and socio-economic challenges.
Solutions
What I am proposing is not rocket science. In fact it is based on common sense, leadership, and trust in the actual collaborative elements and each participant’s desire, motivation and goodwill to do what is in the best interest of the child. The uniqueness of this is in the process and the effectiveness of the process, that is, the ability to get everyone on the same page in a more advanced way than is commonly the case. Often there are only casual conversations between participants rather than the more comprehensive written, face to face, shared and acknowledged communication needed for this process to succeed to a greater degree. The collaborative elements must include the following be effective.
Trust
Respect for different opinions and perspectives
User-friendly and current information
A problem solving approach
Intolerance of blaming
Timing and prioritization of technique/redirection/remediation
Setting of reachable goals
A globally accepted formulation of a child that crosses traditional isolated theoretical orientation
Buy-in/motivation
Flexibility
Interestingly, I have found that the lack of these basic elements is often the root cause of conflicts and mistrust between schools and parents. The collaborative process therefore includes the development of the above mentioned elements with a step by step, carefully planed focus on independence as a primary goal. This allows all participants to guide the child as their influence allows in harmony with the agreed upon plan. It is important to carefully watch for set backs and over burdening and to view the child as a rapidly changing person with various responses to resistance, motivation and frustration. Collaboration is effective only if trust and good communication are established and maintained between participants. The use of the most effective person to provide leadership in the collaboration system can be a group decision and that person needs to be supported by the whole group. Effective timing of accommodations or recommendations can take the place of the inflexible nature of an IEP. If an IEP can be considered a treatment plan and if it is agreed that mental health issues can effect education it make sense that the efforts be connected. In the process of setting up a collaborative system the use of existing and widely used models from, for instance, the business community would be prudent. Such principals as the building or rebuilding of trust, distribution and execution of an executive summary, and the principals of conflict resolution can and should be used. In addition the balance of confidentiality of information and the use of electronic information sharing must be explored so that the timeliness and usefulness of the information can be maintained.
When students, parents, educators and therapists have a strong working relationship the child experiences a sense of momentum and comfort that can be motivating and a commodity to be used to make change. In my proposal in which a collaborative system is created in order to better meet the needs of these children, that not only will the end result be better but that costs and other resources can be more effectively allocated.
By seeking, fostering and guiding positive relationships with the education community, other health professionals, parents and children in the collaborative process, a positive, doable system will results in more effective change, more harmony among the involved participants and therefore more effectiveness for children in need.
Welcome to my newsletter. I hope to also collaborate with you, the reader, in my goal toward pulling all these highly motivated parents and professionals together to more effectively and efficiently help children.
Interview: With Dr. Arthur L. Hanson
Superintendent of Schools Sau16
1) Please comment on what Sara Lawrence-Lightfoot wrote in her book The Essential Conversation: What parents and teachers can learn from each other. She wrote, “the essential conversation is a the crucial exchange that occurs between parents and teachers…[which] is both mirror and metaphor for the larger cultural forces that define family-school relationships and shape the development of our children.” “Kids thrive when they feel the adults in their lives see them in a consistent way. Parents and teachers should try to use the precious minutes that they spend together trying to reach agreements about a child’s strengths and challenges so they can be united on the best ways to respond to children. Through the relationships developed between parents and teachers, children must know that school is a high priority for teachers, parents and children.
2) What are your thoughts on the “confluence of mental health and education?” Specifically how this complex interaction impacts the schools, families and the community. “The confluence of mental health and education is, in my opinion, one of the aspects of education that sorely needs improvement. Too often we are dealing with children who are not academically motivated; exhibit aggressive behavior; are diagnosed with Asperger’s, attention problems or learning disabilities; are experiencing transitional issues; are initiators or victims of bullies; are suicidal; lack the necessary social skills to promote positive behaviors; and are overly stressed by the daily routines of life. Having an opportunity for mental health providers, parents and teachers to have ongoing, non-threatening meetings and dialogue would greatly enhance the ability for these children to experience success”.
3) Currently children and families seem to be using many different supportive services, including, mental health providers, physicians, tutors, occupational therapist and etc. How could services that are utilized external to the school collaborate and help the school with such an important job of educating our children.
“Sharing insider information between professionals such as mental health providers, physicians, tutors, occupational therapists, etc. can only assist parents and teachers to help the child be more successful. By doing this, all stake holders will be able to determine the best way to develop the child as a learner, rather than the alternative of trying to do so in isolation. Sharing information will assist the school (teacher) to determine what the child loves and hates about school, what motivates the child, what has worked with teachers in the past and what medical/psychological issues needs to be addressed. This information will help teachers fine-tune instruction or interactions to be more effective with the child. Additionally, it builds a circle of connected support around the child to assist them at all levels in finding success”.
4) In today’s educational system of inclusion, teachers are increasingly responsible for various accommodations, learning styles, behavior modification, and curriculum, in addition to the management of class full of children. Would a shared sense of ownership, spread to those involved with our children, including external professionals, parents and the children themselves help teachers educate our children?
“Many children need educational modifications and in order to meet those needs, all stakeholders need to be in constant conversation with one another. Working with the children’s mental health providers, therapist, physician, and other specialists is the only way we can be certain that we are offering every possible educational opportunity for each child. Remembering that children in our care see us as role models, it is incumbent that we collaborate, are positive, matter-of-fact, and upbeat about every child, thus encouraging them to follow our lead. If we are at crossroads with one another, children will be the first to reflect this type of attitude and behavior”.
5) Collaboration has been defined as, “labor together or work jointly (especially in an intellectual endeavor) assist, associate, unite, pool.” How could this help child with both special needs and the student body as a whole.
“Collaboration is never an easy task. However, collaboration is the essential element to a child’s success. The history of mental health workers, physicians, health care providers, parents and schools collaborating for the best interest of the child is limited at best. Time and the needs of each group have blurred the vision of what is best for the success of the child. The data on children is often incomplete because of this blurriness. If it has been done at all, each group interacts with the others on a selective basis. This division of purpose must change. In order for the children to be successful, it is incumbent on us to develop a “plan of action” outlining how all of the above named groups can collaborate for the best interest of the children. Good students tend to have what teachers call a broad "fund of knowledge." They have been taken places and they have seen a bit of the world. Conversely, the best teaching can come from a broad “fund of knowledge” regarding the students that are being taught. This can only be accomplished by collaborating on an on-going basis with all of the child’s stakeholders”.
Laziness…Or Poor Executive Skills?
By Peg Dawson Ed.D
As a psychologist who specializes in children with learning and attention disorders, I see a lot of kids who are struggling in school. Very often, their parents are struggling too, with what is causing the problem. When they come to see me, the initial interview often goes like this:
Me: Why don’t you start by telling me how you ended up here and what you’re hoping to get out of this evaluation?
Parents: We can’t figure out why Sam (this could be Samuel or Samantha, but for the sake of simplicity, we’ll assume Sam’s a boy) is having such a hard time in school. He did fine in early elementary school, and his achievement test scores are consistently above average, so we know he’s not stupid. To be honest, we’re beginning to think he’s just lazy.
Me: Tell me what leads you to suspect that.
Parents: Well, if he hasn’t “forgotten” that he has homework or forgotten to bring it home, he puts it off until the last minute and then rushes through it. He makes a million mistakes but can’t bring himself to go back and check his work. And if he has a choice between playing video games or studying for a test—forget it, video games win every time.
Me: Does he remember to hand in his homework?
Parents: That’s another problem. If he has a teacher who’s really strict and checks up on him, then he usually doesn’t forget. But if a teacher is looser about that or expects him to take responsibility for handing it in on his own, then there’s trouble. And long term projects are a nightmare!
Me: What do you mean?
Parents: He often forgets he has them or forgets when they’re due. He has a terrible time coming up with a topic, particularly when he has to write a paper, and he’s not very good about planning his time or organizing the paper, so he leaves it till the last minute. He hates proofreading, and he usually forgets to look at the scoring rubric, so he leaves out stuff the teacher’s asked for. You can imagine the grade he gets.
Me: What’s his report card look like?
Parents: It’s like a roller coaster—he does well one marking period then lousy the next. And if it weren’t for progress reports, he’d probably fail everything. He’s usually failing a couple of classes when those come out and then he has to scramble to bring his grades up.
Me: Are there problems outside of school—like keeping his bedroom neat or keeping track of things like sports equipment?
Parents: How’d you guess? Even when we make him pick up his room, he does the minimum and then seems clueless about why we’re upset—he doesn’t even seem to see the clutter. So then it takes him forever to find his mouth guard or shin pads. He’s a good soccer player, but his coach has taken to keeping an extra shirt on hand—he’s the only kid on the team who doesn’t have an assigned number.
Me: So you think the problem with school is he just doesn’t care?
Parents: Actually, no. He seems to get pretty mad at himself when he forgets something or when he gets low grades on papers or tests—but we just don’t know why he doesn’t make the effort or put in the time to do quality work!
This gives a flavor of the kind of child I see. I also ask about what his backpack looks like, whether he can estimate how long it takes to do something, if he can work on homework without taking breaks, etc., etc. The answers are predictable. And when I ask parents when the problems began, the answer I get, invariably is, “Things were a little bad in elementary school, but it all started falling apart in middle school.”
When you scan the parents’ concerns, it sure looks like laziness. But there may be a better way to conceptualize the problems Sam has. Many youngsters who are considered “underachievers” have a constellation of challenges that fall under the category of executive skills. Executive skills refer to the cognitive processes required to plan and organize activities, including task initiation and follow through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal-directed persistence. Located primarily in the prefrontal cortex (the part of the brain just behind the forehead), these are skills that begin to develop in some form soon after birth, but neuroscientists are now realizing that it takes a full two decades for these skills to fully mature. And for kids with attention disorders, these skills tend to develop even more slowly.
Youngsters who are deficient in these skills, especially when they are seen as having average intelligence, are often viewed by both parents and teachers as chronic underachievers. They have trouble getting started on tasks, get distracted easily, lose papers or assignments, forget to bring home the materials to complete homework or forget to hand homework in. They may rush through work or dawdle, they make careless mistakes that they fail to catch.
Jane’s Corner - Quick Parenting Tips — No Psychobabble
Five Questions to Ask Your Child When They Make a Mistake What was your mistake (and related minor mistakes)? What inside (emotions) or outside (other children, social groups, environment) helped you make the mistake? What did you learn about yourself? What would you do differently? What is the plan to stop or reduce future similar mistakes?
Big or small mistakes encourage the child to work hard with the award of reduced punishment.
| |
|
|