The Problems

Mid-level services refer to services that are a step up from traditional counseling and are a step down from hospitalization or residential care. They typically allow the client to live in their home with their family and receive a more intensive therapeutic intervention. On a continuum of care, they are in the middle. While we do have some opportunities for psychiatric hospitalizations across Idaho for teens. We have very few residential treatment opportunities. Children often need to be taken out of state for residential placements. Some of these children could be served at home in their communities with mid-level services. It would be interesting to know how many.

They may be frightened by the lobby or the drive in the car. They may have problems staying in the regulated state required to hop in the car at a certain time, buckle up, remain safe in the car, and walk in the office door. The transition from school to home to office is challenging for most kids, for these kids, it can be a major problem. Many children are not challenged by the clinical setting, if they are doing fine with one hour a week of therapy, and their needs are met at school, then they are not the client that this school is designed for. There are some children with these challenges, that need a more intensive therapeutic experience and a bridge to get them into more traditional therapeutic experiences.

The scheduling of appointments is too rigid and does not recognize or develop readiness in the client. While this is a skill we want children to develop, we can end up holding therapeutic experiences hostage when we demand that they learn this skill first before they can be treated. This is experienced by the family as a lack of access to the service or the lack of a bridge.

These deficits cannot be covered by the scope and sequence of the grade level. Students continue for years with unmet needs, continually needing to be scaffolded to meet the demands of their current grade level. The time they do spend in class is often wasted wading through material they do not understand and teacher instructions they cannot follow. This creates a bored and disengaged student.

The current special education pull-out system used to fill these gaps means that students miss instruction time, getting further behind. Meeting IEP requirements of time each week sometimes translates into pull-out time being the only time they are met at their level, and that is only if the testing process has gone well. It takes extensive testing to determine that the pullout instruction is appropriate and then it is only a few hours a week with instruction at the student's level. The math here just does not add up to them catching up, or even keeping up.

We need a way to differentiate instruction in a way that takes a realistic amount of teacher planning and puts the child into a learning environment that is structured to help the child stay in a state of regulation more of the time. The Reggio model does this, and I believe it can do it more efficiently.

Parents need opprotunites to learn about the diagnosises and challenges that their children and youth have. They are often doing this at the same time as becoming new parents themselves. They may be managing their own childhood trauma and mental health needs. While needing basic parent education, they also need masters level instruction. All of this is overwhelming. Parents need a support structure for themselves and for their partnerships.

The school provides an opprotunity to not only take parenting classes but to solidify the learning in the lab setting of volunteerism. It will be designed to give parents opprotunities to learn with, and for their children, bonding with them in a way not possible in less structured settings.

Families may experience stigma and rejection in their communities surrounding connecting with services and the labeling of their children.

As needs continue to be unmet, children with these needs can become a burden on the school population. They drain resources and energy from educators. This behavior ostracises them from social networks further straining their own limited internal and external resources. This may cause the community to react to them in ways that are retraumatizing, deepening injuries rather than healing them.

Teachers need training to deal with the very difficult behaviors resulting from mental illness, neglect, abuse and trauma. Lack of training can lead to dangerous outbursts and inappropriate restraint and seclusion. Having trauma-informed staff can help with this and is an intervention that all schools can employ.

Schools can offer a trauma-responsive environment as well. While many organizations are trauma-informed, becoming trauma-responsive means looking at every aspect of an organization's programming, environment, language, and values, and involving all staff in better serving clients who have experienced trauma. Look for more information on this site about trauma-informed and trauma-responsive care.

When rules are not connected logically to the social norms, or when they are only connected to the social norms of a segment of the population, they are difficult to enforce and are often not enforced uniformly. This disconnect with the lives of children is received as disrespect towards them. It breeds disrespect as a pattern in schools. We give respect to get respect.

Examples could include inflexible attendance requirements connected with punitive consequences including loss of credit, random days off, confusing class start times like 8:56 instead of 9:00, out of school suspensions, no eating in class, hat and dress code rules, punitive responses to phone and bathroom use, the taking away of recess. Many of these policies include the taking away of the very tools that children use to stay regulated and then punishing them more because they can't stay regulated. For this population, we must be more flexible. We need to teach them to work within systems, and we will, but we should not hold a child's education hostage to do this.

There are some wonderful new tools and research available to help. Look for more information about rules in the trauma informed section.