Fourth of a series on mental health and children.
Understanding what a child communicates through his or her behavior is a starting point for teachers and counselors to determine various accommodations for emotional and mental health challenges that are afforded by law.
This process of understanding, which happens through a series of interactions between parents, counselors and teachers – as well as navigating and applying applicable laws – can be complicated by a number of factors that include available resources for behavioral analysis as well as the unique situation and experience of the child, according to Disability Rights Center-New Hampshire [DRC-NH] Policy Director Karen Rosenberg.
Rosenberg, along with DRC-NH, advocates on behalf of children with disabilities who may qualify for accommodations, specialized instruction, counseling and other services they require and that the state is meetings its obligations, said determining what a child needs – whether it is specialized instruction and services or less-complex accommodations – begins with a process of identifying the child’s needs.
More than reading and writing
Education, Rosenberg stressed, is more than just learning to read and write, but also involves developing social skills and communication skills, “or what some might consider soft skills that you learn in school to help you become independent when you graduate.”
Children, Rosenberg continued, “don’t always communicate what’s going on like we might expect adults to do.”
“They don’t always say, ‘I’m having a really tough day today, I could use some quiet time,’” she said, explaining that violations of school codes of conduct such as destroying property, refusing to work or using inappropriate language are all forms of communication. “For kids who experience really significant mental illness, their behaviors are often communicating that they’re overwhelmed and having a really difficult time.”
Disabilities and special education attorney Andrew Sirulnik, who is from Massachusetts but has worked on cases in New Hampshire, said one issue that keeps floating to the top in his work is the intersection between the law, mental health and special education. In particular, he said this involves how school districts approach their obligations under federal law and how schools apply these laws to mental health as a disability.
There are two federal laws that protect students in schools — Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities in Education Act [IDEA]. IDEA provides for the substantive and procedural protections that include the Individual Education Program [IEP] process, and Section 504 protects individuals, including students, from discrimination based on a disability.
IDEA is a law that makes available a free, appropriate public education to eligible children with disabilities and ensures special education and related services, including IEPs, to those children. It was originally known as the Education of Handicapped Children Act, passed in 1975. In 1990, amendments to the law were passed, effectively changing the name to IDEA.
The difference between IDEA and Section 504, according to Sirulnik, is that Section 504 is a civil rights act that broadly protects students with disabilities. It requires schools to provide accommodations and services, while IDEA requires schools to provide accommodations and services as well as specially designed instruction.
“Under Section 504, any student with a disability who attends a public school and many private schools has a right to fully participate and benefit from the educational program with accommodations and related services,” Sirulnik said.
According to the New Hampshire Department of Education, in 2021 there were 30,309 out of a total of 168,620 students receiving special education. That’s 17.9 percent of students with a disability of some form making them eligible for special education. Disabilities include a range of physical and mental challenges, including emotional disturbances.
Ben Moenter, director of special education for the ConVal School District, said he is seeing an increased trend in students with IEPs. ConVal currently has 400 students with IEPs.
Moenter said various eligibility requirements come into play, including communication disorders or other more-traditional medical conditions, when determining a student’s needs. One category in the IEP process is called “Other Health Impaired.” This is a broad area that could include a variety of medical conditions, including attention deficit disorder [ADD] and attention deficit hyperactivity disorder [ADHD]. Looking specifically at anxiety and depression, Moenter said that over the last four or five years, he has seen more students age 14 to 16 being eligible for special education plans.
“When combined with other issues, there’s an increase in complexity for our teams with the referral process in terms of making sure we’re evaluating and attending to things such as anxiety or depression,” he said.
Cari Christian-Coates, ConVal’s director of student services, said there are three elements the school district must look at when making a 504 referral: determining whether there is a physical and mental impairment, determining whether that impairment substantially limits a major life function such as reading, concentrating, or learning and finally coming up with a plan. Student Services handles 504 referrals and other student needs and Special Education handles IDEA.
“There’s an exhaustive list of major life functions,” Christian-Coates said, adding that the majority of challenges she has seen in meetings to discuss various children’s cases involve ADHD and anxiety. “If somebody comes to us with a diagnosis of anxiety or depression, that’s one piece of information that’s reviewed by a team which includes the parents.”
Christian-Coates said there are times in the discussion around physical or mental impairments when the 504 team suspects an educational disability. At this point, she said, a referral would be made to Special Education and an IEP could be created.
With IEPs, the district is required to have a Local Education Agency [LEA] representative involved in the process, while this is not the case for 504. This could include, Christian-Coates said, a range of people from the school psychologist to behavior analysts to occupational therapists.
Consistent implementation can be challenging
Sirulnik said school districts are required to follow a very strict procedure if a student has a disability that requires specially designed instruction. But when a disability is found that does not require specially designed instruction, the school district is allowed to limit its obligations to accommodation services that allow the student to have access to school.
“Section 504 is a lot less onerous for [schools] in terms of administrative requirements,” Sirulnik said, adding he hasn’t seen school districts pushing back for students seeking accommodations because the bar is low. “Section 504 accommodations only require there be a condition interfering with a child’s ability to attend school to learn or to demonstrate their learning. A common example is extended time with assignments and tests.”
Sometimes, Sirulnik said, it can be difficult for parents to convince schools their child needs specially designed instruction. While qualifications are in accordance with federal law and regulations, the interpretation of whether a student requires specially designed instruction, and what constitutes specially designed instruction, is difficult. This can be especially true, he said, when mental health conditions are part of the evaluation.
“With something like dyslexia, this wouldn’t be an issue,” Sirulnik said, explaining that anxiety and depression pose a different set of problems in terms of determining accommodations. “It’s common for school districts to push back and say a student is not eligible for an IEP because the student merely has a mental health condition, whatever that is.”
Another issue with respect to mental health and IDEAs, Sirulnik said, happens when parents are convinced, “either from common wisdom or what the school is telling them, that if their student doesn’t have a learning disability they don’t qualify for special education.”
“I’ve spoken to parents who describe a situation that is crying our for close coordination with an independent educational program and they’re not aware the student is entitled to that,” he said. “Sometimes accommodations aren’t sufficient under 504. Sometimes, in my first contact with a client, I try to convince them that what the school has been telling them may not necessarily be the case. If a school can effectively provide accommodations and services without an IEP, it’s no harm, no foul. But again, you have that underlying tension.”
Extreme cases of anxiety
Rosenberg said DRC-NH has had challenging cases with students who are experiencing debilitating anxiety to the point where fears of separating from their parents and even going to school has been the issue.
“That’s a really challenging situation for schools,” she said. “I have had cases where schools have threatened to file educational neglect with DCYF for parents failing to get their kids into the school when the [student] has such severe anxiety that the the parents can’t even get them out of the door.”
Cases like this, Rosenberg said, require behavioral assessments to find out what’s going on. This could involve a psychological evaluation to determine the type of intervention that’s necessary. Luckily, Rosenberg said, this is an extreme example.
Rosenberg said her office is seeing that schools sometimes suspend students up to 10 days or longer for breaking school codes of conduct without always looking at what’s causing the behavior, which could be a manifestation of the child’s disability.
“And so really what they need to do is a functional behavioral analysis where a behavior specialist looks at the [student] and talks to people who are engaged with him or her to try to figure out what the function of this behavior is and why they’re exhibiting it,” she said. “Why are they running out of the classroom, why are they refusing to do the work? What’s going on?”
The continued stigma of mental health
Former state Supreme Court Justice John Broderick has been speaking in schools for years about mental health, and one thing that he continues coming back to –even though he believes strides have been made – is the stigma surrounding mental health. Broderick, whose awareness of the need to destigmatize mental illness came in the years following his oldest son’s suffering with mental illness and a physical attack that left him hospitalized, continues to speak to school-age children and has published a book, “Back Roads and Highways: My Journey to Discovery on Mental Health.”
Today, Broderick works for Dartmouth Health and continues to log miles in his black Jeep, crisscrossing New England on Dartmouth’s REACT campaign. He has talked to tens of thousands of middle- and high-school students in countless gyms and auditoriums about mental health awareness and describes his odyssey as the most-important work he has ever done.
Broderick said that his experiences as a trial lawyer and a judge forced him to pay close attention, and that the students he has listened to following his talks have helped him understand a lot of what they’re dealing with today in terms of anxiety, depression, social stress and other mental-health-related challenges.
“These kids are ready to pop, they have so many expectations,” he said, adding that stigmas around mental health continue to exist in the form of self-stigma involving shame. “I always say to them, ‘Oh my God, don’t be like that, you are who you are.’ Mental health is a health issue; it’s not a character flaw or a weakness.”
The numbers of children reporting anxiety and depression are alarming, Broderick said, and he would like to see mental health issues such as these treated more like the health issues they are.
Sirulnik also sees the issue of stigma sometimes preventing parents from seeking help.
“Students with mental health issues have been increasing, and it interferes with their education and it needs to be addressed,” he said, adding that sometimes parents don’t always know how to receive help and that the issue of disability stigma can act as a barrier for parents to seek help they need from school.
Broderick wants to see mental health more openly discussed and said he has talked to parents who have told him they have gone to the police in their town because they’re worried their my son or daughter might act out.
“The police tell them once arrested, they can get into their system. If my son or daughter had a sore back and you could get arrested to get help … once you commit a crime than you can get help? It’s so pathetic. It’s a topic whose time is long overdue.”
Christian-Coates said Senate Bill 234, an act requiring student identification cards to include the National Suicide Prevention Lifeline and requires that all school district staff be trained in suicide prevention, helps address the stigma of suicide prevention in the schools.
“We do signs of suicide with with our middle- and high-school students as part of the curriculum to enhance the awareness of of suicide prevention,” she said, adding that the district continues to enhance its partnerships with community mental health organizations. “We’re continuing to enhance our relationships. The community partner piece is something we’ve been able to enhance. That falls under the student services, community relationships specifically around mental health.”
Stressed resources in region
A sad thing in this region, Christian-Coates said, is the limited number of mental health providers, adding that the district has embraced community partnerships.
“Fewer and fewer of the organizations in the area are seeing kids,” she said, adding that this is caused by a lack of staff and that it impacts the school district. “Through our relationships with community partners we’ve been able to find a lot of resources. Right now we have a relationship with The River Center and The Grapevine and they’re providing monthly professional development to our staff.”
Moenter said his team works hard to make sure they have needed resources, which include special education coordinators who are trained and work with leadership.
“We’re really making sure we have a strong team who understands special education and our processes,” he said. “The law tells us what we’re supposed to do and we’re looking towards having students in the least-restrictive environment.”