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Virginia Community Schools Redefined – Part 2 – Stop Trying to Provide Mental Health Services in School

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by James C. Sherlock

In Part 1 of this series I described the current Virginia Community School Framework (the Framework) and found it not only lacking, but counter-productive.

Its basic flaw is that it assumes all services to school children will be provided in the schools by school employees, including mental health services.

When you start there, you get nowhere very expensively, less competently, and with considerably more danger in the case of mental health than if the schools were to partner with other government and non-profit services.

This part of the series will deal with child and adolescent mental health services exclusively.

Public mental health, intellectual disability and substance abuse services for children and adolescents are funded by governments at every level. For the federal view of the system of care, see here.

In Virginia, those services are organized, overseen and funded through a state and local agency system.

  • The state agency is the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in the Secretariat of Health and Human Resources. The Department of Medical Assistance Services (DMAS) (Medicaid) plays a funding and patient management role as well;
  • Local agencies funded and overseen by DBHDS are the Community Services Boards (CSB’s) throughout the state.

Some schools and school systems seem to operate on a different planet from their local CSB’s. Indeed, the Framework mentions them only reluctantly and in passing.

The ed school establishment clearly wants to handle child and adolescent mental health problems in-house, with tragic results. They need to stop it now.

There is absolutely no need to wait.

Let’s take a recent obvious and tragic example of apparent lack of school-CSB coordination — the six-year-old shooter in a Newport News elementary school.

He was profoundly emotionally disturbed, as only a kid can be

allegedly told another teacher prior to the shooting that he hated her so much he wanted to set her on fire and watch her die.

  • whose IEP required one of his parents to be at school with him at all times.

There is no report

  • that the child was ever referred to the Hampton-Newport News CSB for mental health support; or, as should have happened…
  • banned from the school until such support had been provided and the kid had been given the go-ahead by a licensed professional to resume in-school education.

If schools cannot ban a kid like that until he or she is better, they are hopelessly dangerous.

If you think I am picking on Newport News schools, I am not. This is happening with such regularity across the state that we are nearly numbed by it.

CSBs. Let’s examine the Hampton-Newport News CSB’s Youth and Family Services. CSB Boards in Virginia are appointed by the City Council(s) or County Board(s).

That organization offers services provided by licensed professionals. Licensed professionals that the schools do not and will not have.

  1. For children birth to five years old: Clinical Assessment and Referrals, Linkage and Coordination of Services and Implementation of the Healthy Families of America Curriculum to promote healthy childhood and development.
  2. For children five to 17:  provides therapeutic mentor services including in-and out-of-home services and supports. Services include crisis intervention, behavioral intervention, participation in treatment planning, outreach, service provider linkage, monitoring, advocacy, daily living support, independent living skills, vocational instruction, medication monitoring, supportive counseling, and positive role modeling.
  3. For children and adolescents. 
    • Children’s Behavioral Health Urgent Care Center provides rapid assessment, crisis intervention, and comprehensive psychiatric evaluation for children and adolescents experiencing a mental health crisis;
    • Children’s Mobile Crisis Services provides comprehensive assessment, short-term crisis counseling, safety planning, linkages, coordination, and follow up.

    4. For adolescents and young adults.

    • Case management and intensive care coordination;
    • Psychological Assessment and Evaluation Services.

The resources are already in place with the CSBs and will be massively increased under the Governor’s three-year Behavioral Health Plan that has bipartisan support in the General Assembly.

The CSB’s already have mobile crisis teams and crisis receiving centers for children and adolescents. Yet they are listed by the authors in the Framework only as “possible community representatives” on school “Advisory Boards.”

The education establishment and Virginia Tiered System of Supports (VTSS).  The authors of the Framework list in community schools’ VTSS profile “Deliver Supports, Branch 2 Student’s Emotional and Mental Health Needs.”

  • Tier 2 supports (some students) may include:
    • Small group counseling on topics such as: social skills, emotional regulation, or coping skills;
    • Mentorship programs; and
    • Parenting courses that reinforce intervention.
  • Tier 3 supports (few students) may include:
    • Individual counseling supports;
    • Counseling services through a community agency;
    • Special considerations for disciplining students with disabilities;
    • Homebased counseling supports; and
    • Functional Behavioral Assessments.

If you find that sounds exactly like the services that CSB’s provide, except that in the case of the CSB’s, provide with licensed personnel, then we have a winner.

Good examples.

A number of school districts have excellent relationships and partnerships with their CSBs.

I am told that good examples of school division/CSB cooperation exist with Highland County CSB in Abingdon and with the Hanover County CSB in Ashland.  Hanover was part of a pilot project that the Governor recommended in the current budget expanding to $15M.

Bottom line.  There is nothing that prevents:

  • the school divisions calling the CSB’s tomorrow to establish cooperation agreements that can be executed with a phone call;
  • schools to stop trying to manage and treat such students and help their parents with school personnel.

To be absolutely clear, I consider this a two-step process.

Step 1. Get students with Level 3 mental health problems out of the schools. Schools have no personnel qualified or licensed to do the job. The results of trying are routinely catastrophic. Do net readmit them until a licensed therapist signs off that they are safe to return to a school setting.

To continue to try under some dysfunctional ed-school view of VTSS is to allow:

  • children and adolescents to proceed through school and life untreated;
  • other students and teachers to continue to be justifiably terrified; and
  • people within the schools to be tragically wounded and killed.

Step 2. The CSB can take over and do what they can.

The Secretary of Health and Human Resources and the Secretary of Education may wish to work this out at the state level with a joint position paper/cooperation agreement.

Local governments do not need to wait for that.

Mayors may wish to call and host meetings between local school division officials and the local CSB to set joint cooperation policy.

Soon.

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14 responses to “Virginia Community Schools Redefined – Part 2 – Stop Trying to Provide Mental Health Services in School”

  1. LarrytheG Avatar
    LarrytheG

    I wouldn’t think schools would be providing ANY service for which they do not have appropriate expertise. For instance, kids get referred for glasses or dental. And last I heard, the nurse cannot even provide OTC or prescription if not specifically permitted on a case by case. Teachers and school nurses may do simple tests for hearing or optical to help determine if a referral is warranted.

    There will be, obviously variation in schools and school systems and perhaps some are not good but reinventing the whole shebang seems more like baby and bathwater.

    Build on what you have, Improve it, make it better, etc.

  2. Lefty665 Avatar
    Lefty665

    You are leaning on a weak reed by championing the CSBs. They vary profoundly across the state. Some are pretty good, some are terrible and some are mediocre, just like the schools.

    With Hanover you chose as an example a terrible CSB. It has a long history of failed services and dead (yes dead) clients. It has a history of profound incompetence. Putting that CSB in the drivers seat for school age kids in Hanover would unquestionably provide poorer services than what they are getting or not getting from the school system.

    Virginia has long had an inter agency services system, the Comprehensive/Children’s Services Act, that provides and coordinates services for kids with severe disabilities who have needs beyond the capacity of individual agencies like the schools, community services boards, social and rehabilitative services or courts to deal with. https://law.lis.virginia.gov/vacodepopularnames/comprehensive-services-act-for-at-risk-youth-and-families/

    Perhaps it would be productive to explore how the state has chosen to provide services for kids with severe mental health issues with needs spanning multiple fields and beyond individual systems resources to serve before advocating jamming a square peg in a round hole by imposing the CSB system, warts and all, on schools, an area it was never designed to serve.

    1. James C. Sherlock Avatar
      James C. Sherlock

      I completely disagree.

      Between the schools and the CSB’s, the only one that has ever been designed and funded to deal with child and adolescent mental health is the CSBs.

      The schools are way out of their lanes there. They do terrible damage to the safety and learning environments even trying to deal with what VTSS calls Tier 3 mental health issues.

      Once schools identify students as Tier 3, they need to suspend them indefinitely conditioned upon a licensed clinical therapist signing off that the student will not be a hazard to himself or others in a school setting.

      If that is a year later or never, it is no longer a school concern. Virginia’s school laws are not meant ever to endanger.

      The CSBs should take over the students the schools cannot handle and do what they can. We will soon discover which ones need new leaders or more funding. But, bottom line, dangerous students will no longer be roaming the schools.

      The Governor has targeted enormous increases in funding for CSBs starting in July. There is no need to wait for the schools to act locally.

      1. Lefty665 Avatar
        Lefty665

        Wrong again Sherlock.

        You assume that CSBs are competent. That is far from universally the case, nor do the CSBs have all the resources to deal with all the kids.

        We agree that kids with severe and profound disabilities, especially violence, tier 3 is perhaps a usable label, are not appropriate to be dealt with in schools.

        The schools have the resources to identify those kids and to make appropriate referrals to agencies who have those capabilities. The Comprehensive/Children’s Services Act (CSA) structure is specifically designed for that purpose.

        Schools have guidance, psychologists, and social work personnel. They are competent to determine what they can deal with, what they cannot, and have the ability to refer kids for outside services when needed. Those include CSBs, CSAs, courts, and others up to residential mental health and education facilities for severely disabled kids who are dangers to the community.

        Newport News profoundly screwed up with the 6 year old shooter in several ways. He likely should not have been in school, and that he was there without the 1:1 staffing was an egregious failure. It looks like the superintendent will pay for that this evening. That’s a start for Newport News to fix its problems.

        CSBs, like the schools, are largely representative of their communities. Imposing another layer of inept bureaucracy on mental health services in schools is guaranteed in some places to make the problem worse.

        “We will soon discover which ones need new leaders or more funding.”

        That is remarkably naive. It displays ignorance of how Virginia has organized the CSBs, They are LOCAL organizations, governed byLOCAL boards appointed by LOCAL politicians. They are squarely in the Virginia conservative tradition of keeping government close to the people.

        Some CSBs are pretty good, and some really suck. We have long known “which ones need new leaders” We do not need to put them in the schools to cause more school tragedies to figure that out.

        The schools already have the tools to identify students who are so dangerous they need to be served elsewhere and the ability to send them elsewhere. They need to do it. Newport News seems to have recognized that and is poised to do something about it. As the old Chinese adage advises “A fish rots from the head”. Other localities could profit from the Newport News example.

        Your proposal makes the problem worse instead of fixing it. I encourage you to try another way.

        1. James C. Sherlock Avatar
          James C. Sherlock

          We are talking past one another.

          You want to have a conversation about how well the individual CSBs perform. In the context of this column, I do not care.

          Our government, yours and mine, has established priorities and organizations to accomplish them.

          My priority here is to get the schools to move mentally unstable students out.

          What happens to them after that is up to their parents and the government safety net. They mental health safety net is the CSB.

          1. Lefty665 Avatar
            Lefty665

            You still don’t get it.

            “You want to have a conversation about how well the individual CSBs perform. In the context of this column, I do not care.”

            Exactly, that is the problem, you “do not care”. The CSBs are profoundly variable and profoundly local. In many places around the state they would make the schools worse rather than better. See also Dick’s comment about the issues with rural regional CSBs.

            CSBs are NOT a statewide solution to getting violent kids out of schools. Perhaps if you “cared” you would understand that.

            Look at the Comprehensive/Children’s Service Act. It is the organization Virginia has created and funded to serve the kids you are concerned about, including through out of school more restricted placements.

            The schools have the tools to identify the kids who need CSA services. They need to make the referrals. The CSBs will not improve that process.

            “They [sic} mental health safety net is the CSB.”

            That is wrong too.

  3. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Jim, in theory, your proposal has merit. There are some practical limitations, however. Funding is a primary issue. A large proportion of CSB clients are Medicaid eligible. CSBs are not prohibited from serving others, but they do so on a limited basis, due to funding and staffing issues. The state now requires CSBs to deliver nine core services (STEP-VA). Mental health services for schools is not one of them. Some CSBs are having trouble complying with that mandate. See the latest JLARC report, just released. http://jlarc.virginia.gov/landing-2022-csb-behavioral-health-services.asp

    Second, many CSBs, especially in rural areas, are regional entities. They are not organized, staffed, or funded to provide MH services to every school over a wide geographic area.

    Third, the degree to which local CSBs are willing to cooperate with other agencies, even on the local, varies widely. In some cases, there is close cooperation. In others, cooperation is grudging, if at all.

    Previously, I might have agreed with you that CSBs seem the logical entity to provide these services. However, more and more schools are using pychologists, who are licensed to provide the types of services you describe. Perhaps a school psychologist, who is in a position to observe students on a day-to-day basis, especially the ones who are creating problems, would be the best way to address the problem.

    1. Lefty665 Avatar
      Lefty665

      Dick, in your second point did you perhaps mean that “They are NOT organized, staffed…”?

      Your third point is one I can attest to from experience, CSBs vary profoundly.

      Schools have the ability to identify the kinds of problems they are not equipped to deal with and the ability to make referrals to organizations that are. CSBs are among those organizations. The Comprehensive/Children’s Services Act (CSA) specifically is comprised of representatives of all involved state agencies, including schools, CSBs, social services, rehab services and courts, and funded to provide needed services to kids.

      Schools need to identify both who for and when they need to avail themselves of those external services. Throwing the CSBs into the mix is extremely unlikely to make that process work any better.

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        Yes, I meant “not”. I fixed it. Thanks.

      2. James C. Sherlock Avatar
        James C. Sherlock

        That argument I have no problem with.

        You and I agree that the schools need to stand down on things they are not staffed to deal with. That is my main point.

        If you wish to dispute whether the CSBs are the proper external agencies with whom they should deal, that is fair. I will make my case.

        The Governor and the Secretary of Health and Human Resources, for whom both the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and what is now the Office of Children’s Services https://www.csa.virginia.gov (ex- CSA) work, have made a huge financial commitment to improve mental health services statewide.

        If you look at the Policy Manual for the Children’s Services Act and jump down to 3 Local Management, you will see that “Each locality, or combination of localities, shall establish a Community Policy and Management Team (“CPMT”) for the receipt and expenditure of funds pursuant to the CSA in accordance with the powers and duties granted by statute in COV § 2.2-5206”

        You will further see that by policy the members of the team will include

        “The local agency heads or their designees from the following community agencies:

        a. Community Services Board established pursuant to § 37.2-501,
        b. Juvenile Court Services Unit,
        c. Department of Health,
        d. Department of Social Services, and
        e. the local school division;

        The part of that money that is for pediatric mental health goes to the Community Services Board. So we are back to where I started.

        Their new Behavioral Health Plan is going to get funded at at least the levels they requested.

        It is the Secretary’s job to coordinate among his agencies to see that the money is coherently spent. The Office of Children’s Services will get their share, and at the local level it will be given to the CSBs.

        1. Lefty665 Avatar
          Lefty665

          Thank you for the lecture on the CSA. I have some familiarity as I have been a member of a CSA Community Policy Management Team as well as on a Family Assistance Planning Team that actually coordinated services under the CSA. In my experience it was an effective operation that routinely dealt with kids with problems that were so severe that individual agencies, like schools or CSBs were not equipped to deal with them.

          I would note that the pediatric funding and services include CSBs but are far more inclusive than CSBs. For example a psychiatric residential educational setting that is likely appropriate for the 6 year old shooter in Newport News is a service employed under CSA but never provided by a CSB. Your characterization of pediatric money going to the CSBs is simplistic.

          I have explained at least 3 times to you why CSBs are not a solution to violence in the schools. Your “I don’t care” statement demonstrates that you have been in full “Don’t confuse me with the facts, I’ve made up my mind already” mode. I will try another way, an analogy.

          During the late unpleasantness in Viet Nam there was frustration in D.C. that the carrier air wings were not doing an effective job of eliminating the violence of the NVA and Viet Cong. A Pentagon genius reasoned that since clubs had been effective weapons going back to the stone age, and since DoD had warehouses full of clubs, that they would equip grunts with clubs to ride the back seats of F4s and beat the NVA into submission instead of using ineffective bombs and rockets. Imagine the geniuses surprise when that worked no better than bombs and rockets, and often times worse.

    2. James C. Sherlock Avatar
      James C. Sherlock

      Dick, I will tell you the same thing I told Lefty.

      First, my focus in this series is on inner city schools where the documented dangers most prominently lie. But I care about rural and suburban schools.

      My prescription for what schools should do – suspend mentally troubled kids indefinitely until a licensed clinical psychologist or psychiatrist clears them to return to school – is the same across the state. School laws are not a suicide pact.

      Second, our government from the federal level through the state level and down to local governments has established the CSBs as the mental health safety net, not the schools. You and I do not need to approve of that. We do not need to think that it is being done well everywhere – or even anywhere. The Governor and GA are in the process of competing to see who can appropriate more money to strengthen them.

      We just need to understand that the schools are not and will never be resourced to handle students who are mentally ill.

      Yet, encouraged by insane policies written by the ed schools, schools continue to try. How many more kids and teachers need to be assaulted and shot before we get it.

      So, in that context, I told Lefty that I do not care how capable the CSB’s are, just that our system of government has made them responsible for the mental health safety net, not the schools.

      Finally, you have a basic misconception about school psychologists. They are neither educated nor licensed to provide clinical psychology support to individual students. If they try it, both the school system and the school psychologist are liable for a bad result. Practicing without a license brings both civil and criminal liability.

      Re-read Part one of this series and I have quoted the regulation.

      1. Lefty665 Avatar
        Lefty665

        The issue is you have misdiagnosed the problem and prescribed an inappropriate, ineffective and expensive non-solution.

        Schools have the resources to identify mental illness and some abilities to deal with it in its less extreme expressions. They also have the ability to refer kids who are more severely disabled to services that are appropriate. Those can include, but are not limited to, psychiatric, restricted environments and the courts.

        Virginia has long established the Comprehensive/Children’s Services Act (CSA) specifically to coordinate among agencies involved with kids and the services they need. Your advocacy to replace that resource by inserting an often inept CSB bureaucracy (see Gus Deeds) with a limited range of services in the schools will do as much harm as good.

        From what little we have seen of the recent Newport News example the school had clearly identified the student as having a very severe emotional disability. So severe in fact that the boy needed a 1:1 aide to function in school. That is as close to out the door to a restrictive setting as it gets. That, apparently, was working until the first day the kid showed up without his 1:1 aide and he shot his teacher.

        What we do not know is why the aide (parent in this case) was not there, why the kid came to school without the aide, why the school did not send him home, provide an aide, or have him spend the day in the principal’s office. We also do not know why the search for the gun failed after the school was warned. For many disasters it takes a string of lesser failures to precipitate the big one. There were clearly several failures here. None of which having a CSB involved would have prevented.

        The failures did not include a failure to identify this kid, the severity of his emotional disability, to provide a plan to deal with it or to dedicate resources. A CSB in the school would be in no position to do anything or more effective.

        I have no more desire than you do to have violent acts in schools. Nor have I ever advocated DIE or related foolishness.

        I do however have an interest in dealing effectively with the issues to prevent violence in schools. Part of that extends to objecting to misguided advocacy for inappropriate solutions and explaining why.

        Your proposed solution is to the wrong problem and advocates using an inappropriate and ineffective tool to fix it.

        I believe you can do better than that if you have help understanding your mistake. Your goal of reducing violence in schools is a good one and one we share.

        1. James C. Sherlock Avatar
          James C. Sherlock

          I advocate that the schools, and not nearly just in Newport News, get mentally unstable students out of their buildings and keep them out until they have been successfully treated by a professional clinician psychologist and certified safe to return.

          Discussing what government agencies should offer them safety net services after they leave the schools is worth doing, as long as that premise is accepted.

          It is clearly not accepted by much of the education establishment.

          Thus the article.

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