Behavioral health is as important as physical health. Due to behavioral health stigmas, lack of recognition of the signs of mental illness, and reluctance to seek help, it takes 8-10 years, on average, from the time a person starts to display symptoms of a mental illness until the time they receive help. Think about the deterioration that can take place in that time. Earlier recognition and connection to services and supports can mitigate this deterioration.

How do behavioral health disorders affect my child at school?

Children’s behavioral health is critical to success in school and in life. Research supports that when students receive behavioral health and social-emotional learning and supports, they not only achieve higher academically, but classroom behavior and on-task learning improves as well.

While not all behavioral health disorders directly impact a child’s academic functioning, there are many that do. In addition to anxiety, depression, Attention Deficit Hyperactivity Disorder (ADHD), or learning disabilities, a child may struggle at school because of other reasons, including family problems at home, financial difficulties, death of a family member, divorce, a sibling’s military deployment, or medical illness. It is prudent to have a good relationship with your child’s school and to keep them informed, as teachers and school counselors may be able to offer tools, adjust your child’s schedule to allow for breaks, time to speak with the counselor, or other resources.

If your child is diagnosed with a behavioral health disorder or disability which may impact their education or functioning at school, request a meeting with the school to discuss possible accommodations your child may need. You can find more information in Section 504 of the Rehabilitation Act or under the Individuals with Disabilities Education Act (IDEA).

What are the "warning signs" of mental illness?

According to the National Alliance on Mental Illness (NAMI), 50% of mental health conditions begin by age 14, and 75% begin by age 24. In addition to parents and guardians, educators are positioned to notice the warning signs first, as they spend a lot of time with your child and can identify when their moods and behavioral patterns shift. They may witness different behavior than you do at home, because your child does not have the stress, boundaries, scheduling, or expectations at home that they do at school. That is a good thing! It means that at home, your child can relax and let down their guard. You have different boundaries and expectations for your child, and what you observe may differ from what school staff observe.

The term “warning signs” is used here, as these signs are not predictive of your child having a mental illness, but they may indicate that your child is exhibiting symptoms of the onset of a mental illness. Or these signs may indicate that your child is going through a difficult time and requires additional support. Warning signs are varied, and a warning sign for one person may not be for another. Pay attention to:

• Deviations from what is typical for your child.
• Whether the behavior is impacting your child’s ability to study, work, or relate to others.
• The age and developmental level of your child, as well as whether they have any developmental or other disabilities. For example, a two-year old throwing themselves on the floor when told “no” is relatively age and developmentally appropriate behavior. However, a seventeen-year-old doing the same is not age appropriate, but it may be developmentally appropriate if the student has an identified diagnosis or disability.

Understanding what is typical in child and adolescent development is also key. Young children often have high energy levels, and it may be difficult to keep their attention. With adolescents, typical development and personality changes can sometimes mask symptoms of mental illness. For example, there is a stage in healthy adolescent development in which adolescents withdraw from their parents to establish autonomy and an independent identity.

Warning signs are often exhibited through changes in mood, behavior, and/or thoughts. These changes may not indicate a mental illness, such as depression or anxiety, but rather the presence of bullying, abuse, neglect, trauma, or grief. Or it could indicate the presence of, or change in a medical condition, such as hypothyroidism or a tumor.

If you are concerned about your child, options include:

• Talking with your child’s medical doctor.
  • He/she can rule out any medical concerns, and can screen for basic mental health concerns, including depression and anxiety.
• Contacting a community mental health professional, such as a Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), or a Psychologist (Ph.D. or Psy.D.), for an evaluation.
  • If required by insurance, you can ask for a referral from your child’s doctor. If finances are a concern, many churches, synagogues, or local mental health agencies may offer sliding scale or reduced fees.
• Contacting school staff.
  • Your child’s school may have staff who are able to test and diagnose. Speak with them about the requirements for doing so.
• If your child is talking about or writing about harm to self or others, suicide, or homicide, it is important to take that seriously and immediately seek help.
  • All talk of suicide and homicide should be taken seriously and is a sign of extreme distress. Even if you believe they are “just making a threat to get attention,” it still indicates the need for additional support and may be a cry for help. The best choice is to always err on the side of caution and have a mental health professional determine intent and risk level. Options include:
  • Calling 911.
  • Transporting them to a children’s behavioral health hospital or nearest (preferably children’s) emergency room for evaluation.
  • Calling the National Suicide Prevention Lifeline: www.suicidepreventionlifeline.org or 1-800-273-8255.

Be honest and specific when meeting with medical and mental health professionals about your concerns.

Based on resources, mental health staffing models may include staff who cover multiple campuses or may include contracted third-party providers.

New Mental Health Legislation

As students typically spend the majority of their day at school, Texas legislators have recognized the need for public school district and open-enrollment charter school staff to be educated on identifying mental health conditions, as well as the need for increased services, supports, and resources to be available to support students’ mental health.

Mental health initiatives have been expanded, strengthening the implementation of trauma-informed approaches and student mental health. Initiatives include:

• Requiring all school district employees that regularly interact with students to complete an evidence-based mental health training program. This program must include recognizing and supporting youth who may be experiencing a mental health or substance use issue that could pose a threat to school safety.
• Expanding Mental Health First Aid training. In addition to school district employees and school resource officers, training now includes employees and contractors of higher education institutions, open enrollment charter schools, private schools, and students.
• Placing a mental health professional at each regional education service center (ESC).
• The creation of Texas Child Health Access Through Telemedicine (TCHATT).
• Increasing student awareness of the importance of mental health.

Safety and emergency protocols have also been strengthened, including establishing the Safe and Supportive School Program (SSSP) and the safe and supportive school program team. The TxSSC and regional ESCs are tasked with providing school-based behavioral threat assessment training for the SSSP team. TEA is tasked with collecting data regarding SSSP Team implementation. Funding to increase campus safety and security is provided through a school safety allotment.

Safe and Supportive School Program (SSSP)

The Safe and Supportive School Program was created by the 86th Texas Legislature in 2019, and requires TEA, in coordination with the TxSSC, to adopt rules establishing the program. The goal of the SSSP is to approach school safety from a comprehensive lens, utilizing school mental health and school safety research-based best practices to achieve physical and psychological safety in an educational environment.

Trauma-Informed Care

Due to the prevalence and impact of trauma, every school district must adopt a policy on trauma-informed care and implement and integrate trauma-informed practices.

The district’s trauma-informed care policy must include methods to:

• Increase parent and staff awareness of trauma-informed care.
• Implement trauma-informed practices and care by campus and district staff.
• Make counseling available for students affected by trauma and grief.

To increase awareness and implementation of trauma-informed practices and care, new and existing staff are required to have specific training.

Behavioral Health Resources

• Increasing awareness of behavioral health resources to support the behavioral health of students.
  • Regional Education Service Centers (ESCs) are tasked with identifying resources that are in their region that support students’ behavioral health, including school-based and community-based programs, school-based behavioral health providers, and other resources such as Communities in Schools. These services can be prevention or intervention focused.
  • TEA is using these to create a Texas-wide inventory and plan, to ensure all students have access to adequate behavioral health resources.
• Texas Child Health Access Through Telemedicine (TCHATT) provides telemedicine or telehealth services to school districts to help increase access to behavioral health services.
• Every Local Mental Health Authority (LMHA) employs a mental health professional who is housed within a regional ESC to be a resource for school districts. This professional will help school staff with education in understanding mental health conditions and substance use disorders, identifying resources, and providing training on mental health first aid, effects of grief and trauma, and prevention and intervention programs.
• Schools may assign, either by employment or through volunteer services, a chaplain to provide support, services, and programs to students. A chaplain employed or volunteering under this chapter is not required to be certified by the State Board for Educator Certification. Some of the services provided by chaplains include suicide prevention programs, mental health support, and behavioral health services.

Curriculum

Health instruction is required to be offered as part of the enrichment curriculum. To increase awareness of the importance of mental health, health curriculum must now include instruction on mental health conditions, substance abuse, emotion regulation skills, suicide prevention, including recognizing suicide-related risk factors and warning signs, and healthy relationships. In addition, each district must provide instruction on digital citizenship, including the criminal consequences of cyberbullying.

Staff Development

All teachers, school counselors, nurses, administrators, and other staff, as well as law enforcement officers and social workers who regularly interact with students must participate in training that includes components of:

• Suicide prevention, including recognizing students at risk of attempting suicide.
• Recognizing students who are or may be the victims of or who engage in bullying.
• Recognizing students displaying early warning signs and a possible need for early mental health or substance abuse intervention.
• Assisting students in returning to school following treatment of a mental health concern or suicide attempt.

Staff development training on an annual basis includes:

1. Suicide prevention, including recognizing warning signs of suicide.
2. Recognizing the signs of mental health conditions and signs of substance use.
3. Supporting positive relationships among students, including conflict resolution.
4. How student learning and behavior is impacted by grief and trauma.
5. How evidence-based, grief-informed, and trauma-informed strategies support the academic success of students affected by grief and trauma.
6. Preventing, identifying, responding to, and reporting incidents of bullying.

What should I know?

It is important to talk about all aspects of health with your children, including behavioral health. Communicate in a simple and straightforward manner. They are looking to you for how they should react, so if you appear to be uncomfortable, they may see it as a taboo topic, or one they should feel ashamed of. Have conversations beyond asking about their teacher, school day, or homework, and ask open-ended questions (questions that cannot be answered simply by saying yes or no).

Examples of open-ended questions include:

• What are three things I don’t know about you?
• If you could change something in your life, what would it be?
• What do you like about your friends?
• What was the best (or worst) part of your week?

Sometimes children are so used to answering “I don’t know” to a question that it may take a few seconds or minutes for them to think about an answer. Be patient and let them know that you care and want an answer other than “I don’t know,” or “I’m fine.”

Young children do not know how to accurately label their emotions as their vocabulary is still developing. Their symptoms can manifest as physical complaints because they are unable to verbalize, “I don’t like school because Alex keeps picking on me, and I am sad because I don’t have any friends.” They may instead say “my stomach hurts,” “my back hurts,” or “I don’t feel good” when asked why they don’t want to do something. They may also express their feelings through their behaviors. As such, it is often necessary to look at young children’s behavior as an indicator for their mental wellness.

Adolescents and young adults are often oversensitive and self-conscious, and they do not yet have the coping skills needed to deal with the problems that come with growing up in today’s world. Parents and educators will often notice periods of sadness, anger, frustration, and anxiety with adolescents. However, this should only last a few days. Typical worry or anxiety may be expressed through anger and defiance. Adolescents may alter their appearance to look intimidating, to keep others from getting too close, and they may use illicit drugs to seek relief from anxiety, fear, or depression.

One way to normalize behavioral and mental health and reduce the stigma surrounding it is by speaking about it. One in five adults and one in five children experiences a behavioral health disorder, so it is important to know that you are not alone, and that help is available. Earlier recognition of a behavioral health illness, and connection to treatment, can make the treatment more effective. Because of how much the brain develops in childhood, and brain development continues until a person's mid-20s, treatment may only need to occur for a short period of time.

If you have concerns, connecting your child to a mental health professional for an evaluation or to a medical doctor for a screening is an important first step.