This article first appeared in the Wisconsin School Counselors Association (WSCA) newsletter, June 2021 edition.

By Dr. Ashley Schoof, Clinical Director, STRONG Child & Adolescent Day Treatment and Christian Family Solutions 

Children and teens communicate their needs through their behavior. You’ve seen it – students in your schools signaling they need help through behaviors such as aggression, isolation, self-harm, and more.  

During the COVID-19 pandemic and virtual learning, school professionals may not have witnessed as many children and teens displaying this behavior, simply because the students haven’t been in school consistently. That doesn’t mean the issues aren’t there. Clinically, we’re now seeing higher numbers of children and higher levels of acuity. In fact, we’re expecting that many more children and teens are going to need mental health treatment in the future. Even though the COVID-19 pandemic descended upon us quickly, its effects will linger. Statistics and studies support this.  

It’s going to take all of us working together to recognize the cries for help, respond appropriately in the moment, refer to appropriate levels of clinical care if necessary, and collaborate to provide consistency in environments so students can be successful. 

Reasons for increased mental health needs 

Beyond the statistics, neuroscience explains why we’re seeing an uptick in mental and behavioral health issues. The pandemic left loneliness, loss of social and emotional skills, and increased anxiety and depression in its wake. This is the equivalent of trauma for some children – an Adverse Childhood Experience (ACE). In fact, UCLA now has a COVID version of PTSD screening. And we know that left untreated, ACEs directly relate to behavioral challenges and medical impacts later in life. 

As a clinical professional, I assess and respond to cries for help with appropriate treatment. No matter where you refer students to clinical treatment, please recognize your role as a “first responder” who can refer children to the help they need and be a proponent of a supportive environment outside of therapy. In the remainder of this article, I’ll talk more about how the adults in students’ lives – clinical professionals, school professionals, and parents/guardians – can collaborate to create environments that are best for children and teens with mental health and behavioral challenges. Adults have autonomy over their care and environment; children do not. So it is critical that adults collaborate for them.  

Provide the IDEAL learning environment 

Trust Based Relational Intervention (TBRI) is one of the evidence-based methods we use clinically to connect with children and create a growth mindset for further learning. Below are three aspects of TBRI that guide the approach adults can use when interacting with children who are dysregulated and acting out. I hope these important perspectives and strategies will guide those of you who are striving to create productive learning environments.  

CONNECTION – Each caregiver needs to be mindful of what he or she brings to the table, such as personal reactions or history, and how those might translate as you respond to a child in any given situation. No matter what the child’s age, you can connect better if you understand yourself and your tendencies. Some examples: Do you have a resting “angry face”? (I do!) Are there cultural differences between you and the child? If you tend to react quickly to a child’s behavior, give yourself three extra seconds before you react. Ask yourself, “Why is the child acting this way?” There is a need behind every single human behavior. If you understand this, you can focus on “why” instead of “what” the child is doing. This will allow you to connect better with the child and effectively use the next two strategies.  

EMPOWERMENT – Now that we are open to understanding the child’s behavior and what it might be communicating, we can move on to what to do in the moment. Think about two main sources of regulated or dysregulated behavior:  

• Wisdom of the Body: Is this child hungry, angry, lonely, or tired? Is there anything sensory triggering the behavior, such as noise, clothing, or temperature? Even a sensation like having shoes that are too small can cause dysregulation.   
• Wisdom of Places: What are we doing to create meaningful, belonging rooms in schools and homes? What helps the child know that this is my classroom and I am welcome here, even if he or she makes a mistake? Sending a child out of a classroom for behavior communicates the opposite. Saying things like, “You’re going to miss out” creates more dysregulation. Instead, flip the language to communicate, “We want you here in your space. We will miss you if you don’t join us.”  

CORRECTION – The approach we use in a therapy setting also translates to the classroom or home environment: Address the behavior, meet the need, and move on. We proactively communicate the ground rules first. Two main ground rules we use are “No hurts” (We do not say anything or do anything that hurts someone else here) and “We belong together” (You belong here and I want you to behave in such a way that keeps you here, or I will miss you). Then we use a “Try that again” strategy to proactively teach in the moment.  

What might all of these strategies look like when put together?  

A child walking from the restroom to the classroom begins dancing in the hallway. A teacher is walking nearby. To connect with the child, the teacher comes alongside and mirrors the behavior, making eye contact with a friendly face. “I notice you are dancing, Johnny.” (Still connecting, seeking what might be causing the behavior.) “Let’s try that again, walking from the restroom to our classroom.” The teacher then models the correct behavior, affirming success when the two arrive to the space where they both belong. 

This is what TBRI pioneer Dr. Karyn Purvis calls the IDEAL response: Immediate, Direct, Efficient, Action-based, Leveled at the behavior, not the child. 

I often say that “we act and talk funny” in day treatment therapy. Ours are not words and actions used in many schools or homes. Yet think of what we could do for children if adults collaborated and provided consistent environments for children, whether a therapy environment, school, or home? The same brain-friendly skills learned in therapy could be practiced with school counselors and shared with teachers and parents. What an amazing and supportive environments we would create for children learn and grow. 

If you are interested in creating this kind of environment in your school, I encourage you to gather and discuss how your school is going to recognize that behavior communicates needs, how you will address those needs consistently, and what is needed to support children whose needs go deeper. Determine where you will refer children for whom these everyday strategies are not working, whose needs run deeper than the school staff can address in that setting. Know that when the child goes to therapy, you are still involved. Be prepared to welcome that child back and provide the necessary consistency and supportive environment for him or her to put what was learned in therapy into practice. 

Finally, remember that the most vulnerable children and teens before the pandemic are most vulnerable now to the lingering impact. Many schools are encouraging enrollment in summer school or other programs that support students who may have lost some academic ground or social-emotional skills during the pandemic. Summer is a great time for those who need a “higher dose” of care to enroll in a skills group or a community-based day treatment program. 

I welcome a continuing dialogue with you as we seek to support the children and teens who are coming through this pandemic area. You can reach me at The STRONG MILWAUKEE Center at 262-293-9747. 

Ashley Schoof, PsyD, LP, BC-TMH, is Southeastern Wisconsin Clinical Director for Christian Family Solutions and director of the STRONG Child & Adolescent Day Treatment Program. Dr. Schoof uses cognitive behavioral and family systems framework during treatment and is also trained in applied behavioral analysis and play therapy. Her areas of expertise include foster care and adoption, Autism Spectrum Disorder, Fetal Alcohol Spectrum Disorder, ADHD, OCD, brain injury, learning disabilities, other childhood disorders, and group and individual therapy.