Skip to the transcript of Episode 10
Show Notes
Candida and Jo-Ann talk with Dr. Jacqui Springer, Assistant Dean for Student Support and Advocacy Services at the University of Rhode Island. Our discussion focuses on the transition back to school from hospitalization or partial hospitalization for mental health treatment and the need for student support systems.
In most cases, the need for a higher level of care for a student does not come as a surprise – there is usually some sort of buildup. There may or may not be a precipitating event, but educators and school staff observe that the student is struggling more than usual.
Preparing Support, Coordination
Dr. Springer reviews some considerations that can help the school and caregivers prepare even before hospitalization is needed. One key question to ask is ” What would it look like to have a higher level of care? What would it mean for school”? Other information to have would be who is the person or office within the school or district that is holding the information to help make a plan moving forward. Who can help the caregivers and navigate the systems to allow communication between the school and the hospital?
Student Support Systems for Their Transition Back To School
One of the difficulties with the hospital-to-school transition is that at the time of hospital discharge, while the patient/student may no longer meet medical criteria for hospitalization, they may not be ready to return to school, at least full time and/or full demand One way schools can help with the gray area is to have a multi-disciplinary team that focuses on student transition back to school. Most schools will have some students who are hospitalized or transitioning back to school at any given time. While it may not be easy to keep such a team due to the many demands on educators’ and administrators’ time and energy, a planful approach to this situation could help students, caregivers, and school staff in the long run.
Dr. Springer pointed us to the BIRCh (Behavioral Health Integrated Services for Children) Project, based at UMass- Boston, UMass – Amherst, and Boston Children’s Hospital. The project is evidence-based and offers graduate-level training opportunities as well as training for educators to strengthen the coordination of behavioral health supports provided by school and community agencies.
Resources
The BIRCh Project https://www.umb.edu/birch/
University of Rhode Island https://www.uri.edu/
American Academy of Child and Adolescent Psychiatry https://www.aacap.org/
UMass Boston https://www.umb.edu/
Boston Children’s Hospital https://www.childrenshospital.org/
UMass Amherst https://www.umass.edu/
Episode 10 AI-Generated transcript, lightly edited for clarity
Candida Fink: Okay. All right. Morning, Jo.
Jo-Ann Berry: Good morning, Candida
Candida Fink: How are you doing this Saturday?
Jo-Ann Berry: Saturday morning leading up to the holidays? Getting a little bit excited for some downtime.
Candida Fink: Yes, indeed, indeed. Got my Christmas tree up today, last night. So. Feeling the spirit today.
Dr. Jacqi Springer: Yeah.
Jo-Ann Berry: So welcome to listeners to Mental Health Goes to School. I’m Jo-Ann Berry. I’m a special educator.
Candida Fink: And I’m Dr. Candida Fink. I’m a child and adolescent psychiatrist, and this is Mental Health Goes to School
Jo-Ann Berry: And today we have with us Dr. Jackie Springer, who is the Assistant Dean for Student Support and Advocacy Services at the University of Rhode Island. So welcome, Jackie.
Dr. Jacqi Springer: Thank you.
Candida Fink: Good welcome. Morning. Thank you so much for being here.
Dr. Jacqi Springer: Happy to be here.
Candida Fink: I was going to say, so I saw you speak at a conference. We were at the American Academy of Child and Adolescent Psychiatry, and I was really interested in a program you were on the panel for. One of the things we wanted to talk about today was something you guys were speaking about there, which was a challenging topic, a challenging situation when kids are hospitalized, when students have to be psychiatrically hospitalized when they require that level of care, and then we’re planning for their return to school. How difficult that transition is and the paucity of resources. So, I think that was sort of my intro to you. So I guess we can sort of start there. You can tell us a little bit about what that program is, was what you’re doing there.
Dr. Jacqi Springer: Yeah, certainly. So again, good morning, Jackie Springer. She/ her pronouns and real happy to be with you all today. This topic is near and dear to me and has been now for about 20 years. In fact, longer, ago than I’d like to admit. It was one of my dissertation projects before folks were really taking a look at transitioning from the hospital to school as its own sort of niche area that people had to be working, around.
And I think we certainly could talk about this from all realms, but the area that I was really focusing on during the presentation at the psychiatry conference was looking at the concept of school transition for teenagers. The reason for the focus on that is when we sort of look at this integral four-year period sometimes that’s more than four years for students.
There are some really pivotal, some very important, times within traditional American high school when the amount of time that a student is out of school really matters. Students who are juniors, particularly at the beginning of that junior year, missing even two weeks of school can make or break their transition to college successfully. And so we’re really talking about how do we help our youngsters who are not well for any number of reasons, and how do we not only get them out of the hospital, then not only get them back to school but help them sort of have support as well as the language needed to help them navigate going back.
It’s not enough for us to say, all right, you don’t meet the criteria for hospitalization anymore, go back and do all your work. And unfortunately, I think for a long time, and even now, that’s still quite a bit of what happens. The student isn’t necessarily given support. What do I say to my peers about why I disappeared for a week or two or three?
Candida Fink: Yeah. The idea of the language for kids is so important. We will sometimes try to practice a script. What are you going to say? Just so you don’t have to think about it can be autopilot, whatever it was that you’re going to, and you don’t have to share with everyone. But I love the point you made that helping kids have language for it, even beyond all the very logistical and important critical supports we need to put in place. But kids need to feel like they can be accepted back by their peers. Right. That’s so critical.
Dr. Jacqi Springer: Absolutely.
Jo-Ann Berry: And that is something that at my school we sometimes work on. I mean, it could be for any subject that a student is having difficulty with. Why they were out or why a certain event happened or whatever, their clinical support folks will try to help them develop a script, or if they’re always struggling with a certain thing, develop a script. Some people think of that as cheating. It is not cheating. How many of us have the script? When you see somebody in the grocery store, hey, how are you? Blah, blah, blah, blah, blah, blah. That’s automatic for most of us.
Candida Fink: It’s a skill right? It’s a skill.
Dr. Jacqi Springer: Especially when we’re talking about hard information. Right. Like, what are you supposed to say, hey, person I see every day for an hour. Here’s this really deeply personal thing that happened to me that’s just not in the realm of everyday conversation.
Jo-Ann Berry: Right. So that’s an excellent point. And what have you found that are the most successful types of supports to help a student transition back into school?
Dr. Jacqi Springer: Yeah, I love that question. And so I would say it starts, or it should start, ideally before the student even goes into the hospital. So I think when we are talking about a youngster, perhaps that is doing some sort of partial hospital program, what we are seeing is it’s not an imminent crisis where people were totally surprised that the student needed to go in. Usually, there’s been some sort of build-up that we’re seeing. And if that person has some level of support, whether we’re talking about it on a high school or college end, ideally there would be someone, a social worker, a counselor, their psychiatrist, a case manager, who can have a conversation with that youngster and or their families about what would it look like if you were to seek a higher level of care at this point in time. Let’s talk about what it would mean for school Right?
And so when those conversations are able to happen, it then sets up a situation where, ideally, the rest of the conversation can go smoothly. Why? So we get things out of the way, like releases of information. There can be a conversation about who is at the school again, high school or college, and who is going to be the person or office that this youngster and their family feels comfortable or confident in receiving this information. And is that person that they’ve identified, someone who can help them make a plan moving forward, both while they’re in the hospital and trying to figure out some transition plan? And then, more importantly, when that youngster, I’m not going to say is back in school but I’m going to say is out of the hospital, because those are two different time periods, right?
So, in theory, that’s where it would start because the world is not perfect. And we know someone is with us in the school today, and we’re hearing in the morning, oh, so and so is at the hospital. One of the most helpful things that I think we can do as teachers, as physicians, as providers, is really help these families navigate what things are needed so that these different institutions can talk. Okay? So sometimes it is that written release, but sometimes it’s a verbal communication. Sometimes it’s the identification of who is this person’s or who is this youth’s treatment team comprised of what are their roles? I think we know, right? Working in therapeutic settings, we understand the difference. The psychiatrist, the psychologist.
Candida Fink: Right.
Dr. Jacqi Springer: The counselor, the milieu, therapist. We know what these things mean. Families have no clue. They’re just like, I don’t know. You’re someone who’s supposed to help.
Candida Fink: Very true.
Dr. Jacqi Springer: So getting a firm. This is the treatment team, and this is the person in each setting that is going to communicate with the other setting is where we see the best plans moving forward because that’s been identified and it leaves a lot less to fall through the cracks. Those are the things, right? It doesn’t even involve the student or patient at that point.
Candida Fink: Who are the people who are involved in each setting and how will they communicate? If there’s one theme that has come across in every interview we’ve done, and every discussion we’ve had, it’s communication. And specifically identifying who is involved in the communication, how you make those communications, and what you need to have those communications happen just as you’re describing. I think it’s so wonderful how you described that very specifically. And really, I hadn’t even thought of this. That idea of really trying to put that in play, at least in some way. If you do see it in escalation and you are anticipating that, like having some planning that includes the family and the patient, when possible, to be thinking about what that communication sort of team effort all around, inpatient, outpatient is going to look like. school right?
Dr. Jacqi Springer: Absolutely. And I would say schools understand this really well if we’re using the right language. Right. So the concept of a multidisciplinary team, anyone who works in a school knows what that is. They have those meetings all the time, IEP meetings, any meeting.
For a youngster who’s having a struggle, as a school psychologist when I meet folks who are sort of struggling to put things together, I’m like, oh, you’re using a different word, but you’re saying a multidisciplinary team. We have roles. Let’s identify people’s jobs. If we do that, then when the hospital, again, whether we’re talking inpatient, whether we’re talking partial hospital, sort of decides that this youngster no longer meets criteria for hospitalization, it allows for there to be a smoother step down process, because, again, we all know that that gray area between not meeting criteria for hospitalization but being ready to go back to school is something that falls heavily on the caregivers.
And notice, I’m not saying parents. I spend a lot of time talking with folks about this, is that we think sometimes as providers assume that if a youngster, first of all, if they are with their custodial or adoptive parents, that those are the people who are able to navigate this transition, and that’s sometimes also an error. So I like to talk about who are critical family partners and whether are we involving them. Right. Sometimes it’s a pastor, sometimes it’s a neighbor, sometimes it’s a grandparent. The people who are going to be able to support the core unit when that youngster is in that transitional space. And I love it when the student or patient is the one who’s able to identify those people because they are comfortable and more likely to communicate with them.
Candida Fink: That’s huge. That transitional space, it’s a scary space for the student. I think sometimes for the school if they’re not sure, often, and certainly for the care providers, those critical care providers, everyone is feeling very unsure and unsafe, not clear on safety, because hospitalization, when you’ve taken to the level of inpatient, it’s often been an issue of safety. And so there’s that gut sense. So all these ways of trying to really provide support, plan the know, capacity to participate in it is, know. I agree.
Dr. Jacqi Springer: Yeah. And Candida, I remember at the presentation, you asked me a question, and I don’t remember what the question was, but I do remember our conversation about it, and it was sort of getting to this concept of, in that area of gray, when you know your client’s not well, but they don’t meet criteria, the school is also like, yeah, no, you can’t come back unless your treating provider is willing to attest to the fact that you are safe, whatever that means, to be in the school space. And so what does it mean when providers who are seeing a patient for 15 minutes, maybe 20 minutes, are then being tasked with sort of the decision for a larger body of people about this human’s ability not only to be safe but to function?
Candida Fink: Right. Because you want to know both. Right. All that information is presumed to be included in that letter that they’re waiting for from the psychiatrist. Right?
Dr. Jacqi Springer: Yes, absolutely. And so, Jo-Ann, I know in a therapeutic setting, right? There’s also the, okay, we safely got this student into the school building, but are they ready for learning? Those are also two different things.
Jo-Ann Berry: Right.
Dr. Jacqi Springer: So, again, when we talk about this sort of, um, psychiatric hospitalization to school transition, I look at the transition as having multiple touch points where we’re going from the big, scary piece of, ooh, this student needs to be inpatient. And our goal, I think we misidentify the goal often, as the goal is to get the student back in school but that’s not really what we mean. Right.
We’re talking about getting the student back to a place where they’re ready to learn and consume information and be able to be a successful member of that school community. And we still have a lot of work to do to sort of go through all of those touch points, because I feel like with as much information as we have and as much as we’ve learned during COVID by and large, many states, due to lack of funding, lack of resources, lack of Mental Health providers, lack of teachers, all the parties. We’re still just vacillating between. All right, can the student be in school where someone will keep them alive, or do they need to be in a sort of lockdown setting, and anything in between isn’t given a great deal of thought and care that it needs to have because people are overextended?
Jo-Ann Berry: Well, and then back to your point of multiple touchpoints. When a student, maybe a student is okay to come back into school but maybe all the teachers shouldn’t jump on them and be like, you owe me all this stuff. A little bit more of an assessment there on first of all, what? Back to your point of junior year. If you miss a bunch of stuff, it’s kind of hard to stay caught up. And in some classes and academic areas, that’s much more important than it is in others.
What are the student’s goals? Think about that a little bit. And if they miss two or three weeks, whatever it might be, what is the most important thing for them to feel successful and competent in that area? Can we just dismiss several of these assignments? And if they can demonstrate they know the material, or you can work with them a little bit to, bring them up to speed, a little bit more thought around that, which I understand is difficult in a large school population. But which of the students do you want not to succeed? Is kind of the way I look at it.
Dr. Jacqi Springer: Absolutely. Because if you ask a group of people to focus more heavily on a smaller number of students, someone’s always getting left behind, and that’s certainly not the goal. And, Jo-Ann, I’m glad you said that because you sort of jogged my memory. I think one of the questions was, are there successful sort of projects that we’re seeing out there? Are there places that match this well? And one of the things that I sort of stumbled upon while I was doing my research for the AACAP presentation happens to be right down the street. Well, not literally, but, like, up the road from me.
So there’s something that’s called the BIRCh project, and it’s capital B-I-R-C and then lowercase H. And that the BIRCh project is a collaboration between UMass Boston, Boston’s Children’s Hospital, and UMass Amherst. And what they did and they took the combination of a bunch of different work that was being done around the country, and they formed this sort of multi-step protocol that gets to what you’re talking about, Jo-Ann. So their touch points are as follows. There’s a planning meeting right off the bat if a student goes into the hospital. They’re deciding who should be on the hospital-to-school transition team, and they’re already talking. They’re saying things like, does the student have a 504 plan? Is the student on an IEP? If they aren’t, who is the person who can sort of help get this in place?
Then the next step would be a welcome back team meeting. And that team meeting is really to help all people who are involved as the touch points with that student to feel comfortable and confident in what their role is. They then list the next piece in this plan as the hospital-to-school transition plan implementation, which they consider to be a six to eight week time frame. So again, this is something they’re looking at over the long term. This is not a, all right, let’s just wrap this up over two weeks.
Then there are three more steps after that. There’s a progress monitoring team meeting and again, reconvening the hospital and the school transition teams to discuss progress in response to interventions. They then look at the hospital-to-school transition plan implementation and monitoring. Again, sort of at the end of that eight week touch point, and then they consider sort of their phasing out piece to be called planning next steps team meeting. So here’s what I think is important about how they’ve set this up. It isn’t something that they convene for one student.
The idea here is we know that at any given point in a school system, there are a number of students who are unwell, or, if schools are working together or if they’re sort of looking at their caseload and what’s happening, I imagine that most schools could get a sense of, at any given point in time, how many youth do we have in some sort of temporary medical leave? Right. It can be for all sorts of things.
Candida Fink: Right.
Dr. Jacqi Springer: So if we sort of move away from this concept of, oh, no. Right. Like, Sarah had this thing, and now we need to figure out who’s supporting Sarah. But we look at it more from a this is a chronic situation that we know we’re going to keep having. Let’s identify the key point people. What are our local area hospitals or partial providers? What does it look like for us to more intentionally schedule these things and then talk about the individual students who need care? So, again, that model would be something that I think most school systems would say, yes, we’d like to do this, but then there’s all the questions about infrastructure, pay time, release time. Right.
If I’m in this meeting, who’s watching my students, and then certainly, I get asked this question often and I’m like, I don’t know, I don’t work in the hospital system. But how does that get billed? Right? How is it getting billed for the provider? What about the psychiatrist who’s coming to this hour-long meeting that doesn’t fit within the structure of any of the billable things you’re doing? This is indirect support.
Candida Fink: Right?
Dr. Jacqi Springer: So who’s paying for it? So I share that model, as a collaboration that seems to be working well. That’s sort of touching the idea of a university system that can really look at some research on what is and isn’t working. A school system, a large school system, and then a hospital system that has the ability to evolve. And so ideally your triad of who has to do the work and then the place that can sort of assess and reassess and provide information would be the unicorn.
Candida Fink: The great idea. There’s the idea, definitely. Well, and you pointed out when you were doing, back in doing your dissertation, this concept of this space was hardly then and is still very unaddressed as a story, as a space, as something like the point. And Jo-Ann, of course in your school this is going to happen in a specialized school you’re going to see it even a little more directly, but there are always kids in some varying degree of levels of need, and they’re always going to be so that creating this idea of some system that brings those players together, bring those key people together on a regular basis, create some story of that as a space that needs to chronically be addressed and understood, and then have the research to do a center that is doing, in that case, doing the research to identify what’s working and what’s not working. I mean, absolutely the dream, right?
Dr. Jacqi Springer: Yeah, that’s the gold star that we all reach for, right? That we’re all hopeful will come to fruition.
Candida Fink: Keep working at it.
Jo-Ann Berry: But hopefully some schools could, if this is the ideal, the platonic ideal, this system could, could implement some of those steps. And just like you said, you know, there’s a certain number of students who are in difficult situations, and even if they’ve missed school for a different other reason than Mental Health, that still has to have some transition planning to come back. So just recognizing that and hopefully creating some space for counselors and teachers to participate and for the parents to feel like, or the caregivers to feel like somebody’s got my child’s interests in mind here.
Dr. Jacqi Springer: Yes, specifically alone.
Jo-Ann Berry: Right, exactly, so this is like you said, it’s the dream, it’s the goal. But recognizing that it is a multi-step process, it’s not like, okay, you’re discharged from the hospital and Monday, you’re in school. Go You!
Dr. Jacqi Springer: It doesn’t quite work. No, it really doesn’t work.
Candida Fink: Could we say that enough times? It doesn’t work.
Dr. Jacqi Springer: Yeah. And so, I mean, for the listeners, I encourage them to look up the BIRCh project again. There are all other sorts of projects that are doing great work as well. But I mentioned that one because, again, of the triad of sort of institutions that are involved, but also because it’s like a 25-page fillable PDF that has predetermined areas for different partners already where families can just go in and fill it out. Right. So to this idea of the students back in school, they miss chemistry, they miss physics, they miss calculus, they miss Spanish. There’s literally like, they can fill in each space and there’s a physical form that they can print, or they can take on the computer and they can sit with the teacher. This is what I’m missing from this class.
Candida Fink: Okay.
Dr. Jacqi Springer: Right.
Jo-ann Berry: We’ll link that in the show notes.
Candida Fink: Yeah, absolutely.
Dr. Jacqi Springer: it’s not just, right, here are some steps, and here’s the document that goes along with this. And everybody has a part. So if people don’t do their part, that doesn’t work. But it’s not all on the youngster who’s trying to figure out how to survive. And that’s really, in my opinion, what makes psychiatric hospitalization so different from any of the other types of, sort of temporary medical leaves.
Candida Fink: Right.
Dr. Jacqi Springer: Like, we see teens, folks with childhood cancer, they have some other sort of major health issue, and it’s not taboo for them to come back and say, I was out because I had surgery. But this element of this almost idea of life was too hard and I couldn’t handle it on top of all the other teen stuff. That’s way too much. It’s too much for us as adults. Right. So how do we expect a teenager to be able to handle that conversation?
Candida Fink: Right? That’s right. So that’s really nice, really scripted, spring loaded. To your point, Jo-Ann, pieces that people can maybe pick and use, some of that, all that work that’s gone into that, the ideal, not necessarily accessible, but pieces of it. So that is great. We’ll definitely list that. I think that would be really valuable for people to know about.
Dr. Jacqi Springer: Wonderful.
Candida Fink: Yeah.
Jo-Ann Berry: Thank you, Dr. Springer, and tune in for part two.