Table 6.
Themes and illustrative quotes related to school processes for reintegration
| Topic and Theme | Participant | Quote(s) |
|---|---|---|
| 1. Re-Entry Processes | ||
| 1.1 Re-Entry Protocols, Meeting, and Planning | School Psychologist | We try to provide those services to help them be successful, and then we do some follow-up on them. If I'm not there, a lot of times that doesn't happen which has been an issue. What ends up happening is instead of a student services meeting, it becomes a counseling meeting where they talk about their paperwork and courses and stuff like that. The socioemotional piece goes to the back burner. I think that happens in a lot of schools in talking to colleagues and friends. That seems to be an overriding concern is that we really have got to work together as a team. |
| 1.1.1 Key Individuals | School Counselor | Part of discharge is doing a teleconference where we talk about how things look, and the kids involved. The parent’s involved. A teacher is involved so we can determine how we do best help this kid, where it’s a team approach instead of just the doctor determining or just me determining. We’re working together. |
| 1.1.2 Key Considerations | School Counselor | The main goals for the meeting are: What do we need to know to make sure that this student is happy and healthy and safe at school? Except from that, the reason the nurse is there is if there's anything medication-related that she needs to know about. The rest of us are there to put a safety plan in place. Do we have to have extra eyes on the student? Are they safe to be unaccompanied at school? What is the follow-up care? Is there anything the student is gonna be do—Do they see the school-based therapist? Will they be seeing somebody here at school, or are they following up with the therapists outside of school? What do we need to know? |
| 1.1.3 Documentation | Social Worker | She was out for so long and then it became the issue that it’s like, “Y’all, we told her not come back until we had it [documentation from hospital] and now she’s got all these days and you’re sending me out,” because I was involved in the process with the mental health, I’m followin’ up on the back end about days. Then the parent tells me that the counselor said that she couldn’t go back until she had seen a therapist and they were waitin’ on an appointment. They’re not always readily available. That’s been an issue. That’s happened and it’s caused issues. |
| School Psychologist | We will try and go about—usually myself or attendants or somebody will try and contact the parents to get some sort of a note, and just let them know that we’re not trying to be nosy, but we need to code the absences correctly so the student’s—and typically that’s how we handle that and then the work can be adjusted accordingly. | |
| 2. Re-Entry Services | ||
| 2.1 Accommodations | Principal | We work with the parents, making sure the child gets here, or we modify the schedules to try to still accommodate the student, make sure they're still able to get the credit and the work that they've done. Sometimes, we have to pull the student out of a class and put them in the online program. Just depends on what the child needs. You know, you're dealing with mental health. It's not like fixing a car. |
| School Psychologist | We've had some cases where we have modified the school day. We've had cases where we've done some online—doing like a hybrid schedule, so maybe an online class and coming for a period or two. I'm hesitant not to have the kid in school because I'm worried about what's gonna be happening at home. I want them to have as much normalcy as possible. It worries me when we push too much for homebound and stuff because I feel like we're making the problem worse in a lot of situations. | |
| 2.1.1 Social and Emotional Modifications | School Counselor | One girl last year, major anxiety. She needed to be touching something. We said, she's holding onto one of my squeeze balls, or she's scratching her pants, moving, doing something, a pen. That's her coping mechanism so let her do that. Another girl that I have right now this year, she will doodle in her notebook. Middle school identified that. She won't necessarily be writing your notes down, but she's drawing. Let her draw. That's her way of coping when she's feeling that anxiety in the classroom. She has asthma, but I think she uses her inhaler as a crutch more so than for asthma. Let her use her inhaler at any time for any reason whatsoever. She's gonna have that with her. |
| 2.1.2 Academic Modifications | Teacher | One of the things I think that’s extremely important that I try to do is get the kids who are in these situations on a plan of self-advocacy when they come back, when they transfer back in. When I get that list together of things like that, when they’re getting their initials from their teacher on what’s exempt and what’s not, I ask them specifically to dialogue with me about how they’re gonna have a conversation with the teacher that says, “I missed this work. What do I need to make up? What do I need to prioritize?” We dialogue it. We practice it. Then they say those things. Or we compose an email together and say, “This is what I need to do.” They learn those skills, so, in case it does happen again, they’re not alone. They have the skills to transfer back into a job, or a college class, or a relationship. You know what I mean? |
| Teacher | A lotta that is really on the student, too, because here’s how it goes. I say this a lot, and it is true. Students get the teacher they ask for. If the student is a good student, then chances are their teachers cut ‘em some slack. If the student was a pain in their rear end, chances are they don’t. Fair or not, that’s the way the world works [laughter]. It works that way in high school too. | |
| 2.1.3 Attendance Modifications | Social Worker | I took a parent to court for attendance and I found out in the courtroom that her son had been hospitalized. She didn’t tell us… She told us in court and so it was like, “That would’ve been somethin’ that would’ve been excused. We would’ve wanted to know to support you and we could’ve avoided this.” We felt like she was just keepin’ him out of school. She wouldn’t respond to us. |
| 2.2 Interventions | School Counselor | Let's make sure everything's good for their schedule. Let's set up a time they're gonna come see me again as we follow up and just check, just kind of a check-on bases. Then I'm usually talking with the student. When's your next appointment? What are your plans? Has your mom followed up? Is she still taking you to therapy? It's so important you continue to do that. |
| 2.3 IEP/504/Behavior Plan | School Counselor | It could be a 504 plan. It just depends on the situation. I'm prepared in all these situations to potentially do a 504 plan, but there are parents that have not brought any kind of documentation. |
| 3. Communication | ||
| 3.1 Family | School Counselor | Okay, I’ve got a kid who’s had surgery before. They come back, and they have—and again, this is up to the parent to share with me, but the parent shares with me what they’re capable of doing. I had one in a car accident right before school started last year, and she transitioned back in where she came one day for first and second and the next day for third and fourth. We had things in place for her, use of the elevator. When a kid comes back for mental health, what is their expectation? What’s too much for them? |
| School Counselor | I think my most frustrating thing is, unless I already have a relationship with the student and the parent, I'm not necessarily gonna know that they've gone to the hospital. That is incredibly frustrating. | |
| School Psychologist | If they [the student] feel comfortable we’ll contact the parents, but sometimes they don’t want us to do that because the parent doesn’t want us to know we were there—they were there. Usually we will contact the parent to try and find out. | |
| 3.2 School Professionals | School Counselor | Any time I talk with a parent about anything, I always say, “Is it okay for the teachers to know?” There’s certain information that should not be shared. If there is a kid who the teacher has no clue what’s goin’ on, they might totally miss what we would think would be a very visible sign that something’s not right. They might just think they’re havin’ an off day when in fact, it’s much more than that. |
| School Counselor | There’s some situations where I email it out, and then there’s some situations where I go and talk to the teacher privately. “Hey, I have a situation I need your help with.” Again, I know the teachers. The doctors don’t know. The parents don’t know. | |
| Teacher | Because that is gonna show in the class. You know? If the teacher is the first one—like on a daily basis with the child—if the teacher is aware of that, I think there is an extra help that that child can have it. | |
| Social Worker | The principal will communicate with the teacher and say, “Look. This is goin’ on with this kid. I need your help in workin’ with them to get this done.” He encourages them to meet, to speak individually and say, “Okay, this is what we need to do.” Sometimes they’ll even waive work. The teachers will go above and beyond if they know what’s goin’ on and how they can help, I feel like. | |
| 3.3 Outside Providers | School Psychologist | Parent will sign the release usually. Then if we have concerns we’ll communicate back and forth with the parent and the therapist so that everybody is on the same page. We’ll even sometimes set up a Google form—a sheet that’ll go back and forth with everybody so people know what’s going on. |
| 3.4 Awareness of Hospitalization | Social Worker | If we know that they're brought to the ER or ED and we know that they're waiting in the hospital, we typically don't know when—we never know when they're—what the resolution to that visit is. Sometimes I'll just happen to be in the hallway and see them walk by. "Oh, what happened?" They'll let me know they were in the ER for 12 days or whatever. |
| 4. Psychosocial Considerations | ||
| School Psychologist | When I sit there, I ask what worked for the child at the hospital, and what they think that they need now to be successful coming back to school. I try to talk about the strengths of that child and build upon those strengths to put a plan in place for that kid. I ask them what they need. I don't try to just throw accommodations at them or ideas at them without hearing from the kid. | |
| Social Worker | As well as, okay, at what point—there's also some limit setting that we have to do. At what point in time do we need to potentially look at more serious steps if that ends up becoming a problem. In other words, if you're making threat of harm to self, at what point are we activating the system again that maybe got you in the hospital in the first place? Because, just 'cause a kids says, "Hey, I wanna hurt myself," doesn't mean that at that exact moment in time you're calling in the Calvary. It may be this is a regular thing for this student, at which point, someone who is trained in it has an opportunity to do a basic suicide assessment to see where they're at. | |
| School Counselor | Just trying to normalize that, trying to say, “If your student came back from a car accident, and they had a broken leg and crutches, I would need to know what we need to do. I would need to know how the school can best help them. Do I need to have their lunch brought to them?” Normalizing it more, drawing the analogy between a mental health concern and a physical health concern and trying to help them understand because, again, a lot of them—sometimes it’s even at the parent level. The kids are more willing to talk about these things than the parents sometimes because it’s—there’s shame, or there’s guilt, or there’s something associated with it. | |
IEP Individualized Education Plan