Tuesday, August 14, 2012

So What Are Educationally Related Mental Health Services?


Since the state of California decided to repeal AB3632, which previously governed the provision of mental health services to students with IEPs in California, there has been a lengthy time period of changes and adjustments as school districts have had to figure out how to provide the services that were previously under the purview of the Department of Mental Health.  Now that the dust has somewhat settled, many parents are hearing a relatively new term for the services that previously were referred to as "AB3632 services"  - - "Educationally Related Mental Health Services" or the acronym "ERMHS."

At the most basic, ERMHS should encompass the same types of services that were previously available under AB3632 within a student's IEP, with the exception of "medication management" services.  This means that ERMHS may include residential placement or intensive outpatient therapeutic services like family therapy / counseling, individual therapy / counseling, and/or group therapy / counseling.  At this time, school districts are responsible for providing these services themselves, the same way that school districts are responsible for other related services such as speech and language therapy or occupational therapy.

Because school districts have always had the responsibility of providing "counseling" services as a related service (or what is called "Designated Instruction and Services" or "DIS" services), there is some confusion about the possible overlap between ERMHS and "DIS Counseling."  Here is a definition of each:


Counseling as a Related Services (DIS Counseling) is defined as counseling services provided to a student’s behavioral and emotional needs that affect their ability to benefit from their special education program and are manifested primarily at school.

Educationally Related Mental Health Services (ERMHS) is defined as services provided to a student whose behavioral and emotional needs are documented to be more intense in frequency, duration or intensity, affect their ability to benefit from their special education program, and are manifested as school, at home and in the community.

From these two definitions, it appears that there is a distinction between these two services.  Counseling as a related service is related to situations when a student presents with behavioral or emotional needs specifically within the context of the school setting.  ERMHS on the other hand is related to the provision of more intense services to address more significant behavioral and emotional needs that occur across settings, including outside of the school.  This would appear to mean that a school district must consider not only the behavioral and emotional needs that manifest in the classroom, but also those that manifest in the home and community.  If those behaviors and emotional needs manifesting in other settings impact the student's ability to access an educational benefit, then ERMHS may be warranted.

Given that ERMHS are intended to be intensive therapeutic services that address a myriad of significant emotional and behavioral problems manifesting across settings, one would assume that in many cases ERMHS may need to be provided outside of the school day in order to achieve the level of intensity of therapy that would be required and to effectively provide services like family therapy.  In many school districts in California, ERMHS are being made available outside the school day - in the student's home or through contracts with non-public (private) mental health clinicians.  Inevitably, however, in other school districts the same issues that already arise with regards to the provision of any related services - issues driven by administrative policies, contractual issues and convenience of the school district rather than by the needs of students.  Thus, there has recently been a push in many schools to assert that ERMHS can only be provided during the school day, and that since it is being provided at school it is ultimately the same as or duplicative of DIS counseling services.  While in some situations DIS counseling and ERMHS may be meeting the same needs and both may not be necessary, every child should be viewed as an individual in consideration of this issue, and there may be situations where an individual child requires both DIS counseling at school to address emotional and behavioral issues that specifically arise in the classroom and ERMHS outside the school day to provide parent training and family therapy, intensive clinical individual therapy where techniques like cognitive behavioral therapy can be applied, and appropriate group counseling services.

As school districts continue to adjust to their new responsibilities with the change from AB3632 to ERMHS here in California, it is essential that parents be aware of their rights and continue to advocate for their child's individual needs.  Many school districts have unfortunately given erroneous information to parents - such as broad statements that all students in residential placements will have to return to local schools because school districts are no longer required to fund residential treatment facilities as a student's educational placement.  At the heart of the issue, the substance of what should be provided and when it should be provided has not changed (with the exception of the provision of medication management as noted above).  IEP teams are still charged with determining whether a child requires mental health services as part of their program in order to receive a FAPE.  When placement decisions are being made, residential placement is still a setting on the "continuum of educational placements," and IEP teams still must consider whether a student requires such a setting in order to access an educational benefit. 

5 comments:

  1. I am a special education teacher in California. I work with very young children, all of whom have eligibilities and IEPs. I was unaware of the repeal of AB3632. I recently heard from the school nurse how medications are to be handled. But, what hasn't been clear in my mind is the definition of Designated Instructional Services (DIS), and who is eligible for these services.

    With the change in the law to now define the children with a greater need as qualifying for ERMHS, can you tell me how school districts provide support to students with ERMHS needs? And, what does this support look like? Who assesses the child/student to determine which, if either, level of service they will be provided?

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    1. Pamela,
      I am a school psychologist (also in California), and your district's school psychologists and/or special ed director should be working to draft a process by which the IEP team determines eligibility. In my district, the IEP team makes a referral to the school psychologist when they suspect that mental health services are necessary. Then, following a social/emotional assessment, the school psychologist makes a recommendation to the IEP team. It is then up to the IEP team to determine services. In some districts, the school psychologist provides these services; in others, they contract with outside agencies.

      Hope that helps!

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    2. Thanks for posting a response to Pamela's question - it was very helpful!
      I would add that we should keep in mind that the bottom line is "educationally related mental health services" are now like any other "related services." There should be a process in the district for evaluating a child's need for these services, just like a district would evaluate a child's need for speech therapy, occupational therapy, etc. And then there should be professionals-as the commenter said either school psychologists or outside agencies-who can provide the services to the student as part of their IEP if the determination is that the student needs those services to access an educational benefit.

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