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School Nurse Mental Health“Be” Plan

By Eileen Gavin, MSN, NCSN, FNP-BC, FNASN posted 08-13-2021 14:34

  

Be the priority for your own emotional well-being. Remember a dysregulated adult cannot help a dysregulated child!✅  I took my own advice and followed my “Be” plan by making my emotional well-being a priority this summer.  It has given me the time to reflect, reset and work on the next steps to reopen school. I feel more prepared to face the new challenges ahead.  I am hoping you have found some time for self-care as well. 

Be Present - Make your role known and be involved in your school community.✅  Building healthy relationships with students and staff includes fostering connectedness and partnerships.  Introduce yourself to your staff and students through email, your school website and other social media platforms.  Explain your role and resources to support student and staff mental well-being. Bridge the anticipated increased need for mental health services by planning a team response. We are in an “all hands on deck” scenario this school year, after more than sixteen months of school disruption. 

Be the person that someone seeks  out for help.✅  This story illustrates the power and importance of relationships in school.  A school nurse who transitioned  from an elementary school to a high school was in the health office when her former student arrived in distress. It was the student’s first day of in-person learning during COVID.  This student sought out the only trusted adult she knew in the building. She shared her overwhelming emotions and suicidal plan.  The nurse, trained in Mental Health First Aid (MHFA), was able to assess the crisis situation and access appropriate care for the student.  This student received life saving care because a professional school nurse was present, prepared, and most importantly, had established a trusting relationship prior to the emergency.  

Be Informed - Seek out mental health training to expand your knowledge base.

Consider expanding your mental health knowledge through MHFA and Psychological First Aid for those in distress.  This is important because the average delay between onset of mental illness symptoms and treatment is about 11 years.  Early identification, diagnosis and treatment can help children reach their full potential.  I urge you to prepare for such an event with Youth Mental Health First Aid and  Psychological First Aid App

Promoting peer support programs to manage stress such as Stress First Aid (SFA) is another important tool to consider introducing to your school community.  SFA is a framework to recognize and promote  recovery from stress reactions, individually and as a group.  Another social emotional (SEL) program to consider implementing in the lower grades is NASN’s Emotional Management K-6 course, presented by Rebecca Kilfoy.  Her course addresses somatization which can lead to frequent health office visits and lost class time.  Finally a simple mindfulness program that is suitable for all grades and staff, is the Fingerhold Practice for Managing Emotions & Stress for mind-body, breathing, and movement strategies to promote wellness and manage stress.  This is an easy strategy to teach your staff and students to self-regulate feelings of anxiety. 


Be Prepared for the anticipated surge of mental health related office visits we expect this  school year.✅  Mental health issues were on the rise prior to the pandemic and school nurses have spent up to 35% of our time on mental health concerns pre-COVID. There were alarming pre-pandemic trends for high schools students reported in the 2019 National Youth Risk Behavior Survey demonstrating increased reports of:

  • Experiences of persistent feelings of sadness or hopelessness
  • Seriously considering suicide, having a suicide plan and following through with a suicide attempts
  • Transgender youth being more likely to have attempted suicide than their cisgender peers.

This past March (2020), Mott’s Children's National Poll  reported 1 in 3 teen girls and 1 in 5 teen boys have experienced new or worsening anxiety.  This time last year, school nurses were planning and focused on public health mitigations strategies to control the spread of the virus.  It is now time for school nurses to lead the reentry planning with mental health in the forefront of our minds and re-opening plans for 2021.   Be prepared with training that provides an action plan to assess the seriousness of the situation, offer resources and support when appropriate or activate emergency crisis response teams.  

Be a Leader - Recognize your own potential to make change.  School nurses are positioned to reinforce the importance of social and emotional well being.  ✅ Investigate the resources your schools are already implementing for social and emotional well-being.  For example, does your school use the multi-tier system of support (MTSS)?  MTSS includes professional development for teachers and school nurses with a focus on creating ways for school staff to team up to help struggling kids.  School nurses can help lead these initiatives.

Be Proactive - Join and participate in your county, state and national school nurse associations/organizations.✅  Belonging to a professional school nurse organization helps establish your professional relationships with colleagues who practice within the framework of NASN 21st Century School Nurse.  This is especially important as guidelines and evidence based practice is constantly evolving.  Our professional associations support school nurses by providing important resources that form the foundation of your school nursing practice.

Be the mental health expert you are!  Have a safe and healthy school year ✅

Mental Health Symposium Panelist Follow Up Questions

Do you work with the school counselor, if there is a counselor available. If you do, what does that look like?

In my Middletown NJ high school of 1500 students, our counselors are all overworked and over-scheduled.  There are a variety of professionals that assist with our students' emotional health.  We are very fortunate to have a partnership with the local YMCA that provides a licensed master social worker (LMSW) who has scheduled students for therapy as they would in private practice.  Our district also has a Student Assistance Counselor (SAC) who provides counseling for alcohol, drug, and tobacco prevention and rehabilitation.  SACs also provide support and emotional counseling to our students along with all of our academic guidance counselors.  Again, it’s an “all hands on deck” approach.  


May I have contact info for Eileen Gavin? Where may I get info on mindfulness in the classroom she is speaking of?

Eileen Gavin egavin2@icloud.com
Here are the SEL and mindfulness programs I discuss during the Mental Health Symposium:  
How do you communicate with students having to repeat a grade in the midst of another crisis experienced from COVID? What resources do you recommend?

Grade retention pre-COVID for any student is very distressing and has even been considered an adverse childhood experience (ACE).  Building relationships with these students is crucial.  Given that the pandemic and the retention can both be considered an ACE, consider expanding your knowledge of Positive and Adverse Childhood Experiences (PACEs) This organization offers webinars on positive relationship building with children that have experienced trauma.  Here are some additional resources:


What are ways to address the impacts of social media being a cause of anxiety & depression to our youth?

The COVID-19 pandemic has increased concern about the mental health effects of social media on our students.  School nurses can protect student's mental health by building relationships and other steps that increase resilience, knowing the warning signs of distress, and connecting students with resources to help.  This article recently published on the Brookings Institution website contains resource links to address mental health issues related to social media and online learning.  (Kathy Reiner, 2021)


How can you help a student with depression/suicidal ideation/substance abuse if they refuse to accept that they have a problem?

Student refusal of assistance with mental health and substance use disorder is certainly not a one-size-fits-all response, however schools need to have protocols and crisis teams in place to to address any suicidal ideations.  There are 2 vital tasks for schools in preventing suicide. School staff can identify at-risk students and ensure students at risk are assessed and evaluated by a mental health professional (within or outside the school setting), according to school protocol or policy. 

Here are some recommended resources:


When there is both a school nurse + school counselor, how do you draw the line between which responsibilities the nurse or counselor should be in charge of?

A flexible, collaborative partnership with your counselor would best benefit your student.  The optimal school environment for students is a trauma-informed/healing-centered school to prevent ACEs and foster resilience.  It should be an “all hands on deck”, whole school approach.

Here are some recommended resources:

    • Child Trauma Toolkit for Educators
    • Ginwright, S. (2020, December 9). The Future of Healing: Shifting From Trauma Informed Care to Healing Centered Engagement. Medium. https://ginwright.medium.com/the-future-of-healing-shifting-from-trauma-informed-care-to-healing-centered-engagement-634f557ce69c
Again, "Be" the mental health expert you are!  Have a safe and healthy school year ✅         
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