COVID-19 Resources from NCSPA

Schools should be prepared for local and community-wide infectious disease outbreaks. While it is difficult to predict or understand the COVID-19 pandemic, there are actions schools can take top provide crisis intervention and response for such events. The majority of the attention on COVID-19 has focused on slowing down the progression of the spread of this virus. The importance of “flattening the curve” to support our medical system has understandably taken center stage in the media. As we continue to further into this crisis, the need for crisis intervention and response is evermore present for our students that we serve. As further physical distancing is required, the impacts of the social isolation has a social. Mental, and cultural impact as we all work to understand and navigate this global pandemic.

Schools need to work collaboratively with their local and state health departments, and be attentive to guidance offered by the CDC, to determine how to ensure safe learning environments. For detailed guidance on how to develop emergency operations plans capable of addressing pandemic illnesses refer to “Preparing for a Pandemic Illness: Guidelines for School Administrators and Crisis Teams” provided by the National Association of School Psychologists. This document provides suggestions for the immediate school response to the threat presented by COVID-19. This document that is being shared is a collaborative effort by the North Carolina School Psychology Association School Safety and Crisis Response Committee to help provide schools and crisis intervention response teams on guidance during the school closures and pandemic. This guidance document outlines the crisis prevention, intervention, and response action steps that schools will want to consider.

Prevention and Initial Action Steps for Crisis Intervention in Schools

One of the first steps that schools will want to consider is to establish a “behavioral health help-line”. Many districts in our state of North Carolina have established a behavioral health help line in order to respond to the social emotional and behavioral health needs for students in crisis. This line can help provide supports and link students and families with needed resources during this unprecedented time. In addition, school teams will want to consider developing a local resource list and detail services of mental health providers during the COVID-19 response team. These resources will help parents, school staff, and community understand specific crisis responses by community providers as they seek help and supports for children. In addition, this resource list should include emergency response numbers for local managed care organization mobile crisis teams and any other 24/7 crisis information that families may need access to during this time. NASP also had a great resources for this here.

Emergency Response Contact/Crisis Numbers

If you are aware of a student that is in immediate danger due to a crisis situation or threat of suicide immediately call 911 and/or a suicide crisis line. The National Suicide Prevention Line number is 1-800-273-8255 and their website is https://suicidepreventionlifeline.org/. Suicide.org also provides a list of North Carolina hotlines here. Alway ensure the immediate safety of the household member before considering other resources.

With the closure of our school districts statewide, families will need access to emergency response services and crisis information from community sources as well. For some families, community resources such as the Local Management Entity (LME)/ Managed Care Organization (MCO) have provided these resources previously and they have experience with these agencies. For other families, these services have traditionally been provided by school resources. The North Carolina Department of Health and Human Services provides a page that lists each LME/MCO, which counties they provide services for, their basic contact information, and their crisis hotline information. For many of these LME/MCO there may be mobile crisis services that can come to the families location for support.

Listed below are some at-risk symptoms/behaviors/contributing factors and what to watch for in a virtual environment:

• Behavior that is out of the ordinary for the student

• Increased irritability, mood swings

• Change in appetite

• Change in sleeping patterns

• Negative response to recent change in structure/routine

• Change in physical activity level

• Change in communication with family members

• Change in work/study habits

• General sense of hopelessness or helplessness

• Friendship issues

• Family relationships are more strained

These are unprecedented times. Lives have been disrupted, leading to fear and worry for many. Social distancing, business and school closures, and shelter-in-place orders have led to greater isolation and distress, particularly among the most vulnerable. Many people’s mental health has been negatively impacted, placing those already suffering from mental illness and substance use disorders at greater risk. The very measures necessary to safeguard public health have increased feelings of hopelessness and anxiety, conditions linked to poor mental health outcomes.

Suicide is a concern and already there are suggestions that suicide rates will rise. Suicide is the 10th leading cause of death for all ages in the United States and a major contributor to premature mortality. According to a report from the National Center for Health Statistics, suicide rates in the United States increased 35%, from 10.5 per 100,000 in 1999 to 14.2 in 2018 (April 2020).

Suicidal ideation is a major mental health risk among adolescents. Among adolescents ages 12 to 17, suicide is the second leading cause of deaths among (The Centers for Disease Control and Prevention, 2016). The CDC also reports an increase of suicidal thoughts and suicide rates among adolescents over time. The 2019 Child Health Report Card highlighted the following:

• The rate of youth suicide has doubled in the previous decade.

• Factors leading to suicidal thoughts include mental health, trauma, persistent stress, family violence, bullying.

• 12% of heterosexual youth reported seriously considering suicide compared to 43% of LGBTQ youth.

• African American youth were twice as likely as white youth to have attempted suicide in the past year and were significantly less likely to get treatment for depression.

The CDC (2020) states that long-term school closure may lead to an increase in mental health issues as students have fewer opportunities to engage with each other. Adolescents with pre-existing mental illness may be more greatly impacted and not have the same mental health services as available due to school closure.

Youth suicide warning signs remain the same regardless of the environment. They include:

• Talking about or making plans for suicide

• Expressing hopelessness about the future

• Displaying severe/overwhelming emotional pain or distress

• Showing worrisome behavioral cues or marked changes in behavior, including

• Withdrawal from or change in social connections/situations

• Changes in sleep (increased or decreased)

• Anger or hostility that seems out of character or out of context

• Recent increased agitation or irritability

In situations where there is forced separation, look for someone expressing feelings of isolation and interpersonal concerns related to social distancing. Withdrawing or shutting down might be manifested in someone not engaging in social media as usual or staying in their rooms. It is important to pay attention and listen to what the person is saying, especially the words and the tone of voice.

SAVE provides information on how a pandemic might affect those with certain mental illnesses, as well as Tips for Preventing Suicide During and After a Pandemic.

National Suicide Prevention Lifeline offers 5 steps to help someone that may be in suicidal crisis. These include ask, keep them safe, be there, help them connect and follow up.

NASP also provides guidance on completing a virtual suicide threat assessment.

Helpful Resources:

• American Foundation for Suicide Prevention: Risk Factors and Warning Signs

• American Foundation for Suicide Prevention's Seize the Awkward’s new Coronavirus page

• Erbacher, T.A., Singer, J.B., & Poland, S. - Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention (School-Based Practice in Action)

• Substance Abuse and Mental Health Services Administration

Preventing suicide: A toolkit for high schools

• Suicide Prevention Resource Center

After a Suicide: A Toolkit for Schools, Second Edition

Preventing Suicide: The Role of High School Mental Health Providers

Preventing Suicide: The Role of High School Teachers

Suicide Prevention Resource Center: Resources to Support Mental Health and Coping with COVID-19

• National Center for the Prevention of Youth Suicide - program of the American Association of Suicidology (AAS), working to change how schools and communities address the issue of suicide among young people.

• SEL and Self-Care Resources

• The TREVOR Project - leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth.

• U-M Injury Prevention Center Suicide Prevention Resources

• Vibrant Emotional Health’s Safe Space provides interactive coping tools to help users when they need it.

Crisis Care Telephone and Text Services:

• Crisis Text Line: Text “HOME” or “Start” to 741741 to reach a crisis counselor. This is a free, 24/7 confidential text message service for people in crisis.

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255) - Provides free and confidential emotional support to people in suicidal crisis or emotional distress 24/7.

• The TREVOR Project: Trevor Lifeline: 1-866-488-7386; Trevor Text: Text “START” to 678678

As the country and the world absorb the impact of the coronavirus (COVID-19), our interconnectedness has never been more clearly on display. SEL offers a powerful means to support one another – children and adults – during this challenging time. Now, more than ever, we understand how important it is to demonstrate empathy and resilience, build relationships across distance, and call upon our collective resolve to strengthen our schools and our communities. Below are links to SEL resources:

• Link to NASP crisis and mental health resources for schools
• NC DPI Social Emotional Learning Supports for COVID-19 and Beyond link to flyer
• Coronavirus Resources for Kids, Parents and Educators
• Resources for parents and educators during COVID-19 from the National Association of Gifted Children
• Trauma Informed SEL Tool Kit: Trauma-informed SEL is an approach to fostering youths’ social-emotional development with practices that support all students, but is particularly inclusive and responsive to the needs of children and youth who have experienced trauma. This approach calls for creating reliable learning environments where students who have experienced adversities and trauma.
• To help teacher, parents, learners and the global community deal with these challenging times and changing learning and working environments, UNESCO MGIEP has developed helpful resources in Social and Emotional (SEL).
• With mention of COVID-19 (commonly known as coronavirus) filling radio and television news, social media feeds, and our email inboxes, it’s no wonder we’re all anxious. Between the uncertainty, the real health risks, and the hype, fear and anxiety are feelings that are both valid and common. This website provides you with a few ideas for managing those feelings.
• Casel Cares is a new resource that connects the SEL community with experts to address how SEL can be most helpful in response to todays circumstances.
• Visit this Resource for teaching online during the school closures
• Emotional ABCs has a research based curriculum that empowers children with the tools they need for social and academic success. Free for a limited times for educators.
• Trauma-Informed Resilient Schools teaches school professionals how to create trauma-informed schools and classrooms. The training focuses on resilience, exploring the core values and beliefs of educators and places an emphasis on understanding how trauma impacts children and their school experience. Lastly, proactive strategies such as fostering connections, prioritizing social and emotional skills, establishing safety, and promoting play are presented. This course provides detailed information and concrete actions that answer not just the “why” but also the “how” to create the best classroom and school supports for traumatized students and the school professionals who serve them. This course covers the first 6 steps of the 10 Steps to Create a Trauma-Informed Resilient School (if you have taken the previous version of the course: Trauma-Informed Schools) LIMITED TIME ONLY! Use the coupon code TRAUMAINFORMED (all caps) at checkout to receive Trauma-Informed Resilient Schools free of charge. Please note that after you type in the coupon code, you must click the "Apply Changes" button to apply the coupon.
• Coronavirus resources for kids, parents and educators to care for your families stress
• Visit this website for resources on simple activities to bring calm and practice mindfulness
• Parent Resource from NASP
• Parent and Student wellness strategies and resources:

• Mindfulness Apps or websites

• https://www.gonoodle.com/

• https://www.smilingmind.com.au/

• Yoga/Mindfulness for students/children

• https://www.youtube.com/user/CosmicKidsYoga

• Children’s Institute knows that children’s social emotional health is greatly impacted by times of anxiety and the recent news about COVID-19. The resources linked discuss how to share information such as this with young children as well as other useful topics to help children and their families navigate through the current situation.

• There are many ways parents can encourage emotionally intelligent behavior in their children. Check out this guide to resources for learning more about character development.

• A Parent's Resource Guide to Social and Emotional Learning: A curated list of articles and videos for parents about fostering skills like kindness, empathy, resilience, perseverance, and focus in children.

• 5 tips for effectively working from home during the coronavirus outbreak, when you have kids

• 10 Tips to Work From Home in a Coronavirus-Plagued WorldI

• Coronavirus Resources for Kids, Parents and Educators

• SUPPORTING PARENTS WITH REMOTE LEARNING

• Resources to support parents from the North Carolina Department of Public Instruction

• Social & Emotional Learning Resources – Covid-19 Resources for Kids & Teens

• Free Covid-19 toolkit for supporting children and youth with ASD

• Supporting Your Gifted Child During COVID 19: As COVID-19 forces us to face new norms like social distancing, remote learning, and shelter-in place orders, gifted children may exhibit increased anxiety, sadness, intense feelings, and out-of-the ordinary behavior.

• Resources for parents and educators during COVID-19 from the National Association of Gifted Children

• General SEL resources that are free or free for a period of time

• Concerns about the spread of COVID-19 are growing. Here, we’ve compiled a list of resources you can use to help young people learn the social-emotional skills they need to get through these challenging events. Remote-Instruction Guidance for Second Step and SEL They understand you may not have access to your kit. Many of the recommendations in this PDF don’t require the physical Second Step kit, like art projects, Brain Builder activities, and sing-alongs. But, some do. We’ll continue to work to provide supports for all of our clients with and without kits.

• Guidance for keeping SEL at the forefront during the COVID-19 pandemic following the four core focus areas of CASEL’s guides for schoolwide SEL and districtwide SEL.

• TeachTown programs are designed to be used as effectively remotely in the home setting as they are in the classroom. All lesson plans are written in such a systematic way, and at an appropriate level, so that parents can easily use and understand them when working with their own children. All of TeachTown’s programs capture data automatically in any location. This will allow you to continue to document student progress even when the student is learning in a remote or home-based setting. Continuous, real-time student data on both usage and skills/concepts both in- progress and mastered is provided. TeachTown's programs keep the teacher in control of what the student is doing– even if being used remotely or in a distance-learning setting – never losing control of a student's course of study and work on IEP goals Our SLP Assist program provides remote access to speech and language therapy lessons – again all under the direction and prescribed treatment plan of your SLPs.

• The team at Inside SEL has put together an initial list of resources, blog posts and guides to help cope during this volatile and difficult time.

• To help teachers, parents, learners and the global community deal with these challenging times and changing learning and working environments, UNESCO MGIEP has developed a ready reckoner of helpful resources in Social and Emotional (SEL). You can scroll their webpage to explore SEL resources for educators, parents and learners.

• Emotional ABCs has a research based curriculum that empowers children with the tools they need for social and academic success. Free for a limited times for educators.

• Check out this free Social Emotional Learning Activities page. Below you will find free resources – lessons, activities, and printables – in the following skill areas: Communication, Cooperation, Emotion Regulation, Empathy, Impulse Control, and Social Initiation. These resources are age-appropriate for elementary and middle school students and are typically used in a classroom or a small group setting. And in most cases, if materials are required for the activity, they are items that you already have in your classroom or office.

• Tools to bring calm and chaos

Social-Emotional Ideas for Educators (Casel Cares Initiative: 5 Strategies for Teacher Self-Care)

• Trim your list: Identify your top 10 priorities and rank them
• Allow yourself time to stop. Look for times when you can relax your brain during the day
• Embrace vulnerability. Practice compassion toward yourself.
• Reach out to experts. Remember: you don’t have to have all the answers.
• “Pass your umbrella”. Reach out to colleagues when you need support to take care of yourself.

School districts are diligently working hard to make the most appropriate decisions and get guidance on expectations as we work through this uncharted territory. School districts crisis intervention and response teams should provide teachers and parents with a crisis referral protocol while students are participating in virtual or remote learning during school closures. We are aware that although students are not in school, distress and anxieties may still be present. As teachers are providing remote learning, concerns may arise and the support of how to link needed resources is a priority. Here are some examples of action steps that school districts will want to provide to their school staff for crisis intervention protocols:

• Develop a staff and parent protocol that details if a student exhibits any distress, anxiety, or somehow concern is presented through email/social media, or if a students’ parent/guardian reports a student is exhibiting concerning behaviors.
• During your virtual lessons, if a student exhibits any distress, anxiety, or somehow a concern is presented through email/social media, or if a student’s parent/guardian reports a student is exhibiting concerning behaviors conduct the following:

• If perceived as a minimal need, it may be possible to speak with the child to deescalate the situation first rather than automatically calling for a crisis responder. Notify your behavioral health problem solving team (specialized instructional support personnel) so that they may help you monitor this student.

• If the student is a student with exceptional needs, please make sure the students’ Exceptional Children’s case manager is also aware. Contact the student’s Exceptional Children’s teacher and inform the teacher of observations and reported behaviors.

• If you perceive that further attention is needed, or would prefer a second opinion call the school districts Behavioral Health Help Line that has been previously set up and notify your school administration. School districts should consider hours of operation and how to handle after hours crisis response and information for after hours response.

• Always make sure that families understand that there needs tobe consistent message around if a student makes a report after after hours that mobile crisis information and 9-1-1 or other 24/7 crisis assistance information is available depending on local resources. It is critical for school districts to understand the local and community resources available from mental health partners for this response.

It may be necessary for school districts to respond to a death, tragic loss, or other possible crisis event for a mass amount of students (i.e. accident occurs and a student passes away that friends are close with and crisis response is needed.) The virtual setting makes for a new challenge as school districts prepare crisis response and supports for students. While this is difficult for school districts, here are some action steps to considering when providing a coordinated crisis response for a crisis event such as a loss of an individual in the school community:

• Develop a behavioral health help line for students and families to call in.
• Specialized instructional support personnel will need to work together collaboratively to develop a list (in alignment with MTSS structures) of students to begin intervention with as soon as possible (identify students who are impacted and set up a systematic intervention call to these students and families.)
• Crisis responders will need create a crisis triage list and develop a way to monitor who has been provided support and also what follow up care is needed beyond the initial crisis intervention response.
• The crisis will verify the guardian’s name, the name of the student, address, and active phone number.
• At a minimum verbal permission will be obtained from parent guardian. If written is possible, this will be obtained. However, if not the crisis responder will take the information down and record it using the a crisis responder form developed by the school district ahead of time.
• If possible, a Webex will be conducted, Zoom Meeting, or other telecommunication method depending on what the student has and crisis response/intervention will take place.
• If further action is needed after completing the crisis responder has completed the crisis intervention/triage, they will connect them with community resources using the provider list or emergency services.
• The Crisis responder should also record action steps, safety plans, and resources provided on a school triage form to help document this information.
• The National Association of School Psychologists also provides a great resources around this topic.

Whenever initiating a virtual crisis intervention, crisis responders should appreciate that safety planning is essential. Whenever suicidal thinking is identified, a safety plan should be among the most immediate topics discussed. The apps My3, Virtual Hope Box, and A Friend Asks might be useful when developing such a plan. And just as would be the case in a brick and mortar school, should there be any risk for suicidal behavior, strive to maintain constant visual (or at least verbal) contact with the student until the appropriate 24/7 resources (e.g., primary caregivers) are activated. Other electronically available resources that can support suicide risk assessment include the Columbia Suicide Severity Rating Scale (C-SSRS; particularly the short form) and SAMHSA’s Suicide Safe Mobile App. A great resource for school districts to consider for safety planning is provided in this resource from the National Association of School Psychologists.

Among the first things school-employed mental health professionals should do as they consider service delivery via one or more of the telecommunication options is to acquire knowledge about this service delivery method. This information below was obtained from the National Association of School Psychologists. Please visit the National Association of School Psychologist-COVID-19 Resource Page.

Before initiating any form of telehealth, familiarity with state telehealth laws is important, and consultation with school district legal counsel is advised. At a minimum, when using telehealth it is important to obtain informed consent, and when doing so to notify students and their primary caregivers of the privacy risks of virtual service delivery. Always strive to make use of available privacy and encryption tools and ensure the highest degree of confidentiality possible (e.g., avoid the use of public internet connections). In addition, school-employed mental health professionals should strive to ensure that not only is their physical service delivery space private, but they should also know the physical location of the student and work to ensure that they have privacy as well. Encouraging the use of headphones with a microphone will give more privacy (and will also cut down on background noise). Especially when delivering high stakes services, such as suicide prevention activities, account for the possibility of telecommunication failure and have back-up communication options (e.g., if using Zoom and your internet connection becomes unstable, then have a cell phone and/or land line that could be called). This should include how to contact any primary caregivers that might be in the home.

Finally, whenever making these services available, schools must work to ensure equal access for all students. Specifically, school-employed mental health professionals must ensure that students with disabilities are able to access these services (see the U.S. Department of Education for more information). In addition, service providers must work to identify and account for youth on the opposite side of the “digital divide,” and use appropriate telecommunication options (e.g., telephones). An especially challenging group is homeless youth, and when meeting their needs collaboration with community mental health is essential.

NASP has provided a great deal of resources to help support the learning and well-being of students, their families and others in the school community during the COVID-19 crisis. While you can find these on the NASP Resource Site, we wanted to also link some of them here for you!

• Comprehensive School Suicide Prevention in Time Distance Learning
• Coping with COVID-19 Crisis: The Importance of Care for Caregiver Tips for Administrators and Crisis Teams
• Health Exception Disclosures
• Telehealth and FERPA
• FERPA and COVID-19
• Helping Children Cope with Changes Resulting from COVID-19
• Virtual Service Delivery in Response to COVID-19 Disruptions

Please make sure to visit the COVID-19 NASP Resource Center for great resources- click here for link. In summary, school district need to provide clear and detailed crisis response protocols during the school closure/pandemic. These protocols provide needed resources to students, families, and community. This information in this document is meant to help provide a framework to help districts develop their own protocol. For more resources, please visit the North Carolina School Psychology Association School Safety and Crisis Response Webpage or contact one of our team members.

Dr. Stephanie Lowe Ellis, Ed.D., NCSP; Chair of NCSPA School Safety and Crisis Response Committee; Executive Director of Behavioral Health, Crisis Intervention, and Student Safety in Rockingham County Schools

Liz Martin, NCSPA Past President

School Psychologist in Guilford County Schools

Amy Lowder; Committee Member

Director of School Wellness and Student Safety in Cabarrus County Schools

Lynn Makor; Committee Member

School Psychology Consultant Department of Public Instruction

Amy Ivey, NASP Delegate; Committee Member

Lead School Psychologist Wayne County Schools

Dr. Melissa Reeves, Committee Member

Associate Professor at Winthrop University

Past President of NASP

Co-Author of PREPaRE School Crisis Prevention and Intervention Curriculum

Dr. Jim Deni, Committee Member

School Psychologist Professor for School Psychology Graduate Program

Appalachian State University

Dr. Lori Unruh, Committee Member

Coordinator of School Psychology Graduate Program

Western Carolina University

Caron Nowell Parrish, NCSPA President, Committee Member

School Psychology Coordinator in Charlotte-Mecklenburg Schools

Fiona Debartolo, Committee Member

School Psychologist inCharlotte-Mecklenburg Schools

Corliss Thompson-Drew, Committee Member

Director of Psychological Services Winston-Salem/Forsyth County Schools

Meagan Bergeron, Committee Member

School Psychologist in Rockingham County Schools

*Please email slellis@rock.k12.nc.us if you have any questions for our committee!

Stephanie Lowe Ellis, Ed.D., NCSP

Chair of NCSPA School Safety and Crisis Response Committee

Please feel free to contact our members or our chair for questions! Please check us out on NCSPA Webpage at www.ncspaonline.com !!

Email: slellis@rock.k12.nc.us
Website: www.ncspaonline.com
Phone: 336-627-2705
Twitter: @NC_School_Psych