​School-based mental health allows students to receive mental health services from a licensed clinical counselor right in the building during school hours.
​By offering those services through telehealth the counselor and student meet through a video and audio connection. Counseling sessions are more readily available— avoiding long wait times for initial appointments, students miss fewer hours from school, and securing services is easier for parents. The school's role changes from being a "base" to being one of "support"-no longer school-based mental health, but school supported mental health. 

How to set up telemental health at your school

The following provides a short "how-to" of the steps in setting up telehealth in a school district.  These steps use a behavioral health provider where services are delivered through Zipnosis, an information and communication technology (think upgraded Zoom for healthcare).

STEP ONE- Contact a mental health provider 
  1. The district signs a MOU with a mental health services provider.
  2. The district will need to go through steps to become a branch of that provider.
    Steps in becoming a branch:
    ​a.     Room setup to comply with State directives (see Site Setup)
    b. HIPAA training for involved staff (coordinator, navigator, others who may have contact with clients or paperwork); training is about one hour and can be done virtually. This is valuable training for any staff member working with behavioral health concerns in your district.
    c. On-site state certification. Certification conducted by the State and set up by the provider.
  3. The district and the mental health provider will set general guidelines for students to be served-- example, grades 4-12; times and dates most available. 

STEP TWO- Site Setup
  1. Identify key roles in the District:
    a.     Coordinator- this is the contact person with the provider in the set up and continuation of the program. The coordinator may be notified of counseling sessions conducted on school grounds.
    b. Navigator- responsible for forms; assists parents with paperwork. Navigator will be notified of counseling sessions conducted on school grounds and be available during sessions.
  2. Select a location that is near an adult staff member, preferably the coordinator or navigator. This provides an opportunity for the adult to assess the student's ability to return to class; the student may need a few minutes to “regroup” before joining their regular routine.
  3. Confidentiality is vital. When the room is in use, no one should be able to hear anything from the room or walk in or see into the room. Consider keying the door locked from the outside when in use, allowing the student to leave but no one to enter.
  4. Posted in the room: “Clinic Certification,” and “Client Right,” both will be supplied by the provider.​

STEP THREE- Room Setup
  1. Technology needed: laptop, Chromebook, tablet, or phone. Suggest having the student use their own device so they become comfortable with how to access the session with their device. 
  2. Create an inviting space. Consider a comfortable chair, rug, and lamp.
  3. Have available for student use: tissues, water, individual journal (one generally given to each client/student) stress/fidget toys. 

STEP FOUR- Referral & Appointment Process
Staff members can identify and respond to student mental health concerns; the actual referral for services must come from the parent or guardian. The parent or guardian is responsible for payment of services to the provider.
  1. All intake paperwork is supplied by the behavioral health provider. Make individual packets with all needed forms and a letter explaining the process available from the principal, school counselor, and navigator. (Consider using large brown envelopes with no writing other than the student name on the outside). The navigator should track who is issued a packet, and when the packet is returned.
  2. At the request of the parent or student, an intake packet is sent home with the student or mailed home to the parent.
  3. The navigator follows up with the parent to answer questions about completing the forms. This also provides an opportunity to answer questions about the process.
  4. When the packet is returned to school, the navigator reviews documents to make sure all have been signed.  All forms are faxed to a specific staff member of the provider. It is best to work with one designated provider staff member. The original copy of the forms is saved for 30 days. 
  5. The provider staff member (not the school) makes contact with the parent to set up the initial intake session that includes a parent or guardian and the student.  A message is sent to the school, to the coordinator or navigator, of the session date and time. Follow up sessions will be scheduled by the parent using the Zipnosis, and the school will be notified of future sessions. 

STEP FIVE- The Counseling Session
  1. Based on your building, use a system for sending the student to the counseling room that is as confidential as possible. You will know how best how to communicate with teachers when a student will be leaving their class for a counseling session. Confidentiality is vital. 
  2. For the initial session, a parent or guardian will attend with the student.  Provide the parent and student with the copy of intake paperwork so they can refer to their responses when meeting with the counselor (this was part of the initial paperwork; parents find it helpful to refresh their memory if they have it in front of them). 
  3. The navigator or coordinator will make sure the student is comfortable and review with the student what to do if there is a technical problem or the student needs help.  The navigator makes sure connection has been made with the counselor, then leaves the room, locking the door. The navigator or coordinator must stay within help-range for the duration of the session. 
  4. At the end of the session, the coordinator or navigator will do a short visual and verbal check to see if the student feels comfortable returning to class. Depending on the session or time of day, a student may wish to stay until the end of the period or hour. 
  5. Generally a survey from the provider is completed by the student following the first and sixth session.  Survey questions relate to the telehealth format and not the counselor or counseling sessions. 
If a provider does not use technology such as Zipnosis--

Then a designated WebEx, Zoom, or BlueJeans account can be used for session transmission. This account can be created by the school or provider.  It is important that it is a secure transmission and designated for only telehealth transmissions. ​ Appointments will be created in WebEx and shared with the school and the mental health counselor; depending on the arrangement with the provider, the appointments created in WebEx will be made by the school or provider staff. 

FAQs

Why partner with a health care provider? 
Partnering with a provider offers your families use of insurance and Medicaid coverage that can be limited when working with individual private counselors. 

How long does it take to set up this program?
Plan on a couple months for the provider to set up your site in the system, your site to be inspected, and your staff to view the HIPAA training. 

How do students respond to telehealth?
Students are very comfortable in front of a screen, and this has applied to receiving counseling in this format as well.  They haven't had any reservations or complaints. 
Picture
Shows room set up with large monitor; any device-- laptop, Chromebook, tablet or phone can now be used by the student.

​Tips on making it work...

Supportive efforts to ensure the program works for students, families, and the district is as important as the laptop and internet connection. 
​
Staff

  • Provide Youth Mental Health First Aid training for staff to increase their awareness and ability to respond.
  • Provide a tour of the counseling room and give information about the process of receiving counseling through telehealth.
  • Provide a process for staff to identify and respond to student mental health concerns (often called “referral process;” consider relabeling it “identify and respond” so as not to be confused with language used by behavioral health).
  • Instruct staff on confidentiality requirements around HIPAA as they are different from confidentiality requirements expected of educators.

Families and Community
  • Provide Youth Mental Health First Aid training for parents and community to increase their awareness and ability to respond. 
  • Create a parent/community group to provide input during the planning process. Include parents with previous experience arranging counseling for their child. Also include an area health professional, such as a doctor or physician assistant, who is familiar with local mental health concerns.  
  • Inform all families in the district about the telehealth service. Consider mailing a brochure and having information at open house or parent teacher conferences. 
  • Provide brochures to local health facilities. 

Students
  • Provide mental health education to students. This can be through health classes and specific programs aimed at educating peers about depression and suicide.
  • Create conversations, postings, and information that normalize getting help. 
  • Provide a reporting system for students if they have concerns about a peer's well being. Inform students in how to help.  
  • Inform students about the telehealth services. This can be done through tours, open house, info cards, and posters. 

District
  • Continue to support practices that break down the stigma around getting help for mental health concerns. 
  • Publish information about the program on the school website and social media. 
  • Prioritize mental health training when scheduling professional development. 
  • Review attendance, grading and  disciplinary policies that might penalize students struggling with mental health concerns.

Brochure 

A brochure is helpful in getting out information about the service. 
Brochure sample.

​Lake Holcombe School District received a 2019-20 School-based Mental Health grant and the funds were used to establish
​school-based mental health services through telehealth.  ​Prevea Health and CESA 10 worked in setting up the delivery of services.