Ten years ago, I was in my office at school when a student came in, threw herself in the chair and stated emphatically, “Life really sucks, and I hate all my teachers.” She then burst into tears with such force that she began to hiccup uncontrollably. I immediately sat across from her, handed her tissues and quietly began instructing her to breathe. After she calmed down, it became clear that she was very depressed. She was abusing drugs and failing four courses. For the next 45 minutes, one thought kept creeping into my mind: To whom am I going to refer this student? Who has experience and expertise in working with adolescents who are depressed and abusing drugs?

After the student left my office, I did what most of us do – I called my colleagues to see what resources they might suggest. The consensus was that our school’s list of community mental health resources and referrals was sorely lacking. True, our list contained the names of approximately 10 excellent clinicians. However, as the need for mental health counseling grows, so does the need for additional resources. My colleagues and I decided to look at how we had connected with community mental health counselors and how we could expand this endeavor. What follows is the evolution of a 10-year program that implemented many of the suggestions noted in Jim Paterson’s August 2009 Counseling Today article, “Filling the gap.”

Getting started

Setting up an effective program that enhances a school’s collaboration with community mental health agencies takes some time, thought and planning, but don’t get overwhelmed. Instead, start small and evolve. Begin with the referral list your school already has in place. Set a meeting date and send invitation letters to the community agencies with which you already work, informing them you are interested in meeting in a roundtable format to discuss opportunities for increasing contact between community mental health workers and school counselors. Let them know you are updating a referral list of community providers, are interested in finding appropriate referrals for students in need of additional services and would like to get a better sense of the specialty areas and interests of community therapists.

In this initial meeting, the focus is on gaining information about the therapist’s special areas of interest, gauging rapport and comfort level, and beginning to assess an appropriate match between the outside therapist and the student in need of services. In a global sense, the meeting is designed to determine the therapist’s basic approach to working with students and schools. Questions to consider as you evaluate potential partners include:

• What is the therapist’s basic interpersonal skill level?
• What is your assessment of the therapist’s ability to connect with children?
• What age level do you see the therapist interacting with successfully?
• What is the therapist’s experience level and area of expertise?
• Does the therapist profess a desire to work with the child’s family?
• How willing is the therapist to collaborate with the school, and what role does she or he see the school taking?
• Do you sense an appreciation of the importance of the role of the school and the school counselor in this child’s treatment?

Second phase

On the basis of the original meeting, develop a spreadsheet. Include all the clinicians, noting their contact information and specialty. Set a date around the anniversary of the first meeting, and send out postcards inviting the clinicians back. As you prepare for the second meeting, develop several case scenarios that you can present to the invited therapists. These scenarios, which can be loosely based on cases that have challenged you during the past few years, will give you the opportunity to further observe the therapists’ interpersonal styles and to assess in more detail their ability to work collaboratively with you.

At this meeting, review the prior meeting and highlight the occasions when you had an opportunity to work with outpatient therapists during the past year. Tell them you would like to share several challenging trends that students are facing. Then give the therapists a case scenario, and ask them how they would respond if the school referred this case to them. For example, one case might involve an 8-year-old boy diagnosed with attention-deficit/hyperactivity disorder who is acting out and being disruptive in class. The kinds of responses you are listening for from the therapist might include, “I want to come in and observe the child when he’s in class”; “I’d like to gather information from the teachers and school personnel”; “I’d want to talk to you about what kinds of things have been tried by you and by the teacher to address his behavior”; and “Would it be possible to set up a meeting with you, the teacher and his parents so we can collaborate on a plan that can be put into place in the school?”
In addition to listening for evidence that the therapist recognizes the importance of collaborating with the school, also evaluate the following:

• Does the therapist have the ability to think in broader, systemic terms?
• Does she or he recognize the connected interplay of school and the family in the child’s life?
• Does the therapist think in developmental terms?
• Does she or he offer age-appropriate interventions and activities for a child?
• Does she or he possess the skills to use play therapy with younger children?
• Does the therapist give evidence that her or his approach can be adapted according to the child and the child’s family?
• Is the therapist’s approach interculturally aware?

Meeting, greeting 
and cruise directing

In the third year, you can consolidate the knowledge you have gained to this point. It is likely you have already begun to make referrals to new outpatient clinicians; now you can formalize your referrals by compiling a complete database of the resources you have identified. Assemble a spreadsheet to share with all the counselors in your school. Record the clinicians’ names, their contact information, their professional background, their strengths and specialties, their theoretical orientation and clinical passions, and any collaborative successes that have been achieved. The annual meeting can take the format of a general meet and greet, followed by a discussion period in which you may solicit opinions on emerging issues and topics. For example, in recent years, our school had noticed a seeming increase in cutting and self-harming behaviors, so a forum was held on whether these behaviors had become more “mainstream” and what clinical implications might be drawn.

At this point in the development of your school’s program, consider yourself the “cruise director.” It is your job to facilitate contacts between school counselors and outpatient clinicians. You may wish to introduce counselor X to clinician Y, highlighting their shared interest and expertise in attachment disorder, their shared passion for object relations theory or their shared histories as nurses or educators. Your goal is to facilitate those invaluable contacts that make counseling so much more personally rewarding and professionally enhancing.

Ongoing collaboration: 
Variations on a theme

Practically speaking, the meetings will vary around emerging themes — shifting demographics, issues of culture and ethnicity and acculturation, the waxing and waning of religious and civic affiliations — that mirror the ongoing plasticity of American society. It is relatively safe to assume that the changing health care landscape will continue to bring insurance issues to the fore, and it is unlikely that mundane but vital issues such as which clinician accepts which insurance will soon be resolved.

To deal with these ongoing themes, collaboration is essential, and the secret to keeping this type of collaborative project going is synergy. Collaborate with other school counselors and other schools. Invite them to annual meetings. One of the most surprising and gratifying outcomes of the program can be the synergistic effect of having multiple schools and multiple agencies at the same table, sharing their resources and passion for change. It is possible at this point that other schools or agencies might want to host the annual meeting. In this instance, consider a round-robin format that alternates meeting sites.

Rather than experiencing a fragmented, harried sense of helplessness, school counselors can be treated to the strengthening nature of collaboration, wherein one’s central mission — to foster student development and success — can be reaffirmed in the presence of other helping professionals.

Both Helen Hamlet, a certified school counselor and certified school psychologist, and Fred Redekop, a licensed professional counselor, teach in the Department of Counseling and Human Services at Kutztown University of Pennsylvania.  They can be contacted at hamlet@kutztown.edu and redekop@kutztown.edu, respectively.
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