Referral and Consultation with Mental Health Agency

The social worker made an immediate referral to a local mental health agency to arrange a psychiatric evaluation and therapy and to provide Pedro’s father with consultation regarding parenting, as well as psychotherapy to address his own depression. With Mr. Lopez’s written permission, the social worker served as the liaison between the school and the mental health agency, updating the therapist on Pedro’s progress at school and providing feedback regarding the effectiveness of the medication that was prescribed. The therapist and psychiatrist remained baffled for a time regarding Pedro’s diagnosis and treatment. They proceeded with the working diagnostic hypothesis of ADHD complicated by PTSD. After several months of treatment with minimal progress, Mr. Lopez brought Pedro to the county medical center, where he had a pediatric neurodevelopment evaluation. It was there that Pedro was diagnosed with autism. This diagnosis was initially difficult for Mr. Lopez to accept, although it was a relief to arrive at a diagnosis that seemed to explain this boy’s behavior. Although Pedro had certainly endured multiple traumas, the key to this diagnosis was a careful review of the boy’s early development (notably behavior problems and truncated speech development) prior to his mother’s death. Classroom Behavior In collaboration with the school psychologist and classroom teacher, a behavior intervention and supports plan (BIP) was designed and implemented in the classroom, whereby Pedro was rewarded for compliant behavior. Given his limited attention span and tolerance for frustration, Pedro initially received reinforcement for very brief intervals of compliance. After 2 weeks of slight behavior improvement, the intervals were gradually lengthened. Pedro was rewarded with either tangibles (a sticker or pretzels) or a favored activity, such as coloring. A time-out procedure was also implemented, minimizing the disruptive impact of Pedro’s behavior on the rest of the class. These interventions were followed and monitored for 3 months with an evaluation at the end of each week indicating either some, little, or no progress. Data Collection Unfortunately, records from Pedro’s previous school in Ecuador were not available. Mr. Lopez did, however, give written permission to obtain psychological and speech records from Florida, where Pedro had been evaluated just prior to his mother’s death. These proved to be very telling. When Pedro was about 4 years old, his parents sought the help of a psychologist out of concern about his unmanageable behavior. At that time he would have frequent tantrums and mood swings. Although Pedro’s speech and language development was normal when he was a toddler, he suddenly stopped speaking at about 3 years of age and began pointing to what he wanted. Just as Pedro had begun treatment, his mother died, and he moved to Ecuador with his father. This report was helpful in that it revealed that there were significant issues with Pedro even prior to his mother’s death. Referral to the IEP Committee After interventions were implemented and Pedro’s progress was reported as minimal, a referral was made to the IEP team. The committee met to determine whether there was sufficient evidence to warrant a full individual evaluation. All IEP team members discussed Pedro’s educational, medical, social, and communication problems and decided an evaluation for eligibility for special education services was appropriate. This involved a thorough evaluation of Pedro’s cognitive ability, academic skills, communication functioning, social competence, physical and medical needs, and speech–language functioning and a social history. Once the IEP team met to review evaluation data and determine eligibility, they decided that Pedro would benefit from a one-to-one aide to monitor the BIP (behavior intervention plan), and he began to receive special education instruction that was tailored to his level of academic and social functioning. He also began speech–language therapy. In addition to services for Pedro, it was clear that Mr. Lopez would need a tremendous amount of support and guidance. It was decided to schedule monthly team meetings with Mr. Lopez, the special education teacher, and the social worker so that there could be a mutual exchange of information about Pedro’s school and home functioning.
The social worker provided Mr. Lopez with educational materials and information about autism, as well as resources for parent support networks. One of these resources was another parent in the school district who had a child with autism. This parent was a dynamic advocate for her own child within the school system and was very knowledgeable about community resources. She made herself available to other parents who needed information and support. (A helpful reference for parents of autistic children is Ozonoff, Dawson, & McPartland, 2002; a book on the topic for children is Russell Is Extra Special [Amenta, 1992].) Child Care Mr. Lopez’s mother was Pedro’s after-school caretaker. She was easily overwhelmed by her grandson’s behavior and tended to give in to him rather than establish boundaries and limits. The decision was made for the social worker to arrange after-school child care at a local day care center. The social worker discussed Pedro’s special needs with the director of the day care center, thereby helping to pave the way for a child such as Pedro. Financial Assistance Mr. Lopez’s financial situation was often strained. The social worker apprised him of Pedro’s probable eligibility for Social Security Disability Insurance based on his special needs (he was born in the United States, which automatically made him a U.S. citizen). This additional source of revenue was a help to the family. Often school personnel will assist a parent with the completion of these applications, because they are often daunting to parents, especially those who are not fluent in English. Camp and Respite Services The social worker researched and provided to Mr. Lopez information regarding recreational and respite programs that catered to children with special needs. These would provide a much-needed occasional break for Mr. Lopez and his mother and provide Pedro with additional opportunities for social stimulation and fun. Summary Over the course of 2 years, adjustments were made to Pedro’s medication and his IEP, and to his BIP and academic program. Pedro made slow but steady progress academically, socially, and behaviorally. A sustained coordinated effort by the school (and the various school professionals within the school), the home, and outside agencies was necessary to ensure Pedro’s growth. The school social worker was instrumental in establishing and sustaining these linkages. The prevalence of autism has increased in the last decade to a rate as high as 1 in 250 children (Calohan & Peeler, 2007). The Centers for Disease Control and Prevention (2018) in their biennial update reports a prevalence rate for autism spectrum disorder as 1 in 59 children (1 in 37 boys and 1 in 151 girls). This represents an increase in prevalence of 15% from the previous report. Two treatments have been found to be effective: applied behavior analysis and medication (Ballan & Hoban, 2006; Bullock, 2009; Calohan & Peeler, 2007). Pedro benefited from both. In applied behavioral analysis, skills are broken down into small steps and may include simple tasks such as making eye contact, as well as appropriate forms of social interactions. “Each step is initially taught using a specific range from physical guidance to verbal cues to very discrete gestures” (Ballan & Hoban, 2006, p. 152). Most researchers emphasize that the earlier treatment begins, the better, and that parents and other significant people in the child’s life should be trained to follow similar procedures as those implemented by the school and/or mental health specialist. Although this chapter cannot cover all the interesting and complex details about autism and its variations (autism spectrum disorder), because children with this disability are present with increasing frequency in schools, it is incumbent upon school social workers to be familiar with the types of treatments that can be most helpful. The issue of providing appropriate schooling for immigrant and refugee children has become quite significant, as families and children have fled from dangerous violence in their homelands. Chapter 16 deals with this topic in detail. Although this chapter has focused on the various challenges of the school social worker in elementary school settings, we must acknowledge that social workers also play an important role in middle school settings and in high schools. Concerns about bullying and the rising rates of suicides in middle schools attest to the compelling need to have knowledgeable social workers available to children and staff who must respond to these alarming situations. Chapter 15 focuses on the topic of bullying and also the related concerns about the impact of social media on the escalation of suicides among middle school children.
CONCLUDING COMMENTS The complex role of the school social worker demands great versatility, the ability to think on one’s feet, and awareness of the reciprocity of multiple interacting systems. Liking children and wanting to advocate for their best interests in the school are only the beginning of the job qualifications of a school social worker. In addition, as illustrated in this chapter, the school social worker must understand and be able to communicate and collaborate with parents, as well as with the various professionals who also participate in and contribute to the child’s educational experience. The whole range of social work knowledge and skills is epitomized in the role of the school social worker, whose regular activities in the course of a week may include such diverse responsibilities as obtaining data and writing a social history, attending and participating in an IEP team meeting, identifying and reporting sexual and/or physical abuse, counseling children on an individual or group basis, conferring with teachers about specific children, working with outside agencies and making referrals, conducting parent group meetings, and consulting with the building administrator about special programs in response to parent concerns about community violence. This demanding role includes the satisfaction of being a child advocate in a manner that seeks to help not only the individual child but also an entire school community of children.