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Evaluating the Educational Needs of Children with Mental Health Conditions

  When Might an Educational Evaluation Be Necessary?
  Why Have a Pre-Referral Meeting?
  What Is an Initial Educational Evaluation?
  How Does an Initial Educational Evaluation Get Underway?
  How Do Clinicians Participate in the Educational Evaluation Process?
  What Happens at the Team Meeting?
  What are the Follow-up Procedures?
  Important Points for Families
  Important Points for School Staff
  Important Points for Clinicians

When Might an Educational Evaluation Be Necessary?

For a number of reasons, students with mental health conditions are more likely than their peers to encounter academic, social, or emotional problems at school. Mental health conditions that affect mood, thinking, interactions with peers, and physical and emotional arousal levels may also interfere with a student’s ability to focus on learning. A range of other factors can interfere with learning and behavior as well, including co-existing vulnerabilities (such as hypersensitivity to noise), learning disabilities, stresses in the student’s life, or side effects from medications.

In some cases teachers can fairly easily help a student who is struggling in class, by changing seating assignments, providing pointers on effective study skills, offering alternative ways to carry out projects, or using a variety of instructional approaches to engage the many types of learners in the classroom. Strategies such as these are outlined by each school district in a document known as a District Service Plan (DSP) or District Curriculum Accommodation Plan (DCAP). Teachers are encouraged to try these approaches for any student and to consult designated specialists within the district who may be able to offer assistance. No formal process is required, nor does a student need to have a specific disability to “qualify” for these accommodations.

If a classroom teacher finds effective ways to help a student, it may not be necessary to investigate further. However, if a student experiences significant academic, social, or emotional difficulties that interfere with learning and that the classroom teacher has not been able to resolve, it is usually a good idea (although not required) for the family and school to meet for preliminary (“pre-referral”) discussions. This meeting may be the first step toward an educational evaluation, which entails a carefully defined process for schools, parents, and clinicians to work together to identify and address students’ educational needs. top

Why Have a Pre-Referral Meeting?

Before any official evaluation begins, either the family or the school can initiate a pre-referral meeting to share observations and ideas.

A pre-referral meeting offers a number of possible benefits:

  • It is important for the family to understand what the school is observing about the child’s difficulties in school. Likewise, it is important for the school to understand what the family is observing at home and to hear how, or if, the student describes these difficulties to family members. A shared understanding of the child’s overall situation helps frame the issues to be looked at during the educational evaluation process.
  • Because teachers work with many students, they may have encountered and successfully handled similar problems before. They can be helpful allies in managing a student’s difficulties, and may be able to provide some simple, rapid interventions that make an immediate difference for the student.
  • Parents can be helpful allies to teachers by recommending strategies and approaches that are effective at home and that may also prove helpful in the classroom.
  • The early establishment of effective communication and mutual understanding between the family and the school serves the long-term best interests of the student, the family, and the school. If the student does have a disability, the family and school may need to work together over many years.
  • After an evaluation is performed, meetings involve many participants and analysis of complex data. However, pre-referral meetings often have a less formal and less technical quality, involving fewer people than meetings that occur later in the process. The more relaxed atmosphere of a pre-referral meeting may be more conducive to building trust and a collaborative relationship between family and school.

If the student’s challenges continue to interfere with learning after the parents and school have met, an Initial Educational Evaluation to determine eligibility for special education is recommended. Schools cannot deliver special education services without first going through this formal assessment, which requires schools to apprise and involve the family. top

What Is an Initial Educational Evaluation?

An Initial Educational Evaluation provides comprehensive data (from standardized testing, observation and teacher input) to help pinpoint what the student’s problem areas are and identify ways to help the student. An Initial Educational Evaluation may (but does not necessarily need to) include any of the following components:
  • Report of classroom functioning (usually by the student’s teacher)
  • Classroom observations by other teachers or special education staff
  • Evaluations by specific school service providers, such as speech therapists, occupational therapists, and/or reading specialists
  • Academic (also called “achievement”) testing usually done by a special educator or school psychologist
  • Psychological testing
  • Medical evaluations (providing diagnoses and/or treatment recommendations)
  • Student interviews and/or home visits/developmental history by school social worker or mental health staff

Depending on the number and type of tests required, the student’s tolerance for testing, and schedules of the specialists involved, an Initial Educational Evaluation may take several months to complete. (This may complicate efforts to meet stipulated timetables for the evaluation process.) The results are written up in reports that are discussed in a team meeting by the student’s family, school staff (educators, special educators, school psychologists or social workers), and other participants invited by the family. The tests need to be repeated at least once every three years in order to determine a student’s current performance. top

How Does an Initial Educational Evaluation Get Underway?

The steps required for an educational evaluation are set out in federal and state laws and regulations. Federal law establishes the right of all students, including those with disabilities, to receive a free and appropriate public education (FAPE). It places the responsibility on the states for identifying all children with disabilities who would qualify for special education services. The process is designed to encourage families, schools, and clinicians to work together on behalf of the student while protecting the interests of all parties.

After clarification of any efforts already made by the school, any parent, teacher, or other school professional who is concerned about a student’s performance in school can formally request an Initial Educational Evaluation for special education eligibility.

Before proceeding with the evaluation, many school districts require a letter documenting the request for an educational evaluation. The letter should be brief, should include the date and the sender’s contact information, and should convey a collaborative tone. It may include brief mention of areas of concern.

A sample request letter is provided below:


Dear [name of Principal or Special Education Director]:  

I am writing to request an Initial Educational Evaluation to determine whether [name of student, date of birth], who attends [name of school, grade level] has a disability, and to determine whether educational interventions or special education services may be appropriate. I am concerned in particular about [student’s skills in a particular subject or student’s behavior in certain settings]. Please let me know how I can best support the educational evaluation process. I would be happy to provide any relevant information to help the school complete this evaluation.  

Please call me at [phone number] to respond to this request, and forward to me at [address] any documents I need to sign to help the school begin this process.  

Thank you in advance for your attention.


[name of family member, clinician, or concerned other]

To ensure a timely response, it is a good idea to follow up (by phone or in person) in approximately a week to 10 days to clarify the status of the request.

Since school staff (or other clinicians hired by the school) will be performing the assessment and delivering any needed interventions, the school recommends which specific areas of the student’s functioning need to be examined. Parents may suggest particular skill areas for testing and have the right to accept the school’s recommendations, request additional testing, or reject the proposal for recommended testing.

Once the request for evaluation is received, a school district has 10 school days to begin the evaluation process. No evaluations can be performed without the written permission of a parent or guardian. Even if the evaluation request was made in writing by a parent, a consent form for the evaluation must be signed by a parent or guardian before any testing can be done as part of this evaluation. top

How Do Clinicians Participate in the Educational Evaluation Process?

In preparation for a team meeting, and often as part of the educational evaluation, clinicians may provide a letter to the school outlining:
  • The student’s diagnosis, based on recognized diagnostic criteria such as the DSM. It is preferable to omit mention of suspected or rule-out diagnoses, because including them makes school disability determinations more difficult.
  • The primary symptoms supporting the diagnosis
  • How the illness interferes with the student’s educational progress (including social-emotional development)
  • Recommended educational interventions, special services (such as occupational therapy, speech therapy, etc.), or specialized instruction (such as specialized reading instruction for students with dyslexia, or check-ins with therapeutic staff for students whose anxiety interferes with educational progress). Recommendations for specific alternative schools or placements are usually not helpful)
  • Side effects from current medications that may interfere with the student’s normal functioning in school   top

What Happens at the Team Meeting?

Within 45 school days of the request for an evaluation, the student’s evaluating team should meet to review the Initial Educational Evaluation assessment reports and outline next steps. The team includes school staff, the family, and anyone invited by the family to accompany them. Because the process can be confusing and overwhelming to family members, many families find it useful to invite a trusted clinician, family member, or friend to join the team meeting. All of the attendees can participate in decisions about the student’s education.

The team will make one of the following recommendations.

  • The student does not have a disability that would require special education or educational interventions.
  • The student has a learning style that requires some educational interventions to allow the student to succeed with the school’s curriculum. In such cases, the school may draw upon strategies and expertise outlined in its District Service Plan (DSP), or District Curriculum Accommodation Plan (DCAP), which is designed to accommodate diverse learning styles within the regular classroom.
  • The student has a disability or handicapping condition that requires specific interventions or accommodations that will provide the student with the same access to the curriculum as non-disabled students. Accommodations often address physiological challenges (such as vision or hearing deficits, the need for a wheelchair, etc.) that can interfere with participation in all the opportunities for learning offered to other students. The Americans with Disabilities Act (ADA) protects students with disabilities against discrimination. A set of accommodations known as a 504 Plan (because it is derived from Section 504 of ADA) is drawn up by the team to document the specific accommodations.
  • The student has a disability and is not making effective progress in school, and requires specialized instruction or related services from specially trained staff (such as speech therapists, occupational therapists, special education teachers, specialized reading teachers, or counselors). In such cases, the school develops, with the family, an IEP or Individualized Educational Program. Students who need specialized instruction are protected by the Individuals with Disabilities Education Act (IDEA), which stipulates the process for developing the IEP. The IEP should include goals and objectives for the student, to be achieved through the use of specified accommodations and modifications (interventions that either alter the ordinary curriculum expectations, or require specialized instruction).

If the student is found eligible for accommodations or special education services, the team will write an official plan that documents the student’s needs and how the school will support them. In complex situations that require many school-related services, a subsequent meeting may be scheduled to develop or finalize the student’s IEP. Once a plan is signed by the parent or guardian, it can be implemented by the school. top

What are the Follow-up Procedures?

If parents do not agree with the team’s findings, they can request an Independent Educational Assessment, an evaluation performed by personnel outside of the school system. They can request that it be done at the school system’s expense, although conditions may apply.

Parents may ask the evaluation team to reconvene at any time to discuss their child’s progress. Students with IEPs receive IEP progress reports at the same frequency that report cards are received by all students. In most cases, this occurs approximately every 3 months (quarterly). IEPs are rewritten on an annual basis (called Annual Reviews) and re-evaluated (with new testing in the area of disability) every three years. Typically, schools will assess the effectiveness of Section 504 plans yearly. top

Important Points for Families

Many parents may feel intense pressure to “do whatever it takes” to overcome any perceived obstacles to success in school. It may feel particularly stressful if your child has shared with you any unhappiness about some aspect of school, leading you to feel that satisfactory resolution of any problems in the classroom is essential to your child’s well-being.

Discussing your child’s social, emotional, and learning problems with a group of people is not easy for most parents, no matter how supportive the other participants in the group may be. You may also feel uncomfortable with the specialized vocabulary, procedures, and regulations that surround the process of getting a plan in place for your child.

While it is important to resolve specific challenges facing your child, the establishment of strong and trusting relationships with the people working with your child is critical. It is likely that your child will derive more benefit over the long term if you work toward fostering a positive relationship with the school. There are some things you can do to foster long-term, collaborative alliances with the staff with your child’s school.

  •  Try to keep an open mind when approaching teachers. If your child has told you about a troubling incident, try to reserve judgment until you hear what the teacher says about what happened and how it was handled. You may learn information from teachers that significantly changes your perception of the situation.
  • Try to find something positive you can share during the discussion, such as feedback about a successful school intervention or a positive comment from your child about a project that was fun.
  • Try not to criticize teachers and other school personnel when talking with your child. As much as possible, try to offer support to your child without undermining the adults your child spends time with every day at school. It is likely that after differences between your child and any teachers are resolved, you will want all parties to move on with a positive attitude.
  • Become involved in the school community via committees, volunteering for special events, etc. as a way to get to know school staff in a more personal way--as individuals rather than officials or potential adversaries.
  • Be punctual to any school meetings so that you show respect for teachers’ schedules. Schools run on very precise schedules because students need to be supervised at all times.
  • Bring a spouse or trusted friend with you to a school meeting for companionship and comfort, whether or not he or she actively participates. Just knowing you have someone at your side who supports you can help “ground” you and increase the chances you can be composed and at your best.
  • Don’t assume that pre-referral efforts are a “stalling” strategy. A pre-referral plan is not an effort for schools to avoid doing appropriate educational evaluations; its purpose is to allow schools to respond rapidly with reasonable educational interventions that can be implemented right away.
  • If the Initial Educational Evaluation leads to recommendations for accommodations derived from a school’s District Service Plan or District Curriculum Accommodation Plan, don’t assume such interventions are inferior to individualized plans. If the formal assessment does not find the student has a disability, a 504 Plan or an IEP cannot be developed. However, even without a formal individualized plan to accommodate a specific disability, teachers can in fact make many useful accommodations within a regular classroom.
  • Don’t assume that a 504 Plan is inferior to (“a runner up prize” for) an IEP. Schools are required to provide a basic floor of educational opportunity for each student in the “least restrictive environment” for a student. A 504 plan may be the most appropriate way to meet one child’s needs, whereas another child might benefit more from an IEP.
  • Consider allowing the school to start with interventions that have been successfully implemented by school staff in other cases. Familiarity with the interventions will help the staff to implement them successfully, and accurately measure their impact. If a child’s disability is new to the school, the staff will need to be educated to understand the disability and to successfully implement appropriate interventions, provide at least one copy of concise materials that explain the nature of the disability.
  • Don’t measure your success in team meetings by the number of services or interventions you obtain from the school. A few services or interventions effectively implemented may benefit the student more than many interventions poorly implemented.
  • Consider notifying and meeting individually with the Special Education Director if you do not feel the team process is working effectively. This step may expedite the process.
  • Consider hiring a professional, such as an educational consultant or an advocate, if you feel the educational evaluation process and its complex rules and procedures are too overwhelming, or if meeting with the Special Education Director is not productive. Another reason to bring in professional assistance from outside the school system is that if there is disagreement with the school, that professional will take the lead in presenting your position—leaving you with a less adversarial role.
  • Once you have reached agreement on a plan, don’t hold up required paperwork. Families sometimes fear signing an IEP or any other school documents, believing that the unsigned document provides them additional leverage. An IEP, 504 Plan, or other educational plan can be amended at any time at the request of the family (or the school).

Despite a family’s best efforts to work with the school, sometimes a child does not benefit from the services provided by the school. Families are not required to “settle” for whatever the school decides is appropriate. If a family disagrees with the findings of the educational team, or if a child does not progress, a family may request an independent evaluation, or contact the State Department of Education to identify legal options. Schools are required to provide families with documentation that explains parental rights. top

Important Points for School Staff

Families whose children are struggling with mental health issues are profoundly affected by their children’s troubles and may want schools to do whatever might possibly help their children. Parents are commonly coping not only with the child’s problems at school, but with the impact of the child’s behavior on siblings and family relationships.

Further, families are rarely equipped to navigate the process of obtaining modified classroom instruction for their children. In addition to coping with the daily stresses of raising a child experiencing problems in school, they are usually not familiar with the process of evaluation or the learning strategies teachers typically use. However, they may be extremely helpful partners with school staff by supplying insights about the child, key information about the child’s condition and interventions that are effective at home, and by reinforcing strategies at home that are effective at school.

There are some things you can do to foster long-term, collaborative alliances with the family:

  • Keep in mind that children may behave very differently (worse or better) at home than at school. Parents may have a very different perception and understanding of the child’s situation than the school staff. Remarks such as, “but he has no problem with that here,” may be perceived by parents as judgmental, since it is not uncommon for children to conduct themselves differently in different settings.
  • Don’t assume that a student’s difficulties in the classroom are caused by a mental health condition or by the medications used to treat it. A mental health condition, particularly if it is severe, may mask other problems, such as learning disorders. A student who becomes upset in class may be overwhelmed because of an undiagnosed learning problem that makes it hard to do the required work. In students with mental health conditions, the stress caused by an untreated learning disorder may exacerbate the mental health condition.
  • Be willing to consider interventions that the family proposes, even if the interventions are not commonly used in the school district. Aware of schools’ resource constraints, families often are skeptical that schools will make the necessary efforts on behalf of a child identified as “disabled.” The family may be consulting books or web sites to identify “cutting edge” or alternative interventions for their child’s disability. While these interventions may not be customary for the school district, the school’s willingness to consider them fosters trust and can improve collaboration with the family.
  • Be willing to make changes if the agreed-upon interventions do not achieve the desired results within a reasonable period of time. The bottom line on any intervention is whether it works. Measurement of the effectiveness of interventions can ally families, clinicians, and schools. If proposed interventions fail, “cherishing the defect” to clarify how the intervention should be modified (or even replaced) further diminishes conflicts and encourages collaboration.
  • Involve the student’s clinician in the work of the team at school, or incorporate the clinician’s findings and recommendations into the plan for the student’s education. When a school minimizes the magnitude of a student’s disability, this can conflict with the way physicians recognize and treat patients, and may impede collaboration. Efforts to identify how certain interventions can be enacted at the school, and how the interventions will be modified or augmented if the student’s condition does not improve, are more likely to enhance partnering with clinicians.
  • Ask the family for advice on the most effective method of contacting the student’s clinicians. Clinicians are often extremely busy with patients, and must “triage” interactions with all others. They may be extremely difficult for you to reach. Suggest that the family alert clinicians that their child’s school will be attempting to be in contact. Even “unilateral” efforts to send information to a clinician (rating scales, classroom observations, etc.) often benefit students. Clinicians vary in their familiarity with educating students with disabilities.
  • Be aware that team meetings can be overwhelming to families, both because of the unfamiliar language, procedures and regulations, and because the family is usually outnumbered by the school staff. This experience for families can be distressing, and parents or guardians may not always be at their best during team meetings. An empathic smile, an acknowledgment of how difficult the process is for families (“I know this process can be overwhelming”), or a kind word (“this may be difficult, but we’ll work together to get through it; we all want what’s best for your child”) can go a long way toward building mutual trust with the family.
  • When talking with a student’s family, don’t make comparisons between the services that student receives and the services provided to other students with similar needs. While you may have been through the educational evaluation process a number of times on behalf of many different students, a family may be going through it for the first time, and their focus is on a single student – their child. A family who feels their child’s needs are not being met is unlikely to welcome comparisons to other students. top

Important Points for Clinicians

Clinicians can significantly influence the way a student’s needs are perceived and accommodated by school staff. Although clinician recommendations are an important part of the educational evaluation, the school is not required to accept or implement any recommendations or suggestions from clinicians. The school does not have to accept findings from an independent evaluation, either, even if the evaluation is paid for by the school. To maximize the impact of your input to the team, consider the following points:
  • Identify school staff who understand the student’s difficulties, who are receptive to attempting different strategies, and who work effectively with other school staff. The identification of helpful school staff and, conversely, staff unlikely to recognize, implement, and monitor appropriate interventions, often allows a clinician to determine the probability that an existing school placement will succeed. The most effective way for a clinician to gather this information is to attend the school’s team meetings. Since this is not always feasible, phone contacts with staff, or observations from family members can be very helpful.
  • Allow the student’s family to review a report prior to submitting it to the school, to ensure that information relevant to clinicians but not to the school is omitted (for example, family history of mental illness). However, school staffs dislikes receiving reports with information “blacked out” since it suggests they are receiving an incomplete description of the student. An abbreviated report or letter is preferable to a report with information marked out.
  • Inform the school staff of any significant clinical changes in the student. When appropriate permission is granted by the family, clinicians’ input to the school on a student’s clinical changes enhances team collaboration and is usually appreciated by school staff.
  • Avoid recommending a specific alternative school or particular place where services should be delivered, since schools often already have arrangements or contracts with alternative schools or programs. If the clinician thinks a certain school would be a good fit for a particular child, a description of the services that make that school attractive should be provided.
  • Clinicians can recommend that a parent seek an independent evaluation if they perceive that the school educational evaluation is inaccurate or incomplete.
  • With permission of the family, contact the case manager or lead teacher to discern whether the team is making reasonable efforts to implement the child’s education plan. If it appears the team is not implementing the plan devised, it may be useful to contact the Special Education Director in writing. Indicate how the student’s disability is not being addressed in a satisfactory way by the school. Such letters also document the good faith efforts of clinicians to collaborate with a school system should the appeal process become necessary.
  • Encourage the family to contact their State Department of Education to identify legal options, if the student is not being adequately served by the school district, and if interactions with the school (by letters or phone) do not suggest a satisfactory resolution.  top
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