COVID-19 Resources from NCSPA

Crisis Response in a Virtual Environment

Guidance to School Districts for Crisis Response in a Virtual Environment

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.

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Prevention During a Pandemic

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 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.

Warning/At Risk Observations and Behaviors in a Virtual Setting-

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

Suicide Prevention Resources

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:

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

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Social Emotional Resources

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:

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.
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Crisis Support Services Protocol

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.
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Safety Planning in a Virtual Environment

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.

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Telehealth Considerations

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.

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Additional Resources and Information

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!

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.

NCSPA School Safety and Crisis Response Committee 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 if you have any questions for our committee!

NCSPA School Safety and Crisis Response 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 !!