LP Educationally Necessary MH Services IEP Procedures Rev 2 24 12 by tMlR88

VIEWS: 0 PAGES: 15

									                                          Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

                                              IEP Procedures

Butte County Behavioral Health (BCBH) has served approximately 75 (+ 5-10) Butte County SELPA
students per year through AB3632 in the last year. For 2011-12, we have developed an agreement with
Butte County Behavioral Health to continue services similar to those provided in the past. But there are
some important changes that we prepared for in the upcoming year. Below is a summary of some of
the changes that will impact our practices immediately:

    1. IEP teams will determine which students with disabilities are eligible for mental health related
       services. The BCBH clinician we will be responsible for assessing students referred as suspected
       of needing mental health related services and for providing a recommendation to the IEP team
       regarding eligibility. BCBH clinicians and IEPs will develop specific goals and services which
       should be written in the IEP (Appendix Ds will no longer be used).

    2. SELPAs will need to develop new policy to determine referral processes, criteria for determining
       needs for services, assessment standards, IEP language, and procedures for accessing services
       since all law references to previous 3632 services has been eliminated.

    3. Although Butte County Behavioral Health will provide most services at least through June 30,
       2012, additional fiscal monitoring and payment of these services will be for now the
       responsibility of the SELPA office. In particular, certain types of residential service payments will
       be done directly by the SELPA effective July 1st and will not be performed via BCBH.

    4. CASEMIS codes related to mental health services will change but it is not yet clear what the new
       requirements will be. CDE has also stated new accountability requirements will be introduced
       that will affect both the districts and SELPA. Important crosswalk information is included in this
       policy to allow translation of mental health language to educational language.

    5. Planning and decisions need to be made regarding provision of services in the 2012-13 school
       year. Decisions regarding plans should be in place by January, 2012, in the event there are
       impacts or changes to the status of current staff.

    6. With the potential that school districts may retain the provision of Mental Health Related
       Services, a systematic transition from Butte County Behavioral Health to school directed services
       must be identified.

This document is an effort to provide our SELPA with an initial service infrastructure and procedures to
provide students mental health as a related service. It should be a fluid document at this point as well,
as CDE continues to provide new information and guidance on mental health services that may affect
the manner in which services are offered.

Definition: Mental Health as a related service is identified as clinical mental health services necessary
for a student to benefit from their special education program and services (formerly known as AB3632
or AB2726 services). Within the educational environment these can include assessment of needs of
mental health services, crisis intervention within the educational setting, outpatient counseling, day



Approved 9/27/11: Revised 10/25/11: 1/24/12                                                        1
                                          Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

treatment placement, case management, parent consultation, and/or residential placement
recommendations. Please note that medication management is not included among these services
since federal guidelines consider it a medically necessary and not an educationally necessary service.
These services can be evaluated and/or provided by a qualified clinician credentialed or licensed
practitioner including but not limited to a School Counselor; School Social Worker; School Psychologist;
Clinical Psychologist; Licensed Clinical Social Worker (LCSW); Marriage, Family, and Child Counselor
(MFCC); or Marriage and Family Therapist (MFT). Thus, the term “Mental Health as a Related Service” is
utilized in place of “AB3632” or “AB2726 services”.

Eligibility: Students identified as an IWEN determined eligible for special education services and have a
thoughtfully developed and consented IEP are eligible for referral and assessment for educationally
necessary mental health services (ENMHS).

Target Population: Students must have significant needs identified through assessment in the areas of
social-emotional or social-behavioral by a school psychologist or clinician. This requires that the
students are currently served under an active IEP. Eligible students for mental health services are not
just those identified as Emotionally Disturbed but can be those of any disability category. Students can
be anywhere on the continuum of placement and services as long as they meet the criteria for Mental
Health referral and assessment, subsequently outlined.

IEP Team Initiation of Referral to BCBH for ENMHS: IEP teams must clearly document the
suspected/identified need related to mental health prior to referral for assessment for ENMHS
eligibility. Prior to the IEP team recommendation to BCBH, the IEP team shall validate and compile the
following information:

       The pupil has recently been assessed by school personnel and a current psychoeducational
        evaluation report (completed within the last three years) is complete.

       Written parental consent for referral to BCBH for the school based mental health assessment
        [which can be completed at the IEP team meeting]. Statement of the referral can be noted in
        the IEP and parent signature on the IEP is sufficient documentation of permission for referral. In
        addition, the parent should sign a release of information to exchange information with BCBH.
        (Parents can always request an assessment outside of the IEP; however the above process is
        encouraged.)

       IEP team documentation that the student exhibits emotional or behavioral characteristics
        symptoms that:

         Are observed by qualified educational staff in educational and other settings, as
          appropriate.

         Impede the pupil from benefiting from any special education services. There must be a
          direct relationship between the emotional/behavioral characteristics and the lack of benefit
          from special education services. This may be shown by lack of progress on goals/objectives,
          grades, standardized test scores, CDM, district assessments, etc.).


Approved 9/27/11: Revised 10/25/11: 1/24/12                                                      2
                                          Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

         Are identified significant, as indicated by their rate of occurrence and intensity.

         Are associated with a condition that cannot be described solely as a temporary adjustment
          problem that can be resolved with less than three months of school counseling.

   The IEP team has reviewed the IEP and determined that all special education and related services
    have been implemented in the areas of need.

   The IEP team has provided appropriate School Based Interventions to the pupil. (i.e. school based
    counseling and guidance interventions, psychological interventions, or social work interventions). In
    cases where these interventions are clearly inadequate or inappropriate to meet the educational
    needs of the pupil, the individualized education program team has documented which of these
    interventions were considered and why they were determined to be inadequate or inappropriate
    prior to a referral for Mental Health Related Services. School Based Interventions, although not
    required prior to referral for assessment, are highly recommended for any student under
    consideration for ENMHS.

   The IEP has systematically designed, implemented, reviewed, and adjusted behavior support plan,
    when appropriate, validated by the PENT scoring rubric (minimum score – 17).

   Consent for release or exchange of information is completed for all applicable private care
    providers.

A student who is in the process of being evaluated and suspected of being an IWEN may require Mental
Health related services, as well. Similar to the above requirements, the initial assessment team must
clearly document the suspected/identified need related to mental health and recommendation for
Mental Health related services. This is a concurrent referral and is only utilized in extraordinary
circumstances for the student (i.e. extended hospitalizations, etc.) The School Psychologist shall validate
and compile the following information:

   Current psychoeducational evaluation report;

   Written parental consent for referral to mental health assessment completed during initial
    evaluation which can be documented in an IEP.

    IEP team documentation that the student exhibits emotional or behavioral characteristic symptoms
    that:

     Are observed by qualified educational staff in educational and other settings, as appropriate.

     Impede the pupil from benefiting from any special education services. There must be a direct
      relationship between the emotional/behavioral characteristics and the lack of benefit from
      special education services. This may be shown by lack of progress on goals/objectives, grades,
      standardized test scores, CDM, district assessments, etc.

     Are identified significant, as indicated by their rate of occurrence and intensity.


Approved 9/27/11: Revised 10/25/11: 1/24/12                                                       3
                                           Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

   The school has provided pre-referral counseling, psychological, and/or guidance services and the IEP
    team has determined that the services do/do not meet the pupil’s educational needs. Or, in cases
    where these services are clearly inappropriate, the IEP team has documented which of these
    services were considered and why they were determined to be inappropriate [including, but not
    limited to, significant history of private psychological/psychiatric care (chronic) and/or
    hospitalizations (acute)].

   The school has identified the specific lack of educational progress and how this is directly related to
    the student’s mental health concerns.

   Consent for release or exchange of information is completed for all applicable private care
    providers.

Transfer Students/Interim Placement: In the case of a student with an IEP indicating Mental Health as a
Related Services newly transfers into the SELPA/LEA, the LEA administrator or designee will immediately
refer the student services,, to BCBH for interim ENMHS. A copy of the completed SELPA ENMHS Referral
Coversheet (Appendix A; page 1) and a copy of the student’s current IEP should be sent to BCBH. A copy
of the ENMHS Referral Coversheet will be sent to SELPA as notification that the district has requested
services from BCBH.

Referral to Butte County Behavioral Health for Related Mental Health Services: Referral packet should
include Mental Health Referral Checklist (see Appendix A); student’s current IEP (including but not
limited to subsequent addendums); and all assessment reports available upon transfer. The BCBH will
assign a mental health evaluator to the student.

Referral Packet: When an IEP team has initiated a referral the School Psychologist will submit to BCBH
the following documents:

       Referral Checklist (see Appendix A – Referral Checklists).

       Current IEP and any subsequent addendums.

       Current assessment reports completed in all areas of suspected disabilities and any outside
        agency reports recently completed.

       Behavior plans (BSP and/or PBIP) and reports on response to other evidence-based
        interventions.

       Supporting letter from a private mental health professional and/or school psychologist
        counseling statement (See Appendix A).

       Parent consent to referral (can be signature in IEP containing language referring student to
        Mental Health as a Related Service) [see also “Transition Action Plan”].

       Consent for release or exchange of information is completed for all applicable private care
        providers.


Approved 9/27/11: Revised 10/25/11: 1/24/12                                                        4
                                          Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

       Send a copy of the ENMHS Referral Cover sheet to Butte County SELPA to notify them that an
        assessment for ENMHS services has been requested.

Referral Procedures and Timelines: Following the referring IEP, within 3 school days of receipt of
parent consent of referral (signature on IEP), the School Psychologist will within 15 calendar days
contact parent and request consent/decline to assess. Parent will be given 15 calendar days to respond,
upon which a second attempt to solicit parent response to assessment plan will be made. If assessment
plan is not responded to by the parent within 30 days from the initial request for consent, the
administrative designee will inform the district that the student cannot be assessed due to lack of
parental response. It is the responsibility of the LEA to reconvene an IEP to address lack of parental
response.

Assessment: Upon receipt of parent consent, the school district will schedule an IEP within 60 days
consistent with legal requirements for other assessments. The BCBH Mental Health evaluator will
conduct the assessment to determine needs and goals for Mental Health related services. At the IEP
meeting discussing assessment results, the team will be provided a copy of the assessment report, goals
will be developed, and services (treatment plan) will be proposed and discussed. The assessment shall
be designed to determine the student’s need for mental health services that are necessary for the
student to make educational progress. This assessment can be a combination of direct assessment with
the student as well existing sources of other information. Sources of information can include, as
appropriate, parent, teacher(s), physician, psychiatrist, social worker, probation officer, school
psychologist, school counselor, administrator, extended family, and other significant adults in the
student’s life. Additionally, information can be collected from the educational cumulative records,
discipline reports, legal documents, and previous clinical (psychological, neuropsychological, medical)
assessments or diagnostics. Consideration of relevant cultural issues, native language, environmental
history, and family history is required as part of this assessment.

Assessment Report: A determination of the student’s need for mental health services to benefit from
his/her special education will be documented in a written report. The report will detail the results of the
assessment including, but not limited to the history of mental and/or behavioral health, which can
include effectiveness of previous interventions and participation in interventions; relevant behavior
noted during observation and interviews; the relationship of that behavior to the student’s academic
and social functioning; educationally relevant health, developmental, and medical findings; the need for
specialized services, materials or equipment for pupils with low incidence disabilities if needed to
receive benefit from Mental Health Related Services; and/or recommendations (if applicable) for Mental
Health Related Services. The assessment report will also indicate whether the student requires a
educationally necessary mental health service in order to benefit from instruction in special education.
Specific evidence of how the student’s mental health status significantly and directly impairs educational
progress must be included in the assessment report.

See Appendix B for an Assessment Report Template.

IEP Meeting for Induction of Mental Health as a Related Service: Within 60 days of receipt of parent
consent, the IEP team will reconvene to discuss results of the assessment. The IEP team will hear and


Approved 9/27/11: Revised 10/25/11: 1/24/12                                                       5
                                          Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

discuss assessment results and recommendations, address recommended goals based on identified
student needs and, if needed, recommended Mental Health Related Services. The BCBH assessor or
other appropriate representative shall attend the IEP meeting to report on assessment findings and
recommendations. All agreed upon goals and services (including location, frequency, duration, and
initiation date) will be documented in the student’s IEP. At this time the student’s Mental Health
Clinician will be identified, as appropriate. Services will commence as indicated on the IEP services
initiation date. Goals and services will be implemented when parent consent is obtained.

Goal Development: Based on the student’s needs identified through assessment, treatment goals that
focus on the reduction of symptoms as a means of improving functional impairments will be developed.
Goals must be observable and measureable. The goals must be written in such a way that a reasonable
layperson can determine whether or not the goals are being met. Progress reporting will occur on a
regular basis, as identified on the student’s IEP. Goals cannot be changed or adjusted without a formal
IEP and parent consent is obtained.

Case Management and Service Provision: The mental health clinician will provide and monitor all
agreed upon mental health related services unless otherwise specified in the IEP. IEP case management
will be maintained by the school district case manager (i.e. special education teacher, SLP, school
psychologist, district designee, etc) as appropriate. Case managers will be responsible for
consultation/collaboration with all program and related service providers, progress reporting on all
goals including mental health, consultation with any outside agencies, and SELPA, as appropriate.

When communication regarding IEP meeting development is needed the case manager will initiate and
facilitate this communication. In the case of the addition of Mental Health as a Related Service, the
Mental Health clinician will provide the case manager with all appropriate contact information other
additional mental health providers to invite to the IEP meeting.

Services: Services can include but are not limited to mental health assessments, crisis intervention
within the educational setting, therapy (individual or group), intensive day treatment, case
management, rehabilitation services, plan development, and/or residential placement
recommendations. Services are recommended and agreed upon at the IEP that are deemed necessary
for the student to access and benefit from their educational program and services. Services must
primarily have an educational purpose and must be directed toward helping the student meet their
special education goals. Data from measurable goals should be used when practical to determine
whether services have contributed towards improved educational success. These services are also
considered included in the student’s Least Restrictive Environment (LRE). Therefore, it is considered
necessary to provide Mental Health Related Services within the setting that has been determined by the
IEP team as LRE. When the services are provided on a school campus, then it is the responsibility of the
Mental Health clinician to insure compliance with all confidentiality laws and regulations.

These are the mental health services that are available for students by category. The bolded description
is the BCBH MediCal term for the service while the italicized term is the IEP language to be written into
SEIS to add services to the IEP. CASEMIS codes are underlined.




Approved 9/27/11: Revised 10/25/11: 1/24/12                                                     6
                                            Butte County SELPA

                   Educationally Necessary Mental Health Services IEP Procedures

Case management (Social Work): This can include activities provided by the clinician to access needed
community resources for eligible individuals, consult with IEP team members, maintain progress
reporting to parents, consult with student’s outside/private agency service providers. CASEMIS Code –
525.

Collateral (Social Work): A collateral service activity is an activity provided to significant support
persons in the student's life, rather than to the student. The definition of collateral service activities
must be clear that the overall goal of collateral service activities is to help improve, maintain, and
restore the student’s mental health status through interaction with the significant support person.
There must be a clear linkage between the collateral service activity and the student’s goals as
expressed in the IEP. CASEMIS Code – 525.

Therapy (Individual Counseling): Individual Therapy includes services designed to provide a goal
directed therapeutic intervention with the patient which focuses on the mental health needs of the
patient. Group Therapy includes services designed to provide a goal directed, face-to-face therapeutic
intervention with the patient and one or more other patients who are treated at the same time, and
which focuses on the mental health needs of the patients. Therapeutic interventions will be provided
consistent with the individual’s treatment goals, which focus on the reduction of symptoms as a means
of improving functional impairments. CASEMIS Code – 510.

Rehabilitation Services (Counseling and Guidance): Group counseling and other services with a client
which address functional impairments: improve, maintain, or restore a functional skill, daily living skill,
social and leisure skills, grooming and personal hygiene skills, meal preparation skills, and/or medication
education. Progress notes must address the goals and interventions on the client plan. CASEMIS – 515.

Plan Development (Social Work): Service activity, which consists of the development of client plans and
the approval of client plans. Progress notes should state that the client plan goals and interventions
were developed, updated, progress toward the goals, or how the interventions will be implemented.
CASEMIS Code – 525.

Residential Treatment Services (Residential Treatment Services): A nonpublic, nonsectarian school that
enrolls students with disabilities pursuant to an IEP and employs at least one special educator where the
student resides. CASEMIS Code – 545.

Assessment (EPDST MediCal only – Do Not Record in IEP services): Assessment includes services
designed to provide formal documented evaluation or analysis of the cause or nature of the patient's
mental, emotional, or behavioral disorder, necessary for the evaluation and treatment of the patient's
mental health needs. This is a MediCal eligible service that is not need to be recorded in an IEP.

Crisis intervention (EPDST MediCal only – Do Not Record in IEP services): Crisis intervention means
quick emergency response (either by phone or in person) enabling the individual to cope with a crisis,
while maintaining his/her status as a functioning community member to the greatest extent possible. A
crisis is an unplanned event that results in the individual's need for immediate service intervention.
Crisis intervention services are limited to stabilization of the presenting emergency. On a case-by-case



Approved 9/27/11: Revised 10/25/11: 1/24/12                                                           7
                                          Butte County SELPA

                    Educationally Necessary Mental Health Services IEP Procedures

basis, when it is deemed necessary to assess for safety or further psychiatric care, the clinician will
ensure proper procedures through in person meeting and the Butte County Mobile Crisis Team will be
utilized as appropriate.

Progress Reports: Progress on IEP goals must be reported to parents at the same frequency as progress
reporting in the school for non-disabled peers. The Mental Health clinician will report progress on goals
at the same frequency of progress reporting for the particular school site the student attends. Progress
reports should be submitted to the student’s case manager at least 5 days prior to the due date for the
progress report. The mental health clinician shall also communicate with the case manager any
recommendations for changes in services levels or type prior to the IEP meeting so appropriate
individuals can be invited to participate in meetings. All changes in services will be considered and
approved in IEP meetings. Progress reports on residential services will be reported each quarter
following residential specialist’s home visits.

Service Location:

Comprehensive campus: Individual or group therapy shall determine needed space at the student’s
school site. When Mental Health Related Services are provided at the school site, the service provider
will discuss space requirements with the site administrator who is responsible to arrange for appropriate
space availability. At minimum a private room will be available to the clinician on a regular basis that
will provide the student needed confidentiality and reliability in service provision.

Student needs greater than a comprehensive campus: When a student’s needs are deemed
significantly beyond the capacity of a comprehensive campus and alternative settings are under
consideration for the student, the IEP team will establish documented regular communication to that
effect. The IEP team will discuss recommendation of the mental health clinician based on the student’s
current functioning. All efforts must be made to address the student’s needs within the continuum of
services within the LEA (including SELPA regional programs) prior to consideration of residential
nonpublic school attendance.



 Just as any review of LRE and services, it must be evident that outside of crisis intervention, the
student’s needs exceed the current supports and services. Therefore, it is vital to review student’s
related service attendance, medication compliance (if applicable), educational environmental supports,
and current diagnostic status.

On extremely rare occasions it may be necessary for the IEP team to consider residential non-public
school to address the student’s educational needs. When this is the case, it is required that the LRE
options and continuum of services have been exhausted. Students being considered for residential
nonpublic school must meet additional criteria prior to referral for services. The mental health clinician
must initiate the residential referral with BCBH residential assessment specialist who will collaborate
with the Butte County Interagency Services Placement Unit (ISPU). Residential placements need to
receive the authorization through the IPSU prior to IEP team recommendation to exhaust all other local
services prior to placement. The district special education coordinators and SELPA office must be


Approved 9/27/11: Revised 10/25/11: 1/24/12                                                       8
                                          Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

notified prior to consideration of a student for residential services to ensure appropriate access to
services is coordinated. In special cases, the SELPA may provide additional pre-residential referral
assessment services to determine if residential services are required for the student to obtain education
benefit.

After the above steps have been taken, the BCBH residential placement specialist should summarize
their recommendations in a written report to the IEP team. IEP team will determine appropriate
placement based on present levels of performance, clinician recommendation, and
recommended/adjusted goals. Such IEP team meetings should include the BCBH residential specialist or
alternate professional who is qualified to explain the assessment recommendations.

IEP meetings for students’ in residential placements must be held every 6 months or sooner. Residential
placements shall be an extension of a student’s non-public school. Per California Education Code
56365(f), if a local educational agency (LEA) places a pupil with a nonpublic, nonsectarian school or
agency outside of this state, the pupil's individualized education program (IEP) team shall submit a
report to the California Department of Education (CDE) within 15 days of the placement decision. This
reporting form is available at the SELPA office or via the CDE website.



Exit Criteria: In the event that a student’s functioning stabilizes, which includes consistent goal
achievement, general adaptive functioning improvement and stabilization, as well as clinician
recommendation; student will be re-evaluated for exit from service. To be eligible for exit, all services
must be completed, student must have an acceptable level of stability, and student must have adequate
community or school resources so that he/she can benefit from their special education program and
services. Recommendations for changes or exit from service are made by the mental health clinician.
Any and all changes to IEP related services shall be addressed in an IEP meeting. Changes can only take
place upon parental consent.




Approved 9/27/11: Revised 10/25/11: 1/24/12                                                     9
                                            Butte County SELPA

                    Educationally Necessary Mental Health Services IEP Procedures

Appendix A                                                                   DATE: _______________

Mental Health as a Related Service: Referral Cover Sheet for:

        Initial Assessment         Interim Placement: IEP date: __________________ (attach copy)

To:     ENMHS Coordinator, Butte County Behavioral Health

From:      _____________________________ _________________________
            Printed Name                 Position/District

Student Name:                                                      DOB:

Parent(s)/Guardian(s):

Address:                                                           Phone:

School:_________                                                   Grade:

Primary Eligibility:

Secondary Eligibility:

Related Services:

Case Manager:                                             Phone:

Psychologist:                                                      Phone:

Other Agencies Involved (Social Services, Foster Placement, Probation, Mental Health, Regional
Center)? Please include case manager names and contact information:




The team affirms that the current IEP contains complete reason why pre-referral services were
considered insufficient by the IEP team or deemed clearly inadequate or inappropriate by the IEP
team, as outlined in sections 1, 2, or 3 of the Referral Checklist form.


Coordinator_________________________________________________Date_________________


Director____________________________________________________Date_________________

*Send a copy of this cover sheet to Butte County SELPA.
Student Name: _          _                                                  DOB: _     _




Approved 9/27/11: Revised 10/25/11: 1/24/12                                                  10
                                         Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

Mental Health as a Related Service

REFERRAL CHECKLISTS

IEP Referral: School Psychologist Statement of care

     Referral cover page

     Referral Checklist

     Counseling Statement

     Current IEP (with referral              Date of last annual:        Date of amendments:
     statement)

     Current BSP/PBIP                        Date of current BSP/PBIP:

     Current Psychoeducational Report        Date of current psych report:

     Other (e.g. Outside Agency Reports)(Specify):

     Other (Specify):

     Other (Specify):


IEP Referral: School Professional Statement of care

     Referral cover page

     Referral Checklist

     Counseling Statement

     Current IEP (with referral statement)   Date of last annual:        Date of amendments:

     Current BSP/PBIP                        Date of current BSP/PBIP:

     Current Psychoeducational Report        Date of current psych report:

     Other (e.g. Outside Agency Reports)(Specify):

     Written Parental Consent for referral for school based mental health assessment.

     Consent for release or exchange of information for all applicable parties.




Approved 9/27/11: Revised 10/25/11: 1/24/12                                                    11
                                             Butte County SELPA

                        Educationally Necessary Mental Health Services IEP Procedures

Interim/Transfer student

     Referral cover page

     Referral Checklist

     Current IEP                              Date of last annual:        Date of amendments:

     Current BSP/PBIP                         Date of current BSP/PBIP:

     Current Psychoed Report                  Date of current psych report:

     Other (Specify):



   Note: **All IEPs must include a statement indicating student’s emotional or behavioral issues directly
   impede his/her ability to benefit from special education program and services, and more services are
   necessary to address these issues.

       1. If pre-referral services provided were not sufficient, this must be stated explicitly in the IEP,
          along with language stating that the student is currently not benefiting from their education
          due to their emotional/behavioral issues.

       2. If referral does not include a previous IEP with pre-referral counseling services, the following
          must be included on the referral IEP: The IEP team must state in the body of the IEP which
          pre-referral services were considered (counseling) and why they were deemed inadequate or
          inappropriate (ie, multiple hospitalizations).

       3. If services from an outside Mental Health Professional are being substituted for in-district pre-
          referral services, the following must be included in a letter from the provider:

               a) A statement of the presenting emotional and/or behavioral issues, diagnosis (if
                  applicable), and summary of progress.

               b) A statement regarding the length treatment has been provided, including frequency
                  and duration, (should normally exceed 3 months), as well as a brief statement
                  addressing client attendance/compliance.

               c) A brief statement of treatment plan recommendations.

   4.     If a parent has requested an assessment outside of the IEP process, then the above
   information should be addressed in the counselor statement as described below.Supporting
   Statement from School Psychologist or Other Mental Health Professional




   Approved 9/27/11: Revised 10/25/11: 1/24/12                                                      12
                                         Butte County SELPA

                  Educationally Necessary Mental Health Services IEP Procedures

(Also Known As “Counseling Statement”): Along with the pre-referral interventions, the packet
should generally include a cover letter or statement from the school psychologist or other clinician
that includes the following information:

Summary of Emotional or Behavioral Characteristics: This must include the following:

     Description of the student’s/client’s emotional/behavioral characteristics in observable,
      measureable terms. (Include the rate of occurrence and intensity of the behaviors).

     How these characteristics negatively affect the student’s educational performance.

Appropriateness for Mental Health Services: This must include:

     Evidence to support the conclusion that the characteristics noted in the referral are due to a
      treatable mental health disorder and not a social maladjustment.

     Evidence that the student’s functioning is Sufficient to enable the student to benefit from
      mental health services. Reference date of psychoeducational or other attached reports as
      appropriate. If not addressed in reports, describe student functioning in a brief narrative.

     Describe how long the professional has served the student/client, duration and frequency of
      services.

     Describe student’s/client’s participation in counseling/therapy to date. Include attendance,
      willfulness to participate, rapport building, etc.

     Describe student’s/client’s progress to date, goals, and current plan for further counseling.

     Include any health/medical conditions, diagnosis, and medication prescriptions the student
      may have. Also indicate whether the student/client is medication compliant.

Present any additional information to support the referral.

If no counseling, psychological and/or guidance services were provided to the student, please describe
in detail which of these services were considered, and why the IEP team determined them to be clearly
inappropriate.

SEND BCBH REFERRAL PACKET TO:

Deedre Doe and Lauren Cole
Butte County Behavioral Health
500 Cohasset Road, Suite 25
Chico, CA 95926
Phone: (530) 879-2456
Email: DDoe@buttecounty.net LACole@buttecounty.net




Approved 9/27/11: Revised 10/25/11: 1/24/12                                                   13
             EDUCATIONALLY NECESSARY MENTAL HEALTH SERVICES

                            ASSESSMENT REPORT TEMPLATE

Identifying Information – Student, Date of Birth, Gender,
Guardian, Address, Phone number, LEA, School, Grade, Examiner,
Date, Referral Source



Statement of Language consideration as appropriate:



Reason for Referral: who and why



Assessment Methods: Some or all of the following: Review of
educational and mental health records, Interview with parents,
Interview with student, Interview with teachers, Observations,
Psychological testing, Standardized social/emotional/behavioral
assessments-rating scales, Adaptive assessments-rating scales,
non-standardized social/emotional/behavioral assessments, Other



Description of Behavioral Concern: Review rate and intensity for
significance, relationship of behavior to pupil’s academic and
social functioning, how long behavior has been occurring (is it
a temporary adjustment problem? This is generally regarded as
between three and six months)



Relevant Health/Development/Medical Findings/Background:
Summarize and also consider outside reports or assessments when
available such as any possible DSM-IV diagnoses.



Relevant Special Education History and Intervention History:
Past and current IEP services/accommodations/modifications,
Identified disability, School Based Interventions – successes
and nonsuccesses (or why inadequate or inappropriate if not
attempted), Review of BSP’s and if adjustments were attempted




Approved 9/27/11: Revised 10/25/11: 1/24/12                   14
             EDUCATIONALLY NECESSARY MENTAL HEALTH SERVICES

                            ASSESSMENT REPORT TEMPLATE

Present Levels of Academic Performance: Standardized scores,
goals/objectives, grades, CBM, etc., progress or lack of
progress in these areas



Summary of Interviews: Parent, Student, Teachers, Service
Providers, Intervention Providers, Etc.



Summary of Observations: Classroom and other settings as
appropriate



Summary of Psychological/Perceptual/Social-Emotional-
Behavioral/Adaptive Assessments and Rating Scales: Statement
about test validity if used.



Determination of environmental, cultural, or economic factors:



Summary and Findings: Is there a determined need for mental
health as a related service? Why or Why not? Is there a direct
relationship between the emotional/behavioral characteristics
and the lack of benefit from special education services?



Recommendations: Consider the pupil’s current functioning,
including cognitive functioning when making mental health
service recommendations.




Approved 9/27/11: Revised 10/25/11: 1/24/12                   15

								
To top