3/12/201
Today I spoke with Emille Refvem, a school psychologist, who in a former life was licensed professional counselor working with youth in state custody. She brings insight and wisdom in how assessing needs also ties into trauma, environment, and how we can resource our caregivers. She allows me to briefly wax poetic when I was inspired by what she brought to the table. We learn that there’s no word for anxiety or autism in certain languages and how that framing issue can close off solutions. I had to make some edits and rerecord a few sections because I say “Ummm” too much, which is why the audio has some level changes, sorry, still a learner.
https://www.nasponline.org/standards-and-certification/nasp-practice-model/about-the-nasp-practice-model
https://www.nasponline.org/Documents/Standards%20and%20Certification/Practice%20Model/NASP%20Practice%20Model%20Overview_2020_FINAL.pptx
About the Shortage
keevin bybee 0:01
Welcome to the one school project. This is keevin Bybee. I’m a family physician, talking with domain experts, and specialists in the areas to know things about how we could start a 24. Seven safe haven for our children, perhaps hubbed at a local elementary school. Today, I’m talking with Emily, who is a school psychologist. And I would love for her to introduce herself. Tell us how she found herself where she’s at today. And why do you think that this is an interesting project worth pursuing?
emily 0:33
Great, thanks, keevin. Hi, I’m Emily, and I am a full time school psychologist. I began working in school psychology about five years ago. And prior to that I was a licensed professional counselor working in residential on day treatment with youth in state custody, either youth that had been incarcerated for a variety of adjudicated crimes, or they were placed based on a mental health need, either at risk to themselves or at risk to others.And when I was going through school, I was looking at school counseling is my profession and ended up with a dual degree as counseling in psychology, which led me to getting certified as a licensed professional counselor for a time and where my clinical practice began. And in that work, I was finding that a lot of the youth that I was serving, that were in state custody were coming from places of trauma, like significant trauma, either from trauma in the home or the community, environmental traumas, intergenerational traumas, and then what ended up in the legal system. And what I learned from a lot of the therapeutic work that I was doing with these youth is that there was a lot of missed opportunities within the school setting. A lot of the youth, their road to incarceration was that school to prison pipeline of the students were exhibiting behaviors, or concerns in the school environment that lead to suspensions or expulsions. And then, you know, we’re getting picked up in the juvenile justice system. And how I ended up getting back into schools was seeing the need for schools to have a more trauma informed perspective on how they’re viewing student behavior and student interaction. And seeing a child from where they’re coming from not just the way that they’re behaving, and order to try to reduce that school to prison pipeline. So many intense things to touch on. You done private clinical practice, you’ve seen a lot of trauma. And that’s pretty similar to why I find this project pretty intriguing as well. And you mentioned, you know, environmental trauma, and how important it is that our kids are in an environment that’s less traumatizing
keevin bybee 3:05
so I think it’s just amazing the work you’re doing. And it’s got to inform how we can do a little bit better for for our kids. and so the I think a neat place to start was the National Association of School psychologists has a neat diagram talking about their six principles and 10 domains of how to take care of our kids. Is that a model that you find pretty useful?
emily 3:36
Yes, I do, because it’s really comprehensive. And it looks at not only just the school based system, but also family and community consultation, mental health, and overall wraparound perspective on seeing a whole student. Instead of just a segmented piece of intervention or assessment, a lot of what school psychologists are trained to do is engage in administering cognitive assessment and different types of academic assessment for looking at levels of functioning.
And we’re also trained to do a lot of other things of seeing early signs providing classroom instruction, intervention, group work and mental health work to address the needs of the whole student.
keevin bybee 4:29
Wonderful. and you mentioned how kids can get, you know, suspended from school for their behaviors. But the problem is, is that they’re learning coping strategies and survival skills that aren’t well adapted to school, and then we’re sending them back into the environments where they learn those skills. And so it just seems like a feed forward snowballing system, what do you think we’re missing to be able to keep those kids in the school physically so we can Help them co regulate instead of send them back to the environment that put them there in the first place.
emily 5:06
I think a lot of it is just access to services. So public education is funded through the federal government. And a lot of the services that we have are based on individual state and district numbers. And what we find is that if there isn’t a certain level, or percentage of representation within a building that would contribute to more funding than schools don’t have additional supports, like restorative justice, or additional mental health providers, social workers, they’re restricted on the funding that they have, based on the numbers, or the percentage of students depending on their need. I’m sorry, I totally lost your question.
keevin bybee 5:52
Yeah, you’re you’re hitting on the point that we’ve got this arbitrary funding model, which says, if you don’t have so many numbers, you don’t get the specific resources. I’m just curious if you have any sense of why we aren’t funding this better? Or, you know, you mentioned the restorative justice part is that, you know, meeting people where they’re at and restoring them to a place where they can be around other people safely and productively. And so, why is it that that’s not the model that we’re currently using? And why is it that we’re not being more proactive? Do you have any sense of that?
emily 6:35
I think that there’s a lot of people that want to use it, and they are trained in it, and they see the benefit, but the overall staffing prevents us from being able to implement it with any kind of efficacy to really show what a program is capable of doing. People in schools are often wearing multiple hats, it’s the other duties as assigned. You know, teachers have gone just from teaching to also being counselors and provide trying to figure out how to provide technology for kids or food resources and the needs of kids have, and families have increased and our resources have decreased in many ways. And we’re going back to the disciplinary question, I think that there’s still the institutional trauma of, you know, white privilege and how behavior is seen, and how what we are what we expect to see as respectful or in line isn’t culturally sensitive. And seeing like how you know how behavior is represented in other cultures, or why a student may be doing something. And sometimes the adults feelings are, when they’re hurt. It’s difficult for folks to see that it’s not personal. It’s the child that’s in a way asking for help and the best way that they can, which isn’t always acceptable, and a building, and then there’s not enough opportunities for them to have an opportunity to learn the new skills. It’s an assumption that, you know, well, this action is taken and you have a consequence. But then what do you do after that natural consequence? How do you learn that skill in order to try to prevent it from happening again, and many schools don’t have those additional resources for that extra social emotional learning that needs to happen outside of a classroom setting. It, there’s so many pieces that go in there, the cultural responsiveness, the fact that people are forced to wear many hats for which they weren’t formally trained. The fact that there’s not enough people to do all of the work that there is to be done, let alone the fact that they’re already spread thin from their own expertise, and lack of specific training and being culturally responsive. And that resonates really highly with me, you know, as a family doctor, part of the reason I like the job is that I get to do a little bit of everything, but people are coming to me for things that I, you know, aren’t exactly medical, and therefore, I don’t have the specific tools. And that’s why I really want to see how we can make the team hug more robust.
keevin bybee 9:24
You mentioned the culturally responsive part and you shared a, an anecdote from another family that was there was no specific word for anxiety in their language. Could you touch on that and tell us how that’s something valuable to learn from?
emily 9:43
Yeah, I mean, I think as we expand our knowledge around mental health and what it means it isn’t acknowledged necessarily in all cultures, in the same way that we as Americans based on the DSM, the Diagnostic and Statistical Manual have these definitions and diagnoses that are based on a lot of white folks, there is some cultural components when we talk about, you know how man of how depression or anxiety manifests in the native community, or in our African Muslim community. It doesn’t always align with how we would define it based on the DSM. And what I see happening is that in some of the cultures, I learned from a family, an Arabic family, actually, that there was no word for autism. And we were looking at autism for their child, and the closest word to autism, and their language was evil. And without that knowledge of culture, and bridging the gap between an American system of education and mental health with the diverse community that lives within our country, there’s a lot of unintentional harm that can be caused, and why there’s the need for you know, well, what if the word anxiety doesn’t exist in Swahili or Somali? What is a similar word? Or how, you know, how would you describe it? And the difference between what is a medical concern related to mental health or psychosomatic symptoms, compared to a religious perspective of God’s will? And how are we you know, being sensitive within those cultures to not cause unintentional harm?
keevin bybee 11:38
so poignant. I definitely suffered from that myself as a somebody who’s hyper literal, and I’m slowly learning but definitely have lots of room to grow. You know, if you’ll permit a small philosophical digression, like you mentioned, the Diagnostic Statistical Manual. What that is, is it’s a clustering of symptoms that tend to go together. But that’s not a box that the universe created. It’s something that humans use to help us understand the world. But we have to be really careful that it’s, we’re understanding the context in which we’re using it not that it’s a box created by the universe for us. And so, I think, keeping that in the forefront of our minds, anytime we’re using these words like language, or anxiety, and autism, and how the word like you mentioned, autism might be evil, even if it’s the same thing in the person, the way we frame it changes how we’re going to respond to it, right? So, so, so, so important. and then thinking about, at the same time, that we have people, we’re training enough people or hiring enough people who might have more of that intuitive background, because we all can’t learn everything. How is it that we can find more people that are culturally or have color similar to the people we’re trying to help?
emily 13:01
I think it’s all about, you know, seeking out a diverse pool of folks, when we’re interviewing, I, sometimes I feel like positions are only open for so long. And then when if a person doesn’t have access, you know, say computer or location to a position, you know, to view a position, then there’s a lot of missed opportunities. I think there’s a lot of really great national resources that are coming online, that are offering telehealth based on culture and language and identity. And the equity piece that I find there is that for my students who need the support, but don’t have regular technology access, they continue to be prevented from getting culturally responsive mental health or medical services, because they don’t have the financial ability, language ability, you know, understanding of navigating the English language or the internet, to be able to reach some of those newly presented opportunities. And so when they’re not available within our community, even though there’s resources out there, they still aren’t able to access them. And that’s why it’s important to have resources within, you know, the city, within our neighborhoods as much as possible. And that we’re looking at creating a space where folks want to be here, where they want to come and provide services because they know that they will be honored and cared for and respected as a diverse community member. In order to retain them.
keevin bybee 14:46
Yeah, exactly. And that’s why I like and trying to figure out how we can bring as many of these services into the the school because that’s where the kids are. And then you mentioned the financial piece. You know, it’s not just having the school, it’s the soup in which we live in the fact that so many services are not free at the point of care. And, you know, we people can get hung up on how many entitlements we have, and how people need to take care of themselves. But I really think, realizing that, you know, nobody was nobody chose the position in life into which we were born. And so how much luck really goes into anything and everything that we have and the outcomes that come from that. And so thinking about how we can for at least for our kids, make it so that these services are free at the point of care and easy to find. just powerful stuff. You one thing I want to touch on is the ratio of how many of you there are for how many kids need you, the National Association of School psychologists mentions that they have a model where they want to have one psychologist for 500 students. And you know, my Google fu was not up to snuff. And I couldn’t find out where they came up with that number. I don’t know if they just like 500 is a good number. I’m just curious if you can speak to that, as well as the National shortage. I read another statistic, like the average is actually 13 101 to 1300, across the country. And then in a perfect world, you know, if we had enough money and training, how many of you do you think there should be? What would the ideal ratio be?
emily 16:37
Good questions. I think that the NASP model, looking at that ratio, the one to 500 is a pretty good ratio, the one because of factors and both general education and special education. One thing that a lot of folks don’t know about the role that school psychologists play is that we are funded from special education. So historically, our jobs going back in time was to identify to identify students of concern, assess them, and either find them help find them eligible or ineligible for services based on the data that was there. That’s the old model. That’s the testing centered model, which isn’t a comprehensive whole person model. And the way that NASP has adjusted it, that one in 500 ratio, looks at one of us per 500 students, regardless of general education or special education. Because a lot of the knowledge that we have, and that we do is we’re looking at data, we’re looking at whole school data, you know, disproportionate referrals for students of color, classroom academic interventions versus accommodations. How we’re, you know, small group instruction, classroom guidance, intervention teams, you know, really looking at kids even that aren’t on special education to see, are they getting the direct interventions that they need in order to make progress? Or are there preventative factors like attendance, a medical condition, mental health, suspected disability that are preventing them from learning even with access to instruction? So for me, I work at a large school. Well, largish, 1600 students, and I’m the only full time school psychologist. We have one other person who’s there one day a week, but she also covers to other schools. And so what we’re able to provide at that mass knowing that we work with, we consult with both general education and we have a caseload, I have a caseload of around 155 students right now, just in special education. But I also am addressing all of the referrals for evaluation for like suicide attempts, psychiatric hospitalizations, things that would prompt a consideration for special education, even if a child wasn’t already eligible. I know places where it’s much higher.
keevin bybee 19:43
Again, I just think it behooves us to consider the larger system in which that takes place. I why as a society is kind of rhetorically, why aren’t we subsidizing this education? You know, we would, I would think that let’s let’s put full scholarships on anybody that wants to go into this educational track and make sure that they’re going to have a really nice salary on the outside. I hear so many people saying, Well, you know, you don’t want to raise the salaries too much, because then you will only get people in it for the money, which strikes me as odd coming from medicine, because nobody says, Oh, shit, we really don’t want to pay doctors a lot, because then they’d only be in it for the medicine. So I, there’s, for me, I see an enormous cognitive dissonance there. And, you know, I don’t expect anybody to have an answer just more putting it out there like, hey, society, you know, maybe this is something to think about, we somehow find enough money to buy tanks. And I think a school psychologist is a little bit cheaper than the tank.
emily 20:43
I think that the value that society has placed on teachers and educational staff is just declined. I mean, we’re, we’re expected to be all and do all entreat all and take care of all with less than less. I mean, there are teachers, I was reading an article on NPR about, like stimulus support. And one particular woman who is a high school teacher and a mother of two, a single mother, who’s living on a salary of $55,000. And had, you know, teachers that have second and third jobs in order to sustain their rent and their food. And, you know,I don’t think that educators get into it for the money, they do it because they want to do well. And one in five educators quits within the first five years. They just, it’s too much. And I think as a society, you know, looking at the pandemic, and everything that’s happening, teachers or mental health providers, they are trying to get basic needs met for kids. And, you know, they’re faced with more and more expectations, meeting state standards, graduation requirements, college property, you know, all of these things that really make it difficult to sustain, if they also want to have a family or be a healthy human being themselves. And it’s a societal problem. You know, and a lot of families rely on school for childcare. You know, they they’re hardworking families that are doing the best that they can to provide for their kids. And their place of support is school. It’s free, and it should be free for families. Yet, education, Stafford are tapped out with what they’re expected to do based on the resources they have available.
keevin bybee 22:45
Yeah, my sentiments Exactly. Again, permit me another philosophical digression, but I just think it’s so important to keep things in context. You know, it’s 2021, the robots are coming, automation is getting more and more prevalent. There’s a narrative out there that Oh, what are people going to do without jobs? How are they going to find meaning? Well, I mean, first of all, the the main sources of work right now retail, people that sit behind a desk, like a bank teller, truck drivers, you name it, all of that stuff is going to go away. So there’s going to be a lot of free hands. And so we have the physical resources in the world, to food, clothes, shelter, and educate literally everybody a couple times over. So it’s it’s not that we don’t have it, it’s a certainly a distribution issue. And we can, we don’t need to get into the weeds of how to distribute it. But that’s why I was really a big fan of Anthony gay or excuse me, Andrew Yang and the the concept of universal basic income, because then at least we can start to subsidize people. So they, they have a little bit of breathing room. And then if we also as a society decide to pay for these jobs from the public coffers, then we can put more people into caregiving roles in a professional caregiving role. And I think that would also help alleviate some of the personnel shortage to do all of the work that needs to be done, which you can’t do with the robot. So like, let’s do what humans do best, which is take care of other humans and a hand to hand face to face way that we’re not currently doing. And that would be great if we just had a lot more people whose jobs were helping other people develop and learn how to take care of themselves. So just curious if you have any response to the Star Trek utopia that I describe.
Unknown Speaker 24:42
I think it as a culture as like white American culture.There’s a very individualistic perspective. It’s you know us before others and that is a society We definitely look out for number one. And that is going to require a big cultural shift. Not everyone has the same skill set or ability to, you know, think of how people might be impacted, you know, our brains get kind of boxed into one way of thinking and being based on how we’re raised, where we come from what people expect from us, what we expect from ourselves. And, and getting into caregiving roles requires a level of empathy. That is hard for some people. I always, you know, I have a friend who is a child oncology nurse, and like, I could never do that job, like it would drown me. And she said the same thing about my job. So I think, you know, it’s finding special people and people who really are invested in care, and then having the support system to take care of the people who are caring for others. The stereotype and stigma around mental health and asking for help, is still really problematic in our country. We say, there’s all this self care stuff and toxic positivity about what we should be doing. And yet, the reality is, is companies, bosses, other large institutions still don’t really value in our country, the self care and the humanity that we bring to the table with us, every time we walk through the door to do a job. So having more people that could help alleviate the tension and the stress and share the load, I think would allow the prevention of some of the burnout that happens with people that are in those roles, for looking at retaining support people in health care providers, mental health providers, educators, for the long term.
keevin bybee 26:57
Yeah, in medicine, you know, burnout, moral injury, moral fatigue are enormous. I mean, we get the, probably the biggest press on it for for better or worse. And certainly I felt it myself. And that, you know, there’s this narrative out there that, well, you’re getting burned out, you know, what you need to do, you need to do more, you know, start exercising, get more sleep, you know, do do these meditation practices. And, you know, like when, how, so you we’ve mentioned, you know, during our previous conversation, just that compassion, fatigue, and how to sustain our caregivers by resourcing them better. You mentioned something about a pro qual Is that something that would be worth sharing and talking about.
emily 27:47
So the protocol is professional quality of life rating scale. And it was initially developed for first responders, looking at how they’re impacted by those traumatic either one time events, or multiple occurrences of events, especially when folks live in areas where there’s a lot more violence or crime or death. And how that prevents people from checking in with themselves and seeing the level of burnout. We like you were saying, We live in a society where it’s like, do more, do more, do more. And then we miss the warning signs that we have where we’re burning out. I found that assessment helpful, like when I was supervising clinical mental health interns, as a way to check in with them and have them fill it out. What I what I bring to it, though, is caution. And that it can be really easy to find an internet questionnaire, a tool and be like, I’m gonna fill that out. But if you’re not prepared to deal with what you learn from it, and it’s adding, it can add more to your burnout and your vicarious trauma and your compassion fatigue as you realize just how impacted you are. So I caution, folks that if they do decide to do something like that, that they’re when he talks about the stages of change, you know, being contemplated about making a change, that you’re going into filling something like out that out with some kind of plan to take an action step to change your current state. Otherwise, it can be really unhealthy. Another unintentional consequence of trying to get better, but unintentionally causing harm to oneself because they’re not prepared to learn what they’re going to learn from filling something like that out. This is been really great. I want to be very respectful of your time. We have a surprisingly beautiful Friday in March. And so with the sun out, it’s not a great idea to sit in front of a screen any longer than we have to.
keevin bybee 29:33
So I really appreciate you letting me like I said, Do my philosophical digression You’ve shared so much wonderful information. You know, I certainly learned a lot, hopefully people listening will have learned a lot. Is there anything that I forgot to ask about or anything else that you would like to plug or share or leave us to contemplate in the meanwhile?
emily 30:08
I just think that the more we can come together as a community, and see the value and humanity, and on each other, the better off we will be. Schools are a hub for our communities. A lot of kids spend more waking hours at school pre COVID, than they do at home with her family members. And I think that, I believe inherently that people are doing the best that they can with the resources that they have. And if they’re struggling, it’s not because they’re choosing to struggle. I mean, I would if it’s just a matter of motivation, I would get on the elliptical every day. But it’s not just about motivation. And that pull yourself up by the bootstraps mentality is preventing us from really seeing the historical and institutional traumas that a lot of folks face that is rooted in their DNA. And that compassion and care for others would bring us a lot of help as being a healthier society. truer words rarely spoken.
keevin bybee 31:17
One thing I was like to try to close with is, you know, part of the my goal here is to expand my network and find other people that can show me my blind spots or what obstacles this project might run into in the future. And you’d mentioned maybe finding a couple of students who would enlighten me. So is that something that you’d be willing to look into and touch base on if it works out in the future?
emily 31:52
Absolutely. I think there’s a lot of power in student voice. And especially in the generation coming, I think, you know, they’re in the midst of a revolution. And it’s an honor to watch and see what they’re doing and anything that we can learn from students and their experiences, and how they represent, you know, the past and the future is a really good opportunity and seeing how we care for our communities moving forward. Yeah, absolutely. I’m really looking forward to this next generation of people who will not be saddled with the baggage that I grew up with in Midwestern white Iowa. So it’s certainly an exciting time. So again, thank you so much, please enjoy the rest of your morning. And I would maybe we could have around to some time in the future. I’m sure I have nowhere near exhausted. Everything you have to say on this topic. I would be happy to do it again.
Transcribed by https://otter.ai