Universal Screening in School Social Work: Celebrating Successes and Overcoming Hurdles

Editor’s Note:  School mental health researchers and policymakers are focused right now on promoting the use of universal screening tools to identify and treat more young people within a K-12 setting.  What has been often left out of these calls for universal screening is a sense of what the “on-the-ground” realities are in making screening work within a school setting and adapting universal screeners to specific school contexts.  School social worker Michael Flood has taken on this topic as his “school-change project” for the Loyola School Mental Health Advanced Practice Program (SMHAPP).  Here he shares the initial stages of developing the project, as well as some of the triumphs and challenges in implementing universal screening in his suburban Chicago middle school.   

Successes and Hurdles of Universal Screening in my School

Sometimes as a school social worker the hardest part of our work can be knowing where to begin.  I am a school social worker in a suburban Chicago junior high and have been practicing there now for seven years.  As my skill and confidence grew in my position, I began to question the way that we were identifying students for social work services, and also how to best go about assessing when students were ready to exit services with me.  I noticed that the kids I got the most referrals for were the kids that were acting out in class, and I had far fewer referrals for students who may be dealing with more “quiet” internalizing troubles, such as anxiety or depression.

The thought also occurred to me, as I assume it has occurred to other school social workers, that it seemed that social worker(s) were often made to feel responsible for the entirety of the mental health and social emotional responsibilities in school, and though we may try, it is not possible for us to tend to all of the needs in our schools.  As passionately as we all pursue our work in our schools, I knew that I needed to find a way to empower the other folks in the building to feel capable to address some social-emotional concerns, while also pairing that with using data in our decisions about what interventions to provide our students to meet their social-emotional needs. 

The thought occurred to me that it seemed that school social workers were often made to feel responsible for the entirety of the mental health and social-emotional responsibilities in school, and though we may try, it is not possible for us to tend to all of our school’s needs by ourselves.     

I began to investigate more objective ways for identifying students for social work.  In my School Mental Health Advanced Practice Program (SMHAPP) through Loyola, I found some of the answers I was looking for.  In looking into best practices for multi-tiered systems of support, Universal Screening was cited as the starting off point for identification of student need (Kelly, Raines, Stone, & Frey, 2010).  This information was pivotal, and the plan seemed so simple; Implement a valid and reliable Universal Screener, and subsequently I will have all the information that I’ll need to make sound decisions about social work services.  With Universal Screening, it seemed I had my answer for a more objective way of identifying students, so I set out to garner support for the idea.  I outlined my idea as part of a quick interview I did last summer at Loyola’s 13th Annual Summer Institute.

To my surprise, teachers and administration alike were on board with the idea and I had plenty of support.  I spent the remainder of the school year figuring out a plan for rolling out a screener. The screener that I used, The BESS-3, was already built into the software that our school uses for behavioral tracking, and upon further research there was evidence supporting this screener as reliable and valid.  My administration and I set a schedule, planned supports in advance based on what the possible results could be, and we rolled out the first of 3 Universal Screening in the fall. We will have 2 more administrations of the Universal Screener before the school year is out.

After our first administration of the screeners, I learned a lot, to say the least.  Some of the insights were just as we had hoped, and other aspects of the process caught us totally by surprise.  I thought an article covering what went well, and what obstacles arose would be helpful for the masses.

Initial Screening Project Successes:  

One of the most amazing aspects of using our Universal Screening tool was that now at the click of a button, I had a pulse on the entire school, and from two different perspectives; teacher and student.  It also broke down scores into different areas of need such as Externalizing, Internalizing, Adaptive Skills, Self-Reliance, and an Overall Risk Index. We spent the following days doing clinical interviews with the highest risk students, and also did risk assessments for students who indicated areas of concern.   

Staff support of this project has so far been an unequivocal success.  The work that I put in prior to roll out in explaining to teachers the benefits of Universal Screening seemed to pay off, as many of them were eager to incorporate the relevant data into their problem solving meetings about student behavior.

Another benefit of utilizing a universal screener is we now had an objective way of assessing how a student was functioning in the moment, and had a benchmark to measure against to determine if progress was being made. This information will be a cornerstone to building social work entrance/exit criteria in our building, and potentially our district, which is one of our next steps. This data was also helpful in creating goals for student progress.  

Since we were able to compare the data from teacher and student responses, we were also able to identify potential relationships that needed to be strengthened if a teacher cited strong areas of concern, and a student indicated no areas of concern.  These insights were able to be shared with teacher in order to work on more relationship building and empathy within the classroom.  

Since we were able to compare the data from teacher and student responses, we were also able to identify potential relationships that needed to be strengthened if a teacher cited strong areas of concern, and a student indicated no areas of concern.  

An unexpected but positive outcome of utilizing the screener was that it confirmed many of the previous decisions that we had made about how to deliver social work services, meaning that the the vast majority of the students with the highest level of need were already on social work caseloads and had intensive wraparound services.  This feedback was heartening to see and affirming to the wisdom of the social workers and teachers alike.

Screening Project Obstacles/Hurdles:

If you screen it, they will come:  

We had some interventions in place for what we anticipated after our first utilization of the screener. But it was clear to see soon after doing the screening that we needed to develop a more clear framework for supporting students identified in the screener.  The tool that I used had scores for overall behavior, externalizing, internalizing, adaptive skills, self-concept, and self-reliance. We are currently doing a deeper dive to see what evidence informed supports could help with different levels of need in this area.  

Tier 2, Still (mostly) the social workers job…  

An aim of Universal Screening was to help us identify what students needed what level of support within our MTSS framework.  Prior to administration of the screener we had a very strong Tier 1 level of support, Tier 3 was social work services, and Tier 2 was beginning to emerge but was still mostly undeveloped.  It seemed like lots of kids went from having Tier 1 supports to Tier 3 with little happening in Tier 2.  The data from our screener indicated that many kids reported needs more in line with a Tier 2 type of support.  While our school is making more concrete plans for incorporating teachers into SEL Tier 2 work, many of those students are still the responsibility of the social worker for the time being.  I hope to see this continue to shift over the rest of the school year into next Fall.

Technical difficulties.  

No one wants to score 700 screeners, so utilizing technology is inevitable, but there are bound to be issues with a tech roll-out as well.  Even though our plan was solid, we still had some difficulties with technology in the classroom. In these situations we just had to roll with the punches and collect the data we could (which thankfully was possible for most students in most classrooms).

Absent Students:  

It was necessary to follow up with students who were absent to have them complete the screener for us as well.  This was just an added logistical hoop. 

Not taking the screener seriously:

We did have to follow up with several students who had high scores in multiple areas only to find that they had not taken the questionnaire seriously and thoughtlessly answered questions.  Although this was rare, it did raise concerns for us, so we are going to build in more pre-teaching about the process to students the next time we use the screener.

So after all of this, what would I recommend to all of you out there for your school mental health practice?  I’d still recommend Universal Screening. Although there were some hiccups and blind spots that I had not planned for, and the planning and follow-up to the Universal Screener created a ton of work, the outcomes that were generated were powerful nonetheless.  

I would suggest, however, that before utilizing a Universal Screener, teams and districts should have a strong outline of MTSS in advance that they feel confident about and that will be in place to support students.  In my experience, this can only be done with teachers and other staff members taking some ownership in Tier 1 and some of the Tier 2 behavioral supports in the building.  We are still working on finding ways for our staff members to support my team in doing this.   While my aim was to identify at-risk students and scaffold the delivery of multi-tiered supports from all staff members, much of the responsibility still lies on the social worker.  But I now have the evidence to demonstrate that this system needs to change, and I plan to use this data to garner support from key opinion leaders like my school principal and teacher leaders. 

References:

Kelly, M. S., Raines, J. C., Stone, S., & Frey, A. (2010). School Social Work: An Evidence-Informed Framework for Practice. Oxford University Press.