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Case Study: Keystone Using In School Support & Grounding Techniques to Help Students’ Anxiety

Updated: Mar 16, 2022

Sandy Gates, LSW, has been the Student Assistance Program (SAP) program director for Keystone Human Services (KHS) since October 2020 and a KHS mental health consultant since 2018. She is also a mom of three children in 4th , 6th , and 10th grades. She knows all too well personally and professionally the havoc that COVID has wreaked on students, teachers, administrators, SAP agencies, and providers.

“We are definitely seeing more depressive and anxious symptoms, including among parents,” said Sandy. “Even social situations, like walking the hallways with all the students in one space, brings stress. That’s coming from being isolated for so long.”

“Most of the students did not do well with virtual learning,” Sandy said. “Failing grades and attendance issues increased. With the return to school, some are reporting a lack of motivation to complete their work and are skipping school. Many are sad, anxious, and not sleeping well.”

KHS is located in Harrisburg, Pa., the state capital. Two other mental health consultants join Sandy in covering 12 Dauphin County school districts with 45 individual schools, one private high school, and two charter schools. KHS screens students 12 and older, grades 6 thru 12. The consultants work remotely and are assigned the schools they manage based on where they live. At press time [second week of January] one entire District and two schools in two other Districts temporarily moved to online learning because of high COVID cases among staff and students.

Grant Allows Elementary Schools to Participate

The pandemic has entered its third year and as Sandy explained, kindergarteners at the start of COVID are now in 2nd grade.

“Teachers are reporting more non-school ready behaviors among students such as difficulty following classroom rules, an increase in conflict with their peers, leaving classrooms without permission, seeking reassurance repeatedly, and increases in panic attacks and physical symptoms as a result of anxiety. Students are reporting confusion with assignments and are often questioning due dates and where their assignments are located all as a result of the combined in person and virtual learning platforms that they have been juggling since the spring of 2020,” Sandy said.

Fortunately, a local grant came through in September 2021 that is funding two more SAP mental health consultants to specifically help 21 elementary schools in the county. Similar to staffing shortages across the state and country, at press time they have only been able to hire one, who starts in February. The elementary schools will generate a parent report when they screen students because of the younger ages.

GLS Grant Participation

Dauphin County government made the decision to participate in the Garrett Lee Smith Grant with the other Pennsylvania SAP agencies, and that included using the bhworks software platform from mdlogix.

“It works well with the paper informal assessment we already have in place and have kept in place for state quarterly reporting reasons,” Sandy commented. The paper assessment works alongside bhworks now.

As Sandy describes it, the informal assessment has a cover sheet for quarterly reporting to the state. It includes demographic information, reason for referral, recommendations, and date of parent contact. The consultants also write personal notes with an outline covering family of origin, academic history, mental health history, suicide assessment, medical history, and drug and alcohol use to guide the consultants to cover every area. It also includes handwritten notes about the parent call.

When they need to submit their state reports each quarter, they use the CareLogic Electronic Health Record system to gather the required information. It is what Keystone has been and will continue to use for that particular task.

bhworks moves into action

When it comes to the bhworks electronic screening module, KHS mental health consultants talk with the student first and then have them take the screener. Consultant communication with parents and students in advance of the screening has meant their refusal rate is low.

Sandy said, “We find the questions asked about risk factors such as being teased by peers, feeling as though their mind is playing tricks on them, and questions in regards to forced sexual experiences; these are questions that students seem to be willing to report when taking the screener but are not always forthcoming verbally.”

The only topics they have found that students are more hesitant to answer truthfully in person and online are questions about drugs and alcohol.

When the consultants show the students the personal reports generated by bhworks immediately after they answer the questions, most of them believe it’s objective data and pretty accurate.

One Challenge

The one ongoing challenge is the barriers that some of their schools have with access to their guest Internet and one school does not have any Internet service. In these instances, the consultants use a hotspot and work on personal phones or laptops.

Resources to Help Student Anxiety

The KHS mental health consultants are a significant, relied upon resource. They have not had a high turnover and they are reliably present for their schools, including in person, by phone, zoom, and via email.

“If we can’t make a meeting, we let them know why we aren’t there. Our dependability deepens the relationship and trust,” Sandy explained.

School SAP teams were formed and consist of school counselors, teachers, administrators, social workers, nurses, one agency mental health consultant, and one drug and alcohol counselor.

“The SAP teams meet anywhere from weekly to biweekly to monthly. We are required to attend at least one meeting a month however we often attend more than that. Although some meetings have returned to in-person, many remain virtual through platforms such as Zoom or Microsoft Teams,” said Sandy.

The SAP teams talked about additional helpful resources and one decision was to disseminate to teachers an excellent guide called, “Living with Worry and Anxiety Amidst Global Uncertainty.”

guide_to_living_with_worry_and_anxiety_amidst_global_uncertainty_en-us (002)
Download PDF • 1.24MB

The second resource is choosing coping skill activities, including sensory–sight, sound, touch and smell, from a grounding technique menu. Both documents are from PsychologyTools.

Download DOCX • 138KB

Classrooms can do group exercises to help relieve anxiety: standing up and stretching, taking breaks, breathing exercises, use of music in the classroom, distraction activities after work completion such as puzzles to work on together in the back of the room or passing a nerf football; and getting outside for physical education and movement. Extra-curricular activities and social gatherings even via Zoom have had a positive impact.

They also employ different mentoring set ups. A student can be mentored by a teacher or another supportive adult in the building that they feel they can turn to for help and guidance. Peers can mentor one another to help make positive social connections especially in situations with new students to the school. One of their school districts also allows the high school students to mentor elementary school students, which has had positive feedback.

“We also offer support to the school staff,” Sandy said. “They are feeling great amounts of stress just like the students. We encourage them to practice self-care. We advise them to find even small pockets of time in the day to do something they enjoy or to use a coping strategy. That’s important for all of us.”

Editor’s Note: Sandy Gates can be reached at if other SAP agency staff would like to discuss or ask questions about this article’s content.

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