Dissertation (Ph.Done.)

My dissertation has been uploaded online by the university and can be viewed/downloaded here.

The study developed and collected/analyzed initial validity evidence for a measure that quantifies the attitudes school principals hold about suicide prevention. Eventually, work like this might enable school mental health professionals and suicide prevention specialists to target their implementation strategies and interventions to match pre-existing attitudes.

While this is a first step and the measure is not ready for prime-time, I’m hopeful that future research can push this area forward and ultimately prevent suicide. Feel free to take a look at the link above and explore the study.

Making measurement matter in sucidology

I was fortunate to recently write a blog post for a great organization I’m a part of called the International Network of Early Career Researchers in Suicide and Self-Harm (netECR).

The post provides an big-picture overview of several measurement challenges in suicide research. I hope it provides some good food for thought. Check it out at the link below.

https://netecr.wordpress.com/2020/07/15/measurement-challenges/

Google: Can school psychologists…?

Inspired by this post from Sean Erreger LCSW about social work, I thought I’d also take a go at asking google about my field.

Two quick notes before I dive into the questions. First, for those looking for a quick introduction to who school psychologists are, I wrote a piece you can read here. Second, for many of the questions in this google search it’s important to understand that there are two levels of licensure for school psychologists.

The first is a specialist level licensure — this allows for school psychologists to practice in schools and typically requires a specialist degree (a masters + 30 additional graduate credits) and at least 1,200 supervised hours. The second is a full health service provider psychology license. This requires a doctorate, at least 1,200 supervised clinical hours before graduation (often much more), generally at least one year of supervised post-doctoral clinical hours, and passing the psychology exam called the EPPP. Being a licensed psychologist allows for full independent clinical practice. The vast majority of practicing school psychologists are certified at the specialist level.

A medical or clinical diagnosis is separate from classification under special education law. This distinction will be important to the questions below. It is important to know that for many of these questions, it is the job of the school psychologists to classify students under the special education disability categories of federal law. This classification system is separate from a clinical or medical diagnosis. All school psychs can do the former, only school psychs who are licensed psychologists can do the latter. Even then, sometimes sometimes school psychologists who are also licensed psychologists do not make clinical diagnoses in their school role.

Lastly, nothing in this article should be confused with legal advice. The laws in special education and mental health practice are complex and can vary by state.

Now, without further ado:

Can school psychologists diagnose dyslexia?

Certified school psychologists, working with the school’s multi-disciplinary team, can classify students as meeting the criteria for special education under the specific learning disabilities classification — which includes dyslexia. School psychologists who are fully licensed psychologists can make the clinical diagnosis of dyslexia, although this might not be their role while employed by the school.

Can school psychologists diagnose autism?

Certified school psychologists, working with a school’s multi-disciplinary team, can classify students as meeting the criteria for autism spectrum disorder under special education classification. Licensed psychologists can make the clinical diagnosis of autism, although this may not be their role while employed by the school. A full evaluation of autism spectrum disorders is often multi-disciplinary — and depending on the child may involve physicians, occupational therapists, speech and language pathologists, and behavior analysts.

Can school psychologists work in private practice?

Certified school psychologists generally only may practice in a school. School psychologists who are also licensed psychologists may have a private practice. Generally speaking, if that licensed psychologist is employed by a public school as a school psychologist they avoid having a private practice within the bounds of their school district or seeing children from that school as clients to avoid professional and ethical conflicts.

Can school psychologists diagnose ADHD?

School psychologists, working with the school’s multi-disciplinary team, can evaluate a student for ADHD and qualify a student for special education services or services under 504. Licensed psychologists can clinically diagnose ADHD.

Can school psychologists get loan forgiveness?

Assuming the school psych meets certain requirements of the programs, the short answer is yes. The more complicated answer is that these programs are very much in jeopardy under the DeVos administration.

Can school psychologists diagnose anxiety?

Certified school psychologists, working on a multi-disciplinary team, can evaluate whether a student’s anxiety interferes with their education and qualify the student under special education or 504. Licensed psychologists can make the clinical diagnosis of various anxiety disorders, although this might not be within their role when employed by the school.

Can school psychologists prescribed medication?

No. Medication is generally only prescribed by physicians or mid level medical professionals such as nurse practitioners or physicians assistants. The fine print is that in five states, licensed psychologists can prescribe medication if they have an additional masters degree in psychopharmacology, additional supervised clinical hours, and pass a psychopharmacology exam. Even in these states, however, prescribing psychologists typically do not work for schools.

Can school psychologists bill Medicade?

Generally speaking, no. Certified school psychologists cannot bill Medicaid or any other insurance. However, schools may recoup some of their special education services costs through medicaid reimbursement. Licensed psychologists can bill Medicaid outside the school system.

Can school psychologists work part time?

Sure!


If you have other questions or think I got something wrong, find me on twitter. For more about the work school psychologists do, visit the website of the National Association of School Psychologists or speak to your local school psych.

Organizing school mental health services for prevention

Why prevention?

Schools are busy places. One school psychologist serves hundreds of children. There is a Farside cartoon one of my professors is fond of: It’s a building on fire, floating down a river, about to fall off a waterfall, with a sign that says “Crisis Clinic”.

Ask a group of people who work in a high needs school if they feel like this cartoon reflects their day to day life and watch the hands go up.

Clinical skills, prevention services

Feeling like you’re operating in crisis mode is not sustainable for the long term. What if schools could respond to student crises and prevent problems from occurring in the first place?

School psychologists take a public health approach to providing school services — we respond to the immediate needs of students, but we also strategize about how to prevent challenges from occurring from the beginning. As schools serve all children regardless of need or health insurance, they are excellent places to take a public health approach to children’s mental health.

A public health approach

The public health approach has been around for decades, but has only recently made inroads into school practice. In schools, this approach is called multi-tiered systems of support (MTSS) — sometimes also referred to as the three-tiered model or the response-to-intervention model. Imagine a triangle. The base of the triangle is the largest area — this represents the universal level that aims to meet the needs of all students. The next part in the triangle is smaller and provides services for about 15% of students who need supports in addition to tier 1 to be successful. Finally, the tip of the triangle is the smallest part and represents tier 3 where about 5% of students receive intensive individualized services. Buy focusing on the universal base of the triangle and intervening early with milder problems as they develop, this model helps prevent challenges before the occur rather than waiting to provide help until problems are severe at tier 3.

At the universal level, all students receive services. This can look like evidence-based systems for positively managing challenging behavior in class, strong reading curriculums, and social-emotional learning instruction to help all children recognize and understand their emotions. Tier 2 services involve a brief problem solving assessment to identify the students’ needs. Interventions at this level are typically time limited or delivered in group format to be resource efficient — for example additional small group instruction might be provided to a struggling reader, group counseling to students with social skills challenges, or brief in class behavioral interventions for students who are off task. In tier 3, assessments are more comprehensive and services are more intensive — such as individualized instruction, counseling, and case management. At this level, services often involve multiple providers both inside and outside of the school, warrant greater family involvement, and may involve services through special education.

At each level, there is an emphasis on providing evidence-based interventions and collecting data so that the team serving the students can make decisions on whether or not the services provided are working.

A public health approach like MTSS helps schools meet the needs of all students. Incorporating population health thinking is critical in schools as most schools do not have enough resources to provide intensive services to a large number of students. Addressing challenges before they start or become severe is the right thing to do for children and helps school providers keep from continually running in crisis mode. Prevention, from both an ethical and logistical standpoint, is the key.


Want to know more? The National Association of School Psychologists has a resource sheet on using MTSS to support all students. Curious about who school psychologists are and what they do? You can find more information about school psychologists here.

How prevalent is child maltreatment?

Content warning: child maltreatment and sexual assault statistics.

If you work with children, chances are you’ll meet kids who have experienced maltreatment. Child maltreatment includes abuse — physical, sexual, and emotional — and neglect. All 50 states have laws that protect children against maltreatment.

Although all states have their own specific laws about what constitutes maltreatment, the definition in federal law is:

Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm.

One way reachers study areas like child maltreatment is by putting numbers to the size of the problem. We call this the prevalence. Prevalence is often described in two different ways: yearly prevalence and lifetime prevalence. Yearly prevalence is straight forward: this is roughly the amount of children who experience maltreatment in any given year. Lifetime prevalence is the number of children who experience maltreatment at any time in their lives. For children, this usually means from birth to 18 years old.

So how prevalent is it? The honest answer is that researchers do not know for sure. Rather, they use a variety of research techniques to make informed estimates. Currently, two large-scale methods are used: 1) looking at data from state child protective services agencies and 2) doing nationally representative survey research.

Looking at child protection agency data

Each year, the Children’s Bureau of the US Department of Health and Human Services releases a report that compiles state level agency data so that readers can get information about the national prevalence. The current report describes data from 2015. This report states:

  • State child protective services agencies across the US received 4 million referrals involving 7.2 million children.
  • Of these children, 683,000 were found to be victims of maltreatment — including 1,670 fatalities.
  • 75% of these children were neglected, 17.2% were physically abused, and 8.7% were sexually abused.
  • About 148,000 of the children found to be victims of maltreatment were placed into foster care.
  • Children under one year of age have the highest prevalence (24 in 1,000) and this generally declines as children age with the lowest prevalence being for 17 year olds (3 in 1,000).

This national data by year is useful, but to get the full picture we also want to understand the lifetime prevalence. A 2014 article in JAMA Pediatrics used a collection of yearly child protective services agency data to estimate lifetime prevalence. The authors calculated that 1 in 8 children in the US will experience abuse or neglect that is substantiated by a state child protective services agency by the time they are 18.

While there are still more ways to examine the above data to gain other details, using a different method — nationally representative surveys — also provides yearly and lifetime prevalences.

Looking at the survey data

The National Survey of Children’s Exposure to Violence (NatSCEV) is a government sponsored, nationally representative survey. By asking a representative group of 4,000 young people ages 0–17 and their caregivers, the researchers can examine both yearly prevalence and lifetime prevalence. The most recent version of this survey took place in 2014 and is described in this article published in JAMA Pediatrics. The authors estimate:

  • In the year prior, 15.2% of youth experienced at least one type of maltreatment assessed in the study: physical abuse, sexual abuse, emotional abuse, neglect, or custodial interference / familial abduction.
  • The lifetime prevalence for the 14–17 year old age group of experiencing any of the above categories for maltreatment was 24.5%.

The survey included many additional types of violence exposure beyond caregiver child maltreatment. For example, 21% of all youth had a lifetime exposure to a sexual offense. 12.9% of 14–17 year old girls had experienced an attempted or completed rape in their lifetimes.

A second nationally representative survey is the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4), which is conducted periodically by the US Department of Health and Human Services. The most recent study collected data from 2005–2006. This survey is unique in that it measures abuse and neglect on two different standards: The harm standard and the endangerment standard. The harm standard is stringent in that it requires ‘demonstrable harm’ to classify an incident as abuse and/or neglect. The endangerment standard is less strict and captures a larger group of children.

Using the stricter harm standard, the NIS-4 found:

  • 1.25 million children experienced abuse and/or neglect during the 2005–2006 year, which is 1 in every 58 children in the US.
  • 44% of the sample were abused while 61% were neglected.
  • Of children who experienced abuse, 58% (323,000) were physically abused, 24% (135,300) were sexually abused, and 27% (148,500) were emotionally abused.

When the less strict endangerment standard was used, NIS-4 found:

  • Nearly 3 million children were abused and/or neglected during the 2005–2006 year, which is about 1 in every 25 children in the US.

Child maltreatment is a major public health problem in the United States. For more resources, visit The National Center for Child Traumatic Stress and the US Centers for Disease Control and Prevention.


If you believe a child is in danger, call the National Child Abuse Hotline at 1–800–4-A-CHILD / 1–800–422–4453 or your state child protective services agency. Help for survivors of sexual violence is available from RAINN via their website or their hotline at 1–800–565-HOPE / 1–800–656–4673.

You’re who? The school psychologist.

School psychology is a broad field. Its researchers and practitioners have a wide range of training and expertise. This can make it hard to explain exactly who school psychologists are, but it’s also one of the field’s greatest strengths.

A quick google search will tell you a lot about who school psychologists are not. We’re not guidance counselors, adjustment counselors, social workers, or psychiatrists (MDs) — although we may work with each of these professionals. Sometimes we’re both school psychologists and licensed health service provider psychologists. Some school psychologists hold specialist degrees (MEd/CAGS or EdS) and some hold doctorates (PhD or PsyD). Sometimes school psychologists are also behavior analysts (BCBAs). Some states have separate licensure for educational psychologists. Confused yet? You’re not alone.

School psychologists are mental health professionals who are trained in education (particularly special education for students with disabilities) and psychology across the areas of prevention, assessment, intervention, and consultation with teachers and families. School psychologists help teachers and parents find solutions to academic, social, emotional, or behavioral challenges their children are experiencing. In addition to working with individuals, school psychologists work at the systems level to ensure the school as a whole is meeting the needs of all students. Importantly, the profession emphasizes evidence-based practices — meaning scientific research guides their decisions and actions.

If you’re interested in learning more about the specifics, I discuss what a day might look like for a school psychologist and the types of training school psychologists typically have.

Beyond the 50 minute hour

When people think of psychologists, they typically imagine them providing individual therapy in hour long sessions. You or someone you know may have participated in these therapy sessions. Although school psychologists do provide some counseling to both individuals and groups, the general practice of school psychology does not often involve the 50 minute hour that clinic-based services can offer. Many school districts have one school psychologist for more than 1000 children. Providing individual therapy to each student who needs support is often not possible. Counseling services are thus usually brief, skill building, and solution-focused.

So if school psychologists don’t hold counseling sessions all day, what does their day look like? While it differs from district to district, a day might involve any combination of: conducting psychological evaluations for special education eligibility, designing and implementing behavioral interventions, running social-skills groups, conducting screenings for social, emotional, or behavioral concerns, helping school staff collect and interpret data, consulting with teachers and parents, responding to students in crisis, attending special education team meetings, or working on prevention programming and systems improvement.

If you’d like to learn more, take a look at this resource from the National Association of School Psychologists.

A look at the alphabet soup

The minimum standard for certification as a school psychologist is typically what’s called a specialist degree. This degree is 60 graduate credits — sometimes thought of as a ‘masters + 30’ — and an internship that is at least 1,200 hours. This amounts to three years of graduate education. The education specialist degree is abbreviated EdS in most states or MA/CAGS (certificate of advanced graduate study) in some others. This training qualifies the school psychologist to obtain certification under their state department of education. School psychologists at the specialist level are also eligible to become Nationally Certified School Psychologists (NCSPs), which denotes that their training conforms to the standards of the National Association of School Psychologists.

School psychologists can also have doctoral degrees, which are typically at least 90 graduate credits and include at least 1,200 hours of internship. Many doctoral internships require significantly more than 1,200 hours. This typically takes 5 to 6 years of training. These school psychologists have PhDs or PsyDs (and sometimes EdDs) and are also certified by their state department of education and are eligible for the NCSP. They may also teach and conduct research at universities.

Some doctoral level school psychologists also become licensed health service providers. This is the license that doctoral clinical psychologists and counseling psychologists have, also called the ‘professional psychology’ license. This allows for independent practice (i.e., private practice, practice at clinics, hospitals, etc). This requires a doctoral degree, an internship meeting a number of specific requirements, and typically at least one year of post-doctoral supervised hours.

An increasing number of school psychologists are pursuing the Board Certified Behavior Analyst (BCBA) credential. As school psychologists often conduct behavioral assessments and interventions, this is seen by some as a logical choice to advance their careers and improve their skillset — especially if they have a passion and expertise working with students with developmental disabilities like autism spectrum disorder. Many states now offer licensure for BCBAs that allows for independent practice. This credential requires additional coursework in applied behavior analysis and supervised practice hours.

Interested in becoming a school psychologist? NASP has a page to help you chose the right path.