Case: John is a 12-year-old African-American boy with a Specific Learning Disorder in Reading and Generalized Anxiety Disorder who you are seeing in follow-up at your clinic. Last fall, when John was having an escalation of his anxiety symptoms at school, he enacted the behavior intervention plan (BIP) that had been previously established by his educational team of informing his teacher that he needed to leave the classroom. He then paced the hallway outside of his classroom as a method of coping with the anxiety that he was experiencing. Approximately 3 months prior, John's teacher was unable to visualize him from her position in the classroom and subsequently called the School Resource Officer (SRO) to locate him. The SRO found John, who was in an emotionally dysregulated state. The SRO subsequently approached John who noted that he wanted to jump off a cliff. Rather than following the BIP which details the need to involve the school counselor and social worker when John is in an emotionally dysregulated state to perform a self-harm/threat assessment, the SRO bypassed this step and, instead, notified the emergency response team, who initiated a petition for psychiatric evaluation, thus temporarily limiting parental rights to make certain treatment decisions. This led to John being transported to the local Emergency Department (ED) in the backseat of a police vehicle. While in the ED, a urine toxicology assessment was performed which returned negative and John was subsequently evaluated by the child and adolescent psychiatrist on call who deemed that John was not an immediate threat to himself or others and discharged him home with his mother. Subsequent to this event, John exhibited refusal to return to school and would remain in his family's car for 30 to 60 minutes before entering the school in the morning. Once at school, he would go to an administrator's office where he felt safe, and his school work was brought to him. His long-standing therapist, who he had been seeing for management of anxiety, began providing Eye Movement Desensitization and Reprocessing therapy with John as a trauma-focused intervention to address the events he experienced at school. John continued to exhibit school avoidance and was placed on home-bound instruction by the school in the spring, which comprised 60 minutes of special education instruction in the home each week, without provision of general education instruction. John went from being an A/B student to earning Ds and Fs, and he was denied compensatory instructional services by the school in the summer. The family comes to your DBP clinic that summer asking for evaluation of his traumatic symptoms and to create a plan for the fall and returning to school.
Valdez et al. (Mon,) studied this question.