Outline/Template for School Psychiatric Letters
Since much information at the public school Individualized Education Program (IEP) meetings may not be subject to the same levels of confidentiality that occurs in hospitals or clinics, it may be indicated to write a separate letter to schools when transmitting critical psychiatric data. Such letters ensure that pertinent data needed to substantiate a recommendation for special education services are provided, without unnecessarily compromising patient or family privacy.
Schools are often reluctant to follow specific recommendations from non-school professionals for a particular special education category or instructional setting; thus, it is more effective to describe a child’s behavior as it matches up with special education eligibility criteria and discuss his/her functional school needs as these match up with the type of classroom required and recommended.
PLEASE be sure to review a draft of your letter with the RNPH education consultant (Ilaina Blum x79170), the patient’s RNPH social worker, and/or your RNPH attending/supervisor prior to finalizing the letter. Please be sure that your letter is co-signed by your attending/supervisor and that a copy of the final, signed letter is put into the patient’s RNPH chart for our reference.
**Unless unique circumstances dictate otherwise, plan to provide a copy of the final, co-signed letter to the parents/guardians directly rather sending it to the school.**
Areas covered in a school letter typically include:
Identifying Information Pertinent history Physical Exam Results #
Course of Current Admission (include specifics/examples about the patient’s presentation)
Diagnoses and Medication Recommendations #
Please see the following pages for descriptions and examples of each section.
As noted, please contact the RNPH education consultant Ilaina Blum x79170 or the patient’s RNPH social worker with any questions regarding this. Thank you.
Identifying information Full name of patient, DOB,
Dates of hospitalization(s), and
Brief description of the reason for admission (list most recent admission first).
If patient was moved between inpatient and partial, indicate that the admissions were related. Reference information about the impact of any difficulties in the school setting. For example: “Johnny (DOB) is a year old male who was admitted to the inpatient psychiatric unit at the UCLA Resnick Neuropsychiatric Hospital (RNPH) from X date to X date due to concerns about increased suicidal ideation in the context of worsening bullying at school… Following discharge, Johnny was transitioned to the UCLA RNPH Adolescent Partial Hospital Program (APHP) on X date and remains in that program at this time.”
Pertinent History #
- A brief general psychiatric
- If applicable – any prior history of difficulties in school and prior school interventions, including if the patient has received formal special education services through an IEP, supports under a 504 Plan, and/or informal interventions within a general education program.
- Additional info. regarding Educational History – Summarize history of schools attended, suspected or identified learning issues, any interventions provided within the school or at home, effect of interventions, attendance problems. For example:
“Sam has had a history of Disorder, Disorder and
Disorder since 2011. He has received regular outpatient psychiatric care with a psychiatrist (Excellent Medman, MD) and a psychologist (Tellme Howyoufeel, PhD.) Despite these interventions and support from his parents, Sam has continued to demonstrate marked symptoms including , and . In addition, although not diagnosed, parents have noted social communication impairments, including ,
and , which have impaired his ability to establish good peer relationships. He was referred to the APHP by Dr. Howyoufeel.
“At the time of his APHP admission, Sam had been having daily arguments with his family members which had worsened since his transition from middle school to high school. This dynamic had been exacerbated by his reports of being bullied by 3 peers on the school bus and feeling overwhelmed by the size and academic pressures of 9th grade.
“In addition, Sam was diagnosed at the age of 5 with neurofibromatosis. Although he does not have obvious physical deformities, he has some neurofibromas and café au lait spots which are visible. He does not discuss his condition, but he is aware that NF is associated with various health concerns that may present as he grows older. Notably, his grades dropped after he did a report on this condition for his science class.
“Sam has had a 504 plan since 7th grade. Supports are limited to preferred seating and the option of taking spontaneous breaks from class if he is distressed.”
Physical exam results #
Specify, briefly, general physical health, results of vision and hearing screening, and if there are any restrictions on physical activity (this data is required for the IEP and often saves the family from having to get a separate note from family physician). For example:
“In terms of his medical health, apart from mental health, Johnny seems healthy. He is fit, moves easily, and has no limitations in terms of his motor skills, coordination skills, and basic perceptions, such as vision and hearing. He has no restrictions on physical activity. He is average height and build and is in good physical health.”
“Susie is in good general health, with no issues related to her hearing, vision, or any restrictions in physical activity.”
Course of treatment #
- Describe treatment program, for example:
“While in the APHP, Susie was involved in various activities within the highly structured, closely supervised and therapeutic group setting, with a maximum of 10 patients and a minimum of 3 staff typically available throughout the program day. There were small group activities (task groups, process and coping skills groups, recreational therapy, etc.) as well as individualized interventions (individual therapy, medication management, family therapy.) Susie attended the program consistently, participating Monday-Friday from 8:30 am – 3:30 pm unless scheduled for time off for therapeutic reasons.”
“As part of the inpatient program, Mark was involved in various activities within the highly structured, supervised, therapeutic setting. This included small group activities (e.g. task groups, coping skills groups, art therapy groups, recreational therapy) as well as individualized interventions (e.g. individual therapy, medication management). Even within this setting…”
(Please be sure that your description matches the program that the patient attended. ABC is very different from APHP, and both are different from 4W. Provide the information relevant to the patient.)
- Specific patient information from hospitalization:
Provide details/examples regarding your patient’s (1) presentation in the program and (2) response to interventions, specifying any problems or stressors that remain after treatment, especially those that may persist after discharge and effect your patient’s functioning at school. Provide SPECIFIC EXAMPLES. For example:
“Within this setting, Mark exhibited variability in his presentations. At times, he was engaged and cooperative with tasks and activities, while at other times, he was easily irritable. He often exhibited impulsivity and intrusiveness, having difficulty waiting his turn. Still, over the course of his admission, he demonstrated a relative improvement in these areas, showing increased patience and gradual implementation of more adaptive coping skills (e.g. good sportsmanship, sharing materials). “
“Even within this contained, therapeutic setting, Joel required on-going staff support and intervention to guide and remind him in using adaptive coping skills. He responded well to reminders from staff to go to a less stimulating area when starting to escalate, take a break from the activity or group that is causing distress, and engaging in arts and crafts when feeling upset. Prior to this hospitalization, when Joel became overwhelmed and was in a less contained environment, he became more dysregulated and was unable to independently settle and/or cope appropriately with his feelings.”
“However, even in this highly specialized, contained and supportive program, Susie continued to have difficulties with and , which then interfered with
. Staff responded by providing (behavioral supports and interventions). By the time of discharge, Susie demonstrated improvement in
but continued to require to help her maintain her progress.”
Summary of Testing Completed during Admission #
Provide a summary of pertinent findings from any testing completed during UCLA admission. Include scores when relevant.
Diagnoses and Medication #
Do not use abbreviations.
It may be helpful to acknowledge previous diagnoses which have been given and to explain the rationale for the current diagnoses, as previous IEPs may include information which is inconsistent with the current clinical assessment.
Also indicate if medication will need to be administered at school or not. For example:
“At this time, no doses of medication will need to be administered at school.”
Lastly, include:
“Following his/her discharge from the partial hospital program/inpatient unit, please refer to his/her outpatient providers for updated information regarding medication.”
Treatment and Educational Recommendations #
- Specify recommendations for patient’s further mental health/psychiatric
- Describe the patient’s behaviors as is consistent with special education eligibility Examples of special education categories that often fit with our patients include the following (see * below for details regarding criteria for some of these categories):
- Emotional Disturbance (ED)*
- Autistic-like behaviors/Autism (AUT)*
- Specific Learning Disability (SLD)
- Speech and Language Impairment (SLI)
- Other Health Impairment (OHI) (typically associated with ADHD) *
- Intellectual Disability (ID)
- Try to describe the child’s current or predicted school functioning in ways that school professionals can recognize (1) whether the child can function all or most of the time in a general education classroom with support throughout the week; (2) whether the child will require intensive specialized instruction and teacher supervision throughout most of the day; or (3) whether the child will require sustained special instruction and therapeutic support both in the classroom and through the entire school day in a setting where trained personnel are available to deal with crises.
For example:
“In summary, Joseph is a 14 year old boy with a history and current presentation of
, , and . These problems have interfered with his ability to learn and function socially in a typical school setting in the following
ways:
.
Even with medication stabilization and consistent outpatient therapy, these problems are likely to continue. They may be exacerbated if he is in an educational setting that does not provide the supports and structure he needs. Therefore, it appears that Joseph requires, and it is recommended that he receive, an increase in special education services and programming to include .”
Please note: The specific suggestions of this section should be discussed and described in collaboration with Ilaina Blum.
Closing #
“With permission from Alison’s parents, we are available to respond to your questions. Please feel free to contact us at .”
*Special Education Eligibility Category Details:
Emotional Disturbance (ED) – A student needs to meet only 1 of the following 5 categories:
(1) an inability to learn, (2) an inability to maintain satisfactory relationships with peers and teachers, (3) inappropriate types of behavior or feelings under normal circumstances, (4) a general pervasive mood of unhappiness or depression, (5) a tendency to develop physical symptoms or fears associated with personal or school problems. Stipulations: These difficulties need to have existed over an extended period of time and to a marked degree AND need to be primary factors adversely affecting the student’s educational functioning.
Autistic-Like Behaviors/Autism (AUT) – The student exhibits any combination of the following autistic-like behaviors to include but not limited to: (1) An inability to use oral language for appropriate communication. (2) A history of extreme withdrawal or relating to people inappropriately and continued impairment in social interaction from infancy through early childhood. (3) An obsession to maintain sameness. (4) Extreme preoccupation with objects or inappropriate use of objects or both. (5) Extreme resistance to controls. (6) Displays peculiar motoric mannerisms and motility patterns. (7) Self-stimulating, ritualistic behavior.
Other Health Impairment (OHI) – A pupil has limited strength, vitality or alertness, due to chronic or acute health problems.