Everything You Need to Know About Handle with Care Programs

Introduction

When a child packs their backpack in the morning before school, they might add their classwork or a take-home quiz. But they also carry with them any experiences that occurred after they left campus the previous day. They might have seen a fun movie with friends, scored the winning goal at their soccer game, or stayed up late talking to a significant other. In other instances, parents may have fought, or they may have witnessed drug use in the home.

Without having someone to talk to about these experiences, whether positive or negative, we can only imagine how they relate to the child’s performance at school. They might be tired from staying up late and feeling extra distracted in class. Or they might be feeling the effects of trauma and not even be aware of those physical and mental effects.

Handle with Care is a way that districts can provide proactive, holistic support to students affected by traumatic events at home. When a first responder is called to a home and a child is present, the school can be notified of that event so that the next day, someone has the opportunity to check in with the child.

Schools are uniquely positioned to provide care to students. Handle with Care is one way to interrupt the cycle of trauma and support students more fully.

In this piece, we’ll dive into the ins and outs of Handle with Care: what it is, why it matters, resources for getting started, and more.

What is Handle with Care (and Why Does it Matter)?

Handle with Care is a notification sent from law enforcement to proactively alert a child’s school that they have experienced or witnessed some form of trauma. At its core, Handle with Care is a framework. Like the frame of a car, frameworks help guide efforts to offer structure and support. Rather than being one piece of legislation, it’s a community-driven initiative.

Being community-driven means that Handle with Care requires grassroots support from the entire community, particularly the district, law enforcement, and child protective services. We’ll dive into the details of how it works, but first it’s important to understand why this framework is so important, especially right now.

Mental health, especially for students, has been thrown under an increasingly large spotlight over the course of the pandemic. Of course, if you work with students, you’ve likely seen this trend bubbling beneath the surface of the national conversation for a long time.

For every breaking news story of gun violence, for every rise in the death toll for COVID-19, or for every data point about rising sea levels, there are children who absorb the force of these words. They then return their attention to their homework or to the number of likes on a recent TikTok before they’ve had a chance to fully process everything they’ve seen, read, or heard. And those news stories don’t even cover the kinds of events they might experience in their own homes.

So it’s no surprise that according to the National Center for Education Statistics, “70% of public schools reported an increase in the percentage of their students seeking mental health services at school since the start of the COVID-19 pandemic, and roughly three-quarters (76%) of schools also reported an increase in staff voicing concerns about their students exhibiting symptoms such as depression, anxiety, and trauma.”

The instances of trauma that many students face qualify as adverse childhood experiences (ACEs), which the Centers for Disease Control and Prevention identify as “potentially traumatic events that occur in childhood (0-17 years).”¹

The Centers for Disease Control and Prevention (CDC) lists examples such as:

• Experiencing violence, abuse, or neglect
• Witnessing violence in the home or community
• Having a family member attempt or die by suicide
• Growing up in a household with substance use problems, mental health problems or instability due to parental separation or household members being in jail or prison

According to the CDC, adverse childhood experiences are common and are linked to physical and mental health problems: “61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE before age 18.”² These experiences are linked to “lasting, negative effects on health, well-being, as well as life opportunities such as education and job potential.”³

What kinds of links are there between adverse childhood experiences and developmental disorders? For one, a 2021 study found that “children exposed to four or more ACEs had higher odds of ADHD and moderate to severe ADHD than children exposed to fewer than four ACEs.”⁴

Another study’s findings support the link between “ACE exposure and behavioral issues and poor physical health outcomes.”⁵ And one more study drives that point home in no uncertain terms: “ACEs have demonstrated risk of depression, anxiety, aggression, suicide risk, personality disorders, and substance abuse.”⁶

Additionally, it is the position of the National Association of School Nurses (NASN) that school nurses “serve a vital role in the recognition of early signs of child maltreatment, assessment, identification, intervention, reporting, referral, and follow-up of children in need. Serving as members of interdisciplinary teams, school nurses also collaborate with school personnel, community stakeholders, healthcare professionals, students, and families to promote the safety and protection of children.”⁷

Too many schools are forced into post-vention for instances of bullying, violence, or suicide in schools. Because of the correlation between traumatic experiences and mental illness in students, it’s crucial for schools to have the ability to proactively support students who are at a greater risk of trauma response. While schools can’t control what happens when children leave campus, they can address trauma’s aftereffects earlier, and that’s exactly with Handle with Care seeks to do: provide earlier intervention to address adverse childhood experiences for students.

While providing earlier intervention can have a positive impact on the life of a single student, its effects don’t end there. A school’s culture, whether positive or negative, impacts student learning.⁸ Students have strong influence over peers’ classroom experience, and every instance of trauma in the community reverberates, sometimes loudly, often silently, across social circles.

So when you consider why Handle with Care initiatives matter, it’s not only because they can change the life of a single student, but also can alter the trajectory of a community.

How did the Handle with Care Model Start?

• Harvard Law School and the Massachusetts Advocates for Children (MAC) set out to help children who endured adverse childhood experiences succeed in the classroom.
• MAC enters into a formal partnership with Harvard Law School called the Trauma and Learning Policy Initiative (TLPI).
• The Helping Traumatized Children Learn manual is published. The publication was created in collaboration with psychologists, educators, and attorneys, and set a foundation for creating trauma-sensitive schools (and since then has been used in schools across the country).
• Brockton Public Schools becomes a pilot district for the Helping Traumatized Children Learn program.
• Plymouth County District Attorney Timothy J. Cruz and his staff help train the West Virginia Center for Children’s Justice on the Helping Traumatized Children Learn model. The West Virginia Center for Children’s Justice uses that training to develop the communication protocol known as Handle with Care.
• A second edition of Helping Traumatized Children Learn is published. This publication is called Creating and Advocating for Trauma-Sensitive Schools and includes Brockton Public Schools as a case study.Mary C. Snow West Side Elementary School in Charleston, West Virginia becomes the pilot district for the Handle with Care program. With 500 students, 93% of whom came from low-income families, the community faced challenges with drugs and violent crime that impacted student performance.
• The results from Brockton Public Schools are in: data “showed an 80% decrease in suspendable issues and a 43% decrease in office referrals at the city’s three pilot schools.”⁹
• 60% of states have implemented Handle with Care in at least one district in the state.

The Basics of Handle with Care

The West Virginia Center for Children’s Justice describes the model as follows:

“If a law enforcement officer encounters a child during a call, that child’s name and three words, HANDLE WITH CARE, are forwarded to the school/child care agency before the school bell rings the next day. The school implements individual, class and whole school trauma-sensitive curricula so that traumatized children are “Handled With Care”. If a child needs more intervention, on-site trauma-focused mental healthcare is available at the school.”¹⁰

Handle with Care programs involve law enforcement, child protective services, and schools. Effective, timely communication is key in making this successful in your community. What does the Handle with Care workflow look like in practice?

First, law enforcement is responsible for submitting a Handle with Care notification to the school. That note doesn’t contain any information about the reason, but simply that the child should be handled with care. From there, it’s up to the school to communicate with that student’s teacher(s). At that point, the teacher can use their discretion to decide if the student requires additional support from a school counselor. Finally, if the school counselor believes the child needs further services or counseling, they’ll make a recommendation to the parent/guardian. Sometimes at this point, a social worker may step in to follow up with the parent/guardian about services for the child.

As you can tell, there are a lot of people who get involved at each stage of the Handle with Care communication protocol. Without effective communication across your district, implementing this program will be more challenging.

A Short Glossary of Relevant Terms

Depending on your experience level, some of the terms below could feel second-nature to you. If they’re new to you, here’s a quick rundown of some terms you’re likely to encounter as you learn more about Handle with Care.

We’ve already touched on them, but adverse childhood experiences, often referred to as ACEs, are “potentially traumatic events that occur in childhood (0-17 years).”¹¹ The types of incidents that would lead to law enforcement submitting a Handle with Care note to a school would qualify as ACEs.

Complex trauma can occur “when a child is repeatedly exposed to adverse experiences, such as abuse, neglect, and dysfunctional family interactions.”¹² The effects of this kind of trauma are exactly what Handle with Care seeks to address.

Trauma-sensitive and trauma-informed refers to a method of educating that implies that there is a level of awareness of the possibility (or certainty) of trauma. More recently, there has been a push toward trauma-responsive care which requires more planning and action on the part of the systems supporting the victim. In the case of a school, that could include the school administration, teachers, bus drivers, cafeteria workers, and more.¹³ Handle with Care could be considered trauma-responsive due to its proactive and action-oriented nature.

Social-emotional learning is the “process of developing the self-awareness, self-control, and interpersonal skills that are vital for school, work, and life success.”¹⁴

Education Corner has a helpful guide to emotional and behavioral disorders and how they can manifest in the classroom. They describe emotional and behavioral disorder as an umbrella term for several disorders, each of which falls into one of two categories: psychiatric and behavioral disorders. The Individuals with Disabilities Education Act offers five characteristics for emotional and behavioral disorders – each disorder must exhibit at least one of these in order to fall into this umbrella term:

• An inability to learn that cannot be explained by intellectual, sensory, or health factors.
• An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
• Inappropriate types of behavior or feelings under normal circumstances.
• A general pervasive mood of unhappiness or depression.
• A tendency to develop physical symptoms or fears associated with personal or school problems.¹⁵

While there isn’t one simple definition for continuum or continuity of care, the general idea behind a continuum of care is to provide comprehensive care that evolves with the student.

A victim-centered approach is “defined as the systematic focus on the needs and concerns of a victim to ensure the compassionate and sensitive delivery of services in a nonjudgmental manner.”¹⁶ Handle with Care takes a victim-centered approach, even if the school does not know exactly what kind of trauma the student experienced.

The Challenges Facing Districts Today

If you’ve made it this far, the idea of the student mental health crisis likely isn’t foreign to you.

And while that crisis might be the biggest challenge you’ll face when getting started with Handle with Care, it’s not the only one. For so many districts, daily processes and the communication that comes with those processes are difficult. Whether it’s working across departments or making sure information gets to the right teacher at the right time, effective communication can be one of the hardest skills for a district to excel at.

If your district does struggle with communication and you haven’t yet implemented Handle with Care, you may want to consider the systems you currently use and how you would add Handle with Care to the workload for your counselors, teachers, administrators, and others.

Frontline has software solutions that can help you get everyone on the same page, so if you’re wondering how to take this concept and turn it into a reality, you don’t have to do it alone. Frontline School Health Management’s automations, workflows, and easy-to-use interface can not only make the day to day easier for all of your health professionals, but also make it feasible to implement a new program like Handle with Care.

Other Districts’ Experiences with Handle with Care

When you think about Handle with Care, or if you search for examples of the program, you might find a few different types or levels of the program.

Why Handle with Care Programs Matter to School District Leaders

Depending on your role in the district, you might be responsible for reporting to key stakeholders, keeping student data safe, communicating with parents, managing crises, or a combination of all of the above.

Keeping students safe is the responsibility of so many educators, and while not every administrator works face-to-face with students on a daily basis, administrators do have the unique power to facilitate programs and initiatives that can make a meaningful difference in the lives of students and their communities. So if you are a leader in your district wondering how you could make a difference even though you work in the central office, Handle with Care is one way you can help.

It’s also a low-cost, high-reward program. The resource you’ll need to call on most to get it up and running is time – that of teachers, counselors, and administrators. That said, if you are able to put in place the right systems to ease the administrative burden on school nurses, counselors, and teachers, it’s doable.

How to Get Started

You might be reading all of this information about Handle with Care and wanting to make it a reality for your district, but wondering how to get a program up and running, especially if your state has not yet widely adopted the model.

To start, you can download a quick-start guide here.

Additionally, you may want to think about your district’s mental health program holistically. Here are a few questions to consider:

• How is your district managing mental health care for students today? How’s that working for you?
• Do you have easy ways to measure student mental wellness and track trends over time?
• How will Handle with Care fit into your teams’ existing workflows?
• Do you have the right systems in place to kick off a new initiative?

Even if you don’t live in West Virginia, the West Virginia Handle with Care website has great resources that can help you get started. Some states like Oklahoma offer free Handle with Care getting started guides and training, too. While your contacts and stakeholders might be different, you may gain knowledge about the types of community members you’ll want to engage as you kick off your local program.

Best Practices & Recommendations

Every community is unique, which means your experience with Handle with Care may be unique, too. The challenges your students face may reflect the challenges your community faces. And that’s the beautiful thing about Handle with Care – it’s a model that recognizes that the students you’re responsible for are the future leaders in the community and treats them as such.

As you move forward, here are a few best practices to keep in mind:

• Select the right stakeholders: before you get started with a kickoff call, you want to make sure you have the right people in the room.
• Get everyone on board: because Handle with Care is a grassroots program, its success hinges on the active participation of each stakeholder.
• Ensure everyone is trained properly: without proper training, you might not see the kinds of success you’re looking for.
• Put standardized systems in place: if you have one school counselor who works in multiple schools across your district, adding Handle with Care to their workload could feel daunting. If you have the opportunity to streamline daily tasks and eliminate redundant paperwork, it will be more feasible to get Handle with Care off the ground.
• Don’t let your Handle with Care workflow end after one day: you should ensure you have a way to continuously provide care to students who have experienced trauma. Equipping your school nurses, counselors, and other health professionals with a comprehensive school nursing management system can help them proactively monitor students over time.

What Comes After the Initial Notification?

A question you might be thinking is simply, what’s next?

While the initial notification process for Handle with Care is a tremendous step forward, offering comprehensive mental healthcare to students means that there will inevitably be students requiring follow up appointments, longer term counseling, and more.

This point in the child’s care is when an electronic health records system with mental health capabilities becomes extremely helpful to anyone in the district responsible for that student’s care.

Whether a school nurse needs to schedule follow up appointments or a counselor wants to schedule weekly meetings, a dedicated system for schools can save time and ensure that everything you might need for future reporting is documented properly to keep your district in compliance.

Frontline School Health Management is a system that can help you round out your Handle with Care program so that you can offer proactive support to every student.

How Software Systems Can Help

If you’re interested in getting started with Handle with Care in your community, you’ll want to consider the system you’ll use to manage the program, and what your goals for the program are. If you want to track trends to see how Handle with Care is impacting student performance and mental wellness over time, you’ll want to consider a system made for K-12 mental health.

Frontline’s software for Mental and Behavioral Health Management was designed in tandem with Frontline’s EHR, and both were designed exclusively with K-12 in mind. Frontline’s mental health software offers workflows designed for school mental health professionals, and has extensive reporting capabilities.

There are also features that pair especially well with a Handle with Care program. One that you might find especially helpful are the alerts in the system. If a student goes to the nurse’s office and the nurse pulls up that student’s record, they’ll immediately see that the student should be handled with care.

You can also identify behavioral patterns in individual students, so if you have a student who you’re handling with care, you can easily access their historical data and add an additional layer to their care. If your community struggles with widespread challenges, you can track behavioral trends across the student body over time as a way to measure the impact of your Handle with Care program.

Additionally, if your school counselor recommends additional services for a student after a Handle with Care notification, Frontline’s system makes it easier for that counselor to communicate with parents about that recommendation and collect required forms such as parental consent.

Finally, one of the tenets of Handle with Care is attention to privacy and security. Frontline’s system is permissions-based, so you can ensure that only required individuals have access to that student’s information.

Measuring the Success of Your Handle with Care Program

Whenever you’re approaching program analysis, there are three keys to measuring success:

• What do we want to measure?

  You may need to do some research around national or state standards. Perhaps that involves looking at the rates of adverse childhood experiences in your community, or rates of mental health disorders. You want to be able to create benchmarks for yourself and your district. If you already have software for health management, you can likely pull reports for variables such as counselor office visits, attendance, or suspensions.

  Next, you’ll want to think about goals. In the next five years, what would you like to see? Your goals might reflect student performance or mental wellness metrics. Make sure your goals are targeted to what Handle with Care can help you achieve.

• How do we want to measure it?

  If you take a look at what you’ve done for step one, the what, that will likely give you clues for how you might approach the how. Look at the variables you used to set your baseline and benchmarks; those will be the key data points you’ll want to monitor as your Handle with Care program matures.

  With dedicated analytics software, you can easily set up dashboards to monitor your data points without having to start from scratch each time.

• Based on the results, what action will we take?

  Only you and your team of stakeholders can decide what action you’ll want to take, but hopefully having data to back up any anecdotal evidence you receive can help you enter conversations with parents/guardians or district stakeholders with more confidence.

Resources for Handle with Care

While not all states have a formal site for Handle with Care, yours might!

If your state is colored in purple on this map, you can click on it to go directly to your state’s Handle with Care site. Some state sites will offer recommended contacts to get Handle with Care started in your community.

Here are some additional resources you might enjoy:

Closing

When you’re healing a wound, sometimes it leaves a scar. Other times, you’re simply left with the memory of the injury. Trauma is similar. Often, the effects of trauma aren’t physically visible, but its impact is lasting. While you can’t take a child’s trauma away – as wonderful as that would be – you can help students become more resilient and to process that trauma in a way that begins to heal. And when enough students in a community have the opportunity to heal from their trauma, you begin to heal a community at large.

If you want to create a foundation for mental wellbeing in your district, get in touch with us. Frontline has a team of representatives who are ready to help you build a program that will make a measurable impact.

You could be the reason your community begins to see positive change.

Start here

References

1. Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing adverse childhood experiences. Centers for Disease Control and Prevention. Retrieved September 15, 2022, from https://www.cdc.gov/violenceprevention/aces/fastfact.html
2. Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing adverse childhood experiences. Centers for Disease Control and Prevention. Retrieved September 15, 2022, from https://www.cdc.gov/violenceprevention/aces/fastfact.html
3. Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing adverse childhood experiences. Centers for Disease Control and Prevention. Retrieved September 15, 2022, from https://www.cdc.gov/violenceprevention/aces/fastfact.html
4. Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing adverse childhood experiences. Centers for Disease Control and Prevention. Retrieved September 15, 2022, from https://www.cdc.gov/violenceprevention/aces/fastfact.html
5. Liming, K. W., & Grube, W. A. (2018, January 19). Wellbeing outcomes for children exposed to multiple adverse experiences in early childhood: A systematic review – Child and adolescent social work journal. SpringerLink. Retrieved September 15, 2022, from https://link.springer.com/article/10.1007/s10560-018-0532-x
6. Nurius, P. S., Green, S., Logan-Greene, P., & Borja, S. (2015, July). Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis. U.S. National Library of Medicine. Retrieved September 15, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470711/
7. Freeland, M., Easterling, T., Reiner, K., & Amidon, C. (2018, June). Prevention and treatment of child maltreatment – the role of the School Nurse. Prevention and Treatment of Child Maltreatment – The Role of the School Nurse – National Association of School Nurses. Retrieved September 15, 2022, from https://www.nasn.org/nasn-resources/professional-practice-documents/position-statements/ps-child-maltreatment/
8. National School Climate Council. (2007). The School Climate Challenge: Narrowing the Gap Between School Climate Research and School Climate Policy, Practice Guidelines and Teacher Education Policy. New York, NY. http://nscc.csee.net/
9. Handle with Care Massachusetts Program overview. Handle With Care Massachusetts. (n.d.). Retrieved September 15, 2022, from https://hwc.plymouthda.com/handle-with-care/
10. Handle with Care Program Overview. West Virginia Center for Children’s Justice. (n.d.). Retrieved September 15, 2022, from http://www.handlewithcarewv.org/handle-with-care.php
11. Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing adverse childhood experiences. Centers for Disease Control and Prevention. Retrieved September 15, 2022, from https://www.cdc.gov/violenceprevention/aces/fastfact.html
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13. Butler Center for Research. (2021, April). Moving to Trauma-Responsive Care. Hazelden Betty Ford Foundation. Retrieved September 15, 2022, from https://www.hazeldenbettyford.org/education/bcr/addiction-research/trauma-responsive-care
14. What is social-emotional learning? Committee for Children. (n.d.). Retrieved September 15, 2022, from https://www.cfchildren.org/what-is-social-emotional-learning/
15. Loveless, B. (n.d.). Emotional and Behavioral Disorders in the Classroom. Education Corner. Retrieved September 15, 2022, from https://www.educationcorner.com/behavioral-disorders-in-the-classroom.html
16. Victim-Centered Approach. OVC TTAC: Office for Victims of Crime Training & Technical Assistance Center. (n.d.). Retrieved September 15, 2022, from https://www.ovcttac.gov/taskforceguide/eguide/1-understanding-human-trafficking/13-victim-centered-approach/
17. Brown, M. (2021, October 5). Teacher’s ‘handle with care’ strategy for students needing extra support goes viral. Parents. Retrieved September 15, 2022, from https://www.parents.com/news/teachers-handle-with-care-strategy-for-students-needing-extra-support-goes-viral/
18. KRTV. (2019, October 2). Power schools introduce “Handle with Care” program. KRTV. Retrieved September 15, 2022, from https://www.krtv.com/news/montana-and-regional-news/power-schools-introduce-handle-with-care-program/
19. Center for Research in Rural Education. (n.d.). Youth aware of mental health. Montana State University: Mountains and Minds. Retrieved September 15, 2022, from https://www.montana.edu/crre/youthawareofmentalhealth.html