key: cord-0978219-ex2yufky
authors: Grumbach, Giesela; Johnson, Annette H; Engel, Erik; Campos-Moreira, Linda D
title: Virtual Termination amid COVID-19: Strategies for School Social Work Interns and Field Instructors
date: 2021-05-29
journal: Child Sch
DOI: 10.1093/cs/cdab008
sha: 49bf6a3f1fc880d2384a78b0db698e55bd917cab
doc_id: 978219
cord_uid: ex2yufky

The COVID-19 pandemic disrupted the natural rhythm of the school year, affecting the way services are rendered. This shift has implications for the termination of services and the guidance of school social work interns through the termination process. This article provides lessons learned from the rapid transition from face-to-face practice to telemental health services in schools. The authors present strategies for supervising the termination process in a remote environment. In keeping with social work’s professional mandate, field instructors must guide interns on conducting termination services properly and engage interns in this reflective process. This article also addresses issues of equity and access for students and their families. Attention is given to the impact of termination on student clients, families, school social work interns, and field instructors. Telemental health demonstrates promise in supporting a model of practice that provides opportunities for innovation. Researchers and practitioners are encouraged to continue this discourse for engaging in and developing best practices for telemental health services, termination of services, and supervision of social work interns in the school setting. The school social work profession must continue to augment policies related to the provision of telemental health services in school settings.

T he traditional school year opens with excitement and energy on the part of students, parents, and school staff. School administrators and teachers prepare for the beginning of the school year by planning their curricula, organizing their classroom, participating in staff development, and conducting welcoming activities for students. Students come to school excited to matriculate to a new grade and to connect with their friends. The same kind of energy is also seen at the end of the school year with closing activities and celebrations of accomplishments. Acknowledging beginnings and endings (that is, termination) is a process that occurs as school social work interns begin their field placement, which aligns with the natural rhythm of the school year. Addressing termination in school social work counseling should be a part of the initial sessions with student clients, setting the structure and foundation for the termination process.

With strict social distancing and shelter-inplace restrictions from the coronavirus disease 2019 (COVID-19) pandemic, K-12 schools had to close abruptly. According to Education Week (2020), school closures affected 55.1 million students in 124,000 U.S. public schools. Early in the pandemic, all 50 states closed their K-12 schools in an effort to reduce the spread of the coronavirus (Auger et al., 2020) . This created many new challenges for schools. The school social work community, in particular, had to create procedures for shifting from in-person to virtual services including termination.

When face-to-face contact was no longer available, school social workers made expedient changes to the delivery of services in light of remote learning. Specifically, school social workers and student interns learned how to provide telemental health services in a school setting. Furthermore, school social workers had to stay informed of emerging school policies while adhering to professional mandates for telemental health services. Despite the pandemic, field instructors are still responsible for adhering to professional standards of practice, including teaching their interns the clinical skills needed for effective termination. Field instructors had to adapt to ending services remotely. Guidance for virtual termination is still emerging, and new policies and procedures are likely to follow.

The purpose of this article is to highlight the rapid transition from face-to-face practice to telemental health services-specifically virtual termination-for guiding school social work interns. We provide strategies for this emerging area of practice based on our consultation with practitioners. This topic is salient and particularly timely in light of increased demands for telemental health services that may endure as a form of treatment after the pandemic for school social work settings.

The termination stage, the final stage of counseling, is just as important as the initial and middle stages. How the therapeutic relationship ends can influence the student client's perspective of future help seeking and treatment, future termination experiences, and how progress made during the social work intervention will be maintained over time (Cummins & Sevel, 2018) . In ideal circumstances, termination occurs when student clients meet their agreed-on goals or when the problem for which student clients entered into counseling has become more manageable or "good enough" (Hatchett, 2020) . In a school setting, social work services have a forced termination time frame by virtue of the academic year. In some cases, services may resume the following school year depending on the student client's individualized education program (more commonly referred to as the IEP), 504, or counseling needs. One definition of forced termination is the end of the counseling relationship before the work of therapy has been fully accomplished (Chernus, 2016) . Nevertheless, school social workers and their interns should still adhere to all of the clinical termination phase components.

One goal of termination is for the therapist to end therapy successfully while mitigating possible client regression, such as a reactivation of losses, fears, or other conflicts that emerge during termination (Nof, Leibovich, & Zilcha-Mano, 2017) . Termination may also evoke behavioral changes due to issues of bereavement and separation (Nof et al., 2017) . Because of the current pandemic, school closures, and shelter-in-place orders, grief or loss may be heightened (Zhai & Du, 2020) for student clients, school social work interns, and field instructors. If the termination process is not handled effectively, it may evoke feelings of abandonment (Aafjes-Van Doorn & Wooldridge, 2018) and affect the reengagement process when the new school year begins. The process of termination requires working through the client's personal meaning of termination (Nof et al., 2017) . Nof and colleagues (2017) recommended two strategies for termination: (1) the use of a clock-like reminder and (2) symbolic listening. The clock-like reminder is the process of reiterating the impending termination to clients. The clock-like reminder should be established at the beginning of treatment, discussed over time, and revisited at the last five sessions of treatment. The clock-like reminder serves to enrich goal achievement and "work through the termination themes" (Nof et al., 2017, p. 30 ). Nof and colleagues also referred to the termination process as a joint effort. The school social worker should emphasize with student clients that change requires working together. The clock-like reminder creates an impetus to strive for progress throughout the counseling relationship. It is also necessary to elicit areas that the student would like to address during the remaining time in counseling.

Symbolic listening involves making connections of client content to symbols or representations of termination. This means listening to what is stated, what is not stated, and how it is stated to explore the client's thoughts and feelings about beginnings and endings. Informed by Mahler's model of Separation-Individuation, Nof and colleagues (2017) proposed three techniques for symbolic listening: validating, interpreting, and [engaging in] personal meaning exploration (VIP). Applying VIP to the school social worker setting, the school social worker should validate the student client's feelings about the counseling process, review the progress they have made, and discuss how they feel in anticipation of terminating services. This is particularly important, as student clients may minimize the growth they have made or neglect to give themselves credit for their development. Next, the school social worker must continually find opportunities to connect the termination experience with the experiences relevant to the student client's daily life. The third step involves the school social worker exploring the meaning that the student client makes of their feelings around termination. The VIP technique is meant to be sequential and is influenced by psychodynamic theory; these tenets can be used in any setting, whether in person or virtually.

Other considerations for effective termination include marking the end with rituals or celebrations. Focusing on termination as a rite of passage or something to be celebrated affirms the student clients' sense of accomplishment. Student clients must be engaged in exploration about the services and the progress they have made while in counseling. Termination presents an opportunity for evaluating what worked and what was missing from the intervention or helping relationship (Cummins & Sevel, 2018) from the student client, intern, and field instructor perspectives.

Student clients are entitled to the best treatment, which implies cultivating a solid therapeutic relationship and ensuring the continuity of care (a mechanism of the termination process). The termination process should proceed in the same manner as face-to-face termination. Despite temporary school closures and the transition to virtual services, student clients should still receive clock-like reminders initiating the termination process. Virtual clock-like reminders may consist of remote reminders during live sessions or other electronic/remote reminders. Nof and colleagues (2017) described the importance of the exploration of personal meanings clients have about termination. Exploration may include listening for meanings of everyday life and their connections to the termination process. For example, if a student client reports that a good friend is moving away, this presents an opportunity to connect their daily life experience to termination. Exploring student clients' feelings and attending to affect during virtual sessions is critical and must not be avoided. Student clients need closure through the intentional termination of services in both in-person and virtual environments.

Student clients should be encouraged to express their feelings about the abrupt nature of termination, school closures, and their use of technology in receiving remote services. It is particularly important to explore the current situation of student clients regarding the crisis (that is, the COVID-19 pandemic).

Virtual termination of student client services introduces other dynamics that must not be ignored. Symbolic listening is about hearing the client's story related to the termination process, and in a remote or virtual session, the social worker is able to observe social cues from the student clients' environment. This implies being aware of student clients' ability to express themselves freely. Student clients' regression may show up in behavioral interactions with their environment and require immediate exploration in the counseling session.

The suddenness of the COVID-19 pandemic required termination to occur virtually. The pandemic necessitated using a newer intervention model for school social workers (that is, telemental health counseling). Although not ideal, virtual termination provides a mechanism for bringing closure to the helping relationship and acknowledging student clients' progress. Virtual termination may occur with either the student client or their parents or guardians in emergency school closures.

When implementing the change to virtual intervention services, it is important to gain parents' or guardians' buy-in and permission for engaging their child in virtual services and remote learning. If permission to engage student clients for virtual social work services cannot be obtained, it is recommended that the termination should occur with the parents or guardians. Successful buy-in may also signify a willingness to engage in helpful practices for virtual learning and intervention.

When terminating with the parents or guardians, the conference should focus on the following five elements: (1) providing general information about student clients' growth and progress, (2) acknowledging student clients' accomplishments, (3) reviewing social-emotional learning development, (4) collaborating on strategies to continue building on skills learned, and (5) providing tools for parents or guardians that can be used in the home environment.

In short, virtual termination can provide opportunities to engage the parents or guardians in the termination process and bring closure for student clients. Recognizing that COVID-19 and sheltering in place can be overwhelming for students, termination can help monitor and assess student clients' current functioning. It is also a way of helping parents or guardians face the unique challenges of helping their children cope emotionally during remote learning.

In the school internship setting, it can take time for the intern to become acclimated to the environment, develop a caseload, and establish a trusting relationship with student clients. As termination approaches, the school social work intern may experience feelings of ambivalence and stress. These issues may be, in part, due to the time performance demands of both coursework and the field placement, and tensions between the two (Butler, Carello, & Maguin, 2017) . Interns may also become distracted by anticipatory demands such as expectations of licensure, impending job searches, and practice expectations that evoke professional selfdoubt (Cummins & Sevel, 2018) .

Termination allows closure for the student client, intern, and field instructor. Addressing termination is a critical part of clinical pedagogy; termination should not be abandoned because of a disruption of the internship placement due to the pandemic and shelter-in-place restrictions. Termination is a multilevel process, and as such, it is critical for the field instructor to provide supervision and guidance to school social work interns on how to terminate on multiple levels, such as with the student client, the field instructor, and other school staff. Supervision can help interns assess their performance, prepare them for termination, and prepare transition plans for student clients expected to continue services in the next school year.

One way of ensuring proper termination virtually is for the school social work intern to do so under the close supervision of the field instructor in the school setting. Virtual supervision provides a unique opportunity for field instructors to observe a live session with real-time feedback. The intern must first disclose that the field instructor is on the call and remind student clients of the field instructor's supervisory role. To minimize intrusion in the counseling process, the field instructor may consider muting their computer (for example, with video stopped and audio on). The field instructor is positioned to discern nonverbal dynamics (that is, facial expressions of the intern and student client) during the session. This type of guidance is similar to one-way mirror supervision, which is not typically available in school settings. The emerging research suggests that this type of supervision enriches supervisory discussions and helps to maintain the clinical focus (Nadan et al., 2020) .

During supervision, the field instructor should process termination in light of past losses and possible secondary trauma associated with crises during the pandemic. COVID-19 and persistent racial injustices compound the typical stress of termination, which places another layer of trauma for both the intern and the field instructor to manage. Even under normal circumstances, these factors may intensify feelings of stress and thereby challenge the delicate balance required of interns in managing coursework, the internship learning experience, and their responsibilities. It is also important to address issues of equity and ethics in the provision of virtual services, especially since the pandemic has magnified disparities in health and well-being (Centers for Disease Control and Prevention [CDC], 2020; Galea, Merchant, & Lurie, 2020) and equitable access to technology (Litvinov, 2020) .

School social work interns and field instructors must be especially attuned to students who need services and lack resources. School social workers must examine issues of equity as they transition to remote modes of service delivery. Termination must include a reflection on privilege juxtaposed to disadvantage as student clients are expected to participate in virtual educational and counseling services. Reich and colleagues (2020) provided in their work what they refer to as best practices and research-based guidance for addressing equity issues during school closures due to COVID-19. The first recommendation is to place equity at the center of remote learning and provide additional support for specialized groups. Students and their families may need additional support to meet their basic human needs, such as food, housing, employment, and overall well-being. This may be especially important for communities that have been disproportionately affected by the pandemic. Specifically, COVID-19 infections, hospitalizations, and death rates for African Americans and Latino people have been higher than for White Americans (CDC, 2020; Ford, Reber, & Reeves, 2020). Essential workers in service and agricultural industries tend to be people of color and of low-income status (CDC, 2020), limiting their options to retreat from public spaces, thereby increasing their risk for being exposed to the virus. Aside from the previously mentioned health concerns, pandemics amplify psychological distress (Galea et al., 2020) . The second recommendation is to provide guidance on how to remediate the challenges or constraints of remote or home-based education. The third recommendation is to clearly communicate with many stakeholders about home-based learning during school closures. Putting equity at the center of providing services means addressing and advocating for policies and funding that maximize students' access to resources (Villarreal Sosa, 2020) .

Students with limited broadband service, an issue prevalent in rural and in lower income urban areas, are differentially affected (Martin, 2018) . For instance, among adults from households earning less than $30,000 a year, 44 percent report limited access to broadband service (Anderson & Kumar, 2019) . Even in households with a computer, the switch to remote learning may have increased the need for additional computers or devices, as there are multiple learners in the household. A recent survey shows that one in seven high school students report that they share one computer with their whole family (Moore, Vitale, & Stawinoga, 2018) . Schools may distribute computing and hotspot devices to families in need. Some schools may invite families to park in school lots with installed Wi-Fi access points or use bus fleets to provide Wi-Fi services (Koop, 2020) . Technological advances benefit many Americans with the exception of those negatively affected by the digital divide.

In schools where few provisions have been made, school social workers may model advocacy for their interns by calling for increased access to computers, quality Internet services, community resources, and specialized assistance for students needing additional accommodations. Besides access to services, school social workers must understand how to support students and their family's ability to use technology (National Association of Social Workers [NASW], Association of Social Work Boards, Council on Social Work Education, & Clinical Social Work Association, 2017), especially for counseling and other social work services. If the family does not have access to technology in the home, school social workers and interns may use the regular postal service to communicate and coordinate school services with the family.

The virtual environment presents questions about how to protect youths (for example, what types of contacts are recommended to ensure the safety of youths: confidentiality and informed consent, legal guidelines). School social workers must adhere to the ethical guidelines of maintaining confidentiality whether their interactions with students are virtual or face-to-face. The NASW (2017) Code of Ethics Standard 1.03 states, "Social workers who use technology to provide social work services should obtain informed consent from the individuals using these services during the initial screening or interview and prior to initiating services" (para. 6). Even during the transition from face-to-face service delivery to telemental health or teletherapy, best practice suggests that online consent should be obtained before initiating contact in virtual spaces, including the process of termination. Because of the emergent nature of school closures, online consent was not readily available in many instances. Nevertheless, NASW provides a list of legal and practice resources, including a telemental health online consent form. For more information, refer to the NASW national Web site (https://www.socialworkers.org).

The use of virtual platforms is a new phenomenon in school social work practice. As we move into the use of virtual technology, it is vital to be aware of privacy, confidentiality, and ethical issues. Privacy is a central concern when addressing the ethical and legal provision of counseling with student clients online. School social workers and interns must honor confidentiality by not sharing specific content of student disclosures with parents or guardians. It is important that clients understand what confidentiality is and what the exceptions to it are (Mignone, Klostermann, Mahadeo, Papagni, & Jankie, 2017) . More important, Yao, Li, Wang, and Hui (2020) asserted that "there is an incongruity of expectation of confidentially among parents, adolescents, and counselors" (p. 2). In their study, Yao and colleagues found a strong correlation between an authoritarian parenting style and parental or guardian desire for breaches of confidentiality in effort to maintain parental control. Yao and colleagues suggested that adolescents may be less likely to engage fully in counseling if they have concerns about confidentiality. Ensuring clients' rights to confidentiality is an important standard of care and must be guarded in all contexts (whether in school settings or with families). The school social work intern must be aware of these dynamics-expectations of student clients and their parents relative to breaching confidences. Moreover, it is important to understand when confidentially may be breached and for what reasons. Therefore, it is recommended that before starting termination, the field instructor and social work intern review the NASW (2017) Code of Ethics, particularly the guidelines for confidentiality and termination.

While engaging in virtual services, school social work interns must also consider how to maintain privacy, as student clients may have others in their immediate environment. Virtual protocol may encourage the use of headphones (if available or provided) or the use of a chat feature so the student client may have more privacy. Nevertheless, virtual protocols must adhere to approved or sanctioned school district guidelines.

It is imperative to review and understand the technology platform that each district uses. Knowing the strengths and limitations of the district's guidelines as they relate to confidentiality and privacy is critical. The school social work intern should adhere to the district's policies in their contact with student clients. Using platforms outside of what Provide closing reports for all student clients to address student needs (whether in the virtual setting or in person) Ending reports are crucial aspects of the termination process for school social work interns and provide a plan for the continuity of care of student clients Create transition plans for all students (as there may be unforeseen consequences) (SL/VIP) Notes: The COVID-19 pandemic highlighted many issues of racial or ethnic and economic disparities. It is important to understand the impact of remote service delivery in light of equity and access to technology for all students. School social workers should develop policies, procedures, and guidelines to enact social and educational justice. CR ¼ clock-like reminder; SL ¼ symbolic listening; VIP ¼ validating, interpreting, and engaging in personal meaning exploration of termination; IEP ¼ individualized education program; SEL ¼ social-emotional learning.

the school district approves is highly discouraged and can leave the practitioner without administrative buy-in or legal support for potential liability issues. Before administering telemental health services, field instructors and school social work interns must consider confidentiality and privacy while engaging in virtual counseling with minor-age students. As school social work interns engage in virtual sessions (individual or group), supervision can play an important role in ensuring best practice. School social work field instructors may provide intense supervision by being present virtually during some of the intern's sessions. Providing real-time supervision of interns may help to enhance supervision. Supervision that includes real-time observation allows the field instructor to assess both the intern and student clients' nonverbal communication during termination sessions. Also, the field instructor may provide live feedback during the session by text and engage in debriefing afterward. Arguably, telemental health may be a well-suited platform to provide supervision while addressing the continuation of treatment and termination during times of crisis. Table 1 identifies strategies for virtual termination of school social work services.

The pandemic has created complex challenges for every aspect of life, including supporting students in a virtual environment and engaging in termination of services. Challenges create windows of opportunity, like transitioning to telemental health services, thereby ushering in an intervention modality rarely used in school social work practice.

This article initiates discussion about virtual termination in school social work practice and policy considerations for telemental health services. The authors provide tools and strategies for implementing termination and providing supervision in a virtual environment. First, it is essential to consider how termination affects student clients, families, school social work interns, and field instructors. Second, it is important to consider the critical role of supervision in guiding school social work interns through the stages of termination from a reflective process-VIP-especially in times of crisis. Third, virtual termination magnifies issues of equity and access. Fourth, the school social work profession must continue to augment policies related to the provision of telemental health services in school settings. Gherardi and Whittlesey-Jerome (2018) reminded school social workers to remain cognizant of current trends in educational policy.

Telemental health demonstrates promise in supporting a model of practice that provides opportunities for innovation. Researchers and practitioners are encouraged to continue this discourse for engaging in and developing best practices for telemental health services, termination of services, and supervision of social work interns in the school setting.

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