Student-Centered Care That Follows You to the Classroom

School psychologists specialize in treating school-age children and school-related problems. While some school psychologists can be found in school settings, helping children succeed academically, socially, behaviorally, and emotionally, many school psychologists also exist in the clinical setting. Clinical school psychologists are much more likely to be involved in services intended to prevent mental health problems and severe behavior disorders or to intervene at early stages to prevent more serious problems. They are also far more likely to work with teachers and parents to improve instruction in the classroom.

“Before stepping into my current role at Dell Children’s,” shares UT Health Austin licensed professional counselor Marcella Maxwell, MA, LMFT, LPC, who serves as the Director of the Dell Children’s Educational Advocacy Program, “my former boss and mentor, Dr. Kevin Stark, who is a licensed school psychologist, identified a gap in care in which our pediatric psychology team was doing an excellent job providing mental health services for our pediatric patients in the hospital setting, but had no way of continuing those services once our patients were discharged and returned to the school setting. To help bridge this gap, I was given the opportunity to develop and run this program.”

Maxwell previously served on the Dell Children’s psychology consultation and liaison team, where she conducted psychological assessments and provided brief evidenced-based treatment for children and adolescents with complex medical histories as well as provided outpatient treatment for children and adolescents diagnosed with anxiety disorders, obsessive-compulsive disorder, and depression through the Texas Child Study Center within UT Health Austin Pediatric Psychiatry at Dell Children’s, a clinical partnership between UT Health Austin and Dell Children’s Medical Center. She continues to work closely with the Texas Child Study Center, now helping patients transition from hospitalization back into the academic setting as quickly and safely as possible while also educating the faculty and staff on the patient’s medical and mental health needs.

“The educational advocacy program is a free resource,” says Maxwell, “and I cannot stress that enough. I am very fortunate that I get to offer these resources to these families, especially when these families already have a lot going on as they navigate this journey while, at the same time, trying to process their own thoughts and emotions around everything that is happening. One of my favorite parts of this job is being able to explain what I do and then getting to say, ‘I’m going to take this off your plate so that you don’t have to worry about it.’”

The Dell Children’s Educational Advocacy Program was originally funded by a group of local donors before proof of concept led to Dell Children’s decision to fund the program indefinitely. This program provides school advocacy by working with the student’s school to identify and advocate for accommodations when a medical condition impacts a student’s ability to participate in regular schooling. Services typically start once a patient has been discharged from the hospital and is ready to return to the academic setting. The Educational Advocacy Program is available to all Dell Children’s patients between the ages of 3 and 22 who are enrolled in school.

“When an adult is in the hospital, one of the first questions they ask is, ‘When can I go back to work?’” says Maxwell. “Well, when you really think about it, a child’s full-time job is school, and we already know that going to school—the routine schedule, peer interaction, and cognitive working of the brain—is therapeutic in of itself. This is something that we really have to focus on. My goal is to get patients back to school in the safest manner possible while also making sure they feel comfortable returning to the classroom setting. The last thing we want to do is force a child into something that scares them. Instead, we’re going to talk about it. With me being a licensed professional counselor, I’m in a unique position in which I’m able to leverage my background in therapy to help these patients prepare for this transition.”

Maxwell serves as the liaison between the patient’s care team, family, and school. For patients who are currently hospitalized, her job involves getting them ready to return to the academic setting post-hospitalization. To accomplish this, she meets with the patient’s care team to determine what medical or mental health needs exist and then works with the patient’s school to ensure the faculty and staff understands what those needs are and how to adequately accommodate those needs. The Educational Advocacy Program aims to help school personnel access any needed information and trainings, so they can provide the best possible care to children with medical conditions.

“In cases of minimal support, such as a student with a gastrointestinal disorder, the accommodation may be as simple as a written letter requesting the student be allowed to stand up, with as little disruption as possible, and go use the bathroom at any time during classroom instruction,” explains Maxwell. “While this may seem like a very small and obvious accommodation, the control over the issue for that patient is paramount in them feeling safe and secure in their classroom by eliminating any chance of experiencing medical symptoms in front of their peers. In other cases, a school may be asked to accommodate a student’s more severe medical condition, causing the school to reach out to us and say, ‘We don’t actually know how to appropriately take care of this child.’ I am proud of those schools who do reach out and ask, ‘Can you teach us?’ and rely on our knowledge to help them provide those students with adequate care.”

Maxwell also works with families of students who are currently in school but may not necessarily feel as if their student is receiving the appropriate accommodations. In these cases, Maxwell reaches out to both the student’s care team to understand what the student’s medical or mental health needs are and the school to inquire about the student’s accommodation plan to determine whether the student is receiving the appropriate level of care and identify where adjustments can be made.

“My goal is to also educate the parents along the way,” says Maxwell. “A lot of parents don’t know that different levels of support are available to their child in the school setting. There are two main levels of support—504 plans and special education. It’s important to me that I educate parents on the differences between these levels of support and help them understand what type of support their child needs and their rights as parents and guardians so that they can become an adequate advocate for their child themselves.”

Maxwell also runs a research lab, supervising both undergraduate and graduate students enrolled at The University of Texas at Austin. Her research includes school refusal in medically fragile children, COVID-19 psychological effects on chronically ill children and their families, and access to care through telehealth.

“Dell Children’s holds a special place in my heart,” shares Maxwell. “While I’m coming up on my 10-year work anniversary, Dell Children’s has always been a part of my family. My grandmother volunteered in the gift shop for 20 years, and when I was little, I would accompany her during my summer breaks throughout elementary and middle school. This was back when Dell Children’s was known as Children’s Hospital of Austin and located on the University Medical Center at Brackenridge campus. By the time I was in high school, I knew I wanted to work at Dell Children’s, and I am so glad that I made it happen.”

For more information about UT Health Austin Pediatric Psychiatry at Dell Children’s, please call 1-512-324-0029 or email childrensmentalhealth@ascension.org.