Welcome to the

School Nurse
Mental Health Toolkit

Practical Strategies for Helping Students

America’s children spend nearly 1,000 hours a year in school

Where do kids in school go when experiencing mental health distress?

A school nurse!

Here you’ll find videos with credit (CEs) available for school nurses, for use during professional development days.

Learning discussion guides and facilitator guides are available here.

View the School Nurse Mental Health Toolkit

In order to view the videos for CE credit, please create a login and record it for future visits.

The following questions will help us better understand your background and experience. Your responses are confidential and will be used to improve future content.

Returning Users Log-in

New User RegistrationFirst Name*

Last Name*

Email*

Choose a Username*

Password*

Confirm Password*

What is your level of education?*

If you are not a school nurse, what is your role in supporting students?

How many years of experience do you have as a school nurse?*

Is the school or one of the schools where you work designated as a Title I school?*

Please enter the ZIP code of your primary work location?*

Number of students at your school/schools:*

*Required field

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Mental Health Crisis Protocols

Does your Virginia school need to develop Mental Health Crisis Protocols? Click here

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Help with CEs

If you are experiencing trouble with your certificate of completion please click here.

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VASN Regional Directors

Click here to access a list of VASN Regional Directors for Facilitator Support

Discussion Facilitator Guides

Purpose of the Facilitator

Your role is to guide an open, respectful discussion that supports learning and sharing around student mental health topics. You may select the most appropriate questions from a provided list to shape the conversation. PDF for Printing

Quick Checklist for Facilitators

✔️ Review and pre-select 3–5 discussion questions

✔️ Open with group ground rules

✔️ Adapt and use questions flexibly

✔️ Encourage diverse voices

✔️ Handle emotional moments thoughtfully

✔️ Summarize key takeaways and close with appreciation

Before the Discussion

Review all pre-screened questions.
Identify questions that feel most relevant to your group’s experiences or needs.
Pre-select 3–5 starter questions to begin the discussion.
Be sensitive to emotional topics, as participants may have personal experiences. Remind them they are welcome to step out and take a break if needed.
Stay flexible and ready to adapt as your school nurse team jumps in.

Starting the Discussion

Establish ground rules (e.g., respect, confidentiality, listening without judgment).
Invite participants to suggest additional topics or questions for focus if they wish.
Create a welcoming environment with a simple check-in or icebreaker.

During the Discussion

Use selected questions flexibly, adapting as needed.
Ask open-ended follow-up questions.
Encourage participation from all attendees.
Respect silence and allow time for reflection—long pauses give participants an opportunity to gather their thoughts.
Watch for shifts in group energy. If negativity surfaces without a path forward, validate the concerns you hear and guide the group back to productive conversation. Try reflecting back what’s been shared (‘What I hear you saying is…’) and posing a question that focuses on what they can influence or improve.
Handle emotional moments with care, reminding participants about available supports.

Navigating Difficult Moments

Normalize vulnerability (“It’s okay not to have all the answers.”).
Keep the discussion focused on applying learning to practice.
De-escalate tension respectfully and refocus on shared goals.

Closing the Discussion

Summarize key insights and common themes.
Invite final reflections (e.g., “One takeaway from today?”).
Express gratitude for participants’ time and contributions.
Share any follow-up resources and supports.

Discussion Guides

School Avoidance
Anxiety
Panic Attacks
Depression
Suicide Prevention
Self Harm
Anger
Coping Relaxation
Resources

Order Printed Version

Introduction to School Nurse Mental Health Curriculum and Action Signs

Please watch this seven minute video before taking the sessions.

Module 1 • School Avoidance

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, you may encounter school avoidance—defined as a student’s frequent refusal to attend school or maintain regular attendance. Please reflect on your experience and answer the following questions:

1 - Pre Assessment - School Avoidance

FIrst Name

Last Name

Email

How often do you work with students who you would consider school avoidant?

Please indicate your level of agreement with the following statement: I have the necessary strategies to manage school avoidance in collaboration with students and their guardians effectively.

Please indicate your level of agreement with the following statement: I feel confident in my ability to manage cases of school avoidance effectively.

Module 2 • Anxiety

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may encounter students who are anxious. Anxiety in students may present as frequent nurse visits, absenteeism, or avoidance of activities like lunch or gym. It can also show up through physical complaints, excessive worry, irritability, or withdrawal from peers and normal routines. Please reflect on your experience and answer the following questions:

2 - Pre Assessment - Anxiety

FIrst Name

Last Name

Email

How often do you work with anxious students at your school?

Please indicate your level of agreement with the following statement: I have all the strategies that I need to handle situations with anxious students effectively.

Please indicate your level of agreement with the following statement: I feel confident that I can handle situations with anxious students effectively.

Module 3 • Panic

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may encounter students experiencing panic attacks, which can involve symptoms such as sudden intense fear, a rapid heartbeat, shortness of breath, or dizziness. Please reflect on your experience and respond to the following questions:

3 - Pre Assessment - Panic Attacks

First Name

Last Name

Email

How often do you work with students experiencing panic attacks at your school?

Please indicate your level of agreement with the following statement: I have all the strategies that I need to support students experiencing panic attacks effectively.

Please indicate your level of agreement with the following statement: I feel confident in my ability to support students experiencing panic attacks effectively.

Module 4 • Depression

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may encounter students who are depressed. Depression in students may appear as persistent sadness, irritability, or loss of interest in activities for at least two weeks. Other signs include changes in sleep or appetite, fatigue, difficulty concentrating, low self-esteem, and in some cases, thoughts of death or dying. Please reflect on your experience and answer the following questions:

4 - Pre Assessment - Depression

First Name

Last Name

Email

How often do you work with depressed students at your school?

Please indicate your level of agreement with the following statement: I have all the strategies that I need to handle situations with depressed students effectively.

Please indicate your level of agreement with the following statement: I feel confident that I can handle situations with depressed students effectively.

Module 5 • Suicidal Ideation

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may encounter suicidal ideation in students. Signs of suicidal thoughts in students may include withdrawal and extreme mood swings. They may express thoughts about death or show a sudden drop in academic performance, increased absences, or substance use. Please reflect on your experience and answer the following questions:

5 - Pre Assessment - Suicidal Ideation

First Name

Last Name

Email

How often do you work with students who show signs of suicidal ideation?

Please indicate your level of agreement with the following statement: I have the necessary strategies to manage suicidal ideation in collaboration with students, their guardians, and my school’s crisis team effectively.

Please indicate your level of agreement with the following statement: I feel confident in my ability to manage suicidal ideation in collaboration with students, their guardians, and my school’s crisis team effectively.

Module 6 • Self Harm

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may encounter students engaging in self-harm—deliberate behaviors intended to cause physical injury without suicidal intent. Examples include cutting, burning, hair pulling, skin picking or biting, hitting or punching oneself, or engaging in risky behaviors with the intent to get hurt. Please reflect on your experience and answer the following questions:

6 - Pre Assessment - Self Harm

First Name

Last Name

Email

How often do you work with students who engage in self-harming behaviors (e.g., cutting, burning, hitting themselves, or other actions intended to cause physical harm without suicidal intent)?

Please indicate your level of agreement with the following statement: I have the necessary strategies to manage students engaging in self-harm in collaboration with students, their guardians, and my school’s crisis team effectively.

Please indicate your level of agreement with the following statement: I feel confident in my ability to manage students engaging in self-harm in collaboration with students, their guardians, and my school’s crisis team effectively.

Module 7 • Anger

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may encounter students who are angry. This intense emotional state often appears as excessive irritability, verbal aggression, physical aggression, moodiness, withdrawal from social situations, or defiance towards authority. Please reflect on your experience and answer the following questions:

7 - Pre Assessment - Anger

First Name

Last Name

Email

How often do you work with angry students at your school?

Please indicate your level of agreement with the following statement: I have all the strategies that I need to handle situations with angry students successfully.

Please indicate your level of agreement with the following statement: I feel confident that I can handle situations with angry students successfully.

Module 8 • Coping Strategies

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, we may need to teach students coping and relaxation strategies–techniques or actions that individuals use to manage stress, difficult emotions, or challenging situations. These strategies help students maintain emotional well-being and build resilience in the face of stressors. Please reflect on your experience and answer the following questions:

8 - Pre Assessment - Coping & Relaxation

First Name

Last Name

Email

How frequently do you encounter students who seem to struggle with using effective coping and relaxation skills in stressful situations?

Please indicate your level of agreement with the following statement: I have the necessary strategies to help students develop coping and relaxation skills.

Please indicate your level of agreement with the following statement: I feel confident in my ability to help students develop coping and relaxation skills.

Module 9 • Resources

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

You’re invited to join a VERY short study to help strengthen school nurses’ voices in student mental health. Your feedback will help shape future resources, support CE development, and highlight the vital role of school nurses. Participation is voluntary, confidential, and low-risk—you can withdraw at any time.

In school settings, you may need to seek out resources related to child and adolescent mental health. Please reflect on your experience and answer the following questions:

9 - Pre Assessment - Resources

First Name

Last Name

Email

How often do you seek out external resources to support students’ mental health needs?

Please indicate your level of agreement with the following statement: I can effectively identify, document, and visually organize mental health and community based resources available to students.

Please indicate your level of agreement with the following statement: I feel confident using the mental health resources I’ve identified and organized to connect students and families with appropriate services.

School Health Committee Mission

The Virginia AAP recognizes that our work as pediatricians is connected with educators and school nurses who are our partners in caring for children and families. Please see our Chapter’s School Health Committee webpage for more information.

This toolkit was born from a collaboration in Virginia between school nurses and pediatricians to learn and partner together to support children and families with evidence-based tools.

Acknowledgments and Gratitude

Virginia Chapter, American Academy of Pediatrics

Jacqueline Cotton, MD, FAAP, project lead for school nurse mental health curriculum, VMAP REACH PPP and Project ECHO faculty, REACH National Program faculty member, Virginia Beach, VA

Leah Rowland, MD, FAAP, project lead for school nurse mental health curriculum, Pediatrician, Children’s Hospital of the King’s Daughters, Assistant Professor, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, School Health Committee Co-Chair, Virginia Chapter, American Academy of Pediatrics (AAP), Norfolk, VA

Amy C. Kryder, MD, FAAP, Associate Professor, Virginia Tech Carilion School of Medicine, Pediatrician, Carilion Pediatric Medicine, VMAP REACH Education Lead, Daleville, VA

John Farrell, MD, FAAP, School Health Committee Co-Chair, South Riding, VA

Amy Kryder, MD, Carilion Pediatric Medicine, Daleville, VA, VMAP PPP lead

Paige Perriello, MD, FAAP, VA-AAP Delegate for Independent Practices, Charlottesville, VA

School Nurse Leadership Contributors

Joanna Pitts, BSN, RN, NCSN, CNOR, Virginia Department of Health School Health Nurse Consultant, Nurse Planner

Na-Keisha A. White, MSN-PH, RN, NCSN, School Health Coordinator, Virginia Department of Education, Virginia Association of School Nurses (VASN) President-Elect, VASN Continuing Education Committee, Nurse Planner

Angela Knupp, BSN, RN, NCSN, Student Health Services: School Nurse Specialist Harrisonburg City Public Schools, Harrisonburg, VA

Heather “Shea” Pugh, BSN, RN, NCSN, Windsor High School, Windsor, VA

Virginia Association of School Nurses Collaborators and Nurse Advisors

Colette Hokana, BSN, RN, NCSN, VASN Continuing Education Committee, Primary Nurse Planner

Betsy Looney, BS, BSN, RN, NCSN, VASN President, School Nurse Coordinator, Nurse Advisor, VASN Continuing Education Committee

Tammy Moody, BSN, RN, NCSN, School Nurse, Lunenburg County Public Schools, VA, Nurse Advisor, VASN Continuing Education Committee

Suzanne Queheillalt, MSN, APRN, ACNS-BC, VASN Continuing Education Committee, Nurse Planner

Sara Vigneault, BSN, RN, School Health Nurse, Greenville Elementary School, Fauquier County Public Schools, VA

Supporting Contributors

Leslie Caughell, PhD, Virginia Wesleyan University

Bethany Geldmaker, PhD, PNP, PMHC, an HRSA grant administrator, Virginia Department of Health

Amy Horvath, Creative Consultant

Mark Hinson, Graphics of Distinction, Web Design

Aaron Cole and Ian Levenstein, V2 LLC

Keith Montgomery, Executive Director, Virginia Chapter, American Academy of Pediatrics

Caroline Moore, MPH, School Health Program Coordinator, Virginia Department of Health

Supporting Partners

Children’s Hospital of The King’s Daughters

The REACH Institute and Lisa Hunter Romanelli, PhD

The Virginia Department of Health

Virginia Mental Health Access Program

This resource is supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,167,341, with 20% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. government. For more information, please visit HRSA.gov.

Consultants

Megan Wojcik, copy editor

“A nurse’s caring smile can brighten the darkest days.”

“Nurses may not always wear capes, but they are always superheroes.”

“School nurses are essential to the mental health of students—they see the whole child.”

National Association of School Nurses (NASN)

“There’s no health without mental health.”

World Health Organization (WHO)

"Mental health is just as important as physical health in children and adolescents.”

American Academy of Pediatrics (AAP)

“When we invest in children’s mental health we invest in their future.”

U.S. Department of Health and Human Services (HHS)

This resource is being made available by the VA-AAP to the general public and is for informational purposes only. The views expressed in this resource should not necessarily be construed to be the views or policy of the VA-AAP, or any partners in this work.

The information in this resource is believed to be accurate. However, the VA-AAP does not make any warranty regarding the accuracy or completeness of any information provided. The information is provided as-is and VA-AAP and its partners expressly disclaim any liability resulting from use of this information. The information in this resource is not, and should not be relied on as medical, legal, or other professional advice, and readers are encouraged to consult a professional advisor for any such advice.

In addition, this resource is not a substitute for the exercise of one’s independent professional judgment, which shall be exercised in the sole discretion of the individual. No part of this resource may be reproduced or distributed in any form or by any means without the prior written permission of the VA-AAP.

Welcome to the

School NurseMental Health Toolkit

America’s children spend nearly 1,000 hours a year in school

Where do kids in school go when experiencing mental health distress?

A school nurse!

View the School Nurse Mental Health Toolkit

Returning Users Log-in

Mental Health Crisis Protocols

Help with CEs

VASN Regional Directors

Discussion Facilitator Guides

Purpose of the Facilitator

Quick Checklist for Facilitators

Before the Discussion

Starting the Discussion

During the Discussion

Navigating Difficult Moments

Closing the Discussion

Discussion Guides

Introduction to School Nurse Mental Health Curriculum and Action Signs

Module 1 • School Avoidance

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

1 - Pre Assessment - School Avoidance

Module 2 • Anxiety

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

2 - Pre Assessment - Anxiety

Module 3 • Panic

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

3 - Pre Assessment - Panic Attacks

Module 4 • Depression

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

4 - Pre Assessment - Depression

Module 5 • Suicidal Ideation

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

5 - Pre Assessment - Suicidal Ideation

Module 6 • Self Harm

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

6 - Pre Assessment - Self Harm

Module 7 • Anger

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

7 - Pre Assessment - Anger

Module 8 • Coping Strategies

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

8 - Pre Assessment - Coping & Relaxation

Module 9 • Resources

Pre Assessment before watching the video

Help School Nurses Get a Seat at the Table!

9 - Pre Assessment - Resources

School Health Committee Mission

This toolkit was born from a collaboration in Virginia between school nurses and pediatricians to learn and partner together to support children and families with evidence-based tools.

Acknowledgments and Gratitude

Virginia Chapter, American Academy of Pediatrics

School Nurse Leadership Contributors

Virginia Association of School Nurses Collaborators and Nurse Advisors

Supporting Contributors

Supporting Partners

Consultants

“A nurse’s caring smile can brighten the darkest days.”

“Nurses may not always wear capes, but they are always superheroes.”

“School nurses are essential to the mental health of students—they see the whole child.”

“There’s no health without mental health.”

"Mental health is just as important as physical health in children and adolescents.”

“When we invest in children’s mental health we invest in their future.”

School Nurse
Mental Health Toolkit