The Virginia Tech shooting and the mental state of assailant Seung-Hui Cho have many asking how schools handle students with mental or behavioral problems. Radio talk shows, cable television news and blogs alike have examined the question locally and on a national level. Tucson is no different.

There are multi-stage systems in place at schools in Tucson and around the state, say education officials, that are meant to monitor students and provide help. With counselors and psychologists assigned to every school and a referral system that connects parents and students to local clinics and social agencies, there are ways to get help if a student is troubled.

But it all begins with a referral, education officials say, be it from a bus driver or parent, and often times the social stigma associated with mental health can stand in the way.

"Sometimes parents feel lost, but there are things in place," said Holly Colonna, lead counselor for the Tucson Unified School District. "There are experts at our schools and great agencies in our community."

TUSD has 175 counselors, with one in every school, Colonna said. There are 60 psychologists as well, said Brent Holt, TUSD's lead psychologist.

The Sunnyside Unified School District is much the same, with at least one counselor and psychologist at every high school, said Brandon Protas, district coordinator for Sunnyside Family Resource & Wellness Centers. There are two counselors and one psychologist at each middle school, he said, and a counselor each for elementary schools.

Flowing Wells Superintendent Nicholas Clement said it takes the effort of the entire district to handle behavior issues.

His district's schools rely on a strict code of consequences to manage students' behavior.

For instance, Clement said if students exhibit issues in writing assignments, teachers are expected to refer them to a counselor or administrator. From there, the district has options to provide students with services should they require additional help.

Most schools have off-site support, called family resource and wellness centers, which initially developed in the early 1990s as a collaborative effort among the city, Pima County, various state agencies and four school districts: Amphitheater, Flowing Wells, Sunnyside and TUSD.

The centers provide mental-health services and referrals, along with other social services, such as health care, financial assistance, adult education, child care and counseling.

But all the support offered through schools is moot, education officials say, if parents, teachers, students or other adults don't keep an eye on a youngster's behavior.

"We talk to parents all the time," Colonna said. "Listen, listen, listen to your children."

Federal and state law require an identification system in schools for students with disabilities, defined as a range of problems from physical impairments to emotional disability.

If there are concerns about a student, then an adult, from parent to bus driver, may refer the student to the school's counselor for an evaluation. From there, Colonna said, a committee comprising a school psychologist, counselor, parents and the individual who made the referral would determine if there's a disability, which can include emotional disturbances. The committee also would examine what sort of services are available for the student.

If a disability is found, by law, the school must create an individualized education plan for the student, which could range from regular class with an aide or placement in a facility to best suit the student's needs.

An individualized education plan is the only document to notify teachers, or other schools if a student transfers, of any emotional or behavioral issues. Outside of counselors' records, neither school districts nor the Arizona Department of Education track student referrals to outside services.

A student's family needs to work with counselors and psychiatrists to really have an effect, noted Dan Ranieri, president and CEO of La Frontera Center, a local nonprofit health-care center. La Frontera is one of more than half a dozen local health agencies that work with student referrals, which now number about 2,500, he said.

"To the degree you can get a child's family, counselor and teacher all working on the same plan, that enhances the chance of success," Ranieri said.

Mental health, like physical health, Colonna said, often requires long-term attention.

For example, explained Protas, if a student attempts suicide, there needs to be a follow-up after he or she is stabilized and released from a medical facility. But there are no mandates for follow-ups, he said, and adults must remain observant, to make sure young people continue with any prescribed medication or therapy.

Referrals are by no means a diagnosis, Protas warned.

"Red flags are just that. Something of concern that might call for an investigation," he said.

State and local officials say the stigma of mental-health problems often prevents adults, teachers and parents alike from seeking help for a young person.

No one should jump to a conclusion about a student seeking mental health, Protas said.

Violent outbursts are very rare, he explained, and disturbances may be the reaction to something else in a student's life, such as divorce.

"Just because there are signs of emotional disturbance doesn't mean there's going to be a violent outbreak," he said.

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