“So – You Are Interested in Getting More Mental Health Services – Now

What?”

Kidstrong ConferenceCharleston, WV

June 11, 2013

ObjectivesParticipants will be able to:• Describe the three tiers of an expanded

school mental health model (ESMH)• Identify at least three resources for

planning and implementing a comprehensive model

• Identify at least three strategies essential to successful implementation

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Introductions• Margy Burns, Executive Director, Youth Health

Services, Elkins WV

• Mindy Thornton, Prestera Center, Cabell County

• Jenni Durham, Prestera Center, Kanawha County

• Linda Anderson, Marshall School Health TA Center

• Tiffany Pittman, Bureau for Behavioral Health 3

Links Between Mental Health and School Success

Facts• 5-9 % of children and teens have a

serious emotional disturbance. (US Surgeon General’s Report, 1999)

• 20% of children and adolescents at any given time have a diagnosable mental disorder which interferes with their functioning.(US Surgeon General’s Report, 1999)

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Facts• 1-2 children in every classroom have a

diagnosable mental health concern which hinders functioning. (President’s New Freedom Commission Report)

• Less than 50% of children and adolescents with a mental illness receive adequate (or any) services (Kataoka, Shang, Wells, 2002)

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Academic Performance• Is negatively affected by:

– Alcohol, tobacco, and other drug use – Emotional problems – Health risk behaviors (e.g. obesity, sexual behavior,

poor diet)– Low self-esteem, risky sexual behavior– Lack of access to health and mental health care– Poor home life

• Is positively affected by:– High levels of resiliency, developmental assets, and

school connectedness(work of CASEL, Search Institute; and others)

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Graduation RatesSchool Mental Health strategies can improve graduation rates by addressing factors that interfere with a student’s ability to succeed in school, such as:• Exposure to violence• Anxiety disorders• Other unmet mental health needs

(Black, et al, 2003, Woodward & Ferguson, 2001; and others)

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DefinitionExpanded School Mental Health refers to programs that build on the core services typically provided by schools. It is a three-tiered framework that includes the full continuum of:

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• Prevention• Early intervention • Treatment• Emphasizes shared

responsibility between schools and community providers

…IN BOTH GENERAL AND SPECIAL EDUCATION

Focuses on all students…

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Builds on existing school programs, services, and strategies.

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(Is consistent with and supported by WVDE policies 4373, etc.)

TIER 1 - UNIVERSAL PREVENTIONRECOMMENDATIONS

1. Infrastructure2. Positive Behavior

Support3. Developmental

guidance4. Early identification5. School climate6. Connectedness

7. Family engagement8. Staff development9. School safety 10. Support for Transitions

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Student Support Services

Social and Emotional Learning

Mental Health Services Act

Student Mental Health Initiative Safe Schools, Healthy Students

Peer-to-Peer Support

School climate

School connectedness

Coordinated school health program

Suicide Prevention

Strengths based

Risk and protective factors

Family support services

Cultural competence

MulticulturalismShared Agenda

School based

School linked

Special Education

NCLB

IDEA

Crisis management

Evidence based practice

Multi system approach

Response to InterventionPBIS

Systems of Care

School linked

Wrap around

Student Assistance Team

Where to Begin?

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Recommended Reading

Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools

National Center for Mental Health Promotion and Youth Violence Prevention:

http://promoteprevent.org/Publications/16

Planning Process1. Educate yourself about ESMH2. Gain administrative support 3. Identify and convene key school staff4. Identify and convene reps from the broader

school and community• Health providers, parents, youth, Regional

Wellness Specialist,FRN, business, potential funders

• Meet regularly• Educate one another, review models• Build RELATIONSHIPS

Planning Process5. Assess needs, resources, feasibility

• School / community data; SWOT analysis• School Improvement Plan• MH-PET: www.nasbhc.org/mhpet

6. Develop an implementation plan• Set vision, goals, objectives, timeframes• Secure financial resources• Establish a Memo of Understanding/contract with a

MH provider: Hours, funding, staffing, liability

8. Monitor, re-assess, evaluate progress

Funding

• School System: Title 1, Safe and Supportive Schools, SIG, Innovation Zone

• Community Mental Health• Third party insurance• Community Health Centers

• Community Foundations- SSJHWF, regional

• Family Resource Network• Corporations/Businesses• Hospitals• County Commission

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1. It doesn’t take a lot of money; just a few committed people

2. Start small – focus on “low hanging fruit”

3. A diversified funding base increases sustainability

National ResourcesCenter for School Mental HealthU of Maryland: www.csmh.umaryland.edu

National Assembly on School Based Health Care: www.nasbhc.org

Compassionate Schoolswww.k12.wa.us/CompassionateSchools

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West Virginia Resources• www.schoolmentalhealthwv.org • www.wvshtac.org• Bureau for Behavioral Health

• RESA Resource Directory

• WV PCA.

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www.schoolmentalhealthwv.org

www.wvshtac.org

Linda Anderson, MPHMarshall UniversityHuntington, West Virginia304-544-3917landerson@marshall.edu

DEVELOPMENT & SHORT-TERM OUTCOMESfor

Health Connections

A RuralEXPANDED SCHOOL MENTAL HEALTH

PROGRAM

Youth Health Service, Inc.Elkins, West Virginia

Serving Five Very Rural Schools

Green Bank Elementary/Middle School

Pocahontas County High School

Tucker Valley Elementary/Middle School

Davis-Thomas Elementary/Middle School

Tucker County High SchoolCombined student population - 2,131 students

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Goals:• Increase access to quality, evidence-based mental

health services for children and adolescents• Improve school attendance, academic performance

and psycho-social functioning of students

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Short-term Outcome: Remove Barriers to MH Services

BARRIER• High social stigma

associated with MH & services

• Teachers/other school personnel feel unprepared

PROGRAM RESPONSE• Move services to youths’

natural environment (schools) & have a low profile initially~

• Establish & train work teams– Community (Core Team),– Program team (school

counselors, nurse, MH staff) work with SATs

• Train all school personnel

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Barriers & Response(cont.)

• High gasoline prices & parents must miss work to get youth to appointments

• Lack of local access to high-end MH services

• Confidential clinical records

• Difficulty in keeping up with staff working in schools

• Move services closer to clients to eliminate travel

• Utilize telemental health services called, YHS-Telecare

• Web-based electronic records

• Central scheduling

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Client Flow Process in YHS ESMH Program

• Referrals may be initiated by parent, teacher, nurse, principal, SAT or student.

• All in-school referrals go to the school counselor first.28

Current Services• Tier 3

– Individual & Group Therapies (all must be evidence-based)

– Family Therapy– Psychiatry– Psychology– Summer Group Program

(Pocahontas County)

• Tier 2– Early Intervention Groups (small

groups, or classroom intervention)

• Tier 1– Dinosaur School

Classroom Intervention (Kindergarten, early elementary)

– SOS for Suicide Prevention

– Primary Prevention Classroom group interventions

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Short-term Outcome: Reach Children who need Tier 3 Services

• 98 children have improved access to high quality children’s mental health services & receive those services in a more consistent manner (lower no-show rates).

• Slightly more boys than girls received services (54% vs. 46%)

• Medicaid was leading insurance coverage (57%), while 43% had private insurance coverage (n=88), all but 10 children had some coverage at enrollment.

Short-term Outcomes cont.

• 32% of all children lived outside of their natural parents home(n=94)

• School personnel were leading referral source, followed by family member

• Most children (91%) were enrolled in regular education with 9% receiving special education services

Family YHS

Community

School C

ounselor05

1015202530354045

Referral Sources

Series 1

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Tier 3 Short-term outcomes cont.

Presenting Problem Areas

• Behavior-39%• Depression-19%• Academic-18%• Trauma-16% • Severe MI 4%• Autism-2%• Drugs-1% (n=98)

Areas of Concern at Entry

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Primary Concerns

AcademicTraumaSubstanceDepressionBehaviorSevere MIAutism

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LESSONS LEARNED & PLANS• ESMH Programs are a win-

win for schools, families and students

• Schools welcome us, provide space and collaborate with staff

• Staff like the school setting• Must adjust to school

calendar, snow days• Must plan for services to

continue in the summer in local communities

• Collaborate with School-Based Health Clinics

• Make all schools SBIRT sites

• Add ESMH sites in all schools that are pilot sites now (12 schools)

• Study the impact of ESMH programs on mental health of staff, students and schools.

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LESSONS LEARNED & PLANS cont.LESSONS• Telemental health is a great way

to provide emergency mental health services and backup supervision for school-based staff.

• A planning period before full implementation is critical.

• Investments in training staff in EBPs & for work in schools is critical

PLANS

• Expand Tier 1, 2 services

• Recruit more therapists who enjoy providing children’s mental health services and who are innovators.

• www.youth-health.org• (304)636-9450

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School-based services support the school environment by helping children stay in school and by identifying and addressing mental health problems that may interfere with the learning process.

Prestera CenterSchool-based Services Kanawha County Cabell County

School-based services

• Chandler Middle School• Chandler High School• SOCRATES• CHANCE• ESMH- Stonewall Jackson Middle School

Chandler AcademyChandler Middle School: Phase 1: Intensive services for 6 weeks Phase 2: Transitioning into the regular

alternative school classroom Phase 3: Follow-up and monitoring in the

home school

Chandler Academy

Chandler High School• This program is designed to assist the student

with adjusting to the alternative school setting and to provide follow-up and monitoring upon the student’s return to his or her home school.

Elementary School-Based Services

• CHANCE• The CHANCE (Caring and Helping Academically while Nurturing Children

Emotionally) program is about working with students that need another chance to improve their behaviors so they can be successful at their home school. This is an eight week intensive program consisting of half a day of academics and half a day of mental health services.

• SOCRATES• The SOCRATES (Specialized Outpatient Counseling Resources Available To

Elementary Students) program provides services to assist the elementary student with improving their functioning in the academic setting to prevent school suspensions

• and expulsions.

ESMH - StonewallProgram Description:

The Expanded School Mental Health Program is a collaborative effort between Prestera Center for Mental Health and Kanawha County Schools, designed to address the emotional and behavioral difficulties that negatively impacts school performance, including attendance, grade point average, and the development of healthy relationships with other students and school authority figures; and optimize overall student health and well-being. The program is housed within Stonewall Jackson Middle School and is designed to operate throughout the regular school year.

ESMH Tier ServicesUniversal Prevention Program (Tier One):

• Cybersmart Curriculum – addressing manners, cyberbullying, and ethics.

• Holt’s Decisions for Health – including worksheets and activities on building self-esteem, healthy body weight, mental and emotional health, stress management activities, conflict resolution, teens and drugs.

Targeted Intervention Program (Tier Two):

• Targeted Group and Early Intervention Programming - embraces at risk students and includes referral services, rapid response capability, study groups, tutoring, mentoring, after school programs, small group interventions to address anger, social skills, substance abuse and other needs, as well as some individual supportive services.

ESMH Tier Services

Tier 3 Services• Individual and family therapy, supportive

counseling, treatment planning and targeted case management as needed.

• Provided only to those students that are assessed as meeting medical necessity for these services.

ESMH – Cabell Alternative School

• All students in this school receive Tier 2 as they are already targeted based on the type of school they are attending.

• All students receive group sessions provided by the school counselor and the Prestera therapist: In Control Anger Management and Too Good for Drugs

• Students are assessed for need of individual and family therapy. Referrals made for psychiatric services as needed. Students that receive Tier 3 also receive transition services after completion of Alternative School. The therapist completes follow up sessions at the home school. This ensures successful reintegration into regular school setting.

Cabell County School Based

• Providing a wide range of mental health services including, individual therapy, supportive counseling, targeted case management, and treatment planning.

• Staff serve as a resource for all school staff in regards to students’ mental and behavioral health.

Cabell School Based (continued)

• Currently serving seven of the Elementary Schools (BOE has recently requested we provide services in the other twelve for Fall 2013)

• All Middle Schools and all High Schools have Prestera Therapists and Case Management teams in place.

The Planning Process

• Who, What, When, Where and How• Who do I talk to?• What do I say?• Where Do I go?• How Do I start?