“So – You Are Interested in Getting
More Mental Health Services – Now
What?”
Regional School Counselor Conference
Bridgeport Conference Center
April 18 , 2013
Introductions
Margy Burns, Youth Health Services, Elkins
• yhsmargy@yahoo.com
Jessica Laslo, School Counselor, Ohio County
• jlaslo@access.k12.wv.us
Linda Anderson, Marshall University
• landerson@marshall.edu
2
Objectives
Participants 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
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)
5
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)
6
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)
7
Graduation Rates
School 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)
8
Definition
Expanded 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:
•
•
•
•
Prevention
Early intervention
Treatment
Emphasizes shared
responsibility between
schools and community
providers
9
Focuses on all students…
…IN BOTH GENERAL AND SPECIAL
EDUCATION
10
Builds on existing
school programs,
services,
and strategies.
11
13
TIER 1 - UNIVERSAL PREVENTION
RECOMMENDATIONS
1. Infrastructure
2. Positive Behavior
Support
3. Developmental
guidance
4. Early identification
5. School climate
6. Connectedness
7. Family engagement
8. Staff development
9. School safety
10. Support for Transitions
14
15
Response to Intervention
PBIS
Student Assistance Team
Student Mental Health Initiative
Safe Schools, Healthy Students
Special Education
Crisis management
Systems of Care
Social and Emotional Learning
School linked
Wrap around
Shared Agenda
Family support services
NCLB
Cultural competence
Multiculturalism
Risk and protective factors
School based
Strengths based
Multi system approach
School linked
Student Support Services
Suicide Prevention
Mental Health Services Act
IDEA
School climate
School connectedness
Coordinated school health program
Peer-to-Peer Support
Evidence based practice
16
Planning Process
1. Support from school administration
• Principal
• District
2. Form core school leadership team
3. Identify and convene key community
agencies, parents, youth
•
•
•
•
Meet regularly
Educate one another
Keep notes
Build RELATIONSHIPS
Planning Process
4. Analyze needs and resources
•
•
•
•
School data
SWOT analysis
MH-PET: www.nasbhc.org/mhpet
School Improvement Plan
5. Define a communications plan
6. Develop an implementation plan
• Set goals, objectives, timeframes
• Shared vision
• Memo of Understanding (MOU)
Funding
It doesn’t take a lot of money; just a few
committed people
Start small – focus on “low hanging fruit”
A diversified funding base increases
sustainability
•
School System: Title 1, Safe and
Supportive Schools, SIG, Innovation
Zone
•
Hospitals
•
County
•
Community Foundations- SSJHWF,
regional
•
Community Mental Health
•
Third party insurance
•
Family Resource Network
•
Community Health Centers
•
Regional School Wellness Specialist
•
Corporations/Businesses
•
BBHHF - Tiffany.J.Pittman@wv.gov
19
DEVELOPMENT & SHORT-TERM
OUTCOMES
for
Health Connections
A Rural
EXPANDED 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
Combined student population - 2,131 students
Tucker County High School
21
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
22
Short-term Outcome: Remove
Barriers to MH Services
BARRIER
• High social stigma
associated with MH &
services
PROGRAM RESPONSE
• Move services to youths’
natural environment
(schools) & have a low
profile initially~
• Teachers/other school
personnel feel
unprepared
• Establish & train work
teams
– Community (Core Team),
– Program team (school
counselors, nurse, MH
staff) work with SATs
• Train all school personnel
23
Barriers & Response(cont.)
• High gasoline prices &
parents must miss work to
get youth to appointments
• Move services closer to
clients to eliminate travel
• Lack of local access to highend MH services
• Utilize telemental health
services called, YHSTelecare
• Confidential clinical records
•
Web-based electronic
records
• Difficulty in keeping up with
staff working in schools
•
Central scheduling
24
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.
25
Current Services
• Tier 3
– Individual & Group
Therapies (all must be
evidence-based)
– Family Therapy
– Psychiatry
– Psychology
• Tier 2
– Early Intervention
Groups (small groups, or
classroom intervention)
• Tier 1
– Dinosaur School
Classroom Intervention
(Kindergarten, early
elementary)
– SOS for Suicide
Prevention
– Summer Group Program
(Pocahontas County)
– Primary Prevention
Classroom group
interventions
26
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
Referral Sources
45
40
35
30
25
20
15
10
5
0
Series 1
28
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
Primary Concerns
Academic
Trauma
Substance
Depression
98
Behavior
Severe MI
Autism
29
LESSONS LEARNED & PLANS
• ESMH Programs are a winwin 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 SchoolBased 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.
30
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
31
Ohio County Schools
Madison Elementary
Expanded School Mental
Health Services
Tier 1
Academic and Behavioral Supports





Co-teaching
PLC bi-weekly
Teacher
study/support groups
Anchor (after school)
Attendance care
calls








Too Good for Drugs
Second Step
Keep a Clear Mind
NetSmartz
Family dinner
nights
Gold Star (PBS)
D.A.R.E
Lunch Buddy
Program
33
Tier 2
Academic and Behavioral Supports







SAT
SPL (RtI)
Tier pull-out
interventions
Extended day tutoring
Homework time
Juvenile Mediation
Program
Extended Year




KOOL Kids Program
(middle school transition)
Save One Students
(mentoring)
Weekend Snack Bag
Program
Group counselingBullfrogs & Butterflies
Afterschool Program
34
Tier 2&3
School- Based Mental Health
CHOICES Program (since 2002)
Group, Individual & Family Therapy in
coordination with Northwood Health Systems
A Center for HOPE & Change (est. 2012)
Individual and family counseling;
Afterschool psycho-educational groups and
developmental guidance in summer school
35
Children Served

Most are in grades K through 5 at the time of
the initial referral
•
Show a demonstrated pattern of
• Disruptive and aggressive behavior
• Disrespectful behavior toward others
• Failure to obey rules
• A violation of the rights of others
• Underachievement in their academic studies
• Emotional and mental health issues including
depression, anxiety, ADHD, & complex traumas
36
Parents, School,
or Students,
identify need
for services
Therapists,
School Staff,
and families
collaborate
regularly about
progress
of children
Teacher, Parent,
Student, and
School Counselor
collaborate to
make referral
With ESMH,
Communication
is Key
Therapist
hold intake/
gather information
Group, Individual,
and home
mental health
services
are provided
37
Challenges and Barriers





Scheduling time for students to be seen
during the school day
Having a regular, confidential space for
children to receive services
Staffing
Family participation and commitment
Keeping cases open through the summer
38
Impact on Students & Families



Having the services at school during the school day
reduces the barriers for children to get needed
services and minimizes the disruption to their
education.
First year outcomes include improved attendance,
increased social skills, decreased aggression, and
improved relationships.
In addition, Madison Elementary was named a 2012
WV Title 1 Distinguished School - one of 12 out of
329 Title 1 schools in West Virginia.
39
2012-13 ESMH SERVICE
HIGHLIGHTS FOR
MADISON ELEMENTARY
“For All” (Tier 1):



37 staff trained to become a Trauma-Informed School
30-35 Families attending Family Night Program
Positive Behavior Support (250 students)
“For Some” (Tier 2):


37 students receive mentoring, after-school group counseling and
other academic/behavior supports
“Kool Kids” significantly impacting 5th grade attendance rate
“For a Few” (Tier 3):


22 students receive individual, group & family therapy through
Northwood “Choices” program
“Center for Hope & Change” offers supports after school and over the
summer
40
Focus on Increasing Numbers of
Children Identified for
Tier 2 & 3 Services
41
Ohio County Schools
Madison Elementary School
We are proud of
A Center for HOPE & Change
Before…
and the CHOICES Program
…After
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/
43
National Resources
Center for School Mental Health
U of Maryland: www.csmh.umaryland.edu
National Assembly on School Based Health
Care: www.nasbhc.org
Compassionate Schools
www.k12.wa.us/CompassionateSchools
44
West Virginia Resources
“WV Educators
Speak” video
Tool Kits
Website Links
45
www.schoolmentalhealthwv.org
www.wvshtac.org
Linda Anderson, MPH
Marshall University
Huntington, West Virginia
304-544-3917
landerson@marshall.edu