School Community Partnership for Mental Health An MPS School Based “Mental Fitness” Program Charlie Bauernfeind, Milwaukee Public Schools Sheri Johnson, Medical College of Wisconsin Carrie Koss Vallejo, IMPACT Planning Council Sebastian Ssempijja, Sebastian Family Psychology Practice Using the Clickers Each of you has a “clicker” that will allow you to respond to questions during the presentation, and we’ll be able to see the responses. Please use the pad of your finger to press buttons –not your fingernail. You can change your answer, but only your last response will “count.” Getting to know our audience What field do you work in? 1. 2. 3. 4. 5. 6. 7. Mental health provider Education- At a university Education- K-12 (Admin) Education – K-12 (SSW) Education – K-12 (School Psy) School Nurses Other 40% 38% 35% 30% 25% 24% 20% 15% 14% 10% 10% 5% 5% 5% 5% 0% 1 2 3 4 5 6 7 SCPMH Goal Statement The goal of the School Community Partnership for Mental Health is to: refine and demonstrate the effectiveness of a collaborative partnership model of mental health promotion and service to influence systems changes needed for sustainability. Partners Research Assistants/ Community Health Workers Community Mental Health Providers HMOs Sebastian Family Psychology Practice, LLC Schools in WI’s largest district and a Head Start provider Academic Partners Funders Story Session Outline Chapter Needs 1: SCPMH – The Early Years Assessment Building the model Addressing Chapter systems barriers 2: SCPMH- The Middle Years Perspectives from School Staff, Researchers, Community Health Workers & Therapists Case Discussion Story Session Outline Chapter 3: SCPMH- Graduation Treatment School Initiation and Parent Satisfaction Behavioral Improvement Stigma Chapter 4: SCPMH-Lessons Learned Outcomes Chapter 1 –The Early Years Needs Assessment, Model Building, Barrier Busting Photo from City of Milwaukee’s I want a strong baby public health campaign The Early Years (2005-2009) 1) National Family Week Partnership study (2005) of mental health services for youth in Milwaukee – ACCESS IS PROBLEMATIC. 2) Milwaukee Public Schools estimated only5% of STUDENTS GET CARE. 3) Youth Mental Health Connections, COMMITS TO ACTION. Connecting Need and Capacity: A Study of Mental Health Services for Youth in Milwaukee County Lengyel et al 2005 The Early Years (2008-2009) Relationships between schools and community providers Incorporation of evidence based practices Engagement with Parents and Caregivers Outcome data Screening and Referral processes Need for better Feedback and coordination with teachers Sustainability Plans Early intervention The Middle Years: Pilot strategies Views from School Staff, Community Mental Health Providers, Researchers and Community Health Workers Case Discussion The Middle Years: 2009-2013 Three community-based agencies providing parttime consultation and direct services in collaboration with four Milwaukee Public Schools Project coordinator working with Leadership Team to oversee implementation Public Health researchers developing and testing a process for outcomes research incorporating Community Health Workers Operations manual and referral system being developed to support expansion 3 Levels of Support System SBIRT & PBIS III II I • • • • Refer selected students Obtain ROI Consultation with Guardian Individual / Family Therapy • Consultation with Staff • Classroom presentations • School embedding activities SCPMH Community Coordinator The coordinator is the “go-to” person for the participating community mental health agencies The coordinator assures that the community partners understand and comply with their roles The coordinator works with insurance providers, community health workers, government agencies, and university researchers to enhance collaborative efforts SCPMH School Coordinator The coordinator is the “go-to” person for schools Coordinates school events and communications Assures record keeping and data collection Addresses problems at schools Assures compliance with SCPMH policies and procedures School Staff Perspective Mental Health is taboo → Mental Fitness Overcoming “union” issues Need full-time support services staff to triage Building Bridges to schools takes time The Building Principal The Pupil Services Support Staff The Classroom Teacher Building trust is a slow process School calendar and attendance are issues COMMUNITY HEALTH WORKER ROLE- Bridge Building Assist with delivery and completion of initial paperwork by parents- ROIs, research consents and data Conduct “check-ins” with providers and teachers Assure two-way communication with families Provide links to broad range of resources – school social worker and others Participate in school’s family events and staff meetings Provide a cultural/linguistic bridge for families to schools and providers CHW/Parent Interactions at School Events Community Health Worker (CHW) Perspective New role Research assistant Varied responsibilities: Making home visits Sharing info with therapist and school Finding additional services for clients What is the first priority for a CHW when meeting a family? 1. 2. 3. 4. Get a Release of Information (ROI) Sign family up for research Connect family to support services Build an alliance/trusting relationship 90% 84% 80% 70% 60% 50% 40% 30% 20% 11% 10% 5% 0% 0% 1 2 3 4 Community Mental Health Agency Perspective Reflections on the process Administrator Clinicians buy in who had the “right fit” Provider/Client Alliance Community Mental Health Agency Perspective Implementation experiences and deliverables Culture shift Agency utilization Feedback and ongoing assessment Standardization momentum of and operational Case Study Discussion Photo credit: MCW Annual Report – SCPMH staff from Medical College of Wisconsin, Milwaukee Publics Schools, IMPACT Planning Council and Sebastian Family Psychology Practice. How should SCPMH intervene? 12 year old male student Classmates Teacher report he was bit by a dog notes grades starting to slip SSW engages student, provides social emotional support Student develops attendance issues SSW discovers student and mother were victims of random gunfire Student detaches from friends What are the major obstacles to school based mental health services? 1. 2. 3. 4. 5. Teachers are resistant School administrators won’t allow it Community providers aren’t interested Parents are not invested There is no good source of funding Evidence Based Therapy is overrated and hard to implement in real world settings 1. 2. True False How important is it that families who receive therapy participate in the research? Please rate 1 (lowest) - 5 (highest) 1 2 3 4 5 Chapter 3: Graduation Do we have the data to go forward? Stages of Implementation (Perales, Johnson, Barret and Eber) Focus Should we do it Stage Description Exploration/ Adoption Decision regarding commitment to adopting the program/practices and supporting successful implementation. Installation Set up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct audit, develop plan. Initial Implementation Try out the practices, work out details, learn and improve before expanding to other contexts. Elaboration Expand the program/practices to other locations, individuals, times- adjust from learning in initial implementation. Continuous Improvement/Re generation Make it easier, more efficient. Embed within current practices. Getting it right Making it better What have we learned? Treatment Initiation Rates Stigma Program School Satisfaction and Challenges Staff Parents Mental Health Providers and Community Health Workers Behavioral Improvement Treatment Initiation Perceptions of Stigma among School Staff and Parents Program Evaluation Open ended interviews with parents of students enrolled in treatment (N=6) Open ended interviews with principals from 4 schools (N=4; 100% response) Closed ended survey data from staff at 4 schools (N=171; 69% response rate) Open ended survey data from community mental health providers and community health workers (N=9; 100% response rate) Overarching Themes - Positive Access Safe environment for kids Convenient for parents Smart/Efficient for everyone Partnership Novel Helpful Needed Outcomes Behavior change Overarching Themes - Negative Logistics Consent Communication Capacity Coordination Parent Lower Involvement than desired Missed opportunity for input Missed opportunity for addressing stigma Stigma Behavioral and Academic Outcomes-The Plan For those who consented to research: Strengths and Difficulties Questionnaire baseline, 3 months, 6 months parent, teacher, student Revised Working 4 Alliance Inventory weeks, 6 months parent, teacher, student + Behavioral Outcomes 2011-2012 Cohort 2012-2013 Cohort 1) Office Referrals: 1) Office Referrals: Significant difference between pre/post intervention (p=.03) Significant difference between pre/post intervention (p=0.014) 2) Disciplinary Action Taken: 2) Disciplinary Action Taken: Significant difference between pre/post (p=.0065) Significant difference between pre/post (p=0.003) Wilcoxon signed rank sum test used to test the significance of two paired samples. Office Referrals- trends toward decline for those in therapy 2011-2012 School Year Attendance – remained stable 2011-2012 School Year Chapter 4: Lessons Learned From the real world Lesson Learned: How do we implement best practices to engage parents? School Staff Survey Results *Dichotomized for Satisfied/Not Satisfied Good News! MPS and partners expanding to a total of 8 schools in September 2014, including an MPS Charter School and a Head Start K5 school MCW Department of Behavioral Medicine and Psychiatry providing evidence-based intervention consultation in 2014-15 school year Project Prevent grant to MPS awarded in September 2014, expanding to 11 additional schools in 2015 and 2016 school years Acknowledgements Dena Sue Radtke and staff, MPS McKenzie, Rogers Memorial Hospital Katie Pritchard and staff, IMPACT Planning Council Audrey Pippa Potter, IMPACT Planning Council Simpson and staff, MCW Chelsea Sandy Hamilton, MCW Bogar, MCW; Vania Trejo, Zoey Schmidt, UWM Kevin O’Brien and staff, Aurora Family Services Cathy Arney and staff, Pathfinders Milwaukee Sebastian Families Family Practice staff and staff at OW Holmes, Hopkins Lloyd, Wedgewood Park and Audubon.