“So – You Are Interested in Getting
More Mental Health Services – Now
What?”
Kidstrong Conference
Charleston, WV
June 11, 2013
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
2
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)
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.
(Is consistent with and supported by
WVDE policies 4373, etc.)
11
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
13
14
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
15
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 Process
1.
2.
3.
4.
Educate yourself about ESMH
Gain administrative support
Identify and convene key school staff
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 Process
5. 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
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
•
School System: Title 1, Safe
and Supportive Schools,
SIG, Innovation Zone
•
Community Mental Health
•
Third party insurance
•
Community Health Centers
•
Community FoundationsSSJHWF, regional
•
Family Resource Network
•
Corporations/Businesses
•
Hospitals
•
County Commission
19
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
20
West Virginia Resources
• www.schoolmentalhealthwv.org
• www.wvshtac.org
• Bureau for Behavioral Health
• RESA Resource Directory
• WV PCA.
21
www.schoolmentalhealthwv.org
www.wvshtac.org
Linda Anderson, MPH
Marshall University
Huntington, West Virginia
304-544-3917
landerson@marshall.edu
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
24
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
25
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
26
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
27
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 1
– Dinosaur School Classroom
Intervention (Kindergarten,
early elementary)
– SOS for Suicide Prevention
– Primary Prevention
Classroom group
interventions
• Tier 2
– Early Intervention Groups
(small groups, or classroom
intervention)
29
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
31
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
32
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.
33
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
34
Prestera Center
School-based Services
Kanawha County
Cabell County
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.
School-based services
•
•
•
•
•
Chandler Middle School
Chandler High School
SOCRATES
CHANCE
ESMH- Stonewall Jackson Middle School
Chandler Academy
Chandler 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 - Stonewall
Program 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 Services
Universal 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?