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

What?”

Regional School Counselor ConferenceBridgeport 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

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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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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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TIER 1 - UNIVERSAL PREVENTIONRECOMMENDATIONS1. 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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Planning Process1. Support from school administration

• Principal• District

2. Form core school leadership team3. Identify and convene key community

agencies, parents, youth• Meet regularly• Educate one another• Keep notes• Build RELATIONSHIPS

Planning Process4. Analyze needs and resources

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

5. Define a communications plan6. Develop an implementation plan

• Set goals, objectives, timeframes• Shared vision• Memo of Understanding (MOU)

Funding

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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

• Community Mental Health

• Third party insurance

• Community Health Centers

• Corporations/Businesses

• Hospitals• County

• Community Foundations- SSJHWF, regional

• Family Resource Network• Regional School Wellness Specialist• BBHHF - Tiffany.J.Pittman@wv.gov

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.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

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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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Ohio County SchoolsMadison 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

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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 counseling- Bullfrogs & Butterflies

Afterschool Program

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Tier 2&3School- 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

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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

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Teacher, Parent, Student, and

School Counselor

collaborate to make referral

Therapisthold intake/

gather information

Group, Individual,and home

mental healthservices

are provided

Therapists, School Staff, and families collaborate

regularly about progress

of children

Parents, School, or Students, identify need for services

With ESMH, Communicati

on is Key

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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

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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.

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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

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Focus on Increasing Numbers of Children Identified for

Tier 2 & 3 Services

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Ohio County SchoolsMadison Elementary School

Before… …After

We are proud of A Center for HOPE & Change

and the CHOICES Program

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/

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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“WV Educators Speak” video

Tool Kits

Website Links

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www.schoolmentalhealthwv.org

www.wvshtac.org

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