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 ID: 659112
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Slide1
“So – You Are Interested in Getting More Mental Health Services – Now What?”
Kidstrong ConferenceCharleston, WVJune 11, 2013Slide2
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
2Slide3
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
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Links Between Mental Health and School SuccessSlide5
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
PerformanceIs 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 behaviorLack 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)
7Slide8
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 violenceAnxiety disordersOther unmet mental health needs
(Black, et al, 2003, Woodward & Ferguson, 2001; and others)
8Slide9
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:
9
Prevention
Early intervention
Treatment
Emphasizes
shared
responsibility
between schools and community providersSlide10
…i
n both general and special educationFocuses on all students…
10Slide11
Builds on
existing school programs, services, and strategies.
11
(Is consistent with and supported by WVDE policies 4373, etc.)Slide12Slide13
Tier 1 - Universal PreventionRecommendations
InfrastructurePositive Behavior SupportDevelopmental guidanceEarly identification
School climateConnectedness
Family
engagement
Staff development
School safety
Support for Transitions
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14Slide15
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
Multiculturalism
Shared Agenda
School based
School linked
Special Education
NCLB
IDEA
Crisis management
Evidence based practice
Multi system approach
Response to Intervention
PBIS
Systems of Care
School linked
Wrap around
Student Assistance Team
Where to Begin?
15Slide16
Recommended Reading
Realizing the Promise of the Whole-School Approach to Children’s
Mental Health: A Practical Guide for SchoolsNational Center for Mental Health Promotion and Youth Violence Prevention:
http://promoteprevent.org/Publications/
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Planning Process
Educate yourself about ESMHGain administrative support Identify and convene key school staff
Identify and convene reps from the broader school and communityHealth providers, parents, youth, Regional Wellness
Specialist,FRN
, business, potential funders
Meet regularly
Educate one another, review models
Build
RELATIONSHIPSSlide18
Planning Process
Assess needs, resources, feasibilitySchool / community data; SWOT analysis
School Improvement Plan
MH-PET:
www.nasbhc.org/mhpet
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 progressSlide19
Funding
School System: Title 1, Safe and Supportive Schools, SIG, Innovation ZoneCommunity Mental HealthThird party insuranceCommunity Health Centers
Community Foundations- SSJHWF, regional Family Resource Network
Corporations/Businesses
Hospitals
County Commission
19
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 Slide20
National Resources
Center 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 University
Huntington, West Virginia
304-544-3917
landerson@marshall.edu
Slide23
DEVELOPMENT & SHORT-TERM OUTCOMESfor
Health Connections
A RuralEXPANDED SCHOOL MENTAL HEALTH
PROGRAM
Youth Health Service, Inc.
Elkins, West Virginia Slide24
Serving Five Very Rural Schools
Green Bank Elementary/Middle School
Pocahontas County High SchoolTucker Valley Elementary/Middle SchoolDavis-Thomas Elementary/Middle School
Tucker County High School
C
ombined 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
BARRIERHigh social stigma associated with MH & servicesTeachers/other school personnel feel unpreparedPROGRAM RESPONSEMove 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 appointmentsLack of local access to high-end MH services Confidential clinical recordsDifficulty in keeping up with staff working in schoolsMove services closer to clients to
eliminate travelUtilize 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
.
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Current Services
Tier 3Individual & Group Therapies (all must be evidence-based)Family TherapyPsychiatryPsychologySummer Group Program (Pocahontas County)Tier 2Early Intervention Groups (small groups, or classroom intervention)
Tier 1Dinosaur 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.Slide31
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
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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
32Slide33
LESSONS LEARNED & PLANS
ESMH Programs are a win-win for schools, families and studentsSchools welcome us, provide space and collaborate with staffStaff like the school settingMust adjust to school calendar, snow daysMust plan for services to continue in the summer in local communities
Collaborate with School-Based Health ClinicsMake 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.
LESSONSTelemental 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 CountySlide36
School-based servicesChandler Middle School
Chandler High SchoolSOCRATESCHANCEESMH- Stonewall Jackson Middle SchoolSlide37
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 schoolSlide38
Chandler AcademyChandler 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.Slide39
Elementary School-Based Services
CHANCEThe 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.
SOCRATESThe SOCRATES (Specialized O
utpatient
C
ounseling
R
esources
A
vailable
T
o
E
lementary
S
tudents) program provides services to assist the elementary student with improving their functioning in the academic setting to prevent school suspensions
and expulsions. Slide40
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.Slide41
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. Slide42
ESMH Tier Services
Tier 3 ServicesIndividual 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.Slide43
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. Slide44
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.Slide45
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.Slide46
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?