An Overview of California Mental Health Services in Schools Senate Mental Health Caucus May 21, 2014

1. An Overview of California Mental Health Services in SchoolsSenate Mental Health CaucusMay 21, 2014 County Superintendents Educational Services Association Sacramento County Office of Education California Mental Health Directors Association California Mental Health Services Authority

3. California’s Public Education System County offices of education 58 School districts 1,043 Schools 10,300 Teachers 300,000 Students in grades K-12 6,221,000

4. Mental Health Programs and Services in California Schools Services for Special Education Students • Students with Individualized Education Plans (IEPs) • Specified mental health needs • 5-10% of population • Formal, regulated processes and services to ensure student needs are met Services for the General Student Population • Students who could benefit from basic supports, social/emotional instructional programs and positive school climate – 100% of population • Students who need short-term or lower level supports and interventions that can be provided at school - 15 to 25% of population • A variety of programs and services provided by districts and schools • School-based Mental Health – a young and tenuously supported field

5. Current Programs and Practices in California Schools Evidence-based Prevention & Early Intervention Programs • School Climate – Positive Behavioral Interventions and Supports (PBIS) and similar programs • Bullying/Cyberbullying Prevention and Intervention • Suicide Prevention and Supports • Social-Emotional Skills Instruction • Counseling Services • Parent Education and Supports • Related instruction and supports, including prevention/intervention of alcohol and other drugs; eating disorders; violence or aggressive behavior

6. Regional PreK-12 Student Mental Health InitiativeStatewide Project of CalMHSA and CCSESA Statewide Infrastructure • 11 CCSESA Regions covering all 58 California counties • 11 Regional Lead County Offices of Education • Collaboration with districts, schools and local mental health agencies • Common goals and focus areas for all 11 regions • Regional/county level activities to meet local needs • Sacramento County Office of Education coordinates regional activities for the state

7. Fulfilling the Promise of School-Based Mental Health • The Vision: Comprehensive System of School-Based Mental Health Programs and Services in each California school • Aimed at providing evidence-based programs and services as early as possible to help prevent more critical needs in the future • Include a continuum of programs and services from prevention and early identification to early identification and supports to referral to intensive services when needed • Train teachers, staff and parents in early identification of mental health needs • Include system navigators and practitioners to provide services and help students stay in school

8. CCSESA’s Regional PreK-12 Student Mental Health Initiative Statewide Report: January 2013-March 2014

9. County Mental Health Departments • Administer a broad continuum of services for individuals of all ages, including children and youth • Key areas of school collaboration • Medi-Cal Specialty Mental Health Services (EPSDT mental health services) • Mental Health Services Act (Prop. 63)

10. EPSDT: A Broad Federal Medicaid Benefit • Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) for all Medicaid beneficiaries under age 21 • Comprehensive screening and preventive health, dental, vision, and developmental services. • Screenings offered through CA’s Child Health & Disability Prevention Program (CHDP) • Most diagnostic and treatment services are provided by Medi-Cal managed care plans Medi-Cal Managed Care plans and their contracted pediatricians are critical partners in identifying and screening for children’s mental health issues.

11. EPSDT Mental Health: Managed Care Plans’ Role • Mental health benefits for mild/moderate conditions were expanded in California’s implementation of health reform • For all Medi-Cal enrollees, including children, the managed care plans now offer: • Individual/group mental health evaluation and treatment (psychotherapy) • Psychological testing • Outpatient services to monitor drug therapy • Outpatient laboratory, drugs, supplies and supplements • Psychiatric consultation MOUs between Medi-Cal managed care plans and county mental health plans are key to collaboration and cross-referrals.

12. EPSDT Mental Health:Counties’ Role • Medi-Cal enrollees who meet medical necessity criteria must access EPSDT specialty mental health services through their local county mental health plan. (See handout for description of eligibility, services) • Collaboration with schools • Schools may refer children to the county • Mobile mental health, rehabilitative, and case management services may be provided on school sites by counties and subcontract providers

13. Prop. 63 Programs: Collaboration with Schools • Education stakeholders participate in each county’s planning for Prop. 63 implementation • Outreach includes schools to help identify program participants • A key goal of Prop. 63 programs is to improve children’s school attendance and academic performance, and reduce school failure/drop-out • A few local examples: • Training school personnel on suicide prevention • Cognitive behavioral therapy on school site for children exposed to trauma • Law enforcement/school/county partnership to prevent school violence • Improving the school climate and anti-bullying programs

14. School-County Partnerships Reflect Local Needs • Local needs, priorities, demographics, and historical relationships contribute to the partnerships between schools and counties throughout California • Referrals • School-based mental health services • Targeted populations • Special education students’ mental health services

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