School-Based Mental Health Integrated Tracking System (SB-MHITS)

1. School-Based Mental Health Integrated Tracking System (SB-MHITS)

2. What is SB-MHITS Monitoring feedback system (MFS) Structured questionnaire templates designed to facilitate efficient and effective clinical encounters Toolkit of standardized assessments (SA), tools for tracking progress over time Web-based can facilitate consultation from a mental health specialist off-site  can also facilitate coordination of care across different health care providers and organizations West Seattle: SBHC, 3 CMHCs, school staff

3. Why are we implementing it? MFS and SA are clinical best practices • SAMSHA registry of evidence-based practice • Substantial research supporting MFS use to support standardized assessment: • Routine administration of SA tools during mental health interventions is associated with clinical improvement (Blais et al., 2009) • Simply giving clinicians client progress ratings, based on how they compared to normative data, resulted in improved psychotherapy outcomes (Lambert et al., 2003).

4. Why are we implementing it? MFS/SA are quickly becoming the standard of care • Ohio, Massachusetts, Utah, Hawaii: state-wide • Great Britain, Austrailia: national • Seattle Children’s Hospital • WA state: MHITS- 110 CHCs, CMHCs, and hospitals • MHITS: 21 implementations in 14 states throughout the US and Canada

5. Why are we implementing it? Seattle voters approved 7 years of funding for our MFS in the 2012 Families and Education Levy • Mental Health Enhancement Strategy 1. Train mental health providers to support the use of standardized assessment tools to: • Screen for mental health issues • Build rapport and engagement • Enhance diagnostic clarity • Plan appropriate treatment • Monitor outcomes over time • Adjust treatment accordingly

6. Why are we implementing it? Seattle voters approved 7 years of funding for our MFS in the 2012 Families and Education Levy • Mental Health Enhancement Strategy 2. Develop a web-based monitoring and feedback system that will : • Track goal attainment and symptom improvement • Provide access to a wide array of screening and diagnostic instruments • Support systematic caseload management • Provide tools for patient engagement

7. Why are we implementing it? Even though the care we are providing now is of extremely high quality… We have a responsibility to always be asking what we can do to improve the quality of our care • Clinical training alone- mixed reviews, questionable impact on practice • MFS and SA- proven strategies, big impact on practice

8. What’s UW got to do with it? MHITS is programmed by the team at the University of Washington AIMS Center, which stands for "Advancing Integrated Mental Health Solutions”. • King County owns the system and the data Seattle Children’s Hospital is a long-time partner of the health department, providing technical assistance, training, and program evaluation expertise. • King County contracts with SCH for the services we want from them, i.e. we’re the boss

9. Is MHITS for research? NO

10. MHITS is NOT for research SB-MHITS is a clinical tool designed to support clinical practice. • We do want to rigorously evaluate SB-MHITS to assess: • Implementation success • Impacts on students • Impacts on outcomes • Impact of including academic data Why? Because we don’t want to do stuff that isn’t effective or has adverse effects.

11. MHITS is NOT for research CDC defines program evaluation as: “the systematic collection of information about the activities, characteristics and outcomes of programs to make judgments about the program, improve program effectiveness, and/or inform decisions about future program development. “ • Goal is to determine whether program meets its goals • Not intended to be replicable Yes, this is what we are doing.

12. MHITS is NOT for research • Research is defined as: “a systematic investigation, including research development, testing and evaluation designed to contribute to generalizable knowledge” • Goal is to test a hypothesis • Often involves experimental or non-standard interventions (e.g. BRISC) • Intended to produce generalizable knowledge

13. MHITS is NOT for research But if you might publish a program evaluation, doesn’t that mean it is really research? No (per the UW IRB) • Our program is not intended to be replicable. • We achieved results in a very specific and unique set of circumstances. • We publish with the intent to share what we accomplished in our specific setting.

14. Academic data in MHITS? Not yet! But coming soon… ish • Will only be for students from whom we have signed FERPA release on file FERPA Forms • There are 2 this year- one for Source, one for ADR (raw data for MHITS). Please get both! • Mail to PHSKC, we enter data and then send originals to district with account info for each site

15. MHITS Contract Expectations • All mental health visits will be entered in MHITS • At least one treatment goal with a corresponding measurement scale will be required for all students who had 2 or more visits. There will be no funding attached to the achievement of this target in 2013-2014.

16. MHITS Contract Expectations We will be adjusting productivity expectations to accommodate the learning curve of MHITS implementation. • Modeling to look at the impact of reduced productivity on # of users • Recommendation to OFE to adjust down your user performance target. • The user reduction is modest- we’ll let you know the final #s once we have approval from OFE.

17. Enhanced Consultation Monthly group consult with Children’s psychiatry fellows • Please schedule Sept ASAP (managers have info) • 2 in person meetings and the rest via BlueJean • GHC will meet in person due to large group size • Goal is to discuss 4 patients in 1 hour consult • Send MHITS IDs to consultant 2 days ahead of time so they can review, make sure record is complete* • Medical provider participation highly encouraged

18. Enhanced Consultation Monthly group consult with Children’s psychiatry fellows • Fellow will create a note for each patient discussed with their recommendations • In-between consult questions are best managed via email, with response time 24-48 hours • Crisis emergent situations should be managed according to your site crisis plan Please let me know if you have scheduling or any other problems

19. Psych Consult Template • Current Psychiatric Diagnosis: • Current Medications: • Previous Psychiatric Diagnoses: • Past Psychiatric Medication History: • Safety Issues (including self-harm and harm to others): • Substance Abuse History: • Medication Allergies: • Significant Medical Concerns: • Pertinent Psychosocial Concerns and Functioning (including key supports): • School Functioning (including academics, behavior, interpersonal):

20. Enhanced Consultation *NEW* Monthly individual psychologist consult • Please schedule ASAP • 1 hour per month per 1.0 FTE (pro-rated) • 1 in-person meeting, then via phone or Bluejean • Flag in MHITS the patients you want to prioritize for consult • Consultant will create note in MHITS re: recommendations and consult summary

21. Enhanced Consultation *NEW* Direct Patient Psychiatric Evaluations • Provided via BlueJean by senior Children’s psychiatrist Dr. Will French • Your psychologist consultant is the “gatekeeper” for these consults and will decide with you when they should be deployed. • Priority is for kids who do not have any other feasible way to get a psych eval

22. MHITS SA Training • Webinars with instructions for using each tool • Printable version of each tool • Scoring instructions On our website: resources>mental health www.seattleschoolbasedhealthcenters.org

23. Questions?