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

1. “So – You Are Interested in Getting More Mental Health Services – Now What?”  Kidstrong Conference Charleston, WV June 11, 2013

2. 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

3. Introductions • Margy Burns, Executive Director, Youth Health Services, Elkins WV • Mindy Thornton, Prestera Center, Cabell County • JenniDurham, Prestera Center, Kanawha County • Linda Anderson, Marshall School Health TA Center • Tiffany Pittman, Bureau for Behavioral Health

4. Links Between Mental Health and School Success

5. 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)

6. 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)

7. AcademicPerformance • 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)

8. 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)

9. 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

10. Focuses on all students… …in both general and special education

11. (Is consistent with and supported by WVDE policies 4373, etc.) Builds on existing school programs, services, and strategies.

12. Tier 1 - Universal PreventionRecommendations • Infrastructure • Positive Behavior Support • Developmental guidance • Early identification • School climate • Connectedness • Family engagement • Staff development • School safety • Support for Transitions

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 Multiculturalism NCLB Family support services Where to Begin? Cultural competence 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 Peer-to-Peer Support School connectedness Evidence based practice Coordinated school health program

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 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

17. Planning Process Assess needs, resources, feasibility School / 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 progress

18. Funding • 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 • Community Foundations- SSJHWF, 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.orgwww.wvshtac.org Linda Anderson, MPH Marshall University Huntington, West Virginia 304-544-3917 landerson@marshall.edu

22. DEVELOPMENT & SHORT-TERM OUTCOMESfor Health Connections A Rural EXPANDED SCHOOL MENTAL HEALTH PROGRAM Youth Health Service, Inc. Elkins, West Virginia

23. 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 School Combined student population - 2,131 students

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 • 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

26. 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

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 2 • Early Intervention Groups (small groups, or classroom intervention) • Tier 1 • Dinosaur School Classroom Intervention (Kindergarten, early elementary) • SOS for Suicide Prevention • Primary Prevention Classroom group interventions

29. Short-term Outcome: Reach Children who need Tier 3 Services 98 children have improved accessto high quality children’s mental health services & receive those services in a more consistent manner (lower no-show rates). Slightly more boys than girlsreceived 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.

30. 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

31. Tier 3 Short-term outcomes cont. Presenting Problem Areas Areas of Concern at Entry • Behavior-39% • Depression-19% • Academic-18% • Trauma-16% • Severe MI 4% • Autism-2% • Drugs-1% (n=98)

32. 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.

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 CenterSchool-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.

35. School-based services • Chandler Middle School • Chandler High School • SOCRATES • CHANCE • ESMH- Stonewall Jackson Middle School

36. 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

37. 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.

38. 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.

39. 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.

40. 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.

41. 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.

42. 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.

43. 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.

44. 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.

45. 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?