In The Trenches: A Look at School Based Mental Health Kristine Sack, LPC, LSS Kelsey Siegel, LCSW, Catholic Charities Megan Sommers, LPC, LSS Tom Kaufman, LPC, Catholic Charities

Agenda & Objectives Introductions What does it mean to be “in the trenches”? Question & Answer

THOUGHTFUL PREPARATION MADISON: 75% direct service & 25% paid consultation: 13 student hours per week staffing with point-person per grade teachers 25% is paid for by commercial insurance companies, school money and grant money Schools: 4 elementary; 1 middle school Students served in 2016-2017 school year: 76 students; almost 1,000 sessions; average 13-14 sessions per student In the T.R.E.N.C.H.E.S.

THOUGHTFUL PREPARATION Appleton/Fox Cities 100% direct client contact Billing: Third party billing to commercial insurance & Medicaid Sliding Fee Scale Fees waived and utilization of philanthropic funds Schools: 2 elementary; 2 middle & 4 high schools Students served in 2016-2017 school year: 104 students; over 1,400 sessions; average 13-14 (13.53)sessions per student In the T.R.E.N.C.H.E.S.

Referral Process Madison: In the T.R.E.N.C.H.E.S. Referral Process: How do students get to our school offices for services? (Ideally) Teacher/parents/school counselors/student/friend of student Each referral is staffed by a “mental health team” at each school School social worker/school counselor contacts student’s parent/s to come in for a meeting Initial paperwork is explained by school social worker and parents sign release for counselor/counselor’s office staff can contact family to verify demographic and insurance information Referral Process: How to students get to our school offices for services? (A bit more realistic) Poor family engagement due to a number of causes Student may have an extensive mental health history, including trauma that have never been addressed In the T.R.E.N.C.H.E.S.

Referral Process: Appleton/Fox Cities In the T.R.E.N.C.H.E.S. Referral Process: How do students get to our school offices for services? Teacher/parents/school counselors/student/friend of student School social worker/school counselor contacts student’s parent/s for a meeting presenting SBMH counseling process & reason for student’s referral Parent/s complete paperwork: ROI for school point-person to release student information to therapist & for therapist to contact family; demographic & insurance information Referral packet provided to counselor: school ROI, family demographic & insurance information, referral form, student class schedule, Person Summary Report “Meet & greet” with student Agency secretary contacts family to verify information & mail them agency intake paperwork Process Barriers: Poor family engagement due to a number of reasons Student may have an extensive mental health history, including trauma that have never been addressed; appropriateness of referral for school setting In the T.R.E.N.C.H.E.S.

Engaging School Staff PBIS: High tier 2/tier 3 students Clarity of roles & boundaries Referral point-person/coordinator Teacher buy-in Staff & faculty education of what school based mental health services entail initially and on-going Education, education, education! Know your resources Team development In the T.R.E.N.C.H.E.S.

Navigating Schools School environment & culture Drill participation Therapist that matches the school Drill participation School schedules Student class schedules Removing kids from classes Late start/early release HIPAA vs FERPA Tom’s story – secretarial; sessions as rewards In the T.R.E.N.C.H.E.S

Navigating Schools: HIPAA vs FERPA FERPA vs HIPAA Thank you for all of your support for your school based mental health counseling program. We are providing you this information to help clarify questions and promote the enforcement of privacy for the kids we all work with including the use of FERPA (School) and HIPAA (Mental Health Agency) Releases of Information (ROI). It can be quite confusing to balance both FERPA laws and HIPAA laws when both have to be practiced in one building. As mentioned above, within a school based mental health program, there will end up being two sets of privacy rules with two separate needs for ROIs. Each student maintains an educational record through your school but once an intake evaluation within the school based mental health program occurs, there also becomes a healthcare record that will be maintained by the providing therapist’s mental health agency. As a healthcare agency, there are specific rules/laws under HIPAA the provider and agency need to follow in order to protect Private Health Information (PHI). The therapist is aware of HIPAA laws and is responsible for answering any questions including when the release is needed, as well as providing details that are in the Consent for Treatment that connect with the ROI and can help the families understand what exactly gets released and how records are housed to protect their PHI. With this being said, it is an expectation of the providing agency that a referral to your school based mental health program include a release of information from the school district. The school release allows the school to provide student specific information to the providing therapist, including the student’s need for therapy services and demographic information. Once the student becomes a school based mental health client, they will then have a HIPAA release signed so further collaboration can include concerns or feedback from the therapist related to the student’s information in the healthcare record. As indicated above, FERPA and HIPAA have many similarities yet enough differences that we need to be careful to maintain documentation that supports both laws including the use of ROIs. The intentions of the laws are to help students, clients and parents feel a sense of privacy and protection over their child’s personal information. Even with these obstacles, the school based mental health program continues to be well utilized because of your diligent efforts in connecting with parents to assist in the follow through of referrals. Thank you for all you do!

Clients: ⅔ first time MH treatment ⅓ special education services ½ experiencing difficulties for over 1 year High tier 2/tier 3 intervention Barriers to care Confidentiality outside of session Common diagnoses In the T.R.E.N.C.H.E.S.

Clients Primary Diagnoses 2016-2017 School Year Madison Appleton/Fox Cities In the T.R.E.N.C.H.E.S.

How to engage families Flexibility Creativity School staff involvement Expectations of families/parents Resources In the T.R.E.N.C.H.E.S.

Evaluate Purpose of evaluating? Student satisfaction School data Who benefits from what data? Student satisfaction School data Academics Behaviors Attendance/Truancy IEP & 504 Plans Therapeutic assessments In the T.R.E.N.C.H.E.S. Therapeutic impressions/prognosis

Stories from the T.R.E.N.C.H.E.S.

Questions? In the T.R.E.N.C.H.E.S.

Additional Information: HIPAA versus FERPA handout www.lsswis.org/LSS/Programs-Services/Mental-Health/School- Based-Mental-Health https://catholiccharitiesofmadison.org/Services/BehavioralHealthin Schools/tabid/613/Default.aspx www.postcrescent.com/series/kidsincrisis www.unitedwayfoxcities.org/our-work/united-ways-path-for- students/ www.schoolmentalhealthwisconsin.org