Building school Capacity to Address Mental Health Needs of Students MSBA’s Initiatives Dr. Kim Ratcliffe

Role of Districts in Mental Health has Evolved Federal Mandates to Identify Children with Disabilities Section 504 of the Rehabilitation Act of 1973 Education for All Handicapped Children’s Act -1975 Keys to the School House Door Institutions Community Placements $ Public Schools = Zero Reject in accountability for high achievement for ALL students Public Schools must take a direct role in meeting the mental health needs of students to enable high achievement.

MSBA’s Focus on Mental Health (MH) 1. Opening up revenue stream to help offset costs (Medicaid Billing) 2. Gaining first-hand experience with providing MH through a grant from MFFH 3. Addressing paucity of providers through telepractice 4. Convening a School-based Health Clinic Task Force Four Initiatives

1. Opening Revenue Stream to Offset Costs 2008 MSBA started assisting districts with Medicaid claiming for direct services. MSBA developed a platform and supportive software MSBA commissioned a Comparative Study of Billable Services –Missouri had least number of billable services Due to MSBA’s advocacy in 2010 billable areas increased: Behavioral health services Private Duty Nurses Personal Care Attendants Audiology/Hearing MSBA worked to remove Third Party Liability and increased transportation claiming

2. Gaining first-hand experience Wrote a grant and received funding from Missouri Foundation for Health “Shared Service for Mental Health: Assessment, Counseling and Consulting in the School Setting”

Missouri Foundation for Health (MFFH) “Missouri Foundation for Health is a resource for the region, working with communities and nonprofits to generate and accelerate positive changes in health.  As a catalyst for change, the Foundation improves the health of Missourians through a combination of partnership, experience, knowledge and funding.”

Project Summary Address the paucity of mental health professionals for children in Central Missouri and their critical need for services A prevention, early intervention and referral model Meeting children where they are-- in school Provide mental health capacity building, assessment and mental health services and parent training

Basis of Need for Enhanced Mental Health Services Statistical data – Approximately 21% of children ages 9-17 have a diagnosable mental or addictive disorder 11% of children 9-17 suffer from major mental illness 48% of children with serious emotional disturbances drop out of school Increased incidences of violence, school shootings, suicides, cuttings, out of home placements…

Response to Data Children are both under identified and under served because of a shortage of mental health services available in schools and communities. Mental health is directly related to children’s learning and development. There is a need for a model of school-based mental health (MH) services.

Desired Outcomes Develop capacity within schools to identify students at-risk of MH issues Possess knowledge and have processes in place to get students connected to assessment and services within schools Develop collaborative relationships with existing regional MH providers for rapid response to referrals of children in crisis Students receiving MH assessments and services will experience greater success at school

Indicators of Student Success Fewer out-of-school suspensions Less absenteeism from school Passing grades Graduate or complete requirements toward graduation consistent with same-age peers (high school students) Students have bright futures and be productive citizens

Lessons Learned to Date Mental health prevention and intervention does not exist as a separate entity. Mental health prevention can be as beneficial to staff as it is to students. Staff require basic Mental Health 101 Training. Continuing PD on mental health topics throughout the year was perceived as helpful. Lessons Learned to Date

Lessons Learned to Date Universal screening was helpful in all locations. Tier 1,2, and 3 level interventions were devised using screening data and other district data. Problem-solving teams were developed to: Build referral systems Build capacity for non-mental health professionals to respond Lessons Learned to Date

Lessons Learned to Date Data plays a part in becoming more efficient and effective. Students benefit from multiple opportunities to discuss and address MH issues. There is a need to reduce MH stigma Need to have a plan for: On-going communication with parents Crisis Response Developing relationships and partnerships with community or regional providers Lessons Learned to Date

3. Filling Personnel Shortage Districts had difficulty billing for Behavioral Health services because of a shortage of qualified providers. Telemedicine is a accepted practice in the medical field. Schools can benefit from access to qualified mental health providers. MSBA can provide access through our teletherapy platform. MSBA’s Medicaid billing software (Therapylog) and platform are FERPA and HIPPA Compliant.

Advantages to teletherapy Can deliver services “On-Demand” or on a continuing basis-- short-term or on-going. Can provide assessments, evaluations, behavior plans, consultation to teachers and other staff, counseling services, parent training… Connect the student with professional(s) with necessary expertise Can provide the technology for homebound instruction Professional will be trained in IDEA spirit and compliance and be contextually relevant. Professional will bill Medicaid, as appropriate.

4. MSBA School-based Health Clinic Task Force One of the greatest needs of our children related to school success and achievement of life goals is access to quality mental health services. MSBA is convening this Task Force to assist school districts in developing a framework that supports the needs of students, districts and families around this critical issue. Invitees represent all 17 MSBA regions and all sizes, student compositions and locations of schools in MO. DSS, DMH, DESE are invitees along with school leadership. DSS commissioned a feasibility study that helps to inform the issues.

PCG Feasibility Study 567 districts 162 high needs (based on criteria) 60 highest needs (based on 12 factors)

Goals at First convening Outlining the mental health needs of students that may be supported through school-based clinics; Defining the boundaries within which a school-based program must be designed to protect the integrity of the educational process; Identifying the potential obstacles facing school districts when considering school-based mental health services; and Proposing information sources and community partners to access or invite respectively to further inform the discussion at the next meeting.

What comes to mind when you hear “school based health clinic”? Thought Question What comes to mind when you hear “school based health clinic”?

Thought Question What are the critical unmet health and mental health needs of the students in your district?

Thought Question What are the barriers to children having their health and mental health needs met in your district?

Thought Question What are the boundaries that need to be drawn to preserve the integrity of the school day and high achievement for all?

How You can get involved Begin Direct Services claiming under MO HealthNet through the MSBA Medicaid Consortium Check out CES mental health connection A manual will be developed of resources and process steps through the MFFH grant Call about Teletherapy services through MSBA Call if you are interested in a seat at the Task Force How You can get involved

MSBA Associate Executive Director, Student Services Contact: Kim Ratcliffe, Ed.D. MSBA Associate Executive Director, Student Services ratcliffe@msbanet.org 573-445-9920, Ext. 362 Msba contact