School Health Alliance for Forsyth County Mental Health Evaluation for and January 11, 2010 School Health Alliance Evaluation Team Stephanie S. Daniel, Ph.D., Center for Youth, Family, and Community Partnerships, UNCG Sebastian G. Kaplan, Ph.D. Wake Forest University School of Medicine, Dept. of Psychiatry

SHA Evaluation-Progress To Date  In conjunction with SHA staff, we have now implemented a more efficient data entry process for the school-based health center data that we hope will be self-sustaining. Consequently, we are now able to analyze and summarize evaluation data for the most recent completed school year  We now have the consistent use of the Strengths and Difficulties Questionnaire (SDQ) as part of the SHA assessment battery across the school-based health centers for both parents and students.  We have initiated a group therapy program for at risk 5 th and 7 th grade students at three different schools and will be able to provide both qualitative and quantitative data regarding the effectiveness of the group program on student emotional and behavioral outcomes in upcoming evaluation summaries.

Demographics (N = 451) Elementary (2)Middle (2)High (2)Total (6) GenderMale Female RaceAfrican-American Caucasian Unknown/Other EthnicityHispanic Non-Hispanic (N = 507) Elementary (2)Middle (2)High (2)Total (6) GenderMale Female RaceAfrican-American Caucasian Unknown/Other EthnicityHispanic Non-Hispanic

Students by Grade Level ( and ) N = 958

Diagnosis and School Type ( and )

Vanderbilt – Total Symptom Score ( and ) TSS = sum of 18 ADHD symptoms on 0 to 3 scale - Item is positive with score of 2 or 3 (TSS 36 to 54). N = 100 for Teacher; 28 for Parent No significant difference between Time 1 and Time 2 TSS scores

Strengths and Difficulties Questionnaire – Self ( and ) Significant differences between above Time 1 and Time 2 SDQ scales N = 45

Satisfaction Survey Summaries ( youth, parents, and faculty/staff)  In order to make the satisfaction survey summaries more user friendly for distribution to each school’s faculty and staff, we now summarize the survey data by school instead of aggregating the data across all schools.  See handouts summarizing satisfaction survey data by year and by school.  In general, youth, staff, and parents continue to report that they value the services provided by the school-based health centers.  Surveys also consistently request more nursing time, more counseling staff time, more group services (covering such things as discipline, home life, and self-esteem), and greater capacity to address the emotional needs related to children’s home lives and community issues. Request noted to just have “more of what we have.”

School-Based Group Therapy Program (Funded by Kate B. Reynolds Poor and Needy Trust)  In Year 1 of our program, school-based group programs were initiated with 5 th and 7 th grade students at three different schools: 1) Ashley Elementary School (AE), 2) Mineral Springs Elementary School (MSE), and 3) Mineral Springs Middle (MSM) School. These age- groups were specifically targeted for the intervention in order to build students’ resilience prior to transition from elementary to middle and middle to high school, respectively, as these are points of particular vulnerability in the pathway to school completion.  All participants in the school-based group programs are students identified and referred by teachers and school administrators as being at risk for mental health problems or already experiencing mental health difficulties.  The group program was developed by Susan Dennison at UNCG and consists of 8 sessions (once a week).

School-Based Group Therapy Program  In the Spring 2009 semester, we conducted two pilot groups with 5 th grade students at Mineral Springs Elementary school to develop the referral procedures for the group program and to identify any problems or logistic issues that might arise related to providing the group program within the school- based health center and school setting and to then develop solutions for any identified issues.  The Spring 2009 group program consisted of a girls group (6 members) and a boys group (5 members). One of the boys left the group at the 4 th group session because he changed schools resulting in 6 girls and 4 boys completing the Spring 2009 group program. Of these 10 students, 7 students were insured by Medicaid, 2 by NC Health Choice and 1 was uninsured.  Group focus was on developing and using your personal power to make good choices.

School-Based Group Therapy Program  Of the 76 students referred (38 boys and 38 girls) to the group program for the Fall 2009 semester, parents of 46 students (22 boys and 24 girls) completed and returned the necessary consent forms for their children to participate in the group and were enrolled in the group program at their respective school.  Group focus was on developing leadership skills including self- control, anger management, positive self-esteem and confidence, and positive peer interactions and relationships.  The school-based health center at MSE and MSM schools requires that each student also enroll in the health center which allows the student to then receive the full range of medical and mental health services available through the health center. Of the 28 students at MSE and MSM that were enrolled in the group program for the Fall semester, 13 of these students were new enrollees to the school- based health center.

School-Based Group Therapy Program  AE, MSE, and MSM have 84.46%, 95.64%, and 91.05% of their student body on Free/Reduced Lunch programs, respectively.  Due to the different structure and enrollment process of the Wellness Center at AE, insurance information is not collected on all students.  During the enrollment process at MSE/MSM, insurance information is routinely obtained. Of the MSE school students enrolled in group, 57% are insured by Medicaid, 7 % are insured by NC Health Choice and 36%, based on Federal Poverty Guidelines, are on a sliding fee scale 0% pay. Of MSM School students enrolled in the SHA’s Health Center, 86% are insured by Medicaid, 7% by NC Health Choice, and 7%,based on Federal Poverty Guidelines, are on a sliding fee scale 0% pay.

School-Based Group Therapy Program  In total for the Spring 2009 and Fall 2009 school semesters, 57 students have participated in the Dennison group program across the three schools.  We have collected pre-group assessments, and post-group assessments and focus group data for all students enrolled in the Fall 2009 group programs.

School-Based Group Therapy Program  Three students (two 5 th graders and one 7 th grader) reported suicidal ideation or thoughts on the pre-group screening assessments and one student reported suicidal ideation on the post- group screening for the Fall 2009 group program. This was an unanticipated outcome for our group screening assessments.  Three of the four students were not currently receiving mental health services or care, and none of the students had come to the attention of school personnel or guidance counselor staff for these specific concerns.  All students were provided with additional clinical assessment by KBR project staff and school personnel. School guidance counselors for each student were notified of the suicide concerns. Parents were also notified of the suicide concerns by either KBR project staff or school guidance counselors and were provided with referrals for individual mental health care and recommendations for safety plans for their children.

Future Directions for Evaluation  We hope to be able to use more sophisticated data analysis methods (e.g., Random Growth Curve Models) to evaluate changes in emotions and behaviors over time to determine the specific areas in which the school-based mental health services make a difference among the students and schools served.  Linking school-based clinic data for each student served to additional behavioral, academic performance and functioning outcomes (disciplinary actions, attendance, performance on standardized tests, course credits completed, etc…) available through the school system.  Developing school-based clinic programs and clinical services that are informed by the evaluation data (e.g., developing or implementing evidence-based treatments that specifically target the psychiatric needs of students at each school type).