“So – You Are Interested in Getting More Mental Health Services – Now What?” Regional School Counselor Conference Bridgeport Conference Center April 18, 2013

Introductions Margy Burns, Youth Health Services, Elkins Jessica Laslo, School Counselor, Ohio County Linda Anderson, Marshall University 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

Links Between Mental Health and School Success

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) 5

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) 6

Academic Performance 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) 7

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) 8

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: 9 Prevention Early intervention Treatment Emphasizes shared responsibility between schools and community providers

…IN BOTH GENERAL AND SPECIAL EDUCATION Focuses on all students… 10

Builds on existing school programs, services, and strategies. 11

13

TIER 1 - UNIVERSAL PREVENTION RECOMMENDATIONS 1.Infrastructure 2.Positive Behavior Support 3.Developmental guidance 4.Early identification 5.School climate 6.Connectedness 7.Family engagement 8.Staff development 9.School safety 10.Support for Transitions 14

15

Student Support Services Social and Emotional Learning Mental Health Services Act Student Mental Health Initiative Safe Schools, Healthy Students Peer-to-Peer Support School climate School connectedness Coordinated school health program Suicide Prevention Strengths based Risk and protective factors Family support services Cultural competence MulticulturalismShared Agenda School based School linked Special Education NCLB IDEA Crisis management Evidence based practice Multi system approach Response to Intervention PBIS Systems of Care School linked Wrap around Student Assistance Team Where to Begin? 16

Planning Process 1.Support from school administration Principal District 2.Form core school leadership team 3.Identify and convene key community agencies, parents, youth Meet regularly Educate one another Keep notes Build RELATIONSHIPS

Planning Process 4.Analyze needs and resources School data SWOT analysis MH-PET: School Improvement Plan 5.Define a communications plan 6.Develop an implementation plan Set goals, objectives, timeframes Shared vision Memo of Understanding (MOU)

Funding 19 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 Corporations/Businesses Hospitals County Community Foundations- SSJHWF, regional Family Resource Network Regional School Wellness Specialist BBHHF -

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

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 21

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 22

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 23

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 24

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. 25

Current Services Tier 3 – Individual & Group Therapies (all must be evidence-based) – Family Therapy – Psychiatry – Psychology Tier 2 – Early Intervention Groups (small groups, or classroom intervention) Tier 1 – Dinosaur School Classroom Intervention (Kindergarten, early elementary) – SOS for Suicide Prevention – Summer Group Program (Pocahontas County) – Primary Prevention Classroom group interventions 26

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

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 28

Tier 3 Short-term outcomes cont. Presenting Problem Areas Behavior-39% Depression-19% Academic-18% Trauma-16% Severe MI 4% Autism-2% Drugs-1% (n=98) Areas of Concern at Entry 29

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. 30

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. (304)

Ohio County Schools Madison Elementary Expanded School Mental Health Services

Tier 1 Academic and Behavioral Supports Co-teaching PLC bi-weekly Teacher study/support groups Anchor (after school) Attendance care calls Too Good for Drugs Second Step Keep a Clear Mind NetSmartz Family dinner nights Gold Star (PBS) D.A.R.E Lunch Buddy Program 33

Tier 2 Academic and Behavioral Supports SAT SPL (RtI) Tier pull-out interventions Extended day tutoring Homework time Juvenile Mediation Program Extended Year KOOL Kids Program (middle school transition) Save One Students (mentoring) Weekend Snack Bag Program Group counseling- Bullfrogs & Butterflies Afterschool Program 34

Tier 2&3 School- Based Mental Health CHOICES Program (since 2002) Group, Individual & Family Therapy in coordination with Northwood Health Systems A Center for HOPE & Change (est. 2012) Individual and family counseling; Afterschool psycho-educational groups and developmental guidance in summer school 35

Children Served Most are in grades K through 5 at the time of the initial referral Show a demonstrated pattern of Disruptive and aggressive behavior Disrespectful behavior toward others Failure to obey rules A violation of the rights of others Underachievement in their academic studies Emotional and mental health issues including depression, anxiety, ADHD, & complex traumas 36

Teacher, Parent, Student, and School Counselor collaborate to make referral Therapist hold intake/ gather information Group, Individual, and home mental health services are provided Therapists, School Staff, and families collaborate regularly about progress of children Parents, School, or Students, identify need for services With ESMH, Communication is Key is Key 37

Challenges and Barriers Scheduling time for students to be seen during the school day Having a regular, confidential space for children to receive services Staffing Family participation and commitment Keeping cases open through the summer 38

Impact on Students & Families Having the services at school during the school day reduces the barriers for children to get needed services and minimizes the disruption to their education. First year outcomes include improved attendance, increased social skills, decreased aggression, and improved relationships. In addition, Madison Elementary was named a 2012 WV Title 1 Distinguished School - one of 12 out of 329 Title 1 schools in West Virginia. 39

ESMH SERVICE HIGHLIGHTS FOR MADISON ELEMENTARY “For All” (Tier 1): 37 staff trained to become a Trauma-Informed School Families attending Family Night Program Positive Behavior Support (250 students) “For Some” (Tier 2): 37 students receive mentoring, after-school group counseling and other academic/behavior supports “Kool Kids” significantly impacting 5th grade attendance rate “For a Few” (Tier 3): 22 students receive individual, group & family therapy through Northwood “Choices” program “Center for Hope & Change” offers supports after school and over the summer 40

Focus on Increasing Numbers of Children Identified for Tier 2 & 3 Services 41

Ohio County Schools Madison Elementary School Before… …After We are proud of A Center for HOPE & Change and the CHOICES Program

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 : 43

National Resources Center for School Mental Health U of Maryland: National Assembly on School Based Health Care: Compassionate Schools 44

West Virginia Resources “ WV Educators Speak” video Tool Kits Website Links 45

Linda Anderson, MPH Marshall University Huntington, West Virginia