Expanded School Mental Health in West Virginia Kidstrong Conference June 14, 2012 Charleston, WV

Objectives Participants will be able to: 1. Describe the three tiers of a comprehensive school mental health model 2. List at least two examples of components in each tier 3. Identify at least three resources for planning and implementing a comprehensive model 4. Identify at least three strategies essential to successful implementation 2

Introductions Linda Anderson, Marshall University Fran Jackson, Youth Health Services Sonnee Stanley, Southern Highlands Mental Health Center Jessica Laslo, Ohio County Schools Tiffany Pittman, Bureau for Behavioral Health 3

Milestones Pre-2000 WVDE Coordinated School Health Model School based health centers System of Care grant BBHHF funds SMH SSJHWF funds SBHCs 4

Milestones 2006 WV Behavioral Health Commission recommends more school MH services 2007 WVDE and BBHHF sign MOU ESMH steering team organized 5

Milestones Designated as subcommittee of WV Behavioral Health Commission Expanded School Mental Health planning sites funded (7) 6

Milestones ESMH implementation sites funded ESMH model defined Policies and practices incorporate ESMH RFA for 4 more planning grants announced 7

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Purpose of the WV Expanded School Mental Health Network A statewide community of stakeholders Advocate for implementation of a full continuum of mental health programs and services in WV schools Develop plans for implementing the 10 critical factors for advancing school mental health ( ) 10

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: 11 Prevention Early intervention Treatment Serves all students Emphasizes shared responsibility between schools and community providers

A partnership between schools and community health organizations… Guided by youth and families.

Builds on existing school programs, services, and strategies.

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

Includes a full array of programs, services, and strategies

Diagram courtesy Louisiana Department of Education 16

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 17

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Expanded School Mental Health Services In Rural Communities Youth Health Service, Inc. Elkins, WV (Randolph, Tucker, Pocahontas, Barbour, Upshur Counties)

The “We” Position ~ School said: “We need Tier 3 mental health services to get to our students.” ~ We said: “We have Tier 3 and a lot more services, but we can't get to your students.” 4-years later~ working together we are achieving good things for children and families thanks to the ESMH Program.

256 students –Tier 1 Services 15 students –Tier 2 Small Group early intervention services, and 53 students –Tier 3 services including weekly intensive mental health therapy, psychological and or psychiatric evaluation, case management, parent consultation and treatment planning Teacher consultation and feedback to school counselors and Student Assistant Teams. During the first six-months of implementation we provided ~

We will provide: Psycho-education and mental health treatment small-groups in local parks for our clients. Transportation to and from services three days per week. Individual therapy in community sites during the summer months. This Summer~

Why do this? Goal: To increase access to mental health services for children living in rural, isolated communities. Expected Outcomes 1) School attendance, academic performance, and child/ adolescent social behavioral functioning improves. 2) Family involvement in a child’s academic success and mental health services improves.

Initial Problems ~ ➲ High social stigma associated with MH services. ➲ 15% of all school-age students at one time will have a mental health problem. ➲ Teachers feel unprepared to screen children. ➲ School counselors identify but do not have time to provide treatment services. ➲ Good prevention services, but severely limited treatment services for children. ➲ No evidence-based treatment services.

Development up to present ~ Planning Process Complete ~ In two counties (Tucker and Pocahontas) - 5 schools

STRATEGIES Strategy 1- Develop and Infrastructure, Collaboration Plan and MOU Strategy 2 - Complete a planning period Strategy 3 - Improve quality through EBPs Strategy 4 - Offer Telemental Health services supported by Electronic Medical Records Strategy 5 - Develop Centralized Scheduling

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ORIGINAL FORECASTS WHICH TURNED OUT TO BE TRUE ~ Children & Parents will Benefit Schools and Communities will Benefit Collaborative Mental Health Organizations will Benefit

ORIGINAL FORECASTS WHICH TURNED OUT NOT TO BE TRUE ~ Instituting telemental health services would be easy! Schools would not be receptive! Staff would not be receptive!

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

Tier 1 Academic and Behavioral Supports Too Good For Drugs (K-5) Second Step (K-5) Keep a Clear Mind (4) NetSmartz Internet Safety D.A.R.E. Classroom interventions Co-teaching Guest Speakers (Harmony House, SAHC, Easter Seals) PLC by-weekly meetings Family Nights Teacher Study Groups (How to work with parents, New teacher support group) Anchor after school program Gold Star Program- PBS Care calls Lunch Buddy Program Universal/All Students

Tier 2 Academic and Behavioral Supports  SAT  SPL (RtI)  Tier 2 and 3 pull out interventions  Extended day tutoring  Mentoring (SOS) with 5 th grade  Homework time at breakfast  Weekend Snack Bag Program  Academic Counseling/Conferences  Extended Year  Group counseling-A Center for HOPE & Change  Juvenile Mediation (truancy)  KOOL Kids Program At-risk students

Tier 3 Academic and Behavioral Supports  Individual therapy- A Center for HOPE & Change  CHOICES Groups  CHOICES individual therapy  Referrals to outside agencies (CPS, YSS, mental health)  Referrals to HealthyCHILD (PK mental health support through HeadStart) Intensive, Individual

Collaboration between Mercer School & Southern Highlands Community Mental Health Center

Structure Strong ESMH advisory Team ESMH counselor Referral process Consents

Programs Universal (tier 1) – Capturing Kids Hearts & Second Step – Truancy Diversion program Early Intervention (Tier 2) – Topics: Children of addicted parents, social skills, relationship building, emotion recognition and management, bullying, substance use, self harm, and self esteem – Programs not provided by ESMH counselor: Girls on the run, Drama group, 3 Musketeer group Intensive (Tier 3) – Cognitive behavioral therapy, ADHD regulation techniques, crisis intervention, Parenting

Kiddos served Universal (tier 1): 365 children Early Intervention (tier 2): 45 children – Boys group (5) – Girls group (5) – Short supportive counseling (35) (Goal was 109 = 41%) Intensive (tier 3): 3 children (Goal was 36 = 8%)

Barriers Space Consents from parents Logistics: billing & technology Turnover Time

Energy Express Community education Parenting Groups

Planning Process Support from School Administration Form school leadership team Identify needs and resources Begin dialogue with community agencies Incorporate into School Improvement Plan Gain commitment through MOU with community agencies

Mental Health Planning and Evaluation Template Developed in partnership with the Center for School Mental Health Used in planning and evaluating activities and services for new or established SMH programs Eight dimensions, 34 indicator measure Web-based, completed by teams, computer generated scores 8/8/1143

8/8/1144

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Academics & Mental Health Information Briefs Video testimonials Website 46

Linda Anderson, MPH Marshall University Huntington, West Virginia

Linda Anderson, MPH Mental Health Richard Crespo, PhD Director Stephanie Montgomery Data and Evaluation Paula Fields, MSN, RN Primary Health Care/SBHCs Stephanie Hayes, MA Mental Health Evaluation Bobbi Jo Muto, RDH, BS Oral Health Coordinator Resources, assistance, and training related to SBHCs, school- based behavioral and oral health programs. 49