Mental Health Services in School-Based Health Centers Susan Furches, LCSW

2 School Health Alliance for Forsyth County (SHA) Jane M. Foy, Medical Director

3 Partner Organizations/Agencies of the School Health Alliance CenterPoint Human Services Forsyth Adolescent Health Coalition Forsyth County Department of Public Health Forsyth County Department of Social Services Forsyth Early Childhood Partnership Forsyth Pediatric Associates Forsyth-Stokes-Davie County Medical Society The North Carolina Baptist Hospitals, Inc. Northwest Area Health Education Center Novant Health Triad Region Wake Forest University School of Medicine Winston-Salem/Forsyth County Schools –Administration – Faculty – PTA Council – Food Services Winston-Salem State University

4 School Health Alliance Centers North Forsyth High School Mineral Springs Student Health Center Winston-Salem Preparatory Academy Wellness Center Ashley Elementary School Wellness Center Meadowlark Middle School Wellness Center Meadowlark Elementary School Wellness Center Model 1 Model 3 Model 4 Model 2 Psychiatrist LCSW Nurse Practitioner/MD RN Psychiatrist LCSW  Nurse Practitioner/MD RN  Psychiatrist LCSW  Nurse Practitioner/MD  RN  Psychiatrist  LCSW  Nurse Practitioner/MD RN Comprehensive Student Health Center Enhanced Mental Health limited physical healthcare, no mental healthcare Wellness Center

5 Mineral Springs Student Health Center School Family The Student Nurse Practitioner and MD Medical Office Assistant Licensed Clinical Social Worker Child Psychiatrist Registered Nurse Pre-school — 8 Model 1 — Comprehensive Student Health Center

6 Mineral Springs Elementary & Middle Schools

7 Mineral Springs Student Health Center Staff Pam Benton (Medical Office Assistant), Beth Spangle (FNP), Dr. Nguyen (Psychiatrist), Becky Stephens (RN), Cindy Tomlinson (DSS). Not pictured: Sarah MacReynolds (LCSW), Ron Lean (LCSW), Susan Furches (LCSW).

8 Winston-Salem Preparatory Academy at Atkins Wellness Center Model 2 — Wellness Center School Family The Student Medical Office Assistant Licensed Clinical Social Worker Child Psychiatrist Registered Nurse 6 — 8 Nurse Practitioner and MD x

9 Winston-Salem Preparatory Academy at Atkins

10 Winston-Salem Preparatory Academy at Atkins Wellness Center Staff Henri Miller (Medical Office Assistant), Maureen Haynes (RN), Dr. Martindale (Psychiatrist), Karen Patterson (LCSW).

11 Ashley Wellness Center School Family The Student Medical Office Assistant Licensed Clinical Social Worker Child Psychiatrist Registered Nurse Pre-school — 5 Nurse Practitioner and MD Model 2 — Wellness Center (half-time) x

12 Ashley Elementary School

13 Ashley Wellness Center Staff Dr. Hough (Psychiatrist), Maureen Haynes (RN), Susan Furches (LCSW), Henri Miller (Medical Office Assistant).

14 Ashley Wellness Center Staff and Students Dr. Hough (Psychiatrist) with student. Student using Wellness Center services.

15 North Forsyth Center Model 3 — Enhanced Mental Health School Family The Student Medical Office Assistant Licensed Clinical Social Worker Child Psychiatrist Registered Nurse 9 — 12 Nurse Practitioner and MD x x x

16 North Forsyth High School

17 North Forsyth Center Staff Cloud Monroe (LCSW). Not Pictured: Henri Miller (Medical Office Assistant).

18 Meadowlark Wellness Center Model 4 — Limited Physical Healthcare, No Mental Healthcare School Family The Student Medical Office Assistant Licensed Clinical Social Worker Child Psychiatrist 9 — 12 Nurse Practitioner and MD x x Registered Nurse x x

19 Meadowlark Elementary & Middle Schools

20 Meadowlark Wellness Center Staff Betsy Wehe (RN).

21 Case Examples Mental Health Work with Families Having Children in Elementary and Middle Schools

Leukemia WSPA Wellness Center RN and LCSW involved with mom and son Case Example: Family A

Leukemia in remission RN and LCSW working with mom and son WSPA Wellness Center Trichotillomania (Hair Pulling) Ashley Wellness Center Ashley WC Crest Ashley WC Case Example: Family A

Case Example: Family A Criminality Eviction Move to a school without SHC/SWC Challenge: no continuity of care Solution: school social worker will follow ? ? ? ? ? ? ? ? ?

25 Ashley Wellness Center WSPA WC NC School for the Deaf Christmas 2003 Case Example: Family B X 21 X

X 22 X Hearing Impaired Grief Withdrawn, distractible, impulsive Hallucinations of death angel coming, terrified, tearful, shaking *Hospice, Camp Carousel Spring – Summer 2004 Spring *Summer Case Example: Family B Ashley Wellness Center WSPA WC NC School for the Deaf

27 Angry, scared, distrustful Quiet, sad, sleepless Drug Bust CPS DSS-relative placements Case Example: Family B X 22 X Fall 2004

X 23 X Spring – Early Fall 2005 Case Example: Family B Ashley Wellness Center WSPA WC NC School for the Deaf ArtisticSmiling Residential Treatment Center Weekends/Holidays

29 Art used to express feelings

30 Case Example: Family C Hurricane Katrina Ten Survivors! Ashley Elementary School WSPA WC 6 Living in one three- bedroom house Head Start Ashley Wellness Center Collaboration with Head Start September 2005

31 Play therapy used to express feelings

32 Play therapy used to express feelings

33 Art used to express feelings Love HurtsLove Heals

34 Differences in Models Staff patterns –As illustrated on puzzle Physical location –Mineral Springs is a separate building –All others are within the school building Hours of operation –Ashley is part time –All others are full time

35 Strengths & Challenges/Solutions Collaboration — All sites Strengths –LCSW on school teams (SAT/CSI) –WFUBMC child psychiatrist –Common screening instruments –RN taking blood pressure and weight of staff Challenges/solutions –Limited availability of school support staff

36 Strengths & Challenges/Solutions Collaboration — Mineral Springs Health Center Strengths –More comprehensive service/more staff –Free standing building = clinic atmosphere Challenges/solutions –Loss of proximity = less teacher interaction –Solution: Effort to be visible in school

37 Strengths & Challenges/Solutions Collaboration — Ashley Wellness Center Strengths –PhD-level school social worker and psychologist –Annual evaluation by extended staff Challenges/solutions –Half-time LCSW and RN prevents consistent care –Solution: Regular conferences with school staff –Solution: Make staff full time

38 Strengths & Challenges/Solutions Referrals At Mineral Springs Health Center – strengths –Abundant referrals from screenings At Ashley Wellness Center – strengths –School counselor is the gatekeeper At Mineral Springs and Ashley – challenges/solutions –Screening reveals more need than staff can meet –Solution: Wait list, group work, discharge no shows

39 Strengths & Challenges/Solutions School Priorities and Local Needs — All sites Strengths –System-wide site based management –Flexibility in meeting local needs Challenges/solutions –System-wide site-based management –SHA uniform policies, difficult to implement Solution: Increase staff communication –Focus on end of grade test Solution: Research data shows academic gains Solution: Cooperate with Dennison Group (UNC-G) Solution: Group for anxious/somatizing boys

40 Strengths & Challenges/Solutions School Priorities and Local Needs — All sites Challenges/solutions –Themes differ per school (Ashley is International Baccalaureate) International airport/different continents –Solutions: Ashley Wellness Center is Gate 150 in Antarctica Poster: “Even at the bottom of the world you can find a friend.” Ashley students collected food and money for Katrina survivors

41 Play therapy works!!!