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

2. 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.

3. 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

4. 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

5. 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”

6. 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.”

7. 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

8. Basis of Need for Enhanced Mental Health Services
Statistical data –
Approximately 21% of children ages 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…

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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.

17. 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.

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

19. 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.

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

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

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

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

24. 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

25. MSBA Associate Executive Director, Student Services
Contact:
Kim Ratcliffe, Ed.D.
MSBA Associate Executive Director, Student Services
, Ext. 362
Msba contact