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

2. 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.” 3-years later~ working together we are achieving good things for children and families thanks to the ESMH Program.

3. 626 students –Tier 1 Services 15 students –Tier 2 Small Group early intervention services, and 77 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 year of implementation we provided ~

4. Key Characteristics at Program Entry of Tier 3 Students 29% (n=77) or 1 in 3 youth had academic problem identified as a problem 35% (n=27) referred by school personnel 22%(n-17) referred by parent or family member 100% (n=77) had DSM-IV diagnosis

5. ~ From Jan 1, 2012-September 30, 2012 12 students discharged 9 students completed services 3 did not complete(n=12) ~ At entry, 6 of the 12 students lived with their parents, and at case closure 9 of the 12 students lived with their parents. ~At entry 1 students was involved with Juvenile Court, at case closure no student was involved with the courts (n=12). Tier 3 Outcomes ~

6. 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~

7. 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.

8. 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.

9. Development up to present ~ Planning Process Complete ~ In two counties (Tucker and Pocahontas) - 5 schools ~Now working with Randolph, Upshur and Barbour County Schools to develop ESMH programs in these counties

10. STRATEGIES ● Strategy 1- Develop Infrastructure, Collaboration Plan and MOU ● Strategy 2 – Depending on the entry, (i.e., test the waters approach) when agency is ready and funding is available complete a 6 mo planning period for a comprehensive ESMH program Strategy 3 - Improve quality through EBPs Strategy 4 - Offer Telemental Health services supported by Electronic Medical Records, Strategy 5 - Develop Centralized Scheduling, Policy Development

12. Original forecasts which turned out to be true ~ Children & Parents will Benefit Schools and Communities will Benefit Collaborative Mental Health Organizations will Benefit

13. 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!