1. Evidenced Based Practices in the Buffalo Trace Region September 21, 2006 Presented by Goldie Williams, Ada Braun and Mike Duffy

2. The Buffalo Trace Region Kentucky 2002 Population = 4,092,891 55,796 Per Capita Income = $18,093 $14,868 Median Household Income = $33,672 $28,168 Families in Poverty = 12.7% 15.5% Poverty in families with children under 5 = 21.6% 24.3% % with Bachelors Degree = 17.1% 10.0% Buffalo Trace 2002 Buffalo Trace Population 55,796 Area 1,379 square miles Population Density = 40/sq.mi.

3. The Community we Serve

4. Mission Statement To improve the mental health, relational and social functioning and the academic achievement of school aged children in our community by providing therapeutic, effective and competent school based behavioral health services.

5. Program Time Line 1992 – Contracts between the CMHC and schools related to preschool evaluations and speech therapy. 1994 – Contract between CMHC and one school to provide on-site substance intervention services. July 1995 – Contract between CMHC and one school for 3 days per week of mental health services with the school paying an hourly fee.

6. Program Time Line (Cont’d) January 1997 – Expanded in the prior school district to the middle and alternative school settings. August 1997 – Expanded to 5 out of 6 school districts – all buildings within those districts. One fee for all schools established.

7. Program Time Line (Cont’d) January 1998 – Expanded to the 6 th school district, but only in one school. July 1998 – All public school buildings in contracts. October 3, 2000 – Receipt of 3 year grant to “Improve school based mental health services”.

8. Program Time Line (Cont’d) October 15, 2001 – Completed needs assessment and strategic plan. 2002 and 2003 – Strategic Plan Implementation. March 30, 2004 – Grant ended. August 15, 2004 – Policy and Procedure Manual Implemented

9. Mission Statement To improve the mental health, relational and social functioning and the academic achievement of school aged children in Our community by providing therapeutic, effective and competent school based behavioral health services.

10. Client Demographics 1 Presently 1652 active children served.

11. Client Demographics Client Income Distribution/Oct.2004.

12. Client Demographics 3

13. Client Demographics 4

14. Service Expansion

15. The Road to EBP…………. Bringing the program to scale 1 year needs assessment 3 year strategic plan Lots of training Ability to Seize the Moment

16. Why CBT? Logical fit for school based mental health services Prior training and use by existing staff---- staff buy-in Staff informal discussions of needs and barriers led naturally to CBT Need for high and effective intervention when using the school clock

17. Why CBT? The big reason…. IT WAS EASY TO IMPLEMENT

18. What made it possible….. Prior work on program goals, mission statement, streamlined service delivery and maximizing billing. Improved Quality and measurement of program effectiveness were the next logical steps. Receipt of a grant from DMHMR in 1-06 for $15,000.

19. How was the money spent TRAINING BECK INSTITUTE---$6000 plus other cost YOUTH CHANGE---$6000

20. Evidenced Based Measurement G.A.I.N. Global Appraisal of Individual Needs Currently staff are in training and plans are for data collection this school year.

21. MAIN CHALLENGES To GAIN IMPLEMENTATION Time constraints COMPUTERS, COMPUTERS Space issues in school Extensive learning commitment Building staff confidence Collaboration with school staff for buy in

22. The positives of the GAIN…. Common language and improved consensus among staff Identification and Assessment of substance abuse history is complete, thorough and reliable Cognitive functioning component Complete assessment across life areas Diagnosis using standardized means Suggests treatment goals

23. Challenges to CBT implementation.. Collaboration with school staff who lack necessary training in how to effectively deal with problem behaviors.’ Tie in with IEP’s and school assessments We need follow up training with Beck Institute trainer

24. Positives of the CBT……. Propels outcomes to the positive CBT techniques and training expanded our toolbox to BUST Common language and improved consensus among staff More bang for the buck Pass it on approach

25. Facilitation made possible by…. Special thanks to DMHMR for the grant opportunity which made the entire implementation possible

26. What would we do differently…. Contracted with the Beck Institute for ongoing training and support over the next 2 years as part of the EBP grant. Spread training out instead of all in a one month time period. Computer’s funded

27. Advice to others…….. Complete a comprehensive needs assessment, strategic plan and follow through Force yourself to train and discuss your program-it builds expertise on your system and forces self analysis

28. How to contact us Goldie Williams gwilliams@comprehendinc.com Ada Braun abraun@comprehendinc.com Mike Duffy mduffy@kywirelesscollc.com THANK YOU……………………

29. How we grew the Program (Cont’d)

30. Growth implemented in 4 Phases Phase 1 – Starting Out Presentation of proposal to CMHC Executive Director. Presentation of proposal to School Superintendents. Developed a written agreement, signed when agreed upon. Held meetings with building Principals and school administrative staff.

31. Phase 2 - Growth Implementation of the growth at the individual level (clinicians and building contacts). Bringing Program to Scale

32. Phase 2 – Growth (Cont’d) Access available at 24 Sites in 2004

33. Phase 2 – Growth (Cont) Development of Funding Streams

34. Phase 2 – Growth (Cont) Definition of the mental health program, therapist and time allotment. Build on the school’s existing resources. Reduce extensive documentation requirements, i.e. use check boxes whenever possible. Uniform paperwork across mental health services.

35. Phase 3 – Optimizing use of Grant Dollars Opportunity - $225,000 over 3 years starting in 1998. Changes occurred within the program due to the grant objectives. Comprehensive needs assessment, strategic plan for program improvement and implementation plan executed. Policy and Procedure Manual Development.

36. Phase 4 – Future Plans Implementation of Policy and Procedure Manual Revise Strategic Plan Build expertise – Forums and opportunities for clinical staff, consultation, education with psychiatrists.

37. Phase 4 – Future Plans (Cont’d) School wide Behavioral Intervention Systems. Extensive use of the Wraparound Model. Early Intervention. Prevention.

38. Steps in building a collaborative school mental health program in a rural setting 1. Build on the school building’s strengths, meet them where they are. 2. Shared mission and concerns for children. Improved Academic achievement and improved mental health are co-existing goals. Top concerns of school and community are top concerns of mental health.

39. Steps in building a collaborative school mental health program in a rural setting 3. Relationship Supports Advisory Council representing every district. School District Contact Person. School Building Contact. 4. Planning for privacy, confidentiality, space, location and ease of access to the school infrastructure.

40. Planning for Sustainability – Why we have been successful Redesigned Service Delivery System focused on ease of access to services, maximizing human resources and incorporation of the program across mental health service areas. Use of pooled dollars

41. Planning for Sustainability (cont) Staffing Patterns – Enhanced Service Capacity. Streamlined billing process, reduction of repetitive paperwork, computers. Image building within community.

42. Planning for Sustainability (cont) Maximized billing potential.

43. Contact Us Goldie Williams 606-564-4016 gwilliams@comprehendinc.com Pam Stewart Mason County Middle School pstewart@mason.k12.ky.us Paul Andis, Consultant pandis@aol.com