Planning Team AssessmentReport

A Chance for Change Planning TeamMarch 2009

Jeffrey Daniels Consulting/Amerpsand Consulting

Manchester is one of 12 Connecticut communities to receive a grant from the Connecticut Health Foundation to conduct a 15-month community planning project. The project is designed to improve the well-being of children who exhibit early signs of social, emotional, and behavioral health problems. When the planning process is completed in June 2009, Manchester will compete for a five-year grant from the foundation to implement the recommendations in the final plan.

A Chance for Change, Manchester’s community planning project, focuses during the planning year on the Nathan Hale Elementary School catchment area. We aim to:

Implement a system to identify, screen, and provide preventive interventions for youth ages 6 to 11 years who are at risk of social, emotional, and/or behavioral health problems.

Address the needs of these Nathan Hale students, preventing them from having to use more intensive mental health services and/or ultimately become involved with the juvenile justice system.

Creating a culturally and linguistically competent plan to address the needs of the estimated 350 children at Nathan Hale School is our highest priority. The success of the planning process depends on input from all sectors of the community–children, parents, teachers, service providers, policy makers, businesses, and many others. To ensure that we have broad community input, we will be hosting focus groups, collecting demographic information, analyzing Manchester’s current resources and assets related to children’s mental health, and conducting two community conversation meetings.

The report that follows is divided into two broad sections:

First, the results of the Planning Team’s extensive effort to reach out to and with the Manchester and Nathan Hale community, seeking this input on the best approaches.

Second, a target look at key information and needs in the community, examining information over a three-year period to help us target the response.

A Chance for Change: A Children’s Mental Health

Planning Project

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OVERVIEW AND KEY FINDINGS

Key Indicators of Need

Nathan Hale 4th graders are less proficient than their Manchester peers in both math and reading, 10% and 18% lower in the respective scores.

In 2008, 82% of Nathan Hale children and families faced economic stress as measured by the percentage of children in the school who are now eligible for free or reduced lunch. This level of poverty is far higher than any of the 10 elementary schools in town.

Nathan Hale has a high level of students who are suspended, virtually all served by removal from school. Nathan Hale’s number of annual suspensions is more than double the average of all elementary schools in the district.

Crime among this younger population is not high; and most first offenders (all juvenile age) are increasingly diverted from the courts to other services.

Key Behavioral Health Information and Issues

Nationally, up to 22% of children, 4 to 17 years, experience some form of behavioral problems, about 3% to 5% severe.

The percentage of Nathan Hale students referred to the school social worker in 2008 is about one in five (22.4%), and is within the upper range of the national data.

Community mental health providers see a small, but growing number of students from Nathan Hale School. The average over three years is 27 students a year among three major institutional providers.

As a percentage of the school population, a very small number of students are referred to traditional mental health services, about 5%. This appears to mirror the national averages.

Using current year social work caseload statistics, approximately 20% of Nathan Hale students are referred and are provided some services, informal or formal, for behavioral issues. Most of that service is carried out within the school.

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Key Findings from Community Outreach

Activities to date have reached more than 170 adults, including: 1 meeting of key stakeholders, many service providers, and public officials. More than 100 Nathan Hale parents were reached through block party, ice cream social, movie night, and parent-teacher conferences. Parents were 54% of the participants in community outreach.

Most participants in all groups said early identification in school and support for families were the most promising ways to identify at-risk children.

The most commonly cited prevention idea across groups was to build structured programs, including after-school and mentoring experiences.

Providers and consumers alike reported that Manchester is a “service rich” community, but knowledge of the range of services and the lack of a real “system” of care in behavioral health are barriers to reaching children in need.

The most frequently mentioned factors that service providers thought Manchester could change or improve were increased support for families and children, increased funding, and more school-based services.

Nathan Hale parent brief survey revealed these findings:• Asked if they were worried about their children’s behavior or moods,

64% said no.• 23% of parents surveyed tried to get help because of their children’s

behavior or moods. Most who sought help asked a neighbor, friend, family member or school social worker.

Asked to comment why they might not seek help when worried about a child’s behavior or moods, responses included:

• Department of Children and Families (DCF) (fear of being reported)• Parents may be unaware of what’s going on in child’s life • Parents may have positive bias toward their child’s behavior (“this

behavior is probably normal for a child her age”)• Family culture (seeking help not acceptable)• Family is focused on basic needs (food, shelter, utilities)• Parents don’t have the energy to deal with younger children if they have

older children who are acting out• Child’s behavior may be normal in a specific family system

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Community Engagement SummaryKey Findings

Between May and November of 2008, the Planning Team conducted focus groups, meetings, and other events to engage the Manchester community in the planning process and solicit input from diverse constituencies. Major findings, outlined in this report, include:

Community engagement activities to date have reached more than 170 adults, including service providers, educators, community member, and parents.

Parents constitute 54% of the participants in community engagement activities conducted to date.

The majority of parents (64%) reported that they were NOT worried about their children’s moods or behavior. Of the parents who were worried, more than three-quarters had NOT sought help for their children.

When service providers were asked what factors might prevent children from entering restrictive mental health settings or the juvenile justice system, 59% of the factors related to family and the school system and to funding for interventions.

Summary of Community Input

There was agreement across groups on several issues. For example, all participants said that Manchester is a resource-rich community. Providers, parents, teachers, and teens were all able to develop lists of the many resources that Manchester offers. Town officials were optimistic about the Spruce Street neighborhood because of its infrastructure, resident-owned homes, and strong local businesses. While the town has tremendous assets, all groups said families might have difficulty understanding the numerous programs and services that exist and how to access them. Further, the waiting lists for clinical programs were perceived as daunting to some parents.

If a system is “…an organized collection of parts…that are highly integrated to accomplish an overall goal…”1 then community findings suggest Manchester does not currently have a system of early identification and intervention for children at risk of entering restrictive mental health settings or the juvenile justice system–but not for want of trying! The East of the River Collaborative, for example, attempts to coordinate children’s mental health care and juvenile justice services. Parents are significant partners in this process. Concomitantly, all the groups noted the gaps in communication and coordination among different providers, the school system, town departments, and families. And while families are critical to systemic success,

1 What is a system? From: Field Guide to Consulting and Organizational Development: Collaborative and Systems Approach to Performance Change and Learning. www.managementhelp.org 2008.

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participants in this process, including parents, acknowledged that involving families in meaningful ways is challenging.

Two additional areas of agreement among the groups2 included perceptions about the most important factors in identifying at-risk children and preventing them from entering restrictive mental health settings or the juvenile justice system. Early identification in school settings and support for families were identified most often as ways to help young children at risk of behavioral, social, and emotional problems. The most commonly cited types of prevention ideas included emphasis on early intervention, structured programs, especially after-school and mentoring programs, and interventions that include support for and participation of families.

2 Teens were not asked about identification but were asked about prevention.6

I. Overview of Community Engagement Activities

Between May and November of 2008, the Planning Team conducted focus groups, meetings, and other events to engage the Manchester community in the planning process and solicit input from diverse constituencies. Table 1 lists the focus groups conducted by constituent type and number of attendees.

Table 1. Focus groups, type, and number of attendees

Focus Group Constituent Type NumberManchester Community Services Council (MCSC)

Diverse group of service providers and community members

31

East of the River Collaborative System of Care

Mental health providers, parents

17

Youth Services Adolescents 4Policy Town of Manchester

officials4

Nathan Hale Teachers Teachers 11Nathan Hale PTA Parents, teachers 10

In addition to the focus groups, the Planning Team solicited input from parents at two events held at Nathan Hale School in the fall: a block party hosted by the project for families and the school’s annual ice cream social. Approximately 60 parents and family members attended the block party with their children. Parents and family members were asked to provide responses to three questions posted on easels at the block party. More than 100 parents and their children attended the ice cream social; parents at this event completed brief questionnaires. Additionally, a planning team member presented information about the project to approximately 12 families at a movie night in the Nathan Hale School district hosted by Ascension Church.

The planning team also held a meeting for a diverse group of stakeholders including police, educators, clergy, representatives of various town departments and the Department of Children and Families (DCF), private therapists, the public defender from Rockville Juvenile Court, parents, teens, and others. The team updated stakeholders about the project and solicited input for the community plan.

II. Focus groups and survey responses

MCSC and East of the River Collaborative focus groups

Manchester is unique in that a diverse group of community members and service providers has been meeting monthly for almost 40 years; MCSC includes human service and mental health providers, educators, town leaders, police, business leaders, clergy, and volunteers. Attendees of the MCSC focus group

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(N=31) completed a written survey and responded in small groups to several questions posed by planning team members.

The East of the River Collaborative is a group of mental health providers, representatives of the juvenile justice system, and parent volunteers who meet monthly. Attendees of this focus group (N=17) completed a written survey and responded to several questions posed by the focus group facilitator.

When asked verbally: What conditions in Manchester benefit families who have children with social, behavioral, and emotional health problems? What are our assets?, attendees of these two focus groups generated a long list of services and resources available to Manchester families. As one participant noted, “Manchester is a resource-rich community.” Attendees agreed however, that families do not have an easy time understanding what services are available and how to access those services. For example, a participant stated that, “Families are not informed about services…they’re sent down a path…leave a message, call these 1-800 numbers. They don’t get a response.”

Participants in these two focus groups were asked to list factors that Manchester could change or improve related to children’s social, behavioral, and emotional health. A total of 52 factors were listed. The majority of responses fell broadly into the categories noted in Table 2.

Table 2. Categories of factors, examples, and percent of total responses

Category Example % of total Families and community

More specific neighborhood outreach Multi-lingual and culturally

competent services Create family ownership Fatherhood initiative Reduce family stress, isolation Services with a parent component

35%

Economic More money Not enough money for prevention Get funding for non-covered services

16%

School-based More social skills for earlier ages in schools

Look at school assessment issues (education vs. psychological interventions)

Expand after-school and summer programs

8%

Other responses 41%

Other factors that participants listed reinforced the finding that while Manchester has many resources, families may find services difficult to access or understand. For example, participants wanted to make services more user friendly,

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decrease fragmented service delivery, and increase the visibility of services. Participants also acknowledged that families sometimes don’t ask for help because they “…fear retribution [from DCF]…”

Written survey responses indicated that focus group attendees believe that the most important factors in identifying children at risk of social, behavioral, or emotional health problems are related to the family (most frequent number of responses) and to school (second most frequent number of responses). Similarly, responders indicated that the most important factors in keeping children with social, behavioral, or emotional health problems in the community were family focused. While intervention factors related to schools were frequently mentioned, responses included a wide variety of other factors influencing intervention and prevention. Communication and collaboration among providers including schools, mental health agencies, and DCF– were mentioned several times.

Parents

Ninety-four Nathan Hale parents completed brief surveys about their children’s behavioral health needs. Surveys were completed at the Nathan Hale PTA focus group, the ice cream social, and before and after parent teacher conferences in November. As Table 4 indicates, one-third of Nathan Hale parents have worried about their children’s behavior or moods; more than 20% sought help for their children.

Table 4. Percent responses, parent survey

Question Yes NoHave you ever worried about your child’s behavior or moods?

36% 64%

Have you tried to get help for your child because of his/her behavior or moods?

23% 77%

An additional survey question asked: If you received help, which person or organization helped you? The majority of parents who responded said that they asked a friend, neighbor, or family member (N=15), a teacher (N=15), or the school social worker (N=14). Seven parents consulted the school psychologist; four went to private counselors, and four to their church. Six parents sought help from the Community Child Guidance Clinic, and one from Connecticut Children’s Medical Center. Two parents talked to a coach and five to a variety of other professionals. Twenty parents sought help from more than one source.

Because early intervention is important in preventing children from entering restrictive mental health settings or the juvenile justice system, we asked parents

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why a family concerned about their children’s behavior or moods might not seek help. Responses included:

DCF (fear of being reported) Parents may be disconnected, unaware of what’s going on in child’s life Parents may have positive bias toward their child’s behavior (“nothing’s

wrong with my child”; “this behavior is probably normal for a child her age”) Family culture (seeking help is not culturally acceptable) Family is focused on basic needs like food, shelter, utilities Parents don’t have the energy to deal with younger children if they have older

children who are acting out Child’s behavior may be normal in a specific family system

At a block party at Nathan Hale School, parents were asked to respond to questions related to children’s behavioral health; questions were posted on easel sheets. Of the 12 responses to the question: What’s the best way to help kids before they have serious behavior or emotional problems? and the 12 responses to the question: What can we do together to prevent kids from developing serious mental health problems or getting into trouble with the police?, three-quarters of the responses related to parenting. Examples included: talk to your kids, know your kids, always be there when they need you at any cost, and do something with your child. The remaining responses related to programs for children, including after-school programs and activities, sports, and early testing.

Similarly, parents at the Nathan Hale PTA focus group said that parent and family issues are the main reasons that young children have social, emotional, or behavioral problems. These parents mentioned mentoring, quality after-school programs, community schools, and in-home assessments with families as ways of preventing kids from entering restrictive mental health settings or the juvenile justice system.

Nathan Hale School Staff

Ten Nathan Hale teachers attended a focus group and completed written surveys; the school social worker was unable to attend but completed a written survey. The principal, who is a member of the planning team, attended the focus group and co-facilitated.

When asked verbally about the most important factors in identifying children at risk of social, emotional, or behavioral health issues, half the respondents cited factors related to early identification and good screening. One participant noted that school is the primary identification site. One teacher said communication is a problem: “Communication” among service providers and school district can be an issue– sometimes the school isn’t informed about a child’s previous history with a mental health provider or hospital.” Other issues related to early identification related to language barriers (when a family’s first language is not English), and long waiting lists at clinical programs in the region.

Youth

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Four teenagers, all girls, attended a focus group at Manchester Youth Service Bureau (YSB). All of the girls were enrolled in a program at YSB at the time of the focus group and all had previously been identified as youth at-risk. One girl had been in the juvenile diversion program, one had completed an anger management program for teens at Manchester Memorial Hospital, and all had been in counseling or therapy.

These girls said that kids ages 6 to 11 have social, emotional, or behavioral problems for three reasons: problems at home including abuse and neglect, peer pressure, and boredom. One girl said, “I had nothing fun to do, nothing constructive. So I started getting into trouble.” Another remarked, “Even if your parent is good, your friends may be a bad influence. It happens because you’re trying to fit in.” And all seemed to agree that kids act out if they have parents “who don’t get along or aren’t doing what they’re supposed to do…”

Town Officials

A meeting was held with four officials from the Town, including General Manager, Superintendent of Schools, a representative of the police department, and director of Pupil Personnel Services. Planning team members introduced officials to the project and solicited input, framed around several discussion questions.

When asked to discuss the Spruce Street neighborhood and, in particular, the most significant issues facing young children in the neighborhood, responses focused on poverty, “…the high proportion of children on free or reduced lunch” and family problems, “lots of family-connected drivers making life hard for these youngsters…”, “single-parent families, particularly female heads-of-household dominate, leading to a host of other issues, including older children serving, inappropriately, as main caregivers to younger children.” Despite this, officials were optimistic about the neighborhood, noting that Spruce Street has many resident home owners, good physical infrastructure, a new middle school model (Bennet Academy), an active Neighborhood Revitalization Zone, and links with business leaders.

III. Stakeholders

The first of three planned meetings was held in October to solicit the input and support from community leaders and members identified by the planning team as key stakeholders. Ten stakeholders of 22 invitees attended the meeting; attendees represented the Board of Education, Bennet Academy (Manchester’s middle school), clergy, the library, the public defender’s office, the neighborhood block watch, DCF, the Town Human Services department, and the police department. Stakeholders did not complete a written questionnaire but discussed a variety of issues related to the planning project.

When asked, From your perspective, where are the gaps in the system as those gaps relate to preventing children from entering restrictive mental health settings or the juvenile justice system?, stakeholders’ responses related primarily to

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the need for structured programs and education for parents. After-school programs, school-based programs, and mentoring were highlighted by the group; stakeholders noted that parents need mental health education designed to reduce the stigma parents might feel asking for help.

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Demographic Picture:Manchester and Nathan Hale Neighborhood

Town of Manchester

Indicator Year Source Total %

5 Year Olds

6-11 Year Olds

Total 5-11

total population under 18 years (12,276) 2000 Census 22.8%

children living in poverty, age 6-11 years 2009

Census; CT Assn

for Human

Services

11.6% 11.4% 10.8% 11.3%

eligible for free and reduced lunch(185% of federal poverty level income)

2006-2007

Strategic School Profiles

34.6%

children born to teen mothers (per 1,000 CT = 15.5%) 2006 CT DPH 13.2%

Manchester – all parents in family in labor force 2000 Census 66.0%

Manchester parents who have not completed high school 2000 Census 3.8%

children with preschool experience ct & Manchester

2006-2007

Strategic School Profiles

79.3% 66.7

adult unemployment rate (ct = 6.1%) July 2008

CT Voices for

Children5.9%

Nathan Hale Neighborhood and SchoolIndicator Year Source Totaltotal student population 2008 Strategic School Profiles 343

% students with non-english home language 2007 Strategic School Profiles 5.5%

% students above entry grade who attended Nathan Hale in previous year

2007 Strategic School Profiles 73.5%

housing stock (residential properties) 2006 Town Planning Department 816

% housing & premises in poor condition 2006 Town Planning Department 26%

% of town’s total violent crime 2006 Town Planning Department 16%

Nathan Hale population density compared to town (people/per square mile)

2006 Town Planning Department 7,124 vs. 2,095

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Nathan Hale School Community – Major Indicators of Need

In looking at the Nathan Hale School community, the Manchester planning team examined important factors that affect the lives of the children and their families. While not a comprehensive analysis, the team looked at five major areas that research literature have shown to affect whether young children may be at risk for social and behavioral concerns.

A note of caution regarding this data is important. Collecting information on just a portion of a community–in this case the Nathan Hale neighborhood and school–can be difficult. It was challenging to obtain consistent information over several years. In many cases, the information was just not readily available, and the town and state do not collect the kinds of information we wanted. Additionally, because of limitations forced often by economics, some of this information, especially about behavioral health services, are not collected and organized as regular practice.

Mental Health providers, the Manchester Police Department and the Manchester Public Schools all contributed their time and energy to pull out information about Nathan Hale students, seeking to provide a clearer picture of the issues facing this community.

Those major indicators, along with some findings, are included in the next several pages. The indicators are:

Academic performance, looking at student achievement on standardized academic proficiency tests given to fourth graders at Nathan Hale School

Poverty, looking at the trend in the free and reduced lunch program, an indicator of the extent of poverty affecting these children and families

Student behavior, examining the status and trends regarding the suspension of elementary school students, town-wide and at Nathan Hale School

Crime and police activity, examining the extent and short-term trends, particularly involving young children and juveniles

.

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Academic Performance

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Math proficiency of Nathan Hale 4th graders is improving, with a 9% increase in the scores on statewide tests over the past three years.

Compared to their peers in town, Nathan Hale 4th graders are improving, but continue to be substantially behind in math proficiency, 10 percentage points lower.

Reading scores for Nathan Hale 4th graders are declining, while the district scores remain about level.

While 72% of district 4th graders are rated proficient at their grade level reading, that number is 54.2% at Nathan Hale, almost 18% lower.

Nathan Hale 4th graders saw nearly a 10% decline in their reading proficiency scores in the last three years.

Poverty

While there is town-wide information regarding the number of families in poverty in Manchester, finding such comparable information specifically about the Nathan Hale school community is more difficult. A proxy, or measure that strongly suggests this, is the number of children who are eligible at the school for a free or reduced lunch, a program supported by federal and state funds. This information is presented here.

This is an important measure of economic stress facing these elementary school children, a major factor in suggesting they will have social and behavioral concerns. To be eligible for free school lunch, a typical family of four has a household income of $2,197 per month or less. To be eligible for a reduced price lunch, that same family’s monthly household income must be $3,269. Presented as annual income, it means a family of four with an income of $39,220 or less can get some support; a family with an income of $27,560 is eligible for free lunch.

In the past year, Nathan Hale students have become the most economically stressed in town, as measured by a marked increase in the number eligible for free/reduced school lunch. Nathan Hale reports, by far, the highest levels of free or reduced lunch, thus child poverty, in the Town of Manchester.

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In the last year, Nathan Hale School has recorded the highest number of children eligible for free or reduced lunch, surpassing Verplanck Elementary School.

After remaining almost flat since 2006, Nathan Hale has experienced a 30% spike in free or reduced lunch in the past year.

In 2008, 82% of Nathan Hale children were eligible for free or reduced lunch, nearly twice the district

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Student Behavior

One measure of student behavior in school can be measured by the percent and number of children who are disciplined by suspending them from school, either by separating them within the school environment to receive intervention, or by an out-of-school suspension, sending them home. This section examines information on suspensions at Nathan Hale and compares that data with other elementary schools in town.

Of the two kinds of suspension, in-school and out-of-school, educators believe in-school offers the most opportunity to intervene and change student behavior. At the elementary level, providing in-school suspension is more challenging, as issues regarding available separate space for the students and staffing present difficulties.

Nathan Hale Student Suspensions Three-year Trends, 2005-2008

8

15

32

8

31

14

05

101520253035

2005-06 2006-07 2007-08

Num

ber

All Suspensions Out of School Suspensions

Out-of-School Suspensions, 2007-2008District Elementary Schools vs. Nathan Hale

31

13.3

0

5

10

1520

25

30

35

40

Average, All ManchesterElementary Schools

Nathan Hale School

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Student suspensions at Nathan Hale reveal no particular pattern or trend, with the three-year data -- a low of 15 to a high of 32 per year.

In the past three years, the school’s response when it suspends a child has been to send the child home.

In the past two school years, school year, fully half of the suspensions at Nathan Hale were for

The number of out-of-school suspensions at Nathan Hale School is more than twice the district average for all elementary schools.

Out-of-School Suspensions - Manchester Elementary Schools 2007-2008

6 70

10 13

31

4 6

43

137 12

2 0

1

21

0

4

0

0

10

20

30

40

50

Bowers

Buckle

y

Highland

Park

Keene

yMart

in

Nathan

Hale

Robert

son

Verplan

ck

Waddell

Washing

ton

Out-of-School Suspensions 2007-08 In-School Suspensions2007-08

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District-wide, the vast majority of elementary school suspensions are served out of school.

In the most recent full school year, Nathan Hale School had the second highest number of suspensions among the district’s 10 elementary schools. Only Waddell had more.

In the most recent full year,

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Crime and Law Enforcement Activities

The level of criminal activity, particularly among juveniles, can be examined by looking at juvenile arrests, at diversion from arrest by police, and at overall arrest records.

The overall crime rate in Manchester reported in 2004 was 4,373 arrests per 1,000 residents, approximately 31% higher than the state average. Family violence incidents where children were present is another measure regarding the impact of crime on young people. In 2005, the town reported 127 incidents of family violence where children ages six to nine years were present.

This section looked at data regarding overall juvenile crime rates, and also examined information regarding younger children, particularly in the Nathan Hale neighborhood and by elementary school in town. Juvenile crime in general among children ages 6 to 11 years is very low, with very few arrests reported by police. In the Nathan Hale School neighborhood, in particular, police reported no more than two arrests in recent years among children in the target age group of this project.

Nevertheless, overall crime in the neighborhood is high (See demographics, page 11). Manchester Police and the school system reported that in one recent year, Nathan Hale School experienced twice the number of “lock-downs” of the school than all other schools in the district. This did not represent crime in the school, but an incident in the neighborhood that caused officials to lock the school to protect its children.

Here are some selected statistics regarding juvenile crime.

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0

100

200

300

400

500

600

700

800

900

Juvenile Offenses

Total Juvenile OffensesTown of Manchester 2006-2008

200620072008

Juvenile crime in Manchester (children under 16 years old) has ranged from about 700 to 900 incidents in the last three years, showing little apparent pattern.

After rising in 2007, the juvenile crime rate in town dropped 20% in 2008, to 716 cases.

Manchester Police report a marked increase in first-time offenses,

Manchester Juvenile DiversionsYears 2002-2008

90

109

77 77

99108

124

0

20

40

60

80

100

120

140

2002 2003 2004 2005 2006 2007 2008

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Diverting first time juvenile offenders from the courts to services has increased steadily since 2002, except in two years.

2008 marked the greatest number of children diverted since 2002, and showed a one-year increase of 15%.

Nathan Hale School Community:Behavioral Health Information

In looking at the needs and key information about the social and behavior health of students in the Nathan Hale School, the Planning Team assembled information about the level of services now available in the community, some context of the need based on national information, and particularly looking at the systems and services available at the school now.

Again, this information is not comprehensive, often reflecting the fact that there is a loosely coordinated “system of care” especially for students who may have social or behavioral concerns, but who are not in need of more intensive services

In all, three areas are highlighted:

Prevalence, a look at the level of behavioral concerns among children 6 to 11 years old, measured by some national statistics. This was then compared with what we do know about Nathan Hale students.

Community services, a look at the level of formal outpatient behavioral health services for Nathan Hale students, along with referral patterns to those services by the school.

School services, in particular the “system” and the social work services now serving Nathan Hale children.

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Prevalence

This section provides information regarding the national statistics on the level or prevalence of emotional and behavioral difficulties, and the key indicators. This is the best information available from which to try to determine if young children require some kind of help or intervention, particularly less than formal mental health services.

In general, this information shows:

Nationally, up to 22% of children, 4 to 17 years old experience some form of behavioral problems, about 3 to 5% are judged severe. The major indicators according to national data are:

Being poor, however the level of poverty seems to not change the intensity of behavioral problems

Being the child of a single parent Boys age 8 to 10 years are affected far more than girls

For Nathan Hale, the most recent information from the school social worker indicate that the active caseload of children who teachers, administrators or parents refer for counseling and services represent about 20% of one in five students at the school. Thus, the pattern at the school appears to mirror the upper end of the national experience.

At Nathan Hale, however, of students with behavioral issues that are addressed through the school’s response–the Positive Behavior Support system–of some 50 cases in 2008, only two involve girls.

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National Statistics on Children with Emotional and Behavioral Difficulties*

Percentage of children ages 4 to 17 reported by a parent to have serious (definite/severe), minor, or no difficulties with emotions, concentration, or getting along with other people. (Selected data characteristics, 2005)**

Characteristic Definite/severe difficulties Minor difficulties No difficultiesAge and genderTotal ages 4–17 4.6 16.2 79.2

Ages 4–7 2.8 14.0 83.2Ages 8–10 4.8 18.4 76.8Ages 11–14 4.9 17.0 78.0Ages 15–17 6.2 15.7 78.1

Males ages 4–17 5.4 17.9 76.7Ages 4–7 3.0 15.3 81.7Ages 8–10 5.5 22.2 72.3Ages 11–14 6.3 18.6 75.1Ages 15–17 6.9 16.4 76.7

Females ages 4–17 3.8 14.4 81.8Ages 4–7 2.5 12.7 84.8Ages 8–10 4.2 14.7 81.1Ages 11–14 3.4 15.4 81.2Ages 15–17 5.4 14.9 79.7

Poverty status

Below 100% poverty 7.1 19.4 73.4100–199% poverty 4.8 17.6 77.5200% poverty and above 3.8 14.8 81.4Race and Hispanic originWhite, non-Hispanic 4.8 16.5 78.7Black, non-Hispanic 5.3 18.3 76.3Hispanic 4.0 14.8 81.2Other, non-Hispanic and multiple races 1.8 11.5 86.7

Family structureTwo parents 3.7 14.4 81.9Mother only 6.9 20.6 72.4Father only 4.2 19.9 75.8No parents 9.8 22.5 67.7

 * Emotional or behavioral difficulties of children were based on parental responses to the following question on the Strengths and Difficulties Questionnaire (SDQ): “Overall, do you think that (child) has any difficulties in one or more of the following areas: emotions, concentration, behavior, or being able to get along with other people?” Response choices were: (1) no; (2) yes, minor difficulties; (3) yes, definite difficulties; and (4) yes, severe difficulties. Children with serious emotional or behavioral difficulties are defined as those whose parent responded “yes, definite” or “yes, severe.” These difficulties may be similar to but do not equate with the Federal definition of serious emotional disturbances (SED), used by the federal government for planning purposes.** Source: Centers for Disease Control and Prevention, National Center for Health Statistics, 2005 National Health Interview Survey.

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Community Services

There are three major institutional providers of community-based behavioral health services to the students and families at Nathan Hale School. Additionally, there are some referrals to the Children’s Medical Center in Hartford. This section looks at those services and referrals to the Manchester-based programs.

In general, and as expected, the number of children referred for traditional formal mental and behavioral health services is not large compared to the total school population of 343 students.

Nathan Hale Student Behavioral HealthUnduplicated Services by Community Provider 2006-2008

0

5

10

15

20

2006 2007 2008 (6 mos.)

Num

ber

Community Child Guidance Clinic Community Health ResourcesManchester Hospital

Nathan Hale School, Referrals to Behavioral Services, 2008 Percentages, by Community Provider

N= 18

44%

11%

17%

28%CommunityChild GuidanceClinic

ConnecticutChildren'sMedical Center

ManchesterHospital

PrivateTherapists

26

Three community behavioral health providers annually serve between 20 and 38 Nathan Hale students.

The sharpest increase occurred in 2008, mostly due to increased services by one provider, Community Health

Nathan Hale School refers students who need more intensive behavioral health services to four kinds of providers.

About 40% of school referrals go to private therapists or the Children’s Medical Center, not the local institutional providers.

The largest institutional provider of behavioral health services to students–Community Health Resources–is not a referral source for the school.

27

Nathan Hale Students Receiving Behavioral Health ServicesDistribution by Age 2006-2008

02468

101214161820

6-8 yrs 9-11 yrs 6-8 yrs 9-11 yrs 6-8 yrs 9-11 yrs

2006 2007 2008

Community Child Guidance Clinic Community Health Resources Manchester Hospital

School Services

Behavioral health services at Nathan Hale School take a number of forms, both formal and informal. The primary work is accomplished by the school’s full-time social worker, and by teachers and administrators who use a program called Positive Behavior Support (PBS), an evidence-based model that is now being introduced in all schools in Manchester.

Nathan Hale School-Based ServicesNumber and Percentage Referred 2005-2008

345330

343

77

0

50

100

150

200

250

300

350

400

2005-06 Referral datanot available

2006-07 Referral datanot available

2008-09 Referrals =22.4%

Total Student Population Referrals

22.4%? ?

28

Mirroring national trends, more children age 9 to 11 from Nathan Hale received formal behavioral health services in the past three years than did younger children.

Data was only available for one year from the largest community provider–Community Health Resources–and it appears

Two years of records indicate 22.4% of students at Nathan Hale are served by the school social worker at any particular time.

Social worker reports note a weekly active caseload of approximately 16 students, 45 to 60 different children served each month.

About 75% of the students are seen in what is called an informal system of

23

Academic and Behavioral Health Interventions Nathan Hale School

SchoolPsychologist

Social Worker

TEACHER--PARENT

N = 77 **

Community-BasedMental Health

Providers N = 38 ***

Early Intervention Plan(EIP)

N = 6

Positive BehaviorSupport (PBS)

N = 50

Regular Education SupportsN = ?

Special Education ****

N = 6

Legend Behavioral intervention

Primarily an academic intervention

Sources primarily in school system

Notes * 2008-2009 Nathan Hale Elementary School enrollment ** Current active caseload, school social worker *** 2008 referral data: Manchester Memorial Hospital Child & Adolescent Ambulatory Services; Community

Child Guidance Clinic; Community Health Resources **** Current caseload, 15% school population (2 students identified as emotionally disturbed) ***** Social work interventions can be formal, primarily for special education students, or informal. Informal

intervention may be used for children with emotional issues who don’t exhibit behavior problems.

Students and FamiliesNathan Hale Neighborhood

N = 343 students*

N = ± 20

N = 18

Principal (mainly responsible for PBS)

Support fromSocial Worker*****