“So – You Are Interested in Getting More Mental Health Services –

Now What?”

Regional School Counselor ConferenceChief Logan State Park

April 16 , 2013

Introductions

Sheila Rose, Youth Health Services, Elkins• srose796@yahoo.com Joumana Elkhansa, Prestera, Kanawha County• Joumana.elkhansa@prestera.org Jenni Durham, Prestera, Kanawha County• Jenni.Durham@prestera.org Linda Anderson, Marshall University• landerson@marshall.edu

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ObjectivesParticipants will be able to:• Describe the three tiers of an expanded

school mental health model (ESMH)• Identify at least three resources for

planning and implementing a comprehensive model

• Identify at least three strategies essential to successful implementation

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Links Between Mental Health and School Success

Facts

• 5-9 % of children and teens have a serious emotional disturbance. (US Surgeon General’s Report, 1999)

• 20% of children and adolescents at any given time have a diagnosable mental disorder which interferes with their functioning.(US Surgeon General’s Report, 1999)

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Facts

• 1-2 children in every classroom have a diagnosable mental health concern which hinders functioning. (President’s New Freedom Commission Report)

• Less than 50% of children and adolescents with a mental illness receive adequate (or any) services . (Kataoka, Shang, Wells, 2002)

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Academic Performance• Is negatively affected by:

– Alcohol, tobacco, and other drug use – Emotional problems – Health risk behaviors (e.g. obesity, sexual behavior,

poor diet)– Low self-esteem, risky sexual behavior– Lack of access to health and mental health care– Poor home life

• Is positively affected by:– High levels of resiliency, developmental assets, and

school connectedness(work of CASEL, Search Institute; and others)

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Graduation RatesSchool Mental Health strategies can improve graduation rates by addressing factors that interfere with a student’s ability to succeed in school, such as:• Exposure to violence• Anxiety disorders• Other unmet mental health needs

(Black, et al, 2003, Woodward & Ferguson, 2001; and others)

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DefinitionExpanded School Mental Health refers to programs that build on the core services typically provided by schools. It is a three-tiered framework that includes the full continuum of:

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• Prevention• Early intervention • Treatment• Emphasizes shared

responsibility between schools and community providers

…IN BOTH GENERAL AND SPECIAL EDUCATION

Focuses on all students…

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Builds on existing school programs, services, and strategies.

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TIER 1 - UNIVERSAL PREVENTIONRECOMMENDATIONS1. Infrastructure2. Positive Behavior

Support3. Developmental

guidance4. Early identification5. School climate6. Connectedness

7. Family engagement8. Staff development9. School safety 10. Support for Transitions

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Student Support Services

Social and Emotional Learning

Mental Health Services Act

Student Mental Health Initiative Safe Schools, Healthy Students

Peer-to-Peer Support

School climate

School connectedness

Coordinated school health program

Suicide Prevention

Strengths based

Risk and protective factors

Family support services

Cultural competence

MulticulturalismShared Agenda

School based

School linked

Special Education

NCLB

IDEA

Crisis management

Evidence based practice

Multi system approach

Response to InterventionPBIS

Systems of Care

School linked

Wrap around

Student Assistance Team

Where to Begin?

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Planning Process

1. Support from school administration• Principal• District

2. Form core school leadership team3. Identify and convene key community

agencies, parents, youth• Meet regularly• Educate one another• Keep notes• Build RELATIONSHIPS

Planning Process4. Analyze needs and resources

• School data• SWOT analysis• MH-PET: www.nasbhc.org/mhpet• School Improvement Plan

5. Define a communications plan6. Develop an implementation plan

• Set goals, objectives, timeframes• Shared vision• Memo of Understanding (MOU)

Funding

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It doesn’t take a lot of money; just a few committed people

Start small – focus on “low hanging fruit”

A diversified funding base increases sustainability

• School System: Title 1, Safe and Supportive Schools, SIG, Innovation Zone

• Community Mental Health

• Third party insurance

• Community Health Centers

• Corporations/Businesses

• Hospitals• County

• Community Foundations- SSJHWF, regional

• Family Resource Network• Regional School Wellness Specialist• BBHHF - Tiffany.J.Pittman@wv.gov

DEVELOPMENT & SHORT-TERM OUTCOMESfor

Health Connections

A RuralEXPANDED SCHOOL MENTAL HEALTH

PROGRAM

Youth Health Service, Inc.Elkins, West Virginia

Serving Five Very Rural Schools

Green Bank Elementary/Middle School

Pocahontas County High School

Tucker Valley Elementary/Middle School

Davis-Thomas Elementary/Middle School

Tucker County High SchoolCombined student population - 2,131 students

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Goals:• Increase access to quality, evidence-based mental

health services for children and adolescents• Improve school attendance, academic performance

and psycho-social functioning of students

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Short-term Outcome: Remove Barriers to MH Services

BARRIER• High social stigma

associated with MH & services

• Teachers/other school personnel feel unprepared

PROGRAM RESPONSE• Move services to youths’

natural environment (schools) & have a low profile initially~

• Establish & train work teams– Community (Core Team),– Program team (school

counselors, nurse, MH staff) work with SATs

• Train all school personnel

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Barriers & Response(cont.)

• High gasoline prices & parents must miss work to get youth to appointments

• Lack of local access to high-end MH services

• Confidential clinical records

• Difficulty in keeping up with staff working in schools

• Move services closer to clients to eliminate travel

• Utilize telemental health services called, YHS-Telecare

• Web-based electronic records

• Central scheduling24

Client Flow Process in YHS ESMH Program

• Referrals may be initiated by parent, teacher, nurse, principal, SAT or student.

• All in-school referrals go to the school counselor first.25

Current Services

• Tier 3– Individual & Group

Therapies (all must be evidence-based)

– Family Therapy– Psychiatry– Psychology

• Tier 2– Early Intervention

Groups (small groups, or classroom intervention)

• Tier 1– Dinosaur School

Classroom Intervention (Kindergarten, early elementary)

– SOS for Suicide Prevention

– Summer Group Program (Pocahontas County)

– Primary Prevention Classroom group interventions

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Short-term Outcome: Reach Children who need Tier 3 Services

• 98 children have improved access to high quality children’s mental health services & receive those services in a more consistent manner (lower no-show rates).

• Slightly more boys than girls received services (54% vs. 46%)

• Medicaid was leading insurance coverage (57%), while 43% had private insurance coverage (n=88), all but 10 children had some coverage at enrollment.

Short-term Outcomes cont.

• 32% of all children lived outside of their natural parents home(n=94)

• School personnel were leading referral source, followed by family member

• Most children (91%) were enrolled in regular education with 9% receiving special education services

Family YHS

Community

School C

ounselor

05

1015202530354045

Referral Sources

Series 1

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Tier 3 Short-term outcomes cont.

Presenting Problem Areas

• Behavior-39%• Depression-19%• Academic-18%• Trauma-16% • Severe MI 4%• Autism-2%• Drugs-1% (n=98)

Areas of Concern at Entry

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Primary Concerns

AcademicTraumaSubstanceDepressionBehaviorSevere MIAutism

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LESSONS LEARNED & PLANS

• ESMH Programs are a win-win for schools, families and students

• Schools welcome us, provide space and collaborate with staff

• Staff like the school setting• Must adjust to school

calendar, snow days• Must plan for services to

continue in the summer in local communities

• Collaborate with School-Based Health Clinics

• Make all schools SBIRT sites

• Add ESMH sites in all schools that are pilot sites now (12 schools)

• Study the impact of ESMH programs on mental health of staff, students and schools.

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LESSONS LEARNED & PLANS cont.LESSONS

• Telemental health is a great way to provide emergency mental health services and backup supervision for school-based staff.

• A planning period before full implementation is critical.

• Investments in training staff in EBPs & for work in schools is critical

PLANS

• Expand Tier 1, 2 services

• Recruit more therapists who enjoy providing children’s mental health services and who are innovators.

• www.youth-health.org• (304)636-9450

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School-based services support the school environment by helping children stay in school and by identifying and addressing mental health problems that may interfere with the learning process.

Prestera CenterSchool-based Services Kanawha County

School-based services

• Chandler Middle School• Chandler High School• SOCRATES• CHANCE• ESMH- Stonewall Jackson Middle School

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Chandler Academy

Chandler Middle School:

Phase 1: Intensive services for 6 weeks

Phase 2: Transitioning into the regular alternative school classroom

Phase 3: Follow-up and monitoring in the home school

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Chandler Academy

Chandler High School• This program is designed to assist the student

with adjusting to the alternative school setting and to provide follow-up and monitoring upon the student’s return to his or her home school.

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Elementary School-Based Services

• CHANCEThe CHANCE (Caring and Helping Academically while Nurturing Children Emotionally) program is about working with students that need another chance to improve their behaviors so they can be successful at their home school. This is an eight week intensive program consisting of half a day of academics and half a day of mental health services.

• SOCRATESThe SOCRATES (Specialized Outpatient Counseling Resources Available To Elementary Students) program provides services to assist the elementary student with improving their functioning in the academic setting to prevent school suspensions • and expulsions.

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Expanded School-Based Mental Health

Services

Stonewall Jackson Middle School

812 Park AvenueCharleston, WV 25302-2599

(304) 348-6123

SCHOOL PROFILEEnrollment Data

2011 – 2012

Race / EthnicityTotal Students = 499 Caucasian = 56%African American = 42.5%Hispanic = 1.2%Asian = .4%

Socioeconomic StatusLow Income = 75%

Key Indicators2011 – 2012

Attendance Rate = 97.2% Drop-out Rate = .30% Average Class Size = 19.4

students Disciplinary Infractions = 934 Out-of-School Suspensions = 531

Academic Proficiency2011 – 2012

Assessment Data West-TestThere are 128 state middle schools Ranked 26th for scores on Math Ranked 39th for scores on Reading

PercentagesMath = 49% proficientReading = 48% proficientScience = 54% proficientSocial Studies = 50% proficient

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ESMH - StonewallThe Expanded School Mental Health Program is a collaborative effort between Prestera Center for Mental Health and Kanawha County Schools, to address the emotional and behavioral difficulties that negatively impact school performance, including attendance, grade point average, and the development of healthy relationships with other students and school authority figures; and optimize overall student health and well-being. The program is housed within Stonewall Jackson Middle School and is designed to operate throughout the regular school year.

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Universal Prevention Program (Tier One)

• Cybersmart Curriculum – addressing manners, cyberbullying, and ethics.

• Holt’s Decisions for Health – including worksheets and activities on building self-esteem, healthy body weight, mental and emotional health, stress management activities, conflict resolution, teens and drugs.

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Targeted Intervention Program (Tier Two)

• At risk students - includes referral services, rapid response capability, study groups, tutoring, mentoring, after school programs, small group interventions to address anger, social skills, substance abuse and other needs, as well as some individual supportive services.

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Intensive Intervention Activities (Tier Three) 

• Information and Referrals• Screening for Mental Health Disorders• Assessment• Individual / Group / Family Therapy• Supportive Intervention (Group / Individual)• Crisis Intervention• Case Management • In-home services during school breaks,summer and by

request.

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Intensive - Tier Three Cont’d

• Information and Referrals• Screening for Mental Health Disorders• Assessment• Individual / Group / Family Therapy• Supportive Intervention (Group / Individual)• Crisis Intervention• Case Management • In-home services during school breaks,summer and by

request.

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Recommended Reading

Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools

National Center for Mental Health Promotion and Youth Violence Prevention:

http://promoteprevent.org/Publications/

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National ResourcesCenter for School Mental HealthU of Maryland: www.csmh.umaryland.edu

National Assembly on School Based Health Care: www.nasbhc.org

Compassionate Schoolswww.k12.wa.us/CompassionateSchools

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West Virginia Resources

“WV Educators Speak” video

Tool Kits

Website Links

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www.schoolmentalhealthwv.org

www.wvshtac.org

Linda Anderson, MPHMarshall UniversityHuntington, West Virginia304-544-3917landerson@marshall.edu