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So You Are Interested in Getting More Mental Health Services Now What? Regional School Counselor Conference Chief Logan State Park April 16 , 2013 Introductions Sheila Rose, Youth Health Services, Elkins [email protected] Joumana Elkhansa, Prestera, Kanawha County [email protected] Jenni Durham, Prestera, Kanawha County [email protected] Linda Anderson, Marshall University [email protected] 2

Objectives Participants 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 3 Links Between Mental Health and School Success Facts 5-9 % of children and teens have a

serious emotional disturbance. (US Surgeon Generals Report, 1999) 20% of children and adolescents at any given time have a diagnosable mental disorder which interferes with their functioning.(US Surgeon Generals Report, 1999) 5 Facts 1-2 children in every classroom have a diagnosable mental health concern which hinders functioning. (Presidents New Freedom Commission Report) Less than 50% of children and adolescents with a mental illness receive adequate (or any) services .

(Kataoka, Shang, Wells, 2002) 6 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)

7 Graduation Rates School Mental Health strategies can improve graduation rates by addressing factors that interfere with a students 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) 8 Definition Expanded 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: Prevention Early intervention Treatment Emphasizes shared responsibility between schools and community providers 9

Focuses on all students IN BOTH GENERAL AND SPECIAL EDUCATION 10 Builds on existing school programs, services, and strategies. 11 13 TIER 1 - UNIVERSAL PREVENTION

RECOMMENDATIONS 1. Infrastructure 2. Positive Behavior Support 3. Developmental guidance 4. Early identification 5. School climate 6. Connectedness 7. Family engagement 8. Staff development 9. School safety 10. Support for Transitions 14

15 Response to Intervention PBIS Student Assistance Team Student Mental Health Initiative Safe Schools, Healthy Students Special Education Crisis management Systems of Care Social and Emotional Learning

School linked Wrap around NCLB Wh ere to B Shared Agenda Family support services Cultural competence School based Strengths based School linked

Multiculturalism egin ? Risk and protective factors Multi system approach Student Support Services Suicide Prevention Mental Health Services Act School climate School connectedness Coordinated school health program

IDEA Peer-to-Peer Support Evidence based practice 16 Planning Process 1. Support from school administration Principal District 2. Form core school leadership team 3. Identify and convene key community agencies, parents, youth

Meet regularly Educate one another Keep notes Build RELATIONSHIPS Planning Process 4. Analyze needs and resources School data SWOT analysis

MH-PET: School Improvement Plan 5. Define a communications plan 6. Develop an implementation plan Set goals, objectives, timeframes Shared vision Memo of Understanding (MOU) Funding It doesnt 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 County Community Mental Health Third party insurance

Community Health Centers Community Foundations- SSJHWF, regional Family Resource Network Regional School Wellness Specialist BBHHF - [email protected]

Corporations/Businesses Hospitals 19 DEVELOPMENT & SHORT-TERM OUTCOMES for Health Connections A Rural EXPANDED 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 School Combined student population - 2,131 students 21 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 22 Short-term Outcome: Remove Barriers to MH Services BARRIER High social stigma associated with MH & services PROGRAM RESPONSE Move services to youths natural environment (schools) & have a low profile initially~

Establish & train work teams Teachers/other school personnel feel unprepared Community (Core Team), Program team (school counselors, nurse, MH staff) work with SATs Train all school personnel 23 Barriers & Response(cont.) High gasoline prices & parents must miss work to

get youth to appointments Lack of local access to highend MH services Move services closer to clients to eliminate travel Utilize telemental health services called, YHS-Telecare Confidential clinical records Web-based electronic records Difficulty in keeping up with staff working in schools Central scheduling

24 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 26 Short-term Outcome: Reach Children who need Tier 3 Services 98 children have improved access to high quality childrens 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. S m m un oo ity lC ou ns el or

Series 1 YH Sc h Most children (91%) were enrolled in regular education with 9% receiving special education services 45 40 35 30 25

20 15 10 5 0 Co School personnel were leading referral source, followed by family member Referral Sources Fa m il y

32% of all children lived outside of their natural parents home(n=94) 28 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 Primary Concerns 98 Academic Trauma Substance

Depression Behavior Severe MI Autism 29 LESSONS LEARNED & PLANS ESMH Programs are a winwin 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. 30 LESSONS LEARNED & PLANS cont. LESSONS

Telemental health is a great way to provide emergency mental health services and backup supervision for school-based staff. PLANS Expand Tier 1, 2 services A planning period before full implementation is critical. Recruit more therapists who enjoy providing childrens mental health services and who are innovators.

Investments in training staff in EBPs & for work in schools is critical (304)636-9450 31 Prestera Center School-based Services Kanawha County 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. School-based services Chandler Middle School Chandler High School SOCRATES CHANCE ESMH- Stonewall Jackson Middle School 33

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 34 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 students return to his or her home school.

35 Elementary School-Based Services CHANCE The 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. SOCRATES The 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.

36 Expanded School-Based Mental Health Services Stonewall Jackson Middle School 812 Park Avenue Charleston, WV 25302-2599 (304) 348-6123 SCHOOL PROFILE Enrollment Data 2011 2012 Race / Ethnicity Total Students = 499

Caucasian = 56% African American = 42.5% Hispanic = 1.2% Asian = .4% Socioeconomic Status Low Income = 75% Key Indicators 2011 2012 Academic Proficiency 2011 2012 Attendance Rate = 97.2% Drop-out Rate = .30%

Average Class Size = 19.4 students Disciplinary Infractions = 934 Out-of-School Suspensions = 531 Assessment Data West-Test There are 128 state middle schools Ranked 26th for scores on Math Ranked 39th for scores on Reading Percentages Math = 49% proficient Reading = 48% proficient Science = 54% proficient Social Studies = 50% proficient

38 ESMH - Stonewall The 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 wellbeing. The program is housed within Stonewall Jackson Middle School and is designed to operate throughout the regular school year. 39 Universal Prevention Program (Tier One)

Cybersmart Curriculum addressing manners, cyberbullying, and ethics. Holts Decisions for Health including worksheets and activities on building selfesteem, healthy body weight, mental and emotional health, stress management activities, conflict resolution, teens and drugs. 40 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.

41 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. 42 Intensive - Tier Three Contd

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. 43 Recommended Reading Realizing the Promise of the Whole-School Approach to Childrens Mental Health: A Practical Guide for Schools

National Center for Mental Health Promotion and Youth Violence Prevention: 44 National Resources Center for School Mental Health U of Maryland: National Assembly on School Based Health Care: Compassionate Schools 45

West Virginia Resources WV Educators Speak video Tool Kits Website Links 46 Linda Anderson, MPH Marshall University Huntington, West Virginia 304-544-3917 [email protected]

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