“So – You Are Interested in Getting More Mental Health Services – Now What?”

1. “So – You Are Interested in Getting More Mental Health Services – Now What?”  Regional School Counselor Conference Bridgeport Conference Center April 18 , 2013

2. Introductions Margy Burns, Youth Health Services, Elkins • yhsmargy@yahoo.com Jessica Laslo, School Counselor, Ohio County • jlaslo@access.k12.wv.us Linda Anderson, Marshall University • landerson@marshall.edu

3. 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

4. Links Between Mental Health and School Success

5. 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)

6. 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)

7. AcademicPerformance • 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)

8. Graduation Rates School 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)

9. 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

10. Focuses on all students… …in both general and special education

11. Builds on existing school programs, services, and strategies.

13. Tier 1 - Universal PreventionRecommendations • Infrastructure • Positive Behavior Support • Developmental guidance • Early identification • School climate • Connectedness • Family engagement • Staff development • School safety • Support for Transitions

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 Shared Agenda Multiculturalism NCLB Family support services Where to Begin? Cultural competence Risk and protective factors School based Strengths based Multi system approach School linked Student Support Services Suicide Prevention Mental Health Services Act IDEA School climate Peer-to-Peer Support School connectedness Evidence based practice Coordinated school health program

16. Planning Process Support from school administration Principal District Form core school leadership team Identify and convene key community agencies, parents, youth Meet regularly Educate one another Keep notes Build RELATIONSHIPS

17. Planning Process Analyze needs and resources School data SWOT analysis MH-PET: www.nasbhc.org/mhpet School Improvement Plan Define a communications plan Develop an implementation plan Set goals, objectives, timeframes Shared vision Memo of Understanding (MOU)

18. Funding 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

19. DEVELOPMENT & SHORT-TERM OUTCOMESfor Health Connections A Rural EXPANDED SCHOOL MENTAL HEALTH PROGRAM Youth Health Service, Inc. Elkins, West Virginia

20. 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 • 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

23. 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 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 accessto high quality children’s mental health services & receive those services in a more consistent manner (lower no-show rates). Slightly more boys than girlsreceived 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.

27. 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

28. Tier 3 Short-term outcomes cont. Presenting Problem Areas Areas of Concern at Entry • Behavior-39% • Depression-19% • Academic-18% • Trauma-16% • Severe MI 4% • Autism-2% • Drugs-1% (n=98)

29. 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.

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. • 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

31. Ohio County SchoolsMadison Elementary Expanded School Mental Health Services

32. Co-teaching PLC bi-weekly Teacher study/support groups Anchor (after school) Attendance care calls Too Good for Drugs Second Step Keep a Clear Mind NetSmartz Family dinner nights Gold Star (PBS) D.A.R.E Lunch Buddy Program Tier 1 Academic and Behavioral Supports

33. SAT SPL (RtI) Tier pull-out interventions Extended day tutoring Homework time Juvenile Mediation Program Extended Year KOOL Kids Program (middle school transition) Save One Students (mentoring) Weekend Snack Bag Program Group counseling- Bullfrogs & Butterflies Afterschool Program Tier 2 Academic and Behavioral Supports

34. Tier 2&3School- Based Mental Health CHOICES Program(since 2002) Group, Individual & Family Therapy in coordination with Northwood Health Systems A Center forHOPE& Change(est. 2012) Individual and family counseling; Afterschool psycho-educational groups and developmental guidance in summer school

35. Children Served • Most are in grades K through 5 at the time of the initial referral • Show a demonstrated pattern of • Disruptive and aggressive behavior • Disrespectful behavior toward others • Failure to obey rules • A violation of the rights of others • Underachievement in their academic studies • Emotional and mental health issues including depression, anxiety, ADHD, & complex traumas

36. With ESMH, Communication is Key

37. Challenges and Barriers • Scheduling time for students to be seen during the school day • Having a regular, confidential space for children to receive services • Staffing • Family participation and commitment • Keeping cases open through the summer

38. Impact on Students & Families • Having the services at school during the school day reduces the barriers for children to get needed services and minimizes the disruption to their education. • First year outcomes include improved attendance, increased social skills, decreased aggression, and improved relationships. • In addition, Madison Elementary was named a 2012 WV Title 1 Distinguished School - one of 12 out of 329 Title 1 schools in West Virginia.

39. 2012-13 ESMH SERVICE HIGHLIGHTS FOR MADISON ELEMENTARY “For All” (Tier 1): • 37 staff trained to become a Trauma-Informed School • 30-35 Families attending Family Night Program • Positive Behavior Support (250 students) “For Some” (Tier 2): • 37 students receive mentoring, after-school group counseling and other academic/behavior supports • “Kool Kids” significantly impacting 5th grade attendance rate “For a Few” (Tier 3): • 22 students receive individual, group & family therapy through Northwood “Choices” program • “Center for Hope & Change” offers supports after school and over the summer

40. Focus on Increasing Numbers of Children Identified for Tier 2 & 3 Services

41. Ohio County SchoolsMadison Elementary School We are proud of A Center forHOPE& Change and the CHOICES Program Before… …After

42. 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/

43. National Resources Center for School Mental Health U of Maryland: www.csmh.umaryland.edu National Assembly on School Based Health Care:www.nasbhc.org Compassionate Schools www.k12.wa.us/CompassionateSchools

44. West Virginia Resources “WV Educators Speak” video Tool Kits Website Links

45. www.schoolmentalhealthwv.orgwww.wvshtac.org Linda Anderson, MPH Marshall University Huntington, West Virginia 304-544-3917 landerson@marshall.edu