School Based Health Centers: A Unique Service System

1. School Based Health Centers:A Unique Service System Andrea Kuebbeler, LCSWAlternatives, Inc.IL Children’s Mental Health PartnershipSchool Mental Health ConferenceJune 27, 2012Andrea Kuebbeler, LCSWAlternatives, Inc.akuebbeler@alternativesyouth.org

2. Objectives Overview of School Based Health Center’s (SBHC)How do they benefit students, parents, school and the communityHow are behavioral health services integrated into this model of service in schools

3. Many of the most significant and costly national health problems are caused by behaviors established during adolescence: • Drug and alcohol abuse • Tobacco use • High-risk sexual behaviors • Inadequate physical activity • Poor dietary habits

4. What are School Health Centers? • School‑based health centers, located on school grounds. • School‑linked health centers, located off school grounds close to a school.

5. 59 SHCs across Illinois 47 serve low income districts Data sources: IDHS FY10 SHC Annual Report; ISBE FY10 eReport Card

6. 29 SHCs in Chicago

7. Common CharacteristicsLocated in schools or on school grounds.Work cooperatively within the school to become an integral part of the school.Provide a comprehensive range of services that meet the specific physical and behavioral health needs of the young people in the community.Employ a multidisciplinary team of providers to care for the students: nurse practitioners, registered nurses, physician assistants, social workers, physicians, alcohol and drug counselors, and other health professionals.

8. Provide clinical services through a qualified health provider such as a hospital, health department, community health center or medical practice.Require parents to sign written consents for their children to receive the full scope of services provided at the SBHC.Have an advisory board consisting of community representatives, parents, youth, and family organizations, to provide planning and oversight.

9. Fundamental Principles of SBHC’s:1. Supports the School2. Focuses on the Community3. Focuses on the Student4. Provides comprehensive care5. Advances health promotion activities

10. 6. Implements effective systems7. Provides leadership in adolescent and child health

11. SBHC BenefitsStudent:Provides medical, mental health, dental and health education services.Provides confidential, culturally sensitive and youth friendly services.Promotes health decision-making.Helps students stay in school.

12. SBHC Benefits Parents: Provides services their children need such as mental health, health education and treatment for acute and chronic diseases.Reduces lost work time.Promotes parental engagement in health care.Provides family assistance for benefits enrollment and other supportive services such as state health insurance programs, food stamps and Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

13. SBHC BenefitsSchool: Integrates health and education to address barriers to learning and promote academic success.Collaborates with school personnel to ensure that students are healthy and ready to learn.Participates in the school’s crisis intervention team to provide assistance in times of school crises and community disasters.Promotes health behaviors throughout the school.

14. SBHC Benefits Community:Links the students and families to community resources.Engages the community in health promotion activities.Respects family values and diversity within the community.Involves the community in improving the health of students and families

15. Staffing Recommended SBHC Staffing is: • Medical Director • Nurse Practitioner or Physician Assistant • Clinically-trained Mental Health Practitioner • Health Educator • Medical Receptionist/Other Support Staff

16. The Need for Behavioral Health Services Around 20% of youth present with an emotional/ behavioral disorderAround 10% of youth experience significant impairmentLess than 50% receive adequate or any servicesOver 75% of youth who receive services, receive them in schools

17. SBHC Behavioral Health Services Goal/Approach: Comprehensive, interdisciplinary and integrated Partnership basedFull range of primary and secondary prevention, early intervention, and treatment services

18. SMH Graduation/Drop-out Grades Standardized Test Scores Teacher Retention Health & Mental Health Factors Academic Outcomes Physical Health/illness Mental Health Mental Health Problems High-risk Behaviors (e.g. Substance use ) Developmental issues Social Competence/Self- esteem Family Strengths/ Issues Attendance Behavioral Competencies Behavioral Problems Educational Motivation Positive Attitudes Toward Schoolwork School Connectedness Educational Behaviors Mental Health and Academic Outcomes ADAPTED FROM: Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.

19. SBHC Behavioral Health Staffing Models SBHC hires on-site behavioral health staff.SBHC partners with local behavioral health agency.SBHC partners with school to collaborate with school social workers and other behavioral health staff because of lack of ability to hire on-site SBHC staff.

20. Benefits to Provision of Behavioral Health Services in SBHC’s Access:Reduction in StigmaServices immediately accessible at schoolLow or no cost for services

21. Benefits to Provision of Behavioral Health Services in SBHC’s Efficiency:Access to teachers in child’s lifeAbility to work collaboratively with systemScreening more prevalent when primary care and behavioral health working together in same space

22. Benefits to Provision of Behavioral Health Services in SBHC’s Effectiveness:Services able to be more immediate as providers can work and observe youth in their natural environmentImprove prevention and early intervention efforts in the school by behavioral health staff serving as consultants to school staff

23. Services Available ScreeningAssessmentCase ManagementCrisis InterventionIndividual, Group and Family TherapyTobacco Use CounselingSubstance Abuse CounselingReferralsClassroom InterventionsSkill BuildingConflict Resolution/MediationPsycho-educationMediation Management/AdministrationConsultation

24. Referral Sources Health Center StaffSchool AdministratorsTeachersSelf ReferralParent/FriendCommunity/Legal

25. Interconnected Systems Framework for School Mental Health • Tier I: Universal/Prevention for All • Coordinated Systems, Data, Practices for Promoting Healthy Social • and Emotional Development for ALL Students • School Improvement team gives priority to social and emotional health • Mental Health skill development for students, staff, families and communities • Social Emotional Learning curricula for all students • Safe & caring learning environments • Partnerships between school, home and the community • Decision making framework used to guide and implement best practices that consider unique strengths and challenges of each school community • Tier 2: Early Intervention for Some • Coordinated Systems for Early Detection, Identification, • and Response to Mental Health Concerns • Systems Planning Team identified to coordinate referral process, decision rules and progress monitor impact of intervention • Array of services available • Communication system for staff, families and community • Early identification of students who may be at risk for mental health concerns due to specific risk factors • Skill-building at the individual and groups level as well as support groups • Staff and Family training to support skill development across settings • Tier 3: Intensive Interventions for Few • Individual Student and Family Supports • Systems Planning team coordinates decision rules/referrals for this level of service and progress monitors • Individual team developed to support each student • Individual plans may have array of interventions/services • Plans can range from one to multiple life domains • System in place for each team to monitor student progress Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters.

26. Tier 1-Universal/Prevention for All Coordinated systems for promoting healthy social and emotional developmentSEL curricula for all studentsSafe and Caring EnvironmentsPartnerships with school, home and community

27. SBHC Services: Tier 1-Universal/Prevention for All Classroom EducationClassroom Observation/Teacher SupportStudent Health ClubPeer Health Education Campaigns

28. Tier 2-Early Intervention For Some Early Detection/IdentificationShort Term/Targeted InterventionsSchool Coordination for ReferralsSkill BuildingStaff and Family Training

29. SBHC Services: Tier 2-Early Intervention For Some Pull Out Groups: -Psychoeducational groups -Skill building groupsIndividual Skill BuildingParent Support Groups/Skill Building GroupsSBHC Staff Participation in School Behavioral Teams

30. Tier 3-Intensive Interventions for Few For Greatest Level of NeedIndividual Student and Family SupportsSchool Team Identified to Support StudentIndividual Plan for Interventions

31. SBHC Services: Tier 3-Intensive Interventions for Few Individual, family and group treatmentSubstance Abuse Assessment and TreatmentPsychiatric Evaluation and Medication Monitoring

32. Models of Behavioral Health Work Cognitive Behavioral Therapy (CBT)Trauma-Focused CBTAdolescent Community Reinforcement Approach (A-CRA) for substance using behaviorGroup Work Models:-Think First-Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

33. Problem Areas DepressionTrauma related issuesSubstance AbuseFamily conflictSchool ProblemsPeer ConflictAnxiety

34. Challenges School ScheduleFundingSpaceChange in School AdministrationCrisis work vs. longer term work

35. Funding Private FoundationsState of Illinois FundingMedicaid Billing

36. Questions?

37. For more SBHC information • Illinois Coalition for School Health Centers • 312-491-8161, www.ilmaternal.org, icshc@ilmaternal.org • National Assembly on School-Based Health Care • www.nasbhc.org, info@nasbhc.org • Illinois Department of Human Services, • Victoria Jackson, School Health Consultant, • 217-785-5368, victoria.jackson@illinois.gov

38. Additional Resources Center of School Mental Health http://csmh.umaryland.eduSchool Mental Health Connection www.schoolmentalhealth.orgCenter for Health & Health Care in Schools www.healthinschools.orgUCLA Center for Mental Health in Schools www.smhp.psych.ucla.edu

39. Presenter:Andrea Kuebbeler, LCSWAlternatives, Inc.4730 N. Sheridan Rd.Chicago, IL 60640akuebbeler@alternativesyouth.org773-506-7474