Creating and Sustaining Effective Mental Health Services and Supports in the Educational Setting

1. Creating and Sustaining Effective Mental Health Services and Supports in the Educational Setting

2. Newport-Mesa Unified School District Team • Melissa Hurd: Psychological Services Coordinator • Joy Cleary: LCSW, PPS • Tucker Cannon: LCSW, PPS • Michelle Lepak: Ed.S., NCSP, School Psychologist, Program Specialist, Behavior Specialist • Eby Kent: MS, School Psychologist, Licensed Educational Psychologist, Behavior Specialist, BCBA

3. Yuba City Unified School District Team • Elizabeth Engelken: Director of Student Support; Credentialed School Psychologist, PPS; Advanced Nurtured Heart Trainer • Veronica Coates: Psychological Services Specialist; Credentialed School Psychologist, PPS; Advanced Nurtured Heart Trainer • Ivona Mikesell: Credentialed School Psychologist, PPS; ERMHS Behaviorist; Advanced Nurtured Heart Trainer

4. Presentation Outline • History: How did we get “from there to here”? (Newport-Mesa/Yuba City) • Program Development and Rationale (Yuba City) • RtI: A Three Tiered Approach (Newport-Mesa) • Foundation and Methodology (Yuba City) • Assessment Process (Newport-Mesa) • ERMH Services (Yuba City) • Next Steps (Newport-Mesa/Yuba City)

5. History of Mental Health Supports in California Schools • In 1984, Assembly Bill 3632 outlined and required a partnership between school districts and county mental health agencies to deliver mental health services to students with individualized education programs (IEPs). A subsequent Assembly Bill, 26.5, updated the mandate for students with disabilities.

6. History of Mental Health Supports as a Related Service • In 2011, the California Legislature passed Assembly Bill 114, which repealed the state mandate on special education and county mental health agencies. This action gave school districts the sole ability to decide how mental health services were delivered. Many districts continue to contract with county mental health or other mental health agencies. The term Educationally Related Mental Health Services (ERMHS) refers to those services related to a students educational plan, and developed to address social, emotional and behavioral areas of significant need.

7. A Journey toward ERMHS • Legal Consortiums • Consultation with SELPA leadership and other major stakeholders • Research and observation of model programs • Develop Program Design; Hire Exceptional Staff • Developing a Three Tiered approach to intervention

8. Foundational Approach • Providing a continuum of services which is effective with special populations • Services which are effective with intense students and families • Acknowledging the common underlying belief that we have tried many methodologies with very limited and poor results • Utilizing a strengths based approach as a foundation for all services delivered • Strengths Based Approach • 100% of staff trained in the Nurtured Heart Approach (NHA), utilizing the strategies from classroom to therapy setting

9. Program Development • ERMH staff is composed of specialists within the field of mental health; psychologists, licensed clinicians, clinical aides and behavior specialists • ERMH clinicians and behaviorists become collaborative and integrated members of IEP teams • Creation of a program which serves students across the special education continuum; from prevention to intense intervention

10. Continuum of Services • ERMH Services are Designated Instructional Services for students with disabilities • ERMH Services fall along the continuum of service – different levels of ERMH intervention are delivered, based on student needs

11. Continuum of Services

12. Response to Intervention: A Three Tiered Approach Psychological Support Services Intensive Interventions and Support Early Intervention Universal Intervention

13. Tier I: Universal Intervention • Site level School-Wide Positive Behavior Interventions and Support • School Psychologists implement research-based curriculum for identified at-risk students • Push-in whole classroom intervention • Targeted group intervention • Curriculum-Based (Second Step, Steps to Respect) • Expressive Therapy • Progress Monitoring • Data collection, progress reports, teacher input, attendance, work completion, grades, etc. • Student Study Teams • Tier I Counseling Referral • Please refer to form in folder • Parent Education Training

14. Tier II: Early Intervention • A need for counseling is suspected for a student receiving special education services. • IEP is held to document a referral for School-Based Counseling • Please refer to Tier I or Tier II Counseling form in folder • Case Carrier completes Counseling Referral and submits to the School Psychologist • School Psychologist reviews referral and determines if additional strategies can be implemented or if Counseling Assessment is warranted. • IEP is held to document School Psych’s recommendations • If Counseling Assessment is recommended, Assessment Plan is presented and consent obtained. • School Psychologist completes ERMHS Counseling Assessment to determine if there is an area of need • IEP is held to document Counseling Assessment results/recommendations • Goals proposed in areas of need • Service recommendation provided • Individual Counseling, Group Counseling (includes Social Skills), Parent Education Training • Minimum of 12 weeks offered (individual and group services)

15. Tier II: Early Intervention • Progress Monitoring • Counseling goals are monitored weekly • IEP team reconvenes after 12 weeks and determines continued need/level of Counseling Services based on progress monitoring • Data collection, rating scales (objective and research-based), attendance, work completion, grades, compliance, and team input • IEP team could determine: • Student met Counseling goals and service is discontinued • Student is progressing towards goals and would benefit from continued School-Based Counseling sessions • Student is not making progress and a Clinic-Based Counseling Referral is recommended

16. Tier III: Intensive Interventions and Support • Clinic-Based Services • Individual Counseling • Group Counseling • Targeted Parent Education Counseling and Training • Collateral Family sessions – Push in home support • Non-Public School Placement • Residential Placement • In-State • Out-of-State

17. Length of Intense Services • Initial referrals for assessment and those exiting service are a fluid process • Average length of service is 12-18 months

18. Referral Process • After exhausting site based services, IEP team recommends an ERMHS referral • Preventive mental health services are required prior to referral

19. Referral Requirements • Parent Approval at IEP to make referral • Site based School Psychologist and Case Manager compile a packet of data to present to Psychological Services Specialist • Psychological Services Specialist analyzes referral with Director of Student Support and ERMH team, assigning a clinician or behaviorist to the student • Once referral is approved, assessment plan is presented to parent

20. Assessment Process • Yuba City Assessments • ERMH Clinician provides assessments to student, parents, and school staff including, but not limited to: • Standardized Assessments • Observations • Consultation • Collaborates with School Psychologist and site based team

21. Assessment Process Newport-Mesa Assessments • Educationally-Related Mental Health Services (ERMHS) Assessments • Conducted by School Psychologists • Residential Assessments • Conducted by a Multi-Disciplinary team of mental health professionals

22. Eligibility • A direct link between social-emotional and/or behavioral functioning and a lack of educational progress must be present • Preventive mental health services must have been provided

23. Goals Drive Service Example of Annual Goal: • By (date) Student will utilize at least three appropriate coping strategies (i.e. positive self-talk, reframing negative thoughts, taking pride in his inner wealth etc.) to increase positive self-perception in counseling and/or school settings, in 4 out of 5 times as measured by observations and interviews.

24. Goals Drive Service Example continued with short term objectives: • By (date), when prompted by a Clinician, Student will identify 5 strengths he sees in himself. 4 out of 5 of these strengths must be statements about his inner wealth, not related to academic or intellectual. • By (date) when prompted by a Clinician, Student will identify at least 3 positive strategies on how he is utilizing his strengths of inner wealth (journaling, verbal positive affirmations, visual positive affirmations, positive self-talk, re-framing negative thoughts, resetting) • By (date) Student will be able to identify 10 positive attributes about himself without prompting, as well as identify how he utilizes these strengths to reset back to inner wealth rather than become trapped in misperceptions of how others feel about him, withdrawal, or negative self talk.

25. Services • Individual Counseling • Group Counseling • Parent Counseling • Social Work Services • Psychological Services • Behavior Intervention Services

26. Individual Counseling • Counseling in a 1:1 setting with an ERMH clinician or other qualified individual • No other students are present • Clinician working directly on students individual goals and objectives

27. Group Counseling • Student participates in a group led by an ERMH clinician. • A group of students working on similar social skills • A group centered around 1or 2 students with neurotypical peers • Groups are led by clinicians and often co-facilitated by a school counselor, school psychologist or clinical aide

28. Social Work Services • Consulting/Training staff and/or parents on specific interventions (i.e. Nurtured Heart Approach) • Training 1:1 aides on specific behavioral and social emotional interventions • Infusing/Modeling strengths based approaches within general and special education classrooms • Assisting teams on Behavior and Social Emotional Care Plans • Psychoeducation groups not related to IEP goals but rather to develop a more positive classroom environment

29. Parent Counseling • Providing parent support in a 1:1 or group setting • Modeling Strengths Based communication to parents • Providing support before and after IEP meetings • Psychoeducation

30. Psychological Services • Services Delivered by the Psychological Services Specialist • Consultation with site based teams • Assessment • Parent support • Counseling • In class Interventions • Liaison to Nonpublic and Residential schools

31. Behavioral Intervention Services • Refinement of current Behavioral Support Plan • Data Collection • In Class modeling of interventions in conjunction with Clinical Aide • 1:1 Aide and Teacher training • Consultation to site based teams

32. Other Services Offered to SELPA and Community • Support provided to sites during crisis or emergency situations (threat assessments, crisis management, grief counseling) • Staff Development Presentations for teachers, administrators and support staff (NHA, Anxiety and Trauma, Selective Mutism, Self-Harming Behaviors, Developing BSP’s, Prevention and Early Intervention)

33. Sustaining Effective Services and Positive Results • Identify new staff to train; keep cycle of training fresh • Develop specialists; classroom support providers, clinical staff for therapy, parenting class and support staff, bilingual staff, training teams • Ongoing Learning Lab • Maintain foundational approach as a district and SELPA wide initiative so that it is embedded in board accepted and approved goals

34. Future Goals for Newport-Mesa • Develop a needs assessment to determine priorities and future professional development • Leadership Training • Eliminating Barriers to Learning through the Early Identification of Student Mental Health Issues • District-Wide collaboration in addressing barriers to learning • High-Touch Impact on students district-wide • Build upon current Parent Training component • Parent Academy • Refine school reintegration procedures for students placed on psychiatric holds • Therapeutic placement between SDC ED/ NPS & RTC • Explore Day School options

35. Next Steps & Future Goals for Yuba City • Continue honing the whole child/strengths based model with a continuum of services • Continue providing trainings SELPA wide (parents, families and staff) • Provide ongoing psychoeducation in classroom settings • Focus on ERMH’s contribution to preventive mental health

36. Q & A Burning Questions