creating a school-based mental health program...mental health program brian boomgarden, lcsw, sac...
TRANSCRIPT
10/16/2019
1
Creating a School-based Mental Health Program
Brian Boomgarden, LCSW, SACManager, Holy Family Memorial Behavioral Health
Rachel Fruin, LPC, SACSchool-based Mental Health Provider, HFM Behavioral Health
October 30, 2019
1
Mental Health in Schools ActHR 2913 (2017)
- Project AWARE- includes staff and community training to foster trauma informed, intervention-focused schools
-Revised cooperative agreement with schools and mental health providers
- Must assist students dealing with trauma and violence
- This is a grant process that will pay for the training of staff and communities, but not the direct services.
- Facility needs to find a way to make this continue to be sustainable after the grant stops (after 5 years)
10/30/19hfmhealth.org
2
School Mental Health Services: A continuum of supports for school-age children that are integrated throughout the school community: Universal strategies to promote the social and emotional well-
being and development of all students;
Selected, brief strategies to support students at risk of or with mild mental health challenges
Intensive, ongoing strategies to support those with significant needs, including a streamlined referral process with community mental health providers to create a seamless service delivery model for children, adolescents, and their families.
3
10/30/19hfmhealth.org
1
2
3
10/16/2019
2
DPI Foundations- Interconnected programs focused on school, families, and communities working together
1. Strong Universal Implementation
2. Integrated Leadership Teams
3. Youth-Family-School-Community Collaboration at all Levels
4. Culturally Responsive Evidence Based Practices
5. Data-Based Continuous Improvement
4
10/30/19hfmhealth.org
DPI Foundation- Interconnected programs focused on school, families, and communities working together
6. Positive School Culture & Climate
7. Staff Mental Health Attitudes, Competencies & Wellness
8. Systemic Professional Development & Implementation
9. Confidentiality & Mental Health Promotion Policies
10. Continuum of Supports
5
10/30/19hfmhealth.org
6
10/30/19hfmhealth.org
4
5
6
10/16/2019
3
Models -Satellite Clinic
-PATH Program (Providing Access to Healing)
-FACE- KIDS (Dane and Rock Counties)
- School Based Mental health (SBMH)
- Central SBMH
7
10/30/19hfmhealth.org
Manitowoc and Psych Needs
Population: 32,697; 79,175 in the county
School aged: 6,500
Number of Schools: 11 schools total
2017 average income: $45,767
Number of MH Hospitals- 0
Residential AODA Programs-2
Eating Disorder Treatment- no specialists
Manitowoc County
10/30/19hfmhealth.org
8
Our Beginnings… Charter School (Relationship with school personnel)
2009 WI Act 28
Bay Area Mental Health Center-Washburn, WI
2014
Rep. Czaja (Child Victims Act), Rep. Tittl (Mental Health), WI Hospital Association, NASW-WI
August 2015
2015 WI Act 294, Introduced in Assembly 1/8/16 and published 3/31/16
9
10/30/19hfmhealth.org
7
8
9
10/16/2019
4
Beginnings continued… Community Need (Rural vs Manitowoc Public
Schools)
School Personnel reported need Director of Pupil Services, principals, superintendent
HFM mission
Budgeting/Pro Forma
10
10/30/19hfmhealth.org
The Plan… Pro Forma included:
Fixed costs
Clinic overhead expenses-part of main clinic budget
Salary
Stipend based on anticipated revenue
School provides space
Productivity same as other therapists
40 hours/week at clinic when not at school Clinic vs School hours
11
10/30/19hfmhealth.org
Washington Jr. High School 12
10/30/19hfmhealth.org
10
11
12
10/16/2019
5
Wilson Jr. High School13
10/30/19hfmhealth.org
Lincoln High School14
10/30/19hfmhealth.org
Contract Considerations Payer source (some do commercial payers only)
Clients’ needs/referrals (others stipulate based on severity)
Access to prescriber (previous MOU with other provider)
Willing to see clients at clinic during holidays
School access by therapist
Conform with school policies (fire drills, etc)
15
10/30/19hfmhealth.org
13
14
15
10/16/2019
6
More Contract Considerations WiFi to be provided by school
Space considerations (confidentiality)
Availability to students
Reasonable wear and tear, no subleasing
30 day notice to move location in school due to ed needs
Joint Commission access
Communication to parents—including we are not school agents
Contract length, escape clauses (120 days w/o penalty), time in school per week/per year (36 weeks)
16
10/30/19hfmhealth.org
Our Model -Therapist time split between school and office
clients
-Main office number given to maintain messages and client needs
- Office at each school is removed from the main school office
-Releases are signed to allow for communication between school and HFM
-Emails encrypted and HIPPA compliant communication used
17
10/30/19hfmhealth.org
STAR-QI What is it? (Strengthening Treatment Access and Retention-
Quality Initiative)
Use for School-Based services
Plan-Do-Study-Act
Walk through
Promotion of service
Referrals
Parental involvement
Coaching
Join STAR-QI to develop and improve your service.
18
10/30/19hfmhealth.org
16
17
18
10/16/2019
7
Referrals School Counselors and Principals initiate referral and
are “gate keepers”
Limited essential paperwork sent home- ROI, Consent, ERC, Background info
Intake Coordinator makes initial contact to set up intake
Parent questionnaire sent home if parent unable to attend
19
10/30/19hfmhealth.org
Stated Needs-Initial
AnxietySchool PhobiaFriend issues
20
10/30/19hfmhealth.org
Actual Needs—In Practice Anxiety
Depression
Cutting
Family Conflict
ODD
Conduct Disorder
Bipolar Disorder
Suicidal Ideation
Eating Disorders
21
10/30/19hfmhealth.org
19
20
21
10/16/2019
8
Program Evaluation1. Beginner-demographics, number of office
referrals, symptom management, diagnoses2. Intermediate- collect academic and
psychosocial data to begin to analyze outcomes
3. Advanced- Long term outcomes; compare those getting services to those not; discover factors which lead to success
22
10/30/19hfmhealth.org
Initial concerns or barriers Effectiveness within budget
School Counselor Ethics
Boundaries
23
10/30/19hfmhealth.org
Safety School Emergency Binder
Exits
How does that school notify of danger?
Check in process
24
10/30/19hfmhealth.org
22
23
24
10/16/2019
9
Building RelationshipsLearning the lingoMeeting Teachers Talking to Classes Getting invited to IEP meetings (now
able to bill through Medicaid)Press Releases
25
10/30/19hfmhealth.org
Challenges - Clarifying Roles
-Advertising
- Funding
-Confidentiality
-Coordinating with parents
- Obtaining outside services
26
10/30/19hfmhealth.org
Joys Coordination
Scheduling
Take off waiting lists
Drop in Visits
Influencing Procedures
27
hfmhealth.org
25
26
27
10/16/2019
10
Initial Stats 3 weeks before getting a case load
Average 9 students per week with a goal of 15 (holidays/snow days/end of school)
25 students serviced in our first year
52 % of students are on state insurance. Many of these had been facing waiting lists of 1-2 years for services
28
10/30/19hfmhealth.org
Feedback Student at one of the middle schools reported telling
her friends, “Rachel is awesome”
Students will from time to time bring in their friends and introduce them to me
Parents enjoy the piece of mind that their student will be seen with little work on their part
“My child has been happier and doing better at home when she sees you”
29
10/30/19hfmhealth.org
Changes for this School Year -Changing the days of the week I am in schools
-Limiting office hours before school vacations
- Added new site on to continue services
- New ways to obtain feedback
- After-school teacher training/Increasing these relationships
30
10/30/19hfmhealth.org
28
29
30
10/16/2019
11
Your Turn!
Small groups of 4-6 people
Consider issues and outline how you might build your program
31
10/30/19hfmhealth.org
Questions to consider Who are your school connections?
Choose population most in need (ie, which schools to put them in)
Identify community resources/needs
Budgeting, billing, insurances, stipend (provide in-service?)
Developing a contract…use attorney?
Space allocation
Staffing- hire or use current? Licensed or In-Training?
Part-time? How do you allocate time if full-time? Reimbursement model for school-based therapist.
Licensure of site
How many days per week?
32
10/30/19hfmhealth.org
Your Thoughts? What do you think will be the most difficult aspect?
What will be the easiest?
What unique situation or problem may exist for you?
How long might it take for you to begin your program?
Other points you would like to share?
33
10/31/19hfmhealth.org
31
32
33
10/16/2019
12
Resources Youth.gov
Dept of Public Instruction- dpi.wi.gov
History of School Based Mental Health Services in the United States by Lois T Flaherty and David Osher.
Mental Health in Schools Act HR2913
University of Wisconsin START-QI Program-coaching calls and assistance
https://www.ernweb.com/educational-research-articles/successful-school-based-mental-health-program/
Healthysafechildren.org
Miami University Center for School Based Mental Health Programs Oxford, OH
34
hfmhealth.org
Thank you!Questions?
35
34
35