Transcript School Community Partnership for Mental Health
S
chool
C
ommunity
P
artnership for
M
ental
H
ealth
An MPS School Based “Mental Fitness” Program
Charlie Bauernfeind, Milwaukee Public Schools Sheri Johnson, Medical College of Wisconsin Carrie Koss Vallejo, IMPACT Planning Council Sebastian Ssempijja, Sebastian Family Psychology Practice
Using the Clickers
Each of you has a “clicker” that will allow you to respond to questions during the presentation, and we’ll be able to see the responses.
Please use the pad of your finger to press buttons –not your fingernail.
You can change your answer, but only your last response will “count.”
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Getting to know our audience What field do you work in?
Mental health provider Education- At a university Education- K-12 (Admin) Education – K-12 (SSW)
40% 35% 30% 25%
Education – K-12 (School Psy)
20%
School Nurses
15%
Other
10% 10% 38% 14% 5% 5% 5% 5% 0% 1 2 3 4 5 6 7 24%
SCPMH Goal Statement
The goal of the School Community Partnership for Mental Health is to: refine and demonstrate the effectiveness of a collaborative partnership model of mental health promotion and service to influence systems changes needed for sustainability.
Research Assistants/ Community Health Workers Partners Community Mental Health Providers HMOs Sebastian Family Psychology Practice, LLC Schools in WI’s largest district and a Head Start provider Academic Partners Funders
Story Session Outline
Chapter 1: SCPMH – The Early Years Needs Assessment Building the model Addressing systems barriers Chapter 2: SCPMH- The Middle Years Perspectives from School Staff, Researchers, Community Health Workers & Therapists Case Discussion
Story Session Outline
Chapter 3: SCPMH- Graduation Treatment Initiation School and Parent Satisfaction Behavioral Improvement Stigma Chapter 4: SCPMH-Lessons Learned Outcomes
Chapter 1 –The Early Years Needs Assessment, Model Building, Barrier Busting Photo from City of Milwaukee’s I want a strong baby public health campaign
The Early Years
(
2005-2009)
1) National Family Week Partnership study (2005) of mental health services for youth in Milwaukee –
ACCESS IS PROBLEMATIC.
2) 3) Milwaukee Public Schools estimated only 5% of STUDENTS GET CARE.
Youth Mental Health Connections,
COMMITS TO ACTION.
Connecting Need and Capacity: A Study of Mental Health Services for Youth in Milwaukee County Lengyel et al 2005
The Early Years (2008-2009)
Relationships between schools and community providers Incorporation of evidence based practices Engagement with Parents and Caregivers Feedback and coordination with teachers Outcome data Sustainability Plans Screening and Referral processes
Need for better
Early intervention
The Middle Years: Pilot strategies Views from School Staff, Community Mental Health Providers, Researchers and Community Health Workers Case Discussion
The Middle Years: 2009-2013
Three community-based agencies providing part time consultation and direct services in collaboration with four Milwaukee Public Schools Project coordinator working with Leadership Team to oversee implementation Public Health researchers developing and testing a process for outcomes research incorporating Community Health Workers Operations manual and referral system being developed to support expansion
3 Levels of Support System
III II
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SBIRT & PBIS
Refer selected students Obtain ROI Consultation with Guardian Individual / Family Therapy • • Consultation with Staff Classroom presentations
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• School embedding activities
SCPMH Community Coordinator
The coordinator is the “go-to” person for the participating community mental health agencies The coordinator assures that the community partners understand and comply with their roles The coordinator works with insurance providers, community health workers, government agencies, and university researchers to enhance collaborative efforts
SCPMH School Coordinator
The coordinator is the “go-to” person for schools Coordinates school events and communications Assures record keeping and data collection Addresses problems at schools Assures compliance with SCPMH policies and procedures
School Staff Perspective
Mental Health is taboo → Mental Fitness Overcoming “union” issues Need full-time support services staff to triage Building Bridges to schools takes time The Building Principal The Pupil Services Support Staff The Classroom Teacher Building trust is a slow process School calendar and attendance are issues
COMMUNITY HEALTH WORKER ROLE Bridge Building
Assist with delivery and completion of initial paperwork by parents- ROIs, research consents and data Conduct “check-ins” with providers and teachers Assure two-way communication with families Provide links to broad range of resources – school social worker and others Participate in school’s family events and staff meetings Provide a cultural/linguistic bridge for families to schools and providers
CHW/Parent Interactions at School Events
Community Health Worker (CHW) Perspective
New role Research assistant Varied responsibilities: Making home visits Sharing info with therapist and school Finding additional services for clients
What is the first priority for a CHW when meeting a family?
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Get a Release of Information (ROI) Sign family up for research Connect family to support services Build an alliance/trusting relationship
90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 11% 2 0% 3 5% 4 84%
Community Mental Health Agency Perspective
Reflections on the process
Administrator buy in Clinicians who had the “right fit” Provider/Client Alliance
Community Mental Health Agency Perspective
Implementation experiences and deliverables
Culture shift Agency utilization Feedback and ongoing assessment Standardization of and operational momentum
Case Study Discussion Photo credit: MCW Annual Report – SCPMH staff from Medical College of Wisconsin, Milwaukee Publics Schools, IMPACT Planning Council and Sebastian Family Psychology Practice.
How should SCPMH intervene?
12 year old male student Classmates report he was bit by a dog Teacher notes grades starting to slip SSW engages student, provides social emotional support Student develops attendance issues SSW discovers student and mother were victims of random gunfire Student detaches from friends
What are the major obstacles to school based mental health services?
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Teachers are resistant School administrators won’t allow it Community providers aren’t interested Parents are not invested There is no good source of funding
Evidence Based Therapy is overrated and hard to implement in real world settings
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True False
How important is it that families who receive therapy participate in the research? Please rate 1 (lowest) - 5 (highest) 1 2 3 4 5
Chapter 3: Graduation Do we have the data to go forward?
Stages of Implementation
(Perales, Johnson, Barret and Eber) Focus Stage Description
Should we do it Exploration/ Adoption Decision regarding commitment to adopting the program/practices and supporting successful implementation.
Getting it right Making it better Installation Initial Implementation Elaboration Continuous Improvement/Re generation Set up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct audit, develop plan.
Try out the practices, work out details, learn and improve before expanding to other contexts.
Expand the program/practices to other locations, individuals, times- adjust from learning in initial implementation.
Make it easier, more efficient. Embed within current practices.
What have we learned?
Treatment Initiation Rates Stigma Program Satisfaction and Challenges School Staff Parents Mental Health Providers and Community Health Workers Behavioral Improvement
Treatment Initiation
Perceptions of Stigma among School Staff and Parents
Program Evaluation
Open ended interviews with parents of students enrolled in treatment (N=6) Open ended interviews with principals from 4 schools (N=4; 100% response) Closed ended survey data from staff at 4 schools (N=171; 69% response rate) Open ended survey data from community mental health providers and community health workers (N=9; 100% response rate)
Overarching Themes - Positive
Access Safe environment for kids Convenient for parents Smart/Efficient for everyone Partnership Novel Helpful Needed Outcomes Behavior change
Overarching Themes - Negative
Logistics Consent Communication Capacity Coordination Parent Involvement Lower than desired Missed opportunity for input Missed opportunity for addressing stigma Stigma
Behavioral and Academic Outcomes-The Plan
For those who consented to research: Strengths and Difficulties Questionnaire baseline, 3 months, 6 months parent, teacher, student Revised Working Alliance Inventory 4 weeks, 6 months parent, teacher, student
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Behavioral Outcomes
2011-2012 Cohort
1) Office Referrals: Significant difference between pre/post intervention (p=.03) 2) Disciplinary Action Taken: Significant difference between pre/post (p=.0065)
2012-2013 Cohort
1) Office Referrals: Significant difference between pre/post intervention (p=0.014) 2) Disciplinary Action Taken: Significant difference between pre/post (p=0.003) Wilcoxon signed rank sum test used to test the significance of two paired samples.
Office Referrals- trends toward decline for those in therapy 2011-2012 School Year
Attendance – remained stable
2011-2012 School Year
Chapter 4: Lessons Learned From the real world
Lesson Learned:
How do we implement best practices to engage parents?
School Staff Survey Results
*Dichotomized for Satisfied/Not Satisfied
Good News!
MPS and partners expanding to a total of 8 schools in September 2014, including an MPS Charter School and a Head Start K5 school MCW Department of Behavioral Medicine and Psychiatry providing evidence-based intervention consultation in 2014-15 school year Project Prevent grant to MPS awarded in September 2014, expanding to 11 additional schools in 2015 and 2016 school years
Acknowledgements
Dena Radtke and staff, MPS Sue McKenzie, Rogers Memorial Hospital Katie Pritchard and staff, IMPACT Planning Council Audrey Potter, IMPACT Planning Council Pippa Simpson and staff, MCW Chelsea Hamilton, MCW Sandy Bogar, MCW ; Vania Trejo, Zoey Schmidt, UWM Kevin O’Brien and staff, Aurora Family Services Cathy Arney and staff, Pathfinders Milwaukee Sebastian Family Practice staff Families and staff at OW Holmes, Hopkins Lloyd, Wedgewood Park and Audubon.