Transcript Something to Consider…

School Community
Partnership for
Mental Health
Story Session
Sheri Johnson, Medical College of Wisconsin
Paul Florsheim, University of Wisconsin, Milwaukee
Sebastian Ssempijja, Sebastian Family Psychology Practice
Charlie Bauernfeind, Milwaukee Public Schools
Carrie Koss Vallejo, IMPACT Planning Council
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.”
Getting to know our audience
What field do you work in?
1.
Healthcare
50%
50%
45%
2.
3.
Behavioral Health
Education- At a university
4.
Education- K-12
5.
Community Based Org
40%
36%
35%
30%
25%
20%
14%
15%
10%
6.
Community Activist
5%
0%
0%
0%
1
2
3
4
0%
5
6
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.
Partners
Schools in Wisconsin’s
largest district
Community Mental Health
Providers
HMOs
Sebastian Family
Psychology Practice, LLC
CHWs/Research
Assistants
Academic Partners
Funders
Story Session Outline
Chapter
Needs
1: SCPMH – The Early Years
Assessment
Building
the model
Addressing
Chapter
systems barriers
2: SCPMH- The Middle Years
Perspectives
from School Staff,
Community Mental Health Providers,
Researchers & Community Health
Workers
Case
Discussion
Story Session Outline
Chapter
3: SCPMH- Graduation
Treatment
School
Initiation
and Parent Satisfaction
Behavioral
Improvement
Stigma
Chapter
4: SCPMH-Lessons Learned
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)
Milwaukee Public Schools estimated
only5% of STUDENTS GET CARE.
3)
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
Outcome
data
Screening
and
Referral
processes
Need
for
better
Feedback and
coordination
with teachers
Sustainability
Plans
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
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
SBIRT & PBIS
III
II
I
•
•
•
•
Refer selected students
Obtain ROI
Consultation with Guardian
Individual / Family Therapy
• Consultation with Staff
• Classroom
presentations
• 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 bridge for families to schools
and providers
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?
1.
2.
3.
4.
Get a Release of
Information (ROI)
Sign family up for
research
Connect family to
support services
Build an
alliance/trusting
relationship
100%
93%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0%
1
7%
0%
2
3
4
Community Mental Health Agency
Perspective
Reflections
on the process
Administrator
Clinicians
buy in
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
momentum
of and operational
Researcher Perspective
Assessing readiness for research vs.
evaluation
Balancing
Data
rigor and feasibility
collection challenges

Consenting

Gathering data over time from multiple sources
Using
administrative data sources to
measure outcomes
Using
real time data to inform
implementation and sustainability
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
Teacher
report he was bit by a dog
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?
1.
2.
3.
4.
5.
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
1.
2.
True
False
83%
90%
80%
70%
60%
50%
40%
30%
17%
20%
10%
0%
1
2
How important is it that families
who receive therapy participate in
the research?
Please rate 1 (lowest) - 5 (highest)
33%
33%
4
5
20%
7%
7%
1
2
1
2
3
3
4
5
Chapter 3: Graduation
Do we have the data to go forward?
Stages of Implementation
(Perales, Johnson, Barret and Eber)
Focus
Should we
do it
Stage
Description
Exploration/
Adoption
Decision regarding commitment to adopting
the program/practices and supporting
successful implementation.
Installation
Set up infrastructure so that successful
implementation can take place and be
supported. Establish team and data systems,
conduct audit, develop plan.
Initial
Implementation
Try out the practices, work out details, learn
and improve before expanding to other
contexts.
Elaboration
Expand the program/practices to other
locations, individuals, times- adjust from
learning in initial implementation.
Continuous
Improvement/Re
generation
Make it easier, more efficient. Embed within
current practices.
Getting it
right
Making it
better
What did we learn?
Treatment
Initiation Rates
Stigma
Program
School
Satisfaction and Challenges
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
 Lower
Involvement
than desired
 Missed
opportunity for input
 Missed
opportunity for addressing stigma
Stigma
+ In their own words:
 Principal: “If
it went away, we wouldn’t have
institutional knowledge of where to place students,
but then again there’s that therapeutic piece where
you have that connection between somebody that’s
coming in here on a consistent basis, building
relationships with students and providing
strategies and solutions. I’ve seen firsthand where
that’s really effective.”

CHW: “More communication between
the therapist and CHW, on a regular
basis, is a must in order to make sure
that everyone is on the same page as
far as clients and their treatment.”
+ In their own words
 Parent: “I
believe a lot of parents would feel
like they’re all by themselves and they don’t
have any help, cause that’s how I felt for a
long time, like ‘I’m the only one going
through this,’ until you find out there’s other
parents going through what you’re going
through.”
 Provider: “After
the school year was over
clients did not want to come to the office, some
parents did not have time, others did not feel
comfortable driving to the office. So out of 10
cases, just one family followed up with therapy
during the summer.”
Behavioral and Academic
Outcomes – The Plan
Administrative
School Data for all
students referred to SCPMH
Attendance
office
referral
disciplinary
special
action
education status
standardized
test scores
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
4
Alliance Inventory
weeks, 6 months
parent, teacher, student
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)
Wilcoxon signed rank sum test used to test the significance
of two paired samples.
Office Referrals- trend toward
decline for those in therapy
Attendance – going the wrong
direction?
Chapter 4:
Lessons Learned
From the real world
Is SCPMH Community Engaged Research
Increasing Level of Community Involvement, Impact, Trust, and
Communication Flow
Outreach
Consult
Involve
Collaborate
Some Community
Involvement
More Community
Involvement
Better Community
Involvement
Community
Involvement
Communication
flows from one to
the other, to
inform
Communication
flows to the
community and
then back, answer
seeking
Communication
flows both ways,
participatory form
of communication.
Communication flow
is bidirectional
Provides
community with
information.
Entities coexist.
Outcomes:
Optimally,
establishes
communication
channels and
channels for
outreach.
Gets information
or feedback from
the community.
Involves more
participant with
community on
issues.
Entities share
information.
Entities cooperate
with each other.
Outcomes:
Develops
connections.
Outcomes:
visibility of
partnership
established with
increased
cooperation.
Forms partnership
with community on
each aspect of
project from
development to
solution.
Entities form
bidirectional
communication
channels.
Outcomes:
Partnership building,
trust building.
Shared
Leadership
Strong
Bidirectional
Relationship
Final decision
making at
community level.
Entities have
formed strong
partnership
structures.
Outcomes:
Broader health
outcome affecting
broader
community.
Strong
bidirectional trust
built.
*Modified version from International Association for Public Participation Principles of Community Engagement , 2 nd Edition CTSA Consortium
45
Lesson Learned:

How do we engage parents as co-collaborators in
program development, implementation and
evaluation?
CHW/Parent Interactions
400
425
450
350
Verbal Interaction
Project Total
Parent Tips
Contact
Information
2012-2013 School Year
39
48
0
38
38
76
50
9
136
100
150
150
168
200
257
250
286
300
Other
2013-2014 School Year
School Staff Survey Results
*Dichotomized for Satisfied/Not Satisfied
The Exchange Boundary Framework: Understanding the
Evolution of Power within Collaborative Decision-Making
Settings -Watson and Foster-Fishman (2013)
 The
presence of disadvantaged stakeholders at
decision-making tables does not ensure the:

valuing

access

use
 of
their resources
Source: Watson, and Foster-Fishman (2013) The Exchange Boundary Framework: Understanding the Evolution of Power within
Collaborative Decision-Making Settings. Am J Community Psych
49
Critical Processes within the
Exchange Boundary Framework
Stakeholders have
opportunity and capacity to:
• Activate and incorporate
resources into
exchanges
• Value less-advantaged
stakeholder resources
Stakeholders have opportunity
and capacity to engage in
discourse to:
• Increase critical
consciousness of
boundaries around
legitimate exchanges
•
Value expanded boundaries
Watson and Foster-Fishman (2013)
Increased
Resource
Exchange
Expanded
Social
Boundaries
50
Less-advantaged
stakeholders better
able to leverage
dependencies
through resource
exchanges
Increased range of
resources that
less-advantaged
stakeholders can
legitimately
exchange
Increased
power for lessadvantaged
stakeholders to
authentically
influence
decisions
Acknowledgements
 Dena
 Sue
Radtke and staff, MPS
McKenzie, Rogers Memorial Hospital
 Katie
Pritchard and staff, IMPACT Planning Council
 Audrey
 Pippa
Potter, IMPACT Planning Council
Simpson and staff, MCW
 Chelsea
 Sandy
Hamilton, MCW
Bogar, MCW; Vania Trejo, Zoey Schmidt, UWM
 Kevin
O’Brien and staff, Aurora Family Services
 Cathy
Arney and staff, Pathfinders Milwaukee
 Sebastian
 Families
Family Practice staff
and staff at OW Holmes, Hopkins Lloyd,
Wedgewood Park and Audubon.