Andrea Kuebbeler, LCSWAlternatives, Inc.

IL Children’s Mental Health PartnershipSchool Mental Health Conference

June 27, 2012

Andrea Kuebbeler, LCSWAlternatives, Inc.

akuebbeler@alternativesyouth.org

School Based Health Centers:

A Unique Service System

Overview of School Based Health Center’s (SBHC)

How do they benefit students, parents, school and the community

How are behavioral health services integrated into this model of service in schools

Objectives

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

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.

59 SHCs across Illinois

47 serve low income districts

Data sources: IDHS FY10 SHC Annual Report; ISBE FY10 eReport Card

29 SHCs in Chicago

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.

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.

Fundamental Principles of SBHC’s:1. Supports the School

2. Focuses on the Community

3. Focuses on the Student

4. Provides comprehensive care

5. Advances health promotion activities

6. Implements effective systems

7. Provides leadership in adolescent and child health

SBHC Benefits Student: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.

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).

SBHC Benefits

School: 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.

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

StaffingRecommended SBHC Staffing is:

• Medical Director• Nurse Practitioner or Physician Assistant• Clinically-trained Mental Health Practitioner• Health Educator• Medical Receptionist/Other Support Staff

Around 20% of youth present with an emotional/ behavioral disorder

Around 10% of youth experience significant impairment

Less than 50% receive adequate or any services

Over 75% of youth who receive services, receive them in schools

The Need for Behavioral Health Services

Goal/Approach:

Comprehensive, interdisciplinary and integrated

Partnership based

Full range of primary and secondary prevention, early intervention, and treatment services

SBHC Behavioral Health Services

Health & MentalHealth Factors Academic

Outcomes

EducationalBehaviors

Physical Health/illness Mental HealthMental Health ProblemsHigh-risk Behaviors (e.g. Substance use )Developmental issuesSocial Competence/Self- esteemFamily Strengths/ Issues

Attendance Behavioral Competencies Behavioral Problems Educational Motivation Positive Attitudes Toward Schoolwork School Connectedness

Graduation/Drop-out Grades Standardized Test Scores Teacher Retention

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.

Mental Health and Academic Outcomes

SMH

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.

SBHC Behavioral Health Staffing Models

Access:Reduction in Stigma

Services immediately accessible at school

Low or no cost for services

Benefits to Provision of Behavioral Health Services

in SBHC’s

Efficiency:Access to teachers in child’s life

Ability to work collaboratively with system

Screening more prevalent when primary care and behavioral health working together in same space

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 environment

Improve prevention and early intervention efforts in the school by behavioral health staff serving as consultants to school staff

Benefits to Provision of Behavioral Health Services in SBHC’s

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

Services Available

Health Center Staff

School Administrators

Teachers

Self Referral

Parent/Friend

Community/Legal

Referral Sources

Tier I: Universal/Prevention for AllCoordinated 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 SomeCoordinated 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.

Interconnected Systems Framework for School Mental Health

Coordinated systems for promoting healthy social and emotional development

SEL curricula for all students

Safe and Caring Environments

Partnerships with school, home and community

Tier 1-Universal/Prevention for All

Classroom Education

Classroom Observation/Teacher Support

Student Health Club

Peer Health Education Campaigns

SBHC Services:Tier 1-Universal/Prevention for All

Early Detection/Identification

Short Term/Targeted Interventions

School Coordination for Referrals

Skill Building

Staff and Family Training

Tier 2-Early Intervention For Some

Pull Out Groups:

-Psychoeducational groups -Skill building groups

Individual Skill Building

Parent Support Groups/Skill Building Groups

SBHC Staff Participation in School Behavioral Teams

SBHC Services:Tier 2-Early Intervention For Some

For Greatest Level of Need

Individual Student and Family Supports

School Team Identified to Support Student

Individual Plan for Interventions

Tier 3-Intensive Interventions for Few

Individual, family and group treatment

Substance Abuse Assessment and Treatment

Psychiatric Evaluation and Medication Monitoring

SBHC Services:Tier 3-Intensive Interventions for Few

Cognitive Behavioral Therapy (CBT)

Trauma-Focused CBT

Adolescent Community Reinforcement Approach (A-CRA) for substance using behavior

Group Work Models:-Think First-Cognitive Behavioral Intervention for Trauma in Schools (CBITS)

Models of Behavioral Health Work

Depression

Trauma related issues

Substance Abuse

Family conflict

School Problems

Peer Conflict

Anxiety

Problem Areas

School Schedule

Funding

Space

Change in School Administration

Crisis work vs. longer term work

Challenges

Private Foundations

State of Illinois Funding

Medicaid Billing

Funding

Questions?

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

Center of School Mental Health http://csmh.umaryland.edu

School Mental Health Connection www.schoolmentalhealth.org

Center for Health & Health Care in Schools www.healthinschools.org

UCLA Center for Mental Health in Schools www.smhp.psych.ucla.edu

Additional Resources

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