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10/16/2019 1 Creating a School-based Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based Mental Health Provider, HFM Behavioral Health October 30, 2019 1 Mental Health in Schools Act HR 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) 10/30/19 hfmhealth.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 10/30/19 hfmhealth.org 1 2 3
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Page 1: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

10/16/2019

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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

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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

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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.

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Page 2: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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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

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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

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Page 3: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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Models -Satellite Clinic

-PATH Program (Providing Access to Healing)

-FACE- KIDS (Dane and Rock Counties)

- School Based Mental health (SBMH)

- Central SBMH

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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

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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

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Page 4: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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Beginnings continued… Community Need (Rural vs Manitowoc Public

Schools)

School Personnel reported need Director of Pupil Services, principals, superintendent

HFM mission

Budgeting/Pro Forma

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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

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Washington Jr. High School 12

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Page 5: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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Wilson Jr. High School13

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Lincoln High School14

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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)

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Page 6: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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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)

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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

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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.

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Page 7: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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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

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Stated Needs-Initial

AnxietySchool PhobiaFriend issues

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Actual Needs—In Practice Anxiety

Depression

Cutting

Family Conflict

ODD

Conduct Disorder

Bipolar Disorder

Suicidal Ideation

Eating Disorders

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Page 8: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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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

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Initial concerns or barriers Effectiveness within budget

School Counselor Ethics

Boundaries

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Safety School Emergency Binder

Exits

How does that school notify of danger?

Check in process

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Page 9: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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Building RelationshipsLearning the lingoMeeting Teachers Talking to Classes Getting invited to IEP meetings (now

able to bill through Medicaid)Press Releases

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Challenges - Clarifying Roles

-Advertising

- Funding

-Confidentiality

-Coordinating with parents

- Obtaining outside services

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Joys Coordination

Scheduling

Take off waiting lists

Drop in Visits

Influencing Procedures

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Page 10: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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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

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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”

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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

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Page 11: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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Your Turn!

Small groups of 4-6 people

Consider issues and outline how you might build your program

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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?

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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?

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Page 12: Creating a School-based Mental Health Program...Mental Health Program Brian Boomgarden, LCSW, SAC Manager, Holy Family Memorial Behavioral Health Rachel Fruin, LPC, SAC School-based

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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

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Thank you!Questions?

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