School Community Partnership for Mental HealthAn MPS School Based “Mental Fitness” Program

Charlie Bauernfeind, Milwaukee Public SchoolsSheri Johnson, Medical College of WisconsinCarrie Koss Vallejo, IMPACT Planning CouncilSebastian 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.”

Getting to know our audienceWhat field do you work in?

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10%

5% 5%

38%

14%

5%

24%

0%

5%

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40%1. Mental health provider2. Education- At a university3. Education- K-12 (Admin)4. Education – K-12 (SSW)5. Education – K-12 (School Psy)6. School Nurses7. Other

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.

PartnersResearch Assistants/

Community Health Workers

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 OutlineChapter 1: SCPMH – The Early YearsNeeds AssessmentBuilding the model Addressing systems barriers

Chapter 2: SCPMH- The Middle YearsPerspectives from School Staff, Researchers, Community Health Workers & Therapists

Case Discussion

Story Session Outline

Chapter 3: SCPMH- GraduationTreatment InitiationSchool and Parent SatisfactionBehavioral ImprovementStigma

Chapter 4: SCPMH-Lessons LearnedOutcomes

Chapter 1 –The Early YearsNeeds 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 only-

5% 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)

Need for better

Screening and

Referral processes

Outcome data

Relationships between

schools and community providers

Engagement with Parents

and Caregivers

Incorporation of evidence

based practices

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

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

II

I

III

• Refer selected students• Obtain ROI• Consultation with Guardian• Individual / Family Therapy

• Consultation with Staff• Classroom

presentations

• School embedding activities

SBIRT & PBIS3 Levels of Support System

SCPMH Community CoordinatorThe 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 CoordinatorThe 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 processSchool 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?

12

34

11%

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84%

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90%

1. Get a Release of Information (ROI)

2. Sign family up for research

3. Connect family to support services

4. Build an alliance/trusting relationship

Community Mental Health Agency Perspective

Reflections on the processAdministrator buy inClinicians who had the “right fit”Provider/Client Alliance

Community Mental Health Agency Perspective

Implementation experiences and deliverablesCulture shiftAgency utilizationFeedback and ongoing assessment

Standardization of and operational momentum

Case Study DiscussionPhoto 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 studentClassmates report he was bit by a dog

Teacher notes grades starting to slipSSW engages student, provides social emotional support

Student develops attendance issuesSSW 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. Teachers are resistant

2. School administrators won’t allow it

3. Community providers aren’t interested

4. Parents are not invested

5. There is no good source of funding

Evidence Based Therapy is overrated and hard to implement in real world settings1. True 2. 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: GraduationDo we have the data to go forward?

Stages of Implementation (Perales, Johnson, Barret and Eber)

Focus 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/Regeneration

Make it easier, more efficient. Embed within current practices.

Getting it right

Making it better

Should we do it

What have we learned?Treatment Initiation RatesStigmaProgram Satisfaction and ChallengesSchool Staff ParentsMental Health Providers and Community Health Workers

Behavioral Improvement

Treatment Initiation

Perceptions of Stigma among School Staff and Parents

Program EvaluationOpen 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 kidsConvenient for parentsSmart/Efficient for everyone

PartnershipNovelHelpfulNeeded

OutcomesBehavior change

Overarching Themes - NegativeLogistics

ConsentCommunicationCapacityCoordination

Parent InvolvementLower 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 monthsparent, teacher, student

Revised Working Alliance Inventory 4 weeks, 6 monthsparent, teacher, student

+Behavioral Outcomes

1) Office Referrals:

Significant difference between pre/post intervention (p=.03)

2) Disciplinary Action Taken:

Significant difference between pre/post (p=.0065)

1) Office Referrals:

Significant difference between pre/post intervention (p=0.014)

2) Disciplinary Action Taken:

Significant difference between pre/post (p=0.003)

2011-2012 Cohort 2012-2013 Cohort

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 stable2011-2012 School Year

Chapter 4: Lessons LearnedFrom 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.