Andrea Kuebbeler, LCSWAlternatives, Inc.
IL Children’s Mental Health PartnershipSchool Mental Health Conference
June 27, 2012
Andrea Kuebbeler, LCSWAlternatives, Inc.
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, [email protected]
• National Assembly on School-Based Health Care• www.nasbhc.org, [email protected]
• Illinois Department of Human Services, • Victoria Jackson, School Health Consultant, • 217-785-5368, [email protected]
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 [email protected]
