& Collective Impact: Implementing SBIRT at Wellness Centers in - - PowerPoint PPT Presentation

Integration, Leverage & Collective Impact:

Implementing SBIRT at Wellness Centers in LAUSD

Monday, January 28th, 2019 The L.A. Trust for Children’s Health

WELCOME!!

MA

Maryjane Puffer BSN, MPA

Executive Director The L.A. Trust MA MA

Robert Renteria

Program Manager The L.A. Trust

Karla Debray

Administrative Office Assistant & Former Fremont SAB member The L.A. Trust

Session Objectives

Participants will learn:

• 1. Describe The L.A. Trust and the Wellness Network at LAUSD
• 1. Explain the components of SBIRT and why the SBHCs are

uniquely positioned to provide SBIRT

• 1. Discuss the environmental scan and the lessons learned for

best practices moving forward

The L.A. Trust

• Founded in 1991 to support and

develop Los Angeles Unified School District School Health programs

• Mission: to improve student health

and increase readiness to learn through increased access to health care, school policy advocacy and effective programs

Los Angeles Unified School District

74.9% 8.5% 9.9% 6.1% 0.4% 0.2% Latino African American White Asian Pacific Islander

540,000 students

Why School Based Health Care?

• School is where the kids are
• Disparities have not shifted ….we

have to do something differently

• LOTS OF RESEARCH:
• Significant increase in

attendance for SBHC users compared to non users

• GPA increases overtime for

students using mental health services

• Burns, et al, Journal of Adolescent Health (2009) 1-7

Why School Based Health Care?

Immunization

• 2015-2016 school year marked the highest rate

(97%) of 7th grade students meeting the pertussis (Tdap) booster requirement. The higher rate of compliance means there were more students enrolled and ready to learn and fewer students being excluded from school. Mental Health

• During the 2014-2015 school year, 1,535 students

were screened for trauma at 53 schools including at Wellness Centers. Of the screened students, 284 received Cognitive Behavioral Intervention for Trauma in Schools (CBITS) group intervention. These students reported an average 33% reduction in Post Traumatic Stress.

Health Disparities

 Health disparities mapped in 2006-07 (“Health Hot Spots”)  Guided investment in Wellness Centers 2009  Re-mapped health and educational indicators in 2013-14

(“Health Need Index”)

 Guided LAUSD investment for Wellness Phase 2  Now working on remapping with DPH for Wellness Phase 3

CHLAMYDIA RATES/CASES 2006 VS. 2012

MJ

TEEN BIRTH RATES 2006 VS. 2012

MJ

BODY COMP FAILURE RATE 2007 VS. 2014

MJ

LAUSD WELLNESS CENTER VS. NEEDS

Crenshaw, Fremont, Jefferson, Manual Arts & Washington Prep HS

Educational focus and funding has shifted based on the Local Control Funding Formula (LCFF)…

• Method schools districts receive

state funding to provide education

• Provides extra support to students

with greater needs:

• Low Income
• English Learners
• Foster Youth
• This means more support through

the schools for the most needy student populations

THE EDUCATIONAL GAP MIRRORS HEALTH DISPARITIES

WHAT IS S.B.I.R.T.?

• Screening a population to identify individuals

who are using substances in a risky or unhealthy way

• Brief Intervention to change behaviors and

attitudes of individuals who are putting their health at risk with substance use. – Sometimes this is one intervention, sometimes a few sessions

• Referral to Treatment for individuals who require

specialty care (behavioral, pharmacological treatments)

A Populat lation ion Appro roach ach to Preve vent ntion/E ion/Early arly Interventio tervention

WHY S.B.I.R.T. AT WELLNESS CENTERS?

• 21.5% of tenth graders and 35.3% of twelfth graders

report past-month alcohol use

• 16.5% of tenth graders and 23.5% of twelve graders

report past-month drug use

• Schools are major source of behavioral health care for

many students – 21 times more likely to visit a school-based health center for behavioral health than a community- based health center

• Visits to treat negative impacts of substance use (injuries,

infections) a “teachable moment”

NIDA 2016, Weinstein 2006

W.A.S.U.P.

Wellness and Substance Use Prevention Project (WASUP)

• Collaborating with 4 Los

Angeles Unified School District high school campuses and their respective Wellness Centers to support substance use prevention activities

W.A.S.U.P.

The Project

• Works with youth, teachers,

parents, and Wellness Center staff at Fremont, Jefferson, Manual Arts and Washington Prep high schools

• Supports integration of substance

use prevention activities, including the incorporation of the Screening, Brief Intervention and Referral to Treatment (SBIRT) evidence-based practice into Wellness Center medical care services

W.A.S.U.P.

Environmental Scans

Needs assessments conducted to understand the culture and decision- making structure at each school

• Identify key staff at the four

Wellness Centers, school campuses, and student leaders to help promote a culture of wellness

• Identify campus-specific

barriers that may impede implementation

W.A.S.U.P.

Environmental Scans

Key: Organizational Facilitator (OF), School Principal, Wellness Center - Clinic Manager (CM)

• 1. School Assets
• 2. School Challenges
• 3. Parental Involvement
• 4. Outside Agency Partners/ Groups
• n Campus
• 5. Substance Use on Campus
• 6. Substance Use Policy
• 7. Suggestions for Addressing

Substance Use among Students

• 8. Perceptions of Wellness Center
• 9. Referrals to Wellness Center
• 10. Wellness Center Student Intake

and Assessment Process

• 11. Additional Wellness Center

Information

• 12. Obstacles to Wellness Center Use
• 13. Mental Health Provider Information
• 14. Trusted Staff/Faculty
• 15. Who we should talk to
• 16. Other Suggestions
• 17. Additional Information Needed

W.A.S.U.P.

Building Partnerships

Lessons we learned:

• Identifying partnerships

○ Patience (who, when) ○ Building trust ○ Personal/Tailored approach

• Integrating holistic approach to

substance use prevention conversation ○ Being practical ○ “Real” ○ Having conversations

W.A.S.U.P.

Screening

Providers at all 4 sites were certified to conduct S.B.I.R.T. as substance use screening and referrals

• early intervention services

support an academic mission as part of comprehensive health care

• S.B.I.R.T screening is “upstream”

and strengthens youth health and wellness through education, prevention and early intervention

W.A.S.U.P.

Capturing data

• S.B.I.R.T. clinic flow

○ Screening ○ + prompts substance use re-screening by provider ○ Positive re-screening prompts BI (motivational interviewing) ○ RT is internal to mental health ○ Mental Health refers to external partners

W.A.S.U.P.

Capturing data

• Fremont WC developed data

points in their EMR (Electronic Medical Record) to capture and extract S.B.I.R.T. information S.B.I.R.T. EMR template S.B.I.R.T. EMR Smart Form

BLUEPRINT FOR WELLNESS POLICY

Determinants of Health

Risk and Protective Factors

POSITIVE YOUTH DEVELOPMENT

RR

STUDENT ENGAGEMENT

http://thelatrust.org/student-engagement/

CHLA SYPP 2013

Youth Campaigns

Youth 2 Youth conference

W.A.S.U.P?

Where we are now:

Now in year two, with a better understanding of school culture at each site, project staff have formed stronger connections with students, school administration and Wellness Center staff. We are moving to further educate parents on cannabis policy and introduce them to local community partners for the opportunity to advocate for their communities.

W.A.S.U.P?

Challenges:

• Schools and clinics have

experienced high turnover of key staff

• Substance use discipline policy at

schools is still unclear to teachers and students

• Communication between schools

and Wellness Centers is not consistent

Highlights:

Student leaders are engaging with peers through substance use prevention activities SBIRT is being conducted at all 4 sites and WASUP staff is collecting data including referrals Engaging with CA state, local, and school district partners to address new cannabis laws which have commenced in 2018

W.A.S.U.P?

Other issues:

• Suspension is off the table, but

therapeutic culture is still not recognized as best practice

• LASPD still requested and

involved when substances are present

• Culturally sensitive substance use

services are not easily accessible where most needed

W.A.S.U.P?

Next steps:

• 5th site (Crenshaw HS) to

implement best practices and sharpen our toolbox

• Provide Professional Development

with parents and school staff around substance use prevention and focus on cultural competency for adolescents

• Working to integrate Best

Practices and lessons learned into school district and local policy

Questions?

Contact: Maryjane@thelatrust.org Robert@thelatrust.org Thank you!