Mental Health Systems (CSMHS) John Crocker, Director of School - - PowerPoint PPT Presentation

Comprehensive School Mental Health Systems (CSMHS)

John Crocker, Director of School Mental Health & Behavioral Services Methuen Public Schools

Activity: What Are You Seeing?

Please discuss the following questions in pairs or small groups and be prepared to report out:

• 1. How often and in what ways do problems related to mental health and

trauma impact your work with students?

• 2. What have you noticed regarding the impact of mental illness and

trauma on academic growth and achievement?

• 3. How prepared are staff to support students who are experiencing

mental illness and trauma in the classroom?

Prevalence of Mental Illness

• 20% of students will experience a mental

health problem of mild impairment.

• 10% of students will experience a mental

health problem of severe impairment. “Half of all lifetime cases begin by age 14; three quarters have begun by age 24. Thus, mental disorders are really the chronic diseases of the young.”

• National Institute of Mental Health

3

Depression is impacting students at an increasing rate, yet...

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health, 2010–2011 to 2013–2014.

… ≈50% do not receive treatment.

Costs of Failing to Provide Mental Health Services

• Poor academic performance
• Increased rate of crisis
• Decreased rate of attendance
• Increased behavioral concerns,

potentially leading to suspension, expulsion, or juvenile justice

• Increased rate of substance use
• Increased rate of incarceration
• Increased healthcare costs
• Decreased productivity for all school

staff

6

• Students whose

scores on the SDQ were in the Very High and High range had a GPA that was, on average, 13 percent lower than all other students.

• Students were also

absent 45 percent more often if they scored in the Very High or High range

• n the SDQ.

7

Connecting Psychosocial Functioning to Academic Outcomes

• Students who scored in the moderate to severe

range for depression are absent 47% more often than the average.

• GPA is consistently lower for high school students

who scored in the moderate to severe range on

• ne or more measures.
• This is particularly concerning because of those

students screened, 16-18.5 percent of students scored in the moderate to severe range for depression or anxiety.

• This is not a small-scale issue isolated to a select

population.

8

Resolving Long-standing Misconceptions

Traditional views of school mental health center around the following misconceptions:

• Making referrals to community-based mental health agencies will

resolve the mental health problems faced by students and is the extent to which schools need to worry about mental health. (Refer and hope)

• School mental health staff are not the primary service providers for

students who require mental health services.

• Even if we wanted to address mental health in schools, school mental

health staff are not trained to administer therapeutic services to students.

9

The Changing Role of School Mental Health Staff

• The traditional role of guidance counselors has lived on

in schools and fueled a misconception that lives on in the general public.

• Training programs have been preparing school

counselors and school psychologists to administer a full range of mental health services for years, however this fact is not universally accepted.

• Nationally, many school districts have maintained a

traditional view of guidance counseling.

• The situation is made more complex by the fact that

large disparities exist in the training among professionals in the field.

10

The Question of Community-Based Mental Health

• How have mental health problems traditionally

been managed in schools?

• How likely is it that community-based mental

health service providers can adequately address the mental health needs of students?

• What does the national data tell us about

community-based mental health for students?

• Why should schools be the primary source of

mental health services for students?

11

Overcoming Barriers to Community Mental Health Services

• Financial/Insurance
• Time out of work for students and

parents

• Childcare
• Transportation
• Mistrust/Stigma
• Negative Past Experiences
• Waiting list/Intake Process
• Anxiety of starting something new
• Unfamiliarity with service providers

12

Mental Health Services in the Community

• Students who are able to bypass

the barriers to receiving mental health services in the community show extraordinarily low rates of persistence in treatment.

• Attrition rates increase drastically

after each session.

• What does this mean for school

mental health providers?

13

We cannot assume that anyone else is going to provide mental health services to our students.

School Mental Health Services: National Rates of Service Delivery

• Of the students affected by mental illness, approximately 50% will receive

mental health services.

• Of those receiving mental health services, 75% receive those services in

schools.

• For every 100 students who require mental health services, approximately 4

percent will receive 6 or more sessions in an outpatient setting.

Schools are already the primary source of mental health services for students. 14

The Advantages of School Mental Health

• Cuts through the red tape of the referral process (9 month waiting list)
• Greater generalizability of treatment to child's context
• Treatment afforded in a less threatening environment
• Crisis management and the onset of services in general occur in a substantially shorter

timeframe

• Clinical efficiency and productivity
• Outreach to youth with internalizing problems occurs at a higher rate
• Efficient and effective large-scale screening leading to referral
• Greater access to all youth
• Less time lost from school and work for parents and students
• Increased ability to engage in mental health promotion/prevention
• Cost effective
• Greater potential to impact the learning environment and educational outcomes
• A tiered system of services that are tailored to students’ presenting problems
• Increased collaboration and consultation with staff who can provide important information

We are uniquely positioned to identify and provide services to students with mental health needs.

15

Why Schools Need to Address Mental Health Concerns Directly

• Schools are uniquely positioned to positively impact the mental health of

children and adolescents. ○ Direct/consistent contact with students ○ Access to services on an ongoing basis ○ A team of individuals watching/evaluating achievement, behavior, etc.

• Students simply cannot learn effectively or make academic progress if their

mental health needs go unmet.

• We are not preparing students for life after school if we do not directly address

students’ mental health concerns.

• We are the de facto mental health system for youth, followed by juvenile justice.

16

Benefits of Providing Mental Health Services

• Increased academic performance - 11 percentile increase in

standardized test scores when SEL programming is implemented, (Dusenbury et al., 2015)

• Decreased rate of crisis
• Increased rate of attendance
• Decreased behavioral concerns - less suspensions, expulsions, and

referrals to juvenile justice

• Decreased rate of substance use
• Decreased rate of incarceration
• Decreased healthcare costs
• Increased productivity for all school staff

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Bringing It All Together...

• Mental health problems are pervasive, especially for school-age children

and result in a litany of problems that impact schools and society in general.

• Community-mental health agencies are part of the solution, however they

do not have the capacity to address this issue on their own.

• Students do not make academic progress when their mental health needs

go unmet. There is a heavy cost associated with inaction, and many benefits to directly addressing the mental health needs of students.

• We are uniquely positioned to positively impact students’ mental health,

and, given the inherent advantages of providing mental health services in schools, we are the best option for the vast majority of students.

18

National Center for School Mental Health

MISSION

• To strengthen the policies and programs in school mental health
• To improve learning and promote success for America’s youth
• Established in 1995. Federal funding from the Health Resources and

services Administration.

• Focus on advancing school mental health policy, research, practice,

and training.

• Shared family-schools-community agenda.
• Co-Directors:

Sharon Hoover, Ph.D. & Nancy Lever, Ph.D. http://csmh.umaryland.edu, (410) 706-0980

Comprehensive School Mental Health System (CSMHS)

“Comprehensive School Mental Health System (CSMHS ) is defined as school-district-community-family partnerships that provide a continuum of evidence-based mental health services to support students, families and the school community.”

• Provides a full array of tiered mental health services
• Includes a variety of collaborative partnerships
• Uses evidence-based services and supports

Social Emotional / Mental Health Tiered System of Supports

Multi-tiered System of Services & Supports:

• Tier I - Universal Supports and Interventions;

Promotion & Prevention Practices

○ Promoting positive mental health in ALL students (SEL Lessons)

• Tier II - Targeted/Selected/Group Supports

and Interventions

○ Focus on students at-risk of developing a mental health challenge

• Tier III - Intensive/Individualized Supports

and Interventions

○ Focus on students experiencing a mental health challenge

What is a CoIIN?

• learn from each other and experts to collectively

make improvements

• innovative, multi-faceted learning framework to

rapidly translate expert knowledge and best practices to practical program change

Collaborative Improvement and Innovation Network

CSMHS Quality and Sustainability Collaborative Improvement and Innovation Network (CoIIN) and Beyond

• Grant funded partnership with the University of Maryland’s Center for School

Mental Health (CSMH)

○ Methuen is 1 of 12 districts selected nationally for participation in the first cohort ○ Implementation of National Performance Measures to improve the quality and sustainability of school mental health services ○ Methuen receives ongoing support, resources, training, and assistance with implementation of project initiatives from the CSMH ○ Communication is frequent, ongoing, and involves the reporting out of progress made toward achieving CoIIN goals (PDSA cycles)

• School Mental Health Improvement and Innovation Task Force
• National Coalition for the State Advancement of School Mental Health (NCSA-

SMH)

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25 CoIIN District-Community School Mental Health Systems

The SHAPE System

SHAPE is used to:

• Monitor a school’s
• r district’s

progress toward achieving the National Performance Measures

• Provide resources

and action planning guides for each domain

• Gather data to

inform the national census to understand school mental health nationally

Expanding Partnerships to Sustain Growth

• School Mental Health

Improvement and Innovation Task Force - CSMH

• Expert Panel on School Mental

Health - SAMHSA

• National Coalition for the State

Advancement of School Mental Health (NCSA-SMH) - CSMH

National Coalition for the State Advancement of School Mental Health (NCSA-SMH)

Securing the NCSA-SMH technical assistance

• pportunity enhanced

MASMHC’s ability to:

• Provide technical

assistance

• Distribute

resources

• Engage in advocacy

efforts

Action Planning and PDSA Cycles

• Plan

○ Define the objective, questions, and predictions ○ Plan for data collection

• Do

○ Carry out the plan ○ Collect and analyze data

• Study

○ Complete the analysis of the data and compare the results to the predictions ○ Summarize what was learned

• Act

○ Determine whether the change will be abandoned, adapted, or adopted

Identifying Areas of Need & Tracking Improvement

October 2015 January 2016 May 2017

October 2015 January 2016 May 2017

Identifying Areas of Need & Tracking Improvement

The Mental Health Initiative in Methuen

Where did we begin? What were the most important aspects of our implementation of school mental health (SMH)? How did we sustain our growth and the changes in our practice? Why did we form the Massachusetts School Mental Health Consortium (MASMHC)?

The Mental Health Initiative in Methuen, MA

Highlights of Implementation:

• Universal mental health screening in

grades 3-12

• Group therapy program established

in all schools

• Professional development to improve

staff readiness

○ Cognitive Behavioral Therapy (CBT) ○ Treatment planning ○ Suicide risk assessment ○ Use of psychosocial and behavioral data ○ PBIS

• Teaming
• CSMHS accountability report
• Mental Health Parent and

Student Advisory Council

• MOUs established with local

CBH providers

• Established the Massachusetts

School Mental Health Consortium (MASMHC)

• Resource mapping and needs

assessment

• Bridge program

District-level Support for the Mental Health Initiative

• Making mental health a priority; sending a consistent message to

all staff

• Establishing teams to guide the work across the district and

ensure consistent implementation of new practices/policies

• Establishing partnerships to leverage resources and professional

development

• Providing training to all staff regarding working with students

with mental health problems and creating trauma-sensitive environments (Trauma-sensitive practices, PBIS, SEL curriculum)

• Aggregating the collected data to share with stakeholders in the

community

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Mental Health Initiative Structure

• Methuen CSMHS CoIIN Team is responsible for:

○ Planning and assessing the progress of the mental health initiative ○ Selecting, testing, and analyzing data related to new practices/policies ○ Communicating and collaborating with the University of Maryland CSMH team ○ Submitting PDSA cycles and monthly run charts to the University of Maryland CSMH team ○ Attending required trainings

• Mental Health Initiative Committee is responsible for:

○ Monitoring the district-wide implementation of practices as they are brought to scale ○ Assisting in identifying test sites to pilot new practices ○ Collecting and reporting out data related to the implementation of new practices/policies ○ Assisting in the identification and resolution of site-specific problems related to implementation

35

Mental Health Staff Readiness

• Defining and promoting a consistent view of mental

health staff

• Provision of professional development that directly

relates to mental health services and supports

• Representation from all schools on district-wide teams

to promote the fidelity of implementation

• Increased collaboration and consultation regarding the

implementation of new practices and policies

• Focusing on the collection of data to assess the

effectiveness of interventions and the impact of mental health staff on students’ academic and psychosocial progress

36

Needs Assessments: Working Smarter

SEL Needs Assessment

• Used to design a SEL curriculum by identifying the critical areas of need

reported by the student population EBP Needs Assessment

• What evidence-based therapeutic practices and programs were being

implemented?

• How did the staff rate their readiness to provide services to address the

range of problems faced by our students?

• What did staff see as the critical areas of professional development that

they needed? Presenting Problems Needs Assessment

• What are the most prevalent presenting problems that mental health

staff are addressing across all tiers?

37

Professional Development

• Northeastern University: Daily Report Cards
• Salem State University: Cognitive Behavioral Therapy
• Inservice days:

○ Models of Case Consultancy ○ Suicide Risk Assessment ○ Intervention Planning and Progress Monitoring ○ Using Psychosocial and Educational Data to Assess and Monitor Interventions ○ SBIRT ○ Resource Mapping

• Implementing PBIS: Tier I and Tier II trainings

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Effective and Efficient Use of Resources

Realignment of caseloads

• Assigning caseloads with consistency
• Decreasing the number of transitions between mental health staff;

increasing the length of time each student is serviced by the same mental health staff member

• Aligning practices across the district (SEL, screening, management of

504, etc.) Resource mapping

• What do we have, where do we have it, and how can we use it better?

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Establishing Community Partners

Creation of a formal agreement designed to guide partnerships with community-based mental health agencies

• What we requested:

○ Consultation and collaboration with in-house staff ○ Use of evidence-based practices ○ Sharing data to aid in progress monitoring and documenting the impact of the CSMHS

• What we offered:

○ Time ○ Space ○ Referrals How has this impacted service delivery?

• 15% increase in mental health staff available to students
• Increased follow through for referrals
• Increased show rates for sessions
• Collaborative case management and consultation with partner agencies
• Increased services during school breaks and over the summer

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Partnering with Community Mental Health - Increased Services

How has this impacted service delivery?

• 15% increase in mental

health staff available to students

• Increased follow through for

referrals

• Increased show rates for

sessions

• Collaborative case

management and consultation with partner agencies

• Increased services during

school breaks and over the summer

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Partnering with Community Mental Health - Increased Services

• The rate and diversity
• f services increased

steadily over three years

• True wraparound was

established as a function of this relationship

Expanding Partnerships with CMH

• Increasing the number of

partnerships

• Implementing group-based services

co-facilitated with school- and community-based mental health staff

• Leveraging supervision hours
• Leveraging professional

development

• Summer services

Establishing Community Partners

• Partnered with local mental health providers, colleges/universities, and other school

districts ○ University of Maryland - Center for School Mental Health (CSMH) ○ Lahey Health and Behavioral Services ○ Children’s Friends and Family Services ○ Family Services of the Merrimack Valley ○ North Shore Community Mediation Center ○ Salem State University ○ Merrimack College ○ Rivier University ○ Northeastern University ○ Consortium of multiple local public school districts

44

Mental Health Parent & Student Advisory Council

• Provides an opportunity for parents and students to have a voice

regarding the mental health initiative

• Our goals:

○ Reduce the stigma associated with seeking help for mental health concerns ○ Provide an outlet to parents and students to discuss issues related to mental health, including the services and supports offered by MPS ○ Provide knowledge and resources to parents and students regarding mental health ○ Foster a shared agenda between all stakeholders to ensure the continued success and expansion of mental health services and supports in Methuen and the larger region

• Monthly meetings are held at Methuen High School

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Marketing and Promoting the Mental Health Initiative

Openly discussing and sharing information about the mental health initiative with district and community stakeholders has increased the understanding of and support for the goals set forth by the committee.

• Legislative funding
• Local news
• Community mental health agency roundtable meetings
• Parent and student advisory council
• Administrative professional development
• Potential partners (school districts, universities, and community

agencies)

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Mental Health Screening: Questions to Consider

Where do we start? Which students should we screen? How do we choose our screening tools? What about consent? What about staff readiness? What will the parent population say? How are we going to pay for this?

47

Selecting Screening Measures

• Identifying tools that matched our population’s needs
• Accounting for funding barriers
• Seeking efficient measures that produce actionable data

Securing Consent to Engage in Screening

• What options do we have for securing consent?
• What is the difference between active and passive consent?
• What else do we screen for in schools?

Passive Consent Message

A consistent message is delivered regarding mental health screening in advance of and immediately prior to all screenings. “In an effort to promote the health and well-being of students in Methuen Public Schools, students will be periodically provided with questionnaires, surveys, and screeners that address issues related to mental health. The information gained will support the school’s ability to provide comprehensive and timely support for your son or daughter if they require any assistance. Students can opt-out of filling out any questionnaire, survey, or screener that they are not interested in taking and you can

• pt-out your son or daughter at any time by contacting the Guidance Office of your son's/daughter's

school or filling out the opt-out form here. A list of the questionnaires, surveys, and screeners is available below for you to review. We are committed to ensuring your son or daughter is supported academically, socially, and emotionally, and we look forward to partnering with each of you toward achieving this goal.” The message above (or a slightly adapted version) is:

• Posted on the district’s website
• Delivered immediately prior to screenings
• Sent directly to parents/guardians in advance of screenings via an automated calling system

Securing & Maintaining the Psychosocial Database

OR...

Evolving Practice: Seeking Innovative Strategies

Initial Phase of Implementation

• Active Consent
• Paper and pencil screening
• Single-student or small group

screening

• Administration facilitated by

SMH staff Improved Practices

• Passive Consent and Opt-out
• Electronic screening
• Grade-level or school-wide

screening

• Administration through

advisory and tech courses

Post-Screening: Coordinated Follow-up

• Data review and coordinated follow-up planned for all

screenings

• Mental health staff receive the data within twenty

minutes of the completed screening, allowing for immediate follow-up to be conducted with students who had elevated scores

○ Parent/guardian follow-up ○ Follow-up procedural guide developed and data rules established prior to screening to identify the population receiving follow-up ○ Clinical interview professional development

• Mental health staff can then make an informed

decision about whether or not to offer services: in- school group or individual therapy, outside referral, etc.

Post-Screening: Best Practices

• 100% of students who required follow-up

received it within 7 days of the screening

• Students who indicated any degree of

suicidal ideation or intent to self-harm received follow-up within 24 hours (same day)

• Crisis teams were placed on call in advance
• f all screenings and local community mental

health partners were informed of the screenings

Identifying Students and Increasing Services

Increasing proactive service delivery for students who require mental health services. ○ Identification of individual students who may require mental health services and supports ■ Proactive identification and referral for services serves to reduce the overall impact of mental health problems on students. ■ The reduction of crises through preventative care improves the

• verall functioning of a mental health system and decreases

the larger impact of crises on the school as a whole. 66% increase in identification of students who require mental health services following implementation of mental health screening in 17-18.

Screening by Area of Concern

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RCADS (17-18) Student Population % Total % Elevated Scores (At-Risk + Clinical) Total Sample 2155 100.00 Grade 5 552 25.62 No Concern 469 84.97 At-Risk 30 5.43 15.03 Clinical Concern 53 9.60 Grade 6 530 24.59 No Concern 448 84.53 At-Risk 22 4.15 15.47 Clinical Concern 60 11.32 Grade 7 523 24.27 No Concern 462 88.34 At-Risk 15 2.87 11.66 Clinical Concern 46 8.79 Grade 8 550 25.52 No Concern 488 88.73 At-Risk 18 3.27 11.27 Clinical Concern 44 8.00 Grades 5-8 AVG = 13.36

13.36 percent of students in grades 5-8 scored in the moderate to severe ranges for internalizing issues (depression, anxiety, etc.) Methuen Public Schools (2018)

3-Year Depression Screening Comparison Data

16.7 percent

• f students

score in the moderate to severe range for depression,

• n average

Methuen Public Schools (2018)

3-Year Anxiety Screening Comparison Data

18.3 percent of students score in the moderate to severe range for generalized anxiety, on average Methuen Public Schools (2018)

Using Aggregated Psychosocial Data

Understanding the mental health needs of the district comprehensively to inform the design of the mental health system. ○ Aggregated data can function as a needs assessment ○ Informs SEL curriculum design and delivery ○ Informs prevention work ○ Informs the design of Tier II interventions that target specific areas of need identified through the data collection ○ Identifies funding and resources gaps ○ Understanding the connection between psychosocial functioning and academic achievement

Evidence-Based Services and Supports

Multi-tiered System of SEL & Mental Health Services and Supports

• Tier I - Universal Supports and

Interventions; Prevention Practices

• Tier II - Targeted/Selected/Group

Supports and Interventions

• Tier III - Intensive/Individualized

Supports and Interventions

Where are we focused?

• Universal screening (Tier I)
• Individual therapy (Tier III)

using CBT

• Implementing SBIRT
• Expanding and improving
• ur SEL curriculum and

delivery (Tier I)

• Implementing PBIS across

the district (Tier I)

• Scaling up therapy groups

(Tier II)

61

Expanding & Improving Mental Health Services and Supports

• Bringing evidence-based therapeutic services

directly to students

• Ensuring only quality mental health services are

provided to students

• Focusing on prevention and the promotion of

mental wellness

• Advocating for the well-being of the whole student
• Increasing access to and knowledge about the

services and supports available to students

62

Cognitive Behavioral Therapy Professional Development

• In order to ensure staff

readiness, MPS committed to the provision of PD to improve SMH staff’s delivery of evidence-based therapy

• Ongoing PD and resource

development supports staff’s implementation of therapeutic practices

• This represents a significant step

forward to underscoring school- based mental health staff’s training and ability to address the mental health needs of students

Group Therapy Implementation Overview - Tier II

Step 1: Analyze Screening Data to Identify Potential Group Members Step 2: Referral Process to Identify Group Members Step 3: Counselor Interviews with Identified Population/Collect Pre-Group Data Step 4: Obtain Informed Consent Step 5: Group Sessions & Progress Monitoring Step 6: Collect Post-Group Data/Group Evaluation

Historic Tiered Services at MHS (Prior to 16-17)

Tier I

• Utilizing SEL needs

assessment data to design and implement curricula to deliver during advisory

• Social Emotional

Learning (SEL) Instruction during school-wide Connections lessons, through classroom lessons, embedded in core content areas

• Universal Mental

Health Screening Tier III

• Providing evidence-based

individual therapeutic services to students identified through screening

• Creating intervention plans

and conducting progress monitoring to determine the impact of services on academic, social/emotional, and behavioral outcomes ○ Incorporating data from screeners to guide practice ○ 5% of each SMH staff member’s caseload Tier II*

• Non-Existent

*Our focus today = Evidence-based Tier II Group Therapy Services in MPS

Prior “Group” Counseling in MPS

Established Groups in MPS:

• Social skills groups (Social Thinking curriculum)
• “Lunch bunch” groups
• Transition groups for new students

Takeaways:

• Mostly targeted towards grammar schools
• No progress monitoring
• No therapeutic groups
• Evidence-based groups in MPS are non-existent

Tier II Services: Why Group Therapy?

• Efficient / effective practices needed for tier II mental health services

to address target 5-15% of students at MHS

• Too often, we jump straight from tier I to tier III (individual therapeutic

services)

• Remember:

○ Focus of tier II: Prevention and promotion using small groups and embedded strategies (World Health Organization, 2016) ○ Tier II services, such as group counseling, are integral to providing and sustaining mental health services in the district

Defining Group Therapy

The Association for Specialists in Group Work (ASGW) has defined four types of groups:

• Task Groups: Promote the accomplishment of group tasks/goals
• Psycho-Educational Groups: Promote typical growth and/or prevent/remediate transitory

difficulties in personal/social, academic, career development

• Counseling Groups: Address problems of living that arise in the lives of students
• Psychotherapy Groups: Address consistent patterns of dysfunctional behaviors and/or

distortions Structured Groups:

• Time limited (about 6 - 8 weeks)
• Students screened in utilizing data & needs assessment
• Homogenous (students share similar needs/problems/characteristics)
• Closed group (students unable to “drop in”)

Association for Specialists in Group Work (2007)

CBT Group Model - Key Components

• 1. Smaller groups – suggestions for the ideal patient-to-therapist ratio vary, but groups are

usually fewer than 12 members

• 2. Interaction between group members is a key part of the intervention
• 3. Psychoeducation will always be part of the group content – but is less likely to be delivered

in didactic format

• 4. Tailored therapy relates to aspects of the group members’ own aims and formulations
• 5. Involves live, in-session cognitive and behavioral interventions

“Group psychotherapy views the interactions between the group members as the vehicle of change.”

Group Therapy Program Session Structure

• Sessions 1-3 and termination session remain consistent

○ Group orientation / norms, review of CBT model, and termination procedures

• Working phase of group therapy draws on modularized sessions,

activities, strategies tailored to the needs of the group

○ Combination of psycho-educational curriculum and open forum ○ Processing and therapeutic techniques embedded into sessions (cognitive restructuring, behavioral activation scheduling, etc.)

• Preparatory work allows for productive time management for

counselors and more targeted services

• All session content and technique / strategies are evidence-based and

draw upon vetted resources

Psychoeducation & Intro to CBT Language

Cognitive Triad and Challenging Automatic Thoughts

Expansion of Groups 2017 - 2019

Implementation of Five Evidence-Based Groups Using CBT:

• Group Therapy for Anxiety

○ Grades 9/10 ○ Grades 11/12

• Group Therapy for Depression

○ Grades 9/10 ○ Grades 11/12

• Mixed Internalizing Group

○ Grades 9-10

Selected Data - 18-19 Mixed Internalizing Group

• 67% of participants

showed improved scores on the PHQ-9 when group terminated

• On average,

participants reported a 38% reduction in symptom presentation at termination

• Show-rate for group

was approximately 84%

Intervention/Treatment Planning - Tier III

Intervention plans have been implemented for approximately 5% of the student population since the 16-17 school year. Intervention plans consist of:

• Documentation of the presenting problem
• An articulated treatment plan using evidence-based services and supports to directly

address the presenting problem

• A data collection plan that outline the frequency of data collection and the type of data to

be collected related to the presenting problem Use of intervention plans has supported:

• Measurement of individual student growth after the start of services
• Assessment of the efficacy of implemented services and supports
• Self-reflection and adjustment to practice
• Accountability for individual staff members and the larger CSMHS

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Intervention / Treatment Planning

ID PRESENTING PROBLEM ADJUSTMENT TO PRACTICE PROGRESS MONITORING IMPLEMENTATION OF EBP PROGRESS MONITORING ADJUSTMENT TO PRACTICE BASELINE DATA COLLECTION TERMINATION OF EBP OUTCOME DATA COLLECTION

Intervention Plan / Treatment Planning Tool

Overview of BRYT Model

Staff, , Ser ervices, , Space, , Students ts

1. 1. Staff: : 1.0 FTE clin inic icia ian (school counselor, adjustment counselor,

• r social worker); 1.0 FTE

acad adem emic ic coord rdin inat ator r (teacher or classroom aide/tutor) 2. 2. Spac ace: : dedicated, private space in school; near an exit; academic and therapeutic space; accessibility of private meeting space 3. 3. Ser ervi vices: 4 domains: academic coordination, clinical care, family engagement, care coordination 4. 4. Students ts: program cap; priority population

Cl Clinical Car Care

• Intentional clinical support

tailored to students’ presenting problems

• On-demand supports
• Crisis intervention (when

needed)

Ac Academic Co Coord rdinati tion

• Academic support

(tutoring)

• Communication/

negotiation with teachers

• Teacher support

Fam Family Engagement

• Frequent, culturally-

appropriate communication with parents

• Sharing progress/needs
• Offering support &

learning/leadership

• pportunities

Car Care Co Coordination

• Communication/

collaboration with in-school and out-of-school service providers

• Connection to outside

service providers as needed

The Brookline Center for Community Mental Health (2019)

Our data related to advocacy, implementation, & sustainability 2018-19

Perry Presenter Vinny Viewer Molly Maker Casey Creator

The most common diagnoses serviced through the Bridge program during the 2018-19 school year were anxiety and mood disorders.

Almost half of the students serviced in Bridge during the 2018-19 school year were not receiving therapeutic services

• utside of school for a variety of

reasons before referral to the

• program. This further makes the

case for the importance of making student support available in school.

Hodges, K. (1999). Child and Adolescent Functional Assessment Scale (CAFAS)

These data in the adjacent chart reflect program-wide admission and termination symptom presentation and school functioning as generated through the Child and Adolescent Functional Assessment Scale (CAFAS).

Sustainability

Student Weeks in Bridge $ District Saved w/o Home Hospital Tutoring Student 1 29 $6,960 Student 2 29 $6,960 Student 3 12 $2,880 Student 4 6 $1,440 Student 5 17 $4,080 Student 6 26 $6,240 Student 7 13 $3,120 Student 8 8 $1,920 Student 9 14 $3,360 Student 10 4 $960 Student 11 10 $2,400 Student 12 9 $2,160 Student 13 9 $2,160 Student 14 12 $2,880 Student 15 8 $1,920 Student 16 19 $4,560

Total: $54,000

What type of data did we collect to make the case for Bridge continuing past year 1?

• Attendance - days and blocks
• Psychosocial data
• # of weeks in the program by student
• # referrals and program students
• Students tracked to drop out and

prevented

• Grades and credit attainment
• Program graduates
• Home-hospital tutoring* prevention
• Qualitative data from

parent/student/staff observations

*HHT: $240 per week per student paid by the district if student is unable to attend school due to medical/mental health reasons (over 14 days)

Progress Monitoring and System Evaluation

In addition to being used to identify students who may require services, psychosocial data is also used to:

• Gauge the efficacy of mental health services and supports
• Monitor the progress of individual students receiving services
• Accountability measure for service providers

Activity

In small groups, discuss the following questions:

• How do we know when our therapeutic interventions

are working? Not working?

• What data do we typically use to assess the efficacy
• f our interventions?
• How often are qualitative data or secondary / tertiary
• utcomes used to evaluate the impact of SMH staff?

What is Progress Monitoring?

“Progress monitoring is used to assess students’ academic performance, to quantify a student rate of improvement or responsiveness to instruction, and to evaluate the effectiveness of instruction. Progress monitoring can be implemented with individual students or an entire class. In progress monitoring, attention should focus on fidelity of implementation and selection of evidence-based tools, with consideration for cultural and linguistic responsiveness and recognition of student strengths.”

• Center on Response to Intervention (RtI)

Progress Monitoring: A Research-driven Approach

“Although monitoring of treatment response is standard practice for many medical conditions, practitioners in mental health treatments, and substance abuse treatment in particular, have been slow to adopt these

• practices. Progress monitoring (PM), consisting of measurement and

feedback, has the potential to significantly improve treatment outcomes.”

• Goodman, McKay, & DePhilippis (2013)

“Research shows that when both therapists and clients receive feedback on progress, clients tend to have better outcomes.”

• Lambert, et al. (2002)

The Importance of Progress Monitoring

• Gauge the efficacy of the therapeutic approach - Determine what is

working and what is not

• Adjustment to practice - Change the treatment / intervention plan if

the student is not responding to the therapeutic approach

• Improves:

○ Student engagement in services ○ Quality of services ○ Consistency of therapy sessions ○ SMH staff self-assessment

Measure Twice, Cut Once...

What specific problem am I hoping to help the student with? Does my therapeutic approach / intervention match the needs of the student? If the student is making progress, what will change? What tools exist to measure this change? How often should I measure this change? Are there multiple changes that I can measure? How will this data inform my practice?

What Are We Measuring?

• Symptom presentation
• Emotional regulation
• Specific behaviors
• Engagement
• Self-concept
• Overall functioning

Consider multiple measures of progress to gain a more complete picture

• f the impact of the intervention.

Methods for Conducting Progress Monitoring

• Embedding progress monitoring

into individual and group therapy sessions

• Leveraging observations from

parents and staff

• Collecting wide-scale baseline data

using universal mental health screening

• Progress monitoring intervals of two weeks (GAD-7, PHQ-9, and SDQ subscales)
• Graphical history of the student’s response to treatment

Post-Group Data/Group Evaluation

Average GAD-7 score pre-group: 15.22 Average GAD-7 score post-group: 8.42

Indicates ~7 point average decrease on the GAD-7 (mild anxiety)

Tier III Mental Health Services and Supports

Academic, behavioral, and social emotional data were collected throughout the year to monitor students’ progress relevant to the intervention plans created. Of the students tracked:

• Academic Outcomes:

○ 91.1% of students improved or maintained their level of academic performance ○ 51.3% of students improved their level of academic performance

• Social Emotional Outcomes:

○ 94.2% of students improved or maintained from a social emotional standpoint ○ 73.0% of students improved from a social emotional standpoint

• Behavioral Outcomes:

○ 88.0% of students improved or maintained behaviorally ○ 68.7% of students improved behaviorally

What data do we typically use to evaluate the effectiveness of SMH staff?

Suggested Professional Practice Goal

A total of 5% of each SMH staff member’s caseload will be tracked using intervention plans. By December 15, 80% of the students who will be tracked with intervention plans will be identified using psychosocial data from the district-level screening program, behavioral and academic data, referrals from staff and parents, and direct observation of and contact with students from each

• caseload. The remaining 20% of students will be identified no later than February 1.

Intervention plans will include a description of the presenting issue that will be the focus of the intervention plan, an evidence-based intervention that directly addresses the identified presenting problem, baseline and progress data that directly correlate to the presenting problem, and a timeline for delivery of the intervention and the progress monitoring. SMH staff will report out on progress regarding these students by March 15 and May 30. Interventions will be adjusted throughout the year based on progress monitoring data to ensure students are receiving the most appropriate and effective services.

Psychosocial Progress Monitoring and Evaluation

I-B-1 - Variety of Assessment Methods - Uses a variety of informal and formal assessments methods, including common interim assessments, to measure students’ learning, growth, and progress toward achieving state/local standards. I-B-2 - Adjustments to Practice - Analyzes results from a variety of assessments to determine progress toward intended outcomes and uses these findings to adjust practice and identify and/or implement differentiated interventions and enhancements for students. I-C-1 - Analysis and Conclusions - Draws appropriate conclusions from a thorough analysis of a wide range of assessment data to inform instructional decisions and improve student learning. I-C-3. - Sharing Conclusions With Students - Based on assessment data, provides descriptive feedback to students, engages them in constructive conversation, and seeks feedback that focuses on how students can improve their performance. IV-A-1 - Reflective Practice - Regularly reflects on the effectiveness of lessons, units, and interactions with students, both individually and with colleagues, and uses insights gained to improve practice and student learning.

Replicating Our Lessons Learned from the NQI CoIIN

• We were able to make positive gains with SMH adoption

and implementation due to:

○ Technical assistance, training, and support ○ Shared resources and collaboration with other districts/partner agencies ○ Promotion of a shared agenda in which SMH was seen as contributing to a variety of outcomes that were valued by all students and staff ○ Teaming to achieve our goals

• MASMHC would seek to foster the same type of

collaborative network of districts who share an agenda of promoting and adopting SMH practices and policies to support students

What is the purpose and intent of the MASMHC?

The Massachusetts School Mental Health Consortium is comprised of Massachusetts school districts committed to improving the mental health services and supports available to students across the Commonwealth. MASMHC member districts recognize the growing needs of our student populations relative to mental illness and substance use and seek creative solutions to enhance prevention efforts, reduce wait time for therapeutic services, and increase the quality and sustainability of school mental health services and supports. Through shared learning, collaboration, and consultation, member districts will actively engage in efforts to improve the well-being of students in order to support their future success.

Advancing Implementation & Advocating for SMH

• As MASMHC grows, opportunities to advocate on behalf of SMH adoption

and implementation will occur more readily owing to the increase in the base of supporters that comprise its membership

• To date, MASMHC has engaged in advocacy efforts related to:

○ Bill H.3707 (licensure parity) - removing barriers to dual licensure in MA in order to: ■ Increase the availability of services for students ■ Support the idea that SMH is on an equal playing field as community-based MH ■ Promote collaborative partnerships between SMH and community-based MH ○ Allocation of state funding - MASMHC submitted recommendations on how funding from a state budget amendment should be allocated to support quality SMH implementation.

Thank you to our sponsors!!!

University of Maryland - Center for School Mental Health (CSMH) SAMHSA/Center for Mental Health Services Lahey Health and Behavioral Services Representative Linda Dean Campbell Merrimack College The Brookline Center - BRYT Program SEEM Collaborative

January 31, 2018

≈30 Districts

October 21, 2019

≈125 District s

Identifying Areas of Focus: A Shared Vision

In order to work efficiently and effectively, we need to know:

• The most common barriers to implementing

SMH practices and policies

• The areas of focus that are shared by member

districts related to SMH

• The resources (practices, policies, materials,

partnerships) that we already have that we can disseminate/scale-up

• The resources (practices, policies, materials,

partnerships) we need that we can create, refine, or leverage from our partners

Consortium-wide Needs Assessment

Supporting Inclusivity and Local Efforts

• Local priorities and goals
• Inclusive membership - All are welcome
• A fully articulated support system

○ Local support through affiliation with member districts ○ Regional/state agencies and organizations ○ National/federal agencies and organizations

Member District Engagement in MASMHC

How we can create a sustainable partnership...

• Member district representation at monthly meetings
• Completion of a free needs assessment through the SHAPE System to:

○ Understand the common needs of member districts related to SMH ○ Foster the use of common language and a framework for SMH ○ Support action planning and access to free resources

• Advocacy, resource sharing, collaboration, and consultation regarding

SMH What we will not do...

• Keep adding to your to-do list
• Dictate your priorities related to SMH
• Ask you to pay for anything

@MassSMHC

www.masmhc.org

MAssachusetts School Mental Health Consortium

Questions?

John Crocker Director of School Mental Health & Behavioral Services Methuen Public Schools jncrocker@methuen.k12.ma.us 978-722-6000 ext: 1154