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School Health Alliance for Forsyth County Mental Health Evaluation Summary May 19, 2008

School Health Alliance for Forsyth County Mental Health Evaluation Summary May 19, 2008. School Health Alliance Evaluation Team Stephanie S. Daniel, Ph.D., Center for Youth, Family, and Community Partnerships, UNCG Sebastian G. Kaplan, Ph.D.

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School Health Alliance for Forsyth County Mental Health Evaluation Summary May 19, 2008

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  1. School Health Alliance for Forsyth County Mental Health Evaluation Summary May 19, 2008 School Health Alliance Evaluation Team Stephanie S. Daniel, Ph.D., Center for Youth, Family, and Community Partnerships, UNCG Sebastian G. Kaplan, Ph.D. Wake Forest University School of Medicine, Dept. of Psychiatry

  2. Acknowledgements • We would like to recognize the efforts of our student volunteers, Margaret Taylor (UNC-Chapel Hill) and Katie Weegar (ECU), who assisted with data entry for the 2006-2007 evaluation year and who helped prepare and present poster presentations at the annual meeting of the North Carolina Psychological Association in April 2008 using the 2006-2007 evaluation data.

  3. SHA Goals for Mental Health • To provide and improve access to mental health services for at-risk students • Improve mental health functioning and in turn school performance for students with mental health problems

  4. SHA Evaluation Goals 4 primary goals: • To summarize mental health service utilization • To describe behavioral and emotional problems and overall psychosocial functioning among students in a school-based setting • To determine frequency of psychiatric diagnoses among students served • To monitor parent, youth, and teacher satisfaction with school-based services

  5. Evaluation Summary for 2006-2007 Academic Year • Data summarized for this presentation are for the 2006-2007 school year and include assessments, surveys, and clinic visit data completed from August, 2006-July, 2007.

  6. Evaluation Summary for 2006-2007 Academic Year • We reviewed and summarized the following data: • Demographics and psychiatric diagnoses • Service utilization • Vanderbilt Assessment Scale (Parent and Teacher Reports) • Strengths and Difficulties Questionnaire (SDQ) Parent and Self Versions • Program Satisfaction Data (Parent, Youth, and Teacher Reports)

  7. N - Table

  8. Demographics N= 145, across two elementary schools, two middle schools, and one high school.

  9. Grade Level (All Schools)

  10. Gender and School Type

  11. Diagnosis and School Type

  12. Psychiatric Diagnoses- School 1 Number of Students

  13. Psychiatric Diagnoses- School 2 Number of Students

  14. Psychiatric Diagnoses- School 4 Number of Students

  15. Psychiatric Diagnoses-All Schools Combined Number of Students

  16. Service Utilization • Data regarding medication treatment were attained from a sub-sample • of 86 students from one elementary and one middle school.

  17. Mental Health Outcomes: Vanderbilt Assessment Scale Data • Parent and Teacher completed measures. • Assesses both symptoms and impairment in performance. • Symptom assessment contains DSM-IV criteria for ADHD, and screens for oppositional defiant behaviors, conduct problems, and difficulties with anxiety/depression. • Performance measures used to determine level of functional impairment for symptoms indicating “somewhat of a problem” and “problematic.”

  18. 1st Administration of Vanderbilt-Parent (All Three Schools) Items 1-8: Performance items on scale of 1 to 5 – Problem defined as score of 4 or 5. Item 9: TSS is the sum of 18 ADHD symptoms on scale of 0 to 3 - Item is positive with score of 2 or 3 (36 to 54 on TSS).

  19. 1st Administration of Vanderbilt-Teacher (All Three Schools) Items 1-9: Performance items on scale of 1 to 5 – Problem defined as score of 4 or 5. Item 10: TSS is the sum of 18 ADHD symptoms on scale of 0 to 3 - Item is positive with score of 2 or 3 (36 to 54 on TSS).

  20. Total Symptom Score (TSS) - VAS 27.07 Total Symptom Score 22.81 N = 43 F(1,42)= .875, p= .018

  21. Conclusions:Demographics, Psychiatric diagnoses, Service Utilization, Behavioral Ratings • Need for consistent repeated assessments over time • African-American students outnumbered Caucasian students • Consistent with population of schools • Diagnostic patterns • ADHD in elementary schools • Adjustment Disorders in middle schools • Depression/Anxiety in high school • Service Trends • Nearly all students received individual therapy • Behavioral symptoms decreased

  22. Program Satisfaction DataSurvey Summaries • Opportunities for completing Satisfaction Surveys were available at all school-based health centers for youth, parents, and faculty/staff • Surveys reported in this summary were administered and completed in Spring 2007

  23. Number of Surveys Returned

  24. Teacher Responses • 6 Questions: • 1. “What services do students need which are not available at the health/wellness center?” • 2. “Is health/wellness center responsive to students’ mental health needs and concerns?” • 3. “What do you like about the health/wellness center/what is working well?” • 4. “What do you dislike about the health/wellness center/how could services be improved?” • 5. “Overall, how satisfied are you with health/wellness center services?” • 6. General Comments

  25. “What services do students need which are not available at the health/wellness center?”(Teacher Response) • (Some respondents listed multiple items; percentages based on 158 teacher surveys returned; listed in order of frequency) • 1. Unsure/no response: (119 responses = 75%) • 2. Dental care: (17 responses = 11%): “Oral hygiene, braces” • 3. Mental health: (13 responses = 8%): “Padded rooms; more counseling groups to deal with behavioral issues (e.g., anger management); psychiatric/emotional help; therapist” • 4. Vision care: (9 responses = 6%): “Comprehensive eye exams & glasses” • 5. Other medical care: (6 responses = 4%): “Occupational therapy & physical therapy through Baptist Hospital; follow-up for contagious symptoms (e.g., ringworm); general health care, ear care” • 6. Other: (4 responses = 3%): “Parent consultation; Spanish translator; personal hygiene”

  26. “Is health/wellness center responsive to students’ mental health needs and concerns?”(Teacher Response)

  27. “What do you like about the health/wellness center/what is working well?”(Teacher Response) • (Some respondents listed multiple items; percentages based on 158 teacher surveys returned; listed in order of frequency) • 1. Convenience/location/availability/hours of operation: (54 responses = 34%;e.g., “On-campus makes visits easy; staff picks up kids; being able to send students over and still be in school; easy for parent/child to visit; eliminates days off for doctor visits”) • 2. Services provided to students, parents, and teachers: (39 responses = 25%): “Provide services to students and staff; medical care available to students that need it; providing information and support to parents; keeping parents on track about their children’s health; meeting physical and mental needs of students; available to those who cannot afford health care; students have a place to go to get help; supply teachers with Tylenol; gives students sense of well-being; helps with attendance • 3. Staff: (36 responses = 23%): “Responsive; concerned about needs of the students; friendly; great willingness to serve; very professional; caring; knowledgeable; always supportive; genuinely want to help students and teachers; rapport with students; competent; good with referrals; consistent and positive approach; receptive” • 4. Unsure/no response: (33 responses = 21%) • 5. Generic positive responses: (11 responses = 7%): “Everything” • 6. Good working relationships with teachers: (10 responses = 6%): “Good communication; works with school; keep us informed on what our children’s health needs are—let us know if anything is missing; easy for teachers to work with; helped me contact parents about ongoing problems; cooperative efforts; supportive; listening to teachers’ concerns; rapport with teachers”

  28. “What do you dislike about the health/wellness center/how could services be improved?”(Teacher Response) • (Some respondents listed multiple items; percentages based on 158 teacher surveys returned; listed in order of frequency) • 1. Unsure/no response: (108 responses = 68%) • 2. More hours/staff needed: (34 responses = 22%): “Nurse only here 3 days/week; need more hours of service—e.g., Saturday morning, lunch hour, before school, and during all school days” • 3. More services needed: (10 responses = 6%): “Offer dental care; more group therapy; more help with mental wellness; weight management; parent health services; wish all students had access for immediate minor issues; dislike that staff not allowed to be members; need Spanish interpreter; more follow-up with students” • 4. Scheduling procedures: (7 responses = 4%): “Dislike when students pulled from core classes—pull from elective classes instead, or alternate times so not always missing same class; dislike when center accepts students who leave class without teacher approval; dislike trying to get appointment slips to students” • 5. Miscellaneous: (3 responses = 2%): “No shelter at the doorway; emphasis sometimes more on protocol than illness; parents should not have to re-enroll their child each year”

  29. “Overall, how satisfied are you with health/wellness center services?”(Teacher Response) Scored on scale of 1 (Least Satisfied) to 5 (Most Satisfied); based on 158 teacher surveys returned

  30. Summary of General Comments(Teacher Response) • (Based on 158 teacher surveys returned) • Positive: “Please keep it here, we need it and its fine professional staff; I would recommend the services to parents and staff—great services to have within the school environment; very valuable resource for our students; students eager to go to the center—it empowers them to think about health and gives them strategies which they use in the classroom; keep up the good work; thank you for all your hard work and caring; staff is doing the best they can with the funding they have; thanks for all you do; wish more families would utilize the center; thank you; I love the center—grateful every day for all you do; school nurse is wonderful, caring, and knowledgeable; wish we could get more students to enroll; staff is great; great to have here on campus; been a great help to my class this year” • Negative/needs improvement: “Need intervention programs for students at elementary level—many students exposed to family violence and drug use; need services daily; need nurse Maureen full time as well as others” • Unsure: “Unfamiliar with the health center and its role; don’t know enough to be objective; have not had opportunities to utilize the center”

  31. Parent Responses • 8 Questions: • 1. “What services are needed by your child but are not available at the health/wellness center?” • 2. “Is the health/wellness center responsive to your child’s mental health needs and concerns?” • 3. “What do you like about the health/wellness center?” • 4. “What do you dislike about the health/wellness center?” • 5. How should the health/wellness center publicize itself to students and families?” • 6. “Does the health/wellness center keep you informed regarding the care provided to your child?” • 7. “Overall, how satisfied are you with health/wellness center services?” (1 = Least satisfied, 5 = Most satisfied) • 8. “Comments”

  32. “What services are needed by your child but are not available at the health/wellness center?”(Parent Response) • (Percentages based on 39 parent surveys returned; listed in order of frequency) • 1. Unsure/no response: (34 responses = 87%) • 2. Other: (5 responses = 13%): “Weight loss program, dermatologist, dental, asthma medicine, place for child to calm down”

  33. “Is the health/wellness center responsive to your child’s mental health needs and concerns?”(Parent Response) • (Percentages based on 39 parent surveys returned; listed in order of frequency) • Yes: (27 responses = 69%) • Unsure or N/A: (12 responses = 31%) • No: (0 responses = 0%)

  34. “What do you like about the health/wellness center?”(Parent Response) • (Some respondents listed multiple items; percentages based on 39 parent surveys returned; listed in order of frequency) • 1. Services: (16 responses = 41%): “Informative letters; parents kept informed about their children; quick emergency response; assessment of student health; firm about parents and children doing their part in the programs; offers mental health services; takes good care of my child; helps children; easy to get appointment; affordable” • 2. Located at school: (12 responses = 31%): “My child can go without me; parents don’t have to miss work; convenient” • 3. Staff/environment: (11 responses = 28%): “Friendly, genuinely concerned about my child’s health, cooperative, courteous, nice, pleasant” • 4. Unsure or N/A: (6 responses = 15%) • 5. General positive: (2 responses = 5%): “Very important”

  35. “What do you dislike about the health/wellness center?”(Parent Response) • (Percentages based on 39 parent surveys returned; listed in order of frequency) • 1. Unsure/Nothing/ N/A: (33 responses = 85%) • 2. More hours/staff needed: (5 responses = 13%): “Not open all year; needs full-time nurse; hours of availability” • 3. Trying to take the place of regular doctor: (1 response = 2%)

  36. “How should the health/wellness center publicize itself to students and families?”(Parent Response) • (Some respondents listed multiple items; percentages based on 39 parent surveys returned; listed in order of frequency) • 1. Written communication given to students/parents: (19 responses = 49%): “Information sheet; newsletter; brochures; flyers; pamphlets; passed out to students, sent home to parents; emails to students and parents; through school newsletter; through progress reports; monthly reminders” • 2. Unsure or N/A: (14 responses = 36%) • 3. Within-school advertising: (5 responses = 13%): “Talk more about what center is doing; word of mouth; signs around school; through the children” • 4. Community advertising: (3 responses = 8%): “Channel 2 school news; local newspaper” • 5. Meetings with parents: (2 responses = 5%): “Open House, PTA meetings”

  37. “Does the health/wellness center keep you informed regarding the care provided to your child?”(Parent Response) • (Percentages based on 39 parent surveys returned; listed in order of frequency) • 1. Yes: (36 responses = 92%) • 2. Unsure or N/A: (3 responses = 8%)

  38. “Overall, how satisfied are you with health/wellness center services?”(Parent Response) Scored on scale of 1 (Least Satisfied) to 5 (Most Satisfied); based on 39 parent surveys returned

  39. Summary of General Comments(Parent Response) • (Based on 39 parent surveys returned) • Positive: “Thanks for making it possible to have trained [health] professionals at school; services are various and convenient; employees are courteous and respectful; everyone doing the necessities for my child” • Negative/needs improvement: “I prefer to take my child to his own doctor; full-time nurse recommended” • Unsure: “It would be nice to know more about the center”

  40. Student Surveys • 4 Questions: • 1. “What do you like about the health/wellness center?” • 2. “What don’t you like about the health/wellness center?” • 3. “What can we do for you to keep you healthy?” • 4. “What else would you like to say about the health/wellness center?”

  41. “What do you like about the health/wellness center?”(Student Response) • (Some respondents listed multiple items; percentages based on 42 student surveys returned; listed in order of frequency) • 1. Staff/environment: (17 responses = 40%): “People that work there; they have very good manners; very nice, funny; great place; gentle, caring; clean; they do a good job; get to be with the nurses” • 2. Help received: (16 responses = 38%): “They take very good care of me; always help you; help you out with scars & give shots that you need; will help you with a headache or something [else]; have medicine when you are sick; you can get help when you need it; they attend you good; they make sure I have my medicine; solve your health problems; have everything that I need” • 3. Relationship/confidentiality: (12 responses = 29%): “They keep things to themselves; having somebody to talk to; don’t have to hide anything, can be myself; can talk to them about anything & know that my problems/issues are safe with them; care about you; look out for you & help you with your problems; you can talk to people if you need help or if you are sick; confidentiality; you can talk to the staff; know me by name” • 4. Good feelings/overall enjoyable experience: (11 responses = 26%): “Makes you feel better after leaving; getting out of class; make you feel like it’s OK and they don’t put you in pain; treat you good; help you feel better with whatever problem you have; a lot; just really like it; OK” • 5. Unsure: (1 response = 2%): “Don’t know”

  42. “What don’t you like about the health/wellness center?”(Student Response) • (Percentages based on 42 student surveys returned; listed in order of frequency) • 1. Nothing I don’t like/I like everything about it or no response: (30 responses = 72%) • 2. Miscellaneous: (12 responses = 28%): “Shots/needles”; “they ask a lot of questions”; “sometimes it takes too long”; “when the nurse is not there”; “having to leave class”; “Treat you like you are their children”; “they make sure children are OK”; “when people draw”

  43. “What can we do for you to keep you healthy?”(Student Response) • (Some respondents listed multiple items; percentages based on 42 student surveys returned; listed in order of frequency) • 1. Nothing/don’t know/keep up the good work: (19 responses = 45%): “Keep having the health center around; you already do a lot for us to keep us healthy; just keep doing the same thing you do” • 2. Physical health needs: (9 responses = 21%): “Just help me when I need help with a pain; keep checking on me; help with bleeding and headaches; give me medicine and shots to keep me healthy; keep seeing me & make sure I’m OK; make me come in every day; take my blood; check-ups” • 3. Nutritional/informational needs: (7 responses = 17%): “Offer a class that gives you tips about eating healthy; have nutrition groups; tell me what I need to do with health; give me packets about health; give me healthy eating tips; put me on a diet; make sure I keep eating healthy foods” • 4. Relational needs: (4 responses = 10%): “Love me always; talk to me; keep the same staff so that I am positive I can trust the staff; encourage me a lot” • 5. Miscellaneous: (4 responses = 10%): “I really have to do everything so I can stay healthy; come here all day [full-time?]; anything that is helpful; always be sterile”

  44. “What else would you like to say about the health/wellness center?”(Student Response) • (Percentages based on 42 student surveys returned; listed in order of frequency) • 1. Good place and staff: (21 responses = 50%): “Friendly nurses; glad we have it; very nice place and staff; everyone is great; feels just like home; great place; hardworking staff; I love everybody; really like it; keep it the way it is; they really do a great job; overjoyed that my teacher showed me people who really care; very helpful people; my problems only stayed in the center [kept confidential]; good to have in school; good place to be & you can tell what’s going on with you” • 2. No response/nothing: (17 responses = 40%) • 3. Thank you: (4 responses = 10%): “Thanks for all the help; thank you for keeping me healthy; thanks for all you’ve done”

  45. Future Directions • SDQ • Implementing a more efficient data entry process (self-sustaining) • Linking school-based clinic data for each student served to additional behavioral, academic performance and functioning outcomes (disciplinary actions, attendance, performance on standardized tests, course credits completed, etc…) available through the school system • Developing school-based clinic programs and clinical services that are informed by the evaluation data (e.g., developing or implementing evidence-based treatments that specifically target the psychiatric needs of students at each school type) • Future Directions of interest to the SHA Board?

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