S ustaining School Mental Health Programs

Sustaining School Mental Health Programs Strategies from SSHS Initiatives Arkansas Children's Behavioral Health Care Commission Thursday, April 21, 2011

Topics of Discussion • Sustainability Strategies from SS/HS grantees • Ideas to build comprehensive SMH programs • Blending Funding within all 3 tiers • IDEA: School Medicaid Claiming Guide • State/local MH partners to build sustainability • SMH funding ideas from various states

Successful Strategies to Sustain Through Blended Funding Community partners, schools, and state agencies can share responsibility for all types of funding… Red, Yellow, and Green Zones

Schools contract with public and/or private MH providers • Third Party Reimbursements • Medicaid • Insurance • Self-Pay

Medicaid / IDEA • Administrative Claiming Guide for Schools • IDEA eligible students • Psychological assessments, screening, counseling, treatment planning, case management, social work services • Many school districts are hiring billing clerks to obtain reimbursements for social work services under IDEA

District site-based school budgets • Work with legislative committees to add a SMH line item in state budget • Partnership with Blue Cross Blue Shield Foundation to fund health and mental health services

PD’s work with county to pass referendums (penny tax, .01% sales tax) to fund SMH programs • Use state/county TANF Funds to fund early intervention programs • Title I, EPSDT, IDEA – early screening, assessment, case management, referrals, early intervention teams and services

Develop partnerships with community non-profits for SS/HS initiatives • Evidence Based Programs decrease school violence and a decrease in cost for school district liability insurance

California • Comprehensive School Health Centers • The Mental Health Services Act (MHSA), Proposition 63, enacted by voters Nov. 2004 • Purpose: transform CA MH system to provide a broad spectrum of prevention and early intervention, treatment, and infrastructure support.

California • Five Concepts: • (1) client/family-driven mental health system, • (2) cultural competence, • (3) community support and collaboration, • (4) service integration, and • (5) focus on recovery, wellness, and resiliency. • http://www.cde.ca.gov/ls/cg/mh/index.asp

California • MH Services Act provided the opportunity for CA Dept of Education and Dept of MH to work together to assist CA’s children/youth to achieve educational and personal goals • 17 state agencies are involved in various efforts in support of MH Services Act • MH Services Act County Coordinators oversee MHSA planning efforts

California • CDE contracts to provide free, quality professional development for school and district level staff in recognizing children’s MH issues • CDE provided free online training in youth suicide prevention for school staff, students, and their families, & suicide prevention resources • Prevention & Early Intervention: Program and Expenditure Plan Proposed Guidelines http://www.dmh.ca.gov/Prop_63/MHSA/Prevention_and_Early_Intervention/PEI_Component_Guidelines.asp

California • SMH services include a broad range of services, settings, and strategies, vary across the state, provided formally or informally by a variety of school personnel • academic counseling, assessment, referral to other systems, brief interventions, behavior problems, individual/family/group counseling,, crisis intervention • Provides strategies, resources, and training in psychological and MH programs such as: coping with tragedy, crisis intervention /prevention, school psychology, and suicide prevention. • SMH services helps to address barriers to learning and provides appropriate student and family support services

California • CSBA Policy Brief on MHSACalifornia School Boards Association (CSBA) developed a policy paper on MHSA, specific focus on prevention and early intervention • www.csba.org • LAUSD Trauma Services Adaptation Center for SchoolsThe Los Angeles Unified School District provides information on how trauma effects learning, and information about the curriculum Cognitive Behavioral Interventions for Trauma in Schools (CBITS) • http://www.tsaforschools.org/

Wisconsin • Comprehensive Community Services • MH, Substance use, or co-occurring disorders in children, youth and adults • Requires financial and functional screening • Flexible array of individualized community based psycho-social rehabilitation services authorized by a MH professional

Wisconsin • Services include: assessment of need, identification of treatment preferences, integrated service plans, service facilitation assistance, family psycho-education • Wraparound model based on System of Care, e.g. flexible, consumer directed, recovery oriented, strength and outcome based • http://www.dhs.wisconsin.gov/mh_bcmh/ccs/index.htm

Pennsylvania School-Based MH Program developed through various grants: SS/HS, SOC and SIG • State/Local Blended Funding • School-Based Outpatient/satellite facility, bills Medical Assistance (MA), • Therapist on site at schools to provide MH and ATOD treatment needs of students • Fee-for-service MH/SA intervention and treatment services • PA SMH program example http://www.pacounseling.com

Pennsylvania • Behavioral Health Rehabilitation services • Wraparound model • Treatment plans • Skill training for parents, teachers, school staff, and specialized treatment for MH diagnoses • Student Assistance Program • Identification/assessment of personal, family and school related problems • Parents/SAP team develop intervention plan • Brief counseling and consultation • Referral to, continued support and follow-up with appropriate and accessible services and resources

PA Student Assistance Program (SAP) • SAP assists school personnel in identifying issues such as MH and ATOD issues which pose a barrier to a student’s success. • SAP is administered by PA Dept. of Education’s Division of Student and Safe School Services & partners with … • PA Department of Health’s Bureau of Drug and Alcohol Programs, • PA Department of Public Welfare’s Office of Mental Health and Substance Abuse Services • http://www.dpw.state.pa.us/provider/studentassistanceprogram/index.htm

PA Child & Adolescent Service System Program – CASSP • PA public children's MH system is based on wraparound principles and framework (past 20 years through CASSP) http://www.parecovery.org/principles_cassp.shtml • CASSP Coordinators funded by each county and develop an infrastructure for an effective children’s MH system • CASSP roles and Children’s MH Coordinators have evolved and serve a variety of functions in their counties such as … • Individual treatment plans are client and family driven • Case management • Referrals and linkage to community resources • Culturally competent • Collaboration with all the child-serving systems that are involved with the child

Michigan • School-Based Services: Birth – 3 years & School Age • Medically necessary Medicaid services • Fee-for-Service • IDEA Medicaid: crisis intervention, psychological, counseling, social work services, physician and psychiatrist services, targeted case management • Dually eligible: Children's Special Health Care Services (CSHCS) & Medicaid (Title V/XIX), or only Medicaid (Title XIX) • MH Providers apply to become SBS provider • Medicaid reimbursements - direct to school districts

Michigan • Psychological, counseling and social work services include planning, managing and providing a program of face-to-face services for beneficiaries with diagnosed psychological conditions. • Evaluations or assessments include tests, interviews and behavioral evaluations that appraise cognitive, emotional, social functioning, self-concept, behavior and functioning • A qualified psychologist, counselor or licensed social worker must complete them the evaluations. • www.michigan.gov/mdch

MH Treatment and Crisis Services • Substance Abuse Treatment • Court/Juvenile Justice Programs • Social Services Resources/Programs • Student Assessments, Interventions, and Progress • Specialized Groups • Case Management • Community Service Projects/Learning • Mentoring • Peer Mediation/Conflict Resolution • After-School Programs/Groups • Parent Education Outreach • School Psychological Assessments • Restorative Justice Practices • Substance Abuse groups • Evidence Based Programs • Social Emotional Skill Development • Violence Prevention Programs

Medicaid Rehabilitation Services • CFR 440.130 (d) - Rehabilitation services - “any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his or her practice under State law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional level.” (4/15/11) • SMH services are often provided under the rehabilitation option in many states • http://medicaidbenefits.kff.org/state_main.jsp

Developing and Upgrading Medicaid IT Enrollment Systems • Federal $ @ 90% cost/75% operational ongoing operations costs provided to states to develop and upgrade IT systems to help people enroll in Medicaid or the Children’s Health Insurance Program (CHIP) (4/15/11) • Increase over previous federal matching rate of 50-percent to assist states prepare for the Medicaid improvements and expansion that will come in 2014 from the Affordable Care Act • CMS-2346-F www.ofr.gov/inspection.aspx

Next Steps • Review various states funding of School MH • Review AR School-Based MH Network Manual and School Medicaid Claiming Guide to determine potential additions or revisions • Determine effective services that SMH staff provide • Determine services that provide positive outcomes • Determine service costs and areas of cost savings • Discuss options to realign and/or revise current funding mechanisms to create additional SMH funding for “yellow zone” students

“Things alter for the worse spontaneously, if they be not altered for the better designedly” Francis Bacon

“I believe that if you show people the problems and you show them the solutions they will be moved to act” Bill Gates

S ustaining School Mental Health Programs