School-Based Mental Health Consultative and Collaborative Services

1. School-Based Mental Health Consultative and Collaborative Services The St. Cloud Model of Mental Health Triage and Mobile Wellness Michael D. Quesnell, Ph.D. Project Coordinator Safe Schools/Healthy Students

2. The Challenges • Shortage of Child and Adolescent Psychiatrists • Shortage of Psychologists trained and experienced in working with young children • Inadequate linkage between community and regional resources • Inadequate emergency services for children’s mental health • Increasing demands on the classroom teacher to work with students with increasing demands, stressors and emotional problems • Poor communication between • Primary care and mental health providers • Schools and mental health providers • Schools and Primary Care

3. Barriers to Learning What percent of your students come to school ready to learn what you have prepared to teach them? Range of Learners Motivationally ready & able Not very motivated, lacking knowledge & skills, different learning rates & styles, minor vulnerabilities Avoidant, very deficient, has a disability, major health problem Instructional Component Classroom Teaching + Enrichment Activity No Barriers Desired Outcomes Barriers to Learning Support Component On Understanding Intervention in Psychology and Education, Adelman & Taylor, 1994

4. Sustainable Community Collaboration • Children and families • Schools • Insurers • Local community

5. Solutions • State and County Government partnerships with Community Agencies • Collaboration and Consultation between mental health providers, primary care providers, and schools • Children’s Emergency Assessment System Coalition (CEAS) • Stearns County Family Services Collaborative Funded School Mental Health Triage System • Education on Children’s Mental Health Issues for: • Parents • Teachers /Education Professionals • Social Workers • Mental Health Providers • Primary Care Providers

6. Triage Referral Flow Chart Mental Health Problem / Concern Contact Person Triage Therapist Diagnostic Assessment Psychiatric Evaluation Mobile Wellness Center

7. Total Number of Referrals • Year 1: March - June 2001 • Year 2: September 2001 - June 2002 • Year 3: September 2002 - June 2003 • Year 4: September 2003 – June 2004

8. The Mobile Wellness Center • A Mobile Mental Health Resource • A St. Cloud Area Community Partnership • Funded by the Federal offices of Education, Justice, and Human Services

9. Mobile Wellness Center Results • Decreased the waiting time for mental health assessment from 8 – 10 weeks to 26.1 calendar days • MWC staff held 118 education events for 1,366 school staff and community members • Triage and Mobile Wellness Center staff made 408 referrals to school and community resources • Evaluations from students, parents, and referral sources showed an 80% satisfaction with the quality of services, access to services, and the outcome of the service • Of more than 700 people who were surveyed after an educational event through the Mobile Wellness Center, 97% said they had a better understanding of mental health issues

10. Mobile Wellness Center DataSept. 2003-June 2004 • 103 students referred for full comprehensive assessment • 82 assessments completed • 17 students received partial services • 4 students/families declined • Referrals generated 350 appointments • 15 (5%) no shows • Sept.-Dec. 2003 162 consults

11. The Mental Health Challenge • Mental disorder was the most common among those with a disorder(32%) • Depression was the most common among all health plans(24%) • Nearly 7 or 10 who had a disorder contacted professional treatment. The Minnesota Mental Health System: Demand, Capacity and Cost, February 2004. Minnesota Psychiatric Society, www.mnpsychsoc.org

12. The CoalitionCommunity-Based System of Care

13. Moving Forward – Assessing Your Capital Intellectual Capital Social Capital Intellectual capital is intellectual material--knowledge, information, intellectual property, experience--that can be put to use to create wealth. It is collective brainpower. Social capital refers to the norms and networks that enable collective action. Social capital is critical for poverty alleviation and sustainable human and economic development. Venture Financial Capital Mission Capital Financial capital, or economic capital, is any liquid medium or mechanism that represents wealth. Mission capital refers to assets that are generated from a shared vision that is passionately embraced.

14. Moving Forward – Assessing Your Capital Intellectual Capital Social Capital School district, Centracare, Stearns County & community leaders MWC Financial Capital Mission Capital Nurturing Families and Strengthening Communities

15. Process of Sustainability IMPLEMENTATION – Phase 2 1) Pursue and secure credentialing as an MA provider as well as other insurance related accreditations. 2) Recruit a long-term community partner to provide the MWC service 3) Fill out the budget through corporate partnerships. IMPLEMENTATION – Phase 1 1) Triage/MWC asset/capital mapping and budget determination, public relations planning, data collection inspection for appropriateness to end vision, systems analysis 2) Begin billing for contracted staff time. PLANNING The vision of the MWC is developed in the schools, community and beyond – Year 2: Staff - $220k + Contracted Staff - $240k, Office set up - $17k, ($477,000 per year). Long term sustainability plans take shape. DISCUSSION The vision of the MWC is made into reality – Year 1: Vehicle purchased - $200k, Staff hired - $220k + Contracted Staff - $240k, Office set up - $17k, Schedule begun ($677,000 start up total)

16. Long-term Funding • Each student receives ~6.5 hours of billable service • 6.5 hours = ~$1,400 • Contracted service is ~$240k annually requiring 171 students to pay for the contract • Additional expenses @ ~$220k would require another 157 students at the billable rate • Total students would need to be 328 annually or 6 new cases weekly • In 2003-2004 the MWC completed 82 full assessments

17. School-Based Mental Health Consultative and Collaborative Services: The St. Cloud Model For more information contact: Michael D. Quesnell, Ph.D. Project Coordinator Safe Schools/Healthy Students (320) 252-2231, x3072 Michael.quesnell@isd742.org www.isd742.org/sshs