School-based Mental Health Services

1. November 21, 2008 UMC Bede Ballroom, Crookston, MN Brenda Anderson, MSW, LICSW Tim Denney, MS, CRC Jessica Shockman, LSW School-basedMental Health Services

2. School-based Mental Health Services Grant Overview • Purpose: To increase accessibility of mental health services for children within their communities. • Sustain existing school social worker positions. • School is a key screening and service delivery point. • Families are more likely to seek and maintain services if services are located in the community. • The goals of the grant include better outcomes in • Academic performance • School attendance • Incidence of disciplinary referrals • Social and emotional functioning

3. School-based Mental Health Services: Research Base SBMHS determined to be effective at some level in 80% of cases if the following factors are associated with services: • Consistent implementation • Multi-component programs (child, teacher, parent included) • Multiple approaches (consulting, skills-building, etc.) • Specific behaviors and skills are targeted • Developmentally-appropriate strategies are used • Strategies are integrated into classroom curriculum Rones & Hoagwood 2000

4. School-based Mental Health Services and System of Care • The SOC cooperative agreement is intended to change the overall system to a consumer-driven, coordinated, culturally competent service system • The SBMHS activities are an enhancement to the overall system of care (SOC) • Training for social workers will reinforce SOC values • Social workers will have the improved SOC system as a support network for their work in the schools

5. School-based Mental Health Services and System of Care • Other agencies are prepared to coordinate with SBMHS social workers • Grant services will be delivered in a way that compliments the system improvement goals of the SOC • Consumer-driven services (family-driven, youth-guided) • Services for families will be coordinated between agencies • Services will be culturally sensitive to each family

6. School-based Mental Health Services and System of Care • The SOC “best practices” of consumer-driven, coordinated care are shown to improve outcomes for children and families • Schools will be at the forefront of system improvement by means of the SBMHS project • Family empowerment is growing across the region, and schools will be able to meet the demand for family-driven services.

7. School-based Mental Health ServicesContracts Purposes of the contractual arrangements: • Replace diminishing LCTS funding in order to sustain school social work positions in 18 Districts • Help fund school-based mental health workers employed by the NWMHC and contracted by 4 districts.

8. School-based Mental Health Services and Funding • LCTS money is not a sustainable source for school social worker funding • The SBMHS approach, utilizing both grant and MA funding, allows for sustainable funding via “fee for service” activities • The SBMHS grant provides money for clinical supervision, allowing all schools to either begin billing now or move employees toward billing eligibility at no cost to the districts • While “fee for service” billing is more paperwork, it is likely to be a more durable funding process for sustainability

9. School-based Mental Health Services and Funding SBMHS funding available equally to all districts for the three years: • 2008-09 $4413.00 plus $3000.00 Crisis funding • 2009-10 $8182.00 • 2010-11 $11, 251.00 • Funds not billed for will be re-allocated in the Spring of each year. • Funds not spent by grantees by 6/30 of each year are returned (“Use it or lose it”).

10. School-based Mental Health ServicesOverview SBMHS social workers (practitioner or professional) will be able to do these activities • Diagnostic Assessments (Mental Health professionals) • Individual and group skills-building activities (under clinical supervision or LICSW professional) • Individual and group psychotherapy (LICSW professional only) • Crisis screening, assessment,intervention, stabilization

11. School-based Mental Health ServicesOverview • Billing for services depends upon a social worker attaining MH practitioner or MH professional status • Until a social worker attains practitioner status, these services cannot be performed or billed to the grant or to MA. Crisis services money can still be accessed, and clinical supervision is provided toward practitioner status

12. School-based Mental Health ServicesAdvantages Schools with practitioner or professional social workers… • Provide Children’s Therapeutic Supports and Services (CTSS) in schools, increasing the likelihood for improved student performance. • Provide these services with clinical supervision. • Provide these services along with other job duties as set forth in the local job descriptions. • Sustain the social worker positions by utilizing billable funding streams. • Access the larger SOC referral network for additional services.

13. School-based Mental Health ServicesAdvantages 6. Schools will benefit from more highly skilled social workers. 7. CTSS activities will be supported by other agencies due to the SOC values being built into the entire system 8. Families are more likely to be actively engaged in service delivery due to locating of service in schools and SOC values behind the service delivery. 9. Instructional staff can be informed and active screeners for behavioral problems that underlie mental health difficulties.

14. School-based Mental Health ServicesAdvantages 10. Grant funds will be redistributed in the Spring based upon under- and over-utilization, allowing for full use of funds. 11. Districts will receive regular reports on their own fund utilization. 12. Districts will receive on-site and phone-based technical assistance in implementing grant activities and providing CTSS at school.

15. School-based Mental Health ServicesContracts District Hosted Position Agreement: • The Agreement establishes two relationships between parties including: • District as provider of CTSS and MH Crisis services reimbursed by the NWMHC from grant and MA funds; • Center as a provider of other mental health services that qualify as Special Education or MA Option 2 services.

16. School-based Mental Health ServicesContracts • Reimbursement rates established: • For Grant and MA funded services reimbursed by the Center (Attachment A) • For Special Education and MA Option 2 services reimbursed by the District (Attachment B) • Funding estimates and sources identified (Attachment C). • Service description included (Attachment D) • Special Education eligibility requirements included (Attachment E).

17. School-based Mental Health ServicesContracts NWMHC Hosted Position Agreement • The relationship established in this agreement includes: • The NWMHC as the provider of MA and grant funded CTSS services, grant funded crisis services, and Special Education/”related” services; • The District as purchaser of Special Education Services and as requested by the District, “Option 2” MA funded MH services. • Note: the agreement has been revised away from a “position funding” approach to a “service reimbursement” approach, for better compliance with Special Education requirements.

18. School-based Mental Health ServicesContracts • Reimbursement rates established: • For Special Education and MA Option 2 services reimbursed by the District (Attachment A) • Service description included (Attachment B) • Position Job Description included (Attachment C) • Special Education eligibility requirements included (Attachment D) • Funding estimates and sources identified (Attachment E)

19. School-based Mental Health ServicesContracts Both Agreements: • Term of the Agreement identified. • Contract termination language included. • Client and service eligibility defined. • Responsibilities of both parties listed. • Ownership of clinical records described. • Responsibility for funding disallowances or paybacks delineated. • “Other Conditions” as required by State and Federal regulations listed.

20. School-based Mental Health Services Accomplishments • Development of the Intake, billing, and quality assurance (QA) manual • Initial training for school social workers complete • Clinical supervision arrangements in place, providing ongoing supervision for each social worker • Steering Committee meeting regularly to oversee the development and growth of SBMHS activities • Special Education-Mental Health workgroup meeting to sort out billing and QA procedures • The school social workers are ready to move forward with the new processes and procedures

21. School-based Mental Health ServicesThe Future • As LCTS money becomes less certain, the sustainability of the school social worker is improved with this funding system • The LCTS funding is replaced with a fee-for-service model focused upon the grant and MA revenues • Children with mental health disabilities in the school setting are more likely to be identified, to receive services, and improve by utilizing school-based services • Student performance is likely to improve as underlying causes for problems are addressed • Children can receive year-round services through mental health partnerships • School staff can be trained in mental health screening, and mental health difficulties can be de-stigmatized.