Caring Across Caring Across Communities: A Communities: A School-

Based Model for Community Mental Health Partnerships

Mark Sander, PsyD, LPMark Sander, PsyD, LPHennepin County/Minneapolis Public Hennepin County/Minneapolis Public

SchoolsSchoolsJim Johnson, MSW, LICSWJim Johnson, MSW, LICSWMinneapolis Public SchoolsMinneapolis Public Schools

Why Mental Health in Why Mental Health in Schools?Schools?

Over the last decade there has been a growing Over the last decade there has been a growing interest and expansion in SMHPinterest and expansion in SMHP

School are a point of universal accessSchool are a point of universal access If integrated well can establish a continuum of If integrated well can establish a continuum of

prevention, early intervention and treatmentprevention, early intervention and treatment Utilizes natural environment of generalization Utilizes natural environment of generalization

of skills of skills School have great impact on social/emotional School have great impact on social/emotional

development and well being of childrendevelopment and well being of children School can be non-threatening environment School can be non-threatening environment

(de-stigmatize mental health) (de-stigmatize mental health)

Vision StatementVision Statement

Form public/private partnerships to Form public/private partnerships to deliver a broad continuum of high deliver a broad continuum of high quality mental health services to the quality mental health services to the students and families of Minneapolis students and families of Minneapolis Public Schools that are universally Public Schools that are universally accessible, culturally competent, accessible, culturally competent, effective, compliant with data effective, compliant with data privacy requirements and privacy requirements and sustainablesustainable

Guiding PrincipleGuiding Principle

We did not create a new set of services. We We did not create a new set of services. We looked for opportunities to:looked for opportunities to:

1.1. Align current effortsAlign current efforts2.2. Capitalize on the strengths and resources of Capitalize on the strengths and resources of

current services and providerscurrent services and providers3.3. Help partners meet organizational goals and Help partners meet organizational goals and

mandatesmandates4.4. Create universal accessCreate universal access5.5. Understand the needs and workings of each Understand the needs and workings of each

partnerpartner6.6. Develop trust and transparency among the Develop trust and transparency among the

partnerspartners

EXPANDED SCHOOL EXPANDED SCHOOL MENTAL HEALTH (ESMH)MENTAL HEALTH (ESMH)

ESMH framework ESMH framework Dr. Mark Weist and colleagues – Center Dr. Mark Weist and colleagues – Center

for School Mental Healthfor School Mental Health Builds on existing resources and Builds on existing resources and

strengthens in schools partnering with strengthens in schools partnering with school staff to develop a full continuum school staff to develop a full continuum of mental health servicesof mental health services

Expanded = augment, build upon; NOT Expanded = augment, build upon; NOT duplicate or replaceduplicate or replace

Program OverviewProgram Overview

The Continuum includes:The Continuum includes: On site services for prevention, early intervention, On site services for prevention, early intervention,

screening, diagnostic evaluation and treatment screening, diagnostic evaluation and treatment (including individual, family and group)(including individual, family and group)

Teacher consultationTeacher consultation Capacity Building – School staff trainingCapacity Building – School staff training

As needed: As needed: Access to Targeted Mental Health Case ManagementAccess to Targeted Mental Health Case Management Day Treatment Day Treatment Residential TreatmentResidential Treatment Crisis Assessment and InterventionCrisis Assessment and Intervention

What it looks like at a What it looks like at a schoolschool

Community Mental Health Agency provides full Community Mental Health Agency provides full time mental health professional at each schooltime mental health professional at each school

SMH clinician partners with student support SMH clinician partners with student support staff staff

The activities and services of the clinician The activities and services of the clinician augment the work done by student support staff augment the work done by student support staff to achieve a broad continuum of services and to achieve a broad continuum of services and supportssupports

Range of services: both direct child and family Range of services: both direct child and family specific as well as school-wide services, including specific as well as school-wide services, including assessment and treatment, teacher consultation, assessment and treatment, teacher consultation, care coordination, classroom presentations, care coordination, classroom presentations, school-wide trainingsschool-wide trainings

School and Provider School and Provider MatchingMatching

School need and readiness to engage in School need and readiness to engage in ESMH ESMH Traditionally underserved populationsTraditionally underserved populations Principal commitment and supportPrincipal commitment and support Appropriate of student support servicesAppropriate of student support services Interest and commitment by school staff to support Interest and commitment by school staff to support

servicesservices Who the partners wereWho the partners were

Cultural and linguistic matchCultural and linguistic match Presence and reputation in the communityPresence and reputation in the community Have necessary infrastructure for sustainability Have necessary infrastructure for sustainability

Immigrants and Immigrants and RefugeesRefugees

Poverty rates are higher for children in immigrant Poverty rates are higher for children in immigrant and refugee families than children in native-born and refugee families than children in native-born familiesfamilies Parents are more likely to perform low-wage work with Parents are more likely to perform low-wage work with

no benefits (lack of health insurance) or limited benefitsno benefits (lack of health insurance) or limited benefits Pre-migration, migration, and post-migration Pre-migration, migration, and post-migration

exposure to traumatic events creates exposure to traumatic events creates vulnerabilitiesvulnerabilities

People with limited English proficiency (LEP) are People with limited English proficiency (LEP) are less likely to seek care and receive needed less likely to seek care and receive needed services (even when economic factors and services (even when economic factors and ethnicity are accounted for)ethnicity are accounted for)

Minneapolis ContextMinneapolis Context

Minneapolis is a culturally diverse city,Minneapolis is a culturally diverse city,

The school district has:The school district has:

76% Students of Color76% Students of Color 26% English Language Learners26% English Language Learners Large African immigrant populationLarge African immigrant population Largest Somali and Oromo communities Largest Somali and Oromo communities

in the nationin the nation Growing Spanish speaking populationGrowing Spanish speaking population

Considerations for Diverse Considerations for Diverse Communities Communities

Improving language access – bilingual and Improving language access – bilingual and bicultural providers bicultural providers

Outreach and bi-directional education Outreach and bi-directional education Providing culturally specific support Providing culturally specific support

servicesservices Enhancing service by training and Enhancing service by training and

adapting interventionsadapting interventions

Ethnicity: 2005-2008Ethnicity: 2005-2008

SY06 # SY06 % SY07 # SY07 % SY08 # SY08 %

Unknown 3 0.9% 6 1.7% 5 1.4%

American Indian/Alaskan Native 22 6.9% 25 7.3% 32 8.7%

Asian/Pacific Islander 12 3.7% 9 2.6% 6 1.6%

Hispanic 82 25.5% 88 25.7% 80 21.7%

African Immigrant 34 10.6% 35 10.2% 16 4.3%

Caucasian 51 15.9% 40 11.7% 51 13.8%

African American 112 34.9% 113 32.9% 137 37.1%

Missing 5 1.6% 27 7.9% 42 11.4%

Total # of Students 321 100.0% 343 100.0% 369 100.0%

2005-2008 Data 2005-2008 Data   Feb 05 – July 06 Aug 06 – July 07 Aug 07 – July 08

Number of Students 321 343 369

Number Seen 263 298 331Male 56% 67% 60.9% *Female 43% 33% 36% *General Ed 59% 56.60% 63.10%Special Ed 41% 43.40% 36.90%ELL 30.50% 31.50% 22.50%Free/Reduced

Lunch80% (18.9%) 70.3% (27.1%) 69.9% (27.1%)

2005-2008 Year 2005-2008 Year HighlightsHighlights

During the past 3 ½ years, 750 students have been During the past 3 ½ years, 750 students have been referred to the program and more than 85% of those referred to the program and more than 85% of those students (more than 660 students) were seen at least students (more than 660 students) were seen at least once face to face; 65% 1once face to face; 65% 1stst time receiving services time receiving services

The program provides equal access to all students The program provides equal access to all students regardless of general or special education status, regardless of general or special education status, ethnicity, or if they are English Language Learners. ethnicity, or if they are English Language Learners.

Students and families had quicker access to mental Students and families had quicker access to mental health services - more than 70% students and families health services - more than 70% students and families were seen within two weeks. were seen within two weeks.

Students and families show continued engagement in Students and families show continued engagement in the intervention services, evidenced by the average the intervention services, evidenced by the average number of face to face visits is 13.5 and that students number of face to face visits is 13.5 and that students and families keep over 90% of their scheduled and families keep over 90% of their scheduled appointments.appointments.

Range of intensity – 1-9 visits (54%, 42%), 10-29 (33% , Range of intensity – 1-9 visits (54%, 42%), 10-29 (33% , 45%) and 30-70 (14%, 13.5%)45%) and 30-70 (14%, 13.5%)

2005-2008 Outcomes2005-2008 Outcomes

Feedback from principals and assistant Feedback from principals and assistant principals:principals: 90% reported Excellent/Good quality and strongly 90% reported Excellent/Good quality and strongly

agreed got service I wantedagreed got service I wanted 80% would strongly recommend/recommend to 80% would strongly recommend/recommend to

other familiesother families Mental Health Outcomes are improving at Mental Health Outcomes are improving at

reported by teacher and parent on SDQreported by teacher and parent on SDQ Impact on suspensions Impact on suspensions

Intervention Yr (SY07) – (n=82) 50% reduced 1-6, Intervention Yr (SY07) – (n=82) 50% reduced 1-6, 32% stayed the same (SY06-SY07); SY05 mean 32% stayed the same (SY06-SY07); SY05 mean 1.5, SY06 mean 2.26 – trending up before SY071.5, SY06 mean 2.26 – trending up before SY07

Analyzing impact on student suspended 3 times or Analyzing impact on student suspended 3 times or moremore

Critical PartnersCritical Partners

Community mental health staffCommunity mental health staff Minneapolis Public Schools Minneapolis Public Schools Hennepin County Children’s Mental HealthHennepin County Children’s Mental Health The Mental Health CollectiveThe Mental Health Collective La Familia Guidance CenterLa Familia Guidance Center Washburn Guidance CenterWashburn Guidance Center Hennepin County – Office of Multicultural Hennepin County – Office of Multicultural

Services Services African Aid African Aid MPS Family Resource CenterMPS Family Resource Center

Thanks to…Thanks to… Safe School Healthy Students Grant – US Safe School Healthy Students Grant – US

Dept of Education, US Dept of Juvenile Dept of Education, US Dept of Juvenile Justice, US Dept Health and Human Justice, US Dept Health and Human ServicesServices

Robert Wood Johnson FoundationRobert Wood Johnson Foundation Medica Foundation Medica Foundation NorthStar FoundationNorthStar Foundation Blue Cross/Blue Shield Foundation Blue Cross/Blue Shield Foundation Leah Kayless Ingber FoundationLeah Kayless Ingber Foundation Hennepin County Children’s Mental Health Hennepin County Children’s Mental Health

Collaborative Collaborative MN Department of Human Services, MN Department of Human Services,

Department of Children’s Mental HealthDepartment of Children’s Mental Health

Contact InformationContact Information Mark Sander, PsyD, LPMark Sander, PsyD, LP

Minneapolis Public Schools/Hennepin County Minneapolis Public Schools/Hennepin County Coordinator, Minneapolis School Mental Health Coordinator, Minneapolis School Mental Health

ProgramProgram Email: Email: mark.sander@co.hennepin.mn.usmark.sander@co.hennepin.mn.us Phone: 612-668-5489Phone: 612-668-5489

Jim Johnson, MWS, LICSW Jim Johnson, MWS, LICSW Minneapolis Public SchoolsMinneapolis Public Schools Director, Student Support ServicesDirector, Student Support Services Email: Email: jim.johnson@mpls.k12.mn.usjim.johnson@mpls.k12.mn.us Phone: 612-668-5432Phone: 612-668-5432