s chool c ommunity p artnership for m ental h ealth
DESCRIPTION
Sheri Johnson, Medical College of Wisconsin Paul Florsheim, University of Wisconsin, Milwaukee Sebastian Ssempijja, Sebastian Family Psychology Practice Charlie Bauernfeind, Milwaukee Public Schools Carrie Koss Vallejo, IMPACT Planning Council. - PowerPoint PPT PresentationTRANSCRIPT
School Community Partnership for Mental HealthStory Session
Sheri Johnson, Medical College of WisconsinPaul Florsheim, University of Wisconsin, MilwaukeeSebastian Ssempijja, Sebastian Family Psychology PracticeCharlie Bauernfeind, Milwaukee Public SchoolsCarrie Koss Vallejo, IMPACT Planning Council
Using the Clickers
Each of you has a “clicker” that will allow you to respond to questions during the presentation, and we’ll be able to see the responses.
Please use the pad of your finger to press buttons –not your fingernail.
You can change your answer, but only your last response will “count.”
Getting to know our audienceWhat field do you work in?
1 2 3 4 5 6
14%
0%
36%
0%
50%
0%0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
1. Healthcare
2. Behavioral Health
3. Education- At a university
4. Education- K-12
5. Community Based Org
6. Community Activist
SCPMH Goal Statement
The goal of the School Community Partnership for Mental Health is to:
refine and demonstrate the effectiveness of
a collaborative partnership model of mental health promotion and service
to influence systems changes needed for sustainability.
PartnersSchools in
Wisconsin’s largest district
Community Mental Health Providers
HMOs
Sebastian Family Psychology
Practice, LLC
CHWs/Research Assistants
Academic Partners Funders
Story Session OutlineChapter 1: SCPMH – The Early Years
Needs AssessmentBuilding the model Addressing systems barriers
Chapter 2: SCPMH- The Middle YearsPerspectives from School Staff, Community Mental Health Providers, Researchers & Community Health Workers
Case Discussion
Story Session Outline
Chapter 3: SCPMH- GraduationTreatment InitiationSchool and Parent SatisfactionBehavioral ImprovementStigma
Chapter 4: SCPMH-Lessons Learned
Chapter 1 –The Early YearsNeeds Assessment, Model Building, Barrier Busting
Photo from City of Milwaukee’s I want a strong baby public health campaign
The Early Years (2005-2009)1) National Family Week Partnership
study (2005) of mental health services for youth in Milwaukee –
ACCESS IS PROBLEMATIC.
2) Milwaukee Public Schools estimated only-
5% of STUDENTS GET CARE.
3) Youth Mental Health Connections,COMMITS TO ACTION.
Connecting Need and Capacity: A Study of Mental Health Services for Youth in Milwaukee County Lengyel et al 2005
The Early Years (2008-2009)
The Middle Years:Pilot strategies
Views from School Staff, Community Mental Health Providers, Researchers and Community Health Workers
Case Discussion
The Middle Years: 2009-2013 Three community-based agencies providing
consultation and direct services in collaboration with four Milwaukee Public Schools
Project coordinator working with Leadership Team to oversee implementation
Public Health researchers developing and testing a process for outcomes research incorporating Community Health Workers
Operations manual and referral system being developed to support expansion
II
I
III
• Refer selected students• Obtain ROI• Consultation with Guardian• Individual / Family Therapy
• Consultation with Staff• Classroom
presentations
• School embedding activities
SBIRT & PBIS3 Levels of Support System
SCPMH Community CoordinatorThe coordinator is the “go-to” person for the participating community mental health agencies
The coordinator assures that the community partners understand and comply with their roles
The coordinator works with insurance providers, community health workers, government agencies, and university researchers to enhance collaborative efforts
SCPMH School CoordinatorThe coordinator is the “go-to” person for schools
Coordinates school events and communications
Assures record keeping and data collection
Addresses problems at schools Assures compliance with SCPMH policies and procedures
School Staff Perspective
Mental Health is taboo → Mental Fitness Overcoming “union” issues Need full-time support services staff to triage Building Bridges to schools takes time The Building Principal The Pupil Services Support Staff The Classroom Teacher Building trust is a slow processSchool calendar and attendance are issues
COMMUNITY HEALTH WORKER ROLE-Bridge Building Assist with delivery and completion of initial
paperwork by parents- ROIs, research consents and data
Conduct “check-ins” with providers and teachers
Assure two-way communication with families
Provide links to broad range of resources – school social worker and others
Participate in school’s family events and staff meetings
Provide a cultural bridge for families to schools and providers
Community Health Worker (CHW) Perspective
New role
Research assistant
Varied responsibilities:
Making home visits
Sharing info with therapist and school
Finding additional services for clients
What is the first priority for a CHW when meeting a family?
12
34
0% 0% 7%
93%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1. Get a Release of Information (ROI)
2. Sign family up for research
3. Connect family to support services
4. Build an alliance/trusting relationship
Community Mental Health Agency Perspective
Reflections on the processAdministrator buy inClinicians who had the “right fit”Provider/Client Alliance
Community Mental Health Agency Perspective
Implementation experiences and deliverablesCulture shiftAgency utilizationFeedback and ongoing assessmentStandardization of and operational momentum
Researcher PerspectiveAssessing readiness for research vs. evaluation
Balancing rigor and feasibilityData collection challenges
Consenting
Gathering data over time from multiple sources
Using administrative data sources to measure outcomes
Using real time data to inform implementation and sustainability
Case Study DiscussionPhoto credit: MCW Annual Report – SCPMH staff from Medical College of
Wisconsin, Milwaukee Publics Schools, IMPACT Planning Council and Sebastian Family Psychology Practice.
How should SCPMH intervene?12 year old male studentClassmates report he was bit by a dog
Teacher notes grades starting to slipSSW engages student, provides social emotional support
Student develops attendance issuesSSW discovers student and mother were victims of random gunfire
Student detaches from friends
What are the major obstacles to school based mental health services?
1. Teachers are resistant2. School administrators
won’t allow it3. Community providers
aren’t interested4. Parents are not
invested5. There is no good
source of funding
Evidence Based Therapy is overrated and hard to implement in real world settings
1
2
17%
83%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1. True 2. False
How important is it that families who receive therapy participate in the research?
Please rate 1 (lowest) - 5 (highest)
33%33%
20%
7%7%
0%
5%
10%
15%
20%
25%
30%
35%
1 2 3 4 5
1 2 3 4 5
Chapter 3: GraduationDo we have the data to go forward?
Stages of Implementation (Perales, Johnson, Barret and Eber)
Focus Stage Description
Exploration/Adoption
Decision regarding commitment to adopting the program/practices and supporting successful implementation.
Installation Set up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct audit, develop plan.
Initial Implementation
Try out the practices, work out details, learn and improve before expanding to other contexts.
Elaboration Expand the program/practices to other locations, individuals, times- adjust from learning in initial implementation.
Continuous Improvement/Regeneration
Make it easier, more efficient. Embed within current practices.
What did we learn?Treatment Initiation RatesStigmaProgram Satisfaction and ChallengesSchool Staff ParentsMental Health Providers and Community Health Workers
Behavioral Improvement
Treatment Initiation
Perceptions of Stigma among School Staff and Parents
Program EvaluationOpen ended interviews with parents of students enrolled in treatment (N=6)
Open ended interviews with principals from 4 schools (N=4; 100% response)
Closed ended survey data from staff at 4 schools (N=171; 69% response rate)
Open ended survey data from community mental health providers and community health workers (N=9; 100% response rate)
Overarching Themes - Positive Access
Safe environment for kidsConvenient for parentsSmart/Efficient for everyone
PartnershipNovelHelpfulNeeded
OutcomesBehavior change
Overarching Themes - NegativeLogistics
ConsentCommunicationCapacityCoordination
Parent InvolvementLower than desired
Missed opportunity for input
Missed opportunity for addressing stigma
Stigma
+In their own words: Principal: “If it went away, we wouldn’t have
institutional knowledge of where to place students, but then again there’s that therapeutic piece where you have that connection between somebody that’s coming in here on a consistent basis, building relationships with students and providing strategies and solutions. I’ve seen firsthand where that’s really effective.”
CHW: “More communication between the therapist and CHW, on a regular basis, is a must in order to make sure that everyone is on the same page as far as clients and their treatment.”
+In their own wordsParent: “I believe a lot of parents would
feel like they’re all by themselves and they don’t have any help, cause that’s how I felt for a long time, like ‘I’m the only one going through this,’ until you find out there’s other parents going through what you’re going through.”
Provider: “After the school year was over clients did not want to come to the office, some parents did not have time, others did not feel comfortable driving to the office. So out of 10 cases, just one family followed up with therapy during the summer.”
Behavioral and Academic Outcomes – The PlanAdministrative School Data for all students referred to SCPMHAttendance office referraldisciplinary action special education status standardized test scores
Behavioral and Academic Outcomes-The Plan
For those who consented to research: Strengths and Difficulties Questionnaire baseline, 3 months, 6 monthsparent, teacher, student
Revised Working Alliance Inventory 4 weeks, 6 monthsparent, teacher, student
Behavioral Outcomes 2011-2012 cohort
1) Office Referrals:
Significant difference betweenpre/post intervention (p<.03)
2) Disciplinary Action Taken:
Significant difference between pre/post (p<.0065)
Wilcoxon signed rank sum test used to test the significance of two paired samples.
Office Referrals- trend toward decline for those in therapy
Attendance – going the wrong direction?
Chapter 4: Lessons LearnedFrom the real world
Increasing Level of Community Involvement, Impact, Trust, and Communication Flow
Outreach Consult Involve Collaborate Shared Leadership
Some Community Involvement
Communication flows from one to the other, to inform
Provides community with information.
Entities coexist.
Outcomes: Optimally, establishes communication channels and channels for outreach.
More Community Involvement
Communication flows to the community and then back, answer seeking
Gets information or feedback from the community.
Entities share information.
Outcomes: Develops connections.
Better Community Involvement
Communication flows both ways, participatory form of communication.
Involves more participant with community on issues.
Entities cooperate with each other.
Outcomes: visibility of partnership established with increased cooperation.
Community Involvement
Communication flow is bidirectional
Forms partnership with community on each aspect of project from development to solution.
Entities form bidirectional communication channels.
Outcomes: Partnership building, trust building.
Strong Bidirectional Relationship
Final decision making at community level.
Entities have formed strong partnership structures.
Outcomes: Broader health outcome affecting broader community. Strong bidirectional trust built.
Is SCPMH Community Engaged Research
45*Modified version from International Association for Public Participation Principles of Community Engagement , 2nd Edition CTSA Consortium
Lesson Learned:
How do we engage parents as co-collaborators in program development, implementation and evaluation?
CHW/Parent Interactions
School Staff Survey Results
*Dichotomized for Satisfied/Not Satisfied
The Exchange Boundary Framework: Understanding the Evolution of Power within Collaborative Decision-Making Settings -Watson and Foster-Fishman (2013)
The presence of disadvantaged stakeholders at decision-making tables does not ensure the: valuing
access
use
of their resources
49Source: Watson, and Foster-Fishman (2013) The Exchange Boundary Framework: Understanding the Evolution of Power within Collaborative Decision-Making Settings. Am J Community Psych
Stakeholders have opportunity and capacity to:•Activate and incorporate resources into exchanges•Value less-advantaged stakeholder resources
Increased
Resource Exchang
e
Less-advantaged stakeholders better able to
leverage dependencies
through resource exchanges Increased
power for less-
advantaged stakeholders
to authentically
influence decisions
Stakeholders have opportunity and capacity to engage in discourse to:•Increase critical consciousness of boundaries around legitimate exchanges•Value expanded boundaries
Expanded Social Boundari
es
Increased range of resources
that less-advantaged stakeholders
can legitimately exchange
Critical Processes within the Exchange Boundary Framework
Watson and Foster-Fishman (2013)
50
Acknowledgements Dena Radtke and staff, MPS
Sue McKenzie, Rogers Memorial Hospital
Katie Pritchard and staff, IMPACT Planning Council
Audrey Potter, IMPACT Planning Council
Pippa Simpson and staff, MCW
Chelsea Hamilton, MCW
Sandy Bogar, MCW; Vania Trejo, Zoey Schmidt, UWM
Kevin O’Brien and staff, Aurora Family Services
Cathy Arney and staff, Pathfinders Milwaukee
Sebastian Family Practice staff
Families and staff at OW Holmes, Hopkins Lloyd, Wedgewood Park and Audubon.