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Charlotte-Mecklenburg Schools Vision. For. School-Based Mental Health Services

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Charlotte-Mecklenburg Schools Vision For School-Based Mental Health Services Special Gratitude to all CMS and Community Committee Members: CMS Staff Karen H. Thomas, Cynthia Shaw, Cynthia Vines, Cheryl
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Charlotte-Mecklenburg Schools Vision For School-Based Mental Health Services Special Gratitude to all CMS and Community Committee Members: CMS Staff Karen H. Thomas, Cynthia Shaw, Cynthia Vines, Cheryl Robinson, Lisa Newman, Brenda Kendrick, Carrie Sargent, Kevin Ligon, Rhonda Harris, Agatha Ratulowski, Cotrane Penn, Lisa Barnes, Valoria Burch, Laura Hamby, Kathy Elling, Lisa Milner, Bettie Chisholm Community Stakeholders Michelle Lancaster, Mecklenburg County; Aaleace Pugh-Lilly, MeckLINK; Andrea Towner, Mental Health Association of the Carolinas/ParentVOICE; Joanna Rivera, Latin American Coalition; Anne Pfeiffer, Pat s Place; Laurie Gallagher, Council for Children s Rights; Sandy Hammond, Women s Commission; Stanley Alexander, Department of Social Services/Youth and Family Service; Candice Wilson, Mental Health Association of the Carolinas/ParentVOICE; Judge Elizabeth Trosch, Mecklenburg County Courts & Taleayah Stanley, Junior League of Charlotte 2 P a g e Contents 1.1 Desired District Outcomes Desired Agency Services Agency Responsibilities Agency Service Effectiveness Measures District Responsibilities School Responsibilities Collaborative Responsibilities Appendix A: CMS Referral to School-Based Mental Health Agency Services Process... Error! Bookmark not defined. Appendix B: Continuum of Care References P a g e Approximately twenty-percent of all children and adolescents present with behavioral and emotional difficulties (Blau, Huang, & Mallery, 2010) but only one-third of children in need of mental health support actually receive services (US Public Health Service, 2000). The Surgeon General and IDEA regulations have identified school as the ideal location for children to receive mental health support, and in fact it is where seventy-percent of students in need receive some type of mental health support (Kutush, Duchnowski, & Green, 2011). For students whose significant mental health needs affect learning or school attendance, the availability of evidence-based mental health services is critical to improving their emotional well-being (Kutush, Duchnowski, & Green, 2011) and enhancing their ability to access and benefit from instruction (Paz Guzman, Jellinek, George, & Marcela, 2011). 1.1 Desired District Outcomes Increased student achievement over time Students with behavioral and emotional difficulties may display poor academic achievement. Achievement deficits may be related to low skills, but inevitably those difficulties are also connected to lost instruction due to disciplinary issues and difficulties attending to instruction related to poor coping skills. Through the receipt of mental health services, it is the District s expectation that over time, children s achievement will increase. Growth in academic skills and performance will be measured using the following assessments: Short-term growth Literacy grades K-5: Reading3D Benchmark scores + Literacy grades K-8: Measures of Academic Progress RIT scores + Math grades K-8: Measures of Academic Progress RIT scores + Grades 9-12: Credits accumulated per semester compared to expected +Baseline will be established using the most recent performance measure on each of the above assessments prior to the start of mental health services. Long-term growth Literacy grades 3-8: NC End of Grade Assessments* Math grades 3-8: NC End of Grade Assessments* Grades 9-12: Credits accumulated by end of school year compared to expected based upon high school entry year *Baseline will be established using the percentile rank and/or standard score once it becomes available at the close of the school year. Improved student attendance Children with emotional and behavioral difficulties may have poor attendance. This can be related to psychiatric hospitalizations, fears and anxieties related to school, disciplinary actions leading to suspension, as well as incarceration amongst other reasons. Through the receipt of mental health services, it is the District s expectation that children s attendance will improve over time. PowerSchool will be used to collect the following attendance data for students receiving school-based mental health services: Number of absences in the school year prior to the start of mental health services Number of absences in the school year(s)while receiving mental health services Number of absences the school year following exit from mental health services 4 P a g e Decreased out-of-school suspension Children with emotional and behavioral difficulties who display externalizing behaviors may accumulate many days of out-of-school suspension (OSS) over time. It is the District s expectation that due to an increase in coping skills, children receiving mental health therapy will receive fewer days of suspension during and post mental health services than pre-mental health services. PowerSchool will be used to collect the following OSS data for students receiving school-based mental health services: Number of OSS days in the school year prior to the start of mental health services Number of OSS days in the school year(s)while receiving mental health services Number of OSS days the school year following exit from mental health services Decreased in-school suspension Children with emotional and behavioral difficulties who display externalizing behaviors may accumulate many days of in-school suspensions (ISS) over time. It is the District s expectation that due to an increase in coping skills, children receiving mental health therapy will receive fewer days of suspension during and post mental health services then pre-mental health services. PowerSchool will be used to collect the following ISS data for students receiving school-based mental health services: Number of ISS days in the school year prior to the start of mental health services Number of ISS days in the school year(s)while receiving mental health services Number of ISS days the school year following exit from mental health services Increased positive coping skills Coping skills allow children to adapt in a way that helps them to meet environmental demands despite behavioral or emotional difficulties that could interfere. It is the expectation that children who receive school-based mental health services will increase their coping skills to the degree that they function better socially, behaviorally, and emotionally. Designated school personnel will facilitate the administration of the Behavioral Assessment System for Children-2 Online, Teacher Edition: Prior to the start of mental health services At the end of the school year or upon termination of services if services end during the school year Each individual agency, the school-based System of Care Designee, and the SBMH Program Specialist will share access to behavioral rating scale results. Increased access to mental health services With the expansion of agency provided mental health services, it is expected that student access to mental health services will increase. Specifically, the increased availability of agency therapists should allow CMS support staff to provide more direct service hours to a larger number of students with less severe needs while increasing the amount of direct service time provided to students with more significant needs via agency provided services. Direct service delivery hours, and number of students served will be monitored annually using internet-based service logs for each of the following CMS staff providers: School psychologists School counselors School social workers Baselines will be established using school staff service logs for the school year prior to the start of agency services. Agency service hours and numbers of students served will be provided to CMS by the agency. 5 P a g e 1.2 Desired Agency Services The District intends to provide agency services at approximately 70 schools and programs in the school year. Individual Therapy School support staff is able to provide counseling and behavioral intervention for individual students on a short-term basis (see Appendix B). It is the expectation that agencies will provide individual therapy for referred students who exhibit a need for long-term support, and for students whose mental health needs require clinical expertise. Medication Consultation The agency therapist should refer students to the agency s staff medical doctor when there is a perceived need for medication intervention. In addition to supporting the family in undergoing a medication evaluation, it is expected that the agency will provide ongoing medication consultation for the family and student. Additionally, the agency therapist will consult with school staff for information about perceived behavioral/emotional changes related to medication management, and communicate that information to the treating physician. Intensive In-Home Services It is highly desired that agencies providing school-based mental health services are able to offer intensive in-home services for eligible students. Research demonstrates that individual therapy alone may be insufficient for children with complicated ecosystems. Intensive in-home service provides team intervention for children and families in the home setting and aims to reduce psychiatric and substance abuse problems, diffuse current crisis, provide wraparound support, and prevent out of home placement for students. The District has a vested interest in children remaining in their homes whenever feasible and in the student s best interest. This allows students more consistent educational access, which is related to higher achievement. Family Therapy In addition to serving referred students, it is expected that the agency will seek to provide family therapy when it is deemed necessary to support students in meeting therapy goals. 6 P a g e 1.3 Agency Responsibilities Provide master's level clinicians with one or more of the following certifications: LCSW, LPC, LPA, or provisional license School-based therapists must be master s level clinicians who are licensed clinical social workers, licensed professional counselors, licensed psychological associates, or provisionally licensed in one of those areas. The agency must provide regular individual clinical supervision and case consultation for their school-based therapists. Maintain at each school, a regular schedule for agency presence at the school For the goodness of the school-agency relationship and coordination of office space, the agency must maintain a regular schedule at each assigned school. It is understood that at times, the agency therapist may need to alter the schedule to attend important meetings at other school sites. In such situations, it is necessary that clear and consistent communication be provided to the school contact person(s). This promotes agency staff accountability to the schools and students they serve. Work collaboratively with teachers and staff who support agency students In addition to providing individual therapy, the therapist will provide general support for their students in the school setting. This includes but is not limited to teacher consultation, classroom observation and feedback to teachers, support staff, and administrators about individual students, crisis support, and attendance at relevant meetings. Attend individual student meetings upon invitation when possible When meeting topics are pertinent, school staff will invite the therapist to student meetings. Agency staff will attend these meetings when possible for the purpose of gaining new information about the student to support therapy as well as sharing information with the team to support instruction. In cases where the focal student is not currently a client but a referral may be made, parent permission will be obtained for the therapist to attend, and the therapist will be available to provide information about the continuum of services available through the agency. Serve 1 unfunded student for every 10 Medicaid/County funded/privately insured students Schools with high numbers of economically disadvantaged students have historically been best able to support the maintenance of agency services because they have more Medicaid insured students. In contrast, schools with high numbers students who are uninsured or privately insured are least able to maintain the services because of prohibitive flat rates or co-pays. Agencies working in CMS schools must make a commitment to serve 1 unfunded student for every 10 funded students. Students may be funded through Medicaid, CMS funds, or private insurance. For equity of service, pro-bono cases are counted based on funded individual agency case totals across the District, not within a single school. Pro-bono cases will then be allocated to schools based on student need, and not based on which schools generated the funded students to support pro bono cases. The SBMH Program Specialist will manage both CMS-funded case approvals and pro bono case distribution. Maintain contact with the student and school when a student is placed in juvenile detention/jail, PRTF, partial hospital, or day treatment program When students are not attending school due to placement in a higher level facility, including jail, the agency will maintain contact with the student and/or the family and the school-based therapist will have access to this information. The therapist will actively update school support staff on the student s status 7 P a g e and any available discharge information. Using this information, the therapist will collaborate with school staff to plan for the student s return to school and support the student s transition upon return to the school campus. Provide consultation and education for school and District level staff on the topic of mental health. In addition to working with individual students, the agency therapist is available to provide consultation and professional development for school and District staff. The therapist may also provide general consultation about behavior and mental health to school District support staff including counselors, psychologists, social workers, and behavior management technicians. Upon request, the agency therapist may provide presentations at staff meetings or department meetings about matters that fall into their areas of expertise. This may include, for example, understanding how mental health disorders manifest in the school setting, children with ADHD, minimizing anxiety etc. Follow established CMS procedures for serving CMS-funded students A District authorization process will be in place for all students in need of District funding in order to receive agency services. This includes uninsured and underinsured students who cannot be accommodated by the 1:10 pro bono agreement. Please see the referral process (Appendix A) for general student eligibility requirements. District approval of services for students requiring Funding will be contingent upon the availability of funds. Agencies will not be paid for any services provided to CMSfunded students prior to the date of service authorization. 8 P a g e 1.4 Agency Service Effectiveness Measures CMS minimum required STAR rating maintained* Upon the state s issuance of the official STAR rating system for mental health agencies, all CMS provider agencies will be required to maintain a certain minimum standard rating. Once CMS determines the minimum standard, all agencies will have one re-evaluation period (in accordance with state standard procedures for re-evaluation) to attain and maintain the CMS minimum standard. For subsequent reevaluations, any agencies failing to meet the minimum CMS standard will be ejected from the District at the end of the school year in which the below standard rating was issued. STAR ratings will be included as part of the agency effectiveness review. *At this time, the STAR system has not been instituted. Agency provided Person-Centered Plans for goal monitoring Agencies will develop and monitor student PCP goals on a monthly basis. Agencies will submit PCPs to the District s SBMH Program Specialist. PCPs will be evaluated at random as part of the agency effectiveness review. Documentation of student contacts with agency Agencies will document each service contact and number of contact hours for all students, including pro bono students. This information will be provided to the District s SBMH Program Specialist. Consistency of student contacts in accordance with the PCP and evidence of collaborative efforts will be used as part of the agency effectiveness review. Standardized measure of behavioral/emotional/coping skills The District will facilitate the administration of the Behavior Assessment System for Children-2 Online for all agency students pre, during, and post agency services as part of the agency effectiveness review. On an annual basis, overall agency student progress will be reviewed in comparison to other agencies. Agencies whose overall student growth is significantly lower than the District agency average growth will be rated less favorably on this factor in the agency effectiveness review. Parent rating of agency services Annually or at the time of discharge from school-based services, agencies will ask all parents to complete an agency rating scale. The rating form will be provided by CMS to ensure consistency across providers. Parent ratings will be a factor in the agency effectiveness review. School rating of agency services Annually, the school staff point person for agency referrals will complete an agency rating scale. The rating form will be provided by CMS to ensure consistently across providers. School staff ratings will be a factor in the agency effectiveness review. Final agency effectiveness review criteria and weighting will be issued to selected provider agencies prior the inception of services. 9 P a g e 1.5 District Responsibilities Determine which schools will receive services and support program maintenance and growth The District surveyed school leaders in November of Of 112 respondents, 80% are interested in hosting agency provided mental health services on their campuses and 14% already have an agency on site. The District will use information about agency and school capacity as well as student needs to determine which schools will receive agency services in year 1. Data points detailed in this document will be used to determine which agencies will be invited to expand their services to more schools for year 2. This gradual expansion of service will allow the District and agencies to build and revise infrastructures to support the ongoing growth of agency provided services in year 2 and into the future. Clearly define pertinent role responsibilities All schools have school counseling and school psychological services. Some schools with high levels of truancy, homelessness, or low graduation rates are also allotted a social worker. CMS Student Services staff provides a range of services including classroom and comprehensive guidance, individual and group counseling, teacher and administrator consultation for individual, class, and school level needs, attendance support, psycho-educational evaluations, behavior intervention support, and referrals to community agencies. The mental health agency supplements CMS Student Services though the provision of long-term therapy, collaboration with school staff, and the provision of behavioral health services that fall outside the scope of school district services. Train school-based agency staff on school culture, roles, and practices The District recognizes that there are significant differences in the culture of schools in comparison to the private mental health industry. The primary difference is that the District s mission is to educate all children; the agency s mission focuses on mental wellness. At times, educational needs and treatment needs may appear to be in conflict with one another. Positive, collaborative relationships between agencies and schools requires that agency
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