School Community Partnership for Mental Health

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School Community Partnership for Mental Health

• Story Session

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
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Using the Clickers

• Each of you has a clicker that will allow you
  to respond to questions during the presentation,
  and well 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.

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Getting to know our audienceWhat field do you
work in?

1. Healthcare
2. Behavioral Health
3. Education- At a university
4. Education- K-12
5. Community Based Org
6. Community Activist

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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.

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Partners
Schools in Wisconsins largest district Community Mental Health Providers HMOs
Sebastian Family Psychology Practice, LLC
CHWs/Research Assistants Academic Partners Funders
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Story Session Outline

• Chapter 1 SCPMH The Early Years
• Needs Assessment
• Building the model
• Addressing systems barriers
• Chapter 2 SCPMH- The Middle Years
• Perspectives from School Staff, Community Mental
  Health Providers, Researchers Community Health
  Workers
• Case Discussion

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Story Session Outline

• Chapter 3 SCPMH- Graduation
• Treatment Initiation
• School and Parent Satisfaction
• Behavioral Improvement
• Stigma
• Chapter 4 SCPMH-Lessons Learned

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Chapter 1 The Early Years

• Needs Assessment, Model Building, Barrier Busting

Photo from City of Milwaukees I want a strong
baby public health campaign
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The Early Years (2005-2009)

• National Family Week Partnership study (2005) of
  mental health services for youth in Milwaukee
  ACCESS IS PROBLEMATIC.
• Milwaukee Public Schools estimated only-
• 5 of STUDENTS GET CARE.
• Youth Mental Health Connections,
• COMMITS TO ACTION.

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The Early Years (2008-2009)
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(No Transcript)
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The Middle Years

• Pilot strategies
• Views from School Staff, Community Mental Health
  Providers, Researchers and Community Health
  Workers
• Case Discussion

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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

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SBIRT PBIS
3 Levels of Support System

• Refer selected students
• Obtain ROI
• Consultation with Guardian
• Individual / Family Therapy
• Consultation with Staff
• Classroom presentations
• School embedding activities

III
II
I
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SCPMH Community Coordinator

• The 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

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SCPMH School Coordinator

• The 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 

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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 process
• School calendar and attendance are issues

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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 schools family events and staff
  meetings
• Provide a cultural bridge for families to
  schools and providers

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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

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What is the first priority for a CHW when meeting
a family?

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

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Community Mental Health Agency Perspective

• Reflections on the process
• Administrator buy in
• Clinicians who had the right fit
• Provider/Client Alliance

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Community Mental Health Agency Perspective

• Implementation experiences and deliverables
• Culture shift
• Agency utilization
• Feedback and ongoing assessment
• Standardization of and operational momentum

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Researcher Perspective

• Assessing readiness for research vs. evaluation
• Balancing rigor and feasibility
• Data 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

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Case Study Discussion Photo credit MCW
Annual Report SCPMH staff from Medical College
of Wisconsin, Milwaukee Publics Schools, IMPACT
Planning Council and Sebastian Family Psychology
Practice.
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How should SCPMH intervene?

• 12 year old male student
• Classmates report he was bit by a dog
• Teacher notes grades starting to slip
• SSW engages student, provides social emotional
  support
• Student develops attendance issues
• SSW discovers student and mother were victims of
  random gunfire
• Student detaches from friends

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What are the major obstacles to school based
mental health services?

1. Teachers are resistant
2. School administrators wont allow it
3. Community providers arent interested
4. Parents are not invested
5. There is no good source of funding

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Evidence Based Therapy is overrated and hard to
implement in real world settings

1. True
2. False

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How important is it that families who receive
therapy participate in the research? Please
rate 1 (lowest) - 5 (highest)

1. 4
2. 4
3. 4
4. 4
5. 5

1 2 3 4 5
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Chapter 3 Graduation

• Do we have the data to go forward?

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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.
Should we do it
Getting it right
Making it better
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What did we learn?

• Treatment Initiation Rates
• Stigma
• Program Satisfaction and Challenges
• School Staff
• Parents
• Mental Health Providers and Community Health
  Workers
• Behavioral Improvement

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Treatment Initiation
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Perceptions of Stigma among School Staff and
Parents
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Program Evaluation

• Open ended interviews with parents of students
  enrolled in treatment (N6)
• Open ended interviews with principals from 4
  schools (N4 100 response)
• Closed ended survey data from staff at 4 schools
  (N171 69 response rate)
• Open ended survey data from community mental
  health providers and community health workers
  (N9 100 response rate)

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Overarching Themes - Positive

• Access
• Safe environment for kids
• Convenient for parents
• Smart/Efficient for everyone
• Partnership
• Novel
• Helpful
• Needed
• Outcomes
• Behavior change

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Overarching Themes - Negative

• Logistics
• Consent
• Communication
• Capacity
• Coordination
• Parent Involvement
• Lower than desired
• Missed opportunity for input
• Missed opportunity for addressing stigma
• Stigma

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In their own words

• Principal If it went away, we wouldnt have
  institutional knowledge of where to place
  students, but then again theres that therapeutic
  piece where you have that connection between
  somebody thats coming in here on a consistent
  basis, building relationships with students and
  providing strategies and solutions. Ive seen
  firsthand where thats 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.

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In their own words

• Parent I believe a lot of parents would feel
  like theyre all by themselves and they dont
  have any help, cause thats how I felt for a long
  time, like Im the only one going through this,
  until you find out theres other parents going
  through what youre 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.

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Behavioral and Academic Outcomes The Plan

• Administrative School Data for all students
  referred to SCPMH
• Attendance
• office referral
• disciplinary action
• special education status
• standardized test scores

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Behavioral and Academic Outcomes-The Plan

• For those who consented to research
• Strengths and Difficulties Questionnaire
• baseline, 3 months, 6 months
• parent, teacher, student
• Revised Working Alliance Inventory
• 4 weeks, 6 months
• parent, teacher, student

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Behavioral Outcomes 2011-2012 cohort

• 1) Office Referrals
• Significant difference between pre/post
  intervention (plt.03)
• 2) Disciplinary Action Taken
• Significant difference between pre/post
  (plt.0065)
• Wilcoxon signed rank sum test used to test the
  significance of two paired samples.

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Office Referrals- trend toward decline for those
in therapy
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Attendance going the wrong direction?
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Chapter 4 Lessons Learned

• From the real world

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Is SCPMH Community Engaged Research
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.
Modified version from International Association
for Public Participation Principles of Community
Engagement , 2nd Edition CTSA Consortium
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Lesson Learned

• How do we engage parents as co-collaborators in
  program development, implementation and
  evaluation?

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CHW/Parent Interactions
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School Staff Survey Results
Dichotomized for Satisfied/Not Satisfied
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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

Source Watson, and Foster-Fishman (2013) The
Exchange Boundary Framework Understanding the
Evolution of Power within Collaborative
Decision-Making Settings. Am J Community Psych
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Critical Processes within the Exchange Boundary
Framework
Less-advantaged stakeholders better able to
leverage dependencies through resource exchanges

• Stakeholders have opportunity and capacity to
• Activate and incorporate resources into exchanges
• Value less-advantaged stakeholder resources

Increased Resource Exchange
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

Increased range of resources that less-advantaged
stakeholders can legitimately exchange
Expanded Social Boundaries
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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 OBrien 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.