Developing a Comprehensive MultiTiered System of Support MTSS
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Developing a Comprehensive Multi-Tiered System of Support (MTSS) for Behavioral Health in Schools Capital Region ESD 113 • Sara Ellsworth, MA, LMHC, CDP, Behavioral Health Clinical Services Manger • Dr. Todd Johnson, Director, Center for Research & Data Analysis NEW ESD 101 • Andrew Bingham, Behavioral Health Systems Navigator
Objectives: Developing a Comprehensive Multi-Tiered System of Support (MTSS) for Behavioral Health in Schools WHY BEHAVIORAL HEALTH IN SCHOOLS? USING A MTSS FRAMEWORK FOR BEHAVIORAL HEALTH IN SCHOOLS WHERE AND HOW TO START BUILDING YOUR BEHAVIORAL HEALTH FRAMEWORK 2
Why Behavioral Health in Schools? • 3 Critical Reasons üWA state students are experiencing significant mental health issues üStudents with mental health and substance use(co-occurring) issues are less likely to graduate üStudents are not connecting with services available in the community 3
Healthy Youth Survey (2018) Washington State Depression and Anxiety Depressive feelings Anxious Can't control worry 80% 60% 55% 50% 40% 68% 67% 70% 59% 55% 41% 40% 32% 30% 20% 10% 0% 8 th 10 th 12 th 4
Healthy Youth Survey (2018) Washington State Suicidal Feelings and Actions Considered suicide 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 20% Made a plan 23% 10% 8 th 22% 18% 16% Attempted 18% 10 th 9% 12 th 5
Students Experiencing Significant Behavioral Health Issues: 10 th Grade Co-Occurring Conditions No Alcohol 80% Alcohol 75% 70% 65% 57% 60% 50% 40% 38% 36% 30% 20% 10% 0% Depression Anxiety Suicide 6
Students Experiencing Significant Behavioral Health Issues: 10 th Grade Co-Occurring Conditions No Marijuana 80% Marijuana 75% 70% 65% 58% 60% 50% 40% 39% 36% 30% 20% 10% 0% Depression Anxiety Suicide 7
Behavioral Health & Graduation 2013 DSHS Report: Key Findings • Youth with behavioral health needs were less likely to graduate from and more likely to drop out of high school than youth without behavioral health needs. Youth with co-occurring needs were the least likely to graduate on time (12%) and most-likely to drop out (80%). Graduation Rates by Category • No Known Behavioral Health Need: 63% (56% on time, 7% late) • Mental Health Only: 46% (36% on time, 10% late) • Substance Abuse Only: 25% (19% on time, 6% late) • Both Mental Health & Substance Abuse: 17% (12% on time, 5% late) FULL REPORT: https: //www. dshs. wa. gov/sesa/rda/researchreports/behavioral-health-needs-and-school-success 8
Access to Care The State of Mental Health in America 2019 • • Washington ranks among those states with higher prevalence of youth mental illness and lower rates of access to care at 31 st overall 25 th in the Nation for children who experience a major depressive episode but did not receive mental health services 42 nd in the Nation for students identified with serious emotional disturbance for IEP Ranked 3 rd overall for Parity, with 4. 2% of children with private insurance that did not cover mental or emotional problems Source: http: //www. mentalhealthamerica. net/issues/state-mental-health-america 9
Access to Care Additional Considerations • Lack of resources in our rural areas • Transportation issues • Students rights to access care on their own over the age of 13 • Disruption to academics for mental health appointments in the community 10
Multi-Tiered System of Supports (MTSS) for School Behavioral Health Supports 11
School-based mental health care impacts academic and mental health outcomes. Students receiving appropriate mental health care exhibit fewer problem behaviors and perform better in the classroom. Locating mental health services in schools increases the effectiveness of interventions and reduces barriers to care that commonly plague mental health providers. Schools and mental health providers form an important piece of the argument for coordinated in-school services. 12
THEORY OF CHANGE: A Community for Student Success in School 13
Mental Health Service Of Care Models School-supported mental health models • Mental Health, Social workers, guidance counselors, and school psychologists are employed directly by the school system. • Separate mental health units exist within the school system. • School nurses or health staff serve as a major portal of entry for students with mental health concerns Community connections models • A mental health agency or individual delivers direct services in the school part-time or fulltime under contract. • Mental health professionals are available within a School Based Health Center or are invited into after-school programs. • There is a formal linkage to an off-site mental health professional and/or to a managed care organization. Comprehensive, integrated models • A comprehensive and integrated mental health program addresses prevention strategies, school environment, screening, referral, special education, and family and community issues and delivers direct mental health services. • School Based Health Centers provide comprehensive and integrated health and mental 14 health services within the school environment.
Multi-Tiered System of Supports (MTSS) • A service delivery framework focused on prevention and problem solving for all students. • Connects all academic and non-academic interventions, supports, and services • Support instruction and eliminates barriers to learning and teaching. 15
Essential Components of an MTSS Framework Creating and maintaining the infrastructure to support an integrated MTSS Framework Universal Screening and Progress Monitoring Data-based Decision Making Family Engagement and Community Partnerships Tiered Continuum of Evidence-based Interventions and Supports (Tier I, III) 16
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SCHOOL-BASED BEHAVIORAL HEALTH SYSTEM OF CARE INDICATORS School Leaders & Staff • Specialized Training • Mental Health First Aid • ACEs awareness • Social & Emotional Learning • Universal Design for Learning training on the framework to improve and optimize teaching and learning for all people • Trauma informed support system • Increased attention and awareness to disproportional discipline practices • Enhanced policies, procedures, & practices to address at-risk students School Culture • Connecting at-risk students with systems of support • Curriculum in the school addressing violence prevention, problemsolving, empathy, GRIT, &/or resilience • Increased trauma awareness and sensitivity across the school supporting students in feeling physically, socially, emotionally, & academically safe. • Healthy, Safe, & Trusted school environment that is maintained & sustained Families & Community • Increased social & emotional awareness • Expanding successful opportunities for learning to ALL • Increased resources to enhance family and community supports to students • Increased mental health awareness by family and community • Advocacy and awareness to address social norming regarding substance abuse • Parents and community involved in schools Students • Improved attendance and GPA • Increased high school graduation • Decreased suspensions & expulsions • Increased Course Completions • Reduced involvement with justice system & child protective services • Increased supports for at-risk students • Increased early warning systems to connect students to supports • Increased early detection of mental health issues and connections to behavioral health systems 18
District and School Diversity Reports 19
Healthier Washington Measures Dashboard The statewide measures for all populations and quality measures for Medicaid population can be compared by region and trended by time . 20
School-Based Behavioral Health Services Getting Started • Develop a referral process to ensure that all students have equal access to services and supports. • Develop a school culture in which teachers and other student support staff are trained to recognize the early warning signs of mental health issues with students. • Develop early intervention services for students in need of additional supports such as skill groups to deal with grief, anger, anxiety, sadness, and so on. • Develop student and family supports and resources. • Develop treatment programs and services that address the various mental health needs of students. • Develop evidence-based programs to provide positive school climate and promote student skills in dealing with bullying and conflicts, solving problems, developing healthy peer relationships, engaging in activities to prevent suicide and substance use, and so on. Green, J. G. , et. al. , (2013). School mental health resources and adolescent mental health service use. Journal of the American Academy of Child and Adolescent Psychiatry, 52(5), 501– 510. doi: 10. 1016/j. jaac. 2013. 002 21
Where and How to Start Building Your Multi-Tiered System of Supports (MTSS) Framework for School Behavioral Health Supports 22
SHAPE System • • • 100% Free Comprehensive Assessments Individualized Reports Strategic Team Planning Resource Center & Quality Guides Screening & Assessment Library School Health Assessment & Performance Evaluation System 23
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SHAPE System Individualized Summary Reports 26
SHAPE System Domain Components 27
SHAPE System Strategic Planning Guide 28
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References • 2018 Healthy Youth Survey (HYS) Washington State. http: //www. askhys. net/Fact. Sheets • Washington State Department of Social and Human Services (2103). Behavioral Health Needs and School Success Youth with Mental Health and Substance Abuse Problems are at Risk for Poor High School Performance. https: //www. dshs. wa. gov/sesa/rda/research-reports/behavioralhealth-needs-and-school-success • The State of Mental Health in America: Mental Health Facts, Stats, and Data by Mental health America http: //www. mentalhealthamerica. net/issues/state-mental-health-america • Satcher, D. “School-Based Mental Health Services. ” Pediatrics, 113: 6, June 2004. pp. 1841– 1842. http: //pediatrics. aappublications. org/content/113/6/1839. short • The Office of Superintendent of Public Instruction (OSPI). Multi-Tiered System of Supports (MTSS). http: //k 12. wa. us/MTSS/default. aspx • Washington State School Report Card https: //washingtonstatereportcard. ospi. k 12. wa. us/ • Healthier Washington Measures Dashboard allows users to explore data on populations and measures for Washington State. https: //bit. ly/2 Zo. Nf. D 4 • SHAPE (School Mental Health Profile, Quality Assessment, and Sustainability Assessment) https: //theshapesystem. com/ • Green, J. G. , et. al. , (2013). School mental health resources and adolescent mental health service use. Journal of the American Academy of Child and Adolescent Psychiatry, 52(5), 501– 510. https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3902042/ 31
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