Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

1. Psychiatry In OurSchools:How A City And A Health Center Created Access To Behavioral Health Services WEITZMAN SYMPOISUM No Time to Waste: Primary Care Innovations in Acton June 4, 2009 R. Timothy Kearney, Ph.D. Director, Behavioral Health, CHC Inc. Jane Hylan, MPH, CHES Director, School Based Services, CHC Inc. Megan Giesen, LCSW School Based Health Center, CHC Inc.

2. Today’s Presentation • Challenges associated with providing children’s behavioral health services • Some characteristics of the children of Meriden • The implementation of the Meriden program • The daily work in the school • What we have learned • Points to ponder • Discussion Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

3. Program Description: Meriden School Based Health Center Behavioral Health Services The Community Health Center (CHC) has partnered with the City of Meriden to bring behavioral health services provided by master’s level social workers into all municipal public schools (eight elementary schools and four middle and high schools). Effective, efficient, consumer driven, culturally competent individual, group, and family therapy is provided on site at all schools with clinic based psychiatric back-up for medication evaluations, prescription of psychotropic medications, and ongoing medication management. Consultation with the schools, the Department of Children and Families, and other community resources impacting a student’s life is an integral part of the service. Coordinated care with medical providers is provided. Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

4. The Challenge: Children’s Behavioral Health Services In CT A crisis of access: • Children’s outpatient behavioral health services are hard to find : • limited number of treatment slots • limited access due to payment issues • language barriers. • shortage in child psychiatry • Limitations of clinic based outpatient services • hours available • transportation issues • no show rates • System of care issues • IOP/PHP availability • limited hospital beds Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

5. Meriden’s Child Well-Being Data From CT Voices For Children • Children below Federal Poverty level (2000): 18% • Children Eligible for Reduced and Free Meals (2007-08) 55.8% • Unemployment rate (March 2009) 9.8% • Cumulative High School Drop Out Rate (2007): 5.8% • Children Enrolled in HUSKY (April 2009):7376 • Children Substantiated as Abused or Neglected (2007): 393 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

6. Children And Mental Health • According to the US Surgeon General’s 1999 report on mental health: • 20% of children younger than 18 have diagnosable mental illness • 10% have a serious impairment • fewer than 20% of these receive treatment • NASBHC’s web page • “schools have become the de facto provider of most mental health services” • “SBHCs bring dedicated experts into the setting.” Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

7. In The Beginning • Only one traditional model to offer Meriden Challenges • Staff • Space • Funding • Maintenance June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 7

8. “The thing that bothered me about this case so greatly was that the child was in full view of everyone for so long.” - CT State Rep. Mary Mushinsky June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 8

9. Suicide Rates In Young Americans • After falling 28% between 1990–2003, rates of suicide for 10-24 year olds climbed 8% (MMWR) • biggest climb in 15 years • 7.32 suicides per 100,000 people • 4500 young lives lost each year to suicide • 3rd leading cause of death • Nationwide survey of youth in grades 9-12 • 15% reported considering suicide • 11% had a plan • 7% had tried to take their own life June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 9

10. Time To RECONNECT And INNOVATE Partnerships – New and existing • Health Department • Area Child Guidance Clinics • Board of Education • School Administration • School Staff • Families/Students June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 10

11. The Meriden Model Priorities Challenges • Even playing field • Nip it in the bud • Territories • ESL • Mastered and licensed • Sustainability • 8 openings • Parental involvement • Academics vs. clinical • Bi-lingual therapists • Recruitment • Sustainability June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 11

12. Meriden School-Based Behavioral Health Services June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 12

13. The Daily Work In The Schools Megan Giesen, LCSW School Based Health clinician Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

14. Meriden School Based Services: Clients Seen School Year 2008-09 • Total clients seen through April 30: 423 total for treatment by school based social worker, of these 175 also seen by child psychiatric team at CHC Meriden State Street site • Total sessions provided at school sites through April 30: 4517 • Sessions provided by type of service: • Psychiatric Services at Clinic site 613 • Clients also seen by CHC Meriden Medical: 156 (37%) Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

15. Meriden School Based Services: Clients Seen School Year 2008-09 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

16. Summary Data Meriden School Based Health: School Year 2008-09 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

17. Summary Data Sites with Medical Services: School Year 2008-09 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

18. What We Have Learned • Access to behavioral health care has been increased for the children of Meriden: • Total unduplicated children seen since start of program: 698 • Total number of unduplicated visits delivered: 13,177 • Average number of sessions received by each child: 18.88 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

19. Meriden Residents Ages 4 - 11 Emergency Room Visits at Connecticut Children's Medical Center & MidState Medical Center for Behavioral Health* Related Primary Diagnoses, FY 2003-08 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

20. Meriden Residents Ages 4 - 11 Emergency Room Visits at Connecticut Children's Medical Center & MidState Medical Center for Behavioral Health* Related Primary Diagnoses, FY 2003-08 June 4, 2009 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services 20

21. Top Ten Diagnosis in the Meriden Schools 2006-09 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

22. Top Ten Diagnoses In Child Outpatient Clinic 2006-09 Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

23. What We Have Learned • The population seen is in addition to those previously seen: • 76% of those seen report this is first BH treatment • Child Guidance Clinic of Central Connecticut (Meriden based community clinic) reports that children seen rose during time since SBHCs started • Clients seen are very similar to outpatient clinic clients in diagnosis with some tendency toward less intense diagnosis • Utilization of sessions is higher in SBHC • Average outpatient no show rate 14.4 vs average SBHC rate of 2.0 (January to March 2009) Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

24. Previously Identified Markers Of Success • Researchers have identified markers for success for School Based Health Care, among them: • Increased delivery of service to children • Reduction in stigma surrounding access to service • Reduction in absences from school • Reduction in hospital ER usage • Improved utilization of service • Early identification of BH issues • Improved coordination with schools Thank you to Roy Chung and Tanya Moss, Wesleyan ’09 students in “Health of Communities” with Dr. Peggy Carey Best Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services

25. Points To Ponder • Directions for ongoing program development and future research • Measures of therapy outcome: • Ohio Scales • DCF measures for child treatment clinics • Tele-psychiatry for medication follow-ups • Model for mobile psychiatric care • Need to update data collection practices through electronic health record • Ongoing work with Wesleyan students • Training social work students in the model Psychiatry In Our Schools: How A City And A Health Center Created Access To Behavioral Health Services