Full Service Schools PLUS

Best Practices of a School Based

Behavioral Health Model

Katrina Taylor, Duval County Public Schools

Tracy McDade, Children’s Home Society of Florida

Kathleen Adkins, Sallye B. Mathis Elementary

Tracy Aguinaga, Sallye B. Mathis/Children’s Home Society of Florida

Blaire Taylor, Children’s Home Society of Florida

Overview of Session

Creation of Full Service

Schools PLUS Model

Implementation of Full Service

Schools PLUS Model

Program Evaluation

Questions & Discussion Panel

Session

Overview

Our community has

embraced the idea that

children will be more

successful in school if they

have the resources to

address their medical,

physical, behavioral, social

and mental health needs.

Full Service

Schools PLUS

Overview

 National Center for School Mental Health at the

University of Maryland School of Medicine co-

directors Drs. Sharon Stephan and Nancy Lever

facilitated a strengths and gaps analysis of the

School Health and Behavioral Health System for

Duval County

 Highlighted the challenges related to access or

quality that currently existed within the Duval

community including:

 inconsistency in accessibility of resources

 parent involvement

 mental health awareness/education

 more effective data tracking

 sharing and inconsistency/lack of fidelity with

implementation of evidence based programs

Mental Health

Summit

 School and Behavioral Health Summits

 The summits occurred three times

over seven months in an effort to:

 Validate strengths, challenges, and gaps;

 Participate in a formal school health and

behavioral health capacity building

process;

 Develop, prioritize, and reach a

consensus on school health and

behavioral health recommendations and

action steps; and

 Assist in the development and

advancement of a coordinated and

systematic district strategy related to

school health and behavioral health.

Recommendations

 Recommendations for advancing student health and

behavioral health:

 Recommendation 1 – Establish an integrated model of school-

based (on-site) student wellness, behavioral health and health

care that ensures adequate capacity for all students and all

schools.

 Recommendation 2 - With assistance from diverse

stakeholders, improve data systems, utilization and oversight of

data to enhance continuous quality improvement and outcomes

monitoring of school health and behavioral health services.

 Recommendation 3 - Using different training modalities and

technology, develop and conduct user-friendly, practical, and

culturally and linguistically sensitive education and

professional development activities for students, families,

school staff and community behavioral health partners to

support improved student health, behavioral health and

wellness.

Action Steps

 Committees were assigned to each recommendation content

area to move the actions steps forward. As a result of the

Executive Summary recommendations the following occurred:

 Hired a dedicated Director of School Behavioral Health

within DCPS

 Built upon a current well positioned infrastructure to expand

delivery of on site school behavioral health services across

a multi-tiered system of care (Ribault HS FSS)

 Improved data systems, utilization and oversight of data to

enhance continuous quality improvement and outcomes

monitoring school behavioral health. Hired an outside data

management team through a competitive bid process

funded by the Chartrand family foundation. Finalized the

MOU between the data team and collaborative partners.

 Trained 212 school based employees in Youth Mental Health

First Aid

Full Service schools plus overview

School readiness during planning year:

 Competitive RFP developed to identify a single service

provider

 Schools volunteered to participate in the new model

 Schools identified a dedicated treatment room for

service providers

 School Staff learned how to make an appropriate

referral

 Schools participated in Youth Mental Health First Aid

Training

 Monthly Advisory Council Meetings were conducted at

each school to discuss progress and resolve issues and

concerns

 Parent Academy sessions held at schools

 Worked with interior decorators to enhance treatment

rooms

School

Readiness

Pilot Schools

Elementary

#91 Sallye B. Mathis

#95 Rutledge

Pearson

#124 St. Clair

Evans Academy

#163 Rufus Payne

#166 Carter G.

Woodson

#169 Samuel A. Hull

#220 Martin Luther

King Jr.

Middle

#155 Northwestern

#212 Jean Ribault

High

#96 Jean Ribault

#165 William M.

Raines

#285 Asa Philip

Randolph

Academies Of

Technology

Core Partners

Duval

County

Public

Schools

Jacksonville

Children’s

Commission

United Way

of Northeast

Florida

Jacksonville

Public

Education

Fund

Jacksonville

System of

Care

The

Chartrand

Family

Foundation

University of

Maryland

Children’s

Home

Society

Community

Foundation

Full Service

Schools Plus

Partners

Full Service Schools PLUS

2016-17 YTD Utilization

SCHOOL NAME

REFERRALS

TRACKED BY

SSW

DUAL

REFERRALS

THERAPEUTIC

ONLY

REFERRALS

SOCIAL

SERVICES ONLY

REFERRALS

GROUP

ONLY

REFERRALS

Jean Ribault High

122 8 104 5 5

William Raines High

90 5 82 3 0

Asa Philip Randolph

82 12 63 2 5

Jean Ribault Middle

47 1 43 3 0

Northwestern Middle

130 12 99 12 7

Martin Luther King ES

56 6 40 6 4

Rutledge Pearson ES

52 1 43 1 7

Sallye

B. Mathis ES 80 4 58 11 7

Carter G. Woodson ES

70 9 58 3 0

St. Clair Evans Academy

133 2 97 8 26

S.A. Hull ES

69 12 46 6 5

Rufus E. Payne ES

60 2 52 1 5

TOTAL

991 74 785 61 71

As of June 2017

#s Inclusive of all 8 FSS sites

(75 schools)

#s inclusive of the 12

FSS PLUS schools

2015-2016 2016-2017 2016-2017

Total

Referrals

4767 4775

1025

School

3388 3338

562

Parent/Staff

877 877

388

Agency

502 560

Total Served by Mental Health

Provider

2053 2357

870

Total

Declining Mental Health

Services

239 239

People referred for services

2103 2103

Total Crisis Interventions

1086 1086

990

Total Children on waitlist for services

9 7

Implementation of

Full Service Schools

PLUS Model

Referral Process

Changed

PLUS

TRADITIONAL

School Culture

and Climate

Changed

 Immediate Feedback loop to

referring persons

 Easier access to students by

therapists being housed on-site as

well as family access to the

provider

 Therapist becomes embroidered

into the culture of the school

Tiers

of service

Tier 3: Students with

Severe/Chronic

Problems

Intensive schools

interventions with

community supports

Tier 2: At Risk Students

Targeted school

interventions with

community supports

Tier 1: ALL Students

School based prevention and universal

intervention, early identification of

students with mental health or

behavioral concerns

School-Based

Tiered

Interventions

Changed

Referral

Reasons

Early Warning

Indicators

DISCIPLINE

ABSENCES

Engage Families

–

Family Buy-in

 Population – Community School

 Demographics

 Taboo

 Stigma

 Messaging

 Family Consultation

 Parent Academy

School Buy in -

Support

 Team with School Counselor

 Teacher Support

 Professional Development

 Consultation

 Visibly Available

 Communication

 The Whole Child

 Untraditional way of engaging student

learning

ENGRAINED IN FABRIC

OF THE SCHOOL

The PERFECT Fit

= Sustainability

GROWS

 Wasn’t involved in interview

process

 Us vs Them

 Worked in isolation

 Adaptability

GLOWS

• Was involved in interview

process

• Open lines of communication

• Collaboration within

leadership team

• Availability

Data Collection, Process &

Impact

Program Evaluation

Data Collection

Source Agencies

Implementation Data

(Process Evaluation)

Impact Data

(Outcomes Evaluation)

Duval County Public

Schools

•

Referral Process

•

Tiered Service Data

• Tier 1 – Prevention

• Tier 2 – Intervention

• Tier 3 – Treatment

•

Data Fidelity/Quality

•

Exit /Completion Data

•

Referral Capacity

•

Cognitive & Behavioral

Functioning

•

Discipline

•

Attendance

•

Stakeholder Perceptions

Jacksonville Children’s

Commission

Children’s Home

Society

United Way of

Northeast Florida

Data collection

Stakeholder Group Method Constructs

Students Survey

•

Awareness

•

Knowledge

•

Comfort

•

Mental Health Training

•

Satisfaction

•

Understanding

•

Communications

•

Feeling Supported

•

School Climate & Culture

Parents/Caregivers

Survey

Focus Group

Teachers & Administrators Survey

Therapists

Survey

Focus Group

Referral Volume

PLUS

459

1041

994

2014-15 2015-16 2016-17

127%

TRADITIONAL

2887

3726 3750

2014-15 2015-16 2016-17

29%

0.6%

-5%

116

539

2521

452

134

250

2000

1500

1082

1000

500

2500

4000

3500

3000

Tier1

Tier2

Elementary Middle High

Tier3

Note:StrippedbarsrepresentSY2015-16.SolidbarsrepresentSY2016-17

Tiers by School

Type

Data Systems

YEARS 1& 2

YEAR 3

Pre/Post

Assessment

YEAR 1

YEAR 2

43.68

39.77

33.84**

28.18

PLUS Traditional

Opening CFARS

Closing CFARS

• SurveyAdministration:

– Paper/ Pencil

– Administeredby

therapists

– January 17 toApril 10

Student Survey

“It does help. ‘Cause I’m by myself too

and I have the three boys. And that

help, that structure. I remember, at the

beginning, I cons idered this a last

resort. Like, okay, let’s see what

happens. And it’s like a godsend to me

now.“

-PLUSParent

PARENT FOCUS GROUP/SURVEY

 Students benefit

 Parents benefit

 Barriers they had to overcome

 Generational

 Cultural

 Accessibility of the therapist

“I know for me at my school, there's less

discipline referrals. Before, last year, due

to the fact that now my AP and principal,

they get the kids to come to me versus

just writing a referral. They say go see

[name redacted] or go see the guidance

counselor, and if it's still they write a

referral, but it has decreased since last

year.”

-PLUS Therapist

 Services benefitted the students

 Shift in the school culture

 Barriers similar to Traditional therapists

 Lack of mental health awareness

 Parental involvement

 Uniquely identified barriers

 Socioeconomics (homelessness and/or

transient families, funding)

 Safety concerns

 Lack of cohesion and reliable resources

 Benefit of a network of communication

THERAPIST FOCUS GROUP/SURVEY

Teacher Survey

AWARENESS

3.87

3.88**

3.67***

3.37**

3.25**

3.72

3.65

3.30

3.09

2.97

Range of MH

Issues

Risk Factors &

Causes

Treatments Local Community

Services

Steps to Access

Local Community

Services

PLUS Traditional

KNOWLEDGE

3.69**

3.64***

3.56***

3.45

3.36

3.22

Signs & Symptoms Appropriate Actions School System Services &

Resources

PLUS Traditional

Teacher Survey

COMFORT LEVEL

3.60

3.33

3.68*

3.66**

3.41

3.20

3.47

3.40

Talking with Students Talking with

Parents/Guardians

Providing Support Accessing School &

System Services

PLUS Traditional

MENTAL HEALTH TRAININGS

48%**

33%*

28%***

41%***

18%

38%

26%

11%

19%

26%*

10%

20%

30%

40%

50%

60%

District or Outside

Training

Support by On-site

Therapist or

Staff/Admin

Accessing

Individual

Consultations

Accessing School

Based Therapist

or Coaching

Services for

Students

Accessing Distrist

Crisis and Bullying

Hotline

PLUS Traditional

Teacher Survey

SCHOOL CLIMATE

4.27***

4.11***

4.34***

4.08**

3.72

3.48

3.61

3.75

Therapist is a Good

Fit for School

Positive Shift in

School Culture on

Mental Health

Therapist a Good

Addition to the Staff

Consider Referral to

Therapist before

Discipline Referral

PLUS Traditional

FEEDBACK ABOUT SERVICES

4.32***

4.15***

3.97***

4.08***

4.03***

3.81

3.6

3.32

3.04

3.18

Easy and

Straightforward

Referral Process

Received Service

in Reasonable

Time

Positive

Improvements in

Students

Consultations

about Students

Tips from

Therapist Useful

PLUS Traditional

Teacher Survey

57%***

19%

18%

36%

25%***

30%***

10%

20%

30%

40%

50%

60%

Satisfied Unsatisfied Unsure

PLUS Traditional

Administrator

survey

MENTAL HEALTH TRAININGS

60%*

43%*

49%*

65%**

38%

23% 23%

30%

10%

20%

30%

40%

50%

60%

70%

District or Outside

Training

Support by On-site

Therapist or Staff/Admin

Accessing Individual

Consultations

Accessing School Based

Therapist or Coaching

Services for Students

PLUS Traditional

FEEDBACK ABOUT SERVICES

4.55*

4.42**

4.21*

4.36**

4.18**

3.88

3.56

3.64

3.48

3.44

Easy and

Straightforward

Referral Process

Received Service in

Reasonable Time

Positive

Improvements in

Students

Consultations about

Students

Tips from Therapist

Useful

PLUS Traditional

• Communicate early and often with

parents.Therapists in both models

should be visible to the parents

bef ore children are ref erred f or

services.

– Have booths or presentations at pre-

existing events at schools (i.e.open

house,parent academy, first day of

school,etc.).

– Useteachers as thegateway to

parents;they are comf ortable

talking to parents about student

mental health (this also means that

teachers should receive more

specialized training).

Year 2 Evaluation

Recommendations

• Shif t the marketing and framing of

the services that are offered.The

stigmaseems to lie with f amilies not

wanting to be perceived as having a

“problem”or that something is wrong

with their child.Theparents who have

used theservices talked about how

much of a burden was lifted from

them.

Year 2 Evaluation

Recommendations

 Examine more official, DCPS-

administered school climate and

culture indicators to see if there is a

school level shift taking place from

the students up to the

administrators and out to the

parents.

Year 2 Evaluation

Recommendations

Year 2 Evaluation

Recommendations

 Expand the PLUS model! Teachers and

administrators are clearly benefitting.

More specifically, the Traditional

administrators hold the belief that

having a resource directly on campus

is very important. Coupled with the

improvements we are seeing in

students on discipline and attendance

over the last two year, this program is

one that has the momentum to expand.

Panel

Discussion and

Questions

Academic achievement is not solely based

on classroom instruction. Some children

come to school with serious problems –

abuse, grief, hunger, drug use,

undetected learning disorders, or poor

health due to lack of medical attention.

Not only are these children not ready to

succeed in school, they often act out in

class from frustration or as a cry for

help.

The Full Service Schools PLUS Model

helps to bridge the gap for services so

these students can receive confidential

treatment within the walls of their

school.

Thank You!

Katrina Taylor, Director of School Behavioral Health

Duval County Public Schools

eunicek@duvalschools.org

Tracy McDade, Director of Operations

Children’s Home Society of Florida

tracy.mcdade@chsfl.org

Blaire Taylor, Clinical Program Supervisor

Children’s Home Society of Florida

blaire[email protected]g

Thank You!

Kathleen Adkins, Principal

Duval County Public Schools

johnsonk5@duvalschools.org

Traci Aguinaga, Therapist

Children’s Home Society of Florida

tr[email protected]g

Kimberly A. Allen, Director, Data & Research

Jacksonville Public Education Fund

kimberly@jaxpef.org