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Episode 7: Join the A Team - Universal Mental Health Screening in Schools
438 Plays1 year ago
Amy D’Addario, Program Manager for Samaritan Wellness Screen and Amy Marsman, Senior Research Analyst with the Wisconsin Office of Children’s Mental Health discuss the benefits of student mental health screening in schools and how schools might begin a universal screening program.
Show Notes
Coalition for Expanding School-Based Mental Health in Wisconsin
Wisconsin Department of Public Instruction - Comprehensive School Mental Health
Wisconsin School Mental Health Framework
Wisconsin Office of Children’s Mental Health
OCMH Fact Sheet on Universal Screening
OCMH School Mental Health Resources
Candid - Mental Wellness Screening Systems
National Center for School Mental Health
School Mental Health Collaborative - Best Practices in Universal Screening: An Implementation Guide
SAHMSA - Ready, Set, Go, Review: Screening for Behavioral Health Risk in Schools
Recommended
Transcript
Introduction & Mission Overview
00:00:17
Speaker
Welcome to School Mental Health Works, a quick-dip monthly podcast presenting dialogues on school mental health in Wisconsin, as viewed through the lens of the array of stakeholders who play a role in the comprehensive model of school mental health services in the state. Our mission is to share the successes and challenges experienced by a range of partners in Wisconsin communities
00:00:39
Speaker
as they continue to collaborate and show that school mental health works. This series is a product of the Coalition of Expanding School-Based Mental Health in Wisconsin, a statewide coalition with a mission to advance and support expanded comprehensive and integrated mental health services within the school setting through school, home, and community partnerships.
Meet the Experts: Amy Marsman & Amy Diodario
00:01:00
Speaker
Hello, my name is Amy Marsman, and I'm the research analyst with the Wisconsin Office of Children's Mental Health.
00:01:07
Speaker
The Office of Children's Mental Health is an independent state agency working to improve the mental health and wellbeing of Wisconsin's children. Our office, which I'll refer to as OCMH for simplicity and ease, is small. We are a team of four people, so we rely on our partnerships and networks across the state to carry out our mission. This is how I met the wonderful Amy Diodario, who graciously agreed to join me today. Amy, welcome.
00:01:34
Speaker
Thank you, Amy. How fun to be with another Amy working in this space. Yes, it's so fun. I'm happy to be here with you today. Can you tell our listeners a bit about yourself and your work? Absolutely. So I have been involved in screening for about 10 years now. I started by training primary care physicians in how to incorporate both developmental and mental health screening into their routine care.
00:02:00
Speaker
And then I made the transition to Samaritan's Wellness Screen just about six years ago. At that time, our program was ready to expand screening from youth self-report to also a parent report model so that we could screen any student age kindergarten through 12th grade.
Understanding Mental Health Screenings
00:02:18
Speaker
And I've been here ever since. That's great. Thank you. I didn't actually realize that you had started out on the clinical side. That's really exciting to know.
00:02:28
Speaker
So today we'll be talking all about universal screening, also called wellness screens. We can't cover everything in this episode. This is just a quick dip after all, but I would like to highlight a few key points and best practices around mental health screening to kick things off. In the last year, the American Academy of Pediatrics, the US Preventative Services Task Force, and the US Surgeon General have all recommended annual mental health screening for kids.
00:02:57
Speaker
Screeners typically look for signs of anxiety, depression, self-harm, and any suicidal thinking. But they also ask kids how they cope with stress and what support they have in their lives. Screening can be done in a doctor's office with a pediatrician or a primary care doctor. And it can also be done at school where kids spend the vast majority of their time.
00:03:19
Speaker
We met at the start of this school year when OCMH was just starting to learn about the breadth of mental health screening in schools across the state. Our office was on a listening tour last summer and we heard about the school-based screening efforts in the Fox Valley that were being replicated in other school districts.
00:03:38
Speaker
Now, thinking back to September of 2022, we knew that kids would be going back to school fully in person this year and that Wisconsin kids were in the midst of the same youth mental health crisis affecting others across the country. So we were really interested in learning more about this aspect of school-based mental health.
00:03:58
Speaker
Amy, I learned that your organization had been screening for a number of years and it was not just in response to the pandemic. Can you give us the background on how Samaritan got involved with school-based mental health screening, how you started and how it's grown? Yeah. So we just finished our 10th year of screening here at Samaritan's Wellness Screen. And it really began in response to a number of teen suicides in our area.
00:04:26
Speaker
After we had lost several students to suicide, many people came together to try and address that problem. So we originally started our screening program using Teenscreen, which was a framework that was developed through Columbia University. Teenscreen already had a tool, a screening model, and other materials that really helped launch this idea of mental health screening in schools in our area.
00:04:53
Speaker
However, after a few years of implementation, teen screen disbanded and that framework just wasn't available to us anymore. So we were really left trying to sort out what to do in response to that and how to move forward. So rather than just letting the idea of mental health screening in schools go, a group of community members came together to really talk about how we could continue this work. So together with some of our primary care physicians,
00:05:22
Speaker
school districts, academics, mental health professionals, they began to create what is now known as wellness screens. So we put together the tool that we now use as well as our screening frameworks and other tools that we've used over the past 10 years. So just to give you a little bit of context, when we began 10 years ago, we were in one school district and we served 23 students.
Growth and Expansion of Wellness Screen
00:05:49
Speaker
Now, 10 years later in 2022, 2023, Wellness Green has served nearly 8,000 students this year in 14 different school districts. So we certainly have grown a lot. That's incredible. Amy, what advice do you have for a school district that may not have that kind of community support quite yet? How do you think they could begin with screening their students? Yeah, I think that's a great question.
00:06:17
Speaker
So I think things that are important when we're meeting with a new school or talking to our existing schools about expansion is really to understand our partnership. So what we really want to know is what currently exists. Many of our school systems are using social emotional learning, which is truly critical for students and for staff.
00:06:39
Speaker
But we want to think about what else does a mental health screener provide? So what do schools already know about their students and what do they want to know? And how do we partner and pair together with that? So we really want to think about current and existing information and assessments that schools are already using. It's also really important for us to know
00:07:03
Speaker
You know, what exists in their school related to, you know, peers around mental health? Do they have things like sources of strength? Do they have Hope Squad? Other peer mentoring? Do they have other partnerships with other mental health providers in the area? So we really want to get to know our school districts and what currently exists and make sure our partnership is one that works for both of us.
00:07:27
Speaker
Schools are asked to do so much now with so little. And so we want to be useful and helpful. So what I would say that we most often run into is sort of how to get started and where to get started. And what I would say is to start somewhere, even if it's one grade band and then work from there. I think what often happens is once our schools have some data around specific mental health issues,
00:07:55
Speaker
They certainly are then able to advocate on behalf of their students to their school board, their community members, local funding, those kinds of things to expand any work that they want to do, but to just get started.
00:08:11
Speaker
Yeah, it's really incredible how gradually, or maybe it wasn't so gradual, maybe it was really quickly you scaled up to serving over 8,000 kids, but it's phenomenal to know that you started out with just 23 kids and seeing how that can grow over time and gradually as parents and school staff and the community begin to embrace
00:08:39
Speaker
student mental health screening, I can see how it would gradually enlarge the partnership. So thinking back to six to 10 years ago, what would you have loved to have known when you had started that you now know?
Challenges & Commitment in Mental Health Initiatives
00:08:58
Speaker
Yeah, so a couple of things come to mind when I think about, you know, things I wish I would have known or advice to possibly give.
00:09:05
Speaker
And I think, again, starting somewhere is really one key piece of this, being reminded that really someone does need you. So I know that what really kept me engaged in this work was very early on in my career here, I had the opportunity to meet with a middle school student who was really struggling with depression and some suicidal ideation.
00:09:30
Speaker
Um, and then, uh, after meeting with that student, I followed up with the parent and I didn't get ahold of the mom right away. Um, I actually got a return call from her on my work cell phone as I was dropping off my own kids at school at about seven 30 in the morning. And I knew I wanted to talk to this parent right away. So I pulled over immediately as soon as my kids were out of the car and we talked through what I had learned about her student. And I just remember her.
00:09:56
Speaker
you know, crying about not knowing what could she do, being afraid and being there in that moment with her. And it was such a beautiful opportunity to realize how powerful this could be. And I think just really reminded me that someone needs you. And so that's really why getting started in any way is so important. I think we all love grand gestures and wish we could be all in, but we can't always. So that would be one piece, right, of why to just get started.
00:10:25
Speaker
I also wish that I would have known to just lean into this mission. So I think people will always question why mental health in schools? Is school the right place? Are schools becoming too involved? And I think that what I have learned is that, you know,
00:10:45
Speaker
This is where kids are. It's safe. They have trusted relationships there. This is so vitally important. And to just really lean into that mission, even when you're unsure if you can afford it, even if you're unsure if your community will embrace it, even if you're unsure if you can logistically do it in your building. I think leading into that mission of really remembering why and what this could do for someone or some family would really be
00:11:13
Speaker
I wish I would have just known that, to lean into all of the challenges and just know that it will be worth it. That's really powerful. If you can have that impact on one child or one family, you've potentially averted a disaster and that is powerful. Yes.
00:11:32
Speaker
So when our office, OCMH first connected with you and your colleagues, we really sensed the need to dig in further to the topic. There was a need to expand the dialogue with others to see what other school districts were learning and doing. And OCMH convened, we started convening monthly discussions.
00:11:56
Speaker
on student mental health screenings. And we connected with school mental health professionals from our largest school districts, from very small communities with providers in the Northwoods and rural communities where mental health supports are often lacking. And it turned into sort of a community of practice and it was very informative. I know our office learned so much.
The Role of Information & Parental Involvement
00:12:18
Speaker
And one of the main takeaways for us was that there was this statewide need for more information on screening.
00:12:25
Speaker
Our partners were hungry for information. They really wanted to know the logistics, the who, what, where, when, and why, and how to start. So in order to meet that need, this week, actually, our office released a fact sheet on universal screening. And the link is in the show notes. It's a brief document that covers the basics around screening. It's not every detail, but it includes what we've learned over the past school year from our discussions.
00:12:54
Speaker
And we're planning to supplement the fact sheet with more guidance and resources for schools because it is a growing movement. But for the moment, I'm curious about what you learned from our little community of practice. What were your takeaways from our monthly discussions?
00:13:12
Speaker
Yeah, well, the first thing that I took away was other people are doing this. That's amazing. Hooray. Sometimes this feels really lonely. You know, school-based mental health screening is relatively new and isn't widespread. And so really being able to connect with others, doing this good work was just
00:13:31
Speaker
so refreshing to talk to others in this work trying to sort it out. Other things that I really took away from that were that we had a lot of agreement around the tool that we're using or at least the base of the tool that we were using. Most of us as we began talking really
00:13:48
Speaker
were rooted in kind of the same questions and the same thresholds and the same things we were looking at. And I think that was really helpful to know. We're sort of all on the same track, looking at the same concerns. I think other things that really resonated with me were
00:14:04
Speaker
Really this idea of needing to not only look for potential concerns, but also really have space to talk with students about their strengths and their resilience and the things they're really good at and the supports that they have and their, you know, sources of strength. So I really appreciated having that opportunity to come together with my colleagues across the state and make sure we were holding space around that.
00:14:31
Speaker
And I think another thing that really resonated with me was that many of us are doing this in similar ways, although we each have some differences, and I think there is no wrong way. So sort of going back to that, getting started, starting small, choosing something. I think the other thing that really
00:14:52
Speaker
you know, was important for me was we do it our way here. And I feel really good about the work that we do and love to share our knowledge of what we've learned over the last 10 years. But there are a lot of people doing really good work in their own ways, too, with their questions and their models. So I think there is no wrong way to do this. And so that was really encouraging, too, to know that there's many ways out here to help support students and families in schools.
00:15:22
Speaker
Likewise, I thought it was encouraging to see other people are either struggling through how to get started, but on the pathway to screening or they've already been screening, it is just an isolating exercise in many ways. So it was kind of our first opportunity to share what we learned and have that dialogue across districts and across regions.
00:15:48
Speaker
What I loved learning from our discussions is that the screening process itself can help build kids' coping skills. So you referenced this, and I know you have found this in your work. Can you describe how that actually happens with a child?
00:16:04
Speaker
Yeah, absolutely. So we have done a lot of work here in our program to think about brief interventions and motivational interviewing so that we can really make the most of the time we have with students and families. So we don't get a lot of time. Our screening takes about 20 minutes or so to actually have the students log in and answer the questions about their thoughts, feelings, and behaviors.
00:16:30
Speaker
And then once we've identified a potential concern, we do meet with students individually to talk about those results and to get to know them better and understand what might be best next steps for them. But again, that's a really short amount of time and we don't usually meet with students again after that. From then on, we're working with families to help
00:16:49
Speaker
get services and supports to that student. So we only have a little bit of time to connect with that student and even the family around their mental health concerns, but also the positives.
00:17:04
Speaker
So we really try to take the opportunity to start thinking about those changes that we may want a student to make or really building up the strategies they already have and the supports they already know they have. So within our process, in our interview with students, we talk with them about their levels of stress, what things they're stressed about.
00:17:26
Speaker
And then we ask them to help identify what things they use to cope with those stressors. So really trying to get them to think about, we all experience stress. What is your level of stress? How do you manage that? And then what do you do about it?
00:17:42
Speaker
Similarly, as we're wrapping up our interview with students, we also talk to them about their sources of strength, the things that help them build resilience, their supports that they already have, whether those are relationships, organizations, things they do well or enjoy. We talk to them about their future planning. And then we also do ask them, how ready are they for change? So if we're talking to them about doing things differently for their mental wellness,
00:18:11
Speaker
How likely are they to do those things? Are they in agreement with us? What are the barriers that might stand in the way? So we really do try to start thinking with them about that and very similar once we stay connected to that family to really help the parents understand as well what kids feel like they're good at, what things are helpful to them and what steps they're ready to take as they start this journey or continue the journey for some of them. Sure.
00:18:39
Speaker
Well, on a personal note, I think as a parent that always strikes me as such a compelling reason to have my own kids screened. You know, I would love to know that when they're at school where they spend so much of their time and where they have their most important relationships aside from family that someone is checking in on them and helping them to self-identify their own coping skills, their own strengths to address adversity because
00:19:05
Speaker
We know from research that kids cite school pressure and academic demands as the major source of stress in their lives. So they have to know how to manage stress and cope with setbacks. As you said, we all experience stress. We have to learn how to handle that. And that these skills can be taught. Resilience is a skill that can be taught.
00:19:27
Speaker
What do you find with parents that they are generally supportive of screening or do you find many parents opt their child out of the wellness screen? Yeah, I think that's a wonderful question. It certainly is a partnership, right? We need parents to be involved in their students' mental health for many reasons, right? For general mental wellbeing, but also needing to take maybe a next step toward services or treatment.
00:19:53
Speaker
So what we find in our program is that we actually have minimal opt-out from parents. So we do notify parents about screening, so they do receive a letter twice that informs them of our screening process and does allow them to opt their student out of that if they would not like them to participate.
00:20:13
Speaker
We actually moved from a hard copy opt-out to an electronic opt-out this past year. We really thought, maybe we've made this too simple, but what we found actually was that we had even less opt-outs than we have in the past. So we have very few, under 10% generally, of parents that choose for their student not to participate in the program.
00:20:36
Speaker
I think another important thing that I've learned over this time with the program is that often what we are is a bridge between students and their parents or parents and the mental health care system. So I think a lot of students have a lot of feelings, a lot of experiences, and they aren't always sure how to share that with their parent or when to share that with their parent.
00:21:02
Speaker
Even the best of relationships, kids just worry. They don't want to disappoint their parent. They don't want their parent to worry about them. So often I feel like what we're doing is bringing some awareness to parents, starting a conversation that kids want to have but are sometimes scared to have or unsure how to have.
00:21:22
Speaker
And then helping support parents and better understanding their child, helping explore next steps, whether they're non-therapeutic or therapeutic, and really trying to make that pathway into mental wellness as simple as possible. That's an incredible way of, as you said, creating this bridge, is the actual opt-out letter that goes to parents is an opening for a conversation. I love that.
00:21:51
Speaker
So what about the students? Do you get very many students who choose not to participate in the moment?
00:21:59
Speaker
Yeah, so again, our students also have the option to participate or not. So when we meet with students in our groups, we explain to them the process very similar to what we do with parents. So we want them to be fully aware of what they're doing, what we're going to be asking, what the process is so that they don't feel uncertain. So we do talk with them about that. They are then asked to assent to participate. So they are allowed to refuse.
00:22:28
Speaker
Overall, about 15% of our students refuse. So again, a very low number. Most students do choose to participate in the screen. And oftentimes what we've learned over our last 10 years is the students that refuse aren't necessarily refusing because
00:22:46
Speaker
They are afraid of talking about their mental health. A lot of times they either feel like they're already in treatment and don't need to participate or they've already maybe done something like this either through us or through their primary care physician in the past. So often the feedback that we get isn't necessarily about not wanting to participate because of the questions, but maybe because they've already been in this system and don't necessarily feel like they need to.
00:23:15
Speaker
we still do encourage students to participate just because we know that even if you're in treatment there are still sometimes things that are unidentified or you're not necessarily talking with your provider about so we do still we do still encourage that but we do certainly have students that you know refuse for those reasons. Right that makes sense. It is reassuring though to know that when you cast such a wide net
00:23:41
Speaker
and you try to do a universal screen that you will also be capturing those kids who are already receiving services. So that makes sense. So we've already talked about obtaining consent from parents and the students themselves getting buy-in from school districts coordinating with the community.
Funding and Support for School Screenings
00:24:00
Speaker
Let's talk about the potentially the biggest barrier to screening funding.
00:24:05
Speaker
Are the schools you screen in using federal funds from the pandemic? Are these all local funds? And how did it work for the schools that have been expanding? It sounds like you've expanded a lot in the last few years. Do you have any insight into that big puzzle piece?
00:24:26
Speaker
Yeah. So I have some, um, our schools do self pay. So we do enter into contracts with them. So they upfront know the cost of our program. So as a third party provider, they are, you know, paying for the service of screening, um, those interviews with students and that case management with families that we will continue to do to get them connected to care. Um, so our schools really are the ones taking on the responsibility of finding those dollars most often.
00:24:55
Speaker
We work very hard to keep our costs reasonable. We've made changes over time, for instance, like going paperless and using electronic links, things like that so that we can stay competitive and make sure our school districts can afford our program. But most often, schools are
00:25:16
Speaker
right, not wanting to take away from their budgets and are looking for grant dollars that are related to mental health. Um, so they are often looking for, um, you know, grants, writing grants, um, both to state and federal. Um, they also do often look at our community
00:25:35
Speaker
and our local donors for additional dollars. So some of our schools will look at our community foundation or other
00:25:47
Speaker
community supporters to do some of this work that are just willing to give those dollars to school districts. So they really are pounding the pavement most of the time to find those funds. We always encourage our schools to be working together with their school board in order to put this in their budget and have sustainable dollars, but that is a big challenge.
00:26:09
Speaker
most are really reliant on those grants, especially for expansion. I do think that the dollars that have been available or more readily available because of the pandemic and our new kind of understanding of adolescent and childhood mental health and the importance of school and the kind of crossroads of the two have helped a lot of our districts add grade levels and expand or brought new schools to us.
00:26:39
Speaker
But I think all along they've really been reliant on state, federal, and local funding. Yes, securing sustainable funding is so hard these days, but it is so critical to the success of any school-based program. Having stable source of funding is a best practice, but also when you don't have a stable source of funding, it just requires schools to apply for grants all the time, the pounding the pavement, as you said.
00:27:09
Speaker
It's a very time consuming process and it sets up a competitive dynamic between schools and districts. So, which is not ideal when we're trying to implement something universally. So having reliable sources of funding really equip schools to build and grow a quality process and we hope we can get there. Well, we are short on time, so let me try to sum up. The purpose of screening we've talked about is to not only identify risk early before a child is in crisis,
00:27:38
Speaker
but also to highlight their strengths and skills, and that screeners are looking for wellness, not just signs of mental distress. That's why the process is often referred to as universal screening. We are trying to check in with all kids at least once a year, just like a vision or a hearing check or an annual sports physical. In this case, it's to keep their brains healthy. We learned that the mechanics of screening differ from one school to the next,
00:28:04
Speaker
which grades are screened, the time of year, the actual screening tool used, they all vary. And screening in middle school and high school are very common, but some schools are working towards implementing wellness checks in all grades, K-12. And I know you've seen that in your work, Amy, the expansion to other grades. We know also that collaboration with the community and third-party partners like yourself and with the school are absolutely essential
00:28:33
Speaker
to a productive partnership. So Amy, any parting words of wisdom or anything I left out that we should put on the record?
Conclusion & Call to Action
00:28:42
Speaker
No, I think you've done a wonderful job of summarizing and really bringing together folks from across the state around this important topic. I think, you know, what I would share is that screening is one piece of this puzzle. It really does help us to identify. And when we're able to identify early and often, we're able to get kids into services and supports that make the likelihood of success so much higher. And we know that when we have mentally healthy kids,
00:29:11
Speaker
they're able to do so much more. They're able to attune to academics and build relationships with friends and family and participate in activities at their highest level. So when we can really find these concerns and address these concerns early, it just does set them up for such success. So certainly as we already talked about getting started, starting wherever you can with whomever you can,
00:29:39
Speaker
do know that somebody out there needs you to be asking these tough questions. Yes, and that we will be cheering them on. Amy is always wonderful to collaborate and talk with you. Thank you for joining me today. Thank you for having me. Until next time, keep working at School Mental Health because school mental health works.
00:29:59
Speaker
Looking forward to future episodes? Make sure to subscribe on the podcast platform of your choice and leave us a rating so that others invested in better mental health for Wisconsin students can find us. We welcome your questions. You can find resources and learn more by checking out today's show notes and by visiting the coalition's website at schoolmentalhealthwisconsin.org. Until next time.