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Episode 9: Navigating the Road Together - Mental Health Referral Pathways
187 Plays1 year ago
Today we are joined by Joanne Greenlee, School Mental Health Navigator from the Marshfield School District and facilitator for the Coalition’s School Mental Health Navigator Community of Practice; and Greta Blancarte, Wellness Coordinator from the Ashland School District and Coalition Board Member. Joanne and Greta share how they came to serve in their current roles and how they help students, families and school staff navigate mental health programs and services, whether in the school setting or with a referral to a community provider.
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
Marshfield School-Based Mental Health Consortium Brochure
Marshfield School-Based Mental Health Sponsorship Application
Marshfield School Mental Health Pathways Program Guide
Recommended
Transcript
Introduction and Podcast Goals
00:00:17
Speaker
Welcome to School Mental Health Works, a Quick Dip monthly podcast presenting dialogues on school mental health in Wisconsin. Our mission is to share the successes and challenges experienced by a range of partners in Wisconsin as communities continue to collaborate and show that school mental health works.
00:00:37
Speaker
This series is a product of the Coalition for 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 Hosts: Greta and Joanne
00:00:57
Speaker
My name is Greta Blancarte and I'm the School Wellness Coordinator and School Social Worker with the Ashland School District. My name is Joanne Greenlee. I am the Mental Health Navigator for the School District of Marshfield. We're so happy to be here. We're talking a little bit about
00:01:16
Speaker
pathways and referral pathways. And I was interested, Greta, in how did your district get started with mental health and when did you become involved? Well, the School District of Ashland was one of the first Project AWARE cohorts. So I came into that project in year three in the 2016-2017 school year.
00:01:36
Speaker
When our team had decided that they needed some type of referral pathway and that pathway needed to have a person at the end. So taking information from any concerned folks in our community about student mental health and finding the right referral and the right resources to connect that student and that family with. They really weren't sure what they wanted that to look like.
00:02:04
Speaker
but they really wanted to find a person to develop the program. So that was my job coming in as a wellness coordinator. We played around with the name for a while, but basically as a mental health navigator to coordinate the different pieces of our mental health program in our school district.
00:02:23
Speaker
We had been working with a few clinics that had providers that were coming into our schools, but there wasn't any central coordinating system.
Coordinating Mental Health Resources
00:02:34
Speaker
It was just if a provider had a relationship with maybe a school counselor and they kind of figured it out if they had either a client at the clinic who was having some barriers or a student at school who was experiencing barriers of getting connected to mental health
00:02:52
Speaker
they were all kind of in a piecemeal patchwork sort of system. So as part of the AWARE grant work, we really wanted to centrally locate within
00:03:06
Speaker
you know, a person and a program on how all of those different resources, the referral health pathway, all the warm handoffs, kind of a central person for both students, families, and for community providers that they could call and coordinate scheduling and resources and availability. So that's how we started the development of our program. I started just a little bit different.
00:03:35
Speaker
In 2018-19 school year, our director of student services wrote a little grant to get some help in developing referral pathways and figuring out what to do. We had a similar situation, Greta, in that we had some space MOUs with some different therapists in town and they'd come in sort of as they wanted to, but no central coordination of that at all.
00:04:00
Speaker
So we did get a consultant to help us do some planning and to develop a school-based mental health consortia and to develop their referral pathway. That also helped us write a DPI grant, a DPI mental health grant that then funded my job as the mental health navigator.
Role of Mental Health Navigators
00:04:19
Speaker
I had been working with the district as a school social worker and I also
00:04:25
Speaker
I happen to be a licensed clinician. I have my LCSW, so it made a lot of sense for me to become the navigator in working with this. I had also been working with the team to sort of develop a plan for bringing mental health services more into our school buildings in a much more systematic way. So that's sort of how we began doing it.
00:04:49
Speaker
Great, and you mentioned mental health navigation. Joanne, you're one of the co-facilitators of the Navigators Community of Practice through the Coalition for Expanding School-Based Mental Health. What are some of the differences you've seen in how your district and other school districts are using that role of a mental health navigator?
00:05:08
Speaker
Yeah, i've talked to a lot of the mental health navigators around the state during this community of practice Um meeting that we have monthly and I recognize really that navigators role Although have a lot of similarities. There's a lot of differences as well
00:05:24
Speaker
It depends a lot on the district's referral pathway and and it depends on the navigators other duties You know, I have luxury of being the mental health navigator. I've have many other roles, but not direct student contact roles So I can concentrate on that we really focus on
00:05:47
Speaker
Our Pathways is focused on relationships, so our school counselors do a lot of the beginning legwork when there's mental health issues for a student. They talk to families, they talk to students about mental health services. Before I'm ever involved with it, I end up doing the secondary part, which is making sure the program is running, but they do most of the family and student contact, whereas
00:06:14
Speaker
several navigators, they just get their referral and they do all of the beginning leg work.
00:06:20
Speaker
in terms of reaching out to the family and setting up services. So ours works just a little bit differently because of that. We also have developed a pathway that looks at what all of our school options are in school options with our school staff, what are our community options, and then finally, of course, what are our consortia options in terms of setting students up with therapists inside of our buildings.
00:06:49
Speaker
So my role ends up being the big picture coordinator instead of the small things, although I do coordinate all of our funding and sponsorship money for when we have financial barriers to
Evolving Referral Pathways
00:07:04
Speaker
service. And I will do any running around case management if papers need to get signed, if somebody needs to get to an appointment, all those kinds of things once they're going in the consortia.
00:07:14
Speaker
What is your role as a navigator in that you do multiple roles in your building? Yeah, I think it is a little bit similar to how you were describing yours, Joanne. Initially, it was more of that one-person show where when referrals were coming in, we have a web-based referral pathway. Those referrals can come from staff, come from outside community partners, from parents, from students,
00:07:43
Speaker
each other or for themselves. And those would kind of land with me and then I'd reach out to all the partners and all the different players and ultimately the family and the student and figure out what resources we had. But it's sort of over the last six, seven years, it's sort of
00:08:01
Speaker
shifted and changed a little bit organically so that it's a little bit more of a team approach like you were talking about. So very often those early conversations about mental health are starting with counselors or teachers, those people that have day-to-day contact with the student and the family.
00:08:21
Speaker
And that works in a lot of ways because they're having those conversations with people that are the most comfortable and knowledgeable about the students. We found that that's really beneficial for families. It can be comforting for them to know that everyone is in their child's corner behind getting this extra support.
00:08:39
Speaker
and that the whole team is understanding around those and flexible around the needs. And it is really normalizing for students and families to have that team approach, I think, in a lot of ways. Every once in a while, there's still a referral that comes to me through the channel that hasn't gone through this team approach. And then it is a little bit of a start to finish in my role. And both of those ways work. So we kind of
00:09:08
Speaker
flex and take it as each individual case comes. So that's been a really nice way of being able to have multiple pathways to get a student and family connected with resources.
Team Approaches in Mental Health
00:09:20
Speaker
Yeah, that sounds really interesting.
00:09:23
Speaker
Something that I think was the most helpful for us for our referral pathway was we instituted what we call student services teams in all of our buildings. This happened when we gained some additional social work time, so it then made sense to do this because we needed to partner a little bit better with all of our student services support team.
00:09:45
Speaker
We have weekly meetings with the principal Social workers school counselors and school psychs like all at one time. It's usually an hour meeting once a week and during that meeting We talk a lot about
00:10:00
Speaker
Uh mental health and behavior issues for students who's struggling who's seeing who what services are we providing to various students? What groups are the counselors running or not running? Um, what behavior or disciplinary issues have come up, um within a building so then We can all together look at
00:10:21
Speaker
what are the services that we can provide and how can we support a student, whether that is, okay, our PBIS program can help with this situation and this particular student. So something more universal or we need to do a check-in. So something more targeted with the student or as I said, you know, some more formal things like a group or
00:10:48
Speaker
additional lessons with a school counselor or whatever those needs are and there's a variety of things that each building can pick from in terms of how they're supporting a student with lots of people outside of even the student services team sometimes it's a mentorship with a staff person that's not on the student services team as well and then
00:11:11
Speaker
Um, from that student services team meeting is where the referrals for additional mental health come from. Um, but that's a weekly occurrence. So we try to stay on top of things. Um, and then if the team makes a decision that we need services in our buildings, mental health services, then, um, we assign up.
00:11:33
Speaker
a person that's a point of contact usually the school counselor who knows the family and then they contact the family and talk through the process and Find out what the family wants Obviously things happen differently than that too because sometimes families will call us and then that goes to the student services team and we say okay the family called and this is what they're interested in or you know with high school students come into the counseling office all the time and and ask for help and
00:12:00
Speaker
So then again, that's brought to the student services team and we discuss sort of how we can meet those needs I will say that is the the way that it usually happens Because things aren't always perfect There's many times that a need happens way faster than the student services team meeting So if we meet on a tuesday and a student services team and a kid comes on wednesday It's not like we won't do anything until the next tuesday as well we um
00:12:30
Speaker
Part of our referral pathway is that we want to do some sort of consultation regarding mental health.
Community Collaboration and Pathway Building
00:12:36
Speaker
And if it's not at the student services team, we ask that counselors talk to a social worker or the principal, another counselor to sort of talk through, have we done what we need to do so that we're always doing things collaboratively and that works well for us.
00:12:54
Speaker
So Greta, can you tell me what's gone well for you in creating your referral pathway and what recommendations you would have for a district?
00:13:03
Speaker
Well, I think that that comprehensive approach that you're talking about and the flexibility of being a bit more nimble as well is really, really important. And I also want to stress the importance of really coordinating and collaborating with the community partners. That was one thing that I think was really beneficial early on in our
00:13:28
Speaker
pathway development. I came from the outside mental health community before I came to education, so I had a lot of those pre-existing relationships. And so it was easy for me early on to really reach out and see what they needed as far as
00:13:45
Speaker
referrals, either going to outpatient clinic or our providers that were coming in here into the schools. Really finding out what those little barriers are all along the way that a family might bump into. Being able to have that experience of kind of taking a family through exactly what to expect at each part so that there really were no surprises. If there was a
00:14:12
Speaker
a really large paperwork packet that they should be planning on getting in the mail or being handed when they walk into a clinic. It was really helpful to talk through some of those things, some of those insurance barriers or how long something might take. What am I going to be asked when I get to this intake appointment? Really having knowledge about all of those pieces from the community partners so that you can
00:14:37
Speaker
with, you know, really openly walk a family through that might be a little nervous or uncomfortable or scared about this whole procedure and process so that they know what to expect at every step. I think that has been really beneficial to our process and then being able to share that out so that
00:14:57
Speaker
If it's someone other than myself who is walking a family or a student through this process, they have that knowledge as well. So the whole team can have a really a full wraparound perspective for all the warm handoffs that need to happen. How about for you, Joanne? Yeah, that sounds great.
00:15:18
Speaker
Well, you know, really thinking about when somebody's starting this process, which is asking for help. There's a lot of models out there and a lot of ways that people do referral pathways and run different things for, you know, providing mental health for students and asking for some help. DPI has great information as well.
00:15:41
Speaker
I think probably one of the things that was key for us is recognizing what we were already doing well. Without having a formal referral pathway, most schools have a referral pathway, a way that things happen. Recognizing, what are you already doing well?
00:15:59
Speaker
And so, you know, for us, the school counselors were doing a big portion of the job. They were already well involved with students and had those relationships. That made a lot of sense for us to continue that.
00:16:13
Speaker
But we realized we also had some gaps in services. So working together, we could say, OK, where are we missing out? What are some things that we're not doing? And when we were earlier in the process, we recognized that we had not articulated very well what all the possibilities are for a student, what all the services could be.
00:16:35
Speaker
doing that was really helpful and then to say what else do we need. We have used some of our getting kids ahead money and mental health funds to do co-facilitated psycho-educational groups with school counselors and mental health providers.
00:16:51
Speaker
in order to build skills. They're clearly psychoeducational, not therapy groups, but they're about building coping skills, building relationship skills, following much of the curriculum that we already use, which is a DBT model.
Innovative Solutions for Service Gaps
00:17:08
Speaker
Dialectical behavioral therapy kind of in schools model and so building some of those schools Skills has been really helpful because then we can grab some students who are either on the waiting list who aren't ready for therapy or who need who are in therapy, but
00:17:26
Speaker
In therapy, they're doing a lot of trauma reprocessing and they still need skill building so then we can grab some of those, but we would not have necessarily decided to do that if we hadn't looked at where do we have gaps in service because everything doesn't have to be
00:17:43
Speaker
They get nothing or they're in therapy. Sometimes there's that in-between piece that's helpful. Another really good example of that is we have a growing Spanish-speaking population in Marshfield. It used to be the numbers were negligible. We did programming, but not
00:18:03
Speaker
heavy programming for those. Now we have many students who come to us only Spanish speaking. I was getting a good number of referrals, mental health referrals, for those Spanish speaking individuals and then having to figure that out because we don't have a Spanish speaking therapist in town. All of that has to go through some translation services or interpreters.
00:18:25
Speaker
But looking at the referrals, we saw a lot of these issues that are being labeled as mental health issues are adjustment issues and coming to the country, newly coming to the country and feeling isolated. And so we created with UW Extension 4-H service a
00:18:46
Speaker
Spanish speaking social or psycho educational group for them that works on transition and works on adjustment and coping and works on sort of future planning. So there's an academic and future academic piece in there as well. And that was hugely successful, but it helped relieve some
00:19:08
Speaker
capacity issues having to do with mental health services or mental health therapy services because it was hard to serve those kids but we
00:19:19
Speaker
develop something totally different for them. I loved what you said, Greta, about being flexible in your planning and nimble because all the time you're coming up, you have an idea of what your pathway is, but different needs come up, different ideas come up. You find different gaps in services and then being able to address those in some sort of way, I think, is an important thing to be able to do.
00:19:45
Speaker
As you said, working as a team to be able to do that is super important because if I had to come up with all the ideas myself as a mental health navigator, it would be very limited. But working with all the teams in all the buildings who are on the ground and doing things or have a different perspective than I do, principals have a very different perspective than I do about what services are needed.
Challenges in Mental Health Services
00:20:11
Speaker
working as a team is really helpful in developing some of the different services that could be available on your pathway. That's great. It sounds like you guys have been really creative about meeting some of these needs. Are there any other barriers or challenges that you've experienced and do you have any suggestions for overcoming any of those? Yeah, I think the barrier that I've heard from many navigators and many school districts comes down to capacity and resources.
00:20:40
Speaker
We only have so many therapists in our community that can come do school-based services. They have all their own rules and procedures that sometimes get in the way as well as just they only have so much time and long waiting lists themselves. We have found that when we get more therapist time, we fill it pretty quickly.
00:21:08
Speaker
so we know that the need is out there. So capacity is always an issue. In terms of resources, it's always a struggle to find resources for families, whether that's outpatient or funding. I was able to write a grant through our Marshall Area United Way to get some money for what we call a sponsorship. So if a family has financial needs, then we can provide some money and have an application for that.
00:21:38
Speaker
It's sort of interesting how that works because it's not the super low income families. They're on badger care and their mental health treatment can be taken care of. It is families that are working and
00:21:53
Speaker
living paycheck to paycheck or close to the edge, but don't qualify for many services and have very high deductibles for mental health services. We are funding some kids for mental health for that and finding ways to overcome some of those barriers.
00:22:12
Speaker
That is absolutely the challenge. Of course, the other barrier that we come across is there's still a lot of stigma related to mental health. I liked what you said earlier about normalizing mental health treatment and normalizing getting help when you need it is really important because there's still some resistance
00:22:33
Speaker
And whether that comes across as, oh, I don't think that this is going to work or outward resistance, sometimes that's it. Or sometimes it just comes across as no follow through. It's not very important.
00:22:49
Speaker
for some families, even if it's important for the student. And so finding ways to partner with parents, that's always a challenge and keeping parents involved is always a challenge for us. What about you Greta? What barriers and challenges have you come across?
00:23:07
Speaker
I definitely agree with all the ones that you brought up with, especially in these post COVID years, resources have been more and more scarce here in our region and demand has been higher. Prior to COVID, we had about eight different agencies that were having providers come into our school, and we are down to two. And this year is better than the last two years, I must say.
00:23:34
Speaker
I'm finding a few more availabilities to connect students and families. But yeah, there was definitely some pretty dry years in there as far as capacity for our provider
Overcoming Stigma and Building Trust
00:23:47
Speaker
community. We lost a lot of providers in this area, either to just telehealth, and not every student and family feels comfortable with the telehealth model. And there were just some that left
00:24:02
Speaker
left the area. It's definitely been challenging. In the past, I've found that sometimes just striking when the iron is hot was really, really helpful for making those connections when whatever happened that the student was interested and the family was interested. If you could make that intake appointment that day and get them connected and
00:24:24
Speaker
you know, set up resources for transportation and everything was moving while everyone was ready, then the follow through was much higher. And now when there's, well, we need to wait and maybe a number of things happen in the meantime before you can find a resource that's going to work for the family, the follow through has been a lot more spotty in times. And I definitely understand that people have gotten
00:24:54
Speaker
Well, that I'm never going to find a resource, so I'm just plodding through best I can, or that giving up on this is just never going to work.
00:25:07
Speaker
heartbreaking, watching some family struggle through that and some kids that are really, really having a hard time and just cannot find resources. I remember talking to a mom last year who said, you know, I always kind of looked down on families that, you know, just weren't getting help for their kid when they clearly needed it. She said, and all of a sudden my child
00:25:28
Speaker
is needing this and I've called seven places today and like most of them won't even take weightless because they're so overloaded and I just I don't know what else to do and I see how hard this is for for families and it was a really kind of eye-opening thing for people in our community who were perhaps reaching out for the first time for services
00:25:50
Speaker
One good thing about COVID I think is it did normalize reaching out behaviors for getting mental health supports in a lot of ways because so many more people were struggling. But then at the same time, that creates a capacity issue. But I do think that helped with some stigma, some stigma busting. Another barrier is just
00:26:14
Speaker
It kind of has always been those families that maybe have had a negative experience in the past with a mental health service or just some distrust. My district incorporates a tribal community where there is understandably a lot of mistrust of both the school system and the mental health system and there's a lot of generational trauma.
00:26:36
Speaker
around institutions like that and really finding the right person to reach out with the right resource in the right way to make that accessible for families that have had some negative experiences and just really being patient. You know, there are times when I've maybe talked to a family
00:26:57
Speaker
two, three, four, 10 times before I even bring up the idea of mental health services, because you just need that relationship building piece before you start bringing up resources that they might be a little wary about or uncomfortable with. And so, yeah, I can't speak highly enough about that relationship building piece throughout this entire process. Yeah, I would totally agree. And you talked about sort of two things
00:27:27
Speaker
either families having to wait or being resistant. And that sort of leads us back to this idea of other than therapy, what are some of the other services and supports we can offer? And there's always a challenge having to do with school district's capacities in terms of
00:27:47
Speaker
seeing kids and doing more individual check-ins and all of those kinds of things because we also have a limited capacity in what all we can do. So trying to fill those gaps can sometimes be challenging. It's a conversation we have in our student services teams all of the time, which is
00:28:09
Speaker
How do we balance all the different things that we have to do and who has time to do it? Who has the relationship to do it? All of those different things can be quite a challenge for any school district with what I think are growing needs.
Concluding Thoughts on School Mental Health
00:28:28
Speaker
We have more referrals this year than we've ever had and
00:28:35
Speaker
We're seeing some more students because we have some increased capacity, but it is only the beginning of the year, the end of the first quarter, and we have kids on a waiting list already just for our services. It is really difficult, and then that capacity of trying to figure out what to do next. Always lots of challenges.
00:29:00
Speaker
It's always fun to talk about this kind of stuff and to bounce ideas back and forth. And so it has been really great talking with you, Greta.
00:29:09
Speaker
Same. Yeah, I love hearing about all the creative ways that your district and other districts you've spoken with have found to just really dig in and get creative and manage those internal and external resources in ways that work for kids and families. Okay, so until next time, keep working at School Mental Health because School Mental Health works.
00:29:31
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 reach us and 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.