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Episode 4: It’s Elementary! Constructing a Continuum of Mental Health Supports
375 Plays2 years ago
The Wisconsin Department of Public Instruction defines the “Continuum of Mental Health Supports” as mental health promotion, early intervention, and treatment services, including crisis support. Often organized based on the level of need, the continuum creates a proactive, responsive and flexible web of support for all student’s mental, behavioral, social and emotional strengths and needs as they shift over time, with a focus on building resilience and protective factors rather than categorizing students based on their perceived deficits.
In the fourth episode of our podcast, Carey Jacobson, Director of Clinical Services at Wellpoint Care Network, and Katrina Johnson, Connect Strength Project Manager, discuss how their organizations partner with schools to create a continuum of support. Wellpoint offers Trauma Sensitive Schools training and consultation and also provides school-based mental health services. Katrina is a regional trainer for Sources of Strength, a school-based suicide prevention program with an emphasis on peer leadership and curriculums for elementary and secondary students.
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
Wellpoint Care Network - School Based Mental Health
Trauma Sensitive Schools Training and Consulting
Youth Mental Health First Aid (WISH Center Training)
Recommended
Transcript
Introduction & Podcast Affiliation
00:00:00
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 Wisconsin.
00:00:16
Speaker
Our mission is to share the success and challenges experienced by a range of partners in Wisconsin as communities continue to collaborate and show that school mental health works. This series is a podcast 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: Kerry & Katrina
00:01:01
Speaker
My name is Kerry Jacobson. I'm the Director of Clinical Services at Wellpoint Care Network and the co-chair of the Coalition Board.
00:01:09
Speaker
And I'm joined today by Katrina. Would you like to introduce yourself? Hi, I'm Katrina Johnson, and I'm a private practice therapist who stumbled upon school-based mental health. And one of the platforms that I work from is just being persistent with an upstream approach. So as we talk about the continuum, Carrie, you and I both being clinical, we can contribute to the
00:01:36
Speaker
best practices with schools by sharing that clinical lens. In our previous time talking, you had talked about the increase of referrals. Do you want to share a little bit about that?
Integrated Mental Health Model in Schools
00:01:50
Speaker
Absolutely. So our program, we've had a school-based mental health program for several years in a couple of different forms. Right now we practice what we call our integrated mental health model and we're in about 13 different districts and 35 different schools.
00:02:07
Speaker
throughout southeast Wisconsin. Our integrated mental health model really looks at that continuum of services. So we provide a universal level of training. We provide small group consultation sort of at that tier two level. And then we provide clinic based therapy, individual therapy services at that tier three level. In the last
00:02:34
Speaker
Two years or so, we've seen a significant increase in the number of referrals. Many of them do the COVID experience, social isolation, and then returning to school and some of the challenges that have presented themselves in that return to school.
00:02:51
Speaker
Our integrated model really wanted to focus on making sure that mental health wasn't provided in a bubble, that there was common language within the school, that universal trauma-sensitive schools training or mental health training provided a language, a common language that we could utilize in our consultations and in
00:03:12
Speaker
successfully referring youth to our programs. We wanted to make sure that we could provide some observation and recommendations to teachers and staff so that they could help continue our mental health work. So help support treatment goals, and we could help support the schools by providing some intervention suggestions, modeling some of those kinds of things in the classroom setting. So that's what we have seen. Karina, can you tell us a little bit about the programs that you support?
00:03:41
Speaker
Yeah. So like your highlight of your discussion is you all have worked to get into the schools through providing trainings and individual one-on-one and consultation.
Growth & Challenges of School-Based Programs
00:03:56
Speaker
And I think before you had said that the referrals increased by almost 300%. Correct. And with our clinical lenses, we're shifting
00:04:07
Speaker
while also holding tight to the clinical model or shifting to being able to infuse more effort and support in the community model in schools. And that is what you've been doing with the training for teachers and being a point of contact to help school systems braid in the best practices of clinical mental health pieces.
00:04:31
Speaker
So five years ago, I asked 12 schools to apply for a school-based mental health grant. And I was very frustrated that only one said yes. And then after that, I was really thankful, very grateful that only one said yes, because we were able to create a really strong model and start small. When we listen to these podcasts, a lot of it is about starting small.
00:05:00
Speaker
Um, because there's a science to it. There's, it's not a business. It's a science of best practice that flows smoothly. Now, um, we have about 18 schools wanting to be in on these school-based mental health programs and.
00:05:20
Speaker
What I have transitioned from frustration and surprise to there is a significant amount of learning, experience, and equipping and empowering the schools and mental health providers to have that common language, identify rated funding. And that's a lot of work. I think in Wisconsin, we have some silos of funding.
00:05:51
Speaker
And with looking at the definition of a continuum, you have like three points. One is you're mentally healthy, one you might have mental problems, and one is mentally ill. That's that continuum definition. But really, the pandemic opened our eyes to practicing
00:06:12
Speaker
the people, places, and things leaning into the strengths that help us deal with the ups and downs of life.
Awareness Campaigns & Early Intervention
00:06:20
Speaker
And I don't really love that word deal, but it's how do we respond, react, support ourselves in stressful situations? And that's mental health. So are schools reaching out more, being more open-minded versus that crisis response piece?
00:06:41
Speaker
I think it's both. I think that continuum piece, there's been more interest in some of that early intervention and prevention model. So let's do mental health awareness campaigns. Let's have that language so people know how to talk about it. There's been some more conversation about
00:07:00
Speaker
We've been doing some more mental health first aid training, so really helping people who are not in the field identify when there is a mental health need or a mental health crisis, and then helping people get to the right place. So I see some of that intervention and early intervention and prevention models happening. On the other end of the spectrum, we do crisis response as well. There continue to be
00:07:24
Speaker
significant things that happen in schools. We work in a lot of schools where there's community violence and so we've responded to support some schools and some families through some of those experiences as well. So I think you're right.
00:07:39
Speaker
We are trying to shift that language, that paradigm to everyone can benefit from mental health wellness, as well as helping people really identify when it rises to a higher level of need, and then having the understanding and the resources to get them to the right place.
00:07:57
Speaker
I think that's been a challenge sometimes for schools and communities. There might be some fear around asking some of the questions because they don't know what to do then with the answer. So hopefully some of the training and some of this conversation helps people understand where their resources are within their community.
00:08:16
Speaker
whether it's directly in their school or another provider, and how to help kids and families access those. You focus on the incorporation that clinical lens and the science of. I have that hope for all of Wisconsin. The identifying prior to the pandemic, the mental health screening that we were incorporating was
00:08:46
Speaker
successful and helpful and for mental health screening versus behavioral health screening it's it's a lot more clinical and it has the steps we use the steps like fondle like why screen um there used to be a fear like you said schools would say well we can't do that we're afraid of what we would find
00:09:06
Speaker
And I used to settle on, settle on, I get that.
Changes in Screening Practices
00:09:10
Speaker
And then August of 2020, the phone was ringing like it was, it was a high level and it hasn't stopped. So mental health screening, in our model with Cadet strength, I didn't mean that before, but with the number of schools increasingly wanting to be involved with these school-based mental health grants, because that's how schools get money specifically earmarked for their plans,
00:09:36
Speaker
We have developed that sources of strength foundation and then infusing readiness for mental health screening. So no longer shall we have fear to identify because not everyone then is actively needing a crisis response. And what's the problem of identifying nothing? What's the problem of not identifying a whole gamut of things?
00:10:03
Speaker
So when we do mental health screening, we find the strengths, talk about strengths. We find the areas that we need to provide some support for parents and the student and the school. And then a lot of psychoeducation. And people can Google psychoeducation lookup videos. But what that is is similar to what there was the research of looking out for kids of, did you know that not sleeping for
00:10:33
Speaker
Two weeks is a problem. Did you know that having erratic, whatever, whatever, is a time to seek help? And that psychoeducation is, I hope, part of not only mental health screening, but integrated SEL in the classroom for everyday ups and downs.
00:10:58
Speaker
you have a high level of resiliency and emotional strengths in what you might identify as kids dealing with a lot of mental health issues. And then you have just like an example, you have the kids that are straight A involved in everything, but perhaps they are dealing with a high level of performance anxiety and are just on the cliff of an emotional dysregulated thing.
00:11:29
Speaker
And having that incorporated and braided into the knowledge of the teachers, the culture of the school, we're just starting.
Supporting Teacher & Family Involvement
00:11:38
Speaker
We're just starting with that.
00:11:42
Speaker
When you look at the content of some of the social emotional learning for kids, you need to be able to, like what you do, Carrie, is provide the training and experience and reevaluation and accountability and permission for by the staff to be walking the walk and talking and talk themselves.
00:12:06
Speaker
And we saw a pivot from those school-based mental health grant monies only going towards student projects to then we know teachers need it too. So some of those grant activities and budget line items were pivoted towards staff mental health pieces.
00:12:29
Speaker
Yeah, I think that's an area that we've seen, uh, grow and had more conversations with schools about we are supported by DPI grants and a couple of the schools that we work in. And they've utilized that, that funding to support the consultation at that mid tier level that isn't.
00:12:46
Speaker
isn't reimbursable by insurance and it isn't necessarily like PD work. So they've used it there as well as to support some of the teacher pieces. During early parts of the pandemic, we were doing a lot of virtual services, a lot of support of the staff directly. So talking with teachers about what they were seeing when they had virtual classrooms and what kind of homes they were looking into and what
00:13:13
Speaker
their level of connectedness was with students that weren't in their schools. As kids have come back and teachers are all back, we've had more conversations about the super high level of expectation to get kids back to where they were educationally, academically, the pressure that's there, as well as kids are coming back with a whole host of new challenges and social delays, emotional delays,
00:13:41
Speaker
peer interactions, all of those things. And so we've spent more time working with teachers to support some of their own mental health needs, quite frankly, as well as the pressures of the teaching environment. The other place that we focused a lot is that family involvement.
00:14:00
Speaker
making sure that the families and the homes that the kids are in are stable and providing the resources that they need as much as possible. And if they don't have some of those basic needs met, it's really difficult to expect the family to meet mental health needs. So we want to make sure families have the resources to meet those basic needs that they have. So kids can get those eight hours of sleep so that they can come with food in their belly so that they can focus when it's time to do schoolwork.
00:14:29
Speaker
So we've tried to make sure that we maintain that family involvement, not just in the family therapy aspect, but also in the everyday needs and resources and making sure that those aren't met. You listed such important areas. And then you have all the kids coming into the office with fevers or nausea and school delays and ice storms.
Collaboration & Overcoming Resistance
00:14:56
Speaker
Following the money is just a theme I want to talk about for a minute in the state. We have shortages of subs. We have such a need for parent and community collaboration. And that is a whole pickle, right? Somewhere there's a fountain of youth of how to engage families. But the beautiful thing is in Wisconsin, there are some, I call it smarty pants. I mean, there's some smarty pants persistent.
00:15:26
Speaker
all you and I being a couple of them, who are working to try to listen to the needs of school districts. And I helped them identify the obstacles. Going back when I called 12 schools and said, do you want to do this? And only one said, yes. I now have a chapter one of obstacles. What, where? Now, after five years, I have
00:15:50
Speaker
I guess you'd call it that success stories piece, like how we introduced it. It takes time. It takes time, but we're moving forward by trying to listen to and start discussions with. I think the work that's happening at Office of Children's Mental Health to bring together the peer-to-peer groups
00:16:13
Speaker
will eventually, over a course of time, create more momentum for the students to feel empowered. When I do trainings for sources of strength, trainings with the kids, it's almost, you know, nine out of 10 times, somebody, some student at the end will raise their hand and say, this will never work in our school. And I kind of hit a wall of, oh, okay, well, just tell them to call me because it's supposed to work and here's all the reasons why.
00:16:41
Speaker
But having the, they call it admin buy-in, all that will come with kind of this fountain of youth of finding how do we listen? How do we have discussions and learn with young brains that typically are not skilled in psychoeducation or typically aren't skilled in?
Adapting Services to Community Needs
00:17:03
Speaker
These are the things going on in my body. And I'm going to translate that as a DSM-5.
00:17:11
Speaker
So I hope in Wisconsin that like, Carrie, you're really seasoned in the clinical world. And I'm pretty passionate about that clinical world is be able to create that common language of we are, we are going to begin to listen. And that, that helps just helped that helps with the belonging and connection pieces for kids.
00:17:33
Speaker
Absolutely. Yeah. I think it's an important place to start. We have to listen and listen to what they're telling us that they need without making the presumption of what they need. It's a good place to start. Cause if we go in and say, this is what we think you need, but it doesn't resonate with, with the school or with the community or with the kids, it can be a really great product, a really great program, but it's not going to work if we haven't listened first. I agree. And equipping them with the language of,
00:18:01
Speaker
Here's options A, B, and C and D. Do any of those resonate with you? Do any of those make sense? And even second graders know what the word resonate means now. See? So we've made some progress. They've picked up a few of our lingo. Yeah. I think that's a good point, though, that we're in a lot of different places. We're in some
00:18:24
Speaker
You know, downtown Milwaukee charter schools were in some suburban neighborhood schools. You might think that their needs are all very, very different and they are to some extent, but the way we approach them is to start with that. We listen first. We look at what the information is telling us, what the families are telling us, the community is telling us, and then we work to develop the program around that. For each school, it is slightly different.
00:18:52
Speaker
But in many ways, there are common themes throughout. When we go on that paradigm shift for our Connect Strength model,
00:19:01
Speaker
We have included a really wonderful cinematographer, Sam Lee. And at first I thought that was a little bit too fancy pants, right? And that was too much money, but actually we have harnessed positive messaging through our campaigns and doing professional videos with our regional retreats where we had 15 school districts come. And the kids voices, the staff voices have been really,
00:19:27
Speaker
Even though you're in the mix of it and you're doing it, when you listen to those interview clips that they do, it's so validating of how can we best listen to these people? Because we all love when somebody produces their own video and they talk about mental wellness. There's this prevention, intervention, and postvention area where strengths can be braided in.
00:19:56
Speaker
And sometimes the intervention and postvention is only seen as, well, we can't talk about that because what would happen if we did?
00:20:08
Speaker
And the important thing to remember is young brains are already talking about it. If they're not old enough to be on their social media pieces, the kids are already talking about it on their playground. And if they are old enough to have their social media pieces, they talked about it as soon as their eyes opened in the morning. So when there are things that happen, such as the overdoses,
00:20:37
Speaker
the community violence pieces. When we talk about it in a way that brings out our own human reaction of that was hard for me. This is the strength I can lean in on my colleague, my dog, drinking more water because I'm just feeling stressed. That's as simple as it needs to be. But the kids need us to allow that to happen. As a clinician,
00:21:07
Speaker
I get to see adults later in life that say, that happened when I was young age and nobody talked about it. And it festers. So that permission to talk about it, we do more harm when we don't. But you do need to be able to open up the floor of how do you, what was your interpretation of that chapter?
00:21:31
Speaker
I agree. I agree. I think we've captured many of these pieces. I was looking back at the DPI framework for that continuum of mental health services, and I think we touched on a lot of them. The mental health supports, the collaboration with the community in the school, that needs assessment or assessing for family needs or student needs.
00:21:54
Speaker
The referral pathway, identifying how we get the kids to the resources that they need or the families to the resources they need. Sustainability, we talked about that with budgeting and DPI grants and how we use those funds to help support this major growing need.
Review of DPI Framework & Resource Challenges
00:22:12
Speaker
And I think we touched just a little bit on that data piece, you know, looking at the outcomes and looking at surveys to find out is this what people want? Is this useful? Is this helpful?
00:22:23
Speaker
To the community or do we need to adjust but I think you know without Quite purposefully doing it. I think we touched on most of the pieces in the continuum. So I feel like we've done a good job there I Like how you reviewed that so professionally good job Is there anything that you think we missed or anything more that you would like to add? I'll go back to the words of follow the money the
00:22:49
Speaker
you know, I am when we and the listeners are our boots on the ground in the school and I pop around to different schools. But the resources on the ground are so needed. So I hope we can help get the resources to where we need it. And that's in the hallways and in the schools. And right now schools are trying to
00:23:16
Speaker
They're talking about their budget cuts because the interventionists have to be let go. The school nurse has to be let go. We need ratios that are appropriate for school social workers, school counselors, SEL nurses. Or that academic goal is just going to be put on a shelf and lost. We need those people there now.
00:23:45
Speaker
take a a guidance and that's but that's the last thing that i'd like to share and um so i just wanted to i mean thank you i think it was a good conversation there are lots of opportunities as you said um i think the piece that i would like to encourage is that those people that are listening if you're not already actively involved to take a look at the website to see if there are ways to get involved in your
00:24:10
Speaker
in the mental health conversation and making sure that it's top priority because without it, the academic achievement can't happen. It's just not going to. We want to make sure that we keep working at school mental health because school mental health works.
Engaging Listeners & Finding Resources
00:24:25
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.