Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Episode 2: Show Your Work - Using Data to Tell Your Story
474 Plays2 years ago
This episode will cover how to build a data set to tell your school-based mental health story and give the listener guidance on crafting how you want to tell your success story. Segments include Dr. David Cipriano’s professional journey to school-based mental health; overarching trends and themes; how school districts can use their data and engage community partners; school-based mental health data that is out there now and useful for your research; a few easily accessible resources folks can use to get started; and, using a school staff mental health survey to help tell your story.
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 Youth Risk Behavior Survey
Children’s Wisconsin School-Based Mental Health
The Strengths and Difficulties Questionnaire (SDQ)
Please email info@schoolmentalhealthwisconsin.org if you would like editable versions of the resources shared, or with any other questions for the Coalition!
Recommended
Transcript
Introduction to School Mental Health Works
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. 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.
Focus on School-Based Mental Health Data in Wisconsin
00:00:46
Speaker
My name is Charlie Bauer and Find, a coalition board member with a background in clinical mental health as well as school social work. The topic for the podcast will be school-based mental health data collection and current data trends across the state of Wisconsin. Our guest today is Dr.
Meet Dr. David Cipriano
00:01:05
Speaker
David Cipriano.
00:01:07
Speaker
I am pleased to be joined by Dave, mental health expert extraordinaire and data guru. Dave is a clinician, associate professor of psychiatry, and director of student and resident behavioral health for the Medical College of Wisconsin. He received his PhD in clinical psychology in 1992.
00:01:28
Speaker
and has been a champion of youth mental health ever since, including numerous teaching positions at the medical college, resident and fellow education, and several professional journal publications and original papers. I could go on and on about as many leadership positions, but let's get this podcast started, shall we? Welcome, Dave. Thank you, Charlie. Very glad to be here.
00:01:54
Speaker
Oh, you're most welcome. Hey, let's start by having you share a little bit about your background and how you came to be connected with School Mental Health in Wisconsin. Can you share a little bit about your professional journey and how you found your way to School Mental Health so that our audience understands how you connect to the topic? You bet.
Dr. Cipriano's Journey in Mental Health
00:02:15
Speaker
Well, as a child psychologist, like any child therapist, I like to work closely with the schools. This is where kids spend most of their days and I appreciate a teacher's input. I always figure teachers have a better normative data set.
00:02:34
Speaker
in their head about what's typical behavior for a kid because they see twenty five thirty thirty five kids at a time everyday for seven hours a day so i always appreciate a teacher's input and i've always worked closely with teachers in my practice.
00:02:51
Speaker
And then for a long while, my first foray into actually practicing within schools was as a mental health consultant for Head Start programs in Milwaukee. And I did that for about 10 years. And that really gave me some great experience with direct service provision within an educational setting. And then when I came to the medical college about 13 years ago,
00:03:17
Speaker
I ran into a group and joined a group at the time it was led by Julia Eline. And it was a work group called Healthy Children Learn Better, I think was the name of it. And we were really taking a look at how, you know, when a child arrives for instruction, feeling good, having all their needs met,
00:03:45
Speaker
they are much more ready to learn. And through that, I got exposed to school-based mental health being conducted, namely the SCPMH group, School Community Partners for Mental Health, helped them do their outcome study about five years ago. And now I'm working with Children's Wisconsin in their statewide school-based mental health program and working with them on outcome studies for their work as well.
00:04:14
Speaker
Wonderful. Thank you. As someone who's done significant research on school-based mental health, what are some of the overarching trends or themes that you have
School vs. Clinic-Based Mental Health Services
00:04:24
Speaker
seen? Great question. First of all, we know that psychotherapy works with kids.
00:04:31
Speaker
and we and as far as a delivery system because that's all we're talking about here is a different delivery system. We're talking school-based mental health versus clinic-based mental health and the fact is we also know that delivering mental health services within schools works as well as it does in the clinic. Now this is no small
00:04:55
Speaker
you know, issue here. We had to show that initially, right? We had to show our decision makers at the state level as well as decision makers within third party payers hierarchies that this worked because for many, many years
00:05:12
Speaker
any checking off the box of any site of service outside of the clinic meant you didn't get paid so we did have to show initially that school-based mental health works and then we had to show some of the benefits of it but by and large the field the empirical field of looking at school-based mental health has matured beyond
00:05:34
Speaker
just that simple question of does it work and so forth. We've been able to show that there's so much good research out there. So now the field has really evolved into taking a look at a lot of different
Collaboration between Clinicians and Schools
00:05:48
Speaker
things. I've been noticing trends at the national level of taking a look at teaming and that is how do the outside clinician and the school personnel
00:05:59
Speaker
That is the educators, the school support staff, such as counselors, social workers, and school psychologists, as well as the administrators. How do they work together? How do they communicate? And so forth. So another trend I'm seeing in the literature is taking a look at who are we capturing.
00:06:20
Speaker
You know, for a long while, the low-hanging fruit were kids with sort of externalizing behavioral issues that is acting out kinds of behaviors or hyperactivity and so forth. Those come across an educator's radar pretty readily and are also the first to get referred. But our concern has been, are we capturing those quieter kids who may be struggling with issues
00:06:47
Speaker
but aren't showing it on the outside so much. That is depression, anxiety, trauma related kinds of issues. So people are taking a look at that. They're taking a look at are we reaching
00:07:02
Speaker
other hard to reach populations, and that is really assuring that we have equity in the delivery of these services. Are we really being inclusive in getting everybody in and reaching everybody? And lastly, I'd say another interesting trend I'm seeing
00:07:21
Speaker
the integration of social emotional learning or SEL with school-based mental health and that is not only can the clinician get involved in the delivery of SEL programming but how do they form this sort of seamless continuum really incorporating
00:07:41
Speaker
some of the great material that kids are learning in SEL programs across the state into their therapy and truly dovetailing that. That is really interesting. We know that school-based mental health works and I am a huge advocate, so how can school districts that are new to school-based mental health or who are still in the planning stages use the data that they already have
00:08:07
Speaker
while engaging their community partners to tell their own success story?
Using Data to Validate Mental Health Initiatives
00:08:12
Speaker
I'm really glad you worded that question that way, Charlie, because that's really what data collection is all about, is we do it for a reason. We do it to answer a question, to tell a story, to answer the why, right? So I really encourage districts and their community partners, the clinicians,
00:08:36
Speaker
to think about what is the story you want to tell. I remember way back when I first started with SCPMH,
00:08:46
Speaker
The story we wanted to tell was, hey, are we seeing good outcomes in kids? And not just good mental health outcomes, but academic outcomes. And of course, we were able to show those kinds of things. So we were taking a look at things like academic outcomes, discipline referrals, attendance, and so forth. Because we were trying to show that was the story we were trying to tell.
00:09:15
Speaker
is we're going to see far-reaching benefits in children from school-based mental health. Now, we were telling a slightly different story a few years later with the Children's Wisconsin Project, and that was one more having to do with access. We were really wanting to tell the story about how school-based mental health opens up access. In other words, reduces barriers to access to care.
00:09:44
Speaker
that many children, especially children in underserved communities face when it comes to mental health. So I encourage people to tell the story or to think about what story they want to tell and then the why. You know, why is this important? Are we looking to bolster the support of our administrators? Are we looking to engage our parents and community
00:10:09
Speaker
Are we looking to use this to raise resources, to increase our resources that we can dedicate to mental health programming? So those are some examples of the why. But to get back to your question, Charlie, there's really two pieces here. And that is, first of all, what sort of data is out there to help you tell your story?
00:10:38
Speaker
And there's plenty, right? I've mentioned a few things I've hinted at a few already. There's basic clinical outcome data. Your clinicians at any district that develops a relationship with a community partner, you can expect that that clinician will be gathering outcome data. Are my patients getting better, right? And there's academic data.
00:11:07
Speaker
There are these issues having to do with discipline rates, attendance, post-secondary plans and outcomes, as well as academic outcomes too. So there's all of that. We capture and focused heavily initially on just utilization data, how many sessions are occurring in the building, how many teacher consults. That's one thing I've always been interested in.
00:11:37
Speaker
because I really don't feel like the whole story is told when a clinician just swoops into a building, does therapy with a few kids and then leaves. That's not really school-based mental health to me. I mean, it is, but I think the ideal of the program is to truly have that clinician integrated into the building so that educators are learning from the clinician and clinicians are learning to use
00:12:07
Speaker
the language that educators use so that we have a truly seamless sort of safety net around these kids that we're trying to help. So lots of data out there that they can collect. I'll get into some more specifics if you'd like later. But here's the thing, too. The second piece to this is not only realizing what sort of data's out there, but
00:12:35
Speaker
Also, to have a clear understanding between the community partner, the community clinical partner and the school district, right? What are the expectations of both? What will the clinician provide? How often will the clinician come to the building and for how many hours will they attend meetings and so forth?
00:12:57
Speaker
But also, what's the expectation of the district? And will the district provide office space for this person? And even little things, will the district provide a mailbox for the clinician and access to the copy machine?
00:13:15
Speaker
Those kinds of things are important as well. Also, what are the communication channels that are set up between the clinician and the district? So those things can all be spelled out. We learned early on, especially in my work with children,
00:13:30
Speaker
to make sure we have a data sharing agreement set up. And this is an agreement that really spells out what will the district share with the clinician or the researcher who's doing the outcome studies. Now, I understand districts are bound by FERPA just the same way that clinicians are bound by HIPAA. So that's all written into the contract or this
00:13:57
Speaker
data sharing agreement is that it's understood that the data that's shared will be anonymized or at least coded and so forth so that all identifying information is taken out of there. But then also, again, to just have it up front, what are we agreeing to share as partners? Because that's the way I think we want to set the model up is really that this is a partnership.
00:14:26
Speaker
between the district and the mental health provider. And then the other thing that we usually have is a sort of a memorandum of understanding MOU. And that is also, again, spelling out those issues about
00:14:45
Speaker
number of hours and communication channels and oh gosh, it even gets into the weeds of professional liability insurance and all the rest of that kind of stuff. So those are, I'd say those are the things we want to get set up first in order to ensure that this, set this relationship up for success.
00:15:09
Speaker
Fascinating stuff, Dave. Hey, can you speak to what school-based mental health data is out there now and what has been useful to you in your research?
Understanding Utilization Data Collection
00:15:19
Speaker
Sure. The first thing that we look at is utilization data. And we collect, of course, information on how many sessions are conducted in the building.
00:15:29
Speaker
how many individual student clients there are in the building, but also importantly, how many kids are referred to treatment and how many ultimately then get in. Charlie, you'll remember that was the impetus for starting your group to begin with.
00:15:45
Speaker
And that is you guys noticed in your little corner of the world that only about 5% of kids that were referred for mental health treatment were actually getting into the clinic's office. And after a few years of developing your school-based mental health program,
00:16:00
Speaker
that number jumped up to over 50%. So that's a great way to show accessibility and so forth. So yeah, we collect other utilization data as well, such as the number of teacher consults that our clinicians do and the number of parent consults as well. Beyond that,
00:16:23
Speaker
We do collect mental health outcome data. We, our clinicians, use a standardized mental health screener that functions as a good measure of mental health outcomes. And they do this at different points throughout the therapy at the beginning and a couple of months in and then at the end of the therapy as well.
00:16:45
Speaker
I send out what I call a school staff survey and on there I have questions for the staff about their perceptions and attitudes toward the service, what they find useful about it, how it's impacted their practice and so forth.
Resources for Data Collection
00:17:08
Speaker
And then finally, there's a wealth of data on the state's Department of Public Instruction website. And that is that that WISE dashboard has just great data in aggregate form on every single school in the state, all kinds of stuff about attendance,
00:17:31
Speaker
disciplinary action, graduation rates, just too much to even go into right now, but it's a terrific tool to have for data collection. Thank you, Dave. Follow-up question, what are some of the resources that you know of that are easily accessible resources that people could get started with?
00:17:54
Speaker
Absolutely. So first of all, is that I would say that the state's DPI website, you look for the WISE dash, W-I-S-E dash, and it's dash standing for dashboard.
00:18:10
Speaker
And again, it's free and open to the public. Really, it has nice tools. Not only is it collecting a ton of data on every single school building in the state, but it gives you the possibility of partitioning that data set and narrowing down on particular populations within that building. So if you want to know what buildings have particular levels
00:18:35
Speaker
of low socioeconomic status or non-English speakers or at least English not as the primary language spoken. You can screen or select for those kinds of particular demographic variables.
00:18:57
Speaker
That's a great one to take a look at. We happen to use the strengths and difficulties questionnaire for our mental health outcome measure, the SDQ. Again, free and open to the public. I believe we'll share a link to that in our resources at the end of the podcast. It's pretty easy. It takes, I'd say, less than five minutes to fill out
00:19:23
Speaker
I know it's a lot to add. We do ask teachers to fill it out. I hesitate to put anything more on a teacher. I know how busy they are, but it's just a few minutes. I really try to sell it to them that it helps us measure how we're doing.
00:19:42
Speaker
and helps guide where we're going in the future. And then, of course, is our school staff survey. Now, there aren't standardized ones out there. I came up with my own. I know that the Madison School District came up with their own.
00:20:00
Speaker
And again, it has questions on it about the staff's beliefs and attitudes about the service provided and how it's helping them in their teaching and helping their school. So those are three that come off the top of my head.
00:20:18
Speaker
Thank you, Dave. I appreciate those three. I was wondering, because this might be something that's not as familiar to our community partners, is the school YRBS data. And I was wondering if you could talk a little bit about that.
Youth Risk Behavior Survey Insights
00:20:32
Speaker
Yeah, absolutely. I forgot to mention that. That is really interesting information. And what we get on there are all kinds of stuff about
00:20:47
Speaker
these children's habits as you know it is given in all state high schools every other year and then it's optional to be given in middle schools across the state and there's just a lot of information about risk behaviors that individuals engage in as well as health behaviors too. What I've been particularly interested on the YRBS are of course the mental health
00:21:14
Speaker
oriented questions and then the school connectedness questions as well. There's a lot of good research out there that shows that the degree to which a child feels connected to their school can really impact outcomes, academic outcomes, as well as mental health outcomes. And what do we mean by connected? It's the degree to which they feel that there's an adult, a trusted adult in that building who listens to them, who cares about them,
00:21:43
Speaker
who they can go to. And it's really become really quite a robust predictor of some of these outcomes, as I had said. But again, there's other straight up mental health questions on the YRBS, questions about anxiety, depression, and also suicide. And these are important things to be keeping track of for districts and for the mental health provider. And I'm very glad that they're on there. I know the old thinking used to be
00:22:12
Speaker
that we shouldn't ask about suicide. We might plant the seed in somebody's head, which has never been found to be the case. And in fact, it's so much better to talk about it, bring it out of the shadows. Let's get rid of that stigma and really raise awareness about depression and suicide. In that way, we increase comfort level with people seeking help and also just increase the detectability.
00:22:43
Speaker
In a sense, we are our brothers and sisters, keepers. We should be watching out. We encourage kids to watch out for each other. Have you noticed a friend that's struggling? Have you noticed a friend that's showing some signs of risk for self-harm? And don't be that secret keeper. Please talk to an adult if you have those kinds of concerns about a friend.
00:23:06
Speaker
And we're only going to get that happening if we bring this out of the shadows and talk about it. So I'm so glad YRBS is there asking those tough questions. Thank you, Dave. I appreciate you going into a little bit more detail about the YRBS.
00:23:24
Speaker
And speaking of a little bit more detail, could you loop back for our audience to the school staff survey that you had created?
Feedback from School Staff on Mental Health Services
00:23:33
Speaker
I'm sure others would be of great interest on that. Can you share it with us so that others don't have to reinvent the wheel? Oh, absolutely. And I'll even share
00:23:43
Speaker
in those resources, a copy of the survey that I use in my work with Children's Wisconsin. The first section of it is kind of a customer satisfaction section. We're asking the school personnel about how satisfied are they with the level of communication and the level of resources, the types of resources.
00:24:08
Speaker
that they're getting from the clinician. We're asking them if they notice benefit from having school-based mental health in their buildings. And then we get to what I am really more interested in.
00:24:24
Speaker
Although, of course, obviously, again, that satisfaction stuff speaks to the relationship between community provider and the school. And that's crucial, as I was talking about earlier. We've got to have that trusting relationship there. You know, it's an interesting thing. Mental health, child mental health,
00:24:45
Speaker
and education are so often, we're obviously working with the same population, but so often really working toward the same outcomes. And yet these are two disciplines that have grown in silos really. So that's the other, what I think is a very exciting benefit of school-based mental health is really bringing these two disciplines together. And so, and in a way that is respectful and collaborative
00:25:10
Speaker
So, of course, the relationship and the satisfaction with it is critical. But I'm very interested in what benefit do the educators get out of collaborating and consulting with the clinician? Do they feel like they're gaining skills in recognition of distress in their students?
00:25:28
Speaker
in being able to address students' trauma issues or other mental health concerns and having those difficult conversations, maybe in addressing behaviors in ways that aren't just fallbacks to a typical sort of disciplinary response. So we've got those things. I call those the self-efficacy questions. How much have we built self-efficacy with our educators to handle emotional and behavioral concerns?
00:25:58
Speaker
And then another one that we added in there was having to do with stigma. And I asked directly in ours, do you feel that having school-based mental health in your building has reduced stigma around mental health? And I just feel that's critical. It's something that Children's Wisconsin has been very interested in as well.
00:26:20
Speaker
because we recognize it as a major barrier to access to care. When people aren't talking about mental health or worse, when there's a stigma against addressing it, as I know there are in many communities. And so it's a nuanced concept, right? It's a complicated concept. In many communities, especially those that have been marginalized historically, there's stigma and for good reason.
Closing Remarks and Resources
00:26:47
Speaker
They have unfortunately
00:26:50
Speaker
because of institutionalized racism, they have experienced real barriers in our society's institutions, not the least of which is healthcare and mental healthcare institutions. So there's some healthy skepticism in certain communities, and I understand that, but we do want to really still address that and
00:27:16
Speaker
and see what we can do to reduce that stigma. Again, all based on trust.
00:27:21
Speaker
Thank you, Dave. It's been great to engage with you today while getting to know your expert insights regarding school-based mental health. We've known each other for a while now and it was great to get a chance to talk big picture with you about the data picture in Wisconsin. Until next time, keep working at school mental health because school mental health works. It almost sounds too Gouda to be true.
00:27:47
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.