Creating and Sustaining Effective Mental Health Services and Supports in the Educational

Setting

Newport-Mesa Unified School District Team

Melissa Hurd: Psychological Services Coordinator

Joy Cleary: LCSW, PPS

Tucker Cannon: LCSW, PPS

Michelle Lepak: Ed.S., NCSP, School Psychologist, Program Specialist, Behavior Specialist

Eby Kent: MS, School Psychologist, Licensed Educational Psychologist, Behavior Specialist, BCBA

Yuba City Unified School District Team

Elizabeth Engelken: Director of Student Support; Credentialed School Psychologist, PPS; Advanced Nurtured Heart Trainer

Veronica Coates: Psychological Services Specialist; Credentialed School Psychologist, PPS; Advanced Nurtured Heart Trainer

Ivona Mikesell: Credentialed School Psychologist, PPS; ERMHS Behaviorist; Advanced Nurtured Heart Trainer

Presentation Outline1. History: How did we get “from there to here”?

(Newport-Mesa/Yuba City)2. Program Development and Rationale (Yuba City)3. RtI: A Three Tiered Approach (Newport-Mesa)4. Foundation and Methodology (Yuba City)5. Assessment Process (Newport-Mesa)6. ERMH Services (Yuba City)7. Next Steps (Newport-Mesa/Yuba City)

History of Mental Health Supports in California Schools

In 1984, Assembly Bill 3632 outlined and required a partnership between school districts and county mental health agencies to deliver mental health services to students with individualized education programs (IEPs). A subsequent Assembly Bill, 26.5, updated the mandate for students with disabilities.

History of Mental Health Supports as a Related Service

In 2011, the California Legislature passed Assembly Bill 114, which repealed the state mandate on special education and county mental health agencies. This action gave school districts the sole ability to decide how mental health services were delivered. Many districts continue to contract with county mental health or other mental health agencies. The term Educationally Related Mental Health Services (ERMHS) refers to those services related to a students educational plan, and developed to address social, emotional and behavioral areas of significant need.

A Journey toward ERMHS Legal Consortiums Consultation with SELPA leadership and

other major stakeholders Research and observation of model

programs Develop Program Design; Hire Exceptional

Staff Developing a Three Tiered approach to

intervention

Foundational Approach

Providing a continuum of services which is effective with special populations

Services which are effective with intense students and families

Acknowledging the common underlying belief that we have tried many methodologies with very limited and poor results

Utilizing a strengths based approach as a foundation for all services delivered

Strengths Based Approach 100% of staff trained in the Nurtured Heart Approach

(NHA), utilizing the strategies from classroom to therapy setting

Program Development ERMH staff is composed of specialists within the

field of mental health; psychologists, licensed clinicians, clinical aides and behavior specialists

ERMH clinicians and behaviorists become collaborative and integrated members of IEP teams

Creation of a program which serves students across the special education continuum; from prevention to intense intervention

Continuum of ServicesERMH Services are Designated

Instructional Services for students with disabilities

ERMH Services fall along the continuum of service – different levels of ERMH intervention are delivered, based on student needs

Continuum of Services Continuum of School Based Behavioral & Mental Health Services

Prevention Teachers, Counselors, Admin, Probation

Site Based Services District Counselors and School Psychologists

Site Based Educationally Related Mental Health Services

District School Psychologists and Counselors

Regionalized Educationally Related Mental Health Services

Clinicians, Behaviorists, Clinical Aide, Psychological Services Specialist

Least Restrictive

County Operated Program + Site Based ERMHS

Clinicians, Psychological Services Specialist, Clinical Aide, Behaviorists, County School

Psychologist

County Operated Program Regional ERMHS

Clinicians, Psychological Services Specialist, Clinical Aide, Behaviorists

NPS Day School Psychological Services Specialist, Clinician,

Behaviorists, NPS Staff

NPS Residential Psychological Services Specialist, Clinician,

Behaviorists, Residential Staff

Most Restrictive

Psychological Support Services

Universal Intervention

Early Intervention

Intensive Interventions and Support

Response to Intervention: A Three Tiered Approach

Site level School-Wide Positive Behavior Interventions and Support

School Psychologists implement research-based curriculum for identified at-risk studentso Push-in whole classroom interventiono Targeted group intervention

o Curriculum-Based (Second Step, Steps to Respect)o Expressive Therapy

Progress Monitoringo Data collection, progress reports, teacher input, attendance, work completion, grades, etc.

Student Study Teams

Tier I Counseling Referral Please refer to form in folder

Parent Education Training

Tier I: Universal Intervention

A need for counseling is suspected for a student receiving special education services.o IEP is held to document a referral for School-Based Counseling

o Please refer to Tier I or Tier II Counseling form in foldero Case Carrier completes Counseling Referral and submits to the School Psychologist

School Psychologist reviews referral and determines if additional strategies can be implemented or if Counseling Assessment is warranted.o IEP is held to document School Psych’s recommendationso If Counseling Assessment is recommended, Assessment Plan is presented and consent

obtained.

School Psychologist completes ERMHS Counseling Assessment to determine if there is an area of need

IEP is held to document Counseling Assessment results/recommendationso Goals proposed in areas of needo Service recommendation provided

o Individual Counseling, Group Counseling (includes Social Skills), Parent Education Training

o Minimum of 12 weeks offered (individual and group services)

Tier II: Early Intervention

Tier II: Early Intervention

Progress Monitoring Counseling goals are monitored weekly

IEP team reconvenes after 12 weeks and determines continued need/level of Counseling Services based on progress monitoringo Data collection, rating scales (objective and research-based),

attendance, work completion, grades, compliance, and team input

IEP team could determine: Student met Counseling goals and service is discontinued Student is progressing towards goals and would benefit from

continued School-Based Counseling sessions Student is not making progress and a Clinic-Based Counseling

Referral is recommended

Clinic-Based Serviceso Individual Counselingo Group Counseling

Targeted Parent Education Counseling and Training Collateral Family sessions – Push in home support

Non-Public School Placement

Residential Placement• In-State• Out-of-State

Tier III: Intensive Interventions and Support

Length of Intense Services

Initial referrals for assessment and those exiting service are a fluid process

Average length of service is 12-18 months

Referral Process

After exhausting site based services, IEP team recommends an ERMHS referral

Preventive mental health services are required prior to referral

Referral Requirements Parent Approval at IEP to make referral Site based School Psychologist and Case

Manager compile a packet of data to present to Psychological Services Specialist

Psychological Services Specialist analyzes referral with Director of Student Support and ERMH team, assigning a clinician or behaviorist to the student

Once referral is approved, assessment plan is presented to parent

Assessment Process Yuba City Assessments ERMH Clinician provides assessments to student,

parents, and school staff including, but not limited to: Standardized Assessments Observations Consultation Collaborates with School Psychologist and site

based team

Assessment Process

Newport-Mesa Assessments Educationally-Related Mental Health Services

(ERMHS) AssessmentsConducted by School Psychologists

Residential Assessments Conducted by a Multi-Disciplinary team of

mental health professionals

Eligibility

A direct link between social-emotional and/or behavioral functioning and a lack of educational progress must be present

Preventive mental health services must have been provided

Goals Drive Service

Example of Annual Goal: By (date) Student will utilize at least three

appropriate coping strategies (i.e. positive self-talk, reframing negative thoughts, taking pride in his inner wealth etc.) to increase positive self-perception in counseling and/or school settings, in 4 out of 5 times as measured by observations and interviews.

Goals Drive ServiceExample continued with short term objectives:1. By (date), when prompted by a Clinician, Student will identify 5

strengths he sees in himself. 4 out of 5 of these strengths must be statements about his inner wealth, not related to academic or intellectual.

2. By (date) when prompted by a Clinician, Student will identify at least 3 positive strategies on how he is utilizing his strengths of inner wealth (journaling, verbal positive affirmations, visual positive affirmations, positive self-talk, re-framing negative thoughts, resetting)

3. By (date) Student will be able to identify 10 positive attributes about himself without prompting, as well as identify how he utilizes these strengths to reset back to inner wealth rather than become trapped in misperceptions of how others feel about him, withdrawal, or negative self talk.

Services Individual CounselingGroup CounselingParent CounselingSocial Work ServicesPsychological ServicesBehavior Intervention Services

Individual Counseling

Counseling in a 1:1 setting with an ERMH clinician or other qualified individual

No other students are present Clinician working directly on students

individual goals and objectives

Group CounselingStudent participates in a group led by

an ERMH clinician. A group of students working on similar

social skillsA group centered around 1or 2 students

with neurotypical peersGroups are led by clinicians and often

co-facilitated by a school counselor, school psychologist or clinical aide

Social Work Services Consulting/Training staff and/or parents on

specific interventions (i.e. Nurtured Heart Approach)

Training 1:1 aides on specific behavioral and social emotional interventions

Infusing/Modeling strengths based approaches within general and special education classrooms

Assisting teams on Behavior and Social Emotional Care Plans

Psychoeducation groups not related to IEP goals but rather to develop a more positive classroom environment

Parent CounselingProviding parent support in a 1:1 or

group settingModeling Strengths Based

communication to parents Providing support before and after IEP

meetingsPsychoeducation

Psychological ServicesServices Delivered by the

Psychological Services SpecialistConsultation with site based teamsAssessmentParent supportCounseling In class InterventionsLiaison to Nonpublic and Residential

schools

Behavioral Intervention Services

Refinement of current Behavioral Support Plan

Data Collection In Class modeling of interventions in

conjunction with Clinical Aide1:1 Aide and Teacher trainingConsultation to site based teams

Other Services Offered to SELPA and Community

Support provided to sites during crisis or emergency situations (threat assessments, crisis management, grief counseling)

Staff Development Presentations for teachers, administrators and support staff (NHA, Anxiety and Trauma, Selective Mutism, Self-Harming Behaviors, Developing BSP’s, Prevention and Early Intervention)

Sustaining Effective Services and Positive Results

Identify new staff to train; keep cycle of training fresh

Develop specialists; classroom support providers, clinical staff for therapy, parenting class and support staff, bilingual staff, training teams

Ongoing Learning Lab Maintain foundational approach as a district and

SELPA wide initiative so that it is embedded in board accepted and approved goals

Future Goals for Newport-Mesa Develop a needs assessment to determine priorities and

future professional development Leadership Training

Eliminating Barriers to Learning through the Early Identification of Student Mental Health Issues

District-Wide collaboration in addressing barriers to learning High-Touch Impact on students district-wide

Build upon current Parent Training component Parent Academy

Refine school reintegration procedures for students placed on psychiatric holds

Therapeutic placement between SDC ED/ NPS & RTC Explore Day School options

Next Steps & Future Goals for Yuba City

Continue honing the whole child/strengths based model with a continuum of services

Continue providing trainings SELPA wide (parents, families and staff)

Provide ongoing psychoeducation in classroom settings

Focus on ERMH’s contribution to preventive mental health

Q & A

Burning Questions