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Mental Health Services in School-Based Health Centers Susan Furches, LCSW.
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Transcript of Mental Health Services in School-Based Health Centers Susan Furches, LCSW.
Mental Health Services in School-Based Health
Centers
Mental Health Services in School-Based Health
Centers
Susan Furches, LCSWSusan Furches, LCSW
3
Partner Organizations/Agencies of the School Health Alliance CenterPoint Human Services Forsyth Adolescent Health
Coalition Forsyth County Department of
Public Health Forsyth County Department of
Social Services Forsyth Early Childhood
Partnership Forsyth Pediatric Associates Forsyth-Stokes-Davie County
Medical Society
The North Carolina Baptist Hospitals, Inc.
Northwest Area Health Education Center
Novant Health Triad Region Wake Forest University School
of Medicine Winston-Salem/Forsyth County
Schools– Administration – Faculty – PTA
Council – Food Services Winston-Salem State University
4
School Health Alliance Centers
North Forsyth High School
Mineral SpringsStudent Health Center
Winston-SalemPreparatory Academy
Wellness Center
Ashley Elementary SchoolWellness Center
Meadowlark Middle School
Wellness Center
Meadowlark Elementary SchoolWellness Center
Model1
Model3
Model4
Model2
Psychiatrist LCSW Nurse Practitioner/MD RN
Psychiatrist LCSW Nurse Practitioner/MD RN
Psychiatrist LCSW Nurse Practitioner/MD RN
Psychiatrist LCSW Nurse Practitioner/MD RN
Comprehensive Student Health Center
Enhanced Mental Health
limited physical healthcare, no mental healthcare
Wellness Center
5
Mineral Springs Student Health Center
SchoolFamily
TheStudentNurse
Practitioner and MD
MedicalOffice
Assistant
Licensed Clinical Social Worker
Child Psychiatrist
RegisteredNurse
Pre-school — 8
Model 1 — Comprehensive Student Health Center
7
Mineral Springs Student Health Center Staff
Pam Benton (Medical Office Assistant), Beth Spangle (FNP), Dr. Nguyen (Psychiatrist), Becky Stephens (RN),
Cindy Tomlinson (DSS). Not pictured: Sarah MacReynolds (LCSW), Ron Lean (LCSW), Susan
Furches (LCSW).
8
Winston-Salem Preparatory Academy at Atkins Wellness Center
Model 2 — Wellness Center
SchoolFamily
TheStudent
MedicalOffice
Assistant
Licensed Clinical Social Worker
Child Psychiatrist
RegisteredNurse
6 — 8
Nurse Practitioner
and MDx
10
Winston-Salem Preparatory Academy at Atkins Wellness Center Staff
Henri Miller (Medical Office Assistant), Maureen Haynes (RN), Dr. Martindale (Psychiatrist), Karen Patterson (LCSW).
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Ashley Wellness Center
SchoolFamily
TheStudent
MedicalOffice
Assistant
Licensed Clinical Social Worker
Child Psychiatrist
RegisteredNurse
Pre-school — 5
Nurse Practitioner
and MD
Model 2 — Wellness Center (half-time)
x
13
Ashley Wellness Center Staff
Dr. Hough (Psychiatrist), Maureen Haynes (RN), Susan Furches (LCSW), Henri Miller (Medical Office Assistant).
14
Ashley Wellness Center Staff and Students
Dr. Hough (Psychiatrist) with student.
Student using Wellness Center services.
15
North Forsyth Center
Model 3 — Enhanced Mental Health
SchoolFamily
TheStudent
MedicalOffice
Assistant
Licensed Clinical Social Worker
Child Psychiatrist
RegisteredNurse
9 — 12
Nurse Practitioner
and MDx x
x
17
North Forsyth Center Staff
Cloud Monroe (LCSW). Not Pictured: Henri Miller (Medical Office Assistant).
18
Meadowlark Wellness Center
Model 4 — Limited Physical Healthcare, No Mental Healthcare
SchoolFamily
TheStudent
MedicalOffice
Assistant
Licensed Clinical Social Worker
Child Psychiatrist
9 — 12
Nurse Practitioner
and MDx
x
RegisteredNurse
xx
21
Case ExamplesCase Examples
Mental Health Work with Mental Health Work with Families Having Children in Families Having Children in
Elementary and Middle Elementary and Middle SchoolsSchools
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1112 8
Leukemia
WSPA Wellness Center
RN and LCSW involved with mom and son
2003-2004
Case Example: Family A
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1213 9
Leukemia in remission
RN and LCSW working with mom and son
WSPA Wellness Center
Trichotillomania (Hair Pulling)
Ashley Wellness Center
Ashley WC Crest Ashley WC
2004-2005
Case Example: Family A
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1314 10
2005-2006
Case Example: Family A
Criminality
Eviction
Move to a school without SHC/SWC
Challenge: no continuity of careSolution: school social worker will follow
? ? ? ? ? ? ? ? ?
25
Ashley Wellness Center
WSPA WC
NCSchool for the Deaf
Christmas 2003
Case Example: Family B
67
1112
X
21
X
26
78
1112
X
22
X
Hearing Impaired
Grief
Withdrawn, distractible, impulsive
Hallucinations of death angel coming,
terrified, tearful, shaking
* Hospice,Camp Carousel
Spring – Summer 2004
Spring
*Summer
Case Example: Family B
Ashley Wellness Center
WSPA WC
NCSchool for the Deaf
27
Angry, scared, distrustful
Quiet, sad, sleepless
Drug Bust
CPS DSS-relative placements
Case Example: Family B
78
1213
X
22
XFall 2004
28
89
1314
X
23
XSpring – Early Fall 2005
Case Example: Family B
Ashley Wellness Center
WSPA WC
NCSchool for the Deaf
ArtisticSmiling
Residential
Treatment Center
Weekends/Holidays
30
Case Example: Family C
611 5 3
Hurricane Katrina
Ten Survivors!
Ashley Elementary School
WSPA WC
6
Living in one three- bedroom
house
Head Start
Ashley Wellness Center
Collaboration with Head Start
September 2005
34
Differences in Models Staff patterns
– As illustrated on puzzle
Physical location– Mineral Springs is a separate building– All others are within the school building
Hours of operation– Ashley is part time– All others are full time
35
Strengths & Challenges/Solutions
Collaboration — All sites
Strengths– LCSW on school teams (SAT/CSI)– WFUBMC child psychiatrist – Common screening instruments– RN taking blood pressure and weight of staff
Challenges/solutions– Limited availability of school support staff
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Strengths & Challenges/Solutions
Collaboration — Mineral Springs Health Center
Strengths– More comprehensive service/more staff– Free standing building = clinic atmosphere
Challenges/solutions– Loss of proximity = less teacher interaction– Solution: Effort to be visible in school
37
Strengths & Challenges/Solutions
Collaboration — Ashley Wellness Center
Strengths– PhD-level school social worker and psychologist– Annual evaluation by extended staff
Challenges/solutions– Half-time LCSW and RN prevents consistent care– Solution: Regular conferences with school staff – Solution: Make staff full time
38
Strengths & Challenges/Solutions
Referrals
At Mineral Springs Health Center – strengths– Abundant referrals from screenings
At Ashley Wellness Center – strengths– School counselor is the gatekeeper
At Mineral Springs and Ashley – challenges/solutions– Screening reveals more need than staff can meet– Solution: Wait list, group work, discharge no shows
39
Strengths & Challenges/Solutions
School Priorities and Local Needs — All sites
Strengths– System-wide site based management– Flexibility in meeting local needs
Challenges/solutions– System-wide site-based management– SHA uniform policies, difficult to implement
• Solution: Increase staff communication
– Focus on end of grade test• Solution: Research data shows academic gains• Solution: Cooperate with Dennison Group (UNC-G)• Solution: Group for anxious/somatizing boys
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Strengths & Challenges/Solutions
School Priorities and Local Needs — All sites
Challenges/solutions– Themes differ per school (Ashley is International
Baccalaureate)• International airport/different continents
– Solutions: • Ashley Wellness Center is Gate 150 in Antarctica • Poster: “Even at the bottom of the world you can find a friend.”• Ashley students collected food and money for Katrina survivors