A discussion of the NH Center for Public Policy's study of mental health services in New Hampshire's schools.

1. All of our reports are available on the web: www.nhpolicy.org New Hampshire Center for Public Policy Studies “… to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.” Board of Directors Donna Sytek, Chair John B. Andrews John D. Crosier, Sr. William H. Dunlap Sheila T. Francoeur Chuck Morse Todd I. Selig Stuart V. Smith, Jr. James E. Tibbetts Brian F. Walsh Kimon S. Zachos Martin L. Gross, Chair Emeritus Staff Steve Norton, Executive Director Ryan Tappin Cathy Arredondo

2. Mental Health in New Hampshire’s Schools CMH Community of Practice and NHASEA June 12, 2009 Ryan Tappin, Research Associate

3. Why look at mental health and schools?

4. Top 20 providers of MH services for children Interesting! 22,967 $852,734 NASHUA SCHOOL DISTRICT 436 $895,072 EASTER SEAL SOCIETY OF NH INC 18,897 $904,534 MANCHESTER SCHOOL DISTRICT 385 $960,273 ECKERD FAMILY YOUTH ALTERNATIVE 838 $1,030,063 LUTHERAN COMMUNITY SERVICES OF NORTHERN NEW ENGLAND 251 $1,354,952 NEW HAMPSHIRE HOSPITAL 550 $1,393,243 EASTER SEALS NH INC - ZACHARY RD 887 $1,487,099 EASTER SEALS NH 9,288 $1,506,753 CLM BEHAVIORAL HEALTH SYSTEMS 1,103 $1,527,389 NASHUA CHILDREN'S HOME 9,558 $1,586,829 BEHAVIORAL HEALTH SERVICES 647 $1,683,859 ODYSSEY HOUSE INC 14,849 $2,201,147 COMMUNITY COUNCIL OF NASHUA 1,632 $2,444,888 MOUNT PROSPECT ACADEMY INC 12,907 $2,487,523 SEACOAST MENTAL HEALTH CENTER 15,333 $2,602,120 MONADNOCK FAMILY SERVICES 18,875 $2,674,982 WEST CENTRAL BEHAVIORAL HEALTH 15,118 $3,013,125 LAKES REGION MENTAL HEALTH 18,817 $3,426,685 THE MENTAL HEALTH CENTER OF GREATER MANCHESTER 22,205 $3,840,202 RIVERBEND COMMUNITYMENTAL HEALTH Service Count Total Expenditures Provider Total Expenditures for Mental Health Services for Medicaid Enrolled Children Up to age 19 for the Top 20 Providers

5. Schools provided $13.5 million in Medicaid funded MH services in 2005 10 $70 $713 3,559 36,305 $2,538,164 Psychologist 20 $981 $19,621 207 4,139 $4,061,514 DCYF Services 14 $225 $3,126 1,402 19,460 $4,382,659 Day Rehabilitation Center 32 $241 $7,761 638 20,587 $4,951,315 Home and Community Based Care 54 $53 $2,890 4,680 253,390 $13,525,760 School Health Services 11 $1,624 $17,225 1,251 13,270 $21,548,382 Private Non-Medical Institution 23 $169 $3,850 6,544 148,927 $25,191,173 Mental Health Clinic Average Number of Services per Child Average Cost per Service Average Cost per Child Total Children Service Count Total Expenditures Provider Type Total Expenditures for Mental Health Services for Medicaid Enrolled Children Up to age 19 by Provider Type

6. Which schools are providing the most services? 1% 2,973 1% $181,819 CONWAY SCHOOL DISTRICT 2% 4,066 1% $184,833 SALEM SCHOOL DISTRICT 3% 8,006 1% $200,426 LONDONDERRY SCHOOL DISTRICT 3% 7,266 2% $224,376 DOVER SCHOOL DISTRICT 2% 4,337 2% $229,291 CLAREMONT SCHOOL DISTRICT 2% 4,957 2% $234,351 PORTSMOUTH SCHOOL DISTRICT 2% 4,312 2% $236,603 LACONIA SCHOOL DISTRICT 1% 2,870 2% $245,518 THE EXETER REGION COOPERATIVE 0% 339 2% $255,921 DERRY COOPERATIVE 1% 1,278 2% $258,594 CONCORD SCHOOL DISTRICT 1% 3,234 2% $286,190 ROCHESTER SCHOOL DISTRICT 2% 5,373 2% $290,006 FALL MOUNTAIN REGIONAL SCHOOL 1% 2,651 2% $299,162 HAVERHILL COOPERATIVE 0% 95 2% $311,111 JAFFREY/RINDGE SCHOOLS 2% 6,097 2% $319,151 TIMBERLANE REGIONAL SCHOOL DISTRICT 2% 6,316 3% $352,681 MONADNOCK REGIONAL SCHOOL 2% 4,391 3% $377,535 CONVAL SCHOOL DISTRICT 4% 9,922 5% $661,437 MERRIMACK SCHOOL DISTRICT 9% 22,967 6% $852,734 NASHUA SCHOOL DISTRICT 7% 18,897 7% $904,534 MANCHESTER SCHOOL DISTRICT Percent of All Services Provided Service Count Percent of All School Service Expenditures Total Expenditures School District Total Expenditures for Mental Health Services for Medicaid Enrolled Children Up to age 19 for the Top 20 School Districts

7. What services are schools providing? 243,664 $13,525,759 Total 222,140 $12,765,281 Psychosocial rehabilitation services, per 15 min. H2017 25,275 $558,003 Mental health services, not otherwise specified H0046 5,975 $202,476 Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approx. 20 to 30 min. face-to-face with the patient 90810 Service Count Total Expenditures Description CPT Code Total Expenditures for Mental Health Services for Medicaid Enrolled Children up to 19 by CPT Code

11. Survey Results

12. Administration and Funding

13. Who receives services?

14. Who has the administrative responsibility?

15. What is the relationship between MH and SPED?

16. How are MH services budgeted?

17. Funding for School Mental Health

18. Has funding for MH changed over the past year?

19. Mental Health Issues in Schools

20. What MH issues are school services treating?

22. What MH issues are school services treating?

23. Social, interpersonal, and family issues are most common

24. High schools tend to have different needs

25. Mental Health Services Provided

26. What services are school MH programs providing?

27. NH is not unlike the rest of the nation

28. Few schools are providing screening….

29. … and prevention services

30. Many barriers to providing services in schools exist…

31. … creating difficulty in providing services

32. Schools with higher poverty levels find more difficulty in providing services

33. Staffing Mental Health Services

34. The majority of MH services are provided by internal staff

35. Little coordination between MH providers and other school staff exists

36. About half of schools contract with an outside provider

37. Individual providers were most reported community partner

38. Collecting Mental Health Services Data

39. One-third of schools do not collect data on MH services provided

40. Few schools collect data on specific service elements

41. Schools and the CMHCs

47. Thank You Questions? Thoughts? Comments?