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Mental Health In N Hs Schools 6.12.2009

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

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Mental Health In N Hs Schools 6.12.2009

  1. 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. 2. Mental Health in New Hampshire’s Schools CMH Community of Practice and NHASEA June 12, 2009 Ryan Tappin, Research Associate
  3. 3. Why look at mental health and schools?
  4. 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. 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. 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. 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
  8. 8. What we wanted to find out <ul><li>More specifically, what services are schools providing? </li></ul><ul><li>How are schools supporting these services and how is funding administered? </li></ul><ul><li>Who are the practitioners providing those services? </li></ul><ul><li>What mental health issues are most commonly seen in the school setting? </li></ul><ul><li>What barriers exist to providing school-based mental health services? </li></ul>
  9. 9. What we did – Part 1 <ul><li>Fielded 2 surveys taken from a national survey of school-based mental health, conducted nationally by SAMHSA in 2002 </li></ul><ul><li>Sent survey to all districts and all schools to eliminate sampling bias </li></ul><ul><li>Response rate – 19% of schools and 31% of districts </li></ul>
  10. 10. What we did - Part 2 <ul><li>Interviews with Children’s Directors at the Community Mental Health Centers. </li></ul><ul><li>Discussions focused around: </li></ul><ul><ul><li>The arrangements of formal agreements with schools districts. </li></ul></ul><ul><ul><li>The existence and structure of informal agreements for services and other informal relationships between CMHCs and schools. </li></ul></ul><ul><ul><li>Advantages, disadvantages, successes, and barriers in providing mental health services in schools. </li></ul></ul>
  11. 11. Survey Results
  12. 12. Administration and Funding
  13. 13. Who receives services?
  14. 14. Who has the administrative responsibility?
  15. 15. What is the relationship between MH and SPED?
  16. 16. How are MH services budgeted?
  17. 17. Funding for School Mental Health
  18. 18. Has funding for MH changed over the past year?
  19. 19. Mental Health Issues in Schools
  20. 20. What MH issues are school services treating?
  21. 22. What MH issues are school services treating?
  22. 23. Social, interpersonal, and family issues are most common
  23. 24. High schools tend to have different needs
  24. 25. Mental Health Services Provided
  25. 26. What services are school MH programs providing?
  26. 27. NH is not unlike the rest of the nation
  27. 28. Few schools are providing screening….
  28. 29. … and prevention services
  29. 30. Many barriers to providing services in schools exist…
  30. 31. … creating difficulty in providing services
  31. 32. Schools with higher poverty levels find more difficulty in providing services
  32. 33. Staffing Mental Health Services
  33. 34. The majority of MH services are provided by internal staff
  34. 35. Little coordination between MH providers and other school staff exists
  35. 36. About half of schools contract with an outside provider
  36. 37. Individual providers were most reported community partner
  37. 38. Collecting Mental Health Services Data
  38. 39. One-third of schools do not collect data on MH services provided
  39. 40. Few schools collect data on specific service elements
  40. 41. Schools and the CMHCs
  41. 42. Schools and the community mental health centers <ul><li>Coordination of services between agencies receiving public support is minimal. This is despite the system relying heavily on public financing. </li></ul><ul><li>This reliance on public financing offers a natural partnership between schools and the CMHCs. However, only about 13% of schools have a formal partnership. </li></ul>
  42. 43. Although few formal agreements exist, informal relationships are commonplace <ul><li>The types of school-based services (and the agreements that govern them) vary greater across the state. </li></ul><ul><ul><li>Logistical agreements </li></ul></ul><ul><ul><li>Specific services, like IEP related activities and psycho educational groups </li></ul></ul><ul><ul><li>Very rarely do schools pay directly for individual services with a CMHC </li></ul></ul><ul><li>Schools are often a catalyst for initiating mental health services. Even through informal relationships with community providers. </li></ul>
  43. 44. Barriers create significant challenges to school/CMHC partnerships <ul><li>Many challenges to school-based mental health care exist </li></ul><ul><ul><li>Expectations between the systems can create a challenge </li></ul></ul><ul><ul><li>Parental engagement can be frustrating to schools and providers </li></ul></ul><ul><ul><li>Resources, staff and logistical resources are ongoing challenges </li></ul></ul><ul><li>Coverage and geography are significant barriers </li></ul><ul><ul><li>Medicaid – parents are often not covered </li></ul></ul><ul><ul><li>Private – does not pay for support services and limits treatment sessions </li></ul></ul><ul><ul><li>Self-pay is rare </li></ul></ul>
  44. 45. Factors influence success -programs have potential <ul><li>Several factors influence whether schools have mental health services available </li></ul><ul><ul><li>Buy-in from administration and school boards </li></ul></ul><ul><ul><li>Availability of private providers (including CMHCs) </li></ul></ul><ul><ul><li>Resources </li></ul></ul><ul><ul><li>Stigma </li></ul></ul><ul><li>Open communication is the greatest avenue to success </li></ul><ul><li>Even with challenges, school-based mental health services has the potential to increase access and improve treatment </li></ul>
  45. 46. Take Aways <ul><li>Schools play a large role in providing MH services to children. </li></ul><ul><li>Little information is available to manage the system in place. </li></ul><ul><li>Little formal coordination of services across systems, particularly among the publicly-supported. </li></ul><ul><li>Significant funding is being utilized without coordination of the various funding sources </li></ul>
  46. 47. Thank You Questions? Thoughts? Comments?

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