UNIQUE CHALLENGES IN IMPLEMENTING SCHOOL-BASED

MENTAL HEALTH IN A “RURAL RURAL” ENVIRONMENT

Cameron Massey, J.P. Jameson, Rafaella Sale, Kurt D. MichaelAppalachian State University

PURPOSE To describe the “rural rural”

environment we are working in

Talk about the ASC Center model and how it’s being implemented

Discuss some of the challenges we are facing

Solicit feedback and experience from others who have faced similar challenges

DEMOGRAPHICS OF THE “HIGH COUNTRY”

Alleghany Ashe Watauga0

10000

20000

30000

40000

50000

60000

Population

DEMOGRAPHICS OF THE “HIGH COUNTRY”

Ashe

Watauga

Alleghany

% White, Not Hispanic % Hispanic

% Black % Other

DEMOGRAPHICS OF THE “HIGH COUNTRY”

0%

5%

10%

15%

20%

25%

30%

% Below Poverty Level 2006-2010

Al-leghany

Ashe

Watauga

State Average

*

*Not really, college town. Actually probably closer to 10%.

Watauga Ashe Alleghany

Population 51,871 27,097 10,927

Median Household Income

$34,848 $35,670 $32,449

RUCC (2013) 5 7 9

High School (9-12)

1 1 1

Elementary (K-8) 8 3 (1 Middle School)

3

Student Population (2012-13)

4,327 3,136 1,380

% with Bachelor’s 38.4 18.8 14.9

Hospital Yes Yes No*

Walmart Yes Yes No

Opportunities for young people to hang out and be engaged in productive activities

Some Not really Does Facebook count? Then no.

9th 10th 11th 12th0

5

10

15

20

25

30

35

Alleghany

Sad & hopelessSeriously consideredMade a planResulting in medical care

Grade Levels

Perc

enta

ges

9th 10th 11th 12th0

5

10

15

20

25

30

35

Ashe

Sad & hopelessSeriously consideredMade a planResulting in medical care

Grade Levels

Perc

enta

ges

Matthew & West, 2012

SCHOOL-BASED MENTAL HEALTH MODEL

Assessment, Support, and Counseling (ASC) Center Previously implemented –

Watauga High School in 2006 Ashe County High School in 2011

Staff: licensed clinicians, ASU faculty members, graduate students, local CMHC therapists

Provide individual outpatient, crisis intervention, behavioral consultation, group therapy, etc.

Adapt services to the school needs & culture Meet on a weekly basis with school counselors, admin, SRO,

etc. to discuss student needs

HISTORY OF ASU – ALLEGHANY PARTNERSHIP

Federal Title V Grant Ashe and Alleghany counties

Spring of 2011: Started talking about SMH program Logistics meetings in summer of 2013

Funding: Title V School-system contract

Creative admin – billing through alternative Medicaid avenues

Established presence in fall of 2013 Designated space at the high school

ALLEGHANY ASC DATA (FALL 2013)

Individual modality: n = 7

24 total service hours/sessions 5th – 12th grades 10-17 years old 3f / 4m

Group modality: n = 4

3 sessions/12 service hours 7th and 8th grade students 4 males

OTHER PLANS

Multi-tiered pregnancy prevention program

Consultation on bullying prevention

Crisis response Website tracking

HIGH COUNTRY HELP

www.highcountryhelp.com

SUCCESS THUS FAR

Buy-in: Board Of Education level -- both director of student services

and Superintendent have shown support Principals at various schools have provided space and

access to students

Didn’t have to reinvent the wheel Used ASC Center model that has been established in two

other schools Learn from experiences Room for innovation

CHALLENGES THUS FAR

Community buy in

Difficulty of trying to establish a single ASC center that serves all schools (4 total)

Cultural issues Counselor’s not

recognizing the problem Counselor’s don’t see us

as helping See us as “after their

jobs”

Limitations:Fewer of usFewer days out of the weekLess visibleTransportation issues

1. Ethical issues:Kids with suicidal ideation

2. Outlying schools:Effectively serving them?

THINGS WE’D LIKE TO CHANGE

Counselor buy-in1. Stack of referrals on desk2. “We’ve got good kids here…”3. “They’re after our jobs…”4. Ethical issues