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

2

School Health Alliance for Forsyth County (SHA)

Jane M. Foy, Medical Director

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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

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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




Comprehensive Student Health Center

Enhanced Mental Health

limited physical healthcare, no mental healthcare

Wellness Center

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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

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Mineral SpringsElementary & Middle Schools

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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).

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Winston-Salem Preparatory Academy at Atkins Wellness Center

Model 2 — Wellness Center

SchoolFamily

TheStudent

MedicalOffice

Assistant


Child Psychiatrist

RegisteredNurse

6 — 8

Nurse Practitioner

and MDx

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Winston-Salem Preparatory Academy at Atkins

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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


Child Psychiatrist

RegisteredNurse

Pre-school — 5

Nurse Practitioner

and MD

Model 2 — Wellness Center (half-time)

x

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Ashley Elementary School

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Ashley Wellness Center Staff

Dr. Hough (Psychiatrist), Maureen Haynes (RN), Susan Furches (LCSW), Henri Miller (Medical Office Assistant).

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Ashley Wellness Center Staff and Students

Dr. Hough (Psychiatrist) with student.

Student using Wellness Center services.

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North Forsyth Center

Model 3 — Enhanced Mental Health

SchoolFamily

TheStudent

MedicalOffice

Assistant


Child Psychiatrist

RegisteredNurse

9 — 12

Nurse Practitioner

and MDx x

x

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North Forsyth High School

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North Forsyth Center Staff

Cloud Monroe (LCSW). Not Pictured: Henri Miller (Medical Office Assistant).

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Meadowlark Wellness Center

Model 4 — Limited Physical Healthcare, No Mental Healthcare

SchoolFamily

TheStudent

MedicalOffice

Assistant


Child Psychiatrist

9 — 12

Nurse Practitioner

and MDx

x

RegisteredNurse

xx

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Meadowlark Elementary & Middle Schools

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Meadowlark Wellness Center Staff

Betsy Wehe (RN).

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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 WC Crest Ashley WC

2004-2005


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1314 10

2005-2006


Criminality

Eviction

Move to a school without SHC/SWC

Challenge: no continuity of careSolution: school social worker will follow

? ? ? ? ? ? ? ? ?

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WSPA WC

NCSchool for the Deaf

Christmas 2003

Case Example: Family B

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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



WSPA WC


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Angry, scared, distrustful

Quiet, sad, sleepless

Drug Bust

CPS DSS-relative placements


78

1213

X

22

XFall 2004

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89

1314

X

23

XSpring – Early Fall 2005



WSPA WC


ArtisticSmiling

Residential

Treatment Center

Weekends/Holidays

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Art used to express feelings

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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


Collaboration with Head Start

September 2005

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Play therapy used to express feelings

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Play therapy used to express feelings

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Art used to express feelings

Love Hurts Love Heals

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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

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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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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

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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

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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

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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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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

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Play therapy works!!!

Mental Health Services in School-Based Health Centers Susan Furches, LCSW.

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