Jacqui: / Hello and welcome to the third webinar in a four-part series on school-based juvenile justice diversion models for youth with behavioral health needs. This webinar, entitled “School-Based Behavioral Health Diversion – Which Youth and What Services?” will provide strategies for identifying youth who are both at risk of juvenile justice system referral from the school setting and who may have behavioral health needs. This webinar is supported by the Office of Juvenile Justice and Delinquency Prevention. It's part of the School Justice Partnership, National Resource Center. That effort is led by the National Council of Juvenile and Family Court Judges, with four core partners. I'm Jacqui Greene from the National Center for Mental Health and Juvenile Justice, and we are happy to be one of the core partners on this project.
[00:01:00] / This is the third in a series of four webinars that we are providing for you on developing school based diversion programs for kids with behavioral health needs. The first was a general overview of the responder model. The second was about building the right team. Obviously today we're going to talk about identifying kids, which kids, how do you know which kids to put in these diversion initiatives? If you'd like to access the first two webinars, they are available at that link in our archives on our website.
[00:02:00] / How do you know which kids to put through a school based diversion program for kids with behavioral health needs? We're talking about diversion from referral to the juvenile justice system, and diversion to behavioral health services. We would suggest the kind of identification structure you see on this slide, where first, you're identifying for yourselves which kids are at risk of referral to the juvenile justice system. I'm going to talk a little bit more about that in a minute. Then out of that category of kids, which of them may have a behavioral health need? We have Katie Eklund with us today who is going to talk about identifying those kids, and some research based ways that you might be able to answer those questions.
Then we're also going to talk today about, okay, so once you identify them, how do you connect them to services? Nancy Lever is going to help us out today by talking about different models to connect kids to behavioral health services from the school setting. Of course trauma plays a huge role for many kids, most kids, who are involved in the juvenile justice system, so we're also going to hear from Isaiah Pickens today, to talk to us about the role of trauma in all of this.
[00:03:00] / One thing that we often hear, as we start to talk about this, is why not screen everybody in the school for behavioral health needs? Our message to you today is not that that's a bad thing to do, it's just that that's not what this particular model is. This is really a targeted strategy to identify those kids at risk of juvenile justice system involvement, who have a behavioral health issue. We go that way for a number of reasons. One is that while we are very supportive of broader school mental health initiatives, we've also found that they can be a really tough lift, and so if you focus in this more targeted way, it may be something that's more attainable, or more quickly attainable in your setting.
[00:04:00] / We know everybody is working with limited resources, and limited resources call for targeted approaches. We know that there's a danger in labeling kids at risk of juvenile justice involvement, so we don't want to widen the net around juvenile justice by pulling a bunch of kids into that label who don't need to be there. We also see huge benefits in the places that we've worked, when folks build intentional relationships between the juvenile justice system stakeholders, the schools, and the behavioral health providers in their communities. By doing this in a very targeted and focused way, you really have an opportunity to build that relationship, and that great relationship may then spill over into other, larger initiatives.
There really is kind of this spectrum of ways that you can define which kids are at risk for juvenile justice referral. You see on this slide, it goes from kind of the most limited way you can define that, to the most expansive way you can define that. You could define that as kids who are already under juvenile justice supervision, who are in your school. Certainly schools have populations of kids who are on probation, or who might be on after care status, having just come back from a residential placement. You might also have kids in your school who are involved in some kind of diversion program from the juvenile justice system, which certainly puts them at high risk for ongoing involvement in referral in the juvenile justice system.
[00:05:00] / You could draw a little bit of a broader line, and talk about kids for whom referral to law enforcement is imminent. Really looking at when, right now, in your school, do you call the police? Taking a close look at what kinds of behaviors are eliciting that law enforcement response in your school setting, and drawing your circle around the kids who would be subject to that response, were it not for your responder initiative. You could draw the circle a little broader than that, and look at kids for whom referral to law enforcement is likely. We hear with many folks who we work with, that it's not a mystery to them when law enforcement is called for some of the kids in their school, that they see patterns of escalating behaviors, behaviors that are kind of on the edge of a call to law enforcement, but maybe the call wax never made.
[00:06:00]
[00:07:00] / You might want to say, well, we're going to draw the circle around not just kids whom we're just about to call the police for, but for kids who are showing some real trouble signs, doing things that are very close to the behaviors for which we would call the police. Then the most expansive way you could draw those lines, is looking at a series of risk factors that are kind of outside of this escalating behavior. We know, for example, there's a strong connection between truancy and juvenile justice involvement. We know there's a strong connection between school attachment and achievement and juvenile justice involvement. We know there's a strong connection between suspension and expulsion and juvenile justice involvement. You could identify a series of factors that are tied to juvenile justice involvement, and then develop a system where you are tracking which kids are kind of accumulating these risk factors, and that is placing them at high risk.
[00:08:00] / We would just caution you that if you want to go that most expansive route, to try to do that in a research informed way. As I said earlier, it's not necessarily a good thing for a kid to be defined as being at risk of juvenile justice involvement, and so we want to make sure that we're doing that orally in appropriate ways, in ways that don't build on people's implicit bias in any way, and in ways that are really research informed. It's really up to you how you want to define which kids in your school are at risk of juvenile justice referral. These are some suggestions on possible ways that you could draw those lines. Once you draw those lines, then the question will be, okay, so of that population of kids, who may have a behavioral health need? Because it's those kids, who are at risk of juvenile justice referral, and who may have a behavioral health need, who really should be the focus of a responder model diversion initiative.
[00:09:00] / We're going to jump to a wonderful panel of presenters that we have on tap for you today to hear, in more depth, about how to make that identification of behavioral health needs, and how to connect them to the appropriate services. First, we have Dr. Nancy Lever. She is an Associate Professor at the University of Maryland, School of Medicine, in the Division of Child and Adolescent Psychiatry. Nancy also co-directs the Center for School Mental Health. For over 20 years, she's led the advancement of high quality, interdisciplinary, innovative school mental health efforts. She has served in diverse roles related to school mental health, including as a program director, researcher, trainer, consultant, and as a clinician, in a comprehensive high school dropout prevention program. She also co-facilitates the connecting school mental health with juvenile justice and dropout prevention practice group within the larger national community of practice on collaborative school behavioral health. We're going to pass it over to Nancy. Go ahead Nancy, thank you.
Nancy:
[00:10:00] / Good afternoon everyone, and thank you, Jacqui, for that lovely introduction. It's a pleasure to be here today. I'm going to be talking to you more about some strategies to connect students to behavioral health services. One thing that we know is that, if you take a given classroom of students, one in five will experience a mental health problem of mild impairment, one in ten will suffer and experience a mental health problem of severe impairment. Of these students, only half of those who need it will actually receive any services. What we do know is when students actually receive mental health services, over 75% of those who receive services, receive those services within a school setting. There's lots of opportunities in schools to help improve the rate of access, where children and youth are actually connecting to services.
When I talk about comprehensive school mental health, we're not just talking about walking into a building because it's a convenient place to receive services. There really is a science, there are best practices connected to doing work in schools. It's important to have those effective partnerships, including working with the community, with schools, with the family. This reaches out to other child serving agencies, so it's not just the education system, but we really need to connect to juvenile services, social services, whatever system the child may be a part of.
[00:11:00] / As Jacqui was mentioning earlier, it's also important to think about multi-tiered systems of support. We don't want a system where the only way to get the support you need is to reach the highest end of need. We want to make sure that youth have the opportunity to receive some mental health promotion as well as prevention services, if they're at risk, and so forth. Other best practices in providing school mental health services include conducting a needs assessment, doing resource mapping within each district, within each school, where the services will be provided. This really isn't a cookie cutter approach. What may be needed in one community may be different from another.
[00:12:00] / If we are going to provide services, our goal is to really promote empirically supported, evidence based practices and programs, to make sure that whatever is being provided is actually working. Beyond just the partnerships that I mentioned originally, it's really important, once treatment is being provided, that there's a teaming process. As the child is learning new skills in their mental health therapy sessions, that that information is being shared and feedback is being provided, in both directions, to whether it's a school resource officer, the educator, whoever is working most closely with the student, we need to make sure that they're sharing information.
To do school mental health well, it's also important to make sure that you're collecting data, so we know that what you're doing is working or not working, and if it's not working, what can we do to improve that? There's always the lovely topic of funding, which is always a challenge, and making sure that if we're creating programs, that we're able to sustain the services, so that youth can continue to receive these services that they need.
[00:13:00] / I'm going to talk briefly about three different models of service delivery that can be provided within a school setting. As we mentioned earlier, when youth receive services in schools, they're more likely to follow through with them, versus, when there's simply a referral to a community setting. Different models of service delivery include a community partnered school behavioral health, school based health centers, and school linked mental health services. I'm just going to describe each of these strategies.
[00:14:00] / In terms of community partnered, school behavioral health, I just want to make the point that, just because you're in a school building, and you are providing mental health services, does not mean that we would consider that to be school behavioral health. What we're referring to in terms of this community partnered strategy, it's really becoming part of the team, becoming part of the culture, within a school building, and integrating into that school setting. It would involve formal partnerships between school and community health, behavioral health organizations, and it really should build on existing programs, services and strategies, so that it would collaborate with school employed staff, as well as the community employed, to figure out what are the services that are needed, not only during a school day, but what might be needed in the summer, in the evenings, weekends, et cetera.
It should focus on all students. We want a system that is not just available to youth in special education, we want to make sure it's available to all students. Again, that three tiered services, making sure that a full array of services are available, from mental health education, to promotion, to intensive intervention. As I mentioned earlier, it's really important that we're using best practices and have a system to focus on quality improvement.
[00:15:00] / Another strategy, which works really well, are school based health centers. Within the country, there's approximately 115,000 schools, there are about 2000 school based health center. School based health centers really represent a commitment between a school and a health care organization, to support the health, well being and academic success of its students. The idea, it's really having a center located within a school, that can provide both health, behavioral health, dental, reproductive health, so it's really a hub for providing health care within the school setting. By providing that, it really helps to reduce the stigma associated with mental health care delivery, because it's just seen as one aspect of the larger health care system. School based health centers work very well, and when they're available, it's definitely a great option.
[00:16:00] / Many communities have also used school linked models, where services are provided off site in a community program, but there's a very strategic connection to that program, with very clear memorandums of understanding related to how youth will be referred. There should be excellent communication, collaboration, sharing of data, so it isn't just making a referral. Perhaps someone from that center would come in and connect with the school and be on site, related to those referrals, on a regular basis. The idea being that they're not school based, but they have a very close partnership.
[00:17:00] / What is it that we're asking the school based staff to do? This is what Jacqui was referring to as, what is the role of school based staff, to help identify youth who may need services? First of all, who are we talking about? Really anyone who works in the school, from our educators to health and mental health providers, para professionals, school administrators, school resource officers, our lunch workers, anyone who is connected to students should be part of this process. To really assist with screening. While some more formal screening may occur in the classroom, anyone could nominate a student, or make a recommendation to the school team if they see something that's concerning. It's really important for people to participate in professional development so that they can be aware of different signs and symptoms, really red flags for concerns.
[00:18:00] / It needs to be clear how to make a referral. I highly recommend having a process that is very open so that anyone in the school building can make that referral. In terms of helping to support diversion, you really want a system that is easy to access, that anyone can access, including youth. Youth should be able to self-refer, or to refer a peer if they have concerns. Other roles of school staff is to learn about how to promote wellness and reduce stress, and to participate along with the mental health providers, when mental health treatment is being provided, to try and implement some of those strategies within the school setting.
This is a handout that we use as part of our school mental health program, and it just really highlights who can be referred. If you notice, we are not putting mental health labels on these, we're really focused on just some of the symptoms. We have anxiety and depression, but we're also looking at poor peer relationships, oppositional behavior, homelessness, bereavement. There's a wide range of symptoms that could be relevant, and something like this could easily be personalized for the type of symptoms that you're particularly concerned about and you'd like your behavioral health programs to address.