April 2007

Question:
Our community is struggling with developing a collaborative model between mental health and education. What are some of the proven models within other system of care communities?

Answer:
Collaboration between education and mental health can occur at various levels. There are five levels of collaboration that have emerged from our system of care communities:

1. Child and family
2. Small group support
3. School-wide support
4. District-wide support
5. County or State initiatives

The first level begins with the individual child and family. Through case management and the family service coordinator, school representatives have been included in team planning and follow-up through the wraparound process. There is usually one staff member from the school where the child attends that becomes part of the process and team.

The second level of collaboration occurs in addressing the needs of a group of children or youth, such as group therapy provided at the school, after school programs, parent support groups or mentoring.

The third level occurs through school wide programs that support all children, such as school wide positive behavioral supports and interventions, social skill classroom instruction, mental health provider assigned to the pre-referral team at the school or behavioral support centers.

The fourth level provides district level support through comprehensive programming with support for referral, assessment, various programs options, both in school and in the community, family supports and consistent case management and follow-up.

The fifth level involves county or state initiatives that maintain comprehensive training and technical assistance structures, referral and assessment centers and ongoing policy and funding initiatives.

There are a variety of ways that mental health clinicians and behavior therapists have been utilized in schools. Several communities have integrated clinicians directly into their schools to work with students, their families, and teachers and administrators. Others have implemented systems in their schools through the use of behavioral specialists, school psychologists and social workers who staff planning centers and integrated social service centers. Consultation and Education Specialists work with the entire school community to make sure no one falls through the cracks. Intensive Case Managers work with students who require more intensive levels of intervention as well as with their families. Case Managers coordinate and provide individualized wraparound services to students. Clinicians work in the school to provide immediate crisis intervention and linkage to other resources. They also provide pro-social skills training and in service training for staff on various topics related to behavior supports and other strategies; one-on-one and group therapy or counseling sessions; academic and behavioral support through "planning centers"; links to other social services; and individualized planning for transitions for the child and family to and from more restrictive placements.

From an administrative perspective, it is a valuable investment to have clinicians on site in schools. It helps build collaboration between several agencies and maintains contact between those agencies with consistent personnel who understand the culture of the systems. Another advantage is the support it provides to school based staff. It is reassuring to staff to have personnel who are experienced in behavioral and emotional needs/supports for children and families readily available if needed. They also can provide valuable information and training. In addition, placing clinicians in schools, the "normal" environment for children reduces the stigma associated with mental health services. Finally, partnering with schools and offering mental health services within the context of behavioral health and support helps clinicians reach a greater proportion of children and families in need.

Throughout all these levels, communication, consistent follow-up, data based decision making and advocacy have all been vital to successful implementation. In addition, committed leadership of someone with authority to delegate resources, impact policy and supervise the implementation is essential. A strategic plan for the system of care development includes areas where it overlaps with the strategic plan of the school district as well as the county or state initiatives as well.