So How Much Does This Cost

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					 School-Based Mental Health
Consultative and Collaborative
           Services
          The St. Cloud Model of Mental
            Health Triage and Mobile
                     Wellness




                Michael D. Quesnell, Ph.D.
                   Project Coordinator
              Safe Schools/Healthy Students
                  The Challenges
►   Shortage of Child and Adolescent Psychiatrists
►   Shortage of Psychologists trained and experienced in
    working with young children
►   Inadequate linkage between community and regional
    resources
►   Inadequate emergency services for children’s mental
    health
►   Increasing demands on the classroom teacher to work
    with students with increasing demands, stressors and
    emotional problems
►   Poor communication between
     Primary care and mental health providers
     Schools and mental health providers
     Schools and Primary Care
            Barriers to Learning
What percent of your students come to school ready to
learn what you have prepared to teach them?
  Range of Learners                              Instructional
  Motivationally ready & able      No Barriers   Component
                                                 Classroom                       Desired
                                                 Teaching                        Outcomes
  Not very motivated, lacking                        +
  knowledge & skills, different                  Enrichment
  learning rates & styles, minor                 Activity
                                     Barriers
  vulnerabilities                       to
                                     Learning
                                                  Support
  Avoidant, very deficient, has                   Component
  a disability, major health
                                                   On Understanding Intervention in Psychology and
  problem                                          Education, Adelman & Taylor, 1994
          Sustainable Community
               Collaboration
► Children   and families
► Schools
► Insurers
► Local   community
                            Solutions
► State and County Government partnerships with Community
  Agencies
► Collaboration and Consultation between mental health
  providers, primary care providers, and schools
     Children’s Emergency Assessment System Coalition (CEAS)
     Stearns County Family Services Collaborative Funded School Mental
      Health Triage System
►   Education on Children’s Mental Health Issues for:
       Parents
       Teachers /Education Professionals
       Social Workers
       Mental Health Providers
       Primary Care Providers
       Triage Referral Flow Chart

                  Mental Health Problem / Concern


                          Contact Person


                         Triage Therapist




Diagnostic Assessment   Psychiatric Evaluation   Mobile Wellness Center
          Total Number of Referrals

350
                                          •Year 1: March - June 2001
                                  313
300                                       •Year 2: September 2001 - June 2002
250                      247              •Year 3: September 2002 - June 2003
200                                       •Year 4: September 2003 – June 2004
                173
150

100

50      49

 0
      Year 1   Year 2   Year 3   Year 4
    The Mobile Wellness Center




►   A Mobile Mental Health Resource
►   A St. Cloud Area Community Partnership
►   Funded by the Federal offices of Education, Justice,
    and Human Services
           Mobile Wellness Center
                   Results
►   Decreased the waiting time for mental health assessment
    from 8 – 10 weeks to 26.1 calendar days
►   MWC staff held 118 education events for 1,366 school staff
    and community members
►   Triage and Mobile Wellness Center staff made 408 referrals
    to school and community resources
►   Evaluations from students, parents, and referral sources
    showed an 80% satisfaction with the quality of services,
    access to services, and the outcome of the service
►   Of more than 700 people who were surveyed after an
    educational event through the Mobile Wellness Center,
    97% said they had a better understanding of mental health
    issues
    Mobile Wellness Center Data
      Sept. 2003-June 2004
► 103students referred for full comprehensive
 assessment
   82 assessments completed
   17 students received partial services
   4 students/families declined
► Referralsgenerated 350 appointments
► 15 (5%) no shows
► Sept.-Dec. 2003 162 consults
           The Mental Health Challenge
                                                          • Mental disorder was the most common
                                                          among those with a disorder (32%)
                                                          • Depression was the most common among
                                                          all health plans (24%)
                                                          • Nearly 7 or 10 who had a disorder
                                                          contacted professional treatment.




The Minnesota Mental Health System: Demand, Capacity
and Cost, February 2004. Minnesota Psychiatric Society,
www.mnpsychsoc.org
                         The Coalition
  Community-Based System of Care
                Catholic       Parent Advocates Stearns County
                Charities                       Human Services
           SCSU
                                                       District 742
    College of Education


 Saint Cloud Hospital                                  Wright County
Behavioral Health Clinic                               Human Services


     Sherburne County                               Central Minnesota
       Social Services                             Mental Health Center
                 Youth                         CentraCare
             Representatives   Benton County Health Foundation
                               Human Services
    Moving Forward – Assessing Your
                Capital

          Intellectual Capital             Social Capital
Intellectual capital is                            Social capital refers to
intellectual material--                            the norms and networks
knowledge, information,                            that enable collective
intellectual property,                             action. Social capital is
experience--that can be
put to use to create
                                 Venture           critical for poverty
                                                   alleviation and
wealth. It is collective                           sustainable human and
brainpower.                                        economic development.

          Financial Capital                  Mission Capital
Financial capital, or                              Mission capital refers to
economic capital, is any                           assets that are
liquid medium or                                   generated from a shared
mechanism that                                     vision that is
represents wealth.                                 passionately embraced.
Moving Forward – Assessing Your
            Capital

     Intellectual Capital         Social Capital
School district,
Centracare,
Stearns County
& community
leaders
                            MWC

     Financial Capital              Mission Capital
                                          Nurturing Families
                                          and Strengthening
                                          Communities
            Process of Sustainability
             IMPLEMENTATION – Phase 2
             1) Pursue and secure credentialing as an MA provider as well as other
             insurance related accreditations. 2) Recruit a long-term community
             partner to provide the MWC service 3) Fill out the budget through
             corporate partnerships.

        IMPLEMENTATION – Phase 1
        1) Triage/MWC asset/capital mapping and budget determination, public
        relations planning, data collection inspection for appropriateness to end
        vision, systems analysis 2) Begin billing for contracted staff time.

    PLANNING
    The vision of the MWC is developed in the schools, community and beyond – Year
    2: Staff - $220k + Contracted Staff - $240k, Office set up - $17k, ($477,000 per
    year). Long term sustainability plans take shape.

DISCUSSION
The vision of the MWC is made into reality – Year 1: Vehicle purchased - $200k, Staff hired
- $220k + Contracted Staff - $240k, Office set up - $17k, Schedule begun ($677,000 start
up total)
            Long-term Funding
► Each student receives ~6.5 hours of
  billable service
► 6.5 hours = ~$1,400
► Contracted service is ~$240k
  annually requiring 171 students to
  pay for the contract
► Additional expenses @ ~$220k would
  require another 157 students at the
  billable rate
► Total students would need to be 328
  annually or 6 new cases weekly
► In 2003-2004 the MWC completed 82
  full assessments
 School-Based Mental Health
Consultative and Collaborative
Services: The St. Cloud Model
          For more information contact:
               Michael D. Quesnell, Ph.D.
                  Project Coordinator
             Safe Schools/Healthy Students
                 (320) 252-2231, x3072
              Michael.quesnell@isd742.org


               www.isd742.org/sshs

				
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