Is_the_focus_on_mental_health_in_the-schools_cost_shifting by ashrafp

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									Is the focus on mental health in the schools cost shifting?
One of my colleagues in Oregon, which is trying to shift more mental health services into the schools wrote of a
meeting in his community:

"She also commented that all the ed/ESD people at the meeting seemed to have an observation that the Children'
Change Initiative as promulgated by the AMHD is having a negative effect on ed, kids and services. She also
mentioned mentioned the cost shifting effect. She emphatically offered that the ed people are not trained MH people
and don't want to be."

When most of the available funds come from Medicaid, how can schools provide equal identification, referral, and
services to all students.
(Submitted by: eldon_holland@msn.com)

Misconception
Posted by Anonymous on February 28, 2007
Each state has it's own rules and regulations covering the provision of mental health services to children and
adults. Not being familiar with Oregon's AMHD and the Children's Change Initiative, my comments on that have little
value.

However, there persists a misconception about the training and abilities of school employed mental health
personnel. The vast majority--but not all--of school mental health providers (typically school social workers, school
counselors, and school psychologists) are masters level professionals who have gone through rigorous programs and
internships or practicums. In addition to knowledge about and experience with children and youth and their many
developmental needs and challenges, school mental health personnel are also familiar with the dynamics of schools,
school culture and climate, school and special education laws and, frequently, community resources.

We need to stop making comments and assumptions that put community resource people at odds with school
employed personnel and vice versa. We also need to expand the training of all persons in schools (teachers, support
staff, administrators, etc.) so that they are familiar with signs and symptoms of mental health difficulties in
students. According to The President's New Freedom Commission on Mental Health, "Every day more than 52
million students attend over 114,000 schools in the U.S. When combined with the six million adults working at those
schools, almost one-fifth of the population passes through the Nation's schools on any given weekday." Early
screening and detection is essential to improved mental health and the logical place to provide that is in the
schools. Community and school mental health personnel must work together.

Although Medicaid is a huge source of funding, we also need to put pressure on legislatures and insurance
companies to provide parity for mental health services. Our children deserve it.



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Posted by cfette@gmail.com on January 26, 2008
First, in Denton Texas many of our middle and high schools have a "student support specialist" position that is a
multidisciplinary mental health position. The school counselors at the elementary campuses vary as to how much
and what kinds of mental health support that they provide ... in higher grades they get bogged down with guidance
counseling duties. There have been several bills introduced in the state legislature that would have assured a
minimum percentage of time that they could attend to mental health counseling and supports ... so far these have not
passed. We also have a Communities in Schools push that has survived the funding woes that provides mental
health supports in schools who choose to buy into the program. Here the issue is about funding those positions
adequately. I have worked with both school and community mental health staff and have seen no animosity between
the two. But then we are grossly underfunded locally and generally all agree that any mental health supports are a
good thing.

In addition to being a family advocate, I am a psychiatric occupational therapist and see that profession as extremely
underutilized in school settings for children with mental health needs. As a related service, occupational therapy is
frequently billed through Medicaid for eligible children with physical and cognitive disabilities ... Where is that being
done for mental health supports?

In Texas, funding in the community mental health system is not set aside for children versus adults and frequently
there is not much left after the adult population is addressed. I don't see mental health in the schools as cost shifting
but it needs to be funded.
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Cost Shifting
Posted by Kate on March 16, 2008
I agree with anonymous that school mental health providers and agency mental health providers need to respectfully
work together.

A child's mental health exists across a continuum with prevention and early intervention being key to helping kids
learn skills to maintain their mental health.

The funding shift is of considerable concern. Medicaid funding in Ohio was used by school social workers to provide
that intervention, prevention, early identification, working with teachers to implement mental health strategies in their
classrooms and assisting ED teachers in integrating mental health/level strategies in their classrooms and linking
students to appropriate agency mental health services, monitoring their participation. These strategies were aimed
at teaching students to decrease their inappropriate behaviors, practice replacement behaviors and support students
to engage with their agency providers to make change. Many of our team's students who were identified early and
received such interventions were able to remain in the regular classroom with our team support (school psych, social
worker, counselor, nurse, OT, PT). Our ED students were able, with team and level support, to move back to the
regular classroom. Some needed agency mental health services, some did not.

Most importantly, MANY of my families will not engage with mental health providers. I am an LISW and do not have
to rely on billable hours. I am able to spend that time to build relationships with families. It has sometimes taken 2-3
years for me to convince families to work with needed agency services. During that time, I am still able to work with
the child, teacher and family. NOTE- it appears Ohio is cutting their school personnel Medicaid billing. Pupil service
providers numbers and support at ODE have greatly declined along with the lack of Medicaid billing funds for school
social workers.
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