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From the Board Room: Mental Health Clinicians in Schools Program update

April 7, 2017
From the Board Room: Mental Health Clinicians in Schools Program update
By Noelle H. Lowery
Today, more than ever before, there is a growing need for mental health services for children and youth.
According the U.S. Department of Health and Human Services, one in five children and adolescents experience a mental health problem while in school, including stress, anxiety, bullying, family problems, depression, a learning disability, and alcohol and substance abuse.  Middle and high school youth also face more serious mental health problems, such as self-injurious behaviors and suicide, and instances of these are on the rise.
Often times, though, these needs go unmet.  Up to 60 percent of students do not receive the treatment they need due to stigma and lack of access to services, and of those who do get help, nearly two thirds do so only in school.
Thanks to a collaborative partnership between the Kodiak Island Borough School District, the Kodiak Island Borough and the Providence Kodiak Island Counseling Center (PKICC), the mental health needs of district students are being met and then some.  During the March 20 regular meeting of the KIBSD’s Board of Education, Mary Guilas-Harwver, director of PKICC, was on hand to discuss the partnership and provide a snapshot of the strides the program has made over the last few years.
School Clinicians 101
Guilas-Harwyer explained that the program is the result of a two-part contract: one between KIB and PKICC Mental Health Services and a Scope of Services contract between KIBSD and PKICC.  According to Guilas-Harwyer, the main goal of the PKICC MH Clinicians in the School Program is “to serve Kodiak’s kids and to support the mission of the KIBSD through collaborative efforts.”
Total funding for the program is $400,000, with KIBSD contributing.
The School Clinicians partnership allows four mental health professionals to be embedded in all of the town schools eight hours a day, five days a week.  These school clinicians also visit each of the eight rural village schools and Rural Head Start at least once a month.  Additionally, they handle any crisis calls for students in their case load seven days week, and they provide assistance and expertise in psychiatric emergencies and crisis stabilization.
On average, the school clinicians are working with 20-30 students at each elementary school, between 35-40 students at Kodiak Middle School and roughly 25-40 students at Kodiak High School, scheduling up to 14 students a day as well as multiple daily unplanned visits.
Guilas-Harwyer laid out the extensive list of services provided through the program:
  • Confidential individual and group counseling
  • Psychoeducational classes/groups for students and staff  
  • Services to children with Individual Education Plans (IEP), including help with IEP planning
  • Village services
  • Confidential family support services
  • Linking to additional resources as needed
  • Crisis stabilization
  • Personalized referrals
  • Consultation services for administration and teachers
  • Supportive services to teachers 
  • Kodiak Children’s Fair
  • U.S. Coast Guard “Welcome Aboard”
  • Attendance at Open House events, as well as classroom introductions, presentations and school assemblies 
  • Collaboration with other community programs, such as Parenting with Love & Limits, Community-Based Action Team (CBAT), Office of Children Services (OCS), Teen Court, Department of Juvenile Justice (DJJ) and Child Advocacy Center 
  • Informing school staff about referral processes 
  • Coordination of Care Meetings with core team in each school 
  • Meetings with school district personnel 
  • Confidential personnel support 
  • Collaboration with other programs for village services, such as Transitional Age Youth Coalition and youth advocate for KIBSD
  • Members of multiple community-wide, district-wide response teams for crisis situations  
  • Opportunities for community education 
  • Work with KIBSD during Professional Development and in-service days
  • Home visits with school staff and administration 
  • Trauma-Informed Care (TIC) 
  • Crisis Stabilization 
  • Participate in the Community Based Action Team to help plan community-wide strategies

Progress and Results

The highlight of the presentation to the BOE was the summary of the program’s progress through the last few school years.  Guilas-Harwyer reported the program partners recently have focused on three main areas: strengthening the collaboration with village service providers; increasing parent involvement in student counseling; and instituting protocols for trauma-informed care, crisis situations and drug/alcohol treatment responses.
Regular collaboration between school clinicians and the Rural Schools principal, resource teachers and counselor and KANA Behavioral Health Aides has resulted in improved and up-to-date services geared toward the express needs of students and without a duplication of efforts.  Additionally, the program has increased services to the villages by being available for crisis interventions via phone or video conferencing equipment, by supporting Rural Schools staff with weekly or monthly check-ins, and by wrapping around services for students who need additional support throughout the entire year.
A parent-friendly/parent-involved approach to counseling students also has been developed.  Parents are part of the treatment plan, are regularly informed on student progress, and now are referred to outside resources, allowing them to become advocates for their students within the district.  Further, the school clinicians program has created a school protocol for the assessment and first-response treatment for high school-age students who are sentenced to drug/alcohol treatment by Teen Court.
A crucial collaboration through the program has been between KIBSD and Kana on the crisis protocol for suicidal or homicidal students in both town and rural schools.  The first step was to improve care for these students by adding of a school clinician with a Master’s Degree to conduct initial risk assessments and interventions, defining chain of command, making a contact list available for all pertinent school personnel, and adding a plan of care for when these students return to school.  Part of this work included consulting on the update of the Counseling Handbook to ensure compliance with Federal and state laws, the code of ethics of the National Association of Social Worker and The Association of School Superintendent, and to ensure best practices.
Trauma-Informed Care
In the final minutes of the presentation, Tara Greer, a mental health clinician who works at Kodiak Middle School, discussed the introduction to the  KIBSD system of the Trauma-Informed Care approach for students with behavioral problems.  Trauma-Informed Care is an organizational structure and treatment framework that involves understanding, recognizing and responding to the effects of all types of trauma. It also emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.
“Trauma-Informed Care focuses on understanding how the brain of the traumatized child works,” explained Greer to the BOE.  “Students want to feel safe, respected and appreciated.  If they don’t, they won’t be learning their math…They won’t be able to learn their science because they can’t because they don’t feel safe.”
The beginning of a pilot project was implemented at KMS at the end of the 2014-2015 school year, with the 2015-2016 school year the first full year of implementation at the school.  The middle school clinician has provided education and training on the trauma-informed framework and types of interventions; modeled the approach; purchased tools for students to have on hand to manage emotions in classrooms; taught students quick distress tolerance skills; introduced weekly coordination of care meetings to target students at risk and plan and implement multiple levels of services and assess progress; modified disciplinary policy to be more restorative vs. punitive; and used the building resiliency factors approach.  
Currently, plans are underway to use the Trauma-Informed Care approach district-wide next year.  Training and support for the approach already have begun within the four town elementary schools and the Rural Schools, including placing “calm down kits” in every school and initiating coordination of care meetings with faculty and staff.
KIBSD Board Member Julie Hill applauded the program: “I am excited to see the scope of services available.  I am probably the only one here who was around when this was implemented 35 years ago.  I commend you on what you have done.”