families, education & treatment student’s bridge to success may 5, 2006
TRANSCRIPT
FAMILIES, EDUCATION & FAMILIES, EDUCATION & TREATMENTTREATMENT
STUDENT’S BRIDGE TO STUDENT’S BRIDGE TO SUCCESSSUCCESS
May 5, 2006May 5, 2006
PresentersPresenters
Gwyn Devendorf, Director of Special Gwyn Devendorf, Director of Special Education, Wallenpaupack Area School Education, Wallenpaupack Area School District District
AnnaBeth Fish, StudentAnnaBeth Fish, Student
MaryAnn Fish, ParentMaryAnn Fish, Parent
Gail Learn, Director, Child & Adolescent Gail Learn, Director, Child & Adolescent Services, Tri-County Human Services CenterServices, Tri-County Human Services Center
Presenters (cont.)Presenters (cont.)Marnell Fortuner, Teacher, R.D. Wilson Marnell Fortuner, Teacher, R.D. Wilson
Elementary School SBPH ProgramElementary School SBPH Program
James Martin, Deputy Administrator, James Martin, Deputy Administrator, Lackawanna-Susquehanna Counties MH/MR Lackawanna-Susquehanna Counties MH/MR OfficeOffice
Denise Stoneroad, Coordinator, Child & Denise Stoneroad, Coordinator, Child & Adolescent Partial Hospitalization ProgramsAdolescent Partial Hospitalization Programs
Mary Jane Yevics, Family Advocate for The Mary Jane Yevics, Family Advocate for The Advocacy Alliance.Advocacy Alliance.
PRESENTATION OUTLINEPRESENTATION OUTLINE INTRODUCTION OF PRESENTERS & OUTLINEINTRODUCTION OF PRESENTERS & OUTLINE
A PARTNERSHIP FOR SCHOOL BASED PARTIAL A PARTNERSHIP FOR SCHOOL BASED PARTIAL HOSPITALIZATIONHOSPITALIZATION
PARENT’S & STUDENT’S VOICESPARENT’S & STUDENT’S VOICES
HISTORY & DEVELOPMENT OF SBPHP HISTORY & DEVELOPMENT OF SBPHP -MH & EDUCATION PERSPECTIVE-MH & EDUCATION PERSPECTIVE
PROGRAM MODEL & OPERATIONPROGRAM MODEL & OPERATION
CLINICAL & EDUCATIONAL COMPONENTSCLINICAL & EDUCATIONAL COMPONENTS
OUTLINE CONTINUEDOUTLINE CONTINUED
KEYS TO SUCCESS KEYS TO SUCCESS
WHAT WE HAVE LEARNED WHAT WE HAVE LEARNED
WHAT WE WOULD CHANGEWHAT WE WOULD CHANGE
QUESTIONS FOR THE PANELQUESTIONS FOR THE PANEL
School Based Partial School Based Partial HospitalizationHospitalization
A Day Treatment Program combining A Day Treatment Program combining mental health treatment and education.mental health treatment and education.
Less intense and acute than an inpatient Less intense and acute than an inpatient psychiatric hospital or MH residential psychiatric hospital or MH residential
treatment facility.treatment facility.
More intensive than outpatient mental More intensive than outpatient mental health treatmenthealth treatment
PARTNERS IN THE PARTNERS IN THE COLLABORATIONCOLLABORATION
N.E.I.U. #19DPW & PDE
TRI-COUNTY HUMAN SERVICES
LOCAL SCHOOL DISTRICTS
L-S & W COUNTIES MH OFFICES
PARENTS, STUDENTS & ADVOCACY GROUPS
Parent & Student VoicesParent & Student Voices
What were the strengths of the SBPH What were the strengths of the SBPH Program? Program?
Which components benefited you or Which components benefited you or your child/adolescent most?your child/adolescent most?
Sharing thoughts and experiences…Sharing thoughts and experiences…
Family, Education and Treatment: Family, Education and Treatment: Student’s Bridge to Success Student’s Bridge to Success
May 5, 2006
2006 Pennsylvania School-Based Behavioral Health Conference
Background / LocationBackground / Location
Background/ Population Background/ Population
County Population
(2000 Census)
MR Served
(FY 2004-05)
MH
Served
(FY 2004-05)
Lackawanna 213,295 2413 11,132
Susquehanna 42,237 164 1,690
Wayne 47,722 233 2,351
Total 303,254 2,810 15,173
MH Total Served MH Total Served Fiscal Year 2004-05Fiscal Year 2004-05
Children and Youth
Adult Aged
Lackawanna 3,298 (29.8%)
6,799
(61.5%)
960 (8.7%)
Susquehanna 587
(34.7%)
963
(57%)
140 (8.3%)
Wayne 753
(68.5%)
140
(12.8%)
205 (18.7%)
Total
Joinder
4,638 (30.6%)
9,155
(60.3%)
1,380 (9.1%)
MR Total Served MR Total Served Fiscal Year 2004-05Fiscal Year 2004-05
Children and Youth
Adult Aged
Lackawanna 1,279
(53%)
997
(41.3%)
137 (5.7%)
Susquehanna 61
(37.2%)
83
(50.6%)
20 (12.2%)
Wayne 130
(55.8%)
90
(38.6%)
13 (5.6%)
Total
Joinder
1,470 (52.3%)
1,170 (41.6%)
170 (6.1%)
Service Delivery System/ StructureService Delivery System/ Structure
Service Delivery System/ Service Delivery System/ StructureStructure
• Lackawanna-Susquehanna County Mental Health/ Mental Retardation
Program Administrative Office• Policy Development
• Contract Management
• Planning and Development
Service Delivery System/ Service Delivery System/ StructureStructure
• Service Delivery• Contracted Services
• 22 Providers Delivering Mental Health Services
Service Delivery System/ Service Delivery System/ StructureStructure
• Service Delivery• Mental Health Contracted Services include:
• Intensive Case management• Partial Hospitalization• Outpatient Treatment• Inpatient Treatment• Behavioral Health Rehabilitation Services• Emergency Services• Crisis Intervention• Family Based Services Resource Coordination• Resource Coordination• Vocational Services
Partial Hospitalization Services Partial Hospitalization Services within the Joinder Programwithin the Joinder Program
• Provider System• Four (4) Providers deliver a range of
Partial Hospitalization Services:• Center Based Programs
• School Based Programs
• After School Programs
• Acute
• Early Childhood
Current Utilization StatisticsCurrent Utilization Statistics
• 413 Child and Adolescent Partial Hospitalization Program Slots within the Joinder Program
• Average Length of Stay is 9-16 Months• Average Daily Attendance is 405 students• 887 Unduplicated children and Adolescents
were served in Fiscal Year 2004-2005 throughout the Joinder Program
School Based Partial Hospitalization School Based Partial Hospitalization Program DevelopmentProgram Development
• Lackawanna/ Susquehanna/Wayne Counties had three school Based Partial Hospitalization Programs in existence prior to 1993• Elk Lake- 5-12 years old • Wallenpaupack- 10-14 Years old • Western Wayne 5-12 Years old
School Based Partial Hospitalization School Based Partial Hospitalization Program Expansion in 1993Program Expansion in 1993
• Department of Education Request:• Eliminate Center Based Option for 57
Adolescents• Transition the Center Based Program to a
School Based Program within local School Districts
Creation of The PartnershipCreation of The Partnership
• Meeting was held with:• Department of Education• Bureau of Special Education• Intermediate Unit #19• Local School Superintendents• Local Mental Health System
Creation of The PartnershipCreation of The Partnership
• Partnership’s Charge:
• Create School Based Options for 57 Adolescents within a nine (9) month period of time- The next School Year
Reasons for moving program Reasons for moving program from Center-Based to School-from Center-Based to School-
BasedBased
Difficulty of re-entering students from Difficulty of re-entering students from center to home schoolcenter to home school
Students not able to mainstream, Students not able to mainstream, integrate in regular educationintegrate in regular education
Students not able to participate in extra-Students not able to participate in extra-curricular, co-curricular activitiescurricular, co-curricular activities
Center far from student’s home – making it Center far from student’s home – making it difficult for family and LEA involvementdifficult for family and LEA involvement
Educational ComponentsEducational Components
Special Education Teacher and Teacher AssistantSpecial Education Teacher and Teacher Assistant
Emotional Support Program with related servicesEmotional Support Program with related services
Individual Education ProgramsIndividual Education Programs
Access to general education curriculumAccess to general education curriculum
Access to special area classes, clubs, activities, extra and Access to special area classes, clubs, activities, extra and co-curricular activities and sportsco-curricular activities and sports
Communication and collaboration among all staffCommunication and collaboration among all staff
Administrative support and active involvement - Administrative support and active involvement - willingness to be flexiblewillingness to be flexible
Community Needs …Community Needs …(Educational perspective)(Educational perspective)
Space for Classroom and Therapy Space for Classroom and Therapy rooms rooms
Understanding of therapeutic elements Understanding of therapeutic elements of programof program
Respect for each disciplineRespect for each discipline Willingness by administrators to adjust Willingness by administrators to adjust
rulesrules Acceptance of students from other Acceptance of students from other
districts as your owndistricts as your own
PROGRAM MODEL TODAYPROGRAM MODEL TODAY
SBPH in the Continuum of CareSBPH in the Continuum of Care
Who does it serve?Who does it serve?
Where are the programs located?Where are the programs located?
How is the program funded?How is the program funded?
TRI-COUNTY HUMAN SERVICES TRI-COUNTY HUMAN SERVICES CONTINUUM OF CARE FOR CONTINUUM OF CARE FOR
CHILDREN & ADOLESCENTSCHILDREN & ADOLESCENTS
Student Assistance ProgramsStudent Assistance Programs School Outreach ProgramsSchool Outreach Programs Community & School Based Community & School Based
Outpatient SitesOutpatient Sites Acute & After School Partial Acute & After School Partial
Hospitalization ProgramsHospitalization Programs
Continuum of CareContinuum of Care
Summer Partial Hospitalization ProgramsSummer Partial Hospitalization Programs
Family Based In-Home ServicesFamily Based In-Home Services
Intensive Case Management & Resource Intensive Case Management & Resource CoordinationCoordination
BHRS & Autism ProgramsBHRS & Autism Programs
Wilderness AdventureWilderness Adventure
Center Based PHPCenter Based PHP
April,2006April,2006Ages of Students Currently in Ages of Students Currently in
SBPHSBPHTotal = 101 StudentsTotal = 101 Students
0
2 2
12
5
10 10
13
98
4
16
6
4
0
2
4
6
8
10
12
14
16
18
5 6 7 8 9 10 11 12 13 14 15 16 17 18
April, 2006April, 2006Sex of StudentsSex of Students
Male69%
Female31%
Axis I DiagnosisAxis I Diagnosis2004-20052004-2005
18
6
3
17
2
14
0 5 10 15 20
Mood Disorders
Anxiety Disorders
PDD
Attention Deficit Disorders
Adjustment Disorders
Behavior Disorders
Discharge
Admit
Mountain View
Elk Lake Forest City R.D. Wilson
Western Wayne High School
Carbondale
Valley View
Mid Valley
Wallenpaupack
Locations of Host Schools
9 School Sites
Home School District At Home School District At AdmissionAdmission2004-20052004-2005Mid Valley
Lakeland
Valley View
Carbondale
Wayne Highlands
Western Wayne
Wallenpaupack
Blue Ridge
Elk Lake
Montrose
Susquehanna
Forest City
Scranton
North Pocono
Other
17 School Districts utilized School Based PHP 17 School Districts utilized School Based PHP
Educational Status at AdmissionEducational Status at Admission2004-20052004-2005
Learn. Sup.14%
Res. Tx.3%
Other3%
Home Bound6%
Center Based Emot. Sup.
8%
Sch. Based Emot. Sup.
25%
Regular Ed.41%
EDUCATIONAL STATUS AT EDUCATIONAL STATUS AT DISCHARGE 2004-2005DISCHARGE 2004-2005
Regular Ed.13%
Learning Support
13%
Home Bound2%
RTF10%
Graduated10%
Quit School2%
Center Based PHP14%
Other10%
School Based Emot. Sup..
26%
Mainstreaming & InclusionMainstreaming & Inclusion Data Collection since 1992Data Collection since 1992 1992-1993: 100% Mainstreamed in Specials 1992-1993: 100% Mainstreamed in Specials
(Art, Music, Physical Education, etc.) *(Art, Music, Physical Education, etc.) * 1992-1993: 80% mainstreamed in at least 1992-1993: 80% mainstreamed in at least
one academic subject*one academic subject* 2005-2006: 95% mainstreamed in Specials*2005-2006: 95% mainstreamed in Specials* 2005-2006: 78 % mainstreamed in at least 2005-2006: 78 % mainstreamed in at least
one acaemic subject*one acaemic subject*
*After completion of diagnostic period*After completion of diagnostic period
Length of StayLength of Stay2004-20052004-2005
20-30 months9%
13-19 months7%
31+ months15% 0-6 months
53%
7-12 months16%
*Discharged Students Only
Most CommonMost CommonReasons For ReferralReasons For Referral
Behavior Issues at school and at homeBehavior Issues at school and at home
Impulsivity and Attention related issuesImpulsivity and Attention related issues
Depression, Anxiety and other mental Depression, Anxiety and other mental health issueshealth issues
School Refusal and TruancySchool Refusal and Truancy
Reason For DischargeReason For Discharge2004-20052004-2005
Withdrew6%
MHRTF6%
Foster Care6%
Juvenile Delinquency
2%
Other10%
Deterioration21%
Improve/Grad.49%
Funding for the SBPHPFunding for the SBPHP
Collaborative approach = Collaborative approach = collaborative funding.collaborative funding.
Shared costsShared costs MH Treatment funded by Medical MH Treatment funded by Medical
Assistance, third party insurance and Assistance, third party insurance and County MH FundingCounty MH Funding
Education Costs are paid by home Education Costs are paid by home school districtsschool districts
PROGRAM MODELPROGRAM MODEL
Therapeutic MilieuTherapeutic Milieu Special Education Special Education Psycho-EducationPsycho-Education MH TreatmentMH Treatment Therapeutic ClassroomTherapeutic Classroom Crisis Prevention & InterventionCrisis Prevention & Intervention Integration & MainstreamingIntegration & Mainstreaming
Demographics of ProgramsDemographics of Programs
Age/Grade LevelsAge/Grade Levels
School DistrictsSchool Districts
Number of Students per ProgramNumber of Students per Program
Physical Set-UpPhysical Set-Up
Educational ComponentEducational Component
Clinical ComponentClinical Component
Staff ComplementStaff Complement ClinicalClinical EducationalEducational
Referral ProcessReferral Process
CriteriaCriteria
Medical Necessity StatementMedical Necessity Statement
Orientation ProcedureOrientation Procedure
Treatment Team MembersTreatment Team Members
Family MembersFamily Members
Clinical StaffClinical Staff
Educational StaffEducational Staff
Support SystemsSupport Systems
Clinical ComponentsClinical Components
Individual, Group & Family TherapiesIndividual, Group & Family Therapies
Crisis InterventionCrisis Intervention
Behavior Modification SystemBehavior Modification System
Treatment Planning and ReviewsTreatment Planning and Reviews
Psychiatric StaffingPsychiatric Staffing
Behavior Management Behavior Management SystemSystem
HomeworkHomework 6 points6 points Morning RoutineMorning Routine 4 points4 points ReadingReading 6 points6 points Social StudiesSocial Studies 4 points4 points LunchLunch 4 points4 points RecessRecess 4 points4 points MathematicsMathematics 6 points6 points Group TherapyGroup Therapy 6 points6 points TOTALTOTAL 40 points 40 points
Behavior Management SystemBehavior Management System Level 3: 36-40 pointsLevel 3: 36-40 points *full privileges*full privileges *full recess*full recess *choice of milk at lunch*choice of milk at lunch *walk independently to activities/restroom*walk independently to activities/restroom
Level 2: 29-35 pointsLevel 2: 29-35 points *most privileges*most privileges *full recess*full recess *no chocolate milk*no chocolate milk *walk with class to activities/restroom*walk with class to activities/restroom
Level 1: 0-28 pointsLevel 1: 0-28 points *no privileges*no privileges *no recess*no recess *no chocolate milk*no chocolate milk *escorted to activities/restroom by adult*escorted to activities/restroom by adult
M. FORTUNER 2005-2006 ROOM 316 PARTIAL PROGRAM
TIME DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6
8:30-9:00 Morning Routine:
(breakfast, lunch count, attendance, check homework, restroom)
9:00-10:30 Reading Reading Reading Reading Reading Reading10:30-11:30
Math Math Math Math Math Math
11:30-12:00
Student Lunch
Student Lunch
Student Lunch
Student Lunch
Student Lunch
Student Lunch
12:00-12:30
Recess Recess Recess Recess Recess Recess
12:30-1:15 Social Studies/Finish-Up Work
Social Studies/Finish-Up Work
Social Studies/Finish-Up Work
Social Studies/Finish-Up Work
Social Studies/Finish-Up Work
Social Studies/Finish-Up Work
1:15-2:15 GroupTherapy
GroupTherapy
GroupTherapy
GroupTherapy
GroupTherapy
GroupTherapy
2:30-3:00 Dismissal Dismissal Dismissal Dismissal Dismissal Dismissal
*Students leave at varying times for specials and mainstreaming per grade level
Discharge/Transition Discharge/Transition ProcedureProcedure
Planning MeetingsPlanning Meetings
Follow-Up ServicesFollow-Up Services
Transition SessionTransition Session
Support SystemsSupport Systems
School DistrictsSchool Districts
Children & Youth ServicesChildren & Youth Services
Juvenile ProbationJuvenile Probation
Other Therapeutic ProgramsOther Therapeutic Programs
Key ComponentsKey Components
Team ApproachTeam Approach
Family InvolvementFamily Involvement
CommunicationCommunication
FlexibilityFlexibility
Psychiatrists travel to Psychiatrists travel to schoolsschools
MH Staff in SchoolsMH Staff in Schools
Building ResiliencyBuilding Resiliency
Focus on Consumer Focus on Consumer Satisfaction & OutcomesSatisfaction & Outcomes
InclusiveInclusive
Cost-EffectivenessCost-Effectiveness
EducationEducation AND AND Treatment Treatment
Advocacy Perspective on Advocacy Perspective on SchoolSchool
Based MH ServicesBased MH Services
Trends of Contacts regarding Family Trends of Contacts regarding Family Contacts – Issues of Reintegration & Contacts – Issues of Reintegration & Academic Catch-upAcademic Catch-up
Consumer/Family Satisfaction Team DataConsumer/Family Satisfaction Team Data
Advocacy Partnership W/Families & Advocacy Partnership W/Families & ProvidersProviders
Advocacy PerspectiveAdvocacy Perspective
School Based PH as a step up or step down School Based PH as a step up or step down provides families w/a continuum of care.provides families w/a continuum of care.
Continuing the “Best CASSP Practice” of Continuing the “Best CASSP Practice” of Least Intrusive/Least Restrictive – Least Intrusive/Least Restrictive – Community BasedCommunity Based
Report from the Action AllianceReport from the Action Alliance
Tri-County Human Services Consumer Tri-County Human Services Consumer Satisfaction Tool & ResultsSatisfaction Tool & Results
44thth Quarter 2005, results from 47 surveys were: Quarter 2005, results from 47 surveys were:
- 92% gave positive scores for “Rate the - 92% gave positive scores for “Rate the care you received”care you received”
- 70% gave positive scores for “Would - 70% gave positive scores for “Would recommend to family and friends.”recommend to family and friends.”
- Some other key drivers included: staff - Some other key drivers included: staff listening closely, feeling safe during listening closely, feeling safe during treatment, and being treated with courtesy treatment, and being treated with courtesy and respect.and respect.
Consumer Satisfaction Consumer Satisfaction DemographicsDemographics
55 % were completed by the patient55 % were completed by the patient 11% were completed by the Patient 11% were completed by the Patient
& a Staff person, & a Staff person, 34% were completed by Family 34% were completed by Family
Member & patientMember & patient
What things work?What things work?
Ability to mainstream but still have access Ability to mainstream but still have access to primary therapist (in the same building) to primary therapist (in the same building) while adjusting and knowing “ safety net is while adjusting and knowing “ safety net is there and make transitioning easier”. there and make transitioning easier”.
Various extracurricular activities: sports -Various extracurricular activities: sports -cheerleading , music, art club, etc.cheerleading , music, art club, etc.
Access to public school advantages; Access to public school advantages; quality of supplies, books, learning quality of supplies, books, learning materials, etc. and teacher’s qualifications materials, etc. and teacher’s qualifications and understanding of inclusion.and understanding of inclusion.
Areas for more opportunityAreas for more opportunity
Special vs. alternative vs. regular Special vs. alternative vs. regular educationeducation
Enhance transition servicesEnhance transition services
Increased Public Awareness about SBPHPIncreased Public Awareness about SBPHP
Continue to Assess OutcomesContinue to Assess Outcomes
FAMILIES, EDUCATION & FAMILIES, EDUCATION & TREATMENTTREATMENT
STUDENT’S BRIDGE TO STUDENT’S BRIDGE TO SUCCESSSUCCESS
May 5, 2006May 5, 2006