Effective Services and Supports in Schools

Creating and Sustaining Effective
Mental Health Services and
Supports in the Educational Setting
Newport-Mesa Unified
School District Team
Melissa Hurd: Psychological Services Coordinator
Joy Cleary: LCSW, PPS
Tucker Cannon: LCSW, PPS
Michelle Lepak: Ed.S., NCSP, School Psychologist, Program
Specialist, Behavior Specialist
Eby Kent: MS, School Psychologist, Licensed Educational
Psychologist, Behavior Specialist, BCBA
Yuba City Unified
School District Team
Elizabeth Engelken: Director of Student Support;
Credentialed School Psychologist, PPS; Advanced Nurtured
Heart Trainer
Veronica Coates: Psychological Services Specialist;
Credentialed School Psychologist, PPS; Advanced Nurtured
Heart Trainer
Ivona Mikesell: Credentialed School Psychologist, PPS;
ERMHS Behaviorist; Advanced Nurtured Heart Trainer
Presentation Outline
History: How did we get “from there to here”?
(Newport-Mesa/Yuba City)
Program Development and Rationale (Yuba City)
RtI: A Three Tiered Approach (Newport-Mesa)
Foundation and Methodology (Yuba City)
Assessment Process (Newport-Mesa)
ERMH Services (Yuba City)
Next Steps (Newport-Mesa/Yuba City)
History of Mental Health
Supports in California Schools
In 1984, Assembly Bill 3632 outlined and
required a partnership between school districts
and county mental health agencies to deliver
mental health services to students with
individualized education programs (IEPs). A
subsequent Assembly Bill, 26.5, updated the
mandate for students with disabilities.
History of Mental Health
Supports as a Related Service
 In 2011, the California Legislature passed
Assembly Bill 114, which repealed the state
mandate on special education and county mental
health agencies. This action gave school districts
the sole ability to decide how mental health
services were delivered. Many districts continue to
contract with county mental health or other
mental health agencies. The term Educationally
Related Mental Health Services (ERMHS) refers to
those services related to a students educational
plan, and developed to address social, emotional
and behavioral areas of significant need.
A Journey toward ERMHS
Legal Consortiums
Consultation with SELPA leadership and
other major stakeholders
Research and observation of model
Develop Program Design; Hire Exceptional
Developing a Three Tiered approach to
Foundational Approach
Providing a continuum of services which is effective with
special populations
Services which are effective with intense students and
Acknowledging the common underlying belief that we have
tried many methodologies with very limited and poor results
Utilizing a strengths based approach as a foundation for all
services delivered
Strengths Based Approach
 100% of staff trained in the Nurtured Heart Approach
(NHA), utilizing the strategies from classroom to therapy
Program Development
ERMH staff is composed of specialists within the
field of mental health; psychologists, licensed
clinicians, clinical aides and behavior specialists
ERMH clinicians and behaviorists become
collaborative and integrated members of IEP
Creation of a program which serves students
across the special education continuum; from
prevention to intense intervention
Continuum of Services
ERMH Services are Designated
Instructional Services for students
with disabilities
 ERMH Services fall along the
continuum of service – different levels
of ERMH intervention are delivered,
based on student needs
Continuum of Services
Continuum of School Based Behavioral & Mental Health Services
Least Restrictive
Teachers, Counselors, Admin, Probation
Site Based Services
District Counselors and School Psychologists
Site Based Educationally Related Mental
Health Services
District School Psychologists and Counselors
Regionalized Educationally Related
Mental Health Services
Clinicians, Behaviorists, Clinical Aide,
Psychological Services Specialist
County Operated Program + Site Based
Clinicians, Psychological Services Specialist,
Clinical Aide, Behaviorists, County School
County Operated Program Regional
Clinicians, Psychological Services Specialist,
Clinical Aide, Behaviorists
NPS Day School
Psychological Services Specialist, Clinician,
Behaviorists, NPS Staff
NPS Residential
Psychological Services Specialist, Clinician,
Behaviorists, Residential Staff
Most Restrictive
Psychological Support Services
and Support
Early Intervention
Universal Intervention
Site level School-Wide Positive Behavior Interventions and Support
School Psychologists implement research-based curriculum for
identified at-risk students
Push-in whole classroom intervention
Targeted group intervention
Curriculum-Based (Second Step, Steps to Respect)
Expressive Therapy
Progress Monitoring
Data collection, progress reports, teacher input, attendance, work completion,
grades, etc.
Student Study Teams
Tier I Counseling Referral
Please refer to form in folder
Parent Education Training
A need for counseling is suspected for a student receiving special education
o IEP is held to document a referral for School-Based Counseling
o Please refer to Tier I or Tier II Counseling form in folder
o Case Carrier completes Counseling Referral and submits to the School
School Psychologist reviews referral and determines if additional strategies
can be implemented or if Counseling Assessment is warranted.
o IEP is held to document School Psych’s recommendations
o If Counseling Assessment is recommended, Assessment Plan is presented and
consent obtained.
School Psychologist completes ERMHS Counseling Assessment to determine if
there is an area of need
IEP is held to document Counseling Assessment results/recommendations
o Goals proposed in areas of need
o Service recommendation provided
o Individual Counseling, Group Counseling (includes Social Skills), Parent
Education Training
o Minimum of 12 weeks offered (individual and group services)
 Progress Monitoring
 Counseling goals are monitored weekly
 IEP team reconvenes after 12 weeks and determines
continued need/level of Counseling Services based on
progress monitoring
o Data collection, rating scales (objective and research-based),
attendance, work completion, grades, compliance, and team input
 IEP team could determine:
 Student met Counseling goals and service is discontinued
 Student is progressing towards goals and would benefit
from continued School-Based Counseling sessions
 Student is not making progress and a Clinic-Based
Counseling Referral is recommended
 Clinic-Based Services
o Individual Counseling
o Group Counseling
 Targeted Parent Education Counseling and Training
 Collateral Family sessions – Push in home support
 Non-Public School Placement
 Residential Placement
Length of Intense Services
Initial referrals for assessment and
those exiting service are a fluid
 Average length of service is 12-18
Referral Process
After exhausting site based services,
IEP team recommends an ERMHS
 Preventive mental health services are
required prior to referral
Referral Requirements
Parent Approval at IEP to make referral
Site based School Psychologist and Case
Manager compile a packet of data to
present to Psychological Services Specialist
Psychological Services Specialist analyzes
referral with Director of Student Support
and ERMH team, assigning a clinician or
behaviorist to the student
Once referral is approved, assessment plan
is presented to parent
Assessment Process
Yuba City Assessments
ERMH Clinician provides assessments to student,
parents, and school staff including, but not limited
 Standardized Assessments
 Observations
 Consultation
 Collaborates with School Psychologist and site
based team
Newport-Mesa Assessments
Educationally-Related Mental Health Services
(ERMHS) Assessments
 Conducted by School Psychologists
Residential Assessments
 Conducted by a Multi-Disciplinary team of
mental health professionals
A direct link between social-emotional
and/or behavioral functioning and a lack of
educational progress must be present
Preventive mental health services must
have been provided
Goals Drive Service
Example of Annual Goal:
 By (date) Student will utilize at least three
appropriate coping strategies (i.e. positive selftalk, reframing negative thoughts, taking pride in
his inner wealth etc.) to increase positive selfperception in counseling and/or school settings, in
4 out of 5 times as measured by observations and
Goals Drive Service
Example continued with short term objectives:
By (date), when prompted by a Clinician, Student will identify 5
strengths he sees in himself. 4 out of 5 of these strengths must
be statements about his inner wealth, not related to academic or
By (date) when prompted by a Clinician, Student will identify at
least 3 positive strategies on how he is utilizing his strengths of
inner wealth (journaling, verbal positive affirmations, visual
positive affirmations, positive self-talk, re-framing negative
thoughts, resetting)
By (date) Student will be able to identify 10 positive attributes
about himself without prompting, as well as identify how he
utilizes these strengths to reset back to inner wealth rather than
become trapped in misperceptions of how others feel about him,
withdrawal, or negative self talk.
Individual Counseling
 Group Counseling
 Parent Counseling
 Social Work Services
 Psychological Services
 Behavior Intervention Services
Individual Counseling
Counseling in a 1:1 setting with an
ERMH clinician or other qualified
 No other students are present
 Clinician working directly on students
individual goals and objectives
Group Counseling
Student participates in a group led by
an ERMH clinician.
A group of students working on similar
social skills
 A group centered around 1or 2 students
with neurotypical peers
Groups are led by clinicians and often
co-facilitated by a school counselor,
school psychologist or clinical aide
Social Work Services
Consulting/Training staff and/or parents on
specific interventions (i.e. Nurtured Heart
Training 1:1 aides on specific behavioral and
social emotional interventions
Infusing/Modeling strengths based approaches
within general and special education classrooms
Assisting teams on Behavior and Social
Emotional Care Plans
Psychoeducation groups not related to IEP goals
but rather to develop a more positive classroom
Parent Counseling
Providing parent support in a 1:1 or
group setting
 Modeling Strengths Based
communication to parents
 Providing support before and after
IEP meetings
 Psychoeducation
Psychological Services
Services Delivered by the
Psychological Services Specialist
Consultation with site based teams
 Assessment
 Parent support
 Counseling
 In class Interventions
 Liaison to Nonpublic and Residential
Behavioral Intervention
Refinement of current Behavioral
Support Plan
 Data Collection
 In Class modeling of interventions in
conjunction with Clinical Aide
 1:1 Aide and Teacher training
 Consultation to site based teams
Other Services Offered to
SELPA and Community
Support provided to sites during crisis or
emergency situations (threat assessments,
crisis management, grief counseling)
Staff Development Presentations for
teachers, administrators and support staff
(NHA, Anxiety and Trauma, Selective
Mutism, Self-Harming Behaviors,
Developing BSP’s, Prevention and Early
Sustaining Effective Services
and Positive Results
Identify new staff to train; keep cycle of training
Develop specialists; classroom support providers,
clinical staff for therapy, parenting class and
support staff, bilingual staff, training teams
Ongoing Learning Lab
Maintain foundational approach as a district and
SELPA wide initiative so that it is embedded in
board accepted and approved goals
Future Goals for Newport-Mesa
Develop a needs assessment to determine priorities and
future professional development
Leadership Training
 Eliminating Barriers to Learning through the Early
Identification of Student Mental Health Issues
District-Wide collaboration in addressing barriers to learning
 High-Touch Impact on students district-wide
Build upon current Parent Training component
 Parent Academy
Refine school reintegration procedures for students placed
on psychiatric holds
Therapeutic placement between SDC ED/ NPS & RTC
 Explore Day School options
Next Steps & Future Goals for
Yuba City
Continue honing the whole child/strengths
based model with a continuum of services
Continue providing trainings SELPA wide
(parents, families and staff)
Provide ongoing psychoeducation in
classroom settings
Focus on ERMH’s contribution to preventive
mental health

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