School Community Partnership for Mental Health

Project Overview

Milwaukee’s School Community Partnership for Mental Health (SCPMH), is an evidence-based, collaborative, multi-system, interdisciplinary approach to improve access and strengthen the capacity of schools, families and providers to improve youth mental health, school success and well-being. The focus is on students in Milwaukee Public Schools (MPS) with mental health needs that extend beyond what can be addressed by school staff.

Milwaukee schools, providers and families currently face obstacles to supporting children challenged by mental illness and trauma. 1) There is no cohesive system in place to allow community mental health providers to collaborate with schools and families to meet the mental health needs of children. 2) With Milwaukee’s high poverty rates, the cultural stigma of mental illness and high levels of bussing to schools outside of a student’s neighborhood, families have great difficulty accessing mental health services for their children and the likelihood of collaboration with the school is extremely low. 3) The reimbursement policies and rates for youth mental health service delivery in Milwaukee are inferior to Albuquerque, Baltimore and Minneapolis, the three cities that SCPMH has used as a model due to their success with community-school mental health service integration.

Milwaukee faces a unique funding and policy challenge. While Milwaukee’s Wraparound program is a national model of effective intervention for youth in crisis, all county directed federal funds go to providing access for these youth. SCPMH will demonstrate a positive return on investment of supporting early intervention which will catalyze policy and funding changes by local and state funding sources and HMOs. MPS district leaders, provider agencies, HMOs, academic evaluators, city, county and state public health officials and parent representatives are members of the Project Leadership Team.

The project will:

  1. Train school staff and parents about conditions that support mental health and school success and processes for referral to services,

  2. Deliver therapeutic and consultation services in schools (agencies and homes) as directed by the school’s Positive Behavior Interventions and Supports (PBIS) process, and

  3. Develop policy solutions that will support and increase mental health services for urban children.

SCPMH has taken steps to create a system for collaboration and coordination in eight (nineteen in school year 2015/16) MPS schools and with three community mental health providers. Community mental health providers, co-located at school sites, offer training and consultation to school staff and parents along with therapeutic services for individual students and/or families as directed by the school’s mental health support staff. Working together, the provider and school mental health staff work to increase parents’ and teachers’ understanding of mental illness and trauma’s impact on children’s learning and life success as well as increase parent follow-up on referrals. We have seen more children in these schools receive needed mental health treatment and thereby improve their mental and behavioral/social health.

As part of the planning and initial implementation process, conversations began with the four Medicaid HMOs that serve Milwaukee’s children. In addition, Milwaukee County Behavioral Health, responsible for the WRAP and REACH programs, have agreed to provide a unique billing code for use by the SCPMH providers so that they can bill for some of the ancillary support services with school personnel such as consultation and collaboration around the individual child. The long-term goal of SCPMH is to create a new system of care for youth with emergent/unmet mental health needs in MPS and the state. By improving access, utilization and quality of services and catalyzing funding and policy changes, Milwaukee will be testing a model for statewide replication.

SCPMH expects that the students with emergent/unmet mental health problems referred for services will experience the following outcomes:

  • Sooner than typical access to therapeutic services;

  • More than typical number of contacts (nine or more) with a mental health provider resulting in fewer symptoms of depression, anxiety or other mental health concerns;

  • Improvement in attendance and reduction in suspensions for students with these problems; and

  • Improved academic achievement.

The SCPMH will measure the number of referrals, follow-up to referrals, clinical contacts per referral, symptom change and academic performance as well as monitor overall school trainings, climate, student attendance, suspensions, and parental and staff satisfaction.

Sustaining this model requires a combination of public, private, and philanthropic funds. Blended funding has been successful in other communities. A sustainable funding model includes: reimbursement from Medicaid HMOs or other insurance companies, state and federal funds, charitable support and support from MPS. The SCPMH Leadership Team will use data from the implementation process and outcomes to establish such a model and to maintain and expand the number of youth mental health providers in Milwaukee and WI.

Adverse childhood experiences ACES:

Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse, as well as family dysfunction (e.g., an incarcerated, mentally ill, or substance-abusing family member; domestic violence; or absence of a parent because of divorce or separation).

ACEs have been linked to a range of adverse health outcomes in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality…

59.4% of respondents reported having at least one ACE, and 8.7% reported five or more ACEs… Non-Hispanic black respondents reported the lowest prevalence of each ACE category among all racial/ethnic groups (p<0.05), with the exception of having had an incarcerated family member, parental separation or divorce, and witnessing domestic violence. Hispanics reported a higher prevalence than non-Hispanic whites of physical abuse (p<0.05), witnessing domestic violence (p<0.05), and having an incarcerated family member (p<0.05). Those respondents with less than a high school education compared with those with more than a high school education had a greater prevalence of physical abuse, an incarcerated family member, substance abuse, and separation/divorce (p<0.05 for all). Among the five states, little variation was observed.

Evidence-based programs exist that have demonstrated reductions in child maltreatment, such as home visits by nurses to mothers at high risk (7) and parenting programs that teach new skills and behaviors to parents (8). However, most child maltreatment goes undetected, as evidenced by the discrepancy between the incidence of confirmed cases of abuse reported by child protective services and retrospectively reported prevalences such as those described in this report. Therefore, secondary and tertiary efforts are important complementary approaches to primary prevention efforts to improve the health and well-being of affected adults and families.

Psychological treatments that can mitigate the progression of ACE-related health problems, such as trauma-focused cognitive-behavioral therapy, are effective (9) and should be widely disseminated. Other promising public health programs, such as trauma survivors’ networks (10), should be more systematically evaluated to add to the repertoire of available evidence-based interventions that can prevent and alleviate the stress-related health risk behaviors, conditions, and disability associated with ACEs. ‘assess associations between childhood maltreatment and later-life health and well-being….

Some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery. contained questions about childhood maltreatment and family dysfunction, as well as items detailing their current health status and behaviors…

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Last edited by Tyler Schuster.   Page last modified on June 25, 2015

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