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Beyond ODRs: Using Universal Screeners to Expedite Interventions for Students at Risk

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Title: Beyond ODRs: Using Universal Screeners to Expedite Interventions for Students at Risk Author: Cari Schindel Last modified by: Cheryle Kennelly – PowerPoint PPT presentation

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Title: Beyond ODRs: Using Universal Screeners to Expedite Interventions for Students at Risk


1
Implementation of Universal Screening A
Community / School PartnershipFond du Lac
TeenScreen ProgramMarian Sheridan Matt Doll
2
Reflection Questions
  • What, if any, roadblocks to universal screening
    for behavior exist in your district/school?

1
3
Potential Roadblocks
  • Absence of administrative support
  • Lack of knowledge regarding the process
  • Fear of labeling students
  • Apprehension regarding parental/guardian response
  • Concerns regarding cost/time to implement
    universal screening

4
Why Screen for Mental Illness and Suicide Risk?
  • Mental illness is treatable.
  • There is ample time to intervene before symptoms
    escalate to a full blown disorder and before a
    teen turns to suicide.
  • Screening tools that effectively and accurately
    identify at-risk teens are available.
  • Screening more accurately identifies teens with
    significant mental health problems than school
    professionals (63 vs. 37 Scott et al., AJPH
    2009).
  • Most mentally ill and suicidal youth arent
    already being helped.
  • At-risk adolescents who do not request help on
    the screening questionnaire are significantly
    more likely to report suicidal ideation in the
    preceding three months than those who request
    help (62 vs. 31 Husky et al., Child Psychiatry
    Hum Dev, 2008).
  • No one else is asking teens about these issues,
    but they will give us the answers if we ask the
    questions.
  • Screening is safe and does not increase distress,
    depressive symptoms, or suicidal ideation (Gould
    et al., JAMA 2005).

The National Research Council and the Institute
of Medicine of the National Academies. (2009).
Anderson 2004 YRBS 2005 U.S. Census 2003
5
Challenges of Implementation
  • Stigma of Mental Health
  • Lack of knowledge
  • Economic (Cost of non-action, Funding)
  • Partnerships (sand box politics)
  • What will we do if we identify

1
6
Stigma
  • Weak to ask/get help
  • Weak to be affected
  • Negative impact on future career (military)
  • All or None Im fine or Im a Wreck
  • Poor Past Experience (treatment, school)
  • Fear of Agents of Social Control (DSS)
  • Labeling

1
7
Stigma
  • Not in Our Community
  • Not in My Family
  • Not in My Child
  • 67 of 17,000 people reported at least on ACE (
    Adverse Childhood Event), 87 more than one ACE
    (abuse, family dysfunction etc.)
  • If we consider self, family, friends...100
    touched by mental health

1
8
Knowledge Five Things To Remember
  • Neurodevelopment Processes
  • Genetic predisposition exasperated by
    environmental influences (Nature And Nurture)
  • Long term negative outcomes for physical
    health, emotional health and society for bad
    things happening to children.
  • Long term positive outcomes when good things
    happen, potentially protective as well.
  • These issues impact us all no social, economic
    or cultural group is immune

9
Knowledge Across the Lifespan
  • Intrauterine Experience - Heart Disease,
    Obesity, Diabetes, Pollution, Mental Illness.
  • Adverse Childhood Experiences (ACE) - long-term
    changes in brain structure and function. 67 of
    all of us (87 lt 1 ACE). 65 experience symptoms
    for at least a year prior to their deaths
  • Mortality - Individuals with an ACE score of 6
    and higher had a lifespan almost 2 decades
    shorter than seen in those with an ACE Score of 0
    but who otherwise have similar characteristics.

1
10
Knowledge Why It Matters
  • Until recently, the persistent effects on
    neurodevelopment were hidden from the view.
  • Now that we have the knowledge, we have the
    responsibility to use it. 65 experience symptoms
    for at least a year prior to their deaths
  • If we can think long term instead of short term,
    our communitys social, emotional, health and
    economic welfare will benefit.

1
11
Start with building a strong community / school
partnership
  • Select Key Area Representatives
  • Business (Sustainability)
  • School (Staff, Leadership)
  • Clergy ( Community)
  • Mental Health (Public, Private)
  • Post Secondary schools (Interns, Research)
  • Other (Potential Sticking Points)

1
12
Positive Behavior Interventions SupportsA
Response to Intervention (RtI) Model
Tier 1/Universal School-Wide Assessment School-W
ide Prevention Systems

ODRs, Attendance, Tardies, Grades,
DIBELS, etc.
Tier 2/Secondary Tier 3/ Tertiary
Check-in/ Check-out
Intervention
Assessment
Social/Academic Instructional Groups
Daily Progress Report (DPR)
(Behavior and Academic Goals)
Individualized Check-In/Check-Out, Groups
Mentoring (ex. CnC)
Competing Behavior Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Brief Functional Behavioral Assessment/ Behavior
Intervention Planning (FBA/BIP)
Complex FBA/BIP
SIMEO Tools HSC-T, RD-T, EI-T
Wraparound
Illinois PBIS Network, Revised August
2009 Adapted from T. Scott, 2004
13
History of TeenScreen
  • TeenScreen developed in 1991 as a result of Dr.
    David Shaffers research on mental illness
    suicide in youth
  • 90 of youth who died by suicide suffered from a
    treatable mental illness
  • 65 experience symptoms for at least a year prior
    to their deaths
  • This shattered the myth that suicide is a random
    and unpredictable event in youth
  • Found there is time to intervene with at risk
    youth, connect with treatment,
  • Potential to save lives

1
14
Why Implement TeenScreen?
  • One in five children has a mental or emotional
    problem that
  • requires treatment
  • At least one in 10 may have a serious emotional
    disturbance
  • that significantly impairs his or her ability to
    function emotionally,
  • socially or academically
  • Two-thirds of children needing mental health
    treatment go without
  • Children with mental health problems are not
    just being
  • children. Mental health problems can disrupt
    daily functioning
  • at school, at home and with peers.
  • Suicide is the second leading cause of death for
    adolescents
  • in Wisconsin.

1
15
Principles of Quality Screening Programs
  • Screening must always be voluntary
  • Approval to conduct screening must be obtained
    from appropriate leadership
  • All screening staff must be qualified and trained
  • Confidentiality must be protected
  • Parents of identified youth must be informed of
    the screening results and offered assistance with
    securing an appointment for further evaluation

16
Prepare Your School to Implement a Universal
Screening
  • Raise awareness and build school/ community
    support
  • Choose a staffing model and identify your team
  • Select your screening population, location,
    schedule and questionnaire
  • Develop a referral network and community resource
    guide

17
Establishing a Strong Foundation for Universal
Screening
  • Administrative Support
  • School Board Members
  • Key Stakeholders
  • Medical Providers
  • Mental Health Providers
  • Community Agencies and Organizations

18
Purpose of Advisory Committee
  • Shared Agenda
  • Problem Solve Roll Out Issues (confidentiality)
  • Problem Solve Ongoing Issues (stigma)
  • Collect Analyze Program Data (refusals)
  • Sustainability Issues

1
19
Educate and Engage School Personnel
  • Teachers, administrators, and school health and
    mental health staff can dramatically influence
    the success of your TeenScreen program.
  • Inform school personnel of your plans to
    implement TeenScreen and obtain their support for
    and commitment to your efforts.
  • Build working relationships with school
    personnel.
  • Present your plans at a faculty meeting and/or
    department meetings.

20
Seek Advice and Help from School Personnel
  • Ask school personnel how they think parents will
    react to screening and how best to reach parents
    and teens.
  • Ask for assistance with promoting the program to
    parents and teens and with distributing and
    securing the return of parent consent forms.
  • Help and buy-in is especially critical from the
    teachers whose classes will be impacted by
    consent distribution or screening.

21
Educate and Engage Parents
  • Know your community and share key facts specific
    to your community with parents to educate them
    about the need for screening.
  • Present information about TeenScreen at a school
    PTA/PTO meetings to raise awareness and build
    support prior to consent distribution.
  • Have a TeenScreen information table at parent
    orientations, registration days or back to school
    nights.
  • Make yourself available to answer questions or
    address concerns about screening .
  • Present information in a culturally appropriate
    manner and anticipate how different cultural
    groups will respond to screening.

22
The Screening Process
23
Principles of Quality Screening Programs
  • Screening must always be voluntary
  • Approval to conduct screening must be obtained
    from appropriate leadership
  • All screening staff must be qualified and trained
  • Confidentiality must be protected
  • Parents of identified youth must be informed of
    the screening results and offered assistance with
    securing an appointment for further evaluation

24
Select Your Screening Questionnaire
25
CHS Overview
  • 14-item, 10-minute, self-completion,
    paper-and-pencil survey for suicide risk
  • Appropriate for 11-18 year-olds
  • 6th grade reading level
  • Trained layperson can administer and score
  • Assesses for symptoms of depression, anxiety,
    substance abuse, suicide ideation and past
    attempts
  • Highlights those who might be at risk and
    screens out those who are not
  • Available in English and Spanish
  • 33 positive rate

26
CHS Sample Question
27
DPS Overview
  • 52-item, 10 minute, self-completion mental
    health screen
  • Appropriate for 11-18 year-olds
  • Computer-based with spoken questions
  • Trained layperson can administer and score
  • Automatic reporting of screening results
  • English and Spanish versions available
  • 20-33 positive rate

28
The DPS Screens For
  • Social Phobia
  • Generalized Anxiety
  • Panic attacks
  • Obsessions and Compulsions
  • Depression
  • Suicide ideation (past month)
  • Suicide attempts (past year)
  • Alcohol Abuse/ Dependence
  • Marijuana Abuse/ Dependence
  • Other Substances Abuse/ Dependence

29
Developing a Mental Health Referral Network and
Community Resource Guide
  • Key Points
  • The Referral Network should include providers
    for insured and uninsured
  • teens
  • Develop relationships with providers in your
    community who
  • Evaluate and treat a variety of conditions
  • Agree to accept your referrals in a timely
    manner and do not have long wait lists
  • Are culturally appropriate
  • The Community Guide should include a variety of
    resources relevant to
  • parents and their teen
  • Planning Questions
  • Have you contacted mental health providers for
    your referral network?
  • Have you identified community resources to
    enhance your services and provide
  • additional linkages and resources to
    at-risk teens?

30
Fond du Lac County Data 2002-present
Over 6,061 students in FDL County have been
screened
1,105 (18) of these students have been
identified for being at potential risk of
suicide, suffering from mental health problems
and received a referral for further evaluation
and appropriate treatment.
31
Playing in the Sandbox of Life
  • Ownership data, license, .
  • Roles screening not mental health diagnosis
  • Follow Up referral options..
  • Interview Questions Forms
  • Best Practice Procedures
  • Community/Professional Education

32
Playing in the Sandbox of Life (cont)
  • I Dont Want to Know Ill Have to Do
    Something
  • I Dont Want you to Know Ill Have to Do
    Something
  • Clearly Define Follow-up Procedures
  • Shared Responsibility Less Weight for All
  • Communication/Relationship Dividends
  • Systemic Improvements

33
Teen Support for Screening- What Teens Say About
TeenScreen -
I feel like someone is paying attention and
listening to me. I thought it was very
helpful, and I finally feel relieved because Im
getting my problems out. The interview on the
computer was a great way to know how we feel
about stuff in our lives. I think its a great
idea. I thought it was insightful because
some of these things are not talked about
enough. I think this is a good way to find out
whats going on with teens these days. Most teens
are afraid to talk about their problems because
they dont want other teens to think they are
different.
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