Creating coordinated care for child mental health care in Connecticut

According to the Yale Daily News, Connecticut may have one of the best child mental health care systems in the entire country. But despite this, the actual use of the state’s mental health services in schools is wildly sporadic from district to district.

The Daily News cited the results of a report by the Child Health and Development Institute of Connecticut, a subsidiary of the Children’s Fund of Connecticut and a not-for-profit organization devoted to promoting children’s physical, behavioral, emotional and cognitive health alongside social development. The report examined how school-based care systems could be an effective model for facilitating access for children to mental health services. The concern, according to the report, is that in those Connecticut districts that fail to provide sufficient mental health services, students are more likely to give poorer academic performances, become disruptive in class and even end up in the juvenile justice system. And according to Jesse White-Frese, the executive director of the Connecticut Association of School-Based Health Centers, the state has seen a rise in the “prevalence and intensity” of mental health issues in young children throughout the last decade.

By the numbers
The report’s authors looked to national statistics to estimate how many children in Connecticut deal with mental health issues. The number, 160,000 children, indicates that one in five are in need of professional care. But only about 20 percent of that number actually receives the level of care they need. As the researchers note, provided the estimates are accurate, about 125,000 children are being left behind.

According to Jeana Bracey, a senior associate at CHDI, this is because too often mental health services are happening in a vacuum and not as part of a coordinated car model.

Creating connections
One program that the report looks to as a potential solution to the severe lack of mental health services where they’re needed most is the Connecticut School-Based Diversion Initiative.

SBDI was originally developed as a component of the MacArthur Foundation Models for Change Mental Health/Juvenile Justice Action Network. It’s currently funded and overseen by various groups, and it’s partially overseen and coordinated by CHDI. It was created in direct reaction to heightened rates of discretionary in-school arrests, expulsions and out-of-school suspensions, especially among those kids with mental health or behavioral needs. As CDHI observed, approximately 65 to 70 percent of young people in juvenile detention have a diagnosable behavioral health condition.

SBDI could meet the needs of at-risk students using community-based mental health services and networks of support, including rapid response aid for managing crises. The coordinated care model could keep students from arrest or expulsion, particularly at the middle and high school levels.

According to CHDI, the goals of the SBDI initiative are trifold:

  1. Reduce the use of discretionary in-school arrests and exclusionary discipline in order to keep students within the community and bolstered by a support network
  2. Improve general mental health and juvenile justice knowledge and skill development in school professionals, while encouraging collaboration with other resources within the continuum of care
  3. Drastically increase the use of both school and community-based mental health services

SBDI’s implementation manual creates step-by-step processes for schools. While in-school services are sometimes scarce, SBDI would help school professionals through training, consultation and support to build awareness of community mental health in schools resources and then link school programs to those resources. In this way, the unifying goal of SBDI is to link students with mental healthcare needs and their families with the proper care, but through a strong network of support.

A number of schools all across Connecticut already participate in SBDI. And a 2011 evaluation of the program showed that it enhances schools’ partnerships with community-based groups and also increased utilization of Emergency Mobile Psychiatric Services, a key alternative to arrest that addresses mental health problems at their core. The data showed that youth who worked with EMPS rather than facing Court Support Services at the time of a behavioral incident had a lower likelihood of repeat arrests, regardless of age, gender, race, ethnicity or prior juvenile justice history. Furthermore, communities with SBDI had lower rates of juvenile arrests, period, compared to similar communities without the program.

The brighter, better future
The Yale Daily News cited Sara Frankel, public policy director for children and young adults at the National Alliance of Mental Illness Connecticut, speaking on the CHDI report.

“The report highlights the need and the opportunity for schools to be the center for delivering mental healthcare by virtue of the fact that it’s where kids spend a majority of their time,” she said. “It doesn’t mean [the services] have to be through school personnel.”

However changes are beginning across the state. For instance, while many Connecticut teachers lack training in mental health first aid, the new mental health legislation that passed in May 2013 – largely as a result of the Sandy Hook shooting – now requires this training for all educators, according to the Daily News. And Connecticut is also starting from a better vantage than most states. According to a 2009 report cited by the Daily News, the National Alliance on Mental Illness rated Connecticut’s mental health system a B. That’s a few grade points higher than the national average, a D.

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