1. In The Trenches: A Look at School Based Mental Health
Kristine Sack, LPC, LSS
Kelsey Siegel, LCSW, Catholic Charities
Megan Sommers, LPC, LSS
Tom Kaufman, LPC, Catholic Charities

2. Agenda & Objectives Introductions
What does it mean to be “in the trenches”?
Question & Answer

3. THOUGHTFUL PREPARATION MADISON:
75% direct service & 25% paid consultation:
13 student hours per week
staffing with point-person per grade
teachers
25% is paid for by commercial insurance companies, school money and grant money
Schools: 4 elementary; 1 middle school
Students served in school year: 76 students; almost 1,000 sessions; average sessions per student
In the T.R.E.N.C.H.E.S.

4. THOUGHTFUL PREPARATION Appleton/Fox Cities 100% direct client contact
Billing:
Third party billing to commercial insurance & Medicaid
Sliding Fee Scale
Fees waived and utilization of philanthropic funds
Schools: 2 elementary; 2 middle & 4 high schools
Students served in school year: 104 students; over 1,400 sessions; average (13.53)sessions per student
In the T.R.E.N.C.H.E.S.

5. Referral Process Madison: In the T.R.E.N.C.H.E.S.
Referral Process: How do students get to our school offices for services? (Ideally)
Teacher/parents/school counselors/student/friend of student
Each referral is staffed by a “mental health team” at each school
School social worker/school counselor contacts student’s parent/s to come in for a meeting
Initial paperwork is explained by school social worker and parents sign release for counselor/counselor’s office staff can contact family to verify demographic and insurance information
Referral Process: How to students get to our school offices for services? (A bit more realistic)
Poor family engagement due to a number of causes
Student may have an extensive mental health history, including trauma that have never been addressed
In the T.R.E.N.C.H.E.S.

6. Referral Process: Appleton/Fox Cities In the T.R.E.N.C.H.E.S.
Referral Process: How do students get to our school offices for services?
Teacher/parents/school counselors/student/friend of student
School social worker/school counselor contacts student’s parent/s for a meeting presenting SBMH counseling process & reason for student’s referral
Parent/s complete paperwork: ROI for school point-person to release student information to therapist & for therapist to contact family; demographic & insurance information
Referral packet provided to counselor: school ROI, family demographic & insurance information, referral form, student class schedule, Person Summary Report
“Meet & greet” with student
Agency secretary contacts family to verify information & mail them agency intake paperwork
Process Barriers:
Poor family engagement due to a number of reasons
Student may have an extensive mental health history, including trauma that have never been addressed; appropriateness of referral for school setting
In the
T.R.E.N.C.H.E.S.

7. Engaging School Staff PBIS: High tier 2/tier 3 students
Clarity of roles & boundaries
Referral point-person/coordinator
Teacher buy-in
Staff & faculty education of what school based mental health services entail initially and on-going
Education, education, education!
Know your resources
Team development
In the T.R.E.N.C.H.E.S.

8. Navigating Schools School environment & culture Drill participation
Therapist that matches the school
Drill participation
School schedules
Student class schedules
Removing kids from classes
Late start/early release
HIPAA vs FERPA
Tom’s story – secretarial; sessions as rewards
In the T.R.E.N.C.H.E.S

9. Navigating Schools: HIPAA vs FERPA
FERPA vs HIPAA
Thank you for all of your support for your school based mental health counseling program. We are providing you this information to help clarify questions and promote the enforcement of privacy for the kids we all work with including the use of FERPA (School) and HIPAA (Mental Health Agency) Releases of Information (ROI). It can be quite confusing to balance both FERPA laws and HIPAA laws when both have to be practiced in one building.
As mentioned above, within a school based mental health program, there will end up being two sets of privacy rules with two separate needs for ROIs. Each student maintains an educational record through your school but once an intake evaluation within the school based mental health program occurs, there also becomes a healthcare record that will be maintained by the providing therapist’s mental health agency. As a healthcare agency, there are specific rules/laws under HIPAA the provider and agency need to follow in order to protect Private Health Information (PHI). The therapist is aware of HIPAA laws and is responsible for answering any questions including when the release is needed, as well as providing details that are in the Consent for Treatment that connect with the ROI and can help the families understand what exactly gets released and how records are housed to protect their PHI.
With this being said, it is an expectation of the providing agency that a referral to your school based mental health program include a release of information from the school district. The school release allows the school to provide student specific information to the providing therapist, including the student’s need for therapy services and demographic information. Once the student becomes a school based mental health client, they will then have a HIPAA release signed so further collaboration can include concerns or feedback from the therapist related to the student’s information in the healthcare record.
As indicated above, FERPA and HIPAA have many similarities yet enough differences that we need to be careful to maintain documentation that supports both laws including the use of ROIs. The intentions of the laws are to help students, clients and parents feel a sense of privacy and protection over their child’s personal information. Even with these obstacles, the school based mental health program continues to be well utilized because of your diligent efforts in connecting with parents to assist in the follow through of referrals. Thank you for all you do!

10. Clients:
⅔ first time MH treatment ⅓ special education services ½ experiencing difficulties for over 1 year High tier 2/tier 3 intervention
Barriers to care Confidentiality outside of session
Common diagnoses
In the T.R.E.N.C.H.E.S.

11. Clients Primary Diagnoses 2016-2017 School Year
Madison
Appleton/Fox Cities
In the T.R.E.N.C.H.E.S.

12. How to engage families Flexibility Creativity School staff involvement
Expectations of families/parents
Resources
In the T.R.E.N.C.H.E.S.

13. Evaluate Purpose of evaluating? Student satisfaction School data
Who benefits from what data?
Student satisfaction
School data
Academics
Behaviors
Attendance/Truancy
IEP & 504 Plans
Therapeutic assessments In the T.R.E.N.C.H.E.S.
Therapeutic impressions/prognosis

14. Stories from the T.R.E.N.C.H.E.S.

15. Questions?
In the T.R.E.N.C.H.E.S.

16. Additional Information:
HIPAA versus FERPA handout
Based-Mental-Health
Schools/tabid/613/Default.aspx
students/