Community Mental Health Providers in Schools: Guidelines ...

Community Mental Health Providers in Schools:

Guidelines for Schools

Introduction

Mental health issues are a concern in schools across the nation. With 1 in 5 students dealing with

a mental health issue (School Mental Health Framework, DPI, 2015), the Wisconsin Department

of Public Instruction (DPI) strives to provide guidance for schools collaborating with community

behavioral health partners proposing to offer direct mental health services to youth within the

hours of the school day and on school grounds. The purpose of this document is to provide

districts with guidance for Model 2 School Based Community Mental Health clinics. This

document will be under continuous revision and additional elements will be added as they are

developed.

The DPI School Mental Health Framework describes Model 2 as: Public or private behavioral

health clinics or providers can, through a mutual agreement with a district, locate a clinic within

a school and provide direct mental health services to students utilizing a clinic-employed, mental

health provider billing families through Medicaid, private insurance or self-pay. The remaining

continuum of mental health services for students, particularly at universal and selected levels are

supported or provided by school-employed mental health providers as part of the district service

delivery model. In this model, schools find ways to promote equal access to school-based

community mental health services and strategies to allow for collaboration and coordination of

services by the community provider, school personnel and families.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a

memorandum of understanding (MOU) is a formal agreement between two or more parties.

Schools and youth-serving community behavioral health providers can use MOUs to form

alliances. MOUs carry a degree of seriousness and mutual respect, stronger than a gentlemen¡¯s

agreement but not as strong as a contract. In US law, a memorandum of understanding is

synonymous with a letter of intent (LOI), which is a non-binding written agreement that implies

a binding contract is to follow.

An MOU may state a purpose, include some required elements, and optional elements. It is

expected that no money changes hand with an MOU. When there are fees and payments

included in the partnership, a contract is required.

In this document you will find:

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Benefits for students and families

Benefits for educators and providers

Guidelines for developing Memoranda of Understandings (MOUs)

Recommended elements of an MOU

Guidance on effective referrals to providers

Frequently Asked Questions (FAQ)

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Benefits for students and families:

The benefits of Community Mental Health Providers in schools are many and may include:

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Increased youth access to care

Increased student time in the classroom, in terms of travel time to and from

appointments, as well as being emotionally regulated to be available to the academic

setting

Deepened ties between community mental health providers and school administrators and

pupil services staff

Increased family engagement and access to care in the school community which may

reduce time away from work for parents

Increased likelihood of better grades, improved attendance, and fewer classroom

disruptions

Provides protections that come from having licensed community professionals overseen

by state regulators, who deliver mental health services in a safe and supportive

environment of the school

Benefits for educators and providers:

The Wisconsin School Mental Health Framework outlines three models of collaboration. The

benefits of these collaborative models are many and may include:

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Development of a comprehensive health and wellness plan including adopting policies

that support positive mental health and safe climates

The use of evidence based programs and interventions

Consultation with public and private agencies on behavioral health issues

Staff training to better understand behavioral health issues and implications on learning

Collaboration with providers that serve youth in the community through high quality

referrals and teaming with families and students on shared goals and strategies

A receptive climate and understanding of children¡¯s mental health issues in schools, in

particular addressing issues related to stigma

Data privacy and confidentiality issues when delivering mental health in schools

Parental consent and family involvement in the delivery of mental health services

Recognition of the important role of school mental health providers (school counselors,

nurses, psychologists and social workers) as well as community providers (therapists,

psychologists and counselors) in continuing to support the mental health needs of

children

Done well, partnerships between schools and community providers offer these outcomes

regardless of model:

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Strong partnerships across agencies

Streamlined referral systems

Caregivers may have choices of providers and will consent to treatment and setting

(school or clinic location)

Equivalent level of service matched to the level of need for the child

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Coordination and integration of mental health services from early identification of needs,

through assessment and diagnosis, to providing services or treatment, and after-care or

supports if/when treatment is completed

Drawing on the expertise of existing systems and personnel, as well as co-creating new

systems if gaps are exposed in the delivery of service

Ensuring culturally responsive collaboration and service delivery

Guidelines for developing effective MOUs with collaborative partners

Schools are always encouraged to work with available community partners (youth serving

agencies, social service agencies, behavioral health providers, hospitals, county boards, law

enforcement, businesses, etc.) to address mental health issues in the community and at school.

Private and public behavioral health treatment agencies are often involved in these efforts.

Memoranda of Understandings (MOUs) assist both districts and providers in outlining clear,

accurate, and respectful relationships between partners. DPI has made available several sample

MOUs for review and consideration. Please note that DPI does not endorse any specific

MOU. Districts should seek their own legal consultation in formulating and finalizing an MOU

to meet their own unique needs. Sample MOUs for your consideration may be found in

Appendix A of this document.

The following questions, adapted from SAMHSA, can guide schools in developing documents

designed to deepen collaboration:

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What are the goals of the collaboration between your school and the agency and expected

outcomes?

What training, if any, will you provide your partners (e.g., trauma sensitive schools,

facility emergency procedures, school procedures, Social Emotional Learning)?

How will providers communicate to schools and vice versa, to assure youth have

streamlined services and treatment planning? How will urgent mental health needs be

addressed when provider is off-site?

Who will be the contact person at the school to arrange for the youth to be available for

treatment? Transition back to class? Communicate absences and school functions to

providers?

Where will services be delivered to assure a warm and confidential environment for

treatment?

What data will be collected by school personnel and providers to measure progress

towards desired outcomes of the collaboration?

Which youth will be identified and how will they be identified for referrals to services?

How will the referral happen that will assure a good and appropriate transition to

providers, clear communication to parents of choices and inclusion in services?

Who will follow up to assure services were accessed, identify barriers if not and know

when services are discharged?

How will the availability of school based services be communicated to staff and to

parents and youth?

How will authorizations for release of information be handled?

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How and when will the collaboration be reviewed to determine if it is meeting the

identified goals and needs for partners?

Who will help the community mental health provider learn about and understand their

responsibilities during emergencies and drills?

What are the agreements regarding rental of space, equipment, costs of supplies, or the

costs related to sharing support staff that might serve both entities?

What will continuity of care over the summer months look like?

Most schools identify a school-employed coordinator who may complete some of the following

types of activities:

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Alerts providers to a student¡¯s absence the day of their appointment

Removes the child from their classroom for their appointments or creates a system to

allow for the child to be available

Communicates with the teacher, who may not be available to connect with the provider

when he or she is in the building, and the provider

Communicates with the parents as needed

Addresses any other issues that might arise with a school-based clinic

Assists providers with scheduling of appointments

Recommended elements of an MOU

(Please note: the following items are for guidance purposes only and does not replace efforts

schools should make in consulting an attorney for their own legal advice)

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Name of school district and clinic

Defined dates of agreement, with severability and termination defined

Locations within the school district named (what school buildings)

Location within the school and any fee/rental language, including none, if no fee exists

Use of space agreements that includes access (days of week), hours of operation, and

privacy for services carried out, as well as equipment, supplies provided.

Term and Termination Agreement: dates of the agreement, beginning and end of school

year, whether the physical spaced will be used in summer, not automatically renewed

language, termination language to include due notice (2 weeks) by either party and in

writing.

Official notice of completion of, or changes to, the MOU document should be sent using

procedures to ensure receipt of delivery.

Records management, HIPAA and FERPA compliance language: where will records be

kept? (Example: a locked cabinet within a locked private room where sessions will be

held for records carried to the facility for that day. Longer storage would be to keep at

the main office location for that clinic.)

Policies and procedures to address: background checks, entering the building, any safety

policies of the school that clinic personnel need to follow (blood borne pathogens, codes

within a building, on-line education which clinic personnel are required to watch and

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sign-off on before entering the school or by a certain date), operating hours, adherence to

any school rules, supervision of students, communications between school/district staff

and the counseling center, any disturbance policy or procedure, reporting policies

regarding damage or destruction of property, harm to clinic staff, restraint policy.

Current copies of insurance and licenses of community providers are provided to the

school/district staff.

Employment status: expectations for a provider dually employed by the district and a

behavioral health clinic should be clearly outlined.

Indemnity

Assumption of risk (liability, workman¡¯s compensation)

Compliance with Wisconsin state statutes and regulations

Marketing language describing whether a clinic can market their school based location

in radio, flyer, phone book, or website/on-line avenues.

Communication agreements on how parents and youth find out about the services

Scope of the service and best practice

Referral forms and criteria

Family involvement in treatment and services

Student voice agreements, language regarding voluntary nature of services

NOTE: Schools may utilize more than one provider. A separate MOU is necessary with

each provider.

Guidance on effective referrals to providers

A referral is appropriate if school staff think there is a behavioral health concern that could be

further assessed and treated by a collaborative partner. A sample referral form will be added to

this document in Appendix B.

Schools may wish to develop referral procedures to ensure smooth transitions that may include

the following:

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A list of area resources and providers, as well as national hotlines and resources

A form that collects the necessary information for the referral partner to get basic

information to make the referral as smooth of a transition as possible for the youth and

the family

Procedures to ensure necessary releases of information are in place and parents are

advised of the benefits of providing consent for appropriate information sharing across

agencies

A designated person to make the referral and follow-up with any questions or concerns

the youth and family may have

A ¡°warm handoff¡± to the referral partner, that includes the youth and family

A follow-up call or meeting to make sure the referral went smoothly, was followed up on

by the youth and the family, and to answer any questions or concerns that may have

surfaced after the referral was made

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