Ohio Registry of Effective Practices
D&E Counseling
Contents
- OMHNSS Interview/Site Visit Team
- Program and Contact Information
- General Program Overview
- Evidence of Effectiveness
- Capacity and Resources
- Family Partnerships
- Community Partnerships
- Sustainability Plan
OMHNSS Interview/Site Visit Team: Sue Mikolic, Kathy Oberlin, and Abby Fruth
Program Name: D & E Counseling Center
Contact Person and Contact Information:
Joe Shorokey, LPCC, Outpatient Director
General Program Overview
D&E Counseling provides Behavioral Consultation services to the teachers, administrators, and students at a number of elementary and middle schools, as well as, Depression Awareness and Suicide-Prevention Programs at local schools.
Behavioral Consultation
Under contracts with the Youngstown City Schools and the Mahoning County Educational Resource Center, the D&E Center provides Behavioral Consultation services based on the theory of Positive Behavior Supports (PBS) to the teachers, administrators, and students at a number of elementary and middle schools, as well as two Alternative Schools; Youngstown’s Odyssey School of Possibilities and Mahoning County Educational Service Center’s (MCESC) P.A.C.E. Alternative School. D&E staff dedicated to these services are Master’s level behavioral consultants/clinicians who perform a variety of functions toward the goal of reducing classroom removals (suspensions, expulsions, etc.) and eliminating emotional/behavioral barriers to learning. Some of those activities are listed below:
- Assist with Functional Behavior Assessments
- Development of Behavior Intervention Plans
- Monitoring of Behavior Plan Implementation
- Consultation and training with teaching staff
- Attendance at student specific school meetings as necessary, including Multi-Disciplinary Student Assistance Teams (MDSAT) at each of the above mentioned schools
- Counseling Services within some E.D. units
In addition to the consultative services mentioned above, a limited amount of direct student counseling is also provided. Students who are identified by the school counselor as having long-term needs related to a serious emotional disorder may be referred to the school-based therapist from D&E. Upon referral and assessment, the student may receive any combination of individual, group, and/or family counseling either at the school or office.
School Mental Health Liaison Service
The branch of D&E’s School/Mental Health Services is the Depression Awareness and Suicide-Prevention Program, known as the “School Mental Health Liaison Service”. The School Mental Health Liaison Service works with students in middle, junior high, and high schools throughout Youngstown City and Mahoning Valley School Districts. The primary function of this service is to advance the early identification of depression, suicide risk, and other mental health issues among students by promoting and coordinating the implementation of the TeenScreen Assessment, Red Flags Program, and Signs of Suicide Program (SOS). Also, the Liaisons act as on-site mental health/behavioral consultants to assist schools in addressing and coordinating services for students with identified mental health needs.
Evidence of Effectiveness:
While D&E’s Behavioral Consultation and School Mental Health Liaison Services were not developed in response to a particular evidence base, their evolution has been fueled by issues that were outlined in The Surgeon General’s Report on Mental Health and the President’s Freedom Commission on Mental Health. The first is an increased awareness of the role that emotional and behavioral problems play in interfering with learning and the possibility of academic success. Making this awareness even more critical are the pressures that schools are under in demonstrating academic accountability and meeting the rigors of No Child Left Behind. Without question, the prevalence of untreated emotional and behavioral problems among today’s students, coupled with the corresponding impacts on academic and life success are staggering challenges for both the mental health and education disciplines. Also guiding D&E’s approach to Behavioral Consultation Services has been the emergence of PBS as an effective practice in addressing social-emotional-behavioral problems in school settings. As such, D&E’s School Mental Health Liaison Service studied and adopted three widely accepted evidence-based and/or effective practices; Red Flags, Signs of Suicide (SOS), and TeenScreen.
Behavioral Consultation
The Behavioral Consulting Services regularly served 188 students in 9 schools in 2005-06. An additional 200 students also received some sort of brief intervention throughout the year. The behavior rating scale is a five item measure of the student’s disruptive classroom behavior as reported by the teacher. The measure asks how much the student is oppositional toward authority, disrupts classroom environment, lacks social skills, is distracted/off task, and physically aggressive. D&E Counseling had the teachers fill out the form every quarter. Also on this form, the teachers are asked to give the number of times the student has been removed from the classroom for that quarter. Of the 188 students, 62% had a decrease in classroom removals between the first and fourth quarters, 19% had no change, and 19% had an increase in classroom removals. The Behavior Rating Scale also showed 66% of the 188 students decreased their disruptive behavior, 11% showed no change, and 23% increased their disruptive behavior between the 1st and 4th quarters.
An administrator survey was also completed at the end of the academic year by the school administrators. The survey asked about the administrator’s perception of the Behavioral Consultation Services in their building and consisted of 12 items. Ten surveys were completed. In 2005-06, 100% of the administrators strongly agreed that their school benefits from the D&E services and that they are satisfied with the services. All of the administrators also said they would recommend the services continue next year.
In 2006-07, 154 students were served on a regular basis by the Behavioral Consulting Services with another 200 receiving brief inventions or consultations. Among the youth served by the program in 2006-07, there was a reduction in official discipline action as measured by referral forms from 155 to 40 for a 74% reduction.There were 19 parents in 2006-07 who filled out a satisfaction survey, and 63% noticed an improvement in their child’s behavior since mental health services started. Seventy-nine percent (79%) noticed an improvement in attendance, and 63% noticed an improvement in grades. Ninety-five percent (95%) were satisfied with the mental health services their child received, felt the counselor listened to their ideas, and would refer a friend to D&E counseling. Finally, 100% felt actively involved in the treatment process.
The administrator survey for 2006-07 was again completed by 10 school administrators. All 10 (100%) of the administrators strongly agreed that
1) the D&E consultant was available to staff when needed;
2) their school benefits from the consultant service;
3) the teaching staff values the service; and
4) the staff is satisfied with the service.
Also 100% would recommend that the services continue next year.
School Liaison Program
Teacher evaluations of Red Flags, SOS, and TeenScreen all revealed positive experiences. For the Red Flags program, D&E received 17 evaluations from 7 out of 9 schools. All of the teachers said they would very much recommend the program to other teachers, felt that the program was very educational, and felt that the students were very receptive to the information. Fourteen out of 17 felt the students have a much better awareness of recognizing depression while the other 3 said only somewhat better. Only 5 evaluations were received on the S.O.S. program from only 2 out of 5 schools. All five teachers felt the program was very educational, and all 5 felt the students had at least a somewhat better awareness of recognizing depression. For TeenScreen, 8 evaluations were received from 3 out of 4 schools. All the teachers felt the program was very beneficial and would very much recommend it to other teachers.
D&E also has results from the Red Flags pre/post knowledge tests. The knowledge test shows that the majority of the students from all but one high school improved their knowledge from pre to posttest.
Capacity and Resources:
As mentioned previously, the Behavioral Consultation Program has evolved over many years and developed into its present form through annual planning and evaluation. D&E’s current Positive Behavior Supports approach to their Behavioral Consultation Services has been in effect for approximately the past four years. The School Mental Health Liaison Program began in March 2006 with formal depression education Mental health screening services began in September 2006. This program enjoyed explosive growth during its first year with staff expansion, the award of a Garrett Lee Smith Grant, and the scheduling of school based services at different schools each week to the extent that a waiting list was developed. All services, within both programs under the School/Mental Health umbrella, are provided by D&E Counseling Center staff. All staff are Master’s level Counselors or Social Workers.
The Behavioral Consultation Service population consists of an inner-city, urban, low income group of students, approximately 65% African-American and 35% Caucasian. Grade levels served are primarily elementary and middle school. In 2006-07, this program served 154 students on a regular basis, and another 200 received brief interventions or consultations. The Behavioral Consultation Service serves youth from approximately 7 through 12 years of age.
The School Mental Health Liaison Service serves a more diverse group of students. These students are the same as above, as well as suburban and rural populations that are predominantly more Caucasian and more diverse in socio-economic levels. Grade levels served in this program are 7-12. Last year, this program provided depression education and awareness programs to 2,111 students and conducted screenings on another 754 students. School Mental Health Liaison Service serves youth from approximately 12 through 18 years of age.
For the School Mental Health Liaison Service, D&E Counseling offers education in the form of Red Flags, Signs of Suicide Program (SOS), or a combination of the two. They also provide screening if the school requests this in the form of TeenScreen or the assessment part of SOS. They always do the education portion; they never do just screening because they feel the screening is better when paired with the education component. Some schools can’t do screening so they just do the education component. If the school is doing the screening portion every student has to get a consent form signed by their parent to take part. The student also has to give their assent to the screening. If the student screens negative, they get a one-on-one debriefing. If the student screens positive, they get a clinical interview to make sure they are positive. The parent is then contacted with recommendations and a list of options (community mental agencies or the school counselor). Two weeks later a follow-up call is made to the parent. If the parent has not taken any action, they are asked if there is anything they need help with. When the counselors do the screening portion, they can be in the school anywhere from one week to 10 days to screen everyone in the target grade or class. In order to get the students to bring back their consents, incentives are given such as a pizza party or dress down day.
The table below gives a breakdown of the number of students served. In 2006-07, 2,111 students were educated on depression/suicide with 1,153 receiving Red Flags and 958 students receiving SOS. As part of the screening component, 754 students received screening with 440 students receiving the SOS screening and 314 students receiving TeenScreen. Of the youth screened, 122 screened positive for depression/suicide risk (70 SOS and 52 TeenScreen), and 93 of the 122 were referred for further mental health evaluations. Of these 93, 65 parents were contacted for further consultation and referred to outpatient counseling. The others were continuing with their current treatment of either school-based services or outpatient counseling.
Family and Community Partnerships:
D&E’s community partners include the Youngstown City Schools for the Behavioral Consultation Component, and multiple schools in Mahoning and Trumbull Counties for the School Mental Health Liaison Service. Additionally, the Mahoning County Mental Health Board, the Margaret Clark Morgan Foundation, the Ohio Suicide and Prevention Foundation, Ohio State University, and Red Flags are all seen as integral partners contributing to the success of the programs.
All D&E staff engage family members in a team approach as an expert about their child. The family member or parent is the crucial partner in order to be effective and knowledgeable around treatment planning and appropriate interventions. Family members also participate in some sessions and approve treatment through a confidential relationship with their staff.
Sustainability Plan:
The Behavioral Consultation Service within the Youngstown City Schools is dependent upon an annual contract with the Youngstown Board of Education. It has been a true testament to the value of D&E’s services to the Youngstown Schools, that at a time when the school district is in the middle of a fiscal emergency and under the control of a state oversight commission, they continue to contract for D&E’s services with no cutbacks. Unfortunately, the service cannot be sustained by Medicaid alone, so D&E’s plan for sustainability is to continue providing value to the purchaser, namely the Youngstown Board of Education, so that the service continues to be seen as indispensable.
The School Mental Health Liaison Service relies heavily on a grant from the Margaret Clark Morgan Foundation, as well as support from the Mahoning County Mental Health Board. While D&E feels the Mental Health Board funding is relatively stable, they are hopeful and confident the Margaret Morgan Clark Foundation will continue to see the positive results as addressing their mission, and continue to fund the program in the future.
Success Stories
As part of the School Liaison Service, D&E Counseling does screening with TeenScreen and refers those youth that need mental health services to the needed services. D&E Counseling’s rates for attendance at first appointment are either at 100% of near 100% for each of the TeenScreen schools. TeenScreen has acknowledged D&E Counseling for their high adherence rates.