An Assessment of SBMHS: Integration of the SMHQAQ National Association of School Psychologists (NASP) Annual Conference Philadelphia, PA 2012 Nichol Moses, Psy.D., NCSP Coordinated Care Services, Inc.
Session Overview Describe an evaluation of county-wide school-based mental health services (SBMHS) using a variety of methods and measures including: key informant interviews; focus groups; a web-based survey; analysis of program outcome measures; and the integration of the School Mental Health Quality Assessment Questionnaire (SMHQAQ) (Weist et al., 2006).
Objectives/Learning Outcomes Participants will learn: how a multi-modal, data-driven assessment of school-based mental health services can provide direction in improving services for children and families; and about the utility of the SMHQAQ and how it can inform practice/program change and improvement.
School-based Mental Health Services (SBMHS) SBMHS provide mental health promotion and intervention for students in general and special education. Such services promote a school-family-community partnership and collaboration, one that bridges the common gap between school services and community-based services. NASP advocates for coordinated, comprehensive, culturally competent, and effective mental health services in schools and sites interagency collaboration as a framework for service provision (NASP, 2008).
Project Design A New York State County identified a need to improve the response and service array for their community s highest need children, youth and families through an assessment of schoolbased mental health services which are currently provided at seven school locations throughout the county by two contracted agencies. Specifically, the assessment focused on: defining the services that were being provided by the agencies; determining if the services were offered in the schools with the highest need; and determining if the modalities and strategies being implemented were in line with established best practices.
Assessment Activities- Areas of Evaluative Focus (1) Review of current service- a comprehensive review of the services in place through an analysis of program documentation; quality indicators and program data; staffing patterns; as well as interviews with program staff, supervisors, and school personnel who are most familiar with the current service providers; (2) Environmental scan of need- perceptions of the need for school-based mental health services were gathered from a wide variety of sources; and (3) Review of quality approaches and best practice literatureusing the School Mental Health Quality Assessment Questionnaire (SMHQAQ) (Weist et al., 2006), a validated tool for the assessment of quality in school-based mental health services.
Review of Current Service & Environmental Scan of Need Initial fiscal analysis Structured interviews & focus groups with: SBMHS Providers (staff and supervisors) School Psychologists & School Administrators SPOA Committee Community Stakeholders Review of service documentation Review of annual service reports Web-based survey focusing on service needs by district and building
Review of Current Service & Environmental Scan of Need- Outcomes Common themes: Disproportionate use of services by high-need children Significant need for clinical and case management support Concerns regarding future reductions in County support and funding Long waiting list for MH services; stigma associated with seeking services Transportation is limited; geographical restrictions High levels of depression in girls, PTSD, high risk behaviors (e.g., cutting, sexual activity, substance use/abuse, physical aggression) High incidence of trauma including: poverty, parental incarceration, parental military deployment, transient families Absent parenting; support needed in the home Need for appropriate credentialing and supervision for SBMHS providers; clear staff roles/responsibilities Need for standardized documentation and monitoring of outcomes
SMHQAQ The School Mental Health Quality Assessment Questionnaire (SMHQAQ) is a research-based measure designed to help clinicians, administrators, and others invested in school mental health to assess strengths and weaknesses within their school mental health services and programming (Weist et al., 2006). Findings from the SMHQAQ can assist in identifying priority areas for improving school mental health services in ten Principle areas.
SMHQAQ Instrument & 10 Principles
SMHQAQ Implementation & Analysis Administrators and staff from both contracted agencies completed this measure (n=8; 4 staff from each agency). Currently there is not a scoring rubric available. Responses were recorded and analyzed for themes (based on strengths & weaknesses). Data analyzed by agency as well as combined.
SMHQAQ Database & Indicator Resources
Total Scores: min. 8 to max 48 Agency Scores: min. 4 to max 24 Identified strengths & weaknesses (by agency 12-15 and below= weakness)
Total Scores: min. 8 to max 48 Agency Scores: min. 4 to max 24 Principle 5; Indicator 17 Identified strengths & weaknesses (by agency 12-15 and below= weakness)
SMHQAQ Results and Implications- Areas of Need Ongoing training and supervision on effective diagnosis, treatment planning and implementation, and subsequent clinical decisionmaking. Regular screening and follow-up assessments Evidence-based practices and programs; Evaluation plan to track outcomes Regular input from stakeholders Increased communication with school administration to obtain feedback, program direction Training and educational activities for families, teachers and other stakeholder groups Activities promoting school-wide mental health Knowledge of referral sources Increased awareness of ethical and legal standards Cultural competency
Overall Project Assessment Results Four overarching themes emerged from the multimodel assessment of the SBMHS including: 1. a need for a more robust service protocol; 2. an opportunity for increased collaboration across providers; 3. a need for quality indicators and outcome monitoring; and 4. an opportunity/need for the promotion of school- and countywide mental health training/resources.
Overall Project Implications A multi-modal assessment provides comprehensive program data Utility of combining quantitative and qualitative assessment Utility of the SMHQAQ User-friendly Comprehensive Useful (providing guidance and recommendations) Appears to provide reliable results- based on commonalities obtained across modes of assessment Using outcomes for Quality Improvement
Resources http://www.schoolmentalhealth.org/index.html http://smhp.psych.ucla.edu/ SMHQAQ Instrument: http://www.schoolmentalhealth.org/resources/clin/qairsrc/q AQ.pdf
References Weist, M.D., Stephan, S., Lever, N., Moore, E., & Lewis, K. (2006). The School Mental Health Quality Assessment Questionnaire. Baltimore, Maryland: Center for School Mental Health Analysis and Action. University of Maryland, Baltimore. National Association of School Psychologists. (2008). The importance of school mental health services (Position Statement). Bethesda, MD: Author.
Q & A nmoses@ccsi.org www.ccsi.org