1. health and fitness

Integrated Behavioral
Health:
Connecting Community
and School Services
Lauren Arnold LCSW
James Wagley LCSW-BACS
Vanguard Behavioral Health Consultants LLC
Presenters - Lauren

Lauren Arnold, LCSW, received a Bachelor of Science in Psychology from Northeast
Louisiana University and a Masters of Social Work from the University of Texas at
Arlington

She has practiced social work for the past fifteen years in many different
environments, including outpatient clinics, school-based clinics, rural health clinics,
Head Start centers, juvenile probation, home health services, and day treatment
programs

Lauren is skilled in working with many different populations including young children,
school-age children, adolescents, adults, and elderly clients.

Has extensive experience with depression, anxiety, PTSD, at risk youth, children in
foster care, families experiencing divorce, oppositional and defiant behavior, school
issues, and resolving difficult family and interpersonal issues.

Received specialized training in Trauma Focused Cognitive Behavior Therapy and
utilizes this to help clients resolve experiences of trauma including child abuse, sexual
abuse, and sexual assault

Provides training in positive behavioral supports for Head Start centers.

She is skilled in individual therapy, family therapy, group therapy, play therapy, inhome counseling and delivering integrated behavioral health services.
Presenters - James

James has practiced social work for the past 40 years in Louisiana, Georgia and
Arkansas. He has worked in day treatment, residential treatment, psychiatric hospitals,
and for the past 12 years in school systems.

His practice emphasis has been in development and implementation of programs and
services for children, youth and families. As Supervisor of Student Services for Sabine Parish
Schools, James implemented alternative education programs, Positive Behavior Supports,
School-based Behavioral Health Services and Coordinated School Health Programs.

Supervised Pupil Appraisal, Health Services, Behavioral Health Services and
Neighborhood Place personnel.

Trainer in Adventure Based Counseling, Positive Behavior Interventions and Supports, Brief
Solution-Focused Therapy and Motivational Interviewing/Stages of Change, IBH

Founded Vanguard Behavioral Health Consultants LLC in 2010.

Directed the startup of Region 8 Coordinated System of Care Wraparound Agency,
Choices.

Provides direct behavioral health services through Vanguard BHC LLC and consultation
for the Louisiana Primary Care Association in integrating behavioral health services in
primary care settings. He continues to train and consult for school systems and human
service organizations throughout Louisiana.

His social work training in systems theory and evidence-based interventions has served
him well as a framework to utilize in coordinating services, programs and resources for
children, youth and families. For more information go to VanguardBHC.com
The Louisiana Story
Adolescent School Health Initiative of 1991
 Established under Gov. Buddy Rhomer
 Authorized OPH to facilitate and encourage the development
of comprehensive school-based health centers in public
schools
 64 OPH funded sites (55 full time, 9 part time)
 7 Operated by FQHCs
 7 Operated by school systems
 28 Operated by Health Care Systems
(DHH-OPH website data for 2012-13)
Act 1225 Juvenile Justice
Act of 2003
 Authorized the BESE Board and Juvenile Justice
Planning Board to develop a model master plan to:
 Improve behavior and discipline in schools
 Enhance classroom management
 Coordinate SPED and JJ Services
 Develop methods for handling school suspensions
 Revise zero tolerance policies
Act 1225 Continued
 Provide mental health services
 Provide better assistance to parents
 Provide more useful annual reports on behavioral and
disciplinary problems for data driven decision making
So how many initiatives made it?
 As a result of Juvenile justice reform, 2000
incarcerated youth has dropped to around 500
ACT 555: Children and Youth
Planning Boards Act of 2004
 Passed to further promote the intent of the Juvenile Justice
Reform Act of 2003
 Purpose was to assist in the assessment, alignment,
coordination, prioritization and measurement of all available
C&Y services and programs that address the needs of those
at risk for or identified with social, emotional, and
developmental problems including but not limited to:
 educational failure, abuse, neglect, exposure to violence,
juvenile or parental mental health or substance abuse,
poverty, developmental disabilities and delinquency
ACT 555 Continued
 Intent was to encourage collaborative efforts among
local stakeholders to access needs and develop
comprehensive plans to address such needs based on
data driven decision making
 The Role of the Children’s Cabinet shall be to facilitate
creation of local (parish) C&YSPBs by offering
guidance, TA to local communities and governing
authorities to include resource identification, needs
assessments, monitoring and evaluation and strategic
planning
 Only in isolated cases were primary care providers
included in this process
 Sabine Experience with C&YSPB
Other State and Regional Efforts Toward
Developing School-Community
Partnerships in the Past
FDOE
 Recovery Act
DOE
 Federal IDEA Mental Health Grant (2002)
 Coordinated School Health Initiative (2005)
 PBIS (2005)
 Comprehensive Learning Supports (2008)
DHH
 OBH Region 7 School-Based Behavioral Health Projects (2005)
 Human Service Districts organized in the 9 DHH Administrative
Regions
 Integration of Behavioral Health and Substance Abuse Services
 CSoC (2010)
 LA Behavioral Health Partnership - Magellan(2013)
 Bayou Health (2013)
State and Federal Initiatives
Supporting Integration Efforts
SAMHSA-HRSA Center for Integrated Care
DHH Integrated Behavioral Health Summits
Louisiana Primary Care Association
Rapides Foundation IBH Grant
Louisiana Public Health Institute
Others?
LPCA – Rapides Integrated
Behavioral Health Project
 Two year grant serving Winn, Grant, Natchitoches and
Vernon Parishes
 Purpose is to implement Integrated Behavioral Health
in four existing FQHCs
 Two sites have included school-based components
IBH IN CONTEXT
Continuum
of Integration
Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare.
Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013
Key Aspects of Integrated
Behavioral Health
Patient-Centered Medical Home Model
Based on a philosophy of primary
care that is patient-centered, and
provides service through a
comprehensive team-based
approach with coordination among
providers and continuous access to
care
Horizontal Programming
Programs and services designed to serve the
entire client population with education and
support (Weight Management, Stress
Management, Smoking Cessation, ADHD
Support, Depression Management Groups)
Akin to universal and secondary PBIS
Vertical Programming
 Protocols for Service Delivery are developed for
specific diseases and conditions, akin to tertiary PBIS:
 Procedures are developed for different categories of
needs such as depression, ADHD, anxiety disorders,
chronic pain, diabetes, etc. These categories are
referred to as registries within the electronic medical
record used to maintain patient’s charts. The registries
are used to coordinate care, monitor and evaluate
outcomes.
 Procedures are in place for both medical providers and
behavioral health specialists (LCSWs) and include the
assessment process, treatment and follow up.
IBH Team
 PCPs
 Nurses
 Behavioral Health Specialists (LCSWs, PhDs)
 Care Coordinators
 Huddles
 Warm Handoffs
 Registries
 Stepped Care (Think RTI)
Implementation of Integrated Behavioral
Health in Schools
 Similarly to primary care providers (PCPs), school
personnel including teachers, school social
workers, etc. are often the first to encounter
behavioral health issues and the challenges
associated with them
 Implementing integrated behavioral health (IBH)
within the school setting connects the health
clinic to school personnel and creates an
opportunity for PCPs, teachers, school social
workers and social workers working within the
school-based clinic to have increased
communication and collaboration on a regular
basis in order to provide the best interventions for
the students being served
Barriers
 Philosophical silos
 Political silos
 Financial silos
 Professional Turf
 Service Gaps
 Urban vs. Rural
 Workforce development and training
Reference the UCLA School Mental Health Project:
Comprehensive Learning Supports
(Howard Edelman PhD, Peggy Taylor PhD)
SPECIAL CONSIDERATIONS:
 Prior to implementation it is important to gain support
from the school board and key personnel by identifying
specific needs that the school-based clinic may help
address such as decreasing suspensions, decreasing
absences/truancy, assisting with behavioral
interventions in the classroom, and increasing parental
involvement
 It is also important for both the school and health clinic
to develop realistic expectations of goals, and services
that will be provided by the school-based clinic and
the responsibilities of all parties involved
 LCSWs within the school-based clinic will need to
develop special skills to help them successfully manage
the unique challenge of learning how to enter the
school environment and facilitate a collaborative and
supportive relationship with school staff
CROSS TRAINING
Implementing IBH in the school setting also provides a
unique opportunity for cross training between
professions as both academic language, medical
language, and language referring to behavioral health
disorders and interventions are being used in the same
setting
Primary Care staff have misconceptions about Mental
Health and its providers. Mental Health Staff have been
trained in the Specialty Model and have a hard time
adjusting to the fast pace of Primary Care
Examples of training efforts in Winn Parish: meetings
and collaboration with Pupil Appraisal, PCPs, medical
staff and behavioral health specialists
TELEHEALTH
 Telehealth is an important tool for IBH in both the
health clinic setting and school-based clinic
setting
 A grant through the Louisiana Primary Care
Association currently gives 2 health clinics and
associated school-based clinics access to a
licensed psychiatrist through a secured
connection via television on a weekly basis in
the health clinic setting.
 An LCSW is present with the patient or student
as they participate in a psychiatric evaluation
and subsequent follow up consultations
 Parents and guardians also take part in the
process when a child is participating in a
psychiatric evaluation via telehealth
Telehealth continued
 A written psychiatric evaluation with diagnosis and
treatment recommendations, including medication, is
provided via secured email to the LCSW and to a case
manager at the health clinic who shares this with patient’s
PCP and/or LCSW providing intervention in the schoolbased clinic and then scans into the chart.
 PCPs and the LCSW are also able to conference with
psychiatrist if needed using the telehealth setting or via
phone to hold a more in depth discussion regarding
patient issue if needed.
 Telehealth also provides another opportunity for
collaboration with school personnel. For example, the
psychiatrist may request that the parent or LCSW obtain
certain information from the teacher and/or inform that
teacher that she may ask questions of or provide relevant
observations to the psychiatrist via the LCSW .
Evidenced-Based Practices
Several evidenced-based practices have proven
particularly effective within in primary care settings
incorporating IBH, including:
 Acceptance and Commitment Therapy (ACT)
 IMPACT : Evidence-based Depression Care
 Motivational Interviewing
 Problem Solving Therapy
 Cognitive Behavioral Therapy
Forecast For the Future
 Affordable Care ACT
 SAMSHA-HRSA Efforts
 DHH Integrated Behavioral Health Summits,
a grass roots conversation
 LA Human Service Districts
 Integration of Behavioral Health and Substance
Abuse
RESOURCES
 Collaborative Family Healthcare Association
 www.cfha.net
 LA Primary Care Association www.lpca.net
 Louisiana Public Health Institute www.lphi.org
 Healthcare Journal of New Orleans
www.healthcarejournalno.com
 SAMHSA-HRSA Center for Integrated Health Solutions
 www.integration.samhsa.gov