By Ron Diimig, NAPSA Member

Like many communities, Council Bluffs Community Schools has seen a decline in the ability of its students to access long-term quality mental health care. Changes in federal and state funding as well as insurance and managed health care have resulted in increasingly common service limits. Declining economic conditions have limited the ability of some parents to pay for services. Those same economic conditions have also limited the ability of providers to serve needy patients at low or no cost. The cumulative impact of all of these factors has even led some areas providers to close their doors permanently.

When children’s mental health needs are unmet, the impact is felt within the family and throughout the community, including human services and juvenile justice agencies, which are already financially struggling to provide services.

The impact on schools can be immediate and severe depending on the unmet need of students. Schools can be faced with student’s declining grades, increasing truancy, disruptive behavior that interferes with school climate and aggressive and assaultive behavior, which significantly endanger the safety of everyone in the building.

Individual schools rarely have the depth or breadth of resources to deal in a truly meaningful way with the needs of significantly mentally ill students, regardless of 504 plans, IEPs and the commitment of staff to serve students. The bottom line is that educators are not mental health experts and mental health providers do not have the resources to reach out and directly serve every needy student in every building.

Using available Medicaid dollars and thanks to increases in federal funding for special education, Council Bluffs Community Schools has taken a two-tiered approach to serving students whose needs are greater than what a traditional school can provide. With this creative approach, the student remains outside of a hospital or residential setting and the schools are not diverting traditional education dollars for non-educational uses.

The district’s first goal is to keep students in school with the necessary support for the student and family. This is accomplished through a contractual arrangement with a local hospital. The hospital provides licensed mental health professionals to work with the school, family and doctor. These professional staff members address a variety of activities including:

•  working with the school nurse and the family to monitor and ensure proper mediation administration in the home and at school

•  working with the school staff on adaptive behavior management plans coordinated with the doctor’s treatment plan

•  working with the parent on effective management of the child’s mental health needs

•  ensuring accurate communication with the doctor regarding status of students mental health and effectiveness of medication and treatment protocols

•  coordinating payment and services with Medicaid and insurance carriers

•  when appropriate; facilitating initial intake evaluation, transition form a hospital-based program and readmissions.

Cumulatively, these services have dramatically improved the school-based success of general and special education of students with mild to moderate mental health issues and improved the adaptive behavior of these students within the home and community.

Schools are also faced with students with severe mental health issues. These students include those who have been refused hospital, residential or other program admission. There may also be students who have been dismissed from placement because of their non-compliant or dangerous behavior. Also included in this group are students who refuse to follow a doctor’s treatment protocol or students whose parents do not follow the doctor’s treatment protocol. There may also be other situations in which the student exhibits severally aberrant and dangerous behavior due to a diagnosed mental illness but cannot access quality treatment outside of the regular school day.

Addressing the need of this group has proven to be very difficult. It eventually required the resources of two school systems and an Area Education Agency, in Iowa , an intermediate agency providing school districts with support services in special education, staff development and access to media.

This initial collaborative approached multiple mental health providers and sought input from other stakeholders. When it came to actual implementation of a model, some declined based on perceived liability and risk factors on the advice of their insurance carriers. Others declined because they didn’t have the personnel resources to commit. Still others questioned whether it was appropriate to commit resources to a population proven to be resistant to treatment. Eventually one provider remained who was willing to partner with the schools and the AEA to address the needs of these students.

As a result, a former runaway shelter was remodeled. Classrooms, offices, meeting rooms, and lunch facilities were created in the remodeled space along with ample access to computer and web-based services for staff and students.

In addition to an on-site program administrator and secretary, a full-time psychologist and psychiatric social worker collaborate with physicians to create a therapeutic and safe environment for the students served in this program. These on-site staff members work with the program’s teachers and classroom associates to provide a seamless continuum addressing both the mental health needs and educational needs of students as well as working with families on a range of issues.

Although still too new for formal evolution, several areas of success are emerging. Issues surrounding learning climate and school safety are clearly being addressed with a positive impact on local schools. The attitude of students and parents toward mental illness is being positively impacted. The involved students and parents are increasing their understanding of an individual illnesses, realizing the negative impact when illness is untreated and gaining the ability to bring about positive change when an illness is treated. Significantly, there have been no injuries to staff or students.

As both a placement of last resort and an intermediate day program, staff has the ability to transition students back to schools or the ability to prepare student and families for needed hospital or residential treatment or to serve student indefinitely without restriction from public or private managed care systems.

It is still too early to know what the program’s eventual outcome will be in either successfully returning students to public school or in readying students for hospital or residential care previously denied them because of the severity of their behavior. However, as the mental health system for students appears to continue to deteriorate, Council Bluff Community School District has found a way to serve students whose need would otherwise be unmet.