Whether pursuant to an Individualized Education Program (IEP) or not, many students require and benefit from school-based mental health counseling services. Students in need who receive social-emotional and mental health support improve both behaviorally and academically. On a larger scale, these programs serve to decrease school suspensions and dropouts while improving school attendance rates.

While school based mental health counseling programs are implemented with the best intentions for the well being of students, services are often delayed or out-of-reach for many. The special education process calls upon school officials to retrieve parental consent for evaluation; then evaluate; present findings in a scheduled IEP team meeting; and await parental consent for a proposed IEP service to be implemented. By regulation, this process can take up to 45 school days.

Since school-aged children and young adults spend most of their time in school and in school-sponsored activities, the time available for mental health services in clinics is limited to evenings and weekends. Because clinicians are often unavailable at these times, waiting lists become lengthy with many students waiting more than one month to be seen.

In response, Everett Public Schools partnered with Eliot Community Human Services in the creation of the Preferred Provider Model. In just one school year, this program quadrupled the number of students receiving mental health counseling in school; while, at the same time, reduced the cost of services to the district by more than 50%.

What is the Preferred Provider Model?

The Preferred Provider Model makes mental health counseling available and accessible in school via a community based human services agency. The human services agency appoints licensed clinicians who are placed full-time in the public schools. Counseling sessions are billed to Mass Health and other student health insurance plans, and only minimally funded through the local school budget.

Case Study: Shelly

Shelly is a 17-year-old female who is in the 11th grade at Everett High School. She enjoys listening to music, spending time with her boyfriend, and participates in competitive cheerleading. She also works part time after school and is on track for a supervisor position at her part-time job. Last quarter, Shelly received all A’s in her classes and has a goal to attend college to pursue a career in forensics and criminal justice. She is entertaining, caring, intelligent, and a strong advocate for herself.

Shelly began working with a Preferred Provider Clinician at the start of the 2016-2017 school year as a 10th grader. At the start of treatment, Shelly had been removed from her home and placed with her father because of aggression towards her grandmother. Before the start of the school year, Shelly had physically assaulted her grandmother and spent a brief time in the custody of the Department of Youth Services (DYS). Shelly reported that from a young age she had met with therapists intermittently for the physical abuse she sustained under the care of her mother.

Shelly also reported a long history of emotional abuse from her grandmother as well. She noted a history of suicidal ideation, self-injurious behaviors, and was hospitalized in the 8th grade for attempting to overdose on Advil. Shelly had a limited knowledge of the impact of the trauma she had suffered at that time and struggled with low frustration tolerance, agitation, and difficulties managing her affect and modulating her behavior. Academically, Shelly was struggling to pass her classes and frequently got into verbal and sometimes physical altercations in school. Shelly met with her guidance counselor in school and requested to meet with a Preferred Provider Clinician as she was aware that her difficulties in managing her anger were negatively impacting her functioning. Shelly was motivated to make a change.

Upon intake, her clinician was impressed with Shelly’s ability to be open and honest with her behavioral and mental health concerns. Shelly advocated for weekly therapy in school, as she historically had been unable to consistently meet with clinicians, over transportation concerns and lack of motivation. She also requested referrals to be made for a Therapeutic Mentor (TM) and In Home Therapy (IHT). Once her clinician explained the Intensive Care Coordination (ICC) service to Shelly, she was motivated to participate in this as well. These services were available through the Children’s Behavioral Health Initiative (CBHI). By the end of September 2016, Shelly and her mother were working with an ICC who helped the family connect with a TM and an IHT provider with an outside agency. Meeting with all providers weekly, she and her mother came together with the team once a month for care planning to coordinate care and to track progress on therapeutic goals.

Over the last year and a half, Shelly was able to graduate from Intensive Care Coordination and Therapeutic Mentoring services, and will soon be graduating from In Home Therapy as well. She continues to meet with the Preferred Provider Clinician on a biweekly basis in school for ongoing support. Shelly has shown significant improvement in her ability to manage her affect and modulate her behavior. Her self-esteem has improved, and she is incredibly self-aware and emotionally intelligent. She has learned the ways in which her past experiences with physical and emotional abuse have impacted her thoughts, feelings, and behaviors and has developed a number of helpful coping and self-regulation skills. Shelly is able to transfer the skills she learned in therapy to multiple settings in order to be more successful at home, work and school. She attends school daily and has no behavioral concerns with peers or adults in the building.

Currently, Shelly maintains a 3.7 GPA, which is a drastic improvement from her GPA of 1.4 last school year. Shelly reports no major struggles with symptoms related to depression, and no longer endorses passive suicidal ideation or struggles with thoughts of self-injurious behaviors. She has also worked very hard with her IHT clinician in family therapy to decrease arguments and fighting with her mother in the home and has no concerns with her grandmother at this time as well. Shelly is working on an application for the Gateway to College Program, as she hopes to earn college credit and raise her GPA to improve her chances of getting into a four-year school. Shelly has received a great deal of support and has dedicated just as much effort and hard work to change her life’s path. Shelly truly has a bright future ahead of her, and her Preferred Provider Clinician is confident that she will utilize her experiences in life and in treatment to make a positive impact on the lives of others.

As a student who would not qualify for special education services, Shelly would have been a student in need of ongoing clinical services and on a waiting list at a clinic in Everett. It is questionable whether she would ever have made it to an appointment. Further, access to CBHI services would have been less likely if she were to receive only triage support in school. This is one example of how the Preferred Provider Model is making a difference in the lives of children and young adults in the Everett Public Schools.

How Do Children and Families Access the Preferred Provider Model?

Students and parents are connected with clinicians by school staff often as a part of a team process or in response to an untoward disciplinary, social-emotional or other situation. When parents consent for services, consent is also provided for Preferred Provider Clinicians to communicate with school staff and release and receive information pertinent to the student’s success in school.

Are Counseling Services Provided in Student IEPs?

No. The Preferred Provider model allows students to be seen in school more than or less than what is stated in an IEP service delivery grid. It also provides services via the CBHI such as therapeutic mentoring and family counseling during the days and hours that school is not in session. Counseling goals and objectives are developed with parents, students, and clinicians. A statement is added to the additional information section of the IEP to inform school staff that services are provided by clinicians from the local human services agency.

How is the Preferred Provider Model Funded?

The largest portion of funding for the Preferred Provider Model comes from student health care plans. The human services agency directly bills insurance companies for services rendered to students. In cases where students have co-pays, no insurance, or insurance that does not cover mental health counseling, the district is billed an hourly rate. The district also pays an annual fee per clinician for work that cannot be billed to insurance, such as professional development and benefits packages.

How Have Services and the Budget Been Impacted in the Everett Public Schools?

In Fiscal Year 2016, the Everett Public Schools paid $1.1 million in salaries and benefits to 10.0 FTE school employee clinicians and 1.0 FTE Clinical Supervisor. In Fiscal Year 2016, the total number of students receiving counseling via the IEP was 101. The Everett Public Schools first implemented the Preferred Provider Model in September, 2016. In March of 2018, 12.0 FTE Preferred Provider clinicians are reported to serve 444 students at a total cost of $360 thousand dollars for the fiscal year. The two-year savings of this model now exceeds $1 million.

A Comparison of Typical School Based Counseling Services and the Preferred Provider School Based Counseling Model

Typical School Based Counseling  Preferred Provider Model
Some students receive only triage support with little to no follow up.  Students who receive triage support are provided follow up in the form of referral for services through the Children's Behavioral Health Initiative (CBHI), if necessary. 
Students referred for assessment wait up to 45 school days to receive regular services via the IEP.  Students referred for assessment are assessed on the day of referral and receive services within 24 hours, if necessary. 
Students who receive services via the IEP are seen weekly until such time as the service is removed from the IEP, whether counseling is needed or not.  Students receive services only as long as it is necessary and of benefit to the student.
School employee clinicians participate in scheduled non-counseling related duties such as hall monitoring and lunch supervision pursuant to the collective bargaining agreement.  Preferred Provider clinicians focus only on providing services to students with little to no interruption or interface due to school district collective bargaining. 
School employee clinicians have a limited understanding of and fewer connections to wrap-around and other services available in the community.  Preferred Provider clinicians are employed by the organization that provides wrap-around and other support services. 
School employee clinicians attend professional development workshops on days and hours that school is in session, thereby limiting access to students in need.  Preferred Provider clinicians attend professional development workshops on days and hours that school is not in session. 
Counseling services are only available when school is in session.  Counseling services are available after school hours, on weekends, and over school vacation. 
Local budget funds clinical services.  Services are funded by Mass Health and other student health plans with only a portion of the cost paid by the local budget 

 

Michael R. Baldassarre (mbaldassarre@ymail.com) is assistant superintendent for student services at Massachusetts’ Woburn Public Schools

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