School-Based Health Center Task Force

The link between physical and mental health and the success of children in school is well researched and documented. In Fall 2016, MSBA convened a School-Based Health Center Task Force comprised of school districts from across the state that represented the diversity in Missouri schools. Collectively, these school districts identified the unmet health care needs of their students and the barriers that existed that made it difficult or impossible to address those needs within their community. Mental health services and supports were the most frequently identified unmet needs in every region and size of community throughout the state.

Over the next two years, MSBA worked closely with school districts, state agencies and community health providers exploring a state-wide model that would have a variety of options of services, health providers, and funding sources to meet the unique health care needs of children and families in their local schools and communities. Through increased opportunities for new collaborative relationships between state agencies, schools and community mental and physical health providers, Missourians are building a brighter future for their children.

As a result of the work of the Task Force, the Department of Social Services has new policy allowing community behavioral/mental health providers to provide services in the school setting when a school district determines it is appropriate to do so. In addition, the policy allows for schools to provide behavioral health services to additional children, without disabilities under the IDEA, and bill for those services, as appropriate. MSBA convened a Behavioral Health Workgroup, comprised of a diverse group of stakeholders, to develop the MO Guidelines to Implementing Behavioral Health Supports in School, to help districts understand the policy and the opportunities it affords. These guidelines and related resources are accessible on this webpage.

In order to sustain the efforts of so many in creating new possibilities for school-based health centers in Missouri as a long-term solution to improving the health and mental wellbeing of children and youth, MSBA is posting the many resources originally made available to the Task Force members, for all to access.

In addition, MSBA has contributed to the creation of a Missouri affiliate to the National School-Based Health Alliance. This affiliation—Show-Me School-Based Health Alliance— will provide to Missouri schools a ready source of researched practices and technical supports to ensure effective partnerships between schools and community health providers resulting in sustainable health care services within Missouri schools.

Behavioral Health Resources

View the entire collection of School-Based Health Task Force videos.

These presentations represent the voice of four types of community physical and/or behavioral health providers with whom schools can partner to give students greater access to quality health care. Although each presenter represents a unique provider, the message is inclusive of other similar community providers across the state.  These presentations will help schools to understand the core mission of these provider types and what services they can provide to schools. 

Schools Partnering with Federally Qualified Health Care Centers (FQHC’s)

Schools Partnering with Hospitals

Schools Partnering with Certified Community Mental Health Centers

Schools Partnering with Private Providers

Presented by the National School-Based Health Alliance in Washington D.C

Powerpoint

MO Guidelines for Implementing Behavioral Health Supports in Schools strongly recommends that behavioral health supports be integrated into the school’s framework or system of positive behavioral supports.  The two presentations below provide to schools the how-to information for such integration.  Dr. Tim Lewis  talks about behavioral health as a component of the over-all school system of support for social and emotional wellbeing of children and the adults who serve them.  Megan Marietta shares effective practices and materials for Developing Partnerships from the St. Louis Public Schools.

MO HealthNet coverage is provided to the majority of families in Missouri through one of three Managed Care Organizations or MCO’s— Home State, Missouricare or United Healthcare.  It is important for schools interested in providing access to quality health care through school-based health models to understand the benefits of working directly with the three managed care organizations.  These MCO’s can collaborate with schools to provide outreach and prevention materials and services and to case manage individual children’s health needs to ensure the greatest access to and benefit from health services.

Resources from the National School-Based Health Alliance

Core Competencies

Services Support Core Competencies Assessment

Existing SBHCs

Planning SBHCs

SBHC Sponsorship Fact Sheet

Guiding Questions MOA development

Memorandum of Agreement Sample

Existing Sites

Engaging Stakeholder Overview

MOU Example Hannibal School District

Core Competencies Infographic

Behavioral Health Workgoup

In April 2018, the Missouri Department of Social Services, MO HealthNet Division, released a bulletin titled Behavioral Health Services in the School Setting. The policy change addressed new opportunities for schools, families and community behavioral health providers to increase access to quality behavioral health services in the schools. Statewide leaders believe this policy change will lead to improved academic achievement and brighter futures for Missouri’s children.

Read the Bulletin

Introduction

One of the major results of the synergy within the workgroup was the quality of conversation and spirit of collaboration around the issues of behavioral health services among a diverse group of stakeholders. Their combined passion and vision of brighter futures for Missouri’s children as a result of new levels of collaboration among state agencies, school districts and the communities they serve will help us all to rise to new levels of success supporting the behavioral health needs of our children.

Portions of these Guidelines were adapted with permission from the Wisconsin School Mental Health Framework published by the Wisconsin Department of Public Instruction.

MSBA acknowledges and sincerely thanks the MSBA Behavioral Health Workgroup members for their contributions.

Dr. Kim Ratcliffe, MSBA Associate Executive Director
Behavioral Health Workgroup Chair

MSBA Behavioral Health Workgroup Members

For local boards of education, student achievement is the bottom line. But today one of the biggest barriers to student achievement and school safety continues to be the unmet behavioral health needs of our students. The good news is that school districts in Missouri are now able to get federal and state reimbursement for behavioral health services provided to any Medicaid eligible students and community providers can be invited into schools to service children and do the same.

This is truly a game-changer for our state. It is critical that schools, parents and community providers understand how this process can work and develop ways to collaborate differently than we’ve done in the past. Now we can give children a brighter future through behavioral health services that can be provided within the context of schools.

We thank members of MSBA’s Behavioral Health Workgroup for their work on this issue. We hope the guidelines in this document can help you deliver the behavioral health services so many of our students desperately need.

Melissa K. Randol, Esq., Executive Director
Missouri School Boards’ Association

It is paramount for Missouri schools to have the ability to partner with quality providers or, on their own, to deliver behavioral health services during school time. Ensuring Missouri’s children and youth immediate access to supports and early interventions has long-term impact on learning and community well-being. The Department of Social Services, MO HealthNet Division is excited to support Missouri schools and families in this effort to improve behavioral health.

Jennifer Tidball, Deputy Director
Department of Social Services

Behavioral health supports are critical to student success in school and life. These supports will assist in establishing and expanding strong partnerships between schools and their communities. The Department of Elementary and Secondary Education is pleased to advocate on behalf of these efforts that benefit Missouri students and their families

Roger Dorson, Ed.D. Deputy Commissioner
Financial and Administrative Services
Missouri Department of Elementary and Secondary Education

The work of MSBA’s Behavioral Health Workgroup was critical because it highlighted the importance of establishing new services that address mental health problems in communities, evolving the school culture to be more supportive of the emotional wellbeing of adults and students, and providing greater access to behavioral health services.

Mike Nietzel, Ph.D., Past, Deputy Director
Department of Mental Health

The MSBA Behavioral Health Workgroup has developed a set of guidelines, Missouri Guidelines for Implementing Behavioral Health Supports in Schools, to assist schools in understanding implications of a new MO HealthNet policy in Missouri. These guidelines may be of value to community behavioral health workers and families, as well, in understanding the roles they play in the physical and mental wellbeing and safety of children within the context of schools. The MSBA Behavioral Health Workgroup also recommended best practices to ensure that the proper school culture and climate exists to support quality behavioral health services in schools.

Executive Summary

Some schools may have community behavioral health (BH) providers knocking at the door and offering services or some providers may come to school and ask for a student to be removed from class so that a behavioral health service, such as counseling, can be provided.

Read the recommended actions, dos and don’ts for schools.

Many have traditionally used the term mental health to refer to a dimension of overall health that includes a continuum from high level wellness to severe illness. More recently, behavioral health has become the preferred term as it is perceived to be less stigmatizing and more inclusive, promoting well-being through prevention and intervention. Behavioral health is related to a person’s mental well-being, their ability to function in everyday life and their concept of self.

School behavioral health addresses all aspects of social-emotional development of school-aged children including wellness, mental illness, substance abuse, and effects of adverse childhood experiences. School behavioral health services refer to a continuum of supports for school-age children that are integrated throughout the school community: universal strategies to promote the social and emotional well-being and development of all students; selected, brief strategies to support students at risk of or with mild behavioral mental health challenges; and intensive, ongoing strategies to support those with significant needs, including a streamlined referral process with community behavioral health providers to create a seamless service delivery model for children, adolescents, and their families. Various family, school, and community resources are coordinated to address barriers to learning as an essential aspect of school functioning and to instill hope and foster a bright future for all of Missouri’s children.

Next Step Options

In order to ensure an effective behavioral health system is in place within your school district, it is important to identify strengths and areas that need improvement. Many schools choose to conduct a self-assessment using a behavioral health assessment tool to determine their ability to support the behavioral health needs of students in their district. This assessment can be used as a tool to develop a plan for strengthening areas of need. To further determine students at-risk for behavioral health challenges, routine behavioral health screening can be conducted on a semi-annual basis.

School Structures Systems and Functions

Mental Health Screening in Schools, NASP

Needs Assessment Plan, WI

School Mental Health Needs Assessment (Fillable), WI

School staff has differing roles and responsibilities depending on their specific job, training, and competencies; however, each has an on-going responsibility for the social, emotional wellbeing of their students.  This wellbeing is best supported through an integrated system of positive behavioral interventions and supports, multi-tiered systems and trauma-informed practices.  Understanding how to integrate structures and programs for the physical and behavioral wellbeing of all students and adults within the school environment is one way to strengthen a district’s performance outcomes. Adults in the school may need to shift their perspectives to understand that attention to their students’ social-emotional needs is critical to students’ academic success.  

Revenue plays a part in what services schools can afford to provide and the personnel they can afford to hire to provide those services.  Schools that employ behavioral health providers (nationally certified school psychologists, psychologists, LCSW’s, LMSW’s, or LPC’s)  who are enroll as a MO HealthNet and/or MCO providers, can file claims for otherwise eligible children who receive those services outside of an IEP under IDEA.  Districts will receive the federal and state portions of the MO HealthNet payment.  Schools can continue to bill for behavioral health services as a Direct Service provided to children under the IDEA, as in the past.  

Technical Guide for Alignment of Initiatives, Programs and Practices

MO-CASE MTSS (Nov 11)

Positive Behavioral Interventions & Supports (PBIS) Website

Aligning and Integrating Mental Health and PBIS to Build Priority for Wellness

School-wide PBIS Fidelity Inventory Action Planning Companion Guide

Selecting Mental Health Interventions within a PBIS Approach

Survey on School Readiness for Interconnecting PBIS and School Mental Health

MH Agency Implementation Checklist

Improving Conditions for Learning-Support Personnel

The Role of the School Nurse

Specialized Instructional Support Personnel

Support Services Referral Form to School Team

Trauma Informed Schools and Organizations

As a result of a district behavioral health assessment or other means of identifying gaps in the district’s ability to manage the social-emotional and behavioral health needs of students, it may be determined that developing partnerships within the community or region with behavioral health providers will enhance the district’s ability to address unmet needs.  Best practice is for school districts to enter into a memorandum of understanding (MOU) to formalize an agreement and ensure role expectations with a community behavioral health provider, whether an entity or individual.

Guide for Effective Partnerships, St. Louis Public Schools Foundation

Partnership PPT for School Leadership Teams

Blank MOU Template

Utilizing Services – What to do after the MOU

Partnership Evaluation Tool

National HIPAA School Consent Form

Parent Consent for Behavioral Health Referral

Choosing a Provider

FQHCs as Potential Partners

Certified Community Behavioral Health Centers

Best Practices in School Partnerships with Community Providers

Sample Behavioral Mental Health Screening Form

Schools can strengthen relationships with community behavioral health providers with whom they have existing MOU’s. They can work with community health providers to understand how the provider can bill for services provided to MO HealthNet eligible children when those services are delivered within the schools, as the result of the new policy.

Working with MOHealthNet and MCO’s

This change in policy provides an opportunity not a mandate.

Contact

Behavioral Health Work Group
Dr. Kim Ratcliffe, Director, Advocacy & Special Projects
573-239-3722
kim@therapylog.com

This is truly a game-changer for our state. It is critical that schools, parents and community providers understand how this process can work and develop ways to collaborate differently than we’ve done in the past. Now we can give children a brighter future through behavioral health services that can be provided within the context of schools.

Melissa Randol, Executive Director, Missouri School Boards' Association

“It is paramount for Missouri schools to have the ability to partner with quality providers or, on their own, to deliver behavioral health services during school time. Ensuring Missouri’s children and youth immediate access to supports and early interventions has long-term impact on learning and community well-being. The Department of Social Services, MO HealthNet Division is excited to support Missouri schools and families in this effort to improve behavioral health.”

Jennifer Tidball, Deputy Director, Missouri Department of Social Services

“Behavioral health supports are critical to student success in school and life.  These supports will assist in establishing and expanding strong partnerships between schools and their communities.  The Department of Elementary and Secondary Education is pleased to advocate on behalf of these efforts that benefit Missouri students and their families.”

Roger Dorson, Ed.D., Deputy Commissioner, Missouri Department of Elementary and Secondary Education

The work of MSBA’s Behavioral Health Workgroup was critical because it highlighted the importance of establishing new services that address mental health problems in communities, evolving the school culture to be more supportive of the emotional wellbeing of adults and students, and providing greater access to behavioral health services.

Mike Nietzel, Ph.D., Past, Deputy Director, Department of Mental Health

“A study estimating the relative influence of 30 different categories of education, psychological, and social variables on learning revealed that social and emotional variables exerted the most powerful influence on academic performance.”

- CASEL, 2003, p.7

More Resources