& Collective Impact: Implementing SBIRT at Wellness Centers in - PowerPoint PPT Presentation

Integration, Leverage & Collective Impact: Implementing SBIRT at Wellness Centers in LAUSD Monday, January 28th, 2019 The L.A. Trust for Children’s Health

WELCOME!! Karla Debray Robert Renteria Maryjane Puffer BSN, MPA Administrative Office Program Manager Executive Director MA MA MA Assistant & Former The L.A. Trust The L.A. Trust Fremont SAB member The L.A. Trust

Session Objectives Participants will learn: 1. Describe The L.A. Trust and the Wellness Network at LAUSD 1. Explain the components of SBIRT and why the SBHCs are uniquely positioned to provide SBIRT 1. Discuss the environmental scan and the lessons learned for best practices moving forward

The L.A. Trust • Founded in 1991 to support and develop Los Angeles Unified School District School Health programs • Mission: to improve student health and increase readiness to learn through increased access to health care, school policy advocacy and effective programs

Los Angeles Unified School District 540,000 students 0.2% 6.1% 0.4% Latino 9.9% African American 8.5% White 74.9% Asian Pacific Islander

Why School Based Health Care? • School is where the kids are • Disparities have not shifted ….we have to do something differently • LOTS OF RESEARCH: • Significant increase in attendance for SBHC users compared to non users • GPA increases overtime for students using mental health services • Burns, et al, Journal of Adolescent Health (2009) 1-7

Why School Based Health Care? Immunization • 2015-2016 school year marked the highest rate (97%) of 7th grade students meeting the pertussis (Tdap) booster requirement. The higher rate of compliance means there were more students enrolled and ready to learn and fewer students being excluded from school. Mental Health • During the 2014 -2015 school year, 1,535 students were screened for trauma at 53 schools including at Wellness Centers. Of the screened students, 284 received Cognitive Behavioral Intervention for Trauma in Schools (CBITS) group intervention. These students reported an average 33% reduction in Post Traumatic Stress.

Health Disparities  Health disparities mapped in 2006- 07 (“Health Hot Spots”)  Guided investment in Wellness Centers 2009  Re-mapped health and educational indicators in 2013-14 (“Health Need Index”)  Guided LAUSD investment for Wellness Phase 2  Now working on remapping with DPH for Wellness Phase 3

C HLAMYDIA R ATES /C ASES 2006 VS . 2012 MJ

T EEN B IRTH R ATES 2006 VS . 2012 MJ

B ODY C OMP F AILURE R ATE 2007 VS . 2014 MJ

LAUSD W ELLNESS C ENTER VS . N EEDS Crenshaw, Fremont, Jefferson, Manual Arts & Washington Prep HS

T HE EDUCATIONAL GAP MIRRORS H EALTH D ISPARITIES Educational focus and funding has shifted based on the Local Control Funding Formula (LCFF)… • Method schools districts receive state funding to provide education • Provides extra support to students with greater needs: • Low Income • English Learners • Foster Youth • This means more support through the schools for the most needy student populations

W HAT IS S.B.I.R.T.? A Populat lation ion Appro roach ach to Preve vent ntion/E ion/Early arly Interventio tervention • Screening a population to identify individuals who are using substances in a risky or unhealthy way • Brief Intervention to change behaviors and attitudes of individuals who are putting their health at risk with substance use. – Sometimes this is one intervention, sometimes a few sessions • Referral to Treatment for individuals who require specialty care (behavioral, pharmacological treatments)

W HY S.B.I.R.T. AT W ELLNESS C ENTERS ? • 21.5% of tenth graders and 35.3% of twelfth graders report past-month alcohol use • 16.5% of tenth graders and 23.5% of twelve graders report past-month drug use • Schools are major source of behavioral health care for many students – 21 times more likely to visit a school-based health center for behavioral health than a community- based health center • Visits to treat negative impacts of substance use (injuries, infections) a “teachable moment” NIDA 2016, Weinstein 2006

W.A.S.U.P. Wellness and Substance Use Prevention Project (WASUP) • Collaborating with 4 Los Angeles Unified School District high school campuses and their respective Wellness Centers to support substance use prevention activities

W.A.S.U.P. The Project • Works with youth, teachers, parents, and Wellness Center staff at Fremont, Jefferson, Manual Arts and Washington Prep high schools • Supports integration of substance use prevention activities, including the incorporation of the Screening, Brief Intervention and Referral to Treatment (SBIRT) evidence-based practice into Wellness Center medical care services

W.A.S.U.P. Environmental Scans Needs assessments conducted to understand the culture and decision- making structure at each school • Identify key staff at the four Wellness Centers, school campuses, and student leaders to help promote a culture of wellness • Identify campus-specific barriers that may impede implementation

W.A.S.U.P. Environmental Scans Key: Organizational Facilitator (OF), School Principal, Wellness Center - Clinic Manager (CM) 9. Referrals to Wellness Center 1. School Assets 10. Wellness Center Student Intake 2. School Challenges and Assessment Process 3. Parental Involvement 11. Additional Wellness Center 4. Outside Agency Partners/ Groups Information on Campus 12. Obstacles to Wellness Center Use 5. Substance Use on Campus 13. Mental Health Provider Information 6. Substance Use Policy 14. Trusted Staff/Faculty 7. Suggestions for Addressing 15. Who we should talk to Substance Use among Students 16. Other Suggestions 8. Perceptions of Wellness Center 17. Additional Information Needed

W.A.S.U.P. Building Partnerships Lessons we learned: • Identifying partnerships ○ Patience (who, when) ○ Building trust ○ Personal/Tailored approach • Integrating holistic approach to substance use prevention conversation ○ Being practical ○ “Real” ○ Having conversations

W.A.S.U.P. Screening Providers at all 4 sites were certified to conduct S.B.I.R.T. as substance use screening and referrals • early intervention services support an academic mission as part of comprehensive health care • S.B.I.R.T screening is “upstream” and strengthens youth health and wellness through education, prevention and early intervention

W.A.S.U.P. Capturing data ● S.B.I.R.T. clinic flow ○ Screening ○ + prompts substance use re-screening by provider ○ Positive re-screening prompts BI (motivational interviewing) ○ RT is internal to mental health ○ Mental Health refers to external partners

W.A.S.U.P. S.B.I.R.T. EMR template Capturing data ● Fremont WC developed data points in their EMR (Electronic Medical Record) to capture and extract S.B.I.R.T. information S.B.I.R.T. EMR Smart Form

B LUEPRINT FOR W ELLNESS P OLICY

Determinants of Health

Risk and Protective Factors

P OSITIVE Y OUTH D EVELOPMENT RR

S TUDENT E NGAGEMENT http://thelatrust.org/student-engagement/ CHLA SYPP 2013

Youth Campaigns

Youth 2 Youth conference

W.A.S.U.P? Where we are now: Now in year two, with a better understanding of school culture at each site, project staff have formed stronger connections with students, school administration and Wellness Center staff. We are moving to further educate parents on cannabis policy and introduce them to local community partners for the opportunity to advocate for their communities.

W.A.S.U.P? Highlights: Challenges: • Student leaders are engaging with Schools and clinics have peers through substance use experienced high turnover of key prevention activities staff • SBIRT is being conducted at all 4 sites Substance use discipline policy at and WASUP staff is collecting data schools is still unclear to teachers including referrals and students • Engaging with CA state, local, and Communication between schools school district partners to address and Wellness Centers is not new cannabis laws which have consistent commenced in 2018

W.A.S.U.P? Other issues: • Suspension is off the table, but therapeutic culture is still not recognized as best practice • LASPD still requested and involved when substances are present • Culturally sensitive substance use services are not easily accessible where most needed

W.A.S.U.P? Next steps: 5 th site (Crenshaw HS) to ● implement best practices and sharpen our toolbox ● Provide Professional Development with parents and school staff around substance use prevention and focus on cultural competency for adolescents ● Working to integrate Best Practices and lessons learned into school district and local policy

Thank you! Questions? Contact: Maryjane@thelatrust.org Robert@thelatrust.org