# Presentation: 382748

## MENTAL HEALTH             ANDREFERRAL PROCESS

- Vanessa Crawford
- Kittrell Wellness Manager

**Notes:**
By: Vanessa Crawford
Wellness Manager

##  Who makes the Referrals?	

- Counseling Staff
- Wellness Staff

## The Counseling Manager is the gatekeeper for center’s referrals. The  Wellness Manager is the gatekeeper for health and wellness referrals. The Referral Process Model

- Academics
- Career Tech.
- Dorms
- Recreation
- S.P.O.
- Security

- Counseling

- CMHC
- Wellness Center

## Mental Health Team	

- CMHC
- Health& Wellness Manager
- Counseling Manager
- TEAP Specialist

## Mental Health Case Management

-    Counseling

- Health/Wellness/Mental
- Health

-       Student Employees

-       Student
-       Success

- Health/Wellness, Mental Health and Counseling are the foundations of support for student employees.

## The Roles of Tier I

- _Dept__	__* *_    		          _Responsibilities_
- Academics   		    Observe
- Career Tech                  Problem Solver
- Dorm                             Intervention
- SPO                              Evaluate                                    		              Refer to Counseling
- Complete a Counseling Action Form

## Tier ll Role of Counselor 

- Receive information
- Assess
- Monitor
- Develop A Plan Of Action
- Evaluate
- Refer to CMHC  (if needed)

## Tier lllCMHC/Wellness

- Evaluate
- Diagnosis-Develop Care Plan
- Emergency Assessment
- Activate IDT Team (if needed)

## New Student (SIF) Interview                  

- History Depression ,Grief, Anxiety, Panic Attacks
- Death in family-Mother died 1yrs ago
- Sexual- Rape 2 yrs ago by father, boyfriends
- Relationships- Poor relationship with parents
- Ran away from home several times
- Homeless
- No referral recommended if student is not currently experiencing signs and/or symptoms

## New Student-Do Not Refer to CMHC, Follow Tier Process

- Drug problem-use marijuana within 3 months
- Drug test may be positive
- Behavior History
- Assault charge at age 17
- Fighting in school, kicked out at 9th grade
- Monitor/observe students and follow _Tier Process. _

## When Counseling Refer to Mental Health for New Student

- History of Bipolar
- History of Schizophrenia
- History of Suicide Attempts/Plan
- History of Homicide
- History of Severe Depression
- On Medication
- Recent Hospitalization within 6 months
- Long Term History of Depression
- History of Depression with other Emotional, Anger, Anxiety, and Panic Attacks

## Refer to Disability Coordinator

- Refer to Disability Coordinator as soon as you are aware of:
- Learning Disability
- ADHD
- IEP
- Physical/ Sensory Disability
- Submit Function evaluation sheet and observation sheet with referral to disability coordinator

## Case Study 1

- _Referral__:_
- Student asleep in class, never finishes
- assignments
- --Open Discussion

## Following the Tier ProcessExample

- _Career Tech_
- Late for class
- Good student
- Argues with classmates at times
- 20% complete
- _Wellness_
- _Every Monday in Wellness with stomach pain_
- Students been in program 278 days no HS / GED, 20% complete in trade, drug test was positive on entry but follow up drug test was negative, and currently on no medication.
- Social intake: difficultly with  reading, family problems, fathers is in jail, never seen him. Lives with mother and her boyfriend, poor relationship.

## Follow the Tier Process:Data

- _Classroom                                    ___________     _SPO____________        _
- Mood swings
- Skips classes
- Never complete task
- Sleeps in class when there
- _Dorm_
- Very argumentative with roommates and others
- Does not get along with other students
- Difficulty completing dorm duties
- Late leaving the dorm everyday

- Never returns to center on time
- AWOL Status
- Security reports they smell alcohol on students breath at times
- Caught bringing alcohol from store

## Tier ll Counseling Analogy Student Employee Data

_**Possible Problem**_
- Alcohol-drinking on weekend
- Over sleep-due to hang over
- Mood swings/argumentative with others-due to alcohol cravings
- Skipping Class-maybe drinking
- Wellness-hangover, Possible use of other drugs
- Relationship with mother-boyfriend takes up too much of mothers time
- Coping with identity- father is in jail never seen him
- Feels boyfriend is taking his fathers place

## Tier ll Counseling Analogy Student Employee Data

_**Plan**_
- TEAP
- Probation-SPO, class attendance, weekend restriction
- Contact mother to get her involved
- Relationship class
- Place on bed time schedule
- Set time line for completion
- Employability skills review
- Monitor Wellness visits
- Referral Disability Coordinator

## Outcome from Counseling Plan

- Reading-improved-TABE out-but mood swing still present
- Attend TEAP
-  Probation- class attendance improved
- 	AWOL 1 time in last 30 days
- Mother-very supportive to the plan
- Relationship class-had difficult at first but is a great student
- Bedtime schedule- out of dorm in the morning on time slow a couple times in the beginning
- Mood swing- continues for no reason, student states she tried very hard but can not control them

## Counselor Sends Referral to CMHC

- Include all data and documents that show all interventions done and outcome
- Include a functional evaluation
- Referral

## CMHC

- Diagnosis-mood swing due to behavior
- Refer to psychiatrist for further evaluation
- Refer to medical physician for-mood stabilizer” medication”
- Follow-up 30 day after starting medication
- Refer to Disability Coordinator

## The Final Phase of Counseling Case Management

- Each Counselor meets with CMHC every week to:
- Update Student Progress
- Evaluate  and Update Plan of Care
- Discharge student from Mental Health Program (if service is no longer needed)
- Document all interventions, progress and updates

## CMHC Services

- Complete Assessment : 30-45 min.
- Follow-Up: 15-30 min.
- Special Follow-Ups: 1 hour

## Mental Health Math Problem

- Your center mental health consultant is contracted for 12 hours weekly. You have 350 students on center. What is the average amount of time the CMHC can spend with each student?

## The Center Mental Health Consultant Hours

- 33% of his hours are to provide staff training and staff awareness session
- 33% for TEAP
- The other 34% is for student evaluation and assessment, which means he only has 24 minutes to see 10 student per week

## Solution to Math Problem	 

- 350 students/ 4 hours (240 min.) weekly
- On the average of 56 students under CMHC Case Management Care
-  How many minutes would he have per student each week?

## Solution to Math Problem	 

- Many of our students have co-occurring disorders and the time dedicated to supporting TEAP could also be used for direct services/assessments.
- Consider implementing an intern program on center to increase services to students.
- 	Helpful guide found at:
- 	_http://jchealth.jobcorps.gov/health-topics/mental-health/mental-health-best-practices/internship-start-up-prototype_

## Goals Of Mental Health Case Management

- Remove Clinical Barriers
- Promote Employability
- Self Care Management

## Team Approach

- Health/Wellness, Mental Health and Counseling provides a variety of support services for our students.
- Therefore, it is very important for staff to:
- work together as a team
- communicate each event
- follow-up
- plan with integrity

## Review:

- Tier I
- _All Department_
- Observe
- Problem Solver
- Intervention
- Evaluate Document
- Refer to Counseling
- Complete a Counseling Action Form

-      Tier III
-      _CMHC_
- Evaluate
- Diagnosis
- Plan Care
- Emergency Assessments
- Refer to LMH
- Activate Disability Meeting if Needed

-     Tier II
- _Counselors_
- Receive information
- Assess
- Monitor
- Plan of Action
- Evaluate Document
- Refer to CMHC if needed by referral program