Report: Greater integration, communication would benefit needs

Vermont has a good framework in place to address the mental health and substance use needs of students but would benefit from increased communication among state agencies and greater integration and coordination with community and home-based services and supports. So says a report exploring the delivery of school-based mental health and substance services.

The report – issued jointly by the Agency of Education and the Agency of Human Services, as a result of Act No. 68 of 2013 (An Act Relating to School-Based Mental Health and Substance Abuse Services) – was based on data from a survey sent to Vermont special education directors.

The report indicates that the growth of frameworks such as Positive Behavioral Interventions and Supports (PBIS) is yielding positive results in the state, according to Charlie Biss, director of the Child, Adolescent, and Family Unit at the Vermont Department of Mental Health, who was one of the report’s writers.

“PBIS is based on the public health model, and is a good evidence-based framework for the state to infuse services into,” Biss says, adding it could increase efficiency in the delivery of services to work from a public health perspective.

Among other issues that have prompted discussion, Biss says attention should be paid to the fact that private insurance providers often do not cover school-based mental health services. In Vermont, Success Beyond Six is a funding mechanism that allows schools to provide Medicaid billable, school-based mental health services through direct contracts with their local mental health designated agencies.

“Private insurance doesn’t cover those kinds of services that we provide for school-based health,” Biss says. “Our Medicaid benefit is much more focused on reaching kids than the private insurance field.” With focus in the state on reducing costs, Biss says the state could save money if Medicaid wasn’t the only funder of these services.

Erin Maguire, executive director of student support services, Chittenden Central Supervisory Union, and also president of the Vermont Council of Special Education Administrators (VCSEA) and a member of the report’s committee, says collaboration around the state’s agencies is critical. “Everything we do needs to be collective; we all need to get on the same page,” Maguire says. “This isn’t just about schools. The reality is we have family structures that need treatment and if we just talk about kids and schools, well never get there. We need to treat the entire family as a whole.”

During testimony earlier this year to the House Committee on Education, Maguire says VCSEA was supportive of the recommendations made in the report, but she also made recommendations above and beyond those in the report. Maguire says mental health services must become an entitlement to all children in need.

“I would like to see the legislature provide funding for entitlements to children who require mental health services,” she says.

“When we use the word entitlement, you think about the entitlement we have for education, and things that people cannot take from us and there’s no waiting, there’s no waitlist – it’s not allowed,” Maguire says. “I don’t think people should wait in line for mental health services. I think that’s morally a problem for our society and something we have not addressed.”

Maguire says one of the current challenges facing schools is that there are many kids with needs, but not enough services through state and community agencies to meet those needs. “Because of that, education ends up doing a lot of treatment work and paying for a lot of treatment work, because we take our obligation to treat students very seriously and when issues interfere with education, we have an obligation to address that.”

Maguire says as the nation transitions its health care system, we must ensure mental health treatment for all citizens. “When people have acute issues from a mental health perspective, the kind of treatment we provide them compared to the kind of treatment we provide to an acute physical health issue is dramatically different,” Maguire says. “I think we have an opportunity to reframe ourselves around that. It’s a matter of public policy. We have come a long way, but I don’t know that we are focusing enough on it.”