Investing in Behavioral Health
The Pennsylvania Model
According to a 2015 report by the US Department of Health and Human Services, more than three million adolescents aged 12-17 reported at least one major depressive episode in the past year.
More than two million reported severe depression that impeded their daily functioning. Of these students, 18% reported seriously contemplating suicide within the past year, and 9% of these students reported a prior suicide attempt. Most state statistics mirror these national rates, showing a troubling pattern that seems to be on the rise.
Leaders and policymakers in the fields of education and behavioral health are scrambling to address the increasing rates of suicide and mental health issues among teens. Task forces are popping up across the country advocating for suicide prevention, and more state and federal agencies are allocating funds to address the behavioral health needs of children and adolescents. Unfortunately, many kids don’t get the help they need, and if left untreated, behavioral health conditions can contribute to poor physical and mental health outcomes in adulthood.
The Pennsylvania Department of Human Services understands the implications mental health and substance use can have on a student’s overall health and wellbeing, and the agency has been trying to identify kids who need behavioral health and social support services throughout the state. With the help of Drexel University’s Center for Family Intervention Science and Baltimore-based technology firm mdlogix, the state has been supporting the use of BH-Works, a multidimensional behavioral health screening tool.
BH-Works is a 100% web-based screening and care coordination platform that assesses risk across 16 domains of behavioral health, including suicide ideation, depression, anxiety, substance use, eating disorders, and self-harm. BH-Works goes beyond most screening tools by offering a comprehensive psychosocial assessment, providing insight into environmental factors that contribute to a person’s health status. Once the assessment is completed, the system generates a “Screen Results” report which provides a summary of risk scores, critical items, patient strengths, and a detailed section of each question and response to the screen.
The state has been offering the tool in a variety of settings where adolescents receive care, particularly primary care facilities, hospital emergency departments, and college and university health clinics. In 2013, the state began providing BH-Works to any SAP team (Pennsylvania Student Assistance Program) interested in using the tool.
SAP, founded in 1984-85 to bolster student success by addressing substance use and other behavioral health problems in schools, uses an integrated model that involves an extensive community support network. Dr. Perri Rosen, Project Director of the Pennsylvania Youth Suicide Prevention in Schools and Colleges grant, and Dr. Guy Diamond, Director of Drexel University’s Center for Family Intervention Science, lead efforts to advocate for multidimensional behavioral health screening to SAP teams across the state. Matt Briner, Director of Clinical Products at mdlogix, along with Tita Atte, Director of Mental Health Screening at the Center for Family Intervention Science, trained and supported the SAP teams as they implemented BH-Works into their workflows.
Dr. Rosen stresses the importance of school-based health efforts. “Given that the rates of suicide are increasing among youth, schools and their community partners play an integral role in identifying the students that may be at risk. Using a tool that screens broadly helps to not only identify the youth that may be thinking about suicide, but also those that may be struggling with other behavioral health issues,” she states. “It gives schools and SAP teams the opportunity to intervene early and proactively, hopefully before a youth would ever get to the point of experiencing a mental health or suicidal crisis.” The team is delighted by the traction the program has seen in the past few years. The success of the Pennsylvania SAP teams, as well as BH-Works screening done with adolescents at Children’s Hospital of Philadelphia, has garnered the attention of other schools and organizations wishing to implement similar programs.
The success of SAP depends on an integrated model that leverages specially trained teams comprised of at least four school staff members – usually administrators, counselors, teachers, and nurses. These teams are then supported by SAP liaison agencies made up of local behavioral health and substance use professionals. Anyone from the community can refer students to the SAP team, including family members, teachers, coaches, and students. The SAP team then gathers objective information about the student’s performance and behavior, helping to implement interventions within the school and community. When a mental health or substance use assessment is recommended, SAP liaison agencies help link students to behavioral health and social support services within the community. The team continues to monitor the student’s progress, committed to giving all students the best opportunity to succeed personally and academically.
Most schools use this referral process to identify students in need of support. Two school districts, however, have chosen to implement periodic behavioral health screening (pending parental consent) to the entire student population, keeping SAP liaisons on-site in case students require intervention. These universal screening days often uncover risk in students who were otherwise seen as healthy and happy kids. These teens – well-liked, good students with no known record of behavioral health issues – have shown clinically significant scores in areas that warrant emergency intervention.
Every young person deserves to live a happy and healthy life, so it’s imperative that communities support efforts to screen and treat their behavioral health problems as soon as possible. In 2016, about 11,000 adolescents in Pennsylvania were screened in various clinical and non-clinical settings using the BH-Works platform (data combines universal and indicated screenings for state and independently funded programs). Of these adolescents, approximately 31% screened positive for moderate to severe depression risk. Additionally, 15% reported contemplating suicide at some point in their lives, and 4% reported contemplating suicide within the past week.
Aaditya Goswami, CEO at mdlogix, hopes the Pennsylvania SAP model inspires schools throughout the country to implement similar programs. “The prevalence of school shootings, suicide, and youth violence clearly indicates that our young people are struggling with mental health problems. We need to do a better job of identifying these problems and getting these kids the help they need.” He continues, “If the schools aren’t able to do these screenings, where else would we be able to have the same impact?”