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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session

MEMORANDUM

Posted: August 20, 2019 11:37 AM
From: Senator Lisa Baker
To: All Senate members
Subject: Expanding Community/School Based Behavioral Health Services
 
The Safe2SaySomething anonymous reporting system was established to teach students, educators, and administrators how to recognize the signs and signals of individuals who may be at risk of hurting themselves or others. The recently released Annual Report for the 2018-2019 School Year revealed that the majority of tips received have not been about students making violent threats to their school or to their classmates. Instead, they have been focused on students struggling with bullying, anxiety, thoughts of self-harm and other serious issues.

According to a 2009 study by the Institute of Medicine and National Research Council, most mental health disorders have their roots in childhood, with 50 percent of affected adults manifesting disorders by age 14, and 75 percent by age 24. Although these problems have been characterized as a public health crisis, approximately 65 percent to 80 percent of the children with behavioral health disorders do not receive the specialty services and supports they need (President’s New Freedom Commission on Mental Health, 2003; U.S. Public Health Services, 2000).

While there will always be questions about the sufficiency of funding, services, and personnel, Pennsylvania seems locked into a model that no longer adequately addresses the severe challenges and mounting needs of today. What has become painfully apparent is that limitations large and small are keeping young people from crucial services at their time of need. There is a growing realization that an overhaul of behavioral health services must be part of a comprehensive solution to helping children in crisis and preventing mass shootings and suicides.

A highly successful model currently operates in northeastern Pennsylvania where Community/School Based Behavioral Health teams become integrated within the schools, working closely with teachers and professional staff. Services may include individual, family or group therapies; behavioral case management, assessment, crisis intervention, family support, service referral and linkage, and consultation and training for faculty. It is an outcomes based program that utilizes a variety of measures to track youth and family functioning, symptom improvement, and overall behavior at home and in the community. School grades and attendance are also monitored to evaluate effectiveness.

School superintendents, teachers, board members, and behavioral health professionals find this approach highly successful and believe it has been effective in helping students and families for the last 10 years. Data suggest the program has been effective in helping to reduce youth residential treatment facility placements, as the average daily attendance in residential facilities has decreased from 250 to 40 during this period.

Following months of inquiry and discussions with care professionals and local officials, I have prepared legislation to substantially open up and expand services and coverage.
Among the principles that serve as the basis for this proposal are the following:
  • The focus is on behavioral health.
  • Schools are required to have a program, but are given the discretion to choose this model or another.
  • Accessibility of services is a paramount consideration. This program is not site specific. In many communities, the school may be a preferable site, but it could be coupled with a private setting.
  • The current private insurance and Medical Assistance coverage is inflexible and inadequate.
  • School officials and students are seeking services that are frequently not available when the need is apparent.
  • The system must accommodate need, rather than forcing folks in crisis to fit within the existing structure.
  • Telemedicine can help fill the breach in certain circumstances, but that again raises the problem of lack of broadband capacity in many rural areas of the state.
Allowing for school based access regardless of the payer represents a comprehensive rebalancing of how behavioral health services are delivered, providing an effective tool to assist children and families in need.

I hope you will join me in supporting this important effort.