David Jones, the new head of the city’s behavioral health system, has a two-word description of what will be at the top of his personal report card in evaluating his work with the city’s public schools: “Graduation rates.”
Jones, named in July as commissioner of the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), says he wants to keep expanding the department’s role beyond helping students with learning disabilities and mental health issues to include helping with overall school climate.
Graduation rates, he says, will be the best measure of success.
As part of this change, his department, the City of Philadelphia, and the School District of Philadelphia announced recently that full-time social workers would be placed in 22 public schools in a pilot program that would be expanded to include other behavioral health workers.
Although many city schools now contract with private providers who offer behavioral health services in the School Therapeutic Services (STS) program, their social workers generally focus on a subset of students in their program.
These new social workers, by contrast, are employed by the city. They will train staff and generally promote overall practices to improve student and teacher well-being, while also offering help when individual students exhibit problems.
Specifically, they will provide Tier 2 behavioral health interventions while STS provides Tier 3 interventions. District officials say they hope the pilot program will be better able to provide more prevention services and reduce the need for crisis responses.
Tier 3 interventions are directed at students with diagnosed behavioral health disorders or symptoms of them.
Tier 2 interventions are directed not only at those students, but also at students considered at higher risk than their peers of developing behavioral health disorders.
(Tier 1 interventions are directed at the entire class.)
Jones, who holds a master's degree in community school/clinical child psychology from Southern Illinois University, had been serving as acting commissioner since February, when Arthur Evans left the department to head the American Psychological Association.
Jones came to Philadelphia from Montgomery County, Maryland, as deputy commissioner in 2013.
He says that efforts to boost school climate and student achievement can’t stop at the school building.
“We want to do even more prevention than we’ve been doing,” he said in a recent interview. “Looking at the entire family unit. The system is ripe for more change.”
Jones explained that the department’s funding is “primarily around treatment,” which means that a behavioral or psychiatric issue has to manifest before triggering intervention.
“We do have some portions of our funds that allow for prevention, intervening on education around [for example] substance abuse disorders."
But, he says, “It’s about more than emotional health. … It’s about stable housing, food security, financial management. So many things happen in the home, in the community. … We want to work with other partners and stakeholders.”
And he says it’s particularly important that the department’s efforts to combat substance abuse among adults – who can be parents or caregivers – connect to its efforts to help students.
“Healthy children tend to be connected to healthy adults,” he said. “We’re in the middle of an opioid epidemic. A number of those people who are experiencing a substance abuse disorder are parents. We have to have someone doing more coordinating work while that parent is getting the treatment they need."
That can involve getting another family member or responsible adult to “provide guidance and support for the child. ... That’s something we’re looking to do more of in the future.”
One approach that might be expanded, he said, is the use of “care coordinators” to work with entire families. Many families have multiple providers. One child might have a learning disability, another a behavioral health issue. A parent or guardian could be a substance abuser or might have bipolar disorder or another issue requiring medication.
The coordinator can tie together all the services.
City Councilwoman Maria Quinones-Sanchez, a frequent critic of DBHIDS, cited this problem in a recent interview.
“A family can have three providers who aren’t speaking to each other. It’s totally unacceptable. No one’s monitoring what’s working,” she said.
The pilot deals with that issue by having the workers employed by the city and reporting directly to principals and the District.
Jones feels that the department has a “robust” system of evaluating its contracted providers that work inside the schools. But he adds that there is a need for an overall review of the main programs – including STS, Behavioral Health Rehabilitation Services, and Family Based Services – to take a fresh look at what is working and what isn’t.
“We’ll look at pay for performance,” he said. “We’ll look at consumer satisfaction surveys … what’s working in other school systems, what services should continue, what should evolve and change.”
Addressing problems before they become chronic
Before the latest initiative, which is called the Support Team for Educational Partnership (STEP) project, no new city behavioral health workers had been added to the school system, with the exception of a short-lived and unsuccessful pilot program (the Community and School Support Team Initiative) in five schools, according to Karyn Lynch, the District’s chief of student services.
Lynch said in an interview that she hoped that the District would be able to place more emphasis on “trying to address [student behavior] issues before they become chronic.”
Jones said he also wanted to expand training for school personnel in dealing with student behavioral issues through programs such as Mental Health First Aid.
He noted that School District Superintendent William Hite was recently added to the board of Community Behavioral Health, a division of DBHIDS that coordinates school behavioral health services.
“We have a great partnership with Dr. Hite right now,” he said.
He said that his department has behavioral health workers assigned to more than 100 District schools, a little less than half the total. Students in some other schools also receive behavioral health services, according to department officials, but these workers are not assigned to individual schools.
Jones said it was too soon to determine when and how the latest initiative might be expanded.
But school officials in Baltimore, whose programs Jones says he is very familiar with, have been pleased with the results of a recent pilot program putting behavioral health workers in schools full time.
Aimee Hoffman, a school-based mental health clinician in an elementary school in Baltimore, attributes her success partly to the fact that she is there every day, seeing children not just for weekly sessions but also to ask in the hallway how they are doing, encourage them, give them a pat on the back.
“It’s knowing [the children] more in-depth,” she said, “seeing how they interact. Being there full-time makes a huge difference.
“When you’re in a school part-time, you miss things and you’re not as visible to the teachers. When the teachers see you every day, you catch those extra opportunities to be supportive.”