Advancing Behavioral Health Initiative

Recognizing an immediate need to improve overall mental and behavioral health outcomes in the Grant County, Green County, Iowa County, Lafayette County and Richland County communities, the project team aims to reduce the rate of adults experiencing 14 or more days of poor mental health by 10% within the five-county region in southwestern Wisconsin by:

• Increasing the acceptability of mental health treatment across the adult population of the five-county region so that more people will be willing to utilize mental health services
• Increasing the accessibility of mental health treatment through development of conduits to a comprehensive network of services
• Increasing the availability of mental health services so that people can receive timely and appropriate care

As young people ages 10-19 make up 15% of the population in La Crosse County (2015), this project seeks to prepare its youth to lead healthy and productive lives by aiming to reverse the trend of youth at risk for depression by reducing the percentage of students at risk for depression from 31% (2015) to 23% (2010 level) as reported in the Youth Risk Behavior Survey. This represents an overall relative decrease of 26%, or approximately 800 less students at risk.

• Building resilience skills and positive social connectedness among the youth population in La Crosse county public schools grades 6-12
• Building the capacity of informal supports such as the faith community, school staff, non-profit staff/volunteers, and employers to assist and respond to potential mental health challenges among youth and their families
• Facilitating communication improvements among youth serving agencies, institutions and organizations

In 2015, one out of five Marathon County high school students reported that they were depressed in the past year, and nearly one-third reported having three or more poor mental health days in the previous month. In addition, 21.3% of Marathon County 9th-12th grade students were at-risk for depression during the past year according to the Youth Risk Behavior Survey. Analysis of the YRBS results demonstrate a clear link between students who were at-risk for depression and students with poor mental health days with an increase in other health risk behaviors, including self-harm, tobacco and alcohol use, and taking prescription drugs without a doctor's prescription. To address student poor mental health days and risk for depression as well as related student health issues, project partners aim to reduce reported depression in 6-12th grade students in Marathon County by 5% by 2020 by:

• Increasing accessibility and utilization of on-site mental health counseling services in all 10 Marathon County school districts
• Increasing knowledge and awareness of student population needs among school districts, community agencies, local government entities, and parents through data sharing
• Using local data to more effectively allocate resources across Marathon County public school districts and Marathon County community organizations to address youth needs within schools and community organizations to improve behavioral health outcomes

In analyzing data relevant to Brown County, it was identified that 33% of employed adults reported one or more poor mental health day and 12% of employed respondents reported 10 or more poor mental health days per month. In addition, 93% of Brown County adults who contemplated suicide in 2016 were employed. To address the needs of this population and support better access to services and systems to provide mental health support across the community, project partners seek to reduce the incidence of poor mental health days per capita in Brown County by 1.5% per year for the next five years (totaling 7.5%), lowering poor mental health days from 40.8 to 37.8 by 2022 by:

• Supporting 125 workplaces with 25 or more employees (20% of employers in Brown Co.) in adopting or modifying mental health/wellness programs, policies or practices to address employee stress, psychological trauma and/or depression
• Increasing community access points to mental health services and information through multiple community sectors
• Developing a local workforce of employment-ready mental health counselors to increase community capacity to provide services

A history of systematic policies and subsequent actions aimed at Native Americans has resulted in persistent effects of historical/generational trauma in American Indian/Alaska Native communities today. It is now widely known that unhealed historical or multigenerational trauma results in identity loss and confusion, profound grief, poor health and social wellbeing, and vulnerability to substance abuse, especially alcohol abuse. In Lac du Flambeau, community members, elders, Tribal government and coalition members have long recognized the impact of substance use on health, family stability, employability and economy. Locally, the excessive drinking rate is roughly 1.5 to two times higher than that of the state of Wisconsin and the county were Lac du Flambeau resides. Deaths from overdose (co-occurring alcohol ingestion may contribute to overdose deaths) were so alarming that the Tribal Council declared a state of emergency in 2013. To promote healing, the project partners aim to strengthen and restore protective factors and decrease excessive drinking among adults ages 18-44 by 10% through the following strategies:

• Changing and sustaining an alcohol use/abuse community "norm" by engaging 10 families in a pilot cohort to provide comprehensive training and support of Ojibwe cultural teachings, traditions, and practices to promoting healing and strengthen protective factors (e.g. respect, cultural identity, social connectiveness, family ties) against alcohol abuse. Grow to two cohorts annually with six family members engaged per family
• Sustaining inter-agency communication, resource sharing, collaboration and service monitoring through organized workgroups to enhance a systems approach to the early identification, management, treatment and support of families under the influence of excessive drinking
• Implementing a substance use community awareness campaign/initiative to increase tribal government and community member knowledge and awareness about substance use, prevention, risks and protective factors, treatment and recovery

High rates of teen depression and suicide-related behaviors among youth in Calumet, Outagamie and Winnebago counties is a serious public health issue in the tri-county region. County-level Youth Risk Behavior Survey data indicate that area youth are attempting suicide at nearly twice the rate of the state and national average. Depression is the No. 1 risk factor for suicide. Currently, 24.6% of tri-county teens surveyed reported being sad or hopeless, a rate the this been slowly increasing for several years. This project aims to reverse that trend, reducing the number of students in grades 9-12 who are at risk for or who are experiencing depression by 20% (from 24.6% to 19.7%) by June 2022 by:

• Improving the school climate by increasing social connectedness for students through building relationships with peers and trusted adults
• Implementing programs aimed at developing healthy coping skills from an early age as well as creating an environment that supports healthy sleep among adolescents
• Screening for signs and symptoms of mental health challenges as a necessary step to address and improve mental health by identifying those who have or are at risk for having depression and also referring them to services
• Connecting youth who have or are at risk for having depression to mental health services in the community by increasing use of help-seeking resources and by developing a local, user-friendly service navigation website

Social emotional learning skills are linked to school achievement; however, the social emotional health of students is often not systematically assessed. In the Racine Unified Schools District (RUSD), this is not systematically assessed past 4K. The next available data on social emotional health of RUSD students is collected in 7th grade and reveal a downward trajectory in the social emotional health of youth between 4K and 7th grade. To improve behavioral health in the community, project partners have identified the social emotional health and development of young children as a priority in order to develop early interventions and policies that can have long-term, positive impacts. This project seeks to enhance the social emotional development of 3rd-5th grade elementary school students in the RUSD on the Panorama Social Emotional Learning student survey in the areas of Emotion Regulation and Social Awareness by:

• Increasing coordination of and exposure to evidence-based opportunities to learn about social emotional development for parents of 4K-5th grade RUSD students
• Creating a school environment that supports students' social emotional (SE) health by educating all child-serving personnel on ways to encourage SE learning interactions with RUSD youth
• Expanding school-based activities that intentionally improve the SE health and development of elementary school students in RUSD
• Improving coordination and pathways to mental health services for RUSD students

Reporting four or more ACEs (Adverse Childhood Experiences) is an indicator of future poor mental health outcomes, and this risk factor is present in one in seven of all community members in Eau Claire and Chippewa Counties. Additionally, current data indicate that approximately 30% (3,600) of area middle and high school public school students are at risk for depression as reported on the Youth Risk Behavior Survey. With a focus on factors that will protect youth from developing depression, including for youth with exposure to ACEs, this project seeks to decrease the number of middle- and high school-age youth who are at risk for depression by 15% (from 28% to 24%) by:

• Increasing capacity of the youth-serving workforce across sectors to build protective factors and resilience for Eau Claire and Chippewa county youth
• Building staff skills to contribute to a positive school climate and youth social-emotional skills
• Creating policy and change practice to improve youth mental health and resilience through use of a systematic, sustainable approach to data-driven decision-making

Unmet mental health needs at young ages can manifest in externalized behaviors, often resulting in school disciplinary actions. Office Discipline Referral (ODR) data is commonly used to assess needs and evaluate strategies aimed at addressing behavioral problems among school-age children. Exclusionary discipline can put children at additional risk for poor outcomes, exacerbating mental health and behavioral problems and resulting in a vicious cycle of poor school engagement, low academic achievement, and participation in the workforce. Therefore, working to identify ways to support children exhibiting these behaviors in other, non-punitive ways may impact positive health and educational outcomes. In Milwaukee, wide disparities exist in ODR rates for African-American students (30%) compared to white students (9%). Research does not suggest that mental health issues that manifest in behavioral problems are any more prevalent among African-American boys, in particular. The striking disparity suggests that this subgroup is being disproportionately affected. This project aims to reduce the Office Discipline Referral rate in Milwaukee Public Schools for children in pre-K through 6th grade by 25% by the 2021/22 school year (from 20% to 15%, or a reduction of approximately 2,500 students by Year 5 of Phase II).

• Utilizing community support workers to support 2,500 families annually in navigating culturally-appropriate, family-directed services
• Developing and implementing a continuum of parent leadership and cross-sector professional development opportunities to increase parent engagement and support the mental, emotional, and behavioral health of Milwaukee's children ages 0 through 8
• Promoting children's optimal social-emotional development by expanding parent-led developmental screening to 50% of children ages 0-5 in Milwaukee and utilizing findings to enhance early intervention services

The cost of a mental health crisis is both psychological and financial and can be staggering to individuals and their communities. In addition, each call has a "ripple effect." Families, friends and classmates left behind experience trauma. Schools and workplaces lose days of participation. In a four-county community with strained resources, partner recognize a need to address behavioral health before a point of crisis. Through a collaborative effort, this project seeks to reduce the number of behavioral health crisis calls in the four counties (Ashland, Bayfield, Sawyer and Washburn Counties) from current totals by 30% by 2022 by:

• Creating a framework for systemic coordination which will allow cross-sector partners to use resources more efficiently and effectively, and address complex needs 
• Increasing access to services for underserved populations in Ashland and Bayfield counties through a mobile drop-in site in high-traffic locations staffed by a trusted high-level cross-trained coordinator who will give clients warm-handoff referrals to resources that address socio-economic conditions as well as clinical needs
• Improving responses to behavioral health crises through data sharing and increased collaboration among partner agencies

The MCW Partner team consists of faculty and staff from the Center for AIDS Intervention Research, a center of the Medical College of Wisconsin Department of Psychiatry and Behavioral Medicine with extensive community engagement expertise. The MCW Partner Team works with each of the 10 community coalitions to provide evaluation support and guidance to each community as they implement their Phase II plans. In addition to providing consultation for program development and evaluation, the MCW Partner Team aims to develop broader systems-level change to reduce fragmentation and result in durable, integrated and sustained improvement in behavioral health outcomes statewide.