It was in 2016 when the Fayette County Drug and Alcohol Commission (FCDAC) joined the Pennsylvania Garrett Lee Smith (GLS) statewide grant program to better address youth mental health and substance use issues. FCDAC Prevention Program Manager Erica Usher, certified tobacco treatment specialist (CTTS), and her Student Assistance Program (SAP) liaisons were witnessing depressive symptoms and suicide ideation steadily ticking upward.
Feeling connected and protected at school is a key support factor for students. The county had increased truancy and dropout rates, putting mental health and substance use issues clearly on their radar for those youth before the pandemic. When COVID hit, and every student was at home, the needed connection wasn’t there for so many more.
“All of this was telling a story that was not contradicting,” Usher said. “We were on this path before the pandemic and it only exacerbated it. We have had crazy high levels ever since.”
Fayette County, Pa., is southeast of Pittsburgh, with Uniontown being the county seat, and the hometown of this article’s author, Marjorie McKee, mdlogix vice president of marketing and communications. Founded in 1783 with lots of Revolutionary War history, it is named for French Military Officer Marquis de Lafayette. A former coal mining area, today about 17.3% of the population (22,000 out of 127,000 people) live below the poverty line, a number that is higher than the national average of 12.3%.
There are six public school districts in Fayette County, with 28 SAP teams covering some elementary schools and all the middle and high schools. FCDAC staff serve as the SAP regional coordinators to the teams, and work on both substance use and behavioral/mental health issues.
Erica has been a prevention supervisor since 2008 and a SAP liaison prior to that. She is also a mom of three kids who attend schools in the Albert Gallatin School District. It is named for the former U.S. Secretary of the Treasury (under President Thomas Jefferson) whose country estate, Friendship Hill, remains open for tours in the county.
Prior to the GLS grant program, the Commission created a homegrown, paper system to keep track of students’ issues and needs. Mental health issues were overwhelmingly getting identified compared to substance use, which the students wouldn’t answer. Students would violate a substance policy and wouldn’t be referred since school providers were more willing to make a referral on mental health issues than on substance use.
They jumped at the chance to use the bhworks software platform from mdlogix, which came with the grant, knowing they could help more students by being more efficient. The software allows for obtaining electronic consent, conducting screenings and referrals, monitoring treatment, and generating outcomes data.
bhworks is a web-based and security compliant software platform that provides a single system to screen whole student populations where students can easily enter responses on any device with an Internet connection (desktop, laptop, mobile phone, tablet, etc.). It takes about 15 minutes to complete.
Results are immediately scored, summarized, and securely sent to the designated liaison for review. Users can add measures in current workflows and/or use the software’s validated assessment which screens across 16 domains of mental health and psychosocial risk. bhworks also gives clients access to more than 140 forms and assessments, including the PHQ-9 (depression), GAD-7 (anxiety), AUDIT-C (alcohol misuse), and C-SSRS (suicide risk). With workflows and best practices configured directly into bhworks, interventions can be managed based on a student’s risk scores.
Usher said, “We needed to focus our efforts and use this resource to make it easier for staff to track student information and see it in real time. There is a lot of reporting we have to do. bhworks screening collects the findings, allowing us to extract data and generate a report. It makes us more efficient. The other benefit we saw was a standardized tool being used in the majority of SAP agencies across the state and submitting needed data for the Joint Quarterly Reporting System.”
Fayette County is screening youth under 12 with the SAP liaison asking the questions. For students 14 and older, they use an iPad to answer the questions. It is the parents’ choice to consent for screening, which is voluntary and confidential. The SAP teams talk with parents and caregivers, as well as send a letter explaining the screening purpose so that a student permission form is completed.
“We monitored and evaluated our communications process; how well we were doing,” Usher commented. “There was a concern that families wouldn’t participate in SAP because of this screening. We had to make it clear that you can participate in SAP without doing the screening, but also to explain why it is important to screen and how that personal data is protected.”
Their improved communications process means that the parental consent rate post-pandemic is better than pre-pandemic. “I can anecdotally say that it’s been a positive experience to have a parent on the phone discussing the screening, send them the consent form, and already have it back before you end the conversation,” Usher said.
The screening report immediately generated in bhworks offers school providers an added check; an alert to follow up in an area. It helps them provide recommendations with the assurance it’s not just a judgment call. The report is their validation and the providers can follow up with the student in person, discuss the results, probe a little further, and offer next steps.
Pandemic Hits
“Our schools really struggled over everything during the pandemic,” said Usher. “Kids were in need but schools struggled to identify them and how to operate in that pandemic world. The schools were strained, not chaotic, but they had to deal with a lot of variables. Things were moving as you were trying to figure things out.”
It was worse if a district didn’t have a strong SAP team and the quarantine restrictions prevented them from connecting with a SAP liaison. Since the Commission’s goal is to better serve students, parents, and caregivers they work to remove barriers to learning; act as representatives in offering action steps; participate in combined research across the state to help outcomes; and of course, continue with the youth suicide prevention grant (GLS).
“We are currently working to be able to use all the tools in bhworks and do all the steps electronically,” Usher explained. “That would have really helped during the pandemic.”
New Data Coming in April
FCDAC relies on the Pennsylvania Youth Survey (PAYS) for data to steer their county resources and program decisions in the right direction. It is a big investment for youth to participate in it and short of the commission doing universal screening, for which it doesn’t have the capacity, the PAYS is an important data set.
The Fall 2021 PAYS is complete and the full report will come out April 30. Fall 2019 was the last time the survey was conducted because of the pandemic. The 2021 data will provide a clear picture of COVID’s impact on students and help determine the best path for Fayette County to take with bhworks to keep identifying those in need and getting them the treatment they need as soon as possible.
Editor’s Note: Erica Usher can be reached at EUsher@fcdaa.org to discuss her experience and answer questions with other school districts.