Effectively identifying and treating youth struggling with mental health.
Schools in King County, like schools across the US, carry much of the burden of poor youth mental health. A The 2018 Healthy Youth Survey found 16% of 8th and 12th graders in King County had made a suicide plan in the last year, and 8-9% of all students had attempted suicide.
Students contemplating suicide are suffering, often silently, and many slip through cracks in the support available in schools and elsewhere. Oftentimes it is the individual no one suspects is suffering. In addition to the potential tragedy of losing a life, students who are suffering impact community wellbeing and often lower their school performance, attendance rates, and graduation rates–all of which can negatively affect school funding. Lack of school funding further impedes the ability to provide services and sets in motion a negative spiral for the entire community and wellbeing of the student body.
With the approval of the Best Starts for Kids (BSK) program, King County schools got to work identifying the students in need, and getting them support including mental health support in its middle and high schools, and improving the health of the community. In partnership with NGO Reclaiming Futures and community services such as Youth Eastside Services, King County’s Department of Community and Human Services implemented a school-based Screening, Brief Intervention and Referral to Treatment (SBIRT) program in 42 middle and high schools to identify and treat students suffering from mental health issues and potential misuse of substances.
A common challenge in typical screening tools is limited accuracy, measured in terms of sensitivity and specificity rates. Youth in particular – afraid of stigma, judgement, and lack of trust – oftentimes do not openly and honestly provide detailed information regarding their lives and challenges and fears they face. King County set out to address this with a more appropriate screening tool to yield higher performance for their students.
“Without the right identification and support, mental health challenges in King County schools can have devastating consequences on the entire school community. Students suffer and are unable to fulfill their academic and extracurricular potential, which hurts the entire education system and community.”
School-Based SBIRT using Check Yourself© Powered by Tickit®
King County uses Digital Empathy to better identify students in need: King County chose Check Yourself, an evidence-based screening tool authored by Seattle Children’s Research Institute in 2018, and designed on the Tickit Health platform to launch a universal digital screening program in 50 middle schools. The unique interactive screening tool based on Tickit Health’s proprietary Digitally Empathy Design Framework™ also includes carefully crafted strengths-based indicators such as, “At school there is an adult who really cares about me,” or “Others have said that I am good at …” to gather information about more protective factors such as connectedness and resiliency.
Other systems didn’t have the same level of sensitivity as Tickit Health. “We looked at all of the validated screening tools, and they all looked for problems. Our kids are not just a set of problems and symptoms,” said King County school-based SBIRT program manager Margaret Soukup, noting that Tickit Health enables the screening “to have a deeper reach”.
The screening is presented as a health and wellness initiative and it is up to each school to select at which grade to administer it, ranging from grade 6 to grade 8. Schools also have the option to administer the program as an “opt-in” or “opt-out” model whereby parents can choose to have their child excluded from the program if they wish. More than 8,000 students participated in the program in its second year and the county is on track to reach 5,000 students this year, despite the fact that most schools transitioned to online learning during the pandemic.
Using Tickit’s dashboard, school counsellors monitor individual student responses in real time, and administrators can monitor results at a population level such as trends within a school, or grade level. Results are streamlined to promote efficiency and to direct support where it is most needed. A green flag means no intervention is required, a yellow flag indicates the need for a brief intervention of a non-urgent nature, and a red flag alerts to concerns that must be addressed immediately or within 24 hours. Tickit is a purpose-built solution that securely controls access to the data on a need-to-know basis. With varied levels of access at the school, district, and county level, Tickit ensures the safety and privacy of students’ responses. According to data from the 2019-20 school year, nearly half of participating students received brief intervention, and 15% were referred to services.
“This is the beautiful part of Tickit,” said Soukup. “The students are taking the screening and in real time the counsellors see the results at the backend … so they can triage and be really efficient.”
School-based interventionists conducted brief Interventions of 15-20 minutes with the moderate and high-risk youth to assess strengths, facilitate goal-setting, provide referrals, and follow-up as needed. Students who needed it were then given a referral to services through school-based services or community partners. Each of the 42 schools determined the screening implementation policies that best suited their specific school’s needs. The vast majority of students participated even though participation wasn’t mandatory. Most districts began the SBIRT implementation in December 2018.
improvement in detection of risk factors not previously known.
Improved detection and treatment of child and youth mental health
Through Tickit’s Check Yourself tool, King County uses Digital Empathy to better identify students in need, efficiently implementing SBIRT across a large population of students. Universal screenings connected kids who were not previously identified as needing support to interventions and referrals. Because of Tickit’s Digitally Empathetic approach, students were more forthcoming with information, so students previously unidentified as being at risk were now identified as needing help.
Tickit Health’s Digitally Empathetic approach to capturing information from vulnerable populations was of particular value to King County. Since introducing the program, counsellors have uncovered a vulnerable group who would have been missed or extremely difficult to identify without Tickit: internalizers, those students who appear to be doing great on the surface but may actually be suffering.
“Counsellors are just unbelievably grateful for the screener because for whatever reason, some of these students will really say what’s going on,” said Soukup.
Through Check Yourself© on the Tickit Platform, King County schools efficiently implemented SBIRT across a large population of students. Universal screenings connected kids who were not previously identified as needing support to interventions and referrals. With Tickit’s Digitally Empathetic approach, students were more forthcoming with information, so students previously unidentified as being at risk were now identified as needing help. Furthermore, the data gathered from Tickit surveys is helpful for informing the design and implementation of school programming that best meets student needs.
SBIRT connected 37% of students who were screened to brief interventions and 15% were referred to community services. Counsellors were more effective during the Brief Interventions as they had more complete information on each student.
Students overall found their experiences with counsellors satisfying: 91% of students felt their interactions during the brief interventions were “good”, “very good” or “excellent”.
Even without interventions, the digital screening powered by Tickit helped students feel more connected to the school community. One SBIRT interventionist commented, “Just knowing that we care enough to have the screener, and the way the questions are geared towards their developmental level, says ‘we care about you, and we want to know how we can support you.’”
Finally, the Digitally Empathetic tool identified students needing support and streamlined the school processes for connecting them to supports. In future years, King County schools will expand this program and use it to identify mental health needs stemming from COVID-19. Work is also being done to create a version of Check Yourself for high school students, by updating language, colours, and icons.
of students felt their interactions during the brief interventions were good, very good, or excellent.
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