Question: "How are school-based counselors in other parts of the country receiving their referrals for Mental Health services at school? I have experienced some complaints about having to complete the demographic information (financial forms, consent to treatment, insurance information, etc.) at school. I am interested in knowing what others do from start to finish. Part of the problem relates to SBCs having to strive to reach a certain percentage of productivity daily."

Response:

We like to be certain that this type of specific concern is discussed in the context of all that needs to be done as part of a comprehensive plan for identification, triage, and referral using the principle of “least intervention needed.” Resources and guidelines accessible through our online clearinghouse Quick Find can be found by directly accessing the topic -- “Case Management” at http://smhp.psych.ucla.edu/qf/casemanagment.htm

There you will see documents our Center has pulled together related to a comprehensive system, as well as links to other relevant online resources and centers.

A quick point specific to the request: There is the concept of gatekeeper or point person at the school. This has been used, for example, with regard to special education. This can be a staff or clerical person who facilitates the initial processes. In the case of collecting necessary info for a referral, this involves designating a person in each school who is willing to assist (e.g., with filling out the forms and tracking referrals). Often asking about income and insurance are uncomfortable for untrained/unwilling staff. By having this handled by a designated, trained inschool “facilitator,” you will have someone experienced in asking the questions, filling out the forms, and keeping a centralized “tickler” system of referrals that can be helpful in supporting follow through.

As a way of stimulating a few quick initial responses, we also sent this request to a number of folks who have experience with these matters in schools. Here are some replies:

(1) “We have not had this kind of complaint. Firstly, 70% of our school population are "members" of the SBHC. So we already have that information prior to any referral being made. At the beginning of every academic year a parent signs a consent form that provides all that demographic info and insurance info. This info is kept on 'file' until the student accesses services. When we get a referral for medical, dental or mental health, we check is this student a member. If yes, we proceed with the referral. If not, we proceed to make them a member. Perhaps the issue is that we have an 'infrastructure' that supports our practitioners.”

(2) “This is a major challenge for schools. The HIPAA/FERPA barrier, combined with the requirement for MedicAid to be the ‘payor of last resort’ all come together to impede the referral process. The other issue is schools having to provide services for all students. Consider that when the student's family is covered by an HMO or a third party that has a hefty copayment. How do we insure that services are provided to all students. The first step is to determine what coverage, if any, the student has. This requires the school to obtain this information when they have the parents sign a consent form. Big hurdle. Not always easy getting access to parents. If there is no coverage, then the job involves convincing parents to apply for Healthy Families or MedicAid. Here we must address resistance, especially among immigrant families that are undocumented. Fears - some founded - many unfounded - impede this effort. Having school-based certified reps to sign up families is helpful. School can check their records to see whether students are eligible for EPSDT full medical benefits and transmit information about these children and families directly to the mental health provider so that they can verify coverage prior to implementing school based programs or individual services for student and family.”

(3) “I run a school based mental health program at 4 schools. We do not have our referral sources at the school complete financial, consent or insurance forms. Part of our referral paperwork does explain the funding needed to participate in the program but we tell our referral sources to review that with the students' parents briefly and that we will follow up with it. If the student referred does not have the funding needed, we assist the family in accessing services elsewhere. It is difficult for school personnel to usually understand all the logistics and they often are already overwhelmed with their current job duties.”

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UCLA Center for Mental Health in Schools
Dept. of Psychology, P.O.Box 951563, Los Angeles, CA 90095.
tel: (310)825-3634
email: Linda Taylor ~ web: https://smhp.psych.ucla.edu