Louisiana ranks last across many social determinants of health, with minority children most impacted. Mental and behavioral health (MBH) is a particular concern, with 32% of Louisiana’s African American children experiencing two or more adverse childhood experiences. Yet, ~60% of youth in need are not receiving MBH services, ranking Louisiana third worst in the country.
Universal screening is an effective early identification tool for students who need MBH support, and schools are a natural platform to provide screenings and health services to children. However, New Orleans’ decentralized school system poses complex implementation challenges. In the absence of a traditional school district, an intermediary is needed to project-manage and provide proof points for replication.
To clarify the need and develop a proposed solution, NPNO spent 10 months spearheading a collaborative, inclusive, strategic planning process. The process was supported with seed funding from Baptist Community Ministries and Children’s Hospital New Orleans (CHNOLA), both of which recognized the value in taking time on the front-end to build a shared awareness of needs and collective ownership of possible solutions. During this planning process, school stakeholders representing over 20,000 students were interviewed regarding their students’ existing needs and gaps in capacity to respond.
Naturally, such robust stakeholder engagement surfaced a wide variety of needs. In order to triage and vet proposals, NPNO recruited and convened a 25-member steering committee with representatives from schools, city and state government, and community-based mental health providers. This cross-sector steering committee analyzed and ranked project ideas – and ultimately selected the following services, which will be piloted in three to four schools:
- Universal MBH screening and connection to services;
- Acute mental health crisis coordination;
- Discharge planning;
- Primary care telehealth; and
- Family health engagement.
Because schools need additional capacity and support to implement the five critical interventions identified by the steering committee, NPNO will be working with CHNOLA to hire a ‘Health Leader’ to provide needed capacity and additional expertise to the pilot schools.
The expected outcomes from the Health Leader pilot program are:
- Improved student mental and behavioral health, leading to reduced disciplinary issues and improved academic performance;
- Development of school-wide prevention and intervention strategies;
- Action plans for acute crises, possibly including a centralized “crisis response team”;
- Improved discharge coordination, including creation of standard protocols for post-acute care and information sharing with schools;
- More equitable access to primary health care for working families; and
- Increased family health literacy.
A third-party evaluator will rigorously analyze outcomes to attest to impact and demonstrate replicability and scalability, including but not limited to, effective school Medicaid billing models.
For the three-year duration of this project, schools will be resourced with additional capacity provided by the health leader as described above. Schools will also have access to relevant, specific professional development trainings from CHNOLA, one of the nation’s premier pediatric hospitals.
NPNO acknowledges there are barriers to long-term sustainability but seeks to overcome them by:
- Providing schools with a toolkit for launching effective school-clinical partnerships and implementation of school-based health services, informed by the project’s key learnings and our relentless attention to project design, adaption, and management;
- Determining how Medicaid reimbursement could cover costs associated with the projects five series;
- Recruiting state agency investment in supporting the expansion in New Orleans, and then state-wide; and
- Encouraging schools create cohorts amongst themselves to cost-share expansion of shared clinical services.