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Sept. 1, 2023
In this issue ...
Reflections from Oregon Health Authority's Child and Family Behavioral Health Director
The school year has begun, and the leaves are beginning to change. The beauty of fall brings to mind new beginnings, the joy of learning and all the friends that children will make in their classrooms. However, this is not the case for all youth as unfortunate as it may be.
The experience of being a child or a youth should be filled with energy, curiosity, and the pursuit of dreams. Yet, for many young people, it can also be a period marked by vulnerability, anxiety, and a sense of isolation. September is Suicide Prevention Month, and youth suicide is a global concern that needs immediate attention. According to the World Health Organization (WHO), suicide is the second leading cause of death among ages 15 to 29 years.
Emotional stress for young people is on the rise with the pressures of school, relationships, family dynamics, and social media. Depression, anxiety, and other mental health issues often go unnoticed or untreated, leading to a sense of hopelessness.
To practice prevention, we need to raise awareness about the signs of mental distress and the risk factors linked with suicide. Preventing youth suicide requires an approach that addresses what is affecting young people. By spreading awareness and building support systems, we can create an environment where young people feel valued and empowered to seek help when needed. Each life saved through these efforts represents a future filled with potential, creativity, and the promise of a better world.
In July, I was able to attend the National Association of State Mental Health Program Directors (NASMHPD) annual conference, along with Behavioral Health Director, Ebony Clarke. While there, we attended presentations from Substance Abuse and Mental Health Services Administration (SAMHSA), the Tribal 988 and Crisis Services Panel. Three were presentations about building sustainable partnerships with Tribal and Indigenous communities, and peer support services across the crisis continuum. The work that NASMHPD does is vital and supports the work that CFBH does— and is crucial in supporting children, youth and families.
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Chelsea Holcomb, Director of CFBH and Michelle Zabel, Director of Institute for Innovation and Implementation
Chelsea Holcomb, Director of CFBH and Ebony Clarke, Behavioral Health Director OHA
September is suicide prevention month. We often say “suicide prevention is everyone’s business.” As we enter the fall season, when suicidality among young people often increases, we are asking you to make it your business as well.
CFBH unit’s Youth Suicide Prevention Policy Coordinator Jill Baker and Youth Suicide Prevention Program Coordinator Shanda Hochstetler recently sent out a memo to school leaders, inviting them to action. While this was designed to invite school leaders into action, we invite you to receive this message to do your part as well to make this fall safer against suicide for our young people:
“Each year, youth suicide attempts and deaths increase in the fall – often corresponding to the start of the school year. This season of increased risk is a 20-year national trend, not only in Oregon but also in many countries around the world. This memo, and the supporting documents, are an urgent request to all elementary, middle, and high school leaders to prepare your school community to be better equipped to identify students who may be at risk of suicide and to refer those students to help.
The Oregon Health Authority (OHA) monitors youth suicide data through county reports of youth suicide deaths filed through the state medical examiner’s office. These data are preliminary and not public due to being potentially identifiable. As of July 2023, the total number of youth suicide deaths in 2023 are similar to 2022 However, in that same time frame, OHA has identified a higher-than-average number of youth suicide deaths in children 14 and younger. Because of this concerning uptick regarding younger youth, we are asking those serving students in grades 4-9 to pay particular attention to their suicide prevention and suicide intervention policies and procedures.
To be clear, youth suicide is largely preventable and there are nearly always signs. Schools hold immense power to recognize risk, create safety, and to link students to lifesaving supports. With attention, supports, good training and thoughtful measures, schools can increase safety for our students against the risk of suicide. We also know that suicide is complex, and there is not one strategy or youth-serving system that can prevent suicide alone.
A trusted adult is one of the most impactful protective factors a young person can experience. Your wellness as a youth-serving adult and school leader, is also essential to the wellbeing of the students in your school(s). Please consider your own well-being as you take steps towards supporting your students.” Read more in this call to action memo.
In July, a team of ten leaders in black youth wellness from Oregon traveled to Baltimore at the invitation of Substance Abuse and Mental Health Services Administration (SAMHSA), to participate in the first cohort in a Black Youth Suicide Prevention Policy Academy. This team had representation from Marion, Linn, Polk, and Portland metro areas.
The travel team gathered data, identified the need for Oregon to establish a Black Youth Suicide Prevention Coalition, and brainstormed an initial list of key partners/roles. The travel team intends to meet again to plan out further community engagement and potentially host a town hall opportunity. To stay informed of these efforts, please email nikobi.petronelli@oha.oregon.gov or jill.baker@oha.oregon.gov.
Left to Right: Des Bansile, Adulting IRL; Nikobi Petronelli, OHA; Anderson DuBoise, REAP; DeShawn Williams, LCSW private practitioner; Ishawn Ealy, Salem-Keizer Public Schools; Sofie Fashana, Western Oregon University student; Jill Baker, OHA; Heather Carmichael, faith leader; James R. Dixon, Multnomah County; Canada Taylor Parker, Multnomah County
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Hello everyone! My name is Julie Graves (she/hers) and I am thrilled to be joining the CFBH Team as the new Intensive Services Coordinator. I hold master’s degrees in experiential education and counseling and a doctorate in educational psychology. I began my career as a therapist (eventually becoming licensed in New Mexico and Colorado, currently a licensed professional counselor in Oregon) working with youth and their families in community-based and residential treatment settings. While in graduate school at University of Colorado at Boulder, I worked full-time as a Program Evaluator at the Colorado Department of Public Health and Environment. In that role I guided teams through the processes of planning and evaluating various kinds of prevention services and led a ground-breaking strategic planning effort to reduce LGBTQ+ health disparities.
Julie Graves with her dogs
Following my doctoral studies, which focused on how adults learn through dialogue with one another, I took a faculty position at Oregon State University in their Human Services program. I taught several undergraduate courses and maintained a large network of partnerships with human service agencies, schools, and government entities that mentored the students in internships.
Since departing OSU, I have worked in K-12 regional systems focusing on suicide prevention as well as diversity, equity, and inclusion (DEI) strategies for another large employer in Oregon. For years I have interacted as professional partners with various members of OHA’s CFBH Team, and I could not be more excited to now be joining you in the outstanding work you do for Oregon families. My career path to this point has taught me much along the way, including the reality that strong and effective programs and facilities need strong and effective systems to support and sustain them, that is what drew me to this position.
In my personal life my priorities include caring for my two puppers (my kiddos!), my home in south Salem, my family from a distance (in Texas), and spending as much time as possible close to nature around a campfire, hiking or kayaking with friends and dogs! I also love to spend time reading, practicing mindfulness, learning the guitar and piano, trying to become a better cook, sampling Oregon’s amazing wines and ciders, and standing my ground against the ever-encroaching blackberry bushes in my yard! I look forward to meeting and working with each of you.
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Hi there! My name is Christianna Rhoads (she/her/hers) and I am honored to join OHA as the Wraparound and System of Care Coordinator. I have over 18 years of experience in wraparound and was first introduced to the process when my youngest child was 4. In my own words, wraparound is a fidelity process that uses a strengths based, team based, family voice and choice approach to support and empower youth and family members to achieve their individual and/or family goals.
In 2005, I graduated from the University of Texas at Austin with a master’s in social work. While working in child welfare, simultaneously caring for my child with complex behavioral needs, I was introduced to wraparound and found my new passion for wraparound related work. Since 2007, I have worked in a variety of Wraparound and System of Care roles such as a family support specialist, a wraparound, system of care and family support trainer, a family partner program coordinator, a local system of care facilitator, and wraparound care coordinator and coach. I come to OHA from Benton County Child and Family Mental Health Program in Corvallis, Oregon, where I have worked since January 2021. I blend my social work background with my professional and lived experience in children’s mental health in hopes of igniting a passion for fidelity wraparound across the state, improving outcomes for youth and families.
In my free time, I enjoy spending time with my family and friends, participating in masters swimming and water aerobics, and nature traveling in my camper van.
Christianna Rhoads
Currently the CFBH unit is conducting a listening tour across Oregon to hear from youth, families, providers, and community partners about their experience with two legislative investments: school-based mental health and mental health promotion and prevention.
School-based mental health programs partner with local schools and districts to create an immediate path for youth, young people and families to receive mental health help. Funded at $2.5 million annually, fifteen community mental health agencies provide on-site counseling, crisis intervention, skill building groups, and support to school staff across seventeen counties.
Mental health promotion and prevention projects across Oregon build awareness of mental health, normalize help-seeking behaviors, and lift up communities. Activities are prioritized to support mental determinants of wellness, including social emotional competence, individual skill development, and healthy communities. Legislatively allocated general funds have been provided by the Oregon Health Authority (OHA) since 2014. Funded at just over $4 million for the current 21-23 biennium, projects are implemented by 24 local public health agencies, culturally specific community-based organizations and coordinated care organizations across 27 counties in Oregon. During the 2025-27 biennium, the CFBH unit hopes to expand capacity both within programs and to broaden efforts to additional counties.
Fran Pearson, who oversees the contracts for both programs, says “families, communities and schools have been asking for additional mental health services and supports even prior to the pandemic and those may look different for each community. I am deeply committed to centering youth, family and community in this process, elevating their ideas on how more funding can help and work together to co-develop a future funding ask to the legislature.” Fran has visited with five programs so far, with 15 program staff and over 30 community partners, youth and families in attendance; with twenty additional visits planned through the end of 2023.
Partnerships between schools and local mental health and community-based organizations can be particularly effective in addressing the mental, emotional and social needs of students and their families. Prior to and during the pandemic, the mental health needs of students outweighed the capacity of many school-employed helping professionals.
Continued provider shortages have created long waiting lists for outpatient mental health clinics and private practices. Having mental health services accessible at school creates immediate access to healing pathways for students reaching out for help and offers safe, supportive alternatives to exclusionary discipline. Community employed mental health clinicians have proven themselves to be a key workforce and can aid schools by serving as a bridge to the local mental health system and other community-based supports. A recent article from the National Center on Safe Supportive Learning Environments cites the benefits of school-community partnerships: “when school staff can collaborate with partner specialists in the school building, services can go deeper, and kids are more likely to get the support they need.”
This figure illustrates ow community providers fulfill complementary roles in local schools and districts, working alongside school staff and educators to support student mental health and wellness.
frontier areas across the state to reduce geographic disparities in areas with little to no access to mental health services. A statewide scan conducted in 2022 to learn the broader scope of school-community partnerships revealed that over 50 agencies across Oregon partner with schools and districts to provide mental health services in school and over one-third of schools have a community-based clinician providing services on-site. Partnerships often use a braided funding approach, including billing Medicaid, use of local/regional grants, and some districts utilize their Student Investment Account dollars to support therapists’ time in schools.
The National Center for School Mental Health has created a foundational document to guide local, state, and national strategies to strengthen school mental health efforts. This framework outlines eight core components (see figure below) where collaboration and teaming between families, schools, and communities are strengthened and how collective support can best be utilized to help student and family health, mental health and wellness. Beginning next month, our newsletter will spotlight one of the core features of a Comprehensive School Mental Health System each month.
Additional resources:
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National System of Care experts from the Innovations Institute at the University of Connecticut are helping OHA to review how we use Medicaid within the state. Some barriers to system change are the historical structures that have been created for Medicaid. Our system has grown one waiver at a time and has been largely adult focused. This means that the children’s system has evolved without whole system design creating a number of silos, missed opportunities and inconsistencies. This review will look at the whole picture across OHA and the Oregon Department of Human Services. Its goal is to make sure resources and power are fairly shared, and to acknowledge, heal, and fix unfairness from both the past and today.
The review will be complete in early 2024 and we expect to share this widely.
Chelsea Holcomb and System of Care Policy Strategist Hilary Harrison will hold two community conversations in September.
These are opportunities for providers, community members, youth and family to engage with OHA and have conversations around topics.
This month these will focus on the continuum of care: What’s new, where are the concerns and what’s next?
Join the September 6 ZoomGov meeting
- Time: September 6, 2 to 3:30 p.m.
- Meeting ID: 160 688 0357, Passcode: 342989
- Dial in: (669) 254 5252
Join the September 21 ZoomGov meeting
- Time: September 21, 5 to 6:30 p.m.
- Meeting ID: 160 752 6471, Passcode: 105841
- Dial in: (669) 254 5252
This group is providing feedback for the development of the next version of the children’s behavioral health strategy, or Roadmap. These meetings are being held the second Thursday of each month from 4 to 5 p.m. on Zoom.
The next meeting is set for September 14.
- Please email Hilary Harrison for the link and more details if you are a family member and would like to be involved.
- The focus for September will be conversations around the data driven decision making pathway in the Roadmap.
If you are a part of a family group in the community then we would welcome your engagement in this work. In the development of the next version of the Roadmap, it is especially important to ensure that we hear and center the voices of those who have been historically marginalized and those experiencing developmental disability.
We are happy to come listen to your group’s insights on system needs for both mental health and substance use disorder for young people, from infancy through age 25, or to facilitate a guided conversation.
The System of Care Advisory Council (SOCAC) facilitated a Safety Workgroup to make recommendations to (1) improve outcomes for youth with a recent history of aggression who need residential care and to (2) ensure safety for those youth and the providers who work with them. The recommendations were sent to the Oregon Legislature and discussed at the SOCAC. The SOCAC Legislative Committee is planning next steps for implementing the legislative recommendations in the report. The full report can be found here.
For further information please contact Anna.K.Williams@oha.oregon.gov.
Intensive Treatment Services capacity remains a critical concern to CFBH. Each week we receive data on capacity for acute care, sub-acute and psychiatric residential, as well as substance use disorder residential programs.
- We monitor these data to understand patterns and to offer help in keeping programs operational.
- We are working on a monthly dashboard and a way to display real time program bed capacity. Discussions are underway on how to display the additional data points collected, which include total referrals received, total weekly admissions, and total weekly discharges. Next month we will display a table of total monthly admissions and discharges to the programs that participate in our data collection.
- In June we connected with more psychiatric residential programs to involve then in our capacity monitoring. Our goal is to have 1or 2 more Psychiatric Residential Treatment Facilities programs participating in these efforts by August.
- There continues to be progress made on the referral management system, which will collect data on referrals to Psychiatric Residential Treatment Facilities (PRTF) in real time. The CFBH team has seen some preliminary examples of what this software will look like and is excited to share more concrete updates as they are available.
The graph below shows capacity over time.
- The top line represents the goal for the system established in 2020, of having 286 beds available for youth.
- The line below shows the highest possible capacity that could have been available, given full staffing and removal of all other barriers.
- The bottom bar chart represents a monthly summary of reported weekly operational capacity, a combination of beds in use and open beds. In the last 12 months the largest impact on capacity has been the ongoing struggle to fill workforce vacancies and manage staffing levels.
Find events, opportunities, trainings and resources in last month’s posting. Many of these trainings are also on our website. We will send updates mid-month — Look for the next one in your inbox on September 15.
For feedback and suggestions for our newsletter and information: kids.team@oha.oregon.gov.
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