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Joint Selectmen and School Committee
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Joint Selectmen and School Committee Meeting
Thursday, March 22, 2018
A Joint Meeting of the Board of Selectmen and School Committee was called to order at 7:02
p.m. on Thursday, March 22, 2018 in Estabrook Hall of the Cary Memorial Building for the
purpose of holding a third in a series of presentations and discussions about Mental Health
Services provided by the Town of Lexington and the Lexington School Department. Present for
the Selectmen were Ms. Barry, Chair; Mr. Pato; Ms. Ciccolo; Mr. Lucente; Ms. Hai; Mr.
Valente, Town Manager; and Ms. Siebert, Recording Secretary.
Present for the Schools were Ms. Jay, Chair; Ms. Colburn, Vice-chair; Mr. Alessandrini; Ms.
Sawhney; and Dr. Czajkowski, Superintendent of Schools. Ms. Linehan was absent.
Also present were Wendy Rundle, Facilitator and management consultant; Charlotte Rodgers,
Director of Human Services; Melissa Interess, Assistant Director of Senior Services; Val
Viscosi, Director of School Counseling; Larry Berkowitz, Director/Co-founder, Riverside
Trauma Center; Deborah Garfield, Director of Clinical Services, Eliot Community Services;
Andrew Fieleke, Psychotherapist, Family Caregiver and Options Group of Minuteman Senior
Services; and Ann Pruszynski, Director of Children’s Behavioral Health Initiative, Advocates,
Inc.
Ms. Rundle opened the meeting by restating the framing question that has formed the foundation
of these discussions: “What should be the role of the Municipal and School departments and the
community in providing mental health services to the community?” Ms. Rundle then
summarized the first two meetings in the series: The first was held in September 2017 to discuss
Lexington mental health services and to identify needs and topics requiring additional
information. The second Joint Meeting was held in February 2018 at which Municipal and
School staff presented information about current services; how Staff, contractors, and
community groups provide those services; and what challenges are faced.
The third Joint Meeting, taking place this evening, will focus on services available from four
outside contractors: Riverside Trauma Center; Eliot Community Services; Minuteman Senior
Services; and Advocates, Inc.
Ms. Colburn, School Committee member, recalled that at the end of the last meeting, a
discussion took place about the process by which the Town and Schools would collaborate to
identify individual and joint priorities. She asked when these discussions about priorities would
occur.
Mr. Valente, Town Manager, said that discussion, which will include staff recommendations and
an opportunity for public input, is tentatively scheduled to take place on May 23, 2018, pending
board and staff availability. Tonight’s meeting is an opportunity for the Board of Selectmen to
hear some of the same presentations made recently to the School Committee and for the School
Committee to hear from additional providers. On April 26, 2018 the results of a survey of other
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towns’ mental health services will be presented by Lexington’s Human Services department.
Ms. Interess, Assistant Director of Senior Services, reminded participants about the four
components of mental health program delivery: identification; prevention; intervention and post-
vention. These phases are not linear. Town and School staff, plus community providers and
community stakeholders, may become involved in any or all phases.
Ms. Interess then introduced the four outside service providers. The providers were chosen
because they work with diverse populations and age groups and have experience with multiple
collaborators and funding sources, including Massachusetts Department of Mental Health
(DMH), Department of Developmental Services (DDS), Department of Public Health (DPH),
and the Executive Office of Elder Affairs (DOEA). The presenters were asked to answer the
three questions in their presentations:
1) Discuss the role of your agency on the Lexington community;
2) Identify trends of mental health and wellness that your agency is noticing and/or
addressing;
3) Where are the gaps in services?
Larry Berkowitz, Director/Co-founder of Riverside Trauma Center said that Riverside
Trauma Center is a service of Riverside Community Care, a large health and human services
agency with about 100 in-patient and out-patient programs across the state and the age spectrum.
The Trauma Center opened 15 years ago and expanded 3 years later with funding for suicide
prevention from the State departments of Mental Health and Public Health. The Center is
designed to respond to tragic events, such as natural disasters, suicides, and the Boston Marathon
bombing. Riverside provides outreach, consultation, education, and support for communities to
recover from traumatic events; it specializes in what Mr. Berkowitz called “healthy grieving”
and post-vention stabilization. Staff and Community stakeholders work directly with Riverside
staff.
1) Lexington role: Riverside was called in to help Lexington in the post-vention stages of
the teen suicides last year. The Center’s intent is to stay involved for several years after
such events, rather than “parachuting in” for brief periods.
2) General trends noted: Mr. Berkowitz said that suicides clusters can occur in all age
groups but are seen particularly among teens. Nationally, the highest rates of suicide are
th
among older white men. Massachusetts ranks 48 in the nation for suicides and has some
of the highest per capita funding for prevention. It is common to observe increased rates
of depression, suicide ideation, and anxiety after suicides. There is not a lot of research
regarding best practices for post-suicide recovery; the most recent CDC
recommendations were published in 1988.
3) Gaps: The CDC recommends, and Mr. Berkowitz supports, forming community-based
coalitions to address mental health and wellness issues, including suicide prevention,
pulling in as many different people and age groups as possible. The best outcomes are
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seen in towns that link with State and regional services/programs to create a robust
mental health network. Communities such as Newton Needham, and Acton-Boxborough
4) have formed such coalitions (Newton Cares; AB Cares) to identify prevention strategies
(such as training; bolstering/supporting/connecting people to local mental health services;
and identifying preventive strategies) but some towns have not yet determined how to
coordinate and share efforts/ responsibilities.
Mr. Lucente, Board of Selectmen, asked what a suicide post-vention might look like. Mr.
Berkowitz said the response depends on what the needs are. Riverside uses a model called
“Psychological First Aid”, also used by FEMA, the Red Cross, and the World Health
Organization. Strategies are intended to normalize a wide range of reactions and provide
guidance to support resources.
Mr. Alessandrini, School Committee, asked if Riverside works with the Schools to develop
prevention programs. Mr. Berkowitz replied that Riverside was asked for input on Lexington’s
existing programs following the suicides; student screening was recommended. The Trauma
Center is not a mental health program, per se, but the larger Riverside Community Care group
does provide direct mental health services at its offices in Needham.
Ms. Jay, School Committee, asked if the Trauma Center guides communities to identify best
practices in the post-vention phase. Mr. Berkowitz said that, since the Trauma Center covers a
wide geographic territory, it often trains partner organizations to help respond to local events.
Some communities ask for help only initially, others ask for a longer-term relationship that might
include meeting facilitation and training. Since the Lexington suicides, Riverside has remained a
consultant on an as-needed basis. For other communities, Riverside may have a seat on the
mental health coalition for a period of time. Mr. Berkowitz recommended that coalitions be
tailored to individual communities. He noted that Lexington has been working on these issues
and already has pieces in place, including canvassing other communities to find out what has
worked for them. Ms. Jay said that meshing all the various groups together will perhaps be the
biggest challenge for Lexington. Mr. Berkowitz cautioned against what he called a “kitchen sink
approach”; efforts should be coordinated. The best approach is for towns to decide what their
priorities are first, then to form the coalition to address them. Keeping people energized over
time, long after a crisis has been experienced, is a noted challenge.
Deborah Garfield, LICSW, Director of Clinical Services, The Eliot Center. The Eliot Center
is a large health and human services agency that provides a wide range of services to residents of
all ages. Eliot has contracts with Department of Mental Health, Department of Developmental
Disabilities, Department of Youth Services, the Department of Children and Families, the
Department of Elder Affairs, and the Children’s Behavioral Health Initiative (CHBI).
Administrative offices are in Lexington. Eliot also runs a number of group homes in the area.
Eliot administers four out-patient mental health clinics in the area, serving 1,600 people a year.
The Center collaborates with Riverside, including helping to found AB Cares. Eliot recently
became licensed as a substance abuse clinic with referrals coming largely from the Concord
District Court. The Center provides opioid overdose outreach to provide services to families and
communities. Clinicians also serve several nearby school districts. Funding from the United
Way helps Eliot defray costs for clients who need financial assistance to access care, although
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Eliot accepts all commercial insurance plans including Mass Health and Tri-Care military
insurance.
1) Lexington role: Eliot has partnered with Gerard Cody, Lexington Health Director, to
provide multiple Mental Health First Aid courses. About 40 Lexington residents were
served in the out-patient clinic in Concord last year in these areas: individual therapy,
diagnostic evaluations, family and group therapy, medication services, and consultation
with collateral contacts such as doctors, schools, mental health providers. Eliot also runs
a grant-funded jail diversion program, partnering with seven different towns, including
Lexington, via the Police departments; the focal point of this program has largely become
the opioid crisis and addiction recovery.
2) General trends: Eliot sees a growing number of people who struggle with multiple
problems: financial, medical, medication, psychiatric, substance abuse. 30% of the 40
Lexingtonians Eliot served last year got more than one form of service. Ms. Garfield said
there has also been an uptick in the number of children and adolescents requiring
assistance; there is a lack of providers for this age cohort, particularly.
3) Gaps: There are not enough providers to provide medication services and there are often
waiting lists to access care. Eliot is fully staffed but, in general, there is a shortage of
psychiatric care providers.
Charlotte Rodgers, Human Services Director, asked what the Eliot Center’s role is in providing
Mental Health First Aid training courses. Ms. Garfield said some Eliot staff are certified as
trainers but the focus has been on providing in-house support for its clients experiencing suicide
ideation. However, along those lines, Eliot has worked in tandem with Riverside and Ms.
Garfield has been working with AB Cares to provide suicide prevention training for
School/Town staff. QPR training (Question, Persuade, Refer) will also take place in Acton-
Boxborough, prompting conversations about the sensitive subject of suicide.
Ms. Colburn, School Committee, asked if Eliot is currently contracted to provide services to
Lexington. Ms. Garfield replied Eliot does not have specific contracts with towns but it works
closely with communities in which many of its clients live. Eliot connected Lexington to
Riverside at the time of the suicides and provided back-up support, addressing individuals that
needed to be seen immediately.
Ms. Ciccolo, Board of Selectmen, asked how often QPR training should be offered and if there is
a certain percentage of trained staff/residents that Lexington should aim for. Ms. Garfield said, in
her experience, it will work best to strategically target training to where it is needed most. QPR
is suited to prevention across the lifespan.
Mr. Lucente asked if the mental health trends Ms. Garfield named are national or higher in this
area of the country. Ms. Garfield said, in her opinion, there is a general uptick, nationwide, as
people deal with many more stressors than they have before. Kids are pressured to succeed;
depression among elders is silent and often missed.
Andrew Fieleke, LMHC, Minuteman Senior Services said Minuteman is an area agency
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receiving state and federal funding to provide services to seniors. This includes seniors at risk or
struggling with mental health issues; stay at home services; subsidized homecare; caregiver
supports; and care options for those under the age of 60 with disabilities; home-delivered meals,
information and referral services for long-term care options; money management and protection
services; and family care.
1) Lexington role: Lexington is in Minuteman’s 15-town service area.
2) Regional trends: As the baby boomer population ages, Minuteman is seeing an increase
in demand for all its services. The number of adult children with mental health or
cognitive issues who live with aging parents is a growing cohort that would benefit from
support services.
3) Gaps: Unmet needs include therapists who provide outreach services to those who are
homebound, services for those with mental health issues who live in subsidized housing
and risk being evicted for their behaviors; support to help people fill out forms to access
services (Lexington Human Resources does provide this assistance); resistance to seeking
help; connecting families to elders who have become unable to live independently; long-
term support for hoarders.
Ms. Sawhney, School Committee, asked how big Minuteman’s caseloads are and what a typical
case might look, noting that Minuteman does not help with follow-ups such as forms and
applications. Mr. Fieleke said referring someone to a State homecare program would result in a
longer-term relationship with the client. His caseload fluctuates between 30-40 people; he
receives several new referrals each week. Once he gets a referral, he schedules an assessment,
often in the home so he can get a picture of what is going on and what resources and services are
needed.
Ms. Interess noted that her office sees a lot of caregivers who ask for support. Mr. Fieleke agreed
that requests for dementia and Alzheimer’s support are common and profound themes. There are
many spouses who act as caregivers and adult children who provide care to aging parents.
Mr. Lucente asked what best practices Mr. Fieleke sees in other communities. Mr. Fieleke said
there are active Senior Centers in other towns that coordinate services and put out informative
newsletters with “at-a glance” resource listings. Arlington has a program that connects middle
schoolers to seniors who need help with raking and snow shoveling, etc. He believes Lexington
does quite well, noting active ethnic organizations that connect residents across town lines.
Ms. Barry, Board of Selectmen, asked if Minuteman sees increased food insecurity among
seniors. Ms. Interess said the number of Meals on Wheels recipients doubled in the last year. Mr.
Fieleke said his data shows that 201 individuals were served in 2017 by the Meals on Wheels
program.
Ann Pruszynski, LICSW Director, Director, CHBI Services, Advocates, Inc. said that
Advocates is a large, non-profit human services agency that provides 24-hour Psychiatric
Emergency Services through a contract with the State. It serves individuals with developmental
disabilities, brain injury, significant mental health issues, with programs that focus specifically
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on children, families, and adults. Advocates’ biggest service, in the Lexington area, is the
Psychiatric Emergency Services Team (PES) that serves 31 towns from two main offices in
Framingham and Waltham. Mental health and substance abuse are commonly the reasons for
contact, usually coming from family members, community members, providers. Navigating the
mental health system is much of what the crisis team assists with; the focus is largely diversion;
intervention itself often diffuses a situation. Hospitalization is considered a last resort. The team
provides assessments in multiple settings, including emergency rooms, home, community
centers, partner organizations. The primary function of the team is to conduct level of care
assessments with a focus on safety.
Advocates often becomes involved when a school calls with concerns about a student’s behavior.
If a person is under the age of 21, s/he is eligible for a range of services provided under
MassHealth (called Mobile Crisis Intervention); in addition to a clinician, Advocates provides a
Family Partner whose role is to support parents in navigating the process. MassHealth also funds
7 days of follow-up support. Crisis Team caseload levels fluctuate between 15-45 per day. The
team makes referrals to other providers. Ms. Pruszynski heads a department called The
Children’s Behavioral Health Initiative, which provides home- and community-based services
via MassHealth for individuals under 21 with a “serious emotional disturbance”. These services
(in-home therapy, therapeutic mentoring, in-home behavioral services, intensive care and mobile
crisis services) are available to all, including those with private insurance. One of the benefits of
the Children’s Behavioral Health Initiative, according to Ms. Pruszynski, is the ability for
families to choose from a menu of services options.
1) Lexington role: Advocates is expanding its catchment area; it does not currently serve
Lexington.
2) Trends: People are dealing with more complex issues at every age level. Schools struggle
to keep up with the needs of the students. Social Media has caused an accelerated of pace
of problems, particularly for adolescents. The opioid crisis has created new sources of
concern.
3) Gaps: Waiting lists for care providers; in-home therapy; outpatient services; in-home
elder care providers.
Mr. Alessandrini asked if a changed definition of mental health has contributed to the increased
need for services. Ms. Pruszynski agreed that a greater willingness to talk about mental health
issues has yielded an increased demand for services. Ms. Garfield said discussion of “disorder of
the brain” rather than “mental illness” has de-stigmatized asking for help.
Dr. Czajkowski, Superintendent of Schools, said people want to know how to access services.
Schools understand there is a link between mental health and time on learning. She asked how
referrals come to the four agencies represented and if models exist for school-based, on-site
mental health clinics, operated by outside mental health agencies. Ms. Garfield said Everett
Schools have a model of this type; they contract with Eliot to provide the service. The school
identifies students for assessment and therapy when learning cannot occur due to poor mental
health. Ms. Pruszynski reported that Advocates is forming a partnership with Marlboro Schools
along these lines. The first challenges are to get the word out that these services are available and
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to decide what an appropriate referral looks like. Being present and available in a school is
positive in itself but finding private space to meet with students can often be problematic.
Ms. Colburn asked if school/agency partnerships extend beyond the academic day/year. Ms.
Garfield said schools have summer school and, somewhat surprisingly, some kids do come in. If
it is not possible to see students at the schools, they can come to the outpatient clinic locations.
Ms. Pruszynski said the benefit of having these services provided by agencies is that they are
available 24/7 throughout the year and schools do not have to develop a protocol for non-
academic timeframes.
Ms. Jay said access to comprehensive services, as well as confidentiality, are issues. If there is a
crisis, how is the referral made and does the agency stay with the individual for a period of time?
Ms. Pruszynski said the referrals can come from a variety of sources and staying connected with
an individual depends on the issue at hand. Advocates provides a crisis team plus a variety of
community and home-based services.
Ms. Jay asked how to get the information out to residents. Ms. Viscosi said it might be helpful
for the School Committee and Board of Selectmen to understand how many total residents are
seen and how many are referred by School staff versus Municipal staff and community members.
In her experience in the Lexington School community, students with less acute tier 1 or 2 issues
are seen by School staff but a small percentage with emergency level/tier 3 needs are referred by
staff to services through Eliot or the Edinburg Center. When suicide ideation safety concerns call
for an immediate comprehensive assessment, Advocates is the go-to agency. Ms. Jay wondered,
then, if services for tier 1 kids constitutes a gap for Lexington.
Ms. Hai asked if there is something the agencies would recommend for non-school residents:
young adults post-college, very young children, and seniors. Ms. Pruszynski said, generally, a
big part of the challenge is making sure residents become familiar with existing services and the
various levels of care that are available. Advocates helps individuals with that and how to
navigate the many layers. Often, the people in various community social service agencies are the
“gate-keepers” of this information. Helping these staff have the right information and training is
vital. Mr. Fieleke said mental health services that see people in their homes is often a gap. Ms.
Garfield said finding the right referral can be difficult, especially if people are resistant to
seeking/accepting help. She sees Lexington as a town that has a lot of practitioners and yet
barriers exist to taking advantage of that abundant availability. Identifying the people that
struggle to get services (financially, transportation-wise, etc) and provide for them is a challenge.
Ms. Ciccolo said that having a child older than 18 who needs help can be difficult because of
HIPPAA confidentiality laws. The same difficulty may exist with seniors who may not have
given information access to their next of kin. Are there best practices Lexington should develop
to help these populations? Mr. Fieleke said Minuteman always encourages seniors to set up
health care proxies and sign power of attorney documents. Taking the step of affirming a health
care proxy is also a way these documents can be made more robust so that a caregiver or family
member can have more input into health care decisions. Ms. Garfield said it is important to set
up such proxies before they are needed; Eliot often refers people to the programs and
information offered by the National Alliance for the Mentally Ill (NAMI). When the adult child
refuses services, Eliot will work with the family to understand the options such as obtaining legal
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guardianship or merely establish stronger limits such as setting up restraining orders. When
situations are life and death, HIPPAA laws are null and void and Police should be called in to
make sure such an individual is taken to the hospital for crisis intervention.
Participants discussed next steps including identifying gaps in service; how to get information
about existing services to the community at large; understanding the stigma and barriers to
getting help; comparing best practices used by other towns; budget constraints; understanding
how diverse cultures will view mental health issues.
Ms. Jay said she is aware that providers specializing in Asian mental health have contacted
Lexington; these resources might be included in a coalition or comprehensive response strategy.
Dr. Czajkowski said that before additional services are provided, the availability of current
services should be organized and promoted. Ms. Ciccolo noted there is a sense of urgency for the
Town’s leadership to act but, so far, what should be done is unclear. Mr. Valente said that, at this
point, it should be made known that the Town is working on the appropriate role and response
and this a legitimate position. At least two more Joint meetings are scheduled in the near future.
Mr. Lucente said that, although Lexington does provide services, he is not sure they are the right
services; the Schools have evolved over time but the Municipal departments may not have kept
pace with the times and population shifts.
Ms. Rundle said good questions have been raised about services and process. She believes it is
vital to continue these conversations, at the upcoming Joint meetings and in between. Ms.
Colburn agreed, emphasizing it is important for the residents to know that the Board of
Selectmen and School Committee are working on the issue.
Upon motion duly made and seconded, the Board of Selectmen voted 5-0 to adjourn at 9:15 p.m.
The School Committee followed suit with a 4-0 vote.
A true record; Attest:
Kim Siebert
Recording Secretary