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HomeMy WebLinkAbout2018-05-02 JM BOS-SC-min Joint Meeting of Selectmen and School Committee Page 1 of 5 Joint Selectmen and School Committee Meeting Wednesday, May 2, 2018 A Joint Meeting of the Board of Selectmen and School Committee was called to order at 7:03 p.m. on Wednesday, May 2, 2018 in Estabrook Hall of the Cary Memorial Building for the purpose of holding the fourth in a series of presentations and discussions related to Mental Health Services provided by the Town of Lexington and the Lexington School Department. Present for the Selectmen (BOS) 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 (SC) were Ms. Jay, Chair; Ms. Colburn, Vice-chair; Mr. Alessandrini; Ms. Linehan; Ms. Sawhney; and Dr. Czajkowski, Superintendent of Schools. Also present were Wendy Rundle, Facilitator; Charlotte Rodgers, Director of Human Services; Melissa Interess, Assistant Director of Senior Services; Gail Fields, Co-chair of the Human Services Committee/clinical social worker; Martha Kurland, Human Services Committee/clinical social worker; and Tony Serio, Assistant Director of Lexington Youth and Family Services. 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 Lexington community?” Mr. Valente summarized the discussions to date, saying that the topic of mental health was first raised by Alessandro Alessandrini in April 2017. Since then, two planning meetings have taken place as well as the first three public meetings convened on September 27, 2017; February 7, 2018; and March 22. 2018. The fourth Joint Meeting, taking place this evening, will focus on a report by the Human Services Committee regarding research it has done on mental health services/programs provided in comparable municipalities. Other topics to be covered are an assessment of challenges and opportunities as identified by staff and a review of Community Health Network Area 15 (CHNA 15) best practices grant for Municipal/School/Community collaboration. A fifth joint meeting, tentatively scheduled on May 23, will focus on Municipal and School staff recommendations to answer the framing question about the Town/School/Community’s role in providing mental health services. It remains to be determined when and how public input will be gathered and processed. Mr. Valente noted that Annual Town Meeting 2018 approved approximately $82,000 to be used for as-yet-unidentified efforts moving forward. Gail Fields, co-Chair of the Human Services Committee, said she and other Committee members conducted individual telephone or in-person surveys of nine comparable towns with similar demographics and school populations. Ms. Fields noted that the Human Services department provided valuable staff support in this effort. Joint Meeting of Selectmen and School Committee Page 2 of 5 Ms. Fields presented town profiles and findings from Action, Arlington, Bedford, Concord, Natick, Needham, Newton, Wellesley, and Westford and followed this analysis with comparable data points from Lexington. Categories included: total population; school population; Health and Human Services programs; clinical staff numbers; program types; if referral services are provided; and if the town has established a mental health coalition. Different models and approaches emerged in this analysis. Each town has developed programs tailored to fit its individual needs. For example, Ms. Fields noted that Acton does not employ clinical staff but does have a Youth Center that serves its relatively large youth population. That facility was originally funded privately. Arlington has a staffed mental health clinic and a youth counseling center funded by an Enterprise Fund/fee for services model. Acton, Arlington, Natick, Needham, and Newton all have mental health coalitions. Seven of the towns offer mental health referral services, using the William James interface that “spans the lifecycle.” Most referral programs, if not all, started with the help of matching funds but eventually came under the Town/School funding model. All towns except one continue to use the William James program; the lone town that dropped out now wants to return. Lexington, compared to other towns, has a large school-to-total population ratio; it has no mental health coalition and no third party referral services but it does have a well-developed Human Services department with 5 clinical staff/ 4+ non-clinical staff. This staff provides assistance for seniors, youth, veterans, and those in need of public transportation services. Ms. Fields emphasized that Lexington does provide crisis intervention and that an effort has now begun to establish a mental health task force/coalition. Ms. Fields reported that in 2008, the Human Services Committee recognized Lexington had no designated Youth department. Since then, additional staff have been hired to provide a safety net. However, demands on the Human Services department continue to grow: Since 2015, the number of seniors requesting assistance has increase by 40%; the non-senior category has risen 20%; and the number of residents seeking mental health and support services has increase 129%. Human Services recognizes that it is critical to work collaboratively in order to meet these demands; additional staff will probably be needed over time to expand capacity. More parenting, psycho-educational, and other complementary/supplementary programs are needed. It was noted that 340 people recently participated in a program called “The Secret Life of Teens.” Charlotte Rodgers, Director of Human Services, reviewed the four-step integrated mental health program Lexington now follows: identification, intervention, prevention, and post-vention. The CHNA15 grant will increase the ability to provide more prevention activities. Mr. Rodgers noted that one common factor in towns with effective mental health programs is a strong Parks and Recreation department. Melissa Interess, Assistant Director of Senior Services, presented a summary of “Challenges and Opportunities” sorted into three key categories: Supportive Mental Health Services; Interdepartmental Communication; Education and Training. Those three categories were then broken down into “areas staff can address/impact” and “challenges the Town might not easily Joint Meeting of Selectmen and School Committee Page 3 of 5 change.” Ms. Interess said staff/department capacity; developing a commonly held understanding of confidentiality; the ability to identify those at risk; access to services; and collaboration among stakeholders are areas of concern. Ms. Fields added the issue of stigma as an important area to be addressed. If privacy is assured, more people are likely to seek available services. Ms. Rodgers provided a status report on Lexington’s efforts: the CHNA 15 “Best Practices in Community Health Response” grant is enabling the formation of a Steering Committee with Town, School, and community stakeholders. The Committee will use this pilot year to plan the next three years; it will present, by December, a vision of what a sustainable community mental health task force model looks like. Other goals include: developing a clear delegation of roles and effective communication protocols; providing opportunities for community conversation; providing mental health education and training programs such as Mental Health First Aid, Question Persuade Refer (QPR), and Parenting programs. At the end of the planning year, Lexington will be able to apply to the CHNA for a $25,000 impact grant to fund the first year of the next three-year program introductory period. Mr. Lucente (BOS) asked what long-term mental health services other communities offer. Using the Town of Bedford as an example, Ms. Rodgers said that clinical services are obtained under a contract with Eliot Community Human Services, one of the providers that presented at the last Joint Meeting. One or two Eliot clinicians come to Bedford twice/three times a week and residents have access to them via appointment. According to Bedford’s Youth and Family Services director, very few people have regular, weekly appointments. Consultations are held in a private environment, similar to a therapy office; Eliot takes health insurance, which is similar to the Arlington fee for services model. In Bedford, if insurance coverage runs out and the clinician and client agree more support is warranted, the Town can assist with funding. Shorter- term behavioral modifications are within the scope of most insurance; hospitalization would be beyond the scope of what a municipal government should expect to cover. Ms. Colburn (SC) asked what a Mental Health Task Force is and what it would do. Ms. Rodgers said this question is one the Steering Committee intends to figure out during the pilot planning year. Lexington has contracted with a consultant to help the group look at models best practice during the planning year. Larger questions about the task force are who owns it and how is it funded? Ms. Rodgers said by the end of the planning year, there should be answers to these questions. One of the key points that has emerged so far is the issue of interdepartmental clarity: what protocols and procedure should be unified across departments so that when an event occurs, all responders work from the same playbook. Ms. Rodgers expects that task force members will be drawn from the Health Department, Human Services, School, Library, Recreation, Police, and Fire. An initial meeting with the Community Coalition, formed several years ago, is planned within the month, however Ms. Rodgers believes municipal and school departments should be in accord before the Coalition is formally drawn in. Joint Meeting of Selectmen and School Committee Page 4 of 5 Ms. Hai (BOS) asked how available services should be communicated to the public and how people in need of services are identified. Ms. Rodgers said Mental Health First Aid and QPR training should make more people comfortable with conversations about mental health. Mental Health First Aid training is 8 hours long; QPR is only 1 hour; Ms. Rodgers feels that the shorter timeframe encourages more people to participate. Those in need of services are often identified when they come to Human Services about another issue, such as financial insecurity, but are then found to have underlying mental health problems. To facilitate communication, Ms. Rodgers suggested an information system with several physical hubs (schools, Community Center, etc.) and the creation of an effective, informational website. Communication will also be improved once all departments are aligned and issuing the same message at the same time. Mr. Alessandrini (SC) asked if having an in-house mental health clinic is more beneficial than offering referral services. Ms. Rodgers said that in-house clinicians are not available 24/7; 911 is the safety net used by all communities for overnight and weekend emergencies. The Enterprise Fund model used by Arlington (about $580,000/year) is unusual but she noted Arlington also has fewer in-school clinicians. Lexington, on the other hand, has a robust in-school staff of counselors and social workers. Ms. Rodgers emphasized that Lexington provides short-term, solution-focused transitional counseling that includes an assessment piece. If longer-term supports are needed, Human Services tries to move the client to appropriate outside providers. Ms. Sawhney (SC) asked what challenges other towns reported. Ms. Fields said the communities contacted were all very positive about their mental health program models. She suggested this question of challenge might be asked of the towns in a follow-up to see what emerges. Staffing capacity and the availability of around-the-clock support are issues all towns mentioned. Ms. Rodgers said a recurring theme in her department, as well as in the presentations made by clinical care providers, was the increasing complexity of the problems being encountered. Ms. Fields believes it important to recognize the broader network of identifiers, such as postal carriers, Meals of Wheels volunteers, and others. Dr. Czajkowski, Superintendent of Schools, addressed the stigma of mental health and the importance of education on the subject. She believes the question of outreach is a large one and that a sort of fragmentation exists in that many people are working on this same issue but the effort and approach is not coordinated. She believes it is important to develop a protocol of communication to use during a crisis and said it would be better to identify troubled kids and families before something happens to compel mandated reporting. Dr. Czajkowski plans to reach out to the Arlington Superintendent of Schools to learn how the schools coordinate with the municipal clinical staff. Ms. Fields said she is aware that not all mandated reporters (such as social workers and nurses) follow through because of a reluctance to have a matter enter the legal and mental health systems. Ms. Jay (SC) said, in tandem with the coordination piece, Lexington’s gaps in service should be identified. She believes accessibility is another key piece of the puzzle. Also, people may need services but not realize it or cultural differences might be barriers to asking for help. Ms. Jai Joint Meeting of Selectmen and School Committee Page 5 of 5 believes people may be coming in “through the back door” rather than accessing services directly. Perhaps a youth center or other facility would be a place where support access occurs more organically; she asked that this question be asked of the comparable communities. Ms. Lenihan (SC) said she was struck by the number of communities that use referral services; she believes Lexington would find great value in providing this resource. Ms. Ciccolo (BOS) agreed that a referral service is probably needed but she also believes Mental Health and QPR training is essential. She would like to consider how to set community-wide expectations, such as that all coaches, teachers, and community volunteers would periodically receive training. Ms. Ciccolo added that she was impressed to learn that teachers take note of behavior changes and flag them to the attention of Guidance Counselors and parents. A gap may be in the follow-through step so that access to needed service is ensured. Ms. Rundle asked how public comments should be gathered. Ms. Barry said she feels strongly that the open public comment phase should begin, although not conclude, at the next joint mental health meeting. Mr. Pato agreed that public comment should begin soon but he noted he has heard from only two residents since these mental health meetings began. He urged those who might not want to speak publicly to contact individual Selectmen privately, in person or by email. Mr. Alessandrini also agreed that public comment should be gathered soon. He recommended that two public comment sessions be held to accommodate different schedules and that community leaders who deal with residents in need be directly invited to attend as well. Ms. Barry asked that an email address be established to channel public comments simultaneously to the members of both boards. She agreed that a second public comment session, perhaps on a weekend, should be considered. A consensus was reached that staff recommendations will be made during the first hour of the next Joint Meeting on mental health on May 23, 2018 to be followed by a second hour dedicated to public comments. Board deliberations will take place at a later meeting to be held on Monday, June 18, 2018 at 7:00-9:00 p.m. 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 5-0 vote. A true record; Attest: Kim Siebert Recording Secretary