University of Southern California Dissertations and Theses

Behavioral Health for All Kids

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Behavioral Health for All Kids

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Content 1
Behavioral Health for All Kids
by
Nathan Edward Popham
Suzanne-Dworak Peck School of Social Work
University of Southern California
Doctor of Social Work
SOWK 722 Implementing Your Capstone and Re-Envisioning Your
Career Dr. Jennifer Lewis
August,2020
2
Contents
Executive Summary ___________________________________________________________ 4
The Behavioral Health Gap _____________________________________________________ 7
Current Practice ____________________________________________________________ 8
Ineffective Policies _________________________________________________________ 10
Other Innovations and Colleagues Management of Issue ____________________________ 10
Proposed Solution ____________________________________________________________ 11
Phase One ________________________________________________________________ 12
Phase Two ________________________________________________________________ 14
Phase Three _______________________________________________________________ 15
Innovation Argument _________________________________________________________ 16
The Problem from Multiple Stakeholder Perspectives ________________________________ 16
Position in Broader Landscape __________________________________________________ 17
Opportunities for Innovation ____________________________________________________ 18
Logic Model ________________________________________________________________ 18
Likelihood of Success _________________________________________________________ 20
Proposed Prototype ___________________________________________________________ 21
Analysis of Market ___________________________________________________________ 22
Implementation Strategy _______________________________________________________ 23
Analysis of Obstacles _______________________________________________________ 25
Alternative Pathways _______________________________________________________ 25
Leadership Strategies _______________________________________________________ 26
Timeline for Implementation _________________________________________________ 26
Financial Plan Summary _______________________________________________________ 26
Program Expenses __________________________________________________________ 27
Program Revenues _________________________________________________________ 28
Methods of Assessment _______________________________________________________ 29
Measuring Objectives _______________________________________________________ 30
Monitoring Objectives ______________________________________________________ 30
Stakeholder Engagement ______________________________________________________ 31
Communication Products and Strategies __________________________________________ 31
Ethical Concerns and Negative Consequences ______________________________________ 32
3
Informing Potential Future Decisions and Actions ___________________________________ 33
Contextualizing BHFAK within Social Work ______________________________________ 34
Implications for Practice and Further Action _______________________________________ 35
Concluding Thoughts _________________________________________________________ 38
References __________________________________________________________________ 39
Appendix A _________________________________________________________________ 46
Appendix B _________________________________________________________________ 47
Appendix C _________________________________________________________________ 54
Appendix D _________________________________________________________________ 60
Appendix E _________________________________________________________________ 70
Appendix F ________________________________________________________________ 103
Appendix G ________________________________________________________________ 104
Appendix H ________________________________________________________________ 105
Appendix I ________________________________________________________________ 106
Appendix J ________________________________________________________________ 120
Appendix K ________________________________________________________________ 121
Appendix L ________________________________________________________________ 122
Appendix M _______________________________________________________________ 124
Appendix N ________________________________________________________________ 125
Appendix P ________________________________________________________________ 127
Appendix Q ________________________________________________________________ 128

4
Executive Summary
The health gap is a grand challenge identified by the American Academy of Social Work
and Social Welfare (American Academy of Social Work and Social Welfare, n.d.). The
behavioral health gap is part of the health gap (Bartram & Lurie, 2017). It represents two-thirds
of youth with a behavioral health condition (BHC) not getting the care they deserve (Kaushik et
al., 2016). The behavioral health gap is highest among children and those living in more rural
states like Alabama, and access to care is a significant cause of the gap (Reijneveld et al., 2010).
The Alabama Department of Mental Health (ADMH) is the state’s largest provider for in-
school behavioral health services (Alabama Department of Mental Health, 2010). These services
provide youth with quality care at a convenient place with a reasonable cost (Alabama
Department of Mental Health, 2010). Per interviews, referrals for these services are slow and
ineffective throughout the state; thus, the current referral process inhibits access to care (Teresa
Dawson, personal communication, June 3, 2019).
Behavioral Health for All Kids (BHFAK) is a program within mental health centers
aimed at reducing the behavioral health gap among Alabama’s youth by improving access to care
through a timely ADMH-sponsored in-school referral process. BHFAK will operate under the
auspices of the board of directors for community mental health centers, and it will gain financial
support from mental health centers and the Alabama Education Association. BHFAK is forward-
thinking by introducing an electronic referral application and behavioral health screenings to
Alabama schools; both are novel within Alabama school systems. BHFAK will be implemented
in the following phases: 1) update ADMH policies through advocacy efforts of an employed
developer and the public so that any school staff can complete an electronic referral – current
policy only allows paper-based referrals that must be completed by school guidance counselors
5
or social workers, 2) provide school employees with a training on the behavioral health gap, how
to screen youth for BHCs, and how to complete the referral, and 3) implement a cloud-based
referral application. Advocacy efforts to get ADMH policy changed are the most pressing.
The BHFAK website helps the public get involved with advocacy and provides a
roadmap for the next steps. Soon after advocacy efforts are underway, special permission should
be sought by the employed developer to complete a pilot study. Data collected from the pilot
may help the developer in advocating for the policy change. In phase two of the training, school
staff will become educated on the issues surrounding the behavioral health gap and when and
how to use the Youth Internalizing Problems Screener and the Youth Externalizing Problems
Screener (Renshaw & Cook, 2018; Renshaw & Cook, 2019). School staff can then make
referrals based on the screeners scores.
BHFAK aims to have short, intermediate, and long-term outcomes, and they are as
follows in respective order: raise awareness about BHCs and create a desire by the state to
address the issue, ADMH endorsement of policy change and acceptance of this innovation, and
finally, ensure youth with BHCs get connected with services in a timely manner. BHFAK can
improve access to behavioral health care for many youths and narrow the gap by helping
Alabama utilize its resources to their full potential. It takes an outdated system and makes it up to
date with policy change, education, and modern technology. Helping youth access care is
instrumental in helping those youth live healthy and productive lives. BHFAK will spread from
one community and county to the next throughout Alabama through the help of the developer.
BHFAK could be used in school systems outside Alabama that also struggle with similar issues,
and it holds promise as a model in school systems outside Alabama without the resources to
6
directly employ behavioral health professionals. BHFAK teachings can be applied in part or
whole.
Keywords: Alabama youth, behavioral health care, in-school therapy, Alabama
Department of Mental Health, Behavioral Health for All Kids, BHFAK
7
Behavioral Health for All Kids
Some significant challenges negatively affect humanity. The American Academy of
Social Work and Social Welfare (AASWSW) identified twelve challenges, and the health gap is
just one (American Academy of Social Work and Social Welfare, n.d.). Michael Marmot, an
expert on the health gap, argues that the health gap cause and solution is political because care
access is regulated by social determinants (Marmot, 2017). Social determinants, such as where
people are born, where they go to school, where they live, income level, and education level, can
contribute to the health gap because these are things that can make people ill or hinder their
access to care (Rine, 2016). Correcting politics and policies is a promising start toward helping
end the gap, and Behavioral Health for All Kids (BHFAK) is a solution.
The Behavioral Health Gap
The behavioral health gap is part of the health gap, and part of the behavioral health gap
encompasses youth with a diagnosable behavioral health condition or BHC for short (Bartram &
Lurie, 2017). 20% of all youth have a BHC (Keynejad et al., 2017). This percent is alarming,
considering that one percent of the entire health workforce provides behavioral health services
(Keynejad et al., 2017). Of all the youth diagnosed with a BHC, only 33.3% receive treatment
(Kaushik et al., 2016). Access to care is a significant challenge for those with BHCs (El-Amin et
al., 2018). Improvements in access to care and behavioral health education have decreased the
frequency and severity of BHCs (Ryst et al., 2016).
The percentage of BHCs is slightly higher than the average in more rural states like
Alabama (Reijneveld et al., 2010). Alabama ranks 48
th
nationwide in terms of overall access to
care; three major reasons are stigma, the lack of accessible behavioral health service providers in
the right places, and the providers that are present not being used in their full capacity (Mental
8
Health America, 2018; Blomme et al., 2020a). Stigma prevents people from talking about
BHCs, and for this reason, people rarely talk about issues in accessing care (Hunter et al., 2017).
Lack of providers causes long wait times and causes people to seek their initial care at urgent
care centers and emergency rooms (Keeler et al., 2018). Alabama has one provider for every 988
people (Blomme et al., 2020b). At the county level, the ratio is as low as 246:1 in Macon County
and ranges to as high as 16,808:1 in Chambers County (Blomme et al., 2020b). Even fewer
Alabama providers are geared toward helping youth and adolescents (Blomme et al., 2020b).
Communities of color and rural communities are disproportionately impacted in accessing care
(Jon-Ubabuco, & Dimmitt Champion, 2019). This lack of accessible services leads to youth
being at risk of other health conditions, abuse, addiction, and criminal justice involvement
(Kaushik et al., 2016). Childhood and adolescence are the ideal time to address these needs
(Reijneveld et al., 2010; Powers et al., 2014). Treatment for BHCs prevents the issues from
progressing in severity, and early treatment is more effective (Ekwemalor et al., 2017).
Current Practice
Currently, Alabama schools are trying to improve access to care by providing in-school
services (Teresa Dawson, personal communication, June 3, 2019). In Alabama, most schools
partner with local ADMH-contracted community mental health centers (MHCs) to provide in-
school services (Teresa Dawson, personal communication, June 3, 2019). While many schools in
other states directly employ behavioral health workers, Alabama partners with MHCs to save
money (Teresa Dawson, personal communication, June 3, 2019). Schools do not provide
monetary compensation or exchange money with the MHCs (Teresa Dawson, personal
communication, June 3, 2019). The MHCs support their services by filing client insurance.
MHCs also get reimbursement from ADMH for some of the services they provide for uninsured
9
clients (Teresa Dawson, personal communication, June 3, 2019). In-school services are offered
free of charge by these MHCs in Alabama (Teresa Dawson, personal communication, June 3,
2019).
School staff knows enough is not being done to help students (Kevin Young, personal
communication, February 21, 2019). Part of their frustration is the long wait times for the initial
assessment after a referral is made and the inability for most school staff to complete a referral
(Kevin Young, personal communication, February 21, 2019). After a school guidance counselor
or social worker completes a referral, it usually takes the therapist one to three weeks to collect
the paper referral (as seen in Appendix A), assess it, and schedule the intake, and then, the
therapists usually do not have the time to complete intake until an additional four to six weeks
(Teresa Dawson, personal communication, February 21, 2019). During this total wait time of
five to nine weeks, school staff feel like nothing is being done, and they feel like their concerns
are not a priority (Kevin Young, personal communication, February 21, 2019). There is little
accountability on the individual completing the referral or the therapist reviewing the referral;
referral forms often go missing (Kevin Young, personal communication, February 21, 2019). A
school thinks a referral was completed all too often, and the MHC is unable to find it (Kevin
Young, personal communication, February 21, 2019). The small pool of people who can
complete the referrals also increases wait times (Collins, 2014). School guidance counselors and
social workers have limited direct interactions with youth unless their behaviors are severe; the
student population is too big (Collins, 2014). With the current referral process, the school staff
must be confident enough in their assessment to reach out to the guidance counselor or social
worker to express their concerns regarding a youth. This process is time-consuming because the
school social worker or guidance counselor must complete the referral with the second-handed
10
information (Priscilla Bartlett, personal communication, June 28, 2019). Appendix B showcases
a journey map for users of the current referral system.
Ineffective Policies
ADMH enforces an outdated code, last updated in 2010, that outlines policies regarding
the in-school behavioral health services (Alabama Department of Mental Health, 2010). These
policies only permit paper-based referrals completed by a school guidance counselor or social
worker (Alabama Department of Mental Health, 2010). The individuals who wrote the current
code included ADMH program directors and the governor’s commissioner (Alabama
Department of Mental Health, 2010). Since 2010, behavioral health has gained greater public
focus (Alabama Department of Public Health., 2015). Technology has advanced recently with
electronic medical records; for example, CED MHC, an in-school mental health provider,
implemented electronic medical records in December 2018 (Teresa Dawson, personal
communication, February 21, 2019). Also, in 2010, the number of clients receiving public mental
health services was drastically lower because the implementation of the Affordable Care Act was
still in its infancy, and many people had not gained the insurance benefits (Olfson et al., 2018).
Other Innovations and Colleagues Management of Issue
In neighboring states, Georgia and Tennessee, BHCs often receive more timely treatment
because many school systems directly employ behavioral health workers (Elizabeth Reaves,
personal communication, June 25, 2020; Mader, 2018). Not all states have the resources to
support these endeavors (Mader, 2018). The University of Southern California currently offers a
web form that allows students, employees, and community members to report BHCs (University
of Southern California, 2019). Other universities and school systems also offer similar programs
(Dunbar et al., 2018). In Alabama schools, including elementary, middle, and high, no electronic
11
behavioral health referral program exists, and no online application exists that targets behavioral
health referrals for school-age youth (Teresa Dawson, personal communication, February 21,
2019).
Schools have gotten creative to compensate for ineffective referrals. Many refer youth to
private providers outside of school (Mandy Caldwell, personal communication, February 21,
2019). Youth who receive behavioral health services outside of the school setting are less
compliant and are faced with more significant financial and transportation burdens (Collins,
2014). Second, many school staff treat BHCs as choices on the students’ behalf instead of
acknowledging the underlying health concern (Mandy Caldwell, personal communication,
February 21, 2019). These staff utilize school policy to discipline BHCs in youth (Mandy
Caldwell, personal communication, February 21, 2019). Third, many therapists are not abiding
by ADMH referral policies (Mandy Caldwell, personal communication, February 21, 2019).
Some therapists take informal referrals without utilizing the referral form, and these referrals to
get overlooked (Mandy Caldwell, personal communication, February 21, 2019).
Proposed Solution
BHFAK is a proposed program embedded within the nonprofit sector, and it will operate
under the auspices of the Board of Directors for Etowah Mental Health Center (EMHC).
BHFAK will reduce Alabama’s behavioral health gap by improving access to care through
restructuring in-school referrals. BHFAK hopes to change outdated ADMH policies that only
allow paper-based referrals that must be completed by school guidance counselors or social
workers. BHFAK also hopes to make it so that any school staff can complete a referral on a
modern, user-friendly electronic referral application. BHFAK is a multiphase innovation with
the following phases: 1) change archaic Alabama Department of Mental Health policies through
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the advocacy efforts of an employed developer and the public so that any school employee can
complete an electronic referral, 2) provide school employees with a training on the behavioral
health gap, how to screen youth for BHCs, and how to complete the referral, and 3) implement a
new electronic referral application. Appendix B and C are journey maps for users without and
with BHFAK, respectively. Importantly, the journey map with the innovation found in Appendix
C has fewer steps than the map without the innovation found in Appendix B, and this translates
into more time efficiency and improved access to care.
Phase One
All school employees should have the right to complete an efficient referral. Policies
need to be changed through advocacy. Advocacy will be achieved through the help of the public
and an employed developer. Advocacy efforts will be geared toward gatekeepers who make
ADMH policies, and those people are Commissioner Lynn Beshear, Gayla Caddell, and Kim
Hammick (Alabama Department of Mental Health, 2019). Commissioner Lynn Beshear is the
Alabama Commissioner of Mental Health, and Lynn Beshear appointed Gayla Caddell and Kim
Hammick as directors of outpatient services (Alabama Department of Mental Health, 2019).
The public can assist in writing letters to the gatekeepers using the template found on the
BHFAK website, www.behavioralhealthforallkids.com, and by signing a petition found on social
media and BHFAK’s website. Appendix D shows screenshots of the BHFAK website. The
developer can choose to present this petition to the gatekeepers.
The developer is instrumental in phase one. This developer will report to CED Board of
Directors. CED is the ADMH-sponsored 501c3 nonprofit MHC for Cherokee, Etowah, and
Dekalb counties (Etowah Mental Health Center, 2018). Sometimes, county offices within CED
are called CMHC, EMHC, and DMHC based upon the county being referenced. The developer
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will be stationed at EMHC in Attalla, Alabama. This location was chosen because of its
proximity to ADMH. The developer will build a relationship with organizations and politicians
to get these two policies changed successfully. Because advocacy is so time and labor intensive,
the developer may choose to have volunteers if he/she choose.
Part of the advocacy will be presenting a valid argument supporting the need for BHFAK
to ADMH. Data for this argument was be gained from piloting BHFAK. ADMH will have to
grant ADMH special permission to pilot BHFAK. The innovation can be piloted at Gadsden City
High School. The data gained from the pilot will hopefully strengthen the case for BHFAK, and
the developer can use it to get policies changed at the state level so that all schools within the
state can benefit from BHFAK. Data collection and analysis will be the duty of the developer.
Some of the data they collect and analyze is discussed later in this proposal.
Current political support for behavioral health treatment is at a high (Public Affairs
Research Council of Alabama, 2018). The Public Affairs Research Council of Alabama
(PARCA) surveyed Alabama voters to rank their top political concerns (Public Affairs Research
Council of Alabama, 2018). On this survey, mental health and substance abuse ranked number
four (Public Affairs Research Council of Alabama, 2018). Advocating to politicians, in particular
state legislators, could be very helpful for BHFAK. Politicians have a larger platform for raising
support and echoing the concerns of the current referral process. Because BHCs affects so many
families in the state of Alabama, many politicians would likely support and champion BHFAK
(Public Affairs Research Council of Alabama, 2018). Alabama does not have a teachers’ union
(Legislature of Alabama, 1867). State law prevents public employees from being represented by
a union per se (Legislature of Alabama, 1867). Alabama does have the Alabama Education
Association (AEA); it is a professional organization that performs many of the duties of a trade
14
union for teachers and school staff(Associated Press, 2011). From interviews we know teachers
and school staff want a way to voice their concerns for youth with BHCs (Alan Crosby, personal
communication, September 24, 2019). Support from the AEA could ignite the support of the
policy changes from ADMH. The AEA is a powerful advocacy organization, and it has a strong
history of making things happen in Alabama (Associated Press, 2011)
Phase Two
All school employees will undergo a formalized interactive pre-recorded three-hour training.
The curriculum guide for this innovation can be found in Appendix E. The developer, who is
also the training instructor, will use this guide, and parts of it can be made available to trainees.
The curriculum has three modules: the behavioral health gap, how to screen youth for BHCs, and
making an appropriate referral. The guide also includes one pre/post-test and evaluation. The
pre/post-test will allow trainees to show what they have learned from the training, and the
evaluations allow the trainees to provide helpful feedback to improve the training in the future.
The training’s primary goal is to educate school staff on the importance of behavioral health,
how to complete screenings in their classroom, and how to make that referral on the proposed
referral application.
This training will take place at staff convenience but will be encouraged on teacher
workdays when students are not present; staff completing the training may receive continuing
education credits for the training depending on their profession. The actual training can be taught
by the developer, who is also a seasoned social worker, hired during BHFAK’s first phase.
Relias Learning will host this training on relias.com, which is already used by MHCs (Teresa
Dawson, personal communication, July 2, 2020). Relias allows the trainee to complete a pre-test,
all three modules of the training, a post-test, and training evaluation (Teresa Dawson, personal
15
communication, July 2, 2020). Relias allows for instant grading of tests, records successful
completion of the training (for CE credits), and sends evaluations to the training coordinator of
the respective MHCs (Teresa Dawson, personal communication, July 2, 2020). The trainee can
also print completion certificates (Teresa Dawson, personal communication, July 2, 2020).
The two evidence-based screenings used in this curriculum guide are the Youth Internalizing
Problems Screener and the Youth Externalizing Problems Screener (Renshaw & Cook, 2018;
Renshaw & Cook, 2019). Both are proven to screen youth sixth through twelfth grade in the
school setting and have been encouraged in toolkit sponsored by the Substance Abuse and
Mental Health Service Administration (Renshaw & Cook, 2018; Renshaw & Cook, 2019; Now
is the Time Technical Assistance Center, 2015). Using both screeners together allows youth to
me screened the most common BHCs (Renshaw & Cook, 2018; Renshaw & Cook, 2019). Some
examples of internalizing problems include anxiety and depression, and some examples of
externalizing problems include defiance disorder, conduct disorder, and attention deficit
hyperactivity disorder (Renshaw & Cook, 2018; Renshaw & Cook, 2019). The screeners can be
found in Appendix F and G. Students who score above 21 on either or both screeners should
have a referral completed by school staff because these scores indicate a high likelihood of a
BHC (Renshaw & Cook, 2018; Renshaw & Cook, 2019; Now is the Time Technical Assistance
Center, 2015).
Phase Three
In the final phase, a new cloud-based referral application will be implemented. This
application will allow instant delivery of referrals from the school to the appropriate therapist.
Any school employee will be entitled to sign into the BHFAK application using their unique
username and password. Once logged in, they will complete a simple referral with as much
16
information as they can. The two questions on the referral asks the staff to input internalization
and externalization screening scores. Greater details regarding the electronic referral application
will be discussed in the Prototype section below.
Innovation Argument
BHFAK is innovative for three reasons. The first reason is that BHFAK is novel. There is
currently nothing else like it, in regard to electronic submittal of behavioral health referrals from
Alabama schools. The second reason BHFAK is innovative is that it is an advancement. BHFAK
is an update through policy, technology, and training to a process that is already in place. The
current policy is outdated and no longer meets the demands placed on it. In 2019, technology can
be implemented to automate and streamline the referral process. The third reason BHFAK is
innovative is because of the process. The current policies were studied, and their implementation
was reviewed. This assessment determined that the referral process would be improved by
updating the two policies that BHFAK addresses.
The Problem from Multiple Stakeholder Perspectives
Multiple perspectives are surrounding the current referral process for in-school
behavioral health services. First, the youth who attend school are important stakeholders in the
situation. They likely have seen many of their peers suffering from BHCs. They have also
probably had their classrooms disturbed by these same health challenges; BHCs are often causes
of disruption in the classroom (Collins, 2014). Second, school staff already deal with BHCs
daily, and they are often a source of job frustration (Greenwood et al., 2016). School staff
frequently report feeling helpless when it comes to BHCs in the youth they serve (Jaffee, 2018).
The AEA is also a stakeholder because they represent the needs of many school staff on a
political level. Third, the parents and families of the youth they serve struggle with the BHCs
17
(Bartram, & Lurie, 2017). Often, they are unaware of how to help their students (Bartram, M., &
Lurie, 2017). They habitually think it is up to the teacher to get their youth the help that they
need (Collins, 2014). They also may become frustrated at the lack of resources for youth with
BHCs (Greenwood et al.,2016). Fourth, the communities-at-large are affected by these BHCs in
youth (Bartram, & Lurie, 2017). They may view these youth as future problem adults. Children
with BHCs often become adults with BHCs (Bartram, & Lurie, 2017). These children and adults
strain the economy, and some may not be able to work and contribute to society in that way
(Collins, 2014). They may also see their hospitals and medical facilities flooded with BHCs and
experience long wait times because of this (Collins, 2014).
Position in Broader Landscape
Alabama has been struggling with meeting the behavioral health needs of its constituents
for years (Alabama Department of Public Health, 2015). Some Alabamians have been refused or
not been offered services because of stigma and ignorance (Alabama Department of Public
Health, 2015; Hunter et al., 2017). For those reasons, requesting services or walking in a MHC
has been taboo (Hunter et al., 2017). Behavioral health services in a school setting offer new
opportunities. School settings are comfortable, emotionally safe, and convenient locations for
youth. Youth seen walking into MHCs in rural communities could be bullied at school or in the
communities because of their needs. BHFAK and programs like it can create a new generation
that appreciates and normalizes behavioral health care. Schools also offer space that can provide
more comfort and discretion than a MHC. As mentioned BHFAK seeks to update ADMH
policies and not change them completely. BHFAK is a community-based model that allows
communities to use their resources to their full potential. BHFAK caters to the youth and
18
communities they serve by understanding the behavioral health history, policies, practices, and
reality that affects its potential clients.
Opportunities for Innovation
There are several systemic elements that BHFAK capitalizes on. First, schools are a
central location for most youth. While school is in session, many youths spend more waking
hours with school staff than their own family. So, it makes sense that this central location would
be the ideal place for youth to be referred for and receive behavioral health services.
Unfortunately, Alabama schools do not use any universal screening to trigger automatic referrals
on a state-wide basis. Part of BHFAK allows teachers to give their students two evidence-based
screenings that will let the teacher know if a referral is needed.
When increasing access to behavioral health care is the focus, many of the existing
opportunities are too expensive to meet the constraints of the budget (Chen, 2017). BHFAK is
relatively inexpensive and requires no specialized equipment to implement. That is what makes
BHFAK realistic for Alabama. Additionally, Alabama does not possess a high number of mental
health professionals (Blomme et al., 2020b). Consequently, most innovations that require an
increase of mental health professionals at start-up are out of the question. Simply put, most
existing opportunities for innovation are not feasible because of the lack of financial resources or
manpower to meet the demands at start-up. It is important to note that BHFAK may require more
behavioral health therapists due to a higher influx of referrals. BHFAK’s plan to reduce that
burden is detailed in the Limitations and Risks section below.
Logic Model
The logic model for BHFAK is straightforward. For clarity, the logic model is explained
in detail below and summarized in Appendix H. There are several inputs required to get BHFAK
19
started. Some of these inputs include the following: funding, manpower to gain funding from
community MHC and the AEA, manpower to advocate, collect, and analyze data, manpower to
create staff training, manpower to refine a new referral application, in-kind donation of
administrative oversight for the developer, and in-kind donation of space. Overall, the inputs are
minimal, and it appears that access to all these inputs can occur without any issues.
The first activity of BHFAK is to hire a full-time advocate, also referred to as a
developer, who will be a master-level social worker. Other activities will happen subsequently.
They include developing the #WeCare campaign to ADMH officials and the public, collect more
data on the usage of the current referral application, record training, and have training set-up on
Relias Learning (a LMS platform), pilot BHFAK, and refine BHFAK as needed. Data collection
and analysis from the current referral system and a pilot study are supposed to strengthen the
policy change argument.
The outputs for BHFAK are highly measurable and make good indicators of success. The
first output is fifteen conversations within 90 days regarding the lack of behavioral healthcare
among Alabama youth with ADMH officials. Another output is improved knowledge on
BHFAK by ADMH and the public, and this can be measured through surveys. Other outputs
include a stronger data-driven argument that can be presented to ADMH for BHFAK, three
hours of training are available to school staff, and a completed pilot will show data of the pilot’s
success/failure. This pilot can then inform future goals and the direction of BHFAK.
There are short term, intermediate-term, and long-term outcomes. The timeline for the
outcomes is one year, five years, and ten years, respectively. For BHFAK, the short-term
outcome is to raise awareness of BHCs and BHFAK and create a desire by the state to address
the issue. The intermediate-term outcome is an endorsement of policy change by ADMH and
20
acceptance of BHFAK throughout the state. The long-term outcome is youth with BHCs are
referred and get the help they need promptly. This long-term outcome will be measured by
reviewing the annual reports by Mental Health America. The Alabama affiliate of Mental Health
America publishes annual reports with many statistics of youth accessing behavioral health care.
So, these reports can be utilized to see that access to care is improving in the counties BHFAK
has been implemented.
Likelihood of Success
Overall, the likelihood of success for BHFAK is promising. The creator of BHFAK has
created a project website, a curriculum of BHFAK training, and a prototype of the referral
application. Thus, BHFAK could be ready for pilot testing in a short amount of time.
Additionally, stakeholders have little to lose and a lot to gain. The costs and resources needed to
implement BHFAK are minimal. This minimal input will translate into fewer reasons to not
implement BHFAK; in other words, the community will have enough money and resources to
cover the cost of BHFAK.
The opposition is expected to be minimal because BHFAK will benefit so many people.
The expected beneficiaries include the youth with the BHC, their family, peers, school staff, and
the community MHCs. Regarding the youth and their family, timely access to care will reduce
stress and strengthen relationship bonds (El-Amin et al., 2018). Schools will become a safer
environment (Greenwood et al., 2016). BHCs are a well-documented cause for violence and
disruption from education (Collins, 2014). School staff’s ability to complete the referrals directly
will appease many staff who are tired of bureaucracy. Community MHCs can benefit financially
from the increased need for services and potential clients (Chen, 2017). They can also benefit
21
from the increased accountability of electronic referrals; no longer will they be accused of
ignoring referrals or not following through with referrals.
Proposed Prototype
The BHFAK application, seen as screenshots in Appendix I, was created using Appypie.com.
Its publication and maintenance will be paid for by the MHC utilizing it for referrals. The
BHFAK application strives for simplicity and user-friendliness. It allows the school staff, who
have undergone training in phase two, to learn more about BHFAK, link to the BHFAK website,
submit a referral in a time-efficient and convenient way, and request technical support. Each of
these goals has a corresponding button on the homepage. The application will ensure the
appropriate therapist from the MHC gets the referral.
The application’s main goal is to collect and securely deliver encrypted referrals in a
manner compliant with the Health Information Portability and Accountability Act (HIPAA).
Encryption will prevent the emails from being read by anyone other than the intended recipient;
the encryption process scrambles messages so that only the intended recipient’s email can
unscramble the referral. Encryption of referrals will satisfy HIPAA security demands. The
BHFAK application is intertwined with all three phases of the innovation, but it is also extremely
important now in taking this innovation from paper to reality. ADMH needs to see a mock
referral application and the training curriculum. So, the guide will also serve in helping persuade
leaders to support BHFAK in phase one.
School staff can download the application directly from Apple’s App Store or Google’s
Play Store. Once downloaded and opened, the first-time user will have to register. Once
completed, the user will get a registration confirmation via email. The user can then log in. From
there, the user will have several button options on the homepage. First, they can click “About
22
Us” to read an introduction to BHFAK, their mission, and their values. Second, they can click
“Behavioral Health for All Kids Website” to be taken to the main BHFAK website. Third, users
can click “Referral” to complete and securely submit a referral to the appropriate mental health
therapist. The therapist will receive the referral via a secure and encrypted email. Finally, the
user can click “Support” to call or email the MHC’s information technology support person.
This prototype will help in implementation. First, ADMH officials need to see the mock
referral application before sponsoring BHFAK. This prototype may help them sway in favor of
supporting BHFAK. Second, the application will need to be developed before the training in
phase two because the staff will need to be trained on how to use the application. Third, BHFAK
will require the final version of this prototype to make referrals.
Analysis of Market
Currently, in Alabama, the school referral is ineffective and functions much the same
way that it did in the 1960s. Unfortunately, most educators now take less of a holistic view of
their job (Collins, 2014). Research shows that most teachers across the United States do not work
mental health education into their classroom lesson plans (Ryst et al., 2016). They see their job
as only to teach the youth traditional material (Ryst et al., 2016). A. few educators see this as a
duty of the school social worker, guidance counselor, or parents (Mandy Caldwell, personal
communication, February 21, 2019). These beliefs must stop.
These misunderstandings need to stop because it puts the youth with the concerns at a
disadvantage. Additionally, it puts classrooms at a disadvantage, including the youth and
teachers in them. Youth with BHCs serve as a distraction for everyone in the classroom (Collins,
2014). Teachers need to realize the youths’ mental status affects their classroom and everyone in
23
it. Also, students miss out on valuable times of instruction while the teacher is dealing with
troubling behaviors (Mandy Caldwell, personal communication, February 21, 2019).
All school employees are capable of completing appropriate referrals for BHCs. While
there is currently a method to address BHCs in the school, it is slow and, in many ways,
inefficient (Alabama Department of Mental Health, 2010). Fortunately, the current environment
in schools allows BHFAK to be applied easily. The easy application of BHFAK will allow the
innovation to have maximum social significance.
Implementation Strategy
The EPIS model was utilized in developing BHFAK. The EPIS model is an
implementation model that is easily applied to innovations in the public sector and usually
increases the likelihood of effective implementation (Nilsen, 2015). The EPIS Model has four
stages, and those stages include exploration, preparation, implementation, and sustainment
(Aarons et al., 2011).
During the exploration stage, there was an awareness that the behavioral health care crisis
among Alabama youth needs to be addressed (Aarons et al., 2011). Interviews were conducted,
and they revealed that most school staff feel frustrated, hopeless, and powerless concerning
BHCs (Alan Crosby, personal communication, September 24, 2019). These staff argue that youth
with BHCs act as classroom safety concerns and distractions; furthermore, these school staff
realize the current referral process for in-school behavioral health services is inadequate (Alan
Crosby, personal communication, September 24, 2019). Media exposure of school violence and
shootings has brought BHCs in youth to public attention (Kaushik et al., 2016).
In the preparation stage, ADMH must agree to allow BHFAK to run a pilot
study(Moullin et al., 2019). This special permission is required to pilot the project, and data from
24
the pilot may help persuade ADMH to change their outdated referral policies. Also, the
technical infrastructure will have to be refined by the developer, and staff, both school and MHC
staff, will need to undergo training on BHFAK.
During the implementation stage, the electronic referral application will also have to be
installed on the appropriate electronic devices at school. Staff training will also be an ongoing
thing during this stage, and it will be a continuation of training started in the preparation phase.
All new and current school employees have to under BHFAK training. The MHC staff will have
to be trained on how to use the electronic referral application and accessing referrals. Also,
during implementation, a 90-day pilot will be conducted. BHFAK will initially be piloted at
CED and Gadsden City High School. Both organizations were chosen because of their moderate
size, current partnership with one another, and proximity to Montgomery, Alabama (where most
advocacy will happen). Data will be collected on this pilot about the effectiveness and efficiency
of BHFAK. The data gained should make future implementation smoother.
After a successful pilot, ADMH will hopefully adopt policy changes. Then, BHFAK will
spread throughout Etowah County. Next, it will be replicated in Cherokee and DeKalb County
due to their relationship with CED. Afterward, BHFAK can spread throughout the state, and it
can be replicated in each individual county. BHFAK would fit in line with MHCs across the state
of Alabama because all MHCs in Alabama currently follow the outdated guidelines of the
ADMH. BHFAK will utilize a sharing economy and the developer will help any district
anywhere if they request it.
In the sustainment phase, BHFAK will continue to function in much the same way as it
did in the pilot. The developer hired in the first phase of the innovation will continue to help the
project sustain and disseminate to other areas. Sustainment will also require the upkeep of the
25
training on Relias Learning in addition to the BHFAK application (Becan et al., 2018). The
financial burden of keeping the application going in addition to the increased training
requirements of schools and MHC staff will all still be present throughout BHFAK and will
require the oversight of the employed developer. A detailed listing of barriers and facilitators
during all phases of implementation is in Appendix J.
Analysis of Obstacles
The state still has to agree to the innovation and to make the policy changes. Them not
agreeing to this would be detrimental. The cost of hiring a full-time advocate, also referred to as
the developer, to help with the policy change, refining the referral application, and maintaining it
throughout sustainment is a concern. Additionally, there is a cost of training all the school staff
and making the trainings available on Relias Learning. BHFAK is an expensive program, but as
shown later in this paper, it is very valuable for families, agencies, and communities. Stigma is
another threat because it causes people to rarely discuss topics related to BHCs, including
accessing care (Hunter et al., 2017). The lack of providers in the right locations and needed
positions can cause an initial challenge but BHFAK’s plan to address that is discussed in the
Limitations and Risks section below (Keeler et al., 2018).
Alternative Pathways
In case BHFAK cannot be implemented in its current state for any reason, alternative
pathways exist. For example, the financial budget shown later in this proposal suggest donors
being AEA and MHC. If either agency did not agree to fund BHFAK, another agency could step-
up. For example, ADMH or the public could also be possible donors. Additionally, if BHFAK
faces significant pushback of any kind, from groups or other agencies, parts of BHFAK could be
implemented instead of a whole. For example, if teachers had increased education on the early
26
signs and symptoms of BHCs, they could still make reports of their concerns to the individuals
who could complete a formal referral.
Leadership Strategies
BHFAK is a program within the public sector and will only require one employee for the
first year. During the first year, leadership will come from the developer, and the developer will
have administrative oversight from the MHC. This leader will need charismatic and
transformative qualities because they are advocating and ushering in change. After successful
policy change and implementation, sustainment can be completed MHCs because it is so
minimal. Thus, leadership in sustainment will come from the executive director of the MHC.
Timeline for Implementation
The current political climate makes the quick success of BHFAK likely (Kaushik et al.,
2016). However, different implementation stages have to be timed perfectly to ensure the highest
likelihood of ADMH policies being changed. BHFAK involves advocacy. The exact amount of
time it takes to change minds varies. As previously mentioned, the salary for the fulltime
employee shall be budgeted for one year, and its likely needed policy changes can occur by then.
Appendix K below details the timeline for the implementation of BHFAK. Appendix L is a Gantt
chart that integrates the timeline and the EPIS Model.
Financial Plan Summary
Acquiring the revenue seems secure and doable, but negotiations are still ongoing with
the AEA and CED. Appendix M is the start-up budget in table form, and appendix N is the first
year-operating budget in table form. The 90-day start-up of BHFAK will require approximately
$11,200, but a surplus of $800 should be added. The first-full-year of BHFAK will require
approximately $88,100, but a surplus of $500 should be added. In both the start-up and first-full-
27
year of BHFAK, the money will come from two different sources. The sources will result in four
main revenue streams: monetary contributions from the EMHC, monetary contributions from the
AEA, in-kind donation of space from EMHC, and in-kind donation of administrative oversight
from EMHC.
Program Expenses
Expenses for BHFAK are less than the projected revenue. This means that BHFAK is
considered financially stable. The majority of the expenses are in the form of personnel costs.
Details of the expenses are contained in budgets found in Appendix M and N. The major
personnel costs come from hiring, onboarding, training, and employing a full-time developer.
The projected cost of onboarding and training the developer is $2,000.00 during the start-up
phase of the innovation. The projected salary of the developer is $48,000 annually for the first
full-year of operation. An additional $5,000 is the projected cost of benefits for this developer
during the first-full-year of operation. The developer should be a master-level social worker with
a mandatory five to ten years of experience in community mental health. The person also needs
to have an excellent understanding of the problem that BHFAK hopes to address. Current
therapists and managers at EMHC have salaries ranging between $28,000 and $50,000 (Teresa
Dawson, personal communication, June 13, 2019). The salary for the developer is based on the
current market rate at EMHC and the surrounding community. Additional personnel costs come
in the form of administrative oversight that will be provided as an in-kind service. This expense
is estimated to be $1,000 during the three-month start-up and $4,000 during the first-full-year of
operation. Administrative oversight will come from the clinical and executive directors in
addition to the human resource coordinator of EMHC. Their oversight is necessary to make sure
the innovation stays on its projected timeline.
28
For the initial 90-day start-up, publishing and maintenance of the referral application is
estimated to cost around $1200 at 400 per month. Website maintenance is $90 at $30 per month.
Hosted training on Relias Learning is $870 at $290 per month. Office supplies and office
furniture have an estimated cost of $1,000 each. Technology for the office to include a computer
and a printer has an estimated cost of $3,000. The final expense is rent; this is an in-kind
donation estimated to be valued at $1,000. This budget is expected to have a surplus of $500.
The surplus will help cover any unaccounted-for costs that may arise.
For the first-full-year of operation, an estimated $9,000 will be needed to allow for
frequent travel of the developer to Montgomery, the capital of Alabama. Website maintenance is
$360 at $30 per month. Application maintenance is $4800 at $400 per month. Hosted training on
Relias Learning is $3480 at $290 per month. Another $4,000 will be needed for office supplies
yearly, and $3,000 will be needed for technology such as a computer and a printer. Meals will
require $2,500 yearly. The final expense is rent; it is an in-kind donation valued at $4,000 yearly.
This budget also allows for a $500 surplus.
Program Revenues
Getting the revenues to fund BHFAK may be tricky. Today’s political climate gives more
support for policy change affecting BHCs than ever before (Grube & Mendenhall, 2016). BHCs
are a hot topic within the AEA because of the growing issues in school(Associated Press, 2011).
Additionally, the mission of all MHCs, including EMHC, is to improve the behavioral health of
people in the communities they serve (Etowah Mental Health Center, 2018). Likely BHFAK’s
funders are the AEA and EMHC. They are stakeholders in the problem BHFAK hopes to
address. Their financial support commitment is tied to the accomplishment of the main goal of
BHFAK, which is improving access to care. Many of the revenues for the start-up and the first-
29
full-year of operations will come from EMHC contributions, AEA contributions, and in-kind
donations of space and administrative oversight from EMHC. For start-up, the amounts are
described below. Monetary contributions from EMHC are $5,000, and the monetary
contributions from the AEA equal $5,000. The in-kind donation for start-up from EMHC, in
terms of donation of space and administrative oversight, are $1,000 each. A monetary estimate
for the donation of space came by dividing the rent and utilities of the entire building by the
square footage of the space donated. The donation of administrative oversight was calculated by
an estimated number of man-hours according to the typical salary of the employees. For the first-
full-year of operations, the yearly amounts are as follows. Monetary contributions from EMHC
equal $39,600. Monetary contributions from AEA equal $34,500. The in-kind donation from
EMHC in terms of donation of space is $4,000, and administrative oversight is $10,000.
Methods of Assessment
Process and outcome objectives are evaluation goals (Grinnell et al., 2016). Meeting
these goals indicate the successes of BHFAK, and fortunately, they can be easily measured
(Grinnell et al., 2016). The developer, their volunteers (if you developer chooses to have them),
and the leadership providing administrative oversight for BHFAK will be tasked with tracking
progress toward these goals. There are several process objectives for BHFAK. Regarding phase
one, there will be increased direct communication between MHCs and ADMH. The developer
will meet with ADMH officials weekly in Montgomery. Regarding phase two, there will be an
increased number of people completing the training. Regarding phase three, there will be an
increase in the number of staff downloading the application, conducting the screening, and
making referrals. Finally, there will be a decrease in the amount of time it takes for a therapist to
review referrals. There is also one main outcome objective, and it is the number of people that
30
actually got into care as a result of BHFAK. This can be determined in the pilot and in full
implementation.
Measuring Objectives
The process objectives will be measured by the developer during the implementation of
BHFAK. The developer will complete a weekly report detailing the process objective data for
the executive director of the MHC. The reports will be sent via email. It will highlight the
following things: the number of times the developer has communicated with ADMH leadership
in terms of policy advocacy, the number of people completing the training, the time it takes for
therapists to review referrals, and number of staff completing downloading the application,
conducting the screening, and making referrals. Of course, the time it takes to review referrals
will be reported to the developer by the actual therapist following up on the referrals. As noted in
the Stakeholder Engagement section below, feedback on the BHFAK pilot and actual
implementation will be requested in the form of completed surveys so any necessary changes can
be made. Surveys will be given quarterly at three, six, nine, and twelve months. The school staff
survey is Appendix O. Additionally, the youth participation needs to be monitored through
surveys to ensure a diverse group of youth is engaging in BHFAK. The youth’s survey is
Appendix P, and for younger youth, this may be completed by parents/guardians.
The outcome objective will also be measured by the developer at the end of the pilot and
quarterly during full implementation. The developer will complete a report for the executive
director of the MHC and send it via email. The report will include the number of people that
accessed care as a result of BHFAK.
Monitoring Objectives
31
There will be continued feedback of outcomes during the pilot and throughout the life on
BHFAK. Data will be collected by the developer employed by BHFAK during the pilot and in
sustainment. Data will be collected weekly and will be analyzed during and at the end of the pilot
study, which is at the end of the 90 days. The same surveys to the ones shown in the appendix O
and P will be used after the policy change has occurred. Data collection will provide important
information on the innovation’s progress.
Stakeholder Engagement
Data shows that stakeholder engagement helps craft innovations that best meet the needs
of the populations they are designed (Chamberlain et al., 2011). Community members are urged
to take charge now and become engaged in helping to advocate for BHFAK. While the majority
of advocacy may be done by the developer, the public is called to action in writing letters to key
ADMH officials and signing a petition for the policy change BHFAK is requesting. The public
can find out more about these advocacy efforts on www.behavioralhealthforallkids.org.
School and MHC staff will need to be actively engaged in refining the referral
application. Both stakeholders will be given surveys at three, six, and twelve months requesting
feedback on BHFAK. This survey is Appendix O. Additionally, the youth within the schools are
an additional stakeholder, and their participation needs to be monitored through surveys to
ensure a diverse group of youth is engaging in BHFAK. The youth’s survey is appendix P.
Communication Products and Strategies
BHFAK will launch a multi-media campaign named #WeCare. The slogan is #WeCare
and so should you. This 30-day campaign will highlight the personal stories of 30 ethnically and
culturally diverse volunteer youth sharing in video format their stories of how they accessed
behavioral health care. While each youth’s story is unique all will highlight that things need to
32
change in Alabama because youth in Alabama are suffering. Because #WeCare has youth and
adults as a target population, it will utilize many different market channels and media catered to
the age group. Millennials and Generation Z prefer to use Twitter, Instagram, and Snapchat (Pew
Research Center, 2019). Adults over thirty prefer using Twitter and Facebook (Pew Research
Center, 2019). Additionally, some other forms of media will be utilized after a successful pilot
run, and these include newspaper ads and possible billboards. These will be used only after the
pilot because they are expensive and much more expensive than social media advertisements.
From videos, viewers will be given a link to the BHFAK website. Once on the website, viewers
can sign a petition to get ADMH policy changes, complete a pre-formed advocacy letter to send
to top-tier policy changing leadership at ADMH. The website will also educate viewers on
behavioral health in Alabama and BHFAK. Infographics in mental health will be disseminated
on the BHFAK website and social media. Appendix Q is one such example of an infographic.
Ethical Concerns and Negative Consequences
There are several ethical concerns to consider with BHFAK. The first concerns are
regarding students of color and minorities being disproportionately referred for services. While
schools will be using the same screener for everyone, the screeners have not been tested on
diverse populations. Historically, the lack of understanding about cultural norms and life
experience has led to minorities being over-diagnosed with BHCs (Bartram & Lurie, 2017). To
minimize this, all school staff need training on diversity. In particular, they need training on
cultural norms and differences in life experiences. As a result, teacher education on cultural
norms and their relation to BHCs will be included in the second phase of the innovation. Second,
the new ADMH policies may be initially flawed, and as a result, may impede the youth from
getting behavioral health care. Thus, careful and thoughtful planning and implementation must
33
be done to reduce these risks. Third, if the need for behavioral health workers surpasses the need
for the available supply, the referral system may become backed up. A plan surrounding this
issue is discussed in the Limitations and Risks section below. Fourth, the MHCs may have to
request employment of underutilized master-level social workers who are employed by the
school. In this situation, there may be obvious kickback from the social workers, but it is
important to recognize the best interest of the youth. Bachelor level social workers could fulfill
many of the job duties of these master-level counterparts because often schools make referrals
and focus on academic success/ grade improvement. Finally, the electronic submittal of referrals
presents some degree of confidentiality risk. Thus, every effort will be made to ensure only the
intended recipient or recipients receive the needed referrals. Referrals will be sent via encrypted
email.
Informing Potential Future Decisions and Actions
BHFAK works to improve access to behavioral health care in youth. In doing this, it
creates a lot of conversations and awareness around BHCs. This is positive news for the plight of
youth with BHCs because it will likely create many unforeseeable opportunities and help
normalize care. Additionally, it will allow MHCs to better serve their communities. While
BHFAK is geared toward children and adolescents, there is perhaps the opportunity for it to
inspire similar models of care for different populations in need of care. The concepts at the
center of BHFAK, such as policy change, education, and technology advances, can be used in
dealing with other disadvantaged populations. While the future of BHFAK does look bright,
questions and logistical issues may arise, and that is expected. Those needed future actions and
decisions can be managed on a local level by the developer and MHCs, and they can also be
34
overseen by ADMH. Much like the current referral process, many issues involving BHFAK can
be solved on the local level. This will allow each community the freedom to best utilize BHFAK.
Contextualizing BHFAK within Social Work
The primary goal of social work is to help humans meet their basic needs and to enhance
their well-being. BHFAK holds promise in improving quality and possibly the quantity of life
(American Academy of Social Work and Social Welfare, n.d.). On average, people with serious
BHCs die significantly sooner than people who do not have them(Bartram, & Lurie, 2017). This
could be caused by a higher than average body mass index on average for someone with a BHC
due to metabolic effects resulting from psychotropic medications (Bartram, & Lurie, 2017). It
could also be caused by higher levels of stress; stress is known to lead to heart disease and
diabetes, among other things (Bartram, & Lurie, 2017).
People are often unconcerned with BHCs until it affects them (Nijs et al., 2014). In 2020,
youth are plagued with the possibility of having to face a school shooting or some other
terrifying trauma. BHFAK could improve school safety. School shootings occur too frequently,
and poplar opinion deems BHCs as being the culprit (Nijs et al., 2014).
What happens to the youth who poses threats or exhibits BHCs in school? Unfortunately,
they are often overlooked (Nijs et al., 2014). This can cause the symptoms to get worse. Mild
and moderate BHCs can progress to severe. Untreated BHCs causes people to become a threat to
themselves and others (Nijs et al., 2014).
The financial implications are also significant (Chen, 2017). The exact amount of money
spent on child and adolescent behavioral health care in Alabama, during any given year, is hard
to determine (Chen, 2017). Indirect costs, including lost productivity from work by the youth and
their caregivers, should be considered (Chen, 2017). Special accommodations made in
35
communities to deal with severe BHCs are expensive; probation, Department of Youth Service
commitments, and court hearings all cost taxpayers money (Chen, 2017).
Implications for Practice and Further Action
The applied implications or indirect results of BHFAK are widespread. The youth of
today make the adults of tomorrow. If youth do not have their behavioral health needs addressed,
their untreated BHCs will cause them to be less productive members of society tomorrow
(Greenwood et al., 2016). Also, untreated BHCs are a frequent precursor to future legal issues
(Greenwood et al., 2016). Untreated BHCs in school-age youth can affect not only the youth but
also other people in society (Greenwood et al., 2016).
School-age youth’s behavioral health needs have been taboo for far too long;
unfortunately, this has been the norm (Greenwood et al., 2016). Because youth are not receiving
healthcare for their behavioral health needs, they will not prioritize the behavioral healthcare
needs of their children (Greenwood et al., 2016). This creates a vicious cycle of untreated BHCs.
While BHFAK is geared toward helping Alabama’s youth. It can be utilized in whole or parts by
other states and/ countries. Thus, BHFAK can serve as a model for improving access to care in
other areas where schools do not have the resources to hire behavioral health professionals
directly.
The prototype, the unpublished application, can be shared immediately with funders and
stakeholders. This application, along with the curriculum for educating school staff on BHFAK,
will provide funders and stakeholders with tangible artifacts that BHFAK wants to offer. Both
will also strengthen the argument for the feasibility of the innovation. The immediate next steps
for this innovation are to secure funding. At this time, no funding has been secured.
36
Conversations with CED, particularly EMHC, and the AEA has been ongoing for several
months.
Limitations and Risks
Initially, some school staff may see BHFAK as added work and responsibility, and they
may resent the innovation. These school staff need to understand that BHFAK was born out of
interviews, in which many of their peers said they felt voiceless and unable to handle BHCs in
the classroom (Teresa Dawson, personal communication, September 13, 2019).
The AEA, who represents many of the interests of schoolteachers and staff in Alabama,
may push back and not approve of the extra work we are requesting of school staff or may not
want to fund the project to the levels explained above. If this happens, additional conversations
will need to be initiated with the AEA. These conversations will urge the AEA to reconsider
based on their mission, school safety, and evidence showing that some school staff want a
greater voice in helping children and taking back charge of their classroom.
Additionally, school staff may flood the MHCs with bogus referrals. This has been
considered, and it will be addressed by tapping into an unused capacity that already exists,
creating new capacity, and using evidence-based approaches to increase capacity. Currently,
CED MHC requires a 60% productivity (Teresa Dawson, personal communication, July 3,
2020). This is 5% less productivity than the industry standard (Robin Kay Wicker, personal
communication, June 23, 2020). This 5% is an unused capacity that could be used to benefit
BHFAK. BHFAK will also help speed up an old-fashioned referral system. Therapists will have
to spend less time collecting and reviewing referrals; it can all be done at the comfort of their
office. This will give the therapists following up on the referrals more time to attend to an
37
increased number of clients. Also, receptionists and MHC admin staff may be used to schedule
providers to their optimal efficiency.
New capacity could be created by MHCs contracting with teletherapy providers out-of-
state to help meet the demand if needed. The increase in billable services will allow the MHC to
hire more therapists as needed. The number of providers in Alabama has drastically increased in
the last two years and will likely continue to increase (Blomme et al., 2020b). Some MHCs such
as CED already use tele-psychiatrists to help meet the need for psychiatric services for children
(Teresa Dawson, personal communication, February 21, 2019). As stated earlier, MHCs
experience reduced “no show” rates with tele-therapy services (Teresa Dawson, personal
communication, July 3, 2020). Additionally, schools already employ master-level social workers.
Although they are trained providers of behavioral health services, they often are charged with
academic achievement and making external referrals. These social workers could be used to meet
the potential shortage of therapists at community MHCs. These social workers could become
employees of community MHCs. Thus, BHFAK helps utilize school employed master social
workers to their full potential.
Approaches to build capacity involve reducing missed appointments at the MHCs. MHCs
have a high degree of “no-show” appointments (Teresa Dawson, personal communication, July
2, 2020). CED averaged 25% pre-COVID-19 pandemic. CED now averages 17.49% after
switching services to telehealth post-COVID-19 pandemic (Teresa Dawson, personal
communication, July 2, 2020). To reduce “no shows,” MHCs can host drop-in hours in-person
and through telehealth (Henderson et al., 2017).
The timeframe of the policy change is uncertain. BHFAK policy changes are expected to
take less than one year; similar policies have been changed in the same amount of time (Magor-
38
Blatch & Rugendyke, 2016). Although the amount of time needed to change ADMH leadership’s
mind is uncertain, the importance of BHFAK will likely happen in the allotted time frame
because of the before mentioned importance and the data provided from the pilot study.
Concluding Thoughts
School-age youth living in the rural South, particularly Alabama, are some of the most
disadvantaged in terms of behavioral health care (El-Amin et al., 2018). Lack of access to
behavioral health care often leads many school-age youths to have untreated BHCs (El-Amin et
al., 2018). This untreated illness often manifests and progresses into more severe BHCs in
addition to physical and sexual health issues (El-Amin et al., 2018). Something needs to be done
to effectively improve access to care for this vulnerable population, and BHFAK is a viable
solution. By increasing access to behavioral healthcare for youth through innovative policy
changes, a new referral application, youth screenings for BHCs, and teacher education, the
youth, their families, and society all benefit. After all, youth are our future hope as a society, and
helping youth access care will help them live healthy and productive lives. BHFAK can go
beyond the scope of Alabama; it can be used as a model with any school system without the
resources to employ behavioral health professionals.

39
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46
Appendix A

47
Appendix B
Journey Map of Users with the Current System
Step # 1 2 3 4
Description of
Step
Teachers,
administrators,
and school staff
come to work
every day with a
set amount of
knowledge
about BHCs that
they gathered
from education
and informal
experiences.
Some school employees
are somewhat comfortable
in recognizing severe cases
of BHCs because of the
current amount of training
they receive on severe
BHCs and suicide. Other
school employees feel
completely lost.
A youth shows
signs and/or
symptoms of
BHCs in front of
a school
employee, and
that employee has
to think about
whether the signs
and symptoms are
worth reporting to
the school social
worker/guidance
counselor. They
may also second
guess if a referral
is necessary, and
they may worry
about the
consequences if
they make the
wrong call about
their concerns.
If deemed
necessary,
the user
reports the
signs and
symptoms
they are
concerned
to the
school
social
worker
and/or the
school
guidance
counselor.
Responsible Party School staff School staff
Youth and school
staff
School
staff
Emotion
Plot
High
Neutral

Low
Description of
Emotion
Somewhat
anxious and
uneasy about
what they do not
know.
The feeling of minor
anxiety continues.
Increase in
anxiety as they
make decisions
Feel some
comfort
that they
are helping
a child.
Notes/Reference
Their
knowledge level
varies and is not
always accurate.
Severe cases of BHCs are
easier to spot to and don’t
always require trainings to
recognize.
School social
workers and
guidance
counselors are the
only ones who
can complete the
referrals. N/A
48

Step # 5 6 7 8
Description of Step
The school guidance
counselor or social
worker contacts the
youths’ parents and
tells them that a
referral will be made
with a school therapist
with the community
mental health center.
It is up to the
school social
worker or
guidance
counselor to
take
responsibility
and complete
the referral, not
forget details,
and try to
deliver in
information as
accurately as it
is told to them.
The school
social worker
and/or
guidance
counselor feels
pressure to
complete the
referral
accurately and
in a timely
manner
The school
guidance
counselor
and/or
social
worker
complete(s)
a paper
referral
form that is
issued by
the
Alabama
Department
of Mental
Health.
Responsible Party
School guidance
counselor/school
social worker
School
guidance
counselor/
school social
worker
School
guidance
counselor/
school social
worker
School
guidance
counselor/
school
social
worker
Emotion
Plot
High
Neutral

Low
Description of
Emotion
Neutral, most want
the youth’s parents to
allow for intake.
A lot of stress
that can cause
anxiety for the
counselor/
social worker.
A lot of stress
that can cause
anxiety for the
counselor/
social worker.
Relief that
the referral
is
completed.
Notes/Reference
If the parent doesn’t
services, the journey
ends.
The referrals
are completed
with
secondhand
information.
A lot of
information
can lost in
translation
when it is
second handed.
Everyone
at the
school
must use
the same
referral
form
according
to policy.
49

Step # 9 10 11 12
Description of Step
The completed referral
form waits in a stack
in school social
worker or guidance
counselor’s office until
a school therapist
(who is actually
contracted by the
school but who is an
employee on the
community mental
health center).
The completed
referral form is
picked up by the
school therapist
and reviewed by
therapist in 1-3
weeks.
The therapist has
to contact the
youth’s
guardians to
verify their
permission to
treat the youth
The therapist
puts the youth on
the schedule for
an intake
assessment (4-6
weeks).
Responsible Party
School therapist School therapist
School therapist
and guardian School therapist
Emotion
Plot
High
Neutral

Low
Description of
Emotion Neutral/negative Neutral/negative Neutral/negative Neutral/negative
Notes/Reference
Some therapists do
not like an increase in
referrals because it
means a greater
workload for them.
They may put some of
the referrals off
intentionally. N/A
A common issue
at this stage is
that therapists
discover that
schools never
contacted the
parent about a
referral being
completed.
The wait is
based on the
therapists’
caseload and the
amount of time
they have to look
through other
referrals.

50
Step # 13 14 15 16
Description of
Step
During this lag
time of 4-6 weeks,
school officials
often become
frustrated because
they don’t believe
nothing is being
done with the youth
they referred for
services.
The youth may
have developed
negative coping
skills for having
to wait so long
before seeing a
mental health
professional.
The youth is
seen for an
intake
assessment by
a therapist
from the
community
mental health
center who
works in the
school.
The youth
makes a
follow up
appointment
with the
therapist
(usually for
individual
and/or family
therapy) if
services are
deemed
necessary.
Responsible Party School officials Youth
School
Therapist and
Youth
School
Therapist
Emotion
Plot
High
Neutral

Low
Description of
Emotion
Frustration
Emotion varies
on mental health
issues, but it is
usually negative.
Both youth
and therapist
are hopeful of
the relationship
Increasing
levels of
hope with
continued
treatment.
Notes/Reference N/A
These negative
coping skills can
cause more
problems for the
youth later down
the line.
For youth
younger than
14, their
guardian must
present at the
intake. For
youth 14 years
old or older,
the guardian
will be invited
to attend but
their presence
is optional.
The paper
referrals are
time
consuming to
therapists and
use time the
therapist
could be
meeting with
the client.

51
Step # 17 18 19 20
Description of Step
If physician
medical
appointment
s, case
management
, group
therapy, or
substance
abuse
treatment is
needed, the
therapist
will have to
make a
referral for
those
services.
The case
manager is
required to
follow up on
the referral
within a week.
The
physician
and/or
substance
abuse
therapist
usually
have a
wait time
for
services
that
ranges
anywhere
from 2-3
months.
The client
will
complete
the intake
for these
services
based on
the
availabilit
y of case
managers
,
substance
abuse
therapists
, and
physician
s.
Responsible Party Therapist Case Manager
Physicia
n/
substance
abuse
therapist
Physicia
n, case
manager,
and/or
substance
abuse
therapist
Emotion Plot
High

Neutral

Low
Description of Emotion
Good
Neutral/Negati
ve
Neutral
Negative Hopeful
Notes/Reference
When
multiple
services are
involved it
takes some
of the
pressure off
the therapist
Follow up time
is agency
policy. N/A N/A

52
Step # 21 22 23 24
Description of Step
During the wait
time for these
additional services
the client continues
to see their
behavioral health
therapist.
Because the
client is not on
any meds for
such a long
period, the
client may
decompensate,
in terms on
their mental
health, this
may lead to
them having
to be
hospitalized
for acute care.
If
hospitalization
occurs, the
client may be
discharged
from 24 hours
to 30 days
later home or
if they still
have
significant
concerns they
may be
discharged to
a residential
facility.

In addition to
hospitalizations,
the client may
have symptoms
of BHCs that
cause them
legal issues.

Responsible Party School therapist
Hospital
personnel
Hospital
personnel Court systems
Emotion Plot
High

Neutral

Low
Description of Emotion
Hope continues
Hope
decreases and
the situation
may become
hopeless.
Hope
decreases and
the situation
may become
hopeless.
Hope decreases
and the
situation may
become
hopeless.
Notes/Reference N/A N/A N/A
As you see, the
lag in mental
health services
causes the
client’s mental
health to spiral
downward.

53
Step # 25 26 27 28
Description of Step
The delay in
treatment can
lead to the client
being placed on
probation of
having legal
charges.

When the
physician
appointment
comes around, the
client may require
more medication
than they
originally
required when the
referral was made
because their
BHCs has
progressed.

The client still
faces
consequences
in school for
the time that
they had
untreated
BHCs.

Finally,
the client
becomes
stable.

Responsible Party Client Client School staff
Client,
mental
health
team,
school
officials
Emotion
Plot
High
Neutral

Low
Description of Emotion
Negative
Negative, but
somewhat
hopeful
Negative, but
somewhat
hopeful
Good,
neutral
Notes/Reference N/A N/A N/A
The time
it takes
for a
client to
become
stale
varies by
individual
and
BHCs.

54
Appendix C
Journey Map of Users with Innovation

Step # 1 2 3 4
Description of Step
Teachers,
administrators,
and other school
staff come to
work every day
with a set about of
knowledge about
BHCs that they
gathered from
formal education,
trainings taught
on the job
(online), and
informal
experiences.
All school
employees
are
comfortable
and confident
with
screening
youth for
BHCs.
School staff
complete
screenings
for BHCs.
Students
who score
21 or
above on
either the
YIPS or
YEPS need
a referral
completed
on their
behalf.
Responsible Party School staff School staff
School
staff
School
staff
Emotion
Plot
High

Neutral

Low
Description of Emotion
Neutral Confident Confident
Confident
and
Qualified
Notes/Reference
Trainings on
BHCs for school
staff dramatically
increased their
confidence in
completing
referrals.
Early
recognition
for BHCs
leads to early
intervention!
Early
intervention
decreases
the chance
of BHCs
having a
major
negative
impact.
This
referral can
be
completed
on any
electronic
device with
wi-fi
connection.
The app is
available
24/7.

55
Step # 5 6 7 8
Description of Step
The completed
referral form
is delivered
instantly and
securely to the
inbox of the
school
therapist
assigned to the
school making
the referral
The completed
referral form is
reviewed by the
school therapist
in 2 business
days.
The
therapist
contacts
the
guardian
of the
youth
and
confirms
that they
approve
the
referral.
The therapist
puts the
youth on the
schedule for
an intake
assessment
(2-3 week
wait period).
Responsible Party
Referral
application
School
therapist
School
therapist
and
guardian
School
therapist
Emotion Plot
High
Neutral

Low
Description of Emotion
Neutral Good
Hopeful
for youth
Hopefulness
continues
Notes/Reference
The therapist
no longer has
to wait to
receive the
referral. The
therapists’
supervisor can
also see a
referral was
sent make
ensure the
therapist
follows up on
it. Major
potential for
the therapists
to become
overwhelmed
with too many
referrals
Less Chance of
the referral
getting lost or
overlooked by
the school
therapist.
Review in 24
hours in the
goal, but
feasibility may
be an issue later
on. So,
increased the
review time to 2
business days.
Guardian
approval
is
required
by the
mental
health
center.
This wait
period is
reduced
because the
therapist is
spending
less time
having to
sort through
paper
referrals.

56
Step # 9 10 11 12
Description of Step
During this
2-3-week
period,
school
officials may
become
frustrated
because they
don’t believe
nothing is
being done
about the
referral they
completed.
The youth
may have
developed
negative
coping
skills for
having to
wait so long
before
seeing a
mental
health
professional
The youth
is seen for
an intake
assessment
by a
therapist
from the
community
mental
health
center who
works in
the school.

The youth
makes a
follow up
appointment
with the
therapist
(usually for
individual
and/or
family
therapy) if
services are
deemed
necessary.

Responsible Party School staff The youth
School
therapist,
youth, and
maybe the
guardian
Youth and
school
therapist
Emotion Plot
High

Neutral

Low
Description of Emotion
Frustration Negative Hopeful
Continued
hopefulness
Notes/Reference
Less
frustration
than before
innovation
because the
wait is
shorter.
The
negative
coping
skills can
case the
youth legal
issues,
issues at
home, and
issues at
school later
down the
road.
The intake
can be
completed
without the
guardian
present if
the youth
is over 14
years old;
the
guardian
can still
come if
they
choose and
the youth
approves.

For intake,
the guardian
must be
present at
the intake if
the youth is
under 14
years old.

57
Step # 13 14 15 16
Description of Step
If physician
medical
appointments,
case management,
group therapy, or
substance abuse
treatment is
needed, the
therapist will have
to make a referral
for those services.

The case
manager is
required to
follow up on
the referral
within a
week.

The physician
and/or
substance
abuse
therapist
usually have a
wait time for
services that
ranges
anywhere
from 2-3
months.

The client
will
complete
the intake
for these
services
based on
the
availability
of case
managers,
substance
abuse
therapists
and
physicians.

Responsible Party School therapist
Case
manager
Mental health
professional
Client and
mental
health
professiona
l
Emotion Plot
High
Neutra
l

Low
Description of Emotion Hopeful Neutral Neutral Neutral
Notes/Reference
This doesn’t
change with the
innovation;
however, it is
important to note
that because
innovation may
have caused the
BHCs to be
detected early on.
The likelihood of
needed case
managers,
prescribers,
substance abuse
therapists are all
decreased.
The follow
up time is an
agency
standard.
The follow
up time is an
agency
standard.
Luckily the
therapist
saved time for
the client
when her/she
was able to
schedule their
intake with
the client
earlier
because of the
innovation. N/A

58
Step # 17 18 19 20
Description of Step
During
the wait
time for
these
additional
services
the client
continues
to see
their
BHCs
therapist.

Because the
client is not
on any meds
for such a
long period,
the client
may
decompensat
e, in terms
on their
mental
health, this
would lead
to them
having to be
hospitalized
for acute
care.

If
hospitalizati
on occurs,
the client
may be
discharged
from 24
hours to 30
days later
home or if
they still
have
significant
concerns
they may be
discharged
to a
residential
facility.

In addition to
hospitalizatio
n, the client
may have
symptoms of
BHCs that
cause them
legal issues.

Responsible Party
School
therapist
Client and
mental
health team
Hospital
team Client
Emotion Plot
High
Neutral

Low
Description of Emotion
Hopeful
Neutral/
Losing hope
Neutral/
Losing hope
Neutral/
Losing hope
Notes/Reference
This step
is less
likely
because
on
innovatio
n.
This step is
less likely
because on
innovation.
This step is
less likely
because on
innovation.
This step is
less likely
because on
innovation.

59
Step # 21 22 23 24
Description of Step
The delay in
treatment can
lead to the client
being placed on
probation of
having legal
charges.
When the
physician
appointment
comes
around, the
client may
require
more
medication
than they
originally
required
when the
referral was
made
because
their BHCs
has
progressed.
The client
still faces
consequences
in school for
the time that
they had
untreated
BHCs. The
client will
complete the
intake for
other
services
needed and
usually case
managers
schedule
clients based
on their
availability.
Finally, the
client
becomes
stable.

Responsible Party Court system
Client,
mental
health team,
and/or
school
Client,
school,
and/or
mental health
team
Client, school
officials, and
mental health
team
Emotion Plot
High
Neutral

Low
Description of Emotion Neutral/ Losing
hope
Neutral/
Losing
hope
Neutral/
Losing hope Good
Notes/Reference
Again, many of
the negative
consequences
will likely be
reduced/eliminate
by the BHCs
being referred
early on!
This step is
less likely
because on
innovation.
This step is
less likely
because on
innovation.
Overall, the
amount of
time it took to
get the client
stable was
shorter than
before the
innovation.

60
Appendix D
Screenshots from BHFAK website

(The above screenshot is the homepage. Note the promotional video.)
61

(The above screenshot is the top half of the problem page. Note all the facts and data.)

62

(The above screenshot is the bottom-half of the problem page. Note all the facts and data.)

63

(The above screenshot is the solution page. It gives a broad overview of the innovation.)

64

(The above screenshot is the top half of the mock referral page. This is an earlier draft of the
referral template.)

65

(The above screenshot is the bottom-half of the mock referral page. This is an earlier draft of the
referral template.)

66

(The above screenshot is the training page. Hopefully links to the trainings hosted on relias.com
will be poster here soon along with the curriculum guide.)

67
(The above screenshot is the advocacy page. It illustrates how people can help by signing a
petition and writing letters to the gatekeepers. A link on this page takes the user to an advocacy
letter to send to the gatekeepers.)

(Here is the advocacy letter that will open in Word when the link is clicked.)

68

(Here is a screen shot of page that allows the user to join the newsletter.)

69

(Finally, here is a screenshot of the contact page.)

70
Appendix E
Curriculum Guide

Behavioral Health for All Kids School Staff Curriculum Guide - Version 1

71

Contents
About the Guide _____________________________________________________________ 72
Curriculum Structure _________________________________________________________ 73
Reviewing the Guide __________________________________________________________ 74
Pre-Post Test ________________________________________________________________ 75
Module 1: Understanding Behavioral Health Gap ___________________________________ 78
Module 2: How to Screen Youth for Behavioral Health Conditions and Screening Implications 84
Module 3: Understanding How to Make an Appropriate Referral. ______________________ 86
Training Evaluation __________________________________________________________ 96
References __________________________________________________________________ 97
Other Resources _____________________________________________________________ 99

72
About the Guide
Behavioral Health for All Kids (BHFAK) Curriculum is resource geared to educating school
staff on behavioral health challenges among school-age youth. This is designed to be a three hour
training. It also focuses on ways that school staff in Alabama can make electronic referrals using
the BHFAK mobile app. This curriculum reflects Diagnostic and Statistical Manual V (DSM-5)
nomenclature. The goal of this guide is not to make school staff experts in mental health; instead,
its goal is to educate school staff on when to make a referral and how to make a referral on the
new referral application. 30 minutes of the training time will be used taking pre and post-tests.
BHFAK has three components or modules:
1. Understanding behavioral health gap (30 minutes)
2. How to screen youth for behavioral health conditions (1 hour)
3. Understanding how to make an appropriate referral (1 hour)
Interactive trainings from this curriculum will be made available on relias.com Links to these
trainings can be found at www.behavioralhealthforallkids.com. This curriculum is an outline and
explanation of the trainings found at www.behavioralhealthforallkids.com.

73
Curriculum Structure
Step 1 – School staff will complete a Pre-test (10 minutes)
Step 2 – School staff will complete all Modules 1-3 (2.5 hours)
Step 3 – School staff will complete a Post-test (10 minutes)
Step 4 – School staff will complete a Training Evaluation (10 minutes) - optional

74
Reviewing the Guide
Module Major Concepts
Module 1:
The behavioral health gap (30 minutes)

• What is the behavioral health gap?
• Current behavioral health statistics
• Alabama’s approach to the behavioral
health gap
• What can we do to help?
Module 2:
How to screen youth for behavioral health
conditions (1 hour)

• Understanding the two screeners we
use
• How to help youth use the screeners
• How to use information from the
screens
Module 3:
Understanding how to make an appropriate
referral (1 hour)

• Applying to knowledge
• The Application
• Safety First

75
Pre-Post Test
This test is given before and after the training. This test will examine what the school staff have
learned about behavioral health conditions in the training.
1. It is most important to address behavioral health conditions only outside the school
setting.
a. true b. false
2. Stigma surrounding behavioral health conditions is strong in the rural South.
a. true b. false
3. Only half of youth with a behavioral health condition get the treatment they need.
a. true b. false
4. School staff can complete referrals using the BHFAK application.
a. true b. false
5. Known traumatic events that affect the daily functioning of a youth qualifies as a reason
for a referral.
a. true b. false
6. The name of the two screeners we use are the youth internalizing problems screen and the
youth externalizing problems screen.
a. true b. false
7. Behavioral Health for All Kids complies with all relevant HIPPA regulations.
a. true b. false
8. A referral to Behavioral Health for All Kids should be the first thing done when a youth
discusses thoughts of homicide or suicide.
a. true b. false
76
9. Adults have a higher rate of undiagnosed behavioral health issues than children.
a. true b. false
10. The ratio of Alabama citizens to mental health workers is 200:1.
a. true b. false
11. A referral can be made without parental approval.
a. true b. false
12. There is no danger in making an unnecessary referral.
a. true b. false
13. Behavioral health conditions rarely cause youth to become involved in the criminal
justice symptoms.
a. true b. false
14. A score below 21 on either the YEPS or YIPS should result in a referral being made.
a. true b. false
15. School staff could be held liable for making an inappropriate referral.
a. true b. false
16. One in ten youth are affected with a behavioral health condition.
a. true b. false

77
Answer Key:
1. B
2. A
3. B
4. A
5. B
6. A
7. A
8. B
9. B
10. B
11. B
12. A
13. B
14. B
15. B
16. B
78
Module 1: Understanding Behavioral Health Gap
• What is the behavioral health gap?
o Social Work Grand Challenges. They are numbered below. We are only focusing
on the health gap (American Academy of Social Work and Social Welfare, n.d.).
1. Close the health gap
• Behavioral Health Gap – Leads to Behavioral issues at home.
• Why are kids not successful at school? See figure 1.
Figure 1
Reasons for Lack of Success at School

• Encourage thoughts about how behavioral health affects school
staff at work.
• Note how other grand challenges are all interrelated to the
behavioral health gap.
2. Ensure healthy development for all youth
3. Stop family violence
4. End homelessness
5. Eradicate social isolation
79
6. Advance long and productive lives
7. Create positive social responses to a changing environment
8. Harness technology for social good
9. Promote smart decarceration
10. Achieve equal opportunity and justice
11. Reduce extreme economic inequality
12. Build financial capability for all
• Start Conversation by showing video found on the homepage of the website
(www.behavioralhealthforallkids.com)
• Current behavioral health statistics
o What percentage of youth are in school K-12? 17.3% (Mental Health America,
2018)
Figure 2
Bar Graph of Target Population vs. Total Population in Alabama
(Mental Health America, 2018)
o One in five youth have a diagnoseable mental health condition at some point in
their childhood and adolescence; thus, a very large percentage of all Alabama is
affected (Keynejad et al., 2017)
Figure 3
80
Illustration of Youth affected with Behavioral Health Conditions
(Kaushik et al., 2016)
• Schools deal with these youth on a daily basis.
• Mental illness is found in all ethnicities, classes, grade levels, and family
backgrounds.
• Recognize that diagnosis comes from symptomology meeting certain DSM-V
criteria.
• Only 33% of youth who need behavioral health care get it! (Keynejad et al., 2017)
Figure 4
Pie Chart of Youth Receiving Behavioral Health Treatment
(Kaushik et al., 2016)
• Many things prevent timely treatment (Marmot, 2017)
• Outdated policies
• Stigma and shame
• Symptoms not being recognized
81
• Unable to access services (due to cost or some other reason)
• Lack of treatment can lead to lifelong difficulties (Keynejad et al., 2017)
• Difficulties at school, work, and home.
• Poor work habits
• Poor grades
• Peer relationships
Figure 5
Illustration showing Alabama’s Rankings for Behavioral Health Treatment
(Mental Health America, 2018)
• Lack of Quality treatment in Alabama
• Due to too few providers in some counties
• Lack of social support programs
• Politics
Figure 6
Illustration showing Alabama’s Rankings for Accessing Behavioral Health Care

82
• (Mental Health America, 2018)
• Alabama’s approach to the behavioral health gap
o Increase in social work graduate programs
o Improve funding to preventative services
o In-school behavioral health referrals
• All of these approaches are still too little.
Figure 7
Illustration showing Alabama’s Approaches to Solving the Behavioral Health Gap

• What can we do to help?
o Keep an open outlook
§ Perspective taking
§ Encourage user to do a perspective taking exercise and what it would be
like to walk in someone else’s shoes.
83
o Make in-school referrals
§ Provided by community mental health center
• No cost to client or their family for in-school therapy (This has
been in practice for years.)
o Insurance will be filed if applicable
o No insurance = no worries
o Client may be seen by a psychiatrist in mental health center
office. Applicable insurance co-pays apply. If client has no
insurance, fees will be based on a sliding fee scale. A $5
minimum fee applies.
§ Old referral system is outdated
• At times, it may take 6-9 weeks to get issues address
§ New referral system uses an online referral application
• Can get issues addressed in two weeks

84
Module 2: How to Screen Youth for Behavioral Health Conditions and Screening
Implications
• Youth should be given the Youth Internalizing Problem Screener and the Youth
Externalizing Problem Screener.
o Youth should be given 15 minutes to complete each screen.
o Ideally these should be completed at least annually.
o The beginning of the school year is an ideal time for completion.
o Both screens can be found near the end of this curriculum guide.
• Trainer should review all the statements in both screeners.
• For both screeners, a score of 21 should result in a referral being made.
• When to make a referral?
o A score above 21 on either screener.
• When not to make a referral?
o A score below 21 on either screener.
• Cultural Competence
o Cultural factors play a role in the development of behavioral health conditions
§ Minority communities are often burdened with social determinants, and
those include the following:
• Poverty
• Exposure to violence
• Discrimination
o Not all symptoms of behavioral health conditions are universal.
§ Some vary on an individual basis
85
§ Others vary based on culture
• Take into account the cultural norms of a client
o For example, some cultures are more verbal, and others are
passive
o Cultural Norms affects students in other ways
§ Do they seek or avoid treatment?
§ How they cope with stress.
§ Stigma associated with mental illness
§ Compliance with treatment
§ How they perceive and express treatment
o If English is not the student’s first language, request a language concordant
provider. Be sure to use a professional interpreter if the provider is not possible.
o Consider how behavioral health conditions are viewed in the student’s religion.
§ This is especially relevant because Behavioral Health for All Kids piloting
in Alabama, and Alabama is, of course, is rural and predominately
protestant Christian.
§ Take into account your own religious views and how they may influence
how you may screen children and make referrals.

86
Module 3: Understanding How to Make an Appropriate Referral
• Applying to knowledge
o Don’t be afraid.
o With well-intentioned referrals the benefits outweigh risks.
o Conversations with youth on mental illness are never easy.
o All people undergoing the training to download and test the application.
• The Application
o Encourage participant to download App as shown during the training.
o Go to Apple App Store or Google Play Store
o Download the application entitled Behavioral Health for All Kids
o Once downloaded, open the application
o During your first use of the app, you will need to register. Register just as you
would using any other app.
Figure 8
Screenshot of Login/Registration Page for BHFAK Application

87

o During registration, you will be emailed a validation code. Once you input this
code during registration, your registration will be complete
Figure 9
Screenshot of Email Confirming Registration

88

o You may now login with your credentials.
o Once logged-in to the application. You will see four tabs.
Figure 10
Screenshot of BHFAK Application Home Page
89

1. About Us- Summary of Behavioral Health for All Kids, mission, and
values are listed
Figure 11
Screenshot of BHFAK About Us Page

90

• Summary - Alabama schools address access to behavioral health
care by providing in-school services. Most Alabama schools’
partner with local Alabama Department of Mental Health
(ADMH)-contracted community mental health centers to provide
in-school services. Behavioral Health for All Kids will reduce the
behavioral health gap among youth in Alabama schools by
improving access to care through a multi-phase innovation, and
those phases are the following: 1) updating ADMH policies, 2)
specific school staff trainings, 3) implementing an electronic
referral. This app can be used to submit a secure electronic
referral.
• Mission - Behavioral Health for All Kids is dedicated to improving
access to behavioral health care for youth living in Alabama
91
through policy change, offering school staff trainings, and
implementing an electronic referral.
• Values - To improve access of behavioral health services to all
school-age youth in the state of Alabama.
2. Behavioral Health for All Kids
Figure 12
Screenshot of BHFAK Application Website Screen

• Link to the website.
• The trainings based on this curriculum will be available on this
website along with a host of other information.
3. Referral
• This is the form where were school staff can complete their
referral. The completed referral will be sent to the appropriate
92
school therapist based upon the school and grade selected.
Additionally, the youth behavioral health coordinator (the
therapist’s supervisor) will receive a copy of the completed
referral.
Figure 13
Screenshot of BHFAK Application Referral Page

• After a referral is submitted by the school staff, the school staff will receive a
message stating that the referral was submitted successfully.
• It is important that the school staff making the referral checks the appropriate answer
when asking if the parent has been notified of the referral being made. This will let
the therapist engage with the parent in the appropriate manner.

93

Figure 14
Screenshot of BHFAK Application Referral Page Showcasing School Options

Figure 15
Screenshot of BHFAK Application Referral Page Showcasing Grade Options
94

Figure 16
Screenshot of BHFAK Application Support Page

(The image reflects what happens when you click support icon.)
95
• This tab links the user to the IT support of the local community
mental health center.
• The support may be via phone or email. The form of
communication used will be whatever is easiest based on the
mental health center.
• Reducing excessive referrals
o Referrals should not be completed with a youth who you are certain is already
known to be in the care of the mental health center.
o Referrals should not be made for youth who score below 21 on the screeners.
Students need to score above 21 on either the YEPS and YIPS.
• Safety First
o Do not keep suicide concerns or self-harm behaviors confidential.
o Let your supervisor know about safety concerns.
• Finally, give the people undergoing the training two sample scenarios with screen scores
and allow them to practice the application. Just make sure they type the word “test” in the
comment section of the referral so that an actual therapist will not follow up on the
referral.

96
Training Evaluation
1. Overall, how would you rate this training on a scale from 1-10? (1 being the worst and 10
being the best)

2. How would you rate the usefulness of the content on a scale from 1-10? (1 being the
worst and 10 being the best)

3. Do you now feel comfortable making a referral using the Behavioral Health for All Kids
referral application?

4. How would you rate the pace of the presentation? (Too fast Too slow Just right)

5. Was the training above or below your current skill level?

6. What did you like best or find most useful about the presentation?

7. What skills did you learn that may help prepare you for technology integration in the
classroom?

8. Were your personal learning goals for the course met? Yes or no
If "No," please describe those expectations that were not met.

9. Any other comments?
97
References

American Academy of Social Work and Social Welfare. (n.d.). About: Grand challenges for
social work. http://aaswsw.org/grand-challenges-initiative/about/
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Kaushik, A., Kostaki, E., & Kyriakopoulos, M. (2016). The stigma of mental illness in children
and adolescents: A systematic review. Psychiatry Research, 243, 469–494.
https://doi.org/10.1016/j.psychres.2016.04.042
Keynejad, R., Dua, T., Barbui, C., & Thornicroft, G. (2017). WHO mental health gap action
programme (mhGAP) Intervention Guide: A systematic review of evidence from low and
middle-income countries. Evidence Based Mental Health, 21(1), 30–34.
https://doi.org/10.1136/eb-2017-102750
Kutcher, S. & Wei Y. (2017). Mental health and high school curriculum
guide. http://teenmentalhealth.org/schoolmhl/wp-content/uploads/2019/01/final-
washington-guide-full-online-version.pdf
Marmot, M. (2017). Closing the health gap. Scandinavian Journal of Public Health, 45(7), 723–
731. https://doi.org/10.1177/1403494817717433
Mental Health America. (2018). The state of mental health in America,
2018. http://www.mentalhealthamerica.net/issues/state-mental-health-america.
Renshaw, T., & Cook, C. (2018). Initial development and validation of
the Youth Internalizing Problems Screener. Journal of Psychoeducational Assessment,
36(4), 366–378. https://doi-org.libproxy2.usc.edu/10.1177/0734282916679757
98
Renshaw, T., & Cook, C. (2019). Preliminary Psychometrics of Responses to the Youth
Externalizing Problems Screener. Journal of Psychoeducational Assessment, 37(8),
1016–1022. https://doi.org/10.1177/0734282918809814

99
Other Resources
American Academy of Child and Adolescent Psychiatry - www.aacap.org
Mentalhealth.gov - https://www.mentalhealth.gov
National Institute for Mental Health (NIMH) - www.nimh.nih.gov/
Substance Abuse and Mental Health Services Administration - https://www.samhsa.gov/find-
help/national-helpline

100
Youth Internalizing Problems Screener (YIPS)
Student Name: _____________________
Date: ____________________
How OLD are you? __________
Are you MALE or FEMALE? __________
What is your RACE or ETHNICITY? __________
Here are some questions about what you think, feel, and do. Read each sentence and
circle your answer (either Almost Never, Sometimes, Often, or Almost Always) for each
question.
1.I feel nervous or afraid.
Almost Never or Some-times or Often or Almost Always
2.I feel very tired and drained of energy.
Almost Never or Some-times or Often or Almost Always
3.I find it hard to relax and settle down.
Almost Never or Some-times or Often or Almost Always
4.I get bothered by things that didn’t bother me before.
Almost Never or Some-times or Often or Almost Always
5.I have uncomfortable and tense feelings in my body.
Almost Never or Some-times or Often or Almost Always
6.I feel moody or grumpy.
Almost Never or Some-times or Often or Almost Always
7.I feel like I’m going to panic or think I might lose control.
Almost Never or Some-times or Often or Almost Always
8.I do not really enjoy doing anything anymore.
Almost Never or Some-times or Often or Almost Always
9.I feel worthless or lonely when I’m around other people.
Almost Never or Some-times or Often or Almost Always
10. I have headaches, stomachaches, or other pains.
Almost Never or Some-times or Often or Almost Always

THANK YOU for completing the survey!
Source: Renshaw, T., & Cook, C. (2018). Initial development and validation of the Youth Internalizing Problems Screener. Journal of
Psychoeducational Assessment, 36(4), 366–378. https://doi-org.libproxy2.usc.edu/10.1177/0734282916679757

101
Youth Externalizing Problems Screener (YEPS)
Student Name: _____________________
Date: ____________________
How OLD are you? __________
Are you MALE or FEMALE? __________
What is your RACE or ETHNICITY? __________
Here are some questions about what you think, feel, and do. Read each sentence and
circle your answer (either Almost Never, Sometimes, Often, or Almost Always) for each
question.
1. I forget things and make mistakes.
Almost Never or Some-times or Often or Almost Always
2. I lose my temper and get angry with other people.
Almost Never or Some-times or Often or Almost Always
3. I have a hard time sitting still when other people want me to.
Almost Never or Some-times or Often or Almost Always
4. I fight and argue with other people.
Almost Never or Some-times or Often or Almost Always
5. I have trouble staying organized and finishing assignments.
Almost Never or Some-times or Often or Almost Always
6. I break rules whenever I feel like it.
Almost Never or Some-times or Often or Almost Always
7. I talk a lot and interrupt others when they are talking.
Almost Never or Some-times or Often or Almost Always
8. I say or do mean things to hurt other people.
Almost Never or Some-times or Often or Almost Always
9. I have hard time focusing on things that are important.
Almost Never or Some-times or Often or Almost Always
10. I like to annoy people or make them upset.
Almost Never or Some-times or Often or Almost Always
THANK YOU for completing the survey!

Source: Renshaw, T., & Cook, C. (2019). Preliminary Psychometrics of Responses to the Youth Externalizing Problems Screener. Journal of
Psychoeducational Assessment, 37(8), 1016–1022. https://doi.org/10.1177/0734282918809814

102
Thank you!
Making referrals and providing hope to some of our most vulnerable youth is no easy
task, but by you taking to time to implement the Behavioral Health for All Kids curriculum it
shows you care. It is our goal to improve the lives of as many youths as possible in Alabama and
throughout the nation. If you have any feedback, please let us know!
Nathan Popham, Founder at nathanedwardpopham@gmail.com
Or you may also message on our website at www.behavioralhealthforallkids.com or call us at
(256)926-8797. Best of luck and thank you for being such a powerful change agent!

103
Appendix F
Youth Internalizing Problems Screener (YIPS)
Student Name: _____________________
Date: ____________________
How OLD are you? __________
Are you MALE or FEMALE? __________
What is your RACE or ETHNICITY? __________
Here are some questions about what you think, feel, and do. Read each sentence and
circle your answer (either Almost Never, Sometimes, Often, or Almost Always) for each
question.
11. I feel nervous or afraid.
Almost Never or Some-times or Often or Almost Always
12. I feel very tired and drained of energy.
Almost Never or Some-times or Often or Almost Always
13. I find it hard to relax and settle down.
Almost Never or Some-times or Often or Almost Always
14. I get bothered by things that didn’t bother me before.
Almost Never or Some-times or Often or Almost Always
15. I have uncomfortable and tense feelings in my body.
Almost Never or Some-times or Often or Almost Always
16. I feel moody or grumpy.
Almost Never or Some-times or Often or Almost Always
17. I feel like I’m going to panic or think I might lose control.
Almost Never or Some-times or Often or Almost Always
18. I do not really enjoy doing anything anymore.
Almost Never or Some-times or Often or Almost Always
19. I feel worthless or lonely when I’m around other people.
Almost Never or Some-times or Often or Almost Always
20. I have headaches, stomachaches, or other pains.
Almost Never or Some-times or Often or Almost Always

THANK YOU for completing the survey!
Source: Renshaw, T., & Cook, C. (2018). Initial development and validation of the Youth Internalizing Problems Screener. Journal of
Psychoeducational Assessment, 36(4), 366–378. https://doi-org.libproxy2.usc.edu/10.1177/0734282916679757
104
Appendix G
Youth Externalizing Problems Screener (YEPS)
Student Name: _____________________
Date: ____________________
How OLD are you? __________
Are you MALE or FEMALE? __________
What is your RACE or ETHNICITY? __________
Here are some questions about what you think, feel, and do. Read each sentence and
circle your answer (either Almost Never, Sometimes, Often, or Almost Always) for each
question.
11. I forget things and make mistakes.
Almost Never or Some-times or Often or Almost Always
12. I lose my temper and get angry with other people.
Almost Never or Some-times or Often or Almost Always
13. I have a hard time sitting still when other people want me to.
Almost Never or Some-times or Often or Almost Always
14. I fight and argue with other people.
Almost Never or Some-times or Often or Almost Always
15. I have trouble staying organized and finishing assignments.
Almost Never or Some-times or Often or Almost Always
16. I break rules whenever I feel like it.
Almost Never or Some-times or Often or Almost Always
17. I talk a lot and interrupt others when they are talking.
Almost Never or Some-times or Often or Almost Always
18. I say or do mean things to hurt other people.
Almost Never or Some-times or Often or Almost Always
19. I have hard time focusing on things that are important.
Almost Never or Some-times or Often or Almost Always
20. I like to annoy people or make them upset.
Almost Never or Some-times or Often or Almost Always
THANK YOU for completing the survey!

Source: Renshaw, T., & Cook, C. (2019). Preliminary Psychometrics of Responses to the Youth Externalizing Problems Screener. Journal of
Psychoeducational Assessment, 37(8), 1016–1022. https://doi.org/10.1177/0734282918809814

105
Appendix H
Logic Model

Inputs Activities Outputs Outcomes
Resources
Methods of service
delivery carried out
by staff
Product or unit of
service provided
Short
-
Term
Inter
medi
ate-
Ter
m

Long-
Term
• Funding
($100,600 – for
start-up and 1
st

year) from AEA
and MHC
• Manpower to
gain funding.
• Manpower from
hired developer
to:
o to advocate,
collect, and
analyze data.
o to create staff
trainings
(curriculum
already
complete).
o to refine new
referral
application
• In -Kind
Donation from
MHC:
o Administrativ
e oversight for
the developer.
o Donation of
space for the
developer.
• Hire Developer
• Developer will:
o Develop and
deliver #We
Care
campaign to
ADMH &
public
o Collect more
data on the
usage of the
current
referral
system, and
then analyze
the data to
anticipate the
success of the
innovation
o Record and
have training
set up in a
Relias
Learning
(LMS
platform).
o Pilot BHFAK
o Refine
BHFAK app.
• 15 conversations
within 90 days
regarding the lack
of behavioral
healthcare among
Alabama youth
with ADMH
officials.
• Improved
knowledge on
BHFAK by
ADMH and
public.
• Stronger data
driven argument
can be presented
to ADMH
• Three hours of
trainings are
available to school
staff.
• Completed pilot
will show data of
pilot’s
success/failure.
Ready to use
BHFAK app.
Raise
aware
ness
aroun
d
behav
ioral
health
condi
tions
and
BHF
AK
and
create
a
desire
by the
state
to
addre
ss the
issue.

End
orse
ment
of
polic
y
chan
ge
and
acce
ptan
ce of
BHF
AK
thro
ugho
ut
state.

Youth
with
behavior
al health
condition
s are
referred
and get
the help
they need
in a
timely
manner.
Measure
d using
reports
gathered
from
Mental
Health
America
describin
g access
to
behavior
al health
care.

106
Appendix I
Prototype of Behavioral Health for All Kids Referral Application

(The above screen is what will greet users soon after they download the Behavioral Health for
All Kids application. Users will have to register the first time they use the application.
Subsequent times, they can simply login.)
107

(The above screen is what users will see the first time they register for the application. Users
will need to complete every field.)

108

(The above screen is an example of a confirmation email users will receive soon after registering
with the application.)

109

(The above screen is an example of a confirmation email the system administrator, usually the
mental health center’s information technology person, will receive soon after a user registers
with the application.)

110

(This is the application’s login-in screen after the user logs-in.)

111

(The above screen is what the user will receive after clicking the “About Us” link on the home
screen.)

112

(The above screen is what the user will receive after clicking the “Behavioral Health for All Kids
Website” link on the home screen.)

113

(The above screen is what the user will receive after clicking the “Referral” link on the home
screen.)

114

(The above screen is what the user will receive after clicking the “Referral” link on the home
screen and then clicking the downward arrow in the “School” field. This screen highlights the
different school options.)

115

(The above screen is what the user will receive after clicking the “Referral” link on the home
screen and then clicking the downward arrow in the “Grade” field. This screen highlights the
different grade level options.)

116

(Then, the user can input the youth’s internalizing problem screener score and the youth’s
externalizing problem screener score.)

117

(The above screen is what the user will receive after completing a referral and clicking the
“Submit” button.)

118

(The above screen is an example of a referral that was submitted via the Behavioral Health for
All Kids application. This referral was received via encrypted email by the appropriate mental
health professional.)

119

(The above screen is what the user will receive after clicking the “Support” link on the home
screen. This link can be changed to call or email the mental health center’s IT support person.)

120
Appendix J
Implementation Framework of Barriers and Facilitators
Explorat
ion
• Outer Context
• Barrier: securing funding and continuity of funding; sociopolitical context-
policies
• Facilitator: Client Advocacy, AEA Advocacy
• Inner Context
• Barrier: EMHC (and other MHC) culture
• Facilitator: EMHC (and other MHCs) perceived need for change, values,
goals, and current leadership.
Preparati
on
• Outer Context
• Barrier: Funding
• Facilitator: Sociopolitical-local enactment
• Inner Context
• Barrier: Organizational characteristics –role specialization, knowledge, skills,
expertise
• Facilitator: Leadership-cultural embedding and championing adoption
Impleme
ntation
• Outer Context
• Barrier: funding: sustained fiscal support
• Facilitator: Sociopolitical-legislative priorities
• Inner Context
• Barrier- Individual adopter characteristics- attitudes toward innovation,
adaptability
• Facilitator-Organizational Characteristics-priorities/goals, culture/climate,
structure
Sustain
ment
• Outer Context
• Barrier: Funding- cost absorptive capacity
• Facilitator: Public-academic collaboration –ongoing positive relationships and
valuing multiple perspectives. Sociopolitical- leadership
• Inner Context
• Barrier: Staffing-staff selection criteria
• Facilitator: Organizational characteristics- leadership, embedded EBP culture

121
Appendix K
Timeline for Implementation
Now-3
rd

Quarter
4
th
Quarter
2020
1
st
Quarter
2021
2
nd

Quarter
2021
3
rd
Quarter
2021
4
th
Quarter
2021
1
st
Quarter
2022
Continue
to explore
issue and
gather data
on how to
best serve
youth.
Advocacy
efforts to
get policy
changed.

Develop
technical
infrastructure
and the
application.
Continue
advocacy
efforts to get
policy
changed.

Adoption
of
innovation
by EMHC.
Train
GCHS
staff and
EMHC
staff on
innovation.
Continue
advocacy
efforts to
get policy
changed.

Complete
pilot study
at GCHS.
Continue
advocacy
efforts to
get policy
changed.

Continue
Advocacy
efforts to
get policy
changed
and
analyze
data in
pilot study
to perfect
innovation
Training
staff in
schools
and EMHC
to work
throughout
county.
Adoption
of
innovation
by other
schools
and MHCs.

Dispersion
of
innovation
to other
areas.

*GCHS is Gadsden City High School.

122
Appendix L
Gantt Chart for Implementation
Stage
Task Target Resource
Activity by Quarters (3-month periods) from the
start of the project
Noe-
3
rd

2020
4
th

2020
1
st

2021
2
nd

2021
3
rd

2021
4
th

2021
1st
2022
-
futur
e
Exploration
Resear
ch
argume
nt that
innovat
ion is
needed
A report
successfully
arguing the
need for the
innovation.
Manpow
er

Preparation
ADM
H
Grants
Permis
sion
for
Pilot
Leadership
of ADMH
signs
agreement
that allows
BHFAK to
pilot
innovation
Manpow
er,
approval
by
ADMH

Implementation
Pilot
Study
Executive
Director of
EMHC sign
completed
pilot study.
Finances,
Manpowe
r of admin
oversight/
developer
/volunteer
,
Approval
by
ADMH

Sustainment
Contin
ued
use of
BHFA
K by
schools
and
MHC
Use of the
innovation
one year
after pilot
ended.
Continue
d
finances,
manpowe
r

123

124
Appendix M
Start-Up Budget
Revenue
Contributions from MHC 5.00 from prevention budget
Contributions from AEA 5.00 statewide organization
In-Kind Donation of Space 1.00 $333.33/month
In-Kind Admin Oversight 1.00 mainly for HR related
Total Revenue 12.00

Expenses
Personnel Expenses
Onboarding/Training 2.00 for new developer
In-Kind Admin Oversight 1.00 mainly for HR related
Total Personnel 3.00

Operating Expenses
Publish/Maintaining 1.20
Website Maintenance 0.09
Training Hosting 0.90 will be hosted on Relias
Office Furniture 1.00 developer office
Office Supplies

1.00 developer office/ printing
Technology for Office 3.00 developer office
Rent (In-Kind) 1.00 $333.33/month

Total Op's 8.20

Total Expenses 11.20

Surplus/Deficit +0.80
* Amounts are given in thousands.

125
Appendix N
First-Full-Year of Operation Budget
Revenue
Contributions from MHC 39.60
Contributions from AEA 34.5
In-Kind Admin Oversight 10.00 mainly oversight from directors
In-Kind Donation of Space 4.00 $333.33/month

Total Revenue 88.60

Expenses
Personnel Expenses
Salary 48.00 competitive for MHC
Benefits 5.00 insurance
In-Kind Admin Oversight 3.60

Total Personnel 56.60

Operating Expenses
Travel 9.00 to Montgomery
Technology 3.00 include support of application
Supplies 4.00 including printing
App Maintenance 4.80
Website Maintenance 0.36
Training Host 3.84 will be hosted on Relias
Meals 2.50 for developer and ADMH staff
Rent (In-Kind) 4.00 $333.33/month

Total Op's 31.50

Total Expenses 88.10

Surplus/Deficit +0.50

126
Appendix O
Survey for School and MHC Staff
Your participation is this survey is completely voluntary, but your participation could be
beneficial is ensuring Behavioral Health for All Kids, a new program aimed at increasing access
to behavioral health care for Alabama school-age youth, is effective. Please complete the
responses below. The responses below will be kept confidential.

1. Have you used the training from Behavioral Health for All Kids? (please circle)
yes or no
2. Was the training beneficial? (please circle) yes or no
3. Please explain your answer to question #2.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4. Have you used the electronic referral application? (please circle) yes or no
5. Please explain your answer to question #4.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
6. In your opinion, how could Behavioral Health for All Kids be improved?

127
Appendix P
Survey for Youth
Your participation is this survey is completely voluntary, but your participation could be
beneficial is ensuring Behavioral Health for All Kids, a new program aimed at increasing access
to behavioral health care for Alabama school-age youth, is helpful for ALL youth. Please
complete the responses below. The responses below will be kept confidential.

Parents please complete the survey for your youth or allow your child to complete it.

1. Have you or your youth received services from Behavioral Health for All Kids?
(please circle one response) yes or no
2. What is the age of your youth? _________
3. What is the gender of your youth? (please circle) Male or Female
4. What is the sexual orientation of your youth? (please circle one response)
Heterosexual or Homosexual or Bisexual or Transgender or Other
5. What is your youth’s race? (please circle one response)
White or African American or Asian or Native American or
Pacific Islander or Other
6. What is your youth’s ethnicity? (please circle one response)
Hispanic or Latino or Not Hispanic or Latino

128
Appendix Q
Sample Communications Flyer

Abstract (if available)

Abstract The health gap is a grand challenge identified by the American Academy of Social Work and Social Welfare (American Academy of Social Work and Social Welfare, n.d.). The behavioral health gap is part of the health gap (Bartram & Lurie, 2017). It represents two-thirds of youth with a behavioral health condition (BHC) not getting the care they deserve (Kaushik et al., 2016). The behavioral health gap is highest among children and those living in more rural states like Alabama, and access to care is a significant cause of the gap (Reijneveld et al., 2010). ❧ The Alabama Department of Mental Health (ADMH) is the state’s largest provider for in-school behavioral health services (Alabama Department of Mental Health, 2010). These services provide youth with quality care at a convenient place with a reasonable cost (Alabama Department of Mental Health, 2010). Per interviews, referrals for these services are slow and ineffective throughout the state

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Asset Metadata

Creator Popham, Nathan Edward (author)

Core Title Behavioral Health for All Kids

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 08/08/2020

Defense Date 07/24/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Alabama Department of Mental Health,Alabama youth,behavioral health care,Behavioral Health for All Kids,BHFAK,in-school therapy,OAI-PMH Harvest

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lewis, Jennifer (committee chair)

Creator Email nathan.popham@aol.com,nathanedwardpopham@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-362541

Unique identifier UC11666259

Identifier etd-PophamNath-8898.pdf (filename),usctheses-c89-362541 (legacy record id)

Legacy Identifier etd-PophamNath-8898.pdf

Dmrecord 362541

Document Type Capstone project

Rights Popham, Nathan Edward

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA