RURAL DAY TREATMENT PROGRAM REVIEW

Introduction
The Rural Day Treatment Program (RDTP) provides mental health services in Northern Minnesota for children and youth with serious emotional disorders (SED). (See Appendix A).

The RDTP is a collaborative effort of the Bemidji Regional Interdistrict Council (BRIC), PAWN Special Education Cooperative, Stellher Human Services, Inc., Human Service Agencies and Children’s Mental Health and Family Services Collaboratives. Included are the counties of Becker, Cass, Hubbard and Mahnomen. The school districts of Cass Lake, Detroit Lakes, Pine River-Backus, Mahnomen, Park Rapids, and Nevis are served by the RDTP. Program sites are Cass Lake Elementary, Cass Lake Middle School (2 groups), Cass Lake Horizon Program, Detroit Lakes Middle School, Detroit Lakes Elementary, Mahnomen High School (3 groups), Park Rapids Elementary, Park Rapids Middle School, Pine River-Backus Elementary and Middle Schools and Nevis Middle School.

This program is designed to serve children diagnosed with SED who live in the rural communities and school districts by providing intensive mental health services in an academic and structured learning environment. Day Treatment is a mental health program located in a school setting that helps children with mental health concerns, social skills, behavior problems, emotional problems and independent living skills. RDTP provides an important link in the continuum of care for children’s mental health. Children and youth with complex needs are able to remain with their families in their communities and schools while receiving intensive mental health treatment. The RDTP service design allows for intensive educational and mental health services to be provided locally with federal and state reimbursement (Medical Assistance and Minnesota Care). Local costs to counties and school districts are minimized, and RDTP provides an alternative to more costly out-of-home placements or residential settings.

Day treatment is typically located in the regular school buildings so the transition for children to be placed back into the mainstream and regular educational setting is also a dynamic part of services for each child. Children learn new skills and are able to practice them through a process of gradual transition from day treatment to regular education classes with the support of day treatment available as necessary.

This report provides a year-end review of the RDTP. Reviews have been an integral part of the program design since 1996. Annual reviews are designed to meet a specific evaluation need: to help program participants evaluate themselves and their program to improve practice. This report is a compilation of survey data collected during the 2003-2004 school year. It provides valuable insight about the program’s strengths and areas where program improvement may be needed. In this capacity, collaboration and participatory work occurs between staff, schools, community and county partners to continually reshape and strengthen the academic and mental health services children and youth with SED require.

Program Review Design
This study was designed as an annual program review and follows similar data collection techniques that have been used for the RDTP review since 1996. Review of the survey instruments occurred during August 2003 through planning meetings that occurred with BRIC and Stellher directors and program supervisors. Strategies of how surveys would be distributed were also planned.

Day treatment staff asked parents or caregivers of students participating in the Rural Day Treatment Programs to fill out a satisfaction survey any time during the year when staff had contact with a parent. Staff collected the completed surveys and returned them by mail to the evaluator. The goal was to have one parent or caregiver of every student complete one survey.

The students who participated in day treatment were also asked to complete surveys. The directors of BRIC and Stellher felt that surveying the student population provides information of how students view their participation with day treatment. The student population of day treatment tends to be more transient due to complex and multiple needs of students including emotional and behavioral issues that affect their stability with attending and participating in school regularly. Students were asked to fill out surveys in November and in April. This was not planned as a pre-post test design to determine the level of progress per student but rather as a way to increase student input by collecting surveys twice during the school year because students enter day treatment at various times through out the school year. The goal of surveying students was to learn how students describe their experiences with day treatment.

Parent Surveys
Approximately 10 parent surveys per program were provided to the day treatment practitioners for distribution between September and May during the 2003-2004 school year although practitioners were encouraged to provide a survey to the caregivers or parents of each day treatment student. A total of 52 completed parent surveys were returned. From the cross sample of parents who have children with SED in day treatment, this report reflects their thoughts and opinions about the services the children and families receive. The following table displays the data collected from the surveys.

Table I. Parent Survey Results - Cumulative Date – All Sites

Some parent wrote comments on the surveys. Several parents wrote how they see day treatment being extremely helpful to their child regarding their child’s ability to get along better with peers and improvement with grades and attendance. Parents indicated that without day treatment, their son or daughter may have required out of home placement. Some parents indicated that day treatment helped their child get back on track regarding high school graduation. A specific breakdown of comments by parents by each program is included in Appendix E.

Student Surveys
Day treatment consists of group psychotherapy and other intensive therapeutic services that are provided by a multi-disciplinary team. The team includes the day treatment practitioner, para-professionals, the EBD teacher, and a mental health professional. Several sites also have mental health outreach workers as a part of the multi-disciplinary team. When possible, the county social workers, children’s mental health case managers or probation officers are invited to participate as members of the team. Day treatment is aimed at stabilizing the student’s mental health status and behavior, providing mental health services, and developing and improving the student’s independent living and socialization skills. The data collected from the student surveys attempts to capture how students perceive their experience in day treatment and day treatment’s influence on their emotional/mental well being.

Day treatment practitioners were asked to have students complete a student survey in November and again in April. A total of 108 surveys were collected. Student enrollment varies at each site and fluctuates during the year. Some students leave the program temporarily, then reenter the program, while others leave and do not return. Students also enter the program at different times during the year. Students leave day treatment for a variety of reasons including:

• Family relocation
• Juvenile offenses/placement
• Hospitalization to stabilize medication/behavior
• Change in living situation
• Out of home placement
• Complete program and reenter mainstream
• Unknown reasons

The data from the student surveys provides a general impression of how students view their participation in the program. Students included comments on many of the surveys. These are broken down by district and available to review in Appendix F. Generally, students wrote that day treatment helped them to get along better with peers, to like and respect themselves better, and to help improve their learning and academics.

During the 2003-2004 school year, day treatment programs served a total of 130 students across the six program sites. A breakdown per district is as follows:

• Cass Lake 39
• Detroit Lakes 23
• Mahnomen 28
• Nevis 9
• Park Rapids 19
• Pine River-Backus 12

Table II. Cumulative Data – All Sites

Breakdown of Data by School District
Y = yes, N = no, C = can’t answer

Program Review Trends – The past five years
Satisfaction surveys have been the primary means of collecting data for this review. Reviews have been conducting during the schools years of:

• 1998-1999
• 1999-2000
• 2000-2001
• 2001-2002
• 2002-2003
• 2003-2004

During this period of time, the basic format has been a combination of parent/caregiver surveys,
staff surveys and student surveys that have provided the primary data collected.

Rate of Response

Response rates are affected by program changes and development. The number of groups each site has may change from year to year, depending on student needs and enrollment. During the 2003-2004 year each district held the following number of day treatment groups. (For the purpose of this report, “group” is defined as the three 45 minute sessions that comprise day treatment.)

• Cass Lake 4
• Detroit Lakes 2
• Mahnomen 3
• Nevis 1
• Pine River-Backus 2
• Park Rapids 2

The Logic Model
Included in the Appendix is a planning document referred to as “The Logic Model” (Appendix G). This format provides a visual table of how the day treatment approach is planned and expected to operate. The Logic Model is a guide to strategic planning and a framework for evaluating program effectiveness. Collecting satisfaction surveys is one way to collect some data about program effectiveness that can be used in future program planning. The Logic Model included in this report suggests other kinds of data to collect, to examine and to learn from to strengthen the day treatment services in order to be effective in meeting the needs of emotionally challenging youth.

Appendixes

Appendix A

Serious emotional disorders (SED) are defined by the state of Minnesota (MN 245.487, Subd. 6) as children that meet diagnostic criteria as Emotionally Disturbed and at least one of the following criteria:

• Has been admitted within the last 3 years or is at risk of being admitted to inpatient or residential treatment program for an emotional disturbance
or
• Is a Minnesota resident receiving treatment for emotional disturbance through interstate contract
or
• Is a child with one of the following as determined by a mental health professional:
1. Psychoses or clinical depression
2. At risk of harming self or others due to emotional disturbance
3. Psychopathological symptoms as a result of being a victim of physical abuse or emotional trauma within the past year
or
• A child, who due to emotional disturbance, has significant impaired home, school, or community functioning that has lasted at least one year or more, or in the written opinion of a mental health professional presents a substantial risk of lasting one year.

The definition of Emotional Disturbance means:

An organic disorder of the brain or a clinically significant disorder of thought, mood, perception, orientation, memory or behavior that:

• Is listed in specific code ranges of the International Classification of Diseases (ICD-9), current edition, or in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Code Ranges: 290.0 to 306.0 and 306.0 to 316.0, Minnesota Comprehensive Children’s Mental Health Act.
and
• Seriously limits a child’s capacity to function in primary aspects of daily living, such as personal relations, living arrangements, work, school and recreation.

Appendix B

RURAL DAY TREATMENT PROGRAM
2003-2004
Parent/Caregiver Survey

District/Program_____________________________________ Date:_________

Please take a moment to fill out the following survey. Circle your answer to each statement. Your input will help us build a better program to serve students. All information is kept confidential and used in making an end of the year report. Thanks for your help.

Appendix C

RURAL DAY TREATMENT PROGRAM
2003-2004
Student Survey

Your school is _____________________________________ Date:_________

Please to fill out the following survey. Circle your answer to each statement. Your answers will help us work better with students. All information is kept confidential and used in making an end of the year report. Thanks for your help.

Appendix D

Parent Surveys -Breakdown of Data by School District

Y = yes, N = no, C = can’t answer

Appendix E

Parent Survey Comments

Detroit Lakes (14)
• Good program
• We would like our daughter to continue in the day treatment program as it is benefiting her. Also if there was any discussion sheets or papers that could be sent home to continue having discussions at home regarding issues that are talked about in day treatment. We have talked to her about summer day treatment.
• I believe without day treatment my son wouldn’t be on his way to graduate. This program has helped him a lot with his grades, respect for others, learning responsibility for his actions and his attitude has changed tremendously.
• Very happy with the program! It really helps my son.

Cass Lake (16)
• An excellent program, have had several youth in the Horizons Program and have had nothing but success.
• My son has struggled during his school years to be successful and failed in the regular school setting. Day treatment has provided the environment and personnel to achieve. He now has passing grades, has been able to learn new skills and also achieves at sports because his mental health needs are being addressed. Thank you!!
• I think your day treatment program has helped my son a lot.

Pine River-Backus (8)
• This is new to me – note from a grandparent of a student who is fairly new to the program.
• Thank you very much for help and participation in this program.
• I believe that all staff at day treatment program are great but a special thanks to Jenny.
• I will not answer this for I feel it is not working for my son.

Park Rapids (7)
• Excellent program He would be lost without it – He would not be where he is today without it!

Mahnomen (4)
• I didn’t anything about the program
• She enjoys the day treatment program and I am glad to see she is attending school regularly. Why don’t I ever see any homework?

Nevis (3)
• No comments

Appendix F

Survey Comments from Students

Park Rapids (7)
• I like to come to day treatment because I get to be with friends.
• We don’t do math in day treatment. I get along better. Good games.
• I respect myself better.
• I learned how to solve my problems better.
• I learn how to respect others.

Pine River – Backus (8)
• I think I’m doing really good and that is all because I’m happier.
• Soars is helping me get only a little better at behavior.
• Others sill tease me.

Mahnomen (12)
• I like day treatment because it helps me get caught up like on my work and it helps me control my problems.
• The teacher is a bomb.
• I want to go in the summer program if there is going to be one.
• I like day treatment.

Nevis (13)
• Leave me alone when I want to be alone.
• Day treatment rocks.
• I love day treatment and I get along with my friend in day treatment.
• I like day treatment.
• I am proud of you.
• I don’t get along with everyone in day treatment sometimes they just make me really mad that I try to handle it and keep it in.
• I don’t like a the teacher when she does things that are unfair to me.
• Let us put our heads down when we don’t feel good please.

Detroit Lakes (27)
• Thank you everyone who helped me this year.
• I like group because it helps and makes me able to get good grades.
• Do we have to talk about everything at home?
• The instructor is very nice!
• I’ve already improved tremendously in the past year do to being in residential care, so most of the stuff is pretty redundant but it has helped me get stress out when we talk about our days in group.

Cass Lake (38)
• Day treatment is good.
• It’s a good program.
• No comments at all superb, top notch. We need Fridays off. It’s not fair for everyone else to get Fridays off. Makes us feel abnormal. I feel discriminated against.
• We need Fridays off. It’s not fair that they have to stay in school when no one else is in here. It would be different if we were in the H.S.
• I don’t think it is fair that we have to go to school on Fridays when upstairs don’t.
• Day treatment helps me get better in everyway you can think of.
• You need to do better things in day treatment because it sucks.
• I think this class is really is good for kids who don’t follow directions.
• I like this class.
• Not all because of day treatment.
• I like it. It is fun.
• It’s good!