This fall, the Meadowlark Day Program held an official ribbon cutting ceremony, to celebrate the unique mental health program for Salem-Keizer students in need. Trillium Family Services and the school district had an existing partnership to provide lower levels of mental health care in some schools. But for some kids, their challenges from depression, anxiety, PTSD and other disorders are so steep as to make it impossible for them to be able to get any educational benefit in school.
Meadowlark is a 10-12-week program that gives kids intense treatment as well as instructional support every day, so they don’t fall further behind. We get the details from Chris Moore, the director of mental health and social-emotional learning for the district, and from Chiharu Blatt, Trillium’s vice president of community services in the Willamette Valley and Central Oregon.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. The Meadowlark Day Program opened in Salem earlier this year in a building that once served as an elementary school. It aims to address two problems, really, at once: the serious shortage of day treatment centers for young people facing major mental health care challenges; and the fact that when young people do get that kind of treatment, it often comes at the expense of progressing academically. Meadowlark, which was created by the Salem-Keizer School District and is run by Trillium Family Services, gives kids intense treatment as well as daily instructional support so they don’t fall further behind in school.
Chris Moore is the director of mental health and social-emotional learning for the district. Chiharu Blatt is Trillium’s vice president of community services in the Willamette Valley and Central Oregon. They both join us now. It’s great to have both of you on Think Out Loud.
Chris Moore: Thank you, Dave.
Chiharu Blatt: Thank you for having us.
Miller: Chris, first – How did Meadowlark start?
Moore: Well, it really is born of a dream in the midst of really difficult circumstances. Most folks, at this point, are aware of the behavioral health crisis in our state, in our communities, in our country. And there’s a recognition that we need to do more, that we have a fragmented mental health system, that we don’t have adequate prevention and early childhood care, that we are oftentimes competing for resources to meet these high level needs.
What we’ve also done is we’ve leveraged relationships in the community over time to figure out how we can come up with innovative solutions to meet the needs of students and families, and not let what we can’t do right now prevent us from doing what we can. So we looked at this idea as a way to meet that emergent need in partnership with Trillium Family Services.
Miller: As you noted, we can see the behavioral health crisis in schools as a nationwide phenomenon. But what did it look like specifically in Salem-Keizer schools?
Moore: I think if you can imagine walking into a third grade classroom with a teacher with 25 students, you’re pretty reliably going to see that about five or six of those 25 students are impacted by trauma, to such an extent that it makes it difficult to access their learning or form or maintain relationships with their peers. You’re gonna see another four or five students who have exceptional needs and struggle to access grade-level content. And then you’re gonna see a teacher who’s doing everything they possibly can, cares deeply about those kids and may have an educational assistant to help them do that work, trying to navigate ways to take care of everyone. Then you see those one or two students who have such deep and profound mental health or behavioral health needs that it tends to distract the learning from the entire space. It’s a lose-lose outcome. Kids who want to access their learning are struggling, teachers who want to make sure that all kids are cared for and the student who has those profound needs isn’t able to access that support.
So when you come to those circumstances, you ask, what do we do now? And we might bring our specialists in in those cases. But what we know oftentimes is that schools aren’t enough, can’t be the only place that students have all of their needs met – whether it’s health care, social services and education. And we need more. When we have community partners that we can reach out to and look at low-burden, high-impact strategies for creating programs to meet those needs, that’s where we start to create a little bit of hope in the community that, one, the need is real and we validate people’s concerns; and, two, we come up with an actionable plan, a strategy and now a program that we can say there is a program available in our community now, for the first time, to meet these needs.
Miller: Chiharu, what is the particular hole in the patchwork of mental health care options that was missing in the area, in Salem, for young people?
Blatt: I think a lot of the work that we as clinicians in the community do – we do our best to support in every capacity that we can, but there’s not enough of us. There’s not enough of us to be able to provide the services that people critically need but also to provide the services in a more preventative fashion. So, how do we support each other as clinicians and as a community in identifying when someone is in need of mental health services and having access to that, but also being able to understand the mental health system and the resources necessary, in order to navigate the support such as this Meadowlark Day Program – that’s something that has been a missing point.
As part of our commitment to the community too, as an organization, we really do lean into the community and the partnerships to be able to work together, to close some of those gaps that we’re kind of speaking to. We can’t magically make providers appear, but as we work together and build partnerships, we’re able to have more of a golden thread together, to work together. And that’s a component that’s such a critical piece and a gift in this partnership with the Salem-Keizer School District.
Miller: Chris, why did you reach out to Trillium to be a partner here?
Moore: Yeah, we had started a school-based mental health program in 2017-2018, around that time, and Trillium was available as a partner to do in-school outpatient mental health care for our students. Now, they had a few clinicians who were available and could support a few schools, but we also have 65 schools across the district. So, while we couldn’t certainly have Trillium support all those schools, we could have them do great work in a handful of our schools.
What we noticed over time is that, one, there was a really high level of care. There was a clear values alignment with how we show up and care for some of our most vulnerable kids and their families. And their well-established reputation in the state to provide a continuum of care helped give us confidence that they would be a great fit partner for us. But we couldn’t just do it without them, because there’s a big funding gap when it comes to looking at programs like this to start up. And that’s where local community partners and philanthropic interests like Mountain West Philanthropy, the Epping Family Foundation, Willamette Health Council and PacificSource – without them, this partnership that we’ve nurtured over time, wouldn’t have been possible.
Miller: I want to talk more about money in just a second because it is a very important piece of this, not just in terms of capital costs at the beginning, but operational costs ongoing. So we’ll come back to that in just a second.
Chiharu, maybe we can get some more specifics about what Meadowlark is actually like. What’s an average day like for a young person who spends their days at Meadowlark?
Blatt: Yeah, it’s a question that we often get. And it’s a great question because we want people to be informed of what they’re going to be experiencing when they’re coming into this level of care. What we call day treatment is also intertwined with the language of partial hospitalization level of care. So we’re offering a short-term adjunct to public school, where individuals are needing short bursts of intensive mental health interventions daily. Our short length of stay is about 10 to 12 weeks. And while that might sound long, historically, at this level of care and just in the system as a whole, we would see kids in programs such as this for six to nine months. So our goal really is to support the kids as intensively as possible, focused on stabilization to be able to return to their home communities.
When kids are coming in, we are always infusing, at every single moment, treatment where we can. So whether that means they’re coming in and they’re doing what we call the community group, based from the Sanctuary Model, or we’re eating breakfast, or we’re playing basketball, we’re always looking to infuse skill sets that will support the individual in gaining more progress in their treatment. We know that micro steps for them are going to be what’s critical for them to be able to take those bigger steps in life that we want them to have in order to be successful.
So they come in, we do what we call level one checks where we’re asking them to take off their shoes and shake out their pockets. The reason for that is to just ensure that there’s an environmental safety around all the kids so that no one is bringing in contraband or something that might harm themselves or somebody else. That’s important to me for families to be aware of because that is intrusive; it’s not something that people experience as they go into daily schooling. So that’s something that I think is important for families to be aware of.
From there, then we’re transitioning into the classroom. So a lot of the day for these individuals is in the classroom setting, as we call our milieu, where they’re receiving education. And while there’s education happening, our mental health team is collaboratively working with the Salem-Keizer educational team to offer the skill sets necessary to push in or pull out as a model, to support the kids in what they need on their mental-health-related goals, to be able to continue forward in their educational day. So it’s a really nice infusion that feels pretty seamless between the two teams in what we’re doing. But the milieu – because many kids will spend most of their day in school, it’s important that they’re in that sort of a setting where they can practice as many skills as possible, with as much repetition as possible, day in and day out.
While our classroom sizes are, of course, going to be significantly smaller than what you might see in a school building, the really unique part of this level of service that I appreciate is that we have the ability to quickly and immediately intensify supports if we need. But we also have the opportunity, as the individuals are progressing through their treatment, to be able to step back, allow for them to be able to practice the skills. And sometimes that means we have to learn distress tolerance and navigate higher levels of anxiety.
But our hope is that as we build in the skill sets and practice with them, they’ll begin to be able to more individually practice those skill sets and feel more confident in themselves. The last thing we definitely don’t want to do is have somebody feel like they need adults around them 24/7 in order to be successful. So this is a beautiful model for us to offer the most intensive services we can. Monday to Friday for them, offer services after-hours for the family if that’s what’s needed in crisis supports. And then from there be able to be home; it’s really important for them to be able to be home and receive services.
So that’s kind of how the general student day looks throughout the course of each day. We will have therapy offered, we’ll have group therapy offered, there’s potentially medication management there. And then we have just intensive skills training that’s occurring throughout the course of every single day for the kiddos.
Miller: Chiharu, I want to go back to something you said at the very beginning, which is that your model, generally, is for kids to be there for treatment for about 10 to 12 weeks, meaning about three to four months. Whereas, the standard length of time for this kind of mental health care for young people in the past has been six to nine months – so, twice as long. What’s different about your model than that other model? I mean, the time difference is really significant.
Blatt: It is, it really is. And I think to be very clear, there are definitely kids that do still need and benefit from that longer length of stay. So while we strive for that 10 to 12 weeks focused on stabilization, I think other programs … and historically, the hope was to hold on to them longer in order to see the gains expected in the treatment facility.
The reason why we really shifted down our length of stay was because, as we hold on to the individuals longer, the more they are out of their home school systems, not graduating high school or continuing on with education, and understanding what it’s like to be as a community member, as you become older, that is so much harder to actually then gain the skill set. To be in a facility for six to nine months and then move into a community where you might be alone in your bedroom for two hours of the day, just hanging out listening to music, and if that becomes a reliance on an adult who will always be around, that’s not always something that’s possible.
So our focus was really to look at how the entire system supports stabilization of these individuals at intensive levels of services and work together to be able to transition them down. So that definitely means, because we’re focused on stabilization, their journey continues. Sometimes that means it intensively continues in the outpatient realm. But we want, as fast as possible and safely as possible, to be able to transition our kiddos back into the community setting,
Miller: Chris Moore, what do you require of families, if their kids are going to be able to take part?
Moore: That’s a really important question because what we know is that treatment works best when there’s wraparound care, when family or caregivers are integrally involved in that treatment experience and they’re learning skills, both how to regulate themselves but also how to support their child through some of these challenges.
That ends up being one of the sticking points for us, too, because insurance companies will pay for services as long as we meet the criteria for a child entering that program, meeting medical necessity. But we also have a screen out process, unfortunately – if a family or caregiver is unable to regularly engage with the program, if there hasn’t already been a level of mental health care in place, or there’s not another medical provider involved, that it may on occasion be a rule-out. So, while we know that we’re very excited to be able to serve up to 100 students over the course of a year, we also know that there are hundreds of other students who could definitely benefit from that level of care, but don’t necessarily have the level of support system around them yet – whether that’s at home, within the community or even from the state – to be able to benefit from that level of care.
Miller: Chris, to stick with you, let’s return now, once again, to money. As you said, you couldn’t have done this without philanthropic help. My understanding is that some of that went to pay for what it took to turn, at that point, an unused former elementary school into a different kind of building. But what about ongoing costs? How long do you have money for? And where does that money come from?
Moore: That’s literally the million dollar question a lot of the time, right? So, one of the things we look at is the different areas of funding streams for this program. On the education side, we have funding through the Oregon Department of Education Long Term Care and Treatment Grant Program. That supports educational services in treatment facilities and hospitals in Oregon, Youth Authority or correctional facilities. And that’s a pretty stable funding source, although we would love to see that increase in the next legislative session to make sure that these programs have stable funding over an extended period of time. And then on the other side, you have your insurance company – PacificSource, generally, or other commercial providers – who are covering the cost of treatment in that space.
We’re excited to have that level of support, we’re confident in the ongoing level of that funding. But we also know there’s overhead associated with the property maintenance, making sure we have all the equipment and furniture there that kids need to be successful. But again, I can’t emphasize enough that some of the operational costs that are key to helping a program like this get going, there’s not just a bucket of money ready to go. I mean, over time, reimbursement for services extends down the road.
This is an example where PacificSource has been a tremendous partner in helping front some of those operational costs during the first few months, so that that behavioral health workforce that we are actively recruiting to come in and serve our students and our families, that we can pay them, that we can hire a program manager, that we can hire a transition specialist and be ready to go. Without that funding, again, we may not be having this conversation today.
Miller: Chiharu, in general, where do these young people go when the three or four months are done?
Blatt: After they’re with us, we really want them to return back to their home communities and that means their home school. I would say majority of our kids, as they’re discharging, they’re going back to the schools that they came from. And we’re working tightly with their schools to be able to offer as many resources and supports that we can related to information. We have a really nice collaboration with the various school districts that we work with. If we have an individual that comes into our level of care, the transition specialist position specifically is intended to collaborate with the Salem-Keizer School District – who offers the education here – our clinical team, and then the resident school district or wherever the kid will be going to school, so that we can understand what the school’s experience has been, what we can support with.
And then we’re able to immediately practice that here in this setting at Meadowlark. And we’re receiving information and feedback from the Salem-Keizer team as well. So there’s a constant and fluid level of communication that happens in order for us to really make sure that we’re dialing in, as much as possible, what we can do to support the individuals going back into the community. But most of them really are working to go back into their resident school districts.
Miller: Chiharu and Chris, thanks very much.
Moore: Thank you, Dave.
Blatt: Thanks.
Miller: Chiharu Blatt is vice president of community services for Trillium Family Services for the Willamette Valley and Central Oregon regions. Chris Moore is the director of mental health and social-emotional learning for the Salem-Keizer School District.
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