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Lewiston, Idaho

Lewiston, a rural blue-collar community of 30,000, is located in northwestern Idaho on the Idaho-Washington state border. ODRC staff became aware of Lewiston's service integration efforts through a conversation with Idaho's Part C coordinator, Mary Jones. Mary suggested that Lewiston be considered as a potential ODRC site, a community with a strong sense of supporting all children, including those with special needs.

Interagency Screening for Young Children

In 1994, Jimelle Martin, Lewiston School District elementary and preschool consulting teacher, John Cronin from the Part C program, and Polly Taylor, Head Start disabilities coordinator, met to discuss how their programs might coordinate their child find efforts as a way to improve the screening and referral process. Through funding from the Idaho Department of Education, they formulated a plan to pull community stakeholders together to talk about services for young children. In 1996, the Community Alliance for Young Children (CAYC) was established. The mission of CAYC is to develop a comprehensive and coordinated array of community services to ensure that all young children and their families receive appropriate intervention. CAYC members include a variety of private and public services, such as hospital, social services and child protective services, Medicaid, and several parent representatives.

One of CAYC's main achievements is a monthly interagency screening clinic for children ages birth to five years. Parents contact the North Central Health District nurse to schedule a screening appointment. Over the phone, the nurse completes a brief health history, including immunization status. Children are screened in the areas of language, hearing, cognition, social/emotional and motor development. Following the clinic, the CAYC interagency team reviews the screening results and makes referral recommendations for the children screened. CAYC screens about 8-12 children per month during the half-day clinic.

The annual budget for the CAYC screening of $1,000 per year is made possible by in-kind donations made by the agencies involved. For example, their employers donate staff time for those administering the screening. St. Joseph's Regional Medical Center Outpatient Rehab Center donates the space for the screening clinic and for follow up team meetings. The Lewiston School District provides secretarial time to type meeting minutes, send reports to families, and other CAYC business. Screening protocols are purchased via blended funding. The formation of CAYC served as a springboard for community development to occur on a larger scale. In 1997, CAYC membership expanded to include the broader community, asking families, businesses, the local college, nearby university, public service entities, such as the police department, to develop a broader vision for all children in the community, including those with special needs.

Joining Forces with ODRC

The need for comprehensive, coordinated services to support the mental health needs of children and positive parenting had emerged as a chronic need. All too often CAYC members were frustrated with trying to help families obtain behavioral/mental health services for children who did not meet eligibility criteria for categorical programs. In their desire to help a family, CAYC members referred them to a community agency only to find out later that the family was turned away and referred someplace else. "We found that we were great at making referrals, but often a family would just get passed on from one agency to the next."

CAYC agreed to target the coordination of early mental health services as the focus of their ODRC effort and formed a Mental Health Task Force. The task force hoped to develop a community-based approach to infant metal health which promotes the healthy emotional development of children, supports family strengths, identifies early signs of emotional and behavioral difficulties, and assists families with special needs (Yoshikawa & Knitzer (1997). The task force includes private and public-funded mental health providers, parents of children with special needs, and other community representatives. Initially, the task force viewed the lack of infant mental health expertise in their community as the primary barrier. In particular, the task force members perceived a lack of mental health providers who served young children, especially those who serious behavior difficulties.

Although family impact was necessary in the needs assessment process, the task force had difficulty recruiting families to attend meetings, in spite of offering parent payments and after-5 dinner meetings. The task force decided to try a new approach to obtaining parent input---team members went to the families instead of expecting the families to come to them. Through a series of focused interviews with families of both younger and older children with behavioral challenges, the task force obtained first-hand insights into the barriers faced by families. The interviews also served as a way to recruit family representatives to join the task force families of older children who had years of experience interacting with the service system from the time their children were very young.

The ODRC needs assessment process revealed that there were, in fact, a number of community mental health providers qualified to serve children under 5 years of age. However, little coordination was occurring among these providers and other early childhood services in Lewiston. Through the ODRC community mapping process, the task force identified an array of mental health services and resources available in Lewiston, ranging from prevention via parenting classes to hospitalization for more severe needs. The task force recognized that access to appropriate mental health care was a challenge for multiple reasons, such as a lack of knowledge regarding resources available; restrictive eligibility criteria; and a lack of public acceptance for seeking mental health services.

Building on their community's assets, the task force decided to first look at how the successful CAYC activities could support their effort to develop comprehensive, coordinated services to meet the mental health needs of children and families. One key strategy they identified was to add a mental health provider to be part of the CAYC screening process. Task force member, Marian Schultz, a child and family therapist, supported this strategy by volunteering her time to "pilot" this important component to the CAYC screening. CAYC members immediately recognized the value of having Marian's perspective to provide insight into the mental health needs of children and families. As one member described it, "Marian offered us a fresh perspective when interpreting our screening results." For example, Marian pointed out that a child whose mental health is at risk due to family strife may demonstrate a delay in language development. "Having Marian as a part of our team broadened our view of the subtle factors that influence a child's behavior, especially during the screening process."

The task force identified other strategies to support more comprehensive, coordinated mental health services in Lewiston, including:
1. a public awareness campaign to focus on the importance of children's mental health
2. the development of a coordinated database to improve tracking of children screened
3. coordination between the screening clinic and the child's medical home
Sustainability

Jimelle Martin, chair of the task force, was keeping her eye out for ways to obtain additional financial support to accomplish these strategies. Thanks to the efforts of Jimelle and other task force members, CAYC received a $75,000 grant from the Albertson's Foundation. The Albertson's Foundation, based in Boise, Idaho, supports community-based efforts designed to ensure healthy child development.
Maintaining community efforts beyond the length of grants can be a challenge. To ensure sustainability, a plan will be developed so that these activities can be supported through joint support from the CAYC partners. CAYC also is negotiating to serve as an internship site for social work students, which would provide dedicated staff time in the future. The task force is confident that additional financial support from public and private agencies will be secured, based on demonstrated success of this grant.

For further information about Lewiston's service integration efforts, contact Jimelle Martin, Lewiston School District Elementary and Preschool Consulting Teacher, at (208) 748-3260 or email her at jmartin@mail.lewiston.k12.id.us.

A Division of the Center for
Persons with Disabilities