Analysis of student health incident data highlights behavioral health issues as experienced in schools. Student aggression is a substantial cause underlying significant injuries at the secondary level. It is important to note that these numbers do not reflect the total number of aggressive incidents on campus, but rather the most severe incidents that involved SHS staff. Nor do they reflect disciplinary events related to aggression, which are tracked and addressed separately by AISD.

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Fewer than 20% of injury incidents at the elementary level are the result of aggression; the majority of injuries at this level are more likely the result of incidents such as playground falls. Although injuries due to aggression comprise only a small proportion at the elementary level, it is noted that injuries due to aggression nearly doubled in 2013-14 over the prior year. At the middle school level, although injury incidents increased over the prior year, the proportion due to aggression decreased. At the high school level, the count of all injuries, those due to aggression and the proportion of aggression related injuries have all been declining. Overall, the total count of aggression-related injuries in SY 2013-14 was 310, up from 278 in the prior year. Of the 71 EMS contacts across the district due to injury, fewer than 6 involved aggression. An additional 13 students were taken to the emergency room by a parent following an aggression incident.

Social Emotional Learning and Aggression Prevention Efforts in AISD

Social and Emotional Learning (SEL) is a process for helping children and adults develop fundamental skills for life effectiveness. SEL teaches the skills we all need to handle ourselves, our relationships, and our work effectively and ethically. These skills include recognizing and managing our emotions, developing caring and concern for others, establishing positive relationships, making responsible decisions, and handling challenging situations constructively and ethically.

AISD is a recognized leader in urban education and one of the first districts in the nation to commit to the development of the whole child by incorporating social and emotional learning. During SY 2014-15, SEL is being implemented in 101 schools serving 80 percent of the students in AISD. By SY 2015-16 the goal is to offer SEL in 129 schools serving all of the district’s 86,000 students.

SEL reaches beyond the classroom to all aspects of life. Skills and concepts are integrated in academic lessons and practiced to enhance the climate of the school. Out of school time providers and parents reinforce SEL skills as well.

There are several other evidenced-based anti-bullying, violence prevention, and mediation programs being implemented in AISD. One example is the Safe Start program, a collaboration between SHS and SafePlace to encourage healthy dating behavior, reducing vulnerability to partner and domestic abuse.

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Based on incidents involving health staff, aggression is an ongoing concern among middle and high school aged youth while substance abuse is more prominent for high school youth. Aggression-induced injuries are not the only behavioral health incidents that are tracked and trended by SHS. Substance abuse, suspected abuse/neglect of students and student suicidal intent episodes involving health staff are also monitored.

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SHS and AISD staff participate in community adolescent suicidality prevention and postvention efforts. School RNs have been trained in the ASK protocol. An additional area of student behavioral health concern and consequent professional development is student depression and non-suicidal self-injury. SHS has worked with Seton Shoal Creek Hospital to insure post-discharge continuity of care for students hospitalized for significant mental health needs.

In addition to the SHS data, over 50% of students seen by the Travis County Juvenile Probation Department, many of whom attend AISD, are identified with mental health issues; and within AISD more than half of students receiving disciplinary placement at the Alternative Learning Campus (ALC) prior to SY 2011-12 were identified to have a behavioral or mental health issue. In SY 2012-13 AISD implemented a new policy to decrease ALC placements through enhanced campus-based services with behavioral health as a significant consideration affecting staffing at the campus level. The annual AISD School Safety and Substance Use and Survey (SSSUS), completed by a random sample of secondary students, provides information on the general behavioral health of AISD students. Behavioral health maps addressing school and community safety, substance use, discipline, clinical care and community supports are available atwww.cohtx.org. Analysis of more recent SSSUS data includes neighborhood level (Zip code) results.

Understanding and responding effectively to student behavioral and mental health needs is an area of on-going collaborative development for SHS, AISD and community partners. Professional development in identifying and addressing behavioral health issues has increased, and individualized health care plan development processes have been refined.

Campus Based Counseling Referral Centers

Austin ISD Campus Based Counseling Referral Centers (CBCRCs) are made possible by strong collaboration between Austin ISD and Seton Healthcare Family. This innovative collaboration supports district-wide initiatives focusing on student comprehensive health needs, which support the whole child. Beginning with the pilot program at Crockett HS in Spring 2012, CBCRCs expanded to six additional campuses in 2013 and were established on the following campuses during the 2013-14 school year: Akins HS, Austin HS, Burnet MS, Dobie MS, Reagan HS, and Travis HS. Plans for the 2014 Expansion include establishing CBCRCs at Eastside Memorial HS, Fulmore MS, Lanier HS, and LBJ/ LASA HS.

The treatment model in Austin ISD CBCRCs is based in the following evidence-based orientations: Cognitive Behavioral Therapy, Trauma Informed Care, and Motivational Interviewing. All services are carried out in the form of individual, group, and family therapy sessions. Students are referred for CBCRC services by the campus Child Study Team, or parent/guardian. Parent/ Guardian consent is required in order for a student to receive services. CBCRC services do not interfere with any other services the student may be receiving. CBCRCs offer a variety of payment options for both insured and uninsured, which help meet the range of needs of AISD families.