Promoting a Strong Mental HealthSchools Families Shared Agenda: Lessons Learned and Future Direction

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Promoting a StrongMental HealthSchools
FamiliesShared Agenda Lessons Learned and
Future Directions

• Carl E. Paternite
• Center for School-Based Mental Health Programs
• Miami University (Ohio), USA
• ESRC Seminar Series The School as a Location for
  the Promotion and Support of Mental Health
• University of Teesside
• March 10, 2009

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Learning Objectives

• Perspectives on importance of expanded school
  mental health in the U.S.
• Strategies for creating strong, diverse
  partnerships (MH-Schools-Family Shared Agenda)
• SMH capacity-building through stakeholder-driven
  projects
• Essential roles of parents and youth
• Critical analysis and future directions

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• Center for School-Based Mental Health Programs
• Miami University (Ohio)
• Formative Influences
• 1970-present Professional/personal life
  experience
• 1975-1976 Work in state of Iowa as a consultant
• 1990 Development of a school-based early
  intervention program
• 1997-1998 Formation of Center with local and
  private foundation funding
• 2001 Formation of statewide network with
  federal/state funding
• 1998-present National collaboration with Center
  for School Mental Health (University of
  Maryland)
• 2002-present Collaboration with many other
  national/federal partners

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Ohio Mental Health Network for School Success
(http//www.omhnss.org)

• Since 2001
• Ohio Department of Mental Health
• Ohio Department of Education
• Center for School-Based Mental
• Health Programs at Miami University
• (http//www.units.muohio.edu/csbmhp)

Mission To help Ohios school districts,
community-based agencies, and families work
together to achieve improved educational and
developmental outcomes for all children
especially those at emotional or behavioral risk
and those with mental health problems.
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• School-Based Mental Health Partnerships
• Many individuals in Ohio have been instrumental
  to our Center school mental health partnerships
  since 1998
• More than 25 faculty/staff from 7 universities
• More than 50 graduate level psychology clinical
  trainees
• and research assistants
• Several hundred community-based partners, formal
  and
• informal teacher consultants, school
  counselors, school
• psychologists, school social workers, school
  nurses, and
• administrators

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Key National Partners and/or Resources

• Center for School Mental Health
  (http//csmh.umaryland.edu)
• IDEA Partnership (http//www.ideapartnership.org)
• Center for the Advancement of Mental Health
  Practices in Schools
• (http//schoolmentalhealth.missouri.edu)
• Collaborative for Academic, Social Emotional
  Learning (http//
• www.casel.org/)
• International Alliance for Child and Adolescent
  Mental Health and Schools
• (http//www.intercamhs.org/)
• National Assembly on School-Based Health Care
  (http//www.nasbhc.org)
• UCLA Center for Mental Health in Schools
  (http//smhp.psych.ucla.edu)
• AND OTHERS

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A National Community of Practice

• CSMH and IDEA Partnership (www.ideapartnership.org
  ) providing support
• 30 professional organizations and 12 states
• 10 practice groups
• Providing mutual support, opportunities for
  dialogue and collaboration
• Advancing multiscale learning systems
• Sign up at www.sharedwork.org

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10 Practice Groups

• Mental Health-Education Integration
• Developing a Common Language
• Connecting Education and Systems of Care
• Connecting SMH and Positive Behavior Support
• Improving SMH for Youth with Disabilities

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10 Practice Groups (cont.)

• SMH, Juvenile Justice and Dropout Prevention
• Family Partnerships (see handout)
• Youth Involvement and Leadership
• SMH Child Welfare Connections
• Quality and Evidence-Based Practice

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Two New SMH Journals

• Advances in School Mental Health Promotion
• The Clifford Beers Foundation and the
  University of Maryland
• www.schoolmentalhealth.co.uk
• School Mental Health A Multidisciplinary
  Research and Practice Journal
• Springer
• http//www.editorialmanager.com/smhe/

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Concerning Facts

• 1 in 5 youth will present an emotional/behavioral
  disorder (5 students in classroom of 25)
• 1 in 10 present significant impairment1 in 20
  present extreme functional impairment
• Between 1/6th and 1/3rd receive any services
• Modal number of specialty MH visits is two
• Virtually no focus on MH promotion/problem
  prevention in traditional settings
• Limited focus systematic quality assessment and
  improvement

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Growing Focus on School Mental Health in the
United States

• Defacto sites for mental health care
• U.S. Surgeon General Reports (1999, 2000)
• Presidents New Freedom Commission on MH Report
  (2003)
• Mandates of No Child Left Behind and
  Individuals with Disabilities Education
  Improvement Act (IDEIA)
• School Mental Health Improvement Act (2007)
• Progress in localities and states multiscale
  learning
• Collaborative research-practice-training networks

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Report of Presidents New Freedom Commission on
Mental Healthhttp//www.mentalhealthcommission.go
v

• Critical Importance of Partnership with Schools
• The mission of public schools is to educate all
  students. However, children with serious
  emotional disturbances have the highest rates of
  school failure. Fifty percent of these student
  drop out of high school, compared to 30 percent
  of all students with disabilities.
• While schools are primarily concerned with
  education, mental health is essential to learning
  as well as to social and emotional development.
  Because of this important interplay between
  emotional health and school success, schools must
  be partners in the mental health care of our
  children.
• July, 2003, p. 58

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Schools The Most Universal Natural Setting

• Over 52 million youth attend 114,000 schools
• (Approximately 1.8 million youth attend more than
  600 school districts in Ohio)
• Over 6 million adults work in schools
• (About 240,000 adults work in Ohios schools)
• Combining students and staff, one-fifth of the
  U.S. population can be found in schools
• (One-fifth of Ohios population found in schools)
• From New Freedom Commission and OMHNSS reports
  (2003)

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Expanded School Mental Health Programs and
Services(Weist, 1997 Weist, Paternite,
Adelsheim, 2005)

• Involve partnership between schools and community
  health/mental health organizations, as guided by
  families
• Build on existing school programs, services, and
  strategies
• All students, general and special education
• Full array of programs, services, and
  strategiesmental health education and promotion
  through intensive intervention
• Emphasize schools as locus of engagement for
  school-based, school-linked, and community-based
  work

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In Addition to Enhanced Access, SMH can

• Reduce stigma for help seeking
• Promote generalization/maintenance of
  intervention gains
• Enhance capacity for prevention/MH promotion
• Foster clinical efficiency and productivity
• Promote a natural, ecologically grounded approach
  to helping youth and families

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SMH Impacts

• Based on a limited knowledge base, when done well
  SMH programs and services are associated with
• Strong satisfaction by diverse stakeholder groups
• Improvement in student emotional/behavioral
  functioning
• Improvement in school outcomes (e.g., climate,
  special education referrals, reduced bullying,
  fewer suspensions)

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Academic Impacts

• An average student enrolled in a social and
  emotional learning program ranks at least 10
  percentile points higher on achievement tests,
  has better attendance and classroom behavior,
  likes school more, has better grades, and is less
  likely to be disciplined (based on research by
  Weissberg and Durlak, see www.casel.org)
• See Hoagwood et al. (2007) J. of Emotional and
  Behavioral Disorders, 15, 66-92, clearly
  suggesting a need for more focused attention on
  academic outcomes

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Why Mental Health in Schools?

• Integrated approaches to reduce academic and
  non-academic barriers to learning are necessary
  if we are to effective achieve outcomes families,
  schools and communities care about
• Comprehensive system of learning supports
  getting the conditions right

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• Critical Challenges
• Critical Opportunities

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expanded school mental health
PBIS
Student Assistance Team
Safe Schools, Healthy Students
Community of Practice
Special Education
Systems of Care
Crisis management
Social and Emotional Learning
School linked
Wrap around
Multiculturalism
Shared Agenda
NCLB
Family support services
Cultural competence
Risk and protective factors
School based
Strengths based
Multi system approach
School linked
Student Support Services
Assets building
Integrated Service Delivery
IDEA
School climate
Pupil Support Services
School connectedness
Evidence based practice
Coordinated school health program
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expanded school mental health
PBIS
Student Assistance Team
Safe Schools, Healthy Students
Community of Practice
Special Education
Systems of Care
Crisis management
Social and Emotional Learning
School linked
Wrap around
Multiculturalism
Shared Agenda
NCLB
Comprehensive System of Learning Supports
Family support services
Cultural competence
Risk and protective factors
School based
Strengths based
Multi system approach
School linked
Student Support Services
Assets building
Integrated Service Delivery
IDEA
School climate
Pupil Support Services
School connectedness
Evidence based practice
Coordinated school health program
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Challenge of Scale Implications of Federalism

• In U.S., more than 50 million students in
  approximately 120,000 schools in 50 states
• States rights, local control (education and
  mental health policies/practices)
• Extreme variability across states and localities
• Local site-based management/decision-making
• Extreme variability across school buildings
• High rates of teacher and school staff turnover
• Fewer than 60 of teachers in the same school
  4 years
• worse in disadvantaged schools

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Unclaimed Children Revisited The Status of
Childrens Mental Health Policy in the United
StatesPolicy Study, November 2008

• Variability among states in efforts to meet MH
  needs of children
• Very few statewide efforts across the age-span
• 42/50 states one or more statewide initiatives
  7/42 consistent support/funding across age-span
• 47/50 states actively involved in SMH
  initiatives Only half report statewide
  initiatives
• http//www.nccp.org/publications/pdf/text_853.pdf

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Unclaimed Children Revisited The Status of
Childrens Mental Health Policy in the United
StatesPolicy Study, November 2008

• 50 states embrace systems of care values and
  principles in service delivery only 18/50 taken
  to legislation/regulation, practice standards,
  and strategic planning
• 49/50 states range of efforts to strengthen
  family/youth voice in policy Many MH advocates
  dissatisfied with success of efforts
• 27/50 states policies to promote access to
  culturally/linguistically competent services
  Only 2/27 purposeful steps to promote
  cultural/linguistic competence
• http//www.nccp.org/publications/pdf/text_85
  3.pdf

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Public Policy ContextSMH and the No Child Left
Behind MandateTwo Important Interrelated Goals
Achievement and Wellbeing

• 1) Achievement promotes wellbeing
• 2) Wellbeing promotes achievement
• School accountabilities often acknowledge 1 but
• fail to sufficiently acknowledge 2

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What is Not Working in School Mental Health

• Marginalization and stigma
• Limited staff and resources
• Turf and silos
• Single system approaches
• Same old roles
• Clinics in schools, co-located models

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What is Not Working in School Mental Health

• Traditional eclectic therapies
• Schools handing off children to other systems
• Bureaucracy
• A fluid environment with frequent changes in
  leadership and front line staff
• Compelling need at all levels
• INERTIA

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SMH Workforce Realities

• Communities/schools are under-resourcednot
  enough SMH staff
• Training tends to be very discipline specific
  (silo)
• Differing licensing, certification, and practice
  standards create much confusion
• Very few interdisciplinary training models, yet
  real world SMH work is inherently
  interdisciplinary
• Blurring in functioning across disciplines

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SMH Workforce Realities (contd)

• Graduate MH program accreditation is not
  connected to evidence-based practice
• Inadequate differentiated focus in training
  curricula and methods to enhancing trainee
  knowledge, skills, and abilities
• Supervision that prepares providers for real
  world practice tends to be poor
• Educators and school leaders are inadequately
  trained and supported to assume their key roles
  as promoters of student mental health (teachers
  are linchpins for effective SMH)

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Need to Empower Educators

• Basic Current Knowledge For Teachers About
• Role of stress in students lives and impacts on
  learning
• Signs and symptoms of mental illness diagnoses
  (e.g., depression, ADHD, anxiety disorders,
  conduct disorders)
• Risk factors and warning signs for suicide
• Protective factors that promote resilience in
  students
• Effective, culturally-informed treatments and
  supports for students with mental health problems
• Medications and effects (intended and side
  effects) on learning and behavior
• How to access community support and referral
• Impacts of stigma

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Need to Empower Educators

• Effective Strategies and Skills for Teachers
• Promoting mental health (well-being) and academic
  achievement through instructional techniques and
  curriculum
• Creating a positive classroom climate that offers
  a healthy learning environment and promotes
  academic, social, and emotional development for
  all students
• Creating a positive, inclusive and safe school
  culture and climate
• Working with students displaying typical
  emotional and behavior problems
• Interacting with parents in empowering and
  affirming ways
• Listening to students

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A Vision for School Mental Health

• Strong stakeholder involvement and a shared
  family-school-community system agenda
• Full continuum of effective supports and services
  for all students in general and special education
• The right staff with the right training,
  supervision, coaching and support

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A Vision for School Mental Health

• Emphasis on quality assessment and improvement
  and evidence-based practice
• Strong focus on achieving valued outcomes
• Outcome findings inform program improvement and
  into policy and advocacy agendas

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Capacity Building Factors
Workforce selection
Cultural competence
Message development
Public awareness/ involvement
Evidence- based practices
Workforce support
Political advocacy
Leadership development
Strong MH-School-Family Collaboration -----------
----------------------- Innovative and Evolving
Agenda
Program expansion
Multi-scale learning
Product development
Need assessment
Program sustainability
Continuous Quality improvement
Resource enhancement
Resource mapping
Organization improvement
Evaluation
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• School Mental Health
• Capacity Building Partnership

A project funded by the Centers for Disease
Control and Prevention, Division of Adolescent
and School Health (DASH)
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Top 10 Common Challenges Experienced by Four
Early Adopter (MD, MO, OH, OR) States

• Lack of a unified statewide school mental health
  vision due to
• Lack of shared ownership of a statewide agenda
  inclusive of all stakeholders
• Fragmentation, duplication, and inequity of
  initiatives and programs across the state
• Lack of organizational infrastructure and
  accountability mechanisms by one or more state
  agencies

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Common Challenges

• Lack of feasible, sustainable funding models to
  support comprehensive SMH services
• Demands on schools to achieve academic results
  can result in marginalization of the SMH agenda
• Limited meaningful youth and family engagement
• See handout What students say about MH

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Common Challenges

• Scarcity of SMH efforts to meet the needs of
  students from diverse cultural backgrounds
• Limited pre-service training and professional
  development for mental health staff and educators
• Many difficulties in implementing evidence-based
  practices

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Common Challenges

• Limited public involvement and social marketing
• Lack of coordinated and uniform approaches to
  evaluation

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More Information

• Laura Hurwitz, LCSW
• Director, School Mental Health Programs
• NASBHC
• LHurwitz_at_nasbhc.org
• www.nasbhc.org
• 202.638.5872 x205
• (on the website follow the links for mental
  health capacity building)

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Building Capacity for a StrongMental
HealthSchoolsFamiliesShared Agenda

• Examples from Ohio

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Imperatives

• Achieve conceptual clarity about SMH
• Prioritize preventive and population- focused
  mental health promotion
• Promote mental health education systems
  integration and strong MHSchoolsFamilies shared
  agenda
• Strengthen the research base in SMH
• Best practice programs
• (intervention/prevention science)
• Best practice processes
• (community science)

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Developing Effective Practice
Institute of Medicine
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Bridging the Gap Between Research and Practice
Community Science (Wandersman, 2003)

• explicit attention is to the mechanisms/processes
  needed to develop, support, and sustain effective
  practices in real world settings
• An interdisciplinary framework for strengthening
  communities by improving the quality of practice
  in treatment, prevention, health promotion, and
  education

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Bridging the gap
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Ohio Mental Health Network for School Success
(http//www.omhnss.org)

• Since 2001
• Ohio Department of Mental Health
• Ohio Department of Education
• Center for School-Based Mental
• Health Programs at Miami University
• (http//www.units.muohio.edu/csbmhp)

Mission To help Ohios school districts,
community-based agencies, and families work
together to achieve improved educational and
developmental outcomes for all children
especially those at emotional or behavioral risk
and those with mental health problems.
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Ohio Mental Health Network for School Success

• Actions
• Build and sustain strong regional action networks
  to promote mental healtheducationfamily
  collaborations, with broad stakeholder
  representation.
• Promote awareness of the mental health needs of
  students attending Ohios schools and the
  critical links between mental health and
  school/academic success.
• Promote the adoption and implementation of
  policies (at all levels) that encourage effective
  practices to improve the mental health and school
  success of Ohios students.
• Help to build capacity within mental health and
  education systems for enhanced collaboration and
  effective school mental health programs and
  services.

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The Ohio Mental Health Network for School Success

• Specific Action Agenda
• See handout

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Ohios Mental Health, Schools, and Families
Shared Agenda Initiative http//www.units.muohio.e
du/csbmhp/sharedagenda.html
Phase 1 Statewide forum for leaders of mental
health, education, and family policymaking
organizations and child-serving systems
(March 3, 2003) Phase 2 Six regional forums
for policy implementers and consumer
stakeholders (April-May, 2003) Phase 3
Legislative forum involving key leadership of
relevant house and senate committees
(October 9, 2003) Phase 4 Development and
release of Shared Agenda report (Summer
2004) Phase 5 Ongoing policy/funding advocacy
and technical assistance to promote
attention to the crucial links between mental
health and school success
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Legislative Forum On Mental Health and School
SuccessCreating A Shared Agenda In OhioOctober
9, 2003
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Legislative Forum On Mental Health and School
SuccessCreating A Shared Agenda In OhioOctober
9, 2003
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Shared Agenda Initiative Report

• ODMH/ODE-sponsored ad hoc workgroup to develop
  Shared Agenda report addressing
• Public Awareness and Advocacy
• Professional Development/Training and Service
  Delivery
• Policy and Funding
• Workgroup met three times between November, 2003
  and March, 2004
• Report released August 2004, updated 2007 (see
  handout for update)

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An Immediate Legislative Outcome
Senate Bill 2 Section 3319.61(E) (effective June
9, 2004) The standards for educator
professional development developed under division
(A) (3) of this section shall include standards
that address the crucial link between academic
achievement and mental health issues.
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More Recently, Ohio H.B. 276Anti-Bullying
Policies(consistent with Shared Agenda goals)

• Requires school to adopt policies prohibiting
  harassment, intimidation, or bullying
• Authorizes school to form bullying prevention
  initiatives and requires training and education
  on student harassment, intimidation, or bullying
• Requires training at least every five years for
  elementary school employees in violence and
  substance abuse prevention and positive youth
  development

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Networks SAMHSA-funded School Mental Health
Initiative

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Initial Goals

• Develop useful tools and content papers,
  accessible to range of stakeholders engaged in
  the process of planning, implementing,
  evaluating, sustaining, and continuously
  improving SMH programs/services.
• Thorough stakeholder credibility checks
• Increase readiness and capacity to implement SMH
  programs/services at the county, district, and/or
  building level.
• University-Community partnerships will contribute
  to the sustainable promotion of SMH
  programs/services.

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Effective Practice Partners (EPPs)

• Miami University
• Ohio University
• Bowling Green State University

• Case Western Reserve University
• Ohio State University
• Kent State University

Disciplines Clinical Psychology Community
Psychology Criminal Justice Public Health
Social Work Teacher Education
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2008-2009Projects

• Communications Team
• Ongoing Regional and Statewide Networking
• Website, On-line Resources, and
• Newsletter (Network News)

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2008-2009Projects

• Quality and Evidence Based Practice Team
• Effective Practice Registry

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2008-2009Projects

• Systems Analysis and Change Team
• On-line School Mental Health Strategies
• Survey for School Principals

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2008-2009Projects

• Policy Development and Advocacy Team
• Works closely with the Communications Team on a
  Wide Variety of Awareness Raising Initiatives
• (e.g., information briefs, see handout)

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2008-2009Projects

• Educator Training with Safety and
• Violence Curriculum Team
• Initial Statewide Roll Out of Training to Address
• H.B. 276 Mandate

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Contact for Follow-up Information

• Amy Wilms
• Center for School-Based Mental Health Programs
• Department of Psychology, Miami University (Ohio)
• Oxford, OH 45056
• PH 513-529-2450 FX 513-529-2420
• wilmsab_at_muohio.edu http//www.units.muohio.edu/cs
  bmhp