School Mental Health

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• School Mental Health
• Capacity Building Partnership
• Oregon Stakeholder Discussion Groups

A project funded through a Cooperative Agreement
with the Centers for Disease Control and
Prevention, Division of Adolescent and School
Health (DASH)
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Promoting School Mental Health through Capacity
Building to State and Local Education Agencies
(SEAs and LEAs)
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Goal 1 Strengthening Intersections

• Strengthen collaborative national efforts to
  improve mental health services in schools by
  increasing intersections between mental health,
  health, and schools.

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Goal 2 Fact finding and Organizing

• Develop, organize, and synthesize key documents
  and resources related to best practices for SEA
  and LEA improvement and expansion of effective
  SMH services.

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Goal 3 Capacity Building

• Using fact finding knowledge, materials, and
  resources developed in Goals 1 2
• Provide technical assistance, resources, and
  professional development to aid SEAs and LEAs in
  implementing effective school mental health
  programs.

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Statewide Stakeholder Discussion Groups PURPOSE

• To gain a deeper understanding of how school
  mental health works at the state and local level
• Through these groups, we learned about successes,
  challenges, and lessons learned related to
  school mental health policies, programs, and
  services

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Statewide Stakeholder Discussion Groups PROCESS

• Four early adopter states selected
• Selection criteria
• Shared mental health/education/family agenda
• Strong state level collaboration
• Vision of how to integrate health into school
  mental health agenda
• Four discussion groups per state
• Three with state and local leaders in education,
  family advocacy, health, and mental health
• One youth only discussion group

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SBHCs Early Adopter States
Oregon
Ohio
Maryland
Missouri
STAKEHOLDER DISCUSSION GROUPS Ohio December
2006 Maryland February 2007 Missouri May
2007 Oregon August 2007
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Oregon Stakeholder Discussion Groups
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Adult Discussion Groups Process

• August 14th and 15th, 2007
• Three 2-hour discussion groups
• Two school mental health stakeholder groups
  (Salem, Portland)
• One Coordinated School Health Group (Monmouth)
• 32 total participants
• Education 12
• Health 9
• Mental Health/Social Services 7
• Youth development 2
• Family members/advocates 1
• Business 1

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Results

• Responses to Questions
• Themes
• Key Quotations
• Challenges
• Opportunities

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Participant awareness of Oregons vision or
agenda for school mental health

• The school mental health vision varies greatly,
  reflecting how mental health services in Oregon
  vary greatly by county.
• While the Childrens System Change Initiative
  reflects a vision of mental health for Oregons
  youth, it has not been fully implemented, and it
  is not inclusive of all youth.

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What would make it a stronger agenda?

• Additional, blended funding
• Statewide summit of legislators and policymakers
• Financial incentives to schools to implement
  school mental health
• Wraparound services
• Increased family involvement incentives to work
  with families
• Public relations/social marketing campaign
• Efforts to de-stigmatize and demystify mental
  health

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What would make it a stronger agenda? (cont.)

• Legislation supporting both public health and
  mental health
• Educating teachers about early identification and
  referral
• Full-time mental health provider in each school
• State guidelines for mental health in
  schools/school-based health centers
• Mechanisms for prioritization
• Research/Data
• More school-based health centers
• More school nurses

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What would make it a stronger agenda? (cont.)

• Partnership between schools and community
  resources to reduce burden on schools
• Comprehensive models that include positive
  behavior support and integrate academic support
• Enhanced focus on prevention
• Mental health training in higher education
  curriculum for educators
• Coordination of efforts
• Communication systems for sharing information
• More consideration of diverse cultures
• State funding

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Major Themes

• Memoranda of Understanding (MOUs) between schools
  and community providers promote mental health
  services in schools, but are often challenged by
  issues of FERPA/HIPAA.
• Schools need to be informed about issues of
  legality related to mental health services, in
  order to reduce the fear associated with
  addressing these issues.

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Major Themes (cont.)

• Efforts to bridge the gap between educators and
  mental health providers, including role
  clarification and interdisciplinary training, is
  critical to breaking down communication barriers.
• Family organization and engagement needs to be
  strengthened in Oregon which includes schools
  adopting a family-centered approach.

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Major Themes (cont.)

• There is a need for a public relations campaign
  to advance the school mental health agenda.
• All schools would benefit from at least one
  full-time, school-based mental health provider.
• Coordination of school and community-based mental
  health efforts is strengthened by the presence of
  a case manager or counselor familiar with the
  array of available services, as well as by the
  presence of behavioral teams involving multiple
  stakeholders.

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Challenges

• Public health and mental health in Oregon are not
  well coordinated at the state level, and the
  coordination varies greatly across regions.
• School-based health centers have been part of
  Oregons school mental health agenda, but have
  not systematically included mental health and
  have not always been promoted due to lack of
  funding and/or misconceptions about their purpose.

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Challenges (cont.)

• Oregons school mental health efforts often
  exclude youth who do not receive Medicaid.
• There is significant difficulty recruiting and
  hiring a workforce that represents the community.

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Challenges (cont.)

• Understanding what is happening in Oregon related
  to school mental health is challenging, and
  requires identifying the right people.
• Despite several legislative and other efforts to
  advance evidence-based practices, there is not
  consensus on the definition of evidence-based
  practices and there is a lack of accountability
  and monitoring of the use of evidence-based
  practices.

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Opportunities

• Oregons leadership in the Wraparound framework
  presents a critical opportunity to advance school
  mental health efforts, and serves as a model for
  successful youth and family engagement.
• A statewide summit of stakeholders, legislators,
  and policymakers would inform the decision-makers
  about best practices and resource allocation
  related to school mental health.

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Opportunities (cont.)

• Increased partnerships between schools, families,
  and communities would strengthen school mental
  health efforts and reduce the burden on schools.
• Youth engagement models, including a new model
  for action research could be applied to the
  school mental health field.
• School-based health centers, funded through
  public health, reflect a model of coordinating
  between health and mental health.

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Opportunities (cont.)

• Oregon has utilized several strategies to
  successfully meet the needs of students from
  diverse cultural backgrounds, including
• hiring bilingual staff
• using interpreters
• conducting in-home parent and family mental
  health training to families with Limited English
  Proficiency
• providing mental health training to front-line
  school staff
• utilizing family resource centers and a
  home-school contact person.
• Oregons Positive Behavioral Supports and
  Response to Intervention efforts may be linked to
  offer a comprehensive model of school mental
  health.

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Oregon Youth Discussion Groups
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Youth Discussion Groups Purpose

• To identify, from a youth perspective, the most
  effective strategies for providing mental health
  services in schools and for engaging youth in the
  development of school mental health policies and
  programs.

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Youth Discussion Group Method

• August 13, 2007
• One 1.5-hour discussion group
• Six students Grades 9-12 four schools
• Four students identified as having emotional
  disabilities
• Recruited from Oregon Family Support Network and
  Columbia River Wrap Around

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Youth Discussion Groups Process

• SAMPLE QUESTIONS
• How can adults at your school make all students
  feel supported both in school as well as other
  areas of their life?
• What can schools do to better understand the
  different cultures or backgrounds a student comes
  from?
• How well do you think that adults in your school
  respond to students with mental health problems?
  

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Youth Discussion Groups Major Themes

• School mental health prevention/promotion
• Schools can improve the physical environment by
  making the school more colorful and the classroom
  more comfortable.
• Adults should not hold biases or judge youth.
• Teachers should engage students more in
  discussion.
• Teachers who speak more openly with students and
  ask questions seem to have a better understanding
  of cultures.

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Youth Discussion Groups Major Themes

• Staff Development
• Adults have a better understanding of physical
  health problems than of mental health problems.
• Teachers should try to understand students with
  mental health problems.
• Adults should make sure that students with mental
  health problems dont get picked on.
• Teachers should receive mental health training
  and have access to a mental health consultant.

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Youth Discussion Groups Major Themes

• Mental Health Services
• Barriers to accessing counseling services
  include
• not believing it is confidential
• lack of availability of a professional
• perception that counselors are for academic (not
  mental health) problems.
• Students would prefer to go to someone they trust
  to talk about a problem.
• Keeping confidentiality is important unless
• a student gives specific permission to tell
  someone, or
• if student makes a direct threat to someones
  life or their own life
• .

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Youth Discussion Groups Major Themes

• Benefits of extracurricular activities include
• Feeling good about helping others
• They have improved self esteem
• Gaining a new perspective
• Leadership Opportunities
• Students are more likely to participate in adult
  led activities when
• there are incentives (e.g. food, money,
  activities)
• interactive activities
• when their friends are participating

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• Laura Hurwitz
• Director, School Mental Health Programs
• LHurwitz_at_nasbhc.org
• 202-638-5872, x205
• 1-888-286-8727 - toll free