best practices and resources in school mental health best practices and resources in school mental...
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Best Practices and Resources in Best Practices and Resources in School Mental HealthSchool Mental Health
Mark D. Weist & Dana CunninghamMark D. Weist & Dana CunninghamUniversity of Maryland University of Maryland
Center for School Mental HealthCenter for School Mental HealthApril 28, May 21, 2008April 28, May 21, 2008
Center for School Mental Health* Center for School Mental Health* University of Maryland School of MedicineUniversity of Maryland School of Medicine
http://csmh.umaryland.eduhttp://csmh.umaryland.edu*Supported by the Maternal and Child Health Bureau of HRSA *Supported by the Maternal and Child Health Bureau of HRSA
and numerous Maryland agenciesand numerous Maryland agencies
Referrals from Schools Referrals from Schools to Other Settingsto Other Settings
96% referred to school-based 96% referred to school-based program received servicesprogram received services
13% referred to other community 13% referred to other community agency didagency did
Catron, T., Harris, V., & Weiss, B. (1998)Catron, T., Harris, V., & Weiss, B. (1998)
72%
49%
26%
9%0%
10%20%30%40%50%60%70%80%90%
100%
Number of Sessions
Pe
rce
nt
of
Yo
uth
Re
ma
inin
g in
Se
rvic
es
Treatment as Usual Show Rates (McKay et al., 2005) from Kimberly Hoagwood
Other Concerning FactsOther Concerning Facts
Around 1 in 5 youth will present an Around 1 in 5 youth will present an emotional/behavioral disorder (5 students in a emotional/behavioral disorder (5 students in a classroom of 25)classroom of 25)
Between 1/6Between 1/6thth and 1/3 and 1/3rdrd receive any services receive any services
Modal number of specialty mental health visits Modal number of specialty mental health visits is 2is 2
Major lack of systematic quality assessment Major lack of systematic quality assessment and improvement in traditional settings and improvement in traditional settings
SilosSilos
““The various systems do not talk to each other, The various systems do not talk to each other, resulting in many children falling through the resulting in many children falling through the cracks and not receiving care, receiving cracks and not receiving care, receiving duplication of services, or families needing to duplication of services, or families needing to negotiate a confusing, fragmented array of negotiate a confusing, fragmented array of services” (Family Advocate, Louisiana)services” (Family Advocate, Louisiana)
““Shame” and “Strain” on FamiliesShame” and “Strain” on Families
““Youth and families experience blame; have Youth and families experience blame; have widespread distrust of professionals; have widespread distrust of professionals; have concerns about losing custody; are often concerns about losing custody; are often unable to pay for care…have to glue services unable to pay for care…have to glue services togethertogether””– Kimberly Hoagwood (Congressional Briefing, October, Kimberly Hoagwood (Congressional Briefing, October,
2007)2007)
April 16, 2007April 16, 2007
““Rather than falling through the Rather than falling through the cracks, Cho crawled into the cracks cracks, Cho crawled into the cracks and hid there”and hid there”--Chris Fynn- director of VA Tech’s Chris Fynn- director of VA Tech’s counseling centercounseling center
Shuchman, M. (2007) Shuchman, M. (2007)
Growing Focus on School Mental Health Growing Focus on School Mental Health
Schools as the “defacto” sites for mental health careSchools as the “defacto” sites for mental health careU.S. Surgeon General Reports (1999, 2000)U.S. Surgeon General Reports (1999, 2000)
President’s New Freedom Commission on Mental Health President’s New Freedom Commission on Mental Health Report (2003; www.mentalhealthcommission.gov)Report (2003; www.mentalhealthcommission.gov)
Educational Mandates, e.g., Response to InterventionEducational Mandates, e.g., Response to Intervention
A range of federal grant programsA range of federal grant programsStrong international interestStrong international interest
AdvantagesAdvantages
ACCESSACCESS
Promotion and PreventionPromotion and Prevention
Efficiency and Cost EffectivenessEfficiency and Cost Effectiveness
Systems Collaboration/ Economies of ScaleSystems Collaboration/ Economies of Scale
Natural/ Ecological ApproachNatural/ Ecological Approach
Reduced StigmaReduced Stigma
A Cogent RationaleA Cogent Rationale
Integrated approaches to reduce academic Integrated approaches to reduce academic and and non-academicnon-academic barriers to learning are the most barriers to learning are the most effective in achieving the outcomes families, effective in achieving the outcomes families, schools and communities care aboutschools and communities care about
Academic Systems Behavioral Systems
1-5% 1-5%
5-10% 5-10%
80-90% 80-90%
Intensive, Individual Interventions•Individual Students•Assessment-based•High Intensity
Intensive, Individual Interventions•Individual Students•Assessment-based•Intense, durable procedures
Targeted Group Interventions•Some students (at-risk)•High efficiency•Rapid response
Targeted Group Interventions•Some students (at-risk)•High efficiency•Rapid response
Universal Interventions•All students•Preventive, proactive
Universal Interventions•All settings, all students•Preventive, proactive
The Public Health ApproachThe Public Health Approach
A Vision for School Mental HealthA Vision for School Mental Health
Strong stakeholder involvement and a shared Strong stakeholder involvement and a shared family-school-community system agendafamily-school-community system agenda
Full continuum of effective supports and Full continuum of effective supports and services for all students in general and special services for all students in general and special educationeducation
The right staff with the right training, The right staff with the right training, supervision, coaching and supportsupervision, coaching and support
Vision (cont.)Vision (cont.)
Emphasis on quality assessment and Emphasis on quality assessment and improvement and evidence-based practiceimprovement and evidence-based practice
Strong focus on achieving valued outcomesStrong focus on achieving valued outcomes
Outcome findings feed back into program Outcome findings feed back into program improvement and into policy and advocacy improvement and into policy and advocacy agendas agendas
Another TriangleAnother Triangle
Desired Outcomes Effective mental health promotion and intervention
Outstanding staff and program qualitiesOngoing training, technical assistance & support
School and community buy-in and investment
Resources Awareness raising, advocacy, policy improvement
But in most communities…But in most communities…
The vision is not a reality as staff and The vision is not a reality as staff and programs are not adequately supported and programs are not adequately supported and often contending with tremendous need, and often contending with tremendous need, and
In an environment of low support and high In an environment of low support and high needs, positive outcomes will most likely not needs, positive outcomes will most likely not be achieved and efforts will stallbe achieved and efforts will stall
Prince George’s County School Mental Prince George’s County School Mental Health InitiativeHealth Initiative
Intensive, evidence-based mental health Intensive, evidence-based mental health intervention for students in special education intervention for students in special education in two schools in two schools
Training and support to 11 schools with Training and support to 11 schools with specialized programs for youth presenting specialized programs for youth presenting emotional problemsemotional problems
Broader training and support county wide (e.g., Broader training and support county wide (e.g., for all school psychologists) for all school psychologists)
PartnersPartners
University of Maryland CSMHUniversity of Maryland CSMH
Prince George’s County Public Schools (PGCPS)Prince George’s County Public Schools (PGCPS)
Maryland State Department of Education (MSDE)Maryland State Department of Education (MSDE)
Staffing for Two SchoolsStaffing for Two Schools
One PGCPS liaisonOne PGCPS liaison
Two therapistsTwo therapists
One case managerOne case manager
Parent LiaisonParent Liaison
Psychiatric consultationPsychiatric consultation
Student CriteriaStudent Criteria
At-risk for non-public placementAt-risk for non-public placement
Social-emotional goals on IEPSocial-emotional goals on IEP
Behavioral intervention plansBehavioral intervention plans
Acting out problemsActing out problems
Multiple risksMultiple risks
Family interestFamily interest
Program FrameworkProgram Framework
Build supportive relationships with the youth and Build supportive relationships with the youth and familyfamily
Decrease risk factorsDecrease risk factors
Enhance strengths and protective factorsEnhance strengths and protective factors
Enhance development of key cognitive behavioral Enhance development of key cognitive behavioral skills skills
Program Framework (cont.)Program Framework (cont.)
Improve problem solvingImprove problem solving
Improve anger management skillsImprove anger management skills
Address trauma historyAddress trauma history
FOCUS ON QUALITY CONSTANTLYFOCUS ON QUALITY CONSTANTLY
Key Processes in Working with Key Processes in Working with FamiliesFamilies
EngagementEngagement
EmpowermentEmpowerment
SupportSupport
CollaborationCollaboration
Family Needs AddressedFamily Needs Addressed
Food, health insurance, medical needs, Food, health insurance, medical needs, clothing, transportation, utilities, substance clothing, transportation, utilities, substance abuse services, mental health services, abuse services, mental health services, tutoring, mentoring, recreational programstutoring, mentoring, recreational programs
Anxiety: Practice ComponentsAnxiety: Practice Components
31
39
44
97
0 20 40 60 80 100
Relaxation
Cognitive/Coping
Modeling
Exposure
% of EBP w/PracticeComponent
Use of Evidence-Based ProgramsUse of Evidence-Based Programs
Anger Management GroupAnger Management Group– Identifying anger earlyIdentifying anger early– Understanding short- and long-term consequencesUnderstanding short- and long-term consequences– Recognizing and managing emotionsRecognizing and managing emotions– Understanding cognitive processesUnderstanding cognitive processes– Developing coping skillsDeveloping coping skills– Learning to problem solveLearning to problem solve– Communicating effectivelyCommunicating effectively
Qualitative Evaluation - FamiliesQualitative Evaluation - Families
““The therapists are always available when we The therapists are always available when we need them”need them”
““My granddaughter is less angry now than she My granddaughter is less angry now than she used to be”used to be”
““The case manager helped me get back on my The case manager helped me get back on my feet after I lost my job”feet after I lost my job”
Student FeedbackStudent Feedback
They liked having a therapist at school for the following reasons:They liked having a therapist at school for the following reasons:
“They are on your side.”
“You can get stuff off
your chest.”
“You get out of class and don’t have to do work.”
“They give you good advice.”
“It’s free.”
“If you have a problem, they are right there.”
Absences by QuarterAbsences by Quarter
0
1
2
3
4
5
6
7
8
9
10
INV 4.24 6 6.06 5.35
Non INV 2.69 5.25 10 9.88
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Suspensions by QuarterSuspensions by Quarter
0
0.5
1
1.5
2
2.5
INV 1.24 0.94 0.94 1.12
Non INV 1 2.06 1.31 1.19
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Data on Non-Public PlacementsData on Non-Public Placements
Between September, 2006 and March, 2008, Between September, 2006 and March, 2008, 43 students were seen for more intensive 43 students were seen for more intensive services in the two schoolsservices in the two schools
All met multiple criteria for placement in non-All met multiple criteria for placement in non-public programspublic programs
3/43 students were placed in a non-public 3/43 students were placed in a non-public programprogram
Data (cont.)Data (cont.)
Preliminary economic analyses indicate:Preliminary economic analyses indicate:– For 1.6 years of services (as of 3/14/08), 25 For 1.6 years of services (as of 3/14/08), 25
placement years were divertedplacement years were diverted– For a savings of between $800,000 and $1,000,000 For a savings of between $800,000 and $1,000,000
for Prince Georges County alonefor Prince Georges County alone
AgendasAgendas
The The Prescriptive AgendaPrescriptive Agenda (e.g., implementing (e.g., implementing evidence-based services in schools, evidence-based services in schools, documenting outcomes, building advocacy, documenting outcomes, building advocacy, growing into more schools) is dependent ongrowing into more schools) is dependent on
The The Collaborative AgendaCollaborative Agenda (i.e., building (i.e., building relationships, promoting dialogue and relationships, promoting dialogue and developing true collaboration and developing true collaboration and partnerships)partnerships)
A National Community of PracticeA National Community of Practice
CSMH and IDEA Partnership CSMH and IDEA Partnership (www.ideapartnership.org) providing support(www.ideapartnership.org) providing support
30 professional organizations and 12 states30 professional organizations and 12 states
10 practice groups10 practice groups
Providing mutual support, opportunities for Providing mutual support, opportunities for dialogue and collaborationdialogue and collaboration
Advancing Advancing multiscale learning systemsmultiscale learning systems
Sign up at www.sharedwork.org Sign up at www.sharedwork.org
10 Practice Groups10 Practice Groups
Mental Health-Education IntegrationMental Health-Education Integration
Developing a Common LanguageDeveloping a Common Language
Connecting Education and Systems of CareConnecting Education and Systems of Care
Connecting SMH and Positive Behavior Connecting SMH and Positive Behavior SupportSupport
Improving SMH for Youth with DisabilitiesImproving SMH for Youth with Disabilities
10 Practice Groups (cont.)10 Practice Groups (cont.)
SMH, Juvenile Justice and Dropout PreventionSMH, Juvenile Justice and Dropout Prevention
Family PartnershipsFamily Partnerships
Youth Involvement and LeadershipYouth Involvement and Leadership
SMH – Child Welfare ConnectionsSMH – Child Welfare Connections
Quality and Evidence-Based PracticeQuality and Evidence-Based Practice
Twelve StatesTwelve States
HawaiiHawaii
IllinoisIllinois
New HampshireNew Hampshire
North CarolinaNorth Carolina
MarylandMaryland
MissouriMissouri
New MexicoNew Mexico
OhioOhio
PennsylvaniaPennsylvania
South CarolinaSouth Carolina
South DakotaSouth Dakota
VermontVermont
Maryland is the National SMH LeaderMaryland is the National SMH Leader
UMBC Dissertation, April, 2007 UMBC Dissertation, April, 2007 Lisa Sadzewicz Lisa Sadzewicz “Diffusion of Innovation: State Factors that “Diffusion of Innovation: State Factors that Influence the Spread of School Mental Health Influence the Spread of School Mental Health Policies and Programs”Policies and Programs”
Survey of State Children’s Mental Survey of State Children’s Mental Health Directors on SMH InnovationHealth Directors on SMH Innovation
Nominations:Nominations:– 1. Maryland (9)1. Maryland (9)– 2. California (6)2. California (6)– 3. Ohio (5)3. Ohio (5)– 4. North Carolina (4)4. North Carolina (4)
Policy/Funding Mechanisms used Policy/Funding Mechanisms used to Support SMHto Support SMH
Number:Number:– 1. Massachusetts (16)1. Massachusetts (16)– 2. Maryland (15)2. Maryland (15)– 3. North Carolina (14)3. North Carolina (14)– 4. Californian (13)4. Californian (13)
School Mental Health WorkgroupSchool Mental Health Workgroup
Established in 2002 as part of MHA’s Established in 2002 as part of MHA’s Blueprint strategic planning processBlueprint strategic planning process
Promoting a coordinated SMH agenda for MDPromoting a coordinated SMH agenda for MD
Two statewide surveys of SMHTwo statewide surveys of SMH
Providing assistance to federal grant proposalsProviding assistance to federal grant proposals
Developing SMH outreach and services for Developing SMH outreach and services for youth in foster careyouth in foster care
CSMH Training EventsCSMH Training Events
1313thth Annual Conference on Advancing School Annual Conference on Advancing School Mental HealthMental Health. Phoenix, Arizona, Florida. . Phoenix, Arizona, Florida. September 25-27, 2008September 25-27, 2008
School Health Interdisciplinary ProgramSchool Health Interdisciplinary Program (SHIP). Ellicott City, Maryland. August 4-7, (SHIP). Ellicott City, Maryland. August 4-7, 20082008
See http://csmha.umaryland.edu or call 410-See http://csmha.umaryland.edu or call 410-706-0980 (or 888-706-0980 toll free)706-0980 (or 888-706-0980 toll free)
www.schoolmentalhealth.orgwww.schoolmentalhealth.org
Website developed and maintained by the Website developed and maintained by the CSMH with funding from the Baltimore City CSMH with funding from the Baltimore City Health DepartmentHealth Department
User-friendly mental health related User-friendly mental health related information and resources for caregivers, information and resources for caregivers, teachers, clinicians, and youthteachers, clinicians, and youth
Welcome to the School Mental Health Connection!Welcome to the School Mental Health Connection!
This site offers school mental healthThis site offers school mental health resources not only for clinicians, but also resources not only for clinicians, but also for educators, administrators, parents/caregivers, families, and for educators, administrators, parents/caregivers, families, and students. To efficiently find resources that fit your needs, just click the link to students. To efficiently find resources that fit your needs, just click the link to the left that corresponds to your role in the school community. However, the left that corresponds to your role in the school community. However, since you may benefit from resources in numerous domains within this site, since you may benefit from resources in numerous domains within this site, we encourage you to explore many areas.we encourage you to explore many areas.The resources on this site emphasize practical information and skills based The resources on this site emphasize practical information and skills based on current research, including prominent evidence-based practices, as well on current research, including prominent evidence-based practices, as well as lessons learned from local, state, and national initiatives. as lessons learned from local, state, and national initiatives.
The School Mental Health Connection is designed for use by anyone who is The School Mental Health Connection is designed for use by anyone who is interested in school mental health. It is also a central feature of the interested in school mental health. It is also a central feature of the Baltimore School Mental Health Technical Assistance and Training Initiative.Baltimore School Mental Health Technical Assistance and Training Initiative.
What's NewWhat's NewView the newly-released Directory of Community Services for View the newly-released Directory of Community Services for Baltimore City.Baltimore City.Educators: Check out the user-friendly Mental Health Fact Sheets Educators: Check out the user-friendly Mental Health Fact Sheets for the Classroom, provided by the Minnesota Association for for the Classroom, provided by the Minnesota Association for Children's Mental Health.Children's Mental Health.
HomeHome
About UsAbout Us
Resources for Resources for CliniciansClinicians
Resources for Resources for EducatorsEducators
Resources for Resources for FamiliesFamilies
Resources for Resources for StudentsStudents
FAQFAQ
Baltimore City Baltimore City Resource DirectoryResource Directory
Consultation & Consultation &
Support LineSupport Line © 2006 The School Mental Health Connection. All Rights Reserved.
Other Helpful Other Helpful School Mental Health WebsitesSchool Mental Health Websites
Center for the Advancement of Mental Health Practices Center for the Advancement of Mental Health Practices in Schoolsin Schools
http://schoolmentalhealth.missouri.edu/about.htmhttp://schoolmentalhealth.missouri.edu/about.htm
Center for School-Based Mental Health ProgramsCenter for School-Based Mental Health Programs
http://www.units.muohio.edu/csbmhp/http://www.units.muohio.edu/csbmhp/
UCLA Center for Mental Health in Schools UCLA Center for Mental Health in Schools
http://smhp.psych.ucla.eduhttp://smhp.psych.ucla.edu
INTERCAMHSINTERCAMHSInternational Alliance for Child andInternational Alliance for Child and
Adolescent Mental Health and SchoolsAdolescent Mental Health and Schools
www.intercamhs.org
Two BooksTwo Books
Handbook of School Mental HealthHandbook of School Mental Health (2003, (2003, paperback – 2007) paperback – 2007) – www.springer.comwww.springer.com
Advances in School-Based Mental Health Advances in School-Based Mental Health InterventionsInterventions (2007) (2007)– www.civicresearchinstitute.com/sbmh.htm www.civicresearchinstitute.com/sbmh.htm
Two New JournalsTwo New Journals
Advances in School Mental Health Advances in School Mental Health Promotion Promotion – The Clifford Beers Foundation and the University The Clifford Beers Foundation and the University
of Marylandof Maryland– www.schoolmentalhealth.co.uk www.schoolmentalhealth.co.uk
School Mental HealthSchool Mental Health– www.springer.comwww.springer.com
Contact InformationContact Information
Center for School Mental Health, Center for School Mental Health, Department of Psychiatry University Department of Psychiatry University of Maryland 737 W. of Maryland 737 W. Lombard Street, 4Lombard Street, 4thth Floor Baltimore, Floor Baltimore, MD 21201 PH: 410-706-MD 21201 PH: 410-706-0980 FX: 410-0980 FX: 410-706-0984 [email protected] 706-0984 [email protected] http://csmh.umaryland.edu http://csmh.umaryland.edu