Building the Research Agenda Building the Research Agenda in School Mental Healthin School Mental Health

Mark D. Weist, Ph.D.Mark D. Weist, Ph.D.Center for School Mental HealthCenter for School Mental Health

University of Maryland University of Maryland 11.05.0911.05.09

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, Health Resources *Supported by the Maternal and Child Health Bureau, Health Resources

and Services Administration, and numerous Maryland agenciesand Services Administration, and numerous Maryland agencies

““Expanded” School Mental HealthExpanded” School Mental Health

Full continuum of effective mental health Full continuum of effective mental health promotion and intervention for students in promotion and intervention for students in general and special educationgeneral and special education

Reflecting a “shared agenda” involving Reflecting a “shared agenda” involving school-family-community system partnershipsschool-family-community system partnerships

Collaborating community professionals (not Collaborating community professionals (not outsidersoutsiders) ) augmentaugment the work of school- the work of school-employed staffemployed staff

Fundamental Three-Part RationaleFundamental Three-Part Rationale

Schools are under-resourced for mental health Schools are under-resourced for mental health promotion and interventionpromotion and intervention

Connections between people and traditional Connections between people and traditional community mental health centers are difficultcommunity mental health centers are difficult

By coming together in the most universal By coming together in the most universal natural setting for youth, there are advantages natural setting for youth, there are advantages for both systems, and synergies enhance for both systems, and synergies enhance opportunities to achieve valued outcomes opportunities to achieve valued outcomes

Access AdvantagesAccess Advantages

Reduced initial stigma of servicesReduced initial stigma of services

Reduced burden of initial help seekingReduced burden of initial help seeking

Increased likelihood of early problem Increased likelihood of early problem identificationidentification

Reduced stigma for ongoing service useReduced stigma for ongoing service use

Reduced burden of ongoing service useReduced burden of ongoing service use

Promotion/Prevention AdvantagesPromotion/Prevention Advantages

Increased ability for environmental Increased ability for environmental enhancement and universal preventionenhancement and universal prevention

Enhanced ability for preventionEnhanced ability for prevention

Increased support to educational staffIncreased support to educational staff

Service Implementation AdvantagesService Implementation Advantages

Increased interdisciplinary collaborationIncreased interdisciplinary collaboration

Increased involvement of diverse stakeholdersIncreased involvement of diverse stakeholders

More efficient (and less costly) servicesMore efficient (and less costly) services

Enhanced ability for assessment and Enhanced ability for assessment and intervention in multiple settings, enhanced intervention in multiple settings, enhanced maintenance/generalizationmaintenance/generalization

Research Supported ProgramsResearch Supported Programs

Substance Abuse and Mental Health Service Substance Abuse and Mental Health Service Administration’s National Registry of Administration’s National Registry of Effective Programs and PracticesEffective Programs and Practices

www.nrepp.samhsa.comwww.nrepp.samhsa.com

On October 24, 2009, 147 research supported On October 24, 2009, 147 research supported interventions were reported, with 54 coming interventions were reported, with 54 coming up with the search term “schools”up with the search term “schools”

Research Supported Programs InvolveResearch Supported Programs Involve

Strong trainingStrong training

Fidelity monitoringFidelity monitoring

Ongoing technical assistance and coachingOngoing technical assistance and coaching

Administrative supportAdministrative support

IncentivesIncentives

IntangiblesIntangibles

Practice in the trenchesPractice in the trenches

Involves NONE of these supportsInvolves NONE of these supports

Other Critical IssuesOther Critical Issues

Contingencies related to financingContingencies related to financing

Absence of accountability mechanismsAbsence of accountability mechanisms

School fluiditySchool fluidity

Crowded agendas in schoolsCrowded agendas in schools

Jadedness of school systems and staffJadedness of school systems and staff

Central Theme of CSMHCentral Theme of CSMH

Bridging research and practice in school Bridging research and practice in school mental health to enhance the implementation mental health to enhance the implementation of high quality, evidence-based programs of high quality, evidence-based programs leading to improvements in outcomes valued leading to improvements in outcomes valued by families and schoolsby families and schools

Four Themes in Quality ServicesFour Themes in Quality Services

Systematic Quality Assessment and Systematic Quality Assessment and ImprovementImprovement

Family Engagement and EmpowermentFamily Engagement and Empowerment

Modular, Evidence-Based Skill TrainingModular, Evidence-Based Skill Training

Implementation SupportImplementation Support

Working Effectively with Working Effectively with Students and FamiliesStudents and Families

Early on focus on engagement, e.g., through Early on focus on engagement, e.g., through candid discussions about past experiencescandid discussions about past experiences

Emphasize empowerment and the potential for Emphasize empowerment and the potential for improvementimprovement

Provide pragmatic supportProvide pragmatic support

Emphasize mutual collaborationEmphasize mutual collaboration

Modular InterventionModular Intervention

Chorpita, B.F., & Daleiden, E.L. (2007). Chorpita, B.F., & Daleiden, E.L. (2007). 2007 2007 Biennial Report: Effective Psychosocial Intervention Biennial Report: Effective Psychosocial Intervention for Youth with Behavioral and Emotional Needsfor Youth with Behavioral and Emotional Needs . . Child and Mental Health Division, Hawaii Child and Mental Health Division, Hawaii Department of Health Department of Health (Reviews most important treatment foci for Anxiety, (Reviews most important treatment foci for Anxiety, Attention Problems, Autism, Depression, Disruptive Attention Problems, Autism, Depression, Disruptive Behavior Disorders, Substance Use, and Traumatic Behavior Disorders, Substance Use, and Traumatic Stress)Stress)http://hawaii.gov/health/mental-health/camhd/library/http://hawaii.gov/health/mental-health/camhd/library/pdf/ebs/ebs012.pdfpdf/ebs/ebs012.pdf

Anxiety: Practice ComponentsAnxiety: Practice Components

31

39

44

97

0 20 40 60 80 100

Relaxation

Cognitive/Coping

Modeling

Exposure

% of EBP w/PracticeComponent

Implementation SupportImplementation Support

Interactive and lively teachingInteractive and lively teaching

Off and on-site coaching, performance Off and on-site coaching, performance assessment and feedback, emotional and assessment and feedback, emotional and administrative supportadministrative support

Peer to peer support Peer to peer support

User friendlinessUser friendliness– see Dean Fixsen, Karen Blasé, National see Dean Fixsen, Karen Blasé, National

Implementation Research Network (NIRN)Implementation Research Network (NIRN)

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

A National Community of PracticeA National Community of Practice

CSMH and IDEA Partnership (CSMH and IDEA Partnership (www.ideapartnership.orgwww.ideapartnership.org) providing support) providing support

30 professional organizations and 13 states30 professional organizations and 13 states

12 practice groups12 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 Sign up at www.sharedwork.orgwww.sharedwork.org

Next Meeting of the National Next Meeting of the National (International) Community(International) Community

In conjunction with the In conjunction with the 1515thth Annual Annual Conference on Advancing School Mental Conference on Advancing School Mental HealthHealth

Albuquerque, New MexicoAlbuquerque, New Mexico

October 6-9, 2010October 6-9, 2010

See http://csmh.umaryland.eduSee http://csmh.umaryland.edu

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 Department and Maryland Departments Health Department and Maryland Departments of Education and Mental Healthof Education and Mental Health

User-friendly school mental health User-friendly school mental health information and resources for caregivers, information and resources for caregivers, teachers, clinicians, and youthteachers, clinicians, and youth

www.schoolmentalhealth.co.ukwww.schoolmentalhealth.co.uk

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 706-0984 mweist@psych.umaryland.edumweist@psych.umaryland.edu http://csmh.umaryland.eduhttp://csmh.umaryland.edu