MENTAL HEALTH MATTERS: DISABILITY, MENTAL HEALTH AND TRANSITION

Marcus Poppen, James Sinclair & Kara Hirano

Agenda

Disability, Mental Health and Transition Our Study and Results Strategies Wrap Up/Discussion

Disability, Mental Health and TransitionThe Perceptions of Practitioners Working with Transition Age Youth who experience Mental Health and Disability

What is mental

health?

Two definitions of Mental Health:

CDC Mental health describes a level of psychological

well-being, or an absence of a mental disorder. Mental health may include an individual's ability to enjoy life, and create a balance between life activities and efforts to achieve psychological resilience.

World Health Organization Mental Health is a state of well-being in which the

individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Well then, what are mental health

concerns or mental illness?

What are mental health concerns or mental illness?

From time to time many people have mental health concerns. These are often temporary and situational.

National Alliance on Mental Illness (NAMI) Mental illnesses are medical conditions that

disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning.

Mental Health

The U.S. Surgeon General reports that 10 percent of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers.

Prevalence rates estimate that nearly half of adolescents aged 13 to 18 are affected by at least one class of mental health disorder while almost 28% are affected by disorders that result in severe impairment of daily life (Merikangas et al., 2010).

Mental illness usually strikes individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.

OK. How about mental health

AND disability?

What about mental health as

a disability?

Mental Health as Disability Emotional Disturbance (IDEA, 2004)

Condition in which one or more of the following characteristics adversely affects educational performance: Inability to learn that cannot be explained by health,

sensory, or intellectual factors Inability to build or maintain relationships with peers and

teachers Inappropriate behaviors or feelings under normal

circumstances General pervasive mood of unhappiness or depression Tendency to develop physical symptoms or frats

associated with personal or school problems

Disability, Mental Health and Transition

Relationships between disability and mental health during transition are complex and underexplored (Rose, et al, 2009).

Disability and mental health during transition increases students risks of experiencing negative post-school outcomes (Hassoitis & Turk, 2012; Haber, et al., 2008).

Despite these known barriers, there remains a dearth of literature describing the unique features of this population and offering effective transition planning strategies for practitioners.

Transition Age Youthand Serious Mental Illness

More than three million transition age youth have serious mental illness (Vander Stoep, et al, 2000).

Prevalence of serious mental illness is greatest among the populations of 18-25 year olds (12%) compared to other adult populations (5-8%; HHS, 2003).

Transition age youth with serious mental illness are three times more likely to become involved with the juvenile justice system, compared to transition age youth without SMI (Vander Stoep, et al, 2000).

More than 60% of transition age youth with serious mental illness do not complete high school, leaving many of these young adults unemployed, unable to benefit from continuing education, and without the skills needed to live independently (Hagner, Cheny, & Malloy 1999).

What about mental health and disability during transition?

What are the unique features of Disability, Mental Health, and Transition? Prevalence Current practices Barriers

What strategies do transition practitioners suggest using to address the mental health needs of transition age youth with disabilities

What training and professional development recommendations do transition practitioners suggest would best meet their needs

Research QuestionsDisability, Mental Health and Transition

Study DesignDisability, Mental Health and Transition

Two Focus Groups (Oregon) National Survey

648 (85%: of 762) Survey respondents completed 80% or more of our survey. 467 (72%) Special Education Staff (Special

Education Teacher, Transition Specialist, Instructional Aid)

133 (21%) Neither special education staff or other school staff.

48 (7%) Community providers All states represented by at least 1 respondent

Female, 84%Male, 16%

Professional Experience

• 41% teaching more than 16 years• 21% 11-15 years• 24% 5-10 years• 13% Less than 5 years

Caseload•45% Greater than 30 students•14% 21-30 students•19% 11-20 students•22% 1-10 students

Education• 5% Doctoral Degree• 69% Masters Degree• 20% Bachelors Degree• 2% AA• 4% Other

Race/Ethnicity• 87% White• 4% African American• 3% Prefer Not to Specify• 6 % Other

Community Setting• 32% Urban• 48% Suburban• 32% Rural (<2,500)

Work Setting• 45% Special Education Classroom• 28% Community Based/Work

Program• 17% Resource Room or Learning

Center• 9% General Education Classroom

Demographics

What did you have to say?

0%

20%

40%

60%

80%

100%

97%

79% 77%68%

56% 54%

42%

21%

11%

Transition Services Offered by School

“Because of your mental health, which is your disability, you fall out of programs that are set up to serve you. And, that just doesn’t make any sense to me!” – Special Education Teacher

Transition Services Offered

Prevalence of Mental Health Issues for Transition Age Youth

94% of survey respondents report working with students who receive mental health services.

Survey respondents report that 48% of their students experience mental health issues.

Mental Health Services for Transition Age Youth with

Disabilities

Very IneffectiveIneffective Effective Very Effective

-20%

0%

20%

40%

60%

Effectiveness

0%

20%

40%

60%

Satisfaction

School Based

Community Based

0% 50% 100%

61%

82%

Type of Mental Health Services Provided

Of the 94% who reported their students receive mental health services

“We are not talking about issues soon enough.” – Special Education Teacher

“What I’ve seen is a lack of awareness of the complexity of the things that these young adults are coming forward with.” – Special Education Teacher

Other

Suicidal Thoughts/Behavior

Alcohol/Drug Abuse

Inappropriate Sexual Behavior

Experience of Trauma

Impulsive/Dangerous Behaviors

Physically or Verbally Aggressive Behaviors

Withdrawal or Social Isolation

Depression

Impaired Self-Esteem

Classroom Disruptiveness

Worrying/anxiety/nervousness

Attention Deficit/Hyperactivity

Peer Relationship Problems

0% 50% 100%Observed

Mental Health Concerns Observed

“When we don’t address it head on, the kids often don’t get the mental health support that they need.” – Special Education Teacher

Mental Health Concerns Present and Those Addressed on the Students IEP

Other

Suicidal Thoughts/Behavior

Alcohol/Drug Abuse

Inappropriate Sexual Behavior

Experience of Trauma

Impulsive/Dangerous Behaviors

Physically or Verbally Aggressive Behaviors

Withdrawal or Social Isolation

Depression

Impaired Self-Esteem

Classroom Disruptiveness

Worrying/anxiety/nervousness

Attention Deficit/Hyperactivity

Peer Relationship Problems

0% 50% 100%Observed

Addressed in IEP

Discussion

In your own experiences, do you see a gap between the mental health concerns experienced by transition age youth and what is addressed in the IEP?

Are there certain mental health concerns that you think are more likely to be addressed on an IEP? If so, why?

“What mental health services are we going to offer the kids, so when we put it on the IEP who is going to pay for it, how are we going to get it, we don’t have a grocery store in our town, so how are we going to get into counseling?”

- Transition Specialist

Mental Health Services Included in IEP

0%

5%

10%

15%

20%

25%

30%

35%

40%

11%

19%22%

34%

9%5%

86%

Occasionally

to Never

“And, so the question is, how do we include other agencies in the process, rather than doing something in isolation.” -- Transition Specialist

Coordination with MH Provider

Never Very Rarely Rarely OccassionallyVery Frequently Always0%

5%

10%

15%

20%

25%

30%

35%

13%

18% 19%

32%

15%

3%

82%

Occasionally to

Never

How often do families of students with mental health concerns participate in the IEP meetings?

Never Very Rarely

Rarely Occa-sionally

Fre-quently

Very Fre-

quently

0%

5%

10%

15%

20%

25%

30%

35%

40%

1%

6% 7%

27%

36%

23%

86%

Occasionally

to Very

Frequently

Barriers

Availability of Resources (e.g., not enough resources, need for

additional resources)

Student Characteristics (e.g., disability specific, student’s

interest in receiving or following up with services, medication)

“Lack of services through the Departments of Health, Human Services, and Education. This is a major, major "gap group" for children and although the child may be serviced as minors, once the child attains age of majority, the child is no longer eligible for many services.”

“Getting students to know their resources when needing help - who to call and when to call.”

Barriers

Family Characteristics (e.g., families not interested in services,

don’t understand complexities of issues, student’s home environment)

Collaboration and Coordination (e.g., communication)

“Families who are not consistent with student meds, make changes and don't alert school staff, remove meds after a bad day, etc.”

“NOT GETTING ASSISTANCE FROM THE MENTAL HEALTH DIVISION. THOUGH THEY ARE INVITED THEY RARELY ATTEND”

Barriers (cont.)

Professional Development (e.g., not enough training to address mental health

issues)

Community/Cultural Characteristics (e.g., cultural language barriers, finding appropriate

work placements or work experiences, stigma of mental health, geographic barriers)

“There seems to have been a sudden influx of severe mental needs within our school and we were not prepared with any type of program or strategies to address the students needs. It has drained our resources as we try to find ways to work with the students and yet provide balance to other students within our special education population that need services also.”

The student not wanting to believe this is them and believing if you have a mental health deficit your 'retarded or psycho'

Strategies

Access to Mental Health Services (e.g., MH evaluations, referrals to

community providers, early intervention)

Student Skill Development (e.g., student focused planning, peer

mentoring, goal setting, self-advocacy, social skills)

These transitions have been most successful when all members of the team are working collaboratively rather than at odds with each other. We are committed to including outside mental health workers and agencies in the IEP process and providing consultative support to families to secure the appropriate services.

Program development rooted in the philosophy of self-determination and intensive instruction on self-determination skills; student involvement in their IEP process

Strategies

Working with Families (e.g., maintaining positive

communication, advocating for families, involving families)

Assessment of needs and conversations with family and providers to provide the optimum level of support and accommodations in the workplace.

Involving the students and their families from the very beginning. Listening to the student and the families. Involving the students in peer supported groups. Connecting the families with other families. Developing trusting relationships

Strategies

Student Teacher Relationship Building (e.g., using active listening skills, showing

empathy, building trust and rapport, setting clear rules and expectations)

Training and Professional Development

By being straight forward with my client and working through it with them, changing negative to positive.

Simply treating them like a human, getting their input on their future. Once a relationship is built with these students it is easier for them to trust you and develop a transition plan. When they are transitioning, it is helpful to gradually introduce hem to their new placement.

Interconnected Systems Framework

ISF is a national movement that is being promoted through the PBiS networks and national communities of practice

Tiered system of support to address the mental health needs and challenges faced by schools across the country that focuses on within school and community collaboration

Makes the case that this is NOT just a special education issue but that it is a school wide issue

Interconnected Systems Framework

Teachers, administrators, and community professionals all participate in making ISF successful

Incorporates mental health into the discussion of school wide interventions where there was minimal efforts previously

Supports all three tiers but provides additional support for tier 2 and 3 behavior focused interventions

Interconnected Systems Framework for Mental Health

Core Features

Effective teams that include community mental health providers

Data based decision making Formal processes for the selection and

implementation of evidence based practices Early access through use of comprehensive screening Rigorous progress-monitoring for both fidelity and

effectiveness Ongoing coaching at both the systems and practices

level

Tiered System of Implementation

Tier 1

• School improvement team gives priority to social and emotional health

• Mental health skills development for students, staff, families, and communities

• Social emotional learning curricula for all students

• Partnerships between school, home and the community

• Decision making framework, used to guide and implement practices that consider unique strengths and challenges of each school community

Tiered System of Implementation

Tier 2

• Systems planning team identified to coordinate referral process, decision rules and progress monitor impact of intervention

• Communication system for staff, families and community

• Early identification of students who may be at risk for mental health concerns due to specific risk factors

• Skill-building at the individual and groups level

Tiered System of Implementation

Tier 3

• Systems planning team coordinates decision rules/referrals for this level of service and progress monitors

• Individual team developed to support each student

• Individual plans may have array of interventions/services

• Plans can range from one to multiple life domains

• System in place for each team to monitor student progress

Collaboration Activity

Identifying your team 1 group of 2, 1 group of 5, 1 group of 10

Scenario: You have seen an increase in anxiety, worrying, and

depression around school. You know that this has impacted many of your student’s performance in the classroom. You want to do something about it.

What are the first steps you can take to increase collaboration with other teachers and administrators to begin implementing a school wide intervention such as the ISF?

Resources and Info:

http://www.pbis.org/school/school_mental_health/interconnected_systems.aspx

www.pbis.org/common/pbisresources/publications/Final-Monograph.pdfwww.pbis.org/common/pbisresources/publications/Final-Monograph.pdf

Marcus Poppen: mpoppen@uoregon.edu James Sinclair: jsinclai@uoregon.edu Kara Hirano: khirano1@uoregon.edu

Wrap-up

Discussion of the Primary Barriers Are these barriers similar to their

experiences? What additional barriers? What strategies could be used to address

these barriers?

Just in case…

Strategies

Agency Collaboration School and Community Resources Family Engagement Student-Teacher Relationship Skills to build positive relationship

Barriers

Homelessness Student Engagement Disability Specific Appropriate Transition Planning Eligibility Stigma Family Engagement Job Descriptions and Responsibilities Training and Professional Development Expectations for the Future

“I think it goes beyond national, to cultural, because people don’t know how to talk about mental health because there is ignorance, fear, stigma….” – Special Education Teacher

Knowledgeable about School Mental Health Services

Not at all like me Not like me Not much like me Somewhat like me Like me Just like me0%

5%

10%

15%

20%

25%

30%

35%

40%

2%5%

9%

29%34%

22%

To what degree does the following statement sound like you: "I am knowledgeable about the services available for stu-

dents with mental health concerns provided by my school"

Knowledgeable about Community Mental Health Services

Not at all like me Not like me Not much like me Somewhat like me Like me Just like me0%

5%

10%

15%

20%

25%

30%

35%

40%

2%5%

13%

35%30%

14%

To what degree does the following statement sound like you: "I am knowledgeable about the services available for stu-

dents with mental health concerns provided by my commu-nity"

No

Yes

0% 50% 100%

60%

40%

No

Undecided

Yes

0% 50% 100%

4%

16%

76%

Who would like additional training in Mental Health

Who has attended training and who would like more training