School Mental Health School Mental Health Capacity Building Capacity Building

Partnership*Partnership*

Maryland Stakeholder Discussion Maryland Stakeholder Discussion GroupsGroups

Bringing Health Care to Schools for Student

Success

*A project funded through a Cooperative Agreement with the Centers for Disease Control and Prevention,

Division of Adolescent and School Health (DASH)

Promoting School Promoting School Mental Health through Mental Health through

Capacity Building Capacity Building to to

State and Local State and Local Education Agencies Education Agencies (SEA’s and LEA’s)(SEA’s and LEA’s)

Project GoalsProject Goals Strengthen collaborative national efforts to

improve mental health services in schools by increasing intersections between mental health, health, and schools.

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

Provide technical assistance, resources and professional development to aid SEA’s and LEA’s in implementing effective school mental health programs.

Goal 1: Mental Health, Health Goal 1: Mental Health, Health and Schoolsand Schools

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

2. Expand and strengthen the capacity of NASBHC to address the mental health needs of the school-based health care field

3. Conduct a national scan of initiatives/models that integrate mental health, health and schools.

4. Strengthen the mental health component of the Coordinated School Health Program Model.

Family/CommunityInvolvement

Health Education

Health Promotionfor Staff

Healthy SchoolEnvironment

MENTAL HEALTH:Counseling,

Psychological & Social Services

Nutrition Services

Health Services

Physical Education

Coordinated School Health ProgramCoordinated School Health ProgramMental Health StrandMental Health Strand

Goal 2: Fact FindingGoal 2: Fact Finding

Organize key documents and resources related to best practices for improvement and expansion of effective SMH services.

Develop electronic toolkit of resources and tools addressing school mental health key dimensions to use in capacity building assistance

Conduct key informant interviews and site visits to four states to enhance understanding of how school mental health is operationalized at the state and local level.

Goal 3: Capacity BuildingGoal 3: Capacity Building

Using fact finding knowledge, materials and resources developed in Goals 1 & 2, provide technical assistance, resources and professional development to aid SEA’s and LEA’s in implementing effective school mental health programs.

Statewide Stakeholder Discussion Statewide Stakeholder Discussion Groups: PURPOSEGroups: PURPOSE

to help identify successes and lessons learned in “early adopter” states -- at both the state and local levels -- related to school mental health policies, programs and services.

Statewide Stakeholder Discussion Statewide Stakeholder Discussion Groups: MethodGroups: Method

4 “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

SBHC’s & Early Adopter StatesSBHC’s & Early Adopter States

Oregon

OhioMaryland

Missouri

STAKEHOLDER DISCUSSION GROUPS: Ohio: December 2006Maryland: February 2007Missouri: May 2007Oregon: August 2007

Maryland School Mental Health Maryland School Mental Health Stakeholder Discussion GroupsStakeholder Discussion Groups

Process: Adult Discussion Process: Adult Discussion GroupsGroups

February 22nd and 23rd, 2007

Three 2-hour discussion groups

26 total participants– Mental Health: 6

– Education: 9

– Health: 7

– Family members/advocates: 4

ResultsResults

Responses to Questions– Themes– Key Quotations

Challenges

Opportunities

Participant awareness of Maryland’s Participant awareness of Maryland’s

vision or agenda for school mental healthvision or agenda for school mental health State blueprint for children’s mental

health, with a subcommittee for school mental health.

Emphasis on prevention and early intervention.

SAMHSA grant in mid 90’s brought national attention.

What would make it a stronger What would make it a stronger agenda? agenda?

Shared ownership and buy-in of all stakeholders

Increased, sustainable funding and equal distribution of resources across the state; Funding options beyond a fee-for-service model

Coordinated and uniform data collection and outcome evaluation

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

Advocacy Recognition of schools as a unique site

for providing mental health servicesIncreased coordination between

existing services, including coordination and partnering with non-profit organizations and universities.

State policy reflecting investment in school mental health

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

Mental health education for teachers, school staff/administration and parents

Clarity/consensus on what is meant by “school mental health”

Social marketing and mental health promotion

Major ThemesMajor Themes

There is a general goal of advancing school mental health in Maryland, but the “vision” is not consistent across people or jurisdictions, does not extend to all parts of the state, and lacks clear ownership.

Specific grants and initiatives (e.g. Maryland School Mental Health Alliance, the Maryland School-Based Health Care Assembly, the Center for School Mental Health) have helped to advance the vision of school mental health in Maryland.

Major Themes (cont.)Major Themes (cont.)

Partnering with community organizations, including universities and non-profit organizations, has been helpful in advancing school mental health in Maryland.

The Maryland Assembly on School-Based Health Care has advanced Maryland’s school mental health efforts in many ways, including advocacy and outcome monitoring, and provides a good example of collaborative health-mental health care.

Major Themes (cont.)Major Themes (cont.)

Increased, sustainable funding (beyond fee-for-service models) and equal distribution of resources across the state are essential for the advancement of school mental health in Maryland.

ChallengesChallenges

Despite Maryland’s “pockets of excellence” in SMH there is inequity across the state with respect to opportunities to advance SMH.

Inequities may reflect disparate allocation of resources, limited opportunities for information sharing and dissemination, and fragmentation of efforts across districts and regions.

Challenges (cont.)Challenges (cont.) Lack of shared ownership by key stakeholders--

including mental health, education and families--of a statewide vision for school mental health.

Lack of organizational infrastructure or responsibility by any one state agency for school mental health programs.

Lack of feasible, sustainable funding models to support comprehensive SMH services. Fee-for-service delivery models and lack of funding to support quality assessment and improvement limit advances in quality.

Challenges (cont.)Challenges (cont.)

Demands on schools to achieve academic results hinder efforts to advance SMH, especially when the connection between academic success and mental health is not made explicit.

Lack of definitional clarity and consensus around what is meant by “school mental health”.

Lack of quality, interdisciplinary pre-service training for mental health providers and educators.

Challenges (cont.)Challenges (cont.)

Limited meaningful youth involvement in the planning, implementation and evaluation of school mental health activities.

Lack of coordinated and uniform data collection that incorporates both psychosocial and academic barriers

Limited staff professional development time which is important in defining and clarifying roles of school personnel

OpportunitiesOpportunities

Connect and mobilize Maryland’s initiatives around school mental health to create momentum and develop a unified, statewide vision for SMH.

This statewide vision should inform state policy around children’s mental health, including SMH as an integral, mandated component.

Opportunities (cont.)Opportunities (cont.)

Expand upon Maryland’s strong school-based health center foundation to develop increased support for health-mental health partnerships in schools.

Build and expand upon models of family partnerships, such as those led by the Maryland Coalition of Families for Children’s Mental Health

Utilize Maryland existing models of university and non-profit partnerships to enhance school mental health linkages and efforts statewide.

Opportunities (cont.)Opportunities (cont.)

Utilize Maryland’s existing dissemination networks, including the CSMHA, the MSMHA, MASBHC and MSDE, to distribute existing resources statewide and to establish learning communities across SMH stakeholder groups.

Maryland’s strong base of universal prevention and early intervention programming in schools can serve as a foundation for statewide implementation of secondary and targeted intervention.

Opportunities (cont.)Opportunities (cont.)

Work towards shared ownership of and participation in the school mental health agenda by all stakeholders (including families, educators, health and mental health).

Maryland Youth Maryland Youth Discussion GroupsDiscussion Groups

Youth Discussion GroupYouth Discussion Group

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.

Youth Discussion Group: MethodYouth Discussion Group: Method

March 27, 2007 One 1.5-hour discussion group Nine participants

– Ages 14-17 from Prince Georges and Anne Arundel Counties

– All were members of “Kiamsha” youth empowerment group for African American Youth

– 8 attended public school, 1 attended private school

Youth Discussion Groups: Youth Discussion Groups: ProcessProcess

SAMPLE QUESTIONS:

1. How can adults at your school make all students feel supported both in school as well as other areas of their life?

2. What can schools do to better understand the different cultures or backgrounds a student comes from?

3. How well do you think that adults in your school respond to students with mental health problems?

Youth Discussion Groups: Youth Discussion Groups: FindingsFindings

Adults should listen to students and value their opinions in order for them to feel supported in school and areas of their life.

Teachers who come from the same culture and/or background as their students may better understand them.

Teachers tend to ignore students’ mental health problems, unless they are especially serious.

Teachers should ask students questions about their mental health problems by pulling them aside to better understand them.

Youth Discussion Groups: Youth Discussion Groups: Findings (cont.)Findings (cont.)

Students are most trusting of adults who are open with them and who do not talk to the student’s parent or another teacher about “their business.”

Students aren’t consistently aware of where they can go to get help; however they are aware of some conditions that would require help (e.g. self-harm)

One barrier to getting help may be fear that their information will be shared with others.

Students would have an easier time asking for help if they knew that their teachers were trained about certain issues.

Youth Discussion Groups: Youth Discussion Groups: Findings (cont.)Findings (cont.)

Schools should have a confidentiality contract signed by the counselor and student.

Programs outside of the classroom make you feel better about yourself, give you access to scholarships, provide opportunities for positive relationships and help reduce stress.

Students would be more likely to participate in an activity with adults (e.g. committees) if there are incentives such as: field trips, money, food, community service hours.

Students can provide a perspective on school mental health that adults cannot since they have direct experience in schools and are familiar with how things are currently.

Youth Discussion Groups: Youth Discussion Groups: Final QuestionFinal Question

“If you could tell the principal or superintendent one thing that they could do (to help students) what would it be?”

Create a safe environment where students do not feel alone and they know that are supported by teachers.

Increase awareness about mental health problems. Have more direct involvement with the students and

schools. Support the teachers. Offer more programs for students. Listen to students’ problems. Try new things.

Discussion Groups: Next StepsDiscussion Groups: Next Steps

Provide summaries to states to use in their own advocacy and capacity building efforts.

Develop cross-state case study highlighting themes of all four states (Fall 2007)

Incorporate findings from case study into school mental health capacity building process for SEA’s and LEA’s (Spring 2008)

Laura HurwitzLaura HurwitzSchool Mental Health Project School Mental Health Project

DirectorDirectorLHurwitz@nasbhc.org

202-638-5872, x2051-888-286-8727 - toll free

Bringing Health Care to Schools for Student Success