School Mental Health Perspectives School Mental Health Perspectives from Baltimore and Beyondfrom Baltimore and Beyond

Mark D. WeistMark D. WeistCenter for School Mental Health Analysis Center for School Mental Health Analysis

and Action, University of Maryland and Action, University of Maryland October, 2005October, 2005

OutlineOutline

The Baltimore ExperienceThe Baltimore Experience

Needs of Youth and Reasons for School Needs of Youth and Reasons for School Mental HealthMental Health

A Public Mental Health Promotion ApproachA Public Mental Health Promotion Approach

Empowering EducatorsEmpowering Educators

An Emerging Advocacy AgendaAn Emerging Advocacy Agenda

BaltimoreBaltimore

A city of around 600,000 growing againA city of around 600,000 growing againSignificant sociodemographic challengesSignificant sociodemographic challengesCollaborative relations between committed child Collaborative relations between committed child system leaders system leaders Vigorous non-acceptance of Vigorous non-acceptance of Same Old Same OldSame Old Same OldHistory in school healthHistory in school healthFunding experience and perseveranceFunding experience and perseveranceInterdisciplinary networksInterdisciplinary networksPolitical will and activismPolitical will and activism

School Mental Health ProgramSchool Mental Health Program

Established in 1989 in 4 schoolsEstablished in 1989 in 4 schools

Currently operating in 30 schoolsCurrently operating in 30 schools

Annual budget of around $1.1 million Annual budget of around $1.1 million ($800,000 contracts; $300,000 fee-for-service)($800,000 contracts; $300,000 fee-for-service)

Interdisciplinary group of about 30 staffInterdisciplinary group of about 30 staff

SMHP – 10 Program QualitiesSMHP – 10 Program Qualities

We build from the access advantageWe build from the access advantage

We strive to be viewed as from the schoolWe strive to be viewed as from the school

Families, youth and other stakeholders guide the Families, youth and other stakeholders guide the programprogram

A proactive, energetic approach is takenA proactive, energetic approach is taken

A full range of services is providedA full range of services is provided

10 Program Qualities (cont.)10 Program Qualities (cont.)

Continuous quality improvement is emphasizedContinuous quality improvement is emphasizedWe help to build school-community partnershipsWe help to build school-community partnershipsWe’re careful about diagnoses, and focus on strengths We’re careful about diagnoses, and focus on strengths and environmental interventionsand environmental interventionsWe are truly interdisciplinaryWe are truly interdisciplinaryWe strive for services to be developmentally and We strive for services to be developmentally and culturally relevant and based on evidence of positive culturally relevant and based on evidence of positive impactimpact

Center for School Mental Health Center for School Mental Health Analysis and ActionAnalysis and Action

CSMHACSMHA

Established in 1995 with a grant from the Established in 1995 with a grant from the Health Resources and Services Administration Health Resources and Services Administration (HRSA)(HRSA)Renewed 5-year funding in 2000 from HRSA, Renewed 5-year funding in 2000 from HRSA, with co-funding from the Substance Abuse and with co-funding from the Substance Abuse and Mental Service Administration (SAMHSA)Mental Service Administration (SAMHSA)Renewed 5-year funding in 2005 from HRSA Renewed 5-year funding in 2005 from HRSA and SAMHSA with a focus on policy analysis and SAMHSA with a focus on policy analysis and disseminationand dissemination

Needs of Youth and Reasons for Needs of Youth and Reasons for School Mental HealthSchool Mental Health

The Crisis of Youth Mental Health The Crisis of Youth Mental Health in the U.S.in the U.S.

About 20% of youth, ages 9 to 17 (15 million), About 20% of youth, ages 9 to 17 (15 million), have diagnosable mental health disorders, (and have diagnosable mental health disorders, (and manymany more are at risk or could benefit from help) more are at risk or could benefit from help)

Between 9-13% of youth, ages 9-17 years, meet Between 9-13% of youth, ages 9-17 years, meet the federal definition of serious emotional the federal definition of serious emotional disturbance (SED)disturbance (SED)

The Crisis of Youth Mental Health in The Crisis of Youth Mental Health in the U.S. (cont.)the U.S. (cont.)

Less than 30% of youth with diagnoses receive Less than 30% of youth with diagnoses receive any services, and these services are often any services, and these services are often inadequateinadequateFor the small percentage of youth who do receive For the small percentage of youth who do receive services, most actually receive them in schoolsservices, most actually receive them in schools

Growing Focus on School Mental Growing Focus on School Mental Health (SMH) in the U.S.Health (SMH) in the U.S.

U.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)Report (2003)

Mandates of “No Child Left Behind” and Individuals Mandates of “No Child Left Behind” and Individuals with Disabilities Education Act (IDEA)with Disabilities Education Act (IDEA)

Progress in localities and statesProgress in localities and states

Collaborative research-practice-training networksCollaborative research-practice-training networks

President’s New Freedom InitiativePresident’s New Freedom Initiative

First presidential commission on mental health First presidential commission on mental health since 1978since 1978

Widely disseminated document: Widely disseminated document: Achieving the Achieving the Promise: Transforming Mental Health Care in Promise: Transforming Mental Health Care in America America (see www.mentalhealthcommission.gov)(see www.mentalhealthcommission.gov)

6 goals, 19 recommendations6 goals, 19 recommendations

Impact expected to last for “decades”Impact expected to last for “decades”

President’s New Freedom President’s New Freedom Commission (cont.)Commission (cont.)

Goal 4: Early Mental Health Screening, Assessment and Goal 4: Early Mental Health Screening, Assessment and Referral to Services are Common PracticeReferral to Services are Common Practice

4.1 Promote the mental health of young children4.1 Promote the mental health of young children4.2 Improve and expand school mental health 4.2 Improve and expand school mental health programsprograms4.3 Screen for co-occurring mental and substance 4.3 Screen for co-occurring mental and substance

abuse disorders and link with integrated treatment abuse disorders and link with integrated treatment strategiesstrategies4.4 Screen for mental disorders across the lifespan 4.4 Screen for mental disorders across the lifespan

and connect to treatment supportsand connect to treatment supports

In Addition to Enhanced In Addition to Enhanced Access, SMH can:Access, SMH can:

Reduce stigma for help seekingReduce stigma for help seeking

Promote generalization/maintenance of intervention Promote generalization/maintenance of intervention gainsgains

Enhance capacity for prevention/MH promotionEnhance capacity for prevention/MH promotion

Foster clinical efficiency and productivityFoster clinical efficiency and productivity

Promote a natural, ecologically grounded approach to Promote a natural, ecologically grounded approach to helping youth and familieshelping youth and families

SMH ImpactsSMH Impacts

Based on a limited knowledge base, Based on a limited knowledge base, when when done welldone well SMH programs and services are SMH programs and services are associated with:associated with:– Strong satisfaction by diverse stakeholder groupsStrong satisfaction by diverse stakeholder groups– Improvement in student emotional/behavioral Improvement in student emotional/behavioral

functioningfunctioning– Improvement in school outcomes (e.g., climate, Improvement in school outcomes (e.g., climate,

special education referrals, reduced bullying, fewer special education referrals, reduced bullying, fewer suspensions)suspensions)

Expanded School Mental Health Expanded School Mental Health (ESMH):(ESMH):

Programs join families, schools, mental health Programs join families, schools, mental health and other community systems and other community systems To develop a full array of effective programs To develop a full array of effective programs and services that improve the school and services that improve the school environment, reduce barriers to learning, and environment, reduce barriers to learning, and provide prevention, early intervention and provide prevention, early intervention and treatment treatment for youth in general and special educationfor youth in general and special education

Critical Challenges for the FieldCritical Challenges for the Field

ESMH still in a relatively small percentage of ESMH still in a relatively small percentage of schoolsschoolsEfforts remain marginalized and under-Efforts remain marginalized and under-supported (STIGMA)supported (STIGMA)Interdisciplinary and intersystem turf and Interdisciplinary and intersystem turf and tensiontensionConsiderable variability in experience Considerable variability in experience Limited community ownership of the Limited community ownership of the programsprograms

A Central ChallengeA Central Challenge

School mental health is a tenuously supported field School mental health is a tenuously supported field with efforts in most communities scattered at bestwith efforts in most communities scattered at best

Scattered, unsupported services do not lead to the Scattered, unsupported services do not lead to the achievement of critical outcomesachievement of critical outcomes

We need to build support for effective services to We need to build support for effective services to enable the documentation of enhanced outcomes, enable the documentation of enhanced outcomes, which will in turn fuel advocacy efforts and bring which will in turn fuel advocacy efforts and bring needed resources into the fieldneeded resources into the field

A Time of Great OpportunityA Time of Great Opportunity

Two plus decades of experience in ESMHTwo plus decades of experience in ESMH

Growing federal awareness and supportGrowing federal awareness and support

Many communities showing strong leadershipMany communities showing strong leadership

Development of organized national and state Development of organized national and state networksnetworks

Increasing international discussion and Increasing international discussion and attention (see attention (see www.intercamhs.orgwww.intercamhs.org))

A Public Mental Health A Public Mental Health Promotion ApproachPromotion Approach

Factors Necessary to Achieve Desired Factors Necessary to Achieve Desired Outcomes for Youth Through ESMH Programs Outcomes for Youth Through ESMH Programs and Servicesand Services (Weist, Paternite & Adelsheim, 2005)(Weist, Paternite & Adelsheim, 2005)

Effective mental health promotion, problem preventionand intervention

Outstanding staff and program qualitiesOngoing training, technical assistance & support

School and community buy-in and investment

Awareness raising, public policy advocacy and improvement,coalition building, systems-level change, and resource commitment

““Enhancing Quality in Expanded Enhancing Quality in Expanded School Mental Health”School Mental Health”

Three year, three state (Delaware, Maryland, Three year, three state (Delaware, Maryland, Texas) study seeking to implement and Texas) study seeking to implement and evaluate a framework for systematic quality evaluate a framework for systematic quality assessment and improvement in school mental assessment and improvement in school mental healthhealth

Funded by the National Institute of Mental Funded by the National Institute of Mental Health (2003-2006)Health (2003-2006)

Principles for Best Practice in Principles for Best Practice in Expanded School Mental HealthExpanded School Mental Health

1) All youth and families are able to access 1) All youth and families are able to access appropriate care regardless of their ability to payappropriate care regardless of their ability to pay

2) Programs are implemented to address needs 2) Programs are implemented to address needs and strengthen assets for students, families, and strengthen assets for students, families, schools, and communitiesschools, and communities

3) Programs and services focus on reducing 3) Programs and services focus on reducing barriers to development and learning, are student barriers to development and learning, are student and family friendly, and are based on evidence of and family friendly, and are based on evidence of positive impactpositive impact

Principles (cont.)Principles (cont.)

4) Students, families, teachers and other important 4) Students, families, teachers and other important groups are actively involved in the program's groups are actively involved in the program's development, oversight, evaluation, and development, oversight, evaluation, and continuous improvementcontinuous improvement 5) Quality assessment and improvement activities 5) Quality assessment and improvement activities continually guide and provide feedback to the continually guide and provide feedback to the programprogram 6) A continuum of care is provided, including 6) A continuum of care is provided, including school-wide mental health promotion, early school-wide mental health promotion, early intervention, and treatmentintervention, and treatment

Principles (cont.)Principles (cont.)

7) Staff hold to high ethical standards, are 7) Staff hold to high ethical standards, are committed to children, adolescents, and committed to children, adolescents, and families, and display an energetic, flexible, families, and display an energetic, flexible, responsive and proactive style in delivering responsive and proactive style in delivering servicesservices 8) Staff are respectful of, and competently 8) Staff are respectful of, and competently address developmental, cultural, and address developmental, cultural, and personal differences among students, personal differences among students, families and stafffamilies and staff

Principles (cont.)Principles (cont.)

9) Staff build and maintain strong 9) Staff build and maintain strong relationships with other mental health and relationships with other mental health and health providers and educators in the health providers and educators in the school, and a theme of interdisciplinary school, and a theme of interdisciplinary collaboration characterizes all effortscollaboration characterizes all efforts

10) Mental health programs in the school 10) Mental health programs in the school are coordinated with related programs in are coordinated with related programs in other community settingsother community settings

Integrated Systems to Support the Integrated Systems to Support the Development of All ChildrenDevelopment of All Children

Systems of Prevention and PromotionSystems of Prevention and Promotion All Students (universal)All Students (universal)

Systems of Early InterventionSystems of Early InterventionStudents At-Risk (selected)Students At-Risk (selected)

Systems of TreatmentSystems of Treatment

Students with ProblemsStudents with Problems (indicated)(indicated)

School, Family, and Community PartnershipsSchool, Family, and Community Partnerships

From: Zins (in progress).

Importance of Family PartnershipsImportance of Family Partnerships

SEARCH Institute study:SEARCH Institute study:– As parental involvement in schools increased, As parental involvement in schools increased,

problem behaviors in students (alcohol use, problem behaviors in students (alcohol use, violence, antisocial problems) decreasedviolence, antisocial problems) decreased

– Roehlkepartain & Benson, 1994Roehlkepartain & Benson, 1994

Barriers to Family PartnershipsBarriers to Family Partnerships

Service availabilityService availability

StigmaStigma

Fear of being blamedFear of being blamed

Feeling unwelcome in the schoolFeeling unwelcome in the school

Fear of violated confidentialityFear of violated confidentiality

Perceived lack of mutualityPerceived lack of mutuality

Traditional ApproachTraditional Approach

““In the past, families were seen primarily as In the past, families were seen primarily as contributing to the mental health problems of contributing to the mental health problems of their children, and their ONLY ROLE was in their children, and their ONLY ROLE was in treatment to alter their structure and/or treatment to alter their structure and/or functioning” (Osher, 2001)functioning” (Osher, 2001)

Best ApproachBest Approach

““The model of therapist as expert is replaced The model of therapist as expert is replaced by a shared-learner framework in which both by a shared-learner framework in which both parties (family member and clinician) parties (family member and clinician) contribute knowledge and insight” (Axelrod et contribute knowledge and insight” (Axelrod et al., 2003)al., 2003)

Key Processes in Working with Key Processes in Working with FamiliesFamilies

EngagementEngagement

EmpowermentEmpowerment

SupportSupport

CollaborationCollaboration

EngagementEngagement

In initial family contacts:In initial family contacts:– Clarify child’s need for servicesClarify child’s need for services

– Openly discuss attitudes and past experiences with the Openly discuss attitudes and past experiences with the mental health systemmental health system

– Identify and strategize about probable obstaclesIdentify and strategize about probable obstacles

– Identify concrete, practical issues that can be addressed Identify concrete, practical issues that can be addressed immediatelyimmediately

– Establish communications systems to promote continuity Establish communications systems to promote continuity and stability in services (see McKay, Nudelman, & and stability in services (see McKay, Nudelman, & McCadam, 1996)McCadam, 1996)

EmpowermentEmpowerment

Reduce perceived barriers to successful outcomesReduce perceived barriers to successful outcomesDevelop realistic and optimistic goals for treatmentDevelop realistic and optimistic goals for treatmentProvide or provide access to relevant informationProvide or provide access to relevant informationEnsure collaborative decision making and parental Ensure collaborative decision making and parental choicechoiceEncourage involvement in relevant organizations and Encourage involvement in relevant organizations and in advocacyin advocacy

SupportSupport

Connect families to needed resourcesConnect families to needed resources

Together consider sources of support within Together consider sources of support within the family, neighborhood and community, and the family, neighborhood and community, and at state and national levelsat state and national levels

Be encouraging and optimistic in all Be encouraging and optimistic in all interactionsinteractions

CollaborationCollaboration

Involve family members as equal partners in Involve family members as equal partners in understanding problems and in developing and understanding problems and in developing and implementing interventions to address targeted implementing interventions to address targeted problemsproblems

On an ongoing basis request feedback from families On an ongoing basis request feedback from families about how you are doing, how the program is doing, about how you are doing, how the program is doing, and how the community is doing in responding to the and how the community is doing in responding to the needs of children, asking for their recommendationsneeds of children, asking for their recommendations

An Excellent Overview Article:An Excellent Overview Article:

Hoagwood, K.E. (2005). Family-based services in children’s mental health: A Hoagwood, K.E. (2005). Family-based services in children’s mental health: A research review and synthesis. research review and synthesis. Journal of Child Psychology and Journal of Child Psychology and Psychiatry, 46Psychiatry, 46(7), 690-713.(7), 690-713.

Deciding on Roles in a SchoolDeciding on Roles in a School(no stereotyping intended)(no stereotyping intended)

Primary Secondary Tertiary

Sch. Psy. XOXOXO XXXXXX XX

Sch. SW. XOXOXO XXXXXX

Sch. Co. XOX0 OOO

Com. St. XO OOOOOO OOOOOOGEN.ED=O SPEC.ED=X

The Optimal School Mental Health The Optimal School Mental Health Continuum?Continuum?

10-20% Broad Environmental Improvement 10-20% Broad Environmental Improvement and Mental Health Promotion (CHANGE and Mental Health Promotion (CHANGE AGENT ROLE)AGENT ROLE)

50-60% Prevention and Early Intervention 50-60% Prevention and Early Intervention (PREVENTION SPECIALIST ROLE)(PREVENTION SPECIALIST ROLE)

20-30% Intensive Assessment and Treatment 20-30% Intensive Assessment and Treatment (THERAPIST ROLE)(THERAPIST ROLE)

Change Agent ActivitiesChange Agent Activities

Promote positive relationships in the schoolPromote positive relationships in the school

Participate on school planning teamsParticipate on school planning teams

Assist in mapping and coordinating various Assist in mapping and coordinating various programs and services programs and services

Assist in bringing resources into the schoolAssist in bringing resources into the school

Help to improve the environmentHelp to improve the environment

Strategies for Environmental Strategies for Environmental ImprovementImprovement

Assess the school climate; problem solve with Assess the school climate; problem solve with peers and families and students on strategies peers and families and students on strategies for improvementfor improvementUse the Assets framework to promote staff-Use the Assets framework to promote staff-student engagement and positive relationshipsstudent engagement and positive relationshipsAssist in ensuring school safetyAssist in ensuring school safetyAssist in bringing in resources (e.g., mentoring Assist in bringing in resources (e.g., mentoring programs, community members as hall programs, community members as hall leaders)leaders)

WHO 2003: Psychosocial WHO 2003: Psychosocial Environment (PSE) ProfileEnvironment (PSE) Profile

Friendly, rewarding and Friendly, rewarding and supportive atmospheresupportive atmosphere

Supports cooperation Supports cooperation and active learningand active learning

Forbids physical Forbids physical punishment and punishment and violenceviolence

Does not tolerate Does not tolerate bullying/harassmentbullying/harassment

Values the development Values the development of creative activitiesof creative activities

Connects school and Connects school and home lifehome life

Promotes equal Promotes equal opportunities for opportunities for participationparticipation

Prevention Specialist ActivitiesPrevention Specialist Activities

““Triage” mental health (1-3 sessions without Triage” mental health (1-3 sessions without diagnosis)diagnosis)

Working collaboratively with educators to Working collaboratively with educators to improve classroom behaviorimprove classroom behavior

Building a theme of mental health skills as Building a theme of mental health skills as promoters of student learningpromoters of student learning

Implementing skill training groupsImplementing skill training groups

The Effective TherapistThe Effective Therapist

Feels well trained, supervised and supportedFeels well trained, supervised and supportedFeels integrated into the school(s)Feels integrated into the school(s)Is able to establish and maintain strong Is able to establish and maintain strong relationships with other staff and with students relationships with other staff and with students and familiesand familiesInteracts with families and students as Interacts with families and students as collaborators, building on their strengthscollaborators, building on their strengthsIs able to conduct an assessment in a way that Is able to conduct an assessment in a way that is therapeuticis therapeutic

The Effective Therapist (cont.)The Effective Therapist (cont.)

Is able to match delivered services to students Is able to match delivered services to students and families in a way that optimally matches and families in a way that optimally matches their presenting needs and goalstheir presenting needs and goals

Develops and implements interventions from Develops and implements interventions from the science basethe science base

Works closely with a range of people Works closely with a range of people important to the studentimportant to the student

The Effective Therapist (cont.)The Effective Therapist (cont.)

Is continually evaluating whether the current Is continually evaluating whether the current plan and services are effective, and is making plan and services are effective, and is making adjustments when indicatedadjustments when indicated

Understands and makes explicit differences in Understands and makes explicit differences in role functioning (e.g., as therapist vs. mentor)role functioning (e.g., as therapist vs. mentor)

Closes cases when problems are mostly Closes cases when problems are mostly resolved in a way that is collegial and allows resolved in a way that is collegial and allows for some ongoing contactfor some ongoing contact

Three Critical Themes in InterventionThree Critical Themes in Intervention

Reduce, help to buffer stress and riskReduce, help to buffer stress and risk

Enhance protective and resilience factorsEnhance protective and resilience factors

Train in evidence-based skillsTrain in evidence-based skills

Addressable Stress/Risk Factors Addressable Stress/Risk Factors

Family LevelFamily Level– Abuse and neglectAbuse and neglect– Criminal behaviorCriminal behavior– Substance abuseSubstance abuse– Family isolationFamily isolation– OvercrowdingOvercrowding– Emotional/behavioral problems in family membersEmotional/behavioral problems in family members– Morbidity and mortality in family membersMorbidity and mortality in family members

Addressable Protective Factors Addressable Protective Factors

Family levelFamily level– Support and nurturanceSupport and nurturance– Rituals and routinesRituals and routines– Self-control displayed and modeled by family Self-control displayed and modeled by family

membersmembers– Healthy behaviors by family membersHealthy behaviors by family members

Top Evidence-Based PracticesTop Evidence-Based Practices

• Parent praiseParent praise• Cognitive copingCognitive coping• Parent psycho-educationParent psycho-education• ModelingModeling• Problem solvingProblem solving• Skill building/behavioral rehearsalSkill building/behavioral rehearsal• Maintenance/relapse preventionMaintenance/relapse prevention• Tangible rewardsTangible rewards

See. Bruce Chorpita, and Evidence Based Services See. Bruce Chorpita, and Evidence Based Services Committee (2004). Biennial report: Summary of effective Committee (2004). Biennial report: Summary of effective interventions for youth with behavioral and emotional needs. interventions for youth with behavioral and emotional needs. Hawaii Department of Health, Child and Adolescent Mental Hawaii Department of Health, Child and Adolescent Mental Health Division. Health Division.

Life TrajectoriesLife Trajectories

SchoolSchoolOn timeOn timePay Pay attentionattentionDo work Do work studystudy

HealtHealthhExerciseExerciseNutritionNutritionSleepSleepAthleticsAthletics

Positive Positive FriendsFriends

Faith/Faith/ChurchChurch

Having Having GoalsGoals

Support from Positive Support from Positive AdultsAdults

Thinking SkillsThinking SkillsHelping Helping OthersOthers

A thousand A thousand possible future possible future lives depending lives depending on the daily on the daily choices you makechoices you make

Age Age 1515

BirthBirth

Age Age 2525

Age Age 2525

Great wife, kids, job, house, car

Jail, sickness, addiction,

death

Roaming the Roaming the hallshalls

Not doing Not doing school workschool work

Alcohol and Alcohol and drug usedrug use

Wrong Wrong friendsfriends

Skipping Skipping schoolschool

Being in the Being in the wrong placeswrong places

Exposure to Exposure to violenceviolence

Violent Violent mediamedia

Empowering EducatorsEmpowering Educators

Teachers are the “De Facto” providers Teachers are the “De Facto” providers of mental health to youth in the U.S.of mental health to youth in the U.S.

This fact needs acknowledgement in local, This fact needs acknowledgement in local, state, and national policystate, and national policy

There is a significant need to empower There is a significant need to empower teachers to fulfill this critical roleteachers to fulfill this critical role

Mental Health Education Integration Mental Health Education Integration Consortium (MHEDIC)Consortium (MHEDIC)

Working to improve interdisciplinary training Working to improve interdisciplinary training and collaboration between educators and and collaboration between educators and mental health staffmental health staff

Making recommendations to address Making recommendations to address limitations in training for both groupslimitations in training for both groups

Mental health training for educators should be Mental health training for educators should be based on “backward analysis” of needs based on “backward analysis” of needs presenting in classroomspresenting in classrooms

MHEDIC (cont.)MHEDIC (cont.)

Key mental health skills for teachers:Key mental health skills for teachers:– Identifying emotional/behavioral problems within Identifying emotional/behavioral problems within

studentsstudents– Referring students with emotional/behavioral Referring students with emotional/behavioral

problems for assistanceproblems for assistance– Promoting positive classroom behaviorPromoting positive classroom behavior– Using mental health concepts to promote learningUsing mental health concepts to promote learning

Mental Health Concepts that Promote Mental Health Concepts that Promote LearningLearning

Self-instruction (e.g., developing an internal Self-instruction (e.g., developing an internal dialogue)dialogue)

Problem solving (e.g., considering costs and Problem solving (e.g., considering costs and benefits of actions)benefits of actions)

Self-control and–reinforcement (e.g., work Self-control and–reinforcement (e.g., work before play)before play)

Template matching (e.g., modeling actions of Template matching (e.g., modeling actions of B+ students)B+ students)

Ten Variables that Affect ComplianceTen Variables that Affect Compliance

Make direct requestsMake direct requestsMake specific requests from shorter distances in soft Make specific requests from shorter distances in soft but firm voicebut firm voiceMake eye contactMake eye contactLimit to two requestsLimit to two requestsGive child 3-5 seconds to comply (without speaking)Give child 3-5 seconds to comply (without speaking)Make more start vs. stop requestsMake more start vs. stop requestsControl negative emotionsControl negative emotionsReinforce complianceReinforce compliance

Levels of Crisis DevelopmentLevels of Crisis Development

Anxiety: muttering, excessive movement, pacing, Anxiety: muttering, excessive movement, pacing, vacant, or withdrawnvacant, or withdrawn

Staff Response: SupportiveStaff Response: Supportive– EmpathicEmpathic– Active listeningActive listening– Avoid being judgmentalAvoid being judgmental

Most potentially explosive situations diffused at Most potentially explosive situations diffused at this levelthis level

An Emerging Advocacy AgendaAn Emerging Advocacy Agenda

The Need for Advocacy TrainingThe Need for Advocacy Training

Most people in most child serving systems Most people in most child serving systems have little or no training in effective advocacyhave little or no training in effective advocacy

Advocacy Involves:Advocacy Involves:

Bringing diverse people together around a Bringing diverse people together around a common themecommon themeUnderstanding the lay of the land in terms of Understanding the lay of the land in terms of the problem and existing efforts to address itthe problem and existing efforts to address itDeveloping an idea that works betterDeveloping an idea that works betterIncreasing support for the idea and refining itIncreasing support for the idea and refining itFacilitating the translation of the idea into Facilitating the translation of the idea into policy and practice change with necessary policy and practice change with necessary resource/system enhancementsresource/system enhancements

Barriers to Support of ESMHBarriers to Support of ESMH

Concerns about: Concerns about: – confidentiality/ privacyconfidentiality/ privacy– competition for resourcescompetition for resources– effectivenesseffectiveness– appropriatenessappropriateness

Myths about School Mental HealthMyths about School Mental Health

““Manipulating children’s minds”Manipulating children’s minds”

Teaching “new age” conceptsTeaching “new age” concepts

Compromising family valuesCompromising family values

Providing services without parental approval and Providing services without parental approval and parental consentparental consent

Stigma is HugeStigma is Huge

Being called “crazy” is about the worst thing Being called “crazy” is about the worst thing you could be calledyou could be called

Stigma accounts for significant utilization Stigma accounts for significant utilization problemsproblems

Knowledge removes stigmaKnowledge removes stigma

Addressing StigmaAddressing Stigma

MESSAGESMESSAGES

Mental health is a positive concept, conveying Mental health is a positive concept, conveying positive thoughts, feelings and actions that positive thoughts, feelings and actions that contribute to success in lifecontribute to success in life

Mental health problems are universal. We all Mental health problems are universal. We all have at some point in our liveshave at some point in our lives

Seeking mental health assistance is a sign of Seeking mental health assistance is a sign of strengthstrength

Addressing Stigma (cont.)Addressing Stigma (cont.)

ACTIONSACTIONSConduct education for students, families and Conduct education for students, families and staff, conveying messages of previous slidestaff, conveying messages of previous slideAppropriately self-discloseAppropriately self-discloseRespect family and student privacy and Respect family and student privacy and confidentialityconfidentialityEmpower some students and families to show Empower some students and families to show their support for the school’s mental health their support for the school’s mental health effortsefforts

Toward Funding for a Full Continuum of Toward Funding for a Full Continuum of Programs and ServicesPrograms and Services

Maximizing all potential sources of revenue:Maximizing all potential sources of revenue:– allocations from schools and departments of allocations from schools and departments of

educationeducation– state and local grants and contractsstate and local grants and contracts– federal and foundation grants and contractsfederal and foundation grants and contracts– ““line item” supportline item” support– innovative prevention fundinginnovative prevention funding– fee-for-servicefee-for-service

The Critical Challenge of FederalismThe Critical Challenge of Federalism

State of residence determines whether youth use State of residence determines whether youth use mental health more than race/ethnicity or incomemental health more than race/ethnicity or income

Differences in mental health use by children across Differences in mental health use by children across states are generally not related to differences in levels states are generally not related to differences in levels of need (e.g. AL and TX present higher rates of need of need (e.g. AL and TX present higher rates of need but lower rates of use)but lower rates of use)– Sturm, Ringel & Andreyeva, 2003 (www.pediatrics.org)Sturm, Ringel & Andreyeva, 2003 (www.pediatrics.org)

To help Ohio’s school districts, community-based agencies, and families work together to achieve improved educational and developmental outcomes for all children — especially those at emotional or behavioral risk and those with mental health problems.

Mission

22ndnd Community Building Forum and 10 Community Building Forum and 10thth Annual Conference on Advancing School Annual Conference on Advancing School

Mental HealthMental HealthFederal funders, HRSA, SAMHSA, OSEPFederal funders, HRSA, SAMHSA, OSEP

Major Partners: IDEA Partnership, NASDSE, Major Partners: IDEA Partnership, NASDSE, CSMHA, Ohio Mental Health Network for School CSMHA, Ohio Mental Health Network for School SuccessSuccess

Cleveland Ohio, October 26 (Forum) – 29, 2005Cleveland Ohio, October 26 (Forum) – 29, 2005

Come to Cleveland, the City that Rocks!!Come to Cleveland, the City that Rocks!!

See See http://csmha.umaryland.eduhttp://csmha.umaryland.edu or contact Christina or contact Christina at at chuntley@psych.umaryland.educhuntley@psych.umaryland.edu

INTERCAMHSINTERCAMHSInternational Alliance for Child andInternational Alliance for Child and

Adolescent Mental Health and SchoolsAdolescent Mental Health and Schools

www.intercamhs.org

UCLA Center for Mental UCLA Center for Mental Health in SchoolsHealth in Schools

Directed by Howard Adelman and Linda Directed by Howard Adelman and Linda TaylorTaylor

Phone: 310-825-3634Phone: 310-825-3634

Enews: listserv@listserv.ucla.eduEnews: listserv@listserv.ucla.edu

web: http://smhp.psych.ucla.eduweb: http://smhp.psych.ucla.edu