Strengthening Partnerships for School Mental Health Services in the United States

1
Strengthening Partnerships for School Mental
Health Services in theUnited States

• Carl E. Paternite
• Center for School-Based Mental Health Programs
• Miami University (Ohio)
• Mark Weist
• Center for School Mental Health Assistance
• University of Maryland
• Presentation at the Clifford Beers Foundation
  Conference
• Mental Health PromotionGoing from Strength to
  Strength
• Dublin, Ireland
• April 21, 2005

2
The Crisis of Youth Mental Health in the U.S.

• About 20 of youth, ages 9 to 17 (15 million),
  have diagnosable mental health disorders, (and
  many more are at risk or could benefit from help)
• Between 9-13 of youth, ages 9-17 years, meet the
  federal definition of serious emotional
  disturbance (SED)

3
The Crisis of Youth Mental Health in the U.S.
(cont.)

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

4
Growing Focus on School Mental Health (SMH) in
the U.S.

• U.S. Surgeon General Reports (1999, 2000)
• Presidents New Freedom Commission on Mental
  Health Report (2003)
• Mandates of No Child Left Behind and
  Individuals with Disabilities Education Act
  (IDEA)
• Progress in localities and states
• Collaborative research-practice-training networks

5
Report of Presidents New Freedom Commission on
Mental Healthhttp//www.mentalhealthcommission.go
v

• the mental health delivery system is fragmented
  and in disarrayleading to unnecessary and costly
  disability, homelessness, school failure and
  incarceration

6
New Freedom Commission Goal 4 Early Mental
Health Screening, Assessment, and Referral to
Services are Common Practice

4.1 Promote the mental health of young
children 4.2 Improve and expand school mental
health programs 4.3 and 4.4 (both focus on
enhancing mental health screening)
7
New Freedom Commission

• Critical importance of partnership with schools
• in mental health care
• While schools are primarily concerned with
  education, mental health is essential to learning
  as well as to social and emotional development.
  Because of this important interplay between
  emotional health and school success, schools must
  be partners in the mental health care of our
  children.
• July, 2003, p. 58

8
Education Policies in the U.S.

• 1) Achievement promotes wellbeing
• 2) Wellbeing promotes achievement
• School accountabilities often acknowledge 1 but
• fail to acknowledge 2

9
Schools The Most Universal Natural Setting

• Over 52 million youth attend 114,000 schools in
  the U.S.
• Over 6 million adults work in schools
• Combining students and staff, one-fifth of the
  U.S. population can be found in schools
• From New Freedom Commission (2003)

10
In Addition to Enhanced Access, SMH can

• Reduce stigma for help seeking
• Promote generalization/maintenance of
  intervention gains
• Enhance capacity for prevention/MH promotion
• Foster clinical efficiency and productivity
• Promote a natural, ecologically grounded approach
  to helping youth and families

11
SMH Impacts

• Based on a limited knowledge base, when done well
  SMH programs and services are associated with
• Strong satisfaction by diverse stakeholder groups
• Improvement in student emotional/behavioral
  functioning
• Improvement in school outcomes (e.g., climate,
  special education referrals, reduced bullying,
  fewer suspensions)

12
SMH Impacts (contd)

• When done well SMH programs and services also can
  play a role in
• Preventing and addressing the impacts of violence
  on youth
• Reducing/preventing school drop-out
• Enhancing student connectedness to school

13
Factors Necessary to Achieve Desired Outcomes
for Youth Through SMH Programs and Services
14
Critical Themes in SMH
15
Need for Conceptual Clarity

• School mental health is a very broad term
• All schools are delivering some form of SMH
• With a vague definition it is difficult to track
  progress and develop advocacy

16
Expanded School Mental Health

• Full continuum of mental health promotion, early
  intervention, prevention and treatment
• For youth in general and special education
• Through collaborative school-community
  partnerships
• (Emphasis on quality, evidence-based practices,
  ongoing evaluation)

17
Service Capacity

• Schools and SMH programs typically struggle to
  meet the needs of students
• Excessive referrals for students with serious
  problems and crises
• Full continuum of MH promotion-prevention-treatmen
  t services is rarely provided
• Schools and communities reluctant to undertake
  systematic MH screening for youth

18
Preventive Services andMH Promotion

• In spite of best intentions, drift toward
  individual services for students with
  severe/chronic problems
• Reflects fundamental bias in U.S. toward mental
  health problems presumed to reside within
  individuals
• WHO model of health promoting schools is inverted
  in the U.S.
• International dialogue is of great benefit to
  U.S. experience

19
Mental Health-Education Systems Integration

• Typically, SMH programs/staff viewed by educators
  to be add ons or frills, not central to the
  academic mission
• Need to move beyond cooperation to MH-Education
  program and systems integration, with close
  collaborative work based on shared values and
  goals

20
To Promote Integration Should Ensure

• Strong family-school-MH collaboration in SMH
  program planning
• That SMH providers understand school culture and
  how to work as collaborative team players
• That SMH practices are of high quality and
  effective
• A connection between SMH programs and services
  and reducing barriers to learning

21
Pre-Service/In-Service Training Needs for
Educators and SMH Staff

• In Addition to Parents, Teachers are on the
  Mental Health Front Line
• Yet, teachers/educators are very poorly trained
  in problem recognition and mental health
  promotion
• Significant need to enhance teacher/educator
  training based on analysis of issues confronted
  in the classroom/school

22
Mental Health Concepts that Promote Learning

• Self-instruction (e.g., developing an internal
  dialogue)
• Problem solving (e.g., considering costs and
  benefits of actions)
• Self-control andreinforcement (e.g., work before
  play)
• Template matching (e.g., modeling actions of B
  students)

23
SMH Research Base

• Is fairly limited
• Most of literature is on research-supported
  studies
• Significant challenges in promoting
  evidence-based practices in schools that are
  operating without formal research support

24
Community Science Approach (Wandersman, 2003)

• Promotes local accountability in community
  delivery processes
• Engages practitioners (MH, education) in
  planning, implementing, evaluating, sustaining,
  and continuously improving services, based on
  locally determined needs
• Process builds local capacity to improve quality
  of practice and achieve positive health outcomes

25
Enhancing Quality in Expanded School Mental Health

• Randomized controlled study to assess impacts of
  systematic quality improvement on clinician
  behavior, satisfaction with services, and student
  outcomes
• First experimental study of quality improvement
  in school mental health
• Will provide guidelines for best practice and
  will help to standardize practice
• (Project 1R01 MH71015-01A1, NIMH, 2003-2006
  PI M. Weist, University of Maryland)

26
Principles for Best Practice in Expanded School
Mental Health

• 1) All youth and families are able to access
  appropriate care regardless of their ability to
  pay
• 2) Programs are implemented to address needs and
  strengthen assets for students, families,
  schools, and communities
• 3) Programs and services focus on reducing
  barriers to development and learning, are student
  and family friendly, and are based on evidence of
  positive impact

27
Principles (cont.)

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

28
Principles (cont.)

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

29
Principles (cont.)

• 9) Staff build and maintain strong relationships
  with other mental health and health providers and
  educators in the school, and a theme of
  interdisciplinary collaboration characterizes all
  efforts
• 10) Mental health programs in the school are
  coordinated with related programs in other
  community settings

30
Importance of Family Involvement

• SEARCH Institute study
• As parental involvement in schools increased,
  problem behaviors in students (alcohol use,
  violence, antisocial problems) decreased
• Roehlkepartain Benson, 1994

31
Engaging Families is a Key

• In initial family contacts
• Clarify childs need for services
• Openly discuss attitudes and past experiences
  with the mental health system
• Identify and strategize about probable obstacles
• Identify concrete, practical issues that can be
  addressed immediately (McKay, Nudelman,
  McCadam, 1996)

32
Toward Funding for a Full Continuum of Programs
and Services

• Maximizing all potential sources of revenue
• allocations from schools and departments of
  education
• state and local grants and contracts
• federal and foundation grants and contracts
• line item support
• innovative prevention funding
• fee-for-service

33
The Significant Impacts of Federalism

• State of residence determines whether youth use
  mental health more than race/ethnicity or income
• Differences in mental health use by children
  across states are generally not related to
  differences in levels of need (e.g. AL and TX
  present higher rates of need but lower rates of
  use)
• Sturm, Ringel Andreyeva, 2003
  (www.pediatrics.org)

34
Ohio Mental Health Network for School Success

• Regional action networks for mental health in
  schools
• Networks raise awareness, develop resources,
  offer TA, do training within and across sites
• Newsletter and regular publication on progress
• Genuine cost sharing across major systems
• Strong partnerships with universities and
  development of centers of excellence

35
Actions to Advance SMH in the U.S.
36
For True Progress in SMH

• Widespread acknowledgement of the marginalized
  status of child and school mental health
  resources and efforts
• Recommendations from policy initiatives (e.g.,
  Surgeon General, New Freedom Commission) broadly
  publicized and implemented

37
For True Progress in SMH

• Nation-to-state infrastructure and plan that
  addresses significant local variability
• Organized state-level initiatives and mechanisms
  for state to state collaboration with national
  support
• Track and support effort in all localities

38
For True Progress in SMH

• Debunk the view of SMH as an add-on or frill
  and assert the crucial links between MH and
  school success
• Confront and resolve language issues
• Promote MH system attention to educationally
  relevant outcomes
• Build a comprehensive research agenda
• Promote international dialogue

39
INTERCAMHSInternational Alliance for Child
andAdolescent Mental Health and Schools
www.intercamhs.org
40
CSMHA Training Events

• School Health Interdisciplinary Program (SHIP).
  Turf Valley Country Club, Ellicott City,
  Maryland. August 1-4, 2005
• 10th Annual Conference on Advancing School-Based
  Mental Health. Cleveland Renaissance Hotel,
  October 26-29, 2005
• See http//csmha.umaryland.edu, or Sylvia Huntley
  at shuntley_at_psych.umaryland.edu