Teachers as Partners in Effective School-Based Mental Health Programs

Therese C. Johnston, Ph.D.

Carl E. Paternite, Ph.D.

Ohio Mental Health Network for School Success

Introductions

Carl Paternite, Ph.D.

Department of Psychology Miami University Oxford, Ohio 45056 [email protected]

Johnston & Paternite, OMHNSS 2

Introductions

Terri Johnston, Ph.D.

Educator Consultant Behavior Consultant [email protected]

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Background and Context

• Most youth in need of MH intervention don’t receive it • Of the small percentage that do the majority receive treatment within a school setting (Rones & Hoagwood, 2000) Johnston & Paternite, OMHNSS 4

Background and Context

• Service realities – Reliance on primary care medical settings – Community mental health clinics – Private practitioners Johnston & Paternite, OMHNSS 5

Background and Context

• Historically, school services focused on special education population • Emphasized individual assessment and intervention Johnston & Paternite, OMHNSS 6

Historical Relationship

• Teachers seen as information source • Teachers often perceived as untrained and unreceptive to consultation from MH provider Johnston & Paternite, OMHNSS 7

Educators vs. Therapists

• Sedlak (1997) discussed the uneasy alliance between service providers and schools • Mental health staff (e.g., social workers, psychologists, counselors, etc.) seen as “frills” not essential to the academic mission of schools Johnston & Paternite, OMHNSS 8

Educators vs. Therapists

• MH Provider Goals – Focused on the individual – Social/emotional goals considered to be not related to academic success – Therapeutic interventions occur in private “pull-out” sessions – Confidentiality sited as reasons not to inform teachers of progress Johnston & Paternite, OMHNSS 9

Educators vs. Therapists

• Teacher Goals – Focused on the group rather than the individual – Academic achievement mandated as primary concern – Feel unprepared to face the emotional demands of ever-changing population Johnston & Paternite, OMHNSS 10

Cooperation vs. Integration

• Many so called school-based programs

co exist

in the buildings • Rarely are mental health staff and educators actually working together identifying and sharing – Values – Goals – Strategies Johnston & Paternite, OMHNSS 11

The Role of Schools

• Can’t be responsible for meeting the all the needs • Must meet then challenges when needs directly affect learning and school success (Carnegie Council Task Force on Education of Young Adolescents, 1989; Elias, Zins, Graczyk, & Weissberg, 2003) Johnston & Paternite, OMHNSS 12

The Role of Schools

• Compelling evidence – Positive associations between mental health and academic success – Emotional, social, and behavioral health problems are significant barriers to learning (Adelman & Taylor, 1999; Atkins, Frazzier, Adil & Talbott, 2003) Johnston & Paternite, OMHNSS 13

Partnership is Critical

• Public schools’ mission is to educate all students • Students with challenges of SED have the highest rates of school failure – 50% drop out compared to 30% for students with other disabilities • Mental health is essential to learning as well as social and emotional development • The interplay between emotional health and school success indicates schools must be partners President’s New Freedom Commission on Mental Health

Achieving the Promise: Transforming Mental Health Care in America (

2003) Johnston & Paternite, OMHNSS 14

Essential Attitudes for Collaboration

• Providers should view educators as valued customers • Focus should explicitly be on MH barriers to schools success Johnston & Paternite, OMHNSS 15

Essential Attitudes for Collaboration

• Educators should be viewed as… – valued colleagues – Essential members of the mental health team Johnston & Paternite, OMHNSS 16

Cognitive Dissonance

• “Equal standing”??????

• Mental health hierarchies – Expert vs. consultee Johnston & Paternite, OMHNSS 17

Teachers Lack Confidence

• Feel ill prepared to design or support interventions for students with psychiatric disorders even when primary disability is attributed to emotional or behavior problems (Maag, 2002) Johnston & Paternite, OMHNSS 18

Student Support

• Educators rarely know anything about mental health services students are receiving nor the nature or intensity of the services • Teachers who are engaged with students day after day play central roles in facilitating social and emotional learning Johnston & Paternite, OMHNSS 19

Student Support

• Important collaboration could include – Assistance and consultation with social skill instruction IN THE CLASSROOM – Development and monitoring of behavior intervention plans – Consultation with parents to encourage consistent strategies and promotion of practice and reinforcement of alternative behaviors across contexts Johnston & Paternite, OMHNSS 20

Models Fully Engaging Educators

• Positive Behavior Support • Re-Education Johnston & Paternite, OMHNSS 21

Continuum of Effective Behavior Support

Students with Chronic/Intense Problem Behavior (1 - 7%) Students At-Risk for Problem Behavior (5-15%) Tertiary Prevention Secondary Prevention Specialized Individual Interventions (Individual Student System) Specialized Group Interventions (At-Risk System) Students without Serious Problem Behaviors (80 -90%) Primary Prevention Universal Interventions (School-Wide System Classroom System) All Students in School

School-Wide PBS

• • • Continuum of integrated activities – Health promotion through intensive intervention – Dependent on effective multi-disciplinary teamwork and engagement of families

“Positive behavior”

student’s success in the home, school and community setting refers to all skills that increase a

“Support”

refers to the methods used to teach, strengthen and expand positive behaviors (Sugai et al., 2000) Johnston & Paternite, OMHNSS 23

PBS

• Shows promise as an effective preventative strategy • Decreases antisocial and other behavior difficulties amongst a growing population of children and youth Johnston & Paternite, OMHNSS 24

Continuum of Effective Behavior Support

Students with Chronic/Intense Problem Behavior (1 - 7%) Students At-Risk for Problem Behavior (5-15%) Tertiary Prevention Secondary Prevention Specialized Individual Interventions (Individual Student System) Specialized Group Interventions (At-Risk System) Students without Serious Problem Behaviors (80 -90%) Primary Prevention Universal Interventions (School-Wide System Classroom System) All Students in School

Project Re-ED

• Re-ED – Re-Education of Emotionally Disturbed Children – Based on the work of Dr. Nicholas Hobbs more than 40 years ago • Observation of residential treatment programs in Western European countries • Noted that programs dominated by an elaborate professional hierarchy were less effective than those relying on and valued the interpersonal rapport of “natural child care workers” Johnston & Paternite, OMHNSS 26

The Heart of Re-ED

• Problems do not reside within a child • Instead, the interaction of contextual variables in the natural setting contributes to the discord Johnston & Paternite, OMHNSS 27

12 Principles of Re-ED

• Life is to be lived now • The group is important • Trust is essential • Competence makes a different • Time is an ally • Intelligence can be taught Johnston & Paternite, OMHNSS 28

12 Principles of Re-ED

• The body is the armature of the self (i.e., the physical self around which the psychological self is constructed • Communities are important • Feelings should be nurtured • Self-control can be taught • Ceremony and ritual give order • A child should know some joy in each day Johnston & Paternite, OMHNSS 29

The Heart of Re-ED

• Therapeutic focus is competence enhancement rather than deficit reduction • Academic achievement is of particular importance • School and school work is the business of children, and successful living is healing (Valore, 2002) Johnston & Paternite, OMHNSS 30

Educators Supporting Mental Health

• Most children fail in school because the feel detached, alienated and isolated from the process, not due to the lack of cognitive skills • “…the bond between the teacher and student creates the foundation upon which a sense of belonging can develop” (Beck & Malley, 1998) Johnston & Paternite, OMHNSS 31

Resilient Youth

• Several studies suggest factors present in resilient youth include – Successful school experiences – Development of reading skills above the 3rd grade – Associations with caring adults outside the family – Ability to maintain hope (Gilliam & Scoot, 1998; McEvoy & Welker, 2000) Johnston & Paternite, OMHNSS 32

Conclusion

• It is essential to engage educators in collaborative partnerships in order to promote both mental health and school success for children and adolescents Johnston & Paternite, OMHNSS 33

Adopt Inclusive definition of the term “educator” • Policy makers, central office administrators, building-level administrators, classroom and non-classroom staff (e.g., guidance counselors, school psychologists, nurses, etc.) • Recognize the diversity of roles and the diversity of strategies these folks can support Johnston & Paternite, OMHNSS 34

Establish formal relationships with key opinion leaders among the educational staff • Teacher-consultants model – Serve as program advisors and champions for initiatives within school related mental health promotion – Can become peer mentors and advocates for demystifying the concept of “mental health” Johnston & Paternite, OMHNSS 35

Become immersed in the school community

• Be reliable about attendance and flexible in program delivery • Attend school events, e.g., sports, concerts award ceremonies, etc.

• Don’t unwittingly transfer the tendency to view what happens behind closed doors with a client as the essence of the providers work Johnston & Paternite, OMHNSS 36

Conduct detailed, local needs assessments

• Survey the perspective of educators, students and parents • Include school climate assessments • Understand the unique characteristics of school cultures Johnston & Paternite, OMHNSS 37

Prioritize mental health promotion and problem prevention initiatives

• Recognize the difficulty in delivering a full spectrum of services • Refuse to allow “drift” toward primarily individual services for students with severe/chronic problems • Focus on adapting programs to the needs and competencies of teachers Johnston & Paternite, OMHNSS 38

Promote EFFECTIVE practices

• This involves more than selecting “evidence-based” practice – Most have not bee examined for effectiveness, palatability, durability, affordability, and sustainability in real-world school settings – Remember to include academic and school success outcomes Johnston & Paternite, OMHNSS 39

“Heart Test”

The story of Teddy.

QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.

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