Transcript Slide 1

Mental Health—Education Integration and
the Promotion of School Success
Carl E. Paternite, Ph.D.
Center for School-Based Mental Health Programs
Department of Psychology
Miami University (Ohio)
http://www.units.muohio.edu/csbmhp
Workshop Presented at the Kappa Delta Pi 44th Biennial Convocation
St. Louis, Missouri
November 15th, 2003
Qu i c k T i m e ™ a n d a T IF F (Un c o m p re s s e d ) d e c o m p re s s o r a re n e e d e d t o s e e t h i s p i c tu re .
Mental Health—Education
Integration and the Promotion of
School Success
Instructional Objectives For Workshop:
 Increase awareness of the associations between student mental health and
school success.
 Increase awareness of the importance of educators in school-based
mental health programs as promoters of student mental health.
 Increase knowledge of effective approaches to enhance educator –
mental health professional collaboration.
Center for School-Based Mental Health Programs, Miami University
See Handout for Summary of Network Vision, Mission, and Action Agenda
For more information about the Network visit www.units.muohio.edu/csbmhp/network.html or http://altedmh.osu.edu/omhn/omhn.htm
Mental Health Needs of Children/Adolescents
and Available Services
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About 20% of children/adolescents (15 million), ages 9-17, have
diagnosable mental health disorders (and many more are at risk or could
benefit from help).
Less than one-third of youth with diagnosable disorders receive any service,
and, of those who do, less than half receive adequate treatment (even fewer
at risk receive help).
For the small percentage of youth who do receive service, most actually
receive it within a school setting.
These realities raise questions about the mental health field’s over-reliance
on clinic-based treatment, and have reinforced the importance of alternative
models for mental health service — especially expanded school-based
programs.
Center for School-Based Mental Health Programs, Miami University
Leading Causes of Death in 15-19 Year
Olds in the United States in 2000
— U N I T E D S T A T E S, 2000 —
CAUSE
Accidents
Homicide
Suicide
Cancer/Leukemia
Heart Disease
Congenital Anomalies
Lung Disease
Stroke
Diabetes
Blood Poisoning
HIV
# OF DEATHS
6573
1861
1574
759
372
213
151
60
40
36
36
1631
From Weist & Adelsheim, 2003
See Handout
See Handout
Developmental Assets
(1997 data, www.search-institute.org)
Approximately 100,000 6th-12th graders.
Youth with Different Levels of Assets.
 8% with 31 or more of 40 assets.
 30% with 21-30 assets.
 42% with 11-20 assets.
 20% with 1-10 assets.
Center for School-Based Mental Health Programs, Miami University
Developmental Assets and Violence
(1997 data, www.search-institute.org)
Approximately 100,000 6th-12th graders.
Definition of violence—three or more acts of fighting, hitting,
injuring a person, carrying a weapon, or threatening physical
harm in the past 12 months (self report).
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61% of youth with fewer than 11 of 40 developmental
assets were violent.
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6% of youth with 31 or more of 40 developmental assets
were violent.
Center for School-Based Mental Health Programs, Miami University
Developmental Assets and School Success
(1997 data, www.search-institute.org)
Approximately 100,000 6th-12th graders.
Succeeds in School—get’s mostly A’s on report card (self
report).
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53% of youth with 31 or more of 40 developmental
assets.
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3% of youth with fewer than 11 of 40 developmental
assets.
Center for School-Based Mental Health Programs, Miami University
Report of President’s New Freedom
Commission on Mental Health
http://www.mentalhealthcommission.gov
“…the mental health delivery system is fragmented and in
disarray…leading to unnecessary and costly disability,
homelessness, school failure and incarceration.”
Unmet needs and barriers to care include
(among others):
• Fragmentation and gaps in care for children.
• Lack of national priority for mental health and suicide
prevention.
July, 2003
Center for School-Based Mental Health Programs, Miami University
Report of President’s New Freedom
Commission on Mental Health: Six Goals
for a Transformed System
• Americans understand that mental health is essential to overall
health.
• Mental health care is consumer and family driven.
• Disparities in mental health services are eliminated.
• Early mental health screening, assessment, and referral to services
are common practice.
• Excellent mental health care is delivered and research is
accelerated.
• Technology is used to access mental health care and information.
July, 2003
Center for School-Based Mental Health Programs, Miami University
Four Recommendations Supporting Goal 4:
Early Mental Health Screening, Assessment,
and Referral to Services are Common Practice
1. Promote the mental health of young children.
2. Improve and expand school mental health programs.
3. Screen for co-occurring mental and substance use disorders
and link with integrated treatment strategies.
4. Screen for mental disorders in primary health care, across the
lifespan, and connect to treatment and supports.
July, 2003
Center for School-Based Mental Health Programs, Miami University
Expanded School-Based
Mental Health Programs
 National movement to place effective mental health programs in
schools, serving youth in general and special ed.
 To promote the academic, behavioral, social, emotional, and
contextual/systems well-being of youth, and to reduce “mental
health” barriers to school success.
 Programs incorporate primary prevention and mental health
promotion, secondary prevention, and intensive
intervention,joining staff and resources from education and other
community systems.
 Intent is to contribute to building capacity for a comprehensive,
multifaceted, and integrated system of support and care.
Center for School-Based Mental Health Programs, Miami University
See Handout
Center for School-Based Mental Health Programs, Miami University
Schools: The Most
Universal Natural Setting
• Over 52 million youth attend 114,000 schools
• Over 6 million adults work in schools
• Combining students and staff, one-fifth of the
U.S. population can be found in schools
From Weist, 2003
Center for School-Based Mental Health Programs, Miami University
Schools: The Most
Universal Natural Setting
 Educators are key partners in efforts to intervene
with children in need and to promote positive
youth development.
 In fact, through their day-to-day interactions with
students, educators are the linchpins of schoolbased efforts to encourage healthy psychological
development of youth.
Center for School-Based Mental Health Programs, Miami University
Potential of Schools as Key Points of
Engagement
 Opportunities to engage youth where they are.
 Unique opportunities for intensive, multifaceted
approaches and are essential contexts for prevention and
research activity.
Center for School-Based Mental Health Programs, Miami University
Educators as Key Members of the
Positive Youth Development/Health
Promotion Team
“Most educators, parents, students, and the
public support a broader educational agenda
that also involves enhancing students’
social-emotional competence, character,
health, and civic engagement.” (Greenberg,
et al., 2003, p. 466)
Center for School-Based Mental Health Programs, Miami University
Educators as Key Members of the
Mental Health Team
 Schools should not be held responsible for meeting every
need of every student.
 However, schools must meet the challenge when the need
directly affects learning and school success. (Carnegie
Council Task Force on Education of Young Adolescents,
1989)
 There is clear and compelling evidence that there are strong
positive associations between mental health and school
success.
Center for School-Based Mental Health Programs, Miami University
Educators as Key Members
of the Mental Health Team
 “Children whose emotional, behavioral, or social difficulties are
not addressed have a diminished capacity to learn and benefit from
the school environment. In addition, children who develop
disruptive behavior patterns can have a negative influence on the
social and academic environment for other children.” (Rones &
Hoagwood, 2000, p.236)
 Contemporary school reform—and the associated high-stakes
testing (including federal legislation signed in 2002)—has not
incorporated the Carnegie Council imperative. That is, recent
reform has not adequately incorporated a focus on addressing
barriers to development, learning, and teaching.
Center for School-Based Mental Health Programs, Miami University
Center for School-Based Mental Health Programs, Miami University
See Handout
Educators as Key Members
of the Mental Health Team
An Exercise:
How much time do you spend (or do you
imagine that you will spend) addressing the
emotional, behavioral, and/or social difficulties
of your students (minutes per hour)?
Center for School-Based Mental Health Programs, Miami University
Problem Behaviors
Insubordination, noncompliance,
defiance, late to class, nonattendance,
truancy, fighting, aggression,
inappropriate language, social
withdrawal, excessive crying, stealing,
vandalism, property destruction,
tobacco, drugs, alcohol, unresponsive,
not following directions, inappropriate
use of school materials, weapons,
harassment, unprepared to learn,
parking lot violation, irresponsible,
trespassing, disrespectful, disrupting
teaching, uncooperative, violent
behavior, disruptive, verbal abuse,
physical abuse, dress code, other, etc.,
etc., etc.
• Exist in every school
• Vary in intensity
• Are associated w/
variety of contributing
variables
• Are concern in every
community
Center for School-Based Mental Health Programs, Miami University
Perceived Problems
And
Teamwork/Collaboration Exercises
See Handouts
Center for School-Based Mental Health Programs, Miami University
Context Examples
Senior high school with
880 students reported
over 5,100 office
discipline referrals in
one academic year.
What does this mean?
• 5100 referrals @ 10
minutes each =
– 51,000 minutes or
– 850 hours or
– 141 6 hour days!
Context Examples
Middle school principal
reports he must teach
classes when teachers
are absent, because
substitute teachers
refuse to work in a
school that is unsafe
and lacks discipline.
Context Examples
Middle school counselor
spends nearly 15% of
day “counseling” staff
who feel helpless &
defenseless in their
classrooms because of
lack of discipline &
support.
Context Examples
Bus transportation company
is threatening to w/draw
their contract if students
don’t improve their
behavior. Recently,
security guards were hired
to ride buses.
Prioritizing Promotion of Healthy
Development and Problem Prevention
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School-based models should capitalize on schools’ unique
opportunities to provide mental health-promoting activities.
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For example, recommended strategies for drop-out and violence
prevention, including those for which the central role of educators is
evident, can be promoted actively within an expanded school-based
mental health program.
Center for School-Based Mental Health Programs, Miami University
Some of What We Know About Youth Violence
From the Surgeon General (2001), U.S. Secret Service (2000),
CDC (2002), Mulvey & Cauffman (2001)
 Violence is a serious public health problem.
 Violence is most often expressive/interpersonal, rather than primarily instrumental or
psychopathological.
 About 30 to 40 percent of male and 15 to 30 percent of female youth report having committed a
serious violent offense by age 17.
 About 10 to15 percent of high school seniors report that they have committed an assault with injury
in the past year — a rate that has been rising since 1980.
 By self-report, about 30 percent of high school seniors have committed a violent act in the past year
— hit instructor or supervisor; serious fight at school or work; in group fight; assault with injury;
used weapon (knife/gun/club) to get something from a person.
 Violent acts are committed much more frequently by male than by female youth. (see Miedzian,
1991)
Center for School-Based Mental Health Programs, Miami University
Some of What We Know About Youth Violence (continued)
 43% of male and 24% of female high school students report that they had been in a physical fight during
the past school year. (CDC, 2002)
 No differences are evident by race for self-report of violent behavior.
 At school, highest victimization rates are among male students.
 Violent behavior seldom results from a single cause.
 School continues to be one of the safest places for our nation’s children.
 Serious acts of violence (e.g., shootings) at school are very rare.
 Targeted violence at school is not a new phenomenon.
 Most school shooters had a history of gun use and had access to them.
 In over 2/3 of school shooting cases, having been bullied played a role in the attack.
Center for School-Based Mental Health Programs, Miami University
“For every complex
problem there is a
simple solution that
is wrong.”
H.L. Mencken
Center for School-Based Mental Health Programs, Miami University
A QUESTION:
WHAT ARE THE CAUSES
OF VIOLENCE, OTHER
PROBLEM BEHAVIOR,
AND DISCIPLINE
PROBLEMS?
Center for School-Based Mental Health Programs, Miami University
Center for School-Based Mental Health Programs, Miami University
Model: Influences on Violent versus
Non-Violent Behavior
(From Shapiro, 1999, Applewood Centers, Inc., Cleveland, OH)
Prioritizing Promotion of Healthy
Development and Problem Prevention
For drop-out prevention, these include:
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Early intervention.
Mentoring and tutoring.
Service learning.
Conflict resolution and violence prevention
curricula and training for students/staff.
 Alternative schooling.
Center for School-Based Mental Health Programs, Miami University
Some of What We Know About
Youth Violence Prevention
From the Surgeon General (2001), U.S. Secret Service (2000),
CDC (2002), Mulvey & Cauffman (2001)
 Promoting healthy relationships and environments is more effective for reducing
school violence than instituting punitive penalties.
 The best predictor of adolescent well-being is a feeling of connection to school.
Students who feel close to others, fairly treated, and vested in school are less likely to
engage in risky behaviors.
 A critical component of any effective school violence program is a school environment
in which ongoing activities and problems of students are discussed, rather than tallied.
Such an environment promotes ongoing risk management, which depends on the
support and involvement of those closest to the indicators of trouble — peers and
teachers.
Center for School-Based Mental Health Programs, Miami University
Aggressive and Rejected Children
• Thinking errors
– Attribute hostile intentions to accidental or ambiguous behavior
– Misinterpret important social cues
– Tease others but respond incompetently when provoked
Center for School-Based Mental Health Programs, Miami University
Educators
• Thinking errors
– If punishment is severe enough, children will cease negative
behavior
– Punishment is in the best interest of the child
– Well controlled classrooms must be quiet classrooms
– Control is like a behavioral ointment:
• no control at home = slather it on in school
– Prescribed discipline programs provide security for staff
Center for School-Based Mental Health Programs, Miami University
Violence Prevention:
What Doesn’t Work
From the Surgeon General (2001) and others
 Scare tactics. (e.g., Scared Straight)
 Deterrence programs — shock incarceration, boot camps.
 Efforts focusing exclusively on providing education/information
about drugs/violence and resistance. (DARE)
 Efforts focusing solely on self-esteem enhancement.
 Vocational counseling.
 Residential treatment.
 Traditional casework and clinic-based counseling.
Prioritizing Promotion of Healthy
Development and Violence Prevention:
Best and Promising Practices
Including:
Structured social skill development programs.
Mentoring. (see Big Brothers/Sisters; Garbarino, 1999)
Employment.
Programs that foster school engagement, participation, and bonding.
Promotion of developmental assets. (see Search Institute)
A variety of approaches that engage parents and families. (e.g., parent
training, MST, functional FT)
Early childhood home visitation programs.
Multi-faceted programs that combine several of the above.
For good examples see “Blueprint Programs.”
Center for School-Based Mental Health Programs, Miami University
Promoting Nonviolence: An
Example of a Heuristic
School-Based Framework
Deutsch (1993) — Educating for a peaceful world
Four Key Components Including:
 Cooperative Learning.
 Conflict Resolution Training.
 Use of Constructive Controversy in Teaching Subject
Matters.
 Mediation in the Schools.
See Handout
Center for School-Based Mental Health Programs, Miami University
Positive Behavior Support
(see www.pbis.org)
• PBS is a broad range of systemic &
individualized strategies for achieving
important social & learning outcomes
while preventing problem behavior with
all students.
Center for School-Based Mental Health Programs, Miami University
Terminology
• Positive Behavior….
– Includes all skills that increase success in home, school and
community settings.
• Supports….
– Methods to teach, strengthen, and expand positive
behaviors.
– System change.
Center for School-Based Mental Health Programs, Miami University
Discipline Defined
• “The steps or actions, teachers,
administrators, parents, and students
follow to enhance student academic and
social behavior success.”
• “Effective discipline is described as
teaching students self-control.”
Center for School-Based Mental Health Programs, Miami University
Science of behavior has taught us
that students….
• Are NOT born with “bad behaviors”
• Do NOT learn when presented contingent aversive
consequences
• Do learn better ways of behaving by being taught
directly & receiving positive feedback
From Johnston (2003)
Center for School-Based Mental Health Programs, Miami University
Teacher Behaviors That
Contribute to Discipline Problems
• Sitting at the desk most of the time, not moving or
mingling with the students
• Using a low, unenthusiastic or uniteresting voice tone
• Becoming easily sidetracked by one student’s irrelevant
question
From Johnston (2003)
Center for School-Based Mental Health Programs, Miami University
Teacher Behaviors That Contribute
to Discipline Problems
• Ignoring students’ interests and tying instruction solely to the
textbook
• Repeating student’s answers too frequently
• Leaving concepts before they have been clarified and/or
expecting independent work before understanding has been
checked
• Not being prepared and leaving “down time” for students to
fill
From Johnston (2003)
Center for School-Based Mental Health Programs, Miami University
Teacher Behaviors That Contribute to
Discipline Problems
• Poorly worded questions that cloud discussion or understanding
• Having questions/answers be directed solely between teacher and
student
• Neglecting to tie content or learning to prior knowledge of
students
• Using too much time to teach the lesson and not focusing on what
is being learned
From Johnston (2003)
Center for School-Based Mental Health Programs, Miami University
Teacher Behaviors That Contribute to
Reduction of Discipline Problems
• Remove conditions that trigger & maintain
undesirable practices
• Increase conditions that trigger & maintain desirable
practices
• Remove aversives that inhibit desirable practices
• Establish environments & routines that support
continuum of PBS
From Johnston (2003)
Center for School-Based Mental Health Programs, Miami University
Promoting Nonviolence: An Example
of a Promising Secondary Violence
Prevention Program
Positive Adolescent Choices Training (PACT)
Developed by
Betty R. Yung & W. Rodney Hammond
Components
I. Violence-Risk Education
II. Anger Management
III. Social Skills
Center for School-Based Mental Health Programs, Miami University
PACT Components I and II
Violence Risk Education:
 Increase awareness of circumstances, risk factors,
and consequences of violence.
Anger Management:
 Understand and normalize feelings of anger,
recognize anger triggers, and manage anger
constructively.
Center for School-Based Mental Health Programs, Miami University
PACT Components III:
Social Skills
Givin’ It:
 Expressing criticism, disappointment, anger, or
displeasure calmly and ventilating strong
emotions constructively.
Takin’ It:
 Listening, understanding, and reacting appropriately to
others’ criticism and anger.
Workin’ It Out:
 Listening, identifying problems and potential
solutions, proposing alternatives when
disagreements persist, and learning to
Center for School-Based Mental Health Programs, Miami University
compromise.
Closing Observations
 Clearly, intellectual, social, and emotional education go handin-hand, and all are linked to creating safe schools, building
healthy character, and achieving academic success:
The proper aim of education is to promote significant learning. Significant
learning entails development. Development means successively asking broader
and deeper questions of the relationship between oneself and the world. This is
as true for first graders as it is for graduate students, for fledgling artists as
graying accountants.
A good education ought to help people become more perceptive to and more
discriminating about the world: seeing, feeling, and understanding more, yet
sorting the pertinent from the peripheral with ever finer touch, increasingly able
to integrate what they see and to make meaning of it in ways that enhance their
ability to go on growing. To imagine otherwise, to act as though learning were
simply a matter of stacking facts on top of one another, makes as much sense as
thinking one can learn a language by memorizing a dictionary. Ideas only
come to life when they root in the mind of a learner. (Daloz, 1999, p. 243)
Center for School-Based Mental Health Programs, Miami University
Closing Observations
 Certainly, educators are key partners in efforts to intervene
with children in need and to promote development.
 In fact, through their day-to-day interactions with students,
educators are the linchpins of school-based efforts to
encourage healthy psychological development of youth.
Center for School-Based Mental Health Programs, Miami University
This PowerPoint Presentation, with a
reference list for cited work, will be
posted on the CSBMHP website
http://www.units.muohio.edu/csbmhp
Center for School-Based Mental Health Programs, Miami University