From Policy to Practice: Using Community Science to Promote School-Based Mental Health

Symposium Presentation at the Annual Meeting of the American Psychological Association August 18, 2005

Presenters :

Paul Flaspohler

Center for School-Based Mental Health Programs, Miami University

Carl E. Paternite

Center for School Based Mental Health Programs, Miami University

Steve Evans

Dept. of Psychology, James Madison University

Elaine Clanton Harpine

Dept. of Psychology, Kent State University Discussant :

Mark Weist

Center for School Mental Health Analysis and Action, U. of Maryland

Tova’s Perspective on Mental Health and School Success Ohio Shared Agenda Legislative Forum Testimony October 9, 2003

Community Science

A means and a method for bridging this gap between research and practice An interdisciplinary framework for strengthening communities by improving the quality of practice in treatment, prevention, health promotion, and education

The Gap between “research” and practice

“Prevention Science” Intervention Basic research Efficacy Effectiveness Services Research GAP Practice Community Organizational Systems 1) Schools 2) Health Agencies 3) Community Coalitions

The preventive intervention research cycle

1. Identity problem or disorder(s) and review information to determine its extent 2. With an emphasis on risk and protective factors, review relevant infor mation—both from fields outside prevention and from existing preventive intervention research programs 3. Design, conduct, and analyze pilot studies and confirmatory and replication trials of the preventive intervention program 4.Design, conduct, and analyze large scale trails of the preventive intervention program

Feedback Loop

5.Facilitate large-scale implementation and ongoing evaluation of the preventive intervention program in the community

Pasteur’s Quadrant

Yes Yes Use Inspired Basic Research Use No Pure Applied Research Understanding No Pure Basic Research

Bridging the Gap

“Prevention Science” Intervention Basic research Efficacy Effectiveness Services Research

Green Characteristics 1) Process 2) Control 3) 4) Self-Evaluation Tailoring Process and new Technology 5) Synthesizing Research

Practice Community Organizational Systems 1) Schools 2) Health Agencies 3) Community Coalitions

Larry Green – From Research to “Best Practices”

“Best Practice” as Process Control by practitioner, client, or community Local evaluation and self-monitoring Research in the Tailoring Process and new technology Consumer driven Synthesis and Translation

Promoting Effective School-Based Mental Health Programs and Services

Carl E. Paternite, Ph.D.

Center for School-Based Mental Health Programs Miami University (Ohio) Steven Adelsheim, M.D.

Health Sciences Center University of New Mexico

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)

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

Less than 30% of youth with diagnosable disorder receive any service, and, for those who do, the services are often inadequate For the small percentage of youth who do receive services, most actually receive them in schools

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

These realities raise questions about the mental health field’s insufficient attention to delivery of ecologically sensitive and effective services; And they reinforce the importance of: – a community-based continuum of mental health supports, – commitment to a public health model of mental health, and – expanded school mental health programs and services.

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

U.S. Surgeon General Reports (1999, 2000) President’s 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

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 New Freedom Commission (2003)

Public Policy Context: SMH and the No Child Left Behind Mandate Two Important Interrelated Goals— Achievement and Wellbeing  1) Achievement promotes wellbeing  2) Wellbeing promotes achievement  School accountabilities often acknowledge 1 but fail to sufficiently acknowledge 2

Report of President’s New Freedom Commission on Mental Health http://www.mentalhealthcommission.gov

Critical Importance

of Partnership with Schools: “The mission of public schools is to educate all students.

However, children with serious emotional disturbances have the highest rates of school failure

. Fifty percent of these student drop out of high school, compared to 30 percent of all students with disabilities. “ “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

Based On a Growing Knowledge Base, Schools That Promote Mental Health Report:  Assistance in reaching underserved youth  Strong satisfaction by diverse stakeholder groups (e.g., teachers, students, families)  Improved student outcomes (e.g., higher academic achievement; higher attendance; fewer behavior problems; increased sense of connectedness to school)  Improved school outcomes (e.g., more supportive, inclusive, and safe school climate; fewer special education referrals)

Strengthening Policy and Practice: Ohio’s Shared Agenda and Mental Health Network for School Success

Paul Flaspohler, Ph.D.

Center for School-Based Mental Health Programs, Miami University (Ohio) Noelle Duvall, Ph.D.

Children’s Resource Center, Bowling Green, OH Kay Reitz, Ph.D.

Office of Children's Services and Prevention .Ohio Department of Mental Health Michael Armstrong Director, Office for Exceptional Children, Ohio Department of Education

Infrastructure for Ohio’s Shared Agenda Initiative Formation in 2001 of the Ohio Mental Health Network for School Success (OMHNSS) Action Networks spearheaded by affiliate organizations in six regions of the State

Mission

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.

Ohio’s Mental Health, Schools, and Families

Shared Agenda

Initiative http://www.units.muohio.edu/csbmhp/sharedagenda.html

Phase 1

Statewide forum for leaders of mental health, education, and family policymaking organizations and child-serving systems (March 3, 2003)

Phase 2

Six regional forums for policy implementers and consumer stakeholders (April-May, 2003)

Phase 3

Legislative forum involving key leadership of relevant house and senate committees (October 9, 2003)

Phase 4

Development and release of

Shared Agenda

report

Phase 5

Ongoing policy/funding advocacy and technical assistance to promote attention to the crucial links between mental health and school success

Integrated Systems to Support the Development of All Children Systems of Prevention and Promotion

All Students (universal)

Systems of Early Intervention

Students At-Risk (selected)

Systems of Treatment

Students with Problems (indicated)

School, Family, and Community Partnerships

From: Zins (in progress).

Legislative Forum On Mental Health and School Success Creating A

Shared Agenda

In Ohio October 9, 2003

Phase 5: An Immediate Legislative Outcome Senate Bill 2 Section 3319.61(E) (effective June 9, 2004) “The standards for educator professional development developed under division (A) (3) of this section shall include standards that address the crucial link between academic achievement and mental health issues.”

Pre- and In-service Training to Promote Interdisciplinary Collaboration in SBMH

Jennifer L. Axelrod, Steven W. Evans, & Robert Burke

Nature of the Problem

National crisis regarding behavioral health workforce (The Annapolis Coalition) – Inadequate training in graduate programs.

– Ineffective methods of continuing education (e.g., symposiums).

– Those with most client contact frequently have least training.

– Little to no family education provided nor is their experience considered in training.

Examples of Problem

Many graduate programs do not teach students about productivity and dealing with managed care which are primary measures of competency in many jobs.

There is little pre-service or in-service training about evidence based practices and how to fit them into a real practice.

Training in evidence based practices frequently barely resembles actual EBP.

School Mental Health

In addition to basic competencies required to be a qualified mental health provider, school based mental health providers require additional competencies – Understanding of education system – Advanced consultation and collaboration skills – Techniques for using meaningful outcome measures – Creativity and flexibility

School Mental Health

Educators also wish to gain knowledge and skills in children’s mental health – Awareness of meaningful variations in behavior – Methods for improving classroom management and educational strategies for children with mental health problems – Techniques for supporting appropriate social development – Approaches for fostering resilience and coping

Mental Health-Education Integration Consortium: MHEDIC

Collaboration of educators and mental health providers with goal of advancing pre-service and in-service training on mental health issues.

– Establish core competencies of professions that are unique to school mental health Educators Mental health providers – Develop training methods for helping professionals achieve these competencies.

Methods

Competencies – Collect information from professionals – Identify core competencies for educators and school mental health providers Training – Modify university training programs – Update technical assistance centers – Develop methods for effective training – Examine impact on education and mental health outcome measures when professionals in school achieve competencies.

After-School Community Based Prevention Projects

Elaine Clanton Harpine, Ph.D.

Kent State University Geauga

Portable Play Therapy Room

From Policy to Practice: Using Community Science to Promote School-Based Mental Health

Discussant Mark Weist Center for School Mental Health Analysis and Action Department of Psychiatry University of Maryland

Center for School Mental Health Analysis and Action

CSMHA

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

Factors Necessary to Achieve Desired Outcomes for Youth Through SBMH Programs and Services

Effective mental health promotion, problem prevention and intervention Outstanding staff and program qualities Ongoing 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

The IDEA Partnership

The Big Picture: A Shared Agenda

Achievement

and

Well Being

as

Dual Goals

Address both academic and non-academic barriers to achievement Share work across education, mental health and family organizations Make explicit the shared interests of school mental health, general education and special education Grow state-based examples Develop and nurture multi-scale learning loops Build a national

Community of Practice

on school based mental health that unites stakeholders around shared interests across organizational boundaries

see www.ideapartnership.org

2 nd 10 th Community Building Forum, and Annual Conference on Advancing School Mental Health

Federal funders, HRSA, SAMHSA, OSEP Major Partners: IDEA Partnership, NASDSE, CSMHA, Ohio Mental Health Network for School Success Cleveland Ohio, October 26 (Community Building Forum) – 29, 2005

Come to Cleveland, the City that Rocks!!

See http://csmha.umaryland.edu

or contact Christina at [email protected]

Practice Groups

Mental Health – Education Integration Developing a Common Language Connecting Education and Systems of Care Connecting School Mental Health (SMH) and Positive Behavior Support Improving SMH for Youth with Disabilities

Practice Groups (cont.)

SMH, Juvenile Justice and Drop-Out Prevention Family Partnerships Youth Involvement and Leadership Faith – Community Partnerships Quality and Evidence-Based Practice

INTERCAMHS

International Alliance for Child and Adolescent Mental Health and Schools www.intercamhs.org

UCLA Center for Mental Health in Schools

Directed by Howard Adelman and Linda Taylor Phone: 310-825-3634 Enews: [email protected]

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