Transcript Classroom-Focused Enabling

THE SCHOOL MENTAL HEALTH
IMPERATIVE
Mark Weist Ph. D.
Steven Adelsheim, M.D.
March 3, 2003
“Could someone help me with these?
I’m late for math class.”
Prevalence of Childhood
Mental Health Problems
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About 20% of children and adolescents
(15 million), ages 9 to 17, have diagnosable
mental health disorders
Between 9-13% of children, ages 9-17 years, meet
the definition of serious emotional disturbance
(SED) that limits their ability to function in the
family, school, and community
An estimated 70% of those identified are not
getting the mental health treatment they need
Proven, Successful Treatments
Exist for Most Disorders
Treatment success rates:
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80% for major depression
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65% for bipolar disorder
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60% for schizophrenia
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45% for heart disease
Mental Health and Disability
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Mental illness is the leading cause of disability
(25%) in Western Europe,Canada, and U.S.
Global Burden of Disease study predicts that
major depression will become the second leading
cause of disability in the world by the year 2010
By 2020, childhood neuropsychiatric disorders
will rise by over 50% internationally to become
one of the 5 most common causes of morbidity,
mortality, disability
The Cost of Mental Illness in the
United States
In addition to the overwhelming human suffering:
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$63 billion in lost productivity due to work absence,
SSI
$12 billion in lost productivity due to premature death
$6 billion incurred costs to incarcerate the 250,000
inmates with serious mental illness
1997 estimated total U.S. cost of mental illnesses was
$148 billion.
Surgeon General’s Suicide Data 1997
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Rate for ages
* 10-14 - 1.6 /100,000
* 15-19 - 9.7 /100,000
* 20-24 - 14.5 /100,000
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For young people 15-24, suicide is third leading
cause of death
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In 1996, more youth and young adults died from
suicide than cancer, heart disease, AIDS, stroke,
pneumonia, & birth defects COMBINED
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
NCHS 2001, preliminary
1999 Surgeon-General’s Report on
Children’s Mental Health
“There is no mental health
equivalent to the federal
government’s commitment to
childhood immunization”
Interim Report of President’s New
Freedom Commission on Mental Health
“Our Nation’s failure to prioritize
mental health is a national tragedy.
So many lives are at stake, so
many families and communities
struggle to stay afloat.”
October
29,2002
STIGMA and Children’s Mental
Health
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1999 study said 71% thought mental illness
caused by emotional weakness, 65% from bad
parenting, 35% from immoral or sinful behavior
(Hinckley, 1999)
66% of people with diagnosable MH problems do
not see treatment, especially true for rural areas
and adolescents
Lack of public willingness to pay for treatment
Issues in Appropriate Assessment for
Mental Health Problems
Less than 50% of adolescents with
significant treatable mental health disorders
are correctly identified as having problems
by school counselors
 Pediatricians correctly identify 35% of
those with diagnosable mental disorders
 Parents are only generally able to identify
acting out problems
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An Attitudinal Shift Towards
Children’s Mental Health Programs
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Public Health perspective similar to that for
immunizations, sexually transmitted diseases
Put children’s services on equal financial footing
as adult programs if we really believe in
prevention and early identification
Equal focus for children’s services at federal,
state, and local systems
University training systems prioritize children
services
Anytown, USA
People don’t know about or care about
youth mental health issues or view them
with stigma
 Limited evaluation/consultative services in
the schools for youth in special education
 Limited treatment services for youth who
act out in community centers and private
offices
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Anytown 2
Significant, unaddressed mental health
needs in child welfare and juvenile justice
 Child serving agencies operating with
significant bureaucracy and passivity
 There is no system of care
 Quality improvement and evaluation are
limited if non existent
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Promiseland, USA
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The public recognizes the critical importance of
youth mental health and is ENGAGED
Policymakers are responsive and resources are
growing progressively
Major child serving systems are joining with
families, youth and other stakeholders to plan and
continuously improve systems of education, youth
development and care
Promiseland 2
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The full continuum of mental health promotion
and intervention is being implemented in schools
through family-school-community partnerships
There is a major emphasis on quality
improvement, evaluation, and building and using
the evidence base
Positive outcomes for youth, families, schools,
and communities are being demonstrated
Why is School Mental Health so
Critical to this Vision?
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Because there is probably no approach with
as much promise to change paradigms and
move the country from an illness care to
health promoting perspective:
 Focus
on youth -- our future
 Schools, the most universal natural setting
 Connecting to a central mission of society
Major Approaches to Mental Health
in Schools
Enabling Framework (Adelman and Taylor)
 Other Education-Based
 School-Based Health Centers
 Community Mental Health Center Outreach
 Private Practitioner Outreach
 Communities in Schools
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Expanded School Mental Health (ESMH)
ESMH programs join staff and resources
from education and other community
systems
 to develop a full array of mental health
promotion and intervention programs and
services
 for youth in general and special education
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Positive Outcomes of ESMH
Programs are Being Shown
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Outreach to under-served youth
Productivity of staff
Cost-effectiveness
Improved satisfaction
Improved student outcomes
Improved school- and system- level outcomes
Progressive Growth of ESMH Also
Being Propelled By:
Increasing recognition of mutual benefits to
schools and other community systems
 Prominent federal developments (Surgeon
General’s reports, Safe Schools/Healthy
Students, No Child Left Behind)
 Increasing training and technical assistance
 Bridging of research and practice
 Growing international dialogue
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But the movement toward ESMH is still in the
early phases
ESMH estimated to be in less than 10% of
the nation’s 114,000 schools
 A concerning trend toward clinics in
schools
 Funding remains limited and illness-focused
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Major Categories of Work to Advance
Mental Health in Schools
Raising awareness of unmet youth mental
health needs and building advocacy
 Involving youth, families and other
stakeholders
 Influencing policy and growing a diverse
array of funding mechanisms
 Applying new resources strategically
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Major Categories of Work II
Enhancing methods of early identification
and screening
 Broadening and improving training at all
levels and for diverse disciplines
 Strengthening quality assessment and
improvement approaches
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Major Categories of Work III
Coordinating services in schools and
making progress toward true systems of
care
 Addressing areas of special need
 Emphasizing prevention and broad efforts
to promote youth mental health
 Supporting, using, and building the
evidence base
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Impacts of September 11
Increasing recognition that mental health
issues and problems are universal
 Underscoring significant capacity problems
in mental health systems
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Impacts of September 11, cont.
Increasing support for expanded school
mental health
 Propelling advocacy, coalition building, and
the breaking down of entrenched boundaries
and bureaucratic obstacles
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Media Issues
Journalistic media pay very little attention
to child and adolescent mental health
 Entertainment media present mental illness
in a “stereotypic and blatantly negative”
light. Mentally ill are presented as “objects
of amusement, derision or fear” (Granello &
Pauley, 2002)
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Toward Interdisciplinary Work
Guided by Stakeholders
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Close collaborative relations among and
between:
 professionals
of different disciplines
 non- and para-professionals
 the stakeholders (e.g., youth, families,
community leaders)
 “being in the trenches, shoulder to shoulder
with the teachers, students and families, trying
to make a difference”
The Optimal School Mental Health
Continuum?
10-20% Broad Environmental Improvement
and Mental Health Promotion
 50-60% Prevention and Early Intervention
 20-30% Intensive Assessment and
Treatment
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To Move Toward This Continuum
We Need To Address The
Over-Reliance On Fee-For-Service
Need to diagnose
 Significant bureaucracy
 Limits on productivity
 Contingencies to hold on to youth and families
who show up and can pay
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Toward Funding for a Full Continuum of
Programs and Services
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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
 innovative prevention funding
 fee-for-service
Under-Explored Funding
Approaches
Early Periodic Screening Diagnosis and
Treatment (EPSDT)
 Transitional Assistance for Needy Families
(TANF)
 Safe and Drug Free Schools funds
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Youth Mental Health Services
in Most Communities
Primary
Secondary Tertiary
Education
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M. Health
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Pub. Health
The Vision
Primary
Secondary
Tertiary
Education
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M. Health
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Pub. Health --------------
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Deciding on Roles in a School
(no stereotyping intended)
Primary
Sch. Psy.
Tertiary
XOXOXO XXXXXX XX
Sch. SW.
Sch. Co.
Com. St.
Secondary
XOXOXO XXXXXX
XOX0
XO
OOO
OOOOOO OOOOOO
REG.ED=O
SPEC.ED=X
Using the Evidence Base
A major feature of school-based mental
health from the beginning
 Perhaps the most dominant issue in child
and adolescent mental health research
 We can lead the way in school mental health
 Significant work and opportunities ahead
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Using the Evidence Base in Context
Building Blocks for the Promotion of Mental Health in Schools
Positive Outcomes
for students, schools and communities
Effective programs and interventions
Training, TA, ongoing support for the use of evidence-based programs and interventions
Staff and program qualities, school and community buy-in and involvement
Adequate capacity
Awareness raising, advocacy, coalition building, policy change, enhanced funding
Lessons from Dialogue with Other
Countries
US focus is primarily on illness in
individuals
 Tremendous variability in US experience
can be a real barrier to communication and
to progress

The Australian MindMatters Program
Mapping and managing mental health
resources in schools
 School-wide training
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 resilience
 bullying
and harassment
 grief and loss
 understanding mental illness
International Network for Child and
Adolescent Mental Health and Schools
Planning meetings in Virginia Beach (98),
Denver (99), Atlanta (00), Paris (01) and
London (02)
 Network established in November, 2002
 Over 100 members from over 20 countries
 First meeting October 22, 2003, Portland
Oregon
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New Mexico Facts
(We Still Have a Lot of Work to Do)
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Greatest Percentage of Children Living in
Poverty
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Greatest Percentage of Teens Not in
School/Working
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2nd Highest Teen Dropout Rate
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2nd Highest Teen Death Rate Due to Accident,
Suicide, Homicide
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6th Highest Teen Suicide Rate
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3rd Worst Health Statistics of All States
State of New
Mexico
Governor’s Office
State Board of
Education
State
Department of
Education
School Health
Unit
Human Services
Department
Income Support
Division
Department of
Health
Behavioral
Health
Division
Others
Others
Child Protective
Services
Others
Public Health
Division
Special Education
Division
Children, Youth and
Families Department
Medical
Assistance
Division
Cimarron
Salud
Office of
School Health
Lovelace
Salud
Presbyterian
Salud
Prevention
And
Intervention
Juvenile
Justice
Division
New Mexico School Behavioral
Health Partnership
Office of School Health
 Behavioral Health Division
 CYFD-Prev. & Interv.
 Dept of Ed.-Spec.Ed.
 Dept. of Ed.-School Health
 Fed. M H Block Grant
 HSD-Med. Asst. Div.
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$300,000
$400,000
$320,000
$165,000
$350,000
$140,000
$84,000
NM DOH Office of School Health
Director
Laurie A. Mueller
HPM-1/Santa Fe
School Health Officer
Jane McGrath
(UNM)/Abq
School-Based Health
Center Consultant
Mary Blea
Nurse-5/Abq
SBHC Nurse Practitioner
Medicaid Consultant
Paula LeSueur
(UNM)/Abq
School Health Advocates
Deb Werner - Dist I
Janie Lee Hall - Dist I
Trudy Perry - Dist II
Laura Mandabach - Dist III
Janice Jordan - Dist IV
Administrative Assistant II
Carol Montoya
(UNM)/Abq
Medical Care Administrator
Vacant
PH Educ./Santa Fe
Healthier Schools Consultant
Randy Sanches
PH Educ./Santa Fe
Planner
Vacant
Santa Fe
Secretary
Pamela Hedrick
Santa Fe
Dropout Prevention
Coordinator
Nissa Patterson
(UNM)/Albq
School Mental Health Advocates
Vacant - UNM / Dist I
Jaynee Fontecchio - UNM /Dist I NW
Joseph Vigil - UNM / Dist II
Albert Sanchez - UNM / Dist III
Steven Courts - UNM / Dist IV
School Mental Health
Initiative, Director
Steve Adelsheim
(UNM)/Abq
Program Manager
Kris Carrillo
(UNM)/Abq
Behavioral Education
Consultant
Vacant
PH Educ./Abq
School-Based Mental Health
Services Consultant
Jacque Masog
(UNM)/Abq
Screening /
Early Identification Consultant
Ernest Coletta
(UNM)/Albq
Administrative Asst. III
Clancey Tarbox
(UNM)/Abq
Continuum of Care for
School Mental Health Programs
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Awareness and training
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Three levels of prevention, including universal,
selective and indicated
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Screening and assessment
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Early identification and early intervention
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Three levels of treatment, including communitybased, transitional, and high-end
Early Identification and Treatment of
Mental Health Issues is Prevention!
Research on brain changes in PTSD and brain cell
neurogenesis
 Results from NYC Schools PTSD survey (Hoven)
 ADHD – Pharmacotherapy reduces risk for later
ASUD (Biederman, 1999)
 Bipolar disorders – early identification in younger
children reduces risk of ASUD 8X (Wilens,1999)
 Opposition Defiant/Conduct Disorders – early
treatment of child, parent, family all decrease later
ASUD risk (Riggs)
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Interdepartmental School
Behavioral Health Partnership
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School Behavioral Health Training Institute
Youth Mental Health Awareness Initiative“Childhood Revealed”
Dropout Prevention Project
School Behavioral Health Screening Program
School-Based Mental Health Center Program
Development
SBHC Mental Health Exemplary Pilot Sites
School Mental Health
Partnerships with Families
Opportunities to collaborate with providers
on-site about education needs of child
 Improved coordination of interventions
around whole child and family
 Access is easier with fewer transportation
issues
 More comfortable community setting
 Stigma issues may be minimized
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School-Community Collaboration in
School Mental Health Programs
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Collaboration and coordination between
school and providers is critical
 Roles
of all on-site providers, including school
health professionals must be clear
 Communication and confidentiality issues must
be directed addressed and established
 Resource coordination efforts must be
determined by organized team within school
(SAT, resource team, etc.)
School Behavioral Health
Training Institute
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Train-the–Trainers model of adult education
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Training 180 teachers and school health
professionals from 14 districts this year
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Training in aspects of school behavioral health and
classroom intervention
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On-site workshops with staff support
Childhood Revealed New Mexico
2001
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Art exhibit as centerpiece for youth mental health
awareness expansion statewide
Linkages to school districts for in-service training
and classroom programs (0ver 5000 youth so far
this year)
Community education programs for expanded
awareness
Media, government, and business support all to
help to decrease stigma
“Marketer of the Year 2001” by American
Marketing Association- New Mexico Chapter
Dropout Prevention Initiative
“PASS”
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Case management model for high risk youth and
their families
Focus on wraparound supports for those identified
of being at risk to dropout
Statewide training and RFP development 2002
fiscal year
Focus on implementation at 3 pilot sites statewide
for fiscal years 2003-4
Target 9th grade students making transition to
high school
New Mexico Screening and
Early Identification Models
Early identification and intervention as
prevention
 Public health screenings vs. selective
screenings in SBHCs
 Piloting computer-based models for early
identification and suicide prevention
 Expanded interest by schools to utilize
screening tools on larger scale
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New Mexico SBHC
Mental Health Program Development
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Expanded funding for mental health and substance
abuse services 17 SBHC programs
One cluster wide Medicaid Managed Care School
Behavioral Health Pilot Program
Standards and protocols for MH/SA services in
schools
Four “Exemplary” School Mental Health Sites
looking at mental health and educational outcomes
New Mexico Medicaid Managed
Care SBHC Pilot Projects
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Pilot with Center for Health Care Strategies
Reimbursement through Medicaid for mental
health and substance abuse services
5 Medicaid Managed Care SBHC pilots
Developing depression, ADHD and substance
abuse protocols for MH/SA services in schools
“Enhanced Mental Health Services” code for some
sites
Find Students With Mental Health
Issues Early and Treat Them!
Prevent later special education referrals
 Reduce primary care and urgent care over
utilization
 Decrease high risk behaviors including violence
and substance abuse
 Improve educational outcomes
 Decrease the accidents, suicides, and homicides
that are the public health mortalities for our
children
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Advocacy Role in School and Child
Mental Health
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Legislation on school mental health and early
behavioral assessment
Collaboration and support for parent advocacy
organizations
Raise awareness about mental health needs of our
state’s children
Increase parental awareness about the educational
rights of our children
Expand funding for school behavioral health to
improve access
Expand awareness of relationship between mental
health issues and other youth risk factors
" It is not the malicious
acts that will do us in ...
but the appalling silence and
indifference of good people."
Martin Luther King, Jr.
Centers for Mental Health in Schools
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Supported by the Office of Adolescent Health,
Maternal and Child Health Bureau, Health
Resources and Services Administration;
With co-funding from the Center for Mental
Health Services, Substance Abuse and Mental
Health Services Administration, U.S. Department
of Health and Human Services.
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
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University of Maryland
Center for School Mental Health Assistance
Provide technical assistance and
consultation
 Provide national training and education
 Disseminate and develop knowledge
 Promote communication and networking
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phone: 410-706-0980 (888-706-0980 toll free)
email: [email protected]
web: http://csmha.umaryland.edu
New Mexico School
Mental Health Initiative
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Statewide efforts to link families, communities,
schools and behavioral health programs
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Phone: 505-841-5879
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Fax: 505-841-5885
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Email: [email protected]
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Website: http://www.nmsmhi.org