Transcript Quotes - The Carolina Network for School Mental Health

Transforming Child and
Adolescent Mental Health
Mark D. Weist, Ph.D.
Department of Psychology,
University of South Carolina
Appalachian State University, 4.19.13
Thanks to

Vittoria Anello
 Jason Bird
 Lori Chappelle
 Kendra DeLoach
 Melissa Dvorsky
 Melissa George
 Lucille Eber
 Johnathan Fowler
 Nancy Lever
 Bobby Markle

Heather McDaniel
 Kurt Michael
 Elaine Miller
 Samantha Paggeot
 Sharon Stephan
 Kathy Short
 Joni Splett
 Leslie Taylor
 John Terry
 Rachel Williamson
 Eric Youngstrom
Center for School Mental Health*
University of Maryland School of Medicine
http://csmh.umaryland.edu
*Supported by the Maternal and Child Health Bureau of
HRSA and numerous Maryland agencies
Outline
 Realities
 Expanded
school mental health
 Achieving evidence-based practice
 Interconnection with PBIS
 Other collaborative projects
 Progress, …but many challenges
 A National Community of Practice
Reality 1
 Child
and adolescent mental health is
among the most if not the most neglected
health care need in the US
Reality 2
 Children,
youth and families are not
getting to places where mental health
services are traditionally delivered
Reality 3
 Schools
are under-resourced to address
mental health issues, and may view this as
beyond their mission
“Expanded” School Mental Health
 Full
continuum of effective mental health
promotion and intervention for students in
general and special education
 Reflecting a “shared agenda” involving
school-family-community system
partnerships
 Collaborating community professionals
(not outsiders) augment the work of
school-employed staff
A Vision
Ontario students are
flourishing,
with a strong sense of
belonging at school,
ready skills for
managing academic
and social/emotional
challenges,
and surrounded by
caring adults and
communities equipped
to identify and
intervene early with
students struggling
with mental health
problems
(from Kathy Short)
A Vision for Student Mental Health and WellBeing in Ontario Schools
Research Supported Programs
 Substance
Abuse and Mental Health
Service Administration’s National Registry
of Effective Programs and Practices
 www.nrepp.samhsa.com
 Roughly 56 of 170 research supported
interventions can be implemented in
schools
Research Supported Programs
Involve
 Strong
training
 Fidelity monitoring
 Ongoing technical assistance and
coaching
 Administrative support
 Incentives
 Intangibles
Practice in the trenches
 Involves
NONE of these supports
Johns Hopkins Center for
Prevention & Early Intervention
Leads: Nick Ialongo, Phil Leaf,
Catherine Bradshaw
http://www.jhsph.edu/prevention/
Barriers to Evidence-Based
Programs in Schools
 Clinician
 School
Setting
 Funding/Resources
Clinician Related Barriers
 Limited
prior training on evidence-based
practices
 Resistance
 Role constraints
 Need for administrative support
 Need for ongoing coaching and technical
assistance
Typical Work for Clinician for
Evidence-Based Prevention Group
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Screen students
Analyze results of
screen
Obtain
consent/assent
Obtain teacher buy-in
Coordinate student
schedules
Get them to and from
groups
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Rotate meeting times
Implement effectively
Promote group
cohesion
Address disruptive
behaviors
Conduct session by
session evaluation
Deal with students
who miss groups
School Related Barriers
 Fluidity
of the school environment
 Teacher turnover
 Tenuous principal buy-in
 Lack of time
 Lack of dedicated change agents
Evidence-Based “Manualized”
interventions (from Sharon Stephan)
Intervention/Indicated:
Cognitive Behavioral Intervention for Trauma in
Schools, Coping Cat, Trauma Focused CBT,
Interpersonal Therapy for Adolescents (IPT-A)
Prevention/Selected:
Coping Power, FRIENDS for Youth/Teens, The
Incredible Years, Second Step, SEFEL and
DECA Strategies and Tools, Strengthening
Families Coping Resources Workshops
Promotion/Universal:
Good Behavior Game, PATHS to PAX,
Positive Behavior Interventions and Support,
Social and Emotional Foundations of Early
Learning (SEFEL), Olweus Bullying
Prevention, Toward No Tobacco Use
“Packaging” Problem
 Blind
commitment to parameters of
manuals (e.g., hour long sessions, too
many sessions), without consideration of
school realities
 Instead group key intervention
components in “phases” and deliver
flexibly

See Steve Evans, Julie Owens, Ohio
University
Strengthening School
Mental Health Services
Study Overview
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NIMH, R01MH081941-01A2, 2010-14
(building from a prior R01)
46 school mental health clinicians, 34
schools
Randomly assigned to either:
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
Personal/ Staff Wellness (PSW)
Clinical Services Support (CSS)
CSS: Four Key Domains
 Quality
Assessment and Improvement
 Family Engagement and Empowerment
 “Modular” Evidence Based Practice
 Implementation Support
Quality Assessment and Improvement
(QAI) Principles

Emphasize access
 Tailor to local needs
and strengths
 Emphasize quality
and empirical support
 Active involvement of
diverse stakeholders

Full continuum from
promotion to
treatment
 Committed and
energetic staff
 Developmental and
cultural competence
 Coordinated in the
school and connected
in the community
Working Effectively with
Students and Families
 Engagement
 Support
 Collaboration
 Empowerment

see the work of Kimberly Hoagwood and Mary
McKay
Modular Evidence-Based Practice
(EBP)
• 10 skills for disruptive behavior problems:
o
o
o
o
o
o
o
o
o
o
Active Ignoring
Commands
Communication Skills
Monitoring behavior
Praise
Problem Solving
Psychoeducation
Response cost
Tangible rewards
Time out/ Grounding
SEE: Chorpita, B.F., & Daleiden, E.L. (2009). Biennial Report: Effective Psychosocial Intervention for Youth
with Behavioral and Emotional Needs. Child and Mental Health Division, Hawaii Department of Health
Implementation Support
Interactive and lively teaching
Off and on-site coaching, performance
assessment and feedback, emotional and
administrative support
Peer to peer support
User friendliness
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see Dean Fixsen, Karen Blasé, National
Implementation Research Network (NIRN)
A “Transformative” Impact?
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Largest and most prominent SMH program in
SC
In a network of SMH in all jurisdictions
Strong interest in the study across all relevant
sectors
Pursuing integrated QAI – Wellness strategy
now
Given positive findings, the study approach is
set up for rapid replication in SC and beyond
But
 SMH
programs and services continue to
develop in an ad hoc manner, and
 LACK AN IMPLEMENTATION
STRUCTURE
Positive Behavior Intervention
and Support (www.pbis.org)
 In
17,000 plus schools
 Decision making framework to guide
selection and implementation of best
practices for improving academic and
behavioral functioning
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Data based decision making
Measurable outcomes
Evidence-based practices
Systems to support effective implementation
Tiered Support in Systems of Care
E-B Clinical
Intervention
Targeted
Evidence-Based
Prevention
Universal Evidence-Based
Mental Health Promotion, SocialEmotional Learning
School Districts
Community
Evidence-Based Clinical
Intervention
Targeted
Evidence-Based
Prevention
Universal E-B Mental
Health Promotion
Interconnected Systems
Framework (ISF) for SMH-PBIS
 Strategy
for interconnection of two
systems across multiple tiers
 Emphasizes state teams working with
district teams and schools, and strong
team planning and actions at each tier
 Two national centers (for SMH and PBIS)
and a number of states involved
 Numerous training events and a
monograph in progress
ISF Defined
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A strong, committed and functional team
guides the work, using data at three tiers of
intervention
Sub-teams having “conversations” and
conducting planning at each tier
Evidence-based practices and programs are
integrated at each tier
SYMMETRY IN PROCESSES AT STATE,
DISTRICT AND BUILDING LEVELS
ISF cont.
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Key stakeholders from education and
mental health are involved and these
people have the authority to reallocate
resources, change roles and functioning of
staff, and change policy
There is a priority on strong
interdisciplinary, cross-system
collaboration
Old Approach 
 Each
school
works out their
own plan with
Mental Health
(MH) agency
New Approach
 District
has a plan
for integrating
MH at all buildings
(based on
community and
school data)
Old Approach 
A
MH counselor
is housed in a
school building
1 day a week to
“see” students
New Approach
 MH
person
participates in
teams at all 3
tiers
Old Approach 
 No
data to
decide on or
monitor
interventions
New Approach
 MH
person leads
classroom, group
or individual
interventions
based on data
ISF, School Readiness
Assessment
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1) High status leadership and team with active
administrator participation
2) School improvement priority on
social/emotional/behavioral health for all
students
3) Investment in prevention
4) Active data-based decision making
5) Commitment to SMH-PBIS integration
6) Stable staffing and appropriate resource
allocation
ISF, Indicators of Team
Functioning
 Strong
leadership
 Good meeting attendance, agendas and
meeting management
 Opportunities for all to participate
 Taking and maintaining of notes and the
sense of history playing out
 Clear action planning
 Systematic follow-up on action planning
Team Members

*School psychologist
 *Collaborating
community mental
health professional
 School counselor
 Special educator
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*co-leaders
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Assistant principal
School nurse
General educator
Parent
Parent
(Older student)
Student Emotional and Educational
Development (SEED)

Interdisciplinary, evidence-based intervention
for youth with mood disorders in schools
 USC, ASU and UNC
 More than 20 student participants and
promising data
 Likely big grant application by this fall
SEED Team
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Appalachian State
University
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Kurt Michael
J.P. Jameson
Abby Albright
Theresa Egan
Alex Kirk
Cameron Massey
Rafaella Sale
University of North
Carolina at Chapel Hill

Eric Youngstrom
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University of South
Carolina
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Mark Weist
Aidyn Iachini
Mary Ellen Warren
Melissa George
Joni Splett
Leslie Taylor
Support: Heather
McDaniel, Bryn Schiele,
Elaine Miller
Trainees in Psychiatry,
Social Work, School and
Clinical-Community
Psychology
CLIMB
 Changing
Lifestyles to Improve Mind
and Body (Melissa George et al.)
 10 middle school participants, 6 sessions
integrated into work of SMH clinicians
(enhanced exercise and/or reduced
screen time, increased fruit and vegetable
intake and/or reduced junk food)
 Strong feasibility and acceptability and
preliminary evidence of impact
Progress, but…. many other
challenges
 Suspension
 Expulsion
 Very
poor transitions
 Schools
and people doing what they are
used to doing (and being highly resistant
to change)
Roles of School-Employed MH
Staff (in some instances)
 Course
scheduling
 Attendance monitoring
 Examination monitoring
 Career guidance
 Logistics assistance

See Steve Evans, Ohio University
Significant Accountability Issues
 “Optimizing”

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School staff doing rote administrative work
Community mental health staff seeing same
clients and delivering passive, eclectic, non
evidence-based interventions
Special Education Challenges
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Schools and staff as gatekeepers
“Social maladjustment”
Highly variable labeling
“Manifestation” hearings
Increasing but not decreasing restrictiveness
Pro-forma meetings and poor follow-up
Accomodations
A National Community of Practice
(COP); www.sharedwork.org
 CSMH
and IDEA Partnership
(www.ideapartnership.org) providing
support
 30 professional organizations and 16
states
 12 practice groups
 Providing mutual support, opportunities for
dialogue and collaboration
Example Practice Groups
 Learning
the Language
 Quality and Evidence-Based Practice
 Family Involvement
 Youth Leadership
 SMH and PBIS
 SMH and Special Education
 SMH and Systems of Care
 Military Families
Sixteen States
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Hawaii
Illinois
New Hampshire
North Carolina
Maryland
Minnesota*
Missouri
Montana*
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New Mexico
Ohio
Pennsylvania
South Carolina
South Dakota
Utah*
Vermont
West Virginia
Ohio Mental Health Network
for School Success (http://www.omhnss.org)
 Since 2001
 Ohio Department of Mental Health
 Ohio Department of Education
 Center for School-Based Mental
Health Programs at Miami University
(http://www.units.muohio.edu/csbmhp)
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
Montana’s Integrated School
Mental Health Initiative
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American Foundation for Suicide Prevention, South Carolina
Appalachian State University
Clemson University
Eastern Carolina University
Medical University of South Carolina
North Carolina Department of Public Instruction
South Carolina Department of Education
South Carolina Department of Mental Health
University of North Carolina at Chapel Hill
University of North Carolina at Greensboro
University of North Carolina at Pembroke
University of South Carolina
Wake Forest University
Advances in School Mental Health
Promotion
New to Routledge for 2012!
Editor in Chief – Mark Weist
Consulting Editor – Michael Murray
Deputy Editor – Sharon Stephan
Published on behalf of The Clifford Beers Foundation
Published in collaboration with the University of Maryland
School of Medicine
18th Annual SMH Conference
Crystal City, Arlington, Virginia
October 3-5, 2013
Contact Information
 Department
of Psychology
University of South Carolina
1512 Pendleton St., Room 237D
 Columbia, SC 29208
Ph: 803 777 8438
[email protected]