1. Best Practices and Resources in School Mental Health Best Practices and Resources in School Mental Health Mark D. Weist & Dana Cunningham University of Maryland Center for School Mental Health April 28, May 21, 2008

2. 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 http://csmh.umaryland.edu

3. Referrals from Schools to Other Settings 96% referred to school-based program received services 13% referred to other community agency did Catron, T., Harris, V., & Weiss, B. (1998)

4. Treatment as Usual Show Rates (McKay et al., 2005) from Kimberly Hoagwood

5. Other Concerning Facts Around 1 in 5 youth will present an emotional/behavioral disorder (5 students in a classroom of 25) Between 1/6 th and 1/3 rd receive any services Modal number of specialty mental health visits is 2 Major lack of systematic quality assessment and improvement in traditional settings

6. Silos “The various systems do not talk to each other, resulting in many children falling through the cracks and not receiving care, receiving duplication of services, or families needing to negotiate a confusing, fragmented array of services” (Family Advocate, Louisiana)

7. “Shame” and “Strain” on Families “Youth and families experience blame; have widespread distrust of professionals; have concerns about losing custody; are often unable to pay for care…have to glue services together” –Kimberly Hoagwood (Congressional Briefing, October, 2007)

8. April 16, 2007 “Rather than falling through the cracks, Cho crawled into the cracks and hid there” - Chris Fynn- director of VA Tech’s counseling center Shuchman, M. (2007) Shuchman, M. (2007)

9. Growing Focus on School Mental Health Schools as the “defacto” sites for mental health care U.S. Surgeon General Reports (1999, 2000) President’s New Freedom Commission on Mental Health Report (2003; www.mentalhealthcommission.gov) Educational Mandates, e.g., Response to Intervention A range of federal grant programs Strong international interest

10. Advantages ACCESS Promotion and Prevention Efficiency and Cost Effectiveness Systems Collaboration/ Economies of Scale Natural/ Ecological Approach Reduced Stigma

11. A Cogent Rationale Integrated approaches to reduce academic and non-academic barriers to learning are the most effective in achieving the outcomes families, schools and communities care about

12. Academic SystemsBehavioral Systems 1-5% 5-10% 80-90% Intensive, Individual Interventions Individual Students Assessment-based High Intensity Intensive, Individual Interventions Individual Students Assessment-based Intense, durable procedures Targeted Group Interventions Some students (at-risk) High efficiency Rapid response Targeted Group Interventions Some students (at-risk) High efficiency Rapid response Universal Interventions All students Preventive, proactive Universal Interventions All settings, all students Preventive, proactive The Public Health Approach

13. A Vision for School Mental Health Strong stakeholder involvement and a shared family-school-community system agenda Full continuum of effective supports and services for all students in general and special education The right staff with the right training, supervision, coaching and support

14. Vision (cont.) Emphasis on quality assessment and improvement and evidence-based practice Strong focus on achieving valued outcomes Outcome findings feed back into program improvement and into policy and advocacy agendas

15. Another Triangle Another Triangle Desired Outcomes Effective mental health promotion and intervention Outstanding staff and program qualities Ongoing training, technical assistance & support School and community buy-in and investment Resources Awareness raising, advocacy, policy improvement

16. But in most communities… The vision is not a reality as staff and programs are not adequately supported and often contending with tremendous need, and In an environment of low support and high needs, positive outcomes will most likely not be achieved and efforts will stall

17. Prince George’s County School Mental Health Initiative Intensive, evidence-based mental health intervention for students in special education in two schools Training and support to 11 schools with specialized programs for youth presenting emotional problems Broader training and support county wide (e.g., for all school psychologists)

18. Partners University of Maryland CSMH Prince George’s County Public Schools (PGCPS) Maryland State Department of Education (MSDE)

19. Staffing for Two Schools One PGCPS liaison Two therapists One case manager Parent Liaison Psychiatric consultation

20. Student Criteria At-risk for non-public placement Social-emotional goals on IEP Behavioral intervention plans Acting out problems Multiple risks Family interest

21. Program Framework Build supportive relationships with the youth and family Decrease risk factors Enhance strengths and protective factors Enhance development of key cognitive behavioral skills

22. Program Framework (cont.) Improve problem solving Improve anger management skills Address trauma history FOCUS ON QUALITY CONSTANTLY

23. Key Processes in Working with Families EngagementEmpowermentSupportCollaboration

24. Family Needs Addressed Food, health insurance, medical needs, clothing, transportation, utilities, substance abuse services, mental health services, tutoring, mentoring, recreational programs

25. Anxiety: Practice Components

26. Use of Evidence-Based Programs Anger Management Group –Identifying anger early –Understanding short- and long-term consequences –Recognizing and managing emotions –Understanding cognitive processes –Developing coping skills –Learning to problem solve –Communicating effectively

27. Qualitative Evaluation - Families “The therapists are always available when we need them” “My granddaughter is less angry now than she used to be” “The case manager helped me get back on my feet after I lost my job”

28. Student Feedback They liked having a therapist at school for the following reasons: “They are on your side.” “You can get stuff off your chest.” “You get out of class and don’t have to do work.” “They give you good advice.” “It’s free.” “If you have a problem, they are right there.”

29. Absences by Quarter

30. Suspensions by Quarter

31. Data on Non-Public Placements Between September, 2006 and March, 2008, 43 students were seen for more intensive services in the two schools All met multiple criteria for placement in non- public programs 3/43 students were placed in a non-public program

32. Data (cont.) Preliminary economic analyses indicate: –For 1.6 years of services (as of 3/14/08), 25 placement years were diverted –For a savings of between $800,000 and $1,000,000 for Prince Georges County alone

33. Agendas The Prescriptive Agenda (e.g., implementing evidence-based services in schools, documenting outcomes, building advocacy, growing into more schools) is dependent on The Collaborative Agenda (i.e., building relationships, promoting dialogue and developing true collaboration and partnerships)

34. A National Community of Practice CSMH and IDEA Partnership (www.ideapartnership.org) providing support www.ideapartnership.org 30 professional organizations and 12 states 10 practice groups Providing mutual support, opportunities for dialogue and collaboration Advancing multiscale learning systems Sign up at www.sharedwork.org www.sharedwork.org

35. 10 Practice Groups Mental Health-Education Integration Developing a Common Language Connecting Education and Systems of Care Connecting SMH and Positive Behavior Support Improving SMH for Youth with Disabilities

36. 10 Practice Groups (cont.) SMH, Juvenile Justice and Dropout Prevention Family Partnerships Youth Involvement and Leadership SMH – Child Welfare Connections Quality and Evidence-Based Practice

37. Twelve States HawaiiIllinois New Hampshire North Carolina MarylandMissouri New Mexico OhioPennsylvania South Carolina South Dakota Vermont

38. Maryland is the National SMH Leader UMBC Dissertation, April, 2007 Lisa Sadzewicz “Diffusion of Innovation: State Factors that Influence the Spread of School Mental Health Policies and Programs”

39. Survey of State Children’s Mental Health Directors on SMH Innovation Nominations: –1. Maryland (9) –2. California (6) –3. Ohio (5) –4. North Carolina (4)

40. Policy/Funding Mechanisms used to Support SMH Policy/Funding Mechanisms used to Support SMH Number: –1. Massachusetts (16) –2. Maryland (15) –3. North Carolina (14) –4. Californian (13)

41. School Mental Health Workgroup Established in 2002 as part of MHA’s Blueprint strategic planning process Promoting a coordinated SMH agenda for MD Two statewide surveys of SMH Providing assistance to federal grant proposals Developing SMH outreach and services for youth in foster care

42. CSMH Training Events 13 th Annual Conference on Advancing School Mental Health. Phoenix, Arizona, Florida. September 25-27, 2008 School Health Interdisciplinary Program (SHIP). Ellicott City, Maryland. August 4-7, 2008 See http://csmha.umaryland.edu or call 410- 706-0980 (or 888-706-0980 toll free) See http://csmha.umaryland.edu or call 410- 706-0980 (or 888-706-0980 toll free)http://csmha.umaryland.edu

43. www.schoolmentalhealth.org Website developed and maintained by the CSMH with funding from the Baltimore City Health Department User-friendly mental health related information and resources for caregivers, teachers, clinicians, and youth

44. Welcome to the School Mental Health Connection! This site offers school mental health resources not only for clinicians, but also for educators, administrators, parents/caregivers, families, and students. To efficiently find resources that fit your needs, just click the link to the left that corresponds to your role in the school community. However, since you may benefit from resources in numerous domains within this site, we encourage you to explore many areas. The resources on this site emphasize practical information and skills based on current research, including prominent evidence-based practices, as well as lessons learned from local, state, and national initiatives. The School Mental Health Connection is designed for use by anyone who is interested in school mental health. It is also a central feature of the Baltimore School Mental Health Technical Assistance and Training Initiative. school mental health Baltimore School Mental Health Technical Assistance and Training Initiative.school mental health Baltimore School Mental Health Technical Assistance and Training Initiative. What's New View the newly-released Directory of Community Services for Baltimore City. Directory of Community Services for Baltimore CityDirectory of Community Services for Baltimore City Educators: Check out the user-friendly Mental Health Fact Sheets for the Classroom, provided by the Minnesota Association for Children's Mental Health. Mental Health Fact Sheets for the ClassroomMental Health Fact Sheets for the Classroom Home About Us Resources for Clinicians Resources for Educators Resources for Families Resources for Students FAQ Baltimore City Resource Directory Consultation & Support Line Consultation & Support Line © 2006 The School Mental Health Connection. All Rights Reserved.

45. Other Helpful School Mental Health Websites Center for the Advancement of Mental Health Practices in Schools http://schoolmentalhealth.missouri.edu/about.htm Center for School-Based Mental Health Programs http://www.units.muohio.edu/csbmhp/ UCLA Center for Mental Health in Schools http://smhp.psych.ucla.edu http://smhp.psych.ucla.edu

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

47. Two Books Handbook of School Mental Health (2003, paperback – 2007) –www.springer.com Advances in School-Based Mental Health Interventions (2007) –www.civicresearchinstitute.com/sbmh.htm

48. Two New Journals Advances in School Mental Health Promotion –The Clifford Beers Foundation and the University of Maryland –www.schoolmentalhealth.co.uk School Mental Health –www.springer.com

49. Contact Information Center for School Mental Health, Department of Psychiatry University of Maryland 737 W. Lombard Street, 4 th Floor Baltimore, MD 21201 PH: 410-706-0980 FX: 410-706-0984 mweist@psych.umaryland.edu http://csmh.umaryland.edu mweist@psych.umaryland.edu http://csmh.umaryland.edu mweist@psych.umaryland.edu http://csmh.umaryland.edu