CAMHPS-MPER School Mental Health Leadership Academy Session 1 - Fall 2007

School Mental Health Why do we need school leaders to LEAD the school mental health effort?

Review Mental Health vs. Mental Illness School Mental Health—What is it? Leadership Academy

School Mental Health What is it NOT? Treatment services for a few students A way to separate students with emotional and behavior disorders from the “regular” population The prioritization of the needs of a certain group of children with mental health concerns

Differing Agendas Inadequate mental health services and poor access Classroom management and school-wide discipline Social-emotional learning and youth development School bonding and school engagement Etc.

Differing Structures School-linked, or School-based Integrated, or Co-located Role confusion, and Role rotation

SMH as School Improvement “The complexity of factors interfering with learning and teaching underscore the need to coalesce efforts to address the variety of factors that interfere with a school accomplishing its mission. And, the coalesced efforts must be embedded into the larger agenda for school improvement.” --Adelman & Taylor, 2007

Four Fundamental Concerns 1.Expand Policy 2.Reframe Interventions 3.Reconceive Infrastructure 4.Rethink the Implementation Problem

Expanded School Improvement “This work of getting the conditions “right” entails work at the school, in the surrounding communities, and, perhaps above all, at the boundaries between schools and their surrounding community ecologies. Aimed at internal and external barriers to learning, getting the conditions right also entails maximizing heretofore untapped opportunities for learning in family and community settings; and then facilitating bridge building between school and community learning structures and opportunities.” --Lawson, 2006

Expanded School Improvement ESI builds on conventional, building-centered improvement planning with its emphases on standards, alignment, and quality assurances ESI shifts planning from one school to the school community, including resource-sharing and transition-supportive relationships with other schools that will serve the same children and youth In ESI models, leadership and management are both collaborative and distributed

Expanded School Improvement Accountability mechanisms can start with academic achievement standards but not end with them. Expanded standards include, for example, those for quality after school programs, effective social and health services programs, and research-supported, parent-family engagement programs. New school improvement agendas can influence state policy

Interconnected Systems for Meeting the Needs of ALL Systems for Prevention Systems for Early Intervention Systems of Care School Resources Community Resources

Starting Point: Systems for Prevention

Why prevention? –Proactive –Cost-effective –Reduces overall number of children needing intensive supports –Beneficial to schools, families, children, & society in general

Prevalence of MH Disorders 50% have a life-time MH disorder anxiety 28.8% mood (depression) 20.8% impulse-control 24.8% substance abuse 14.6% 50% of all lifetime diagnosable MH problems begin before age 14 85% of children receiving community-based MH services reported having experienced symptoms in the classroom (Kessler et al., NCS-R, 2005; Zima et al., 2005)

Summary of Early Prevention Program Benefits Source: Welsh, B.C Economic costs and benefits of early developmental prevention. In Serious and Violent Juvenile Offenders: Risk Factors and Successful Interventions, edited by R. Loeber and D.P. Farrington. Thousand Oaks, CA: Sage Publications, Inc., pp. 339–355.

What does prevention look like? Who should receive prevention programming?

Primary Prevention: All Students Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior ~80% of Students ~15% ~5%

Reducing Risk Factors Individual Victimization and exposure to violence Poor refusal skills Low academic achievement Negative attitude toward school/low school attachment Truancy/frequent absences Suspension Family Family management problems/poor parental monitoring Poor family attachment/bonding Family violence Parental use of physical punishment/harsh and/or erratic discipline practices Low parent education level/illiteracy Maternal depression School Inadequate school climate/poorly organized and functioning schools/negative labeling by teachers Identified as learning disabled Frequent school transitions Peer Association with delinquent/aggressive peers Peer rejection Community Availability/use of alcohol, tobacco, and other drugs in neighborhood High-crime neighborhood Economic deprivation/poverty/residence in a disadvantaged neighborhood Social and physical disorder/disorganized neighborhood

Promoting Protective Factors Individual Social competencies and problem-solving skills Perception of social support from adults and peers School motivation/positive attitude toward school Family Good relationships with parents/bonding or attachment to family Opportunities and reward for prosocial family involvement Having a stable family High family expectations Peer Involvement with positive peer group Good relationship with peers Parental approval of friends School Student bonding and connectedness (attachment to teachers, belief, commitment) Academic achievement/reading ability and mathematics skills Opportunities and rewards for prosocial school involvement High-quality schools/clear standards and rules High expectations of students Presence and involvement of caring, supportive adults Community Safe and health-promoting environment/supportive law enforcement presence Opportunities and rewards for prosocial community involvement Neighborhood/social cohesion

Effective InstructionBehavioral Supports STUDENT ACHIEVEMENT

Fall of Grade 1 Boys

Fall of Grade 1 Girls

Characteristics for Risk Classes Boys vs. Girls

6 th Grade Outcomes for Boys Academic & Behavior Problems Academic Problems Only Behavior Problems Only Poor Grades2.36* Special Education11.31* Suspensions5.74* * Conduct Problems11.21* * Deviant Peer Affiliation 2.46* Depression Anxiety Note: All associations are in relation to Normal Class and are given as odds ratios *p<.05.

6 th Grade Outcomes for Girls Note: All associations are in relation to Normal Class and are given as odds ratios *p<.05. Academic & Behavior Problems Academic Problems Only Poor Grades3.13*3.30* Special Education10.99*12.59* Suspensions Conduct Problems3.70*1.57 Deviant Peer Affiliation Depression Anxiety2.87*2.83*

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

Ineffective Strategies U.S. National Institute of Justice, 1998 Didactic programs targeted on arousing fear (e.g. Scared Straight) D.A.R.E.* Counseling problem students in a peer context. Segregating problem students into separate groups. After school activities with limited supervision and absence of more potent programming. * See for information about research and changes to DARE curriculum.

Wide Ranging Approaches Have Been Found To Be Effective 1. Prenatal & Infancy Programs 2. Early Childhood Education 3. Parent Training 4. After-school Recreation 5. Mentoring with Contingent Reinforcement 6. Youth Employment with Education 7. Organizational Change in Schools 8. Classroom Organization, Management, and Instructional Strategies 9. School Behavior Management Strategies 10. Classroom Curricula for Social Competence Promotion 11. Community & School Policies 12. Community Mobilization

Choosing Prevention Programming? More isn’t always better Inventory what you have Use data to determine need Discontinue infective or poorly implemented programs Integrate programs

“Evidence-based Practices” Programs, interventions, or services that are theory- based, have been carefully studied, and rigorous research studies have shown them to be effective Blueprints for violence prevention – Substance Abuse and Mental Health Services Administration (SAMHSA) –

Early Childhood Examples Universal (Green) –School-wide PBIS –Good Behavior Game (GBG) –Promoting Alternative THinking Strategies (PATHS) social emotional curriculum –Second Step violence prevention curriculum –Bullying Prevention Program (Olweus program) Selected (Yellow) –Incredible Years –First Step –Coping Power Indicated (Red) –Functional Behavioral Assessment (FBA) –Wraparound

pbis.org

On-Line Resources Blueprints for violence prevention – Substance Abuse & Mental Health Services Admin. (SAMHSA) – Information on Character Education – Stop Bullying Now! – National Association of School Psychologist (NASP) –Success in school on line resource kit – PBIS – – – JHU Center for the Prevention of Youth Violence –