School Mental Health Capacity Building Partnership* Ohio Stakeholder Discussion Groups Bringing Health Care to Schools for Student Success *A project funded through a Cooperative Agreement with the Centers for Disease Control and Prevention, Division of Adolescent and School Health (DASH)

“Promoting School Mental Health through Capacity Building to State and Local Education Agencies (SEA’s and LEA’s)”

Goal 1 Strengthen collaborative national efforts to improve mental health services in schools by increasing intersections between mental health, health, and schools.

Goal 2 Develop, organize and synthesize key documents and resources related to best practices for SEA and LEA improvement and expansion of effective SMH services.

Goal 3 Provide technical assistance, resources and professional development to aid SEA’s and LEA’s in implementing effective school mental health programs.

Statewide Stakeholder Discussion Groups: PURPOSE to help identify successes and lessons learned in “early adopter” states -- at both the state and local levels -- related to school mental health policies, programs and services.

Statewide Stakeholder Discussion Groups: PROCESS 4 “early adopter” states selected Selection criteria: –Shared mental health/education/family agenda –Strong state level collaboration –Vision of how to integrate health into school mental health agenda Four discussion groups per state –Three with state and local leaders in education, family advocacy, health and mental health –One youth only discussion group

Stakeholder Discussion Groups: Ohio: December 2006 Maryland: February 2007 Missouri: May 2007 Oregon: August 2007

Ohio School Mental Health Stakeholder Discussion Groups

Process: Adult Discussion Groups December 7 th and 8 th, 2006 Three 2-hour discussion groups 30 total participants –Mental Health: 13 –Education: 7 –Health: 7 –Family members/advocates: 2 –Youth development: 1

Results Responses to Questions –Themes –Key Quotations Challenges Opportunities

Stakeholder groups began with the following introduction to the state’s school mental health agenda: For the last few years Ohio has been in the process of developing a school mental health agenda that aims to accomplish the following: Promote a better understanding of the importance of children's mental health, especially as it is linked with school climate and academic achievement. Identify and facilitate effective strategies to reduce stigma for children and families who need mental health services and supports.

Expand state and local collaboration across education, mental health, families, and family-serving organizations to support schools as a primary place of engagement to address children's mental health and academic achievement. Enhance the awareness of and improve access to effective school/community mental health promotion initiatives, as well as effective prevention, early intervention and treatment practices for children at risk and those with identified problems.

Are you all aware that Ohio has this school mental health agenda? Most participants were aware of Ohio’s efforts. There is not necessarily just one agenda - multiple agendas in Ohio exist related to school mental health. Since the initiative has been driven by the Department of Mental Health, there is not a sense of shared ownership (with the Department of Education), leading to fragmented communication.

How do you know about it? Departments of Mental Health, Health and Education Regional networks Local committees and boards Professional associations and trainings State agencies University and national centers for school mental health Local and state mental health initiatives and grants

What would make it a stronger agenda? Shared ownership and buy-in of all stakeholders Social marketing and mental health promotion Funded legislative mandates Enhanced link between mental health and physical health Shared funds and resources, with an emphasis on reducing duplication of efforts

Major Themes The existence of an overall state school health agenda is unclear, and state policies connecting mental health to health are not necessarily put into practice. Having a “champion” for school mental health is important; however leadership must be imbedded into a collaborative approach in order to ensure sustainability.

Major Themes (continued) Strategies designed to increase stakeholder involvement in school mental health efforts emphasize the importance of involving family, youth and school staff in all aspects of school mental health, including policy and program development, planning, service delivery, and evaluation.

Major Themes (continued) There is a scarcity of efforts that ensure that school mental health services meet the needs of students from diverse cultural backgrounds. A range of mechanisms to ensure successful coordination of school mental health services include: - holding regular meetings with stakeholders - having a resource/service coordinator to coordinate referrals and services - actively engaging the community in the planning, oversight and evaluation of school mental health efforts.

Major Themes (continued) Strategies to ensure that school staff is equipped to respond to the mental health needs of students include: –pre-service training and ongoing professional development for educators on topics related to mental health; –opportunities for educators and mental health providers to understand their respective roles related to the mental health of students –school-wide programs that provide training and resources related to mental health to all school staff.

Challenges Statewide fragmentation and duplication of efforts due to the localization of efforts Lack of effective social marketing or public awareness efforts related to mental health in schools Limited resources and funding to establish or sustain school mental health efforts

Challenges (continued) Lack of a shared agenda inclusive of all stakeholders including families, education, health and mental health Sustainability of efforts after the departure of key leaders or “champions” of school mental health Lack of pre-service and ongoing teacher education on mental health issues

Opportunities Reduce duplication of efforts and enhance communication and shared learning at all levels (i.e., local-to-local, local-to-state, state-to-local). –many state, regional, and local efforts to advance school mental health in Ohio –statewide agenda provides a potential opportunity to connect efforts and facilitate communication

Opportunities (continued) Increase stakeholder and public understanding about mental health through social marketing and public awareness efforts. –already present in some of Ohio’s communities –existing needs assessment and quality outcome evaluation data can support these efforts. –include a dialogue about effective language that will resonate with stakeholders and consumers (e.g., “mental health” versus “wellness”)

Opportunities (continued) Institute pre-service and ongoing teacher education related to mental health. –Several educator training programs exist in local communities –pending legislation to mandate such training at the state level.

Opportunities (continued) Improve efforts related to ensuring that school mental health services meet the needs of students from diverse cultural backgrounds. –several communities are pursuing this agenda related to education around socioeconomic differences and poverty –need enhanced efforts in addressing other cultural differences including race/ethnicity and sexual orientation.

Opportunities (continued) Work towards shared ownership of and participation in the school mental health agenda by all stakeholders (including families, educators, health and mental health). –Examples of models in Ohio that have shared ownership and service integration include: School-based health centers Family and Children First Programs, Cincinnati Community Learning Centers

Youth Discussion Group PURPOSE: to identify, from a youth perspective, the most effective strategies for providing mental health services in schools and for engaging youth in the development of school mental health policies and programs.

Youth Discussion Group PROCESS December 6th, 2006 One 1.5-hour discussion group Eight participants –Ages –Four from the Youngstown City Schools Student Advisory Board (SAB) and four from Ohio Mental Health Teen Resiliency Group –7 attended public school, 1 high school graduate –4 students were known to have had mental disorders

Process: Youth Discussion Groups SAMPLE QUESTIONS: 1. How can adults at your school make all students feel supported both in school as well as other areas of their life? 2. What can schools do to better understand the different cultures or backgrounds a student comes from? 3. How well do you think that adults in your school respond to students with mental health problems?

Process: Youth Discussion Groups FINDINGS: Students emphasized the importance of the whole school environment –the facility as well as all staff – in feeling accepted and supported at school. Students stressed the need to have adults around them whom they can trust, who accept their differences, and who get to know them as individuals in order to feel supported.

Process: Youth Discussion Group FINDINGS: While students acknowledge the importance of staff being trained in how to respond to students with mental health problems, they would prefer to talk to the adult whom they trust most, regardless of their role at school or training. Students with mental health problems expressed a need for policies that address their individual situations rather than harsh discipline.

Process: Youth Discussion Groups FINDINGS: Students communicated the value of being involved in extracurricular activities in developing leadership skills, confidence, and a connectedness to other students and the school. Students are most likely to participate in adult led activities when they get rewards, but more importantly they want the youth voice to be taken seriously.

Discussion Groups: Next Steps Provide summaries to states Develop cross-state case study highlighting themes of all four states (Fall 2007) Incorporate findings from case study into school mental health capacity building process for SEA’s and LEA’s (Spring 2008)

Laura Hurwitz School Mental Health Project Director , x toll free Bringing Health Care to Schools for Student Success