1. Youth Substance Use and Academic Achievement
Louise Fink, Ph.D.,
Baltimore City Public Schools
Rita Mattison, DM, MHS, LCADC,
Baltimore Substance Abuse Systems, Inc.

2. Expanded School Mental Health Program
Baltimore City Public Schools
Baltimore Mental Health System
Baltimore Substance Abuse System

3. PROGRAM OVERVIEW
Baltimore City Public Schools has partnered with external agencies to supplement clinical services to students in general education since 1991
Financial support for these services has remained level ($1.4 million annually) while the number of providers and schools covered has increased
Currently there are 4 lead agencies providing service in a total of 105 schools.

4. Funding Sources The ESMH program has four funding sources
PREVENTION SERVICES
Baltimore City Schools $1.4 Million
Baltimore Mental Health System (BMHS) $726,000
Baltimore Substance Abuse System (BSAS) $420,000
TREATMENT
Public Mental Health System/Medicaid
fee for service

5. ESMH Services Model
Category 1: School-wide Supportive Activities - 20% of clinician time
Category 2: Treatment Services - 50% of clinician time
Category 3: Group Prevention Activities - 20% of clinician time
Category 4: Clinician Professional Development - 10% of clinician time

6. ESMH Services Model

7. School-wide Supportive Activities
Consultation with school staff
In-service presentations
Participation in school-wide crisis management
Participation in school-wide behavior management plan
Participation in school teams
Attendance at school functions

8. Treatment Services Screening/assessment/evaluation/treatment planning
Crisis Response
Family services
Teacher consultation
Clinical Documentation
Activities for reimbursement

9. Group Prevention Activities
Prevention groups for small groups of students
Classroom-wide prevention activities
School-wide prevention activities/assemblies
Parent/family focused
group prevention activities

10. OUTCOME INDICATORS
Student Attendance: percentage of students attending at least 90% of school days
Suspension: percentage of students with no suspensions after beginning services
Special Education referrals: decrease in the
the number of inappropriate referrals to
Child Study teams
Promotion: percentage of students
promoted to the next grade

11. Robert Balfanz 4 indicators
Poor Attendance

12. Robert Balfanz 4 indicators
Poor Reading Skills

13. Robert Balfanz 4 indicators
Behavior Issues

14. Robert Balfanz 4 indicators
Poor Math Skills

15. Robert Balfanz 4 indicators
• Students who fall off track in the sixth grade tend to have one or two off-track indicators. Relatively few sixth graders have three or four indicators, that is, failing math and English and having low attendance and poor behavior.

16. Baltimore Substance Abuse Systems, Inc.
Baltimore Substance Abuse Systems, Inc. (bSAS)
Designated substance abuse treatment and prevention authority for Baltimore City
Administrator of federal, state and local grant funds for substance abuse and prevention services
Monitors treatment programs
Collects client demographic and treatment data
Works in collaboration with other agencies to improve services, and plan/develop new services

17. Collaborative Effects
ESBHI is a behavioral health intervention funded by bSAS in collabration with:
Baltimore Mental Health Systems, Inc. (BMHS)
Baltimore City Public Schools (BCPS)
Baltimore City Health Department (BCHD)

18. Context
Sixth Grade Initiative is nestled within Expanded School Mental Health Initiative (ESMH)
ESMH
Began in 1993
Multi-agency partnership
Provides supplemental mental health prevention, early intervention, and treatment services to children in Baltimore City public schools

19. ESMH Target Population
Children enrolled in general education programs
Grades K through 12
Clinicians work with student support team (SST) to identify social/emotional needs of children and strategies for addressing these

20. What is to be different in 6th Grade Initiative Schools
Targeted high-risk sixth graders
Individualized iterative interventions, regular follow-up, and tracking through SST
Initially used Why Try as the primary small-group intervention / FY12 Botvin’s LifeSkills as primary intervention
S.A. prevention training for faculty/staff
Standardized school-wide behavior management intervention

21. Defining High-Risk Sixth Graders
Research by Dr. Robert Balfanz – Identified children at risk for school drop out as early as 6th grade based on the following 4 risk factors:
Poor attendance
Behavior problems
Lack of math proficiency
Lack of reading proficiency
Retention
School Administrators/Staff
Substance abuse is associated with school drop out

22. 6th Grade Initiative
Concept: bSAS funding is leveraged with BCPS funding to provide targeted interventions with substance abuse focus to at-risk sixth graders
Goal: To prevent school drop-out which minimizes substance use and other negative outcomes for children

23. What Does bSAS Money Buy?
Partially funded mental health clinicians in 35 schools (25% of FTE)
Minimum of 36 consultations for teachers and other school staff
Minimum of prevention group activities/committee meetings
Minimum of 1 family outreach activity
Minimum of 1 in-service presentation to school staff
Approximately $10,000 per clinician. In addition….(1) Benefit of school infrastructure; (2) Access to additional school resources; (3) Full complement of ESMH services if needed; and (4) Access to large group of high-risk children

24. Sixth Grade Initiative – As Implemented
Program began fall 2008
Baltimore City Schools and City Health Department identified 895 6th grade children as meeting at least one targeted risk factor
Clinicians in conjunction with SST identified individualized strategies and interventions for selected population
Clinicians offered enhanced behavioral health services

25. Evaluation of the Impact of ESBHI
Evaluation of ESMH Services during the academic year
Approved by Georgetown University Institutional Review Board (IRB) and BCPS
553 Students in ESBHI were tracked
Service use data was merged with measures of school and academic performance, provided by the Division of Research, Evaluation, Assessment (DREAA) of BCPS.

26. Relationship to Academic Outcomes Benchmarks
Figure 5: Math Benchmark
Comparisons 18 16 14 12 10 8 6 4 2
N=77
N=53
Percent of Students Showing Increases in Benchmarks
Comparison ESBHI
6th Grade Cohort

27. Relationship to School Functioning Attendance
Figure 9: Change in Percent
Attendance for Subcohorts 2 1
Change in Percent Attendance -1 -2 -3
GS-Lo GS-Mid GS-Hi
ESBHI Subcohort

28. Relationship to School Functioning Suspensions
Figure 10 : Change From 5th to 6th Grade in Percent of Students Receiving Different Numbers of Suspensions 6 5 4 3 2 1 -1 -2 -3 23
Comparison
ESBHI
Change in Percent Suspensions 7
-­‐1
-­‐2
-2* -3
Number of Suspensions

29. Conclusion
The relationship between ESBHI participation and academic, attendance and suspension outcomes were evident in students who attended most of the sessions.
Results suggest that participating in a school-based behavioral health life skills groups, implemented with reasonable fidelity, can lead to academic success and school functioning found to reduce or delay onset of substance use and behavioral health problems in youth.
Anthony, B. J. & Sebian, J. K. (2011)

30. Perspectives
“The kids love the group! This is one really great thing that happened this week...it made me so proud of them: Some of my kids created a mini-play that talked about fighting and how they would solve the problem (without me asking them to do so!)! Four of them acted it out at the end of our group and it was really creative and drove the problem-solving point home! I may have them do it again for their parents at the graduation ceremony!”
Behavioral Health Clinician
 ”Coming to the groups has helped me not to fuss with other students when they get on my nerves and I have learned to walk away and not get into fights.”
Student
“I believe the 6th Grade Initiative is good for the students and I would like to see it continued next year.”
Principal

31. References
Anthony, B. J., & Sebian, J. K. (2011). Baltimore Expanded School Mental  Health: Report of the  Program Evaluation. Appendix B:6th Grade Expanded School Behavioral Health Initiative Evaluation Report. Washington, DC: Georgetown University Center for Child and Human Development.  
Balfanz, R., Ruby, A, & Mac Iver, D. (2002).
Essential components and next steps for comprehensive whole-school reform in high poverty middle schools. In S. Stringfield, & D. Land, (Eds.), Educating at-risk students (pp ). Chicago: National Society for the Study of Education.

32. Contact Information
Louise Fink. Ph.D (410) Cityschoolsinside.org Rita Mattison, DM, MHS, LCADC (410) x217