! 1. Expanded School Mental Health. School Mental Health, PBIS and the Interconnected Systems Framework

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1 Expanded School Mental Health School Mental Health, PBIS and the Interconnected Systems Framework Mark D. Weist, Ph.D. Department of Psychology, University of South Carolina PBIS Leadership Forum, Ø Full continuum of effective mental health promotion and intervention for students in general and special education Ø Reflecting a shared agenda involving school-family-community system partnerships Ø Collaborating community professionals (not outsiders) augment the work of school-employed staff Center for School Mental Health* University of Maryland School of Medicine *Supported by the Maternal and Child Health Bureau of HRSA and numerous Maryland agencies Johns Hopkins Center for Prevention & Early Intervention Leads: Nick Ialongo, Phil Leaf, Catherine Bradshaw 1

2 Barriers to Evidence-Based Programs in Schools Ø Clinician Ø School Setting Ø Funding/Resources Clinician Related Barriers Ø Limited prior training on evidence-based practices Ø Resistance Ø Role constraints Ø Need for administrative support Ø Need for ongoing coaching and technical assistance Typical Work for Clinician for Evidence-Based Prevention Group School Related Barriers Ø Screen students Ø Analyze results of screen Ø Obtain consent/ assent Ø Obtain teacher buy-in Ø Coordinate student schedules Ø Get them to and from groups Ø Rotate meeting times Ø Implement effectively Ø Promote group cohesion Ø Address disruptive behaviors Ø Conduct session by session evaluation Ø Deal with students who miss groups Ø Fluidity of the school environment Ø Teacher turnover Ø Tenuous principal buy-in Ø Lack of time Ø Lack of dedicated change agents Evidence-Based Manualized interventions (from Sharon Stephan) Modular Intervention Intervention/Indicated: 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 Ø SEE: Ø 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 Ø camhd/library/pdf/ebs/ebs013.pdf! 2

3 CSMH Study on EBPs (from S. Stephan) Ø Study 1: l Anonymous, online survey of 25 school mental health clinicians in four Maryland programs: Anne Arundel County Baltimore School Mental Health Initiative Prince George s County School Mental Health Program Frequency ratings of materials by presenting problem l All clinicians received monthly professional development in evidence-based skills, with subscriptions to PracticeWise Clinicians reported a significantly greater likelihood of using PracticeWise materials as compared to manualized EBPs for both Anxiety (p=.02) and Depression (p<.01). Ø Study 2: CSMH Study 2 on EBPs (from S Stephan) l Professional Development Evaluation: N = 70 school mental health clinicians in Baltimore City Expanded School Mental Health Network (ESMH) l Mixed Methods with Random Assignment 3 different professional development groups Online surveys + in-person interviews Examined knowledge about and attitudes toward EBPs, + self-reported use of practice elements Practice Elements with Best Support ANXIETY Exposure DISRUPTIVE BEHAVIOR Praise Tangible Rewards Time Out Diff. Reinforcement Psychoeducation for parent Commands DEPRESSION Activity Scheduling Psychoeducation for youth Maintenance/ Relapse Prevention Self-monitoring Goal Setting Self-Reward/ Praise INATTENTION Stimulus Cntrl/ Antecedent Mgmt (Connors, E., Stephan, S., & Schiffman, J., 2012) High Rankings Practice Elements: Ranked most used by clinicians ANXIETY Exposure DISRUPTIVE BEHAVIOR Time Out Diff. Reinforcement Psychoeducation for parent Commands DEPRESSION Activity Scheduling Psychoeducation for youth Maintenance/ Relapse Prevention Self-monitoring Self-Reward/ Praise INATTENTION Stimulus Cntrl/ Antecedent Mgmt Practice Elements: Ranked least used by clinicians ANXIETY DISRUPTIVE BEHAVIOR Praise Tangible Rewards Time Out Psychoeducation for parent Commands DEPRESSION Activity Scheduling Psychoeducation for youth Goal Setting Self-Reward/ Praise INATTENTION Stimulus Cntrl/ Antecedent Mgmt Low Rankings! 3

4 Study Overview Strengthening School Mental Health Services NIMH, R01MH A2, (building from a prior R01) 46 school mental health clinicians Randomly assigned to either: Personal/ Staff Wellness (PSW) Supporting clinician, family and student wellness Clinical Services Support (CSS) Quality Assessment and Improvement Family Engagement/Empowerment Modular Evidence-Based Practice Implementation Support Four Key Domains Quality Assessment and Improvement (QAI) Principles Ø Quality Assessment and Improvement Ø Family Engagement and Empowerment Ø Modular Evidence Based Practice Ø Implementation Support Ø Emphasize access Ø Tailor to local needs and strengths Ø Emphasize quality and empirical support Ø Active involvement of diverse stakeholders Ø Full continuum from promotion to treatment Ø Committed and energetic staff Ø Developmental and cultural competence Ø Coordinated in the school and connected in the community Ø Engagement Ø Support Ø Collaboration Ø Empowerment Working Effectively with Students and Families l see the work of Kimberly Hoagwood and Mary McKay Modular Evidence-Based Practice (EBP) 10 skills for disruptive behavior problems: o Active Ignoring o Commands o Communication Skills o Monitoring behavior o Praise o o Psychoeducation o Response cost o Tangible rewards o 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! 4

5 Ø Ø Ø Ø 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 l see Dean Fixsen, Karen Blasé, National Implementation Research Network (NIRN) Interconnected Systems Framework (ISF) for SMH-PBIS Ø Strategy for interconnection of two systems across multiple tiers Ø Emphasizes state teams working with district teams and schools, and strong team planning and actions at each tier Ø Two national centers (for SMH and PBIS) and a number of states involved Ø Numerous training events and a monograph in progress ISF, School Readiness Assessment Ø 1) High status leadership and team with active administrator participation Ø 2) School improvement priority on social/ emotional/behavioral health for all students Ø 3) Investment in prevention Ø 4) Active data-based decision making Ø 5) Commitment to SMH-PBIS integration Ø 6) Stable staffing and appropriate resource allocation ISF, Indicators of Team Functioning Ø Strong leadership Ø Good meeting attendance, agendas and meeting management Ø Opportunities for all to participate Ø Taking and maintaining of notes and the sense of history playing out Ø Clear action planning Ø Systematic follow-up on action planning ISF, Ongoing Qualitative Research Ø Examples of questions: l To what extent do PBIS and SMH providers work jointly to coordinate services for youth and families? l What are the barriers to their active collaboration? l How can those barriers be overcome? A National Community of Practice (COP); Ø CSMH and IDEA Partnership ( providing support Ø 30 professional organizations and 16 states Ø 12 practice groups Ø Providing mutual support, opportunities for dialogue and collaboration Ø Advancing multiscale learning! 5

6 Montana s Integrated School Mental Health Initiative Conclusions Ø Need the right clinicians Ø For true EBP demands are intense at multiple levels Ø TRAINING/IMPLEMENTATION SUPPORT + INCENTIVES + ACCOUNTABILITY Ø Tension between productivity and quality Conclusions 2 Ø Need for concurrent policy change (e.g., related to fee-for-service demands) Ø How enhance infrastructure for quality implementation? Ø School leadership and functioning of teams are critical variables Ø Significant need for training, practice, and policy enhancement in interconnected PBIS and SMH 17 th Annual SMH Conference Salt Lake City, Utah October 25-27, 2012 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! 6

7 Contact Information Ø Department of Psychology University of South Carolina 1512 Pendleton St., Room 237D Ø Columbia, SC Ph: Schooling and Mental Health: What Matters Most? Marc S. Atkins, Ph.D. Professor of Psychiatry and Psychology University of Illinois at Chicago Institute for Juvenile Research National Spotlight on Schools No Child Left Behind No Child Left Untested U.S Ranking of 30 Countries 25th in Math 21st in Science Global Marketplace China and India rising Teacher Stress Low morale, depressed, feeling unfairly blamed for the ills of society? You must be a teacher. - NY Times Educa?onal Supplement (1997) 50% of teachers in high poverty schools leave within 3-5 years (20% of all teachers) Shernoff et al., School Psychology Review! 7

8 High School Completion Students with Disabilities Service Use by Sector Great Smokey Mountain Study Sole Source of Services (1 Year) Percentage Speech LD MR Emotional U. S. Department of Education, Institute of Education Sciences, National Center for Special Education Research, National Longitudinal Transition Study Percentage None Mild High Level of Need Burns et al., 1995 None Health Education MH School-Based Mental Health Service Models Clinic within schools (Medical Model) Counseling (50% of NYC Special Education) Low parent involvement High need students (Special Ed Model) Targeted or intensive services Self-contained or mainstreamed School-wide reform (Whole School Model) Difficult to implement and sustain Mental health resources rarely involved Mental Health Problems Identified by Schools School Mental Health Services in the United States, SAMHSA, 2005 Mental Health Services Provided by Schools Tutoring vs. Social Skills Training Reading Vocabulary Mean Baseline Post-Test Follow-Up Control Tutoring Social Skills Combined School Mental Health Services in the United States, SAMHSA, 2005 Coie & Kriebel, 1984, Child Development, 55, ! 8

9 Mean Tutoring vs. Social Skills Training Social Preference Baseline Post-Test Follow-Up Control Tutoring Social Skills Combined Coie & Kriebel, 1984, Child Development, 55, School Goals Are Mental Health Goals Predic?ve of delinquency: Academic failure Low school bonding Truancy Low grades and aggression in first grade highly predic?ve of not gradua?ng high school* Academic achievement protec?ve for urban children *Ensminger & Slusarcick (1992). Sociology of Education, 65, Enhancing School Engagement National Academies 2003 Prevention AND Promotion Redesign high school courses to increase adolescent engagement and learning Ongoing classroom assessment of students understanding and skills Enhanced teacher preparation both preservice and ongoing on adolescent development and pedagogy Foster personalized learning environments that enhance student-teacher relations Diffuse school guidance and counseling services among staff, including teachers, with support of mental health professionals 52 Mental Health Promotion Ø Enhance individuals ability to achieve developmentally appropriate tasks (developmental competence) Ø Enhance individuals positive sense of selfesteem, mastery, well-being, and social inclusion Ø Strengthen their ability to cope with adversity 53! 9

10 Prevention Window 55 Effective Schools Low Communality High Communality Public Health Model Building a Base Low Academic Press No one succeeds here, no matter how hard they try Everyone succeeds here, whether or not they try Mental health services Intensive High Academic Press Boyd & Shouse, 1997 Not everyone succeeds even if they try Everyone succeeds here as long as they try Targeted Universal Rely on Indigenous Resources New Goals for School-Based Mental Health Programs Expanded mental health workforce From a limited number of trained professionals to include the key people most important to children s development Realigned mental health resources To effect the key predictors that promote successful adaptation Revised program goals To allow schools to adopt the programs they need at the pace they want Reduce the silos of mental health and schools To promote a natural extension from prevention (universal programs) to intervention (targeted and intensive programs) Atkins et al. (2010). Towards the integration of education and mental health in schools. Administration and Policy in Mental Health and Mental Health Services Research, 37:40-47.! 10