Mental Health and Schools Together-NH A Guide to Supporting Collaborative Practice

1. Mental Health and Schools Together-NHA Guide to Supporting Collaborative Practice Sponsored by the Mental Health and Schools Together (MAST-NH) Initiative New Hampshire Center for Effective Behavioral Interventions and Supports at SERESC (NH CEBIS) www.nhcebis.seresc.net

2. MAST-NH (Mental Health & Schools Together) Emerged From a Clear Need for Change • Planning MAST-NH began as we surmised that effective systems to support children & families w/ intensive needs were not in place • Require multi-systems collaboration • Anecdotal & research data supported the premise • We learned effective systems features that were needed & addressed some roadblocks • MAST-NH developed to design & begin to implement a vision to better support schools, children & families • Targets Mental Health, an issue so often a factor in working w/ children with intensive needs • MAST Cornerstone is systems-building & collaboration amongst home, school & mental health providers • Supports PBIS model: build a FULL continuum of support

3. Funding for the Mental Health and Schools Together New Hampshire Initiative is provided by The United States Department of Education Office of Safe and Drug-Free SchoolsDana Carr, Project Director

4. Mental Health and Schools Together-NH:A Guide to Supporting Collaborative Practice Shared Work, Shared Success Shared Challenges, Shared Students

5. Discuss the role schools and educators play in supporting good mental health through UNIVERSAL interventions for ALL Children Hopes for Today: A Mental Health Primer

6. Discuss the role schools and educators play in supporting the mental health of SOME children who are at risk for chronic problem behavior through TARGETED interventions Hopes for Today: A Mental Health Primer

7. Discuss the role schools and educators play (in collaboration with community-based providers) in supporting children with mental illness and their families through INTENSIVE interventions Hopes for Today: A Mental Health Primer

8. Other Hopes for Today: • Discuss indicators of healthy social/ emotional development & information regarding the prevalence of mental illness • Discuss the connections between mental health & behavioral/ academic outcomes in school • Discuss our work in NH to: • Improve on-going communications when schools & community-based agencies are involved with common families • Develop the vision for linking home, school & MH providers for more effective work with children & families with intensive needs

9. I’d Guess There are Differing Views in this Audience • “Discussing Mental Health issues is just not a good use of my time – it’s not relevant to me” • “I am a skeptic, I think any effort we make to help our most troubled students and their families will probably be ineffective” • “It seems that educators have now become de facto mental health providers” • “I embrace this idea” • “I see this as an unfortunate reality • “I believe that is simply NOT the correct role for educators” Well.. I’m not here to try to tell you what to think – rather, to provide information and food for thought. I respect and understand all these feelings and beliefs

10. If nothing else, that the discussion today fuels some hope in you that through partnership with families and other community systems, we can discover how to better support children and families – so that we can achieve outcomes that allow us ALL to do our jobs more effectively MY big wish for today…

11. The Values/Principles/Vision that Guide this Work • Shared Work and communication are critical when it comes to supporting children & families with intensive needs • Identification and implementation of effective practices (supports, services, & strategies) that are efficiently accessible • Construct systems (processes, protocols) that support collaborative work that are reviewed continually for effectiveness and efficiency

12. Today’s Presentation is NOT intended to Encourage schools totake on sole ownership or feel isolated in supporting mental health of students or student’s families (in fact, to the contrary) Suggest that school staff members should EVER diagnose mental illness, emotional disorders, OR discuss medication issues with students or families Provide extensive, in-depth information on any aspect of mental health or illness

13. “The children of today are too much in love with living. They have terrible manners, mock authority, and have no respect for their elders. …I can only fear what kind of awful creatures they will become.” Socrates, 369 B.C.

14. Schools and Children’s Mental Health There is considerable evidence that children’s schooling plays an important role in their adjustment. Success in school is clearly associated with positive mental health & well-being.

15. MH Risk IndicatorsOsher, Dwyer, and Jackson (2004) Alienation Segregation Academic Frustration Chaotic Transitions Negative Relationships with Adults and Peers Teased, Bullied School-driven Mobility ‘School hopping’ School failure Suspension, Expulsion, Drop Out

16. Positive MH IndicatorsOsher, Dwyer, and Jackson (2004) Making Interpersonal Connections Positive Relationships with Adults and Peers Academic Success Successful Transitions Caring Interactions Interactions with Pro-social Peers Stability Over Time

17. Early Recognition: Prevention Means Knowing What to Look for One clue to healthy development is when we see evidence of children meeting typical human needs: • Need for belonging • Need for recognition and attention • Resiliency • Need for control and power • Self-Regulation • Need for Accomplishment, Mastery and Competence The ABCs of Children’s Mental Health (Whelley, 2005)

18. Relationship Between Academics and Behavior The relationship between academic underachievement (particularly reading) and externalizing behaviors suggests that students may act out to avoid academic tasks The relationship between academic underachievement (particularly reading) and internalizing behaviors suggests that students may withdraw to escape academic tasks

19. Classroom teachers can play a key role in supporting mental health and identifying students who MAY be in need of assistance

20. Schools ARE commonly regarded as the de facto providers of mental health services for children and youth (Burns, et al., 1995; Farmer,et al., 2003). Schools and Children’s Mental HealthYou Are Already Providing It!

21. 21% of US children ages 9 to 17 have a diagnosable mental or addictive disorder that causes at least minimal impairment and behavioral challenges Who Comes To School? US Surgeon General’s Latest Report on Children’s Mental Health

22. 10% of US children and adolescents suffer from a serious mental disorder that causes significant functional impairment at home, at school and with peers Who Comes To School? US Surgeon General’s Latest Report on Children’s Mental Health

23. Prevalence Estimates for MH in Children

24. The Fictitious Story of Lizzy Watson The Cast Lizzy Watson: A Female Student (now in 9th grade) Mrs. Watson: Lizzy’s Mother Mr. Jones: Lizzy’s 9th Grade Math Teacher Mr. Strickland: High School Principal Mrs. Gerhardt: Lizzy’s 1st Grade Teacher Mr. Smith: Lizzy’s 3rd Grade Teacher Ms. Perry: Lizzy’s 7th grade Teacher Mrs. Nelson: Middle School Guidance Counselor

25. Process for the Periodic ‘Think’ Sessions • Presenter will periodically pose questions to think about after pieces of the story • Doesn’t need to be silent – can be quiet discussion with person next to you • Can’t expect silence for a full minute, but please use quiet voices • Our limited time together means that we’ll need to get right back to the presentation as soon as the minute ends • Quick silence when presenter raises his hand • Practice

26. We begin near the end of her school experience– the beginning of 9th grade Team Conference Mr. Jones, 9th grade teacher The Fictitious Story of Lizzy Watson

27. Discussion Questions:1 minute Think Can you recall situations where children left you feeling hopeless and discouraged? Can you remember talking with a child and you just didn’t know what to say next – didn’t know what to do next?

28. We Don’t Want to Lose Anyone!

29. And Yet We Do!Mental Illness and Dropout Students with mental illness have the highest dropout rate of any disability group Nationally, 50% of children with serious emotional & behavioral disorders and 30% of students with other disabilities drop out of high school Over half of the adolescents in the United States who fail to complete their secondary education have a diagnosable psychiatric disorder Sources: Stoep et al., 2003; U.S. Dept. of Education, 2001

30. Many Students Not Getting Needed Mental Health Supports We know that 50% of all mood, anxiety, impulse-control and substance-use disorders start by age 14… … But, in any given year, it is estimated that only 20% of children with any type of mental disorder receive mental health services (Goodman et al., 1997). … And studies indicated that of those children who did receive services, fewer than 50% received the appropriate service relative to their need (Kazdin, 1996).

31. It begins early... Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

32. The proportion of preschool children meeting the criteria for the clinical diagnosis of ODD (Oppositional Defiant Disorder) ranges from 7% to 25% of children in the United States, depending on the population surveyed. ( Webster-Stratton, 1997) Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

33. Of the young children who show early signs of problem behavior, it has been estimated that fewer than 10% receive services for these difficulties. Kazdin & Kendall, 1998 Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

34. The Fictitious Story of Lizzy Watson Lizzy in First Grade Lizzy screened for vision, hearing and academics – but not for behavior Adequate academic skills Sweet, shy, soft spoken Mrs. Gerhardt, First Grade Teacher

35. Early Struggles have Lasting Effect Children who fall behind in 1st grade have a one in eight chance of ever catching up to grade level without extraordinary efforts (Journal of Educational Psychology, 1994)

36. Example of School Effects: Impact of 1st Grade Teachers on 7th Grade Behavior The Impact of First Grade Teacher Capacity on 7th Grade Behavior (Kellam, Ling, Merisca, Brown, & Ialongo, 1998)

37. The Fictitious Story of Lizzy Watson Lizzy in Fifth Grade Mr. Smith, 5th grade teacher On grade level, but work of poor quality, and hardly ever finished No friends Low participation in class Not eligible for school services

38. Lizzy If Lizzy had a broken leg, you’d know what was wrong; If she wasn’t reading in 5th grade, You’d know who to speak to; If she was throwing chairs through the window, You’d know there was something really wrong; but, it seems that mental health issues aren’t always clear cut or as visible as other types of issues Lizzy isn’t really a behavior problem and she isn’t presenting major academic problems. Perhaps it’s just her temperament? Perhaps she is like her dad – a little different.

39. Discussion Questions1 Minute Think Have you run across a student where your gut tells you something’s wrong, but you’re not sure what to do about it – you’re not sure if you are over-reacting? Not sure if it really is a problem? Do you know where to turn get information if you had concerns? Do you know who to go to if you wanted to talk through your concerns or just vent your thoughts? Do some students like Lizzy fall between the cracks in terms of qualifying for extra supports and services?

40. A recent analysis of three national databases indicated that nearly 80% of low income youths in need of mental health services did not receive services within the preceding 12 months, with rates approaching 90% for uninsured families (Kataoka, Zhang, & Wells, 2002). Many Students Not Getting Needed Mental Health Supports

41. Barriers to Involvement in Child Mental Health InterventionsMcKay (2007) Poverty, single parent status and stress Concrete obstacles: time, transportation, child care, competing priorities Stigma associated with mental illness and seeking care Previous negative experiences with mental health or institutions Scarce mental health resources Concerns about confidentiality Isolation

42. Even those families who receive mental health services experience attrition rates of greater than 50%, with low-income, minority children at especially high risk (Kazdin, 1996; Kazdin, Holland, & Crowley, 1997; Yeh, et al., 2003). Keeping Mental Health Services Alive

43. The Fictitious Story of Lizzy Watson Lizzy in 7th grade Mrs. Perry, 7th grade LA teacher Failing some classes; barely passing others Socially isolated except for Sheila Superficial cutting behavior beginning Discipline referrals for disrespect Won’t go to counseling

44. Discussion Questions Have you ever been frustrated with not having clear expectations about follow-up and on-going communications amongst home, school and mental health providers? Does it seem that school is left holding the bag when you see family or outside agencies not doing their parts? Do you ever feel like giving up because others don’t follow through?

45. To be alienated is to lack a sense of belonging, to feel cut off from family, friends, school or work – the four worlds of childhood Urie Brofenbrenner, 1986

46. Students with Serious Emotional Disturbance (SED) miss more days of school than do students in all other disability categories (U.S. Department of Education, 1994) More than half of students with SED drop out of grades 9-12, the highest rate for all disability categories. (U.S. Department of Education, 2002) Of those students with SED who drop out of school, 73% are arrested within five years of leaving school (Jay & Padilla, 1987) Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

47. Lizzy in 9th grade School meeting Not attending classes Likely to fail classes Waiting to drop out ‘Cutting’ more frequent Mrs. Watson blames school The Fictitious Story of Lizzy Watson

48. Discussion Questions We all know where this meeting could go -- we’ve all felt blamed. It would be easy for this to end in a ‘blame game’ where no one wins What’s a typical reaction to being blamed? How do you respond? What could be said or done that might end the blaming before it stops the problem-solving? What could Mr. Strickland say after Mrs. Watson spoke that would have both supported his staff AND at the same time have helped the team to problem solve?

49. There are evidence-based practices that are effective in changing the developmental trajectory…the problem is not what to do, but rests in ensuring access to intervention and support We CAN Impact Future Performance Center for Evidence Based Practice: Young Children with Challenging Behavior www.challengingbehavior.org

50. Creating a Caring CommunityOsher (2006) Students perform better on tests when they believe that their teachers care about them This correlation is stronger for students who are judged to be at risk for dropping out of high school Supportive relationships promote student engagement, positive attitudes, a sense of belonging to school, motivation, & academic achievement Connections with adults in the school protect against a range of anti-social outcomes which impact academic performance (e.g., substance abuse)