Mental Health—Education Integration and the Promotion of School Success

1. Mental Health—Education Integration and the Promotion of School Success Carl E. Paternite, Ph.D. Center for School-Based Mental Health Programs Department of Psychology Miami University (Ohio) http://www.units.muohio.edu/csbmhp Workshop Presented at the Kappa Delta Pi 44th Biennial Convocation St. Louis, Missouri November 15th, 2003

2. Mental Health—Education Integration and the Promotion of School Success • Instructional Objectives For Workshop: • Increase awareness of the associations between student mental health and school success. • Increase awareness of the importance of educators in school-based mental health programs as promoters of student mental health. • Increase knowledge of effective approaches to enhance educator – mental health professional collaboration.

3. See Handout for Summary of Network Vision, Mission, and Action Agenda For more information about the Network visit www.units.muohio.edu/csbmhp/network.html or http://altedmh.osu.edu/omhn/omhn.htm

4. Mental Health Needs of Children/Adolescents and Available Services • About 20% of children/adolescents (15 million), ages 9-17, have diagnosable mental health disorders (and many more are at risk or could benefit from help). • Less than one-third of youth with diagnosable disorders receive any service, and, of those who do, less than half receive adequate treatment (even fewer at risk receive help). • For the small percentage of youth who do receive service, most actually receive it within a school setting. • These realities raise questions about the mental health field’s over-reliance on clinic-based treatment, and have reinforced the importance of alternative models for mental health service — especially expanded school-based programs.

5. Leading Causes of Death in 15-19 Year Olds in the United States in 2000— U N I T E D S T A T E S, 2000 — 1631 CAUSE # OF DEATHS Accidents 6573 Homicide 1861 Suicide 1574 Cancer/Leukemia 759 Heart Disease 372 Congenital Anomalies 213 Lung Disease 151 Stroke 60 Diabetes 40 Blood Poisoning 36 HIV 36 From Weist & Adelsheim, 2003

6. See Handout

7. See Handout

8. Developmental Assets (1997 data, www.search-institute.org) • Approximately 100,000 6th-12th graders. • Youth with Different Levels of Assets. • 8% with 31 or more of 40 assets. • 30% with 21-30 assets. • 42% with 11-20 assets. • 20% with 1-10 assets.

9. Developmental Assets and Violence(1997 data, www.search-institute.org) • Approximately 100,000 6th-12th graders. • Definition of violence—three or more acts of fighting, hitting, injuring a person, carrying a weapon, or threatening physical harm in the past 12 months (self report). • 61% of youth with fewer than 11 of 40 developmental assets were violent. • 6% of youth with 31 or more of 40 developmental assets were violent.

10. Developmental Assets and School Success(1997 data, www.search-institute.org) • Approximately 100,000 6th-12th graders. • Succeeds in School—get’s mostly A’s on report card (self report). • 53% of youth with 31 or more of 40 developmental assets. • 3% of youth with fewer than 11 of 40 developmental assets.

11. Report of President’s New Freedom Commission on Mental Healthhttp://www.mentalhealthcommission.gov “…the mental health delivery system is fragmented and in disarray…leading to unnecessary and costly disability, homelessness, school failure and incarceration.” Unmet needs and barriers to care include (among others): • Fragmentation and gaps in care for children. • Lack of national priority for mental health and suicide prevention. July, 2003

12. Report of President’s New Freedom Commission on Mental Health: Six Goals for a Transformed System • Americans understand that mental health is essential to overall health. • Mental health care is consumer and family driven. • Disparities in mental health services are eliminated. • Early mental health screening, assessment, and referral to services are common practice. • Excellent mental health care is delivered and research is accelerated. • Technology is used to access mental health care and information. July, 2003

13. Four Recommendations Supporting Goal 4: Early Mental Health Screening, Assessment, and Referral to Services are Common Practice Promote the mental health of young children. Improve and expand school mental health programs. Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies. Screen for mental disorders in primary health care, across the lifespan, and connect to treatment and supports. July, 2003

14. Expanded School-Based Mental Health Programs • National movement to place effective mental health programs in schools, serving youth in general and special ed. • To promote the academic, behavioral, social, emotional, and contextual/systems well-being of youth, and to reduce “mental health” barriers to school success. • Programs incorporate primary prevention and mental health promotion, secondary prevention, and intensive intervention,joining staff and resources from education and other community systems. • Intent is to contribute to building capacity for a comprehensive, multifaceted, and integrated system of support and care.

15. See Handout

16. Schools: The Most Universal Natural Setting • Over 52 million youth attend 114,000 schools • Over 6 million adults work in schools • Combining students and staff, one-fifth of the U.S. population can be found in schools From Weist, 2003

17. Schools: The Most Universal Natural Setting • Educators are key partners in efforts to intervene with children in need and to promote positive youth development. • In fact, through their day-to-day interactions with students, educators are the linchpins of school-based efforts to encourage healthy psychological development of youth.

18. Potential of Schools as Key Points of Engagement • Opportunities to engage youth where they are. • Unique opportunities for intensive, multifaceted approaches and are essential contexts for prevention and research activity.

20. Educators as Key Members of the Positive Youth Development/Health Promotion Team “Most educators, parents, students, and the public support a broader educational agenda that also involves enhancing students’ social-emotional competence, character, health, and civic engagement.” (Greenberg, et al., 2003, p. 466)

21. Educators as Key Members of the Mental Health Team • Schools should not be held responsible for meeting every need of every student. • However, schools must meet the challenge when the need directly affects learning and school success. (Carnegie Council Task Force on Education of Young Adolescents, 1989) • There is clear and compelling evidence that there are strong positive associations between mental health and school success.

22. Educators as Key Members of the Mental Health Team • “Children whose emotional, behavioral, or social difficulties are not addressed have a diminished capacity to learn and benefit from the school environment. In addition, children who develop disruptive behavior patterns can have a negative influence on the social and academic environment for other children.” (Rones & Hoagwood, 2000, p.236) • Contemporary school reform—and the associated high-stakes testing (including federal legislation signed in 2002)—has not incorporated the Carnegie Council imperative. That is, recent reform has not adequately incorporated a focus on addressing barriers to development, learning, and teaching.

23. See Handout

24. Educators as Key Members of the Mental Health Team An Exercise: How much time do you spend (or do you imagine that you will spend) addressing the emotional, behavioral, and/or social difficulties of your students (minutes per hour)?

25. Insubordination, noncompliance, defiance, late to class, nonattendance, truancy, fighting, aggression, inappropriate language, social withdrawal, excessive crying, stealing, vandalism, property destruction, tobacco, drugs, alcohol, unresponsive, not following directions, inappropriate use of school materials, weapons, harassment, unprepared to learn, parking lot violation, irresponsible, trespassing, disrespectful, disrupting teaching, uncooperative, violent behavior, disruptive, verbal abuse, physical abuse, dress code, other, etc., etc., etc. Exist in every school Vary in intensity Are associated w/ variety of contributing variables Are concern in every community Problem Behaviors

26. Perceived Problems And Teamwork/Collaboration Exercises See Handouts

27. Context Examples Senior high school with 880 students reported over 5,100 office discipline referrals in one academic year.

28. What does this mean? • 5100 referrals @ 10 minutes each = • 51,000 minutes or • 850 hours or • 141 6 hour days!

29. Context Examples Middle school principal reports he must teach classes when teachers are absent, because substitute teachers refuse to work in a school that is unsafe and lacks discipline.

30. Context Examples Middle school counselor spends nearly 15% of day “counseling” staff who feel helpless & defenseless in their classrooms because of lack of discipline & support.

31. Context Examples Bus transportation company is threatening to w/draw their contract if students don’t improve their behavior. Recently, security guards were hired to ride buses.

32. Prioritizing Promotion of Healthy Development and Problem Prevention • School-based models should capitalize on schools’ unique opportunities to provide mental health-promoting activities. • For example, recommended strategies for drop-out and violence prevention, including those for which the central role of educators is evident, can be promoted actively within an expanded school-based mental health program.

33. Some of What We Know About Youth ViolenceFrom the Surgeon General (2001), U.S. Secret Service (2000),CDC (2002), Mulvey & Cauffman (2001) • Violence is a serious public health problem. • Violence is most often expressive/interpersonal, rather than primarily instrumental or psychopathological. • About 30 to 40 percent of male and 15 to 30 percent of female youth report having committed a serious violent offense by age 17. • About 10 to15 percent of high school seniors report that they have committed an assault with injury in the past year — a rate that has been rising since 1980. • By self-report, about 30 percent of high school seniors have committed a violent act in the past year — hit instructor or supervisor; serious fight at school or work; in group fight; assault with injury; used weapon (knife/gun/club) to get something from a person. • Violent acts are committed much more frequently by male than by female youth. (see Miedzian, 1991)

34. Some of What We Know About Youth Violence (continued) • 43% of male and 24% of female high school students report that they had been in a physical fight during the past school year. (CDC, 2002) • No differences are evident by race for self-report of violent behavior. • At school, highest victimization rates are among male students. • Violent behavior seldom results from a single cause. • School continues to be one of the safest places for our nation’s children. • Serious acts of violence (e.g., shootings) at school are very rare. • Targeted violence at school is not a new phenomenon. • Most school shooters had a history of gun use and had access to them. • In over 2/3 of school shooting cases, having been bullied played a role in the attack.

35. “For every complex problem there is a simple solution that is wrong.” H.L. Mencken

36. A QUESTION: WHAT ARE THE CAUSES OF VIOLENCE, OTHER PROBLEM BEHAVIOR, AND DISCIPLINE PROBLEMS?

39. Model: Influences on Violent versus Non-Violent Behavior (From Shapiro, 1999, Applewood Centers, Inc., Cleveland, OH)

40. Prioritizing Promotion of Healthy Development and Problem Prevention For drop-out prevention, these include: • Early intervention. • Mentoring and tutoring. • Service learning. • Conflict resolution and violence prevention curricula and training for students/staff. • Alternative schooling.

41. Some of What We Know AboutYouth Violence PreventionFrom the Surgeon General (2001), U.S. Secret Service (2000),CDC (2002), Mulvey & Cauffman (2001) • Promoting healthy relationships and environments is more effective for reducing school violence than instituting punitive penalties. • The best predictor of adolescent well-being is a feeling of connection to school. Students who feel close to others, fairly treated, and vested in school are less likely to engage in risky behaviors. • A critical component of any effective school violence program is a school environment in which ongoing activities and problems of students are discussed, rather than tallied. Such an environment promotes ongoing risk management, which depends on the support and involvement of those closest to the indicators of trouble — peers and teachers.

42. Aggressive and Rejected Children • Thinking errors • Attribute hostile intentions to accidental or ambiguous behavior • Misinterpret important social cues • Tease others but respond incompetently when provoked

43. Educators • Thinking errors • If punishment is severe enough, children will cease negative behavior • Punishment is in the best interest of the child • Well controlled classrooms must be quiet classrooms • Control is like a behavioral ointment: • no control at home = slather it on in school • Prescribed discipline programs provide security for staff

44. Violence Prevention:What Doesn’t WorkFrom the Surgeon General (2001) and others • Scare tactics. (e.g., Scared Straight) • Deterrence programs — shock incarceration, boot camps. • Efforts focusing exclusively on providing education/information about drugs/violence and resistance. (DARE) • Efforts focusing solely on self-esteem enhancement. • Vocational counseling. • Residential treatment. • Traditional casework and clinic-based counseling.

45. Prioritizing Promotion of Healthy Development and Violence Prevention:Best and Promising Practices Including: • Structured social skill development programs. • Mentoring. (see Big Brothers/Sisters; Garbarino, 1999) • Employment. • Programs that foster school engagement, participation, and bonding. • Promotion of developmental assets. (see Search Institute) • A variety of approaches that engage parents and families. (e.g., parent training, MST, functional FT) • Early childhood home visitation programs. • Multi-faceted programs that combine several of the above. • For good examples see “Blueprint Programs.”

46. Promoting Nonviolence: An Example of a Heuristic School-Based Framework • Deutsch (1993) — Educating for a peaceful world • Four Key Components Including: • Cooperative Learning. • Conflict Resolution Training. • Use of Constructive Controversy in Teaching Subject Matters. • Mediation in the Schools. See Handout

47. Positive Behavior Support(see www.pbis.org) • PBS is a broad range of systemic & individualized strategies for achieving important social & learning outcomes while preventing problem behavior with all students.

48. Terminology • Positive Behavior…. • Includes all skills that increase success in home, school and community settings. • Supports…. • Methods to teach, strengthen, and expand positive behaviors. • System change.

49. Discipline Defined • “The steps or actions, teachers, administrators, parents, and students follow to enhance student academic and social behavior success.” • “Effective discipline is described as teaching students self-control.”

50. Science of behavior has taught us that students…. • Are NOT born with “bad behaviors” • Do NOT learn when presented contingent aversive consequences • Do learn better ways of behaving by being taught directly & receiving positive feedback From Johnston (2003)