Tim Knoster McDowell Institute: Bloomsburg University

1. Enhancing Professional Educator Pre-service Training to Address Social, Emotional & Behavioral Wellness of PK-12 Students Tim Knoster McDowell Institute: Bloomsburg University Danielle Empson McDowell Institute: Bloomsburg University Keywords: Training, Mental Health, and Alignment

2. Maximizing Your Session Participation • Consider 4 questions… • 1. Where are we in our implementation? • 2. What do I hope to learn? • 3. What did I learn? • 4. What will I do with what I learned?

3. Exploration & Adoption • We think we know what we need so we are planning to move forward (evidence-based) Where are you in the implementation process?Adapted from Fixsen & Blase, 2005 Installation • Let’s make sure we’re ready to implement (capacity infrastructure) Initial Implementation • Let’s give it a try & evaluate (demonstration) Full Implementation • That worked, let’s do it for real and implement all tiers across all schools (investment) • Let’s make it our way of doing business & sustain implementation (institutionalized use)

4. Leadership Team Action Planning Worksheets: Steps Self-Assessment: Accomplishments & Priorities Leadership Team Action Planning Worksheet Session Assignments & Notes: High Priorities Team Member Note-Taking Worksheet Action Planning: Enhancements & Improvements Leadership Team Action Planning Worksheet

5. Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT FRAMEWORK: ~5% Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior ~15% Primary Prevention: School-/Classroom- Wide Systems for All Students, Staff, & Settings -Students -Staff -Parents/ Families ~80% of Students

6. Advancing Education Effectiveness: Interconnecting School Mental Health and School-Wide Positive Behavior Support Editors: Susan Barrett, Lucille Eber and Mark Weist pbis.orgcsmh.umaryland IDEA Partnership NASDSE

7. Situating Suicide Prevention within PBIS • PBIS Core Components • Evidence based interventions and strategies. • Data informed decision making. • System development to enable accurate and durable implementation • School-based Suicide Prevention • Policies and procedures for prevention, intervention and postvention • Education for students, staff, and families • Screening and assessment

8. Prevalence of Mental Health Related Issues • According to the Center for Behavioral Health Statistics and Quality (2015), approximately one in five children currently have or will experience a severe mental disorder. • A little over one in five (22.2 percent) adolescents between the ages of 13-18 experience a mental disorder that has a severe impact on daily functioning (Merikangas et al., 2010). In essence, this equates to the potential for as many as five students in a typical classroom of 25 students having a mental disorder that severely affects daily functioning. • For people who do experience mental health disorders, most experience their first symptoms before young adulthood (half with onset of symptoms by age 14). It is further reported that close to half of these students will likely drop out of school. • Further alarming is the fact that suicide is the second leading cause of death among adolescents and young adults (Center for Disease Control and Prevention, 2013). • Given the amount of time children and adolescents spend in school, coupled with the proportion of students that have mental health challenges, it is not surprising that educators (and in particular teachers) are on the front line to notice challenges, and, in turn, implement evidence-based prevention and intervention programs.

9. Importance of Understanding ACEs & Trauma • Adverse Childhood Experiences (ACEs) are traumatic events that can have negative, long-lasting effects on learning, health, and well-being over the lifespan. Building awareness and skills associated with trauma-informed classroom practices within educators is a logical, necessary step to creating trauma informed instructional practice in our schools. • Trauma, in particular, is commonly viewed as one of the most powerful risk factors associated with mental health disorders and is directly linked to suicide risk (National Alliance on Mental Illness, 2015). • Looking further into the prevalence of specific mental health disorders associated with (at least in part) childhood trauma, the data is compelling as it pertains to the importance of educators receiving training in trauma informed approaches to instruction.

10. ACEs Study: Let’s take a look https://vimeo.com/139998006

11. Importance of Social Emotional Learning • Extensive research, including a meta-analysis of 213 studies, has shown that programs designed to promote social and emotional competence in students produce important outcomes, including improvements in standardized academic test scores that are, on average, 11 percentage points higher for students who received SEL programming, compared to students who did not receive SEL (Durlak, Weissberg, Dymnicki, Taylor, & Shellinger, 2011). • In addition, high-quality instruction in SEL has been associated with reduced problem behaviors including conduct problems, drug use, and violence (e.g., Botvin et al., 1995; Farrell & Meyer, 2001). • The cost effectiveness of these approaches has also been established in a recent report finding that programs designed to promote social and emotional competence produce, on average, a benefit to cost ratio of 11:1 (Belfield et al., 2015).

12. So What Does This Look Like in Educator Preparatory Programs? Example One: Bloomsburg University Example Two: Statewide YMHFA-IHE Initiative

13. Bloomsburg University COE Youth Mental Health First Aid (YMHFA): Situated just prior to Capstone/Student Teaching YMHFA is an 8-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis. The evidence behind the program demonstrates that it does build mental health literacy, helping the public identify, understand, and respond to signs of mental illness. Mental Health First Aiders learn a single 5-step strategy that includes assessing risk, respectfully listening to and supporting the individual in crisis, and identifying appropriate professional help and other supports. Participants are also introduced to risk factors and warning signs for mental health or substance use problems, engage in experiential activities that build understanding of the impact of illness on individuals and families, and learn about evidence-supported treatment and self-help strategies.

14. Bloomsburg University COE Question – Persuade – Refer (QPR): Situated upon Formal Entry to Teacher Candidacy QPR is a 2 hour educational program designed to teach lay and professional "gatekeepers" the warning signs of a suicide crisis and how to respond. The process follows three steps: (1) Question the individual's desire or intent regarding suicide, (2) Persuade the person to seek and accept help, and (3) Refer the person to appropriate resources. QPR training results in increased knowledge about suicide, gatekeeper self-efficacy, knowledge of suicide prevention resources, gatekeeper skills, and diffusion of gatekeeper training information. The specific objectives of QPR training include: 1) increasing the ability to recognize someone at risk for suicide, 2) building skills to effectively intervene with those at risk; and 3) developing skills to refer someone at risk to an appropriate resource.

15. Bloomsburg University COE Virtual Modules: Embedded within Targeted Course Courses Kognito is a virtual professional development platform that has developed numerous mental health awareness modules that accomplish two main goals: 1) increase fluency in basic understanding of mental health issues for educators and 2) skill building in association with having conversations with students of concern. These goals are addressed by using simulated conversations with virtual humans (avatars). The At-risk Middle School module is strategically embedded within EDFOUND 291. McDowell Institute Valued-added Modules and course alignment: - Introduction to Trauma (SPECED 101) - Rapport as a Protective Factor (SPECED 275) - Adverse Childhood Experiences: Considerations of Trauma for Teachers (SPECED 358) - Building Student resiliency through Social Emotional Behavioral Expectations (SPECED 358) - Positive Reinforcement as a Protective Factor in Building Student Resiliency -Impact of Implicit Bias (EDFOUND 406)

16. Bloomsburg University COE PDE Endorsement in Social-Emotional-Behavioral Wellness PK-12 Students: Elective The purpose of this endorsement is to further prepare professional educators to build resiliency in students by facilitating social, emotional, and behavioral wellness in order to address non-academic barriers to learning. This endorsement is a 12 credit program that requires additional, in depth study and field experiences in conjunction with completion of an educator preparatory program at BU. Endorsement, like professional certification, occurs through PDE once the initial certification is obtained based on application documenting successful completion of the PDE approved 12 credit program.

17. Bloomsburg University COE Additional Alignment of Health & Wellness Initiatives across Campus: - Mental health Awareness Day - Minding Your Mind Presentations - Stress Less with Pets - Stomp Out Stigma - Messaging Campaign (Positivity Rocks, Tissue Times, Random Acts of Kindness month) IT IS ALL ABOUT STRATEGIC PARTNERSHIPS AND ALIGNMENT

18. Statewide: YMHFA-IHE Initiative The primary goal is expanding impact on Preservice educator training in the Commonwealth of Pennsylvania There are over 90 educator preparatory programs in Pennsylvania The goal is to create a critical mass of programs replicating…in a contextually relevant manner for sustainability…embedding mental health literacy more explicitly within their programs Once a critical mass is reached market forces should begin to further motivate IHEs that have not, to date, explicitly embedded mental health literacy more explicitly within their programs

19. YMHFA-IHE Initiative: 2017-2018 The McDowell Institute, through state level partnerships, procures external resources to support the launch of this initiative Fifteen IHEs that operate educator preparatory programs were on-boarded to this initiative: - Bloomsburg University (BU) - Cabrini University - California University - Eastern University - East Stroudsburg University - Edinboro University - Holy Family University - Indiana University (IUP) - Nuemann University - Shippensburg University - Slippery Rock University - St. Joe’s University - Susquehanna University - Temple University - York College

20. YMHFA-IHE Initiative: 2017-2018

21. YMHFA-IHE Initiative: 2017-2018

22. YMHFA-IHE Initiative: 2017-2018 • Outcomes: Cohort One - All fifteen IHEs have at least 1 credentialed YMHFA Instructor on permanent faculty - 5 of these IHEs have more than 1 credentialed instructor, with 3 of these same IHEs having multiple trainers…and have been providing collaborative trainings with one another in the cohort - Over 700 future educators have become certified YMHFAiders via this initiative in one year

23. YMHFA-IHE Initiative: 2017-2018 • Outcomes: Cohort One Continued - Approximately one third of these programs have either embedded virtual modules within targeted courses or at touch points in program matriculation, or are in the planning phase to this same end - A few of these programs have either embedded QPR within targeted courses or at touch points in program matriculation, or are in the planning phase to this same end

24. Impact of YMHFA Training (Part 1) Statements / Questions Survey 1 using a Likert type scale for Responses: To occur between 1 – 4 weeks following initial training (response options are 1= strongly disagree, 2=disagree, 3= agree, and 4= strongly agree). As a result of YMHFA training, I am more aware of how social, emotional and behavioral matters might influence student learning. As a result of YMHFA training, I am more aware of my own social, emotional and behavioral health and well-being. As a result of YMHFA training, I am better able to recognize the signs that a student may be experiencing a mental health challenge. As a result of YMHFA training, I am better able to effectively reach out to a student who may be experiencing a mental health challenge. As a result of YMHFA training, I am better able to assess for risk of immediate harm when interacting with a student who appears to be experiencing a mental health challenge. As a result of YMHFA training, I am better able actively and compassionately listen in a non-judgmental manner to a student in distress. As a result of YMHFA training, I am better able to offer a student who appears distressed basic “first aid” level mental health information and reassurance. As a result of YMHFA training, I am better able to assist a student who is experiencing a mental health problem or crisis seek professional help. As a result of YMHFA training, I am better able to assist a student who may be experiencing a mental health problem or crisis to connect with appropriate community, peer and personal support. As a result of YMHFA training, I am more aware of my own views and feelings about mental health problems and disorders and how my views and feelings can influence my interactions with my students. As a result of YMHFA training, I am better able to ask a student whether s/he is considering self-injury and/or suicide. Based on my experiences with initial YMHFA training, I feel sufficiently prepared to provide mental health first aid to a student at school or in the community.

25. Impact of YMHFA Training (Part 2) Statements / Questions Survey 2: To occur between 3 - 4 months following initial training (responses will be in drop down menu form). Since my initial training in YMHFA, have you been more sensitive to the social, emotional and behavioral health needs of your students? (Drop down menu with Yes, No, Uncertain options) Since my initial training in YMHFA, have you applied aspects of the YMHFA action plan referred to as ALGEE (or applied the action plan known as ALGEE in its entirety) with a youth in either school or community settings? (Drop down menu of Yes or No) ----------------------------------------------------------------- Note: The following items become relevant for those who indicated they have applied aspects of the YMHFA action plan or ALGEE in its entirety: Since your initial training in YMHFA, which aspects of the YMHFA action plan known as ALGEE have you applied with a youth? (drop down menu of ALGEE asking them to check all that apply) Since your initial training in YMHFA, have you pro-actively researched/explored local community-based mental health resources to support students in your school? (Drop down menu of Yes or No) With how many students /young people have you applied aspects of the YMHFA action plan or ALGEE in its entirety? (drop down menu of 1-2, 3-4, 4-5, and more than 5 students/youth). When applying aspects of the YMHFA action plan or ALGEE in its entirety, were you able to readily recall the basic steps involved to provide YMHFA to the student/young person/people of concern? (Drop down menu of Yes, No, Uncertain) When providing YMHFA to youth, did you think back to / reference your YMHFA training experience/materials? (Drop down of Yes, No, Uncertain) As a result of your efforts in providing YMHFA, in your own opinion, did your provision of YMHFA have a constructive impact? (Drop down menu of Yes, No, Uncertain) To what degree have you been attentive to your own personal needs for support after providing aspects of the YMHFA action plan or ALGEE in its entirety? (Drop down menu of Yes- I thought about and/or addressed my own needs, Somewhat- I briefly thought about and/or partially addressed my needs, or No-I did not think about or address my own needs)

26. Snapshot of Impact: Cohort One 97.6% of respondents (n = 82) reported YMHFA helped them to be more sensitive to the social, emotional, and behavioral needs of students Nearly half of all respondents (48.8%; n = 41) reported using some or all elements of ALGEE with youth in either their school or community setting in past three months 70.7% used elements of ALGEE with 1-2 students with 25% using elements of ALGEE with 3 or more students Special Notes: 1) Recall that most respondents are pre-service educators, so it is logical to project actual application should increase as years of in-serve practice increases; and 2) only a small portion of IHEs in cohort 1 had officially launched their campus specific trainings at the time these data were collected.

27. YMHFA-IHE Initiative: 2019 • Targeted Outcomes in Year Two - Continued support for Cohort 1 IHEs to further build sustainable capacity to provide YMHFA training to their respective education majors. - Expansion of support for Cohort 1 IHEs to further build sustainable capacity to provide QPR training to their respective education majors and/or on their respective campuses. - Expansion of support for Cohort 1 IHEs to further build sustainable capacity to expand mental health literacy explicitly within their educator preparatory programs. - Identification of the participant IHEs in cohort 2 with educator preparatory programs for on-boarding (up to a maximum of 15 IHEs). - Credentialing/Certification as YMHFA Instructor of (at a minimum) one faculty/staff member at each IHE in the targeted cohort 2 educator preparatory programs. - YMHFA training conducted at each IHE in targeted cohort 2 educator preparatory programs. - YMHFA training of (at a minimum) 500 pre-service educators in aggregate across the targeted IHEs in cohort 2. - Identification of additional IHEs outside of the targeted cohort 2 educator preparatory programs that express interest in YMHFA, QPR and/or mental health literacy and suicide prevention resources.

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30. Save the dates, February 20 – 23, 2019 for the… Pre-Conference Workshops FEBRUARY 20 Skill-Building Workshops FEBRUARY 23 Breakout Sessions FEBRUARY 21 - 22 Networking | Posters | Exhibits Washington, DC Grand Hyatt Washington For more information, visit: conference.apbs.org