Addressing Behavior Disorders in Schools: The Integration of Education and Mental Health

1. Addressing Behavior Disorders in Schools: The Integration of Education and Mental Health Albert J. Duchnowski, Ph.D. Krista Kutash, Ph.D. Department of Child & Family Studies University of South Florida The Institute of Education Sciences (IES) 5th Annual Research Conference June 2010 - National Harbor, MD

2. Integrating Education and Mental Health Into School-Based Mental Health Historically, difficult to establish effective partnerships For many reasons….

4. Contrasting PerspectivesOverarching Influence Education System Individuals with Disabilities Education Act (IDEA) Mental Health System Diagnostic & Statistical Manual (DSM)

5. Contrasting PerspectivesConceptual Framework Language Education System Behavior Disorders, Challenging Behavior, Academic Deficits Mental Health System Psychopathology, Abnormal Behavior, Impaired functioning

7. Contrasting PerspectivesImportant Theoretical Influences Mental Health System Behavior Theory, Cognitive Theory, Developmental Psychology, Biological/Genetic Perspective, Psychopharmacology Education System Behaviorism, Social Learning Theory

8. Contrasting PerspectivesFocus of Intervention Education System Behavior Management, Skill Development, Academic Improvement Mental Health System Insight, Awareness, Improved Emotional Functioning

9. Contrasting PerspectivesCommon Focus • Education / Mental Health System • Improving Social and Adaptive Functioning. • Importance of and Need to Increase Availability, Access, and Range of Services

11. Refocusing School-Based Mental Health Services On the Core Foundation of Schools To Promote Learning

12. Schools have the inherent capacity to bridge home and neighborhood ecologies Schools are the ‘de facto’ children’s mental health system

13. The Refocused Role of Mental Health Services Support Teachers: the Primary Change Agents Mental Health Providers Become: “Educational Enhancers” Serve the Core Function of Schools Promoting Social/Emotional Development, no Longer Tangential

14. Social Context of the School Technology to promote learning Academic Success Relations with Peers Relations with Teachers Relations with Parents

15. Does Anything Work?

16. Some Program Models with Organizational Potential for Success

17. “The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better.” – Weiss, 2002 …unless it is getting and using data…

18. Positive Behavior Supports

19. RtI Response to Intervention Problem Identification Evaluate Response to Intervention (RtI) Problem Analysis Implement Plan Continuous Improvement Model Home Involvement Student/Family Assistance Community Outreach/Volunteer Classroom-Focused Enabling Crisis Assistance Transitions

20. 1. Surveillance at the population / community level What is the problem? Use systematic data collection strategies to determine the mental health service needs in your community. 2. Identify risk and protective factors What are the causes? Use the information collected in and on your community on a regular basis and integrate with the research literature. The Public Health Model 4. Implementation monitoring and scaling-up Is it meeting the intended needs? Monitor interventions for proper implementation, scale-up interventions and measure impact. 3. Develop and Evaluate Interventions What works and for whom? Review literature on empirical based interventions and apply/adapt to local community needs.

21. Universal All Students ED – PBS MH - Screening FAM ED MH EBP’s (PATHS) Cognitive Behavior Therapy and other EBPs Implemented in organizations that support and facilitate collaborative, integrated systems of services. RtI Group Interventions Team Monitors Progress Team Monitors Progress Selective At-Risk Students ED – FBA / PBS MH – Assessment FAM ED MH MH ED ED MH FAM Intensive Students in Special Ed due to Emotional Disturbances ED – FBA / PBS MH – Assessment FAM ED MH ED FAM MH Common Vision Families (FAM) Mental Health (MH) Education (ED) Integrated Partnership

22. But Wait… • Some people say that Families are the barriers to good collaboration • If “those parents” would just……

23. Families as The “Cause,” The Patient, The Credible Informant, Equal Decision Making Partners, Evaluator and Research Partners, Policy Makers

25. Are you Ready?

26. Evidence Based Practices • Multiple Registries • Narrow Focus • Anxiety • Depression • ADHD • Require Fidelity of Implementation • Talk Therapy Continues to Dominate

27. Alice said to the Cheshire Cat: “Would you tell me please, which way I ought to go from here?” “That depends a good deal on where you want to get to,” said the Cat. “I don’t much care where,” said Alice. “Then it doesn’t matter which way you go,” said the Cat. …it depends a good deal on where you want to get to…

28. We must … Develop Competency in Implementation Science

29. Model of Implementation Complexity IMPLEMENTATION EFFECTIVENESS Can you implement the innovation with accuracy and fidelity? FIT Does the innovation fit within your organization Complement or Compete? CLIMATE Willing to remove obstacles? Are there rewards? Leadership support? Clarity of Goals? INNOVATION EFFECTIVENESS Impact of innovation, commitment, and satisfaction VOLITION Is there capacity and willingness to implement? FIDELITY BELIEFS Favorable attitudes toward practice Complexity of innovation

30. Resources Download this 115 page monograph FREE at: http://rtckids.fmhi.usf.edu/rtcpubs/study04/ Atkins, M., Hoagwood, K., Kutash, K., &Seidman, E. (in press and on-line as of March 2010). Toward the Integration of Education and Mental Health in Schools. Administration and Policy in Mental Health Services Research. Cappella, E., Frazier, S. L., Atkins, M. S., Schoenwald, S. K., & Glisson, C. (2008). Enhancing Schools’ Capacity to Support Children in Poverty: An Ecological Model of School-Based Mental Health Services. Adm Policy Ment Health, 35, 395-409.