Mental Health and Transition: Interconnected Systems Framework

1. Mental Health and Transition: Interconnected Systems Framework Joanne Cashman, IDEA Partnership Robert Crouse, AZ CoP on Transition Marcus Poppen, University of Oregon James Sinclair, University of Oregon Kara Hirano, University of Oregon Capacity Building Institute May 7, 2013

2. Transition Age Youth (TAY) and Serious Mental Illness • More than three million transition age youth have serious mental illness (Vander Stoep, et al, 2000). • Prevalence of serious mental illness is greatest among the populations of 18-25 year olds (12% compared to other adult populations (HHS, 2003). • Transition age youth with serious mental illness are three times more likely to become involved with the juvenile justice system, compared to transition age youth without SMI (Vander Stoep, et al, 2000). • More than 60% of transition age youth with serious mental illness do not complete high school, leaving many of these young adults unemployed, unable to benefit from continuing education, and without the skills needed to live independently (Hagner, et al, 1999). http://www.apa.org/about/gr/issues/cyf/transition-youth.pdf

3. Disability, Mental Healthand Transition • Relationships between disability, mental health and transition are complex and underexplored (Rose, et al, 2009). • Disability, mental health and transition increase students risks of experiencing negative post-school outcomes (Hassoitis & Turk, 2012; Haber, et al., 2008). • Despite these known barriers, there remains a dearth of literature describing the unique features of this population and offering effective transition planning strategies for practitioners.

4. To what extent is the impact of MH issues a priority for you and your colleagues? • Not a priority • Somewhat a priority • Sporadically a priority • One of several high priorities • Greatest priority

5. Disability, Mental Health and Transition Marcus Poppen, James Sinclair & Kara Hirano

6. Study DesignDisability, Mental Health and Transition • Two Focus Groups (Oregon) • National Survey • 700 Survey Respondents • 493 Special Education Staff (Special Education Teacher, Transition Specialist, Instructional Aid) • 207 Other (VR Counselors, School Psychologists, School Administrators) • For this presentation • SPED Staff who completed more than 80% of our survey (n = 461) • All states represented by at least 1 respondent

7. Teaching Experience • 39% teaching more than 16 years • 21% 11-15 years • 26% 5-10 years • 14% Less than 5 years Demographics Education • 3% Doctoral Degree • 66% Masters Degree • 25% Bachelors Degree • 3% AA • 1% Other Female, 87% Male, 12% Caseload • 44% Greater than 30 students • 14% 21-30 students • 22% 11-20 students • 21% 1-10 students Work Setting • 48% Special Education Classroom • 25% Community Based/Work Program • 17% Resource Room or Learning Center • 10% General Education Classroom Community Setting • 32% Urban • 46% Suburban • 32% Rural (<2,500) Race/Ethnicity • 89% White • 4% African American • 3% Prefer Not to Specify • 4% Other

8. Knowledgeable about School Mental Health Services

9. Knowledgeable about Community Mental Health Services

10. Prevalence of Mental Health Issues for Transition Age Youth • Special Education Staff report that 46% of their students experience mental health issues. • 92% of Special Education Staff report working with students who receive mental health services.

11. Mental Health Services for Transition Age Youth with Disabilities Of the 92% who reported their students receive MH services

12. “Because of your mental health, which is your disability, you fall out of programs that are set up to serve you. And, that just doesn’t make any sense to me!” – Special Education Teacher

13. Transition Services Offered

14. To what extent is mental health available to your students? • Not available • Available, but inadequate • Available at an appropriate level for need • Available and meets needs • Exceptional availability and service

15. What did participants have to say?

16. “We are not talking about issues soon enough.” – Special Education Teacher “What I’ve seen is a lack of awareness of the complexity of the things that these young adults are coming forward with.” – Special Education Teacher

17. Mental Health Concerns Present and Those Addressed on the Students IEP

18. “When we don’t address it head on, the kids often don’t get the mental health support that they need.” – Special Education Teacher

19. Mental Health Concerns Present and Those Addressed on the Students IEP

20. Mental Health Concerns Present and Those Addressed on the Students IEP

21. “I get maybe 10 minutes at the end of an IEP to talk about what I do little bit, which, is somewhat out of context, I mean we talked about all academic stuff and strengths and weaknesses, and now we’re going to give you you little ten minutes to talk about, like, transition.” -- Transition Specialist

22. Mental Health Services Included in IEP

23. “And, so the question is, how do we include other agencies in the process, rather than doing something in isolation.” -- Transition Specialist

24. Coordination with MH Provider

25. Training

26. To what extent do these finding match your experience? • Mismatch • A few similarities • Many similarities • Close match

27. Barriers “I think it goes beyond national, to cultural, because people don’t know how to talk about mental health because there is ignorance, fear, stigma….” – Special Education Teacher • Homelessness • Student Engagement • Disability Specific • Appropriate Transition Planning • Eligibility • Stigma • Family Engagement • Job Descriptions and Responsibilities • Training and Professional Development • Expectations for the Future

28. Strategies • Agency Collaboration • School and Community Resources • Family Engagement • Student-Teacher Relationship • Something about Job Descript? Role? • Something about skills to build positive relationship?

29. Does the Picture of MH in Special Education Differ Significantly from General Education? • 1 in 5 youth have a diagnosable MH Condition • About 70% of those youth get no treatment • School is the de facto MH provider • We need Mental Health partnerships.... • Cross the boundaries between school and agencies • Integrate the work of school employed staff and agency staff • Build a comprehensive system school mental health!

33. The MH/Transition ‘Twins’ • While Special Ed focuses on MH in Transitions.... • SAMHSA is focused and funding Transition in MH (Healthy Transition Grant) • Lets get together.... WI is doing it!

34. To what extent do you and your colleagues work across agencies to meet transition needs? • Never • Infrequently • Sometimes • Often • Always

40. Pooled Resources: Working across Programs and People • Who has the training? • School employed • Community employed • Who has the assignment? • Shared roles • Distinct roles • Are the systems .... • Coherent? • Comprehensive? • Sustainable?

41. ISF: Building the Bridge across Systems • Learning the language • Defining the roles • Building the relationship • Creating support through ongoing engagement • Meeting the challenges over and over.....because situations and people change.

45. To what extent does the ISF address issues that you and your colleagues care about? • Not at all • A few issues • More than a few issues • Many issues • Very many issues

46. May is Mental Health Awareness Month • NAMI NH has provided a customizable Info Card for your use • Attach a green ribbon and distribute • Customize the card with your data or your efforts

47. Based on what we have discussed today.... • Is there interest in developing a cross-state workgroup on MH and transition.... • Should we develop a webinar to bring the ISF to transition staff... • Should we identify and promote some promising programs that address both transition and MH...