Overview and Fundamentals of School Mental Health

1. Overview and Fundamentals of School Mental Health

2. Icebreaker

3. Acknowledgements • National Steering Committee: • Joanne Cashman • TJ Cosgrove • Paul Flaspohler • C. Veree’ Jenkins • James Koller • Carl E. Paternite • Morton Sherman • Mark Weist • Karen Weston • School Mental Health Capacity Building Partnership • Centers for Disease Control and Prevention, Division of Adolescent and School Health (DASH) • Staff: Laura Hurwitz • Consultant: Sharon Stephan

4. Objectives • Define school mental health (SMH) • Describe benefits of SMH • Describe connection of SMH to academic outcomes • Define essential dimensions of quality SMH at the school building level

5. Setting the Stage • Federal Policy • Healthcare parity • Health care reform • Education initiatives • Federal agencies • Substance Abuse and Mental Health Administration (SAMHSA) • Department of Education • Department of Health and Human Services • Maternal and Child Health Bureau (MCHB) • Centers for Disease Control and Prevention (CDC) • Interagency work • State Initiatives

6. Response to Intervention PBIS Student Assistance Team Student Mental Health Initiative Safe Schools, Healthy Students Special Education Crisis management Systems of Care Social and Emotional Learning School linked Wrap around Shared Agenda Multiculturalism School Mental Health NCLB Family support services Cultural competence Risk and protective factors School based Strengths based Multi system approach School linked Student Support Services Suicide Prevention Mental Health Services Act IDEA School climate Peer-to-Peer Support School connectedness Evidence based practice Coordinated school health program

7. Definition of school mental health

8. Principles of School Mental Health • Involves partnerships between schools and their community • Reaches all students; general and special education • Provides services to youth and families regardless of their ability to pay • Addresses needs and strengthens assets for students, families, schools, and communities • Utilizes the school setting as locus of school and community activity • Builds on existing school programs, services and strategies • Develops and implements programs and services that are driven/guided by families and youth • Addresses developmental, cultural, and personal differences among students, families, and staff • - Center for School Mental Health

9. Public Health Triangle Levels and Types of Intervention Intervention/Indicated Prevention/Selected Promotion/Universal

10. What does school mental health look like? Systems of Prevention and Promotion All Students (universal) Systems of Early Intervention Students At-Risk (selected) Systems of Treatment Students with Problems (indicated) School, Family, and Community Partnerships From work of Joe Zins

11. Coordinated School Health Program: Mental Health Component

12. Making the Case for School Mental Health • What we know intuitively • Demonstrated need • Benefits of a school setting • Consistency with mission of schools • Connection to academic outcomes • Social and economic costs

13. We know that… • Healthy students make better learners • You cannot teach a child who is not able to focus on schoolwork • A child who succeeds in school is more likely to enjoy lifelong health and mental health

14. The need • Around 20% of youth present with an emotional/ behavioral disorder • Around 10% present experience significant impairment • Less than 50% receive adequate or any services • Over 75% of youth who receive services, receive them in schools

15. School setting • Schools are the most universal and natural setting • Over 52 million US youth in 114,000 schools • Over 6 million adults work in these schools • Students and staff comprise 20 percent of the U.S. population --New Freedom Commission, 2007

16. School setting • Schools are the “defacto” mental health system • Advantages of the school setting • Students don’t miss a whole day of school • Parents don’t miss work • Less threatening environment • Students are in their own social context • Services are more timely • Potential to impact the learning environment and educational outcomes

17. Schools remove barriers to care • Bureaucracy • Waiting Lists • Transportation • Cost • Stigma

18. Mission of school mental health • Consistent with the mission of schools, SMH strives to: • Create a safe, caring, and enriching environment • Encourage family driven policies and practices • Support high-quality academic instruction • Serve culturally diverse populations • Foster positive and healthy youth development • Coordinate delivery of effective services for youth • Prepare students for lifelong success

19. SMH Graduation/Drop-out Grades Standardized Test Scores Teacher Retention Health & Mental Health Factors Academic Outcomes Physical Health/illness Mental Health Mental Health Problems High-risk Behaviors (e.g. Substance use ) Developmental issues Social Competence/Self- esteem Family Strengths/ Issues Attendance Behavioral Competencies Behavioral Problems Educational Motivation Positive Attitudes Toward Schoolwork School Connectedness Educational Behaviors Mental health and academic outcomes ADAPTED FROM: Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.

20. Mental Health and Academic Outcomes • By enhancing factors that increase a student’s ability to succeed in school, AND • By reducing factors that interfere with a student’s ability to succeed in school… • SMH strategies have been shown to improve academic outcomes such as: • academic achievement • discipline referrals • graduation rates • attendance • teacher retention • school climate

21. SMH reduces long-term costs • Reduces costs of untreated mental health problems • Reduces economic/social burden of multiple systems when mental health problems are not addressed early • Reduces cost of school dropout

22. Three Pathways from Poor Health to High School Dropout A. Disparities in healthcare can allow treatable disorders to negatively impact schooling B. Childhood conditions can directly affect learning and behavior C. Poor academic performance can increase adolescent risk behavior From: Breslau (2010) http://cdrp.ucsb.edu/dropouts/pubs_reports.htm

23. Cost of drop-out in the US • A student who drops out earns about $260K less over a lifetime and pays about $60K less in taxes than a high school (HS) graduate • $192 billion in combined income and tax revenue for each cohort of students who never completes HS • Increasing the HS completion rate by 1 percent for males ages 20-60 would save up to $1.4 billion per year in reduced costs from crime • HS dropouts have a life expectancy that is 9.2 years shorter than for HS graduates (California Dropout Research Project)

24. What does quality SMH look like? • Committed and energetic staff • Developmental and cultural competence • Coordinated in the school and connected in the community • Emphasize access • Tailor to local needs and strengths • Emphasize quality and empirical support • Active involvement of diverse stakeholders • Full continuum from promotion to treatment (Center for School Mental Health)

25. Eight Dimensions of Quality • Operations • Stakeholder involvement • Staff and training • Identification, referral, and assessment • Service delivery • School coordination and collaboration • Community coordination and collaboration • Quality assessment and improvement

26. Mental Health Planning and Evaluation Template (MHPET) • www.nasbhc.org/mhpet • Developed in partnership with the Center for School Mental Health • Used in planning and evaluating activities and services for new or established SMH programs • Eight dimensions, 34 indicator measures • Web-based, completed by teams, computer- generated scores

27. ACTIVITY: What are your hopes and dreams for all students and for all schools in your state or district?

28. SBHC resources www.nasbhc.org

29. General SMH Resources • Center of School Mental Health http://csmh.umaryland.edu • School Mental Health Connection www.schoolmentalhealth.org • Center for Health & Health Care in Schools www.healthinschools.org • UCLA Center for Mental Health in Schools www.smhp.psych.ucla.edu

30. Questions? • Add presenter’s contact info.