SAMHSA’s Center for Mental Health Services (CMHS), Mental Health Promotion Branch

1. SAMHSA’s Center for Mental Health Services (CMHS), Mental Health Promotion Branch Joyce Sebian, MS Ed. Public Health Advisor, Mental Health Promotion Branch Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services November #, 2018

2. Disclaimer The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

3. Agenda • Drivers of SAMHSA Policy and Programming: Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) • Children’s Mental Health in SAMHSA • Mental Health Promotion Branch and • Child Adolescent and Family Branch • Project LAUNCH (PL) • Indigenous LAUNCH (IL) • Infant and Early Childhood Mental Health Grant Program (IECMH) • Center of Excellence for Infant and Early Childhood Mental Health Consultation (COE IECMHC) • ReCAST • Project AWARE SEA • Mental Health Awareness Training (MHAT) • SAMHSA and School Mental Health

4. Interdepartmental Serious Mental Illness Coordinating Committee Per our federal cross-system action blueprint (“ISMICC”): • 15% of children age 2-8 have parent-reported MEBD diagnosis • 3.1-million adolescents with major depressive episodes (2017) • Adverse childhood experiences increase likelihood for SED -> SMI • SAMHSA estimates prevalence of SED between 6.8 – 11.5%. • Suicide rate increase quickly among young Black children 5-11 y.o.

5. Children and Adolescents with Mental Health Challenges Children are not receiving MH services they need: • Only 20% of children, adolescents with MH disorders were identified and receiving MH services -- U S Surgeon General, 1999 • Fewer than 2% of school-age population identified with emotional/ behavioral disorders that qualify for special education under IDEA – National Center for Education Statistics, US DOE, 2013 • 66.6% of young adults with any mental illness had received no MH services in past 12 months -- SAMHSA, 2014 Schools as Primary Access Points for Mental Health Services

6. SAMHSA’s Child, Adolescent & Family Branch (CAFB) (C Child Adolescent and Family Branch MHS) Children’s Mental Health Initiative (CMHI) SAMHSA/CMHS: Key Children’s Mental Health Programs Safe Schools/Healthy Students – (NCE now wrapping up 2018) Circles of Care Project AWARE SEA (STATE) Now is The Time (NITT) – Healthy Transitions Community Resilience and Recovery Initiative (ReCAST) CMHS: Mental Health Promotion Branch (MHPB) CMHS: Child Adolescent and Family Branch (CAFB) Statewide Family Networks Mental Health AWARENESS Training Grants (MHAT) NEW Clinical High Risk for Psychosis Project LAUNCH Technical Assistance Early Childhood Centers of Excellence Caring for Every Child’s Mental Health Campaign I LAUNCH (Indigenous) NEW Infant and Early Childhood Grant Program (2019) NEW Project AWARE Community (wrapping up 2018)

7. Mental Health Promotion Branch ISMICC Alignment • Project Launch, Indigenous Launch, and Center of Excellence Infant and Early Childhood Mental Health (IECMH), IECMH Grant Program, Project AWARE SEA, and MHAT predominantly align with two ISMICC Focus Areas: • Focus 2: Access and Engagement: Make it Easier to Get Good Care • Focus 3: Treatment and Recovery: Close the Gap between What Works and What is offered • ReCAST- Closely aligns with SAMHSA’s Recovery Support and Trauma and Justice Strategic Initiatives. In addition, this program seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use, and outcomes among the racial and ethnic minority populations served. • MHAT - Per the 21st Century Cures Act the MHAT grant program aligns with the following ISMICC recommendations: (1) maximizing the capacity of the behavioral health workforce; and (2) developing and sustaining therapeutic justice dockets in federal, state, and local courts for any person with SMI or SED who becomes involved in the justice system.

8. Mental Health Promotion Branch (MHPB) • The work of the Mental Health Promotion Branch is based on the understanding that a broad array of evidence-based programs is available to help prevent the most frequently occurring mental disorders across the life span. • The work of this Branch reflects the definition of prevention of the National Institute of Mental Health: “Prevention refers not only to interventions that occur before the initial onset of a disorder, but also to interventions that prevent comorbidity, relapse, disability, and the consequences of severe mental illness for families.” • Mental health promotion and mental illness prevention demand a coordinated developmental approach that spans service systems, communities, and families, and builds resilience in children and youth to promote mental health for a lifetime.

9. Project LAUNCH Context • 60 awards since 2008; embedding mental health promotion, prevention, screening and early intervention into early childhood settings and building the early childhood mental health workforce ISMICC Focus 2: Access and Engagement: Make it Easier to Get Good Care 2.6. Prioritize early identification and intervention for children, youth, and young adults 2.8. Maximize the capacity of the behavioral health workforce 2.9. Support family members and caregivers 2.10: Expect SMI and SED screening in all primary care settings Focus 3: Treatment and Recovery 3.2. Making screening and early intervention among children, youth…a national expectation 3.5: Implement effective systems of care for children throughout the nation Relevant Meetings and Committees • Maternal Depression: Toolkit, Expert Meeting, Blueprint with OPPI and CBHSQ • Federal Workgroup on the Impact of Opioids on Young Children and Families • Co-hosts IIMHL Exchange: Infant and Perinatal Mental Health • National Early Childhood Family Leadership Network • Birth to Five: Watch Me Thrive (SAMHSA-developed guide) • Colorado LAUNCH Together • National Latino Behavioral Health Association Priority Areas that need additional resources/support and why • Early Childhood Common Indicators of Social Emotional Wellbeing https://www.childtrends.org/project/common-indicators-of-social-emotional-well-being-in-early-childhood

10. Indigenous LAUNCH Context • 14 Indigenous awards in FY18 • LAUNCH model tailored based on tribal input • Special attention to trauma, opioids/NAS, and maternal mental health ISMICC Focus 2: Access and Engagement: Make it Easier to Get Good Care 2.6. Prioritize early identification and intervention for children, youth, and young adults 2.8. Maximize the capacity of the behavioral health workforce 2.9. Support family members and caregivers 2.10: Expect SMI and SED screening in all primary care settings Focus 3: Treatment and Recovery: Close the Gap between What Works and What is offered 3.2. Making screening and early intervention among children, youth…a national expectation 3.5: Implement effective systems of care for children throughout the nation TA • $10k supplement Relevant Meetings and Committees • Partnered with ACF to develop: Supporting the Development of Young Children in American Indian and Alaska Native Communities Who Are Affected by Alcohol and Substance Exposure: https://www.acf.hhs.gov/ecd/tribal-policy-statement Priority Areas that need additional resources/support and why • General need: more evidence-based practices (or adaptations) for indigenous populations

11. IECMH Grant Program Context • Funded through 21st Century Cures Act; approx. 190 applications for 9 awards • Full continuum of evidence-based promotion, prevention, and treatment services, including attention to NAS, dyadic approaches, mental health consultation • Key aspect is workforce development ISMICC Focus 2: Access and Engagement: Make it Easier to Get Good Care 2.6. Prioritize early identification and intervention for children, youth, and young adults 2.8. Maximize the capacity of the behavioral health workforce 2.9. Support family members and caregivers 2.10: Expect SMI and SED screening in all primary care settings Focus 3: Treatment and Recovery: Close the Gap between What Works and What is offered 3.2. Making screening and early intervention among children, youth…a national Relevant Meetings and Committees • ACL Neonatal Abstinence Syndrome Training Initiative • POIA Workgroup • HRSA Maternal Mortality Summit (Steering Committee)

12. Center of Excellence IECHMC Context • First funded in 2015; Toolkit on samhsa.gov went live in 2016 • More than 50 original resources (interactive tools, products, podcasts, videos) for national audiences; focus includes models, workforce (core competencies), funding, evaluation • Special topic areas: maternal depression and opioid and other substance misuse • Universal Reach: > 12,000 registrants for 8 webinars; 2,500 podcast downloads; 12,000 video views • Targeted Reach: mentoring 12 states and 2 tribes to develop or refine their IECMHC systems ISMICC Focus 2: Access and Engagement: Make it Easier to Get Good Care 2.6. Prioritize early identification and intervention for children, youth, and young adults 2.8. Maximize the capacity of the behavioral health workforce 2.9. Support family members and caregivers Focus 3: Treatment and Recovery: Close the Gap between What Works and What is offered 3.2. Making screening and early intervention among children, youth, transition-age youth, and young adults a national expectation Relevant Meetings and Committees • Georgetown/RWJF Advisory Committee on IECMHC in Family, Friend and Neighbor Care • HRSA ECCS COIIN Expert Advisory Team Priority Areas that need additional resources/support and why • Partnership with HRSA and ACF (how to move forward since ending formal IAA)

13. ReCAST • Context: In the wake of several high-profile incidents of civil unrest, Congress appropriated funds to engage affected communities and to help high risk youth and families who have experienced trauma. The goal was to introduce evidence-based violence prevention and community youth engagement programs and provide linkages to trauma-informed behavioral health services. The ReCAST program is designed to strengthen the integration of behavioral health services and community systems and to build resilient and trauma-informed communities. • To date, ReCAST grantees have trained 4,343 members of the mental health workforce in trauma-informed approaches; trained 11,495 community stakeholders in trauma-informed approaches, including violence prevention, and mental health literacy; provided 12,063 youth, young adults, and family members with high-quality trauma-informed behavioral health services; and established over 1,225 new partnerships to support high-risk youth and their families. • Justice Strategic Initiative: The ReCAST Program closely aligns with SAMHSA’s Recovery Support and Trauma and Justice Strategic Initiatives. In addition, this program seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use, and outcomes among the racial and ethnic minority populations served. • TA: Supplemental Funding and MHTTC • Correspondence: Report to Congress submitted annually

14. Project AWARE - SEA • Context: The purpose of this program is to build or expand the capacity of State Educational Agencies, in partnership with State Mental Health Agencies (SMHAs) overseeing school-aged youth and local education agencies (LEAS), to: (1) increase awareness of mental health issues among school-aged youth; (2) provide training for school personnel and other adults who interact with school-aged youth to detect and respond to mental health issues; and (3) connect school-aged youth, who may have behavioral health issues (including serious emotional disturbance [SED] or serious mental illness [SMI]), and their families to needed services. • This program builds upon the successful strategies of the Safe Schools/Healthy Students (SS/HS) Initiative that have been effective in creating safe and secure schools and promoting the mental health of students in communities across the country. • ISMICC: Focus 2: Access and Engagement: Make it Easier to Get Good Care • 2.6. Prioritize early identification and intervention for children, youth, and young adults • 2.7 Use telehealth and other technologies to increase access to care • 2.8. Maximize the capacity of the behavioral health workforce • 2.9. Support family members and caregivers Focus 3: Treatment and Recovery: Close the Gap between What Works and What is offered • 3.2. Making screening and early intervention among children, youth, transition-age youth, and young adults a national expectation • 3.5 Implement effective systems of care for children and youth throughout the nation. • TA: $25,000 Supplement Funding and MHTTC

15. Mental Health Awareness Training Grant (MHAT) • Context: The purpose of this program is to: (1) train individuals (e.g., school personnel, emergency first responders, law enforcement, veterans, armed services members and their families) to recognize the signs and symptoms of mental disorders, particularly serious mental illness (SMI) and/or serious emotional disturbance (SED); (2) establish linkages with school- and/or community-based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services; (3) train emergency services personnel, veterans, law enforcement, fire department personnel, and others to identify persons with a mental disorder and employ crisis de-escalation techniques; and (4) educate individuals about resources that are available in the community for individuals with a mental disorder. • ISMICC: Per the 21st Century Cures Act The MHAT grant program aligns with the following ISMICC recommendations: (1) maximizing the capacity of the behavioral health workforce; and (2) developing and sustaining therapeutic justice dockets in federal, state, and local courts for any person with SMI or SED who becomes involved in the justice system. • TA: 10% budget set-aside and MHTTC

16. SAMHSA activities in school mental health • Introduction • Grant programs • Federal School Safety Commission • Partnerships for Wide Scale Adoption of Comprehensive School Mental Health Systems (CSMHS): Getting to a Tipping Point. • What are Comprehensive School Mental Health Systems • Benefits/Why/Advancing SMH • Expert panels and Convening's • National and regional forums for engagement

17. Schools are a Natural Setting to Promote Student Mental Health and Address Mental Illness

18. What School Mental Health is NOT Comprehensive School Mental Health Systems are NOT an Add-on Sharon Hoover- CSMH- UMD

19. Federal School Safety Commission • In March 2018, President Trump appointed Betsy DeVos to lead the federal commission on school safety • Departments include: Education, Health and Human Services, Homeland, and Justice • Consists of: • Commission meetings (4) • Listening sessions (4) • Site visits (4) • Report to President Trump likely October 2018

20. Getting to a Tipping Point for Comprehensive SMH Systems The point at which a series of small changes or incidents becomes significant enough to cause a larger, more important change. Goal: Schools across the nation integrate comprehensive school mental health systems as a common practice. 2) Next group of adopters and a later group come on board- moving towards a majority of schools adopting School Mental Health systems- spread continues as more schools and society adopts SMH Late comers adopt SMH system New Norm- wide scale adoption of School MH 1) Early Adopters of School Mental Health- benefits shared and spread

21. School Mental Health Expert Panels and Convening’s Development of the State of SMH briefing and identification of local, state and national/federal strategies • May 17, 2018 : School Mental Health in Rural Communities • June 5, 2018: Social Emotional Learning and Trauma in Schools (a component of CSMHS) • June 15, 2018: School Mental Health State Summit • June 19, 2018: Trauma and Telebehavioral Health(a component of CSMHS) (a component of CSMHS) • June 25 and 26, 2018: Screening in Schools for Children and Adolescents: Effectiveness, Feasibility, and Response. (a component of CSMHS) Tipping Point: Getting to Wide Scale Adoption of Comprehensive School mental Health Systems: Expert Panel on School Mental Health Sept 2017 2017 2018

22. Ingrid Donato, SAMHSA/ former Mental Health Promotion Branch Chief, now CSAP Joyce Sebian, SAMHSA/ Mental Health Promotion Branch Andrea Alexander, SAMHSA/ Child Adolescent and Family Branch Trina Anglin, HRSA, Maternal and Child Health Bureau Nancy Lever, Center for School Mental Health- UMB Sharon Hoover, Center for School Mental Health- UMB Olga Price, Center for Health and Health Care in Schools (CHHCS) GW Linda Sheriff, Center for Health and Health Care in Schools (CHHCS) GW Nisha Sachdev, Bainum Family Foundation          Noel  Bravo, Bainum Family Foundation John Schlitt: School-Based Health Alliance School Mental Health Planning Workgroup

23. Participants/Partner Organizations Federal Partners: HHS/Office of the Assistant Secretary for Planning & Evaluation U.S. Department of Education Substance Abuse Mental Health Services Administration (SAMHSA) SAMHSA/CMHS/Office of Tribal Affairs and Policy Health Resources Services Administration (HRSA) CMS/Center for Medicaid & CHIP Services U.S. Department of Justice Centers for Disease Control and Prevention (CDC) Bureau of Indian Education States TN, NC, SC, CT, WI, MD, PA, DC, CoIIN Sites (States/LEA’s- HRSA-CSMH) System of Care Grantees (SAMHSA) Project AWARE Grantee States (SAMHSA) Safe Schools/Healthy Students States Philanthropies: • Bainum Family Foundation sites • Marriott Foundation: Bridger…From School to Work Local Schools and School Districts • New York City • Washington DC • Minneapolis, MN • Chapel Hill-Carrboro Schools, NC Universities and Colleges • George Washington • University of MD • Georgetown University

24. Participants/Partners (cont-2) National Associations: National Association of School Psychologists National Governors Association National Conference of State Legislators National Rural Health Association American Public Health Association National Association of State Mental Health Program Directors National Association of State Directors of Special Education National Association of School Nurses School Social Work Association of America School Based Health Alliance Family Led Organizations: Family Run Executive Directors Leadership Association (FREDLA) National Federal of Families for Children’s Mental Health Youth Leaders Montgomery County Federation of Families for Children’s Mental Health Other Organizations: American Institutes for Research Communities for Just Schools Management and Training Innovations Please Pass the Love

25. States Can… • Work across State Education and Behavioral Health/Mental Health Departments and Law Enforcement to ensure that mental health is at the table. • Ensure that teams incorporate mental health needs across the developmental continuum into EOP goals and objectives and “before, during and after” plans, e.g., Active Shooter drills, crisis intervention, response, and post-interventions. • Provide guidance and technical support to community mental health providers and schools to identify aspects of the planning process that would benefit from mental health expertise and knowledge and ensure that the plans represent the needs of the school community and families, the broader community, and first responders. • Other?

26. States Have a Critical Role in Social-Emotional Learning (SEL) • What is SEL? Processes through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to: • Understand and manage emotions • Set and achieve positive goals • Feel and show empathy for other • Establish and maintain positive relationships • Make responsible decisions • States can: • Establish learning benchmarks, guidelines, and goals • Provide funding and professional development support to districts • Create a platform for districts and schools to share best practices and lessons learned • Help create the conditions where SEL can thrive at the district, school, community, and family levels https://casel.org/state-page/

27. Adapted from Sharon Hoover- CSMH- UMD Comprehensive School Mental Health Systems What’s under the umbrella? Trauma-informed Social Emotional Learning Mental Health Treatment Restorative Justice Safe and Supportive Positive Disciplinary Policies Multi-Tiered Systems and Supports Mental Health Promotion Positive School Climate Educating the Whole Child Mental Health Literacy Substance Use Prevention and Intervention Resilience-Promoting ACES Aware Youth and Family engagement Post Crisis Intervention Planning School Safety and Security Planning L Developmentally appropriate Active Shooter Drills and other appropriate preparations/drills Communications with Families, media and other community partners Crisis Planning Crisis Response Positive Disciplinary Policies Assess school environment i.e. School entry controls/school climate, use of school resource officers Restorative Justice Practices Intensive Wrap around services and interventions- school re-entry, discharge planning, community wrap around services, school supports School Safety and Security Needs and Gaps Assessment processes School/Community Partnerships- Law Enforcement, Mental Health, Juvenile Justice Trauma informed schools

28. Consider Two Visions of Schools

29. Studies Show:

32. SAFE SECURE SCHOOLS = Mental, Emotional and Physical Safety and Security • Schools should Support a Positive School Climate • Built on a culture of safety, respect, trust, and social and emotional support • Teachers and staff in safe school environments support diversity, encourage community, intervene in conflicts and work to prevent teasing and bullying. • Students feel empowered to share concerns with adults • Administrators can take action to develop and sustain positive safe school climates. • Help Students feel connected to the school, their classmates and teachers. • Build positive, trusting relationships with students- active listening and interest • Break down “code of Silence” From “Enhancing School Safety Using a Threat Assessment Model”: USDHS US Secret Service, National Threat Assessment Center July 2018 https://www.secretservice.ogv/protection/ntac

33. School Safety and Security • Crisis/Emergency Preparedness Planning, Training and Drills • Active Shooter Training • Threat Assessment • Positive School Climate • Bullying Prevention • Suicide Prevention Addressing Emotional, Mental and Physical Safety includes Comprehensive School Mental Health Systems • Mental Health Screening • Crisis Response • Post Crisis Intervention Planning • Developmentally Appropriate • Trauma-Informed Schools • Caring Adult There is NO profile of a student who will cause harm. Threat assessment should be a component of a comprehensive approach maintaining a safe school, which offers a balance between physical and psychological safety. https://www.secretservice.ogv/protection/ntac

34. Berkeley County West VA Project AWARE https://www.youtube.com/watch?v=09zllcNJVVM&feature=youtu.be

35. March 2018 Congressional Briefing: School Violence, Safety, and Well-Being: A Comprehensive Approach http://www.npscoalition.org/school-violence

36. Contact Information Joyce Sebian Public Health Advisor HHS/SAMHSA/CMHS/Division of Prevention, Traumatic Stress, and Special Programs/Mental Health Promotion Branch Joyce.sebian@samhsa.hhs.gov

37. Thank You SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. www.samhsa.gov 1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)