The West Virginia Expanded School Mental Health Initiative

1. The West Virginia Expanded School Mental Health Initiative History, Status, Tools and Resources Linda Anderson, MPH WV Student Success Summit August 2-3,2011

3. Objectives Participants will be able to • Describe at least two aspects of the history of the ESMH Initiative • Identify at least three characteristics of successful school mental health programs • Identify at least three resources for information and technical assistance

4. Outline • Define ESMH • Links between mental health and school success • History of school mental health in West Virginia • Factors for success • Resources

6. The Conundrum School Mental Health Academic Performance

7. Links Between Mental Health and School Success

8. Facts • 5-9 % of children and teens have a serious emotional disturbance. (US Surgeon General’s Report, 1999) • 20% of children and adolescents at any given time have a diagnosable mental disorder which interferes with their functioning.(US Surgeon General’s Report, 1999)

9. Facts • 1-2 children in every classroom have a diagnosable mental health concern which hinders functioning. (President’s New Freedom Commission Report) • Less than 50% of children and adolescents with a mental illness receive adequate (or any) services . (Kataoka, Shang, Wells, 2002)

11. Mental Health & Academic Outcomes Connection Graduation/Drop-out Grades Standardized test scores Teacher Retention Poor health Physical illness High-risk behaviors (e.g. Substance use ) Mental illness Developmental issues Low self-esteem Family problems Health & Mental Health Factors Educational Outcomes Attendance B Behavioral Problems Educational motivation Attitudes toward schoolwork School Connectedness Educational Behaviors SMH 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.

12. Why MH in Schools? • Evidence clearly demonstrates that addressing mental health needs is associated with positive school outcomes • School mental health promotion activities create a positive learning environment

13. Why MH in Schools? • School mental health programs and services improve teaching conditions for teachers and staff • Schools are where children are located – efficient use of resources • Reduces costs for treatment • Contributes to the economy

14. AcademicPerformance Is negatively affected by: Alcohol, tobacco, and other drug use Emotional problems Health risk behaviors (e.g. obesity, sexual behavior, poor diet) Low self-esteem, risky sexual behavior Lack of access to health and mental health care Poor home life Is positively affected by: High levels of resiliency, developmental assets, and school connectedness (work of CASEL, Search Institute; and others)

15. Graduation Rates SMH strategies can improve graduation rates by addressing factors that interfere with a student’s ability to succeed in school, such as : • Exposure to violence • Anxiety disorders • Other unmet mental health needs (Black, et al, 2003, Woodward & Ferguson, 2001; and others)

16. School Connectedness “ Definition: the extent to which a student feels welcomed, accepted and respected in his or her school. Students who feel connected to their school: • Better achievement • Better school attendance • Stay in school longer • Less likely to engage in many risk behaviors (Fletcher et al., 2008; Shochet et al., 2006; Anderman, 2002; and others)

17. WV Educators Speak:Mental Health & School Success

18. Definition Expanded School Mental Health refers to programs that build on the core services typically provided by schools. It is a three-tiered framework that includes the full continuum of: • Prevention • Early intervention • Treatment • Serves all students • Emphasizes shared responsibility between schools and community mental health providers

19. A Comprehensive System of Learning Supports Behavioral Health Systems School Systems Intensive 1-5% Targeted 5-15% Universal 80-90%

20. Tier 1 - Universal PreventionA School wide Foundation • Creating a caring school environment • Teaching appropriate behaviors and problem solving skills • Positive behavioral support • Effective academic instruction

21. TIER 2 - TARGETEDIDENTIFY & INTERVENE EARLY • Interventions that occur early for individual students or small groups of students at risk • Examples of programmatic interventions include social skills groups, anger management; family support; grief and loss, suicide / depression screening; short term counseling and stress management.

22. TIER 3 - INTENSIVETREATING SEVERE & CHRONIC PROBLEMS • Individualized therapeutic interventions for high risk students with severe, chronic or pervasive concerns that may or may not meet diagnostic criteria • Services might include crisis intervention, cognitive behavioral therapy, and family therapy; and may be community or school - based.

23. 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

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

25. WV HISTORY Prior to 2000 • Coordinated School Health Program Initiated • School-based Health Center Initiative • System of Care – SAMHSA grant 2000 • School mental health funding – BHHF block grant • Sisters of St Joseph Health and Wellness Foundation funds mental health services in SBHCs

26. WV MILESTONES 2006 • West Virginia Behavioral Health Commission convenes • First meeting with WVDE 2007 • ESMH steering team organized • Strategic planning process begins (Dec.)

27. WV MILESTONES 2008 • ESMH Team recognized as subcommittee of Behavioral Health Commission • MOU signed by Commissioners 2009 • Planning grants awarded by BHHF • Selected by NASBHC as pilot state for their Mental Health Capacity Building Project

28. WV MILESTONES 2011 • Website • Ten Components of Universal Tier defined • Analysis of county improvement plans • Second statewide ESMH conference • School policies reflect increased focus on social-emotional learning and mental health • ESMH Implementation grants

29. MISSION To develop and strengthen policies, practices and services that promote learning and social- emotional well-being for all of WV’s youth through a collaborative process that engages schools, families, and community-based agencies.

30. VISION Every student in WV will benefit from a school environment that supports social and emotional well-being to achieve his/her full potential.

33. WV Educators Speak:Building A Successful ESMH Program

34. Steering Team Goals Strengthen the infrastructure Define ESMH Tiers 2 and 3 Ensure quality Develop a reporting system Regionalize training and TA Sustain and increase programs

35. Tier 1 - Universal Preventionten Recommendations •  An infrastructure that supports and sustains a comprehensive school mental health model • A systemic approach to early identification of students at risk • An effective, classroom-based developmental guidance curriculum that is consistent and reinforced within and outside of the classroom

36. Tier 1 Recommendations - Cont’d • A school-wide positive behavior program based upon evidence /promising practices • Annual training for all staff to improve their skills in identifying and addressing mental health needs of students • Policies and practices to strengthen student connectedness • Policies and practices to strengthen parent and family involvement

37. Tier 1 Recommendations - Cont’d • A program to address school climate, based upon evidence and promising practices • School safety plans that incorporate both crisis prevention and response • Specific activities and programs that support families and students as they negotiate transitions such as grade and school changes

38. 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 NCLB Family support services Where to Begin? 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

39. Mental Health Planning and Evaluation Template 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 measure Web-based, completed by teams, computer generated scores

40. Community Coordination and Collaboration • RATIONALE: Coordination and collaboration with community-based mental health and child-serving agencies • enhances resources • maximizes efficiencies • reduces fragmentation and duplication

41. Community Coordination and Collaboration • A collaboration is a “formal or informal agreement among participants to establish a process and structure for achieving goals that no one member can achieve independently.” (EDC) • Linkages between school and a particular agency • Coalitions that serve youth in the community • School coalitions of community partners

42. Community Coordination and Collaboration: Key Strategies • Support and leadership from the school principal is essential • Establish a school level leadership team • Build a school-community partnership with community agencies that serve youth • Conduct an inventory of needs and resources • Determine a leadership structure and formalize relationship with an Memo of Understanding (MOU) • Engage group in small scale strategic planning process

43. School Coordinating Teams • Composed of multiple stakeholders, convened by school health coordinator/school counselor • Conduct planning and quality improvement process • Conduct assessment of needs and resources related to school health and mental health • Act collectively in providing guidance and leadership on school policies (e.g. discipline) that promote school health/ mental health • Coordinate, implement, train and evaluate ESMH activities • Link to community health services and resources • Oversee collection and analysis of student health data • Implement crisis prevention and intervention

44. A Word About Funding…. • Diversified funding base • Local Community • School system sources: Title 1, Safe and Supportive Schools, other • Third party insurance • BHHF – new planning grants (maybe) • FQHCs/SBHCs

45. Recommended Reading • Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools National Center for Mental Health Promotion and Youth Violence Prevention: http://promoteprevent.org/Publications/

46. www.promote.prevent.org

47. National Resources Center for School Mental Health U of Maryland www.csmh.umaryland.edu National Assembly on School Based Health Care www.nasbhc.org

48. Resources for schools, parents, students, communities Directory of SMH programs Tool Kits www.schoolmentalhealthwv.org landerson@marshall.edu

49. RESOURCES Tool Kits • Guide for developing an ESMH program • Community and school needs assessment tools • Sample Forms/MOUs • Family Engagement • Stigma reduction • Quality/Standards • Sample educational handouts for school staff, parents, students • CBT core skills