School-Based Mental Health: Results of a Statewide Survey

1. School-Based Mental Health: Results of a Statewide Survey David Wheeler, School Psychology Consultant Student Support Services Project/USF

2. Gria Davison, School Social Work Consultant November 27, 1958 – September 14, 2013

3. Ana Grace Marquez-Greene A Parent’s Response

4. Ana Grace Marquez-Greene Killed December 14, 2012 Sandy Hook Elementary School

5. Best Practices for Creating Safe and Successful Schools - A Framework for Safe and Successful Schools, 2013 • Integrate services through collaboration. • Implement multi-tiered systems of support. • Improve access to school-based mental health supports. • Integrate school safety and crisis/emergency prevention, preparedness, response, and recovery. • Balance physical and psychological safety. • Employ effective, positive school discipline. • Allow for the consideration of context. • Acknowledge that sustainable and effective improvement takes patience and commitment.

6. School-Based Mental Health Florida’s Framework for Promoting Social-Emotional and Behavioral Health

7. What are school-based mental health services? • Broad spectrum of assessment, prevention, intervention, postvention services. • Essential to school’s ability to ensure a safe and healthy learning environment for all students, support students’ social-emotional needs, identify & respond to mental health problems, and promote students academic success. • Ideally, school-based services dovetail with community-based services so that children and youth receive the support they need in a seamless, coordinated, and comprehensive system of care.

8. Why school-based mental health? • Mental health and psychological wellness are integral to school success. • Students who receive social-emotional support and prevention services achieve better academically. • Left unaddressed, mental health problems are linked to academic and behavior difficulties, dropping out, delinquency, and risk behaviors • Growing and unmet need for mental health services for children and youth. • Schools are a natural place to provide services. • Wise investment – prevention and intervention are less costly than negative outcomes of unmet mental health problems.

9. Adverse Childhood Experiences (ACE) Over 17,000 Kaiser Permanente members participated in a study to find out about how stressful or traumatic experiences during childhood affect adult health. • Emotional abuse • Physical abuse • Sexual abuse • Emotional Neglect • Physical Neglect • Domestic violence • Household substance abuse • Household mental illness • Parental separation/divorce • Incarcerated household member http://www.cdc.gov/ace/index.htm

11. ACE Score correlated with Risk • Alcoholism and alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Suicide attempts • Fetal death • Health-related quality of life • Illicit drug use • Liver disease • Risk for intimate partner violence • Multiple sexual partners • Sexually transmitted diseases (STDs) • Unintended pregnancies • Early initiation of sexual activity • Adolescent pregnancy • Smoking • Early initiation of smoking

12. Prevalence of Mental Health Disorders in Children and Youth • Approximately 20% of school-age children and youth have a diagnosable mental disorder (Merikangas et al., 2010; CDC, 2013); • One in five children met criteria for psychiatric disorder at school entry (Carter et al., 2010) • Most common mental health disorders (CDC, 2013) • ADHD (7%) • Behavior or conduct disorders (3.5%) • Anxiety (3%) • Depression (2%) • 10% of Florida’s youth have mental health disorder causing significant functional impairment (Florida Adolescent Mental Health Fact Sheet)

13. FL Youth Risk Behavior Survey (2011) • Suicide/Depression • 26% experienced significant feelings of sadness or hopelessness • 21% seriously considered attempting suicide • 7% attempted suicide at least once during the previous 12 months • Suicide was the 2nd leading cause of death for 5-14 year olds, and the 3rd leading cause of death for 15-24 year olds in 2011 (Florida Vital Statistics Annual Reports) • Bullying/Violence • 14% were bullied on school property • 10% engaged in a physical fight on school property • 7% were threatened with a weapon on school property

14. Total Bullying/Harassment Incidents (FL) Number of Incidents

15. Who provides school-based mental health services? • Student Services Personnel (school mental health professionals) • School counselors – 5,433 (1:491) • School psychologists – 1,381 (1:1940) • School social workers – 1,008 (1:2658) • School nurses – 1,163 (1:2286) • Contracted mental health professionals • Safe and Drug Free Schools Personnel • School Resource Officers

16. What are some challenges to SBMH? • Systematic screening for mental issues is not a common practice. • School-based mental health professionals are typically assigned to multiple schools and too often used for crisis response as opposed to crisis prevention. • Limited access to professional development opportunities that address mental health issues. • Fragmentation of services within schools and between school and community-based services.

17. Multi-Tiered System of Supports & School-based Mental Health How are school-based mental health services provided?

18. System of Supports for School-Based Mental Health Services Few Some All

19. Multi-tiered System of Support • Tiered supports • Tier 1 – Preventive services applied to all students • Tier 2 – Targeted group interventions applied to some students • Tier 3 – Intensive interventions applied to individual students • Level of intervention support based on student need. • Problem-solving and data-based decision making. • Monitor the effectiveness of intervention/support.

20. Intervention for Internalizing Disorders in a Three-tier Model Adapted from Merrell & Gueldner (2010). Preventive interventions for students with internalizing disorders. In Shinn & Walker (Eds.), Interventions for Achievement and Behavior Problems in a Three-Tier Model Including RTI.

21. Mental Health in Schools Survey March 22 – April 5, 2013

22. Data was needed to determine: • What part a multi­tiered system of supports plays in implementing Mental Health services (prevention; intervention; response) in public schools. • If school-based Mental Health services are provided within a positive student engagement framework. • What existing services are provided to public school students (K­12) who have mental health needs or other behavioral issues. • What role student services personnel play in collaboration among schools, law enforcement, mental health agencies, and other local organizations. • If students with mental health needs are receiving mental health services and/or treatment.

23. Response to Survey • 47 Districts (70% of districts in FL) • 78 Respondents • Respondent role in district • Director/Coordinator/Supervisor of Student Services • ESE Directors • Supervisor/Coordinator of Student Service Profession

28. List mental health prevention services provided in your district. • Multi-tiered supports (schoolwide/universal supports) • Positive Behavior Support (e.g., PBS, CHAMPS, Tough Kids) • Developmental guidance program • Bullying, Suicide, and Substance Abuse Prevention programs (e.g., Silence Hurts Initiative, Be Safe, HOPE curriculum, Kids at Hope) • Character education programs • Social skills training (e.g., Skillstreaming, Stop and Think, Too Good for Violence • Early Warning Systems • School climate initiatives • Health education

30. Who provides the training for prevention services? • District and school Student Services personnel • Community Mental Health Agencies & Outside Mental Health Providers (e.g., DCF, Children’s Services Council) • FDOE funded Projects – FLPBS, FDLRS, ISRD • District PBS staff and behavior analysts • SEDNET • County Health Department • Professional Associations • Webinars • University

31. Who receives the training for prevention services? • Student services staff • School staff (administrators, teachers, support staff) • District employees • Students • Parents

34. Who provides the training for intervention services? • Student Services staff • District staff (Safe & Healthy Schools, PBS, Health Services) • Community Mental Health agencies & outside professionals • FDLRS, ISRD, PAEC, DCF

35. Who receives the training for intervention services? • Student services staff • District staff & administrators • School staff • Contracted mental health providers • Educators & Parents

38. Who provides the training for response services? • Student Services staff • ESE & Student Services staff • District staff • Community mental health and emergency response partners • Outside agencies • Specialized training (NOVA)

39. Who receives the training for response services? • Crisis response team • Student Services staff • District staff • School administrators • School staff/teachers • ESE specialists

40. What other trainings are being implemented? • Crisis Intervention Training (PREPaRE, NOVA) • Bullying and Suicide Prevention Awareness and Training (e.g., Gate Keeper Training, Eight to Great, Early Warning Signs, Silence Hurts) • American Red Cross Psychological First Aid • Positive Behavior Supports • Critical Incident Stress Management • Risk Assessment/Threat Assessment Training

47. Briefly explain their involvement in Baker Act • Student services staff collaborate with police (SROs) to Baker Act –help determine if criteria are met. • Initiate the process – refer to SRO after completing risk/threat assessment. • Assess and Baker when needed (primarily LCSW but other qualified licensed staff, too). • Provide follow-up (school psychologist, social worker, counselor). • Make referral to law enforcement (SRO). • Part of response/crisis team that provides crisis intervention and determine when Baker Act is necessary. • Communication and support to family.

48. Implications of Survey • Need for systematic screening to identify students needing social-emotional support. • Target Prevention for improvement in district activities/tools/systems. • Ensure that existing MH providers are appropriately used to address prevention, intervention, crisis response needs. • Rather than mandated PD or programs in isolation, establish a holistic approach that incorporates the critical and common elements across issues. • Need for greater collaboration and coordination between school and community mental health resources. • Mutual Aid Agreement among districts would be a logical recommendation.

49. Next Steps?

50. Mental Health Screening