Parents and Teachers as Allies Partnering with Schools to Improve the Lives of Students Living with Mental Illnesses

1. Parents and Teachers as Allies Partnering with Schools to Improve the Lives of Students Living with Mental Illnesses Darcy Gruttadaro, Director, NAMI National Child & Adolescent Action Center Donna Pollard, Program Director & Parents and Teachers as Allies Trainer, NAMI Orange County Donna Wallis, Executive Director & Parents and Teachers as Allies Trainer, NAMI Orange County NAMI Convention, June 2007, San Diego, CA

2. The Vital Need for Early Identification of Mental Illnesses… The overwhelming majority of children and adolescents with mental illnesses fail to be identified and linked with services. There are often tragic and avoidable consequences. Many school professionals lack an understanding of early onset mental illnesses. NAMI Convention, June 2007, San Diego, CA

3. Research Supports Early Identification NIMH researchers found that half of all lifetime cases of mental illness begin by age 14, and that despite effective treatments, there are long delays — sometimes decades — between first onset of symptoms and when people seek and receive treatment. Untreated mental illnesses can lead to a more severe, more difficult to treat illness, and to the development of co-occurring mental illnesses. NIMH Funded Research, Released in June 2005. NAMI Convention, June 2007, San Diego, CA

4. The Role of Schools in Early Identification NAMI recognized the tremendous value of having parents and school professionals working together as allies… which led to the development of the Parents and Teachers as Allies publication in 1999 (updated in 2003). NAMI Convention, June 2007, San Diego, CA

5. Parents and Teachers as Allies… The P&T as Allies publication covers the following: • Keys to early recognition and links to appropriate evaluation and services (teachers are never asked to diagnose children or to recommend medications); • Understanding family reactions to mental illnesses and guidelines for helping families; • Navigating the referral process and linking to services as allies; • Strengthening the alliance between parents and school professionals and lists resources for both. NAMI Convention, June 2007, San Diego, CA

6. President Bush’s NFC Recommends Schools Play a Bigger Role … Goal 4 of President Bush’s New Freedom Commission Report on Mental Health, issued in July 2003, calls for schools to play a larger role in the early identification of mental health treatment needs in children and in linking them to appropriate services. This is just what NAMI’s P&T as Allies program targets. NAMI Convention, June 2007, San Diego, CA

7. The Words of the NFC … “The mission of public schools is to educate all students. However, children with serious emotional disturbances have the highest rates of school failure. Fifty percent of these students drop out of high school, compared to 30% of all students with disabilities. Schools are where children spend most of each day … NAMI Convention, June 2007, San Diego, CA

8. The Words of the NFC … …While schools are primarily concerned with education, mental health is essential to learning as well as to social and emotional development … Schools must be partners in the mental health care of our children.” NFC Report, 2003 NAMI Convention, June 2007, San Diego, CA

9. Why Schools … Schools are in a unique and key position to identify mental health concerns early and to link students with appropriate services. Strong school mental health programs can help to address the needs of students, reduce unnecessary suffering, and help to ensure academic achievement. Goal 4 of The President’s New Freedom Commission on Mental Health NAMI Convention, June 2007, San Diego, CA

10. The Success of the Publication NAMI leaders recognized the value in sharing the publication with schools and began to use it to better inform school professionals about early onset mental illnesses. Innovative NAMI leaders in a number of states developed an in-service presentation program based on the publication. NAMI Convention, June 2007, San Diego, CA

11. The Focus of NAMI’s In-Service Program Helping schools to better understand the early warning signs of mental health treatment needs in students and how best to intervene so that youth with treatment needs are linked with services. NAMI Convention, June 2007, San Diego, CA

12. The In-Service Early Pilot Program The In-Service presentation follows the contentof the P&T as Allies publication, with the lived experience representing a critical component. The In-Service presentation was launched in Orange County, FL (12th largest school district in the country) and has been delivered in multiple pilot sites in states around the country, including CA, IL, VA, WA, MN, CT, and others. NAMI Convention, June 2007, San Diego, CA

13. The In-Service Early Pilot Program School professionals give extremely high grades to the early pilot program. School professionals often admit feeling ill equipped to address the needs of these students and how best to work with families. NAMI national received a four-year foundation grant to expand the early pilot program. NAMI Convention, June 2007, San Diego, CA

14. Expansion of the Pilot Program The Pilot Program expansion targets public schools in urban, suburban, rural, and culturally diverse communities. NAMI continues to focus on cultural competence in the program. It will be available in Spanish in 2007-08. NAMI Convention, June 2007, San Diego, CA

15. Expansion of the Pilot Program The foundation grant has allowed NAMI to expand the scope and reach of the program. Two additional modules added: • Module to instruct grassroots family leaders about effective outreach to schools; • Module to include a presentation on early warning signs for parents and caregivers and effective outreach to families within the school community. NAMI Convention, June 2007, San Diego, CA

16. Overview of Parents & Teachers as Allies In-Service Education Program • Two-hour in-service education program. • Most schools require school professionals to have in-service training/education. • The Program includes a team of four presenters: educator/family member, facilitator/F2F teacher, parent of a child, and consumer that had early onset MI. • The Publication is provided to all participants. NAMI Convention, June 2007, San Diego, CA

17. Content of the In-Service Program Welcome and Introductions Lead by: Educator/Family Member Speaks from personal experience, warms up the room, connects with the audience as a credible education professional. Focuses on stigma and different perspectives we all have about MI. NAMI Convention, June 2007, San Diego, CA

18. Some Suggestions for Welcome and Introductions • Make the objectives for the presentation clear, • Be sure to introduce NAMI to the audience. • Provide NAMI’s definition of mental illness: “Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.” NAMI Convention, June 2007, San Diego, CA

19. Content of the In-Service Program Early Warning Signs of Mental Illness Lead by: Facilitator/Family Member Directs group to publication. Reviews the early warning signs. Reinforces that teachers are not diagnosticians but can certainly recognize early warning signs if they know what to look for. NAMI Convention, June 2007, San Diego, CA

20. Suggestions • We want the audience to become familiar with the monograph. • We have asked members of the audience to read portions for a change of pace. • Stress listening to families. NAMI Convention, June 2007, San Diego, CA

21. Content of the In-Service Program Family Response: Predictable Stages of Emotional Reactions Among Family Members Lead by: Parent/Family Member Reviews stages from the publication (pg. 21-22). Parent recounts their personal journey with their child (infusing the lived experience). Talks about where things are now and steps a school took that were helpful. NAMI Convention, June 2007, San Diego, CA

22. Content of the In-Service Program Living with Mental Illnesses: A View from the Inside Lead by: Consumer Consumer shares his/her experiences as a child living with mental illness. Focus is on the struggles, especially in school, teachers that helped, what was harmful, what was needed and how bad experiences can be turned around. Professionals are interested in knowing how to properly handle classroom circumstances that they have not been trained to address. NAMI Convention, June 2007, San Diego, CA

23. Living with Mental Illness • The consumer presentation captures the heart of the audience. • Just having some understanding of the feelings a child is experiencing helps teachers cope with difficult behaviors. NAMI Convention, June 2007, San Diego, CA

24. Content of the In-Service Program Group Discussion Lead by: Educator/Family Member Everyone on the presenting team fields questions from in-service participants. Presenters are trained to know about the FAQ (differentiating between bad behavior and early warning signs, who do I refer a child to, isn’t medicating a child controversial, how does all this help with classroom management, etc.) NAMI Convention, June 2007, San Diego, CA

25. Content of the In-Service Program Closing Lead by: Facilitator/Family Member Thanks participants and those who arranged the in-service training. Evaluations for program completed (satisfaction survey and pre- and post-test). We have found that school professionals want much more information (effective behavior interventions, classroom based EBPs, etc.). NAMI Convention, June 2007, San Diego, CA

26. Effective Outreach to Schools • Many schools have not engaged in the MH agenda yet and some resist it. • It may not be a priority for schools. • School professionals are stretched very thin. • Many school-based MH professionals are over-extended, working at multiple schools with huge case loads and some fail to understand early onset MI. NAMI Convention, June 2007, San Diego, CA

27. Outreach to Schools … • The key to success is to go in to schools knowing the challenges that they face. • We see this task as akin to cultural and social anthropologists – we put ourselves in their shoes. • This program is a beginning to help schools understand the pressing need to recognize the early warning signs of mental illnesses and to link students with services. NAMI Convention, June 2007, San Diego, CA

28. Outreach … We know that there are many successful ways to conduct outreach with schools. An outreach strategy that works wonders in one district may not work at all in another. A thread of common importance – establish a firm connection with the targeted school and build a relationship of trust. NAMI Convention, June 2007, San Diego, CA

29. Outreach … Some basic suggestions: • Start where you are most likely to succeed (capitalize on early success, the ripple effect and benefits of the grapevine). • Find your strongest school-based allies. • Find your strongest community allies (other advocacy groups, the PTA, etc.). NAMI Convention, June 2007, San Diego, CA

30. Outreach … • The advantages and dangers of starting at the top. • Craft your message carefully -- what matters most to this school? • In our experience, school districts are hungry for this information but it can be difficult to make it a priority for them. NAMI Convention, June 2007, San Diego, CA

31. How the Program Fits Within an Overall Advocacy Agenda The education community is key to reaching the NAMI goal of reducing stigma and discrimination. Given the early onset of mental illness and the advantage of early identification we must find ways to reach educators. NAMI Convention, June 2007, San Diego, CA

32. Our Orange County Experience Orange county is a large county with 31 school districts and 500,000 students. • We have been providing lessons in education system. • schools for 10 years. • We have done some teacher in-services before the present PTasA program. • We have made some friends in the county education department. NAMI Convention, June 2007, San Diego, CA

33. The Snowball Effect • Our first presentation after the our training in St. Louis was at the Orange County department of Education which was arranged by a NAMI member there. Personnel from the Orange county Health Care Agency attended. • After that meeting five more presentations were scheduled. • Because county personnel attended, we have beenasked to present at the school nurse convention in August. NAMI Convention, June 2007, San Diego, CA

34. The Snowball Effect, cont’d • From the original five presentations, two more are scheduled for the future with a couple more possibilities. • We have been asked to speak at two church groups, too. • We did another presentation at OCDE in April. • The more we do, the more we will be asked to do. NAMI Convention, June 2007, San Diego, CA

35. Building Your Team • Go for the gold! • Find a well credentialed educator. • The family member and consumer are key! • Consumer presenters are the more difficult to find. • The training day is from 8-5. • We recommend training at least 3 teams. • Make sure each team member understands the requirements. NAMI Convention, June 2007, San Diego, CA

36. Securing Team Commitment • On training day, determine the role of each participant. • Stress the importance of meeting before a presentation to practice. • Each participant needs to come to practice prepared. • If there is not a program coordinator, one of the team members needs to be a leader. • Our evaluations have been very motivating to our teams. (See handout) NAMI Convention, June 2007, San Diego, CA

37. Training Opportunities Kingston Jr. High in Kingston WA needed a presentation for their faculty following two suicides. We were asked to do this and we asked to be able to train NAMI WA in the program. This was financed by a memorial fund for one of the victims. We have also gone to San Luis Obispo, CA to train folks there. This is an excellent program with the capability of helping in the prevention and early intervention of mental illness! NAMI Convention, June 2007, San Diego, CA

38. Comment from Kingston, WA Email received from Eric Kvistad, father of student at Kingston Junior High: “I am the one who should be thanking you. This never would have been possible without you and Donna helping. My wife and I are gratified this subject has received so much attention in our local area. It may be the ray of hope that a troubled youth needs in order to get help.” NAMI Convention, June 2007, San Diego, CA

39. Next Steps Our first national train-the-trainers meeting for this program was held in March 2006 in St. Louis. NAMI and CHADD leaders from 14 states participated (CA, CT, FL, ID, IL, MD, TX, MN, MI, NC, OH, PA, TN, UT). Numerous schools in these states have received the PTasA Program and evaluations from these sites are currently being analyzed to create an evidence base for this Program. The expanded program will continue to be rolled out as additional states become trained during the next two years of the foundation grant. NAMI Convention, June 2007, San Diego, CA

40. The Roll-Out Family advocacy leaders participating in the program are receiving ongoing technical assistance from the NAMI national office. This interaction between the field and NAMI national provides us with direct feedback on the program’s effectiveness. The evaluation component of the program allows us to measure its ongoing success to help ensure continuous program improvement. NAMI continues to focus on cultural competence in the program. It will be available in Spanish in 2007-08. NAMI Convention, June 2007, San Diego, CA

41. NAMI Believes That … …together families, school professionals and mental health providers can make a tremendous difference in the lives of children and families. NAMI is pleased to see so many schools opening their doors to family advocates working to raise awareness about early onset mental illnesses. We look forward to continuing to build our partnerships and alliances with the school and mental health advocacy and provider communities. NAMI Convention, June 2007, San Diego, CA

42. Contact Information Darcy Gruttadaro Director, NAMI Child & Adolescent Action Center Phone: 703.516.0698 Email: darcy@nami.org Donna Pollard Program Director, NAMI Orange County Phone: 714.544.8488 Email: dpollard@namioc.org NAMI Convention, June 2007, San Diego, CA