Youth Substance Use and Academic Achievement

1. Youth Substance Use and Academic Achievement Louise Fink, Ph.D., Baltimore City Public Schools Rita Mattison, DM, MHS, LCADC, Baltimore Substance Abuse Systems, Inc.

2. Expanded School Mental Health Program Baltimore City Public Schools Baltimore Mental Health System Baltimore Substance Abuse System

3. PROGRAM OVERVIEW • Baltimore City Public Schools has partnered with external agencies to supplement clinical services to students in general education since 1991 • Financial support for these services has remained level ($1.4 million annually) while the number of providers and schools covered has increased • Currently there are 4 lead agencies providing service in a total of 105 schools.

4. Funding Sources • The ESMH program has four funding sources • PREVENTION SERVICES • Baltimore City Schools $1.4 Million • Baltimore Mental Health System (BMHS) $726,000 • Baltimore Substance Abuse System (BSAS) $420,000 • TREATMENT • Public Mental Health System/Medicaid • fee for service

5. ESMH Services Model • Category 1: School-wide Supportive Activities - 20% of clinician time • Category 2: Treatment Services - 50% of clinician time • Category 3: Group Prevention Activities - 20% of clinician time • Category 4: Clinician Professional Development - 10% of clinician time

6. ESMH Services Model

7. School-wide Supportive Activities • Consultation with school staff • In-service presentations • Participation in school-wide crisis management • Participation in school-wide behavior management plan • Participation in school teams • Attendance at school functions

8. Treatment Services • Screening/assessment/evaluation/treatment planning • Treatment services • Crisis Response • Family services • Teacher consultation • Clinical Documentation • Activities for reimbursement

9. Group Prevention Activities • Prevention groups for small groups of students • Classroom-wide prevention activities • School-wide prevention activities/assemblies • Parent/family focused group prevention activities

10. OUTCOME INDICATORS • Student Attendance: percentage of students attending at least 90% of school days • Suspension: percentage of students with no suspensions after beginning services • Special Education referrals: decrease in the the number of inappropriate referrals to Child Study teams • Promotion: percentage of students promoted to the next grade

11. Robert Balfanz4 indicators • Indicator 1 • Poor Attendance

12. Robert Balfanz 4 indicators • Indicator 2 • Poor Reading Skills

13. Robert Balfanz 4 indicators • Indicator 3 • Behavior Issues

14. Robert Balfanz 4 indicators • Indicator 4 • Poor Math Skills

15. Robert Balfanz 4 indicators • Students who fall off track in the sixth grade tend to have one or two off-track indicators. Relatively few sixth graders have three or four indicators, that is, failing math and English and having low attendance and poor behavior.

16. Baltimore Substance Abuse Systems, Inc. Baltimore Substance Abuse Systems, Inc. (bSAS) • Designated substance abuse treatment and prevention authority for Baltimore City • Administrator of federal, state and local grant funds for substance abuse and prevention services • Monitors treatment programs • Collects client demographic and treatment data • Works in collaboration with other agencies to improve services, and plan/develop new services

17. Collaborative Effects ESBHI is a behavioral health intervention funded by bSAS in collabration with: • Baltimore Mental Health Systems, Inc. (BMHS) • Baltimore City Public Schools (BCPS) • Baltimore City Health Department (BCHD)

18. Context Sixth Grade Initiative is nestled within Expanded School Mental Health Initiative (ESMH) • ESMH • Began in 1993 • Multi-agency partnership • Provides supplemental mental health prevention, early intervention, and treatment services to children in Baltimore City public schools

19. ESMH Target Population • Children enrolled in general education programs • Grades K through 12 • Clinicians work with student support team (SST) to identify social/emotional needs of children and strategies for addressing these

20. What is to be different in 6th Grade Initiative Schools • Targeted high-risk sixth graders • Individualized iterative interventions, regular follow-up, and tracking through SST • Initially used Why Try as the primary small-group intervention / FY12 Botvin’sLifeSkillsas primary intervention • S.A. prevention training for faculty/staff • Standardized school-wide behavior management intervention

21. Defining High-Risk Sixth Graders • Research by Dr. Robert Balfanz – Identified children at risk for school drop out as early as 6th grade based on the following 4 risk factors: • Poor attendance • Behavior problems • Lack of math proficiency • Lack of reading proficiency • Retention • School Administrators/Staff • Substance abuse is associated with school drop out

22. 6th Grade Initiative Concept: bSAS funding is leveraged with BCPS funding to provide targeted interventions with substance abuse focus to at-risk sixth graders Goal: To prevent school drop-out which minimizes substance use and other negative outcomes for children

23. What Does bSAS Money Buy? • Partially funded mental health clinicians in 35 schools (25% of FTE) • Minimum of 36 consultations for teachers and other school staff • Minimum of 15-18 prevention group activities/committee meetings • Minimum of 1 family outreach activity • Minimum of 1 in-service presentation to school staff

24. Sixth Grade Initiative – As Implemented • Program began fall 2008 • Baltimore City Schools and City Health Department identified 895 6th grade children as meeting at least one targeted risk factor • Clinicians in conjunction with SST identified individualized strategies and interventions for selected population • Clinicians offered enhanced behavioral health services

25. Evaluation of the Impact of ESBHI • Evaluation of ESMH Services during the 2008-09 academic year • Approved by Georgetown University Institutional Review Board (IRB) and BCPS • 553 Students in ESBHI were tracked • Service use data was merged with measures of school and academic performance, provided by the Division of Research, Evaluation, Assessment (DREAA) of BCPS.

26. Relationship to Academic Outcomes Benchmarks Figure 5: Math Benchmark Comparisons N=77 18 16 14 12 10 8 6 4 2 0 N=53 Percent of Students Showing Increases in Benchmarks Comparison ESBHI 6th Grade Cohort

27. Relationship to School Functioning Attendance Figure 9: Change in Percent Attendance for Subcohorts 1 0 2 Change in Percent Attendance -1 -2 -3 GS-Lo GS-Mid GS-Hi ESBHI Subcohort

28. Relationship to School Functioning Suspensions Figure 10 : Change From 5th to 6th Grade in Percent of Students Receiving Different Numbers of Suspensions 6 5 4 3 2 1 0 -1 -2 -3 23 Comparison ESBHI Change in Percent Suspensions 7 -­‐2 -­‐1 -2* -3 -10 -10 0 1 2 3 Number of Suspensions

29. Conclusion • The relationship between ESBHI participation and academic, attendance and suspension outcomes were evident in students who attended most of the sessions. • Results suggest that participating in a school-based behavioral health life skills groups, implemented with reasonable fidelity, can lead to academic success and school functioning found to reduce or delay onset of substance use and behavioral health problems in youth. Anthony, B. J. & Sebian, J. K. (2011)

30. Perspectives • “The kids love the group! This is one really great thing that happened this week...it made me so proud of them: Some of my kids created a mini-play that talked about fighting and how they would solve the problem (without me asking them to do so!)! Four of them acted it out at the end of our group and it was really creative and drove the problem-solving point home! I may have them do it again for their parents at the graduation ceremony!” Behavioral Health Clinician • ”Coming to the groups has helped me not to fuss with other students when they get on my nerves and I have learned to walk away and not get into fights.” Student • “I believe the 6th Grade Initiative is good for the students and I would like to see it continued next year.” Principal

31. References • Anthony, B. J., &Sebian, J. K. (2011). BaltimoreExpandedSchool Mental  Health:Reportof the 2008-2009ProgramEvaluation. AppendixB:6thGradeExpanded School Behavioral HealthInitiativeEvaluation Report. Washington, DC:GeorgetownUniversity CenterforChildandHuman Development. • Balfanz, R., Ruby, A, & Mac Iver, D. (2002). Essential components and next steps for comprehensive whole-school reform in high poverty middle schools. In S. Stringfield, & D. Land, (Eds.), Educating at-risk students (pp. 128-147). Chicago: National Society for the Study of Education.

32. Contact Information Louise Fink. Ph.D llfink@bcps.k12.md.us (410)396-0775 Cityschoolsinside.org Rita Mattison, DM, MHS, LCADC rmattison@bsasinc.org (410)637-1900 x217 www.bsasinc.org