Transforming Child and Transforming Child and Adolescent Mental HealthAdolescent Mental Health
Mark D. Weist, Ph.D.Mark D. Weist, Ph.D.
Department of Psychology, Department of Psychology,
University of South Carolina University of South Carolina
Appalachian State University, 4.19.13Appalachian State University, 4.19.13
Thanks toThanks to
Vittoria AnelloVittoria Anello Jason BirdJason Bird Lori ChappelleLori Chappelle Kendra DeLoachKendra DeLoach Melissa DvorskyMelissa Dvorsky Melissa GeorgeMelissa George Lucille EberLucille Eber Johnathan FowlerJohnathan Fowler Nancy LeverNancy Lever Bobby MarkleBobby Markle
Heather McDanielHeather McDaniel Kurt MichaelKurt Michael Elaine MillerElaine Miller Samantha PaggeotSamantha Paggeot Sharon StephanSharon Stephan Kathy ShortKathy Short Joni SplettJoni Splett Leslie TaylorLeslie Taylor John TerryJohn Terry Rachel WilliamsonRachel Williamson Eric YoungstromEric Youngstrom
Center for School Mental Health* Center for School Mental Health* University of Maryland School of MedicineUniversity of Maryland School of Medicine
http://csmh.umaryland.edu*Supported by the Maternal and Child Health Bureau of *Supported by the Maternal and Child Health Bureau of
HRSA and numerous Maryland agenciesHRSA and numerous Maryland agencies
Outline Outline
RealitiesRealities Expanded school mental healthExpanded school mental health Achieving evidence-based practiceAchieving evidence-based practice Interconnection with PBISInterconnection with PBIS Other collaborative projectsOther collaborative projects Progress, …but many challengesProgress, …but many challenges A National Community of PracticeA National Community of Practice
Reality 1Reality 1
Child and adolescent mental health is Child and adolescent mental health is among the most if not the most neglected among the most if not the most neglected health care need in the UShealth care need in the US
Reality 2Reality 2
Children, youth and families are not Children, youth and families are not getting to places where mental health getting to places where mental health services are traditionally deliveredservices are traditionally delivered
Reality 3Reality 3
Schools are under-resourced to address Schools are under-resourced to address mental health issues, and may view this as mental health issues, and may view this as beyond their missionbeyond their mission
““Expanded” School Mental HealthExpanded” School Mental Health
Full continuum of effective mental health Full continuum of effective mental health promotion and intervention for students in promotion and intervention for students in general and special educationgeneral and special education
Reflecting a “shared agenda” involving Reflecting a “shared agenda” involving school-family-community system school-family-community system partnershipspartnerships
Collaborating community professionals Collaborating community professionals (not (not outsidersoutsiders) ) augmentaugment the work of the work of school-employed staffschool-employed staff
A Vision for Student Mental Health and Well-A Vision for Student Mental Health and Well-Being in Ontario SchoolsBeing in Ontario Schools
Ontario students are Ontario students are flourishing, flourishing,
with a strong sense of with a strong sense of belonging at school,belonging at school,
ready skills for ready skills for managing academic managing academic and social/emotional and social/emotional
challenges, challenges,
and surrounded by and surrounded by caring adults and caring adults and
communities equipped communities equipped to identify and intervene to identify and intervene
early with students early with students struggling with mental struggling with mental
health problemshealth problems
(from Kathy Short)(from Kathy Short)
A Vision
Research Supported ProgramsResearch Supported Programs
Substance Abuse and Mental Health Substance Abuse and Mental Health Service Administration’s National Registry Service Administration’s National Registry of Effective Programs and Practicesof Effective Programs and Practices
www.nrepp.samhsa.com Roughly 56 of 170 research supported Roughly 56 of 170 research supported
interventions can be implemented in interventions can be implemented in schoolsschools
Research Supported Programs Research Supported Programs InvolveInvolve
Strong trainingStrong training Fidelity monitoringFidelity monitoring Ongoing technical assistance and Ongoing technical assistance and
coachingcoaching Administrative supportAdministrative support IncentivesIncentives IntangiblesIntangibles
Practice in the trenchesPractice in the trenches
Involves NONE of these supportsInvolves NONE of these supports
http://www.jhsph.edu/prevention/
Johns Hopkins Center for
Prevention & Early Intervention Leads: Nick Ialongo, Phil Leaf,
Catherine Bradshaw
Clinician Related Barriers
Limited prior training on evidence-based practices
Resistance Role constraints Need for administrative support Need for ongoing coaching and technical
assistance
Typical Work for Clinician for Evidence-Based Prevention Group
Screen students Analyze results of
screen Obtain
consent/assent Obtain teacher buy-in Coordinate student
schedules Get them to and from
groups
Rotate meeting times Implement effectively Promote group
cohesion Address disruptive
behaviors Conduct session by
session evaluation Deal with students
who miss groups
School Related Barriers
Fluidity of the school environment Teacher turnover Tenuous principal buy-in Lack of time Lack of dedicated change agents
Evidence-Based Evidence-Based “Manualized” interventions “Manualized” interventions (from Sharon Stephan)(from Sharon Stephan)
Intervention/Indicated: Cognitive Behavioral Intervention for Trauma in Schools, Coping Cat, Trauma Focused CBT, Interpersonal Therapy for Adolescents (IPT-A)
Prevention/Selected:
Coping Power, FRIENDS for Youth/Teens, The Incredible Years, Second Step, SEFEL and DECA Strategies and Tools, Strengthening Families Coping Resources Workshops
Promotion/Universal:Good Behavior Game, PATHS to PAX, Positive Behavior Interventions and Support, Social and Emotional Foundations of Early Learning (SEFEL), Olweus Bullying Prevention, Toward No Tobacco Use
““Packaging” ProblemPackaging” Problem
Blind commitment to parameters of Blind commitment to parameters of manuals (e.g., hour long sessions, too manuals (e.g., hour long sessions, too many sessions), without consideration of many sessions), without consideration of school realitiesschool realities
Instead group key intervention Instead group key intervention components in “phases” and deliver components in “phases” and deliver flexiblyflexibly See Steve Evans, Julie Owens, Ohio See Steve Evans, Julie Owens, Ohio
UniversityUniversity
Study OverviewStudy Overview
NIMH, R01MH081941-01A2, 2010-14 NIMH, R01MH081941-01A2, 2010-14 (building from a prior R01)(building from a prior R01)
46 school mental health clinicians, 34 46 school mental health clinicians, 34 schoolsschools
Randomly assigned to either:Randomly assigned to either: Personal/ Staff Wellness (PSW)Personal/ Staff Wellness (PSW) Clinical Services Support (CSS)Clinical Services Support (CSS)
CSS: Four Key DomainsCSS: Four Key Domains
Quality Assessment and ImprovementQuality Assessment and Improvement Family Engagement and EmpowermentFamily Engagement and Empowerment ““Modular” Evidence Based PracticeModular” Evidence Based Practice Implementation Support Implementation Support
Quality Assessment and Improvement Quality Assessment and Improvement (QAI) Principles (QAI) Principles
Emphasize accessEmphasize access Tailor to local needs Tailor to local needs
and strengthsand strengths Emphasize quality Emphasize quality
and empirical supportand empirical support Active involvement of Active involvement of
diverse stakeholdersdiverse stakeholders
Full continuum from Full continuum from promotion to promotion to treatmenttreatment
Committed and Committed and energetic staffenergetic staff
Developmental and Developmental and cultural competencecultural competence
Coordinated in the Coordinated in the school and connected school and connected in the communityin the community
Working Effectively with Working Effectively with Students and FamiliesStudents and Families
EngagementEngagement SupportSupport CollaborationCollaboration Empowerment Empowerment
see the work of Kimberly Hoagwood and Mary see the work of Kimberly Hoagwood and Mary McKayMcKay
Modular Evidence-Based Practice Modular Evidence-Based Practice (EBP)(EBP)
SEE: Chorpita, B.F., & Daleiden, E.L. (2009). Biennial Report: Effective Psychosocial Intervention for Youth with Behavioral and Emotional Needs. Child and Mental Health Division, Hawaii Department of Health
• 10 skills for disruptive behavior problems:o Active Ignoringo Commandso Communication Skillso Monitoring behavioro Praiseo Problem Solvingo Psychoeducationo Response costo Tangible rewardso Time out/ Grounding
Implementation SupportImplementation Support
Interactive and lively teachingInteractive and lively teaching Off and on-site coaching, performance Off and on-site coaching, performance
assessment and feedback, emotional and assessment and feedback, emotional and administrative supportadministrative support
Peer to peer support Peer to peer support User friendlinessUser friendliness
see Dean Fixsen, Karen Blasé, National see Dean Fixsen, Karen Blasé, National Implementation Research Network (NIRN)Implementation Research Network (NIRN)
A A “Transformative” “Transformative” Impact?Impact?
Largest and most prominent SMH program in Largest and most prominent SMH program in SCSC
In a network of SMH in all jurisdictionsIn a network of SMH in all jurisdictions Strong interest in the study across all relevant Strong interest in the study across all relevant
sectorssectors Pursuing integrated QAI – Wellness strategy Pursuing integrated QAI – Wellness strategy
nownow Given positive findings, the study approach is Given positive findings, the study approach is
set up for rapid replication in SC and beyondset up for rapid replication in SC and beyond
ButBut
SMH programs and services continue to SMH programs and services continue to develop in an ad hoc manner, anddevelop in an ad hoc manner, and
LACK AN IMPLEMENTATION LACK AN IMPLEMENTATION STRUCTURESTRUCTURE
Positive Behavior Intervention Positive Behavior Intervention and Support (www.pbis.org)and Support (www.pbis.org)
In 17,000 plus schoolsIn 17,000 plus schools Decision making framework to guide Decision making framework to guide
selection and implementation of best selection and implementation of best practices for improving academic and practices for improving academic and behavioral functioningbehavioral functioning Data based decision makingData based decision making Measurable outcomesMeasurable outcomes Evidence-based practicesEvidence-based practices Systems to support effective implementationSystems to support effective implementation
Tiered Support in Systems of CareTiered Support in Systems of Care
Universal Evidence-BasedMental Health Promotion, Social-Emotional Learning
Targeted Evidence-
Based Prevention
E-B ClinicalIntervention
Evidence-Based Clinical Intervention
Targeted Evidence-
Based Prevention
Universal E-B Mental Health
Promotion
Community
School Districts
Interconnected Systems Interconnected Systems Framework (ISF) for SMH-PBISFramework (ISF) for SMH-PBIS
Strategy for interconnection of two systems Strategy for interconnection of two systems across multiple tiersacross multiple tiers
Emphasizes state teams working with Emphasizes state teams working with district teams and schools, and strong team district teams and schools, and strong team planning and actions at each tierplanning and actions at each tier
Two national centers (for SMH and PBIS) Two national centers (for SMH and PBIS) and a number of states involvedand a number of states involved
Numerous training events and a monograph Numerous training events and a monograph in progressin progress
ISF DefinedISF Defined
A strong, committed and functional team A strong, committed and functional team guides the work, using data at three tiers of guides the work, using data at three tiers of interventionintervention
Sub-teams having “conversations” and Sub-teams having “conversations” and conducting planning at each tierconducting planning at each tier
Evidence-based practices and programs are Evidence-based practices and programs are integrated at each tierintegrated at each tier
SYMMETRY IN PROCESSES AT STATE, SYMMETRY IN PROCESSES AT STATE, DISTRICT AND BUILDING LEVELSDISTRICT AND BUILDING LEVELS
ISF cont.ISF cont.
Key stakeholders from education and Key stakeholders from education and mental health are involved and these mental health are involved and these people have the people have the authorityauthority to reallocate to reallocate resources, change roles and functioning of resources, change roles and functioning of staff, and change policystaff, and change policy
There is a priority on strong There is a priority on strong interdisciplinary, cross-system interdisciplinary, cross-system collaborationcollaboration
Old Approach Old Approach New ApproachNew Approach
Each school Each school works out their works out their own plan with own plan with Mental Health Mental Health (MH) agency(MH) agency
District has a plan District has a plan for integrating MH for integrating MH at all buildings at all buildings (based on (based on community and community and school data)school data)
Old Approach Old Approach New ApproachNew Approach
A MH counselor A MH counselor is housed in a is housed in a school building school building 1 day a week to 1 day a week to “see” students“see” students
MH person MH person participates in participates in teams at all 3 teams at all 3 tierstiers
Old Approach Old Approach New ApproachNew Approach
No data to No data to decide on or decide on or monitor monitor interventionsinterventions
MH person leads MH person leads classroom, group classroom, group or individual or individual interventions interventions based on databased on data
ISF, School Readiness ISF, School Readiness AssessmentAssessment
1) High status leadership and team with active 1) High status leadership and team with active administrator participationadministrator participation
2) School improvement priority on 2) School improvement priority on social/emotional/behavioral health for all studentssocial/emotional/behavioral health for all students
3) Investment in prevention3) Investment in prevention 4) Active data-based decision making4) Active data-based decision making 5) Commitment to SMH-PBIS integration5) Commitment to SMH-PBIS integration 6) Stable staffing and appropriate resource 6) Stable staffing and appropriate resource
allocationallocation
ISF, Indicators of Team FunctioningISF, Indicators of Team Functioning
Strong leadership Strong leadership Good meeting attendance, agendas and Good meeting attendance, agendas and
meeting managementmeeting management Opportunities for all to participateOpportunities for all to participate Taking and maintaining of notes and the Taking and maintaining of notes and the
sense of history playing outsense of history playing out Clear action planningClear action planning Systematic follow-up on action planningSystematic follow-up on action planning
Team MembersTeam Members
*School psychologist*School psychologist *Collaborating *Collaborating
community mental community mental health professionalhealth professional
School counselorSchool counselor Special educatorSpecial educator
*co-leaders*co-leaders
Assistant principalAssistant principal School nurseSchool nurse General educatorGeneral educator ParentParent ParentParent (Older student) (Older student)
Interdisciplinary, evidence-based intervention Interdisciplinary, evidence-based intervention for youth with mood disorders in schoolsfor youth with mood disorders in schools
USC, ASU and UNCUSC, ASU and UNC More than 20 student participants and More than 20 student participants and
promising datapromising data Likely big grant application by this fall Likely big grant application by this fall
Student Emotional and Educational Student Emotional and Educational Development (SEED)Development (SEED)
CLIMBCLIMB
Changing Lifestyles to Improve Mind Changing Lifestyles to Improve Mind and Body and Body (Melissa George et al.)(Melissa George et al.)
10 middle school participants, 6 sessions 10 middle school participants, 6 sessions integrated into work of SMH clinicians integrated into work of SMH clinicians (enhanced exercise and/or reduced (enhanced exercise and/or reduced screen time, increased fruit and vegetable screen time, increased fruit and vegetable intake and/or reduced junk food)intake and/or reduced junk food)
Strong feasibility and acceptability and Strong feasibility and acceptability and preliminary evidence of impactpreliminary evidence of impact
Progress, but…. many other Progress, but…. many other challenges challenges
SuspensionSuspension
ExpulsionExpulsion
Very poor transitionsVery poor transitions
Schools and people doing what they are Schools and people doing what they are used to doing (and being highly resistant used to doing (and being highly resistant to change)to change)
Roles of School-Employed MH Roles of School-Employed MH Staff (in some instances)Staff (in some instances)
Course schedulingCourse scheduling Attendance monitoringAttendance monitoring Examination monitoringExamination monitoring Career guidanceCareer guidance Logistics assistanceLogistics assistance
See Steve Evans, Ohio UniversitySee Steve Evans, Ohio University
Significant Accountability IssuesSignificant Accountability Issues
““Optimizing” Optimizing” School staff doing rote administrative workSchool staff doing rote administrative work Community mental health staff seeing same Community mental health staff seeing same
clients and delivering passive, eclectic, non clients and delivering passive, eclectic, non evidence-based interventionsevidence-based interventions
Special Education Challenges Special Education Challenges
Schools and staff as gatekeepersSchools and staff as gatekeepers ““Social maladjustment”Social maladjustment” Highly variable labelingHighly variable labeling ““Manifestation” hearingsManifestation” hearings Increasing but not decreasing restrictivenessIncreasing but not decreasing restrictiveness Pro-forma meetings and poor follow-upPro-forma meetings and poor follow-up AccomodationsAccomodations
A National Community of Practice A National Community of Practice (COP); www.sharedwork.org(COP); www.sharedwork.org
CSMH and IDEA Partnership (CSMH and IDEA Partnership (www.ideapartnership.org) providing ) providing supportsupport
30 professional organizations and 16 30 professional organizations and 16 statesstates
12 practice groups12 practice groups Providing mutual support, opportunities for Providing mutual support, opportunities for
dialogue and collaborationdialogue and collaboration
Example Practice Groups Example Practice Groups
Learning the LanguageLearning the Language Quality and Evidence-Based PracticeQuality and Evidence-Based Practice Family InvolvementFamily Involvement Youth LeadershipYouth Leadership SMH and PBISSMH and PBIS SMH and Special EducationSMH and Special Education SMH and Systems of CareSMH and Systems of Care Military FamiliesMilitary Families
Sixteen StatesSixteen States
HawaiiHawaii IllinoisIllinois New HampshireNew Hampshire North CarolinaNorth Carolina MarylandMaryland Minnesota*Minnesota* MissouriMissouri Montana*Montana*
New MexicoNew Mexico OhioOhio PennsylvaniaPennsylvania South CarolinaSouth Carolina South DakotaSouth Dakota Utah*Utah* VermontVermont West VirginiaWest Virginia
MissionTo help Ohio’s school districts, community-based agencies,and families work together to achieve improved educationaland developmental outcomes for all children — especially
those at emotional or behavioral risk and those withmental health problems
Since 2001 Ohio Department of Mental Health Ohio Department of Education Center for School-Based Mental Health Programs at Miami University (http://www.units.muohio.edu/csbmhp)
Ohio Mental Health Networkfor School Success (http://www.omhnss.org)
Montana’s Integrated School Montana’s Integrated School Mental Health InitiativeMental Health Initiative
American Foundation for Suicide Prevention, South Carolina Appalachian State University Clemson University Eastern Carolina University Medical University of South Carolina North Carolina Department of Public Instruction South Carolina Department of Education South Carolina Department of Mental Health University of North Carolina at Chapel Hill University of North Carolina at Greensboro University of North Carolina at Pembroke University of South Carolina Wake Forest University
Advances in School Mental Health Advances in School Mental Health PromotionPromotion
New to Routledge for 2012!
Published on behalf of The Clifford Beers Foundation
Published in collaboration with the University of Maryland School of Medicine
Editor in Chief – Mark WeistConsulting Editor – Michael Murray Deputy Editor – Sharon Stephan
1818thth Annual SMH Conference Annual SMH ConferenceCrystal City, Arlington, VirginiaCrystal City, Arlington, Virginia
October 3-5, 2013October 3-5, 2013
Contact InformationContact Information
Department of Psychology Department of Psychology University of South Carolina University of South Carolina 1512 Pendleton St., Room 237D 1512 Pendleton St., Room 237D
Columbia, SC 29208Columbia, SC 29208
Ph: 803 777 8438 Ph: 803 777 8438 [email protected]