transforming mental health care: a focus on the schools larke nahme huang, ph.d. american institutes...

Transforming Mental Health Care: Transforming Mental Health Care: A Focus on the SchoolsA Focus on the Schools

Larke Nahme Huang, Ph.D.Larke Nahme Huang, Ph.D.American Institutes for ResearchAmerican Institutes for Research

99thth Annual Conference on Annual Conference onAdvancing School-Based Mental HealthAdvancing School-Based Mental Health

Dallas, TexasDallas, TexasOctober 8, 2004October 8, 2004

President’s New Freedom President’s New Freedom Commission on Mental HealthCommission on Mental Health

The MissionThe Mission

Conduct a comprehensive study of the U.S. Conduct a comprehensive study of the U.S. mental health service delivery system and mental health service delivery system and recommend improvements to the President. recommend improvements to the President.


ChargeCharge

“ “ The Commission …shall…recommend The Commission …shall…recommend improvements to enable adults with improvements to enable adults with serious mental illnesses and children serious mental illnesses and children with severe emotional disturbances to with severe emotional disturbances to live, work, learn, and participate fully in live, work, learn, and participate fully in their communities.”their communities.”

About the CommissionAbout the Commission

15 Commissioners15 Commissioners Public, private; payers, providers, consumers, family Public, private; payers, providers, consumers, family

members, policy makers, researchersmembers, policy makers, researchers 7 Federal Ex officio members:7 Federal Ex officio members:

Labor, Education, Veterans Affairs, HUDLabor, Education, Veterans Affairs, HUD CMS, SAMHSA, NIMH, CMS, SAMHSA, NIMH,

Monthly meetingsMonthly meetings Site Visits,Testimony and Town Hall meetingsSite Visits,Testimony and Town Hall meetings Research Review/ConsultantsResearch Review/Consultants Website Responses – content analysisWebsite Responses – content analysis 15 Subcommittees15 Subcommittees

15 Working Subcommittees15 Working Subcommittees

Acute CareAcute Care Children and FamiliesChildren and Families Consumer IssuesConsumer Issues Co-occurring DisordersCo-occurring Disorders Criminal JusticeCriminal Justice Cultural CompetenceCultural Competence Employment & Income Employment & Income

SupportSupport Evidence-based Evidence-based

Practice & Medication Practice & Medication IssuesIssues

Housing and Housing and HomelessnessHomelessness

Medicare/MedicaidMedicare/Medicaid Mental Health Interface Mental Health Interface

with General Medicinewith General Medicine Older AdultsOlder Adults Rights and EngagementRights and Engagement Rural IssuesRural Issues Suicide PreventionSuicide Prevention

Analysis of Federal Funding Analysis of Federal Funding StreamsStreams


Interim Report, October 2002Interim Report, October 2002

““The mental health delivery system is fragmented The mental health delivery system is fragmented and in disarray – not from lack of commitment and in disarray – not from lack of commitment and skill of those who deliver care, but from and skill of those who deliver care, but from underlying structural, financing, and underlying structural, financing, and organizational problems… The system’s organizational problems… The system’s failings lead to unnecessary and costly failings lead to unnecessary and costly disability, homelessness, school failure, and disability, homelessness, school failure, and incarceration.”incarceration.”

Selected Findings: Selected Findings: A Public Health Crisis in Mental A Public Health Crisis in Mental

HealthHealth 20% adults/children have a mental health problem20% adults/children have a mental health problem ½ have a serious emotional disorder½ have a serious emotional disorder

20 million suffer from serious disabling mental illness20 million suffer from serious disabling mental illness

Suicide: ~30,000 a year [80/day]Suicide: ~30,000 a year [80/day] ~40% had contact with primary care provider within the last ~40% had contact with primary care provider within the last

monthmonth Adolescents 15-19y/o: 3Adolescents 15-19y/o: 3rdrd leading cause of death; 17-19% leading cause of death; 17-19%

think about killing themselves; 5-8% make attempt; only 1/3 think about killing themselves; 5-8% make attempt; only 1/3 get treatmentget treatment

YET,YET, Only half of individuals with serious mental illness get treatment, Only half of individuals with serious mental illness get treatment,

services or supports services or supports

Scope of MH Needs of YouthScope of MH Needs of Youth

““By the year 2020, childhood neuropsychiatric By the year 2020, childhood neuropsychiatric disorders will rise by over 50% internationally disorders will rise by over 50% internationally to become one of the five most common to become one of the five most common causes of morbidity, mortality, and disability causes of morbidity, mortality, and disability among children… no other illnesses damage among children… no other illnesses damage so many children so seriously.”so many children so seriously.”

World Health Organization, 2002World Health Organization, 2002

Presenting Problems of Youth Presenting Problems of Youth Admitted to MH Services: 1997Admitted to MH Services: 1997

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46% 44%

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16% 16% 13%11%

Update, www.ihhcpar.rutgers.edu, 2002

Selected Findings for ChildrenSelected Findings for Children

Of children with serious emotional/behavioral disorders: Of children with serious emotional/behavioral disorders: ~50% drop-out of high school (compared to 30% of ~50% drop-out of high school (compared to 30% of students with other disabilities) students with other disabilities) (Dept of Education)(Dept of Education)

Youth entering Juvenile Justice: ~66-75% have serious Youth entering Juvenile Justice: ~66-75% have serious emotional problemsemotional problems (Coalition on Juvenile Justice; Teplin)(Coalition on Juvenile Justice; Teplin)

~500,000 children in foster care: estimates up to 85% ~500,000 children in foster care: estimates up to 85% have emotional/behavioral and/or substance abuse have emotional/behavioral and/or substance abuse problem; 44% < 5 yrs oldproblem; 44% < 5 yrs old ((The AFCARS Report: Preliminary FY 2001 The AFCARS Report: Preliminary FY 2001 Estimates as of March 2003. Washington, D.C., DHHS, 2003. ( latest federal statistics on Estimates as of March 2003. Washington, D.C., DHHS, 2003. ( latest federal statistics on foster care supplied by the states for the Adoption and Foster Care Analysis and Reporting foster care supplied by the states for the Adoption and Foster Care Analysis and Reporting System; Zero to Three) System; Zero to Three)

1/3 children in mental health system have a co-1/3 children in mental health system have a co-occurring disorderoccurring disorder (~age 11; ~age 17-18 SA) (~age 11; ~age 17-18 SA)

Disparities for Children of Disparities for Children of Diverse Racial and Ethnic Diverse Racial and Ethnic

GroupsGroups Black and Latino kids identified/referred at same rates as Black and Latino kids identified/referred at same rates as

general population, but less likely to receive specialty mental general population, but less likely to receive specialty mental health or medshealth or meds (Kelleher, 2000)(Kelleher, 2000)

Minority children tend to receive mental health services through Minority children tend to receive mental health services through juvenile justice and child welfare systems more often than juvenile justice and child welfare systems more often than through schools or mental health settingthrough schools or mental health setting (Alegria, 2000)(Alegria, 2000)

African American and Latino children have highest rates of unmet need African American and Latino children have highest rates of unmet need (Sturm, 2000)(Sturm, 2000)

Asian American and Latino female teens have highest rates of Asian American and Latino female teens have highest rates of depression depression (Commonwealth Fund, 1997)(Commonwealth Fund, 1997)

In child welfare, minority youth have poorer outcomes, fewer services, In child welfare, minority youth have poorer outcomes, fewer services, less likely to have plans for family contact and more likely to be in out-less likely to have plans for family contact and more likely to be in out-of-home placements of-home placements (Courtney et al, 1996).(Courtney et al, 1996).

Rural DisparitiesRural Disparities

Rates of mental disorders are similar between rural Rates of mental disorders are similar between rural and urban youth, although limited sampling in rural and urban youth, although limited sampling in rural AmericaAmerica

Exception: Rural adolescents have higher rate of Exception: Rural adolescents have higher rate of suicide than urban counterpartssuicide than urban counterparts

Significantly higher rate among Native American youthSignificantly higher rate among Native American youth

Child poverty higher in rural areas; children of color at-Child poverty higher in rural areas; children of color at-risk with 46% African American, 43% Native American risk with 46% African American, 43% Native American and 41% Hispanic rural children in povertyand 41% Hispanic rural children in poverty

President’s New Freedom President’s New Freedom Commission on Mental Health Commission on Mental Health

Final ReportFinal Report

Achieving the Promise: Achieving the Promise: Transforming Mental Health Care in AmericaTransforming Mental Health Care in America

“ “ We envision a future when everyone with a We envision a future when everyone with a mental illness will recover, a future when mental illness will recover, a future when mental illness can be prevented or cured, a mental illness can be prevented or cured, a future when mental illnesses are detected future when mental illnesses are detected early, and a future when everyone with a early, and a future when everyone with a mental illness at any stage of life has access to mental illness at any stage of life has access to effective treatment and supports-essentials for effective treatment and supports-essentials for living, working, learning, and participating fully living, working, learning, and participating fully in the community.”in the community.”

Principles Underlying Principles Underlying TransformationTransformation

Services and treatments that –Services and treatments that – Are consumer and family-driven, not Are consumer and family-driven, not

focused primarily on the demands of focused primarily on the demands of bureaucracies bureaucracies

Provide real and meaningful choice of Provide real and meaningful choice of treatments, services and supports – treatments, services and supports – and providersand providers

Engage consumers, families, youthEngage consumers, families, youth

Principles Underlying Principles Underlying TransformationTransformation

Care is focused on:Care is focused on: Promoting consumers’ and family’s ability Promoting consumers’ and family’s ability

to manage life’s challenges successfullyto manage life’s challenges successfully Facilitating recoveryFacilitating recovery Building resilience, not just managing Building resilience, not just managing

symptomssymptoms


Goals of a Transformed System:Goals of a Transformed System:

1 1 Americans Understand that Mental Health is Americans Understand that Mental Health is Essential to Overall HealthEssential to Overall Health

2 2 Mental Health Care is Consumer and Family DrivenMental Health Care is Consumer and Family Driven 33 Disparities in Mental Health Care are EliminatedDisparities in Mental Health Care are Eliminated 44 Early Mental Health Screening, Assessment, andEarly Mental Health Screening, Assessment, and

Referral to Services are Common PracticeReferral to Services are Common Practice 55 Excellent Mental Health Care is Delivered andExcellent Mental Health Care is Delivered and

Research is AcceleratedResearch is Accelerated 66 Technology is Used to Access Mental Health CareTechnology is Used to Access Mental Health Care

and Informationand Information

Transforming Concepts: Transforming Concepts: Recovery and ResiliencyRecovery and Resiliency

““Consumers and families told the Commission that having hope Consumers and families told the Commission that having hope

and the opportunity to regain control of their lives was vital to and the opportunity to regain control of their lives was vital to

their recovery. Indeed, emerging research has validated that their recovery. Indeed, emerging research has validated that

hope and self-determination are important factors hope and self-determination are important factors

contributing to recovery”contributing to recovery”

Metro Youth, Chicago: compelling testimony and Metro Youth, Chicago: compelling testimony and

survey data presented importance of youth survey data presented importance of youth

voice.voice.

President’s New Freedom Commission President’s New Freedom Commission

Transforming Concept:Transforming Concept:Consumer & Family-Driven Consumer & Family-Driven

“…“…the effectiveness of services, no matter what they are, may hinge less on the effectiveness of services, no matter what they are, may hinge less on

the particular type of service than on how, when, and why families or the particular type of service than on how, when, and why families or

caregivers are engaged in the delivery of care…it is becoming caregivers are engaged in the delivery of care…it is becoming

increasingly clear that family engagement is a key component not only of increasingly clear that family engagement is a key component not only of

participation in care, but also in the effective implementation of it”participation in care, but also in the effective implementation of it” (Burns, Hoagwood, & Mrazek, 1999)(Burns, Hoagwood, & Mrazek, 1999)

““Not all the studies show that the improvements resulted from the intervention Not all the studies show that the improvements resulted from the intervention

specifically. Family engagement may play a stronger role in outcomes specifically. Family engagement may play a stronger role in outcomes

than the actual intervention program”than the actual intervention program”

(Thomlison, 2003)(Thomlison, 2003)

Direct implications for schools: have the interventions, have the Direct implications for schools: have the interventions, have the

technology, but how do we ENGAGE students?technology, but how do we ENGAGE students?

So, what?So, what?

How is the NFC relevant to what you do?How is the NFC relevant to what you do?

How can you use the report?How can you use the report?

Is there a children’s goal?Is there a children’s goal?

What will it take to What will it take to transform mental transform mental health care for health care for children and children and families?families?

There is no single There is no single children’s goal or children’s goal or recommendation.recommendation.

Children’s issues Children’s issues embedded embedded throughout.throughout.

Recommendations with Implications Recommendations with Implications for Children and Familiesfor Children and Families

1.1- National anti-stigma campaign, and 1.1- National anti-stigma campaign, and national strategy for suicide preventionnational strategy for suicide prevention

2.1- Individualized plans of care2.1- Individualized plans of care 2.2 -Consumers and families fully involved 2.2 -Consumers and families fully involved

in orienting system toward recoveryin orienting system toward recovery 2.3 -Align federal programs to improve 2.3 -Align federal programs to improve

access and accountabilityaccess and accountability 2.4 -Comprehensive State Mental Health 2.4 -Comprehensive State Mental Health

PlanPlan 2.5 -Protect and enhance rights of people 2.5 -Protect and enhance rights of people

with mental illnesseswith mental illnesses


3.1- Improve access to quality, culturally 3.1- Improve access to quality, culturally competent carecompetent care

4.1- Promote mental health of young 4.1- Promote mental health of young childrenchildren

4.2- Improve and expand school 4.2- Improve and expand school mental mental health programshealth programs

4.3- Screen for co-occurring disorders, 4.3- Screen for co-occurring disorders, and link with and link with integrated treatmentintegrated treatment

4.4- Screen in primary care, and 4.4- Screen in primary care, and connect connect to treatment and supportsto treatment and supports


5.2- Advance evidence-based practice 5.2- Advance evidence-based practice using dissemination & demonstration using dissemination & demonstration projectsprojects

5.3- Improve and expand workforce 5.3- Improve and expand workforce providing evidence-based providing evidence-based services services and supportsand supports

5.4- Develop knowledge base in four 5.4- Develop knowledge base in four understudied areas understudied areas (trauma, medications, (trauma, medications, disparities, acute)disparities, acute)

6.2- Integrated electronic health record, and 6.2- Integrated electronic health record, and online personal health information online personal health information systems/resourcessystems/resources

Is there a school-related goal?Is there a school-related goal?

““The fundamental policy problem related to mental health in The fundamental policy problem related to mental health in schools is that schools is that

existing student support services and school health programs existing student support services and school health programs do not have high status in the educational hierarchy…do not have high status in the educational hierarchy…

schools and districts treat such activity, in policy and practice, schools and districts treat such activity, in policy and practice, as desirable but not a primary consideration… as desirable but not a primary consideration…

the programs and staff are the programs and staff are marginalizedmarginalized…… interventions are referred to as”auxiliary”…interventions are referred to as”auxiliary”… Student support personnel almost never a prominent part of a Student support personnel almost never a prominent part of a

school’s organizational structure…deemed dispensable as school’s organizational structure…deemed dispensable as budgets tighten.”budgets tighten.”

Adelman & Taylor, Submitted to the NFCAdelman & Taylor, Submitted to the NFC

Goal 4/Rec 4.2 - Improve and Expand Goal 4/Rec 4.2 - Improve and Expand School Mental Health ProgramsSchool Mental Health Programs

Work with parents, local providers, local agencies to Work with parents, local providers, local agencies to support screening, assessment and early intervention;support screening, assessment and early intervention;

Ensure that mental health services are part of school Ensure that mental health services are part of school health centershealth centers

Ensure that these services are federally funded as health, Ensure that these services are federally funded as health, mental health and education programsmental health and education programs

Implement empirically supported prevention, early Implement empirically supported prevention, early intervention approaches at the school district, local school, intervention approaches at the school district, local school, classroom, and individual student levels;classroom, and individual student levels;

Create State-level structure for school-based mental health Create State-level structure for school-based mental health services to provide state leadership and collaboration services to provide state leadership and collaboration among education, general health, and mental healthamong education, general health, and mental health

Key Learnings:Key Learnings:

Mental health consumers/ Mental health consumers/ youth/families are not in the mental youth/families are not in the mental health system – de facto systemshealth system – de facto systems

Stigma: key barrier to changing Stigma: key barrier to changing practicepractice

Gap between what we know works Gap between what we know works and what we practice.and what we practice.

Places that have changed their Places that have changed their systems: better outcomes and cost systems: better outcomes and cost savingssavings

Mental health consumers/youth/families are Mental health consumers/youth/families are not in the mental health system – de facto not in the mental health system – de facto

systems - schoolssystems - schools

Over 52 million children in ~ 100,000 schools in U.S.; Over 52 million children in ~ 100,000 schools in U.S.; 6 million adults working in the schools: 1/5 of U.S. 6 million adults working in the schools: 1/5 of U.S. populationpopulation

Children receive more MH services through schools Children receive more MH services through schools than any other public systemthan any other public system

Student support services/school health programs Student support services/school health programs need greater focus in health and education policy need greater focus in health and education policy initiativesinitiatives

Must serve ALL children….. so they can learn in Must serve ALL children….. so they can learn in schools.schools.

Stigma: Stigma: prevents accessing mental healthprevents accessing mental health

Schools are accessible, familiar to familiesSchools are accessible, familiar to families Stigma and school-comfort level variable Stigma and school-comfort level variable

among diverse groupsamong diverse groups Generally, stigma, non-compliance, Generally, stigma, non-compliance,

inaccessibility lesser in schoolsinaccessibility lesser in schools Youth report: painful stigma in classroom- Youth report: painful stigma in classroom-

prefer jj involvement, SA disorder rather prefer jj involvement, SA disorder rather than MH disorderthan MH disorder

Schools- pivot point to families, community Schools- pivot point to families, community stakeholdersstakeholders

Gap between what we know works Gap between what we know works and what we practice.and what we practice.

School MH programs decrease absence School MH programs decrease absence and discipline referrals, improve test scores and discipline referrals, improve test scores (Jennings et al., 2000).(Jennings et al., 2000).

School “connectedness” related to School “connectedness” related to academic, behavioral and social success in academic, behavioral and social success in schools schools (Blum & Hibbey, 2004).(Blum & Hibbey, 2004).

School-based wraparound decrease out-of-School-based wraparound decrease out-of-school & out-of-home placements school & out-of-home placements (Eber et al., (Eber et al., 1996).1996).

Positive behavioral interventions and Positive behavioral interventions and supports supports (PBIS- Horner & Carr, 1997; Sugai et al.2000)(PBIS- Horner & Carr, 1997; Sugai et al.2000)

Promotion and Prevention InterventionsPromotion and Prevention Interventions

Children and Families Issue Paper:Children and Families Issue Paper:Background ReportBackground Report

Comprehensive Comprehensive overview of children’s overview of children’s issues; resources and issues; resources and rationalerationale

9 Policy Areas, 26 9 Policy Areas, 26 Recommendations and Recommendations and 120 Implementation 120 Implementation OptionsOptions

Broad stakeholder Broad stakeholder InputInput

Children and Family Issue Paper: Children and Family Issue Paper: 9 Policy Areas9 Policy Areas

1)1) Cross Agency Responsibility, Coordination Cross Agency Responsibility, Coordination and Financing to Reduce Fragmentationand Financing to Reduce Fragmentation

2)2) Family & Youth Partnerships and SupportFamily & Youth Partnerships and Support3)3) Access to Care and Reducing DisparitiesAccess to Care and Reducing Disparities4)4) Broaden Array of Services and SupportsBroaden Array of Services and Supports5)5) Develop & Apply KnowledgeDevelop & Apply Knowledge6)6) Build WorkforceBuild Workforce7)7) Prevent DisordersPrevent Disorders8)8) Communication Strategy and StigmaCommunication Strategy and Stigma9)9) Accountability and Quality ImprovementAccountability and Quality Improvement

Built on:Built on:

Surgeon General’s Reports: Surgeon General’s Reports: Mental Health; Mental Mental Health; Mental Health: Culture, Race & EthnicityHealth: Culture, Race & Ethnicity

Surgeon General’s National Action Agenda for Surgeon General’s National Action Agenda for ChildrenChildren

National Academy of Sciences: National Academy of Sciences: From Neurons to From Neurons to Neighborhoods Neighborhoods

New Freedom Commission on Excellence in Special New Freedom Commission on Excellence in Special EducationEducation

Reviews of Evidence-base Practices in Prevention Reviews of Evidence-base Practices in Prevention and Treatmentand Treatment

Etc.Etc.

Stakeholder Input & Key ExpertsStakeholder Input & Key Experts

American Psychological AssociationAmerican Psychological Association AACAPAACAP CWLACWLA NASPNASP Federation of Families for Children’s Federation of Families for Children’s

Mental HealthMental Health State Family OrganizationsState Family Organizations NMHANMHA NAMINAMI CHADDCHADD Professional Guilds/AssociationsProfessional Guilds/Associations NASMHPDNASMHPD State Children’s MH DirectorsState Children’s MH Directors National Racial/Ethnic AssociationsNational Racial/Ethnic Associations Child Policy CentersChild Policy Centers Natl Assoc. State Directors of Special Natl Assoc. State Directors of Special

EducationEducation Policymaking PartnershipPolicymaking Partnership

Families & YouthFamilies & Youth National Assembly on School-based National Assembly on School-based

Health CareHealth Care University Child Study CentersUniversity Child Study Centers Bazelon Center for MH LawBazelon Center for MH Law Amer. Acad. PediatricsAmer. Acad. Pediatrics Gains Center (JJ)Gains Center (JJ) Natl Council on DisabilityNatl Council on Disability Natl Assoc Psychiatric Health Natl Assoc Psychiatric Health

SystemsSystems Calif. Institute of Mental HealthCalif. Institute of Mental Health Early Childhood ProgramsEarly Childhood Programs Community AgenciesCommunity Agencies NASADADNASADAD School Mental Health ProjectsSchool Mental Health Projects Coalition for Juvenile JusticeCoalition for Juvenile Justice Natl Council for Community Natl Council for Community

Behavioral HealthCareBehavioral HealthCare

School-related Recommendations in School-related Recommendations in C&F Background Issue PaperC&F Background Issue Paper

Policy option IV.4.3: Promote Policy option IV.4.3: Promote Mental Health in the Mental Health in the Education SystemEducation System Multi-level, tiered approachMulti-level, tiered approach Collaboration at Federal, State, Collaboration at Federal, State,

local levellocal level WorkforceWorkforce

(1) Strengthen mental health services in (1) Strengthen mental health services in schools and the role of schools in promoting schools and the role of schools in promoting

social and emotional well-beingsocial and emotional well-being

ED & DHHS Collaborate to Strengthen and ED & DHHS Collaborate to Strengthen and Develop/Implement Plan:Develop/Implement Plan: Identify strategies to promote the social and Identify strategies to promote the social and

emotional well-being of children in schoolsemotional well-being of children in schools Identify children who need specialized servicesIdentify children who need specialized services Encourage partnerships with familiesEncourage partnerships with families Provide or link children with needed services and Provide or link children with needed services and

supportssupports TA on service options, payment mechanisms, TA on service options, payment mechanisms,

outcomesoutcomes

(2) Expand Prevention and Early Intervention (2) Expand Prevention and Early Intervention Approaches and Positive Behavioral Approaches and Positive Behavioral

Supports in SchoolsSupports in Schools

ED and SAMHSA work together to expand ED and SAMHSA work together to expand existing efforts and develop prevention/early existing efforts and develop prevention/early intervention approach to social and emotional intervention approach to social and emotional well being of children in schools. Include well being of children in schools. Include interventions at:interventions at: School system/district level School system/district level School building levelSchool building level Classroom levelClassroom level Individual level with students with special needsIndividual level with students with special needs

(3) Ensure that Mental Health Services are (3) Ensure that Mental Health Services are Provided as Part of School Health CentersProvided as Part of School Health Centers

DHHS ensure that mental health services are DHHS ensure that mental health services are provided through school health centers and provided through school health centers and allocate funding for this as part of Federally allocate funding for this as part of Federally funded mental health and education programs. funded mental health and education programs. This will increase access to care.This will increase access to care.

(4) Train teachers and school personnel to recognize (4) Train teachers and school personnel to recognize signs of emotional problems in children and to make signs of emotional problems in children and to make appropriate referrals for assessment and servicesappropriate referrals for assessment and services

Pre-service and professional development and staff Pre-service and professional development and staff training for teachers and school personnel to increase training for teachers and school personnel to increase ability to recognize “early warning signs” and take ability to recognize “early warning signs” and take appropriate action:appropriate action: Referrals for assessment/servicesReferrals for assessment/services Classroom accommodationsClassroom accommodations Partnering with familiesPartnering with families Maximize established funding streams (IDEA,No Maximize established funding streams (IDEA,No

Child Left Behind)Child Left Behind)

(5) Ensure Special Education and Related (5) Ensure Special Education and Related Services for Children with Emotional Services for Children with Emotional

Disturbances under IDEADisturbances under IDEA

ED work with States to more effectively ED work with States to more effectively implement IDEAimplement IDEA

Services coordination should be considered Services coordination should be considered related services and included in IEPs for related services and included in IEPs for children with emotional disturbances under children with emotional disturbances under Part B of IDEA.Part B of IDEA.

(6) Create a State-level Infrastructure for (6) Create a State-level Infrastructure for School-based Mental Health ServicesSchool-based Mental Health Services

Ensure clear, coordinated State agenda for Ensure clear, coordinated State agenda for school health and mental health servicesschool health and mental health services

Collaboration between Education and Mental Collaboration between Education and Mental HealthHealth

Pool funding for school-based mental health Pool funding for school-based mental health servicesservices

Link with State’s comprehensive plan for Link with State’s comprehensive plan for children’s mental health (Goal 2, NFC)children’s mental health (Goal 2, NFC)

(7) Create Specific Funding Streams for (7) Create Specific Funding Streams for School Mental Health ServicesSchool Mental Health Services

To support provision of mental health and To support provision of mental health and substance abuse services, designate small substance abuse services, designate small percentage of funds from selected programs:percentage of funds from selected programs: Safe and Drug Free SchoolsSafe and Drug Free Schools No Child Left BehindNo Child Left Behind Safe Schools/Healthy StudentsSafe Schools/Healthy Students Title VTitle V School-based Health Center Grants School-based Health Center Grants

(8) Create a Collaborative Grant (8) Create a Collaborative Grant Program to Support Effective School-Program to Support Effective School-

Based Mental Health ApproachesBased Mental Health Approaches SAMHSA and ED grants to States, other units SAMHSA and ED grants to States, other units

of government, and private nonprofit of government, and private nonprofit organizations to schools in providing:organizations to schools in providing: Screening and assessmentScreening and assessment Early intervention, crisis interventions, and Early intervention, crisis interventions, and

mental health services to children with or at-mental health services to children with or at-risk of emotional/behavioral disordersrisk of emotional/behavioral disorders

(9) Study the Role of School Culture in (9) Study the Role of School Culture in Promoting Social and Emotional Well-beingPromoting Social and Emotional Well-being

ED, SAMHSA, NIMH study and identify ED, SAMHSA, NIMH study and identify evidence-based interventions for promoting evidence-based interventions for promoting both academic success and social and both academic success and social and emotional well-being through strengthening emotional well-being through strengthening school culture.school culture.

Information on these interventions to be Information on these interventions to be disseminated and technical assistance disseminated and technical assistance provided to increase “uptake” provided to increase “uptake”

(10) Develop a Comprehensive Strategy (10) Develop a Comprehensive Strategy for School-based Response to Traumafor School-based Response to Trauma

DHHS, Federal Homeland Security & ED DHHS, Federal Homeland Security & ED Train/prepare teachers and other school personnelTrain/prepare teachers and other school personnel Develop linkages with trained mental health Develop linkages with trained mental health

providers for trauma responseproviders for trauma response Include school-based mental health interventions in Include school-based mental health interventions in

Federal, State and community disaster and Federal, State and community disaster and emergency response plansemergency response plans

Consider needs of children beyond initial crisis to Consider needs of children beyond initial crisis to identify/refer/treat PTSD and other mental health identify/refer/treat PTSD and other mental health problems following traumaproblems following trauma

Policy Option IV.5: Policy Option IV.5: Achieve Cultural CompetenceAchieve Cultural Competence

Develop federal leadership to focus on Develop federal leadership to focus on disproportionate numbers of youth of color with disproportionate numbers of youth of color with MH problems in JJ, foster care and special MH problems in JJ, foster care and special education.education. Strengthen capacity of schools to be key link to Strengthen capacity of schools to be key link to

comprehensive, seamless system of school- and comprehensive, seamless system of school- and community-based identification, assessment and community-based identification, assessment and treatment services.treatment services.

Involve SAMHSA, CMS, Office of SpEd and Involve SAMHSA, CMS, Office of SpEd and Rehabilitation Services (0SERS), State agenciesRehabilitation Services (0SERS), State agencies

Thrust of RecommendationsThrust of Recommendations

Build a continuum of mental health Build a continuum of mental health services in schools: promotion, services in schools: promotion, prevention, early identification, and prevention, early identification, and treatmenttreatment

Federal Level:Federal Level:SAMHSA Child and Families SAMHSA Child and Families

Action Plan – FY 05Action Plan – FY 05 New InitiativesNew Initiatives

State MH Transformation Grants to State MH Transformation Grants to include children and families (offered)include children and families (offered)

Prototype grants to fund State Prototype grants to fund State adolescent SA treatment coordinators adolescent SA treatment coordinators to build infrastructure/capacity for to build infrastructure/capacity for services integrationservices integration

Enhance TA EffortsEnhance TA Efforts Develop toolkit on SA and MH Develop toolkit on SA and MH

screening for use in multiple settings screening for use in multiple settings with multiple age groups, strategies and with multiple age groups, strategies and incentives for linking to careincentives for linking to care

Develop prototype of individualized plan Develop prototype of individualized plan of care for children and their familiesof care for children and their families

Federal Level:Federal Level:SAMHSA Child and Families SAMHSA Child and Families

Action PlanAction Plan

Align Federal ProgramsAlign Federal Programs Collaborate with Dept of Education Collaborate with Dept of Education

to expand school-based mental to expand school-based mental health programshealth programs

Collaborate with ASPE, ACF,CMS Collaborate with ASPE, ACF,CMS and Depts. of Education and Justice and Depts. of Education and Justice on eliminating practice of parents on eliminating practice of parents giving up custody for treatmentgiving up custody for treatment

Track and Report Child/Family focus Track and Report Child/Family focus across relevant grantsacross relevant grants

Leverage NFC Report for Leverage NFC Report for State-Level ReformState-Level Reform

MH/School Leadership participate in State MH/School Leadership participate in State Mental Health Plans (use experience, Mental Health Plans (use experience, outcome and cost data).outcome and cost data).

Major reform efforts in New Mexico Major reform efforts in New Mexico (legislation (legislation

May 2004 Purchasing Collab.17 agencies)May 2004 Purchasing Collab.17 agencies), Illinois, Illinois(Ch MH (Ch MH

Partnership),Partnership), South Carolina drawing on NFC South Carolina drawing on NFC Different strategies: focus on specific goal Different strategies: focus on specific goal

areas or general concept of transformation areas or general concept of transformation and recovery (and recovery (www.nasmhpd.orgwww.nasmhpd.org for state for state implementation activities)implementation activities)

Leverage NFC Report for Leverage NFC Report for Local ReformLocal Reform

Educate public officials about NFC report and its Educate public officials about NFC report and its alignment with mental health in school effortsalignment with mental health in school efforts

Use NFC recommendations to fuel innovation, Use NFC recommendations to fuel innovation, e.g., Westchester County implement recommendation in e.g., Westchester County implement recommendation in Goal 4; screening for mental health in Latino primary care Goal 4; screening for mental health in Latino primary care clinicsclinics

Use NFC financing discussion to map behavioral Use NFC financing discussion to map behavioral health financing and expenditures across child-health financing and expenditures across child-serving systems to identify opportunities for serving systems to identify opportunities for improved integration and efficiencyimproved integration and efficiency

Social marketing of NFC to gain political willSocial marketing of NFC to gain political will

Using the Report StrategicallyUsing the Report Strategically

1.1. Alignment of NFC principles with Alignment of NFC principles with underlying principles in school-based underlying principles in school-based mental healthmental health

2.2. Leverage NFC report for local reformLeverage NFC report for local reform

3.3. Leverage NFC report and local & State Leverage NFC report and local & State data for State level reformdata for State level reform

4.4. NFC report and background papers for NFC report and background papers for advocacy, promoting transformationadvocacy, promoting transformation

Websites to Access (Pending) Websites to Access (Pending) ReportReport

www.samhsa.govwww.samhsa.gov.. www.mentalhealthcommission.govwww.mentalhealthcommission.gov www.tapartnership.orgwww.tapartnership.org

transforming mental health care: a focus on the schools larke nahme huang, ph.d. american institutes...

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