Expanding Partnerships in Systems Expanding Partnerships in Systems of Care: Education, Mental Health of Care: Education, Mental Health

and Families Working Togetherand Families Working Together

Joanne Cashman, National Association of Joanne Cashman, National Association of State Directors of Special Education State Directors of Special Education

& Mark Weist, University of Maryland& Mark Weist, University of MarylandSeptember 15, 2005September 15, 2005

The IDEA PartnershipThe IDEA Partnership

Center for School Mental Health Center for School Mental Health Analysis and ActionAnalysis and Action

Guiding Principles for a Guiding Principles for a Families, Schools, Mental Families, Schools, Mental

Health Health Shared AgendaShared Agenda

Mental health is crucial to school successMental health is crucial to school success

There are shared opportunities for families, There are shared opportunities for families, students, schools, and mental health systems and students, schools, and mental health systems and staff to work together more effectivelystaff to work together more effectively

The Big Picture: A Shared AgendaThe Big Picture: A Shared Agenda

AchievementAchievement and and Well BeingWell Being as as Dual GoalsDual GoalsAddress both academic and non-academic barriers to Address both academic and non-academic barriers to achievementachievementShare work across education, mental health and family Share work across education, mental health and family organizationsorganizationsMake explicit the shared interests of school mental health, Make explicit the shared interests of school mental health, general education and special educationgeneral education and special educationGrow state-based examplesGrow state-based examplesLearn what works across states and with federal agenciesLearn what works across states and with federal agenciesBuild a national Build a national Community of PracticeCommunity of Practice on school-based on school-based mental health that unites stakeholders around shared mental health that unites stakeholders around shared interests across organizational boundariesinterests across organizational boundaries

Growing Focus on School Mental Growing Focus on School Mental Health (SMH) in the U.S.Health (SMH) in the U.S.

U.S. Surgeon General Reports (1999, 2000)U.S. Surgeon General Reports (1999, 2000)

President’s New Freedom Commission on Mental Health President’s New Freedom Commission on Mental Health Report (2003)Report (2003)

Mandates of “No Child Left Behind” and Individuals Mandates of “No Child Left Behind” and Individuals with Disabilities Education Act (IDEA)with Disabilities Education Act (IDEA)

Progress in localities and statesProgress in localities and states

Collaborative research-practice-training networksCollaborative research-practice-training networks

President’s New Freedom InitiativePresident’s New Freedom Initiative

First presidential commission on mental health First presidential commission on mental health since 1978since 1978

Widely disseminated document: Widely disseminated document: Achieving the Achieving the Promise: Transforming Mental Health Care in Promise: Transforming Mental Health Care in America America (see www.mentalhealthcommission.gov)(see www.mentalhealthcommission.gov)

6 goals, 19 recommendations6 goals, 19 recommendations

Impact expected to last for “decades”Impact expected to last for “decades”

President’s New Freedom President’s New Freedom Commission (cont.)Commission (cont.)

Goal 4: Early Mental Health Screening, Assessment and Goal 4: Early Mental Health Screening, Assessment and Referral to Services are Common PracticeReferral to Services are Common Practice

4.1 Promote the mental health of young children4.1 Promote the mental health of young children4.2 Improve and expand school mental health 4.2 Improve and expand school mental health programsprograms4.3 Screen for co-occurring mental and substance 4.3 Screen for co-occurring mental and substance

abuse disorders and link with integrated treatment abuse disorders and link with integrated treatment strategiesstrategies4.4 Screen for mental disorders across the lifespan 4.4 Screen for mental disorders across the lifespan

and connect to treatment supportsand connect to treatment supports

In Addition to Enhanced In Addition to Enhanced Access, SMH can:Access, SMH can:

Reduce stigma for help seekingReduce stigma for help seeking

Promote generalization/maintenance of intervention Promote generalization/maintenance of intervention gainsgains

Enhance capacity for prevention/MH promotionEnhance capacity for prevention/MH promotion

Foster clinical efficiency and productivityFoster clinical efficiency and productivity

Promote a natural, ecologically grounded approach to Promote a natural, ecologically grounded approach to helping youth and familieshelping youth and families

SMH ImpactsSMH Impacts

Based on a limited knowledge base, Based on a limited knowledge base, when when done welldone well SMH programs and services are SMH programs and services are associated with:associated with:– Strong satisfaction by diverse stakeholder groupsStrong satisfaction by diverse stakeholder groups– Improvement in student emotional/behavioral Improvement in student emotional/behavioral

functioningfunctioning– Improvement in school outcomes (e.g., climate, Improvement in school outcomes (e.g., climate,

special education referrals, reduced bullying, fewer special education referrals, reduced bullying, fewer suspensions)suspensions)

Expanded School Mental Health Expanded School Mental Health (ESMH):(ESMH):

Programs join families, schools, mental health Programs join families, schools, mental health and other community systems and other community systems To develop a full array of effective programs To develop a full array of effective programs and services that improve the school and services that improve the school environment, reduce barriers to learning, and environment, reduce barriers to learning, and provide prevention, early intervention and provide prevention, early intervention and treatment treatment for youth in general and special educationfor youth in general and special education

Critical Challenges for for the FieldCritical Challenges for for the Field

ESMH still in a relatively small percentage of ESMH still in a relatively small percentage of schoolsschoolsEfforts remain marginalized and under-Efforts remain marginalized and under-supported (STIGMA)supported (STIGMA)Interdisciplinary and intersystem turf and Interdisciplinary and intersystem turf and tensiontensionConsiderable variability in experience Considerable variability in experience Limited community ownership of the Limited community ownership of the programsprograms

A Central ChallengeA Central Challenge

School mental health is a tenuously supported field School mental health is a tenuously supported field with efforts in most communities scattered at bestwith efforts in most communities scattered at best

Scattered, unsupported services do not lead to the Scattered, unsupported services do not lead to the achievement of critical outcomesachievement of critical outcomes

We need to build support for effective services to We need to build support for effective services to enable the documentation of enhanced outcomes, enable the documentation of enhanced outcomes, which will in turn fuel advocacy efforts and bring which will in turn fuel advocacy efforts and bring needed resources into the fieldneeded resources into the field

Factors Necessary to Achieve Desired Factors Necessary to Achieve Desired Outcomes for Youth Through ESMH Programs Outcomes for Youth Through ESMH Programs and Servicesand Services (Weist, Paternite & Adelsheim, 2005)(Weist, Paternite & Adelsheim, 2005)

Effective mental health promotion, problem preventionand intervention

Outstanding staff and program qualitiesOngoing training, technical assistance & support

School and community buy-in and investment

Awareness raising, public policy advocacy and improvement,coalition building, systems-level change, and resource commitment

““Enhancing Quality in Expanded Enhancing Quality in Expanded School Mental Health”School Mental Health”

Three year, three state (Delaware, Maryland, Three year, three state (Delaware, Maryland, Texas) study seeking to implement and Texas) study seeking to implement and evaluate a framework for systematic quality evaluate a framework for systematic quality assessment and improvement in school mental assessment and improvement in school mental healthhealth

Funded by the National Institute of Mental Funded by the National Institute of Mental Health (2003-2006)Health (2003-2006)

Principles for Best Practice in Principles for Best Practice in Expanded School Mental HealthExpanded School Mental Health

1) All youth and families are able to access 1) All youth and families are able to access appropriate care regardless of their ability to payappropriate care regardless of their ability to pay

2) Programs are implemented to address needs 2) Programs are implemented to address needs and strengthen assets for students, families, and strengthen assets for students, families, schools, and communitiesschools, and communities

3) Programs and services focus on reducing 3) Programs and services focus on reducing barriers to development and learning, are student barriers to development and learning, are student and family friendly, and are based on evidence of and family friendly, and are based on evidence of positive impactpositive impact

Principles (cont.)Principles (cont.)

4) Students, families, teachers and other important 4) Students, families, teachers and other important groups are actively involved in the program's groups are actively involved in the program's development, oversight, evaluation, and development, oversight, evaluation, and continuous improvementcontinuous improvement 5) Quality assessment and improvement activities 5) Quality assessment and improvement activities continually guide and provide feedback to the continually guide and provide feedback to the programprogram 6) A continuum of care is provided, including 6) A continuum of care is provided, including school-wide mental health promotion, early school-wide mental health promotion, early intervention, and treatmentintervention, and treatment

Principles (cont.)Principles (cont.)

7) Staff hold to high ethical standards, are 7) Staff hold to high ethical standards, are committed to children, adolescents, and committed to children, adolescents, and families, and display an energetic, flexible, families, and display an energetic, flexible, responsive and proactive style in delivering responsive and proactive style in delivering servicesservices 8) Staff are respectful of, and competently 8) Staff are respectful of, and competently address developmental, cultural, and address developmental, cultural, and personal differences among students, personal differences among students, families and stafffamilies and staff

Principles (cont.)Principles (cont.)

9) Staff build and maintain strong 9) Staff build and maintain strong relationships with other mental health and relationships with other mental health and health providers and educators in the health providers and educators in the school, and a theme of interdisciplinary school, and a theme of interdisciplinary collaboration characterizes all effortscollaboration characterizes all efforts

10) Mental health programs in the school 10) Mental health programs in the school are coordinated with related programs in are coordinated with related programs in other community settingsother community settings

Key Processes in Working with Key Processes in Working with FamiliesFamilies

EngagementEngagement

EmpowermentEmpowerment

SupportSupport

CollaborationCollaboration

Teachers are the “De Facto” providers Teachers are the “De Facto” providers of mental health to youth in the U.S.of mental health to youth in the U.S.

This fact needs acknowledgement in local, This fact needs acknowledgement in local, state, and national policystate, and national policy

There is a significant need to empower There is a significant need to empower teachers to fulfill this critical roleteachers to fulfill this critical role

Mental Health Education Integration Mental Health Education Integration Consortium (MHEDIC)Consortium (MHEDIC)

Working to improve interdisciplinary training Working to improve interdisciplinary training and collaboration between educators and and collaboration between educators and mental health staffmental health staff

Making recommendations to address Making recommendations to address limitations in training for both groupslimitations in training for both groups

Mental health training for educators should be Mental health training for educators should be based on “backward analysis” of needs based on “backward analysis” of needs presenting in classroomspresenting in classrooms

MHEDIC (cont.)MHEDIC (cont.)

Key mental health skills for teachers:Key mental health skills for teachers:– Identifying emotional/behavioral problems within Identifying emotional/behavioral problems within

studentsstudents– Referring students with emotional/behavioral Referring students with emotional/behavioral

problems for assistanceproblems for assistance– Promoting positive classroom behaviorPromoting positive classroom behavior– Using mental health concepts to promote learningUsing mental health concepts to promote learning

Mental Health Concepts that Promote Mental Health Concepts that Promote LearningLearning

Self-instruction (e.g., developing an internal Self-instruction (e.g., developing an internal dialogue)dialogue)

Problem solving (e.g., considering costs and Problem solving (e.g., considering costs and benefits of actions)benefits of actions)

Self-control and–reinforcement (e.g., work Self-control and–reinforcement (e.g., work before play)before play)

Template matching (e.g., modeling actions of Template matching (e.g., modeling actions of B+ students)B+ students)

The Critical Challenge of FederalismThe Critical Challenge of Federalism

State of residence determines whether youth use State of residence determines whether youth use mental health more than race/ethnicity or incomemental health more than race/ethnicity or income

Differences in mental health use by children across Differences in mental health use by children across states are generally not related to differences in levels states are generally not related to differences in levels of need (e.g. AL and TX present higher rates of need of need (e.g. AL and TX present higher rates of need but lower rates of use)but lower rates of use)– Sturm, Ringel & Andreyeva, 2003 (www.pediatrics.org)Sturm, Ringel & Andreyeva, 2003 (www.pediatrics.org)

The IDEA PartnershipThe IDEA Partnershipwww.ideapartnership.orgwww.ideapartnership.org

55 National Organizations55 National OrganizationsFocused on the shared implementation of the Individuals Focused on the shared implementation of the Individuals with Disabilities Education Act (IDEA)with Disabilities Education Act (IDEA)IDEA issues are IDEA issues are notnot just special ed issues just special ed issuesStronger, more connected systems help all students, Stronger, more connected systems help all students, including students with disabilities including students with disabilities Connecting to the issues already on the national agenda of Connecting to the issues already on the national agenda of partner organizations provides opportunities for deeper partner organizations provides opportunities for deeper work than separate projects that operate on the marginswork than separate projects that operate on the marginsIdentify the Identify the big picturebig picture issues that will draw people issues that will draw people togethertogetherDo Do real workreal work together around shared interests together around shared interests

IDEA Partnership StrategyIDEA Partnership Strategy

The Shared AgendaThe Shared Agenda : : Education, Mental Health and Education, Mental Health and FamiliesFamilies

Grounding Document Grounding Document www.ideapartnership.orgwww.ideapartnership.org

Seed grants to states to build communities of practice Seed grants to states to build communities of practice around issuesaround issuesVTVT NCNC NMNM SCSC

NHNH OHOH MOMO

HIHI MDMD TXTX

Linking school based MH programs with PBISLinking school based MH programs with PBIS

Connect OSEP and SAMHSA funded efforts Connect OSEP and SAMHSA funded efforts

IDEA Partnership Strategy 2IDEA Partnership Strategy 2

Develop Develop communities of practicecommunities of practice within states that within states that bring the stakeholders together around a bring the stakeholders together around a Shared Shared AgendaAgenda

Connect the states that are pursuing the Connect the states that are pursuing the Shared Shared AgendaAgenda strategy in a strategy in a cross-state community of cross-state community of practicepractice

Build aBuild a national community of practice national community of practice that includes that includes federal agencies, states, national organizations, federal agencies, states, national organizations, researchers and technical assistance centersresearchers and technical assistance centers

What is a Community of Practice?What is a Community of Practice?

Communities of PracticeCommunities of Practice are made up of groups that care are made up of groups that care passionately about an issue and agree to come together passionately about an issue and agree to come together routinely to improve the state of practice around that routinely to improve the state of practice around that issue.issue.To enable work that has real observable outcomes, To enable work that has real observable outcomes, communitiescommunities form practice groups that explore pieces of form practice groups that explore pieces of an issue and bring it back to the whole community.an issue and bring it back to the whole community.The community keeps the The community keeps the practice groupspractice groups focused on the focused on the ‘big picture.’ The ‘big picture.’ The practice groupspractice groups keep the keep the communitycommunity aware of all the dimensions of the issue.aware of all the dimensions of the issue.Together, the community and its practice groups can Together, the community and its practice groups can bridge policy, research and practice!bridge policy, research and practice!

The Community and Its Practice GroupsThe Community and Its Practice Groups

The The CommunityCommunity affiliates individuals and affiliates individuals and groups that care deeply about the same issue groups that care deeply about the same issue and agree to work together, share information and agree to work together, share information and engage in co-ordinated efforts that will and engage in co-ordinated efforts that will move the issuesmove the issues

Practice groupsPractice groups are subgroups of the are subgroups of the community that cut across organizational community that cut across organizational boundaries to address specific issuesboundaries to address specific issues

IDEA Partnership Strategy 3IDEA Partnership Strategy 3

National Community Building Forum with CSMHANational Community Building Forum with CSMHADevelop a work plan that can be shared across groupsDevelop a work plan that can be shared across groups2004 National Community Meeting2004 National Community Meeting

8 issues (beginning of issue based practice groups)8 issues (beginning of issue based practice groups)10 concrete actions 10 concrete actions

Build the mechanism to share information and workBuild the mechanism to share information and workSupport individuals from different disciplines, Support individuals from different disciplines, organizations to come together with agencies and states to organizations to come together with agencies and states to do shared workdo shared workSupport face-face interaction and routine communicationSupport face-face interaction and routine communicationBe intentional about sharing the Be intentional about sharing the new knowledgenew knowledge

22ndnd Community Building Forum and 10 Community Building Forum and 10thth Annual Conference on Advancing School Annual Conference on Advancing School

Mental HealthMental HealthFederal funders, HRSA, SAMHSA, OSEPFederal funders, HRSA, SAMHSA, OSEP

Major Partners: IDEA Partnership, NASDSE, Major Partners: IDEA Partnership, NASDSE, CSMHA, Ohio Mental Health Network for School CSMHA, Ohio Mental Health Network for School SuccessSuccess

Cleveland Ohio, October 26 (Forum) – 29, 2005Cleveland Ohio, October 26 (Forum) – 29, 2005

Come to Cleveland, the City that Rocks!!Come to Cleveland, the City that Rocks!!

See See http://csmha.umaryland.eduhttp://csmha.umaryland.edu or contact Christina or contact Christina at at chuntley@psych.umaryland.educhuntley@psych.umaryland.edu

UCLA Center for Mental UCLA Center for Mental Health in SchoolsHealth in Schools

Directed by Howard Adelman and Linda Directed by Howard Adelman and Linda TaylorTaylor

Phone: 310-825-3634Phone: 310-825-3634

Enews: listserv@listserv.ucla.eduEnews: listserv@listserv.ucla.edu

web: http://smhp.psych.ucla.eduweb: http://smhp.psych.ucla.edu