Mental Health and Schools Together-NH A Guide to Supporting Collaborative Practice Sponsored by the...

Mental Health and Schools Together-NH

A Guide to Supporting Collaborative Practice

Sponsored by the Mental Health and Schools Together (MAST-NH) Initiative

New Hampshire Center for Effective Behavioral Interventions and Supports at SERESC (NH CEBIS)

www.nhcebis.seresc.net

MAST-NH (Mental Health & Schools Together) Emerged From a Clear Need for Change

Planning MAST-NH began as we surmised that effective systems to support children & families w/ intensive needs were not in place Require multi-systems collaboration Anecdotal & research data supported the premise

We learned effective systems features that were needed & addressed some roadblocks

MAST-NH developed to design & begin to implement a vision to better support schools, children & families

Targets Mental Health, an issue so often a factor in working w/ children with intensive needs

MAST Cornerstone is systems-building & collaboration amongst home, school & mental health providers Supports PBIS model: build a FULL continuum of support

Funding for the Mental Health and Schools Together

New Hampshire Initiative is provided by

The United States Department of Education

Office of Safe and Drug-Free SchoolsDana Carr, Project Director

Mental Health and Schools Together-NH:A Guide to Supporting Collaborative

Practice

Shared Challenges,

Shared Students

Shared Work, Shared Success

Hopes for Today: A Mental Health Primer

Discuss the role schools and educators play in supporting good mental health through UNIVERSAL interventions

for ALL Children


Discuss the role schools and educators play in supporting the mental

health of SOME children who are at risk for

chronic problem behavior through TARGETED

interventions


Discuss the role schools and educators play (in

collaboration with community-based

providers) in supporting children with mental

illness and their families through INTENSIVE

interventions

Other Hopes for Today:

Discuss indicators of healthy social/ emotional development & information regarding the prevalence of mental illness

Discuss the connections between mental health & behavioral/ academic outcomes in school

Discuss our work in NH to: Improve on-going communications when schools &

community-based agencies are involved with common families

Develop the vision for linking home, school & MH providers for more effective work with children & families with intensive needs

I’d Guess There are Differing Views in this Audience

“Discussing Mental Health issues is just not a good use of my time – it’s not relevant to me”

“I am a skeptic, I think any effort we make to help our most troubled students and their families will probably be ineffective”

“It seems that educators have now become de facto mental health providers” “I embrace this idea” “I see this as an unfortunate reality “I believe that is simply NOT the correct role for educators”

Well.. I’m not here to try to tell you what to think – rather, to provide information and food for thought.

I respect and understand all these feelings and beliefs

MY big wish for today…

If nothing else, that the discussion today fuels some hope in you that through partnership with families and other community systems, we can discover how to better support children and families – so that we can achieve outcomes that allow us ALL to do our jobs more effectively

The Values/Principles/Vision that Guide this Work

Shared Work and communication are critical when it comes to supporting children & families with intensive needs

Identification and implementation of effective practices (supports, services, & strategies) that are efficiently accessible

Construct systems (processes, protocols) that support collaborative work that are reviewed continually for effectiveness and efficiency

Today’s Presentation is NOT intended to

Encourage schools to take on sole ownership or feel isolated in supporting mental health of students or student’s families (in fact, to the contrary)

Suggest that school staff members should EVER diagnose mental illness, emotional disorders, OR discuss medication issues with students or families

Provide extensive, in-depth information on any aspect of mental health or illness

“The children of today are too much in love with living. They have

terrible manners, mock authority, and have no respect for their

elders. …I can only fear what kind of awful creatures they will

become.”

Socrates, 369 B.C.

Schools and Children’s Mental Health

There is considerable evidence that children’s schooling plays an important role in their adjustment.

Success in school is clearly associated with positive mental health & well-being.

MH Risk IndicatorsOsher, Dwyer, and Jackson (2004)

Alienation Segregation Academic Frustration Chaotic Transitions Negative Relationships with

Adults and Peers Teased, Bullied School-driven Mobility

‘School hopping’ School failure Suspension, Expulsion, Drop

Out

Positive MH Indicators Osher, Dwyer, and Jackson (2004)

Making Interpersonal Connections

Positive Relationships with Adults and Peers

Academic Success Successful Transitions Caring Interactions Interactions with Pro-

social Peers Stability Over Time

Early Recognition: Prevention Means Knowing What to Look for

One clue to healthy development is when we see evidence of children meeting typical human needs: Need for belonging

Need for recognition and attention

Resiliency

Need for control and power

Self-Regulation

Need for Accomplishment, Mastery and Competence

The ABCs of Children’s Mental Health (Whelley, 2005)

Relationship Between Academics and Behavior

The relationship between academic underachievement (particularly reading) and externalizing behaviors suggests that students may act out to avoid academic tasks

The relationship between academic underachievement (particularly reading) and internalizing behaviors suggests that students may withdraw to escape academic tasks

Classroom teachers can play a key role in supporting mental health and identifying students who MAY be in need of assistance

Schools and Children’s Mental HealthYou Are Already Providing It!

Schools ARE commonly regarded as the de facto providers of mental health services for children and youth (Burns, et al., 1995; Farmer,et al., 2003).

21% of US children ages 9 to 17 have a diagnosable mental or addictive disorder that causes at least minimal impairment and behavioral challenges

Who Comes To School?

US Surgeon General’s Latest Report on Children’s Mental Health

10% of US children and adolescents suffer from a serious mental disorder that causes significant functional impairment at home, at school and with peers

Who Comes To School?

US Surgeon General’s Latest Report on Children’s Mental Health

Prevalence estimates of major mental health disorders of children in NH

DisorderAge

bracketPrevalence Estimate

Estimated number of children affected in NH

Any mental health disorder 5-19 20% 55,756

Serious emotional disturbance 9-17 5% 9,557

Any depressive disorder 9-17 10-15% 19,113 - 28,670

Any anxiety disorder 9-17 13% 24,847

Attention disorders 5-19 3-5% 8,363 - 13,939

Disruptive disorders 9-17 1-6% 1,911 - 11,468

Autism spectrum disorders 5-19 0.7% 952

Eating disorders (girls only) 12-25 3% 8,077

Substance use disorders 12-17 9% 17,202

Suicidal thoughts 14-18 14% 26,758

Any suicide attempt 14-18 7% 13,379

Prevalence Estimates for MH in Children

The Fictitious Story of Lizzy Watson

The Cast Lizzy Watson: A Female Student (now in 9th grade)

Mrs. Watson: Lizzy’s Mother

Mr. Jones: Lizzy’s 9th Grade Math Teacher

Mr. Strickland: High School Principal

Mrs. Gerhardt: Lizzy’s 1st Grade Teacher

Mr. Smith: Lizzy’s 3rd Grade Teacher

Ms. Perry: Lizzy’s 7th grade Teacher

Mrs. Nelson: Middle School Guidance Counselor

Process for the Periodic ‘Think’ Sessions

Presenter will periodically pose questions to think about after pieces of the story

Doesn’t need to be silent – can be quiet discussion with person next to you Can’t expect silence for a full minute, but please use quiet

voices Our limited time together means that we’ll need to get

right back to the presentation as soon as the minute ends Quick silence when presenter raises his hand

Practice

We begin near the end of her school experience– the beginning of 9th grade

Team Conference Mr. Jones, 9th

grade teacher


Discussion Questions:1 minute Think

Can you recall situations where children left you feeling hopeless and discouraged?

Can you remember talking with a child and you just didn’t know what to say next – didn’t know what to do next?

We Don’t Want to Lose Anyone!

And Yet We Do!Mental Illness and Dropout

Students with mental illness have the highest dropout rate of any disability group

Nationally, 50% of children with serious emotional & behavioral disorders and 30% of students with other disabilities drop out of high school

Over half of the adolescents in the United States who fail to complete their secondary education have a diagnosable psychiatric disorder

Sources: Stoep et al., 2003; U.S. Dept. of Education, 2001

Many Students Not Getting Needed Mental Health Supports

We know that 50% of all mood, anxiety, impulse-control and substance-use disorders start by age 14…

… But, in any given year, it is estimated that only 20% of children with any type of mental disorder receive mental health services (Goodman et al., 1997).

… And studies indicated that of those children who did receive services, fewer than 50% received the appropriate service relative to their need (Kazdin, 1996).

Center for Evidence Based Practice: Young Children with Challenging Behavior

www.challengingbehavior.org

The proportion of preschool children meeting the criteria for the clinical diagnosis of ODD (Oppositional Defiant Disorder) ranges from 7% to 25% of children in the United States, depending on the population surveyed.

( Webster-Stratton, 1997) Center for Evidence Based Practice: Young

Children with Challenging Behavior www.challengingbehavior.org

Of the young children who show early signs of problem behavior, it has been estimated that fewer than 10% receive services for these difficulties. Kazdin & Kendall, 1998 Center for Evidence Based Practice: Young

Children with Challenging Behavior www.challengingbehavior.org


Lizzy in First Grade Lizzy screened for

vision, hearing and academics – but not for behavior

Adequate academic skills

Sweet, shy, soft spoken

Mrs. Gerhardt, First Grade Teacher

Early Struggles have Lasting Effect

Children who fall behind in 1st grade have a one in eight chance of ever catching up to grade level without extraordinary efforts

(Journal of Educational Psychology, 1994)

Example of School Effects: Impact of 1st Grade Teachers on 7th Grade Behavior

2.7

58.7

0

10

20

30

40

50

60

Odds ratio

Rate of 7th GradeMisehavior:Students from Well-managed 1st GradeClassroom

Rate of 7th GradeMisbehavior:Students fromChaotic 1st GradeClassroom

The Impact of First Grade Teacher Capacity on 7th Grade Behavior(Kellam, Ling, Merisca, Brown, & Ialongo, 1998)


Lizzy in Fifth Grade Mr. Smith, 5th grade teacher On grade level, but work of

poor quality, and hardly ever finished

No friends Low participation in class Not eligible for school

services

Lizzy

If Lizzy had a broken leg, you’d know what was wrong; If she wasn’t reading in 5th grade, You’d know who to speak to; If she was throwing chairs through the window, You’d know there was something really wrong; but, it seems that mental health issues aren’t always clear cut or as visible as other types of issues

Lizzy isn’t really a behavior problem and she isn’t presenting major academic problems. Perhaps it’s just her temperament? Perhaps she is like her dad – a little different.

Discussion Questions1 Minute Think

Have you run across a student where your gut tells you something’s wrong, but you’re not sure what to do about it – you’re not sure if you are over-reacting? Not sure if it really is a problem?

Do you know where to turn get information if you had concerns? Do you know who to go to if you wanted to talk through your concerns or just vent your thoughts?

Do some students like Lizzy fall between the cracks in terms of qualifying for extra supports and services?

A recent analysis of three national databases indicated that nearly 80% of low income youths in need of mental health services did not receive services within the preceding 12 months, with rates approaching 90% for uninsured families (Kataoka, Zhang, & Wells, 2002).

Many Students Not Getting Needed Mental Health Supports

Barriers to Involvement in Child Mental Health Interventions

McKay (2007) Poverty, single parent status and

stress Concrete obstacles: time,

transportation, child care, competing priorities

Stigma associated with mental illness and seeking care

Previous negative experiences with mental health or institutions

Scarce mental health resources Concerns about confidentiality Isolation

Even those families who receive mental health services experience attrition rates of greater than 50%, with low-income, minority children at especially high risk (Kazdin, 1996; Kazdin, Holland, & Crowley, 1997; Yeh, et al., 2003).

Keeping Mental Health Services Alive


Lizzy in 7th grade Mrs. Perry, 7th grade LA

teacher Failing some classes; barely

passing others Socially isolated except for

Sheila Superficial cutting behavior

beginning Discipline referrals for

disrespect Won’t go to counseling

Discussion Questions

Have you ever been frustrated with not having clear expectations about follow-up and on-going communications amongst home, school and mental health providers?

Does it seem that school is left holding the bag when you see family or outside agencies not doing their parts?

Do you ever feel like giving up because others don’t follow through?

To be alienated is to lack a sense of belonging, to feel cut off from family, friends, school or work – the four worlds of childhood

Urie Brofenbrenner, 1986

Students with Serious Emotional Disturbance (SED) miss more days of school than do students in all other disability categories

(U.S. Department of Education, 1994)

More than half of students with SED drop out of grades 9-12, the highest rate for all disability categories.

(U.S. Department of Education, 2002)

Of those students with SED who drop out of school, 73% are arrested within five years of leaving school

(Jay & Padilla, 1987)

Center for Evidence Based Practice:

Young Children with Challenging

Behavior www.challengingbe

havior.org

Lizzy in 9th grade School meeting Not attending

classes Likely to fail

classes Waiting to drop out ‘Cutting’ more

frequent Mrs. Watson

blames school


Discussion Questions

We all know where this meeting could go -- we’ve all felt blamed. It would be easy for this to end in a ‘blame game’ where no one wins

What’s a typical reaction to being blamed? How do you respond?

What could be said or done that might end the blaming before it stops the problem-solving?

What could Mr. Strickland say after Mrs. Watson spoke that would have both supported his staff AND at the same time have helped the team to problem solve?

There are evidence-based practices that are effective in changing the developmental trajectory…the problem is not what to do, but rests in ensuring access to intervention and support

Center for Evidence Based Practice: Young Children with Challenging Behavior

www.challengingbehavior.org

We CAN Impact Future Performance

Creating a Caring CommunityOsher (2006)

Students perform better on tests when they believe that their teachers care about them This correlation is stronger for students who are

judged to be at risk for dropping out of high school Supportive relationships promote student

engagement, positive attitudes, a sense of belonging to school, motivation, & academic achievement

Connections with adults in the school protect against a range of anti-social outcomes which impact academic performance (e.g., substance abuse)

“Every child needs one person who is crazy about him”

Uri Bronfenbrenner, Psychologist and Co-Founder of Head Start

Lizzy’s Story Could Be Different

What would it be like for children like Lizzy and those who live and work with her if we had a full continuum of school-based and community-based supports in place?

What will it take to get there?

Creating a System of Care and Education in New Hampshire

Gaps in the Continuum of Supports were identified based on 5 years of PBIS-NH implementation

Mental health And Schools Together-New Hampshire (MAST-NH) is helping to fill in the gaps

Starts with a Commitment to Early Recognition (all along the continuum)

and Shared Work

Systematic Screening (a MAST-NH Feature)

Active promotion of Home-School connection (PBIS)

High level of direct communication and collaboration when multiple systems are involved: home-school-mental health center (MAST-NH)

Continuum of Effective Supports: New Hampshire’s System of Care and Education

Linkages to Wrap-NH Facilitation

School-basedIntensive Supports

Coordinator

Linkages to Community-based

Supports

School-wide and General Education Classroom Systems for PreventativeInstructional and Behavior Management Practices

Systematic ScreeningPromote Positive Parent Contact

Array of Evidence-Based Group Interventions Addressing Prevalent Functions of Behavior Available for Students Who

Don’t Respond to SW and Social Contracting

Function-Based Support Planning(Functional Assessment and Intervention Planning)

Available for SW and Group non-responders

School-basedIntensive Supports

Linkages to Case Centered Collaboratives

Mann & Muscott (2007)

Efficient Systematic Intervention for Students Who Do Not Respond to SW and Classroom Prevention and Response Systems

Intensive Behavior Support Plans

and Crisis Intervention

Supporting the Personal, Social, Physical and Academic Development of Every Child

What does your school already do to support children’s development through early intervention and prevention? Screenings? A.M. Bus Greeters? Greeting students by name? Systems for effective communication Systems for efficient referral to higher level supports Providing information and resources to families & staff Providing a continuum of effective supports?

Teaching & recognizing desired social behavior Targeted group interventions including supports that encourage

belonging, social/ emotional development & academic skill development

Knowing what ‘Function of behavior’ means and how understanding function can lead to effective support

Other ways in which student mental health is supported?

Mental Health and Schools Together-NH (MAST-NH) Major Features

1. Mental Health Primer for School Staff

2. Life Space Crisis Intervention Techniques (LSCI)

3. Assessment of School-based Systems of Emergency Preparedness

4. School-based Referral Protocols to Targeted & Intensive Teams

5. Community-based Referral Protocols to Community Mental Health Centers

6. Wraparound Facilitator Training and Development of Mentored and Peer Support System

7. Development or Expansion of Community or Regional Collaboratives

8. Community Resource Mapping to Identify Needs & Action Plan

What is MAST-NH Doing?

Enhanced the work of the Seacoast Collaborative Bringing systems throughout the community together:

DCYF (Child Welfare) DJJS (Justice) Mental Health Medical Health Schools Youth development and recreation Substance abuse Family representation

Monthly meetings, action planning Breaking down systems barriers Determining how to support families AND system partners Community Resource Mapping

What is MAST-NHDoing?

Building capacity building for Wraparound: Newly trained Wrap-NH facilitators in Somersworth area:

Kate Salvati, Strafford Learning Center Kathy Francoeur, Somersworth Schools Jon Drake, APEX II Diane Cyr, Seacoast mental health Kyle Sczepanik- family, family rep to collaborative Miranda Snow, CHOICES Gary Reynolds, SAU 44 Liz Card, HUB Parent Greg Burdwood, HUB Family Resource Center Kimberly Cartier, Rockingham Community Action Program Heidi Wyman, Strafford Learning Center, Transition Network

Building Mentor capacity to develop a system for facilitator support Kate Salvati @ SLC building system for on-going facilitator training and

support Kevin Murphy @ SLC planning for future capacity-building and funding


Soon to be Senior Trainers in Life Space Crisis Intervention Joel Eastman Sue Cohen, SLC Glynn Talley, Powers School

‘Senior’ Trainers will be authorized to certify new trainees through a 5-day course in LSCI

These 5 have already committed to a five-day LSCI training through MAST-NH: Laurie Conley Grace Fuller Corinne White Donna Drolet Judy Tyndall Christine Williams

These folks have committed to a One-Day training (January 11): Dana Mitchell Holly Prud’homme Ted Ready Richard Walsh


Developed training process for Intensive Systems Systematic Screening for Behavior Disorders Crisis Response/ Emergency Response Intensive Functional Assessment Person-Centered Planning (January 18th) Already attended some of our trainings in Intensive Systems:

Laurie Conley Laurie Lambert Dana Mitchell Kelly Warren

What is MAST-NHDoing?

Worked w/ Janet Salisbury of Community Partners of Strafford County, your community mental health center to: Develop a flowchart to clarify their referral process Design a ‘facilitated referral to Mental Health Services’

Design worksheet/ process for an ideal school to MH referral Join with an SAU-56 Team to establish protocols for on-

going communications amongst school, family, MH providers and medical providers

Janet Salisbury, Children’s Director @ Community Partners Rebecca Paschal of Community Partners, housed at the middle

school Representative SAU 56 Team: All Schools Represented

See Joel Eastman


SAU 56 team with reps from each school -- to address issues related to supporting children and families with intensive needs Need a K-12 effort Developing internal referral processes and promoting a full continuum

of effective supports Addressing on-going communications with MH and medical providers Meeting at end January Community Partners will be at the table K-12 representation

MAST-NH Leadership Team Statewide A Statewide Collaborative All regions and systems represented

Supporting a common vision

Vision for Somersworth Schools

Internal protocols for referrals to Intensive Supports Systems that support staff (to decrease stress of not

knowing what to do next) Have data that supports good decision-making and

evidences progress Have a full continuum of support at each school Have a continuum of accessible community-based supports Develop specific protocols for a facilitated referral to

Community Partners or other community-based supports Develop specific protocols for on-going communications

amongst Schools, Home, MH and Medical Systems

School-Home-Mental Health Collaboration Works

School-based programs focused on consultation with teachers and parents can be effective approaches to enhancing children’s mental health (Lowie, Lever, Ambrose,Tager, & Hill, 2003; McKay, et al., 2003; Weiss, et al., 2003).

Consultation with teachers can maximize opportunities to effect children’s academic learning and classroom behavior (Fantuzzo & Atkins, 1992; Ringeisen et al., 2003).

The ‘shared work’ dilemma

Some hear ‘Shared Work’ & feel relieved that Mental Health support is not all on the shoulders of educators

Others hear ‘Shared Work’ & feel a burden & are anxious that it sounds like educators are being asked to spend precious time working outside their scope of expertise

We believe (as with Special Education) that if MH support is simply a ‘hand-off’ (“Please Fix Him”), or if clear predictors are ignored, the likelihood of effective intervention decreases

Solving the Critical Issue of Making Shared Work a Reality

How can the SAU and schools best support the work of the Community Partners?

How can Community Partners best support the work of schools?

School Administrative Unit 56

to ‘Community Partners of Strafford County’

Promoting a School Facilitated or Supported Referral

What is the process when staff from the Somersworth Schools help families facilitate a

referral to Community Partners?

Components of a Facilitated Referral from School to Community Partners (First Draft)

Parents to sign a school release to CMHC to facilitate referralSchool to call Admissions department with the following information:

Reason for referralAcademic functioningBehavioral functioning

Social functioningRecent change or deterioration in any of the areas of functioning

Special Education or 504 planContact person at school

Parents to contact Admissions Department at CMHC and provide the following information:Demographic information

Reason for referralFamily structure

Academic, behavioral and social functioningMedical information, including any medications – current and past

Insurance information

What will tell you that things are getting better?What is the school hoping for with this referral?What is the family hoping for with this referral?

Referral, Intake and Treatment Protocol for Community Partners

School Facilitated or Supported Referral

*Level 4 ’Urgent Care’ Intake Appointment

Urgent care Treatment OnlyAppointment within 48 hours

In-Office Therapy w/ minimal

Case Management

Mix of Community Based or Office-Based Tx with

options for Case Management

Intake Appointment:Intake Clinician completes intake assessment

Approximately 1 to 2 hoursIntake Clinician then presents case at

Admissions Conference

Admissions Conference:Internal meeting with managers, clinicians, and psychiatrist

Determines array of services that matches to level of care neededAssigned to local Team (Dover or Rochester)

Family Intensive TreatmentCommunity-based Supports Home or In-Office Therapy

Case Management

Clinician Assignment:Assigned by location to clinician best matched to family

Clinician and Family develop written Treatment Plan With goals and objectives and a review process

Initial Contact:Call Received by Community Partners

Admissions Specialist Takes General Information (Demographic information, reason for call, brief history of problems)An intake appointment is scheduled*

Tells parent what to bring/ when to arrive/ where to go/ who with*Emergency circumstances processed differently

OR OR

OR

12/07

What Does Community Partners Provide? Child and Adolescent Services provides

assessment, treatment and case management services to children and adolescents.

The division emphasizes the provision of care to youngsters "at risk" and with moderate to severe emotional and behavioral disturbances.

1. Individual Therapy: Pre-school, Latency, Adolescent

2. Group Therapy: Pre-school, Latency, Adolescent, Parents/ Caregivers

3. Family Therapy

4. Emergency Services/ Crisis Stabilization

5. Prescribe Medication

6. Monitor Medication7. Admission/Discharge

Planning8. Medical/Psychiatric

Screening9. Case Management10. Community-Based

Functional Supports11. Dialectical Behavioral

Therapy Program for Adolescents

Expected Outcomes

What Can a Family Expect from Treatment?

Expected outcomes of treatment are incorporated into the individual treatment planning process

Outcomes may include: The improvement of presenting problems Improvement in emotional and behavioral

functioning Stabilization of functioning Maintenance of functioning Prevention strategies Problem-solving strategies

MAST-NH Regions and Schools

6 Regional Collaboratives Candia, Lakes Region, Littleton, Londonderry,

Monadnock, Strafford County

27 PBIS Schools

6 Community Mental Health Centers

NH CEBIS and MAST-NH (Watch for new website!)

\

http://www.nhcebis.seresc.net

Mental Health and Schools Together-NH A Guide to Supporting Collaborative Practice Sponsored by the...

Documents

Transcript of Mental Health and Schools Together-NH A Guide to Supporting Collaborative Practice Sponsored by the...