Schools Based Mental Health Program

8/18/2019 Schools Based Mental Health Program

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A Comprehensive Student Support

Program in Mental Health

Sherein Abdeen MA, Samah JabrMD, Michael Morse MD, MPA,

Katherine Lyman MA, ElizabethBerger MD, M.Phil


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• Palestinian Medical EducationInitiative (PMED) held a one-year pilot

comprehensive program to supportstudent mental health estalished at theDar Al-He!meh Schools in East "erusalem

during the school year #$%&-#$%'unded y Deutschen *esellschat +rInternationale ,usammenariet (*I,)


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• Program involved intensive year-longace-to-ace engagement o a PMEDmental health

psychotherapist.trainer at the school


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A child psychiatrist ased in /e0 1or! and thePMED 2S Medical Director provided 0ee!lysupervision and consultation through S!ype

3ther PMED sta4 provided valuale consultationregarding various aspects o the program


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• 5o improving student

mental health in Palestine 6

50o ostacles6- ongoing damage

imposed y occupation

-

stigma against mental disorders


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• student prolems70hether everydayprolems or symptoms o mental

health disorders7are oten met ytheir parents their teachers andtheir peers 0ith a degree o

impatience and criticism


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Main aim

• 5o improve student resilience andmental health this pro8ect undertoo!the mission o constructive culture

change 0ithin a school through anintensive year-long program otrainings or parents and sta4 and

the estalishment o a leadership 5as!orce 0ithin each ranch


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5he partner institution

• 3ne ranch serves6 %9$ !indergartenstudents oth girls and oys

• Another ranch serves6 %&$ oys in grades :

through ;• A third ranch serves6 :'$ students in

grades % through ;< at the third ranch thestudents in grades %-= are girls and oys and

the students in grades : through ; are girls• 5here are 9;$ students enrolled altogether


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Assumption

• student resilience is mediated y t0opsychological actors6

%6 sel-esteem

#6 roust relationships 0ith others7and that interaction 0ith adults thatraise student sel-esteem andsupport meaningul relationships 0illtherey enhance resilience


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Method

• In the spring o the school yearpreceding program implementationthe PMED trainer met several times

0ith the administrative leadership othe schools (ie the principals andthe chair o the schools> oard o

directors) to share perspectives onneeds and program logistics


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• one principal estimated that morethan one ?uarter o the students hadeen reerred to the school guidance

counselor the previous year and thatno amily had ollo0ed up on reerralto proessionals outside the school


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• 5he planning sessions generated a detailed listo the !inds o concerns that the schools0anted the program to address7or e@amples!ills or teachers to improve school moraleand classroom discipline

• s!ills or teachers.guidance counselors torecognie and to manage students presentinglearning prolems and emotional. ehavioralissues

• and s!ills or the parents to 0or! moree4ectively 0ith the school


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Bey programmatic elements

• Bey programmatic elements 0ere6

- a series o intensive trainings or allschool sta4


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• 5he curriculum involved an overvie0o common mental disorders ound inchildren and young adolescents and

their symptoms including earningDisorders ADHD Conduct Disorderand 3ppositional Deant Disorder


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• 5he curriculum also presented anovervie0 o common classroomprolems such as poor academic

perormance disruptiveness andailure to ollo0 directions as 0ell ascommon school-0ide issues such as

ullying and demoraliation due tothe occupation


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• specic s!ills to respond to thesevarious challenges in the classroomin the school overall in

communication 0ith amilies and inreerrals to the school guidancecounselor or proessional in the

community


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esults o sta4 training

• Core themes throughout the schoolsta4 trainings 0as the e4ectivenesso positive eedac! rather than

punishment in dealing 0ith studentsand the value o actively ostering aculture 0ithin the school community

ased on empathy cooperation andmutual respect


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5he evaluation o thetraining

• 5he training 0as evaluated y%$$F o the participants as eitherGgood or Gvery good


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- a series o intensive trainings orparents


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• 5he principal o each o the threeranches at the Dar El-He!mehSchools invited all parents to attend

and specically reached outindividually to the parents o children0ith special diculties stressing the

importance o their attendance


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• 5he initial eight-hour parent training0as held in Decemer #$%& over ourdays delivered to appro@imately

orty parents each day All o theattendees o the parent training 0eremothers


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• 5he training program curriculuminvolved an introduction to variouscommon diagnoses in childhood

• prolems that children might presentin their academic perormance

• and the potential role o psychological

actors in these prolems


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• Specic parenting s!ills andrela@ation techni?ues 0ere taught

• Psychoeducation 0as o4ered toreduce stigma and to help parentsvie0 student diculties as prolemsthat can e solved through ongoing

communication and planning 0ithteachers guidance counselorsand.or mental health proessionals


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results

• 5he specic s!ills and lessons or parents andteachers 0ithin the trainings 0ere thusdesigned to shit the emphasis rompunishment to praise and to oster acommitment to understanding the otherperson>s point o vie07t0o necessary stepsto0ards constructive conJict resolution andenhanced morale

• 5he parent training emphasied the overallthemes o positive eedac! and empathyet0een parents and their children


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evaluation o parentstraining

• 5he parent trainings 0ere perceivedy participants as very valuale


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• ?uanlitative measures indicated ahigh level o enthusiasmappreciation and practical enet

claimed y parents 0ho attended thetrainings

• A large ma8ority o the participants

called or additional trainings and orthe involvement o athers


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• School guidance counselors notedthat ater the parent trainingsparents had spontaneously egun to

telephone the school re?uestingappointments to discuss concernsaout their children7a ne0 ehavior

or parents


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• the estalishment o a permanentschool-ased 5as!orce


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tas!orce

• 5he 5as!orce under the leadershipo the PMED trainer consisted o t0oteachers the school principal and

the school guidance counselor 5he 5as!orce met 0ee!ly and orged aormal communication net0or! 0ith

all o the teachers


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5he mission o each 5as!orce 0ast0o-old6

• to enhance psychological resilienceamong all students on a school-0ideasis

• to address specic

emotional.ehavioral or learningprolems posed y individualstudents


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• the long-term goal that the 5as!orce0ould e capale o unctioningindependently o the trainer in

suse?uent years


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• each 5as!orce estalished acommunication net0or! 0ith all othe teachers 0ithin that ranch Each

memer o the 5as!orce 0asassigned to a small group o teachersand met 0ee!ly 0ith that group so

that every teacher 0ithin the schoolhad a ormal relationship 0ith adesignated 5as!orce memer


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3ne o the activities

Early in the school year the 5as!orces developed andimplemented a daily Kiteen Minute

Activity or the entire school 0hich0as scheduled to ta!e place early inthe morning ater the students

arrived replacing a period o timeordinarily lled y unstructuredactivity on the school yard


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• ho0 the students elt aout theirrelationships 0ith various amilymemers 0ith teachers or 0ith peers

or 0hat students 0anted theirclassrooms to e li!e

• E@6 GI hate my ather during a 0riting

e@ercise ocused on amily relationshipsor dra0 a picture illustrating adisturingly morid theme


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• 5hese activities resulted in tangileresults7or e@ample certainclassrooms developed standards and

rules or classroom clean-up 0ithstudents ta!ing on moreresponsiility or their o0n

environment than previously


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• esponding to the issue o ullyingamong students6

• one 5as!orce called or a special0or!shop on ullying or school-0idesta4 a plan 0hich 0as implemented


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• A pressing issue 0ith proound impact onstudent 0ell-eing 0as the escalatingpolitical.military violence relative to theoccupation that emerged in 3ctoer #$%& inthe East "erusalem vicinity 5he students 0ereoserved to e oth an@ious and sometimes

rec!lessly agitated y these violent eventsand also to seem to eel demoralied andhopeless in reaction to them

•


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• Specic crisis-intervention programs0ere initiated or the 0hole school inresponse to the violence e@perienced

y the community such as6• rela@ation and deep-reathing

e@ercises


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• An art pro8ect helped studentse@press their emotions regarding thecrisists


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• Children too! part in an activityinvolving alloons attached to theirlegs ater the children had 0ritten

onto the alloons various names orimages symoliing things theydisli!ed


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• 5he school reached out to parentsthrough its Kaceoo! pageencouraging parents to prepare

special oods or to engage theirchildren in special activities duringthese dicult days


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Keedac! rom Parents

• Parents through Kaceoo! postingsand school sta4 oth reported thatthese measures 0ere very e4ective

in improving demoraliation amongthe students through deusingemotion in symolic play and

restoring a sense o cohesion 0ithinthe school


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• In preparation or this underta!ingthe entire school sta4 0as trained tomaintain strict condentiality in all

communications and in record-!eeping regarding any individualstudent


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• Each student reerred to the 5as!orce 0as entered onto a list oruse y the 5as!orce and the dateand severity o the student>s prolemrated on a one-to-ten score


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• 5he 5as!orce 0ould then elicitinormation regarding the reerredstudent discuss the situation and

develop a plan 0hich 0ould ecommunicated to the child>s teacher


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• Sometimes the plan 0ould e ?uite simple7or the class to ocus on a student 0hoappeared to have lo0 sel-esteem ore@ample creating a list o all the li!ealethings that the classmates oserved aoutthat student and vo0ing to ta!e a riendlyencouraging role to0ards him or her 5hesevery simple measures oten had remar!ale

impact on unhappy youngsters andsometimes led to impressive sustainedimprovements in their oserved mood


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• Kor other students the 5as!orceplan might involve reerring thestudent to the guidance counselor or

a certain numer o individualsessions or inviting the parents toschool or a discussion


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• Some students 0ere reerred to a mentalhealth proessional outside o the school 5hese 0ere oten students 0hom the 5as!orce 8udged as needing a ormalevaluation to estalish a diagnosis (egADHD or Autism Spectrum Disorder)

students 0ho already had een ta!ing apsychotropic medication that the 5as!orceelt might enet rom an updatedad8ustment or students 0ho had notimproved 0ith the in-school plan


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esults o 5as!orce 0or!

• 5he three 5as!orce 5eams 0erereerred &: students altogether

during a reporting period o ourmonths


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• 3 these teacher ratings o prolem severitytrac!ed over time 0ere availale or == students70ith the ratings o #: (9=F) o these studentsdemonstrating improvements

• 5hirteen students reerred to the 5as!orces 0erereerred to psychiatrists

• Initially no amily ollo0ed up on reerrals< onrepeated encouragement y the school eight

amilies eventually ollo0ed throughdemonstrating that the programs had helped the 5as!orce memers to ecome sustantially mores!illul in communicating 0ith parents


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• 5hese data 0ere not su8ect toormal statistical analysis ecausethe numers 0ere ?uite small (eg

?uantied measure o outcomesregarding appro@imately :$ schoolsta4 memers and :$ parents)

Schools Based Mental Health Program

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