THE SCHOOL MENTAL HEALTH IMPERATIVETHE SCHOOL MENTAL HEALTH IMPERATIVE

Steven Adelsheim, M.D.University of New Mexico Department of Psychiatry

NM Department of Health, OSH

Jenni JenningsDallas Independent School District

THE SCHOOL MENTAL HEALTH IMPERATIVETHE SCHOOL MENTAL HEALTH IMPERATIVE

Steven Adelsheim, M.D.University of New Mexico Department of Psychiatry

NM Department of Health, OSH

Mark D. Weist, Ph.D.University of Maryland

Department of Psychiatry

Prevalence of Childhood Mental Health ProblemsPrevalence of Childhood Mental Health Problems About 20% of children and adolescents

(15 million), ages 9 to 17, have diagnosable mental health disorders

Between 9-13% of children, ages 9-17 years, meet the definition of serious emotional disturbance (SED) that limits their ability to function in the family, school, and community

An estimated 70% of those identified are not getting the mental health treatment they need

Surgeon General’s Conference on Children’s Mental HealthSurgeon General’s Conference on Children’s Mental Health By 2020, childhood neuropsychiatric disorders will

rise by over 50% internationally to become one of the 5 most common causes of morbidity, mortality, disability

Global Burden of Disease study predicts that major depression will become the second leading cause of disability in the world by the year 2010

“There is no mental health equivalent to the federal government’s commitment to childhood immunization”

Surgeon General’s Suicide Data -1997Surgeon General’s Suicide Data -1997 Rate for ages * 10-14 - 1.6 /100,000

* 15-19 - 9.7 /100,000

* 20-24 - 14.5 /100,000 For young people 15-24, suicide is third leading

cause of death In 1996, more youth and young adults died from

suicide than cancer, heart disease, AIDS, stroke, pneumonia, & birth defects COMBINED

2001 New Mexico YRRS 2001 New Mexico YRRS

13.7% of students had attempted suicide in

the 12 months prior to the survey

15.5% of females

7.1% of males

Up from 9.1% in 1999

An Attitudinal Shift Towards Children’s Mental Health ProgramsAn Attitudinal Shift Towards Children’s Mental Health Programs Public Health perspective similar to that for

immunizations, sexually transmitted diseases Put children’s services on equal financial

footing as adult programs if we really believe in prevention and early identification

Equal focus for children’s services at federal, state, and local systems

University training systems prioritize children services

Prevalence of Mental Health Problems Post 9/11Prevalence of Mental Health Problems Post 9/11 64% of students had been exposed to one or more

traumatic events BEFORE 9/11 10.5% of students were estimated to have PTSD (75,000) Previous exposure to traumatic event or exposure of a

family member or were more important than personal physical exposure in predicting who developed PTSD

26.5% have at least one of the seven assessed mental health problems, excluding alcohol abuse (190,000 students)

At least 66% of students with probable PTSD following the 9/11 attacks had not sought out ANY mental health services!

Early Identification and Treatment of Psychiatric Disorders as PreventionEarly Identification and Treatment of Psychiatric Disorders as Prevention

ADHD – Pharmacotherapy reduces risk for later substance use disorder (Biederman, et al, 1999)

Bipolar disorders – early identification of BAD in younger children reduces risk of ASUD 8X over adolescent identification (Wilens et al, 1999)

Opposition Defiant/Conduct Disorders – early treatment of child, parent, family all decrease later ASUD risk (Riggs)

NYC Mental Health System RecommendationsNYC Mental Health System Recommendations

All interventions should be school-based to increase access and decrease stigma

Outreach and training in schools to identify youth with mental health problems

Screening and assessment system within schools. that includes a seamless link to services

Evidence–based models of intervention Increase school-based clinics throughout NYC

schools

Schools: The Most Universal Natural SettingSchools: The Most Universal Natural Setting

Over 52 million youth attend 114,000 schools

Over 6 million adults work in schools

Combining students and staff, one-fifth of the

U.S. population can be found in schools

Why Put Mental Health Services in Schools?Why Put Mental Health Services in Schools? Improve access: It’s where the students are! Families more comfortable in community setting Minimize stigma issues Opportunities to observe and intervene directly in

setting where most student’s time is spent Clinical efficiency and productivity Ability to collaborate and advocate directly for

education needs of students Greater ability to reach those with “internalizing

disorders”

Major Approaches to Mental Health in SchoolsMajor Approaches to Mental Health in Schools School-Based Health Centers (1,400) Community Mental Health Center Outreach

(114,000 schools) Private Practitioner Outreach Communities in Schools Enabling Framework (Adelman and Taylor) Other Education-Based, Including Special

Education Linked and Consultation

School Mental Health Partnerships with FamiliesSchool Mental Health Partnerships with Families Opportunities to collaborate with providers on-

site about education needs of child Improved coordination of interventions around

whole child and family Access is easier with fewer transportation

issues More comfortable community setting Stigma issues may be minimized

School-Community Collaboration in School Mental Health ProgramsSchool-Community Collaboration in School Mental Health Programs

Collaboration and coordination between school and providers is criticalRoles of all on-site providers, including school

health professionals must be clear Communication and confidentiality issues must be

directed addressed and establishedResource coordination efforts must be determined

by organized team within school (SAT, resource team, etc.)

School Mental Health Programs and Special EducationSchool Mental Health Programs and Special Education Currently most school mental health professionals work

only with special education students SBHCs may have a critical role to play in evaluation,

recommendations, interventions, IEPs for special education

School mental health providers may find students in need of further educational assessment and be on site to advocate for their needs

On-site school mental health professionals are a resource for administrators struggling with difficult discipline issues

School mental heath providers may give direct guidance to teachers in meeting student classroom needs

School Mental Health Program OutcomesSchool Mental Health Program Outcomes

Improved grades, attendance, and behavior in

students

Decreased inappropriate referrals to special

education

Improved school climate

Funding a Continuum of School Mental Health Programs and ServicesFunding a Continuum of School Mental Health Programs and Services

State and local grants and contracts Federal and foundation grants and contracts Innovative prevention funding Medicaid: fee-for-service, Medicaid managed

care, Medicaid in the Schools Allocations from schools, special education

services, and departments of education

Continuum of Care for School Mental Health ProgramsContinuum of Care for School Mental Health Programs

Awareness and training Three levels of prevention, including

universal, selective and indicated Screening and assessment Early identification and early intervention Three levels of treatment, including

community-based, transitional, and high-end

Director Laurie A. Mueller HPM-1/Santa Fe

Secretary Pamela Hedrick

Santa Fe

Planner Vacant

Santa Fe

School Mental Health Initiative, Director Steve Adelsheim

(UNM)/Abq

Healthier Schools Consultant Randy Sanches

PH Educ./Santa Fe

Medical Care Administrator Vacant

PH Educ./Santa Fe

Program Manager Kris Carrillo (UNM)/Abq

Administrative Asst. III Clancey Tarbox

(UNM)/Abq

Behavioral Education Consultant

Vacant PH Educ./Abq

School Mental Health Advocates Vacant - UNM / Dist I Jaynee Fontecchio - UNM /Dist I NW Joseph Vigil - UNM / Dist II Albert Sanchez - UNM / Dist III Steven Courts - UNM / Dist IV

School Health Advocates Deb Werner - Dist I Janie Lee Hall - Dist I Trudy Perry - Dist II Laura Mandabach - Dist III Janice Jordan - Dist IV

SBHC Nurse Practitioner Medicaid Consultant

Paula LeSueur (UNM)/Abq

School-Based Health Center Consultant

Mary Blea Nurse-5/Abq

School-Based Mental Health Services Consultant

Jacque Masog (UNM)/Abq

Dropout Prevention Coordinator

Nissa Patterson (UNM)/Albq

Administrative Assistant II Carol Montoya

(UNM)/Abq

School Health Officer Jane McGrath

(UNM)/Abq

Screening / Early Identification Consultant

Ernest Coletta (UNM)/Albq

NM DOH Office of School Health NM DOH Office of School Health

Office of

School Health

Locations District III

District IV

New Mexico School Behavioral Health PartnershipNew Mexico School Behavioral Health Partnership

Office of School Health $300,000 Behavioral Health Division $400,000 CYFD-Prev. & Interv. $320,000 Dept of Ed.-Spec.Ed. $170,000 Dept. of Ed.-School Health $350,000 Fed. M H Block Grant $140,000 HSD-Med. Asst. Div.

Interdepartmental School Behavioral Health PartnershipInterdepartmental School Behavioral Health Partnership Funded Programs School Behavioral Health Training Institute Youth Mental Health Awareness Initiative-

“Childhood Revealed” Dropout Prevention Project School Behavioral Health Screening Program School-Based Mental Health Center Program

Development SBHC Mental Health Exemplary Pilot Sites

School Mental Health System RecommendationsSchool Mental Health System Recommendations Through schools, train educators, students,

and families about children's mental health issues and their impact on education

Continue to fund evidence-based prevention programs, including indicated prevention activities

Expand incentives to increase the numbers of child-trained MH providers and require a school-based component to their training

School Mental Health System Recommendations-continuedSchool Mental Health System Recommendations-continued

Implement screening and assessment for behavioral health issues:Head StartChild Find and IDEAEPSDTEntrance to schools with vision and hearingAt critical junctures in school such as at transition

grades and at point of disciplinary action

School Mental Health System Recommendations-continuedSchool Mental Health System Recommendations-continued Create specific funding for school-based mental

health services in school-based health centers and as a part of federally funded mental health and education programs

Examples: SCHIPS Medicaid Medicaid in the Schools “No Child Left Behind”-Safe and Drug Free Schools, Title

1 and other entitlements

School Mental Health System Recommendations-continuedSchool Mental Health System Recommendations-continued Support state level infrastructure for mental health

service system delivery between mental health and education systems

Fund school mental health demonstration sites and disseminate the most effective models

Create Office of School Health/Mental Health at federal level (joint Health and Ed.), pool funds from multiple agencies and distribute to school-community collaboratives

Integrate school-based mental health and primary care services

Find Children and Adolescents with Behavioral Health Problems Early and

Treat Them

Find Children and Adolescents with Behavioral Health Problems Early and

Treat Them Prevent later special education referrals Reduce primary care and urgent care over

utilization Decrease high risk behaviors including

violence and substance abuse Improve educational outcomes Decrease the accidents, suicides, and

homicides that are the public health mortalities for our children

The National Child Psychiatrist ShortageThe National Child Psychiatrist Shortage

In 1990, COGME reported a national need for

30,000 child psychiatrists by 2000

Currently there are 6,300

A minimum projected need for 12,624 to meet

demand by 2020 with a predicted 30%

increase in numbers to 8,312

New Mexico School Behavioral Health Training InstituteNew Mexico School Behavioral Health Training Institute

Train-the–Trainers model of adult education

Training 180 teachers and school health

professionals from 14 districts this year

Training in aspects of school behavioral

health and classroom intervention

On-site workshops with staff support

Childhood Revealed New Mexico 2001Childhood Revealed New Mexico 2001 Art exhibit as centerpiece for youth mental

health awareness expansion statewide Linkages to school districts for in-service

training and classroom programs (0ver 5000 youth so far this year)

Community education programs for expanded awareness

Media, government, and business support all to help to decrease stigma

New Mexico School Mental Health Prevention ProgramsNew Mexico School Mental Health Prevention Programs

Dropout Prevention Program

Peer Navigator’s Program

Crisis Prevention and Intervention

Coordination

Prevention Programs Resource

New Mexico Dropout Prevention InitiativeNew Mexico Dropout Prevention Initiative Case management model for high risk youth and

their families Focus on wraparound supports for those identified

of being at risk to dropout Statewide training and RFP development 2002 fiscal

year Focus on implementation at 3 pilot sites statewide

for fiscal years 2003-4 Target 9th grade students making transition to high

school

New Mexico K-6th Behavioral Health AssessmentNew Mexico K-6th Behavioral Health Assessment

Training for teachers and school health professionals statewide in behavioral health issues

Website development as training and resource model-www.nmsmhi.org

Developing of screening and assessment tools for K-6th grade use statewide

Focus on student support team system development for schools

Funded by state legislature through SDE

New Mexico Screening and Early Identification Models New Mexico Screening and Early Identification Models

Early identification and intervention as prevention

Public health screenings vs. selective screenings in SBHCs

Piloting computer-based models for early identification and suicide prevention

Expanded interest by schools to utilize screening tools on larger scale

New Mexico School-Based Health Center Mental Health Program DevelopmentNew Mexico School-Based Health Center Mental Health Program Development

Expanded funding for mental health and substance abuse services 17 SBHC programs

One cluster wide Medicaid Managed Care School Behavioral Health Pilot Program

Standards and protocols for MH/SA services in schools

Four “Exemplary” School Mental Health Sites looking at mental health and educational outcomes

New Mexico Medicaid Managed Care SBHC Pilot ProjectsNew Mexico Medicaid Managed Care SBHC Pilot Projects

Pilot with Center for Health Care Strategies Reimbursement through Medicaid for mental health

and substance abuse services 5 Medicaid Managed Care SBHC pilots Developing depression, ADHD and substance

abuse protocols for MH/SA services in schools “Enhanced Mental Health Services” code for some

sites

New Mexico School Mental Health InitiativeNew Mexico School Mental Health Initiative

Statewide efforts to link families, communities,

schools and behavioral health programs

Phone: 505-841-5879

Fax: 505-841-5885

Email: stevea@doh.state.nm.us

Website: http://www.nmsmhi.org

University of MarylandCenter for School Mental Health AssistanceUniversity of MarylandCenter for School Mental Health Assistance

Provide technical assistance and consultation Provide national training and education Disseminate and develop knowledge Promote communication and networking

phone: 410-706-0980 (888-706-0980 toll free) email: csmha@psych.umaryland.eduweb: http://csmha.umaryland.edu

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

Directed by Howard Adelman and

Linda Taylor

Phone: 310-825-3634

Enews: listserv@listserv.ucla.edu

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