Maryland School Mental Health Alliance

School Mental Health Integration Grant

IntroductionsIntroductions

• Milt McKennaMilt McKenna Maryland State Department of EducationMaryland State Department of Education

• Nancy Lever, Mark WeistNancy Lever, Mark Weist University of Maryland, Center for School University of Maryland, Center for School

Mental Health Analysis and ActionMental Health Analysis and Action

• Catherine BradshawCatherine Bradshaw Johns Hopkins UniversityJohns Hopkins University

• Susan TagerSusan Tager Maryland Coalition of Families for Children’s Maryland Coalition of Families for Children’s

Mental HealthMental Health

HistoryHistory

Call for proposals April 2005 from the Call for proposals April 2005 from the U.S. Department of Education (Grant U.S. Department of Education (Grant Due in mid May!)Due in mid May!)

““Grants for the Integration of Schools and Mental Grants for the Integration of Schools and Mental Health Systems will provide funds to increase Health Systems will provide funds to increase student access to high-quality mental health care student access to high-quality mental health care by developing innovative approaches that link by developing innovative approaches that link school systems with the local mental health school systems with the local mental health

system.”system.”

HistoryHistory Commitment from key local, state, and national partners to Commitment from key local, state, and national partners to

collaborate and form an Alliance to advance school-mental collaborate and form an Alliance to advance school-mental health system integration in Maryland health system integration in Maryland

Strong support for children’s mental health and school Strong support for children’s mental health and school mental health in the statemental health in the state

A strong PBIS structure within the state and an interest in A strong PBIS structure within the state and an interest in enhancing mental health support and resources for red and enhancing mental health support and resources for red and yellow zone youth yellow zone youth

Notified of award in September 2005Notified of award in September 20051 of 20 funded projects (84 total applicants)1 of 20 funded projects (84 total applicants)

Project OverviewProject Overview

Maryland School Mental Health Maryland School Mental Health Alliance (MSMHA)Alliance (MSMHA)

Maryland State Department of EducationMaryland State Department of Education

Center for School Mental Health Analysis and Action - University of Center for School Mental Health Analysis and Action - University of MarylandMaryland

Center for Prevention and Early Intervention - Johns Hopkins UniversityCenter for Prevention and Early Intervention - Johns Hopkins University

Governor’s Office for ChildrenGovernor’s Office for Children

Maryland Assembly on School-Based Health CareMaryland Assembly on School-Based Health Care

Maryland Coalition of Families for Children’s Mental HealthMaryland Coalition of Families for Children’s Mental Health

Maryland Department of Juvenile ServicesMaryland Department of Juvenile Services

Mental Hygiene Administration Department of Health and Mental HygieneMental Hygiene Administration Department of Health and Mental Hygiene

Mental Health Association of MarylandMental Health Association of Maryland

Primary Grant ObjectivesPrimary Grant Objectives1. To further build a systematic state initiative for school mental 1. To further build a systematic state initiative for school mental

health (SMH)health (SMH)

2. To improve outcomes related to red and yellow zone youth in PBIS 2. To improve outcomes related to red and yellow zone youth in PBIS schools through:schools through:

Helping school staff to better identify and refer students who Helping school staff to better identify and refer students who could benefit from mental health servicescould benefit from mental health services

Enhancing mechanisms for effective communication between Enhancing mechanisms for effective communication between schools and the mental health system to help better integrate schools and the mental health system to help better integrate quality mental health care for studentsquality mental health care for students

Developing training and resources to assist school staff with Developing training and resources to assist school staff with creating environments that support academic, social, and creating environments that support academic, social, and emotional learning for children with more intensive mental emotional learning for children with more intensive mental health needshealth needs

Key Structural ComponentsKey Structural Components

1 Management Team1 Management Team

1 Advisory Board1 Advisory Board

5 Counties (Anne Arundel, Baltimore, 5 Counties (Anne Arundel, Baltimore, Harford, St. Mary’s, Washington)Harford, St. Mary’s, Washington)

5 County Integration Teams5 County Integration Teams

15 PBIS Schools (3/County) and 15 PBIS Schools (3/County) and Demonstration TeamsDemonstration Teams

County Integration TeamsCounty Integration Teams

PurposePurpose

Responsible for pursing improved school-Responsible for pursing improved school-mental health system integration in their mental health system integration in their county through:county through:

• Active communicationActive communication• Needs assessmentNeeds assessment• Resource sharingResource sharing• Problem solving Problem solving

Demonstration ProjectDemonstration Project

Demonstration ProjectDemonstration Project

Presents an opportunity for three Presents an opportunity for three schools in each of the five counties schools in each of the five counties to do a very strong assessment of to do a very strong assessment of school mental health programmingschool mental health programming

Based on this assessment, the team Based on this assessment, the team will implement a quality assessment will implement a quality assessment and improvement process from and improvement process from February 2006 to December 2007February 2006 to December 2007

Demonstration TeamDemonstration Team

Based on discussions, the team will identify Based on discussions, the team will identify

2-3 indicators for best practice that will be the focus for 2-3 indicators for best practice that will be the focus for improvement over the next yearimprovement over the next year

1 or 2 pressing emotional-behavioral problems (ADHD, 1 or 2 pressing emotional-behavioral problems (ADHD, Disruptive Behavior Disorder, Depression, or Anxiety) for Disruptive Behavior Disorder, Depression, or Anxiety) for the demonstration team members to receive skill training the demonstration team members to receive skill training on best practice related to the disorderon best practice related to the disorder

2-3 strategies to improve coordination and linkages 2-3 strategies to improve coordination and linkages between schools and mental health systemsbetween schools and mental health systems

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

University of Maryland CSMHAUniversity of Maryland CSMHA

Established in 1995, one of two national Established in 1995, one of two national centers focused on the advancement of centers focused on the advancement of training, practice, research and policy in training, practice, research and policy in SMHSMH

Funded by the Health Resources and Funded by the Health Resources and Services Administration, with co-funding Services Administration, with co-funding from the Substance Abuse and Mental from the Substance Abuse and Mental Health Services AdministrationHealth Services Administration

http://csmha.umaryland.eduhttp://csmha.umaryland.edu,, csmha@psych.umaryland.educsmha@psych.umaryland.edu, , (410) 706-0980(410) 706-0980

CSMHA SupportCSMHA Support

Sharing of diverse resources developed Sharing of diverse resources developed through 10 year history as a national through 10 year history as a national center, and intensive resources related to center, and intensive resources related to quality assessment and improvement and quality assessment and improvement and evidence-based practice from an NIMH evidence-based practice from an NIMH funded research studyfunded research study

Technical Assistance (by phone and email Technical Assistance (by phone and email and time and resource permitting in and time and resource permitting in person)person)

Linkages to local, state, and national Linkages to local, state, and national leaders, resources and initiatives in SMHleaders, resources and initiatives in SMH

Family PartnershipsFamily Partnerships

Maryland Coalition of Families for Maryland Coalition of Families for Children’s Mental HealthChildren’s Mental Health

Our Coalition is dedicated to:Our Coalition is dedicated to:

- Improving services for children with - Improving services for children with

mental health needs and their mental health needs and their familiesfamilies- Building a network of information - Building a network of information and support for families across and support for families across MarylandMaryland

Family Participation and Family Participation and LeadershipLeadership

Families as equal partners at all levels of the Families as equal partners at all levels of the project, (planning, implementation, evaluation, project, (planning, implementation, evaluation, management, and continuous improvement)management, and continuous improvement)

Training, oversight, and resource development Training, oversight, and resource development facilitated by the Maryland Coalition of Families facilitated by the Maryland Coalition of Families for Children’s Mental Healthfor Children’s Mental Health

Major goal to empower family members to Major goal to empower family members to

become effective advocates for children’s mental become effective advocates for children’s mental health and improve their linkages to and true health and improve their linkages to and true collaboration with schoolscollaboration with schools

Benefits of This ProjectBenefits of This Project Further build a systematic initiative for SMH in MDFurther build a systematic initiative for SMH in MD

Enhanced focus on helping red and yellow zone youthEnhanced focus on helping red and yellow zone youth

A voice in enhancing mental health integration into PBIS at A voice in enhancing mental health integration into PBIS at the county, state, and national levelsthe county, state, and national levels

Meaningful family partnerships and training and resources Meaningful family partnerships and training and resources for familiesfor families

Improved linkages between families, schools and mental Improved linkages between families, schools and mental health systemshealth systems

Improved outcomes for students (we hope)Improved outcomes for students (we hope)

Benefits (cont.)Benefits (cont.) Training for PBIS coaches/leaders on Training for PBIS coaches/leaders on

helping school staff and families helping school staff and families understand mental health issues in youth understand mental health issues in youth and promote mental health for red and and promote mental health for red and yellow zone youthyellow zone youth

Website with key information about Website with key information about mental health for families, teachers, and mental health for families, teachers, and providers (providers (http://www.msmha.orghttp://www.msmha.org))

Newsletter highlighting the project and Newsletter highlighting the project and key mental health initiatives in the statekey mental health initiatives in the state

How This Project Fits With How This Project Fits With

Your NeedsYour Needs

PBIS Needs AssessmentPBIS Needs Assessment

PBIS Needs Assessment: PBIS Needs Assessment: OverviewOverview

PurposePurpose• To determine training needs of PBIS To determine training needs of PBIS

teamsteams

Conducted by Leadership TeamConducted by Leadership Team• 2005 Summer Institute for Returning 2005 Summer Institute for Returning

TeamsTeams

High Response RateHigh Response Rate• 524 respondents = 87%524 respondents = 87%

Respondent CharacteristicsRespondent Characteristics Role in schoolRole in school

• 27% Team leaders27% Team leaders• 17% Coaches17% Coaches• 16% Administrators16% Administrators

Type of schoolType of school• 50% Elementary50% Elementary• 29% Middle29% Middle• 9% High9% High• 5% Alternative/Special5% Alternative/Special

Secondary Programs:Secondary Programs: % Needing Additional Training by Topic% Needing Additional Training by Topic

5257

54

62

5153

0

10

20

30

40

50

60

70

Conducting FBAs ImplementingFBA plan

Targeted foryellow-zone

Intensive for red-zone

Selectinginterventions

Alternatives to in-school

suspension

% N

eedi

ng A

dditi

onal

Tra

inin

g

Summary of Needs Assessment Summary of Needs Assessment FindingsFindings

School-Wide PBISSchool-Wide PBIS• Maintaining momentum among Maintaining momentum among school staffschool staff

(57%) and (57%) and team membersteam members (45%) (45%) Secondary ProgramsSecondary Programs

• Intensive for red (62%)Intensive for red (62%)• Targeted for yellow (54%)Targeted for yellow (54%)• Implementing an FBA plan (57%)Implementing an FBA plan (57%)

External CollaborationExternal Collaboration• Family involvement (70%)Family involvement (70%)• Community mental health (38%)Community mental health (38%)• Department of Social Services (37%)Department of Social Services (37%)• Department of Juvenile Justice (36%)Department of Juvenile Justice (36%)

National ConnectionsNational Connections

Significant Growth of School Mental Significant Growth of School Mental Health in the United StatesHealth in the United States

Unprecedented access, helps achieve Unprecedented access, helps achieve valued outcomes when done wellvalued outcomes when done well

Strong federal support, and increasing Strong federal support, and increasing numbers of strong initiatives in states and numbers of strong initiatives in states and communitiescommunities

Two major forces: PBIS, and Expanded Two major forces: PBIS, and Expanded School Mental Health (ESMH) programsSchool Mental Health (ESMH) programs

Increasing efforts to connect PBIS and Increasing efforts to connect PBIS and ESMH togetherESMH together

An OversimplificationAn Oversimplification Schools with strong PBIS often struggle Schools with strong PBIS often struggle

with problems presented by youth in with problems presented by youth in yellow and red zonesyellow and red zones

Schools with ESMH often struggle to Schools with ESMH often struggle to develop school-wide efforts to promote develop school-wide efforts to promote positive behavior and mental healthpositive behavior and mental health

Connecting ESMH and PBIS will lead to a Connecting ESMH and PBIS will lead to a full continuum of effective services across full continuum of effective services across the green, yellow, and red zonesthe green, yellow, and red zones

Related to MD’s leadership in ESMH and Related to MD’s leadership in ESMH and PBIS, and this grant, there is a significant PBIS, and this grant, there is a significant opportunity to make this connectionopportunity to make this connection

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

Programs join families, schools, mental Programs join families, schools, mental health and other community systems health and other community systems

To develop a full array of effective To develop a full array of effective programs and services that improve the programs and services that improve the school environment, reduce barriers to school environment, reduce barriers to learning, and provide prevention, early learning, and provide prevention, early intervention and treatment intervention and treatment

for youth in general and special for youth in general and special educationeducation

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

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

Funded by the National Institute of Funded by the National Institute of Mental Health (2003-2006)Mental 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 1) All youth and families are able to access appropriate care regardless of access appropriate care regardless of their ability to paytheir ability to pay

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

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

Principles (cont.)Principles (cont.)

4) Students, families, teachers and other 4) Students, families, teachers and other important groups are actively involved in important groups are actively involved in the program's development, oversight, the program's development, oversight, evaluation, and continuous improvementevaluation, and continuous improvement

5) Quality assessment and improvement 5) Quality assessment and improvement activities continually guide and provide activities continually guide and provide feedback to the programfeedback to the program

6) A continuum of care is provided, 6) A continuum of care is provided, including school-wide mental health including school-wide mental health promotion, early intervention, and promotion, early intervention, and treatmenttreatment

Principles (cont.)Principles (cont.)

7) Staff hold to high ethical 7) Staff hold to high ethical standards, are committed to children, standards, are committed to children, adolescents, and families, and display adolescents, and families, and display an energetic, flexible, responsive and an energetic, flexible, responsive and proactive style in delivering servicesproactive style in delivering services

8) Staff are respectful of, and 8) Staff are respectful of, and competently address developmental, competently address developmental, cultural, and personal differences cultural, and personal differences among students, families and staffamong students, families and staff

Principles (cont.)Principles (cont.)

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

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

Four Critical Themes in School Four Critical Themes in School Mental Health InterventionMental Health Intervention

Establish and maintain strong Establish and maintain strong relationships, especially with familiesrelationships, especially with families

Reduce, help to buffer stress and riskReduce, help to buffer stress and risk Enhance protective and resilience Enhance protective and resilience

factorsfactors Train in evidence-based skillsTrain in evidence-based skills

Addressable Stress/Risk Factors Addressable Stress/Risk Factors

Family LevelFamily Level• Abuse and neglectAbuse and neglect• Criminal behaviorCriminal behavior• Substance abuseSubstance abuse• Family isolationFamily isolation• OvercrowdingOvercrowding• Emotional/behavioral problems in family Emotional/behavioral problems in family

membersmembers• Morbidity and mortality in family Morbidity and mortality in family

membersmembers

Addressable Protective Factors Addressable Protective Factors

Family levelFamily level• Support and nurturanceSupport and nurturance• Rituals and routinesRituals and routines• Self-control displayed and modeled by Self-control displayed and modeled by

family membersfamily members• Healthy behaviors by family membersHealthy behaviors by family members

Top Evidence-Based PracticesTop Evidence-Based Practices

• Parent praiseParent praise• Cognitive copingCognitive coping• Parent psycho-educationParent psycho-education• ModelingModeling• Problem solvingProblem solving• Skill building/behavioral rehearsalSkill building/behavioral rehearsal• Maintenance/relapse preventionMaintenance/relapse prevention• Tangible rewardsTangible rewards

See. Bruce Chorpita, and Evidence Based See. Bruce Chorpita, and Evidence Based Services Committee (2004). Biennial report: Services Committee (2004). Biennial report: Summary of effective interventions for youth with Summary of effective interventions for youth with behavioral and emotional needs. Hawaii behavioral and emotional needs. Hawaii Department of Health, Child and Adolescent Department of Health, Child and Adolescent Mental Health Division. Mental Health Division.

The IDEA PartnershipThe IDEA Partnership

Building a Community of Practice in Building a Community of Practice in SMHSMH

CSMHA and IDEA Partnership (CSMHA and IDEA Partnership (www.ideapartnership.orgwww.ideapartnership.org) providing ) providing supportsupport

60 professional organizations and 10 60 professional organizations and 10 statesstates

10 practice groups10 practice groups Providing mutual support, opportunities for Providing mutual support, opportunities for

dialogue and collaborationdialogue and collaboration Advancing “multiscale learning systems”Advancing “multiscale learning systems”

10 Practice Groups10 Practice Groups

Mental Health-Education IntegrationMental Health-Education Integration Developing a Common LanguageDeveloping a Common Language Connecting Education and Systems Connecting Education and Systems

of Careof Care Connecting SMH and Positive Connecting SMH and Positive

Behavior SupportBehavior Support Improving SMH for Youth with Improving SMH for Youth with

DisabilitiesDisabilities

10 Practice Groups (cont.)10 Practice Groups (cont.)

SMH, Juvenile Justice and Dropout SMH, Juvenile Justice and Dropout PreventionPrevention

Family PartnershipsFamily Partnerships Youth Involvement and LeadershipYouth Involvement and Leadership Faith-Community PartnershipsFaith-Community Partnerships Quality and Evidence-Based PracticeQuality and Evidence-Based Practice

To help Ohio’s school districts, community-based agencies, and families work together to achieve improved educational and developmental outcomes for all children — especially those at emotional or behavioral risk and those with mental health problems.

Mission

CSMHA Annual Conferences on CSMHA Annual Conferences on Advancing School Mental HealthAdvancing School Mental Health

Baltimore, 1996Baltimore, 1996 New Orleans, 1997New Orleans, 1997 Virginia Beach, Virginia Beach,

19981998 Denver, 1999Denver, 1999 Atlanta, 2000Atlanta, 2000 Portland, 2001*Portland, 2001*

Philadelphia, 2002Philadelphia, 2002 Portland, 2003Portland, 2003 Dallas, 2004Dallas, 2004 Cleveland, 2005Cleveland, 2005 Baltimore, 2006Baltimore, 2006

• *the 2001 conference *the 2001 conference was cancelled related to was cancelled related to the events of the events of September 11September 11

School Health Interdisciplinary School Health Interdisciplinary Program (SHIP)Program (SHIP)

Organized by the CSMHA with Organized by the CSMHA with leadership of MSDE, MHA and most leadership of MSDE, MHA and most child serving systems in MDchild serving systems in MD

Many other state collaboratorsMany other state collaborators Intensive, interdisciplinary training Intensive, interdisciplinary training

reflecting the coordinated school reflecting the coordinated school health modelhealth model

Held every summer in Maryland Held every summer in Maryland since 2002since 2002

PBIS Leaders Embrace the PBIS Leaders Embrace the Connection to ESMHConnection to ESMH

George Sugai presented at CSMHA George Sugai presented at CSMHA conferences in Maryland in 2003 (SHIP) conferences in Maryland in 2003 (SHIP) and in Dallas (as keynote) in 2004and in Dallas (as keynote) in 2004

Lucille Eber is likely to be a keynote for the Lucille Eber is likely to be a keynote for the 1111thth Annual Conference on Advancing SMH Annual Conference on Advancing SMH

Drs. Sugai and Eber will be active in the Drs. Sugai and Eber will be active in the PBIS Practice Group, and with a number of PBIS Practice Group, and with a number of people from this project will meet in people from this project will meet in Chicago in February to move the group Chicago in February to move the group forwardforward

Unprecedented State and National Unprecedented State and National Resources and Initiatives in MDResources and Initiatives in MD

UM, Quality R01UM, Quality R01 UM, CSMHAUM, CSMHA JHU, Center for EBPJHU, Center for EBP JHU, Center for Viol JHU, Center for Viol

PrPr MSDE, MH-School MSDE, MH-School

Int.Int. GOC, GOC,

TransformationTransformation

MSDE, PBISMSDE, PBIS MHA, ESMHMHA, ESMH GOC, Innovations GOC, Innovations

Inst.Inst. MSDE, MHA, MSDE, MHA,

WkFrceWkFrce OtherOther …………

An Unprecedented Time to Link An Unprecedented Time to Link this Work Togetherthis Work Together

And advance PBIS and school mental And advance PBIS and school mental health in Maryland, as we show health in Maryland, as we show national leadership in building national leadership in building integrated approaches that address integrated approaches that address academic and nonacademic barriers academic and nonacademic barriers to student learningto student learning

Mental Health and PBISMental Health and PBIS

What are the most pressing mental What are the most pressing mental health concerns in your schools?health concerns in your schools?

What is currently available for red, What is currently available for red, yellow and green zone youth?yellow and green zone youth?

What is needed for red, yellow and What is needed for red, yellow and green zone youth?green zone youth?