orlando 2007 publish - university of south...

Krista Kutash, Ph.D. and Al Duchnowski, Ph.D.Enhancing School-based Mental Health Through Systems Integration

What Works In School? Sustaining A National Community of Practice on Collaborative School Behavioral Health ConferenceOrlando Florida • October 25, 2007

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Enhancing School-based Mental Health Through Systems Integration

Krista Kutash, Ph.D.Albert J. Duchnowski, Ph.D. Deputy Directors, Research and Training Center for Children’s Mental HealthLouis de la Parte Florida Mental Health InstituteUniversity of South Florida

What Works In School? Sustaining A National Community of Practice on Collaborative School Behavioral Health ConferenceOctober 25, 2007 Orlando Florida

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Presentation Goals

Role of Families

Strategies or Tools for Change

Building Sustainable Systems



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What is a “System of Care?”

A system of care is a comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families.

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System of Care

CHILDAND

FAMILY

IISOCIAL

SERVICES

IIIEDUCATIONAL

SERVICES

IVHEALTH

SERVICESVSUBSTANCE

ABUSE SERVICES

VIVOCATIONAL

SERVICES

VIIRECREATIONAL

SERVICES

VIIIOPERATIONAL

SERVICES

IMENTALHEALTH

SERVICES

…to meet the multiple and

changing needs of

children…



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SOC Research UpdateAnd while service integration has shown promise at the system level with increased continuity of care, that is, retention in care and diversity of service use, There is a paucity of research in the area with only a handful of empirical investigation and limited evidence of subsequent functional changes in youth (Durbin, Goering, Steiner, & Pink, 2006).

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Implementation Factors



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Role of Education in Systems of Care

Historically, difficult to establish effective partnerships

For many reasons….

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Contrasting Perspectives

Overarching Influence

Education System

Individuals with Disabilities Education Act (IDEA)

Mental Health System

Diagnostic & Statistical Manual (DSM)



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Conceptual Framework Language

Education System

Behavior Disorders,

Challenging Behavior,

Academic Deficits


Psychopathology,

Abnormal Behavior,

Impaired functioning

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Important Theoretical Influences

Education System

Behaviorism,

Social Learning Theory


Behavior Theory,

Cognitive Theory,

Developmental Psychology,

Biological/Genetic Perspective,

Psychopharmacology



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Focus of Intervention

Education System

Behavior Management,

Skill Development,

Academic Improvement


Insight,

Awareness,

Improved Emotional Functioning

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Education / Mental Health System

Improving Social and Adaptive Functioning.

Importance of and Need to Increase Availability, Access, and Range of Services


Common Focus



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But Wait…

Some people say that Families are the barriers to good collaboration

If “those parents” would just……

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Families as

“Cause”



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Families as

“Patient”

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Families as

Credible Informants



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Families as

Equal decision making partners

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Families as

Evaluator and Research Partner



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Families as

Policy Makers

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Transformation to Family Driven Care

Family-driven means families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory, and nation. This includes:

Choosing support, services, and providers;Setting goals;Designing and implementing programs;Monitoring outcomes;Participating in funding decisions; andDetermining the effectiveness of all efforts to promote the mental health and well being of children and youth.

…families have a primary decision making role…



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Family Driven Care

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What is the Common Vision?

Three partners:

SchoolsSchools

Mental Mental HealthHealth

FamiliesFamilies



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Common Vision

In school, at home, and out of trouble

Sense of belonging and connectedness

Feeling valued in the community

Hopeful about the future

Quality of Life

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Tools for building a Common Vision

What tools do we have?



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Positive Behavior Supports

All Children and Youth

Youth with Chronic/Intense Problem Behavior (1 – 7%)

Youth At-Risk forProblem Behavior (5 – 15%)

Youth without seriousProblem Behavior (80 – 90%)

Intensive Prevention

Selective Prevention

Universal Prevention

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Response to Intervention (RtI)

Emerging approach in the diagnosis of learning and behavior problems

Uses a structured, problem solving process

Use data to make decisions



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Evidence-based practices

Interventions and practices for which there is consistent scientific evidence showing they improve client outcomes

Clinical trials; experimental modelQuasi-experimentalProgram/System evaluationsObservations of “successful”interventionsInterviews with participantsCombination of the above

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Common Vision

How do we operationalize this common vision between Schools, Mental Health and Families?



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Common Vision

Families (FAM)Mental Health (MH)Education (ED)

Common Vision

Families (FAM)Mental Health (MH)Education (ED)

IntensiveStudents in

Special Ed due to Emotional Disturbances

ED – FBA / PBS

MH – Assessment

FAMEDMH

EDFAMMH

IntensiveStudents in

Special Ed due to Emotional Disturbances

ED – FBA / PBS

MH – Assessment

FAMEDMH

EDFAMMH

Cognitive Behavior Therapy and other EBPs

Team Monitors Progress

UniversalAll Students

ED – PBS

MH - Screening

FAMED MH

UniversalAll Students

ED – PBS

MH - Screening

FAMED MH

EBP’s (PATHS)

SelectiveAt-Risk Students

ED – FBA / PBS

MH – Assessment

FAMED MH

MHED

EDMHFAM

SelectiveAt-Risk Students

ED – FBA / PBS

MH – Assessment

FAMED MH

MHED

EDMHFAM

Group Interventions

Team Monitors Progress

RtI

Implementedin organizations

that support and facilitatecollaborative, integrated

systems of services.Integrated Partnership

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From Model to Practice

Next steps…



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Alice said to the Cheshire Cat: “Would you tell me please, which way

I ought to go from here?”

“That depends a good deal on where you want to get to,” said the Cat.

“I don’t much care where,” said Alice.

“Then it doesn’t matter which way you go,” said the Cat.

…it depends a good deal on where

you want to get to…

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We need to …

Engage in building a Performance Measurement Strategy



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“The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better.”

– Weiss, 2002

…unless it is

getting and using

data…

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We must …Develop Competency in Implementation Science



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Model of Implementation Complexity

FIT

Does the innovation fit within your

organization

Complement or Compete?

FIT

Does the innovation fit within your

organization

Complement or Compete?

CLIMATE

Willing to remove

obstacles?

Are there rewards?

Leadership support?

Clarity of Goals?

CLIMATE

Willing to remove

obstacles?

Are there rewards?

Leadership support?

Clarity of Goals?

IMPLEMENTATION EFFECTIVENESS

Can you implement the innovation with

accuracy and fidelity?

IMPLEMENTATION EFFECTIVENESS

Can you implement the innovation with

accuracy and fidelity?

INNOVATION EFFECTIVENESS

Impact of innovation,

commitment, and satisfaction

INNOVATION EFFECTIVENESS

Impact of innovation,

commitment, and satisfaction

VOLITION

Is there capacity and willingness to implement?

VOLITIONVOLITION

Is there capacity and willingness to implement?

FIDELITY BELIEFS

Favorable attitudes toward practice Complexity of innovation

FIDELITY BELIEFSFIDELITY BELIEFS

Favorable attitudes toward practice Complexity of innovation

Panzano, Fixsen, Naoom (2007)

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We must …..

Consider the Public Health Model as a guiding framework for community collaboration



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The Public Health The Public Health ModelModel

1. Surveillance at the population / community level

What is the problem?

Use systematic data collection strategies to determine the

mental health service needs in your community.





2. Identify risk and protective factors

What are the causes?

Use the information collected in and on your community on a regular basis and integrate with the research literature.




3. Develop and Evaluate Interventions

What works and for whom?

Review literature on empirical based interventions and

apply/adapt to local community needs.





4. Implementation monitoring and scaling-up

Is it meeting the intended needs?

Monitor interventions for proper implementation, scale-up

interventions and measure impact.















Use the information collected in and on your community on a

regular basis and integrate with the research literature.



Use the information collected in and on your community on a

regular basis and integrate with the research literature.

















The Public Health The Public Health ModelModel































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Summary

Before we change what we DO, we need to change how we THINK.

Before we can change how we think, we have to change what we BELIEVE.



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39http://rtckids.fmhi.usf.edu/rtcpubs/study04/http://rtckids.fmhi.usf.edu/rtcpubs/study04/

http://http://cfs.fmhi.usf.edu/resources/publications/fam_driven_care.pdfcfs.fmhi.usf.edu/resources/publications/fam_driven_care.pdf

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