Overview and Fundamentals of School Mental Health

Icebreaker

Acknowledgements School Mental Health

Capacity Building Partnership

Centers for Disease Control and Prevention, Division of Adolescent and School Health (DASH)

Staff: Laura Hurwitz

Consultant: Sharon Stephan

National Steering Committee:

– Joanne Cashman– TJ Cosgrove– Paul Flaspohler– C. Veree’ Jenkins– James Koller– Carl E. Paternite– Morton Sherman– Mark Weist– Karen Weston

Objectives

Define school mental health (SMH)

Describe benefits of SMH

Describe connection of SMH to academic outcomes

Define essential dimensions of quality SMH at the school building level

Setting the Stage• Federal Policy

– Healthcare parity – Health care reform– Education initiatives

• Federal agencies– Substance Abuse and Mental Health

Administration (SAMHSA)– Department of Education– Department of Health and Human Services

Maternal and Child Health Bureau (MCHB)

Centers for Disease Control and Prevention (CDC)

• Interagency work • State Initiatives

Student Support Services

Social and Emotional Learning

Mental Health Services Act

Student Mental Health Initiative

Safe Schools, Healthy Students

Peer-to-Peer SupportSchool climate

School connectedness

Coordinated school health program

Suicide Prevention

Strengths based

Risk and protective factors

Family support services

Cultural competence

MulticulturalismShared Agenda

School based

School linked

Special Education

NCLB

IDEA

Crisis management

Evidence based practice

Multi system approach

Response to InterventionPBIS

Systems of Care

School linked

Wrap around

Student Assistance Team

School Mental Health

Definition of school mental health

Principles of School Mental HealthUtilizes the school setting

as locus of school and community activity

Builds on existing school programs, services and strategies

Develops and implements programs and services that are driven/guided by families and youth

Addresses developmental, cultural, and personal differences among students, families, and staff

Involves partnerships between schools and their community

Reaches all students; general and special education

Provides services to youth and families regardless of their ability to pay

Addresses needs and strengthens assets for students, families, schools, and communities

- Center for School Mental Health

Public Health Triangle

Levels and Types of Intervention

Intervention/Indicated

Prevention/Selected

Promotion/Universal

What does school mental health look like?

Systems of Prevention and Promotion All Students (universal)

Systems of Early InterventionStudents At-Risk (selected)

Systems of Treatment

Students with Problems (indicated)

School, Family, and Community Partnerships

From work of Joe Zins

Coordinated School Health Program: Mental Health Component

Making the Case for School Mental Health

• What we know intuitively

• Demonstrated need

• Benefits of a school setting

• Consistency with mission of schools

• Connection to academic outcomes

• Social and economic costs

We know that…

Healthy students make better learners

You cannot teach a child who is not able to focus on schoolwork

A child who succeeds in school is more likely to enjoy lifelong health and mental health

The need

Around 20% of youth present with an emotional/ behavioral disorder

Around 10% present experience significant impairment

Less than 50% receive adequate or any services

Over 75% of youth who receive services, receive them in schools

School setting

Schools are the most universal and natural setting

– Over 52 million US youth in 114,000 schools

– Over 6 million adults work in these schools

– Students and staff comprise 20 percent of the U.S. population

--New Freedom Commission, 2007

School setting

Schools are the “defacto” mental health system

Advantages of the school setting– Students don’t miss a whole day of school– Parents don’t miss work– Less threatening environment– Students are in their own social context– Services are more timely– Potential to impact the learning environment

and educational outcomes

Schools remove barriers to care

Bureaucracy

Waiting Lists

Transportation

Cost

Stigma

Mission of school mental health

Consistent with the mission of schools, SMH strives to:– Create a safe, caring, and enriching environment

– Encourage family driven policies and practices– Support high-quality academic instruction– Serve culturally diverse populations– Foster positive and healthy youth development– Coordinate delivery of effective services for youth– Prepare students for lifelong success

Health & MentalHealth Factors Academic

Outcomes

EducationalBehaviors

Physical Health/illness

Mental Health

Mental Health Problems

High-risk Behaviors

(e.g. Substance use )

Developmental issues

Social Competence/Self-

esteem

Family Strengths/ Issues

Attendance Behavioral Competencies Behavioral Problems Educational Motivation Positive Attitudes Toward Schoolwork School Connectedness

Graduation/Drop-out Grades Standardized Test Scores Teacher Retention

ADAPTED FROM: Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.

Mental health and academic outcomes

SMH

Mental Health and Academic Outcomes

By enhancing factors that increase a student’s ability to succeed in school, AND

By reducing factors that interfere with a student’s ability to succeed in school…

SMH strategies have been shown to improve academic outcomes such as:

– academic achievement– discipline referrals– graduation rates– attendance– teacher retention– school climate

SMH reduces long-term costs

Reduces costs of untreated mental health problems

Reduces economic/social burden of multiple systems when mental health problems are not addressed early

Reduces cost of school dropout

A. Disparities in healthcare can allow treatable disorders to negatively impact

schooling

B. Childhood conditions can directly affect learning and behavior

C. Poor academic performance can increase adolescent risk behavior

Three Pathways from Poor Health to High School Dropout

From: Breslau (2010) http://cdrp.ucsb.edu/dropouts/pubs_reports.htm

Cost of drop-out in the US

A student who drops out earns about $260K less over a lifetime and pays about $60K less in taxes than a high school (HS) graduate

$192 billion in combined income and tax revenue for each cohort of students who never completes HS

Increasing the HS completion rate by 1 percent for males ages 20-60 would save up to $1.4 billion per year in reduced costs from crime

HS dropouts have a life expectancy that is 9.2 years shorter than for HS graduates

(California Dropout Research Project)

What does quality SMH look like?

Emphasize access

Tailor to local needs and strengths

Emphasize quality and empirical support

Active involvement of diverse stakeholders

Full continuum from promotion to treatment

Committed and energetic staff

Developmental and cultural competence

Coordinated in the school and connected in the community

(Center for School Mental Health)

Eight Dimensions of Quality

1. Operations

2. Stakeholder involvement

3. Staff and training

4. Identification, referral, and assessment

5. Service delivery

6. School coordination and collaboration

7. Community coordination and collaboration

8. Quality assessment and improvement

Mental Health Planning and Evaluation Template (MHPET)

www.nasbhc.org/mhpet

Developed in partnership with the Center for School Mental Health

Used in planning and evaluating activities and services for new or established SMH programs

Eight dimensions, 34 indicator measures

Web-based, completed by teams, computer- generated scores

ACTIVITY:

What are your hopes and dreams for all students and for all schools

in your state or district?

SBHC resources www.nasbhc.org

General SMH Resources

Center of School Mental Health http://csmh.umaryland.edu

School Mental Health Connection www.schoolmentalhealth.org

Center for Health & Health Care in Schools www.healthinschools.org

UCLA Center for Mental Health in Schools www.smhp.psych.ucla.edu

Questions?

Add presenter’s contact info.