prevention science in children’s school mental health
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Prevention Science in Children’s School Mental Health. Beth Doll University of Nebraska Lincoln. What are preventive school mental health services?. Services that have been carefully designed to meet the mental health needs of ALL students enrolled in a school - PowerPoint PPT PresentationTRANSCRIPT
Prevention Science in Children’s School Mental Health
Beth DollUniversity of Nebraska Lincoln
What are preventive school mental health services?
Services that have been carefully designed to meet the mental health needs of ALL students enrolled in a school
(Doll and Cummings, 2008; Chapter 1)
Referral vs. preventive
Referral
Assessment
Planning + Services
Assessment
Planning + Services
Prevalence of mental disorders in the United States
Disorder Children AdolescentsAll Mental Disorders 200 200Anxiety Disorders 150 150ADHD 74 54Conduct Disorders 40 140Depression 15 70OCD 2-4 4Autism, schizophrenia 3-4 3-4
National Comorbidity Survey Replication (Adults)
12-month Lifetime
Any disorder26.2% 46.4%
Anxiety Disorders18.1% 28.8%
Mood Disorders9.5% 20.8%
Impulse Control Disorders8.9% 24.8%
Substance Use Disorders3.8% 14.6%
What we have learned from prevalence…
Age-of-onset for most mental disorders are concentrated during the first two decades of life
20% of students in the typical school classroom meet the criteria for one or more mental disorder
5% of students are typically receiving mental health services through community or private mental health centers
1% of hundred students are identified with emotional or behavioral disabilities
The US must direct a greater part of our thinking about public mental health interventions to the child and adolescent years
Schools are the primary providers of mental health services to children and adolescents
Risk = Students are more likely to be unsuccessful adults
Risk Poverty Low parent education Marital/family dysfunction Poor parenting student maltreatment Poor health Parental illness Large family
Adult outcomes Mental illness Physical illness Educational disability Delinquency Teen parenthood Financial dependence Unemployment Low social competence
Doll & Lyon, 1998
Resilience = Vulnerable students who become successful adults
Individual Positive social orientation Friendships Internal locus of control Positive self-concept Achievement orientation Community engagement
Family & community Close bond with one caretaker Effective parenting Nurturing by other adults Positive adult models Connections with pro-social
organizations Effective schools
Broad principles
One in five school-age students in the USA has a diagnosable mental disorder
Only ¼ of these students receive community mental health services
The strongest predictors of students' mental health are characteristics of communities and families
Schools are an important protective factor for many students And they are the primary provider of mental health services
for many students Students' school success is directly related to their
psychological wellness and mental disorders
And a roadmap to preventive school mental health
Promote students’ friendships Foster their self-determination and internal locus of control Strengthen their personal efficacy Build students self-discipline Provide frequent and authentic opportunities for adult nurturing Engage students with prosocial organizations in the community Provide students with opportunities to pass it forward
Goals of preventive school mental health services
1. Promote the psychological well-being of all students so that they can achieve developmental competence
2. Promote caretaking environments that nurture students and allow them to overcome minor risks and challenges
3. Provide protective support to vulnerable students; and
4. Remediate social, emotional or behavioral disturbances so that students can develop competence.
Intentional cycle of planning
Carefully collect information about the mental health status of students
Construct a plan describing the mental health services that are needed, who provides them, and who receives them Competing needs are reconciled based on the urgency of
needs and the anticipated outcomes of services Incorporate school-wide, class-wide, small group, and
individual services Incorporate prevention, early intervention, and remedial
services Implement the plan Monitor the impact of services and the changing face of the
schools’ mental health needs Refine the plan as needed
Making Classrooms Mentally Healthy
STEP ONEUse the ClassMaps
Survey as a practical and reliable measure of the complex classroom
environment
Assess Class
Needs
Make Sense of the Data
Plan & Implement
Class Changes
Evaluate & Refine
Temporary playground - pre
Making Classrooms Mentally Healthy
STEP TWOInformation from the CMS is then used in a
problem-solving process that identifies classroom strengths
and weaknesses
Assess Class
Needs
Make Sense of the Data
Plan & Implement
Class Changes
Evaluate & Refine
Making Classrooms Mentally Healthy
STEP THREEThe data-based problem solving
process identifies intervention strategies to reinstate essential
contextual supports in classrooms
Assess Class
Needs
Make Sense of the Data
Plan & Implement
Class Changes
Evaluate & Refine
Making Classrooms Mentally Healthy
STEP FOURVerify the effectiveness of those supports once they are implemented
Assess Class
Needs
Make Sense of the Data
Plan & Implement
Class Changes
Evaluate & Refine
Temporary playground - post
Continuum of school mental health interventions
Infrastructure building activities to anchor preventive services in the community
Universal mental health services
Selected mental health services
Remedial Services
Adapted from Doll & Cummings, 2008; Chapter 1; and from Doll (In press) chapter in the Encyclopedia of Public Health, London: Elsevier
Assessing the collective mental health of students
Systematic analysis of existing school records attendance or discipline records
Epidemiological procedures including multi-tier assessment models in which broad screening is followed by comprehensive mental health assessments (Short & Strein, 2008; Chapter 2) Sampling Technically sound measures
Traditional mental health assessments administered and aggregated across the school’s enrollment (Baker, 2008; Chapter 3)
Assessment of demographic and functional risk and protective factors
Finding effective preventive assessment measures
Center for Academic, Social, and Emotional Learning (http://www.casel.org/assessment/tools.php): an annotated bibliography of measures to monitor children’s social and emotional well-being; CASEL-developed tools
The Annenberg Institute for School Reform (http://www.annenberginstitute.org/tools/index.php): a bibliography describing measures of children’s developmental health that can be used school-wide or district-wide
The World Health Organization (http://www.who.int/school_youth_health/assessment) describes the Global school-based student health survey that measures behavioral risk factors of adolescents.
Adapted from Cummings & Doll, Chapter 12; and Doll (In press) chapter in the Encyclopedia of Public Health, London: Elsevier
Creating a preventive plan for school mental health services
To match the mental health needs against services provided in the school and community – Resource mapping (Adelman & Taylor, Chapter 11) UCLA Center for Mental Health in the Schools (
Http://smhp.psych.ucla.edu): A packet including instructions and tools for mapping community resources onto school mental health needs
Collaborative for Academic, Social and Emotional Learning (www.casel.org): a practice rubric for implementing and sustaining social emotional learning interventions in schools.
The World Health Organization ( http://www.who.int/school_youth_health/assessment): Rapid Assessment and Response Guide for strategies to improve health-promotion in schools.
Options for interventions
Partnering with families to enhance students’ mental health (Christenson, Whitehouse, & VanGetson, 2008; Chapter 4)
School-wide approaches to behavior problems (Bear, 2008; Chapter 5) Response to intervention: A school-wide approach for promoting academic
wellness for all students (Martinez & Nellis, 2008; Chapter 6) Social and emotional learning: A school-wide approach to intervention for
socialization, friendship problems, and more (Merrell, Gueldner, & Tran, 2008; Chapter 7)
School-wide approaches to intervention for school aggression and bullying (Swearer, Espelage, Love, & Kingsbury, 2008; Chapter 8)
School-wide approaches to prevention of and intervention for depression and suicidal behaviors (Mazza & Reynolds, 2008; Chapter 9)
Evaluation of prevention services
1. Were the services effective in reducing the frequency or severity of children’s psychiatric disorders?
2. Were the services effective in increasing children’s psychological wellness and developmental competence?
3. What were the unintended positive or negative consequences of the services?
4. What factors increased or decreased the services effectiveness?
5. Were the preventive mental health services implemented with fidelity?
6. Were the preventive mental health services acceptable to children? To families? To mental health service providers?
7. How can the evaluation data be used for refining and enhancing the community’s mental health services for children?
Evaluation resources
Center for Academic, Social, and Emotional Learning provides an Implementation Toolkit (available at no cost from www.casel.org) that includes publicly available measures and suggestions for evaluation practices
the Evaluation Center at Western Michigan University (http://www.wmich.edu/evalctr/checklists/index.html) includes annotated bibliographies describing major evaluation models, measures, and tools for self-checking an evaluation plan.
UCLA Center for Mental Health in the Schools (http://smhp.psych.ucla.edu) provides a technical aid packet on evaluation and accountability
Adapted from Cummings & Doll, 2008; Chapter 12 and from Doll (In press) chapter in the Encyclopedia of Public Health, London: Elsevier
Ten essential preventive mental health services
1. Monitor students’ mental health status including their academic, social-emotional and relational competence
2. Diagnose and investigate psychological disturbance in students
3. Inform, educate and empower students and their families about mental health issues
4. Mobilize school-family-community partnerships to identify and solve psychological disturbances
5. Develop policies and plans that support student, family, school and community mental health efforts
Ten essential preventive mental health services
6. Implement policies and practices that protect students mental health and ensure developmental competence
7. Link students and their families to universal, selected and intensive interventions as needed
8. Provide appropriate staff training and monitor throughout intervention
9. Evaluate effectiveness, accessibility, and quality of school mental health services
10. Research new insights and innovative approaches to promoting mental health
Cummings & Doll, 2008; Chapter 12
Mental health is essential to schooling
School mental health’s goal of promoting psychological wellness is not ancillary to students’ academic success, but is integral to it
Possibilities of preventive services
Reconcile school mental health services with students’ mental health needs
Strengthen the planfulness of mental health services Leverage existing resources so that more students receive
mental health services earlier and with more impact Integrate and coordinate school and community mental health
services around common goals Highly compatible with the mission of public schools
To provide students with the knowledge and skills necessary for productive and successful lives
A mission that is shared with other important societal entities such as families, churches, the legal system, and social services
Limitations of preventive services
Principally implemented in a small scale in practice Only possible within institutions that are already population-
focused (e.g., schools, military bases, public health services) Demand for services is much greater than anticipated Payoff of preventive services may be several budget-cycles
removed from their initial implementation Incompatible with many funding mechanisms
Doll, B., & Cummings, J. (2008). Transforming School Mental Health Services: preventive approaches to promoting the competency and wellness of children. Thousand Oaks, CA: Corwin Press / NASP.
