MPER-CAMHPS School Mental Health Leadership Academy

1. MPER-CAMHPS School Mental Health Leadership Academy Session II January 15, 2008

2. Costs of Addressing Mental Health Services in Schools • Many public funding sources tend to focus on remediation (e.g., juvenile justice and foster care) rather than supporting healthy development or preventive efforts • State and Federal funding can be time-limited • SAMHSA report (2006): the majority of MH funding came from special education dollars • Medicaid billing can be problematic • Time costs are often not included in estimates of the cost of an intervention

3. The Costs of NOT Addressing Mental Health in Schools National Longitudinal Transition Study-2 (Wagner & Cameto, 2004): • 38% of youth with ED have been held back a grade at least once in their school careers • Youth with ED are less likely to be taking occupationally specific vocational education than students in the general population • Youth with ED are more likely than those with disabilities as a whole to be involved in bullying or fighting while coming to, being at, or going from school, either as victims or as perpetrators • 44% are reported by parents to have been suspended in the current school year, which is more than twice the rate of suspensions of youth with disabilities as a whole (19%) • Although on average, their reading and mathematics abilities are closer to grade level than those of youth with disabilities as a whole, they are more likely to receive poor grades.

4. The Costs of NOT Addressing Mental Health in Schools National Adolescent and Child Treatment Study (NACTS; Greenbaum et al., 1998): • 66.5% of the children with ED in the study were reported to be involved in crimes in which they were the perpetrator • 43.3% of children in the study were arrested at least once • 49.3% made a court appearance before a judge, and 34.4% were adjudicated for a crime. Other studies demonstrate that, in general, youth with ED have more difficulty adjusting to the social demands of adult life than their typically developing or mildly-disabled peers, are more likely to be unemployed, and more likely to develop substance abuse problems (e.g., Frank, Sitlington, & Carson, 1995; Kauffman, 2001).

5. The Costs of NOT Addressing Mental Health in Schools • APPROXIMATELY 50% OF STUDENTS WITH ED DROP OUT OF SCHOOL! • Health-related losses for the estimated 600,000 high school dropouts in 2004 totaled at least $58 billion, or nearly $100,000 per student. High school dropouts have a life expectancy that is 9.2 years shorter than that of graduates. • Increasing the high school completion rate by 1% for men ages 20 to 60 could save the U.S. up to $1.4 billion a year in reduced costs from crime. A one-year increase in average years of schooling for dropouts correlates with reductions of almost 30 % in murder and assault, 20% in car theft, 13% in arson, and 6% in burglary and larceny.

7. Expanded System of Positive Behavior Supports • Universal: Programs that focus on reducing risk factors and increasing protective factors (e.g., coping skills) • Selected: Programs that target students who exhibit social and emotional concerns or early stages of mental illness, but who function well in many social and academic activities • Targeted: Programs that target students with mental illness or multiple mental health concerns that make functioning at school extremely difficult

8. Universal Example The Good Behavior Game • Teacher sets expectations for behavior • Students work in teams during game time • Teams receive a check if displaying inappropriate behavior • If at “end” of game the team has not received the maximum checks, members receive a reward • Teacher eventually begins the game with no warning

9. Selected Example First Step to Success • Universal screening and early detection of antisocial behavior (kindergarten) • School and home interventions • Trained consultant works with teacher and parents (weekly home visits) • Minimum 2 months for student to complete • Frequent monitoring and rewards initially, then faded over time

10. Targeted Example Early Risers • For high risk children—children who have exhibited aggressive and disruptive behavior (conduct disorder) • Teaches self-regulation, positive peer affiliation, positive attitude toward learning, problem-solving, assertive communication, constructive coping • Parent component • Training = 3-4 days at a cost of $7000 • Use of trained family advocate • Intensive summer program

11. Table Talk: Pros & Cons • What are the pros and cons of using a curriculum-based prevention program? • What are the pros and cons of having outside providers bring prevention programs into your school? • What are the pros and cons of spending valuable resources (money and time) on early childhood prevention efforts?