Creating a P..A..T..H .. for expanded school mental health in west virginia

1. Creating aP..A..T..H ..for expanded school mental health in west virginia WVDE School Counselor Workshops October 2, 9, and 14 2008

2. Objectives: • Increase awareness of current state level efforts to define and implement a model for expanded school mental health services in WV. • Increase knowledge of the PATH process. • Increase understanding of the concept and components of an expanded school mental health (ESMH) model from a national perspective.

3. Context: the big squeeze!

4. background • Studies estimate that 20% - 38% of youth need active mental health intervention. • Between 9-13% of youth ages 9-17 meet the federal definition of serious emotional disturbance (SED). (Goodman, 1997; Marsh, 2004) • 9% (2.2 million) of adolescents 12 – 17 years experienced at least one major depressive episode in the past year.(SAMHSA,2006) • Half of all mental illness begins by age 14, three-fourths by age 24.

5. However: • As few as one sixth to one third of youth with diagnosable disorders receive any treatment. (Burns, et al 1995; Leaf et al, 1996) •  Of those who do receive treatment, less than half receive adequate treatment. • And even fewer of the youth “at risk” receive any help whatsoever. (Weisz, 2004)

6. Furthermore: • Children with chronic physical problems are much more likely to have emotional and behavioral health needs. • The WV BBHF estimates the prevalence of serious emotional disturbance (SED) among youth at 13% and in any given year: -only 28% of youth with serious emotional problems are receiving any care at all. -This does not include youth with short term, acute problems or those at risk

7. WV milestones • 1994 – School-based health center Initiative – WV Bureau for Public Health • 1999 - System of Care – SAMHSA grant – WV Bureau Behavioral Health • 2000 – School-based mental health funding through block grant • 2006 - West Virginia Behavioral Health Commission

8. milestones 2007 • WV Bureau for Behavioral Health and WV Dept. Of Education meet • MOU signed by commissioners • Planning process begins • Steering team organized • Strategic planning process begins

9. School mental health programs • SOC – SAMHSA Grant • SBMH • WVCBHC • MOU SBMH PATH (strategic planning process) • ESMH Steering Team

10. Public Policy Context: ESMH and the No Child Left Behind Mandate - Two Important Interrelated Goals — Achievement and Wellbeing Schools often acknowledge 1 but historically have failed to acknowledge 2

11. Traditional school m H: • Typically limited to assessment and consultation • Minimal treatment only for those youth in special education or those with 504 accommodations • Some students may receive brief counseling • Referrals to community settings usually do not occur or fail (Catron, Harris,&Weiss, 1998)

12. Expanded School Mental Health Programs and Services • Is the model by President’s New Freedom Commission on Mental Health • Emphasizing shared responsibility of schools and community • Is a partnership between schools and community health/mental health organizations. (Weist, 1997; Weist, Paternite, & Adelsheim, 2005)

13. ESMH Programs: • Build on existing school programs/services • Programs/services are for all students • Include full array of programs/services from prevention through intensive intervention

14. Advantages: • Reduces stigma for help-seeking(Nabors & Reynolds, 2000); • Promotes generalization/maintenance of intervention gains • Enhances capacity for prevention/MH promotion • Fosters clinical efficiency and productivity(Flaherty & Weist , 1999) • Promotes a natural, ecologically grounded approach to helping youth and families

15. ESMH Impacts Several studies document evidence of strong positive associations between school mental health services, access to care, and academic success. • Strong satisfaction by diverse stakeholder groups (Nabors, Reynolds & Weist, 2000) • Improvement in school outcomes (e.g., climate, special education referrals, reduced bullying, fewer suspensions) (Nabors, Reynolds & Weist, 2000)

16. Impacts, cont’d: • Increased student attendance and reduced drop out rates (Drake, 1995; Schargel & Smink, 2001; ) • Enhanced motivation and sense of competence (Christenson, Rounds & Gorney, 1992; Grolnick & Slowiaczek, 1994) • Increased access (Dial, et al, 2002; Weist, Myers, Hastings, Ghuman, and Han, 1999)

17. Impacts, cont’d: • Increases student connectedness to school which is associated with improvement in many areas including academic performance, decreased incidence of fighting, bullying, vandalism, absenteeism, substance use, early sexual engagement, disruptive behaviors, and graduation rates and school attendance (Blum & Libbey, 2004; CD(Blum & Libbey, 2004; CDC’s Wingspread study, Declaration on School Connections, 2004)

18. SAT Evidence Based ESMH Assets Building School Climate Putting the pieces together Community of Practice Multi System NCLB Integrated Service Delivery RTI Health Family support to achieve a comprehensive system of learning supports and expanded mental health Safe Schools Cultural competence Mental Health Services Social & Emotional Learning Multiculturalism Coordinated school health Psy.. Services Spec. Ed. IDEA School Based Wrap Around Students Tiered interventions Student Supports Faculty Shared Agenda PBIS Systems of Care

19. Steering team • Parent Network Rep • WVDE – EBD, Healthy Schools, Counselors • WVBBH – Children’s Division, Substance Abuse • African -American churches • Director, Community Mental Health Agency • School Superintendent • Marshall TA • Will add others

20. WV SBMH 12/07-12/12 PATH

21. WV’s Desired Outcomes:

22. Strengths • collaborative committed state stakeholders • timing couldn’t be better (PCG & Behavior Health Com. rec.) • resources dedicated to awareness • PBS Network relationships & connections • WV System of Care • Children’s Outreach Liaison within comprehensives • background readiness training • Developing a Service Array Process in DHHR • nearly 50 SBHC with 2/3 have mental health • DHHR (top-down) vs. DOE (local control) • We haven’t selected a model or structure • Unclear about state level role vs. local control (Educ.) • lack of consistent programming • children are not historically a focus of comprehensives • BCF federal review in 2004-05 cited deficiencies Problems

23. Opportunities • Cultural attitudes about mental health • Unclear focus for state agencies • Not taking action • Willingness of school counselors and mental health counselors to partner (territorial issues) • Changes in education and DHHR institutional cultures • Competing priorities of schools service array process time is right to take action new school in Marion Co. w/ Valley beginning a new school year for pilot project developing a statewide System of Care children’s outreach liaisons Threats

24. Steering Committee formed and functioning • Steering Committee drives the 5 year plan for ESMH • Model designed • Outcomes established “start with the end in mind” • Strategies for 5 year plan implementation • Gap analysis completed Targeted for completion by 12/08

25. Study group conducted visits and phone calls • Illinois PBIS Network • Center for School Based Mental Health Programs – Miami University, Ohio • Center for School Mental Health - U of Maryland - Baltimore • University of Southern Florida Research and Training Center for Children’s Mental Health

26. Baseline Survey of Schools • To learn more about what currently exists in WV’s schools • What agencies are in the schools and where • What EBPs are being implemented • What are the greatest needs re MH • What are their top 5 MH/BH problems

27. Survey Method • Survey designed by ESMH Committee; used similar surveys from other states (Mass., MD) • On line: surveymonkey.com • Letter from State Superintendent to all schools • Data compiled and analyzed by Marshall University TA

28. Results • 364 schools out of 701 in the state • Schools in 51 counties responded • Representative in terms of regions, demographics, and school level

34. If you could do one thing to improve access to mental health services…

35. WV’s Proposed Expanded School Mental Health (ESMH) • Is a framework • Builds on the core services • Recognizes emotional /academic learning link • Is a shared responsibility • Provides the full continuum of care • Complements, supports and is linked with school counselors, PBS, SOC, SBHCs and SAT • Incorporates a public health approach

36. Population based – organized, interdisciplinary, scientific data drives decisions Promotion of mental health and prevention of challenges or illness. Interventions to improve and enhance the quality of life. Engages the whole community to assure the optimal physical and mental health of children and families. Promotes social and emotional well-being and the optimal mental health for all Creates supportive and nurturing environments Develops skills and knowledge Promotes mental health and prevents and intervenes early in the pathways to mental illness Comprehensive, evidence based, integrated, Seeks to eliminate disparities Cross systems and multi-disciplinary Public Health Themes for Mental Health “Caring for Every Child’s Mental Health”, All children, youth and their families live, learn, work and participate fully in communities where they experience joy, health, love and hope.

37. Health & Mental Health care system Community Assuring the Conditions for Population Health-Including Mental Health Governmental Public Health Infrastructure Employers and Business Academia The Media Everyone has a Role in promoting the Mental Health of Children and Youth Families, Primary Caregivers Individuals

38. What is a Public Health Approach? Essential Public Health Services The Mission of Public Health is to “fulfill society’s interest in assuring conditions in which people can be healthy.” (IOM) 1988

39. Families EMS Juvenile Justice MCOs Health Department Philanthropist Faith-Communities Community Centers Social Supports Recreation Parks Doctors/Psyciatrists Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups Early Childhood Fire-Police Tribal Health Employers Promotion and Prevention Economic Development Drug Treatment Mental Health The Public Health System for Mental Health is Complex Adapted From George R. Flores, MD, MPH Committee on Assuring the Health of the Public in the 21st Century

40. The public health approach

41. Created by Ohio Dept of Ed

42. WV’s Values and Principles for Planning and Implementing ESMH • MH crucial to school success • MH shared responsibility • ESMH focuses on reducing barriers to learning • All students access • All stakeholders are involved in development/oversight/ evaluation

43. WV’s Values and Principles for Planning and Implementing ESMH • Uses evidence-based & strengths-based practices • Develops school connectedness • Is sensitive to developmental, cultural, and personal differences • Fosters interdisciplinary collaboration and coordination

44. Long term goals • A functioning ESMH model that fits WV. • Every county with at least one ESMH program. • Trained personnel in each county to support ESMH at all levels. • A statewide reporting/performance system. • A TA center established to support and sustain ESMH. • Legislative appropriation.

45. Useful websites • Center For School Mental Health Action and Analyses, University of Maryland: http://csmha.umaryland.edu • Center for School Mental Health Programs, Miami University, Ohio http://www.units.muohio.edu/csbmhp/ • National Assembly on School Based Health Care (NASBHC) http://nasbhc.org/

46. Thank You for your attention! Questions? For additional information contact: Jackie Payne: jackiepayne@wvdhhr.org Linda Anderson: landerson@marshall.edu