School Mental Health Capacity Building Partnership* Maryland Stakeholder Discussion Groups

1. Bringing Health Care to Schools for Student Success School Mental Health Capacity Building Partnership* Maryland Stakeholder Discussion Groups *A project funded through a Cooperative Agreement with the Centers for Disease Control and Prevention, Division of Adolescent and School Health (DASH)

2. Promoting School Mental Health through Capacity Building to State and Local Education Agencies (SEA’s and LEA’s)

3. Project Goals • Strengthen collaborative national efforts to improve mental health services in schools by increasing intersections between mental health, health, and schools. • Develop, organize and synthesize key documents and resources related to best practices for SEA and LEA improvement and expansion of effective SMH services. • Provide technical assistance, resources and professional development to aid SEA’s and LEA’s in implementing effective school mental health programs.

4. Goal 1: Mental Health, Health and Schools • Strengthen collaborative national efforts to improve mental health services in schools by increasing intersections between mental health, health, and schools. • Expand and strengthen the capacity of NASBHC to address the mental health needs of the school-based health care field • Conduct a national scan of initiatives/models that integrate mental health, health and schools. • Strengthen the mental health component of the Coordinated School Health Program Model.

5. Health Education Family/Community Physical Education Involvement Health Services Health Promotion for Staff Nutrition Services Healthy School Environment Coordinated School Health ProgramMental Health Strand MENTAL HEALTH: Counseling, Psychological & Social Services

6. Goal 2: Fact Finding • Organize key documents and resources related to best practices for improvement and expansion of effective SMH services. • Develop electronic toolkit of resources and tools addressing school mental health key dimensions to use in capacity building assistance • Conduct key informant interviews and site visits to four states to enhance understanding of how school mental health is operationalized at the state and local level.

7. Goal 3: Capacity Building • Using fact finding knowledge, materials and resources developed in Goals 1 & 2, provide technical assistance, resources and professional development to aid SEA’s and LEA’s in implementing effective school mental health programs.

8. Statewide Stakeholder Discussion Groups: PURPOSE • to help identify successes and lessons learned in “early adopter” states -- at both the state and local levels -- related to school mental health policies, programs and services.

9. Statewide Stakeholder Discussion Groups: Method • 4 “early adopter” states selected • Selection criteria: • Shared mental health/education/family agenda • Strong state level collaboration • Vision of how to integrate health into school mental health agenda • Four discussion groups per state • Three with state and local leaders in education, family advocacy, health and mental health • One youth only discussion group

10. SBHC’s & Early Adopter States Oregon Ohio Maryland Missouri STAKEHOLDER DISCUSSION GROUPS: Ohio: December 2006 Maryland: February 2007 Missouri: May 2007 Oregon: August 2007

11. Maryland School Mental Health Stakeholder Discussion Groups

12. Process: Adult Discussion Groups • February 22nd and 23rd, 2007 • Three 2-hour discussion groups • 26 total participants • Mental Health: 6 • Education: 9 • Health: 7 • Family members/advocates: 4

13. Results • Responses to Questions • Themes • Key Quotations • Challenges • Opportunities

14. Participant awareness of Maryland’s vision or agenda for school mental health • State blueprint for children’s mental health, with a subcommittee for school mental health. • Emphasis on prevention and early intervention. • SAMHSA grant in mid 90’s brought national attention.

15. What would make it a stronger agenda? • Shared ownership and buy-in of all stakeholders • Increased, sustainable funding and equal distribution of resources across the state; Funding options beyond a fee-for-service model • Coordinated and uniform data collection and outcome evaluation

16. What would make it a stronger agenda? (cont.) • Advocacy • Recognition of schools as a unique site for providing mental health services • Increased coordination between existing services, including coordination and partnering with non-profit organizations and universities. • State policy reflecting investment in school mental health

17. What would make it a stronger agenda? (cont.) • Mental health education for teachers, school staff/administration and parents • Clarity/consensus on what is meant by “school mental health” • Social marketing and mental health promotion

18. Major Themes • There is a general goal of advancing school mental health in Maryland, but the “vision” is not consistent across people or jurisdictions, does not extend to all parts of the state, and lacks clear ownership. • Specific grants and initiatives (e.g. Maryland School Mental Health Alliance, the Maryland School-Based Health Care Assembly, the Center for School Mental Health) have helped to advance the vision of school mental health in Maryland.

19. Major Themes (cont.) • Partnering with community organizations, including universities and non-profit organizations, has been helpful in advancing school mental health in Maryland. • The Maryland Assembly on School-Based Health Care has advanced Maryland’s school mental health efforts in many ways, including advocacy and outcome monitoring, and provides a good example of collaborative health-mental health care.

20. Major Themes (cont.) • Increased, sustainable funding (beyond fee-for-service models) and equal distribution of resources across the state are essential for the advancement of school mental health in Maryland.

21. Challenges • Despite Maryland’s “pockets of excellence” in SMH there is inequity across the state with respect to opportunities to advance SMH. • Inequities may reflect disparate allocation of resources, limited opportunities for information sharing and dissemination, and fragmentation of efforts across districts and regions.

22. Challenges (cont.) • Lack of shared ownership by key stakeholders--including mental health, education and families--of a statewide vision for school mental health. • Lack of organizational infrastructure or responsibility by any one state agency for school mental health programs. • Lack of feasible, sustainable funding models to support comprehensive SMH services. Fee-for-service delivery models and lack of funding to support quality assessment and improvement limit advances in quality.

23. Challenges (cont.) • Demands on schools to achieve academic results hinder efforts to advance SMH, especially when the connection between academic success and mental health is not made explicit. • Lack of definitional clarity and consensus around what is meant by “school mental health”. • Lack of quality, interdisciplinary pre-service training for mental health providers and educators.

24. Challenges (cont.) • Limited meaningful youth involvement in the planning, implementation and evaluation of school mental health activities. • Lack of coordinated and uniform data collection that incorporates both psychosocial and academic barriers • Limited staff professional development time which is important in defining and clarifying roles of school personnel

25. Opportunities • Connect and mobilize Maryland’s initiatives around school mental health to create momentum and develop a unified, statewide vision for SMH. • This statewide vision should inform state policy around children’s mental health, including SMH as an integral, mandated component.

26. Opportunities (cont.) • Expand upon Maryland’s strong school-based health center foundation to develop increased support for health-mental health partnerships in schools. • Build and expand upon models of family partnerships, such as those led by the Maryland Coalition of Families for Children’s Mental Health • Utilize Maryland existing models of university and non-profit partnerships to enhance school mental health linkages and efforts statewide.

27. Opportunities (cont.) • Utilize Maryland’s existing dissemination networks, including the CSMHA, the MSMHA, MASBHC and MSDE, to distribute existing resources statewide and to establish learning communities across SMH stakeholder groups. • Maryland’s strong base of universal prevention and early intervention programming in schools can serve as a foundation for statewide implementation of secondary and targeted intervention.

28. Opportunities (cont.) • Work towards shared ownership of and participation in the school mental health agenda by all stakeholders (including families, educators, health and mental health).

29. Maryland Youth Discussion Groups

30. Youth Discussion Group PURPOSE: • to identify, from a youth perspective, the most effective strategies for providing mental health services in schools and for engaging youth in the development of school mental health policies and programs.

31. Youth Discussion Group: Method • March 27, 2007 • One 1.5-hour discussion group • Nine participants • Ages 14-17 from Prince Georges and Anne Arundel Counties • All were members of “Kiamsha” youth empowerment group for African American Youth • 8 attended public school, 1 attended private school

32. Youth Discussion Groups: Process SAMPLE QUESTIONS: • How can adults at your school make all students feel supported both in school as well as other areas of their life? • What can schools do to better understand the different cultures or backgrounds a student comes from? • How well do you think that adults in your school respond to students with mental health problems?

33. Youth Discussion Groups: Findings • Adults should listen to students and value their opinions in order for them to feel supported in school and areas of their life. • Teachers who come from the same culture and/or background as their students may better understand them. • Teachers tend to ignore students’ mental health problems, unless they are especially serious. • Teachers should ask students questions about their mental health problems by pulling them aside to better understand them.

34. Youth Discussion Groups: Findings (cont.) • Students are most trusting of adults who are open with them and who do not talk to the student’s parent or another teacher about “their business.” • Students aren’t consistently aware of where they can go to get help; however they are aware of some conditions that would require help (e.g. self-harm) • One barrier to getting help may be fear that their information will be shared with others. • Students would have an easier time asking for help if they knew that their teachers were trained about certain issues.

35. Youth Discussion Groups: Findings (cont.) • Schools should have a confidentiality contract signed by the counselor and student. • Programs outside of the classroom make you feel better about yourself, give you access to scholarships, provide opportunities for positive relationships and help reduce stress. • Students would be more likely to participate in an activity with adults (e.g. committees) if there are incentives such as: field trips, money, food, community service hours. • Students can provide a perspective on school mental health that adults cannot since they have direct experience in schools and are familiar with how things are currently.

36. Youth Discussion Groups: Final Question “If you could tell the principal or superintendent one thing that they could do (to help students) what would it be?” • Create a safe environment where students do not feel alone and they know that are supported by teachers. • Increase awareness about mental health problems. • Have more direct involvement with the students and schools. • Support the teachers. • Offer more programs for students. • Listen to students’ problems. • Try new things.

37. Discussion Groups: Next Steps • Provide summaries to states to use in their own advocacy and capacity building efforts. • Develop cross-state case study highlighting themes of all four states (Fall 2007) • Incorporate findings from case study into school mental health capacity building process for SEA’s and LEA’s (Spring 2008)

38. Bringing Health Care to Schools for Student Success Laura Hurwitz School Mental Health Project Director LHurwitz@nasbhc.org 202-638-5872, x205 1-888-286-8727 - toll free