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School-Community Mental Health Partnerships: A Key to Neighborhood Revitalization. Colleen Cicchetti , Ph.D. Director , Advocacy and Community-Linked Mental Health Services Program Department of Child and Adolescent Psychiatry Children’s Memorial Hospital
School-Community Mental Health Partnerships: A Key to Neighborhood Revitalization Colleen Cicchetti, Ph.D. Director, Advocacy and Community-Linked Mental Health Services Program Department of Child and Adolescent Psychiatry Children’s Memorial Hospital Assistant Professor, Northwestern Feinberg School of Medicine Co-Chair School-Age Committee, Illinois Children’s Mental Health Partnership
Today... • Introduction and Overview • Why School Mental Health • The Three-Tiered Framework • Initiatives Contributing to the Three-Tiered Framework • Why School-Community Partnerships • Steps for Creating School-Community Partnerships • Assessing School and Community Resources
7.5 Million U.S. Children with Unmet MH Need • 6% to 7.5% U.S. children received MH services in 1997 • Only 21% of children in need received services within year • Uninsured especially vulnerable • Courtesy of Tara Mehta, Ph.D.University of Illinois-Chicago
Why SMH? The need • Around 20% of youth present with an emotional/ behavioral disorder • Around 10% present with significant impairment • Only 16 to 33 % receive any services • Of those youth who receive services, 75% receive them in schools • 10% of Illinois children suffer from a mental illness severe enough to impair daily life, only 20% receive any help • 23% of Illinois and 34% of Chicago adolescents exhibit signs of depression
Mental Health is a Major Public Health Issue • impairment for those directly affected and their family members • societal/population effects: • cost to society across multiple domains • health care dollars • impact upon social structures: schools, employers, lost income, school drop out and mortality
What isn’t working for Kids, Families and Communities? • Little or no emphasis on prevention or early intervention • Only a small percentage of children who need treatment receive it • Little coordination among families, agencies and schools • Unequal access to services • Resources are not maximized • Families are not fully engaged as partners 7
Why SMH?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
Why Behavioral Health in Schools? • Research shows that preventive behavioral health improves students’ positive behavior and reduces negative behavior. • Effective Social Emotional Learning in schools significantly improves: • Social-emotional skills • Attitudes about self and others • Social interactions • Effective Social Emotional Learning in schools significantly decreases: • Emotional distress • Behavioral problems • Source: Weissberg et. al. (2009) The Impact of Enhancing Students' Social and Emotional Learning: A Meta-analysis of School-based Universal Interventions. Available at CASEL.org
We know that… • Healthy students make better learners • You cannot teach a child who is not able to focus on his/her schoolwork • A child who succeeds in school is more likely to enjoy lifelong health and mental health
Mental Health Issues and Schools • Mental Health directly impacts school functioning for individual students, classrooms and school climate • Educators have a direct role in mental health delivery-recognizing, referring, making accommodations • Need new models, partnerships and training to facilitate access to services and to overcome multiple barriers
Mental health and academic outcomes SMH Graduation/Drop-out Grades Standardized Test Scores Teacher Retention Health & Mental Health Factors Academic Outcomes 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 Educational Behaviors 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.
State of Illinois Services for Youth to promote Mental Health • 2003 White Paper • Highlights significant concerns; lack of coordination • Lack of resources in multiple areas of the state
Fragmented Policy Fragmented Practices After School Programs Special Education Clinic Violence & Crime Prevention Pupil Services Health Services SCHOOLS Juvenile Court Services Community Based Organizations Drug Prevention Social Services Child Protection Services Mental Health Services Drug Services Courtesy of Lisa Betz, Mental Health and Schools Coordinator, Illinois Department of Human Services. Adapted from: Health is Academic:A guide to Coordinated School Health Programs (1998). Edited by E. Marx & S.F. Wooley with D. Northrop. New York: Teachers College Press.Lisa B
Illinois Children’s Mental Health Partnership: Development of a Public Health Approach to School Based Mental Health
Children’s MentalHealth Act of 2003 • Establishes the Illinois Children’s Mental Health Partnership (appointments by the Governor) • Develop a Children’s Mental Health Plan. • Requires ISBE to develop social/emotional learning standards • Requires local school districts to develop policies on social/emotional development.
ICMHP Plan Prevention • Work with ISBE to ensure that school districts develop policies on social/emotional development. • Promote increased collaboration among schools, community mental health agencies, health care, juvenile justice, substance abuse, developmental disability and other agencies to promote optimal social/emotional development of children/youth • Fund prevention initiatives (consultation) • Public Awareness
ICMHP Plan Treatment • Build and strengthen a quality system of care in Illinois to ensure that children have access to services that are developmentally, culturally, linguistically and clinically appropriate
Universal/Prevention • Coordinated Systems for Promoting Healthy Social and Emotional Development in Students • Promotion of Mental Wellness • Mental Health Skill Development • ISBE Social Emotional Learning Standards • Safe & Caring Learning Environments with a “One School Culture” • Development of connections between school, home and the community • Consultation and Mental Health Awareness for Educators, Parents, and Students • Stigma Reduction • PBIS, RtI, SAP, and Systems of Care Universal Interventions • Early Intervention • Coordinated Systems for Early Detection, Identification, • and Response to Mental Health Concerns • Interventions as early after the onset of an identified concern, including assessments, referral, and follow-up • Early identification targets students who may be at risk for mental health concerns due to risk factors, trauma, or ACES and students who are not meeting the Social Emotional Learning Standards. • Student Engagement and Truancy Reduction Activities • Mental Health Consultation for Educators • Skill-building at the individual and groups level as well as, Support Groups, • Crisis Intervention and ongoing support • Student Support Services • PBIS, RtI, SAP, and Systems of Care Secondary Interventions • Treatment • Comprehensive Treatment and Family Supports • Assessment, diagnostic, and referral, services for • chronic, severe, pervasive mental health concerns • Therapy and support services • Wrap Around Services • PBIS, RtI, SAP, and Systems of Care Tertiary Interventions • Special Education Illinois’ Interconnected Systems Model for School Based Mental Health
Academic Systems Behavioral Systems An Integrated Framework Intensive Interventions Individuals or small groups (2-3) Customized interventions High intensity Intensive Interventions Individuals or small groups (2-3) Customized interventions High Intensity and longer duration Strategic Supports Some students (at-risk) Strategic Supports (small groups) Some students (at-risk) Universal Instruction All students Preventive, proactive Universal School Climate, Student Skills, Adult Skills, Classroom Management All settings, all students Preventive, proactive
Three-Tier Model for Behavioral Health • Tier I: strategies necessary for effective learning climate and school culture; impacts all students and/or adults in building • Tier II: strategies necessary for the 10-15% students whose social, emotional or behavioral problems are a barrier to their learning or the learning of their peers; short term interventions designed to build skills necessary to effectively participate in learning environment • Tier III: strategies necessary for the 1-5% of students with intensive, ongoing needs who may be involved in multiple service systems; may be ongoing interventions to build skills necessary to effectively participate in learning environment
Overview: Initiatives Contributing to the Framework • Illinois Children’s Mental Health Partnership (ICMHP) • Social and Emotional Learning (SEL) • Positive Behavioral Intervention and Supports (PBIS) • RtI (Response to Intervention) • Chicago Public Schools-Positive Behavioral Supports (PBSS-2011)
Social and Emotional Learning: Universal Foundation for School Success
Mental Health Through Social and Emotional Learning (SEL) Social and Emotional Learning (SEL) is the process of acquiring skills to recognize and manage emotions, develop caring and concern for others, establish positive relationships, make responsible decisions, and handle challenging decisions effectively. - CASEL (2005), Safe and Sound, IL Edition
Benefits of Social and Emotional Learning • Good Science Links SEL to the Following Student Gains: • increase in social-emotional skills • Improved attitudes about self, others, and school • increase in positive classroom behavior • 11 percentile-point gain on standardized achievement tests • And Reduced Risks for Failure: • reduction in conduct problems • reduction in aggressive behavior • reduction in Emotional distress Source: Durlak, J.A., Weissberg, R.P., Dymnicki, A.B., Taylor, R.D., & Schellinger, K. (in press). The Impact of Enhancing Students’ Social and Emotional Learning: A Meta-Analysis of School-Based Universal Interventions. Child Development.
social & emotional learning Self-awareness Self-management Responsible decision-making Social awareness Relationship Skills What are the Core SEL Competencies? Recognizing one’s emotions and values as well as one’s strengths and limitations Managing emotions and behaviors to achieve one’s goals Making ethical, constructive choices aboutpersonal andsocial behavior Forming positiverelationships, working inteams, and dealing effectivelywith conflict Showing understanding and empathy for others Source: Collaborative for Academic, Social, and Emotional Learning
How Do Students Acquire SEL Skills? • Explicit interactive instruction • Practice and feedback • Observation of modeling by adults and peers • Reflection on one’s experiences • Application and generalization within the school
How Can The Learning Environment Support SEL? Schools and classrooms that are: • Safe • Caring • Highly participatory • Well managed • Engaging • High in behavioral and academic expectations
Illinois Social and Emotional Learning Goals Graphic: University of Illinois Extension
Core Features of a Response to Intervention (RtI) Approach • Investment in prevention • Universal Screening • Early intervention for students not at “benchmark” • Multi-tiered, prevention-based intervention approach • Progress monitoring • Use of problem-solving process at all 3-tiers • Active use of data for decision-making at all 3-tiers • Research-based practices expected at all 3-tiers • Individualized interventions commensurate with assessed level of need
The Illinois School Model Illinois PBIS Network, Revised May 2008. Adapted from "What is school-wide PBS?", OSEP Technical Assistance on Positive Behavioral Interventions & Supports.
RtI OSEP Center on Positive Behavioral Interventions and Supports
Social-Emotional Policy, Chicago Public Schools, 2004 • Every school must provide... • School-wide policies • Classroom instruction • Teacher training • Parent education • Community partnerships • Screening, early intervention • Clinical referral
Trauma and Exposure to Violence: Research Findings • Decreased IQ and reading ability (Delaney-Black et al., 2003) • Lower grade-point average(Hurt et al., 2001) • More days of school absence(Hurt et al., 2001) • Decreased rates of high school graduation (Grogger, 1997) • Increased expulsions and suspensions(LAUSD Survey)
Impact of Neighborhood Violence on Academic Performance • Results demonstrated a statistically significant decrease in student’s scores during the week following a homicide that occurred on their block (regardless of connection to the victim) Sharkey,P. May 2010: www.pnas.org Project on Human Development in Chicago Neighborhoods (PHDCN) http://www.icpsr.umich.edu/PHDCN
Chicago Public Schools • Multiple efforts to improve school and student success addressing range of issues that impact our students: • Office of Special Education and Supports • Safety and Security: Culture of Calm • District Initiatives: Community Schools • Office of School Improvement: Turn-Around and Transformation Schools • Pathways to College Success
Schools, Mental Health and Families • Shared values and beliefs • Improved academic outcomes • Improved behavioral outcomes • Development of life skills • Enhanced social and emotional functioning • All partners bring strengths • All face difficult challenges 42
Education and Mental Health: A Shared Agenda • All children have equal opportunity to develop to their fullest cognitive, social and emotional capacities • The needs of those with psychosocial problems are effectively and efficiently addressed • Common conceptual framework • Universal (positive development, prevention) • Targeted-early identification • Intensive interventions 43
Desired Outcomes • Families • Greater voice in schools and mental health services and programs • Increased family support from peers • Increased access and satisfaction with services; increased choice • Increased access to information
Desired Outcomes • Systems • Safe effective schools • Better trained workforce • Enhanced retention and job satisfaction • Efficient use of resources • Communities • Improved quality of life • Increased citizen contribution • Enhanced sense of efficacy • Decrease stigma • Decrease violence
Why Partnerships? • Commonly shared values and goals • Easier to identify available community resources and gaps in services • Easier to plan and create the best continuum/array of community services • Decrease duplication of services, leaving dollars for other identified needs • Increase the ability to access funding
Defining Partnership • A collaboration between school and community mental health organization(s) that mutually agree to address the mental health needs of students through provision of a range of services and supports that lead to enhanced academic and social/emotional outcomes
Key Idea • Through collaboration, goals can be attained that cannot be reached through individual efforts alone: • Student academic and social/emotional outcomes • Families involved • Systems changed • Communities strengthened
Mental Health and Schools: Challenges • Separate cultures, language, mandates • Legal issues • Funding streams re-enforce silos • Anxiety • Failed history • Control and power issues