The West Virginia Expanded School Mental Health InitiativeHistory, Status, Tools and Resources

Linda Anderson, MPHWV Student Success Summit

August 2-3,2011

Objectives

Participants will be able to1.Describe at least two aspects of the

history of the ESMH Initiative2.Identify at least three characteristics

of successful school mental health programs

3.Identify at least three resources for information and technical assistance

Outline• Define ESMH• Links between mental health and

school success• History of school mental health in

West Virginia• Factors for success• Resources

4

The Conundrum

Academic

Performance

School Mental Health

Links Between Mental Health and School Success

Facts

• 5-9 % of children and teens have a serious emotional disturbance. (US Surgeon General’s Report, 1999)

• 20% of children and adolescents at any given time have a diagnosable mental disorder which interferes with their functioning.(US Surgeon General’s Report, 1999)

8

Facts

• 1-2 children in every classroom have a diagnosable mental health concern which hinders functioning. (President’s New Freedom Commission Report)

• Less than 50% of children and adolescents with a mental illness receive adequate (or any) services . (Kataoka, Shang, Wells, 2002)

9

Health & MentalHealth Factors Educational

Outcomes

EducationalBehaviors

Poor healthPhysical illness High-risk behaviors (e.g. Substance use ) Mental illness Developmental issuesLow self-esteem Family problems

AttendanceB Behavioral ProblemsEducational motivationAttitudes toward schoolworkSchool Connectedness

Graduation/Drop-out Grades Standardized test scores Teacher Retention

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.

Mental Health & Academic Outcomes Connection

SMH

11

Why MH in Schools?

• Evidence clearly demonstrates that addressing mental health needs is associated with positive school outcomes

• School mental health promotion activities create a positive learning environment

Why MH in Schools?

• School mental health programs and services improve teaching conditions for teachers and staff

• Schools are where children are located – efficient use of resources

• Reduces costs for treatment• Contributes to the economy

Academic Performance• Is negatively affected by:

– Alcohol, tobacco, and other drug use – Emotional problems – Health risk behaviors (e.g. obesity, sexual behavior,

poor diet)– Low self-esteem, risky sexual behavior– Lack of access to health and mental health care– Poor home life

• Is positively affected by:– High levels of resiliency, developmental assets, and

school connectedness(work of CASEL, Search Institute; and others)

14

Graduation Rates

SMH strategies can improve graduation rates by addressing factors that interfere with a student’s ability to succeed in school, such as :

–Exposure to violence–Anxiety disorders–Other unmet mental health needs

(Black, et al, 2003, Woodward & Ferguson, 2001; and others)

15

School ConnectednessDefinition: the extent to which a student feels welcomed, accepted and respected in his or her school. Students who feel connected to their school:–Better achievement–Better school attendance–Stay in school longer–Less likely to engage in many risk behaviors(Fletcher et al., 2008; Shochet et al., 2006; Anderman, 2002; and others)

“    

WV Educators Speak:Mental Health & School Success

DefinitionExpanded School Mental Health refers to programs

that build on the core services typically provided by schools. It is a three-tiered framework that includes the full continuum of:

PreventionEarly intervention TreatmentServes all students Emphasizes shared responsibility between schools and community mental health providers

4/6/2011 18

A Comprehensive System of Learning SupportsSchool

Systems Behavioral Health Systems

Universal80-90%

Intensive1-5%

Targeted5-15%

TIER 1 - UNIVERSAL PREVENTIONA SCHOOL WIDE FOUNDATION

Creating a caring school environmentTeaching appropriate behaviors and problem solving skillsPositive behavioral support Effective academic instruction

4/6/2011 20

TIER 2 - TARGETEDIDENTIFY & INTERVENE EARLY

Interventions that occur early for individual students or small groups of students at riskExamples of programmatic interventions include social skills groups, anger management; family support; grief and loss, suicide / depression screening; short term counseling and stress management.

4/6/2011 21

TIER 3 - INTENSIVETREATING SEVERE & CHRONIC PROBLEMS

Individualized therapeutic interventions for high risk students with severe, chronic or pervasive concerns that may or may not meet diagnostic criteriaServices might include crisis intervention, cognitive behavioral therapy, and family therapy; and may be community or school - based.

4/6/2011 22

What does School Mental Health look like?

Systems of Prevention and Promotion All Students (universal)

Systems of Early InterventionStudents At-Risk (selected)

Systems of Treatment

Students with Problems (indicated)

School, Family, and Community Partnerships

From work of Joe Zins

What Does Quality ESMH Look Like?

• Emphasize access• Tailor to local needs

and strengths• Active involvement of

diverse stakeholders• Full continuum from

promotion to treatment

• Committed and energetic staff

• Developmental and cultural competence

• Coordinated in the school and connected in the community

• Emphasize quality and empirical support

(Center for School Mental Health)

WV HISTORYPrior to 2000• Coordinated School Health Program Initiated• School-based Health Center Initiative• System of Care – SAMHSA grant2000• School mental health funding – BHHF block

grant• Sisters of St Joseph Health and Wellness

Foundation funds mental health services in SBHCs

25

WV MILESTONES2006• West Virginia Behavioral Health Commission

convenes• First meeting with WVDE2007• ESMH steering team organized• Strategic planning process begins (Dec.)

26

WV MILESTONES

2008• ESMH Team recognized as subcommittee of

Behavioral Health Commission• MOU signed by Commissioners2009• Planning grants awarded by BHHF• Selected by NASBHC as pilot state for their

Mental Health Capacity Building Project

27

WV MILESTONES2011• Website • Ten Components of Universal Tier defined• Analysis of county improvement plans• Second statewide ESMH conference• School policies reflect increased focus on

social-emotional learning and mental health

• ESMH Implementation grants28

MISSION

To develop and strengthen policies, practices

and services that promote learning and social-

emotional well-being for all of WV’s youth

through a collaborative process that engages

schools, families, and community-based

agencies.

VISION

Every student in WV will benefit from a school

environment that supports social and

emotional well-being to achieve his/her full

potential.

4/6/2011 32

WV Educators Speak:Building A Successful ESMH Program

Steering Team Goals

1. Strengthen the infrastructure2. Define ESMH Tiers 2 and 33. Ensure quality4. Develop a reporting system5. Regionalize training and TA6. Sustain and increase programs

TIER 1 - UNIVERSAL PREVENTIONTEN RECOMMENDATIONS

1. An infrastructure that supports and sustains a comprehensive school mental health model

2. A systemic approach to early identification of students at risk

3. An effective, classroom-based developmental guidance curriculum that is consistent and reinforced within and outside of the classroom

4/6/2011 35

Tier 1 Recommendations - Cont’d4. A school-wide positive behavior program

based upon evidence /promising practices5. Annual training for all staff to improve their

skills in identifying and addressing mental health needs of students

6. Policies and practices to strengthen student connectedness

7. Policies and practices to strengthen parent and family involvement

4/6/2011 36

Tier 1 Recommendations - Cont’d8. A program to address school climate, based

upon evidence and promising practices

9. School safety plans that incorporate both crisis prevention and response

10. Specific activities and programs that support families and students as they negotiate transitions such as grade and school changes

4/6/2011 37

Student Support Services

Social and Emotional Learning

Mental Health Services Act

Student Mental Health Initiative Safe Schools, Healthy Students

Peer-to-Peer Support

School climate

School connectedness

Coordinated school health program

Suicide Prevention

Strengths based

Risk and protective factors

Family support services

Cultural competence

MulticulturalismShared Agenda

School based

School linked

Special Education

NCLB

IDEA

Crisis management

Evidence based practice

Multi system approach

Response to InterventionPBIS

Systems of Care

School linked

Wrap around

Student Assistance Team

Where to Begin?

Mental Health Planning and Evaluation Template

• www.nasbhc.org/mhpet• Developed in partnership with the Center for

School Mental Health• Used in planning and evaluating activities and

services for new or established SMH programs• Eight dimensions, 34 indicator measure• Web-based, completed by teams, computer

generated scores

Community Coordination and Collaboration

• RATIONALE: Coordination and collaboration with community-based mental health and child-serving agencies– enhances resources– maximizes efficiencies– reduces fragmentation and duplication

Community Coordination

and Collaboration

• A collaboration is a “formal or informal agreement among participants to establish a process and structure for achieving goals that no one member can achieve independently.” (EDC)

– Linkages between school and a particular agency– Coalitions that serve youth in the community – School coalitions of community partners

Community Coordination and Collaboration: Key Strategies

• Support and leadership from the school principal is essential

• Establish a school level leadership team• Build a school-community partnership with community

agencies that serve youth• Conduct an inventory of needs and resources• Determine a leadership structure and formalize

relationship with an Memo of Understanding (MOU)• Engage group in small scale strategic planning process

School Coordinating Teams

• Composed of multiple stakeholders, convened by school health coordinator/school counselor– Conduct planning and quality improvement process– Conduct assessment of needs and resources related to school

health and mental health– Act collectively in providing guidance and leadership on school

policies (e.g. discipline) that promote school health/ mental health

– Coordinate, implement, train and evaluate ESMH activities– Link to community health services and resources– Oversee collection and analysis of student health data– Implement crisis prevention and intervention

A Word About Funding….• Diversified funding base

– Local Community – School system sources: Title 1, Safe and

Supportive Schools, other – Third party insurance

• BHHF – new planning grants (maybe)• FQHCs/SBHCs

Recommended Reading

• Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools

National Center for Mental Health Promotion and Youth Violence Prevention:

http://promoteprevent.org/Publications/

45

4/6/2011 46www.promote.prevent.org

National Resources

Center for School Mental HealthU of Marylandwww.csmh.umaryland.edu

National Assembly on School Based Health Care

www.nasbhc.org

Resources for schools, parents, students, communitiesDirectory of SMH programsTool Kits

www.schoolmentalhealthwv.org landerson@marshall.edu

4/6/2011 48

RESOURCES Tool Kits • Guide for developing an ESMH program• Community and school needs assessment tools• Sample Forms/MOUs• Family Engagement• Stigma reduction • Quality/Standards• Sample educational handouts for school staff,

parents, students • CBT core skills

49

4/6/2011 50

4/6/2011 51

WV Educators Speak:Impact of ESMH on One WV Student

Contact Info

Linda Anderson, MPHCoordinator

School Health Technical Assistance CenterRC Byrd Center for Rural Health

Marshall University304-544-3917

landerson@marshall.edu

Linda Anderson, MPHMental Health304-544-3917landerson@marshall.edu

Stephanie MontgomeryData and Evaluation304-634-1008smontgom@marshall.edu

Paula Fields, MSN, RNClinical Issues304-846-9739pfields4@yahoo.com

Bobbi Jo Muto, RDH, BSOral Health Coordinator304-542-9592bjmuto.steele@marshall.edu

Richard Crespo, PhDDirector304-691-1193crespo@marshall.edu

Resources, assistance, and training related to SBHCs, school-based behavioral and oral health programs.

55

Thank You for your attention!

Questions?