3/16/2018 Child Mind Institute The Child Mind Institute is an - - PDF document

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Paving the Way for School- Based Mental Health Initiatives Caroline Axelrod Mendel, PsyD

Child Mind Institute

 Gold Standard Clinical Care ► Treated 6,000+ families from 45 states, 33 nations ► Given away over $3.3M in donated care  Trusted Resources for Kids, Families, Communities ► Childmind.org has an annual growth rate of 150% and

about 600,000 visits each month

► Teacher training & trauma services in 158 NYC schools ► Annual Children’s Mental Health Report synthesizes the

latest data on prevalence and the gap between need and care

► Recognize community and influential leaders at the

annual Change Maker Awards

 Groundbreaking Research on the Developing Brain ► Use a Big Data / Open Science approach to discover the

biomarkers of mental illness

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The Child Mind Institute is an independent nonprofit that is transforming the way we treat children with mental health and learning disorders, and leading the world to a better understanding of the developing

• brain. We provide:

The Child Mind Institute does not accept funding from the pharmaceutical industry.

Outline

The scope of the problem The promise of schools Models for school-based intervention Case example: Child Mind Institute Student Success

Program

Paving the way for implementation Q & A

The scope of the problem

 One in five youth suffers from a mental health or

learning disorder (Merikangas et al., 2010)

 50% of mental health disorders begin before age

14; 75% onset before age 24 (Kessler et al., 2005)

 Mental health disorders significantly impact

functioning in school and in life

 In 2015, suicide was the third leading cause of

death among 10-14 year olds, and the second leading cause of death among 15-24 year olds (CDC,

2015)

The promise of schools

The majority of youth with a diagnosable mental

health disorder do not receive treatment. Barriers include:

►Availability of mental health providers ►Cost ►Logistics (e.g., transportation, child care) ►Stigma

Schools are in a unique position to address these

barriers and promote access to care

The promise of schools

Research has identified treatments that effectively treat

mental health disorders in children and adolescents

The focus is now on dissemination and implementation

• f these evidence-based treatments so that children can

benefit

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Why invest in mental health?

 Social-emotional programs yield

improvements in academic outcomes such as grades and standardized test scores (e.g.,

Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Greenberg, Weissberg, O’Brien, Zins, et al., 2003; Zins, Weissberg, Wang, & Walberg, 2004)

 School mental health programs decrease

absences and discipline referrals (Jennings,

Pearson, & Harris, 2000)

 Expulsions in prekindergarten are nearly

reduced by half when classrooms have regular access to a psychiatrist or psychologist (Gilliam, 2005)

Models for school-based intervention

Impact of the intervention ►Schoolwide ►Classwide ►Group ►Individual ►Students or teachers Level of intervention ►Primary or Universal ►Secondary ►Tertiary

Primary Secondary

Tertiary

Models for school-based intervention

Target problem area

►Behavior management ►Bullying ►Drug/alcohol prevention ►Suicide prevention ►Depression ►Anxiety ►Trauma ►Emotion regulation ►Anger management ►Mindfulness ►Executive functioning/

• rganizational skills

►Identification and referral

Models for school-based intervention

Providers ►Partnership with an outside organization or

university/research team

►School-based health center ►School personnel

• School psychologist / social worker
• School counselors
• Teachers
• Related service providers
• School nurse

Models for school-based intervention

Ingredients of an effective intervention

►Evidence-based ►Clear, measurable outcomes; data-driven decision making ►Sustainable

National Registry of Evidence-based Programs and

Practices: https://www.samhsa.gov/nrepp

►An evidence-based repository and review system for mental

health and substance use interventions

►About a third of programs are deliverable in school settings ►Mean cost was $4,338 + $7,589 for year 1

• $1,856 + $6,805 for continuing in the second year

11 George, Taylor, Schmidt & Weist, 2013

Multitiered resource mapping

Allows districts/communities to:

 Identify all available resources/programs in the school/community  Recognize gaps in services and resources  Better understand program requirements to access services  Avoid duplication of services and resources  Better match service needs with available resources/programs  Increase awareness of underused partnerships/resources  Cultivate new relationships to address gaps in care 12

Stephan, Sugai, Lever & Connors, 2015

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Whole-school supports Targeted group-level supports

Individual student supports  Resources for school communities,

including guides for identifying at-risk students, constructing community

• utreach networks, and parent

engagement.

 Training for student support staff  Social-emotional skill-building workshops

for students

 Teacher consultation and coaching on

classroom management

 Behavioral and emotional skills groups for students and

parents

 Individual student evaluations with treatment

recommendations

 Connections to community-based care

Case Example – Child Mind Institute Student Success Program Facets of implementation

Proctor et al., 2011

Implementation Acceptability Sustainability Penetration Fidelity Appropriateness Feasibility Adoption Cost

Paving the way for implementation

Program Selection

Program selection

 What is the student body need? What is the appropriateness of fit to that need?  Cost/benefit of implementation ► Multicomponent interventions may offer an advantage over those developed

for one problem area

► Use of indigenous resources  Is there a robust evidence-base?  A standardized manual can facilitate implementation  Who are my key stakeholders and are they a part of the selection process?  Is there a good fit with the school’s existing goals, policies, and programs? 16

Paving the way for implementation

Program Selection Establishing Implementation Plan

Establishing an implementation plan

 Who will deliver the intervention? Facilitators include: ► Use of regular school staff, presence of local coordinator, knowing another

implementer (Forman & Barakat, 2011; Langley et al., 2010)

► Acceptability/beliefs about the intervention (Forman et al., 2009; Beidas et al.,

2012)

► Good interpersonal skills (Forman et al., 2009) ► Character traits, e.g. warmth, self-efficacy, ability to handle ambiguity (Forman et

al., 2009)

► Desire to provide mental health services (Suldo, Friedrich, & Michalowski, 2010) ► Lower burnout/size of caseload/role strain (Suldo, Friedrich, & Michalowski, 2010) ► Level of prior training, e.g. knowledge, skill, and confidence (Suldo, Friedrich, &

Michalowski, 2010)

 How will they be trained? ► Lectures and workshops lead to knowledge, not behavior change ► Other critical elements for program implementation include:

• Ongoing coaching and consultation
• Constructive performance feedback
• Self-reflection
• Access to problem-solving and supports to develop mastery

 What are the other organizational or systemic barriers and how will these be addressed? 18

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Paving the way for implementation

Program Selection Establishing Implementation Plan Implementation

Implementation

Facilitators include: ►Support from teaching staff (Langley et al., 2010; Suldo, Friedrich, & Michalowski,

2010)

►Administrator support (Forman & Barakat, 2011; Forman et al., 2009; Langley et al., 2010;

Suldo, Friedrich, & Michalowski, 2010)

Barriers include: ►Logistical barriers (e.g. time, funding, space, scheduling,

competing priorities) (Forman et al., 2009; Langley et al., 2010; Suldo, Friedrich, &

Michalowski, 2010) 20

Paving the way for implementation

Program Selection Establishing Implementation Plan Implementation Sustainability

Sustainability

Is there a plan for long-term implementation? How will the program sustain itself even with shifting priorities,

budgetary allocations, etc.?

How will we manage staff turnover?

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Takeaways

Schools are in a unique position to identify and target social-

emotional needs. This would help to reduce the public health burden of mental illness and promote children's academic success.

There is a solid evidence-base for interventions that effectively

prevent and treat mental health disorders – the remaining challenge is successful implementation in schools

Selecting and implementing a program requires consideration of

program, provider, organizational, and systemic characteristics

Research provides guidelines for effective implementation, and

implementation is an iterative process that is highly contextual

Resources

www.childmind.org www.schoolmentalhealth.org www.effectivechildtherapy.org www.samhsa.gov/nrepp www.pbis.org www.casel.org

If you are interested in receiving Trauma Toolkits from the Child Mind Institute, please contact Rebecca.Fleischman@childmind.org

3/16/2018 5 Child Mind Institute Student Success Webinar Program

Student Success Webinars are live and recorded online workshops that bring expert, evidence-based trainings to schools across the country, equipping educators with the knowledge and skills they need to identify and support students’ mental health needs in schools. Visit childmind.org/student-success-webinar to view pricing, schedule a live webinar, or view a prerecorded program. Topics Include:

Effective Behavior Management

Strategies for Educators

Trauma-Informed School Support When to Worry About a Student’s Worries Mindfulness in School Settings Educator Stress Reduction

References

 Becker, K.D., Buckingham, S.L, Brandt, N>E (2015). Engaging Youth and Families in School mental health services. Child and Adolescent Psychiatric Clinics of North America, 24, 385-398.  Beidas, R.S., Mychailyszyn, M.P., Edmunds, J.M, Khanna, M.S., Downey, M.M., & Kendall, P.C. (2012). Training school mental health providers to deliver cognitive-behavioral therapy. School Mental Health, 4, 197-206.  Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of Enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82, 405-432.  Eiraldi, R., Wolk, C.B., Locke, J., Beidas, r. (2016). Clearing hurdles: The challenges of implementation of mental health evidence-based practices in under-resourced schools. Advances in School Mental Helath Promotion, 8, 124-145.  Forman, S.G. & Barakat, N.M. (2011). Cognitive-behavioral therapy in schools: Bringing research to practice through effective implementation. Psychology in the Schools, 48, 283-296.  Forman, S., Fagley, N.S., Chu, B., & Walkup, J. (2012). Factors influencing school psychologists’ willingness to implement evidence based interventions. School Mental Health, 4, 207-218.  Forman, S. G., Olin, S. S., Hoagwood, K. E., Crowe, M., & Saka, N. (2009). Evidence-based interventions in schools: Developers’ views of implementation barriers and facilitators. School Mental Health, 1, 26-36.  George, M., Taylor, L., Schmidt, S.C., Weist, M.D. (2013). A Review of School Mental Health Programs in SAMHSA’s National Registry of Evidence-Based Programs and Practices. Psychiatric Services, 64, 483-486.  Gilliam, W.S. (2005). Prekindergarteners Left Behind: Expulsion Rates in State Prekindergarten Systems. Yale University Child Study Center. Retrieved from: http://ziglercenter.yale.edu/publications/National%20Prek%20Study_expulsion_tcm350-34774_tcm350-284-32.pdf  Greenberg, M. T., Weissberg, R. P., O’Brien, M. U., Zins, J. E., Fredericks, L., Resnick, H., & Elias, M. J. (2003). Enhancing school-based prevention and youth development though coordinated social, emotional, and academic learning. American Psychologist, 58, 466-474.  Jennings, J., Pearson, G., & Harris, M. (2000). Implementing and maintaining school-based mental health services in a large, urban school district. Journal of School Health, 70, 201-205.  Kessler, R.C., Berglund, Demler, Jin, Merikangas, Walters (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62 (2005), pp. 593-602  Langley, A.K., Nadeem, E., Kataoka, S.H., Stein, B.D., & Jaycox, L.H. (2010). Evidence-based mental health programs in schools: barriers and facilitators of successful implementation. School Mental Health, 2, 105-113.  Merikangas, K.R., He, J., Burstein, M., Swanson, S.A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., Swendsen, J. (2010). Lifetime Prevalence of Mental Disorders in US Adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017  Ohan, J.L., Seward, R.J., Stallman, H.M., Bayliss, D.M., Sanders, M.R. (2015). Parents barriers to using school psychology services for their child’s mental health problems. School Mental Health, 7, 287- 297.  Owens, J.S., Lyon, A.R., Brandt, N.E., Masia Warner, C., Nadeem, E., Spiel, C., & Wagner, M. (2014). Implementation science in school mental health: Key constructs in developing a research agenda. School Mental Health, 6, 99-111.  Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., … Hensley, M. (2011). Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Administration and Policy in Mental Health, 38(2), 65–76. http://doi.org/10.1007/s10488-010-0319-7  Stephan, S.H., Sugai, G., Level, N., Connors, E. (2015). Strategies for Integrating Mental Health into School via a Multitiered System of Support. Child and Adolescent Psychiatric Clinics of North America, 24, 211-231.  Suldo, S. M., Friedrich, A., & Michalowski, J. (2010). Personal and systems-level factors that limit and facilitate school psychologists' involvement in school-based mental health services. Psychology in the Schools, 47, 354-373.  Zins, J. E., Weissberg, R. P., Wang, M. C., & Walberg, H. J. (Eds.) (2004). Building academic success on social and emotional learning: What does the research say? NY: Teachers College Press.