3/16/2018 Child Mind Institute 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: Gold Standard Clinical Care Paving the Way for School- ► Treated 6,000+ families from 45 states, 33 nations ► Given away over $3.3M in donated care Based Mental Health Trusted Resources for Kids, Families, Communities Initiatives ► Childmind.org has an annual growth rate of 150% and about 600,000 visits each month Caroline Axelrod Mendel, ► Teacher training & trauma services in 158 NYC schools PsyD ► 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 The Child Mind Institute does not accept biomarkers of mental illness funding from the pharmaceutical industry. 2 Outline The scope of the problem The scope of the problem One in five youth suffers from a mental health or The promise of schools learning disorder (Merikangas et al., 2010) Models for school-based intervention 50% of mental health disorders begin before age Case example: Child Mind Institute Student Success 14; 75% onset before age 24 (Kessler et al., 2005) Program Mental health disorders significantly impact Paving the way for implementation functioning in school and in life Q & A 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 promise of schools The majority of youth with a diagnosable mental Research has identified treatments that effectively treat health disorder do not receive treatment . mental health disorders in children and adolescents Barriers include: The focus is now on dissemination and implementation ► Availability of mental health providers of these evidence-based treatments so that children can ► Cost benefit ► Logistics (e.g., transportation, child care) ► Stigma Schools are in a unique position to address these barriers and promote access to care 1
3/16/2018 Why invest in mental health? Models for school-based intervention Social-emotional programs yield Impact of the intervention improvements in academic outcomes such Primary ► Schoolwide as grades and standardized test scores (e.g., ► Classwide Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Greenberg, Weissberg, O’Brien, Zins, et al., 2003; Zins, Weissberg, Wang, & ► Group Walberg, 2004) ► Individual Secondary School mental health programs decrease ► Students or teachers absences and discipline referrals (Jennings, Level of intervention Pearson, & Harris, 2000) ► Primary or Universal Tertiary Expulsions in prekindergarten are nearly ► Secondary reduced by half when classrooms have ► Tertiary regular access to a psychiatrist or psychologist (Gilliam, 2005) Models for school-based intervention Models for school-based intervention Providers Target problem area ► Partnership with an outside organization or ► Emotion regulation ► Behavior management university/research team ► Anger management ► Bullying ► School-based health center ► Mindfulness ► Drug/alcohol prevention ► School personnel ► Executive functioning/ ► Suicide prevention • School psychologist / social worker organizational skills ► Depression • School counselors ► Identification and referral ► Anxiety • Teachers • Related service providers ► Trauma • School nurse Multitiered resource mapping Models for school-based intervention Allows districts/communities to: Identify all available resources/programs in the school/community Ingredients of an effective intervention Recognize gaps in services and resources ► Evidence-based Better understand program requirements to access services ► Clear, measurable outcomes; data-driven decision making Avoid duplication of services and resources ► Sustainable Better match service needs with available resources/programs National Registry of Evidence-based Programs and Increase awareness of underused partnerships/resources Practices: https://www.samhsa.gov/nrepp Cultivate new relationships to address gaps in care ► 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 George, Taylor, Schmidt & Weist, 2013 Stephan, Sugai, Lever & Connors, 2015 11 12 2
3/16/2018 Case Example – Child Mind Institute Facets of implementation Student Success Program Resources for school communities, Whole-school Acceptability including guides for identifying at-risk students, constructing community supports Cost Sustainability outreach networks, and parent engagement. Training for student support staff Targeted Social-emotional skill-building workshops Penetration Adoption Implementation group-level for students supports Teacher consultation and coaching on classroom management Feasibility Fidelity Individual Behavioral and emotional skills groups for students and student parents supports Appropriateness Individual student evaluations with treatment recommendations Proctor et al., 2011 Connections to community-based care Paving the way for implementation 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? Program Selection 16 Paving the way for implementation 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? Establishing ► Lectures and workshops lead to knowledge, not behavior change Implementation ► Other critical elements for program implementation include: • Ongoing coaching and consultation Plan • Constructive performance feedback • Self-reflection Program • Access to problem-solving and supports to develop mastery Selection What are the other organizational or systemic barriers and how will these be addressed? 18 3
3/16/2018 Paving the way for 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: Implementation ► Logistical barriers (e.g. time, funding, space, scheduling, competing priorities) (Forman et al., 2009; Langley et al., 2010; Suldo, Friedrich, & Michalowski, 2010) Establishing Implementation Plan Program Selection 20 Paving the way for implementation 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? Sustainability Implementation Establishing Implementation Plan Program Selection 22 Takeaways Resources 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. www.childmind.org www.schoolmentalhealth.org There is a solid evidence-base for interventions that effectively www.effectivechildtherapy.org prevent and treat mental health disorders – the remaining www.samhsa.gov/nrepp challenge is successful implementation in schools www.pbis.org www.casel.org Selecting and implementing a program requires consideration of program, provider, organizational, and systemic characteristics Research provides guidelines for effective implementation, and If you are interested in receiving Trauma Toolkits from the Child Mind Institute, please contact Rebecca.Fleischman@childmind.org implementation is an iterative process that is highly contextual 4
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