MSMHA

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Maryland School Mental Health Alliance
MSMHA
School Mental Health Integration Grant
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Introductions

• Milt McKenna
• Maryland State Department of Education
• Nancy Lever, Mark Weist
• University of Maryland, Center for School Mental
  Health Analysis and Action
• Catherine Bradshaw
• Johns Hopkins University
• Susan Tager
• Maryland Coalition of Families for Childrens
  Mental Health

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History

• Call for proposals April 2005 from the U.S.
  Department of Education (Grant Due in mid May!)
• Grants for the Integration of Schools and Mental
  Health Systems will provide funds to increase
  student access to high-quality mental health care
  by developing innovative approaches that link
  school systems with the local mental health
  system.

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History

• Commitment from key local, state, and national
  partners to collaborate and form an Alliance to
  advance school-mental health system integration
  in Maryland
• Strong support for childrens mental health and
  school mental health in the state
• A strong PBIS structure within the state and an
  interest in enhancing mental health support and
  resources for red and yellow zone youth
• Notified of award in September 2005
• 1 of 20 funded projects (84 total applicants)

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• Project Overview

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Maryland School Mental Health Alliance (MSMHA)

• Maryland State Department of Education
• Center for School Mental Health Analysis and
  Action - University of Maryland
• Center for Prevention and Early Intervention -
  Johns Hopkins University
• Governors Office for Children
• Maryland Assembly on School-Based Health Care
• Maryland Coalition of Families for Childrens
  Mental Health
• Maryland Department of Juvenile Services
• Mental Hygiene Administration Department of
  Health and Mental Hygiene
• Mental Health Association of Maryland

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Primary Grant Objectives

• 1. To further build a systematic state initiative
  for school mental health (SMH)
• 2. To improve outcomes related to red and yellow
  zone youth in PBIS schools through
• Helping school staff to better identify and refer
  students who could benefit from mental health
  services
• Enhancing mechanisms for effective communication
  between schools and the mental health system to
  help better integrate quality mental health care
  for students
• Developing training and resources to assist
  school staff with creating environments that
  support academic, social, and emotional learning
  for children with more intensive mental health
  needs

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Key Structural Components

• 1 Management Team
• 1 Advisory Board
• 5 Counties (Anne Arundel, Baltimore, Harford, St.
  Marys, Washington)
• 5 County Integration Teams
• 15 PBIS Schools (3/County) and Demonstration
  Teams

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• County Integration Teams

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Purpose

• Responsible for pursing improved school-mental
  health system integration in their county
  through
• Active communication
• Needs assessment
• Resource sharing
• Problem solving

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• Demonstration Project

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Demonstration Project

• Presents an opportunity for three schools in each
  of the five counties to do a very strong
  assessment of school mental health programming
• Based on this assessment, the team will implement
  a quality assessment and improvement process from
  February 2006 to December 2007

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Demonstration Team

• Based on discussions, the team will identify
• 2-3 indicators for best practice that will be the
  focus for improvement over the next year
• 1 or 2 pressing emotional-behavioral problems
  (ADHD, Disruptive Behavior Disorder, Depression,
  or Anxiety) for the demonstration team members to
  receive skill training on best practice related
  to the disorder
• 2-3 strategies to improve coordination and
  linkages between schools and mental health
  systems

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Center for School Mental Health Analysis and
Action
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University of Maryland CSMHA

• Established in 1995, one of two national centers
  focused on the advancement of training, practice,
  research and policy in SMH
• Funded by the Health Resources and Services
  Administration, with co-funding from the
  Substance Abuse and Mental Health Services
  Administration
• http//csmha.umaryland.edu,
• csmha_at_psych.umaryland.edu,
• [phone]

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CSMHA Support

• Sharing of diverse resources developed through 10
  year history as a national center, and intensive
  resources related to quality assessment and
  improvement and evidence-based practice from an
  NIMH funded research study
• Technical Assistance (by phone and email and time
  and resource permitting in person)
• Linkages to local, state, and national leaders,
  resources and initiatives in SMH

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• Family Partnerships

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Maryland Coalition of Families for Childrens
Mental Health

• Our Coalition is dedicated to- Improving
  services for children with mental health needs
  and their families- Building a network of
  information and support for families across
  Maryland

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Family Participation and Leadership

• Families as equal partners at all levels of the
  project, (planning, implementation, evaluation,
  management, and continuous improvement)
• Training, oversight, and resource development
  facilitated by the Maryland Coalition of Families
  for Childrens Mental Health
• Major goal to empower family members to become
  effective advocates for childrens mental health
  and improve their linkages to and true
  collaboration with schools

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Benefits of This Project

• Further build a systematic initiative for SMH in
  MD
• Enhanced focus on helping red and yellow zone
  youth
• A voice in enhancing mental health integration
  into PBIS at the county, state, and national
  levels
• Meaningful family partnerships and training and
  resources for families
• Improved linkages between families, schools and
  mental health systems
• Improved outcomes for students (we hope)

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Benefits (cont.)

• Training for PBIS coaches/leaders on helping
  school staff and families understand mental
  health issues in youth and promote mental health
  for red and yellow zone youth
• Website with key information about mental health
  for families, teachers, and providers
  (http//www.msmha.org)
• Newsletter highlighting the project and key
  mental health initiatives in the state

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How This Project Fits With Your Needs

• PBIS Needs Assessment

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PBIS Needs Assessment Overview

• Purpose
• To determine training needs of PBIS teams
• Conducted by Leadership Team
• 2005 Summer Institute for Returning Teams
• High Response Rate
• 524 respondents 87

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Respondent Characteristics

• Role in school
• 27 Team leaders
• 17 Coaches
• 16 Administrators
• Type of school
• 50 Elementary
• 29 Middle
• 9 High
• 5 Alternative/Special

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Secondary Programs Needing Additional
Training by Topic
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Summary of Needs Assessment Findings

• School-Wide PBIS
• Maintaining momentum among school staff (57) and
  team members (45)
• Secondary Programs
• Intensive for red (62)
• Targeted for yellow (54)
• Implementing an FBA plan (57)
• External Collaboration
• Family involvement (70)
• Community mental health (38)
• Department of Social Services (37)
• Department of Juvenile Justice (36)

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• National Connections

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Significant Growth of School Mental Health in the
United States

• Unprecedented access, helps achieve valued
  outcomes when done well
• Strong federal support, and increasing numbers of
  strong initiatives in states and communities
• Two major forces PBIS, and Expanded School
  Mental Health (ESMH) programs
• Increasing efforts to connect PBIS and ESMH
  together

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An Oversimplification

• Schools with strong PBIS often struggle with
  problems presented by youth in yellow and red
  zones
• Schools with ESMH often struggle to develop
  school-wide efforts to promote positive behavior
  and mental health
• Connecting ESMH and PBIS will lead to a full
  continuum of effective services across the green,
  yellow, and red zones
• Related to MDs leadership in ESMH and PBIS, and
  this grant, there is a significant opportunity to
  make this connection

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Expanded School Mental Health (ESMH)

• Programs join families, schools, mental health
  and other community systems
• To develop a full array of effective programs and
  services that improve the school environment,
  reduce barriers to learning, and provide
  prevention, early intervention and treatment
• for youth in general and special education

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Enhancing Quality in Expanded School Mental
Health

• Three year, three state (Delaware, Maryland,
  Texas) study seeking to implement and evaluate a
  framework for systematic quality assessment and
  improvement in school mental health
• Funded by the National Institute of Mental Health
  (2003-2006)

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Principles for Best Practice in Expanded School
Mental Health

• 1) All youth and families are able to access
  appropriate care regardless of their ability to
  pay
• 2) Programs are implemented to address needs and
  strengthen assets for students, families,
  schools, and communities
• 3) Programs and services focus on reducing
  barriers to development and learning, are student
  and family friendly, and are based on evidence of
  positive impact

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Principles (cont.)

• 4) Students, families, teachers and other
  important groups are actively involved in the
  program's development, oversight, evaluation, and
  continuous improvement
• 5) Quality assessment and improvement activities
  continually guide and provide feedback to the
  program
• 6) A continuum of care is provided, including
  school-wide mental health promotion, early
  intervention, and treatment

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Principles (cont.)

• 7) Staff hold to high ethical standards, are
  committed to children, adolescents, and families,
  and display an energetic, flexible, responsive
  and proactive style in delivering services
• 8) Staff are respectful of, and competently
  address developmental, cultural, and personal
  differences among students, families and staff

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Principles (cont.)

• 9) Staff build and maintain strong relationships
  with other mental health and health providers and
  educators in the school, and a theme of
  interdisciplinary collaboration characterizes all
  efforts
• 10) Mental health programs in the school are
  coordinated with related programs in other
  community settings

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Four Critical Themes in School Mental Health
Intervention

• Establish and maintain strong relationships,
  especially with families
• Reduce, help to buffer stress and risk
• Enhance protective and resilience factors
• Train in evidence-based skills

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Addressable Stress/Risk Factors

• Family Level
• Abuse and neglect
• Criminal behavior
• Substance abuse
• Family isolation
• Overcrowding
• Emotional/behavioral problems in family members
• Morbidity and mortality in family members

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Addressable Protective Factors

• Family level
• Support and nurturance
• Rituals and routines
• Self-control displayed and modeled by family
  members
• Healthy behaviors by family members

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• Top Evidence-Based Practices
• Parent praise
• Cognitive coping
• Parent psycho-education
• Modeling
• Problem solving
• Skill building/behavioral rehearsal
• Maintenance/relapse prevention
• Tangible rewards

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• See. Bruce Chorpita, and Evidence Based Services
  Committee (2004). Biennial report Summary of
  effective interventions for youth with behavioral
  and emotional needs. Hawaii Department of Health,
  Child and Adolescent Mental Health Division.

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The IDEA Partnership
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Building a Community of Practice in SMH

• CSMHA and IDEA Partnership (www.ideapartnership.or
  g) providing support
• 60 professional organizations and 10 states
• 10 practice groups
• Providing mutual support, opportunities for
  dialogue and collaboration
• Advancing multiscale learning systems

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10 Practice Groups

• Mental Health-Education Integration
• Developing a Common Language
• Connecting Education and Systems of Care
• Connecting SMH and Positive Behavior Support
• Improving SMH for Youth with Disabilities

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10 Practice Groups (cont.)

• SMH, Juvenile Justice and Dropout Prevention
• Family Partnerships
• Youth Involvement and Leadership
• Faith-Community Partnerships
• Quality and Evidence-Based Practice

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(No Transcript)
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Mission
To help Ohios school districts, community-based
agencies, and families work together to achieve
improved educational and developmental outcomes
for all children especially those at emotional
or behavioral risk and those with mental health
problems.
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CSMHA Annual Conferences on Advancing School
Mental Health

• Baltimore, 1996
• New Orleans, 1997
• Virginia Beach, 1998
• Denver, 1999
• Atlanta, 2000
• Portland, 2001

• Philadelphia, 2002
• Portland, 2003
• Dallas, 2004
• Cleveland, 2005
• Baltimore, 2006
• the 2001 conference was cancelled related to the
  events of September 11

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School Health Interdisciplinary Program (SHIP)

• Organized by the CSMHA with leadership of MSDE,
  MHA and most child serving systems in MD
• Many other state collaborators
• Intensive, interdisciplinary training reflecting
  the coordinated school health model
• Held every summer in Maryland since 2002

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PBIS Leaders Embrace the Connection to ESMH

• George Sugai presented at CSMHA conferences in
  Maryland in 2003 (SHIP) and in Dallas (as
  keynote) in 2004
• Lucille Eber is likely to be a keynote for the
  11th Annual Conference on Advancing SMH
• Drs. Sugai and Eber will be active in the PBIS
  Practice Group, and with a number of people from
  this project will meet in Chicago in February to
  move the group forward

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Unprecedented State and National Resources and
Initiatives in MD

• UM, Quality R01
• UM, CSMHA
• JHU, Center for EBP
• JHU, Center for Viol Pr
• MSDE, MH-School Int.
• GOC, Transformation

• MSDE, PBIS
• MHA, ESMH
• GOC, Innovations Inst.
• MSDE, MHA, WkFrce
• Other

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An Unprecedented Time to Link this Work Together

• And advance PBIS and school mental health in
  Maryland, as we show national leadership in
  building integrated approaches that address
  academic and nonacademic barriers to student
  learning

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Mental Health and PBIS

• What are the most pressing mental health concerns
  in your schools?
• What is currently available for red, yellow and
  green zone youth?
• What is needed for red, yellow and green zone
  youth?