Mental Health

1
Mental HealthEducation Integration and the
Promotion of School Success
Carl E. Paternite, Ph.D. Center for School-Based
Mental Health Programs Department of
Psychology Miami University (Ohio) http//www.unit
s.muohio.edu/csbmhp Workshop Presented at the
Kappa Delta Pi 44th Biennial Convocation St.
Louis, Missouri November 15th, 2003
2
Mental HealthEducation Integration and the
Promotion of School Success

• Instructional Objectives For Workshop
• Increase awareness of the associations between
  student mental health and school success.
• Increase awareness of the importance of educators
  in school-based mental health programs as
  promoters of student mental health.
• Increase knowledge of effective approaches to
  enhance educator mental health professional
  collaboration.

3
See Handout for Summary of Network Vision,
Mission, and Action Agenda For more information
about the Network visit www.units.muohio.edu/csbmh
p/network.html or http//altedmh.osu.edu/omhn/omhn
.htm
4
Mental Health Needs of Children/Adolescents and
Available Services

• About 20 of children/adolescents (15 million),
  ages 9-17, have diagnosable mental health
  disorders (and many more are at risk or could
  benefit from help).
• Less than one-third of youth with diagnosable
  disorders receive any service, and, of those who
  do, less than half receive adequate treatment
  (even fewer at risk receive help).
• For the small percentage of youth who do receive
  service, most actually receive it within a school
  setting.
• These realities raise questions about the mental
  health fields over-reliance on clinic-based
  treatment, and have reinforced the importance of
  alternative models for mental health service
  especially expanded school-based programs.

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Leading Causes of Death in 15-19 Year Olds in
the United States in 2000 U N I T E D S T A
T E S, 2000
CAUSE OF DEATHS Accidents 6573 Homicide 1861 Sui
cide 1574 Cancer/Leukemia 759 Heart
Disease 372 Congenital Anomalies 213 Lung
Disease 151 Stroke 60 Diabetes 40 Blood
Poisoning 36 HIV 36
From Weist Adelsheim, 2003
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See Handout
7
See Handout
8
Developmental Assets (1997 data,
www.search-institute.org)

• Approximately 100,000 6th-12th graders.
• Youth with Different Levels of Assets.
• 8 with 31 or more of 40 assets.
• 30 with 21-30 assets.
• 42 with 11-20 assets.
• 20 with 1-10 assets.

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Developmental Assets and Violence(1997 data,
www.search-institute.org)

• Approximately 100,000 6th-12th graders.
• Definition of violencethree or more acts of
  fighting, hitting, injuring a person, carrying a
  weapon, or threatening physical harm in the past
  12 months (self report).
• 61 of youth with fewer than 11 of 40
  developmental assets were violent.
• 6 of youth with 31 or more of 40 developmental
  assets were violent.

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Developmental Assets and School Success(1997
data, www.search-institute.org)

• Approximately 100,000 6th-12th graders.
• Succeeds in Schoolgets mostly As on report
  card (self report).
• 53 of youth with 31 or more of 40 developmental
  assets.
• 3 of youth with fewer than 11 of 40
  developmental assets.

11
Report of Presidents New Freedom Commission on
Mental Healthhttp//www.mentalhealthcommission.go
v

• the mental health delivery system is fragmented
  and in disarrayleading to unnecessary and costly
  disability, homelessness, school failure and
  incarceration.
• Unmet needs and barriers to care include
• (among others)
• Fragmentation and gaps in care for children.
• Lack of national priority for mental health and
  suicide prevention.
• July, 2003

12
Report of Presidents New Freedom Commission on
Mental Health Six Goals for a Transformed System

• Americans understand that mental health is
  essential to overall health.
• Mental health care is consumer and family driven.
• Disparities in mental health services are
  eliminated.
• Early mental health screening, assessment, and
  referral to services are common practice.
• Excellent mental health care is delivered and
  research is accelerated.
• Technology is used to access mental health care
  and information.
• July, 2003

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Four Recommendations Supporting Goal 4 Early
Mental Health Screening, Assessment, and Referral
to Services are Common Practice

• Promote the mental health of young children.
• Improve and expand school mental health programs.
• Screen for co-occurring mental and substance use
  disorders and link with integrated treatment
  strategies.
• Screen for mental disorders in primary health
  care, across the lifespan, and connect to
  treatment and supports.
• July, 2003

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Expanded School-Based Mental Health Programs

• National movement to place effective mental
  health programs in schools, serving youth in
  general and special ed.
• To promote the academic, behavioral, social,
  emotional, and contextual/systems well-being of
  youth, and to reduce mental health barriers to
  school success.
• Programs incorporate primary prevention and
  mental health promotion, secondary prevention,
  and intensive intervention,joining staff and
  resources from education and other community
  systems.
• Intent is to contribute to building capacity for
  a comprehensive, multifaceted, and integrated
  system of support and care.

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See Handout
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Schools The Most Universal Natural Setting

• Over 52 million youth attend 114,000 schools
• Over 6 million adults work in schools
• Combining students and staff, one-fifth of the
  U.S. population can be found in schools
• From Weist, 2003

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Schools The Most Universal Natural Setting

• Educators are key partners in efforts to
  intervene with children in need and to promote
  positive youth development.
• In fact, through their day-to-day interactions
  with students, educators are the linchpins of
  school-based efforts to encourage healthy
  psychological development of youth.

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Potential of Schools as Key Points of Engagement

• Opportunities to engage youth where they are.
• Unique opportunities for intensive, multifaceted
  approaches and are essential contexts for
  prevention and research activity.

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Educators as Key Members of the Positive Youth
Development/Health Promotion Team
Most educators, parents, students, and the
public support a broader educational agenda that
also involves enhancing students
social-emotional competence, character, health,
and civic engagement. (Greenberg, et al., 2003,
p. 466)
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Educators as Key Members of the Mental Health
Team

• Schools should not be held responsible for
  meeting every need of every student.
• However, schools must meet the challenge when the
  need directly affects learning and school
  success. (Carnegie Council Task Force on
  Education of Young Adolescents, 1989)
• There is clear and compelling evidence that there
  are strong positive associations between mental
  health and school success.

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Educators as Key Members of the Mental Health Team

• Children whose emotional, behavioral, or social
  difficulties are not addressed have a diminished
  capacity to learn and benefit from the school
  environment. In addition, children who develop
  disruptive behavior patterns can have a negative
  influence on the social and academic environment
  for other children. (Rones Hoagwood, 2000,
  p.236)
• Contemporary school reformand the associated
  high-stakes testing (including federal
  legislation signed in 2002)has not incorporated
  the Carnegie Council imperative. That is, recent
  reform has not adequately incorporated a focus on
  addressing barriers to development, learning, and
  teaching.

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See Handout
24
Educators as Key Members of the Mental Health Team

• An Exercise
• How much time do you spend (or do you imagine
  that you will spend) addressing the emotional,
  behavioral, and/or social difficulties of your
  students (minutes per hour)?

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Problem Behaviors

• Insubordination, noncompliance, defiance, late
  to class, nonattendance, truancy, fighting,
  aggression, inappropriate language, social
  withdrawal, excessive crying, stealing,
  vandalism, property destruction, tobacco, drugs,
  alcohol, unresponsive, not following directions,
  inappropriate use of school materials, weapons,
  harassment, unprepared to learn, parking lot
  violation, irresponsible, trespassing,
  disrespectful, disrupting teaching,
  uncooperative, violent behavior, disruptive,
  verbal abuse, physical abuse, dress code, other,
  etc., etc., etc.

• Exist in every school
• Vary in intensity
• Are associated w/ variety of contributing
  variables
• Are concern in every community

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Perceived Problems And Teamwork/Collaboration
Exercises See Handouts
27
Context Examples

• Senior high school with 880 students reported
  over 5,100 office discipline referrals in one
  academic year.

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What does this mean?

• 5100 referrals _at_ 10 minutes each
• 51,000 minutes or
• 850 hours or
• 141 6 hour days!

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Context Examples

• Middle school principal reports he must teach
  classes when teachers are absent, because
  substitute teachers refuse to work in a school
  that is unsafe and lacks discipline.

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Context Examples

• Middle school counselor spends nearly 15 of day
  counseling staff who feel helpless
  defenseless in their classrooms because of lack
  of discipline support.

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Context Examples

• Bus transportation company is threatening to
  w/draw their contract if students dont improve
  their behavior. Recently, security guards were
  hired to ride buses.

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Prioritizing Promotion of Healthy Development and
Problem Prevention

• School-based models should capitalize on schools
  unique opportunities to provide mental
  health-promoting activities.
• For example, recommended strategies for drop-out
  and violence prevention, including those for
  which the central role of educators is evident,
  can be promoted actively within an expanded
  school-based mental health program.

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Some of What We Know About Youth ViolenceFrom
the Surgeon General (2001), U.S. Secret Service
(2000),CDC (2002), Mulvey Cauffman (2001)

• Violence is a serious public health problem.
• Violence is most often expressive/interpersonal,
  rather than primarily instrumental or
  psychopathological.
• About 30 to 40 percent of male and 15 to 30
  percent of female youth report having committed a
  serious violent offense by age 17.
• About 10 to15 percent of high school seniors
  report that they have committed an assault with
  injury in the past year a rate that has been
  rising since 1980.
• By self-report, about 30 percent of high school
  seniors have committed a violent act in the past
  year hit instructor or supervisor serious
  fight at school or work in group fight assault
  with injury used weapon (knife/gun/club) to get
  something from a person.
• Violent acts are committed much more frequently
  by male than by female youth. (see Miedzian, 1991)

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Some of What We Know About Youth Violence
(continued)

• 43 of male and 24 of female high school
  students report that they had been in a physical
  fight during the past school year. (CDC, 2002)
• No differences are evident by race for
  self-report of violent behavior.
• At school, highest victimization rates are among
  male students.
• Violent behavior seldom results from a single
  cause.
• School continues to be one of the safest places
  for our nations children.
• Serious acts of violence (e.g., shootings) at
  school are very rare.
• Targeted violence at school is not a new
  phenomenon.
• Most school shooters had a history of gun use and
  had access to them.
• In over 2/3 of school shooting cases, having been
  bullied played a role in the attack.

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For every complex problem there is a
simple solution that is wrong.
H.L.
Mencken
36
A QUESTION WHAT ARE THE CAUSES OF VIOLENCE,
OTHER PROBLEM BEHAVIOR, AND DISCIPLINE PROBLEMS?
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(No Transcript)
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Model Influences on Violent versus Non-Violent
Behavior (From Shapiro, 1999, Applewood Centers,
Inc., Cleveland, OH)
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Prioritizing Promotion of Healthy Development and
Problem Prevention

• For drop-out prevention, these include
• Early intervention.
• Mentoring and tutoring.
• Service learning.
• Conflict resolution and violence prevention
  curricula and training for students/staff.
• Alternative schooling.

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Some of What We Know AboutYouth Violence
PreventionFrom the Surgeon General (2001), U.S.
Secret Service (2000),CDC (2002), Mulvey
Cauffman (2001)

• Promoting healthy relationships and environments
  is more effective for reducing school violence
  than instituting punitive penalties.
• The best predictor of adolescent well-being is a
  feeling of connection to school. Students who
  feel close to others, fairly treated, and vested
  in school are less likely to engage in risky
  behaviors.
• A critical component of any effective school
  violence program is a school environment in which
  ongoing activities and problems of students are
  discussed, rather than tallied. Such an
  environment promotes ongoing risk management,
  which depends on the support and involvement of
  those closest to the indicators of trouble
  peers and teachers.

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Aggressive and Rejected Children

• Thinking errors
• Attribute hostile intentions to accidental or
  ambiguous behavior
• Misinterpret important social cues
• Tease others but respond incompetently when
  provoked

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Educators

• Thinking errors
• If punishment is severe enough, children will
  cease negative behavior
• Punishment is in the best interest of the child
• Well controlled classrooms must be quiet
  classrooms
• Control is like a behavioral ointment
• no control at home slather it on in school
• Prescribed discipline programs provide security
  for staff

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Violence PreventionWhat Doesnt WorkFrom the
Surgeon General (2001) and others

• Scare tactics. (e.g., Scared Straight)
• Deterrence programs shock incarceration, boot
  camps.
• Efforts focusing exclusively on providing
  education/information about drugs/violence and
  resistance. (DARE)
• Efforts focusing solely on self-esteem
  enhancement.
• Vocational counseling.
• Residential treatment.
• Traditional casework and clinic-based counseling.

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Prioritizing Promotion of Healthy Development and
Violence PreventionBest and Promising Practices

• Including
• Structured social skill development programs.
• Mentoring. (see Big Brothers/Sisters Garbarino,
  1999)
• Employment.
• Programs that foster school engagement,
  participation, and bonding.
• Promotion of developmental assets. (see Search
  Institute)
• A variety of approaches that engage parents and
  families. (e.g., parent
• training, MST, functional FT)
• Early childhood home visitation programs.
• Multi-faceted programs that combine several of
  the above.
• For good examples see Blueprint Programs.

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Promoting Nonviolence An Example of a
Heuristic School-Based Framework

• Deutsch (1993) Educating for a peaceful world
• Four Key Components Including
• Cooperative Learning.
• Conflict Resolution Training.
• Use of Constructive Controversy in Teaching
  Subject
• Matters.
• Mediation in the Schools.

See Handout
47
Positive Behavior Support(see www.pbis.org)

• PBS is a broad range of systemic individualized
  strategies for achieving important social
  learning outcomes while preventing problem
  behavior with all students.

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Terminology

• Positive Behavior.
• Includes all skills that increase success in
  home, school and community settings.
• Supports.
• Methods to teach, strengthen, and expand positive
  behaviors.
• System change.

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Discipline Defined

• The steps or actions, teachers, administrators,
  parents, and students follow to enhance student
  academic and social behavior success.
• Effective discipline is described as teaching
  students self-control.

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Science of behavior has taught us that students.

• Are NOT born with bad behaviors
• Do NOT learn when presented contingent aversive
  consequences
• Do learn better ways of behaving by being taught
  directly receiving positive feedback
• From Johnston (2003)

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Teacher Behaviors That Contribute to Discipline
Problems

• Sitting at the desk most of the time, not moving
  or mingling with the students
• Using a low, unenthusiastic or uniteresting voice
  tone
• Becoming easily sidetracked by one students
  irrelevant question
• From Johnston (2003)

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Teacher Behaviors That Contribute to Discipline
Problems

• Ignoring students interests and tying
  instruction solely to the textbook
• Repeating students answers too frequently
• Leaving concepts before they have been clarified
  and/or expecting independent work before
  understanding has been checked
• Not being prepared and leaving down time for
  students to fill
• From Johnston (2003)

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Teacher Behaviors That Contribute to Discipline
Problems

• Poorly worded questions that cloud discussion or
  understanding
• Having questions/answers be directed solely
  between teacher and student
• Neglecting to tie content or learning to prior
  knowledge of students
• Using too much time to teach the lesson and not
  focusing on what is being learned
• From Johnston (2003)

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Teacher Behaviors That Contribute to Reduction of
Discipline Problems

• Remove conditions that trigger maintain
  undesirable practices
• Increase conditions that trigger maintain
  desirable practices
• Remove aversives that inhibit desirable practices
• Establish environments routines that support
  continuum of PBS
• From Johnston (2003)

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Promoting Nonviolence An Example of a Promising
Secondary Violence Prevention Program

• Positive Adolescent Choices Training (PACT)
• Developed by
• Betty R. Yung W. Rodney Hammond
• Components
• I. Violence-Risk Education
• II. Anger Management
• III. Social Skills

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PACT Components I and II

• Violence Risk Education
• Increase awareness of circumstances, risk
  factors, and consequences of violence.
• Anger Management
• Understand and normalize feelings of anger,
  recognize anger triggers, and manage anger
  constructively.

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PACT Components III Social Skills

• Givin It
• Expressing criticism, disappointment, anger, or
  displeasure calmly and ventilating strong
• emotions constructively.
• Takin It
• Listening, understanding, and reacting
  appropriately to others criticism and anger.
• Workin It Out
• Listening, identifying problems and potential
• solutions, proposing alternatives when
• disagreements persist, and learning to
• compromise.

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Closing Observations

• Clearly, intellectual, social, and emotional
  education go hand-in-hand, and all are linked to
  creating safe schools, building healthy
  character, and achieving academic success
• The proper aim of education is to promote
  significant learning. Significant learning
  entails development. Development means
  successively asking broader and deeper questions
  of the relationship between oneself and the
  world. This is as true for first graders as it is
  for graduate students, for fledgling artists as
  graying accountants.
• A good education ought to help people
  become more perceptive to and more discriminating
  about the world seeing, feeling, and
  understanding more, yet sorting the pertinent
  from the peripheral with ever finer touch,
  increasingly able to integrate what they see and
  to make meaning of it in ways that enhance their
  ability to go on growing. To imagine otherwise,
  to act as though learning were simply a matter of
  stacking facts on top of one another, makes as
  much sense as thinking one can learn a language
  by memorizing a dictionary. Ideas only come to
  life when they root in the mind of a learner.
  (Daloz, 1999, p. 243)

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Closing Observations

• Certainly, educators are key partners in efforts
  to intervene with children in need and to promote
  development.
• In fact, through their day-to-day interactions
  with students, educators are the linchpins of
  school-based efforts to encourage healthy
  psychological development of youth.

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This PowerPoint Presentation, with a reference
list for cited work, will be posted on the CSBMHP
website http//www.units.muohio.edu/csbmhp