Mental Health and Transition: Interconnected Systems Framework

Capacity Building InstituteMay 7, 2013

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Joanne Cashman, IDEA PartnershipRobert Crouse, AZ CoP on TransitionMarcus Poppen, University of OregonJames Sinclair, University of OregonKara Hirano, University of Oregon

Transition Age Youth (TAY) and Serious Mental Illness• More than three million transition age youth have serious mental

illness (Vander Stoep, et al, 2000).• Prevalence of serious mental illness is greatest among the

populations of 18-25 year olds (12% compared to other adult populations (HHS, 2003).

• Transition age youth with serious mental illness are three times more likely to become involved with the juvenile justice system, compared to transition age youth without SMI (Vander Stoep, et al, 2000).

• More than 60% of transition age youth with serious mental illness do not complete high school, leaving many of these young adults unemployed, unable to benefit from continuing education, and without the skills needed to live independently (Hagner, et al, 1999).http://www.apa.org/about/gr/issues/cyf/transition-youth.pdf

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Disability, Mental Health and Transition

• Relationships between disability, mental health and transition are complex and underexplored (Rose, et al, 2009).

• Disability, mental health and transition increase students risks of experiencing negative post-school outcomes (Hassoitis & Turk, 2012; Haber, et al., 2008).

• Despite these known barriers, there remains a dearth of literature describing the unique features of this population and offering effective transition planning strategies for practitioners.

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To what extent is the impact of MH issues a priority for you and your colleagues?

41 2 3 4 5

0% 0% 0%0%0%

1. Not a priority2. Somewhat a priority3. Sporadically a priority4. One of several high

priorities5. Greatest priority

Disability, Mental Health and Transition

Marcus Poppen, James Sinclair & Kara Hirano

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Study DesignDisability, Mental Health and Transition

• Two Focus Groups (Oregon)• National Survey

– 700 Survey Respondents• 493 Special Education Staff (Special Education Teacher,

Transition Specialist, Instructional Aid)• 207 Other (VR Counselors, School Psychologists, School

Administrators)

– For this presentation• SPED Staff who completed more than 80% of our survey (n =

461)• All states represented by at least 1 respondent

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Female, 87%Male, 12%

Teaching Experience• 39% teaching more than 16

years• 21% 11-15 years• 26% 5-10 years• 14% Less than 5 years

Caseload•44% Greater than 30 students•14% 21-30 students•22% 11-20 students•21% 1-10 students

Education• 3% Doctoral Degree• 66% Masters Degree• 25% Bachelors Degree• 3% AA• 1% Other

Race/Ethnicity• 89% White• 4% African American• 3% Prefer Not to Specify• 4% Other

Community Setting• 32% Urban• 46% Suburban• 32% Rural (<2,500)

Work Setting• 48% Special Education Classroom• 25% Community Based/Work Program• 17% Resource Room or Learning

Center• 10% General Education Classroom

Demographics

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Knowledgeable about School Mental Health Services

Not at all like me Not like me Not much like me Somewhat like me Like me Just like me0%

5%

10%

15%

20%

25%

30%

35%

2%5%

10%

31%33%

18%

To what degree does the following statement sound like you: "I am knowledgeable about the services available for stu-

dents with mental health concerns provided by my school"

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Knowledgeable about Community Mental Health Services

Not at all like me Not like me Not much like me Somewhat like me Like me Just like me0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

2%6%

16%

39%

27%

11%

To what degree does the following statement sound like you: "I am knowledgeable about the services available for stu-

dents with mental health concerns provided by my commu-nity"

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Prevalence of Mental Health Issues for Transition Age Youth

• Special Education Staff report that 46% of their students experience mental health issues.

• 92% of Special Education Staff report working with students who receive mental health services.

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Mental Health Services for Transition Age Youth with Disabilities

Very Ineffec-tive

Ineffective Effective Very Effective

-20%

0%

20%

40%

60%

Effectiveness

Very Ineffective Ineffective Effective Very Effective

-20%

0%

20%

40%

60%

Satisfaction

School Based

Community Based

0% 50% 100%

59%

81%

Type of Mental Health Services Provided

Of the 92% who reported their students receive MH services 11

“Because of your mental health, which is your disability, you fall out of programs that are set up to serve you. And, that just doesn’t make any sense to me!” – Special Education Teacher

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0%

20%

40%

60%

80%

100%

99%

80% 79%

58%

45% 43%

33%

21%

9%

Transition Services Offered by School

Transition Services Offered

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To what extent is mental health available to your students?

141 2 3 4 5

0% 0% 0%0%0%

1. Not available2. Available, but

inadequate3. Available at an

appropriate level for need

4. Available and meets needs

5. Exceptional availability and service

What did participants have to say?

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“We are not talking about issues soon enough.” – Special Education Teacher

“What I’ve seen is a lack of awareness of the complexity of the things that these young adults are coming forward with.” – Special Education Teacher

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Mental Health Concerns Present and Those Addressed on the Students IEP

Other

Suicidal Thoughts/Behavior

Alcohol/Drug Abuse

Inappropriate Sexual Behavior

Experience of Trauma

Impulsive/Dangerous Behaviors

Withdrawal or Social Isolation

Physically or Verbally Aggressive Behaviors

Impaired Self-Esteem

Depression

Classroom Disruptiveness

Worrying/anxiety/nervousness

Attention Deficit/Hyperactivity

Peer Relationship Problems

0% 50% 100%Observed

Addressed in IEP17

“When we don’t address it head on, the kids often don’t get the mental health support that they need.” – Special Education Teacher

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Mental Health Concerns Present and Those Addressed on the Students IEP

Other

Suicidal Thoughts/Behavior

Alcohol/Drug Abuse

Inappropriate Sexual Behavior

Experience of Trauma

Impulsive/Dangerous Behaviors

Withdrawal or Social Isolation

Physically or Verbally Aggressive Behaviors

Impaired Self-Esteem

Depression

Classroom Disruptiveness

Worrying/anxiety/nervousness

Attention Deficit/Hyperactivity

Peer Relationship Problems

0% 50% 100%Observed

Addressed in IEP19

Mental Health Concerns Present and Those Addressed on the Students IEP

Other

Suicidal Thoughts/Behavior

Alcohol/Drug Abuse

Inappropriate Sexual Behavior

Experience of Trauma

Impulsive/Dangerous Behaviors

Withdrawal or Social Isolation

Physically or Verbally Aggressive Behaviors

Impaired Self-Esteem

Depression

Classroom Disruptiveness

Worrying/anxiety/nervousness

Attention Deficit/Hyperactivity

Peer Relationship Problems

0% 50% 100%Observed

Addressed in IEP20

“I get maybe 10 minutes at the end of an IEP to talk about what I do little bit, which, is somewhat out of context, I mean we talked about all academic stuff and strengths and weaknesses, and now we’re going to give you you little ten minutes to talk about, like, transition.” -- Transition Specialist

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Mental Health Services Included in IEP

Never Very Rarely Rarely Occassionally Very Frequently Always0%

5%

10%

15%

20%

25%

30%

35%

40%

12%

20%22%

34%

7%5%

Mental Health Services Included in IEP

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“And, so the question is, how do we include other agencies in the process, rather than doing something in isolation.” -- Transition Specialist

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Coordination with MH Provider

Never Very Rarely Rarely Occassionally Very Frequently Always0%

5%

10%

15%

20%

25%

30%

35%

17%20% 20%

29%

12%

2%

Teacher Coordinates Services with MH Provider

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No

Yes

0% 50% 100%

61%

39%

SPED Teachers who Have Attended a MH Training

No

Undecided

Yes

0% 50% 100%

3%

17%

80%

SPED Teachers who would like additional training in Mental Health

Training

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To what extent do these finding match your experience?

261 2 3 4

0% 0%0%0%

1. Mismatch2. A few similarities3. Many similarities4. Close match

Barriers

• Homelessness• Student Engagement• Disability Specific• Appropriate Transition Planning• Eligibility• Stigma• Family Engagement• Job Descriptions and Responsibilities• Training and Professional Development• Expectations for the Future

“I think it goes beyond national, to cultural, because people don’t know how to talk about mental health because there is ignorance, fear, stigma….” – Special Education Teacher

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Strategies

• Agency Collaboration• School and Community Resources• Family Engagement• Student-Teacher Relationship• Something about Job Descript? Role?• Something about skills to build positive

relationship?

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Does the Picture of MH in Special Education Differ Significantly from General Education?

• 1 in 5 youth have a diagnosable MH Condition

• About 70% of those youth get no treatment

• School is the de facto MH provider

• We need Mental Health partnerships....o Cross the boundaries between school and agencieso Integrate the work of school employed staff and agency staffo Build a comprehensive system school mental health!

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The MH/Transition ‘Twins’

• While Special Ed focuses on MH in Transitions....

• SAMHSA is focused and funding Transition in MH (Healthy Transition Grant)

• Lets get together.... WI is doing it!33

To what extent do you and your colleagues work across agencies to meet transition needs?

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1 2 3 4 5

0% 0% 0%0%0%

1. Never2. Infrequently3. Sometimes4. Often5. Always

35

36

37

38

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Pooled Resources: Working across Programs and People

• Who has the training?o School employedo Community employed

• Who has the assignment?o Shared roleso Distinct roles

• Are the systems ....o Coherent?o Comprehensive?o Sustainable?

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ISF: Building the Bridge across Systems

• Learning the language

• Defining the roles

• Building the relationship

• Creating support through ongoing engagement

• Meeting the challenges over and over.....because situations and people change.

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To what extent does the ISF address issues that you and your colleagues care about?

451 2 3 4 5

0% 0% 0%0%0%

1. Not at all2. A few issues3. More than a few

issues4. Many issues5. Very many issues

May is Mental Health Awareness Month

• NAMI NH has provided a customizable Info Card for your use

• Attach a green ribbon and distribute

• Customize the card with your data or your efforts

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Based on what we have discussed today....

• Is there interest in developing a cross-state workgroup on MH and transition....

• Should we develop a webinar to bring the ISF to transition staff...

• Should we identify and promote some promising programs that address both transition and MH...

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