School-based Programs: A National Perspective 1 2006 School-Based Behavioral Health Conference Grantville, Pennsylvania, May 3 – 5 School-based Programs:

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School-based Programs: A National PerspectiveSchool-based Programs: A National Perspective

2006 School-Based Behavioral Health Conference2006 School-Based Behavioral Health Conference Grantville, Pennsylvania, May 3 – 5 Grantville, Pennsylvania, May 3 – 5

School-based Programs: School-based Programs: A National PerspectiveA National Perspective

Albert DuchnowskiAlbert Duchnowski, Ph.D.

Research and Training Center for Children’s Mental Health

Louis de la Parte Florida Mental Health InstituteUniversity of South Florida

Tampa, Florida

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Research and Training Research and Training CenterCenter

for Children’s Mental for Children’s Mental HealthHealth

Web Address:Web Address: http://rtckids.fmhi.usf.edu

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Presentation OverviewPresentation Overview

Current status of school-based mental health

Competing models currently driving school-based mental health services

Potential solution: public health approach

Vision for Pennsylvania

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Presently there is growing attention to the mental health needs of children

And

In school-based mental health programs

Why?

Current ConditionsCurrent Conditions

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Increasing prevalence

Gaps in need and service

Recognition of school as the children’s mental health system

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Less than 30% who need it, get help

70% who get any help, get it from the school.

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Time of OpportunityTime of Opportunity

A Role for EveryoneA Role for Everyone

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Driving QuestionsDriving Questions

How can we improve access to care for those in need?

How can we improve quality and effectiveness of care?

How can we improve the mental health status and well-being of all children and families?

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What Do We Want for the What Do We Want for the Kids and Families We Kids and Families We

Serve?Serve?

In school, at home, and out of trouble

Sense of belonging and connectedness

Feeling valued in the community Hopeful about the future Quality of Life

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What is the Current What is the Current Status of School-Based Status of School-Based

Mental Health?Mental Health?

Fragmented Understudied Complicated funding

mechanisms Competing conceptual models

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Different Approaches for Different Approaches for School-based Mental School-based Mental

HealthHealth

Services supplied by the District

Mental health unit within school health clinic

Co-locate community services in schools

Specialized curriculum in special education class

Comprehensive, multi-faceted, integrated approach between community and school

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Children Who Have Emotional Children Who Have Emotional and Behavioral Disorders Have and Behavioral Disorders Have Multiple and Complex Problems Multiple and Complex Problems and Needsand Needs

Education Mental Health Child Welfare Health Care Juvenile Justice Family

Support

school

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Changing Roles of Changing Roles of FamiliesFamilies

Cause Patient Credible Informant Equal Decision-Making

Partner Evaluator/Research Partner Policy Maker

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Contrasting Perspectives Contrasting Perspectives in in

School Based Mental School Based Mental HealthHealth

Education System Mental Health System

Overarching Influence

Individuals with Disabilities Education Act (IDEA) Diagnostic and Statistical Manual (DSM)

Conceptual Framework

Behavior Disorders, Challenging Behavior, Academic Deficits

Psychopathology, Abnormal Behavior, Impaired Functioning

Important Theoretical Influences

Behaviorism, Social Learning Theory

Cognitive Psychology, Developmental Psychology, Biological/Genetic Perspectives, Psychopharmacology

Focus of Intervention

Behavior Management, Skill Development, Academic Improvement

Insight,Awareness,Improved Functioning

Common Focus

Improving Social and Adaptive Functioning. Importance of and Need to Increase Availability, Access, and Range of Services

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Competing Models of Competing Models of School Based Mental School Based Mental

Health ProgramsHealth Programs

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Prevention

Treatment

MaintenanceMaintenance

Universal

Selective

IndicatedC

ase Identification

Standard Treatments for Known Disorders

Compliance

with Long-term

Treatment

After-care (Including Rehabilitation)

(Goal: Reduction

in Relapse and

Recovery)

Mental Health Mental Health SpectrumSpectrum

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Indicated PreventionSelective

Prevention

Universal Prevention

Health Promotion /

Positive Development

Time– limited

Therapy

Enhanced Therapy

Continuing Care

Home

School

Neighborhood Agency Primary

Care Clinic

Outpatient Mental Health

Day Treatment Program

Residential Facility

Inpatient Unit

Culture

Community

Family

Youth

Reprinted with permission from: Weisz, J., Sandler, I., Durlak, J., & Anton, B. (2005). Promoting and protecting youth mental health through evidence-based prevention and treatment. American Psychologist, 60(6), 628-648, American Psychological Association

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School-based Programs: A National PerspectiveSchool-based Programs: A National PerspectiveSystems of PreventionPrimary prevention

(low-end need/low-cost per individual programs)

Systems of Early InterventionEarly-after-onset

(moderate need, moderate cost per individual)

Systems of CareTreatment of severe and chronic

problems(high-end need/high cost per

individual programs)

Interconnected Interconnected SystemsSystems

Systems of PreventionPrimary prevention

(low-end need/low-cost per individual programs)

Systems of Early InterventionEarly-after-onset

(moderate need, moderate cost per individual)

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All Students in School

Students with Chronic/Intense Problem Behavior (1 – 7%)

Students At-Risk for Problem Behavior (5 – 15%)

Students without serious Problem Behavior (80 – 90%)

Intensive Prevention

Selective Prevention

Universal Prevention

Positive Behavior Positive Behavior SupportsSupports

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““NoNo mass disorder afflicting mass disorder afflicting humankind has been humankind has been

eliminated or brought under eliminated or brought under control by attempts at treating control by attempts at treating the affected individual, the affected individual, nornor by by

training large numbers of training large numbers of individual practitioners”individual practitioners”

George Albee George Albee

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How Do We How Do We Organize ServicesOrganize Services

UniversalSelective Indicated

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The Public Health ModelThe Public Health Model1. Surveillance at the

population / community level

What is the problem?

Use systematic data collection strategies to

determine the mental health service needs in your

community.

2. Identify risk and protective factors

What are the causes?

Use the information collected in and on your community on a regular basis and integrate with the research literature.

3. Develop and Evaluate Interventions

What works and for whom?

Review literature on empirical based interventions

and apply/adapt to local community needs.

4. Implementation monitoring and scaling-up

Is it meeting the intended needs?

Monitor interventions for proper implementation, scale-up interventions and measure

impact.

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The Public Health ModelThe Public Health Model

1. Surveillance at the population / community level

What is the problem?

Use systematic data collection strategies to determine the

mental health service needs in your community.

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2. Identify risk and protective factors

What are the causes?

Use the information collected in and on your community on a regular basis and integrate with the research literature.

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3. Develop and Evaluate Interventions

What works and for whom?

Review literature on empirical based interventions and

apply/adapt to local community needs.

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4. Implementation monitoring and scaling-up

Is it meeting the intended needs?

Monitor interventions for proper implementation, scale-up interventions and measure

impact.

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Mental Health & AcademicsMental Health & Academics

What is the relationship?

Indirect Intervention Direct Intervention

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Is anybody doing all of this?

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What is Pennsylvania’s Vision?

What is your part in creating the new service delivery

system?

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Before we change what we DO, we need to change how we THINK.

Before we can change how we think, we have to change what

we BELIEVE.

Improving the ProcessImproving the Process

Documents

School-based Programs: A National Perspective 1 2006 School-Based Behavioral Health Conference Grantville, Pennsylvania, May 3 – 5 School-based Programs: