Expanding Partnerships in Systems of Care: Education, Mental Health and Families Working Together Joanne Cashman, National Association of State Directors of Special Education & Mark Weist, University of Maryland September 15, 2005

The IDEA Partnership

Center for School Mental Health Analysis and Action

Guiding Principles for a Families, Schools, Mental Health Shared Agenda Mental health is crucial to school success There are shared opportunities for families, students, schools, and mental health systems and staff to work together more effectively

The Big Picture: A Shared Agenda Achievement and Well Being as Dual Goals Address both academic and non-academic barriers to achievement Share work across education, mental health and family organizations Make explicit the shared interests of school mental health, general education and special education Grow state-based examples Learn what works across states and with federal agencies Build a national Community of Practice on school-based mental health that unites stakeholders around shared interests across organizational boundaries

Growing Focus on School Mental Health (SMH) in the U.S. U.S. Surgeon General Reports (1999, 2000) President’s New Freedom Commission on Mental Health Report (2003) Mandates of “No Child Left Behind” and Individuals with Disabilities Education Act (IDEA) Progress in localities and states Collaborative research-practice-training networks

President’s New Freedom Initiative First presidential commission on mental health since 1978 Widely disseminated document: Achieving the Promise: Transforming Mental Health Care in America (see 6 goals, 19 recommendations Impact expected to last for “decades”

President’s New Freedom Commission (cont.) Goal 4: Early Mental Health Screening, Assessment and Referral to Services are Common Practice 4.1 Promote the mental health of young children 4.2 Improve and expand school mental health programs 4.3 Screen for co-occurring mental and substance abuse disorders and link with integrated treatment strategies 4.4 Screen for mental disorders across the lifespan and connect to treatment supports

In Addition to Enhanced Access, SMH can: Reduce stigma for help seeking Promote generalization/maintenance of intervention gains Enhance capacity for prevention/MH promotion Foster clinical efficiency and productivity Promote a natural, ecologically grounded approach to helping youth and families

SMH Impacts Based on a limited knowledge base, when done well SMH programs and services are associated with: –Strong satisfaction by diverse stakeholder groups –Improvement in student emotional/behavioral functioning –Improvement in school outcomes (e.g., climate, special education referrals, reduced bullying, fewer suspensions)

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

Critical Challenges for for the Field ESMH still in a relatively small percentage of schools Efforts remain marginalized and under- supported (STIGMA) Interdisciplinary and intersystem turf and tension Considerable variability in experience Limited community ownership of the programs

A Central Challenge School mental health is a tenuously supported field with efforts in most communities scattered at best Scattered, unsupported services do not lead to the achievement of critical outcomes We need to build support for effective services to enable the documentation of enhanced outcomes, which will in turn fuel advocacy efforts and bring needed resources into the field

Factors Necessary to Achieve Desired Outcomes for Youth Through ESMH Programs and Services (Weist, Paternite & Adelsheim, 2005) Factors Necessary to Achieve Desired Outcomes for Youth Through ESMH Programs and Services (Weist, Paternite & Adelsheim, 2005) Effective mental health promotion, problem prevention and intervention Outstanding staff and program qualities Ongoing training, technical assistance & support School and community buy-in and investment Awareness raising, public policy advocacy and improvement, coalition building, systems-level change, and resource commitment

“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 ( )

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

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

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

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

Key Processes in Working with Families EngagementEmpowermentSupportCollaboration

Teachers are the “De Facto” providers of mental health to youth in the U.S. This fact needs acknowledgement in local, state, and national policy There is a significant need to empower teachers to fulfill this critical role

Mental Health Education Integration Consortium (MHEDIC) Working to improve interdisciplinary training and collaboration between educators and mental health staff Making recommendations to address limitations in training for both groups Mental health training for educators should be based on “backward analysis” of needs presenting in classrooms

MHEDIC (cont.) Key mental health skills for teachers: –Identifying emotional/behavioral problems within students –Referring students with emotional/behavioral problems for assistance –Promoting positive classroom behavior –Using mental health concepts to promote learning

Mental Health Concepts that Promote Learning Self-instruction (e.g., developing an internal dialogue) Problem solving (e.g., considering costs and benefits of actions) Self-control and–reinforcement (e.g., work before play) Template matching (e.g., modeling actions of B+ students)

The Critical Challenge of Federalism State of residence determines whether youth use mental health more than race/ethnicity or income Differences in mental health use by children across states are generally not related to differences in levels of need (e.g. AL and TX present higher rates of need but lower rates of use) –Sturm, Ringel & Andreyeva, 2003 (

The IDEA Partnership National Organizations Focused on the shared implementation of the Individuals with Disabilities Education Act (IDEA) IDEA issues are not just special ed issues Stronger, more connected systems help all students, including students with disabilities Connecting to the issues already on the national agenda of partner organizations provides opportunities for deeper work than separate projects that operate on the margins Identify the big picture issues that will draw people together Do real work together around shared interests

IDEA Partnership Strategy The Shared Agenda : Education, Mental Health and Families Grounding Document Seed grants to states to build communities of practice around issues VTNCNMSC NHOHMO HIMDTX Linking school based MH programs with PBIS Connect OSEP and SAMHSA funded efforts

IDEA Partnership Strategy 2 Develop communities of practice within states that bring the stakeholders together around a Shared Agenda Connect the states that are pursuing the Shared Agenda strategy in a cross-state community of practice Build a national community of practice that includes federal agencies, states, national organizations, researchers and technical assistance centers

What is a Community of Practice? Communities of Practice are made up of groups that care passionately about an issue and agree to come together routinely to improve the state of practice around that issue. To enable work that has real observable outcomes, communities form practice groups that explore pieces of an issue and bring it back to the whole community. The community keeps the practice groups focused on the ‘big picture.’ The practice groups keep the community aware of all the dimensions of the issue. Together, the community and its practice groups can bridge policy, research and practice!

The Community and Its Practice Groups The Community affiliates individuals and groups that care deeply about the same issue and agree to work together, share information and engage in co-ordinated efforts that will move the issues Practice groups are subgroups of the community that cut across organizational boundaries to address specific issues

IDEA Partnership Strategy 3 National Community Building Forum with CSMHA Develop a work plan that can be shared across groups 2004 National Community Meeting 8 issues (beginning of issue based practice groups) 10 concrete actions Build the mechanism to share information and work Support individuals from different disciplines, organizations to come together with agencies and states to do shared work Support face-face interaction and routine communication Be intentional about sharing the new knowledge

2 nd Community Building Forum and 10 th Annual Conference on Advancing School Mental Health 2 nd Community Building Forum and 10 th Annual Conference on Advancing School Mental Health Federal funders, HRSA, SAMHSA, OSEP Major Partners: IDEA Partnership, NASDSE, CSMHA, Ohio Mental Health Network for School Success Cleveland Ohio, October 26 (Forum) – 29, 2005 Come to Cleveland, the City that Rocks!! See or contact Christina at

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