School Mental Health Capacity Building Partnership Oregon Stakeholder Discussion Groups A project funded through a Cooperative Agreement with the Centers for Disease Control and Prevention, Division of Adolescent and School Health (DASH)

Promoting School Mental Health through Capacity Building to State and Local Education Agencies (SEAs and LEAs)

Goal 1: Strengthening Intersections Strengthen collaborative national efforts to improve mental health services in schools by increasing intersections between mental health, health, and schools.

Goal 2: Fact finding and Organizing Develop, organize, and synthesize key documents and resources related to best practices for SEA and LEA improvement and expansion of effective SMH services.

Goal 3: Capacity Building Using fact finding knowledge, materials, and resources developed in Goals 1 & 2… Provide technical assistance, resources, and professional development to aid SEAs and LEAs in implementing effective school mental health programs.

Statewide Stakeholder Discussion Groups: PURPOSE To gain a deeper understanding of how school mental health works at the state and local level Through these groups, we learned about successes, challenges, and “lessons learned” related to school mental health policies, programs, and services

Statewide Stakeholder Discussion Groups: PROCESS Four “early adopter” states selected Selection criteria: –Shared mental health/education/family agenda –Strong state level collaboration –Vision of how to integrate health into school mental health agenda Four discussion groups per state –Three with state and local leaders in education, family advocacy, health, and mental health –One youth only discussion group

SBHC’s & Early Adopter States Oregon Ohio Maryland Missouri STAKEHOLDER DISCUSSION GROUPS: Ohio: December 2006 Maryland: February 2007 Missouri: May 2007 Oregon: August 2007

Oregon Stakeholder Discussion Groups

Adult Discussion Groups Process: August 14 th and 15 th, 2007 Three 2-hour discussion groups –Two school mental health stakeholder groups (Salem, Portland) –One Coordinated School Health Group (Monmouth) 32 total participants –Education: 12 –Health: 9 –Mental Health/Social Services: 7 –Youth development: 2 –Family members/advocates: 1 –Business 1

Results Responses to Questions –Themes –Key Quotations Challenges Opportunities

Participant awareness of Oregon’s vision or agenda for school mental health The school mental health vision varies greatly, reflecting how mental health services in Oregon vary greatly by county. While the Children’s System Change Initiative reflects a vision of mental health for Oregon’s youth, it has not been fully implemented, and it is not inclusive of all youth.

What would make it a stronger agenda? Additional, blended funding Statewide summit of legislators and policymakers Financial incentives to schools to implement school mental health Wraparound services Increased family involvement; incentives to work with families Public relations/social marketing campaign Efforts to de-stigmatize and demystify mental health

What would make it a stronger agenda? (cont.) Legislation supporting both public health and mental health Educating teachers about early identification and referral Full-time mental health provider in each school State guidelines for mental health in schools/school-based health centers Mechanisms for prioritization Research/Data More school-based health centers More school nurses

What would make it a stronger agenda? (cont.) Partnership between schools and community resources to reduce burden on schools Comprehensive models that include positive behavior support and integrate academic support Enhanced focus on prevention Mental health training in higher education curriculum for educators Coordination of efforts Communication systems for sharing information More consideration of diverse cultures State funding

Major Themes Memoranda of Understanding (MOUs) between schools and community providers promote mental health services in schools, but are often challenged by issues of FERPA/HIPAA. Schools need to be informed about issues of legality related to mental health services, in order to reduce the fear associated with addressing these issues.

Major Themes (cont.) Efforts to bridge the gap between educators and mental health providers, including role clarification and interdisciplinary training, is critical to breaking down communication barriers. Family organization and engagement needs to be strengthened in Oregon which includes schools adopting a family- centered approach.

Major Themes (cont.) There is a need for a public relations campaign to advance the school mental health agenda. All schools would benefit from at least one full- time, school-based mental health provider. Coordination of school and community-based mental health efforts is strengthened by the presence of a case manager or counselor familiar with the array of available services, as well as by the presence of behavioral teams involving multiple stakeholders.

Challenges  Public health and mental health in Oregon are not well coordinated at the state level, and the coordination varies greatly across regions. School-based health centers have been part of Oregon’s school mental health agenda, but have not systematically included mental health and have not always been promoted due to lack of funding and/or misconceptions about their purpose.

Challenges (cont.) Oregon’s school mental health efforts often exclude youth who do not receive Medicaid. There is significant difficulty recruiting and hiring a workforce that represents the community.

Challenges (cont.) Understanding what is happening in Oregon related to school mental health is challenging, and requires identifying “the right people”.  Despite several legislative and other efforts to advance evidence-based practices, there is not consensus on the definition of evidence-based practices and there is a lack of accountability and monitoring of the use of evidence-based practices.

Opportunities Oregon’s leadership in the “Wraparound” framework presents a critical opportunity to advance school mental health efforts, and serves as a model for successful youth and family engagement. A statewide summit of stakeholders, legislators, and policymakers would inform the decision-makers about best practices and resource allocation related to school mental health.

Opportunities (cont.) Increased partnerships between schools, families, and communities would strengthen school mental health efforts and reduce the burden on schools.  Youth engagement models, including a new model for “action research” could be applied to the school mental health field.  School-based health centers, funded through public health, reflect a model of coordinating between health and mental health.

Opportunities (cont.) Oregon has utilized several strategies to successfully meet the needs of students from diverse cultural backgrounds, including –hiring bilingual staff –using interpreters –conducting in-home parent and family mental health training to families with Limited English Proficiency –providing mental health training to front-line school staff –utilizing family resource centers and a home-school contact person. Oregon’s Positive Behavioral Supports and Response to Intervention efforts may be linked to offer a comprehensive model of school mental health.

Oregon Youth Discussion Groups

Youth Discussion Groups Purpose: To identify, from a youth perspective, the most effective strategies for providing mental health services in schools and for engaging youth in the development of school mental health policies and programs.

Youth Discussion Group: Method August 13, 2007 One 1.5-hour discussion group Six students; Grades 9-12; four schools Four students identified as having emotional disabilities Recruited from Oregon Family Support Network and Columbia River Wrap Around

Youth Discussion Groups: Process SAMPLE QUESTIONS: 1. How can adults at your school make all students feel supported both in school as well as other areas of their life? 2. What can schools do to better understand the different cultures or backgrounds a student comes from? 3. How well do you think that adults in your school respond to students with mental health problems?

Youth Discussion Groups: Major Themes School mental health prevention/promotion: Schools can improve the physical environment by making the school more colorful and the classroom more comfortable. Adults should not hold biases or judge youth. Teachers should engage students more in discussion. Teachers who speak more openly with students and ask questions seem to have a better understanding of cultures.

Youth Discussion Groups: Major Themes Staff Development: Adults have a better understanding of physical health problems than of mental health problems. Teachers should try to understand students with mental health problems. Adults should make sure that students with mental health problems don’t get picked on. Teachers should receive mental health training and have access to a mental health consultant.

Youth Discussion Groups: Major Themes Mental Health Services Barriers to accessing counseling services include: –not believing it is confidential –lack of availability of a professional –perception that counselors are for academic (not mental health) problems. Students would prefer to go to someone they trust to talk about a problem. Keeping confidentiality is important unless: –a student gives specific permission to tell someone, or –if student makes a direct threat to someone’s life or their own life.

Youth Discussion Groups: Major Themes Benefits of extracurricular activities include: –Feeling good about helping others –They have improved self esteem –Gaining a new perspective –Leadership Opportunities Students are more likely to participate in adult led activities when: –there are incentives (e.g. food, money, activities) –interactive activities –when their friends are participating

Laura Hurwitz Director, School Mental Health Programs , x toll free Bringing Health Care to Schools for Student Success