MPER-CAMHPS School Mental Health Leadership Academy Session II January 15, 2008

Costs of Addressing Mental Health Services in Schools Many public funding sources tend to focus on remediation (e.g., juvenile justice and foster care) rather than supporting healthy development or preventive efforts State and Federal funding can be time-limited SAMHSA report (2006): the majority of MH funding came from special education dollars Medicaid billing can be problematic Time costs are often not included in estimates of the cost of an intervention

The Costs of NOT Addressing Mental Health in Schools National Longitudinal Transition Study-2 (Wagner & Cameto, 2004): 38% of youth with ED have been held back a grade at least once in their school careers Youth with ED are less likely to be taking occupationally specific vocational education than students in the general population Youth with ED are more likely than those with disabilities as a whole to be involved in bullying or fighting while coming to, being at, or going from school, either as victims or as perpetrators 44% are reported by parents to have been suspended in the current school year, which is more than twice the rate of suspensions of youth with disabilities as a whole (19%) Although on average, their reading and mathematics abilities are closer to grade level than those of youth with disabilities as a whole, they are more likely to receive poor grades.

The Costs of NOT Addressing Mental Health in Schools National Adolescent and Child Treatment Study (NACTS; Greenbaum et al., 1998): 66.5% of the children with ED in the study were reported to be involved in crimes in which they were the perpetrator 43.3% of children in the study were arrested at least once 49.3% made a court appearance before a judge, and 34.4% were adjudicated for a crime. Other studies demonstrate that, in general, youth with ED have more difficulty adjusting to the social demands of adult life than their typically developing or mildly- disabled peers, are more likely to be unemployed, and more likely to develop substance abuse problems (e.g., Frank, Sitlington, & Carson, 1995; Kauffman, 2001).

The Costs of NOT Addressing Mental Health in Schools APPROXIMATELY 50% OF STUDENTS WITH ED DROP OUT OF SCHOOL! Health-related losses for the estimated 600,000 high school dropouts in 2004 totaled at least $58 billion, or nearly $100,000 per student. High school dropouts have a life expectancy that is 9.2 years shorter than that of graduates. Increasing the high school completion rate by 1% for men ages 20 to 60 could save the U.S. up to $1.4 billion a year in reduced costs from crime. A one-year increase in average years of schooling for dropouts correlates with reductions of almost 30 % in murder and assault, 20% in car theft, 13% in arson, and 6% in burglary and larceny.

Expanded System of Positive Behavior Supports Universal: Programs that focus on reducing risk factors and increasing protective factors (e.g., coping skills) Selected: Programs that target students who exhibit social and emotional concerns or early stages of mental illness, but who function well in many social and academic activities Targeted: Programs that target students with mental illness or multiple mental health concerns that make functioning at school extremely difficult

Universal Example The Good Behavior Game Teacher sets expectations for behavior Students work in teams during game time Teams receive a check if displaying inappropriate behavior If at “end” of game the team has not received the maximum checks, members receive a reward Teacher eventually begins the game with no warning

Selected Example First Step to Success Universal screening and early detection of antisocial behavior (kindergarten) School and home interventions Trained consultant works with teacher and parents (weekly home visits) Minimum 2 months for student to complete Frequent monitoring and rewards initially, then faded over time

Targeted Example Early Risers For high risk children—children who have exhibited aggressive and disruptive behavior (conduct disorder) Teaches self-regulation, positive peer affiliation, positive attitude toward learning, problem-solving, assertive communication, constructive coping Parent component Training = 3-4 days at a cost of $7000 Use of trained family advocate Intensive summer program

Table Talk: Pros & Cons What are the pros and cons of using a curriculum-based prevention program? What are the pros and cons of having outside providers bring prevention programs into your school? What are the pros and cons of spending valuable resources (money and time) on early childhood prevention efforts?