School Mental Health Capacity Building Partnership* Missouri Stakeholder Discussion Groups Bringing Health Care to Schools for Student Success *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 (SEA’s and LEA’s)”

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

Goal 2 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 Provide technical assistance, resources and professional development to aid SEA’s and LEA’s in implementing effective school mental health programs.

Statewide Stakeholder Discussion Groups: PURPOSE to help identify successes and lessons learned in “early adopter” states -- at both the state and local levels -- related to school mental health policies, programs and services.

Statewide Stakeholder Discussion Groups: PROCESS 4 “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

Stakeholder Discussion Groups: Ohio: December 2006 Maryland: February 2007 Missouri: April and May 2007 Oregon: August 2007

Missouri School Mental Health Stakeholder Discussion Groups

Process: Adult Discussion Groups May 10 th and 11 th, 2007 Three 2-hour discussion groups 30 total participants –Mental Health: 6 –Education: 11 –Health: 4 –Family members/advocates: 3 –Youth development: 6

Results Responses to Questions –Themes –Key Quotations Challenges Opportunities

Participant awareness of Missouri’s vision or agenda for school mental health No –Most participants indicated no awareness of a statewide vision or agenda for school mental health. –State level efforts to develop a school mental health agenda are not filtered down to the local level. –Local groups and initiatives have distinct and different visions, and they are not statewide.

Yes –Collaborative effort among many agencies and services associated with children and mental health to bring a continuum of high quality mental health services to children and families. –Federal legislation has created mandates that support an agenda for school mental health.

Yes –There are several statewide initiatives in Missouri have advanced a vision of school mental health including: Healthy Minds, Healthy Learners, Healthy Schools Project Caring Communities Transformation Grant Safe Schools Grant (Springfield) Systems of Care sites Council on Adolescent School Health (CASH); and Bright Futures Initiative Center for the Advancement of Mental Health Practices in Schools

What would make it a stronger agenda? Increased, sustainable funding More service providers in schools Improved pre-service training for educators and mental health providers Family engagement

What would make it a stronger agenda (cont.)? Legislation to allow community mental health agencies to provide services in schools School-based health centers Increased collaboration/partnership of agencies/schools/families Awareness of research supporting link between mental health and academic success

What would make it a stronger agenda? (cont.) Better integration of health and mental health Increased coordination between DESE and DMH Increased school buy-in Policy, legislative support and supportive certification Mental health resources for youth in juvenile justice Increased substance abuse education/prevention

Major Themes There is not a commonly understood or agreed upon statewide vision or agenda for school mental health There is a lack of coordination between state departments of education and mental health, difficulties filtering information from the state to local levels, and to the local (versus state) control of school mental health efforts. Specific grants and initiatives have helped to advance the vision of school mental health in Missouri.

Major Themes (continued) Enhanced awareness of the evidence linking student mental health with academic success would support the advancement of school mental health. Successful school mental health requires increased family and youth involvement in all levels of program planning and implementation.

Major Themes (continued) Interagency meetings are essential in ensuring successful coordination of mental health services and understanding of roles and responsibilities. Pre-service training for educators and mental health professionals, standards for professional certification and competency, and accountability mechanisms are critical to building the school mental health capacities of the education system.

Challenges Lack of feasible, sustainable funding models to support comprehensive school mental health services. Lack of quality, interdisciplinary pre- service training for mental health providers and educators. (Limited mechanisms for quality control in credentialing and service delivery add to this problem.)

Challenges (continued) The lack of state standards for school social workers, and the absence of school mental health from the Missouri School Improvement Plan are major obstacles to successful school mental health in the state. Lack of mechanisms to allow community mental health agencies to provide services in schools.

Challenges (continued) Lack of school buy-in for the importance of mental health. Educators and school administrators are over-burdened, and may not recognize the importance of mental health efforts in achieving academic success. Lack of meaningful family and youth engagement in school mental health efforts due to limited training opportunities, barriers to involvement (e.g., transportation, meeting times, language), and poor outreach.

Challenges (continued) Efforts to meet the needs of students from diverse cultural backgrounds have been difficult related to challenges hiring staff that reflects the race and ethnicity of the client population, and challenges implementing effective, up-to-date training on multiculturalism and diversity. Requirements to use evidence-based practices in schools raise problems including exclusion of effective practices that lack research funding and support and the difficulties associated with implementing programs with fidelity in schools.

Opportunities Missouri’s efforts to develop core mental health competencies for educators and to embed this into the education curriculum reflects its significant progress in developing a teacher workforce equipped to address mental health issues in schools. Missouri’s Senate Bill 1003 offers legislative support for providing coordinated mental health services to youth in a public health framework.

Opportunities (continued) Missouri’s Bright Futures Project serves as a model of interdisciplinary training approach that bridges education, health and mental health utilizing a statewide dissemination mechanism via regional professional development training. With enhanced understanding about the benefits of school-based health centers in improving both student health and mental health, Missouri may consider enhancing support and resources for the development of school-based health centers in the state.

Opportunities (continued) Despite not being funded as a Coordinated School Health Program (CSHP) state, Missouri has embraced the CSHP model in its school assessments and service delivery, reflecting a connection between health and mental health; Being funded as a CSHP state would likely add emphasis to the model and provide further momentum.

Opportunities (continued) Missouri’s Center for the Advancement of Mental Health Practices in Schools (CAMHPS) serves as a central point in the state for accessing resources and advancing a statewide vision for school mental health. Missouri has several good examples of formal evaluations used to assess the effectiveness of school mental health efforts in the state including PBIS, Head Start, Bright Futures, Big Brothers Big Sisters, and Systems of Care.

Missouri 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 March 15, 2007 and April 15, 2007 Two 1.5-hour discussion groups Moberly High School –Five participants, ages –two African-American, three Caucasian –Recruited though assistant principal University Behavioral Health –Four participants, ages –Students with emotional disabilities

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 Students believe that confidentiality is important. Extracurricular activities provide positive outlets for students. Teachers and other school personnel have a negative attitude toward mental health issues and students that have mental health problems. Opportunities to discuss mental health as a whole school need to be provided

Youth Discussion Groups: Findings (cont.) Barriers to Accessing Counseling Services include: being afraid, counselors not having the time, teachers not letting students leave class Trust Issues – Students think that trust is an important issue when relating to school personnel and reciprocal trust is needed. Special Attention – School personnel should give special attention to students with health/mental health issues.

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