School-based Programs: A National Perspective School-Based Behavioral Health Conference Grantville, Pennsylvania, May 3 – 5 School-based Programs: A National Perspective Albert Duchnowski Albert Duchnowski, Ph.D. Research and Training Center for Children’s Mental Health Louis de la Parte Florida Mental Health Institute University of South Florida Tampa, Florida

School-based Programs: A National Perspective 2 Research and Training Center for Children’s Mental Health Web Address:

School-based Programs: A National Perspective 3 Presentation 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

School-based Programs: A National Perspective 4 Presently there is growing attention to the mental health needs of children And In school-based mental health programs Why? Current Conditions

School-based Programs: A National Perspective 5 Increasing prevalence Gaps in need and service Recognition of school as the children’s mental health system

School-based Programs: A National Perspective 6 Less than 30% who need it, get help 70% who get any help, get it from the school.

School-based Programs: A National Perspective 7 Time of Opportunity A Role for Everyone

School-based Programs: A National Perspective 8 Driving 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?

School-based Programs: A National Perspective 9 What Do We Want for the Kids and Families We 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

School-based Programs: A National Perspective 10 What is the Current Status of School-Based Mental Health? Fragmented Understudied Complicated funding mechanisms Competing conceptual models

School-based Programs: A National Perspective 11 Different Approaches for School-based Mental Health  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

School-based Programs: A National Perspective 12 Children Who Have Emotional and Behavioral Disorders Have Multiple and Complex Problems and Needs Education Mental Health Child Welfare Health Care Juvenile Justice Family Support

School-based Programs: A National Perspective 13 Changing Roles of Families Cause Patient Credible Informant Equal Decision-Making Partner Evaluator/Research Partner Policy Maker

School-based Programs: A National Perspective 14 Contrasting Perspectives in School Based Mental Health Education SystemMental 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

School-based Programs: A National Perspective 15 Competing Models of School Based Mental Health Programs

School-based Programs: A National Perspective 16 Prevention Treatment Maintenance Universal Selective Indicated Case Identification Standard Treatments for Known Disorders Compliance with Long- term Treatment After-care (Including Rehabilitation) (Goal: Reduction in Relapse and Recovery) Mental Health Spectrum

School-based Programs: A National Perspective 17 Indicated Prevention Selective 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), , American Psychological Association

School-based Programs: A National Perspective 18 Systems of Prevention Primary prevention (low-end need/low-cost per individual programs) Systems of Early Intervention Early-after-onset (moderate need, moderate cost per individual) Systems of Care Treatment of severe and chronic problems (high-end need/high cost per individual programs) Interconnected Systems Systems of Prevention Primary prevention (low-end need/low-cost per individual programs) Systems of Early Intervention Early-after-onset (moderate need, moderate cost per individual)

School-based Programs: A National Perspective 19 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 Supports

School-based Programs: A National Perspective 20 “No mass disorder afflicting humankind has been eliminated or brought under control by attempts at treating the affected individual, nor by training large numbers of individual practitioners” George Albee

School-based Programs: A National Perspective 21 How Do We Organize Services Universal Selective Indicated

School-based Programs: A National Perspective 22 The 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. 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.

School-based Programs: A National Perspective 23 The 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.

School-based Programs: A National Perspective 24 The Public Health Model 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.

School-based Programs: A National Perspective 25 The Public Health Model 3. Develop and Evaluate Interventions What works and for whom? Review literature on empirical based interventions and apply/adapt to local community needs.

School-based Programs: A National Perspective 26 The Public Health Model 4. Implementation monitoring and scaling-up Is it meeting the intended needs? Monitor interventions for proper implementation, scale- up interventions and measure impact.

School-based Programs: A National Perspective 27 Mental Health & Academics What is the relationship? Indirect Intervention Direct Intervention

School-based Programs: A National Perspective 28 Is anybody doing all of this?

School-based Programs: A National Perspective 29 What is Pennsylvania’s Vision? What is your part in creating the new service delivery system?

School-based Programs: A National Perspective 30 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 Process