1. Wisconsin School Mental Health Project Steve Fernan-Assistant Director Student Services Team Wisconsin Department of Public Instruction Coming Soon!

2. Wisconsin Youth Risk Behavior Survey (2013) Percentage of students who felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months Sad/Hopeless = 24.6%

3. CDC: 1 in 5 children have a mental health disorder

4. Up to 1 of 5 children experience a mental disorder in a given year (Perou et al., 2013) In Wisconsin, that would mean as many as 174,000 school-age children last year WI DPI (2015)

5. 60-90% of children with mental health disorders do not receive treatment In Wisconsin that means between 104,000 – 157,000 School-age children with a diagnosable mental health disorder do not receive treatment yearly

6. Of the 10 – 40% who do receive treatment About ¾ of children & youth receiving mental health services get these services in schools only Burns et al., 1995

7. Disproportionate Access to Care …have disproportionately poor access to mental health care (including challenges in cultural competency of providers) Children of color Children of poverty Sexual Minority Adolescents

8. Shortages of Mental Health Providers in Schools Pupil Services Wisconsin Pupil Services Ratios 2012 [data from Department of Public Instruction National Organization Recommendations School Counselors 466:1250:1 School Psychologists 956:1500-700:1 School Social Workers 1,050:1250:1 School Nurses 1,596:1750:1* * 750 to 1 for students in the general population, 225 to 1 in the student populations requiring daily professional school nursing services or interventions, 125 to 1 in student populations with complex health care needs, and 1 to 1 may be necessary for individual students who require daily and continuous professional nursing services (National Association of School Nurses, 2010)

9. Shortages of mental health providers in communities NPPES, 2013

10. Cost of Depression and Schizophrenia: Children and Adults “The annual cost to society associated with depression has been estimated that $30 billion to 44 billion in the US annually (800 million Wisconsin projection)” “Similarly, the total annual costs associated with schizophrenia in the US has been estimated at 62.7 billion ($1 billion Wisconsin projection)”

11. Is Suicide A Problem? 11 CDC – WSQARS Fatal Injury Data (age 5-19) 2000-2013 (accessed 9/2015)

12. Let’s look at those youth suicides 12 533 Males, 130 Females (greater than a 4:1 ratio) Firearms consists of about half of the deaths (302) –Of those 302, more than 90% (272) were males Suffocation resulted in 274 deaths –Of those 274, more than 74% (203) were males –Suffocation is the highest manner of death for females (71) Other methods include poisoning, falls (jumps), motor vehicles CDC – WSQARS Fatal Injury Data (age 5-19) 2000-2013 (accessed 9/2015)

13. US vs. WI: 13 In the U.S Suicide is #3 cause ages 5 - 19 Causes 10% of all deaths In Wisconsin Suicide is #2 cause ages 5 - 19 Causes about 14% of all deaths CDC – WSQARS Fatal Injury Data (age 5-19) 2000-2013 (accessed 9/2015)

14. Some Hypotheses… 14 Drinking: lower inhibition, alter judgment –Highest rate of youth binge drinking in US Availability of Lethal Means –12th highest gun ownership rate—44% Mental Health Service Availability –8.2 Child/Adolescent Psychiatrists/100,000 youth vs. recommended 14 Stigma…  as cited in Miller, 2007  Moreno, C. et. al. (2007) Arch. Gen Psychiatry 64:1032-1039

15. Wisconsin School Mental Health Project Coming Soon! 1.To improve student mental health by participating in the Wisconsin School Mental Health Framework. 2. Because improving mental health improves student learning. 3. Because focusing on mental health improves conditions for teachers. 4. Because all children and youth deserve it and are entitled to it.

16. An Aspirational Vision Children are entitled to special care and assistance…the child should be fully prepared to live an individual life in society, and to be brought up in the spirit of…peace, dignity, tolerance, freedom, equality and solidarity. The education of the child shall be directed to…the development of the child's personality, talents and mental and physical abilities to their fullest potential. UN Declaration on the Rights of the Child “Every child is safe, nurtured, and supported to promote optimal health and well-being.” Wisconsin Office of Children’s Mental Health “All Wisconsin children will graduate from high school academically prepared and socially and emotionally competent…These proficiencies/attributes come from rigorous, rich, and well-rounded school experiences.” Wisconsin Department of Public Instruction, Agenda 2017

17. Psychological Testing Juvenile Courts Environmental Health Crime Prevention After-school Programs Special Education Physical Education Child Protective Services Social Services School Safety Pupil Services Nutrition Education Immunizations Staff Wellness School Food Services Drug Prevention Health Services Pregnancy Prevention Clinic HIV/STD Prevention Health Education Drug Services Smoking Cessations Counseling An Example of a Typical School Community Organizations Mental Health Services

18. Thank you for coming! But how?

19. Thank you for coming! But how?

20. Capacity building project 3 years 50 school-communities Inquiry-based professional development journey Thank you for coming! So what’s the plan? Wisconsin School Mental Health Project Suicide Prevention AODA Prevention Safe & Supportive Schools CLC Wisconsin School Mental Health Project Project AWARE Safe Schools / Healthy Students Trauma Sensitive Schools Positive Behavioral Intervention and Supports What is the context? Advocacy for Children’s Mental Health Wisconsin School Mental Health Framework Climate Transformation Safe Schools/Healthy Students AWARE Emergency Management Inquiry Based Professional Development

21. Making Connections COMPONENTS OF A MULTI LEVEL SYSTEM OF SUPPORT Effective Instruction Student and Teacher Relationships Family and Community Engagement School and Instructional Leadership Continuum of Supports Strong Universal Implementation Culturally Responsive Evidence-Based Practices Positive School Culture & Climate Youth, Family and Community Engagement Data-based Continuous Improvement Integrated Leadership Teams Systemic Professional Development & Implementation Staff Mental Health Attitudes, Competencies & Wellness Confidentiality & Mental Health Promotion Policies Effective Implementation Implementation Leadership

22. Three Models of Service Delivery 1 Mental Health Services Delivered by Pupil Services Providers with Referral to Community-Based Providers Designed and implemented by school-employed mental health providers Referred to community-based services

23. 2 Satellite Clinics Co-Located in Schools and Pupil Services Providers Satellite clinic school-employed mental health providers

24. Satellite Clinics Co-Located in Schools Mental (behavioral) health or substance abuse treatment Medicaid-enrolled provider, Licensed by WDSPS Working in a Medicaid-enrolled & DHS Chapter 35-certified mental health outpatient clinic DHS approved satellite clinic co-located in a school through MOU with local school district

25. 3 Community-Based Mental Health Service Providers as Full Collaborative Partners

27. Wisconsin School Mental Health Framework Available soon for ALL Wisconsin Schools Coming Soon!

28. Collaboration is the Key

29. Thank You Steve Fernan Assistant Director-Student Services Team Wisconsin Department of Public Instruction 608-266-3889 Steven.fernan@dpi.wi.gov