School Mental Health ASSIST

School Mental Health ASSIST
Équipe d’appui en santé mentale pour les écoles Mental Health Leaders’ Meeting January 13th, 2012

Agenda Ordre du jour Welcome and Overview Mot de bienvenue et aperçu Introductions Présentations School Mental Health ASSIST Équipe d’appui en santé mentale pour les écoles – aperçu Organizational Leadership Module Module sur le leadership organisationnel Lunch Déjeuner Dialogue Spaces Espace dialogues Learning Together Apprendre ensemble Mental Health Awareness Webinar Webinaire de sensibilisation en santé mentale Closing and Next Steps Prochaines étapes et mot de la fin 1/13/2012 School Mental Health ASSIST

Welcome! 1/13/2012 School Mental Health ASSIST

Key Messages to Take Away
This work is important. You are critical to its’ success. We are here to support you. Together, we will shape the future of school mental health in Ontario. 1/13/2012 School Mental Health ASSIST

This Work is Important 1 in 5 students – the need is great Educators feel ill-prepared to deal with the magnitude of the problem (Taking Mental Health to School, 2009) Schools are an optimal place to promote student well-being, and to identify and support students who struggle with mental health and addictions - but resources and supports are required The province is committed to working collaboratively across Ministries to support child and youth mental health in Ontario 1/13/2012 School Mental Health ASSIST

Our priorities for the next three years
Close Critical Service Gaps Increase availability of culturally appropriate services and serve more children and youth in Aboriginal, remote and underserved communities With complex mental health needs At the key transition point from secondary to post-secondary education Identify & Intervene Early Provide tools and support to those in contact with children and youth so they can identify mental health issues sooner Provide resources for effective responses to mental health issues Build mental health literacy and local leadership Fast Access to High Quality Services Build capacity in the community-based sector Reduce wait times Meet community needs Link education, child and youth mental health, youth justice, health care, and the community Support System Change Support development of an effective and accountable service system for all Ontarians Build on efforts that promote evidence-informed practice, collaboration, and efficiencies Develop standards and tools to better measure outcomes for children and youth 1/13/2012 School Mental Health ASSIST

OVERVIEW OF THE MENTAL HEALTH AND ADDICTIONS STRATEGY FIRST 3 YEARS
Starting with Child and Youth Mental Health Our Vision: An Ontario in which children and youth mental health is recognized as a key determinant of overall health and well-being, and where children and youth reach their full potential. Provide fast access to high quality service Kids and families will know where to go to get what they need and services will be available to respond in a timely way. Identify and intervene in kids’ mental health needs early Professionals in community-based child and youth mental health agencies and teachers will learn how to identify and respond to the mental health needs of kids. Close critical service gaps for vulnerable kids, kids in key transitions, and those in remote communities Kids will receive the type of specialized service they need and it will be culturally appropriate THEMES INDICATORS Reduced child and youth suicides/suicide attempts Educational progress (EQAO) Fewer school suspensions and/or expulsions Decrease in severity of mental health issues through treatment Decrease in inpatient admission rates for child and youth mental health Higher graduation rates More professionals trained to identify kids’ mental health needs Higher parent satisfaction in services received Fewer hospital (ER) admissions and readmissions for child and youth mental health Reduced Wait Times Provide designated mental health workers in schools Implement Working Together for Kids’ Mental Health Hire Nurse Practitioners for eating disorders program Improve service coordination for high needs kids, youth and families Implement standardized tools for outcomes and needs assessment Amend education curriculum to cover mental health promotion and address stigma Develop K-12 resource guide for educators Implement school mental health ASSIST program &mental health literacy provincially Enhance and expand Telepsychiatry model and services Provide support at key transition points Hire new Aboriginal workers Implement Aboriginal Mental Health Worker Training Program Create 18 service collaboratives Expand inpatient/outpatient services for child and youth eating disorders Reduce wait times for service, revise service contracting, standards, and reporting Funding to increase supply of child and youth mental health professionals Improve public access to service information Pilot Family Support Navigator model Y1 pilot Increase Youth Mental Health Court Workers Provide nurses in schools to support mental health services Implement Mental Health Leaders in selected School Boards Outcomes, indicators and development of scorecard Strategy Evaluation INITIATIVES 7 1/13/2012 School Mental Health ASSIST

EDU Commitments Amend the education curriculum Develop a K-12 Resource Guide/Website Provide support for professional learning in mental health for all Ontario educators Implement School Mental Health ASSIST Fund and support Mental Health Leaders in 15 school boards Support Working Together for Kids’ Mental Health 1/13/2012 School Mental Health ASSIST

You are Critical to Our Success
Research highlights the importance of leadership in effective school mental health This leadership relies on key system mobilizers who create and sustain organizational conditions necessary for effective school mental health EDU has invested in you to serve this critical role 1/13/2012 School Mental Health ASSIST

We are here to support you
Leadership Modules Focus on implementation science and creating conditions for effective school mental health Mental Health Awareness & Literacy materials For system leaders For schools Communication tools for use in your board Ongoing implementation and coaching support via School Mental Health ASSIST 1/13/2012 School Mental Health ASSIST

Together, we will shape the future of school mental health in Ontario
Together, we will shape the future of school mental health in Ontario. We will be consulting with you, questioning with you, struggling with you, walking with you… to find the best ways to help all of Ontario students. 1/13/2012 School Mental Health ASSIST

Introductions Take 5 minutes to chat with your team What are the top concerns for your board right now (in the area of school mental health) What are your hopes for student outcomes resulting from the Mental Health and Addictions Strategy? Spokesperson will introduce team members and their roles, and will share board concerns and hopes Remember t/c participants Remember regional office leads 1/13/2012 School Mental Health ASSIST

Awareness, Strategy Selection & Implementation Support Team School Mental Health ASSIST Équipe d’appui en santé mentale pour les écoles Interactive Overview Interrupt! Ask Questions! Jot down questions for the parking lot (green for questions!)

Key Messages to Take Away
School Mental Health ASSIST… Is here to support you. 1/13/2012 School Mental Health ASSIST

Context Part of the Ministry of Education commitment to Open Minds, Healthy Minds Led by Special Education Policy and Programs Branch Contract with HWDSB to lead the initiative benefits from real-world proximity to issues and challenges of implementation Hospital for Sick Children & Ontario Centre of Excellence for Child and Youth Mental Health are key partners involved in resource development, resource sharing, and implementation support 1/13/2012 School Mental Health ASSIST

Working in close relationship with SEPPB School Mental Health ASSIST
Core Team School Mental Health ASSIST team includes: Director (Dr. Kathy Short) Co-Lead (John Malloy, Director of Education, HWDSB) Implementation Support Team: Dr. Bruce Ferguson, Dr. Ian Brown 2 additional team members joining soon Administrative Support (Ruth Millar) Working in close relationship with SEPPB (Barry Finlay, Maureen Cox, Trudy Blugerman, Mike Gildea, Paul Grogan, Caroline Hicks, Michel Laverdiere, Naila Manji, Caroline Parkin) 1/13/2012 School Mental Health ASSIST

School Mental Health ASSIST is…
Designed to help all school boards to support student mental health and well-being and address addictions - with particular focus in on 15 boards Focus on leadership, capacity-building, and implementation of evidence-based strategies Through hands-on, audience-specific resources & practical implementation support We are a provincial school mental health implementation support team Have a look at our draft Mission statement – suggestions? (pink) 1/13/2012 School Mental Health ASSIST

Rationale Great need – 20% with diagnosable disorder but larger number of students with problems that interfere with well-being and achievement 1/13/2012 School Mental Health ASSIST

Rationale, continued Schools play a critical role in supporting child and youth mental health and addressing addictions …but we can’t do it alone Taking Mental Health to School Recommendations Model Coordination and Leadership Enhance Mental Health Literacy Increase Access to Evidence Based Practices Provide Implementation Support Research points to the importance of dedicated implementation support for effective school mental health delivery 1/13/2012 School Mental Health ASSIST

Implementation Science
Implementation Research: A Synthesis of the Literature Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231). Download all or part of the monograph at: 1/13/2012 School Mental Health ASSIST

Elements of our Draft Vision
All boards (and, ultimately, all schools) will have a Mental Health and Addictions Strategy All boards will have structures and processes for implementation support All educators will use their enhanced mental health literacy to be the caring adults that students need… Have a look at our draft Vision statement – suggestions? (pink) 1/13/2012 School Mental Health ASSIST

This is complex work! Provincial Level (e.g., interministry coordination, SMH ASSIST) Board Level (e.g., MH Strategy, coordinated mental health literacy training, menu of evidence-based strategies) School Level (e.g., enhanced staff understanding of students with behavioral problems and helpful strategies, more accurate identification and referral, more caring adults) Student Level (e.g., enhanced sense of belonging, more help-seeking, stronger coping skills) Better mental health and academic outcomes 1/13/2012 School Mental Health ASSIST

So, how will we get there? Beginning with mental health awareness activities in ALL boards Deeper level of support in 15 boards Mental Health Leadership and Organizational Conditions for Effective School Mental Health Mental Health Literacy for Educators Implementation of Mental Health Promotion and Prevention Programming 1/13/2012 School Mental Health ASSIST

The Capacity-Building Continuum
Mental Health Awareness Mental Health Literacy Mental Health Expertise Strategies for providing basic mental health information, tailored for different school board audiences Strategies for providing deeper working knowledge for those who have a direct role in supporting student mental health Strategies for providing SMH professionals with the skills and knowledge to effectively provide evidence-based promotion, prevention, and intervention ALL SOME FEW Resources will be tailored to different education audiences (e.g., trustees, senior administrators, school mental health professionals, school administrators, school staff, parents, youth) 1/13/2012 School Mental Health ASSIST

School Mental Health ASSIST Activities for ALL Boards
Help ALL boards with school mental health awareness level initiatives Co-create awareness materials for leaders with CODE, OPSBA, etc. Prepare Webinar Series (District Level, School Level) Support Educator Guide Create on-line resource space Provide decision-making tools (e.g., educator mental health literacy selection guide) Facilitate MyHealth Magazine 1/13/2012 School Mental Health ASSIST

School Mental Health ASSIST Activities for 15 Boards
School Mental Health Awareness activities, PLUS: SMH Leadership Educator MH Literacy Implementation Support Modules on implementation science Menu of modules for school administrators Ongoing coaching re: strategy selection Modules on creating conditions for SMH Menu of modules for school staff Ongoing coaching re: implementation Support for conducting resource mapping Ongoing coaching re: progress monitoring and evaluation Support in developing a board MH Strategy SMH ASSIST learning network 1/13/2012 School Mental Health ASSIST

Types of Support Resources Needs Assessment / Resource Mapping Tools Communication Tools Mental Health Leadership Series Strategy Development Templates School Mental Health Literacy Series Menu of evidence-based programs… Ongoing coaching & implementation support Face-to-face, , telephone support Opportunities for networking across boards What else do you need? (yellow) 1/13/2012 School Mental Health ASSIST

Alignment of Ministry Initiatives
School Boards Health care settings Community MCYS/Centre Community-Based MH Workers Working Together SSLI MOHLTC Nurse Leaders MHA Nurses in DSB program SSLI EDU/ASSIST SMH ASSIST SSLI 1/13/2012 School Mental Health ASSIST Ontario Ministry of Education School Mental Health ASSIST

2011-2012 Tiered Support All Boards 2011-2012 Focus Boards Leadership
Materials created with key stakeholders (CODE, OPSBA) Capacity MH Awareness webinar Educator’s guide On-line resource for teachers Decision-making tools MyHealth Magazine Implementation Support Limited Q & A Leadership Mental Health Leaders Leadership Modules Alignment with Strategy initiatives Capacity MH Literacy modules for schools MH Expertise training, as needed Implementation Support Ongoing coaching / technical assistance ASSIST Learning Network Cross-ministerial alignment 1/13/2012 School Mental Health ASSIST

Highlights of the MH Leader Role
Provide leadership for school mental health and addictions in your board Help to create organizational conditions necessary for effective school mental health Through a resource mapping process, and consultation with stakeholders, create and enact a board mental health and addictions strategy Select, tailor, and implement mental health awareness and literacy resources Select, tailor, implement, and monitor mental health promotion/prevention programming 1/13/2012 School Mental Health ASSIST

General Timelines (nb. we are not all starting at the same place…)
Activity Broad Time Frame Leadership Module #1 January Individual Meeting with SMH ASSIST January - February Needs Assessment / Resource Mapping MH Awareness Activities (webinar, MyHealth) Leadership Module #2 February Leadership Module #3 March School Administrator MH Literacy April School Staff MH Literacy May Progress Review with SMH ASSIST June 1/13/2012 School Mental Health ASSIST

Monitoring and Evaluation
Recommended first step is a board needs assessment / resource mapping Baseline data collection for all boards (district level survey, brief, January) Proposing school, teacher, and ultimately student level data collection in focus boards – coming soon! Will be seeking your feedback along the way, and via year-end satisfaction measures 1/13/2012 School Mental Health ASSIST

What should/can we measure… - At the district level. - School level
What should/can we measure… - At the district level? - School level? - Teacher level? - Student level? 1/13/2012 School Mental Health ASSIST

We don’t have all of the answers
We don’t have all of the answers. To serve you best, we are working with LEADERS in the province, and beyond, to gather the best thinking on effective School Mental Health. That includes learning from you. 1/13/2012 School Mental Health ASSIST

Who should we consult with?
Interministerial Staff Team, Regional Offices Coalition for Child & Youth Mental Health Council for Ontario Directors of Education Chief Psychologists, Chief Social Workers MACSE, Principals’ Reference Group School Mental Health Research Advisors Researchers with experience in school mental health implementation, scale up, and evaluation National SBMHSA Consortium Educator Mental Health Literacy Roundtable Mental Health Literacy Experts in Ontario Who else should we be consulting with? (purple) 1/13/2012 School Mental Health ASSIST

When might we turn to YOU
When might we turn to YOU? List 1-3 areas in which you have developed some particular knowledge / expertise related to school mental health Like, Developing district infrastructure or protocols Working with community partners Supporting families in rural/remote communities Working with immigrant and refugee children Helping students with behavioral disorders Implementing evidence-based programs Working with FNMI communities Mental Health Literacy for Educators Suicide prevention…. Include your name! 1/13/2012 School Mental Health ASSIST

Learning Together Sign In Apply for Membership Home About Resources
Search Discussion Howdy, Stranger! It looks like you're new here. If you want to get involved, click one of these buttons! Sign In Apply for Membership Learning Together 1/13/2012 School Mental Health ASSIST

Contact ASSIST Kathy Short, Ph.D., C.Psych. Director, School Mental Health ASSIST , x2634 1/13/2012 School Mental Health ASSIST

Understanding Implementation in School Mental Health
Leadership Module #1 Understanding Implementation in School Mental Health 1/13/2012 School Mental Health ASSIST

Introduction Module #1 focus is on implementation Specifically, our role as leaders in implementation To begin, we need to understand our own biases about mental health, and change Changing values, not just behaviours To obtain the mental health outcomes we want for our students need to change the knowledge AND attitudes and values of adults who support students 1/13/2012 School Mental Health ASSIST

Case Study #1 and #2 1/13/2012 School Mental Health ASSIST

School Mental Health ASSIST (Fixsen)
Education Supports “For every increment of performance I demand from you, I have an equal responsibility to provide you with the capacity to meet that expectation” (R. Elmore, 2002) 1/13/2012 School Mental Health ASSIST (Fixsen)

Successful Districts Clear vision – we will do literacy, math, mental health this way Unwavering instructional/mental health leadership and support Good communication plan with consistent messages Effective supports in place to help Principals, teachers, and staff follow through and “do it” 1/13/2012 School Mental Health ASSIST (Fixsen) (c) Dean Fixsen and Karen Blase, 2004

Successful Districts Assure consistent supports across buildings Do not depend so much on unique principals or teachers who come and go Achieve more consistent student outcomes, across teachers, buildings, and years 1/13/2012 School Mental Health ASSIST (Fixsen) (c) Dean Fixsen and Karen Blase, 2004

Longitudinal Studies of Comprehensive School Reforms Evidence-based Actual Supports Years 1-3 Outcomes Years 4-5 Every Teacher Trained Fewer than 50% of the teachers received some training Fewer than 10% of the schools used the CSR as intended Every Teacher Continually Supported Fewer than 25% of those teachers received support Vast majority of students did not benefit Aladjem, D. K., & Borman, K. M. (2006, April). Summary of Findings from the National Longitudinal Evaluation of Comprehensive School Reform. Paper presented at the Annual meeting of the American Educational Research Association, San Francisco, CA. Vernez, G., Karam, R., Mariano, L. T., & DeMartini, C. (2006). Evaluating comprehensive school reform models at scale: Focus on implementation. Santa Monica, CA: RAND Corporation. Aladjem & Borman, 2006; Vernez, Karam, Mariano, & DeMartini, 2006

An intervention is one thing Implementation is something else altogether Like serum and a syringe Each is necessary Neither one is useful without the other 1/13/2012 School Mental Health ASSIST (Fixsen)

Formula for Success X = Good outcomes Effective intervention practices
Effective implementation practices = Good outcomes Disproportional Impact: Students benefit 8 to 12 times more 47

Actual Benefits IMPLEMENTATION Effective INTERVENTION NOT Effective
(Institute of Medicine, 2000; 2001; 2009; New Freedom Commission on Mental Health, 2003; National Commission on Excellence in Education,1983; Department of Health and Human Services, 1999) IMPLEMENTATION Effective NOT Effective Actual Benefits Inconsistent; Not Sustainable; Poor outcomes Effective INTERVENTION Poor outcomes; Sometimes harmful NOT Effective Poor outcomes 1/13/2012 School Mental Health ASSIST (Fixsen)

Letting it happen Recipients are accountable Helping it happen Making it happen Implementation Teams are accountable Based on Greenhalgh, Robert, MacFarlane, Bate, & Kyriakidou, 2004 49

Impl. Team NO Impl. Team Effective Effective use of Implementation Science & Practice IMPLEMENTATION INTERVENTION 80%, 3 Yrs 14%, 17 Yrs Balas & Boren, 2000 Fixsen, Blase, Timbers, & Wolf, 2001 Letting it Happen Helping it Happen 3X to 12X Return on Investment Balas & Boren, 2000 It takes an estimated average of 17 years for only 14% of new scientific discoveries to enter day-to-day clinical practice (Balas & Boren, 2000) Balas EA, Boren SA. Yearbook of Medical Informatics: Managing Clinical Knowledge for Health Care Improvement. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000. With the use of competent Implementation Teams, over 80% of the implementation sites were sustained for 6 years or more (up from 30%) and the time for them to achieve Certification was reduced to 3.6 years. Fixsen, D. L., Blase, K. A., Timbers, G. D., & Wolf, M. M. (2001). In search of program implementation: 792 replications of the Teaching-Family Model. In G. A. Bernfeld, D. P. Farrington & A. W. Leschied (Eds.), Offender rehabilitation in practice: Implementing and evaluating effective programs (pp ). London: Wiley.

Best Data Show These Methods, When Used Alone, Do Not Result In Uses of Innovations As Intended: Diffusion/ Dissemination of information Training Passing laws/ mandates/ regulations Providing funding/ incentives Organization change/ reorganization About 5% to 20% Return on Investment Paul Nutt (2002). Why Decisions Fail

and Use new Skills in the Classroom)
OUTCOMES (% of Participants who Demonstrate Knowledge, Demonstrate new Skills in a Training Setting, and Use new Skills in the Classroom) TRAINING COMPONENTS Knowledge Skill Demonstration Use in the Classroom Theory and Discussion 10% 5% 0% ..+Demo in Training 30% 20% …+ Practice & Feedback in Training 60% …+ Coaching in Classroom 95% The 2002 meta-analysis of training and coaching data by Joyce and Showers makes a compelling case for the need for skillful coaching. Only when training was accompanied by coaching in the service setting – in this case a classroom, was there substantial implementation in the practice setting. These findings move supervision from systems that monitor units of service, react to crises and advise around case specifics to active coaching systems that monitor adherence to evidence-based practices, are purposeful in developing practitioner skills and offer support in trying out new approaches during that “awkward stage” just after training. Joyce and Showers, 2002 52

Reliable Benefits Consistent uses of Innovations
Implementation Drivers Performance Assessment Systems Intervention Facilitative Administration Decision Support Data System Organization Drivers Coaching Training Competency Drivers Selection Integrated & Compensatory Adaptive Technical Leadership Drivers © Fixsen & Blase, 2008 53

System Reinvention Executive Management Team System Change
“External” System Change Support Executive Management Team Practice Informed Policy Adaptive Challenges Duplication Fragmentation Hiring criteria Salaries Credentialing Licensing Time/ scheduling Union contracts RFP methods Federal/ Prov. laws Policy Enabled Practice System Change Implementation Team Teachers Innovations Students (c) Dean Fixsen and Karen Blase, 2004 (c) Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008 54 54

System Reinvention EDU System Change School MH ASSIST Support
Practice Informed Policy Adaptive Challenges Duplication Fragmentation Hiring criteria Salaries Credentialing Licensing Time/ scheduling Union contracts RFP methods Federal/ Prov. laws Policy Enabled Practice System Change Board Implementation Team MH Leaders SMH Professionals Teachers

PACE Modules Effective Tiered implementation Teams Provincial ASSIST District MH Teams, with MH Leaders School MH Teams Homework Assignment  We will send a link to the modules Review and participate in on-line dialogue 1/13/2012 School Mental Health ASSIST

Move to Dialogue Spaces
Organizational Leadership Educator Mental Health Literacy Mental Health Promotion and Prevention Programming 1/13/2012 School Mental Health ASSIST

Dialogue Spaces A chance to share experiences and ideas A chance to ask questions and learn from each other 3 topics, groups of tables: SMH Leadership Educator Mental Health Literacy Implementation (Mental Health Promotion and Prevention Programming) 15 minutes per topic, then full group sharing 1/13/2012 School Mental Health ASSIST

Dialogue Questions What are you doing in this area now that you feel is working? What do you need in order to be more successful in this area? 1/13/2012 School Mental Health ASSIST

Learning Together Your Ideas?

How would you like to work and learn together?
Ideas for carrying the conversation, sharing ideas, across our boards Connecting individually with the implementation support team Main SMH ASSIST contact for each board? Is face-to-face visiting important to you? How can we make web-based learning most optimal for you? How would you like to provide feedback to us as things move forward? 1/13/2012 School Mental Health ASSIST

Mental Health Awareness Webinar
Positioning This Resource Effectively in your Board

Suggestions? How might the content be modified to meet the needs out there? How should boards consider offering this resource? 1/13/2012 School Mental Health ASSIST

With Your Board Team… What content needs to be tweaked for our purpose? Who should receive this? In which order should audiences receive this? How should this be delivered? Who should deliver it? Other questions we should ask… 1/13/2012 School Mental Health ASSIST

Closing and Next Steps And Thank You!

Resources Coming Your Way
Communication tools for your board Needs assessment/resource mapping tool Baseline District Survey District MH Awareness Webinar Mental Health Literacy Selection Guide MyHealth Magazine invitation Implementation Science Modules 1/13/2012 School Mental Health ASSIST

Next Steps Connect with ASSIST Implementation Team to schedule an individual meeting and begin the needs assessment process Complete the on-line implementation modules Decide how/with whom MH Awareness activities will be offered Attend leadership sessions #2 (February) and #3 (March) 1/13/2012 School Mental Health ASSIST

A visit to the Parking Lot
Burning Questions and Comments… Please complete the evaluation form Thank you! 1/13/2012 School Mental Health ASSIST

School Mental Health ASSIST

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