1. Addressing Noncognitive Barriers to Learning Carl E. Paternite, Center for School-Based Mental Health Programs (Miami University) and the Ohio Mental Health Network for School Success Diana Leigh, Center for Learning Excellence (The Ohio State University) and the Ohio Mental Health Network for School Success Kay Rietz, Ohio Department of Mental Health (Columbus) Terre Garner, Ohio Federation for Children’s Mental Health (Cincinnati) David Estrop, Superintendent, Lakewood City School District (Lakewood) 2004 Capital Conference Columbus, Ohio November 9, 2004

4. To help Ohio’s school districts, community-based agencies, and families work together to achieve improved educational and developmental outcomes for all children — especially those at emotional or behavioral risk and those with mental health problems. Mission

5. The Ohio Mental Health Network for School Success Action Agenda Create awareness about the gap between children’s mental health needs and “treatment” resources, and encourage improved and expanded services (including new anti-stigma campaign). Partner with regional action networks to enhance within-region implementation of the action agenda, actively soliciting student and family input. Also, contribute to statewide efforts (e.g., training institutes, workshops, research, etc.). Conduct surveys of mental health agencies, families, and school districts to better define the mental health needs of children and to gather information about promising practices.

6. The Ohio Mental Health Network for School Success Action Agenda (continued) Provide training and technical assistance to mental health agencies and school districts, to support adoption of evidence-based and promising practices, including improvement and expansion of school-based mental health services. Develop a guide for education and mental health professionals and families, for the development of productive partnerships.

7. The Ohio Mental Health Network for School Success Action Agenda (continued) Assist in identification of sources of financial support for school-based mental health initiatives. Assist university-based professional preparation programs in psychology, social work, public health, and education, in developing inter-professional strategies and practices for addressing the mental health needs of school-age children.

8. School-Based Mental Health Full array of mental health care for youth in special and regular education –Screening and assessment –Treatment –Case management –Prevention (all levels) –Mental health promotion Related Services –Classroom observation –Consultation –Training with school staff, families, and community members –School wide initiatives (e.g., media, outreach, climate)

9. SBMH and the No Child Left Behind Mandate: Two Important Goals— Achievement and Wellbeing  1) Achievement promotes wellbeing  2) Wellbeing promotes achievement  School philosophy often acknowledges 1 but fails to acknowledge 2 (CSMHA)

10. School Effectiveness in Promoting Achievement and the NCLB Mandate Least effective: Limited focus on academic and nonacademic barriers More effective: Focus on academic barriers Most effective: Integrated Focus on academic and nonacademic barriers (CSMHA)

12. Non-academic barriers to learning exert a powerful negative influence Environmental –Poor nutrition –Family stress –Family conflict –Peer influences –Exposure to violence –Abuse, Neglect –Poor school environment Personal –Attentional difficulties –Behavioral problems –Depression –Anxiety –Social problems –Trauma reactions (CSMHA)

13. See Handout

15. Report of President’s New Freedom Commission on Mental Health http://www.mentalhealthcommission.gov “…the mental health delivery system is fragmented and in disarray…leading to unnecessary and costly disability, homelessness, school failure and incarceration.” Unmet needs and barriers to care include (among others): Fragmentation and gaps in care for children. Lack of national priority for mental health and suicide prevention. July, 2003

16. The Crisis of Youth Mental Health About 20% of youth, ages 9 to 17 (15 million), have diagnosable mental health disorders, (and many more are at risk or could benefit from help) Between 9-13% of youth, ages 9-17 years, meet the federal (not special ed.) definition of serious emotional disturbance (SED)

17. The Crisis of Youth Mental Health Less than 30% of youth with diagnosable disorder receive any service, and, of those who do, less than half receive adequate Tx (even fewer at risk receive help) For the small percentage of youth who do receive service, most actually receive it within a school setting.

18. New Freedom Commission on Mental Health Goal 4: Early Mental Health Screening, Assessment, and Referral to Services are Common Practice 4.1 Promote the mental health of young children. 4.2 Improve and expand school mental health programs. 4.3 Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies. 4.4 Screen for mental disorders in primary health care, across the lifespan, and connect to treatment and supports.

19. New Freedom Commission on Mental Health Critical importance of partnership with schools in mental health care: “The mission of public schools is to educate all students. However, children with serious emotional disturbances have the highest rates of school failure. Fifty percent of these student drop out of high school, compared to 30 percent of all students with disabilities. “ “While schools are primarily concerned with education, mental health is essential to learning as well as to social and emotional development. Because of this important interplay between emotional health and school success, schools must be partners in the mental health care of our children.” July, 2003, p. 58

20. SBMH Advantages Access to youth Reduced stigma; Increased youth/family comfort Outreach to youth with “internalizing” problems Enhanced ability to promote generalization Enhanced capacity for prevention/MH promotion

21. SBMH Advantages Moves toward MH—Education systems integration, providing critical support to education, and enhancing access to youth for mental health care Expands and connects education and mental health knowledge bases and promotes interdisciplinary collaboration Assists in the development and delivery of a true system of care

22. SBMH Impacts/Outcomes Based on growing knowledge base, there is evidence that SBMH, when done well –Assists in reaching underserved youth –Is associated with strong satisfaction by diverse stakeholder groups (e.g., teachers, students, families) –Improves student outcomes (e.g., behavior, attendance, connectedness to school, school success) –Improves school outcomes (e.g., climate, special education referrals)

23. In Schools Without SBMH Barriers to mental health care are more pronounced There are pressures to increase referrals to special education for students to receive MH care MH care within special education is generally very far from achieving principles associated with best practice, including: –short latency between referral and treatment –treatment by well trained providers –adequate duration of treatment –connection of treatment to quality improvement and empirically supported practice Reduced effectiveness in fulfilling the mandates of NCLB

24. In Addition to Parents, Teachers are on the Mental Health “Front Line” Yet, teachers/educators are very poorly trained in problem recognition and mental health promotion Significant need to enhance teacher/educator training based on analysis of issues confronted in the classroom/school Related significant need to enhance training of mental health professionals to prepare them to engage with educators and function effectively in/with schools

25. Ohio’s Mental Health, Schools, and Families Shared Agenda Initiative http://www.units.muohio.edu/csbmhp/sharedagenda.html Phase 1—Statewide forum for leaders of mental health, education, and family policymaking organizations and child-serving systems (March 3, 2003) Phase 2—Six regional forums for policy implementers and consumer stakeholders (April-May, 2003) Phase 3—Legislative forum involving key leadership of relevant house and senate committees (October 9, 2003) Phase 4—Ongoing policy/funding advocacy and technical assistance to promote attention to the crucial links between mental health and school success

27. Guiding Principles for a Mental Health,Schools, Families Shared Agenda Mental health is crucial to school success There are shared opportunities for mental health, schools, students and families to work together more effectively See Handout - Shared Agenda Report

28. Legislative Forum On Mental Health and School Success Creating A Shared Agenda In Ohio October 9, 2003

31. Comments from Legislators Following the Testimony From Representative Joyce Beatty (Member House Education Committee) In a question/challenge to fellow legislative panelists: “Is there legislation that we should be looking at?” From Representative Arlene Setzer (Chair, House Education Committee) In response to Representative Beatty: “During this whole process I was also taking notes…because, as you indicated there have been some specifics provided to us which we truly need many times when looking at legislation…as most of you know currently the House and the Senate are working on Senate Bill 2 which is for…teacher success and identifying highly qualified teachers...I am going to guide that discussion around some of the things that I have heard today about the idea that teachers need to understand regardless of what their teaching assignment might be…”

32. Comments from Legislators Following the Student Testimony From Senator Bill Harris (Chair, Senate Finance Committee) “…I listened to the very brave and courageous young people tell us about things of their life. And as you were explaining that to us I am thinking about my sons, I am thinking about my grandchildren, I am thinking about other people that I know and some of the struggles that they have…” From Representative Joyce Beatty (Member, House Education Committee) “…All of the student panel members, I don’t think I have ever heard anything so compelling and moving and informative and educating in my entire life. So let me say to you thank you and let me give it to you with that smile that can be comforting because you have helped us…”

33. Phase 4: An Immediate Legislative Outcome Senate Bill 2 Section 3319.61(E) (effective June 9, 2004) “The standards for educator professional development developed under division (A) (3) of this section shall include standards that address the crucial link between academic achievement and mental health issues.”

34. One of Several Phase 4 Steps for Ohio’s Shared Agenda Initiative Expansion of Ohio’s Positive Behavior Support Initiative will continue through collaborative efforts of: Special Education Regional Resource Centers The Ohio Association of Elementary School Administrators The Ohio Association of Secondary School Administrators

36. Mental Health and School Success Websites National: National Association of State Directors of Special Education (www.nasdse.org) Center for School Mental Health Assistance (CSMHA, http://csmha.umaryland.edu) Center for Mental Health in Schools (http://smhp.psych.ucla.edu) Ohio: Center for School-Based Mental Health Programs (http://www.units.muohio.edu/csbmhp) Center for Learning Excellence, Alternative Education and Mental Health Projects (http://altedmh.osu.edu/omhn/omhn.htm) Ohio’s Shared Agenda Initiative (http://www.units.muohio.edu/csbmhp/sharedagenda.html)

37. This PowerPoint Presentation is posted on Ohio’s Shared Agenda website http://www.units.muohio.edu/csbmhp/sharedagenda.html