1. Leading for Effective School Mental Health
School Mental Health ASSIST
Summit on Children and Youth Mental Health 2012

2. Session Agenda Activity Time Frame Overview Presentation – SMH ASSIST
10:00-10:45
Top 10 Carousel Rotation #1 – MH Leaders
10:50-11:20
Top 10 Carousel Rotation #2 – MH Leaders
11:25-11:55
Lunch
12:00-12:55
Top 10 Carousel Rotation #3 – MH Leaders
1:00-1:30
Top 10 Carousel Rotation #4 – MH Leaders
1:35-2:05
Closing Keynote - Dr. John Malloy
2:15-3:00

3. With an elbow partner, or two…
LEADERSHIP
With an elbow partner, or two…
What does effective leadership look like at a School or Board level?
Paint a Picture…

4. Ontario Leadership Framework
Leadership is a lever to support large scale system improvement to enhance achievement and well-being. The Ontario Leadership Framework is relevant to our work with student mental health and well-being.

5. Ontario Leadership Framework
5 Domains:
Setting Directions
Building Relationships and Developing People
Developing the Organization
Leading the Instructional Program
Securing Accountability
5 Core Leadership Capacities:
Promoting Collaborative Learning Cultures
Aligning Resources with Priorities
Using Data
Setting Goals
Engaging in Courageous Conversations

6. What are some of the qualities of an effective leader?
Jot down a few ideas….
What are some of the qualities of an effective leader?
Which of these do you possess, and value most strongly?

9. Overview The Promise of School Mental Health
Provincial, National and International Initiatives
Acknowledging Past (and present) Challenges
Ontario’s Mental Health & Addictions Strategy
School Mental Health ASSIST
Top 10 Conditions for Effective School Mental Health

10. The Promise of School Mental Health

11. Mental Health is…
“A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”
World Health Organization

12. Mental Health Exists on a Continuum

13. Mental Health Problems are Common
Roughly one in five students in Canadian schools struggle with a mental health problem that interferes with their day to day functioning.

14. What are Mental Health Problems?
Mental health problems are emotional, behavioural and brain-related disturbances that interfere with development, personal relationships, and functioning Disturbances that are severe and persistent enough to cause significant symptoms, distress, and impairment in one or more areas of daily life are termed mental health disorders/mental illness.

15. Mental Health Problems include a Range of Difficulties
Mental health problems are characterized by
many different signs and symptoms,
and present in various forms
Some mental health problems manifest outwardly (externalizing)
Students appear aggressive, impulsive, non-compliant
Some mental health problems manifest inwardly (internalizing)
Students appear withdrawn, lonely, anxious, depressed

16. The Good News Proven strategies and supports
Psychosocial and pharmacological treatments are most common, and are often used together
While many mental disorders are chronic, we can help with coping
Early identification and intervention improves prognosis

17. But Most Do Not Receive the Help They Need
Up to 80% of children and youth who experience a mental health problem will not receive treatment
Major barriers include:
Lack of, difficulty accessing, or long waitlists for local services
Stigma
Misidentification or lack of
identification of symptoms

18. Schools Have a Unique Opportunity
Schools are an optimal setting in which to:
Reduce stigma
Promote positive mental health
Build student social-emotional learning skills
Prevent mental health problems in high risk groups
Identify students in need
Build pathways to care

19. School Mental Health is Not New…
Schools and communities in Canada and elsewhere have been dealing with these issues for decades
Inconsistent, fragmented approaches, with pockets of excellence…
What’s new is the galvanizing of research, policy and practice to reach an integrated solution to a complex problem

20. National, International, & provincial initiatives
Moving Forward on the Promise of School Mental Health

21. OUT OF THE SHADOWS AT LAST The Honourable Michael J. L. Kirby, Chair
The Standing Senate Committee on Social Affairs, Science and Technology
The Honourable Michael J. L. Kirby, Chair
May 2006
Making the school a site for the effective delivery of mental health services involves several key steps.  First, its potential must be recognized.

22. National Initiatives Related to School Mental Health
School-Based Mental Health & Substance Abuse Consortium
Canada’s Mental Health Strategy (MHCC)
Evergreen
National Infant Child & Youth Mental Health Consortium
Opening Minds
Joint Consortium for School Health
Public Health Agency of Canada
Canadian Association for School Health
Health Canada
Canadian Centre for Substance Abuse

23. SBMHSA Consortium
40 member team of researchers, education professionals, school mental health professionals, etc.
3 year project
Led by Ontario Centre of Excellence for Child & Youth Mental Health
Synthesis of Research
Scan of Nominated Practices
National Survey
Findings:
Research gives us clear direction
Programming does not consistently reflect research
Organizational and systemic barriers impede

24. International Initiatives in School Mental Health
International Alliance for Child and Adolescent Mental Health in Schools (Intercamhs)
US – Canada Alliance for School Mental Health
SBMHSA webinar - international initiatives (Aus, Germany, US)
Advances in School Mental Health Promotion
Key international conferences featuring School Mental Health
17th Annual Conference on Advancing School Mental Health, October 25-27, Salt Lake City, Utah --- see Mark Weist at CMHO!
26th Annual Children’s Mental Health Research and Policy Conference, March 3-6, Tampa, Florida

25. Provincial Initiatives in School Mental Health
Emergence of government strategies (e.g., BC, MN, NS, ON)
Development of provincial coalitions (e.g., BC, ON)
Funded provincial initiatives related to mental health capacity building (e.g., AB, QB, NS, ON)
Cross-sectoral initiatives, infrastructure, protocols (e.g., BC, NB, ON)
Student mental health in provincial curriculum

26. Acknowledging challenges
Learning from past and present

27. Taking Mental Health to School
Different models of mental health service delivery across Ontario boards (Taking Mental Health to School, 2009)
Variable leadership structures, levels/types of professional support, relationship with community, range of services
Acknowledgement of promising supports (e.g., Student Support Leadership Initiative)
Need for
leadership,
coordination,
access to evidence-based approaches,
implementation support,
evaluation

28. Past (present) Systemic Challenges
School boards are complex systems
Infrastructure, processes and protocols lacking
Lack of clarity re: roles and responsibilities
Special services are…special
Inconsistencies across Boards with respect to:
Leadership
Programming
Funding
Access to services
Collaboration
Structural Challenges

29. Past (present) Systemic Challenges
Mental Health is not well understood
Not traditionally part of educator training
PD as a “one time event”
Links to high pressure achievement agenda unclear
Stigma, Attitudinal Biases
Discomfort and fear
Sometimes seen as outside of educator role
Worry about making a mistake, getting too close
Knowledge Challenges

30. Mental Health Literacy
Concern about Mental Health…
Educator Preparedness…

31. Past (present) Systemic Challenges
Inconsistent access to high-quality programming
Evidence-based programs are expensive
Regional differences (in services, access, needs)
Funding shortfalls
Competing demands
Academic achievement agenda, with inherent pressures and supports, occupy most of time
Plates are full and increasing
Fragmented systems
Service pathways and protocols are not well-defined
Implementation Challenges

32. Commitments to the Mental Health & Addictions Strategy
Ontario Ministry of Education
Commitments to the Mental Health & Addictions Strategy

33. Strategy Priorities for the Next 3 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

34. OVERVIEW OF THE MENTAL HEALTH & 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 34

35. Interconnected Initiatives
School Boards
Health Care
Settings
Community
MOHLTC
Nurse Leaders
MHA Nurses in DSB program
Service Collaboratives
SSLI
MCYS
MH Workers with Schools
Working Together
Student Support Leadership Initiative (SSLI)
EDU
SMH ASSIST

36. EDU Strategy Commitments
Amend the education curriculum
Develop a K-12 Resource Guide/Website
Provide support for professional learning in mental health for all Ontario educators
Fund and support Mental Health Leaders
Implement School Mental Health ASSIST

37. School Mental Health ASSIST is a provincial implementation support team designed to help Ontario school boards to promote student mental health and well-being, through leadership, practical resources and systematic research-based approaches to school mental health.

38. Leadership Structure Ontario Ministry of Education Lead
Special Education Policy & Programs Branch
School Board Lead
Hamilton-Wentworth District School Board
SMH ASSIST Core Team
Director, and 4+ P/T Implementation Coaches (3 Senior School Mental Health Professionals, 1 Superintendent),.5 Research Associate (new!)
Cross-Sector Partners
Interministerial Staff Team
Hospital for Sick Children, Ontario Centre of Excellence for Child & Youth MH
Provincial Stakeholder Organizations
Evaluation and Implementation Consultation Team
Drs. Michael Boyle, Bruce Ferguson, Tom Kratochwill, Robert Lucio, Ian Manion, Doris McWhorter, Karen Milligan, Caroline Parkin, Joyce Sebian, Mark Weist

39. Support to ALL Ontario Boards
Resources
Webinar series, other staff development materials
Decision support tools
Templates
School Administrators’ Toolkit
Consultation
Workshops
Representation on provincial reference groups & committees

40. Focus Boards 15 Focus Boards in 2011-2012
Another 15 announced for
Boards receive 1 FTE Mental Health Leader and SMH ASSIST support
Reciprocal relationship with SMH ASSIST
ASSIST provides leadership & implementation support
Focus Boards help with piloting resources that will be rolled out to all boards in time

41. First Priorities
Organizational Conditions for Effective School Mental Health
(addressing structural challenges)
Mental Health Capacity-Building
(addressing knowledge challenges)
Implementation of Evidence-Based Mental Health Promotion and Prevention Programming
(addressing implementation challenges)

42. Organizational Conditions for Effective School Mental Health

43. Organizational Conditions
Commitment
School Mental Health Leadership Team
Clear & Focused Vision
Shared Language
Assessment of Initial Capacity
Standard Processes
PD Protocols
School Mental Health Strategy / Action Plan
Broad Collaboration
Ongoing Quality Improvement

44. Self Reflection
Where is your board currently, TODAY, along each of the conditions…
Feel free to discuss, leave blank…
For your records…

45. Condition #1 Commitment
Board leaders view child and youth mental health as a priority, and communicate this through action
Board leaders commit to Tiered Support Model
Help board staff to understand the rationale for the model, emphasizing the focus in schools on mental health promotion and prevention and the need to work with community partners for help with students with significant mental health concerns
Board leaders consistently attend community liaison meetings and internal MH team meetings
Board leaders provide visible, strategic and tangible support for needed infrastructure, resources, staffing

46. Tiered Support in Systems of Care
Organizational Conditions
Universal Evidence-Based
Mental Health Promotion, Social-Emotional Learning
Targeted Evidence-Based Prevention
E-B Clinical
Intervention
Evidence-Based Clinical Intervention
Universal E-B Mental Health Promotion
Community
Mental Health Capacity
Engagement
Implementation Focus
School Districts
Continuous Quality Improvement

47. School Mental Health Leadership Team
Condition #2
Board has a multidisciplinary, multi-layered mental health leadership team
All of the right people are at the table (in terms of expertise, influence, relationships, representation)
Parent and youth voice are critical
Team has meaningful liaison with community partners
Team is focused on vision-setting, leadership, collaboration, strategy/program selection, problem-solving

48. Clear and Focused Vision
Condition #3
Board has shared, realistic goals
Vision is aligned with AOP, BIPSA, Strategic Directions
Vision is aligned with key principles in school mental health (e.g., preventive, linked with instruction, evidence-based, connected with partners at home and school, strong use of data)
Vision and goals are created collaboratively
Vision is the basis for decision-making

49. Condition #4 Shared Language
The Board Vision for school mental health is communicated clearly across the organization
Foundational knowledge about student mental health is conveyed
Terms are defined consistently
Where differences in language occur (e.g., across sectors), there is translation
Use of early identification tools can be helpful for finding common ways to speak of problem areas

50. Assessment of Initial Capacity
Condition #5
Assessment data informs the development of the board mental health strategy
Before setting priorities, an assessment of organizational strengths, needs, and resources (resource mapping) can be very helpful
This assessment includes a scan of resources, in the form of people, processes, and programs
Staff and student voice data can deepen understanding of needs

51. Condition #6 Standard Processes
Board has standard processes for school mental health:
Who does what (role clarification)
Selection of school and classroom evidence-based programs
Delivery of training and coaching on programs and strategies
Standards and tools for monitoring progress
Partnerships with community
Pathways to service

52. Protocols for Professional Development
Condition #7
Board has a systematic approach to capacity building in mental health that includes:
Mental Health Awareness for all
Mental Health Literacy for those with students
Mental Health Expertise for those delivering specialized assessment & intervention services
High quality training protocols, delivered by an engaging expert
Job-embedded, with ongoing coaching
Tools + Training + Technical Assistance + Quality Assurance

53. Mental Health Strategy / Action Plan
Condition #8
The Board Mental Health Strategy is aligned with system goals
The Strategy is founded on evidence-based practices in school mental health
The Strategy is tailored to local context and data with respect to board needs and strengths
The Strategy is focused on measureable outcomes
An implementation support plan is clearly articulated

54. Condition #9 Broad Collaboration
The Board has several established platforms for dialogue and collaboration:
Across departments and schools
With community and health agencies
With universities and other research organizations
With parents
With students
With other boards
With government

55. Ongoing Quality Improvement
Condition #10
The board has a system of ongoing quality improvement, that includes measurement:
Of program / strategy implementation
Of teacher perceptions and knowledge
Of student perceptions and knowledge
Of student outcomes

56. Visit SMH ASSIST

57. Contact School Mental Health ASSIST
Kathy Short, Ph.D., C.Psych.
Director, School Mental Health ASSIST
, x2634
School Mental Health
ASSIST
Équipe d’appui en santé mentale pour les écoles
Questions???