1. Maryland School Mental Health Alliance School Mental Health Integration Grant

2. Introductions Milt McKennaMilt McKenna Maryland State Department of Education Maryland State Department of Education Nancy Lever, Mark WeistNancy Lever, Mark Weist University of Maryland, Center for School Mental Health Analysis and Action University of Maryland, Center for School Mental Health Analysis and Action Catherine BradshawCatherine Bradshaw Johns Hopkins University Johns Hopkins University Susan TagerSusan Tager Maryland Coalition of Families for Children’s Mental Health Maryland Coalition of Families for Children’s Mental Health

3. History Call for proposals April 2005 from the U.S. Department of Education (Grant Due in mid May!) “Grants for the Integration of Schools and Mental Health Systems will provide funds to increase student access to high-quality mental health care by developing innovative approaches that link school systems with the local mental health system.”

4. History Commitment from key local, state, and national partners to collaborate and form an Alliance to advance school-mental health system integration in Maryland Commitment from key local, state, and national partners to collaborate and form an Alliance to advance school-mental health system integration in Maryland Strong support for children’s mental health and school mental health in the state Strong support for children’s mental health and school mental health in the state A strong PBIS structure within the state and an interest in enhancing mental health support and resources for red and yellow zone youth A strong PBIS structure within the state and an interest in enhancing mental health support and resources for red and yellow zone youth Notified of award in September 2005 Notified of award in September 2005 1 of 20 funded projects (84 total applicants)

5. Project Overview

6. Maryland School Mental Health Alliance (MSMHA) Maryland State Department of Education Maryland State Department of Education Center for School Mental Health Analysis and Action - University of Maryland Center for School Mental Health Analysis and Action - University of Maryland Center for Prevention and Early Intervention - Johns Hopkins University Center for Prevention and Early Intervention - Johns Hopkins University Governor’s Office for Children Governor’s Office for Children Maryland Assembly on School-Based Health Care Maryland Assembly on School-Based Health Care Maryland Coalition of Families for Children’s Mental Health Maryland Coalition of Families for Children’s Mental Health Maryland Department of Juvenile Services Maryland Department of Juvenile Services Mental Hygiene Administration Department of Health and Mental Hygiene Mental Hygiene Administration Department of Health and Mental Hygiene Mental Health Association of Maryland Mental Health Association of Maryland

7. Primary Grant Objectives 1. To further build a systematic state initiative for school mental health (SMH) 2. To improve outcomes related to red and yellow zone youth in PBIS schools through: Helping school staff to better identify and refer students who could benefit from mental health services Helping school staff to better identify and refer students who could benefit from mental health services Enhancing mechanisms for effective communication between schools and the mental health system to help better integrate quality mental health care for students Enhancing mechanisms for effective communication between schools and the mental health system to help better integrate quality mental health care for students Developing training and resources to assist school staff with creating environments that support academic, social, and emotional learning for children with more intensive mental health needs Developing training and resources to assist school staff with creating environments that support academic, social, and emotional learning for children with more intensive mental health needs

8. Key Structural Components 1 Management Team 1 Advisory Board 5 Counties (Anne Arundel, Baltimore, Harford, St. Mary’s, Washington) 5 County Integration Teams 15 PBIS Schools (3/County) and Demonstration Teams

9. County Integration Teams

10. Purpose Responsible for pursing improved school- mental health system integration in their county through: Active communication Active communication Needs assessment Needs assessment Resource sharing Resource sharing Problem solving Problem solving

11. Demonstration Project

12. Presents an opportunity for three schools in each of the five counties to do a very strong assessment of school mental health programming Presents an opportunity for three schools in each of the five counties to do a very strong assessment of school mental health programming Based on this assessment, the team will implement a quality assessment and improvement process from February 2006 to December 2007 Based on this assessment, the team will implement a quality assessment and improvement process from February 2006 to December 2007

13. Demonstration Team Based on discussions, the team will identify 2-3 indicators for best practice that will be the focus for improvement over the next year 2-3 indicators for best practice that will be the focus for improvement over the next year 1 or 2 pressing emotional-behavioral problems (ADHD, Disruptive Behavior Disorder, Depression, or Anxiety) for the demonstration team members to receive skill training on best practice related to the disorder 1 or 2 pressing emotional-behavioral problems (ADHD, Disruptive Behavior Disorder, Depression, or Anxiety) for the demonstration team members to receive skill training on best practice related to the disorder 2-3 strategies to improve coordination and linkages between schools and mental health systems 2-3 strategies to improve coordination and linkages between schools and mental health systems

14. Center for School Mental Health Analysis and Action

15. University of Maryland CSMHA Established in 1995, one of two national centers focused on the advancement of training, practice, research and policy in SMH Established in 1995, one of two national centers focused on the advancement of training, practice, research and policy in SMH Funded by the Health Resources and Services Administration, with co-funding from the Substance Abuse and Mental Health Services Administration Funded by the Health Resources and Services Administration, with co-funding from the Substance Abuse and Mental Health Services Administration http://csmha.umaryland.edu, http://csmha.umaryland.edu, http://csmha.umaryland.edu csmha@psych.umaryland.edu, csmha@psych.umaryland.edu, csmha@psych.umaryland.edu (410) 706-0980 (410) 706-0980

16. CSMHA Support Sharing of diverse resources developed through 10 year history as a national center, and intensive resources related to quality assessment and improvement and evidence-based practice from an NIMH funded research study Sharing of diverse resources developed through 10 year history as a national center, and intensive resources related to quality assessment and improvement and evidence-based practice from an NIMH funded research study Technical Assistance (by phone and email and time and resource permitting in person) Technical Assistance (by phone and email and time and resource permitting in person) Linkages to local, state, and national leaders, resources and initiatives in SMH Linkages to local, state, and national leaders, resources and initiatives in SMH

17. Family Partnerships

18. Maryland Coalition of Families for Children’s Mental Health Our Coalition is dedicated to: - Improving services for children with mental health needs and their families - Building a network of information and support for families across Maryland Our Coalition is dedicated to: - Improving services for children with mental health needs and their families - Building a network of information and support for families across Maryland

19. Family Participation and Leadership Families as equal partners at all levels of the project, (planning, implementation, evaluation, management, and continuous improvement) Families as equal partners at all levels of the project, (planning, implementation, evaluation, management, and continuous improvement) Training, oversight, and resource development facilitated by the Maryland Coalition of Families for Children’s Mental Health Training, oversight, and resource development facilitated by the Maryland Coalition of Families for Children’s Mental Health Major goal to empower family members to become effective advocates for children’s mental health and improve their linkages to and true collaboration with schools Major goal to empower family members to become effective advocates for children’s mental health and improve their linkages to and true collaboration with schools

20. Benefits of This Project Further build a systematic initiative for SMH in MD Further build a systematic initiative for SMH in MD Enhanced focus on helping red and yellow zone youth Enhanced focus on helping red and yellow zone youth A voice in enhancing mental health integration into PBIS at the county, state, and national levels A voice in enhancing mental health integration into PBIS at the county, state, and national levels Meaningful family partnerships and training and resources for families Meaningful family partnerships and training and resources for families Improved linkages between families, schools and mental health systems Improved linkages between families, schools and mental health systems Improved outcomes for students (we hope) Improved outcomes for students (we hope)

21. Benefits (cont.) Training for PBIS coaches/leaders on helping school staff and families understand mental health issues in youth and promote mental health for red and yellow zone youth Training for PBIS coaches/leaders on helping school staff and families understand mental health issues in youth and promote mental health for red and yellow zone youth Website with key information about mental health for families, teachers, and providers (http://www.msmha.org) Website with key information about mental health for families, teachers, and providers (http://www.msmha.org)http://www.msmha.org Newsletter highlighting the project and key mental health initiatives in the state Newsletter highlighting the project and key mental health initiatives in the state

22. How This Project Fits With Your Needs PBIS Needs Assessment

23. PBIS Needs Assessment: Overview Purpose Purpose To determine training needs of PBIS teamsTo determine training needs of PBIS teams Conducted by Leadership Team Conducted by Leadership Team 2005 Summer Institute for Returning Teams2005 Summer Institute for Returning Teams High Response Rate High Response Rate 524 respondents = 87%524 respondents = 87%

24. Respondent Characteristics Role in school Role in school 27% Team leaders27% Team leaders 17% Coaches17% Coaches 16% Administrators16% Administrators Type of school Type of school 50% Elementary50% Elementary 29% Middle29% Middle 9% High9% High 5% Alternative/Special5% Alternative/Special

25. Secondary Programs: % Needing Additional Training by Topic

26. Summary of Needs Assessment Findings School-Wide PBIS School-Wide PBIS Maintaining momentum among school staff (57%) and team members (45%)Maintaining momentum among school staff (57%) and team members (45%) Secondary Programs Secondary Programs Intensive for red (62%)Intensive for red (62%) Targeted for yellow (54%)Targeted for yellow (54%) Implementing an FBA plan (57%)Implementing an FBA plan (57%) External Collaboration External Collaboration Family involvement (70%)Family involvement (70%) Community mental health (38%)Community mental health (38%) Department of Social Services (37%)Department of Social Services (37%) Department of Juvenile Justice (36%)Department of Juvenile Justice (36%)

27. National Connections

28. Significant Growth of School Mental Health in the United States Unprecedented access, helps achieve valued outcomes when done well Unprecedented access, helps achieve valued outcomes when done well Strong federal support, and increasing numbers of strong initiatives in states and communities Strong federal support, and increasing numbers of strong initiatives in states and communities Two major forces: PBIS, and Expanded School Mental Health (ESMH) programs Two major forces: PBIS, and Expanded School Mental Health (ESMH) programs Increasing efforts to connect PBIS and ESMH together Increasing efforts to connect PBIS and ESMH together

29. An Oversimplification Schools with strong PBIS often struggle with problems presented by youth in yellow and red zones Schools with strong PBIS often struggle with problems presented by youth in yellow and red zones Schools with ESMH often struggle to develop school-wide efforts to promote positive behavior and mental health Schools with ESMH often struggle to develop school-wide efforts to promote positive behavior and mental health Connecting ESMH and PBIS will lead to a full continuum of effective services across the green, yellow, and red zones Connecting ESMH and PBIS will lead to a full continuum of effective services across the green, yellow, and red zones Related to MD’s leadership in ESMH and PBIS, and this grant, there is a significant opportunity to make this connection Related to MD’s leadership in ESMH and PBIS, and this grant, there is a significant opportunity to make this connection

30. Expanded School Mental Health (ESMH): Programs join families, schools, mental health and other community systems Programs join families, schools, mental health and other community systems To develop a full array of effective programs and services that improve the school environment, reduce barriers to learning, and provide prevention, early intervention and treatment To develop a full array of effective programs and services that improve the school environment, reduce barriers to learning, and provide prevention, early intervention and treatment for youth in general and special education for youth in general and special education

31. “Enhancing Quality in Expanded School Mental Health” Three year, three state (Delaware, Maryland, Texas) study seeking to implement and evaluate a framework for systematic quality assessment and improvement in school mental health Three year, three state (Delaware, Maryland, Texas) study seeking to implement and evaluate a framework for systematic quality assessment and improvement in school mental health Funded by the National Institute of Mental Health (2003-2006) Funded by the National Institute of Mental Health (2003-2006)

32. Principles for Best Practice in Expanded School Mental Health 1) All youth and families are able to access appropriate care regardless of their ability to pay 1) All youth and families are able to access appropriate care regardless of their ability to pay 2) Programs are implemented to address needs and strengthen assets for students, families, schools, and communities 2) Programs are implemented to address needs and strengthen assets for students, families, schools, and communities 3) Programs and services focus on reducing barriers to development and learning, are student and family friendly, and are based on evidence of positive impact 3) Programs and services focus on reducing barriers to development and learning, are student and family friendly, and are based on evidence of positive impact

33. Principles (cont.) 4) Students, families, teachers and other important groups are actively involved in the program's development, oversight, evaluation, and continuous improvement 4) Students, families, teachers and other important groups are actively involved in the program's development, oversight, evaluation, and continuous improvement 5) Quality assessment and improvement activities continually guide and provide feedback to the program 5) Quality assessment and improvement activities continually guide and provide feedback to the program 6) A continuum of care is provided, including school-wide mental health promotion, early intervention, and treatment 6) A continuum of care is provided, including school-wide mental health promotion, early intervention, and treatment

34. Principles (cont.) 7) Staff hold to high ethical standards, are committed to children, adolescents, and families, and display an energetic, flexible, responsive and proactive style in delivering services 7) Staff hold to high ethical standards, are committed to children, adolescents, and families, and display an energetic, flexible, responsive and proactive style in delivering services 8) Staff are respectful of, and competently address developmental, cultural, and personal differences among students, families and staff 8) Staff are respectful of, and competently address developmental, cultural, and personal differences among students, families and staff

35. Principles (cont.) 9) Staff build and maintain strong relationships with other mental health and health providers and educators in the school, and a theme of interdisciplinary collaboration characterizes all efforts 9) Staff build and maintain strong relationships with other mental health and health providers and educators in the school, and a theme of interdisciplinary collaboration characterizes all efforts 10) Mental health programs in the school are coordinated with related programs in other community settings 10) Mental health programs in the school are coordinated with related programs in other community settings

36. Four Critical Themes in School Mental Health Intervention Establish and maintain strong relationships, especially with families Establish and maintain strong relationships, especially with families Reduce, help to buffer stress and risk Reduce, help to buffer stress and risk Enhance protective and resilience factors Enhance protective and resilience factors Train in evidence-based skills Train in evidence-based skills

37. Addressable Stress/Risk Factors Family Level Family Level Abuse and neglectAbuse and neglect Criminal behaviorCriminal behavior Substance abuseSubstance abuse Family isolationFamily isolation OvercrowdingOvercrowding Emotional/behavioral problems in family membersEmotional/behavioral problems in family members Morbidity and mortality in family membersMorbidity and mortality in family members

38. Addressable Protective Factors Family level Family level Support and nurturanceSupport and nurturance Rituals and routinesRituals and routines Self-control displayed and modeled by family membersSelf-control displayed and modeled by family members Healthy behaviors by family membersHealthy behaviors by family members

39. Top Evidence-Based Practices Parent praise Parent praise Cognitive coping Cognitive coping Parent psycho-education Parent psycho-education Modeling Modeling Problem solving Problem solving Skill building/behavioral rehearsal Skill building/behavioral rehearsal Maintenance/relapse prevention Maintenance/relapse prevention Tangible rewards Tangible rewards

40. See. Bruce Chorpita, and Evidence Based Services Committee (2004). Biennial report: Summary of effective interventions for youth with behavioral and emotional needs. Hawaii Department of Health, Child and Adolescent Mental Health Division. See. Bruce Chorpita, and Evidence Based Services Committee (2004). Biennial report: Summary of effective interventions for youth with behavioral and emotional needs. Hawaii Department of Health, Child and Adolescent Mental Health Division.

41. The IDEA Partnership

42. Building a Community of Practice in SMH CSMHA and IDEA Partnership (www.ideapartnership.org) providing support CSMHA and IDEA Partnership (www.ideapartnership.org) providing supportwww.ideapartnership.org 60 professional organizations and 10 states 60 professional organizations and 10 states 10 practice groups 10 practice groups Providing mutual support, opportunities for dialogue and collaboration Providing mutual support, opportunities for dialogue and collaboration Advancing “multiscale learning systems” Advancing “multiscale learning systems”

43. 10 Practice Groups Mental Health-Education Integration Mental Health-Education Integration Developing a Common Language Developing a Common Language Connecting Education and Systems of Care Connecting Education and Systems of Care Connecting SMH and Positive Behavior Support Connecting SMH and Positive Behavior Support Improving SMH for Youth with Disabilities Improving SMH for Youth with Disabilities

44. 10 Practice Groups (cont.) SMH, Juvenile Justice and Dropout Prevention SMH, Juvenile Justice and Dropout Prevention Family Partnerships Family Partnerships Youth Involvement and Leadership Youth Involvement and Leadership Faith-Community Partnerships Faith-Community Partnerships Quality and Evidence-Based Practice Quality and Evidence-Based Practice

46. 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

47. CSMHA Annual Conferences on Advancing School Mental Health Baltimore, 1996 Baltimore, 1996 New Orleans, 1997 New Orleans, 1997 Virginia Beach, 1998 Virginia Beach, 1998 Denver, 1999 Denver, 1999 Atlanta, 2000 Atlanta, 2000 Portland, 2001* Portland, 2001* Philadelphia, 2002 Philadelphia, 2002 Portland, 2003 Portland, 2003 Dallas, 2004 Dallas, 2004 Cleveland, 2005 Cleveland, 2005 Baltimore, 2006 Baltimore, 2006 *the 2001 conference was cancelled related to the events of September 11

48. School Health Interdisciplinary Program (SHIP) Organized by the CSMHA with leadership of MSDE, MHA and most child serving systems in MD Organized by the CSMHA with leadership of MSDE, MHA and most child serving systems in MD Many other state collaborators Many other state collaborators Intensive, interdisciplinary training reflecting the coordinated school health model Intensive, interdisciplinary training reflecting the coordinated school health model Held every summer in Maryland since 2002 Held every summer in Maryland since 2002

49. PBIS Leaders Embrace the Connection to ESMH George Sugai presented at CSMHA conferences in Maryland in 2003 (SHIP) and in Dallas (as keynote) in 2004 George Sugai presented at CSMHA conferences in Maryland in 2003 (SHIP) and in Dallas (as keynote) in 2004 Lucille Eber is likely to be a keynote for the 11 th Annual Conference on Advancing SMH Lucille Eber is likely to be a keynote for the 11 th Annual Conference on Advancing SMH Drs. Sugai and Eber will be active in the PBIS Practice Group, and with a number of people from this project will meet in Chicago in February to move the group forward Drs. Sugai and Eber will be active in the PBIS Practice Group, and with a number of people from this project will meet in Chicago in February to move the group forward

50. Unprecedented State and National Resources and Initiatives in MD UM, Quality R01 UM, Quality R01 UM, CSMHA UM, CSMHA JHU, Center for EBP JHU, Center for EBP JHU, Center for Viol Pr JHU, Center for Viol Pr MSDE, MH-School Int. MSDE, MH-School Int. GOC, Transformation GOC, Transformation MSDE, PBIS MSDE, PBIS MHA, ESMH MHA, ESMH GOC, Innovations Inst. GOC, Innovations Inst. MSDE, MHA, WkFrce MSDE, MHA, WkFrce Other Other …… ……

51. An Unprecedented Time to Link this Work Together And advance PBIS and school mental health in Maryland, as we show national leadership in building integrated approaches that address academic and nonacademic barriers to student learning And advance PBIS and school mental health in Maryland, as we show national leadership in building integrated approaches that address academic and nonacademic barriers to student learning

52. Mental Health and PBIS What are the most pressing mental health concerns in your schools? What is currently available for red, yellow and green zone youth? What is needed for red, yellow and green zone youth?