New Levels of Work Together for New Levels of Work Together for School-Wide PBIS and School School-Wide PBIS and School

Mental Health, Part 2Mental Health, Part 2

Mark D. Weist, Ph.D.Mark D. Weist, Ph.D.Center for School Mental HealthCenter for School Mental Health

University of Maryland University of Maryland 10.9.0910.9.09

Center for School Mental Health* Center for School Mental Health* University of Maryland School of MedicineUniversity of Maryland School of Medicine

http://csmh.umaryland.eduhttp://csmh.umaryland.edu*Supported by the Maternal and Child Health Bureau of HRSA *Supported by the Maternal and Child Health Bureau of HRSA

and numerous Maryland agenciesand numerous Maryland agencies

““Expanded” School Mental HealthExpanded” School Mental Health

Full continuum of effective mental health Full continuum of effective mental health promotion and intervention for students in promotion and intervention for students in general and special educationgeneral and special education

Reflecting a “shared agenda” involving Reflecting a “shared agenda” involving school-family-community system partnershipsschool-family-community system partnerships

Collaborating community professionals (not Collaborating community professionals (not outsidersoutsiders) ) augmentaugment the work of school- the work of school-employed staffemployed staff

Fundamental Three-Part RationaleFundamental Three-Part Rationale

Schools are under-resourced for mental health Schools are under-resourced for mental health promotion and interventionpromotion and intervention

Connections between people and traditional Connections between people and traditional community mental health centers are difficultcommunity mental health centers are difficult

By coming together in the most universal By coming together in the most universal natural setting for youth, there are advantages natural setting for youth, there are advantages for both systems, and synergies enhance for both systems, and synergies enhance opportunities to achieve valued outcomes opportunities to achieve valued outcomes

RolesRoles

10-20% Broad Environmental Improvement 10-20% Broad Environmental Improvement and Mental Health Promotion (CHANGE and Mental Health Promotion (CHANGE AGENT ROLE)AGENT ROLE)

50-60% Prevention and Early Intervention 50-60% Prevention and Early Intervention (PREVENTION SPECIALIST ROLE)(PREVENTION SPECIALIST ROLE)

20-30% Intensive Assessment and Treatment 20-30% Intensive Assessment and Treatment (CLINICIAN ROLE)(CLINICIAN ROLE)

Roles, cont. Roles, cont.

Tier 1 Tier 2 Tier 3

Sch. Psy. XOXOXO XXXXXX XX

Sch. SW. XOXOXO XXXXXX

Sch. Co. XOX0 OOO

Com. St. XO OOOOOO OOOOOOGEN.ED=O SPEC.ED=X

Expanded School Mental Health Expanded School Mental Health Services in Baltimore CityServices in Baltimore City

1989: 4 schools1989: 4 schools2009: 105 schools2009: 105 schools

– 42 Elementary schools42 Elementary schools

– 41 Middle/K-8 schools41 Middle/K-8 schools

– 22 High schools22 High schools

Baltimore ESMH Funding 2009Baltimore ESMH Funding 2009

Baltimore City Public School

System, $1,450,000

Baltimore Substance Abuse

Systems, Inc., $383,000

Family League of Baltimore, Inc.,

$177,000

Baltimore City Health

Department, $235,950

Department of Labor Grant,

$105,000

Baltimore Mental Health Systems, Inc., $768,000

47%

25%

12%

3%

6%7%

Themes Helping ESMH in Baltimore Themes Helping ESMH in Baltimore to Move to the Next Levelto Move to the Next Level

A strategic planA strategic plan

One network with common expectationsOne network with common expectations

A prominent and diverse advisory boardA prominent and diverse advisory board

Strong cross-agency connectionsStrong cross-agency connections

Strong state, national and federal connectionsStrong state, national and federal connections

Embracing “mental health”Embracing “mental health”

Informal ‘Mental Health’ DefinitionInformal ‘Mental Health’ Definition

““Healthy thoughts, feelings and actions that Healthy thoughts, feelings and actions that help you be successful”help you be successful”

A positive concept like ‘physical health’A positive concept like ‘physical health’

Prince George’s School Mental Health Prince George’s School Mental Health Initiative (PGSMHI)Initiative (PGSMHI)

Funding from the State Department of EducationFunding from the State Department of Education

Intensive, evidence-based mental health intervention Intensive, evidence-based mental health intervention for students in special education in 2 and then 6 for students in special education in 2 and then 6 schools schools

Training and support to 11 schools with specialized Training and support to 11 schools with specialized programs for youth presenting emotional problemsprograms for youth presenting emotional problems

Broader training and support county wide (e.g., for all Broader training and support county wide (e.g., for all school psychologists) school psychologists)

Family Needs AddressedFamily Needs Addressed

Food, health insurance, medical needs, Food, health insurance, medical needs, clothing, transportation, utilities, substance clothing, transportation, utilities, substance abuse services, mental health services, abuse services, mental health services, tutoring, mentoring, recreational programstutoring, mentoring, recreational programs

Absences by QuarterAbsences by Quarter

0

1

2

3

4

5

6

7

8

9

10

INV 4.24 6 6.06 5.35

Non INV 2.69 5.25 10 9.88

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Data on Non-Public PlacementsData on Non-Public Placements

Between September, 2006 and January, 2009, Between September, 2006 and January, 2009, 78 students were seen for more intensive 78 students were seen for more intensive services in the four schoolsservices in the four schools

All met multiple criteria for placement in non-All met multiple criteria for placement in non-public programspublic programs

3/78 students were placed in a non-public 3/78 students were placed in a non-public programprogram

Economic ImplicationsEconomic Implications

Non public cost per student/year above special Non public cost per student/year above special education cost = $39,038education cost = $39,038Cost of program per student/year = $7,212Cost of program per student/year = $7,212Difference = $31,826 saved per student/yearDifference = $31,826 saved per student/year102 nonpublic placement years diverted102 nonpublic placement years divertedFOR A NET SAVINGS OF AROUND FOR A NET SAVINGS OF AROUND $3.2 MILLION$3.2 MILLION– Slade et al, 2009, Advances in School Mental Slade et al, 2009, Advances in School Mental

Health PromotionHealth Promotion

Anne Arundel School Anne Arundel School Mental Health InitiativeMental Health Initiative

Began in 2008-09 school yearBegan in 2008-09 school year

Operating in two regions of the county, north Operating in two regions of the county, north and westand west

Services in north focused on youth in the red Services in north focused on youth in the red zone at risk of more restrictive placements (6 zone at risk of more restrictive placements (6 schools)schools)

Services in west focused on early intervention Services in west focused on early intervention (3 schools near Army base)(3 schools near Army base)

Referrals and EnrollmentReferrals and Enrollment61 Referrals 61 Referrals

44 Enrolled 44 Enrolled 34 with 4+ sessions 34 with 4+ sessions

1815

11

43

2924

61

44

34

0

10

20

30

40

50

60

70

North West Total

Referred

Enrolled

4+ Sessions

Student Outcomes: Total (n=34)Student Outcomes: Total (n=34)

Prior to 1Prior to 1stst sessionsession

From the 4From the 4thth session on*session on*

ChangeChange

AttendanceAttendance 24 students24 students 24 students24 students 0%0%

Informal Informal ReferralsReferrals

18 students18 students 15 students15 students 16% 16%

Suspensions Suspensions (# times)(# times)

9 students9 students 5 students5 students 44% 44%

* The average length of time to complete four sessions is approximately one month.

Student OutcomesStudent Outcomes

Primary and intermediate elementary students demonstrated decreases Primary and intermediate elementary students demonstrated decreases in absences and tardies, with the exception of increased tardies among in absences and tardies, with the exception of increased tardies among

intermediate students.intermediate students.

Absences and Tardies: West County

7.7

6.5

3.8

2.3

6.55.8

2.93.4

0123456789

Before After Before After

Absences Tardies

Ave

rage

# o

f Tim

es

Primary

Intermediate

A National Community of PracticeA National Community of Practice

CSMH and IDEA Partnership (CSMH and IDEA Partnership (www.ideapartnership.orgwww.ideapartnership.org) providing support) providing support

30 professional organizations and 12 states30 professional organizations and 12 states

12 practice groups12 practice groups

Providing mutual support, opportunities for Providing mutual support, opportunities for dialogue and collaborationdialogue and collaboration

Advancing Advancing multiscale learning systemsmultiscale learning systems

Sign up at Sign up at www.sharedwork.orgwww.sharedwork.org

Next CSMH ConferenceNext CSMH Conference

1414thth Annual Conference on Advancing School Annual Conference on Advancing School Mental HealthMental Health. Minneapolis, November 1-4. Minneapolis, November 1-4

Sunday evening – Community Share FareSunday evening – Community Share Fare

Monday – Community Meetings/Intensive Monday – Community Meetings/Intensive TrainingTraining

Tuesday, Wednesday – Conference ProgramTuesday, Wednesday – Conference Program

See See http://csmh.umaryland.eduhttp://csmh.umaryland.edu, , www.sharedwork.orgwww.sharedwork.org or call 410-706-0980 or call 410-706-0980

www.schoolmentalhealth.orgwww.schoolmentalhealth.org

Website developed and maintained by the Website developed and maintained by the CSMH with funding from the Baltimore City CSMH with funding from the Baltimore City Health Department and Maryland Departments Health Department and Maryland Departments of Education and Mental Healthof Education and Mental Health

User-friendly school mental health User-friendly school mental health information and resources for caregivers, information and resources for caregivers, teachers, clinicians, and youthteachers, clinicians, and youth

Two New JournalsTwo New Journals

Advances in School Mental Health Advances in School Mental Health Promotion Promotion – The Clifford Beers Foundation and the University The Clifford Beers Foundation and the University

of Marylandof Maryland– www.schoolmentalhealth.co.uk www.schoolmentalhealth.co.uk

School Mental HealthSchool Mental Health– www.springer.comwww.springer.com

Advances in School Advances in School Mental Health PromotionMental Health Promotion

Contact InformationContact Information

Center for School Mental Health Center for School Mental Health Department of Psychiatry University Department of Psychiatry University of Maryland 737 W. of Maryland 737 W. Lombard Street, 4Lombard Street, 4thth Floor Baltimore, Floor Baltimore, MD 21201 PH: 410-706-MD 21201 PH: 410-706-0980 FX: 410-0980 FX: 410-706-0984 706-0984 mweist@psych.umaryland.edumweist@psych.umaryland.edu http://csmh.umaryland.eduhttp://csmh.umaryland.edu