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Providing School-Based Mental Health ServicesOSHS Project Director Training - Grantee SessionPresenters: Elizabeth V. Freeman, AIR; and Dr. Sharon Stephan, CSMH

Agenda1Presentation2Panel Discussion3Reflection4Group Discussion and Initial Action PlanningThe content of this presentation was prepared under a contract from the U.S.Department of Education, Office of Safe and Healthy Students to the AmericanInstitutes for Research (AIR). This presentation does not necessarily represent thepolicy or views of the U.S. Department of Education, nor do they imply endorsementby the U.S. Department of Education.Page 2

Presentation Topics1Multi-Tiered System of Supports for Students2Integration of Student Intervention Teams at School andCommunity Levels3Tools & Strategies: Student Screens4Tools & Strategies: Universal, Selective and IndicatedInterventions for Students5Tools & Strategies: Providing Interventions in a MultiTiered System of Supports for Students that addressmental and behavioral health problemsPage 3

Comprehensive School MentalHealth Programs Provide a full array of services at three tiers: Universal mental health promotion for all students. Selective services for students identified as at risk for a mentalhealth concern or problem. Indicated services for individual students who already display amental health concern or problem. Build on planned, purposeful partnerships betweenschools and community systems. Use evidence-based practices to the extent possible andwork to address quality improvement.Page 4

Multi-Tiered System of SupportsIndicatedInterventionsSelective InterventionsUniversal School-Wide PreventionPage 5 Indicated interventions are provided forindividual students that exhibit seriousproblem behaviors and emotions. Selective Interventions are provided forstudent exhibiting risky behaviors inorder to reduce the cause of problembehaviors, and build social andemotoinal skills for healthier functioning Universal prevention is provided forthe whole-school student populationto promote healthy social andemotional understanding and skills.

Integration of Student Intervention Teams atSchool & Community Levels School and community partners join together to form astudent intervention team. The team meets regularly to discuss and plan interventionsfor students that have been referred for school mental healthservices. Together the team develops an intervention plan for thestudent. The team ensures individual tasks are designated to ensurecare coordination, treatment and follow up care is providedfor the student and their family. The team provides oversight for the full intervention process.Page 6

Typical Partners forIntervention TeamSchool PartnersCommunity Providers Administrators Psychiatrists / Doctors Nurses Clinical Supervisors Psychologists Clinical Counselors Guidance Counselors Clinical Psychologists Social Workers Social Workers Behavioral Interventionists School Resource Officers Hospital inpatient / outpatientprograms IEP Team Members Case Managers Referring Teacher Juvenile Probation Court systemPage 7

The Intake Process The Student Intervention Team will Review the needs of students referred for mental health services; Determine appropriate services and supports for each student; and Refer students and their parents or guardians to an appropriate staffmember or to the community mental health agency. School or community-employed mental health providers whotreat students then keep the Student Intervention Teaminformed about the students’ progress.Page 8

Benefits of a school-communityIntervention Team Bringing different strengths and skills together. Avoiding overlap and duplication of services. Having open communication and various viewpoints. Accessing more resources for the student and family asyou partner across team members and school staff.Page 9

Student Screening Purposes of Screening Identify students at risk for poor outcomes. Identify students who may need monitoring or intervention (i.e.,secondary or tertiary). Inform decisions about needed services based on identified needs. Screening tools or processes in schools may include: Office discipline referrals (ODRs) Teacher/Peer nominations Informal/”Homegrown” screening measures Formalized, validated screening measuresPage 10

Selecting Screening ToolsAssemble a team. Work within your school mental health team(s) to assemble a team of keyfamily-school-community stakeholders to plan and implement a universalscreening process. Provide education to stakeholders on the benefits of mental health screening.Select screening tool(s). Provide education to stakeholders on the benefits of mental health screening. Choose tool(s) that is/are reliable, valid, and evidence-based.Consider the following questions: Can it be purchased for a reasonable cost? Does it take long to administer and score? Does it offer ready access to training and technical support for staff? Does it reflect your current needs for screening (e.g., type of mental health risk,age range)?Page 11

Developing Screening ProcessEstablish a tracking, triage and referral system. Identify team(s) that will use screening data to inform decisions . Develop a data collection process. Address legal and ethical considerations such as parent/guardian consent,student privacy, and a plan to screen students in a timely manner. Plan to address student mental health concerns identified within school and/orthe community. Evaluate data sharing practices across team members.Collect screening and follow up data. Implement the screening procedures, share data as appropriate, and utilize datato plan school mental health services and supports at the individual, family,group, classroom, grade level, and/or school-wide level.Page 12

Resources on Screening Tools Center for School Mental Health, Summary of FreeAssessment Measures. Center on Response to Intervention at American Institutesfor Research, Screening Briefs Desrochers, J., & Houck, G. (2013). Depression inChildren and Adolescents: Guidelines for School Practice.Handout H: Mental Health Screening in Schools. Screening for concurrent substance use and mentalhealth problems in youth. UCLA Center for Mental Health in Schools, ScreeningMental Health Problems in schools.Page 13

Screening ToolsPediatric SymptomChecklist (PSC)A psychosocial screen designed to facilitate therecognition of cognitive, emotional, and behavioralproblems so that appropriate interventions can beinitiated as early as possible. Included are twoversions, the parent-completed version (PSC) andthe youth self-report (Y-PSC)4-16 (use YPSC forages 11 f/professionals/ped sympton chklst.pdfPersonal ExperienceScreeningQuestionnaireQuick and cost-effective, the PESQ allows routinescreening of adolescents for substance ? pageid 53,69732& dad portal& schema PORTALStrengths &DifficultiesQuestionnairea brief behavioral screening questionnaire about 316 year olds. It exists in several versions to meet theneeds of researchers, clinicians and sAdolescentAdjustmentScreening Inventory(RAASI)Appropriate for use with adolescents in school and inclinical use, as well as youth in juvenile detention,correctional facilities, and substance abusetreatment programs12-19 ProductID RAASIPage 14

Screening ToolsAges & StagesQuestionnaire –Social Emotional(ASQ-SE)Quick social-emotional screen; can be administeredby a paraprofessional; has parent component;available in English and Spanish6 months –5 yearswww.brookespublishing.comBehavioral andEmotional ScreeningSystem (BESS)The BESS has a combination of advantages that arenot matched by other screening tools: it collectsinformation from three sources: parents, teachers,and youth, it comes with companion assessmenttools (Behavior Assessment System for Children-2ndedition (BASC-2), includes validity scales to check forresponse biases, measures strengths in addition toweaknesses, it can be used for children as young as3 years of ultures/enus/Productdetail.htm?Pid PAaBASC2bessChild andAdolescent Needsand StrengthsAssessment-MentalHealth (CANS-MH)CANS-MH could be used as a functional assessmentof both the child’s and the caregiver’s needs andstrengths to summarize results of the mental healthassessment and guide intervention planning.Birth dfoundation.org/CANS-MH%20Manual.pdfGuidelines forAdolescentPreventativeServices (GAPS)Questionnaires for younger adolescent, middle/olderadolescents, and parents to screen for depression,substance abuse, suicide and behavioral ve-services.pagePage 15

Searchable Intervention RegistriesSAMHSANational Registry of Evidencebased Programs and Practices(NREPP)Institute of EducationSciences (IES)What Works Clearinghouse(WWC)Annie E. CaseyFoundationBlueprints for HealthyDevelopmentOffice of JuvenileJustice and DelinquencyPrevention (OJJDP)Page 16 http://nrepp.samhsa.gov Mental health and substance abuse interventions http://ies.ed.gov/ncee/wwc Academic and emotional/behavioral interventions http://www.blueprintsprograms.com Academic, emotional/behavioral, and health interventions http://www.ojjdp.gov/mpg/mpgSearch.aspx Academic, aggression/violence, substance use, gang, trauma

Examples of Tier 1 Interventions /UniversalPrevention/Intervention GoalSecond StepClassroom curriculum that teaches social emotional skills to decrease impulsiveand aggressive behavior and increase social competence.Project ALERTGroup or classroom intervention to prevent alcohol, tobacco, and marijuana useand violence.Project ACHIEVEGroup or classroom intervention to improve resilience, protective factors andeffective self-management skills.Life Skills TrainingGroup or classroom intervention to promote general social skills, self-management,drug resistance, and violence prevention.Good Behavior GameClassroom intervention with a set of evidence-based strategies to and a classroomgame to increase self-regulation and cooperation and decrease unwantedbehaviors.Page 17

Examples of Tier 2 Interventions /TargetedPrevention/Intervention GoalThe StrengtheningFamilies Program (SFP)Family skills training program designed to increase resilience and reduce riskfactors (specifically, to improve social competencies & school performance, andreduce problem behaviors, delinquency, and alcohol and drug abuse in high-riskchildren).Coping PowerGroup intervention targeted towards children at-risk for aggressive behaviors, druguse, and delinquency. Uses cognitive-behavioral techniques to teach children howto identify and cope with anger and anxiety, decrease impulsivity, and develop andimprove social, academic, and problem-solving skills.Positive ActionComprehensive curriculum-based program that is designed to improve academicachievement; school attendance; and problem behaviors such as substance use,violence, suspensions, disruptive behaviors, dropping out, and sexual behavior. It isalso designed to improve parent–child bonding, family cohesion, and familyconflict.Guiding Good ChoicesA drug use prevention program that provides parents of children in grades 4through 8 (9 to 14 years old) with the knowledge and skills needed to guide theirchildren through early adolescence; strengthens and clarifies family expectationsfor behavior; promotes bonding within the family; teaches skills that allow childrento resist drug use successfully.Page 18

Examples of Tier 3 Interventions /IndicatedPrevention /InterventionGoalAggression ReplacementTrainingCBT-based intervention to help children and adolescents improve social skillcompetence and moral reasoning, better manage anger, and reduce aggressivebehavior.New Beginnings(Intervention for Childrenof Divorce)Parent groups designed for divorced parents who have children between the agesof 3 and 17. Promoted resilience of children following parental divorce; 10 weeklygroup sessions, 2 individual sessions; skills to improve parent-child relationshipquality and effectiveness of discipline, reduce exposure to inter-parental conflict,and decrease barriers to nonresidential parent-child contact. Groups are co-led bytwo master's-level clinicians.A cognitive behavioral group intervention that targets specific problems typicallyexperienced by depressed adolescents, e.g., discomfort and anxiety, irrationalnegative thoughts, poor social skills, and limited experiences of pleasant activities.Consists of 16 2-hour sessions conducted over an 8-week period for mixed-gendergroups of up to 10 adolescents. Each participant receives a workbook that providesstructured learning tasks, short quizzes, and homework forms. To encouragegeneralization of skills to everyday situations, adolescents are given homeworkassignments that are reviewed at the beginning of the subsequent session.A school-based group and individual intervention designed to reduce symptoms ofposttraumatic stress disorder (PTSD), depression, behavioral problems; improvepeer and parent support; enhance coping skills among students exposed totraumatic life events, e.g., community/school violence, physical abuse, domesticviolence, accidents, and natural disasters.Adolescents Coping withDepressionCognitive BehavioralIntervention for Trauma inSchoolsPage 19

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ReflectionsIndividually, reflect on the following questions: What are you already doing that aligns with what you learned in thissession? Identify THREE major points you will take away from this session. Identify TWO resources or methods of support that would advance yourschool-based mental health provision. Identify ONE specific step you can take to advance this work in yourdistrict.Page 29

ContactsDr. Sharon StephanCenter for School Mental [email protected] V. FreemanAmerican Institutes of [email protected] 30

Page 4 Comprehensive School Mental Health Programs Provide a full array of services at three tiers: Universal mental health promotion for all students. Selective services for students identified as at risk for a mental health concern or problem. Indicated services for individual student