Executive
Summary
School-Based
Mental Health Initiatives: Update
and Next Steps
This report updates the status of mental
health, family and education systems collaborations since the April 2002 report
to the Board of Regents on this effort.
The report summarizes outcome data and critical lessons learned from five
major field-based initiatives.
The Regents have recognized that some
students have mental health needs that present severe barriers to learning for
themselves and often their peers.
Educators are increasingly challenged to find ways to address disruptive
student behaviors through disciplinary actions or crisis
interventions.
Since the Regents September 2000 Legislative
Conference on School-based Mental Health Collaboration, the Office of Vocational
and Educational Services for Individuals with Disabilities (VESID) has been
working with the Office for Elementary, Middle, Secondary and Continuing
Education (EMSC), the Office of Mental Health (OMH), the Department of Health
(DOH) and the family organization, Families Together in New York State, Inc.
(FTNYS), to implement the spirit and intent of the Legislative Conference
recommendations. Five field-based initiatives undertaken
include:
·
Effective practices in collaborative
school-based mental health services were identified in 12 sites and replicated
in 20 locations.
·
The Coordinated Children’s Services
Initiative was designed to support cross-system planning and coordination of
services at the local, regional and State levels.
·
School Support and Closing the Gap
projects in 57 school districts designed to evaluate models to collocate mental
health services at the school district level.
·
Special Education Space Planning
initiatives in several BOCES regions intended to identify additional strategies
to address students with severe emotional distrubance on home instruction.
·
Positive Behavioral Interventions and
Supports (PBIS) models are being implemented in over 150 schools to create
supportive environments for all students.
Data indicate that this collaborative
approach is valuable to New York State students, families, and schools, as well
as municipal and State service systems.
There are implications for improving learning environments and
educational outcomes for all grade levels, particularly for middle level
education.
Recommendations
for next steps include legislation to overcome space availability barriers
impeding the collocation of intensive clinical services and a shift in program
development emphasis to expand the Positive Behavioral Interventions and
Supports (PBIS) model.
Enhancing
Collaboration Between the
Mental Health and Education
Systems
Introduction
Since the September 2000 Regents Legislative
Conference, the Office of Vocational and Educational Services for Individuals
with Disabilities (VESID) has been working with the Office for Elementary,
Middle, Secondary and Continuing Education (EMSC), the Office of Mental Health
(OMH), the Department of Health (DOH) and the family organization, Families
Together in New York State, Inc. (FTNYS), to implement the spirit and intent of
the Legislative Conference recommendations. Five major initiatives include the
following.
1.
Effective
Practices in Collaborative School-Based Mental Health Services were identified
in 12 sites then replicated in 20 locations.
2.
Department
participation with other agencies in the Coordinated Children’s Services
Initiative (CCSI) Tier III interagency planning initiative to prevent out of
home placements through voluntary cross-systems planning by municipal mental
health and school leaders in 56 locations.
3.
School
Support and Closing the Gap Projects piloted various approaches to co-location
of mental health and parent support services in 57 schools to serve individual
students and families and to consult with teachers and administrators on
strategies to address urgent student needs.
4.
In nine
BOCES regions, VESID targeted additional Program Development Grant resources
through the space planning initiative, to develop instructional strategies and
research-based approaches in school districts with large numbers of students
with severe emotional disturbance who remained on home instruction or who were
awaiting placement because existing programs and services could not
appropriately meet their educational needs.
5.
PBIS models
are being phased-in at 151 schools across the State as the first phase of a
systems change effort. PBIS
incorporates preventive strategies for the early identification of behavioral
issues that could impede learning and the utilization of district and school
level strategies to address these issues.
Regents Goal
#1:All students will meet high standards for academic performance and personal
behavior and demonstrate the knowledge and skills required by a dynamic
world.
Background
According to the U.S. Department of Health
and Human Services, approximately 20 percent of children in the United States
between the ages of 9 and 17 have a diagnosable mental health disorder. Of these children, 70 percent never
receive mental health services.
For a large number of New York State’s
school-age children, emotional and behavioral problems impede the ability to
learn and prepare for a successful post-school life. For example, annually in New York State
about 125,000 students, or 4.4 percent of all NYS public school students, are
suspended one or more times from school during the course of the school
year. Educators are increasingly
challenged to find ways to address disruptive student behaviors through
disciplinary actions or crisis interventions.
New York State OMH estimates that 100,000
children and adolescents are served annually by the public mental health
system. This is 3 percent of the
school age population in New York State.
OMH diagnoses include attention deficit disorder (25 percent), conduct
disorder (19 percent), mood disorders such as depression (15 percent), psychotic
disorders (3 percent) or other disorders (38 percent). A mix of general as well
as special education students is served by OMH. In New York State, students with
disabilities represent 62 percent of children admitted for the most intensive
levels of in-patient mental health services. Seventy-one percent of these students
were classified as emotionally disturbed by their Committees on Special
Education (CSE).
Students with disabilities classified as
emotionally disturbed in 2002-03 were 2.3 times more likely to drop out than
graduate. Students classified as emotionally disturbed, representing 11 percent
of all students with disabilities, also accounted for 26 percent of out of
school suspensions for students with disabilities. Their rate of participation
in separate educational programs is 27 percent, almost 4 times the New York
State average rate of 7.7 percent for all students with disabilities. Of those placed in separate programs,
one out of every ten is placed in a State agency residential program, including
the Office for Children and Family Services (OCFS), the Department of
Correctional Services (DOCS) or OMH, and another two out of every ten are placed
in private residential facilities.
September 2000 Regents Legislative
Conference
In September 2000, a panel of practitioners
and audience participants joined members of the Board of Regents in discussing
steps that encourage expansion of effective school-based mental health services,
an increased role for parents and development of mechanisms to support the
parent role. Panelists gave
multiple examples where effective collaboration and parental involvement
improved outcomes for children in the school and community. Increasing the availability of quality
mental health interventions was cited as critical if schools are to support
children’s efforts to achieve success in their school and community, especially
in high need areas of the State where the numbers of children at risk are
concentrated. This State level
discussion echoed national public policy
conversations.
As a follow-up to the Legislative Conference,
in April 2001, nine recommendations were presented to the Board on actions that
could enhance collaboration between the mental health and education
systems.
1.
Advocate
with the Legislature and Governor for increased resources and access to clinical
services in schools.
2.
Support the
development of a mechanism that would provide counties, schools and
municipalities the authority to blend funding for collaborative services at the
local level.
3.
Encourage
school districts to include space for collocated health, mental health or other
human services when districts are planning expansion of school space.
4.
Establish
parent supports and increase parent involvement.
5.
Encourage
school district leadership to recognize partnerships as a critical component to
students achieving academic success, especially in Closing the Gap schools and
communities.
6.
Adopt
guiding principles for a “system of care” approach to improving educational
outcomes, including infusing them in an updated policy statement on Parent
Partnerships, and assisting school districts in adopting these principles,
recognizing their importance in providing a safe and supportive learning
environment for all students.
7.
Develop
guidance documents for the field that address stigma identification/reduction to
assist school districts in implementing the Safe Schools Against Violence in
Education (SAVE) Act of the Laws of 2000.
8.
Ensure
that school pupil services personnel and their human services counterparts
acquire the competencies to collaborate with one another to meet the needs of
children and their families.
9.
Encourage
schools to include in their discipline policies and practices a range of
positive supports, strategies and interventions to lessen the need for removals
and suspensions.
In April 2002, the Board received a status
report regarding activities focused on assisting children in achieving success
in their school and community through collaboration. Since that time, OMH, DOH, FTNYS and the
State Education Department (SED) have continued working together to support the
recommendations to increase resources and access to clinical services in
schools. Columbia University Center
for the Advancement of Children’s Mental Health was funded to develop a
comprehensive evaluation plan and provide technical assistance.
The primary methods used for implementing the
recommendations include:
§
Legislative action;
§
Policy guidance issued to the field;
§
Inclusion of key principles in quality
review practices with local schools;
§
Collaboration with other state agencies
and family organizations in planning and carrying out new school-based mental
health initiatives;
§
Funding directed toward school-based
mental health initiatives;
§
Professional development and support
activities to assist local school districts and mental health providers to
implement new approaches to assist children with emotional and behavioral needs;
and
§
Program evaluation data to assess and
adjust strategies.
Summary
of Program Initiatives Implementing Mental Health
Services in Schools
The Effective
Practices in Collaborative School-Based Mental Health Services
initiative developed effective and innovative collaborations between schools and
mental health agencies and service providers to improve outcomes for children
and their families. SED and OMH, as
members of the interagency collaborative, Partners
for Children, developed two Requests for Proposals (RFP). The first RFP (Phase I) provided
financial support between 1999-2003 to 12 established school-mental health
collaborations. The second RFP
(Phase II) supported 20 less-developed school partnerships between 2000-03. Funding was used for program
enhancement, and to enable Phase I partnerships to mentor Phase II school
partnerships.
The most
successful school-based mental health collaborative partnerships identified
under the Effective Practices initiative were found to include tthese
components:
§
a collaboratively developed mission, plan
and goals;
§
consistent support from the school
district superintendent, principal(s), board of education, teachers and other
school staff;
§
consistent family involvement;
§
strength-based service planning (including
wrap-around services, individualized student-centered planning and targeted
funding);
§
collaborative ties with a wide range of
community services and agencies; and
§
valid, clear means for collection of data
and outcome measurement for use in evaluating effectiveness and programmatic
decision-making.
While many of these projects funded through
the RFP process demonstrated positive impact on individual student behavioral
and academic performance, subsequent staffing and funding changes occurring
between the schools and community service programs undermined the sustainability
of the efforts. School-wide
measures such as academic performance, disciplinary actions and attendance were
not impacted, since the projects were targeted to individual children in need,
not the entire student body at the participating
schools.
Coordinated Children’s Services Initiatives
(CCSI)
The Coordinated Children’s Services
Initiative (CCSI) is an interagency effort to plan and implement services
designed to maintain children who have complex emotional and behavioral service
needs in their homes, schools and communities. CCSI uses an interagency structure to
coordinate planning and address barriers to effective service delivery at three
levels -- local (municipality, community, family and school), regional and
statewide. Local initiatives vary
from county to county, but the consistent criterion is that CCSI activities
target children who are at imminent risk of an out-of-home
placement.
CCSI began in 1993 as a grass roots
initiative serving some locations.
State legislation passed in 2002 formalized the process to make it
accessible statewide. State
agencies, including SED, jointly fund seed grants to support local creation of
CCSI teams. CCSI is an important tool to assist schools in partnering with other
agencies to help these children. In
the counties submitting semi-annual reports in 2003, 1,491 children were
referred to CCSI, and 1,319 were accepted into the process. Of these, only 77 (6 percent) resulted
in an out-of-home placement. In
addition to reducing the volume of out-of-home placements, CCSI teams strive to
assure that placements are made in the least restrictive environment and for the
shortest length of time.
Despite its value, the funding for staff at
the municipal level to provide team leadership and coordination is an ongoing
challenge in maintaining the collaborative planning process given ever shrinking
municipal resources.
School Support Projects to Integrate Mental
Health Services in Schools
Beginning in 1999, SED, OMH, DOH and FTNYS
targeted resources and expertise to serve children with significant behavioral
issues that put them at risk of academic failure, suspension, special education
placement or placement out of school, and children in special education
placements whose behavioral needs must be addressed in order to successfully
return them to general education classrooms. School Support Project (SSP) models were
developed to:
§
Identify successful strategies for
integrating mental health services from multiple systems into school
buildings;
§
Provide student and family supports in an
environment that fosters the system of care approach;
§
Provide high quality mental health
services to children and families; and
§
Identify the lessons learned to ensure
that future collaborations will be successful.
Program Development Projects Build Instructional
Models to Reduce Home Bound Instruction
In 2002, VESID issued a Program Development Grant
Application Request to stimulate program development targeting approximately 700
students with disabilities whose learning is extraordinarily challenged by
autism or severe emotional and behavioral issues. Students previously were placed on home
instruction or placed in inappropriate placements. Seven of the grants developed programs
in collaboration with local mental-health agencies and three developed
partnerships with universities to provide
on-site consultation and support in the area of behavior management. Mid-point progress reports indicate
increases in student attendance rates, decreases in suspensions and other
disciplinary referrals, increases in positive student behaviors, good academic
progress including passage of Regents Competency Tests (RCT) and Regents exams,
increases in parental involvement, and increases in teachers using strategies
learned in professional development.
Positive Behavioral Interventions and
Supports (PBIS)
Recommendation 9 from the Board of Regents Legislative
Conference was to encourage schools to consider a range of positive supports,
strategies and interventions beyond removals and suspensions in discipline
policies and practices.
The PBIS projects focus on creating and maintaining safe and
supportive learning environments
in schools. PBIS is a data-driven,
research-based approach to preventing and responding to classroom and school
discipline problems by creating systems changes. National data indicate that schools
fully implementing PBIS may expect to reduce discipline referrals, suspensions
and expulsions while increasing academic performance. Because of the increasing
body of research supporting this approach, increasing the use of PBIS is an
emphasis of the newly reauthorized Individuals with Disabilities Education Act
(IDEA).
Schools that adopt a school-wide PBIS approach must
commit to establishing a full continuum of behavior supports, using primary,
secondary and tertiary strategies. Primary interventions (80 percent of student
needs) are preventive and involve restructuring the environment so that all
staff, from teachers and administrators to cafeteria workers and bus drivers,
learn to use approaches with all students that reinforce positive
behaviors. Secondary interventions
(15 percent of student needs) target specific strategies to address the
disruptive behaviors of groups of students with similar needs. Tertiary interventions (five percent of
student needs) are the most intensive levels of services needed by individual
students and families to address the most severe behavioral and emotional
needs. Clinical services such as
those provided in SSP II and III projects are examples of tertiary-level
wrap-around services.
The PBIS initiative began in March 2002. Seven regional Technical Assistance
Centers (TACs) are being established in
SED Student Support Services Network Centers to develop the capacity of schools that have committed
to redesign their school programs over multiple years to incorporate all levels
of PBIS intervention. Involving
families in project planning teams, in receiving and providing training, and in
providing family specific support is a unique approach being incorporated in the
New York State PBIS initiative.
Currently, 151 schools across the State are in various stages of implementing PBIS with
TAC support. Preliminary
data indicate 78 percent of the first cohort of schools to begin PBIS
implementation, are actively implementing universal level strategies focusing on
changing school climate; 88 percent are forming teams to target assistance to
groups of students requiring special attention; and 64 percent are beginning
staff development to prepare to address intensive individual student and family
support needs. A statewide interagency leadership team guides the
ongoing coordination of the project.
Data for the year 2003-04 indicate that in the six schools farthest along in developing PBIS approaches,
office discipline referrals declined by 28 percent. Exemplary data from these sites indicate
reductions in office discipline referrals, insubordination, and tardiness to
school or class. Trend data from school
report cards will be gathered over time to assess the impact on
schools’ academic performance and
school climate, and identify and share effective approaches.
Lessons
Learned Implementing Mental Health Initiatives in Schools
While the long-term potential systems change impact for each of the
strategies summarized above varies widely, the following lessons learned from
the initiatives provide valuable insight to guide future
efforts.
§
School
Climate: Achieving and sustaining systemic change will
require a school-wide or district-wide approach to school environment such as
PBIS plus development of the mental health service components necessary to
supplement this effort. Integrated
mental health services have a greater chance of success if implemented in
schools and districts that have already begun initiatives focused on creating a positive school climate, such as PBIS.
The mental health services then can be used for those five percent of students
who need more individualized interventions and services.
Recommendations and Next
Steps
1.
Regents Priority Legislative Proposal
The
Regents 2005 Priority Legislative package includes a
proposal to authorize use of school space to improve student
access to health, dental and mental health clinic services through interagency
collaboration.
This bill will remove legislative barriers to
implementing mental health, health and dental services in school buildings. Students and families who are most in
need of services will have ready access to services needed to help
ensure students stay in school and achieve. The President’s New Freedom Commission
on Mental Health emphasizes that providing access in schools to mental health
services and supports provides the mechanism for early detection, assessment and
links with treatment and supports that can prevent childhood mental health
problems from spiraling downward through school failure, poor employment
opportunities and adult poverty. It
can overcome a significant barrier to families in poverty who have limited time
and access to transportation to get to mental health clinics and who stay away
because of the stigma of going to a mental health center Making services available in the
natural setting of a school makes it easier for students and families to seek
the help they need.
2.
Invest in Positive Behavioral Interventions and Supports (PBIS)
Because PBIS includes both school-wide and
student-specific clinical interventions, it has the potential to improve the
capacity of schools to redirect efforts from student discipline to student
achievement. Investing in PBIS
implementation should be the thrust of educational program development over the
next several years. PBIS addresses
the widest spectrum of student needs and represents a critical strategy
for addressing the needs of middle school students in
particular. Forty-four percent of the 55
School Support Project schools decided to begin
PBIS implementation in addition to providing mental health services. Research consistently cites the power of schools to
turn the lives of children from risk to resilience. However, there are many
challenges to bringing PBIS alive in all school buildings in the State. Implementation will require multiple
year commitments on the part of local school boards and administrators and top
down support that is USNY-wide, interagency and family-oriented.
