The Honorable the Members of the Board of Regents


Rebecca H. Cort 




School-Based Mental Health Initiatives:  Update and Next Steps


January 14, 2005




Updated Understanding of Mental Health Initiatives


Goal #1






This is a status report on the collaborations between the mental health and education systems since the April 2002 report to the Board of Regents.  The partnership was expanded to include health services, families and community agencies.  The report summarizes outcome data and lessons learned from five major field-based initiatives.  Recommendations for future actions include legislation to overcome space availability barriers impeding the co-location of intensive clinical services and a shift in program development emphasis to expand the Positive Behavioral Interventions and Supports (PBIS) model.









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



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.



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.


Schools, students and families valued bringing community mental health services into the school environment. The greatest percentage of successful outcomes for students found to no longer need services occurred in programs where consultation with teachers was combined with family support and individual student therapy. Family participation was increased with the provision of support specifically targeted to their needs, especially when family-to-family support was available. The ability to collaborate effectively required cross-systems professional development.  Adequate preparation of all participants (student, family, school and mental health provider) was necessary so that everyone understood expectations, roles and how different service systems work.

Significant systems barriers included funding and lack of space. It was expected that students with significant emotional and behavioral needs would be Medicaid eligible. However, this did not occur because most children were not Medicaid eligible and managed care provisions for private insurance do not recognize preventive and support services. A second major systems barrier was the lengthy process necessary to collocate clinical services on school grounds.  Many SSPs faced significant delays in starting up because of the lengthy approval process to use school space for clinical treatment needs.

Closing the Gap

          The two Closing the Gap projects are in six buildings in the Buffalo City School District (in the fourth year) and four buildings of the Newburgh Enlarged City School District (beginning its second year). The goal is to enhance the academic success of students by addressing the nonacademic issues facing children and families and providing academic supports including tutors, mentors, peer support and after-school and summer programs such as the State-funded Extended School Day and Advantage Programs and the federal No Child Left Behind Act 21st Century Community Learning Centers Program.  Project funding enables school districts to hire site facilitators to create and build the infrastructure to integrate health, mental health and social services within the districts.  Partnerships are being developed with county social services, mental health, health and probation offices as well as United Way, Catholic Charities and other community health and human service providers.  The direct services provided to students include mental health, health, family support and academic enrichment.

Buffalo served 726 students in 2003-04. Program data indicate the following benefits to participating students:

§       Increases in student grade point averages were documented for 42 to 83 percent of participating students, depending on the building.

§       Increases in attendance range from 48 to 81 percent of participating students.

§       Decreases in detention range from 74 to 100 percent of participating students.

§       Decreases in informal suspensions range from 68 to 100 percent of participating students.

§       Decreases in formal suspensions range from 87 to 100 percent of participating students.



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. 

§       Funding: One systems barrier is the lack of funding available to sustain efforts, especially for general education students.  Availability of funding for mental health services varies among elementary, middle and high schools. It is affected by the need/resource capacity of school districts and the availability of other supports for students. For example, the funding for the School Support Projects (SSPs) was the same for all projects and, in retrospect, did not account for significant demographic differences across schools. Mental Health projects need sufficient funding to support sustained implementation in schools. Medicaid revenue is of limited use due to the lack of eligibility for most students. 

§       Shared Responsibility: Shared responsibility and accountability for the successful integration of mental health services by all partners at the school level is essential.  Successful projects establish management teams with representatives from the school, health, mental health and family support entities. These teams annually assess the progress of the project and are accountable for design, implementation, data collection and evaluation.

§       Cross-systems Professional Development: Integrating mental health services within a school setting brings together a number of systems. The success of this effort is directly related to the ability of these systems to speak a similar language and problem solve as a team. This requires that technical assistance be intensive, consistent and provided by staff from involved agencies and families that understand the challenges. Extensive pre-service and in-service professional development is needed to bring systems and families together.

§       Exchanging Information: Schools that are integrating Mental Health services need an ongoing forum to meet and learn from one another.  OMH, SED, DOH and FTNYS jointly convened a statewide cross-systems training session in November 2004 to bring School Support Project partners (schools staff, mental health providers and family support workers) and representatives from other school mental health projects together to review the current status of projects, offer insights to improvement, identify lessons learned and provide support to one another. Many participants commented on the need for additional opportunities to share experiences and strategies at the local level to support on going implementation efforts.


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.