THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234
The Honorable the Members of the Board of Regents
Rebecca H. Cort
TITLE OF ITEM:
School-Based Mental Health Initiatives: Update and Next Steps
DATE OF SUBMISSION:
January 14, 2005
RATIONALE FOR ITEM:
Updated Understanding of Mental Health Initiatives
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.
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.
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.
#1:All students will meet high standards for academic performance and personal
behavior and demonstrate the knowledge and skills required by a dynamic
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
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.
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beingin SED Student Support Services Network Centers SPreliminary 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. sixby 28 percent. Exemplary data from these sites indicate reductions in office discipline referrals, insubordination, and tardiness to school or class. ’, 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.
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for. It is affected by the /For example, tthe 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. due to the lack of eligibility for most students
Successful projects establish mhealth, ies
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