Mental Health in Schools: Meeting Accountability Demands with an Online Resource

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1 Mental Health in Schools: Meeting Accountability Demands with an Online Resource Joelle D. Powers, PhD The University of North Carolina at Chapel Hill Prepared by Casey Rubenstein University of North Carolina Copyright 2011

2 Background Schools are held more accountable by legislation for the growth and proficiency of all students, including those with mental health problems and disabilities Critical obstacle impeding schools to effectively support students is the lack of access to quick, user-friendly, prescreened and organized information about interventions that effectively address youth mental health problems Barriers such as lack of time, poor access to scholarly databases and high costs of journals impede schools ability to effectively treat students with mental health problems

3 Online Resource Methods and Results Development of a new mental health database to address the multiple barriers preventing schools from accessing information about effective practices included an extensive review of academic databases and online materials Numerous best practices were identified and results of these searches were organized by mental health diagnosis and resource type This process resulted in the development of a new mental health best practices database and made available online Provides access to free and user-friendly information about empirical and effective interventions for use in schools

4 Introduction An estimated 20% of youth ages 5-18 have a diagnosable mental health problem (Committee on Health, 2004; Nemeroff et al., 2008; Roe-Sepowitz & Thyer, 2004; Rones & Hoagwood, 2000; Weist & Paternite, 2006) The majority of these youth do not receive adequate (if any) treatment (Weissberg, 2000) Persistent mental health problems for children are associated with academic underachievement, behavior problems, and erratic school attendance (DeSocio & Hootman, 2004; Ringeisen, Henderson, & Hoagwood, 2003) Untreated youth mental disorders leads to poor life trajectories

5 Introduction Schools are becoming legislatively responsible for the growth and proficiency of students including those with mental health problems and disabilities (Individuals with Disabilities Education Act (IDEA) of 2004 (P.I and No Child Left Behind Act (NCLB of 2001 (P.I, ) Educators are being encouraged to use evidence-based practices and scientifically supported interventions to promote school success for their exceptional students Current school services are limited and not grounded in research (Franklin, 2004) Vulnerable students with mental health problems remain untreated and at risk for negative school outcomes

6 Literature Review National Institute of Mental Health believes the future of our society depends on the strength and mental health of youth (2009) Mental health problems have increased over the past 10 years (Roe- Sepowitz & Thyer, 2004) 20% of children need mental health interventions, 11% have significant functional impairment, and 5% gave extreme impairment (U.S. Surgeon General s Report on Mental Health) Specific diagnoses for children include autism, depression, anxiety, eating and behavioral disorders among others Mental health problems influence and co-occur with problem sin other areas of a child s life (DeSocio & Hootman, 2004) including the school setting

7 Literature Review Mental health problems can compromise a child s school success (Repie, 2005) An estimated 1 of 10 school-aged children have an undiagnosed/untreated mental health problem which directly or indirectly affects their academic performance (Puskar & Bernardo, 2007) The relationship between school performance and mental health has been identified as bidirectional Young people with mental health problems are more likely to perform poorly in school and develop mental health problems (DeSocio & Hootman, 2004) Without the appropriate treatment children with mental health problems will continue to lack success in future educational, employment, and family roles (Raines, 2008; Stephan, Weist, Katoka, Adelsheim, & Mills, 2007)

8 School Accountability for Empirical Mental Health Practices Schools are held accountable for the academic performance and proficiency of all students Including those with mental health disorders Supported by Individuals with Disabilities Education Act (IDEA) of 2004 (P.L ) and the No Child Left Behind Act (NCLB) of 2001 (P.L ) The mandated accountability of schools through this legislation is directly related to children s mental health diagnoses, special education services, and academic success

9 School Accountability for Empirical Mental Health Practices Approximately 10% of children in public schools are identified by schools as needing exceptional children s services (special education) in some capacity (Pomeroy & Hopson, 2006) In order to be eligible for exceptional services, a student must be diagnosed with one of the 14 disorders outlined in IDEA and the disability must adversely affect the child s education performance (NICHCY, 2009) Exceptional students are entitled to free and appropriate education under the law which ensures all children with disabilities have access to special education and related services These services are designed to meet with unique needs and prepare them for future education, employment and independent living

10 School Accountability for Empirical Mental Health Practices The NCLB act requires schools to demonstrate academic progress each year for all students (Goertz & Duffy, 2003) NCLB act also stipulates that all students are expected to make appropriate gains in reading, science, and math similar to their regular education counterparts Schools that do not make regularly yearly progress according to set standards receive sanctions

11 School Accountability for Empirical Mental Health Practices IDEA and NCLB explicitly state that schools can more effectively accomplish these lofty goals and meet expected levels of accountability by implementing evidence-based interventions Interventions must promote maximum school success and prevent negative outcomes for students (Christenson, 2004; Isaacs, 2003) IDEA challenges schools to use scientific, research-based interventions to meet student needs more than 80 times (Raines, 2004; 2008) NCLB calls for the same expectations over 100 times (Raines, 2004; 2008)

12 School Accountability for Empirical Mental Health Practices Empirical treatments for youth mental health problems exist and are available for youth in schools Children s mental health intervention research has doubled in the past decade (Hoagwood, ) New programs and interventions have been proven to improve both mental health and academic skills (Hoagwood et al., 2007; Stephan, Weist, Katoka, Adelsheim, & Mills, 2007) Despite the high number of students with untreated illnesses, evidence of the interference this causes for school performance, legislative support for scientifically-based interventions, and availability of such programs- most schools are not providing effective mental health services and students remain untreated and at a risk (Franklin, 2001; Franklin & Hopson, 2004; Walker, 2004)

13 School Accountability for Empirical Mental Health Practices A primary reason for the disconnect between existing practices and their utilization in school is the lack of awareness of their existence by school practitioners Important information about empirically supported assessments and interventions are commonly disseminated through scholarly journals This may not be the most effective method for transferring knowledge to school staff (Powers, Bowen, & Bowen, In press) Barriers such as lack of time, poor access to scholarly databases and the high costs of journals impede the information about evidencebased practices from being accessed by school educators and practitioners

14 A New Online Resource of Mental Health Interventions To reduce aforementioned barriers to knowledge of effective practices a new mental health module was developed and added to an existing online database of best practices for schools The E/SSP Best Practices Database is part of the School Success Online resource package that provides assessments, data driven decision-making support, and access to information about effective interventions for schools (Bowen & Powers, Under Review) The School Success Profile (SSP) and Elementary School Success Profile (ESSP) are ecological assessment tools designed for use in schools Help educators identify student strengths and risk factors across various domains that impact school performance in order to guide effective practice (Bowen, Richman, Bowen, & Broughton, 2003; Bowen & Powers, 2005)

15 A New Online Resource of Mental Health Interventions The online database provides schools with free and easy access to information about evidence-based programs, promising practices, and other resources (Powers, Bowen & Bowen, In press) Has been praised by school practitioners for translating research into a user-friendly and easily accessible tool that provides information about existing ecological interventions that promote health for students With the success of these databases, practitioners are beginning to request the same type of information for addressing and supporting students with mental health problems At this request, a new module of mental health resources has been developed and added to the original best practice database for schools

16 Methods Firstly, a thorough review of empirical literature regarding school-based mental health was conducted to identify best practices for assessing and addressing mental health problems in school Summer 2009 two doctoral students research assistants completed the extensive literature search Reviewed assessments, promising practices, and empirical interventions for common youth mental health problems: Depression, anxiety, school refusal, selective autism, ADHD, behavior disorders, bipolar disorder, and Autistic spectrum disorders

17 Methods Research assistants employed two strategies during literature review First, an electronic search of the Academic Search Premier, ERIC, Education Full Text, JSTOR, PsycINFO, and Sociological Abstracts databases was conducted Search terms included: school, mental health, prevention, intervention, and services, and specific mental health diagnostic labels (depression, anxiety, and autism) Second, a review of existing online materials and other reputable websites which provide information about empirically supported mental health interventions took place National school mental health center websites (Hoagwood et al., 2007) SAMHAA

18 Methods Promising results were yielded during the search to be included in the database In order to be included in the database, programs and strategies were required to have empirical support from previous evaluation in a school setting Also, all assessments must have demonstrated both reliability and validity in their use with youth

19 Methods The intervention information included in the database was organized into three types Evidence-based programs Strongest empirical support and rigorous evaluation Likely to be the most costly in regards to the implementation of resources such as purchase prices, staffing, time, and training requirements Promising practices Less empirical support Typically cost less to implement Resources Make the promising practices more feasible for some schools Primarily assessment tools which can be used to make appropriate mental health diagnosis for students being evaluated in schools

20 Methods Each intervention included in the database required a one-page write-up which was developed to include the most critical information school practitioners would need Appropriateness, feasibility, and fit between student population and the resources required A basic description and the primary objectives of each intervention or resources Cost, target age of the youth, amount of time required, person/people responsible for implementing intervention, and other resource requirements were included Research and evaluation references and contact information for further details were also included

21 Methods A unique search engine was also created and added to the mental health best practices site This search engine will only investigate reputable websites identified and chosen by the developers to ensure the information accessed is empirically appropriate for schools Goal is to reduce valuable time potentially wasted by practitioners forced to sift through websites are unhelpful or insufficiently evaluated

22 Methods The database search engine only explores websites for the following institutes and centers for information National Institute for Health (NIH), National Institute for Mental Health (NIMH), National Institute for Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), the Association for Supervision and Curriculum Development (ASCD), Center for Comprehensive School Reform Improvement, and the Center for Mental Health in Schools at the University of California Los Angeles This provides a good starting point for school-based practitioners while filtering less helpful and potentially harmful intervention information Including the search tool to the database allows schools to identify existing information about mental health problems and effective practices for a larger range of diagnosis from reputable sources

23 Results The search engine and all intervention information gathered and organized by mental health disorder and resource type were uploaded to the new mental health database on the School Success Online website in February 2010 A total of 22 evidence-based programs, 46 promising practices, and 26 resources were made available on the database Table 1 provides the type and number of resources available for each other the eight previously listed mental health diagnostic categories

24 Table 1: Number and Type of Mental Health Database Resources Diagnostic Category Evidence-Based Programs (n) Promising Practices (n) Assessments (n) Attention Deficit Hyperactivity Disorder Anxiety Autism Spectrum Behavior Disorders Bipolar Disorder Depression School Refusal Selective Mutism Total (n)

25 Navigating the Website The mental health best practice module is free and can be accessed at Provides in-depth information about the entire package of ecological assessment instruments Practitioners can access the new mental health best practices database with or without using the assessment tool After logging onto the website, the Tools options allows practitioners to choose between E/SSP Best Practices (original ecological interventions) or the new Mental Health Best Practices Practitioners can then choose between the three types of interventions: evidence-based programs, promising practices, and resources

26 Navigating the Website Goal of database is to ensure that practitioners have the most recent intervention information available to them Requires the site to be dynamic so new information and resources will be added as they are located Changes are made to the site based on practitioners feedback Initial responses from school staff have been overwhelmingly positive Easy accessibility, detailed descriptions of programs, and the relevance and usefulness of the content Some ideas for improvement have been shared and resulted in alterations to the website Practitioners suggested altering the text of the program description to make the information easier to read and engaging

27 Discussion Schools are key to promoting health and success for vulnerable students with mental health problems Schools have excellent access to clients as administrators, teachers, and staff interact with families and children almost daily (Nemeroff et al., 2008) Schools are also staffed with multidisciplinary personnel with the potential to identify and work with students to improve their functioning in multiple domains including mental health (Elias, Zins, Graczyk, & Weissberg, 2003)

28 Discussion Currently, schools are required by law to improve the learning of all students by using scientifically supported interventions To do this, schools must be aware of the available evidence basedpractices that have proven to be effective schools This website was developed at the request of practitioners and provides access to free and use-friendly information about empirical and effective mental health interventions Will be helpful for staff to recognize and effectively response to those problems before they significantly interfere with students academic careers This is a valuable resource needed for the promotion of health, improved learning and school success among students with mental health problems

29 References Bowen, G. L., Richman, J. M., Bowen, N. K., Broughton, A. (2003). The School Success Profile online. Journal of Technology in Human Services, 21 (1/2), Bowen, N. K. & Powers, J. D. (Under Review). The Elementary School Success Profile Model of Assessment and Prevention: Balancing effective practice standards and feasibility. Preventing School Failure. Bowen, N. K., & Powers, J. D. (2005). Knowledge gaps among school staff and the role of high quality ecological assessments in schools. Research on Social Work Practice, 15, Christenson, S. L. (2004). The family-school partnership: An opportunity to promote the learning competence of all students. School Psychology Review, 33, Committee on School Health. (2004). Policy statement: School-based mental health services. Pediatrics, 113, DeSocio, J., & Hootman, J. (2004). Children s mental health and school success. The Journal of School Nursing, 20, Elias, M. J., Zins, J. E., Graczyk, P. A., Weissberg, R. P. (2003). Implementation, sustainability, School Psychology Review, 32, and scaling up of social-emotional and academic innovations in public schools. Franklin, C. G. (2001). Onward to evidence-based practices for schools. Children & Schools, 23(3), Franklin, C., & Hopson, L. (2004). Into the schools with evidence-based practices. Children & Schools, 26, Franklin, C. G. & Kelly, M. S. (2009). Becoming evidence-informed in the real world of school social work practice. Children & Schools, 31, Goertz, M., & Duffy, M. (2003). Mapping the landscape of high-stakes testing and accountability programs. Theory Into Practice, 42, Hoagwood, K. ( ). Evidence-based practice in child and adolescent mental health: It s meaning, application, and limitations. Emotional & Behavioral Disorders in Youth, 4, 7 8. Hoagwood, K. E., Olin, S. S., Kerker, B. D., Kratochwill, T. R., Crowe, M., & Saka, N. (2007). Empirically based school interventions targeted at academic and mental health functioning. Journal of Emotional and Behavioral Disorders, 15, Individuals With Disabilities Education Improvement Act of 2004, PL , 118 Stat (2004). Isaacs, M. L. (2003). Data-driven decision making: The engine of accountability. Professional School Counseling, 6, National Dissemination Center for Children with Disabilities (NICHCY) (2009) Categories of Disability Under IDEA Law. Retrieved July 2, 2009 from National Institute of Mental Health (NIMH) (2009). Child and adolescent mental health. Retrieved July 2, 2009 from, Nemeroff, R., Levitt, J. M., Faul, L., Wonpat-Borja, A., Bufferd, S., Setterberg, S, & Jensen, P. S. (2008). Establishing ongoing, early identification programs for mental health programs in our schools: A feasibility study. Journal of the American Academy of Child & Adolescent Psychiatry, 47, No Child Left Behind Act of 2001, P.L , 115, Stat (2001).

30 References Pomeroy, E. C. & Hopson, H. (2006). Understanding the use of mental health classification and DSM-IV TR in schools. In C. Franklin, M. B. Harris, & P. Allen-Meares (Eds.), The School services sourcebook (pp ). New York: Oxford University Press. Powers, J.D., Bowen, N. K., & Bowen, G. L. (In Press). Supporting evidence-based practice in schools with an online database of best practices. Children & Schools. Powers, J. D., Bower, H. A., Webber, K. C. & Martinson, N. (Under Review). Promoting school-based mental health: Perspectives from practitioners about needs for success. Social Work in Mental Health. Puskar, K. R., & Bernardo, L. M. (2007). Mental health and academic achievement: Role of school nurses. Journal for Specialists in Pediatric Nursing, 12, Raines, J. C. (2004). Evidence-based practice in school social work: A process in perspective. Children & Schools, 26, Raines, J. C. (2008). Evidence-based practice in school mental health. New York: Oxford University Press. Repie, M. S. (2005). A school mental health issues survey from the perspective of regular and special education teachers, school counselors, and school psychologists. Education and Treatment of Children, 28, Ringeisen, H., Henderson, K., & Hoagwood, K. (2003). Context matters: Schools and the research to practice gap in children s mental health. School Psychology Review, 32, Roe-Sepowitz, D. E., & Thyer, B. A. (2004). Adolescent mental health. In L. A. Rapp-Paglicci, C. N. Dulmus, & J. S. Wodarski (Eds.), Handbook of prevention interventions for children and adolescents (pp ). New York: John Wiley & Sons. Rones, M. R., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3, Spernak, S. M., Schottenbauer, M. A., Ramey, S. L., & Ramey, C. T. (2006). Child health and academic achievement among former Head Start children. Children and Youth Services Review, 28, Stephan, S. H., Weist, M., Katoka, S.,Adelsheim, & Mills, C. M. (2007). Transformation of Children s mental health services: The role of school mental health. Psychiatric Services, 58, U.S. Surgeon General s Report on Mental Health. (2001). Retrieved July 2, 2009 from Walker, H. M. (2004). Use of evidence-based interventions in schools: Where we ve been, where we are, and where we need to go [Commentary]. School Psychology Review, 33, Weissberg, R. P. (2000). Improving the lives of millions of school children. American Psychologist, 55, Weist, M. D. & Paternite, C. E. (2006). Building an interconnected policy-training-practice-research agenda to advance school mental health. Education and Treatment of Children, 29,

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