Educating Youth About Mental Illness: A Research and Practice Collaboration using YES in Schools Kristen Hood, LMSW Joanne Riebschleger, PhD, LMSW MASSW Conference, Lansing, MI October 2015 Introductions Kristen Hood, LMSW Waverly Community Schools-Lansing 5 years at Waverly Middle School Site of 3 cohorts of YES groups Joanne Riebschleger, PhD, LMSW Michigan State University Associate Professor, School of Social Work YES Designer and Lead Researcher Agenda I. Overview of YES I. Development of Research and School Collaboration II. III. YES Lesson Design and Implementation - Experiential Examples Research Results and Future Directions IV. Implications for Daily Practice with Students, Families, and Colleagues 1
Learning Objectives 1. Describe YES as a treatment group or an educational group, and explain why researchers selected that model 2. Describe the components of a lesson module, and describe at least one learning activity used in YES lessons 3. Identify misperceptions held by youth regarding mental illness and corresponding facts that remedy those misperceptions I. Overview of YES YES is A 10 week mental health literacy program developed by Dr. Riebschleger for adolescents with parents or other family members with whom they regularly interact that have a mental illness, substance abuse, or co-occurring disorder. Designed to educate youth with factual information about mental health, including: - improved understanding of mental illness - treatment and recovery - mental illness and/or substance abuse - coping skills People (kids especially) fear what they do not understand. Kids need answers to questions like: What is going on? Why is this happening to me? How can I make my parent better? Social Work Today, Sept/Oct. 2007 2
II. YES is Not A treatment group YES is Not Yet (but we re working on it!): An evidence-based practice With continuing research implementation over the next 5 years, goal is to become certified as an evidence-based practice III. YES Implementation Cohorts 60+ youth participated in over 12 groups in three Community Mental Health Agencies and Two Waverly Community Schools. Youth were 11-15 years. They were in grades 5-8. All had a parent or other family member who reportedly had a mental illness (MI), substance abuse (SA) or co-occurring disorders (MI + SA). Five of the groups took place during the school day. The rest took place after school. IV. Development of Research/School Collaboration 3
The Road to a School Partnership 20 year historical development beginning with one case in a public mental health facility Identified a need for information for kids about mental health Attempts to collaborate with local CMH agencies - Recruitment and retention challenges At an MSU Field Instructor s meeting, Joanne Riebschleger and Mark Nester develop a plan to consider a MSU and Waverly schools collaboration. YES at Waverly Middle School 2009 Waverly Middle School identified as a persistently lowachieving by Michigan Department of Education (MDE; lowest 5% of districts academically state-wide) Awarded a School Improvement Grant (SIG) in 2010 Creation of role of Positive Behavior Support Specialist combined with a culture of innovation and improvement initiatives to create a unique opportunity for YES Idealism meets Reality Approval from District and school administrators required Recruitment/Scheduling a function of the daily schedule & facilitator availability - 7 th vs 8 th graders, Foundations Class Screening for mental illness of loved ones based on student self-report - Self-report didn t always match parent report 4
Requirements, Grants, and Supporters Requirements of grants influenced the implementation requirements from year to year Grant Funders: Substance Abuse Mental Health and Services Administration (SAMHSA), Gerstacker Foundation, Guidance Center, State of Michigan Department of Community Health. Plus Michigan State University seed grants School of Social Work, Provost s Undergraduate Research Initiative, Family and Children Together program. Other Support: Also significant in-kind support from Waverly Schools, Shiawassee Community Mental Health, Bay-Arenac Behavioral Health, and the Guidance Center of downriver Detroit (Wayne County). Contributions from MSU colleagues, especially Deb Bybee (Psychology), Esther Onaga (Human Development & Family Studies), and Betty Tableman (Outreach). III. YES Lesson Design and Implementation Program Components Recruitment/Group Formation Permission: paperwork, paperwork, paperwork Pre-testing Group Sessions Post-testing 5
Curriculum Elements Group 1 YES orientation Group 2 Coping Group 3 Mental illness & recovery (MI) Group 4 Depression Group 5 Substance abuse & recovery (SA) Group 6 Co-occurring MI/SA Group 7 Stigma Group 8 Recovery & families Group 9 The future Group 10 Graduation Every session has Check in on coping Word of the Day - Reflecting learning theme Food (Budget generously!) Lively, fun activities Discussion Youth evaluation of the session Parent take home documents Incentives for completing the evaluation and bringing back parent documents Selected YES activities Myths and truths (Group wall poster) MYTH? TRUTH! Use of facts from KMIR pre/post test Stress monster 6
Coping Intentionally teach coping as a concept Healthy vs unhealthy coping mechanisms Balance the coping mobile as an interactive activity Stigma Teach the definition of stigma and show examples Stigma Mental illness is common ( 1 in 5) Recovery works 7
Lessons WE Learned In Delivering the Program Applying best teaching practices to help students improve knowledge - repetition and multiple sources of information High levels of stress reported by students Normalizing mental illness has the danger of normalizing unsafe behaviors of mentally ill individuals - a conscious distinction needs to be made Lessons WE Learned Needed technology (and back up plans) Perceptions of substance abuse/mental health dichotomy students didn t distinguish Parent engagement challenges Coping skills became a major focus and results suggest possible improvements IV. Research Results and Future Study 8
Research Results - Quantitative 1. KNOWLEDGE MI - Youth knowledge of mental illness and recovery increased significantly. The most change was on the stigma subscale. These findings were still holding at nearly 2 months post intervention. This is really good. 2. SUBSTANCE USE Youth reported substance use did not increase across pre, post, and follow up phases of data collection. This is good. 3. COPING Previously, youth reported coping per the ACOPE instrument did not show any change from pre to post. This is not good. We added coping to every session and changed the outcome measure to examine the number of coping skills and youth reported coping change (or lack of change). We have not run the stats on this as we need a larger sample. However, there are more coping skills identified at post intervention and all of the youth reported improved coping. We will be working on additional analysis after the last group. 4. FIDELTY - Program fidelity was high overall 88%. This is excellent especially for the first year of fidelity data collection. 5. Retention was excellent (89% retention). Among those who left the group, most left early. Reasons for leaving parent consent withdrawal during divorce proceedings (1), move to foster care (1), move to kinship care (1) and unknown. A number of youth asked to take the program over again because they said they liked it. Research Results - Qualitative Youth session responses were quite positive. Many said they were surprised there were other youth that shared similar family circumstances. Youth were able to describe myths and truths about mental illness and recovery. Youth were able to identify and give examples of stigma. A number of youth indicated that the group was the first place they ever talked about their family members mental health challenges. One said this is the ONLY place we can talk about it (parent mental illness). Parents said that they appreciated that the program was being offered and said, I wish they had that when I was a kid. Several mentioned a need for a parent group. Most parents said they read the materials that came home. One was not happy with a handout that came home on parental mental illness. One asked to help obtain food from local businesses for future groups. Future Research Directions Look for other sites to participate in extended research in the future (instrument testing and program delivery). Finish knowledge scale development and testing. Obtain external funding for continued research with control or comparison group. Randomized assignment is best. Complete pilot data and apply for becoming an evidencebased program. Develop a Mental Health Literacy website for COPMI, family members, and professionals. Expand to other schools and institutions - This includes developing a training program for the YES program. (Best of all) Change the world so ALL people have accurate information about mental illness. 9
V. Implications for Daily Practice with Students, Families and Colleagues Think Pair : Share Questions: What is one take-away idea or strategy you can use in your daily practice? What is one thing you will commit to doing back at school? Step 1: Think quietly, write your answers on a sheet of paper Step 2: Share and discuss your ideas with a neighbor (pair) and/or Step 3: Be prepared to share aloud with the group Daily Work with Students Be conscious about teaching knowledge before interventions When kids have better information, they are empowered Recognize the very high stress levels reported by students, even though it is not always visible 10
Daily Work with Colleagues and Families Colleagues often lack knowledge about mental health as well (as well as parents, family members, and the general public) When colleagues have better information, they can be more sympathetic, willing to engage in supportive interventions for students Recovery works seek treatment sooner for self or loved ones Questions & Comments Resources Selected Readings Armstrong, C., Hill, M., & Secker, J. (2000). Young people s perceptions of mental health. Children and Society, 14, 60-72. Bassani, D.G., Padoin, C.V., & Veldhuizen, S. (2008). Counting children at risk: Exploring a method to estimate the number of children exposed to parental mental illness using adult health survey data. Social Psychiatry Psychiatric Epidemiology, 43, 927 935 Drost, L.M., & Schippers, G.M. (2015). Online support for children of parents suffering from mental illness: A case study. Clinical Child Psychology and Psychiatry, 20, 53-67. England, M.J., & Sims, L.J. (Eds.) (2009). Depression in parents, parenting, and children. National Research Council and the Institute of Medicine. Washington, DC: National Academies Press. Falkov, A. (2012). The family model handbook: An integrated approach to supporting mentally ill parents and their children. Hove, BN, UK: Pavillion. 11
*Gladstone, B. M., Boydell, K. M., Seeman, M. V., & McKeever, P. D. (2011). Children's experiences of parental mental illness: A literature review. Early Intervention in Psychiatry, 5, 271-289. *Mordoch, E., & Hall, W. A. (2008). Children's perceptions of living with a parent with a mental illness: Finding the rhythm and maintaining the frame. Qualitative Health Research, 18, 1127-1144. *Reupert, A. Maybery, D., Nicholson, J., Göpfert, M., & Seeman, M.V. (2015). Parental psychiatric disorder (3 rd ed.). Cambridge, UK: Cambridge University Press. *Tolan, P., Szapocznik, J., & Samrano, S. (Eds.). (2007). Preventing youth substance abuse. Washington, DC: American Psychological Association. *Van Santvoort, F., Hosman, C. M., Van Doesum, K. T., & Janssens, J. M. (2013). Children of mentally ill or addicted parents participating in preventive support groups. International Journal of Mental Health Promotion, 15(4), 198-213. Web Resources Resources for Supporting Families Dealing with Parental Mental Illness Compiled by the Daughters and Sons of Parents with Mental Illness Work Group (NAMI website) Resources for and about Children of a Parent with a Psychiatric Illness Compiled by Joanne Riebschleger (NAMI website) http://www.copmi.net.au/ Excellent Australian Website http://www.aacap.org/aacap/families_and_youth/facts_for_famili es/facts_for_families_pages/children_of_parents_with_mental_ill ness_39.aspx Psychiatry website http://www.mentalhealthamerica.net/ MH Crisis training for the public, crisis responders, educators, health providers, and educators And for further questions, contact us at: Kristen Hood, LMSW School Social Worker/ Positive Behavior Support Specialist Waverly Community Schools khood@waverlyk12.net Joanne Riebschleger, PhD, LMSW Associate Professor School of Social Work Michigan State University riebsch1@msu.edu 12