Evidence-Based Practices in School Mental Health Interventions

Evidence-Based Practices in School Mental Health Interventions Carey Dimmitt, Ph.D. Ronald H. Fredrickson Center for School Counseling Outcome Research and Evaluation UMass Amherst

Goals for Session Define terms Tiered interventions Mental health prevention and interventions Executive Functions how related? Identify research-based practices for mental health prevention and interventions with elementary, middle and high school students Share experiences implementing prevention programs and interventions that are working in your site Develop plans for next steps for your program in this domain

Theoretical Context: Levels of Intervention from RTI Tier One: Primary Prevention All students (100%) Ex: School-wide interventions Tier Two: Secondary Prevention/ Intervention At-risk behavior (10-20%) get Tier 1 and 2 Ex: Group interventions Tier Three: Tertiary Prevention/ Intervention, and Treatment High-risk behavior (5-10%) get Tier 1, 2 and 3 Ex: Individual interventions

RTI Levels of Intervention Model Tier 3 Few Students (5-10%) Reduce severity, intensity and complications of existing problems Tier 2 At-Risk Students (10-20%) Small Group Reduce current problems Tier I All Students (100%) Reduce new problems Preventative, Proactive Intense, Individualized Support Targeted, Supplemental Supports Evidence-Based Practices & Interventions Services across tiers are fluid and data-driven District/Community Team Student Services Team Student Services Team Grade Level Teams Core Curriculum, Instruc0on, and Learning Student Services Team Environment School Improvement

What are Executive Functions (EF)? Advanced cognitive skills that help us regulate our behaviors and emotions = self-regulation skills a) EF primarily involving behaviors 1. Response inhibition 2. Emotional control/self-regulation of affect, motivation 3. Sustained attention 4. Task initiation 5. Flexibility 6. Goal-directed persistence, monitoring

What are Executive Functions? b) EF primarily involving thinking 1. Working memory 2. Planning/prioritization 3. Organization 4. Time management 5. Metacognition

Providing the support that children need to build these skills at home, in early care and education programs, and in other settings they experience regularly is one of society s most important responsibilities. Growthpromoting environments provide children with "scaffolding" that helps them practice necessary skills before they must perform them alone. Adults can facilitate the development of a child s executive function skills by establishing routines, modeling social behavior, and creating and maintaining supportive, reliable relationships. It is also important for children to exercise their developing skills through activities that foster creative play and social connection, teach them how to cope with stress, involve vigorous exercise, and over time, provide opportunities for directing their own actions with decreasing adult supervision. Center on the Developing Child, Harvard University http://developingchild.harvard.edu/key_concepts/executive_function/

What Do We Mean by Mental Health Interventions? Tier 1 School-wide interventions for wellbeing, positive social and emotional skills, and executive functions Self-care and healthy behaviors (sleep, nutrition) Managing emotions and behaviors, selfregulation Interpersonal skills, friendship skills Problem-solving, decision-making skills Time management skills

What Do We Mean by Mental Health Interventions? Tier 1 (con.) School-wide interventions for wellbeing, positive social and emotional skills, and executive functions Multiple academic skills such as organizing, studying, test-taking, etc. Coping strategies managing anxiety, stress, and facing challenges Resiliency capacity for overcoming difficulty What else, in your experience?

What Do We Mean by Mental Health Interventions? Tier 2 Tier 1 interventions AND Interventions to move youth at risk back into effective school functioning Group level support, counseling, and skills development for youth coping with various challenges: Learning disabilities; poverty, homelessness; family challenges (illness, death, divorce), etc.

What Do We Mean by Mental Health Interventions? Tier 2 Tier 1 interventions AND Group level support, counseling and skills development for youth with mental health diagnoses not receiving community-based services, or in transition What else in your experience?

What Do We Mean by Mental Health Interventions? Tier 3 Tier 1 and 2 interventions AND Interventions to move youth with significant mental health challenges back into effective school functioning Individual level support, counseling, and skills development for youth coping with various challenges Individual level support, counseling and skills development for youth with mental health diagnoses in collaboration with community-based services, or in transition What else in your experience?

Discussion with Colleague/Neighbors What is your school counseling program currently doing for prevention and mental health interventions at these three levels? How do you evaluate whether or not what you are doing is working? Fill in worksheet, left hand column

Discussion: Sharing Ideas What are you doing that you know works?

Tier 1/Primary Prevention (School- Wide): Successful Programs Summary 1. School improvement efforts (all levels) 2. Focus on school climate, safety (all levels) 3. Positive Behavioral Interventions and Supports (PBIS) (all levels) 4. School-wide approach to discipline (all levels) 5. Building student competencies: Comprehensive Guidance Curriculum (all levels) 6. Career Development Education: Navigation 101, High Schools that Work, Career Academies (MS, HS)

Tier 1 School-Wide Primary Prevention Positive Behavioral Interventions and Supports (PBIS) K-12 http://www.pbis.org PBIS uses a behaviorally-based systems approach to enhance and support learning PBIS seeks to make problem behaviors less effective, efficient, and relevant, and desired behavior more functional

Tier 1 School-Wide Primary Prevention Positive Behavioral Interventions and Supports (PBIS) Core components to support student outcomes: Clearly communicated expectations and goals Consistent positive reinforcement for appropriate behaviors school-wide Focus on simultaneous development of student competencies in academic and social-emotional domains

Tier 1 School-Wide Primary Prevention Comprehensive Guidance Curriculum (K-12) to develop all students competencies Evidence-based curriculum materials where available Counselor-generated materials that are site-specific Guidance curriculum integrated into academic curriculum is more effective Problem-solving Conflict resolution Study skills Metacognitive skills Executive functioning, self-regulation skills

Tier 1 School-Wide Primary Prevention Comprehensive Guidance Curriculum received by all students: Violence/Bullying Prevention Second Step/Steps to Respect Violence Prevention (Elem and MS versions) Olweus Bullying Prevention Programs (K-8) Bully Proofing Your School (best family components) (K-12) Bully Busters (teacher-based) (K-8) PeaceBuilders (K-6)

Tier 1 School-Wide Primary Prevention Comprehensive Guidance Curriculum received by all students: Academic Skill development Caring School Community (K-6) Student Success Skills (prek-9) Social/Emotional Skill development Social Decision Making/Social Problem Solving (2-8) Resolving Conflicts Creatively Program (1-6) Promoting Alternative Thinking Strategies (K-6) I Can Problem Solve (ICPS) (PreK-5)

Tier 1 School-Wide Primary Prevention Comprehensive Guidance Curriculum received by all students: Social skill development; Drug, alcohol, violence prevention Life Skills Training (K-12) Lions-Quest Skills (K-12) Project Achieve (PreK-8, has been used in HS) Project Northland (6-8) Michigan Model for Comprehensive School Health Education (K-12) Too Good for Drugs (K-12) Too Good for Violence (K-12)

Tier 1 School-Wide Primary Prevention Responsive Classroom (elem) www.responsiveclassroom.org An integrated approach to elementary education that emphasizes social, emotional, and academic growth in a strong and safe school community Goal is to create classroom environments that enable optimal student learning and emotional safety for all students To be successful academically and socially, children need a set of social skills: cooperation, assertion, responsibility, empathy, and selfcontrol.

Tier 1 School-Wide Primary Prevention Turning Points (MS) http://www.turningpts.org/ Identifies middle school years as a distinctive developmental period that must be treated uniquely Advocates for reforms to make middle school education more personalized, supportive, and active Emphasizes academic excellence and the provision of developmentally appropriate, equitable instruction

Tier 1/School-Wide Primary Prevention NAVIGATION 101: Career Planning (HS) http://www.k12.wa.us/secondaryeducation/ CareerCollegeReadiness/Handbook.aspx https://www.k12.wa.us/secondaryeducation/ CareerCollegeReadiness/Nav101Lessons.aspx Focused on goal setting Bi-monthly, 45 minute meetings Grades 6 thru 12 (Sequenced) Nine recurring themes Twenty advisory-based lessons/year 140 downloadable lesson plans Online materials to support implementation Evaluation data templates

Tier 2/At-Risk Students: Successful Programs Summary 1. Academic skill development: Peer tutoring 2. Group interventions for academic development: 3. Coping Power intervention for youth with aggressive behaviors 4. Skillstreaming or social skills development groups 5. Many of the Tier 1 programs have Tier 2 components for group level work

Tier 2 Academic Skill Development: Peer Tutoring Variety of models May also use elders, college students, parent volunteers as tutors Evaluation Improvement in math and reading scores in elementary schools Self-reported increase in connectedness to school and peers Increased GPA for secondary students Increased achievement for both mentors and mentees

Tier 2 Student Success Skills http://www.studentsuccessskills.com/ Booster for at-risk students Structured groups Teaches cognitive skills, metacognitive skills, self-management of motivation, optimism Outcome Research: Improved FCAT scores for lower quartile students

Tier 2 Coping Power Meets IES What Works Clearinghouse evidence standards for EBP Designed for students with aggressive behaviors (at risk or diagnosed with ODD or CD) in grades 4 and 5 and their parents Highly structured with specific goals, objectives, and structured exercises for each session CBT is theoretical orientation Emphasizes social and emotional skills needed during transition to middle school Addresses both child-level and contextual factors

Tier 2 Coping Power: Student Component Lessons on goal setting, organizational and study skills, improving emotional awareness, coping with peer pressure, social problem solving, anger management and peer relationships for students 34 fifty-minute small group (4-6 students) sessions 30-minute monthly individual sessions (6-8) for targeted student behavioral change Designed to be implemented across 2 school years

Tier 2 Coping Power: Parent Component 16 ninety-minute group sessions for 10-12 mothers and fathers Held at the school either during the school day or after school Lessons support and coincide with child components, use social learning theory Designed to build group cohesion among parents and to develop community and school involvement Content on setting expectations, praise, discipline, managing stress, communication, child study skills, identifying and supporting positive behaviors

Tier 2 Coping Power: Skill Development Create positive peer culture by having group develop own guidelines Use social power of other group members to support positive coping skills Ongoing goal setting/monitoring related to anger management Identify internal and external cues related to emotional arousal Develop self-monitoring skills

Tier 2 Coping Power: Skill Development Increase self-management of arousal through self-talk and individualized coping statements Other stress management strategies such as relaxation, visualization, and distraction strategies Increased repertoire of social problem-solving skills and social perspective-taking Use of role playing, script development, videotaping of possible responses

Tier 3 High Risk: Successful Programs Summary 1. Case management 2. Incredible Years 3. Coping Cat intervention for students with anxiety diagnosis 4. Individual counseling: Cognitive- Behavioral Therapy and Solution-Focused Brief Therapy 5. Behavior education programs

Tier 3 Case Management Case Management: School Counselor as coordinator of services, more than provider Coordination of services with family, community service providers, tutors, School Psychologist, Nurse, Special Education (where relevant), Truancy Officer, School Social Worker, etc.

Tier 3 Incredible Years http://www.incredibleyears.com/ Linked programs for parents, teachers, and children aged 0-13 EBP with children aged 2-8 Teach parents and teachers to: Promote children s social, emotional and academic competence Prevent, reduce and treat aggression and emotional problems Strengthens adult competencies Fosters parent-school communication

Tier 3 Incredible Years Goals of program Improving child-parent relationships Decreasing problem behaviors Increasing home-school communication Building supportive family networks Helping parents teach children social skills Helping parents teach children emotional regulation

Tier 3 Coping Cat Meets SAMHSA s standards for EBP Designed for students with generalized anxiety disorder, social phobia, and/or separation anxiety disorder Manualized Cognitive-Behavioral Treatment (CBT), and related workbook with client tasks Ages 6-12 = Coping Cat Program Ages 13-17 = C.A.T Project Program Parent companion materials Computerized version = Camp Cope-A-Lot: The Coping Cat DVD

Tier 3 Coping Cat Intervention 16 sessions for youth 8 skills training sessions on: Physiological components of anxiety Recognition of anxious self-talk Modifying problematic self-talk Developing stress management, distraction, and coping strategies Self-evaluation, success attribution Self-reward for successful management 8 skills practice sessions Rehearsal, multiple attempts Social support for group members Generalization to other contexts

Tier 3 Coping Cat Intervention FEAR acronym 1. Feeling frightened = recognize physiological signs of anxiety 2. Expecting bad things to happen = identifying anxious cognition(s) 3. Attitudes and Actions that can help = coping strategies 4. Results and Rewards = contingency management Use of STIC tasks as weekly homework Show That I Can Mastery over new skills learned in session

Tier 3 Cognitive-Behavioral Therapy Has consistent, considerable evidence of effectiveness for: Social skills development Anxiety disorders, phobias Depression Academic failure Behavior disorders PTSD Many mental health, physical health, and relational difficulties

Tier 3 Solution-Focused Counseling Has increasing evidence of effectiveness for: Relationship issues Anxiety disorders Academic difficulties Behavior disorders More for internalizing than externalizing behaviors, more for girls than boys

Tier 3 Solution-Focused Counseling Much of what school counselors do is solutionfocused out of necessity Time limited (1-5 sessions) Interventions introduced quickly Very focused sessions, with high level of counselor activity Counseling is as unobtrusive, relevant, accessible and quick as possible Act as if this is the only chance you ll have to help this person.

Tier 3 Behavior Education Program (BEP) Define behavioral expectations Teach the expectations Build a regular cycle of checking in and checking out with adults Formalize consequence for problem behaviors across the school and home Collect information for ongoing evaluation and adaptation Crone, Horner, & Hawken, 2004

Conversation with a Neighbor: How can you use this information? Using the programs on the handout and the ones we talked about, what are some interventions you want to look into? What needs might they meet at your school? Which students? How could you assess it at your school, to see if it was working? Fill in the right hand column of your handout

Questions?

Thank You! cdimmitt@educ.umass.edu Ronald H. Fredrickson Center for School Counseling Outcome Research and Evaluation www.umass.edu/schoolcounseling/