School-Based Mental Health:
Results of a Statewide
Survey
David Wheeler, School Psychology Consultant
Student Support Services Project/USF
Gria Davison, School Social Work Consultant
November 27, 1958 – September 14, 2013
Ana Grace
Marquez-Greene
A Parent’s Response
Ana Grace
Marquez-Greene
Killed December 14, 2012
Sandy Hook Elementary School
Best Practices for Creating Safe and Successful Schools
- A Framework for Safe and Successful Schools, 2013
 Integrate services through collaboration.
 Implement multi-tiered systems of support.
 Improve access to school-based mental health supports.
 Integrate school safety and crisis/emergency prevention,
preparedness, response, and recovery.
 Balance physical and psychological safety.
 Employ effective, positive school discipline.
 Allow for the consideration of context.
 Acknowledge that sustainable and effective improvement takes
patience and commitment.
School-Based Mental
Health
Florida’s Framework for Promoting Social-Emotional and Behavioral Health
What are school-based mental health
services?
 Broad spectrum of assessment, prevention, intervention,
postvention services.
 Essential to school’s ability to ensure a safe and healthy
learning environment for all students, support students’
social-emotional needs, identify & respond to mental
health problems, and promote students academic
success.
 Ideally, school-based services dovetail with community-
based services so that children and youth receive the
support they need in a seamless, coordinated, and
comprehensive system of care.
Why school-based mental health?
 Mental health and psychological wellness are integral to
school success.
 Students who receive social-emotional support and prevention
services achieve better academically.
 Left unaddressed, mental health problems are linked to
academic and behavior difficulties, dropping out, delinquency,
and risk behaviors
 Growing and unmet need for mental health services for
children and youth.
 Schools are a natural place to provide services.
 Wise investment – prevention and intervention are less
costly than negative outcomes of unmet mental health
problems.
Adverse Childhood Experiences (ACE)
Over 17,000 Kaiser Permanente members participated in a
study to find out about how stressful or traumatic experiences
during childhood affect adult health.
• Emotional abuse
• Physical abuse
• Sexual abuse
• Emotional Neglect
• Physical Neglect
• Domestic violence
• Household
substance abuse
• Household mental
illness
• Parental
separation/divorce
• Incarcerated
household member
http://www.cdc.gov/ace/index.htm
ACE Score correlated with Risk
 Alcoholism and alcohol
 Risk for intimate partner
 Chronic obstructive
 Multiple sexual partners
abuse
pulmonary disease (COPD)
 Depression
violence
 Sexually transmitted
diseases (STDs)
 Suicide attempts
 Unintended pregnancies
 Fetal death
 Early initiation of sexual
 Health-related quality of
life
activity
 Adolescent pregnancy
 Illicit drug use
 Smoking
 Liver disease
 Early initiation of smoking
Prevalence of Mental Health Disorders in Children
and Youth
 Approximately 20% of school-age children and youth have a
diagnosable mental disorder (Merikangas et al., 2010; CDC, 2013);
 One in five children met criteria for psychiatric disorder at school
entry (Carter et al., 2010)
 Most common mental health disorders (CDC, 2013)
 ADHD (7%)
 Behavior or conduct disorders (3.5%)
 Anxiety (3%)
 Depression (2%)
 10% of Florida’s youth have mental health disorder causing
significant functional impairment (Florida Adolescent Mental Health
Fact Sheet)
FL Youth Risk Behavior Survey (2011)
 Suicide/Depression
 26% experienced significant feelings of sadness or
hopelessness
 21% seriously considered attempting suicide
 7% attempted suicide at least once during the previous 12
months
 Suicide was the 2nd leading cause of death for 5-14 year olds,
and the 3rd leading cause of death for 15-24 year olds in 2011
(Florida Vital Statistics Annual Reports)
 Bullying/Violence
 14% were bullied on school property
 10% engaged in a physical fight on school property
 7% were threatened with a weapon on school property
Total Bullying/Harassment Incidents (FL)
Number of Incidents
8000
7000
6000
5000
4000
3000
2000
1000
0
2008-2009
2009-2010
2010-2011
Year
2011-2012
Who provides school-based mental health
services?
 Student Services Personnel (school
mental health professionals)
 School counselors – 5,433 (1:491)
 School psychologists – 1,381 (1:1940)
 School social workers – 1,008 (1:2658)
 School nurses – 1,163 (1:2286)
 Contracted mental health professionals
 Safe and Drug Free Schools Personnel
 School Resource Officers
What are some challenges to SBMH?
 Systematic screening for mental issues is not a common
practice.
 School-based mental health professionals are typically
assigned to multiple schools and too often used for crisis
response as opposed to crisis prevention.
 Limited access to professional development
opportunities that address mental health issues.
 Fragmentation of services within schools and between
school and community-based services.
Multi-Tiered System of Supports
& School-based Mental Health
How are school-based mental health services provided?
Few
System of Supports for School-Based Mental Health
Services
Intensive, Individualized Interventions
Brief individual counseling
Individual Educational Plan w/ Counseling as a Related Service
Behavior Intervention/Support Plan
Crisis Intervention
Targeted, Supplemental Interventions & Supports
Small group interventions
Anger management/self-management training
Targeted social skills training
Student Engagement/Attendance
Peer counseling/peer mediation
Adult mentor
All
Some
Wraparound services
Schoolwide, Preventive Systems of Support
Schoolwide Positive Behavior Support
Safe & Healthy Schools (School Climate)
Schoolwide Social Skills Training
Social/Emotional Learning
Bullying Prevention
Multi-tiered System of Support
 Tiered supports
 Tier 1 – Preventive services applied to all students
 Tier 2 – Targeted group interventions applied to some students
 Tier 3 – Intensive interventions applied to individual students
 Level of intervention support based on student need.
 Problem-solving and data-based decision making.
 Monitor the effectiveness of intervention/support.
Intervention for Internalizing Disorders in a
Three-tier Model
UNIVERSAL
TARGETED
INTENSIVE
All Students
15-20% of students
about 5% of students
- Effective classroom
routines (PBS)
- Effective policies and
responses to bullying
- School connectedness
- Structured SEL curricula
in general education
- Targeted SEL
programming
- Individual treatment
and case management
- Special education
- Small group counseling
and skill training
- Referral to community
based services
- Evidence-based group
intervention programs
- Wraparound services
- Systems of Care
Adapted from Merrell & Gueldner (2010). Preventive interventions for students with internalizing disorders. In Shinn & Walker (Eds.),
Interventions for Achievement and Behavior Problems in a Three-Tier Model Including RTI.
Mental Health in Schools
Survey
March 22 – April 5, 2013
Data was needed to determine:
1.
What part a multitiered system of supports plays in
implementing Mental Health services (prevention; intervention;
response) in public schools.
2.
If school-based Mental Health services are provided within a positive
student engagement framework.
3.
What existing services are provided to public school students (K12)
who have mental health needs or other behavioral issues.
4.
What role student services personnel play in collaboration among
schools, law enforcement, mental health agencies, and other local
organizations.
5.
If students with mental health needs are receiving mental health
services and/or treatment.
Response to Survey
 47 Districts (70% of districts in FL)
 78 Respondents
 Respondent role in district
 Director/Coordinator/Supervisor of Student Services
 ESE Directors
 Supervisor/Coordinator of Student Service Profession
List mental health prevention services
provided in your district.
 Multi-tiered supports (schoolwide/universal supports)
 Positive Behavior Support (e.g., PBS, CHAMPS, Tough Kids)
 Developmental guidance program
 Bullying, Suicide, and Substance Abuse Prevention programs (e.g., Silence
Hurts Initiative, Be Safe, HOPE curriculum, Kids at Hope)
 Character education programs
 Social skills training (e.g., Skillstreaming, Stop and Think, Too Good for
Violence
 Early Warning Systems
 School climate initiatives
 Health education
Who provides the training for
prevention services?
 District and school Student Services personnel
 Community Mental Health Agencies & Outside Mental Health Providers
(e.g., DCF, Children’s Services Council)
 FDOE funded Projects – FLPBS, FDLRS, ISRD
 District PBS staff and behavior analysts
 SEDNET
 County Health Department
 Professional Associations
 Webinars
 University
Who receives the training for
prevention services?
 Student services staff
 School staff (administrators, teachers, support
staff)
 District employees
 Students
 Parents
Who provides the training for
intervention services?
 Student Services staff
 District staff (Safe & Healthy Schools, PBS, Health
Services)
 Community Mental Health agencies & outside
professionals
 FDLRS, ISRD, PAEC, DCF
Who receives the training for
intervention services?
 Student services staff
 District staff & administrators
 School staff
 Contracted mental health providers
 Educators & Parents
Who provides the training for response
services?
 Student Services staff
 ESE & Student Services staff
 District staff
 Community mental health and emergency response
partners
 Outside agencies
 Specialized training (NOVA)
Who receives the training for response
services?
 Crisis response team
 Student Services staff
 District staff
 School administrators
 School staff/teachers
 ESE specialists
What other trainings are being
implemented?
 Crisis Intervention Training (PREPaRE, NOVA)
 Bullying and Suicide Prevention Awareness and Training
(e.g., Gate Keeper Training, Eight to Great, Early Warning
Signs, Silence Hurts)
 American Red Cross Psychological First Aid
 Positive Behavior Supports
 Critical Incident Stress Management
 Risk Assessment/Threat Assessment Training
Briefly explain their involvement in
Baker Act
 Student services staff collaborate with police (SROs) to Baker Act –
help determine if criteria are met.
 Initiate the process – refer to SRO after completing risk/threat
assessment.
 Assess and Baker when needed (primarily LCSW but other
qualified licensed staff, too).
 Provide follow-up (school psychologist, social worker, counselor).
 Make referral to law enforcement (SRO).
 Part of response/crisis team that provides crisis intervention and
determine when Baker Act is necessary.
 Communication and support to family.
Implications of Survey
 Need for systematic screening to identify students needing social-
emotional support.
 Target Prevention for improvement in district activities/tools/systems.
 Ensure that existing MH providers are appropriately used to address
prevention, intervention, crisis response needs.
 Rather than mandated PD or programs in isolation, establish a holistic
approach that incorporates the critical and common elements across
issues.
 Need for greater collaboration and coordination between school and
community mental health resources.
 Mutual Aid Agreement among districts would be a logical
recommendation.
Next Steps?
Mental Health Screening
Systematic Mental Health Screening:
 Annually assess school climate.
 Build capacity of school staff to recognize when social-
emotional and behavioral barriers to learning are present.
 Screen for mental health and behavioral issues at the school
level:
 Assess overall level of risk present in school
 Identify students needing intervention
 Provide support for identified students.
School Screening – Pros/Cons
 Schools provide ready access
 MH is one of those matters
and reduce costs.
that should remain a domain
for family, not school,
intervention.
 Schools are a direct
beneficiary because
screening and effective
treatment enhances student
success at school.
 Scarce school
time/resources will be used
for matters not directly
related to teaching.
 There are not enough
competent school personnel
to plan, implement, and
evaluate large-scale
screening.
UCLA Center for School Mental Health – Policy Brief
52
Screening issues/dilemmas
 Community Acceptance
 Family Rights
 Identification – False positives
 Treatment
Chafouleas et al., (2010). Ethical Dilemmas in School-Based Behavioral Screening.
53
Consent for screening?
 SBE Rule 6A-6.0331 problem solving activities that include the
provision of educational and behavioral evaluations, services,
and supports.
 The Protection of Pupil Rights Amendment (PPRA) requires
written parental consent for participation in surveys or
evaluations that reveal sensitive personal information
including mental and psychological problems
http://www2.ed.gov/policy/gen/guid/fpco/
 How do we reconcile?
 Use existing student data
 Use indirect & prosocial screening methods
 Include parents in the problem solving process
 Remember the purpose of screening – do not need a diagnosis
54
Systematic Screening Methods
 Early Warning Systems
 Gated Screening Methods
 Systematic Screening for Behavior Disorders (SSBD) –
Walker & Severson
 Adaptive Model of Behavioral Assessment (AMBA) – Volpe
 Screening Scales
 Student Risk Screening Scale (SRSS) – Drummond
 Student Internalizing Behavior Screener (SIBS) – Cook
 Teen Screen – National Center for Mental Health Checkups
 Prosocial Behavior/Positive Psychology scales
 RtI:B Database
Early Warning Systems
Indicators
Thresholds
Attendance
Student missed 10% of more of instructional
time (absences)
Course Performance
Failure in one or more courses
Earned 2.0 or lower GPA (4-point scale)
Behavior
Locally validated thresholds (e.g., referrals, inor out-of-school suspensions, behavior
grades)
http://betterhighschools.org/
Student Internalizing Behavior Screener
58
RtI:B Database
rtidb@usf.edu
www.flrtib.org
59
Student Support Services
Project
Promoting School-based Mental Health
Policies & Practices
Promoting School-based Mental
Health Policies & Practices
 Policy Recommendations to Legislature
 Collaborative Partnership between Student Support Services,
Safe Schools, & Emergency Management
 Development of a Comprehensive Student Services Plan
 Establish Professional Practices (SSPEM)
 Resources for School-based Mental Health
 Websites
 Student Support Services http://sss.usf.edu
 FL Multi-tiered System of Supports www.florida-rti.org/
SSPEM & School-Based Mental
Health
 Collaborates with teachers and administrators to develop
and implement school-wide positive behavior supports.
 Collaborates with school personnel and students to foster
student engagement (e.g., involvement, motivation,
persistence, resilience, ownership).
 Promotes safe school environments.
 Provides a continuum of crisis intervention services.
 Provides relevant information regarding child and
adolescent development, barriers to learning, and student
risk factors.
Recommendations for House Healthy
Families Committee
 Require districts develop and implement a Comprehensive
Student Services Plan that supports student mental health
within a multi-tiered, prevention/intervention framework.
 Annually assess school climate and require universal screening
for mental health and behavioral issues at the school level.
 Build capacity school staff to promote healthy development
and recognize social-emotional/behavioral barriers to learning.
 Provide school-wide programs to promote social-emotional
development and enhance resiliency and protective factors.
 Promote a continuum of services that includes school-wide
mental health prevention programming and intensive
interventions.
Recommendations for House Healthy
Families Committee
 Use student Services personnel (school social workers,
school psychologists, and school counselors) to provide
school-based mental health interventions.
 Expand school-based mental health services to focus on
early identification and use of evidence-based interventions
for social-emotional issues.
 Support professional development and access to relevant
trainings for Student Services personnel.
 Enhance System of Care approach for coordination and
continuity of mental health services among schools,
agencies, and community providers, especially for youth
involved in multiple agencies.
School-Based Mental
Health Resources
Evidence-based Interventions
 National Registry of Evidence-Based Programs (SAMHSA)
http://nrepp.samhsa.gov/
 Evidence-based resilience-enhancing and violence prevention
programs
http://www.samhsa.gov/grants/content/2002/YouthViolence/evide
nce_based.htm
 Suicide Prevention Resource Center – Best Practices Registry
http://www.sprc.org/bpr
 Promising Practices Network http://www.promisingpractices.net/
 Summary of Recognized Evidence-based Programs
http://csmh.umaryland.edu/Resources/ClinicianTools/index.html
 What Works Clearinghouse http://ies.ed.gov/ncee/wwc/
Student Support Services
 Heather Diamond hdiamond@usf.edu
 Curtis Jenkins ctjenkins@usf.edu
 Helen Lancashire hlancash@usf.edu
 Dianne Mennitt dmennitt@usf.edu
 David Wheeler wheeler@usf.edu
 Jayna Jenkins jayna@usf.edu
http://sss.usf.edu/