Leading for Effective School Mental Health

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Leading for Effective School Mental HealthSchool Mental Health ASSIST

Summit on Children and Youth Mental Health 20121Session AgendaActivityTime FrameOverview Presentation SMH ASSIST10:00-10:45Top 10 Carousel Rotation #1 MH Leaders10:50-11:20Top 10 Carousel Rotation #2 MH Leaders11:25-11:55Lunch12:00-12:55Top 10 Carousel Rotation #3 MH Leaders1:00-1:30Top 10 Carousel Rotation #4 MH Leaders1:35-2:05Closing Keynote - Dr. John Malloy2:15-3:002With an elbow partner, or twoWhat does effective leadership look like at a School or Board level?

LEADERSHIPPaint a Picture3Ontario Leadership FrameworkLeadership is a lever to support large scale system improvement to enhance achievement and well-being. The Ontario Leadership Framework is relevant to our work with student mental health and well-being.

44Ontario Leadership Framework5 Domains:

Setting Directions

Building Relationships and Developing People

Developing the Organization

Leading the Instructional Program

Securing Accountability5 Core Leadership Capacities:

Promoting Collaborative Learning Cultures

Aligning Resources with Priorities

Using Data

Setting Goals

Engaging in Courageous Conversations55Jot down a few ideas.What are some of the qualities of an effective leader?

Which of these do you possess, and value most strongly?

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8OverviewThe Promise of School Mental HealthProvincial, National and International InitiativesAcknowledging Past (and present) ChallengesOntarios Mental Health & Addictions StrategySchool Mental Health ASSISTTop 10 Conditions for Effective School Mental Health9

The Promise of School Mental Health

10Mental Health is11A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

World Health Organization

Mental Health Exists on a Continuum12

Mental Health Problems are Common13

Roughly one in five students in Canadian schools struggle with a mental health problem that interferes with their day to day functioning.What are Mental Health Problems?Mental health problems are emotional, behavioural and brain-related disturbances that interfere with development, personal relationships, and functioning

Disturbances that are severe and persistent enough to cause significant symptoms, distress, and impairment in one or more areas of daily life are termed mental health disorders/mental illness.14

Mental Health Problems include a Range of DifficultiesMental health problems are characterized by many different signs and symptoms, and present in various forms

Some mental health problems manifest outwardly (externalizing)Students appear aggressive, impulsive, non-compliant

Some mental health problems manifest inwardly (internalizing)Students appear withdrawn, lonely, anxious, depressed

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The Good News Proven strategies and supportsPsychosocial and pharmacological treatments are most common, and are often used togetherWhile many mental disorders are chronic, we can help with copingEarly identification and intervention improves prognosis16

But Most Do Not Receive the Help They NeedUp to 80% of children and youth who experience a mental health problem will not receive treatment

Major barriers include: Lack of, difficulty accessing, or long waitlists for local servicesStigmaMisidentification or lack of identification of symptoms17

Schools Have a Unique OpportunitySchools are an optimal setting in which to:

Reduce stigmaPromote positive mental health Build student social-emotional learning skillsPrevent mental health problems in high risk groupsIdentify students in needBuild pathways to care

18School Mental Health is Not NewSchools and communities in Canada and elsewhere have been dealing with these issues for decades

Inconsistent, fragmented approaches, with pockets of excellence

Whats new is the galvanizing of research, policy and practice to reach an integrated solution to a complex problem19

19National, International, & provincial initiativesMoving Forward on the Promise of School Mental Health20

OUT OF THE SHADOWS AT LAST

The Standing Senate Committee on Social Affairs, Science and Technology

The Honourable Michael J. L. Kirby, Chair

May 2006

21Making the school a site for the effective delivery of mental health services involves several key steps. First, its potential must be recognized.

National Initiatives Related to School Mental HealthSchool-Based Mental Health & Substance Abuse Consortium

Canadas Mental Health Strategy (MHCC)EvergreenNational Infant Child & Youth Mental Health ConsortiumOpening Minds

Joint Consortium for School HealthPublic Health Agency of CanadaCanadian Association for School HealthHealth CanadaCanadian Centre for Substance Abuse22

SBMHSA Consortium40 member team of researchers, education professionals, school mental health professionals, etc.3 year projectLed by Ontario Centre of Excellence for Child & Youth Mental Health

Synthesis of ResearchScan of Nominated PracticesNational Survey

Findings:Research gives us clear directionProgramming does not consistently reflect researchOrganizational and systemic barriers impede23

International Initiatives in School Mental HealthInternational Alliance for Child and Adolescent Mental Health in Schools (Intercamhs) http://www.intercamhs.net/

US Canada Alliance for School Mental Health

SBMHSA webinar - international initiatives (Aus, Germany, US)

Advances in School Mental Health Promotion

Key international conferences featuring School Mental Health

17th Annual Conference on Advancing School Mental Health, October 25-27, Salt Lake City, Utah --- see Mark Weist at CMHO!

26th Annual Childrens Mental Health Research and Policy Conference, March 3-6, Tampa, Florida24Provincial Initiatives in School Mental HealthEmergence of government strategies (e.g., BC, MN, NS, ON)

Development of provincial coalitions (e.g., BC, ON)

Funded provincial initiatives related to mental health capacity building (e.g., AB, QB, NS, ON)

Cross-sectoral initiatives, infrastructure, protocols (e.g., BC, NB, ON)

Student mental health in provincial curriculum25Acknowledging challengesLearning from past and present26

Taking Mental Health to SchoolDifferent models of mental health service delivery across Ontario boards (Taking Mental Health to School, 2009)Variable leadership structures, levels/types of professional support, relationship with community, range of services

Acknowledgement of promising supports (e.g., Student Support Leadership Initiative)

Need for leadership, coordination, access to evidence-based approaches, implementation support, evaluation27

27Past (present) Systemic ChallengesSchool boards are complex systemsInfrastructure, processes and protocols lackingLack of clarity re: roles and responsibilitiesSpecial services arespecialInconsistencies across Boards with respect to: LeadershipProgrammingFundingAccess to servicesCollaboration28

Structural ChallengesPast (present) Systemic Challenges

Mental Health is not well understoodNot traditionally part of educator trainingPD as a one time eventLinks to high pressure achievement agenda unclear

Stigma, Attitudinal BiasesDiscomfort and fearSometimes seen as outside of educator roleWorry about making a mistake, getting too close

29Knowledge ChallengesMental Health Literacy30

Concern about Mental Health Educator PreparednessPast (present) Systemic Challenges

Inconsistent access to high-quality programmingEvidence-based programs are expensiveRegional differences (in services, access, needs)Funding shortfallsCompeting demandsAcademic achievement agenda, with inherent pressures and supports, occupy most of timePlates are full and increasingFragmented systems Service pathways and protocols are not well-defined

31Implementation ChallengesCommitments to the Mental Health & Addictions StrategyOntario Ministry of Education32

33Strategy Priorities for the Next 3 Years

Close Critical Service Gaps

Increase availability of culturally appropriate services and serve more children and youthin Aboriginal, remote and underserved communities With complex mental health needsAt the key transition point from secondary to post-secondary education

Identify & Intervene Early

Provide tools and support to those in contact with children and youth so they can identify mental health issues soonerProvide resources for effective responses to mental health issuesBuild mental health literacy and local leadershipFast Access to High Quality Services

Build capacity in the community-based sectorReduce wait timesMeet community needsLink education, child and youth mental health, youth justice, health care, and the community

Support System ChangeSupport development of an effective and accountable service system for all OntariansBuild on efforts that promote evidence-informed practice, collaboration, and efficiencies Develop standards and tools to better measure outcomes for children and youth3334Starting with Child and Youth Mental Health Our Vision: An Ontario in which children and youth mental health is recognized as a key determinant of overall health and well-being, and where children and youth reach their full potential.34Provide fast access to high quality serviceKids and families will know where to go to get what they need and services will be available to respond in a timely way.

Identify and intervene in kids mental health needs earlyProfessionals in community-based child and youth mental health agencies and teachers will learn how to identify and respond to the mental health needs of kids. Close critical service gaps for vulnerable kids, kids in key transitions, and those in remote communitiesKids will receive the type of specialized service they need and it will be culturally appropriate

THEMESINDICATORSReduced child and youth suicides/suicide attemptsEducational progress (EQAO)Fewer school suspensions and/or expulsions Decrease in severity of mental health issues through treatmentDecrease in inpatient admission rates for child and youth mental health

Higher graduation rates More professionals trained to identify kids mental health needs Higher parent satisfaction in services received

Fewer hospital (ER) admissions and readmissions for child and youth mental health

Reduced Wait Times

OVERVIEW OF THE MENTAL HEALTH & ADDICTIONS STRATEGY - FIRST 3 YEARSINITIATIVESProvide designated mental health workers in schoolsImplement Working Together for Kids Mental Health Hire Nurse Practitioners for eating disorders programImprove service coordination for high needs kids, youth and familiesImplement standardized tools for outcomes and needs assessmentAmend education curriculum to cover mental health promotion and address stigma

Develop K-12 resource guide for educatorsImplement School Mental Health ASSIST program &mental health literacy provincially Enhance and expand Telepsychiatry model and servicesProvide support at key transition pointsHire new Aboriginal workers Implement Aboriginal Mental Health Worker Training Program

Create 18 service collaborativesExpand inpatient/outpatient services for child and youth eating disorders

Reduce wait times for service, revise service contracting, standards, and reportingFunding to increase supply of child and youth mental health professionalsImprove public access to service information

Pilot Family Support Navigator modelY1 pilotIncrease Youth Mental Health Court Workers Provide nurses in schools to support mental health servicesImplement Mental Health Leaders in selected School Boards Outcomes, indicators and development of scorecardStrategy Evaluation34Interconnected Initiatives35MOHLTCNurse LeadersMHA Nurses in DSB programService CollaborativesSSLIMCYSMH Workers with SchoolsWorking Together Student Support Leadership Initiative (SSLI)EDUSMH ASSIST SSLI35EDU Strategy CommitmentsAmend the education curriculumDevelop a K-12 Resource Guide/WebsiteProvide support for professional learning in mental health for all Ontario educatorsFund and support Mental Health LeadersImplement School Mental Health ASSIST36

37School Mental Health ASSIST is a provincial implementation support team designed to help Ontario school boards to promote student mental health and well-being, through leadership, practical resources and systematic research-based approaches to school mental health.

Leadership StructureOntario Ministry of Education Lead Special Education Policy & Programs Branch

School Board Lead Hamilton-Wentworth District School Board

SMH ASSIST Core TeamDirector, and 4+ P/T Implementation Coaches (3 Senior School Mental Health Professionals, 1 Superintendent),.5 Research Associate (new!)

Cross-Sector PartnersInterministerial Staff TeamHospital for Sick Children, Ontario Centre of Excellence for Child & Youth MHProvincial Stakeholder Organizations

Evaluation and Implementation Consultation Team Drs. Michael Boyle, Bruce Ferguson, Tom Kratochwill, Robert Lucio, Ian Manion, Doris McWhorter, Karen Milligan, Caroline Parkin, Joyce Sebian, Mark Weist38

Support to ALL Ontario BoardsResourcesWebinar series, other staff development materialsDecision support toolsTemplatesSchool Administrators ToolkitConsultationWorkshopsRepresentation on provincial reference groups & committees

39Focus Boards15 Focus Boards in 2011-2012 Another 15 announced for 2012-2013Boards receive 1 FTE Mental Health Leader and SMH ASSIST supportReciprocal relationship with SMH ASSISTASSIST provides leadership & implementation supportFocus Boards help with piloting resources that will be rolled out to all boards in time40

41First PrioritiesOrganizational Conditions for Effective School Mental Health (addressing structural challenges)

Mental Health Capacity-Building(addressing knowledge challenges)

Implementation of Evidence-Based Mental Health Promotion and Prevention Programming(addressing implementation challenges)

42Organizational Conditions for Effective School Mental Health

42Organizational ConditionsCommitmentSchool Mental Health Leadership TeamClear & Focused VisionShared LanguageAssessment of Initial CapacityStandard ProcessesPD ProtocolsSchool Mental Health Strategy / Action PlanBroad CollaborationOngoing Quality Improvement43

43Self ReflectionWhere is your board currently, TODAY, along each of the conditionsFeel free to discuss, leave blankFor your records

44CommitmentCondition #1Board leaders view child and youth mental health as a priority, and communicate this through actionBoard leaders commit to Tiered Support Model Help board staff to understand the rationale for the model, emphasizing the focus in schools on mental health promotion and prevention and the need to work with community partners for help with students with significant mental health concernsBoard leaders consistently attend community liaison meetings and internal MH team meetingsBoard leaders provide visible, strategic and tangible support for needed infrastructure, resources, staffing4545Tiered Support in Systems of CareUniversal Evidence-BasedMental Health Promotion, Social-Emotional LearningTargeted Evidence-Based PreventionE-B ClinicalInterventionEvidence-Based Clinical InterventionTargeted Evidence-Based PreventionUniversal E-B Mental Health PromotionCommunitySchool DistrictsOrganizational ConditionsMental Health CapacityContinuous Quality ImprovementEngagementImplementation Focus4646School Mental Health Leadership Team Condition #2Board has a multidisciplinary, multi-layered mental health leadership team

All of the right people are at the table (in terms of expertise, influence, relationships, representation)

Parent and youth voice are critical

Team has meaningful liaison with community partners

Team is focused on vision-setting, leadership, collaboration, strategy/program selection, problem-solving

4747Clear and Focused Vision Condition #3Board has shared, realistic goalsVision is aligned with AOP, BIPSA, Strategic DirectionsVision is aligned with key principles in school mental health (e.g., preventive, linked with instruction, evidence-based, connected with partners at home and school, strong use of data)Vision and goals are created collaborativelyVision is the basis for decision-making

4848Shared LanguageCondition #4The Board Vision for school mental health is communicated clearly across the organizationFoundational knowledge about student mental health is conveyedTerms are defined consistentlyWhere differences in language occur (e.g., across sectors), there is translationUse of early identification tools can be helpful for finding common ways to speak of problem areas4949Assessment of Initial CapacityCondition #5Assessment data informs the development of the board mental health strategyBefore setting priorities, an assessment of organizational strengths, needs, and resources (resource mapping) can be very helpfulThis assessment includes a scan of resources, in the form of people, processes, and programsStaff and student voice data can deepen understanding of needs5050Standard Processes Condition #6Board has standard processes for school mental health:Who does what (role clarification)Selection of school and classroom evidence-based programsDelivery of training and coaching on programs and strategiesStandards and tools for monitoring progressPartnerships with communityPathways to service5151Protocols for Professional Development Condition #7Board has a systematic approach to capacity building in mental health that includes:Mental Health Awareness for allMental Health Literacy for those with studentsMental Health Expertise for those delivering specialized assessment & intervention servicesHigh quality training protocols, delivered by an engaging expertJob-embedded, with ongoing coachingTools + Training + Technical Assistance + Quality Assurance5252Mental Health Strategy / Action Plan Condition #8The Board Mental Health Strategy is aligned with system goalsThe Strategy is founded on evidence-based practices in school mental healthThe Strategy is tailored to local context and data with respect to board needs and strengthsThe Strategy is focused on measureable outcomesAn implementation support plan is clearly articulated

5353Broad CollaborationCondition #9The Board has several established platforms for dialogue and collaboration:Across departments and schoolsWith community and health agenciesWith universities and other research organizationsWith parentsWith studentsWith other boardsWith government

5454Ongoing Quality ImprovementCondition #10The board has a system of ongoing quality improvement, that includes measurement:Of program / strategy implementationOf teacher perceptions and knowledgeOf student perceptions and knowledgeOf student outcomes

5555Visit SMH ASSISThttp://smh-assist.ca/56

Contact School Mental Health ASSISTKathy Short, Ph.D., C.Psych.Director, School Mental Health [email protected], x2634

57Questions???

School Mental Health

ASSISTquipe dappui en sant mentale pour les coles