Addressing Behavior Disorders in Schools:Addressing Behavior Disorders in Schools: The Integration of Education and Mental HealthThe Integration of Education and Mental Health
The Institute of Education Sciences (IES) 5th Annual Research ConferenceJune 2010 - National Harbor, MD
Albert J. Duchnowski, Ph.D.Krista Kutash, Ph.D.
Department of Child & Family StudiesUniversity of South Florida
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Integrating Education Integrating Education and Mental Health Into and Mental Health Into
School-Based Mental HealthSchool-Based Mental Health
Historically, difficult to establish effective partnerships
For many reasons….
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Contrasting Perspectives
Overarching Influence
Education System
Individuals with Disabilities Education Act (IDEA)
Mental Health System
Diagnostic & Statistical Manual (DSM)
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Contrasting Perspectives
Conceptual Framework Language
Education System
Behavior Disorders,
Challenging Behavior,
Academic Deficits
Mental Health System
Psychopathology,
Abnormal Behavior,
Impaired functioning
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Contrasting Perspectives
Important Theoretical Influences
Education System
Behaviorism,
Social Learning Theory
Mental Health System
Behavior Theory,
Cognitive Theory,
Developmental Psychology,
Biological/Genetic Perspective,
Psychopharmacology
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Contrasting Perspectives
Focus of Intervention
Education System
Behavior Management,
Skill Development,
Academic Improvement
Mental Health System
Insight,
Awareness,
Improved Emotional Functioning
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Education / Mental Health System
Improving Social and Adaptive Functioning.
Importance of and Need to Increase Availability, Access, and Range of Services
Contrasting Perspectives
Common Focus
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Refocusing School-Based Mental Health Services On the Core
Foundation of SchoolsTo Promote Learning
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Schools have the inherent capacity to bridge home and
neighborhood ecologies
Schools are the ‘de facto’ children’s mental health system
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The Refocused Role of Mental Health Services
• Support Teachers: the Primary Change Agents
• Mental Health Providers Become: “Educational Enhancers”
• Serve the Core Function of Schools• Promoting Social/Emotional
Development, no Longer Tangential
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Relations with Peers
Relations with
Teachers
Relations with
Parents
Academic Success
Technology to promote learning
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Does Does Anything Anything
Work?Work?
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Some Program Models with Organizational
Potential for Success
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“The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better.”
– Weiss, 2002
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18 Positive Behavior Supports
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EvaluateResponse to
Intervention (RtI)
Problem Analysis
Problem Identification
Implement PlanImplement Plan
Classroom-Focused Enabling
Student/Family Assistance
Crisis AssistanceTransitions
Community Outreach/Volunteer
Home Involvement
Continuous Improvement Model
RtIResponse to Intervention
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The Public Health The Public Health ModelModel
1. Surveillance at the population / community level
What is the problem?
Use systematic data collection strategies to determine the
mental health service needs in your community.
1. Surveillance at the population / community level
What is the problem?
Use systematic data collection strategies to determine the
mental health service needs in your community.
2. Identify risk and protective factors
What are the causes?
Use the information collected in and on your community on a
regular basis and integrate with the research literature.
2. Identify risk and protective factors
What are the causes?
Use the information collected in and on your community on a
regular basis and integrate with the research literature.
3. Develop and Evaluate Interventions
What works and for whom?
Review literature on empirical based interventions and
apply/adapt to local community needs.
3. Develop and Evaluate Interventions
What works and for whom?
Review literature on empirical based interventions and
apply/adapt to local community needs.
4. Implementation monitoring and scaling-up
Is it meeting the intended needs?
Monitor interventions for proper implementation, scale-up
interventions and measure impact.
4. Implementation monitoring and scaling-up
Is it meeting the intended needs?
Monitor interventions for proper implementation, scale-up
interventions and measure impact.
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Common Vision
Families (FAM)Mental Health (MH)Education (ED)
IntensiveStudents in
Special Ed due to Emotional Disturbances
ED – FBA / PBS
MH – Assessment
FAMEDMH
EDFAMMH
Cognitive Behavior Therapy and other EBPs
Team Monitors Progress
UniversalAll Students
ED – PBS
MH - Screening
FAMED MH
EBP’s (PATHS)
SelectiveAt-Risk Students
ED – FBA / PBS
MH – Assessment
FAMED MH
MHED
EDMHFAM
Group Interventions
Team Monitors Progress
RtI
Implementedin organizations
that support and facilitatecollaborative, integrated
systems of services.
Integrated Partnership
But Wait…
• Some people say that Families are the barriers to good collaboration
• If “those parents” would just……
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Families asFamilies as
The “Cause,”The Patient,The Credible Informant,Equal Decision Making Partners,Evaluator and Research Partners,Policy Makers
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Are you Ready?
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Evidence Based Practices
• Multiple Registries• Narrow Focus
– Anxiety– Depression– ADHD
• Require Fidelity of Implementation• Talk Therapy Continues to Dominate
• Multiple Registries• Narrow Focus
– Anxiety– Depression– ADHD
• Require Fidelity of Implementation• Talk Therapy Continues to Dominate
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Alice said to the Cheshire Cat: “Would you tell me please, which way I ought to go from
here?”
“That depends a good deal on where you want to get to,”
said the Cat.
“I don’t much care where,” said Alice.
“Then it doesn’t matter which way you go,” said the Cat.
…it depends a good deal
on where you
want to get to…
We must …
Develop Competency in Implementation Science
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Model of Implementation ComplexityModel of Implementation Complexity
FIT
Does the innovation fit within your
organization
Complement or Compete?
FIT
Does the innovation fit within your
organization
Complement or Compete?
CLIMATE
Willing to remove
obstacles?
Are there rewards?
Leadership support?
Clarity of Goals?
CLIMATE
Willing to remove
obstacles?
Are there rewards?
Leadership support?
Clarity of Goals?
IMPLEMENTATION EFFECTIVENESS
Can you implement the innovation with
accuracy and fidelity?
IMPLEMENTATION EFFECTIVENESS
Can you implement the innovation with
accuracy and fidelity?
INNOVATION EFFECTIVENESS
Impact of innovation,
commitment, and satisfaction
INNOVATION EFFECTIVENESS
Impact of innovation,
commitment, and satisfaction
VOLITIONVOLITION
Is there capacity and Is there capacity and willingness to implement?willingness to implement?
VOLITIONVOLITION
Is there capacity and Is there capacity and willingness to implement?willingness to implement?
FIDELITY BELIEFSFIDELITY BELIEFS
Favorable attitudes toward Favorable attitudes toward practice Complexity of innovationpractice Complexity of innovation
FIDELITY BELIEFSFIDELITY BELIEFS
Favorable attitudes toward Favorable attitudes toward practice Complexity of innovationpractice Complexity of innovation
Download this 115 page monograph FREE at: http://rtckids.fmhi.usf.edu/rtcpubs/study04/
ResourcesResourcesResourcesResources
Atkins, M., Hoagwood, K., Kutash, K., &Seidman, E. (in press and on-line as of March 2010). Toward the Integration of Education and Mental Health in Schools. Administration and Policy in Mental Health Services Research.
Cappella, E., Frazier, S. L., Atkins, M. S., Schoenwald, S. K., & Glisson, C. (2008). Enhancing Schools’ Capacity to Support Children in Poverty: An Ecological Model of School-Based Mental Health Services. Adm Policy Ment Health, 35, 395-409.
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