Mental Health in Schools: Past, Present and Future Challenges, Study Guides, Projects, Research of Social Work

Download Mental Health in Schools: Past, Present and Future Challenges and more Study Guides, Projects, Research Social Work in PDF only on Docsity! A Center Policy Report . . . The Current Status of Mental Health in Schools: A Policy and Practice Analysis (March, 2006) The Center is co-directed by Howard Adelman and Linda Taylor and operates under the auspices of the School Mental Health Project, Dept. of Psychology, UCLA, Write: Center for Mental Health in Schools, Box 951563, Los Angeles, CA 90095-1563 Phone: (310) 825-3634 Fax: (310) 206-8716 Toll Free: (866) 846-4843 email: smhp@ucla.edu website: http://smhp.psych.ucla.edu Support comes in part from the Office of Adolescent Health, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration (Project #U45 MC 00175) U.S. Department of Health and Human Services. Executive Summary i Report Contents Preface Introduction 1 Part I. Past as Prologue 3 The Last 50 Years 3 Federal Support for MH in Schools 3 Another Call for Collaboration 4 School Professionals Involved with MH & Psychosocial Concerns 5 Part II. Where the Field is Now 6 The Need from the School’s Perspective 6 Broadening Understanding of the term “Mental Health” 8 Funding 15 Marginalization 17 Addressing the Key Policy Problem 21 Part III. Where’s the Field Going? 23 Schools and the Transformation of the MH System in the U.S. 23 Emerging View 23 About Connecting with School Improvement Planning 29 Part IV. Policy Implications 32 End the Marginalization by Embedding MH in Policy for Learning Supports 32 Address Systemic Change 33 Encouraging Policy Action by Emphasizing Benefits, Feasibility, and Prudence 35 Concluding Comments 40 Appendices 43 A. New Freedom Commission on Mental Health Recommendations B. Reframing How Schools Address Barriers to Learning C. Some Natural Opportunities to Enhance Mental Health at School D. Guidelines for Mental Health in Schools E. Examples of Policy Statements for a Unifying Approach in Schools F. Examples of Provisions in Federal Law that Allow Districts to Redeploy Federal Resources to Improve Systems (e.g., to create a cohesive System of Learning Supports) ii Where the Field is Now Most schools have some interventions to address a range of MH and psychosocial concerns, such as school adjustment and attendance problems, bullying, violence, relationship difficulties, emotional upset, physical and sexual abuse, substance abuse, dropouts, and delinquency. Some are funded by the schools or through extra-mural funding; others are the result of linkages with community service and youth development agencies. Some programs and services are found throughout a district; others are carried out at or linked to targeted schools. The interventions may be offered to all students in a school, to those in specified grades, or to those identified as "at risk." Overlapping problems may be targeted and dealt with in isolation of each other through separate, categorical programs or may be addressed as part of other school-wide and classroom programs. The activities may be implemented in regular or special education classrooms or as "pull out" programs and may be designed for an entire class, groups, or individuals. Despite the range of personnel and activity, it is common knowledge that few schools come close to having enough resources to deal with a large number of students with MH and psychosocial problems. And, schools do report having many children and adolescents in need of assistance; for some, the numbers have risen to over half those enrolled. Given this state of affairs, it is poignant to see how low a priority schools assign in both policy and practice to addressing psychosocial and mental health concerns. Indeed, this arena of activity is extremely marginalized. As a result, interventions are developed and function in relative isolation of each other, and they rarely are envisioned in the context of a comprehensive approach to addressing behavior, emotional, and learning problems and promoting healthy development. Organizationally, the tendency is for policy makers to mandate and planners and developers to focus on specific services and programs, with too little thought or time given to mechanisms for program development and collaboration. Functionally, most practitioners spend their time applying specialized interventions to targeted problems, usually involving individual or small groups of students. Consequently, efforts to address behavior, emotional, learning, and physical problems rarely are coordinated with each other or with educational programs. Intervention planning and implementation are widely characterized as being fragmented and piecemeal which is an ineffective way for schools to deal with the complex sets of problems confronting teachers and other school staff. The fragmentation has been well documented, and a variety of federal, state, and local initiatives have offered models for enhancing coordination. Analyses indicate that there is a fundamental policy weakness that maintains the unsatisfactory status quo related to how schools address learning, behavior, and emotional problems. School policy and school improvement planning are currently dominated by a two-component systemic model. That is, the primary thrust is on improving instruction and school management. While these two facets obviously are essential, ending the marginalization of efforts to effectively address barriers to learning, development, and teaching requires establishing a third component as a fundamental facet of transforming the educational system. In states and localities where pioneering efforts are underway to move from a two- to a three- component policy framework, the component to address barriers to learning is denoted by various terms, such as an Enabling Component, a Learning Supports Component, a Comprehensive Student Support System. This third component not only is intended to provide a basis for combating marginalization, it establishes a focal point for developing a comprehensive approach in which MH and psychosocial concerns are embedded and fully integrated with the school’s mission. To this end, the pioneering efforts recognize that all three components are essential, complementary, and overlapping. iii Where is the Field Going? It is clear that the field of mental health in schools is in flux. There is widespread agreement that a great deal needs to be done to improve what is taking place, but no specific perspective or agenda is dominating policy, practice, research, or training. One perspective on the future comes from the New Freedom Initiative’s efforts to follow-up on the work of the President’s New Freedom Commission on Mental Health. The stated aim in the Commission’s report is to more wisely invest and use sparse resources. One set of relevant resources certainly are those already committed to MH in schools. However, because of the Commission’s limited focus on MH in schools, this venue is unlikely to play a major role in immediate efforts to transform the mental health system, never mind enhancing MH in schools. Approaching MH in schools from a different perspective, a variety of stakeholders are pushing to enhance policy and practice in ways that directly connect various mental health agenda with the mission of schools. This emerging view is calling for much more than expanded services and full service schools. It is focused on enhancing strategic collaborations to develop comprehensive approaches that strengthen students, families, schools, and neighborhoods and doing so in ways that maximize learning, caring, and well-being. Moreover, advocates of the emerging view stress that when students are not doing well at school, mental health concerns and the school's mission usually overlap because the school cannot achieve its mission for such students without addressing factors interfering with progress. This is especially the case in schools where the number of students not doing well outnumbers those who are. The specific emphasis of the emerging view is on developing, over time, a full continuum of systemically interconnected school and community interventions that encompasses (a) a system for promoting healthy development and preventing problems, (b) a system for responding to problems as soon after onset as is feasible, and (c) a system for providing intensive care. This encompasses the full integration of mental health concerns into a school’s efforts to provide students with learning supports by connecting in major ways with the mission of schools. Policy Implications • Ending the Marginalization of MH is Schools. Based on the background and analyses set forth in this report, it is concluded that the most fundamental policy concern at this time is to end the marginalization of mental health in schools. To achieve this goal, it is suggested that a policy shift is needed to ensure that every school improvement effort includes a focus on development, implementation, and validation of a comprehensive system to address barriers to learning and teaching. Moreover, it is suggested that such a system needs to be built using a unifying umbrella concept that fits school improvement needs and embeds concerns about mental health. The report includes specific examples of policy that incorporate this perspective. • Addressing the Complications of Systemic Change. At the same time, to address the complexities of implementing innovative changes in schools, policy must specifically focus on the complications of systemic change, including rethinking and redeploying use of existing resources and phasing-in changes over time. Those who set out to enhance mental health in schools across a district are confronted with two enormous tasks. The first is to develop, implement, and validate prototypes; the second involves large-scale replication. One without the other is insufficient. The report provides a framework highlighting key elements of and the linkages between these tasks. Policy is needed to ensure that strategic planning for school improvement accounts for each of the highlighted elements with respect to (1) prototypes for ensuring that all students have an equal opportunity to succeed in school and (2) how the school will accomplish and validate essential changes. And, at the district level, the need is for policy ensuring strategic planning for how the district will facilitate replication and scale-up of prototype practices iv Concluding Comments At present, mental health activity is going on in schools with competing agenda vying for the same dwindling resources. Diverse school and community stakeholders are attempting to address complex, multifaceted, and overlapping psychosocial and mental health concerns in highly fragmented and marginalized ways. This has led to inappropriate competition for sparse resources and inadequate results. Enhancing MH in schools clearly is not an easy task. The bottom line is that limited efficacy seems inevitable as long as the full continuum of necessary programs is unavailable and staff development remains deficient; limited cost effectiveness seems inevitable as long as related interventions are carried out in isolation of each other; limited systemic change is likely as long as the entire enterprise is marginalized in policy and practice. The present state of affairs calls for realigning policy and practice around a unifying and cohesive framework based on well-conceived models and the best available scholarship. Initiatives for MH in schools must be connected in major ways with the mission of schools and integrated into a restructured system of education support programs and services. This means braiding resources and interventions with a view to ensuring there is a system of learning supports, rather than separate programs and services. Coordinated efforts naturally are part of this, but the key is development of a system of learning supports that meets overlapping needs and does so by fully integrating mental health agenda into school improvement planning at school and district levels. The implications for policy and practice seem clear: Policy and practice must end the marginalization of mental health in schools. To do less is to leave too many children behind. School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge. Carnegie Council Task Force on Education of Young Adolescents (1989) The Center is co-directed by Howard Adelman and Linda Taylor and operates under the auspices of the School Mental Health Project, Dept. of Psychology, UCLA, Write: Center for Mental Health in Schools, Box 951563, Los Angeles, CA 90095-1563 Phone: (310) 825-3634 Fax: (310) 206-8716 Toll Free: (866) 846-4843 email: smhp@ucla.edu website: http://smhp.psych.ucla.edu Support comes in part from the Office of Adolescent Health, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration (Project #U45 MC 00175) with co-funding from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Both are agencies of the U.S. Department of Health and Human Services. 2 So, how does MH connect with the schools mission? Then, after developing an understanding of what school leaders currently are doing to achieve the mission of schools, they need to clarify how agenda for mental health in schools help accomplish that mission. This includes matters such as how MH agenda help meet the demands for school improvement, close the achievement gap, and address racial, ethnic, disability, and socio-economic disparities. Because schools are not in the mental health business, they tend to shy away from the term, especially since it usually is viewed as only about treating mental disorders. They also tend to marginalize all mental health initiatives. Nevertheless, a variety of mental health in school activity is pursued across the country. And, ironically, available research suggests that for some youngsters’ schools are the main providers of mental health services. As Burns and her colleagues (1995) found, “the major player in the de facto system of care was the education sector – more than three-fourths of children receiving mental health services were seen in the education sector, and for many this was the sole source of care.” Anyone who has spent time in schools can itemize the multifaceted mental health and psychosocial concerns that warrant attention. The question for all of us is: How should our society’s schools address these matters? In answering this question, it is useful to reflect on what schools have been and are doing about mental health concerns. Therefore, this report begins by highlighting a bit of history and outlines the current status of MH in schools. Then, we explore emerging trends and discuss policy implications. 3 Part I. Past as Prologue It is, of course, not a new insight that physical and mental health concerns must be addressed ifschools are to function satisfactorily and students are to succeed at school. It has long beenacknowledged that a variety of psychosocial and health problems affect learning and performance in profound ways. Such problems are exacerbated as youngsters internalize the debilitating effects of performing poorly at school and are punished for the misbehavior that is a common correlate of school failure. The Last 50 Years Federal Support for MH in Schools Because of all this, school policy makers, have a lengthy (albeit somewhat reluctant) history of trying to assist teachers in dealing with problems that interfere with schooling. Prominent examples are seen in the range of health, social service, counseling, and psychological programs schools have provided from the end of the 19th century through today (Baumgartner, 1946; Dryfoos, 1994; Flaherty, Weist, & Warner, 1996; Tyack, 1992). One interesting policy benchmark appeared in the middle of the 20th century when NIMH increased the focus on mental health in schools by publishing a major monograph on the topic (Lambert, Bower, & Caplan, 1964). Since then, many initiatives and a variety of agenda have emerged – including efforts to expand clinical services in schools, develop new programs for “at risk” groups, and incorporate programs for the prevention of problems and the promotion of social-emotional development (Califano, 1977; Dryfoos, 1994; Knitzer, Steinberg, & Fleisch, 1990; Millstein, 1988; Steiner, 1976; Stroul & Friedman, 1986). Over the past 20 years, a renewed emphasis in the health and social services sectors on enhancing access to clients has resulted in increased linkages between schools and community service agencies (Center for the Future of Children, 1992; Warren, 2005). This "school-linked services" movement has added impetus to advocacy for mental health in schools. It has promoted school-based health centers, school-based family resource centers, after school programs, and other efforts to connect community resources to the schools. More recently, some advocates for school-linked services have coalesed their efforts with those working to enhance initiatives for youth development, community schools, and the preparation of healthy and productive citizens and workers (Melaville & Blank, 1998). These coalitions have expanded interest in social-emotional learning and protective factors as ways to increase students' assets and resiliency and reduce risk factors (Greenberg, Weissberg, O'Brien, Zins, Fredericks, Resnik, & Elias, 2003; Hawkins & Catalano, 1992). However, the amount of actual mental health activity in schools generated by these efforts remains relatively circumscribed (SAMHSA, 2005). In 1995, a direct effort to advance mental health in schools was initiated by the U.S. Department of Health and Human Services through its Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). When this Mental Health in Schools Program was renewed in 2000 and again in 2005, HRSA and SAMHSA’s Center for Mental Health Services braided resources to co-support the work. The purpose of this program is to enhance the role schools play in mental health for children and adolescents. Specifically, the emphasis is on increasing the 4 Another Call for Collaboration capacity of policy makers, administrators, school personnel, primary care health providers, mental health specialists, agency staff, consumers, and other stakeholders so that they can enhance how schools and their communities address psychosocial and mental health concerns. Particular attention is given to prevention and responding early after the onset of problems as critical facets of reducing the prevalence of problems. The core of the work has been embedded in two national centers. The two which were initially funded in 1995, with a primary emphasis on technical assistance and training, successfully reapplied during the 2000 open competition. A third open competition for a 5 year funding cycle was offered in 2005 with an increasing emphasis on policy and program analyses to inform policy, practice, research, and training. Again, the initially funded Centers applied and were successful in the process. The two Centers are the Center for Mental Health in Schools at UCLA and the Center for School Mental Health Analysis and Action (formerly the Center for School Mental Health Assistance) at the University of Maryland, Baltimore (Anglin, 2003). Other federal initiatives promote mental health in schools. These include programs supported by (1) the U.S. Department of Education’s Office of Safe and Drug Free Schools (including a recently added grants program for the “Integration of Schools and Mental Health Systems”), its Office of Special Education and Rehabilitative Services, and some of the school improvement initiatives under the No Child Left Behind Act, (2) the “Safe Schools/Healthy Students” initiative, which is jointly sponsored by SAMHSA, U.S.D.O.E., and the U.S. Department of Justice, (3) components of the Center for Disease Control and Prevention’s “Coordinated School Health Program” and (4) SAMHSA through its “Elimination of Barriers Initiative” and various other programs and projects, as well as its focus on schools in the Mental Health Transformation State Incentive Grant Program. A smattering of projects that relate to agenda for MH in schools also are supported by several other federal agencies. The future of all federal programs related to MH in schools is at risk because of budget cuts in 2006. In 2000, the Policymaker Partnership at the National Association of State Directors of Special Education and the National Association of State Mental Health Program Directors met to explore how the two entities could collaborate to promote closer working relations between state mental health and education agencies, schools and family organizations. This led, in 2002, to the concept paper Mental Health, Schools and Families Working Together for All Children and Youth: Toward a Shared Agenda. Development of the concept paper was funded by the Office of Special Education Programs for purposes of encouraging state and local family and youth organizations, mental health agencies, education entities and schools across the nation to enter new relationships to achieve positive social, emotional and educational outcomes for every child. The paper focuses on needed policy development and changes to move toward systemic coordination and integration of programs and services. The vision presented is for schools, families, child-serving agencies, and the broader community to work collaboratively to promote opportunities for and to address barriers to healthy social and emotional development and learning. The aim is to align systems and ensure the promise of a comprehensive, highly effective system for children and youth and their families. In stating the need for agencies and schools to work together, the report stresses: 7 Exhibit 1 Some 2004 Data on Students with MH Needs (Reported by the Annenberg Public Policy Center) From April 5 to May 28, 2004, the Annenberg Public Policy Center (APPC) as part of the Annenberg Foundation Trust at Sunnylands’ Initiative on Adolescent Mental Health surveyed over 1400 public school professionals. The focus of the survey was on how schools provide treatment and counseling for students in need of such services. The Princeton Survey Research Associates International conducted telephone interviews with 725 high-school and 515 middle-school professionals knowledgeable about the mental health services in their schools.* Survey findings indicate that the respondents view high school student depression and use of alcohol and illegal drugs as even more serious problems than various forms of violence, including bullying, fighting and use of weapons. More than two thirds (68%) of the high school professionals surveyed identified depression as a great (14%) or moderate (54%) problem in their schools. Similar overall levels of concern were raised about use of alcohol (71%) and illegal drugs (72%). In contrast, 54% of high school professionals identified bullying as a great (11%) or moderate (43%) problem. Even lower levels of concern were expressed about fighting between students (37%) and weapon carrying (6%) at the high school level. Other concerns cited were anxiety disorders (42%), eating disorders (22%), and various forms of self harm such as cutting (26%). Unlike their counterparts in high schools, middle school professionals are more concerned about interpersonal conflict. Although high proportions of middle school professionals identify depression (57%) and use of alcohol (28%) and illegal drugs (37%) as at least moderate problems, bullying is seen as a problem by 82% of professionals and fighting by 57% of professionals in middle schools. Weapon carrying remains a concern among only 5% of professionals. Although 66% of the high schools indicated having a process for referring students with mental health conditions to appropriate providers of care, only 34% reported having a clearly defined and coordinated process for identifying such students. Comparable findings come from the middle schools; however, 42% of professionals reported having a clearly defined process for identifying students with mental conditions. Only about 3% of the high schools indicated use of universal screening. An additional 5% claim to screen most of their students. When asked what percentage of their students who might need counseling or treatment actually receive such services, only 7% of high school professionals said that all do and only 31% said that most do. The majority indicated that only half or fewer received the services they need. When asked the same question about receiving services on site at their school, the percentages were even lower: 6% said all do and 22% said most do. Only 24% of school professionals say their high schools have counseling available for students with alcohol or drug dependence problems. *A minimum of 20 attempts were made to contact a mental health professional at each school. Calls were staggered over different times of day and days of the week to maximize the chance of making contact with potential respondents. Prior to being called, the principal of each school was sent a letter introducing the research and explaining that a mental health professional in the school could expect a call to participate in the study in the coming weeks. In addition, the principals as well as the respondents were told that for their participation a $20,000 charitable donation would be made in the name of all participating schools to an organization that works to improve mental health care among adolescents. The letter also gave an 800 number so that mental health professionals could call in and take the survey at their own convenience. The response rate for the survey was 72%. The sample of schools contained 2,000 public schools drawn from the Common Core of Data Public Elementary/Secondary School Universe 2002-2003—a database of virtually all public elementary and secondary schools in the United States produced annually by the National Center for Education Statistics (NCES). The sample was selected to represent all schools that have at least 100 students and that have classes in at least one middle or high school grade. It is estimated that this sample frame represents more than 90% of all adolescent students in the US. The database is compiled from the administrative records provided by state education agencies. The margin of error for the high school component is +/- 3.7% and 4.4% for the middle schools. Results are being included in a forthcoming Oxford University Press book, “A Call for Effective Treatments for Adolescent Mental Health.” www.appcpenn.org 8 Broadening Understanding of the term “Mental Health” The reality is that when many people hear the term mental health, they think mental illness. Many people hear mental health in schools and they think it’s only about therapy and counseling. The reality, of course, is that MH in schools is about much more than providing students with therapy or counseling. Mental health in schools also means to be about such matters as • providing programs to (a) promote social-emotional development, (b) prevent mental health and psychosocial problems, and (c) enhance resiliency and protective buffers • providing programs and services to intervene as early after the onset of learning, behavior, and emotional problems as is feasible • enhancing the mental health of families and school staff • building the capacity of all school staff to address barriers to learning and promote healthy development • addressing systemic matters at schools that affect mental health, such as high stakes testing (including exit exams) and other practices that engender bullying, alienation, and student disengagement from classroom learning • developing a comprehensive, multifaceted, and cohesive continuum of school-community interventions to address barriers to learning and promote healthy development. Even more to the point, analyses of the contrasting enterprises being pursued under the banner of MH in schools find seven different agenda with respect to policy, practice, research, and/or training. In Exhibit 2, the agenda are grouped and subdivided in terms of the primary vested interests of various parties. Advocates for the first six items would argue for “school-based mental health” as essential to what they want to achieve. However, while some agenda items are complementary, some are not. Given the diverse agenda, it is not surprising that competing interests come into conflict with each other. For example, those concerned with nurturing positive youth development and mental health and those focusing on the treatment of mental and behavioral disorders often find themselves in counter-productive competition for sparse school time and resources. This contributes to the marginalization (see p. 16) that characterizes MH in schools and to the backlash to efforts to enhance policy and practice. 9 Exhibit 2 Diverse Agenda for Mental Health in Schools (1) Efforts to use schools to increase access to kids and their families for purposes of (a) conducting research related to mental health concerns (b) providing services related to mental health concerns. (2) Efforts to increase availability of mental health interventions (a) through expanded use of school resources (b) through co-locating community resources on school campuses (c) through finding ways to combine school and community resources. (3) Efforts to get schools to adopt/enhance specific programs and approaches (a) for treating specific individuals (b) for addressing specific types of problems in targeted ways (c) for addressing problems through school-wide, “universal interventions (d) for promoting healthy social and emotional development. (4) Efforts to improve specific processes and interventions related to mental health in schools (e.g., improve systems for identifying and referring problems and for case management, enhancing “prereferral” and early intervention programs) (5) Efforts to enhance the economic interests of various entities (e.g., specific disciplines, guilds, contractors, businesses, organizations) that are (a) already part of school budgets (b) seeking to be part of school budgets. (6) Efforts to change how student supports are conceived at schools (e.g., rethink, reframe, reform, restructure) through (a) enhanced focus on multi-disciplinary team work (e.g. among school staff, with community professionals) (b) enhanced coordination of interventions (e.g., among school programs and services, with community programs and services) (c) appropriate integration of interventions (e.g., that schools own, that communities base or link with schools) (d) modifying the roles and functions of various student support staff (e) developing a comprehensive, multifaceted, and cohesive component for systematically addressing barriers to student learning at every school. (7) Efforts to reduce school involvement in mental health programs and services (e.g., to maximize the focus on instruction, to use the resources for youth development, to keep the school out of areas where family values are involved). 12 Exhibit 4 Delivery Mechanisms and Formats for MH in Schools The five mechanisms and related formats are: 1. School-Financed Student Support Services – Most school districts employ pupil services professionals such as school psychologists, counselors, school nurses, and social workers to perform services related to mental health and psychosocial problems (including related services designated for special education students). The format for this delivery mechanism tends to be a combination of centrally-based and school-based services. 2. School-District Mental Health Unit – A few districts operate specific mental health units that encompass clinic facilities, as well as providing services and consultation to schools. Some others have started financing their own School-Based Health Centers with mental health services as a major element. The format for this mechanism tends to be centralized clinics with the capability for outreach to schools. 3. Formal Connections with Community Mental Health Services – Increasingly, schools have developed connections with community agencies, often as the result of the school-based health center movement, school-linked services initiatives (e.g., full service schools, family resource centers), and efforts to develop systems of care (“wrap-around” services for those in special education). Four formats and combinations thereof have emerged: • co-location of community agency personnel and services at schools – sometimes in the context of School-Based Health Centers partly financed by community health organizations • formal linkages with agencies to enhance access and service coordination for students and families at the agency, at a nearby satellite clinic, or in a school-based or linked family resource center • formal partnerships between a school district and community agencies to establish or expand school-based or linked facilities that include provision of MH services • contracting with community providers to provide needed student services 4. Classroom-Based Curriculum and Special Out of Classroom Interventions – Most schools include in some facet of their curriculum a focus on enhancing social and emotional functioning. Specific instructional activities may be designed to promote healthy social and emotional development and/or prevent psychosocial problems such as behavior and emotional problems, school violence, and drug abuse. And, of course, special education classrooms always are supposed to have a constant focus on mental health concerns. Three formats have emerged: • integrated instruction as part of the regular classroom content and processes • specific curriculum or special intervention implemented by personnel specially trained to carry out the processes • curriculum approach is part of a multifaceted set of interventions designed to enhance positive development and prevent problems 5. Comprehensive, Multifaceted, and Integrated Approaches – A few school districts have begun the process of reconceptualizing their piecemeal and fragmented approaches to addressing barriers that interfere with students having an equal opportunity to succeed at school. They are starting to restructure their student support services and weave them together with community resources and integrate all this with instructional efforts that effect healthy development. The intent is to develop a full continuum of programs and services encompassing efforts to promote positive development, prevent problems, respond as early-after-onset as is feasible, and offer treatment regimens. Mental health and psychosocial concerns are a major focus of the continuum of interventions, as reflected in initiatives designated as expanded school mental health. Efforts to move toward comprehensive, multifaceted approaches are likely to be enhanced by initiatives to integrate schools more fully into systems of care and the growing movement to create community schools. Three formats are emerging: • mechanisms to coordinate and integrate school and community services • initiatives to restructure student support programs/services and integrate them into school reform agenda • community schools 13 Federal and state mandates tend to determine how many pupil services professionals are employed As indicated in Part I, school districts use a variety of their own personnel to address student support concerns. These may include “pupil services” or “support services” specialists such as psychologists, counselors, social workers, psychiatrists, and nurses, as well as a variety of related therapists. Federal and state mandates tend to determine how many pupil services professionals are employed, and states regulate compliance with mandates. Governance of their work usually is centralized at the district level. In large districts, counselors, psychologists, social workers, and other specialists may be organized into separate units, overlapping regular, compensatory, and special education. Specialists tend to focus mainly on students seen as problems or as having problems. Their many functions can be grouped into: (1) direct services and instruction, (2) coordination, development, and leadership related to programs, services, resources, and systems, and (3) enhancement of connections with community resources. (In keeping with this last function, the focus often is on linking and collaborating with community agencies and programs to enhance resources and improve access, availability, and outcomes.) Prevailing direct intervention approaches encompass responding to crises, identifying the needs of targeted individuals, prescribing one or more interventions, offering brief consultation, and providing referrals for assessment, corrective services, triage, diagnosis, and various gatekeeping functions. In some situations, however, resources are so limited that specialists can do little more than assess for special education eligibility, offer brief consultations, and make referrals to special education and/or community resources. It should be stressed that, because the need is so great, across the country a variety of individuals often are called upon to play a role in addressing problems of youth and their families. These may encompass instructional professionals (health educators, other classroom teachers, special education staff, resource staff), administrative staff (principals, assistant principals), students (including trained peer counselors), family members, and almost everyone else involved with a school (aides, clerical and cafeteria staff, custodians, bus drivers, para-professionals, recreation personnel, volunteers, and professionals-in-training). In addition, as noted, some schools are using specialists employed by other public and private agencies, such as health departments, hospitals, social service agencies, and community-based organizations, to provide services to students, their families, and school staff (Atkins, Graczyk, Frazier, & Abdul-Adil, 2003; Romer & McIntosh, 2005). Exhibit 5 provides a summary of some 2002-2003 data excerpted from the first national survey of school mental health services (Foster, Rollefson, Doksum, Noonan, Robinson, G., & Teich, 2005). The sample was representative of public schools across the U.S., and the data amplify and support previous findings, including those discussed above. 14 Exhibit 5 Some Base Line Data on School Mental Health Services (Excerpted from a national survey funded by the Center for Mental Health Services, SAMHSA, U.S. Dept. of Health and Human Services) As reported in School Mental Health Services in the United States, 2002–2003,* the survey topics included: types of mental health problems encountered in school settings; types of mental health services that schools are delivering; numbers and qualifications of school staff providing mental health services; types of arrangements for delivering mental health services in schools, including collaboration with community-based providers; and major sources of funding for school MH services. Key Findings as Reported in the Executive Summary • Nearly three quarters (73 percent) of the schools reported that “social, interpersonal, or family problems” were the most frequent mental health problems for both male and female students. • For males, aggression or disruptive behavior and behavior problems associated with neurological disorders were the second and third most frequent problems. • For females, anxiety and adjustment issues were the second and third most frequent problems. • All students, not just those in special education, were eligible to receive mental health services in the vast majority of schools (87 percent). • One fifth of students on average received some type of school-supported mental health services in the school year prior to the study. • Virtually all schools reported having at least one staff member whose responsibilities included providing mental health services to students. • The most common types of school mental health providers were school counselors, followed by nurses, school psychologists, and social workers. School nurses spent approximately a third of their time providing mental health services. • More than 80 percent of schools provided assessment for mental health problems, behavior management consultation, and crisis intervention, as well as referrals to specialized programs. A majority also provided individual and group counseling and case management. • Financial constraints of families and inadequate school mental health resources were the most frequently cited barriers to providing mental health services. • Almost half of school districts (49 percent) used contracts or other formal agreements with community-based individuals and/or organizations to provide mental health services to students. The most frequently reported community-based provider type was county mental health agencies. • Districts reported that the most common funding sources for mental health services or interventions were the Individuals with Disabilities Education Act (IDEA), State special education funds, and local funds. In 28 percent of districts, Medicaid was among the top five funding sources for mental health services. • One third of districts reported that funding for mental health services had decreased since the beginning of the 2000–2001 school year, while over two thirds of districts reported that the need for mental health services increased. • Sixty percent of districts reported that since the previous year, referrals to community-based providers had increased. One third reported that the availability of outside providers to deliver services to students had decreased. While survey findings indicate that schools are responding to the mental health needs of their students, they also suggest increasing needs for mental health services and the multiple challenges faced by schools in addressing these needs. Further, more research is needed to explore issues identified by this study, including training of school staff delivering mental health services, adequacy of funding, and effectiveness of specific services delivered in the school setting. *Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., & Teich, J. (2005). School Mental Health Services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05-4068. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. http://www.mentalhealth.samhsa.gov/media/ken/pdf/SMA05-4068/SMA05-4068.pdf 17 Marginalization Student supports are developed in an ad hoc, piecemeal, and highly marginalized way Another perspective on where the field is at this juncture comes from the types of requests for assistance that centers such as ours receive from practitioners. Exhibit 6 provides an indication of what those in the field have been asking about and asking for. This affords a glimpse into the concerns and needs encountered by practitioners in schools across the country. Note that many requests ask about the research/science/knowledge base for practices and for data to make the case for student supports. Other common requests are for resources and strategies to use in daily practice and to facilitate continuing education of school personnel. Practical, ethical, and relationship issues are frequently raised. And, there is increasing interest in school improvement planning as a context for enhancing how schools address mental health and psychosocial concerns. Despite the range of activity related to mental health and psychosocial problems, the overall enterprise is not assigned a high priority most of the time. This reflects the fact that existing student support services and school health programs do not have high status in the educational hierarchy and in current health and education policy. As noted already, aspects of the enterprise gain stature when a high visibility event such as a shooting on campus occurs. But, the elevated status is brief. Because of their usual humble status, student supports continue to be developed in an ad hoc, piecemeal, and highly marginalized way. And, the marginalization not only produces fragmented approaches, it contributes to redundancy, counterproductive competition, and inadequate results. The continuing trend, in policy and practice, is for schools and districts to treat the activity as desirable but not a primary consideration. Since the activity is not seen as essential, the programs and staff are pushed to the margins. Planning of programs, services, and delivery systems tends to be done on an ad hoc basis; interventions are referred to as "auxiliary" or "support" services, and student support personnel almost never are a prominent part of a school's organizational structure. And, such staff usually are among those deemed dispensable as budgets tighten. This, of course, reduces availability and access. The marginalization spills over to how schools pursue special education mandates and policies related to inclusion. It also shapes how they work with community agencies and initiatives for systems of care, wrap-around services, school-linked services, and other school-community collaborations. And, it negatively effects efforts to adopt evidence-based practices and to implement them with fidelity. It also spills over into school improvement. Analyses of school improvement planning guides indicate that too little attention is given to how schools do and do not address mental health and psychosocial concerns (Center for Mental Health in Schools, 2005a, b, c). 18 Exhibit 6 Practitioner’s Requests What’s being asked about? What’s being asked for? Assessment Instruments to • Measure individuals (e.g., self-esteem, mental “health,” behavior problems, anger management, psychosocial competence, parenting knowledge and skills, client satisfaction) • Screen problems (e.g., depression, suicide, at risk kindergarteners) • Assess violence prevention at school • Map and analyze systems Available Research/Science/Knowledge-Base on • Best/effective practices for schools related to >mental health >providing health and social services >behavioral health >suicide prevention >strengthening community mental health >promoting parent/child communication >anger management for high school students >working with neighborhood vendettas • Empirically supported therapeutic relationships • Effects of dress codes on academic achievement and graduation rates • Effects of exposure to violence on learning • Cost-effectiveness • "Huffing" as gateway drug • Moving students with problems into special settings • Comparative efficacy of school & community services • Racial disproportionality in special education • Most common barriers to learning • “Knowledge-based Compensation System” • Connection between bullying and substance abuse • School based depression screening programs • Students living in poverty with a single parent • Homelessness and mental health • Prevalence and incidence of various problems • Student use of MH services in schools • Making the case for MH in schools >need for MH in schools >effectiveness of school MH >impact on school performance >effect on academics >impact on suicide prevention >implications of the “Plateau Effect” >productivity of school-based MH clinicians • Social marketing >the value of school-based student support >the value of mental health at the school site Confidentiality and Consent Concerns • Using email to share info about a student’s problems • Do school mental health staff have to tell the principal if a student is suicidal? • Is a consent form needed for school counseling? • Can MH staff see a student under age 12 one time without parent consent? • Does writing therapy goals in an IEP violate confidentiality? • Conducting research on school-based MH practice Evaluation of • School-based individual interventions • School-based programs • MH intervention outcomes in schools • Parent involvement • Family functioning before and after interventions • Systemic changes • School consultation teams • 8th grade transition program • School-community collaboration • MH workers in schools • Multiservice family centers Funding for Doing and Enhancing the Work • Writing proposals • Leveraging grant funding • Coping with budget reductions • Resources for delivering mental health in schools • Funding for afterschool counseling • Strengthening a school-based student/family center (cont.) 19 Inservice/CE Topics, Strategies, and Resources (e.g., teaching teachers, support staff, administrators) [Note: All of the other categories, of course, contain matters relevant to inservice and continuing education.] • Info for establishing ways to >orient new support staff >support for new teachers >help teachers and other school staff learn more about school MH, about imparting MH info, and about being sensitive to student MH >provide leadership training on mobilizing staff >tell parents about a teacher's molestation conviction • Info to help in covering specific topics such as >student transitions >homework as a MH concern and barrier to learning >engaging parents of middle school students >resilience and high school students >suicide prevention and referral guidelines >dealing with the hurricane aftermath >avoiding “triangulation” • Requests for resource materials >powerpoint presentation for school staff on MH >short but comprehensive MH handbook for teachers >guides for behavioral management systems for schools >protocols on school planning to respond to terrorism >for planning/implementing disaster aftermath efforts >lesson plans for conflict resolution for middle school >curriculum materials on various MH issues >guides for suicide prevention and aftermath >to use with non-English speaking populations >for use by special education assistants and aides >on social-emotional learning >on helping students cope with holiday stressors >on helping students cope with grief and loss >on paraeducator training • Questions about dealing with the following specific types of student problems >bullying >teen depression >substance abuse >attention problems >fear of talking >grief >won’t speak at school >communication disorders >verbally aggressive >cries at school every day >oppositional defiant disorder >suicide >huffing >extreme separation anxiety >bipolar disorders >choking game >cutters >bright, turned off student >those impacted because of family deployment to war >students on medication >exposure to domestic abuse >student who made false abuse accusation >classroom disruptors >residential school students >understand sibling with Asperger's Syndrome >avoidance behavior around homework >disaster victims >obesity as an eating disorder >computer game addiction >children living in poverty Intervention Approaches (How to do it) • Mental health in schools "How do I start?" • Behavior supports • Dealing with behavioral outbursts • Guidelines on alternatives to corporal punishment • Addressing truancy and student attendance • Alternatives to suspension • Starting a counseling program at a school • Group counseling guidelines • MH interventions for 10-14 year olds • Helping to transition new students • Human sexuality curriculum for special populations • Curriculum for sexual abuse prevention • Developing a day treatment program • Promoting MH through classroom curriculum • Using interactive software (e.g., for MH education) • Strategies to minimize dependence and enhance independence in students • Using social-emotional themes in students’ reading • Processes for triage, referral, tracking, session planning, care management, progress evaluation • Transition programs for ninth grade • Suicide prevention for 5th grade • Preventing violence among deaf adolescents • Resources for crisis response • Adventure-based counseling in schools • Strategies to support cultural & linguistic diversity • Introducing non-English speakers to MH concerns • Working with troubled kindergarten students • Working with a gifted but unmotivated student • Working with students concerned about death of friends/relatives • Working with families through a student "life map" • Family Systems Therapy in schools • Info on juvenile justice for "high risk" youth • Practices for keeping students out of jail • Rural school MH and teleconsultation • Helping grandparents who are raising grandchildren • Re-engaging disengaged students in learning • Strategies to keep kids engaged during the summer • Enhancing "self-discipline" through class projects • Enhancing student connectedness • Talking with students about motivation • Homework as "work at home" • What to do (and not to do) on the anniversary of a school shooting or other tragedy Intervention Issues • Helping vs. socialization • School-wide screening for depression and suicide • Continuing counseling at school after graduation • How to account for diversity • First grade retention • Intervening at school vs. in a special setting • Medication refusal at school • Why don't classrooms account for emotional problems? • "Mental health" can be a scary term for students and families: What's a better term? • Does early drug abuse education increase curiosity about drugs? Peer Programs • Youth council to address MH stigma • Peers imparting mental health info • Training 4th-6th graders as peer coaches for coping (cont.) 22 Instructional Component What’s Missing (To directly facilitate learning) Student Management Component (for governance and resource management) Instructional Component Enabling Component* (To directly facilitate learning) (to address barriers to learning)Student School Family Community Management Component (for governance and resource management) Exhibit 7 Moving from a Two- to a Three-component Policy Framework for School Improvement FROM TO Direct Facilitation of Direct Facilitation of Addressing Barriers Development & Learning Development & Learning to Learning Developmental/ Developmental/ Enabling Instructional Instructional Component* Component Component Besides offering a small amount of school-owned student "support" services, schools outreach to the community to add a few school-based/linked services. Governance and Governance and Resource Management Resource Management Management Component Management Component *The third component (an enabling or learning supports component) is established in policy and practice as primary and essential and is developed into a comprehensive approach by weaving together school and community resources. 23 Part III. Where is the Field Going? Prediction is a risky business. When it comes to thinking about the future of MH in schools, afew matters are evident. For one, it is clear that the field is in flux. For another, practitionersin the schools who are most associated with mental health concerns are realizing that changes are needed and are afoot. There is widespread agreement that a great deal needs to be done to improve what is taking place, but no specific perspective or agenda is dominating policy, practice, research, or training. Schools and the Transformation of the MH System in the U.S. Emerging View It is also evident that schools and communities increasingly are being called on to meet the needs of all youngsters, especially those experiencing behavior, learning, and emotional problems. All this provides both an opportunity and challenge to rethink mental health in ways that involve schools and communities working together to develop comprehensive, multifaceted, and cohesive systems for intervention. One perspective on the future comes from the New Freedom Initiative’s efforts to follow-up on the work of the President’s New Freedom Commission on Mental Health. The Commission’s recommendations are designed to transform the mental system in the U.S. As we have indicated in a previous policy report, each recommendation can be operationalized into agenda items for mental health in schools (see Appendix A). As the Commission’s report notes, this is a time of sparse resources for public enterprises. With this in mind, the report stresses the importance of “policy and program changes that make the most of existing resources by increasing cost effectiveness and reducing unnecessary and burdensome regulatory barriers, coupled with a strong measure of accountability.” The aim is to more wisely invest and use sparse resources. One set of relevant resources certainly are those already committed to mental health in schools. However, because of the Commission’s limited focus on MH in schools (see Rec. 4.2 in Appendix A), this venue is unlikely to play a major role in immediate efforts to transform the mental health system, never mind enhancing MH in schools. Approaching MH in schools from a different perspective a variety of stakeholders are pushing to enhance policy and practice in ways that directly connects various mental health agenda with the mission of schools. We see this as an emerging view. As illustrated in Exhibit 8, this emerging view calls for developing, over time, a full continuum of systemically interconnected school and community interventions that encompasses a > system for promoting healthy development and preventing problems > system for responding to problems as soon after onset as is feasible > system for providing intensive care 24 Exhibit 8 Interconnected Systems for Meeting the Needs of All Students Providing a Continuum of School-community Programs & Services Ensuring use of the Least Intervention Needed School Resources (facilities, stakeholders, programs, services) Examples: • General health education • Drug and alcohol education • Enrichment programs • Support for transitions • Conflict resolution • Home involvement • Drug counseling • Pregnancy Prevention • Violence prevention • Dropout prevention • Suicide Prevention • Learning/behavior accommodations and response to intervention • Work Programs • Special education for learning disabilities, emotional disturbance, and other health impairments Systems for Promoting Healthy Development & Preventing Problems primary prevention – includes universal interventions (low end need/low cost per individual programs) Systems of Early Intervention early-after-onset – includes selective & indicated interventions (moderate need, moderate cost per individual) Systems of Care treatment/indicated interventions for severe and chronic problems (High end need/high cost per individual programs) Community Resources (facilities, stakeholders, programs, services) Examples: • Public health & safety programs • Prenatal care • Immunizations • Pre-school programs • Recreation & enrichment • Child abuse education • Early identification to treat health problems • Monitoring health problems • Short-term counseling • Foster placement/group homes • Family support • Shelter, food, clothing • Job programs • Emergency/crisis treatment • Family preservation • Long-term therapy • Probation/incarceration • Disabilities programs • Hospitalization • Drug treatment Systemic collaboration* is essential to establish interprogram connections on a daily basis and over time to ensure seamless intervention within each system and among systems of prevention, systems of early intervention, and systems of care. *Such collaboration involves horizontal and vertical restructuring of program sand services (a) within jurisdictions, school districts, and community agencies (e.g., among departments, divisions, units, schools, clusters of schools) (b) between jurisdictions, school and community agencies, public and private sectors; among schools; among community agencies 27 What are the gaps? Although schools cannot do everything, the frameworks outlined in Exhibits 8 and 9 provide a reasonable basis for beginning to map and conduct a variety of analyses of what is currently being done by and with schools. The focus of such mapping is on how well the current state of the art approximates the ideal of having a comprehensive, multifaceted, and cohesive approach for addressing barriers to learning. Appendix B provides a more extensive framework for such mapping and analyses. To date, society’s policy makers have not committed to establishing the interconnected set of systems outlined in Exhibits 8 and 9. However, as discussed in the preceding section, work is underway to establish the type of policy and practice shift that can institutionalize such a comprehensive, multifaceted, and integrated approach in schools. Two parables help differentiate the old and emerging views of mental health in schools. The old view fits the starfish metaphor. The day after a great storm had washed up all sorts of sea life far up onto the beach, a youngster set out to throw back as many of the still-living starfish as he could. After watching him toss one after the other into the ocean, an old man approached him and said: It’s no use your doing that, there are too many, You're not going to make any difference. The boy looked at him in surprise, then bent over, picked up another starfish, threw it in, and then replied: It made a difference to that one! This parable, of course, reflects all the important clinical efforts undertaken by staff alone and when they meet together to work on specific cases. The emerging view is captured by what can be called the bridge parable. In a small town, one weekend a group of school staff went fishing together down at the river. Not long after they got there, a child came floating down the rapids calling for help. One of the group on the shore quickly dived in and pulled the child out. Minutes later another, then another, and then many more children were coming down the river. Soon every one was diving in and dragging children to the shore and then jumping back in to save as many as they could. In the midst of all this frenzy, one of the group was seen walking away. Her colleagues were irate. How could she leave when there were so many children to save? After long hours, to everyone’s relief, the flow of children stopped, and the group could finally catch their breath. At that moment, their colleague came back. They turned on her and angrily shouted: How could you walk off when we needed everyone here to save the children? She replied: It occurred to me that someone ought to go upstream and find out why so many kids were falling into the river. What I found is that the old wooden bridge had several planks missing, and when some children tried to jump over the gap, they couldn’t make it and fell through into the river. So I got someone to fix the bridge. Fixing and building better bridges is a good way to think about what the emerging view adds to previous thinking about MH in schools. It underscores the importance of taking time to improve and enhance resources, programs, and systems in schools. 28 All – not just some students The emerging view stresses connecting MH agenda with the mission of schools Both metaphors are embedded in the emerging view of MH in schools. This view recognizes that schools must be concerned with all, not just some students and with preventing problems and promoting development. In keeping with a commitment to all students, emerging trends are to • define mental health broadly – i.e., encompass the agenda for mental health in schools within the broad context of the psychosocial and mental health concerns encountered each day at schools – including an emphasis on strengths as well as deficits and on the MH of students’ families and school staff • enhance partnerships among schools, communities, and the home – e.g., coalesce and enhance the roles of schools/communities/homes in addressing emotional, behavioral, and learning problems • confront equity considerations – e.g., stress the role mental health in schools can play in ensuring all students have an equal opportunity to succeed at school • address the related problems of marginalization, fragmentation, and counterproductive competition for sparse resources – i.e., work to coalesce policy, agencies, organizations, and daily practice • address the challenges of evidence-based strategies and achieving results – e.g., stress ways to build on current in- school practices using a science-base Relatedly, there is growing recognition of the drawbacks to framing MH in schools only in terms of (a) screening and diagnosing problems, (b) providing clinical services, and (c) connecting community mental health providers to schools to expand and integrate, school-linked services. These, indeed, are all fundamental to improving MH, but they don’t connect well enough to a school’s mission to make the case that MH in schools is an imperative. The emerging view emphasizes connecting various MH agenda in major ways with the mission of schools and integrating with the full range of student learning supports designed to address barriers to learning. It also emphasizes the importance of taking advantage of the natural opportunities at schools for countering psychosocial and mental health problems and promoting personal and social growth that arise each day, over the school year, during every transition, and as soon as a student is identified as having problems (see Appendix C). 29 About Connecting with School Improvement Planning The Policy Leadership Cadre for Mental Health in Schools (2001) has translated the emerging view into the first-ever set of guidelines for mental health in schools (see Appendix D). The type of comprehensive approach reflected in the guidelines, of course, requires unifying frameworks and major systemic changes. Such changes involve strategic collaborations focused on weaving school owned and community owned resources together to develop comprehensive, multifaceted, and integrated systems for addressing barriers to learning and enhancing healthy development. In sum, the emerging view recognizes that schools are not in the mental health business. Indeed, it acknowledges that the mission of schools is to educate all students and that many school stakeholders are leery of MH, especially when the focus is presented in ways that equate the term only with mental disorders. At the same time, advocates of the emerging view stress that when students are not doing well at school, MH concerns and the school's mission usually overlap because the school cannot achieve its mission for such students without addressing factors interfering with progress. This is especially the case in schools where the number of students not doing well outnumbers those who are. Thus, the emerging view takes the position that school improvement planning must encompass a comprehensive system of interventions that includes a focus on MH and psychosocial concerns (Center for Mental Health in Schools, 2005a and b). In that context, mental health in schools can be conceived both as (a) part of essential learning supports systems that enable students to learn so that schools can achieve their mission and (b) a fundamental facet of the initiative to transform the mental health system. Moreover, existing resources can be deployed and redeployed in ways that enhance equity with respect to availability, access, and effectiveness. Before leaving discussion of where the field is going, we want to highlight the following as some of the basic considerations that will arise if the field moves toward connecting with school improvement planning. The field must be ready to propose how schools should • promote social-emotional development, preventing mental health and psychosocial problems, and enhancing resiliency and protective buffers • intervene as early after the onset of emotional, behavior, and learning problems as is feasible and to address severe and chronic problems • address systemic matters at schools that affect student and staff well-being, such as practices that engender bullying, alienation, and student disengagement from classroom learning 32 Part IV. Policy Implications Based on the background and analyses set forth in this report, we suggest that the mostfundamental policy concern at this time is to end the marginalization of mental health inschools. To do so, policymaker should consider embedding the school focus on mental health and psychosocial concerns in policy for learning supports. At the same time, to address the complexities of implementing innovative changes in schools, policy must specifically focus on the complications of systemic change, including rethinking and redeploying use of existing resources and phasing-in changes over time. End the Marginalization by Embedding MH in Policy for Learning Supports In arguing for ending the marginalization of mental health in schools, a good starting place is the statement of the Carnegie Council Task Force on Education of Young Adolescents. In their 1989 report they stress: School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge. Furthermore, given that many schools currently are not meeting the challenge in a significant manner, the case can be made that this is a major reason why they are so unsuccessful in enhancing student progress and closing the achievement gap. Analyses of school improvement processes and capacity building (including pre and inservice staff development) indicate short shrift has been given to efforts to address barriers to learning and teaching (including mental health and psychosocial concerns). The simple psychometric reality is that in schools where a large proportion of students encounter major barriers to learning, test score averages are unlikely to increase much until such programs are rethought and redesigned. With these points made, it can be argued that meeting the challenge requires a policy shift. Policy is needed to ensure that every school improvement effort includes a focus on development, implementation, and validation of a comprehensive system to address barriers to learning and teaching. The policy shift outlined in Part II of this report, the emerging view described in Part III, and the work outlined in Appendices B, C, and D indicate the type of changes that can end the marginalization of mental health in schools. The focus is on development, implementation, and validation of a comprehensive, multifaceted system of interventions, built using a unifying umbrella concept that fits school improvement needs and embedding concerns about mental health. As discussed, one way to designate such a system is as a component for addressing barriers to learning. Appendix E provides examples of policy statements and legislation for comprehensive systems of learning support to address barriers to learning and teaching. Each reflects a fundamental commitment to MH and psychosocial concerns. 33 Address Systemic Change Policy for school improvement tends to give short shrift to the process of systemic change Meeting the challenge, of course, also means addressing complications stemming from the scale of public education. That is, those who set out to enhance mental health in schools across a district are confronted with two enormous tasks. The first is to develop, implement, and validate prototypes; the second involves large-scale replication. One without the other is insufficient. Current school improvement efforts generally do not address the systemic change considerations involved in both these matters. Thus, the need for policy attention. Elsewhere, we have explored in some detail a basic framework highlighting how key elements involved in designing major school improvements (such as enhancing the focus on mental health and psychosocial concerns) are logically connected to considerations about designing systemic change (Center for Mental Health in Schools, 2005c). Exhibit 11 outlines the framework. As can be seen, the same elements can be used to frame key design concerns related to school improvement and accomplishing systemic changes, and each is intimately linked to the other. The elements are conceived as encompassing • the vision, aims, and underlying rationale for the work • the resources needed to do the work • the general functions, major tasks, activities, and phases that must be pursued • the infrastructure and strategies needed to carry out the functions, tasks, and activities • the positive and negative results that emerge. Policy is needed to ensure that strategic planning for school improvement accounts for each of the elements outlined with respect to (1) prototypes for ensuring that all students have an equal opportunity to succeed in school and (2) how the school will accomplish and validate essential changes. At the district level, the need is for policy ensuring strategic planning for how the district will facilitate replication and scale-up of prototype practices. 34 Exhibit 11 Linking Logic Models for Designing School Improvement and Systemic Change Key considerations with respect to both (a) desired school improvements and (b) “getting from here to there” (e.g., systemic changes): >What is the vision, long-term aims, and underlying rationale? >What are the existing resources that might be (re)deployed and woven together to make good progress toward the vision? >What general functions, major tasks, activities, and phases need to be implemented? >What infrastructure and strategies are needed to carry out the functions, tasks, and activities? >What short-term indicators will be used as process benchmarks, what intermediate outcomes will indicate progress toward long-range aims, and how will negative outcomes be identified? Vision/Aims/Rationale for school improvements to address problems and enhance the well-being of students and schools for systemic changes to accomplish the above (e.g., image of future system, understanding of how organizations change) Resources to be (re)deployed and woven together (e.g., dollars, real estate space, equipment, human and social capital, etc.) for pursuing desired school improvements to be (re)deployed for pursuing necessary systemic changes General Functions, Major Tasks, Activities & Phases for pursuing desired school improvements in keeping with the stated vision for pursuing necessary systemic changes Infrastructure & Strategies Interconnected mechanisms for implementing functions and accomplishing intended outcomes (e.g., mechanisms for governance, resource management, planning, etc.) Interconnected temporary mechanisms to guide and facilitate systemic changes (e.g., leadership for change, steering group, organizational change facilitators) Positive & Negative Outcomes Formative/summative evaluation and accountability (e.g., data on students, schools, families, & neighborhood; data to “get credit” for all that is done and for social marketing) School Improvement Outcome Indicators Short-term Intermediate Long-term (benchmarks) Systemic Change Outcome Indicators Short-term Intermediate Long-term (benchmarks) 37 Rethinking and Redeploying Resources (b) Systemic change considerations. Major systemic changes, of course, must be made strategically. With this in mind, the following can be outlined in discussing the feasibility of the proposed changes and can be incorporated into facilitative guidelines accompanying policy. The emphasis throughout is on realistically phasing-in changes (See Exhibit 13). To develop a comprehensive, multifaceted, and cohesive component for addressing barriers to learning and teaching at every school, there must be a focus on doing the following over time (1) weaving resources into a cohesive and integrated continuum of interventions. Specifically, school staff responsible for the component must collaborate with families and community stakeholders to evolve systems for (a) promoting healthy development and preventing problems, (b) intervening early to address problems as soon after onset as feasible, and (c) assisting those with chronic and severe problems. (2) restructuring at every school and district-wide with respect to • redefining administrative roles and functions to ensure there is dedicated administrative leadership that is authorized and has the capability to facilitate, guide, and support the systemic changes for ongoing development of such a component at every school • reframing the roles and functions of pupil services personnel and other student support staff to ensure development of the component • redesigning the infrastructure to establish a team at every school and district-wide that plans, implements, and evaluates how resources are used to build the component’s capacity (3) expanding standards and accountability indicators for schools to ensure the systemic changes are fully integrated with the instructional component at a school and are pursued with equal effort in policy and practice. In addition, it will be useful to guide boards of education toward establishing a standing subcommittee focused specifically on ensuring effective implementation of the enacted policies (Center for Mental Health in Schools, 2004c). It also will be important to move pre- and in-service programs for school personnel toward including a substantial focus on the concept of an enabling or learning supports component and how to operationalize it at a school in ways that fully integrate with instruction. 38 Exhibit 13 About the Phases of Systemic Change Any approach to significantly enhancing mental health in schools requires substantive organizational and programmatic transformation (Adelman & Taylor, 2003; Elias, et al., 2003; Taylor, Nelson, & Adelman, 1999). Whether the focus is on establishing a prototype at one site or replicating it at many, the systemic changes can be conceived in terms of four overlapping phases: (1) creating readiness – increasing a climate/culture for change through enhancing the motivation and capability of a critical mass of stakeholders, (2) initial implementation – change is carried out in stages using a well- designed infrastructure to provide guidance and support, (3) institutionalization – accomplished by ensuring there is an infrastructure to maintain and enhance productive changes, and (4) ongoing evolution – through use of mechanisms to improve quality and provide continuing support in ways that enable stakeholders to become a community of learners and facilitates periodic creative renewal. Key stakeholders and their leadership must understand and commit to the changes. And, the commitment must be reflected in policy statements and creation of an organizational structure at all levels that ensures effective leadership and resources for systemic change (including well-trained change agents). With respect to development of a comprehensive, multifaceted, and cohesive system to address barriers to learning and teaching at every school, the first phases require special attention to: (1) building interest and consensus for establishing the new system (2) introducing basic concepts to relevant groups of stakeholders (3) establishing a policy framework that recognizes such a system is a primary and essential facet of the institution's activity (4) ensuring appointment of high level leaders (at school and district levels) to ensure commitments are carried out related to this component Because of various pressures, it is not uncommon for insufficient time and attention to be spent on creating readiness by enhancing a climate/culture for change. This may account for the frequency with which changes end up being superficial rather than substantial. 39 There is much work to be done as public schools across the country strive to leave no child behind. In general, for significant prototype development, implementation, and validation and systemic change to occur, policy and program commitments must be demonstrated through effective allocation and redeployment of resources to facilitate organizational and operational changes. That is, finances, personnel, time, space, equipment, and other essential resources must be made available, organized, and used in ways that adequately operationalize policy and promising practices. This includes ensuring sufficient resources to develop an effective structural foundation for prototype development, systemic changes, sustainability, and ongoing capacity building. To do less is to undermine substantive systemic change and perpetuate an unsatisfactory status quo. In sum, the next decade must mark a turning point in how schools and communities address the problems of children and youth. With respect to policy, there must be a focus on reforming and restructuring how schools work to prevent and ameliorate the many learning, behavior, and emotional problems experienced by students. 42 • systemic change frameworks that enhance replicability, sustainability, and scale-up with appropriate fidelity Enhancing mental health in schools clearly is not an easy task. The bottom line is that limited efficacy seems inevitable as long as the full continuum of necessary programs is unavailable and staff development remains deficient; limited cost effectiveness seems inevitable as long as related interventions are carried out in isolation of each other; limited systemic change is likely as long as the entire enterprise is marginalized in policy and practice. And, mental health in schools is likely to remain marginalized as long as its advocates do not embed their agenda under a unifying concept that is an integral component of school improvement. When this is done, the likelihood is enhanced that mental health in schools will be understood as essential to the aim of leaving no child behind. 43 APPENDICES A. New Freedom Commission on Mental Health Recommendations B. Reframing How Schools Address Barriers to Learning C. Some Natural Opportunities to Enhance Mental Health at School D. Guidelines for Mental Health in Schools D. Examples of Policy Statements for a Unifying Approach in Schools E. Examples of Provisions in Federal Law that Allow Districts to Redeploy Federal Resources to Improve Systems (e.g., to create a cohesive System of Learning Supports) A-1 Appendix A New Freedom Commission on Mental Health Recommendations Launched by President Bush in February 2001, the stated intent of the New Freedom Initiative is “to promote full access to community life for people with disabilities, including access to employment and educational opportunities and to assistive and universally designed technologies.” In April 2002, the President signed Executive Order 13263 establishing the New Freedom Commission on Mental Health and charged the group with conducting a comprehensive study of the problems and gaps in the mental health service system and to make concrete recommendations for immediate improvements that the Federal government, State governments, local agencies, as well as public and private health care providers, can implement. The Commission members met for 1 year to study the research literature and to receive comments from more than 2,300 mental health consumers, family members, providers, administrators, researchers, government officials, and other key stakeholders. The Commission framed its work around the five principles set forth in the Executive Order that established its responsibilities. These principles seek to improve the outcomes of mental health care; promote collaborative, community-level models of care; maximize existing resources and reduce regulatory barriers; use mental health research findings to influence service delivery; and promote innovation, flexibility, and accountability at the Federal, State, and local levels. In particular, the President directed the Commission to: • Focus on the desired outcomes of mental health care, which are to attain each individual's maximum level of employment, self-care, interpersonal relationships, and community participation. • Focus on community-level models of care that effectively coordinate the multiple health and human service providers and public and private payers involved in mental health treatment and delivery of services. • Focus on those policies that maximize the utility of existing resources by increasing cost-effectiveness and reducing unnecessary and burdensome regulatory barriers. • Consider how mental health research findings can be used most effectively to influence the delivery of services. • Follow the principles of Federalism, and ensure that its recommendations promote innovation, flexibility, and accountability at all levels of government and respect the constitutional role of the States and Indian tribes In 2004, the Center for Mental Health in Schools was involved in the preparation of a brief* designed to apply the extant body of knowledge related to mental health in schools in ways that might contribute to operationalizing the recommendations of the President’s New Freedom Commission on Mental Health. The brief also incorporates the goals of Healthy People 2010, and the ideas set forth in Bright Futures, Mental Health. Moreover, it reflects input from the wide range of stakeholders across the country with whom the center works. As a result, the brief draws on what has been learned over many years, in many contexts, and from many sources. The underlying message in the brief was that efforts to transform how mental health interventions are delivered can and should capitalize on the needs of and opportunities presented by schools. _____________________________ * See Integrating Agendas for Mental Health in Schools into the Recommendations of the President's New Freedom Commission on Mental Health http://smhp.psych.ucla.edu/pdfdocs/newfreedomcommisison/newfreedbrief.pdf A-4 Commission Goal 4 - Making early mental health screening, assessment, and referral to services common practice Rec. 4.1 Promote the mental health of young children. • Schools increasingly are focusing on pre-schoolers and the special needs of students in primary grades. Head start has always had a mental health focus; all pre-schools are concerned with promoting social and emotional development. Teachers of young children and other staff at their schools are critical elements in promoting mental health (or contrib- uting to emotional and behavioral problems). They also are essential to early detection and referral. And, with an enhanced focus on MH in schools, more student support programs and services can be available to prevent and address problems early after their onset. Rec. 4.2 Improve and expand school mental health programs. • Continue and expand the federal Mental Health in Schools Program. • Expand the federal mental health research agenda to enhance the focus on mental health in schools. A strong research agenda is needed related to the interface between school and mental health policy, research, training, and practice. • Coalesce mental health-related federal categorical programs in schools. The Safe Schools/Healthy Students initiative has pioneered an interagency approach that braids funds from three federal departments in ways that have improved and expanded mental health programs. A broader initiative is now needed to address the problems of so-called “silo” funding to schools within and across federal agencies. (Also, see school-related recommendation for 2.3 above.) Rec. 4.3 Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies. • Substance abuse is a major concern in schools. Because of this, schools provide an invaluable venue for addressing co-occurring MH and substance problems. Next to parents, teachers and student support staff are in a strategic position to detect problems early. And, by definition, an integrated intervention approach requires the involvement of school staff. Rec. 4.4 Screen for mental disorders in primary health care, across the lifespan, and connect to treatment and supports. • School nurses, other student support staff, and the staff of school-based health centers should be viewed as providing primary health care. Such personnel do and can play an even greater role in early detection and referral of mental health problems and in coordinating and integrating interventions at school and with community providers. Commission Goal 5 - Delivering excellent mental health care and accelerating research Rec. 5.1 Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses. • Expand the federal mental health research agenda to accelerate the focus on mental health in schools. There are many areas in need of extensive research. For example: research on resilience and protective buffers related to schools is still in its earliest stages; research on A-5 the outcomes of special education programs for emotional and behavioral problems has yet to identify approaches that have a high degree of lasting effectiveness; research is needed related to replication and school districts scale-up of science-based prevention programs. Rec. 5.2 Advance evidence-based practices using dissemination and demonstration projects and create a public-private partnership to guide their implementation. • Schools increasingly are being called upon to use evidence-based MH practices. In doing so, they have developed demonstration projects and various dissemination strategies. The next step is to focus on sustainability, replication, and scale-up strategies. Lessons learned from the current federal initiative for diffusing Comprehensive School Reform models will be instructive with respect to creating public-private partnerships. Also useful will be what has been learned from the extensive work across the country focused on developing school- community collaboratives. Rec. 5.3 Improve and expand the workforce providing evidence-based MH services and supports. • Build the capacity of student support staff and other mental health professionals who come into schools for incorporating science-based activity. The current federal Mental Health in Schools Program has begun this process through the two national training and technical assistance centers it established. Obviously, such capacity building is a long-term concern, and one that must be institutionalized into pre- and in-service programs across the country. Rec. 5.4 Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care. • Schools must play a role in each of these areas. School involvement is indispensible both as contexts and sources for child and adolescent samples. With an enhanced focus on mental health in schools, some of the barriers to conducting such research can be reduced. Commission Goal 6 - Using technology to access mental health care and information Rec 6.1 Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations. • Schools already are involved in pioneering use of health technology and telehealth. The next step is to evolve and sustain the demonstrations and develop replication and scale-up strategies. Rec. 6.2 Develop and implement integrated electronic health record and personal health info systems. • Schools currently are in the process of revamping and computerizing their information management systems. In response to the accountability demands of the No Child Left Behind Act (and the protections required by Family Educational Rights and Privacy Act [FERPA] and Health Insurance Portability and Accountability Act [HIPAA]), school districts across the country are redesigning and computerizing their information management systems. The opportunity exists to influence the type of health data included and improve system connectivity with health and other agencies. B-1 Appendix B Reframing How Schools Address Barriers to Learning Leaving no child behind means addressing the problems of the many who are not benefitting from instructional reforms. Because of the complexity of ensuring that all students have an equal opportunity to succeed at school, policy makers and practitioners need an operational framework to guide development of a comprehensive, multifaceted, and cohesive system of learning supports. Such a system encompasses healthy development, prevention, and addressing barriers. For individual youngsters, the intent of a system of learning supports is to prevent and minimize as many problems as feasible and to do so in ways that maximize engagement in productive learning. For the school and community as a whole, the intent is to produce a safe, healthy, nurturing environment/culture characterized by respect for differences, trust, caring, support, and high expectations. In accomplishing all this, the focus is on restructuring support programs and melding school, community, and home resources. The process is designed from the school outward. That is, the initial emphasis is on what the classroom and school must do to reach and teach all students effectively. Then, the focus expands to include planning how the feeder pattern of schools and the surrounding community can complement each other's efforts and achieve economies of scale. Central district and community agency staff then restructure in ways that best support these efforts. The focus includes: • Addressing barriers through a broader view of “basics” and through effective accommodation of learner differences • Enhancing the focus on motivational considerations with a special emphasis on intrinsic motivation as it relates to learner readiness and ongoing involvement and with the intent of fostering intrinsic motivation as a basic outcome • Adding remediation as necessary, but only as necessary. Pioneering efforts have operationalized such a system by combining the continuum presented as Exhibit 8 in the body of this report with a component framework consisting of six programmatic arenas. Based on this work, the intervention arenas are conceived as (1) enhancing regular classroom strategies to enable learning (i.e., improving instruction for students who have become disengaged from learning at school and for those with mild-moderate learning and behavior problems) (2) supporting transitions (i.e., assisting students and families as they negotiate school and grade changes and many other transitions) • increasing home and school connections • responding to, and where feasible, preventing crises • increasing community involvement and support (outreach to develop greater community involvement and support, including enhanced use of volunteers) • facilitating student and family access to effective services and special assistance as needed. In practice, the six arenas constitute the “curriculum” of an enabling or learning supports component. They categorize and capture the essence of the multifaceted ways schools need to address barriers to learning (see Exhibit B-1). As a whole, the six arenas combined with the continuum provide a unifying umbrella framework to guide the reframing and restructuring of the daily work of all staff who provide learning supports at a school. Note that a key element of the component involves building the capacity of classrooms to enhance instructional effectiveness. Such “classroom-focused enabling” involves personalized instruction that accounts for motivational and developmental differences and special assistance in B-4 Crisis Assistance and Prevention. Schools must respond to, minimize the impact of, and prevent crises. This requires school-wide and classroom-based systems and programmatic approaches. Such activity focuses on (a) emergency/crisis response at a site, throughout a school complex, and community-wide (including a focus on ensuring follow-up care) and (b) prevention at school and in the community to address school safety and violence reduction, suicide prevention, child abuse prevention, and so forth. Desired outcomes of crisis assistance include ensuring immediate emergency and follow-up care so students are able to resume learning without undue delay. Prevention activity outcome indices reflect a safe and productive environment where students and their families display the type of attitudes and capacities needed to deal with violence and other threats to safety. A key mechanism in this area often is development of a crisis team. Such a team is trained in emergency response procedures, physical and psychological first-aid, aftermath interventions, and so forth. The team also can take the lead in planning ways to prevent some crises by facilitating development of programmatic approaches to mediate conflicts, enhance human relations, and promote a caring school culture. Crisis Assistance and Prevention encompasses • Ensuring immediate assistance in emergencies so students can resume learning • Providing Follow up care as necessary (e.g., brief and longer-term monitoring) • Forming a school-focused Crisis Team to formulate a response plan and take leadership for developing prevention programs • Mobilizing staff, students, and families to anticipate response plans and recovery efforts • Creating a caring and safe learning environment (e.g., developing systems to promote healthy development and prevent problems; bullying and harassment abatement programs) • Working with neighborhood schools and community to integrate planning for response and prevention • Staff/stakeholder development focusing on the role and responsibility of all in promoting a caring and safe environment Support for Transitions. Students and their families are regularly confronted with a variety of transitions – changing schools, changing grades, encountering a range of other daily hassles and major life demands. Many of these can interfere with productive school involvement. A comprehensive focus on transitions requires school-wide and classroom-based systems and programmatic approaches designed to (a) enhance successful transitions, (b) prevent transition problems, and (c) use transition periods to reduce alienation and increase positive attitudes toward school and learning. Examples of programs include school-wide and classroom specific activities for welcoming new arrivals (students, their families, staff) and rendering ongoing social support; counseling and articulation strategies to support grade-to-grade and school-to-school transitions and B-5 moves to and from special education, college, and post school living and work; and before and after- school and inter-session activities to enrich learning and provide recreation in a safe environment. Anticipated overall outcomes are reduced alienation and enhanced motivation and increased involvement in school and learning activities. Examples of early outcomes include reduced tardies resulting from participation in before-school programs and reduced vandalism, violence, and crime at school and in the neighborhood resulting from involvement in after-school activities. Over time, articulation programs can reduce school avoidance and dropouts, as well as enhancing the number who make successful transitions to higher education and post school living and work. It is also likely that a caring school climate can play a significant role in reducing student transiency. Support for Transitions encompasses • Welcoming & social support programs for newcomers (e.g., welcoming signs, materials, and initial receptions; peer buddy programs for students, families, staff, volunteers) • Daily transition programs for (e.g., before school, breaks, lunch, afterschool) • Articulation programs (e.g., grade to grade – new classrooms, new teachers; elementary to middle school; middle to high school; in and out of special education programs) • Summer or intersession programs (e.g., catch-up, recreation, and enrichment programs) • School-to-career/higher education (e.g., counseling, pathway, and mentor programs; Broad involvement of stakeholders in planning for transitions; students, staff, home, police, faith groups, recreation, business, higher education) • Staff/stakeholder development for planning transition programs/activities Home Involvement in Schooling. This arena expands concern for parent involvement to encompass anyone in the home who is influencing the student’s life. In some cases, grandparents, aunts, or older siblings have assumed the parenting role. Older brothers and sisters often are the most significant influences on a youngster’s life choices. Thus, schools and communities must go beyond focusing on parents in their efforts to enhance home involvement. This arena includes school-wide and classroom-based efforts designed to strengthen the home situation, enhance family problem solving capabilities, and increase support for student well-being. Accomplishing all this requires school- wide and classroom-based systems and programmatic approaches to (a) address the specific learning and support needs of adults in the home, such as offering them ESL, literacy, vocational, and citizenship classes, enrichment and recreational opportunities, and mutual support groups, (b) help those in the home improve how basic student obligations are met, such as providing guidance related to parenting and how to help with schoolwork, (c) improve forms of basic communication that promote the well-being of student, family, and school, (d) enhance the home-school connection and sense of community, (e) foster participation in making decisions essential to a student's well- being, (f) facilitate home support of student learning and development, (g) mobilize those at home to problem solve related to student needs, and (h) elicit help (support, collaborations, and partnerships) from those at home with respect to meeting classroom, school, and community needs. The context for some of this activity may be a parent or family center if one has been established at the site. Outcomes include indices of parent learning, student progress, and community enhancement specifically related to home involvement. B-6 Home Involvement in Schooling encompasses • Addressing specific support and learning needs of family (e.g., support services for those in the home to assist in addressing basic survival needs and obligations to the children; adult education classes to enhance literacy, job skills, English-as-a-second language, citizenship preparation) • Improving mechanisms for communication and connecting school and home (e.g., opportunities at school for family networking and mutual support, learning, recreation, enrichment, and for family members to receive special assistance and to volunteer to help; phone calls from teacher and other staff with good news; frequent and balanced conferences – student-led when feasible; outreach to attract hard-to-reach families – including student dropouts) • Involving homes in student decision making (e.g., families prepared for involvement in program planning and problem-solving) • Enhancing home support for learning and development (e.g., family literacy; family homework projects; family field trips) • Recruiting families to strengthen school and community (e.g., volunteers to welcome and support new families and help in various capacities; families prepared for involvement in school governance) • Staff/stakeholder development to broaden awareness of and plan programs to enhance opportunities for home involvement Community Outreach for Involvement and Support (including volunteers). Most schools do their job better when they are an integral and positive part of the community. Unfortunately, schools and classrooms often are seen as separate from the community in which they reside. This contributes to a lack of connection between school staff, parents, students, and other community residents and resources. And, it undercuts the contributions community resources can make to the school’s mission. For example, it is a truism that learning is neither limited to what is formally taught nor to time spent in classrooms. It occurs whenever and wherever the learner interacts with the surrounding environment. All facets of the community (not just the school) provide learning opportunities. Anyone in the community who wants to facilitate learning might be a contributing teacher. This includes aides, volunteers, parents, siblings, peers, mentors in the community, librarians, recreation staff, college students, etc. They all constitute what can be called the teaching community. When a school successfully joins with its surrounding community, everyone has the opportunity to learn and to teach. For schools to be seen as an integral part of the community, outreach steps must be taken to create and maintain linkages and collaborations. The intent is to maximize mutual benefits, including better student progress, a enhanced sense of community, community development, and more. In the long run, the aims are to strengthen students, schools, families, and neighborhoods. Outreach focuses on public and private agencies, organizations, universities, colleges, and facilities; businesses and professional organizations and groups; and volunteer service programs, B-9 The Overall Framework for a System of Learning Supports In the body of the report, we included a framework for a continuum of interventions. Combining that continuum with the six arenas of the enabling or learning supports component produces a matrix which frames the range of intervention activity encompassed by our discussion (see Exhibit B-2). This is what we mean by the phrase a system of learning supports and a comprehensive, multifaceted, and integrated approach. The matrix can be used to guide mapping and analysis of the scope and content of a component to address barriers to learning, development, and teaching. Exhibit B-3 captures the essence of the matrix but is intended to convey another message. The aim in developing such a comprehensive approach is to prevent the majority of problems, deal with another significant segment as soon after problem onset as is feasible, and end up with relatively few needing specialized assistance and other intensive and costly interventions. Rethinking Infrastructure A well-designed and supported infrastructure is needed to establish, maintain, and evolve the type of a comprehensive approach to addressing barriers to student learning outlined above. Such an infrastructure includes mechanisms for coordinating among enabling activity, for enhancing resources by developing direct linkages between school and community programs, for moving toward increased integration of school and community resources, and for integrating the instructional/developmental, enabling, and management components (Adelman & Taylor, 2006; Center for Mental Health in Schools, 2005d). Key mechanisms. To the above ends, existing infrastructure mechanisms must be modified in ways that guarantee new policy directions are translated into appropriate daily practices (Center for Mental Health in Schools, 2005e). Well-designed infrastructure mechanisms ensure local ownership, a critical mass of committed stakeholders, processes that overcome barriers to stakeholders effectively working together, and strategies that mobilize and maintain proactive effort so that changes are implemented and there is renewal over time. From this perspective, the importance of creating an atmosphere that encourages mutual support, caring, and a sense of community takes on another dimension. Institutionalization of comprehensive, multifaceted approaches necessitates restructuring the mechanisms associated with at least six infrastructure concerns. These encompass processes for daily (1) governance, (2) leadership, (3) planning and implementation of specific organizational and program objectives, (4) coordination and integration for cohesion, (5) management of communication and information, and (6) capacity building. Properly redesigned infrastructure changes, for example, ensure integration, quality improvement, accountability, and self-renewal of an enabling or learning support component. In redesigning mechanisms to address these matters, new collaborative arrangements must be established, and authority (power) redistributed – easy to say, extremely hard to accomplish. Major systemic changes obviously require ensuring that those who operate essential mechanisms have adequate resources and support, initially and over time. Moreover, there must be appropriate incentives and safeguards for individuals as they become enmeshed in the complexities of systemic change. B-10 Exhibit B-2 Matrix outlining a system of learning supports* Scope of Intervention Systems for Promoting Systems for Systems of Care Healthy Development & Early Intervention Preventing Problems (Early after problem onset) Classroom- Focused Enabling Crisis/ Organizing Emergency around the Assistance & Prevention Content/ “curriculum” Support for (for addressing transitions barriers to learning & promoting Home healthy Involvement development) in Schooling Community Outreach/ Volunteers Student and Family Assistance Accommodations for differences & disabilities Specialized assistance & other intensified interventions (e.g., Special Education & School-Based Behavioral Health) *Note that specific school-wide and classroom-based activities related to positive behavior support, “prereferral” interventions, and the eight components of Center for Prevention and Disease Control’s Coordinated School Health Program are embedded into the six content (“curriculum”) areas. B-11 Exhibit B-3 Reducing the Number of Students Needed “Deep-end” Services Intervention Continuum Systems for Promoting Healthy Development & Preventing Problems (a)* Systems for Early Intervention (early-after (b)* problem onset) Declining Enabling Systems Component (c)* Proportion of Care (arenas of activity) of (d)* Students (e)* (f)* Accommodations for Specialized Assistance & other differences & disabilities intensive interventions (a) = Classroom-based approaches to enable and re-engage students in classroom learning (b) = Support for transitions (c) = Home involvement in schooling (d) = Community outreach/volunteers (e) = Crisis/emergency assistance and prevention (f) = Student and family assistance B-14 counselors, health educators, special education staff, after school program staff, bilingual and Title I program coordinators, safe and drug free school staff, and union reps. It also should include representatives of any community agency that is significantly involved with schools. Beyond these "service" providers, such a team is well-advised to add the energies and expertise of administrators, regular classroom teachers, non-certificated staff, parents, and older students. Where creation of "another team" is seen as a burden, existing teams, such as student or teacher assistance teams and school crisis teams, have demonstrated the ability to do resource-oriented functions. In adding the resource-oriented functions to another team’s work, great care must be taken to structure the agenda so sufficient time is devoted to the additional tasks. For small schools, a large team often is not feasible, but a two person team can still do the job. Properly constituted, trained, and supported, a resource-oriented team complements the work of the site's governance body through providing on-site overview, leadership, and advocacy for all activity aimed at addressing barriers to learning and teaching. Having at least one representative from the resource team on the school's governing and planning bodies ensures the type of infrastructure connections that are essential if programs and services are to be maintained, improved, and increasingly integrated with classroom instruction. And, of course, having an administrator on the team provides the necessary link with the school’s administrative decision making about allocation of budget, space, staff development time, and other resources. Not an Isolated Mechanism, Part of an Integrated Infrastructure. Resource-oriented mechanisms at all levels cannot be isolated entities. The intent is for them to connect to each other and be part of an integrated infrastructure. A Learning Supports Resource Team must be a formal unit of a school’s infrastructure. And, it must be fully connected with the other infrastructure mechanisms at the school (e.g., those associated with instruction and management/governance). Figure B-5 illustrates relationships of such a team to other major infrastructure units. Having at least one representative from the resource team on the school's governing and planning bodies ensures the type of infrastructure connections that are essential if student and learning supports are to be maintained, improved, and increasingly integrated with classroom instruction. And, of course, having an administrator on the team provides the necessary link with the school’s administrative decision making related to allocation of budget, space, staff development time, and other resources. A multi-site resource-oriented mechanism. Beyond the school, it is invaluable to link schools together to maximize use of limited resources. Schools in the same geographic or catchment area have a number of shared concerns, and schools in the feeder pattern often interact with the same family because each level has a youngster from that family who is having difficulties. Furthermore, some programs and personnel already are or can be shared by several neighboring schools, thereby minimizing redundancy and reducing costs. A multi-site team can provide a mechanism to help ensure cohesive and equitable deployment of resources and also can enhance the pooling of resources to reduce costs. Such a mechanism can be particularly useful for integrating the efforts of high schools and their feeder middle and elementary schools. This clearly is important in addressing barriers with those families who have youngsters attending more than one level of schooling in the same cluster. It is neither cost-effective nor good intervention for each school to contact a family separately in instances where several children from a family are in need of special attention. With respect to linking with community resources, multi- school teams are especially attractive to community agencies who often don't have the time or personnel to make independent arrangements with every school. B-15 In general, a group of schools can benefit from a multi-site resource mechanism designed to provide leadership, facilitate communication and connection, and ensure quality improvement across sites. For example, a multi-site body, or what we call a Learning Supports Resource Council, might consist of a high school and its feeder middle and elementary schools. It brings together one-two representatives from each school's resource team. The Council meets about once a month to help (a) coordinate and integrate programs serving multiple schools, (b) identify and meet common needs with respect to guidelines and staff development, and (c) create linkages and collaborations among schools and with community agencies. In this last regard, it can play a special role in community outreach both to create formal working relationships and ensure that all participating schools have access to such resources. When a “family of schools” in a geographic area collaborates to address barriers, they can share programs and personnel in many cost-effective ways. This includes streamlined processes to coordinate and integrate assistance to a family that has children at several of the schools. For example, the same family may have youngsters in the elementary and middle schools and both students may need support during a family crisis. This might be accomplished by assigning one counselor and/or case manager to work with the family. Also, in connecting with community resources, a group of schools can maximize distribution of scarce resources in ways that are efficient, effective, and equitable. Creation of resource-oriented mechanisms at schools, for “families” of schools, and at the district level is essential for weaving together existing school and community resources, enabling programs and services to function in an increasingly cohesive and cost-efficient way, and developing a full continuum of interventions over time. Such mechanisms are seen as vital in reducing marginalization and fragmentation of student and learner supports through transforming current approaches for addressing barriers to student learning and promoting healthy development. Establishing and building the capacity of resource-oriented mechanisms, of course, are not simple tasks. As a result, it is essential to think in terms of a phase-in process (Center for Mental Health in Schools, 2005f). And, because establishing such a team involves significant organizational change, staff assigned to accomplish the tasks must have the skills of a systemic change agent. We designate this type of change agent as an organization facilitator (Adelman & Taylor 2006; Lim & Adelman, 1997; Rosenblum, DiCecco, Taylor, & Adelman, 1995). B-16 Exhibit B-5 Learning Supports Resource Team as Part of an Integrated Infrastructure at a School Site Learning Supports or Enabling Component Instructional Component Advisory’Steering Leadership Committee* for instruction for Component Case- Oriented (Various teams focused Teams on improving instruction) Learning moderate Supports roblems Management/ Resource Governance Team** Component severe problems Management/ Governance Ad hoc and standing work groups*** Team *A Learning Supports or Enabling Component Advisory/Steering Committee at a school site consists of a leadership group whose responsibility is to ensure the vision for the component is not lost. It meets as needed to monitor and provide input to the Learning Supports Resource Team. **A Learning Supports Resource Team is the key to ensuring component cohesion, integrated implementation, and ongoing development. It meets weekly to guide and monitor daily implementation and development of all programs, services, initiatives, and systems at a school that are concerned with providing learning supports and specialized assistance. ***Ad hoc and standing work groups are formed as needed by the Learning Supports Resource Team to address specific concerns. These groups are essential for accomplishing the many tasks associated with such a team’s functions. D-1 Appendix D Guidelines for Mental Health in Schools The following set of Guidelines were developed by the Policy Leadership Cadre for Mental Health in Schools as part of the major work presented in the document entitled: Mental Health in Schools: Guidelines, Models, Resources & Policy Considerations. This field-defining resource and reference work is designed to address national policy and practice concerns about what mental health (MH) in schools is, is not, and should be. Major topics covered include: » definitional concerns » the rationale for MH in schools » specific guidelines for a comprehensive, multifaceted approach » ways in which MH and psychosocial concerns currently are addressed in schools » ways to advance the field. To enhance the document’s resource value for policy and capacity building, a variety of supportive documents and sources for materials, technical assistance, and training also are provided. The document (along with an executive summary) can be downloaded from the Cadre webpages which are hosted on the website of the Center for Mental Health in Schools – go to http://smhp.psych.ucla.edu/policy.htm These guidelines have been adapted into Guidelines for a Student Support Component – see http://smhp.psych.ucla.edu/pdfdocs/studentsupportguidelines.pdf D-2 Guidelines for Mental Health in Schools 1. General Domains for Intervention in Addressing Students’ Mental Health 1.1 Ensuring academic success and also promoting healthy cognitive, social, and emotional development and resilience (including promoting opportunities to enhance school performance and protective factors; fostering development of assets and general wellness; enhancing responsibility and integrity, self-efficacy, social and working relationships, self-evaluation and self-direction, personal safety and safe behavior, health maintenance, effective physical functioning, careers and life roles, creativity) 1.2 Addressing barriers to student learning and performance (including educational and psychosocial problems, external stressors, psychological disorders) 1.3 Providing social/emotional support for students, families, and staff 2. Major Areas of Concern Related to Barriers to Student Learning 2.1 Addressing common educational and psychosocial problems (e.g., learning problems; language difficulties; attention problems; school adjustment and other life transition problems; attendance problems and dropouts; social, interpersonal, and familial problems; conduct and behavior problems; delinquency and gang-related problems; anxiety problems; affect and mood problems; sexual and/or physical abuse; neglect; substance abuse; psychological reactions to physical status and sexual activity) 2.2 Countering external stressors (e.g., reactions to objective or perceived stress/demands/ crises/deficits at home, school, and in the neighborhood; inadequate basic resources such as food, clothing, and a sense of security; inadequate support systems; hostile and violent conditions) 2.3 Teaching, serving, and accommodating disorders/disabilities (e.g., Learning Disabilities; Attention Deficit Hyperactivity Disorder; School Phobia; Conduct Disorder; Depression; Suicidal or Homicidal Ideation and Behavior; Post Traumatic Stress Disorder; Anorexia and Bulimia; special education designated disorders such as Emotional Disturbance and Developmental Disabilities) 3. Type of Functions Provided related to Individuals, Groups, and Families 3.1 Assessment for initial (first level) screening of problems, as well as for diagnosis and intervention planning (including a focus on needs and assets) 3.2 Referral, triage, and monitoring/management of care 3.3 Direct services and instruction (e.g., primary prevention programs, including enhancement of wellness through instruction, skills development, guidance counseling, advocacy, school-wide programs to foster safe and caring climates, and liaison connections between school and home; crisis intervention and assistance, including psychological first-aid; prereferral interventions; accommodations to allow for differences and disabilities; transition and follow-up programs; short- and longer- term treatment, remediation, and rehabilitation) 3.4 Coordination, development, and leadership related to school-owned programs, services, resources, and systems – toward evolving a comprehensive, multifaceted, and integrated continuum of programs and services 3.5 Consultation, supervision, and inservice instruction with a transdisciplinary focus 3.6 Enhancing connections with and involvement of home and community resources (including but not limited to community agencies) (cont.) D-3 Guidelines for Mental Health in Schools (cont.) 4. Timing and Nature of Problem-Oriented Interventions 4.1 Primary prevention 4.2 Intervening early after the onset of problems 4.3 Interventions for severe, pervasive, and/or chronic problems 5. Assuring Quality of Intervention 5.1 Systems and interventions are monitored and improved as necessary 5.2 Programs and services constitute a comprehensive, multifaceted continuum 5.3 Interveners have appropriate knowledge and skills for their roles and functions and provide guidance for continuing professional development 5.4 School-owned programs and services are coordinated and integrated 5.5 School-owned programs and services are connected to home & community resources 5.6 Programs and services are integrated with instructional and governance/management components at schools 5.7 Program/services are available, accessible, and attractive 5.8 Empirically-supported interventions are used when applicable 5.9 Differences among students/families are appropriately accounted for (e.g., diversity, disability, developmental levels, motivational levels, strengths, weaknesses) 5.10 Legal considerations are appropriately accounted for (e.g., mandated services; mandated reporting and its consequences) 5.11 Ethical issues are appropriately accounted for (e.g., privacy & confidentiality; coercion) 5.12 Contexts for intervention are appropriate (e.g., office; clinic; classroom; home) 6. Outcome Evaluation and Accountability 6.1 Short-term outcome data 6.2 Long-term outcome data 6.3 Reporting to key stakeholders and using outcome data to enhance intervention quality E-3 Policy Resolution Proposed to and Passed by the Los Angeles Unified School District's Board of Education in 1998 In the mid 1990s, the Los Angeles Unified School District began the task of restructuring its student support services. In 1998, the district's Board of Education resolved that a component to address barriers to student learning and enhance healthy development is one of the primary and essential components of the District's educational reform. In keeping with the California Department of Education's adoption of the unifying concept of Learning Support, the Board adopted this term to encompass efforts related to its component of addressing barriers to student learning and enhancing healthy development. Whereas, in its "Call to Action", the Los Angeles Unified School District has made clear its intent to create a learning environment in which all students succeed; Whereas, new governance structures, higher standards for student performance, new instructional strategies, and a focus on results are specified as essential elements in attaining student achievement; Whereas, a high proportion of students are unable to fully benefit from such reforms because of learning barriers related to community violence, domestic problems, racial tension, poor health, substance abuse, and urban poverty; Whereas, teachers find it especially difficult to make progress with the high proportion of youngsters for whom barriers to learning have resulted in mild-to- moderate learning and behavior problems; Whereas, many of these youngsters end up referred for special services and often are placed in special education; Whereas, both the Los Angeles Unified School District and various community agencies devote resources to addressing learning barriers and initial processes have been implemented to reform and restructure use of their respective resources - including exploring strategies to weave District and community efforts together -- in ways that can overcome key barriers to student achievement; Whereas, a comprehensive, integrated partnership between all District support resources and community resources will provide the LEARNING SUPPORT necessary to effectively break down the barriers to student achievement; now, therefore, be it Resolved, that the Board of Education should adopt the following recommendations made by the Standing Committee on Student Health and Human Services: 1. The Board should resolve that a component to address barriers to student learning and enhance healthy development be fully integrated with efforts to improve the instructional and management/governance components and be pursued as a primary and essential component of the District's education reforms in classrooms, schools, complexes/clusters, and at the central office level. (cont.) . E-4 2. In keeping with the California Department of Education's adoption of the unifying concept of Learning Support, the Board should adopt this term to encompasses efforts related to its component for addressing barriers to student learning and enhancing healthy development. 3. In adopting the concept of Learning Support, the Board should adopt the seven area framework currently used by the Division of Student Health and Human Services to guide coordination and integration of existing programs and activities related to school, home, and community. 4. The Board should direct the Superintendent to convene a working group to develop a plan that promotes coordination and integration of the Learning Support component with instruction and management reform efforts at every school site. This plan would also clarify ways for complex/cluster and central office operations to support school site efforts (e.g. helping schools achieve economics of scale and implement practices that effectively improve classroom operations and student learning). The plan would also focus on ways to further promote collaboration with communities at the classroom, school, complex/cluster, and central office levels. Such a plan should be ready for implementation by Spring 1998. 5. To counter fragmentation stemming from the way programs are organized and administered at the central office, the Board should restructure the administrative organization so that all programs and activity related to the Learning Support including Special Education are under the leadership of one administrator. Such an administrator would be charged with implementing the strategic plan developed in response to recommendation #4. 6. The Board should direct those responsible for professional and other stakeholder development activity throughout the District to incorporate a substantial focus on the Learning Support component into all such activity (e.g. all teacher professional education, training activity related to LEARN, the Chanda Smith Special Education Consent Decree, early literacy programs). 7. To facilitate continued progress' related to the restructuring of student health and human services, the Board should encourage all clusters and schools to support the development of Cluster/Complex Resource Coordinating Councils and School-Site Resource Coordinating Teams, Such Councils and Teams provide a key mechanism for enhancing the Learning Support component by ensuring that resources are mapped and analyzed and strategies are developed for the most effective use of school, complex, and District-wide resources and for appropriate school-community collaborations. E-5 Hawaii’s Legislation for its Comprehensive Student Support System S.B. NO. 519 – TWENTIETH LEGISLATURE, 1999 STATE OF Hawaii A Bill for an Act Relating to a Comprehensive Student Support System DESCRIPTION: Requires the department of education to establish a comprehensive student support system (CSSS) in all schools to create a school environment in which every student is cared for and respected. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: SECTION 1. The legislature finds that the goal of the superintendent of education's success compact program is total support for every student, every time; every school, every time; and every community, every time. This integrated model focuses on the student and identifies the importance of literacy for every student, every time. To fulfill government's obligation to the children of this State, the superintendent, the board of education, the governor, and the legislature must reach every student, school, and community by realigning and redefining existing services and programs into a comprehensive student support system that systematically strengthens students, schools, and communities rather than by impulsively responding to crisis after crisis. It is the legislature's intention to create the comprehensive student support system from existing personnel and programmatic resources, i.e., without the need for additional or new appropriations. The comprehensive student support system is a coordinated array of instructional programs and services that, as a total package, will meet the needs of traditional and nontraditional learners in school and community settings. This package takes what works, improves on others, and creates new avenues to services. The result will be customized support throughout a student's K-12 educational career. These services will include developmental, academic core, preventive, accelerated, correctional, and remedial programs and services. Linkages with other organizations and agencies will be made when services needed are beyond the purview of the department of education. To achieve in school, students need to be wanted and valued. They need a positive vision of the future. They need safe, orderly schools, strong community support, high-quality care, and adults they can trust. Students often become alienated because they may not feel worthy, they may not have a supportive home or opportunities to learn to care, or they may not be successful in handling frustrations, or have good experiences in school. They may not see relevance to their education or have positive role models or may not have access to support services. Consequently, the superintendent, the board of education, the governor, and the legislature need to ensure that each student can read, write, and relate effectively, has self-worth, has meaning-based learning opportunities, and has positive support networks from other students, teachers, and members of the school community. The legislature finds that the generalized school support groups and individualized student support teams created by the comprehensive student support system can give parents what they and their children want most from government -- schools that are safe, and where the environment is focused on teaching and learning. The educational climate in Hawaii's public schools, as measured by average class and school size, absenteeism, tardiness, classroom misbehavior, lack of parental involvement, and other indicators, suggests that the time to implement the success compact program and the comprehensive student support system is today--not tomorrow when the State's economy might improve. According to the 1999 "Education Week, Quality Counts" survey, the educational climate in the State's public schools, given the grade of "F" (as in failed), would be hard pressed to get any worse than it already is. The legislature's objective is to ensure that every student will become literate, confident, and caring, and be able to think critically, solve problems, communicate effectively, and function as a contributing member of society. The purpose of this Act is to authorize the department of education to establish a comprehensive student support system to meet this objective. E-8 §§302A-H Student support team. (a) "Student support team" includes the student, family, extended family, close family friends, school, and other related professionals and agency personnel who are knowledgeable about the student or appropriate teaching methods, and programs and services and their referral processes. "Student support team" includes the parent and family at the outset of the planning stage and throughout the delivery of support. (b) If community programs and services become necessary to address needs that are not being met by existing supports within the school, then professionals with specific expertise who are not located at the school shall be contacted by a designated student support team member, and may become additional members of the student support team. (c) A student support team's general responsibilities shall include functions such as assessing student and family strengths and needs, identifying appropriate services, determining service and program eligibility, and referring to or providing services, or both. A student support team shall have the authority and resources to carry out decisions and follow-up with actions. The responsibilities of the student support team shall be determined by the issues involved and the supports and services needed. (d) Each profession or agency involved shall adhere to its particular ethical responsibilities. These responsibilities shall include: (1) The ability to work as members of a team; (2) Actively listen; (3) Develop creative solutions; enhance informal supports; (4) Arrive at a mutually acceptable plan; and (5) Integrate and include the family's views, input, and cultural beliefs into the decision- making process and plan itself. (e) Student support teams may focus on the following activities: (1) Working with the classroom teacher to plan specific school-based interventions related to specific behavior or learning needs, or both; (2) Participating in strength-based assessment activities to determine appropriate referrals and eligibility for programs and services; (3) Ensuring that preventive and developmental, as well as intervention and corrective, services are tailored to the needs of the student and family, and provided in a timely manner; (4) Facilitating the development of a coordinated service plan for students who require support from two or more agencies. The service plan shall incorporate other plans such as the individualized education plan, modification plan, individual family service plan, and treatment plan. A designated care coordinator shall monitor the coordination and integration of multi-agency services and programs, delivery of services, and evaluation of supports; and (5) Including parents and families in building a community support network with appropriate agencies, organizations, and service providers. B. Implementation §§302A-I School level implementation of the comprehensive student support system. (a) School-communities may implement the comprehensive student support system differently in their communities; provided that, at a minimum, the school-communities shall establish both school support groups and student support teams in which all students are cared for. (b) All school-communities shall design and carry out their own unique action plans that identify items critical to the implementation of the comprehensive student support system at the school level using the state comprehensive student support system model to guide them. The local action plan may include: (1) Information about school level policies, guidelines, activities, procedures, tools, and outcomes related to having the comprehensive student support system in place; (2) Roles of the school support group and student support team; (3) Roles of the school level cadre of planners; (4) Partnerships and collaboration; (5) Training; (6) Identification, assessment, referral, screening, and monitoring of students; (7) Data collection; and (8) Evaluation. E-9 (c) If there are existing action plans, projects, or initiatives that similarly address the comprehensive student support system goals, then the cadre of planners shall coordinate and integrate efforts to fill in the gaps and prevent duplication. (d) The action plan shall be an integral part of the school's school improvement plan, not separated but integrated. §§302A-J Complex level implementation of the comprehensive student support system. The comprehensive student support system shall be supported at the school complex level. A school- complex resource teacher shall provide staff support, technical assistance, and training to school- communities in each school complex in the planning and implementation of comprehensive student support system priorities and activities. §§302A-K State level implementation of the comprehensive student support system. (a) The department shall facilitate the process of bringing other state departments, community organizations, and parent groups on board with the department and allow line staff to work collaboratively in partnerships at the school level. (b) The department, at the state level in partnership with other agencies, shall provide on- going professional development and training that are especially crucial in this collaborative effort. (c) The department shall facilitate the procurement of needed programs and services currently unavailable or inaccessible at school sites. (d) The department shall be responsive to complex and individual school needs. C. Evaluation §§302A-L Purpose of evaluating the comprehensive student support system. (a) The department shall evaluate the comprehensive student support system to: (1) Improve the further development and implementation of the comprehensive student support system; (2) Satisfy routine accountability needs; and (3) Guide future replication and expansion of the comprehensive student support system. (b) Successful program development and implementation shall result in: (1) Improved prevention and early intervention support; (2) Coordinated services made possible through cross- discipline, cross-agency teams with a problem-solving, collaborating orientation; (3) Promotion of pro-social skills; (4) Increased family involvement in collaborative planning to meet the needs of students; (5) Development of schools' capacity to assess and monitor progress on the program's objectives through the use of specially developed educational indicators; and (6) Successful long and short-term planning integrated with school improvement plans. §§302A-M Outcomes expected of the comprehensive student support system. The outcomes expected of the comprehensive student support system are: (1) Increased attendance; (2) Improved grades; (3) Improved student performance, as measured by established content and performance standards; (4) A substantial increase in parental participation; and (5) At the secondary level, increased participation in extracurricular activities." SECTION 3. If any provision of this Act, or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the Act which can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable. SECTION 4. In codifying the new sections added to chapter 302A, Hawaii Revised Statutes, by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in the new sections' designations in this Act. SECTION 5. This Act shall take effect on January 1, 2000. Online at: http://www.capitol.hawaii.gov/session1999/bills/sb519_.htm E-10 MULTNOMAH EDUCATION SERVICE DISTRICT MEMORANDUM Date: July 20, 2004 To: MESD Board of Directors From: Board Program Review Committee Re: Policy for Learning Supports The Program Review Committee has spent the year conducting specific reviews of elements of the MESD programs. Additionally the Committee has considered the larger question of the nature of today’s learners and the role MESD plays in their education. We would like to share with members of the Board observations and findings we have made throughout the year. 1. We wish to affirm our intent to create a learning environment in which all students succeed. 2. We endorse State Superintendent Castillo’s 2003-04 initiative to close the achievement gap on behalf of all students. . We are clear that the recently revised mission statement should be followed by all employees of the ESD To support our local school districts and share in providing a quality education for the children and families of our communities. 4. Further, we are committed to our vision statement that we hold for the district: We work as a team dedicated to enhancing the learning of the communities’ children by designing and delivering services responsive to family and school district needs. We strive to demonstrate leadership, wise utilization of resources, cooperative relationships with school districts and other agencies and a commitment to being a learning organization. 5. We support the following value statements upon which the mission and vision are based: 4. Children are our most important natural resource; 5. Families should be supported in education of their children; 6. Each student should reach proficiency on challenging academic standards and assessments; 7. A quality staff is essential in carrying out the mission of the agency; 8. Supportive working relationships that value diversity within the ESD are vital to achieving our mission; 9. Community partnerships maximize resources; 10. Adequate and stable financial resources are required for a quality education; 11. Interagency relationships strengthen services to children; 12. Delivering effective services to schools is a process of continuous improvement; 13. A strong system of public education is essential to the future of our society. 6. Higher standards for student performance, new instructional strategies, and a focus on results are specified as essential elements in attaining student achievement. 7. As an agency, we strive to utilize the developmental assets and strength-based approach to students and families. 8. A high proportion of students are unable to benefit fully from educational reforms because of learning barriers related to lack of engagement in the learning process for many reasons E-13 An Example of an Early Legislative Proposal California took an early lead in focusing attention on the need to develop policy for a component to address barriers to student learning. In 1995, California Assembly Member Juanita McDonald brought together a set of task forces to develop an Urban Education Initiative package of legislation. One major facet focused on Overcoming Barriers to Pupil Learning. This facet of the legislation called on school districts to ensure that schools within their jurisdiction had an enabling component in place. On the following pages is the draft of that part of the bill. Just before the legislation was to go to the Education Committee for review, McDonald was elected to Congress. CALIFORNIA LEGISLATURE—1995–96 REGULAR SESSION ASSEMBLY BILL No. 784 AMENDED IN ASSEMBLY APRIL 25, 1995 Introduced by Assembly Member McDonald (Principal coauthor: Assembly Member Alpert) (Coauthors: Assembly Members Archie-Hudson, Baca, Ducheny, Kuehl, and Napolitano) (Coauthor: Senator Watson) February 22, 1995 An act to add Part 29.5 (commencing with Section 55000) to the Education Code, relating to urban school districts. LEGISLATIVE COUNSEL’S DIGEST AB 784, as amended, McDonald. Education: urban school districts: equal opportunity to learn: teacher credentialing reform. CHAPTER 5. OVERCOMING BARRIERS TO PUPIL LEARNING Article 1. Enabling Pupils to Overcome Learning Barriers 55040. (a) It is the intent of the Legislature that on or before the commencement of the 1996–97 school year, each school district ensure that the schools within their jurisdiction have an enabling component in place. The enabling component shall enable pupils to overcome barriers that interfere with their ability to learn and to benefit from instructional and management reforms made at schools. For the purposes of this chapter, an “enabling component” means a comprehensive, integrated continuum of school-based and school-linked activity designed to enable schools to teach and pupils to learn. That continuum shall include prevention, including promotion of wellness, early-age and early-after-onset intervention, and treatments for severe, pervasive, and chronic conditions. (b) Each enabling component developed by each school shall include, but not necessarily be limited to, the following: (1) A plan for restructuring school education support programs and services. (2) A plan for coordinating school district and community resources. (3) A plan for coordinating school district enabling activities with health and human services provided by the state and by local government. (4) A plan for enhancing the performance of persons involved in the delivery of education services to pupils. (5) Strategies for replicating promising innovations. (6) Strategies for the improvement of the quality of education and accountability of the school. 55041. The department shall develop and report to the Legislature on a plan for the implementation of the enabling components consistent with requirements set forth in subdivision (b) of Section 55040 and with any other requirements determined to be necessary by the department to enable E-14 pupils to overcome barriers to learning. The report shall include specific recommendations on coordinating school-based enabling activities with community resources and the ways in which the parents and guardians of pupils may be included in enabling activities. The report shall include specific recommendations on changes necessary to existing laws and on any new legislation that is necessary to implement the plan. The department shall report the plan to the Legislature not later than December 31, 1996. It is the intent of the Legislature that any necessary implementing legislation be enacted for the 1997–98 school year. 55042. School districts may request assistance from the department in the development of the enabling component described in Section 55040. The department shall assist school districts that have demonstrated readiness to develop enabling components to coordinate school-based enabling activities with community resources and to involve the parents and guardians of pupils in those activities. Article 2. Restructuring Education Programs and Coordinating With Other Support Programs 55045. (a) For the purpose of enabling pupils to overcome barriers to learning, the department shall develop a strategic plan to guide and stimulate restructuring of education support programs and services operated by schools for pupils and their parents and guardians. The department shall include within that plan methods of coordinating school services with community services that are made available to pupils and their families by local government agencies or private nonprofit groups. The department shall also develop a plan for those programs and services that are operated by school districts and by the department. The plan shall include, but not be limited to, the following: (1) Moving from fragmented, categorical and single discipline-oriented services toward a comprehensive, integrated, cross-disciplinary approach. (2) Moving from activity that is viewed as supplementary toward a full-fledged integrated component that is understood to be primary and essential to enabling learning. (3) Involving pupils and their parents and guardians, and communities in the education process in a manner that capitalizes on their strengths and the many ways in which they can contribute to the education process. (4) Restructuring education support programs and services offered at schoolsites. (5) Coordinating services offered by school districts with other services available in the community. (6) Coordinating enabling components with health and human services offered by the state and by local government. (7) Involving all persons having an interest in the education process in developing the enabling component. (8) Strategies for replicating at school sites innovations to improve pupil learning that are successful at other school sites. (9) Strategies for improving the quality of education and for improving school accountability. (10) Establishing a comprehensive, integrated, cross-disciplinary approach to teaching. (11) Establishing an integrated component that is understood to be essential to learning. (12) Involving all persons having an interest in the education process in a manner that best utilizes their various strengths. (13) Integrating the enabling component with the instructional and management components of the education process. (14) Developing leadership to effectively operate and implement the enabling component. (15) Developing and incorporating integrated planning for the use of advanced multifaceted technology, to assist pupils and their parents or guardians in the learning process, to provide responses to and prevention of emergencies and other crises, to support transitions, and to provide for community and volunteer outreach. (16) Facilitating teacher recruitment, continuing education for teachers, and retention of teachers. E-15 (17) Infrastructure changes, particularly those related to operation space at schoolsites, allocation and maximization of fiscal resources, administrative and staff leadership, and mechanisms for effective coordination of essential system elements and resources. (18) Strategies for phasing in the restructuring of education programs. (19) Strategies to ensure the long-term success of planned changes. (20) The types of leadership, infrastructure, and specific mechanisms that can be established at a schoolsite for high schools and their feeder schools, and in communities to facilitate coordinated and integrated governing, planning, and implementation of enabling components. (21) Methods for schoolsites to ensure significant roles and leadership training for parents and guardians of pupils and for other community residents, representatives of community- based organizations, and, when appropriate, pupils. (22) Methods to seek waivers of state and federal laws and regulations thereto when necessary to facilitate efforts to evolve a comprehensive, integrated approach to learning. (23) Evaluating the progress of schools in implementing reforms and enhancing outcomes. (24) Methods to provide professional preparation and continuing education programs that focus on the type of interprofessional collaborations necessary for the development of a comprehensive, integrated approach to enabling pupil learning. (b) The department shall disseminate the strategic plan adopted pursuant to this section to school districts on or before December 31, 1996. The department shall also report the strategic plan to the Legislature not later than December 31, 1996 , along with specific recommendations on any changes to existing law that are necessary to implement the plan and on any new legislation required to implement the plan. It is the intent of the Legislature that any necessary implementing legislation be enacted for the 1997–98 school year. 55046. (a) The department shall assist urban school districts or schools that demonstrate readiness to restructure their education support programs and services in a manner consistent with the strategic plan developed pursuant to Section 55045. (b) The department may provide assistance to schools by any of the following methods: (1) Informational guidelines and guidebooks. (2) Leadership training. (3) Regional workshops. (4) Demonstrations of effective methods of restructuring education. (5) Opportunities for interchanges. (6) Technical assistance in developing plans. Article 3. Models of Strategies to Enable Pupil Learning 55050. On or before December 31, 1996, the department shall develop a plan to enable schools to replicate methods of overcoming barriers to pupil learning that have been successfully implemented at the school site level. The plan shall include recommendations on the following: (a) Guidelines and procedures for identifying successful innovations that are designed to address barriers to pupil learning and implemented at the school site or school district level. (b) Procedures for analyzing new initiatives and promising innovations to identify possible redundancy and fragmentation of methods. (c) Disseminating successful innovations that are designed to overcome barriers to learning and, in doing so, reduce redundancy and fragmentation of methods. (d) Using demonstrations of innovative methods of overcoming pupil learning barriers as catalysts to stimulate interest in reform. (e) Developing replication models that can be adopted for use at the school site level. (f) Providing technical assistance for implementing replication strategies for school districts implementing innovations designed to address barriers to pupil learning. 55051. The department shall make the plan developed pursuant to Section 55050 available to school districts on or before December 31, 1996 . E-18 (c) It is the intent of the Legislature that these goals be accomplished by involving pupils, teachers, pupil support professionals, family members, and other school and community stakeholders in the development, daily implementation, monitoring, and maintenance of a learning support system at every school and by braiding together the human and financial resources of relevant public and private agencies. 52059.2. The department shall facilitate the establishment of the CPLSS by doing all of the following: (a) Developing standards and strategic procedures to guide the establishment of the CPLSS component at each school. (b) Providing ongoing technical assistance, leadership training, and other capacity building supports. (c) Rethinking the roles of pupil services personnel and other support staff for pupils and integrating their responsibilities into the educational program in a manner that meets the needs of pupils, teachers, and other educators. (d) Detailing procedures for establishing infrastructure echanisms between schools and school districts. (e) Coordinating with other state agencies that can play a role in strengthening the CPLSS. (f) Ensuring that the CPLSS is integrated within the organization of the department in a manner that reflects the school action plans developed by schools pursuant to subdivision (a) of Section 52059.3. (g) Enhancing collaboration with state agencies and other relevant resources to facilitate local collaboration and braiding of resources. (h) Including an assessment of the CPLSS in all future school reviews and accountability reports. 52059.3. (a) Each elementary, middle, and high school may develop a CPLSS component by developing a school action plan based on the guidelines developed by the department pursuant to Section 52059.2. (a) Each elementary, middle, and high school may develop a CPLSS component by developing a school action plan based on the guidelines developed by the department pursuant to Section 52059.2. (b) Each school action plan shall be developed with the purpose of doing all of the following: (1) Enhance the capacity of teachers to address problems, engage and re-engage pupils in classroom learning, and foster social, emotional, intellectual, and behavioral development. The component of the school action plan required by this paragraph shall emphasize ensuring that teacher training and assistance includes strategies for better addressing learning, behavior, and emotional problems within the context of the classroom. Interventions may include, but not be limited to, all of the following: (A) Addressing a greater range of pupil problems within the classroom through an increased emphasis on strategies for positive social and emotional development, problem prevention, and accommodation of differences in the motivation and capabilities of pupils. (B) Classroom management that emphasizes re-engagement of pupils in classroom learning and minimizes over-reliance on social control strategies. (C) Collaboration with pupil support staff and the home in providing additional assistance to foster enhanced responsibility, problem solving, resilience, and effective engagement in classroom learning. (2) Enhance the capacity of schools to handle transition concerns confronting pupils and their families. The component of the school action plan required by this paragraph shall emphasize ensuring that systems and programs are established to provide supports for the many transitions pupils, their families, and school staff encounter. Interventions may include, but are not limited to, all of the following: (A) Welcoming and social support programs for newcomers. (B) Before, during, and afterschool programs to enrich learning and provide safe recreation. E-19 (C) Articulation programs to support grade transitions. (D) Addressing transition concerns related to vulnerable populations, including, but not limited to, those in homeless education, migrant education, and special education programs. (E) Vocational and college counseling and school-to-career programs. (F) Support in moving to postschool living and work. (G) Outreach programs to re-engage truants and dropouts in learning. (3) Respond to, minimize the impact of, and prevent crisis. The component of the school action plan required by this paragraph shall emphasize ensuring that systems and programs are established for emergency, crisis, and followup responses and for preventing crises at a school and throughout a complex of schools. Interventions may include, but are not limited to, all of the following: (A) Establishment of a crisis team to ensure immediate response when emergencies arise, and to provide aftermath assistance as necessary and appropriate so that pupils are not unduly delayed in re-engaging in learning. (B) Schoolwide and school-linked prevention programs to enhance safety at school and to reduce violence, bullying, harassment, abuse, and other threats to safety in order to ensure a supportive and productive learning environment. (C) Classroom curriculum approaches focused on preventing crisis events, including, but not limited to, violence, suicide, and physical or sexual abuse. (4) Enhance home involvement. The component of the school action plan required by this paragraph shall emphasize ensuring there are systems, programs, and contexts established that lead to greater involvement to support the progress of pupils with learning, behavior, and emotional problems. Interventions may include, but are not limited to, all of the following: (A) Interventions that address specific needs of the caretakers of a pupil, including, but not limited to, providing ways for them to enhance literacy and job skills and meet their basic obligations to the children in their care. (B) Interventions for outreaching and re-engaging homes that have disengaged from school involvement. (C) Improved systems for communication and connection between home and school. (D) Improved systems for home involvement in decisions and problem solving affecting the pupil. (E) Enhanced strategies for engaging the home in supporting the basic learning and development of their children to prevent or at least minimize learning, behavior, and emotional problems. (5) Outreach to the community in order to build linkages. The component of the school action plan required by this paragraph shall emphasize ensuring that there are systems and programs established to provide outreach to and engage strategically with public and private community resources to support learning at school of pupils with learning, behavior, and emotional problems. Interventions may include, but are not limited to, all of the following: (A) Training, screening, and maintaining volunteers and mentors to assist school staff in enhancing pupil motivation and capability for school learning. (B) Job shadowing and service learning programs to enhance the expectations of pupils for postgraduation opportunities. (C) Enhancing limited school resources through linkages with community resources, including, but not limited to, libraries, recreational facilities, and postsecondary education institutions. (D) Enhancing community and school connections to heighten a sense of community. (6) Provide special assistance for pupils and families as necessary. The component of the school action plan required by this paragraph shall ensure that there are systems and programs established to provide or connect with direct services when necessary to address barriers to the learning of pupils at school. Interventions may include, but are not limited to, all of the following: E-20 (A) Special assistance for teachers in addressing the problems of specific individuals. (B) Processing requests and referrals for special assistance, including, but not limited to, counseling or special education. (C) Ensuring effective case and resource management when pupils are receiving direct services. (D) Connecting with community service providers to fill gaps in school services and enhance access for referrals. (c) The development, implementation, monitoring, and maintenance of the school action plan shall include, but not be limited to, all of the following components: (1) Ensuring effective school mechanisms for assisting individuals and families with family decision making and timely, coordinated, and monitored referrals to school and community services when indicated. (2) A mechanism for an administrative leader, support staff for pupils, and other stakeholders to work collaboratively at each school with a focus on strengthening the school action plan. (3) A plan for capacity building and regular support for all stakeholders involved in addressing barriers to learning and promoting healthy development. (4) Compliance with the guidelines developed by the department pursuant to Section 52059.2. (5) Accountability reviews. (6) Minimizing duplication and fragmentation between school programs. (7) Preventing problems and providing a safety net of early intervention. (8) Responding to pupil and staff problems in a timely manner. (9) Connecting with a wide range of school and community stakeholder resources. (10) Recognizing and responding to the changing needs of all pupils while promoting the success and well-being of each pupil and staff member. (11) Creating a supportive, caring, respectful, and safe learning environment. 52059.4. Each school with a CPLSS school action plan shall integrate the CPLSS school action plan with other school safety plans, school improvement plans, or other programs to improve instruction, and focus on maximizing its use of available resources at the individual school level and the school district level in order to implement this program. The school action plan shall reflect all of the following: (a) School policies, goals, guidelines, priorities, activities, procedures, and outcomes relating to implementing the CPLSS. (b) Effective leadership and staff roles and functions for the CPLSS. (c) A thorough infrastructure for the CPLSS. (d) Appropriate resource allocation. (e) Integrated school/community collaboration. (f) Regular capacity building activity. (g) Delineated standards, quality and accountability indicators, and data collection procedures. 52059.5. (a) For the purposes of this section, “complex of schools” means a group of elementary, middle, or high schools associated with each other due to the natural progression of attendance linking the schools. (b) To ensure that the CPLSS is developed cohesively, efficiently uses community resources, and capitalizes on economies of scale, CPLSS infrastructure mechanisms shall be established at the school and district level. (c) Complexes of schools are encouraged to designate a pupil support staff member to facilitate a family complex CPLSS team consisting of representatives from each participating school. (d) Each school district implementing a CPLSS shall establish mechanisms designed to build the capacity of CPLSS components at each participating school, including, but not limited to, providing technical assistance and training for the establishment of effective CPLSS components.