Addressing Behavior Disorders in Schools:Addressing Behavior Disorders in Schools: The Integration of Education and Mental HealthThe Integration of Education and Mental Health

The Institute of Education Sciences (IES) 5th Annual Research ConferenceJune 2010 - National Harbor, MD

Albert J. Duchnowski, Ph.D.Krista Kutash, Ph.D.

Department of Child & Family StudiesUniversity of South Florida

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Integrating Education Integrating Education and Mental Health Into and Mental Health Into

School-Based Mental HealthSchool-Based Mental Health

Historically, difficult to establish effective partnerships

For many reasons….

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Contrasting Perspectives

Overarching Influence

Education System

Individuals with Disabilities Education Act (IDEA)

Mental Health System

Diagnostic & Statistical Manual (DSM)

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Contrasting Perspectives

Conceptual Framework Language

Education System

Behavior Disorders,

Challenging Behavior,

Academic Deficits

Mental Health System

Psychopathology,

Abnormal Behavior,

Impaired functioning

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Contrasting Perspectives

Important Theoretical Influences

Education System

Behaviorism,

Social Learning Theory

Mental Health System

Behavior Theory,

Cognitive Theory,

Developmental Psychology,

Biological/Genetic Perspective,

Psychopharmacology

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Contrasting Perspectives

Focus of Intervention

Education System

Behavior Management,

Skill Development,

Academic Improvement

Mental Health System

Insight,

Awareness,

Improved Emotional Functioning

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Education / Mental Health System

Improving Social and Adaptive Functioning.

Importance of and Need to Increase Availability, Access, and Range of Services

Contrasting Perspectives

Common Focus

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Refocusing School-Based Mental Health Services On the Core

Foundation of SchoolsTo Promote Learning

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Schools have the inherent capacity to bridge home and

neighborhood ecologies

Schools are the ‘de facto’ children’s mental health system

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The Refocused Role of Mental Health Services

• Support Teachers: the Primary Change Agents

• Mental Health Providers Become: “Educational Enhancers”

• Serve the Core Function of Schools• Promoting Social/Emotional

Development, no Longer Tangential

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Relations with Peers

Relations with

Teachers

Relations with

Parents

Academic Success

Technology to promote learning

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Does Does Anything Anything

Work?Work?

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Some Program Models with Organizational

Potential for Success

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“The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better.”

– Weiss, 2002

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18 Positive Behavior Supports

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EvaluateResponse to

Intervention (RtI)

Problem Analysis

Problem Identification

Implement PlanImplement Plan

Classroom-Focused Enabling

Student/Family Assistance

Crisis AssistanceTransitions

Community Outreach/Volunteer

Home Involvement

Continuous Improvement Model

RtIResponse to Intervention

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The Public Health The Public Health ModelModel

1. Surveillance at the population / community level

What is the problem?

Use systematic data collection strategies to determine the

mental health service needs in your community.

1. Surveillance at the population / community level

What is the problem?

Use systematic data collection strategies to determine the

mental health service needs in your community.

2. Identify risk and protective factors

What are the causes?

Use the information collected in and on your community on a

regular basis and integrate with the research literature.

2. Identify risk and protective factors

What are the causes?

Use the information collected in and on your community on a

regular basis and integrate with the research literature.

3. Develop and Evaluate Interventions

What works and for whom?

Review literature on empirical based interventions and

apply/adapt to local community needs.

3. Develop and Evaluate Interventions

What works and for whom?

Review literature on empirical based interventions and

apply/adapt to local community needs.

4. Implementation monitoring and scaling-up

Is it meeting the intended needs?

Monitor interventions for proper implementation, scale-up

interventions and measure impact.

4. Implementation monitoring and scaling-up

Is it meeting the intended needs?

Monitor interventions for proper implementation, scale-up

interventions and measure impact.

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Common Vision

Families (FAM)Mental Health (MH)Education (ED)

IntensiveStudents in

Special Ed due to Emotional Disturbances

ED – FBA / PBS

MH – Assessment

FAMEDMH

EDFAMMH

Cognitive Behavior Therapy and other EBPs

Team Monitors Progress

UniversalAll Students

ED – PBS

MH - Screening

FAMED MH

EBP’s (PATHS)

SelectiveAt-Risk Students

ED – FBA / PBS

MH – Assessment

FAMED MH

MHED

EDMHFAM

Group Interventions

Team Monitors Progress

RtI

Implementedin organizations

that support and facilitatecollaborative, integrated

systems of services.

Integrated Partnership

But Wait…

• Some people say that Families are the barriers to good collaboration

• If “those parents” would just……

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Families asFamilies as

The “Cause,”The Patient,The Credible Informant,Equal Decision Making Partners,Evaluator and Research Partners,Policy Makers

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Are you Ready?

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Evidence Based Practices

• Multiple Registries• Narrow Focus

– Anxiety– Depression– ADHD

• Require Fidelity of Implementation• Talk Therapy Continues to Dominate

• Multiple Registries• Narrow Focus

– Anxiety– Depression– ADHD

• Require Fidelity of Implementation• Talk Therapy Continues to Dominate

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Alice said to the Cheshire Cat: “Would you tell me please, which way I ought to go from

here?”

“That depends a good deal on where you want to get to,”

said the Cat.

“I don’t much care where,” said Alice.

“Then it doesn’t matter which way you go,” said the Cat.

…it depends a good deal

on where you

want to get to…

We must …

Develop Competency in Implementation Science

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Model of Implementation ComplexityModel of Implementation Complexity

FIT

Does the innovation fit within your

organization

Complement or Compete?

FIT

Does the innovation fit within your

organization

Complement or Compete?

CLIMATE

Willing to remove

obstacles?

Are there rewards?

Leadership support?

Clarity of Goals?

CLIMATE

Willing to remove

obstacles?

Are there rewards?

Leadership support?

Clarity of Goals?

IMPLEMENTATION EFFECTIVENESS

Can you implement the innovation with

accuracy and fidelity?

IMPLEMENTATION EFFECTIVENESS

Can you implement the innovation with

accuracy and fidelity?

INNOVATION EFFECTIVENESS

Impact of innovation,

commitment, and satisfaction

INNOVATION EFFECTIVENESS

Impact of innovation,

commitment, and satisfaction

VOLITIONVOLITION

Is there capacity and Is there capacity and willingness to implement?willingness to implement?

VOLITIONVOLITION

Is there capacity and Is there capacity and willingness to implement?willingness to implement?

FIDELITY BELIEFSFIDELITY BELIEFS

Favorable attitudes toward Favorable attitudes toward practice Complexity of innovationpractice Complexity of innovation

FIDELITY BELIEFSFIDELITY BELIEFS

Favorable attitudes toward Favorable attitudes toward practice Complexity of innovationpractice Complexity of innovation

Download this 115 page monograph FREE at: http://rtckids.fmhi.usf.edu/rtcpubs/study04/

ResourcesResourcesResourcesResources

Atkins, M., Hoagwood, K., Kutash, K., &Seidman, E. (in press and on-line as of March 2010). Toward the Integration of Education and Mental Health in Schools. Administration and Policy in Mental Health Services Research.

Cappella, E., Frazier, S. L., Atkins, M. S., Schoenwald, S. K., & Glisson, C. (2008). Enhancing Schools’ Capacity to Support Children in Poverty: An Ecological Model of School-Based Mental Health Services. Adm Policy Ment Health, 35, 395-409.

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