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CMHPSR/LDI Research Seminar_New Models for Childrens Mental Health Services Drilling Deeper in Urban Schools 10_1_12

CMHPSR/LDI Research Seminar_New Models for Childrens Mental Health Services Drilling Deeper in Urban Schools 10_1_12






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    CMHPSR/LDI Research Seminar_New Models for Childrens Mental Health Services Drilling Deeper in Urban Schools 10_1_12 CMHPSR/LDI Research Seminar_New Models for Childrens Mental Health Services Drilling Deeper in Urban Schools 10_1_12 Presentation Transcript

    • Marc  S.  Atkins,  Ph.D.  University  of  Illinois  at  Chicago  Institute  for  Juvenile  Research  
    • Presenta(on  Goals    Review  concerns  with  current   system  of  children’s  mental  health   care  in  U.S.    Ecological  principles  and  public   health  framework  as  justification   for  focus  on  schooling    Present  experimental  intervention   model  and  preliminary  results    Future  directions  
    • Dulal  Bhaumik,  Ph.D.   Runa  Bhaumik,  Ph.D.   University  of  Illinois  Chicago   Center  for  Health  Sta(s(cs   Marc Atkins,  Ph.D.   Robert  Gibbons   Tara  Mehta,  Ph.D.   University  of  Chicago   Elisa  Shernoff,  Ph.D.   Ane  Marinez-­‐Lora,  Ph.D.   
 Department  of  Health  Studies   David  Henry,  Ph.D..   Amy  Starin,  Ph.D.   University  of  Illinois  Chicago   University  of  Illinois  Chicago   Ins(tute  for  Health  Research  and   Ins(tute  for  Juvenile  Research   Policy   Charles  Glisson,  Ph.D.   Anthony  Hemmelgarn,  Ph.D.   D.Bridget  Hamre,  Ph.D.     University  of  Tennessee,  Knoxville   University  of  Virginia   Children’s  Mental  Health  Services  Research  Center   Center  for  Advanced  Study  in  Teaching  and  Learning   Sonja  Schoenwald,  Ph.D.   Ashli  Sheidow,  Ph.D.   Elise  Cappella,  Ph.D.   Stacy  Frazier,  Ph.D.   Jason  Chapman,  Ph.D.   New  York  University   Florida  Interna(onal    University   Medical  University  of  South  Carolina   Steinhardt  School  of  Educa(on   Center  for  Children  and  Families   Family  Services  Research  Center   and  Culture  Developing  Center  for  Innova(on  in  Services  and  Interven(on  Research  (NIMH  P20  MH078458)  
    • Drilling  Deeper    Social  Rela(ons     Teachers     Students    Organiza(onal  Theory     Culture     Climate    Mental  Health  Prac(ce       Teachers     Parents  
    • Na(onal  Focus  on  Children s  Mental  Health    First  ever  Surgeon  General  report  on   mental  health  (2001)     Established  mental  health  needs   of  children  as  national  priority     Current  system  inadequate  to   meet  needs    President s  New  Freedom   Commission  on  Mental  Health   (2003)     Mental  health  services   fragmented,  disconnected,  and   inadequate.  
    • 7.5  Million  U.S.  Children  with  Unmet  Mental  Health  Need   Kataoka  et  al.  Am.  J.  Psychiatry  2002;  159:1548-­‐1555   6
    • Service  Use  by  Sector   Great  Smokey  Mountain  Study  90  80  70  60   Child  Welfare  50   Health  40   Mental  Health  30   Education  20   10   0   None   Mild   SED   Mental  Health  Need  
    • Institute of MedicinePrevention Children’s Mental Health Disorders 2009  
    • Ins(tute  of  Medicine   One factor lurks in the background of every discussion of the risks for mental, emotional, and behavioral disorders and antisocial behavior: poverty ... Although not the focus of this report, there is evidence that changes in social policy that reduce exposure to these risks are at least as important for preventing mental, emotional and behavioral disorders in young people as other preventive interventions. We are persuaded that the future mental health of the nation depends crucially on how, collectively, the costly legacy of poverty is dealt with.
    • Na(onal  Spotlight  on  Schools    No  Child  Left  Behind     No  Child  Left  Untested    School  violence     Not  just  in  urban   communities  anymore    Global  marketplace     China  and  India  rising     Another  Sputnik   moment?  •  U.S  Ranking  of  30  Countries     25th  in  Math     21st  in  Science  
    • Teacher  Stress         Low  morale,  depressed,   feeling  unfairly  blamed   for  the  ills  of  society?  You   must  be  a  teacher.   -­‐  NY  Times  Educa(onal   Supplement  (1997)     50%  of  teachers  in  high   poverty  schools  leave   within  3-­‐5  years  (20%  of   all  teachers)  Shernoff  et  al.,.  School  Mental  Health  2011;  3:59-­‐69  
    • What  Do  We  Know  About  Urban  Schools?   •     Overcrowding  and  large  class  sizes   •     Deteriora(ng  condi(ons     •     Significant  unmet  mental  health  needs     (Boyd  &  Shouse,  1997;  Cappella  et  al.,  2008  )  
    • What  Do  We  Know  About  Teacher  A7ri9on?   •     Teacher  shortages  due  to  migra(on  and  afri(on     •       Up  to  20%  of  public  school  teachers  leave  within  their  first  5  years       •       New  teachers  ogen  placed  in  hardest-­‐to-­‐staff  schools   •       Behavior  management  most  common  reason   (Barnes,  Crowe  &  Schaefer,  2007;  Guarino  et  al.,  2006;  Smith  &  Ingersoll,  2004)  
    • School Goals Are Mental Health Goals   Predictive of delinquency:   Academic failure   Low school bonding   Truancy   Low grades and aggression in first grade highly predictive of not graduating high school (ES = .78   Academic achievement protective for urban childrenEnsminger & Slusarcick. Sociology of Education 1992, 65:95-113.Spencer et al., Educational Psychologist 2001; 36:1, 21-30  
    • Ecological Principles: Services Support Settings   Consider primary mission of setting (e.g., different goals for schools vs. after school)   Consider these goals as mental health goals (don t ask setting to change goals)   Consider how mental health resources can be reallocated to support setting goals   Always think sustainability (no shortcuts)Atkins & Frazier. Perspectives on Psychological Science 2011; 6: 483-487.
    • Ecological  Theory     Interacting  nature  of   natural  contexts  and   their  impact  on   growth  and   development     Reciprocal  relations   among  natural   elements  in  an   environment  
    • Sustainability    Able  to  be  maintained   at  a  certain  rate  or   level    Conserving  an   ecological  balance  by   avoiding  depletion  of   natural  resources    Able  to  be  upheld  or   defended  
    • Diffusion of Innovation  
 •  Innovative interventions initiated by a relatively small segment of opinion leaders•  Via modeling, innovations are diffused through the population, influencing others•  Rogers (1983) noted that despite their knowledge, professional change agents often have little or no influence
    • Social Networks: Burt s Two-Step Diffusion TheoryStep  1   Informa(on  is   spread  via  cohesion   (key  informants)  Step  2   Adop(on  and  use   spread  via  structural   similarity   (compe(tors  or   partners)  
    • Teacher Key Opinion Leader (KOL)Influence Network
    • Influence  of  KOL  Teachers
 Classroom  Prac(ces  Atkins  et  al.,  Journal  of  ConsulEng  and  Clinical  Psychology  2008;,  76:  905-­‐908.  
    • Watling-­‐Neal  et  al.,  Social  Development  2011;  20:376-­‐393.      
    • Links  to  Learning       Unite teacher, parent, and MH provider around predictors of learning   Link MH providers with indigenous resources to support teachers and parents   Sustain services through fee-for-service Medicaid billing NIMH R01 MH073749 (PI: Atkins)
    • Links to Learning Service Model KOL Teachers   School Teachers Behavior   Effective Instruction CR Management Parent Outreach   MH AcademicProviders   Achievement   Parents   Home-Based School-Linked   Home Behavior   Parent Advocates  
    • Sample  Characteris(cs  •  7  high  poverty  poor   performing  CPS  schools   !Baseline!(Parent!Report)•  4  CMH  agencies  •  171  students  (104  Links,  67   100 80 control)  grades  K  -­‐4   75 68 76•  136  teachers  (71  Links  65   50 43 Control)   25 0•  3  year  interven(on  
    • Dissemination to Teachers andMental Health Providers  KOL teachers identified by sociometric interview and enrolled with MH providers enrolled in on-line graduate course on best practices  Site based workshop   10 week schoolwide professional learning series hosted by KOL teachers and MH providers in KOL teacher’s classroom for district CEU credit   KOL classroom was laboratory for MH providers and other teachers  MH providers follow-up in classrooms of teachers of students on their caseload 28Watling-Neal et al.,The Community Psychologist 2008, 41:2, 53-57
    • Classroom  Interven(on  Strategies     Universal       Good  Behavior   Game     Peer-­‐Assisted   Learning       Targeted     Daily  Report  Cards     Individual  Tutoring     Good  News  Note  
    • Parent  Curriculum   •  Home  rou(nes  that   support  learning   •  Homework   •  Reading  materials   •  Reading  opportuni(es   •  Home-­‐school   communica(on   •  Conferences   •  School-­‐home  notes  
    • Mental  Health  Service  Use   100" 90" 80" 70" Percentage) 60" 50" Links" 40" TAU" 30" 20" 10" 0" Entered" 6"Months" 1"Year" 2"Year" 3"Year"
    • Teachers  Use  of  Strategies  Links  Only   20   18   16   14   12   10   Targeted   8   Universal   6   4   2   0   Spring,  Year  1   Fall,  Year  2   Winter,  Year  2   Spring,  Year  2   Fall,  Year  3   Winter,  Year  3   Spring,  Year  3   32
    • Dependent  Measures    Child  behavior    Academic  performance    Parent  involvement     Parent  and  teacher  report  (Fast  Track)    Parent  and  teacher  stress     Parent  report  (Caregiver  Strain  Q)     Teacher  report  (Quality  of  Teacher  Work  Life)   33
    • Random  Effects  Models    yit  =  λ0t  η0i  +  λ1t  η1i  +εitη0i  =  υ0  +γ0  zi  +ζ0i  η1i  =  υ1  +γ1  zi  +ζ1i  yit    -­‐    individual    i  at  occasion  tλ1t  -­‐  time  of  measurement  η0i    -­‐  individual  intercept  with  expectations  υ0    and  residuals  ζ0iη1i    -­‐  individual  slope  with  expectations  υ1    and  residuals  ζ1iγ0,  γ1  -­‐  effects  of  time-­‐invariant  covariate  on  the  initial  level  and  linear  slopeεit  ~  N(0,σε2)Random  components  are  independent                         34
    • Classroom Observations:Year 1Academic  Engagement   70 65Percent of Intervals 60 55 Links Control 50 Links PC 45 Control PC 40 35 30 BL Spring
    • 3  Year  Classroom  Observa(ons  Peer  Comparisons  Engagement  Scores   80   75   Mean  Percentage  of  Time  Observed  Engaged   70   Target  Children   65   Peer   Comparisons   60   55   50   45   40   35   30   Fall  Yr  1   Spring  Yr  1   Fall  Yr  2   Spring  Yr  2   Fall  Yr  3   Spring  Yr  3   36
    • Classroom  Observa(ons  Peer  Comparisons   Off  –Task  Behavior   80   75   70   65   Target  Children   60   Peer  Comparisons   55   50   45   40   35   30   Fall  Yr  1   Spring  Yr  1   Fall  Yr  2   Spring  Yr  2   Fall  Yr  3   Spring  Yr  3  
    • Curriculum  Based  Measures  Three  Years  Links  vs.  Controls  Reading   60   55   50   45   Links   40   Control   35   30   25   Fall  Yr  1   Winter   Spring   Fall  Yr  2   Winter   Spring   Fall  Yr  3   Winter   Spring   Yr  1   Yr  1   Yr  2   Yr  2   Yr  3   Yr  3   38
    • Curriculum  Based  Measures  Year  3:  Links  vs.  Controls  Reading   60   58   56   54   52   50   Links   48   Control   46   44   42   40   Fall  Yr  3   Winter  Yr  3   Spring  Yr  3   39
    • Teacher  Ra(ngs  3  Years  Links  vs.  Controls    Academic  Competence   4   3.5   3   2.5   Links   Control   2   1.5   1   Fall  Yr  1   Spring  Yr  1   Fall  Yr  2   Spring  Yr  2   Fall  Yr  3   Spring  Yr  3   40
    • Parent  Report  3  Year  SSRS  Social  Skills   41
    • Ongoing  Studies     Retaining  early  career  teachers  (Shernoff)     Connectedness  and  Effec(veness  (IES  Goal  II)     The  Classroom  Project  (Frazier)     Teacher  prac(ces,  classroom  climate,  student   outcomes     8  schools,  77  teachers,  620  students     Family  Student  Liaison  (Starin)     Community  members  suppor(ng  parents  to   support  their  children s  learning     The  Bridge  Project  (Cappella)     Mental  health  consulta(on  to  enhance  posi(ve   classroom  emo(onal  climate  
    • Project  Bridge    Trained  community  MH  providers  in  NYC   public  schools:     Links  to  Learning  for  universal  and   targeted  mental  health  programs     MyTeachingPartner  (MTP)  web-­‐based   teacher  instruction  for  classroom   organization,  emotional  climate,  &   student  relations    Random  assignment:  MTP  or  MTP  +  Links     36  classrooms  (K  to  5th  grade),  n  =  364     Implementation  January  through  April   43
    • Project Bridge Cappella, Hamre et al. JCCP 2012; 80:4, 597-610
    • Summary    The LINKS Center focuses on a program of research to improve the mental health of children living in high poverty urban communities  Links to Learning is a Medicaid fee-for-service mental health service model implemented by community mental health staff in high poverty urban schools  Results suggest that services led to modest improvements in children s learning and behavior  Ongoing studies will expand the model to activate indigenous resources in schools to provide additional support to students, teachers, and families
    • Final  Thoughts   But  in  urban  schools     Given  the  large  needs  for  this  requires  afen(on  to   mental  health  services  in   the  unique  social   high  poverty  communi(es,   con(ngencies  that   and  the  importance  of   inform  and  promote   schooling  for  children’s   school  success  and  the   development,  schools  are   ac(va(on  of  indigenous   an  ideal  semng  to   resources  to  support   promote  urban  children’s     semng  goals   health  and  well  being.   The  goal  is  to  relieve  schools  from  the  job   of  providing  mental  health  services  by   making  successful  schooling  the  job  of   mental  health  services