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)
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
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
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
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