The School-Based Community Intervention Model

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An original community psychology model for creating community-wide change capacity through school-based psychological services. With a case study from an Ultra-Orthodox/Hassidic community

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  • Interaction of multiple components with communities’ histories leads to processes and outcomes that are non-linear and unpredictableInterventions carried out within one level or segment of the community can have their primary effects elsewhere in the community Framing of interventions needs to include:“Local ecological” knowledge Knowledge of the ways in which levels and components or sectors of a community are interconnected and individuals interact to produce new knowledge and action
  • Capacity buildingDeveloping:Mental health-related roles among school personnelActivity settings for service provisionPathways to mental healthcare for students and familiesConnect to existing infrastructureCounselor IntegrationFully integrate counselor’s work within the overall function and mission of the school, making it both more effective and more likely to be sustained.
  • The School-Based Community Intervention Model

    1. 1. …And Keep the Change<br />A School-Based <br />Community <br />Intervention Model<br />Binyamin Goldman, PsyD, CSP<br />
    2. 2. Overview<br />Background<br /> Problems of service and change in resistant communities<br />Schensul & Trickett’s Model<br />Multilevel Community Based Interventions<br />The Present Model<br />School-Based Community Interventions<br />Case Study<br />Rockland County, NY Ultra-Orthodox & Hassidic community<br />
    3. 3. Background<br />Accessing Care, School-based Services, <br />& Community Interventions<br />
    4. 4. Accessing Care<br />Service gap<br />Most adults & 80% of children with mental health needs receive no care<br />Ethnic minorities’ and other underserved populations’ level of care increasingly disparate relative to general population<br />
    5. 5. Accessing Care<br />Barriers to care<br />Problem identification<br />Unawareness of symptom severity<br />Cultural differences in identification threshold<br />Religious explanatory models of distress<br />Help-seeking<br />Not knowing where to access<br />Belief that no one can help<br />Lack of access<br />Stigma<br />Cultural opposition to psychology<br />
    6. 6. Community Based Interventions<br />Instead of increasing access to an intervention, address the individuals’ context<br />Systematic change efforts that target:<br />Local concerns and wellness goals<br />Prevention<br />Empowerment <br />Capacity<br />
    7. 7. Community Based Interventions<br />Address and avoid many barriers<br />“Bottom-up” approach<br />Ecological perspective<br />Participatory methods<br />Social justice ethic<br />
    8. 8. Community Based Interventions<br />But face other barriers:<br />Reluctance of individuals to challenge status quo<br />System not suited for change, or experienced too much change<br />Cultural opposition to change<br />Interventions represent: <br /> “planned intrusions into [settings’] ongoing cultural mores, traditions, institutional arrangements, and locally defined hopes for the future” <br />Trickett, 2009, p. 259<br />
    9. 9. Schools & Interventions<br />Schools are:<br />Key settings for children’s development<br />Single community agency with universal access to population of children<br />Historically used as contexts to reach children with services<br />
    10. 10. Broadening Perspective<br />Calls in the literature for adopting more ecological and systems perspective of: <br />Interventions and activities within schools<br />Schools’ place within community context<br />Examples:<br />School-wide positive development programs<br />School-community-parent partnerships<br />School-based/school-linked services and all-in-one schools<br />
    11. 11. Multilevel Community Based Interventions<br />Schensul & Trickett’s Model<br />
    12. 12. Communities as Dynamic Systems<br />Communities are: <br />Dynamic, complex eco-social systems <br />Comprised of:<br />Multiple, interrelated ecological layers, components, and agents <br />Constant interaction and ongoing problem solving and change<br />
    13. 13. Communities as Dynamic Systems<br />Implications<br />Non-linearity and unpredictability<br />Cross-level effects<br />Need for “local ecological” knowledge <br />
    14. 14. Intervention vs. Analysis<br />
    15. 15. Intervention vs. Analysis <br />Individual <br />Outcomes<br />Individual <br />Interventions<br />Multilevel<br />Interventions<br />Multilevel<br />Outcomes<br />
    16. 16. Multilevel Interventions & Schools<br />
    17. 17. Schools in Multilevel Contexts<br />Schools are seen and utilized not just as systems that encompass students, classrooms, etc., but also as components within the larger community system.<br />Within each school or school system, culture, micro-politics, and cycling of resources are all linked to larger community forces that must be understood and appreciated. <br />School-based interventions represent “but one element in [the] larger network of action” within their community context (Braa, Monteiro, & Sahay, 2004, pg. 231) . <br />Schools as “cultural hook”<br />
    18. 18. School-Based Community Intervention Model (SBCI)<br />The EPIC OSCaR Process<br />
    19. 19. EPIC OSCaR<br />
    20. 20. EPIC OSCaR<br />Ethnography<br />Partnering<br />Intervention Setup<br />Clinician Integration<br />Ownership<br />School Network Building<br />Cross-Level Problem-Solving<br />and Readiness<br />
    21. 21. Pre-Entry Phase<br />Ecological Levels:<br /><ul><li>Community-wide
    22. 22. Cross-sector</li></ul>Ethnographic Inquiry<br />Become true community “insiders” <br />Build reciprocal, trusting relationships <br />Understand community culture and social ecology, and schools’ function<br />Partnering<br />Build upon “ecological map” of networks of support, resistance, resources and innovation<br />Community Partners- “front-line problem-solvers”<br />School-System Partners- ideally, current obstacles to innovation that are candidates for change<br />
    23. 23. Service Delivery Phase<br />Intervention Setup/Individual Service<br />Capacity building<br />Mental health exposure <br />Counselor/Consultant Integration<br />Micro-systemic mirror of initial ethnography stage <br />Build trust, deepen relationships<br />Become embedded within culture and social network of school<br />Deepen alliance between school and the planning agency/clinician and administrators<br />School Ownership<br />Schools embed intervention within org. context and routine<br />Extensiveness <br />Intensiveness<br />Ecological Levels:<br /><ul><li>Whole-School
    24. 24. Individual</li></li></ul><li>Scale-UpPhase<br />Ecological Levels:<br /><ul><li>Inter-School
    25. 25. Cross-Sector</li></ul>School Network-Building<br />Organize schools to form a network around school and mental health-related issues <br />Facilitate joint problem-solving<br />Cross-Sector Problem-Solving<br />Increase interdependence amongwellness-focused organizations and systems in community <br />Strengthen ties between community-based organizations and specialized expertise outside the community. <br />
    26. 26. Impact Phase<br />Ecological Levels:<br /><ul><li>Community-wide</li></ul>Readiness<br />Reflected in the “structures, processes, and networks of relationships that promote organized action with respect to community issues” (Trickett 2009, pg 411)<br />Examples:<br />New roles, settings<br />Increased interdependence<br />Decreased resistance<br />New pathways to support<br />Community-level learning<br />
    27. 27. Case Study<br />The Ultra-Orthodox/Hassidic Jewish (UOHJ) Community of Rockland County, NY<br />
    28. 28. CAPs School-Based Services<br />
    29. 29. Intervention Context<br />BikurCholim-Partners in Health, Monsey, NY<br />Long-standing social service organization operated by and for UOHJ community<br />Hospital visits, medical referrals, medical equipment lending, etc.<br />Center for Applied Psychology (CAPs) at BikurCholim<br />NYS OMH-licensed mental health clinic serving primarily UOHJ population<br />Clinicians and admin. Orthodox, but not all UOHJ<br /> Opened 2002<br />
    30. 30. Intervention Context<br />School-Based Clinical Services Division<br />Funded through district<br />Schools <br />10-15 non-public schools, currently all UOHJ<br />Majority of schools have counselors for ≤ 3 years<br />Participation: Modern ➔ Yeshivish ➔ Hassidic<br />Partners:<br />District personnel<br />Local rabbis<br />BikurCholim supporters<br />Individual administrators<br />Parents<br />
    31. 31. Community Socio-Demographics<br />3 Major factions<br />Hassidic <br />“Yeshivish”<br />“Modern Orthodox” <br />Other groups<br />Sefardic/Middle Eastern<br />“BaaleiTeshuva” <br />
    32. 32. Community Culture<br />“Torah Values”<br />Primacy of learning<br />Strict adherence to biblical and rabbinic dictates<br />Value of “authentic” traditions and behaviors<br />
    33. 33. Community Culture<br />Insularity<br />Response to persecution, assimilation<br />Resistance: <br />To change <br />To influences of contemporary, outside culture <br />Particularly in areas of socialization and education<br />
    34. 34. In the society, but not of it<br />
    35. 35. External information limited, but still flows<br />
    36. 36. Community Structure<br />Hassidic community<br />Highly structured hierarchy and role assignments<br />Geographically demarcated <br />Impermeable boundaries<br />Group vs. individual orientation<br />
    37. 37. Community Structure<br />Yeshivish and Modern Orthodox<br />More fluid structure and boundaries<br />Socially and idiologically<br />Grouping according to synagogue attendance, school, neighborhood<br />Less centralized power<br />
    38. 38. Hassidic Community Structure<br />
    39. 39. Hassidic Community<br />Distinctive clothing<br />Yiddish as spoken language<br />Strict segregation between men and women<br />Little English or secular academic instruction<br />
    40. 40. Prior Services <br />Percentage of schools, by number of years receiving any mental health services prior to 2008 – 2009 school year<br />
    41. 41. SBCI Process<br />The Model, Applied<br />
    42. 42. Ethnography<br />Pre-Entry Phase<br />Group supervision as ethnographic collaboration<br />Utilizing BikurCholim<br />Utlizing DCS<br />Continued inquiry<br />
    43. 43. Partnering<br />Pre-Entry Phase<br />External Agency<br />The school district- a “good shiddukh”<br />School System & Community<br />Resistance in more conservative communities<br />Slow “domino effect”<br />
    44. 44. Intervention<br />Service Delivery Phase<br />Intervention Setup<br />Psychoeducation<br />Modalities & Frequency<br />2-16 hours/wk/school<br />Individual counseling, most frequent<br />Large variance in schools’ utilization of administrative and school-wide support<br />
    45. 45. Clinician Integration<br />Service Delivery Phase<br />Clinician Preparation<br />Yeshivish vs. Hassidic patterns<br />Yeshivish- greater integration, but more scrutiny<br />Hassidich- less integration, but more acceptance<br />
    46. 46. Service Delivery Phase<br />Ownership<br />Program Extensiveness<br />School-parent communications<br />Yeshivish/Hassidic differences<br />Program Intensiveness<br />Related to: <br />Clinician integration <br />School micro-politics<br />
    47. 47. Scaling Up Phase<br />School Network Building<br />Principals’ Meetings<br />Provided:<br />Interaction and engagement<br />Seeing the others who are involved<br />Safe forum<br />Guided, joint problem-solving<br />
    48. 48. Scaling Up Phase<br />Cross-Sector<br />Network Building<br />Referrals to DCS<br />Protective Services<br />Monsey Community Coalition for Health and Wellness<br />
    49. 49. Impact<br />New roles and settings in schools<br />School ownership<br />Parenting program<br />Referral source<br />New and strengthened networks <br />Principals<br />Community<br />Schools and district<br />Increase in<br />Consultation by teachers and administrators<br />Referrals for outside services<br />Parental involvement<br />Prevention and positive development focus<br />
    50. 50. Impact: Attitudes<br /><ul><li>Attitudes toward counselor in school, before & after 2008 – 2009 school year, by faculty role </li></li></ul><li>Impact: Attitudes<br />Attitudes toward counselor in school, by number of previous years served by a counselor<br />MANOVA: * Within Group F=2.8;p = .03; d.f. = 4<br /> ** Between Group; F = 5.63;p = .008; d.f. =2<br />Post-hoc- Tukey HSD, “0-1 Yrs” x “4-5 Yrs”: p = .006<br />Strongly <br />in Favor<br />Neutral <br />
    51. 51. Discussion<br />
    52. 52. Limitations<br />Barriers to implementation<br />Resistance<br />Non-school goals<br />Empirical validation<br />Methodological challenges<br />Requires mixed-methods design<br />
    53. 53. Changing School’s Perspectives & Goals<br />Understanding complex interactions with community systems<br />Increased collaboration with community<br />Using school psychologists to facilitate SBCIs<br />Other applications<br />
    54. 54. Conclusion<br />Value of school-based programs: beyond direct service or school-wide, with individual outcomes<br />Broader, more sustainable change through “local ecological” knowledge” <br />In resistant communities, school systems can be “cultural hook”<br />Interventions can help create new roles, settings, and networks for problem-solving community mental health issues and change attitudes and perceptions that serve as barriers to service access community-wide.<br />

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