THE SCHOOL MENTAL HEALTH IMPERATIVE Steven Adelsheim, M.D.

THE SCHOOL MENTAL
HEALTH IMPERATIVE
Steven Adelsheim, M.D.
University of New Mexico
Department of Psychiatry
NM Department of Health, OSH
Jenni Jennings
Dallas Independent School District
THE SCHOOL MENTAL
HEALTH IMPERATIVE
Steven Adelsheim, M.D.
University of New Mexico
Department of Psychiatry
NM Department of Health, OSH
Mark D. Weist, Ph.D.
University of Maryland
Department of Psychiatry
Prevalence of Childhood
Mental Health Problems
About 20% of children and adolescents
(15 million), ages 9 to 17, have diagnosable
mental health disorders
 Between 9-13% of children, ages 9-17 years,
meet the definition of serious emotional
disturbance (SED) that limits their ability to
function in the family, school, and community
 An estimated 70% of those identified are not
getting the mental health treatment they need

Surgeon General’s Conference
on Children’s Mental Health
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By 2020, childhood neuropsychiatric disorders will
rise by over 50% internationally to become one of
the 5 most common causes of morbidity, mortality,
disability
Global Burden of Disease study predicts that major
depression will become the second leading cause of
disability in the world by the year 2010
“There is no mental health equivalent to the federal
government’s commitment to childhood
immunization”
Surgeon General’s Suicide Data 1997

Rate for ages * 10-14 - 1.6 /100,000
* 15-19 - 9.7 /100,000
* 20-24 - 14.5 /100,000

For young people 15-24, suicide is third leading
cause of death

In 1996, more youth and young adults died from
suicide than cancer, heart disease, AIDS, stroke,
pneumonia, & birth defects COMBINED
2001 New Mexico YRRS

13.7% of students had attempted suicide in
the 12 months prior to the survey
 15.5%
 7.1%
 Up
of females
of males
from 9.1% in 1999
An Attitudinal Shift Towards Children’s
Mental Health Programs
Public Health perspective similar to that for
immunizations, sexually transmitted diseases
 Put children’s services on equal financial
footing as adult programs if we really believe
in prevention and early identification
 Equal focus for children’s services at federal,
state, and local systems
 University training systems prioritize children
services

Prevalence of Mental Health
Problems Post 9/11
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64% of students had been exposed to one or more
traumatic events BEFORE 9/11
10.5% of students were estimated to have PTSD (75,000)
Previous exposure to traumatic event or exposure of a
family member or were more important than personal
physical exposure in predicting who developed PTSD
26.5% have at least one of the seven assessed mental
health problems, excluding alcohol abuse (190,000
students)
At least 66% of students with probable PTSD following the
9/11 attacks had not sought out ANY mental health
services!
Early Identification and Treatment of
Psychiatric Disorders as Prevention

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ADHD – Pharmacotherapy reduces risk for later
substance use disorder (Biederman,
et al, 1999)
Bipolar disorders – early identification of BAD in
younger children reduces risk of ASUD 8X over
adolescent identification (Wilens et al, 1999)
Opposition Defiant/Conduct Disorders – early
treatment of child, parent, family all decrease later
ASUD risk (Riggs)
NYC Mental Health System
Recommendations

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All interventions should be school-based to increase
access and decrease stigma
Outreach and training in schools to identify youth
with mental health problems
Screening and assessment system within schools.
that includes a seamless link to services
Evidence–based models of intervention
Increase school-based clinics throughout NYC
schools
Schools: The Most
Universal Natural Setting

Over 52 million youth attend 114,000 schools

Over 6 million adults work in schools

Combining students and staff, one-fifth of the
U.S. population can be found in schools
Why Put Mental Health Services
in Schools?
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Improve access: It’s where the students are!
Families more comfortable in community setting
Minimize stigma issues
Opportunities to observe and intervene directly in
setting where most student’s time is spent
Clinical efficiency and productivity
Ability to collaborate and advocate directly for
education needs of students
Greater ability to reach those with “internalizing
disorders”
Major Approaches to
Mental Health in Schools
School-Based Health Centers (1,400)
 Community Mental Health Center Outreach
(114,000 schools)
 Private Practitioner Outreach
 Communities in Schools
 Enabling Framework (Adelman and Taylor)
 Other Education-Based, Including Special
Education Linked and Consultation

School Mental Health
Partnerships with Families
Opportunities to collaborate with providers onsite about education needs of child
 Improved coordination of interventions around
whole child and family
 Access is easier with fewer transportation
issues
 More comfortable community setting
 Stigma issues may be minimized

School-Community Collaboration in
School Mental Health Programs

Collaboration and coordination between
school and providers is critical
 Roles
of all on-site providers, including school
health professionals must be clear
 Communication and confidentiality issues must be
directed addressed and established
 Resource coordination efforts must be determined
by organized team within school (SAT, resource
team, etc.)
School Mental Health Programs
and Special Education

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Currently most school mental health professionals work
only with special education students
SBHCs may have a critical role to play in evaluation,
recommendations, interventions, IEPs for special
education
School mental health providers may find students in need
of further educational assessment and be on site to
advocate for their needs
On-site school mental health professionals are a resource
for administrators struggling with difficult discipline issues
School mental heath providers may give direct guidance to
teachers in meeting student classroom needs
School Mental Health
Program Outcomes

Improved grades, attendance, and behavior in
students

Decreased inappropriate referrals to special
education

Improved school climate
Funding a Continuum of School
Mental Health Programs and Services

State and local grants and contracts

Federal and foundation grants and contracts
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Innovative prevention funding

Medicaid: fee-for-service, Medicaid managed
care, Medicaid in the Schools

Allocations from schools, special education
services, and departments of education
Continuum of Care for
School Mental Health Programs
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Awareness and training

Three levels of prevention, including
universal, selective and indicated

Screening and assessment

Early identification and early intervention

Three levels of treatment, including
community-based, transitional, and high-end
NM DOH Office of School Health
Director
Laurie A. Mueller
HPM-1/Santa Fe
School Health Officer
Jane McGrath
(UNM)/Abq
School-Based Health
Center Consultant
Mary Blea
Nurse-5/Abq
SBHC Nurse Practitioner
Medicaid Consultant
Paula LeSueur
(UNM)/Abq
School Health Advocates
Deb Werner - Dist I
Janie Lee Hall - Dist I
Trudy Perry - Dist II
Laura Mandabach - Dist III
Janice Jordan - Dist IV
Administrative Assistant II
Carol Montoya
(UNM)/Abq
Medical Care Administrator
Vacant
PH Educ./Santa Fe
Healthier Schools Consultant
Randy Sanches
PH Educ./Santa Fe
Planner
Vacant
Santa Fe
Secretary
Pamela Hedrick
Santa Fe
Dropout Prevention
Coordinator
Nissa Patterson
(UNM)/Albq
School Mental Health Advocates
Vacant - UNM / Dist I
Jaynee Fontecchio - UNM /Dist I NW
Joseph Vigil - UNM / Dist II
Albert Sanchez - UNM / Dist III
Steven Courts - UNM / Dist IV
School Mental Health
Initiative, Director
Steve Adelsheim
(UNM)/Abq
Program Manager
Kris Carrillo
(UNM)/Abq
Behavioral Education
Consultant
Vacant
PH Educ./Abq
School-Based Mental Health
Services Consultant
Jacque Masog
(UNM)/Abq
Screening /
Early Identification Consultant
Ernest Coletta
(UNM)/Albq
Administrative Asst. III
Clancey Tarbox
(UNM)/Abq
Office
of
School
Health
Locations
District IV
District III
New Mexico School
Behavioral Health Partnership
Office of School Health
 Behavioral Health Division
 CYFD-Prev. & Interv.
 Dept of Ed.-Spec.Ed.
 Dept. of Ed.-School Health
 Fed. M H Block Grant
 HSD-Med. Asst. Div.

$300,000
$400,000
$320,000
$170,000
$350,000
$140,000
Interdepartmental School
Behavioral Health Partnership
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Funded Programs
School Behavioral Health Training Institute
Youth Mental Health Awareness Initiative“Childhood Revealed”
Dropout Prevention Project
School Behavioral Health Screening Program
School-Based Mental Health Center Program
Development
SBHC Mental Health Exemplary Pilot Sites
School Mental Health System
Recommendations
Through schools, train educators, students,
and families about children's mental health
issues and their impact on education
 Continue to fund evidence-based prevention
programs, including indicated prevention
activities
 Expand incentives to increase the numbers of
child-trained MH providers and require a
school-based component to their training

School Mental Health System
Recommendations-continued

Implement screening and assessment for
behavioral health issues:
 Head
Start
 Child Find and IDEA
 EPSDT
 Entrance to schools with vision and hearing
 At critical junctures in school such as at transition
grades and at point of disciplinary action
School Mental Health System
Recommendations-continued
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Create specific funding for school-based mental
health services in school-based health centers and
as a part of federally funded mental health and
education programs
Examples:
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SCHIPS
Medicaid
Medicaid in the Schools
“No Child Left Behind”-Safe and Drug Free Schools, Title
1 and other entitlements
School Mental Health System
Recommendations-continued
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Support state level infrastructure for mental health
service system delivery between mental health and
education systems
Fund school mental health demonstration sites and
disseminate the most effective models
Create Office of School Health/Mental Health at
federal level (joint Health and Ed.), pool funds from
multiple agencies and distribute to schoolcommunity collaboratives
Integrate school-based mental health and primary
care services
Find Children and Adolescents with
Behavioral Health Problems Early and
Treat Them
Prevent later special education referrals
 Reduce primary care and urgent care over
utilization
 Decrease high risk behaviors including
violence and substance abuse
 Improve educational outcomes
 Decrease the accidents, suicides, and
homicides that are the public health
mortalities for our children

The National
Child Psychiatrist Shortage

In 1990, COGME reported a national need for
30,000 child psychiatrists by 2000

Currently there are 6,300

A minimum projected need for 12,624 to meet
demand by 2020 with a predicted 30%
increase in numbers to 8,312
New Mexico School
Behavioral Health Training Institute

Train-the–Trainers model of adult education

Training 180 teachers and school health
professionals from 14 districts this year

Training in aspects of school behavioral
health and classroom intervention

On-site workshops with staff support
Childhood Revealed New Mexico
2001
Art exhibit as centerpiece for youth mental
health awareness expansion statewide
 Linkages to school districts for in-service
training and classroom programs (0ver 5000
youth so far this year)
 Community education programs for expanded
awareness
 Media, government, and business support all
to help to decrease stigma

New Mexico School Mental Health
Prevention Programs
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Dropout Prevention Program
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Peer Navigator’s Program
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Crisis Prevention and Intervention
Coordination

Prevention Programs Resource
New Mexico Dropout Prevention
Initiative
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Case management model for high risk youth and
their families
Focus on wraparound supports for those identified
of being at risk to dropout
Statewide training and RFP development 2002 fiscal
year
Focus on implementation at 3 pilot sites statewide
for fiscal years 2003-4
Target 9th grade students making transition to high
school
New Mexico K-6th
Behavioral Health Assessment
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Training for teachers and school health
professionals statewide in behavioral health issues
Website development as training and resource
model-www.nmsmhi.org
Developing of screening and assessment tools for
K-6th grade use statewide
Focus on student support team system development
for schools
Funded by state legislature through SDE
New Mexico Screening and
Early Identification Models
Early identification and intervention as
prevention
 Public health screenings vs. selective
screenings in SBHCs
 Piloting computer-based models for early
identification and suicide prevention
 Expanded interest by schools to utilize
screening tools on larger scale

New Mexico School-Based Health Center
Mental Health Program Development
Expanded funding for mental health and
substance abuse services 17 SBHC programs
 One cluster wide Medicaid Managed Care
School Behavioral Health Pilot Program
 Standards and protocols for MH/SA services
in schools
 Four “Exemplary” School Mental Health Sites
looking at mental health and educational
outcomes

New Mexico Medicaid Managed Care
SBHC Pilot Projects
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Pilot with Center for Health Care Strategies
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Reimbursement through Medicaid for mental health
and substance abuse services
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5 Medicaid Managed Care SBHC pilots
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Developing depression, ADHD and substance abuse
protocols for MH/SA services in schools
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“Enhanced Mental Health Services” code for some
sites
New Mexico School
Mental Health Initiative

Statewide efforts to link families, communities,
schools and behavioral health programs
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Phone: 505-841-5879
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Fax: 505-841-5885
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Email: [email protected]
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Website: http://www.nmsmhi.org
University of Maryland
Center for School Mental Health Assistance
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Provide technical assistance and consultation
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Provide national training and education
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Disseminate and develop knowledge
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Promote communication and networking
 phone:
 email:
 web:
410-706-0980 (888-706-0980 toll free)
[email protected]
http://csmha.umaryland.edu
UCLA
Center for Mental Health in Schools

Directed by Howard Adelman and
Linda Taylor
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Phone: 310-825-3634
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Enews: [email protected]

web: http://smhp.psych.ucla.edu