Transcript School Mental Health and Foster Care

School Mental Health and
Foster Care
Mark Weist, Ph.D.1
Nancy Lever, Ph.D.1
Michael Lindsey, PhD, MSW, MPH2
Sylvia Huntley, BA1
Dana Cunningham, Ph.D.
1University
of Maryland Center for School Mental Health
University of Maryland School of Social Work
3Prince George’s County School Mental Health Initiative
2
Welcome
Introduction of University of Maryland
Team
Participants-- role and your connection to
school mental health and/or foster care
Center for School Mental Health*
University of Maryland School of Medicine
http://csmh.umaryland.edu
*Supported by the Maternal and Child Health Bureau of HRSA and
numerous Maryland agencies
What is Not Working in
School Mental Health (SMH)
“Turf” and “siloed” approaches
Single system approaches
Same old roles
Clinics in schools
Co-located models
Traditional eclectic therapies
Schools handing off children to other
systems
Referrals from Schools
to Other Settings
96% referred to school-based
program received services
13% referred to other community
agency did
Catron, T., Harris, V., & Weiss, B. (1998)
Treatment as Usual Show Rates
Percent of Youth Remaining in Services
(McKay et al., 2005) from Kimberly Hoagwood
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
72%
49%
26%
9%
Number of Sessions
Other Concerning Facts
Around 1 in 5 youth will present an
emotional/behavioral disorder (5 students
in a classroom of 25)
Between 1/6th and 1/3rd receive any
services
Modal number of specialty mental health
visits is 2
Major lack of systematic quality
assessment and improvement in
traditional settings
Silos
“The various systems do not talk to each
other, resulting in many children falling
through the cracks and not receiving care,
receiving duplication of services, or
families needing to negotiate a confusing,
fragmented array of services” (Family
Advocate, Louisiana)
“Shame” and “Strain” on Families
“Youth and families experience blame;
have widespread distrust of professionals;
have concerns about losing custody; are
often unable to pay for care…have to glue
services together”
Kimberly Hoagwood (Congressional Briefing, October,
2007)
Why Mental Health in Schools?
Integrated approaches to reduce
academic and non-academic barriers to
learning are the most effective in achieving
the outcomes families, schools and
communities care about
Advantages
ACCESS
Promotion and Prevention
Efficiency and Cost Effectiveness
Systems Collaboration/ Economies of
Scale
Natural/ Ecological Approach
Reduced Stigma
School Mental Health Promotion
Intensive Intervention
1-5%
Targeted Individual, Group,
Family Intervention
5-40%
Selective Prevention
All Students
Universal Prevention
Relationship Development
Systems for Positive Behavior
Diverse Stakeholder Involvement
Climate Enhancement
Another Triangle
Desired Outcomes
Effective mental health promotion and intervention
Outstanding staff and program qualities
Ongoing training, technical assistance & support
School and community buy-in and investment
Resources
Awareness raising, advocacy, policy improvement
But in most communities…
The vision is not a reality as staff and
programs are not adequately supported
and often contending with tremendous
need, and
In an environment of low support and high
needs, positive outcomes will most likely
not be achieved and efforts will stall
Many Challenges to Overcome…
Marginalization and stigma
Limited staff and resources
Disciplinary silos and turf
Bureaucracy
A fluid environment with frequent changes
in leadership
Compelling need at all levels
INERTIA
Making Empirically Supported Practice in
Schools Achievable
Overarching Emphasis on Quality
Effectively Working with Families and
Students
Enhanced Modular Intervention
On-Site Coaching and Support
Quality Assessment and Improvement
(QAI) Principles
 Emphasize access
 Tailor to local needs
and strengths
 Emphasize quality
and empirical support
 Active involvement of
diverse stakeholders
 Full continuum from
promotion to
treatment
 Committed and
energetic staff
 Developmental and
cultural competence
 Coordinated in the
school and connected
in the community
Working Effectively with
Students and Families
Early on focus on engagement, e.g.,
through candid discussions about past
experiences
Emphasize empowerment and the
potential for improvement
Provide pragmatic support
Emphasize mutual collaboration
School Mental Health Services for Youth
in Foster Care
Services can include:
After school recreational and enrichment activities
School-wide mental health promotion
Classroom and small group prevention activities
Group therapy (for youth with similar emotional or
behavioral concerns)
Individual therapy
Family therapy
Teacher consultation
Mental health evaluation
Assistance with mental health referrals
School Mental Health and Foster Care
Initiative
 Goal: To effectively integrate and improve school mental
health services and ultimate outcomes for children,
adolescents, and graduates of Maryland’s foster care system
Key Objectives Include:
 Develop a training curriculum and conduct training related
to effective school-based outreach, support, mental health
promotion and intervention for youth in foster care in
Maryland Schools
 Provide statewide information and technical support on
effective school mental health promotion and intervention
for youth in foster care through the website,
www.schoolmentalhealth.org and a listserv
 Funding - Maryland Mental Health Transformation Grant # 5
U79SM57459-02 from SAMHSA
Conceptual Framework
Foster Care – School Mental Health Interface
Conceptual Framework
A Public Mental Health Promotion Approach for Youth in Foster Care
Training Curriculum: School Mental Health and Foster Care: A
Training Curriculum for Child Welfare Workers, Teachers, and
Clinicians
 Module 1: Understanding the Foster Care System
 Module 2: Mental Health Needs of Children in Foster Care
 Module 3: Understanding Schools and School Mental Health
Services
 Module 4: Prevention and Mental Health Promotion for Youth
in Foster Care in Schools
 Module 5: Early Identification and Intervention
 Module 6: Confidentiality and Sharing Information
 Module 7: Coordinated Service Delivery and Integrated
Treatment Planning
 Module 8: Evidence-Based Treatment for Children in Foster
Care in Schools
 Module 9: Family Engagement and Meaningful Involvement
 Module 10: Policy and Funding
What is Foster Care?
Foster care is one aspect of child welfare
which has as its objective, the provision of
short term out of home care for children
removed from their family homes; at the
same time, the child’s family also receives
services that aim to help them reduce the
risk of future neglect or abuse in
preparation for the child’s return home
(Child Welfare Information Getaway,
2006).
Permanency Planning
 As part of the foster care process,
permanency planning is initiated.
 Permanency planning is principled to include prevention
of out of home care, once a child has entered into care,
the purpose of the plan is to ensure the shortest length
of stay and to develop a plan for permanent home
placement in concert with the family (Anderson, 1997;
Pelton,1991)
 The main goal of the plan is always reunification of child
and family. If reunification is not attainable, then other
permanency options are explored such as discharge to
independent living, kinship care, or placement in a
suitable adoptive family.
Types of Foster Care
 Court-appointed foster care: Caretaking of
children displaced from biological parent(s),
typically by a caring adult who has met the
requirements to be a foster parent by their local
jurisdiction. This situation is intended to be
temporary.
 Kinship care: Caretaking of children who have
been displaced from a biological parent(s), typically
by grandparents or other relatives. Kinship care
also improves stability by keeping displaced
children closer to their extended families,
neighborhoods and schools.
What Happens Once in Care?
 Initial intake session and first 60 days plan
 Key players and their role
 Case worker, typically a master’s-level Social Worker
 Case management
 Clinical intervention
 Permanency planning
 Reunification support
 Support services, typically offered by a bacherlor’s-level worker
 Mentoring
 Crisis intervention
 Therapeutic support
 Outcomes at the end of foster care:
 Return home
 Adoption
 Discharge to independent living
The Situation in Maryland
(Based on 2003 Statistics)
 Total population: 11,521
 Age (Average: 11.4 Years)
 4% <1 year
 19% 1-5 years
 19% 6-10 years
 33% 11-15 years
 20% 16-18 years
 6% ≥ 19 years
 Male: 53% Female: 47%
Source: http://www.fostercaremonth.org/AboutFosterCare/StatisticsAndData/Documents/MD-FactsFCM07.pdf
MD Stats: Race/Ethnicity
Race/Ethnicity
In out-of-home care State child population
Black (non-Hispanic)
75%
32%
White (non-Hispanic)
20%
56%
Hispanic
2%
5%
Am. Indian/Alaska
Native
0%
0%
Asian/Pacific Islander
0%
4%
Unknown
1%
N/A
2 or more races
(non-Hispanic)
1%
3%
MD Stats: Additional Items
 Length of stay
 The average length of stay for children in care on September 30,
2003 was 48 months.
 Reunified
 Forty-one percent of the young people leaving the system in FY 2003
were reunified with their birth parents or primary caregivers.
 Foster home
 In 2002, there were a total of 4,440 licensed kinship and non-relative
foster homes in Maryland
 On September 30, 2003, 35% of youth living in out-of-home care
were residing with their relatives.
 Adoption
 Of children with state agency involvement adopted in FY 2003, 56%
were adopted by their non-relative foster parents and 40% were
adopted by relatives.
Challenges connecting to SMH
 Schools are difficult systems to navigate
 Can be hard to figure out who is providing
services to children and adolescents in the
school and who would best serve the student
 Capacity issues
 Schedules – child welfare workers and families
may only be available in the later day or evening
 Limited or lack of understanding and
appreciation about child welfare system.
 Services may not be available every day (split
FTE), school vacations, and in the summer
Schools can help children in foster
care succeed by…
 understanding the demands of the foster care
system (e.g., court appearances during school
time)
 offering information about the best ways to
communicate with and gather information from
the school (e.g., scheduling, consent forms, and
how to meet with teachers)
 establishing regular communication about the
child’s successes and challenges, including
mental health
Schools can help children in foster
care succeed by…(Continued)
 helping to coordinate school transfers when
necessary and making sure all available records
transfer with the student
 identifying children in foster care who are in
need of special education services and ensuring
that these services are provided across school
placements
 training school staff about the mental health
issues associated with foster care and how to
help youth in foster care be more successful in
school
Resources
http://www.aacap.org/cs/root/facts_for_fam
ilies/foster_care
http://www.fostercaremonth.org/AboutFost
erCare/StatisticsAndData/Documents/MDFacts-FCM07.pdf
http://www.acf.hhs.gov/programs/cb/stats_
research/afcars/tar/report10.htm
Statistics Related to Mental Health for
Youth in Foster Care
 Youth in foster care experience even more
mental health symptomatology than other high
risk youth
 In a recent study of children and adolescents in
foster care, 54% had one or more mental health
problems in the past 12 months (compared with
22% of the general population)
 Remarkably, 25% had Post-Traumatic Stress
Disorder within the past 12 months (twice the
rate of U.S. war veterans) (Pecora et al., 2005)
What are the unique mental health issues that are
commonly seen in youth in foster care?
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Anger/Irritability
Nightmares
Distressing memories
Sleep problems
Depression and Anxiety
Avoidance
Attention problems
Problems with attachment
Delinquency
Oppositional Behavior
How do these issues manifest in a
classroom/school setting?
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Sleeping in class
Defiant or disruptive
Refusal to participate/do homework
Excessive absences/tardiness/truancy
Easily distracted/poor concentration
Irritability
Destructive behavior to self/others/objects
Change in grades/attitude
Excessive worry
Sadness/tearful
Lying
Unprovoked anger outbursts
Discussion
 How do you respect the privacy of a
youth in foster care, but still be able to
identify these students so that they can
be prioritized for mental health
promotion, prevention, and
intervention services?
 How can this balance best be
achieved?
 What specific strategies would you
recommend?
Strategies for Successful Identification
and Consent
 Education for child welfare workers about available
services in schools
 Improved professional development for school staff and
clinicians on unique mental health issues for youth in
foster care.
 Provide information on counseling services/prevention
services available to youth as a regular part of
orientation/registration for incoming students
 Inquire about the health and mental health services
available in the building and how to access – Consider
connecting with this person directly
 Request a release of information from the school as a
standard procedure when registering a child in school
Cognitive Behavioral Intervention
for Trauma in Schools (CBITS)
Training Developed by:
National Child Traumatic Stress Network
LAUSD/RAND/UCLA Trauma Services Adaptation Center for
Schools
Why a trauma program
in schools?
Why a program for traumatized students?
 More and more youth are experiencing traumatic
events
Community violence
Natural and technological disasters
Terrorism
Family and interpersonal violence
 Most youth with mental health needs do not
seek treatment
 Many internalizing disorders in children go
undetected
National Survey of Adolescents
Prevalence of Violence History
(N=1,245) Kilpatrick et. al., 1995
No Violence
(27%)
Direct
Assault Only
(2%)
Witness Only
(48%)
Assault +
Witness
(23%)
Consequences of trauma exposure
 Posttraumatic Stress Disorder (PTSD)
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Re-experiencing
Numbing/Avoidance
Hyperarousal
Prevalence in adolescents
 4% of boys
 6% of girls
 75% of those with PTSD have additional
mental health problem
Breslau et al., 1991; Kilpatrick 2003, Horowitz, Weine & Jekel, 1995
Consequences of trauma exposure
 Posttraumatic Stress Disorder (PTSD)
 Depression
 Substance abuse
 Behavioral problems
 Poor school performance
Impact of trauma on learning
 Decreased IQ and reading ability
(Delaney-Black et al., 2003)
 Lower grade-point average (Hurt et al., 2001)
 More days of school absence (Hurt et al., 2001)
 Decreased rates of high school graduation
(Grogger, 1997)
 Increased expulsions and suspensions
(LAUSD Survey)
CBITS Program
10 child group therapy sessions for trauma
symptoms
1-3 individual child sessions for exposure
to trauma memory and treatment planning
Parent outreach, 2 sessions on education
about trauma, parenting support
1 teacher session including education
about detecting and supporting
traumatized students (1 session)
Goals of CBITS
Symptom Reduction
PTSD symptoms
General anxiety
Depressive symptoms
Low self-esteem
Behavioral problems
Aggressive and impulsive
Build Resilience
Peer and Parent
Support
CBITS and other School Mental Health
Programming
Sharing of implementation experiences
and relevancy of CBITS and other SMH
services for youth in foster care
Discussion
What are strategies that you think would
help a school to be more trauma sensitive
to its students?
Fostering Community Connections and
Collaboration with Schools
It takes a village to help each student to be
successful
Who are needed partners to help youth in foster
care to be successful in schools?
How can we improve coordination and
collaboration?
How can we learn about each others systems
to enhance a coordinated mental health model
of care?
Developing a Directory of Health and
Mental Health Services in BCPSS Schools
Goals
To share information about who provides
mental health related services in schools
Increase awareness of services available at
each school
Promote ease of connecting with schools and
school staff
Large Group Discussion
How can the initiative better outreach to
youth and parents/guardians to enhance
their involvement in advancing mental
health in schools for youth in foster care?
www.schoolmentalhealth.org
Website developed and maintained by the
CSMH with initial funding from the
Baltimore City Health Department
User-friendly mental health related
information and resources for caregivers,
teachers, clinicians, and youth
Section on School mental health for youth
in foster care
Conclusions
 School mental health services and programming
can help reduce barriers to learning and
promote success for youth in foster care
 Building effective partnerships and
communication among schools, families, mental
health providers, and child welfare staff is a
priority
 Educators, clinicians and child welfare staff
would benefit from enhanced training related to
school mental health and foster care
 Youth in foster care need to be a priority
population in schools
A National Community of Practice
CSMH and IDEA Partnership
(www.ideapartnership.org) supporting
30 professional organizations and 12
states, 10 practice groups
Providing mutual support, opportunities for
dialogue and collaboration
Advancing multiscale learning systems
Sign up at www.sharedwork.org
10 Practice Groups
Social, Emotional, and Mental Health in
Schools
Developing a Common Language
Connecting Education and Systems of
Care
Connecting SMH and Positive Behavior
Support
Improving SMH for Youth with Disabilities
10 Practice Groups (cont.)
Connecting School Mental Health with
Juvenile Justice and Dropout Prevention
Family Partnerships
Youth Involvement and Leadership
SMH – Child Welfare Connections
Quality and Evidence-Based Practice
13th Annual Conference
13th Annual Conference on Advancing
School Mental Health. Phoenix, Arizona.
September 25-27, 2008
See http://csmh.umaryland.edu or call 410706-0980 (or 888-706-0980 toll free)
www.schoolmentalhealth.org
Website developed and maintained by the
CSMH with initial funding from the
Baltimore City Health Department
User-friendly mental health related
information and resources for caregivers,
teachers, clinicians, and youth
Two New Journals
Advances in School Mental Health
Promotion
The Clifford Beers Foundation and the
University of Maryland
www.schoolmentalhealth.co.uk
School Mental Health
www.springer.com
Question and Answers
Contact Information
[email protected]
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