Change Direction. Mission. Typical or Troubled? School Mental Health Education Program. Typical or Troubled? Today s Presentation

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1 School Mental Health Education Program Change Direction 1. Personality Change Notice. Talk. Act A Program of The American Psychiatric Foundation 2. Agitation 3. Isolation 4. Decline in personal appearance 5. Hopelessness Mission Advance public understanding that mental illnesses are real and can be treated Raise funds and awareness Conduct public education and outreach programs Focus on patients, families and community 1. Typical or Troubled? 2. Work in Schools? 3. 1 none, but want to learn more, 2 - some, 3 fair, 4 - good, 5 excellent -- knowledge mental health Other areas of Foundation focus Today s Presentation Judicial Leadership Initiative Brings judges and justiceinvolved individuals from all levels of state judiciaries together to improve judicial understanding of, and responses to, individuals with mental illnesses in our nation's courts. Partnership for Workplace Mental Health Leading resource for information about workplace mental health for employers, government, media, health plans, benefits consultants, and mental health organizations 1. Adolescent Mental Health 2. Your Role in the School 3. The Typical or Troubled? Program 4. Prevention and Impact 5. Best Practices for Implementation 6. Getting Involved 7. Q&A 1

2 Mental Health Disorders in Students Approximately 1/3 of adolescents with major depressive disorder also suffer from another mental disorder. FALSE: It s 2/3 20% of 9-17 year olds have diagnosable psychiatric disorders with at least minimum impairment. 10% suffer from severe mental illness causing significant impairment Fewer than one in five receive needed treatment in a given year Note: One in five kids in the pediatrician s office has an emotional disorder Background & Trends Mental Health Disorders in Adolescents Teens mental health issues permeate every town across the nation 90% of students show warning signs by age 14 Untreated can result: Worsening illness Substance abuse Trouble w/the law Failure in school Tragedies such as suicide Troubling relations Unlike most cancers or heart disease, young people with mental disorders suffer when they are on prime of life. (NIMH) 90% show early warning signs by age 15 Suicide is the 3 rd leading cause of death among teens 15 to 24 years old Mental Health Disorders in Students Mental Illness in U.S. Adolescents Count from 1 to 5 Despite effective treatments, there are long delays sometimes DECADES between first onset of symptoms and when people seek and receive treatment. (NIMH) Early identification and connecting to help is critical 2

3 No Help Leads to Pain Suffering Failing Those with a untreated mental health disorder are three times more likely to develop a secondary disorder Early identification training program for teachers, school personnel and parents to identify the early warning signs of mental illness and have the knowledge to refer the students to a mental health professional. Help Leads To Better academic achievement Less substance abuse Notice Talk Act Improved chances for their future What is in it for them? Research Conducted on Where to Have Impact School Community connected to kids, adults, supports Targeting teachers, school personnel (coaches, nurses, other) See the signs and don t know what to do, want to know Want to help, most believe it is their job to help teens Want to avoid consequences of not acting Appreciate information from a credible source not misinformation Want to know the difference between typical or troubled Want to know how to refer Don t want to be Junior Psychiatrists Goal Reduce the gap between on-set and treatment Objective Educate school personnel about teen/adolescent mental health Science of mental illness Notice, Talk, Act Notice the early warning signs Talk to students and parents Act by properly executing referrals 3

4 School Community Informed Program Research based program Community informed every element Materials developed with school, community and experts Focus groups tested Piloted and revised Evaluated over 7 years Overview TRAINED 70,000 Teachers and School Staff* 37 States, D.C., and U.S. Territories REACHED 1 Million Students / Típico o Problemático? provides training and technical assistance: Encourage and equip adults to know and notice warning signs of mental health problems; Teach intervention strategies; and Train adults on referral systems in schools Curriculum Questions for the Audience Warning Signs of Mental Illness + School Referral Process Eating Disorders Schizophrenia ADHD Oppositional Depression Defiant Disorder Bipolar Disorder Conduct Disorder Anxiety Disorder Substance Abuse What are some of the mental health issues you ve seen in the classroom Question for the Audience Measures of Success Expanded Awareness of NTA and mental health issues Collaboration Educating Parents Increased Referrals Preventing Tragedy Ready to Implement Curriculum Catalyst for Referral Process What is being done in your school to address Student mental health Any programs. 4

5 Question for the Audience Today s Presentation How do you help identify kids and connect them to help Getting involved in ToT Your Role? State of the problem Treatment Steps to take Warning signs Normal teen development Types of mental health problems Referral process Talking to parents Managing the Classroom Sample Presentation (Insert Name of School) Typical or Troubled? TM Know the Difference, Make a Difference A Program of the American Psychiatric Foundation Typical or Troubled? Sections Everyone Can Make a Difference Section 1: Introduction Section 2: Early Warning Signs Section 3: Mental Health Disorders Section 4: Connecting to Help Section 5: Referral Process Section 6: Managing Classroom, Engaging Parents, Resources Every Adult School Staff Parents 5

6 Depression Frequent outbursts Marked change in school performance Abuse of alcohol/ drugs Intense fear of becoming obese Unusual behavior Aggression Threat to harm self or others Self-injury Nightmares Physical complaints Sexual acting out Threats to run away Inability to cope Typical Teens Complex period of rapid change, transition Challenges: fitting in, defining identity, competing demands (school, home) Sometimes - other home issues (divorce, violence or substance abuse) Bottom line: May display alterations of mood, distressing thoughts, anxiety, and impulsive behavior. 31 Typical or Troubled? TM Teen Mental Health Disorders Mood disorders Psychotic disorders Anxiety disorders Behavioral/ disruptive disorders Experiencing more than normal developmental challenges Without treatment, more likely to have serious problems: Academic Relationships Employment Signs of Trouble 35 Typical or Troubled? TM Typical or Troubled? As you NOTICE signs, ask yourself, are they: Typical? Troubled? FREQUENT? (e.g., student is quiet, withdrawn over multiple days/weeks) EXTREME? (e.g., violent outburst) If either: TALK with student ACT by communicating what you ve seen/heard with school MH staff 33 Typical or Troubled? TM 36 Typical or Troubled? TM 6

7 Quantitative Outcome Overview Results of survey of 70,000 ToT school staff On average 86.5% now know the warning signs of mental illness to look for in an adolescent After receiving the training, 81% would now refer a student to a mental health professional 25% increase between the pre-training survey and post-training survey showing that teachers/staff now know how to talk to student suspect is showing warning signs of mental illness Customizable Qualitative Outcomes The paraprofessionals made a 180 degree shift to knowing that they could help the student. This is the most useful presentation we have ever attended! This is the most useful presentation we have ever attended! As of mid-january, we already outpaced our total referral numbers for the entire school year from the one training we provided in November. The training was detailed enough, but not too detailed. A lot of teachers forget that they are a resource to the kids and to look for signs. It s a good reminder to be on the lookout Outcomes Referral Survey Percentage of Participants 95% Strengthened Process and Increased Referrals 85% Staff Knows Role in Referral Process Outcomes 50% Will Continue Training Background MN TAP and 2014 Grantees- representing 8 school systems in MN, SC, and OH TOT presentations in Aug. & Sept TOT intervention schools and 1 non-intervention (control) school participated 100% of participants completed all survey rounds 7

8 Study Methods Spring vs. Fall 2014 Data Referrals Defined Teacher/school staff speaks to lead trainer, counselor or social worker in school about student mental health concern; Teacher/school staff contacts or talks to student or parent about concern; and/or, Other action by a teacher/school staff to connect student to help and/or support within the school 4 Rounds of Surveys conducted- 1, 2, 4, and 8 weeks after TOT Training All Participants asked number of referrals they ve received on monthly basis (before training/survey) and if external mental health providers worked in school Spring Week 4 10% 10% 20% 50% Week 8 10% 10% 30% 50% 1-3 Referrals 4-7 Referrals 8-9 Referrals Referrals 20+ Referrals Week 4 12% 25% 63% Week 8 38% 63% Fall Intervention Group 30% 100% 71% Trends Tripled # of Referrals from Week 1 Doubled # of Referrals from Week 1 Surpassed Monthly Referral Average TOT intervention groups demonstrated a continued increase in the # of referrals after the 1st month of the study, whereas the non-intervention group plateaued in the # of referrals after the 1st month of the study Week 4 & Week 8 Results Average Referrals Week 4 Week 8 TOT Interention Group Control Group Baseline Referrals Trends Continued 2-3 referrals/ month baseline referral average was doubled on average in actual referrals received after the TOT intervention No referrals received prior to school year start date Average baseline for referrals prior to study/tot intervention trainings was 2-3 referrals per month No correlation seen between referrals and grade levels served or external mental health professional in school Field Testimony Ben Harrington And Tracey Glascoe 8

9 Outcomes Outcomes Ben Harrington Mental Health Association of East Tennessee Knoxville, TN Specialized referrals from schools for diagnoses which may be beyond the scope of traditional school mental health services Diagnoses include: Trichotillomania Cutting Early psychosis Home of the Big Orange Home of Big Ideas! Outcomes Mental Health 101 Typical Or Troubled? Potato Chip Effect & Thirsting for more Doing BOTH Outcomes Trained nearly 1,000 educators Who pledged to Notice, Talk, Act.refer more students Big Ideas, Big Outcomes 13% decrease in high school youth meeting diagnostic criteria for depression = Earlier intervention before stress manifests to depression Increased student mental health referrals Largest CMHC in Knoxville 453% increase in C&Y patients since % Decrease in suicide contemplation 30% Decrease in Suicide planning 57% Decrease in high school teens attempting suicide 9

10 Most Importantly 0Teen Suicides Importance of Early Intervention Programs Early identification and proper treatment has been found to dramatically reduce problems experienced by youth with ADHD. school failure and dropout (30-50%) depression behavioral disorders vocational problems (into the adult years) relationship problems (into the adult years) substance use and abuse accidents (4x more likely MVA) and injury, teen pregnancy Importance of Early Intervention Programs Tracy Glascoe, LCSW We know that the brains of traumatized children are not as well intergraded as the brains of non-traumatized children often causing significant problems with emotional regulation and learning, but because our brains are not fully developed until the end of adolescents age 23 it is never too late intervene and change the trajectory of a child s life. Importance of Early Intervention Programs Many mental illnesses have an early age of onset 90% of children will show early warning signs of mental illness by age 15 Suicide is still the 3rd leading cause of death among teens We know that severe disorders are preceded by less severe disorders (if left untreated) The consequences of non-treatment can be, and are devastating Why Schools? Schools are critical settings for reaching youth with mental health needs Teachers are on the front line with student s every day and may notice worrisome behaviors and appearances, they often have existing relationships with students, and do not need to be mental health experts but can take small steps to make big differences. 70% of youth with mental health problems do not get tested and for those who do, schools have increasingly become the main site for the provision of mental health treatment. 10

11 Mental Health & Academic Outcomes Implementation Overview Schools are under increased pressure to demonstrate that programming promotes student academic achievement. There is strong evidence that helping students obtain mental health treatment not only can improve emotional functioning but also academic and behavioral outcomes (ex.expulsions, office referrals) in the school setting. In our school we found Teachers were very interested It was helpful to include personal stories of teacher experiences It changed teacher s perceptions of some students with challenges vs. bad behavior Additional sections we added include: Kids who need most love ask for it in the most unloved ways Students that identified teacher as only support in conjunction with serious illness plan Teachers have the ability to make a life-long impression Implementation Overview Field Expert Questions Vanderbilt Psychiatry School-Based Program 35 MNPS E/M school sites 32 Mental Health Clinicians Psychiatry Fellows & a NP Uniquely positioned to offer the trainings Implementation Overview 1. Administered mid-late summer 2.Requested minutes of training 3.Sent principal letters and made follow-up phone calls Presentation included: Apply for the Program Application Deadline extended for you! April 24 th deadline Two presenters Customized slides Allocated slide emphasis On a school basis Interaction with audience Katrina@reillygroupinc.com 11

12 Technical Assistance Partnership Questions 12