Leading for Effective School Mental Health

1. Leading for Effective School Mental Health School Mental Health ASSIST Summit on Children and Youth Mental Health 2012

2. Session Agenda

3. LEADERSHIP With an elbow partner, or two… What does effective leadership look like at a School or Board level? Paint a Picture…

4. Ontario Leadership Framework Leadership is a lever to support large scale system improvement to enhance achievement and well-being. The Ontario Leadership Framework is relevant to our work with student mental health and well-being.

5. Ontario Leadership Framework 5 Domains: • Setting Directions • Building Relationships and Developing People • Developing the Organization • Leading the Instructional Program • Securing Accountability 5 Core Leadership Capacities: • Promoting Collaborative Learning Cultures • Aligning Resources with Priorities • Using Data • Setting Goals • Engaging in Courageous Conversations

6. Jot down a few ideas…. What are some of the qualities of an effective leader? Which of these do you possess, and value most strongly?

9. Overview • The Promise of School Mental Health • Provincial, National and International Initiatives • Acknowledging Past (and present) Challenges • Ontario’s Mental Health & Addictions Strategy • School Mental Health ASSIST • Top 10 Conditions for Effective School Mental Health

10. The Promise of School Mental Health

11. Mental Health is… “A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” World Health Organization

12. Mental Health Exists on a Continuum

13. Mental Health Problems are Common Roughly one in five students in Canadian schools struggle with a mental health problem that interferes with their day to day functioning.

14. What are Mental Health Problems? Mental health problems are emotional, behavioural and brain-related disturbances that interfere with development, personal relationships, and functioning Disturbances that are severe and persistent enough to cause significant symptoms, distress, and impairment in one or more areas of daily life are termed mental health disorders/mental illness.

15. Mental Health Problems include a Range of Difficulties Mental health problems are characterized by many different signs and symptoms, and present in various forms Some mental health problems manifest outwardly (externalizing) • Students appear aggressive, impulsive, non-compliant Some mental health problems manifest inwardly (internalizing) • Students appear withdrawn, lonely, anxious, depressed

16. The Good News • Proven strategies and supports • Psychosocial and pharmacological treatments are most common, and are often used together • While many mental disorders are chronic, we can help with coping • Early identification and intervention improves prognosis

17. But Most Do Not Receive the Help They Need • Up to 80% of children and youth who experience a mental health problem will not receive treatment • Major barriers include: • Lack of, difficulty accessing, or long waitlists for local services • Stigma • Misidentification or lack of identification of symptoms

18. Schools Have a Unique Opportunity Schools are an optimal setting in which to: Reduce stigma Promote positive mental health Build student social-emotional learning skills Prevent mental health problems in high risk groups Identify students in need Build pathways to care

19. School Mental Health is Not New… • Schools and communities in Canada and elsewhere have been dealing with these issues for decades • Inconsistent, fragmented approaches, with pockets of excellence… • What’s new is the galvanizing of research, policy and practice to reach an integrated solution to a complex problem

20. National, International, & provincial initiatives Moving Forward on the Promise of School Mental Health

21. OUT OF THE SHADOWS AT LAST  The Standing Senate Committee on Social Affairs, Science and Technology The Honourable Michael J. L. Kirby, Chair May 2006 Making the school a site for the effective delivery of mental health services involves several key steps.  First, its potential must be recognized.

22. National Initiatives Related to School Mental Health • School-Based Mental Health & Substance Abuse Consortium • Canada’s Mental Health Strategy (MHCC) • Evergreen • National Infant Child & Youth Mental Health Consortium • Opening Minds • Joint Consortium for School Health • Public Health Agency of Canada • Canadian Association for School Health • Health Canada • Canadian Centre for Substance Abuse

23. SBMHSA Consortium • 40 member team of researchers, education professionals, school mental health professionals, etc. • 3 year project • Led by Ontario Centre of Excellence for Child & Youth Mental Health • Synthesis of Research • Scan of Nominated Practices • National Survey Findings: • Research gives us clear direction • Programming does not consistently reflect research • Organizational and systemic barriers impede

24. International Initiatives in School Mental Health • International Alliance for Child and Adolescent Mental Health in Schools (Intercamhs) http://www.intercamhs.net/ • US – Canada Alliance for School Mental Health • SBMHSA webinar - international initiatives (Aus, Germany, US) • Advances in School Mental Health Promotion • Key international conferences featuring School Mental Health • 17th Annual Conference on Advancing School Mental Health, October 25-27, Salt Lake City, Utah --- see Mark Weist at CMHO! • 26th Annual Children’s Mental Health Research and Policy Conference, March 3-6, Tampa, Florida

25. Provincial Initiatives in School Mental Health • Emergence of government strategies (e.g., BC, MN, NS, ON) • Development of provincial coalitions (e.g., BC, ON) • Funded provincial initiatives related to mental health capacity building (e.g., AB, QB, NS, ON) • Cross-sectoral initiatives, infrastructure, protocols (e.g., BC, NB, ON) • Student mental health in provincial curriculum

26. Acknowledging challenges Learning from past and present

27. Taking Mental Health to School • Different models of mental health service delivery across Ontario boards (Taking Mental Health to School, 2009) • Variable leadership structures, levels/types of professional support, relationship with community, range of services • Acknowledgement of promising supports (e.g., Student Support Leadership Initiative) • Need for • leadership, • coordination, • access to evidence-based approaches, • implementation support, • evaluation

28. Past (present) Systemic Challenges • School boards are complex systems • Infrastructure, processes and protocols lacking • Lack of clarity re: roles and responsibilities • Special services are…special • Inconsistencies across Boards with respect to: • Leadership • Programming • Funding • Access to services • Collaboration Structural Challenges

29. Past (present) Systemic Challenges • Mental Health is not well understood • Not traditionally part of educator training • PD as a “one time event” • Links to high pressure achievement agenda unclear • Stigma, Attitudinal Biases • Discomfort and fear • Sometimes seen as outside of educator role • Worry about making a mistake, getting too close Knowledge Challenges

30. Mental Health Literacy Concern about Mental Health… Educator Preparedness…

31. Past (present) Systemic Challenges • Inconsistent access to high-quality programming • Evidence-based programs are expensive • Regional differences (in services, access, needs) • Funding shortfalls • Competing demands • Academic achievement agenda, with inherent pressures and supports, occupy most of time • Plates are full and increasing • Fragmented systems • Service pathways and protocols are not well-defined Implementation Challenges

32. Commitments to the Mental Health & Addictions Strategy Ontario Ministry of Education

33. Strategy Priorities for the Next 3 Years • Close Critical Service Gaps • Increase availability of culturally appropriate services and serve more children and youth • in Aboriginal, remote and underserved communities • With complex mental health needs • At the key transition point from secondary to post-secondary education • Fast Access to High Quality Services • Build capacity in the community-based sector • Reduce wait times • Meet community needs • Link education, child and youth mental health, youth justice, health care, and the community • Identify & Intervene Early • Provide tools and support to those in contact with children and youth so they can identify mental health issues sooner • Provide resources for effective responses to mental health issues • Build mental health literacy and local leadership • Support System Change • Support development of an effective and accountable service system for all Ontarians • Build on efforts that promote evidence-informed practice, collaboration, and efficiencies • Develop standards and tools to better measure outcomes for children and youth

34. Starting with Child and Youth Mental Health Our Vision: An Ontario in which children and youth mental health is recognized as a key determinant of overall health and well-being, and where children and youth reach their full potential. Identify and intervene in kids’ mental health needs early Professionals in community-based child and youth mental health agencies and teachers will learn how to identify and respond to the mental health needs of kids. Close critical service gaps for vulnerable kids, kids in key transitions, and those in remote communities Kids will receive the type of specialized service they need and it will be culturally appropriate Provide fast access to high quality service Kids and families will know where to go to get what they need and services will be available to respond in a timely way. THEMES • Fewer hospital (ER) admissions and readmissions for child and youth mental health • Reduced Wait Times • Reduced child and youth suicides/suicide attempts • Educational progress (EQAO) • Fewer school suspensions and/or expulsions • Higher graduation rates • More professionals trained to identify kids’ mental health needs • Higher parent satisfaction in services received • Decrease in severity of mental health issues through treatment • Decrease in inpatient admission rates for child and youth mental health INDICATORS Implement Working Together for Kids’ Mental Health Implement standardized tools for outcomes and needs assessment Enhance and expand Telepsychiatry model and services Provide support at key transition points Pilot Family Support Navigator model Y1 pilot Improve public access to service information Develop K-12 resource guide for educators Improve service coordination for high needs kids, youth and families Amend education curriculum to cover mental health promotion and address stigma Funding to increase supply of child and youth mental health professionals Increase Youth Mental Health Court Workers Hire new Aboriginal workers Implement Aboriginal Mental Health Worker Training Program Outcomes, indicators and development of scorecard Expand inpatient/outpatient services for child and youth eating disorders Hire Nurse Practitioners for eating disorders program Implement School Mental Health ASSIST program &mental health literacy provincially Provide designated mental health workers in schools Reduce wait times for service, revise service contracting, standards, and reporting Strategy Evaluation Implement Mental Health Leaders in selected School Boards Create 18 service collaboratives Provide nurses in schools to support mental health services OVERVIEW OF THE MENTAL HEALTH & ADDICTIONS STRATEGY - FIRST 3YEARS INITIATIVES 34

35. MCYS MH Workers with Schools Working Together Student Support Leadership Initiative (SSLI) MOHLTC Nurse Leaders MHA Nurses in DSB program Service Collaboratives SSLI EDU SMH ASSIST SSLI Interconnected Initiatives

36. EDU Strategy Commitments • Amend the education curriculum • Develop a K-12 Resource Guide/Website • Provide support for professional learning in mental health for all Ontario educators • Fund and support Mental Health Leaders • Implement School Mental Health ASSIST

37. School Mental Health ASSIST is a provincial implementation support team designed to help Ontario school boards to promote student mental health and well-being, through leadership, practical resources and systematic research-based approaches to school mental health.

38. Leadership Structure • Ontario Ministry of Education Lead • Special Education Policy & Programs Branch • School Board Lead • Hamilton-Wentworth District School Board • SMH ASSIST Core Team • Director, and 4+ P/T Implementation Coaches (3 Senior School Mental Health Professionals, 1 Superintendent),.5 Research Associate (new!) • Cross-Sector Partners • Interministerial Staff Team • Hospital for Sick Children, Ontario Centre of Excellence for Child & Youth MH • Provincial Stakeholder Organizations • Evaluation and Implementation Consultation Team • Drs. Michael Boyle, Bruce Ferguson, Tom Kratochwill, Robert Lucio, Ian Manion, Doris McWhorter, Karen Milligan, Caroline Parkin, Joyce Sebian, Mark Weist

39. Support to ALL Ontario Boards Resources Webinar series, other staff development materials Decision support tools Templates School Administrators’ Toolkit Consultation Workshops Representation on provincial reference groups & committees

40. Focus Boards • 15 Focus Boards in 2011-2012 • Another 15 announced for 2012-2013 • Boards receive 1 FTE Mental Health Leader and SMH ASSIST support • Reciprocal relationship with SMH ASSIST • ASSIST provides leadership & implementation support • Focus Boards help with piloting resources that will be rolled out to all boards in time

41. First Priorities • Organizational Conditions for Effective School Mental Health (addressing structural challenges) • Mental Health Capacity-Building (addressing knowledge challenges) • Implementation of Evidence-Based Mental Health Promotion and Prevention Programming (addressing implementation challenges)

42. Organizational Conditions for Effective School Mental Health

43. Organizational Conditions • Commitment • School Mental Health Leadership Team • Clear & Focused Vision • Shared Language • Assessment of Initial Capacity • Standard Processes • PD Protocols • School Mental Health Strategy / Action Plan • Broad Collaboration • Ongoing Quality Improvement

44. Self Reflection • Where is your board currently, TODAY, along each of the conditions… • Feel free to discuss, leave blank… • For your records…

45. Commitment Condition #1 • Board leaders view child and youth mental health as a priority, and communicate this through action • Board leaders commit to Tiered Support Model • Help board staff to understand the rationale for the model, emphasizing the focus in schools on mental health promotion and prevention and the need to work with community partners for help with students with significant mental health concerns • Board leaders consistently attend community liaison meetings and internal MH team meetings • Board leaders provide visible, strategic and tangible support for needed infrastructure, resources, staffing

46. Tiered Support in Systems of Care Organizational Conditions Community Universal E-B Mental Health Promotion E-B Clinical Intervention Mental Health Capacity Engagement Implementation Focus Targeted Evidence-Based Prevention Targeted Evidence-Based Prevention Universal Evidence-Based Mental Health Promotion, Social-Emotional Learning School Districts Continuous Quality Improvement Evidence-Based Clinical Intervention

47. School Mental Health Leadership Team Condition #2 • Board has a multidisciplinary, multi-layered mental health leadership team • All of the right people are at the table (in terms of expertise, influence, relationships, representation) • Parent and youth voice are critical • Team has meaningful liaison with community partners • Team is focused on vision-setting, leadership, collaboration, strategy/program selection, problem-solving

48. Clear and Focused Vision Condition #3 • Board has shared, realistic goals • Vision is aligned with AOP, BIPSA, Strategic Directions • Vision is aligned with key principles in school mental health (e.g., preventive, linked with instruction, evidence-based, connected with partners at home and school, strong use of data) • Vision and goals are created collaboratively • Vision is the basis for decision-making

49. Shared Language Condition #4 • The Board Vision for school mental health is communicated clearly across the organization • Foundational knowledge about student mental health is conveyed • Terms are defined consistently • Where differences in language occur (e.g., across sectors), there is translation • Use of early identification tools can be helpful for finding common ways to speak of problem areas

50. Assessment of Initial Capacity Condition #5 • Assessment data informs the development of the board mental health strategy • Before setting priorities, an assessment of organizational strengths, needs, and resources (resource mapping) can be very helpful • This assessment includes a scan of resources, in the form of people, processes, and programs • Staff and student voice data can deepen understanding of needs