School Mental Health ASSIST quipe dappui en sant

School Mental Health ASSIST Équipe d’appui en santé mentale pour les écoles Mental Health Leaders’ Meeting January 13 th, 2012

Agenda Ordre du jour Welcome and Overview Mot de bienvenue et aperçu Introductions Présentations School Mental Health ASSIST Équipe d’appui en santé mentale pour les écoles – aperçu Organizational Leadership Module sur le leadership organisationnel Lunch Déjeuner Dialogue Spaces Espace dialogues Learning Together Apprendre ensemble Mental Health Awareness Webinar Webinaire de sensibilisation en santé mentale Closing and Next Steps Prochaines étapes et mot de la fin 1/13/2012 School Mental Health ASSIST 2

Welcome! 1/13/2012 School Mental Health ASSIST 3

Key Messages to Take Away 1. This work is important. 2. You are critical to its’ success. 3. We are here to support you. Together, we will shape the future of school mental health in Ontario. 1/13/2012 School Mental Health ASSIST 4

This Work is Important � 1 in 5 students – the need is great �Educators feel ill-prepared to deal with the magnitude of the problem (Taking Mental Health to School, 2009) �Schools are an optimal place to promote student well-being, and to identify and support students who struggle with mental health and addictions - but resources and supports are required �The province is committed to working collaboratively across Ministries to support child and youth mental health in Ontario 1/13/2012 School Mental Health ASSIST 5

Our priorities for the next three years 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 Close Critical Service Gaps 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 • 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 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 1/13/2012 School Mental Health ASSIST 6

OVERVIEW OF THE MENTAL HEALTH AND ADDICTIONS STRATEGY FIRST 3 YEARS INDICATORS THEMES 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. Provide fast access to high quality service Identify and intervene in kids’ mental health needs early Kids and families will know where to go to get what they need and services will be available to respond in a timely way. 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. • Reduced child and youth suicides/suicide attempts • Educational progress (EQAO) • Fewer school suspensions and/or expulsions 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 • Higher graduation rates • Decrease in severity of mental • More professionals trained to identify kids’ mental health needs • Decrease in inpatient admission health issues through treatment rates for child and youth mental health • Fewer hospital (ER) admissions and readmissions for child and youth mental health • Reduced Wait Times • Higher parent satisfaction in services received INITIATIVES Improve public access to service information Pilot Family Support Navigator model Y 1 pilot 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 Funding to increase supply of child and youth mental health professionals Increase Youth Mental Health Court Workers Amend education curriculum to cover mental health promotion and address stigma Develop K-12 resource guide for educators Hire new Aboriginal workers Implement Aboriginal Mental Health Worker Training Program Improve service coordination for high needs kids, youth and families Reduce wait times for service, revise service contracting, standards, and reporting Outcomes, indicators and development of scorecard Implement school mental health ASSIST program &mental health literacy provincially Provide designated mental health workers in schools Expand inpatient/outpatient services for child and youth eating disorders Hire Nurse Practitioners for eating disorders program Implement Mental Health Leaders in selected School Boards 7 Provide nurses in Create 18 service Strategy Evaluation schools to support collaboratives mental 1/13/2012 health services School Mental Health ASSIST 7

EDU Commitments �Amend the education curriculum �Develop a K-12 Resource Guide/Website �Provide support for professional learning in mental health for all Ontario educators �Implement School Mental Health ASSIST �Fund and support Mental Health Leaders in 15 school boards �Support Working Together for Kids’ Mental Health 1/13/2012 School Mental Health ASSIST 8

You are Critical to Our Success �Research highlights the importance of leadership in effective school mental health �This leadership relies on key system mobilizers who create and sustain organizational conditions necessary for effective school mental health �EDU has invested in you to serve this critical role 1/13/2012 School Mental Health ASSIST 9

We are here to support you �Leadership Modules ◦ Focus on implementation science and creating conditions for effective school mental health �Mental Health Awareness ◦ For system leaders ◦ For schools �Communication & Literacy materials tools for use in your board �Ongoing implementation and coaching support via School Mental Health ASSIST 1/13/2012 School Mental Health ASSIST 10

Together, we will shape the future of school mental health in Ontario. We will be consulting with you, questioning with you, struggling with you, walking with you… to find the best ways to help all of Ontario students. 1/13/2012 School Mental Health ASSIST 11

Introductions �Take 5 minutes to chat with your team ◦ What are the top concerns for your board right now (in the area of school mental health) ◦ What are your hopes for student outcomes resulting from the Mental Health and Addictions Strategy? � Spokesperson will introduce team members and their roles, and will share board concerns and hopes 1/13/2012 School Mental Health ASSIST 12

Awareness, Strategy Selection & Implementation Support Team School Mental Health ASSIST Équipe d’appui en santé mentale pour les écoles Interactive Overview Interrupt! Ask Questions! Jot down questions for the parking lot (green for questions!)

Key Messages to Take Away School Mental Health ASSIST… 1. Is here to support you. 1/13/2012 School Mental Health ASSIST 14

Context � Part of the Ministry of Education commitment to Open Minds, Healthy Minds � Led by Special Education Policy and Programs Branch � Contract with HWDSB to lead the initiative ◦ benefits from real-world proximity to issues and challenges of implementation � Hospital for Sick Children & Ontario Centre of Excellence for Child and Youth Mental Health are key partners ◦ involved in resource development, resource sharing, and implementation support 1/13/2012 School Mental Health ASSIST 15

Core Team School Mental Health ASSIST team includes: � Director (Dr. Kathy Short) � Co-Lead (John Malloy, Director of Education, HWDSB) � Implementation Support Team: ◦ Dr. Bruce Ferguson, Dr. Ian Brown ◦ 2 additional team members joining soon � Administrative Support (Ruth Millar) Working in close relationship with SEPPB (Barry Finlay, Maureen Cox, Trudy Blugerman, Mike Gildea, Paul Grogan, Caroline Hicks, Michel Laverdiere, Naila Manji, Caroline Parkin) 1/13/2012 School Mental Health ASSIST 16

School Mental Health ASSIST is… � Designed to help all school boards to support student mental health and well-being and address addictions - with particular focus in 2011 -2012 on 15 boards � Focus on leadership, capacity-building, and implementation of evidence-based strategies � Through hands-on, audience-specific resources & practical implementation support We are a provincial school mental health implementation support team Have a look at our draft Mission statement – suggestions? (pink) 1/13/2012 School Mental Health ASSIST 17

Rationale � Great need – 20% with diagnosable disorder but larger number of students with problems that interfere with well-being and achievement 1/13/2012 School Mental Health ASSIST 18

Rationale, continued � Schools play a critical role in supporting child and youth mental health and addressing addictions …but we can’t do it alone � Taking Mental Health to School Recommendations ◦ Model Coordination and Leadership ◦ Enhance Mental Health Literacy ◦ Increase Access to Evidence Based Practices ◦ Provide Implementation Support � Research points to the importance of dedicated implementation support for effective school mental health delivery 1/13/2012 School Mental Health ASSIST 19

Implementation Science Implementation Research: A Synthesis of the Literature Fixsen, D. L. , Naoom, S. F. , Blase, K. A. , Friedman, R. M. & Wallace, F. (2005). Implementation Research: A Synthesis of the Literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231). Download all or part of the monograph at: http: //www. fpg. unc. edu/~nirn/resources/detail. cfm? resource. ID=31 1/13/2012 School Mental Health ASSIST 20

Elements of our Draft Vision �All boards (and, ultimately, all schools) will have a Mental Health and Addictions Strategy �All boards will have structures and processes for implementation support �All educators will use their enhanced mental health literacy to be the caring adults that students need… Have a look at our draft Vision statement – suggestions? (pink) 1/13/2012 School Mental Health ASSIST 21

This is complex work! Board Level (e. g. , MH Strategy, coordinated mental health literacy training, menu of evidence-based strategies) Provincial Level (e. g. , interministry coordination, SMH ASSIST) Student Level (e. g. , enhanced sense of belonging, more help-seeking, stronger coping skills) Better mental health and academic outcomes School Level (e. g. , enhanced staff understanding of students with behavioral problems and helpful strategies, more accurate identification and referral, more caring adults) 1/13/2012 School Mental Health ASSIST 22

So, how will we get there? �Beginning with mental health awareness activities in ALL boards �Deeper level of support in 15 boards ◦ Mental Health Leadership and Organizational Conditions for Effective School Mental Health ◦ Mental Health Literacy for Educators ◦ Implementation of Mental Health Promotion and Prevention Programming 1/13/2012 School Mental Health ASSIST 23

The Capacity-Building Continuum Mental Health Awareness Mental Health Literacy Mental Health Expertise Strategies for providing basic Strategies for providing SMH mental health information, deeper working knowledge for professionals with the skills tailored for different school those who have a direct role in and knowledge to effectively board audiences supporting student mental provide evidence-based health promotion, prevention, and intervention ALL SOME FEW Resources will be tailored to different education audiences (e. g. , trustees, senior administrators, school mental health professionals, school administrators, school staff, parents, youth) 1/13/2012 School Mental Health ASSIST 24

School Mental Health ASSIST Activities for ALL Boards �Help ALL boards with school mental health awareness level initiatives ◦ Co-create awareness materials for leaders with CODE, OPSBA, etc. ◦ Prepare Webinar Series (District Level, School Level) ◦ Support Educator Guide ◦ Create on-line resource space ◦ Provide decision-making tools (e. g. , educator mental health literacy selection guide) ◦ Facilitate My. Health Magazine 1/13/2012 School Mental Health ASSIST 25

School Mental Health ASSIST Activities for 15 Boards School Mental Health Awareness activities, PLUS: SMH Leadership Educator MH Literacy Implementation Support Modules on implementation science Menu of modules for school administrators Ongoing coaching re: strategy selection Modules on creating conditions for SMH Menu of modules for school staff Ongoing coaching re: implementation Support for conducting resource mapping Ongoing coaching re: progress monitoring and evaluation Support in developing a board MH Strategy SMH ASSIST learning network 1/13/2012 School Mental Health ASSIST 26

Types of Support �Resources ◦ Needs Assessment / Resource Mapping Tools ◦ Communication Tools ◦ Mental Health Leadership Series ◦ Strategy Development Templates ◦ School Mental Health Literacy Series ◦ Menu of evidence-based programs… �Ongoing coaching & implementation ◦ Face-to-face, email, telephone support �Opportunities support for networking across boards What else do you need? (yellow) 1/13/2012 School Mental Health ASSIST 27

Alignment of Ministry Initiatives Commun ity settings MCYS/Centre Community-Based MH Workers Working Together SSLI Health care settings School Boards Ontario Ministry of Education EDU/ASSIST SMH ASSIST 1/13/2012 SSLI MOHLTC Nurse Leaders MHA Nurses in DSB program SSLI School Mental Health ASSIST 28

2011 -2012 Tiered Support All Boards 2011 -2012 Focus Boards � Leadership ◦ Materials created with key stakeholders (CODE, OPSBA) � Capacity ◦ ◦ ◦ MH Awareness webinar Educator’s guide On-line resource for teachers Decision-making tools My. Health Magazine � Implementation ◦ Limited Q & A Support ◦ Mental Health Leaders ◦ Leadership Modules ◦ Alignment with Strategy initiatives � Capacity ◦ MH Literacy modules for schools ◦ MH Expertise training, as needed � Implementation Support ◦ Ongoing coaching / technical assistance ◦ ASSIST Learning Network ◦ Cross-ministerial alignment 1/13/2012 School Mental Health ASSIST 29

Highlights of the MH Leader Role � Provide leadership for school mental health and addictions in your board � Help to create organizational conditions necessary for effective school mental health � Through a resource mapping process, and consultation with stakeholders, create and enact a board mental health and addictions strategy � Select, tailor, and implemental health awareness and literacy resources � Select, tailor, implement, and monitor mental health promotion/prevention programming 1/13/2012 School Mental Health ASSIST 30

General Timelines (nb. we are not all starting at the same place…) Activity Broad Time Frame Leadership Module #1 January Individual Meeting with SMH ASSIST January - February Needs Assessment / Resource Mapping January - February MH Awareness Activities (webinar, My. Health) January - February Leadership Module #2 February Leadership Module #3 March School Administrator MH Literacy April School Staff MH Literacy May Progress Review with SMH ASSIST June 1/13/2012 School Mental Health ASSIST 31

Monitoring and Evaluation �Recommended first step is a board needs assessment / resource mapping �Baseline data collection for all boards (district level survey, brief, January) �Proposing school, teacher, and ultimately student level data collection in focus boards – coming soon! �Will be seeking your feedback along the way, and via year-end satisfaction measures 1/13/2012 School Mental Health ASSIST 32

What should/can we measure… - At the district level? - School level? - Teacher level? - Student level? 1/13/2012 School Mental Health ASSIST 33

We don’t have all of the answers. To serve you best, we are working with LEADERS in the province, and beyond, to gather the best thinking on effective School Mental Health. That includes learning from you. 1/13/2012 School Mental Health ASSIST 34

Who should we consult with? �Interministerial Staff Team, Regional Offices �Coalition for Child & Youth Mental Health �Council for Ontario Directors of Education �Chief Psychologists, Chief Social Workers �MACSE, Principals’ Reference Group �School Mental Health Research Advisors ◦ Researchers with experience in school mental health implementation, scale up, and evaluation �National SBMHSA Consortium ◦ Educator Mental Health Literacy Roundtable �Mental Health Literacy Experts in Ontario Who else should we be consulting with? (purple) 1/13/2012 School Mental Health ASSIST 35

When might we turn to YOU? List 1 -3 areas in which you have developed some particular knowledge / expertise related to school mental health Like, • Developing district infrastructure or protocols • Working with community partners • Supporting families in rural/remote communities • Working with immigrant and refugee children • Helping students with behavioral disorders • Implementing evidence-based programs • Working with FNMI communities • Mental Health Literacy for Educators • Suicide prevention…. 1/13/2012 de e! u l c m In na ur o y School Mental Health ASSIST 36

Home About Howdy, Stranger! It looks like you're new here. If you want to get involved, click one of these buttons! Resources Discussion Search o Sign In o Apply for Membership Learning Together 1/13/2012 School Mental Health ASSIST 37

Contact ASSIST � Kathy Short, Ph. D. , C. Psych. Director, School Mental Health ASSIST Kathy. Short@hwdsb. on. ca 905 -527 -5092, x 2634 1/13/2012 School Mental Health ASSIST 38

Leadership Module #1 Understanding Implementation in School Mental Health 1/13/2012 School Mental Health ASSIST

Introduction �Module #1 focus is on implementation �Specifically, our role as leaders in implementation �To begin, we need to understand our own biases about mental health, and change �Changing values, not just behaviours �To obtain the mental health outcomes we want for our students need to change the knowledge AND attitudes and values of adults who support students 1/13/2012 School Mental Health ASSIST 40

Case Study #1 and #2 1/13/2012 School Mental Health ASSIST 41

Education Supports “For every increment of performance I demand from you, I have an equal responsibility to provide you with the capacity to meet that expectation” (R. Elmore, 2002) 1/13/2012 School Mental Health ASSIST (Fixsen) 42

Successful Districts � Clear vision – we will do literacy, math, mental health this way � Unwavering instructional/mental health leadership and support � Good communication plan with consistent messages � Effective supports in place to help Principals, teachers, and staff follow through and “do it” 1/13/2012 School Mental Health ASSIST (Fixsen) 43

Successful Districts �Assure consistent supports across buildings ◦ Do not depend so much on unique principals or teachers who come and go �Achieve more consistent student outcomes, across teachers, buildings, and years 1/13/2012 School Mental Health ASSIST (Fixsen) 44

Implementation Science Longitudinal Studies of Comprehensive School Reforms Evidence-based Actual Supports Years 1 -3 Outcomes Years 4 -5 Every Teacher Trained Fewer than 50% of the teachers received some training Fewer than 10% of the schools used the CSR as intended Every Teacher Continually Supported Fewer than 25% of those teachers received support Vast majority of students did not benefit Aladjem & Borman, 2006; Vernez, Karam, Mariano, & De. Martini, 2006

Implementation Science �An intervention is one thing �Implementation altogether �Like is something else serum and a syringe ◦ Each is necessary ◦ Neither one is useful without the other 1/13/2012 School Mental Health ASSIST (Fixsen) 46

Formula for Success Effective intervention practices X Effective implementation practices = Good outcomes Disproportional Impact: Students benefit 8 to 12 times more

(Institute of Medicine, 2000; 2001; 2009; New Freedom Commission on Mental Health, 2003; National Commission on Excellence in Education, 1983; Department of Health and Human Services, 1999) IMPLEMENTATION INTERVENTION Effective NOT Effective Actual Benefits Poor outcomes 1/13/2012 Inconsistent; Not Sustainable; Poor outcomes; Sometimes harmful School Mental Health ASSIST (Fixsen) 48

Implementation Science �Letting it happen ◦ Recipients are accountable �Helping it happen ◦ Recipients are accountable �Making it happen ◦ Implementation Teams are accountable Based on Greenhalgh, Robert, Mac. Farlane, Bate, & Kyriakidou, 2004

Implementation Science IMPLEMENTATION INTERVENTION Impl. Team Effective NO Impl. Team 80%, 3 Yrs 14%, 17 Yrs Effective use of Implementation Science & Practice Letting it Happen Helping it Happen Fixsen, Blase, Timbers, & Wolf, 2001 Balas & Boren, 2000 3 X to 12 X Return on Investment

Implementation Science Best Data Show These Methods, When Used Alone, Do Not Result In Uses of Innovations As Intended: � Diffusion/ Dissemination of information � Training � Passing laws/ mandates/ regulations � Providing funding/ incentives � Organization change/ reorganization About 5% to 20% Return on Investment

OUTCOMES (% of Participants who Demonstrate Knowledge, Demonstrate new Skills in a Training Setting, and Use new Skills in the Classroom) TRAINING COMPONENTS Knowledge Skill Demonstration Use in the Classroom Theory and Discussion 10% 5% 0% . . +Demo in Training 30% …+ Practice & Feedback in Training 60% 5% 95% 95% …+ Coaching in Classroom 20% 0% Joyce and Showers, 2002

Reliable Benefits Consistent uses of Innovations on i t ta n e s m r e l e p riv m I D Performance Assessment Training Selection Systems Intervention n tio za ni rs ga ive Or Dr Co m Dr pet iv en er cy s Coaching Facilitative Administration Integrated & Compensatory Decision Support Data System Leadership Drivers Technical Adaptive © Fixsen & Blase, 2008

Implementation Team Teachers Innovations Students Practice Informed Policy System Change Executive Management Team Policy Enabled Practice “External” System Change Support System Reinvention Adaptive Challenges • Duplication • Fragmentation • Hiring criteria • Salaries • Credentialing • Licensing • Time/ scheduling • Union contracts • RFP methods • Federal/ Prov. laws

System Reinvention Board Implementation Team MH Leaders SMH Professionals Teachers Practice Informed Policy System Change Policy Enabled Practice School MH ASSIST Support EDU Adaptive Challenges • Duplication • Fragmentation • Hiring criteria • Salaries • Credentialing • Licensing • Time/ scheduling • Union contracts • RFP methods • Federal/ Prov. laws 55

PACE Modules �Effective Tiered implementation Teams ◦ Provincial ASSIST ◦ District MH Teams, with MH Leaders ◦ School MH Teams �Homework Assignment ◦ We will send a link to the modules ◦ Review and participate in on-line dialogue 1/13/2012 School Mental Health ASSIST 56

Move to Dialogue Spaces Organizational Leadership Educator Mental Health Literacy Mental Health Promotion and Prevention Programming 1/13/2012 School Mental Health ASSIST

Dialogue Spaces �A �A chance to share experiences and ideas chance to ask questions and learn from each other � 3 topics, groups of tables: ◦ SMH Leadership ◦ Educator Mental Health Literacy ◦ Implementation (Mental Health Promotion and Prevention Programming) � 15 minutes per topic, then full group sharing 1/13/2012 School Mental Health ASSIST 58

Dialogue Questions �What are you doing in this area now that you feel is working? �What do you need in order to be more successful in this area? 1/13/2012 School Mental Health ASSIST 59

Learning Together Your Ideas?

How would you like to work and learn together? �Ideas for carrying the conversation, sharing ideas, across our boards �Connecting individually with the implementation support team ◦ Main SMH ASSIST contact for each board? ◦ Is face-to-face visiting important to you? ◦ How can we make web-based learning most optimal for you? ◦ How would you like to provide feedback to us as things move forward? 1/13/2012 School Mental Health ASSIST 61

Mental Health Awareness Webinar Positioning This Resource Effectively in your Board

Suggestions? �How might the content be modified to meet the needs out there? �How should boards consider offering this resource? 1/13/2012 School Mental Health ASSIST 63

With Your Board Team… �What content needs to be tweaked for our purpose? �Who should receive this? �In which order should audiences receive this? �How should this be delivered? �Who should deliver it? �Other questions we should ask… 1/13/2012 School Mental Health ASSIST 64

Closing and Next Steps And Thank You!

Resources Coming Your Way �Communication �Needs tools for your board assessment/resource mapping tool �Baseline District Survey �District MH Awareness Webinar �Mental Health Literacy Selection Guide �My. Health Magazine invitation �Implementation Science Modules 1/13/2012 School Mental Health ASSIST 66

Next Steps �Connect with ASSIST Implementation Team to schedule an individual meeting and begin the needs assessment process �Complete the on-line implementation modules �Decide how/with whom MH Awareness activities will be offered �Attend leadership sessions #2 (February) and #3 (March) 1/13/2012 School Mental Health ASSIST 67

A visit to the Parking Lot �Burning �Please Questions and Comments… complete the evaluation form Thank you! 1/13/2012 School Mental Health ASSIST 68