LDI Research Seminar_ Standardization under Group Incentives 4_27_12
CMHPSR/LDI Research Seminar_New Models for Childrens Mental Health Services Drilling Deeper in Urban Schools 10_1_12
1. Marc
S.
Atkins,
Ph.D.
University
of
Illinois
at
Chicago
Institute
for
Juvenile
Research
2. Presenta(on
Goals
Review
concerns
with
current
system
of
children’s
mental
health
care
in
U.S.
Ecological
principles
and
public
health
framework
as
justification
for
focus
on
schooling
Present
experimental
intervention
model
and
preliminary
results
Future
directions
3. Dulal
Bhaumik,
Ph.D.
Runa
Bhaumik,
Ph.D.
University
of
Illinois
Chicago
Center
for
Health
Sta(s(cs
Marc Atkins,
Ph.D.
Robert
Gibbons
Tara
Mehta,
Ph.D.
University
of
Chicago
Elisa
Shernoff,
Ph.D.
Ane
Marinez-‐Lora,
Ph.D.
Department
of
Health
Studies
David
Henry,
Ph.D..
Amy
Starin,
Ph.D.
University
of
Illinois
Chicago
University
of
Illinois
Chicago
Ins(tute
for
Health
Research
and
Ins(tute
for
Juvenile
Research
Policy
Charles
Glisson,
Ph.D.
Anthony
Hemmelgarn,
Ph.D.
D.Bridget
Hamre,
Ph.D.
University
of
Tennessee,
Knoxville
University
of
Virginia
Children’s
Mental
Health
Services
Research
Center
Center
for
Advanced
Study
in
Teaching
and
Learning
Sonja
Schoenwald,
Ph.D.
Ashli
Sheidow,
Ph.D.
Elise
Cappella,
Ph.D.
Stacy
Frazier,
Ph.D.
Jason
Chapman,
Ph.D.
New
York
University
Florida
Interna(onal
University
Medical
University
of
South
Carolina
Steinhardt
School
of
Educa(on
Center
for
Children
and
Families
Family
Services
Research
Center
and
Culture
Developing
Center
for
Innova(on
in
Services
and
Interven(on
Research
(NIMH
P20
MH078458)
4. Drilling
Deeper
Social
Rela(ons
Teachers
Students
Organiza(onal
Theory
Culture
Climate
Mental
Health
Prac(ce
Teachers
Parents
5. Na(onal
Focus
on
Children s
Mental
Health
First
ever
Surgeon
General
report
on
mental
health
(2001)
Established
mental
health
needs
of
children
as
national
priority
Current
system
inadequate
to
meet
needs
President s
New
Freedom
Commission
on
Mental
Health
(2003)
Mental
health
services
fragmented,
disconnected,
and
inadequate.
6. 7.5
Million
U.S.
Children
with
Unmet
Mental
Health
Need
Kataoka
et
al.
Am.
J.
Psychiatry
2002;
159:1548-‐1555
6
7. Service
Use
by
Sector
Great
Smokey
Mountain
Study
90
80
70
60
Child
Welfare
50
Health
40
Mental
Health
30
Education
20
10
0
None
Mild
SED
Mental
Health
Need
9. Ins(tute
of
Medicine
One factor lurks in the background of
every discussion of the risks for
mental, emotional, and behavioral
disorders and antisocial behavior:
poverty ... Although not the focus of
this report, there is evidence that
changes in social policy that reduce
exposure to these risks are at least
as important for preventing mental,
emotional and behavioral disorders
in young people as other
preventive interventions. We are
persuaded that the future mental
health of the nation depends
crucially on how, collectively, the
costly legacy of poverty is dealt
with.
10. Na(onal
Spotlight
on
Schools
No
Child
Left
Behind
No
Child
Left
Untested
School
violence
Not
just
in
urban
communities
anymore
Global
marketplace
China
and
India
rising
Another
Sputnik
moment?
• U.S
Ranking
of
30
Countries
25th
in
Math
21st
in
Science
11.
12.
13. Teacher
Stress
Low
morale,
depressed,
feeling
unfairly
blamed
for
the
ills
of
society?
You
must
be
a
teacher.
-‐
NY
Times
Educa(onal
Supplement
(1997)
50%
of
teachers
in
high
poverty
schools
leave
within
3-‐5
years
(20%
of
all
teachers)
Shernoff
et
al.,.
School
Mental
Health
2011;
3:59-‐69
14. What
Do
We
Know
About
Urban
Schools?
•
Overcrowding
and
large
class
sizes
•
Deteriora(ng
condi(ons
•
Significant
unmet
mental
health
needs
(Boyd
&
Shouse,
1997;
Cappella
et
al.,
2008
)
15. What
Do
We
Know
About
Teacher
A7ri9on?
•
Teacher
shortages
due
to
migra(on
and
afri(on
•
Up
to
20%
of
public
school
teachers
leave
within
their
first
5
years
•
New
teachers
ogen
placed
in
hardest-‐to-‐staff
schools
•
Behavior
management
most
common
reason
(Barnes,
Crowe
&
Schaefer,
2007;
Guarino
et
al.,
2006;
Smith
&
Ingersoll,
2004)
16. School Goals Are Mental
Health Goals
Predictive of delinquency:
Academic failure
Low school bonding
Truancy
Low grades and aggression
in first grade highly predictive of not graduating
high school (ES = .78
Academic achievement protective for urban
children
Ensminger & Slusarcick. Sociology of Education 1992, 65:95-113.
Spencer et al., Educational Psychologist 2001; 36:1, 21-30
17. Ecological Principles:
Services Support Settings
Consider primary mission of setting (e.g.,
different goals for schools vs. after school)
Consider these goals as mental health goals
(don t ask setting to change goals)
Consider how mental health resources can be
reallocated to support setting goals
Always think sustainability (no shortcuts)
Atkins & Frazier. Perspectives on Psychological Science 2011; 6: 483-487.
18. Ecological
Theory
Interacting
nature
of
natural
contexts
and
their
impact
on
growth
and
development
Reciprocal
relations
among
natural
elements
in
an
environment
19. Sustainability
Able
to
be
maintained
at
a
certain
rate
or
level
Conserving
an
ecological
balance
by
avoiding
depletion
of
natural
resources
Able
to
be
upheld
or
defended
20. Diffusion of Innovation
• Innovative interventions
initiated by a relatively small
segment of opinion leaders
• Via modeling, innovations are
diffused through the
population, influencing others
• Rogers (1983) noted that
despite their knowledge,
professional change agents
often have little or no influence
21. Social Networks: Burt s Two-
Step Diffusion Theory
Step
1
Informa(on
is
spread
via
cohesion
(key
informants)
Step
2
Adop(on
and
use
spread
via
structural
similarity
(compe(tors
or
partners)
25. Links
to
Learning
Unite teacher, parent,
and MH provider around
predictors of learning
Link MH providers with
indigenous resources to
support teachers and
parents
Sustain services
through fee-for-service
Medicaid billing
NIMH R01 MH073749 (PI: Atkins)
26. Links to Learning Service Model
KOL Teachers
School
Teachers Behavior
Effective Instruction
CR Management
Parent Outreach
MH Academic
Providers
Achievement
Parents
Home-Based
School-Linked
Home
Behavior
Parent Advocates
28. Dissemination to Teachers and
Mental Health Providers
KOL teachers identified by sociometric interview and
enrolled with MH providers enrolled in on-line
graduate course on best practices
Site based workshop
10 week schoolwide professional learning series
hosted by KOL teachers and MH providers in KOL
teacher’s classroom for district CEU credit
KOL classroom was laboratory for MH providers and
other teachers
MH providers follow-up in classrooms of teachers of
students on their caseload
28
Watling-Neal et al.,The Community Psychologist 2008, 41:2, 53-57
29. Classroom
Interven(on
Strategies
Universal
Good
Behavior
Game
Peer-‐Assisted
Learning
Targeted
Daily
Report
Cards
Individual
Tutoring
Good
News
Note
30. Parent
Curriculum
• Home
rou(nes
that
support
learning
• Homework
• Reading
materials
• Reading
opportuni(es
• Home-‐school
communica(on
• Conferences
• School-‐home
notes
31. Mental
Health
Service
Use
100"
90"
80"
70"
Percentage)
60"
50" Links"
40" TAU"
30"
20"
10"
0"
Entered" 6"Months" 1"Year" 2"Year" 3"Year"
32. Teachers
Use
of
Strategies
Links
Only
20
18
16
14
12
10
Targeted
8
Universal
6
4
2
0
Spring,
Year
1
Fall,
Year
2
Winter,
Year
2
Spring,
Year
2
Fall,
Year
3
Winter,
Year
3
Spring,
Year
3
32
33. Dependent
Measures
Child
behavior
Academic
performance
Parent
involvement
Parent
and
teacher
report
(Fast
Track)
Parent
and
teacher
stress
Parent
report
(Caregiver
Strain
Q)
Teacher
report
(Quality
of
Teacher
Work
Life)
33
34. Random
Effects
Models
yit = λ0t η0i + λ1t η1i +εit
η0i = υ0 +γ0 zi +ζ0i
η1i = υ1 +γ1 zi +ζ1i
yit -‐ individual i at occasion t
λ1t -‐ time of measurement
η0i -‐ individual intercept with expectations υ0 and residuals ζ0i
η1i -‐ individual slope with expectations υ1 and residuals ζ1i
γ0, γ1 -‐ effects of time-‐invariant covariate on the initial level
and linear slope
εit ~ N(0,σε2)
Random components are independent
34
36. 3
Year
Classroom
Observa(ons
Peer
Comparisons
Engagement
Scores
80
75
Mean
Percentage
of
Time
Observed
Engaged
70
Target
Children
65
Peer
Comparisons
60
55
50
45
40
35
30
Fall
Yr
1
Spring
Yr
1
Fall
Yr
2
Spring
Yr
2
Fall
Yr
3
Spring
Yr
3
36
37. Classroom
Observa(ons
Peer
Comparisons
Off
–Task
Behavior
80
75
70
65
Target
Children
60
Peer
Comparisons
55
50
45
40
35
30
Fall
Yr
1
Spring
Yr
1
Fall
Yr
2
Spring
Yr
2
Fall
Yr
3
Spring
Yr
3
38. Curriculum
Based
Measures
Three
Years
Links
vs.
Controls
Reading
60
55
50
45
Links
40
Control
35
30
25
Fall
Yr
1
Winter
Spring
Fall
Yr
2
Winter
Spring
Fall
Yr
3
Winter
Spring
Yr
1
Yr
1
Yr
2
Yr
2
Yr
3
Yr
3
38
39. Curriculum
Based
Measures
Year
3:
Links
vs.
Controls
Reading
60
58
56
54
52
50
Links
48
Control
46
44
42
40
Fall
Yr
3
Winter
Yr
3
Spring
Yr
3
39
40. Teacher
Ra(ngs
3
Years
Links
vs.
Controls
Academic
Competence
4
3.5
3
2.5
Links
Control
2
1.5
1
Fall
Yr
1
Spring
Yr
1
Fall
Yr
2
Spring
Yr
2
Fall
Yr
3
Spring
Yr
3
40
42. Ongoing
Studies
Retaining
early
career
teachers
(Shernoff)
Connectedness
and
Effec(veness
(IES
Goal
II)
The
Classroom
Project
(Frazier)
Teacher
prac(ces,
classroom
climate,
student
outcomes
8
schools,
77
teachers,
620
students
Family
Student
Liaison
(Starin)
Community
members
suppor(ng
parents
to
support
their
children s
learning
The
Bridge
Project
(Cappella)
Mental
health
consulta(on
to
enhance
posi(ve
classroom
emo(onal
climate
43. Project
Bridge
Trained
community
MH
providers
in
NYC
public
schools:
Links
to
Learning
for
universal
and
targeted
mental
health
programs
MyTeachingPartner
(MTP)
web-‐based
teacher
instruction
for
classroom
organization,
emotional
climate,
&
student
relations
Random
assignment:
MTP
or
MTP
+
Links
36
classrooms
(K
to
5th
grade),
n
=
364
Implementation
January
through
April
43
45. Summary
The LINKS Center focuses on a program of
research to improve the mental health of children
living in high poverty urban communities
Links to Learning is a Medicaid fee-for-service
mental health service model implemented by
community mental health staff in high poverty
urban schools
Results suggest that services led to modest
improvements in children s learning and behavior
Ongoing studies will expand the model to
activate indigenous resources in schools to
provide additional support to students, teachers,
and families
46. Final
Thoughts
But
in
urban
schools
Given
the
large
needs
for
this
requires
afen(on
to
mental
health
services
in
the
unique
social
high
poverty
communi(es,
con(ngencies
that
and
the
importance
of
inform
and
promote
schooling
for
children’s
school
success
and
the
development,
schools
are
ac(va(on
of
indigenous
an
ideal
semng
to
resources
to
support
promote
urban
children’s
semng
goals
health
and
well
being.
The
goal
is
to
relieve
schools
from
the
job
of
providing
mental
health
services
by
making
successful
schooling
the
job
of
mental
health
services