Bill Pfohl, NCSP NASP President 2005 -06 billnasp@aol. com 1
Why Prevention? n n n n In NASP Training Standards Blueprint II area – Prevention, Promotion of Wellness & Crisis Intervention No place all information tied together for trainers or practitioners Our job roles – consultation, parent training, prereferral intervention, school safety; suicide, MH needs of our youth. Position Paper – Prevention & Intervention Research in the Schools Grant activity by NASP office with EDC, AIR, CASEL, SMHP Futures Conference outcome focus 2
We Do Not Have Enough Resources to Provide Helping Services to All Children Who Need Them • Epidemiological data suggest that 15% to 22% of the nation’s young people experience social, emotional, and mental health problems that require treatment. • Approximately 25 -30% of American children experience school adjustment problems. • For some economically disadvantaged urban districts, school maladjustment runs as high as 60%. • Research documents clear associations between school maladjustment and later serious problem behaviors. • Unfortunately, 70% to 80% of children in need are not getting appropriate mental health services. 5 CASEL at UIC
Youth Risk Behavior Survey (CDC, 2003) Behaviors U. S. % Had 5 or more alcoholic drinks in a couple of hours (30 days) 28. 3 Used marijuana (life) 40. 2 In a physical fight on school property (12 months) 12. 8 Carried a gun (30 days) 5. 4 Did not go to school because felt unsafe at school or on way to or from school (30 days) 6. 6 Felt so sad or hopeless almost every day for two weeks or more in a row that stopped doing some usual activities (12 months) 28. 6 Made a plan to attempt suicide (12 months) 16. 5 Currently sexually active (3 months) 34. 3 6 CASEL at UIC
But WHY? - Really § § NASP Shortages – estimated at 9, 000 between 2000 and 2010! Total: 15, 000 by 2020! 7
D. Erasmus “Prevention is Better Than Cure” 8
Ben Franklin “An Ounce Of Prevention is Worth a Pound of Cure” 9
History n n n Mental Hygiene Movement – early 1900’s Child Guidance Clinics – 1920’s and 1930’s Crisis Theory (Eric Lindemann) – 1940’s Joint Commission on Mental Health and Mental Illness – 1961 Community Mental Health Centers Act 1963 Advocates (e. g. , Albee, Cowen, Caplan, Goldston) 10
History (continued) n n n Task Panel on Prevention, President’s Commission on Mental Health - 1978 APA Task Force on Prevention – 1980’s Committee on the Prevention of Mental Disorders, Institute of Medicine - 1994 APA Presidential Task Force on Prevention (Seligman) – 1998 Priorities for Prevention Research at NIMH (NAMHC Workgroup report) - 2001 11
2002 Futures Conference n n Prevention was envisioned as a primary activity of school psychologists Every outcome area from the Conference stressed the centrality of prevention in the practice of school psychologists – 12 out of 15 priority goals involved prevention in some way 12
Do I Practice Prevention Already? 18
Prevention Activities n n n n n Screening Safe schools Pre-referral Suicide Social skills Bully-proofing Parent training Consultation Early literacy n n n n n Social competency Resiliency classrooms Counseling Drug education Violence prevention Health promotion Character education School reform Mental health 19
What is prevention? 20
Theory Base n n n n Mental Health Community Psychology Social Psychology Consultation Early Childhood education Parent training What Works research Public health 21
Caplan’s (1964) Terms n n n Primary prevention: decrease the number of new cases of disorders Secondary prevention: early identification and efficient treatment of existing cases Tertiary prevention: rehabilitation to reduce the severity of impairment caused by an existing disorder 22
NIMH Intervention Spectrum 23
Adelman & Taylor 24
The Goal: Full Integration of Prevention Into School Culture Addressing Barriers Instruction (Prevention) Student Management 25
Prevention, risk, and resilience 30
What has worked? n n Primary Mental Health Project (Cowen) – 1950’s Head Start – Economic Opportunity Act of 1964 Project RE-ED (Hobbs) - 1968 Healthy Start – Hawaii – 1970’s 31
Legacy of Longitudinal Studies of Developmental Risk n n n n Kauai Longitudinal Study Newcastle Thousand Family Study Boston Underclass Study Oakland Growth Study Rochester Longitudinal Study Isle of Wight study Minnesota Longitudinal Study of Parents and Children Doll & Lyon, 1998 32
Risk = Children are More Likely To Be Unsuccessful Adults Risk n n n n Poverty Low parent education Marital/family dysfunction Poor parenting Child maltreatment Poor health Parental illness Large family n n n n n Adult outcomes Mental illness Physical illness Educational disability Delinquency/ criminality Teen parenthood Financial dependence Unemployment Low social competence Low adult intelligence Doll & Lyon, 1998 33
Resilience = Vulnerable Children Who Become Successful Adults n n n Individual Positive social orientation Friendships Internal locus of control Positive self-concept Achievement orientation Community engagement n n n Family & community Close bond with one caretaker Effective parenting Nurturing from other adults Access to positive adult models Connections with prosocial organizations Effective schools 34
Dryfoos’ conclusions 1. 2. 3. A significant proportion of children will fail to grow into successful adults without major changes is how they are taught and nurtured. Families and schools require transformations to more adequately raise and educate children. New community resources and arrangements are needed to support the development of young people. Dryfoos, 1994 35
Prevention = Increasing strengths + Reducing problems 36
Strengths That Matter in Schools n n n Sustain warm and caring relationships with adults Sustain high academic and personal efficacy Promote satisfying peer relationships Promote student’s self-control Promote goal setting and decision-making Doll, Zucker, & Brehm, 2004; Resilient Classrooms 37
Mental Health: “The possession of skills necessary to cope with life's challenges” NASP, 2002 38
Mental Health: A Report of the Surgeon General n n n Identifying the factors that place children at risk is the first line of prevention n Cannot separate health from mental health n 20% of children and youth have a diagnosable mental illness Helping children receive services is the 2 nd step Barriers to help n Stigma n Lack of knowledge about treatment 39 Summarized in COPS Promoting Mental Health in Schools
Reducing Problems Prevalence of Disorders National Comorbidity Survey Replication, Kessler et al. , 2005 12 -month Lifetime Any disorder 26. 2% 46. 4% Anxiety Disorders 18. 1% 28. 8% Mood Disorders 9. 5% 20. 8% Impulse Control Disorders 8. 9% 24. 8% Substance Use Disorders 3. 8% 14. 6% 40
When do disorders begin? National Comorbidity Survey Replication, Kessler et al. , 2005 n The age of onset for most disorders was concentrated in the first two decades of life Anxiety disorders – 11 years average of onset n Impulse Control disorders – 11 years average of onset n Substance Use disorders – 20 years average of onset n Mood disorders – 30 years average of onset n 41
n n The majority sought treatment eventually, but usually waited between 6 and 23 years We should direct a greater part of our thinking about public health interventions to the child and adolescent years Outreach efforts need to increase access to and the initiation of treatments Interventions need to improve 42
Societal Problems That Matter (but may not always be in the DSM) n n n Substance abuse Violence Delinquency and criminal behavior Financial dependence and unemployability School failure Cost to society – pay me now or pay me later 43
What works? 44
Greenberg et al. , 2003 There is solid and growing empirical base indicating that well-designed, well implemented school-based prevention and youth development programming can positively influence a diverse array of social, health, and academic outcomes. p. 470 45
Evidence-based interventions are treatments with rigorous empirical evidence demonstrating that they have a significant, positive impact on children’s social and emotional well-being. 46
What works in prevention? Nation et al. , 2003, American Psychologist n n Comprehensive: Programs need to provide an array of interventions to address the most salient precursors of the problem. This includes both multiple interventions, and interventions in multiple settings (school, community, family) Varied teaching methods: Programs need to incorporate interactive discussion and hands-on experience 47
What works in prevention? Nation et al. , 2003, American Psychologist n n n Sufficient dosage: Programs need to be of sufficient length and intensity, with more intensity when there is more risk Theory driven: Programs need an empirical rationale for the prevention program, incorporating both etiological evidence of the causes and intervention evidence of the best methods. Positive relationships: Programs need to provide strong, positive relationships between children and parents, children and peers, children and 48 other adult caretakers.
What works in prevention? Continued n n Appropriately timed: Programs need to occur at the time in a child’s life when they will have maximal impact. (e. g. drop out prevention programs need to occur in 4 th to 6 th grades when the trajectory into dropping out of school begins. ) Socioculturally relevant: Programs need to be relevant within the local community norms, cultural beliefs, and practices 49
What works in prevention? Continued n n Outcome evaluation: Programs need to include evaluations to determine program effectiveness, even if they are anecdotally believed to be effective Well-trained staff: Programs need providers that are carefully-selected, highly trained and supervised 50
Evidence-based School Prevention n Schrumpf et al. 's (1997) Peer mediation training program for elementary through high school. Includes a program guide and accompanying video. (Schrumpf, F. , Crawford, D. , & Usedal, H. C. (1997). Peer Mediation: Conflict Resolution in Schools, Revised Edition. Champaign, IL: n Research Press) Mc. Ginnis' and Goldstein's (1997) Skillstreaming the Elementary School Child, Revised. 51
n n Murphy's and/or Sklare's Solution Focused approaches to problem solving and conflict resolution. Solution-Focused Counseling in Middle and High School, 1997 by John J. Murphy; Brief Counseling That Works by Gerald B. Sklare 2005. 52
Evidence-based interventions for behavioral self control n n Kendall and Braswell’s (1985) Stop & Think program teaches individual children to stop and evaluate their behavior before acting. Their research has shown this to be an effective strategy for impulsive children. Eddy et al. ’s (2000) LIFT [Linking the Interests of Families and Teachers] program teaches children specific social behaviors, incorporates a ‘Good Behavior Game’ at recess, and provides parents with instruction in good discipline through 6 meetings at their child’s school. The program has been identified as a Blueprints Promising Program of the Center for the Study and Prevention of Violence. 53
Evidence-Based Interventions for peer relationships n n Olweus’ (1999) Bullying Prevention Program alerts teachers, students and parents to the varying and subtle forms of bullying and prepares them to respond promptly and decisively to discourage bullying. The program was identified as a ‘Blueprints Model Program’ by the Center for the Study and Prevention of Violence. Greenberg, Kusche & Mihalic’s (1998) PATHS program teaches children emotional literacy, self control, social competence and interpersonal problem solving skills. It has been identified as a Blueprints Model Program of the Center for the Study and Prevention of Violence. 54
Evidence-Based Interventions n n Sheridan’s Conjoint Behavioral Consultation showed effect sizes ranging from 1. 08 to 1. 11 in solving academic and behavioral problems (Sheridan, Eagle, Cowen & Mickelson, 2001) Huggin et al. (1993). ASSIST program series, Teaching Friendship Skills for primary and intermediate populations. Longmont: Sopris West. 55
Evidence-based Interventions n n n Shure’s (1993) I Can Problem Solve - ICPS Kendall & Bartel’s (1990) Teaching problem solving to students with learning and behavior problems – Cool Cats Elias & Tobias’s (1996) Social Problem Solving interventions 56
Basic Principles – Crystal Kruykendall (2005) n Three Needs of all Children Affection = love is an action word n Appreciation = we want you in our schools n Achievement = will find a way to succeed n n n Be a “Merchant of Hope” “We must give the best of ourselves to get the best of our kids” 57
Climate Counts n n n Proximity Courtesy Praise and affirmation Acceptance of feelings Appreciation of differences Build on strengths 58
What is NASP doing? 59
NEAT n n n National Emergency Assistance Team School safety Crisis intervention Training Curriculum 60
Katrina and Rita Hurricanes n n One of the most devastating disasters to hit the United States in its history School psychologists are instrumental in making sure the trauma doesn’t become life-impairing 61
Making prevention easier to find… n n n NASP 2006 in Anaheim! Coming soon: Prevention website Communiqué inserts The top 100 references Continuing Professional Development Advocating for prevention n n Position statements Blueprint 62
What you can do Occasionally you have to go out on a limb, because that is where the fruit is 63
Sell, Sell n n n n It works It is effective and efficient Supported by research Logical – face validity Good use of personnel Biggest impact! Big picture thinking 64
Four Major Phases of System Change L Creating Readiness L Initial Implementation (start-up & phase-in) L Institutionalization (maintenance, sustainability) L Ongoing Evolution & Creative Renewal 65
Edward Young “Who would not give a trifle to prevent what he would give a thousand worlds to cure? ” 69
Bill Pfohl “Prevent failure, do not wait for it” 70
Finding Out More 71
Adelman, H. & Taylor, L. (2005) The School Leader’s Guide to Student Learning Supports: New Directions for Addressing Barriers to Learning. Thousand Oaks, CA: Corwin Press. Or find out more information from http: //smhp. psych. ucla. edu/ This is a concise guide to the resources and information available from the Center for Mental Health in the Schools at UCLA. The book provides an extensive and carefully constructed rationale for prevention services, strategies for supporting student learning in schools, and a guide to resources. 72
Howard S. Adelman & Linda Taylor (2006). The implementation guide to student learning supports in the classroom and schoolwide: New directions for addressing barriers to learning. Thousand Oaks, CA. : Corwin Press. 73
Brock, S. , Lazarus, P. , & Jimerson, S. (Eds. ). (2002). Best practices in school crisis prevention and intervention. Bethesda, MD: National Association of School Psychologists. A NASP publication that is more relevant than ever in the aftermath of Hurricane Katrina. 74
Mrazek, P. J. , & Haggerty, R. J. (Eds). (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academy Press. An Institute of Medicine report that’s been heavily cited. It proposed replacing Caplan’s scheme (primary, secondary, and tertiary) with universal, selective, and indicated. The World Health Organization now uses this system. 75
Society for Prevention Research. (2004). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Falls Church, VA: Author. This is a very concise and helpful document for those who are involved in prevention. 76
Weissberg, R. P. , & Kumpfer, K. L. (Eds. ). (2003). Prevention that works for children and youth [Special Issue]. American Psychologist, 58(6/7). This is a very comprehensive special issue on prevention. Every article is helpful. 77
Center for School Mental Health Assistance, University of Maryland http: //csmha. umaryland. edu/ Center for the Study and Prevention of Violence: lists evidence-based interventions that have been identified through systematic research reviews http: //www. colorado. edu/cspv National Technical Assistance Center on Positive Behavioral Interventions and Supports (PBIS) http: //www. pbis. org/primaryprevention. htm 78
Research and Training Center on Family Support and Children's Mental Health at Portland State University, Portland, Oregon http: //www. rtc. pdx. edu/ North Carolina Healthy Schools Project focuses on improving the health of students and staff by providing coordination and resources in eight component areas of school health. http: //www. nchealthyschools. org/ Center for Effective Collaboration and Practice - Focuses on Prevention issues in regular and special education; great source http: //www. air. org/cecp/ 79 79
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