School Mental Health Capacity Building Partnership: Oregon Site Visit

Oregon Stakeholder Discussion Group: Overview of Key Themes, Challenges, and Opportunities

          On August 14th and 15th, 2007, thirty-two of Oregon’s state and local leaders in education (12), health (9), mental health/social services (7), youth development (2), family advocacy (1), and business (1) participated in a series of three stakeholder discussion groups conducted by the School Mental Health Capacity Building Partnership (SMH-CBP). The SMH-CBP is a national initiative made possible through a cooperative agreement between the National Assembly on School-Based Health Care (NASBHC) and the Centers for Disease Control-Division of Adolescent and School Health (CDC-DASH). The goal of this initiative is to build the capacity of state and local education agencies to provide effective and sustainable school mental health services. Based on its achievements in school mental health, Oregon was selected as one of four states to participate in the statewide discussion groups, with groups also conducted in Maryland, Missouri, and Ohio. The purpose of the discussion groups was to help identify successes and lessons learned in these “early adopter” states, at both the state and local levels related to school mental health policies, programs, and services. As Oregon is a CDC-funded Coordinated School Health Program (CSHP) state, one of the two discussion groups was focused specifically on CSHP. Based on audio recordings, and notes from both participants and designated note takers, themes from the discussion groups were identified. These themes, challenges, and opportunities are summarized below for the two school mental health stakeholder discussion groups and the one CSHP discussion group.

School Mental Health Stakeholder Discussion Groups:   

          Participants were specifically asked about innovative and best practice in school mental health, defined as strategies or practices with some longevity or that are especially innovative, can be generalized to another population and location, and have shown some evidence that it works. In addition, participants shared information about successes and challenges in advancing the agenda of mental health in schools at local and state levels.

 Key Themes:

  • The school mental health vision varies greatly, reflecting how mental health services in Oregon vary greatly by county.
  • While the Children’s System Change Initiative reflects a vision of mental health for Oregon’s youth, it has not been fully implemented and is not inclusive of all youth.
  • Memoranda of Understanding (MOUs) between schools and community providers promote mental health services in schools, but are often challenged by issues of FERPA/HIPAA.
  • Schools need to be informed about issues of legality related to mental health services, in order to reduce the fear associated with addressing these issues.
  • Efforts to bridge the gap between educators and mental health providers, including role clarification and interdisciplinary training, is critical to breaking down communication barriers.
  • Family organization and engagement needs to be strengthened in Oregon which includes schools adopting a family-centered approach.
  • There is a need for a public relations campaign to advance the school mental health agenda.
  • All schools would benefit from at least one full-time, school-based mental health provider.
  • Coordination of school- and community-based mental health efforts is strengthened by the presence of a case manager or counselor familiar with the array of available services, as well as by the presence of behavioral teams involving multiple stakeholders.
Challenges to School Mental Health:
  • Public health and mental health in Oregon are not well coordinated at the state level, and the coordination varies greatly across regions.
  • Oregon’s vision of school mental health is fragmented and is not shared across all systems or geographic areas.
  • School-based health centers have been part of Oregon’s school mental health agenda, but have not systematically included mental health and have not always been promoted due to lack of funding and/or misconceptions about their purpose.
  • Oregon’s school mental health efforts often exclude youth who do not receive Medicaid.
  • There is significant difficulty recruiting and hiring a workforce that represents the community.
  • Understanding what is happening in Oregon related to school mental health is challenging, and requires identifying “the right people”.
  • Despite several legislative and other efforts to advance evidence-based practices, there is not consensus on the definition of evidence-based practices and there is a lack of accountability and monitoring of the use of evidence-based practices.

Opportunities to Advance School Mental Health in Oregon:

  • Oregon’s leadership in the Wraparound Framework presents a critical opportunity to advance school mental health efforts, and serves as a model for successful youth and family engagement.
  • A statewide summit of stakeholders, including legislators and policymakers, would inform the decision-makers about best practices and resource allocation related to school mental health.
  • Increased partnerships between schools, families, and communities would strengthen school mental health efforts and reduce the burden on schools.
  • Youth engagement models, including a new model for “action research”, could be applied to the school mental health field.
  • School-based health centers, funded through public health, reflect a successful model of coordinating between health and mental health.
  • Oregon has utilized several strategies to successfully meet the needs of students from diverse cultural backgrounds including hiring bilingual staff, using interpreters, conducting in-home parent and family mental health training to families with limited English proficiency, providing mental health training to front-line school staff, and utilizing family resource centers and a home-school contact person.
  • Oregon’s Positive Behavioral Supports and Response to Intervention efforts may be linked to other school mental health efforts to provide a comprehensive model of school mental health.

Coordinated School Health Discussion Group

Participants in this group were asked about the Coordinated School Health Program (CSHP) as it is implemented in Oregon. They were asked questions about how the CSHP is structured in Oregon, how the model has impacted mental health in schools, how they define the mental health component of the model, and successes and challenges in its implementation.

Key Themes:

  • Coordinated School Health Program was defined as a model that:
    • is funded by the CDC and led by specialists from the Department of Education and the Department of Human Services/Health Services, in collaboration with other health and education organizations.
    • is known in Oregon as “Healthy Kids Learn Better” and uses a coalition of non-governmental agencies made up of 35 members, to provide functions that cannot be performed by government, including legislation and advocacy.
    • involves a comprehensive and holistic view of health, rather than a fragmented approach.
    • includes a data driven process that emphasizes evidence-based practice.
    • is being implemented in Oregon through the Coordinated School Health Blueprint group.
  • The brand “Healthy Kids Learn Better” has assisted with social marketing efforts related to school health in Oregon.
  • Due to its appeal, the CSHP model has been extended to several other school health initiatives (e.g., wellness, tobacco prevention).
  • In some schools, there are obvious indications that the CSHP model has been implemented including utilization of an exercise room, walking paths, vending machine and lunchroom selections, etc.
  • Schools that have advisory councils that meet regularly are more likely to have sustainable CSHP programs.
  • Having a champion of coordinated school health and a strong administrative person is critical to success.
  • The CSHP efforts differ from traditional program models by emphasizing the connection between all components of school health.
  • The CSHP model helps to coordinate and integrate services, and reduces service duplication, fragmentation and turf issues.
  • When all players in the CSHP have an equal voice, there is more buy-in and investment in the process.
  • The State Department of Health’s School Mental Health Demonstration Project, which has developed and implemented the School Mental Health Inventory, is one of the only efforts looking specifically at the connection between mental health and the CSHP model’s seven other components.
  • In-services and memoranda of understanding are important to coordinating mental health with other CSHP components, especially for schools that do not have access to a mental health provider.
  • Oregon’s CSHP training institutes provide teaching about integration and coordination of the model’s components, and involve multidisciplinary teams of trainers and trainees.
  • The initial CDC funding for the CSHP model was critical to creating continued funding and support for sustained CSH efforts.

Challenges to School Mental Health:

  • Despite efforts to implement CSHP in the state, some schools have done little to nothing, often due to lack of readiness for implementation or difficulties with sustainability.
  • The mental health component of the CSHP model represents traditional school support services, which does not reflect the broader concept of mental health that, in fact, should be a thread throughout all components of the model.
  • At the state level in Oregon, mental health is defined narrowly by some as encompassing traditional intervention services without an emphasis on prevention, and this is reflected in the definition of school mental health.
  • Despite efforts to develop integrated health-mental health models, billing constraints make this difficult.
  • Turf issues between the counseling/guidance framework and the Coordinated School Health Program model have resulted in difficulties partnering between the Oregon Department of Education and Healthy Kids Learn Better.
  • School nursing is not incorporated into the counseling, psychological, and services component despite their critical involvement in this area, particularly in rural settings.

Opportunities to Advance School Mental Health in Oregon:

  • While funding for CSHP is still topic–specific (e.g. asthma, tobacco), CSHP offers a good framework for school mental health.
  • The CSHP model has increased the visibility of school mental health programs in Oregon.
  • The initial CDC funding for the CSHP model was critical in creating continued funding and support for sustained CSH efforts.
  • The CSHP funding has led to increased partnerships among agencies.
  • CSHP created advocates and led to local communities talking about mental health more openly.
  • The Oregon School Mental Health Demonstration Project, if expanded, could offer more schools an opportunity to improve their school based health and mental health services.

Further Information and Resources: