Presidential Message by C1c84G

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									        Bill Pfohl, NCSP
NASP President 2005-06
           billnasp@aol.com
                         1
              Why Prevention?
   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,
    pre-referral 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      6.6
to or from school (30 days)
Felt so sad or hopeless almost every day for two weeks or        28.6
more in a row that stopped doing some usual activities (12
months)
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
   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)
   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

   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
   Screening            Social competency
   Safe schools         Resiliency classrooms
   Pre-referral         Counseling
   Suicide              Drug education
   Social skills        Violence prevention
   Bully-proofing       Health promotion
   Parent training      Character education
   Consultation         School reform
   Early literacy       Mental health
                                              19
  What is
prevention?




              20
               Theory Base

   Mental Health
   Community Psychology
   Social Psychology
   Consultation
   Early Childhood education
   Parent training
   What Works research
   Public health               21
        Caplan’s (1964) Terms

   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
     Continuum of Effective Behavior
               Support

                                                        Specialized Individual
                          Tertiary Prevention           Interventions
Students with
Chronic/Intense                                         (Individual Student
Problem Behavior                                        System)
(1 - 7%)                   Secondary Prevention
                                                        Specialized Group
Students At-Risk                                        Interventions
for Problem                                             (At-Risk System)
Behavior
(5-15%)




Students
without
                                   Primary Prevention   Universal Interventions
Serious
Problem                                                 (School-Wide System
Behaviors                                               Classroom System)
(80 -90%)



                                            Adelman & Taylor
                   All Students in School                                         24
 The Goal: Full Integration of
Prevention Into School Culture

  Instruction               Addressing Barriers
                               (Prevention)

                Student




                          Management



                                                  25
Prevention, risk,
 and resilience




                30
           What has worked?

   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
   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                       Adult outcomes
   Poverty                         Mental illness
   Low parent education            Physical illness
   Marital/family dysfunction      Educational disability
   Poor parenting                  Delinquency/ criminality
   Child maltreatment              Teen parenthood
   Poor health                     Financial dependence
   Parental illness                Unemployment
   Large family                    Low social competence
                                    Low adult intelligence

                                                 Doll & Lyon, 1998
                                                                     33
Resilience = Vulnerable Children
Who Become Successful Adults
           Individual                Family & community
   Positive social                Close bond with one
    orientation                     caretaker
   Friendships                    Effective parenting
   Internal locus of control      Nurturing from other
   Positive self-concept           adults
   Achievement orientation        Access to positive adult
   Community engagement            models
                                   Connections with pro-
                                    social organizations
                                   Effective schools


                                                               34
           Dryfoos’ conclusions
1.   A significant proportion of children will fail to
     grow into successful adults without major
     changes is how they are taught and nurtured.
2.   Families and schools require transformations to
     more adequately raise and educate children.
3.   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

   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
   Identifying the factors that place children at risk
    is the first line of prevention
      Cannot separate health from mental health

      20% of children and youth have a
       diagnosable mental illness
   Helping children receive services is the 2nd step
   Barriers to help
      Stigma

      Lack of knowledge about treatment


                     Summarized in COPS Promoting Mental Health in Schools
                                                                       39
                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


   The age of onset for most disorders was
    concentrated in the first two decades of
    life
       Anxiety disorders – 11 years average age of
        onset
       Impulse Control disorders – 11 years average
        age of onset
       Substance Use disorders – 20 years average
        age of onset
       Mood disorders – 30 years average age of
        onset
                                                                     41
   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)

   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

   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
   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
    other adult caretakers.                         48
      What works in prevention?
                      Continued

   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 4th to 6th 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

   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
   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:
    Research Press)
   McGinnis' and Goldstein's (1997)
    Skillstreaming the Elementary School
    Child, Revised.
                                               51
   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
   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
   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

   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

   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)
   Three Needs of all Children
       Affection = love is an action word
       Appreciation = we want you in our schools
       Achievement = will find a way to succeed
   Be a “Merchant of Hope”
   “We must give the best of ourselves to get
    the best of our kids”

                                                    57
              Climate Counts

   Proximity
   Courtesy
   Praise and affirmation
   Acceptance of feelings
   Appreciation of differences
   Build on strengths


                                  58
What is NASP
  doing?




               59
                   NEAT

   National Emergency Assistance Team
   School safety
   Crisis intervention
   Training
   Curriculum



                                         60
             Katrina and Rita
               Hurricanes
   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…
   NASP 2006 in Anaheim!
   Coming soon: Prevention website
   Communiqué inserts
   The top 100 references
   Continuing Professional Development
   Advocating for prevention
       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, Sell

   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


 Creating Readiness




 Initial Implementation (start-up & phase-in)




 Institutionalization (maintenance, sustainability)



 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

								
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