REQUEST FOR PROPOSALS School based Mental Health and Addictions

REQUEST FOR PROPOSALS School-based Mental Health and Addictions Services 1. Issuer Child & Youth Advisory Committee, Mental Health Commission of Canada 2. Background Mental disorders such as depression and anxiety, as well as emotional and behavioural problems including substance use and misuse have been on the rise in the school-aged population (Waddell, et al, 2007; Weinberg, 1998). Although schools have long been considered practical settings for the delivery of mental health services (Rones & Hoagwood, 2000; Puskar, et al, 2006), programs are limited in most Canadian jurisdictions. A quick scan of the related literature, however, indicates that in the past decade or so there has been a proliferation of programs and services as well as frameworks and models for delivery of mental health and addictions services (from prevention through intensive treatment), as part of a general trend in growth of school-based health interventions (Weist 2001; Rones & Hoagwood, 2000). Interventions can be as minimal as a single school counselor to as comprehensive as multi-tiered and community-linked programs. The literature also reveals a dizzying array of programming topics (especially on the prevention side) for health concerns ranging from HIV, teen pregnancy, tobacco use, obesity, bullying, violence and aggression, suicide, disordered eating and dangerous driving, in addition to those focused on the reduction of drug and alcohol use and mental disorders. While these developments are encouraging in terms of long-term benefit for children and youth, the research base is fragmented and the practice landscape is increasingly complex. Educators, mental health professionals and policymakers must navigate all the information on school-based programs, while balancing multiple considerations, to make the best choices for service delivery in each jurisdiction. These considerations include: ensuring developmental appropriateness for ages spanning pre-school to high-school developing a collaborative system that integrates health program agenda with education program agenda in a manner that respects and reflects the primary mandate of each system developing and sustaining partnerships with the appropriate health providers and organizations choosing programming from different philosophical approaches such as general vs. specific interventions 1 ensuring interventions selected are effective, flexible and coherent in the local context balancing the needs of school populations across the continuum of interventions* identifying unique needs across and within schools and communities for locally relevant or targeted interventions General trends in school-based health that are reflected in the current literature are a) multi-level, tiered or ecological school-based programs and models (e.g. comprehensive school health/health promoting schools; whole school approaches; public health model and community school models as well as programs that identify children and youth at risk (i.e. both universal and targeted approaches b) the introduction of new concepts such as mentally healthy schools; c) greater intensity of service delivery at the school level for mental health and addictions (e.g. school-based health clinics, expanded school mental health programs; specialist school-based mental health teams) d) greater involvement of parents, teachers and community as integral partners; e) greater focus on learning outcomes and outcomes over the longer term; f) stronger messages about the need for evidence-based programming (Walrath, et al, 2004; Weist & Albus, 2004), g) recognition that a program can have any of positive effects, no effects and even unintended effects including direct or opportunity costs (Committee on School Health, 2004). Larger context considerations for mental health and addictions school-based programs are also important. Despite evidence of comorbidity in both community and treatment samples of children and adolescents (see for example, Costello, et al, 2003) substance use and mental disorders services in most jurisdictions have been historically quite separate. Most importantly for the current project, the literature and clinical observation indicate that school-based substance abuse prevention and treatment programming have also been largely separate from mental disorders prevention and treatment programming. To date a broad new policy direction towards integrating addictions and mental health services has not had much impact on school-based programming. Questions about how to design, overcome barriers, implement, evaluate and sustain school-based interventions are frequent among practitioners and policymakers. Other questions about how school-based programs can most effectively interface with other key players (parents, sports and leisure programs and service sectors – e.g. primary care, child welfare and juvenile justice) – each of which are also seeing dynamic evolution of prevention and treatment approaches - remain. Furthermore, school-based intervention research often focuses on one * components listed for the continuum vary – the most detailed version found comes from the report of the United States New Freedom Commission on Mental Health (2003) which lists the components as mental health education, mental health promotion, assessment, problem prevention, early intervention and treatment. Some authors add follow-up. By mental health promotion we mean the support of recovery and the enhancement of wellbeing. 2 component (e.g. promotion vs. treatment) or one disorder (e.g. ADHD), failing to address the fact that in reality risks and protective factors are often common for multiple outcomes in individuals and adverse outcomes often manifest concurrently in individuals. Another concern expressed by some is that most programs to date are at the extremes of broad-based health promotion or very specific manualized treatments with little in between (Weist, 2004). Current knowledge suggests that school-based interventions ought to be situated in a broad multi-level framework that considers the population as a whole as well as those at risk, and all components of the system that serve that population, including preschool, post-secondary and out-of-school populations (e.g. Waddell 2007). Increasingly these comprehensive frameworks are being developed for other health risks and illnesses, especially in the chronic disease context (e.g. obesity, cancer) as well as in the context of comprehensive school health around the world and there is much potential to learn from other areas of health. So far, an ideal framework for school-based mental health and addictions programming has not been identified nor applied in the Canadian context. Even so, there is much potential for policy and practice advancement in this area. Conceptual frameworks are, by themselves, insufficient to inform programs for specific populations, locations and contexts; very specific and practical information is also needed. Despite the challenges, the good news is that there is also a growing commitment on the part of policy-makers and practitioners to find effective ways and means to deliver and integrate programs and services. Most of the literature describes individual programs and approaches, but other useful information and tools are also increasingly available. This information includes frameworks within which to situate mental health and addictions related interventions (e.g. Committee on School Health 2004; Wyn 2000), reviews of effectiveness of specific programs and approaches (e.g. Rones & Hoagwood 2000), as well as tools for evaluating whether programs meet current recommended practice (e.g. Hackbarth 2005), guidance for effective administration of programs (e.g. Armbruster 2002); and even survey methods specific to this topic. In addition, innovations that may hold much promise and relevance for school-based programming in the future may not be documented in the academic literature, and would be lost without a survey or scan of existing programs across the country and elsewhere. Unfortunately, there is no overall synthesis of the current status of science and practice; nor is there a comprehensive forum for interpretation of this literature in the Canadian context to guide policy and practice. A comprehensive review which would identify frameworks and promising practices in other developed countries, combined with an environmental scan of innovations in the Canadian context would provide guidance for future policy, planning as well as direction for further research on the effectiveness of school-based interventions within these complex systems. 3 3. Context A key recommendation of the Out of the Shadows Report was that more mental health services for children and youth be delivered in school settings (Standing Senate Committee on Children and Youth, 2006). For additional background information, prospective bidders are referred to the link: http://www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci-e/repe/rep02may06part2-e.htm#_Toc133223086. The purpose of this project is to provide practitioners and policy makers in education, health, child welfare and related organizations and agencies with a variety of policy and practice options for the delivery of school-based mental health and addictions (SBMHA) services from promotion through treatment. By engaging key stakeholders, including Alberta Health Services (Alberta Alcohol and Drug Abuse Commission and Alberta Mental Health Board), the Joint Consortium for School Health, The Canadian Association for School Health, the Federal Provincial Territorial Advisory Committee on Mental Health, interested school districts such as the Bluewater District School Board in Ontario, and others, the successful contractor will develop an appropriate broad framework and practical recommendations on SBMHA services that is applicable across geography and jurisdictions. 4. Objective The goal of this RFP is to hire a qualified individual or team to conduct a national and international assessment of the current state of mental health and addictions (MHA) services delivery in schools, ranging from prevention/promotion initiatives to integrated treatment systems. The team is expected to be multidisciplinary and must include either directly or indirectly expertise on the key components of school-based interventions. The definition of “school” will be broad and inclusive of programs in alternative settings such as incarcerated youths. This project will also consider school-based MHA services for First Nations and immigrant communities, paying particular attention to issues of cultural appropriateness for ethnocultural and other diverse groups, addressing factors such as language barriers. 5. Description of Work The contractor will be working with a Project Committee of the MHCC Child and Youth Advisory Committee. As such, status updates and consultation with the Project Committee will be scheduled on a regular basis. The contractor will consult and liaise with key stakeholders, including the Joint Consortium for School Health, Alberta Health Services (Alberta Alcohol and Drug Abuse Commission and Alberta Mental Health Board), the Canadian Association for School Health, the Federal Provincial Territorial Advisory Committee on 4 Mental Health, interested School Districts such as the Bluewater District School Board in Ontario, and other stakeholders identified in the process to develop a strategy for building the evidence for the best practices of SBMHA services. The contractor will conduct the necessary research to synthesize the current national and international literature, describe current practices, and extract practical information for decisions makers across the full range of school-based mental health and addiction services in the context of broad systems of care using four components: a. An in-depth review of the national and international literature (including grey literature) on frameworks and best practices in each major component of school-based interventions (i.e. promotion, prevention, early intervention and treatment), as well as relevant frameworks, models, strategies for overcoming barriers, implementation and evaluation approaches as well as approaches for interfacing programs and services with other sectors and systems and sustaining partnerships; b. an environment scan of existing programs and services in Canada, including key informant interviews, including adaptation and evaluation of a framework for best practices in school-based mental health and addictions service delivery through stakeholder consultations and testing on selected promising practices in the Canadian context; c. a national survey of school districts to document current practices as well as perceived needs for school-based mental health and addictions interventions d. translation and exchange of all findings of the review throughout the process as well as in an interactive, national stakeholders Symposium involving researchers, educators, clinicians and policy-makers which may result in consensus recommendations for best principles and practices. N.B. While conceptualization of the Symposium component is expected as part of submitted proposals; funds for the actual organization and delivery of the Symposium will be held separately and responsibilities will be negotiated at a later date. All information will be synthesized in such a way that it is accessible to individual school districts, communities and modifiable to local contexts. Furthermore, preparation of information and related tools should be in easily accessible formats (e.g. web-based programs/databases) that can facilitate the uptake/modification of promising practices by individual communities, and be in formats that can be updated for future knowledge exchange activities. 6. Deliverables The successful contractor will provide in accordance with a negotiated schedule, and specified in the contract, all of the following deliverables: 5 1. Interim and final reports of the literature review with complete list of citations, written in English and/or French, provided electronically in MSWord. If the report includes graphs or charts, the contract will provide the accompanying spreadsheet in MSExcel and provide all underlying data represented in the graphs. 2. Interim and final reports from the environment scan, culminating in a catalog of best practices which includes the list of sources for the scan. 3. A copy of the questionnaire used in the national survey of school districts and details of the methods of producing the questionnaire. 4. A report of the findings from the national survey of school districts, which include methods of data collection, analyses and interpretation. 5. Information and tools of successful programs/practices provided in easily accessible formats. 6. Symposium documents including an evaluation of participants. 7. A final report on the knowledge translation outcomes of the Symposium. 7. Schedule of Payments Payments will be made in installments associated with deliverables and due dates. The payment and deliverable schedule will be agreed upon by the MHCC and the successful Bidder, and specified within the terms of the contract. The length of the contract is anticipated to be three years. 8. Submission Process Requirements It is the responsibility of the Bidder to ensure the submission package is complete; incomplete submissions will not be considered. Submissions must include: 1. A proposal a. detailing the work planned for carrying out this project, including the identification of specific outputs and a schedule for their completion, b. describing the methodological approach(es) used in the research and provide an understanding of how such approach(es) will meet the project objectives, c. describing the appropriate plan(s) for analysis of the data (if applicable), d. describing the plans for reporting and dissemination of the findings. 2. Biographies a. Short curriculum vitae, including publication list, of the principal and co-investigators, showing experience in conducting similar work of relevance to this project, as well as in the analysis and synthesis of information as it pertains to the subject area (maximum 4 pages). 6 3. Certification a. The following certification MUST be included in the proposal and signed: Availability of Personnel The Bidder certifies that, should it be authorized to provide services under any Contract resulting from this solicitation, the persons proposed in its bid will be available to commence performance of the work immediately upon contract award and will remain available to perform the work in relation to the fulfillment of this requirement. Signature/ Date 4. Budget The cost for components 1 – 3 (see Description of work) and general conceptualization of the Symposium shall not exceed the available budget of $385,000 (including applicable taxes). Bidders must submit a detailed statement of their estimated unit costs and time-line for the work for all years for the duration of the contract. The proposal must be type written with a minimum 12 pt font, single spaced, with one inch margins in MSWord; maximum 15 pages in the main body of the proposal (i.e. excluding appendices). Proposals must be submitted via email to: bleung@mentalhealthcommission.ca Proposals will be accepted until: January 30, 2009 9. Submission Contact: Prospective bidders may direct questions about this RFP to: Brenda Leung Associate Research Officer Mental Health Commission of Canada 10301 Southport Lane SW Suite 800 Calgary, AB T2W 1S7 Phone: 403-385-4041 Email: bleung@mentalhealthcommission.ca 7 References Armbruster P. The administration of school-based mental health services. Child Adolesc Psychiatr Clin N Am. 2002 Jan; 11(1):23-41. Committee on School Health. School-Based Mental Health Services. Pediatrics 2004; 113: 1839-1845 Costell EJ, Mustill,S, Erkanli,A, Keeler G, Angold A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch Gen Psychiatry. 2003;60:837-844 Davidson L, White W. The concept of recovery as an organizing principle for integrating mental health and addiction services. J Behav Health Serv Res. 2007 Apr; 34(2):10920. Hackbarth D, Gall GB. Evaluation of school-based health center programs and services: the whys and hows of demonstrating program effectiveness. Nurs Clin North Am. 2005 Dec; 40(4): 711-24. Puskar KR, Stark KH, Fertman CI, Bernardo LM, Engberg RA, Barton RS. School Based Mental Health Promotion: Nursing Interventions for Depressive Symptoms in Rural Adolescents. Californian J Health Promot. 2006 Dec; 4(4):13-20. Rones M, Hoagwood K. School-Based Mental Health Services: A Research Review. Clinical Child and Family Psychology Review. 2000, Dec; 3(4): 223-241. Waddell C, Hua JM, Garland OM, Peters RD, McEwan K. Preventing mental disorders in children: a systematic review to inform policy-making. Can J Public Health. 2007 May-Jun; 98(3):166-73. Walrath CM, Bruns EJ, Anderson KL, Glass-Siegal M, Weist MD. Understanding Expanded School Mental Health Services in Baltimore City. Behav Modif. 2004; 28; 472-490. Weist MD, Albus KE. Expanded school mental health: exploring program details and developing the research base. Behav Modif. 2004 Jul; 28(4):463-71. Weinberg NZ, Rahdert E, Colliver JD, Glantz MD. Adolescent substance abuse: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1998 Mar; 37(3):252-61. Wyn J, Cahill H, Holdsworth R, Rowling L, Carson S. MindMatters, a whole-school approach promoting mental health and wellbeing. Aust N Z J Psychiatry. 2000 Aug;34(4):594-601. 8