Some of the richest opportunities for improving educational outcomes may emerge from initiatives that prevent and address mental health issues in children.
Interventions like the Good Behavior Game or the Incredible Years Teacher Classroom Management Program have proven to be effective in improving academic, mental health, and substance use outcomes with impressive returns on investment, but they are not widely adopted around the country.
Why? What might be done to encourage more effective, earlier interventions to promote academic success and healthier outcomes for children?
Those questions are being explored by experts brought together by the National Collaborative on Education and Health and Mental Health America (MHA), with support from the W.K. Kellogg Foundation (WKKF) in a grant to MHA. The answers can influence both practice and policy in education and mental health in the coming years.
Why This Working Group?
The National Collaborative brings together working groups to make recommendations on topics in public health, health care, and education. Its steering committee has members representing funders, government agencies, health and education systems, and advocacy groups. After a fruitful working group on substance misuse, the collaborative turned its attention to mental health. In 2016 the collaborative cochairs, from Trust for America's Health and the Healthy Schools Campaign, reached out to MHA to help convene a new working group.
The WKKF was interested in mental health in schools as a next direction for the collaborative as part of the foundation's mission to support healthy kids, racial equity, and community engagement. Preventive interventions in mental health help vulnerable children to succeed in their academic and later working careers and generally engage families and communities as partners to make the interventions successful.
The WKKF provided $50,000 to convene the working group and to draft a white paper with recommendations on promoting mental health in schools, which MHA would use in its work and disseminate.
What Did the Working Group Find?
The working group discovered that many of the interventions and implementation models used to promote mental health were almost identical to those previously examined in the substance misuse working group. Program implementation models such as PROSPER and Communities That Care, and policy recommendations around collective impact model approaches, braiding funding, and sustainability in the substance use prevention area, all appeared to overlap with strategies and initiatives that promoted mental health among children.
So, the working group went in a different direction and began to explore a world of other initiatives seemingly related to prevention for mental health, but under a number of different names—such as social and emotional learning, mindsets, school climate, and trauma-informed schools.
A New Challenge Emerges
As the group looked into this, it found that there was very little consensus about how the different initiatives overlapped, even though they all sought to achieve similar outcomes. For example, prevention in mental health, as well as social and emotional learning, contained many of the same concepts and components but used different terminology that made it difficult to understand how one idea mapped over to another. This became especially complicated for schools implementing multiple interventions, since they could use Positive Behavioral Interventions and Supports (a school-wide discipline/classroom-management system), the Good Behavior Game (a classroom management intervention), and the 4Rs Program (a social and emotional learning intervention built into the classroom curriculum) all at once.
Do multiple interventions co-exist effectively? No one could really say. And mental health promotion is most effective when it is integrated seamlessly into the classroom, not offered as a side program. No one had access to a ready set of principles or recommendations that cut across literatures to guide an integration effort.
The Collaborative Response
To address this challenge, the working group on mental health promotion widened its net to engage more participants.
At its first in-person meeting, twenty-five stakeholders from government, academia, education, health, and advocacy came together. They learned about the high prevalence of mental health challenges in children and its consequences for academic achievement. They examined compelling research on the value of implementing interventions that promote mental health and academic achievement and demonstrate returns on investment (estimated at 12:1 for the 4Rs intervention, for example).
The group then took on the question of how to adopt and integrate programs that worked, using some models already being implemented. The AppleTree Institute, in Washington, D.C., designed its teacher training and student curriculum around the latest science in healthy social and emotional development and then used data to promote continuous learning; Gainesville City Schools, in Georgia, implemented the University of California, Los Angeles's (UCLA's) Transforming Student and Learning Supports framework to make sure existing resources were used to address common goals; and the School Culture and Climate Initiative used comprehensive needs assessments to find out what staff and students thought were their biggest problems—which were almost always social and emotional—and then they worked together to address them.
The Program and Policy Opportunities That Emerged
From this work, three major program and policy opportunities emerged.
The first is to build on pre-service training—that is, the training in college or graduate school that people receive before starting their careers, since professional development today may be inadequate for integrating mental health promotion interventions into classrooms. New training opportunities must be identified to accomplish this.
The second is to capitalize on the Every Student Succeeds Act. As states implement this December 2015 law, they should assess community needs, take stock of school resources, and orient existing capacities to most effectively promote social and emotional well-being to support conditions for learning. Using this working group's recommendations, funders can help states and school districts with these coordination efforts to ensure that they get the most out of this opportunity for children and staff.
The third is to determine how health care and educational dollars can complement one another to support mental health promotion in schools. We see an early example with Nationwide Children's Hospital partnering with Columbus City Schools, in Ohio, to support teachers who are implementing the Good Behavior Game. The policy environment should foster more of these collaborations throughout the country.
Next Steps
Next, the working group will meet to explore these policy opportunities in greater detail and to come up with some specific recommendations.
Stay tuned. We'll have more to say in a few months about the consensus around policy that emerges from our next set of dialogues.
Editor's Notes
Related reading:
Paul Gionfriddo, "What Funders Can Do In the Aftermath Of The Tragedy of Sandy Hook, Connecticut," December 17, 2012, GrantWatch section of Health Affairs Blog.
Melinda K. Abrams and Donald Moulds of the Commonwealth Fund, "Integrating Medical And Social Services: A Pressing Priority For Health Systems And Payers," July 5, 2016, GrantWatch section of Health Affairs Blog.
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