Bill Pfohl, NCSP NASP President 2005-06 billnasp@aol.com

1. Bill Pfohl, NCSP NASP President 2005-06billnasp@aol.com

2. 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

3. 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. CASEL at UIC

4. Youth Risk Behavior Survey (CDC, 2003) CASEL at UIC

5. But WHY? - Really • NASP Shortages – estimated at 9,000 between 2000 and 2010! • Total: 15,000 by 2020!

6. D. Erasmus “Prevention is Better Than Cure”

7. Ben Franklin “An Ounce Of Prevention is Worth a Pound of Cure”

8. 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)

9. 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

10. 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

11. Do I Practice Prevention Already?

12. Screening Safe schools Pre-referral Suicide Social skills Bully-proofing Parent training Consultation Early literacy Social competency Resiliency classrooms Counseling Drug education Violence prevention Health promotion Character education School reform Mental health Prevention Activities

13. What is prevention?

14. Theory Base • Mental Health • Community Psychology • Social Psychology • Consultation • Early Childhood education • Parent training • What Works research • Public health

15. 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

16. NIMH Intervention Spectrum

17. Adelman & Taylor

18. The Goal: Full Integration of Prevention Into School Culture Addressing Barriers (Prevention) Instruction Student Management

19. Prevention, risk, and resilience

20. 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

21. 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

22. Risk Poverty Low parent education Marital/family dysfunction Poor parenting Child maltreatment Poor health Parental illness Large family Adultoutcomes Mental illness Physical illness Educational disability Delinquency/ criminality Teen parenthood Financial dependence Unemployment Low social competence Low adult intelligence Doll & Lyon, 1998 Risk = Children are More Likely To Be Unsuccessful Adults

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

24. Dryfoos’ conclusions • 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

25. Prevention = Increasing strengths+Reducing problems

26. 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

27. Mental Health: “The possession of skills necessary to cope with life's challenges” NASP, 2002

28. 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

29. Reducing ProblemsPrevalence of DisordersNational Comorbidity Survey Replication, Kessler et al., 2005

30. 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

31. 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

32. 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

33. What works?

34. 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

35. 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.

36. 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

37. 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.

38. 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

39. 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

40. 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.

41. 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.

42. 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.

43. 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.

44. 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.

45. 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

46. 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”

47. Climate Counts • Proximity • Courtesy • Praise and affirmation • Acceptance of feelings • Appreciation of differences • Build on strengths

48. What is NASP doing?

49. NEAT • National Emergency Assistance Team • School safety • Crisis intervention • Training • Curriculum

50. Katrina and RitaHurricanes • 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