Executive Summary

Volume III:  The Role of Education in a System of Care:
Effectively Serving Children with Emotional or Behavioral Disorders

Introduction

Children with Serious Emotional Disturbance

Methodology

Promising Practices That Involve Education in a System of Care

Cross-Site Findings Regarding Development of Systems of Care

Conclusion

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INTRODUCTION
Improving outcomes for children with serious emotional disturbance depends not only on improving their school and learning opportunities, but also on promoting effective collaboration across other critical areas of support: families, social services, health, mental health, and juvenile justice. Although bringing about such collaboration poses a major challenge—due to different system priorities, agendas, structures, and ways of operating—the results of collaboration for children with serious emotional disturbance and their families include greater school retention and improved educational, emotional, and behavioral development.

Our study examines the efforts, experiences, and outcomes for three urban sites that have struggled, with some success, to overcome the challenges to creating a comprehensive, school-based system of care.

 
top CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCE
Children with serious emotional disturbance may be eligible for special education and related services under the Individuals with Disabilities Education Act (IDEA); however, although mental health researchers estimate that up to 19 percent of the student population exhibit symptoms of serious emotional disturbance, only one percent of students are identified and referred for the necessary support services.

Indeed, national evaluation data from the Center for Mental Health Services (CMHS) reinforce the point that many children and youth with serious emotional disturbance are not receiving special education services.

Students that are identified by schools as having serious emotional disturbance are usually male, over 13, and come from families with an annual income of less than $12,000. Many come from single-parent homes, and African American children and youth are over-represented among this group. Because these students do not receive a full range of needed services, they typically realize poor school outcomes.

Specifically, students with serious emotional disturbance fail more classes; miss more days of school; have lower grades; are retained at the same grade level; drop out more frequently; have a lower graduation rate; and have a higher dropout rate than other students with disabilities.

Meeting the Needs of Children with Serious Emotional Disturbance

The education system has struggled to accommodate the needs of children and youth with serious emotional disturbance and to effectively integrate them into mainstream classrooms. IDEA was passed, in part, to address the fact that more than a million children with behavioral disorders were excluded from public schooling on account of their behavior and the lack of services to meet their individual needs.

IDEA, signed into law in 1975, established that all children with disabilities have a right to a free, appropriate public education. It offers funding and policy assistance to states in providing appropriate support services (e.g., counseling and transportation) to students with special needs. In 1984, Congress authorized the National Institute of Mental Health to start the Child and Adolescent Service System Program (CASSP) to help states develop comprehensive, community-based systems of care for emotionally disturbed children and youth.

However, neither IDEA nor CASSP has had a significant impact on the education of children with serious emotional disturbance, as observed by Congress during the 1990 reauthorization of IDEA. As a result, the U.S. Department of Education developed the National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance. The Agenda’s targets include expanding positive learning opportunities; strengthening school and community capacity; addressing issues of diversity; collaborating with families; promoting appropriate assessment; providing ongoing skill development; and creating comprehensive and collaborative systems.

The Role of Education in a System of Care

Education plays a critical role in the development of children. Positive learning experiences help to prevent emotional and behavioral problems. Furthermore, schools provide a logical setting for both early identification of children at risk for serious emotional disturbance and for effective provision of services.

Despite this acknowledged importance a 1992 study found schools to be only marginally involved in systems of care. Much more needs to be learned about how to involve schools in a system of care. In December 1997 and February 1998, focus groups comprised of staff from CMHS program grantees defined key questions regarding this issue. Those questions follow:

  • How do you build a real partnership with schools?
  • How do you provide prevention services for children and youth who are as yet nidentified as having serious emotional disturbance?
  • How do you get school personnel to buy into wraparound (system of care) strategies?
  • How do you engage local education agencies in the system of care?
  • How do you build opportunities for parents to work as partners with schools?
  • How do you help school staff feel safe "outside of their usual box"?
  • How do you have an impact on school services and programs?
  • How do you integrate "plans" of various agencies and partners?

The issues posed by these questions are relevant in analyzing promising practices employed by select CMHS partnerships.

 
top METHODOLOGY
After a careful review of the literature on promising educational practices and on systems of care in education-based settings, three sites were chosen for participation in this monograph. There were several criteria for selection. First, they were chosen from a group of CMHS grantees that were at or near the end of their five-year funding cycle. This allowed us to examine the successes and challenges that the sites faced over time, and to also see how site administrators developed and evolved their programs and agency interactions to address specific issues. Second, they were nominated by individuals knowledgeable about education in all the sites. Third, program data suggested that they were realizing positive outcomes. Other criteria included: operation by the partnership in urban settings; use of local schools and the community as a foundation for services; and the integration of both families and service providers (i.e., education, juvenile justice, social services, health, and mental health) into their partnership. Two researchers visited each site and focus groups, interviews, and observations were conducted with a variety of stakeholders, including program administrators, clinicians, teachers, family members, and children. In addition to these visits, the researchers gathered information from other CMHS sites, including schools and state and county officials in Eugene, Oregon; Stark County, Ohio; and Vermont.

 
top PROMISING PRACTICES THAT INVOLVE EDUCATION IN A SYSTEM OF CARE
As noted earlier, collaboration among service providers helping children and youth with serious emotional disturbance is difficult. Yet, collaboration is possible and has shown itself to be effective in improving outcomes for children. To see what was possible, this study examined three urban, CMHS funded sites that have struggled with and started to overcome the challenges to collaboration. The sites are located in East Baltimore, South Philadelphia, and Rhode Island. The fact that these are urban sites was particularly crucial since the literature review found that the research focusing on promising school-based practices largely ignores urban contexts, where educators and service providers view the challenges as especially daunting. The monograph focuses on these settings in order to develop the knowledge base about interventions in urban contexts.

The Three Sites

The South Philadelphia Family Partnership, Philadelphia, Pennsylvania

The South Philadelphia Partnership, sponsored by the Children’s Unit of the Philadelphia Office of Mental Health, is a collaborative effort involving the participation of more than a dozen groups, including citywide service agencies, family advocacy groups, and the school district of Philadelphia. The partnership provides an array of services and support to children with serious emotional disturbance and their families. A key feature of the partnership’s approach to implementing an effective system of care is its emphasis on school-based behavioral health services that are comprehensive, preventative, family driven, integrated, and flexible. Working in support of the partnership are consultation and education (C&E) specialists, who are mental health professionals, and intensive case managers (ICMs), who are trained mental health clinicians. They work with schools, children with serious emotional disturbance, and their families to provide comprehensive support.

East Baltimore Mental Health Partnership, Baltimore, Maryland

The East Baltimore Partnership was developed in 1993 by a coalition of state, city, and local leaders, including representatives from city agencies; state departments; and other private and public entities (e.g., Johns Hopkins University, University of Maryland, Families Involved Together, and Alliance for the Mentally Ill). The Partnership’s core service programs to assist children with serious emotional disturbance and their families include the Family Resources Coordination Unit, an outpatient unit, and the School-Based Program. Four principles guide the work of the Partnership: systems of care should be child and family centered; the needs of the child and family dictate the type and mix of services; systems of care should place decision-making responsibility in the hands of the local community; and services should help families empower themselves to achieve the highest level of participation in community life.

Project REACH, Rhode Island

The Resources Effectively Allocated for Children Project (REACH) focuses on children and youth who meet the CMHS standards for severe emotional and behavioral problems and their families, regardless of their eligibility within state guidelines. A set of concrete principles defines how REACH serves those needs. First, the overarching goal of the project is to identify and provide a full continuum of services for children and youth with severe emotional and behavioral problems. Second, the provision of services must be highly flexible, child and family driven, and community based. Third, services should also consist of collaborations among both public and private agencies, and must be planned in a culturally competent manner to maximize access and delivery. REACH is a statewide program, operating in all of Rhode Island’s "catchment" areas, each with a Local Coordinating Council (LCC) responsible for implementing the system of care in the communities within that region.

 
top CROSS-SITE FINDINGS REGARDING DEVELOPMENT OF SYSTEMS OF CARE
The programs profiled here illustrate both the complexities and rewards of establishing school-based systems of care. Our visits to the partnerships revealed practices that were common to all the partnerships and evident in their success. The six practices that seem most integral to the success of the systems of care follows:
  • The use of clinicians or other student support providers in the schools to work with students, their families, and all members of the school community, including teachers and administrators.
  • The use of school-based and school-focused wraparound services to support learning and transition.
  • The use of school-based case management. Case managers help determine needs; they help identify goals, resources and activities; they link children and families to other services; they monitor services to ensure that they are delivered appropriately; and they advocate for change when necessary.
  • The provision of schoolwide prevention and early intervention programs. Prevention helps those students with or at risk of developing emotional and behavioral problems to learn the skills and behaviors that help in following school rules and enjoying positive academic and social outcomes. Early intervention allows schools to provide students with the support and training they need to be more successful in managing their behavior.
  • The creation of "centers" within the school to provide support to children and youth with emotional and behavioral needs and their families. Students in the centers interact with caring staff members who can help students and their families connect with the entire system of care to help in meeting their needs.
  • The use of family liaisons or advocates to strengthen the role and empowerment of family members in their children’s education and care. All three sites studied have harnessed the power that involving family members as equal partners brings to their comprehensive programs.

 
top CONCLUSION
It is possible to improve outcomes for children with serious emotional disturbance. While many urban schools fail to attend to students’ mental health needs, the South Philadelphia Partnership’s efforts are helping to develop school-based practices that address the mental health needs of all students. Similarly, while many have written off "poor, multi-problem families" as being unable to support their children, East Baltimore’s efforts have enabled mothers struggling with HIV and addiction to play a healthy and active role in collaborating with schools and clinicians to develop, implement, and monitor interventions for their children — while their children’s grades, and behavior improve. Finally, while 56 percent of students with serious emotional disturbance nationally drop out of school, only 5 percent do so in Narragansett, Rhode Island.

Changing outcomes for children and youth with serious emotional disturbance and their families is not easy. It requires:

  • Strong capacity in homes, schools, and communities to care for and address the needs of children with serious emotional disturbance and their families;
  • Robust and developmentally appropriate learning opportunities, and support for youth to use their skills at home, school, and in the community;
  • Creative efforts to embrace as well as address diversity;
  • Persistent collaboration with families;
  • Child- and family-driven assessments, planning and monitoring of all interventions;
  • Ongoing staff development and training that enables individuals to collaborate and to master new ways of doing things; and
  • A comprehensive and seamless system of care that provides appropriate, culturally competent child- and family-centered services.

The three sites examined here have started to do these things. In so doing they have produced results that have led to institutionalization at the school level, and to the scaling up of services at the city (Philadelphia) and state (Rhode Island) levels.

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Effectively Serving Children with Emotional or Behavioral Disorders

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