Louise Fink, Ph.D., Baltimore City Public Schools

Rita Mattison, DM, MHS, LCADC,Baltimore Substance Abuse Systems, Inc.

YOUTH SUBSTANCE USE AND ACADEMIC ACHIEVEMENT

EXPANDED SCHOOL MENTAL HEALTH PROGRAM

Baltimore City Public SchoolsBaltimore Mental Health SystemBaltimore Substance Abuse System

PROGRAM OVERVIEW• Baltimore City Public Schools has partnered with external agencies to supplement clinical services to students in general education since 1991

• Financial support for these services has remained level ($1.4 million annually) while the number of providers and schools covered has increased

• Currently there are 4 lead agencies providing service in a total of 105 schools.

• The ESMH program has four funding sources• PREVENTION SERVICES• Baltimore City Schools $1.4 Million• Baltimore Mental Health System (BMHS) $726,000• Baltimore Substance Abuse System (BSAS) $420,000• TREATMENT • Public Mental Health System/Medicaid• fee for service

Funding Sources

ESMH Services Model• Category 1: School-wide Supportive Activities - 20% of

clinician time• Category 2: Treatment Services - 50% of clinician time• Category 3: Group Prevention Activities - 20% of clinician

time• Category 4: Clinician Professional Development - 10% of

clinician time

ESMH Services Model

Prevention Activities Treatment group interventions Staff training0

0.1

0.2

0.3

0.4

0.5

0.6

School-wide Supportive Activities• Consultation with school staff • In-service presentations• Participation in school-wide crisis management• Participation in school-wide behavior management plan• Participation in school teams• Attendance at school functions

Treatment Services• Screening/assessment/evaluation/treatment planning• Treatment services• Crisis Response• Family services• Teacher consultation• Clinical Documentation• Activities for reimbursement

Group Prevention Activities

• Prevention groups for small groups of students• Classroom-wide prevention activities• School-wide prevention activities/assemblies• Parent/family focused group prevention activities

OUTCOME INDICATORS• Student Attendance: percentage of students attending at

least 90% of school days• Suspension: percentage of students with no suspensions

after beginning services• Special Education referrals: decrease in the the number of inappropriate referrals to Child Study teams • Promotion: percentage of students promoted to the next grade

Robert Balfanz 4 indicators

• Indicator 1

• Poor Attendance

Robert Balfanz 4 indicators• Indicator 2

• Poor Reading Skills

Robert Balfanz 4 indicators• Indicator 3

• Behavior Issues

Robert Balfanz 4 indicators• Indicator 4

• Poor Math Skills

Robert Balfanz 4 indicators• Students who fall off track in the sixth grade tend to have one or two off-track indicators. Relatively few sixth graders have three or four indicators, that is, failing math and English and having low attendance and poor behavior.

Baltimore Substance Abuse Systems, Inc.

Baltimore Substance Abuse Systems, Inc. (bSAS)• Designated substance abuse treatment and prevention authority

for Baltimore City• Administrator of federal, state and local grant funds for substance

abuse and prevention services• Monitors treatment programs• Collects client demographic and treatment data• Works in collaboration with other agencies to improve services,

and plan/develop new services

Collaborative EffectsESBHI is a behavioral health intervention funded by bSAS in collabration with:

• Baltimore Mental Health Systems, Inc. (BMHS)• Baltimore City Public Schools (BCPS)• Baltimore City Health Department (BCHD)

ContextSixth Grade Initiative is nestled within Expanded School Mental Health Initiative (ESMH)• ESMH

• Began in 1993• Multi-agency partnership • Provides supplemental mental health prevention, early intervention,

and treatment services to children in Baltimore City public schools

ESMH Target Population• Children enrolled in general education programs

• Grades K through 12

• Clinicians work with student support team (SST) to identify social/emotional needs of children and strategies for addressing these

What is to be different in 6th Grade Initiative Schools

• Targeted high-risk sixth graders• Individualized iterative interventions, regular follow-up, and

tracking through SST• Initially used Why Try as the primary small-group

intervention / FY12 Botvin’s LifeSkills as primary intervention

• S.A. prevention training for faculty/staff• Standardized school-wide behavior management

intervention

Defining High-Risk Sixth Graders• Research by Dr. Robert Balfanz – Identified children at

risk for school drop out as early as 6th grade based on the following 4 risk factors:– Poor attendance– Behavior problems– Lack of math proficiency– Lack of reading proficiency

• Retention• School Administrators/Staff• Substance abuse is associated with school drop out

6th Grade Initiative

Concept: bSAS funding is leveraged with BCPS funding to provide targeted interventions with substance abuse focus to at-risk sixth graders

Goal: To prevent school drop-out which minimizes substance use and other negative outcomes for children

What Does bSAS Money Buy?• Partially funded mental health clinicians in 35 schools

(25% of FTE)• Minimum of 36 consultations for teachers and other

school staff• Minimum of 15-18 prevention group activities/committee

meetings• Minimum of 1 family outreach activity• Minimum of 1 in-service presentation to school staff

Sixth Grade Initiative – As Implemented

• Program began fall 2008• Baltimore City Schools and City Health Department

identified 895 6th grade children as meeting at least one targeted risk factor

• Clinicians in conjunction with SST identified individualized strategies and interventions for selected population

• Clinicians offered enhanced behavioral health services

Evaluation of the Impact of ESBHI• Evaluation of ESMH Services during the 2008-09

academic year• Approved by Georgetown University Institutional Review

Board (IRB) and BCPS• 553 Students in ESBHI were tracked• Service use data was merged with measures of school

and academic performance, provided by the Division of Research, Evaluation, Assessment (DREAA) of BCPS.

Relationship to Academic Outcomes Benchmarks

 

 

Figure 5: Math Benchmark Comparisons

N=77

N=53

Comparison ESBHI 6th Grade Cohort

18

16

14

12

10

8

6

4

2

0

Perc

ent o

f Stu

dent

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owin

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crea

ses

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ench

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Relationship to School Functioning Attendance

Figure 9: Change in PercentAttendance for Subcohorts

GS-Lo GS-Mid GS-HiESBHI Subcohort

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0

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-2

-3

2

Cha

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ttend

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Relationship to School Functioning Suspensions

Figure 10 : Change From 5th to 6th Grade in Percent of Students Receiving Different Numbers of Suspensions

ComparisonESBHI

0 1 2 3

Number of Suspensions

Cha

nge

in P

erce

nt S

uspe

nsio

ns

-10 -10

-3- ‐1 - ‐2

7

23

-2*

6

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3

2

1

0

-1

-2

-3

Conclusion• The relationship between ESBHI participation and

academic, attendance and suspension outcomes were evident in students who attended most of the sessions.

• Results suggest that participating in a school-based behavioral health life skills groups, implemented with reasonable fidelity, can lead to academic success and school functioning found to reduce or delay onset of substance use and behavioral health problems in youth.

Anthony, B. J. & Sebian, J. K. (2011)

Perspectives• “The kids love the group! This is one really great thing that happened this week...it

made me so proud of them: Some of my kids created a mini-play that talked about fighting and how they would solve the problem (without me asking them to do so!)! Four of them acted it out at the end of our group and it was really creative and drove the problem-solving point home! I may have them do it again for their parents at the graduation ceremony!”

Behavioral Health Clinician

•  ”Coming to the groups has helped me not to fuss with other students when they get on my nerves and I have learned to walk away and not get into fights.”

Student

• “I believe the 6th Grade Initiative is good for the students and I would like to see it continued next year.”

Principal

References• Anthony, B. J., & Sebian, J. K. (2011).

Baltimore Expanded School Mental  Health: Report of the 2008-2009 Program Evaluation. Appendix B:6th Grade Expanded School Behavioral Health Initiative Evaluation Report. Washington, DC: Georgetown University Center for Child and Human Development.  

• Balfanz, R., Ruby, A, & Mac Iver, D. (2002).Essential components and next steps for comprehensive whole-school reform in high poverty middle schools. In S. Stringfield, & D. Land, (Eds.), Educating at-risk students (pp. 128-147). Chicago: National Society for the Study of Education.

Contact Information

Louise Fink. Ph.Dllfink@bcps.k12.md.us

(410)396-0775Cityschoolsinside.org

Rita Mattison, DM, MHS, LCADCrmattison@bsasinc.org

(410)637-1900 x217www.bsasinc.org