18. School Mental Health Collaboration: What We Know and Where to Go From Here

Speaking: Elizabeth Mellin

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Background

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School and Community Collaboration

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Focus Groups

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Collaboration with School Colleagues

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Bridging Social Capitol

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MIKE: Our presenter is Dr. Mellin. She is currently in Associate Professor of Education and Counselor Education Program in Penn State University. Her research interests are primarily focused on

supporting role of counselors in collaborative approaches to promoting mental health among youth including interdisciplinary collaboration, school-family-community partnerships, and expanded school

mental health. In addition, Dr. Mellin is involved in engaged scholarships focused on addressing educational and mental health disparities among historically underrepresented youth. Prior to joining

the Penn State, as an assistant professor in 2006, Dr. Mellin was a child and adolescent counselor, clinical supervisor, and grant writer for public mental health program in Atlanta, Georgia. She is

a nationally published author on topics related to counselor prep and professional development for working with youth. In addition to her appointment at Penn State University, Dr. Mellin is also

involved in variety of service activities related to mental health promotion at the national, state, and local levels. At the end of this, we'll provide you the code but if you would please welcome Dr.

Mellin.

ELIZABETH MELLIN: All right. For my first check, I'm going to put this microphone on. Good afternoon.

AUDIENCE: Good afternoon.

ELIZABETH MELLIN: How are you guys?

AUDIENCE: Good. Good.

ELIZABETH MELLIN: Oh, that's great, energetic for this time of the day. Well, I was just telling Mike, it's hard to sit in these rooms all day. I have an appreciation for kiddos in school who are

sitting for long periods of time. So like Mike told you, my name is Elizabeth Mellin. I am an Associate Professor at Penn State University. I am also the coordinator of our CEDAR counseling clinic,

and I also broadly coordinate a new program called Clinical Mental Health Counseling in Schools and Communities which is really focused on where a lot of my interest is in and that's Expanded School

Mental Health. So before I get started, do you all understand what Expanded School Mental Health is? I just want to do a check-in of the language. Okay. I see some no's and some affirmatives.

Basically, Expanded School Mental Health refers to any mental health programs that are bringing in supports from the community, right? So school mental health could just be focused on the traditional

mental health services that are guiding high schools, high school counselors, school psychologists, school social workers. But when we talk about Expanded School Mental Health, we're really talking

about mental health supports to come in from the community to all mental services that are made available by school counselors, school psychologists, school social workers. Does that make sense?

Okay, great. This room is still lined up a little bit. I was telling to Mike, you know, the other day, they sent the information, 'Here's your final registration,' and I scanned through the e-mail,

and I was like, "The registration number is not in here at all. There's something wrong. It must be mistaken." I scanned through it again, scanned through it again, and then all of the sudden I saw a

number and it said 147. And I'm like, "Oh, 147?" Like, I thought that was the session number or something, not the number of people being here. So, maybe we scared some people away because it doesn't

seem like there's 147 people in the room today. But 147 people, a microphone that's being taped, my anxieties are crazy right now. So anyway, like Mike said in his introduction "My Prior Life", prior

to being an academic and a faculty person, I was a community mental health counselor in Georgia. I spent a lot of time working in schools. We didn't really work in a PBIS model back then, but we did

work in schools and I worked with students that were having trouble, the uncalled troubles that were getting in the way of their learning. Also along the way, I completed my PhD and my supervisor

said to me, "Hey, Liz, there's the scramp out there." It's the SAMHSA Youth -- Young Offender Reentry grant. Anybody familiar with that? It's basically a program to help young offenders return to the

community through SAMHSA. And he said to me, "Listen, you have a PhD. You must be able to know how to write grants. Why don't you write this grant for us?" I've never written a grant in my life,

folks. But I took a chance and I wrote it. We didn't get it. They asked me again to write it. I wrote it the second time, and then we got it. So it's a Young Offender Reentry grant that is focused on

helping adolescents return to the community, return to their schools after a period of adjudication and incarceration. So we get the grant, five million dollars to implement these services. Guess who

doesn't show up to the table? Well, Education showed up. Juvenile Justice, even worse. So we had -- we had a grant that is all focused around Juvenile Justice, mental health, and schools. And

Juvenile Justice refuses to come to the table. And I'm thinking, "How could this be so?" We have five million dollars to provide services to only 200 adolescents over four years. This is an enormous

opportunity. And what I found out was that the Juvenile Court themselves applied for this grant several times. And haven't gotten it. And we're feeling hurt by the fact that we got the grant and

refuse to come to the table. So over and over in my workbook directive with adolescents and children, as well as in the community through grant writing, I figured out very quickly that when things

fell apart, it was often because the adults in the lives of children and adolescents were working really well together. But at the same time, we heard all of these messages about how important it is

to collaborate. So today we're going to talk about collaboration and what we know about collaboration. I'm going to introduce you to a new tool that you might find useful to use in your programs.

We're also going to talk a little bit about focus groups that I've done with people much like yourselves who are doing this work. So very first thing to go along today -- Not Arnie Duncan. I

don't mean that. But the first thing to go wrong today is that this video actually won't play. So let me just give you a context, you might be able to play it when you download the hand -- oh, no,

the handout won't give you the link. I'd be happy to provide you the link. This is really his confirmation here and it's a short clip from it. But it was talking about how important it is for schools

and communities to come together to wrap this holistic services around kids. So you might want to check it out. It's a great little piece -- two-minute piece if you need to kind of sell this idea to

anybody, mindless about our main activities, no matter what you feel about them. It's a good video. So today, I'd like to talk a little bit about the types of collaboration you guys are involved in

in the State of Pennsylvania. I'd like to talk about the significance of research on collaboration. Also, I would like to introduce a theoretical line for collaboration that is Social Capital one I'm

going to talk about in a little bit. I'm going to show you a mixed methods study. How many people in here don't like numbers? Yeah, like how many people like doubt when it comes in stories? All

right. So you're going to find some stories today. We're going to present some of that kind of data to you as well. I also will present some number of data to you for those of you who are interested.

We're going to talk about what this work means and also some plans for future research. Okay. So first, I want to talk and start a little bit of dialogue at the tables that you're at. So, if you

could take about the next 10 minutes and focus on these questions with the folks that are sitting at the table with you. So in what ways are schools and communities working together in Pennsylvania

to support learning and promote mental health, right? And that might be happening in some really obvious ways through PBIS. Or what facilitates our kids in the way of this work? So when you're

reaching out to a community, sort of where schools are reaching out to you, for any community members who might be in the audience, what facilitates our kids in a way of collaboration and what do you

perceive to be the benefits of collaboration between schools and communities? Right? A lot of rhetoric around the collaboration, a lot of celebration of collaboration, but what do we think it

changes? Like, besides some inherent kind of common practice wisdom that we need to collaborate in order to get things done, how does collaboration actually make a difference or does it actually make

a difference? So if you could spend about the next 10 minutes in your small tables discussing some of these points. And if somebody at the table could keep some notes on what you're talking about,

then we'll do a report out just to make sure we keep everybody awake and moving today; and also, so I can have a better understanding of your experiences here in Pennsylvania. Ready to go? All right,

let's do it. Hey, might all of us come back together? I know we're scheduled to end at 5:00. I'm hoping to get us out a few minutes early. I love all the dialogs of collaboration and

that's happening. All right. So I appreciate those of you who let me duff in at your tables and hear a little bit of the conversation, but I'd like to hear from the broader group. So in response to

that first question, in what ways in schools and communities working together in Pennsylvania, what were some of the ways that you talked about? What were some of the initiatives or projects that are

happening in your communities? Sure, do you want to stand up or no?

AUDIENCE MEMBER: It doesn't matter. [inaudible]

ELIZABETH MELLIN: I feel you. I feel you. Got it.

AUDIENCE MEMBER: I'm from Westmoreland County [inaudible] a couple of years ago and provide some of these therapy services for our students in our school which is a good thing. That's what we're

trying to collaborate. And one of the things that you're talking about is it -- then a lot of kinds of facilities come in and then these [inaudible] kids were talking about they don't have assurance,

they don't have great assurance where they say they don't have something [inaudible] because they're new and then sometimes they come in, they all try to understand how the education system works.

And they don't understand if it's needed to be in a Math class and when they sign the Math class. They don't understand it. If you come back later at lunch, [inaudible] so it's something that they're

trying to [inaudible]

ELIZABETH MELLIN: That's right. That's right. I think a lot of what we'll talk today about [inaudible] with you, especially in terms of community providers like myself, not really understanding the

culture of schools. And schools -- those of you who work in schools know that schools have very unique culture. Thank you so much for sharing. Others? Yes?

AUDIENCE MEMBER: We have 39 co-workers of mental health school-wide program in our district with value and part of that is mental health comes in, a monthly meeting and [inaudible] system from a

mental health perspective. And we say to them that it feels wrong with [inaudible].

ELIZABETH MELLIN: And I'm here to collect the debts in my -- what I sent to you. You guys must have a really strong relationship to have. It sounds like some very honest conversations and feedback

that happened across the stuff.

AUDIENCE MEMBER: We're blessed in helping manage care provider and our superintendent is very open for change. And then we have [inaudible] outpatient on mental health program. They had once believed

with their supervisor with this. They had representations from Milton Hershey School and [inaudible] of mental health purposes. And we're an urban school district. In a rural school district with

outpatient services that they've been trying to get for many years, and they had sort of 32 slots. I was in their district [inaudible]

ELIZABETH MELLIN: Wow. Excellent. Thank you so much for sharing. Others? Other ways in which you are collaborating with community partners? Yes?

AUDIENCE MEMBER: Hi, [inaudible].

AUDIENCE MEMBER: We have a [inaudible] in our school. We had just [inaudible]. We started in a collaboration and it's part of our school family and we're working with [inaudible] in understanding

agency to do a lot of this work with -- in their school. So why would we collaborate? What is the purpose? Certainly, it doesn't sound easy to do. Yes?

their language, understanding our language; and it could be really positive. There are certain things you can do like plunging in the access that could [inaudible] but in schools, it worked really

well.

ELIZABETH MELLIN: Absolutely. Thank you so much for sharing a really positive experience. And you're right. What I hear is that you have to learn one another's language and really establish that

AUDIENCE MEMBER: [inaudible]

relationship to one another to work very well. Thank you so much. All right. So how about the second one? What facilitates or get in -- or gets in the way of these collaborations? Yes?

AUDIENCE MEMBER: We're going to talk a little about [inaudible] in a small area and using resources, you know, that'd help a lot of our -- some of our families, you know, some teachers from all of the

community [inaudible] and that kind of stuff and, you know, and you get the access those services. We're able to talk about, you know [inaudible] services and they say, you know, they can get to do

plenty of services [inaudible]. And then it's also, you know, if you're talking about the same thing, the purpose [inaudible]

ELIZABETH MELLIN: Sure. Sure. Contract difference, it sounds like primarily systems issues, right, around [inaudible] and I'm even thinking about failing as a system and how they interact with

communities and schools. Thank you so much. Anyone else? Yes?

AUDIENCE MEMBER: Territorial protection.

ELIZABETH MELLIN: Yes. Turf issues. Now, we'll talk -- we'll talk a little bit about that as well. Great. And so at the end of the day, why do we collaborate? Right. So in some ways -- I don't -- I

don't want to call Milton Hershey out, right? Milton Hershey is a branded community provider. They've made a community in their school. They've -- essentially, it sounds like establishing community

AUDIENCE MEMBER: [inaudible]

AUDIENCE MEMBER: Collaboration can build capacity because it shares knowledge usually and competencies sometimes.

ELIZABETH MELLIN: Absolutely. I can learn from you, you can learn from me, and together we can both work in a broader, more holistic way with the child. Yes?

AUDIENCE MEMBER: It can also build a choice [inaudible] to work with and when you're dealing with therapy, sometimes finding the right personality not just the one that they [inaudible].

ELIZABETH MELLIN: Absolutely. Absolutely. That's what you're saying, it's a challenge too with some of the work that happens in your district, right, that there's not that big community provider, so

some already fit but it's still apart. But yes, winding scope of services that are available. Yes?

AUDIENCE MEMBER: My big concern is school districts have their funding [inaudible] they're forced to go outside from the school system.

ELIZABETH MELLIN: Uh-hmm. Absolutely. Okay. So let me go forward and let's save the time and because I promised like I got in here a few minutes earlier. So I think there's a broad scope of community

-- school community collaboration that's happening in many different ways not only in Pennsylvania but across the nation. But at the same time there are obvious practice challenges to collaboration.

And most of the literature that's out there -- just let me clarify, there really isn't a rigorous research study that will tell you that collaboration improves outcomes for kids. In fact, in some

research to tell you that that's not the fact, Lan Bigman -- are you guys familiar with Lan Bigman's work, who does a lot around systems of care? Did the study, I think it was in 1997, [inaudible]

kids who were in systems of care, right, when they're on multiple systems collaborating with one another versus kids who were not in systems of care and found what would surprise everybody that it

didn't make a difference if kids were in systems of care. Right. But yeah, it continued collaborating. Now, the major problem with that study was that it's just a dichotomous spherical, like either

yes or no a child was in a system of care. And as you guys know from the work that you've done in schools and communities, collaborations, you can have a collaboration. It doesn't mean it's a good

collaboration or successful collaboration. So there wasn't really a question of quality there. But there's other time confusion about the roles and responsibilities. I think particularly from mental

health professionals. I've talked to a lot of school psychologists who now have a clinical psychologist coming in from the outside and they're thinking, "Wait a second. What's your role and what's my

role? Are you stepping on my turf? Are you going to work me out of the job here?" And in some respects that has happened with the implementation of school mental health programs across the United

States. School Counselors were one of the first groups of professionals to start losing their jobs when schools realized that they could contract out mental health services far cheaper than they

could to employ a full-time school counselor. So for that reason, many people now when they do contracts -- when communities do contracts coming into the school will stipulate that they will pull out

of that contract if any school mental health -- school-employed mental health professional like a school counselor, school psychologist, school social worker is fired. There's also progression to --

due to differences, in terms of our paradigms, in terms of our philosophies and how we think about kids in their development, oftentimes, we come from very different places. We also have very

different terms, right, and different language that we use to describe what are various similar concepts. Whether you're talking about social or emotional learning or mental health, it's kind of all

over the map language that we use. There are also power and status questions. Our professions, our service delivery structures oftentimes set off a culture of competition in autonomy that doesn't

necessarily reward collaboration. As we all know we're busy, right? We have a lot to do on our plate in reaching out to other community partners. It's not always feasible with our schedules. And last

but not the least, I say graduate training here because I'm mostly focused on training professional counselors but this happens just as much at the undergraduate level when people get into the

majors, but we do train people in professional silos. So one of my favorite examples of this, a colleague of mine, who's a social worker in Ohio State, one day somehow she ended up looking up and

there were four different group counseling process happening on the Ohio State campus at the same time. One of those classes was in counseling, one was in social work, one was in nursing, and one was

in psychology. She then went and got the syllabi for all of those classes. All of those classes were using the same Corey Textbook that's always been used in same psychiatric counseling classes.

Right? We need new textbook. Not that Corey's not good but you need to expand it a little bit. But the point was here we were offering basically the same exact class to groups of professionals that

were not going to primarily work with other professionals who were like them. They were going to work with those professionals in a interdisciplinary way. And one of this opportunity that it was for

interdisciplinary training. And like I referenced at the end of this, there's a lack of research evidence. We don't know whether collaboration makes a difference. And if it does, for whom or on what

circumstances that it makes a difference. One of my favorite folks out there is collaboration has this inherent value that nobody dared to question. Nobody yet has written an article about what's bad

about collaboration. But we've all been parts of collaborative groups that have been failures, right, where we could have done the work more effectively on our own rather than with broader group of

people. And sometimes we get really fixated on this. If we just throw more circumstances, more stuff at kids and families that will help. But if we're throwing a bunch of bad services at people, that

doesn't necessarily make them better. So we need to think more critically about collaboration and how it works and whether it works because we haven't answered that question yet, where almost every

single federal grant now will require you to collaborate across systems in the absence of any evidence that would make things bad. The other case that's the same from collaboration, is any theory

behind it? Right? It just kind of feels good to us. And theoretically, we think we should be collaborating. If we want to work with kids and families, many of them have very complex issues, we need

more people at the table with more knowledge and more resources. It makes sense, right? But that doesn't really get us to, "Wait, how does this impact the outcomes? What are the different types of

collaboration that will happen?" So are you -- how many people in the room are familiar with Social Capital? Just -- okay, just a few. Social Capital is a theory that really came out of economics but

it has been applied in education and human development in all sorts of different ways. But basically, the core of the theory is it's all about the relationship, right? And when you have relationships

with other people that are characterized by the simple trust and cooperation, your knowledge expands, your set of resources expand. Some like collaboration? Some like the point of what we're doing,

right? So essentially, Social Capital can be thought up as a collaboration, right? We can't do this work alone. At least we think we can't do this work alone. We need access to other people. There

are three primary types of Social Capital that can help organize your thinking a little bit about the types of collaborations that you're involved with. And the first is Bonding Social Capital. All

right. This is when you're collaborating with the people who are like you. All right. That might be people in your school that you belong to the same school districts, the same elementary school, the

same high school, right? And then there'd also be people in your profession. All right. So I'm a psychologist and I collaborate with a lot of other psychologists. This is not collaboration that

happens within groups of like-people. Right? It's what's happening in Milton Hershey. Right? You're collaborating within your system. That's bonding. And that collaboration, not trust, really has to

be there before you reach out to other partners. I usually compare it to a date, right? You got to like yourself and know yourself before you go enter into a relationship with other people. So if

you're in a school district, you better have trust, you better have cooperation and communication among the people in your school district before you reach out to people in the community which is the

next kind of Social Capital and that's Bridging Social Capital. Okay. And that's when we link -- those types are usually a little less strong, little weaker, but that's when we link to people who are

different from us in some way. So again, putting this in the -- in the framework of collaboration, this is where me, as the councilor, might be collaborating with the teacher. Right? Or where

somebody from the school is collaborating in the community attribute or different but we're working together. And we begin to bridge; we access new ideas and new resources that we wouldn't have had

previously. And linking this is a really interesting form of Social Capital to me. So the two that I just described are horizontal, right? The relationships are basically equal. Even if we're

different, we're equal in these two types of Social Capital. Linking is vertical, right? This is when we collaborate with people who have more or less power than us. Okay? So oftentimes this is the

kind of collaboration we're talking about when we talk about families collaborating with schools. Families do not have as much power in the school system as the school professional does, so they are

linking up. When schools collaborate with governmental organizations, say, at the state level, right? They're linking up to somebody who has more power than that. So this is where a lot of the social

justice type of work gets done in terms of addressing educational disparities. Right? It's linking people who are working together with different power. Does that make sense? Okay. So the rationale

for this study is I went out to start studying this, I couldn't find a tool to measure anything that was happening. Everything that was out there was based on specific profession in terms of

interdisciplinary collaboration. So talk about siloed use of collaboration. If I only ask the school counselors how the collaboration's going, I'm not really going to understand the collaboration,

right, if I don't ask the other partners of the table. And in addition, when I went out there to look all of the research, all what's available -- I won't call it research -- all of the literature is

primarily program descriptions and anecdotal accounts of what's happening in collaborations. Nobody can really study this in a very systematic way or using any type of theory. Okay. So when that

happens, there's not a lot we have to start with a clean slate and that's qualitative research. Right? We're doing some exploring, figuring out what's going on and what we really wanted to look at

were the influences and perceived benefits of collaboration. I did this with Mark Weist. Anybody familiar with Mark in the Center for School Mental Health? They do a wonderful conference every year.

It used to be at the University of Maryland where the center started in 1997. It's an excellent, excellent resource for those of you who are involved in this work. Please check out their website. He

is now at the University of South Carolina but he established one of only two School Mental Health Centers in the nation. So he and I did the first part of the study together. We're also working on

the second part of the study along with one of his post-doctoral colleagues. So we'll talk a little bit about the first. The first one, we basically sat down the people who were doing this work and

ask them the same questions that you talked about. What facilitates or impedes collaboration between school or community professionals and what are the perceived benefits of collaboration? We did

this in focus groups. We held separate focus groups for community professionals and separate focus groups for school professionals, so that people feel like they could talk handedly about their

experiences because many of these people work together. The study took place in a large, very established School Mental Health program in the Mid-Atlantic section of the United States and it was

fairly informal. We did have an interview guy but we hear from that guy when necessary. Altogether, we talked to 26 people, 20% of them were female, 62% of them were white, 30% of them were black,

and the 8% identified as multiracial. There was an over representation I would say of community providers, right, slightly more than half for community providers. All right. We recorded all of those

conversations and we have them transcribed word for word. We went through and did a content analysis and that's basically for those of you who maybe unfamiliar with qualitative research. You go

through with the reading, come up with all of these codes, and then you look at the codes and you figure out -- you put them into clusters, right, because they seemed to go together, like black, red,

blue, brown, right? They're all colors. You put them together into clusters and then you group them into categories. And those categories were what we were looking for in terms of developing factors

for an instrument. As we did this, we went back, we gave our initial findings to all the people who participated and asked them to provide feedback about our findings. We also triangulated the data

and that we got representation from different groups of people, so from community providers, from principals, from teachers, from family members. We went back and revisited the participant responses

to check, 'Does this make sense? Can we find evidence that what we're thinking is not true?' And when you stick descriptions which you'll see in a minute to kind of highlight what we're talking

about, so this is what you really want to see, right? These are the results of the study. So we came up -- for our first question, what influences collaboration? We came up with five separate

AUDIENCE MEMBER: [inaudible]

categories. The first and what seemed to be the most important especially for the school professionals was the outreaching approach by the mental health professionals from collaborating agencies.

Right. This included a variety of sub-categories but one that was brought up earlier in our discussion was understanding of school culture. So anywhere that we see something folded, that quotation

goes as a representation. So the quote says what I found early on this that I could not superimpose my message on mental health and mental wellness without learning how to speak school, we've always

got to remember that the primary objective is academic achievement of the students. Does this resonate with anybody in the audience? Yeah. How so? Can you say anything about that from your

experiences? Yes?

AUDIENCE MEMBER: When you're working with a public -- a public school study is not like any other. And when, you know, the suggestions were made from the Math that yes, you may do this, yes, you would

try this, at times [inaudible] prevent the child from school setting every time you put [inaudible]

ELIZABETH MELLIN: Right. Right. Right. It might pull them from that Math class that they really need to be in or sometimes maybe they provide us more focused on measuring kind of outcomes. We're

talking about outcomes that are very mental healthy, for lack of a better word, right? Well, see?

AUDIENCE MEMBER: [inaudible]

ELIZABETH MELLIN: We're not there yet. So the next is the interpersonal processes and these are the types of things. Remember when I said earlier it's all about the relationship, right? These are the types of

things that need to be there. I mentioned both clearly. This is a school psychologist saying, working with an outside agency is kind of like what is your role? In the beginning I was a little

confused as to what you do as compared to what I do. Right? So that gets into some of that role clarity, that definition and also a little bit of the turf issues that are coming up, because no doubt

this person was feeling a little threat into her role. School Climate: The school environment and practices influence collaboration. This is a quote from a principal. He said, "We reach out." Parents

and community members say that not only are you welcome to the school but the school is happy to have you here with open arms. When you include not only school staff but also clinicians and outside

partners and folks, that's going to build and inspire. Right? This was an urban school district in many of the schools that require a 24-hour advance notice of a visitor to come into the school. He

had a very different setup that parents could stop in on their way to a dentist appointment if they had a few minutes to help in the holidays and the difference he said was tremendous in the school

when you were bringing parents and outside providers in, but it was really the culture of the school that we are part of the community. Yes? We're you going to say something?

AUDIENCE MEMBER: I was. You know, just kind of piggybacking on what you said is one of the other things too for school fees and the school climate is that schools are focused on all the students in

their district whereas mental health professionals only focus on their client.

ELIZABETH MELLIN: Right.

AUDIENCE MEMBER: And even if you do have a group of five to six students at one time, even though your [inaudible] was going to make that client be successful in school environment, you know. I've been

doing school days therapy through our school for eight years and just today, it's time putting that perspective in my mind and that's one of those eight areas. It doesn't have to be up here. You're

going to teach these kinds something that you're both aware of, you know, and implementing one thing for one student in a classroom is not necessary for the betterment of the other 25 students in there.

there.

ELIZABETH MELLIN: Absolutely.

AUDIENCE MEMBER: And that's one of the places where like the School-wide Behavior Program is going to be really effective. [Inaudible]

ELIZABETH MELLIN: Absolutely. Good -- excellent point. Excellent point. The other thing that came up that I didn't highlight here was the question of confidentiality. And the difference again, that

kind of also goes back to school culture, right? That oftentimes in schools, a child's business is kind of everybody's business in school, right? It takes a village. So the secretary is used to

knowing what's happening with the -- with the student. And so sometimes what would happen when the community providers came in and they kind of clamed up according to their confidentiality, their

ethics standards and said I can't tell you anymore about what's happening with the student, then that was occluding to the school professionals who are like, listen, we're supposed to be

collaborating and working together and I need to know this to effectively help the student. And so when people didn't have conversations upfront about what they could expect in terms of

confidentiality, quickly the relationship would go south. Buy-In among school professionals. I've seen this in a couple of different presentations today and I know that's a key in PBIS, but most

people think if you get the kids' trust, that the teachers will trust you, but I believe the opposite. You have to get the key structure of the school which is the staff defined to what you're doing.

Does that resonate with anybody?

AUDIENCE MEMBER: Yeah.

ELIZABETH MELLIN: All right. The teachers can make or break this for you. Yes.

AUDIENCE MEMBER: Oh, and I -- and I think it's just kind of related when you're talking about school speech, you know, you want to take it like a [inaudible] just in terms of the way schools work in

terms of the mental health provider [inaudible] replacement, understanding the hierarchical nature of the school setting. And then, you know, for example -- and then that conflict issue of who is

your client? You know, your client is your child, but also working for the school and trying to strike around this therapy for example is not putting the -- is not potentially going against the director

or the teacher or the ministry or understanding, you know, that you need to kind of back up the structure of the school as well as advocating [inaudible]

ELIZABETH MELLIN: Right. Yeah. It is -- it -- that's a paradigm shift I think. I mean, it's a paradigm shift especially for [inaudible] saying we're used to having one client, right? But now the

client has become a school and understanding that just as they want to understand the client is critical for doing [inaudible] for man powering. Thank you. So also last but not the least, the

importance of administrative support. I just think that's what's the most important thing is, the support from the administrator team which trickles down to the teachers, right? So over and over

again, people involved in this focus groups talked about if the principal wasn't on board, if the principal didn't prioritize this, if my office was in a broom closet on the back hallway of the

school, I'm not really in that school, right? I'm not really a part of that school and the collaboration isn't happening. Okay. Any questions about that? I want it pretty quickly. Okay. We also

remember asked about the benefits of collaboration. One of them, I [inaudible] and again, this was done primarily with an urban school district, so it will be interesting to see over time how this

might hold up. But it is a school district where it's primarily African-American population who has been historically marginalized by the education system, who did not feel welcome in the schools and

who were very weary of any recommendations for mental health services. And so here the clinicians would say -- then many of the clinicians themselves were from this particular neighborhood, which was

another context for the study, but they talked about improved access and consistency for you- for families and one of the most interesting was the attitudinal access that came. The families

understand that I'm not a part of the school and I can't tell the school what they're telling me. It's safe, right? So there was not only increased physical access, but -- so I remember somebody

during a study. She had her keys around her neck and she was like, here, I show these to the families. I'm like, listen, I'm the only one who has these keys and your child's file is in here, and I

work for a such as such community mental help provider. I work with the school, but I don't work for them, right? So in other words, this information is going with me when I leave the school. It

doesn't stay here and follow your son throughout the school district. And immediately that created some openness to accepting those services in a way that she hadn't seen before. Okay. The new

resources and supports for schools. One of the most interesting things to come out that I didn't expect was special education referrals. The referral rate was down. And the ones that were referred do

qualify, right? And so this is from the perspective of the school psychologist who's saying, we're not wasting our time and resources testing all these kids that don't need to be tested, for services

the community providers are very much preventative. All right. So they have another outlet and it really expanded. The services that were available for general education students as well. And this is

my favorite, increased professional support especially for teachers. This is a teacher saying, sometimes, I go to see him, the community provider. And I just go, I need to talk to you, not to deal

with the kids or anything, it's just like talk me through the day. And both the community providers and the teachers talked about the community providers actually gaining a source of mental health

support for the teachers and even the other school mental health professionals in the school to talk to somebody from the outside, right? So it may not have felt comfortable going to the school

psychology service school counselor of the school social worker because they're considered an administrative part of the school, but they did feel comfortable going to the community mental health

provider, right? And in some of the schools, they were actually offering [inaudible] groups for teachers. It seemed to be very much appreciated. Okay. So now what do we do with all these? We got some

stories, so those of you who'd like this data or the story, there you go. There's some of that out there for you. Now, we're going to get to the researching -- different researching part, and that is

the development of an incident and I told you eventually I want to use this so that I can do larger scale of research on what's happening in the schools and communities. And then we can get beyond

that dichotomous kind of chat whether or not collaboration was happening because we all know that it happens at different levels. So we took again literally things that people were telling us in

these focus groups and we made an instrument, very long instrument. I think originally it had, well, over a hundred items on it, but we threw it all in there. And we distributed to people through the

center who were registered on the list from the Center for School Mental Health. We offered incentives for the research, so I think one out of every 15 people want o have a 15 dollar Starbucks card.

Truly, gets people respond. So we ended up with nearly 500 participants. I'm just going to share the participants who represented schools today, which is about 200 after we cleaned up the data, but

there's another version of the scale that's coming out that will be meeting that community perspective. So we're just focusing on school, but I thought most people that were in today would be

representing the school perspective. So again we had about 209 people complete the instrument, when we threw a [inaudible] categories like I've said, exact statements from people and you'll those in

a minute, 77% female, 86% white, 61% for school employment of health professionals, that means like school counselors, school psychologists, school social workers, 25% school administrators, and 8%

teachers. I would have like to have more in there, but we'll get them next time hopefully. 30% -- 36% came from the elementary level, 17% from middle, and 34% from high school. We also asked about

the type of community knowing that there could be variations like we were talking about in the back between urban and rural. So we had a pretty nice split there of 37% rural, 33% suburban, and 30%

urban. So we put these all into SPSS where we do the stats. We did a couple of exploratory factor analysis. This instrument which is called the Expanded School Mental Health Collaboration instrument

-- I'll say that one more time if anybody wants to know that. It's the Expanded School Mental Health Collaboration instrument has three different scales. One is the types of collaborations, and here

we go, full circle with social capital. We'll talk about the collaborations that happened within our system across the other systems to -- and with families, bless you. It also measures influences on

collaboration and also the perceived benefits of collaboration. And, again, these are just perceived benefits but for schools who are looking -- I have a friend and a colleague in Minnesota and he's

actually now working -- he's working very closely with Sen. Franken on the School Mental Health Act that came out that has been introduced, but another piece that he's working on is getting Medicaid

reimbursement for collaboration and consultation, which is a real barrier to doing some of the work. And so it needs ways to measure the perceived benefits. So it can give you an idea of what to look

like -- look at and see if it's changing. Okay. So as we withdrew the data and we're going to have a chance to actually take those tool in just a few minutes. These were the three types of

collaboration that came out as factors, right, the differentiated one person's response from another person's response, right? So the first is collaboration with community mental health providers --

professionals, sorry. So remember, this is from the perspective of somebody who works for a school district. So I'm saying one of the ways in which they do this is the sample item is that they

participate in school-based teams with community mental health professionals. They also talked about collaboration with families, right? And that particular subscale has five items. They develop

plans for intervening with students and the -- and families in collaboration with the school colleagues, and my role as a school professional I consult the school colleagues about student needs. All

right? Kind of [inaudible] nothing really shocking in here that's coming out, but one thing I do want to mention, and it's come up. This is the second scale I've developed. I did another one that is

focused on team collaboration in schools. If anybody is interested in that one, please feel free to email me. I'd be happy to share it with you. But it's the inner index of interprofessional team

collaboration. All right. So this focus more within the schools, but I had a bunch of questions in there about how teams were collaborating with families and every single one of those items fell out,

right? Meaning, that it wasn't -- ended up come up a significant meaning that for the school professionals, they didn't really see families as mentors of their teams, all right? And in this one,

there was the same question, participate in school-based teams with families that came out to. All right. That same question that, well, when we were talking about families, so there is all this

rhetoric around how we include use of families as mentors of school-based teams, but from the perspective of school professionals, that doesn't quite hold. The next major scale is influences on

collaboration. And again you'll see some of these similar types of categories that came from the qualitative data. You'll see that again reflected here. They're not exactly the same. So that first

was the outreaching approach by community mental health professionals from collaborating agencies, so the sample items, community mental health professionals who work in the school who make effort to

build relationships with teachers, right? They've reached out and they developed that kind of responsibility, and of course on processes -- again that held up school professionals and community

mental health professionals in the school respect each other. Bless you. How many people on tape today say blessed you out to the audience? The man behind the camera doesn't speak. Okay. School

outreach to communities and families, so this is kind of a little bit like the school environment practices that we've talked about earlier but it kind of came together as a school outreach

communities and families, and so one of those items is the school values partnerships with community agencies. The school administrative support also came up as the insignificant, and that is the

principle of the -- of the school communicates with community mental health professionals. All right. So that's one of the sample items from that. You'll notice that the Buy-In from school

professionals did not show up as important on the score sheet. All right. We'll be interested to see when we look at the community providers if that shows up as important. And this came out a little

bit differently too, the perceived benefits of collaboration, right? Support for students and school professionals, how they got lumped together, so their student behaviors have improved and

also questions about teachers and feeling less stress are also included in the subscale. Increased mental health programming, there are more prevention services for students, improved access for

students and families again that includes that attitudinal on physical access, families are more willing to accept mental health services and held that as an important item and improved family-school

relationships. Families feel more comfortable in the school as a result of bringing them with the community, right? In some ways it almost seems like the community at least in the focus group that we

did and that -- and to some extent in this qualitative version access of cultural broker. Before we get to the discussion and implications I wanted to give you a few minutes just to try out some of

the items. We don't have time to do them all, but we do like to take a look at the scale and see what it looks like. Okay. Let's do it. Let's do something a little bit different. So I'm going to flip

over the board here. So when I saw that there were a hundred and forty-seven people, I was like no way I'd print this whole scale for a hundred and forty-seven people, so if anybody wants it, please

feel free to email me. I'd be happy to send it to you in word. Like I said we're in preparation, we're getting ready to submit the manuscript for publication. So this is a basic introduction to the

scale. It's pretty nondescript. The one thing is you're filling out if you would like to fill out some of your responses to these questions, and again you're not really going to have time to total it

or do anything of that sort if you've worked in more than one school, please base your responses on the school you work most frequently, yeah, or just once only, it's not going to get confusing. So

I'm going to scroll down and I'm going to give you just a few minutes. I'm going to watch the audience and see when I need to flip, but most of you are -- in this room, how many are school

professionals? Most of you are school professionals. Community professionals, you can take this as many of the same items. It just depends on the perspective that you're looking at. So for these

eight items, just think about in your role as a school professional, how often do you consult the school colleagues? How often do you develop plans for intervening? Is that never? Is that rarely? Is

that sometimes? Or is that often? So go ahead and jot because I'd like to have your feedback on some of the items in here, what resonated for you, what seems to be missing, what were not asking, let

me take just a few minutes and I'll kind of just [inaudible] questions. So this is the first set of questions, are these questions for the types of collaborations. We'll start now to the influences

scale. So the first scale that you see up there, the school professionals and community mental health providers in a school, that's the interpersonal processes scale, subscale. I was interested in that

people talked a lot in the focus group about how much they use text with one another now that teachers would all but be texting the community mental health professionals throughout the day like,

Hey, can you come down here real quick? It's not -- let's go down a little bit more. This is the outreach and approach by the community mental health professionals, so for those of you who'd like --

the group I've talked to in the back was working on setting up, these are things that you want to consider, right? As community professionals are [inaudible] inviting them into the school like the

community professionals need to be thinking about as they're coming out into the school, like, how are we really becoming part of the school community? One of those interesting during the focus

groups I remember really clearly, one person, the community mental health provider talking about acting often as a mediator between the families and the school to really kind of link their

relationship and she talked about, you know, a mom might be complaining on a teacher just had it out for her child, and she might say, "Well, gee, do you -- do you -- I wonder, you know, what it's

like to be Mrs. Smith and how seven classes of thirty-five students a day and do you think that some of this could be her stress from other resources that seemed to help." You know, the mother have a

different perspective as well as saying to the teacher, "Well, did you understand that the mother is working three jobs and then she recently got divorced." To again try to get the two parties to the

table in a way that was productive. The principal of the school, that's really important, these are some of the items that fall under the administrative leadership of the school. One thing, a few of

the principals said to me with my time with them is that absolutely hands down before they would bring anybody into the school, they would bring the two parties together, so we're bringing an outside

counselors then we're going to bring in some teachers, some school counselors to be a part of those initial meetings rather than having those initial meetings, making a plan for the school and then

simply dumping it on the school, that that makes so much difference. And talking about things that can be difficult to navigate upfront, like confidentiality and these were some characteristics again

from the school that seemed to make a difference in terms of collaboration, except for number 34, right [inaudible] trust is important. So these are the things that very informally with this tool without

even scoring that you could complete with your community partners to talk about what's going well and what's not going so well. I've been doing this work now in collaboration probably for six years

and I'd mentioned earlier that I developed another tool and a big part of that tool is how often people evaluate their work together. And I can't tell you how many emails I get from people who are

involved in these collaborations who would tell me, we always just talk about the kids. It's rare that we ever talk about our work together. And I've never really thought about our work together in

this way and how important that is to the work that we're trying to do on behalf of children. So even taking five minutes at the end of a school-based team meeting to talk about the process and how

it went can make huge drives in improving collaborations. And these are the benefits of collaboration. Well, the perceived benefits. We don't know if they actually are, but if you are looking to

demonstrate, right, if you're looking to bring data to the table, that collaboration makes a difference, these would be some of the areas you'd want to think about looking at and think about what it

might be making a difference in your school. Okay. Take us back out, so I promised. I said we'd get it out of here, right? A few minutes early. All right. So with educations to the study. The first

-- the first part of the study, those focus groups that we did, well, they were lifted by the fact that in any type of group discussion, there may be people in that discussion who don't particularly

feel comfortably talking in a group, so we may not have heard some perspectives. Also, I'm sure this will come to a shock to you, but sometimes, groups like that can become dominated by one or two

people with a specific agenda or conversation point. And so in some ways, that can limit or sway the conversation in a particular area and to attract some other areas that may have come up. In terms

of the quantitative portion of the study, we didn't take [inaudible] test to the liability, we didn't look at converging the validity, meaning, we didn't get out of the measures of social capital and

see if they make sense, see if they're similar to what we're producing. Those will be things that we follow up on and study. But some takeaways, right. Besides getting out this instrument and doing

it in one of your next team meetings and using it as a point of discussion, what are some things that I want you to take away in terms of the three types of social capital or the three types of

collaboration that we've talked about? And so bonding social capital, it's really important, right? But sometimes if there's too much bonding in social capital, it can exclude other parties. In some

ways in school community or mental health collaboration, the way it gets -- the way it happens is that it marginalizes community partners, right? So thinking about where the community partners are

located in the school, how are they included and embedded into the school community, the fabric of the school is really important. If your mental health professionals have a closet, like I said, in a

broom closet in the back hallway of the school, they will be marginalized and the bonding social capital that's happening among other people in the school will force them out, right? It won't be very

productive. Also from the community and people coming into schools need to begin to learn about school culture. Clearly, me, even in my clinical mental health counseling training, right, I didn't get

any knowledge of school counselor. I never had -- or working in schools. I'm -- I didn't know about schools. The first time I learned about schools is when I walked into lead a group as a twenty-two

year old intern, right? Thinking I knew something. And I didn't. There's a lot of things that I didn't know about schools. So we have to help our community providers understand schools, right? And so

some of that can be done at the graduate education level and that's what I'm doing now because in clinical mental health counseling in schools and communities, we spend a lot of time talking

about school culture and school systems and how to enter and what's important and what some of the pressures and mandates are on schools. But in a very informal way, you could think about having

somebody in the school be a mentor to community provider to give them some insight about how the school operates, what policy and procedures are relevant, what some of the unspoken rules are in the

school to help them fit in. In terms of bridging social capital, if community providers really want to get into schools, it seems that they have to work hard at engaging the teachers, right?

Getting the Buy-In of the teachers is important. Again, the clear articulation of rules and responsibilities, and I cannot tell you how often I hear now of contracts that improve that stipulation

that if you terminate one of your school employee mental health professionals and replace their services with one of our professionals, we will pull out of this contract. We are coming into

opend services, not replace the services provided. And I think that is critical to do upfront. Okay? And linking social capital, involvement in the community and school leadership, families

often don't have a lot power in schools, right? I mean, we have honest conversations about the power to parental it includes families in genuine, meaningful ways rather than bringing them to the

table and not actually giving them any role models or translating any of the conversation that's happening. There's a bunch of acronyms If we actually bring them in and invite the community,

invite our families to be involved in school performance, school improvement plans, we can build linking social capital. And last but not the least for community providers to think of themselves

especially community providers who are coming from the neighborhoods for which they serve as cultural brokers between the schools and the families. I think they can make a lot of progress. Okay. So

I'm just going to go to the end of this presentation because I know we're starting to run out of time and I want to make sure that I leave enough time for your questions. Are there any questions or

anything that this presentation brought up to you? Pretty that you'd like to talk about more? Yes?

AUDIENCE MEMBER: One thing I'll just say is just -- as -- in working with the entire education and supporting special educators, behavioral consultants, people were in that sort of potentially those

collaborative consultants just -- I think the important thing about in the training to create minds that there is an ethical responsibility to your client, to your focus [inaudible] with that, I

would -- I think it's nice to really encourage a spirit of you're always building capacity with every interaction with every student and every time you walk in and interface as a teacher, they -- you

are educating about mental health or about the next kid. So I was thinking about how these referrals went down, but that really made the result of somebody who's thinking about the opportunity

to build capacity in their interaction around one kid in the spirit of collaboration.

ELIZABETH MELLIN: Sure. Sure. I can call it at that way. That's really -- really great.

AUDIENCE MEMBER: So yeah, I'm like -- I'm like evangelist of that concept as a behavioral, but then behavioral service is often -- it's very like client, client, client where instead of really trying

to generalize a teacher's capacity building [inaudible] always thinking about how are you interacting it's important the students are also building the capacity in that teacher, in that

teacher in that supports that and it's just amazing the kind of people to be back in line.

ELIZABETH MELLIN: Absolutely.

AUDIENCE MEMBER: And then the question that I had is in a system that's trying to make a choice in [inaudible] are being talked about and kind of how the consensus that the needs of students are more

intense, they're more need intensive in their own more [inaudible] of experiencing more intensive needs across, you know, the board. And so in a district or a system that [inaudible] to the side to

collaborate, to partner up to try to build and hire, to build what would be your recommendation? I mean, I'm looking at some of your result, I'm also wondering if I have [inaudible] data system

[inaudible] soon, what would be your commendation?

ELIZABETH MELLIN: You know I honestly can't make a recommendation because I don't know in the long run. The isn't research to say what's more effective in the long run. You know, I -- and there are different

experiences in the room between [inaudible] some of the other school districts, right? [inaudible] having it its own kind of in-house thing, so I think there's pros and cons to both. But I think it

really does matter the context of your community, right? And so in a -- in a world community, is there -- are you taxing the community mental health provider too much by having them come into the

school, right? Do you need a high of your own outside the community [inaudible] I don't -- I don't know that I have a great answer to that, but I don't like to answer questions, but I don't know but

just my opinion, but I do. I think -- I think it's more costly for the school to do it upfront to hire their own because they're taking on [inaudible] and other types of things and they

typically don't take off through their contractional work, but anybody else have anything [inaudible] that question? Who's maybe worked in a system or they've done it both ways or two different

systems? Yeah.

AUDIENCE MEMBER: Well, one of the things -- I guess I'm [inaudible] community providers [inaudible] well, one of the things, there's pros and cons obviously.

AUDIENCE MEMBER: But the thing that's really important [inaudible] and, you know, oftentimes having that clinical supervisor or psychiatrist, that medical health support or something, you can't build

ELIZABETH MELLIN: Yeah.

all that in school sometimes if we do not [inaudible] you know you get surprising effect.

ELIZABETH MELLIN: Thanks. Thanks. I appreciate it.

Male: Yeah. I have another question.

ELIZABETH MELLIN: Yes?

Male: You referenced some of the interest [inaudible]. The reference was mental assistance or medical assistant for your purpose, for collaboration of schools, you mentioned somebody's name and you

said something, you said [inaudible] statement, it is their -- that the reimbursable service proposed.

ELIZABETH MELLIN: There is not. They are -- they are talking in Minnesota about -- in their state plan, about adding that and they're looking for evidence that consultation or collaboration improves

outcomes for kids. So it sounds statewide work that's happening, I'd be happy to put you in contact with the person who's doing that work in Minnesota. But it is not -- let me clear, that's not part

of their current reimbursable services. It is a -- it is a movement. There is some interest in doing that in that state, which would be tremendous, right? Any other questions? There's laughter,

there's cheering over there, that can only mean one thing, it's almost 5:00. Thank you so much for your time today. Please, if you have any questions or comments or would like the copy of the

[inaudible] or anything like, please feel free, just shoot me an email. It's not showing up really well there but it's eam20@est.pdu. Thank you so much.