Mental Health Standards and Guidelines

Tennessee State Board of Education Agenda
April 17, 2009 First Reading Item: III. B.

Mental Health Standards and Guidelines

The Background:
SBE Rule 0520-1-3-.08 addresses pupil services that relate to guidance, psychological, social work, and health. These standards are designed to serve as a guiding document in support of this rule.

In 2008, the Tennessee Department of Education, Office of Coordinated School Health (OCSH) received a grant from the U.S. Office of Education to address the integration of schools and mental health systems. The OCSH applied for this grant since one of the eight major components of the Coordinated School Health (CSH) model includes addressing the social, counseling and mental health needs of students. The purpose of this grant is to create a seamless system where students are identified, referred and followed-up for needed social, emotional, behavioral and mental health services so that they may achieve strong academic outcomes. Local Education Agencies (LEAs) need to develop strong protocols, standards and guidelines to insure that students receive the support they need to stay in school and graduate. We know that there is substantial need for this kind of support:

?? Approximately 68,000 Tennessee children meet the diagnostic criteria of being seriously emotionally disturbed; approximately 45,500 of these children are enrolled in TennCare.
?? 1 in every 5 children has a diagnosed mental disorder; however, only 1 in every 10 receives treatment.
?? Half (50%) of all children in state custody, including 69% of the adolescents and 84% of all adjudicated delinquents, have a mental health diagnosis. (2004 CPORT/TCCY Report)
?? According to the 2007 High School Youth Risk Behavior Survey, 26.8% of all Tennessee high school student respondents felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months; 14.1% of the total Tennessee student respondents seriously considered attempting suicide during the past 12 months.
?? According to the 2008 Tennessee Middle School Youth Risk Behavior Survey, 19.5% of all Tennessee middle school student respondents reported that they had seriously considered killing themselves.
?? 4.79% of youth 4-17 have been diagnosed and are currently medicated for Attention-Deficit/Hyperactivity Disorder. (National Survey of Children's Health, 2003)
?? In 2003, approximately 21,000 children ages 12–17 in Tennessee needed but had not received treatment for illicit drug use in the past year.
?? In 2003, approximately 22,000 children ages 12–17 needed but had not received treatment for alcohol use in the past year. (CWLA Tennessee’s Children 2006)
?? 69.9% of Tennessee high school students have had at least one drink of alcohol on one or more days during their life (TN Youth Behavior Risk Survey, 2007)
?? 38.1% of Tennessee high school students say they have used marijuana one or more times during their life. (TN Youth Behavior Risk Survey, 2007)
?? Adolescents with serious emotional problems are nearly four times more likely to be dependent on alcohol and/or drugs than adolescents with low levels of emotional problems.
?? According to a “1 Day Census” survey of all juveniles held in secure state facilities:
53% of the youth in juvenile justice facilities were experiencing mental health problems.
15% were taking some type of psychiatric medicine while in the juvenile justice facilities.
42% were known to have substance abuse problems.
30% had co-occurring mental health and substance use problems.

A new brief from the federal government reports a strong positive impact of social and emotional learning (SEL) instruction on student academic achievement. Featuring CASEL research, the brief reports that in addition to significantly improving a broad range of student health and behavioral outcomes, SEL improves students’ school performance as well.

Titled Social and Emotional Learning (SEL) and Student Benefits: Implications for the Safe Schools/Healthy Students Core Elements, the brief describes substantial benefits of well-implemented SEL programming. Specifically, it highlights the results of CASEL’s recent meta-analysis of more than 700 research studies. The meta-analysis found that school, family, and community programming designed to promote SEL in children (age 5-18) resulted in an average of:
• 23% improvement in students’ social and emotional skills
• 9% improvement in attitudes about self, others, and school
• 9% improvement in school and classroom behavior
• 9% decrease in conduct problems such as classroom misbehavior and aggression
• 10% decrease in emotional distress such as anxiety and depression
• 11% gain in achievement test scores

A growing body of research makes the compelling case that social and emotional factors are integral to academic learning and other positive educational outcomes for children. SEL has been found to improve academic attitudes (motivation and commitment), behaviors (attendance, study habits, cooperative learning), and performance (grades, scores on standardized tests, and subject mastery).

Strategies for integrating schools and mental health services include:
?? LEAs will use CDC’s School Health Index (SHI) assessment tool to analyze their unique social, emotional, behavioral and mental health needs. The SHI tool is already being utilized in school systems through their CSH initiative.
?? LEAs will develop protocols and standards and guidelines for the prevention, identification, referral and follow-up of students needing social, emotional, behavioral or mental health services.
?? LEAs will establish Memorandum’s of Understanding with community mental health services to be used on an as-needed basis.
?? LEAs will train school staff on the proper protocol to make a student referral,

The Master Plan Connection:
If this rule is adopted both the “resources” and “teaching” aspects of the Master Plan will be enhanced.
? Student access to effective services and special assistance as needed would be increased.
? Regular classroom strategies will be enhanced to enable learning (i.e., improving instruction for students who have become disengaged from learning at school and for those with mild to moderate learning and behavior problems).
? Support for transitions (i.e., assisting students and families as they negotiate school and grade changes and many other transitions) would be enhanced.
? Home and school connections would increase.
? The ability to respond to, and where feasible, prevent crises would be enhanced.
? Community involvement and support would increase due to new partnerships established.

The Recommendation:
The Tennessee Department of Education recommends acceptance of these standards and guidelines on first reading. The SBE staff concurs with this recommendation.
Tennessee Integration of Schools and Mental Health
Systems Grant
State Advisory Committee Members
Governor’s Office on Children’s Care Coordination
Bob Duncan, Executive Director
School System Representatives
Director of Schools
Dr. Michael Martin, Campbell County Schools
Dr. Wanda Shelton, Lincoln County Schools
Dr. Kathleen Airhart, Putnam County Schools
Director of School Counseling
Dr. Kellie Hargis, Metro Nashville Schools
Dr. Kate Donnelly, Williamson County Schools
Dee Dee Lunsford, Shelby County Schools
High School Counselor
Amy Raglund, Memphis City Schools
Middle School Counselor
Joseph Gordon, Metro Nashville Schools
Elementary School Counselor
Linda Crutcher, Wilson County Schools
Nita Jones, Dyersburg City Schools
Social Work/Homeless Director
Vickie Fleming, Metro Nashville Schools
Coordinated School Health Coordinator
Lori Paisley, Putnam County Schools
Alexis Keiser, Campbell County Schools
Shannon Wheeler, Monroe County Schools
Alternative Education
Larry Saunders, Metro Nashville Schools
Trent McVay, Shelby County Schools
Select Committee on Children and Youth
Cindy Perry, Director
Tennessee Association of Mental Health Organizations
Ellyn Wilbur, Director of Evaluation and Policy Analysis
Tennessee Commission on Children and Youth
Linda O’Neal, Director
Tennessee Council of Juvenile and Family Court Judges
Judge Rachel Anthony, President
Tennessee Department of Children’s Services
Juvenile Justice Division
Steven Hornsby, Deputy Commissioner
Tennessee Department of Education
Office of Coordinated School Health
Connie Givens, Director
Sara Smith, State Coordinator
Office of School Safety and Learning Support
Mike Herrmann, Executive Director
Office of Curriculum and Instruction
Susan Bunch, Assistant Commissioner
Nicole Cobb, Guidance and Counseling Specialist
Division of Special Education
Joe Fischer, Assistant Commissioner
Linda Copas, Director of Behavioral & Autism Services
Legislative Liaison
Vickie Hall
Office of Civil Rights
Leslie Farmer
Tennessee Department of Mental Health and Developmental Disabilities
Office of Special Populations & Minority Services
Dr. Freda Outlaw, Assistant Commissioner
Lygia Williams, Program Planner
Tennessee PTA
Cindy Dearing, President
Tennessee Suicide Prevention Network
Scott Ridgeway, Executive Director
Tennessee Voices for Children
Charlotte Bryson, Director
Tennessee Voices for Children Youth Advocacy Members
Vanderbilt Center of Excellence for Children in State Custody
Michael Cull, Executive Director
Renae Love, Psychiatric Nurse Practitioner
Sheryl Margolis, Social Worker
Tim Stambaugh, Counselor


Mental Health Standards and Guidelines
The goal of these guidelines is to improve student achievement by reducing fragmentation of services and aligning and integrating mental health services to children. This policy addresses the infrastructure necessary to coordinate, improve, and evaluate support programs currently offered in school and in the community. It does not require new program development, but calls on schools to consider how best to support resilience in youth, identify students who need in-school mental health support, and provide a family driven and seamless integration within established community systems of care.

1. Local Educational Authorities will work to align their systems and available resources to enable all pupils to have an equal opportunity for success at school by addressing barriers to and promoting engagement in learning and teaching. This includes prevention, early intervention, referral and follow up procedures within a system of care.1

2. Schools will develop and maintain a positive school climate ensuring a global approach to addressing barriers to learning and promoting resilience in children. Current laws regarding the prevention of hazing, bullying, and intimidation will be fully implemented as an essential element in the protection of student mental health and the fostering of a positive school climate.2

3. Schools will employ effective early intervention activities such as social and emotional learning, positive behavior supports and strength-based developmental assets. This standard is previously addressed in the Tennessee Comprehensive School Counseling Model and other curriculum standards.3

4. School personnel will create a plan whereby appropriate staff can provide proactive on-site support services to students having social, emotional, and mental health concerns, including those students that do not meet criteria for special education services.4

5. Local Educational Authorities will require school staff and administrators to attend professional development on how to identify warning signs of emotional and behavioral barriers to learning, how to address such barriers, and promote engagement in learning.5 School staff new to the district will receive this professional development in a timely manner.

6. Local schools will have clearly identified referral policies for in-school student support that is easily accessible to all students, families, and school personnel. Intentional effort will be made to reduce stigma, keep the referral process simple and user friendly, and provide a variety of strategies to assist students in need.

7. Local Educational Authorities will create linkages and Memorandums of Understanding between schools and community resources. These will include agreements regarding the responsibility of both entities with respect to working together (e.g. formal linkages, weaving resources together, sharing information,
making and accepting referrals, intervention during and after a crisis).6 These agreements will be reviewed and updated as needed.

8. A plan will be created for maintaining the confidentiality of each student throughout the referral process that is consistent with HIPAA7 and FERPA8 standards.

9 Schools will acquire parental consent prior to making any referral as prescribed by existing policy unless otherwise specified by law. 9

10. Schools will facilitate smooth transitions for students who are entering and exiting the classroom due to involvement with community mental health treatment, department of children’s services including juvenile justice services, or other child serving programs.

11. Each Local Educational Authority will appoint a team leader to oversee overall implementation of this policy. Team leaders will engage the participation of families10, students, educators, community mental health providers, local Department of Children’s Services, and local juvenile court representatives, as well as all student support divisions within the district (including school social work, school counseling, school psychology, and coordinated school health) in the development of policies and agreements. Policies will address routine concerns as well as crisis response. Referral policies will be family driven, student guided, and whenever possible allow for universal access. This team will meet regularly to review the integration and alignment of services.

12. Promoting a positive school climate, in-school support strategies that enhance social and emotional development, clear and effective relationships with community agencies, and effective transition practices between schools and community programs are successful strategies used to address barriers to learning and therefore must be included in all continuous school improvement planning as well as the Tennessee Comprehensive System-wide Planning Process.

13. School policies will honor cultural diversity, provide culturally and linguistically competent services, and respect the dignity of all individuals.


1 See T.C.A. §49-1-1002
2 See T.C.A. §49-6-801, §49-6-1016, §49-6-4216, §49-2-120
3 Tennessee School Counseling Model, Policy 5.103, pp. 60-74
4 See T.C.A. §49-5-302, §49-6-303, TN Dept. of Ed. SBOE rule 0520-2-2-.26, SBOE
Standards and Guidelines 5.103
5 See T.C.A. §49-6-3004(c) (1)
6 See T.C.A. §33-1-308
7 See Public Law 104-191
8 See 20 U.S.C. § 1232g; 34 CFR Part 99
9 See T.C.A §10-7-504(4) (A), §§33-3-206—33-3-209, §37-1-403, §37-1-605, §33-8-202
10 See TN SBOE Policy, Standards, and Guidelines 4.207

Additional Resources:
Tennessee Office of Coordinated School Health, Tennessee Department of Education
Tennessee Model for Comprehensive School Counseling Guidelines
Center for Disease Control and Prevention – Mental Health
Center for School Mental Health, University of Maryland School of Medicine
Collaborative for Academic, Social, and Emotional Learning
National Community of Practice on Collaborative School Behavioral Health
National Registry of Evidence-Based Programs and Practices
Office of Juvenile Justice and Delinquency Prevention
Office of Juvenile Justice and Delinquency Prevention’s Model Program Guide
Positive Behavior Interventions and Supports
Search Institute – Developmental Assets
Substance Abuse and Mental Health Services Administration
Tennessee National Alliance for the Mentally Ill
UCLA Center for Mental Health in Schools