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Research in Brief

Lauralee Harris, executive director of the MHA of Tarrant County in Texas, talked to The Bell recently about her MHA’s pioneering new School-based Mental Health Education Project pilot program, their lessons learned and plans to take the program national.

NMHA: First, would you please give us a brief overview of your pilot project and its goals?
Laurlee Harris: We are developing a mental health education curriculum, based on a public health model, that is fully integrated into general school curriculum. We have just launched the pilot project in six schools in the county but designed the program for distribution to elementary, middle and high schools nationwide. It is designed to supplement material traditionally taught, rather than having to be taught as a separate class. Although some very good material has been available on specific issues such as bullying, stress and selfesteem, it was difficult for teachers to implement because they had to take extra class time to present the materials and to incorporate them into the topic at hand. By designing this curriculum, we hope that mental health education will be provided on a consistent basis, through a number of subjects.

NMHA: What sparked the idea for this project?
LH: This project was conceived because we were not able to measure any long-term outcomes from the individual class session approach we had been taking to educating students— basically, we would receive a call from a teacher or school to design and instruct a single class session on a specific mental health issue We also realized that if we were to educate large numbers of students, it would be impossible to do so with our own staff and volunteers. We believed that it was important to provide a comprehensive mental health education curriculum that could be easily taught by regular classroom teachers, and that could fit into regular subject content.

NMHA: How is the program being piloted and when?
LH: We are conducting student and teacher focus groups and expect to pilot the 8th grade modules in six schools this school year, and to develop 7th and 9th grade modules for piloting in the 2005-6 school year.

NMHA: How is the curriculum structured and how is it applied in the classroom?
LH:The curriculum is integrated into several different subjects, so that all students will receive information over several years. It is designed to fit into the course content, is matched to achievement tests in terms of required skills, and is grade-level specific. Although it could be used as stand-alone material, it is our intent that it be much more fully integrated into regular learning opportunities.

NMHA: What topics does the curriculum cover?
LH: The 8th grade modules are designed to be integrated into literature/language arts and social studies/history. They also include recommendations for coordinating with science, health, math, drama, music and art activities. The 8th grade modules include topics such as understanding mental health, stigma, depression and suicide, and eating disorders. Other grade levels will include bullying, self-esteem, anxiety disorders, major mental illnesses, stress and other topics. Each module contains an introduction to the concept, an overview of the mental health issue addressed, a power point presentation, lesson plans and scripts, pre- and post-tests, hand-outs and other recommended resources, and activities. Each module has components that can be taught over several class sessions.

NMHA: Would you give an example of how the curriculum is integrated? For example, how would a teacher integrate a mental health lesson into a literature class?
LH:The teacher and class would discuss, for instance, how depression is affecting a certain character in a book the students are reading. Or the teacher may cover how depression may have affected the author, if that’s the case. The teacher would also ask students to write in their journals about emotions. A group discussion could lead to such topics as what it means to have depression or to feel stigmatized — or whatever the subject matter dictates.

NMHA: Do teachers who present the curriculum need special training?
LH:Teachers need no special training, only motivation to actually use the materials. An implementation guide is provided to assist administrators, program coordinators and teachers in successfully integrating the modules into their classes.

NMHA: How is the project funded? How long did it take to secure funding?
LH:The project was funded for one year through a federal appropriations earmark by the office of Congresswoman Kay Granger. Although this is a direct grant, it must be administered by an agency to oversee quality control standards and other issues, and ours was assigned to HRSA. Our project manager has been an enthusiastic supporter of this effort, and has provided input, review and guidance. We helped to ensure a seamless process with HRSA by writing the project as if it were for a competitive bid, with accountability, technical assistance, outcome measures and evaluation built in. In fact, we’d developed the basic project concept and submitted it for funding to two other agencies several years before Rep. Granger offered us funding. We had confidence that the concept was important and fundable, and constantly looked for resources to develop the project. More recently, we won a grant from a local foundation that will ensure a second year of the project.

NMHA: How did the MHA devise the curriculum? Who took part in the process?
LH:The curriculum development began in August 2003 by a team of educators hired through the grant. These include a masters-level special education teacher, a retired school principal who is also a counselor, and a classroom teacher with mental health experience. The grant also provided funds for technical assistance — our national consultant team was drawn from technical assistance centers already under SAMHSA contracts, and a couple of others who just had an interest in the project. These include NMHA, UCLA, the University of Maryland, and nationally recognized curriculum and mental health experts. We have worked closely with subject area curriculum specialists in the Ft. Worth Independent School District.

NMHA: What challenges did you face in the project development phase?
LH:As we have developed this project it has become apparent to us that there is both a wealth of information and assistance available for school mental health education efforts, and a serious lack of easy access to information and resources or coordination of efforts. For example, the UCLA and University of Maryland School Mental Health Resource Centers are valuable resources for background material— which we ultimately used to help develop the curriculum— but we were not directed to them initially. Our grant was placed in HRSA for management, but, in the meantime, SAMHSA has also issued grants to two national companies for development of mental health education materials, neither of which appeared to be coordinated with other similar efforts. But, in the end, our team of consultants ensured that our vision dramatically expanded from a community-based program to one that potentially has tremendous value on a national level.

NMHA: Have you faced any challenges to implementation?
LH: Our major barrier was understanding the educational system bureaucracy. Structuring the curriculum so that it is flexible and can be easily implemented by school administrators and teachers nationwide was also a challenge. We managed to escape a potentially major hurdle quite by accident: Because we had designed our curriculum to supplement existing subject curriculum, it does not require extensive state or local approval for use. Had we devised an independent curriculum, we would have faced an extensive and complex review process.

NMHA: What types of reactions have you received from within the school system?
LH:We have received nothing but enthusiasm. Everyone who has reviewed the 8th grade curriculum manual has been highly complimentary regarding both content and ease of implementation. The general reaction has been “Wow! Why hasn’t this been done before?"

NMHA: Have you received any reactions from students?
LH:We are just now beginning student piloting, but our experience with our Youth Suicide Prevention Project (YSP), which we implemented in spring 2004 in 17 schools, leads us to believe that students will both enjoy this new material and benefit from it. Our experience with YSP showed that students want this information, talk about it with each other, and request counseling assistance as a result of their education. Also, if schools desire to inform parents/guardians about the use of the curriculum, a form has been included for that purpose, and they are encouraged to include parents in the learning environment.

NMHA: How will you evaluate the project and measure outcomes?
LH: Our grant included an evaluation component. The University of North Texas Health Science Center School of Public Health is conducting a process evaluation, and has developed outcome evaluation instruments for us. Outcomes from this approach, as with most public health approaches, are expected to take several years to be measurable. We expect to see evidence of reduced absenteeism, fewer disciplinary referrals and referrals to alternative education, increased utilization of school counseling and referral resources, and improvements in academic achievement.

NMHA: What are your plans for expanding the pilot and taking the program into full swing?
LH: We hope to acquire funding to produce modules for grades 6-12, offer the entire curriculum to school districts nationwide and to be able to provide regular updates. Our vision includes a subscription Web site that will include multimedia downloads and constantly changing new materials. At a minimum, we will offer each grade level a curriculum manual in hard copy when it is finalized. We expect to make the 8th grade manual available by the end of 2004. However, if any MHA chapters would be interested in assisting with piloting, we would be delighted to talk with them. We are only one small MHA, but what we are doing has the potential for major national impact, in spite of a national education system that is only beginning to address the healthy mental and emotional development of its students.