1. Leading for
School Mental Health
Creating Sustainable and Equitable Funding and
Policy Strategies, Structures, and Systems
Lisa Eisenberg, CSHA
Leora Wolf-Prusan, Pacific Southwest MHTTC
2019 CALIFORNIA SCHOOL-BASED
HEALTH CONFERENCE
May 9th ~ 10am-1pm

2. The views, opinions, and content expressed in this
presentation do not necessarily reflect the views,
opinions, or policies of the Center for Mental Health
Services (CMHS), the Substance Abuse and Mental
Health Services Administration (SAMHSA), or the U.S.
Department of Health and Human Services (HHS).
DISCLAIMER

3. Pacific Southwest Mental Health
Technology Transfer Center (MHTTC)

4. Our Role
We offer a collaborative MHTTC model in order to provide
training, technical assistance (TTA), and resource dissemination
that supports the mental health workforce to adopt and effectively
implement evidence-based practices (EBPs) across the mental
health continuum of care.
Our Goal
To promote evidence-based, culturally appropriate mental health
prevention, treatment, and recovery strategies so that providers
and practitioners can start, strengthen, and sustain them effectively.
Pacific Southwest Mental Health
Technology Transfer Center (MHTTC)

5. Introduction and Grounding

6. Objectives
❏Explore the relationship between school mental health and trauma informed
approaches (policy and practice);
❏Assess and reflect on the status of where you and your school community are in
relation to key SMH principles and practices;
❏Understand major funding sources such as Medi-Cal and Mental Health Services Act
(MHSA) that can be braided with school funding to sustain school mental health;
❏Identify leadership choice points and define next steps for enhancing funding and
policies in your school(s); and,
❏Integrate strategies and knowledge that will support enhanced leadership to drive
school mental health equitably in your school community.

7. Agenda
1. Opening and Welcome
2. Part 1: Adaptive Leadership: what are the leadership tools to build
your SMH system sustainably and equitably?
3. Part 2: How do you sustain these best practices to which you have
committed? Funding
4. Part 3: How do you sustain these best practices to which you have
committed? Policies
5. Part 4: Action Mapping
6. Close, feedback, and thank yous

8. WELCOME!

9. What are you curious
about?
Excited for or about?
What information
do you need to feel
grounded in your
work?
What is
causing
concern?
Elbow partner

10. Identify the Outcome…
Name the Practice…
Inform the Policy

11. Implementation Stages
Metz A, Bartley L. Active Implementation Frameworks for Program Success: How to Use Implementation
Science to Improve Outcomes for Children. Zero to Three 2012, pp. 11-18.

12. Choice Points
1) Options leaders have to consider, including the costs
and benefits of each option
2) Choice points are decision-making opportunities that
influence outcomes
3) The cumulative impacts of many small choices can be
as significant as the impacts of big decisions

13. Chalk Talk:
An activity that
involves no chalk
and no talk
Around the room, there are
several prompts.
Pick a marker. Offer an
example, question, idea,
issue, or resource.
GO WILD.
Leading
Adaptively.

14. Principles and Practice

16. Principle 1
Mental health programs and services are responsive to
the needs identified in your school community.
• Engage parents, youth, and community partners in
developing services and understanding the needs.
• Assess the educational and health outcomes or disparities
impacting your students.
• Review needs periodically - this is an ongoing process!

17. Principle 2
Mental health services are leveraged through strong school staff
and community provider partnerships.
• Bring in outside resources to help you build your school mental
health programs - trainers, providers, and funding streams.
• Use the funding you control strategically by investing in services
that do not have a more restricted funding stream.
• Invest in strong school-site staff or even a team to coordinate
on-campus services and manage referrals.

18. Principle 3
Mental health services reach ALL students.
• Start by building a positive school climate, focus on
prevention strategies.
• Deliver in a tiered intervention framework.
• Invest in teacher and staff training and coaching.
• Ensure that a special education designation isn’t the only
gateway into receiving mental health services.

19. Principle 4
Mental health services are trauma-informed, healing-
centered, and resilience-focused.
• Train all school staff on integrating trauma-informed practices into
the classroom and schoolwide.
• Make changes if your mental health referrals and pathways may
be re-traumatizing.
• Ask students what types of services they need and want on
campus (then figure out how to fund).
• Hire staff and engage partners (for example, using
paraprofessionals, interns, student/parent liaisons) that reflect the
lived experiences of students.

20. Where are we
in the work?

21. How do you sustain these
best practices to which
you have committed?
Funding

23. Tier 3
Longer-Term
Intensive
Interventions
Tier 2
Short-Term Targeted
Interventions
Tier 1
School-Wide Interventions
Medi-Cal
Specialty
Mental
Health
Medi-Cal
Mild/
Moderate
Mental
Health
Mental
Health
Services
Act
LEA Billing
Option
Program
Educationally
Related
Mental
Health
Services
Local
Control
Funding
Formula
Title
1

24. “County” Funding:
The Who? What? How?
Medi-Cal
Specialty
Mental Health
• Sometimes called “EPSDT funding or
services”
• Controlled by County Mental Health Plans
• Intensive, clinical services
• Must contract with the county
Medi-Cal
Mild/Moderate
• Controlled by Medi-Cal Managed Care
Plans
• Shorter term brief interventions
• Must contract with managed care plan
Mental Health
Services Act
(MHSA)
• Distributed directly to the counties
• Enhance, rather than replace, existing
programs
• PEI funding category! Three year spending
plans submitted by the county!

25. “School” Funding:
The Who? What? How?
Educationally-
Related MH
Services
(ERMHS)
• Restricted funds to SELPAs
• Mental health identified in a student’s IEP
• Usually school-employed MH providers
LEA Billing
Option Program
• Reimbursement program for schools
• 50% share of cost for school-employed providers
like LCSWs, MFTs
Local Control
Funding
Formula (LCFF)
• Per student funding for public schools
• LCFF funds almost every service provided by
public schools
• District personnel, training, schoolwide and
targeted programs
Every Student
Succeeds Act
(ESSA)
• Federal funding from states, then to LEAs
• Two sections, Title I and IV, promote investments
beyond academically focused learning supports

26. Choice Points for Funding
Needs Drive Funding
• What are your current services and what are the gaps?
• What need for services is expressed by students, families, and communities?
• How might the funding available to you (or available to partners) help address those
gaps and needs?
Student Population
• What percentage of your students are eligible for or enrolled in Medi-Cal?
• What mental health access issues are impacting your students?
Partnership and Collaboration
• What funding power dynamics (real and perceived) exist between schools, counties,
and community providers?
• What infrastructure does you school have that will encourage partnerships?
• Can you free up more flexible funding by working with partners?
• Who in the community is also serving your students?
Tradeoffs
• What are the barriers to working with partners?
• How do you coordinate and share information with partners?
• Based on your funding streams, who has access to services? Who is excluded? How
will you serve all students?

28. How do you create, grow,
and sustain these best
practices to which you
have committed?
Policies

29. Today’s Four Key Policy Choice Points

30. Choice Point 1
Names and Definitions
What is the intended outcome of the SMH/ trauma-
informed work, and how might you choose policy
language that reflects the mission and vision of the
work?

31. Mental health is a dimension of overall health and includes a continuum from high level
wellness to severe illness. School mental health includes practices to address this
continuum from high level emotional wellbeing to significant student mental health
challenges. School mental health addresses all aspects of social-emotional
development of school-age children including wellness, mental illness, substance
abuse, and effects of adverse childhood experiences. Stigma associated with mental
illness needs to be directly addressed and eliminated. This is most effectively done
through an inclusive approach and offering examples of people who are similar to
students and who share positive results and recovery. School mental health may include
but is much broader than a school-based or –linked mental health clinic.
School mental health services refer to a continuum of supports for school age
children that are integrated throughout the school community: universal
strategies to promote the social and emotional well-being and development of all
students; selected, brief strategies to support students at risk of or with mild mental
health challenges; and intensive, ongoing strategies to support those with significant
needs, including a streamlined referral process with community mental health
providers to create a seamless service delivery model for children, adolescents, and
their families.
Various family, school, and community resources are coordinated to address barriers to
learning as an essential aspect of school functioning.
The Wisconsin School Mental Health Framework, 2015

32. Definition
One
“Historically, the concept of trauma has focused on individual trauma—childhood abuse and neglect, adult or
adolescent sexual assault, and abuse by an intimate partner, as well as the individual effects of combat
trauma and military sexual assault. Yet many people experience collective forms of trauma, as well—trauma
that affects people as part of a particular community, culture, or group.
These experiences continue to affect individuals and communities across generations, including the
ongoing legacies of trauma resulting from structural violence, slavery, and colonization; the trauma
of war, poverty, displacement, and persecution; the trauma of transphobic, homophobic, and gender-
based violence; as well as the insidious, microaggressive trauma of objectification, dehumanization,
and marginalization that many people experience daily.” | National Center on Domestic Violence, Trauma
& Mental Health, 2018, p. 48-49
Definition
Two
“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an
individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the
individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” | SAMHSA, 2014,
p. 7
Definition
Three
“Experiences or situations that are emotionally painful and distressing, and that overwhelm people’s ability
to cope, leaving them powerless.” | Center for Nonviolence and Social Justice, Drexel University
Choosing a Definition That Matches
Your Culture, Climate, and Outcomes
Examples of Definition Variations Within a Term

33. Language Matters.
Trauma
Responsive/
Sensitive
Schools
Trauma sensitive practices may involve a more general appreciation of the impact of trauma and global
supportive strategies such as encouraging quality of relationships and promoting safety. | Blodgett &
Dorado, 2015, p. 46
A trauma-sensitive and trauma-informed school provides increased access to behavioral and mental
health services, effective community collaboration, an increased feeling of physical, social, and emotional
safety among students, and positive and culturally responsive discipline policies and practices that
increase school connectedness. | National Resilience Institute
Compassionate
Schools
Compassionate schools support all students and are focused ultimately on helping teachers
understand fundamental brain development and function, learning pedagogy, recognize a mandate
for self-care, correctly interpret behaviors, manage negative behaviors successfully with compassionate
and effective strategies, and engage students, families, and the community. | Washington State Office
of Superintendent of Public Instruction
Healing-
Centered
Engagement
A healing-centered approach is holistic involving culture, spirituality, civic action, and collective
healing. A healing-centered approach views trauma not simply as an individual isolated experience,
but rather highlights the ways in which trauma and healing are experienced collectively. The term
“healing-centered engagement” expands how we think about responses to trauma and offers more holistic
approach to fostering well-being. | Ginwright, 2018
Resilience-
Oriented
Schools
Teachers routinely work with children who experience traumatic life events ranging from abuse and
neglect, natural disasters, and the death of someone close. The effects of others’ trauma can negatively
impact life at work and home. Like first responders who respond to critical incidents, teachers need
training and coping skills to protect their own physical, emotional, and mental health. Resilient school
environments not only focus on student well-being, but also on school employee wellness. |
Kaiser Permanente Southern California

34. The Pair of ACEs
Adverse Childhood Experiences
Adverse Community Experiences
Maternal Depression
Emotional & Sexual Abuse
Substance Abuse
Domestic Violence
Physical & Emotional Neglect
Divorce
Mental Illness
Incarceration
Homelessness
Poverty
Discrimination
Community Disruption
Violence
Poor Housing
Quality &
Affordability
Lack of Opportunity, Economic Mobility, & Social Capital
Ellis, W., Dietz, W. (2017) A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience (BCR) Model. Academic Pediatrics. 17 (2017) pp. S86-S93. DOI information: 10.1016/j.acap.2016.12.011

35. Choice Point 4
Matching Process to Product
Mirror a trauma-informed approach
in the development of the policy

36. 1) Safety
2) Transparency and Trustworthiness
3) Choice and Collaboration
4) Peer Support
5) Mutuality and Empowerment
6) Attunement to Cultural, Historical, and Gender Issues
SAMHSA’s Six Trauma-Informed Principles
Choice Point 4: Matching Process to Product

37. How the Process of Trauma-informed
Policy Development Can Embody
the Principles It Espouses
• Cross sector collaboration
• Transparent communication
• Center equity and justice
• Other?

38. Action Mapping

39. Options, Options, Options
1. SMH Funding and Policy paired coaching with guided
leadership questions
2. SMH Self Assessment (Wisconsin DOE, 2015)
3. SMH Funding and Policy action mapping with printed
resources
a. Trauma-Informed Policy Guide
b. Sample TI-policies (resolutions, etc.)
c. Funding Guide
4. Other (go rogue!)

40. Closing

41. Some journeys are direct, and
some are circuitous; some are
heroic, and some are fearful and
muddled.
But every journey, honestly
undertaken, stands a chance of
taking us toward the place where
our deep gladness meets the
world’s deep need.
-Parker Palmer

42. Reflection
and Take
Aways
• I discovered…
• I re-learned…
• I was surprised to learn…
• I forgot that…
• I noticed that…
• I plan to…
• I will tell colleagues about...

43. Thank you for attending!
We need to hear from you to keep
bringing you these no-cost resources:
https://www.surveymonkey.com/r/2209TRS203
Please take a few minutes to give us your feedback!
We use it to plan our future events—and we are required to
include it in our reports for our funder, SAMHSA.

44. Contact Info
Email: pacificsouthwest@mhttcnetwork.org
Phone: (844) 856-1749
Website: https://mhttcnetwork.org/pacificsouthwest
Join the PS MHTTC Newsletter!
https://tinyurl.com/pacsw-mh-news
Let us know about your
TTA needs and topic interests.
www.surveymonkey.com/r/MHTTCneedsassessment

45. Services Available
No-cost training, technical assistance, and resources
Pacific Southwest Mental Health
Technology Transfer Center (MHTTC)

46. Resources
From this presentation
• Public Funding for School Mental Health Programs, (California School-Based Health Alliance, 2018)
• “Why Student Mental Health Matters,” Student Supports: Getting the Most out of Your LCFF Investment, (California
School-Based Health Alliance and Partnership for Children and Youth, 2016)
• Link to this webinar’s accompanying guide, “Creating Trauma-Informed Policies:
A Practice Guide for School and Mental Health Leadership”
• Link to this webinar’s accompanying infographic “Trauma Informed Policies: Infographic”
• Responding to Trauma through Policies that Create Supportive Learning Environments (ChildTrends, 2019)
Other helpful resources
• Federal Grants for Trauma-Informed Interventions in Schools (ACES Connection, 11/18)
• For existing policies see the NASBE State Policy Database on School Health
• Measuring Progress Towards Becoming a Trauma-Informed School (Now is the Time TA Center for SAMHSA, 2017)
• How Trauma-Informed Schools Help Every Student Succeed (Eilers, Crisis Prevention Institute, 2018)
• Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy (Bowen & Murshid, 2016)
• Trauma Sensitive Schools Training Package (National Center of Safe Supportive Learning Environments)—includes training modules on
discipline practices, communication with students and families, and safety procedures (alignment with trauma-informed principles and
guiding questions for school leaders)
• Yatchmenoff, D. (2015). Creating the Conditions for Change: Emerging Policies to Promote and Support Trauma-Informed Care (Vol. 29,
Trauma Informed Care, pp. 28-31, Issue brief). Focal Point: Youth, Young Adults, & Mental Health.
• Warshaw, C., Tinnon, E., & Cave, C. (2018). Tools for Transformation: Becoming Accessible, Culturally Responsive, and Trauma-
Informed Organizations An Organizational Reflection Toolkit (Publication). National Center on Domestic Violence, Trauma & Mental
Health.
• Wisconsin Department of Instruction’s Tool: Review Tool for School Policies, Protocols, Procedures & Documents:
Examination Using a Trauma-Sensitive School Lens

47. Thank you.
SAMHSA’s mission is to reduce
the impact of substance abuse and
mental illness on America’s communities.
www.samhsa.gov
1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)