On August 8, 2003 the Illinois Children’s Mental Health Act (ICMHA) became law (LuAllen, Koch, Taylor, Payton, Weissberg ; O’Brien, 2005). A report by the Illinois Children’s Mental Health Task Force (2003) states the current system, prior to passage of the ICMH, is “fragmented, limited in scope, and poorly resourced”. The Illinois General Assembly is attempting to address these issues with the passage of this act.
This law promotes the development and the implementation of a coordinated mental health programs specifically aimed at children from birth to their 18th birthday. The coordination of services is addressed in section 5-1 of the ICMHA which states, “…the mental health plan shall contain short-term and long-term recommendations to provide comprehensive, coordinated service…” The programs are to consist of public and private agencies forming a referral network to serve the children in rural and urban settings of Illinois.
LuAllen, et al, (2005), state that the greatest impact on service delivery will be made by utilizing both public and private agencies. This mental health system is to make early intervention, preventative measures, and treatment programs available for all children, birth thru 18 years of age, regardless of their socio-economic situation. The intervention and preventative aspects are to be both long and short term. ICMHA makes recommendations as to how to fund the programs by the use of federal, state, and local government sources (Pub. L. No. 93-0495).
Section 15 of the ICMHA addresses how the social and emotional needs of school children, K thru 12, will be met by the school districts. Section 15 mandates that individual school districts develop and implement policies to address the mental health needs of its children. These policies developed by the school districts are to be made an integral part of their educational programs. Specifically the act states; “Every Illinois school district shall develop a policy for incorporating social and emotional development into the district’s educational program.
The policy shall address teaching and assessing social and emotional skills and protocols for responding to children with social, emotional, or mental health problems, or a combination of such problems, that impacts learning ability. Each district must submit this policy to the Illinois State Board of Education by August 31, 2004” (p. 2). Section 15 of the ICMHA requires the Illinois Board of Education to incorporate standards for social and emotional learning into the Illinois Learning Standards.
This requirement’s intent is to better measure and strengthen the children’s readiness for academic achievement. Definition of the Policy The Illinois Children’s Mental Health Act of 2003 reads as follows; “The State of Illinois shall develop a Children’s Mental Health Plan containing short-term and long-term recommendations to provide comprehensive, coordinated mental health prevention, early intervention, and treatment services for children from birth through age 18”. What this means is that from cradle to the age of 18 the mental health of children will be addressed by the State of Illinois.
The intent of this act is for all children of Illinois to be screened for social and emotional issues which might be an impediment to the child’s successful negotiation thru the educational system which may bode poorly for their functioning in society. Cooper (2008), appears to support this thinking by stating, “…Children and youth with emotional and behavioral problems have poorer academic outcomes than children with other disabilities. They experience lower levels of social adjustment…” (p 4).
Children with social and emotional challenges do not fare as well in the job market compared to children with other disabilities. Dwyer (2002) reports that research suggest that children with social and emotional concerns are expelled more frequently from school in addition to having higher rates of unemployment later in life. The ICHMA give recommendations that mental health screenings and services ware to be provided through the collaboration of public and private sector agencies along with the participation of parents.
Section 15 of the ICHMA recommends that schools play an active role in the delivery of mental health services. It is the recommendation of the Children’s Mental Health Act that schools participate fully in providing mental health services by developing and implementing programs into their educational programs. This recommendation suggests that schools are a natural environment for children’s mental health service delivery and screening. Cooper (2008) suggests that the state’s approach is on target when she states, “Provision of health care in schools is a logical component of an advanced industrial society…”.
In the article, School-Based Mental Health Programs and Services: Overview and Introduction to the special Issue, Paternite (2005) lends support to the ICMHA recommendations’ in stating “In the United States, schools offer unparalleled access to youth as a point of engagement for addressing their educational, emotional, and behavioral needs” (p 657). Han ; Weiss (2005) state “There is substantial evidence indicating that, when properly developed and implemented, school-based mental health programs can produce positive effects on children’s behavioral and emotional functioning” (p665).
The ICMHA section 15 contains recommendations for training school staff in providing mental health services to children. Schools have had psychologists, social workers, and counselors in place for some time; the Illinois State Board of Education recognizes that teachers also need training if the school mental health programs are to be effective. Paternite ; Johnston (2005) state, “Through their day to day interactions with children and adolescents, educators are the linchpins of school-based efforts to encourage healthy psychological development” (p 41).
The training will create an interdisciplinary team comprised of educators and mental health professionals (e. g. , social workers, psychologists, and counselors) and teachers in the classroom. The team concept historically has been impeded for two reasons. First the mental health staff has been considered by educators as “add-ons” incompatible with the academic goals of the schools. Second, educators and school mental health professionals have not always seen themselves as colleagues (Paternite ; Johnston, 2005).
According to these authors, educators have frequently felt looked upon only as sources of information for mental health professionals which has resulted in teachers having a “lack of confidence” in dealing with children with social and emotional issues. Rational Regarding the Importance of this Policy It is safe to say that one of most precious resources in Illinois and in the United States are our children. All Most if not all parents have hopes and dreams for their children’s success and well being in life.
The Illinois Children’s Mental Health Task Force states in its 2003 report, Children’s Mental Health: An Urgent Priority for Illinois supports this view; “Children are born with great promise, and we must do everything possible to help them develop socially and emotionally so they can meet the challenges of learning and living in today’s complex society”. Children are the future movers and shakers in our society so as a consequence their welfare ought to be the responsibility of the society at large.
In her introduction letter to the 2001 Surgeon General’s report on Youth and Violence, former Secretary of Human and Health Services, Donna E. Shalala clearly succinctly stated, “The first, most enduring responsibility of any society is to ensure the health and well-being of its children”. Great strides have been made in children’s physical health. Books, scholarly journal articles, and news reports have been done on how to better protect our children’s physical well-being; however, their mental health is another issue.
In their article, Mental Health Services for Children: An Overview, Kenny, Oliver ; Poppe (2002) state the following: “Just as things go wrong with the heart, the lungs, the liver and the kidneys, things go wrong with the brain,” says former Surgeon General David Satcher. One in 10 young people suffer from mental illness severe enough to cause some level of impairment, but fewer than 20 percent of these children receive needed treatment each year. At least 7.
5 million children and adolescents in the United States (12 percent) suffer from one or more mental disorders, including autism, depression, and alcohol and substance abuse and dependence” (p 1). The Mental Health for Children Working Group (MHCWG) of 2001, which was made up of 15 members representing school districts, mental health agencies along with city and state officials, compiled a report, White Paper on Mental Health Services for Children and Youth in Illinois. This report took a look at the state of mental health among persons 18 and younger in the State of Illinois.
What was determined is that while mental health services are available in Illinois, all too often many children who need services are not receiving them. The reasons were many including miss information on the part of parents, teachers, and medical professionals, fears of stigmatizing children, costs to the state and local government, and a lack of a coordinated mental health system. It was found that the children who received the most mental health services were those who were diagnosed with ADD, ADHD, along with other cognitive deficit issues otherwise termed “Special Needs” children.
In addition the White Paper report cited an Illinois survey which found that 42% of child care programs with pre-school age children needed to ask the parents to withdraw their children due to behavioral issues. One in ten Illinois children suffers from some type of mental illness serious enough to cause at least some impairment yet less than a quarter of these young people received any form of mental health service. What this report was indicating was that the mental health system in Illinois was not reaching enough of the children who needed help.
The White Paper report playing a major role the Illinois General Assembly drafted legislation which resulted in what is called “The Illinois Children’s Mental Health Act”. In addition to recommending a comprehensive coordinated mental health system the state General assembly added section 15 into the act which calls on school district throughout the state to develop and implement mental health into their educational systems. The General assembly took the following into account; According to the United States Census Bureau in 2007 percentage of the population of the State of Illinois was 12, 419, 293 of which 24.
9% is 18 or younger. With such a large number of the state’s population being of school age it was determined that schools would be a good setting for implementing a reformed mental health system. Walter, Gouze & Lim (2006) lend support to the belief that schools are an ideal setting for mental health initiatives. The authors state, “In many ways, schools are an ideal location for the provision of mental health services to young people. Schools require attendance, are highly accessible to children and families, and may be less intimidating than hospitals and clinics” (p61).
Historical Factors The Illinois Children’s Mental Health Act was enacted into law in August 2003; however, its roots can be traced back to after the American Civil War (Weist, Myers, Danforth, McNeil, Ollendick, & Hawkins 2000). In 2000 that the U. S. Surgeon General published a published a report titled, “Mental Health: A Report of the Surgeon General (Martin, 2000).
This report according to the Illinois Children’s Mental Health Task Force (2003) highlights the areas of prevention and service delivery in mental health. According to the Surgeon General’s report great strides have been made over many decades in the area of physical health.
Advances have been made in how the body works, diseases affecting our bodies, and treatment which have all contributed to the increased life span that we enjoy today. The report continues on to state that advances have also been made in human behavior and the brain; however, in spite of these advances, mental health has all too often been relegated to an afterthought. In its report, Children’s Mental Health: An urgent Priority for Illinois, Children’s mental health is important to children’s well-being, academic successes and overall health.
Be that as it may, little attention was given to children’s socio-emotional health except for those children presenting with severe mental health issues and this occurred even after research findings indicated that prevention and early intervention shows improvement to the mental well-being on children, birth to 18 years of age. The report states, “Bold reform of a highly fragmented and under-resourced system is needed to create a comprehensive and coordinated mental health system that meets the needs of children ages 0-18 years and their families” (p 2).
In 1999 the Clinton administration convened the White House Conference on Mental Health (Martin, 2000). The conference brought national attention to the issue of mental health and the plight of children and adults suffering with mental health concerns. Laurie Flynn, executive director for the National Alliance for the Mentally Ill (NAMI) commented of the increased attention by stating; “Because of the renewed focus on mental health issues, people throughout the country are being educated and empowered.
Many individuals and families for the first time will see that they are not alone and that there is hope for the future”. From the White House Conference on Mental Health and the U. S. Surgeon General’s report, the Illinois Children’s Mental Health Task Force was created. The focus of the task force was two-fold; “1) To assess the status of Illinois’ mental health system for children ages 0-18 years, and 2) Develop short and long term recommendations for assuring that all Illinois children have access to a coordinated and comprehensive mental health services and programs”.
One of the results of this new found exposure in addition to the task forces was that the federal government along with individual states began to draft legislation and policy on the mental health. One of the first to draft and enact legislation directed on mental health was Illinois which enacted the ICMHA of 2003. Applicability to Current Population The ICMHA applies directly to all the children of the state of Illinois ages 0-18. The act recognizes that 1 in 10 Illinois children suffers from mental illness yet only about only a quarter of these children receive services.
The parents and families of Illinois children will also be served because this act calls for education on child mental health issues. The parents will know where to turn for help, barriers to help will be lifted, and because children’s mental health issues will be more recognized there might be fewer obstacles to seeking treatment. The ICMHA has a specific aspect of it that pertains to school age children K through 12. Section 15 specifically addresses the need for a more comprehensive system of services.
Our society will be a better place when all fewer children are left behind due to social and emotional issues (Dwyer, 2002). For the children of Illinois the ICMHA provides comprehensive services providing, intervention, prevention, and treatment for those children who have social and emotional issues. This act is contains recommendations for receiving and using federal, state and local funding to provide a sustainable program. Screening of children 0-18 years also will help to target children with depression.
Untargeted populations which may be beneficiaries of the ICMHA are children who do not present with social emotional issues. Research shows that with broad based mental health initiatives focusing on prevention, intervention, and treatment reduce disruptions in classrooms and frees teachers up to teach. Paternite & Johnston (2005) lend support to the idea that mental health programs give teachers more teaching time by stating; “…a teacher who spends10 minutes of each academic class period per day dealing with disruptive behavior would spend 60 hours in a 9-week grading period.
This translates into 240 hours or roughly 34 seven hour days in a school year” (p 42). This may, in part, create a better environment in which students can learn (Weist, Sanders, Walrath, Link, Nabors, Adelsheim, Moore, Jennings, & Crillo 2004). Paternite (2005) suggests another population which may benefit from the ICMHA, children at risk. Some estimation put the number of children in need of mental health intervention at 20% with other estimates reaching 38% of students; however, these numbers do not include children deemed by school staff as being “at risk”.
Much has been said about the benefits of mental health initiatives for children. It has documented that there are substantial benefits to expanded programs especially in schools. One area that has not garnered enough research and attention is that of teacher burnout. Han, Weiss (2005) state,”…teachers’ program implementation appears to be negatively correlated with their sense of professional burnout” (p 668). The authors’ present three components which seem to be relevant to burnout; 1) Emotional exhaustion, which can distract from teachers engaging in teach activities and intervention of behavioral issues.
2). Depersonalization, teachers no longer have positive feeling about their students. The lack of positive feelings toward students is said to lead to indifference and negative emotions aimed at the students. 3) A sense of low person accomplishment of the job. Burnout has been blamed on high teacher turnover, calling in sick and somatic disorders. Converse to teacher burnout is what some teachers are reporting to be as “increased bonding with students”.
A result of the increased emphasis on school based mental health initiatives, teachers are receiving additional education on mental health issues and this appears to have helped teachers understand and relate to their students in positive ways which has led to increased bonding between students and educators (Paternite & Johnston, 2005). While research findings suggest mental health programs in schools promote positive results, lower absenteeism, improvement is academics, increased teaching time, and increased student self-esteem; there are still impediments to mental health programs.
Nabors, Reynolds, & Weist (2000) report that results from focus groups conducted in Baltimore with school children and adults found that “All groups mentioned the stigma of being perceived by others as “being crazy if you go to therapy” had a negative impact” (p 6). Results from the same focus groups showed that participants believed that increased education and awareness of “Expanded school mental health programs” would go a long way to “de-stigmatizing” mental health programs in schools.
Increased awareness of mental health intervention, prevention, and treatment are addressed in the ICMHA of 2003. Populations That Would Benefit The ICMHA of 2003 recommends providing mental health, intervention, prevention and treatment programs to “all” children in Illinois. While the act appears to assist the children of Illinois s 0 18 years of age; one population group maybe in line for greater benefits. It is the urban children that may see a heightened level of service. Urban youth experience stressors at levels not seen by many suburban and rural youth.
Children in some urban settings experience high levels of violence on the streets, in school, and in domestic environments (United States Surgeon General, 2001). Urban students, especially in the more economically challenged areas of Illinois have in the past been uninsured which limits the accessibility to services. The ICMHA of 2003, while mandating a certain dollar amount to spend on community mental health initiatives including schools, it does have recommendations as money to be has as well as recommendations as how access funding.
Another population which would see benefits in his mental health act are those student on non-dominant cultural backgrounds. A component of the ICMHA is recommendations for “Best Practice along with research pertaining to evidence based practices. Neglected population Ironically a population which may benefit might also be on the neglected end of service provision simply because of lack of funding. The ICMHA has recommendations for funding; however, contains precious little as to how much and lacks muscle to mandate funding by the state.
Doster (2009) states “Illinois ranks 30th nationwide in per capita mental health spending”. The Daley administration’s recent proposal to cut social services in the name of budget cuts and the Illinois Department of Human Services cut funding for the city public health department by 1. 2 million dollars are examples of how urban youth are subjected to limited services despite the intention of the ICMHA. Lora Thomas, executive director of NAMI warned “…if we do not spend money effectively, we spend more money in emergency rooms, hospitals, jails, and prisons”. Kerkorian, McKay, Bannon (2006) lend
support to inner city youths being neglected; “Prior research suggest that 17% to 26% of youths in the United States might benefit from some form of mental health care. Unfortunately, inner city youths, though more likely to experience significant psychosocial stressors and more apt to suffer from mental health difficulties that warrant services, rte least likely to receive them” (p 161). Procedures to Modify The ICMHA is an important first step in securing a better mental health system for the children of Illinois; some modifications would make it a better policy.
One such modification is for the ICMHA to address the subject of suicide among young people. A component of ICMHA is prevention; perhaps adding an educational aspect for school staff as well as students might help. Suicide is the 3rd leading cause of death among children and adolescents (Nock, 2009). According to a 2007 report from The Illinois Department of Public Health suicides among the states adolescents “fluctuates” between the second and third leading cause of death among adolescents.
The report also says that suicide is recognized as a “chronic epidemic”. This prompted the Illinois General Assembly in 2004 to pass The Suicide Prevention, education, and Treatment Act (Public Act 093-0907). This act creates an advisory board to come up with plans for addressing the suicide rate in Illinois. The ICMHA does a lot in making recommendations as to what needs to be done and how (e. g. creating a comprehensive delivery of services by using community agencies as well as private sector groups to refer and provide intervention).
Illinois schools are required by this act to develop individualized policies to address the recommendations of the act; however, the act itself is vague in the sense that it lets the individual schools come up with their own ideas as to meeting the recommendations. This could be an issue. Cooper (2008) in the article “The Federal Case for School-Based Mental Health Services and Supports says that schools that do have mental health policies there is not enough evidence to support the “quality or effectiveness” of the programs. Cooper (2008) states “…some of the data suggest that the quality of the care provided is highly variable”.
In another part of the same article it is suggested that some school are simply adding mental health staff without making culture changes in terms of providing services. There are Some school districts require their social workers to serve more than one school building with some rural districts having one or two mental health professionals for an entire district. If the ICMHA was more specific as to how to accomplish the goals of intervention, prevention and treatment the school districts would have more direction and less room for interpretation. Personal Reaction
This writer’s reaction to the ICMHA is positive overall. The act goes a long way to making mental health policy for schools and the communities. However, there are perceived holes in the policy which if filled might make the act a more solid piece of legislation. In the past year there has been multitudes written in news papers and television news stories about the condition of Illinois finances. Each day there are proposals by government officials that this program or that needs to be cut to save money’; for example, Chicago’s mayor has recently proposed closing several community mental health centers.
The ICMHA act only makes recommendations as to how to acquire federal, state and local funding and does not make specific money available to provide services. While it is true that even with specific language concerning the financing of the policy budget axes could still chop away; however, there would be some money dedicated to the policy itself left over. The ICMHA policy does raise a concern for writer about the schools resources are being stretch too thin. Walter, Gouze & Lim (2006) raise similar concerns in their article, “Teachers’ Beliefs About Mental Health Needs in Inner City Elementary School”.
The authors state “Schools have become a major de facto mental health service provider for Americas’ youth” (p 65). They contend that because there are many barriers for gaining access to mental health services outside of school that the majority of children needing services receive them in school. Walter et al (2006) give the requirements of the Individuals with Disabilities Act as already putting a strain on school mental health services which are provided by, psychologists, social workers and school nurses.
The majority of schools in America provide an array of social and emotional support to students and although when seen cumulatively it looks encouraging the schools are face with a dizzying array of constraints; funding, competing academic priorities, limited evidence of program effectiveness, and lack of coordination among providers, all add up to a marginalized system. So then the question is if the Illinois policy as stated in the ICMHA does not do enough to support the school systems in delivering services?
This writer does not have an answer; however, it does cause one to pause in order to take a closer look at what is occurring or perhaps not occurring with regards to our children’s social and emotional well-being. Reference Cooper, J. , L. (2008). The federal case for school-based mental health services and supports. Journal of the American Academy of Child and Adolescent Psychiatry. 47 (1), 4 8. Doster, A. (2009). Illinois’ mental health system in disrepair. Progress Illinois. Retrieved on April 5, 2009, from http://www. progressillionois. com/2009/3/11/mental-health-system-in- disrepair. Dwyer, K. , P. (2002).
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