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Psychology outreach program deemed national leader, part 1

Jan. 19, 2007
By Anita Martin

Into the classroom

Annapolis Coalition on the Behavioral Health Workforce commends Y.E.S.S.

Go to the Web site for the Annapolis Coalition on the Behavioral Health Workforce, and you'll read, in no uncertain terms, that training of the behavioral health work force has reached national crisis status. 

"The baseline is pretty abysmal," says Mark Weis, director of the National Center for Mental Health at the University of Maryland, an affiliate of the Annapolis Coalition. "Graduate and residency programs are not training the behavioral practices shown in literature to be effective." 

Add to that the national trends of haphazard recruitment, minimal supervision of new staff and a lack of educational support for families and other consumers. Suddenly, the need for reform becomes clear -- and urgent. 

Two organizations joined forces to form the Annapolis Coalition in order to address this need. The founding groups are the American College of Mental Health Administration (a national, interdisciplinary body promoting improvements in behavioral health care), and the Academic Behavioral Health Consortium (a nonprofit membership organization of universities and their departments of psychiatry). 

The coalition publishes recommendations for improving the quality and relevance of education, training, recruitment and retention; convenes expert panels; and maintains a network of stakeholders. In addition, they identify innovative practices in work force education and publish those exemplary programs -- such as Ohio University's Youth Experiencing Success in Schools (Y.E.S.S.) program -- in their national registry. According to Weis, Y.E.S.S. demonstrates the "infrastructure for effectiveness" by following evidence-based practices, offering interdisciplinary training and providing educational support for parents and teachers. Within the category of school-based intervention, he says, Y.E.S.S. did "the best job of reflecting system reform" with its innovative practices. 

"You don't hear the word 'innovation' applied to rural procedures very often," says Katie Golden, a psychology graduate student and Y.E.S.S. clinician. Golden participates in another of Y.E.S.S.' innovative training programs: teleconferencing with psychiatry residents in the Cleveland Clinic and other mental health agencies. Through videoconferencing, agencies in Southeastern Ohio can exchange notes about behavioral and medical treatments.

To collaborate, of course, Y.E.S.S. needed all players on board: students, parents, teachers and principals. 

"In beginning there were some hurdles," Walter says. "There was a good amount of paperwork, which teachers typically don't like. And they had to make time to consult with the clinicians." 

Y.E.S.S. responded by offering a financial stipend to teachers and parents for filling out paperwork, and by paying for a floating substitute to step in for teachers taken away from the classroom for Y.E.S.S. consultation.  When consulting with teachers, Y.E.S.S clinicians discuss behavior theory and classroom-based strategies that teachers can use for dealing with the particular child, and how the entire classroom responds to that child.  In-class strategies include practical goal-setting and consistent positive reinforcement. While Rob Ramage was the principal of East Elementary School in Athens, he began to implement some of the Y.E.S.S. clinicians' suggestions himself.

"The Y.E.S.S. motto is two to one: positive to negative," says Ramage, who is now the principal of Green Elementary. "So I made a list of 'positive contact kids,' the ones I frequently saw for disciplinary reasons, and I tried to have twice as much positive contact ? even just saying 'nice shirt' when they got off the bus. It made a world of difference." 

Ramage, though initially unsure of the program, says that disciplinary referrals dropped by 50 percent for Y.E.S.S. students at East Elementary. He continues to apply Y.E.S.S. strategies at Green Elementary, though they currently do not have a Y.E.S.S. program. 

The home front 

Teachers may be the ones who identify student candidates for Y.E.S.S., but it's up to the parents to sign them up.

"One of the main challenges in this environment is that you're an outsider coming in," says former Y.E.S.S. clinician Jill Fullenkamp, BSW '05, MSW '06. "You want to share these techniques with parents, but they have to trust you first." 

Fullenkamp earned parents' trust by showing genuine interest in them and their families and by providing consistent support. 

"We make sure our clinicians are not taking an approach of 'we're the experts,'" Owens says. "We always take a team approach: 'You're the expert on your child, but here are some ideas that might be helpful.'" 

According to Owens, many parents lack the resources to pay for mental health services or face limitations in terms of transportation and childcare. Y.E.S.S. provides free services that requires little running around, increasing access to care.

"There's also a certain stigma about mental health services," she says. "It's less conspicuous to walk into a school than into a clinic. Families that normally would not consider seeking services now can get them through Y.E.S.S. at the school."

Applied learning  Not only are school-based services more convenient, but they're also more effective, say Y.E.S.S. clinicians. 

"What is most beneficial about the program is that it takes place at school, where children are expected to focus for the longest amount of time during the day," Fullenkamp says. "School is an environment that's ideal for a student to grow, learn and enhance self-esteem." 

Caroline Murphy, MS '03, PhD '05, a Y.E.S.S. postdoctoral fellow, adds that the school environment offers immediate implementation of new strategies and skills around the student's peers.

"It's a much more realistic way to learn (new) habits, rather than coming to a clinic one hour a week," she says.

Murphy served as a Y.E.S.S. clinician as a graduate student. As a fellow, she now supervises clinicians.  Clinicians and school employees agree that kids respond well to the program.

"We develop a great rapport with our kids, and I think it appears to be fun to the others," Fullenkamp says. "I was known around school as the 'Y.E.S.S. lady.'" 

Y.E.S.S. clinicians observe the students in their classrooms and typically meet with them during individual study time, lunch breaks or recess, to avoid taking them away from in-class learning time.  New patterns  The question remains: Will Y.E.S.S. fulfill the original goal of keeping kids out of juvenile court? 

"There is tremendous research to suggest that without intervention, children with inattentive and disruptive problems are at a higher risk for criminal behavior, substance abuse, failure in jobs and inter-personal relationships," Murphy says. "At a younger age, you can head off that trajectory."

According to Murphy, elementary school children more easily learn concrete strategies for acceptable behavior because their schedules are more stable. What's more, they don't yet face the influences of puberty and the changing social structure that comes with it.

"Human nature shows that the longer we behave in certain way, the harder that habit is to break," Walter says. "If we can help them to understand material and get better grades now, they don't have to wind up on the path to dropping out."

Children suffering from inattentive and disruptive problems do not always understand that they're being disruptive, say Y.E.S.S. clinicians. Still, they often face negative expectations for how they'll turn out. 

"They may be making bad choices, but that's not because they're bad," Fullenkamp says. "They just need to learn how to make better choices."

Anita Martin formerly worked in the College of Arts and Science's dean's office.


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Published: Jul 20, 2006 3:50:00 PM
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