EdFix Episode 9: Improving School Mental Health for Children Living in Poverty

TRANSCRIPT

OLGA ACOSTA PRICE:
It isn't any one system's responsibility. This is where we have to do the hard work of trying to figure out what are the effective practices for how we collaborate as cross-system partners.

MICHAEL J. FEUER:
Welcome back to EdFix, your source for insights about the practice and promise of education. I'm Michael Feuer. Today I have a special pleasure to welcome two guests, Olga Acosta Price and Nisha Sachdev. Dr. Price is a member of the faculty of the George Washington University Milken Institute School of Public Health, an Associate Professor in Prevention and Community Health, and Nisha Sachdev is the Senior Director for Evaluation at the Bainum Family Foundation and an Adjunct Professor in the Milken Institute School of Public Health. They have dropped by to talk to us about some very exciting work on the way and it's a pleasure to welcome you both. I'm going to start by asking Dr. Olga Acosta Price to say a few words about yourself. Olga, welcome.

OLGA ACOSTA PRICE:
Well, thank you for having me. So I have been at GW for about 13 years and I am a clinical psychologist by training actually and have my work and my area of specialization is school mental health, which is essentially working at the intersection of public health, healthcare and education and really trying to take a systems approach for how we might improve the access to high quality care, particularly for behavioral health, but for all health care for young people in public schools. And so I direct the Center for Health and Health Care in Schools here at GW. And that's our aim to really promote and advance effective school health practices to really best understand how we could co-locate quality care, prevention and really think about creating the most nurturing and supportive environments for young people so they could be the most engaged learners. And so that's been my passion in the work I've been doing for most of my career.

MICHAEL J. FEUER:
Hello, first of all, Nisha-

NISHA SACHDEV:
Hello.

MICHAEL J. FEUER:
... and welcome to EdFix. Tell us what the foundation is about and what your current role is there.

NISHA SACHDEV:
So the Bainum Family Foundation focuses on early learning opportunities and the birth to three space and then continuum of services for three and up to ensure that there's educational opportunities and positive outcomes for children and families in the district. And then we do some work nationally through Seventh Day Adventist programs and we have a nutrition aspect to our work also specifically here in the district. And so my role at the foundation is to oversee the evaluation efforts of our initiative and then to make sure investments are targeted in the right place and that we're having an impact. And then also another role I have is to partner with Olga and her team to roll out our school mental health strategy, which is the area we're focusing on in the three year old and up space.

MICHAEL J. FEUER:
Give us the thumbnail version of the main project that you're working on now with our colleagues here at GW.

OLGA ACOSTA PRICE:
The Center for Health and Health Care in Schools at GW is working in partnership with the Bainum Family Foundation to support the ability for schools to address the breadth of behavioral health needs of all kids in the those respective schools. We are working in partnership with four charter schools in Ward seven and eight and we're providing them tailored technical assistance to really improve their practices and providing them an opportunity for learning where they will feel that they are better equipped to identify and address and prevent some of the behavioral health issues that become barriers to their learning.

NISHA SACHDEV:
The 4.1 million actually does also include bringing together 15 to 20 stakeholders in the community to their researchers, practitioners, policymakers and providers to come together to help to think about how we can leverage resources across the system. And there's also a knowledge building piece nationally where we're working with SAMSA, HRSA, the Center for School Mental Health and the school-based health Alliance to.

MICHAEL J. FEUER:
SAMSA and HERSA sounds like diseases.

OLGA ACOSTA PRICE:
Substance Abuse and Mental Health Services Administration.

MICHAEL J. FEUER:
Mental Health Services Administration, and the Health Research...

NISHA SACHDEV:
Health Services Research Resources Administration to talk about what our strategies at the federal, state and local level to help increase the quality of school mental health nationally. And the last part or the $4.1 Million is two schools we invested in facility development. Knowing that space is a big issue when we're thinking about how to provide quality school mental health. So we are able to provide facility funds to help recreate some of those spaces.

MICHAEL J. FEUER:
So there we have the university, the foundation, and then you have of course the City of Washington, DC and as if that's not complicated enough, it's the nation's capital. It's not a state. Say a little bit about doing... Am I right that this is a pretty interesting bit of choreography among all these institutions?

NISHA SACHDEV:
I think what's exciting about the foundation is that they really take a system's approach and ensure that we are bridging research, practice and policy along with philanthropy to make an impact in the areas that we fund. And so we don't do our work separately. And aside from, I wouldn't say exactly but in line with where the city is doing their work. So we work in close partnership with district agencies to do the work. So I think that makes the work a little less siloed and more seamless so we can tie together and not trying to take investments and match it with what the city's doing, but instead working with the city to decide what needs to be done and fill those gaps.

MICHAEL J. FEUER:
And Olga, from your standpoint, say a word about how a faculty member, researcher managers in that kind of an interaction.

OLGA ACOSTA PRICE:
Well first, thank you for acknowledging how challenging that actually is but I think that part of what is so not just exciting but fun about this initiative and partnering with Nisha and Bainum is that we really I think have very similar kind of underlying philosophy about how we are going to sustain our public and private investments. And I really consider myself to be an applied researcher, someone who really thinks about the application of knowledge and innovation and how we implement that in ways that can in the last five years or so I've really taken on and tried to understand what do we mean by sustainability from the perspective of even researching what do we mean by that and have examined school community and government collaborations and to understand how those are very important mechanisms to facilitate the kind of change but lasting change that we want.

OLGA ACOSTA PRICE:
It is part of why I have been at GW so long. It's part of why I chose to come to GW because although a private institution I think has always at its core had as a mission to really serve the DC community. And so certainly being in the School of Public Health, I think it sort of really fits really thinking about how we examine working partnership with our community. So of course DC government is one of our partners, but probably more specifically it is the schools, the school districts, both DC public schools and then all of the charter LEAs that we're partnering with and the individual schools that we are eager to hear from and to find space for, to allow them to help us understand where the real challenges are so that we could go and research best practices that are occurring here and in other places and then really work with them to figure out how to apply them. So as hard as it is, it's been very rewarding work.

MICHAEL J. FEUER:
By the way, LEA stands for Local Education Agency. And I have to say that to some extent the reputation of some of the big philanthropies involved in education reform, I think it's a little bit unfair, but you do hear this that some of the foundations have it all figured out and they're only investing in the programs that they already think are the ones that will work. At which point they're kind of missing the opportunity to invest in knowledge production of the sort that Olga and her colleagues are doing. Is this something that at the Bainum Family Foundation you actually talk about as a philosophy or philanthropy?

NISHA SACHDEV:
So one of our core areas at the foundation is knowledge building. And so we know funders can come in and pull out at any time. So one of our driving kind of philosophies is how do we sustain the investments that we provide. And so one of the areas that we've found that foundations can have a driving role in is this knowledge building piece. So how do we implement and invest in and try innovative practices? But couple that with the research and disseminating that research in the field to other funders, to other providers, to policymakers. And so that is a core area. And knowing that we don't have all the answers.

NISHA SACHDEV:
We also are very intentional about having a learning phase through our work. So this project in specific, we went through a year and a half of a learning phase where we talk to the community. We invested in two schools to pilot. Is it just that we pay for positions or is it that we pay for a program? What are the needs of that school? And then worked with an expert that has the research policy and practice background to help really create the strategy. So it wasn't done just in-house, but it's in partnership with those that have the expertise.

MICHAEL J. FEUER:
It would be interesting to just get a even an approximation of the level of funding that the foundation provides an array in a typical year.

NISHA SACHDEV:
So just in this school mental health space, we have a $4.1 million investment over three years. In the early learning space in the district, it's $10 million investment over five years. And then there is the investment in the nutrition space. We own and operate a farm and then we're working on how to increase distribution to Ward seven and eight. And so I don't have the exact numbers on those or the Seventh Day Adventist, but just to get an idea in the district, it's about a $15 million investment in the last five years.

OLGA ACOSTA PRICE:
That's the other thing that's exciting too and this is my opinion, that Bainum really has served in, I've been in DC about 20+ years, as a leader among sort of philanthropists and philanthropic organizations in at least kind of their approach and what I have found in the years I started out in district government for six years and so from that perspective I had a at a sense of who are some of the players who were interested in trying to invest at the public level. And it often felt somewhat piecemeal as you said, sort of signature projects or sort of things that they were interested in investing but not having a sort of a picture of how it all fits together.

OLGA ACOSTA PRICE:
And I think that and my sense is that others are really looking to Bainum and sort of emulating some of that or consulting with each other now in terms of how might we make this investment, how much you leverage it so that it's actually not its own separate piece that may not have as much impact, but how might we contribute to a broader vision. And I think that's also really exciting to see.

MICHAEL J. FEUER:
Does the Bainum Family Foundation go into partnerships with other foundations to jointly support projects?

NISHA SACHDEV:
So that's a great segue into some of the work we're doing here is we have found in the school mental health space that there's a lot of funders that are interested and we're an operating foundation, which is a little bit different than grant making. So we have more of the staff capacity to take the time to learn to partner and to be in, I don't want to say intentional, but really to learn and partner. And so we have in this space set up a funder scan that's going to be launched and complete in March where we're working with other funders to see where are they funding in the school mental health space and where is their duplication of funding and where are there some ways that we can realign our funding to fill some of the gaps that need to be filled to leverage the public dollars.

NISHA SACHDEV:
And so we've gotten great interest from local funders to do this work and have asked Bainum to take the lead because we have the staff capacity to do that and working together to have a coordinated funding strategy rather than having one-off funding.

MICHAEL J. FEUER:
So what would you say are the three most significant mental health challenges in a place like the DC education, including the traditional public schools and the charter schools?

OLGA ACOSTA PRICE:
There are children who might express symptoms that are associated with post-traumatic stress, which are ways that kids are trying to cope with the exposure to any traumatic or chronic traumatic event. There is depression. There's quite a bit of depression. It just doesn't always look the same way it does with adults in terms of, and many with young people, depression really expresses itself more as aggressive or acting out behaviors and anxiety. I mean I would probably say those might be sort of the top three categories of mental illness or mental health problems.

OLGA ACOSTA PRICE:
But I wouldn't want to stop there in that I think I would want to make sure folks appreciate that these are the expressions sort of distress and suffering that young people use because they have often not a lot of other coping strategies or supports. But what we need to also focus on. So we want to ameliorate and alleviate that certainly. So that's where our treatment work and in our case management and much of the wraparound that we need to do. But if we don't attend to the drivers, to the sort of the things that influence those behaviors, we will not serve our community well.

MICHAEL J. FEUER:
Poverty of course is one of the determinants, if you will, one of the explanatory factors in these observable behaviors. Is that a fair statement or are you getting some of these mental health issues even across the income distribution?

OLGA ACOSTA PRICE:
Well, I think that the research shows certainly that we are seeing an increase or we're just getting better at really identifying, but I think there is really an increase across the economic spectrum in terms of the levels of anxiety and depression that young people are reporting. Having said that, my work has often been in urban areas and so where I really focus my work and so I don't want to dismiss that body of work. It is very important. And some researchers are doing really important ways to elevate that and the kinds of pressures that kids are under and to perform and those kinds of things that are really undermining their success. But I think there are different sort of set of consequences here. And I often will say poverty, yes, absolutely. But what do we mean by that? Right? What does that entail?

OLGA ACOSTA PRICE:
And what that often means is housing and stability. What that often means is food insecurity. What that often means is greater exposure to domestic and community violence. It's unpacking what the actual risk factors are and the level of exposure that young people and their families are experiencing and where we get to. And I think the community schools models and other approaches have really sort of contributed to our understanding of what can work is to really think about these school community collaboratives, these partnerships. How do we make them work? Because I think what we hear from schools very much is, yes, we see. We experienced and understand these problems. We empathize, we sympathize. But what is our role as educators?

OLGA ACOSTA PRICE:
That's not my role to have help parents find employment. It's not my role to figure out how to help this child with how stability of housing. But I appreciate that if they don't have that stability, I can't ask them to learn. This is too difficult. So I again, using more of the public health lens is saying it isn't any one system's responsibility. This is where we have to do the hard work of trying to figure out what are the effective practices for how we collaborate as cross-system partners both at a sort of a local and ultimately at a state level. But DC being both, either makes it easier or harder because sometimes it's the same people wearing those hats. And so how do we come together to say this is a very complex problem. Poverty is a very complex set of issues. And so what roles do we play? What responsibility and what resources do we have?

OLGA ACOSTA PRICE:
And so this is part of what we've come together to try to think about. And the schools have been very open to sharing who they've partnered with, how those partnerships have gone well or not, what they need. How do they identify the kinds of struggles that their kids and families are going through, and therefore to know how to reach out to the relevant folks. And to me then there's some research questions that continually emerge from this in terms of, all right, what is the best practice around this? What does the research tell us is the best ways to do that? And that's what we're constantly sort of drawing and trying to be informed by the literature and then identify where we still don't know very well much and where then we will use our practice-based evidence in DC to then guide where we go.

NISHA SACHDEV:
I think it's important as we think about those evidence-based practices or best practices is that there's not going to be a one-size-fits-all, and so we have to shift our mind from that and thinking about how do we, again, find the foundations across these interventions and then tailor them to the community and the needs of those communities, whether it's income or race, ethnicity, and those characteristics.

MICHAEL J. FEUER:
You've got a SWAT team approach now to these number of schools. What's happening there?

NISHA SACHDEV:
One of the biggest drivers of the participation, it's really 100% participation is that we spent a lot of time relationship building and tailoring our efforts to what the school needs and where they're at. And so with the four schools, we're in the needs assessment phase where we are really intentionally interviewing staff, doing observations, reviewing piles of documents around their existing policies, around their ways they do teaming, around the ways they use data and really getting to understand the school. So it's not, we're telling them what to do, but we're collectively and collaboratively designing a technical assistance plan that will help them in the next two years.

NISHA SACHDEV:
And so I think that while this goes back to people wanting to see results right away, is that we're being very intentional about saying we can provide your result in different ways, like a case study on what's happened so far from the school selection to the needs assessment process. But it's going to take time to see those actual changes in teacher's behavior or the student outcomes. And so I think it's managing the expectations. When you ask how's it going in a research term, we can't give you that quantitative, but we know there's some anxiety around policymakers, the investors and even the school board members to know. And so that's why I think we're using kind of different evaluation approaches to give those touchpoints before in a year or two. Being able to give that quantitative data, that really is what people are looking at.

MICHAEL J. FEUER:
I love the phrase that you use there to manage expectations. Are you finding that policy policymakers and practitioners can go along with you and take a deep breath and say, okay, I won't have all the answers by Thursday, but I'm still going to stick with the program?

NISHA SACHDEV:
I think it's really taking a shift in thinking and it's really doing a lot of education around evaluation, around change. How do we use existing research to put comfort in the investors and the policy makers to know that longterm you will see change. And right now it's really we need to look at implementation and look at the processes and how we can sustain and understand how to effectively implement to drive change. And so I think it has been a lot of education over the last years, especially on the foundation side. And I think what the policymakers to know that.

MICHAEL J. FEUER:
When you do an evaluation you are ready, willing and able to say, huh, we tried something may not have been the best way to allocate these resources and we're going to steer a little different direction.

NISHA SACHDEV:
We are really invested in continual monitoring, so understanding earlier than later when things might not be working, but this is really where the knowledge building piece comes in to be able to share back in the fields what worked and what didn't. So there's not others that are trying to reinvent the wheel or try things that might not have worked and to share those lessons learned on what we would've done differently.

MICHAEL J. FEUER:
Terrific. Yeah, sure.

OLGA ACOSTA PRICE:
... policymakers just a quick example and maybe more on the side of how not so much maybe influencing or shaping policy as, but helping schools deal with a policy once or a piece of legislation once it's been enacted. So for example, very recently the legislation as it relates to suspension and expulsion for DC schools is now in effect and being enforced. And I use air quotes on that, which I think was based on research and what we know. They really drew from experts on how they want it. And the intention behind that policy is a very good one around let's have uniform and a consistent definitions of suspension. What would elevates to requiring a suspension and expulsion is that there was some real concerns about that in DC as well as other places.

OLGA ACOSTA PRICE:
So I think that the law drew on some good evidence, but where again, I think that we learned that things are less than ideal is now in the implementation of that law and how we get to schools because we now have a community of practice. So the four schools that we're working with, we're bringing them together once a month. We're not only are we able to maybe bring an in part knowledge that we have, but they share with each other because they have expertise they need to share and then they share with us. So it's this great learning environment that we've launched. And they brought this to us and said we're supposed to be reviewing our policies, we're supposed to be enacting change as it relates to suspension and expulsion policies. Maybe now even having a more robust in-school suspension approach, we don't know what to do. How do we proceed?

OLGA ACOSTA PRICE:
So I think that there is a disconnect that maybe hasn't been as well-anticipated or where, I know there are district agencies that are responsible for providing some technical assistance, but their ability to get up to speed and ready to do that is delayed. And meanwhile the schools are going to be held accountable. And so that's the kind of implementation gap that we want to identify to bring back to policymakers and say, so let's be careful as we roll these kinds of things out. Let's think about how either within the policy or in a staged way, we are making sure that we are supporting... Because schools want to comply, but they need some help in being able to do that. And it's very clear how suspension and expulsion policies are linked to behavioral health. There's many, many ways that they are. These are kids who are disproportionately suspended and expelled to those who have behavioral health problems.

OLGA ACOSTA PRICE:
So we really want those policies to be based on what we know to be the best evidence. And yet schools are not being supported sufficiently to do that. And so that's where we are constantly trying to identify and think about kind of the whole system and how you know, so who's responsible, how do we enforce and how do we provide technical assistance? How do we monitor that schools... Who's responsible for doing that? And even if we are not doing that, meaning GW, but that we can say, so let's identify the landscape because maybe folks have been only thinking about their piece of this, but we are ultimately going to be unsuccessful if we're not thinking about all the pieces together.

NISHA SACHDEV:
This is really where it's seen that you need to drive research, practice and policy together because there's still very siloed in some aspects.

MICHAEL J. FEUER:
This has been a super treat for me and I hope for our listeners. Thank you both so very, very much. Professor Olga Acosta Price, Dr. Nisha Sachdev, lots of ideas and I have pages of notes scribbled and more things and more questions. We will continue these conversations I hope. For those who want more information about this podcast and previous editions, you can visit our website at go.gwu.edu/edfix. EdFix is available on Spotify, iHeartRadio, iTunes, Stitcher, SoundCloud, or Player FM.

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