A blueprint for healthy school changes

MedStar report takes aim at universal health education, mental health access, and school culture.

A small but enthusiastic crowd last Thursday embraced both the findings and sweeping recommendations of a plan designed to create a coordinated K-12 approach to education, physical, emotional, and mental wellness among students and staff, as well as establishing a consistent culture throughout the Martha’s Vineyard school system.

The presentation of findings and priorities by MedStar, an affiliate of George Washington University Hospital, at the Performing Arts Center was distilled from more than 140 pages of research findings into three top-priority actionable items for Island schools: establishing universal health education, delivering accessible mental health and substance use supports, and creating positive school climate.

School Superintendent Matt D’Andrea described MedStar “as a comprehensive school wellness consultation team that has been conducting an assessment of the Martha’s Vineyard Public Schools’ health and wellness programs, along with the services that are available for our students across the Island.”

The $70,000 MedStar report includes results of nearly 1,100 contacts (interviews, surveys, focus groups) with Island stakeholders, offered in richly detailed summaries of responses by topic and group, and a review of national best practice sources related to the MedStar recommendations. MedStar spent nearly a year building its findings.

The complete MedStar report is available online at mvyps.org/superintendent.

The distinctive Island culture and the restrictions on available resources on a small Island were a consistent thread in the narrative. The picture that emerges from the work depicts a group of individual schools, all of whom do some different programs well, in a physical environment that provides limited outside professional resources and lacks a collaborative interschool system.

Dr. Matthew Biel and Dr. Jeff Bostic used the information to achieve a degree of specificity not normally found In more broad-brush consultancy approaches, and they were able to encapsulate programs that are working and where shortfalls exist.

For example, to support their health education initiative, the researchers asserted that health education staffing and curricula vary across Island schools, that preparation for high school with respect to social and emotional competencies and wellness curriculum varies by elementary school. They recommended hiring an all-Island health director, and included a sample job description.

While some schools have structured, well-staffed health education curricula, and the Island’s Youth Task Force has worked to identify best practices in substance use prevention and intervention in schools, the team found that health education staffing is inconsistent across the schools, some with full-time health educators and others having none.

The report described a challenging situation for students with mental health and emotional issues, the subject of MedStar’s second recommendation. “Families experience stigma related to seeking mental health services … Here on MV it’s also a cultural-difference issue. Overall wellness is not a priority in some cultures, especially with males,” the researchers said, adding, “Teachers are inadequately prepared to identify and address student mental health issues in the classroom and inadequate resources [exist] to conduct comprehensive diagnostic and threat/safety assessment. Increasingly frequent transiency of students [from school to school] increases vulnerability of students and decreases familiarity [with] school staff. Students who are not identified early and placed into mental health programming in school may have difficulty accessing services,” they said, suggesting that services be imbedded in the system under a mental health professional facilitator.

The report found pluses that vary by school. Many school teams recognize the presence of mental health needs among students and the connection between mental health and student learning; many of the health and mental health programs were integrating evidence-based tools, practices, and programs into their work with students; and many schools have successfully integrated interpreters and cultural liaisons to support ELL students with mental health needs.

While school teams use multidisciplinary collaboration to address mental health issues, collaboration was not a strong suit for Island schools overall. The report also noted that teachers and counselors are feeling the effects of managing their students’ mental health and emotional issues, and several reported high stress levels, fear of burnout, and morale issues.

The researchers offered available government resources that could benefit mental health treatment. For example, the research team suggested use of Massachusetts Child Psychiatry Access Program (MCPAP) by Island pediatricians to treat patients with mental health issues, a program with which Island physicians are generally unfamiliar, they said. MCPAP was a Massachusetts brainchild now being used by 30 states.

They recommended hiring an all-Island mental health director, and provided a job description for that post as well.

Assessing and improving school climate, MedStar’s third priority, involves creating a team of school leaders, staff, youth, families, and community partners (i.e. Martha’s Vineyard Community Services) to ascertain students’ degree of connectedness and sense of safety, and to look at school staff relationships, morale, and well-being.

The initiative envisions repeated annual assessment of the school climate, and the researchers provide an enormous cache of available resources in federal and state government to aid in the process.

While the process may seem disarmingly simple, a review of the opinions and attitudes of stakeholders indicate that everyone in the community is not on the same page. The process of bringing stakeholders into the same tent may also benefit community climate, though the researchers did not specifically claim that.

In sum, the MedStar report combines deep-digging research, a trove of resources available, and some common-sense solutions as a blueprint for action. For example, Biel and Bostic repeatedly called for vigorous and ongoing informational campaigns to draw stakeholder commitment to their initiatives.

They noted that the country of Iceland engaged on a full-bore campaign 20 years ago to reduce Europe’s highest rate of substance use and dropout rates, and reduced those rates by 90 percent in a decade, a model now used by more than 30 European countries. “That program, though expensive, could happen here,” Biel said.