An original community psychology model for creating community-wide change capacity through school-based psychological services. With a case study from an Ultra-Orthodox/Hassidic community

1. …And Keep the Change A School-Based Community Intervention Model Binyamin Goldman, PsyD, CSP

2. Overview Background Problems of service and change in resistant communities Schensul & Trickett’s Model Multilevel Community Based Interventions The Present Model School-Based Community Interventions Case Study Rockland County, NY Ultra-Orthodox & Hassidic community

3. Background Accessing Care, School-based Services, & Community Interventions

4. Accessing Care Service gap Most adults & 80% of children with mental health needs receive no care Ethnic minorities’ and other underserved populations’ level of care increasingly disparate relative to general population

5. Accessing Care Barriers to care Problem identification Unawareness of symptom severity Cultural differences in identification threshold Religious explanatory models of distress Help-seeking Not knowing where to access Belief that no one can help Lack of access Stigma Cultural opposition to psychology

6. Community Based Interventions Instead of increasing access to an intervention, address the individuals’ context Systematic change efforts that target: Local concerns and wellness goals Prevention Empowerment Capacity

7. Community Based Interventions Address and avoid many barriers “Bottom-up” approach Ecological perspective Participatory methods Social justice ethic

8. Community Based Interventions But face other barriers: Reluctance of individuals to challenge status quo System not suited for change, or experienced too much change Cultural opposition to change Interventions represent: “planned intrusions into [settings’] ongoing cultural mores, traditions, institutional arrangements, and locally defined hopes for the future” Trickett, 2009, p. 259

9. Schools & Interventions Schools are: Key settings for children’s development Single community agency with universal access to population of children Historically used as contexts to reach children with services

10. Broadening Perspective Calls in the literature for adopting more ecological and systems perspective of: Interventions and activities within schools Schools’ place within community context Examples: School-wide positive development programs School-community-parent partnerships School-based/school-linked services and all-in-one schools

11. Multilevel Community Based Interventions Schensul & Trickett’s Model

12. Communities as Dynamic Systems Communities are: Dynamic, complex eco-social systems Comprised of: Multiple, interrelated ecological layers, components, and agents Constant interaction and ongoing problem solving and change

13. Communities as Dynamic Systems Implications Non-linearity and unpredictability Cross-level effects Need for “local ecological” knowledge

14. Intervention vs. Analysis

15. Intervention vs. Analysis Individual Outcomes Individual Interventions Multilevel Interventions Multilevel Outcomes

16. Multilevel Interventions & Schools

17. Schools in Multilevel Contexts Schools are seen and utilized not just as systems that encompass students, classrooms, etc., but also as components within the larger community system. Within each school or school system, culture, micro-politics, and cycling of resources are all linked to larger community forces that must be understood and appreciated. School-based interventions represent “but one element in [the] larger network of action” within their community context (Braa, Monteiro, & Sahay, 2004, pg. 231) . Schools as “cultural hook”

18. School-Based Community Intervention Model (SBCI) The EPIC OSCaR Process

19. EPIC OSCaR

20. EPIC OSCaR Ethnography Partnering Intervention Setup Clinician Integration Ownership School Network Building Cross-Level Problem-Solving and Readiness

22. Cross-sectorEthnographic Inquiry Become true community “insiders” Build reciprocal, trusting relationships Understand community culture and social ecology, and schools’ function Partnering Build upon “ecological map” of networks of support, resistance, resources and innovation Community Partners- “front-line problem-solvers” School-System Partners- ideally, current obstacles to innovation that are candidates for change

25. Cross-SectorSchool Network-Building Organize schools to form a network around school and mental health-related issues Facilitate joint problem-solving Cross-Sector Problem-Solving Increase interdependence amongwellness-focused organizations and systems in community Strengthen ties between community-based organizations and specialized expertise outside the community.

27. Case Study The Ultra-Orthodox/Hassidic Jewish (UOHJ) Community of Rockland County, NY

28. CAPs School-Based Services

29. Intervention Context BikurCholim-Partners in Health, Monsey, NY Long-standing social service organization operated by and for UOHJ community Hospital visits, medical referrals, medical equipment lending, etc. Center for Applied Psychology (CAPs) at BikurCholim NYS OMH-licensed mental health clinic serving primarily UOHJ population Clinicians and admin. Orthodox, but not all UOHJ Opened 2002

30. Intervention Context School-Based Clinical Services Division Funded through district Schools 10-15 non-public schools, currently all UOHJ Majority of schools have counselors for ≤ 3 years Participation: Modern ➔ Yeshivish ➔ Hassidic Partners: District personnel Local rabbis BikurCholim supporters Individual administrators Parents

31. Community Socio-Demographics 3 Major factions Hassidic “Yeshivish” “Modern Orthodox” Other groups Sefardic/Middle Eastern “BaaleiTeshuva”

32. Community Culture “Torah Values” Primacy of learning Strict adherence to biblical and rabbinic dictates Value of “authentic” traditions and behaviors

33. Community Culture Insularity Response to persecution, assimilation Resistance: To change To influences of contemporary, outside culture Particularly in areas of socialization and education

34. In the society, but not of it

35. External information limited, but still flows

36. Community Structure Hassidic community Highly structured hierarchy and role assignments Geographically demarcated Impermeable boundaries Group vs. individual orientation

37. Community Structure Yeshivish and Modern Orthodox More fluid structure and boundaries Socially and idiologically Grouping according to synagogue attendance, school, neighborhood Less centralized power

38. Hassidic Community Structure

39. Hassidic Community Distinctive clothing Yiddish as spoken language Strict segregation between men and women Little English or secular academic instruction

40. Prior Services Percentage of schools, by number of years receiving any mental health services prior to 2008 – 2009 school year

41. SBCI Process The Model, Applied

42. Ethnography Pre-Entry Phase Group supervision as ethnographic collaboration Utilizing BikurCholim Utlizing DCS Continued inquiry

43. Partnering Pre-Entry Phase External Agency The school district- a “good shiddukh” School System & Community Resistance in more conservative communities Slow “domino effect”

44. Intervention Service Delivery Phase Intervention Setup Psychoeducation Modalities & Frequency 2-16 hours/wk/school Individual counseling, most frequent Large variance in schools’ utilization of administrative and school-wide support

45. Clinician Integration Service Delivery Phase Clinician Preparation Yeshivish vs. Hassidic patterns Yeshivish- greater integration, but more scrutiny Hassidich- less integration, but more acceptance

46. Service Delivery Phase Ownership Program Extensiveness School-parent communications Yeshivish/Hassidic differences Program Intensiveness Related to: Clinician integration School micro-politics

47. Scaling Up Phase School Network Building Principals’ Meetings Provided: Interaction and engagement Seeing the others who are involved Safe forum Guided, joint problem-solving

48. Scaling Up Phase Cross-Sector Network Building Referrals to DCS Protective Services Monsey Community Coalition for Health and Wellness

49. Impact New roles and settings in schools School ownership Parenting program Referral source New and strengthened networks Principals Community Schools and district Increase in Consultation by teachers and administrators Referrals for outside services Parental involvement Prevention and positive development focus

51. Discussion

52. Limitations Barriers to implementation Resistance Non-school goals Empirical validation Methodological challenges Requires mixed-methods design

53. Changing School’s Perspectives & Goals Understanding complex interactions with community systems Increased collaboration with community Using school psychologists to facilitate SBCIs Other applications

54. Conclusion Value of school-based programs: beyond direct service or school-wide, with individual outcomes Broader, more sustainable change through “local ecological” knowledge” In resistant communities, school systems can be “cultural hook” Interventions can help create new roles, settings, and networks for problem-solving community mental health issues and change attitudes and perceptions that serve as barriers to service access community-wide.