Capacities Needed to Improve School Mental Health Programs with Frank Rider

On this episode of “In Session,” we speak with Frank Rider, a seasoned Technical Assistance Specialist (TAS) at NCSSLE, about the capacities Local Education Agencies (LEAs) and State Education Agencies (SEAs) need to improve their school mental health programs and systems. As he nears the end of his 40 year career, Frank shares his expertise with the field at large. Specifically, he discusses common characteristics of successful change initiatives, advice for new grant managers, and what he has learned over the course of his impactful career. This discussion will be helpful for both new grantees (P2C3 and others) and those grantees who are nearing the end of their grants (MHSP 2019, P2C2, SBMH 2020, TR). This conversation is guided by NCSSLE’s Annie Knowles and Brianna Cunniff.

0:45- Welcome and introduction

2:16- Common characterstics of technical assistance (TA) recipients who have successfully facilitated change initiatives

4:28- Key characteristics of a compelling impetus for change

6:00- Recognizing the important phases of systems change for successful change initiatives

7:45- Primary advice for first time grante managers

10:43- Secondary piece of advice for new grant leaders

14:06- Lessons learned

17:29- Suggestions for technical assistance providers aiming to support successful grant funded systems change initiatives

19:08- Defining SAMHSA and GPRA

20:34- Challenges and questions for grant managers close to the end of the grany cycle

24:10- Taking an initiative to the "next level"

27:21- What Frank has learned from successful change agents through his TA work

31:14- Final takeaways and closing

For all questions or feedback, you can email [e-mail]. Thanks for listening!

Please note, the contents of this podcast do not necessarily represent the policy or views of the U.S. Department of Education, nor does it imply endorsement by the U.S. Department of Education.

What is In Session?

In Session is an education-centered podcast where we speak with changemakers working towards safe supportive learning environments within their communities, co-hosted by Annie Knowles and Brianna Cunniff at the National Center on Safe Supportive Learning Environments. Our guests include state and local education agencies and their partners - all grant recipients from the Department of Education, using their funding to advance school-based mental health services, support mental health service professionals, and establish trauma recovery and prevention programs. Please note, the contents of this podcast do not necessarily represent the policy or views of the U.S. Department of Education, nor does it imply endorsement by the U.S. Department of Education.

Brianna Cunniff: Hello, and welcome to In Session, a podcast where we speak with change-makers working towards safe, supportive learning environments within their communities. Our guests include state and local education agencies and their partners, all grant recipients from the Department of Education, using their funding to advance school-based mental health services, support mental health service professionals, and established trauma recovery and prevention programs.
I'm Brianna, and this is Annie at the National Center on Safe Supportive Learning Environments, or NCSSLE, and we produce In Session. On this episode, we speak with Frank Rider, a seasoned technical assistance specialist at NCSSLE, about the capacities that LEAs and SEAs need to improve their school mental health programs and systems.

Annie Knowles: Alrighty. Welcome, Frank. Thanks for joining Brianna and I today on this episode of In Session. We're really excited to talk to you and hear about all of your expertise and experience. The first question that we have for you today is, when you think of TA recipients that have successfully facilitated change in their context, what are some of the characteristics that they had in common?

Frank Rider: Hi, Annie and Brianna. Yeah, I am getting near the end of a career in which, for the past 35 years, I have been deeply involved in large-scale human service system change. So, before coming to work at the national level, I had an amazing opportunity to lead one of the nation's very largest such initiatives, a statewide reform of children's mental health services, known as the J.K. Settlement Agreement. That effort accomplished a unifying of efforts among six traditionally separate child and family serving systems in Arizona between 2001 and 2007. By the end of the sixth year, we had more than 25,000 children and youth and their families being supported through a very specific, well-defined practice model, generally referred to as wraparound and, in particular, the Arizona child and family team.
During the 16 years since then, I've had the pleasure of working with up to a hundred change initiatives supported with federal grants in more than 35 states. Based on both my direct work in the field and as a national technical assistance provider, the most important variable I have noticed that distinguishes ultimately successful change initiatives is a foundation that is built on a broad-based impetus for change. By impetus, I mean an event or a policy decision that becomes the trigger for unified action among a broad-based coalition of stakeholders. So my career in Arizona was marked by two different types of such impetus. First, in the mid-1980s, our state secured an unprecedented waiver from the Centers for Medicare and Medicaid services that committed us to develop a system of home and community-based services for people needing long-term care and support, including older persons, people with developmental disabilities and other persistent and serious health conditions.
That single agreement made Arizona the final state to enter the Medicaid program, and it required many previously separate systems to join together to create a program unlike any other states. Then, later in 2001, a federal court in Tucson ratified a settlement agreement between two public interest law firms and the state of Arizona to completely revamp how the state would address the mental health needs of children on Medicaid and especially those in the child welfare system where I was working at the time. Sometimes, the necessary broad-based impetus for change is a piece of legislation, a city council resolution, or an executive order from a governor. Sometimes, it is a required or negotiated response to a class action lawsuit, a consent decree, or in Arizona's case, a negotiated settlement agreement. Occasionally, it can be generated more organically, and it grows into a community initiative.
In fact, I have sometimes been invited to help organize and launch those kinds of grassroots coalitions. Let me share some key characteristics of a compelling impetus for change. One, it builds from a locally or a state-specific need or initiative or motivation that already exists and that has already attracted popular support or key leadership interest and support. Second, you identify and reach out to and engage with who else in my community or state caress about this same problem or priority. So you'll notice, so far I have not mentioned the grant opportunity as an effective impetus for change. Based on my experience with scores and scores of grant-funded change initiatives since the 1990s, it's clear to me that identification of compatible grant opportunities should follow and support the driving need or vision or goal. So my advice would be to resist the temptation to allow the existence of a grant opportunity to be the primary impetus or catalyst for a change initiative.
What is important to motivate and sustain large-scale system change is an overriding sense that whether by way of this grant, or otherwise, we will do whatever it takes to accomplish the intended change. It is that important or we have no choice but to do this. A second characteristic among successful change initiatives is a strategic sense of development over time. Successful leaders or change agents need to recognize the important phases of systems change that even precede applying for winning and implementing grants. The granted period needs to be used strategically to learn, test ideas and strategies, develop measurement and communications dimensions, partnerships, et cetera, where the grant money the resources can be particularly helpful.
And then an extended post-grant period during which the granted initiative is designed to expand, refine, adapt to changing circumstances continuously, shed obsolete parts, and grow new buds. And so, there should be like a conscious staging of development sort of parallel to human development that provides a palpable context for implementation of specific grants. And then, finally, I'll say a third characteristic that I think is helpful, but it's not a prerequisite at all. Prior expertise working with federal or other public or even philanthropic grants. I think that kind of experience is helpful as many grant application processes, fiscal and reporting requirements, and protocols are very particular and somewhat arcane. So, all things being equal, it is helpful to have some experience working with those formal kind of grants.

Brianna Cunniff: Wonderful. It sounds like you've had a long, impactful career, and we're excited to get the opportunity to talk with you today and hear all these great insights you have to share. What would be your primary advice to a first-time grant manager?

Frank Rider: Well, based on my experience, building and sustaining effective and enduring systemic change relies more than anything on building, growing, energizing, and maintaining a broad foundation of stakeholder support and investment. In my view, the single most important set of stakeholders are the very people the human service systems are designed and intended to support. So specifically, my first piece of advice to that new grant leader is align with children, youth, and families that the initiative is intended to benefit. Their primary interest and expertise can serve as tried and true north stars when political, bureaucratic, and other considerations can waiver and change over time.
The expertise that youth and their families bring is uniquely valuable. It's sort of like the Nielsen ratings on TV in identifying what will work, what has been tried that doesn't work, and what is truly needed to shift the trajectory of these young people and their families from distress and limitation to hope, progress, accomplishment, and long-term viability. Invest in enabling and cultivating those voices of young people and their families. System professionals, bureaucrats, elected officials, all of those people will come and go. But children and youth with special needs, their families and friends, they are in it for the long haul.
They also, as I said, conserve as sort of a north star to help keep the professionals focused on the true end goal instead of focusing on things like budget limitations, systemic rivalries, blaming and shaming, and other less-than-professional behavior that we unfortunately sometimes do see among professionals who ought to know better. Strong alliance with multiple young people, families, and stakeholders, in my view, is the best way to ensure sensitivity and responsiveness to the unique needs and considerations of subpopulations beneath the overall mean average experience in a community or state. And also, in the past 20 years, we have increasingly come to appreciate that motivated youth and family members can uniquely help to expand the long-term workforce necessary to sustain the innovation.
So we have seen many youth and family members become somewhat professionals within the workforce. That's particularly important right now when the National Behavioral Health Workforce is otherwise very insufficient to meet the volume of need that is out there. So that's my first piece of advice to the new grant leader. My second piece of advice is related to that first one, avoid the temptation to try to control the change initiative, just the opposite. Try to consciously, intentionally find ways to basically give it away. Try to constantly grow the investment among stakeholders who will preserve and protect the innovation no matter what challenges might come over the horizon. Don't try to hog the glory, the authority, the purse strings to fulfill your ego as a grant leader.
Isolation can make your grant initiative vulnerable, whereas giving it away, sharing information, sharing decision-making influence and voice, sharing recognition broadly helps to insulate the change initiative from risks of isolation, like to narrow a constituency, and it strengthens the constituent's support to be able to sustain and expand it in the long term. So I would tell the new grant leader find ways to strategically invite and involve valuable stakeholders and potential partners in grant-related activities, have celebrations, bring them to grantee meetings, have events, training sessions, conferences, webinars where they can physically be feeling part of the overall initiative. Provide these stakeholders with a sense of belonging and acceptance. That means sometimes carving out time for anyone's input at each governance or management meeting.
Provide them with business cards, give them a lapel pin. Have a group name, branding, t-shirts. These are small, inexpensive kinds of symbols that help to create a shared identity to support the ongoing commitment and investment among the desired partners and stakeholders who will keep the initiative vibrant and alive. For that matter, even schedule meetings and schedule the work in intentionally varied ways and at different times to allow as many people as possible to participate. So I ran a federal grant, a SAMHSA grant down in Pima County, Arizona, in Tucson, where our governance meetings every third month would be held at a different time. So, in month A, that meeting might be on a weekday during business hours. In month B, the governance meeting would be on a weekday evening. In month C, the governance meeting would be at 10:00 AM on Saturday.
That way, everybody had some inconvenience. Everybody's schedule would sometimes be most supported, and they would be able to participate. And along that line, we also eventually created ways for people to not have to be physically present but to participate in meetings by telephone, conference call, or these days, Zoom. And finally... And one other thing I would say is to rotate the meeting locations because that also creates opportunities to invite new colleagues. So sometimes, with our statewide work in Arizona, we would have our key meetings in Phoenix, in Tucson, in Flagstaff, so that they were, again, always more convenient for some, less convenient for others, but always there would be times when people would be able to really participate. A third lesson that I have learned both personally and through work with successful initiatives around the country is to publicize everything.
So I'm kind of old. There's an old beautiful song by Carly Simon called, We Have No Secrets. To me, A successful change initiative will be led by a person or actually even better led by a group that will always insist on open and honest communication always. Full disclosure generates trust. Nobody and nothing is going to be perfect. Those who try to pretend otherwise face both an impossible task and invite suspicion. So be fully transparent about both the data that quantifies and justifies the need to act and improve in the first place. And then also the related data as the initiative unfolds from small pilots to full implementation through fidelity monitoring and improvement to wide-scale adoption and innovative applications of the initiative to priority subpopulations or to new challenges. So sharing performance data that falls short of what is ultimately intended, in my experience, can actually be motivating.
As we were trying to develop and expand the Arizona Child and Family Team model throughout the six regions of the State of Arizona, we came to a point where we started to really pay attention to the fidelity with which that model was being implemented. And in the early going, people were not getting stellar grades. In fact, in Maricopa County, the by far most populous county in Arizona, had the worst fidelity to the model. The first time that we applied our fidelity model, their score was less than 50%. That's like hit or miss. Okay. But by publicizing that, people began to get a little competitive and to say, "We do not want to be in last place. We want to improve." Literally three months later, when we came back and did our fidelity testing again, that 50% had already increased to 63% in Maricopa County. That is a really significant gain of large-scale practice improvement.
So sharing performance data, even when it might be a little bit embarrassing, it supports your credibility. It builds trust, but it also can unleash the motivation of a lot of people who have a hand in who improving the implementation. Now, on the other hand, sharing performance data and impact data that approaches or meets or even exceeds expectations and intentions is really reinforcing. It fortifies the credibility and influence of those people whose commitments can make or break the staying power of the initiative. Also, sharing, expenditure, activities, and performance information openly, voluntarily, regularly prevents the emergence of mistrust and suspicion, and it empowers or enables everybody to offer their best ideas based on real relevant data. Finally, a couple of suggestions for technical assistance providers who are aiming to support successful grant-funded system change initiatives.
One, offer a clear concrete guide for project directors or lead evaluators that lay out basic project management tasks and tools, specifically with some of the grants that we work with with federal grants, federal agencies right now, those GPRA measures on performance reporting. And then second, offer specific activities designed for new grant managers. Everybody is a rookie before they become an experienced professional. So create venues that are really comfortable for rookies, including collectively among their equally new peers. So a non-embarrassing venue to ask those, quote-unquote, dumb questions and to inform helpful tools. So I used to run a new communities TA call series for SAMHSA Grants, System of Care grants where all of the first-year funded project directors would get together on a call and ask those, quote-unquote, embarrassing questions, share stories about attempts that good efforts that may not have succeeded and learning from each other, and also building a little bit of comradery among a peer group that can provide a lot of support as the grant leader grows and develops in the ensuing years.
So I would recommend those specific activities for new grant leaders during the first 12 to 18 months of a five or six-year kind of a granted initiative. So I have... When I refer to SAMHSA, I want to make sure people understand that SAMHSA stands for the Substance Abuse and Mental Health Services Administration, the federal agency within the US Department of Health and Human Services that is our nation's lead agency to provide mental health and substance use disorder prevention, intervention treatment services. I mentioned GPRA, GPRA measures. GPRA, G-P-R-A, is an acronym for the Government Performance Results Act. This is legislation that originated during the Clinton Administration that applies to many federal grants and calls for some specific quantified accountability back to Congress on an annual basis.

Annie Knowles: Thank you, Frank. What I love about the advice you just shared, especially, is I feel like it really focuses on kind of the intrinsic qualities that grant managers hopefully already have, like this idea of aligning with why you're really doing this work, the children that you're hoping to benefit, staying true to that, sharing what you found with others, seeking support.
I think that this is advice that hopefully new grant managers will be hopeful hearing because they have a lot of this already. So you've just spoken about new grant managers. So now we want to shift for the more experienced grant managers or people close to the end of their grant cycle. What question would you ask them, or how would you challenge them to get to the next level?

Frank Rider: The next level. Well, let's start with the first level, then we can talk about the next level. So, let's start with sustaining the change initiative after grant funding and grant accountability and formal technical support is no longer being provided. Sustainability must be understood, even before submitting the initial grant application as a necessary and constant objective. So here are many important considerations that I've learned about how to continue the change initiative far beyond the time-limited grant funding. You want to select what components or elements must be continued, which you would like to continue, and which should be cut loose. You don't need to sustain everything, just what works and what is helpful.
Second, try to figure out strategies to integrate the ownership of the initiative into the permanent service system. For example, into procurement processes, personnel requirements, funding and budgeting processes, infrastructure components. How can you embed things that might have been created initially, specifically for the grant, into the ongoing permanent processes and structures? You want to think about developing a supportive infrastructure like a process of work groups or a structure of committees that will support the salient grant activities even after the grant funding is gone. You want to try to identify some policy levers to support the continuation of the program once the unique context of the grant has ended. You want to try to figure out how to connect the initiative to ongoing funding streams while you wean it off of reliance on the particular grant funding.
You want to think about how to maintain or expand stakeholder support as targeted grant funding goes away. You want to also be thinking about how to seed and cultivate the next generation of workforce that's going to be needed to maintain and advance the work that the grant has supported. In recent years, a lot of grant focus has turned to institutions of higher education colleges and universities, and even below that now into high school grades and grow your own initiatives very strategically, anticipating that we will need to develop a much broader and larger workforce in order to implement the necessary improved services and approaches. You also want to think about how to connect to an ongoing peer group or a community of practice. As the grant-related support goes away, that doesn't mean that you necessarily need to detach from grants who are working on similar efforts in other parts of your state or country.
That's a very helpful kind of a support to a grant leader. You want to be thinking about how to systematically collect data that will help you to inform continuous improvement activities. And you want to think about how to develop redundant expertise and staffing capacity so that the whole innovation will not disappear when the original project director leaves. Having co-directors, having co-chairs with staggered terms of governance groups and committees are one good way to build in that kind of redundancy and depth to maintain continuity while you're welcoming or orienting new blood all the time. So, to me, that describes the first level. Now, we can talk about taking it to the next level. To me, the next level talks about expanding, improving, and applying what works to new challenges.
So some of the advice that I would give to experienced leaders trying to take an initiative to the next level would be, one, consider opportunities to take your local success and apply it statewide and or across multiple service sectors within your state. A good innovation coming out of mental health or coming out of public education can then infect child welfare, can infect juvenile justice, and can spread and become more comprehensive through that kind of lateral expansion. You want to also think about how to support other innovators in other places by sharing your hard-won expertise generously and effectively. So some of the people that we get to interact with may be based in New York or Texas, but helping folks in Texas and Oklahoma just by sharing their experience.
Third is think about how to disseminate your successful strategies through publications, through online events, through conferences. Fourth consideration in taking things to the next level would be needing to continuously adapt to new priorities, new opportunities, new threats. So just think about in our lifetimes, things like 9/11, things like The Great Recession of 2008, 2009, what a profound impact they had in changing the landscape, and therefore, creating both new challenges but also, I would say, new opportunities. So being able to take something out of a static context and having it be flexible enough to succeed and adapt to a very dynamic context is part of what I think taking it to the next level requires.
And then finally, I would think about CQI, Continuous Quality Improvement for which subpopulations, which subpopulations is the success that we have demonstrated still not significant enough, not sufficient? Are there specific strategies that are needed to strengthen the positive impact for people who have been traditionally marginalized and disadvantaged, for example? Are there some people in our community who are still not gaining the full benefit? And what can we do to really refine our approaches, maybe increase the resource support to make sure that we can have comparable impacts and successes for everybody, not just for a mean average?

Brianna Cunniff: Great. Thank you, Frank. I know that sustainability piece is so important. It's something that I'm sure folks are continuously thinking about, but it's a lot harder to bring that to fruition. And so a lot of these tips are going to be helpful for people to be thinking about it early and often and to ensure that they can sustain their programs over time. So thank you. So what is something that you've learned from your technical assistance recipients that has stuck with you?

Frank Rider: Well, I think the single most important thing that I have learned from successful change agents through my technical assistance work is to try to integrate these discreetly granted initiatives into larger, more fundamental efforts across the community or across the state. So you want to figure out how to use the discreet grant opportunities to support and contribute to and improve those larger, more fundamental, and widely held visions than any single grant alone. I mentioned my work in Arizona with the J.K. Settlement, and I mentioned a grant in Pima County in Tucson. It was called Project MATCH, a SAMHSA grant that we were awarded, but that became one of the sources of support for our larger statewide implementation of the settlement agreement. We also, through our child welfare system in Arizona, at the same time, pursued a Title IV-E waiver that would help to support that larger vision of improving support for kids in the foster care system.
So those are just a couple of examples of how to identify and use the grant strategically to contribute to a greater hold and preferably a greater hold that predates the initial grant application and will persist long beyond it. So a couple of examples that I have seen besides my own experience. I used to work with several different communities in the State of Michigan, each of which had one individual grants from SAMHSA to create systems of care for children with mental health needs and their families. We would have large national meetings once or twice a year that these various grant teams from Grand Rapids, from Lansing, from Kalamazoo would all come together for a couple of days. What Michigan did on their own was to bring their four or five major local grantees together and to invite their state-level system leaders and their university colleagues all to those meetings to orchestrate their efforts together as a single whole.
I had the opportunity with AIR to work on a five-year program of Safe Schools/Healthy Students grants. There were seven states involved. Literally, the design of those grants from SAMHSA required not only a state-level plan but also three different local sort of laboratories within the state to pioneer and test unique approaches that would contribute to that same single statewide vision. Right now, I've been working with several school districts, one in Eureka City, California, that stands out to me. They are unifying their work on a mental health services professional grant, a school-based mental health grant from the Department of Education, a new wellness center that they have created, and they have housed them all within a single community school's vision. So those are a few concrete examples of the main point. Real substantial system change, I think, is more likely to come through such widely held overarching visions rather than ever being built around any single discreet grant.

Annie Knowles: Thank you so much, Frank. I think that a lot of your specific TA recipients will probably agree that your expertise and experience has helped them a lot. And now, through this episode, you can hopefully help a lot of other TA recipients or just grantees in the field with their grant journeys. And you're taking your own advice in terms of publicizing it, so you are practicing what you preach.
But yeah, we just want to thank you so much for sharing with us today. I think this episode will be really, really helpful to all the listeners and offer you space if you'd like to share any last-minute thoughts. And if not, we will just wrap up here and let you get back to your busy schedule.

Frank Rider: Well, thank you. I guess I will share one more thought, and that is, as I mentioned, I'm nearing the end of my career right now. I want to say what a pleasure it is. How lucky to be able to spend so much time working with people all across the country who took the initiative. They stood up among their peers and said, "We're going to take a chance here. We're going to take a risk. We don't have to do this. At our discretion, we are choosing to put ourselves out on that limb to see if we can make our corner of the world a little bit better."
Many of us don't get to choose all of the people that we work with. I have been really privileged to be able to work predominantly with people who share motivation to try to do something concrete every day to make the world a little bit better. So anybody who might aspire or consider the possibility of becoming a technical assistance provider specialist, I can't think of a better perk than every day to be able to interact with people who have self-selected to be the leaders of positive change.

Annie Knowles: And how lucky are they to have a technical assistance specialist like Frank.

Frank Rider: Thank you very much. Thanks for the opportunity to share some of what I have learned.

Annie Knowles: Of course. Thank you, Frank.
In Session is brought to you by the National Center on Safe Supportive Learning Environments or NCSSLE at the American Institutes for Research. This podcast is funded by the US Department of Education. If you'd like to learn more about NCSSLE, visit safesupportivelearning.ed.gov. For all questions or feedback, you can email us at [e-mail]. Thanks for listening. Please note, the contents of this podcast do not necessarily represent the policy or views of the US Department of Education, nor does it imply endorsement by the US Department of Education.