Transcript Quotes - Illinois Children`s Mental Health Partnership

Interconnecting School Mental Health
& School-wide Positive Behavior Support
Lucille Eber, IL PBIS Network
[email protected]
A Session presented at the
IL School Mental Health Conference:
Families, Schools, and Communities Working Together to
Improve Student Mental Health
June 26-27, 2012
Advancing Education Effectiveness:
Interconnecting School Mental Health
& School-wide Positive Behavior Support
June 2012 – September 2013
Collaborative effort of the OSEP TA Center of PBIS, Center for School Mental
Health, and IDEA Partnership bringing together national-level experts in the
areas of SMH and PBIS, state and district leaders, and selected personnel from
exemplar sites currently implementing collaborative initiatives to:
 Define the common goals of SMH and PBIS
 Discuss the advantages of interconnection
 Identify successful efforts to implement collaborative strategies and crossinitiative efforts
 Define the research, policy, and implementation agendas that are needed to
take current lessons learned to the next action level
 Publish a monograph that provides a summary and framework for
interconnection, documents examples of success, and lays out a research,
policy, and technical assistance agenda for the future
Today’s Session:
 The
Interconnected Systems Framework
(ISF) concept/paper (2009)
 A Developing Monograph on SMH/PBIS
Interconnection being produced by 3
national Centers
 Local examples
 Next Steps…
June 2012 – September 2013
Outcomes
Define the common goals of SMH and PBIS
Discuss the advantages of interconnection
Identify successful efforts to implement collaborative
strategies and cross-initiative efforts
Define the research, policy, and implementation agendas that
are needed to take current lessons learned to the next action
level
Publish a monograph that provides a summary and
framework for interconnection, documents examples of
success, and lays out a research, policy, and technical
assistance agenda for the future
The Developing Monograph….
National PBIS TA Center
www.pbis.org
Center for School Mental Health*
University of Maryland School of Medicine
http://csmh.umaryland.edu
*Supported by the Maternal and Child Health Bureau of HRSA
and numerous Maryland agencies
A National Community of Practice
(COP); www.sharedwork.org
 CSMH
and IDEA Partnership
(www.ideapartnership.org) providing
support
 30 professional organizations and 16
states
 12 practice groups
 Providing mutual support, opportunities for
dialogue and collaboration
 Advancing multiscale learning
Application
 Implementation

Science
Intervention v. Implementation
 Tiered
 CoP
Framework
Chapter Outline
Preface: Al Duchnowski
Chapter 1: Introductory Chapter
Mark Weist, Joanne Cashman, Susan Barrett, Lucille Eber
Chapter 2: PBIS School Mental Health Implementation
Framework
George Sugai and Sharon Stephan
Chapter Outline: Break Outs
Chapter 3: School Level Systems
Nancy Lever and Bob Putnam
Jill Johnson, Susan Alborell, Deanna Aister (IL)
Jennifer Parmalee (NY)
Chapter 4: School level Practices
Steve Evans, Brandi Simonsen, Ginny Dolan
Pam Horn, Juli Kartel (IL) jessica Leitzel (PA)
Chapter 5: School Level Data
Dan Maggin and Carrie Mills
Kelly Perales (PA) Michele Capio (IL) Helen Mae Newcomer (PA)
Chapter Outline: Break Outs
Chapter 6: Advancing the ISF in Districts/Communities
Rob Horner, Mark Sander
Bob Stephens (SC), Kathy Lane (MD), Mark Vinciquerra (NY)
Jeanne Davis (IL)
Chapter 7: Advancing the ISF in states
Carl Paternite , Erin Butts
Carol Ewen (MT) Jim Palmiero (PA) Sheri Leucking (IL)
Chapter Outline
Chapter 8: Federal Investment in SWPBIS and SMH
Renee Bradley, OSEP, Joanne Cashman, NASDE, and Trina Anglin,
MCHB
Chapter 9: Building Policy Support for SWPBIS and SMH
Joanne Cashman, NASDE, Consider reaching out to school-based
professional organizations as part of this – NASP, ASHA, SSWA,
and policy specialists
Chapter 10: Commentaries on ISF and important
directions for its advancement (Policy, Research,
messages for federal level staff)
Marc Atkins, University of Illinois
Kimberly Hoagwood, Columbia University
Krista Kutash, University of South Florida
ISF Monograph Next Steps
 Chapter
drafts developed (June-Jan)
 Solicit additional exemplars for appendix
from advisory group (July-Oct)
 Share drafts with Advisory group (Feb?)
 Next webinar with Advisory Group
(March?)
 Complete Monograph (September 2013?)
A Quick History…
Interconnected Systems
Framework paper
(Barrett, Eber and Weist , revised 2011)
Developed through a collaboration of the
National SMH and National PBIS Centers
www.pbis.org http://csmh.umaryland.edu
And Lisa Betz, The IL Department of Human Services, Division of Mental health
“Expanded” School Mental Health
 Full
continuum of effective mental health
promotion and intervention for students in
general and special education
 Reflecting a “shared agenda” involving
school-family-community system
partnerships
 Collaborating community professionals
(not outsiders) augment the work of
school-employed staff
Positive Behavior Intervention
and Support (www.pbis.org)

In 16,000 plus schools
 Decision making framework to guide selection
and implementation of best practices for
improving academic and behavioral functioning




Data based decision making
Measurable outcomes
Evidence-based practices
Systems to support effective implementation
ISF: Key Emphases





Developing interdisciplinary and cross-system
relationships moving toward real collaboration
Strong stakeholder and especially family and
youth engagement
“Achievable” use of evidence-based practices
Data-based decision making
Focus on valued outcomes and continuous
quality improvement of all processes
SMH and PBIS Framework
Intensive Intervention
1-5%
Targeted Individual, Group,
Family Intervention
5-15%
Selective Prevention
All Students
Universal Prevention
Relationship Development
Systems for Positive Behavior
Diverse Stakeholder Involvement
Climate Enhancement
Stages of Implementation
Implementation occurs in stages:
 Exploration/Adoption
 Installation
 Initial
Implementation
 Full Implementation
 Innovation
 Sustainability
Fixsen, Naoom, Blase, Friedman, & Wallace, 2005
2 – 4 Years
ISF, Building From 4 Stages of
Implementation
 EXPLORATION (e.g., identifying and organizing
the most useful tools, conducting needs assessments
and resource mapping)
 INSTALLATION (e.g., developing interdisciplinary
and cross system teams, identifying challenges and
ways to overcome challenges to effective team
functioning)
 INITIAL
IMPLEMENTATION
 IMPLEMENTATION
ISF, School Readiness
Assessment
1) High status leadership and team with active
administrator participation
2) School improvement priority on
social/emotional/behavioral health for all students
3) Investment in prevention
4) Active data-based decision making
5) Commitment to SMH-PBIS integration
6) Stable staffing and appropriate resource
allocation
ISF, Indicators of Team
Functioning
 Strong
leadership
 Good meeting attendance, agendas and
meeting management
 Opportunities for all to participate
 Taking and maintaining of notes and the
sense of history playing out
 Clear action planning
 Systematic follow-up on action planning
Interconnected Systems Framework for School Mental Health
Tier 3: Intensive Interventions for Few
Individual Student and Family Supports
 Systems Planning team coordinates decision rules/referrals for this level of service and
progress monitors
 Individual team developed to support each student
 Individual plans may have array of interventions/services
 Plans can range from one to multiple life domains
 System in place for each team to monitor student progress
Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification,
and Response to Mental Health Concerns
 Systems Planning Team identified to coordinate referral process, decision rules and progress
monitor impact of intervention
Array of services available
Communication system for staff, families and community
Early identification of students who may be at risk for mental health concerns due
to specific risk factors
Skill-building at the individual and groups level as well as support groups
 Staff and Family training to support skill development across settings
Tier I: Universal/Prevention for All
Coordinated Systems, Data, Practices for Promoting Healthy Social
and Emotional Development for ALL Students






School Improvement team gives priority to social and emotional health
Mental Health skill development for students, staff, families and communities
Social Emotional Learning curricula for all students
Safe & caring learning environments
Partnerships between school, home and the community
Decision making framework used to guide and implement best practices that
consider unique strengths and challenges of each school community
Structure for Developing an ISF:
Community Partners Roles in Teams
A District/Community leadership that includes families,
develops, supports and monitors a plan that includes:
 Community partners participate in all three levels of
systems teaming: Universal, Secondary, and Tertiary

Team of SFC partners review data and design
interventions that are evidence-based and can be
progress monitored

MH providers from both school and community develop,
facilitate, coordinate and monitor all interventions
through one structure
Old Approach 




Each school works out
their own plan with
Mental Health (MH)
agency;
A MH counselor is
housed in a school
building 1 day a week to
“see” students;
No data to decide on or
monitor interventions;
“Hoping” that
interventions are working;
but not sure.
New Approach




District has a plan for
integrating MH at all
buildings (based on
community data as well
as school data);
MH person participates in
teams at all 3 tiers;
MH person leads group
or individual interventions
based on data;
For example, MH person
leads or co-facilitates
small groups, FBA/BIPs
or wrap teams for
students.
Pause for:
Feedback from Participants:
Before we move to examples, do
you have comments/observations
about the proposed framework for
the ISF you would like to share?
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT
~5%
~15%
Primary Prevention:
School-/ClassroomWide Systems for
All Students,
Staff, & Settings
~80% of Students
Tertiary Prevention:
Specialized
Individualized
Systems for Students
with High-Risk Behavior
Secondary Prevention:
Specialized Group
Systems for Students
with At-Risk Behavior
Tier 1 - Universal

Interventions that target the entire population of a school to promote
and enhance wellness by increasing pro-social behaviors, emotional
wellbeing, skill development, and mental health

This includes school-wide programs that foster safe and caring
learning environments that, engage students, are culturally aware,
promote social and emotional learning and develop a connection
between school, home, and community

Data review should guide the design of Tier 1 strategies such that 8090% of the students are expected to experience success, decreasing
dependence on Tier II or III interventions

The content of Tier 1/Universal approaches should reflect the specific
needs of the school population

For example, cognitive behavioral instruction on anger management
techniques may be part of a school-wide strategy delivered to the
whole population in one school, while it may be considered a Tier 2
intervention, only provided for some students, in another school
Example: Community Clinicians
Augment Strategies

A school located near an Army base had a disproportionate
number of students who had multiple school placements due to
frequent moves, students living with one parent and students who
were anxious about parents as soldiers stationed away from home

These students collectively received a higher rate of office
discipline referrals than other students

The school partnered with mental health staff from the local Army
installation, who had developed a program to provide teachers
specific skills to address the particular needs students from
military families

Teachers were able to generalize those skills to other at risk
populations

As a result, office discipline referrals decreased most significantly
for those students originally identified as at risk but also for the
student body as a whole
Tier 2 - Secondary

Interventions at Tier 2 are scaled-up versions of Tier 1 supports for particular
targeted approaches to meet the needs of the roughly 10-15% of students who
require more than Tier 1 supports

Typically, this would include interventions that occur early after the onset of an
identified concern, as well as target individual students or subgroups of
students whose risk of developing mental health concerns is higher than
average

Risk factors do not necessarily indicate poor outcomes, but rather refer to
statistical predictors that have a theoretical and empirical base, and may
solidify a pathway that becomes increasingly difficult to shape towards positive
outcomes

Examples include loss of a parent or loved one, or frequent moves resulting in
multiple school placements or exposure to violence and trauma

Interventions are implemented through the use of a comprehensive
developmental approach that is collaborative, culturally sensitive and geared
towards skill development and/or increasing protective factors for students and
their families
Agency/School Collaboration:
A Real Example

Middle schools SWIS data indicated an increase in
aggression/fighting between girls

Community agency had staff trained in the intervention
Aggression Replacement Training (ART) and available to lead
groups in school

This evidence-based intervention is designed to teach
adolescents to understand and replace aggression and
antisocial behavior with positive alternatives. The program's
three-part approach includes training in Prosocial Skills,
Anger Control, and Moral Reasoning

Agency staff worked for nine weeks with students for 6 hours
a week; group leaders did not communicate with school staff
during implementation
Agency/School Collaboration Example
(cont)

SWIS Referrals for the girls dropped significantly during group

At close of group there was not a plan for transference of skills (i.e.
notifying staff of what behavior to teach/prompt/reinforce)

There was an increase in referrals following the group ending

Secondary Systems team reviewed data and regrouped by
meeting with ART staff to learn more about what they could do to
continue the work started with the intervention

To effect transference and generalization, the team pulled same
students into groups lead by school staff with similar direct
behavior instruction

Links back to Universal teaching of expectations (Tier 1) is now a
component of all SS groups (Tier 2)
Tier 3 - Tertiary

Interventions for the roughly 1-5% of individuals who are identified
as having the most severe, chronic, or pervasive concerns that
may or may not meet diagnostic criteria

Interventions are implemented through the use of a highly
individualized, comprehensive and developmental approach that
uses a collaborative teaming process in the implementation of
culturally aware interventions that reduce risk factors and increase
the protective factors of students

Typical Tier 3 examples in schools include complex functionbased behavior support plans that address problem behavior at
home and school, evidence-based individual and family
intervention, and comprehensive wraparound plans that include
natural support persons and other community systems to address
needs and promote enhanced functioning in multiple life domains
of the student and family
Next Steps to Consider in Moving
Towards A More Blended System
• Repositioning Existing Personnel in New Roles
• Developing RtI Structures in Schools
(teaming model for decision making/data
review)
• Developing District/Community Teaming Models
• Specific Steps to Expedite Improved
Quality of Life for our Older Youth…
Social Worker/School Psychologist
Discussion of Role Changes
Questions raised by
Current Model

What data /criteria are used for
determining support services?

What data /criteria are used for
monitoring student progress?

What data /criteria are used for
determining whether student
are prepared for exiting or
transitioning from support
services?
Specifics Provided by
Innovation

Review ODRs, CICO, grades,
attendance, parent/teacher
concerns

We model, reinforce, practice
skills we want students to
obtain (rate skill attainment)

Review ODRs, CICO, grades,
attendance, parent/teacher
concerns
Social Worker/School Psychologist
Discussion of Role Changes
Current Model
Proposed Changes

Testing for special
education eligibility

Facilitate team based
brief FBA/BIP meetings

Referrals for support
services not based on
specific data

Act as a communication
liaison for secondary /
tertiary teams

Facilitate individual/family
support plan meetings
Team Structure for Core
District/Community Leadership Team
District/
Community
Leadership
Team
Integration
Workgroup
SEL, RtI, PBIS,
Mental Health,
SSHS grant
Data
Assessment
Workgroup
Tier 3/Tertiary
Workgroup
Transitions:
JJ, Hospitals,
From school to
school
Possible Tasks/Functions of
Core Leadership Team:







Developing a three tiered support network that
integrates schools and communities
Review data for community and school planning
Develop a consistent mission for mental
wellness for all youth
Address re-positioning staff for more integrated
support systems
Assess how resources can be used differently
Creating integrated system, procedures and
protocols
Community and District resource mapping
Community Partners
Roles in Teams
 Participate
in all three levels of systems
teaming: Universal, Secondary, and
Tertiary
 Facilitate or co-facilitate tertiary teams
around individual students
 Facilitate or co-facilitate small groups with
youth who have been identified in need of
additional supports
Example: Systems Collaboration
and Cost Savings

A local high school established a mental health team that included a board
coalition of mental health providers from the community

Having a large provider pool increased the possibility of providers being
able to address the specific needs that the team identified using data,
particularly as those needs shifted over time

In one case, students involved with the Juvenile Justice System were
mandated to attend an evidence-based aggression management
intervention

The intervention was offered at school during lunch and the school could
refer other students who were not mandated by the court system, saving
both the school and the court system time and resources and assuring that
a broader base of students were able to access a needed service

As a result of their efforts, the school mental heath team was able to reintegrate over ten students who were attending an off site school, at a cost
savings of over $100,000
pause for
Feedback from Participants:
Have you observed/experienced
Examples of or movement
towards more integrated mental
health through structures/systems
in schools?
A quick examples of proposed exemplar for
the developing manual….
Family and Community
Involvement in District-Wide
Implementation of SWPBIS: A
Panel Discussion
Montrose Area School District
NHS Human Services of N.E. PA
Penn State University
Community Care Behavioral Health
Family and Community
Involvement in DistrictWide Implementation of
SWPBIS: A Panel Discussion
Montrose Area School District
NHS Human Services of N.E. PA
Penn State University
Community Care Behavioral Health
May 23, 2012
PA PBS Implementer’s Forum
Jan Cohen – Penn State Extension/Integrated
Children’s Services Planning
 Mike Ognosky, Chris McComb, and Greg Adams
– Montrose Area School District
 Michael Lynch and Erin Stewart, NHS Human
Services
 Judy Ochse – Family Member/School Nurse
MASD
 Kelly Perales – Community Care Behavioral
Health

What is ICSP?
1.
2.
3.
Family Resiliency Educator - Cost-shared position between
Penn State Extension and Susq. Co. Children & Youth.
Responsibilities include Integrated Children’s Services
Planning, parenting education, and other
prevention/education efforts.
ICSP Leadership Team – Comprised of parents, community
volunteers, and directors/leaders from county offices and
agencies/organizations, whose role it is to oversee all ICSP
work, create sub-committees/work groups, and
create/implement the ICSP Plan. Members include: CYS,
JPO, NHS, Trehab, MHMR, County Assistance Office,
Community Care, CARES/LEARN Team, Big Brothers Big
Sisters, PA Treatment & Healing, and School Districts
ICSP Sub-Committees/Work Groups – Needs Assessment,
Health Insurance Access/Health Services, Human Services
Resource Directory, Coalition of Parent Educators and
Mental Health Outreach and Services
School Based Behavioral Health
(SBBH) Journey
 District
and families participate in
evaluation committee
 Communication and collaboration among
all stakeholder groups
 Ongoing opportunities for feedback
 Unique features of rural implementation
Accountable Clinical Home







Accountable TO the family and FOR the care
Accessible, coordinated, and integrated care
Comprehensive service approach
Increased accountability and communication
Single point of contact for behavioral health
School is “launching pad” for services delivered
in all settings
Youth continue on the team with varying intensity
of service
SBBH Team Components
LICENSED
MASTER’S
PREP
CLINICIANS
(MHP)
EXPERIENCED
BACHELOR’S
PREP WORKERS
(BHW)
ADMIN AGENCY
SUPPORT
CONSULTATION
TO MHPS PRN
SBBH Service Components
CLINICAL
CASE
INTERVENTIONS
MANAGEMENT
CASE
CRISIS
INTERVENTION
CONSULTATION
AND TRAINING
for educational staff
District and Community Leadership
Team
 Quarterly
meetings
 Stakeholder representation
 Implementer’s blueprint
 Systems, data and practices
 Scaling and sustainability
Outcomes
Change in Family Functioning
1.8
1.6
1.4
1.2
1.0
Improving
0.8
0.6
0.4
0.2
0.0
Change at 3 mos
Not Implementing
Change at 6 mos
Low Fidelity
Change at 9 mos
High Fidelity
Outcomes
Change in Child Functioning
1.8
1.6
1.4
1.2
1.0
Improving
0.8
0.6
0.4
0.2
0.0
Change at 3 mos
Not Implementing
Change at 6 mos
Low Fidelity
Change at 9 mos
High Fidelity
Outcomes – SDQ-P
Change in Difficulties Score
1.0
0.5
0.0
Improving
-0.5
Change Q1
Change Q2
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
Not Implementing
Low Fidelity
High Fidelity
Outcomes – SDQ-T
Change in Difficulties Score
1.0
0.5
0.0
Improving
-0.5
Change Q1
Change Q2
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
-4.0
Not Implementing
Low Fidelity
High Fidelity
Feedback from Participants:
Suggestion/feedback for the
process and/or developing
monograph?
[email protected]