Transcript Slide 1

PA Tertiary Demonstration
Project: Creating an
Interconnected Systems
Framework
May 18, 2011
Kelly Perales, LCSW
Jessica Leitzel, Principal
Frances Willard Elementary School, Scranton, PA
Erin Stewart, LCSW, MHP
SBBH Team, Montrose School District
© 2010 Community Care Behavioral Health
Why We Need MH/Community Partnerships
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One in 5 youth have a MH “condition”
About 70% of those get no treatment
School is “defacto” MH provider
JJ system is next level of system default
1-2% identified by schools as EBD
Those identified have poor outcomes
Suicide is 4th leading cause of death among
young adults
School-based Behavioral
Health Team Service (SBBH)
Accountable Clinical Home
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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 Service Components
CLINICAL
CASE
INTERVENTIONS
MANAGEMENT
CASE
CRISIS
INTERVENTION
CONSULTATION
AND TRAINING
for educational staff
SBBH Team Components
LICENSED
MASTER’S
PREP
CLINICIANS
(MHP)
EXPERIENCED
BACHELOR’S
PREP WORKERS
(BHW)
ADMIN AGENCY
SUPPORT
CONSULTATION
TO MHPS PRN
Community Care Support of
SBBH Teams
LEARNING
COLLABORA
TIVE
TRAINING
COACHING
MODEL
FIDELITY
TECHNICAL
ASSISTANCE
EVIDENCEBASED
PRACTICES
CARE
MANAGEMEN
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Montrose SBBH Team
Northwestern Human Services (NHS)
• 2 MHPs and 5 BHWs
– 1 MHP and 2.5 BHWs at Lathrop St. Elementary School
– 1 MHP and 2.5 BHWs at Choconut Valley Elementary
• Each “mini” team meets weekly with school staff to
ensure ongoing dialogue regarding services.
– Referrals of new youth
– Review of ongoing cases
– Discussion of collaboration between education and mental
health
• Collaboration with other child serving systems
Scranton SBBH Team(s)
Scranton Counseling Center (SCC)
Lourdesmont
• One team at Frances Willard and one team at George
Bancroft Elementary Schools provided by SCC with 2
MHPs and 5 BHWs each
• One team at Scranton High School provided by
Lourdesmont with 2 MHPs and 3 BHWs
• Each team meets weekly with school staff to ensure
ongoing dialogue regarding services.
– Referrals of new youth
– Review of ongoing cases
– Discussion of collaboration between education and mental
health
• Collaboration with other child serving systems
SWPBS Tertiary Demonstration Project
• Community Care as affiliated partner in the PA Positive
Behavior Support (PBS) Network
• Blending of School-Wide (SWPBS) and School Mental
Health
• Interconnected Systems Framework
School-Wide Systems for Student Success:
A Response to Intervention (RtI) Model
Academic Systems
Behavioral Systems
Tier 3/Tertiary Interventions
1-5%
1-5%
Tier 3/Tertiary Interventions
•Individual students
•Assessment-based
•High intensity
Tier 2/Secondary Interventions
•Individual students
•Assessment-based
•Intense, durable procedures
5-15%
5-15%
Tier 2/Secondary Interventions
•Some students (at-risk)
•High efficiency
•Rapid response
•Small group interventions
•Some individualizing
•Some students (at-risk)
•High efficiency
•Rapid response
•Small group interventions
• Some individualizing
Tier 1/Universal Interventions 80-90%
•All students
•Preventive, proactive
Illinois PBIS Network, Revised May 15, 2008.
Adapted from “What is school-wide PBS?”
OSEP Technical Assistance Center on Positive
Behavioral Interventions and Supports.
Accessed at http://pbis.org/schoolwide.htm
80-90%
Tier 1/Universal Interventions
•All settings, all students
•Preventive, proactive
Public Health & Disease Prevention
Kutash et al., 2006; Larson, 1994
• Tertiary (FEW)
– Reduce complications,
intensity, severity of current
cases
• Secondary (SOME)
– Reduce current cases of
problem behavior
• Primary (ALL)
– Reduce new cases of problem
behavior
Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal
School-Wide Assessment
School-Wide Prevention Systems
Tier 2/
Secondary
ODRs,
Attendance,
Tardies, Grades,
DIBELS, etc.
Check-in/
Check-out (CICO)
Social/Academic
Instructional Groups (SAIG)
Daily Progress
Report (DPR)
(Behavior and
Academic Goals)
Competing Behavior
Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Group Intervention with
Individualized Feature
(e.g., Check and Connect -CnC
and Mentoring)
Tier 3/
Tertiary
Brief Functional Behavior Assessment/
Behavior Intervention Planning (FBA/BIP)
Complex or Multiple-domain FBA/BIP
Illinois PBIS Network, Revised October 2009
Adapted from T. Scott, 2004
SIMEO Tools:
HSC-T, RD-T, EI-T
Wraparound
Continuum of Support for
Tier 2/Secondary-Tier 3/Tertiary Level Systems
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Small group interventions: Check-in Check-Out (CICO),
social/academic instructional groups (SAIG), tutor/homework clubs,
etc.
2.
Group interventions with individualized focus: Utilizing a unique
feature for an individual student, e.g. CICO individualized into a
Check & Connect (CnC), mentoring/tutoring, etc.
3.
Simple individual interventions: A simple individualized functionbased behavior support plan for a student focused on one specific
behavior, e.g. brief FBA/BIP-one behavior; curriculum adjustment;
schedule or other environmental adjustments, etc.
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Multiple-domain FBA/BIP: A complex function-based behavior
support plan across settings, e.g. FBA/BIP home and school and/or
community
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Wraparound: A more complex and comprehensive plan that
addresses multiple life domain issues across home, school and
community, e.g. basic needs, MH treatment, behavior/academic
interventions, as well as multiple behaviors
Illinois PBIS Network, Revised Sept., 2008
Interconnected Systems Framework for School Mental Health
Tier I: Universal/Prevention for All
Coordinated Systems, Data, Practices for Promoting Healthy Social
and Emotional Development for ALL Students
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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
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 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
Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a
Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters.
3-Tiered System of Support
Necessary Conversations (Teams)
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Secondary
Systems Team
Problem Solving
Team
Tertiary
Systems Team
Uses Process data;
determines overall
intervention
effectiveness
Standing team; uses
FBA/BIP process for
one youth at a time
Uses Process data;
determines overall
intervention
effectiveness
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
Sept. 1, 2009
FBA/
BIP
Complex
FBA/BIP
WRAP
Montrose School District
SWPBS Implementation
• District and Community Leadership Team established
• Tier One training and implementation at both elementary
schools
• Tier Two planning at both elementary schools
• Overview and Tier One training being planned for
seventh grade
• Tier Two and Three interventions being provided by
SBBH Team
Scranton School District
SWPBS Implementation
• District and Community Leadership Team established
• Tier One training and implementation at both elementary
schools and Scranton High School
• Tier Two training and implementation has begun at
Frances Willard. Tier Two planning at George Bancroft
and Scranton High still to come
• Tier Two and Three interventions being provided by
SBBH Team
Principal’s Perspective
• Summary of early successes and challenges
• Summary of data
– SWIS reports
– Impact on placement
– Academic Impact
• Plans for next year
Big 5 SWIS Data Report
Big 5 SWIS Data Report
Big 5 SWIS Data Report
Big 5 SWIS Data Report
Big 5 SWIS Data Report
Social Worker’s Standpoint
• Summary of experience with SBBH implementation thus
far – successes and challenges
• Blending of Mental Health with School-Wide – how is it
going?
• Data
– SDQs
– COS
• Plans for next year
The Smith Family
• Angelica was referred to the SBBH Team in November of
2009 due to a history of disruptive negative attention
seeking behaviors.
• Veronica, A’s mother, reported that she “has tantrums
and argues everyday about just about evertything –
snacks, clothing, if she does not get her way, she throws
a fit!”.
• School staff reported that A can be stubborn and she
often shuts down or withdraws particularly if she believes
that she is in trouble.
• Socially, she does not pick up on social cues, and
therefore inadvertently annoys her peers.
The Smith Family cont.
• Caroline, A’s sister, was referred to the SBBH Team in
October 2010 as a fourth grade student.
• She was referred due to behavioral concerns within the
family setting and needing significant adult interaction in
order to perform routine tasks. It was reported she had
limited social, emotional, and coping skills.
• Her teacher reported, “She often has a look of confusion
and rarely speaks up about anything. She is slacking in
social skills and self confidence. She is able to complete
her work, but does not.”
• In addition, C needed to learn coping skills to deal with
the death of a sibling.
The Smith Family cont.
• Interventions:
– Case management
• Coordination of community resources such as assistance with
medical supplies, transportation to adult therapy appointments, and
dental appointments for the family.
• Referrals for assistance with holiday meals, gifts, and financial
assistance for bills including telephone and electic.
– Educational support
• A. has been identified as needing learning support
• Social skill and peer relationship instruction
– Therapy
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Coping skills
Problem solving skills
Social and peer relation skills
For C. coping with grief and loss
Solve Problems
Shared Decisions
4/18/11
3/18/11
2/18/11
1/18/11
12/18/10
11/18/10
10/18/10
9/18/10
8/18/10
7/18/10
6/18/10
5/18/10
4/18/10
3/18/10
2/18/10
1/18/10
12/18/09
11/18/09
Level of Success
Child Outcomes Survey (COS) Family Functioning:
Child A
10
9
8
7
6
5
4
3
2
1
0
FAMILY
PEERS
SCHOOL
TASKS
Ave Inventory
4/18/11
3/18/11
2/18/11
1/18/11
12/18/10
11/18/10
10/18/10
9/18/10
8/18/10
7/18/10
6/18/10
5/18/10
4/18/10
3/18/10
2/18/10
1/18/10
12/18/09
11/18/09
Level of Success
Child Outcomes Survey (COS) Child Functioning and Therapeutic
Inventory: Child A
10
9
8
7
6
5
4
3
2
1
0
4/27/11
4/6/11
3/16/11
2/23/11
2/2/11
1/12/11
12/22/10
12/1/10
11/10/10
10/20/10
9/29/10
9/8/10
8/18/10
7/28/10
7/7/10
6/16/10
5/26/10
5/5/10
4/14/10
3/24/10
3/3/10
2/10/10
1/20/10
12/30/09
12/9/09
11/18/09
Days
Child Outcomes Survey (COS) Overall Wellness:
Child A
14
12
10
8
6
4
2
0
Child Outcomes Survey (COS) Family Functioning:
Child B
10
9
8
6
5
4
3
2
1
Solve Problems
Shared Decisions
4/21/11
3/21/11
2/21/11
1/21/11
12/21/10
11/21/10
0
10/21/10
Level of Success
7
Child Outcomes Survey (COS) Child Functioning and Therapeutic
Inventory: Child B
10
9
7
6
5
4
3
2
1
FAMILY
PEERS
SCHOOL
TASKS
ave inventory
4/21/11
3/21/11
2/21/11
1/21/11
12/21/10
11/21/10
0
10/21/10
Level of Success
8
Child Outcomes Survey (COS) Overall Wellness:
Child B
14
12
10
6
4
2
4/21/11
3/21/11
2/21/11
1/21/11
12/21/10
11/21/10
0
10/21/10
Days
8
Emotional Sympt
Conduct Probs
Hyperactivity
Peer Probs
1/18/11
12/18/10
11/18/10
10/18/10
9/18/10
8/18/10
7/18/10
6/18/10
5/18/10
4/18/10
3/18/10
2/18/10
1/18/10
12/18/09
11/18/09
Score
Strength and Difficulties-Parent Report: Child A
10
9
8
7
6
5
4
3
2
1
0
Strength and Difficulties-Parent Report: Child B
10
9
7
6
5
4
3
2
1
Emotional Sympt
Conduct Probs
Hyperactivity
4/1/11
3/1/11
2/1/11
1/1/11
12/1/10
0
11/1/10
Score
8
Peer Probs
Video clips
• Parent interviews
Questions?
Contact information:
Kelly Perales, LCSW
[email protected]
717-770-9365
Jessica Leitzel
[email protected]
570-348-3692
Erin Stewart, LSW
[email protected]
570-278-7300