Transcript Connecting School Mental Health and School

D11 - School Mental Health & PBIS
Integration: Implementation
Progress/Examples
Kelly Perales, Community Care Behavioral Health (PA)
Jill Johnson, Illinois PBIS Network
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
 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
Interconnected Systems Framework for School Mental Health
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
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
Illinois
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
Pathway to ISF
• Youth and Family Service Director and IL PBIS
TAC passion for ISF
– Relationship built four years earlier in writing a
SSHS grant in Urbana
• SAMSHA grant, Champaign County
• Local leaders and administrators belief in need
for integration to address all students’ needs
Systems Features
Exploration and Adoption
• At the building level
– Admin team was meeting weekly and looking at the data to determine
needs
• Gaps were identified – mental health
– Administrators, Community Elements Director for Youth Services and
PBIS TAC meet every 6-8 weeks together to set up system features
– Secondary Systems Team was formed
Systems Features cont…
• At community mental health agency level
– Wrote for additional funding from the local United Way to help
support the implementation of the EBP practice, SPARCS, in the
schools so as to relieve any financial burden on the school during the
implementation stages
• Key – Having a PBIS TAC and mental health leader work as liaisons
between the two systems, who believe in what is being done and work
through the hard issues that arise
Organizational Structures
Administrative
Team Centennial
HS &
Secondary Systems
Team
Liaisons
Jill & Juli
Community
Elements
(United Way/708
Board/ACCESS
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
Installation Phase
Systems Features
– Community mental health staff (Director and Program Coordinator)
with the assistance of the PBIS TAC set up meetings with key school
administrators (Principal, AP’s) to introduce SPARCS to them
• Follow-up meetings periodically to deal with larger system issues
– PowerPoint presentation of key program features presented to
admins, school social workers, school psychologist and counselors
• Shifting of school-based staff roles/responsibilities discussed
– Discussion of potential target population and how data would be used
to identify students
– Discussion on how referral process to community provider would
happen and who would communicate with student’s parents
– Referral form and program flyers developed for school staff to share
with parents
– One school contact person was identified for on-going communication
(mostly by email) and problem solving as issues arose
• This person was key as she was responsive and reliable
– Community Elements workers were added to secondary systems team
Organizational Structures
Identifying Students with Needs
• Data-based Decision Rules for Entrance
– At Centennial, students are referred for SPARCS
because they are freshman/freshman status and
• They have been through two tier two interventions and
have not responded
• They are READY (alternative school) students
transitioning back to Centennial**
• They have had multiple SASS contacts
• Meet criteria for trauma experience as screened using
the TESI-SR (Traumatic Events Screening Inventory-Self Report)
** READY, Juvenile Detention & MH providers also providing across the community
Organizational Structures
Funding
• SAMHSA SOC Cooperative Agreement
– ACCESS Initiative
• United Way of Champaign County
• Medicaid billing (future)
• Probation/Court Services (future
Organizational Structure
Assessing Personnel Skills/Talents
• Community Elements personnel hired
specifically to provide school-based supports
• School-based staff, with behavioral
background, are present during group
• SPARCS trained
– Ongoing support by national SPARCS trainers
Referral to Release Name to
Community Elements
Referral for SPARCS
Back of Referral
School-Community Parnter
Information Sheet
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
Initial Implementation
System Features
• Secondary Systems Team meetings
– Meeting twice a month
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to talk through systems response
to work through system implementation issues
to build rapport and building relationship
to communicate and implement with fidelity
• Liaisons that understand and can build
relationships between the two systems
Initial Implementation
Systems Features
– The school staff initiated the referrals to the program by first
identifying appropriate youth, contacting parents and receiving
permission to provide student’s name to community provider
– Community mental health staff completed all intake paperwork and
screenings with students/families and subsequent follow-up
information
– School staff made sure each student arrived to the group on time
– Community mental health works facilitated groups and one school
social worker sat in on the groups to assist with any issues as they may
be related to school policy and staying connected with the students
– School staff tracked data to report at year end
Outcomes
School Data – Office Discipline Referrals
ODR Comparison 14 Weeks Before Intervention and 14 Weeks on Intervention
10
9
8
37%
Reduction
Overall
Number of ODRs
7
6
23%↓
5
25%↓
ODR Total 14 Weeks Before Intervention
45%↓
4
ODR Total 14 Weeks On Intervention
3
2
66%↓
100%↑
1
0
Student 1
Student 2
Student 3
Students
Student 4
Student 5
Outcomes
School Data – In-School and Out-of-School Suspension
ISS and OSS 14 Weeks Before vs 14 Weeks During Intervention for
Group
25
Total Number
20
15
23%↓
Before
10
25% ↓
5
0
Total Number ISS
Total Number OSS
Offenses
After
Outcomes
School Data – Tardies and Absences
70
60
50
40
30
20
10
0
First Semester
Unexcused Tardies
Second Semester
Unexcused Tardies
Absences by Semester
Excused and Unexcused
Number
Number
Unexcused Tardies by
Semester
30
25
20
15
10
5
0
First Semester
Absences
Second Semester
Absences
Students
Students
Outcomes
School Data - Grades
Total Semester 1
Total Semester 2
A
B
C
D
F
Student 3 Grades by
Semester
Number
Grades
0
Total Semester 2
B
C
Grades
D
F
Number
Total Semester 2
A
B
C
D
F
Grades
Total Semester
1
5
Total Semester 1
A
Total Semester 1
10
Student 4 Grades by
Semester
5
4
3
2
1
0
4
3
2
1
0
A
B
C
D
Grades
F
Total Semester
2
Student 5 Grades by
Semester
Number
5
4
3
2
1
0
Student 2 Grades by
Semester
Number
Number
Student 1 Grades by
Semester
5
Total Semester
1
0
A
B
C
D
Grades
F
Total Semester
2
Staff Feedback
• Mental Health Providers
– Positives
• Being part of Tier II team helpful
• Having school staff facilitate arrival/departures from group very
helpful
– Future Improvements
• Need to improve communication with school staff when events
occur with students in group
• Having one dedicated administrator is essential to coordination
• Need more time prior to group start to get to know
students/families
Student Feedback
Student Survey Results
1=strongly agree 2=disagree 3= don’t know 4=agree 5=strongly agree
Skills were helpful to me:
a) Mindfulness
3.8
b) Self-sooth/distract 4.4
c) LET ‘M GO
4.0
d) MAKE A LINK
4.2
Have used skills outside
of group
4.4
Student Feedback Continued
• What was the best part of group?
“It helped me to make better choices and not get
into trouble”
“That you can talk about stress level and feelings”
“It allowed me to share”
“It helped me to identify my sources of anger”
“I liked that it had structure, that we had a lesson
plan that we followed and I liked the handbook”
“Food”
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
Future for Full Implementation
Goals for Integration
• Identify incoming freshman – service Summer 2012
• Potential for multiple groups next year at Centennial; feeder middle
school, other high school and alternative high school is also beginning
2012-2013SY
• Refine data decisions for appropriate ID of students
• Provide further teacher/staff training in SPARCS skills and develop plan for
further integration of skills
• Utilize students to co-lead group
• Build stronger parent engagement
• Build sustainability plan
• Universal screener – Spring 2013
• Professional development plan for all staff
How Do We Get Change to Occur?
Lessons Learned
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Schedule meetings with stakeholders
– Bi-monthly “Secondary Systems” meetings
– Monthly/Quarterly administrative meetings
• Allows all stakeholders to have voice
• Keeps communication lines open
Establish procedures and protocols
System where academic and behavior interventions linked
Create true partnerships
– Stakeholders need to be seen as viable members in both settings (team
membership, professional development)
Make interventions sustainable
– Funding
– Part of system of support
Pennsylvania
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
PAPBS Network
Tertiary Demonstration Project
• Community Care as affiliated partner in the PA
Positive Behavior Support (PBS) Network
• History of PA SBBH Community of Practice
• History of Community Care transformation of
children’s behavioral health services
Pennsylvania’s Community of Practice (CoP) on
School Based Behavioral Health (SBBH)
The CoP on SBBH was initially established in 2006 through the Bureau
of Special Education (BSE) as a means by which to address schoolbased behavioral health.
Presently, the CoP includes membership of approximately 52
individuals including representatives from the Pennsylvania
Departments of Education, Health, and Public Welfare in addition to
youth serving provider agencies, managed care organizations,
advocates, and youth and family members.
The Commonwealth of
Pennsylvania
• Local control for counties and school districts
• Behavioral health managed care organizations
– Carve out
– County choice
• Community Care
– Over half of the counties
– Oversight from stakeholders
• Office of Mental Health and Substance Abuse
Services (OMHSAS)
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– Systems of Care
© 2010 Community Care
Pennsylvania Mental Health
Continuum of Care
Inpatient
Residential Treatment Facility (RTF)
Individualized Residential Treatment (IRT)/TFC/CCR Host Home
Behavioral Health Rehabilitation
Services (BHRS)
Family Based Mental Health Services
(FBMHS)
Family Based Partial Hospital
School-Based Mental Health (SBMH)
Outpatient
Intensive Case Management/Resource Coordination (ICM/RC)
Crisis Services (Mobile Crisis, Emergency Room, and Walk-in Crisis Centers)
History of the Development of
School Based Behavioral Health (SBBH) Team Service
A Clinical Home Model
• Stakeholder input regarding current BHRS and
children’s service delivery
– Families
– Educators
– County partners – child serving systems
• Unique opportunity to partner with
Department of Welfare and OMHSAS
• Transformation of children’s services
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– Partnership with oversight
– Stakeholder input© 2010 Community Care
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
EXPERIENCED
LICENSED
MASTER’S PREP
CLINICIANS (MHP)
BACHELOR’S PREP
WORKERS (BHW)
ADMIN AGENCY
SUPPORT
CONSULTATION TO
MHPS PRN
Community Care Support of SBBH
Teams
LEARNING
COLLABORATIVE
TECHNICAL
ASSISTANCE
TRAINING
EVIDENCE-BASED
PRACTICES
COACHING
CARE
MANAGEMENT
MODEL FIDELITY
Learning Collaborative
A Community of Practice for Providers
• Training, case consultation, coaching –
stability of workforce, integrity of practices,
fidelity to model
• Platform –
– Family systems theory and interventions
– Resiliency/recovery principles and supports
– Trauma informed care
– Identification of co-occuring disorders
– Positive behavior interventions and supports
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© 2010 Community Care
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
District and Community Leadership
Team
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Quarterly meetings
Stakeholder representation – System of Care
Implementer’s blueprint
Systems, data and practices
Scaling and sustainability
Time Line
School Year
Activity
2008-09
•Community Care engaged district through ICSP regarding SBBH
Team
2009-10
•SBBH Team begins work within district – September 2009
•District and Community Leadership Team is established, district
commitment signed, tertiary demonstration project begins – spring
2010
2010-11
•Tier One SWPBIS is fully implemented with kickoff at the start of
the school year
•Tier Two training begins in the spring of 2011 with some
implementation
2011-12
•All three tiers are being implemented at both elementary schools
•Montrose Junior High receives Tier One training in fall, with “soft”
kickoff in January 2012
•Discussion of SBBH Team model expanding into Junior and Senior
High
Montrose Elementary Schools
K-6th Grade
Data
Practices
Tertiary, Tier 3, Individual
Child Outcomes Survey
Strengths and Difficulties Q.
Teacher feedback
Academic data
1-5%
5-10%
1-5%
5-10%
Tertiary, Tier 3, Individual
•Guidance counselors see
individual students
•SBBH Team
Secondary, Tier 2
Group/Individual
Secondary, Tier 2
Group/Individual
Data from Tier One team
Progress monitoring
Data decision rules
80-90%
80-90%
•Guidance counselors run
Targeted groups
•IST
•CICO
•mentoring
Universal, Tier 1
Whole School
Universal, Tier 1,
Whole school
ODRs, teacher nominations,
Card system, MMS,
•Guidance counselors teach
“I Can Problem Solve” lessons
•Treehab D and A awareness
•Bully prevention/Character Ed
•Peer Mediation
(lessons learned)
Scranton High School
School-Wide Systems for Student Success:
A Response to Intervention (RtI) Model:
Resources
Needs
Tier 3/Tertiary Interventions
Tier 2/Secondary Interventions
1-5%
5-15%
1-5%
5-15%
80-90%
Tier 1/Universal Interventions80-90%
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/school-wide.htm
Tier 3/Tertiary Interventions
•SBBH Team
•Outpatient therapy
•SB Partial
•Guidance – individual support
•SAVES/school aged mothers
Tier 2/Secondary Interventions
•SAP
•Guidance – groups
•Community Partners – groups
•Resource Officer
Tier 1/Universal Interventions
•SWPBIS
•Drug and Alcohol
Prevention
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation 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
The Smith Family
• Jason was referred to the SBBH Team in
November. He is a seven-year-old first grader
who was having difficulty coming to school
and being separated from his mother.
• When he was four, Jason and his family were
in a car accident in a rural area. The members
of the family were taken to different hospitals
and Jason did not know where his mom was
or if she was okay.
• Every day, since the first day of school, Jason’s
The Smith Family cont.
• Once referred to the team, they were
immediately able to work with Jason and his
family to create strategies to help him
separate more smoothly.
• Jason found the SBBH Team office/room a safe
place to be. His mother also spent time there
to help create a nice transition area.
• After the Holiday break, Jason began riding
the bus for the fist time, accompanied by one
of the BHWs from the team.
• Soon, Jason was able to ride the bus on his
Child Outcomes Survey (COS) Family Functioning:
Child X
10
9
7
6
5
4
3
2
1
Solve Problems
Shared Decisions
2/21/12
2/7/12
1/24/12
1/10/12
12/27/11
12/13/11
0
11/29/11
Level of Success
8
Child Outcomes Survey (COS) Child Functioning and
Therapeutic Inventory: Child X
10
9
8
6
5
4
3
2
1
TASKS
ave inventory
2/21/12
SCHOOL
2/7/12
PEERS
1/24/12
1/10/12
FAMILY
12/27/11
12/13/11
0
11/29/11
Level of Success
7
Child Outcomes Survey (COS) Overall Wellness:
Child X
14
12
10
6
4
2
2/21/12
2/7/12
1/24/12
1/10/12
12/27/11
12/13/11
0
11/29/11
Days
8
Strength and Difficulties-Parent Report: Child X
10.00
9.00
Subscale Score
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
11/1/11
Emotional Symptoms
Peer Problems
2/1/12
Conduct Problems
ProSocial
Hyperactivity
Strength and Difficulties-Teacher Report: Child X
10
9
Subscale Score
8
7
6
5
4
3
2
1
0
11/1/11
Emotional Symptoms
Peer Problems
2/1/12
Conduct Problems
ProSocial
Hyperactivity
Interconnected Systems
Framework Systems Features
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Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
Scranton School District
Year One
2009-10
Year Two
2010-11
Year Three
2011-12
Year Four
2012-13
Year Five
2013-14
Year Six
2014-15
District and Community Leadership Team established.
District commits to implementing SWPBIS with fidelity across the district.
SBBH Teams begin implementation at Frances Willard Elementary, George Bancroft Elementary, and Scranton High. A Tier Three support.
Frances Willard Elementary, George
Bancroft Elementary, and Scranton High
all receive training to implement Tier
One SWPBIS.
Frances Willard Elementary, George Bancroft Elementary, and Scranton High all implement Tier One SWPBIS.
Frances Willard Elementary reaches implementation fidelity.
Frances Willard Elementary receives training for implementation of Tier Two and
begins implementation.
Frances Willard Elementary implements three tiers of Interconnected Systems Framework.
Isaac Tripp Elementary, McNichols Plaza
Elementary, and South Scranton
Intermediate all receive training to
implement Tier One SWPBIS.
Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton
Intermediate all implement Tier One SWPBIS.
George Bancroft Elementary and Scranton High receive training for implementation of Tier Two and begin implementation
Scranton High receives training and begins implementation of RENEW.
SBBH Teams begin implementation at Northeast Intermediate, John F. Kennedy Elementary, McNichols Plaza Elementary, and
John G. Whittier Elementary.
John F. Kennedy Elementary, John G.
Whittier Elementary, and Northeast
Intermediate all receive training to
implement Tier One SWPBIS.
John F. Kennedy Elementary, John G.
Whittier Elementary, and Northeast
Intermediate all implement Tier One
SWPBIS.
Montrose
• Jr High implementation
• SBBH and school collaboration – doing more
with less – reallocation of resources
• Fiscal and clinical responsibility
• Community connections and partners
– ICSP - SOC