Transcript Interconnected Systems Framework

Interconnected Systems Framework
Local Implementation Sites
Experiences and Lessons Learned
Lucille Eber, Illinois PBIS Network
Jill Johnson, Illinois PBIS Network
Kelly Perales, Community Care Behavioral Health
Bob Stevens, Charleston South Carolina
Mark Weist, University of South Carolina
October 25, 2012
Center for School Mental Health
National Conference
Content for Today…
• How Multi-tiered Systems of Support
(MTSS) can enhance mental health in
schools
• Installing SMH through MTSS in Schools
• The Interconnected Systems Framework
(ISF)
Why We Need
MH Partnerships
• 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
• Suicide is 4th leading cause of death among
young adults
Why We Need
MH Partnerships (cont.)
• At least twice as many youth need high
levels of support than identified as EBD.
• Youth who are identified as EBD have
experienced very poor outcomes
• Schools can’t do it alone; partnerships
with communities are needed for success
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(NASDE) bringing together national-level
experts in the SMH and PBIS, state and district
leaders, and selected personnel from exemplar sites
currently implementing collaborative initiatives.
Advancing Education Effectiveness:
Interconnecting School Mental Health
& School-wide Positive Behavior Support (cont.)
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 Context
• Over 18,000 schools engaged in
implementation of SWPBIS (MTSS )
prevention based system
• Current focus on capacity to scale-up
• MTSS as platform to install effective
interventions for youth w/or at-risk of EBD
The Context (cont.)
• Emphasis now on scaling with expansion and
connection to other systems
– i.e. academic, juvenile justice, mental health
• Emphasis on deliberate actions that foster
connections w/families & community
“Expanded” School
Mental Health
• Full continuum of effective mental health promotion and
intervention for ALL students
• Reflecting a “shared agenda” involving school-family-community
partnerships
• Collaborating community professionals (augment the work of
school-employed staff
Positive Behavior Intervention and Support
(www.pbis.org)
• Decision making framework to guide selection
and implementation of best practices for
improving academic /behavioral functioning
• Data-based, measurable outcomes, evidencebased practices, systems to support effective
implementation
Core Features of a Response to
Intervention (RtI) Approach
• Investment in prevention, screening and early
intervention for students not at “benchmark”
• Multi-tiered intervention approach
• Use of progress monitoring and problem-solving
process at all 3-tiers
• Research-based practices and active use of data for
decision-making at all 3-tiers
• Use of progress monitoring and problem-solving
process at all 3-tiers
ISF Defined
– structure and process for education and mental health systems
to interact in most effective and efficient way.
– key stakeholders in education and mental health system who
have the authority to reallocate resources, change role and
function of staff, and change policy.
– strong interdisciplinary, cross-system collaboration.
– tiered prevention logic as the overall organizer to develop an
action plan.
– cross system problem solving teams that use data to decide
which evidence based practices to implement.
– ongoing progress monitoring for both fidelity and impact.
– active involvement by youth, families, and other school and
community stakeholders.
Structure for Developing an ISF:
A District/Community leadership that includes families,
develops, supports and monitors a plan that includes:
– Community partners participating in all three levels of
systems teaming in schools: 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 
New Approach
• Each school works
out their own plan
with Mental
Health (MH)
agency;
• District has a plan
for integrating MH
at all buildings
(based on
community data as
well as school data);
Old Approach 
New Approach
• A MH counselor
is housed in a
school building 1
day a week to
“see” students;
• MH person
participates in
teams at all 3 tiers;
Old Approach 
• No data to
decide on or
monitor
interventions;
New Approach
• MH person leads
group or individual
interventions based
on data;
SPARCS Integration
Jill Mathews-Johnson, MSW, LCSW
IL PBIS Network
[email protected]
Interconnected Systems Framework
Systems Features
•
•
•
•
•
Exploration and Adoption
Installation Phase
Initial Implementation
Full Implementation
Innovation and Sustainability
Fixsen, 2010
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 met to determine intervention to
meet needs and continued meeting every few weeks to set
up system features
– Secondary Systems Team was formed
Organizational Structures
Administrative
Team Centennial
HS &
Secondary Systems
Team
Liaisons
Jill & Juli
Community
Elements
(United Way/708
Board/ACCESS
Intervention - SPARCS
• SPARCS – Structured Psychotherapy for
Adolescents Responding to Chronic Stress
– Mission of SPARCS: To enhance trauma focused
services available to traumatized children and
adolescents (complex trauma)
– Group members – history of chronic interpersonal
trauma, living with significant ongoing stressors,
may or may not meet full criteria for PTSD and
exhibit functional impairment.
http://sparcstraining.com/
SPARCS
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Evidenced informed intervention
16-one hour groups
Adolescents 12-21
History of trauma (broadly defined)
Living with ongoing stressors
Exhibit functional impairment
Trauma Screening (TESI)
Interconnected Systems Framework
Systems Features
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•
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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
The Nuts and Bolts
– 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 Partner
Information Sheet
Interconnected Systems Framework
Systems Features
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•
•
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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
Data Systems
• School
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–
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–
–
–
ODRs
ISS
OSS
Credits/Grades
Attendance
Additional SASS calls (future)
• Mental Health
– Youth group survey results
– (2012-2013) Strengths and Difficulties Questionaire, TESI-R
and YOQ
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
Expansion
• Feeder middle school
• Other Champaign high school
• Alternative school (that Centennial refers out
to or receives students back from
• Additional sites in: Rantoul and Urbana
How Do We Get Things Started?
Embedding SPARCS in All Three Tiers
SPARCS
How Do We Get Change to Occur?
Lessons Learned
• Stakeholders
Decision
Makers
Field
Staff
Student
Outcomes
Administrators
Liaisons
• Liaisons who:
– understand both systems
– are open to integration
– have “power” in at least one system
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)
Student and family voice
Make interventions sustainable
– Funding
– Part of system of support
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)
– Systems of Care
– Integrated Children’s Service Planning
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© 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
– Partnership with oversight
– Stakeholder input
– Development of program description template
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© 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
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
• Jr High implementation
• SBBH and school collaboration – doing more
with less – reallocation of resources
• Fiscal and clinical responsibility
• Community connections and partners
– ICSP - SOC
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 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.
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
Key features
• Systems
– District and building teaming models
– Facilitation, technical assistance, coaching
– Stakeholder participation and buy-in
• Practices
– Mental health and school staff work in an integrated way to
support students across tiers
– Using assessment and screening in order to determine which
EBPs to use, progress monitor
– One plan for both education and mental health
• Data
– Shared decision rules
– Used for decision making with all stakeholders at the table – school,
mental health, other child serving systems, family
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 mom
would bring him into the school and the school staff
would literally have to peel Jason off of his mother and
hold him so she could leave.
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 own,
increasing his confidence and allowing him some relief
from his anxiety.
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
Lessons Learned
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Return on investment
Funding efficiency
Scaling and sustaining SBBH Teams – size
Community “politics”
SBMH Conference
October 2012
Bob Stevens, Charleston, SC
Charleston County, SC
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45,000 students in 78 schools.
Over 100 miles from the most distant schools
Rural, inner city, and suburban schools
Student Population: 46% African American; 46% Caucasian;
3% Mixed; Asian 2%; 1% Native Amer.; 1% other
14% Identify themselves as Latin or Hispanic
60% receive free or reduced meals
9.5% have IEP’s
6% not English proficient
Historically in CCSD schools; nurses, guidance counselors, a
few contracted mental health counselors, para-professional
behavior support staff; school psychologists not school
based.
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
80-90%
Tier 1/Universal Interventions
•All settings, 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
Old Mental Health Provider Job Description
• Provides services on IEP
• Maintains channels of communication with principals
and teachers
• Provides assistance in crisis situations
• Maintains communication with students, parents,
educational personnel, and community
• Provides and participates in in-service
• Conducts seminars for parents
• Other duties as assigned.
Newly Designed Job Description
•
•
•
•
•
•
Participate in building based activities that support the School Improvement Plan
Participate in Secondary and Tertiary intervention planning meetings
Participate in development and implementation of strategies and activities related
to PBIS
Use data to determine effectiveness of research based intervention (pre and post)
Use the three tiered approach to intervention planning to enter, progress monitor,
and exit youth from interventions (based on data)
Providing coaching and professional development for staff
Job Description (New, cont.)
• Provide conflict resolution training, drug and alcohol education, and
social skills training based on secondary or tertiary team
• Provide direct services to children in crisis
• Provide school social work services to children as determined in the
IEP process based on a continuum of preventative interventions
• Develop and maintain working relationships with students, parents,
educational personnel, and community
• Participate in the development of Tertiary interventions in the form of
FBA/BIP or wraparound teams
Common Trends
•
•
•
•
•
Moving from reactive to preventative
Time efficient and least restrictive
Moving from Tier 1 to leading Tier 2/3
Facilitating Tier 3 Interventions
Serving students needs vs. “labeled”
populations
• Systems approach
• Intervention vs. Referral to Professional
Developing Charleston’s Interconnected Systems Framework
Low Level
Communication between Providers
To
Collaboration with Providers
To
High level
Integration of Providers
Developing an Integrated Systems Framework
School-based Mental Health in Charleston SC
Developing an Integrated Systems Framework
School-based Mental Health in Charleston SC
Developing an Integrated Systems Framework
School-based Mental Health in Charleston SC
The Evolution in Charleston, SC
• Mental health counselors when supported by
Medicaid
• Part-time guidance in many schools which focused
primarily on academic counseling.
• Very limited number of social workers in the district
office working in the Office of Exceptional Children
supporting identified students
• School psychologists assigned to multiple schools
with “testing” as priority.
From 0 to 60 in two years
Expanded Mental Health
•
•
•
•
•
•
•
Federal Counseling Grant
Charleston Promise Neighborhood
Medical University of South Carolina
Climate Grant
Gear Up Grant
Allocation from General Operating Fund
Community In Schools Support
ISF
• SSW, MH, CIS developing new roles in CCSD
schools
• Integrating with current systems, creating new
systems
• Existing Teams – School Leadership
– PBIS
– TEAM Two
– CORE (Tier 3)
• External Partners
Use Data to Drive Activities
• Data that will lead to intervention before
referral
– At-Risk Alert System
– SWIS
– Social Emotional Measures
Intervention Vs. Referral
• ARAS (pronounced “air-us”) is the At-Risk Alert System: a
data tool developed by Charleston County School
District as part of a federal Safe Schools/Healthy
Students grant.
• Helps identify students potentially at-risk by using
existing academic & behavior data.
• Transforms data into reports to support effective
decision making.
• Provides composite views of magnitudes of risk
factors existing for students and schools.
• Supports a variety of student support models.
Risk Indicators
• ARAS uses student academic and behavior data
currently available in PowerSchool and other district
data bases as indicators to assess potential risk.
• For each of eight indicators, students are assigned to
one of three levels:
– Level 1 (Motivated/Low Risk)
– Level 2 (Vulnerable/Moderate Risk)
– Level 3 (Critical; High Risk)
Use Data to Monitor Practices
Tier
Three
Tier Two
Tier One
Academic
Social
Emotional
Mental
Health
Physical
What Services are Delivered
# of Services
180
160
140
120
100
80
60
40
20
0
Initially Focus on Tier One
# of Level 1 Services by Month
120
100
80
60
# of Services
40
20
0
PBIS Problem Solving Logic used by
CCSD for School-based Social Workers
1.
2.
3.
4.
Establish Ground Rules
Start with Data
Match Practices to Data
Align Resources to Implement Practices
Lewis, PBIS Missouri
Common Trends
From Illinois and Pennsylvania
adopted in Charleston, SC
•
•
•
•
•
Moving from reactive to preventative
Time efficient and least restrictive
Moving from Tier 1 to leading Tier 2/3
Facilitating Tier 3 Interventions
Serving students needs vs. “labeled”
populations
• Systems approach
• Intervention vs. Referral to Professional