Transcript Intro webinar for ISF operational definitions for the field

The Interconnected Systems Framework:
School Mental Health within a Multi-Tiered System
of Behavioral Supports in Schools
The Wisconsin PBIS Conference
August 20-21, 2013
Lucille Eber, IL PBIS Network
National PBIS TA Center
acknowledgements
Susan Barrett, Sheppard-Pratt Health systems, Baltimore MD
Kelly Peralis, Community Care Behavioral Health, Pittsburg, PA
Mark Wiest, University of South Carolina
Jill Johnson, IL PBIS Network
PBIS: Equity in Education
Making Education Work for All
2013 National PBIS Leadership Forum
|
October 10-11, 2013
| Donald E. Stephens Convention Center
|
Rosemont, Illinois
School Mental Health Strand:
•
•
•
•
Integrating SMH & PBIS: Examples at All 3 Tiers
Integrating SMH & PBIS: Using Data
Integrating SMH & PBIS: Selecting Evidence-based Practices
Interconnected Systems Framework Monograph: Lessons from
the Field
• Implementing an Interconnected System Framework in an
Urban School System
• Integrating SMH & PBIS at the State Level
• The Changing Role of School-based Clinicians
Content:
• Describe the features of an Interconnected
Systems Framework (ISF) for Integrating
Mental Health in Schools
• Describe efforts and resources from blended
efforts of National Centers to promote a
broader continuum of evidence-based
practices to support the mental health of all
students
• Describe emerging examples of ISF
BIG Ideas…
• How Multi-tiered Systems of Support (MTSS)
can enhance mental health in schools
• Installing SMH through MTSS in Schools
• The Interconnected Systems Framework (ISF)
SMH +MTSS=ISF
History-Rationale
• Sparse availability of MH providers in schools
• Labels and ‘places’ confused with
interventions
• Separate delivery systems (Sp.Ed., Mental
health, etc)
• Minimal accountability for outcomes for most
vulnerable populations
Why Partnership Are Needed
• 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
SMH and PBIS
Common Purpose
• Schools supporting/promoting MH of ALL
students
• Prevention, early access, interventions
commensurate with level of need (vs label)
• School personnel feel confident and
competent in identifying and intervening with
accuracy and effectiveness
Logic
– Youth with MH needs require multifaceted
education/behavior and mental health supports
– The usual systems have not routinely provided a
comprehensive, blended system of support.
– Supports need to be provided in a clustered and
integrated structure,
– Academic/behavior and mental health supports
need to be efficiently blended
Promotion and Prevention
Simple and complex supports require integrated
systems with foundation of a school-wide system
• Schools and community serve as protective factor
• problem-solving teams with
school/family/youth/community voice
• use of data for decision-making (screening/ selection
and monitoring/outcomes)
• layers supports from the foundational/universal to the
more complex
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
•Intense, durable procedures
•Individual students
•Assessment-based
•High intensity
Tier 2/Secondary Interventions
5-15%
•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
5-15%
Tier 2/Secondary Interventions
•Some students (at-risk)
•High efficiency
•Rapid response
•Small group interventions
•Some individualizing
80-90%
Tier 1/Universal Interventions
•All settings, all students
•Preventive, proactive
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT:
What is meant by
“layering”
interventions?
~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
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 problemsolving process at all 3-tiers
Core Features of a Response to
Intervention (RtI) Approach
• Research-based practices and active use
of data for decision-making at all 3-tiers
• Use of progress monitoring and problemsolving process at all 3-tiers
3-Tiered System of Support
Necessary Conversations (Teams)
Universal
Team
Meeting
Plans
schoolwide &
classroom
supports
Universal
Support
Secondary
Systems Team
Meeting
Uses process data;
determines overall
intervention
effectiveness
Problem Solving
Team Meeting
Tertiary Systems
Team Meeting
Standing team; uses
FBA/BIP process for
one student at a time
Uses process data;
determines overall
intervention
effectiveness
Check-In
Check-Out
Skills
Groups
Group w.
individual
feature
Brief
Complex
Wraparound
FBA/BIP
FBA/BIP
Brief
FBA/BIP
Rev. 11.19.2012
Illinois PBIS Network
Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal
School-Wide Assessment
School-Wide Prevention Systems
ODRs,
Attendance,
Tardies, Grades,
DIBELS, etc.
Tier 2/
Secondary
Check-in
Check-out (CICO)
Social/Academic
Instructional Groups (SAIG)
Daily Progress
Report (DPR)
Group Intervention with
Individualized Feature
(e.g., Check and Connect - CnC
and Mentoring)
(Behavior and Academic Goals)
Competing Behavior
Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Tier 3/
Tertiary
Individual Student
Information System (ISIS)
SIMEO Tools:
HSC-T, RD-T, EI-T
Brief Functional Behavior Assessment/
Behavior Intervention Planning (FBA/BIP)
Complex or Multiple-domain FBA/BIP
Wraparound
Illinois PBIS Network, Revised October 2009
Adapted from T. Scott, 2004
Definition of school mental health
•Involves partnership between schools and
community health/mental health organizations, as
guided by families and youth
•Builds on existing school programs, services, and
strategies
•Focuses on all students, both general and special
education
•Involves a full array of programs, services, and
strategies- mental health education and promotion
through intensive intervention
(Weist & Paternite, 2006)
“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
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, child welfare,
systems of care
• Emphasis on deliberate actions that foster
connections w/families & community
Development of ISF
• 2002-2007: Site Development with PBIS Expansion
(informal and independent)
• 2005 CoP focus on integration of PBIS and SMH
• 2008: ISF White Paper: formal partnership between
PBIS and SMH
• 2009- 2013 Monthly calls with implementation sites,
national presentations (from sessions to strands)
• 2009-2011 Grant Submissions
• June 2012- September 2013 ISF Monograph
• Monograph Advisory group
Interconnected Systems Framework
paper
(Barrett, Eber and Weist , revised 2009)
Developed through a collaboration of the
National SMH and National PBIS Centers
www.pbis.org
www.pbis.org http://csmh.umaryland.edu
ISF Monograph Development
June 2012 – September 2013
• Define the common goals of SMH and PBIS
• Discuss the advantages of interconnection
• Identify successful local efforts to implement
collaborative strategies and cross-initiative efforts
• Define the research, policy, and implementation
agendas to take us to the next action level
ISF Defined
– ISF provides structure and process for education and mental
health systems to interact in most effective and efficient way.
– ISF is guided by key stakeholders in education and mental health
system who have the authority to reallocate resources, change
role and function of staff, and change policy.
– ISF applies strong interdisciplinary, cross-system collaboration.
ISF Defined
– ISF uses the tiered prevention logic as the overall
organizer to develop an action plan.
– ISF involves cross system problem solving teams that
use data to decide which evidence based practices to
implement.
ISF Defined (cont)
– ISF involves ongoing progress monitoring for both fidelity and
impact.
– ISF emphasizes active involvement by youth, families, and
other school and community stakeholders.
Interconnected Systems Framework
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
 Safe & caring learning environments
 Partnerships : school, home & community
 Decision making framework guides use of
and best practices that consider unique
strengths and challenges of each school
community
MH/PBIS: An Expanded Tier One
• Universal screening for social, emotional, and behavioral atrisk indicators
• Universal screening for families who may request assistance
for their children
• Teaching social skills with evidence-based curricula to all
students
• Teaching appropriate emotional regulation and expression
to all students
• Teaching behavioral expectations to all students
• Mental health professionals are part of the Tier 1 systems
team, providing input and progress monitoring data
• Opportunity to review community data and expand Tier 1
intervention options based on data
Interconnected Systems Framework
Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification,
and Response to Mental Health Concerns
 Systems Planning Team coordinates referral
process, decision rules and progress monitors
 Array of services available
 Communication system: staff, families and
community
 Early identification of students 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
MH/PBIS: An Expanded Tier Two
• Mental health/community professionals part of
secondary systems and problem solving teams
• Working smarter matrix completed to ensure key
resources are both efficient and effective (i.e., initiatives
are aligned and combined such as “bully prevention”,
“discipline”, “character education”, “RtI behavior”, etc.)
• Groups co-facilitated by school staff and community
partner (example – guidance counselor and community
provider clinician)
• Opportunity to expand the continuum of interventions
based on data (i.e. trauma informed interventions)
• Out-reach to families for support/interventions
Interconnected Systems Framework
Tier 3: Intensive Interventions for Few
Individual Student and Family Supports
 Systems Planning team
coordinates decision
rules/referrals and progress
monitors
 Individual team developed to
support each student
 Individual plans have array of
interventions/services
 Plans can range from one to
multiple life domains
 System in place for each team
to monitor student progress
MH/PBIS: An Expanded Tier Three
• Mental health professional(s) part of tertiary
systems team
• FBA/BIP and/or person-Centered Wraparound
plans completed together with school staff
and mental health provider for one concise
plan, rather than each completing paperwork
to be filed
• Quicker access to community-based supports
for students and families
Traditional
• Each school works
out their own plan
with Mental
Health (MH)
agency;
 Preferred
• District has a plan
for integrating MH
at all buildings
(based on
community data as
well as school data);
Traditional
• A MH counselor
is housed in a
school building 1
day a week to
“see” students;
 Preferred
• MH person
participates in
teams at all 3 tiers;
Traditional
• No data to
decide on or
monitor
interventions;
 Preferred
• MH person leads
group or individual
interventions based
on data;
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 in the building:
Universal, Secondary, and Tertiary
Structure for Developing an ISF:
Community Partners Roles in Teams (cont.)
• Team of SFC partners review data and design
interventions that are evidence-based and can
be progress monitored
• MH providers from both school & community
develop, facilitate, coordinate and monitor all
interventions through one structure
3-Tiered System of Support Necessary Conversations
Family and
community
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Family and
community
Community
Secondary
Systems Team
Problem Solving
Team
Uses Process data;
determines overall
intervention
effectiveness
Standing team with
family; uses FBA/BIP
process for one youth
at a time
Tertiary
Systems Team
Uses Process data;
determines overall
intervention
effectiveness
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
Sept. 1, 2009
Family and
community
FBA/
BIP
Complex
FBA/BIP
WRAP
SPARCS – IL HS
• 5 students participated in group
– 1 student internalizer
– 1 student participated last year as well
• Time 1 = Seven weeks before starting SPARCS
Time 2 = First seven weeks on intervention
Time 3 = Second seven weeks on intervention
(with a total of 14 weeks of group)
ODRs Over Time
Total Number ODR All Participants
16
13%↑
14
12
ODR Total
10
80%↓
8
Total Number ODR
6
4
2
0
ODR Time 1
ODR Time 2
Time Period
ODR Time 3
ODRs by Student
ODRs Over Time
9
8
7
Number of ODRs
6
5
Time 1 - 7 weeks before SPARCS
4
Time 2 - First 7 weeks SPARCS
Time 3 - Second 7 weeks SPARCS
3
2
1
0
Student 1
Student 2
Student 3
Students
Student 4
Student 5
OSS Data
ISS/OSS Days Out
4.5
4
Number of Days Out
3.5
3
Student 1
2.5
Student 2
2
Student 3
Student 4
1.5
Student 5
1
0.5
0
ISS Time 1
ISS Time 2
ISS Time 3
OSS Time 1
Time Period
OSS Time 2
OSS Time 3
Grades
Overall Grade Distribution Over Time Periods for All Students
14
12
Number
10
8
Time 1
Time 2
6
Time 3
4
2
0
A
B
C
Grades
D
F
TRAC-Nom Data
• Increased (Moving in Right Direction)
•
•
•
•
Life satisfaction
.67 Significance Level
Anxiety/depression symptoms
.34
Drug use
.46
Time spent living outside of the home
(e.g. in jail, an emergency room, or
psychiatric hospital)
.37
• Decreased (Moving in Wrong Direction)
• Unexcused Absences
• Support Systems
.42
Youth Outcomes Questionaire
• On the Youth Outcome Questionnaire (self report) it
measures six subscales: Somatic; Social Isolation;
Aggression; Conduct/Delinquency;
Hyperactivity/Distraction; Depression/Anxiety
– Students reported a decrease in symptoms/problems on all six
scales from pre to post
– The largest reported improvement was on Aggression, second
was Hyperactivity/Depression and third was Depression/Anxiety
– Out of the 5 students that completed the group, we had 2
parents that completed both the pre and post YOQ and both
reported a reduction in symptoms/problems in their child…one
score dropped from 40 to 18 and the other from 22 to 15
PA example
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 Service Components
CLINICAL
CASE
INTERVENTIONS
MANAGEMENT
CASE
CRISIS
INTERVENTION
CONSULTATION AND
TRAINING
for educational staff
District and Community Leadership
Team
•
•
•
•
•
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 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
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.
Lessons Learned
•
•
•
•
Return on investment
Funding efficiency
Scaling and sustaining SBBH Teams – size
Community “politics”
For More Information:
• www.sharedwork.org
• www.pbis.org