Transcript Getting Started: Integrating Community Mental Health Services into School-wide Positive Behavior Support in a Large Urban District Bob Putnam May Institute Steve Gramet Syracuse Public Schools Jennifer Parmalee Onondaga.

Getting Started: Integrating Community
Mental Health Services into School-wide
Positive Behavior Support in a Large
Urban District
Bob Putnam
May Institute
Steve Gramet
Syracuse Public Schools
Jennifer Parmalee
Onondaga County Department of Mental Health
Monique Fletcher
Say Yes
, Ph.D.
National PBIS Forum
October 28, 2011
Rosemont, IL
Where are you in implementation
process?
Adapted from Fixsen & Blase, 2005
Exploration & Adoption
• We think we know what we need so we are planning to move forward (evidencebased)
Installation
• Let’s make sure we’re ready to implement (capacity infrastructure)
Initial Implementation
• Let’s give it a try & evaluate (demonstration)
Full Implementation
• That worked, let’s do it for real (investment)
Sustainability & Continuous Regeneration
• Let’s make it our way of doing business (institutionalized use)
School Mental Health Partnership
More
than a
place for
services
Challenges
Education






Primarily focused on
services during school day
Use of evidenced based
practices
Limited data based decision
making
Less focus on the family
Limited mental health
expertise
Limited continuum of
services
Mental Health





Community mental health
services often focused on those
with severe and persistent
mental health issues
Limited prevention services due
to funding tied to direct
services
Accessibility of services
Limited data based decision
making
Use of evidence based practices
Contrasting Perspectives in the
Education and Mental Health Systems
• Education
• Overarching
influence
• Language
– IDEA
– Behaviors disorders,
challenging behavior
• Important
theoretical
influences
– Behaviorism , social
learning theory
• Focus of
intervention
Duchnowski & Kutash, 2009
– Behavior management,
skill development,
academic
improvement
• Mental Health
– DSM
– Psychopathology, abnormal
behavior, impaired
functioning
– Psychoanalytic
approaches, behavior
theory, cognitive
psychology, developmental
psychology,
biological/genetic
perspectives,
psychopharmacology
– Insight, awareness,
improved emotional
functioning
Outcomes for Students with Mental
Health Concerns


Early appearing behavioral problems during a
child's preschool years are the single best
predictors of school dropout, delinquency,
gang membership, and adult incarceration
(Center for Evidence-Based Practice, 2004)
Furthermore, unless behavioral problems are
dealt with early on, the child's behaviors tend
to become chronic (Campbell & Ewing, 1990).
Outcomes for Students with Mental
Health Concerns


Highest rate of dropouts among all disabilities
are those with EBD.
Depression, anxiety and conduct disorder in
adolescents are one of the lead indicators of
substance abuse.
School-wide Positive Behavior Intervention
and Support
Evidence-based features of SWPBIS







Prevention
Define and teach positive social expectations
Acknowledge positive behavior
Arrange consistent consequences that don’t allow the
functions of problem behavior to be achieved
On-going collection and use of data for decision-making
Continuum of intensive, individual intervention
supports.
Implementation of the systems that support
effective practices
Integrating Education and Mental Health
Services can Enhance Overall Services
•
Enables PBS schools to work better with children in
Tiers Two and Three and to engage families.
•
Significantly strengthens a mental health system of
care by engaging the school and enabling all parties
to come together around a single plan of care
•
An effective mental health system of care can assist
teachers and other personnel through consultation
on mental health issues and help schools fully
engage families.
Benefits Cited by Mental Health Agencies
Collaborating with PBS Schools



PBS focuses on prevention and early intervention.
Communication improves among stakeholders—
schools, families, mental health and other community
service providers—resulting in increased support to
children and families. A unified plan, understood by
all stakeholders, is more likely to be effective.
A less disruptive and more supportive school climate
increases the likelihood that students with mental
health problems can stay in school and succeed.
(Judge David L. Bazelon Center for Mental Health Law, 2006)
Benefits Cited by Mental Health Agencies
Collaborating with PBS Schools

Teachers have more time to focus on the academic
strengths and needs of students with serious mental
disorders because less behavior problems no longer
divert their attention. This can lead to greater school
success and improved functioning for children with
serious mental disorders.
Mental health staff feel they develop a better
understanding of a student’s behavioral motivations
and psychosocial needs when they are co-located in
the school and can observe the student in school.
(Judge David L. Bazelon Center for Mental Health Law, 2006)
Where Do We Start?
Implementation process
Adapted from Fixsen & Blase, 2005
Exploration & Adoption
• We think we know what we need so we are planning to move forward (evidencebased)
Installation
• Let’s make sure we’re ready to implement (capacity infrastructure)
Initial Implementation
• Let’s give it a try & evaluate (demonstration)
Full Implementation
• That worked, let’s do it for real (investment)
Sustainability & Continuous Regeneration
• Let’s make it our way of doing business (institutionalized use)
Need,
Agreements,
Adoption, & 1.
Outcomes
Local
Demonstration
w/ Fidelity
IMPLEMENTATION
PHASES
4. Systems
Adoption, Scaling,
& Continuous
Regeneration
3.
2.
Sustained
Capacity,
Elaboration, &
Replication
Getting Ready





Commit to a process that will result in the implementation
of a joint initiative.
Training of leadership across both organizations in
collaborative SW-PBIS models and systems of care
District leadership team is formed.
Education and mental health authorities should ensure that
the PBS planning group with inclusive participation from
school and mental health leadership
Once formed, the leadership team should engage in a joint
goal setting exercise and delineate the objectives and
outcomes desired from the PBS initiative.
Getting Ready


Commitment to establishment of systems of care
(PBIS) by both the school and mental health that will
serve not only children with serious mental disorders,
but also children who show behavior or other
social/emotional problems that put them at risk for
serious disorders.
Formulate policy and plan training and technical
assistance that will improve the quality of services to
children, using the most effective services and a
strength-based, family-driven, culturally relevant
approach to service delivery.
Supporting Social Competence &
Academic Achievement
4 PBS
Elements
OUTCOMES
Supporting
Decision
Making
Supporting
Staff Behavior
PRACTICES
Supporting
Student Behavior
CONTINUUM OF
SCHOOL-WIDE
INSTRUCTIONAL &
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 Systems
Mental Health
Education
Develop and implement
SW-PBS Plan
Training for staff around
mental health disorders
Training for coaches
around incorporating
universal prevention
strategies for most
common mental health
disorders
Screening for
internalizing disorders



Representative/s participate on
team
Training around SWPBS model
for administrative/clinical
supervisors
Training for school based
clinical staff on SWPBS and
building based SWPBS plan
Tier 1 Practices

Training and technical assistance in
developing and implementing a SWPBS plan






Three to five positive worded school rules
Teaching matrix for common areas in the school
Training staff and students to fluency on these
expectations
Reinforcement system for students for following
the expectations/staff for following the plan
Consistent consequences for infractions
Data collection system in place for data based
decision making
Tier 1 Data




SWIS data
 ODRS
 Student
 Problem behavior
 Location
 Time
Suspensions
Academic performance
Data from screening for internalizing disorders (i.e.;
Systematic Screening for Behavior Disorders)
Tier 2 Systems
Mental Health
Education



Tier 2 team
Mental health
representative
participates on Tier 2
team
Training of coaches in
evidenced based
social/behavior and
mental health
interventions




Connections to family/
community
Training of mental health
providers on evidenced based
interventions
Review of student progress
Referral to appropriate services
Tier 2 Practices



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
Check and Connect
Behavior Education Program
Functional based social skills groups
Evidenced based social skills groups
diagnostic groups (anxiety, depression)
Mentoring
Homework club
Tier 2 Data

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ODRs
Suspensions
Attendance
Academic success
CICO Data
Brief functional behavior assessment
Social skills assessments
Mental health assessments
DBR (Daily behavior report) measures
Tier 3 Systems
Mental Health
Education

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
Tier 3 Team
Wraparound teams
Monitor effectiveness of
services
Training of staff on
evidenced based
interventions




Actively participate in Tier 3
team
Coordinate wrap around
services for individual students
Advocate for family needs
Training of staff on evidenced
based interventions
Tier 3 Practices
Education


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
Conduct intensive FBAs
Design and implement
wraparound plans
Develop and implement
coordinated behavior
support plans
Implement individualized
evidenced based
social/behavior and mental
health interventions
Mental Health
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

Conduct intensive FBAs
Develop and implement
coordinated behavior support
plans/wraparound plans
Intensive assessment and
implement individualized
evidenced based social/behavior
and mental health interventions
Provide supports to family
Coordinate medical and
psychopharmacology
Tier 3 Data

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

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
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ODRs
Suspensions
Attendance
Academic success
CICO Data
Functional behavior assessment info
Social skills assessments/progress monitoring
Mental health assessments/progress monitoring
Emotion thermometers
DBR (Daily behavior report) measures
SIMEO measures
Family Involvement
Family involvement is crucial. Families and
youth must receive training and support so
they can participate fully in leadership and
planning groups at the school and district
level.
Self-assessment tools i.e.; family engagement
checklist (Muscott & Mann, 2004) should be
used for district and school levels. External
assessment of family involvement is also a
good idea.
Syracuse City School District
and Promise Zone
Steve Gramet
Director of Pupil Services
Who we are
32
Syracuse City Schools is an urban district
located in Central New York.
Approximately 90, 000 residents
Home of Syracuse University (Say Yes
partnership)
New Superintendent of Schools, Sharon L.
Contreras
Who we are
33

We operate 32 schools
 21, 094 students
•
•
•
•
5 High Schools
6 Kindergarten – 8th grade buildings
6 Middle Schools (6 - 8)
15 Elementary Schools
Who we are
34
Enrollment

50% African American

25% Caucasian

13% Hispanic

7% Asian

5 % other
Who we are
35
14 % of students are English Language
Learners or long term English as a Second
Language students (2900)
20% of students are listed as Special
Education (4,457)
Close to 85% of students are eligible receive
free or reduced price lunch.
We are a dependent district that relies on
local, state and federal dollars for funding
Data – Averages Over the Past Three Years
36
Over the last three years SCSD 22% have been
students suspended out of school at least one time
That equates to approximate 24,000 days each year
of lost instructional time for these students.
In addition over the last three years, 5,000 days of
instructional time is lost to In School Suspension.
There has been a downward trend the last three
years in these indicators
Tiered Academic Services – Committed to
37 Making
Data Based Decision
School based Intervention Teams (SBIT) for academics
have been operating in the district for the last ten
years.
SBIT uses data based decision making system to
assess, progress monitor, and evaluate a tiered set of
academic strategies.
Curriculum based measurement (DIBELS, CBM
measures)
In order to effectively use our social and behavior
support resources the district adopted a teired system
for social/behavior modeled after the SBIT-A teams
Protocol
38
PBIS Leadership Team
.
Examines School Wide Data, Creates Matrix, Plans Kickoff, etc
Members include Admin., Parent, Teacher, Pupil Services Staff
Student Support Team
Looks for any student receiving three (3) referrals, makes initial intervention
Members include Admin., Social Worker, School Counselor, Say Yes Site Director, others as appropriate
Intervention and Data monitored by Day Yes Site Director and Student Support Team members
SBIT-B Team
Students receiving seven (7) referrals, close examining of function of behavior, individual or small group intervention, family involvement
Members include Clinician, School Psychologist, Social Worker, Say Yes Site Director and others as appropriate
Intervention monitored by Say Yes Site Director, if issues continue referral to Onondaga County Access
Team for wrap around services and other family intervention
Referral to clinic services can happen through either SST or SBIT –B team
PBIS
39
Full implementation began in September 2010 (a
few schools have been using PBIS strategies for
several years)
SCSD hired a PBIS District Coordinator
PBIS staff development has been enhanced with
emphasis on the universal strategies
SET’s were implemented to all schools in October
2010 and again in the spring of 2011.
SET Scores
40
SET Scores Across Schools
100
90
T
o
t
l
a
S
c
o
r
e
80
70
60
50
40
30
20
10
0
Interconnected Services
41
In 2007 Say Yes to Education became an
external partner of SCSD.
As a result, relationships between the SCSD
district and county improved
Due to funding cuts, the district and the
county entered into agreement to try to
integrate their services.
This unique partnership between the district,
county, Say Yes to Education provided easier
access to services.
Steps To Implementation
42

A stated goal of our previous Superintendent was for every school to
provide Mental Health services at school due access issues of our
population and data based decision making.

Schools were given a brief overview of the possible services and proposed
protocol.

A rollout plan approved by the current Superintendent has been approved
and we are moving forward
Syracuse Promise Zone
A partnership of the Dept. Mental
Health, Syracuse City School District,
Say Yes to Education, System of Care,
& Community Based Organizations
Jennifer Parmalee, Onondaga County
Department of Mental Health
Monique Fletcher
Say Yes to Education
What is Promise Zone
Grant to 3 Urban districts for innovative
solutions that result in improved student
achievement
Designed to increase community
collaboration and the districts ability to
identify and support students with
serious emotional challenges
Mission
Long Term
Improve academic performance
Increase graduation rates
Increase student wellness
Short Term
Reduce suspensions
Keep students in class and ready to learn
Match students emotional behavioral needs
with proper and targeted interventions
Action Plan - Systems
 Expand
mental health clinics from 13 to 35
and integrate clinician into Tier 3 teams
 District Wide Protocol for identifying and
supporting youth
 Clarify the role of the social workers
 Expand PBIS with fidelity
 District Leadership team to monitor progress
at building and district levels concerning
PBIS/RTI
 Clarify the role of the Say Yes Site Director
 Improve the Crisis Response for students
and staff
Community Strengths from Which to Build
Highly effective Academic School Based
Intervention Teams (SBIT) based on RtI
framework
Mental Health Clinic Satellites currently serving
13 schools
Say Yes to Education site directors in all
elementary and K-8 schools
Talent of Social Workers
District wide implementation of Positive
Behaviors and Supports
System of Care Community
Onondaga Department of Mental Health
Oversight
Planning and Quality Improvement
Contract Management (95 programs)
County (City) Demographics
Population:
454,753 (138,560)
Children ages 5-19:
95,308 (32,423)
95% of funding from State Authorities (OMH,
OASAS OPWDD)
ONCARE – System of Care
Partnership of Mental Health, Child Welfare,
Juvenile Justice, Family Organization,
Community Based Organizations
Guiding Principles
All our children/youth
Parents/Caregivers as “experts”
Family-driven & Youth-guided
“Community Table” to “Kitchen Table”
“No Wrong Door”
Single plan of care
Strength Based approach
Cultural and Linguistic relevant
Maximize the Use of Blended Funding to
Improve Effectiveness and Efficiency
Blended funding
Syracuse City School District
Multiple Onondaga County Departments
Say Yes resources
Outpatient agencies
Family support
Other resources
How is data shared to determine the selection of
interventions?
How is data shared to determine effectiveness of
interventions
Say Yes To Education
Say Yes to Education, Inc. (Say Yes) is a national,
non-profit education foundation committed to
dramatically increasing high school and college
graduation rates for our nation's urban youth.
Say Yes provides comprehensive supports,
including the promise of free college tuition,
aligned with what research indicates is needed to
enable every child in the program to achieve his
or her potential.
Say Yes Community-wide Involvement
After school-Tier 1
9 Community based organizations in 20 schools
Summer camp-Tier 1
Syracuse University
Tutoring-Tier 2
Syracuse University Literacy Corp Volunteers
Family Support Services-Tier 3
Huntington Family Centers
Student Assistance Program-Tier 3
Contact Community Services
Facilitated Enrollment-Tier 3
Salvation Army
Legal clinics-Tier 3
Pro bono services from legal community
System Involvement
Onondaga County Supports Schools
Department of Aging and Youth
Youth Program Quality Assessment (YPQA)
Department of Social Services
Educational Neglect
Health Department
Health insurance enrollment
Department of Mental Health
Promise Zone
Say Yes – Commitment to Data Based
Decision Making
Say Yes Site Coordinators routinely collect data
on





Attendance
Behavior (ODR/Suspensions)
Academics(i.e., DIBELS)
These data are presented to SCSD principals
and teams on a monthly basis
Say Yes Site Directors assist in linking
services and resources to improve these
outcomes
Moving Towards an Interconnected System
Established members of Tier 3 team
Utilizing evidence based intervention for all students
Progress monitoring
Prioritizing school functionality in treatment goals
Sharing data with team of school professionals
Accountability to team in addition to child and family
with family’s permission
Community responsibility to engage families
Challenges
•
56
Increasing the number of schools implementing Tier 1
to fidelity
•
Increasing of schools implementing Tier 2 and Tier 3
systems and evidenced based practices
•
The use of common language
•
Training for the SBIT -B teams around understanding
behavioral function in order to put the appropriate
interventions in place (ie. Check/Connect, ART,
individual counseling, mentoring etc…)
Challenges

Learning to work effectively with external partners
57
such as Onondaga County and Say Yes to Education

Redefining the role of the Social Worker

Helping in-school clinicians to use strategies that are
reasonably short term, evidenced based and result in
improved school performance
•
New York State Medicaid redesign delay creates
system in flux
•
Schools have to provide appropriate space for clinic.
The space must approved by the state as adequate.
For more information
[email protected]
pbis.org