Promoting Positive Behavioral & Mental Health in Schools: Promising Practices from Early Childhood through High Schools Lucille Eber Lise Fox Beth Harn Krista Kutash George Sugai IL PBIS Network University of S.
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Promoting Positive Behavioral & Mental Health in Schools: Promising Practices from Early Childhood through High Schools Lucille Eber Lise Fox Beth Harn Krista Kutash George Sugai IL PBIS Network University of S. FL University of OR University of S. FL University of CT July 2011 OSEP Project Directors Meeting Washington D.C. Promoting Positive Behavioral & Mental Health in Schools: Promising Practices from Early Childhood through High Schools Agenda (BH Moderator) Audience PD, SPDG, GSEG, TA&D, Researchers, Parent Programs 10:30 Conceptual Framework & 10:40 Elementary (GS) 10:55 Early Childhood (LF) 11:15 High Schools (LE) 11:35 Mental Health Perspective & 11:55 Concluding Comments (KK) Variable use of databased decision making Variable use of evidence-based practices School-familycommunity disconnect Poor implementation fidelity Reactive exclusionary consequences Non-evidencebased practices Special education v. mental health v. general education Objectives Evidencebased Practices & Systems Implementation Fidelity Implementation Sustainability & Scaling Increase working knowledge of importance, evidencebased practices, & supporting systems of coordinated multi-tiered approaches for promoting positive behavioral &mental health for all children, including children & youth w/ disabilities; Identify & describe strategies & systems for improving implementation fidelity, durability, & scaling of multitiered approaches for promoting positive behavioral & mental health for all children; & Identify & describe capacity-expanding strategies & systems that promote positive behavioral & mental health development in schools & educational programs. Positive predictable • Surgeon General’s school-wide Report on Youth climate Multi-component, Violence (2001) multi-year school• Coordinated Social family-community Emotional effort & Learning (Greenberg et al., 2003) • Center for Study & Prevention of adult Positive Violence role (2006) models • White House Conference on School Violence (2006) High rates academic & social success VIOLENCE VIOLENCE PREVENTION PREVENTION Positive active supervision & reinforcement Formal social skills instruction Conceptual Logic! Successful individual student Effective Work behavior & mental health support Efficient Doable is linked to host environments or Relevant & communities Cultural/contextual schools that are effective, efficient, Durable Lasting relevant, durable, scalable, & logical for all Scalable Transferrable students Logical (Zins & Ponti, 1990) Conceptually sound Positive Behavior & Mental Health Framework for enhancing adoption & implementation of Continuum of evidencebased interventions to achieve Academically & behaviorally important outcomes for All students IMPLEMENTATION W/ FIDELITY CONTINUUM OF CONTINUOUS EVIDENCE-BASED PROGRESS INTERVENTIONS MONITORING UNIVERSAL SCREENING RtI DATA-BASED DECISION MAKING & PROBLEM SOLVING CONTENT EXPERTISE & FLUENCY TEAM-BASED IMPLEMENTATION Prevention Logic for All Biglan, 1995; Mayer, 1995; Walker et al., 1996 Decrease development of new problem behaviors Prevent worsening & reduce intensity of existing problem behaviors Prompt, Eliminate teach, triggers & monitor, & maintainers of acknowledge problem prosocial behaviors behavior Consideration of risk & protective factors in redesign of teaching environments…not students CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT FEW ~5% ~15% SOME Primary Prevention: School-/ClassroomWide Systems for All Students, Staff, & Settings ALL ~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 “Early Triangle” (p. 201) Walker, Knitzer, Reid, et al., CDC Intensive Targeted Universal Few Some All Dec 7, 2007 Continuum of Support for ALL Math Intensive Science Continuum of Support for ALL “Theora” Targeted Spanish Reading Soc skills Universal Soc Studies Basketball Label behavior & practice…not people Dec 7, 2007 Intensive Continuum of Support for ALL: “Molcom” Anger man. Prob Sol. Targeted Ind. play Adult rel. Self-assess Attend. Universal Coop play Peer interac Dec 7, 2007 Label behavior & practice…not people Start w/ What Works Focus on Fidelity Detrich, Keyworth, & States (2007). J. Evid.-based Prac. in Sch. Enhancing Adult Behavior 1. “Change is slow, difficult, gradual process for teachers Guskey, 1986, p. 59 2. “Teachers need to receive regular feedback on student learning outcomes” 3. “Continued support & follow-up are necessary after initial training” Integrated Elements Supporting Social Competence & Academic Achievement OUTCOMES Supporting Decision Making Supporting Staff Behavior PRACTICES Supporting Student Behavior Funding Visibility Political Support Policy SWPBS Implementation LEADERSHIP TEAM Blueprint (Coordination) www.pbis.org Training Coaching Evaluation Local School/District Implementation Demonstrations Behavioral Expertise Where are you in implementation process? Adapted from Fixsen & Blase, 2005 EXPLORATION & ADOPTION INSTALLATION • We think we know what we need, so we ordered 3 month free trial (evidence-based) • 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) Academic-Behavior Connection Algozzine, B., Wang, C., & Violette, A. S. (2011). Reexamining the relationship between academic achievement and social behavior. Journal of Positive Behavioral Interventions, 13, 3-16. Burke, M. D., Hagan-Burke, S., & Sugai, G. (2003). The efficacy of function-based interventions for students with learning disabilities who exhibit escape-maintained problem behavior: Preliminary results from a single case study. Learning Disabilities Quarterly, 26, 15-25. McIntosh, K., Chard, D. J., Boland, J. B., & Horner, R. H. (2006). Demonstration of combined efforts in school-wide academic and behavioral systems and incidence of reading and behavior challenges in early elementary grades. Journal of Positive Behavioral Interventions, 8, 146-154. McIntosh, K., Horner, R. H., Chard, D. J., Dickey, C. R., and Braun, D. H. (2008). Reading skills and function of problem behavior in typical school settings. Journal of Special Education, 42, 131-147. Nelson, J. R., Johnson, A., & Marchand-Martella, N. (1996). Effects of direct instruction, cooperative learning, and independent learning practices on the classroom behavior of students with behavioral disorders: A comparative analysis. Journal of Emotional and Behavioral Disorders, 4, 53-62. Wang, C., & Algozzine, B. (2011). Rethinking the relationship between reading and behavior in early elementary school. Journal of Educational Research, 104, 100-109. RCT & Group Design PBIS Studies Bradshaw, C.P., Koth, C.W., Thornton, L.A., & Leaf, P.J. (2009). Altering school climate through school-wide Positive Behavioral Interventions and Supports: Findings from a group-randomized effectiveness trial. Prevention Science, 10(2), 100-115 Bradshaw, C.P., Koth, C.W., Bevans, K.B., Ialongo, N., & Leaf, P.J. (2008). The impact of school-wide Positive Behavioral Interventions and Supports (PBIS) on the organizational health of elementary schools. School Psychology Quarterly, 23(4), 462473. Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of School-Wide Positive Behavioral Interventions and Supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12, 133-148. Bradshaw, C.P., Reinke, W. M., Brown, L. D., Bevans, K.B., & Leaf, P.J. (2008). Implementation of school-wide Positive Behavioral Interventions and Supports (PBIS) in elementary schools: Observations from a randomized trial. Education & Treatment of Children, 31, 1-26. Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., & Esperanza, J., (2009). A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Journal of Positive Behavior Interventions, 11, 133-145. Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptionality, 42(8), 1-14. ESTABLISHING CONTINUUM of SWPBS ~5% ~15% TERTIARY TERTIARY PREVENTION PREVENTION •• Function-based support •• Wraparound •• Person-centered planning •• •• SECONDARY SECONDARY PREVENTION PREVENTION •• Check in/out •• Targeted social skills instruction •• Peer-based supports •• Social skills club •• ~80% of Students PRIMARY PRIMARY PREVENTION PREVENTION •• Teach SW expectations •• Proactive SW discipline •• Positive reinforcement •• Effective instruction •• Parent engagement •• Behavior Support Elements *Response class *Routine analysis *Hypothesis statement Problem Behavior *Alternative behaviors *Competing behavior analysis *Contextual fit *Strengths, preferences, & lifestyle outcomes *Evidence-based interventions Functional Assessment Intervention & Support Plan • Team-based *Implementation support *Data plan *Continuous improvement *Sustainability plan Fidelity of Implementation • Behavior competence Impact on Behavior & Lifestyle Disproportionality High poverty, low achieving districts Bullying behavior High schools SW-PBIS “Current Efforts” Cultural diversity & relevance Implementation fidelity, durability, scaling v Promising Practices for Early Childhood The Context Concerns about increases in children’s challenging behavior Growing awareness of the relationship between social emotional development and school readiness Myriad of approaches to address particular social emotional issues; lacking comprehensive models Reliance on clinical approaches Pyramid Model Tertiary Intervention Secondary Prevention Universal Promotion Nurturing and Responsive Relationships Foundation of the pyramid Essential to healthy social development Includes relationships with children, families and team members 28 High Quality Environments Inclusive early care and education environments Comprehensive system of curriculum, assessment, and program evaluation Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC 29 Supportive Home Environments Supporting families and other caregivers to promote development within natural routines and environments Providing families and other caregivers with information, support, and new skills 30 Targeted Social Emotional Supports Self-regulation, expressing and understanding emotions, problem solving, developing social relationships Explicit instruction Increased opportunities for instruction, practice, feedback Family partnerships Progress monitoring and data-based decision-making Targeted Social Emotional Supports The support and coaching of families to enhance their child’s social development within natural environments and activities Self-regulation, expressing and understanding emotions, developing social relationships 32 Individualized Intensive Interventions Team developed Parents as partners Comprehensive interventions (all environments) Assessment-based (functional assessment) Skill-building 33 The Pyramid Model: Program-Wide Implementation Program-Wide Commitment Data-Based Decision Making including screening and progress monitoring Teacher Training and Technical Assistance (coaching) Partnerships with Families Well-Defined Procedures ALL Levels Require Administrative Support Mental Health Framework for the Early Childhood Mental Consultant to build capacity Emphasis on prevention with intensive individualized intervention available Embedded screening for efficient identification and support Comprehensive interventions that focus children and families See www.ecmhc.org for resources Outcomes Teacher and parent satisfaction Continual growth in implementation fidelity (practitioners and programs) Decreases in behavior incidents Experimental Child Outcomes Non-target children Differences between social skills scores for children in intervention versus control classrooms (Cohen’s d = .46). Lower mean scores for problem behavior Target children Higher mean social skills scores in intervention classrooms (Cohen’s d = .41). Differences in problem behavior scores Significant differences in frequency of positive social interactions The non-system of early childhood “Early childhood policies and procedures are highly fragmented, with complex and confusing points of entry that are particularly problematic for underserved populations and those with special needs. This lack of an integrative early childhood infrastructure makes it difficult to advance prevention-oriented initiatives for all children and to coordinate services for those with complex problems.” (Shonkoff & Phillips, 2000, p.11) Partnership for Scaling Up Center on the Social and Emotional Foundations for Early Learning www.vanderbilt.edu/csefel/ Primary Partner Associations Division for Early Childhood of the Council for Exceptional Children (DEC) National Head Start Association (NHSA) National Association of Child Care Resource & Referral Agencies (NACCRRA) National Association of State Mental Health Program Directors (NASMHPD) Parent Advocacy Coalition for Educational Rights (PACER) National Association for Bilingual Education (NABE) National Association of State Directors of Special Education (NASDSE) IDEA Infant and Toddler Coordinators Association (ITCA) National Association for the Education of Young Children (NAEYC) IDEA 619 Consortium Commitment Unified message Evidence-based practices Comprehensive approach for supporting/promoting the social emotional competence of all children Focus on the enhancement of social competencies rather than the remediation of problems Application to the full range of programs and service settings Affordable, feasible, and acceptable to diverse personnel, families and communities Changing Practice Training alone is inadequate Coaching is necessary for translation of training to classroom practice Fidelity of implementation focus of coaching Administrative support and systems change necessary for sustained adoption Data driven systems necessary for ensuring targeted program, practitioner, and child outcomes Capacity Building State Cross Sector Leadership Team • Building a system for ongoing training and technical assistance for scaling up the implementation of the model within programs across service systems Master T/TA Cadre Expertise in all aspects of model Will provide training (of additional trainers, coaches, and practitioners), external coaching, guide program-wide implementation, support data collection Demonstration Sites Data System System and procedures for measuring implementation fidelity, outcomes, and using data for decision-making Promoting Positive Behavioral and Mental Health in Schools: Promising Practices from Early Childhood Through High School OSEP Project Director’s Conference Washington DC July 19, 2011 Supporting Youth at the Secondary Level Lucille Eber, Statewide Director, IL PBIS Network www.pbisillinois.org [email protected] Big Ideas • Challenges and Context • A multi-tiered Systemic Approach • Effect of PBIS on existing ‘clinical’ supports in place in schools and a developing model in IL • A developing national model: National SMH and National PBIS Center Some “Big Picture” Challenges • Low intensity, low fidelity interventions for behavior/emotional needs • Habitual use of restrictive settings (and poor outcomes) for youth with disabilities • High rate of undiagnosed MH problems (stigma, lack of knowledge, etc) • Changing the routines of ineffective practices (systems) that are “familiar” to systems 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 • 1-2% identified by schools as EBD • Those identified have poor outcomes • Suicide is 4th leading cause of death among young adults It Takes a System… School-Wide Systems for Student Success: A Response to Intervention (RtI) Model Academic Systems Behavioral Systems Tier 3/Tertiary Interventions 1-5% 1-5% Tier 3/Tertiary Interventions •Individual students •Assessment-based •High intensity Tier 2/Secondary Interventions •Individual students •Assessment-based •Intense, durable procedures 5-15% 5-15% Tier 2/Secondary Interventions •Some students (at-risk) •High efficiency •Rapid response •Small group interventions •Some individualizing •Some students (at-risk) •High efficiency •Rapid response •Small group interventions • Some individualizing Tier 1/Universal Interventions 80-90% •All students •Preventive, proactive Illinois PBIS Network, Revised May 15, 2008. Adapted from “What is school-wide PBS?” OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. Accessed at http://pbis.org/schoolwide.htm 80-90% Tier 1/Universal Interventions •All settings, all students •Preventive, proactive Core Features of a Response to Intervention (RtI) Approach • • • • • • • • • Investment in prevention Universal Screening Early intervention for students not at “benchmark” Multi-tiered, prevention-based intervention approach Progress monitoring Use of problem-solving process at all 3-tiers Active use of data for decision-making at all 3-tiers Research-based practices expected at all 3-tiers Individualized interventions commensurate with assessed level of need Examples of Ineffective Secondary/Tertiary Structures • Referrals to Sp. Ed. seen as the “intervention” • FBA seen as required “paperwork” vs. a needed part of designing an intervention • Interventions the system is familiar with vs. ones likely to produce an effect – (ex: student sent for insight based counseling at point of misbehavior) Positive Behavior Interventions & Supports: A Response to Intervention (RtI) Model Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems Tier 2/ Secondary ODRs, Attendance, Tardies, Grades, DIBELS, etc. Social/Academic Instructional Groups Daily Progress Report (DPR) (Behavior and Academic Goals) Illinois PBIS Network, Revised April2011 Adapted from T. Scott, 2004 Check-in/ Check-out Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Tier 3/ Tertiary Individualized CheckIn/Check-Out, Groups & Mentoring (ex. CnC) Brief Functional Behavioral Assessment/ Behavior Intervention Planning (FBA/BIP) Complex FBA/BIP SIMEO Tools: HSC-T, RD-T, EI-T Wraparound/RENEW Interconnected Systems Framework paper Examples from the Field Provided by: Colette Lueck, Managing Director, Illinois Children's Mental Health Partnership Lisa Betz, Mental Health and Schools Coordinator, IL Division of MH The IL PBIS Network Team Community Partners Roles in Teams • Participate in all three levels of systems teaming: Universal, Secondary, and Tertiary • Facilitate or co-facilitate tertiary teams around individual students • Facilitate or co-facilitate small groups with youth who have been identified in need of additional supports 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 Tier 2: Early Intervention for Some Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns •Systems Planning Team identified to coordinate referral process, decision rules and progress monitor impact of intervention •Array of services available •Communication system for staff, families and community •Early identification of students who may be at risk for mental health concerns due to specific risk factors •Skill-building at the individual and groups level as well as support groups •Staff and Family training to support skill development across settings Tier 3: Intensive Interventions for Few Individual Student and Family Supports •Systems Planning team coordinates decision rules/referrals for this level of service and progress monitors •Individual team developed to support each student •Individual plans may have array of interventions/services •Plans can range from one to multiple life domains •System in place for each team to monitor student progress Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Tier 1 - Universal • Interventions that target the entire population of a school to promote and enhance wellness by increasing pro-social behaviors, emotional wellbeing, skill development, and mental health. • This includes school-wide programs that foster safe and caring learning environments that, engage students, are culturally aware, promote social and emotional learning and develop a connection between school, home, and community. • Data review should guide the design of Tier 1 strategies such that 80-90% of the students are expected to experience success, decreasing dependence on Tier II or III interventions. • The content of Tier 1/Universal approaches should reflect the specific needs of the school population. • For example, cognitive behavioral instruction on anger management techniques may be part of a school-wide strategy delivered to the whole population in one school, while it may be considered a Tier 2 intervention, only provided for some students, in another school. Tier 2 - Secondary • Interventions at Tier 2 are scaled-up versions of Tier 1 supports for particular targeted approaches to meet the needs of the roughly 10-15% of students who require more than Tier 1 supports. • Typically, this would include interventions that occur early after the onset of an identified concern, as well as target individual students or subgroups of students whose risk of developing mental health concerns is higher than average. • Risk factors do not necessarily indicate poor outcomes, but rather refer to statistical predictors that have a theoretical and empirical base, and may solidify a pathway that becomes increasingly difficult to shape towards positive outcomes. • Examples include loss of a parent or loved one, or frequent moves resulting in multiple school placements or exposure to violence and trauma. • Interventions are implemented through the use of a comprehensive developmental approach that is collaborative, culturally sensitive and geared towards skill development and/or increasing protective factors for students and their families. Tier 3 - Tertiary • Interventions for the roughly 1-5% of individuals who are identified as having the most severe, chronic, or pervasive concerns that may or may not meet diagnostic criteria. • Interventions are implemented through the use of a highly individualized, comprehensive and developmental approach that uses a collaborative teaming process in the implementation of culturally aware interventions that reduce risk factors and increase the protective factors of students. • Typical Tier 3 examples in schools include complex function-based behavior support plans that address problem behavior at home and school, evidence-based individual and family intervention, and comprehensive wraparound plans that include natural support persons and other community systems to address needs and promote enhanced functioning in multiple life domains of the student and family. Example 1: A District-Level Re-Design 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); • 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; • No data to decide on or monitor interventions; • MH person leads small groups based on data; • “Hoping” that interventions are working; but not sure. • MH person co-facilitates FBA/BIP or wrap individual teams for students. Example 2: Planning for Transference and Generalization • Middle schools SWIS data indicated an increase in aggression/fighting between girls. • Community agency had staff trained in the intervention Aggression Replacement Training (ART) and available to lead groups in school. • This evidence-based intervention is designed to teach adolescents to understand and replace aggression and antisocial behavior with positive alternatives. The program's three-part approach includes training in Prosocial Skills, Anger Control, and Moral Reasoning. • Agency staff worked for nine weeks with students for 6 hours a week; group leaders did not communicate with school staff during implementation. Example 2: Planning for Transference and Generalization (cont.) • SWIS Referrals for the girls dropped significantly during group. • At close of group there was not a plan for transference of skills (i.e. notifying staff of what behavior to teach/prompt/reinforce). • There was an increase in referrals following the group ending. • Secondary Systems team reviewed data and regrouped by meeting with ART staff to learn more about what they could do to continue the work started with the intervention. • To effect transference and generalization, the team pulled same students into groups lead by school staff with similar direct behavior instruction. • Links back to Universal teaching of expectations (Tier 1) is now a component of all SS groups (Tier 2). Example #3: Community Clinicians Augment Strategies • A school located near an Army base had a disproportionate number of students who had multiple school placements due to frequent moves, students living with one parent and students who were anxious about parents as soldiers stationed away from home. • These students collectively received a higher rate of office discipline referrals than other students. • The school partnered with mental health staff from the local Army installation, who had developed a program to provide teachers specific skills to address the particular needs students from military families. • Teachers were able to generalize those skills to other at risk populations. • As a result, office discipline referrals decreased most significantly for those students originally identified as at risk but also for the student body as a whole. Example #5: Systems Collaboration and Cost Savings • A local high school established a mental health team that included a board coalition of mental health providers from the community. • Having a large provider pool increased the possibility of providers being able to address the specific needs that the team identified using data, particularly as those needs shifted over time. • In one case, students involved with the Juvenile Justice System were mandated to attend an evidence-based aggression management intervention. • The intervention was offered at school during lunch and the school could refer other students who were not mandated by the court system, saving both the school and the court system time and resources and assuring that a broader base of students were able to access a needed service. • As a result of their efforts, the school mental heath team was able to reintegrate over ten students who were attending an off site school, at a cost savings of over $100,000. Number of IL PBIS High Schools as of April 2011 LRE Data Trends at the High School Level – Significantly higher use of restrictive placements of students with disabilities in most restrictive settings •Over 20% in some high schools – Drop out rates exacerbate the issue – Students with any behavioral/emotional component to disability more likely to be placed and/or drop out – ….and lots more NOT identified with a disability How High Schools Are Different • Size • Expectations of staff • Staff is departmentalized • More groundwork is needed • Teams can become layered • Implementation comes more slowly They’re not as different as they think they are! The concepts are the same but the practices may look different. Building-level Team Development Teaching Data Core Team Acknowledgement Communication SECONDARY • Check In Check out (CICO) – Training with high school examples – TA with only high schools • Small Group Interventions (SA/IG) • Check & Connect (C&C) – University of Minnesota • Brief FBA/BIP TERTIARY • Complex FBA/BIP • Wrap-Around applying RENEW – – – – Two day training SIMEO training Follow up phone TA Follow up TA days Rehabilitation, Empowerment, Natural Supports, Education and Work {RENEW} J. Malloy and colleagues at UNH • Developed in 1996 as the model for a 3-year RSAfunded employment model demonstration project for youth with “SED” • Focus is on community-based, self-determined services and supports • Promising results for youth who typically have very poor post-school outcomes (Bullis & Cheney; Eber, Nelson & Miles, 1997; Cheney, Malloy & Hagner, 1998) 71 RENEW Overview • RENEW (Rehabilitation, Empowerment, Natural Supports, Education and Work) is an application of wraparound – Reflects key principles: person-centered, community and strengths-based, natural supports – Focused on student, versus parent engagement (e.g., student-centered teams, student-developed interests) RENEW Overview • The RENEW framework and the practice of mapping are ideal for engaging older students – For example, a key element of transition planning, especially for older students, is building in opportunities/activities that the student has identified as important to their personal development Promoting Positive Behavioral and Mental Health in Schools: Promising Practices from Early Childhood through High School The Mental Health Perspective Krista Kutash, Ph.D. Department of Child & Family Studies University of South Florida Office of Special Education Programs (OSEP) Annual Conference July 2011 – Washington DC 74 Integrating Education and Mental Health Into School-Based Mental Health Historically, difficult to establish effective partnerships For many reasons…. 75 Contrasting Perspectives Important Theoretical Influences Education System Mental Health System Behaviorism, Behavior Theory, Social Learning Theory Cognitive Theory, Developmental Psychology, Biological/Genetic Perspective, Psychopharmacology 76 Contrasting Perspectives Focus of Intervention Education System Mental Health System Behavior Management, Insight, Skill Development, Awareness, Academic Improvement Improved Emotional Functioning 77 Perspectives Common Focus Education / Mental Health System Improving Social and Adaptive Functioning. Importance of and Need to Increase Availability, Access, and Range of Services 78 What about evidence based practices….??? 79 Evidence Based Practices • Last Count = 92 mental health and SEL programs across five sources • 53% of the programs aimed at universal level and 47% aimed at the selective/indicated levels • 58% of the programs are schoolbased, 26% community based and 16% both community and school based • 61% have a family component and 47% have a teacher component. 80 Evidence Based Practices • A 2007 examination of 2,000 studies of School-based Mental Health Programs revealed; – 3% used rigorous empirical designs – 37% examined school outcomes – 15 programs dually effective at meeting both academic & behavioral needs of youth. 81 Effect sizes for emotional functioning, functional impairment, & achievement. 0.8 0.6 0.4 Effect Size 0.2 0 -0.2 Integrated 1 -0.4 Emotional Functioning Integrated 2 Pull-Out 1 Pull-Out 2 Program Functional Impairment Reading Math Kutash, K., Duchnowski, A.J., Green, A.L. (in press). School-based mental health programs for students who have emotional disturbances: Academic and social-emotional outcomes. School Mental Health. 82 Refocus School-Based Mental Health Services On the Core Foundation of Schools: To Promote Learning 83 The Refocused Role of Mental Health Services • Support Teachers: the Primary Change Agents • Mental Health Providers Become: “Educational Enhancers” • Serve the Core Function of Schools • Promoting Social/Emotional Development, no Longer Tangential 84 Need to Involve Parents & Families 85 Common Vision Families (FAM) Mental Health (MH) Education (ED) Universal Selective Intensive All Students At-Risk Students Students in Special Ed due to Emotional Disturbances ED – PBS ED – FBA / PBS MH - Screening MH – Assessment FAM ED MH Implemented in organizations that support and facilitate collaborative, integrated systems of services. EBP’s (PATHS) ED – FBA / PBS FAM ED MH RtI MH – Assessment MH ED Group Interventions FAM Cognitive Behavior ED Therapy and other MH EBPs ED MH FAM Team Monitors Progress ED Team FAM Monitors MH Progress 86 Integrated Partnership Some Program Models with Organizational Potential for Success 87 “The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better.” – Weiss, 2002 88 Model of Implementation Complexity FIT CLIMATE Does the innovation fit within your organization Willing to remove obstacles? Are there rewards? Complement or Compete? IMPLEMENTATION EFFECTIVENESS INNOVATION EFFECTIVENESS Can you implement the innovation with accuracy and fidelity? Impact of innovation, commitment, and satisfaction Leadership support? Clarity of Goals? VOLITION FIDELITY BELIEFS Is there capacity and willingness to implement? Favorable attitudes toward practice Complexity of innovation 89 System Integration Strategies: Systems of Care Effective Service Systems Requires • A range of services with a community • Collaboration between service sectors, organizations, parents and professionals • Attention to careful planning • Performance measurement • Continuous quality improvement • Comprehensive Financing Plan • Individualized, comprehensive and Culturally Competent services • Transformative Leadership 90 Recently Concluded Study – SOC-IS (Surveyed 225 Randomly Selected Counties on Their Level of SOC Implementation) 91 National Levels of Implementation of Systems of Care •75% of the counties surveyed rated themselves as having adequate implementation on 6 or more of the 14 factors associated with Systems of Care • 26% of counties surveyed rated them selves as having adequate levels of implementation on 11 of the 14 factors associated with Systems of Care 92 Implementing Systems of Care 6 Factors that had the highest levels of implementation nationally • • • • • • Systems management approach Leadership Services based a statement of values & principles Family voice and choice Individualized, comprehensive cultural competent treatment A written theory of change for system improvement 2 Factors with the lowest levels of implementation • An implementation plan for service system improvement • An adequate level of skilled provider network 93 Systems of Care Information on the Systems of Care slides based on: Kutash K., Greenbaum P., Wang W., Boothroyd R., Friedman R. (2011) Levels of system of care implementation: A national benchmarking study. Journal of Behavioral Health Services and Research, 2011; 38(3). Boothroyd R.A., Greenbaum P.E., Wang W., Kutash K., Friedman R. (2011) Development of a measure to assess the implementation of children’s systems of care: The system of care implementation survey (SOCIS). Journal of Behavioral Health Services and Research, 2011; 38(3). Greenbaum P.E., Wang W., Boothroyd R., Kutash K., Friedman R.M. Multilevel confirmatory factor analysis of the system of care implementation survey (SOCIS) (2011). Journal of Behavioral Health Services and Research, 2011; 38(3). Lunn L.M., Heflinger C.A., Wang W., Greenbaum P.E., Kutash K., Boothroyd R.A., Friedman R.M. (2011). Community characteristics and implementation factors associated with effective systems of care. Journal of Behavioral Health Services and Research, 2011; 38(3). 94 …it depends a good deal on where you want to get to… Alice said to the Cheshire Cat: “Would you tell me please, which way I ought to go from here?” “That depends a good deal on where you want to get to,” said the Cat. “I don’t much care where,” said Alice. “Then it doesn’t matter which way you go,” said the Cat. 95 Where do we go from here? • Build on strengths of schools • Build on strengths of families • Focus on learning • Improve & build feedback systems • Provide services & system coaches • and of course …. 96 Fund More Research A written summary of many of the points made in this presentation can be found in the following materials: Atkins, M., Hoagwood, K., Kutash, K., & Seidman, E. (2010) Toward the Integration of Education and Mental Health in Schools. Administration and Policy in Mental Health and Mental Health Services Research, 37, 40-47. Reducing Behavior Problems in the Elementary School Classroom This guide is intended to help elementary school educators as well as school and district administrators’ develop and implement effective prevention and intervention strategies that promote student behavior. The guide includes concert recommendations and indicates the quality of the evidence that supports them. Additionally, we have described some ways in which each recommendation could be carried out. For each recommendation, we also acknowledge roadblocks to implementation that may be encountered and suggest solutions that have the potential to circumvent the roadblocks. Finally, technical details about the studies that support the recommendations are provided in the Appendix. Download a free copy at: http://ies.ed.gov/pubsearch/pubsinfo.asp?pubid=WWC2008012 School-Based Mental Health: An Empirical Guide for Decision-Makers Krista Kutash, Ph.D., Albert J. Duchnowski, Ph.D., Nancy Lynn, M.S.P.H. This monograph provides a discussion of barriers to school-based services with the intention of improving service effectiveness and capacity. Reviews the history of mental health services supplied in schools, implementation of services and provides an overview of the evidence base for school-based interventions. Includes recommendations for evidence-based mental health services that can be used in schools. Download a free copy at: http://rtckids.fmhi.usf.edu/rtcpubs/study04/ Or purchase a printed copy for $5.95 at https://fmhi.pro-copy.com/ 97