Transcript PBIS Maryland Mental Health Partnerships:

Mental Health Partnerships:
PBIS Maryland
Susan Barrett, Sheppard Pratt Health System
Milt McKenna, Maryland State Department of Education
Andrea Alexander, Maryland State Department of Education
Nancy Lever, University of Maryland
Sharon Grose, Harford County Public Schools
Catherine Bradshaw, Johns Hopkins University
October 13, 2006 - Rosemont, IL
Overview
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PBIS organizational structure in Maryland
Mental Health Integration Grant
School district exemplar
Summary of related initiatives
Susan Barrett
Sheppard Pratt Health System
Pennsylvania
D.C.
Maryland Organizational Model
School Level
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- Team leaders (one per school)
- Behavior Support Coaches (250+)
District Level (24)
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Regional Coordinators
State Level
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Student
467 PBIS Teams (one per school)
State Leadership Team
Classroom
School
District
State
- Maryland State Department of Education (MSDE)
- Sheppard Pratt Health System
- Johns Hopkins Center for Prevention of Youth Violence
- 24 Local school districts
- Department of Juvenile Services, Mental Health Administration
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Management Team
Advisory Group
National Level
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National PBIS Technical Assistance Center
- University of Oregon & University of Connecticut
# Trained
Cumulative Number of PBIS School
Teams and Behavior Support Coaches
by Year Trained
500
450
400
350
300
250
200
150
100
50
0
Schools Trained
Coaches
1999 2000 2001 2002 2003 2004 2005 2006
Year
Anticipated Growth
Currently 34% of MD schools trained
& 50% will be trained by 2010
800
700
600
500
400
300
200
100
0
714
644
574
504
434
364
FY 05
FY 06
FY 07
Anticipated Growth at 5%
FY 08
FY 09
FY 10
Linear (Anticipated Growth at 5%)
Milt McKenna
Maryland State Department of
Education (MSDE)
Current Energy and Efforts
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Institutionalize funding level and commitment at MSDE
- Divisions of Student Services and Special Education
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Pursue other funding opportunities
Expand and sustain green zone with high fidelity
Increase marketing and visibility
Implement yellow zone in districts that have solid green zone
and have infrastructure to expand
Continue linkage with school mental health, System of Care,
and wraparound efforts
Maryland School
Mental Health Alliance
School Mental Health
Integration Grant
History of Alliance
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U.S. Department of Education
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Call for proposals posted in April 2005
Grant Due in mid May!
Goal: “Grants for the Integration of Schools and Mental Health
Systems will provide funds to increase student access to high-quality
mental health care by developing innovative approaches that link
school systems with the local mental health system.”
History of Integration Grant
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Commitment from key local, state, and national partners to
collaborate and form an Alliance to advance schoolmental health system integration in Maryland
Strong support for children’s mental health and school
mental health in the state
A strong PBIS structure within the state and an interest in
enhancing mental health support and resources for red
and yellow zone youth
State-wide needs assessment data indicated need for additional
mental health training
Notified of award in September 2005
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1 of 20 funded projects (84 total applicants)
Andrea Alexander
Maryland State Department of
Education (MSDE)
Maryland School Mental
Health Alliance (MSMHA)
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Maryland State Department of Education
Center for School Mental Health Analysis and Action - University
of Maryland
Center for Prevention and Early Intervention - Johns Hopkins
University
Governor’s Office for Children
Maryland Assembly on School-Based Health Care
Maryland Coalition of Families for Children’s Mental Health
Maryland Department of Juvenile Services
Mental Hygiene Administration Department of Health and Mental
Hygiene
Mental Health Association of Maryland
Required Grant
Components
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Enhance collaboration between schools and mental health
systems to improve prevention, diagnosis and treatment
for students
Enhance crisis intervention, appropriate referrals and
ongoing mental health services
Training for school personnel and mental health providers
Technical assistance and consultation to the school system,
mental health agencies and families
Provide linguistically appropriate and culturally competent
services
Evaluate the effectiveness of increasing student access to
quality mental health services
Primary Grant Objectives
Aim 1: To further build a systematic state initiative for
school mental health (SMH)
Aim 2: To improve outcomes related to red and yellow
zone youth in PBIS schools through:
 Helping school staff to better identify and refer students
who could benefit from mental health services
 Enhancing mechanisms for effective communication
between schools and the mental health system to help
better integrate quality mental health care for students
 Developing training and resources to assist school staff
with creating environments that support academic,
social, and emotional learning for children with more
intensive mental health needs
Maryland School
Mental Health Alliance
For More Information About the
MSMHA and to Access Resources
Developed for the Project,
Visit Our Website:
http://www.msmha.org
Nancy Lever
University of Maryland
CSMHA
University of Maryland, Center for School
Mental Health Analysis and Action
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To strengthen the policies and programs in school mental
health to improve learning and promote success for
America’s youth
Established in 1995. Currently with a 5-year funding
cycle beginning in 2005 from HRSA with a focus on
advancing school mental health policy, research, practice,
and training.
It is our goal to develop and disseminate high quality,
user-friendly, and culturally and developmentally sensitive
materials to help foster a mental health- schools-families
shared agenda.
http://csmha.umaryland.edu, (410) 706-0980
Expanded School
Mental Health (ESMH)
Full continuum of mental health services for
children and adolescents in both regular and
special education.
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Evaluation
Treatment
Case Management
Mental Health Promotion
Prevention
Crisis Management
Consultation
ESMH augments services offered by school
hired staff and is designed to fill in gaps in
care
ESMH Outcomes
When Programs are Done Well, we can see
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Improved grades, attendance, and behavior
Decreased discipline referrals
Decreased inappropriate referrals to special
education
Decreased high intensity use of mental health
services
Improved school climate
Improved awareness of mental health issues
Three Levels of Project
Advancing linkages to and coordination
between schools and the public mental health
system, while advancing knowledge, skills, and
resources related to children’s mental health
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State
County
School
Key Structural
Components
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Management Team
Advisory Board
4 Counties
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Anne Arundel, Baltimore, Harford, St. Mary’s,
Washington
4 County Integration Teams
12 PBIS Schools
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3 per county and Demonstration Teams
County Integration Teams
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Comprised of families, educational staff, PBIS leaders,
child and adolescent mental health system
representatives, leaders from the Department of
Juvenile Services, and other community partners
Responsible for pursing improved school-mental health
system integration in their county through:
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Active communication
Needs assessment
Resource sharing
Problem solving
Demonstration Teams
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A team at each of three schools per county (12 schools)
The team includes 4-5 people most involved in the school
mental health effort in the building and have some
diversity (e.g., school administrators, social workers, school
psychologists, etc.)
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Ideally, this team can take advantage of already existing
teams (PBIS/Student Support) and an existing meeting
time.
With guidance from the county Integration team and support
from the CSMHA, these teams implemented a systematic quality
assessment and improvement (QAI) agenda
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Demonstration Project
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Presents an opportunity for 3 schools in the county to
do a very strong assessment of school mental health
programming
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Based on this assessment and on-site consultation from
the CSMHA to each of the teams, the team will
implement a quality assessment and improvement
process to advance the quality of mental health
resources and programming within the school setting
Demonstration “Team”
Process
1) How well the school coordinates mental health services
and links with available community resources
2) How well the school implements mental health services
3) How knowledgable staff are about evidence-based
practices
4) How well the school and school staff partner
effectively with families
5) Extent of exposure to training, knowledge and sense
of competency related to identifying mental health
concerns and making appropriate referrals
What does my county receive?
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Train-the-Trainer Trainings for PBIS Coaches/Leaders to Enhance
Mental Health Identification and Referral and Effective Classroom
Management for Students with Mental Health Concerns
Access to the MSMHA website
Technical Assistance/Consultation from the CSMHA and other
Management Team Agenices/Organizations
Newsletter Highlighting the Five County Initiative
A Voice in Improving Mental Health Integration into PBIS Schools
in Maryland
More Focus on Red and Yellow Zone Youth
Resources to advance mental health identification and referral and
family involvement within the school setting
Hopefully Improved Academic and Emotional/Behavioral
Outcomes
Funding, $10,000
Sharon Grose
Harford County Public Schools
District Demographics
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Number of Schools
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PBIS
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Elementary
Middle
High
Elementary
Middle
High
32
8
8
10
6
3
1
School Mental Health Integration (3)
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Special (John Archer)
Harford Technical
Alternative Education
Enrollment & Student
Characteristic (2006)
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Preschool/PreK/K 3,710
Elementary
14,698
Middle
9,315
High
12,489
Special
158
Alternative Ed
Total= 40,212
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African American 18.00%
American Indian
.56%
Asian
2.30%
Hispanic
2.90%
White
75.52%
Wealth, Expenditures, Staffing,
Length of Year (2005)
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Wealth Per Pupil
$253,036
Per Pupil Expenditures
$7,655
Instructional Staff per 1,000 Pupils
60.8
Professional Staff per 1,000 Pupils
13.4
Instructional Assistants per 1,000 Pupils 12.3
Average Length of School Day for Pupils 6.5 hours
Length of School Year for Pupils
180 days
School-Mental Health
Integration
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Goal is to improve:
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coordination and linkages between schools
and mental health systems
referral and identification of mental health
issues among students
Enhance integrated approaches to reduce
barriers to student learning
Implementation of Grant
in HCPS
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Local Goal
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Active Schools
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To integrate PBIS and school mental health
Hall’s Crossroads, Edgewood Middle School, and
William Paca/Old Post Road
District Coordination
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Representatives from each school meet with the
Children’s Mental Health Roundtable to share needs
Grant Activities
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Conduct needs assessment
Provide staff development
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help teachers and staff to identify students with mental
health needs.
give teachers and staff strategies to work with students
with mental health problems
Provide resources for staff
Provide additional resources during crisis situations
at schools
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special programs, information for parents
Nancy Lever
& Andrea Alexander
Successes
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Development of mental health trainings and resources
geared for families, teachers, and providers
Formation of state and county alliances to connect
schools and the public mental health systems
Families are engaged as advocates at every level (school,
county, state) to represent the family voice in children’s
mental health
Less fragmentation and more unification and
ownership across community agencies and schools
Challenges
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Sustainability
Geographic dispersion
Limited professional development time available
Buy-in (school systems and individual schools)
Coordination with existing groups
Incorporating the work into the school
environment/culture (not an add-on)
Lessons Learned
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Need to continually assess that the right people
are at the table
Regular meetings with school, community, and
family partners to advance the shared agenda are
essential
Connecting mental health work to advancing
academics and the success of PBIS helps to
increase buy-in at all levels
Personalizing mental health programming to
each school and community is critical
Lessons Learned (Cont.)
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School implementation and district
implementation are very different processes each
with a different focus
Buy-in at all levels of the system and in-person
introduction and ongoing connections is critical
Sustainability is a challenging and an ongoing
process that begins at the start of the project
and necessitates blended funding and creativity
The efforts of a relatively small scale project can
be a catalyst for larger scale efforts
Lessons Learned (Cont.)
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Family connectedness to schools, especially around
mental health, is a necessary component that takes time
and expertise from family advocates and advocacy
groups
Alignment with existing organizations, avoiding
duplication of efforts, and filling in gaps in services is
essential
All zones (green, yellow, and red) need to be viewed as
a priority to increase the success of PBIS
With the right people and a clear focus, anything is
possible!
Catherine Bradshaw
Johns Hopkins University
Related Research Centers
Center for the Prevention of Youth
Violence
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Funded by CDC (Phil Leaf, PI)
Focused on Baltimore City
Center for Prevention and Early
Intervention
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Funded by NIMH & NIDA (Nick Ialongo, PI)
Focused on Baltimore City
Piloting evidence-based mental health programs
Related Ongoing &
Proposed Projects
Bullying Prevention
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Using Internet to facilitate data-based decision making
Provides school teams with local data to inform school improvement plans
Evidence-based MH Programs for Non-responders
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Grant under review to determine mental health needs of non-responders
Combine school-wide PBIS with targeted programs
PBIS + FBA
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Grant under review to test combination of SW-PBIS and FBA (P. Leaf, PI)
In collaboration w/ Terry Scott
On-site technical assistance in simplified FBA
School-based Wraparound
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Combines PBIS, ESMH, and wraparound
Logic Model for the Wraparound, PBIS, and ESMH Pilot Project
INPUTS
80% School-wide
universal PBIS
implementation
Staff available to
participate in
wraparound process
Need and buy-in from
school and
community
District-level
infrastructure to
support PBIS,
wraparound, and
system integration
Multiple district, state,
agency, family, and
university
partnerships
Regional expertise in
PBIS, evidence-based
practice, family
involvement, and
crisis management
ACTIVITIES
IMPLEMENT SCHOOL-BASED
WRAPAROUND
-Assessment
-Family involvement
-Care Coordination
-Integration of services
-Mental health services
-Program placement
-Crisis planning & management
OUTPUTS
Development of
secondary and tertiary
PBIS systems
Improved crisis planning
and management
TECHNICAL ASSISTANCE
-Wraparound model
-Universal PBIS
-Evidence-based practice
-Crisis planning & management
-Community collaboration
-Family Involvement
-Mental Health Identification & Referral
LINK EXISTING AGENCIES,
SERVICES & INTIAITVES
-School-based mental health
-Community-based programs and services
-School re-entry
-Crisis management
-Core service agencies
-Children’s Cabinet Systems of Care
-MH Transformation Grant
TRAINING
Wraparound Coordinator
(Intensive wraparound training, PBIS, crisis,
community collaboration, family involvement)
Wraparound Team (Intensive wraparound
process, referral, family involvement, community
collaboration, evidence-based practice)
Community Partners (Wraparound overview,
PBIS, school-based services, crisis intervention)
Parents/Families (Wraparound overview, PBIS,
mental health & stigma)
Administrators (Integration of PBIS and
wraparound, crisis management and planning,
family involvement)
Teachers/School Staff (Mental health
identification, referral, crisis planning, family
involvement, behavior management, wraparound)
Increased linkage
protocols,
communication, &
coordination across
agencies
Further stabilization of
universal PBIS systems
Knowledge Transfer
-Skills in detecting signs and
symptoms of MH problems
-Understanding risk and
protective factors
-Managing mental health
problems in schools
-Understanding the value of
and strategies to encourage
family and community
partnerships
-Implementation of wraparound
process
-Knowledge of available
resources
OUTCOMES
Intermediate
Ultimate
Increased time on
task & opportunity
for learning
Reduction in
inappropriate
referrals for services
Reduction in office
discipline referrals
Increased academic
performance
Increased
graduation rates
and reduced high
school dropout
Reduction in need
for juvenile services
and child protective
services
Increased parental
involvement in
educational process
Increased teacherefficacy for behavior
management
Reduction of risk
factors and increase
in protective factors
in children and
adolescents
Reduction in
suspensions and
acts of school
violence
Reduced
disproportionality in
achievement &
discipline problems
Increased use of
evidence-based
practices
June 21, 2006
Maryland’s Approach to
Children's Mental Health
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System of Care
Local Access Mechanisms
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Navigation functions
Single point of access/no wrong door
Wraparound – practice model
Current Organization of
Wraparound Services & Supports
Children’s Cabinet
Governor’s Office for Children
State Agencies
(DHMH, DHR, DJS, MSDE)
Local Management Boards
Local Agency Partners
(CSA, DSS, DJS, LSS)
Children, Families and Communities
DHMH = Department of Health & Mental Hygiene
DHR = Department of Human Resources (Child Welfare)
DJS = Department of Juvenile Services
MSDE = Maryland Department of Education
CSA = Core Service Agency (local mental health)
DSS = Department of Social Services
DJS = Local/Regional Office
LSS = Local School System
Wraparound Implementation
Wraparound Funding
-develop case rate or alternate funding
mechanism for each enrolled child
Local Management Board (LMB)
Care Management Entity/Unit
(could be LMB)
-organize and manage provider network
-staff and mange referral and billing process
-responsible for quality assurance and outcome mgmt. and monitoring
Care Coordinator (could be part of Care Management Entity/Unit)
-creates child and family team and individualized treatment plan
Provider
Provider
Provider
Questions
www.pbismaryland.org
www.msmha.org