a session presented at the il school mental health conference:
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Interconnecting School Mental Health & School-wide Positive Behavior Support Lucille Eber, IL PBIS Network [email protected]. A Session presented at the IL School Mental Health Conference: Families, Schools, and Communities Working Together to Improve Student Mental Health - PowerPoint PPT PresentationTRANSCRIPT
Interconnecting School Mental Health & School-wide Positive Behavior Support
Lucille Eber, IL PBIS Network
A Session presented at the IL School Mental Health Conference:
Families, Schools, and Communities Working Together to Improve Student Mental Health
June 26-27, 2012
Advancing Education Effectiveness: Interconnecting School Mental Health
& School-wide Positive Behavior Support
June 2012 – September 2013
Collaborative effort of the OSEP TA Center of PBIS, Center for School Mental Health, and IDEA Partnership bringing together national-level experts in the areas of SMH and PBIS, state and district leaders, and selected personnel from exemplar sites currently implementing collaborative initiatives to:Define the common goals of SMH and PBISDiscuss the advantages of interconnectionIdentify successful efforts to implement collaborative strategies and cross-initiative effortsDefine the research, policy, and implementation agendas that are needed to take current lessons learned to the next action levelPublish a monograph that provides a summary and framework for interconnection, documents examples of success, and lays out a research, policy, and technical assistance agenda for the future
Today’s Session:
The Interconnected Systems Framework (ISF) concept/paper (2009)
A Developing Monograph on SMH/PBIS Interconnection being produced by 3 national Centers
Local examples Next Steps…
OutcomesDefine the common goals of SMH and PBISDiscuss the advantages of interconnectionIdentify successful efforts to implement collaborative strategies and cross-initiative effortsDefine the research, policy, and implementation agendas that are needed to take current lessons learned to the next action levelPublish a monograph that provides a summary and framework for interconnection, documents examples of success, and lays out a research, policy, and technical assistance agenda for the future
June 2012 – September 2013
The Developing Monograph….
Center for School Mental Health* University of Maryland School of Medicine
http://csmh.umaryland.edu*Supported by the Maternal and Child Health Bureau of HRSA
and numerous Maryland agencies
A National Community of Practice (COP); www.sharedwork.org
CSMH and IDEA Partnership (www.ideapartnership.org) providing support
30 professional organizations and 16 states 12 practice groups Providing mutual support, opportunities for
dialogue and collaboration Advancing multiscale learning
Application
Implementation Science Intervention v. Implementation
Tiered Framework CoP
Chapter Outline
Preface: Al Duchnowski
Chapter 1: Introductory Chapter
Mark Weist, Joanne Cashman, Susan Barrett, Lucille Eber
Chapter 2: PBIS School Mental Health Implementation Framework
George Sugai and Sharon Stephan
Chapter Outline: Break OutsChapter 3: School Level Systems
Nancy Lever and Bob Putnam
Jill Johnson, Susan Alborell, Deanna Aister (IL)
Jennifer Parmalee (NY)
Chapter 4: School level Practices Steve Evans, Brandi Simonsen, Ginny Dolan
Pam Horn, Juli Kartel (IL) jessica Leitzel (PA)
Chapter 5: School Level Data Dan Maggin and Carrie Mills
Kelly Perales (PA) Michele Capio (IL) Helen Mae Newcomer (PA)
Chapter Outline: Break Outs
Chapter 6: Advancing the ISF in Districts/Communities Rob Horner, Mark Sander
Bob Stephens (SC), Kathy Lane (MD), Mark Vinciquerra (NY)
Jeanne Davis (IL)
Chapter 7: Advancing the ISF in statesCarl Paternite , Erin Butts
Carol Ewen (MT) Jim Palmiero (PA) Sheri Leucking (IL)
Chapter Outline
Chapter 8: Federal Investment in SWPBIS and SMH Renee Bradley, OSEP, Joanne Cashman, NASDE, and Trina Anglin,
MCHB
Chapter 9: Building Policy Support for SWPBIS and SMH Joanne Cashman, NASDE, Consider reaching out to school-based
professional organizations as part of this – NASP, ASHA, SSWA, and policy specialists
Chapter 10: Commentaries on ISF and important directions for its advancement (Policy, Research, messages for federal level staff)
Marc Atkins, University of Illinois
Kimberly Hoagwood, Columbia University
Krista Kutash, University of South Florida
ISF Monograph Next Steps
Chapter drafts developed (June-Jan) Solicit additional exemplars for appendix
from advisory group (July-Oct) Share drafts with Advisory group (Feb?) Next webinar with Advisory Group
(March?) Complete Monograph (September 2013?)
A Quick History…
Interconnected Systems Framework paper
(Barrett, Eber and Weist , revised 2011)
Developed through a collaboration of theNational SMH and National PBIS Centers
www.pbis.org http://csmh.umaryland.edu And Lisa Betz, The IL Department of Human Services, Division of Mental health
“Expanded” School Mental Health
Full continuum of effective mental health promotion and intervention for students in general and special education
Reflecting a “shared agenda” involving school-family-community system partnerships
Collaborating community professionals (not outsiders) augment the work of school-employed staff
Positive Behavior Intervention and Support (www.pbis.org)
In 16,000 plus schools Decision making framework to guide selection
and implementation of best practices for improving academic and behavioral functioning Data based decision making Measurable outcomes Evidence-based practices Systems to support effective implementation
ISF: Key Emphases
Developing interdisciplinary and cross-system relationships moving toward real collaboration
Strong stakeholder and especially family and youth engagement
“Achievable” use of evidence-based practices Data-based decision making Focus on valued outcomes and continuous
quality improvement of all processes
SMH and PBIS Framework
Selective Prevention
All Students
5-15%
1-5%
Universal PreventionRelationship Development
Systems for Positive BehaviorDiverse Stakeholder Involvement
Climate Enhancement
Targeted Individual, Group, Family Intervention
Intensive Intervention
Stages of Implementation
Exploration/Adoption Installation Initial Implementation Full Implementation Innovation Sustainability
Implementation occurs in stages:
Fixsen, Naoom, Blase, Friedman, & Wallace, 2005
2 – 4 Years
ISF, Building From 4 Stages of Implementation
EXPLORATION (e.g., identifying and organizing the most useful tools, conducting needs assessments and resource mapping)
INSTALLATION (e.g., developing interdisciplinary and cross system teams, identifying challenges and ways to overcome challenges to effective team functioning)
INITIAL IMPLEMENTATION IMPLEMENTATION
ISF, School Readiness Assessment
1) High status leadership and team with active administrator participation
2) School improvement priority on social/emotional/behavioral health for all students
3) Investment in prevention
4) Active data-based decision making
5) Commitment to SMH-PBIS integration
6) Stable staffing and appropriate resource allocation
ISF, Indicators of Team Functioning
Strong leadership Good meeting attendance, agendas and
meeting management Opportunities for all to participate Taking and maintaining of notes and the
sense of history playing out Clear action planning Systematic follow-up on action planning
Interconnected Systems Framework for School Mental Health
Tier 3: Intensive Interventions for FewIndividual 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/servicesPlans can range from one to multiple life domains
System in place for each team to monitor student progress
Tier 2: Early Intervention for SomeCoordinated 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 availableCommunication system for staff, families and community Early identification of students who may be at risk for mental health concerns due to specific risk factorsSkill-building at the individual and groups level as well as support groups
Staff and Family training to support skill development across settings
Tier I: Universal/Prevention for AllCoordinated 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
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: Universal, Secondary, and Tertiary
Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored
MH providers from both school and community develop, facilitate, coordinate and monitor all interventions through one structure
Old Approach New Approach
Each school works out their own plan with Mental Health (MH) agency;
A MH counselor is housed in a school building 1 day a week to “see” students;
No data to decide on or monitor interventions;
“Hoping” that interventions are working; but not sure.
District has a plan for integrating MH at all buildings (based on community data as well as school data);
MH person participates in teams at all 3 tiers;
MH person leads group or individual interventions based on data;
For example, MH person leads or co-facilitates small groups, FBA/BIPs or wrap teams for students.
Pause for:
Feedback from Participants:
Before we move to examples, do you have comments/observations about the proposed framework for the ISF you would like to share?
Primary Prevention:School-/Classroom-Wide Systems for
All Students,Staff, & Settings
Secondary Prevention:Specialized Group
Systems for Students with At-Risk Behavior
Tertiary Prevention:Specialized
IndividualizedSystems for Students
with High-Risk Behavior
~80% of Students
~15%
~5%
SCHOOL-WIDE POSITIVE BEHAVIOR
SUPPORT
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
Example: 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
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
Agency/School Collaboration: A Real Example
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
Agency/School Collaboration Example (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)
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
Next Steps to Consider in Moving Towards A More Blended System
• Repositioning Existing Personnel in New Roles
• Developing RtI Structures in Schools (teaming model for decision making/data review)
• Developing District/Community Teaming Models
• Specific Steps to Expedite Improved Quality of Life for our Older Youth…
Social Worker/School Psychologist
Discussion of Role Changes Questions raised by Current
Model
What data /criteria are used for determining support services?
What data /criteria are used for monitoring student progress?
What data /criteria are used for determining whether student are prepared for exiting or transitioning from support services?
Specifics Provided by Innovation
Review ODRs, CICO, grades, attendance, parent/teacher concerns
We model, reinforce, practice skills we want students to obtain (rate skill attainment)
Review ODRs, CICO, grades, attendance, parent/teacher concerns
Social Worker/School Psychologist Discussion of Role Changes
Current Model
Testing for special education eligibility
Referrals for support services not based on specific data
Proposed Changes
Facilitate team based brief FBA/BIP meetings
Act as a communication liaison for secondary / tertiary teams
Facilitate individual/family support plan meetings
Team Structure for Core District/Community Leadership Team
District/ Community Leadership
Team
Integration Workgroup
SEL, RtI, PBIS, Mental Health,
SSHS grant
Data AssessmentWorkgroup
Tier 3/Tertiary Workgroup
Transitions:JJ, Hospitals,
From school to school
Possible Tasks/Functions of Core Leadership Team:
Developing a three tiered support network that integrates schools and communities
Review data for community and school planning Develop a consistent mission for mental
wellness for all youth Address re-positioning staff for more integrated
support systems Assess how resources can be used differently Creating integrated system, procedures and
protocols Community and District resource mapping
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
Example: 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 re-integrate over ten students who were attending an off site school, at a cost savings of over $100,000
pause forFeedback from Participants:
Have you observed/experienced
Examples of or movement towards more integrated mental
health through structures/systems in schools?
A quick examples of proposed exemplar for the developing manual….
Family and Community Involvement in District-Wide Implementation of SWPBIS: A
Panel Discussion
Montrose Area School District
NHS Human Services of N.E. PA
Penn State University
Community Care Behavioral Health
Family and Community Involvement in District-Wide Implementation of
SWPBIS: A Panel DiscussionMontrose Area School District
NHS Human Services of N.E. PAPenn State University
Community Care Behavioral Health
May 23, 2012PA PBS Implementer’s Forum
Jan Cohen – Penn State Extension/Integrated Children’s Services Planning
Mike Ognosky, Chris McComb, and Greg Adams – Montrose Area School District
Michael Lynch and Erin Stewart, NHS Human Services
Judy Ochse – Family Member/School Nurse MASD
Kelly Perales – Community Care Behavioral Health
What is ICSP?1. Family Resiliency Educator - Cost-shared position between
Penn State Extension and Susq. Co. Children & Youth. Responsibilities include Integrated Children’s Services Planning, parenting education, and other prevention/education efforts.
2. ICSP Leadership Team – Comprised of parents, community volunteers, and directors/leaders from county offices and agencies/organizations, whose role it is to oversee all ICSP work, create sub-committees/work groups, and create/implement the ICSP Plan. Members include: CYS, JPO, NHS, Trehab, MHMR, County Assistance Office, Community Care, CARES/LEARN Team, Big Brothers Big Sisters, PA Treatment & Healing, and School Districts
3. ICSP Sub-Committees/Work Groups – Needs Assessment, Health Insurance Access/Health Services, Human Services Resource Directory, Coalition of Parent Educators and Mental Health Outreach and Services
School Based Behavioral Health (SBBH) Journey
District and families participate in evaluation committee
Communication and collaboration among all stakeholder groups
Ongoing opportunities for feedback Unique features of rural implementation
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 Team Components
SBBH Service Components
District and Community Leadership Team
Quarterly meetings Stakeholder representation Implementer’s blueprint Systems, data and practices Scaling and sustainability
OutcomesChange in Family Functioning
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Change at 3 mos Change at 6 mos Change at 9 mos
Not Implementing Low Fidelity High Fidelity
Improving
OutcomesChange in Child Functioning
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Change at 3 mos Change at 6 mos Change at 9 mos
Not Implementing Low Fidelity High Fidelity
Outcomes – SDQ-PChange in Difficulties Score
-3.5
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
Change Q1 Change Q2
Not Implementing Low Fidelity High Fidelity
Outcomes – SDQ-TChange in Difficulties Score
-4.0
-3.5
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
Change Q1 Change Q2
Not Implementing Low Fidelity High Fidelity
