integrating school mental health and pbis: selecting evidence-based practices
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Integrating School Mental Health and PBIS: Selecting Evidence-based Practices. Jill Johnson Illinois PBIS Network Sharon Stephan, Ph.D. University of Maryland School of Medicine PBIS Annual Meeting October 10 th , 2013. Objectives. - PowerPoint PPT PresentationTRANSCRIPT
Jill JohnsonIllinois PBIS Network
Sharon Stephan, Ph.D.University of Maryland School of Medicine
PBIS Annual MeetingOctober 10th, 2013
Integrating School Mental Health and PBIS:
Selecting Evidence-based Practices
Objectives1. Describe at least two strategies for integrating PBIS and school mental health.
2. Name at least one evidence-based mental health practice at each level of the public health triangle.
3. Describe the difference between evidence-based manualized and modularized mental health interventions.
Center for School Mental Health
MISSIONTo strengthen the policies and programs in school mental healthto improve learning and promote success for America’s youth
• Established in 1995. Federal funding from the Health Resources and services Administration.
• Focus on advancing school mental health policy, research, practice, and training.
• Shared family-schools-community agenda.
• Co-Directors:Sharon Stephan, Ph.D. & Nancy Lever, Ph.D.http://csmh.umaryland.edu, (410) 706-0980
Our Team
SCHOOL MENTAL HEALTH – A DEFINITION
A partnership between schools and community health organizations…
Guided by youth and families.
Builds on existing school programs, services, and strategies.
Focuses on all students…
…in both general and special education
Includes a full array of programs, services, and strategies
Definition of school mental health •Involves partnership between schools and community health/mental health organizations, as guided by families and youth
•Builds on existing school programs, services, and strategies
•Focuses on all students, both general and special education
•Involves a full array of programs, services, and strategies- mental health education and promotion through intensive intervention
(Weist & Paternite, 2006)
Who provides mental health services in schools?
Research Supported Interventions Involve….
• Strong training• Fidelity monitoring• Ongoing technical assistance and coaching• Administrative support• Incentives• Intangibles
Practice in the Trenches?
• Involves NONE of these supports
What’s happening on the “front lines”?
“Some Good Stuff”• Increasing emphasis on:
– Evidence-based (research-supported) Practice (EBP)
– Outcomes– Consideration of cultural context in
development, implementation and evaluation of EBP
– Recognition of the importance of meaningfully partnering with families
– Increased emphasis on workforce development of mental health providers and educators
“Some Not-So-Good Stuff”
• Limited control/accountability of providers and services provided
• Gaps in training, particularly related to schools and evidence-based practice
• “C.O.W. Therapy” – Crisis of the Week
Challenges selecting evidence-based MH practices
• School/clinician has not:– assessed specific needs of school/students– identified target outcomes– defined “success” (of interventions)– identified a way to measure intervention fidelity
• MH interventions are often not designed for complex issues
ActivityThink of a current intervention that your district/school/organization uses to address student needs. Answer the following questions regarding said intervention:•Selection of the intervention allows for clear and measureable outcomes YES NO•The intervention provides for generalization
YES NO•The implementation of the EBP allows for the assessment of implementation fidelity
YES NO
Consumer Guide to Selecting Evidenced Based Mental Health Services
Main Components
• Assessment• Interventions Selection• Intervention Progress Monitoring
Assessment
Intervention Selection
Intervention Progress Monitoring
Potential Uses of the Tool
• To determine needs of a school/agency/community
• To determine what EBP may be most effective to address needs
• To guide the implementation of an EBP• To reflect on current EBP
– Celebrate that components are in place– Action plan on how to include necessary components
Who Can Utilize the Tool
• Building or District-level teams• Community-level teams• Joint building or district-community teams• Practitioners
Illinois ExampleReflecting on Current Evidence-based Practices
• District Leadership Team had a concern that interventions utilized by staff were not culturally relevant nor appropriate to address needs– Wanted a non-confrontation way for social
workers to reflect on their practices, lack there-of
• Tool was used at a School Social Work meeting within the district
School Social Work Meeting ResultsMean = 6
District Leader Thoughts• Partnership between school and community providers
is lacking• Implementation fidelity not addressed• Progress monitoring interventions not done
systematically• Self-assessment by social workers may not be accurate
– Budget issues– Defensive
• Example: They scored themselves 100% on culturally relevant interventions: however, students on intervention were all African-American and at-risk for change of placement
District Action Steps• Work towards school-community partnership on Strategic
Plan/District Leadership Team– Short-term goal: Quarterly, one community partner invited to school
social work meeting• Long-term goal: add community partners back on DLT• Long-term goal: each building collaborate with one community partner; add
to tiered team• Add implementation fidelity and evaluation tools to practice
– Short term goal: Strickland tools• Offer professional development/support for social workers
– Short-term goal: Use Consumer Guide, BAT, ISSET to drive school social work meetings monthly
CURRENT TRENDS AND FUTURE DIRECTIONSIN SMH
Four Themes in Quality Services
• Systematic Quality Assessment and Improvement
• Family Engagement and Empowerment
• Modular, Evidence-Based Skill Training
• Implementation Support
Quality Assessment and Improvement (QAI) Principles
• Emphasize access• Tailor to local needs
and strengths• Emphasize quality and
empirical support• Active involvement of
diverse stakeholders
• Full continuum from promotion to treatment
• Committed and energetic staff
• Developmental and cultural competence
• Coordinated in the school and connected in the community
Examples of QAI tools• School Mental Health Quality
Assessment Questionnaire (SMH-QAQ)– https://csmh.umaryland.edu
• Mental Health Planning and Assessment Template (MHPET)– www.nasbhc.org
Effectively Partnering with Families• Early focus on engagement, e.g., through candid
discussions about past experiences
• Emphasize empowerment and the potential for improvement
• Provide pragmatic support
• Emphasize mutual collaboration
• See McKay, Hoagwood
Results of using these elements
Focus on Evidence-Based Practice – “Manualized” and “Modularized”
Intervention/Indicated: Cognitive Behavioral Intervention for Trauma in Schools, Coping Cat, Trauma Focused CBT, Interpersonal Therapy for Adolescents (IPT-A)
Prevention/Selected:
Coping Power, FRIENDS for Youth/Teens, The Incredible Years, Second Step, SEFEL and DECA Strategies and Tools, Strengthening Families Coping Resources Workshops
Promotion/Universal:Good Behavior Game, PATHS to PAX, Positive Behavior Interventions and Support, Social and Emotional Foundations of Early Learning (SEFEL), Olweus Bullying Prevention, Toward No Tobacco Use
Modularized Interventions – aka “Common Elements” approaches
• Chorpita, B.F., & Daleiden, E.L. (2007). 2007 Biennial Report: Effective Psychosocial Intervention for Youth with Behavioral and Emotional Needs. Child and Mental Health Division, Hawaii Department of Health– (Reviews most important treatment foci for Anxiety,
Attention Problems, Autism, Depression, Disruptive Behavior Disorders, Substance Use, and Traumatic Stress)
Origins of the “Common Elements” Approach
39
How will I ever master all these
treatment manuals ???
Treatment Family
Treatment Protocols
Practice Elements
Illustration of Common Elements terminology
From Chorpita & Marder, 2009. UCLA Common Elements Summer Social Work Workshop
PracticeWise Resources
• www.practicewise.com• Subscription-based resources:
– PracticeWise Evidence-Based Services Database (PWEBS)
– PracticeWise Practitioner Guides– PracticeWise Clinical Dashboards– Modular Approach to Therapy for Children
(MATCH)
Example of printable PDF describing practice element:
Audience
Goals of this practice element
Steps for
using this
practice element
Clinical Dashboards• Microsoft Excel based monitoring tool
– Tracks achievement of treatment goals or other progress measures on a weekly/session basis
– Documents which practice elements were used when
• Dashboard can be customized:– Display up to 5 progress measures;– Write-in additional practice elements
• Potential uses:– Documenting session activities– Tracking client progress– Clinical supervision
Progress
Measures
Document which practice element was used when
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Implementation Support
• Focus on “indigenous” school resources• Moving beyond “Train and Hope”• Focus on:
– Interactive and lively teaching– Off and on-site coaching, performance
assessment and feedback, emotional and administrative support
– Peer to peer support – User friendliness
• see Dean Fixsen, Karen Blasé, National Implementation Research Network (NIRN)
SCHOOL MENTAL HEALTH RESOURCES…
National Community of Practice on School Behavioral Health
www.sharedwork.org • CSMH and IDEA Partnership
12 practice groups:– Connecting School Mental Health and Positive Behavior Supports– Connecting School Mental Health with Juvenile Justice and Dropout
Prevention– Education: An Essential Component of Systems of Care– Families in Partnership with Schools and Communities– Improving School Mental Health for Youth with Disabilities– Learning the Language: Promoting Effective Ways for interdisciplinary
Collaboration– Psychiatry and Schools– Quality and Evidence-Based Practice– School Mental Health and Culturally Diverse Youth– School Mental Health for Military Families– Social, Emotional, and Mental Health in Schools– Youth Involvement and Leadership
CSMH Annual Conference on Advancing School Mental Health
• 1996 Baltimore• 1997 New Orleans• 1998 Virginia Beach• 1999 Denver• 2000 Atlanta• 2002 Philadelphia• 2003 Portland, OR• 2004 Dallas*
* Launch of National Community of Practiceon School Behavioral Health
• 2005 Cleveland• 2006 Baltimore• 2007 Orlando• 2008 Phoenix• 2009 Minneapolis• 2010 Albuquerque• 2011 Charleston, SC• 2012 Salt Lake City, UT
Mark your calendars for Oct 3-5, 2013 in Crystal City-Arlington, Virginia
JOURNALS School Mental Health
• A Multidisciplinary Research and Practice Journal
• Editor-in-Chief: Steven W. Evans
• International efforts in SMH research, practice, policy and training
• Editor-in-Chief: Mark Weist• Deputy Editor: Sharon Stephan (Editor-
in-Chief, as of January 2014)
Advances in School Mental Health Promotion
Nicole Evangelista, [email protected]
Center for School Mental HealthUniversity of Maryland, BaltimoreSchool of MedicineDivision of Child and Adolescent Psychiatry737 W. Lombard St. 4th floorBaltimore, Maryland 21201(http://csmh.umaryland.eduEmail: [email protected] Phone: (410) 706-0980
Sharon Stephan, [email protected]