School-based Mental Health and Positive Behavioral Interventions and Supports and High Schools Maryland Safe and Supportive Schools Initiative

A Collaborative Effort of the MSDE, Sheppard Pratt Health System, and Johns Hopkins UniversitySusan BarrettDirector, PBIS Regional TTACSheppard Pratt Health System, Implementer Partner Center on PBISsbarrett@pbismaryland.org

Interconnected Systems Framework for School Mental Health

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 communitiesSocial Emotional Learning curricula for all studentsSafe & caring learning environments Partnerships between school, home and the communityDecision making framework used to guide and implement best practices that consider unique strengths and challenges of each school community

MDS3 InitiativeFunding: U.S. Department of Educations Office of Safe and Healthy Students (OSHS)Number of awards: 11 states (of 33 applicants):Arizona, California, Iowa, Kansas, Louisiana, Maryland, Michigan, South Carolina, Tennessee, West Virginia and Wisconsin are S3 Grantees in the first cohortAmount: 13MLength: 4 years (October 2010-2014)Partners: MSDE, Sheppard Pratt Health System, Johns Hopkins University

MDS3 Goals1) Assess school climate, student engagement, and the school environment,2) Implement evidence-based programs (EBPs) to meet student needs, based on survey 3) Improve conditions for learning, 4) Reduce school violence and substance use, and improve student engagement and the school environment to support student learning.

Keys to 10 Year SuccessCommitment of leadership at state, district and school levelsPrivate, public, & university partnership Standards and Protocols developed and implementedINFRASTRUCTURE developed to support state and regional training capacityState-wide impact:877 schools in all 24 systems trained740 implementing Tier 1/Universal PBIS with fidelityPBIS Maryland WEBSITE and DATABASE, WIKI (www.pbismaryland.org)

Keys to 10 Year Success (cont)Ongoing Technical Assistance-Coaching Capacity (400 trained)Ongoing Evaluation/Progress Monitoring Evaluation ToolsOngoing Data Collection for Decision MakingIPI (Implementation Phases Inventory), SETs, SWIS, BOQOngoing expansion of Local School System infrastructure as numbers of schools increasestaff designation, coaches for schools, and fundingFederal Grants to support Rigorous Randomized Evaluation Activity through JHU

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USDOEs S3 School Climate Model

Using Lessons Learned to Build Next PhaseTraining must be ongoing and connected to previous and upcoming activities.High schools require additional supports to successfully launch PBIS and implement it with fidelity.Adolescent students with unmet social and emotional needs create challengesHigh schools are often unprepared to implement Tier 2 and Tier 3 interventions or to address mental health needs and resources at the local and state level have been ??Relatively few developmentally appropriate EBPs (Greenberg et al., 2001). Coaching is NECESSARY and supported by evidence (NIRN) School Liaisons need to have a small school to staff person ratio (PBIS Plus-6:1; MDS3 3:1)Need to make the Focus School condition worthwhile for those schools.

Planning and Launching MDS3MSDE , Sheppard Pratt and Johns Hopkins participated in the recruitment of school systems and schools for the Initiative.JHU developed a sustainable statewide, web-based measurement system and administered to assess school safety, student engagement, and the school environment, as reported by students, parents, and school staff.Data from the school climate surveys will be used, in combination with incident data (e.g., suspensions, truancy) from MSDE, to generate a climate (safety) score, which will be posted and used to determine the need for tailored interventions and support services. *

Maryland Safe and Supportive Schools (MDS3)Research and evaluationsustainable system to measure Administrationdisseminate outcomes to stakeholders Implementationdevelop capacity in schoolsto improve

MethodologyParticipating Schools52 high schools across the state of Maryland 10 districts: Anne Arundel, Baltimore County, Charles, Caroline, Dorchester, Somerset, Washington, Wicomico, Worcester, and Queen Annes Second cohort of up to 8 additional schools possible for spring 2012, for a total of 60 schoolsDesign 3 years (spring 2011 through summer 2014)All 52 schools participated in the data collection activities29 implementation schools who are implementing the MDS3 Initiative 23 schools are in the focus or control groupSchools were randomly assigned to these groups

3/11/2012*

Design of MDS3 Observational StudyFunded by William T. Grant Foundation4 data points, over 3 years2 data collectors (1 ASSIST and 1 SAfETy)25 classrooms per school (1500 per time point)30+ non-classroom locationsUsing handheld devices to collect dataInstrumentsAssessing School Settings: Interactions of Students & Teachers (ASSIST): Rusby et al. (2001); Cash & DebnamPraise, opportunities to respond, punishing statements, transitions, supervision, positive interactions, engagement, aggressive behavior etc.Both event based and global ratingsSchool Assessment for Environmental Typology (SAfETy): Bradshaw, Lindstrom Johnson, Milam, & Furr-HoldenFeatures of the school environment that encourage access control, surveillance, territoriality, physical maintenance, and behavioral management (e.g., disorder, substance use, broken windows)

Menu of Evidence-Based ProgramsPositive Behavioral Interventions and Supports (PBIS; Sugai & Horner, 2006)3 tiered prevention model, focused on climate and behavior managementOlweus Bullying Prevention Program (Olweus, 2007)Bullying and school climateBotvins Life Skills program (Botvin et al., 2006)Substance abuse preventionCheck-in/Check-Out (Hawken & Horner, 2003)Mentoring and behavior managementCheck & Connect (Anderson et al., 2004)Mentoring and truancy preventionCognitive Behavioral Intervention for Trauma in Schools (Kataoka et al., 2003)Focused on mental health issues (e.g., anxiety, depression)

Center for School Based Mental HealthNancy Lever and Sharon StephanLink to EBP resources specific to HSMobilize student, family, community CBITSCommunity Resource Mapping ManualCross trainCommon CalendarIncrease ISF awareness, visibility

MDS3 School Climate Model: % Time Spent on Valued Outcomes

Evidence-Based ProgramsImplemented 2010-2011

Year 1: Foundation: Applying the Tiered LogicContinuum of EBPFidelity of ImplementationTeaming StructureData SystemUniversal Screening and Decision Rules for AccessData Base Decision Making Team Problem SolvingContinuous Progress Monitoring

Evidence-Based Programs Implemented2010-2011 and 2011-2012

Evidence-Based ProgramsAnticipated Implementation for Year Two

MDS3 Data SourcesData for Decision-making:

Web-based school climate survey (students, school staff, parents)

Site visits - Health and safety of school environment

School-level records: referrals, suspensions, attendance, nurse and counselor log, academics

School-wide Evaluation Tool (SET), Individual Student Systems Evaluation Tool (ISSET)

Spring 2011 MSD3 Student Climate Survey ResultsSafety___% feel safe at school___% reported being bullied during the school year___% reported that other students try to stop bullying ___% often or very often feel sad___% reported that substance abuse is a problem at their school

Spring 2011 MSD3 Student Climate Survey ResultsSafety83.0% feel safe at school25.0% reported being bullied during the school year31.7% reported that other students try to stop bullying 20.2% often or very often feel sad64.9% reported that substance abuse is a problem at their school

Spring 2011 MSD3 Student Climate Survey ResultsEngagement___% feel they belong at school___% feel their teachers encourage them to work hard___% feel their parents are informed when they do well___% feel students of all races are treated equally

Spring 2011 MSD3 Student Climate Survey ResultsEngagement67.5% feel they belong at school81.2% feel their teachers encourage them to work hard43.9% feel their parents are informed when they do well57.9% feel students of all races are treated equally

Spring 2011 MSD3 Student Climate Survey ResultsEnvironment___% report that disruptions in the classroom get in the way of their learning___% report the school building is clean and well-maintained___% report that students who need help with their problems are able to get it at school

Spring 2011 MSD3 Student Climate Survey ResultsEnvironment60.5% report that disruptions in the classroom get in the way of their learning49.4% report the school building is clean and well-maintained63.6% report that students who need help with their problems are able to get it at school

Stages of Implementation Fixsen

FocusStageDescription

Exploration/AdoptionDecision regarding commitment to adopting the program/practices and supporting successful implementation.InstallationSet up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct audit, develop plan.Initial ImplementationTry out the practices, work out details, learn and improve before expanding to other contexts.ElaborationExpand the program/practices to other locations, individuals, times- adjust from learning in initial implementation.Continuous Improvement/RegenerationMake it easier, more efficient. Embed within current practices.

Expanding the SWPBS Implementation Blueprint

www.pbis.org*ContentSystems CoachISF Leadership TeamISF Implementation TeamFamily Community Implementation Demonstrations

Funding

Visibility

Policy

PoliticalSupport

LEADERSHIP TEAM(Coordination)

Training

Coaching

Behavioral Expertise

Evaluation

Local School/District Implementation Demonstrations

Policy: Shapes Adult BehaviorEqual priority to Social Emotional Health and WellbeingAcademic AchievementAcademic BehaviorsOrganizational SkillsTeam Problem SolvingStudy Skills

TrainingActivity Based TrainingWIIFMResource/Continuum MappingInventory current interventions, practicesService Delivery Teams- Who?organization, role and function, communication from case management to systems planning assess skills, competencies across staffData: Student List, Early Warning Systems, ODR as screening tool

Implementation Snapshots and Practice Profiles

WIIFM? Why Am I Here? How can I use this training to benefit the work I do everyday?Prioritize which topics align with your districts missionWith your schools goalsShare your thoughts at your table

Before you add one more thing.www.safetycenter.navy.mil

Resource MappingTaking InventoryLinking to Outcome/Strategic PlanHow do we support adults?How do we make sure we invest in what works with our students/youth?What data will help keep us on track?

Tier 3Tier 2Tier 1Triangle Activity:Applying the Three-Tiered Logic to Your School , District or State*Practices, Initiatives, Programs for a FEWPractices, Initiatives, Programs for SOMEPractices, Initiatives, Programs for ALL

Screening & Feedback Essential to developing effective systemsEffective systems allow for high fidelity of implementation Often overlooked

Activity: Student List Who gets access to an intervention that integrates academic/behavioral support ? Choose 6 students.

NameGrade LevelGPA last yearBehavior ReferralsCore GradesAttendanceCredits Jana92.24 ref1 D 1 F82%On TrackBlake111.303F88%-3Toby102.816 ref 1 S2D 1 F84%-2Carlos10.722 S 3 S4 F62%-4Yvonne92.72 ref2 D 1 F86%-1Lin112.301 F90%-2Maria121.916 ref 2 S4 D 1 F74%-4Doug93.12 ref1 F81%On TrackTyrone92.910 ref2 D89%On TrackSam102.413 ref2D 1 F87%-2Paul93.41 ref1 D86%On TrackTia93.702 C60%On Track

Activity: Student ListDo you have rules for access? Do you need to lower the threshold?Are there other sources of data available?Can you get access to a data dash board? What else should we know about the students? Do any staff in building have relationship with the student?What are some possible political implications of choosing the students you chose? Leads to the integrationReflect on the team dynamics

Decision Rules for Access to Advanced Tiers (and decision rules for prevention-if we can predict the trajectories , then we can prevent it from happening)

Youth has 2 Major ODRsYouth has 1 SuspensionYouth experiences more than ? minutes out of instruction Youth misses more than ? days unexcused absencesYouth drops GPA by more than ??Youth benchmark testing- McIntosh Youth- incomplete class work/homeworkAttendance (look at predictors for drop-out and school completion)Admin ReferralTeacher/Staff ReferralFamily ReferralOther:

Services and Interventions are available as soon as the student demonstrates a need

Screening: Early Warning Systems Research is clear that ninth grade is a make or break year. More students fail ninth grade than any other grade in high school, and a disproportionate number of students who are held back in ninth grade subsequently drop out (Herlihy, 2007). The most powerful predictors of whether a student will complete high school include course performance and attendance during the first year of high school (Allensworth & Easton, 2005; 2007). Therefore, systematic collection of student attendance and course performance data can be used to develop an effective early warning system that can also be tailored to local contexts. http://betterhighschools.org/ews.asp#EWS1

Relationship

Critical Features for Implementing Advanced Tiers of Support: Establish decision rules for access to the interventionExplore data and look for students in need**Refrain from grouping students with similar life circumstance (divorce/bully etc)Group based on demonstrated need- response to the life circumstance and the coping skills requiredInterventions are linked directly to the SW expectations and/or academic goalsInterventions are always available to studentsMonitor progress of student- (outcome with data in and data out)Staff are trained, receive ongoing support, and are provided feedback.

Types of Coaching: Selection and Recruitment for the Right FitCoaching for Individual Change: focus on skill development, support and performance feedback (content specific: academic, behavior)Coaching for Team/Group Change: focus on collaboration and facilitation, group dynamicsCoaching for Systems Change: focus on organizational change

Development of the Team/StaffLevel 4 High Competence, High Commitment Fluent and experienced with innovation, and comfortable with their own ability to do it well. May even be more skilled than the coach .Level 3 High Competence, Variable Commitment Experienced and capable, but may lack the confidence to go it alone, or the motivation to do it well / quickly.Level 2 Some Competence, Low Commitment May have some relevant skills, but wont be able to do the job without help. The task or the situation may be new to them.Level 1 Low Competence, High Commitment Generally lacking the specific skills required for the job in hand, but has the confidence and / or motivation to tackle it.*

Support To LeadershipListen, modelAdvocate for School-Wide Support through dataBroker Resources to Include EBPsBe a New Pair of Eyes Provide an Objective View of a SituationLead in the Direction of Sustainability

Skill/Coach for PractitionersProvide Direct Training, recruit next trainerServe as the System Level InterventionistPromote Common Language Thats ProductiveProvide ScaffoldingModel Active Listening

Facilitator/CommunicatorDevelop Effective Communication SystemsFacilitate Sharing Different Views and PerspectivesGuide Through:a. Self-Assessment of EfficiencyEvaluationNeeds Assessment Use of DataCritical Features of Systems and Programs

Coaching: % Of Time Spent w/ Each Group

Coaching: % Of Time Spent On Each Type Of Coaching

Percentage Of Time Spent On

Top Small Group Hours

Challenges

What is a School Climate Specialist? School leadership opposition Staff buy-in Lack of systems structure B.D.T.R.B. Syndrome Been Down This Road Before Involvement of whole staff

School Climate Specialists School Visits

Lessons Learned in the School Climate Specialist Role Support May Look Different From School-to-School

Expect Successes and Challenges

Healthy Debriefing Among Colleagues is Good Practice

Pushback from Schools is not Personal

Flexibility is Key in Maintaining Healthy Relationships with School Teams

Three Schools Seem to Be the Limit for Successful Implementation of EBPs

Serve as a Guide, Facilitate not Direct

Celebrate Even the Smallest of Successes

Remember You are a Guest in the School

Lessons Learned AboutEvidence-Based ProgramsLet Schools Work Within their Own TimelineFor Some Interventions (e.g., Tier 2 and Tier 3), It Is Okay to Start Small and Work the Kinks OutUtilize Data To Make Decisions about Evidence-Based ProgramsCelebrate Even the Smallest SuccessesRealize that Program Implementation Will Not Take Place the Day After TrainingWork With Whats Already in Place To Formalize or Document EBPsDont just do IT to say we do IT.

Lessons Learned about StakeholdersAdministrator Buy-In is Critical for SuccessMake Sure Team is Representative of StaffKnow Who Has the Power in the School and Work Through ThemGather Student Feedback and ParticipationFor Sustainability, Business/Community Support is ImperativeExpect Changes in Team Composition Over TimeRecognize school readiness signals in order to advance to next steps

Lessons Learned in Implementation StepsEach school is in a different phase-make sure you are also in that phase.Each stakeholder on the team has a different agenda and perspective about needs.Each member of the team will have the aha moment at different times.Implementing step 2 before step 1 will sometimes help you have a stronger team. It is okay to go back.Staff may need training in the program before they can commit and commitment is never assured.

Year 2 State Integration TeamDistrict and Community TeamCommunity Resource MappingGIS (geographic information system) mapping of the locations of the schools in relation to community-based resources (e.g., libraries, churches, hospitals, community centers) and risks (e.g., alcohol outlets, crime). We are also linking the schools with community level census data (e.g., income of surrounding zip codes). This will allow us to examine some macro-level factors related to the survey data and school-based observational data collected in the project. Data will enrich the information available to the schools, as well as the research on community-level correlates of school climate.

Year 2: CapacityRENEWCBITSSchool based team expansionImplementation BriefsISF Facilitation GuidesFunding, Tools, TeamReadiness Checklist for IntegrationISF Consumer Guide

Share Your ThoughtsQuestions?AcknowledgementsThe Elite ElevenBeth Chatfield, Kim Crawford, Lacey Hentz, Wayne Hickman, Christina Jordan, Christina Knepper, Mike Muempfer, Rebecca Piermattei, Rebecca Philbrick, Morgen Piper, Brian TureckPatti Hershfeldt, Jerry Bloom, Aniket Joshi, Muriel SmootCatherine Bradshaw, Katrina DebnamMartha Essenmacher, Mike Ford, Andrea Alexander

No significant learning occurs without a significant relationship."Dr. James Comer

Christina :Who is in the room: counties, roles etc. Intro of ourselves. *A2*A2

This initiative provides the opportunity to formally connect student achievement with the other conditions that we all understand are necessary for learning. As my Asst Sup. Says, this is about the elephant in the room.***AA **Participating schools were randomly assigned to either the Intervention or Focus condition. Intervention Schools were trained immediately, and Focus schools will participate in annual data collection and receive training at the end of the 4-year grant period. School Climate Specialists are assigned to Intervention schools and provide assistance in using data for decision making, providing ongoing coaching, training, support, and on-site technical assistance in the implementation of a continuum of evidence-based prevention programs (EBPs). Ongoing data collection, SCS intervention, District/Community Supports and State supports will contribute to sustainability.

*PBIS- BethOlweus- Rebecca- period of time 6 months or up to 1 year. SW/UniversalBotvins- Beth- Universal,CICO- WayneCheck and Connect- Rebecca CBITS- Christina- intense intervention lasts for 10 weeks for those who display symptoms of PTSD, Anxiety Depression related to trauma- DV, Nat disasters, violence 10 week session facilitated by a clinical/counselor-school/local MH agency, and student learn of their common ground, and develop coping skills to manage stress to increase their functioning in schools and everyday life.**These are the numbers of schools who implemented PBIS in the intervention group prior to the initiative 16 out of 29 schools.

*Current school year, red indicates this schools year and EBPs that schools have been trained in and are planning to implement or are implementing.*Current year, and upcoming what schools are planning to implement next year, proposed plan. *RebeccaTalk about the project design slide along withAll results are available on-line through a password protected web siteSchools and LEAs received a password to access data3 Report OptionsQuick Report all data for all schools you have access toAdvanced Report sorting functionExecutive Summary - specific itemsFrom Spring 2011Students (n=22,389) ; Staff (n=3,842) ; Parents (n=2,063)

*Would predicting results increase rate of return?*3 separate slides and make it disappear and click on it.*Beth3 separate slides and make it disappear and click on it.*Beth3 separate slides and make it disappear and click on it.*Rebecca*Rebecca*Implementation is not an event A mission-oriented process involving multiple decisions, actions, and corrections

*ChristinaPrint these on card stock - Print for all *We plan for systems to support top two tiers .Creating foundations to support the maintenance of those behaviors.*Conversation starter: This is not to be completed, just to get them started and then they can take back.Materials: Lamenated triangle poster, removable stickers, list of ebp and resources for identifying ebps*See workbookWhat do you have in place for behavior interventions for all, some, and a few? Think about this on a school-wide level and maybe think about it around one of the top behaviors in your school. Say disrespect or disruption. Think about kids down the road too-who do not respond to universal.

Be sure to make the connections to the pyramid for academics and you will always look to both the connections. Our work will be looking at what we have, what can we tweak, and what are we missing.

What are the EBPs? How are you monitoring effectiveness with data? Are there any that are really getting significant outcomes?

How will you take your staff through this process?*George & Barrett (2011)*Flags for discussionData Dashboard Multiple places to get accessdata we've used in a couple of districts. As far as academics go, they're not 100% predictors (i.e., not all students with academic deficits end up with behavior challenges), but people have been using them as flags for discussion. So if a student is flagged as "at risk" (aka deficit, tier III, red zone), their name gets raised as a possible student requiring behavior support as well. Because some students have academic problems but won't ever need behavior support, it's ok for a team/teacher to veto the need for behavior support.*Expansion of community data with GPS*This is innovation neutral. It could be for academic or behavior or the two combined.*Office referral as a universal screener*Rebecca*These are all skills we model in the school even though we are not an appointed leader*: think FBA language that teachers are not trained inmore integrated approach and overlapping their language and getting on same page with programs *Wayne/Beth*% of time across al visits**Wayne/Beth

Dont get into general situations of support SST etcjust go over the fact that we start where schools are and build from there.*Wayne/Beth

*Wayne and Beth#5 some kids have to go down the river. Have a plan and structure. Not going to happen right away. #6 Some schools are already using EBPs, but need more training and/or to formalize and set up criteria- Becky has example. #7 what George was saying this morning about starting slow, small and doing it for right reasons.*Christina7. positive nag*Rebecca*A process that utilizes the strengths of the individual, fosters his/her self determination and builds a system of care around the individual so that s/he will more likely be successful in school and other life domains

*Rebecca and all*