Advancing Education Effectiveness: Interconnecting School Mental Health and School-wide Positive

Behavior Support

Susan Barrett (sbarrett@pbismaryland.org)Joanne Cashman

(joanne.cashman@nasdse.org)Mark Weist (weist@mailbox.sc.edu)

“Advancing Education Effectiveness: Interconnecting School Mental Health and

School-wide Positive Behavior Support “

Publish 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

(available on-line October 1, 2013)

OSEP TA Center of PBIS (www.pbis.org), Center for School Mental Health (www.csmh.umaryland.edu), and

IDEA Partnership (NASDE) (www.ideapartnership.org)

Key Rationale

• PBIS and SMH systems are operating separately

• Results in ad hoc, disorganized delivery of SMH and contributes to lack of depth in programs at Tiers 2 and 3 for PBIS

• By joining together synergies are unleashed and the likelihood of achieving depth and quality in programs at all three tiers is greatly enhanced

Goal today:• Describe the Interconnected Systems Framework

(ISF)• Clarify the features of School-Wide Positive

Behavior Interventions and Supports (SWPBIS) School Mental Health (SMH) in the context of the ISF

• Describe emerging examples of ISF• Share Implementation Tools• Federal Investment and Stakeholder

Recommendations

Development of ISF

• 2002-2007: Site Development with PBIS Expansion (informal and independent)

• 2005 CoP focus on integration of PBIS and SMH• 2008: ISF White Paper: formal partnership between

PBIS and SMH• 2009- 2013 Monthly calls with implementation sites,

national presentations (from sessions to strands)• 2009-2011 Grant Submissions• June 2012- September 2013 ISF Monograph• 2012 ISF Monograph Advisory group

ISF in developmentCurrent Resources

– ISF White Paper (Barrett, Eber and Weist, 2012)– ISF Monograph (Sept 2013)– ISF Blueprint ( Jan 2014 ) – ISF webinar recordings

History-Rationale

• Sparse availability of MH providers in schools• Labels and ‘places’ confused with

interventions• Separate delivery systems (Sp.Ed., Mental

health, etc)• Minimal accountability for outcomes for most

vulnerable populations

Why Partnership Are Needed• 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

• Suicide is 4th leading cause of death among young adults

• Factors that impact mental health occur ‘round the clock’

• It is challenging for educators to address the factors beyond school

• It is challenging for community providers to address the factors in school

• Potential partners must come together in a comprehensive system

Partnerships Demand Attention to Both Services and Service Providers

• Potential partners have:o Different vocabularyo Different training traditionso Experience delivering service in different settingso Unique perspectiveso Unique ability to deliver some serviceso Shared capability to deliver specific services

• Potential Partners need:o Authentic engagement in planning and delivering a

comprehensive system

SMH and PBISCommon Purpose

• Schools supporting/promoting MH of ALL students

• Prevention, early access, interventions commensurate with level of need (vs label)

• School personnel feel confident and competent in identifying and intervening with accuracy and effectiveness

Logic

– Youth with MH needs require multifaceted education/behavior and mental health supports

– The usual systems have not routinely provided a comprehensive, blended system of support.

– Supports need to be provided in a clustered and integrated structure,

– Academic/behavior and mental health supports need to be efficiently blended

Promotion and Prevention

Simple and complex supports require integrated systems with foundation of a school-wide system

• Schools and community serve as protective factor• problem-solving teams with

school/family/youth/community voice• use of data for decision-making (screening/ selection

and monitoring/outcomes)• layers supports from the foundational/universal to the

more complex

ISF Defined– structure and process for education and mental health systems

to interact in most effective and efficient way.– key stakeholders in education and mental health system who

have the authority to reallocate resources, change role and function of staff, and change policy.

– strong interdisciplinary, cross-system collaboration.– tiered prevention logic as the overall organizer to develop an

action plan.– cross system problem solving teams that use data to decide

which evidence based practices to implement.– ongoing progress monitoring for both fidelity and impact. – active involvement by youth, families, and other school and

community stakeholders.

Structure for Developing an ISF:

A District/Community leadership that includes families, develops, supports and monitors a plan that includes:

– Community partners participating in all three levels of systems teaming in schools: 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

ISF cont.

– Key stakeholders from education and mental health are involved and these people have the authority to reallocate resources, change roles and functioning of staff, and change policy

– There is a priority on strong interdisciplinary, cross-system collaboration

Chapters in the ISF Book

• Overview• Implementation

Framework• School Level Systems• School Level Practices• Effectively Using Data

• District/Community Role

• Advancing in States• Policy, Practice and

People• Commentaries

Current Tools

• Dialogue Guides (IDEA partnership)• 4 Simple Questions (IDEA partnership)• Implementation Guides (Funding, Team,

Evaluation)• Knowledge Development Surveys• Readiness Checklist• Resource Mapping• Consumer Guide for Selecting MH practices

What have we learned?

• 10 Knowledge Development Sites• Survey

Stages of ImplementationFocusFocus StageStage DescriptionDescription

Exploration/Preparation Activities

Decision regarding commitment to adopting the program/practices and supporting successful implementation.

Installation Set up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct baseline data, develop plan.

Initial Implementation

Roll-out the practices, work out details, learn and improve before expanding to other contexts.

Full Implementation

Expand the program/practices to other locations, individuals, times- adjust from learning in initial implementation.

Sustainability/Continuous Regeneration

Make it easier, more efficient. Embed within current practices.

Steve Goodman

Common PurposeSetting Event

• Funding Source: Grant, Foundation• Crisis, Event• New leadership• Rallying around a data point

– Global Information System (protective/risk factor ratio- churches to liquor outlets)

– 360 view of our children and youthTrauma, poverty, homelessness, crime rate,

disability, other community factors

Exploration PhaseSystems Features that Created the

PathwayCommon Implementation Framework: PBIS framework is in place and expansion effort

is embraced by educators and community mental health providersAuthority: Key Opinion Leaders with decision making authority have political will to

examine current condition and make change organizational structures that promote efficiency and effectiveness (job descriptions, use of staff, teaming structure, data systems)

Equal Priority: Key Opinion Leaders promote social emotional behavioral health alongside academic achievement to achieve socially important outcomes

Flexible Funding: Fee for service includes opportunity for service providers to be paid for direct care and to serve on cross systems planning teams.

Structured Processes: Innovative tools such as Self Assessment, Resource Mapping, Dialogue Guides used to broaden knowledge and create common vision and generate solutions across range of stakeholders, educators and service providers.

Local Demonstration Sites Knowledge development sites established to learn about innovation and professional learning communities established to support staff.

Overwhelming Sense of Common Purpose: All members rally around a common purpose and common data point with a commitment for improving the lives of children and youth.

4 Simple Questions: IDEA Partnership

• Who cares about this issue and why?• What work is underway separately?

Sort by • Organization/Group• Initiative Document or Tool• Unique Vocabulary/difference in perspective• Value to Our Common Interest

• What shared work could unite us? DATA point• How can we deepen our connection?

– Interactions must be ongoing

Exploration PhaseWhat data was used to assess need?

Student Outcomes Determined: Measurable Student outcome measures (grades, special ed referral attendance, ODR, suspension, truancy, expulsion) linked to effort

Fidelity Measures: ISF team examines current use of fidelity tools (Team Implementation Checklist, School-wide evaluation tool, Benchmarks of Quality, Benchmarks for Advanced Tiers)

Social Validity: Focus groups, satisfaction surveys and other perception data used to assess need, progress monitor effort and demonstrate impact

Mental Health Data Overall review of current condition included State and District level academic and behavior data as well as community demographic information, psychiatric hospital emergency room visits, and outpatient clinic information.

Cost Benefit Analysis: Economist provide health and economic benefit on investment.

Community data : Additional data provided to provide team with 360 view of student and youth need (demographic, #of students receiving MH services, in jj instructional time for access to services, calls to crisis center)

Workforce data (ratio of service providers/support staff to student, skill/competency assessment) team reviews extent to which staff have skills and support required to implement with fidelity

Broader View: Geographic Information System

• Mapping of the locations of the schools inrelation to

• community-based resources (e.g., libraries, churches, hospitals,• community centers)• risks (e.g., alcohol outlets, crime).• community level census data (e.g., income of surrounding zip codes)

• Examine some macro-level factors related toImpact of health• Enrich the information available to the schools,as well as the research on community-levelcorrelates of school climate.

Other DatasetsPositive Assets• Parks & Playgrounds• Hospitals• Community Centers• Recreation Centers• Vacant housing• Community• Core service agencies

Disadvantage• Census (income, familystructure, population

Potential Risk Factors• Alcohol Outlets• Crime• Libraries• Religious Buildings• Fast food outlets• Lottery outlets

Exploration Phase:What current Practices are in place?

Are they effective?Community Mapping/Asset Mapping- webinar• Current inventory• Anchor to Framework• Who is being served?• Do staff have skills and support to do with

fidelity?• Do students and families benefit?

Installation Phase: SystemsWhat resources are required?

How can structures and staff be repositioned?Memorandum of Agreement: Team develops clear role and function for all implementers

(leaders willing to shift in role/allocation of time) agreements around resources and financial obligations established.

Co-coordination: Community MH providers and Educators co-lead and serve on teams across the tiers.

Multi-year Action Plan: measurable goals/outcomes established with clearly defined implementation strategies and process for tracking progress.

Single point of access: Structure and process streamlined and formalized to ensure common strength based approach and availability of services across all child serving agencies.

Decision rules for accessing supports installed across district and community. Request For Assistance common process created and used by educators and community

providers.Expand Additional sites added to original demo sites and knowledge gathering and

transfer continues.Workforce Development Cross training and training capacity led, developed and taught

by school and community based providers.Systems Coaching co-led by school and community providers with implementation

science experience.

Relationships as Strategy• 4 states represented in the 10 Knowledge

development sites crossed the interagency boundaries through Community of Practice (CoP)

• CoPs build capability and capacity across the potential partners through:o Leading by conveningo Coalescing around issueso Ensuring relevant participationo Doing work togethero Attending to the task and the relationship

Consumer Guide to Selecting Evidenced Based Mental Health Services

(Putnam et al)

Main Components

• Assessment• Interventions Selection• Intervention Progress Monitoring

Assessment

Intervention Selection

Intervention Progress Monitoring

Federal Investment• Setting the Stage : Investments over the years

• OSEP• PBIS• IDEA Partnership

• HRSAo Center for School MH

• SAMHSAo Systems of Careo Safe and Healthy Students with EDo TA Investments

• Envisioning a Comprehensive System• Policy to Practice: The Focus on Transformation

Stakeholder Perspective

• Two pictures:o strategy as envisioned o strategy as experienced

• Learning from and with the stakeholderso Survey to over 300 from ED and community

provider roleso High agreement with ISF principleso Lesser confidence in system ability to implement a

comprehensive system with multiple partners

Recommendations1. Take a landscape view2. Keep children and youth at the center of the work 3. Pay attention to identity 4. Pay attention to context 5. Aim for authentic engagement 6. Recognize the impact of authority and influence 7. Remember, in complex systems, everybody comes as

a learner8. Act! Convene and collaborate based upon the shared

values and goals of children’s mental health and education.