d11 - school mental health & pbis integration: implementation progress/examples kelly perales,...

D11 - School Mental Health & PBIS Integration: Implementation

Progress/Examples

Kelly Perales, Community Care Behavioral Health (PA)Jill Johnson, Illinois PBIS Network

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 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

Interconnected Systems Framework for School Mental Health

Tier 2: Early Intervention for Some

Coordinated 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 available· Communication system for staff, families and

community · Early identification of students who may be at risk

for mental health concerns due to specific risk factors

· Skill-building at the individual and groups level as well as support groups

· Staff and Family training to support skill development across settings

Interconnected Systems Framework for School Mental HealthTier 3: Intensive Interventions for Few

Individual 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/services

· Plans can range from one to multiple life domains

· System in place for each team to monitor student progress

Illinois

Interconnected Systems Framework Systems Features

• Exploration and Adoption• Installation Phase• Initial Implementation• Full Implementation• Innovation and Sustainability

Pathway to ISF

• Youth and Family Service Director and IL PBIS TAC passion for ISF– Relationship built four years earlier in writing a

SSHS grant in Urbana • SAMSHA grant, Champaign County• Local leaders and administrators belief in need

for integration to address all students’ needs

Systems FeaturesExploration and Adoption

• At the building level– Admin team was meeting weekly and looking at the data to determine

needs• Gaps were identified – mental health

– Administrators, Community Elements Director for Youth Services and PBIS TAC meet every 6-8 weeks together to set up system features

– Secondary Systems Team was formed

Systems Features cont…

• At community mental health agency level– Wrote for additional funding from the local United Way to help

support the implementation of the EBP practice, SPARCS, in the schools so as to relieve any financial burden on the school during the implementation stages

• Key – Having a PBIS TAC and mental health leader work as liaisons between the two systems, who believe in what is being done and work through the hard issues that arise

Organizational Structures

Administrative Team Centennial HS

&Secondary Systems

Team

LiaisonsJill & Juli

Community Elements

(United Way/708 Board/ACCESS

Installation Phase Systems Features

– Community mental health staff (Director and Program Coordinator) with the assistance of the PBIS TAC set up meetings with key school administrators (Principal, AP’s) to introduce SPARCS to them

• Follow-up meetings periodically to deal with larger system issues

– PowerPoint presentation of key program features presented to admins, school social workers, school psychologist and counselors

• Shifting of school-based staff roles/responsibilities discussed

– Discussion of potential target population and how data would be used to identify students

– Discussion on how referral process to community provider would happen and who would communicate with student’s parents

– Referral form and program flyers developed for school staff to share with parents

– One school contact person was identified for on-going communication (mostly by email) and problem solving as issues arose

• This person was key as she was responsive and reliable

– Community Elements workers were added to secondary systems team

Organizational StructuresIdentifying Students with Needs

• Data-based Decision Rules for Entrance– At Centennial, students are referred for SPARCS

because they are freshman/freshman status and• They have been through two tier two interventions and

have not responded• They are READY (alternative school) students

transitioning back to Centennial**• They have had multiple SASS contacts• Meet criteria for trauma experience as screened using

the TESI-SR (Traumatic Events Screening Inventory-Self Report)

** READY, Juvenile Detention & MH providers also providing across the community

Organizational StructuresFunding

• SAMHSA SOC Cooperative Agreement– ACCESS Initiative

• United Way of Champaign County• Medicaid billing (future)• Probation/Court Services (future

Organizational StructureAssessing Personnel Skills/Talents

• Community Elements personnel hired specifically to provide school-based supports

• School-based staff, with behavioral background, are present during group

• SPARCS trained – Ongoing support by national SPARCS trainers

Referral to Release Name to Community Elements

Referral for SPARCS

Back of Referral

School-Community PartnerInformation Sheet

Initial ImplementationSystem Features

• Secondary Systems Team meetings – Meeting twice a month

• to talk through systems response • to work through system implementation issues • to build rapport and building relationship• to communicate and implement with fidelity

• Liaisons that understand and can build relationships between the two systems

Initial ImplementationSystems Features

– The school staff initiated the referrals to the program by first identifying appropriate youth, contacting parents and receiving permission to provide student’s name to community provider

– Community mental health staff completed all intake paperwork and screenings with students/families and subsequent follow-up information

– School staff made sure each student arrived to the group on time– Community mental health works facilitated groups and one school

social worker sat in on the groups to assist with any issues as they may be related to school policy and staying connected with the students

– School staff tracked data to report at year end

OutcomesSchool Data – Office Discipline Referrals

Student 1 Student 2 Student 3 Student 4 Student 50

1

2

3

4

5

6

7

8

9

10

ODR Comparison 14 Weeks Before Intervention and 14 Weeks on Intervention

ODR Total 14 Weeks Before InterventionODR Total 14 Weeks On Intervention

Students

Num

ber o

f ODR

s

100%↑

23%↓ 25%↓

66%↓

45%↓

37% Re-ductionOverall

OutcomesSchool Data – In-School and Out-of-School Suspension

Total Number ISS Total Number OSS0

5

10

15

20

25

ISS and OSS 14 Weeks Before vs 14 Weeks During Intervention for Group

BeforeAfter

Offenses

Tota

l Num

ber

25% ↓

23%↓

OutcomesSchool Data – Tardies and Absences

Studen

t 1

Studen

t 2

Studen

t 3

Studen

t 4

Studen

t 50

10203040506070

Unexcused Tardies by Se-mester

First Semester Un-excused TardiesSecond Semester Unexcused Tardies

Students

Num

ber

Studen

t 1

Studen

t 2

Studen

t 3

Studen

t 4

Studen

t 505

1015202530

Absences by Semester Excused and Unexcused

First Semester AbsencesSecond Semester Absences

Students

Num

ber

OutcomesSchool Data - Grades

A B C D F012345

Student 1 Grades by Se-mester

Total Semester 1Total Semester 2

Grades

Num

ber

A B C D F0

1

2

3

4



Grades

Num

ber

A B C D F012345



Grades

Num

ber

A B C D F0246

Student 3 Grades by Semester


Grades

Num

ber

A B C D F0

4

Student 5 Grades by Semester


GradesN

umbe

r

Staff Feedback

• Mental Health Providers– Positives

• Being part of Tier II team helpful• Having school staff facilitate arrival/departures from

group very helpful

– Future Improvements• Need to improve communication with school staff

when events occur with students in group• Having one dedicated administrator is essential to

coordination• Need more time prior to group start to get to know

students/families

Student FeedbackStudent Survey Results

1=strongly agree 2=disagree 3= don’t know 4=agree 5=strongly agree

Skills were helpful to me:a) Mindfulness 3.8b) Self-sooth/distract 4.4c) LET ‘M GO 4.0d) MAKE A LINK 4.2

Have used skills outsideof group 4.4

Student Feedback Continued

• What was the best part of group?“It helped me to make better choices and not get

into trouble”“That you can talk about stress level and feelings”“It allowed me to share”“It helped me to identify my sources of anger”“I liked that it had structure, that we had a lesson

plan that we followed and I liked the handbook”“Food”

Future for Full Implementation

Goals for Integration• Identify incoming freshman – service Summer 2012• Potential for multiple groups next year at Centennial; feeder middle

school, other high school and alternative high school is also beginning 2012-2013SY

• Refine data decisions for appropriate ID of students• Provide further teacher/staff training in SPARCS skills and develop plan for

further integration of skills• Utilize students to co-lead group• Build stronger parent engagement• Build sustainability plan• Universal screener – Spring 2013• Professional development plan for all staff

How Do We Get Change to Occur?Lessons Learned

• Schedule meetings with stakeholders – Bi-monthly “Secondary Systems” meetings– Monthly/Quarterly administrative meetings

• Allows all stakeholders to have voice• Keeps communication lines open

• Establish procedures and protocols• System where academic and behavior interventions linked• Create true partnerships

– Stakeholders need to be seen as viable members in both settings (team membership, professional development)

• Make interventions sustainable– Funding – Part of system of support

Pennsylvania

PAPBS Network Tertiary Demonstration Project

• Community Care as affiliated partner in the PA Positive Behavior Support (PBS) Network

• History of PA SBBH Community of Practice• History of Community Care transformation of

children’s behavioral health services

Pennsylvania’s Community of Practice (CoP) on

School Based Behavioral Health (SBBH)

The CoP on SBBH was initially established in 2006 through the Bureau of Special Education (BSE) as a means by which to address school-based behavioral health.

Presently, the CoP includes membership of approximately 52 individuals including representatives from the Pennsylvania Departments of Education, Health, and Public Welfare in addition to youth serving provider agencies, managed care organizations, advocates, and youth and family members.

The Commonwealth of Pennsylvania

• Local control for counties and school districts• Behavioral health managed care organizations

– Carve out – County choice

• Community Care– Over half of the counties– Oversight from stakeholders

• Office of Mental Health and Substance Abuse Services (OMHSAS)– Systems of Care– Integrated Children’s Service Planning

39© 2010 Community Care

Pennsylvania Mental HealthContinuum of Care

Inpatient

Residential Treatment Facility (RTF)

Individualized Residential Treatment (IRT)/TFC/CCR Host Home

Behavioral Health Rehabilitation Services (BHRS)

Family Based Mental Health Services (FBMHS)

Family Based Partial Hospital School-Based Mental Health (SBMH)

Outpatient

Intensive Case Management/Resource Coordination (ICM/RC)

Crisis Services (Mobile Crisis, Emergency Room, and Walk-in Crisis Centers)

• Stakeholder input regarding current BHRS and children’s service delivery– Families– Educators– County partners – child serving systems

• Unique opportunity to partner with Department of Welfare and OMHSAS

• Transformation of children’s services– Partnership with oversight– Stakeholder input– Development of program description template


History of the Development ofSchool Based Behavioral Health (SBBH) Team Service

A Clinical Home Model

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 Service Components

CLINICAL INTERVENTIONS

CASE MANAGEMENT

CRISIS INTERVENTION

CASE CONSULTATION AND TRAININGfor educational staff

SBBH Team Components

LICENSED MASTER’S

PREP CLINICIANS

(MHP)

EXPERIENCED

BACHELOR’S PREP

WORKERS (BHW)

ADMIN AGENCY

SUPPORT

CONSULTATION TO

MHPS PRN

Community Care Support of SBBH Teams

LEARNING COLLABORATIV

ETRAINING

TECHNICAL ASSISTANC

EEVIDENCE-

BASED PRACTICES

COACHINGMODEL

FIDELITY

Learning CollaborativeA Community of Practice for Providers

• Training, case consultation, coaching – stability of workforce, integrity of practices, fidelity to model

• Platform – – Family systems theory and interventions– Resiliency/recovery principles and supports– Trauma informed care– Identification of co-occuring disorders– Positive behavior interventions and supports


District and Community Leadership Team

• Quarterly meetings• Stakeholder representation – System of Care• Implementer’s blueprint• Systems, data and practices• Scaling and sustainability

Time Line

School Year Activity

2008-09 •Community Care engaged district through ICSP regarding SBBH Team

2009-10 •SBBH Team begins work within district – September 2009•District and Community Leadership Team is established, district commitment signed, tertiary demonstration project begins – spring 2010

2010-11 •Tier One SWPBIS is fully implemented with kickoff at the start of the school year•Tier Two training begins in the spring of 2011 with some implementation

2011-12 •All three tiers are being implemented at both elementary schools•Montrose Junior High receives Tier One training in fall, with “soft” kickoff in January 2012•Discussion of SBBH Team model expanding into Junior and Senior High

1-5% 1-5%

5-10% 5-10%

80-90% 80-90%

Tertiary, Tier 3, Individual

Child Outcomes SurveyStrengths and Difficulties Q.Teacher feedbackAcademic data

Tertiary, Tier 3, Individual

• Guidance counselors see individual students• SBBH Team

Secondary, Tier 2 Group/Individual

Data from Tier One teamProgress monitoringData decision rules

Secondary, Tier 2 Group/Individual

• Guidance counselors run Targeted groups• IST• CICO• mentoring

Universal, Tier 1 Whole School ODRs, teacher nominations,Card system, MMS,

(lessons learned)

Universal, Tier 1, Whole school

• Guidance counselors teach “I Can Problem Solve” lessons• Treehab D and A awareness• Bully prevention/Character Ed• Peer Mediation

Montrose Elementary SchoolsK-6th Grade

Data Practices

Tier 3/Tertiary Interventions 1-5%1-5% Tier 3/Tertiary Interventions

•SBBH Team•Outpatient therapy•SB Partial•Guidance – individual support•SAVES/school aged mothers

Tier 2/Secondary Interventions 5-15%5-15% Tier 2/Secondary Interventions

•SAP•Guidance – groups•Community Partners – groups•Resource Officer

Tier 1/Universal Interventions80-90%

80-90% Tier 1/Universal Interventions•SWPBIS•Drug and Alcohol Prevention

School-Wide Systems for Student Success:A Response to Intervention (RtI) Model:

Resources

Illinois PBIS Network, Revised May 15, 2008. Adapted from “What is school-wide PBS?” OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. Accessed at http://pbis.org/school-wide.htm

Needs

Scranton High School

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

Impr

ovin

g

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


Impr

ovin

g

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


Impr

ovin

g

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

Impr

ovin

g


The Smith Family

• Jason was referred to the SBBH Team in November. He is a seven-year-old first grader who was having difficulty coming to school and being separated from his mother.

• When he was four, Jason and his family were in a car accident in a rural area. The members of the family were taken to different hospitals and Jason did not know where his mom was or if she was okay.

• Every day, since the first day of school, Jason’s mom would bring him into the school and the school staff would literally have to peel Jason off of his mother and hold him so she could leave.

The Smith Family cont.

• Once referred to the team, they were immediately able to work with Jason and his family to create strategies to help him separate more smoothly.

• Jason found the SBBH Team office/room a safe place to be. His mother also spent time there to help create a nice transition area.

• After the Holiday break, Jason began riding the bus for the fist time, accompanied by one of the BHWs from the team.

• Soon, Jason was able to ride the bus on his own, increasing his confidence and allowing him some relief from his anxiety.

Child Outcomes Survey (COS) Family Functioning:Child X

11/2

9/11

12/1

3/11

12/2

7/11

1/10

/12

1/24

/12

2/7/

12

2/21

/12

0

1

2

3

4

5

6

7

8

9

10

Solve Problems Shared Decisions

Leve

l of S

ucce

ss

Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child X

11/2

9/11

12/1

3/11

12/2

7/11

1/10

/12

1/24

/12

2/7/

12

2/21

/12

0

1

2

3

4

5

6

7

8

9

10

FAMILY PEERS SCHOOL TASKS ave inventory

Leve

l of S

ucce

ss

Child Outcomes Survey (COS) Overall Wellness:Child X

11/2

9/11

12/1

3/11

12/2

7/11

1/10

/12

1/24

/12

2/7/

12

2/21

/12

0

2

4

6

8

10

12

14

Day

s

Strength and Difficulties-Parent Report: Child X

11/1/11 2/1/120.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

Emotional Symptoms Conduct Problems Hyperactivity Peer ProblemsProSocial

Subs

cale

Sco

re

Strength and Difficulties-Teacher Report: Child X

11/1/11 2/1/120

1

2

3

4

5

6

7

8

9

10

Emotional Symptoms Conduct Problems Hyperactivity Peer ProblemsProSocial

Subs

cale

Sco

re

Scranton School District

Year One2009-10

Year Two2010-11

Year Three2011-12

Year Four2012-13

Year Five2013-14

Year Six2014-15

District and Community Leadership Team established. District commits to implementing SWPBIS with fidelity across the district.

SBBH Teams begin implementation at Frances Willard Elementary, George Bancroft Elementary, and Scranton High. A Tier Three support.

Frances Willard Elementary, George Bancroft Elementary, and Scranton High all receive training to implement Tier One SWPBIS.

Frances Willard Elementary, George Bancroft Elementary, and Scranton High all implement Tier One SWPBIS.

Frances Willard Elementary reaches implementation fidelity.

Frances Willard Elementary receives training for implementation of Tier Two and begins implementation.

Frances Willard Elementary implements three tiers of Interconnected Systems Framework.

Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton Intermediate all receive training to implement Tier One SWPBIS.

Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton Intermediate all implement Tier One SWPBIS.

George Bancroft Elementary and Scranton High receive training for implementation of Tier Two and begin implementation

Scranton High receives training and begins implementation of RENEW.

SBBH Teams begin implementation at Northeast Intermediate, John F. Kennedy Elementary, McNichols Plaza Elementary, and John G. Whittier Elementary.

John F. Kennedy Elementary, John G. Whittier Elementary, and Northeast Intermediate all receive training to implement Tier One SWPBIS.

John F. Kennedy Elementary, John G. Whittier Elementary, and Northeast Intermediate all implement Tier One SWPBIS.

Montrose

• Jr High implementation• SBBH and school collaboration – doing more

with less – reallocation of resources• Fiscal and clinical responsibility• Community connections and partners

– ICSP - SOC

d11 - school mental health & pbis integration: implementation progress/examples kelly perales,...

Documents

mental health concerns

school mental health

mental health administrators

school community slide

coordinated systems

secondary systems team

mental health leader

individual team