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Integrating SMH/PBIS in Large Urban School Systems
Bob PutnamMay Institute
Raymond Palmer & Helena Rodriguez Jennifer Parmalee New York City Department of Education Onondaga Department of Mental Health
Devon Bandison Mark VinciquerraThe Visiting Nurse Service of New York Syracuse Public Schools
Linda Brown
OCM /BOCES
National PBIS Leadership ForumOctober 19, 2012Chicago, Illinois, Ph.D.
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Integrating SMH/PBIS in Large Urban School Systems
Bob PutnamMay Institute
National PBIS Leadership ForumOctober 19, 2012Chicago, Illinois, Ph.D.
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School Mental Health Partnership
More than a place for services
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Context of Urban Schools
Higher rates of Community poverty (U.S. Census Bureau, 2002) Community crime (Sampson et al; 1997, Brooks-
Gunn, 1997) Cultural and racial diversity (U.S. Census Bureau,
2002) Staff turnover (Cuban, 2001; National Commission
on Teaching and American’s Future, 2005) Low performing schools (Williams, 1996) “persistently dangerous” schools (NCLB:20 U.S.C.
7912, 2001)
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Urban Systems
Urban systems, particularly those with high rates of poverty, face multiple challenges Higher rates of problem behavior
Lower rates of academic readiness for school (Smith et al., 1994) Increased exclusionary disciplinary procedures (Fusarelli, 1999;
Winbinger et al., 2000)
The combination of these factors leads to higher dropout rates (Mayer, 1997; McLoyd, 1998) which places these students back in the community with chronic exposure to violence, drug abuse, and higher mortality rates (Lane et al; 2002)
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Need for Effective Mental health Services Almost one in five youths has a MH “condition” (New
Freedom Commission on Mental Health, 2003) and it is reported that about 70% of those get no treatment (Kataoka, Zhang & Wells; 2002).
Only one to two percent of these students are identified by schools as emotionally impaired. Often these identified students have poor outcomes. (National Center for Children in Poverty, 2006)
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Interconnected Systems Framework (ISF)
Strategy for interconnection of two systems across multiple tiers
Strong team planning and actions at each tier 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
Eber, Barrett & Weist, 2011
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SYST
EMS
PRACTICES
DATASupportingStaff BehaviorSupportingStaff Behavior
SupportingStudent BehaviorSupportingStudent Behavior
OUTCOMES
Supporting Social Competence &Academic Achievement
Supporting Social Competence &Academic Achievement
SupportingDecisionMaking
SupportingDecisionMaking
Emphasize:4 IntegratedElements
Emphasize:4 IntegratedElements
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Evidenced Based Practices (EBP)
Children who received evidenced based interventions were functioning better after treatment than more than 75% of children in the control group. These changes often were found to sustain after treatment termination.
Where therapists were able to use their clinical judgment to deliver treatment as they saw fit and in which there was a comparison of their treatment to a control condition little or no changes in treatment outcomes were seen (Weisz, Sandler, Durlak & Anton; 2005).
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Evidenced Based Mental Health Treatment
American Psychological Association website http://effectivechildtherapy.com/content/ebp-options-specific-disorders
Evidenced Based Behavioral Practice website funded grant from by the National Institutes of Health http://www.ebbp.org/index.html
Kutash, Duchnowski, & Lynn, School-based mental health: An empirical guide for decision makers. http://rtckids.fmhi.usf.edu/rtcpubs/study04/SBMHfront-TOC.pdf
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“Organizations get the outcomes they are designed
to deliver”
Aubrey Daniels
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Barriers to Evidence-Based Programs in Schools Clinician Systems within a school setting Overall mental health systems
Funding/Resources
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Systems to Support the Use of EBP
Many of the school based and community partners have limited expertise.
Without staff competencies and systems (adequate training, ongoing coaching, performance feedback) on their use, these interventions will not maximize their potential benefits to students. (Fixsen, Blasé, Duda, Naoom, & Van Dyke; 2010).
Training alone, even when it is fairly intensive, appears to increase knowledge but has a limited impact on practice (Ganju, 2006).
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How to Build Clinical Capacity
Training Exposure Cross training
Coaching and performance feedback
Treatment integrity
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Systems within a School Setting
Typical school delivers, on average, 14 separate programs that broadly address social-emotional issues.
Of these programs, however, most were not empirically-based.
There was found no evidence of a systematic deployment of these programs, but rather, they seem to emerge in response to immediate pressures or trends.
(Zins, Weissberg, Wang, & Walberg; 2004)
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Evidence-Based “Manualized” interventions (from Sharon Stephan) 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 DE:CA Strategies and Tools, Strengthening Families Coping Resources Workshops
C
Promotion/UniversalGood 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
Weist, 2012
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Assessment
Intervention
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Mental Health Systems
More flexible funding More emphasis on functional outcomes that both
improve school and community functioning and support families
Early prevention – Accessing mental health services across the tiers
Schools leveraging the access of students to allow creative use of clinicians time
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Collaboration between Systems
Valuing the family as partner –wrap around (Eber) Improving effectiveness
Assessment Practices
Training and building capacity
Treatment integrity
Improving efficiency Assess to each others resources and natural resources Focusing on socially valid outcomes for students in
school, home and community
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Selecting Mental Health Interventions within a PBIS Approach
Robert Putnam, Susan Barrett, Lucille Eber, Tim Lewis and George Sugai