Integrating Mental Health Across All Three Tiers of SW-PBS

Lucille Eber, Statewide Director, IL PBIS NetworkKenley Wade, IL PBIS State Leadership Team Member

Jose Tores, Superintendent, Elgin School District

SW-PBS National Implementer’s ForumHyatt O’Hare Rosemont, IL

October 30-31, 2008

Session C-7

1. Why do schools need Mental Health and other community partners?

2. How can Mental Health and other community partners effectively collaborate with schools?

3. Perspectives of an Education and a Mental Health Leader.

Shared Goals

Success for all youth at school, home, community: academic/social/emotional

Safe, effective, supportive learning environments

Systemic approaches that are prevention based

Challenges : Fragmentation of efforts on behalf of youth

Lack of early interventions for students at-risk of developing MH problems

Lack of effective behavior practices in schools

Lack of data-based decision making

Low fidelity or low dosage interventions

Examples of Ineffective Practices:

Referrals to Special Education seen as the “intervention”

FBA seen as required “paperwork” vs. a needed part of designing an intervention

Interventions the system is familiar with vs. ones likely to produce an effect – (ex: student sent for insight based counseling at

point of misbehavior)

Does School-wide PBIS increase a school’s capacity to :

identify and support MH needs of students;

effectively support families in a timely manner?

A Key Question

Schools Need Partners:

MH and other agencies serving

youth/families

Families

Other community members

• Community leaders

• Policy makers

KS-IL Tertiary Demonstration Project (OSEP/ISBE)

Enhance SOC integration into SW-PBS– Wraparound practices– data-based decision-making as part of

wraparound intervention– Connect schools with MH and other

community providers– Development of strength-needs data tools– Web-based data system

Positive Behavior Interventions & Supports:

A Response to Intervention (RtI) Model

Tier 1/Universal School-Wide Assessment

School-Wide Prevention Systems

Tier 2/Secondary

Tier 3/Tertiary

SIMEO Tools: HSC-T, RD-T, EI-T

Small Group Interventions (CICO, SSI, etc)

In

terv

entio

nAssessm

en

tIllinois PBIS Network, Revised May 15, 2008Adapted from T. Scott, 2004

Group Interventions withIndividualized Focus (CnC, etc)

Simple Individual Interventions(Simple FBA/BIP, Schedule/ Curriculum Changes, etc)

Multiple-Domain FBA/BIP

Wraparound

ODRs, Attendance, Tardies, Grades,

DIBELS, etc.

Daily Progress Report (DPR) (Behavior and Academic Goals)

Competing Behavior Pathway, Functional Assessment Interview,

Scatter Plots, etc.

Summary of FY 2008SIMEO Student Demographics-Study Cohort

→ 10.3 years Mean Age

→ 70% male students

→ 45% (14) in 2-4 grade

→ 41% (18) Special Education Identified;

→ 65% (29) in General Ed Placement 100% of day

74% of students were “discharged” in June, July, August or September of School Year

Transition from middle school to high school was a time period likely to result in “discharge” from wraparound

Families in vulnerable situations were more likely to “opt out” of participation – having a family member struggling with a mental illness– having a child transition from Foster Care (where wrap was

started) back to biological family

Summary of “Discharge” Findings (n=20 students left wraparound from June-Dec.2007)

Summary of FY 2008 Office Referrals:Mean Number of Office Discipline Referrals

per SIMEO Student

6.3

3.6

0

1

2

3

4

5

6

7

8

Baseline Time 2

Office Disciplinary Referrals

N=44N=44

IL PBIS Network

Summary of FY 2008 Office Referrals:Mean Number of Office Discipline Referrals

per SIMEO Student for Students with Same Data Points

2.27

6.3

3.35

0

1

2

3

4

5

6

7

8

Baseline Time 2 Time 3

Office Disciplinary Referrals

N=19N=19 N=19

IL PBIS Network

Immediate & Sustainable Change Noted in Placement

Risk

1.3

1.78

1.5

1

1.25

1.5

1.75

2

Baseline Time2 Time 3

High Risk

Low/No Risk

(n = 19)

Wraparound-07

n =19 n=19

Why Schools Need Partnerships with Mental Health

One in 5 youth have a MH “condition”About 70% of those get no treatmentSchool is “defacto” MH providerJJ system is next level of system default1-2% identified by schools as EBDThose identified have poor outcomesSuicide is 4th leading cause of death among young

adults

We Need to Go Beyond Use of

Office discipline Referrals (ODRs)?

High rate of unidentified MH problems

Youth get identified only after “crisis” which makes it harder and more “costly” to intervene.

Capacity to go beyond ODR’s…

Apply RtI process to mental health “status”– SSBD– Teen Screen– Other?

Engage community partners and families in the 3-tiered system/process

Explore other data points to consider/pursue

Data about School “L”

High rates of poverty Students with incarcerated parents Grandparents functioning as parents Trauma experiences

– Neglect, abuse, murder/death, violence, etc

Families have history of negative school experiences

Useful Questions about School “L”

1. What information and support do teachers need to be effective?

2. What information and support do families need?

3. What services and interventions are likely to increase student’s successful engagement in instruction?

4. What other data could be helpful to this school?

Useful Questions: School “L”

4. What preventive MH interventions can be provided

• to ALL students, families, teachers? • To targeted groups (10%) of students,

families, teachers?

5. How can mental health assist schools in providing comprehensive supports to the 1-5% of students, and their families and teachers?

How can Community Agencies support SW-PBS?

Assist with gaps:– Family partnerships at all three tiers– Universal screening (beyond ODR’s)– Universal MH supports integrated into the

curriculum for all– Targeted interventions for some students

when data indicates they are at-risk– Coaching support for wraparound and

behavioral interventions

Mental Health/Community Support at the Universal Level

•Family involvement in school activities•Community outreach activities•Family support activities•School-wide events that support learning•Participate in PBIS Universal team planning•Development of community-based support networks

Promoting healthy development of all students

Mental Health/Community Support :

Examples at the targeted/tier 2 Level

• Assist on problem-solving team• Assist with classroom-based interventions• Assist with individual or group interventions• Assist with behavior support planning • Family outreach and support• Linkages with community resources• Access to clinical services for students,

families• Social support needs of students, families,

and teachers

Mental Health Involvement

with Students with Complex Needs (1-5%)

Role of Mental Health/Community Providers:• intensifies in scope and strategy• is flexibly designed per each student’s plan• reflects unique needs, culture of family

Mental Health/Community Providers:• as team facilitators, co-facilitator, or team members• linkages with community supports• provide clinical services per students’ individual plan• provide support to teachers and families

Where to begin?

• Share Information about PBIS– “Way to Go” Report– www.pbis.org– www.pbisillinois.org– Form a community leadership team

• Identify partners at the school level

• Be willing to use data and design and deliver based on a 3-tiered model

Resources: Fixen, et al, 2005.“Implementation Research: A Synthesis of the

Literature http://mim.fmhi.usf.edu

Kutash et al, 2006. “School-based Mental Health: An Empirical

Guide for Decision-Makers” http://rtckids.fmhi.usf.edu

(Bazelon Center, 2006)“Way to Go”….School Success for Children

with Mental Health Care Needs www.bazelon.org Freeman, R., Eber, L., Anderson C, Irvin L, Bounds M, Dunlap G,

and Horner R. (2006). “Building Inclusive School Cultures Using School-wide PBS: Designing Effective Individual Support Systems for Students with Significant Disabilities”. The Association for Severe Handicaps (TASH) Journal, 3 (10), 4-17. (www.pbis.org)

www.pbisillinois.org

www.pbis.org