National PBIS Leadership ForumOctober 2013

Jennifer Parmalee, MPADirector of Children &Family ServicesOnondaga County Department of Mental Health

Linda BrownBehavior Specialist OCM BOCES

Patty ClarkDirector, Pupil Services Syracuse City School District

Lura LunkenhiemerPresident Peaceful Schools

What is Promise Zone Grant to 3 urban districts from New York State

Mental Health Agency (Office of Mental Health)

Purpose is to increase graduation rates

Goal: create replicable model that integrates community and school to best support students and their families

Syracuse City School District

Urban district in Central New York 147,000 residents 31 schools in the SCSD 5 High Schools

6 Kindergarten – 8th grade buildings6 Middle Schools (6th – 8th)10 Elementary Schools

21, 000 students 85% Free and Reduced Lunch 20% Listed as Special Education

Braid Multi-Tier Support Systems

PBIS

RtIPromise Zone

OnCare (SOC)Say Yes

TIER 3

4 Tiered Problem-Solving FrameworkAcademic Behavioral

TIER1

CORE CURRICULUM AND UNIVERSAL BEHAVIORAL

EXPECTATIONS

CORE CURRICULUM AND UNIVERSAL BEHAVIORAL

EXPECTATIONS

Core Instruction Board of Education Adopted

Core Curriculum Differentiated instruction Small guided groups Centers/stations for skill-based

practice

Core Universal Interventions • All settings, all students• Preventive, proactive• School Wide or Classroom Systems

Strategic, Targeted Interventions• Some students (at-risk)• Group or individual delivery• High efficiency/ Rapid response• Function-based logic

Strategic, Targeted Interventions• Some students• High efficiency / Rapid response• Frequent progress monitoring

SMALL GROUP, TARGETED INSTRUCTION

TIER 2

SPECIALIZED INSTRUCTION & SERVICES

INDIVIDUALIZED TARGETED

INTERVENTIONS

TIER 3

Intensive, Individually Designed Interventions• Address individual needs of student• High intensity/longer duration/daily • Individualized Learning Plan (ILP)

Intensive, Individually Designed Interventions• Individually designed behavior plan• Intense, sustainable prosocial strategies• Function-based assessments• Intense, durable strategies

T4

04/21/23

Syracuse 4-Tiered System of Support

Necessary Conversations (Teams)

CICO

SAIG

Group w. individual

feature

Complex

FBA/BIP

Universal

Support

SBIT-B Team

Tier 4

Simple

FBA/BIP

Universal

Team

WRAP

Screening Team

Plans SW & Class-wide supports

Uses Process data; determines overall

intervention effectiveness

Standing team; uses problem-solving

process for one youth at a time

Uses Process data; determines overall

intervention effectiveness

Syracuse PBIS Implementation Story Began as pilot in 2003 and then district wide

implementation in 2010 Started using SET then moved to the

Benchmark of Quality Over time schools became more

knowledgeable and therefore more critical of themselves.

2012 limited coaching support

PBIS Universal Fidelity Measures

SET 2003-2011; BoQ 2012 & 2013; Full district support 2010

Tier 2 Context 13 schools implemented screening. BAT served as a POST Training assessment. Scores for 4 different schools in one year. Fidelity at each level = 80%. Emphasis on tier 2 and 3.

Benchmarks for Advanced Tiers (BAT) 2012-2013

Schools

SCORES

By

%

Onondaga Department of Mental Health

Oversight Planning and Quality Improvement Contract Management (95 programs)

County (City) DemographicsPopulation: 454,753

(147,000)Children ages 5-19: 95,308

(32,423)

95% of funding from State Authorities (OMH, OASAS OPWDD)

Syracuse Promise Zone Mission

Match SCSD students emotional/behavioral needs with effective interventions

Keep SCSD students in class and ready to learn

Syracuse Promise Zone Increase access to Mental Health Services

in schools. Expand Outpatient Mental Health Clinic

Satellites to all schools in SCSD (10 additional sites since 2010 – 23 total)

Integrate Mental Health Clinicians into SCSD school based problem solving teams for youth at risk. (SBIT-B)

Expand access to family based care coordination services that link with the school team (current staff of 47 coordinators)

Expand access to skills based groups for youth at risk (Check In Check Out)

Syracuse Promise Zone Establish uniform school based problem

solving procedures and process to ensure right kids get right interventions at the right time. Trained 14 schools in Screening and School

Based Intervention Teams – Behavior protocols.

10 additional schools to be trained in 2013-2014

5 Keys To Implementation

MH Licensed Clinician in every school

Clinician integrate into school team

Problem Solving Teams at tier 2/3

Expand community services for youth at risk

Systems to identify and intervene with youth at risk

Problem Solving Processes Screening Team – Tier 2 - Get into interventions

fast Who is on team – Administrator, school based support

staff Decision Rules

3-5 Office Discipline Referral’s Less than 90% Attendance At- Risk Referrals from faculty/staff

SBIT-B – Tier 3 – Individualized Targeted Process Who is on team – Administrator, outpatient clinician,

school based support staff, general education teacher, Decision Rules;

6+ ODR’s Attendance At- Risk Referral from faculty/staff

Number of Schools Trained in Screening and SBIT-B

2013 - 2014

Data from Screening teams 2012-2013 Screening reviewed 571 students through

April 30, 2013

Referral to Interventions from Screening Teams made 779 referrals to Interventions

through April 30, 2013

Data from SBIT-B Teams 2012-2013 SBIT-B teams reviewed 59 students (11

schools)

Data from SBIT-B Teams 2012-2013

Outpatient Mental Health Delivery Clinics supported approximately 615 students

in 23 schools in 2012-2013 (admitted to clinic) Donate 1.5 hours a week per school Prioritize school functionality in treatment Use of classroom data to progress monitor Dedicated to delivering EBP (Trauma as

focus..TF-CBT) Consultation role on teams – support

decision making for treatment, community mental health supports,

Top 5 Reasons for Referral to MH Service as of December 2012 (N=473)

Student Engagement (Sept – Dec 2012) Individual Psychotherapy Sessions

Steps in Mental Health EBP Implementation in Schools Review current cases: reasons for referrals,

assessments Identified significant number of youth with trauma

histories and displaying symptoms of PTSD Reviewed EBP’s in area of trauma, narrowed

down to 3 Chose EBP to best meet our needs – Trauma

Focused - CBT Individual work (rather than group) Family component Relatively inexpensive Fit into the billing framework Incorporated a narrative component

Trained 12 clinicians phase 1, 60 phase 2

Evidence Based Practice in School Based Outpatient MH – TF-CBT

IS ANY OF THIS WORKING?

Out of School Suspensions – PBIS Tier 1 BOQ Measure

Change in Suspension Incidents

Per 100 Students

Compare Sept 2011

- April 2012 &

Sept 2012 - April 2013

Days of Lost Instruction – PBIS Tier 1 BOQ Measure

Change in Days of Lost Instruction

Per 100 Students

Compare Sept 2011

- April 2012 &

Sept 2012 - April 2013

Out of School Suspensions – PBIS Tier 2

Change in Suspension Incidents

Per 100 Students

Compare Sept 2011

- April 2012 &

Sept 2012 - April 2013

Days of Lost Instruction – PBIS Tier 2

Change in Days of Lost Instruction

Per 100 Students

Compare Sept 2011

- April 2012 &

Sept 2012 - April 2013

HOW DO WE KNOW IF THE INTERCONNECTION IS WORKING AND HAVING AN IMPACT?

How Should Mental Health Look in Schools?

How should the mental health system integrate into the school system What is the right amount of mental health

services/supports/focus What is the purpose and function of

interventions/services Who delivers the interventions/services How are outcomes determined

Syracuse Benchmark of Interconnected Systems Purpose: Assess Integration, Implementation

of Mental Health within the 4 Tier Structure, Treatment Integrity

Function: Teams to gather data and use in systems and practice development/enhancement at all 4 tiers

How did we develop: BOQ, Literature review, NYS SEDL Guidelines, practical experience

TIER 3

Benchmark of Interconnected Systems

TIER1School wide Social Emotional

Learning practices are communicated to families

Increase Family and Student Engagement

Staff with Mental Health Knowledge Part of Planning and

Decision Making

Mental Health First Aid delivered to faculty and staff

Universal Screening

School wide Social Emotional Learning practices are

communicated to families

Increase Family and Student Engagement

Staff with Mental Health Knowledge Part of Planning and

Decision Making

Mental Health First Aid delivered to faculty and staff

Universal Screening

TIER 2

TIER 3

T4

Mental Health Coordinator is part of Planning and Decision Making

Solicits and Prioritizes family perspective in decision making

protocol

Intervention goals focus on behavioral health challenges

impacting students

Evidence based protocols are identified as supporting mental health challenges (CICO, Coping

CAT)

Mental Health Coordinator is trained in PBIS

Second Gate of Screening process

Mental Health Coordinator is part of Planning and Decision Making

Solicits and Prioritizes family perspective in decision making

protocol

Intervention goals focus on behavioral health challenges

impacting students

Evidence based protocols are identified as supporting mental health challenges (CICO, Coping

CAT)

Mental Health Coordinator is trained in PBIS

Second Gate of Screening process

To Be Determine

d

To Be Determine

d

Family/Outpatient Clinician/Case Manager integrated into problem

solving team

School Functionality prioritized in Mental Health

intervention goals

Interventions are EBP’s

Progress is monitored using school based data

Family/Outpatient Clinician/Case Manager integrated into problem

solving team

School Functionality prioritized in Mental Health

intervention goals

Interventions are EBP’s

Progress is monitored using school based data

Lessons from Field Testing Areas of evolution of thought

Universal Screening Faculty and Staff knowledge on impact of mental

health on brain and learning Family Engagement

Results of Field Test

Results from the Field

Next Steps Field Test with non-exemplars Develop rubric for each tier to go with

questions Separate/clarify some questions to support

fidelity Match with the ISF monograph and other

learnings from exemplars at National PBIS Conference

Questions and Feedback