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CSMH Conference

Saturday Oct 1, 2016

Integrating School Mental Health PBIS:

Action Planning Companion Guide to the

SWPBS Tiered Fidelity Inventory (TFI)

www.midwestpbis.org

www.midatlanticpbis.org

(under “Mental Health” Tab)

ISF National Leadership Team�

• Susan Barrett, Director, Mid-Atlantic PBIS�sbarrett@midatlanticpbis.org �
• Lucille Eber, Director, Midwest PBIS �lucille.eber@midwestpbis.org

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• Bob Putnam, Executive Vice President of PBIS and Consultation, May Institute

bputnam@mayinstitute.org

• Kelly Perales, Director of Training and Technical Assistance PBIS/MH Integration, Midwest PBIS Network

kelly.perales@midwestpbis.org

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• Mark Weist, Professor, Clinical-Community and School Psychology, U South Carolina�weist@mailbox.sc.edu

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• Sharon Stephan, Co-Director, CSMH�sstephan@psych.umaryland.edu�
• Nancy Lever, Co-Director, CSMH�nlever@psych.umaryland.edu

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• Joni Splett, Assistant Professor, University of Florida

splett@coe.ufl.edu

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• Ashley Quell, University of South Carolina

quell@mailbox.sc.edu

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Acknowledgements

• Mark Weist, Susan Barrett, Kelly Perales
• Rob Horner & George Sugai - National PBIS TA Center
• Sharon Stephen & Nancy Lever - National Center for SMH
• Bob Putnam- May Institute
• Joanne Cashman- NASDE
• Mid-Atlantic and Midwest PBIS Network
• All the ISF Authors and participants

Content

• ISF Overview
• History, Rationale, Definition, Core Features
• Drill Down: Key themes
• Engaging stakeholders to work differently
• Establishing a structure for integrated work
• Creating a shared system
• School Level: ISF Action Planning Companion Guide
• District Level Workflow – getting started
• Application Examples and ‘Practice” with Tools

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Big Ideas

• Rationale/need for interconnected systems
• How PBIS can serve as a framework for an expanded continuum of school mental health interventions.
• How changing roles of clinicians, cross-training, and shared decision making can lead to an expanded system of behavioral health support.
• How tools can guide the development and implementation of an ISF.

Key Questions

• Can we expand the effectiveness of the school-based continuum if we include a broader group of school/community mental health providers?

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• Can we enhance the continuum with a greater array of EBP’s to meet the needs of more students with greater effectiveness ?

�Assessing “Current Status” �of Your District:

1. Just getting started with establishing a District Leadership Team?

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• Have a District Leadership Team and want to add Community Partners?

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• Already have a District and Community Leadership Team?

�Assessing “Current Status” �of your Schools:

1. Just getting started with installing PBIS?

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• Implementing PBIS, need to boost fidelity?

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• Implementing PBIS with fidelity, want to enhance with Mental Health Integration (ISF)?

HISTORY & RATIONALE

Partnerships are needed:

• One in 5 youth have a MH “condition”
• About 70% of those get no treatment
• School is “defacto” MH provider
• Juvenile Justice 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

Confusion about what constitutes effective support?

• Exclusion (or placements) seen as “intervention”
• Not so great interventions
• Confuse label and team as “ intervention”
• Confuse paperwork with intervention
• Not so great fidelity
• Not enough resources

PBIS is

• for enhancing adoption & implementation of
• of evidence-based interventions to achieve
• & behaviorally important outcomes for
• students

Framework

Continuum

Academically

All

Primary Prevention:

School-/Classroom-

Wide Systems for

All Students,

Staff, & Settings

Secondary Prevention:

Specialized Group

Systems for Students with At-Risk Behavior

Tertiary Prevention:

Specialized

Individualized

Systems for Students with High-Risk Behavior

~80% of Students

~15%

~5%

SCHOOL-WIDE

POSITIVE BEHAVIOR

SUPPORT FRAMEWORK:

• Students
• Staff
• Parents/Families

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Advantages

• Promotes effective decision making
• Improves climate & learning environment
• Changes adult behavior
• Reduces punitive approaches
• Reduces OSS and ODRs
• Improves student academic performance

Experimental Research on SWPBIS

Bradshaw, C.P., Koth, C.W., Thornton, L.A., & Leaf, P.J. (2009). Altering school climate through school-wide Positive Behavioral Interventions and Supports: Findings from a group-randomized effectiveness trial. Prevention Science, 10(2), 100-115

Bradshaw, C.P., Koth, C.W., Bevans, K.B., Ialongo, N., & Leaf, P.J. (2008). The impact of school-wide Positive Behavioral Interventions and Supports (PBIS) on the organizational health of elementary schools. School Psychology Quarterly, 23(4), 462-473.

Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of School-Wide Positive Behavioral Interventions and Supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12, 133-148.

Bradshaw, C.P., Reinke, W. M., Brown, L. D., Bevans, K.B., & Leaf, P.J. (2008). Implementation of school-wide Positive Behavioral Interventions and Supports (PBIS) in elementary schools: Observations from a randomized trial. Education & Treatment of Children, 31, 1-26.

Bradshaw, C., Waasdorp, T., Leaf. P., (2012 )Effects of School-wide positive behavioral interventions and supports on child behavior problems and adjustment. Pediatrics, 130(5) 1136-1145.

Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., & Esperanza, J., (2009). A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Journal of Positive Behavior Interventions, 11, 133-145.

Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptionality, 42(8), 1-14.

Ross, S. W., Endrulat, N. R., & Horner, R. H. (2012). Adult outcomes of school-wide positive behavior support.

Journal of Positive Behavioral Interventions. 14(2) 118-128.

Waasdorp, T., Bradshaw, C., & Leaf , P., (2012) The Impact of Schoolwide Positive Behavioral Interventions and

Supports on Bullying and Peer Rejection: A Randomized Controlled Effectiveness Trial. Archive of

Pediatric Adolescent Medicine. 2012;166(2):149-156

Bradshaw, C. P., Pas, E. T., Goldweber, A., Rosenberg, M., & Leaf, P. (2012). Integrating schoolwide Positive Behavioral Interventions and

Supports with tier 2 coaching to student support teams: The PBISplus Model. Advances in School Mental Health Promotion, 5(3),

177-193. doi:10.1080/1754730x.2012.707429

Freeman, J., Simonsen, B., McCoach D.B., Sugai, G., Lombardi, A., & Horner, ( submitted) Implementation Effects of School-wide

Positive Behavior Interventions and Supports on Academic, Attendance, and Behavior Outcomes in High Schools.

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SWPBIS Experimentally Related to:

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1. Reduction in problem behavior
2. Increased academic performance
3. Increased attendance
4. Improved perception of safety
5. Reduction in bullying behaviors
6. Improved organizational efficiency
7. Reduction in staff turnover
8. Increased perception of teacher efficacy
9. Improved Social Emotional competence

PBIS Provides a Solid Foundation…. but More is Needed…

• Many schools implementing PBIS struggle to implement effective interventions at Tiers 2 and 3

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• Youth with “internalizing” issues may go undetected

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• PBIS systems (although showing success in social climate and discipline) often do not address broader community data and mental health prevention.

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A Foundation…. but More is Needed…

• Many schools implementing PBIS struggle to implement effective interventions at Tiers 2 and 3

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• Youth with “internalizing” issues may go undetected

• Not enough staff and resources

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• PBIS systems (although showing success in social climate and discipline) often do not address broader community data and mental health prevention.

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School Mental Health�School and Community Partners�Broader Range of EBP�Emphasis on Family System�

“SMH provides a full continuum of mental health promotion programs and services in schools, including enhancing environments, broadly training and promoting social and emotional learning and life skills, preventing emotional and behavioral problems, identifying and intervening in these problems early on and providing intervention for established problems.

School mental health promotion programs should be available to all students, including those in general and special education, in diverse educational settings, and should reflect a shared agenda - with families and young people, school and community partners actively involved in building, continuously improving, and expanding them”

Need for Interconnected Systems: Challenges

Constraints on School-Employed Mental Health Staff

• Too few of them, with ratios for school psychology, counseling and social work far below recommendations of national organizations

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• Status quo, narrowed functioning of positions (e.g., school psychology – evaluation, counseling – academic advising; social work – crisis management)

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• Pressures related to “gatekeeping”

Need for Interconnected Systems: Challenges

Ad hoc and weak connections of community mental health providers to schools

• Need for community partners to be integrated into school teams;
• Need funding/support for partners to function at Tier 1 and 2, vs only “co-located” at Tier 3
• Need for systematic MOUs to clarify roles and functions of integrated teams/’work’

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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
• Monograph Advisory group
• 2015: ISF Learning Community, SOC Webinar Series
• 2016: RCT Grant awarded

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Advancing Education Effectiveness: Interconnecting School Mental Health and

School-Wide Positive Behavior Support

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Editors: Susan Barrett,

Lucille Eber and Mark Weist

pbis.org

csmh.umaryland

IDEA Partnership NASDSE

WHAT IS ISF?� �DEFINITION �CORE FEATURES, �BIG MESSAGES

An Interconnected Systems Framework

• A Structure and process for education and mental health systems to interact in most effective and efficient way.

• guided by key stakeholders in education and mental health/community systems

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

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ISF Defined

• Structure and process for education and mental health systems to interact in most effective and efficient way.

• Guided by key stakeholders in education and mental health/community systems

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

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ISF Defined

• Tiered prevention logic
• Cross system problem solving teams
• Use of data to decide which evidence based practices to implement.
• Progress monitoring for both fidelity and impact.
• Active involvement by youth, families, and other school and community stakeholders.

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ISF Core Features

• Effective teams that include community mental health providers
• Data-based decision making
• Formal processes for the selection & implementation of evidence-based practices (EBP)
• Early access through use of comprehensive screening
• Rigorous progress-monitoring for both fidelity & effectiveness
• Ongoing coaching at both the systems & practices level

What Does it Mean to Integrate?

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Change in routines and procedures?

(e.g. who needs to be available to participate in team meetings?)

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Change in how interventions are selected and monitored?

(e.g. team review of data/research vs individual clinician choice?)

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Change in language we use?

(e.g. identifying specific interventions vs generic terms such as “counseling” or “supports”?)

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Changes in Roles/functions of staff?

(e.g. clinicians coordinating/overseeing some interventions that non-clinicians deliver?)

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• Common Pitfalls
• MH counselor “sees” student at appt.

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• Clinicians only do “mental health”

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• Case management notes

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• An Interconnected MTSS
• MH person on teams all tiers

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• Contribute to integrated plan

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• Contribute to fidelity & data

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Why Integrate: PA Example

• Mental Health CSBBH Teams collect functional and behavioral outcomes to guide treatment
• Outcomes are collected from a variety of stakeholders including youth, family, and school partners
• Gathering and reporting outcomes can improve care and the activities are integrated into care

Comparison of Schools with MH/PBIS (ISF) and Schools with Only MH Teams in Schools

• Significant improvement over time for child and family functioning at all schools

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• For PBIS schools, higher report of family functioning than non PBIS schools

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• Therapeutic Alliance ratings were higher in the PBIS schools.

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© 2014 Community Care Behavioral Health Organization

G. Elementary Major ODRs per 100 Students

G. Elementary Students with 6+ ODRs

• Key Messages

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• 1. Single System of Delivery

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• 2. Access is NOT enough

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• 3. Mental Health is for ALL

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• 4. MTSS essential to install SMH

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1. Single System of Delivery

• One committed and functional team with authority guides the work, using data at three tiers of intervention
• MH participates across ALL Tiers
• Evidence Based Practices/ Programs integrated at each tier
• Symmetry (of process) at District and Building level
• District has a plan to integrate MH at all buildings
• Plan is based on community and school data
• Plan to build “social emotional” capacity across staff
• Training and Coaching in place for ALL staff (community and school employed)
• Staff are competent and confident in identifying, intervening and/or referring

2. Access is NOT enough�

All work is focused on ensuring positive outcomes for ALL children and youth and their families.

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• Interventions matched to presenting problem using data, monitored for fidelity and outcome
• Teams and staff are explicit about types of interventions students and youth receive (e.g. from “student receives counseling” to “student receives 4 coping skills group sessions)
• Skills acquired during sessions are supported by ALL staff (e.g. staff are aware that student is working on developing coping skills and provides prompts, pre-corrects, acknowledges across school day)

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Child Outcomes Survey (COS) Family Functioning (n= 285 youth 11 schools)�DATA linked to specific intervention

Child Outcomes Survey (COS) Child Functioning(n= 285 youth 11 schools):�DATA linked to specific intervention

Measuring Fidelity:�ISF Implementation Inventory

• Tool designed and piloted to measure fidelity of ISF implementation in schools
• Benefits:
• To assist school and community partners in their installation and implementation of ISF
• To assess baseline and/or ongoing progress on critical features of ISF implementation
• For action planning

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3. Mental Health is for ALL

• Positive school climate and culture serves as protective factor. Social/emotional/behavioral health addressed with same level of attention and concern as is our children’s academic and cognitive achievement.
• Social behavior skills taught and reinforced by ALL staff across ALL settings, and embedded in ALL curriculum
• Behavior examples used to explicitly teach what behaviors look like and sound like across school settings.

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EBP =Teaching Skills�(same for social/emotional as for academics)

• Define simply

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• Model/demonstrate w/ range of examples

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• Practice in range of natural settings

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• Monitor & provide positive feedback & reinforcement

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• Based on data, adjust instruction & reteach

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Where Do Specific�“MH” Interventions Fit?

• That depends on the data of the school and community

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Examples of Expanded View of data:

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• Child welfare contacts,
• Violence rates
• Incarceration rates
• Deployed families,
• Homeless families,
• Unemployment spikes

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Multiple Evidence-Based Interventions of Varying Intensity

• Install foundational interventions School-wide
• Ensuring identification, monitoring, and selection process are in place
• Identifying additional interventions that might be needed such as:
• Trauma Informed Interventions
• Coping Cat
• Check and Connect

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4. Installed and aligned with core features of MTSS framework. �

• Teams
• Data-based Decision- making
• Continuum of linked EBP’s
• Screening
• Progress monitoring
• Ongoing PD/coaching

Are these features in place (or partially/in progress) in your district?

MTSS: Teams Representative of All Stakeholders

• Integrated teams representative of all stakeholders including families and students;
• Apply data-based decision making;
• Have a formal process for selecting and implementing evidence-based practices;
• Ensure early access through comprehensive screening;
• Progress monitor for both fidelity and effectiveness;
• Ensure coaching.

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CICO

SAIG

Group w. individual

feature

Complex

FBA/BIP

Problem Solving Team

Tertiary Systems Team

Brief

FBA/BIP

Brief FBA/BIP

WRAP

RENEW

Secondary Systems Team

Plans SW & Class-wide supports

Uses Process data; determines overall intervention effectiveness

Standing team with family; uses FBA/BIP process for one youth at a time

Uses Process data; determines overall intervention effectiveness

Universal�Team

Universal Support

Family and community

Family and community

Family and community

Community

MTSS: Data-based Decision Making at Each Tier

• Fidelity and outcomes
• Adjust action plans based on data
• Blended data
• Outcome measures commensurate with complexity of presenting ‘problem’

USDOE-OSEP Tertiary Demo Project

#H326M0060010

USDOE-OSEP Tertiary Demo Project

#H326M0060010

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Tier 2/Tier 3 Tracking Tool

http://tinyurl.com/hzr9ufy

“New” Data Points to Consider? �

“I feel connected to my school”

Student Voice

MTSS: A Continuum of Evidence-Based Practices (EBP’s) linked across Tiers

• A formal process for selecting and implementing evidence-based practices
• Team process (not individual clinicians)
• Interventions linked across Tiers with dosage and specificity of interventions increasing from lower to higher tiers

Rundlett MS Pyramid of Interventions

Individualization and Intensity of

Interventions Increases

A Few Students

>5%

ALL Students

100%

Some Students

>15%

Tier 1 Interventions & Supports- Structured Behavior Interventions for all students

• PRIDE Expectation Matrix,
• PRIDE Classroom Expectations & PRIDE Classroom Lessons
• Guidance Services,
• Homeroom Guidance
• Continuum of Discipline Responses
• Student/Parent Conferences,
• Before & After School Program (21C)
• Project Success (Substance Use)

Tier 2: Behavioral Interventions & Supports- Supports for some students who struggle with meeting the expectations

• Simple Behavior Support Plans
• Simple Functional Behavioral Assessments (FBA)
• Targeted Counseling,
• Coping CAT
• Academic Seminar
• Check In/Check Out,
• Mentoring
• Recovery Room

Tier 3: Individualized Supports -Structured Interventions for the

few students with the greatest need

• Complex Functional Behavioral Assessment (FBA) and Behavior Support
• 3 R (Respectful, Relevant, Realistic) Plan(s)
• Individualized Family and Youth-Driven Planning and Support
• Community Supports (WRAP, DCYF, Mental Health, and Child and Family Services)
• Enhanced Academic Seminar

A CONTINUUM OF RESTORATIVE PRACTICES

Intensive Intervention

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Return from suspension

Administrative transfer or school crime diversion:

• Victim offender meetings
• Family/community group conferences
• Restitution

Early Intervention

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Alternatives to suspension:

• Youth/peer court
• Peer mediation
• Conflict resolution training
• Restitution

Prevention & Skill Building

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Peace-keeping circles for:

• Morning meetings
• Social/emotional instruction
• Staff meetings

Prevention & Skill Building

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• Define and teach expectations
• Establish consequence system
• Collection and use of data

Early Intervention

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• Check-in/ Check-out
• Social Skills Curricula

Intensive Intervention

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• Function-based support
• Wraparound support

A CONTINUUM OF SWPBIS PRACTICES

MTSS: Comprehensive Screening/Early Access

• Screening coordinated across all Tiers
• Screening results used by teams
• Screen for internalizing and externalizing issues

MTSS: Progress Monitoring

• Access is not enough…
• Fidelity
• Effectiveness
• Tools/process aligned with continuum
• commensurate with complexity of need/Tier
• Linked across Tiers (ensure fidelity as well as transference & generalization;)
• Linked to PD and Coaching

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MTSS: Ongoing PD/Coaching

• Ensure fluency, fidelity, effectiveness
• Adaptable structure
• Ongoing refinement of implementation
• Sustainability

Elgin U-46 School District Example�53 school buildings

• Community partners are sitting on Tier 1 and Tier 2 teams as active team members
• 20 Community Partners
• i.e: Boys & Girls Club, Police Department, Hospice, Family Services, Girl Scouts, Community Crisis Center, YMCA, etc.
• 57 providers trained in PBIS/Social Academic Instructional Groups
• Community partners regularly attend district PBIS trainings with school staff
• School district is partnering with local mental health agency to integrate restorative practices into the PBIS framework
• Community partners are facilitating interventions (i.e. social skills groups, mentoring, RENEW)
• (other ISF core features include : Universal Screening, progress monitoring student outcomes and intervention fidelity, and ongoing coaching at systems and practices levels)

Quick Reflection

• Similarities/Differences with Vision/Systems in your district?
• Does your District have a current district-level leadership team that has responsibility for overseeing/supporting MTSS in all schools?
• Are there community/family representatives on this team?

�Assessing “Current Status” �of Your District:

1. Just getting started with establishing a District Leadership Team?

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• Have a District Leadership Team and want to add Community Partners?

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• Already have a District and Community Leadership Team?

�Assessing “Current Status” �of your Schools:

1. Just getting started with installing PBIS?

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• Implementing PBIS, need to boost fidelity?

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• Implementing PBIS with fidelity, want to enhance with Mental Health Integration (ISF)?

Break!

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MISSION

The mission of the U-46 School and Community Alliance is to

create, integrate and leverage existing and new school/community

partnerships that develop a full continuum of systematic interventions

based on data. It encompasses three intervention tiers:

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• Systems for promoting healthy development and preventing problems

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• Systems for responding to problems as soon after onset as is feasible

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• Systems for providing intensive care

How to Get Started and Keep Moving Forward�

• Applying Implementation Science
• Engaging community partners
• Engaging families and youth
• Selecting EBP
• Using data to monitor fidelity and outcomes
• Increasing staff competence and confidence
• Communication with district level staff

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Social Transformation and Wayfinders

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• Ability to look at overall organization and see the way it shapes behavior and continually adjust

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The term wayfinding itself is taken from an ancient wisdom tradition that enabled Micronesian master navigators to travel vast distances on the open ocean. Using finely-tuned observations of the stars, the sun, the clouds, the ocean swells, and other signs of nature for clues as to direction and location of a vessel at sea, these master navigators were voyaging with pinpoint accuracy for thousands of years before the invention of European navigational instruments. By continuously monitoring the environment they knew where they were, relative to where they had come from. Wayfinders were the navigators who held their vessels to be fixed points on a star compass - the art and science of wayfinding enshrined in their ability to visualize a destination until it became visible on the horizon. These mental constructs ensured they did not get lost.

Integrated Thinkers�and Knowledge Management

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• From student deficit to system deficit
• Whole Child Approach
• Equal Priority
• Learning Environment
• Differentiated Instruction, Behavior Science
• Brain Development
• Impact of trauma, ADHD, hunger
• Implicit Bias
• Healthy Workforce

Tier 3

Tier 2

Tier 1

Resource Mapping:

Applying the Three-Tiered Logic to Your School

Practices, Initiatives, Programs for ALL

Practices, Initiatives, Programs for SOME

Practices, Initiatives, Programs for a FEW

Systems attend to adult learning

Implementation with fidelity is best achieved when the system intentionally creates learning and support for adults who are using the practices.

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Implementation Science

• ISF Implementation is not a single event
• A mission-oriented process involving multiple decisions, actions, and corrections- Continuous Improvement/Regeneration
• Uses stages to make the process of change doable
• Anchored to tiered framework
• Always connected to strategic plan

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The Need to Be Plan-ful:�

• Exploration-Adoption
• Installation
• Initial Implementation
• Full Implementation
• Innovation
• Sustainability

Implementation occurs in stages:

Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

Establish a Structure for Integrated Work

• Establish a “way of work”. Move away from “more is better”.
• Utilize a formal process for selection and implementation (data/practices/systems) 
• New emphasis on “sustainability” and “efficiency” have heightened attention on the need for effective systems of alignment.
• (Greenwald, Poulos, & Horner, 2015)

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New Roles to Consider: �

Coordinator

• Organizes and/or oversees the specific interventions such as CICO, Skill groups�
• Roles may include: scheduling meetings, reviewing & collecting data to share during team meetings, curriculum development, training, mentoring, etc…

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Facilitator

• Directly provides intervention support services to youth/families�
• Roles include: meeting with students for CICO, running groups, delivering mentoring support, etc.

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VS.

Engaging Stakeholders to Work Differently

• Need buy-in from all participants
• “What’s In It For Me?”
• Need a mission statement and/or common goals to “rally” around
• Helpful to look at community data in addition to school data (are there issues with substance abuse, gangs, violence, trauma, poverty, etc.)
• Need key decision makers at the table

Social Beings

• We thrive in environments that are safe, feel valued, have social connections and have the skills to be successful

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• Mental Health = Skills to navigate life social skills across settings (home, work, school, neighborhood, community) across life span

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Adaptive to fit ALL

Large Urban Districts

Small Rural

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Practice

Practice

Practice

MTSS =Core Features or Way of Work

Evidence Based= Skill acquisition across domains

• Stakeholder Based Leadership
• Training and Coaching with performance feedback
• Data to continuously monitor fidelity and impact
• Early screening with increase and adaptive supports layered and connected

Selection of EBP is a Formal Process and Routine

TOOLS that may be useful…

Monograph: Appendices

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District/Division Community Level:

• Team Implementation Planning Guide

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School Level

• Survey on School Readiness for Interconnecting Positive Behavior Interventions & Supports & School Mental Health (Anello & Weist, 2013)

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• ISF companion for TFI Action Planning

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• Consumer Guide to Selecting Evidenced Based Mental Health Services within a SWPBS model

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Interconnected Systems Framework�Action Planning Companion Guide��SW-PBS Tiered Fidelity Inventory

Purpose of the School-wide PBIS �Tiered Fidelity Inventory

• The purpose of the School-wide PBIS Tiered Fidelity Inventory is to provide an efficient and valid index of the extent to which PBIS core features are in place within a school.
• Tier I (Universal PBIS)
• Whole School Universal Prevention
• Tier II (Targeted PBIS)
• Secondary, Small Group Prevention
• Tier III (Intensive PBIS)
• Tertiary, Individual Support Prevention

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�ISF Action Planning Companion Guide to SWPBIS TFI

• The purpose is to guide action planning for integration of Mental Health into PBIS

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• Not for use in scoring the TFI
• (at this point, the ISF enhancements do not impact PBIS fidelity measures; to measure ISF fidelity, consider piloting the ISF II)

Tier I

School-wide PBIS

Tiered Fidelity Inventory

with ISF Enhancements

1.1 Team Composition

1.1 Team Composition: SMHP Example

1.2 Team Operating Procedures

Vermont Joint House/Senate Resolution �( J.R.H 6) 2013�

Whereas, following the mass shootings at the Sandy Hook Elementary School in Newtown, Connecticut, we, as a nation, have had time to reflect collectively on who we are and how best to respond to the slaughter of the innocents, and

Whereas, the General Assembly rejects the singular response of meeting force with force, and

Whereas, alternatively, the General Assembly embraces a Vermont

commitment that the mental, physical, and nutritional health of our students and their caregivers is addressed with the same level of attention and concern as is our students’ academic and cognitive achievement, and

 Whereas, Vermont schools must offer a learning environment that

encourages all students to attain mastery of academic content, to practice generosity, to experience belonging, and to realize independence in their daily lives, now therefore be it

 Resolved by the Senate and House of Representatives:

 That the tears of Sandy Hook and our nation will not fall on fallow ground but will give rise to a rededication to our goal of maintaining safe and healthy schools, and be it further

 Resolved: That the General Assembly declares Vermont to be a state in which equity, caring, and safety, both emotional and physical, are evident in all of our schools’ practices.

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School Data 🡪 Community Data Student and System level

• Academic (Benchmark, GPA, Credit accrual etc)
• Discipline
• Attendance
• Climate/Perception
• Visits to Nurse, Social Worker, Counselor, etc
• Screening from one view

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• Community Demographics
• Food Pantry Visits
• Protective and Risk Factors
• Calls to crisis centers, hospital visits
• Screening at multiple views

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1.3 Behavioral Expectations

What does our curriculum look like?

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Expectations

1. Expectations

2. NATURAL CONTEXT (Locations)

3. Rules or Specific Behaviors

Specific Behaviors + Social-Emotional Skills

Specific Behaviors + Pro-Social Skills

Specific Behaviors

• Throw paper in the waste can
• Use the right side of the stairway
• Bring all materials to class
• Keep hands, feet, and other objects to yourself

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Pro-Social Skills

• Choose kindness over being right; pick up trash even if it isn’t yours
• Encourage others; tell peer they did a good job

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Expectations

1. Expectations

2. NATURAL CONTEXT (Locations)

3. Rules or Specific Behaviors

Have a lunch plan and choose quiet or social lunch area

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Invite friends to join me

Invite those sitting alone to join in

Use my breathing technique

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Listen to my signals

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Expectations

1. Expectations

2. NATURAL CONTEXT (Locations)

3. Rules or Specific Behaviors

WALK: Invite people

who are being disrepected to

to join you and move away.

Invite those who are

alone to

join in.

STOP: Interrupt & model respect, rather than watch or join in

Stop: Interrupt,

Say “that’s not ok.”

Walk: Walk away Don’t be an audience

Talk:

REPORT to an adult

PBIS Matrix for Home

• .

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I am respectful Listen to my parents

Be truthful to my parents

Play cooperatively

Speak nicely to others

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I am responsible Put away my toys, bike, and equipment

Help with jobs at home

Follow my parents’ directions

Share Thursday folder with parents

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I am safe Play safely with others

Stay in designated areas

Stay away from strangers

Wear bike helmet and equipment

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I am prepared Finish homework and share with parent

Pack backpack at night for school the next day

Go to bed on time

Get up and get ready for school when called

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How do we help our children and youth look at differences in school, home and community?

Culturally Responsive Adaptation: Personal Matrix �(Leverson, Smith, McIntosh, & Rose, in prep)

• Aka “behavior dictionary”
• Tool to assist in “code-switching”
• The tweak:
• Take school expectations and…
• Add differences at home
• Add differences in community
• Use after tailoring expectations to students, families, and community

posters

Sustaining PBIS Implementation Community-wide

• External Coach from the community setting�
• Monthly Community-wide Leadership Team mtgs.

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• Monthly Community-wide Coaches meetings�
• Annual assessment of implementation�
• Family/Community Forum/s�
• On-going training (new summer staff at pool/park etc.)�
• Picnic and other community events

1.4 Teaching Expectations

Instructional Process for Skill Acquisition

• Academic Enablers
• -Organizational Skills
• -Study Skills
• -Group Process
• -Time Management
• Social/Emotional
• -Communication Skills
• -Healthy Relationships
• -Managing Stress
• Academic
• Content
• -Academic Standards
• -Graduation Requirements

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And…if we ask employers

“What are the skills you are looking for in a potential employee?”

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So what are the skills required to succeed in college, career and life?

How? …An Instructional Process for Academics

• DEFINE
• (TELL)
• Simplify

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• MODEL
• (SHOW)

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• PRACTICE
• In setting

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• MONITOR

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• ADJUST
• (RETEACH)
• For
• efficiency

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BE CONSISTENT

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How?... The Same Process for Social Emotional Behavior

BE CONSISTENT

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• DEFINE
• (TELL)
• Simplify

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• MODEL
• (SHOW)

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• PRACTICE
• In setting

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• MONITOR

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• ADJUST
• (RETEACH)
• For
• efficiency

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Where?... Teach in Context

…in the restrooms

…in the cafeteria

• Support staff considering the cafeteria as a place to embed services in the natural context
• Teaching how to socialize in the cafeteria
• Teaching healthy eating habits
• Team approach that involves admin, teachers, café supervisors, food service personnel, students and families

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How will we teach behavior? �When will we teach behavior?

Kick-off events

• Teaching staff, students and families the

expectations and rules

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On-going Direct Instruction

• Data-driven and scheduled designed lessons
• Pre-correction
• Re-teaching immediately after behavioral errors

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Embedding into curriculum

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Booster trainings

• Scheduled and data-driven

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Continued visibility

• Visual Displays – posters, agenda covers
• Daily announcements
• Newsletters

1.4 Teaching Expectations: WI SMHP Example

1.5 Problem Behavior Definitions

Broaden Use of Data:

Focus on Internalizing Issues

1.10 Faculty Involvement

Other Datasets�Using Census (income, family�structure, population)�

Positive Assets

• Parks & Playgrounds

• Hospitals

• Community Centers

• Recreation Centers

• Libraries

• Religious Buildings

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Potential Risk Factors

• Alcohol Outlets

• Crime

• Vacant Housing

• Fast food outlets

• Lottery/Gambling Outlets

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Belonging

Relationships and Youth Connectedness

ESSENTIAL to children’s well being.

• A sample of 2,022 students (999 boys and 1,023 girls) ages 12-14 years was measured at two time points twelve months apart on school connectedness and mental health symptoms (general functioning, depression, and anxiety symptoms). After adjusting for any prior conditions that could have led to mental health problems, the authors of the study reported stronger than previous evidence of the association with school connectedness and adolescent depressive symptoms and a predictive link between school connectedness to future mental health problems.

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• 22 Early studies suggest that there are substantial percentages of violent youth who do not perceive themselves to be liked by classmates and who report loneliness.

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(Clin, 2006 Adol Psychology)

Pause and Reflect

• Which PBIS Tier 1 feature(s) could be enhanced most easily in your school (s)?

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• How could this tool be used with your school(s)?

ADVANCED ORGANIZER:�

Which of the following Tier 2/3 enhanced features may be a good fit for implementation in your school(s)?

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• Easiest to install?
• Builds on existing strengths?
• Would provide the most impact with the least amount of effort?

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2.1 Team Composition

2.2 Team Operating Procedures

2.3 Screening

John Crocker�

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Methuen Public Schools

Methuen, MA

Comprehensive School Mental Health System

National Quality Initiative Summit

April 26, 2016

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Example – Screening for Internalizing Problems

• Two large scale screenings at Methuen High School
• GAD-7 anxiety screener (January)
• PHQ-9 depression screener (April)
• Electronic screening using Google forms
• Parent notification and opt-out process in advance
• 100% of students who required follow-up received it within 7 days of the screening

Methuen HS, cont.

• The two screenings yielded the following data:
• GAD-7 (January)
• 840 responses (approx. 45% of the high school pop.)
• 85 students scored in the severe range (10.1% of respondents)
• 104 students scored in the moderate range (12.4% of respondents)
• PHQ-9 (April)
• 853 responses (approx. 45% of the high school pop.)
• 69 students scored in the severe range (8.1% of respondents)
• 102 students scored in the moderate range (12.0% of respondents)
• 8.1% of students scored in the moderate or severe range on both screeners
• 2.3% of students scored in the severe range on both screeners

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2.5 Options for Tier II Interventions

2.6 Tier II Critical Features

2.10 Level of Use

2.11 Student Performance Data

2.12 Fidelity Data

School-wide PBIS

Tiered Fidelity Inventory

with ISF Enhancements

Tier 3

3.2 Team Operating Procedures

3.3 Screening

3.5 Staffing

3.6 Student/Family/Community Involvement

3.7 Professional Development

3.8 Quality of Life Indicators

3.11 Comprehensive Support

3.12 Formal and Natural Supports

3.14 Data System

3.15 Data-Based Decision Making

Selecting Mental Health Interventions within a PBIS Approach ��

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Which Tier? �Depends on your Data

Tier 3 – Intensive mental health supports designed to meet the unique needs of students who already display a concern or problem.

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Tier 2 – Targeted mental health supports provided �for groups of students identified as at risk for a �concern or problem.

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Tier 1 – Universal supports that all students receive. �Promoting wellness & positive life skills can �prevent or reduce mental health concerns or �problems from developing.

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Trauma-sensitive schools

Trauma-sensitive schools

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• recognize the prevalence & impact of traumatic occurrence in students’ lives &

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• create a flexible framework that provides universal supports, is sensitive to the unique needs of students & is mindful of avoiding re-traumatization.

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• Adapted from Helping Traumatized Children Learn

Nic Dibble, DPI, WI PBIS Leadership Forum 2015

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A Trauma-Informed “Core”

Kansas MTSS incorporates Positive Behavior Supports (PBIS) and Social-Emotional Learning (SEL) to:

• Teach skills
• Elevate relationships and emotional literacy
• Create safe, predictable environments

And avoid the common default mode of mere behavior compliance

Why use the PBIS framework for trauma-sensitive schools?� �The fundamental purpose of PBIS is to make schools more effective & equitable learning environments. Rob Horner, Co-Director of the OSEP Technical Assistance Center for PBIS�

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Predictable

Consistent

Positive

Safe

Department of Public Instruction Trauma-Sensitive Schools Resources�http://sspw.dpi.wi.gov/sspw_mhtrauma

Spring 2014: Identified Need

• A small (15) group of students who were asking to go to the office on a daily basis or were frequently absent.
• Most behaviors were internalizing: anxiety, withdrawal, avoidance of others.
• These were students who performed academically, not special education eligible.
• School psychologist researched small group interventions for these students.
• Found Coping Cat

Coping CAT is a Cognitive Behavioral Intervention that helps students recognize and analyze feeling related to stress and develop strategies to cope with stress provoking situations. It is an 8 week, group intervention that meets on a weekly basis for 45 minutes.

Modified Coping Cat

Coping Cat small groups (6 students) are co-facilitated by a Riverbend Community Mental Health Counselor and an RMS counselor. Student responsibilities include participating in weekly group sessions, completing homework assignments (using coping strategies), and self-monitoring progress.

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Teacher responsibilities include prompting students to use their coping strategies and a willingness to participate in professional development regarding stress management and/or anxiety. Coping Cat instructor responsibilities include implementing the Coping Cat curriculum with fidelity and monitoring student progress with students and teachers.

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Pre-post measure: Screen for Child Anxiety Related Disorders (SCARED). Birmaher, Khetarpal, Cully, Brent, & McKenzie,1995.

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Pre/Post Coping Cat�Students Report on the SCARED (n=18)

Average Number of Absences per Student (Full Days)�Pre (7 weeks prior to group); During (8 school weeks of intervention); Post (7 weeks after group)

Average Number of Visits to the Nurse (per week)�Pre (7 weeks prior to group); During (8 school weeks of intervention); Post (7 weeks after group)

Case Example # 1�8^th Grade Female Student

Tool to Shape Team Routine�Consumer Guide to Selecting Evidenced Based Mental Health Services within a SWPBS model �Robert Putnam, Susan Barrett, Lucille Eber, Tim Lewis & George Sugai� ��

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Advancing Education Effectiveness: Interconnecting School Mental Health & School-wide Positive Behavior Support, Appendix F, pages 148-9�https://www.pbis.org/common/cms/files/Current%20Topics/Final-Monograph.pdf

Take an inventory (and examine effectiveness and fidelity) of current practices

before investing in new interventions or programs.

When data indicates a need for a new initiative, consider using this guide

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Purpose

• Many schools and systems are bogged down with too many initiatives/practices and interventions that often lead to poor implementation and an overwhelmed workforce.

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• This consumer guide was designed to help integrated system teams interested in expanding the continuum of behavioral supports and mental health services to invest in formalizing a selection process.

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• It will be important for the system to take an inventory of current practices, examine effectiveness and fidelity of those current practices before investing in new interventions or programs.

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• When a data indicates a need for a new initiative, this guide, checklist and case examples should be used to determine the best fit and will also guide teams to install systems features like data decision systems as well as training and coaching features that increase intervention fidelity and positive outcomes for children, youth and families.

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Consumer Guide Logic�Guiding Questions

• Are need and intended outcome specified?
• Is the most appropriate evidence-based practice selected?
• Is practice adaptable to local context and culture?
• Is support for local implementation developed?
• Is system level continuous progress monitoring and planning in place?

Pause and Reflect

• How could this tool be used with your school(s)?

Role/Function of the DCLT

District and Community Leadership Team: Form/Expand Team Membership

Local Integration team identified (membership should include representatives from the following areas to ensure local stakeholders is fully represented).

a.) School System Student Services and Special Education Directors

b.) Local Mental Health Provider

c.) Core Service Agency’s Child and Adolescent Coordinator

d.) Juvenile Services Coordinator/Law Enforcement

e.) Coalition of Families offices

f.) Family, Youth and Community members

g.) Local Management Board representative

h.) Social Services representative other to include (where present) Youth MOVE Rep, System of Care Case Management entity or Family Navigator, community health provider, non-public special education school rep, recreation services, local health dept, board of education representative or other stakeholders identified by leadership

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Who else should be included? Can this team change job descriptions, re-allocate/flex funding, shape policy and address other organizational barriers that come up?

ISF District Community Leadership Guide

DCLT: Big Idea

• Big Idea #1: Provide the authority and problem solving needed to overcome organizational barriers and implement the efficiencies needed to functionally interconnect educational, behavioral and mental health supports. This typically requires the difficult process of abandoning long held patterns of “doing business” and creating new models based on the strengths of the schools/district/community, and the changing needs of students and families.

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Actions

1. Get the right people on the team (cabinet level people with authority to change policy, positions and funding)

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Guiding Questions:

Which voices of with mental health expertise within school system could benefit this team?

Which voices of mental health agency partners could benefit this team?

Consider individuals who are positioned to be social/emotional leaders for the district

In what ways are we ensuring that multiple stakeholder’s voices (i.e. staff, MH agencies, parents/families, students, etc.) will stay at the table through the development of systems and overall implementation

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Actions

2. Establish meeting procedures and common way of work (role and function clearly established)

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3. Define how evidence-based practices will be selected so the process is transparent.

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4.Provide the funding, visibility, and political support needed to allow school teams to travel through the full sequence of adoption stages.

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Adopting an integrated framework is process

that will challenge the assumptions and traditional practices of most school faculty, and mental health systems.

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Where do you want to be with this?

(what will it look like and sound like)?

What do you have in place?

What do you need to do to reach your desired outcome?

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Charting a Course of Action:

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Primary Purpose of the DCLT

• Reflect and Respond….

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MISSION

The mission of the U-46 School and Community Alliance is to

create, integrate and leverage existing and new school/community

partnerships that develop a full continuum of systematic interventions

based on data. It encompasses three intervention tiers:

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• Systems for promoting healthy development and preventing problems

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• Systems for responding to problems as soon after onset as is feasible

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• Systems for providing intensive care

U46 (Elgin IL)�20 Community Partners �57 providers trained in PBIS/SAIG

Boys and Girls Club of Elgin*Centro de Informacion* Community Crisis Center*Crossroads Kids Club* Easter Seals*Elgin Police Department* Family Service Association of Greater Elgin Area*Fox Valley Pregnancy Center*Fox Valley Volunteer Hospice*Girl Scouts of Northern Illinois*Hanover Township Youth and Family Services*Kenneth Young*Renz Center*Streamwood Behavioral Healthcare System*Taylor Family YMCA*The Y*WAYS*West Ridge Community Church*Youth Leadership Academy

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Role & Function of District Team�Clear and Consistent Leadership

• Define how evidence-based practices will be selected so the process is transparent.- Consumer Guide
• Provide the authority and problem solving needed to overcome organizational barriers and implement the efficiencies needed to functionally interconnect educational, behavioral and mental health supports. This typically requires the difficult process of abandoning long held patterns of “doing business” and creating new models based on the strengths of the schools/district/community, and the changing needs of students and families.

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Clear and Consistent Leadership

• Provide the funding, visibility, and political support needed to allow school teams to travel through the full sequence of adoption stages. Adopting an integrated framework is process that will challenge the assumptions and traditional practices of most school faculty, and mental health systems.
• Provide the training, coaching and feedback systems needed to establish personnel with both the specific technical skills needed to deliver integration and the organizational vision to deliver those skills within a unified framework.

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Establish a Structure for Integrated Work

• Establish a DCLT with stakeholders who have the authority to reallocate people, funding, resources
• Include an integrated professional development plan for both school and community employed staff
• Focus on cross-system teams that hold themselves accountable with data-based decisions

Alignment Workbook�3 step process

1. Assessing Current Status

2. Deciding to add new initiatives

3. Designing an integrated/aligned/changed plan

Example of Work Flow Checklist

1. Select District and Schools
2. Form or Expand District Team (Workgroup of existing team?)
• Membership
3. Establish Operating Procedures
4. Conduct Resource Mapping of current programs/initiatives/teams
• Identify gaps/needs
• Assess staff utilization
• Examine organizational barriers
• Establish priority- measureable outcomes
5. Develop Evaluation Plan
• District and School Level
• Tools Identified
• Economic Benefits
6. Develop Integrated Action plan
• Identification of Formal Process for Selecting EBP’s
• System for Screening
• Communication and Dissemination Plan
7. Write MOU- Determine who will implement the plan

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Planning for Change

• Examine Current Conditions
• Using ‘Resource Mapping’ to assess/take an inventory for what your district/school/community already does/has to support youth and their families.
• Integrated Action Plan for priorities

Resource Mapping

• A process for a building and/or district level team to use in order to assess what interventions are currently in place across tiers and where there may be gaps.
• Assess staff utilization, organizational barriers
• Establish priorities

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• Leads to data sharing, action planning, making informed decisions and the selection of evidence-based practices.

Integrated Action Plan

• School employed and community employed staff share responsibilities and resources

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• Uses framework of PBIS and blends in SMH across Tiers to provide full continuum of prevention and intervention based on data and use of EBPs

Memorandum of Understanding (MOU)

• An agreement between the school district and a community partner organization
• Clearly articulates the roles and responsibilities of each group
• Provides an opportunity to have meaningful dialogue regarding key aspects of the partnership

Element 2: Memoranda of Understanding Between Community Mental Health Centers and School Districts within the SS/HS Framework

• Designed to create collaborative relationships between community-based clinicians and school staff
• Features of the MOUs:
• Clinicians are supported by the district to participate on Tier 1, Tier 2, and Tertiary Implementation Teams* (community mental health reimbursement is client-specific)
• Clinicians are supported by the district to help plan and provide school-wide and small group (Tier 2) evidence-based interventions such as….
• Education for faculty of trauma-informed care.
• Co-lead Coping Cat groups with school staff.
• Develop functional behavioral support plans for non-mental health eligible students.
• Design a facilitated referral process and promote student screening and assessments.

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Concord School District MOU with Riverbend Community Mental Health Center

Key components of the concord school district safe schools/healthy students contract with Riverbend community mental health center

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Riverbend Community Mental Health will:

• Provide clinical and administrative supervision to Riverbend staff who provide services in the Concord School District
• Bill for services on a monthly basis

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Clinician activities will include:

• Participation in school-based teams
• Facilitation school-based psycho-educational groups to promote social, emotional and mental health.
• Provision of consultation, mental health education and prevention information to school personnel.

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Concord School District MOU with Riverbend Community Mental Health Center (cont.)

Clinicians will:

• Provide appropriate feedback to assist school staff in the implementation of behavior plans and service planning.
• Facilitate parent education activities.
• Serve as a liaison with Riverbend Community Mental Health Center and facilitate communication and referrals (Facilitated Referral Process)
• Adhere to relevant school related confidentiality regulations and district policies
• Exercise clinical/ethical judgment regarding sharing information with school personnel
• Complete a Monthly Activity Summary for data collection purposes

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Concord School District MOU with Riverbend Community Mental Health Center (cont.)

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The District will:

• Provide and administrative contact at each school
• Provide Clinicians with adequate workspace, internet access and access to a telephone Assist Clinicians in collection of data
• Collaborate with Clinicians to assess effectiveness of services
• Support the purpose, mission and work of the Clinicians and Riverbend Community Health Center

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Quick Reflection

• What elements/features of an interconnected system are evident or emerging in your districts/schools?
• What action/steps could move your school(s) towards more efficient and effective integrated ‘behavioral health’ system in your state/district/schools?
• Questions/comments?

Summarizing�Resources�Possible Next Steps

A Common Implementation Framework for� Social Emotional/Behavioral Health�

• We organize our resources
• Multi-Tier Mapping, Gap Analysis
• So kids get help early
• Actions based on outcomes (data!), not procedures
• We do stuff that’s likely to work
• Evidence-Based interventions
• We provide supports to staff to do it right
• Fidelity: Benchmarks of Quality
• And make sure they’re successful
• Coaching and Support
• Progress monitoring and performance feedback
• Problem-Solving process
• Increasing levels of intensity

National ISF Work Group Webinars

http://www.midwestpbis.org/events/webinar-recordings

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ISF Targeted Workgroup�Purpose�

Selected group from each site to:

• Learn and interact with other sites
• Create learning example to serve as national demonstration
• Access to higher frequency of Technical Assistance
• Increase ISF Capacity at State/Regional Level
• Test and Refine ISF Tools
• Document effort in a Technical Assistance Brief

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ISF Targeted Work Group Webinars

June 30, 2015:

https://midwestpbis.adobeconnect.com/p2h0r0t84lz/

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July 30, 2015: 

https://midwestpbis.adobeconnect.com/p1a4p0b7g4g/

August 28, 2015:

https://midwestpbis.adobeconnect.com/p3a36fu0x45/

September 23, 2015:

https://midwestpbis.adobeconnect.com/p4hc10s2epb

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ISF Targeted Work Group Webinars

October 28, 2015:

https://midwestpbis.adobeconnect.com/p1k21tz0u1e/

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December 11, 2015:

https://midwestpbis.adobeconnect.com/p5btifgqpol

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January 15, 2016:

https://midwestpbis.adobeconnect.com/p6myqem298d/

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February 12, 2016:

https://midwestpbis.adobeconnect.com/p7dwku8try5/

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Wellbeing

Should central role of education be building and improving wellbeing ?

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How would academic achievement improve if we had students, youth, educators in environments that fostered emotional health and wellbeing?

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How would that impact healthcare?

Justice system, Poverty, Homelessness, Drug Use? Unemployment?

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Protective Factor or� Vulnerable Contexts

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“Failing School”

“High Achieving School”

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Don’t mistake academic label as an indication of “health”

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sbarrett@midatlanticpbis.org

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