SWK Interconnecting Mental Health within a School-Wide System of PBIS: �Systems, Practices, Data

APBS Pre-Conference Workshop

April 13, 2022

San Diego, CA

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lucille.eber@midwestpbis.org

kelly.perales@midwestpbis.org

sbarrett@ODU.edu

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www.pbis.org

Agenda

1:00 – 2:20:

• Intro, context, history – compelling “why” (30 min + 10 min. activity)
• ISF defined, key messages, core features – examples and what does it look like at the school level (30 min. + 10 min. activity)

2:20 – 2:45:

• Break

2:45 – 3:45:

• District Installation with Examples (45 min. + 5 min. activity + 10 min. activity)

3:45 – 4:45:

• School Installation with Examples (a few quick activities woven into content)

4:45 – 5:00:

• Wrap up – resources, respond to questions

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Who’s in the room?

• States, territories, countries?

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• Level of implementation – state, regional, district, school, community?

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• Role of participant – TA provider, leader, coach, teacher, parent?

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• Other?

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Acronyms & Abbreviations

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Defining the Terms

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Context/Rationale/Need

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2021-2022 Addressing Multiple National Crises:

COVID-19, Racial Injustice, Environmental Impacts

• Significant socio-economic impacts (e.g., unemployment, food insecurity, homelessness)
• COVID-19 impacting our black, brown and migrant communities and our populations w/minoritized identities at higher rate than others.
• Rooted in social inequalities (e.g., residential segregation, differential access to healthcare and treatment)
• Increased mental health challenges for children, youth and families across the board with particular increase in anxiety, depression, obsessive compulsive disorder and eating disorders

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Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

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Schools Play a Major Role in Promoting the Emotional Wellness of Our Children & Youth

• Only 20% of youth who require mental health services receive them
• Social-emotional learning programs improve achievement by 13% on average

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• Youth are more likely to access MH services from schools than any other setting
• Positive school climate protects youth from external risk factors

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Why Mental Health in Schools?

• Youth are 6x more likely to complete mental health treatment in schools than in community settings (Jaycox et al., 2010)
• Mental health treatment has large effects on decreasing mental health symptoms (Sanchez et al., 2018)
• Mental health services are most effective when they are integrated into students’ academic instruction (Sanchez et al., 2018)

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School-based mental health services reach children in typical, every-day environments. The natural, non-stigmatizing location offers an early and effective environment for intervention.

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(Hidden Slide Title) Common Responses to Disaster for Children & Youth

Common Responses to Disaster for Children & Youth

Emotional: clinginess, separation anxiety, preoccupation with death, terror, sadness, guilt, concern about re-occurrence of the event

Cognitive: difficulty concentrating, difficulty learning new information, intrusive thoughts and memories, regress in developmental stages

Physical: sleep disturbance and nightmares, hyperactivity, physical complaints e.g. tummy aches, enuresis, encopresis

Behavioral: crying spells, aggressive behavior, tantrums, school impairment, substance abuse, re-living events through play, increased questions and story telling about the event, increased deviance and delinquency, sleep impairment

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Next Level Teacher Exhaustion

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Disaster recovery response

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Consider what we know about disaster recovery to inform our next steps

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Check out our Practice Brief on Supporting PBIS Implementation through Phases of Crisis Recovery

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Visit this link --

https://www.pbis.org/resource/supporting-pbis-implementation-through-phases-of-crisis-recovery

https://www.pbis.org/current/returning-to-school-during-and-after-crisis

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Immediate

Crisis Response

Initial

Recovery

Intermediate

Recovery

Enhanced Implementation

Ensure Safety

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Stabilize Learning Environment

Differentiate

Based on Data

Promote Culture

of Wellness

Implementation Level

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Getting Started

Strengthening

• Enhance existing tier 1 supports to teach & reinforce new protocols

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• Include mental health supports

• Invest in tier 1 practices school-wide

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• Use existing data to screen & match student to supports

• Refine tier 1 based on data

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• Enhance screening protocol

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• Develop/enhance tier 2 & tier 3 support to match need

• Use data to make ongoing adjustments to an evidence-based, trauma-informed, & equitable continuum of supports

• Ensure physical & emotional safety of all

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• Implement clear communication & resource distribution plan

• Prioritize staff wellness

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• Invest in positive, predictable, & safe tier 1 classroom practices

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Expectations

1. Expectations

2. NATURAL CONTEXT (Locations)

3. Rules or Specific Behaviors

WALK: Invite people

who are being disrespected 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

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Trauma Integration

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District-Level Implementation of ISF: Expand Your Team, Expand Your Results

Watch Recorded Session

Kelly Perales, Jennifer Kubista, Britta Centoni, Susan Barrett

Presentation | Handout

Mental Health/Social-Emotional Well-Being

Interconnected Systems Framework (ISF)

Alignment

Follow this link -- https://www.pbis.org/resource/building-a-culture-of-staff-wellness-through-multi-tiered-system-of-supports

Building a Culture of Staff Wellness Through Multi-tiered System of Supports

Watch Recorded Session

Ami Flammini, Kimberly Yanek

Presentation | Handout

Mental Health/Social-Emotional Well-Being

Social relationships

Social skills

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�MTSS: System investment in common way of work�Continuous Improvement Framework

• We organize our resources and examine our strengths and needs
• We make sure students get help early
• We invest in what is likely to work for our students
• We invest in our staff so they can support ALL students
• We make sure we are implementing well as we review student outcomes
• We continuously adjust based on strengths and need and improve based on our stakeholder's input.

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Student Mental Health: An Important Element of Student Academic Success

•  Student mental health supports are not only needed to support the psychological well being of students, they are also an important part of academic success.

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• Students with high levels of psychological distress are less academically successful: they have more test anxiety, lower academic self‐efficacy, and less effective time management and use of study resources (Brackney and Karabenick, 1995).

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

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New Resource from US Department of Education

Follow this link ---https://www2.ed.gov/documents/students/supporting-child-student-social-emotional-behavioral-mental-health.pdf

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SMH Report Card

The Hopeful Futures Campaign partners have assembled a first-ever national report card grading every state in the country on policies that support school mental health, with recommendations so that every state can take further action to help their children.

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Access the report at this link –

https://hopefulfutures.us/wp-content/uploads/2022/02/Final_Master_021522.pdf

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Pause:

• Take a few minutes to look at this report

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• Let’s discuss what stands out to you

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• What are some considerations for technical assistance around the information in this document?

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Using MTSS Logic to Redesign the System

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Schools Can’t Do This Alone

Need for a structure and process to embed community providers into teams across tiers in school

• Build a single, interconnected system.
• All Social/emotional/behavioral health support through one set of teams with both community and school behavioral health providers on the teams
• Resist the temptation to set up another system

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MTSS Core Features

• Effective teams that include community mental health providers
• Data-based decision making that include school data beyond ODRs and community data
• Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision making
• Early access through use of comprehensive screening, which includes internalizing and externalizing needs
• Rigorous progress-monitoring for both fidelity & effectiveness of all interventions regardless of who delivers
• Ongoing coaching at both the systems & practices level for both school and community employed professionals

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PBIS is a Mental Health Initiative�We need to start with designing a positive school environment where the majority of emotional needs are met.

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Addressing Limitations of MTSS and Inequitable Learning Conditions

• Not enough staff and resources, especially students of color who are more likely to attend a school with an SRO, but not a school counselor, than white students (U.S. Department of Education, 2016).
• Schools struggle to implement effective interventions at Tiers 2 and 3 with a “wait to fail” model.
• Many systems have challenges aligning multiple social, emotional, and behavioral initiatives.
• Youth, family voice are put on hold.
• Youth with “internalizing” issues may go undetected/ “externalizing” issues are punished

To what extent do we have an experienced & stable teaching workforce ?

• Schools serving mostly students of color are more likely to be taught by out-of-field and novice teachers (Bromberg, 2016; U.S. Department of Education, 2016).
• Students of color are more likely to attend schools where more than 50% of teachers were absent for more than 10 days (U.S. Department of Education, 2016).

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Need for Interconnected Systems

Ad hoc and weak connections of community mental health providers in schools; school mental health providers operating in silos

• Need to create a single system of SEB support with all school and community mental health providers working through one set of teams and applying MTSS features consistently
• Need for funding/support for community partners and school-employed clinicians to function at Tier 1 and 2 vs only (and often “co-located”) at Tier 3
• Need for systematic MOUs to clarify roles and functions of integrated teams/work

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Addressing Mental Health/Social Emotional Well-Being in a Tiered Framework

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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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ISF History/Development:

• 2002-2007: Site Development with PBIS Expansion (informal and independent), Community of Practice focus on integration of PBIS & 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: Randomized Control Trial Grant awarded
• 2016-2017: Targeted Work Group Webinars, knowledge development sites
• 2018: Continued webinars/knowledge development sites, expanded Training/TA curriculum and workbook available online
• 2019: Targeted Work Group (PLC) webinars

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Defining ISF, Critical Features and Key messages

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Moving From Co-located to a Single System…….�

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

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Interconnected Systems Framework (ISF)

• Deliberate application of the multi-tiered PBIS Framework for all social-emotional-behavioral (SEB) interventions �(e.g. Mental Health, Social Emotional Instruction, Trauma-Informed Practices, Bully Prevention, etc.)
• Aligning all SEB related initiatives through one system at the state/regional, district and school level in which education and mental health systems are integrated across tiers of support.
• Moving from co-location to integration of community mental health providers
• A clear plan is developed at the district for integrating mental health and other SEB supports at all buildings based on school AND community data.
• Active participation of Family and Youth is a central feature of ISF.

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ISF Enhances MTSS Core Features

• Effective teams that include community mental health providers
• Data-based decision making that include school data beyond ODRs and community data
• Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision making
• Early access through use of comprehensive screening, which includes internalizing and externalizing needs
• Rigorous progress-monitoring for both fidelity & effectiveness of all interventions regardless of who delivers
• Ongoing coaching at both the systems & practices level for both school and community employed professionals

www.pbis.org

Why Use the Interconnected Systems Framework to Address Mental Health in Schools? (TITLE HIDDEN, for Accessibility purposes)

Visit the Center on PBIS website for resources – https://www.pbis.org/mental-health-social-emotional-well-being

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District/Community Installation Guide

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1. Single System of Delivery�One set of teams

• Community and School MH staff serve on leadership team and make decisions as a TEAM
• Symmetry of Process
• State
• County
• District
• School
• A seamless system for accessing interventions
• Both school and community- based supports

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What Does it Look Like?

• Invest in one set of school “behavioral health” teams organized around tiers.
• Flexibility of funding to allow community employed staff to serve on teams and assist serving ALL students.
• Role and function of staff are explicitly stated in MOU.
• ALL Requests for Assistance managed within one set of teams.
• ALL school and community employed staff take part in teaching Social/Emotional/Behavioral (SEB) necessary to navigate social situations, school, family and work environments.

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2. Access is NOT Enough�Success is defined by student impact

What Does it Look Like?

• The District and School team includes community providers, families, students and persons who have authority to make structural changes within their organizations.
• Teams works collaboratively with leaders to continuously assess student needs, implement programs, and eliminate, adjust, replace programs at all tiers to increase their impact on students.
• Ineffective programs or practices are eliminated.

• Interventions are evidenced based and matched to presenting problem using data
• Interventions are progress monitored for fidelity and impact
• Teams are explicit about intervention description (what, when, how long)
• Skills taught in Tier 2/3 interventions are assessed across all tiers by ALL Staff across ALL settings linked to Tier 1 Social Emotional Behavioral (SEB) instruction

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3. Mental Health is FOR ALL�From Few to ALL

• Integrate SEB competencies into PBIS Matrix
• Vast majority of students will benefit from safe, predictable, positive nurturing environment, mentoring and academic support.
• Universal Screening to identify ALL possible MH/Behavioral needs (externalizers and internalizers)
• Need MH experts to triage and identify students with positive screen to determine next steps. However, not all interventions require clinical expertise

What Does it Look Like?

ALL staff are trained and supported through PD plan/coaching process.

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MOU defines roles of all staff working in schools.

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Clinicians role includes support of systems and support of ALL adults as well as delivery of some interventions with students.

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Teachers provide social emotional behavior (SEB) instruction along with academic content.

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District Leadership prioritizes Staff Wellness

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An Interconnected System Framework Applies MTSS Features to all SEB Interventions�

• Effective teams that include community mental health providers

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• Data-based decision making that include school data beyond ODRs and community data

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• Formal team process for the selection & implementation of evidence-based practices across tiers

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• Early access through comprehensive screening, which includes internalizing and externalizing needs

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• Rigorous progress-monitoring for both fidelity & effectiveness of all interventions regardless of who delivers

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• Ongoing coaching at the systems & practices level for both school & community employed staff

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4. Use MTSS Framework�Need implementation science to guide the work

• All S-E-B* instruction and interventions are decided upon and monitored through team process across tiers.
• Data-based decision making is used by teams at all tiers with type of data matched to specifics and complexity of interventions.
• A formal process for selecting and implementing evidence-based practices is established.
• Comprehensive screening allows for early access to interventions.
• Progress monitoring for both fidelity and effectiveness;
• Ongoing professional development and coaching to ensure fluency and to guide refinement of implementation.

*Social–emotional-behavioral (S-E-B)

What Does it Look Like?

• All initiatives/programs are aligned and installed with core features of MTSS
• The continuum of evidence-based interventions are linked across tiers, with dosage and specificity of interventions increasing from lowest to highest tiers.
• Skills taught in Tier 2/3 interventions are supported by ALL Staff across ALL settings linked to Tier 1 S-E-B* instruction

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www.pbis.org

Substance Use: Alcohol (Pennsylvania Youth Survey, 2021)

LIFETIME ALCOHOL USE: Any use in a student's lifetime

• The chart below displays data for the question: "On how many occasions (if any) have you: had beer, wine, or hard liquor?”
• These data are of ALL students, and display data for students who have used alcohol one or more times in their LIFETIME, compared to students who indicated never using alcohol in their lifetime. Note that lifetime substance use is considered to be a measurement of experimental use. 
• Full profile reports released on April 30th will provide both lifetime use and past-30 day use for alcohol.

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The light blue bar represents the percentage of students that reported alcohol use 1 or more times in their lifetime. The dark blue represents the percentage of students that reported no alcohol use in their lifetime.

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Suicide Risk: Serious Consideration of Suicide (Pennsylvania Youth Survey, 2021)

SERIOUSLY CONSIDERED SUICIDE IN THE PAST YEAR

• The chart below displays data for the question: "During the past 12 months, did you ever seriously consider attempting suicide?"

These data compare the percent of students at each grade level marking "Yes" (light blue bar) to those marking "No" (dark blue bar).

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Integration of Community Data

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Sample Middle School

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Table or Small Group Activity:

• Discuss what data you are currently using for decision making

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• Discuss how you would go about gathering additional school and/or community data

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• Be prepared to report out strategies and potential challenges

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Quick Reflection

In your experiences:

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1. What did you hear that is similar to the structures and way of work in your site?
2. What is different?
3. Possible Challenges you are thinking about?

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What QUESTIONS do you have?

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BREAK!

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Installing within District/Community Leadership Teams

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Addressing Mental Health/Social Emotional �Well-Being in a Tiered Framework

• School and community clinicians are embedded on systems teams at all 3 tiers.

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• Youth, Families and community provide expanded context and participate in decisions across tiers.

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• Teams use a protocol for selection and delivery of evidence-based interventions across tiers.

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• Teams continuously monitor fidelity and outcomes, adjusting to improve effectiveness and efficiency.

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National ISF Leadership First Random Control Trial: 2016-2018

• 24 Participating Elementary Schools
• 2 school districts in the Southeast
• Prior to study all were implementing PBIS; none were implementing SMH
• Each school is randomized to one of three conditions
• PBIS Only
• PBIS + SMH (business as usual)
• Interconnected Systems Framework (ISF)
• ISF Intervention in place for 2 academic years
• All students in the building are participants unless they opt of study

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More Effective Teaming (Proximal Findings)

In ISF Schools…

• Greater team participation by principals, school counselors, school psychologists, and school mental health clinicians
• Greater commitment to team meetings
• 3.7 times more team meetings per quarter (w/more productivity!);
• 25 minutes longer
• ISF Teams had more Tier 1 problem-solving/discussion
• Using data to address issues discussed

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www.pbis.org

Beyond Access (Proximal Findings)

In ISF Schools….

• More students identified proactively and connected to Tier 2 and Tier 3 interventions Use of Universal Screener and triangulation of data
• Catching students before higher level of need arose
• More Tier 2 and Tier 3 interventions were provided to students
• Continuum of interventions developed and used by integrated teams
• Students of color were increasingly identified and appropriately connected to intervention for Social-Emotional-Behavioral need

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When compared to other two study conditions

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Access is Not Enough: Outcomes!

In ISF Schools:

• Reduced in-school suspensions
• Reduced office discipline referrals (ODRs)
• Reduced out-of-school suspensions and ODRs for students of color

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Expanded/Current Application of ISF

• Current study (NIMH*) in a large district using the ISF and specifically addressing disproportionate discipline

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• New study (IES*) just starting further iterating from our learning in two different districts

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• Two OSEP funded Model Demonstration Projects using the ISF

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• Applying the logic of the ISF in a Model Demonstration Project with the Center on PBIS – multiple states, regions, and districts

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www.pbis.org

STAGES of IMPLEMENTATION�(Fixsen, Blasé, 2005)

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Monograph Volume 2: free publication

Follow this link to accees this publication–

Advacning Education Effectiveness: Interconnecting School Mental Health and SWPBIS, Volume 2: An Implementation Guide

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Exploration Steps�

1. Establish an exploration team
2. Examine current partnerships
3. Assess impact of existing initiatives and programs
4. Develop shared understanding of the ISF
5. Determine benefit/decide to adopt or not

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Adoption Decisions

Establish commitment to:

• Develop and revise contractual agreements/memorandums of understanding.
• Establish executive level leadership team.
• Consider needed changes to policy, funding, professional development (PD), coaching and data systems.
• Develop 3 - 5 year action plan focused on large system change efforts:
• Installation in and support of Pilot/Demo Sites

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Central School District, Oregon

• Central School District has strengthened and relied upon its community partnerships to prioritize the social and emotional needs of students, staff and families.
• Consolidated teams at District Level
• Invested in Staff Wellness at the Organization level
• Central’s employee wellness program, Get Fit, and the Whole Child Program that has supported educators with mental health and wellness resources and weekly virtual staff wellness groups throughout the Pandemic
• Developed marketing campaign to decrease stigma.
• https://vimeo.com/561941472

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Consolidate teams within School Improvement Process

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Exploration (District Level)

Steps:

• Establish an exploration team
• Examine current partnerships
• Assess impact of existing initiatives/programs
• Develop a shared understanding of ISF
• Determine benefit
• Decide to adopt or not

Coaching Questions:

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• Do you have an existing district leadership team?

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• Do you have family or community partners on your team?

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• What existing agreements do you have with community partners?

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• What is current status of MTSS structures/implementation?

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What is the Status in Your District/Community?

• Is there a District leadership Team for PBIS/SMH/SEL? (One team? multiple teams?)

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• Is there an established Interagency Leadership Team that wants to move forward with implementation?
• Do leaders with decision making authority from each part of the organizations part of the team?
• Does the team have operating procedures (e.g. agenda, clear roles, communication plan, process)

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• Does the District have current service agreements?

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www.pbis.org

What is Different with ISF?

Adapted from: Bradshaw, C. P., Williamson, S. K., Kendziora, K., Jones, W., & Cole, S. (2019). Multitiered Approaches to School-Based Mental Health, Wellness, and Trauma. Keeping Students Safe and Helping Them Thrive: A Collaborative Handbook on School Safety, Mental Health, and Wellness, 85

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How is ISF Different?

• Clinicians no longer have separate meetings to select and monitor interventions but instead engage with teachers and other school staff to select and monitor interventions through one set of teams. (Note: Clinicians may want to repurpose their current ‘mental health’ meetings as a form of peer clinical supervision where fidelity and accuracy of different evidence-based practices are discussed.)
• The integrated system moves from a referral (which implies a ‘hand off’ of a student from one team to another) to a request for assistance process, further delineating decision-making through a single set of teams that include both agency and school staff.
• All interventions, including individualized supports provided by clinicians, are specifically described to include dosage, frequency and the assessment process; progress monitoring, fidelity and outcome measures are agreed upon by teams before initiating interventions.

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www.pbis.org

Installing ISF at State/Regional/District Leadership Level

• Establish (or enhance) Leadership Team
• Assess Current Status of PBIS and SMH
1. System structures
2. Current initiatives
3. Staff Utilization
4. Existing school/community data
• Establish Mission
• Establish Team Routines and Procedures for MTSS
• Comprehensive Universal screening process
• Single Request for Assistance process
• Routines for selecting EBPs
• Process for Fidelity
• Process for measuring outcomes
• Implementation Plan (ongoing)
• Evaluation Plan
• PD/Coaching
• Select Demo Sites
• Establish MOUs as Needed

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�2b. Conduct a Review of Current Initiatives �

• More is not necessarily better
• Examine for outcomes achieved, overlap, connection to Mission
• Evidence of fidelity
• Opportunities to align and eliminate
• Focus on efficiency and effectiveness
• Establish routine of initiative review (quarterly) and always before adding any new initiative

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ISF Initiative Inventory�ISF V2 Ch4: State/District Level Installation Guide (in press) - Step 2b: Conduct a Review of Current Initiatives

Purpose of this tool is to (a) provide an overall picture of existing social emotional behavioral related initiatives or programs available to the larger community, (b) determine the effectiveness, relevance, and fidelity for each, (c) determine funding and resource allocation, and (d) determine areas of redundancy. This process is led by the District Community Leadership Team with representation from both education and community stakeholders.

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Adapted from NIRN Initiative Inventory

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Sample Initiative Inventory

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Quick Activity: District Initiative Inventory

• ISF Initiative Inventory�ISF V2 Ch4: State/District Level Installation Guide (in press) - Step 2b: Conduct a Review of Current Initiatives

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1. How many SEB Initiatives?
2. Are outcomes monitored? Evidence of fidelity and effectiveness?
3. Any silos or co-located initiatives?

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Step 4: Establish Procedures & Routines �to ensure use of MTSS features

1. Selecting and installing a universal screener
2. Request for Assistance (RFA) process
3. Selection process for evidence-based practices
4. Process to monitor fidelity
5. Process to monitor outcomes of interventions

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Lehigh County Pennsylvania�Systems of Care

EXAMPLE:

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Hexagon Tool Results

Prioritization of practices / interventions:

• Mental Health and Alcohol / Substance Abuse screener

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• Implement advanced tiered interventions that were evidenced based (e.g., locally-developed mentoring program not necessarily evidenced based)

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• Align students with intervention groups based on need not convenience (e.g., scheduling)

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BIMAS Data

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The Positive Action program features scripted lessons that are easy to prepare and teach.

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Grades K-12

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Pre and Post Assessment

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Approximately15+ minutes instruction 3 days

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Classroom Kits- 140 lessons per Kit

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https://www.positiveaction.net

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School Police Officer

• School Building Safety
• Crime Prevention Through Environmental Design
• Security and access to the building

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• Promote Positive Relationship with Police

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• Member SWPBIS Team

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• Aggression Replacement Trainer of Trainer

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AGGRESSION REPLACEMENT TRAINING®

Aggression Replacement Training features three coordinated and integrated components:

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• Social Skills

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• Anger

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• Moral Reasoning

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Secondary Tier 2 Supports

Groups of students that data suggests they need more teaching , training, and skills

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Examples: Student Assistance Program , Check in Check Out/ Check &Connect, Aggression Replacement Therapy, Pro-social Skills, PATHS…

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Secondary Tier 3 Supports

Individual Supports for that data suggests they may need intensive training, counseling and skills.

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Examples: RENEW, Behavior Intervention Plan, PTR

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RENEW is a structured school-to-career transition planning and individualized wraparound process for youth with emotional and behavioral challenges.

http://iod.unh.edu/projects/rehabilitation-empowerment-natural-supports-education-and-work-renew

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Installation of SWPBIS Tiers

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Note. SET = Schoolwide Evaluation Tool; BoQ = Benchmarks of Quality; SPO = School Police Office; SAP = Student Assistance Program; ART = Aggression Replacement Therapy; RENEW = Rehabilitation, Empowerment, Natural Supports, Education, and Work.

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Office Discipline Referral Data

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Placement Data

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Small Group/Table Activity:

• Discuss what interventions/practices you have in place within your school/district

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• Discuss how decisions are currently made about interventions/practice – which ones, when and how used, who receives support, etc.

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• Be prepared to discuss strategies and potential challenges

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A Deeper Dive at the school Level

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Prioritize Staff Wellness

Focus on Universal Prevention to Promote Wellness for All

• Provide space for self care and recovery
• Use Human Resources/Employee Assistance/Insurance Plan
• Build awareness, show benefits of enhancing Tier 1
• Reduce demands – integration and de-implementation

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1a) To what extent are our staff healthy?�List indicators.�

• % of staff who can manage their workload. (staff survey)
• % staff who feel like they belong (staff survey)
• Staffing ratios
• Staff attendance
• Staff turnover
• Pro-Quality of Life survey

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Public Health Multi-Tiered Framework for Healthy Workforce

All

80%

Some 15%

A few 5%

Employee Assistance Program: increased free telehealth sessions

• Stress
• Job dissatisfaction
• Relationship Difficulties
• Child/Adolescent Issues
• Anger Management
• Substance Abuse
• Depression
• Grief
• Personal Development

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Employee Assistance Program/Department: Peer Checks, time in meetings for checking in, strengthening relationships, flexibility with schedule

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Employee Assistance Program: Medical benefits, leave

COVID: regular communication w/r safety tips from CDC, Coping with Stress Webinar Series, Family First Crisis Response Act, letter writing campaign

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How do we invest in a culture of wellness?

Focus on building a Whole System response by building pro-social communities for students, families and staff.

• Use public health approach to organize.
• Equal priority for social- emotional-behavioral and addressing the academic slide
• Teaching social emotional skills, co-designing positive climate/culture, sense of belonging is academic instructional time.
• Bring community to school.
• 23% students were receiving supports in schools (Duong et al., 2020)
• Youth 6 times more likely to complete evidence-based treatment when offered in schools than in other community settings (Jaycox et al., 2010)

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Immediate

Crisis Response

Initial

Recovery

Intermediate

Recovery

Enhanced Implementation

Ensure Safety

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Stabilize Learning Environment

Differentiate

Based on Data

Promote Culture

of Wellness

Implementation Level

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Getting Started

Strengthening

• Enhance existing tier 1 supports to teach & reinforce new protocols

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• Include mental health supports

• Invest in tier 1 practices school-wide

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• Use existing data to screen & match student to supports

• Refine tier 1 based on data

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• Enhance screening protocol

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• Develop/enhance tier 2 & tier 3 support to match need

• Use data to make ongoing adjustments to an evidence-based, trauma-informed, & equitable continuum of supports

• Ensure physical & emotional safety of all

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• Implement clear communication & resource distribution plan

• Prioritize staff wellness

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• Invest in positive, predictable, & safe tier 1 classroom practices

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Trauma Integration

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Identifying Specific Action Steps by Data

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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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Promoting a Climate of Belonging�

• Shelton School District in Washington State has been participating in the School Climate Transformation Grant (SCTG) project made shifts in arrival and breakfast for their elementary students that has promoted a climate of belonging.
• The district staggered morning bus drop off time to allow for temperature scans and COVID exposure questions.
• All school staff were positioned in the student arrival off zones to allow them to check in individually with students.
• The staff agreed to prioritize a warm welcome to try to reduce the fear or uncertainty students felt about being in school.  

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Promoting a Climate of Belonging �Shelton School District, Washington State

• They also incorporated morning community building during breakfast time in each classroom. Breakfast in the classroom was intended to help with contact tracing, in the event there was COVID transmission.
• Staff found an additional, unexpected benefit to having a relaxed, welcoming environment to practice SEL skills and community building.
• With school-wide warm greetings, and a community focused breakfast the staff and students reported that the school day began very calmly, with very few behavior issues and the teachers reported more positive connections with students. 

• Next year, the district is going to maintain the staggered drop off, to allow teachers to connect with each and every student.
• They have committed to not scheduling morning meetings for staff so they can be physically present to create a warm, welcoming environment for students and families.
• They are also going to maintain the breakfast and SEL time to increase community building and help students start the day focused on a community of belonging. 

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Re-establish school as a safe, positive, predictable place. �Priority for wellness shows up in budget, accountability system and messaging�

• Academic success requires mental health skills and strategies (e.g., emotional regulation)
• Teaching social emotional behavior skills IS academic instructional time
• Mental health is everyone’s job
• Resilience can be intentionally taught, practiced and developed (all ages)
• Position Social Emotional leaders to build capacity

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Clifton Public Schools, New Jersey

• Leveraged their Multi-Tiered Systems of Support (MTSS) Framework to support their transitions among in-person, remote, and hybrid learning modes.
• Expanded district leadership team that includes representation from each school, key areas of expertise (e.g., mental health/wellness, physical education/wellness, special education), and representation from families.
• This team coordinates with other school and community partners (e.g., food service, local law enforcement, child welfare) to proactively support students and families.
• Each of their schools uses the MTSS framework to teach, remind, and reinforce positive expectations to support learning and wellness.  To ensure expectations are accessible to most families and students, educators presented expectations in English, Spanish, and Arabic.
• Further, staff used district-wide data to drive decisions about intensifying their universal support (for all), targeted support (for some), and intensive support (for individual students identified with significant need).  And they did all of this while building a strong, positive, and vibrant community—celebrating the “Heart of the Mustang.”  

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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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Where the Rubber Meets the Road: Routines and Procedures

1. More specific descriptions of interventions (i.e. skills being taught vs methodology )

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• Determine specifics of how an intervention will be monitored before it begins

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• Focus on systems by routines to review progress of interventions by type/category ( i.e. Tier 2/3 Tracking Tool )

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The Request for Assistance (RFA) Process

• Integrated teams use an internal request for assistance process that places decisions about all interventions (e.g. who will deliver what interventions and how impact will be monitored) within the single set of blended teams.
• The use of a referral is reserved for circumstances outside the scope of the integrated service team such as students with medical or family support needs

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3) What are the evidence-based practices ?�“Tier 1 Kernels”

• Greetings at the Door
• Community Builders:

1) Co-develop and teach positive expectations, predictable routines,

2) Use matrix to define teach and prompt key SEB skills. 3) incorporate bio breaks/social time in daily schedule, increase time for movement across day

• Define SW calming strategy (e.g., belly breaths)
• 5:1 Behavior Specific Praise (PBG)
• Active Listening
• Neutralizing Routine

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Daily Progress Report (DPR) Sample

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NAME:______________________ DATE:__________________

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Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s achievement� in relation to the following sets of expectations/behaviors.

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Adapted from Grant Middle School STAR CLUB

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Adapted from Responding to Problem Behavior in Schools: The Behavior Education Program by Crone, Horner, and Hawken

Trauma-Informed

Tier 2 Group

Self-Check

Use calming strategy

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Use your words

Use safe hands

Ask for help

Connect with safe person

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Understanding Types of Groups�Monitor Data, Select Practice, Install Systems

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4. How will we know if we are implementing with fidelity?

• Tiered Fidelity Inventory
• Direct Observation
• Self-report
• Quick checks

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Fidelity Checklist for Intervention

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5) How will we know if what we are doing is making a positive impact?

• Academic Health
• Universal Screening Data
• Attendance rates
• Request for Assistance Rates
• Behavior Data

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Steps for Installation within Schools�All steps guided by Coaches and DCLT�

1. Establish Single Set of Integrated Team(s)
2. Assess Current Status
3. Establish School Level Routines and Procedures
4. Develop an Integrated Action Plan
1. Monitor effectiveness of the system
2. Monitor student impact
3. Conduct professional development

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School Installation Guide��Follow this link - https://drive.google.com/file/d/12neA1en5rwyq_kQgdjCIYiBUHFB1sQKd/view

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Steps for Installation within Schools�guided by Coaches and DCLT

1. Establish Single Set of Integrated Team(s)
1. Identify need for merging teams with similar goals.
2. Expand team membership
3. Establish roles and functions of teams across tiers of support
4. Roles and Functions
5. Consider role changes for staff
6. Establish team operating procedures and problem-solving approaches (for each team)

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• Assess Current Status
• PBIS/SMH (Action Planning Companion Guide to TFI)
• Assess structures for identifying students who need more supports
• Conduct Intervention Inventory
• Assess data being used to identify social-emotional-behavioral needs

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Salinas Union High School District�Social Emotional Leaders building capacity for all staff to embed mindfulness skills into their academic lessons.

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Interconnected Systems Framework

OLD APPROACH

• Minimal communication between educational and mental health supports to facilitate generalization of learned skills
• MH counselors are contracted and provider is in building 1 day a week to “see” students
• No data used to decide on or monitor interventions
• Mental health interventions primarily provided by clinicians

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NEW APPROACH

• Structured communication to facilitate coordination between educational and mental health supports to increase generalization of learned skills
• MH providers become embedded members of the school and participate on teams at all 3 tiers
• Selected interventions are based on evidence and data gathered and reviewed by team to monitor response to interventions

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Salinas Union High School District

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Looking at a Tier 1 Intervention

Data used to uncover need will be used to monitor progress and impact.

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Looking at a Tier 2 Intervention

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Reflection and Discussion

1. Understanding the need for District/agency-level commitment (i.e. not move immediately to building-level training).

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• Understanding what would be different if adoption were to occur? (e.g. not just focus on referral and interventions but focus on teaming structures for shared decision-making)

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Wrap-Up, Summary, Possible Next Steps, Additional Resources

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ISF Initiative Inventory�ISF V2 Ch4: State/District Level Installation Guide (in press) - Step 2b: Conduct a Review of Current Initiatives

Purpose of this tool is to (a) provide an overall picture of existing social emotional behavioral related initiatives or programs available to the larger community, (b) determine the effectiveness, relevance, and fidelity for each, (c) determine funding and resource allocation, and (d) determine areas of redundancy. This process is led by the District Community Leadership Team with representation from both education and community stakeholders.

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Adapted from NIRN Initiative Inventory

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Key Takeaways

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School Mental Health within an MTSS Framework

Fact Sheets Created by the Pacific Southwest MHTTC

To view the three-part Interconnected Systems Framework webinar series, click this link: bit.ly/ISFwebinars

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Use and Adapt Teaching Matrices

• Developed by community members based on core values of the community
• Provides common language
• Explicit examples across locations/contexts

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Installation at District and School Level

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• Access “Installing an Interconnected Systems Framework at the School Level at this link - https://www.pbis.org/resource/installing-an-interconnected-systems-framework-at-the-school-level-recommendations-and-examples-to-guide-school-leadership-teams-practitioners-and-coaches

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• Access “Installing an Interconnected Systems Framework at the District/Community Level at this link - https://www.pbis.org/resource/installing-an-interconnected-systems-framework-at-the-district-community-level-recommendations-and-strategies-for-coaches-and-district-leaders

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Expand and Connect:�Parent Screener for ALL students transitioning to Middle school

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Be bold…our kids deserve more!�

• Hiring, buying with additional funds without changing the system will lead to poor outcomes for most.
• Wellness is NOT a place
• We should not hire mental health professionals to be referral sources.
• Screening is NOT a diagnostic assessment
• Screen responsibly, be prepared to respond
• ACES is NOT a screener
• Prevention/Promotion and Upstream work will be very challenging with current crisis level of need
• Call out practices that are not in line with our values.
• Set up how we measure fidelity and outcomes beforehand.
• We can’t return to status quo.

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APBS and Mental Health Initiatives: �Finding Our Shared Agendas �

�Please join us for an exploratory conversation with Mental Health leaders at the national, state and local level. This dialogue will guide the work of the APBS MH committee in 2022 and beyond.

During this interactive session, attendees will work with MH leaders to examine current trends and identify ways to share, learn and act together.

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Join us today at 12:30 in Seaport A

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The National PBIS Leadership Forum is a technical assistance activity of the Center on PBIS

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