Vittoria anello ami flammini and mark weist university of south carolina and illinois pbis network
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Readiness to Interconnect Positive Behavior Interventions and Supports ( PBIS) and School Mental Health (SMH ): Development and Testing of a Stakeholder Survey. Vittoria Anello, Ami flammini and Mark Weist University of South Carolina, and illinois pbis network. Overview.

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Vittoria anello ami flammini and mark weist university of south carolina and illinois pbis network

Readiness to Interconnect Positive Behavior Interventions and Supports (PBIS) and School Mental Health (SMH): Development and Testing of a Stakeholder Survey

Vittoria Anello, Ami flamminiand Mark Weist

University of South Carolina, and illinoispbis network


Overview

Overview

  • Background

    • PBIS

    • SMH

  • PBIS-SMH interconnection

  • Need for assessment of readiness

  • Survey development

  • Survey testing in Illinois

  • Future directions


Background pbis

Background: PBIS

  • Framework for promoting and reinforcing positive behaviors

    • Sugai & Horner, 2002

  • System of employing positive behavior strategies

  • Prevention and early intervention perspective


Background pbis1

Background: PBIS

Not an intervention

Ideal for incorporating other school-based interventions and services


Background pbis2

Background: PBIS

PBIS can “render problem behavior irrelevant, inefficient, and ineffective by helping an individual achieve his or her goals in a socially acceptable manner, thus reducing, or eliminating altogether, episodes of problem behavior” (Carr et al., 2002)

Aligns with mandates of NCLB and Successful, Safe, and Healthy Students Program (ESEA)


Background pbis3

Background: PBIS

3-tier system

Tier I: Primary interventions to promote appropriate behavior across student population

Tier II: Secondary interventions targeting students not responding to Tier I interventions (~15%)

Tier III: Tertiary interventions to assist students not responding to Tier II interventions (~5%)


Background pbis4

Background: PBIS


Vittoria anello ami flammini and mark weist

SCHOOL-WIDE

POSITIVE BEHAVIOR

SUPPORT:

What is meant by “layering” interventions?

Tertiary Prevention:

Specialized

Individualized

Systems for Students with High-Risk Behavior

~5%

Secondary Prevention:

Specialized Group

Systems for Students with At-Risk Behavior

~15%

Primary Prevention:

School-/Classroom-

Wide Systems for

All Students,

Staff, & Settings

~80% of Students


School wide systems for student success a response to intervention rti model

School-Wide Systems for Student Success:A Response to Intervention (RtI) Model

Academic Systems

Behavioral Systems

  • Tier 3/Tertiary Interventions 1-5%

  • Individual students

  • Assessment-based

  • High intensity

  • 1-5%Tier 3/Tertiary Interventions

    • Individual students

    • Assessment-based

    • Intense, durable procedures

  • 5-15%Tier 2/Secondary Interventions

    • Some students (at-risk)

    • High efficiency

    • Rapid response

    • Small group interventions

    • Some individualizing

  • Tier 2/Secondary Interventions 5-15%

  • Some students (at-risk)

  • High efficiency

  • Rapid response

  • Small group interventions

  • Some individualizing

  • Tier 1/Universal Interventions 80-90%

  • All students

  • Preventive, proactive

  • 80-90%Tier 1/Universal Interventions

    • All settings, all students

    • Preventive, proactive

Illinois PBIS Network, Revised May 15, 2008. Adapted from “What is school-wide PBS?” OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. Accessed at http://pbis.org/school-wide.htm


Background pbis5

Background: PBIS

  • Main focus is behavior, but PBIS aims to improve quality of life and functioning for all students

  • Improved behavior  increased academic achievement

  • Much research and implementation of Tier I

    • Relatively few resources needed for implementation

  • Much less research and very inconsistent implementation of Tiers II & III

    • Most at-risk students may not receive assistance


Background pbis6

Background: PBIS

  • Uneven dissemination across U.S. and within states

    • Just 7.90% of schools using school-wide PBIS

    • 47 states report using PBIS

  • Need for improved data collection and analysis systems, ongoing training and technical support, and adequate resources


Background smh

Background: SMH

  • Many youth with behavior problems also have mental health issues

  • 13.1% of youth ages 8 to 15 have a diagnosable mental disorder

    • Only 50.6% of them receive treatment


Background smh1

Background: SMH

  • Good mental health 

  • Increases in:

    • Prosocial behavior

    • Family engagement in school

    • Socio-emotional development

    • School functioning

  • Decreases in:

    • Discipline referrals

    • Special education referrals

    • Emotional and behavior problems


Background smh2

Background: SMH

  • SMH services are varied in scope and focus

  • Assessment

  • Counseling

    • Individual, group, and family

  • Mental health education and promotion

  • Collaboration/wraparound supports


Background smh3

Background: SMH

  • SMH: Providing mental health promotion and services at school

  • Benefits:

    • Reduces barriers to participation (stigma, lack of transportation, etc.)

    • Reduces stress on special education system

    • Reaches a large number of youth and families

  • Challenges

    • Funding

    • Lack of coordination among school and community mental health service providers

    • Buy-in and support from administrators and key stakeholders

    • Training and technical support


Pbis smh interconnection

PBIS-SMH Interconnection


Pbis smh interconnection1

PBIS-SMH Interconnection

PBIS and SMH currently not interconnected

PBIS can support SMH services

Both operate on multi-tier service delivery systems

Emphasis on evidence-based interventions and data-based decision making

Common goal: promoting success of students across domains


Pbis smh interconnection2

PBIS-SMH Interconnection

Other benefits:

Resolves issues of accessibility

Normalizing mental health issues and help-seeking behaviors

Promoting mental health awareness  prevention and early intervention


Need for pbis smh interconnection

Need for PBIS-SMH Interconnection

  • Must consider readiness for change

  • Transtheoretical model of change (Levesque, Prochaska, & Prochaska, 1999)

    • Do schools and communities view PBIS and SMH as important issues?

    • Are they thinking about making changes?

    • Do they have the resources to do so?


Need for pbis smh interconnection1

Need for PBIS-SMH Interconnection

Change process framework (Fixsen et al., 2005)

1. Exploration and adoption

2. Program installation

3. Initial implementation

4. Full implementation

5. Innovation

6. Sustainability


Need for pbis smh interconnection2

Need for PBIS-SMH Interconnection

Exploration and Adoption is key

Readiness for change examined here

Important to clearly identify needs of the school and community

Support and buy-in from key stakeholders is critical for successful adoption and initial implementation

Compatibility between intervention and stakeholders’ beliefs and values


Need for pbis smh interconnection3

Need for PBIS-SMH Interconnection

  • Other factors to consider:

  • Acceptability

    • Goodness of fit

    • Iatrogenic effects

    • Long-term results

  • Leadership team

  • Communication

  • Support from district, administrators, and community

  • Community and family readiness


Need for pbis smh interconnection4

Need for PBIS-SMH Interconnection

  • No measure for readiness to integrate PBIS and SMH

  • Existing measures examine :

    • PBIS implementation and fidelity

    • Practitioners’ attitudes toward particular interventions


Need for pbis smh interconnection5

Need for PBIS-SMH Interconnection

  • Existing measures do not evaluate:

  • School and community attitudes about change

  • Perceptions of intervention outcomes

  • Knowledge of PBIS and SMH

  • Support from various constituents

    • Administrators, teachers, parents, community members, other school professionals


Purpose of current study

Purpose of Current Study

To develop a measure of readiness to interconnect PBIS and SMH

To be used with professionals and other stakeholders involved with PBIS and/or SMH


Pilot study and survey development

Pilot Study and Survey Development


Pilot study

Pilot Study

Survey of professionals and stakeholders attending CSMH 16th Annual Conference in Charleston, SC (September 2011)

Survey of top factors facilitating/hindering PBIS, SMH, and PBIS-SMH integration


Pilot study1

Pilot Study

  • N = 25 key PBIS/SMH stakeholders

    • Government officials, family members/advocates, directors of state PBIS centers, technical assistance providers

  • 72% female

  • Working in field: M = 21.58 years (SD = 8.89 years)

  • Using PBIS: M = 7.00 years (SD = 2.83 years)

  • Survey responses aggregated and distilled into 20 main themes


Selection of key themes

Selection of Key Themes

  • Support/buy-in from principal and other key staff

  • Data-based decision-making

  • Active family and community involvement

  • Effective leadership of teams focused on behavior and mental health

  • Belief in impact on

    • School behavior

    • Academic performance

    • Promotion of a positive learning environment


Selection of key themes1

Selection of Key Themes

Adequate funding

Active, comprehensive training and implementation support

Staff understanding of PBIS and SMH

Staff endorsement of benefits of collaborative PBIS and SMH

Active student involvement


Survey development

Survey Development

  • 20 themes were used to develop a 35-item survey

  • Survey was distributed via e-mail to key informants

    • Experts in PBIS, SMH, and/or related fields

  • Key informants evaluated the survey’s content, wording of items, and the importance of the items and concepts to PBIS-SMH interconnection

  • 3 items were dropped

    • Based on importance ratings and scatter plot data


Survey development1

Survey Development

Revised version of survey distributed to several members of the National Community of Practice (CoP) for School Behavioral Health

Individuals with particular interest in PBIS-SMH interconnection

Survey revised again based on comments from this group and consultation with collaborators on this project (Eber, Barrett, Cashman, & Bazyk)


Survey development2

Survey Development

Consultation with survey expert Robert Johnson of USC College of Education

Survey wording and formatting revised based on Johnson’s recommendations

Final survey was disseminated via SurveyMonkey from June – August 2012

Potential participants reached via email, listservs, and CoP conference calls


Current study and survey

Current Study and Survey


Design

Design

  • Mixed method design

    • Qualitative analyses: interviews with key informants

    • Quantitative analyses: survey development and psychometric analyses

  • Online survey

    • 98 items


Participants

Participants

Individuals working in a setting using PBIS and SMH

Those delivering mental health services to youth enrolled in schools

Community members who support PBIS and SMH

Examples: teachers, PBIS staff, SMH staff, school administrators, family members of students, and older youth

N=346


Reaching participants

Reaching Participants

  • Collaborations with various groups

    • Communities of Practice through the IDEA Partnership

    • Discussion of survey on conference calls

    • Promotion of survey on listserv announcements

  • Reaching out to

    • Teachers

    • School principals

    • School nurses

    • Other school professionals


Utility of survey

Utility of Survey

  • Initiates conversations among stakeholders

    • Issues of readiness

    • Benefits of PBIS-SMH interconnection

    • Frank look at resources

  • Compare and contrast domains that are ready for change with areas needing progress

  • Opportunities for building buy-in with administrators, staff, and community


Utility of survey1

Utility of Survey

Online format

Available for free

Can be used at multiple time points in the stages of preparing to adopt and implement combined PBIS and SMH

Can be used to identify potential “pilot schools” in a district for PBIS-SMH interconnection


Future directions

Future Directions


Implementation factors

Implementation Factors

The power of buy-in and support from key persons in the school and community

Positive working relationships

Use of data to show schools and communities the link between academic performance and mental health


Implementation factors1

Implementation Factors

  • Less restrictive funding streams

    • Increased flexibility for schools and communities to meet students’ needs

  • District PBIS and SMH coaches

    • Similar to instructional coaches


Paradigm shifts

Paradigm Shifts

  • Person-centered approach to intervention planning

    • Can be expanded to community-centered approach

  • Emphasis on data-based decision making

    • Moving away from reliance on anecdotal records


Paradigm shifts1

Paradigm Shifts

  • Use of survey results to assist with resolving the fragmentation of youth mental health services

    • Improving coordination and communication among service providers to reduce redundancy and increase consistency in service provision

  • Increased collaboration across disciplines

    • Pooling resources to effect greater change


Future research

Future Research

Development of readiness-increasing activities based on areas identified by the survey

Development of measures of systemic change


Future research1

Future Research

  • Development of more succinct measures and screeners for readiness for PBIS-SMH interconnection

  • Development of in-school mental health screening to identify at-risk students

    • Similar to brief reading and math screenings


Future research2

Future Research

  • Measuring the impact of PBIS-SMH interconnection on the community at large

    • Cases of DSS involvement, founded cases of child abuse, number of children removed from families

    • Number of children receiving mental health services (counseling, medication, etc.)

    • Number of students exhibiting self-injurious behavior (e.g. cutting) and suicidal thoughts or behaviors


Future research3

Future Research

  • Investigation of the link between readiness for interconnection and subsequent implementation and sustainability

  • Improvement in tools needed for proper PBIS-SMH implementation

    • Data collection systems

    • Communication methods among school professionals

    • School-community communication


Implementing pbis schools over 14 years as of june 30 2012

Implementing PBIS Schools Over 14 Years as of June 30, 2012

* Excludes CPS data


Implementing pbis high schools over 14 years as of june 30 2012

Implementing PBIS High Schools Over 14 Years as of June 30, 2012

* Excludes CPS data


Percentage of il public schools implementing pbis 2011 12

Percentage of IL Public Schools Implementing PBIS 2011-12


Illinois pbis implementation status fy11 fy12

Illinois PBIS Implementation Status FY11 & FY12


Vittoria anello ami flammini and mark weist

Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model

Tier 1/Universal

School-Wide Assessment

School-Wide Prevention Systems

ODRs, Attendance, Tardies, Grades, DIBELS, etc.

Tier 2/Secondary

Tier 3/

Tertiary

Check-in/ Check-out (CICO)

Intervention

Assessment

Social/Academic Instructional Groups (SAIG)

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

Group Intervention with Individualized Feature (e.g., Check and Connect -CnC and Mentoring)

Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc.

Brief Functional Behavior Assessment/

Behavior Intervention Planning (FBA/BIP)

Complex or Multiple-domain FBA/BIP

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

Wraparound

Illinois PBIS Network, Revised October 2009

Adapted from T. Scott, 2004


I mpacting systems and roles of school based clinicians special education structures

Impacting systems and roles of school-based clinicians& Special Education structures


Social worker school psychologist discussion of role changes

Social Worker/School Psychologist Discussion of Role Changes

Questions raised by Current Model

Specifics of

Proposed Model

  • Review ODRs, CICO, grades, attendance, parent/teacher concerns

  • We model, reinforce, practice skills we want students to obtain (rate skill attainment)

  • Review ODRs, CICO, grades, attendance, parent/teacher concerns

  • What data /criteria are used for determining support services?

  • What data /criteria are used for monitoring student progress?

  • What data /criteria are used for determining whether student are prepared for exiting or transitioning from support services?


Social worker school psychologist discussion of role changes1

Social Worker/School Psychologist Discussion of Role Changes

Current Model

Proposed Model

Facilitate team based brief FBA/BIP meetings

Act as a communication liaison for secondary / tertiary teams

Facilitate individual/family support plan meetings

Testing for special education eligibility based on…

Referrals for support services based on…


Social skills academic instructional groups

Social Skills/Academic Instructional Groups

Selection into groups should be based on youths’ reaction to life circumstance not existence of life circumstances (ex. fighting with peers, not family divorce)

Goals for improvement should be common across youth in same group (ex. use your words)

Data should measure if skills are being USED in natural settings, not in counseling sessions (transference of skills to classroom, café etc.)

Stakeholders (teachers, family etc.) should have input into success of intervention (ex. Daily Progress Report)


Community participation in building based district leadership teams

Communityparticipation in Building Based & District Leadership Teams


Community partners roles in teams

Community Partners Roles in Teams

  • Participate in all three levels of systems teaming: Universal, Secondary, and Tertiary

  • Facilitate or co-facilitate tertiary teams around individual students

  • Facilitate or co-facilitate small groups with youth who have been identified in need of additional supports


Vittoria anello ami flammini and mark weist

3-Tiered System of Support

Necessary Conversations (Teams)

UniversalTeam

Secondary Systems Team

Problem Solving Team

Tertiary Systems Team

Uses Process data; determines overall intervention effectiveness

Uses Process data; determines overall intervention effectiveness

Plans SW & Class-wide supports

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

CICO

Universal Support

Brief

FBA/BIP

SAIG

Complex

FBA/BIP

WRAP

Group w. individual

feature

Brief FBA/BIP

Sept. 1, 2009


Vittoria anello ami flammini and mark weist

3-Tiered System of Support Necessary Conversations

Family and community

Family and community

Family and community

community

UniversalTeam

Secondary Systems Team

Problem Solving Team

Tertiary Systems Team

Uses Process data; determines overall intervention effectiveness

Uses Process data; determines overall intervention effectiveness

Plans SW & Class-wide supports

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

CICO

Universal Support

Brief

FBA/BIP

SAIG

Complex

FBA/BIP

WRAP

Group w. individual

feature

Brief FBA/BIP

Sept. 1, 2009


Possible tasks functions of core leadership team

Possible Tasks/Functions of Core Leadership Team:

  • Developing a three tiered support network that integrates schools and communities

  • Review data for community and school planning

  • Develop a consistent mission for mental wellness for all youth

  • Address re-positioning staff for more integrated support systems

  • Assess how resources can be used differently

  • Creating integrated system, procedures and protocols

  • Community and District resource mapping


Team structure for core district community leadership team

District/Community

Leadership Team

Integration

Workgroup

SEL, RtI, PBIS,

Mental Health,

SSHS grant

Data Assessment

Workgroup

Tier 3/Tertiary

Workgroup

Transitions:

JJ, Hospitals,

From school to

school

Team Structure for Core District/Community Leadership Team


Vittoria anello ami flammini and mark weist

Supt/

Asst. Supt

Special

Education

Director

Supervisor

SW/Psych

Police

Juvenile

Justice

Building

Principal

Rep.

Family

Groups

Service

Providers

Core

District and

Community

Leadership Team

RtI

Coordinator

Local Area

Network

Co-Convener

Curriculum/

Prof. Dev

Homeless

Coordinator

Mental

Health/

708 Board


Building level model

Grade

Level

Teachers

Community/

Family

Special

Education

Teachers

Building

Leadership

Team

Mental

Health

Rep.

Principal

SW,

School Psych

Guidance

Building Level Model


Community partners assist schools with interventions

Community Partners Assist Schools with Interventions

Elgin SD U-46, in partnership with Streamwood Behavioral Health, initiated social skills instructional groups for selected students at Lords Park Elementary School. Students on a Check-In Check-Out intervention who were not achieving a 70% rate with daily progress reports (DPRs) were identified. Following the targeted group intervention, these students began experiencing success within the first week and consistently achieved DPRs of 70% or higher for the following six weeks.

Lords Park Elementary Social Skills Instructional Group


Urbana sd 116 integration

Urbana SD 116 Integration

  • Classroom teachers providing Social Emotional Lesson plans

  • Classrooms community Circles

  • School-wide bully prevention integration

  • Local public Mental Health practitioner participating as active member on Tier 2 systems team

  • SPARCS co-lead groups (mental health and social worker) in EBD self-contained elementary classrooms and as tier two supports within middle school

  • Community agencies at tier 2/3 district trainings

  • Community partners present at district in-service days

  • Tier 2/3 Coach active member of ACCESS Initiative team


Sparcs

SPARCS

Mission of SPARCS: To enhance trauma focused services available to traumatized children and adolescents (complex trauma)

Group members – history of chronic interpersonal trauma and living with significant ongoing stressors

The National Child Traumatic Stress Network, 2005


Champaign sd 4 integration

Champaign SD 4 Integration

  • Co-lead (mental health/school counselor) SPARCS group at Centennial High School

    • 2011-2012SY Mental health worker one day/week at high school

      • Member of secondary systems meeting

      • Co-lead groups

      • Wraparound/RENEW

  • External coach a member of SAMSHA team

  • Community mentor coordinator sitting on tier 2 systems team at Westview Elementary


Integration efforts crosspoint human services

Integration Efforts Crosspoint Human Services

DMH Grant – Hoopeston School District #11

DMH Grant - Pine Crest

Urbana SD #116


Piloting the readiness check list

Piloting the Readiness Check-list

Jacksonville, Illinois


Special thanks to

Special Thanks to:

  • Lucille Eber and Susan Barrett

    • National PBIS Technical Assistance Center

  • Joanne Cashman and Mariola Rosser

    • IDEA Partnership

  • Sue Bazyk

    • Cleveland State University

  • Nancy Lever

    • Center for School Mental Health

  • Survey participants

  • Jacksonville, Il School District

  • Jill Johnson, IL PBIS Technical Assistance Coordinator


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