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School-based Mental Health and Positive Behavioral Interventions and Supports and High Schools Maryland Safe and Supportive Schools Initiative A Collaborative Effort of the MSDE, Sheppard Pratt Health System, and Johns Hopkins University. Susan Barrett Director, PBIS Regional TTAC

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School-based Mental Health and Positive Behavioral Interventions and Supports and High Schools Maryland Safe and Supportive Schools InitiativeA Collaborative Effort of the MSDE, Sheppard Pratt Health System, and Johns Hopkins University

Susan Barrett

Director, PBIS Regional TTAC

Sheppard Pratt Health System, Implementer Partner Center on PBIS


Interconnected Systems Framework for School Mental Health

  • Tier I: Universal/Prevention for All
  • Coordinated Systems, Data, Practices for Promoting Healthy Social
  • and Emotional Development for ALL Students
    • School Improvement team gives priority to social and emotional health
    • Mental Health skill development for students, staff/, families and communities
      • Social Emotional Learning curricula for all students
  • Safe & caring learning environments
  • Partnerships between school, home and the community
    • Decision making framework used to guide and implement best practices that consider unique strengths and challenges of each school community
mds3 initiative
MDS3 Initiative
  • Funding: U.S. Department of Education’s Office of Safe and Healthy Students (OSHS)
  • Number of awards: 11 states (of 33 applicants):

Arizona, California, Iowa, Kansas, Louisiana, Maryland, Michigan, South Carolina, Tennessee, West Virginia and Wisconsin are S3 Grantees in the first cohort

  • Amount: 13M
  • Length: 4 years (October 2010-2014)
  • Partners: MSDE, Sheppard Pratt Health System, Johns Hopkins University
mds3 goals
MDS3 Goals

 1) Assess school climate, student engagement, and the school environment,

 2) Implement evidence-based programs (EBPs) to meet student needs, based on survey

3) Improve conditions for learning,

4) Reduce school violence and substance use, and improve student engagement and the school environment to support student learning.

keys to 10 year success
Keys to 10 Year Success

Commitment of leadership at state, district and school levels

Private, public, & university partnership

Standards and Protocols developed and implemented

INFRASTRUCTURE developed to support state and regional

training capacity

State-wide impact:

877 schools in all 24 systems trained

740 implementing Tier 1/Universal PBIS with fidelity


keys to 10 year success cont
Keys to 10 Year Success (cont)
  • Ongoing Technical Assistance-Coaching Capacity (400 trained)
  • Ongoing Evaluation/Progress Monitoring
  • Evaluation Tools
  • Ongoing Data Collection for Decision Making
    • IPI (Implementation Phases Inventory), SETs, SWIS, BOQ
  • Ongoing expansion of Local School System infrastructure as numbers of schools increase—staff designation, coaches for schools, and funding
  • Federal Grants to support Rigorous Randomized

Evaluation Activity through JHU

using lessons learned to build next phase
Using Lessons Learned to Build Next Phase
  • Training must be ongoing and connected to previous and

upcoming activities.

  • High schools require additional supports to successfully

launch PBIS and implement it with fidelity.

    • Adolescent students with unmet social and emotional

needs create challenges

    • High schools are often unprepared to implement

Tier 2 and Tier 3 interventions or to address

mental health needs and resources at the local and

state level have been ??

    • Relatively few developmentally appropriate EBPs

(Greenberg et al., 2001).

  • Coaching is NECESSARY and supported by evidence (NIRN)
  • School Liaisons need to have a small school to staff person ratio

(PBIS Plus-6:1; MDS3 3:1)

  • Need to make the Focus School condition worthwhile for those schools.
maryland safe and supportive schools mds3
Maryland Safe and Supportive Schools (MDS3)


“develop capacity in schools

to improve”

Research and evaluation

“sustainable system to



“disseminate outcomes to stakeholders”

  • Participating Schools
    • 52 high schools across the state of Maryland
      • 10 districts: Anne Arundel, Baltimore County, Charles, Caroline, Dorchester, Somerset, Washington, Wicomico, Worcester, and Queen Anne’s
    • Second cohort of up to 8 additional schools possible for spring 2012, for a

total of 60 schools

  • Design
    • 3 years (spring 2011 through summer 2014)
    • All 52 schools participated in the data collection activities
      • 29 “implementation schools” who are implementing the MDS3 Initiative
      • 23 schools are in the “focus” or control group
        • Schools were randomly assigned to these groups
design of mds3 observational study
Design of MDS3 Observational Study

Funded by William T. Grant Foundation

4 data points, over 3 years

2 data collectors (1 ASSIST and 1 SAfETy)

25 classrooms per school (≈1500 per time point)

30+ non-classroom locations

Using handheld devices to collect data


Assessing School Settings: Interactions of Students & Teachers (ASSIST): Rusby et al. (2001); Cash & Debnam

Praise, opportunities to respond, punishing statements, transitions, supervision, positive interactions, engagement, aggressive behavior etc.

Both event based and global ratings

School Assessment for Environmental Typology (SAfETy): Bradshaw, Lindstrom Johnson, Milam, & Furr-Holden

Features of the school environment that encourage access control, surveillance, territoriality, physical maintenance, and behavioral management (e.g., disorder, substance use, broken windows)

menu of evidence based programs
Menu of Evidence-Based Programs

Positive Behavioral Interventions and Supports

(PBIS; Sugai & Horner, 2006)

3 tiered prevention model, focused on climate and behavior management

Olweus Bullying Prevention Program

(Olweus, 2007)

Bullying and school climate

Botvin’s Life Skills program

(Botvin et al., 2006)

Substance abuse prevention


(Hawken & Horner, 2003)

Mentoring and behavior management

Check & Connect

(Anderson et al., 2004)

Mentoring and truancy prevention

Cognitive Behavioral Intervention for Trauma in Schools

(Kataoka et al., 2003)

Focused on mental health issues (e.g., anxiety, depression)

center for school based mental health nancy lever and sharon stephan
Center for School Based Mental HealthNancy Lever and Sharon Stephan
  • Link to EBP resources specific to HS
  • Mobilize student, family, community
  • Community Resource Mapping Manual
  • Cross train
  • Common Calendar
  • Increase ISF awareness, visibility
year 1 foundation applying the tiered logic
Year 1: Foundation: Applying the Tiered Logic
  • Continuum of EBP
  • Fidelity of Implementation
  • Teaming Structure
  • Data System
  • Universal Screening and Decision Rules for Access
  • Data Base Decision Making Team Problem Solving
  • Continuous Progress Monitoring
mds3 data sources
MDS3 Data Sources

Data for Decision-making:

Web-based school climate survey (students, school staff, parents)

Site visits - Health and safety of school environment

School-level records: referrals, suspensions, attendance, nurse and counselor log, academics

School-wide Evaluation Tool (SET), Individual Student Systems Evaluation Tool (ISSET)

spring 2011 msd3 student climate survey results
Spring 2011 MSD3 Student Climate Survey Results


___% feel safe at school

___% reported being bullied during the school year

___% reported that other students try to stop bullying

___% often or very often feel sad

___% reported that substance abuse is a problem at their school

spring 2011 msd3 student climate survey results1
Spring 2011 MSD3 Student Climate Survey Results


83.0% feel safe at school

25.0% reported being bullied during the school year

31.7% reported that other students try to stop bullying

20.2% often or very often feel sad

64.9% reported that substance abuse is a problem at their school

spring 2011 msd3 student climate survey results2
Spring 2011 MSD3 Student Climate Survey Results


___% feel they belong at school

___% feel their teachers encourage them to work hard

___% feel their parents are informed when they do well

___% feel students of all races are treated equally

spring 2011 msd3 student climate survey results3
Spring 2011 MSD3 Student Climate Survey Results


67.5% feel they belong at school

81.2% feel their teachers encourage them to work hard

43.9% feel their parents are informed when they do well

57.9% feel students of all races are treated equally

spring 2011 msd3 student climate survey results4
Spring 2011 MSD3 Student Climate Survey Results


___% report that disruptions in the classroom get in the way of their learning

___% report the school building is clean and well-maintained

___% report that students who need help with their problems are able to get it at school

spring 2011 msd3 student climate survey results5
Spring 2011 MSD3 Student Climate Survey Results


60.5% report that disruptions in the classroom get in the way of their learning

49.4% report the school building is clean and well-maintained

63.6% report that students who need help with their problems are able to get it at school

stages of implementation fixsen
Stages of Implementation Fixsen

Should we do it

Getting it right

Making it better


Expanding the SWPBS Implementation Blueprint

ISF Leadership Team

ISF Implementation Team

Systems Coach


Family Community

Implementation Demonstrations

policy shapes adult behavior
Policy: Shapes Adult Behavior

Equal priority to

  • Social Emotional Health and Wellbeing
  • Academic Achievement
  • Academic Behaviors
    • Organizational Skills
    • Team Problem Solving
    • Study Skills


  • Activity Based Training
  • Resource/Continuum Mapping
  • Inventory current interventions, practices
  • Service Delivery Teams- Who?
    • organization, role and function, communication
    • from case management to systems planning
    • assess skills, competencies across staff
  • Data: Student List, Early Warning Systems, ODR as screening tool
  • Implementation Snapshots and Practice Profiles
wiifm why am i here
WIIFM? Why Am I Here?
  • How can I use this training to benefit the work I do everyday?
    • Prioritize which topics align with your district’s mission
    • With your schools goals
    • Share your thoughts at your table

Before you add one more thing….

resource mapping
Resource Mapping
  • Taking Inventory
  • Linking to Outcome/Strategic Plan
  • How do we support adults?
  • How do we make sure we invest in what works with our students/youth?
  • What data will help keep us on track?

Triangle Activity:

Applying the Three-Tiered Logic to Your School , District or State

Tier 3

Practices, Initiatives,

Programs for a FEW

Tier 2

Practices, Initiatives,

Programs for SOME

Tier 1

Practices, Initiatives,

Programs for ALL

screening feedback
Screening & Feedback
  • Essential to developing effective systems
    • Effective systems allow for high fidelity of implementation
  • Often overlooked

Activity: Student List

Who gets access to an intervention that integrates academic/behavioral support ? Choose 6 students.

activity student list
Activity: Student List
  • Do you have rules for access?
  • Do you need to lower the threshold?
  • Are there other sources of data available?
  • Can you get access to a data dash board?
  • What else should we know about the students?
  • Do any staff in building have relationship with the student?
  • What are some possible political implications of choosing the students you chose?
  • Leads to the integration
  • Reflect on the team dynamics

Decision Rules for Access to Advanced Tiers (and decision rules for prevention-if we can predict the trajectories , then we can prevent it from happening)

  • Youth has 2 Major ODRs
  • Youth has 1 Suspension
  • Youth experiences more than ? minutes out of instruction
  • Youth misses more than ? days unexcused absences
  • Youth drops GPA by more than ??
  • Youth – benchmark testing- McIntosh
  • Youth- incomplete class work/homework
  • Attendance (look at predictors for drop-out and school completion)
  • Admin Referral
  • Teacher/Staff Referral
  • Family Referral
  • Other:

Services and Interventions are available as soon as the student demonstrates a need

screening early warning systems
Screening: Early Warning Systems
  • Research is clear that ninth grade is a “make or break” year. More students fail ninth grade than any other grade in high school, and a disproportionate number of students who are held back in ninth grade subsequently drop out (Herlihy, 2007).
  • The most powerful predictors of whether a student will complete high school include course performance and attendance during the first year of high school (Allensworth & Easton, 2005; 2007).
  • Therefore, systematic collection of student attendance and course performance data can be used to develop an effective early warning system that can also be tailored to local contexts.

critical features for implementing advanced tiers of support
Critical Features for Implementing Advanced Tiers of Support:
  • Establish decision rules for access to the intervention
  • Explore data and “look” for students in need

**Refrain from grouping students with similar life circumstance (divorce/bully etc)

    • Group based on demonstrated need- response to the life circumstance and the coping skills required
  • Interventions are linked directly to the SW expectations and/or academic goals
  • Interventions are always available to students
  • Monitor progress of student- (outcome with data in and data out)
  • Staff are trained, receive ongoing support, and are provided feedback.
types of coaching selection and recruitment for the right fit
Types of Coaching: Selection and Recruitment for the “Right Fit”

Coaching for Individual Change:

focus on skill development, support and performance feedback (content specific: academic, behavior)

Coaching for Team/Group Change:

focus on collaboration and facilitation, group dynamics

Coaching for Systems Change:

focus on organizational change


Support To Leadership

  • Listen, model
  • Advocate for School-Wide Support through data
  • Broker Resources to Include EBPs
  • Be a “New Pair of Eyes”
  • Provide an Objective View of a Situation
  • Lead in the Direction of Sustainability

Skill/Coach for Practitioners

  • Provide Direct Training, recruit next trainer
  • Serve as the System Level Interventionist
  • Promote Common Language That’s Productive
  • Provide Scaffolding
  • Model Active Listening


  • Develop Effective Communication Systems
  • Facilitate Sharing Different Views and Perspectives
  • Guide Through:
  • a. Self-Assessment of Efficiency
    • Evaluation
    • Needs Assessment
    • Use of Data
    • Critical Features of Systems and Programs

What is a School Climate Specialist?

School leadership oppositionStaff buy-inLack of systems structure“B.D.T.R.B. Syndrome” Been Down This Road Before

Involvement of whole staff


Lessons Learned in the School Climate Specialist Role

  • Support May Look Different From School-to-School
  • Expect Successes and Challenges
  • Healthy Debriefing Among Colleagues is Good Practice
  • Pushback from Schools is not Personal
  • Flexibility is Key in Maintaining Healthy Relationships with School Teams
  • Three Schools Seem to Be the Limit for Successful Implementation of EBPs
  • Serve as a Guide, Facilitate not Direct
  • Celebrate Even the Smallest of Successes
  • Remember… You are a Guest in the School
lessons learned about evidence based programs
Lessons Learned AboutEvidence-Based Programs
  • Let Schools Work Within their Own Timeline
  • For Some Interventions (e.g., Tier 2 and Tier 3), It Is Okay to Start Small and Work the Kinks Out
  • Utilize Data To Make Decisions about Evidence-Based Programs
  • Celebrate Even the Smallest Successes
  • Realize that Program Implementation Will Not Take Place the Day After Training
  • Work With What’s Already in Place To Formalize or Document EBPs
  • Don’t just do “IT” to say “we do IT.”
lessons learned about stakeholders
Lessons Learned about Stakeholders
  • Administrator Buy-In is Critical for Success
  • Make Sure Team is Representative of Staff
  • Know Who Has the Power in the School and Work Through Them
  • Gather Student Feedback and Participation
  • For Sustainability, Business/Community Support is Imperative
  • Expect Changes in Team Composition Over Time
  • Recognize school readiness signals in order to advance to next steps
lessons learned in implementation steps
Lessons Learned in Implementation Steps
  • Each school is in a different phase-make sure you are also in that phase.
  • Each stakeholder on the team has a different agenda and perspective about needs.
  • Each member of the team will have the “aha” moment at different times.
  • Implementing step 2 before step 1 will sometimes help you have a stronger team. It is okay to go back.
  • Staff may need training in the program before they

can commit and commitment is never assured.

year 2
Year 2
  • State Integration Team
  • District and Community Team
  • Community Resource Mapping
    • GIS (geographic information system) mapping of the locations of the schools in relation to community-based resources (e.g., libraries, churches, hospitals, community centers) and risks (e.g., alcohol outlets, crime). We are also linking the schools with community level census data (e.g., income of surrounding zip codes).
    • This will allow us to examine some macro-level factors related to the survey data and school-based observational data collected in the project.
    •   Data will enrich the information available to the schools, as well as the research on community-level correlates of school climate.
year 2 capacity
Year 2: Capacity
  • School based team expansion
  • Implementation Briefs
  • ISF Facilitation Guides
    • Funding, Tools, Team
    • Readiness Checklist for Integration
    • ISF Consumer Guide
share your thoughts questions
Share Your Thoughts…Questions?


“The Elite Eleven”

Beth Chatfield, Kim Crawford, Lacey Hentz, Wayne Hickman, Christina Jordan, Christina Knepper, Mike Muempfer, Rebecca Piermattei, Rebecca Philbrick, Morgen Piper, Brian Tureck

Patti Hershfeldt, Jerry Bloom, Aniket Joshi, Muriel Smoot

Catherine Bradshaw, Katrina Debnam

Martha Essenmacher, Mike Ford, Andrea Alexander

“No significant learning occurs without a significant relationship."

Dr. James Comer