Redesigning Partnerships and Roles of Community Mental Health Providers

1. C9 Redesigning Partnerships and Roles of Community Mental Health ProvidersLeader Presenter: Susan BarrettExemplars: Kacey Rodenbush, Esther RubioKey Words: Mental Health,

2. Maximizing Your Session Participation • When Working In Your Team • Consider 4 questions: • Where are we in our implementation? • What do I hope to learn? • What did I learn? • What will I do with what I learned?

3. Where are you in the implementation process?Adapted from Fixsen & Blase, 2005

4. Leadership Team Action Planning Worksheets: Steps • Self-Assessment: Accomplishments & Priorities • Leadership Team Action Planning Worksheet • Session Assignments & Notes: High Priorities • Team Member Note-Taking Worksheet • Action Planning: Enhancements & Improvements • Leadership Team Action Planning Worksheet

5. 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.

6. Current Status: Impact to Society • Suicide 2nd leading cause of death among teens in USA (June 2016) • One in 5 youth have a MH “condition” that impacts social and academic success (5 million children and youth) • About 80% of those get no treatment • On average, every counselor has almost 500 students • Early diagnosis and medical intervention improves outcomes dramatically, but there is only one child psychiatrist for every 7,000 children with a mental illness or behavioral disorder. • School is “defacto” MH provider • Of those that do…75% receive services in schools • JJ system is next level of system default • Each year, more than 600,000 youth in America are placed in juvenile detention centers with mental health disorders 3X rate of general population.

7. 21st Century Learning OutcomesCollege Career ReadyESSASocial Emotional Competencies, School Climate and Culture “The scientific foundation has been created for the nation to begin to create a society in which young people arrive at adulthood with the skills, interests, assets, and health habits needed to live healthy, happy, and productive lives in caring relationships with others” ~Institute of Medicine, 2009 “What if, making our environments more nurturing could guide us in preventing almost every problem we face?” The Nurture Effect, Biglan

8. Step 1: Using Data to Uncover Need Step 3: Use Implementation Framework to Ensure High Quality Implementation Support for Staff Laser focus on student benefit BIG IDEA: Early intervention: ALL NEEDS-SOCIAL EMOTIONAL BEHAVIORAL AND ACADEMIC Make Initial Projections School Enrollment Community and School Data 1 in 5 Rule Step 2: Match EBP to Level of Need and Type of Need BIG IDEA: Invest in interventions that are likely to work in your community Invest in Prevention and Start with Core Instruction Core Instruction is a blended approach : SOCIAL, EMOTIONAL, BEHAVIORAL, ACADEMIC

10. Recommendations Invest in one set of school “behavioral health” teams organized around tiers (PBIS, MTSS, Wellness, Climate, Leadership etc) with 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 District MOU. ALL school and community employed staff take part in teaching life skills necessary to navigate social situations, school, family and work environments. 1. Single System of DeliveryOne 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 Referral process Part of team’s responsibility

11. Recommendations The District and School team includes community providers, families, students and have authority to make structural changes within their organizations. Teams works collaboratively with leaders to continuously assesses student needs, implement programs, and eliminate, adjust, replace programs at all tiers to increase their impact on students. Eliminate ineffective programs regardless of how much they have cost or currently cost. 2. Access is NOT EnoughSuccess is defined by student impact Interventions are evidenced based and matched to presenting problem using data Interventions are progress monitored for fidelity and impact Teams are explicit about ”what” students are receiving Skills acquired during group and individual sessions are supported by ALL Staff across ALL settings linked to Tier 1 SEB instruction - -

12. Recommendations • Train and support ALL staff • Everyone PLAYS A role • MOU defines staff roles • Clinicians provide clinical supports and train and support ALL adults • Teaching staff will teach social emotional behavior content along with academic content • District Leadership will prioritize Staff Wellness 3. Mental Health is FOR ALLFrom Few to ALL uncovering needs and delivering mental health care Universal Screening Not all supports require technical skills Vast majority of students will benefit from safe, predictable, positive nurturing environment, mentoring and academic support. Need MH experts to triage and identify students with positive screen to determine next steps. -

13. Recommendations Invest in a Public Health Approach Install and align all initiatives 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. 4. Use MTSS FrameworkNeed implementation science to guide the work Data-based decision making is used 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. -

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

15. Funding Stakeholder Support Policy & Systems Alignment Workforce Capacity Executive Functions LEADERSHIP TEAMING Implementation Functions Training Coaching Evaluation & Performance Feedback Behavioral Expertise Local Implementation Demonstrations

16. State and District Community Team’s Guiding Principles and MOU • Effective leadership teams that include school and community mental health providers – ALL Professional Development is delivered to teams with leadership support coaching support and data • Data-based decision making that include school level data and community data- Team Initiated Problem Solving used across all levels of teaming (State, District/Community and School) • Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision-making. State and District Community invests in formal routine and as a team determine the “what” based on children, youth, families’ specific needs • Early access through use of comprehensive screening, which includes internalizing and externalizing needs- This includes family screening (Dishion) • 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- Culture of Coaching existed across cascade that involves professional learning networks

17. Change is Hard… Adopting an integrated framework is a process that will challenge the assumptions and traditional practices of most school faculty, and mental health systems. This typically requires the difficult process of abandoning long held patterns of “doing business” and creating new models based on the strengths of the schools/district/community, and the changing needs of students and families.

18. Example of Work Flow Checklist • Establish or Re-purpose Team • Establish Mission/Vision and Operating Procedures • Installing a MH Screener • Formal Process for Selecting EBP • Assess Current Status • Conduct resource mapping of current programs/initiatives/teams • Identify gaps/needs • Assess staff utilization • Examine organizational barriers • Establish priority- measureable outcomes • Review/Revise/Develop MOU or MOA • Select Sites (Knowledge Development/Demonstration) • Develop Evaluation Plan • District and School Level • Tools Identified (to monitor fidelity and outcomes) • Economic Benefits • Develop Integrated Action plan • Professional Development/Coaching • System for Screening & Identification of Formal Process for Selecting EBP’s • Communication and Dissemination Plan

19. Esther Rubio, School Climate and Culture Coordinator Monterey County Office of Education Kacey Rodenbush, Education Team Services Manager Monterey County Behavioral Health Better Together: How Monterey County Behavioral Health and Monterey County Office of Education Support the Mental Health and Wellness of Children, Youth and Families through Effective School-Based Interagency Collaboration and Partnership

20. Monterey County Office of Education: PBIS Installation and Implementation

21. PBIS In Monterey County

22. PBIS County Wide Implementation • 7 Districts, 72 Schools • Ailsal Union School District (12 Schools) • Gonzales Unified School District (3 Schools) • King City Union School District (4 Schools) • Monterey Peninsula Unified School District (20 Schools) (Training provided by the district) • Salinas City Elementary School District (14 Schools) • Salinas Union High School District (11 Schools) • Soledad Unified School District (8 Schools)

24. Districts, Schools, Tiers

25. School Climate Transformation Leadership Team Representatives • Monterey County Office of Education • Building Healthy Communities • City of Salinas Community Alliance for Safety & Peace (CASP) • California State University, Monterey Bay • Harmony at Home • Monterey County Behavioral Health • Monterey County Health Department • Monterey County Probation Department • Partners for Peace • Restorative Justice Partners, Inc. • Santa Clara County Office of Education, Training & Technical Assistance Center • School Districts: • Alisal USD • Gonzales USD • Monterey Peninsula USD • King City USD • Salinas City ESD • Salinas UHSD • Soledad USD • Special Education Local Planning Area (SELPA)

26. Strategic Plan Goals, 2016 - 2019 • Implement an Interconnected Systems Framework to provide improved access to mental health services. • Build the capacity of school districts through training to build Multi-Tiered Systems of Support. • Increase parent and community engagement. • Show significant measurable improvement through the collection and tracking of data • Develop methods to sustain PBIS and other support systems for students.

27. County Office Of Education (COE) Support • Coordinate the monthly School Climate Transformation Leadership team meeting. • In collaboration with the districts, schedule trainings for school districts and conduct trainings for school districts. Tailor trainings when needed. • Hold special trainings, such as Mindfulness to support the implementation of PBIS at schools. • Host the quarterly Coaches Network. • Coordinate the Community Engagement Committee to train parents and community members about PBIS.

28. County Office of Education (COE) Support • Sponsor School Wide Information System (SWIS) trainings. • Support districts and schools with implementing the Interconnected Systems Framework (ISF) implementation. • Host the annual PBIS Showcase for participating schools and community partners. • As part of the Scale Up Multi-Tiered System of Support (SUMS) Regional training team, support districts with establishing MTSS at schools.

29. Achievements • Building a training model that is being replicated at other schools and districts. • In 2017, the Salinas City ESD schools received the Golden Bell Award for their work with implementing PBIS. • In 2017, received recognition from the California Mental Health Services Oversight and Accountability Commission for the implementation of PBIS and our efforts to integrate mental health services in the framework. • In 2016, several Alisal USD schools received the Gold Ribbon from the California State Department of Education for their PBIS implementation.

30. FAMILY AND COMMUNITY ENGAGEMENT TOOLKIT “Be engaged with your schools.” PBIS Understanding PBIS and Parent /caregivers Engagement January 2018 Edition Mindfulness Moments for Families and Community Engagement

32. ISF Integration and Coordination • ISF Committee • School Site Selection • Administrative Team Development • Partner Agreements • Specialized Training • Integration of School Partners • Goals for ISF Schools

33. MCOE PBIS Showcase

34. Federal Data Reporting

35. 34 Salinas schools in three school districts: • Alisal Union School District • Salinas City Elementary School District • Salinas Union High School District County Office of Education

36. Attendance 41% of schools increased attendance in 2017/18 compared to the previous year

37. Office Discipline Referrals (ODRs) Number of Major ODRs per 100 Students, 2017/18: Elementary schools: 26.2 Middle schools: 17.0 High schools: 23.5

38. Suspensions, Lost Instructional Days, and Expulsions

39. Fidelity of PBIS Implementation

40. Student Voice: School Climate Survey Results 35% of the schools administering the survey both years reported a more positive school climate in the second year. 7,655 students participated in 2017/18.

41. Monterey County Behavioral Health (MCBH): System of Care Mental Health Integration

42. MCBH Education Program History and ISF Development 2014 2011 2016 2017

43. MCBH Education Program At a Glance • Team of 70 Psychiatric Social Workers, Unit Supervisors, Support Staff and MSW Interns • Serving 25 school districts • 10 school districts receiving integrated IEP and General Education specialty mental health services • 110 schools served

44. Blending Funding: An Integrated Approach • MCOE has funded training and implementation of PBIS through the School Climate Transformation grant • MCBH has contracted with SELPA and partnering school districts to provide FTEs • MCBH services that meet medical necessity are billed to Medi-Cal • IEP services not reimbursable to Medi-Cal are paid for through IDEA funding • General Education services not reimbursable through Medi-Cal are paid for through LCAP funding • MCBH Tier I trainings to staff are included in the administrative costs per FTE • Training in Youth Mental Health First Aid and Mindfulness have been funded through MCOE School Climate Transformation grant

45. ISF Defined • Structure and process for education and mental health systems to interact in a most effective and efficient way • Guided by key stakeholders in education and mental health who have the authority to reallocate resources, change role and function of staff, and change policy • Helps to build social emotional capacity across staff so that they are competent and confident in identifying mental health problems in students andreferring for mental health services • Mental health participates across ALL tiers • Progress monitoring for both fidelity and impact

46. Why the Need for ISF? • Need for students receiving mental health services to generalize skills across settings • ISF will help schools implementing PBIS to provide a full continuum of mental health support that will assist with prevention and intervention • Mental health clinicians can share their knowledge and expertise with PBIS teams that will helpbuild capacity in school staff to respond to students with mental health problems

47. ISF: Old Approach vs. New Approach OLD APPROACH 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 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

48. ISF Knowledge Development Sites in Monterey County 2017-2018 Salinas Union High School District Salinas High Monterey Peninsula Unified School District Los Arboles Middle Salinas City Elementary Unified School District Monterey Park Elementary Alisal Union School District Virginia Rocca Barton Elementary 2018-2019 Salinas Union High School District Washington Middle Monterey Peninsula Unified School District Crumpton Elementary Salinas City Elementary Unified School District Loma Vista, Mission Park Alisal Union School District Montebella

49. MCBH Integration in Schools • MCBH Clinicians are assigned to school districts/sites vs. all being itinerant- this allows for them to become part of the school culture • MCBH provides integrated services in school districts where both General Education and Special Education contracts exist • MCBH Clinicians attend PBIS Tier II/III meetings to provide input and expertise that will assist in decision making around mental health referrals and level of intervention • MCBH Clinicians provide monthly drop-in consultation/office hours for teachers and school staff • MCBH Supervisors provide on-site clinical supervision and attend any student-related meetings that are require administrative support • MCBH Education Team Services Manager is an active member on the School Climate Transformation Leadership Team • MCBH and MCOE co-coordinate and co-facilitate ISF Leadership Team meetings at each ISF Knowledge Development site

50. ISF Fidelity Measures and Implementation Tools • ISF Implementation Inventory- serves as an efficient and valid assessment of ISF implementation for the purposes of ongoing evaluation and action planning • ISF Action Planning Companion Guide- assist schools implementing PBIS and using the Tiered Fidelity Inventory (TFI) to enhance current implementation to include ISF approach • ISF Implementation Workbook-supports district and school leadership teams with identifying action steps towards implementation of an Interconnected Systems Framework (ISF)