A Session presented at the IL School Mental Health Conference:

1. Interconnecting School Mental Health & School-wide Positive Behavior SupportLucille Eber, IL PBIS Networklucille.eber@pbisillinois.org A Session presented at the IL School Mental Health Conference: Families, Schools, and Communities Working Together to Improve Student Mental Health June 26-27, 2012

2. Advancing Education Effectiveness: Interconnecting School Mental Health & School-wide Positive Behavior Support June 2012 – September 2013 Collaborative effort of the OSEP TA Center of PBIS, Center for School Mental Health, and IDEA Partnership bringing together national-level experts in the areas of SMH and PBIS, state and district leaders, and selected personnel from exemplar sites currently implementing collaborative initiatives to: • Define the common goals of SMH and PBIS • Discuss the advantages of interconnection • Identify successful efforts to implement collaborative strategies and cross-initiative efforts • Define the research, policy, and implementation agendas that are needed to take current lessons learned to the next action level • Publish a monograph that provides a summary and framework for interconnection, documents examples of success, and lays out a research, policy, and technical assistance agenda for the future

3. Today’s Session: • The Interconnected Systems Framework (ISF) concept/paper (2009) • A Developing Monograph on SMH/PBIS Interconnection being produced by 3 national Centers • Local examples • Next Steps…

4. June 2012 – September 2013 Outcomes • Define the common goals of SMH and PBIS • Discuss the advantages of interconnection • Identify successful efforts to implement collaborative strategies and cross-initiative efforts • Define the research, policy, and implementation agendas that are needed to take current lessons learned to the next action level • Publish a monograph that provides a summary and framework for interconnection, documents examples of success, and lays out a research, policy, and technical assistance agenda for the future

5. The Developing Monograph….

6. National PBIS TA Center www.pbis.org

7. Center for School Mental Health* University of Maryland School of Medicinehttp://csmh.umaryland.edu*Supported by the Maternal and Child Health Bureau of HRSA and numerous Maryland agencies

8. A National Community of Practice (COP); www.sharedwork.org • CSMH and IDEA Partnership (www.ideapartnership.org) providing support • 30 professional organizations and 16 states • 12 practice groups • Providing mutual support, opportunities for dialogue and collaboration • Advancing multiscale learning

9. Application • Implementation Science • Intervention v. Implementation • Tiered Framework • CoP

10. Chapter Outline Preface: Al Duchnowski Chapter 1: Introductory Chapter Mark Weist, Joanne Cashman, Susan Barrett, Lucille Eber Chapter 2: PBIS School Mental Health Implementation Framework George Sugai and Sharon Stephan

11. Chapter Outline: Break Outs Chapter 3: School Level Systems Nancy Lever and Bob Putnam Jill Johnson, Susan Alborell, Deanna Aister (IL) Jennifer Parmalee (NY) Chapter 4: School level Practices Steve Evans, Brandi Simonsen, Ginny Dolan Pam Horn, Juli Kartel (IL) jessica Leitzel (PA) Chapter 5: School Level Data Dan Maggin and Carrie Mills Kelly Perales (PA) Michele Capio (IL) Helen Mae Newcomer (PA)

12. Chapter Outline: Break Outs Chapter 6: Advancing the ISF in Districts/Communities Rob Horner, Mark Sander Bob Stephens (SC), Kathy Lane (MD), Mark Vinciquerra (NY) Jeanne Davis (IL) Chapter 7: Advancing the ISF in states Carl Paternite , Erin Butts Carol Ewen (MT) Jim Palmiero (PA) Sheri Leucking (IL)

13. Chapter Outline Chapter 8: Federal Investment in SWPBIS and SMH Renee Bradley, OSEP, Joanne Cashman, NASDE, and Trina Anglin, MCHB Chapter 9: Building Policy Support for SWPBIS and SMH Joanne Cashman, NASDE, Consider reaching out to school-based professional organizations as part of this – NASP, ASHA, SSWA, and policy specialists Chapter 10: Commentaries on ISF and important directions for its advancement(Policy, Research, messages for federal level staff) Marc Atkins, University of Illinois Kimberly Hoagwood, Columbia University Krista Kutash, University of South Florida

14. ISF Monograph Next Steps • Chapter drafts developed (June-Jan) • Solicit additional exemplars for appendix from advisory group (July-Oct) • Share drafts with Advisory group (Feb?) • Next webinar with Advisory Group (March?) • Complete Monograph (September 2013?)

15. A Quick History…

16. Interconnected Systems Framework paper (Barrett, Eber and Weist , revised 2011) Developed through a collaboration of the National SMH and National PBIS Centers www.pbis.orghttp://csmh.umaryland.edu And Lisa Betz, The IL Department of Human Services, Division of Mental health

17. “Expanded” School Mental Health • Full continuum of effective mental health promotion and intervention for students in general and special education • Reflecting a “shared agenda” involving school-family-community system partnerships • Collaborating community professionals (not outsiders) augment the work of school-employed staff

18. Positive Behavior Intervention and Support (www.pbis.org) • In 16,000 plus schools • Decision making framework to guide selection and implementation of best practices for improving academic and behavioral functioning • Data based decision making • Measurable outcomes • Evidence-based practices • Systems to support effective implementation

19. ISF: Key Emphases • Developing interdisciplinary and cross-system relationships moving toward real collaboration • Strong stakeholder and especially family and youth engagement • “Achievable” use of evidence-based practices • Data-based decision making • Focus on valued outcomes and continuous quality improvement of all processes

20. SMH and PBIS Framework Intensive Intervention 1-5% Targeted Individual, Group, Family Intervention 5-15% Selective Prevention Universal Prevention Relationship Development Systems for Positive Behavior Diverse Stakeholder Involvement Climate Enhancement All Students

21. 2 – 4 Years Stages of Implementation • Exploration/Adoption • Installation • Initial Implementation • Full Implementation • Innovation • Sustainability Implementation occurs in stages: Fixsen, Naoom, Blase, Friedman, & Wallace, 2005

22. ISF, Building From 4 Stages of Implementation • EXPLORATION (e.g., identifying and organizing the most useful tools, conducting needs assessments and resource mapping) • INSTALLATION (e.g., developing interdisciplinary and cross system teams, identifying challenges and ways to overcome challenges to effective team functioning) • INITIAL IMPLEMENTATION • IMPLEMENTATION

23. ISF, School Readiness Assessment 1) High status leadership and team with active administrator participation 2) School improvement priority on social/emotional/behavioral health for all students 3) Investment in prevention 4) Active data-based decision making 5) Commitment to SMH-PBIS integration 6) Stable staffing and appropriate resource allocation

24. ISF, Indicators of Team Functioning • Strong leadership • Good meeting attendance, agendas and meeting management • Opportunities for all to participate • Taking and maintaining of notes and the sense of history playing out • Clear action planning • Systematic follow-up on action planning

25. Interconnected Systems Framework for School Mental Health • Tier 3: Intensive Interventions for Few • Individual Student and Family Supports • Systems Planning team coordinates decision rules/referrals for this level of service and progress monitors • Individual team developed to support each student • Individual plans may have array of interventions/services • Plans can range from one to multiple life domains • System in place for each team to monitor student progress • Tier 2: Early Intervention for Some • Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns • Systems Planning Team identified to coordinate referral process, decision rules and progress monitor impact of intervention • Array of services available • Communication system for staff, families and community • Early identification of students who may be at risk for mental health concerns due to specific risk factors • Skill-building at the individual and groups level as well as support groups • Staff and Family training to support skill development across settings • 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

26. Structure for Developing an ISF:Community Partners Roles in Teams A District/Community leadership that includes families, develops, supports and monitors a plan that includes: • Community partners participate in all three levels of systems teaming: Universal, Secondary, and Tertiary • Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored • MH providers from both school and community develop, facilitate, coordinate and monitor all interventions through one structure

27. Old Approach  New Approach Each school works out their own plan with Mental Health (MH) agency; A MH counselor is housed in a school building 1 day a week to “see” students; No data to decide on or monitor interventions; “Hoping” that interventions are working; but not sure. District has a plan for integrating MH at all buildings (based on community data as well as school data); MH person participates in teams at all 3 tiers; MH person leads group or individual interventions based on data; For example, MH person leads or co-facilitates small groups, FBA/BIPs or wrap teams for students.

28. Pause for:Feedback from Participants: Before we move to examples, do you have comments/observations about the proposed framework for the ISF you would like to share?

29. Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT ~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

30. Tier 1 - Universal • Interventions that target the entire population of a school to promote and enhance wellness by increasing pro-social behaviors, emotional wellbeing, skill development, and mental health • This includes school-wide programs that foster safe and caring learning environments that, engage students, are culturally aware, promote social and emotional learning and develop a connection between school, home, and community • Data review should guide the design of Tier 1 strategies such that 80-90% of the students are expected to experience success, decreasing dependence on Tier II or III interventions • The content of Tier 1/Universal approaches should reflect the specific needs of the school population • For example, cognitive behavioral instruction on anger management techniques may be part of a school-wide strategy delivered to the whole population in one school, while it may be considered a Tier 2 intervention, only provided for some students, in another school

31. Example: Community Clinicians Augment Strategies • Aschool located near an Army base had a disproportionate number of students who had multiple school placements due to frequent moves, students living with one parent and students who were anxious about parents as soldiers stationed away from home • These students collectively received a higher rate of office discipline referrals than other students • The school partnered with mental health staff from the local Army installation, who had developed a program to provide teachers specific skills to address the particular needs students from military families • Teachers were able to generalize those skills to other at risk populations • As a result, office discipline referrals decreased most significantly for those students originally identified as at risk but also for the student body as a whole

32. Tier 2 - Secondary • Interventions at Tier 2 are scaled-up versions of Tier 1 supports for particular targeted approaches to meet the needs of the roughly 10-15% of students who require more than Tier 1 supports • Typically, this would include interventions that occur early after the onset of an identified concern, as well as target individual students or subgroups of students whose risk of developing mental health concerns is higher than average • Risk factors do not necessarily indicate poor outcomes, but rather refer to statistical predictors that have a theoretical and empirical base, and may solidify a pathway that becomes increasingly difficult to shape towards positive outcomes • Examples include loss of a parent or loved one, or frequent moves resulting in multiple school placements or exposure to violence and trauma • Interventions are implemented through the use of a comprehensive developmental approach that is collaborative, culturally sensitive and geared towards skill development and/or increasing protective factors for students and their families

33. Agency/School Collaboration: A Real Example Middle schools SWISdata indicated an increase in aggression/fighting between girls Community agency had staff trained in the intervention Aggression Replacement Training (ART) and available to lead groups in school This evidence-based intervention is designed to teach adolescents to understand and replace aggression and antisocial behavior with positive alternatives. The program's three-part approach includes training in Prosocial Skills, Anger Control, and Moral Reasoning Agency staff worked for nine weeks with students for 6 hours a week; group leaders did not communicate with school staff during implementation

34. Agency/School Collaboration Example (cont) SWIS Referrals for the girls dropped significantly during group At close of group there was not a plan for transference of skills (i.e. notifying staff of what behavior to teach/prompt/reinforce) There was an increase in referrals following the group ending Secondary Systems team reviewed data and regrouped by meeting with ART staff to learn more about what they could do to continue the work started with the intervention To effect transference and generalization, the team pulled same students into groups lead by school staff with similar direct behavior instruction Links back to Universal teaching of expectations (Tier 1) is now a component of all SS groups (Tier 2)

35. Tier 3 - Tertiary • Interventions for the roughly 1-5% of individuals who are identified as having the most severe, chronic, or pervasive concerns that may or may not meet diagnostic criteria • Interventions are implemented through the use of a highly individualized, comprehensive and developmental approach that uses a collaborative teaming process in the implementation of culturally aware interventions that reduce risk factors and increase the protective factors of students • Typical Tier 3 examples in schools include complex function-based behavior support plans that address problem behavior at home and school, evidence-based individual and family intervention, and comprehensive wraparound plans that include natural support persons and other community systems to address needs and promote enhanced functioning in multiple life domains of the student and family

36. Next Steps to Consider in Moving Towards A More Blended System • Repositioning Existing Personnel in New Roles • Developing RtI Structures in Schools • (teaming model for decision making/data review) • Developing District/Community Teaming Models • Specific Steps to Expedite Improved • Quality of Life for our Older Youth…

37. Social Worker/School Psychologist Discussion of Role Changes Questions raised by Current Model Specifics Provided by Innovation • 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? • 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

38. Social Worker/School Psychologist Discussion of Role Changes Current Model Proposed Changes Testing for special education eligibility Referrals for support services not based on specific data Facilitate team based brief FBA/BIP meetings Act as a communication liaison for secondary / tertiary teams Facilitate individual/family support plan meetings

39. 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

40. 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

41. 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

42. Example: Systems Collaboration and Cost Savings • A local high school established a mental health team that included a board coalition of mental health providers from the community • Having a large provider pool increased the possibility of providers being able to address the specific needs that the team identified using data, particularly as those needs shifted over time • In one case, students involved with the Juvenile Justice System were mandated to attend an evidence-based aggression management intervention • The intervention was offered at school during lunch and the school could refer other students who were not mandated by the court system, saving both the school and the court system time and resources and assuring that a broader base of students were able to access a needed service • As a result of their efforts, the school mental heath team was able to re-integrate over ten students who were attending an off site school, at a cost savings of over $100,000

43. pause forFeedback from Participants: Have you observed/experienced Examples of or movement towards more integrated mental health through structures/systems in schools?

44. A quick examples of proposed exemplar for the developing manual….

45. Family and Community Involvement in District-Wide Implementation of SWPBIS: A Panel Discussion Montrose Area School District NHS Human Services of N.E. PA Penn State University Community Care Behavioral Health

46. Family and Community Involvement in District-Wide Implementation of SWPBIS: A Panel Discussion Montrose Area School District NHS Human Services of N.E. PA Penn State University Community Care Behavioral Health May 23, 2012 PA PBS Implementer’s Forum

47. Jan Cohen – Penn State Extension/Integrated Children’s Services Planning • Mike Ognosky, Chris McComb, and Greg Adams – Montrose Area School District • Michael Lynch and Erin Stewart, NHS Human Services • Judy Ochse – Family Member/School Nurse MASD • Kelly Perales – Community Care Behavioral Health

48. What is ICSP? Family Resiliency Educator - Cost-shared position between Penn State Extension and Susq. Co. Children & Youth. Responsibilities include Integrated Children’s Services Planning, parenting education, and other prevention/education efforts. ICSP Leadership Team – Comprised of parents, community volunteers, and directors/leaders from county offices and agencies/organizations, whose role it is to oversee all ICSP work, create sub-committees/work groups, and create/implement the ICSP Plan. Members include: CYS, JPO, NHS, Trehab, MHMR, County Assistance Office, Community Care, CARES/LEARN Team, Big Brothers Big Sisters, PA Treatment & Healing, and School Districts ICSP Sub-Committees/Work Groups – Needs Assessment, Health Insurance Access/Health Services, Human Services Resource Directory, Coalition of Parent Educators and Mental Health Outreach and Services

49. School Based Behavioral Health (SBBH) Journey • District and families participate in evaluation committee • Communication and collaboration among all stakeholder groups • Ongoing opportunities for feedback • Unique features of rural implementation

50. Accountable Clinical Home Accountable TO the family and FOR the care Accessible, coordinated, and integrated care Comprehensive service approach Increased accountability and communication Single point of contact for behavioral health School is “launching pad” for services delivered in all settings Youth continue on the team with varying intensity of service