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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


  • 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%)

Vittoria anello ami flammini and mark weist




What is meant by “layering” interventions?

Tertiary Prevention:



Systems for Students with High-Risk Behavior


Secondary Prevention:

Specialized Group

Systems for Students with At-Risk Behavior


Primary Prevention:


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

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 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


  • Mixed method design

    • Qualitative analyses: interviews with key informants

    • Quantitative analyses: survey development and psychometric analyses

  • Online survey

    • 98 items


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


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

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

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/


Check-in/ Check-out (CICO)



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



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)


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


Universal Support







Group w. individual



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



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


Universal Support







Group w. individual



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


Leadership Team




Mental Health,

SSHS grant

Data Assessment


Tier 3/Tertiary



JJ, Hospitals,

From school to


Team Structure for Core District/Community Leadership Team

Vittoria anello ami flammini and mark weist


Asst. Supt

















District and


Leadership Team



Local Area




Prof. Dev





708 Board

Building level model

















School Psych


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


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