CONTEXT FOR TODAY

1. A10 – An Introduction to an Interconnected Systems Framework for Integrating PBIS and School Mental HealthLead Presenter: Kelly PeralesKey Words: Mental Health, Systems Alignment, Coaching

3. CONTEXT FOR TODAY • Language is important; you need to decide what works best in your state/district/community. • Acronyms – there are many, so let’s clarify! • Questions and discussion – please interject at any time; it will be more helpful for everyone • DOTS – “Depends on the Situation” – context is important, so we will work together to clarify • The ISF process is iterative and we are always learning too. Some of the content in this session has been updated recently and may be different than prior materials. • New versions of materials are posted and we are still preparing final versions for October 2019. Please visit www.midwestpbis.org

4. Advancing Education Effectiveness: Interconnecting School Mental Health (ISF) and School-Wide Positive Behavior Support (PBIS) Editors: Susan Barrett, Lucille Eber and Mark Weist pbis.org csmh.umaryland IDEA Partnership NASDSE

5. ISF Volume 2: An Implementation Guide(*currently available at www.midwestpbis.org) • Chapter 1: Context and Structure for Volume • Chapter 2: Defining ISF: Origins, Critical Features, and Key Messages • Chapter 3: Exploration and Adoption • Chapter 4: Installing ISF at the District and Community Level • Chapter 5: Installing and Initial Implementation of ISF at the Building Level • Chapter 6: Implementation, Sustainability and Recommendations to the Field

6. Context and Structure:

7. Partnerships are needed: • One in 5 youth have a MH “condition” • At least 50%, perhaps 80%, of those get no treatment • School is “defacto” MH provider • Juvenile Justice system is next level of system default • Suicide is 2nd leading cause of death among young adults • Factors that impact mental health occur‘round the clock’ • It is challenging for educators to address the factors beyond school • It is challenging for community providers to address the factors in school

8. Additional Context • 33% increase in teens reporting symptoms of depression • 46% of children in the US have experienced at least one Adverse Childhood Experience (ACE) • US has highest rate of opioid use in the world • The CDC reports “electronic aggression” as an emerging public health problem • Any type of harassment or bullying that occurs through email, a chat room, instant messaging, a website or text messaging

9. Why an Interconnected Systems Framework? • A whole population need requires a whole population response… • We need more expertise in our schools and we need to re-position how we use our ‘experts’ • We need to build capacity because…

10. Public Health Implementation FrameworkSocial Emotional and Behavioral Mental 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

11. Outcomes associated with Implementation (George, H. 2018)

12. Current National Data: Principals’ Concerns

13. Current National Statistics (National Institute of Mental Health, 2018: https://www.nimh.nih.gov/health/statistics/suicide.shtml#part_154968)

14. Defining ISF with Key Messages:

15. 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.

16. ISF Enhances MTSS Core Features • Effective teams that include community mental health providers • Data-based decision making that include school data beyond ODRs and community data • Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision making • Early access through use of comprehensive screening, which includes internalizing and externalizing needs • 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

18. 1. Single System of DeliveryOne set of teams What Does it Look Like? Invest in one set of school “behavioral health” teams organized around tiers. 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 MOU. ALL Requests for Assistance managed within one set of teams. ALL school and community employed staff take part in teaching Social/Emotional/Behavioral (SEB) necessary to navigate social situations, school, family and work environments. Community and School MH staff serve on leadership team and make decisions as a TEAM Symmetry of Process State County District School A seamless system for accessing interventions Both school and community based supports

19. 2. Access is NOT EnoughSuccess is defined by student impact What Does it Look Like? The District and School team includes community providers, families, students and persons who have authority to make structural changes within their organizations. Teams works collaboratively with leaders to continuously assess student needs, implement programs, and eliminate, adjust, replace programs at all tiers to increase their impact on students. Ineffective programs or practices are eliminated. Interventions are evidenced based and matched to presenting problem using data Interventions are progress monitored for fidelity and impact Teams are explicit about intervention description (what, when, how long) Skills taught in Tier 2/3 interventions are assessed across all tiers by ALL Staff across ALL settings linked to Tier 1 Social Emotional Behavioral (SEB) instruction - -

20. 3. Mental Health is FOR ALLFrom Few to ALL What Does it Look Like? ALL staff are trained and supported through PD plan/coaching process. MOU defines roles of all staff working in schools. Clinicians role includes support of systems and support of ALL adults as well as delivery of some interventions with students. Teachers provide social emotional behavior (SEB) instruction along with academic content. District Leadership prioritizes Staff Wellness Integrate SEB competencies into PBIS Matrix Vast majority of students will benefit from safe, predictable, positive nurturing environment, mentoring and academic support. Universal Screening to identify ALL possible MH/Behavioral needs (externalizers and internalizers) Need MH experts to triage and identify students with positive screen to determine next steps. However, not all interventions require clinical expertise -

21. 4. Use MTSS FrameworkNeed implementation science to guide the work What Does it Look Like? The system models a Public Health Approach All initiatives/programs are aligned and installed 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. 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; Skills taught in Tier 2/3 interventions are supported by ALL Staff across ALL settings linked to Tier 1 SEB instruction Ongoing professional development and coaching to ensure fluency and to guide refinement of implementation. -

22. Our First RCT: • 24 Participating Elementary Schools • Charleston County, SC (12) • Marion County, FL (12) • Prior to study all were implementing PBIS; none were implementing SMH • Each school is randomized to one of three conditions • PBIS Only • PBIS + SMH (business as usual) • Interconnected Systems Framework (ISF) • Intervention (ISF) in place for 2 academic years • All students in the building are participants unless they opt of study

23. Teaming * In ISF Schools… • Greater team participation by principals, school counselors, school psychologists, and school mental health clinicians • Greater commitment to team meetings • 3.7 times more team meetings per quarter (w/more productivity!); • 25 minutes longer • ISF Teams had more Tier 1 problem-solving/discussion • Using data to address issues discussed *preliminary results

24. Percentage of Students At-Risk or Presenting EB Problems Receiving Services • Students at risk for or presenting EB problems (as rated by teachers) received more services in the ISF condition compared to the PBIS-only and PBIS+SMH conditions during the first year of intervention

25. Services in ISF Schools for Students At-Risk and at Elevated-Risk for EB • Prior to intervention, schools supported 9.6% of students identified with elevated risk for EB problems and 19.8% of students identified with extremely elevated risk for EB problems • After one year of ISF intervention, ISF schools were serving 20.8% of students identified as elevated and 40.7% of students identified as extremely elevated • Essentially doubled the number of students receiving needed services

26. Percentage of African American Students Connected to Services Across Conditions • A greater proportion of African American students were connected to services in the ISF condition (47.7%) compared to the other two conditions (23.1%)

27. Percentage of Students With Abnormal SDQ Risk Student Ratings • The percentage of students reporting Abnormal levels of risk on the SDQ declined from pre-treatment to post-treatment for the ISF condition • Other groups reported similar (PBIS) or slightly increasing (PBIS +SMH) percentages of cases with Abnormal risk post-treatment • In middle school, all three treatment groups yielded similar percentages of students noting high risk

28. PROGRESS MONITOR

29. Other Indications of Success in ISF Schools* • Teams documented progress to monitor outcomes (behavior, attendance, emotional barometer) • Teams using data for decision making • Action Planning for continuous quality improvement • Improvement in PBIS fidelity • Improvement in family engagement in some schools: • Team participation; matrices for home; family google folder of support resources *preliminary analysis

30. Exploration and adoption:

31. STAGES of IMPLEMENTATION(Fixsen, Blasé, 2005)

32. Exploration Steps • Establish an exploration team • Examine current partnerships • Assess impact of existing initiatives and programs • Develop shared understanding of the ISF • Determine benefit/decide to adopt or not

33. Common Vision/Expectations Common Language Common Practices ConsistencyMatters SCHOOL COMMUNITY (USDOE OSEP PBIS TA Center, 2010)

34. Steps for Alignment • Coordinate the process with an executive level team • Define the valued outcome(s) to be achieved • Develop an inventory of the related initiatives that are currently implemented across the district • Identify core system features for initiatives targeted for alignment • Analyze and make decisions for alignment of initiatives • Design the plan for effective alignment including implementation, evaluation, and professional development

35. Barrett, S., Eber, L., McIntosh, K., Perales, K., & Romer, N. (2018). Teaching Social-Emotional Competencies within a PBIS Framework. OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. www.pbis.org. For more go to session E11

36. 1. Expectations 2. NATURAL CONTEXT (Locations) Invite those sitting alone to join in • Have a lunch plan and choose quiet or social lunch area • Invite friends to join me Expectations 3. Rules or Specific Behaviors • Use my breathing technique • Listen to my signals

37. Exploration (District Level) Steps: Coaching Questions: Do you have an existing district leadership team? Do you have family or community partners on your team? What existing agreements do you have with community partners? What is current status of MTSS structures/implementation? • Establish an exploration team • Examine current partnerships • Assess impact of existing initiatives/programs • Develop a shared understanding of ISF • Determine benefit • Decide to adopt or not

38. Trauma Informed Strategies Discipline and Safety School Mental Health Wraparound Check & Connect Function-based Support Classroom Management One Social Emotional Academic Framework Restorative Practices Wellness & Self-Regulation Cognitive Behavior Counseling Check In Check Out Social Emotional Learning Dropout Prevention Bullying Prevention School Climate Literacy Instruction Cultural Responsiveness Social Skills Programming

39. Muskegon County Challenges Adverse Childhood Experiences MiPHY* 2018 38.3% (1041)of 9th and 11thgraders AND 27.8% (431) of 7thgraders reported 2 or more of the following things happened to them during their life: -death or a parent or caregiver -mental abuse -physical abuse -sexual abuse -saw violence in home or neighborhood -lived with person who had mental illness or attempted suicide -lived with a person who was an alcoholic or used drugs -lived with a person who wen to jail or prison *MiPHY– MI Profile for Health Youth – youth survey for grades 7, 9, and 11

40. Adoption Decisions Establish commitment to: • Develop and revise contractual agreements/memorandums of understanding. • Establish executive level leadership team. • Consider needed changes to policy, funding, professional development (PD), coaching and data systems. • Develop 3-5 year action plan focused on large system change efforts: • Installation in and support of Pilot/Demo Sites

41. Installing ISF at State/Regional/District Leadership Level • Establish (or enhance) Leadership Team • Assess Current Status of PBIS and SMH • Establish Mission • Establish Team Routines and Procedures for MTSS • Agenda/mtg process in place? • How we select district/community-level EBPs? • Is data system sufficient for needed measurement of fidelity & outcomes? • Ensuring PD/Coaching plan addresses systems/data/practices? • Implementation Plan • Establish MOUs as Needed • Select Demo Sites • PD/Coaching • Evaluation Plan

43. ISF DCLT Installation Guide Purpose:  This guide is intended to be used by facilitators and coaches to support District/Community Leadership Teams to install structures/systems needed to support an Interconnected System Framework (ISF). The goal is for teams to examine current system using installation activities and generate actions to move toward a more efficient and effective service delivery model.

44. Grant Wood AEA, Iowa For more go to session D11

45. ISF School Installation Guide Purpose: This guide is intended to be used by facilitators and coaches to support District/Community Leadership Teams to install structures/systems needed to support an Interconnected System Framework (ISF). The goal is for teams to examine current system using installation activities and generate actions to move toward a more efficient and effective service delivery model at the building level.

46. For more go to session E12

47. ISF Implementation Inventory • Fidelity measure that can be used for action planning and as part of evaluation plan • Currently available at www.midwestpbis.org: • ISF Implementation Inventory

48. Other Sessions in the Mental Health Strand: • A9 - Supporting the Evolving Role of the School-based Clinician • B9 - Tier II Groups for Students with Internalizing Mental Health Needs • B10 - Integrating Trauma-informed Care into the PBIS Framework • C9 - Integrating Mental Health at the District & School Level: Steps for Installation   • C10 - Building a Culture of Wellness in High Schools • D9 - Installing Suicide Prevention District-wide through Community Partnerships • D10 - Mental Health & PBIS: Regional Collaboration & Capacity Building

49. Other “Notable” Sessions and Roundtable Discussion: • RDQ 8 - Installing an Interconnected Systems Framework for Integrating PBIS & School Mental Health: Supporting the Social-Emotional-Behavioral Needs of All Students • E5 - Supporting the Implementation of Trauma Informed Classroom Practices • C14 - Creating Systems to Support Staff Impacted by Secondary Trauma *Any session focused on families!

50. Resources are available at: www.pbis.org Under topics: