Interconnected Systems Framework

1. Interconnected Systems Framework • Kelly Perales • Midwest PBIS Network • www.midwestpbis.org • National PBIS TA Center • www.pbis.org • January 25, 2018

2. Where We’ve Been: • 2002-2007: Site Development with PBIS Expansion (informal and independent) • 2005: CoP focus on integration of PBIS and SMH • 2008: ISF White Paper: formal partnership between PBIS and SMH • 2009- 2013 Monthly calls with implementation sites, national presentations (from sessions to strands) • 2009-2011 Grant Submissions • June 2012- September 2013 ISF Monograph • Monograph Advisory group • 2015: ISF Learning Community, SOC Webinar Series • 2016: RCT Grant awarded • 2016: Targeted Work Group Webinars (8) • 2017: Targeted Work Group Webinars continuing, knowledge development sites across country

3. School District Knowledge Development Sites • Marion County, Florida • Alton, Illinois • Community Consolidated School District, Illinois • Sandoval, Illinois • Springfield, Illinois • Special School District of St. Louis, Missouri

4. School District Knowledge Development Sites • Buncombe County, North Carolina • Chapel Hill-Carrboro City, North Carolina • Bellefonte Area, Pennsylvania • Keystone Central, Pennsylvania • Scranton, Pennsylvania • Charleston, South Carolina

5. Role of the ISF State and/or Regional “Facilitators” (within ISF Targeted Work Group) • Coordinates and leads state teams through the process of establishing and maintaining the implementation of ISF • Coordinates and communicates across levels of implementation with direct connection to state/region and building • Provides coordination and leadership for team and action plan implementation. • Facilitates the collection, aggregation and utilization of data for decision making. • Select local district/community(s) to work though the ISF • Provides training and technical assistance to district community teams. • Assesses training needs, arranges training experiences and develops capacity.

6. Advancing Education Effectiveness: Interconnecting School Mental Health and School-Wide Positive Behavior Support Editors: Susan Barrett, Lucille Eberand Mark Weist pbis.org csmh.umaryland IDEA Partnership NASDSE

7. How can we installeffective systems for mental health support for all youth through schools? Describe history, rationale and structure for an integrated framework (The Interconnected Systems Framework-ISF). Share local examples of community and school leaders and practitioners exploring, adopting, installing, implementing, refining, and improving an integrated system. Resources available to support implementation Content

8. One in 5 youth have a MH “condition” At least 50% 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 Partnerships are needed:

9. Some Big Picture Challenges: • Low intensity, low fidelity interventions for behavior/emotional needs • Habitual use of restrictive settings (and poor outcomes) for youth with disabilities • High rate of undiagnosed MH problems (stigma, lack of knowledge, etc.) • Changing the routines of ineffective practices (systems) that are “familiar” to systems • “Referrals to a MH person” viewed as an intervention

10. Challenges • Ad hoc and weak connections of community mental health providers to schools • Need for systematic MOUs that clarify roles • Integration into school-based teams • Funding support to function at Tier 1 and 2, and to not be “co-located” at Tier 3

11. Detention/ RTF APS Compelling Factors AAA Detox Probation Counseling Partial Residential Court Mentor Truancy Psych Special Ed Intake Psychiatrist t h Ed. Sys JJ Sys Eligibility Intake Residential Therapist. Inpatient D&A Sys Health Sys TSS/BSC Referral Referral CW Sys MCO Sys Case Mgmt. Referral Referral Intake Referral Referral MR Sys Referral MH Sys Partial Mobile T Intake Intake Intake Intake Case Mgmt.. Case Work Foster Care Hospital. ER Primary Care Care Mgmt.

12. SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT FRAMEWORK: Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior ~5% Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior ~15% Primary Prevention: School-/Classroom- Wide Systems for All Students, Staff, & Settings • Students • Staff • Parents/Families ~80% of Students

13. Experimental Research on SWPBIS • SWPBIS Experimentally Related to: • Reduction in problem behavior • Increased academic performance • Increased attendance • Improved perception of safety • Reduction in bullying behaviors • Improved organizational efficiency • Reduction in staff turnover • Increased perception of teacher efficacy • Improved Social Emotional competence Bradshaw, C.P., Koth, C.W., Thornton, L.A., & Leaf, P.J. (2009). Altering school climate through school-wide Positive Behavioral Interventions and Supports: Findings from a group-randomized effectiveness trial. Prevention Science, 10(2), 100-115 Bradshaw, C.P., Koth, C.W., Bevans, K.B., Ialongo, N., & Leaf, P.J. (2008). The impact of school-wide Positive Behavioral Interventions and Supports (PBIS) on the organizational health of elementary schools. School Psychology Quarterly, 23(4), 462-473. Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of School-Wide Positive Behavioral Interventions and Supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12, 133-148. Bradshaw, C.P., Reinke, W. M., Brown, L. D., Bevans, K.B., & Leaf, P.J. (2008). Implementation of school-wide Positive Behavioral Interventions and Supports (PBIS) in elementary schools: Observations from a randomized trial. Education & Treatment of Children, 31, 1-26. Bradshaw, C., Waasdorp, T., Leaf. P., (2012 )Effects of School-wide positive behavioral interventions and supports on child behavior problems and adjustment. Pediatrics, 130(5) 1136-1145. Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., & Esperanza, J., (2009). A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Journal of Positive Behavior Interventions, 11, 133-145. Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptionality, 42(8), 1-14. Ross, S. W., Endrulat, N. R., & Horner, R. H. (2012). Adult outcomes of school-wide positive behavior support. Journal of Positive Behavioral Interventions. 14(2) 118-128. Waasdorp, T., Bradshaw, C., & Leaf , P., (2012) The Impact of Schoolwide Positive Behavioral Interventions and Supports on Bullying and Peer Rejection: A Randomized Controlled Effectiveness Trial.Archive of Pediatric Adolescent Medicine.2012;166(2):149-156 Bradshaw, C. P., Pas, E. T., Goldweber, A., Rosenberg, M., & Leaf, P. (2012). Integrating schoolwide Positive Behavioral Interventions and Supports with tier 2 coaching to student support teams: The PBISplusModel. Advances in School Mental Health Promotion, 5(3), 177-193. doi:10.1080/1754730x.2012.707429 Freeman, J., Simonsen, B., McCoach D.B., Sugai, G., Lombardi, A., & Horner, ( submitted) Implementation Effects of School-wide Positive Behavior Interventions and Supports on Academic, Attendance, and Behavior Outcomes in High Schools.

14. Many schools implementing PBIS struggle to implement effective interventions at Tiers 2 and 3 Youth with “internalizing” issues may go undetected PBIS systems (although showing success in social climate and discipline) often do not address broader community data and mental health prevention. PBIS Provides a Solid Foundation…. but More is Needed…

15. Comparison of School-wide and Program-wide PBIS

16. 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. ISF Defined

17. 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. Comparison of School-wide and Program-wide PBIS Focus on public areas like hallways, cafeteria, etc. Emphasis on tangible reinforcement for meeting behavior expectations Consequences for undesired behavior are specified and predictable Specific social skills instruction is often provided as targeted group support. Depending on age of students, it may or may not be part of universal instruction. SW PAPBS facilitator is usually either a consultant provided by the IU or a contracted behavioral health provider Focus on classrooms Usually some combination of tangible and social reinforcement for meeting behavior expectations Family involvement is specifically called for in the EC Benchmarks of Quality Specific social skills instruction is part of universal instruction. Children needing targeted supports usually get additional instruction and/or practice rather than new content. Most programs support one of their own staff to become a PW PAPBS facilitator Stronger in School-wide Stronger in Program-wide

21. 1. Single System of Delivery • One committed and functional team with authority guides the work, using data at three tiers of intervention • MH/community partners participate across ALL Tiers • Evidence Based Practices/ Programs integrated at each tier • Symmetry (of process) at District and Building level • District has a plan to integrate MH at all buildings • Plan is based on community and school data • Plan to build “social emotional” capacity across staff • Training and Coaching in place for ALL staff (community and school employed) • Staff are competent and confident in identifying, intervening and/or referring

22. ISF Implementation Inventory

23. What Does it Mean to Integrate? Change in routines and procedures? (e.g. who needs to be available to participate in team meetings?) Change in how interventions are selected and monitored? (e.g. team review of data/research vs individual clinician choice?) Change in language we use? (e.g. identifying specific interventions vs generic terms such as “counseling” or “supports”?) Changes in Roles/functions of staff? (e.g. clinicians coordinating/overseeing some interventions that non-clinicians deliver?)

24. Who should be on the team? Academic MTSS Director School Improvement Special Education Director, Professional Development/Teacher Mentoring Local MH provider/Core Service Agency Board Member Family Youth Community Leaders District Community Leadership Team Law Enforcement Implementation Team Juvenile Services Coordinator Youth Move Social Services Afterschool Dept of Recreation Services Student Supports Director Administrative and TeacherRepresentative (Union)

25. Who should be on the team? EC Administrator Program Improvement Local MH provider/Core Service Agency Professional Development/Teacher Mentoring EC Administrator Family Youth Community Leaders Early Childhood Community Leadership Team Early Intervention B-3 Implementation Team Family Center Early Intervention Preschool Library Dept of Recreation Services EC Administrator Social Services

26. Trauma Informed Strategies Discipline Handbook School Mental Health Wraparound Check & Connect Function-based Support Classroom Management Academic & Social Emotional Behavior Success 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

27. Example of Work Flow Checklist • Form or Expand District Team (Workgroup of existing team?) • Membership • Establish Operating Procedures • Select Sites (knowledge Development/Demonstration) • Conduct Resource Mapping of current programs/initiatives/teams • Identify gaps/needs • Assess staff utilization • Examine organizational barriers • Establish priority- measureable outcomes • Develop Evaluation Plan • District and School Level • Tools Identified • Economic Benefits • Develop Integrated Action plan • Identification of Formal Process for Selecting EBP’s • System for Screening • Communication and Dissemination Plan • Write MOU- Determine who will implement the plan

28. CIU 10 ISF Installation • Bellefonte Area School District • Keystone Central School District • Early Childhood, School Age, other Community Stakeholders

29. Getting Started • We got support from the Leadership Team to move ahead and asked them who they felt should be invited to the table • An email was sent to various community agencies including the Infant Development Program, The Women’s Center, Children and Youth, Probation, various Mental Health providers, Drug and Alcohol prevention and counseling services, community drug/alcohol prevention groups, Lock Haven University, Lock Haven and Renovo YMCA, Clinton County Commissioners, Police agencies/Clinton County District Attorney, physicians, preschools, Head Start, Clinton County Economic Partnership, KCSD School Board President, and members of the Leadership Team for the district • We promised lunch…they came to the meeting!

30. Getting Started cont. • Discussion of moving beyond access • SAP Data on referrals and those connected to interventions within the community • Discussion of Early Childhood and School Age connections – education and mental health • Discussion of school and community data

31. Moving forward • All agencies are overwhelmed by the needs in our community…there is no doubt we have to work together if any of us are going to be successful • The communication has already brought to light how little we sometimes know about one another…and how important it is that we become better acquainted with what our agencies and programs have to offer • This communication has opened lines for better problem solving and a “we’re all in this together” mentality

32. Integrated Action Plan • School employed and community employed staff share responsibilities and resources • Uses framework of PBIS and blends in SMH across Tiers to provide full continuum of prevention and intervention based on data and use of EBPs

33. 2. Access is NOT enough All work is focused on ensuring positive outcomes for ALL children and youth and their families. • Interventions matched to presenting problem using data, monitored for fidelity and outcome • Teams and staff are explicit about types of interventions students and youth receive (e.g. from “student receives counseling” to “student receives 4 coping skills group sessions) • Skills acquired during sessions are supported by ALL staff (e.g. staff are aware that student is working on developing coping skills and provides prompts, pre-corrects, acknowledges across school day)

34. Messages on Data-Based Decision Making • Expanded view of data within schools • Visits to nurse, counselor, time out of class • Expanded view of data from community • Student and family perception • Connected to other child serving systems – JJ, CYS • Risk and protective factors • Demographics • High rate of: unemployment, military, immigrant

35. Where Do Specific“MH” Interventions Fit? • That depends on the data of the school and community • Examples of Expanded View of data: • Child welfare contacts, • Violence rates • Incarceration rates • Deployed families, • Homeless families, • Unemployment spikes • New comers

36. Tier 3 Multi-Tiered System of Support Staff to Student Ratio Individual students that are receiving support from individualized teams of adults Tier 2 Groupings of youth that are being supported by 1-2 adults at a time Tier 1 All youth interspersed with all adults. All staff are supporting all youth. Staff Students

37. Multiple Evidence-Based Interventions of Varying Intensity • Install foundational interventions School-wide • Ensuring identification, monitoring, and selection process are in place • Identifying additional interventions that might be needed such as: • Trauma Informed Interventions • Coping Cat • Check and Connect

38. School Data  Community Data Student and System level Academic (Benchmark, GPA, Credit accrual etc) Discipline Attendance Climate/Perception Visits to Nurse, Social Worker, Counselor, etc Screening from one view Community Demographics Food Pantry Visits Protective and Risk Factors Calls to crisis centers, hospital visits Screening at multiple views

39. 3. Mental Health is for ALL • Positive school climate and culture serves as protective factor. Social/emotional/behavioral health addressed with same level of attention and concern as is our children’s academic and cognitive achievement. • Social behavior skills taught and reinforced by ALL staff across ALL settings, and embedded in ALL curriculum • Behavior and social emotional examples used to explicitly teach what behaviors look like and sound like across school settings.

40. Messages on Continuum of Interventions • SEL/PBIS begin with foundation at Tier One • Increase support with CICO and DPR • Small group instruction on specific skill sets • Social, coping, problem solving etc. skills as low level generic, higher frequency dosage of teaching • Skills are layered into DPR • Small group instruction to address a specific identified need • Use of screening, expanded data, referral

42. ISF Spreadsheet (BESS + Early Warning System Data) Private Student and Teacher info

43. Which students might we consider forSocial Academic Instructional Groups? Why?

44. 4. Installed and aligned with core features of MTSS framework. • Integrated teams representative of all stakeholders including families and students; • Apply data-based decision making; • Have a formal process for selecting and implementing evidence-based practices; • Ensure early access through comprehensive screening; • Progress monitor for both fidelity and effectiveness; • Ensure coaching.

45. “Individualized Student Card for Mark” (FBA/BIP) “Social & Academic Instructional Groups”(sample academic skills group) Daily Progress Report (DPR) Sample NAME:______________________ DATE:__________________ Walk to classKeep hands to self Mark will keep hands to self Possible behaviors taught in previous SAIG groups Use appropriate languageRaise hand to speak Mark will hold up a yellow card to indicate needing a break Replacement behavior Mark will fill out assignment notebook Bring materials Fill out assignment notebook

46. Before you Start Developing NEW, Assess What’s Currently in Place • What groups are currently running? • Who are they led by? • What data is gathered to assess: • If students are responding? • If the intervention is being done with fidelity? • Is the intervention being done with fidelity? • Are students responding? • IF YES- KEEP IT! • IF NO - Consider modifying or adding NEW

47. Example of a School Assessment of Social Academic Instructional Groups

48. The Hexagon ToolThe National Implementation Research Network (NIRN) • http://implementation.fpg.unc.edu/sites/implementation.fpg.unc.edu/files/NIRN-Education-TheHexagonDiscussionandAnalysisTool.pdf • http://implementation.fpg.unc.edu/sites/implementation.fpg.unc.edu/files/NIRN-Education-TheHexagonDiscussionCaptureTool.pdf The Hexagon Tool can help states, districts, and schools appropriately select evidence-based instructional, behavioral, and social- emotional interventions and prevention approaches by reviewing six broad factors in relation to the program or practice under consideration.

49. Think big and ask questions first

50. Installation of SWPBIS Tiers Note. SET = Schoolwide Evaluation Tool; BoQ = Benchmarks of Quality; SPO = School Police Office; SAP = Student Assistance Program; ART = Aggression Replacement Therapy; RENEW = Rehabilitation, Empowerment, Natural Supports, Education, and Work.