Building and Sustaining Successful School Behavioral Health Programs

1. Building and Sustaining Successful School Behavioral Health Programs Mona Johnson, CAFBHO Mark Weist, University of South Carolina September 22, 2011 Advancing School Mental Health Conference, Charleston

2. 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

4. Relevant History American Academy of Child and Adolescent Psychiatry meeting in 2000 in NYC 12 trips to Tripler Army Medical Center, 2000-10 Witnessing the growth of a critically needed agenda

5. Opportunities To help military families in a time of significant need Participate in the biggest scale up of mental health capacity in history To do the work in a way that leads SBH and Child and Adolescent Mental Health Services for the Armed Services and Beyond

7. Purpose of Army’s SBH Initiative: To facilitate access to care by embedding behavioral health providers within the school setting To provide state of the art prevention, evaluation, intervention and treatment through standardization of school behavioral health services and programs

8. SBH Mission: To implement a cost effective array of SBH programs and services to support children, their families, and the Army Community at Schools and Child Development Centers directed at the promotion of optimal Soldier readiness and Army Family Wellness and resilience

9. Purpose of SBH Guide: Assist Installations in more rapidly building SBH programs and services Increase likelihood that these services are effective in achieving valued outcomes, including improving student school success, Military Family adjustment and Soldier Readiness Promote standardization, implementation and evaluation across sites to increase capacity and impact the initiative

10. Guiding Principles An inclusive approach reaching out to all interested youth and families, to purposefully overcome barriers to promotion and prevention Build programs in ways that are responsive to students, schools and military needs, while building on strengths Focus on reducing barriers to student learning through programs that build from evidence of what works

11. Guiding Principles Involve all stakeholders in program development, improvement and growth Emphasize and support systemic quality assessment, improvement and evaluation Ensure full promotion (prevention) to intervention continuum of BH Hire right staff and provide right training as well as on-going coaching and support

12. Guiding Principles Assure that all efforts are sensitive to the full range of developmental, cultural/ethnic and personal differences in students Build interdisciplinary relationships, strong teams and coordinating mechanisms in schools Build strong connections between programs and resources within schools and in other community settings

13. Core Elements Coordinate and integrate BH services and programs in schools with Embedded Clinical Providers facilitating easy and simple access to care Increase awareness of BH issues and decrease stigma in seeking assistance Establish Memoranda of Agreement (MOA) and strong working relationships Develop a School District Advisory Council chaired by the Installation Leader and District Superintendent

14. Core Elements (Continued) Develop School Building Advisory and Triage Teams Standardize and effectively implement evidence-based practices and strategies outlined in the CAF-BHO SBH Manual Pursue Continuous Quality Improvement

16. Qualities of SBH Staff Experience in child and adolescent BH Integrity and ethics Experience delivering service in schools Familiarity with evidence-based practices, systems of care Eagerness for on-going learning, training Outstanding social skills, interdisciplinary relationships, and effective participation with teams Commitment to providing high quality services Ability to work independently Ability to handle stress Ability to work effectively with others from diverse cultural/ethnic backgrounds

18. Three Tiered Approach Tier 1: Emphasis on overall school environment Examples: classroom education and prevention; resilience and wellness activities; skill building strategies targeting all students; promoting positive interactions among students and staff; bullying prevention; supporting implementation of Positive Behavior Intervention and Support (PBIS)

19. Three Tiered Approach cont. Tier 2: Prevention and early identification/intervention Examples: Focused assessment and intervention services, working collaboratively with educators in promoting positive classroom environments, and managing negative behavior with students

20. Three Tiered Approach cont. Tier 3: More intensive intervention/treatment Examples: more intensive assessment and diagnostic evaluation, individual, group and family therapy, some clinical case management

21. An Interconnected Systems Framework for School Mental Health and PBIS Mark D. Weist,1 and Lucille Eber2 University of South Carolina1 Illinois PBIS Network2 Missoula, MT; September 9, 2011 (with thanks to Heather Lasky)

22. Montana shows Promise for National Leadership in SMH and PBIS

23. Old Approach ? New Approach Each school works out their own plan with 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 District has a plan for integrating MH at all buildings MH staff participates in teams at all 3 tiers MH staff leads small groups based on data MH staff co-facilitates FBA/BIP or wrap individual teams for students

24. Core Features of a Response to Intervention (RtI) Approach Investment in prevention Universal Screening Early intervention for students not at “benchmark” Multi-tiered, prevention-based intervention approach Progress monitoring

25. Core RtI (cont) Use of problem-solving process at all 3-tiers Active use of data for decision-making at all 3-tiers Research-based practices expected at all 3-tiers Individualized interventions commensurate with assessed level of need

26. Examples of Ineffective Tier 2 and 3 Approaches Special education referral viewed as the “intervention” Key processes (e.g., FBA, IEP) seen as required “paperwork” versus integral to effectiveness Doing what people are “used to” instead of what is effective

27. Goal 1: Enhance school climate & broadly promote mental health, wellness and school success for students, families and staff Conduct ongoing needs assessments to understand pressing needs and enable proactive actions to address them Build relationships with school staff, military staff, through structured and unstructured forums Systematically seek to reduce stigma regarding BH through staff training and awareness raising events Develop comprehensive directory of school and community resources

28. Goal 2: Deliver a range of health promoting and preventive interventions focusing on the theme of resilience, wellness and coping with stress for Military Families and school staff Pursue a broad range of promotion and prevention themes particularly emphasizing: Resilience Wellness Effective coping with stress SBH website containing a variety of additional resources and materials to meet the educational intent of this goal located at http://brainhealth.army.mil/SBH

29. Goal 3: Deliver effective interventions through the delivery of training and implementation of evidence-based practices and effective clinical case management services Train staff to effectively identify and refer students to SBH services Emphasize training, ongoing coaching and implementation support for SBH staff to implement the most effective modular evidence-based skill training for disorders of depression, anxiety, disruptive behavioral disorders, ADHD, and trauma-related Have individual staff assume particular areas of expertise to serve as resources for others

30. Goal 3: Deliver effective interventions through the delivery of training and implementation of evidence-based practices and effective clinical case management services (continued) Ensure strong and ongoing engagement and empowerment with Military students and families Provide appropriate and effective clinical case management services for military students and families determined to be in need Provide implementation support to clinical staff to ensure effective evidence-based interventions Weekly “all hands staff meetings”

31. Goal 4: Ensure effective SBH services will be evaluated and continuously improved through the use of standardized outcome measures  School Mental Health Quality Assessment Questionnaire Implement a core evaluation strategy Strengths and Difficulties Questionnaire (SDQ) Parental Stress Scale (PSS) Key variables from student records (see examples in SBH Manual); Develop and implement strategies to assure student level findings actively inform evolving treatment planning and monitoring

32. Goal 4: Ensure effective SBH services will be evaluated and continuously improved through the use of standardized outcome measures Organize program evaluation data and share with School Advisory Council to assist in continuous quality improvement efforts Assure that developed programs and plans for prevention and intervention undergo stakeholder credibility checks to ensure they are acceptable and meet identified needs of Military students and families, as well as Military and School leaders

33. Goal 5: Conduct BH training and build support for the delivery of effective SBH services to Military Families Expand externships, internships and fellowship opportunities for behavioral health disciplines on effective SBH for Military Families, when possible Conduct training on effective SBH and its benefits to Military Families at local, regional and state levels

34. Goal 6: Expand and improve SBH services for Military Families through advocacy and community of practice activities Build relations with high level school, military, community and business leaders with youth serving agencies to gain their support for SBH Participate actively in the National Community of Practice and related events on School Behavioral Health sponsored by the IDEA Partnership, University of Maryland and CAF-BHO

36. Contact Information: Mona M. Johnson MA, CPP, CDP Director of School Behavioral Healthmona.m.johnson1@us.army.mil (253) 968-4745 main office (253) 968-4440 desk Mark Weist, USC, weist@mailbox.sc.edu