Integrating School-based Mental Health & School-wide PBS Part 1

1. Integrating School-based Mental Health & School-wide PBS Part 1 National PBIS Leadership Forum Hyatt Regency O’Hare, Rosemont, IL October 8, 2009 Session B-7 Lucille Eber, Statewide Director, IL PBIS Network Jill Johnson, Technical Assistance Coordinator, IL PBIS Network Mark Weist, CSMHA Director, University of Maryland

2. Interconnected Systems Framework for School Mental Health • 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 • 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 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 Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters.

3. 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 • 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

5. 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

6. Why We Need MH/Community Partnerships • One in 5 youth have a MH “condition” • About 70% of those get no treatment • School is “defacto” MH provider • JJ system is next level of system default • 1-2% identified by schools as EBD • Those identified have poor outcomes • Suicide is 4th leading cause of death among young adults

7. Examples of Ineffective Secondary/Tertiary Structures • Referrals to Sp. Ed. seen as the “intervention” • FBA seen as required “paperwork” vs. a needed part of designing an intervention • Interventions the system is familiar with vs. ones likely to produce an effect • (ex: student sent for insight based counseling at point of misbehavior)

8. Problem Innovative practices do not fare well in old organizational structures and systems Organizational and system changes are essential to successful use of innovations Expect it Plan for it © Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008

9. Examples of Ineffective Secondary/Tertiary Structures • Referrals to Sp. Ed. seen as the “intervention” • FBA seen as required “paperwork” vs. a needed part of designing an intervention • Interventions the system is familiar with vs. ones likely to produce an effect • (ex: student sent for insight based counseling at point of misbehavior)

10. Problem Innovative practices do not fare well in old organizational structures and systems Organizational and system changes are essential to successful use of innovations Expect it Plan for it © Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008

11. 3-Tiered System of Support Necessary Conversations (Teams) Universal Team 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 CICO Brief FBA/BIP SAIG Complex FBA/BIP WRAP Group w. individual feature Brief FBA/BIP

12. Taking it to Scale Visibility Political Support Funding Leadership Team Active Coordination Evaluation Training Coaching Local School Teams/Demonstrations

13. Fragmented Structures Fragmented Practices Student Assistance Teams School-based Mental Health Services Student Support Leaders RtI SEL STUDENTS in one school Special Education Pre-referral Interventions Student Assistance Teams After School Programs Social Work Services Family Coordinators How does a school decide how to support different students?

14. Fragmented Policy Fragmented Practices After-School Programs Special Education Clinic Violence & Crime Prevention Pupil Services Health Services SCHOOL Juvenile Court Services Community Based Organizations Drug Prevention Social Services Child Protection Services Mental Health Services Drug Services Adapted from: Health is Academic:A guide to Coordinated School Health Programs (1998). Edited by E. Marx & S.F. Wooley with D. Northrop. New York: Teachers College Press.

15. Proposed Core District/Community Leadership Team Structure

16. Supt/ Asst. Supt Special Education Director Supervisor SW/Psych Police Juvenile Justice Building Principal Rep. Family Groups Service Providers Core District and Community Leadership Team RtI Coordinator Local Area Network Co-Convenor Curriculum/ Prof. Dev Homeless Coordinator Mental Health/ 708 Board

17. Service Providers Examples • Community Mental Healthy Agencies • Lutheran Child and Family Services • Catholic Social Services • Youth Service Bureau

18. District 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

19. Purpose of Proposed Core District/Community Leadership Team "In order to be effective and sustainable, school-community partnerships require an intentional commitment on behalf of all involved.” (Quote from Safe Schools Healthy Students Grant Application)

20. 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

21. Grade Level Teachers Community/ Family Special Education Teachers Building Leadership Team Mental Health Rep. Principal SW, School Psych Guidance Building Level Model

22. 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

23. 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 small groups based on data; MH person co-facilitates FBA/BIP or wrap individual teams for students. Old Approach  New Approach

24. 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.

25. 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. • Team pulled same students into groups lead by school staff with similar direct behavior instruction.

26. Activity • How will you know if integrated partnerships are successful at a building level? What will it “look” like? • At a district level?

27. Commitments for Success* Examples of District/Building Tier 2/3 Commitments : • Tier 2/3 Coaching FTE • Position Personnel to Facilitate Tertiary Intervention Teams for 3-5% of Students • Comprehensive Training and “Practice” • Data-based decision-making is part of all practices • Tertiary District Leadership Team • Review Special Education and Disproportionality Data • Review District Policies *See IL PBIS Network Commitment for Success Agreement

28. District-wide Tertiary Implementation Process • District meeting quarterly • District outcomes • Capacity/sustainability • Other schools/staff • Building meeting monthly • Check on all levels • Cross-planning with all levels • Effectiveness of practices (FBA/Wrap) • Tertiary Coaching Capacity • Facilitators for complex FBA/BIP and wraparound teams

29. Social Worker/School Psychologist Discussion of Role Changes Questions raised by Current Model Specifics of Proposed Model • 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

30. Social Worker/School Psychologist Discussion of Role Changes Current Model Proposed Model Testing for special education eligibility based on… Referrals for support services based on… Facilitate team based brief FBA/BIP meetings Act as a communication liaison for secondary / tertiary teams Facilitate individual/family support plan meetings

31. Ensuring Capacity at All 3 Tiers • Begin assessment and development of secondary and tertiary tiers at start-up of universal • Assess resources and current practices (specialized services) • Review current outcomes of students with higher level needs • Position personnel to guide changes in practice • Begin planning and training with select personnel • All 3 tiers addressed at all district meetings and at every training

32. Application of Data from Tertiary Demos: IL PBIS Network Level • Revised PoI Tool with clearer benchmarks of secondary/tertiary intervention • New “Commitments for Success” document that now includes secondary/tertiary requirements • Support for Districts to change policies/procedures including: • Revised Job descriptions for specialized staff • FBA/BIP procedures • Policies re: supports to students w/tertiary plans as they transition within the district

33. School/Community Agency Partnership • Waldo Middle School, East Aurora School District 131, and Communities in Schools, a community agency, collaborated to help students at risk be more successful in school. • 17 students received support via a Social/Academic Instructional Group (a Tier 2/secondary intervention). • need for assistance based on data showing five or more ODRs for disrespect, disruption, or non-compliance. • students met with a group leader to learn effective skills in communication, problem-solving, how to work cooperatively, and set goals. • 48% decline in referrals. • 60% of the participants changed their belief that fighting was an effective way to handle their anger.

34. Application of Data from Tertiary Demos:District and Building Levels • Need for more constant monitoring of ALL students needing more than Universals • It is not OK to NOT do interventions commensurate with student needs (i.e. FBA/BIP and wraparound) • Ongoing team meetings facilitated for each student with data used at each meeting • Need for more aggressive review of EE data and all “placement” data: • Interventions vs. Identification/placement

35. Commitments Needed at Tertiary Level • District Commitment to review data, ongoing planning, support tertiary development at district and building levels • Designated Buildings/District Staff positioned to facilitate tertiary teams for individual students (3-5%) • External Tertiary Coach/Coordinator positioned • Continuum of Skill Sets (training, guided learning, practice, coaching, consultation) • Commitment to use of Data at System and Practice Levels: • Going beyond ODRs (i.e. SSBD) • Self assessment/fidelity (i.e. CISS, PoI) • System monitoring (SR-T, Tier2/3 Tracking Tool, etc) • SIMEO-Student Outcomes (complex FBA/BIP and wraparound)

36. District-wide Tertiary Implementation Process • District meeting quarterly • District outcomes • Capacity/sustainability • Other schools/staff • Building meeting monthly • Check on all levels • Cross-planning with all levels • Effectiveness of practices (FBA/Wrap) • Tertiary Coaching Capacity • Facilitators for complex FBA/BIP and wraparound teams

37. On-going Self–Assessment of Secondary/Tertiary Implementation Building Level: • IL Phases of Implementation (PoI) Tool • IL Secondary/Tertiary Intervention Tracking Tool • Sp. Ed Referral Data • Suspensions/Expulsions/Placements (ongoing) • Aggregate Individual Student Data (IL SIMEO data) • LRE Data trends • Subgroup data (academic, discipline, Sp. Ed. Referral, LRE, etc) District Level: • Referral to Sp. Ed. Data • LRE Data (aggregate and by building) • IL Out-of-Home-School-Tracking Tool (multiple sorts) • Aggregate SIMEO data • Aggregate PoI Data

38. Interconnected Systems Framework paper

39. Next Steps: • Share at conferences/mtgs

40. Social Skills Group Reduces Problem Behavior • Middle School partnered with Communities in Schools; • 17 students in Social/Academic Instructional  Group (Lunch Bunch); • Participation criteria: 5+ ODRs (SWIS); • ODRs for disrespect, disruption, or non compliance; • Students met during lunch with group leader; • Skills: communication, problem-solving, working cooperatively and setting goals; • Overall, 48% decline in referrals; • Post-test measure (survey): 60% of the participants changed belief that fighting was an effective way to handle their anger.

41. Social Skills Group Reduces Problem Behavior

42. Replication of Tertiary Demos Moving Rapidly Phases of Implementation: Secondary Phase I(n=8 Replication Schools)

43. More Students Access Tier 2/3 Interventions When Tier 1/ Universal is in Place FY09 School Profile Tool Students Accessing Tier 2/Tier 3 Interventions

44. Successes With Mental Health Integration Pine Crest Elementary • School Mental Health Coordinator • Acted as Secondary/Tertiary Coach for tier 2/3 team • Set-up secondary systems (decision rules, procedures and protocols) • Provided professional development for staff (trauma, SASS, autism) • Collaborated with community partners and agencies • Helped to strengthen universal PBIS systems and practices • Provided opportunities for parent engagement at all three tiers • Educated teachers through professional development and weekly newsletters • Mental health integration at tier one • SSBD screener • SEL curriculum

45. Tier two supports • Decision rules, procedures and protocols • Use of Tier 2/Tier 3 Tracking Tool to drive systems discussions • CICO (SWIS-CICO) • SAIGs • Brief FBA • Teacher support • Summer mental health services provided in town for students and families (HUGE success) • Mental health integration at tier three • Complex FBA • Community partner assistance (708 Board, LAN, local mental health agencies) • Trained in T100-T301

46. Lessons Learned Pine Crest ElementaryRecommendations for 2009-2010SY • Mental health integration at all three tiers • School Mental Health Coordinator needs to attend universal team meetings • Complex FBA and wraparound needs to begin Fall 2009 • SIMEO training needed for data-based decision-making for individual students • Professional development for staff • Braiding initiatives • Building understanding/competency • Integration of SAIGs content into universal SEL lessons for generalization • Engaging parents as partners • Quarterly Community Partnership Leadership meetings = LEADERSHIP & VISION • Presentation to the school board = VISIBILITY

47. New Frontier: Tertiary Replication Site With Mental Health Integration • Began in Fall 2008 – Writing the Safe Schools Healthy Students grant • Strong relationships with community partners existed and a promise was made… Even if we didn’t get the grant (ie. NO money) we were going to move forward with a three tiered, integrated model of support for the students and families of Urbana because it was the right thing to do • Administrative Academy 696

48. What Conversations Are We Having in Urbana? • Common Vision • MOA • Strong Leadership • Core Leadership Team • Quarterly Meetings • Work groups • Data, Systems, Braiding Initiatives, Community • Resource Mapping • District • Community • Coaching Capacity • Secondary/Tertiary coach • Training Opportunities • Secondary and Tertiary series for school and community partners • Integration • At all three tiers • Within the school building • Using resources differently

49. 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)