Integrating School Mental Health and PBIS: Examples at All 3 Tiers

1. Integrating School Mental Health and PBIS: Examples at All 3 Tiers Michele Capio, Oak Park School District Pam Horn, Elgin School District U-46 Kelly Perales, Community Care Behavioral Health

2. Agenda • Describe key features of the Interconnected Systems Framework (ISF) • Share tools that have been developed and how to use them in practice • Share examples of early implementation at all three tiers

3. ConnectionsandPartnerships • OSEP National PBIS Technical Assistance Center (www.pbis.org) • Center for School Mental Health (www.csmh.umaryland.edu) • NASDSE (www.ideapartnership.org) • National COP for SBBH (www.sharedwork.org)

4. BIG Ideas… • How Multi-tiered Systems of Support (MTSS) can enhance mental health in schools • Installing SMH through MTSS in Schools • The Interconnected Systems Framework (ISF) SMH +MTSS=ISF

5. History-Rationale • Sparse availability of MH providers in schools • Labels and ‘places’ confused with interventions • Separate delivery systems (Sp.Ed., Mental health, etc) • Minimal accountability for outcomes for most vulnerable populations

6. Why Partnership Are Needed • 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 • Suicide is 4th leading cause of death among young adults

7. SMH and PBISCommon Purpose • Schools supporting/promoting MH of ALL students • Prevention, early access, interventions commensurate with level of need (vs label) • School personnel feel confident and competent in identifying and intervening with accuracy and effectiveness

8. Logic • Youth with MH needs require multifaceted education/behavior and mental health supports • The usual systems have not routinely provided a comprehensive, blended system of support. • Supports need to be provided in a clustered and integrated structure, • Academic/behavior and mental health supports need to be efficiently blended

9. Promotion and Prevention Simple and complex supports require integrated systems with foundation of a school-wide system • Schools and community serve as protective factor • problem-solving teams with school/family/youth/community voice • use of data for decision-making (screening/ selection and monitoring/outcomes) • layers supports from the foundational/universal to the more complex

10. SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT: What is meant by “layering” interventions? 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 ~80% of Students

11. Core Features of a Response to Intervention (RtI) Approach • Investment in prevention, screening and early intervention for students not at “benchmark” • Multi-tiered intervention approach • Use of progress monitoring and problem-solving process at all 3-tiers

12. Core Features of a Response to Intervention (RtI) Approach • Research-based practices and active use of data for decision-making at all 3-tiers • Use of progress monitoring and problem-solving process at all 3-tiers

13. 3-Tiered System of Support Necessary Conversations (Teams) UniversalTeam Meeting Secondary Systems Team Meeting Problem Solving Team Meeting Tertiary Systems Team Meeting Standing team; uses FBA/BIP process for one student at a time Uses process data; determines overall intervention effectiveness Uses process data; determines overall intervention effectiveness Plans schoolwide & classroom supports Check-In Check-Out Universal Support Complex FBA/BIP Wraparound Skills Groups Brief FBA/BIP Group w. individual feature Brief FBA/BIP Illinois PBIS Network Rev. 11.19.2012

14. 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/ Tertiary Check-in/ Check-out (CICO) Intervention Assessment 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 SIMEO Tools: HSC-T, SD-T, EI-T Wraparound Illinois PBIS Network, Revised October 2009 Adapted from T. Scott, 2004

15. Definition of school mental health • Involves partnership between schools and community health/mental health organizations, as guided by families and youth • Builds on existing school programs, services, and strategies • Focuses on all students, both general and special education • Involves a full array of programs, services, and strategies- mental health education and promotion through intensive intervention • (Weist & Paternite, 2006)

16. “Expanded” School Mental Health • Full continuum of effective mental health promotion and intervention for ALL students • Reflecting a “shared agenda” involving school-family-community partnerships • Collaborating community professionals (augment the work of school-employed staff

17. The Context • Over 18,000 schools engaged in implementation of SWPBIS (MTSS ) prevention based system • Current focus on capacity to scale-up • MTSS as platform to install effective interventions for youth w/or at-risk of EBD

18. The Context (cont.) • Emphasis now on scaling with expansion and connection to other systems • i.e. academic, juvenile justice, mental health, child welfare, systems of care • Emphasis on deliberate actions that foster connections w/families & community

19. Development of ISF • 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

20. Interconnected Systems Framework paper (Barrett, Eber and Weist , revised 2009) Developed through a collaboration of the National SMH and National PBIS Centers www.pbis.orghttp://csmh.umaryland.edu

21. ISF Monograph DevelopmentJune 2012 – September 2013 • Define the common goals of SMH and PBIS • Discuss the advantages of interconnection • Identify successful local efforts to implement collaborative strategies and cross-initiative efforts • Define the research, policy, and implementation agendas to take us to the next action level

22. ISF Defined • ISF provides structure and process for education and mental health systems to interact in most effective and efficient way. • ISF is guided by key stakeholders in education and mental health system who have the authority to reallocate resources, change role and function of staff, and change policy. • ISF applies strong interdisciplinary, cross-system collaboration.

23. ISF Defined • ISF uses the tiered prevention logic as the overall organizer to develop an action plan. • ISF involves cross system problem solving teams that use data to decide which evidence based practices to implement.

24. ISF Defined (cont) • ISF involves ongoing progress monitoring for both fidelity and impact. • ISF emphasizes active involvement by youth, families, and other school and community stakeholders.

25. Interconnected Systems Framework • 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 • Safe & caring learning environments • Partnerships : school, home & community • Decision making framework guides use of and best practices that consider unique strengths and challenges of each school community

26. MH/PBIS: An Expanded Tier One • Universal screening for social, emotional, and behavioral at-risk indicators • Universal screening for families who may request assistance for their children • Teaching social skills with evidence-based curricula to all students • Teaching appropriate emotional regulation and expression to all students • Teaching behavioral expectations to all students • Mental health professionals are part of the Tier 1 systems team, providing input and progress monitoring data • Opportunity to review community data and expand Tier 1 intervention options based on data

27. Interconnected Systems Framework • Tier 2: Early Intervention for Some • Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns • Systems Planning Team coordinates referral process, decision rules and progress monitors • Array of services available • Communication system: staff, families and community • Early identification of students 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

28. MH/PBIS: An Expanded Tier Two • Mental health/community professionals part of secondary systems and problem solving teams • Working smarter matrix completed to ensure key resources are both efficient and effective (i.e., initiatives are aligned and combined such as “bully prevention”, “discipline”, “character education”, “RtI behavior”, etc.) • Groups co-facilitated by school staff and community partner (example – guidance counselor and community provider clinician) • Opportunity to expand the continuum of interventions based on data (i.e. trauma informed interventions) • Out-reach to families for support/interventions

29. Interconnected Systems Framework • Tier 3: Intensive Interventions for Few • Individual Student and Family Supports • Systems Planning team coordinates decision rules/referrals and progress monitors • Individual team developed to support each student • Individual plans have array of interventions/services • Plans can range from one to multiple life domains • System in place for each team to monitor student progress

30. MH/PBIS: An Expanded Tier Three • Mental health professional(s) part of tertiary systems team • FBA/BIP and/or person-Centered Wraparound plans completed together with school staff and mental health provider for one concise plan, rather than each completing paperwork to be filed • Quicker access to community-based supports for students and families

31. Traditional  Preferred Each school works out their own plan with Mental Health (MH) agency; District has a plan for integrating MH at all buildings (based on community data as well as school data);

32. Traditional  Preferred A MH counselor is housed in a school building 1 day a week to “see” students; MH person participates in teams at all 3 tiers;

33. Traditional  Preferred No data to decide on or monitor interventions; MH person leads group or individual interventions based on data;

34. Structure for Developing an ISF: Community Partners Roles in Teams • A District/Community leadership that includes families, develops, supports and monitors a plan that includes: • Community partners participate in all three levels of systems teaming in the building: Universal, Secondary, and Tertiary

35. Structure for Developing an ISF: Community Partners Roles in Teams (cont.) • Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored • MH providers from both school & community develop, facilitate, coordinate and monitor all interventions through one structure

36. 3-Tiered System of Support Necessary Conversations Family and community Family and community Family and community Community UniversalTeam 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 with family; uses FBA/BIP process for one youth at a time CICO Universal Support Brief FBA/BIP SAIG Complex FBA/BIP WRAP Group w. individual feature Brief FBA/BIP Sept. 1, 2009

37. Using and Expanding the Framework • Change creates uncertainty and fear • Struggle always precedes growth Help foster new mental map- framework leads to having people think in different ways Tools • Tools help manage conversation in smaller groups • Lead to minimizing danger and maximizing reward • Lead to overwhelming sense of purpose David Rock

38. Current Tools (in development) • Dialogue Guides (IDEA partnership) • Implementation Guides (Funding, Team) • Crosswalk of Demo Sites (Data, Systems, Practices) • Readiness Checklist • Resource Mapping • Consumer Guide for Selecting MH practices

39. U-46 at a Glance Enrollment: Total school enrollment 40,570 54.8% Low Income 97 languages spoken in U-46 homes Facilities: 40 Elementary Schools (PreK-6) 8 Middle Schools (7-8) + 1 Alternative Middle School 5 High Schools + 2 Alternative High Schools 2 Early Childhood Centers Communities Served: 11 communities 3 counties (Cook, DuPage, Kane)

40. SD U-46 Student Profile Based on School Report Card 2012

41. MISSION • The mission of the U-46 School and Community Alliance is to • create, integrate and leverage existing and new school/community • partnerships that develop a full continuum of systematic interventions • based on data. It encompasses three intervention tiers: • Systems for promoting healthy development and preventing problems • Systems for responding to problems as soon after onset as is feasible • Systems for providing intensive care

43. 22 Community Partners 78 providers trained in PBIS/SAIG Boys and Girls Club of Elgin*Centro de Informacion* Community Crisis Center*Crossroads Kids Club* Easter Seals*Elgin Police Department* Family Service Association of Greater Elgin Area*Fox Valley Pregnancy Center*Fox Valley Volunteer Hospice*Girl Scouts of Northern Illinois*Hanover Township Youth and Family Services*Kenneth Young*Kids’ Hope USA*Renz Center*Streamwood Behavioral Healthcare System*Taylor Family YMCA*The Y*WAYS*West Ridge Community Church*Youth Leadership Academy

44. U-46 School and Community Alliance Work Groups 2009-2012

45. U-46 School and Community Alliance Work Groups 2012-2013

46. 3-Tiered System of Support Necessary Conversations (Teams) UniversalTeam 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 CICO Universal Support Brief FBA/BIP SAIG Complex FBA/BIP WRAP Group w. individual feature Brief FBA/BIP

47. Training • 2009-2013 Separate training for partners (condensed versions of school training) • 2011-2013 Community partners attend Team Planning Day with their PBIS Tier 2/3 System Teams • 2012-current Community partners attend full training with school teams • Examples: Wraparound, RENEW, and Trauma informed CPI

48. Tier 1 Network Example Hanover Township Youth & Family Services • Elementary (Grades 4-5-6) Open Gym • Middle and High School Healthy Living in Health Classes

49. Elgin High Example Tier 1 Examples Boys & Girls Club (Elgin) • Club Elgin: daily, after school RENZ • Freshman Transition: prevention model Tier 2 Examples Boys & Girls Club (Elgin) • SAIG: 2-3 groups, not responding to CICO, DPR card electronically Family Service Association of Greater Elgin • Group Mentoring: 5 groups, 3-5 girls/group, anger management and conflict resolution Hanover Township Youth & Family Services • Group Mentoring: 2 groups, daily CICO with counselor • Alternative to Suspension Program: restorative program

50. Tier 2/Social Academic Instruction Groups (SAIG) • Coordinated by Elgin High School Counselor • Facilitated by Community Partner • Data: Feedback from Teachers and Students • Groups 6-8 weeks • Student identification based on teacher/dean/counselor input and lack of response to CICO • Agency partners are active members of secondary systems team