SBHC mental health providers : Role on CARE teams and Delivery of Tier II Group Interventions March 5, 2012

1. SBHC mental health providers :Role on CARE teams and Delivery of Tier II Group InterventionsMarch 5, 2012 Ashley Abbett, MA Youth Guidance Laura Hurwitz, LCSW Community-Linked Mental Health Services Program Karen Mertig, Alternatives

2. Objectives: • Describe the CARE Team model including: • Rationale • Core functions • Structure • Expectations/implications for school staff • Key Components to successful implementation • Describe Roles and Responsibilities of SBHC mental health provider on a CARE team. • Making Referrals/Receiving referrals • Consultation • Delivery of Interventions • Identify successes and challenges of SBHC providers implementing CBITS and Think First

3. Behavior Continuum Academic Continuum RTI Integrated Continuum OSEP Center on Positive Behavioral Interventions and Supports

4. The Illinois School Model Illinois PBIS Network, Revised May 2008. Adapted from "What is school-wide PBS?", OSEP Technical Assistance on Positive Behavioral Interventions & Supports. 

5. Three Tiers • Tier I - Universal: policies and practices that target the entire population of a school to promote and enhance wellness by improvingsocial, emotional, and behavioral skills (e.g., school-wide and classroom programs and activities that foster safe and caring learning environments that engage students) • Tier II - Secondary: interventions that target students who have already evidenced early signs of an identified concern or who are at risk of developing mental health or behavioral concerns (e.g., groups that address aggression, exposure to violence) • Tier III - Tertiary: interventions for the individuals who are identified as having the most severe, chronic, or pervasive concerns. (e.g., evidence-based individual and family interventions)

6. Social-Emotional Policy, Chicago Public Schools, 2004 • Every school must provide... • School-wide policies • Classroom instruction • Teacher training • Parent education • Community partnerships • Screening, early intervention • Clinical referral

7. Behavioral Health at CPS • Formerly part of Coordinated School Health Program in Office of Special Education and Supports • Currently Youth Development and Positive Behavioral Support in Office of Pathways to College and Careers. Includes: • Positive Behavior Supports • Culture of Calm • Service Learning • Sports Administration • Safe Schools, Healthy Students • TOPs grant • Other related initiatives: • School Counseling • Community Schools

8. CPS: Behavioral Health

9. CARE Team: Mission and Purpose • Supports students’ social, emotional, and behavioral needs in order to maximize their learning • Functions as a web of support for students exhibiting social, emotional, or behavioral difficulties • Supports a three-tiered model of mental health and prevention • Assesses student needs, matches them to appropriate intervention(s), and collaborates with other adults to advocate for the student and monitor their progress • Intervenes as early as possible in order to prevent escalation of problematic behaviors and to prevent the need for more intensive services

10. CARE Teams help to link and coordinate services for students PEER JURY DISCIPLINE OFFICE WEEKLY ADVISORY IN-SCHOOL SUSPENSION CARE TEAM ATTENDANCE OFFICE HEALTH SERVICES COUNSELING OFFICE MENTORS RESTORATIVE JUSTICE COMMUNITY MENTAL HEALTH AGENCY RE-ENTRY SUPPORT

11. CARE Teams utilize best practices to coordinate cohesive services that benefit all students ATTENDANCE OFFICE DISCIPLINE OFFICE PEER JURY IN-SCHOOL SUSPENSION CARE TEAM RESTORATIVE JUSTICE HEALTH SERVICES SBHC COUNSELING OFFICE COMMUNITY MENTAL HEALTH AGENCY MENTORS WEEKLY ADVISORY RE-ENTRY SUPPORT

12. CARE Team Objectives The CARE Team is a place for concerned educators to effectively address the needs and problems of their schools’ at-risk students. A CARE Team: Cares about both the individual and the system Assesses by gathering information, discussing, and planning Responds by following through with interventions Evaluates the effectiveness of interventions and determines the need to reassess

13. CARE Team: Structure and Services CARE Teams are school-based groups composed of school counselors, school social workers, school psychologist, community mental health provider, and administrators that: • Come together on a weekly basis to collaborate in finding solutions to the problems of at-risk students and families. • Deliver three levels of interventions that address students’ social, emotional, and behavioral needs. • Facilitate referrals to school and community-based resources to further support student needs. • Collaborate with school personnel (e.g., teachers, deans, student advocates) and community-based organizations to coordinate services and supports. • Collect, interpret, and report on data to improve quality of services.

14. Criteria for CARE Team Referral • Early Intervention: • Students with social/emotional issues that are negatively impacting academic and social functioning at school • Students with problems with anger • Students exposed to trauma • Students at risk of behavioral health problems (e.g., symptoms of depression or anxiety, experimental substance use, peer issues) • Students already receiving clinical services (or IEP plans) are not excluded from Tier II services (but not the primary target of supports)

15. Referral Process INCIDENTS REFERRAL POINT INTERVENTIONS GRADE LEVEL TEAMS • Bullying • Verbal confrontation • Fight • Trauma • Persistent classroom disruption • Drug / alcohol abuse • Persistent truancy • OTHER • Classroom Intervention • Conference with student, parent, and/or teacher • In-school suspension • Restorative Justice • Mentoring • Tier II group interventions • Tier III counseling HANDLE DIRECTLY DISCIPLINE OFFICE CARE TEAM

16. Possible Action Items following Grade Level Team Meetings Classroom Level Supports • Lead teacher chosen to monitor supports • Grade Level Team develops intervention (student support) plans • Lead teacher collaborates with team /monitors progress • Report back to Grade Level next meeting on progress CARE Team Referral • Teachers complete referral (RFA) and SDQ • Collaborate with CARE Team Lead • CARE Team meets to review RFA and conduct additional screenings • CARE team representative reports back to Grade Level next meeting

17. Referral Process for Struggling Students

18. What Teachers Can Expect from CARE Team • Prompt response to referrals • Ongoing communication about students’ attendance and progress in groups • Consultation to support work with students: • When to refer a student • What clinical issues look like • How clinical issues may affect academics • How to support your student while they are dealing with social-emotional or behavioral issues • Classroom management for students who do not respond to universal strategies • Crisis intervention

19. What CARE Team Expects from Teachers • Referrals for students exhibiting significant social-emotional or behavioral concerns • Continuing collaboration and communication about the student’s progress or about ongoing problematic behaviors • Continued efforts to provide Tier I interventions to complement CARE Team interventions • Completion of necessary referral forms • Completion of intervention-specific pre-post screening forms (to evaluate effectiveness of interventions) • Ongoing communication/progress monitoring during group intervention

20. CARE team Interventions 20 Group and individual Skill-building Normative peer support School-based: removes barriers to access, decreases stigma Manualized and evidence-based Generalization to classroom setting Address behaviors that impact school performance and attendance

21. CARE Team Readiness Criteria • Staff • Training and Meetings • School Resources • School and Community Resources • Support from School Administration 21

22. Staffing: CARE Team Lead • Existing staff member or someone hired specifically for this position • Approximately 14-16 hours per week • Type 73 masters’ level clinician (social worker, psychologist, licensed clinical professional counselor) • Skills and experience: - Leadership skills (e.g. setting agendas, convening meetings) - Clinical skills - Skill in building community partnerships - Strong organizational skills - Interest and ability to gather, enter, manage, and use data to drive practice - Interest and experience in training and public speaking 22

23. Staffing: CARE Team Members • Minimum of three internal staff members (counselors, social worker, psychologist, special education case manager) • Estimated time commitment: approximately 4-6 hours per week • Previously trained on and has implemented district-supported tier II group interventions (CBITS and think first) • An administrative liaison (e.g., Culture of calm coordinator, assistant principal) • Behavioral health community partner clinician providing school-based services 23

24. School and Community Resources • Existence of (or interest in developing) Tier One structures to help address student social/emotional/behavioral issues such as: • Grade level teacher teams (e.g., SLCs) in which teachers meet to discuss students’ academic and behavioral progress in the classroom • Student Advisory • Tier One Restorative Justice initiatives • Collaboration with community partners who have successfully provided services to the school and students 24

25. Support from School Administration • School must designate an administrator (e.g. Culture of Calm Coordinator) to take on the following roles: • Oversight of the CARE Team • Supervision of CARE Team members (e.g., meeting attendance, delegation of CARE Team tasks) • Liaison to Children's Memorial Hospital consulting team • Liaison to community providers • Administrator should integrate CARE Team into school’s professional development calendar throughout the year to engage the entire school in the implementation and adoption of the model 25

26. Role of CMH Consultant • Assist with the CARE Team implementation, including: • Aligning CARE Team practices with school’s philosophy and mission • Partner and collaborate with existing school-based teams • Consult with staff around implementation issues and individual case issues • Provide professional development on interventions and strategies • Collect and analyze data about the effectiveness of the interventions • Support school in partnering with existing community and school-based resources to help address students’ social, emotional, and behavioral needs 26

27. Roles and Responsibilities of SBHC mental health provider on clemente’sCARE team

28. Clemente CARE Team Participants • Core participants: • Counselors: • School Social Worker • School Psychologist • Special Education Case Manager • Community Agency Clinician • Clinical Consultants • Administrative Support • Principal and/or Assistant Principal • Culture of Calm Staff • At-Risk Coordinator • SEL Coordinator • Community Partners:

29. CARE team Meeting Agenda: Closed CARE teams • New Referrals • Student Updates • Identify Concerns impacting student success • Prioritize concerns as a group • Review strategies already implemented (successful and not successful; barriers/challenges) • Supported Implementation on Groups • Support to Grade Level Teams • Professional Development for school staff

30. CARE team Meeting Structure • Meets every week on Tuesday afternoons for 1.5 hours • Alternates between CLOSED and OPEN CARE team meetings • OPEN CARE teams include community partners

31. Training and Meetings • CARE Team members attend a bi-weekly CARE Team meeting • CARE Team leads attend bi-weekly meeting with CMH consultant • Staff who have not previously been trained on CBITS or Think First must attend 4-5 days of training in these interventions. • CARE Team staff should attend district-wide technical assistance meetings (BTAT) to receive support in the implementation of the Tier II behavioral health supports 31

32. CARE team Meeting Agenda: Open CARE teams Part One (first hour) • New Referrals • Student Updates • Identify Concerns impacting student success • Prioritize concerns as a group • Review strategies already implemented (successful and not successful; barriers/challenges) • Program Updates Part Two: (for those implementing groups) • Supported Implementation

33. Clemente’s Community Partners and Services • Youth Guidance: Project Prepare/Project Strive • ASPIRA • Arts of Living • YWCA • Knock at Midnight • Assist Her • Planned Parenthood • Talent Search • School-Based Health Center!

34. Health Center Services

35. Health Center Behavioral Health Services

36. Health Center Staff

37. Role on Grade Level Teams • Grade level teams are designed to: • Identify students who are not successful in one or more areas (academic, behavior, social-emotional) • Formulate hypotheses about why a particular student is struggling • Develop, implement and monitor individual, data-driven, asset-based action plans that: • Mobilize and utilize student supports • Provide the right interventions to the right students • Use a Professional Learning Community • Use a problem solving process to generate creative solutions to mutually defined problems

38. Professional Development for School STaff • Trauma 101 • Responding to Students with….

39. Communication with School Staff

40. IMPLEMENTING Tier II GROUP Interventions: Cbits and think first

41. Selecting Interventions • Should match needs of students/school/ community • Number of students referred • Presenting issues of students referred • Time of year/Number of Sessions • Age or developmental level of children/youth • Materials and/or space needed • Previous success with intervention • Experience and training of facilitators • If using an alternate intervention (Universal)… • Must demonstrate effectiveness • Establish plan for supervision 41

42. Tier II Group Interventions

43. Co-facilitation Requirements: Lead Facilitator CBITS/Think First/Anger Coping SBC Clinician (Masters level social worker, psychologist, or counselor supervised by a Licensed Mental Health Professional (LMHP) (LCPC, LCSW, PhD, PsyD) Must attend in-person training on intervention Must attend ongoing TA sessions 43

44. Co-facilitation Requirements: Second Facilitator CBITS: SBC Clinician Type 73 school based professional (school psychologist, school social worker, school counselor) Graduate trainees/interns must be supervised by masters level social worker, psychologist, or counselor. (Interns may not conduct individual sessions). Must complete training. On-line training can be used until in-person training is available. (www.cbitsprogram.org) 44

45. Co-facilitation Requirements: Second Facilitator Think First/Anger Coping: SBC Clinician Type 73 school based professional (school psychologist, school social worker, school counselor) Graduate trainees/interns supervised by masters level social worker, psychologist, or counselor Teacher, school/program support staff, administrators Training and attendance at CPS or NRI TA sessions recommended. If second group leader does not have clinical training and/or does not attend training, this person is to assist with activities and behavior management, not the delivery of content. Preparation for group must include: Reading manual before beginning the group Meeting with lead facilitator/supervisor to review manual and intervention binder training materials prior to and throughout the group. 45

46. Deliver Group Interventions Confirm rosters Space Schedule Send letter to students and family members Set up group and individual files Plan group sessions Plan family information session Discuss roles of co-facilitators 46

47. Steps for Implementing Interventions In order to facilitate appropriate referrals, timely communication, and effective supports to students, the CARE Team has best practices in place for each of the following: 47 Outreach Referral Process Screening Intake Process Consents Implement Intervention Documentation Progress Monitoring Post-Intervention Assessment

48. Referral to CARE team Required Documentation • Request for Assistance (RFA): • Check list of presenting problems • Student strengths • Interventions • Goals of referral • Strengths and Difficulties Questionnaire (SDQ) • Pre/Post behavioral screen • Teacher version required; MUST BE completed by a teacher • Student and parent forms available (optional) • Teachers must answer all items-if not sure, give student “benefit of the doubt”

49. SDQ • Brief behavioral screen for all students receiving Tier II services • Includes 25 psychological attributes, some positive, some negative • Back side includes questions related to impact of issues on classroom • Five scales: • Emotional issues • Conduct problems • Hyperactivity/inattention • Peer relationships • Pro-social behavior