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Interconnected Systems Framework Local Implementation Sites Experiences and Lessons Learned Lucille Eber, Illinois PBIS Network Jill Johnson, Illinois.

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Presentation on theme: "Interconnected Systems Framework Local Implementation Sites Experiences and Lessons Learned Lucille Eber, Illinois PBIS Network Jill Johnson, Illinois."— Presentation transcript:

1 Interconnected Systems Framework Local Implementation Sites Experiences and Lessons Learned Lucille Eber, Illinois PBIS Network Jill Johnson, Illinois PBIS Network Kelly Perales, Community Care Behavioral Health Bob Stevens, Charleston South Carolina Mark Weist, University of South Carolina October 25, 2012 Center for School Mental Health National Conference

2 Content for Today… How Multi-tiered Systems of Support (MTSS) can enhance mental health in schools Installing SMH through MTSS in Schools The Interconnected Systems Framework (ISF)

3 Why We Need MH 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 Suicide is 4th leading cause of death among young adults

4 Why We Need MH Partnerships (cont.) At least twice as many youth need high levels of support than identified as EBD. Youth who are identified as EBD have experienced very poor outcomes Schools can’t do it alone; partnerships with communities are needed for success

5 Advancing Education Effectiveness: Interconnecting School Mental Health & School-wide Positive Behavior Support June 2012 – September 2013 Collaborative effort of the OSEP TA Center of PBIS, Center for School Mental Health, and IDEA Partnership(NASDE) bringing together national-level experts in the SMH and PBIS, state and district leaders, and selected personnel from exemplar sites currently implementing collaborative initiatives.

6 Advancing Education Effectiveness: Interconnecting School Mental Health & School-wide Positive Behavior Support (cont.) Publish a monograph that provides a summary and framework for interconnection, documents examples of success, and lays out a research, policy, and technical assistance agenda for the future.

7 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

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

9 “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

10 Positive Behavior Intervention and Support (www.pbis.org) Decision making framework to guide selection and implementation of best practices for improving academic /behavioral functioning Data-based, measurable outcomes, evidence- based practices, systems to support effective implementation

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 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

12 ISF Defined – structure and process for education and mental health systems to interact in most effective and efficient way. – key stakeholders in education and mental health system who have the authority to reallocate resources, change role and function of staff, and change policy. – strong interdisciplinary, cross-system collaboration. – tiered prevention logic as the overall organizer to develop an action plan. – cross system problem solving teams that use data to decide which evidence based practices to implement. – ongoing progress monitoring for both fidelity and impact. – active involvement by youth, families, and other school and community stakeholders.

13 Structure for Developing an ISF: A District/Community leadership that includes families, develops, supports and monitors a plan that includes: – Community partners participating in all three levels of systems teaming in schools: Universal, Secondary, and Tertiary – Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored – MH providers from both school and community develop, facilitate, coordinate and monitor all interventions through one structure

14 Old Approach  New Approach 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);

15 Old Approach  New Approach 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;

16 Old Approach  New Approach No data to decide on or monitor interventions; MH person leads group or individual interventions based on data;

17 SPARCS Integration Jill Mathews-Johnson, MSW, LCSW IL PBIS Network

18 Interconnected Systems Framework Systems Features Exploration and Adoption Installation Phase Initial Implementation Full Implementation Innovation and Sustainability Fixsen, 2010

19 Pathway to ISF Youth and Family Service Director and IL PBIS TAC passion for ISF – Relationship built four years earlier in writing a SSHS grant in Urbana SAMSHA grant, Champaign County Local leaders and administrators belief in need for integration to address all students’ needs

20 Systems Features Exploration and Adoption At the building level – Admin team was meeting weekly and looking at the data to determine needs Gaps were identified – mental health – Administrators, Community Elements Director for Youth Services and PBIS TAC met to determine intervention to meet needs and continued meeting every few weeks to set up system features – Secondary Systems Team was formed

21 Organizational Structures Administrative Team Centennial HS & Secondary Systems Team Liaisons Jill & Juli Community Elements (United Way/708 Board/ACCESS

22 Intervention - SPARCS SPARCS – Structured Psychotherapy for Adolescents Responding to Chronic Stress – Mission of SPARCS: To enhance trauma focused services available to traumatized children and adolescents (complex trauma) – Group members – history of chronic interpersonal trauma, living with significant ongoing stressors, may or may not meet full criteria for PTSD and exhibit functional impairment.

23 SPARCS Evidenced informed intervention 16-one hour groups Adolescents History of trauma (broadly defined) Living with ongoing stressors Exhibit functional impairment Trauma Screening (TESI)

24 Interconnected Systems Framework Systems Features Exploration and Adoption Installation Phase Initial Implementation Full Implementation Innovation and Sustainability

25 Installation Phase Systems Features – Community mental health staff (Director and Program Coordinator) with the assistance of the PBIS TAC set up meetings with key school administrators (Principal, AP’s) to introduce SPARCS to them Follow-up meetings periodically to deal with larger system issues – PowerPoint presentation of key program features presented to admins, school social workers, school psychologist and counselors Shifting of school-based staff roles/responsibilities discussed

26 The Nuts and Bolts – Discussion of potential target population and how data would be used to identify students – Discussion on how referral process to community provider would happen and who would communicate with student’s parents – Referral form and program flyers developed for school staff to share with parents – One school contact person was identified for on-going communication (mostly by ) and problem solving as issues arose This person was key as she was responsive and reliable – Community Elements workers were added to secondary systems team

27 Organizational Structures Identifying Students with Needs Data-based Decision Rules for Entrance – At Centennial, students are referred for SPARCS because they are freshman/freshman status and They have been through two tier two interventions and have not responded They are READY (alternative school) students transitioning back to Centennial** They have had multiple SASS contacts Meet criteria for trauma experience as screened using the TESI-SR ( Traumatic Events Screening Inventory-Self Report) ** READY, Juvenile Detention & MH providers also providing across the community

28 Organizational Structures Funding SAMHSA SOC Cooperative Agreement – ACCESS Initiative United Way of Champaign County Medicaid billing (future) Probation/Court Services (future

29 Organizational Structure Assessing Personnel Skills/Talents Community Elements personnel hired specifically to provide school-based supports School-based staff, with behavioral background, are present during group SPARCS trained – Ongoing support by national SPARCS trainers

30 Referral to Release Name to Community Elements

31 Referral for SPARCS

32 Back of Referral

33 School-Community Partner Information Sheet

34 Interconnected Systems Framework Systems Features Exploration and Adoption Installation Phase Initial Implementation Full Implementation Innovation and Sustainability

35 Initial Implementation System Features Secondary Systems Team meetings – Meeting twice a month to talk through systems response to work through system implementation issues to build rapport and building relationship to communicate and implement with fidelity Liaisons that understand and can build relationships between the two systems

36 Initial Implementation Systems Features – The school staff initiated the referrals to the program by first identifying appropriate youth, contacting parents and receiving permission to provide student’s name to community provider – Community mental health staff completed all intake paperwork and screenings with students/families and subsequent follow-up information – School staff made sure each student arrived to the group on time – Community mental health works facilitated groups and one school social worker sat in on the groups to assist with any issues as they may be related to school policy and staying connected with the students – School staff tracked data to report at year end

37 Data Systems School – ODRs – ISS – OSS – Credits/Grades – Attendance – Additional SASS calls (future) Mental Health – Youth group survey results – ( ) Strengths and Difficulties Questionaire, TESI-R and YOQ

38 Outcomes School Data – Office Discipline Referrals

39 Outcomes School Data – In-School and Out-of-School Suspension

40 Outcomes School Data – Tardies and Absences

41 Outcomes School Data - Grades

42 Staff Feedback Mental Health Providers – Positives Being part of Tier II team helpful Having school staff facilitate arrival/departures from group very helpful – Future Improvements Need to improve communication with school staff when events occur with students in group Having one dedicated administrator is essential to coordination Need more time prior to group start to get to know students/families

43 Student Feedback Student Survey Results 1=strongly agree 2=disagree 3= don’t know 4=agree 5=strongly agree Skills were helpful to me: a)Mindfulness 3.8 b)Self-sooth/distract 4.4 c)LET ‘M GO4.0 d)MAKE A LINK 4.2 Have used skills outside of group4.4

44 Student Feedback Continued What was the best part of group?  “It helped me to make better choices and not get into trouble”  “That you can talk about stress level and feelings”  “It allowed me to share”  “It helped me to identify my sources of anger”  “I liked that it had structure, that we had a lesson plan that we followed and I liked the handbook”  “Food”

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46 Interconnected Systems Framework Systems Features Exploration and Adoption Installation Phase Initial Implementation Full Implementation Innovation and Sustainability

47 Expansion Feeder middle school Other Champaign high school Alternative school (that Centennial refers out to or receives students back from Additional sites in: Rantoul and Urbana

48 How Do We Get Things Started?

49 SPARCS Embedding SPARCS in All Three Tiers

50 How Do We Get Change to Occur? Lessons Learned Stakeholders Liaisons who: – understand both systems – are open to integration – have “power” in at least one system Student Outcomes Decision Makers Liaisons Admin- istrators Field Staff

51 How Do We Get Change to Occur? Lessons Learned Schedule meetings with stakeholders – Bi-monthly “Secondary Systems” meetings – Monthly/Quarterly administrative meetings Allows all stakeholders to have voice Keeps communication lines open Establish procedures and protocols System where academic and behavior interventions linked Create true partnerships – Stakeholders need to be seen as viable members in both settings (team membership, professional development) Student and family voice Make interventions sustainable – Funding – Part of system of support

52 PAPBS Network Tertiary Demonstration Project Community Care as affiliated partner in the PA Positive Behavior Support (PBS) Network History of PA SBBH Community of Practice History of Community Care transformation of children’s behavioral health services

53 Pennsylvania’s Community of Practice (CoP) on School Based Behavioral Health (SBBH) The CoP on SBBH was initially established in 2006 through the Bureau of Special Education (BSE) as a means by which to address school- based behavioral health. Presently, the CoP includes membership of approximately 52 individuals including representatives from the Pennsylvania Departments of Education, Health, and Public Welfare in addition to youth serving provider agencies, managed care organizations, advocates, and youth and family members.

54 The Commonwealth of Pennsylvania Local control for counties and school districts Behavioral health managed care organizations – Carve out – County choice Community Care – Over half of the counties – Oversight from stakeholders Office of Mental Health and Substance Abuse Services (OMHSAS) – Systems of Care – Integrated Children’s Service Planning 54© 2010 Community Care

55 Pennsylvania Mental Health Continuum of Care Inpatient Residential Treatment Facility (RTF) Individualized Residential Treatment (IRT)/TFC/CCR Host Home Behavioral Health Rehabilitation Services (BHRS) Family Based Mental Health Services (FBMHS) Family Based Partial HospitalSchool-Based Mental Health (SBMH) Outpatient Intensive Case Management/Resource Coordination (ICM/RC) Crisis Services (Mobile Crisis, Emergency Room, and Walk-in Crisis Centers)

56 Stakeholder input regarding current BHRS and children’s service delivery – Families – Educators – County partners – child serving systems Unique opportunity to partner with Department of Welfare and OMHSAS Transformation of children’s services – Partnership with oversight – Stakeholder input – Development of program description template 56© 2010 Community Care History of the Development of School Based Behavioral Health (SBBH) Team Service A Clinical Home Model

57 Accountable Clinical Home Accountable TO the family and FOR the care Accessible, coordinated, and integrated care Comprehensive service approach Increased accountability and communication Single point of contact for behavioral health School is “launching pad” for services delivered in all settings Youth continue on the team with varying intensity of service

58 SBBH Service Components C LINICAL I NTERVENTIONS C ASE M ANAGEMENT C RISIS I NTERVENTION C ASE C ONSULTATION AND T RAINING for educational staff

59 SBBH Team Components L ICENSED M ASTER ’ S P REP C LINICIANS (MHP) E XPERIENCED B ACHELOR ’ S P REP W ORKERS (BHW) A DMIN A GENCY S UPPORT C ONSULTATION TO MHP S PRN

60 Community Care Support of SBBH Teams LEARNING COLLABORATIVE T RAINING TECHNICAL ASSISTANCE E VIDENCE - BASED P RACTICES COACHING M ODEL F IDELITY CARE MANAGEMENT

61 Learning Collaborative A Community of Practice for Providers Training, case consultation, coaching – stability of workforce, integrity of practices, fidelity to model Platform – – Family systems theory and interventions – Resiliency/recovery principles and supports – Trauma informed care – Identification of co-occuring disorders – Positive behavior interventions and supports 61© 2010 Community Care

62 District and Community Leadership Team Quarterly meetings Stakeholder representation – System of Care Implementer’s blueprint Systems, data and practices Scaling and sustainability

63 Time Line School YearActivity Community Care engaged district through ICSP regarding SBBH Team SBBH Team begins work within district – September 2009 District and Community Leadership Team is established, district commitment signed, tertiary demonstration project begins – spring Tier One SWPBIS is fully implemented with kickoff at the start of the school year Tier Two training begins in the spring of 2011 with some implementation All three tiers are being implemented at both elementary schools Montrose Junior High receives Tier One training in fall, with “soft” kickoff in January 2012 Discussion of SBBH Team model expanding into Junior and Senior High

64 Montrose Jr High implementation SBBH and school collaboration – doing more with less – reallocation of resources Fiscal and clinical responsibility Community connections and partners – ICSP - SOC

65 1-5% 5-10% 80-90% Tertiary, Tier 3, Individual Child Outcomes Survey Strengths and Difficulties Q. Teacher feedback Academic data Tertiary, Tier 3, Individual Guidance counselors see individual students SBBH Team Secondary, Tier 2 Group/Individual Data from Tier One team Progress monitoring Data decision rules Secondary, Tier 2 Group/Individual Guidance counselors run Targeted groups IST CICO mentoring Universal, Tier 1 Whole School ODRs, teacher nominations, Card system, MMS, (lessons learned) Universal, Tier 1, Whole school Guidance counselors teach “I Can Problem Solve” lessons Treehab D and A awareness Bully prevention/Character Ed Peer Mediation Montrose Elementary Schools K-6 th Grade Data Practices

66 Scranton School District Year One Year Two Year Three Year Four Year Five Year Six District and Community Leadership Team established. District commits to implementing SWPBIS with fidelity across the district. SBBH Teams begin implementation at Frances Willard Elementary, George Bancroft Elementary, and Scranton High. A Tier Three support. Frances Willard Elementary, George Bancroft Elementary, and Scranton High all receive training to implement Tier One SWPBIS. Frances Willard Elementary, George Bancroft Elementary, and Scranton High all implement Tier One SWPBIS. Frances Willard Elementary reaches implementation fidelity. Frances Willard Elementary receives training for implementation of Tier Two and begins implementation. Frances Willard Elementary implements three tiers of Interconnected Systems Framework. Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton Intermediate all receive training to implement Tier One SWPBIS. Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton Intermediate all implement Tier One SWPBIS. George Bancroft Elementary and Scranton High receive training for implementation of Tier Two and begin implementation Scranton High receives training and begins implementation of RENEW. SBBH Teams begin implementation at Northeast Intermediate, John F. Kennedy Elementary, McNichols Plaza Elementary, and John G. Whittier Elementary. John F. Kennedy Elementary, John G. Whittier Elementary, and Northeast Intermediate all receive training to implement Tier One SWPBIS. John F. Kennedy Elementary, John G. Whittier Elementary, and Northeast Intermediate all implement Tier One SWPBIS.

67 Scranton High School

68 Key features Systems – District and building teaming models – Facilitation, technical assistance, coaching – Stakeholder participation and buy-in Practices – Mental health and school staff work in an integrated way to support students across tiers – Using assessment and screening in order to determine which EBPs to use, progress monitor – One plan for both education and mental health Data – Shared decision rules – Used for decision making with all stakeholders at the table – school, mental health, other child serving systems, family

69 Outcomes Change in Family Functioning

70 Outcomes Change in Child Functioning

71 Outcomes – SDQ-P Change in Difficulties Score

72 Outcomes – SDQ-T Change in Difficulties Score

73 The Smith Family Jason was referred to the SBBH Team in November. He is a seven-year-old first grader who was having difficulty coming to school and being separated from his mother. When he was four, Jason and his family were in a car accident in a rural area. The members of the family were taken to different hospitals and Jason did not know where his mom was or if she was okay. Every day, since the first day of school, Jason’s mom would bring him into the school and the school staff would literally have to peel Jason off of his mother and hold him so she could leave.

74 The Smith Family cont. Once referred to the team, they were immediately able to work with Jason and his family to create strategies to help him separate more smoothly. Jason found the SBBH Team office/room a safe place to be. His mother also spent time there to help create a nice transition area. After the Holiday break, Jason began riding the bus for the fist time, accompanied by one of the BHWs from the team. Soon, Jason was able to ride the bus on his own, increasing his confidence and allowing him some relief from his anxiety.

75 Child Outcomes Survey (COS) Family Functioning: Child X

76 Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child X

77 Child Outcomes Survey (COS) Overall Wellness: Child X

78 Strength and Difficulties-Parent Report: Child X

79 Strength and Difficulties-Teacher Report: Child X

80 Lessons Learned Return on investment Funding efficiency Scaling and sustaining SBBH Teams – size Community “politics”

81 SBMH Conference October 2012 Bob Stevens, Charleston, SC

82 Charleston County, SC 45,000 students in 78 schools. Over 100 miles from the most distant schools Rural, inner city, and suburban schools Student Population: 46% African American; 46% Caucasian; 3% Mixed; Asian 2%; 1% Native Amer.; 1% other 14% Identify themselves as Latin or Hispanic 60% receive free or reduced meals 9.5% have IEP’s 6% not English proficient Historically in CCSD schools; nurses, guidance counselors, a few contracted mental health counselors, para-professional behavior support staff; school psychologists not school based.

83 Tier 3/Tertiary Interventions 1-5% Individual students Assessment-based High intensity 1-5%Tier 3/Tertiary Interventions Individual students Assessment-based Intense, durable procedures Tier 2/Secondary Interventions 5-15% Some students (at-risk) High efficiency Rapid response Small group interventions Some individualizing 5-15%Tier 2/Secondary Interventions Some students (at-risk) High efficiency Rapid response Small group interventions Some individualizing Tier 1/Universal Interventions 80-90% All students Preventive, proactive 80-90%Tier 1/Universal Interventions All settings, all students Preventive, proactive School-Wide Systems for Student Success: A Response to Intervention (RtI) Model Academic Systems Behavioral Systems Illinois PBIS Network, Revised May 15, Adapted from “What is school-wide PBS?” OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. Accessed at

84 Old Mental Health Provider Job Description Provides services on IEP Maintains channels of communication with principals and teachers Provides assistance in crisis situations Maintains communication with students, parents, educational personnel, and community Provides and participates in in-service Conducts seminars for parents Other duties as assigned.

85 Newly Designed Job Description Participate in building based activities that support the School Improvement Plan Participate in Secondary and Tertiary intervention planning meetings Participate in development and implementation of strategies and activities related to PBIS Use data to determine effectiveness of research based intervention (pre and post) Use the three tiered approach to intervention planning to enter, progress monitor, and exit youth from interventions (based on data) Providing coaching and professional development for staff

86 Job Description (New, cont.) Provide conflict resolution training, drug and alcohol education, and social skills training based on secondary or tertiary team Provide direct services to children in crisis Provide school social work services to children as determined in the IEP process based on a continuum of preventative interventions Develop and maintain working relationships with students, parents, educational personnel, and community Participate in the development of Tertiary interventions in the form of FBA/BIP or wraparound teams

87 Common Trends Moving from reactive to preventative Time efficient and least restrictive Moving from Tier 1 to leading Tier 2/3 Facilitating Tier 3 Interventions Serving students needs vs. “labeled” populations Systems approach Intervention vs. Referral to Professional

88 Developing Charleston’s - Interconnected Systems Framework Low Level Communication between Providers To Collaboration with Providers To High level Integration of Providers

89 Developing an Integrated Systems Framework School-based Mental Health in Charleston SC

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92 The Evolution in Charleston, SC Mental health counselors when supported by Medicaid Part-time guidance in many schools which focused primarily on academic counseling. Very limited number of social workers in the district office working in the Office of Exceptional Children supporting identified students School psychologists assigned to multiple schools with “testing” as priority.

93 From 0 to 60 in two years Expanded Mental Health Federal Counseling Grant Charleston Promise Neighborhood Medical University of South Carolina Climate Grant Gear Up Grant Allocation from General Operating Fund Community In Schools Support

94 SYSTEMS PRACTICES DATA Supporting Staff Behavior Supporting Decision Making Supporting Student Behavior SW-Positive Behavior Support OUTCOMES Social Competence & Academic Achievement

95 ISF SSW, MH, CIS developing new roles in CCSD schools Integrating with current systems, creating new systems Existing Teams – School Leadership – PBIS – TEAM Two – CORE (Tier 3) External Partners

96 Use Data to Drive Activities Data that will lead to intervention before referral – At-Risk Alert System – SWIS – Social Emotional Measures

97 Intervention Vs. Referral ARAS (pronounced “air-us”) is the At-Risk Alert System: a data tool developed by Charleston County School District as part of a federal Safe Schools/Healthy Students grant. Helps identify students potentially at-risk by using existing academic & behavior data. Transforms data into reports to support effective decision making. Provides composite views of magnitudes of risk factors existing for students and schools. Supports a variety of student support models.

98 Risk Indicators ARAS uses student academic and behavior data currently available in PowerSchool and other district data bases as indicators to assess potential risk. For each of eight indicators, students are assigned to one of three levels: – Level 1 (Motivated/Low Risk) – Level 2 (Vulnerable/Moderate Risk) – Level 3 (Critical; High Risk)

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103 Use Data to Monitor Practices Tier Three Tier Two Tier One AcademicSocial Emotional Mental Health Physical

104 What Services are Delivered

105 Initially Focus on Tier One

106 PBIS Problem Solving Logic used by CCSD for School-based Social Workers 1.Establish Ground Rules 2.Start with Data 3.Match Practices to Data 4.Align Resources to Implement Practices Lewis, PBIS Missouri

107 Common Trends From Illinois and Pennsylvania adopted in Charleston, SC Moving from reactive to preventative Time efficient and least restrictive Moving from Tier 1 to leading Tier 2/3 Facilitating Tier 3 Interventions Serving students needs vs. “labeled” populations Systems approach Intervention vs. Referral to Professional


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