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1 © 2010 Children’s Memorial Hospital SBHC mental health providers : Role on CARE teams and Delivery of Tier II Group Interventions March 5, 2012 Ashley.

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Presentation on theme: "1 © 2010 Children’s Memorial Hospital SBHC mental health providers : Role on CARE teams and Delivery of Tier II Group Interventions March 5, 2012 Ashley."— Presentation transcript:

1 1 © 2010 Children’s Memorial Hospital SBHC mental health providers : Role on CARE teams and Delivery of Tier II Group Interventions March 5, 2012 Ashley Abbett, MA Youth Guidance Laura Hurwitz, LCSW Community-Linked Mental Health Services Program Karen Mertig, Alternatives

2 2 © 2010 Children’s Memorial Hospital 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 3 Academic Continuum Behavior Continuum OSEP Center on Positive Behavioral Interventions and Supports RTI Integrated Continuum

4 4 © 2010 Children’s Memorial Hospital The Illinois School Model Illinois PBIS Network, Revised May Adapted from "What is school-wide PBS?", OSEP Technical Assistance on Positive Behavioral Interventions & Supports.

5 5 © 2010 Children’s Memorial Hospital Three Tiers Tier I - Universal: policies and practices that target the entire population of a school to promote and enhance wellness by improving social, 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 6 © 2010 Children’s Memorial Hospital 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 7 © 2010 Children’s Memorial Hospital 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 8 © 2010 Children’s Memorial Hospital CPS: Behavioral Health

9 9 © 2010 Children’s Memorial Hospital 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 10 © 2010 Children’s Memorial Hospital CARE Teams help to link and coordinate services for students HEALTH SERVICES RESTORATIVE JUSTICE COMMUNITY MENTAL HEALTH AGENCY MENTORS CARE TEAM IN-SCHOOL SUSPENSION DISCIPLINE OFFICE WEEKLY ADVISORY COUNSELING OFFICE PEER JURY ATTENDANCE OFFICE RE-ENTRY SUPPORT

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

12 12 © 2010 Children’s Memorial Hospital 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: C ares about both the individual and the system A ssesses by gathering information, discussing, and planning R esponds by following through with interventions E valuates the effectiveness of interventions and determines the need to reassess

13 13 © 2010 Children’s Memorial Hospital 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 14 © 2010 Children’s Memorial Hospital 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 15 © 2010 Children’s Memorial Hospital Referral Process INCIDENTSREFERRAL POINTINTERVENTIONS 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 DISCIPLINE OFFICE CARE TEAM HANDLE DIRECTLY GRADE LEVEL TEAMS

16 16 © 2010 Children’s Memorial Hospital 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 17 Referral Process for Struggling Students Remediation Plan (teacher) Student does not fulfill the terms of remediation plan Name is submitted to the CARE Team by teacher CARE Team discusses student’s progress in other courses, recommendation is made Behavior Recommendation (RFA) Screening and student is referred to Think First, CBITS or other needed intervention Academic Recommendation Student is referred for Academic Interventions Student fulfills requirements and is passing class, plan removed Student continues on plan Student is referred for academic interventions Before/After school tutoring and in class supports take place throughout the semester. When that is not effective, the remediation plan is put into place.

18 18 © 2010 Children’s Memorial Hospital 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 19 © 2010 Children’s Memorial Hospital 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 20 CARE team Interventions 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 20

21 21 © 2010 Children’s Memorial Hospital CARE Team Readiness Criteria Staff Training and Meetings School Resources School and Community Resources Support from School Administration 21

22 22 © 2010 Children’s Memorial Hospital Staffing: CARE Team Lead Existing staff member or someone hired specifically for this position Approximately 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 23 © 2010 Children’s Memorial Hospital 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 24 © 2010 Children’s Memorial Hospital 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 25 © 2010 Children’s Memorial Hospital 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 26 © 2010 Children’s Memorial Hospital 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 27 © 2010 Children’s Memorial Hospital ROLES AND RESPONSIBILITIES OF SBHC MENTAL HEALTH PROVIDER ON CLEMENTE’S CARE TEAM

28 28 © 2010 Children’s Memorial Hospital 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 29 © 2010 Children’s Memorial Hospital 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 30 © 2010 Children’s Memorial Hospital 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 31 © 2010 Children’s Memorial Hospital 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 32 © 2010 Children’s Memorial Hospital 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 33 © 2010 Children’s Memorial Hospital 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 34 © 2010 Children’s Memorial Hospital Health Center Services

35 35 © 2010 Children’s Memorial Hospital Health Center Behavioral Health Services

36 36 © 2010 Children’s Memorial Hospital Health Center Staff

37 37 © 2010 Children’s Memorial Hospital 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 38 © 2010 Children’s Memorial Hospital Professional Development for School STaff Trauma 101 Responding to Students with….

39 39 © 2010 Children’s Memorial Hospital Communication with School Staff

40 40 © 2010 Children’s Memorial Hospital IMPLEMENTING TIER II GROUP INTERVENTIONS: CBITS AND THINK FIRST

41 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 42 © 2010 Children’s Memorial Hospital Tier II Group Interventions Think FirstCBITS Students with a pattern of impulsive/reactive aggression Students exposed to traumatic events demonstrating clinical symptoms Approximately 15 sessionsApproximately 10 sessions Small groups (6-8 students) Target/Skill Areas Goal setting Increasing locus of control: personal choice behaviors Anger management training: Anger cue recognition; palliative anger regulation; Self-instruction in anger regulation Social Problem Solving: problem identification; response generation and enactment Target/Skill Areas Reduce symptoms of Post Traumatic Stress Disorder (PTSD), depression, and anxiety Recognition of normative responses to trauma Relaxation Processing traumatic memories Coping strategies for managing exposure to associated events Social problem-solving

43 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 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)www.cbitsprogram.org 44

45 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 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 47 Steps for Implementing Interventions 1.Outreach 2.Referral Process 3.Screening 4.Intake Process 5.Consents 6.Implement Intervention 7.Documentation 8.Progress Monitoring 9.Post-Intervention Assessment 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

48 48 © 2010 Children’s Memorial Hospital 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 49 © 2010 Children’s Memorial Hospital 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

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52 52 Group-specific Screenings  CBITS –Student: Trauma Symptom Inventory administered by Clinician  Think First –Multidimensional School Anger Inventory (MSAI-18); completed by student  Anger Coping –Teacher Report of Reactive and Proactive Behavior (TRRPB), completed by teacher 52

53 53 © 2010 Children’s Memorial Hospital Essential Components for Success SIMPLE, CLEAR, & EFFECTIVE REFERRAL PROCESSES CONNECTING STUDENTS TO THE BEST SUPPORTS TO MEET THEIR INDIVIDUAL NEEDS TRACKING & EVALUATING EFFECTIVENESS OF INTERVENTIONS AND STUDENT PROGRESS INTEGRATING SERVICES INTO THE REST OF THE BUILDING

54 54 © 2010 Children’s Memorial Hospital Contact Information Ashley Abbett Laura Hurwitz, LCSW Mental Health Consultant Community-Linked Mental Health Services Children’s Memorial Hospital Karen Mertig


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