1. D11 - School Mental Health & PBIS Integration: Implementation Progress/Examples Kelly Perales, Community Care Behavioral Health (PA) Jill Johnson, Illinois PBIS Network

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

3. Interconnected Systems Framework for School Mental Health 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

4. Interconnected Systems Framework for School Mental Health 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

5. Illinois

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

7. 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

8. 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 meet every 6-8 weeks together to set up system features – Secondary Systems Team was formed

9. Systems Features cont… At community mental health agency level – Wrote for additional funding from the local United Way to help support the implementation of the EBP practice, SPARCS, in the schools so as to relieve any financial burden on the school during the implementation stages Key – Having a PBIS TAC and mental health leader work as liaisons between the two systems, who believe in what is being done and work through the hard issues that arise

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

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

12. 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

13. – 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 email) 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

14. 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

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

16. 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

17. Referral to Release Name to Community Elements

18. Referral for SPARCS

19. Back of Referral

20. School-Community Partner Information Sheet

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

22. 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

23. 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

24. Outcomes School Data – Office Discipline Referrals

25. Outcomes School Data – In-School and Out-of-School Suspension

26. Outcomes School Data – Tardies and Absences

27. Outcomes School Data - Grades

28. 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

29. 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

30. 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”

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

33. Future for Full Implementation Goals for Integration Identify incoming freshman – service Summer 2012 Potential for multiple groups next year at Centennial; feeder middle school, other high school and alternative high school is also beginning 2012-2013SY Refine data decisions for appropriate ID of students Provide further teacher/staff training in SPARCS skills and develop plan for further integration of skills Utilize students to co-lead group Build stronger parent engagement Build sustainability plan Universal screener – Spring 2013 Professional development plan for all staff

34. 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) Make interventions sustainable – Funding – Part of system of support

35. Pennsylvania

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

37. 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

38. 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.

39. 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 39© 2010 Community Care

40. 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)

41. 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 41© 2010 Community Care History of the Development of School Based Behavioral Health (SBBH) Team Service A Clinical Home Model

42. 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

43. 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

44. 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

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

46. 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 46© 2010 Community Care

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

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

49. Time Line School YearActivity 2008-09 Community Care engaged district through ICSP regarding SBBH Team 2009-10 SBBH Team begins work within district – September 2009 District and Community Leadership Team is established, district commitment signed, tertiary demonstration project begins – spring 2010 2010-11 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 2011-12 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

50. 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

51. Scranton High School

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

53. Outcomes Change in Family Functioning

54. Outcomes Change in Child Functioning

55. Outcomes – SDQ-P Change in Difficulties Score

56. Outcomes – SDQ-T Change in Difficulties Score

58. 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.

59. 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.

60. Child Outcomes Survey (COS) Family Functioning: Child X

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

62. Child Outcomes Survey (COS) Overall Wellness: Child X

63. Strength and Difficulties-Parent Report: Child X

64. Strength and Difficulties-Teacher Report: Child X

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

66. Scranton School District Year One 2009-10 Year Two 2010-11 Year Three 2011-12 Year Four 2012-13 Year Five 2013-14 Year Six 2014-15 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. 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