1. Syracuse Public Schools Onondaga County Department of Mental Health
Getting Started: Integrating Community Mental Health Services into School-wide Positive Behavior Support in a Large Urban District
Bob Putnam
May Institute
Steve Gramet
Syracuse Public Schools
Jennifer Parmalee
Onondaga County Department of Mental Health
Monique Fletcher
Say Yes
National PBIS Forum
October 28, 2011
Rosemont, IL
, Ph.D. 1

2. Where are you in implementation process
Where are you in implementation process? Adapted from Fixsen & Blase, 2005
Exploration & Adoption
We think we know what we need so we are planning to move forward (evidence-based)
Installation
Let’s make sure we’re ready to implement (capacity infrastructure)
Initial Implementation
Let’s give it a try & evaluate (demonstration)
Full Implementation
That worked, let’s do it for real (investment)
Sustainability & Continuous Regeneration
Let’s make it our way of doing business (institutionalized use)

3. School Mental Health Partnership
More than a place for services

4. Challenges Education Mental Health
Primarily focused on services during school day
Use of evidenced based practices
Limited data based decision making
Less focus on the family
Limited mental health expertise
Limited continuum of services
Community mental health services often focused on those with severe and persistent mental health issues
Limited prevention services due to funding tied to direct services
Accessibility of services
Limited data based decision making
Use of evidence based practices

5. Contrasting Perspectives in the Education and Mental Health Systems
IDEA
Behaviors disorders, challenging behavior
Behaviorism , social learning theory
Behavior management, skill development, academic improvement
Mental Health
DSM
Psychopathology, abnormal behavior, impaired functioning
Psychoanalytic approaches, behavior theory, cognitive psychology, developmental psychology, biological/genetic perspectives, psychopharmacology
Insight, awareness, improved emotional functioning
Overarching influence
Language
Important theoretical influences
Focus of intervention
Duchnowski & Kutash, 2009

6. Merikangas, He, Brody, Fisher, Bourdon, & Koretz 2010 

8. Outcomes for Students with Mental Health Concerns
Early appearing behavioral problems during a child's preschool years are the single best predictors of school dropout, delinquency, gang membership, and adult incarceration (Center for Evidence-Based Practice, 2004)
Furthermore, unless behavioral problems are dealt with early on, the child's behaviors tend to become chronic (Campbell & Ewing, 1990). 

9. Outcomes for Students with Mental Health Concerns
Highest rate of dropouts among all disabilities are those with EBD.
Depression, anxiety and conduct disorder in adolescents are one of the lead indicators of substance abuse.

10. School-wide Positive Behavior Intervention and Support
Evidence-based features of SWPBIS
Prevention
Define and teach positive social expectations
Acknowledge positive behavior
Arrange consistent consequences that don’t allow the functions of problem behavior to be achieved
On-going collection and use of data for decision-making
Continuum of intensive, individual intervention supports.
Implementation of the systems that support
effective practices

11. Integrating Education and Mental Health Services can Enhance Overall Services
Enables PBS schools to work better with children in Tiers Two and Three and to engage families.
Significantly strengthens a mental health system of care by engaging the school and enabling all parties to come together around a single plan of care
An effective mental health system of care can assist teachers and other personnel through consultation on mental health issues and help schools fully engage families.

12. Benefits Cited by Mental Health Agencies Collaborating with PBS Schools
PBS focuses on prevention and early intervention.
Communication improves among stakeholders—schools, families, mental health and other community service providers—resulting in increased support to children and families. A unified plan, understood by all stakeholders, is more likely to be effective.
A less disruptive and more supportive school climate increases the likelihood that students with mental health problems can stay in school and succeed.
(Judge David L. Bazelon Center for Mental Health Law, 2006)

13. Benefits Cited by Mental Health Agencies Collaborating with PBS Schools
Teachers have more time to focus on the academic strengths and needs of students with serious mental disorders because less behavior problems no longer divert their attention. This can lead to greater school success and improved functioning for children with serious mental disorders.
Mental health staff feel they develop a better understanding of a student’s behavioral motivations and psychosocial needs when they are co-located in the school and can observe the student in school.
(Judge David L. Bazelon Center for Mental Health Law, 2006)

14. Where Do We Start?

15. Implementation process Adapted from Fixsen & Blase, 2005
Exploration & Adoption
We think we know what we need so we are planning to move forward (evidence-based)
Installation
Let’s make sure we’re ready to implement (capacity infrastructure)
Initial Implementation
Let’s give it a try & evaluate (demonstration)
Full Implementation
That worked, let’s do it for real (investment)
Sustainability & Continuous Regeneration
Let’s make it our way of doing business (institutionalized use)

16. 1. IMPLEMENTATION PHASES 2. 3. Local Demonstration w/ Fidelity Need,
Agreements,
Adoption, &
Outcomes 1.
IMPLEMENTATION
PHASES 2.
4. Systems
Adoption, Scaling,
& Continuous
Regeneration
Sustained
Capacity,
Elaboration, &
Replication 3.

17. Getting Ready
Commit to a process that will result in the implementation of a joint initiative.
Training of leadership across both organizations in collaborative SW-PBIS models and systems of care
District leadership team is formed.
Education and mental health authorities should ensure that the PBS planning group with inclusive participation from school and mental health leadership
Once formed, the leadership team should engage in a joint goal setting exercise and delineate the objectives and outcomes desired from the PBS initiative.

18. Getting Ready
Commitment to establishment of systems of care (PBIS) by both the school and mental health that will serve not only children with serious mental disorders, but also children who show behavior or other social/emotional problems that put them at risk for serious disorders.
Formulate policy and plan training and technical assistance that will improve the quality of services to children, using the most effective services and a strength-based, family-driven, culturally relevant approach to service delivery.

19. Supporting Social Competence &
Academic Achievement
4 PBS Elements
OUTCOMES
Supporting
Decision
Making
Supporting
Staff Behavior
DATA
SYSTEMS
PRACTICES
Supporting
Student Behavior

20. Systems for Students with High-Risk Behavior CONTINUUM OF SCHOOL-WIDE
Tertiary Prevention:
Specialized
Individualized
Systems for Students with High-Risk Behavior
CONTINUUM OF
SCHOOL-WIDE
INSTRUCTIONAL &
POSITIVE BEHAVIOR
SUPPORT
~5%
Secondary Prevention:
Specialized Group
Systems for Students with At-Risk Behavior
~15%
Primary Prevention:
School-/Classroom-
Wide Systems for
All Students,
Staff, & Settings
SAY: One of the most important organizing components of PBS is the establishment of a continuum of behavior support that considers all students and emphasizes prevention. This logic of this 3-tiered approach is derived from the public health approach to disease prevention.
All students and staff should be exposed formally and in an on-going manner to primary prevention interventions. Primary prevention is provided to all students and focuses on giving students the necessary pro-social skills that prevents the establishment and occurrence of problem behavior. If done systemically and comprehensively, a majority of students are likely to be affected.
Some students will be unresponsive or unsupported by primary prevention, and more specialized interventions will be required. One form of assistance is called secondary prevention, and is characterized by instruction that is more specific and more engaging. These interventions can be standardized to be applied similarly and efficiently across a small number of students. The goal of secondary prevention is to reduce/prevent the likelihood of problem behavior occurrences, and to enable these students to be supported by the school-wide PBS effort.
If primary prevention is in place, a small proportion of students will require highly individualized and intensive interventions. The goal or tertiary level interventions is to reduce the intensity, complexity, and impact of the problem behaviors displayed by these students by providing supports that are (a) function-based, (b) contextually appropriate and person-centered, (c) strength-based and instructionally oriented, (d) continuously evaluated and enhanced, and (e) linked to the school-wide PBS approach.
~80% of Students

21. Tier 1 Systems Education Mental Health
Develop and implement SW-PBS Plan
Training for staff around mental health disorders
Training for coaches around incorporating universal prevention strategies for most common mental health disorders
Screening for internalizing disorders
Representative/s participate on team
Training around SWPBS model for administrative/clinical supervisors
Training for school based clinical staff on SWPBS and building based SWPBS plan

22. Tier 1 Practices
Training and technical assistance in developing and implementing a SWPBS plan
Three to five positive worded school rules
Teaching matrix for common areas in the school
Training staff and students to fluency on these expectations
Reinforcement system for students for following the expectations/staff for following the plan
Consistent consequences for infractions
Data collection system in place for data based decision making

23. Tier 1 Data SWIS data ODRS Student Problem behavior Location Time
Suspensions
Academic performance
Data from screening for internalizing disorders (i.e.; Systematic Screening for Behavior Disorders)

24. Tier 2 Systems Education Mental Health Tier 2 team
Mental health representative participates on Tier 2 team
Training of coaches in evidenced based social/behavior and mental health interventions
Connections to family/ community
Training of mental health providers on evidenced based interventions
Review of student progress
Referral to appropriate services

25. Tier 2 Practices Check and Connect Behavior Education Program
Functional based social skills groups
Evidenced based social skills groups diagnostic groups (anxiety, depression)
Mentoring
Homework club

26. Tier 2 Data ODRs Suspensions Attendance Academic success CICO Data
Brief functional behavior assessment
Social skills assessments
Mental health assessments
DBR (Daily behavior report) measures

27. Tier 3 Systems Education Mental Health Tier 3 Team Wraparound teams
Monitor effectiveness of services
Training of staff on evidenced based interventions
Actively participate in Tier 3 team
Coordinate wrap around services for individual students
Advocate for family needs
Training of staff on evidenced based interventions

28. Tier 3 Practices Education Mental Health Conduct intensive FBAs
Design and implement wraparound plans
Develop and implement coordinated behavior support plans
Implement individualized evidenced based social/behavior and mental health interventions
Conduct intensive FBAs
Develop and implement coordinated behavior support plans/wraparound plans
Intensive assessment and implement individualized evidenced based social/behavior and mental health interventions
Provide supports to family
Coordinate medical and psychopharmacology

29. Tier 3 Data ODRs Suspensions Attendance Academic success CICO Data
Functional behavior assessment info
Social skills assessments/progress monitoring
Mental health assessments/progress monitoring
Emotion thermometers
DBR (Daily behavior report) measures
SIMEO measures

30. Family Involvement
Family involvement is crucial. Families and youth must receive training and support so they can participate fully in leadership and planning groups at the school and district level.
Self-assessment tools i.e.; family engagement checklist (Muscott & Mann, 2004) should be used for district and school levels. External assessment of family involvement is also a good idea.

31. Syracuse City School District and Promise Zone
Steve Gramet
Director of Pupil Services

32. Who we are 32
Syracuse City Schools is an urban district located in Central New York.
Approximately 90, 000 residents
Home of Syracuse University (Say Yes partnership)
New Superintendent of Schools, Sharon L. Contreras

33. Who we are We operate 32 schools 21, 094 students 5 High Schools
6 Kindergarten – 8th grade buildings
6 Middle Schools (6 - 8)
15 Elementary Schools

34. Who we are Enrollment 50% African American 25% Caucasian 13% Hispanic
5 % other

35. Who we are
14 % of students are English Language Learners or long term English as a Second Language students (2900)
20% of students are listed as Special Education (4,457)
Close to 85% of students are eligible receive free or reduced price lunch.
We are a dependent district that relies on local, state and federal dollars for funding

36. Data – Averages Over the Past Three Years
Over the last three years SCSD 22% have been students suspended out of school at least one time
That equates to approximate 24,000 days each year of lost instructional time for these students.
In addition over the last three years, 5,000 days of instructional time is lost to In School Suspension.
There has been a downward trend the last three years in these indicators

37. Tiered Academic Services – Committed to Data Based Decision Making
School based Intervention Teams (SBIT) for academics have been operating in the district for the last ten years.
SBIT uses data based decision making system to assess, progress monitor, and evaluate a tiered set of academic strategies.
Curriculum based measurement (DIBELS, CBM measures)
In order to effectively use our social and behavior support resources the district adopted a teired system for social/behavior modeled after the SBIT-A teams

38. Team for wrap around services and other family intervention
Protocol
PBIS Leadership Team
Examines School Wide Data, Creates Matrix, Plans Kickoff, etc.
Members include Admin., Parent, Teacher, Pupil Services Staff
Student Support Team
Looks for any student receiving three (3) referrals, makes initial intervention
Members include Admin., Social Worker, School Counselor, Say Yes Site Director, others as appropriate
Intervention and Data monitored by Day Yes Site Director and Student Support Team members
SBIT-B Team
Students receiving seven (7) referrals, close examining of function of behavior, individual or small group intervention, family involvement
Members include Clinician, School Psychologist, Social Worker, Say Yes Site Director and others as appropriate
Intervention monitored by Say Yes Site Director, if issues continue referral to Onondaga County Access
Team for wrap around services and other family intervention
Referral to clinic services can happen through either SST or SBIT –B team

39. PBIS
Full implementation began in September 2010 (a few schools have been using PBIS strategies for several years)
SCSD hired a PBIS District Coordinator
PBIS staff development has been enhanced with emphasis on the universal strategies
SET’s were implemented to all schools in October 2010 and again in the spring of 2011.

40. SET Scores

41. Interconnected Services
In 2007 Say Yes to Education became an external partner of SCSD.
As a result, relationships between the SCSD district and county improved
Due to funding cuts, the district and the county entered into agreement to try to integrate their services.
This unique partnership between the district, county, Say Yes to Education provided easier access to services.

42. Steps To Implementation
A stated goal of our previous Superintendent was for every school to provide Mental Health services at school due access issues of our population and data based decision making.
Schools were given a brief overview of the possible services and proposed protocol.
A rollout plan approved by the current Superintendent has been approved and we are moving forward

43. Jennifer Parmalee, Onondaga County Department of Mental Health
Syracuse Promise Zone
A partnership of the Dept. Mental Health, Syracuse City School District, Say Yes to Education, System of Care, & Community Based Organizations
Jennifer Parmalee, Onondaga County Department of Mental Health
Monique Fletcher
Say Yes to Education

44. What is Promise Zone
Grant to 3 Urban districts for innovative solutions that result in improved student achievement
Designed to increase community collaboration and the districts ability to identify and support students with serious emotional challenges

45. Mission Long Term Short Term Improve academic performance
Increase graduation rates
Increase student wellness
Short Term
Reduce suspensions
Keep students in class and ready to learn
Match students emotional behavioral needs with proper and targeted interventions

46. Action Plan - Systems
Expand mental health clinics from 13 to 35 and integrate clinician into Tier 3 teams
District Wide Protocol for identifying and supporting youth
Clarify the role of the social workers
Expand PBIS with fidelity
District Leadership team to monitor progress at building and district levels concerning PBIS/RTI
Clarify the role of the Say Yes Site Director
Improve the Crisis Response for students and staff

47. Community Strengths from Which to Build
Highly effective Academic School Based Intervention Teams (SBIT) based on RtI framework
Mental Health Clinic Satellites currently serving 13 schools
Say Yes to Education site directors in all elementary and K-8 schools
Talent of Social Workers
District wide implementation of Positive Behaviors and Supports
System of Care Community

48. Onondaga Department of Mental Health
Oversight
Planning and Quality Improvement
Contract Management (95 programs)
County (City) Demographics
Population: ,753 (138,560)
Children ages 5-19: ,308 (32,423)
95% of funding from State Authorities (OMH, OASAS OPWDD)
What is SED population

49. ONCARE – System of Care
Partnership of Mental Health, Child Welfare, Juvenile Justice, Family Organization, Community Based Organizations
Guiding Principles
All our children/youth
Parents/Caregivers as “experts”
Family-driven & Youth-guided
“Community Table” to “Kitchen Table”
“No Wrong Door”
Single plan of care
Strength Based approach
Cultural and Linguistic relevant
Better outcomes for children/youth who have emotional or behavioral challenges.
Target populations: disproportionality, transition age youth.

50. Maximize the Use of Blended Funding to Improve Effectiveness and Efficiency
Syracuse City School District
Multiple Onondaga County Departments
Say Yes resources
Outpatient agencies
Family support
Other resources
How is data shared to determine the selection of interventions?
How is data shared to determine effectiveness of interventions

51. Say Yes To Education
Say Yes to Education, Inc. (Say Yes) is a national, non-profit education foundation committed to dramatically increasing high school and college graduation rates for our nation's urban youth.
Say Yes provides comprehensive supports, including the promise of free college tuition, aligned with what research indicates is needed to enable every child in the program to achieve his or her potential.

52. Say Yes Community-wide Involvement
After school-Tier 1
9 Community based organizations in 20 schools
Summer camp-Tier 1
Syracuse University
Tutoring-Tier 2
Syracuse University Literacy Corp Volunteers
Family Support Services-Tier 3
Huntington Family Centers
Student Assistance Program-Tier 3
Contact Community Services
Facilitated Enrollment-Tier 3
Salvation Army
Legal clinics-Tier 3
Pro bono services from legal community

53. System Involvement Onondaga County Supports Schools
Department of Aging and Youth
Youth Program Quality Assessment (YPQA)
Department of Social Services
Educational Neglect
Health Department
Health insurance enrollment
Department of Mental Health
Promise Zone

54. Say Yes – Commitment to Data Based Decision Making
Say Yes Site Coordinators routinely collect data on
Attendance
Behavior (ODR/Suspensions)
Academics(i.e., DIBELS)
These data are presented to SCSD principals and teams on a monthly basis
Say Yes Site Directors assist in linking services and resources to improve these outcomes

55. Moving Towards an Interconnected System
Established members of Tier 3 team
Utilizing evidence based intervention for all students
Progress monitoring
Prioritizing school functionality in treatment goals
Sharing data with team of school professionals
Accountability to team in addition to child and family with family’s permission
Community responsibility to engage families

56. Challenges
Increasing the number of schools implementing Tier 1 to fidelity
Increasing of schools implementing Tier 2 and Tier 3 systems and evidenced based practices
The use of common language
Training for the SBIT -B teams around understanding behavioral function in order to put the appropriate interventions in place (ie. Check/Connect, ART, individual counseling, mentoring etc…)

57. Challenges
Learning to work effectively with external partners such as Onondaga County and Say Yes to Education
Redefining the role of the Social Worker
Helping in-school clinicians to use strategies that are reasonably short term, evidenced based and result in improved school performance
New York State Medicaid redesign delay creates system in flux
Schools have to provide appropriate space for clinic. The space must approved by the state as adequate.

58. For more information
pbis.org