1. Integrating School Mental Health and PBIS: Examples at All 3 Tiers
Michele Capio, Oak Park School District
Pam Horn, Elgin School District U-46
Kelly Perales, Community Care Behavioral Health

2. Agenda
Describe key features of the Interconnected Systems Framework (ISF)
Share tools that have been developed and how to use them in practice
Share examples of early implementation at all three tiers

3. Connections and Partnerships
OSEP National PBIS Technical Assistance Center (
Center for School Mental Health (
NASDSE (
National COP for SBBH (

4. BIG Ideas…
How Multi-tiered Systems of Support (MTSS) can enhance mental health in schools
Installing SMH through MTSS in Schools
The Interconnected Systems Framework (ISF)
SMH +MTSS=ISF

5. History-Rationale Sparse availability of MH providers in schools
Labels and ‘places’ confused with interventions
Separate delivery systems (Sp.Ed., Mental health, etc)
Minimal accountability for outcomes for most vulnerable populations

6. Why Partnership Are Needed
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

7. SMH and PBIS Common Purpose
Schools supporting/promoting MH of ALL students
Prevention, early access, interventions commensurate with level of need (vs label)
School personnel feel confident and competent in identifying and intervening with accuracy and effectiveness

8. Logic
Youth with MH needs require multifaceted education/behavior and mental health supports
The usual systems have not routinely provided a comprehensive, blended system of support.
Supports need to be provided in a clustered and integrated structure,
Academic/behavior and mental health supports need to be efficiently blended

9. Promotion and Prevention
Simple and complex supports require integrated systems with foundation of a school-wide system
Schools and community serve as protective factor
problem-solving teams with school/family/youth/community voice
use of data for decision-making (screening/ selection and monitoring/outcomes)
layers supports from the foundational/universal to the more complex

10. What is meant by “layering” interventions?
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT:
What is meant by “layering” interventions?
Tertiary Prevention:
Specialized
Individualized
Systems for Students with High-Risk Behavior
~5%
Secondary Prevention:
Specialized Group
Systems for Students with At-Risk Behavior
~15%
Primary Prevention:
School-/Classroom-
Wide Systems for
All Students,
Staff, & Settings
You can use the all, some, few description for this triangle and also talk about the layering of interventions that this represents.
~80% of Students

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

12. Core Features of a Response to Intervention (RtI) Approach
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

13. 3-Tiered System of Support Necessary Conversations (Teams)
Universal Team
Meeting
Secondary Systems Team
Meeting
Problem Solving Team Meeting
Tertiary Systems Team Meeting
Standing team; uses FBA/BIP process for one student at a time
Uses process data; determines overall intervention effectiveness
Plans schoolwide & classroom supports
Uses process data; determines overall intervention effectiveness
Check-In Check-Out
Universal Support
Skills Groups
Complex
FBA/BIP
Wraparound
Brief
FBA/BIP
Group w. individual
feature
Brief FBA/BIP
Illinois PBIS Network
Rev 13 13

14. Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal
School-Wide Assessment
School-Wide Prevention Systems
ODRs, Attendance, Tardies, Grades, DIBELS, etc.
Tier 2/ Secondary
Tier 3/
Tertiary
Check-in/ Check-out (CICO)
Assessment
Intervention
Social/Academic Instructional Groups (SAIG)
Daily Progress Report (DPR) (Behavior and Academic Goals)
Group Intervention with Individualized Feature (e.g., Check and Connect -CnC and Mentoring)
Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc.
Brief Functional Behavior Assessment/
Behavior Intervention Planning (FBA/BIP)
Complex or Multiple-domain FBA/BIP
SIMEO Tools: HSC-T, SD-T, EI-T
Illinois PBIS Network, Revised October 2009
Adapted from T. Scott, 2004
Wraparound

15. Definition of school mental health
Involves partnership between schools and community health/mental health organizations, as guided by families and youth
Builds on existing school programs, services, and strategies
Focuses on all students, both general and special education
Involves a full array of programs, services, and strategies- mental health education and promotion through intensive intervention
(Weist & Paternite, 2006)

16. “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

17. 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

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

19. Development of ISF
: Site Development with PBIS Expansion (informal and independent)
CoP focus on integration of PBIS and SMH
2008: ISF White Paper: formal partnership between PBIS and SMH
Monthly calls with implementation sites, national presentations (from sessions to strands)
Grant Submissions
June September 2013 ISF Monograph
Monograph Advisory group

20. Interconnected Systems Framework paper (Barrett, Eber and Weist , revised 2009)
Developed through a collaboration of the
National SMH and National PBIS Centers

21. ISF Monograph Development June 2012 – September 2013
Define the common goals of SMH and PBIS
Discuss the advantages of interconnection
Identify successful local efforts to implement collaborative strategies and cross-initiative efforts
Define the research, policy, and implementation agendas to take us to the next action level

22. ISF Defined
ISF provides structure and process for education and mental health systems to interact in most effective and efficient way.
ISF is guided by key stakeholders in education and mental health system who have the authority to reallocate resources, change role and function of staff, and change policy.
ISF applies strong interdisciplinary, cross-system collaboration.

23. ISF Defined
ISF uses the tiered prevention logic as the overall organizer to develop an action plan.
ISF involves cross system problem solving teams that use data to decide which evidence based practices to implement.

24. ISF Defined (cont)
ISF involves ongoing progress monitoring for both fidelity and impact.
ISF emphasizes active involvement by youth, families, and other school and community stakeholders.

25. Interconnected Systems Framework 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
Safe & caring learning environments
Partnerships : school, home & community
Decision making framework guides use of and best practices that consider unique strengths and challenges of each school community

26. MH/PBIS: An Expanded Tier One
Universal screening for social, emotional, and behavioral at-risk indicators
Universal screening for families who may request assistance for their children
Teaching social skills with evidence-based curricula to all students
Teaching appropriate emotional regulation and expression to all students
Teaching behavioral expectations to all students
Mental health professionals are part of the Tier 1 systems team, providing input and progress monitoring data
Opportunity to review community data and expand Tier 1 intervention options based on data

27. Interconnected Systems Framework Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns
Systems Planning Team coordinates referral process, decision rules and progress monitors
Array of services available
Communication system: staff, families and community
Early identification of students 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

28. MH/PBIS: An Expanded Tier Two
Mental health/community professionals part of secondary systems and problem solving teams
Working smarter matrix completed to ensure key resources are both efficient and effective (i.e., initiatives are aligned and combined such as “bully prevention”, “discipline”, “character education”, “RtI behavior”, etc.)
Groups co-facilitated by school staff and community partner (example – guidance counselor and community provider clinician)
Opportunity to expand the continuum of interventions based on data (i.e. trauma informed interventions)
Out-reach to families for support/interventions

29. Interconnected Systems Framework
Tier 3: Intensive Interventions for Few
Individual Student and Family Supports
Systems Planning team coordinates decision rules/referrals and progress monitors
Individual team developed to support each student
Individual plans have array of interventions/services
Plans can range from one to multiple life domains
System in place for each team to monitor student progress

30. MH/PBIS: An Expanded Tier Three
Mental health professional(s) part of tertiary systems team
FBA/BIP and/or person-Centered Wraparound plans completed together with school staff and mental health provider for one concise plan, rather than each completing paperwork to be filed
Quicker access to community-based supports for students and families

31. Traditional  Preferred
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);

32. Traditional  Preferred
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;

33. Traditional  Preferred
No data to decide on or monitor interventions;
MH person leads group or individual interventions based on data;

34. Structure for Developing an ISF: Community Partners Roles in Teams
A District/Community leadership that includes families, develops, supports and monitors a plan that includes:
Community partners participate in all three levels of systems teaming in the building: Universal, Secondary, and Tertiary

35. Structure for Developing an ISF: Community Partners Roles in Teams (cont.)
Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored
MH providers from both school & community develop, facilitate, coordinate and monitor all interventions through one structure

36. CICO SAIG Universal Team Secondary Systems Team Problem Solving Team
3-Tiered System of Support Necessary Conversations
Family and community
Family and community
Family and community
Community
Universal Team
Secondary Systems Team
Problem Solving Team
Tertiary Systems Team
Uses Process data; determines overall intervention effectiveness
Uses Process data; determines overall intervention effectiveness
Plans SW & Class-wide supports
Standing team with family; uses FBA/BIP process for one youth at a time
CICO
Universal Support
Brief
FBA/BIP
SAIG
Complex
FBA/BIP
WRAP
Group w. individual
feature
Brief FBA/BIP
Sept. 1, 2009 36 36

37. Using and Expanding the Framework
Change creates uncertainty and fear
Struggle always precedes growth
Help foster new mental map- framework leads to having people think in different ways
Tools
Tools help manage conversation in smaller groups
Lead to minimizing danger and maximizing reward
Lead to overwhelming sense of purpose
David Rock

38. Current Tools (in development)
Dialogue Guides (IDEA partnership)
Implementation Guides (Funding, Team)
Crosswalk of Demo Sites (Data, Systems, Practices)
Readiness Checklist
Resource Mapping
Consumer Guide for Selecting MH practices

39. U-46 at a Glance Enrollment: Facilities: Communities Served:
Total school enrollment 40,570
54.8% Low Income
97 languages spoken in U-46 homes
Facilities:
40 Elementary Schools (PreK-6)
8 Middle Schools (7-8) + 1 Alternative Middle School
5 High Schools + 2 Alternative High Schools
2 Early Childhood Centers
Communities Served:
11 communities
3 counties (Cook, DuPage, Kane)

40. Based on School Report Card 2012
SD U-46 Student Profile
Based on School Report Card 2012

41. MISSION The mission of the U-46 School and Community Alliance is to
create, integrate and leverage existing and new school/community
partnerships that develop a full continuum of systematic interventions
based on data. It encompasses three intervention tiers:
Systems for promoting healthy development and preventing problems
Systems for responding to problems as soon after onset as is feasible
Systems for providing intensive care

43. 22 Community Partners 78 providers trained in PBIS/SAIG
Boys and Girls Club of Elgin*Centro de Informacion* Community Crisis Center*Crossroads Kids Club* Easter Seals*Elgin Police Department* Family Service Association of Greater Elgin Area*Fox Valley Pregnancy Center*Fox Valley Volunteer Hospice*Girl Scouts of Northern Illinois*Hanover Township Youth and Family Services*Kenneth Young*Kids’ Hope USA*Renz Center*Streamwood Behavioral Healthcare System*Taylor Family YMCA*The Y*WAYS*West Ridge Community Church*Youth Leadership Academy

44. U-46 School and Community Alliance Work Groups 2009-2012
Operations
Tier 2/3
High School Violence Prevention

45. U-46 School and Community Alliance Work Groups 2012-2013
Tier 1 Trauma Informed Care
Tier 2 Interventions
Tier 3 RENEW/WRAP

46. Secondary Systems Team
3-Tiered System of Support
Necessary Conversations (Teams)
Universal Team
Secondary Systems Team
Problem Solving Team
Tertiary Systems Team
Uses Process data; determines overall intervention effectiveness
Uses Process data; determines overall intervention effectiveness
Plans SW & Class-wide supports
Standing team; uses FBA/BIP process for one youth at a time
CICO
Universal Support
Brief
FBA/BIP
SAIG
Complex
FBA/BIP
WRAP
Group w. individual
feature
Brief FBA/BIP 46 46

47. Training
Separate training for partners (condensed versions of school training)
Community partners attend Team Planning Day with their PBIS Tier 2/3 System Teams
2012-current Community partners attend full training with school teams
Examples: Wraparound, RENEW, and Trauma informed CPI

48. Hanover Township Youth & Family Services
Tier 1 Network Example
Hanover Township Youth & Family Services
Elementary (Grades 4-5-6)
Open Gym
Middle and High School
Healthy Living in Health Classes

49. Elgin High Example Tier 1 Examples Tier 2 Examples
Boys & Girls Club (Elgin)
Club Elgin: daily, after school
RENZ
Freshman Transition: prevention model
Tier 2 Examples
SAIG: 2-3 groups, not responding to CICO,
DPR card electronically
Family Service Association of Greater Elgin
Group Mentoring: 5 groups, 3-5 girls/group,
anger management and conflict resolution
Hanover Township Youth & Family Services
Group Mentoring: 2 groups, daily CICO with counselor
Alternative to Suspension Program: restorative program

50. Tier 2/Social Academic Instruction Groups (SAIG)
Coordinated by Elgin High School Counselor
Facilitated by Community Partner
Data: Feedback from Teachers and Students
Groups 6-8 weeks
Student identification based on teacher/dean/counselor input and
lack of response to CICO
Agency partners are active members of secondary systems team

51. Weekly Progress Report
Elgin High School
Weekly Progress Report
NS=No School A=Absent all day NP=No show M=Missing data
Period 1
Period 2
Date
Earn & Give Respect Goal (Stop, think and act before reacting to something)
Hold Yourself Responsible (Stop, think and act before reacting to something)
Safety First Goal (Stop, think and act before reacting to something)
2/6/2012
2/7/2012
2/8/2012
2/9/2012
2/10/2012

52. Weekly Progress Report Earn and Give Respect (student will not talk back to staff) Hold Yourself Responsible (Student will be on time to class) Safety First (Student will wear ID around neck)

53. Pre-test/Post-test
1. I attend school regularly 2. I skip ___# of classes each week 3. I receive all A’s, B’s, and C’s for grades 4. I receive _____# of disciplinary referrals per week 5. I feel connected to my school 6. I feel respected and important while at school 7. I can count on friends for support 8. I can count on my family members for support

54. I feel connected to my school

55. I feel respected & important at school

56. Next Steps at EHS…
Move from instructional short-term groups to long-term group mentoring with skill instruction embedded in the mentoring
Increase communication between deans/facilitators/staff of the interventions
Align initiatives
Explore more intensive interventions for students with unmet mental health needs

57. Next Steps for Community Alliance…
Increase trauma focus at all three tiers
Directory of partners/agencies
Blend & coordinate initiatives across district
Expand alternative to suspension
Utilize district exemplars as examples for other schools
Increase communication between district and community partners

58. Using and Expanding the Framework
Change creates uncertainty and fear
Struggle always precedes growth
Help foster new mental map- framework leads to having people think in different ways
Tools
Tools help manage conversation in smaller groups
Lead to minimizing danger and maximizing reward
Lead to overwhelming sense of purpose
David Rock

59. 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

63. Crosswalks What creates the pathway? Systems, Data, Practices
Identified need (gaps in services, lack of services)
Identified cost savings
Shift in population (increased poverty, homelessness, health concerns)
Frustration with current condition (restrictive, inefficient, ineffective)
Flexible funding source identified (United Way, Walter Reed, community care, blended)
PBIS foundation (provided both structure and process)
Local “Champions”
Demo sites created opportunity
Received Grant (Systems of Care)
Non profit working with school system for district wide change
Data: Moving beyond Office Referrals and Suspensions to 360 view that
include community data
hearing data, # of student encounters with law enforcement, calls to crisis centers, instructional time lost for services, use of screeners, behavioral health assessments
Practices: Broader range: EBP with Trauma focus

64. Scranton, PA History and Time Line
District and Community Leadership Team – established in school year
Transformation of mental health services for children/youth and families
Utilized PBIS Implementer’s Blueprint and Stages of Implementation (Fixen)
Began in two schools, after reviewing data indicating positive outcomes, then expansion

65. Scranton, PA “Current Conditions”
Eleven Elementary Schools (K-5)
2 implementing ISF at all three tiers
3 implementing PBIS at tier one and have SMH
1 implementing PBIS at tier one
2 will be trained/kick off PBIS this year (1 w/ SMH)
Three Intermediate Schools (grades 6-8)
1 implementing PBIS at tier one and has SMH
2 have SMH and will be trained/kick off PBIS this year
Two High Schools (grades 9-12)
1 with SMH and previously implementing PBIS

66. 2013-14 School Year 20 licensed mental health professionals
38 bachelor’s level behavioral health workers
Closure of center-based partial hospitalization program
Closure of five school-based partial hospitalization programs
ROI – less restrictive educational placements, return to home schools, less restrictive mental health placements, cost savings
Increased collaboration, communication – improved outcomes

67. Resource Mapping Definition
Mapping focuses on what communities have to offer by identifying assets and resources that can be used for building a system
It is not a "one-shot" drive to create a published list or directory
It is a catalyst for joint planning and professional development, resource and cost sharing, and performance-based management of programs and services
(National Center on Secondary Education and Transition, 2003)

68. Resource Mapping: Identifying community resources, assess duplication and build comprehensive, sustainable resources
Identify the geographic community
Identify all currently participating organizations
Discuss the description of required target population
Identify services/programs available
Inventory each agency/organization’s expenditures
Identify funds expended but not fully matched
Discuss spending resources collaboratively
Assess redundancy
Use resource map
Develop and implement plan
Share information and results to ensure support
4/15/ Hershfeldt

69. Activity: What’s in Place?
1-5% Tier 3-Resources/Supports for a Few
Community-Based Services/Resources and Providers
5-15% Tier 2- Resources/Supports for Some
School-Based Services &
Resources
Adapted from 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
Poster paper:
Draw this framework on your poster. We are going to go through taking inventory for each part, once piece at a time.
Let’s do PBIS together all the way through (ESD SW practice, ESD Team, ODRs, Attendance)
(4: schools need to flush out their own triangle) So…first thing you want to do when you go back to school tomorrow…is to think about “what interventions do we actually have at each tier”. List them out..plug them in where you think they belong based on what you know about the 3 tiers. If you’ve done this before, do it again : ) you want to make sure you’re capturing everything..including any new interventions you may have developed recently. If you haven’t done this…you may find the “crack” that children are falling thru…you may find (as many of our schools have) that the ‘gap’ we need to close is actually the yellow part of this triangle… Most schools do not have enough secondary interventions (both in quantity and type/quality) needed to support their student body. Think about it…can your Secondary system hold 15-20% of the youth in your school? (school of 1,000 is 200 kids, 500 is 100 kids)?? Everyone needs to know what this completed triangle looks like for your school: your teacher
Areas to consider—insurance/financial, geographic location/accessibility by public transportation, hours, specialty area, wait times
s, clinicians, administrators, families…
80-90% Tier 1 –Resources/Supports for All 69

70. Applying the Logic to Families
Tier 3: Intensive, Individual Interventions
Family Liaison-matched with family, needs matched with community resources
Individual Skill Building Sessions-
1-5%
Tier 2: Targeted Group Interventions
Support Groups (Military Families, Newcomer Group)
Skill Building Sessions (Academic and Behavior)
5-10%
Tier 1: Universal Interventions
Self Assessments: Family Engagement Checklist, Surveys
Skill Building Series Guest Speaker (Topics Vary- Survey Families)
Newsletter, Resource Library , “Shout Outs”
Volunteer Opportunities (DOGS- Dads of Great Students)
Teacher Conferences- Goal Setting, Family Vision, Strengths Discovery
Family Fun Nights throughout the year
School Handbook (Description, Teaching Matrix – promote common language between school and home)
Tier 1 – For All
Tier 2- increase frequency, more specific to group, more involvement in development of feedback forms
80-90%

71. School-Wide Systems for Student Success: A Response to Intervention (RtI) Model: SUPPORTS
Academic Systems
Behavioral Systems
1-5% Tier 3/Tertiary Interventions
SBMH, Partial Hospitalization
Alt Ed
FBA/PBISP
Home School Visitor
Tier 3/Tertiary Interventions %
1:1 instruction
Increased time
504
5-15% Tier 2/Secondary Interventions
Counselor groups, lunch bunch
Friendship groups
Behavior Chart/plan
IST
Parenting Classes
Tier 2/Secondary Interventions %
Title I Reading and Math
ERI, RM, RN, etc.
IST
As part of the discussion, remind them that a system means something is available at each tier- and that the tiers are interdependent in the system— i.e., secondary systems will be less effective without a strong universal system! Basic purpose of tier one is to prevent new problem behaviors from occurring; tier two is to reduce the frequency of problem behaviors; and tier three is to reduce the intensity of problem behaviors
80-90% Tier 1/Universal Interventions
Character Education curriculum
Bullying Prevention
SWPBS (some schools)
Act 211 D&A awareness
Counselor classroom lessons
Community Activities
Health Screening
Tier 1/Universal Interventions80-90%
Core Curriculum – reading and math
AIMS Web
MAP
PSSAs
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 71

72. Scranton High School

73. Building Level Action Plan
UNIVERSAL SYSTEM
SECONDARY SYSTEM
TERTIARY SYSTEM
Problem Solving Team (individual student)
Universal Systems Team
Secondary Systems Team
Tertiary Systems Team
PRACTICES
PRACTICES
PRACTICES
PRACTICES
Team Activity: Teams will complete the Universal Systems component to ensure that they know the following elements within the Universal system of tiered supports:
Team members
Practices
Data Decision Rules
Data Decision Rule
Data Decision Rule 73 73

74. Annual Fidelity Check Action Planning
Benchmarks of Advanced Tiers
Do we have more than one strategy available to support students who need more?
Do we use data to make decisions?
Are we selecting Evidence-Based Practices?
Do we have the staff and resources to implement with fidelity?
Are we progress monitoring?

75. Revisit Resource Map
Do we have a continuum of interventions and supports?
Does our systems team include representatives from our community partners?
Are their gaps that we need filled?
Can we present needs to our district and community leadership team?

76. School-Wide Systems for Student Success: A Response to Intervention (RtI) Model: SUPPORTS
Academic Systems
Behavioral Systems
Tier 3/Tertiary Interventions %
_____________________
1-5% Tier 3/Tertiary Interventions
___________________________
Tier 2/Secondary Interventions %
___________________________
5-15% Tier 2/Secondary Interventions
____________________________
As part of the discussion, remind them that a system means something is available at each tier- and that the tiers are interdependent in the system— i.e., secondary systems will be less effective without a strong universal system! Basic purpose of tier one is to prevent new problem behaviors from occurring; tier two is to reduce the frequency of problem behaviors; and tier three is to reduce the intensity of problem behaviors
Tier 1/Universal Interventions80-90%
________________________
80-90% Tier 1/Universal Interventions
____________________________
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 76

77. Consumer Guide to Selecting Evidenced Based Mental Health Services (Putnam et al, 2012 in draft) Main Components
Assessment
Interventions Selection
Intervention Progress Monitoring

78. Assessment

79. Intervention Selection

80. Intervention Progress Monitoring

81. Use of EBP Tool Scranton Assessment
Current Condition
Future Planning
Assessment/Screening happens upon referral to SMH Team
SDQ and COS used in addition to progress monitor and track outcomes
Universal Screening
Tie in work that happens in other processes - SAP

82. Use of EBP Tool Scranton Intervention Selection
Current Condition
Future Planning
Clinicians report almost exclusively selecting interventions that address all nine areas on the tool
There is not a place for indicated which interventions are selected and whether or not they are identified as EBPs
Combined training for school-employed and community-employed staff who will be supporting youth/families who need Tier Two and Three interventions that specifically address how to select EBPs that match area assessed/screened

83. Use of EBP Tool Scranton Intervention Progress Monitoring
Current Condition
Future Planning
Clinicians utilize outcome tools of COS and SDQ
Not differentiating implementation fidelity to a particular intervention (TF-CBT)
Sharing outcome data in aggregate per school annually, not always by student and more frequent
Utilize tools to monitor fidelity of implementation of intervention
Share data with systems teams on a more frequent basis and by student for planning purposes, consistently

84. Trauma Informed Care
3 Community Mental Health Provider Agencies employ the SMH staff working across home/school/community
As part of comprehensive assessment, include a trauma screening
Traumatic Events Screening Inventory (TESI)
UCLA PTSD Index

85. Trauma Screening Tools
TESI
UCLA PTSD Index
Used by most clinicians
Free
On our preferred list
15-item clinician-administered interview
Variety of potential traumatic events
Requires licensing agreement for use
On our preferred list
Recommended by TF-CBT
48-item interview
Assesses a child’s exposure to 26 types of traumatic events

86. “Once You Screen, You Must Intervene” K. Lane
If trauma uncovered in screening/assessment, clinician works with family to determine:
If previously addressed/resolved
If not addressed, yet not currently causing presenting issues/concerns/problems/symptoms
If not addressed, and contributing to current concerns
Clinician selects EBP that is trauma informed

87. National Child Traumatic Stress Network
Evidence-based treatment fact sheets
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Child/youth and family component (+)
Can receive free web-based training (+/-)
Important to have good clinical supervision

88. “Arianna” 13 year old Caucasian female in 7th grade
Adopted at 18 months into a family with two half-siblings, who were also adopted.
17 year old sister diagnosed with Asperger’s Syndrome and Bi-Polar Disorder
12 year old brother diagnosed with Asperger’s Syndrome
Moved into area at age 4

89. “Arianna” continued
Referred to SMH team due to self-injurious behaviors
School reported risk of change in educational placement and concern for risk of drop-out
At the time of referral, Arianna did not have a positive peer group
Trauma uncovered during screening/assessment
Clinician utilized TF-CBT

90. Child Outcomes Survey (COS) Family Functioning: Child X
A large improvement is observed in both domains of family functioning

91. Child Outcomes Survey (COS) Overall Wellness: Child X
Overall wellness improves dramatically

92. “Arianna” today Attending school with academic success
Participating on the girls basketball team
Reports having improved relationships with a more positive peer group
Reports having improved relationships with family members
School reports no risk for change in placement or drop-out at this time
Arianna told the team, through a drawing, that they “saved her life”!

93. School Mental Health

94. Child Outcomes Survey (COS) Family Functioning: Scranton School District

95. Child Outcomes Survey (COS) Child Functioning: Scranton School District

96. Child Outcomes Survey (COS) Therapeutic Alliance: Scranton School District

97. Strengths and Difficulties Questionnaire Parent (SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton School District

98. Questions?