 Gain an understanding of the Interconnected Systems Framework (ISF)  Gain two examples for how the ISF is embedded into ongoing school services ◦ Scranton School District, Pennsylvania ◦ Maryland’s Emerging Adult Initiative (formerly Healthy Transitions Initiative)

Lucille Eber Ed.D. IL PBIS Network & National PBIS TA Center

 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

 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

 : Site Development with PBIS Expansion (informal and independent)  2005 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

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

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

Publish a monograph that provides a summary and framework for interconnection, documents examples of success, and lays out a research, policy, and technical assistance agenda for the future.

 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

Primary Prevention: School-/Classroom- Wide Systems for All Students, Staff, & Settings Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior ~80% of Students ~15% ~5% SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT: What is meant by “layering” interventions?

 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

 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

◦ Kids 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

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

ISF provides structure and process for education and mental health systems to interact in most effective and efficient way. ◦ 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. ◦ Applies strong interdisciplinary, cross-system collaboration.

◦ Uses the tiered prevention logic as the overall organizer to develop an action plan. ◦ Involves cross system problem solving teams that use data to decide which evidence based practices to implement. ◦ Involves ongoing progress monitoring for both fidelity and impact. ◦ Emphasizes active involvement by youth, families, and other school and community stakeholders.

◦ 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.

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)

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

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

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

 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

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

 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

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

 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

 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

 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

Quick Reflection : What features of the ISF are in place in your district/community? 1.Mental health providers participate in Tier 1/Universal Behavior Support Teams, assisting in selection/design/delivery of behavioral support through Tier 1/Universal curriculum for all students? 2.Community/mental health partners participate on Tier 2/3 systems teams in tandem with school personnel to review data, identify students with Tier 2/3 needs and design interventions? 3.ALL social/emotional/mental health interventions are monitored through blended teams (school & mental health personnel) using data?

PBIS: Equity in Education Making Education Work for All Integrating School Mental Health Strand: Integrating SMH & PBIS: Examples at All 3 Tiers Integrating SMH & PBIS: Using Data Integrating SMH & PBIS: Selecting Evidence-based Practices Interconnected Systems Framework Monograph: Lessons from the Field Implementing an Interconnected System Framework in an Urban School System Integrating SMH & PBIS at the State Level The Changing Role of School-based Clinicians

Kelly Perales Jessica Leitzel

 Local control for the human services system - 67 counties ◦ Child Welfare ◦ Mental Health ◦ Juvenile Justice  Local control for education school districts  Behavioral health ◦ Funding to County Mental Health Programs ◦ Medicaid Behavioral health – carve out from physical health, some counties hold the contract ◦ Managed care organizations – 5 in PA © 2010 Community Care33

 Pennsylvania has a diverse service delivery system  Understanding, accessing and obtaining services is difficult and confusing  Current services are based on diagnoses and problems rather than building on strengths and needs, limited focus on prevention  Services are fragmented  Limited youth & family participation in many areas  All systems struggle to serve youth with complex behavioral health needs, multi-system involvement and their families

Detention/ RTF t h Intake CW Sys Intake Referral MH Sys D&A Sys JJ Sys Ed. Sys Intake MCO Sys MR Sys Intake Referral Partial Psych Detox AAA Intake Court Probation Residential Eligibility Counseling Special Ed Truanc y Mentor APS Partial Residential Mobile T Case Mgmt. TSS/BSC Inpatient Case Mgmt.. Care Mgmt.Primary Care Case Work Foster Care Health Sys ER Intake Hospital. Therapist. Psychiatrist Supports Services Supports Services Case Mgmt. TSS/BSC Special Ed

Established in 2006 through the Bureau of Special Education (BSE) in the Department of Education Membership includes 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

The primary strategy of the CoP is to support the scale-up of the Positive Behavior Interventions and Supports (PBIS) with fidelity In the past 5 years, the PAPBS network has expanded its reach to over 400 schools state wide, with approximately 100 PBIS facilitators providing regional training and technical assistance across the multiple tiers of prevention and intervention

 Systems of Care – Hi Fidelity Wrap Around  Early Childhood – Program Wide and Home Based Positive Behavior Intervention and Support  Juvenile Justice – CoP for Transition and RENEW  Children and Youth – CoP for Transition and RENEW

 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 © 2010 Community Care40

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

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

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

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

 Quarterly meetings  Stakeholder representation – System of Care  Implementer’s blueprint  Systems, data and practices  Scaling and sustainability  Implementation Science - Fixen

Connections and Partnerships  Scranton School District  Scranton Counseling Center  Lourdesmont  Friendship House  Community Care  NEIU 19  PaTTAN KOP

 Steady increase in enrollment for the past 4 years:  SY Total Enrollment = 9,732  Special Education = 1,742  Free and Reduced Lunch  English Language Learners 780  200 internal transfers per month (going between schools) 100 withdrawals and first time enrollment monthly

District and Community Leadership Team Began meeting during the school year. Meet on a quarterly basis. Follow the PBIS Implementation Blueprint. Tier Three – School Based Behavioral Support (SBBH) Teams Willard Elementary Bancroft Elementary Scranton High Tier One – School Year Willard Elementary Bancroft Elementary Scranton High

Tier Two Willard reaches implementation fidelity at Tier One and begins training for implementation of Tier Two. Willard implements Tier Two beginning School Year. Tier One – School Year Isaac Tripp Elementary McNichols Plaza Elementary South Scranton Intermediate Tier Three – School Year Scranton High participates in RENEW pilot project. SBBH expands to Kennedy Elementary, Whittier Elementary, Plaza Elementary, SSIS, NEIS, and WSIS

Tier One – Three more schools to be trained and implement Tier One Scott Ross Bully Prevention to be implemented Universal Screening Tier Two – Bancroft, SHS, and perhaps more to be trained and begin implementing Tier Two Tier Three – Additional school employed and provider employed staff will be trained to facilitate RENEW SBBH will be scaled to more schools

Formerly known as Healthy Transitions Initiative (HTI)

 A five year systems change state/community partnership to create developmentally appropriate and effective youth guided local systems of care that will improve outcomes for transitioning youth with mental health and co- occurring disorders in the areas of:  education,  employment,  housing,  and decrease contacts with juvenile and criminal justice systems toward a goal of  Effecting statewide policy change and replication  Improving the capacity of communities to effectively serve these youth and young adults

 Seven states have been awarded five-year cooperative agreements that began in fiscal year  These states are: Maryland Georgia Oklahoma MaineUtah MissouriWisconsin

 Strengths-based coordinated care to provide seamless transition into adulthood  Involvement in normative activities including employment and/or continuing education, and productive community contribution  Family education, support and empowerment

 Youth & Young Adult Level  Family Level  Community/System Level

Service tunnels – services are largely provided within segregated service systems, not integrated across systems; policy, regulations, eligibility criteria not aligned (i.e., mental health, juvenile justice, social service/foster care, education) Age transition cliffs – services end due to an increase in age rather than a change in the need for the service (Child and adolescent mental health system versus adult mental health system –differing eligibility criteria, priority population, service types)

Special Education (pre K-12) Post Secondary Education/Employment  IDEA  Services mandated for qualified students  Schools responsible for ◦ Identification, ◦ Eligibility ◦ Provision of services  Section 504 & ADA  Individuals are responsible for: ◦ Applying for services ◦ Providing appropriate identification ◦ Asking for reasonable accommodations in employment & educational settings  Requirements vary among agencies

 Collaboration is critical  Necessary to shift locus of power & share responsibility  Look at communities with micro & macro perspective & be willing to do things differently in both perspectives  More Every Day

 Youth and young adults 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

 All aspects of the work are guided by youth, families, school and community stakeholders with an emphasis on ongoing quality assessment and improvement.  The functioning of Transition teams is critical to all efforts, and are emphasized and supported strongly.  Aligned conceptually and operationally to promotion of health, mental health and wellness that increases student’s participation in programs and activities.

 Promote enhanced collaboration toward system integration among families, youth and adult serving agencies, and initiatives that connect.  Shared Agenda with strong collaborations moving to partnerships among families, schools, and mental health and other community systems.

 Commitment to identify – acknowledge - and reduce barriers to learning, school, and community success  Shared agenda to foster commitment  Strong family engagement and empowerment  Shared vision to create and maintain a full continuum of multi-tiered programs and services for TAY and their families

 Working Together  Establishing Demonstration Sites  Building Interconnected Systems  Braiding community resources  Community Clinicians Bringing in Augmenting Strategies  Systems Collaboration and Cost Savings Highlighted  Planning for Transference and Generalization on Multiple Levels ◦ Teaching transferable skills to Mutual Benefit

 Develop empirically-supported services and supports which are designed specifically for TAY and which transcend the age transition cliff (ages 16-25), rather than retro-fit child and adolescent or adult services to met the unique needs of transition age youth.  Leverage funding and pool resources across multiple systems.  Cultivate youth peer support to engage youth in service and provide natural support.  Anchor TAY initiatives in supported employment and education – use as a point of entry to other mental health services.

 Define population  Identify systems and organizations who serve this population  Seek potential visionary allies in the public mental health arena  Identify community resources that may have similar goals  Identify what is working and what is not working  Establish a commitment from stakeholders  Develop a shared vision(i.e. seamless transition for youth with emotional disabilities)  Make a plan and do it

A new report indicates that young adults (ages 18–25) taking part in community-based treatment programs achieve positive outcomes in behavioral and emotional health, daily life skills, employment, enrollment in school, and reduced homelessness. This report by the Substance Abuse and Mental Health Services Administration (SAMHSA) also shows that older adolescents and young adults who had participated in these SAMHSA-supported treatment programs reported lower levels of substance use disorders (SAMHSA Press Office, 5/7/2013, 9:30 AM)

Primary Prevention: School-/Classroom- Wide Systems for All Students, Staff, & Settings Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior ~80% of Students ~15% ~5% SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT: What is meant by “layering” interventions?

Contact Information:  Lucille Eber, Illinois PBIS Network  Kelly Perales, CCBH, Pennsylvania  Jessica Leitzel, Scranton S.D., PA  John Coppola, Maryland HTI,  Deanne Unruh, University of Oregon,