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

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)

School Mental Health Partnership More than a place for services

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

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

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

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). 

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.

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

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.

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)

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)

Where Do We Start?

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)

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.

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.

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.

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

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

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

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

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)

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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.

SET Scores

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.

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

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

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

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

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

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

Onondaga Department of Mental Health Oversight Planning and Quality Improvement Contract Management (95 programs) County (City) Demographics Population: 454,753 (138,560) Children ages 5-19: 95,308 (32,423) 95% of funding from State Authorities (OMH, OASAS OPWDD) What is SED population

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.

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

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.

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

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

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

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

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…)

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.

For more information bputnam@mayinstitute.org pbis.org