National PBIS Leadership Forum October 2013 Jennifer Parmalee, MPA Director of Children &Family Services Onondaga County Department of Mental Health Linda Brown Behavior Specialist OCM BOCES Patty Clark Director, Pupil Services Syracuse City School District Lura Lunkenhiemer President Peaceful Schools

What is Promise Zone  Grant to 3 urban districts from New York State Mental Health Agency (Office of Mental Health)  Purpose is to increase graduation rates  Goal: create replicable model that integrates community and school to best support students and their families

Syracuse City School District  Urban district in Central New York  147,000 residents  31 schools in the SCSD 5 High Schools 6 Kindergarten – 8 th grade buildings 6 Middle Schools (6 th – 8 th ) 10 Elementary Schools  21, 000 students  85% Free and Reduced Lunch  20% Listed as Special Education

Braid Multi-Tier Support Systems PBIS RtI Promise Zone OnCare (SOC) Say Yes

TIER 3 4 Tiered Problem-Solving Framework Academic Behavioral TIER1 CORE CURRICULUM AND UNIVERSAL BEHAVIORAL EXPECTATIONS Core Instruction  Board of Education Adopted Core Curriculum  Differentiated instruction  Small guided groups  Centers/stations for skill-based practice Core Universal Interventions All settings, all students Preventive, proactive School Wide or Classroom Systems Strategic, Targeted Interventions Some students (at-risk) Group or individual delivery High efficiency/ Rapid response Function-based logic Strategic, Targeted Interventions Some students High efficiency / Rapid response Frequent progress monitoring SMALL GROUP, TARGETED INSTRUCTION TIER 2 SPECIALIZED INSTRUCTION & SERVICES INDIVIDUALIZED TARGETED INTERVENTIONS TIER 3 Intensive, Individually Designed Interventions Address individual needs of student High intensity/longer duration/daily Individualized Learning Plan (ILP) Intensive, Individually Designed Interventions Individually designed behavior plan Intense, sustainable prosocial strategies Function-based assessments Intense, durable strategies T4 8/23/2015

Syracuse 4-Tiered System of Support Necessary Conversations (Teams) CICO SAIG Group w. individual feature Complex FBA/BIP Universal Support SBIT-B TeamTier 4 Simple FBA/BIP Universal Team WRA P Screening Team Plans SW & Class-wide supports Uses Process data; determines overall intervention effectiveness Standing team; uses problem-solving process for one youth at a time Uses Process data; determines overall intervention effectiveness

Syracuse PBIS Implementation Story  Began as pilot in 2003 and then district wide implementation in 2010  Started using SET then moved to the Benchmark of Quality  Over time schools became more knowledgeable and therefore more critical of themselves.  2012 limited coaching support

PBIS Universal Fidelity Measures SET ; BoQ 2012 & 2013; Full district support 2010

Tier 2 Context  13 schools implemented screening.  BAT served as a POST Training assessment.  Scores for 4 different schools in one year.  Fidelity at each level = 80%.  Emphasis on tier 2 and 3.

Benchmarks for Advanced Tiers (BAT) Schools SCORES By%SCORES By%

Onondaga Department of Mental Health  Oversight  Planning and Quality Improvement  Contract Management (95 programs) County (City) Demographics Population: 454,753 (147,000) Children ages 5-19: 95,308 (32,423) 95% of funding from State Authorities (OMH, OASAS OPWDD)

Syracuse Promise Zone  Mission  Match SCSD students emotional/behavioral needs with effective interventions  Keep SCSD students in class and ready to learn

Syracuse Promise Zone  Increase access to Mental Health Services in schools.  Expand Outpatient Mental Health Clinic Satellites to all schools in SCSD (10 additional sites since 2010 – 23 total)  Integrate Mental Health Clinicians into SCSD school based problem solving teams for youth at risk. (SBIT-B)  Expand access to family based care coordination services that link with the school team (current staff of 47 coordinators)  Expand access to skills based groups for youth at risk (Check In Check Out)

Syracuse Promise Zone  Establish uniform school based problem solving procedures and process to ensure right kids get right interventions at the right time.  Trained 14 schools in Screening and School Based Intervention Teams – Behavior protocols.  10 additional schools to be trained in

5 Keys To Implementation MH Licensed Clinician in every school Clinician integrate into school team Problem Solving Teams at tier 2/3 Expand community services for youth at risk Systems to identify and intervene with youth at risk

Problem Solving Processes  Screening Team – Tier 2 - Get into interventions fast  Who is on team – Administrator, school based support staff  Decision Rules  3-5 Office Discipline Referral’s  Less than 90% Attendance  At- Risk Referrals from faculty/staff  SBIT-B – Tier 3 – Individualized Targeted Process  Who is on team – Administrator, outpatient clinician, school based support staff, general education teacher,  Decision Rules;  6+ ODR’s  Attendance  At- Risk Referral from faculty/staff

Number of Schools Trained in Screening and SBIT-B

Data from Screening teams  Screening reviewed 571 students through April 30, 2013

Referral to Interventions from Screening  Teams made 779 referrals to Interventions through April 30, 2013

Data from SBIT-B Teams  SBIT-B teams reviewed 59 students (11 schools)

Data from SBIT-B Teams

Outpatient Mental Health Delivery  Clinics supported approximately 615 students in 23 schools in (admitted to clinic)  Donate 1.5 hours a week per school  Prioritize school functionality in treatment  Use of classroom data to progress monitor  Dedicated to delivering EBP (Trauma as focus..TF- CBT)  Consultation role on teams – support decision making for treatment, community mental health supports,

Top 5 Reasons for Referral to MH Service as of December 2012 (N=473)

Student Engagement (Sept – Dec 2012) Individual Psychotherapy Sessions

Steps in Mental Health EBP Implementation in Schools  Review current cases: reasons for referrals, assessments  Identified significant number of youth with trauma histories and displaying symptoms of PTSD  Reviewed EBP’s in area of trauma, narrowed down to 3  Chose EBP to best meet our needs – Trauma Focused - CBT  Individual work (rather than group)  Family component  Relatively inexpensive  Fit into the billing framework  Incorporated a narrative component  Trained 12 clinicians phase 1, 60 phase 2

Evidence Based Practice in School Based Outpatient MH – TF-CBT

IS ANY OF THIS WORKING?

Out of School Suspensions – PBIS Tier 1 BOQ Measure Change in Suspension Incidents Per 100 Students Compare Sept April 2012 & Sept April 2013

Days of Lost Instruction – PBIS Tier 1 BOQ Measure Change in Days of Lost Instruction Per 100 Students Compare Sept April 2012 & Sept April 2013

Out of School Suspensions – PBIS Tier 2 Change in Suspension Incidents Per 100 Students Compare Sept April 2012 & Sept April 2013

Days of Lost Instruction – PBIS Tier 2 Change in Days of Lost Instruction Per 100 Students Compare Sept April 2012 & Sept April 2013

HOW DO WE KNOW IF THE INTERCONNECTION IS WORKING AND HAVING AN IMPACT?

How Should Mental Health Look in Schools?  How should the mental health system integrate into the school system  What is the right amount of mental health services/supports/focus  What is the purpose and function of interventions/services  Who delivers the interventions/services  How are outcomes determined

Syracuse Benchmark of Interconnected Systems  Purpose: Assess Integration, Implementation of Mental Health within the 4 Tier Structure, Treatment Integrity  Function: Teams to gather data and use in systems and practice development/enhancement at all 4 tiers  How did we develop: BOQ, Literature review, NYS SEDL Guidelines, practical experience

TIER 3 Benchmark of Interconnected Systems TIER1 School wide Social Emotional Learning practices are communicated to families Increase Family and Student Engagement Staff with Mental Health Knowledge Part of Planning and Decision Making Mental Health First Aid delivered to faculty and staff Universal Screening School wide Social Emotional Learning practices are communicated to families Increase Family and Student Engagement Staff with Mental Health Knowledge Part of Planning and Decision Making Mental Health First Aid delivered to faculty and staff Universal Screening TIER 2 TIER 3 T4 Mental Health Coordinator is part of Planning and Decision Making Solicits and Prioritizes family perspective in decision making protocol Intervention goals focus on behavioral health challenges impacting students Evidence based protocols are identified as supporting mental health challenges (CICO, Coping CAT) Mental Health Coordinator is trained in PBIS Second Gate of Screening process Mental Health Coordinator is part of Planning and Decision Making Solicits and Prioritizes family perspective in decision making protocol Intervention goals focus on behavioral health challenges impacting students Evidence based protocols are identified as supporting mental health challenges (CICO, Coping CAT) Mental Health Coordinator is trained in PBIS Second Gate of Screening process To Be Determined Family/Outpatient Clinician/Case Manager integrated into problem solving team School Functionality prioritized in Mental Health intervention goals Interventions are EBP’s Progress is monitored using school based data Family/Outpatient Clinician/Case Manager integrated into problem solving team School Functionality prioritized in Mental Health intervention goals Interventions are EBP’s Progress is monitored using school based data

Lessons from Field Testing  Areas of evolution of thought  Universal Screening  Faculty and Staff knowledge on impact of mental health on brain and learning  Family Engagement

Results of Field Test

Results from the Field

Next Steps  Field Test with non-exemplars  Develop rubric for each tier to go with questions  Separate/clarify some questions to support fidelity  Match with the ISF monograph and other learnings from exemplars at National PBIS Conference

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