Integrating SMH/PBIS in Large Urban School Systems Bob Putnam May Institute Raymond Palmer & Helena Rodriguez Jennifer Parmalee New York City Department of Education Onondaga Department of Mental Health Devon Bandison Mark Vinciquerra The Visiting Nurse Service of New York Syracuse Public Schools Linda Brown OCM /BOCES National PBIS Leadership Forum October 19, 2012 Chicago, Illinois, Ph.D.

Integrating SMH/PBIS in Large Urban School Systems Bob Putnam May Institute National PBIS Leadership Forum October 19, 2012 Chicago, Illinois, Ph.D.

School Mental Health Partnership More than a place for services

4 Context of Urban Schools Higher rates of  Community poverty (U.S. Census Bureau, 2002)  Community crime (Sampson et al; 1997, Brooks- Gunn, 1997)  Cultural and racial diversity (U.S. Census Bureau, 2002)  Staff turnover (Cuban, 2001; National Commission on Teaching and American’s Future, 2005)  Low performing schools (Williams, 1996)  “persistently dangerous” schools (NCLB:20 U.S.C. 7912, 2001)

5 Urban Systems Urban systems, particularly those with high rates of poverty, face multiple challenges  Higher rates of problem behavior  Lower rates of academic readiness for school (Smith et al., 1994)  Increased exclusionary disciplinary procedures (Fusarelli, 1999; Winbinger et al., 2000)  The combination of these factors leads to higher dropout rates (Mayer, 1997; McLoyd, 1998) which places these students back in the community with chronic exposure to violence, drug abuse, and higher mortality rates (Lane et al; 2002)

Need for Effective Mental health Services Almost one in five youths has a MH “condition” (New Freedom Commission on Mental Health, 2003) and it is reported that about 70% of those get no treatment (Kataoka, Zhang & Wells; 2002). Only one to two percent of these students are identified by schools as emotionally impaired. Often these identified students have poor outcomes. (National Center for Children in Poverty, 2006)

Interconnected Systems Framework (ISF) Strategy for interconnection of two systems across multiple tiers Strong team planning and actions at each tier Full continuum of effective mental health promotion and intervention for students in general and special education Reflecting a “shared agenda” involving school- family-community system partnerships Collaborating community professionals (not outsiders) augment the work of school-employed staff Eber, Barrett & Weist, 2011

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

Evidenced Based Practices (EBP) Children who received evidenced based interventions were functioning better after treatment than more than 75% of children in the control group. These changes often were found to sustain after treatment termination. Where therapists were able to use their clinical judgment to deliver treatment as they saw fit and in which there was a comparison of their treatment to a control condition little or no changes in treatment outcomes were seen (Weisz, Sandler, Durlak & Anton; 2005).

Evidenced Based Mental Health Treatment  American Psychological Association website options-specific-disorders options-specific-disorders  Evidenced Based Behavioral Practice website funded grant from by the National Institutes of Health  Kutash, Duchnowski, & Lynn, School-based mental health: An empirical guide for decision makers. nt-TOC.pdf

“Organizations get the outcomes they are designed to deliver” Aubrey Daniels

Barriers to Evidence-Based Programs in Schools Clinician Systems within a school setting Overall mental health systems Funding/Resources

Systems to Support the Use of EBP Many of the school based and community partners have limited expertise. Without staff competencies and systems (adequate training, ongoing coaching, performance feedback) on their use, these interventions will not maximize their potential benefits to students. (Fixsen, Blasé, Duda, Naoom, & Van Dyke; 2010). Training alone, even when it is fairly intensive, appears to increase knowledge but has a limited impact on practice (Ganju, 2006).

How to Build Clinical Capacity Training  Exposure  Cross training Coaching and performance feedback Treatment integrity

Systems within a School Setting Typical school delivers, on average, 14 separate programs that broadly address social-emotional issues. Of these programs, however, most were not empirically-based. There was found no evidence of a systematic deployment of these programs, but rather, they seem to emerge in response to immediate pressures or trends. (Zins, Weissberg, Wang, & Walberg; 2004)

Evidence-Based “Manualized” interventions (from Sharon Stephan) Intervention/Indicated: Cognitive Behavioral Intervention for Trauma in Schools, Coping Cat, Trauma Focused CBT, Interpersonal Therapy for Adolescents (IPT-A) Prevention Selected Coping Power, FRIENDS for Youth/Teens, The Incredible Years, Second Step, SEFEL and DE:CA Strategies and Tools, Strengthening Families Coping Resources Workshops C Promotion/Universal Good Behavior Game, PATHS to PAX, Positive Behavior Interventions and Support, Social and Emotional Foundations of Early Learning (SEFEL), Olweus Bullying Prevention, Toward No Tobacco Use Weist, 2012

Assessment Intervention

Mental Health Systems More flexible funding More emphasis on functional outcomes that both improve school and community functioning and support families Early prevention – Accessing mental health services across the tiers Schools leveraging the access of students to allow creative use of clinicians time

Collaboration between Systems Valuing the family as partner –wrap around (Eber) Improving effectiveness  Assessment  Practices  Training and building capacity  Treatment integrity Improving efficiency  Assess to each others resources and natural resources  Focusing on socially valid outcomes for students in school, home and community

Selecting Mental Health Interventions within a PBIS Approach Robert Putnam, Susan Barrett, Lucille Eber, Tim Lewis and George Sugai