1. Understanding the Interconnected Systems Framework (ISF) for Integrating Mental Health Supports in Schools
January 28, 2013

2. A National Community of Practice (COP); www.sharedwork.org
IDEA Partnership ( providing support
22 professional organizations and 16 states
12 practice groups
Opportunities for dialogue and collaboration
Advancing multi-scale learning

3. Our goal today: Describe the Interconnected Systems Framework (ISF)
Clarify the features of School-Wide Positive Behavior Interventions and Supports (SWPBIS) School Mental Health (SMH) in the context of the ISF
Describe emerging examples of ISF

4. Poll Question #1

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

8. 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

9. 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

10. 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

11. 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

12. School-Wide Systems for Student Success: A Response to Intervention (RtI) Model
Academic Systems
Behavioral Systems
1-5% Tier 3/Tertiary Interventions
Individual students
Assessment-based
Intense, durable procedures
Tier 3/Tertiary Interventions %
Individual students
Assessment-based
High intensity
Tier 2/Secondary Interventions %
Some students (at-risk)
High efficiency
Rapid response
Small group interventions
Some individualizing
5-15% Tier 2/Secondary Interventions
Some students (at-risk)
High efficiency
Rapid response
Small group interventions
Some individualizing
Important points:
Family engagement at all three tiers (ex. Universal: parent volunteers using school reinforcer; Secondary: pushing teams to think about more than just consent but helping parents/families understand and be engaged in the intervention; Tertiary: Families need to be active member on the team
School population (race, free/reduced lunch, urban/rural, large/small buildings) Regardless of student population the percentage breakdowns remain the same. Any behavior that is impacting more than 20% of the student body is a universal issue.
Universal team/all students, Secondary team/small groups/generic problem solving team/Tertiary team/formed for individual student
Discuss importance of mental health, mental wellness
Tier 1/Universal Interventions %
All students
Preventive, proactive
80-90% Tier 1/Universal Interventions
All settings, all students
Preventive, proactive
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 12

13. Positive Behavior Intervention and Support (www.pbis.org)
Decision making framework to guide selection and implementation of best practices for improving academic /behavioral functioning
Data-based, measurable outcomes, evidence- based practices, systems to support effective implementation

14. 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

15. 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

16. 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

17. Components of SWPBIS 3-5 agreed upon common expectations
Positive statement of purpose
Clear and positive expectations for behavior
Procedures for teaching expected behavior
Continuum of consistent procedures for encouraging expected behavior
Continuum of consistent procedures for discouraging inappropriate behavior
Procedures for on-going monitoring and evaluation

18. 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)

19. “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

20. SMH at Tier One
Universal screening for social, emotional, and behavioral at-risk indicators
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 One systems team, providing input and progress monitoring data

21. SMH at Tier Two
Mental health 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)

22. SMH at Tier Three
Mental health professional part of tertiary systems team
FBA/BIP completed together with school staff and mental health provider for one concise plan, rather than each completing paperwork to be filed

23. 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

24. 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

25. 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

26. 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

27. 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.

28. 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.

29. 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.

30. 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: Universal, Secondary, and Tertiary
Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored
MH providers form both school and community develop, facilitate, coordinate and monitor all interventions through one structure

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. Poll Question #2

35. 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

36. 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

37. 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
Universal Support
CICO
Brief
FBA/BIP
SAIG
Complex
FBA/BIP
WRAP
Group w. individual
feature
Brief FBA/BIP 37 37

38. 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 38 38

39. 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 students
Safe & caring learning environments
Partnerships between school, home and the community
Decision making framework used to guide and implement best practices that consider unique strengths and challenges of each school community

40. School Improvement Team Gives Priority
Community mental health staff (Director and Program Coordinator) with the assistance of the PBIS TAC set up meetings with key school administrators (Principal, AP’s) to introduce SPARCS to them
Follow-up meetings periodically to deal with larger system issues
PowerPoint presentation of key program features presented to admins, school social workers, school psychologist and counselors
Shifting of school-based staff roles/responsibilities discussed

41. 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 students
Safe & caring learning environments
Partnerships between school, home and the community
Decision making framework used to guide and implement best practices that consider unique strengths and challenges of each school community

42. Partnerships Between Home, School & Community School-Community Partner Information Sheet

43. 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 students
Safe & caring learning environments
Partnerships between school, home and the community
Decision making framework used to guide and implement best practices that consider unique strengths and challenges of each school community

44. Determine Strengths and Needs
At the building level
Admin team was meeting weekly and looking at the data to determine needs
Gaps were identified – mental health
Administrators, Community Elements Director for Youth Services and PBIS TAC met to determine intervention to meet needs and continued meeting every few weeks to set up system features
Secondary Systems Team was formed

45. Tier 2: Early Intervention for Some Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns
Systems Planning Team identified to coordinate referral process, decision rules and progress monitor impact of intervention
Array of services available
Communication system for staff, families and community
Early identification of students who may be 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

46. Systems Planning Team Secondary Systems Team meetings
Meeting twice a month
to talk through systems response
to work through system implementation issues
to build rapport and relationships between service providers
to communicate and implement with fidelity

47. Coordinated Referral Process with Decision Rules
Data-based Decision Rules for Entrance
At Centennial, students are referred for SPARCS because they are freshman/freshman status and
They have been through two tier two interventions and have not responded
They are READY (alternative school) students transitioning back to Centennial**
They have had multiple SASS contacts
Meet criteria for trauma experience as screened using the TESI-SR (Traumatic Events Screening Inventory-Self Report)
** READY, Juvenile Detention & MH providers also providing across the community

48. Monitor the Impact of the Intervention Tier Two Tracking Tool- SY2012

49. Outcomes School Data – Office Discipline Referrals

50. Outcomes School Data – In-School and Out-of-School Suspension

51. Student Feedback Student Survey Results Skills were helpful to me:
1=strongly agree 2=disagree 3= don’t know 4=agree 5=strongly agree
Skills were helpful to me:
Mindfulness 3.8
Self-sooth/distract 4.4
LET ‘M GO 4.0
MAKE A LINK 4.2
Have used skills outside
of group 4.4

52. Student Feedback Continued
What was the best part of group?
“It helped me to make better choices and not get into trouble”
“That you can talk about stress level and feelings”
“It allowed me to share”
“It helped me to identify my sources of anger”
“I liked that it had structure, that we had a lesson plan that we followed and I liked the handbook”
“Food”

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

54. 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

55. SBBH Service Components
Clinical Interventions
Case Management
Crisis Intervention
Case Consultation and Training
for educational staff

56. District and Community Leadership Team
Quarterly meetings
Stakeholder representation – System of Care
Implementer’s blueprint
Systems, data and practices
Scaling and sustainability

57. Time Line School Year Activity 2008-09
Community Care engaged district through ICSP regarding SBBH Team
SBBH Team begins work within district – September 2009
District and Community Leadership Team is established, district commitment signed, tertiary demonstration project begins – spring 2010
Tier One SWPBIS is fully implemented with kickoff at the start of the school year
Tier Two training begins in the spring of 2011 with some implementation
All three tiers are being implemented at both elementary schools
Montrose Junior High receives Tier One training in fall, with “soft” kickoff in January 2012
Discussion of SBBH Team model expanding into Junior and Senior High

58. Scranton School District
Year One
Year Two
Year Three
Year Four
Year Five
Year Six
District and Community Leadership Team established.
District commits to implementing SWPBIS with fidelity across the district.
SBBH Teams begin implementation at Frances Willard Elementary, George Bancroft Elementary, and Scranton High. A Tier Three support.
Frances Willard Elementary, George Bancroft Elementary, and Scranton High all receive training to implement Tier One SWPBIS.
Frances Willard Elementary, George Bancroft Elementary, and Scranton High all implement Tier One SWPBIS.
Frances Willard Elementary reaches implementation fidelity.
Frances Willard Elementary receives training for implementation of Tier Two and begins implementation.
Frances Willard Elementary implements three tiers of Interconnected Systems Framework.
Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton Intermediate all receive training to implement Tier One SWPBIS.
Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton Intermediate all implement Tier One SWPBIS.
George Bancroft Elementary and Scranton High receive training for implementation of Tier Two and begin implementation
Scranton High receives training and begins implementation of RENEW.
SBBH Teams begin implementation at Northeast Intermediate, John F. Kennedy Elementary, McNichols Plaza Elementary, and John G. Whittier Elementary.
John F. Kennedy Elementary, John G. Whittier Elementary, and Northeast Intermediate all receive training to implement Tier One SWPBIS.
John F. Kennedy Elementary, John G. Whittier Elementary, and Northeast Intermediate all implement Tier One SWPBIS.

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

60. Outcomes Change in Family Functioning

61. Outcomes Change in Child Functioning

62. Outcomes – SDQ-P Change in Difficulties Score

63. Outcomes – SDQ-T Change in Difficulties Score

64. The Smith Family
Jason was referred to the SBBH Team in November. He is a seven-year-old first grader who was having difficulty coming to school and being separated from his mother.
When he was four, Jason and his family were in a car accident in a rural area. The members of the family were taken to different hospitals and Jason did not know where his mom was or if she was okay.
Every day, since the first day of school, Jason’s mom would bring him into the school and the school staff would literally have to peel Jason off of his mother and hold him so she could leave.

65. The Smith Family cont.
Once referred to the team, they were immediately able to work with Jason and his family to create strategies to help him separate more smoothly.
Jason found the SBBH Team office/room a safe place to be. His mother also spent time there to help create a nice transition area.
After the Holiday break, Jason began riding the bus for the fist time, accompanied by one of the BHWs from the team.
Soon, Jason was able to ride the bus on his own, increasing his confidence and allowing him some relief from his anxiety.

66. Child Outcomes Survey (COS) Family Functioning: Child X

67. Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child X

68. Child Outcomes Survey (COS) Overall Wellness: Child X

69. Strength and Difficulties-Parent Report: Child X

70. Strength and Difficulties-Teacher Report: Child X

71. Lessons Learned Return on investment Funding efficiency
Scaling and sustaining SBBH Teams – size
Community “politics”

72. 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

73. 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

74. 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

75. For More Information: