1. PA Tertiary Demonstration Project: Creating an Interconnected Systems Framework © 2010 Community Care Behavioral Health May 18, 2011 Kelly Perales, LCSW Jessica Leitzel, Principal Frances Willard Elementary School, Scranton, PA Erin Stewart, LCSW, MHP SBBH Team, Montrose School District

2. Why We Need MH/Community Partnerships 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 1-2% identified by schools as EBD Those identified have poor outcomes Suicide is 4th leading cause of death among young adults

3. School-based Behavioral Health Team Service (SBBH)

4. 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

5. 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

6. SBBH Team Components L ICENSED M ASTER ’ S P REP C LINICIANS (MHP) E XPERIENCED B ACHELOR ’ S P REP W ORKERS (BHW) A DMIN A GENCY S UPPORT C ONSULTATION TO MHP S PRN

7. Community Care Support of SBBH Teams LEARNING COLLABORA TIVE T RAINING TECHNICAL ASSISTANCE E VIDENCE - BASED P RACTICES COACHING M ODEL F IDELITY CARE MANAGEMEN T

8. Montrose SBBH Team Northwestern Human Services (NHS) 2 MHPs and 5 BHWs –1 MHP and 2.5 BHWs at Lathrop St. Elementary School –1 MHP and 2.5 BHWs at Choconut Valley Elementary Each “mini” team meets weekly with school staff to ensure ongoing dialogue regarding services. –Referrals of new youth –Review of ongoing cases –Discussion of collaboration between education and mental health Collaboration with other child serving systems

9. Scranton SBBH Team(s) Scranton Counseling Center (SCC) Lourdesmont One team at Frances Willard and one team at George Bancroft Elementary Schools provided by SCC with 2 MHPs and 5 BHWs each One team at Scranton High School provided by Lourdesmont with 2 MHPs and 3 BHWs Each team meets weekly with school staff to ensure ongoing dialogue regarding services. –Referrals of new youth –Review of ongoing cases –Discussion of collaboration between education and mental health Collaboration with other child serving systems

10. SWPBS Tertiary Demonstration Project Community Care as affiliated partner in the PA Positive Behavior Support (PBS) Network Blending of School-Wide (SWPBS) and School Mental Health Interconnected Systems Framework

11. Tier 3/Tertiary Interventions 1-5% Individual students Assessment-based High intensity 1-5%Tier 3/Tertiary Interventions Individual students Assessment-based Intense, durable procedures Tier 2/Secondary Interventions 5-15% 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 Tier 1/Universal Interventions 80-90% All students Preventive, proactive 80-90%Tier 1/Universal Interventions All settings, all students Preventive, proactive School-Wide Systems for Student Success: A Response to Intervention (RtI) Model Academic Systems Behavioral Systems Illinois PBIS Network, Revised May 15, 2008. Adapted from “What is school-wide PBS?” OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. Accessed at http://pbis.org/schoolwide.htm

12. Public Health & Disease Prevention Kutash et al., 2006; Larson, 1994 Tertiary (FEW) –Reduce complications, intensity, severity of current cases Secondary (SOME) –Reduce current cases of problem behavior Primary (ALL) –Reduce new cases of problem behavior

13. Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems SIMEO Tools: HSC-T, RD-T, EI-T Check-in/ Check-out (CICO) Group Intervention with Individualized Feature (e.g., Check and Connect -CnC and Mentoring) Brief Functional Behavior Assessment/ Behavior Intervention Planning (FBA/BIP) Complex or Multiple-domain FBA/BIP Wraparound ODRs, Attendance, Tardies, Grades, DIBELS, etc. Daily Progress Report (DPR) (Behavior and Academic Goals) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Social/Academic Instructional Groups (SAIG) Positive Behavior Interventions & Supports: A Response to Intervention (RtI) Model Illinois PBIS Network, Revised October 2009 Adapted from T. Scott, 2004 Tier 2/ Secondary Tier 3/ Tertiary Intervention Assessment

14. Continuum of Support for Tier 2/Secondary-Tier 3/Tertiary Level Systems 1.Small group interventions: Check-in Check-Out (CICO), social/academic instructional groups (SAIG), tutor/homework clubs, etc. 2.Group interventions with individualized focus: Utilizing a unique feature for an individual student, e.g. CICO individualized into a Check & Connect (CnC), mentoring/tutoring, etc. 3.Simple individual interventions: A simple individualized function- based behavior support plan for a student focused on one specific behavior, e.g. brief FBA/BIP-one behavior; curriculum adjustment; schedule or other environmental adjustments, etc. 4.Multiple-domain FBA/BIP: A complex function-based behavior support plan across settings, e.g. FBA/BIP home and school and/or community 5.Wraparound: A more complex and comprehensive plan that addresses multiple life domain issues across home, school and community, e.g. basic needs, MH treatment, behavior/academic interventions, as well as multiple behaviors Illinois PBIS Network, Revised Sept., 2008

15. 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 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 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 Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters. Interconnected Systems Framework for School Mental Health

16. 3-Tiered System of Support Necessary Conversations (Teams) 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; uses FBA/BIP process for one youth at a time Uses Process data; determines overall intervention effectiveness Sept. 1, 2009 Universal Team Universal Support

17. Montrose School District SWPBS Implementation District and Community Leadership Team established Tier One training and implementation at both elementary schools Tier Two planning at both elementary schools Overview and Tier One training being planned for seventh grade Tier Two and Three interventions being provided by SBBH Team

18. Scranton School District SWPBS Implementation District and Community Leadership Team established Tier One training and implementation at both elementary schools and Scranton High School Tier Two training and implementation has begun at Frances Willard. Tier Two planning at George Bancroft and Scranton High still to come Tier Two and Three interventions being provided by SBBH Team

19. Principal’s Perspective Summary of early successes and challenges Summary of data –SWIS reports –Impact on placement –Academic Impact Plans for next year

20. Big 5 SWIS Data Report

25. Social Worker’s Standpoint Summary of experience with SBBH implementation thus far – successes and challenges Blending of Mental Health with School-Wide – how is it going? Data –SDQs –COS Plans for next year

26. The Smith Family Angelica was referred to the SBBH Team in November of 2009 due to a history of disruptive negative attention seeking behaviors. Veronica, A’s mother, reported that she “has tantrums and argues everyday about just about evertything – snacks, clothing, if she does not get her way, she throws a fit!”. School staff reported that A can be stubborn and she often shuts down or withdraws particularly if she believes that she is in trouble. Socially, she does not pick up on social cues, and therefore inadvertently annoys her peers.

27. The Smith Family cont. Caroline, A’s sister, was referred to the SBBH Team in October 2010 as a fourth grade student. She was referred due to behavioral concerns within the family setting and needing significant adult interaction in order to perform routine tasks. It was reported she had limited social, emotional, and coping skills. Her teacher reported, “She often has a look of confusion and rarely speaks up about anything. She is slacking in social skills and self confidence. She is able to complete her work, but does not.” In addition, C needed to learn coping skills to deal with the death of a sibling.

28. The Smith Family cont. Interventions: –Case management Coordination of community resources such as assistance with medical supplies, transportation to adult therapy appointments, and dental appointments for the family. Referrals for assistance with holiday meals, gifts, and financial assistance for bills including telephone and electic. –Educational support A. has been identified as needing learning support Social skill and peer relationship instruction –Therapy Coping skills Problem solving skills Social and peer relation skills For C. coping with grief and loss

29. Child Outcomes Survey (COS) Family Functioning: Child A

30. Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child A

31. Child Outcomes Survey (COS) Overall Wellness: Child A

32. Child Outcomes Survey (COS) Family Functioning: Child B

33. Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child B

34. Child Outcomes Survey (COS) Overall Wellness: Child B

35. Strength and Difficulties-Parent Report: Child A

36. Strength and Difficulties-Parent Report: Child B

37. Video clips Parent interviews

38. Questions? Contact information: Kelly Perales, LCSW peraleskl@ccbh.com 717-770-9365 Jessica Leitzel Jessica.leitzel@scrsd.org 570-348-3692 Erin Stewart, LSW ekstewart@nhsonline.org 570-278-7300