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Mental Health Partnerships: PBIS Maryland

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Title: Mental Health Partnerships: PBIS Maryland


1
Mental Health Partnerships PBIS Maryland
  • Susan Barrett, Sheppard Pratt Health System
  • Milt McKenna, Maryland State Department of
    Education
  • Andrea Alexander, Maryland State Department of
    Education
  • Nancy Lever, University of Maryland
  • Sharon Grose, Harford County Public Schools
  • Catherine Bradshaw, Johns Hopkins University
  • October 13, 2006 - Rosemont, IL

2
Susan Barrett Sheppard Pratt Health System
Overview
  • PBIS organizational structure in Maryland
  • Mental Health Integration Grant
  • School district exemplar
  • Summary of related initiatives

3
Pennsylvania
West Virginia
Delaware
D.C.
Virginia
4
Maryland Organizational Model
  • School Level
  • 467 PBIS Teams (one per school)
  • - Team leaders (one per school)
  • - Behavior Support Coaches (250)
  • District Level (24)
  • Regional Coordinators
  • State Level
  • State Leadership Team
  • - Maryland State Department of Education (MSDE)
  • - Sheppard Pratt Health System
  • - Johns Hopkins Center for Prevention of Youth
    Violence
  • - 24 Local school districts
  • - Department of Juvenile Services, Mental Health
    Administration
  • Management Team
  • Advisory Group
  • National Level
  • National PBIS Technical Assistance Center
  • - University of Oregon University of
    Connecticut

5
Cumulative Number of PBIS School Teams and
Behavior Support Coaches by Year Trained
Trained
6
Anticipated GrowthCurrently 34 of MD schools
trained 50 will be trained by 2010
7
Milt McKennaMaryland State Department of
Education (MSDE)
8
Current Energy and Efforts
  • Institutionalize funding level and commitment at
    MSDE
  • - Divisions of Student Services and Special
    Education
  • Pursue other funding opportunities
  • Expand and sustain green zone with high fidelity
  • Increase marketing and visibility
  • Implement yellow zone in districts that have
    solid green zone and have infrastructure to
    expand
  • Continue linkage with school mental health,
    System of Care, and wraparound efforts

9
Maryland School Mental Health Alliance
MSMHA
School Mental Health Integration Grant
10
History of Alliance
  • U.S. Department of Education
  • Call for proposals posted in April 2005
  • Grant Due in mid May!
  • Goal Grants for the Integration of Schools and
    Mental Health Systems will provide funds to
    increase student access to high-quality mental
    health care by developing innovative approaches
    that link school systems with the local mental
    health system.

11
History of Integration Grant
  • Commitment from key local, state, and national
    partners to collaborate and form an Alliance to
    advance school-mental health system integration
    in Maryland
  • Strong support for childrens mental health and
    school mental health in the state
  • A strong PBIS structure within the state and an
    interest in enhancing mental health support and
    resources for red and yellow zone youth
  • State-wide needs assessment data indicated need
    for additional mental health training
  • Notified of award in September 2005
  • 1 of 20 funded projects (84 total applicants)

12
Andrea AlexanderMaryland State Department of
Education (MSDE)
13
Maryland School Mental Health Alliance (MSMHA)
  • Maryland State Department of Education
  • Center for School Mental Health Analysis and
    Action - University of Maryland
  • Center for Prevention and Early Intervention -
    Johns Hopkins University
  • Governors Office for Children
  • Maryland Assembly on School-Based Health Care
  • Maryland Coalition of Families for Childrens
    Mental Health
  • Maryland Department of Juvenile Services
  • Mental Hygiene Administration Department of
    Health and Mental Hygiene
  • Mental Health Association of Maryland

14
Required Grant Components
  • Enhance collaboration between schools and mental
    health systems to improve prevention, diagnosis
    and treatment for students
  • Enhance crisis intervention, appropriate
    referrals and ongoing mental health services
  • Training for school personnel and mental health
    providers
  • Technical assistance and consultation to the
    school system, mental health agencies and
    families
  • Provide linguistically appropriate and culturally
    competent services
  • Evaluate the effectiveness of increasing student
    access to quality mental health services

15
Primary Grant Objectives
  • Aim 1 To further build a systematic state
    initiative for school mental health (SMH)
  • Aim 2 To improve outcomes related to red and
    yellow zone youth in PBIS schools through
  • Helping school staff to better identify and refer
    students who could benefit from mental health
    services
  • Enhancing mechanisms for effective communication
    between schools and the mental health system to
    help better integrate quality mental health care
    for students
  • Developing training and resources to assist
    school staff with creating environments that
    support academic, social, and emotional learning
    for children with more intensive mental health
    needs

16
Maryland School Mental Health Alliance
For More Information About the MSMHA and to
Access Resources Developed for the Project,
Visit Our Website http//www.msmha.org
MSMHA
17
Nancy LeverUniversity of Maryland
18
CSMHA
University of Maryland, Center for School Mental
Health Analysis and Action
  • To strengthen the policies and programs in school
    mental health to improve learning and promote
    success for Americas youth
  • Established in 1995. Currently with a 5-year
    funding cycle beginning in 2005 from HRSA with a
    focus on advancing school mental health policy,
    research, practice, and training.
  • It is our goal to develop and disseminate high
    quality, user-friendly, and culturally and
    developmentally sensitive materials to help
    foster a mental health- schools-families shared
    agenda.
  • http//csmha.umaryland.edu, (410) 706-0980

19
Expanded SchoolMental Health (ESMH)
  • Full continuum of mental health services for
    children and adolescents in both regular and
    special education.
  • Evaluation
  • Treatment
  • Case Management
  • Mental Health Promotion
  • Prevention
  • Crisis Management
  • Consultation
  • ESMH augments services offered by school hired
    staff and is designed to fill in gaps in care

20
ESMH Outcomes
  • When Programs are Done Well, we can see
  • Improved grades, attendance, and behavior
  • Decreased discipline referrals
  • Decreased inappropriate referrals to special
    education
  • Decreased high intensity use of mental health
    services
  • Improved school climate
  • Improved awareness of mental health issues

21
Three Levels of Project
  • Advancing linkages to and coordination between
    schools and the public mental health system,
    while advancing knowledge, skills, and resources
    related to childrens mental health
  • State
  • County
  • School

22
Key Structural Components
  • Management Team
  • Advisory Board
  • 4 Counties
  • Anne Arundel, Baltimore, Harford, St. Marys,
    Washington
  • 4 County Integration Teams
  • 12 PBIS Schools
  • 3 per county and Demonstration Teams

23
County Integration Teams
  • Comprised of families, educational staff, PBIS
    leaders, child and adolescent mental health
    system representatives, leaders from the
    Department of Juvenile Services, and other
    community partners
  • Responsible for pursing improved school-mental
    health system integration in their county
    through
  • Active communication
  • Needs assessment
  • Resource sharing
  • Problem solving

24
Demonstration Teams
  • A team at each of three schools per county (12
    schools)
  • The team includes 4-5 people most involved in the
    school mental health effort in the building and
    have some diversity (e.g., school administrators,
    social workers, school psychologists, etc.)
  • Ideally, this team can take advantage of already
    existing teams (PBIS/Student Support) and an
    existing meeting time.
  • With guidance from the county Integration team
    and support from the CSMHA, these teams
    implemented a systematic quality assessment and
    improvement (QAI) agenda

25
Demonstration Project
  • Presents an opportunity for 3 schools in the
    county to do a very strong assessment of school
    mental health programming
  • Based on this assessment and on-site consultation
    from the CSMHA to each of the teams, the team
    will implement a quality assessment and
    improvement process to advance the quality of
    mental health resources and programming within
    the school setting

26
Demonstration Team Process
  • 1) How well the school coordinates mental health
    services and links with available community
    resources
  • 2) How well the school implements mental health
    services
  • 3) How knowledgable staff are about
    evidence-based practices
  • 4) How well the school and school staff partner
    effectively with families
  • 5) Extent of exposure to training, knowledge and
    sense of competency related to identifying mental
    health concerns and making appropriate referrals

27
What does my county receive?
  • Train-the-Trainer Trainings for PBIS
    Coaches/Leaders to Enhance Mental Health
    Identification and Referral and Effective
    Classroom Management for Students with Mental
    Health Concerns
  • Access to the MSMHA website
  • Technical Assistance/Consultation from the CSMHA
    and other Management Team Agenices/Organizations
  • Newsletter Highlighting the Five County
    Initiative
  • A Voice in Improving Mental Health Integration
    into PBIS Schools in Maryland
  • More Focus on Red and Yellow Zone Youth
  • Resources to advance mental health identification
    and referral and family involvement within the
    school setting
  • Hopefully Improved Academic and
    Emotional/Behavioral Outcomes
  • Funding, 10,000

28
Sharon GroseHarford County Public Schools
29
Harford County,Maryland
30
District Demographics
  • Number of Schools
  • Elementary 32
  • Middle 8
  • High 8
  • PBIS 10
  • Elementary 6
  • Middle 3
  • High 1
  • School Mental Health Integration (3)
  • Special (John Archer)
  • Harford Technical
  • Alternative Education

31
Enrollment Student Characteristic (2006)
  • Preschool/PreK/K 3,710
  • Elementary 14,698
  • Middle 9,315
  • High 12,489
  • Special 158
  • Alternative Ed
  • Total 40,212
  • African American 18.00
  • American Indian .56
  • Asian 2.30
  • Hispanic 2.90
  • White 75.52

32
Wealth, Expenditures, Staffing, Length of Year
(2005)
  • Wealth Per Pupil  253,036
  •  Per Pupil Expenditures  7,655
  •  Instructional Staff per 1,000 Pupils  60.8 
  • Professional Staff per 1,000 Pupils  13.4 
  • Instructional Assistants per 1,000 Pupils  12.3
  •  Average Length of School Day for Pupils  6.5
    hours
  •  Length of School Year for Pupils  180 days 

33
School-Mental Health Integration
  • Goal is to improve
  • coordination and linkages between schools and
    mental health systems
  • referral and identification of mental health
    issues among students
  • Enhance integrated approaches to reduce barriers
    to student learning

34
Implementation of Grantin HCPS
  • Local Goal
  • To integrate PBIS and school mental health
  • Active Schools
  • Halls Crossroads, Edgewood Middle School, and
    William Paca/Old Post Road
  • District Coordination
  • Representatives from each school meet with the
    Childrens Mental Health Roundtable to share
    needs

35
Grant Activities
  • Conduct needs assessment
  • Provide staff development
  • help teachers and staff to identify students with
    mental health needs.
  • give teachers and staff strategies to work with
    students with mental health problems
  • Provide resources for staff
  • Provide additional resources during crisis
    situations at schools
  • special programs, information for parents

36
Nancy Lever Andrea Alexander
37
Successes
  • Development of mental health trainings and
    resources geared for families, teachers, and
    providers
  • Formation of state and county alliances to
    connect schools and the public mental health
    systems
  • Families are engaged as advocates at every level
    (school, county, state) to represent the family
    voice in childrens mental health
  • Less fragmentation and more unification and
    ownership across community agencies and schools

38
Challenges
  • Sustainability
  • Geographic dispersion
  • Limited professional development time available
  • Buy-in (school systems and individual schools)
  • Coordination with existing groups
  • Incorporating the work into the school
    environment/culture (not an add-on)

39
Lessons Learned
  • Need to continually assess that the right people
    are at the table
  • Regular meetings with school, community, and
    family partners to advance the shared agenda are
    essential
  • Connecting mental health work to advancing
    academics and the success of PBIS helps to
    increase buy-in at all levels
  • Personalizing mental health programming to each
    school and community is critical

40
Lessons Learned (Cont.)
  • School implementation and district implementation
    are very different processes each with a
    different focus
  • Buy-in at all levels of the system and in-person
    introduction and ongoing connections is critical
  • Sustainability is a challenging and an ongoing
    process that begins at the start of the project
    and necessitates blended funding and creativity
  • The efforts of a relatively small scale project
    can be a catalyst for larger scale efforts

41
Lessons Learned (Cont.)
  • Family connectedness to schools, especially
    around mental health, is a necessary component
    that takes time and expertise from family
    advocates and advocacy groups
  • Alignment with existing organizations, avoiding
    duplication of efforts, and filling in gaps in
    services is essential
  • All zones (green, yellow, and red) need to be
    viewed as a priority to increase the success of
    PBIS
  • With the right people and a clear focus, anything
    is possible!

42
Catherine BradshawJohns Hopkins University
43
Related Research Centers
  • Center for the Prevention of Youth Violence
  • Funded by CDC (Phil Leaf, PI)
  • Focused on Baltimore City
  • Center for Prevention and Early Intervention
  • Funded by NIMH NIDA (Nick Ialongo, PI)
  • Focused on Baltimore City
  • Piloting evidence-based mental health programs

44
Related Ongoing Proposed Projects
  • Bullying Prevention
  • Using Internet to facilitate data-based decision
    making
  • Provides school teams with local data to inform
    school improvement plans
  • Evidence-based MH Programs for Non-responders
  • Grant under review to determine mental health
    needs of non-responders
  • Combine school-wide PBIS with targeted programs
  • PBIS FBA
  • Grant under review to test combination of SW-PBIS
    and FBA (P. Leaf, PI)
  • In collaboration w/ Terry Scott
  • On-site technical assistance in simplified FBA
  • School-based Wraparound
  • Combines PBIS, ESMH, and wraparound

45
Logic Model for the Wraparound, PBIS, and ESMH
Pilot Project
INPUTS
OUTCOMES
ACTIVITIES
OUTPUTS

Intermediate
Ultimate
  • IMPLEMENT SCHOOL-BASED WRAPAROUND
  • Assessment
  • Family involvement
  • Care Coordination
  • Integration of services
  • Mental health services
  • Program placement
  • Crisis planning management

Increased academic performance
Increased time on task opportunity for learning
Increased graduation rates and reduced high
school dropout
Reduction in inappropriate referrals for services
  • TECHNICAL ASSISTANCE
  • Wraparound model
  • Universal PBIS
  • Evidence-based practice
  • Crisis planning management
  • Community collaboration
  • Family Involvement
  • Mental Health Identification Referral

Reduction in office discipline referrals
Reduction in need for juvenile services and child
protective services
Increased parental involvement in educational
process
  • LINK EXISTING AGENCIES, SERVICES INTIAITVES
  • School-based mental health
  • Community-based programs and services
  • School re-entry
  • Crisis management
  • Core service agencies
  • Childrens Cabinet Systems of Care
  • MH Transformation Grant

Reduction in suspensions and acts of school
violence
Increased teacher-efficacy for behavior management
Reduced disproportionality in achievement
discipline problems
Reduction of risk factors and increase in
protective factors in children and adolescents
TRAINING Wraparound Coordinator (Intensive
wraparound training, PBIS, crisis, community
collaboration, family involvement) Wraparound
Team (Intensive wraparound process, referral,
family involvement, community collaboration,
evidence-based practice) Community Partners
(Wraparound overview, PBIS, school-based
services, crisis intervention) Parents/Families
(Wraparound overview, PBIS, mental health
stigma) Administrators (Integration of PBIS and
wraparound, crisis management and planning,
family involvement) Teachers/School Staff
(Mental health identification, referral, crisis
planning, family involvement, behavior
management, wraparound)
June 21, 2006
46
Marylands Approach to Children's Mental Health
  • System of Care
  • Local Access Mechanisms
  • Navigation functions
  • Single point of access/no wrong door
  • Wraparound practice model

47
  • Current Organization of Wraparound Services
    Supports

Governors Office for Children
Local Management Boards
DHMH Department of Health Mental Hygiene CSA
Core Service Agency (local mental health) DHR
Department of Human Resources (Child
Welfare) DSS Department of Social Services DJS
Department of Juvenile Services DJS
Local/Regional Office MSDE Maryland Department
of Education LSS Local School System
48
Wraparound Implementation
Wraparound Funding -develop case rate or
alternate funding mechanism for each enrolled
child
Local Management Board (LMB)
Care Management Entity/Unit (could be
LMB) -organize and manage provider network -staff
and mange referral and billing process -responsibl
e for quality assurance and outcome mgmt. and
monitoring
Care Coordinator (could be part of Care
Management Entity/Unit) -creates child and family
team and individualized treatment plan
Provider
Provider
Provider
49
Questions
  • www.pbismaryland.org
  • www.msmha.org
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