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Getting Started: Integrating Community Mental Health Services into School-wide Positive Behavior Support in a Large Urban District

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Title: Getting Started: Integrating Community Mental Health Services into School-wide Positive Behavior Support in a Large Urban District


1
Getting Started Integrating Community Mental
Health Services into School-wide Positive
Behavior Support in a Large Urban District
Bob Putnam May Institute Steve Gramet Syracuse
Public Schools Jennifer Parmalee Onondaga
County Department of Mental Health Monique
Fletcher Say Yes
National PBIS Forum October 28, 2011 Rosemont, IL
, Ph.D.
2
Where are you in implementation process? Adapted
from Fixsen Blase, 2005
3
School Mental Health Partnership
  • More than a place for services

4
Challenges
  • Education
  • Mental Health
  • Primarily focused on services during school day
  • Use of evidenced based practices
  • Limited data based decision making
  • Less focus on the family
  • Limited mental health expertise
  • Limited continuum of services
  • Community mental health services often focused on
    those with severe and persistent mental health
    issues
  • Limited prevention services due to funding tied
    to direct services
  • Accessibility of services
  • Limited data based decision making
  • Use of evidence based practices

5
Contrasting Perspectives in the Education and
Mental Health Systems
  • Education
  • IDEA
  • Behaviors disorders, challenging behavior
  • Behaviorism , social learning theory
  • Behavior management, skill development, academic
    improvement
  • Mental Health
  • DSM
  • Psychopathology, abnormal behavior, impaired
    functioning
  • Psychoanalytic approaches, behavior theory,
    cognitive psychology, developmental psychology,
    biological/genetic perspectives,
    psychopharmacology
  • Insight, awareness, improved emotional
    functioning
  • Overarching influence
  • Language
  • Important theoretical influences
  • Focus of intervention

Duchnowski Kutash, 2009
6
Merikangas, He, Brody, Fisher, Bourdon, Koretz
2010 
7
(No Transcript)
8
Outcomes for Students with Mental Health Concerns
  • Early appearing behavioral problems during a
    child's preschool years are the single best
    predictors of school dropout, delinquency, gang
    membership, and adult incarceration (Center for
    Evidence-Based Practice, 2004)
  • Furthermore, unless behavioral problems are dealt
    with early on, the child's behaviors tend to
    become chronic (Campbell Ewing, 1990). 

9
Outcomes for Students with Mental Health Concerns
  • Highest rate of dropouts among all disabilities
    are those with EBD.
  • Depression, anxiety and conduct disorder in
    adolescents are one of the lead indicators of
    substance abuse.

10
School-wide Positive Behavior Intervention and
Support
  • Evidence-based features of SWPBIS
  • Prevention
  • Define and teach positive social expectations
  • Acknowledge positive behavior
  • Arrange consistent consequences that dont allow
    the functions of problem behavior to be achieved
  • On-going collection and use of data for
    decision-making
  • Continuum of intensive, individual intervention
    supports.
  • Implementation of the systems that support
  • effective practices

11
Integrating Education and Mental Health Services
can Enhance Overall Services
  • Enables PBS schools to work better with children
    in Tiers Two and Three and to engage families.
  • Significantly strengthens a mental health system
    of care by engaging the school and enabling all
    parties to come together around a single plan of
    care
  • An effective mental health system of care can
    assist teachers and other personnel through
    consultation on mental health issues and help
    schools fully engage families.

12
Benefits Cited by Mental Health Agencies
Collaborating with PBS Schools
  • PBS focuses on prevention and early intervention.
  • Communication improves among stakeholdersschools,
    families, mental health and other community
    service providersresulting in increased support
    to children and families. A unified plan,
    understood by all stakeholders, is more likely to
    be effective.
  • A less disruptive and more supportive school
    climate increases the likelihood that students
    with mental health problems can stay in school
    and succeed.
  • (Judge David L. Bazelon Center for Mental Health
    Law, 2006)

13
Benefits Cited by Mental Health Agencies
Collaborating with PBS Schools
  • Teachers have more time to focus on the academic
    strengths and needs of students with serious
    mental disorders because less behavior problems
    no longer divert their attention. This can lead
    to greater school success and improved
    functioning for children with serious mental
    disorders.
  • Mental health staff feel they develop a better
    understanding of a students behavioral
    motivations and psychosocial needs when they are
    co-located in the school and can observe the
    student in school.
  • (Judge David L. Bazelon Center for Mental Health
    Law, 2006)

14
Where Do We Start?
15
Implementation process Adapted from Fixsen
Blase, 2005
16
Local Demonstration w/ Fidelity
Need, Agreements, Adoption, Outcomes
1.
IMPLEMENTATION PHASES
2.
Sustained Capacity, Elaboration, Replication
4. Systems Adoption, Scaling,
Continuous Regeneration
3.
17
Getting Ready
  • Commit to a process that will result in the
    implementation of a joint initiative.
  • Training of leadership across both organizations
    in collaborative SW-PBIS models and systems of
    care
  • District leadership team is formed.
  • Education and mental health authorities should
    ensure that the PBS planning group with inclusive
    participation from school and mental health
    leadership
  • Once formed, the leadership team should engage in
    a joint goal setting exercise and delineate the
    objectives and outcomes desired from the PBS
    initiative.

18
Getting Ready
  • Commitment to establishment of systems of care
    (PBIS) by both the school and mental health that
    will serve not only children with serious mental
    disorders, but also children who show behavior or
    other social/emotional problems that put them at
    risk for serious disorders.
  • Formulate policy and plan training and technical
    assistance that will improve the quality of
    services to children, using the most effective
    services and a strength-based, family-driven,
    culturally relevant approach to service delivery.

19
Supporting Social Competence Academic
Achievement
4 PBS Elements
OUTCOMES
Supporting Decision Making
DATA
Supporting Staff Behavior
SYSTEMS
PRACTICES
Supporting Student Behavior
20
Tertiary Prevention Specialized
Individualized Systems for Students with
High-Risk Behavior
CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL
POSITIVE BEHAVIOR SUPPORT
5
Secondary Prevention Specialized Group Systems
for Students with At-Risk Behavior
15
Primary Prevention School-/Classroom- Wide
Systems for All Students, Staff, Settings
80 of Students
21
Tier 1 Systems
  • Education
  • Mental Health
  • Develop and implement SW-PBS Plan
  • Training for staff around mental health disorders
  • Training for coaches around incorporating
    universal prevention strategies for most common
    mental health disorders
  • Screening for internalizing disorders
  • Representative/s participate on team
  • Training around SWPBS model for
    administrative/clinical supervisors
  • Training for school based clinical staff on SWPBS
    and building based SWPBS plan

22
Tier 1 Practices
  • Training and technical assistance in developing
    and implementing a SWPBS plan
  • Three to five positive worded school rules
  • Teaching matrix for common areas in the school
  • Training staff and students to fluency on these
    expectations
  • Reinforcement system for students for following
    the expectations/staff for following the plan
  • Consistent consequences for infractions
  • Data collection system in place for data based
    decision making

23
Tier 1 Data
  • SWIS data
  • ODRS
  • Student
  • Problem behavior
  • Location
  • Time
  • Suspensions
  • Academic performance
  • Data from screening for internalizing disorders
    (i.e. Systematic Screening for Behavior
    Disorders)

24
Tier 2 Systems
  • Education
  • Mental Health
  • Tier 2 team
  • Mental health representative participates on Tier
    2 team
  • Training of coaches in evidenced based
    social/behavior and mental health interventions
  • Connections to family/ community
  • Training of mental health providers on evidenced
    based interventions
  • Review of student progress
  • Referral to appropriate services

25
Tier 2 Practices
  • Check and Connect
  • Behavior Education Program
  • Functional based social skills groups
  • Evidenced based social skills groups diagnostic
    groups (anxiety, depression)
  • Mentoring
  • Homework club

26
Tier 2 Data
  • ODRs
  • Suspensions
  • Attendance
  • Academic success
  • CICO Data
  • Brief functional behavior assessment
  • Social skills assessments
  • Mental health assessments
  • DBR (Daily behavior report) measures

27
Tier 3 Systems
  • Education
  • Mental Health
  • Tier 3 Team
  • Wraparound teams
  • Monitor effectiveness of services
  • Training of staff on evidenced based interventions
  • Actively participate in Tier 3 team
  • Coordinate wrap around services for individual
    students
  • Advocate for family needs
  • Training of staff on evidenced based
    interventions

28
Tier 3 Practices
  • Education
  • Mental Health
  • Conduct intensive FBAs
  • Design and implement wraparound plans
  • Develop and implement coordinated behavior
    support plans
  • Implement individualized evidenced based
    social/behavior and mental health interventions
  • Conduct intensive FBAs
  • Develop and implement coordinated behavior
    support plans/wraparound plans
  • Intensive assessment and implement individualized
    evidenced based social/behavior and mental health
    interventions
  • Provide supports to family
  • Coordinate medical and psychopharmacology

29
Tier 3 Data
  • ODRs
  • Suspensions
  • Attendance
  • Academic success
  • CICO Data
  • Functional behavior assessment info
  • Social skills assessments/progress monitoring
  • Mental health assessments/progress monitoring
  • Emotion thermometers
  • DBR (Daily behavior report) measures
  • SIMEO measures

30
Family Involvement
  • Family involvement is crucial. Families and youth
    must receive training and support so they can
    participate fully in leadership and planning
    groups at the school and district level.
  • Self-assessment tools i.e. family engagement
    checklist (Muscott Mann, 2004) should be used
    for district and school levels. External
    assessment of family involvement is also a good
    idea.

31
Syracuse City School Districtand Promise Zone
  • Steve Gramet
  • Director of Pupil Services

32
Who we are
32
  • Syracuse City Schools is an urban district
    located in Central New York.
  • Approximately 90, 000 residents
  • Home of Syracuse University (Say Yes partnership)
  • New Superintendent of Schools, Sharon L.
    Contreras

33
Who we are
  • We operate 32 schools
  • 21, 094 students
  • 5 High Schools
  • 6 Kindergarten 8th grade buildings
  • 6 Middle Schools (6 - 8)
  • 15 Elementary Schools

34
Who we are
  • Enrollment
  • 50 African American
  • 25 Caucasian
  • 13 Hispanic
  • 7 Asian
  • 5 other

35
Who we are
  • 14 of students are English Language Learners or
    long term English as a Second Language students
    (2900)
  • 20 of students are listed as Special Education
    (4,457)
  • Close to 85 of students are eligible receive
    free or reduced price lunch.
  • We are a dependent district that relies on local,
    state and federal dollars for funding

36
Data Averages Over the Past Three Years
  • Over the last three years SCSD 22 have been
    students suspended out of school at least one
    time
  • That equates to approximate 24,000 days each year
    of lost instructional time for these students.
  • In addition over the last three years, 5,000 days
    of instructional time is lost to In School
    Suspension.
  • There has been a downward trend the last three
    years in these indicators

37
Tiered Academic Services Committed to Data
Based Decision Making
  • School based Intervention Teams (SBIT) for
    academics have been operating in the district for
    the last ten years.
  • SBIT uses data based decision making system to
    assess, progress monitor, and evaluate a tiered
    set of academic strategies.
  • Curriculum based measurement (DIBELS, CBM
    measures)
  • In order to effectively use our social and
    behavior support resources the district adopted a
    teired system for social/behavior modeled after
    the SBIT-A teams

38
Protocol

PBIS Leadership Team Examines School Wide Data,
Creates Matrix, Plans Kickoff, etc. Members
include Admin., Parent, Teacher, Pupil Services
Staff Student Support Team Looks for any
student receiving three (3) referrals, makes
initial intervention Members include Admin.,
Social Worker, School Counselor, Say Yes Site
Director, others as appropriate Intervention and
Data monitored by Day Yes Site Director and
Student Support Team members SBIT-B
Team Students receiving seven (7) referrals,
close examining of function of behavior,
individual or small group intervention, family
involvement Members include Clinician, School
Psychologist, Social Worker, Say Yes Site
Director and others as appropriate Intervention
monitored by Say Yes Site Director, if issues
continue referral to Onondaga County Access Team
for wrap around services and other family
intervention Referral to clinic services can
happen through either SST or SBIT B team
39
PBIS
  • Full implementation began in September 2010 (a
    few schools have been using PBIS strategies for
    several years)
  • SCSD hired a PBIS District Coordinator
  • PBIS staff development has been enhanced with
    emphasis on the universal strategies
  • SETs were implemented to all schools in October
    2010 and again in the spring of 2011.

40
SET Scores
41
Interconnected Services
  • In 2007 Say Yes to Education became an external
    partner of SCSD.
  • As a result, relationships between the SCSD
    district and county improved
  • Due to funding cuts, the district and the county
    entered into agreement to try to integrate their
    services.
  • This unique partnership between the district,
    county, Say Yes to Education provided easier
    access to services.

42
Steps To Implementation
  • A stated goal of our previous Superintendent was
    for every school to provide Mental Health
    services at school due access issues of our
    population and data based decision making.
  • Schools were given a brief overview of the
    possible services and proposed protocol.
  • A rollout plan approved by the current
    Superintendent has been approved and we are
    moving forward

43
Syracuse Promise Zone
  • A partnership of the Dept. Mental Health,
    Syracuse City School District, Say Yes to
    Education, System of Care, Community Based
    Organizations
  • Jennifer Parmalee, Onondaga County Department of
    Mental Health
  • Monique Fletcher
  • Say Yes to Education

44
What is Promise Zone
  • Grant to 3 Urban districts for innovative
    solutions that result in improved student
    achievement
  • Designed to increase community collaboration and
    the districts ability to identify and support
    students with serious emotional challenges

45
Mission
  • Long Term
  • Improve academic performance
  • Increase graduation rates
  • Increase student wellness
  • Short Term
  • Reduce suspensions
  • Keep students in class and ready to learn
  • Match students emotional behavioral needs with
    proper and targeted interventions

46
Action Plan - Systems
  • Expand mental health clinics from 13 to 35 and
    integrate clinician into Tier 3 teams
  • District Wide Protocol for identifying and
    supporting youth
  • Clarify the role of the social workers
  • Expand PBIS with fidelity
  • District Leadership team to monitor progress at
    building and district levels concerning PBIS/RTI
  • Clarify the role of the Say Yes Site Director
  • Improve the Crisis Response for students and
    staff

47
Community Strengths from Which to Build
  • Highly effective Academic School Based
    Intervention Teams (SBIT) based on RtI framework
  • Mental Health Clinic Satellites currently serving
    13 schools
  • Say Yes to Education site directors in all
    elementary and K-8 schools
  • Talent of Social Workers
  • District wide implementation of Positive
    Behaviors and Supports
  • System of Care Community

48
Onondaga Department of Mental Health
  • Oversight
  • Planning and Quality Improvement
  • Contract Management (95 programs)
  • County (City) Demographics
  • Population 454,753
    (138,560)
  • Children ages 5-19 95,308
    (32,423)
  • 95 of funding from State Authorities (OMH, OASAS
    OPWDD)

49
ONCARE System of Care
  • Partnership of Mental Health, Child Welfare,
    Juvenile Justice, Family Organization, Community
    Based Organizations
  • Guiding Principles
  • All our children/youth
  • Parents/Caregivers as experts
  • Family-driven Youth-guided
  • Community Table to Kitchen Table
  • No Wrong Door
  • Single plan of care
  • Strength Based approach
  • Cultural and Linguistic relevant

50
Maximize the Use of Blended Funding to Improve
Effectiveness and Efficiency
  • Blended funding
  • Syracuse City School District
  • Multiple Onondaga County Departments
  • Say Yes resources
  • Outpatient agencies
  • Family support
  • Other resources
  • How is data shared to determine the selection of
    interventions?
  • How is data shared to determine effectiveness of
    interventions

51
Say Yes To Education
  • Say Yes to Education, Inc. (Say Yes) is a
    national, non-profit education foundation
    committed to dramatically increasing high school
    and college graduation rates for our nation's
    urban youth.
  • Say Yes provides comprehensive supports,
    including the promise of free college tuition,
    aligned with what research indicates is needed to
    enable every child in the program to achieve his
    or her potential.

52
Say Yes Community-wide Involvement
  • After school-Tier 1
  • 9 Community based organizations in 20 schools
  • Summer camp-Tier 1
  • Syracuse University
  • Tutoring-Tier 2
  • Syracuse University Literacy Corp Volunteers
  • Family Support Services-Tier 3
  • Huntington Family Centers
  • Student Assistance Program-Tier 3
  • Contact Community Services
  • Facilitated Enrollment-Tier 3
  • Salvation Army
  • Legal clinics-Tier 3
  • Pro bono services from legal community

53
System Involvement
  • Onondaga County Supports Schools
  • Department of Aging and Youth
  • Youth Program Quality Assessment (YPQA)
  • Department of Social Services
  • Educational Neglect
  • Health Department
  • Health insurance enrollment
  • Department of Mental Health
  • Promise Zone

54
Say Yes Commitment to Data Based Decision
Making
  • Say Yes Site Coordinators routinely collect data
    on
  • Attendance
  • Behavior (ODR/Suspensions)
  • Academics(i.e., DIBELS)
  • These data are presented to SCSD principals and
    teams on a monthly basis
  • Say Yes Site Directors assist in linking services
    and resources to improve these outcomes

55
Moving Towards an Interconnected System
  • Established members of Tier 3 team
  • Utilizing evidence based intervention for all
    students
  • Progress monitoring
  • Prioritizing school functionality in treatment
    goals
  • Sharing data with team of school professionals
  • Accountability to team in addition to child and
    family with familys permission
  • Community responsibility to engage families

56
Challenges
  • Increasing the number of schools implementing
    Tier 1 to fidelity
  • Increasing of schools implementing Tier 2 and
    Tier 3 systems and evidenced based practices
  • The use of common language
  • Training for the SBIT -B teams around
    understanding behavioral function in order to put
    the appropriate interventions in place (ie.
    Check/Connect, ART, individual counseling,
    mentoring etc)

57
Challenges
  • Learning to work effectively with external
    partners such as Onondaga County and Say Yes to
    Education
  • Redefining the role of the Social Worker
  • Helping in-school clinicians to use strategies
    that are reasonably short term, evidenced based
    and result in improved school performance
  • New York State Medicaid redesign delay creates
    system in flux
  • Schools have to provide appropriate space for
    clinic. The space must approved by the state as
    adequate.

58
  • For more information
  • bputnam_at_mayinstitute.org
  • pbis.org
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