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

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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.
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Where are you in implementation process? Adapted
from Fixsen Blase, 2005
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School Mental Health Partnership

• More than a place for services

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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

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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
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Merikangas, He, Brody, Fisher, Bourdon, Koretz
2010 
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(No Transcript)
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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). 

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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.

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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

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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.

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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)

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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)

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Where Do We Start?
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Implementation process Adapted from Fixsen
Blase, 2005
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Local Demonstration w/ Fidelity
Need, Agreements, Adoption, Outcomes
1.
IMPLEMENTATION PHASES
2.
Sustained Capacity, Elaboration, Replication
4. Systems Adoption, Scaling,
Continuous Regeneration
3.
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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.

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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.

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Supporting Social Competence Academic
Achievement
4 PBS Elements
OUTCOMES
Supporting Decision Making
DATA
Supporting Staff Behavior
SYSTEMS
PRACTICES
Supporting Student Behavior
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Tertiary Prevention Specialized
Individualized Systems for Students with
High-Risk Behavior
CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL
POSITIVE BEHAVIOR SUPPORT
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Secondary Prevention Specialized Group Systems
for Students with At-Risk Behavior
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Primary Prevention School-/Classroom- Wide
Systems for All Students, Staff, Settings
80 of Students
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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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.

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Syracuse City School Districtand Promise Zone

• Steve Gramet
• Director of Pupil Services

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Who we are
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• 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

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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

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Who we are

• Enrollment
• 50 African American
• 25 Caucasian
• 13 Hispanic
• 7 Asian
• 5 other

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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

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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

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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

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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
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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.

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SET Scores
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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.

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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.

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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

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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

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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

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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

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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)

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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.

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