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

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

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

Poll Question #1

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

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

Interconnected Systems Framework paper (Barrett, Eber and Weist , revised 2009) Developed through a collaboration of the National SMH and National PBIS Centers www.pbis.org www.pbis.org http://csmh.umaryland.edu

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

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

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

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

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 1-5% Individual students Assessment-based High intensity 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 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 80-90% All students Preventive, proactive 80-90% Tier 1/Universal Interventions All settings, all students Preventive, proactive 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

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

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

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

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

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

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)

“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

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

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)

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

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

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

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

Development of ISF 2002-2007: Site Development with PBIS Expansion (informal and independent) 2005 CoP focus on integration of PBIS and SMH 2008: ISF White Paper: formal partnership between PBIS and SMH 2009- 2013 Monthly calls with implementation sites, national presentations (from sessions to strands) 2009-2011 Grant Submissions June 2012- September 2013 ISF Monograph Monograph Advisory group

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.

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.

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.

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

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);

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;

Traditional  Preferred No data to decide on or monitor interventions; MH person leads group or individual interventions based on data;

Poll Question #2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Outcomes School Data – Office Discipline Referrals

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

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

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”

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  

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

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

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

Time Line School Year Activity 2008-09 Community Care engaged district through ICSP regarding SBBH Team 2009-10 SBBH Team begins work within district – September 2009 District and Community Leadership Team is established, district commitment signed, tertiary demonstration project begins – spring 2010 2010-11 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 2011-12 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

Scranton School District Year One 2009-10 Year Two 2010-11 Year Three 2011-12 Year Four 2012-13 Year Five 2013-14 Year Six 2014-15 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.

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

Outcomes Change in Family Functioning

Outcomes Change in Child Functioning

Outcomes – SDQ-P Change in Difficulties Score

Outcomes – SDQ-T Change in Difficulties Score

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.

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.

Child Outcomes Survey (COS) Family Functioning: Child X

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

Child Outcomes Survey (COS) Overall Wellness: Child X

Strength and Difficulties-Parent Report: Child X

Strength and Difficulties-Teacher Report: Child X

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

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

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

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

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