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, Rosemont, IL

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

Pennsylvania Delaware D.C. Virginia West Virginia

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 State District School Classroom Student

Cumulative Number of PBIS School Teams and Behavior Support Coaches by Year Trained # Trained

Anticipated Growth Currently 34% of MD schools trained & 50% will be trained by 2010

Milt McKenna Maryland State Department of Education (MSDE)

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

Maryland School Mental Health Alliance School Mental Health Integration Grant

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.”

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 children’s 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)

Andrea Alexander Maryland State Department of Education (MSDE)

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   Governor’s Office for Children   Maryland Assembly on School-Based Health Care   Maryland Coalition of Families for Children’s Mental Health   Maryland Department of Juvenile Services   Mental Hygiene Administration Department of Health and Mental Hygiene   Mental Health Association of Maryland

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

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

Maryland School Mental Health Alliance For More Information About the MSMHA and to Access Resources Developed for the Project, Visit Our Website:

Nancy Lever University of Maryland

CSMHA   To strengthen the policies and programs in school mental health to improve learning and promote success for America’s youth   Established in 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.   (410) University of Maryland, Center for School Mental Health Analysis and Action

Expanded School Mental 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

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

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 children’s mental health   State   County   School

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

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

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

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

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

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

Sharon Grose Harford County Public Schools

District Demographics   Number of Schools   Elementary32   Middle8   High8   PBIS 10   Elementary6   Middle3   High1   School Mental Health Integration (3)   Special (John Archer)   Harford Technical   Alternative Education

Enrollment & Student Characteristic (2006)   Preschool/PreK/K 3,710   Elementary14,698   Middle9,315   High12,489   Special158   Alternative Ed Total=40,212  African American 18.00%  American Indian.56%  Asian 2.30%  Hispanic 2.90%  White 75.52%

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

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

Implementation of Grant in HCPS   Local Goal   To integrate PBIS and school mental health   Active Schools   Hall’s Crossroads, Edgewood Middle School, and William Paca/Old Post Road   District Coordination   Representatives from each school meet with the Children’s Mental Health Roundtable to share needs

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

Nancy Lever & Andrea Alexander

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 children’s mental health   Less fragmentation and more unification and ownership across community agencies and schools

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)

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

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

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!

Catherine Bradshaw Johns Hopkins University

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

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

OUTCOMES INPUTS ACTIVITIES OUTPUTS Intermediate Ultimate Logic Model for the Wraparound, PBIS, and ESMH Pilot Project June 21, 2006 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) TECHNICAL ASSISTANCE -Wraparound model -Universal PBIS -Evidence-based practice -Crisis planning & management -Community collaboration -Family Involvement -Mental Health Identification & Referral LINK EXISTING AGENCIES, SERVICES & INTIAITVES -School-based mental health -Community-based programs and services -School re-entry -Crisis management -Core service agencies -Children’s Cabinet Systems of Care -MH Transformation Grant IMPLEMENT SCHOOL-BASED WRAPAROUND -Assessment -Family involvement -Care Coordination -Integration of services -Mental health services -Program placement -Crisis planning & management Reduction in inappropriate referrals for services Reduction in office discipline referrals Reduction in suspensions and acts of school violence Increased time on task & opportunity for learning Reduction of risk factors and increase in protective factors in children and adolescents Reduction in need for juvenile services and child protective services Increased graduation rates and reduced high school dropout Reduced disproportionality in achievement & discipline problems Increased parental involvement in educational process Increased teacher- efficacy for behavior management Increased academic performance Staff available to participate in wraparound process 80% School-wide universal PBIS implementation Need and buy-in from school and community District-level infrastructure to support PBIS, wraparound, and system integration Multiple district, state, agency, family, and university partnerships Regional expertise in PBIS, evidence-based practice, family involvement, and crisis management Increased linkage protocols, communication, & coordination across agencies Knowledge Transfer -Skills in detecting signs and symptoms of MH problems -Understanding risk and protective factors -Managing mental health problems in schools -Understanding the value of and strategies to encourage family and community partnerships -Implementation of wraparound process -Knowledge of available resources Improved crisis planning and management Further stabilization of universal PBIS systems Development of secondary and tertiary PBIS systems Increased use of evidence-based practices

Maryland’s Approach to Children's Mental Health System of Care Local Access Mechanisms Navigation functions Single point of access/no wrong door Wraparound – practice model

Current Organization of Wraparound Services & Supports Governor’s Office for Children Local Management Boards Children’s Cabinet State Agencies (DHMH, DHR, DJS, MSDE) Local Agency Partners (CSA, DSS, DJS, LSS) Children, Families and Communities DHMH = Department of Health & Mental HygieneCSA = Core Service Agency (local mental health) DHR = Department of Human Resources (Child Welfare)DSS = Department of Social Services DJS = Department of Juvenile ServicesDJS = Local/Regional Office MSDE = Maryland Department of EducationLSS = Local School System

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 -responsible 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

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