PBIS Maryland: Current Interagency Approach Susan Barrett Sheppard Pratt Health System Milt McKenna Maryland State Department of Education (MSDE) Oct. 11, 2006 Rosemont, IL

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

Annual Training and Support Events Spring Forum (March) ~ 400 Summer Training Institute (June) New Teams ~ 830: Central Returning Teams ~ 1600: 3 regional events Coaches Meetings (3 per year) ~ Regional / District Meetings (2 per year) Special Schools (2 per year) High Schools (2 per year)

PBIS Maryland: Political Support and Visibility Andrea Alexander Maryland State Department of Education (MSDE) Michelle Zabel University of Maryland Oct. 11, 2006 Rosemont, IL

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, Systems of Care, and wraparound efforts

Annotated Code of Maryland State Board of Education Subtitle 08 STUDENTS Chapter 06: Positive Behavioral Interventions and Support Program Authority: 13A Title 13A Education Article, §2-205 and

A. Upon receipt of notification from the Department that an elementary school's suspension rate exceeds 18 percent, the local school superintendent or the superintendent's designee shall direct the principal of the school to implement: (1) PBIS; or (2) An alternative behavioral modification program developed in collaboration with the Department. B. The school principal or the principal's designee and appropriate staff members shall develop a plan for implementing a program as set forth in §A of this regulation. C. The following apply to an elementary school that has at least one grade beyond grade 5: (1) The 18 percent suspension rate in §A of this regulation shall apply to students in pre-kindergarten through grade 5; and (2) PBIS or the alternative behavioral modification program shall focus on students in pre-kindergarten through grade 5. D. Nothing in this regulation precludes a school system from implementing PBIS or an alternative behavioral modification program either in specific schools or system-wide. Legislation Requiring PBIS Implementation

Related State-Level Child Mental Health Programs: Agreed Underlying Values and Intended Outcomes HB 1386: Improving access to services for children with intensive needs Developing community based resources for children with intensive needs and children at risk of residential placement Reducing the number of children in placements outside of their home communities

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

Identified How Services & Supports Will Be Organized 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

The Commitment: Governor Robert L. Ehrlich Jr.’s Executive Order January, Custody Relinquishment and Access to Services for Children House Bill Session – Children with Intensive Needs Mental Health Transformation State Incentive Grant 2005 SAMHSA grant award

PBIS Maryland: Evaluation & Demonstrations Jerry Bloom Sheppard Pratt Health System Catherine Bradshaw & Phil Leaf Johns Hopkins Bloomberg School of Public Health Susan Barrett Sheppard Pratt Health System Nancy Lever University of Maryland Oct. 11, 2006 Rosemont, IL

Evaluation Questions What schools have been trained and are active? How well are schools implementing PBIS? What impact does PBIS have on behavior & achievement? Evaluation Tools Team Implementation Checklist SWIS SET Coaches Checklist Staff Survey Satisfaction Surveys Implementation Phases Inventory (IPI) Evaluation Capacity Establishing Measurable Outcomes

Evaluation Tools Maryland website Various Levels: Any user Team/coach District Point of Contact State Team Maryland Forms Matrix Access Database Data Entry and Storage Report Generation SWIS PBS surveys (

Randomized Trial of PBIS: Project Target Funding Phil Leaf, PI Centers for Disease Control & Prevention (CDC) National Institute of Mental Health (NIMH) Goal: Determine Impact of PBIS on Student Behavior - Discipline referrals - Disruptive behavior - Academic achievement School Environment - School climate - Organizational health Sample 37 Elementary Schools - 5 Counties 3,454 Staff 26,143 Students Design Randomly Assigned - 21 PBIS - 16 Focus Baseline + 4 years

Preliminary Findings from Project Target PBIS schools have high program fidelity PBIS increased organizational health Some positive effects on student outcomes Reduced office discipline referrals Reduced suspensions Project Target

Related Initiatives Bullying Prevention Using Internet to facilitate data-based decision making Provides school teams with local data to inform school improvement plans PBIS + FBA Grant under review to test combination of SW-PBIS and FBA (P. Leaf, PI) In collaboration with Terry Scott On-site technical assistance in simplified FBA 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

Yellow Zone Program: Behavior Education Program (BEP) Target Districts with solid green zone and infrastructure to support yellow zone expansion Training Materials Responding to Problem Behavior in Schools: The Behavior Education Program (Crone, Horner, & Hawken) Locally developed CD Training Format Regional training of school teams On-site technical assistance & support Evaluation & Expansion Preliminary findings positive

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

Maryland’s School Mental Health Integration Grant (USDOE) 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: 1. Helping school staff to better identify and refer students who could benefit from mental health services 2. Enhancing mechanisms for effective communication between schools and the mental health system to help better integrate quality mental health care for students 3. 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

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 Resources