1. Interconnected Systems Framework PA PBS Network Professional Learning Community Webinar #2
February 14, 2017

2. Agenda Follow up since 1/27 webinar
Getting Started – District and Community Leadership
Getting Started – Building Level Implementation

3. Follow Up from Last Time
Questions, feedback, comments
ISF Implementation Inventory
Did not receive any consent to participate

4. Please Share
One item you took from last webinar back to your site for discussion or follow up
One way you have identified you will use this PLC to advance the goals of your project
One question you would like addressed today

5. An Interconnected Systems Framework
A Structure and process for education and mental health systems to interact in most effective and efficient way.
guided by key stakeholders in education and mental health/community systems
who have the authority to reallocate resources, change role and function of staff, and change policy.

6. Core Features Aligned
Effective teams that include community mental health providers, family/youth
Data based decision making
Formal processes for the selection and implementation of evidence based practices (EBP)
Early access through use of comprehensive screening
Rigorous progress-monitoring for both fidelity and effectiveness
Ongoing coaching at both the systems and practices level.

7. Getting Started - DCLT

8. Example of Work Flow Checklist
Select District and Schools
Form or Expand District Team (Workgroup of existing team?)
Membership
Establish Operating Procedures
Conduct Resource Mapping of current programs/initiatives/teams
Identify gaps/needs
Assess staff utilization
Examine organizational barriers
Establish priority- measureable outcomes
Develop Evaluation Plan
District and School Level
Tools Identified
Economic Benefits
Develop Integrated Action plan
Identification of Formal Process for Selecting EBP’s
System for Screening
Communication and Dissemination Plan
Write MOU- Determine who will implement the plan

9. What is “current status” of District Leadership Team(s) that guides PBIS/MH?
Just getting started with establishing a District Leadership Team?
Have a District Leadership Team and want to add Community Partners?
Already have a District and Community Leadership Team?

10. How to Get Started and Keep Moving Forward
Applying Implementation Science
Engaging community partners
Engaging families and youth
Selecting EBP
Using data to monitor fidelity and outcomes
Increasing staff competence and confidence
Communication with district level staff

11. Implementation Science
ISF Implementation is not a single event
A mission-oriented process involving multiple decisions, actions, and corrections- Continuous Improvement/Regeneration
Uses stages to make the process of change doable
Anchored to tiered framework
Always connected to strategic plan

12. Stages of Implementation
Focus
Stage
Description
Exploration/
Adoption
Decision regarding commitment to adopting the program/practices and supporting successful implementation.
Installation
Set up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct audit, develop plan.
Initial Implementation
Try out the practices, work out details, learn and improve before expanding to other contexts.
Elaboration
Expand the program/practices to other locations, individuals, times- adjust from learning in initial implementation.
Continuous Improvement/Regeneration
Make it easier, more efficient. Embed within current practices.
Should we do it
Getting it right
Implementation is not an event
A mission-oriented process involving multiple decisions, actions, and corrections
Fixen et al
Making it better

13. Engaging Stakeholders to Work Differently
Need buy-in from all participants
“What’s In It For Me?”
Need a mission statement and/or common goals to “rally” around
Helpful to look at community data in addition to school data (are there issues with substance abuse, gangs, violence, trauma, poverty, etc.)
Need key decision makers at the table

14. Mike

15. Establish a Structure for Integrated Work
Establish a “way of work”. Move away from “more is better”.
Utilize a formal process for selection and implementation (data/practices/systems) 
New emphasis on “sustainability” and “efficiency” have heightened attention on the need for effective systems of alignment.
(Greenwald, Poulos, & Horner, 2015)

16. Establish a Structure for Integrated Work
Establish a DCLT with stakeholders who have the authority to reallocate people, funding, resources
Include an integrated professional development plan for both school and community employed staff
Focus on cross-system teams that hold themselves accountable with data-based decisions

17. District and Community Leadership Team: Form/Expand Team Membership
Local Integration team identified (membership should include representatives from the following areas to ensure local stakeholders is fully represented). a.) School System Student Services and Special Education Directors b.) Local Mental Health Provider c.) Core Service Agency’s Child and Adolescent Coordinator d.) Juvenile Services Coordinator/Law Enforcement e.) Coalition of Families offices f.) Family, Youth and Community members g.) Local Management Board representative h.) Social Services representative other to include (where present) Youth MOVE Rep, System of Care Case Management entity or Family Navigator, community health provider, non-public special education school rep, recreation services, local health dept, board of education representative or other stakeholders identified by leadership Who else should be included? Can this team change job descriptions, re-allocate/flex funding, shape policy and address other organizational barriers that come up?

18. Clear and Consistent Leadership
Provide the funding, visibility, and political support needed to allow school teams to travel through the full sequence of adoption stages.
Provide the training, coaching and feedback systems needed to establish personnel with both the specific technical skills needed to deliver integration and the organizational vision to deliver those skills within a unified framework.
Again, reflecting the DCLT graphic, the team has the authority to provide funding (flex funding for MH providers to get paid beyond fee for service model and serve on systems planning teams), promote visibility and political support and understand that this is a process that takes time to install, implement- taking place in stages and changing current structures
The team will also provide ongoing access to training (PD is delivered to school/community teams with admin support, use of data and assigned a coach to support implementation )
Do you have an implementation team dedicated to this?

19. Examples of Role & Function of District Team
Define how evidence-based practices will be selected so the process is transparent.- Consumer Guide
Provide the authority and problem solving needed to overcome organizational barriers and implement the efficiencies needed to functionally interconnect educational, behavioral and mental health supports.

20. Site Example – Buncombe Co., NC
Large district – 25,000 students
Multiple MH provider agencies
Multiple initiatives – some from grants
Mission around alignment and integration

21. How did we get here? Elementary and Secondary School Counseling Grant:
One of the absolute priorities is to increase access to mental health services
Hired 4 additional elementary school counselors
Currently have 4 major school-based mental health agencies with MOA for services, since early 1990s.
Some progress with integration, more “co-located” model

22. Fall 2015 and Spring 2016
Attended PBIS Midwest Leadership Forum and Advancing School Mental Health Conference
Assembled Current School-based providers: Defined our current model, completed resource mapping, and Hexagon tool. Outcome was to move forward.
March, Presentation to MCO, School district administration, school board member, and county government, DHHS.

23. Initiated Planning Process
Negotiated with local Managed Care Organization and County Department of Health and Human Services to fund a part-time planning facilitator. Former District Judge and excellent child advocate.
Utilizing federal grant funds to contract for training and technical assistance.

24. Identified core leadership group for initial planning:
School-based mental health coordinators
Representative from Managed Care
Representative from DHHS
School district representatives

25. Facilitator and Director of Student Services conducted four focus groups consisting of over 30 community agency, school, and parent groups.
1. Mental health providers,
2. Public school administrators and university representatives.
3. Medical providers and related integrated services.
4. Legally mandated services, Juvenile Court, Dept. of Heath and Human Services, Family Justice Center, etc.

26. Next Steps:
Held a face to face day to establish DCLT from larger stakeholder group
Established four workgroups
Funding and sustainability
Evaluation (data and outcomes)
Parent and community voice
Selecting evidence-based practices
Convened “pilot” schools (elementary, middle, and high school) 8 total

27. Quick Reflection
What elements/features of an interconnected system are evident or emerging in your districts/schools?
What action/steps could move your school(s) towards more efficient and effective integrated ‘behavioral health’ system in your district/schools?
Questions/comments?

28. What is “Current Status” of School Building PBIS Implementation
Just getting started with installing PBIS?
Implementing PBIS, need to boost fidelity?
Implementing PBIS with fidelity, want to enhance with Mental Health Integration (ISF)?

29. What is “Current Status” of MH in Schools?
Mainly a referral/handoff system?
MH clinicians delivering interventions in schools but through separate systems?
Some level of integrated system for delivery of interventions?
Data used regularly by teams?
???

30. Sample High School: PBIS (Within Placer County)
Third year of PBIS implementation
Tiers I and II are solid
Partially implementing Tier III (School based Wraparound)
50% reduction in office referrals
Mike

31. Sample High School: PBIS
Systems (Supporting Adult Behavior)
District Leadership Team (guided by DCA)
2 district PBIS coaches support 18 schools across the district
Tier I Team & Intervention Team
Team completes Tiered Fidelity Inventory two times per year (Tier I = 84%, Tier II = 75%, Tier III = 34%)
Mike

32. Sample High School: PBIS
Tier III: Wraparound
Tier II: Check in Check Out
Peer Mentoring
Tier I: 4 Pos. Rules (SOAR)
Rules Defined/Taught-Video
Acknowledgment System
Consistent Consequences
Use of Data
Family Engagement
Mike
Safety
Organization
Achievement
Respect

33. Sample High School: PBIS
Data (Supporting Decision Making)
Outcome data: Tier I: School Wide Information System (SWIS), Tier II: Check in Check out SWIS, Tier III: Considering ISIS SWIS
Fidelity data: Tiered Fidelity Inventory and Schoolwide Evaluation Tool
Mike

34. Sample High School: School Mental Wellness (SMW)
Current needs: Sample High School is a high performing school with a diverse student body of 2,000 students.
Recent data indicates that Sample High School’s students reflect national trends with approximately 20% (400 students) reporting mental health concerns that are significant enough to cause impairment.
California Healthy Kids Survey/school counselors report high number of students are leaving class and high levels of suicidal ideation.
Mike

35. Sample High School: Gatekeeper Programs
Tier III: ASIST
Tier II: Mental Health
First Aid
Tier I: Eliminating
Barriers to
Learning (EBL)
Alicia

36. Eliminating Barriers to Learning
Alicia
Universal System to Identify Students with Possible Mental Health Needs

37. Five Modules Eliminating Barriers for Learning: The Foundation
Social-emotional development, stigma, and discrimination
Social-Emotional Development, Mental Health, and Learning
Overview of disorders, effects on learning, risk factors, and classroom strategies
Making Help Accessible to Students and Families
Formulate a plan to help students with mental health needs
Strategies To Promote a Positive Classroom Climate
Create a climate that promotes learning and mental wellness
Create a formal action plan for promoting mental wellness
Infusing Cultural Competence into Mental Wellness Initiatives
Practical considerations for the classroom and campus
Mike
3 min

38. Mental Health First Aid
Mike
Mental Health First Aid

39. Mental Health First Aid
8-hour course that teaches you how to help someone who is developing a mental health problem or experiencing a mental health crisis
Helps you identify, understand, and respond to signs of mental illnesses and substance use disorders
A ssess for risk of suicide or harm
L isten nonjudgmentally
G ive reassurance and information
E ncourage appropriate professional help
E ncourage self-help and other support strategies
Mental Health First Aid

40. (ASIST) Applied Suicide Intervention Skills Training
Alicia
(ASIST) Applied Suicide Intervention Skills Training

41. Applied Suicide Intervention Skills Training
For caregivers who want to feel more comfortable, confident and competent in helping to prevent the immediate risk of suicide
Two-day, highly interactive and practice-oriented workshop (15 hours)
Develop skills
Learn how to communicate with a suicidal individual
Recognize and review risk
Intervene to prevent the immediate risk of suicide
Understand resources available
Alicia
Applied Suicide Intervention Skills Training

42. Below is Sample High School’s Tier II Inventory
Tier II Intervention
Capacity
(# of students
at 1 time?)
Who coordinates intervention?
Describe students who would be good fit for intervention
What data is used to evaluate student outcomes?
How many students have been:
Maintain,
Revise or
Discontinue
Referred
Successful
Check in Check out 25
 Mike
Students with emerging behavioral concerns that would benefit from additional structure and that enjoy adult attention
 CICO Daily Progress Notes and ODRs
 15
 10
 Maintain
 Reconnecting Youth
Up to groups of 10
 Kerri + Denae
 Students with emerging substance abuse and/or mental health issues
 Grades, attendance, and substance abuse reports and Behavior Rating Scale (BRS) 9
 Peer Mentoring
 Celeste
Students with emerging behavioral concerns that enjoy peer attention
Pre and post assessment and ODRs 15
Maintain
Luke

43. Reconnecting Youth
Alicia

44. 75 lessons in the RY curriculum
75 lessons in the RY curriculum. It is typically offered as a semester-long, for-credit class by a teacher/facilitator –
RY program goals:
Increased school performance
Decreased drug involvement
Decreased emotional distress
Activities Focus On
Self-esteem Enhancement
Decision Making
Personal Control
Interpersonal Communication
Alicia
Reconnecting Youth

45. Eliminating Barriers to Learning in Action
Anna has been struggling to complete her assignment for the past few months and often appears worried in class. Her attendance has been poor, her grades recently declined and Ms. Dennis suspects that Anna may be abusing alcohol or drugs. Ms. Dennis responds by:
Providing immediate support and
Referring Anna to Sample High School’s Intervention Team
Luke

46. The Intervention Team at Sample High School
The Intervention Team at Sample High School meets and after reviewing the progress on the effectiveness of their Tier II interventions and review progress monitoring data on specific students that have been placed into these interventions, the team begins reviewing new referrals.
Ms. Dennis had completed a Request for Assistance Form for Anna and the team begins by reviewing this form.
Specific concerns included: possible anxiety, possible drug use, frequent absences, withdrawal, and poor work completion
The team decides to place Anna into a Tier II Intervention
Luke
Examine Sample High School’s Intervention Inventory and select the most appropriate intervention for Anna

47. Intervention Team Meeting
After several weeks, the Intervention Team reconvened and discussed Anna’s progress to date. Anna continued to have significant needs, substance use continues and there appears to be complex family needs.
They quickly ruled out fading supports and decided to either
Keep Anna in her existing Tier II intervention or
Place her into School Based Wraparound
Mike

48. School Based Wraparound
Alicia

49. School Based Wraparound
 Holistic method of engaging with individuals with complex needs
Focus on home, school and community
Process aims to achieve positive outcomes by providing a structured, creative and individualized team planning process
Focus on strength and needs
Development of family and students resources
Begins from the principle of “voice and choice”
Mike
School Based Wraparound

50. Anna’s Wraparound Team
Team Members: Anna, Science Teacher, School Counselor, Pastor, Neighbor and Family Friend/Previous Girl Scout Leader
Second Meeting:
Anna does not show up for the meeting
Ms. Irvin, the family friend, reports that Anna had told her that she does not want to participate because she “does not plan on being around for next semester.”
Ms. Brown, the school counselor, identifies this as a possible warning sign and establishes time to meet with Anna to conduct an ASIST intervention
Alicia

51. (ASIST) Applied Suicide Intervention Skills Training
Alicia
(ASIST) Applied Suicide Intervention Skills Training

52. Anna’s ASIST Intervention
Ms. Brown meets with Anna, engages and connects Anna’s warning signs/invitations and asks directly and clearly if Anna is having thoughts of suicide.
Anna reports that yes she has recently been thinking about ending her life but does not yet have a suicide plan.
Ms. Brown follows the school’s protocol and notifies Anna’s parents. Ms. Brown provides connections to formal supports in the community and is an ongoing support contact for Anna at school.

53. Wraparound
Anna’s Wrap around team continues to meet and after several months, they reevaluate her progress.
Anna is no longer having thoughts of suicide and is not using drugs
Anna attendance has improved but could still be better
Anna has not had a behavioral referral in 6 weeks and she is passing her classes
Below is pre and post data from wrap
Measure
Pre
Post
GPA
1.22
2.40
School Attendance
60%
75%
BERS, Teacher rating of student 86
111
BERS, Parent rating of student 76 94
BERS, Student rating of self 69
100
Discipline Violations, Average per month 4 1
Alicia

54. Quick Reflection
What elements/features of an interconnected system are evident or emerging in your districts/schools?
What action/steps could move your school(s) towards more efficient and effective integrated ‘behavioral health’ system in your district/schools?
Questions/comments?

55. Getting started at the building level
Identify a building or two to become demos
Complete ISF Implementation Inventory
Provide training, coaching and TA on core features

56. ISF Implementation Inventory

57. Purpose of ISF Implementation Inventory
To assist school and community partners in their installation and implementation of ISF
To assess baseline and/or ongoing implementation progress of critical ISF features
To inform action planning that advances and enhances ISF implementation
To measure ISF implementation fidelity
ISF Implementation Inventory is multi-purposed. is it was developed as a fidelity tool, but we also want to make sure it includes that action planning piece. So we specifically identified it as an implementation inventory not an implementation fidelity checklist. Fidelity was left out intentionally so that it wasn’t seen as a research tool or something that was very evaluation-heavy but more as a tool that was supportive of advancing implementation in a succinct and strategic way. So we’re really looking at it as a tool that schools who are in that installation and implementation stages of ISF can use. You can use it for a baseline and then continue using it for progress-monitoring. Really, the items on the scales are around those critical features for ISF implementation, so that’s why it is not just a fidelity check, but also training—we’re organizing training around those items and then organizing the action planning that goes with it. So its kind of a multipurpose, singular tool. And I like it, in case you can’t tell.”

58. ISF Implementation Inventory: Tiered Domains
19 items
16 items
Implementation of SWPBIS: Are core features of SWPBIS implemented with fidelity?
Teaming: Do team members collaborate? Do team members include education and mental health system representatives, families, and students as indicated with active opportunities for participation and collaboration
Collaborative Planning and Training: Do all team members have PD and training across systems and core features of ISF, as well as intervention practices as appropriate?
Family and Youth Engagement: Are students and families included in teaming, decision making, intervention selection and implementation, intervention monitoring, and system processes?
Intervention Selection, Implementation and Progress: Are evidence-based interventions selected based on need, implemented with fidelity, progress monitored, and concluded after attainment of positive outcomes?
Data-Based Decision Making: Are data representative of school, home and community behavior collected, analyzed and used for decision making, including outcome/impact, process, and fidelity data?
ISF Implementation Inventory: Tiered Domains

59. ISF Implementation Inventory Report Card
Percent of implementation fidelity is graphed
Graphed by tier and assessment time point
“The next part of the report card moves into actually the Implementation Inventory results outside of that one item. And so first we’re showing you your percentage of implementation by each tier and the way we’ve build these charts is that you’re using them iteratively and over time—subsequently I guess would be the right word. But basically if you use it in the fall and then again in the spring and then again next year, we’ll keep adding bars to the graphs so you can evaluate your implementation fidelity over time and across tiers.”

60. Tier implementation score
ISF Implementation Inventory Report Card
Item to consider for action planning to create immediate change
Items will already be highlighted based on scoring by the ISF research team. Schools will be encouraged to review highlights for action planning
Item to consider for action planning but may need additional time/more intensive system changes for score improvement
“And so then we’ve broken it down by item level, so you can see here why some of the items and why—this is tier II, right? Yes—so why tier II isn’t quite at that 80%, because a couple of their items are rated in that mild to moderate range. So we’ve gone ahead and highlighted the yellow and red for you to indicate where the items are falling. Then you can see the distribution of those scores. So for example, item 2.7 might be one that you would want to do some consensus-building around because there is kind of an even distribution across the 2 and the 3 rating, so you would want to figure out whether the team really thinks it’s a 2 or a 3. Item 2.3 has a lot of distribution across all 3 points of the rating scale and so you might want to build consensus around there too, because even though it’s below a 2, somebody actually thinks it’s in place and the majority of people think it’s at least somewhat in place, but the average isn’t necessarily representing that, so you might want to do some consensus-building and report an adjusted score. What we’ve also said in the action planning guide is those highlighted yellow are some that you could create action planning to create some immediate change. They’re really close at the cusp at that strength cutoff. And those highlighted yellow [RED?] are going to need more time and more intensive systems-change processes to see improvement. And again, similar to what we’ve done on the others, is you get a total tier II mean score as well as the implementation score, that’s a percentage—72.62% in place, really close to the 80% cutoff. And I’ve already gone over everything highlighted.”
Tier implementation score

61. ISF Implementation Inventory Report Card
Items will be pre-sorted by implementation level and tier
Supports action planning
Use this row for quick comparison of implementation across tiers
Use this row for quick comparison of item responses and action planning. Refer to previous report pages for actual items.
“So then the report card for this school continuing, then we’ve distributed the item across the strengths, mild, and moderate improvement areas. And I’ve already gone over those but you can see here how we distributed those and really I think what we’re going to do with these report cards is include the item numbers actually so that you can refer back to them very quickly. So this table gives you a very quick snapshot and analysis of the distribution of your items and you can refer back to the tables that look like this [previous slide] for that item-level analysis.”

62. Process for Completion
Need an from district or building administrator for consent – by ?
A link will be sent from USC or UF Research Team – individual completion – by
A report card will be generated within two weeks – by

63. Next Steps Identify action steps for your sites
What would be helpful for next time?
How can we best support you?

68. Kelly Perales Kelly.perales@midwestpbis.org 717-770-9365
Thank You!
Kelly Perales