1. School Mental Health/ PBIS Integration: Funding and Policy Nancy Lever, Center for School Mental Health Mariola Rosser, IDEA Partnership Joanne Cashman, IDEA Partnership Mark Weist, University of South Carolina National PBIS Leadership Forum October 30, 2014

2. “Expanded” School Mental Health Full continuum of effective mental health promotion and intervention for students in general and special education Reflecting a “shared agenda” involving school-family-community system partnerships Collaborating community professionals (not outsiders) augment the work of school- employed staff

3. Advantages Improved access Improved early identification/intervention Reduced barriers to learning, and achievement of valued outcomes WHEN DONE WELL

4. But SMH programs and services continue to develop in an ad hoc manner, and LACK AN IMPLEMENTATION STRUCTURE

5. Positive Behavior Intervention and Support (www.pbis.org) In 18,000 plus schools Decision making framework to guide best practices for improving academic and behavioral functioning – Data based decision making – Measurable outcomes – Evidence-based practices – Systems to support effective implementation

6. Advantages Promotes effective decision making Reduces punitive approaches Improves student behavior Improves student academic performance WHEN DONE WELL

7. But Many schools implementing PBIS lack resources and struggle to implement effective interventions at Tiers 2 and 3

8. Key Rationale PBIS and SMH systems are operating separately Results in ad hoc, disorganized delivery of SMH and contributes to lack of depth in programs at Tiers 2 and 3 for PBIS By joining together synergies are unleashed and the likelihood of achieving depth and quality in programs at all three tiers is greatly enhanced

9. Tier 1 Tier 2 Tier 3 Mental Health Education

10. Not two, but one

12. A Cyclical Story

13. Insights in the Cycle Many agencies have goals related to behavioral health Each has specific initiatives aligned to its mission and goals Each initiative reaches a specific group of implementers Each is targeted to a specific unit for scale for intervention: Federal, state, local, site, individuals Sometimes implementers find their commonalities… sometimes they don’t!

14. Emerging Approaches New insights link interventions at varying levels of scale o New initiatives create interventions linking the state and local level  Safe Schools Healthy Students –State grant must include local pilots as a core feature  Project AWARE -State grant must include local pilots as a core feature New initiatives link MH and Education Interventions o Project AWARE grants required submission of the School Climate Grant o New Juvenile Justice grants will require similar coordination

15. A Word to the Wise ….. Technical strategies to coordination and increased funding ‘open’ as we understand more about options that exist in policy Never forget…..people make it happen! We need a technical and an adaptive approach for real progress in practice!

16. Persistent Challenges Technical Challenge Requires information, knowledge or tools Adaptive (Relationship) Challenges Requires understanding and a willingness to make behavior changes Source: Heifetz and Linsky, Leadership on the Line, 2002

17. Learning that technical solutions are necessary but often not sufficient Knowing when a persistent problem needs a adaptive (relationship) solution Building adaptive (relationship) skills as a part of strategy The Leadership Challenge

18. Let’s explore some options for funding School Based Mental Health…

19. Funding Sources School level – Principal discretionary dollars – Funding from PTA/PTO for supplies/EBP purchase Local level – General Revenue (education purposes) – Categorical Revenue (targeted for specific for specific student population in need of supplemental services – Tax levies – Private Foundations More Flexible with Prevention/Mental Health Promotion – Community Businesses

20. State Funding – Mental Health Block Grants – Grant Programs to develop SMH infrastructure (Minnesota) – Children’s Health Insurance Program Provides health coverage to nearly eight million children in families with incomes too high to quality for Medicaid but who can’t afford private coverage

21. Federal Funding – Block Grants (fixed amount of funding based on population, unemployment, and demographics) Maternal and Child Health Block Grant Social Services Block Grant Preventive Health and Health Services Block Grant – Project Grants – Discretionary grants awarded through a competitive process to fund discrete projects over a specified period of time – Legislative Earmarks- Provide funding over one fiscal year and are not competitive – Direct Payments (Medicaid) – Federal Assistance provided directly to individuals who meet eligibility requirements

22. Best Practice Funding Considerations Use Diverse Funding Sources Use Funding Strategies that Rely on Shared Funding and Promote Sustainability – Braided/Pooled/Blended Funding – Increase reliance on more permanent versus short-term funding Leveraging of Funding Return on Investment Seed Money

23. Best Practice Funding Considerations (Cont.) Matching Funding to Service Delivery Across Multiple Tiers Utilize Evidence-Based Practices and Programs Evaluate and Document Outcomes Demonstrate Connections Between Mental Health and Academic Functioning Cross-Training and Sharing of Professional Development Expenses

24. EXAMPLES OF SCHOOL MENTAL FUNDING

25. SMH in Baltimore 1989: 4 schools 2014: 114 schools Serving elementary, middle, and high schools across the City of Baltimore Led by 4 Outpatient Clinic Programs each Leading 1 Quadrant of the City’s SMH Services

26. FY 15 Funding Strategy ESMH BHS Baltimore/MHA $726,000 BHS Baltimore/ADAA $345,935 BCPS $948,065 Foundation $144,000 Projected Fee-for-Service $2,166,000

27. PGSMHI Goals Divert students who are at risk for entering non-public educational settings. Complement existing special education programs with a mental health component. Improve student functioning Improve school climate Increase knowledge of community resources Provide training and support to PGCPS school staff

28. PGSMHI Target Population and Enrollment Students in Transition ED Programs who are at risk of entering non-public settings due to an increase in behavioral and/or emotional problems Students in non-public settings who are returning to the Transition ED Programs 2013-2014 School Year: – 8 Schools (Elementary/Middle/High) – 160 enrolled – 495 students seen

29. Costs AggregatePer student per day Per student per year Total Nonpublic Costs 3,964,928163 39,038 Total PGSMHI Costs 732,487 30 7,212 Total Savings 3,232,440133 31,826 See: Slade et al. (2009). Advances in School Mental Health Promotion. Note: Data is based on a program year of 240 days

30. Syracuse Promise Zone Model for Funding District Wide Mental Health Supports April 7, 2014 Jennifer Parmalee, MPA Onondaga County Dept of Children & Family Services Director of School Based Initiatives

31. Syracuse City School District  Urban district in Central New York  95,000 residents  31 schools in the SCSD 5 High Schools 6 Kindergarten – 8 th grade buildings 6 Middle Schools (6 th – 8 th ) 10 Elementary Schools  21, 000 students  75% Free and Reduced Lunch (4 th highest in state)  20% Listed as Special Education  Syracuse Promise Zone is a district wide approach

32. Funding Syracuse Promise Zone

33. Total Funding $10.5 Million ItemBehavioral Health State AidSchool DistrictLocal DSSMedicaid Family Case Managers 62% / 38% Outpatient Mental Health10%90% Student Assistance Counselors75%25% SBIT Teaching Assistants100% STEP Program (Intensive FBA/BIP)40%60% PBIS Coaching Support40%60% Data Resource Specialists80%20% Primary Project10%90% PAX Good Behavior Game10%50% Universal Screening100% Chronic Stress and Trauma85%15% 2 X 1040%60% Check In Check Out40%60% Functional Behavior Analysis100% County ACCESS Team65%10%25%

34. Let’s look at the adaptive side of your funding effort using a tool from…. Leading By Convening: A Blueprint for Authentic Engagement Four Simple Questions 34© 2014 Community Care Behavioral Health Organization

35. Convening in the Landscape of Practice on SBBH Coalescing around issues Ask yourself: Who cares about this issue and why? Ensuring relevant participation Ask yourself: What work is already underway? Doing work together Ask yourself: What shared work could unite us? Leading by convening Ask yourself: Can you successfully lead on this issue without the other stakeholders ? How can we deepen our connections? Source: IDEA Partnership