1. Building an Interconnected Systems Framework, a Tertiary Demonstration Project © 2010 Community Care Behavioral Health September 23, 2011 Kelly Perales, LCSW Dawn Jones, Special Education Teacher Frances Willard Elementary School, Scranton, PA Carlyn Fontini, Program Director SBBH Teams, Scranton School District

2. SWPBS Tertiary Demonstration Project Community Care as affiliated partner in the PA Positive Behavior Support (PBS) Network Blending of School-Wide (SWPBS) and School Mental Health Interconnected Systems Framework

4. Why We Need MH/Community Partnerships 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 1-2% identified by schools as EBD Those identified have poor outcomes Suicide is 4th leading cause of death among young adults

5. School-based Behavioral Health Team Service (SBBH)

6. 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

7. SBBH Service Components C LINICAL I NTERVENTIONS C ASE M ANAGEMENT C RISIS I NTERVENTION C ASE C ONSULTATION AND T RAINING for educational staff

8. SBBH Team Components L ICENSED M ASTER ’ S P REP C LINICIANS (MHP) E XPERIENCED B ACHELOR ’ S P REP W ORKERS (BHW) A DMIN A GENCY S UPPORT C ONSULTATION TO MHP S PRN

9. Community Care Support of SBBH Teams LEARNING COLLABORA TIVE T RAINING TECHNICAL ASSISTANCE E VIDENCE - BASED P RACTICES COACHING M ODEL F IDELITY CARE MANAGEMEN T

10. Scranton SBBH Team(s) Scranton Counseling Center (SCC) Lourdesmont One team at Frances Willard and one team at George Bancroft Elementary Schools provided by SCC with 2 MHPs and 5 BHWs each One team at Scranton High School provided by Lourdesmont with 2 MHPs and 3 BHWs Each team meets weekly with school staff to ensure ongoing dialogue regarding services. –Referrals of new youth –Review of ongoing cases –Discussion of collaboration between education and mental health Collaboration with other child serving systems

11. Tier 3/Tertiary Interventions 1-5% Individual students Assessment-based High intensity 1-5%Tier 3/Tertiary Interventions Individual students Assessment-based Intense, durable procedures 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 Tier 1/Universal Interventions 80-90% All students Preventive, proactive 80-90%Tier 1/Universal Interventions All settings, all students Preventive, proactive School-Wide Systems for Student Success: A Response to Intervention (RtI) Model Academic Systems Behavioral Systems 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. Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems SIMEO Tools: HSC-T, RD-T, EI-T Check-in/ Check-out (CICO) Group Intervention with Individualized Feature (e.g., Check and Connect -CnC and Mentoring) Brief Functional Behavior Assessment/ Behavior Intervention Planning (FBA/BIP) Complex or Multiple-domain FBA/BIP Wraparound ODRs, Attendance, Tardies, Grades, DIBELS, etc. Daily Progress Report (DPR) (Behavior and Academic Goals) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Social/Academic Instructional Groups (SAIG) Positive Behavior Interventions & Supports: A Response to Intervention (RtI) Model Illinois PBIS Network, Revised October 2009 Adapted from T. Scott, 2004 Tier 2/ Secondary Tier 3/ Tertiary Intervention Assessment

13. Continuum of Support for Tier 2/Secondary-Tier 3/Tertiary Level Systems 1.Small group interventions: Check-in Check-Out (CICO), social/academic instructional groups (SAIG), tutor/homework clubs, etc. 2.Group interventions with individualized focus: Utilizing a unique feature for an individual student, e.g. CICO individualized into a Check & Connect (CnC), mentoring/tutoring, etc. 3.Simple individual interventions: A simple individualized function- based behavior support plan for a student focused on one specific behavior, e.g. brief FBA/BIP-one behavior; curriculum adjustment; schedule or other environmental adjustments, etc. 4.Multiple-domain FBA/BIP: A complex function-based behavior support plan across settings, e.g. FBA/BIP home and school and/or community 5.Wraparound: A more complex and comprehensive plan that addresses multiple life domain issues across home, school and community, e.g. basic needs, MH treatment, behavior/academic interventions, as well as multiple behaviors Illinois PBIS Network, Revised Sept., 2008

14. 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 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 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 Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters. Interconnected Systems Framework for School Mental Health

15. 3-Tiered System of Support Necessary Conversations (Teams) CICO SAIG Group w. individual feature Complex FBA/BIP Problem Solving Team Tertiary Systems Team Brief FBA/ BIP Brief FBA/BIP WRAP Secondary Systems Team Plans SW & Class-wide supports Uses Process data; determines overall intervention effectiveness Standing team; uses FBA/BIP process for one youth at a time Uses Process data; determines overall intervention effectiveness Sept. 1, 2009 Universal Team Universal Support

16. Scranton School District SWPBS Implementation District and Community Leadership Team established Tier One training and implementation at two elementary schools and Scranton High School Tier Two training and implementation has begun at Frances Willard. Tier Two planning at George Bancroft and Scranton High on action plan for this year Tier Two and Three interventions being provided by SBBH Team and school staff

17. School Perspective Summary of early successes and challenges Summary of data –SWIS reports –Impact on placement –Academic Impact Plans for 2011-12 and beyond

18. Big 5 SWIS Data Report

23. Mental Health Perspective Summary of experience with SBBH implementation thus far – successes and challenges Blending of Mental Health with School-Wide – how is it going? Data –SDQs –COS Plans for 2011-12 and beyond

24. The Smith Family Andy was referred to the SBBH team in 2009 due to episodes of shutting down to include hiding in the school, attempting to elope from the school building, task refusal, and refusal to speak for entire school days. School personnel reported having to take the entire day to work with Andy. Team began utilizing strategies such as unconditional positive regard, as well as allowing Andy to write down what he was thinking and feeling. Therapist reviewed coping skills and reason for his anxiety.

25. The Smith Family cont. Jonah, Andy’s brother, was referred to the SBBH team for similar behaviors to Andy, but to a lesser degree and intensity. Team utilized same interventions for Jonah and his work production as well as anxiety began to decrease. Both boys began seeking out SBBH team members when distressed, which shocked school personnel, as both were so introverted in the past. Family therapy was successful to help mother get her own therapy as well as work on family dynamics. In addition, the entire family needed to learn coping skills to deal with the death of a sibling.

26. The Smith Family cont. Interventions: –Case management Coordination of community resources such as assistance with medical supplies, transportation to adult therapy appointments, and dental appointments for the family. Referrals for assistance with holiday meals, gifts, and financial assistance for bills including telephone and electic. –Educational support A. has been identified as needing learning support Social skill and peer relationship instruction –Therapy Coping skills Problem solving skills Social and peer relation skills For C. coping with grief and loss

37. Interconnected Systems Framework Evaluation Tool Guide Funding Tool Guide District and Community Leadership Team

38. Questions? Contact information: Kelly Perales peraleskl@ccbh.com 717-770-9365 Dawn Jones Dawn.jones@scrsd.org 570-348-3692 Carlyn Fontini ekstewart@nhsonline.org 570-