1. Building an Interconnected Systems Framework, a Tertiary Demonstration Project © 2010 Community Care Behavioral Health March 16, 2012 Kelly Perales, LCSW Community Care Behavioral Health Michael Lynch, MA NHS Human Services

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 COLLABORATIVE T RAINING TECHNICAL ASSISTANCE E VIDENCE - BASED P RACTICES COACHING M ODEL F IDELITY CARE MANAGEMENT

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. Montrose SBBH Team Northwestern Human Services (NHS) 2 MHPs and 5 BHWs –1 MHP and 2.5 BHWs at Lathrop St. Elementary School –1 MHP and 2.5 BHWs at Choconut Valley Elementary Each “mini” 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. Montrose Area School District SWPBS Implementation District and Community Leadership Team established Tier One and Two training and implementation at both elementary schools (K-6) Tier One training and implementation began for junior high students at jr/sr high building (7-12) Tier Two and Three interventions being provided by SBBH Team and school staff 18 © 2010 Community Care

19. Big 5 SWIS Data Report

24. 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 Action planning moving forward

25. The Smith Family Jason was referred to the SBBH Team in November. He is a seven-year-old first grader who was having difficulty coming to school and being separated from his mother. When he was four, Jason and his family were in a car accident in a rural area. The members of the family were taken to different hospitals and Jason did not know where his mom was or if she was okay. Every day, since the first day of school, Jason’s mom would bring him into the school and the school staff would literally have to peel Jason off of his mother and hold him so she could leave.

26. The Smith Family cont. Once referred to the team, they were immediately able to work with Jason and his family to create strategies to help him separate more smoothly. Jason found the SBBH Team office/room a safe place to be. His mother also spent time there to help create a nice transition area. After the Holiday break, Jason began riding the bus for the fist time, accompanied by one of the BHWs from the team. Soon, Jason was able to ride the bus on his own, increasing his confidence and allowing him some relief from his anxiety.

27. Child Outcomes Survey (COS) Family Functioning: Child X

28. Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child X

29. Child Outcomes Survey (COS) Overall Wellness: Child X

30. Strength and Difficulties-Parent Report: Child X

31. Strength and Difficulties-Teacher Report: Child X

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

33. Questions? Contact information: Kelly Perales peraleskl@ccbh.com 717-770-9365 Michael Lynch mhlynch@nhsonline.org 570-282-1732 ext. 264