Getting Started: Integrating Community Mental Health Services into School-wide

Positive Behavior Support in a Large Urban District

Bob PutnamMay Institute

Steve Gramet Syracuse Public Schools

Jennifer Parmalee Onondaga County Department of Mental Health

Monique Fletcher Say Yes

National PBIS ForumOctober 28, 2011

Rosemont, IL, Ph.D.

Where are you in implementation process? Adapted from Fixsen & Blase, 2005

School Mental Health Partnership

More than a place for services

Challenges

Education

Primarily focused on services during school day

Use of evidenced based practices

Limited data based decision making

Less focus on the family Limited mental health

expertise Limited continuum of

services

Mental Health Community mental health

services often focused on those with severe and persistent mental health issues

Limited prevention services due to funding tied to direct services

Accessibility of services Limited data based decision

making Use of evidence based practices

Contrasting Perspectives in the Education and Mental Health Systems

• Education– IDEA– Behaviors disorders,

challenging behavior

– Behaviorism , social learning theory

– Behavior management, skill development, academic improvement

• Mental Health– DSM– Psychopathology, abnormal

behavior, impaired functioning

– Psychoanalytic approaches, behavior theory, cognitive psychology, developmental psychology, biological/genetic perspectives, psychopharmacology

– Insight, awareness, improved emotional functioning

• Overarching influence

• Language

• Important theoretical influences

• Focus of intervention

Duchnowski & Kutash, 2009

Outcomes for Students with Mental Health Concerns Early appearing behavioral problems during a

child's preschool years are the single best predictors of school dropout, delinquency, gang membership, and adult incarceration (Center for Evidence-Based Practice, 2004)

Furthermore, unless behavioral problems are dealt with early on, the child's behaviors tend to become chronic (Campbell & Ewing, 1990). 

Outcomes for Students with Mental Health Concerns Highest rate of dropouts among all disabilities

are those with EBD. Depression, anxiety and conduct disorder in

adolescents are one of the lead indicators of substance abuse.

School-wide Positive Behavior Intervention and Support

Evidence-based features of SWPBIS Prevention Define and teach positive social expectations Acknowledge positive behavior Arrange consistent consequences that don’t allow the

functions of problem behavior to be achieved On-going collection and use of data for decision-making Continuum of intensive, individual intervention

supports. Implementation of the systems that support

effective practices

Integrating Education and Mental Health Services can Enhance Overall Services • Enables PBS schools to work better with children in

Tiers Two and Three and to engage families.

• Significantly strengthens a mental health system of care by engaging the school and enabling all parties to come together around a single plan of care

• An effective mental health system of care can assist teachers and other personnel through consultation on mental health issues and help schools fully engage families.

Benefits Cited by Mental Health Agencies Collaborating with PBS Schools

PBS focuses on prevention and early intervention. Communication improves among stakeholders—

schools, families, mental health and other community service providers—resulting in increased support to children and families. A unified plan, understood by all stakeholders, is more likely to be effective.

A less disruptive and more supportive school climate increases the likelihood that students with mental health problems can stay in school and succeed.

(Judge David L. Bazelon Center for Mental Health Law, 2006)

Benefits Cited by Mental Health Agencies Collaborating with PBS Schools Teachers have more time to focus on the academic

strengths and needs of students with serious mental disorders because less behavior problems no longer divert their attention. This can lead to greater school success and improved functioning for children with serious mental disorders.

Mental health staff feel they develop a better understanding of a student’s behavioral motivations and psychosocial needs when they are co-located in the school and can observe the student in school.

(Judge David L. Bazelon Center for Mental Health Law, 2006)

Where Do We Start?

Implementation process Adapted from Fixsen & Blase, 2005

IMPLEMENTATIONPHASES

Need,Agreements, Adoption, &Outcomes

LocalDemonstration w/ Fidelity

Sustained Capacity,Elaboration, &Replication

4. SystemsAdoption, Scaling,& ContinuousRegeneration

2.

3.

1.

Getting Ready

Commit to a process that will result in the implementation of a joint initiative.

Training of leadership across both organizations in collaborative SW-PBIS models and systems of care

District leadership team is formed. Education and mental health authorities should ensure that

the PBS planning group with inclusive participation from school and mental health leadership

Once formed, the leadership team should engage in a joint goal setting exercise and delineate the objectives and outcomes desired from the PBS initiative.

Getting Ready

Commitment to establishment of systems of care (PBIS) by both the school and mental health that will serve not only children with serious mental disorders, but also children who show behavior or other social/emotional problems that put them at risk for serious disorders.

Formulate policy and plan training and technical assistance that will improve the quality of services to children, using the most effective services and a strength-based, family-driven, culturally relevant approach to service delivery.

SYST

EMS

PRACTICES

DATASupportingStaff Behavior

SupportingStudent Behavior

OUTCOMES

Supporting Social Competence &Academic Achievement

SupportingDecisionMaking

4 PBS Elements

Primary Prevention:School-/Classroom-Wide Systems forAll Students,Staff, & Settings

Secondary Prevention:Specialized GroupSystems for Students with At-Risk Behavior

Tertiary Prevention:Specialized IndividualizedSystems for Students with High-Risk Behavior

~80% of Students

~15%

~5%

CONTINUUM OFSCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIORSUPPORT

Tier 1 Systems

Education Develop and implement

SW-PBS Plan Training for staff around

mental health disorders Training for coaches

around incorporating universal prevention strategies for most common mental health disorders

Screening for internalizing disorders

Mental Health Representative/s participate on

team Training around SWPBS model

for administrative/clinical supervisors

Training for school based clinical staff on SWPBS and building based SWPBS plan

Tier 1 Practices

Training and technical assistance in developing and implementing a SWPBS plan Three to five positive worded school rules Teaching matrix for common areas in the school Training staff and students to fluency on these

expectations Reinforcement system for students for following

the expectations/staff for following the plan Consistent consequences for infractions Data collection system in place for data based

decision making

Tier 1 Data

SWIS data ODRS

Student Problem behavior Location Time

Suspensions Academic performance Data from screening for internalizing disorders (i.e.;

Systematic Screening for Behavior Disorders)

Tier 2 Systems

Education Tier 2 team Mental health

representative participates on Tier 2 team

Training of coaches in evidenced based social/behavior and mental health interventions

Mental Health Connections to family/

community Training of mental health

providers on evidenced based interventions

Review of student progress Referral to appropriate services

Tier 2 Practices

Check and Connect Behavior Education Program Functional based social skills groups Evidenced based social skills groups

diagnostic groups (anxiety, depression) Mentoring Homework club

Tier 2 Data

ODRs Suspensions Attendance Academic success CICO Data Brief functional behavior assessment Social skills assessments Mental health assessments DBR (Daily behavior report) measures

Tier 3 Systems

Education Tier 3 Team Wraparound teams Monitor effectiveness of

services Training of staff on

evidenced based interventions

Mental Health Actively participate in Tier 3

team Coordinate wrap around

services for individual students Advocate for family needs Training of staff on evidenced

based interventions

Tier 3 Practices

Education Conduct intensive FBAs Design and implement

wraparound plans Develop and implement

coordinated behavior support plans

Implement individualized evidenced based social/behavior and mental health interventions

Mental Health Conduct intensive FBAs Develop and implement

coordinated behavior support plans/wraparound plans

Intensive assessment and implement individualized evidenced based social/behavior and mental health interventions

Provide supports to family Coordinate medical and

psychopharmacology

Tier 3 Data

ODRs Suspensions Attendance Academic success CICO Data Functional behavior assessment info Social skills assessments/progress monitoring Mental health assessments/progress monitoring Emotion thermometers DBR (Daily behavior report) measures SIMEO measures

Family Involvement

Family involvement is crucial. Families and youth must receive training and support so they can participate fully in leadership and planning groups at the school and district level.

Self-assessment tools i.e.; family engagement checklist (Muscott & Mann, 2004) should be used for district and school levels. External assessment of family involvement is also a good idea.

Steve Gramet

Director of Pupil Services

Syracuse City School Districtand Promise Zone

Who we are

Syracuse City Schools is an urban district located in Central New York.

Approximately 90, 000 residents Home of Syracuse University (Say Yes

partnership) New Superintendent of Schools, Sharon L.

Contreras

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Who we are

We operate 32 schools 21, 094 students

• 5 High Schools• 6 Kindergarten – 8th grade buildings• 6 Middle Schools (6 - 8)• 15 Elementary Schools

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Who we are

Enrollment

50% African American

25% Caucasian

13% Hispanic

7% Asian

5 % other

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Who we are

14 % of students are English Language Learners or long term English as a Second Language students (2900)

20% of students are listed as Special Education (4,457)

Close to 85% of students are eligible receive free or reduced price lunch.

We are a dependent district that relies on local, state and federal dollars for funding

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Data – Averages Over the Past Three Years

Over the last three years SCSD 22% have been students suspended out of school at least one time

That equates to approximate 24,000 days each year of lost instructional time for these students.

In addition over the last three years, 5,000 days of instructional time is lost to In School Suspension.

There has been a downward trend the last three years in these indicators

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Tiered Academic Services – Committed to Data Based Decision Making School based Intervention Teams (SBIT) for academics

have been operating in the district for the last ten years. SBIT uses data based decision making system to assess,

progress monitor, and evaluate a tiered set of academic strategies.

Curriculum based measurement (DIBELS, CBM measures) In order to effectively use our social and behavior support

resources the district adopted a teired system for social/behavior modeled after the SBIT-A teams

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Protocol38

PBIS Leadership TeamExamines School Wide Data, Creates Matrix, Plans Kickoff, etc.Members include Admin., Parent, Teacher, Pupil Services Staff

Student Support TeamLooks for any student receiving three (3) referrals, makes initial intervention

Members include Admin., Social Worker, School Counselor, Say Yes Site Director, others as appropriate

Intervention and Data monitored by Day Yes Site Director and Student Support Team members

SBIT-B Team

Students receiving seven (7) referrals, close examining of function of behavior, individual or small group intervention, family involvementMembers include Clinician, School Psychologist, Social Worker, Say Yes Site Director and others as appropriate

Intervention monitored by Say Yes Site Director, if issues continue referral to Onondaga County AccessTeam for wrap around services and other family intervention

Referral to clinic services can happen through either SST or SBIT –B team

PBIS

Full implementation began in September 2010 (a few schools have been using PBIS strategies for several years)

SCSD hired a PBIS District Coordinator PBIS staff development has been enhanced with

emphasis on the universal strategies SET’s were implemented to all schools in October

2010 and again in the spring of 2011.

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SET Scores40

Interconnected Services

In 2007 Say Yes to Education became an external partner of SCSD.

As a result, relationships between the SCSD district and county improved

Due to funding cuts, the district and the county entered into agreement to try to integrate their services.

This unique partnership between the district, county, Say Yes to Education provided easier access to services.

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Steps To Implementation42

A stated goal of our previous Superintendent was for every school to provide Mental Health services at school due access issues of our population and data based decision making.

Schools were given a brief overview of the possible services and proposed protocol.

A rollout plan approved by the current Superintendent has been approved and we are moving forward

Syracuse Promise Zone

A partnership of the Dept. Mental Health, Syracuse City School District, Say Yes to Education, System of Care,

& Community Based Organizations

Jennifer Parmalee, Onondaga County Department of Mental Health

Monique Fletcher

Say Yes to Education

What is Promise Zone

Grant to 3 Urban districts for innovative solutions that result in improved student achievement

Designed to increase community collaboration and the districts ability to identify and support students with serious emotional challenges

Mission

Long Term Improve academic performance Increase graduation rates Increase student wellness

Short Term Reduce suspensions Keep students in class and ready to learn Match students emotional behavioral needs

with proper and targeted interventions

Action Plan - Systems Expand mental health clinics from 13 to 35

and integrate clinician into Tier 3 teams District Wide Protocol for identifying and

supporting youth Clarify the role of the social workers Expand PBIS with fidelity District Leadership team to monitor progress

at building and district levels concerning PBIS/RTI

Clarify the role of the Say Yes Site Director Improve the Crisis Response for students

and staff

Community Strengths from Which to Build Highly effective Academic School Based

Intervention Teams (SBIT) based on RtI framework

Mental Health Clinic Satellites currently serving 13 schools

Say Yes to Education site directors in all elementary and K-8 schools

Talent of Social Workers District wide implementation of Positive

Behaviors and Supports System of Care Community

Onondaga Department of Mental Health

Oversight Planning and Quality Improvement Contract Management (95 programs)

County (City) Demographics

Population: 454,753 (138,560)

Children ages 5-19: 95,308 (32,423)

95% of funding from State Authorities (OMH, OASAS OPWDD)

ONCARE – System of Care

Partnership of Mental Health, Child Welfare, Juvenile Justice, Family Organization, Community Based Organizations

Guiding Principles All our children/youth Parents/Caregivers as “experts” Family-driven & Youth-guided “Community Table” to “Kitchen Table” “No Wrong Door” Single plan of care Strength Based approach Cultural and Linguistic relevant

Maximize the Use of Blended Funding to Improve Effectiveness and Efficiency Blended funding

Syracuse City School District Multiple Onondaga County Departments Say Yes resources Outpatient agencies Family support Other resources

How is data shared to determine the selection of interventions?

How is data shared to determine effectiveness of interventions

Say Yes To Education

Say Yes to Education, Inc. (Say Yes) is a national, non-profit education foundation committed to dramatically increasing high school and college graduation rates for our nation's urban youth.

Say Yes provides comprehensive supports, including the promise of free college tuition, aligned with what research indicates is needed to enable every child in the program to achieve his or her potential.

After school-Tier 1 9 Community based organizations in 20 schools

Summer camp-Tier 1 Syracuse University

Tutoring-Tier 2 Syracuse University Literacy Corp Volunteers

Family Support Services-Tier 3 Huntington Family Centers

Student Assistance Program-Tier 3 Contact Community Services

Facilitated Enrollment-Tier 3 Salvation Army

Legal clinics-Tier 3 Pro bono services from legal community

Say Yes Community-wide Involvement

Onondaga County Supports Schools Department of Aging and Youth

Youth Program Quality Assessment (YPQA) Department of Social Services

Educational Neglect Health Department

Health insurance enrollment Department of Mental Health

Promise Zone

System Involvement

Say Yes – Commitment to Data Based Decision Making

Say Yes Site Coordinators routinely collect data on

Attendance Behavior (ODR/Suspensions) Academics(i.e., DIBELS)

These data are presented to SCSD principals and teams on a monthly basisSay Yes Site Directors assist in linking services and resources to improve these outcomes

Moving Towards an Interconnected System

Established members of Tier 3 team Utilizing evidence based intervention for all students Progress monitoring Prioritizing school functionality in treatment goals Sharing data with team of school professionals Accountability to team in addition to child and family

with family’s permission Community responsibility to engage families

Challenges56

• Increasing the number of schools implementing Tier 1 to fidelity

• Increasing of schools implementing Tier 2 and Tier 3 systems and evidenced based practices

• The use of common language

• Training for the SBIT -B teams around understanding behavioral function in order to put the appropriate interventions in place (ie. Check/Connect, ART, individual counseling, mentoring etc…)

Challenges57

Learning to work effectively with external partners such as Onondaga County and Say Yes to Education

Redefining the role of the Social Worker

Helping in-school clinicians to use strategies that are reasonably short term, evidenced based and result in improved school performance

• New York State Medicaid redesign delay creates system in flux

• Schools have to provide appropriate space for clinic. The space must approved by the state as adequate.

For more information

bputnam@mayinstitute.orgpbis.org