PA Tertiary Demonstration Project: Creating an

Interconnected Systems Framework

© 2010 Community Care Behavioral Health

May 18, 2011Kelly Perales, LCSW

Jessica Leitzel, Principal Frances Willard Elementary School, Scranton, PA

Erin Stewart, LCSW, MHPSBBH Team, Montrose School District

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

School-based Behavioral Health Team Service (SBBH)

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

SBBH Service Components

CLINICAL INTERVENTIO

NS

CASE MANAGEMEN

T

CRISIS INTERVENTIO

N

CASE CONSULTATIO

N AND TRAINING

for educational staff

SBBH Team Components

LICENSED MASTER’S

PREP CLINICIANS

(MHP)

EXPERIENCED

BACHELOR’S PREP

WORKERS (BHW)

ADMIN AGENCY

SUPPORT

CONSULTATION TO MHPS

PRN

Community Care Support of SBBH Teams

LEARNING COLLABORA

TIVE

TRAINING

TECHNICAL ASSISTANCE

EVIDENCE-BASED

PRACTICES

COACHING

MODEL FIDELITY

CARE MANAGEMEN

T

Montrose SBBH TeamNorthwestern 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

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

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

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

Public Health & Disease PreventionKutash et al., 2006; Larson, 1994

• Tertiary (FEW)– Reduce complications,

intensity, severity of current cases

• Secondary (SOME)– Reduce current cases of

problem behavior• Primary (ALL)

– Reduce new cases of problem behavior

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 2009Adapted from T. Scott, 2004

Tier 2/Secondary

Tier 3/Tertiary

Inte

rven

tio

nAssessm

en

t

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

Tier I: Universal/Prevention for AllCoordinated 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 SomeCoordinated 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

3-Tiered System of Support

Necessary Conversations (Teams)

CICO

SAIG

Group w. individual

feature

ComplexFBA/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

UniversalTeam

Universal Support

Montrose School DistrictSWPBS Implementation

• District and Community Leadership Team established• Tier One training and implementation at both elementary

schools• Tier Two planning at both elementary schools• Overview and Tier One training being planned for

seventh grade• Tier Two and Three interventions being provided by

SBBH Team

Scranton School DistrictSWPBS Implementation

• District and Community Leadership Team established• Tier One training and implementation at both 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 still to come

• Tier Two and Three interventions being provided by SBBH Team

Principal’s Perspective

• Summary of early successes and challenges• Summary of data

– SWIS reports– Impact on placement– Academic Impact

• Plans for next year

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Social Worker’s Standpoint

• 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 next year

The Smith Family

• Angelica was referred to the SBBH Team in November of 2009 due to a history of disruptive negative attention seeking behaviors.

• Veronica, A’s mother, reported that she “has tantrums and argues everyday about just about evertything – snacks, clothing, if she does not get her way, she throws a fit!”.

• School staff reported that A can be stubborn and she often shuts down or withdraws particularly if she believes that she is in trouble.

• Socially, she does not pick up on social cues, and therefore inadvertently annoys her peers.

The Smith Family cont.

• Caroline, A’s sister, was referred to the SBBH Team in October 2010 as a fourth grade student.

• She was referred due to behavioral concerns within the family setting and needing significant adult interaction in order to perform routine tasks. It was reported she had limited social, emotional, and coping skills.

• Her teacher reported, “She often has a look of confusion and rarely speaks up about anything. She is slacking in social skills and self confidence. She is able to complete her work, but does not.”

• In addition, C needed to learn coping skills to deal with the death of a sibling.

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

Child Outcomes Survey (COS) Family Functioning:Child A

11/1

8/09

12/1

8/09

1/18

/10

2/18

/10

3/18

/10

4/18

/10

5/18

/10

6/18

/10

7/18

/10

8/18

/10

9/18

/10

10/1

8/10

11/1

8/10

12/1

8/10

1/18

/11

2/18

/11

3/18

/11

4/18

/11

0

1

2

3

4

5

6

7

8

9

10

Solve Problems Shared Decisions

Le

vel o

f S

ucc

ess

Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child A

11/1

8/09

12/1

8/09

1/18

/10

2/18

/10

3/18

/10

4/18

/10

5/18

/10

6/18

/10

7/18

/10

8/18

/10

9/18

/10

10/1

8/10

11/1

8/10

12/1

8/10

1/18

/11

2/18

/11

3/18

/11

4/18

/11

0

1

2

3

4

5

6

7

8

9

10

FAMILY PEERS SCHOOL TASKS Ave Inventory

Leve

l of S

ucce

ss

Child Outcomes Survey (COS) Overall Wellness:Child A

11/1

8/09

11/2

8/09

12/8

/09

12/1

8/09

12/2

8/09

1/7/

101/

17/1

01/

27/1

02/

6/10

2/16

/10

2/26

/10

3/8/

103/

18/1

03/

28/1

04/

7/10

4/17

/10

4/27

/10

5/7/

105/

17/1

05/

27/1

06/

6/10

6/16

/10

6/26

/10

7/6/

107/

16/1

07/

26/1

08/

5/10

8/15

/10

8/25

/10

9/4/

109/

14/1

09/

24/1

010

/4/1

010

/14/

1010

/24/

1011

/3/1

011

/13/

1011

/23/

1012

/3/1

012

/13/

1012

/23/

101/

2/11

1/12

/11

1/22

/11

2/1/

112/

11/1

12/

21/1

13/

3/11

3/13

/11

3/23

/11

4/2/

114/

12/1

14/

22/1

15/

2/11

0

2

4

6

8

10

12

14

Days

Child Outcomes Survey (COS) Family Functioning:Child B

10/2

1/10

11/2

1/10

12/2

1/10

1/21

/11

2/21

/11

3/21

/11

4/21

/11

0

1

2

3

4

5

6

7

8

9

10

Solve Problems Shared Decisions

Leve

l of S

ucce

ss

Child Outcomes Survey (COS) Child Functioning and Therapeutic Inventory: Child B

10/2

1/10

11/2

1/10

12/2

1/10

1/21

/11

2/21

/11

3/21

/11

4/21

/11

0

1

2

3

4

5

6

7

8

9

10

FAMILY PEERS SCHOOL TASKS ave inventory

Leve

l of S

ucce

ss

Child Outcomes Survey (COS) Overall Wellness:Child B

10/2

1/10

11/2

1/10

12/2

1/10

1/21

/11

2/21

/11

3/21

/11

4/21

/11

0

2

4

6

8

10

12

14

Days

Strength and Difficulties-Parent Report: Child A

11/1

8/09

12/1

8/09

1/18

/10

2/18

/10

3/18

/10

4/18

/10

5/18

/10

6/18

/10

7/18

/10

8/18

/10

9/18

/10

10/1

8/10

11/1

8/10

12/1

8/10

1/18

/11

0

1

2

3

4

5

6

7

8

9

10

Emotional Sympt Conduct Probs Hyperactivity Peer Probs

Scor

e

Strength and Difficulties-Parent Report: Child B

11/1

/10

12/1

/10

1/1/

11

2/1/

11

3/1/

11

4/1/

11

0

1

2

3

4

5

6

7

8

9

10

Emotional Sympt Conduct Probs Hyperactivity Peer Probs

Scor

e

Video clips

• Parent interviews

Questions?Contact information:

Kelly Perales, LCSWperaleskl@ccbh.com

717-770-9365

Jessica LeitzelJessica.leitzel@scrsd.org

570-348-3692

Erin Stewart, LSWekstewart@nhsonline.org

570-278-7300