Pennsylvania’s Integration of Mental Health and Positive Behavior Interventions and Supports (PBIS)

Ron Sudano, Ed.S. NCSP – PA Training and Technical Assistance NetworkKelly Perales, LCSW – Community Care Behavioral Health

A Community of Practice Approach using Social Entrepreneurism to Scale Social Impact

• Community of Practiceo Intentional integration of Mental Health and PBIS

• Social Entrepreneurismo SWPBS to initiate and expand Mental Health Supports

for ALL children and youth

• Innovationo Distributed Leadership & Contributiono Affiliated Networko Tertiary Demonstration Project

Big Ideas

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Communities of Practice:A Conceptual Framework

“Groups of people who share a concern, a set of problems or a passion about a topic, and who deepen their understanding and knowledge of this area by interacting on an ongoing basis.”

(Etienne Wenger, Richard McDermott, William Snyder, A Guide to Managing Knowledge,

Cultivating Communities of Practice, 2002, p. 4)

What is a Community of Practice?

• Based on relationships and natural bonds• Supportive and convening functions enable a collective

intelligence• Share learning at all levels to escalate progress• Create new knowledge grounded in ‘doing’ the work• Reflect a “pull” versus a “push”

Sponsors of the National Community of Practice on School Behavioral Health are the IDEA Partnership funded by OSEP and housed at NASDSE and the Center for School Mental Health funded by HRSA and housed at the University of Maryland.www.ideapartnership.org

www.sharedwork.org

Communities of Practice:A Variety of Activities

• Problem-solving• Requests for

Information• Seeking

Experience• Reusing Assets• Mapping

Knowledge

• Coordination and Synergy

• Discussing Developments

• Documentation Projects

• Visits• Identifying Gaps

PA State Leadership Team

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• Allegheny County Department of Human Services

• Bureau of Autism Services• Community Care Behavioral Health• Devereux Center for Effective Schools• Disability Rights Network of Pennsylvania• Education Law Center• Juvenile Court Judge’s Commission• Mental Health Association of Pennsylvania• Office of Child Development and Early

Learning• Pennsylvania Community Care Providers• Pennsylvania Department of Education

o Bureau of Special Educationo Division of Student Services and Safe

Schools• Pennsylvania Department of Health

oBureau of Drug and Alcohol Programs

• Pennsylvania Department of Labor and Industry

oOffice of Vocational Rehabilitation• Pennsylvania Department of Public Welfare

oOffice of Mental Health and Substance Abuse Services

• Pennsylvania Governor’s Commission on Children and Families

• Pennsylvania Intermediate Unit (PAIU) Special Education Directors

• Pennsylvania Network for Student Assistance Services

• Pennsylvania Training and Technical Assistance Network (PaTTAN)

• Pennsylvania Youth Leadership Network• Philadelphia Public Citizens for Children and

Youth• Value Behavioral Health• Youth and Family Training Institute

The state leadership team was founded in 2006 and the following departments, agencies and stakeholder groups represent a partial list.

Scaling SWPBSPennsylvania’s Approach

Promoting the entrepreneurial pursuit of social impact

(Adapted from - John Kalafatas: Approaches to Scaling Social Impact)

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The mission of the Pennsylvania Positive Behavior Support Network (PAPBS Network), through training and technical assistance, is to support schools and their family and community partners to create and sustain comprehensive, school-based behavioral health support systems in order to promote the academic, social and emotional well-being of all Pennsylvania’s students. The network’s goal is to ensure that all schools have the necessary technical assistance, collaborative opportunities, and evaluative tools needed to overcome non-academic barriers to learning and achieve competence and confidence in advancing academic, social, and emotional success for all students.

Mission Statement

Scaling Social Impact: The process of increasing positive social impact to better correspond to the magnitude of the identified social need.

John Kalafatas: Approaches to Scaling Social Impact.http://www.caseatduke.org/knowledge/scalingsocialimpact/frameworks.html

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Definition: What is Scaling Social Impact?

• Increase Quantity and/or Quality of Impact

• Diversify Communities Served• Diversify Services Offered• Expand Geographically

• Influence Public Policy

• Establish a Social Movement

• Change/Create Markets

Impact through Direct Service Impact through Indirect Influence

• Promote a Model

MH & SWPBS Integration

GOALS for

Scaling MH &

SWPBS

STRATEGIES for

Scaling MH & SWPBS

• Organizational Branching and/or Affiliation

• Expanding Organization’s Delivery Capacities (via volunteers, technology, etc.)

• Research & Public Policy Development

• Influencing Public Awareness, Norms or Behaviors

• Direct Advocacy & Lobbying

• Convening Networks

• Technical Assistance

• Knowledge Dissemination

• Partnerships/Alliances

• Packaging/LicensingAdapted from: John Kalafatas: Approaches to Scaling Social Impact.

http://www.caseatduke.org/knowledge/scalingsocialimpact/frameworks.html 10

Pennsylvania’s Strategy

Situational Organization Contingencies Capabilities

Labor needs

Start-up Capital

Public Support

Potential Allies

Supportive Public Policy

Staffing

Dispersion of Beneficiaries

Strength of Economic Incentives

Communicating

Alliance-Building

Lobbying

Stimulating Market Forces

Earnings Generation

Replication

PA SCALERS

Scale of

SocialImpact

+ High valence- Low valence

+

-

+

+

-

-

+

Adapted with permission: Bloom, P. N. & Chatterji, A. K. (In press, 2008). Scaling Social Entrepreneurial Impact. Fuqua School of Business, Center for the Advancement of Social Entrepreneurship: Duke University. Retrieved January 18, 2008 from http://www.fuqua.duke.edu/centers/case/knowledge/scalingsocialimpact/articlespapers.html

• Broad representation on State Leadership Team

• Develop evaluation plan from beginning based on interests of stakeholders

• Commitments from central office and building-level administrators

• Ideal: secure commitment from mental health agency to participate at all 3 tiers of support

• Establish leadership infrastructure to roll-out

• Plan for scaling-up

Lessons Learned

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Tertiary DemonstrationProject

Integrating PBIS and Mental Health Services

School Based Behavioral Health (SBBH ) Teams

What is Community Care?

• Non-profit behavioral health managed care organization (BHMCO)

• Public health mission• Transformation of mental health services to

children and families• Affiliated partner in PA PBS Network – have co-

director and coordinator• Partnering with school districts for integration of

services, along with other child serving systems

Overview of the SBBH Team Model

Goals of SBBH Team Program

• To provide services that are more flexible than traditional services in meeting unique behavioral needs of youth and families

• To provide a behavioral health home for youth and families through availability of care in school, home and community settings as needed

• To improve communication among youth, family, educators, clinicians and other child serving systems

Goals of SBBH Team Program

• To maximize integration of behavioral health services, school intervention programs and family and community resources

• To improve access to service for youth returning to district schools from partial hospitalization, inpatient care, RTF or out of home placement

• To support school staff with training and case specific consultation

How is SBBH different?

• Quicker access to assessment and service

• No requirement for a specific prescription of SBBH hours

• Greater flexibility in types of interventions and intensity of service delivered

• Any team staff can intervene with a youth

How is SBBH different?

• Focus on resiliency concepts, understanding of trauma informed care and structural family therapy

• Increased qualifications for staff - licensure, experience and ongoing training

How is SBBH different?

• Enhanced integration with school interventions via positive behavioral supports

• 24/7 availability for phone crisis response

• Evaluation component is included

Behavioral Health Home Concept

• Increased accountability via clinical home • School is “launching pad” for services that can

be delivered in all settings• Comprehensive service approach• Youth continue on the team with varying

intensity of service

Who Can Receive SBBH Team Services?

• Youth, 5-18 years, and their families• Have a serious emotional or behavioral

disturbance (internalizing or externalizing) • Receive Medical Assistance • Community Care member• School related problems not required• IEP not required• ASD diagnosis on case by case basis

Where and when is service delivered?

• School is the physical location of team

• Services may extend into home and community settings on evenings, weekends and during summers

• 24/7 availability for crisis intervention

SBBH Service Components

• Clinical interventions

• Case management

• Crisis intervention

• Case consultation & training for teachers

Team Composition

• Mental Health Professionals

• Behavioral Health Workers

• Consultant

• Clinical director

SBBH Evaluation Plan

• Assessment of impact of SBBH Team on: Academic performance – grades, attendance,

behavior Child functioning at home/community and

school Family satisfaction Service utilization and cost

SBBH Evaluation Plan

• Child Outcomes Survey (COS) Completed by families monthly and at discharge Measures child functioning and family

perception of treatment process• Strengths and Difficulties Questionnaire (SDQ)

1 page questionnaire with 25 items related to emotional symptoms, conduct, peer problems and prosocial behavior

Completed by families and teachers at admission, quarterly and at discharge

Tertiary Demonstration Project

• Three districts who would have a SBBH Team at the start of the 2009-10 school year were invited to participate

• Logic of having Tier 3 services and beginning Tier 1 in order to build three tiered system

• District/community leadership teams were established that included mental health partners at the table from the beginning

• Districts committed to implementing SWPBS at all three tiers across the district

Current Status

• 2 of 3 districts were trained in Tier 1 and “kicked off” at the start of the 2010-11 school year in those buildings that have SBBH Team

• Use blueprint to develop action plan for other buildings to begin process as well as assess needs for mental health across tiers

• Planning for training and implementation of Tier 2 during this school year in those buildings implementing Tier 1

• Full integration of mental health

Questions?