Vittoria Anello, Ami flammini and Mark Weist

V I TT O R I A A N E L L O, A M I F L A M M I N I A N D M A R K W E I S TU N I V E R S I T Y O F S O U T H C A R O L I N A , A N D I L L I N O I S P B I S N E T W O R K

Readiness to Interconnect Positive Behavior Interventions and Supports (PBIS) and School Mental

Health (SMH):

Development and Testing of a Stakeholder Survey

Overview

Background PBIS SMH

PBIS-SMH interconnectionNeed for assessment of readinessSurvey developmentSurvey testing in IllinoisFuture directions

Background: PBIS

Framework for promoting and reinforcing positive behaviors Sugai & Horner, 2002

System of employing positive behavior strategies

Prevention and early intervention perspective

Background: PBIS

Not an intervention

Ideal for incorporating other school-based interventions and services

Background: PBIS

PBIS can “render problem behavior irrelevant, inefficient, and ineffective by helping an individual achieve his or her goals in a socially acceptable manner, thus reducing, or eliminating altogether, episodes of problem behavior” (Carr et al., 2002)

Aligns with mandates of NCLB and Successful, Safe, and Healthy Students Program (ESEA)

Background: PBIS

3-tier system

Tier I: Primary interventions to promote appropriate behavior across student population

Tier II: Secondary interventions targeting students not responding to Tier I interventions (~15%)

Tier III: Tertiary interventions to assist students not responding to Tier II interventions (~5%)

Background: PBIS

Primary Prevention:School-/Classroom-Wide Systems for

All Students,Staff, & Settings

Secondary Prevention:Specialized Group

Systems for Students with At-Risk Behavior

Tertiary Prevention:Specialized

IndividualizedSystems for Students

with High-Risk Behavior

~80% of Students

~15%

~5%

SCHOOL-WIDE POSITIVE BEHAVIOR

SUPPORT: What is meant by

“layering” interventions?

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/school-wide.htm

Background: PBIS

Main focus is behavior, but PBIS aims to improve quality of life and functioning for all students

Improved behavior increased academic achievement

Much research and implementation of Tier I Relatively few resources needed for implementation

Much less research and very inconsistent implementation of Tiers II & III Most at-risk students may not receive assistance

Background: PBIS

Uneven dissemination across U.S. and within states Just 7.90% of schools using school-wide PBIS 47 states report using PBIS

Need for improved data collection and analysis systems, ongoing training and technical support, and adequate resources

Background: SMH

Many youth with behavior problems also have mental health issues

13.1% of youth ages 8 to 15 have a diagnosable mental disorder Only 50.6% of them receive treatment

Background: SMH

Good mental health

Increases in: Prosocial behavior Family engagement in school Socio-emotional development School functioning

Decreases in: Discipline referrals Special education referrals Emotional and behavior problems

Background: SMH

SMH services are varied in scope and focus

Assessment

Counseling Individual, group, and family

Mental health education and promotion

Collaboration/wraparound supports

Background: SMH

SMH: Providing mental health promotion and services at school

Benefits: Reduces barriers to participation (stigma, lack of transportation, etc.) Reduces stress on special education system Reaches a large number of youth and families

Challenges Funding Lack of coordination among school and community mental health

service providers Buy-in and support from administrators and key stakeholders Training and technical support

PBIS-SMH Interconnection


PBIS and SMH currently not interconnected

PBIS can support SMH services

Both operate on multi-tier service delivery systems

Emphasis on evidence-based interventions and data-based decision making

Common goal: promoting success of students across domains


Other benefits:

Resolves issues of accessibility

Normalizing mental health issues and help-seeking behaviors

Promoting mental health awareness prevention and early intervention

Need for PBIS-SMH Interconnection

Must consider readiness for change

Transtheoretical model of change (Levesque, Prochaska, & Prochaska, 1999) Do schools and communities view PBIS and SMH as

important issues? Are they thinking about making changes? Do they have the resources to do so?


Change process framework (Fixsen et al., 2005)

1. Exploration and adoption

2. Program installation

3. Initial implementation

4. Full implementation

5. Innovation

6. Sustainability


Exploration and Adoption is key

Readiness for change examined here

Important to clearly identify needs of the school and community

Support and buy-in from key stakeholders is critical for successful adoption and initial implementation

Compatibility between intervention and stakeholders’ beliefs and values


Other factors to consider:

Acceptability Goodness of fit Iatrogenic effects Long-term results

Leadership team

Communication

Support from district, administrators, and community

Community and family readiness


No measure for readiness to integrate PBIS and SMH

Existing measures examine :

PBIS implementation and fidelity

Practitioners’ attitudes toward particular interventions


Existing measures do not evaluate:

School and community attitudes about change

Perceptions of intervention outcomes

Knowledge of PBIS and SMH

Support from various constituents Administrators, teachers, parents, community members,

other school professionals

Purpose of Current Study

To develop a measure of readiness to interconnect PBIS and SMH

To be used with professionals and other stakeholders involved with PBIS and/or SMH

Pilot Study and Survey Development

Pilot Study

Survey of professionals and stakeholders attending CSMH 16th Annual Conference in Charleston, SC (September 2011)

Survey of top factors facilitating/hindering PBIS, SMH, and PBIS-SMH integration

Pilot Study

N = 25 key PBIS/SMH stakeholders Government officials, family members/advocates, directors of

state PBIS centers, technical assistance providers

72% female

Working in field: M = 21.58 years (SD = 8.89 years)

Using PBIS: M = 7.00 years (SD = 2.83 years)

Survey responses aggregated and distilled into 20 main themes

Selection of Key Themes

Support/buy-in from principal and other key staff

Data-based decision-makingActive family and community involvementEffective leadership of teams focused on

behavior and mental healthBelief in impact on

School behavior Academic performance Promotion of a positive learning environment

Selection of Key Themes

Adequate fundingActive, comprehensive training and

implementation supportStaff understanding of PBIS and SMHStaff endorsement of benefits of collaborative

PBIS and SMHActive student involvement

Survey Development

20 themes were used to develop a 35-item survey

Survey was distributed via e-mail to key informants Experts in PBIS, SMH, and/or related fields

Key informants evaluated the survey’s content, wording of items, and the importance of the items and concepts to PBIS-SMH interconnection

3 items were dropped Based on importance ratings and scatter plot data

Survey Development

Revised version of survey distributed to several members of the National Community of Practice (CoP) for School Behavioral Health

Individuals with particular interest in PBIS-SMH interconnection

Survey revised again based on comments from this group and consultation with collaborators on this project (Eber, Barrett, Cashman, & Bazyk)

Survey Development

Consultation with survey expert Robert Johnson of USC College of Education

Survey wording and formatting revised based on Johnson’s recommendations

Final survey was disseminated via SurveyMonkey from June – August 2012

Potential participants reached via email, listservs, and CoP conference calls

Current Study and Survey

Design

Mixed method design Qualitative analyses: interviews with key informants Quantitative analyses: survey development and

psychometric analyses

Online survey 98 items

Participants

Individuals working in a setting using PBIS and SMH

Those delivering mental health services to youth enrolled in schools

Community members who support PBIS and SMH

Examples: teachers, PBIS staff, SMH staff, school administrators, family members of students, and older youth

N=346

Reaching Participants

Collaborations with various groups Communities of Practice through the IDEA

Partnership Discussion of survey on conference calls Promotion of survey on listserv announcements

Reaching out to Teachers School principals School nurses Other school professionals

Utility of Survey

Initiates conversations among stakeholders Issues of readiness Benefits of PBIS-SMH interconnection Frank look at resources

Compare and contrast domains that are ready for change with areas needing progress

Opportunities for building buy-in with administrators, staff, and community

Utility of Survey

Online format

Available for free

Can be used at multiple time points in the stages of preparing to adopt and implement combined PBIS and SMH

Can be used to identify potential “pilot schools” in a district for PBIS-SMH interconnection

Future Directions

Implementation Factors

The power of buy-in and support from key persons in the school and community

Positive working relationships

Use of data to show schools and communities the link between academic performance and mental health

Implementation Factors

Less restrictive funding streams Increased flexibility for schools and communities to

meet students’ needs

District PBIS and SMH coaches Similar to instructional coaches

Paradigm Shifts

Person-centered approach to intervention planning Can be expanded to community-centered approach

Emphasis on data-based decision making Moving away from reliance on anecdotal records

Paradigm Shifts

Use of survey results to assist with resolving the fragmentation of youth mental health services Improving coordination and communication among

service providers to reduce redundancy and increase consistency in service provision

Increased collaboration across disciplines Pooling resources to effect greater change

Future Research

Development of readiness-increasing activities based on areas identified by the survey

Development of measures of systemic change

Future Research

Development of more succinct measures and screeners for readiness for PBIS-SMH interconnection

Development of in-school mental health screening to identify at-risk students Similar to brief reading and math screenings

Future Research

Measuring the impact of PBIS-SMH interconnection on the community at large Cases of DSS involvement, founded cases of child

abuse, number of children removed from families Number of children receiving mental health services

(counseling, medication, etc.) Number of students exhibiting self-injurious behavior

(e.g. cutting) and suicidal thoughts or behaviors

Future Research

Investigation of the link between readiness for interconnection and subsequent implementation and sustainability

Improvement in tools needed for proper PBIS-SMH implementation Data collection systems Communication methods among school professionals School-community communication

Implementing PBIS Schools Over 14 Years as of June 30, 2012

19 19 20 20 20 20 20 20 20 20 20 20 20 20

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

23120 184

303394 444

520 587 654

895

*1,081

*1,3071,460

1,655

* Excludes CPS data

Implementing PBIS High Schools Over 14 Years as of June 30, 2012

19 19 20 20 20 20 20 20 20 20 20 20 20 20

0

20

40

60

80

100

120

140

160

180

200

1 3 6 10 11 14 2129 36

55

*84

*122

156

179

* Excludes CPS data

Percentage of IL Public Schools Implementing PBIS 2011-12

0%10%20%30%40%

39% 26%

Illinois PBIS Implementation Status FY11 & FY12

2010-11 2011-121,350

1,400

1,450

1,500

1,550

1,600

1,650

1,700

76%

77%

78%

79%

80%

81%

82%

1,460 1,655

78%

81%

Total Number Schools Trained

Num

ber

of S

choo

ls

Perc

enta

ge o

f Sch

ools

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

tionAssessm

en

t

Impacting systems and roles

of school-based clinicians&

Special Education structures

Social Worker/School Psychologist

Discussion of Role Changes

Questions raised by Current Model

What data /criteria are used for determining support services?

What data /criteria are used for monitoring student progress?

What data /criteria are used for determining whether student are prepared for exiting or transitioning from support services?

Specifics of Proposed Model

Review ODRs, CICO, grades, attendance, parent/teacher concerns

We model, reinforce, practice skills we want students to obtain (rate skill attainment)

Review ODRs, CICO, grades, attendance, parent/teacher concerns

Social Worker/School Psychologist Discussion of Role Changes

Current Model

Testing for special education eligibility based on…

Referrals for support services based on…

Proposed Model

Facilitate team based brief FBA/BIP meetings

Act as a communication liaison for secondary / tertiary teams

Facilitate individual/family support plan meetings

Social Skills/Academic Instructional GroupsSelection into groups should be based on youths’

reaction to life circumstance not existence of life circumstances (ex. fighting with peers, not family divorce)

Goals for improvement should be common across youth in same group (ex. use your words)

Data should measure if skills are being USED in natural settings, not in counseling sessions (transference of skills to classroom, café etc.)

Stakeholders (teachers, family etc.) should have input into success of intervention (ex. Daily Progress Report)

Communityparticipation in Building Based

& District Leadership Teams

Community Partners Roles in TeamsParticipate in all three levels of systems teaming:

Universal, Secondary, and TertiaryFacilitate or co-facilitate tertiary teams around

individual studentsFacilitate or co-facilitate small groups with youth who

have been identified in need of additional supports

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



Sept. 1, 2009

UniversalTeam

Universal Support

3-Tiered System of Support Necessary Conversations

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



Standing team; uses FBA/BIP process for one youth at a time



Sept. 1, 2009

UniversalTeam

Universal Support

Family and

community

Family and

community

Family and

communitycommuni

ty

Possible Tasks/Functions of Core Leadership Team:

Developing a three tiered support network that integrates schools and communities

Review data for community and school planningDevelop a consistent mission for mental wellness

for all youthAddress re-positioning staff for more integrated

support systems Assess how resources can be used differentlyCreating integrated system, procedures and

protocolsCommunity and District resource mapping

Team Structure for Core District/Community Leadership Team

District/Community Leadership

Team

Integration Workgroup

SEL, RtI, PBIS, Mental Health,

SSHS grant

Data AssessmentWorkgroup

Tier 3/Tertiary Workgroup

Transitions:JJ, Hospitals,

From school to school

SupervisorSW/Psych

BuildingPrincipal

Rep.

Service Providers

Local Area Network

Co-Convener

Homeless Coordinator Mental

Health/708 Board

Curriculum/Prof. Dev

RtI Coordinator

FamilyGroups

PoliceJuvenile Justice

Special EducationDirector

Supt/Asst. Supt

Core District and Community Leadership

Team

Building Level Model

Community/Family

Mental Health

Rep.

SW, School Psych

Guidance

Principal

Special Education Teachers

Grade Level

Teachers

Building Leadership

Team

Community Partners Assist Schools with Interventions

Elgin SD U-46, in partnership with Streamwood Behavioral Health, initiated social skills instructional groups for selected students at Lords Park Elementary School. Students on a Check-In Check-Out intervention who were not achieving a 70% rate with daily progress reports (DPRs) were identified. Following the targeted group intervention, these students began experiencing success within the first week and consistently achieved DPRs of 70% or higher for the following six weeks.

Lords Park Elementary Social Skills Instructional Group

Urbana SD 116 Integration

Classroom teachers providing Social Emotional Lesson plans

Classrooms community CirclesSchool-wide bully prevention integrationLocal public Mental Health practitioner participating as

active member on Tier 2 systems teamSPARCS co-lead groups (mental health and social

worker) in EBD self-contained elementary classrooms and as tier two supports within middle school

Community agencies at tier 2/3 district trainingsCommunity partners present at district in-service daysTier 2/3 Coach active member of ACCESS Initiative team

SPARCS

Mission of SPARCS: To enhance trauma focused services available to traumatized children and adolescents (complex trauma)

Group members – history of chronic interpersonal trauma and living with significant ongoing stressors

The National Child Traumatic Stress Network, 2005

Champaign SD 4 Integration

Co-lead (mental health/school counselor) SPARCS group at Centennial High School 2011-2012SY Mental health worker one day/week at high

school Member of secondary systems meeting Co-lead groups Wraparound/RENEW

External coach a member of SAMSHA teamCommunity mentor coordinator sitting on tier 2 systems

team at Westview Elementary

Integration Efforts Crosspoint Human Services

DMH Grant – Hoopeston School District #11DMH Grant - Pine Crest Urbana SD #116

Piloting the Readiness Check-list

Jacksonville, Illinois

Special Thanks to:

Lucille Eber and Susan Barrett National PBIS Technical Assistance Center

Joanne Cashman and Mariola Rosser IDEA Partnership

Sue Bazyk Cleveland State University

Nancy Lever Center for School Mental Health

Survey participants

Jacksonville, Il School District Jill Johnson, IL PBIS Technical Assistance Coordinator

Vittoria Anello, Ami flammini and Mark Weist

Documents

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