Integrating School Mental Health and PBIS:
Selecting Evidence-based Practices
Jill Johnson
Illinois PBIS Network
Sharon Stephan, Ph.D.
University of Maryland School of Medicine
PBIS Annual Meeting
October 10th, 2013
Objectives
1. Describe at least two strategies for integrating
PBIS and school mental health.
2. Name at least one evidence-based mental health
practice at each level of the public health triangle.
3. Describe the difference between evidence-based
manualized and modularized mental health
interventions.
Center for School Mental Health
MISSION
To strengthen the policies and programs in school mental health
to improve learning and promote success for America’s youth
• Established in 1995. Federal funding from the Health
Resources and services Administration.
• Focus on advancing school mental health policy, research,
practice, and training.
• Shared family-schools-community agenda.
• Co-Directors:
Sharon Stephan, Ph.D. & Nancy Lever, Ph.D.
http://csmh.umaryland.edu, (410) 706-0980
Our Team
SCHOOL MENTAL HEALTH –
A DEFINITION
A partnership between schools and community health
organizations…
Guided by youth and families.
Builds on existing
school programs,
services,
and strategies.
Focuses on all students…
…in both general and special education
Includes a full array of
programs, services, and
strategies
Definition of school mental health
•Involves partnership between schools and
community health/mental health organizations,
as guided by families and youth
•Builds on existing school programs, services,
and strategies
•Focuses on all students, both general and
special education
•Involves a full array of programs, services, and
strategies- mental health education and
promotion through intensive intervention
(Weist & Paternite, 2006)
Who provides mental health services in
schools?
Research Supported Interventions
Involve….
•
•
•
•
•
•
Strong training
Fidelity monitoring
Ongoing technical assistance and coaching
Administrative support
Incentives
Intangibles
Practice in the Trenches?
• Involves NONE of these supports
What’s happening on the
“front lines”?
“Some Good Stuff”
• Increasing emphasis on:
– Evidence-based (research-supported) Practice (EBP)
– Outcomes
– Consideration of cultural context in development,
implementation and evaluation of EBP
– Recognition of the importance of meaningfully
partnering with families
– Increased emphasis on workforce development of
mental health providers and educators
“Some Not-So-Good Stuff”
• Limited control/accountability of
providers and services provided
• Gaps in training, particularly
related to schools and evidencebased practice
• “C.O.W. Therapy” –
Crisis of the Week
Challenges selecting evidencebased MH practices
• School/clinician has not:
– assessed specific needs of school/students
– identified target outcomes
– defined “success” (of interventions)
– identified a way to measure intervention fidelity
• MH interventions are often not designed for
complex issues
Activity
Think of a current intervention that your
district/school/organization uses to address student
needs. Answer the following questions regarding said
intervention:
• Selection of the intervention allows for clear and
measureable outcomes
YES NO
• The intervention provides for generalization
YES NO
• The implementation of the EBP allows for the
assessment of implementation fidelity
YES
NO
Consumer Guide to Selecting Evidenced
Based Mental Health Services
Main Components
• Assessment
• Interventions Selection
• Intervention Progress Monitoring
Assessment
Intervention Selection
Intervention Progress Monitoring
Potential Uses of the Tool
• To determine needs of a
school/agency/community
• To determine what EBP may be most effective to
address needs
• To guide the implementation of an EBP
• To reflect on current EBP
– Celebrate that components are in place
– Action plan on how to include necessary components
Who Can Utilize the Tool
•
•
•
•
Building or District-level teams
Community-level teams
Joint building or district-community teams
Practitioners
Illinois Example
Reflecting on Current Evidence-based Practices
• District Leadership Team had a concern that
interventions utilized by staff were not
culturally relevant nor appropriate to address
needs
– Wanted a non-confrontation way for social
workers to reflect on their practices, lack there-of
• Tool was used at a School Social Work meeting
within the district
School Social Work Meeting Results
Mean = 6
Social Worker Responses to Assessment
120%
100%
Percentage
80%
60%
Social Worker Response
40%
20%
0%
Assessment of
need/risk
Assessment
strengths/deficits
Appropriate team
Assessment Questions
Appropriate sb
intervention
Referral to mh
professional
Social Worker Response Intervention Selection
120
100
Percentage
80
60
40
20
Social Worker Response
0
Assessment Questions
Social Worker Response Intervention Progress Monitoring
90
80
70
Percentage
60
50
40
Social Worker Response
30
20
10
0
MH Intervention implementation
fidelity
Ongoing data-based progress
monitor
Progress Monitoring Questions
Report/Review progress at team
District Leader Thoughts
• Partnership between school and community providers
is lacking
• Implementation fidelity not addressed
• Progress monitoring interventions not done
systematically
• Self-assessment by social workers may not be accurate
– Budget issues
– Defensive
• Example: They scored themselves 100% on culturally relevant
interventions: however, students on intervention were all AfricanAmerican and at-risk for change of placement
District Action Steps
• Work towards school-community partnership on Strategic
Plan/District Leadership Team
– Short-term goal: Quarterly, one community partner invited to school
social work meeting
• Long-term goal: add community partners back on DLT
• Long-term goal: each building collaborate with one community partner; add to
tiered team
• Add implementation fidelity and evaluation tools to practice
– Short term goal: Strickland tools
• Offer professional development/support for social workers
– Short-term goal: Use Consumer Guide, BAT, ISSET to drive school social
work meetings monthly
CURRENT TRENDS AND
FUTURE DIRECTIONS
IN SMH
Four Themes in Quality Services
• Systematic Quality Assessment and
Improvement
• Family Engagement and Empowerment
• Modular, Evidence-Based Skill Training
• Implementation Support
Quality Assessment and Improvement
(QAI) Principles
• Emphasize access
• Tailor to local needs
and strengths
• Emphasize quality and
empirical support
• Active involvement of
diverse stakeholders
• Full continuum from
promotion to treatment
• Committed and
energetic staff
• Developmental and
cultural competence
• Coordinated in the
school and connected in
the community
Examples of QAI tools
• School Mental Health Quality
Assessment Questionnaire (SMH-QAQ)
– https://csmh.umaryland.edu
• Mental Health Planning and Assessment
Template (MHPET)
– www.nasbhc.org
Effectively Partnering with Families
• Early focus on engagement, e.g., through candid
discussions about past experiences
• Emphasize empowerment and the potential for
improvement
• Provide pragmatic support
• Emphasize mutual collaboration
• See McKay, Hoagwood
Results of using these elements
120
100
80
60
40
100
88
85
76
64
52
40
20
0
Accepted 1st Appt. 2nd Appt. 3rd Appt.
% for first interview
(n=33)
% for comparison
(n=74)
Focus on Evidence-Based Practice –
“Manualized” and “Modularized”
Intervention/Indicated:
Cognitive Behavioral Intervention for Trauma in
Schools, Coping Cat, Trauma Focused CBT,
Interpersonal Therapy for Adolescents (IPT-A)
Prevention/Selected:
Coping Power, FRIENDS for Youth/Teens, The
Incredible Years, Second Step, SEFEL and DECA
Strategies and Tools, Strengthening Families
Coping Resources Workshops
Promotion/Universal:
Good Behavior Game, PATHS to PAX, Positive
Behavior Interventions and Support, Social and
Emotional Foundations of Early Learning (SEFEL),
Olweus Bullying Prevention, Toward No Tobacco
Use
Modularized Interventions –
aka “Common Elements” approaches
• Chorpita, B.F., & Daleiden, E.L. (2007). 2007 Biennial
Report: Effective Psychosocial Intervention for Youth
with Behavioral and Emotional Needs. Child and
Mental Health Division, Hawaii Department of Health
– (Reviews most important treatment foci for Anxiety,
Attention Problems, Autism, Depression, Disruptive
Behavior Disorders, Substance Use, and Traumatic Stress)
Origins of the “Common Elements” Approach
Step 3:
Step 1:
Emphasis on
evidenced-based
treatments
Step 2:
Development of
treatment manuals
Information
overload: Too many
treatment manuals
to learn and manuals
change as new
knowledge is gained
39
How will I ever
master all these
treatment
manuals ???
Illustration of Common Elements
terminology
Treatment Family
Treatment Protocols
Practice Elements
From Chorpita & Marder, 2009. UCLA Common Elements Summer Social Work Workshop
PracticeWise Resources
• www.practicewise.com
• Subscription-based resources:
– PracticeWise Evidence-Based Services
Database (PWEBS)
– PracticeWise Practitioner Guides
– PracticeWise Clinical Dashboards
– Modular Approach to Therapy for Children
(MATCH)
Example of
printable PDF
describing
practice
element:
Audience
Goals of this
practice element
Steps
for
using
this
practice
element
Clinical Dashboards
• Microsoft Excel based monitoring tool
– Tracks achievement of treatment goals or other progress measures
on a weekly/session basis
– Documents which practice elements were used when
• Dashboard can be customized:
– Display up to 5 progress measures;
– Write-in additional practice elements
• Potential uses:
– Documenting session activities
– Tracking client progress
– Clinical supervision
Document
which
practice
element
was used
when
48
Implementation Support
•
•
•
Focus on “indigenous” school resources
Moving beyond “Train and Hope”
Focus on:
– Interactive and lively teaching
– Off and on-site coaching, performance assessment
and feedback, emotional and administrative support
– Peer to peer support
– User friendliness
• see Dean Fixsen, Karen Blasé, National Implementation
Research Network (NIRN)
SCHOOL MENTAL HEALTH
RESOURCES…
National Community of Practice on School
Behavioral Health
www.sharedwork.org
• CSMH and IDEA Partnership
12 practice groups:
– Connecting School Mental Health and Positive Behavior Supports
– Connecting School Mental Health with Juvenile Justice and Dropout
Prevention
– Education: An Essential Component of Systems of Care
– Families in Partnership with Schools and Communities
– Improving School Mental Health for Youth with Disabilities
– Learning the Language: Promoting Effective Ways for interdisciplinary
Collaboration
– Psychiatry and Schools
– Quality and Evidence-Based Practice
– School Mental Health and Culturally Diverse Youth
– School Mental Health for Military Families
– Social, Emotional, and Mental Health in Schools
– Youth Involvement and Leadership
CSMH Annual Conference on Advancing
School Mental Health
•
•
•
•
•
•
•
•
1996 Baltimore
• 2005 Cleveland
1997 New Orleans
• 2006 Baltimore
1998 Virginia Beach
• 2007 Orlando
1999 Denver
• 2008 Phoenix
2000 Atlanta
• 2009 Minneapolis
2002 Philadelphia
• 2010 Albuquerque
2003 Portland, OR
• 2011 Charleston, SC
• 2012 Salt Lake City, UT
2004 Dallas*
* Launch of National Community of Practice
on School Behavioral Health
Mark your calendars for
Oct 3-5, 2013 in Crystal CityArlington, Virginia
JOURNALS
School Mental Health
• A Multidisciplinary Research and
Practice Journal
• Editor-in-Chief: Steven W. Evans
Advances in School Mental Health Promotion
• International efforts in SMH research,
practice, policy and training
• Editor-in-Chief: Mark Weist
• Deputy Editor: Sharon Stephan (Editorin-Chief, as of January 2014)
Sharon Stephan, Ph.D.
sstephan@psych.umaryland.edu
410-706-0941
Center for School Mental Health
University of Maryland, Baltimore
School of Medicine
Division of Child and Adolescent Psychiatry
737 W. Lombard St. 4th floor
Baltimore, Maryland 21201
(http://csmh.umaryland.edu
Email: csmh@psych.umaryland.edu
Phone: (410) 706-0980
Nicole Evangelista, Ph.D.
nevangel@psych.umaryland.edu