Integrating School Mental Health
and PBIS: Examples at All 3 Tiers
Michele Capio, Oak Park School District
Pam Horn, Elgin School District U-46
Kelly Perales, Community Care Behavioral Health
Agenda
• Describe key features of the Interconnected
Systems Framework (ISF)
• Share tools that have been developed and
how to use them in practice
• Share examples of early implementation at all
three tiers
Connections
and
Partnerships
• OSEP National PBIS Technical Assistance
Center (www.pbis.org)
• Center for School Mental Health
(www.csmh.umaryland.edu)
• NASDSE (www.ideapartnership.org)
• National COP for SBBH (www.sharedwork.org)
BIG Ideas…
• How Multi-tiered Systems of Support (MTSS)
can enhance mental health in schools
• Installing SMH through MTSS in Schools
• The Interconnected Systems Framework (ISF)
SMH +MTSS=ISF
History-Rationale
• Sparse availability of MH providers in schools
• Labels and ‘places’ confused with
interventions
• Separate delivery systems (Sp.Ed., Mental
health, etc)
• Minimal accountability for outcomes for most
vulnerable populations
Why Partnership Are Needed
• 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
• Suicide is 4th leading cause of death among
young adults
SMH and PBIS
Common Purpose
• Schools supporting/promoting MH of ALL
students
• Prevention, early access, interventions
commensurate with level of need (vs label)
• School personnel feel confident and
competent in identifying and intervening with
accuracy and effectiveness
Logic
– Youth with MH needs require multifaceted
education/behavior and mental health supports
– The usual systems have not routinely provided a
comprehensive, blended system of support.
– Supports need to be provided in a clustered and
integrated structure,
– Academic/behavior and mental health supports
need to be efficiently blended
Promotion and Prevention
Simple and complex supports require integrated
systems with foundation of a school-wide system
• Schools and community serve as protective factor
• problem-solving teams with
school/family/youth/community voice
• use of data for decision-making (screening/ selection
and monitoring/outcomes)
• layers supports from the foundational/universal to the
more complex
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT:
What is meant by
“layering”
interventions?
~5%
~15%
Primary Prevention:
School-/ClassroomWide Systems for
All Students,
Staff, & Settings
~80% of Students
Tertiary Prevention:
Specialized
Individualized
Systems for Students
with High-Risk Behavior
Secondary Prevention:
Specialized Group
Systems for Students
with At-Risk Behavior
Core Features of a Response to
Intervention (RtI) Approach
• Investment in prevention, screening and
early intervention for students not at
“benchmark”
• Multi-tiered intervention approach
• Use of progress monitoring and problemsolving process at all 3-tiers
Core Features of a Response to
Intervention (RtI) Approach
• Research-based practices and active use
of data for decision-making at all 3-tiers
• Use of progress monitoring and problemsolving process at all 3-tiers
3-Tiered System of Support
Necessary Conversations (Teams)
Universal
Team
Meeting
Plans
schoolwide &
classroom
supports
Universal
Support
Secondary
Systems Team
Meeting
Uses process data;
determines overall
intervention
effectiveness
Problem Solving
Team Meeting
Tertiary Systems
Team Meeting
Standing team; uses
FBA/BIP process for
one student at a time
Uses process data;
determines overall
intervention
effectiveness
Check-In
Check-Out
Skills
Groups
Group w.
individual
feature
Brief
Complex
Wraparound
FBA/BIP
FBA/BIP
Brief
FBA/BIP
Rev. 11.19.2012
Illinois PBIS Network
Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal
School-Wide Assessment
School-Wide Prevention Systems
Tier 2/
Secondary
ODRs,
Attendance,
Tardies, Grades,
DIBELS, etc.
Check-in/
Check-out (CICO)
Social/Academic
Instructional Groups (SAIG)
Daily Progress
Report (DPR)
(Behavior and
Academic Goals)
Competing Behavior
Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Group Intervention with
Individualized Feature
(e.g., Check and Connect -CnC
and Mentoring)
Tier 3/
Tertiary
Brief Functional Behavior Assessment/
Behavior Intervention Planning (FBA/BIP)
Complex or Multiple-domain FBA/BIP
Illinois PBIS Network, Revised
October 2009
Adapted from T. Scott, 2004
SIMEO Tools:
HSC-T, SD-T, EI-T
Wraparound
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)
“Expanded” School
Mental Health
• Full continuum of effective mental health promotion and
intervention for ALL students
• Reflecting a “shared agenda” involving school-family-community
partnerships
• Collaborating community professionals (augment the work of
school-employed staff
The Context
• Over 18,000 schools engaged in
implementation of SWPBIS (MTSS )
prevention based system
• Current focus on capacity to scale-up
• MTSS as platform to install effective
interventions for youth w/or at-risk of EBD
The Context (cont.)
• Emphasis now on scaling with expansion and
connection to other systems
– i.e. academic, juvenile justice, mental health, child welfare,
systems of care
• Emphasis on deliberate actions that foster
connections w/families & community
Development of ISF
• 2002-2007: Site Development with PBIS Expansion
(informal and independent)
• 2005 CoP focus on integration of PBIS and SMH
• 2008: ISF White Paper: formal partnership between
PBIS and SMH
• 2009- 2013 Monthly calls with implementation sites,
national presentations (from sessions to strands)
• 2009-2011 Grant Submissions
• June 2012- September 2013 ISF Monograph
• Monograph Advisory group
Interconnected Systems Framework
paper
(Barrett, Eber and Weist , revised 2009)
Developed through a collaboration of the
National SMH and National PBIS Centers
www.pbis.org http://csmh.umaryland.edu
ISF Monograph Development
June 2012 – September 2013
• Define the common goals of SMH and PBIS
• Discuss the advantages of interconnection
• Identify successful local efforts to implement
collaborative strategies and cross-initiative efforts
• Define the research, policy, and implementation
agendas to take us to the next action level
ISF Defined
– ISF provides structure and process for education and mental
health systems to interact in most effective and efficient way.
– ISF is guided by key stakeholders in education and mental health
system who have the authority to reallocate resources, change
role and function of staff, and change policy.
– ISF applies strong interdisciplinary, cross-system collaboration.
ISF Defined
– ISF uses the tiered prevention logic as the overall
organizer to develop an action plan.
– ISF involves cross system problem solving teams that
use data to decide which evidence based practices to
implement.
ISF Defined (cont)
– ISF involves ongoing progress monitoring for both fidelity and
impact.
– ISF emphasizes active involvement by youth, families, and
other school and community stakeholders.
Interconnected Systems Framework
Tier I: Universal/Prevention for All
Coordinated 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
 Safe & caring learning environments
 Partnerships : school, home & community
 Decision making framework guides use of
and best practices that consider unique
strengths and challenges of each school
community
MH/PBIS: An Expanded Tier One
• Universal screening for social, emotional, and behavioral atrisk indicators
• Universal screening for families who may request assistance
for their children
• Teaching social skills with evidence-based curricula to all
students
• Teaching appropriate emotional regulation and expression
to all students
• Teaching behavioral expectations to all students
• Mental health professionals are part of the Tier 1 systems
team, providing input and progress monitoring data
• Opportunity to review community data and expand Tier 1
intervention options based on data
Interconnected Systems Framework
Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification,
and Response to Mental Health Concerns
 Systems Planning Team coordinates referral
process, decision rules and progress monitors
 Array of services available
 Communication system: staff, families and
community
 Early identification of students 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
MH/PBIS: An Expanded Tier Two
• Mental health/community professionals part of
secondary systems and problem solving teams
• Working smarter matrix completed to ensure key
resources are both efficient and effective (i.e., initiatives
are aligned and combined such as “bully prevention”,
“discipline”, “character education”, “RtI behavior”, etc.)
• Groups co-facilitated by school staff and community
partner (example – guidance counselor and community
provider clinician)
• Opportunity to expand the continuum of interventions
based on data (i.e. trauma informed interventions)
• Out-reach to families for support/interventions
Interconnected Systems Framework
Tier 3: Intensive Interventions for Few
Individual Student and Family Supports
 Systems Planning team
coordinates decision
rules/referrals and progress
monitors
 Individual team developed to
support each student
 Individual plans have array of
interventions/services
 Plans can range from one to
multiple life domains
 System in place for each team
to monitor student progress
MH/PBIS: An Expanded Tier Three
• Mental health professional(s) part of tertiary
systems team
• FBA/BIP and/or person-Centered Wraparound
plans completed together with school staff
and mental health provider for one concise
plan, rather than each completing paperwork
to be filed
• Quicker access to community-based supports
for students and families
Traditional
• Each school works
out their own plan
with Mental
Health (MH)
agency;
 Preferred
• District has a plan
for integrating MH
at all buildings
(based on
community data as
well as school data);
Traditional
• A MH counselor
is housed in a
school building 1
day a week to
“see” students;
 Preferred
• MH person
participates in
teams at all 3 tiers;
Traditional
• No data to
decide on or
monitor
interventions;
 Preferred
• MH person leads
group or individual
interventions based
on data;
Structure for Developing an ISF:
Community Partners
Roles in Teams
• A District/Community leadership that includes
families, develops, supports and monitors a
plan that includes:
• Community partners participate in all three
levels of systems teaming in the building:
Universal, Secondary, and Tertiary
Structure for Developing an ISF:
Community Partners Roles in Teams (cont.)
• Team of SFC partners review data and design
interventions that are evidence-based and can
be progress monitored
• MH providers from both school & community
develop, facilitate, coordinate and monitor all
interventions through one structure
3-Tiered System of Support Necessary Conversations
Family and
community
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Family and
community
Community
Secondary
Systems Team
Problem Solving
Team
Uses Process data;
determines overall
intervention
effectiveness
Standing team with
family; uses FBA/BIP
process for one youth
at a time
Tertiary
Systems Team
Uses Process data;
determines overall
intervention
effectiveness
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
Sept. 1, 2009
Family and
community
FBA/
BIP
Complex
FBA/BIP
WRAP
Using and Expanding the Framework
• Change creates uncertainty and fear
• Struggle always precedes growth
Help foster new mental map- framework leads to having people
think in different ways
Tools
• Tools help manage conversation in smaller groups
• Lead to minimizing danger and maximizing reward
• Lead to overwhelming sense of purpose
David Rock
Current Tools (in development)
• Dialogue Guides (IDEA partnership)
• Implementation Guides (Funding, Team)
• Crosswalk of Demo Sites (Data, Systems,
Practices)
• Readiness Checklist
• Resource Mapping
• Consumer Guide for Selecting MH practices
U-46 at a Glance
Enrollment:



Total school enrollment 40,570
54.8% Low Income
97 languages spoken in U-46 homes
Facilities:




40 Elementary Schools (PreK-6)
8 Middle Schools (7-8) + 1 Alternative Middle School
5 High Schools + 2 Alternative High Schools
2 Early Childhood Centers
Communities Served:


11 communities
3 counties (Cook, DuPage, Kane)
SD U-46 Student Profile
Based on School Report Card 2012
2%
1%
Hispanic 50%
7%
Caucasian 32%
8%
Asian-American 8.3%
50%
32%
African-American 6.7%
Multi-Race 2.4%
Native American 0.5%
MISSION
The mission of the U-46 School and Community Alliance is to
create, integrate and leverage existing and new school/community
partnerships that develop a full continuum of systematic interventions
based on data. It encompasses three intervention tiers:
•Systems for promoting healthy development and preventing problems
•Systems for responding to problems as soon after onset as is feasible
•Systems for providing intensive care
# of Agencies
U-46 School & Community Alliance
Trained Agency Partners
20
10
0
19
19
22
9
# of People Trained
U-46 School & Community Alliance
Trained Partners
80
70
78
60
50
67
40
30
57
20
10
0
16
22 Community Partners
78 providers trained in PBIS/SAIG
Boys and Girls Club of Elgin*Centro de Informacion*
Community Crisis Center*Crossroads Kids Club*
Easter Seals*Elgin Police Department*
Family Service Association of Greater Elgin
Area*Fox Valley Pregnancy Center*Fox Valley
Volunteer Hospice*Girl Scouts of Northern
Illinois*Hanover Township Youth and Family
Services*Kenneth Young*Kids’ Hope USA*Renz
Center*Streamwood Behavioral Healthcare
System*Taylor Family YMCA*The Y*WAYS*West
Ridge Community Church*Youth Leadership
Academy
U-46 School and Community Alliance
Work Groups
2009-2012
Operations
Tier 2/3
High School Violence Prevention
U-46 School and Community Alliance Work
Groups 2012-2013
Tier 1 Trauma Informed Care
Tier 2 Interventions
Tier 3 RENEW/WRAP
3-Tiered System of Support
Necessary Conversations (Teams)
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Secondary
Systems Team
Problem Solving
Team
Tertiary
Systems Team
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
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
FBA/
BIP
Complex
FBA/BIP
WRAP
Training
• 2009-2013 Separate training for partners
(condensed versions of school training)
• 2011-2013 Community partners attend
Team Planning Day with their PBIS Tier 2/3
System Teams
• 2012-current Community partners attend
full training with school teams
• Examples: Wraparound, RENEW, and
Trauma informed CPI
Tier 1 Network Example
Hanover Township Youth & Family Services
• Elementary (Grades 4-5-6)
Open Gym
• Middle and High School
Healthy Living in Health Classes
Elgin High Example
Tier 1 Examples
Boys & Girls Club (Elgin)
• Club Elgin: daily, after school
RENZ
• Freshman Transition: prevention model
Tier 2 Examples
•
•
•
•
Boys & Girls Club (Elgin)
SAIG: 2-3 groups, not responding to CICO,
DPR card electronically
Family Service Association of Greater Elgin
Group Mentoring: 5 groups, 3-5 girls/group,
anger management and conflict resolution
Hanover Township Youth & Family Services
Group Mentoring: 2 groups, daily CICO with counselor
Alternative to Suspension Program: restorative program
Tier 2/Social Academic Instruction
Groups (SAIG)
•
•
•
•
•
Coordinated by Elgin High School Counselor
Facilitated by Community Partner
Data: Feedback from Teachers and Students
Groups 6-8 weeks
Student identification based on
teacher/dean/counselor input and
lack of response to CICO
• Agency partners are active members of
secondary systems team
Elgin High School
Weekly Progress Report
NS=No School
Date
2/6/2012
2/7/2012
2/8/2012
2/9/2012
2/10/2012
A=Absent all day
NP=No show
Period 1
Period 2
Earn & Give
Respect Goal
(Stop, think and
act before
reacting to
something)
Earn & Give
Respect Goal
(Stop, think and
act before
reacting to
something)
Hold Yourself
Responsible (Stop,
think and act
before reacting to
something)
Safety First Goal
(Stop, think and
act before
reacting to
something)
M=Missing data
Hold Yourself
Responsible (Stop,
think and act
before reacting to
something)
Safety First Goal
(Stop, think and
act before
reacting to
something)
Weekly Progress Report
Earn and Give Respect
(student will not talk back to
staff)
Hold Yourself
Responsible
(Student will be on time to
class)
Safety First
(Student will wear ID around
neck)
Pre-test/Post-test
1.
2.
3.
4.
5.
6.
7.
8.
I attend school regularly
I skip ___# of classes each week
I receive all A’s, B’s, and C’s for grades
I receive _____# of disciplinary referrals per week
I feel connected to my school
I feel respected and important while at school
I can count on friends for support
I can count on my family members for support
I feel connected to my school
I feel respected & important at school
Next Steps at EHS…
Move from instructional short-term groups to
long-term group mentoring with skill
instruction embedded in the mentoring
Increase communication between
deans/facilitators/staff of the interventions
 Align initiatives
Explore more intensive interventions for
students with unmet mental health needs
Next Steps for Community Alliance…
Increase trauma focus at all three tiers
Directory of partners/agencies
Blend & coordinate initiatives across district
Expand alternative to suspension
Utilize district exemplars as examples for
other schools
Increase communication between district and
community partners
Using and Expanding the Framework
• Change creates uncertainty and fear
• Struggle always precedes growth
Help foster new mental map- framework leads to having people
think in different ways
Tools
• Tools help manage conversation in smaller groups
• Lead to minimizing danger and maximizing reward
• Lead to overwhelming sense of purpose
David Rock
Key features
• Systems
– District and building teaming models
– Facilitation, technical assistance, coaching
– Stakeholder participation and buy-in
• Practices
– Mental health and school staff work in an integrated way to
support students across tiers
– Using assessment and screening in order to determine which
EBPs to use, progress monitor
– One plan for both education and mental health
• Data
– Shared decision rules
– Used for decision making with all stakeholders at the table – school,
mental health, other child serving systems, family
Crosswalks
What creates the pathway?
Systems, Data, Practices
• Systems:
–
–
–
–
–
–
–
–
–
–
Identified need (gaps in services, lack of services)
Identified cost savings
Shift in population (increased poverty, homelessness, health concerns)
Frustration with current condition (restrictive, inefficient, ineffective)
Flexible funding source identified (United Way, Walter Reed, community care, blended)
PBIS foundation (provided both structure and process)
Local “Champions”
Demo sites created opportunity
Received Grant (Systems of Care)
Non profit working with school system for district wide change
• Data: Moving beyond Office Referrals and Suspensions to 360 view that
include community data
– hearing data, # of student encounters with law enforcement, calls to crisis centers,
instructional time lost for services, use of screeners, behavioral health assessments
• Practices: Broader range: EBP with Trauma focus
Scranton, PA
History and Time Line
• District and Community Leadership Team –
established in 2009-10 school year
• Transformation of mental health services for
children/youth and families
• Utilized PBIS Implementer’s Blueprint and
Stages of Implementation (Fixen)
• Began in two schools, after reviewing data
indicating positive outcomes, then expansion
Scranton, PA
“Current Conditions”
• Eleven Elementary Schools (K-5)
–
–
–
–
2 implementing ISF at all three tiers
3 implementing PBIS at tier one and have SMH
1 implementing PBIS at tier one
2 will be trained/kick off PBIS this year (1 w/ SMH)
• Three Intermediate Schools (grades 6-8)
– 1 implementing PBIS at tier one and has SMH
– 2 have SMH and will be trained/kick off PBIS this year
• Two High Schools (grades 9-12)
– 1 with SMH and previously implementing PBIS
– 1 implementing PBIS at tier one and has SMH
2013-14 School Year
•
•
•
•
20 licensed mental health professionals
38 bachelor’s level behavioral health workers
Closure of center-based partial hospitalization program
Closure of five school-based partial hospitalization
programs
• ROI – less restrictive educational placements, return to
home schools, less restrictive mental health
placements, cost savings
• Increased collaboration, communication – improved
outcomes
Resource Mapping Definition
• Mapping focuses on what communities have to offer
by identifying assets and resources that can be used
for building a system
– It is not a "one-shot" drive to create a published
list or directory
– It is a catalyst for joint planning and professional
development, resource and cost sharing, and
performance-based management of programs and
services
(National Center on Secondary Education and Transition, 2003)
Resource Mapping: Identifying community
resources, assess duplication and build
comprehensive, sustainable resources
 Identify the geographic community
 Identify all currently participating organizations
 Discuss the description of required target population
 Identify services/programs available
• Inventory each agency/organization’s expenditures
• Identify funds expended but not fully matched
• Discuss spending resources collaboratively
• Assess redundancy
• Use resource map
• Develop and implement plan
• Share information and results to ensure support
4/15/2013 - Hershfeldt
Activity: What’s in Place?
1-5%
Community-Based
Services/Resources and
Providers
Tier 3-Resources/Supports for a Few
5-15%
SchoolBased
Services &
Resources
Tier 2- Resources/Supports for Some
80-90% Tier 1 –Resources/Supports for All
Applying the Logic to Families
Tier 3: Intensive, Individual Interventions
Family Liaison-matched with family, needs matched with
community resources
 Individual Skill Building Sessions-
1-5%
Tier 2: Targeted Group Interventions
Support Groups (Military Families, Newcomer Group)
5-10%
Skill Building Sessions (Academic and Behavior)
Tier 1: Universal Interventions
Self Assessments: Family Engagement Checklist, Surveys
Skill Building Series Guest Speaker (Topics Vary- Survey Families)
Newsletter, Resource Library , “Shout Outs”
80-90%
Volunteer Opportunities (DOGS- Dads of Great Students)
Teacher Conferences- Goal Setting, Family Vision, Strengths
Discovery
Family Fun Nights throughout the year
School Handbook (Description, Teaching Matrix – promote
common language between school and home)
School-Wide Systems for Student Success:
A Response to Intervention (RtI) Model: SUPPORTS
Academic Systems
Behavioral Systems
Tier 3/Tertiary Interventions
•1:1 instruction
•Increased time
•504
1-5%
1-5%
5-15%
Tier 2/Secondary Interventions
•Title I Reading and Math
•ERI, RM, RN, etc.
•IST
5-15%
80-90%
Tier 1/Universal Interventions80-90%
•Core Curriculum – reading and math
•AIMS Web
•MAP
•PSSAs
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
Tier 3/Tertiary Interventions
•SBMH, Partial Hospitalization
•Alt Ed
•FBA/PBISP
•Home School Visitor
Tier 2/Secondary Interventions
•Counselor groups, lunch bunch
•Friendship groups
•Behavior Chart/plan
•IST
•Parenting Classes
Tier 1/Universal Interventions
•Character Education
curriculum
•Bullying Prevention
•SWPBS (some schools)
•Act 211 D&A awareness
•Counselor classroom
lessons
•Community Activities
•Health Screening
Scranton High School
School-Wide Systems for Student Success:
A Response to Intervention (RtI) Model:
Resources
Needs
Tier 3/Tertiary Interventions
Tier 2/Secondary Interventions
1-5%
5-15%
1-5%
5-15%
80-90%
Tier 1/Universal Interventions80-90%
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
Tier 3/Tertiary Interventions
•SBBH Team
•Outpatient therapy
•SB Partial
•Guidance – individual support
•SAVES/school aged mothers
Tier 2/Secondary Interventions
•SAP
•Guidance – groups
•Community Partners – groups
•Resource Officer
Tier 1/Universal Interventions
•SWPBIS
•Drug and Alcohol
Prevention
Building Level Action Plan
UNIVERSAL SYSTEM
SECONDARY SYSTEM
TERTIARY SYSTEM
Universal Systems
Team
Secondary Systems
Team
Problem Solving Team
(individual student)
Tertiary Systems
Team
PRACTICES
PRACTICES
PRACTICES
PRACTICES
Data Decision Rule
Data Decision Rule
Data Decision Rule
Data Decision Rule
73
Annual Fidelity Check
Action Planning
• Benchmarks of Advanced Tiers
– Do we have more than one strategy available to
support students who need more?
– Do we use data to make decisions?
– Are we selecting Evidence-Based Practices?
– Do we have the staff and resources to implement
with fidelity?
– Are we progress monitoring?
Revisit Resource Map
• Do we have a continuum of interventions and
supports?
• Does our systems team include
representatives from our community
partners?
• Are their gaps that we need filled?
• Can we present needs to our district and
community leadership team?
School-Wide Systems for Student Success:
A Response to Intervention (RtI) Model: SUPPORTS
Academic Systems
Tier 3/Tertiary Interventions
Behavioral Systems
1-5%
1-5%
Tier 3/Tertiary Interventions
•_____________________
•_____________________
•_____________________
Tier 2/Secondary Interventions
•___________________________
•___________________________
•___________________________
•___________________________
•___________________________
•___________________________
Tier 1/Universal Interventions80-90%
•________________________
•________________________
•________________________
•________________________
•________________________
•________________________
•___________________________
•___________________________
•___________________________
5-15%
5-15%
Tier 2/Secondary Interventions
•____________________________
•____________________________
•____________________________
•____________________________
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80-90%
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
Tier 1/Universal Interventions
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Consumer Guide to Selecting Evidenced
Based Mental Health Services
(Putnam et al, 2012 in draft)
Main Components
• Assessment
• Interventions Selection
• Intervention Progress Monitoring
Assessment
Intervention Selection
Intervention Progress Monitoring
Use of EBP Tool
Scranton
Assessment
Current Condition
• Assessment/Screening
happens upon referral to
SMH Team
• SDQ and COS used in
addition to progress
monitor and track outcomes
Future Planning
• Universal Screening
• Tie in work that happens in
other processes - SAP
Use of EBP Tool
Scranton
Intervention Selection
Current Condition
• Clinicians report almost
exclusively selecting
interventions that address
all nine areas on the tool
• There is not a place for
indicated which
interventions are selected
and whether or not they are
identified as EBPs
Future Planning
• Combined training for
school-employed and
community-employed staff
who will be supporting
youth/families who need
Tier Two and Three
interventions that
specifically address how to
select EBPs that match area
assessed/screened
Use of EBP Tool
Scranton
Intervention Progress Monitoring
Current Condition
• Clinicians utilize outcome
tools of COS and SDQ
• Not differentiating
implementation fidelity to a
particular intervention (TFCBT)
• Sharing outcome data in
aggregate per school
annually, not always by
student and more frequent
Future Planning
• Utilize tools to monitor
fidelity of implementation
of intervention
• Share data with systems
teams on a more frequent
basis and by student for
planning purposes,
consistently
Trauma Informed Care
• 3 Community Mental Health Provider
Agencies employ the SMH staff working across
home/school/community
• As part of comprehensive assessment, include
a trauma screening
– Traumatic Events Screening Inventory (TESI)
– UCLA PTSD Index
Trauma Screening Tools
TESI
• Used by most clinicians
• Free
• On our preferred list
• 15-item clinicianadministered interview
• Variety of potential
traumatic events
UCLA PTSD Index
• Requires licensing
agreement for use
• On our preferred list
• Recommended by TF-CBT
• 48-item interview
• Assesses a child’s exposure
to 26 types of traumatic
events
“Once You Screen, You Must Intervene”
K. Lane
• If trauma uncovered in screening/assessment,
clinician works with family to determine:
– If previously addressed/resolved
– If not addressed, yet not currently causing
presenting issues/concerns/problems/symptoms
– If not addressed, and contributing to current
concerns
• Clinician selects EBP that is trauma informed
National Child Traumatic Stress
Network
• Evidence-based treatment fact sheets
– Trauma-Focused Cognitive Behavioral Therapy (TFCBT)
– Child/youth and family component (+)
– Can receive free web-based training (+/-)
– Important to have good clinical supervision
“Arianna”
• 13 year old Caucasian female in 7th grade
• Adopted at 18 months into a family with two
half-siblings, who were also adopted.
• 17 year old sister diagnosed with Asperger’s
Syndrome and Bi-Polar Disorder
• 12 year old brother diagnosed with Asperger’s
Syndrome
• Moved into area at age 4
“Arianna” continued
• Referred to SMH team due to self-injurious
behaviors
• School reported risk of change in educational
placement and concern for risk of drop-out
• At the time of referral, Arianna did not have a
positive peer group
• Trauma uncovered during
screening/assessment
• Clinician utilized TF-CBT
Child Outcomes Survey (COS) Family Functioning:
Child X
A large improvement is observed in both domains of family functioning
Child Outcomes Survey (COS) Overall Wellness:
Child X
Overall wellness improves dramatically
“Arianna” today
• Attending school with academic success
• Participating on the girls basketball team
• Reports having improved relationships with a
more positive peer group
• Reports having improved relationships with
family members
• School reports no risk for change in placement or
drop-out at this time
• Arianna told the team, through a drawing, that
they “saved her life”!
School Mental Health
Child Outcomes Survey (COS) Family Functioning:
Scranton School District
8
7.8
7.6
7.4
7.2
7
6.8
6.6
6.4
6.2
Baseline
3 mo
6 mo
9 mo
COS Family Functioning
12 mo
15 mo
Child Outcomes Survey (COS) Child Functioning:
Scranton School District
8
7.5
7
6.5
6
5.5
5
Baseline
3 mo
6 mo
9 mo
COS Child Functioning
12 mo
15 mo
Child Outcomes Survey (COS) Therapeutic Alliance:
Scranton School District
9.5
9
8.5
8
7.5
7
Baseline
3 mo
6 mo
9 mo
COS Therapeutic Alliance
12 mo
15 mo
Strengths and Difficulties Questionnaire Parent
(SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton
School District
19
18
17
16
15
14
13
12
11
10
Baseline
3 mo
SDQ-P Total Difficulties Score
6 mo
9 mo
SDQ-T Total Difficulties Score
12 mo
Questions?