Integrating Mental Health
Within a School-wide
System of PBIS
WI-PBIS LEADERSHIP
CONFERENCE, 2014
Jeannette Deloya, Madison Metropolitan School District
Jessica Swain-Bradway, IL PBIS Network
With contributions from:
Lucille Eber, Illinois PBIS Network & Kelly Perales, Community Care
Behavioral Health
Agenda
Introductions
 The BIG Idea
 ISF defined
 Rationale for ISF
 Exemplar
 Q&A

SO, who are these people at the
front of the room??

Jeannette Deloya
◦ Madison Metropolitan School District

Jessica Swain-Bradway
◦ Illinois PBIS Network
Who is this
chick?
I don’t knownever heard of
her.
In the News… June 16, 2014

Mental health care in schools in WI

Great idea, how do we actualize?
Activate your Brain!


What mental health supports are currently
available in your school / district?
What does this look like on a daily basis?
◦ For kids?
◦ For families?
◦ For teachers?

Please share with someone you do not know
and then be prepared to share with us.
BIG Idea…

Multi-tiered Systems of Support (MTSS) can
enhance availability and effectiveness of mental
health supports in schools

Use the logic of MTSS to install tiered, data driven
school-based mental health (SMH) practices

The Interconnected Systems Framework (ISF)
SMH +MTSS=ISF
ISF
Utilizes tiered prevention logic
 Alignment with other initiatives and
practices
 Develop an action plan
 Provides structure and process for education
and mental health systems to interact in most
effective and efficient way.
 Involves cross system problem solving teams
◦ Maximizes interdisciplinary, cross-system
collaboration
◦ Expands selection of evidence based practices
based on data

ISF
Emphasizes active involvement by youth,
families, and other school and community
stakeholders.
 Guided by key stakeholders in education and
mental health system
◦ Personnel with authority to reallocate
resources, change role and function of staff,
and change policy.
 Ongoing progress monitoring
◦ Fidelity and impact.

Traditional Provision of SMH
 Each
school interacts with Mental
Health (MH) agency
What happens
then??
Necessity of Enhanced Partnerships
One in 5 youth have a MH “condition”
About 80% of those get no treatment
School is “defacto” MH provider
JJ system is the next defacto MH provider
Suicide is 4th leading cause of death among young
adults
 Factors that impact mental health occur ‘round
the clock’
 It is challenging for educators to address the
factors beyond school
 It is challenging for community providers to
address the factors in school





Preferred SMH
 District
has a plan for integrating MH
at all buildings
◦ School data
◦ Community data
What happens
then??
Logic
Youth with challenging
emotional/behavioral problems require
a system
of care (SAMHSA)
ALL children
benefit
 The “usual”
approaches
do not work
from mental
health
◦ Suspension,
expulsion, juvenile
promotion.
detention
 Enhanced resources, staff and practices
provide ADDITIONAL options for care
and support

Logic (cont.)
• Effective schools are SUPPORTIVE
schools
• Supportive schools must build the
foundation for the whole child
• For every child
APPLYING THE LOGIC
MH Embedded within the System

Expand: MH system within the school
◦ Team membership
◦ Current continuum of interventions
◦ Data sources for identifying needs and
monitoring

Use: Logic of Implementation Science
◦ THINK: Sustainability, Scale, Reaching ALL
students
◦ BUILD on what you have
◦ Match intensity of support to need
TEAMS
Traditional
MH
 Preferred
counselor is MH person(s)
housed in a
participates in
school building 1
teams at all 3
day a week to
Tiers
“see” students
Traditional  Preferred
School
personnel only
attempting to
“do mental
health”
A
blended team
of school and
community
providers “divide
and conquer”
based on
strengths of that
team
EXPANDED: Teams
Mental health service provider
 Social worker
 Behavioral health
 United Way / Community organizations
 Hospital
 Police Department
 Probation

Take 2

Who are the community groups /
resources available in your district?
◦ Do you know?
◦ How can you begin to find out?
INTERVENTIONS
Traditional  Preferred
 Mental
health
promotion does
not exist beyond
expectations &
acknowledgements
 Expanded
Universal Team
selects curricula,
practices to
promote mental
health
EXPANDED: Interventions
Suicide prevention (universal)
 Substance abuse (all tiers)
 Trauma informed interventions (small
group and individual)

◦ SPARCS
DeRosa, R., Habib, M., Pelcovitz, D., Rathus, J., Sonnenklar, J., Ford, J.,…Kaplan, S. (2005). SPARCS: Structured
Psychotherapy for Adolescents Responding to Chronic Stress: A Trauma-Focused Guide. Great Neck, NY: North ShoreLong Island Jewish Health system, Inc.
Take 1: Shout it out

What are some of the interventions your
district is providing that are unique to
your community needs?
DATA
Traditional  Preferred
 Mental
health risk
factors and outcomes
are not measured
 Students are
identified after major
incident (or not at
all)
 Data used for
developing Tier 2 and
3 IVs are limited.
 District
screens for
mental health risk
factors, planful
progress monitoring
for students receiving
support
EXPANDED: Data
•
•
•
•
•
•
•
•
Absences
Trips to nurses office
Screening data
Child welfare contacts
Violence rates
Arrests / Incarceration rates
Unemployment spikes
Families who are:
• Deployed
• Homeless
Take 2: Think and share
Which data are the most relevant in your
community?
 What relationships do you have to build /
foster to get access to some of these
data?

The Strengths and Difficulties
Questionnaire (SDQ)
The SDQ measures caregiver and teacher report of
child behavior
 The SDQ contains 4 sub-scales for difficulties

◦
◦
◦
◦
emotional symptoms
hyperactivity
peer problems
conduct problems
A summation of the 4 difficulties scales is made to
compute Total Difficulties
 One strength-based sub-scale-- pro-social behaviors
 The SDQ is completed by the caregiver and teacher
quarterly

© 2013 Community Care
29
Interventions to
match need
Measures to screen
/ identify risk
Teams
SMH & PBIS
Common Purpose

Schools promote MH of ALL students
◦ Supports available across the continuum

Prevention, early access, interventions
commensurate with level of need

School personnel feel confident and
competent in identifying and intervening
with accuracy and effectiveness
Jeannette Deloya, Madison Metropolitan School District
INTEGRATING MENTAL
HEALTH PROFESSIONALS
IN SCHOOLS
State Context

Wisconsin:
◦ WI Dept. Health Services Memo (Oct., 2013)
◦ 118 sites in WI
◦ Coalition for Advancing School-Based Mental
Health in Wisconsin
 Developing standards for practice
 Networking (web-site and meetings)
 Interconnected Systems Framework as best
practice
33
“Proposal would put mental
health care programs in
schools”
Similar program has seen results in Fox Cities
Dave Delozier, Wisconsin TV, June 16, 2014
School-Community Integrative Model for
Children’s Mental Health
Organization and Policy
Management, Partnership Protocols, Community Engagement & Organization Endorsement
Parent
Leadership
Parent
Leadership
Council
--Language
Interpreting
--Meaningful
supports
Professional
Development
Schools
--SchoolCommunity
Integration
Access and
Direct
Services
School-based
health services
--Continuum of
services
--Coordinated
Critical
Response
Services
Coordination
Coordination &
Informationsharing across
systems
--School-based
coordination
Partnership/
Management and
Monitoring
CMHC Advisory
Board
--CMHC Work
Teams
--MMSD
--MMSD
Partnership
Protocol
Note: Action plans are developed for each of the vertical plan components listed above
Funding
Grants
--Patient
revenue
--Partner
collaborations
--Budget
--Advocacy
Why:
Mental health touches all of us…
National: Between 15–20% of children
living in the United States experience a
mental health disorder in a given year.
 Dane County: 1 in 12 high school students
reports one or more suicide attempt in
past year; 1 in 4 struggle with depression.
 MMSD: Low income students twice as
likely to be identified with a MH concern

Why:
Access to Mental Health Services

National: 60-90% of adolescents with MH
disorders fail to receive treatment;
especially impactful for children in
poverty.

MMSD: 1 in 2 non-low income students
receive services in community; 1 in 5 lowincome elementary students with MH
concerns do so.
MMSD Insurance Status
◦ Yes
 Employer: 55.2%
 Medical Assistance: 40.2%
 Self: 3.0%
Other: 1.6%
◦ No
District Low Income rate
97.4%
2.6%
48.6%
38
Why:
Mental Health and School Success
Students with significant mental health
concerns:

are more truant & chronically absent
 have
 have
higher discipline referral & suspension rates
lower grade point averages & are less likely
to graduate
School-Community Integrated Model

Recommendation: Establish school-based health
services that articulate with and build on existing
programs to optimize a) screening for mental
health and AOD issues, b) early detection,
intervention and referral for mental health
concerns, and c) holistic health promotion and
care
◦ Develop pilots for integrating mental health
professionals in schools
40
Integrated School-Based Model to Support
Children’s Mental Health
Funding Streams
Management Structure
42
Journey-Sennett Pilot Outcomes
Students: Clinical and academic gains
Parents: Positive connection to MH services
School Staff: Professional Development MH
Journey Staff: Reduction in no shows; Increase in
therapeutic relevancy for students
• Community: Link to primary care
• District: Increase in understanding about
reimbursement complexities and cross-systems
team structure (clinical and operational)
•
•
•
•
43
Behavior & Mental
Health in MMSD
Tier 3
Tier 2
Tier 1
Specialized Services
School & Community
Individual Direct Services
Case Coordination
Crisis Response
Restorative Practices
Small Group and brief interventions
Teaching Social Emotional Skills
Universal Positive Behavioral Supports
Universal Mental Health Screeners
Foundational Practices of Mental Health Services Delivery:
Family Leadership
Community Partnership
Evidence-based and Research-informed
Data-based decision-making (inform & evaluate)
Consultation & Collaboration SchoolCultural Literacy
Inclusive Practices
Trauma Informed Care
MH Professional in Schools
Integrated Model - Proposed
Treatment Services:
 School-wide and Teaming:
 Professional Development:

75%
15%
10%
45
46
RESOURCES
Advancing
Education
Effectiveness:
Interconnecting
School Mental
Health and
School-Wide
Positive Behavior
Support
Editors: Susan Barrett,
Lucille Eber and Mark Weist
DEVELOPMENT OF AN INTERCONNECTED
SYSTEMS FRAMEWORK FOR SCHOOL MENTAL
HEALTH
 Access on the Center for School Mental Health or
National PBIS websites:
• http://csmh.umaryland.edu/Resources/
Reports/SMHPBISFramework.pdf
• http://www.pbis.org/school/school_mental_healt
h/interconnected_systems.aspx
 Edited by: Susan Barrett and Lucille Eber, National PBIS Center Partners; and
Mark Weist, University of South Carolina (and Senior Advisor to the University of
Maryland, Center for School Mental Health)
Resource Mapping
ACTION STEPS FOR
YOUR TEAMS
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
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?

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
Thank You!
Jessica Swain-Bradway
Jessica.swainbradway@pbisillinois.org

Jeannette Deloya, Madison Metropolitan
School District
jdeloya@madison.k12.wi.us
