National PBIS Leadership Forum
October 2013
Jennifer Parmalee, MPA
Director of Children &Family Services
Onondaga County Department of Mental Health
Patty Clark
Director, Pupil Services
Syracuse City School District
Linda Brown
Behavior Specialist
OCM BOCES
Lura Lunkenhiemer
President
Peaceful Schools
What is Promise Zone

Grant to 3 urban districts from New York State Mental
Health Agency (Office of Mental Health)

Purpose is to increase graduation rates

Goal: create replicable model that integrates community
and school to best support students and their families
Syracuse City School District
Urban district in Central New York
 147,000 residents
 31 schools in the SCSD
5 High Schools
6 Kindergarten – 8th grade buildings
6 Middle Schools (6th – 8th)
10 Elementary Schools
 21, 000 students
 85% Free and Reduced Lunch
 20% Listed as Special Education

Braid Multi-Tier Support
Systems
PBIS
RtI
Promise Zone
Say Yes
OnCare (SOC)
4 Tiered Problem-Solving Framework
Behavioral
Academic
Intensive, Individually Designed Interventions
• Address individual needs of student
• High intensity/longer duration/daily
• Individualized Learning Plan (ILP)
SPECIALIZED INSTRUCTION &
SERVICES
Strategic, Targeted Interventions
• Some students
• High efficiency / Rapid response
• Frequent progress monitoring
Intensive, Individually Designed Interventions
• Individually designed behavior plan
• Intense, sustainable prosocial strategies
• Function-based assessments
• Intense, durable strategies
T4
TIER
33
TIER
INDIVIDUALIZED TARGETED
INTERVENTIONS
TIER 2
Strategic, Targeted Interventions
• Some students (at-risk)
• Group or individual delivery
• High efficiency/ Rapid response
• Function-based logic
SMALL GROUP,TARGETED
INSTRUCTION
Core Instruction
 Board of Education Adopted
Core Curriculum
 Differentiated instruction
 Small guided groups
 Centers/stations for skill-based
practice
TIER1
Core Universal Interventions
• All settings, all students
• Preventive, proactive
• School Wide or Classroom Systems
CORE CURRICULUM AND UNIVERSAL
BEHAVIORAL EXPECTATIONS
4/13/2015
Syracuse 4-Tiered System of Support
Necessary Conversations (Teams)
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Screening
Team
Uses Process data;
determines overall
intervention
effectiveness
SBIT-B Team
Standing team; uses
problem-solving
process for one youth
at a time
Tier 4
Uses Process data;
determines overall
intervention
effectiveness
CICO
SAIG
Group w.
individual
feature
Simple
Complex
FBA/BIP
FBA/BIP
WRA
P
Syracuse PBIS Implementation Story




Began as pilot in 2003 and then district wide
implementation in 2010
Started using SET then moved to the Benchmark of
Quality
Over time schools became more knowledgeable and
therefore more critical of themselves.
2012 limited coaching support
PBIS Universal Fidelity Measures
SET 2003-2011; BoQ 2012 & 2013;
2010
Full district support
Tier 2 Context





13 schools implemented screening.
BAT served as a POST Training assessment.
Scores for 4 different schools in one year.
Fidelity at each level = 80%.
Emphasis on tier 2 and 3.
Benchmarks for Advanced Tiers (BAT)
2012-2013
S
C
O
R
E
S
B
y
%
Schools
Onondaga Department of Mental Health



Oversight
Planning and Quality Improvement
Contract Management (95 programs)
County (City) Demographics
Population:
454,753 (147,000)
Children ages 5-19:
95,308 (32,423)
95% of funding from State Authorities (OMH,
OASAS OPWDD)
Syracuse Promise Zone

Mission

Match SCSD students emotional/behavioral needs with
effective interventions

Keep SCSD students in class and ready to learn
Syracuse Promise Zone
 Increase
access to Mental Health Services in
schools.




Expand Outpatient Mental Health Clinic Satellites to
all schools in SCSD (10 additional sites since 2010 – 23
total)
Integrate Mental Health Clinicians into SCSD school
based problem solving teams for youth at risk. (SBIT-B)
Expand access to family based care coordination
services that link with the school team (current staff of
47 coordinators)
Expand access to skills based groups for youth at risk
(Check In Check Out)
Syracuse Promise Zone
 Establish
uniform school based problem solving
procedures and process to ensure right kids get
right interventions at the right time.


Trained 14 schools in Screening and School Based
Intervention Teams – Behavior protocols.
10 additional schools to be trained in 2013-2014
5 Keys To Implementation
Systems to identify
and intervene with
youth at risk
MH Licensed Clinician in every
school
Clinician integrate into
school team
Expand community
services for youth at risk
Problem Solving Teams at
tier 2/3
Problem Solving Processes

Screening Team – Tier 2 - Get into interventions fast


Who is on team – Administrator, school based support staff
Decision Rules




3-5 Office Discipline Referral’s
Less than 90% Attendance
At- Risk Referrals from faculty/staff
SBIT-B – Tier 3 – Individualized Targeted Process


Who is on team – Administrator, outpatient clinician, school
based support staff, general education teacher,
Decision Rules;



6+ ODR’s
Attendance
At- Risk Referral from faculty/staff
Number of Schools Trained in Screening
and SBIT-B
30
25
20
15
10
5
0
Yr 1
Yr 2
Yr 3
Yr 4
2013 - 2014
Data from Screening teams 2012-2013

Screening reviewed 571 students through April 30, 2013
Total
571
Screened
8,058
7% of Enrollment
in 13 schools
was “screened”
Referral to Interventions from Screening

Teams made 779 referrals to Interventions through April
30, 2013
Level of Interventions
350
300
291
314
250
200
150
92
100
70
50
0
Tier 2
Tier 3
Tier 4
Other
Data from SBIT-B Teams 2012-2013

SBIT-B teams reviewed 59 students (11 schools)
59
Total
Reviewed
6499
1% of Enrollment
in 11 schools
was “reviewed”
Data from SBIT-B Teams 2012-2013
SBIT-B Cases by School
14
12
10
8
6
4
2
0
A
B
C
D
E
F
G
H
I
J
K
Outpatient Mental Health Delivery

Clinics supported approximately 615 students in 23
schools in 2012-2013 (admitted to clinic)
 Donate 1.5 hours a week per school
 Prioritize school functionality in treatment
 Use of classroom data to progress monitor
 Dedicated to delivering EBP (Trauma as focus..TFCBT)
 Consultation role on teams – support decision making
for treatment, community mental health supports,
Top 5 Reasons for Referral to MH
Service as of December 2012 (N=473)
250
223
200
150
113
109
100
50
11
6
0
Behavior
Difficulties at
school
Family Concerns Social Concerns Attendance Issues
at School
Other School
Concerns
Student Engagement (Sept – Dec 2012)
Individual Psychotherapy Sessions
16
15
14
12
11
10
8
6
4
2
1
0
Weeks of school (Sept - Dec) Average Number of Sessions
(Sept - Dec)
NYS Model Number of
Sessions
Steps in Mental Health EBP
Implementation in Schools




Review current cases: reasons for referrals, assessments
Identified significant number of youth with trauma
histories and displaying symptoms of PTSD
Reviewed EBP’s in area of trauma, narrowed down to 3
Chose EBP to best meet our needs – Trauma Focused CBT






Individual work (rather than group)
Family component
Relatively inexpensive
Fit into the billing framework
Incorporated a narrative component
Trained 12 clinicians phase 1, 60 phase 2
Evidence Based Practice in School
Based Outpatient MH – TF-CBT
120
100
80
60
40
20
0
Before 8/12
Dec-12
June-13
IS ANY OF THIS WORKING?
Out of School Suspensions –
PBIS Tier 1 BOQ Measure
7
6
6
5
4
3
Compare
Sept 2011 April 2012
& Sept 2012
- April 2013
2
1
0
0
Schools at PBIS Fidelity
Change in
Suspension
Incidents
Per 100
Students
Non PBIS Fidelity Schools
Days of Lost Instruction –
PBIS Tier 1 BOQ Measure
5
6
4
2
0
-2
Schools at PBIS Fidelity
Non PBIS Fidelity Schools
Change in
Days of Lost
Instruction
Per 100
Students
-4
-6
-8
-10
-12
-14
-12
Compare
Sept 2011 April 2012
& Sept 2012
- April 2013
Out of School Suspensions –
PBIS Tier 2
5
4
4
3
2
1
0
-1
Schools with Screening
Teams Meeting
-2
-2
Schools not trained or
not meeting
Change in
Suspension
Incidents
Per 100
Students
Compare
Sept 2011 April 2012
& Sept 2012
- April 2013
Days of Lost Instruction –
PBIS Tier 2
0
-2
Schools with Screening
Teams Meeting
-4
Schools not trained or
not meeting
-2
Change in
Days of Lost
Instruction
Per 100
Students
-6
Compare
Sept 2011 April 2012
& Sept 2012
- April 2013
-8
-10
-12
-11
HOW DO WE KNOW IF THE
INTERCONNECTION IS WORKING AND
HAVING AN IMPACT?
How Should Mental Health Look in
Schools?

How should the mental health system integrate into the
school system




What is the right amount of mental health
services/supports/focus
What is the purpose and function of interventions/services
Who delivers the interventions/services
How are outcomes determined
Syracuse Benchmark of Interconnected
Systems

Purpose: Assess Integration, Implementation of Mental
Health within the 4 Tier Structure, Treatment Integrity

Function: Teams to gather data and use in systems and
practice development/enhancement at all 4 tiers

How did we develop: BOQ, Literature review, NYS SEDL
Guidelines, practical experience
Benchmark of Interconnected Systems
To Be
Determined
T4
Family/Outpatient Clinician/Case
Manager integrated into problem
solving team
School Functionality prioritized
in Mental Health intervention
goals
TIER 3
TIER 3
Mental Health Coordinator is part of
Planning and Decision Making
Interventions are EBP’s
Solicits and Prioritizes family perspective
in decision making protocol
Progress is monitored using
school based data
Intervention goals focus on behavioral
health challenges impacting students
TIER 2
Evidence based protocols are identified as
supporting mental health challenges
(CICO, Coping CAT)
School wide Social Emotional Learning
practices are communicated to families
Mental Health Coordinator is trained in
PBIS
Increase Family and Student Engagement
Second Gate of Screening process
Staff with Mental Health Knowledge Part
of Planning and Decision Making
Mental Health First Aid delivered to
faculty and staff
Universal Screening
TIER1
Lessons from Field Testing

Areas of evolution of thought



Universal Screening
Faculty and Staff knowledge on impact of mental health on
brain and learning
Family Engagement
Results of Field Test
Score MH Coord and
PBIS Coach
Score PBIS Coach
92%
92%
90%
90%
90%
88%
88%
86%
86%
84%
82%
84%
82%
82%
80%
79%
80%
78%
78%
76%
76%
74%
74%
72%
72%
A
84%
B
C
79%
74%
A+MH
B+MH
C+MH
Results from the Field
Next Steps




Field Test with non-exemplars
Develop rubric for each tier to go with questions
Separate/clarify some questions to support fidelity
Match with the ISF monograph and other learnings from
exemplars at National PBIS Conference
Questions and Feedback