Pennsylvania’s Integration of Mental
Health and Positive Behavior
Interventions and Supports (PBIS)
A Community of Practice Approach using
Social Entrepreneurism to Scale Social Impact
Ron Sudano, Ed.S. NCSP – PA Training and Technical Assistance Network
Kelly Perales, LCSW – Community Care Behavioral Health
Big Ideas
• Community of Practice
o
Intentional integration of Mental Health and PBIS
• Social Entrepreneurism
o
SWPBS to initiate and expand Mental Health Supports
for ALL children and youth
• Innovation
o
o
o
Distributed Leadership & Contribution
Affiliated Network
Tertiary Demonstration Project
2
Communities of Practice:
A Conceptual Framework
“Groups of people who share a concern, a
set of problems or a passion about a topic,
and who deepen their understanding and
knowledge of this area by interacting on
an ongoing basis.”
(Etienne Wenger, Richard McDermott, William Snyder,
A Guide to Managing Knowledge,
Cultivating Communities of Practice, 2002, p. 4)
What is a Community of Practice?
• Based on relationships and natural bonds
• Supportive and convening functions enable a
collective intelligence
• Share learning at all levels to escalate progress
• Create new knowledge grounded in ‘doing’ the work
• Reflect a “pull” versus a “push”
 Sponsors
of the National Community of Practice on
School Behavioral Health are the IDEA Partnership
funded by OSEP and housed at NASDSE and the
Center for School Mental Health funded by HRSA
and housed at the University of Maryland.
www.ideapartnership.org
www.sharedwork.org
Communities of Practice:
A Variety of Activities
• Problem-solving
• Requests for
Information
• Seeking
Experience
• Reusing Assets
• Mapping
Knowledge
• Coordination and
Synergy
• Discussing
Developments
• Documentation
Projects
• Visits
• Identifying Gaps
PA State Leadership Team
The state leadership team was founded in 2006 and the following departments, agencies
and stakeholder groups represent a partial list.
• Allegheny County Department of Human
Services
• Bureau of Autism Services
• Community Care Behavioral Health
• Devereux Center for Effective Schools
• Disability Rights Network of Pennsylvania
• Education Law Center
• Juvenile Court Judge’s Commission
• Mental Health Association of Pennsylvania
• Office of Child Development and Early
Learning
• Pennsylvania Community Care Providers
• Pennsylvania Department of Education
o Bureau of Special Education
o Division of Student Services and Safe
Schools
• Pennsylvania Department of Health
o Bureau of Drug and Alcohol Programs
• Pennsylvania Department of Labor and
Industry
o Office of Vocational Rehabilitation
• Pennsylvania Department of Public Welfare
o Office of Mental Health and Substance
Abuse Services
• Pennsylvania Governor’s Commission on
Children and Families
• Pennsylvania Intermediate Unit (PAIU)
Special Education Directors
• Pennsylvania Network for Student Assistance
Services
• Pennsylvania Training and Technical
Assistance Network (PaTTAN)
• Pennsylvania Youth Leadership Network
• Philadelphia Public Citizens for Children and
Youth
• Value Behavioral Health
• Youth and Family Training Institute
6
Promoting the entrepreneurial pursuit of social impact
Scaling SWPBS
Pennsylvania’s Approach
(Adapted from - John Kalafatas: Approaches to Scaling Social Impact)
7
Mission Statement
The mission of the Pennsylvania Positive Behavior Support
Network (PAPBS Network), through training and technical
assistance, is to support schools and their family and
community partners to create and sustain comprehensive,
school-based behavioral health support systems in order to
promote the academic, social and emotional well-being of all
Pennsylvania’s students. The network’s goal is to ensure that all
schools have the necessary technical assistance, collaborative
opportunities, and evaluative tools needed to overcome nonacademic barriers to learning and achieve competence and
confidence in advancing academic, social, and emotional
success for all students.
Scaling Social Impact: The process of increasing positive
social impact to better correspond to the magnitude of the
identified social need.
John Kalafatas: Approaches to Scaling Social Impact.
http://www.caseatduke.org/knowledge/scalingsocialimpact/frameworks.html
9
 Impact through Direct Service
GOALS
for Scaling
MH &
SWPBS
• Increase Quantity and/or
Quality of Impact
• Diversify Communities Served
 
Impact through Indirect Influence 
• Promote a Model
MH & SWPBS
Integration
• Diversify Services Offered
• Influence Public Policy
• Establish a Social
Movement
• Change/Create Markets
• Expand Geographically
• Organizational Branching
STRATEGIES and/or Affiliation
for Scaling MH
& SWPBS • Expanding Organization’s
Delivery Capacities (via
volunteers, technology, etc.)
• Technical Assistance
• Knowledge
Dissemination
• Research & Public Policy
Development
• Partnerships/Alliances
• Influencing Public
Awareness, Norms or
Behaviors
• Packaging/Licensing
• Direct Advocacy & Lobbying
• Convening Networks
Adapted from: John Kalafatas: Approaches to Scaling Social Impact.
http://www.caseatduke.org/knowledge/scalingsocialimpact/frameworks.html
10
Situational
Contingencies
Labor needs
Organization
Capabilities
Staffing
-
Communicating
+
Alliance-Building
+
Lobbying
+
Earnings
-
Public Support
Potential Allies
Supportive Public
Policy
PA SCALERS
Start-up Capital
Dispersion of
Beneficiaries
Strength of
Economic
Incentives
Generation
Replication
-
Stimulating Market
+
Scale
of
Social
Impact
Forces
Adapted with permission: Bloom, P. N. & Chatterji, A. K. (In press, 2008). Scaling Social Entrepreneurial
Impact. Fuqua School of Business, Center for the Advancement of Social Entrepreneurship: Duke University.
Retrieved January 18, 2008 from
http://www.fuqua.duke.edu/centers/case/knowledge/scalingsocialimpact/articlespapers.html
+ High valence
- Low valence
Lessons Learned
• Broad representation on State Leadership Team
• Develop evaluation plan from beginning based on
interests of stakeholders
• Commitments from central office and building-level
administrators
• Ideal: secure commitment from mental health agency to
participate at all 3 tiers of support
• Establish leadership infrastructure to roll-out
• Plan for scaling-up
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Tertiary Demonstration
Project
Integrating PBIS and Mental
Health Services
School Based Behavioral
Health (SBBH ) Teams
What is Community Care?
• Non-profit behavioral health managed care
organization (BHMCO)
• Public health mission
• Transformation of mental health services to
children and families
• Affiliated partner in PA PBS Network – have
co-director and coordinator
• Partnering with school districts for integration
of services, along with other child serving
systems
Overview of the SBBH
Team Model
Goals of SBBH Team Program
• To provide services that are more flexible than
traditional services in meeting unique behavioral
needs of youth and families
• To provide a behavioral health home for youth
and families through availability of care in
school, home and community settings as
needed
• To improve communication among youth, family,
educators, clinicians and other child serving
systems
Goals of SBBH Team Program
• To maximize integration of behavioral health
services, school intervention programs and
family and community resources
• To improve access to service for youth returning
to district schools from partial hospitalization,
inpatient care, RTF or out of home placement
• To support school staff with training and case
specific consultation
How is SBBH different?
• Quicker access to assessment and service
• No requirement for a specific prescription of
SBBH hours
• Greater flexibility in types of interventions and
intensity of service delivered
• Any team staff can intervene with a youth
How is SBBH different?
• Focus on resiliency concepts, understanding of
trauma informed care and structural family
therapy
• Increased qualifications for staff - licensure,
experience and ongoing training
How is SBBH different?
• Enhanced integration with school interventions
via positive behavioral supports
• 24/7 availability for phone crisis response
• Evaluation component is included
Behavioral Health Home
Concept
• Increased accountability via clinical home
• School is “launching pad” for services that can
be delivered in all settings
• Comprehensive service approach
• Youth continue on the team with varying
intensity of service
Who Can Receive SBBH Team Services?
• Youth, 5-18 years, and their families
• Have a serious emotional or behavioral
disturbance (internalizing or externalizing)
• Receive Medical Assistance
• Community Care member
• School related problems not required
• IEP not required
• ASD diagnosis on case by case basis
Where and when is service delivered?
• School is the physical location of team
• Services may extend into home and community
settings on evenings, weekends and during
summers
• 24/7 availability for crisis intervention
SBBH Service Components
• Clinical interventions
• Case management
• Crisis intervention
• Case consultation & training for teachers
Team Composition
• Mental Health Professionals
• Behavioral Health Workers
• Consultant
• Clinical director
SBBH Evaluation Plan
• Assessment of impact of SBBH Team on:
 Academic performance – grades, attendance,
behavior
 Child functioning at home/community and
school
 Family satisfaction
 Service utilization and cost
SBBH Evaluation Plan
• Child Outcomes Survey (COS)
 Completed by families monthly and at discharge
 Measures child functioning and family perception
of treatment process
• Strengths and Difficulties Questionnaire (SDQ)
 1 page questionnaire with 25 items related to
emotional symptoms, conduct, peer problems
and prosocial behavior
 Completed by families and teachers at admission,
quarterly and at discharge
Tertiary Demonstration Project
• Three districts who would have a SBBH
Team at the start of the 2009-10 school year
were invited to participate
• Logic of having Tier 3 services and beginning
Tier 1 in order to build three tiered system
• District/community leadership teams were
established that included mental health
partners at the table from the beginning
• Districts committed to implementing SWPBS
at all three tiers across the district
Current Status
• 2 of 3 districts were trained in Tier 1 and
“kicked off” at the start of the 2010-11 school
year in those buildings that have SBBH Team
• Use blueprint to develop action plan for other
buildings to begin process as well as assess
needs for mental health across tiers
• Planning for training and implementation of
Tier 2 during this school year in those
buildings implementing Tier 1
• Full integration of mental health
Questions?