Mental Health Mental Health Partnerships: Partnerships: PBIS PBIS

MarylandMarylandSusan Barrett, Sheppard Pratt Health System

Milt McKenna, Maryland State Department of EducationAndrea Alexander, Maryland State Department of

Education Nancy Lever, University of Maryland

Sharon Grose, Harford County Public Schools Catherine Bradshaw, Johns Hopkins University

October 13, 2006 - Rosemont, IL

Susan Barrett Sheppard Pratt Health System

PBIS organizational structure in Maryland Mental Health Integration Grant School district exemplar Summary of related initiatives

OverviewOverview

Pennsylvania

Delaw

are

D.C.

Virginia

West Virginia

Maryland Organizational Maryland Organizational ModelModel

School Level 467 PBIS Teams (one per school)

- Team leaders (one per school)

- Behavior Support Coaches (250+)

District Level (24) Regional Coordinators

State Level State Leadership Team

- Maryland State Department of Education (MSDE)- Sheppard Pratt Health System- Johns Hopkins Center for Prevention of Youth Violence- 24 Local school districts- Department of Juvenile Services, Mental Health Administration

Management Team Advisory Group

National Level National PBIS Technical Assistance Center

- University of Oregon & University of Connecticut

State

District

School

Classroom

Student

Cumulative Number of PBIS Cumulative Number of PBIS School Teams and Behavior School Teams and Behavior

Support Coaches by Year TrainedSupport Coaches by Year Trained

050

100150200250300350400450500

1999 2000 2001 2002 2003 2004 2005 2006Year

Schools Trained

Coaches

# T

rain

ed

364434

504574

644714

0

100

200

300

400

500

600

700

800

FY 05 FY 06 FY 07 FY 08 FY 09 FY 10

Anticipated Growth at 5% Linear (Anticipated Growth at 5%)

Anticipated GrowthAnticipated GrowthCurrently 34% of MD schools trained Currently 34% of MD schools trained

& 50% will be trained by 2010& 50% will be trained by 2010

Milt McKennaMaryland State

Department of Education (MSDE)

Current Energy and Current Energy and EffortsEfforts

Institutionalize funding level and commitment at MSDE- Divisions of Student Services and Special

Education Pursue other funding opportunities Expand and sustain green zone with high

fidelity Increase marketing and visibility Implement yellow zone in districts that have

solid green zone and have infrastructure to expand

Continue linkage with school mental health, System of Care, and wraparound efforts

Maryland SchoolMaryland SchoolMental Health AllianceMental Health Alliance

School Mental Health Integration Grant

History of History of AllianceAlliance

U.S. Department of Education Call for proposals posted in April 2005 Grant Due in mid May!

Goal: “Grants for the Integration of Schools and Mental Health Systems will provide funds to increase student access to high-quality mental health care by developing innovative approaches that link school systems with the local mental health system.”

History of Integration History of Integration GrantGrant

Commitment from key local, state, and national partners to collaborate and form an Alliance to advance school-mental health system integration in Maryland

Strong support for children’s mental health and school mental health in the state

A strong PBIS structure within the state and an interest in enhancing mental health support and resources for red and yellow zone youth

State-wide needs assessment data indicated need for additional mental health training

Notified of award in September 2005 1 of 20 funded projects (84 total applicants)

Andrea AlexanderMaryland State

Department of Education (MSDE)

Maryland School Maryland School Mental Health Alliance Mental Health Alliance

(MSMHA)(MSMHA) Maryland State Department of Education Center for School Mental Health Analysis and

Action - University of Maryland Center for Prevention and Early Intervention -

Johns Hopkins University Governor’s Office for Children Maryland Assembly on School-Based Health Care Maryland Coalition of Families for Children’s

Mental Health Maryland Department of Juvenile Services Mental Hygiene Administration Department of

Health and Mental Hygiene Mental Health Association of Maryland

Required Grant Required Grant ComponentsComponents

Enhance collaboration between schools and mental health systems to improve prevention, diagnosis and treatment for students

Enhance crisis intervention, appropriate referrals and ongoing mental health services

Training for school personnel and mental health providers

Technical assistance and consultation to the school system, mental health agencies and families

Provide linguistically appropriate and culturally competent services

Evaluate the effectiveness of increasing student access to quality mental health services

Primary Grant Primary Grant ObjectivesObjectives

Aim 1: To further build a systematic state initiative for school mental health (SMH)

Aim 2: To improve outcomes related to red and yellow zone youth in PBIS schools through:

Helping school staff to better identify and refer students who could benefit from mental health services

Enhancing mechanisms for effective communication between schools and the mental health system to help better integrate quality mental health care for students

Developing training and resources to assist school staff with creating environments that support academic, social, and emotional learning for children with more intensive mental health needs

Maryland School Maryland School Mental Health AllianceMental Health Alliance

For More Information About the For More Information About the MSMHA and to Access Resources MSMHA and to Access Resources

Developed for the Project, Developed for the Project,

Visit Our Website: Visit Our Website: http://www.msmha.org

Nancy LeverUniversity of Maryland

CSMHACSMHA

To strengthen the policies and programs in school mental health to improve learning and promote success for America’s youth

Established in 1995. Currently with a 5-year funding cycle beginning in 2005 from HRSA with a focus on advancing school mental health policy, research, practice, and training.

It is our goal to develop and disseminate high quality, user-friendly, and culturally and developmentally sensitive materials to help foster a mental health- schools-families shared agenda.

http://csmha.umaryland.edu, (410) 706-0980

University of Maryland, Center for University of Maryland, Center for School Mental Health Analysis and School Mental Health Analysis and

ActionAction

Expanded SchoolExpanded SchoolMental Health (ESMH)Mental Health (ESMH)

Full continuum of mental health services for children and adolescents in both regular and special education.

Evaluation Treatment Case Management Mental Health Promotion Prevention Crisis Management Consultation

ESMH augments services offered by school hired staff and is designed to fill in gaps in care

ESMH ESMH OutcomesOutcomes

When Programs are Done Well, we can see Improved grades, attendance, and behavior Decreased discipline referrals Decreased inappropriate referrals to special

education Decreased high intensity use of mental health

services Improved school climate Improved awareness of mental health issues

Three Levels of Three Levels of ProjectProject

Advancing linkages to and coordination between schools and the public mental health system, while advancing knowledge, skills, and resources related to children’s mental health

State County School

Key Structural Key Structural ComponentsComponents

Management Team Advisory Board 4 Counties

Anne Arundel, Baltimore, Harford, St. Mary’s, Washington

4 County Integration Teams 12 PBIS Schools

3 per county and Demonstration Teams

County Integration County Integration TeamsTeams

Comprised of families, educational staff, PBIS leaders, child and adolescent mental health system representatives, leaders from the Department of Juvenile Services, and other community partners

Responsible for pursing improved school-mental health system integration in their county through:

Active communication Needs assessment Resource sharing Problem solving

Demonstration Demonstration TeamsTeams A team at each of three schools per county

(12 schools) The team includes 4-5 people most involved

in the school mental health effort in the building and have some diversity (e.g., school administrators, social workers, school psychologists, etc.)

Ideally, this team can take advantage of already existing teams (PBIS/Student Support) and an existing meeting time. With guidance from the county Integration team and support from the CSMHA, these teams implemented a systematic quality assessment and improvement (QAI) agenda

Demonstration Demonstration ProjectProject

Presents an opportunity for 3 schools in the county to do a very strong assessment of school mental health programming

Based on this assessment and on-site consultation from the CSMHA to each of the teams, the team will implement a quality assessment and improvement process to advance the quality of mental health resources and programming within the school setting

Demonstration “Team” Demonstration “Team” ProcessProcess

1) How well the school coordinates mental health services and links with available community resources2) How well the school implements mental health services3) How knowledgable staff are about evidence-based practices4) How well the school and school staff partner effectively with families5) Extent of exposure to training, knowledge and sense of competency related to identifying mental health concerns and making appropriate referrals

What does my county What does my county receive?receive?

Train-the-Trainer Trainings for PBIS Coaches/Leaders to Enhance Mental Health Identification and Referral and Effective Classroom Management for Students with Mental Health Concerns

Access to the MSMHA website Technical Assistance/Consultation from the CSMHA and

other Management Team Agenices/Organizations Newsletter Highlighting the Five County Initiative A Voice in Improving Mental Health Integration into PBIS

Schools in Maryland More Focus on Red and Yellow Zone Youth Resources to advance mental health identification and

referral and family involvement within the school setting Hopefully Improved Academic and Emotional/Behavioral

Outcomes Funding, $10,000

Sharon GroseHarford County Public

Schools

District District DemographicsDemographics Number of Schools

Elementary 32 Middle 8 High 8

PBIS 10 Elementary 6 Middle 3 High 1

School Mental Health Integration (3) Special (John Archer) Harford Technical Alternative Education

Enrollment & Enrollment & Student Student

Characteristic Characteristic (2006)(2006)

Preschool/PreK/K 3,710

Elementary 14,698 Middle 9,315 High 12,489 Special 158 Alternative Ed

Total=40,212

African American 18.00%

American Indian .56%

Asian 2.30%

Hispanic 2.90%

White 75.52%

Wealth, Expenditures, Wealth, Expenditures, Staffing, Length of Staffing, Length of

Year Year (2005)(2005) Wealth Per Pupil  $253,036  Per Pupil Expenditures  $7,655  Instructional Staff per 1,000 Pupils  60.8  Professional Staff per 1,000 Pupils  13.4  Instructional Assistants per 1,000 Pupils  12.3  Average Length of School Day for Pupils  6.5

hours  Length of School Year for Pupils  180 days 

School-Mental School-Mental Health IntegrationHealth Integration

Goal is to improve: coordination and linkages between

schools and mental health systems referral and identification of mental

health issues among students Enhance integrated approaches

to reduce barriers to student learning

Implementation of Implementation of GrantGrant

in HCPSin HCPS Local Goal To integrate PBIS and school mental health

Active Schools Hall’s Crossroads, Edgewood Middle

School, and William Paca/Old Post Road District Coordination

Representatives from each school meet with the Children’s Mental Health Roundtable to share needs

Grant ActivitiesGrant Activities Conduct needs assessment Provide staff development

help teachers and staff to identify students with mental health needs.

give teachers and staff strategies to work with students with mental health problems

Provide resources for staff Provide additional resources during crisis

situations at schools special programs, information for parents

Nancy Lever& Andrea Alexander

SuccessesSuccesses Development of mental health trainings

and resources geared for families, teachers, and providers

Formation of state and county alliances to connect schools and the public mental health systems

Families are engaged as advocates at every level (school, county, state) to represent the family voice in children’s mental health

Less fragmentation and more unification and ownership across community agencies and schools

ChallengesChallenges Sustainability Geographic dispersion Limited professional development

time available Buy-in (school systems and individual

schools) Coordination with existing groups Incorporating the work into the school

environment/culture (not an add-on)

Lessons LearnedLessons Learned Need to continually assess that the right

people are at the table Regular meetings with school,

community, and family partners to advance the shared agenda are essential

Connecting mental health work to advancing academics and the success of PBIS helps to increase buy-in at all levels

Personalizing mental health programming to each school and community is critical

Lessons LearnedLessons Learned (Cont.)(Cont.)

School implementation and district implementation are very different processes each with a different focus

Buy-in at all levels of the system and in-person introduction and ongoing connections is critical

Sustainability is a challenging and an ongoing process that begins at the start of the project and necessitates blended funding and creativity

The efforts of a relatively small scale project can be a catalyst for larger scale efforts

Lessons LearnedLessons Learned (Cont.)(Cont.)

Family connectedness to schools, especially around mental health, is a necessary component that takes time and expertise from family advocates and advocacy groups

Alignment with existing organizations, avoiding duplication of efforts, and filling in gaps in services is essential

All zones (green, yellow, and red) need to be viewed as a priority to increase the success of PBIS

With the right people and a clear focus, anything is possible!

Catherine BradshawJohns Hopkins University

Related Research Related Research CentersCenters

Center for the Prevention of Youth Violence Funded by CDC (Phil Leaf, PI) Focused on Baltimore City

Center for Prevention and Early Intervention Funded by NIMH & NIDA (Nick

Ialongo, PI) Focused on Baltimore City Piloting evidence-based mental health

programs

Related Ongoing & Related Ongoing & Proposed ProjectsProposed Projects

Bullying Prevention Using Internet to facilitate data-based decision making Provides school teams with local data to inform school

improvement plans

Evidence-based MH Programs for Non-responders Grant under review to determine mental health needs of non-

responders Combine school-wide PBIS with targeted programs

PBIS + FBA Grant under review to test combination of SW-PBIS and FBA (P.

Leaf, PI) In collaboration w/ Terry Scott On-site technical assistance in simplified FBA

School-based Wraparound Combines PBIS, ESMH, and wraparound

OUTCOMESINPUTS ACTIVITIES OUTPUTS Intermediate Ultimate

Logic Model for the Wraparound, PBIS, and ESMH Pilot Project

June 21, 2006

TRAININGWraparound Coordinator(Intensive wraparound training, PBIS, crisis, community collaboration, family involvement)Wraparound Team (Intensive wraparound process, referral, family involvement, community collaboration, evidence-based practice)Community Partners (Wraparound overview, PBIS, school-based services, crisis intervention)Parents/Families (Wraparound overview, PBIS, mental health & stigma)Administrators (Integration of PBIS and wraparound, crisis management and planning, family involvement) Teachers/School Staff (Mental health identification, referral, crisis planning, family involvement, behavior management, wraparound)

TECHNICAL ASSISTANCE -Wraparound model-Universal PBIS-Evidence-based practice-Crisis planning & management-Community collaboration-Family Involvement-Mental Health Identification & Referral

LINK EXISTING AGENCIES, SERVICES & INTIAITVES

-School-based mental health-Community-based programs and services-School re-entry-Crisis management-Core service agencies-Children’s Cabinet Systems of Care-MH Transformation Grant

IMPLEMENT SCHOOL-BASED WRAPAROUND

-Assessment-Family involvement-Care Coordination-Integration of services-Mental health services-Program placement-Crisis planning & management

Reduction in inappropriate

referrals for services

Reduction in office discipline referrals

Reduction in suspensions and

acts of school violence

Increased time on task & opportunity

for learning

Reduction of risk factors and increase in protective factors

in children and adolescents

Reduction in need for juvenile services and child protective

services

Increased graduation rates and reduced high school dropout

Reduced disproportionality in

achievement & discipline problems

Increased parental involvement in

educational process

Increased teacher-efficacy for behavior

management

Increased academic performance

Staff available to participate in

wraparound process

80% School-wide universal PBIS implementation

Need and buy-in from school and community

District-level infrastructure to support PBIS,

wraparound, and system integration

Multiple district, state, agency, family, and

university partnerships

Regional expertise in PBIS, evidence-based

practice, family involvement, and

crisis management

Increased linkage protocols,

communication, & coordination across

agencies

Knowledge Transfer-Skills in detecting signs and symptoms of MH problems-Understanding risk and protective factors-Managing mental health problems in schools-Understanding the value of and strategies to encourage family and community partnerships-Implementation of wraparound process-Knowledge of available resources

Improved crisis planning and management

Further stabilization of universal PBIS systems

Development of secondary and tertiary

PBIS systems

Increased use of evidence-based

practices

Maryland’s Approach Maryland’s Approach to Children's Mental to Children's Mental

HealthHealth• System of Care• Local Access Mechanisms

• Navigation functions• Single point of access/no wrong

door• Wraparound – practice model

Current Organization of Wraparound Services &

Supports

Governor’s Office for Children Local Management Boards

Children’s Cabinet

State Agencies(DHMH, DHR, DJS, MSDE)

Local Agency Partners(CSA, DSS, DJS, LSS)

Children, Families and CommunitiesDHMH = Department of Health & Mental Hygiene CSA = Core Service Agency (local mental health)DHR = Department of Human Resources (Child Welfare) DSS = Department of Social ServicesDJS = Department of Juvenile Services DJS = Local/Regional OfficeMSDE = Maryland Department of Education LSS = Local School System

Wraparound Wraparound ImplementationImplementation

Wraparound Funding-develop case rate or alternate funding

mechanism for each enrolled child

Local Management Board (LMB)

Care Management Entity/Unit(could be LMB)

-organize and manage provider network-staff and mange referral and billing process

-responsible for quality assurance and outcome mgmt. and monitoring

Care Coordinator (could be part of Care Management Entity/Unit)-creates child and family team and individualized treatment plan

ProviderProviderProvider

QuestionsQuestions

www.pbismaryland.orwww.pbismaryland.orgg

www.msmha.orgwww.msmha.org