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Promoting Positive Behavioral & Mental Health in Schools:
Promising Practices from Early Childhood through High Schools
Lucille Eber
LiseFox
Beth Harn
Krista Kutash
George Sugai
IL PBIS Network
University of S. FL
University of OR
University of S. FL
University of CT
July 2011 OSEP Project Directors MeetingWashington D.C.
Promoting Positive Behavioral & Mental Health in Schools: Promising Practices from
Early Childhood through High Schools
Audience
PD, SPDG, GSEG, TA&D,
Researchers, Parent
Programs
Agenda (BH Moderator)
10:30 Conceptual Framework
& 10:40 Elementary
(GS)
10:55 Early Childhood
(LF)
11:15 High Schools
(LE)
11:35 Mental Health
Perspective & 11:55
Concluding Comments
(KK)
School-based Mental Health
Challenges
School-family-community disconnect
Variable use of data-based decision
making
Variable use of evidence-based
practices
Poor implementation
fidelity
Reactive exclusionary consequences
Non-evidence-based practices
Special education v. mental health v.
general education
Increase working knowledge of importance, evidence-based practices, & supporting systems of coordinated multi-tiered approaches for promoting positive behavioral &mental health for all children, including children & youth w/ disabilities;
Identify & describe strategies & systems for improving implementation fidelity, durability, & scaling of multi-tiered approaches for promoting positive behavioral & mental health for all children; &
Identify & describe capacity-expanding strategies & systems that promote positive behavioral & mental health development in schools & educational programs.
ObjectivesEvidence-
basedPractices
& Systems
ImplementationFidelity
ImplementationSustainability
& Scaling
VIOLENCE PREVENTION
Positive predictable school-wide
climate High rates academic &
social success
Formal social skills
instructionPositive active supervision & reinforcement
Positive adult role models
Multi-component, multi-year school-family-community effort VIOLENCE
PREVENTION
• Surgeon General’s Report on Youth Violence (2001)
• Coordinated Social Emotional & Learning (Greenberg et al., 2003)
• Center for Study & Prevention of Violence (2006)
• White House Conference on School Violence (2006)
Conceptual Logic!Successful individual student behavior & mental health support is linked to host environments or schools & communities that are effective, efficient, relevant, durable, scalable, & logical for all students(Zins & Ponti, 1990)
Effective Work
Efficient Doable
Relevant Cultural/contextual
Durable Lasting
Scalable Transferrable
Logical Conceptually sound
Positive Behavior & Mental Health
Framework for enhancing adoption & implementation of
Continuum of evidence-based interventions to achieve
Academically & behaviorally important outcomes for
All students
IMPLEMENTATION W/ FIDELITY
CONTINUUM OF EVIDENCE-BASEDINTERVENTIONS
CONTENT EXPERTISE &
FLUENCY
TEAM-BASED IMPLEMENTATION
CONTINUOUSPROGRESS
MONITORING
UNIVERSAL SCREENING
DATA-BASEDDECISION MAKING
& PROBLEM SOLVING
RtI
Prevention Logic for AllBiglan, 1995; Mayer, 1995; Walker et al., 1996
Decrease development
of new problem
behaviors
Prevent worsening &
reduce intensity of
existing problem
behaviors
Eliminate triggers &
maintainers of problem
behaviors
Prompt, teach,
monitor, & acknowledge
prosocial behavior
Consideration of risk & protective factors in redesign of teaching environments…not students
Primary Prevention:School-/Classroom-Wide Systems for
All Students,Staff, & Settings
Secondary Prevention:Specialized Group
Systems for Students with At-Risk Behavior
Tertiary Prevention:Specialized
IndividualizedSystems for Students
with High-Risk Behavior
~80% of Students
~15%
~5%
CONTINUUM OFSCHOOL-WIDE
INSTRUCTIONAL & POSITIVE BEHAVIOR
SUPPORT
ALL
SOME
FEW
“Early Triangle”
(p. 201)Walker, Knitzer,
Reid, et al., CDC
Universal
Targeted
Intensive
All
Some
FewContinuum of Support for
ALL
Dec 7, 2007
Universal
Targeted
IntensiveContinuum of
Support for ALL“Theora”
Dec 7, 2007
Science
Soc Studies
Reading
Math
Soc skills
Basketball
Spanish
Label behavior & practice…not people
Universal
Targeted
IntensiveContinuum of Support for
ALL:“Molcom”
Dec 7, 2007
Prob Sol.
Coop play
Adult rel.
Anger man.
Attend.
Peer interac
Ind. play
Self-assess
Label behavior & practice…not people
Detrich, Keyworth, & States (2007). J. Evid.-based Prac. in Sch.
Startw/
What Works
Focus on Fidelity
Enhancing Adult Behavior
1.
“Change is slow,
difficult, gradual process
for teachers
2.
“Teachers need to receive regular
feedback on student learning
outcomes”
3.
“Continued support & follow-up
are necessary after initial training”
Guskey, 1986, p. 59
SYST
EMS
PRACTICES
DATASupportingStaff Behavior
SupportingStudent Behavior
OUTCOMES
Supporting Social Competence &Academic Achievement
SupportingDecisionMaking
IntegratedElements
Funding Visibility PolicyPoliticalSupport
Training CoachingBehavioral Expertise
Evaluation
LEADERSHIP TEAM(Coordination)
Local School/District Implementation Demonstrations
SWPBS Implementation
Blueprint
www.pbis.org
Where are you in implementation process?Adapted from Fixsen & Blase, 2005
• We think we know what we need, so we ordered 3 month free trial (evidence-based)
EXPLORATION & ADOPTION
• Let’s make sure we’re ready to implement (capacity infrastructure)
INSTALLATION
• Let’s give it a try & evaluate (demonstration)
INITIAL IMPLEMENTATION
• That worked, let’s do it for real (investment)
FULL IMPLEMENTATION
• Let’s make it our way of doing business (institutionalized use)
SUSTAINABILITY & CONTINUOUS
REGENERATION
Algozzine, B., Wang, C., & Violette, A. S. (2011). Reexamining the relationship between academic achievement and social behavior. Journal of Positive Behavioral Interventions, 13, 3-16.
Burke, M. D., Hagan-Burke, S., & Sugai, G. (2003). The efficacy of function-based interventions for students with learning disabilities who exhibit escape-maintained problem behavior: Preliminary results from a single case study. Learning Disabilities Quarterly, 26, 15-25.
McIntosh, K., Chard, D. J., Boland, J. B., & Horner, R. H. (2006). Demonstration of combined efforts in school-wide academic and behavioral systems and incidence of reading and behavior challenges in early elementary grades. Journal of Positive Behavioral Interventions, 8, 146-154.
McIntosh, K., Horner, R. H., Chard, D. J., Dickey, C. R., and Braun, D. H. (2008). Reading skills and function of problem behavior in typical school settings. Journal of Special Education, 42, 131-147.
Nelson, J. R., Johnson, A., & Marchand-Martella, N. (1996). Effects of direct instruction, cooperative learning, and independent learning practices on the classroom behavior of students with behavioral disorders: A comparative analysis. Journal of Emotional and Behavioral Disorders, 4, 53-62.
Wang, C., & Algozzine, B. (2011). Rethinking the relationship between reading and behavior in early elementary school. Journal of Educational Research, 104, 100-109.
Academic-Behavior Connection
“Viewed as outcomes, achievement and
behavior are related; viewed as causes of
each other, achievement and behavior are
unrelated. In this context, teaching behavior
as relentlessly as we teach reading or other
academic content is the ultimate act of
prevention, promise, and power underlying
PBS and other preventive interventions in
America’s schools.”
Algozzine, Wang, & Violette (2011), p. 16.
Bradshaw, C.P., Koth, C.W., Thornton, L.A., & Leaf, P.J. (2009). Altering school climate through school-wide Positive Behavioral Interventions and Supports: Findings from a group-randomized effectiveness trial. Prevention Science, 10(2), 100-115
Bradshaw, C.P., Koth, C.W., Bevans, K.B., Ialongo, N., & Leaf, P.J. (2008). The impact of school-wide Positive Behavioral Interventions and Supports (PBIS) on the organizational health of elementary schools. School Psychology Quarterly, 23(4), 462-473.
Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of School-Wide Positive Behavioral Interventions and Supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12, 133-148.
Bradshaw, C.P., Reinke, W. M., Brown, L. D., Bevans, K.B., & Leaf, P.J. (2008). Implementation of school-wide Positive Behavioral Interventions and Supports (PBIS) in elementary schools: Observations from a randomized trial. Education & Treatment of Children, 31, 1-26.
Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., & Esperanza, J., (2009). A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Journal of Positive Behavior Interventions, 11, 133-145.
Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptionality, 42(8), 1-14.
RCT & Group Design PBIS Studies
• Reduced major disciplinary infractions
• Improvements in academic achievement
• Enhanced perception of organizational health
& safety• Improved school climate• Reductions in teacher reported bullying
behavior
~80% of Students
~5%
ESTABLISHING CONTINUUM of SWPBS
SECONDARY PREVENTION• Check in/out• Targeted social skills
instruction• Peer-based supports• Social skills club•
TERTIARY PREVENTION• Function-based support• Wraparound• Person-centered planning• •
PRIMARY PREVENTION• Teach SW expectations• Proactive SW discipline• Positive reinforcement• Effective instruction• Parent engagement•
SECONDARY PREVENTION• • • • •
TERTIARY PREVENTION• • • • •
PRIMARY PREVENTION• • • • • •
~15%
Behavior Support Elements
Problem Behavior
Functional Assessment
Intervention & Support Plan
Fidelity of Implementation
Impact on Behavior & Lifestyle
*Response class*Routine analysis*Hypothesis statement *Alternative behaviors
*Competing behavior analysis *Contextual fit*Strengths, preferences, & lifestyle outcomes*Evidence-based interventions
*Implementation support*Data plan
*Continuous improvement*Sustainability plan
• Team-based• Behavior competence
SW-PBIS “Current Efforts”
Cultural diversity & relevance
Bullying behavior
DisproportionalityHigh poverty, low achieving districts
High schools
Implementation fidelity, durability,
scaling
vPromising Practices for Early
Childhood
The ContextThe Context
Concerns about increases in children’s challenging behavior
Growing awareness of the relationship between social emotional development and school readiness
Myriad of approaches to address particular social emotional issues; lacking comprehensive models
Reliance on clinical approaches
Pyramid ModelPyramid Model
UniversalPromotion
SecondaryPrevention
TertiaryIntervention
28
Nurturing and Responsive Relationships
Nurturing and Responsive Relationships
Foundation of the pyramidEssential to healthy social developmentIncludes relationships with children,
families and team members
29
High Quality EnvironmentsHigh Quality Environments
Inclusive early care and education environments
Comprehensive system of curriculum, assessment, and program evaluation
Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC
30
Supportive Home Environments
Supportive Home Environments
Supporting families and other caregivers to promote development within natural routines and environments
Providing families and other caregivers with information, support, and new skills
Targeted Social Emotional Supports
Targeted Social Emotional Supports
Self-regulation, expressing and understanding emotions, problem solving, developing social relationships
Explicit instructionIncreased opportunities for
instruction, practice, feedback
Family partnershipsProgress monitoring and
data-based decision-making
32
Targeted Social Emotional Supports
Targeted Social Emotional Supports
The support and coaching of families to enhance their child’s social development within natural environments and activities
Self-regulation, expressing and understanding emotions, developing social relationships
33
Individualized Intensive Interventions
Individualized Intensive Interventions
Team developed
Parents as partners
Comprehensive interventions (all environments)
Assessment-based (functional assessment)
Skill-building
The Pyramid Model: Program-Wide Implementation
ALL Levels Require Administrative
Support
Data-Based Decision Makingincluding screening and progress monitoring
Program-Wide Commitment
Teacher Training and Technical
Assistance (coaching)
Well-Defined Procedures
Partnerships with Families
Mental HealthMental Health
Framework for the Early Childhood Mental Consultant to build capacity
Emphasis on prevention with intensive individualized intervention available
Embedded screening for efficient identification and support
Comprehensive interventions that focus children and families
See www.ecmhc.org for resources
OutcomesOutcomes
Teacher and parent satisfaction
Continual growth in implementation fidelity (practitioners and programs)
Decreases in behavior incidents
Experimental Child Outcomes
Experimental Child Outcomes
Non-target children
Differences between social skills scores for children in intervention versus control classrooms (Cohen’s d = .46).
Lower mean scores for problem behavior
Target children
Higher mean social skills scores in intervention classrooms (Cohen’s d = .41).
Differences in problem behavior scores
Significant differences in frequency of positive social interactions
The non-system of early childhoodThe non-system
of early childhood
“Early childhood policies and procedures are highly fragmented, with complex and confusing points of entry that are particularly problematic for underserved populations and those with special needs. This lack of an integrative early childhood infrastructure makes it difficult to advance prevention-oriented initiatives for all children and to coordinate services for those with complex problems.”
(Shonkoff & Phillips, 2000, p.11)
Partnership for Scaling UpPartnership for Scaling Up
Center on the Social and Emotional Foundations for Early Learningwww.vanderbilt.edu/csefel/
Primary Partner Associations
Primary Partner Associations
Division for Early Childhood of the Council for
Exceptional Children (DEC)
IDEA Infant and Toddler Coordinators Association (ITCA)
National Association for Bilingual Education
(NABE)
National Association of Child Care Resource & Referral Agencies (NACCRRA)
National Association for the Education of Young Children (NAEYC)
National Association of State Directors of Special Education
(NASDSE)
National Association of State Mental Health Program Directors (NASMHPD)
National Head Start Association (NHSA)
Parent Advocacy Coalition for Educational Rights (PACER)
IDEA 619 Consortium
CommitmentCommitment
Unified messageEvidence-based practicesComprehensive approach for supporting/promoting the
social emotional competence of all childrenFocus on the enhancement of social competencies
rather than the remediation of problemsApplication to the full range of programs and service
settings Affordable, feasible, and acceptable to diverse
personnel, families and communities
Changing PracticeChanging Practice
Training alone is inadequateCoaching is necessary for translation of
training to classroom practiceFidelity of implementation focus of coachingAdministrative support and systems change
necessary for sustained adoptionData driven systems necessary for ensuring
targeted program, practitioner, and child outcomes
Capacity BuildingCapacity Building
State Cross Sector Leadership Team• Building a system for ongoing training and technical assistance
for scaling up the implementation of the model within programs across service systems
Master T/TA CadreExpertise in all aspects of model Will provide training (of additional trainers, coaches, and
practitioners), external coaching, guide program-wide implementation, support data collection
Demonstration SitesData System
System and procedures for measuring implementation fidelity, outcomes, and using data for decision-making
Promoting Positive Behavioral and
Mental Health in Schools:
Promising Practices from
Early Childhood Through High School
Lucille Eber, Statewide Director, IL PBIS Networkwww.pbisillinois.org
Supporting Youth at the Secondary Level
OSEP Project Director’s ConferenceWashington DCJuly 19, 2011
Big Ideas
• Challenges and Context• A multi-tiered Systemic Approach• Effect of PBIS on existing ‘clinical’ supports
in place in schools and a developing model in IL
• A developing national model: National SMH and National PBIS Center
Some “Big Picture” Challenges
• Low intensity, low fidelity interventions for behavior/emotional needs
• Habitual use of restrictive settings (and poor outcomes) for youth with disabilities
• High rate of undiagnosed MH problems (stigma, lack of knowledge, etc)
• Changing the routines of ineffective practices (systems) that are “familiar” to systems
Why We Need MH Partnerships
• 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• 1-2% identified by schools as EBD• Those identified have poor outcomes• Suicide is 4th leading cause of death
among young adults
It Takes a System…
Tier 3/Tertiary Interventions 1-5%• Individual students• Assessment-based• High intensity
1-5% Tier 3/Tertiary Interventions• Individual students• Assessment-based• Intense, durable procedures
Tier 2/Secondary Interventions 5-15%• Some students (at-risk)• High efficiency• Rapid response• Small group interventions• Some individualizing
5-15% Tier 2/Secondary Interventions• Some students (at-risk)• High efficiency• Rapid response• Small group interventions• Some individualizing
Tier 1/Universal Interventions 80-90%• All students• Preventive, proactive
80-90% Tier 1/Universal Interventions• All settings, all students• Preventive, proactive
School-Wide Systems for Student Success:
A Response to Intervention (RtI) ModelAcademic Systems Behavioral Systems
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/schoolwide.htm
Core Features of a Response to Intervention
(RtI) Approach• Investment in prevention• Universal Screening• Early intervention for students not at
“benchmark”• Multi-tiered, prevention-based intervention
approach• Progress monitoring• Use of problem-solving process at all 3-tiers• Active use of data for decision-making at all 3-
tiers• Research-based practices expected at all 3-tiers• Individualized interventions commensurate with
assessed level of need
Examples of Ineffective Secondary/Tertiary Structures
• Referrals to Sp. Ed. seen as the “intervention”
• FBA seen as required “paperwork” vs. a needed part of designing an intervention
• Interventions the system is familiar with vs. ones likely to produce an effect – (ex: student sent for insight based
counseling at point of misbehavior)
Tier 1/Universal School-Wide Assessment
School-Wide Prevention Systems
SIMEO Tools: HSC-T, RD-T, EI-T
Check-in/ Check-out
Individualized Check-In/Check-Out, Groups & Mentoring (ex. CnC)
Brief Functional Behavioral Assessment/Behavior Intervention Planning (FBA/BIP)
Complex FBA/BIP
Wraparound/RENEW
ODRs, Attendance, Tardies, Grades, DIBELS, etc.
Daily Progress Report (DPR) (Behavior and Academic Goals)
Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc.
Social/Academic Instructional Groups
Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model
Illinois PBIS Network, Revised April2011Adapted from T. Scott, 2004
Tier 2/Secondary
Tier 3/Tertiary
Inte
rven
tio
nAssessm
en
t
Interconnected Systems Framework paper
Examples from the Field
Provided by:
Colette Lueck, Managing Director, Illinois Children's Mental Health Partnership Lisa Betz, Mental Health and Schools Coordinator, IL Division of MH
The IL PBIS Network Team
Community Partners Roles in Teams
• Participate in all three levels of systems teaming: Universal, Secondary, and Tertiary
• Facilitate or co-facilitate tertiary teams around individual students
• Facilitate or co-facilitate small groups with youth who have been identified in need of additional supports
Tier I: Universal/Prevention for AllCoordinated 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 students• Safe & caring learning environments • Partnerships between school, home and the community• Decision making framework used to guide and implement best practices that
consider unique strengths and challenges of each school community
Tier 2: Early Intervention for SomeCoordinated Systems for Early Detection, Identification,
and Response to Mental Health Concerns
• Systems Planning Team identified to coordinate referral process, decision rules and progress monitor impact of intervention
• Array of services available• Communication system for staff, families and community • Early identification of students who may be 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
Tier 3: Intensive Interventions for FewIndividual Student and Family Supports
• Systems Planning team coordinates decision rules/referrals
for this level of service and progress monitors• Individual team developed to support each student • Individual plans may have array of interventions/services• Plans can range from one to multiple life domains• System in place for each team to monitor student progress
Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children ’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters.
Interconnected Systems Framework for School Mental Health
Tier 1 - Universal• Interventions that target the entire population of a school to
promote and enhance wellness by increasing pro-social behaviors, emotional wellbeing, skill development, and mental health.
• This includes school-wide programs that foster safe and caring learning environments that, engage students, are culturally aware, promote social and emotional learning and develop a connection between school, home, and community.
• Data review should guide the design of Tier 1 strategies such that 80-90% of the students are expected to experience success, decreasing dependence on Tier II or III interventions.
• The content of Tier 1/Universal approaches should reflect the specific needs of the school population.
• For example, cognitive behavioral instruction on anger management techniques may be part of a school-wide strategy delivered to the whole population in one school, while it may be considered a Tier 2 intervention, only provided for some students, in another school.
Tier 2 - Secondary• Interventions at Tier 2 are scaled-up versions of Tier 1 supports
for particular targeted approaches to meet the needs of the roughly 10-15% of students who require more than Tier 1 supports.
• Typically, this would include interventions that occur early after the onset of an identified concern, as well as target individual students or subgroups of students whose risk of developing mental health concerns is higher than average.
• Risk factors do not necessarily indicate poor outcomes, but rather refer to statistical predictors that have a theoretical and empirical base, and may solidify a pathway that becomes increasingly difficult to shape towards positive outcomes.
• Examples include loss of a parent or loved one, or frequent moves resulting in multiple school placements or exposure to violence and trauma.
• Interventions are implemented through the use of a comprehensive developmental approach that is collaborative, culturally sensitive and geared towards skill development and/or increasing protective factors for students and their families.
Tier 3 - Tertiary• Interventions for the roughly 1-5% of individuals who are
identified as having the most severe, chronic, or pervasive concerns that may or may not meet diagnostic criteria.
• Interventions are implemented through the use of a highly individualized, comprehensive and developmental approach that uses a collaborative teaming process in the implementation of culturally aware interventions that reduce risk factors and increase the protective factors of students.
• Typical Tier 3 examples in schools include complex function-based behavior support plans that address problem behavior at home and school, evidence-based individual and family intervention, and comprehensive wraparound plans that include natural support persons and other community systems to address needs and promote enhanced functioning in multiple life domains of the student and family.
Old Approach New Approach• Each school works out
their own plan with Mental Health (MH) agency;
• A MH counselor is housed in a school building 1 day a week to “see” students;
• No data to decide on or monitor interventions;
• “Hoping” that interventions are working; but not sure.
• District has a plan for integrating MH at all buildings (based on community data as well as school data);
• MH person participates in teams at all 3 tiers;
• MH person leads small groups based on data;
• MH person co-facilitates FBA/BIP or wrap individual teams for students.
Example 1: A District-Level Re-Design
Example 2: Planning for Transference and Generalization
• Middle schools SWIS data indicated an increase in aggression/fighting between girls.
• Community agency had staff trained in the intervention Aggression Replacement Training (ART) and available to lead groups in school.
• This evidence-based intervention is designed to teach adolescents to understand and replace aggression and antisocial behavior with positive alternatives. The program's three-part approach includes training in Prosocial Skills, Anger Control, and Moral Reasoning.
• Agency staff worked for nine weeks with students for 6 hours a week; group leaders did not communicate with school staff during implementation.
• SWIS Referrals for the girls dropped significantly during group.
• At close of group there was not a plan for transference of skills (i.e. notifying staff of what behavior to teach/prompt/reinforce).
• There was an increase in referrals following the group ending.
• Secondary Systems team reviewed data and regrouped by meeting with ART staff to learn more about what they could do to continue the work started with the intervention.
• To effect transference and generalization, the team pulled same students into groups lead by school staff with similar direct behavior instruction.
• Links back to Universal teaching of expectations (Tier 1) is now a component of all SS groups (Tier 2).
Example 2: Planning for Transference and Generalization (cont.)
Example #3: Community Clinicians Augment Strategies
• A school located near an Army base had a disproportionate number of students who had multiple school placements due to frequent moves, students living with one parent and students who were anxious about parents as soldiers stationed away from home.
• These students collectively received a higher rate of office discipline referrals than other students.
• The school partnered with mental health staff from the local Army installation, who had developed a program to provide teachers specific skills to address the particular needs students from military families.
• Teachers were able to generalize those skills to other at risk populations.
• As a result, office discipline referrals decreased most significantly for those students originally identified as at risk but also for the student body as a whole.
Example #5: Systems Collaboration and Cost Savings
• A local high school established a mental health team that included a board coalition of mental health providers from the community.
• Having a large provider pool increased the possibility of providers being able to address the specific needs that the team identified using data, particularly as those needs shifted over time.
• In one case, students involved with the Juvenile Justice System were mandated to attend an evidence-based aggression management intervention.
• The intervention was offered at school during lunch and the school could refer other students who were not mandated by the court system, saving both the school and the court system time and resources and assuring that a broader base of students were able to access a needed service.
• As a result of their efforts, the school mental heath team was able to re-integrate over ten students who were attending an off site school, at a cost savings of over $100,000.
Number of IL PBIS High Schoolsas of April 2011
LRE Data Trends at the High School Level
– Significantly higher use of restrictive placements of students with disabilities in most restrictive settings• Over 20% in some high schools
– Drop out rates exacerbate the issue– Students with any behavioral/emotional
component to disability more likely to be placed and/or drop out
– ….and lots more NOT identified with a disability
How High Schools Are Different
• Size• Expectations of staff• Staff is departmentalized• More groundwork is needed• Teams can become layered• Implementation comes more slowly
They’re not as different as they think they are!
The concepts are the same but the practices may look different.
Building-level Team Development
Core Team
Teaching
Acknowledgement
Data
Communication
SECONDARY• Check In Check out (CICO)
– Training with high school examples
– TA with only high schools
• Small Group Interventions (SA/IG)
• Check & Connect (C&C)– University of Minnesota
• Brief FBA/BIP
TERTIARY
• Complex FBA/BIP• Wrap-Around applying RENEW
– Two day training– SIMEO training– Follow up phone TA– Follow up TA days
Rehabilitation, Empowerment, Natural Supports, Education and Work {RENEW}
J. Malloy and colleagues at UNH
• Developed in 1996 as the model for a 3-year RSA-funded employment model demonstration project for youth with “SED”
• Focus is on community-based, self-determined services and supports
• Promising results for youth who typically
have very poor post-school outcomes (Bullis & Cheney; Eber, Nelson & Miles, 1997; Cheney, Malloy & Hagner, 1998) 71
RENEW Overview
• RENEW (Rehabilitation, Empowerment, Natural Supports, Education and Work) is an application of wraparound – Reflects key principles: person-centered,
community and strengths-based, natural supports
– Focused on student, versus parent engagement (e.g., student-centered teams, student-developed interests)
RENEW Overview
• The RENEW framework and the practice of mapping are ideal for engaging older students – For example, a key element of transition
planning, especially for older students, is building in opportunities/activities that the student has identified as important to their personal development
Promoting Positive Behavioral and Mental Health in Schools: Promising Practices from Early Childhood through
High School
Office of Special Education Programs (OSEP) Annual ConferenceJuly 2011 – Washington DC
The Mental Health Perspective
Krista Kutash, Ph.D.Department of Child & Family Studies
University of South Florida
74
Integrating Education and Mental Health Into
School-Based Mental Health
Historically, difficult to establish effective partnerships
For many reasons….
75
Contrasting Perspectives
Important Theoretical Influences
Education System
Behaviorism,
Social Learning Theory
Mental Health System
Behavior Theory,
Cognitive Theory,
Developmental Psychology,
Biological/Genetic Perspective,
Psychopharmacology
76
Contrasting Perspectives
Focus of Intervention
Education System Behavior Management,
Skill Development,
Academic Improvement
Mental Health SystemInsight,
Awareness,
Improved Emotional Functioning
77
Education / Mental Health System
Improving Social and Adaptive Functioning.
Importance of and Need to Increase Availability, Access, and Range of Services
Perspectives
Common Focus
78
What about evidence based practices….???
79
Evidence Based Practices
• Last Count = 92 mental health and SEL programs across five sources
• 53% of the programs aimed at universal level and 47% aimed at the selective/indicated levels
• 58% of the programs are school-based, 26% community based and 16% both community and school based
• 61% have a family component and 47% have a teacher component.
80
• A 2007 examination of 2,000 studies of School-based Mental Health Programs revealed;– 3% used rigorous empirical designs– 37% examined school outcomes – 15 programs dually effective at
meeting both academic & behavioral needs of youth.
81
Evidence Based Practices
82
Effect sizes for emotional functioning, functional impairment, & achievement.
Integrated 1Integrated 2
Pull-Out 1Pull-Out 2
-0.4
-0.2
0
0.2
0.4
0.6
0.8
Emotional Functioning Functional Impairment Reading Math
Effect Size
Program
Kutash, K., Duchnowski, A.J., Green, A.L. (in press). School-based mental health programs for students who have emotional disturbances: Academic and social-emotional outcomes. School Mental Health.
Refocus School-Based Mental Health Services On the Core Foundation of
Schools:To Promote Learning
83
The Refocused Role of Mental Health Services
• Support Teachers: the Primary Change Agents
• Mental Health Providers Become: “Educational Enhancers”
• Serve the Core Function of Schools• Promoting Social/Emotional
Development, no Longer Tangential
84
Need to Involve Parents & Families
85
86
Common Vision
Families (FAM)Mental Health (MH)Education (ED)
IntensiveStudents in
Special Ed due to Emotional Disturbances
ED – FBA / PBS
MH – Assessment
FAMEDMH
EDFAMMH
Cognitive Behavior Therapy and other EBPs
Team Monitors Progress
UniversalAll Students
ED – PBS
MH - Screening
FAMED MH
EBP’s (PATHS)
SelectiveAt-Risk Students
ED – FBA / PBS
MH – Assessment
FAMED MH
MHED
EDMHFAM
Group Interventions
Team Monitors Progress
RtI
Implementedin organizations
that support and facilitatecollaborative, integrated
systems of services.
Integrated Partnership
Some Program Models with Organizational
Potential for Success
87
“The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better.”
– Weiss, 2002
…unless it is getting and using
data…
88
89
Model of Implementation Complexity
FIT
Does the innovation fit within your
organization
Complement or Compete?
CLIMATE
Willing to remove
obstacles?
Are there rewards?
Leadership support?
Clarity of Goals?
IMPLEMENTATION EFFECTIVENESS
Can you implement the innovation with
accuracy and fidelity?
INNOVATION EFFECTIVENESS
Impact of innovation,
commitment, and satisfaction
VOLITION
Is there capacity and willingness to implement?
FIDELITY BELIEFS
Favorable attitudes toward practice Complexity of innovation
System Integration Strategies: Systems of Care
Effective Service Systems Requires• A range of services with a community• Collaboration between service sectors, organizations, parents and professionals
• Attention to careful planning• Performance measurement• Continuous quality improvement• Comprehensive Financing Plan• Individualized, comprehensive and Culturally Competent services
• Transformative Leadership
90
Recently Concluded Study – SOC-IS(Surveyed 225 Randomly Selected Counties
on Their Level of SOC Implementation)
91
National Levels of Implementation of Systems of Care
•75% of the counties surveyed rated themselves as having adequate implementation on 6 or more of the 14 factors associated with Systems of Care
• 26% of counties surveyed rated them selves as having adequate levels of implementation on 11 of the 14 factors associated with Systems of Care
92
Implementing Systems of Care 6 Factors that had the highest levels of implementation nationally
• Systems management approach • Leadership • Services based a statement of values & principles • Family voice and choice • Individualized, comprehensive cultural competent treatment • A written theory of change for system improvement
2 Factors with the lowest levels of implementation
• An implementation plan for service system improvement• An adequate level of skilled provider network
93
Systems of Care
Information on the Systems of Care slides based on:
Kutash K., Greenbaum P., Wang W., Boothroyd R., Friedman R. (2011) Levels of system of care implementation: A national benchmarking study. Journal of Behavioral Health Services and Research, 2011; 38(3).
Boothroyd R.A., Greenbaum P.E., Wang W., Kutash K., Friedman R. (2011) Development of a measure to assess the implementation of children’s systems of care: The system of care implementation survey (SOCIS). Journal of Behavioral Health Services and Research, 2011; 38(3).
Greenbaum P.E., Wang W., Boothroyd R., Kutash K., Friedman R.M. Multilevel confirmatory factor analysis of the system of care implementation survey (SOCIS) (2011). Journal of Behavioral Health Services and Research, 2011; 38(3).
Lunn L.M., Heflinger C.A., Wang W., Greenbaum P.E., Kutash K., Boothroyd R.A., Friedman R.M. (2011). Community characteristics and implementation factors associated with effective systems of care. Journal of Behavioral Health Services and Research, 2011; 38(3).
94
95
Alice said to the Cheshire Cat: “Would you tell me please, which
way I ought to go from here?”
“That depends a good deal on where you want to get to,” said the Cat.
“I don’t much care where,” said Alice.
“Then it doesn’t matter which way you go,” said the Cat.
…it depends a good deal
on where you
want to get to…
Where do we go from here?
• Build on strengths of schools • Build on strengths of families • Focus on learning• Improve & build feedback
systems• Provide services & system
coaches • and of course ….
96
Fund More Research
97
A written summary of many of the points made in this presentation can be found in the following materials:
Atkins, M., Hoagwood, K., Kutash, K., & Seidman, E. (2010) Toward the Integration of Education and Mental Health in Schools. Administration and Policy in Mental Health and Mental Health Services Research, 37, 40-47.
Reducing Behavior Problems in the Elementary School Classroom
This guide is intended to help elementary school educators as well as school and district administrators’ develop and implement effective prevention and intervention strategies that promote student behavior. The guide includes concert recommendations and indicates the quality of the evidence that supports them. Additionally, we have described some ways in which each recommendation could be carried out. For each recommendation, we also acknowledge roadblocks to implementation that may be encountered and suggest solutions that have the potential to circumvent the roadblocks. Finally, technical details about the studies that support the recommendations are provided in the Appendix. Download a free copy at: http://ies.ed.gov/pubsearch/pubsinfo.asp?pubid=WWC2008012
School-Based Mental Health: An Empirical Guide for Decision-MakersKrista Kutash, Ph.D., Albert J. Duchnowski, Ph.D., Nancy Lynn, M.S.P.H.
This monograph provides a discussion of barriers to school-based services with the intention of improving service effectiveness and capacity. Reviews the history of mental health services supplied in schools, implementation of services and provides an overview of the evidence base for school-based interventions. Includes recommendations for evidence-based mental health services that can be used in schools. Download a free copy at: http://rtckids.fmhi.usf.edu/rtcpubs/study04/Or purchase a printed copy for $5.95 at https://fmhi.pro-copy.com/