Integrating School Mental Health and PBIS: Examples at All 3 Tiers
Michele Capio, Oak Park School DistrictPam Horn, Elgin School District U-46
Kelly Perales, Community Care Behavioral Health
Agenda
• Describe key features of the Interconnected Systems Framework (ISF)
• Share tools that have been developed and how to use them in practice
• Share examples of early implementation at all three tiers
Connectionsand
Partnerships
• OSEP National PBIS Technical Assistance Center (www.pbis.org)
• Center for School Mental Health (www.csmh.umaryland.edu)
• NASDSE (www.ideapartnership.org)• National COP for SBBH (www.sharedwork.org)
BIG Ideas…
• How Multi-tiered Systems of Support (MTSS) can enhance mental health in schools
• Installing SMH through MTSS in Schools• The Interconnected Systems Framework (ISF)
SMH +MTSS=ISF
History-Rationale
• Sparse availability of MH providers in schools• Labels and ‘places’ confused with
interventions• Separate delivery systems (Sp.Ed., Mental
health, etc)• Minimal accountability for outcomes for most
vulnerable populations
Why Partnership Are Needed
• 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• Suicide is 4th leading cause of death among
young adults
SMH and PBISCommon Purpose
• Schools supporting/promoting MH of ALL students
• Prevention, early access, interventions commensurate with level of need (vs label)
• School personnel feel confident and competent in identifying and intervening with accuracy and effectiveness
Logic
– Youth with MH needs require multifaceted education/behavior and mental health supports
– The usual systems have not routinely provided a comprehensive, blended system of support.
– Supports need to be provided in a clustered and integrated structure,
– Academic/behavior and mental health supports need to be efficiently blended
Promotion and Prevention
Simple and complex supports require integrated systems with foundation of a school-wide system
• Schools and community serve as protective factor• problem-solving teams with
school/family/youth/community voice• use of data for decision-making (screening/ selection
and monitoring/outcomes)• layers supports from the foundational/universal to the
more complex
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%
SCHOOL-WIDE POSITIVE BEHAVIOR
SUPPORT:
What is meant by “layering”
interventions?
Core Features of a Response to Intervention (RtI) Approach
• Investment in prevention, screening and early intervention for students not at “benchmark”
• Multi-tiered intervention approach
• Use of progress monitoring and problem-solving process at all 3-tiers
Core Features of a Response to Intervention (RtI) Approach
• Research-based practices and active use of data for decision-making at all 3-tiers
• Use of progress monitoring and problem-solving process at all 3-tiers
3-Tiered System of Support
Necessary Conversations (Teams)
Check-In Check-Out
Skills Groups
Group w. individual
feature
Complex
FBA/BIP
Problem Solving Team Meeting
Tertiary Systems Team Meeting
Brief
FBA/BIP
Brief FBA/BIP
Wraparound
Secondary Systems Team
Meeting
Plans schoolwide &
classroom supports
Uses process data; determines overall
intervention effectiveness
Standing team; uses FBA/BIP process for one student at a time
Uses process data; determines overall
intervention effectiveness
Rev. 11.19.2012
UniversalTeam
Meeting
Universal Support
Illinois PBIS Network
Tier 1/Universal School-Wide Assessment
School-Wide Prevention Systems
SIMEO Tools: HSC-T, SD-T, EI-T
Check-in/ Check-out (CICO)
Group Intervention with Individualized Feature (e.g., Check and Connect -CnC and Mentoring)
Brief Functional Behavior Assessment/Behavior Intervention Planning (FBA/BIP)
Complex or Multiple-domain FBA/BIP
Wraparound
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 (SAIG)
Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model
Illinois PBIS Network, Revised October 2009Adapted from T. Scott, 2004
Tier 2/Secondary
Tier 3/Tertiary
Inte
rven
tio
nAssessm
en
t
Definition of school mental health •Involves partnership between schools and community health/mental health organizations, as guided by families and youth
•Builds on existing school programs, services, and strategies
•Focuses on all students, both general and special education
•Involves a full array of programs, services, and strategies- mental health education and promotion through intensive intervention
(Weist & Paternite, 2006)
“Expanded” School Mental Health
• Full continuum of effective mental health promotion and intervention for ALL students
• Reflecting a “shared agenda” involving school-family-community partnerships
• Collaborating community professionals (augment the work of school-employed staff
The Context
• Over 18,000 schools engaged in implementation of SWPBIS (MTSS ) prevention based system
• Current focus on capacity to scale-up • MTSS as platform to install effective
interventions for youth w/or at-risk of EBD
The Context (cont.)
• Emphasis now on scaling with expansion and connection to other systems – i.e. academic, juvenile justice, mental health, child
welfare, systems of care
• Emphasis on deliberate actions that foster connections w/families & community
Development of ISF
• 2002-2007: Site Development with PBIS Expansion (informal and independent)
• 2005 CoP focus on integration of PBIS and SMH• 2008: ISF White Paper: formal partnership between
PBIS and SMH• 2009- 2013 Monthly calls with implementation sites,
national presentations (from sessions to strands)• 2009-2011 Grant Submissions• June 2012- September 2013 ISF Monograph• Monograph Advisory group
Interconnected Systems Framework paper
(Barrett, Eber and Weist , revised 2009)
Developed through a collaboration of theNational SMH and National PBIS Centers
www.pbis.org http://csmh.umaryland.edu
• Define the common goals of SMH and PBIS
• Discuss the advantages of interconnection
• Identify successful local efforts to implement collaborative strategies and cross-initiative efforts
• Define the research, policy, and implementation agendas to take us to the next action level
ISF Monograph DevelopmentJune 2012 – September 2013
ISF Defined– ISF provides structure and process for education and mental
health systems to interact in most effective and efficient way. – ISF is guided by key stakeholders in education and mental health
system who have the authority to reallocate resources, change role and function of staff, and change policy.
– ISF applies strong interdisciplinary, cross-system collaboration.
ISF Defined– ISF uses the tiered prevention logic as the overall
organizer to develop an action plan.– ISF involves cross system problem solving teams that
use data to decide which evidence based practices to implement.
ISF Defined (cont)
– ISF involves ongoing progress monitoring for both fidelity and impact.
– ISF emphasizes active involvement by youth, families, and other school and community stakeholders.
Interconnected Systems Framework
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 Safe & caring learning environments Partnerships : school, home & community Decision making framework guides use of
and best practices that consider unique strengths and challenges of each school community
MH/PBIS: An Expanded Tier One• Universal screening for social, emotional, and behavioral
at-risk indicators• Universal screening for families who may request
assistance for their children• Teaching social skills with evidence-based curricula to all
students• Teaching appropriate emotional regulation and expression
to all students• Teaching behavioral expectations to all students• Mental health professionals are part of the Tier 1 systems
team, providing input and progress monitoring data• Opportunity to review community data and expand Tier 1
intervention options based on data
Interconnected Systems Framework
Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns
Systems Planning Team coordinates referral process, decision rules and progress monitors
Array of services availableCommunication system: staff, families and community Early identification of students at risk for mental health concerns due to specific risk factorsSkill-building at the individual and groups level as well as support groups
Staff and Family training to support skill development across settings
MH/PBIS: An Expanded Tier Two• Mental health/community professionals part of
secondary systems and problem solving teams• Working smarter matrix completed to ensure key
resources are both efficient and effective (i.e., initiatives are aligned and combined such as “bully prevention”, “discipline”, “character education”, “RtI behavior”, etc.)
• Groups co-facilitated by school staff and community partner (example – guidance counselor and community provider clinician)
• Opportunity to expand the continuum of interventions based on data (i.e. trauma informed interventions)
• Out-reach to families for support/interventions
Interconnected Systems FrameworkTier 3: Intensive Interventions for FewIndividual Student and Family Supports
Systems Planning team coordinates decision rules/referrals and progress monitors
Individual team developed to support each student Individual plans have array of interventions/servicesPlans can range from one to multiple life domains System in place for each team
to monitor student progress
MH/PBIS: An Expanded Tier Three
• Mental health professional(s) part of tertiary systems team
• FBA/BIP and/or person-Centered Wraparound plans completed together with school staff and mental health provider for one concise plan, rather than each completing paperwork to be filed
• Quicker access to community-based supports for students and families
Traditional Preferred
• Each school works out their own plan with Mental Health (MH) agency;
• District has a plan for integrating MH at all buildings (based on community data as well as school data);
Traditional Preferred
• A MH counselor is housed in a school building 1 day a week to “see” students;
• MH person participates in teams at all 3 tiers;
Traditional Preferred
• No data to decide on or monitor interventions;
• MH person leads group or individual interventions based on data;
Structure for Developing an ISF: Community Partners
Roles in Teams
• A District/Community leadership that includes families, develops, supports and monitors a plan that includes:
• Community partners participate in all three levels of systems teaming in the building: Universal, Secondary, and Tertiary
Structure for Developing an ISF: Community Partners Roles in Teams (cont.)
• Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored
• MH providers from both school & community develop, facilitate, coordinate and monitor all interventions through one structure
3-Tiered System of Support Necessary Conversations
CICO
SAIG
Group w. individual
feature
Complex
FBA/BIP
Problem Solving Team
Tertiary Systems Team
Brief
FBA/BIP
Brief FBA/BIP
WRAP
Secondary Systems Team
Plans SW & Class-wide supports
Uses Process data; determines overall
intervention effectiveness
Standing team with family; uses FBA/BIP process for one youth
at a time
Uses Process data; determines overall
intervention effectiveness
Sept. 1, 2009
UniversalTeam
Universal Support
Family and community Family and
community
Family and community
Community
Using and Expanding the Framework
• Change creates uncertainty and fear• Struggle always precedes growth
Help foster new mental map- framework leads to having people think in different ways
Tools• Tools help manage conversation in smaller groups• Lead to minimizing danger and maximizing reward• Lead to overwhelming sense of purpose
David Rock
Current Tools (in development)
• Dialogue Guides (IDEA partnership)• Implementation Guides (Funding, Team)• Crosswalk of Demo Sites (Data, Systems,
Practices)• Readiness Checklist• Resource Mapping• Consumer Guide for Selecting MH practices
U-46 at a Glance
Enrollment: Total school enrollment 40,57054.8% Low Income97 languages spoken in U-46 homes
Facilities: 40 Elementary Schools (PreK-6)8 Middle Schools (7-8) + 1 Alternative Middle School5 High Schools + 2 Alternative High Schools2 Early Childhood Centers
Communities Served:11 communities3 counties (Cook, DuPage, Kane)
SD U-46 Student ProfileBased on School Report Card 2012
MISSIONMISSION The mission of the U-46 School and Community Alliance is to
create, integrate and leverage existing and new school/community partnerships that develop a full continuum of systematic interventions
based on data. It encompasses three intervention tiers:
•Systems for promoting healthy development and preventing problems
•Systems for responding to problems as soon after onset as is feasible
•Systems for providing intensive care
22 Community Partners 78 providers trained in PBIS/SAIG
Boys and Girls Club of Elgin*Centro de Informacion* Community Crisis Center*Crossroads Kids Club* Easter Seals*Elgin Police Department*
Family Service Association of Greater Elgin Area*Fox Valley Pregnancy Center*Fox Valley
Volunteer Hospice*Girl Scouts of Northern Illinois*Hanover Township Youth and Family
Services*Kenneth Young*Kids’ Hope USA*Renz Center*Streamwood Behavioral Healthcare
System*Taylor Family YMCA*The Y*WAYS*West Ridge Community Church*Youth Leadership
Academy
U-46 School and Community Alliance Work Groups
2009-2012
U-46 School and Community Alliance Work Groups 2012-2013
3-Tiered System of Support Necessary Conversations (Teams)
CICO
SAIG
Group w. individual
feature
Complex
FBA/BIP
Problem Solving Team
Tertiary Systems Team
Brief
FBA/BIP
Brief FBA/BIP
WRAP
Secondary Systems Team
Plans SW & Class-wide supports
Uses Process data; determines overall
intervention effectiveness
Standing team; uses FBA/BIP process for one youth at a time
Uses Process data; determines overall
intervention effectiveness
UniversalTeam
Universal Support
Training
• 2009-2013 Separate training for partners (condensed versions of school training)
• 2011-2013 Community partners attend Team Planning Day with their PBIS Tier 2/3 System Teams
• 2012-current Community partners attend full training with school teams
• Examples: Wraparound, RENEW, and Trauma informed CPI
Tier 1 Network Example
Hanover Township Youth & Family Services
• Elementary (Grades 4-5-6) Open Gym• Middle and High School Healthy Living in Health Classes
Elgin High ExampleTier 1 Examples
Boys & Girls Club (Elgin) •Club Elgin: daily, after school
RENZ •Freshman Transition: prevention model
Tier 2 ExamplesBoys & Girls Club (Elgin)
•SAIG: 2-3 groups, not responding to CICO, DPR card electronically
Family Service Association of Greater Elgin •Group Mentoring: 5 groups, 3-5 girls/group, anger management and conflict resolution
Hanover Township Youth & Family Services•Group Mentoring: 2 groups, daily CICO with counselor•Alternative to Suspension Program: restorative program
Tier 2/Social Academic Instruction Groups (SAIG)
• Coordinated by Elgin High School Counselor• Facilitated by Community Partner• Data: Feedback from Teachers and Students• Groups 6-8 weeks• Student identification based on
teacher/dean/counselor input and lack of response to CICO• Agency partners are active members of
secondary systems team
Elgin High School Weekly Progress Report
NS=No School A=Absent all day NP=No show M=Missing data
Period 1 Period 2
Date
Earn & Give Respect Goal (Stop, think and act before reacting to something)
Hold Yourself Responsible (Stop, think and act before reacting to something)
Safety First Goal (Stop, think and act before reacting to something)
Earn & Give Respect Goal (Stop, think and act before reacting to something)
Hold Yourself Responsible (Stop, think and act before reacting to something)
Safety First Goal (Stop, think and act before reacting to something)
2/6/2012
2/7/2012
2/8/2012
2/9/2012
2/10/2012
Weekly Progress ReportEarn and Give Respect (student will not talk back to staff)
Hold Yourself Responsible (Student will be on time to class)
Safety First (Student will wear ID around neck)
1. I attend school regularly2. I skip ___# of classes each week3. I receive all A’s, B’s, and C’s for grades4. I receive _____# of disciplinary referrals per week5. I feel connected to my school6. I feel respected and important while at school7. I can count on friends for support8. I can count on my family members for support
Pre-test/Post-test
I feel connected to my school
I feel respected & important at school
Next Steps at EHS…
Move from instructional short-term groups to long-term group mentoring with skill instruction embedded in the mentoring
Increase communication between deans/facilitators/staff of the interventions
Align initiativesExplore more intensive interventions for
students with unmet mental health needs
Next Steps for Community Alliance…
Increase trauma focus at all three tiersDirectory of partners/agenciesBlend & coordinate initiatives across districtExpand alternative to suspension Utilize district exemplars as examples for
other schoolsIncrease communication between district
and community partners
Using and Expanding the Framework
• Change creates uncertainty and fear• Struggle always precedes growth
Help foster new mental map- framework leads to having people think in different ways
Tools• Tools help manage conversation in smaller groups• Lead to minimizing danger and maximizing reward• Lead to overwhelming sense of purpose
David Rock
Key features• Systems
– District and building teaming models – Facilitation, technical assistance, coaching– Stakeholder participation and buy-in
• Practices– Mental health and school staff work in an integrated way to
support students across tiers– Using assessment and screening in order to determine which
EBPs to use, progress monitor– One plan for both education and mental health
• Data– Shared decision rules– Used for decision making with all stakeholders at the table – school,
mental health, other child serving systems, family
CrosswalksWhat creates the pathway?
Systems, Data, Practices• Systems:
– Identified need (gaps in services, lack of services)– Identified cost savings– Shift in population (increased poverty, homelessness, health concerns)– Frustration with current condition (restrictive, inefficient, ineffective)– Flexible funding source identified (United Way, Walter Reed, community care, blended)– PBIS foundation (provided both structure and process)– Local “Champions”– Demo sites created opportunity– Received Grant (Systems of Care)– Non profit working with school system for district wide change
• Data: Moving beyond Office Referrals and Suspensions to 360 view that include community data
– hearing data, # of student encounters with law enforcement, calls to crisis centers, instructional time lost for services, use of screeners, behavioral health assessments
• Practices: Broader range: EBP with Trauma focus
Scranton, PAHistory and Time Line
• District and Community Leadership Team – established in 2009-10 school year
• Transformation of mental health services for children/youth and families
• Utilized PBIS Implementer’s Blueprint and Stages of Implementation (Fixen)
• Began in two schools, after reviewing data indicating positive outcomes, then expansion
Scranton, PA“Current Conditions”
• Eleven Elementary Schools (K-5)– 2 implementing ISF at all three tiers– 3 implementing PBIS at tier one and have SMH – 1 implementing PBIS at tier one– 2 will be trained/kick off PBIS this year (1 w/ SMH)
• Three Intermediate Schools (grades 6-8)– 1 implementing PBIS at tier one and has SMH– 2 have SMH and will be trained/kick off PBIS this year
• Two High Schools (grades 9-12)– 1 with SMH and previously implementing PBIS– 1 implementing PBIS at tier one and has SMH
2013-14 School Year
• 20 licensed mental health professionals• 38 bachelor’s level behavioral health workers• Closure of center-based partial hospitalization program• Closure of five school-based partial hospitalization
programs• ROI – less restrictive educational placements, return to
home schools, less restrictive mental health placements, cost savings
• Increased collaboration, communication – improved outcomes
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: Identifying community resources, assess duplication and build comprehensive, sustainable resources
Identify the geographic community Identify all currently participating organizations Discuss the description of required target population Identify services/programs available• Inventory each agency/organization’s expenditures• Identify funds expended but not fully matched• Discuss spending resources collaboratively• Assess redundancy• Use resource map • Develop and implement plan• Share information and results to ensure support
4/15/2013 - Hershfeldt
1-5% Tier 3-Resources/Supports for a Few
5-15% Tier 2- Resources/Supports for Some
80-90% Tier 1 –Resources/Supports for All
Activity: What’s in Place?
Community-Based Services/Resources and Providers
School-Based Services &Resources
Applying the Logic to Families
80-90%
5-10%
1-5%
Tier 1: Universal InterventionsSelf Assessments: Family Engagement Checklist, Surveys
Skill Building Series Guest Speaker (Topics Vary- Survey Families)
Newsletter, Resource Library , “Shout Outs”
Volunteer Opportunities (DOGS- Dads of Great Students)
Teacher Conferences- Goal Setting, Family Vision, Strengths Discovery
Family Fun Nights throughout the year
School Handbook (Description, Teaching Matrix – promote common language between school and home)
Tier 2: Targeted Group InterventionsSupport Groups (Military Families, Newcomer Group)
Skill Building Sessions (Academic and Behavior)
Tier 3: Intensive, Individual InterventionsFamily Liaison-matched with family, needs matched with community resources
Individual Skill Building Sessions-
Tier 3/Tertiary Interventions 1-5%•1:1 instruction•Increased time•504
1-5% Tier 3/Tertiary Interventions•SBMH, Partial Hospitalization•Alt Ed•FBA/PBISP•Home School Visitor
Tier 2/Secondary Interventions 5-15%•Title I Reading and Math•ERI, RM, RN, etc.•IST
5-15% Tier 2/Secondary Interventions•Counselor groups, lunch bunch•Friendship groups•Behavior Chart/plan•IST•Parenting Classes
Tier 1/Universal Interventions80-90%•Core Curriculum – reading and math•AIMS Web•MAP•PSSAs
80-90% Tier 1/Universal Interventions•Character Education curriculum•Bullying Prevention•SWPBS (some schools)•Act 211 D&A awareness•Counselor classroom lessons•Community Activities•Health Screening
School-Wide Systems for Student Success:A Response to Intervention (RtI) Model: SUPPORTS
Academic 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/school-wide.htm
Tier 3/Tertiary Interventions 1-5%1-5% Tier 3/Tertiary Interventions
•SBBH Team•Outpatient therapy•SB Partial•Guidance – individual support•SAVES/school aged mothers
Tier 2/Secondary Interventions 5-15%5-15% Tier 2/Secondary Interventions
•SAP•Guidance – groups•Community Partners – groups•Resource Officer
Tier 1/Universal Interventions80-90%
80-90% Tier 1/Universal Interventions•SWPBIS•Drug and Alcohol Prevention
School-Wide Systems for Student Success:A Response to Intervention (RtI) Model:
Resources
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/school-wide.htm
Needs
Scranton High School
Building Level Action Plan
Problem Solving Team (individual student)
Tertiary Systems Team
Secondary Systems Team
Universal Systems Team
PRACTICES PRACTICES PRACTICES PRACTICES
Data Decision Rule Data Decision Rule Data Decision Rule Data Decision Rule
UNIVERSAL SYSTEM SECONDARY SYSTEM TERTIARY SYSTEM
73
Annual Fidelity CheckAction Planning
• Benchmarks of Advanced Tiers– Do we have more than one strategy available to
support students who need more?– Do we use data to make decisions?– Are we selecting Evidence-Based Practices?– Do we have the staff and resources to implement
with fidelity?– Are we progress monitoring?
Revisit Resource Map
• 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?
Tier 3/Tertiary Interventions 1-5%•_____________________•_____________________•_____________________
1-5% Tier 3/Tertiary Interventions•___________________________•___________________________•___________________________
Tier 2/Secondary Interventions 5-15%•___________________________•___________________________•___________________________•___________________________•___________________________•___________________________
5-15% Tier 2/Secondary Interventions•____________________________•____________________________•____________________________•____________________________•____________________________•____________________________
Tier 1/Universal Interventions80-90%•________________________•________________________•________________________•________________________•________________________•________________________
80-90% Tier 1/Universal Interventions•____________________________•____________________________•____________________________•____________________________•____________________________
School-Wide Systems for Student Success:A Response to Intervention (RtI) Model: SUPPORTS
Academic 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/school-wide.htm
Consumer Guide to Selecting Evidenced Based Mental Health Services
(Putnam et al, 2012 in draft)
Main Components• Assessment• Interventions Selection• Intervention Progress Monitoring
Assessment
Intervention Selection
Intervention Progress Monitoring
Use of EBP ToolScranton
AssessmentCurrent Condition• Assessment/Screening
happens upon referral to SMH Team
• SDQ and COS used in addition to progress monitor and track outcomes
Future Planning• Universal Screening• Tie in work that happens in
other processes - SAP
Use of EBP ToolScranton
Intervention SelectionCurrent Condition• Clinicians report almost
exclusively selecting interventions that address all nine areas on the tool
• There is not a place for indicated which interventions are selected and whether or not they are identified as EBPs
Future Planning• Combined training for
school-employed and community-employed staff who will be supporting youth/families who need Tier Two and Three interventions that specifically address how to select EBPs that match area assessed/screened
Use of EBP ToolScranton
Intervention Progress MonitoringCurrent Condition• Clinicians utilize outcome
tools of COS and SDQ• Not differentiating
implementation fidelity to a particular intervention (TF-CBT)
• Sharing outcome data in aggregate per school annually, not always by student and more frequent
Future Planning• Utilize tools to monitor
fidelity of implementation of intervention
• Share data with systems teams on a more frequent basis and by student for planning purposes, consistently
Trauma Informed Care
• 3 Community Mental Health Provider Agencies employ the SMH staff working across home/school/community
• As part of comprehensive assessment, include a trauma screening– Traumatic Events Screening Inventory (TESI)– UCLA PTSD Index
Trauma Screening Tools
TESI• Used by most clinicians• Free• On our preferred list• 15-item clinician-
administered interview• Variety of potential
traumatic events
UCLA PTSD Index• Requires licensing
agreement for use• On our preferred list• Recommended by TF-CBT• 48-item interview• Assesses a child’s exposure
to 26 types of traumatic events
“Once You Screen, You Must Intervene” K. Lane
• If trauma uncovered in screening/assessment, clinician works with family to determine:– If previously addressed/resolved– If not addressed, yet not currently causing
presenting issues/concerns/problems/symptoms– If not addressed, and contributing to current
concerns
• Clinician selects EBP that is trauma informed
National Child Traumatic Stress Network
• Evidence-based treatment fact sheets– Trauma-Focused Cognitive Behavioral Therapy
(TF-CBT)– Child/youth and family component (+)– Can receive free web-based training (+/-)– Important to have good clinical supervision
“Arianna”
• 13 year old Caucasian female in 7th grade• Adopted at 18 months into a family with two
half-siblings, who were also adopted. • 17 year old sister diagnosed with Asperger’s
Syndrome and Bi-Polar Disorder• 12 year old brother diagnosed with Asperger’s
Syndrome• Moved into area at age 4
“Arianna” continued
• Referred to SMH team due to self-injurious behaviors
• School reported risk of change in educational placement and concern for risk of drop-out
• At the time of referral, Arianna did not have a positive peer group
• Trauma uncovered during screening/assessment
• Clinician utilized TF-CBT
Child Outcomes Survey (COS) Family Functioning:Child Outcomes Survey (COS) Family Functioning:Child XChild X
A large improvement is observed in both domains of family functioning
Child Outcomes Survey (COS) Overall Wellness:Child Outcomes Survey (COS) Overall Wellness:Child XChild X
Overall wellness improves dramatically
“Arianna” today• Attending school with academic success• Participating on the girls basketball team• Reports having improved relationships with a
more positive peer group• Reports having improved relationships with
family members• School reports no risk for change in placement or
drop-out at this time• Arianna told the team, through a drawing, that
they “saved her life”!
School Mental Health
Child Outcomes Survey (COS) Family Functioning:Child Outcomes Survey (COS) Family Functioning:Scranton School DistrictScranton School District
Child Outcomes Survey (COS) Child Functioning: Child Outcomes Survey (COS) Child Functioning: Scranton School DistrictScranton School District
Child Outcomes Survey (COS) Therapeutic Alliance: Child Outcomes Survey (COS) Therapeutic Alliance: Scranton School DistrictScranton School District
Strengths and Difficulties Questionnaire Parent Strengths and Difficulties Questionnaire Parent (SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton (SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton
School DistrictSchool District
Questions?
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