National PBIS Leadership Forum October 3 4 2019
National PBIS Leadership Forum | October 3 -4, 2019, Chicago, IL C 9 - Integrating Mental Health at the District and School Level: Steps for Installation Lucille Eber Midwest PBIS Network lucille. eber@midwestpbis. org Jamie Ganske Chippewa Falls Unified School District ganskejl@chipfalls. org Key Words: mental health, alignment, ISF
Advancing Education Effectiveness: Interconnecting School Mental Health (ISF) and School-Wide Positive Behavior Support (PBIS) Editors: Susan Barrett, Lucille Eber and Mark Weist pbis. org csmh. umaryland IDEA Partnership NASDSE
Where We’ve Been: • 2002 -2007: Site Development with PBIS Expansion (informal and independent) • 2005: Community of Practice focus on integration of Positive Behavioral Interventions and Supports (PBIS) and School Mental Health (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 • 2015: ISF Learning Community, SOC Webinar Series • 2016: Randomized Control Trial (RCT) Grant awarded • 2016: Targeted Work Group Webinars (8) • 2017: Targeted Work Group Webinars continuing, knowledge development sites across country • 2018: Continued webinars and knowledge development sites • 2018: Expanded Training/TA curriculum and workbook available online • 2019: Targeted Work Group (PLC) webinars
Where We* are Headed • National PBIS Center: Development of ISF Demonstration sites • Expanding on-line curriculum, resources, tools, • Volume 2 of ISF monograph: An Implementation Guide * OSEP’s National PBIS TA Center (PBIS V -
ISF Volume 2: An Implementation Guide Chapter 1: Context and Structure for Volume Chapter 2: Defining ISF: Origins, Critical Features, and Key Messages Chapter 3: Exploration and Adoption Chapter 4*: Installing ISF at the District and Community Level Chapter 5*: Installing ISF at the Building Level Chapter 6: Full Implementation and Sustainability * Includes Installation Guide
ISF District/Community Installation Guide Purpose: ISF V 2 Chapter 4 (in press) This guide is intended to be used by facilitators and coaches to support District/Community Leadership Teams to install structures/systems needed to support an Interconnected System Framework (ISF). The goal is for teams to examine current system using installation activities and generate
ISF School Installation Guide Purpose: This guide is intended to be used by facilitators and ISF V 2 Chapter 5 (in press) coaches to support District/Community Leadership Teams to install structures/systems needed to support an Interconnected System Framework (ISF). The goal is for teams to examine current system using installation activities and generate actions to move toward a more efficient and effective service delivery model at the building level.
Partnerships are needed: • • One in 5 youth have a MH “condition” At least 50%, perhaps 80%, of those get no treatment School is “defacto” MH provider Juvenile Justice system is next level of system default Suicide is 2 nd leading cause of death among young adults Factors that impact mental health occur ‘round the clock’ It is challenging for educators to address the factors beyond school It is challenging for community providers to address the factors in school
Current National Data: Principals’ Concerns
DEFINING ISF, CRITICAL FEATURES, IMPLEMENTATION STRUCTURES
ISF Defined – Structure and process for education and mental health systems to interact in most effective and efficient way. – Guided by key stakeholders in education and mental health/community systems – Who have the authority to reallocate resources, change role and function of staff, and change policy.
ISF Applies MTSS Core Features • Effective teams that include community mental health providers • Data-based decision making that include school data beyond ODRs and community data • Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision making • Early access through use of comprehensive screening, which includes internalizing and externalizing needs • Rigorous progress-monitoring for both fidelity & effectiveness of all interventions regardless of who delivers • Ongoing coaching at both the systems & practices level for both school and community employed professionals
Traditional An Interconnected Systems Framework MH counselor “sees” student at appointments MH person on teams at all tiers. Interventions are defined (core features, dosage, frequency, outcomes) Clinicians only do “mental health” MH is everyone’s job. Clinicians contribute to integrated plan Case management notes Fidelity AND outcome data determined before delivery; data monitored continuously by teams
The Sustainability Focus Needed at the State, Regional, District/Communit Stakeholder Support Funding Policy & Systems Alignment Workforce Capacity Executive Functions LEADERSHIP TEAMING Implementation Functions Training Coaching Evaluation & Performance Feedback Local Implementation Demonstrations Social, Emotional, Behavioral Expertise
1. Single System of Delivery is s s e c c 2. A gh u o n e T NO Key Messages 4. MTSS essential to install SEBMH 3. Mental Health is for ALL
What Does it Mean to Integrate? Change in routines and procedures? (e. g. who needs to be available to participate in team meetings? ) Change in how interventions are selected and monitored? (e. g. team review of data/research vs individual clinician choice? ) Change in language we use? (e. g. identifying specific interventions vs generic terms such as “counseling” or “supports”? ) Changes in Roles/functions of staff? (e. g. clinicians coordinating/overseeing some interventions that non-clinicians deliver? )
Percentage of High School Students Who Seriously Considered Attempting Suicide, * by Sex, † Grade, and Race/Ethnicity, 2017 *Ever during the 12 months before the survey †F > M (Based on t-test analysis, p < 0. 05. ) All Hispanic students are included in the Hispanic category. All other races are non-Hispanic. Note: This graph contains weighted results. Delaware - YRBS, 2017 - QN 26
Percentage of High School Students Who Made a Plan About How They Would Attempt Suicide, * by Sex, † Grade, and Race/Ethnicity, 2017 *During the 12 months before the survey †F > M (Based on t-test analysis, p < 0. 05. ) All Hispanic students are included in the Hispanic category. All other races are non-Hispanic. Note: This graph contains weighted results. Delaware - YRBS, 2017 - QN 27
Teaching Matrix Expectations Respectful Achieving & Organized INCORPORATE Coping Strategies for Managing Stress All Settings Halls s n io t a t Be on task. Give your best effort. Be prepared. Walk. Be kind. Hands/feet to self. Help/share with others. Use normal voice volume. Walk to right. c e p x E. 1 Playgrounds Have a plan. Share equipment. Include others. c i f i c e p S Responsible r o s s e r l o u i v R a. h 3 Be Recycle. Clean up after self. Lunch Library/ Comput er Lab Invite those sitting alone to join in Study, read, compute. Have a lunch plan and choose quiet or social lunch area Invite friends to join me Use my breathing Pick up Use equipment technique litter. properly. Maintain Put litter in physical Listen to my signals garbage can. space. CO Assembly Bus 2. NT NA EX TU T( R Lo AL ca tio ns Sit in one spot. Watch for your stop. Whisper. Return books. Listen/watc Use a h. quiet voice. Use Stay in appropriate your seat. applause. Push in chairs. Treat books carefully. Pick up. Treat chairs carefully. Wipe your feet.
Trauma-Informed Tier 2 Group Daily Progress Report (DPR) Sample NAME: ___________ DATE: _________ EXPECTATIONS Be Safe Teachers please indicate YES (2), SO-SO (1), or NO (0) regarding the student’s 1 st block 2 nd block 3 rd block achievement in relation to the following sets of expectations/behaviors. 4 th block 2 1 0 2 1 0 2 1 0 2 1 0 Self-Check Use calming strategy Be Respectful Use your words Use safe hands Be Responsible Ask for help Connect with safe person Total Points Teacher Initials Adapted from Grant Middle School STAR CLUB
STAGES of IMPLEMENTATION (Fixsen, Blasé, 2005) Exploration/ • Should we do this? Adoption Installation • Put resources and systems in place Initial Implementation • Initial pilots and assess results Full Implementation • The practice was successful, adopt system- wide Innovation • Adopt variations of the practice and assess results Sustainability • Make this the way of doing business
Exploration (District Level) Steps: Coaching Questions: • Establish an exploration team • Do you have an existing district leadership team? • Examine current partnerships • Assess impact of existing initiatives/programs • Develop a shared understanding of ISF • Determine benefit • Decide to adopt or not • Do you have family or community partners on your team? • What existing agreements do you have with community partners? • What is current status of MTSS structures/implementation?
Adoption Decisions Establish commitment to: • Develop and revise contractual agreements/memorandums of understanding. • Establish executive level leadership team. • Consider needed changes to policy, funding, professional development (PD), coaching and data systems. • Develop 3 -5 year action plan focused on large system change efforts: – Installation in and support of Pilot/Demo Sites
Installing ISF at State/Regional/District Leadership Level 1. 2. 3. 4. Establish (or enhance) Leadership Team Assess Current Status of PBIS and SMH Establish Mission Establish Team Routines and Procedures for MTSS a. Agenda/mtg process in place? b. Do we have a sufficient screening process? c. How we select district/community-level EBPs? d. Is data system sufficient for needed measurement of fidelity & outcomes? e. Ensuring PD/Coaching plan addresses systems/data/practices? 5. Implementation Plan a. Select Demo Sites b. PD/Coaching c. Evaluation Plan d. Establish MOUs as Needed
ISF District/Community Installation Guide ISF V 2 Chapter 4 (in press) Purpose: This guide is intended to be used by facilitators and coaches to support District/Community Leadership Teams to install structures/systems needed to support an Interconnected System Framework (ISF). The goal is for teams to examine current system using installation activities and generate actions to move toward a more efficient and effective service delivery model.
Step 1: Establish a Leadership Team a) Representative Stakeholders Identified – Executive leadership from both school and agency systems – Family/Youth as active team members b) Establish Team Operating Procedures – Meeting protocol – Time to meet (at least quarterly) – Confidentiality agreements
Step 2: Assess Current Status of Mental Health & PBIS Systems a) Conduct assessment of current system structures – Stakeholder Support, Funding, Policy & Systems Alignment, & Workforce Capacity (PBIS Blueprint Selfassessment Tool) b) Conduct review of current initiatives & practices - Initiative Inventory c) Conduct staff utilization review d) Review current school & community data
ISF Initiative Inventory ISF V 2 Ch 4: State/District Level Installation Guide (in press) - Step 2 b: Conduct a Review of Current Initiatives Purpose of this tool is to (a) provide an overall picture of existing social emotional behavioral related initiatives or programs available to the larger community, (b) determine the effectiveness, relevance, and fidelity for each, (c) determine funding and resource allocation, and (d) determine areas of redundancy. This process is led by the District Community Leadership Team with representation from both education and community stakeholders. Adapted from NIRN Initiative 32
ISF Initiative Inventory ISF V 2 Ch 4: State/District Level Installation Guide (in press) - Step 2 b: Conduct a Review of Current Initiatives District Example
Changing Roles of Staff: District Level Discussion Guide ISF V 2 State/District Installation Guide – Step 2 c: Conduct Staff Utilization Review Purpose: This document is intended to support coaches in facilitating critical discussions around role changes within an integrated framework. The goal is to move from discussion to action planning around systems change to better support the social/emotional/behavioral needs of all youth. This document is broken into three topic areas to help with organization which each include guiding questions, prompts to consider other stakeholder voices, and potential activities to complete. It may be beneficial to review the Changing Roles of Staff: School Level Discussion Guide that is a partner to this document. NEW!
2 a. Assess Current System Structures Part 2 of the PBIS Blueprint • Self Assessment of current status of PBIS framework • Items for each of the 10 system elements Coming soon (for pilot use through National PBIS Center): The State System Fidelity Inventory (SSFI) Self. Assessment The District System Fidelity Inventory (DSFI) Self. Assessment
2 c. Staff Utilization Review Assess current workforce capacity • Identify changes needed for integration and efficiency • Review roles, responsibilities, time allocation of both school and community-employed clinicians working in schools • Consider a time-study
2 d. Review Existing School and Community Data • Whole population Needs – Community Data – School Data – Youth/Family Perspective Data – Local ‘events’ impacting families
Step 4: Establish Procedures & Routines to ensure use of MTSS features a) Selecting and installing a universal screener b) Request for Assistance (RFA) process c) Selection process for evidence-based practices d) Process to monitor fidelity e) Process to monitor outcomes of interventions
4 b The Request for Assistance (RFA) Process • Integrated teams use an internal request for assistance process that places decisions about all interventions (e. g. who will deliver what interventions and how impact will be monitored) within the single set of blended teams. • The use of a referral is reserved for circumstances outside the scope of the integrated service team such as students with medical or family support needs
4 e. Establish Process to Monitor Outcomes of Interventions Protocol for evaluating ALL interventions, regardless of who delivers them. Includes: a) identifying entrance criteria into an intervention, b) progress monitoring during intervention, and c) criteria for exiting an intervention.
NEW!
5 c. Selection of Demo Sites Possible Indicators to Consider • Schools with implementation success • Schools with specific demographics/need • Building administration traits (i. e. highly motivated and/or experienced) • Grade Level cohorts • Schools with established relationships with community partners • Other?
5 d. Finalize Memorandum of Understanding/Agreement (MOU/A) • Clarifies roles and responsibilities of each organization and their staff • Consideration given to: – Staff working together on teams – Funding of staff time – Sharing information (confidentiality) – Interconnected PD and Coaching • Sample 1 • Sample 2
In Summary: How DCLTs set-up for Installation at School Level • Review MOU and redefine expectations of clinician functioning – for team-based MTSS features – Address funding issues to allow the new functioning • Review existing programs and interventions and target some for change (possibly elimination? ) • Staff utilization review • Develop co-coaching system and feedback loop from pilot schools to DCLT
BUILDING LEVEL INSTALLATION
ISF Enhances MTSS Core Features • Effective teams that include community mental health providers • Data-based decision making that include school data beyond ODRs and community data • Formal processes for the selection & implementation of evidence-based practices (EBP) across tiers with team decision making • Early access through use of comprehensive screening, which includes internalizing and externalizing needs • Rigorous progress-monitoring for both fidelity & effectiveness of all interventions regardless of who delivers • Ongoing coaching at both the systems & practices level for both school and community employed professionals
Steps for Installation within Schools All steps guided by Coaches and DCLT 1. Establish Single Set of Integrated Team(s) 2. Assess Current Status 3. Enhance MTSS Routines and Procedures 4. Develop an Integrated Action Plan a. Evaluation Plan b. Professional Development Plan
Step 1: Establish Single Set of Integrated Team(s) a. b. c. d. e. f. Review Current Structures Align (“Working Smarter”) Expand Membership Roles and Functions Consider Role Changes Establish Norms, Confidentiality, Team process (TIPs)
School Intervention Map ISF V 2 Ch. 5 School Installation Guide (in press) – Step 2 c: Conduct an Intervention Inventory Purpose of this tool is to (a) provide an overall picture of existing social emotional behavioral related interventions or initiatives available to students in your building, (b) determine the effectiveness, relevance, and fidelity for each, (c) resource allocation, and (d) determine areas of redundancy. This process is led by the School Level Team with representation from both education and community stakeholders.
School Intervention Map ISF V 2 Ch. 5 School Installation Guide (in press) – Step 2 c: Conduct an Intervention Inventory School Example
Universal Screener Timeline ISF V 2 State/District Installation Guide – Step 4 a: Selecting and Installing a Universal Screener Purpose: The purpose of this document is to lay out what a possible timeline could look like for the Universal Screening process and who might need to be involved with each step. Considerations are made for professional development and communication necessary for the transparent delivery of a Universal Screener that stakeholders support and the results in more youth being supported by appropriate interventions. NEW!
Subscale Implementation ISF Enhancements 1. 5 Problem Behavior Definitions Tiered Fidelity Inventory: Tier I Features 1. 5 Problem Behavior Definitions: School has clear definitions for behaviors that interfere with academic and social success and a clear policy/procedure (e. g. , flowchart) for addressing office-managed versus staff-managed problems. PBIS Big Idea: Explicit definitions of acceptable versus unacceptable behavior provides clarity to both students and staff and is a critical component of identifying clear procedures for staff to respond to inappropriate behavior objectively. ISF Big Idea: . Community, family/student input to the definitions of acceptable vs unacceptable behaviors expands the view of behavioral definitions and increases likelihood of cultural relevancy and student engagement. The school team develops a clearly documented and predictable system for managing disruptive behavior that represent community family/student values and culture. Referral procedures include ways to track students leaving their instructional environment (e. g. , visits to the nurse or school counselor) so the needs of youth with internalizing as well as externalizing challenges inform the behavior definition process.
Broaden Use of Data: Focus on Internalizing Issues
1. 11 Student/Family/Community Involvement Subscale Tiered Fidelity Inventory: Tier I Features 1. 11 Student/Family/Community Involvement: Stakeholders (students, families, and community members) provide input on universal foundations (e. g. , expectations, consequences, acknowledgements) at least every 12 months. PBIS Big Idea: Engaging stakeholders enhances the Implementation contextual fit of SWPBIS systems and may increase consistency across school and other settings. ISF Big Idea: Having: Family and community members as full and active team members expands the opportunities for cultural relevance and improved implementation. Family and community members actively participate on the District and Community Leadership Team, as well as the building level Tier I systems team. ISF Enhancements Family and community member perspectives on the components of ISF Implementation are solicited at least
National PBIS Leadership Forum | October 3 -4, 2019, Chicago, IL Chippewa Falls Area Unified School District Jamie Ganske Director of Mental Health and Resiliency
PBIS Systems School District Make-up • 6 Elementary Schools, 1 Middle School, 1 High School, 1 Alternative High School Tier 1 • 6 Elementary Schools, 1 Middle School, 2 High Schools Tier 2 • 6 Elementary Schools, 1 Middle School, 1 High School Tier 3 • Educational Wraparound • 2 Elementary Schools, 1 Middle School, 2 more elementary schools getting trained this year • Complex FBA/BIP • 2 Elementary Schools
District and Community Leadership Team Created in 2017 -2018 Who was invited to the table for the first meeting? • • • Director of Student Services CFAUSD RTI/PBIS Coordinator CFAUSD Mental Health Agency Director Building Principal, Southview Elementary Family Member Director of Human Services Chippewa County Regional PBIS Technical Assistance Coordinator CFMS Social Emotional Interventionist
Initiation of a District/Community Level Team ● Purpose of this Team: Develop an Interconnected Systems Framework for Mental Health and Wellness ○ DCLT will meet at least 3 times per year ○ Authority to reallocate resources, change policy, sustain and scale the key elements and core features of the ISF. ○ Share Key Messages of ISF (video) ○ Develop Capacity, Competence and Confidence ○ Additional members? ● Create a shared Mission and Vision and Goals connected to need ● Action Plan
Sample from First Action Plan
Data Shared During Early District/Community Team Meetings a. School Data i. PBIS ii. SBMH b. Talked about what data to add the following year
**Our goal is to move away from counting referrals to reporting outcomes specific to Mental Health Interventions. By working with therapists, our goal is to be able to describe all mental health interventions as we do with PBIS interventions with data. (ISF Message: “Access is Not Enough”.
Our District and Community Leadership Team (DCLT) Year 2 The District and Community Leadership Team (DCLT) is a group of school district and community executive level administration, who have the authority to reallocate resources, change policy, sustain, and scale the key elements and core features of the ISF. The DCLT meets at least three times throughout the school year. Mission/Vision of DCLT: Our community partnerships will promote staff awareness and increase understanding of mental health supports and resources so all students will develop life-long resiliency Progress Monitoring Goal: We will establish baseline data measuring frequency of community clinician contacts with educators for consultation, collaboration, and professional development. (REALiving will track this data) Group Norms: Start and end on time, Be open to possibilities, Follow-through on agreements, Actively participate, Be solutions oriented, Enjoy our time together, Bring snacks (Chris)
Action Planning for 20182019 • TFI/ISF Action Planning Companion Guide • Areas of Focus used to create DCLT Action Plan • Team Composition • Faculty/Community Involvement • Communication • Operating Procedures • Professional Development • MOU Changes
We used the ISF Implementation Workbook to help us change the wording in our MOU. We were able to discuss the changes at our DCLT meetings and through phone calls with the agency directors that were not at the table for the DCLT meetings. https: //docs. google. com/document/d/1 t 4 K 2 q 0 Iob. AN 18 KKq 5 fl. G 5 LMa. Y 01_p. DCUs. J 0 dfb. Du 5 I/edit
Chippewa Falls, WI We sent out information about ISF in the parent newsletter to our three pilot schools with a link to take a survey. We plan to send out information about ISF in the parent newsletters for all schools in the 2019 -2020 school year.
Our District and Community Leadership Team Grew!
. . . And then grew again!!!
Getting Started at the School Level • Use of the ISF Action Planning Companion Guide to the SWPBIS Tiered Fidelity Inventory (TFI) • Integrating Trauma Informed Practices into the PBIS Teaching Matrix • Dialogue with Teams and Mental health Clinicians about plan to move from co-located to an integrated system • Timelines for clinicians integrated into Tiered Teams and discussion on what that really looks like • Choosing Interventions for co-facilitation • Use of data for progress monitoring
Examples of Tier 2 Co-Facilitated Group Interventions Co-facilitation of coping mechanisms groups *Middle School *Students were screened and surveyed *Connection to our EMLSS Next steps *pre and post data *Link skills they are learning to DPR *Discussion about fidelity checks
RDQ Brief as example with Mental Health Integration Technical Guide for Alignment of Initiatives, Programs and Practices in School Districts (OSEP Technical Assistance Center on PBIS, 2017) http: //www. pbis. org/blueprintbriefstools Roundtable Dialogue: Aligning and Integrating Mental Health and PBIS to Build Priority for Wellness http: //www. pbis. org/presentations/chicago-forum-17 Recorded webinar
CALL FOR PAPERS OPENS Miami, FL JUNE 2019 Hyatt Regency Miami March 11 -14, 2020 For more information, visit: conference. apbs. org
Additional Resources • Monograph • Recorded webinar on ISF • Action Planning Companion Guide to the Tiered Fidelity Inventory
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