school-wide pbs and school-based mental health: integration opportunities in pennsylvania

School-wide PBS and School-based Mental

Health:

Integration Opportunitiesin Pennsylvania

Harrisburg, Pennsylvania November, 2006

Lucille Eber, (lewrapil@aol.com) IL PBIS Network www.pbisillinois.org

Resources: (Fixen, et al, 2005)“Implementation Research:

A Synthesis of the Literature http://mim.fmhi.usf.edu

(Kutash et al, 2006) “School-based Mental

Health: An Empirical Guide for Decision-Makers” http://rtckids.fmhi.usf.edu

(Bazelon Center, 2006)“Way to Go”….School

Success for Children with Mental Health Care

Needs www.bazelon.org

www.pbisillinois.org

www.pbis.org

A Key Question:

How do we move from “expert driven”, one-student at a time, reactive approaches to building capacity within schools to support the behavior/mental health of ALL students?

The Role of the Behavior Specialist or Behavior support Team?? Reactive? Too little, too late? Integrity of interventions? Structures to ensure prevention as well as

effective interventions?OR

Ensuring/guiding capacity of local school staff to be behaviorally competent?

Students with Complex Needs….

Need access to and can benefit from all 3 levels of SW-PBS

And may need additional support from beyond school-based services as well.

1-5% 1-5%

5-10% 5-10%

80-90% 80-90%

Tertiary Interventions•Individual Students•Assessment-based•High Intensity

Tertiary Interventions•Individual Students•Assessment-based•Intense, durable procedures

Secondary Interventions•Some students (at-risk)•High efficiency•Rapid response•Small Group Interventions• Some Individualizing

Secondary Interventions•Some students (at-risk)•High efficiency•Rapid response• Small Group Interventions• Some Individualizing

Universal Interventions•All students•Preventive, proactive

Universal Interventions•All settings, all students•Preventive, proactive

School-Wide Systems for Student Success

A Response to Intervention ModelAcademic Systems Behavioral Systems

Positive Behavioral Interventions & Supports

“PBIS” is a research-based systems approach designed to enhance the capacity of schools to…

(Lewis & Sugai, 1999; Sugai et al., 1999; Sugai & Horner, 1994, 1999)

effectively educate all students, including students with challenging social behaviors adopt & sustain the use of effective instructional practices

“Big Idea”

Goal is to establish host environments that support adoption, sustain use, & expansion of evidence-based practices

(Zins & Ponti, 1990)

PRACTICES

DATASupportingStaff Behavior

SupportingDecisionMaking

SupportingStudent Behavior

OUTCOMES

Social Competence &Academic Achievement

Going to Scale withEffective Systems/Practices

If you invest, do it so it will last 10 years!

1. Implement with high fidelity2. Must be durable3. Must be sustained (in place 5 years)4. Delivered by typical agents5. Outcome data used to adapt6. Modify to local setting7. Establish system

Implementation emphasizes:

Team-based planning & problem

solving

Instructional approaches; data-based

Active administrator

support/participation

Long-term action planning

Staff commitment

On-going professional development

What SW-PBS is… Evidenced based practices imbedded

in a systems change process

A prevention continuum

A process with conceptual foundations in Applied Behavior Analysis (ABA)

A framework for organizing mental health supports and services

What does PBIS look like?

SW-PBS (primary)

>80% of students can tell you what is expected of them & give behavioral example because they have been taught, actively supervised, practiced, & acknowledged.

Positive adult-to-student interactions exceed negative

Data- & team-based action planning & implementation are operating.

Administrators are active participants.

Full continuum of behavior support is available to all students

Secondary & Tertiary

Team-based coordination & problem solving

Local specialized behavioral capacity

Function-based behavior support planning

Person-centered, contextually & culturally relevant

Capacity for wraparound facilitation

District/regional behavioral capacity

Linked to SW-PBS practices & systems

Universal Example

Leadership Team identifies need Response to high frequency of bullying (data)

Lessons taught school-wide (all staff all kids) Direct instruction linked to “Respect” expectation Practice activities in all settings Prompts in settings (i.e. playground, halls,

classroom) Recognition of skills being demonstrated

Assessment of outcomes Has bullying decreased?

Questions to Guide IL PBIS Implementation:

How do we decide what data to collect/examine/use?How do we use the data to help us decide how to spend our time?

Implementation Effect Integrity/Fidelity Capacity Sustainability

If we train schools, do they implement?If schools implement, do students/schools benefit?Do students with greater needs benefit from implementation?

If schools implement, is there fidelity?If schools implement, is there sustainability? Over time?

Evaluation Linked to Implementation

Implementation Surveys (all 3 levels) Team Checklists, Coaches Checklists School-wide Evaluation Tool (SET) Levels of implementation & Profiles Existing School-based data:

Behavior Academics ODRs Homework ISSs Class work OSSs Grades Tardies ISAT Attendance Achievement Test Scores On task-Academic

System-wide Evaluation Tool (SET) Research quality tool for assessing

Universal/School-wide PBIS External person spend 2 hours at school,

reviewing documents, interviewing staff, interviewing students.

PBIS is “in place” when with a score of at least 80% Total and 80% on Teaching sub-scale.

School-wide Evaluation Tool (SET)

Assess features that are in place

Determine annual goals for team

Evaluate on-going efforts Design and revise

procedures Compare efforts from year

to year

Expectation defined Expectation taught System for rewarding

behavior expectations System for responding to

behavioral violationa Monitoring and decision-

making Management District-level support

Does PBIS Implementation Result in Changes in Student Behavior?

Is there a reduction in Office Discipline Referrals when PBIS is implemented?

Do students and faculty perceive the environment as more safe when PBIS procedures are implemented?

Are there savings in faculty/student time?

Are there gains in academic performance?

Establish Procedures for Data Collection and Analysis PBIS teams CONSISTENTLY review the following data/graphs:

The Average # of referrals: Per day per month By type of behavior By location By time of day By student

Sep Nov Jan Mar MayMonths

Office Referrals per Day per Month1994-1995

1 2 3 4 5 6 7 8 9 101112131415Behaviors

Office Referrals by Behavior1994-1995

Classroom Bus

Location

Office Referrals by Location1994-1995

Major ODR’s by Time - Mid Year(9/2/02-3/01/03)

1 7 13 19 25 31 37 43 49 55 61 67 73 79

No. of Referrals

Office Referrals by Student1994-1995

Partial Implementation Full Implementation

Level of Implementation

Illinois: Partial vs. Full Implementation 05-06

2 to 5

n=61 Schools n=91 SchoolsOD

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

100.00%

2004-2005- PartialImplementation

2005-2006 - FullImplementation

L. Elementary School Partial Implementation to Full Implementation 04-05 to 05-06

6 + 14.15% 0.25%

2 to 5 28.54% 4.33%

0 to 1 57.30% 95.40%

2004-2005- Partial Implementation 2005-2006 - Full Implementation

0%10%20%30%40%50%60%70%80%90%

2004-2005 PartialImplementation

2005-2006 FullImplementation

S. School - Partial Implementation to Full Implementation04-05 to 05-06

% 6 and up ODR's 6.95% 2.20%

% 2 to 5 ODR's 15.25% 3.90%

% 0 to 1 ODR's 77.80% 93.90%

2004-2005 Partial Implementation 2005-2006 Full Implementation

2 0 %4 0 %

6 0 %8 0 %

1 0 0 %

P a rt ia l ( n = 3 7 ) Fu ll 8 0 / 8 0 ( n = 4 0 )

R isk R a t io

P ro t e c t iv e R a t io

Comparing School Safety Survey Partial vs. Fully Implementation FY06

Stu d e n ts W h o M e e t o r Ex c e e d Re a d in g Sta n d a rd s

o n 3 rd G ra d e ISA T6 4

P B IS N o t in P la c e ( n = 8 4 )

S c h o o ls

P B IS in P la c e ( n = 1 1 2 )

S c h o o ls

MARK TWAIN PRIMARY SCHOOLKankakee, IL

DISCIPLINARY REFERRALS FOR CLASSROOM BEHAVIOR

2001-02 2002-03 2003-04 2004-05 2005-06 (TO DATE)

NUMBER OF SUSPENSIONS (MARK TWAIN PRIMARY SCHOOL - KANKAKEE, ILLINOIS)

2002-03 2003-04 2004-05 2005-06 (TO DATE)

NUMBER OF STUDENT REFERRALS FOR SPECIAL EDUCATION (MARK TWAIN PRIMARY SCHOOL - KANKAKEE, ILLINOIS)

2002-03 2003-04 2004-05 2005-06 (TO DATE)

ISAT 00-05 MARK TWAIN - % MEETS AND EXCEEDS

% 28.8

100.0%

READING MATH WRITING

BEFORE PBIS AFTER PBIS BEFORE PBIS AFTER PBIS AFTER PBISBEFORE PBIS

020406080

100120140

1999-00 2000-01 2001-02 2002-03 2003-04 2004-05

Monitor Resource Self contained

Six Year Comparison of Sparta School District

Least Restrictive Environment

Dewey Elementary:Changes in Least Restrictive

Environment

2003-04 2004-05

Students in SPED < 21% of Day

Students in SPED 21-60% of Day

ISAT Scores

Opportunity for MH integration through School-based

Leadership Team

System and Data Structures Needed: leadership team is in place…

Team looks at range of universal data (not just ORD’s)

Capacity to get 80-90% of staff consistently implementing inventions

MH Integration opportunity at the Universal Level

High % of youth come from multiple homeless shelters in the neighborhood

High % of kids have experienced death/violence

High % of suicide threats/attempts

Does School-wide PBIS increase school’s capacity to “catch” and respond toMH needs of students sooner?

School-wide Positive Behavior Supports

A Response to Intervention Model

Universal School-Wide Assessment

School-Wide Prevention Systems

Secondary

Tertiary

AnalyzeStudent Data

Interviews, Questionnaires, etc.

Multi-Disciplinary Assessment & Analysis

Small group interventions

Individualized Interventions

(simple)

Complex individualized interventions

Group Interventions

Team-Based Wraparound Interventions

tionAssessm

Adapted from T. Scott, 2004

Multiple Perspectives

Observations, FBA

Multiple settings

Number of Secondary/Tertiary Interventions Reported - 04-05

Full Implementation PartialImplementation

No-SET Data

Average Self-Report on Secondary/Tertiary Intervention Impact (Scale from 1- 6)

Full Implementation PartialImplementation

No SET Total Average

2004-2005

Secondary and Tertiary Interventions Reported on the IL School Profile Form for Fully and Partially Implementing

Schools ( FY05 n = 197; FY06 n = 135)

100150200

Fully Implementation Partial Implementation No SET Data

2004-05

2005-06

Number of Individualized Interventions Reported by Level of Fidelity of PBIS

020406080

SET Met SET Not Met No SET

Level of PBIS Fidelity

# inte

rventi

report

ed Small Group Interventions

Individualized Interventions

A Unique Secondary Example…

AA males (26) ; 30% of schools ODR’s Function: Attention/recognition (24) High status mentors from community Instruction on individual goals Modeling social/emotional

skills/responses “Built in” reinforcement (attention from

high status adults)

Teaching Excellence Academics Motivation

(TEAM) Meetings to discuss goals Meetings monthly with a speaker from the community to

discuss topics such as: Respect Peer Pressure Pride Discipline Goal Setting Importance of School School/Athletes Personal Experiences

Guest Speakers

Sept: Dr. Maurice P. (U of I Professor) Oct: Mr. Joe S. (State Farm Insurance) Nov: Reverend D. (Talks Mentoring) Jan: Mr. Jonathan W. (Champ. Police Officer) Feb: Mr. C. (School Superintendent) Mar: Mr. Verdell J. (Basketball Camp Director) April: Glenn M. (Computer Programmer) May: Mr. Tracy L. (President of Urban League)

Community Outings/Incentives

•University of Illinois vs. Michigan football game

•University of Illinois vs. Wisconsin basketball game

•Bowling at GT’s Western Bowl

•Chicago Bulls vs. Cleveland Cavaliers basketball game

•Thanksgiving Dinner

•Christmas Celebration/Gathering

•Parkland College tour/class observation

Results of Secondary Intervention TEAM members represented 19% of all discipline

referrals, (baseline was 26%) 88% (21) had improved behavior/academics Three (3) attained honor roll status

SOC components embedded in intervention: Cultural relevancy Unique Strengths/needs approach Community resources integrated

Does School-wide PBIS increase School’s capacity to identify MH needs and reach out to families in a timely manner?

MH Integration Opportunity at Secondary Level

Screening for MH needs not “caught” via ODR’s

i. Use of SSBDii. Connections with families early on

Social skills instruction for at-risk studentsi. More likely to succeed as part of systemic

processii. Cool tools can be scheduled as follow-up to

ensure transference and generalization

Does School-wide PBIS increase School’s abilities to effectively educate students with more complex needs?

% Students % Referrals

Mean Percentage of Students by Major ODRs 04-05 673 schools Grades K-6 (292,021 students)

6+ ODRs

'2-5 ODRs

'0-1 ODRs

% Students % Referrals

Mean Percentage of Students by Major ODRs 04-05 255 schools Grades 6-9 (170,700 students)

Series3

Series2

Series1

%Students % Referrals

Mean Percentage of Students by Major ODRs 04-05 67 schools, Grades 9-12 (62,244 students)

6+ ODRs

'2-5 ODRs

'0-1 ODRs

Continuum of Support for Secondary-Tertiary Level Systems

Targeted group interventions (BEP, Check and Connect, social or academic skills groups, tutor/homework clubs, etc)

Targeted group with a unique feature for an individual student

Individualized function based behavior support plan for a student focused on one specific problem behavior

Behavior Support Plan across all settings (ie: home and school)

Wraparound: More complex and comprehensive plan that address multiple life domain issues across home, school and community (i.e. basic needs, MH treatment as well as beahvior/academic intervemtions)

Need for MH Integration…… Age 10 male in BD Class Excellent teacher; good progress Teacher frustrated; can’t get him “out”

more Incidents decrease in frequency but

NOT in intensity (hits head on wall; screams “hates himself”)

Needs other supports to deal with past trauma he has experienced?

Missed Opportunity for Positive Behavior

Support….?? Kindergartner; tantrums; hurts small animals

In principal’s office by noon daily “Waiting” to be accepted for MH

assessment No FBA/BIP done

Although “transitions” were a known trigger School became immobilized by the “setting

events” (i.e. possible psychiatric disorder)

Planning at the Tertiary Level

Facilitator Skills

Emphasis onUnique Strengths

Emphasis onMultiple Life

Domain Needs

The Art of EngagementFamily VoiceBlending Perspectives

Science of InterventionsData-Based Decision-making viaFBASIMEO

Team-Building:Home, School and Community

Individualized Planning Supports Across Multiple Life Domains

Facilitate/guide an individualized team planning process Family/student/teacher ownership of plan Access full range of school and community support

services across life domains Home, school, community settings Individualized academic and behavior interventions are

integrated into comprehensive wraparound plans.

Tertiary Level System Components

Individualized Teams at the Tertiary Level

Are unique to the individual child & family Blend the family’s supports with

the school representatives who know the child best

Meeting Process Meet frequently Regularly develop & review

interventions Facilitator Role

Role of bringing team together Role of blending perspectives

What is Wraparound?

Wraparound is a process for developing

family-centered teams and plans that are

strength and needs based (not deficit based)

across multiple settings and life domains.

Wraparound plans include natural supports,

are culturally relevant, practical and realistic.

What is Wraparound?(cont’d)

Blending perspectives of team members

results in a variety of traditional and

nontraditional strategies that are directly

linked to agreed upon outcomes.

The wraparound process creates a

context for effective implementation of

research-based behavioral, academic and

clinical interventions.

Wraparound and PBIS

The wraparound process is a key component on the continuum of a school-wide system of PBIS.

Value-base: Quality of Life; Voice/Ownership

Data-based Decision-Making: Efficient & Effective Actions

Value Base

Build on strengths to meet needs One family-one plan Increased parent choice Increased family independence Support for youth in context of families Support for families in context of community Unconditional: Never give up

P.Miles, 2004

Implementing Wraparound :Key Elements Needed for Success

Engaging students, families & teachers Team development & team ownership Ensuring student/family/teacher voice

Getting to real (big) needs

Effective interventions Serious use of strengths Natural supports Focus on needs vs. services

Monitoring progress & sustaining System support buy-in

used with individual students

plans reflect voice, priorities of youth and family

based on unique youth and family needs

culturally relevant teams and plans

built upon youth, family and provider strengths

uses traditional and non-traditional interventions

encompasses multiple life domains

Features of Wraparound:

Features of Wraparound (cont.):

resources are blended; must be flexible

services are planned, implemented, and

evaluated by a team

team supports youth, family and

providers

unconditional - if the plan doesn’t work,

change the plan

Wraparound

Is: An ongoing planning

process used by A team of people Who come together Around family strengths &

needs To create a unique plan of

interventions & supports Based upon a process of

unconditional care – no blame, no shame

Is not: A set of services A one or two time meeting A special education

evaluation An individual school

counselor who links with the family or student

The presence of flexible funds

Only for families and students we judge as “workable”

Four Phases of Wraparound Implementation

Team Preparation Get people ready to be a team Complete strengths/needs chats

Initial Plan Development Hold initial planning meetings Develop a team “culture”

Plan Implementation & Refinement Hold team meetings to review plans Modify, adapt & adjust team plan

Plan Completion & Transition Define good enough “Unwrap”

Can teams use data-based decision-making to prioritize needs, design strategies, & monitor progress of the child/family team?

more efficient teams, meetings, and plans? less reactive (emotion-based) actions? more strategic actions?more effective outcomes?longer-term commitment to maintain success?

DATA: The BIG Question

Example of

Getting to Strengths and Needs at Baseline

Using Data and Voice & Choice

“Roman”Using the Data to get to Strengths and Needs

Baseline 3 months 6 months

Controls Anger Has friends Gets along with children

Baseline 3 months 6 months

Controls Anger Has friends Gets along with children

Home School

Challenges: Engaging the “disengaged” (youth,family, teacher…) Differentiating between needs & services

Professionals wanting family to “comply”

Keeping team strength-focused while problem-solving

Family unable/unwilling to identify natural supports

Staying “at the table” long enough to get change

Using data-based decision-making to design interventions

Incongruent system habits (“schools can’t do that”)

Coaching: Keeping the team “working”

Even if the placement changes Don’t let one “sub-system” dominate Have the team embrace them as partners

“Better reintegration plan” As expectations change (i.e. academics)

Be in classroom>>>to participate like others Give him choices (“He surprises us”)

Reasons for Wrap ReferralBaseline

Poor school attendanceTardinessRefusal to participate in 2nd grade classroom activities. Did work independently in office/partial school days.Previous hospitalization (Bipolar Disorder)Retention – currently repeating 2nd grade yearFailing GradesFamily Support Needs

“Jacob”Home/School/Community ToolGetting to Strengths & Needs at Baseline: Family Voice

“Jacob”

“Jacob”Educational Information ToolTime 3

Example of Advanced Skill Set:

How to recognize when teams are trying to make parents “comply” with interventions

How to redirect teams back to the big need and other ways to accomplish it

How to keep the team at the “table”, even through the ups and downs

IL TOT Aug ‘06

Functional Assessment Pathway

Setting EventTriggeringEvent or

Antecedent

Problem Behavior

MaintainingConsequence

THE FUNCTION“Get something”“Get away from

Something”

When the Setting Event is perceived to be out of their control, the team often becomes immobilized

SIMEO FY 2006 Study Cohort Placement Risk

Baseline Time2 Time 3N=10N=19N=19

High Risk

Low/No Risk

Baseline-Time 2: P<.08, t=1.84, df=18; Time 2-Time 3: P<.443, t=.802, df=9; Base-Time3: P<.193; t=1.40, df=9

26% Decrease

14% Decrease

School Risk Behaviors Substantially Decline for Student Engaged in Wrap

Baseline (n=19) Time 2 (n=19) Time 3 (n=8)

Po sitiv e C la ssro o m Be h a v io r & A c a d e m ic A c h ie v e m e n t Lin k e d

2 .2 12 .4 5

2 .8 3

2 .1 92 .1 3

B a se lin e ( n = 2 6 ) Tim e 2 ( n = 2 6 ) Tim e 3 ( n = 1 2 )

C la ssro o m B e h a v io r Fu n c t io n in g A c a d e m ic A c h ie v e m e n t

Always

SIMEO FY 2006: Home School Community-ToolEmotional Functioning Sub-Scale

2.54 2.79

2.462.15

Baseline Time2 Time 3

Community Home School

N=10N=21N=21

High Strength

High Need

Somewhat Need

Somewhat Strength

Red= Statistically Significant Changes

Building Capacity for Wraparoundin Schools

Establish full-continuum of PBIS in schools

Identify and train facilitators

Train other school personnel about wrap

Ongoing practice refinement and skill

development

Review data around outcomes of teams

and plans

Methods of Coaching Facilitators

Wrap meeting preparation session Observational feedback of wrap meeting Co-facilitation of wrap meeting Face-to-face task/skill set meeting Role play Debriefing after wrap meetings Case review with other facilitators Group mentoring/consultation Telephone question/answering sessions

Worcester, MA

What’s Different for Practitioners (schools)?

•Data-based decision-making across settings/life domains.•Integrated teams with MH and other community partners •Natural supports and unique strengths are

emphasized in team and plan development. • Youth/family access, voice, ownership are

critical features. • Plans include supports for adults/family as well as youth.

What’s New with SOC/Wraparound?

Skill set specificity Focus on intervention design/effectiveness Integration with school-wide PBS Phases to guide

implementation/supervision Data-based decision-making (tools) Integrity/fidelity assessment (tools)

Challenges at Tertiary Level

Requires complex skills Need to find internalizers sooner (SSBD) Data is buried in family/student stories Capacity to stay “at the table” long enough to

effect change Engage key players, Establish voice and ownership Translate stories into data to guide plans

How We Build Local Capacity:Develop Coaching Capacity

Coaches are school personnel who have:

Fluency with systems & practices Capacity to delivery high level technical

assistance Capacity to sustain teams in efforts to

implement systems & practices

Why Redefine Staff Roles to Coach?

Sustainability & Accountability

Hands-on technical assistance Guide problem solving Local training Team start-up & sustainability Public relations/communications Support local leadership Local coordination of resources Provide prompts & reinforcers

Examples of Coaches Roles:

PRACTICES•Support use of effective practices•Leadership on targeted and intensive (wraparound)•Develop behavioral, wraparound skills in school personnel

DATAAssist with data analysis and use of data• collection strategies and priorities/focus for analysis• revise current strategies• decision-making strategies

SYSTEM• Prepare Teams for Training• Support Team Leaders over time• Assist with faculty buy-in• Support ongoing team meeting

•structure/agenda/next steps

PBIS External Coaches by Title over a Two Year Period

Clinical Staff DistrictAdmin

District PBISPosition

PBISCoordinators

ROE/ISC Special Ed.Admin

• Volume• Quality• Consistency• Dosage/practice

Ongoing Staff Development:Components to Consider:

Building-level Commitments Building-level Commitments

Three-five year focus to get sustainable change

Active administrative support and participation

Administrative leadership for PBIS teams Commitment from staff (80%) Ongoing communication and support with

staff Completion and use of data collection

(discipline and academic data, survey, checklists)

Staff participation in ongoing training

District Commitments Needed: District leadership team Coaching FTE District Improvement Plan Resources allocated Staff development prioity-ongoing Data collection and use-ongoing Implementation of research-based practices

Specialized services as well as general ed

Universal Team Training Universal Team Training

Initiating Leadership Team

Developing Action Plan

Engaging ALL Staff & families

Classroom & non-classroom

strategies

Using data to make decisions

Keeping teams moving

Secondary Level Training

Problem solving structure &

process

Individual or small group

interventions

Functional assessment

Behavior support plans

Academic interventions

Mental health supports

Voice/Ownership (family/teacher)

Tertiary Level Training Tertiary Level Training

Engaging and supporting families and

teachers

Developing Individualized Teams

Accessing community supports

Mental Health supports

Behavior support plans

Academic interventions

Other life domains (safety, medical,

spiritual…)

Interagency connections

Resources: (Fixen, et al, 2005)“Implementation Research: A

Synthesis of the Literature http://mim.fmhi.usf.edu

(Kutash et al, 2006) “School-based Mental Health: An

Empirical Guide for Decision-Makers” http://rtckids.fmhi.usf.edu

(Bazelon Center, 2006)“Way to Go”….School

Success for Children with Mental Health Care Needs www.bazelon.org

www.pbisillinois.org

www.pbis.org

school-wide pbs and school-based mental health: integration opportunities in pennsylvania

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