School Mental Health/PBIS Integration: Funding and Policy

Nancy Lever, Center for School Mental HealthMariola Rosser, IDEA Partnership

Joanne Cashman, IDEA PartnershipMark Weist, University of South Carolina

National PBIS Leadership ForumOctober 30, 2014

“Expanded” School Mental Health• Full continuum of effective mental health

promotion and intervention for students in general and special education

• Reflecting a “shared agenda” involving school-family-community system partnerships

• Collaborating community professionals (not outsiders) augment the work of school-employed staff

Advantages• Improved access• Improved early identification/intervention• Reduced barriers to learning, and

achievement of valued outcomes• WHEN DONE WELL

But• SMH programs and services continue to

develop in an ad hoc manner, and• LACK AN IMPLEMENTATION STRUCTURE

Positive Behavior Intervention and Support (www.pbis.org)

• In 18,000 plus schools• Decision making framework to guide best

practices for improving academic and behavioral functioning– Data based decision making– Measurable outcomes– Evidence-based practices– Systems to support effective implementation

Advantages• Promotes effective decision making• Reduces punitive approaches• Improves student behavior• Improves student academic performance• WHEN DONE WELL

But• Many schools implementing PBIS lack

resources and struggle to implement effective interventions at Tiers 2 and 3

Key Rationale• PBIS and SMH systems are operating separately• Results in ad hoc, disorganized delivery of SMH

and contributes to lack of depth in programs at Tiers 2 and 3 for PBIS

• By joining together synergies are unleashed and the likelihood of achieving depth and quality in programs at all three tiers is greatly enhanced

Tier 1 Tier 2 Tier 3

Mental Health

Education

Not two, but one

A Cyclical Story

Insights in the Cycle• Many agencies have goals related to behavioral

health• Each has specific initiatives aligned to its mission and

goals• Each initiative reaches a specific group of

implementers• Each is targeted to a specific unit for scale for

intervention: Federal, state, local, site, individuals• Sometimes implementers find their commonalities…

sometimes they don’t!

Emerging ApproachesNew insights link interventions at varying levels of scale

o New initiatives create interventions linking the state and local level

Safe Schools Healthy Students –State grant must include local pilots as a core feature

Project AWARE -State grant must include local pilots as a core feature

• New initiatives link MH and Education Interventionso Project AWARE grants required submission of the School Climate

Granto New Juvenile Justice grants will require similar coordination

A Word to the Wise …..

• Technical strategies to coordination and increased funding ‘open’ as we understand more about options that exist in policy

• Never forget…..people make it happen!

• We need a technical and an adaptive approach for real progress in practice!

Persistent Challenges

• Technical ChallengeRequires information, knowledge or tools

• Adaptive (Relationship) Challenges Requires understanding and a willingness to make behavior changes

Source: Heifetz and Linsky, Leadership on the Line, 2002

Learning that technical solutions are necessary but often not sufficient

Knowing when a persistent problem needs a adaptive (relationship) solution

Building adaptive (relationship) skills as a part of strategy

The Leadership Challenge

• Let’s explore some options for funding School Based Mental Health…

Funding Sources• School level

– Principal discretionary dollars– Funding from PTA/PTO for supplies/EBP purchase

• Local level– General Revenue (education purposes) – Categorical Revenue (targeted for specific for specific

student population in need of supplemental services– Tax levies– Private Foundations

• More Flexible with Prevention/Mental Health Promotion

– Community Businesses

State Funding

– Mental Health Block Grants– Grant Programs to develop SMH infrastructure

(Minnesota)– Children’s Health Insurance Program

• Provides health coverage to nearly eight million children in families with incomes too high to quality for Medicaid but who can’t afford private coverage

Federal Funding– Block Grants (fixed amount of funding based on

population, unemployment, and demographics)• Maternal and Child Health Block Grant• Social Services Block Grant• Preventive Health and Health Services Block Grant

– Project Grants – Discretionary grants awarded through a competitive process to fund discrete projects over a specified period of time

– Legislative Earmarks- Provide funding over one fiscal year and are not competitive

– Direct Payments (Medicaid) – Federal Assistance provided directly to individuals who meet eligibility requirements

Best Practice Funding Considerations• Use Diverse Funding Sources• Use Funding Strategies that Rely on Shared

Funding and Promote Sustainability– Braided/Pooled/Blended Funding– Increase reliance on more permanent

versus short-term funding• Leveraging of Funding• Return on Investment • Seed Money

Best Practice Funding Considerations (Cont.)

• Matching Funding to Service Delivery Across Multiple Tiers

• Utilize Evidence-Based Practices and Programs• Evaluate and Document Outcomes• Demonstrate Connections Between Mental Health

and Academic Functioning• Cross-Training and Sharing of Professional Development Expenses

EXAMPLES OF SCHOOL MENTAL FUNDING

SMH in Baltimore

• 1989: 4 schools• 2014: 114 schools

Serving elementary, middle, and high schools across the City of Baltimore

Led by 4 Outpatient Clinic Programs each Leading 1 Quadrant of the City’s SMH Services

FY 15 Funding Strategy ESMH

BHS Baltimore/MHA $726,000

BHS Baltimore/ADAA $345,935

BCPS $948,065

Foundation $144,000

Projected Fee-for-Service $2,166,000

PGSMHI Goals

• Divert students who are at risk for entering non-public educational settings.

• Complement existing special education programs with a mental health component.

• Improve student functioning

• Improve school climate

• Increase knowledge of community resources

• Provide training and support to PGCPS school staff

PGSMHI Target Population and Enrollment • Students in Transition ED Programs who are at

risk of entering non-public settings due to an increase in behavioral and/or emotional problems

• Students in non-public settings who are returning to the Transition ED Programs

• 2013-2014 School Year: – 8 Schools (Elementary/Middle/High)– 160 enrolled– 495 students seen

CostsAggregate Per student

per dayPer student per year

Total Nonpublic Costs

3,964,928 163 39,038

Total PGSMHI Costs

732,487 30 7,212

Total Savings 3,232,440 133 31,826

See: Slade et al. (2009). Advances in School Mental Health Promotion. Note: Data is based on a program year of 240 days

Syracuse Promise ZoneModel for Funding District Wide Mental

Health Supports April 7, 2014

Jennifer Parmalee, MPAOnondaga County Dept of Children & Family ServicesDirector of School Based Initiatives

Syracuse City School District Urban district in Central New York 95,000 residents 31 schools in the SCSD 5 High Schools

6 Kindergarten – 8th grade buildings6 Middle Schools (6th – 8th)10 Elementary Schools

21, 000 students75% Free and Reduced Lunch (4th highest in

state)20% Listed as Special Education Syracuse Promise Zone is a district wide

approach

Funding Syracuse Promise Zone

Total Funding $10.5 Million

ItemBehavioral Health State

AidSchool District

Local DSS

Medicaid

Family Case Managers62% / 38%

Outpatient Mental Health 10% 90%

Student Assistance Counselors 75% 25%

SBIT Teaching Assistants 100%STEP Program (Intensive FBA/BIP)

40% 60%

PBIS Coaching Support 40% 60%

Data Resource Specialists 80% 20%

Primary Project 10% 90%

PAX Good Behavior Game 10% 50%

Universal Screening 100%

Chronic Stress and Trauma 85% 15%

2 X 10 40% 60%

Check In Check Out 40% 60%

Functional Behavior Analysis 100%

County ACCESS Team 65% 10% 25%

Let’s look at the adaptive side of your funding effort using a tool from….

Leading By Convening: A Blueprint for Authentic Engagement

Four Simple Questions

34© 2014 Community Care Behavioral Health Organization

Convening in the Landscape of Practice on SBBH

• Coalescing around issuesAsk yourself: Who cares about this issue and why?

• Ensuring relevant participationAsk yourself: What work is already underway?

• Doing work together Ask yourself: What shared work could unite us?

• Leading by convening Ask yourself: Can you successfully lead on this issue without the other stakeholders? How can we deepen our connections?

Source: IDEA Partnership