Building an Interconnected Systems Framework, a Tertiary Demonstration Project © 2010 Community...

Building an Interconnected Systems

Framework, a Tertiary Demonstration Project

© 2010 Community Care Behavioral Health

September 23, 2011Kelly Perales, LCSW

Dawn Jones, Special Education Teacher Frances Willard Elementary School, Scranton, PA

Carlyn Fontini, Program DirectorSBBH Teams, Scranton School District

SWPBS Tertiary Demonstration Project

• Community Care as affiliated partner in the PA Positive Behavior Support (PBS) Network

• Blending of School-Wide (SWPBS) and School Mental Health

• Interconnected Systems Framework

Why We Need MH/Community Partnerships

• One in 5 youth have a MH “condition”• About 70% of those get no treatment• School is “defacto” MH provider• JJ system is next level of system default• 1-2% identified by schools as EBD• Those identified have poor outcomes• Suicide is 4th leading cause of death among

young adults

School-based Behavioral Health Team Service (SBBH)

Accountable Clinical Home

• Accountable TO the family and FOR the care• Accessible, coordinated, and integrated care• Comprehensive service approach • Increased accountability and communication• Single point of contact for behavioral health• School is “launching pad” for services delivered in all

settings• Youth continue on the team with varying intensity of

service

SBBH Service Components

SBBH Team Components

Community Care Support of SBBH Teams

Scranton SBBH Team(s)Scranton Counseling Center (SCC)

Lourdesmont• One team at Frances Willard and one team at George

Bancroft Elementary Schools provided by SCC with 2 MHPs and 5 BHWs each

• One team at Scranton High School provided by Lourdesmont with 2 MHPs and 3 BHWs

• Each team meets weekly with school staff to ensure ongoing dialogue regarding services.– Referrals of new youth– Review of ongoing cases– Discussion of collaboration between education and mental

health• Collaboration with other child serving systems

Tier 3/Tertiary Interventions 1-5%•Individual students•Assessment-based•High intensity

1-5% Tier 3/Tertiary Interventions•Individual students•Assessment-based•Intense, durable procedures

Tier 2/Secondary Interventions 5-15%•Some students (at-risk)•High efficiency•Rapid response•Small group interventions• Some individualizing

5-15% Tier 2/Secondary Interventions•Some students (at-risk)•High efficiency•Rapid response•Small group interventions•Some individualizing

Tier 1/Universal Interventions 80-90%•All students•Preventive, proactive

80-90% Tier 1/Universal Interventions•All settings, all students•Preventive, proactive

School-Wide Systems for Student Success:A Response to Intervention (RtI) Model

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/schoolwide.htm

Tier 1/Universal School-Wide Assessment

School-Wide Prevention Systems

SIMEO Tools: HSC-T, RD-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

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Continuum of Support for Tier 2/Secondary-Tier 3/Tertiary Level Systems

1. Small group interventions: Check-in Check-Out (CICO), social/academic instructional groups (SAIG), tutor/homework clubs, etc.

2. Group interventions with individualized focus: Utilizing a unique feature for an individual student, e.g. CICO individualized into a Check & Connect (CnC), mentoring/tutoring, etc.

3. Simple individual interventions: A simple individualized function-based behavior support plan for a student focused on one specific behavior, e.g. brief FBA/BIP-one behavior; curriculum adjustment; schedule or other environmental adjustments, etc.

4. Multiple-domain FBA/BIP: A complex function-based behavior support plan across settings, e.g. FBA/BIP home and school and/or community

5. Wraparound: A more complex and comprehensive plan that addresses multiple life domain issues across home, school and community, e.g. basic needs, MH treatment, behavior/academic interventions, as well as multiple behaviorsIllinois PBIS Network, Revised Sept., 2008

Tier I: Universal/Prevention for AllCoordinated Systems, Data, Practices for Promoting Healthy Social

and Emotional Development for ALL Students

• School Improvement team gives priority to social and emotional health • Mental Health skill development for students, staff, families and communities• Social Emotional Learning curricula for all students• Safe & caring learning environments • Partnerships between school, home and the community• Decision making framework used to guide and implement best practices that consider unique

strengths and challenges of each school community

Tier 2: Early Intervention for SomeCoordinated Systems for Early Detection, Identification,

and Response to Mental Health Concerns

• Systems Planning Team identified to coordinate referral process, decision rules and progress monitor impact of intervention

• Array of services available• Communication system for staff, families and community • Early identification of students who may be at risk for mental health concerns due to specific

risk factors• Skill-building at the individual and groups level as well as support groups • Staff and Family training to support skill development across settings

Tier 3: Intensive Interventions for Few Individual Student and Family Supports

• Systems Planning team coordinates decision rules/referrals for this level of service and progress monitors

• Individual team developed to support each student • Individual plans may have array of interventions/services• Plans can range from one to multiple life domains• System in place for each team to monitor student progress

Adapted from the ICMHP Interconnected Systems Model for School Mental Health, which was originally adapted from Minnesota Children’s Mental Health Task Force, Minnesota Framework for a Coordinated System to Promote Mental Health in Minnesota; center for Mental Health in Schools, Interconnected Systems for Meeting the Needs of All Youngsters.

Interconnected Systems Framework for School Mental Health

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

Sept. 1, 2009

UniversalTeam

Universal Support

Scranton School DistrictSWPBS Implementation

• District and Community Leadership Team established• Tier One training and implementation at two elementary

schools and Scranton High School• Tier Two training and implementation has begun at

Frances Willard. Tier Two planning at George Bancroft and Scranton High on action plan for this year

• Tier Two and Three interventions being provided by SBBH Team and school staff

School Perspective

• Summary of early successes and challenges• Summary of data

– SWIS reports

– Impact on placement

– Academic Impact

• Plans for 2011-12 and beyond

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Big 5 SWIS Data Report

Mental Health Perspective

• Summary of experience with SBBH implementation thus far – successes and challenges

• Blending of Mental Health with School-Wide – how is it going?

• Data– SDQs

– COS

• Plans for 2011-12 and beyond

The Smith Family

• Andy was referred to the SBBH team in 2009 due to episodes of shutting down to include hiding in the school, attempting to elope from the school building, task refusal, and refusal to speak for entire school days.

• School personnel reported having to take the entire day to work with Andy.

• Team began utilizing strategies such as unconditional positive regard, as well as allowing Andy to write down what he was thinking and feeling.

• Therapist reviewed coping skills and reason for his anxiety.

The Smith Family cont.

• Jonah, Andy’s brother, was referred to the SBBH team for similar behaviors to Andy, but to a lesser degree and intensity.

• Team utilized same interventions for Jonah and his work production as well as anxiety began to decrease.

• Both boys began seeking out SBBH team members when distressed, which shocked school personnel, as both were so introverted in the past.

• Family therapy was successful to help mother get her own therapy as well as work on family dynamics.

• In addition, the entire family needed to learn coping skills to deal with the death of a sibling.

The Smith Family cont.

• Interventions:– Case management

• Coordination of community resources such as assistance with medical supplies, transportation to adult therapy appointments, and dental appointments for the family.

• Referrals for assistance with holiday meals, gifts, and financial assistance for bills including telephone and electic.

– Educational support• A. has been identified as needing learning support• Social skill and peer relationship instruction

– Therapy• Coping skills• Problem solving skills• Social and peer relation skills• For C. coping with grief and loss

Interconnected Systems Framework

• Evaluation Tool Guide• Funding Tool Guide• District and Community Leadership Team

Questions?Contact information:

Kelly Peralesperaleskl@ccbh.com

717-770-9365

Dawn JonesDawn.jones@scrsd.org

570-348-3692

Carlyn Fontiniekstewart@nhsonline.org

570-