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V I TT O R I A A N E L L O, A M I F L A M M I N I A N D M A R K W E I S TU N I V E R S I T Y O F SO U T H C A R O L I N A , A N D I L L I N O I S P B I S N E T W O R K
Readiness to Interconnect Positive Behavior Interventions and Supports (PBIS) and School Mental
Health (SMH):
Development and Testing of a Stakeholder Survey
Overview
Background PBIS SMH
PBIS-SMH interconnectionNeed for assessment of readinessSurvey developmentSurvey testing in IllinoisFuture directions
Background: PBIS
Framework for promoting and reinforcing positive behaviors Sugai & Horner, 2002
System of employing positive behavior strategies
Prevention and early intervention perspective
Background: PBIS
Not an intervention
Ideal for incorporating other school-based interventions and services
Background: PBIS
PBIS can “render problem behavior irrelevant, inefficient, and ineffective by helping an individual achieve his or her goals in a socially acceptable manner, thus reducing, or eliminating altogether, episodes of problem behavior” (Carr et al., 2002)
Aligns with mandates of NCLB and Successful, Safe, and Healthy Students Program (ESEA)
Background: PBIS
3-tier system
Tier I: Primary interventions to promote appropriate behavior across student population
Tier II: Secondary interventions targeting students not responding to Tier I interventions (~15%)
Tier III: Tertiary interventions to assist students not responding to Tier II interventions (~5%)
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?
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/school-wide.htm
Background: PBIS
Main focus is behavior, but PBIS aims to improve quality of life and functioning for all students
Improved behavior increased academic achievement
Much research and implementation of Tier I Relatively few resources needed for implementation
Much less research and very inconsistent implementation of Tiers II & III Most at-risk students may not receive assistance
Background: PBIS
Uneven dissemination across U.S. and within states Just 7.90% of schools using school-wide PBIS 47 states report using PBIS
Need for improved data collection and analysis systems, ongoing training and technical support, and adequate resources
Background: SMH
Many youth with behavior problems also have mental health issues
13.1% of youth ages 8 to 15 have a diagnosable mental disorder Only 50.6% of them receive treatment
Background: SMH
Good mental health
Increases in: Prosocial behavior Family engagement in school Socio-emotional development School functioning
Decreases in: Discipline referrals Special education referrals Emotional and behavior problems
Background: SMH
SMH services are varied in scope and focus
Assessment
Counseling Individual, group, and family
Mental health education and promotion
Collaboration/wraparound supports
Background: SMH
SMH: Providing mental health promotion and services at school
Benefits: Reduces barriers to participation (stigma, lack of transportation, etc.) Reduces stress on special education system Reaches a large number of youth and families
Challenges Funding Lack of coordination among school and community mental health
service providers Buy-in and support from administrators and key stakeholders Training and technical support
PBIS-SMH Interconnection
PBIS and SMH currently not interconnected
PBIS can support SMH services
Both operate on multi-tier service delivery systems
Emphasis on evidence-based interventions and data-based decision making
Common goal: promoting success of students across domains
PBIS-SMH Interconnection
Other benefits:
Resolves issues of accessibility
Normalizing mental health issues and help-seeking behaviors
Promoting mental health awareness prevention and early intervention
Need for PBIS-SMH Interconnection
Must consider readiness for change
Transtheoretical model of change (Levesque, Prochaska, & Prochaska, 1999) Do schools and communities view PBIS and SMH as
important issues? Are they thinking about making changes? Do they have the resources to do so?
Need for PBIS-SMH Interconnection
Change process framework (Fixsen et al., 2005)
1. Exploration and adoption
2. Program installation
3. Initial implementation
4. Full implementation
5. Innovation
6. Sustainability
Need for PBIS-SMH Interconnection
Exploration and Adoption is key
Readiness for change examined here
Important to clearly identify needs of the school and community
Support and buy-in from key stakeholders is critical for successful adoption and initial implementation
Compatibility between intervention and stakeholders’ beliefs and values
Need for PBIS-SMH Interconnection
Other factors to consider:
Acceptability Goodness of fit Iatrogenic effects Long-term results
Leadership team
Communication
Support from district, administrators, and community
Community and family readiness
Need for PBIS-SMH Interconnection
No measure for readiness to integrate PBIS and SMH
Existing measures examine :
PBIS implementation and fidelity
Practitioners’ attitudes toward particular interventions
Need for PBIS-SMH Interconnection
Existing measures do not evaluate:
School and community attitudes about change
Perceptions of intervention outcomes
Knowledge of PBIS and SMH
Support from various constituents Administrators, teachers, parents, community members,
other school professionals
Purpose of Current Study
To develop a measure of readiness to interconnect PBIS and SMH
To be used with professionals and other stakeholders involved with PBIS and/or SMH
Pilot Study
Survey of professionals and stakeholders attending CSMH 16th Annual Conference in Charleston, SC (September 2011)
Survey of top factors facilitating/hindering PBIS, SMH, and PBIS-SMH integration
Pilot Study
N = 25 key PBIS/SMH stakeholders Government officials, family members/advocates, directors of
state PBIS centers, technical assistance providers
72% female
Working in field: M = 21.58 years (SD = 8.89 years)
Using PBIS: M = 7.00 years (SD = 2.83 years)
Survey responses aggregated and distilled into 20 main themes
Selection of Key Themes
Support/buy-in from principal and other key staff
Data-based decision-makingActive family and community involvementEffective leadership of teams focused on
behavior and mental healthBelief in impact on
School behavior Academic performance Promotion of a positive learning environment
Selection of Key Themes
Adequate fundingActive, comprehensive training and
implementation supportStaff understanding of PBIS and SMHStaff endorsement of benefits of collaborative
PBIS and SMHActive student involvement
Survey Development
20 themes were used to develop a 35-item survey
Survey was distributed via e-mail to key informants Experts in PBIS, SMH, and/or related fields
Key informants evaluated the survey’s content, wording of items, and the importance of the items and concepts to PBIS-SMH interconnection
3 items were dropped Based on importance ratings and scatter plot data
Survey Development
Revised version of survey distributed to several members of the National Community of Practice (CoP) for School Behavioral Health
Individuals with particular interest in PBIS-SMH interconnection
Survey revised again based on comments from this group and consultation with collaborators on this project (Eber, Barrett, Cashman, & Bazyk)
Survey Development
Consultation with survey expert Robert Johnson of USC College of Education
Survey wording and formatting revised based on Johnson’s recommendations
Final survey was disseminated via SurveyMonkey from June – August 2012
Potential participants reached via email, listservs, and CoP conference calls
Design
Mixed method design Qualitative analyses: interviews with key informants Quantitative analyses: survey development and
psychometric analyses
Online survey 98 items
Participants
Individuals working in a setting using PBIS and SMH
Those delivering mental health services to youth enrolled in schools
Community members who support PBIS and SMH
Examples: teachers, PBIS staff, SMH staff, school administrators, family members of students, and older youth
N=346
Reaching Participants
Collaborations with various groups Communities of Practice through the IDEA
Partnership Discussion of survey on conference calls Promotion of survey on listserv announcements
Reaching out to Teachers School principals School nurses Other school professionals
Utility of Survey
Initiates conversations among stakeholders Issues of readiness Benefits of PBIS-SMH interconnection Frank look at resources
Compare and contrast domains that are ready for change with areas needing progress
Opportunities for building buy-in with administrators, staff, and community
Utility of Survey
Online format
Available for free
Can be used at multiple time points in the stages of preparing to adopt and implement combined PBIS and SMH
Can be used to identify potential “pilot schools” in a district for PBIS-SMH interconnection
Implementation Factors
The power of buy-in and support from key persons in the school and community
Positive working relationships
Use of data to show schools and communities the link between academic performance and mental health
Implementation Factors
Less restrictive funding streams Increased flexibility for schools and communities to
meet students’ needs
District PBIS and SMH coaches Similar to instructional coaches
Paradigm Shifts
Person-centered approach to intervention planning Can be expanded to community-centered approach
Emphasis on data-based decision making Moving away from reliance on anecdotal records
Paradigm Shifts
Use of survey results to assist with resolving the fragmentation of youth mental health services Improving coordination and communication among
service providers to reduce redundancy and increase consistency in service provision
Increased collaboration across disciplines Pooling resources to effect greater change
Future Research
Development of readiness-increasing activities based on areas identified by the survey
Development of measures of systemic change
Future Research
Development of more succinct measures and screeners for readiness for PBIS-SMH interconnection
Development of in-school mental health screening to identify at-risk students Similar to brief reading and math screenings
Future Research
Measuring the impact of PBIS-SMH interconnection on the community at large Cases of DSS involvement, founded cases of child
abuse, number of children removed from families Number of children receiving mental health services
(counseling, medication, etc.) Number of students exhibiting self-injurious behavior
(e.g. cutting) and suicidal thoughts or behaviors
Future Research
Investigation of the link between readiness for interconnection and subsequent implementation and sustainability
Improvement in tools needed for proper PBIS-SMH implementation Data collection systems Communication methods among school professionals School-community communication
Implementing PBIS Schools Over 14 Years as of June 30, 2012
19
19
20
20
20
20
20
20
20
20
20
20
20
20
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
23120
184303
394 444520
587654
895
*1,081
*1,3071,460
1,655
* Excludes CPS data
Implementing PBIS High Schools Over 14 Years as of June 30, 2012
19
19
20
20
20
20
20
20
20
20
20
20
20
20
0
20
40
60
80
100
120
140
160
180
200
1 3 6 10 11 1421
2936
55
*84
*122
156
179
* Excludes CPS data
Illinois PBIS Implementation Status FY11 & FY12
2010-11 2011-121,350
1,400
1,450
1,500
1,550
1,600
1,650
1,700
76%
77%
78%
79%
80%
81%
82%
1,460 1,655
78%
81%
Total Number Schools Trained
Nu
mb
er
of
Sch
ools
Perc
en
tag
e o
f S
ch
ools
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
rven
tio
nAssessm
en
t
Social Worker/School Psychologist
Discussion of Role Changes
Questions raised by Current Model
What data /criteria are used for determining support services?
What data /criteria are used for monitoring student progress?
What data /criteria are used for determining whether student are prepared for exiting or transitioning from support services?
Specifics of
Proposed Model
Review ODRs, CICO, grades, attendance, parent/teacher concerns
We model, reinforce, practice skills we want students to obtain (rate skill attainment)
Review ODRs, CICO, grades, attendance, parent/teacher concerns
Social Worker/School Psychologist Discussion of Role Changes
Current Model
Testing for special education eligibility based on…
Referrals for support services based on…
Proposed Model
Facilitate team based brief FBA/BIP meetings
Act as a communication liaison for secondary / tertiary teams
Facilitate individual/family support plan meetings
Social Skills/Academic Instructional Groups
Selection into groups should be based on youths’ reaction to life circumstance not existence of life circumstances (ex. fighting with peers, not family divorce)
Goals for improvement should be common across youth in same group (ex. use your words)
Data should measure if skills are being USED in natural settings, not in counseling sessions (transference of skills to classroom, café etc.)
Stakeholders (teachers, family etc.) should have input into success of intervention (ex. Daily Progress Report)
Community Partners Roles in TeamsParticipate in all three levels of systems teaming:
Universal, Secondary, and TertiaryFacilitate or co-facilitate tertiary teams around
individual studentsFacilitate or co-facilitate small groups with youth who
have been identified in need of additional supports
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
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; 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
communitycommuni
ty
Possible Tasks/Functions of Core Leadership Team:
Developing a three tiered support network that integrates schools and communities
Review data for community and school planningDevelop a consistent mission for mental wellness
for all youthAddress re-positioning staff for more integrated
support systems Assess how resources can be used differentlyCreating integrated system, procedures and
protocolsCommunity and District resource mapping
Team Structure for Core District/Community Leadership Team
District/Community Leadership
Team
Integration Workgroup
SEL, RtI, PBIS, Mental Health,
SSHS grant
Data AssessmentWorkgroup
Tier 3/Tertiary Workgroup
Transitions:JJ, Hospitals,
From school to school
SupervisorSW/Psych
BuildingPrincipal
Rep.
Service Providers
Local Area Network
Co-Convener
Homeless Coordinator Mental
Health/708 Board
Curriculum/Prof. Dev
RtI Coordinator
FamilyGroups
PoliceJuvenile Justice
Special EducationDirector
Supt/Asst. Supt
Core District and Community Leadership
Team
Building Level Model
Community/Family
Mental Health
Rep.
SW, School Psych
Guidance
Principal
Special Education Teachers
Grade Level
Teachers
Building Leadership
Team
Community Partners Assist Schools with Interventions
Elgin SD U-46, in partnership with Streamwood Behavioral Health, initiated social skills instructional groups for selected students at Lords Park Elementary School. Students on a Check-In Check-Out intervention who were not achieving a 70% rate with daily progress reports (DPRs) were identified. Following the targeted group intervention, these students began experiencing success within the first week and consistently achieved DPRs of 70% or higher for the following six weeks.
Lords Park Elementary Social Skills Instructional Group
Urbana SD 116 Integration
Classroom teachers providing Social Emotional Lesson plans
Classrooms community CirclesSchool-wide bully prevention integrationLocal public Mental Health practitioner participating as
active member on Tier 2 systems teamSPARCS co-lead groups (mental health and social
worker) in EBD self-contained elementary classrooms and as tier two supports within middle school
Community agencies at tier 2/3 district trainingsCommunity partners present at district in-service daysTier 2/3 Coach active member of ACCESS Initiative team
SPARCS
Mission of SPARCS: To enhance trauma focused services available to traumatized children and adolescents (complex trauma)
Group members – history of chronic interpersonal trauma and living with significant ongoing stressors
The National Child Traumatic Stress Network, 2005
Champaign SD 4 Integration
Co-lead (mental health/school counselor) SPARCS group at Centennial High School 2011-2012SY Mental health worker one day/week at high
school Member of secondary systems meeting Co-lead groups Wraparound/RENEW
External coach a member of SAMSHA teamCommunity mentor coordinator sitting on tier 2 systems
team at Westview Elementary
Integration Efforts Crosspoint Human Services
DMH Grant – Hoopeston School District #11DMH Grant - Pine Crest Urbana SD #116
Special Thanks to:
Lucille Eber and Susan Barrett National PBIS Technical Assistance Center
Joanne Cashman and Mariola Rosser IDEA Partnership
Sue Bazyk Cleveland State University
Nancy Lever Center for School Mental Health
Survey participants
Jacksonville, Il School District Jill Johnson, IL PBIS Technical Assistance Coordinator
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