School-based Mental Health and School-based Mental Health and Positive Behavioral Interventions Positive Behavioral Interventions and Supports and High Schoolsand Supports and High Schools Maryland Safe and Supportive Schools Initiative

A Collaborative Effort of the MSDE, Sheppard Pratt Health System, and Johns Hopkins University

School-based Mental Health and School-based Mental Health and Positive Behavioral Interventions Positive Behavioral Interventions and Supports and High Schoolsand Supports and High Schools Maryland Safe and Supportive Schools Initiative

A Collaborative Effort of the MSDE, Sheppard Pratt Health System, and Johns Hopkins University

Susan BarrettDirector, PBIS Regional TTACSheppard Pratt Health System, Implementer Partner Center on PBISsbarrett@pbismaryland.org

Susan BarrettDirector, PBIS Regional TTACSheppard Pratt Health System, Implementer Partner Center on PBISsbarrett@pbismaryland.org

Interconnected Systems Framework for School Mental Health

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 studentsSafe & 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

MDS3 InitiativeMDS3 Initiative• Funding: U.S. Department of Education’s Office of

Safe and Healthy Students (OSHS)• Number of awards: 11 states (of 33 applicants):

Arizona, California, Iowa, Kansas, Louisiana, Maryland, Michigan, South Carolina, Tennessee, West Virginia and Wisconsin are S3 Grantees in the first cohort

• Amount: 13M• Length: 4 years (October 2010-2014)• Partners: MSDE, Sheppard Pratt Health System,

Johns Hopkins University

MDS3 GoalsMDS3 Goals

1) Assess school climate, student engagement, and the school environment,

2) Implement evidence-based programs (EBPs) to meet student needs, based on survey

3) Improve conditions for learning, 4) Reduce school violence and substance

use, and improve student engagement and the school environment to support student learning.

Keys to 10 Year SuccessKeys to 10 Year Success

• Commitment of leadership at state, district and school levels• Private, public, & university partnership• Standards and Protocols developed and implemented• INFRASTRUCTURE developed to support state and regional training capacity• State-wide impact:

– 877 schools in all 24 systems trained• 740 implementing Tier 1/Universal PBIS with fidelity

• PBIS Maryland WEBSITE and DATABASE, WIKI (www.pbismaryland.org)

Keys to 10 Year Success (cont)Keys to 10 Year Success (cont)

• Ongoing Technical Assistance-Coaching Capacity (400 trained)• Ongoing Evaluation/Progress Monitoring • Evaluation Tools• Ongoing Data Collection for Decision Making

• IPI (Implementation Phases Inventory), SETs, SWIS, BOQ• Ongoing expansion of Local School System infrastructure as

numbers of schools increase—staff designation, coaches for schools, and funding

• Federal Grants to support Rigorous Randomized Evaluation Activity through JHU

8

USDOEUSDOE’’s S3 School Climate Models S3 School Climate Model

Using Lessons Learned to Build Next PhaseUsing Lessons Learned to Build Next Phase

• Training must be ongoing and connected to previous and upcoming activities.• High schools require additional supports to successfully launch PBIS and implement it with fidelity.

– Adolescent students with unmet social and emotional needs create challenges– High schools are often unprepared to implement Tier 2 and Tier 3 interventions or to address mental health needs and resources at the local and state level have been ??– Relatively few developmentally appropriate EBPs (Greenberg et al., 2001).

• Coaching is NECESSARY and supported by evidence (NIRN) • School Liaisons need to have a small school to staff person ratio (PBIS Plus-6:1; MDS3 3:1)• Need to make the Focus School condition worthwhile for those schools.

Maryland Safe and Supportive Schools Maryland Safe and Supportive Schools (MDS3)(MDS3)

Research and evaluation

“sustainable system to measure”

Administration“disseminate outcomes to stakeholders”

Implementation“develop capacity in

schoolsto improve”

MethodologyMethodology• Participating Schools

– 52 high schools across the state of Maryland • 10 districts: Anne Arundel, Baltimore County, Charles, Caroline, Dorchester,

Somerset, Washington, Wicomico, Worcester, and Queen Anne’s– Second cohort of up to 8 additional schools possible for spring 2012, for a total of 60 schools

• Design – 3 years (spring 2011 through summer 2014)– All 52 schools participated in the data collection activities

• 29 “implementation schools” who are implementing the MDS3 Initiative

• 23 schools are in the “focus” or control group– Schools were randomly assigned to these groups

3/11/2012 13

Design of MDS3 Observational StudyDesign of MDS3 Observational Study

• Funded by William T. Grant Foundation• 4 data points, over 3 years

– 2 data collectors (1 ASSIST and 1 SAfETy)– 25 classrooms per school (≈1500 per time point)– 30+ non-classroom locations

• Using handheld devices to collect data• Instruments

– Assessing School Settings: Interactions of Students & Teachers (ASSIST): Rusby et al. (2001); Cash & Debnam

• Praise, opportunities to respond, punishing statements, transitions, supervision, positive interactions, engagement, aggressive behavior etc.

• Both event based and global ratings– School Assessment for Environmental Typology (SAfETy): Bradshaw,

Lindstrom Johnson, Milam, & Furr-Holden• Features of the school environment that encourage access control,

surveillance, territoriality, physical maintenance, and behavioral management (e.g., disorder, substance use, broken windows)

Menu of Evidence-Based Programs

• Positive Behavioral Interventions and Supports – (PBIS; Sugai & Horner, 2006)– 3 tiered prevention model, focused on climate and behavior

management• Olweus Bullying Prevention Program

– (Olweus, 2007)– Bullying and school climate

• Botvin’s Life Skills program – (Botvin et al., 2006)– Substance abuse prevention

• Check-in/Check-Out – (Hawken & Horner, 2003)– Mentoring and behavior management

• Check & Connect – (Anderson et al., 2004)– Mentoring and truancy prevention

• Cognitive Behavioral Intervention for Trauma in Schools – (Kataoka et al., 2003)– Focused on mental health issues (e.g., anxiety, depression)

Center for School Based Mental HealthCenter for School Based Mental HealthNancy Lever and Sharon StephanNancy Lever and Sharon Stephan

• Link to EBP resources specific to HS• Mobilize student, family, community • CBITS• Community Resource Mapping

Manual• Cross train• Common Calendar• Increase ISF awareness, visibility

MDS3 School Climate Model: MDS3 School Climate Model: % Time Spent on % Time Spent on ““Valued OutcomesValued Outcomes””

Evidence-Based ProgramsEvidence-Based ProgramsImplemented 2010-2011Implemented 2010-2011

Year 1: Year 1: Foundation: Applying the Tiered LogicFoundation: Applying the Tiered Logic

• Continuum of EBP• Fidelity of Implementation• Teaming Structure• Data System• Universal Screening and Decision

Rules for Access• Data Base Decision Making Team

Problem Solving• Continuous Progress Monitoring

Evidence-Based Programs ImplementedEvidence-Based Programs Implemented2010-2011 and 2011-20122010-2011 and 2011-2012

Evidence-Based ProgramsEvidence-Based ProgramsAnticipated Implementation for Year TwoAnticipated Implementation for Year Two

MDS3 Data Sources

• Data for Decision-making:

• Web-based school climate survey (students, school staff, parents)

• Site visits - Health and safety of school environment

• School-level records: referrals, suspensions, attendance, nurse and counselor log, academics

• School-wide Evaluation Tool (SET), Individual Student Systems Evaluation Tool (ISSET)

Spring 2011 MSD3 Student Climate Survey Results

• Safety– ___% feel safe at school– ___% reported being bullied during the school

year– ___% reported that other students try to stop

bullying – ___% often or very often feel sad– ___% reported that substance abuse is a

problem at their school

Spring 2011 MSD3 Student Climate Survey Results

• Safety– 83.0% feel safe at school– 25.0% reported being bullied during the

school year– 31.7% reported that other students try to

stop bullying – 20.2% often or very often feel sad– 64.9% reported that substance abuse is

a problem at their school

Spring 2011 MSD3 Student Climate Survey Results

• Engagement– ___% feel they belong at school– ___% feel their teachers encourage them to

work hard– ___% feel their parents are informed when they

do well– ___% feel students of all races are treated

equally

Spring 2011 MSD3 Student Climate Survey Results

• Engagement– 67.5% feel they belong at school– 81.2% feel their teachers encourage them

to work hard– 43.9% feel their parents are informed

when they do well– 57.9% feel students of all races are

treated equally

Spring 2011 MSD3 Student Climate Survey Results

• Environment– ___% report that disruptions in the

classroom get in the way of their learning

– ___% report the school building is clean and well-maintained

– ___% report that students who need help with their problems are able to get it at school

Spring 2011 MSD3 Student Climate Survey Results

• Environment– 60.5% report that disruptions in the

classroom get in the way of their learning

– 49.4% report the school building is clean and well-maintained

– 63.6% report that students who need help with their problems are able to get it at school

Stages of Implementation Stages of Implementation FixsenFixsen

FocusFocus StageStage DescriptionDescription

Exploration/Adoption

Decision regarding commitment to adopting the program/practices and supporting successful implementation.

Installation Set up infrastructure so that successful implementation can take place and be supported. Establish team and data systems, conduct audit, develop plan.

Initial Implementation

Try out the practices, work out details, learn and improve before expanding to other contexts.

Elaboration Expand the program/practices to other locations, individuals, times- adjust from learning in initial implementation.

Continuous Improvement/Regeneration

Make it easier, more efficient. Embed within current practices.

Funding Visibility PolicyPoliticalSupport

Training CoachingBehavioral Expertise

Evaluation

LEADERSHIP TEAM(Coordination)

Local School/District Implementation Demonstrations

Expanding the SWPBS Implementation Blueprint

www.pbis.org

31

ContentSystems Coach

ISF Leadership TeamISF Implementation Team

Family Community Implementation Demonstrations

Policy: Shapes Adult BehaviorPolicy: Shapes Adult Behavior

Equal priority to • Social Emotional Health and

Wellbeing• Academic Achievement• Academic Behaviors

– Organizational Skills– Team Problem Solving– Study Skills

Training

Activity Based Training•WIIFM•Resource/Continuum Mapping• Inventory current interventions, practices• Service Delivery Teams- Who?

• organization, role and function, communication • from case management to systems planning • assess skills, competencies across staff

•Data: Student List, Early Warning Systems, ODR as screening tool

•Implementation Snapshots and Practice Profiles

WIIFM? Why Am I Here? WIIFM? Why Am I Here?

• How can I use this training to benefit the work I do everyday?– Prioritize which topics align with your

district’s mission– With your schools goals– Share your thoughts at your table

Before you add one more thing….

www.safetycenter.navy.mil

Resource MappingResource Mapping

• Taking Inventory

• Linking to Outcome/Strategic Plan

• How do we support adults?

• How do we make sure we invest in what works with our students/youth?

• What data will help keep us on track?

Tier 3

Tier 2

Tier 1

Triangle Triangle Activity:Activity:

Applying the Applying the Three-Tiered Three-Tiered

Logic to Logic to Your Your

SchoolSchool , District or

State

38

Practices, Initiatives, Programs for a FEW

Practices, Initiatives, Programs for SOME

Practices, Initiatives, Programs for ALL

Screening & Feedback Screening & Feedback

• Essential to developing effective systems– Effective systems allow for high

fidelity of implementation

• Often overlooked

Name Grade Level

GPA last year

Behavior Referrals

Core Grades

Attendance Credits

Jana 9 2.2 4 ref 1 D 1 F 82% On TrackBlake 11 1.3 0 3F 88% -3Toby 10 2.8 16 ref 1 S 2D 1 F 84% -2Carlos 10 .7 22 S 3 S 4 F 62% -4Yvonne 9 2.7 2 ref 2 D 1 F 86% -1Lin 11 2.3 0 1 F 90% -2Maria 12 1.9 16 ref 2 S 4 D 1 F 74% -4Doug 9 3.1 2 ref 1 F 81% On TrackTyrone 9 2.9 10 ref 2 D 89% On TrackSam 10 2.4 13 ref 2D 1 F 87% -2Paul 9 3.4 1 ref 1 D 86% On TrackTia 9 3.7 0 2 C 60% On Track

Activity: Student List

Who gets access to an intervention that integrates academic/behavioral support ? Choose 6 students.

Activity: Student ListActivity: Student List

• Do you have rules for access? • Do you need to lower the threshold?• Are there other sources of data available?• Can you get access to a data dash board? • What else should we know about the

students? • Do any staff in building have relationship

with the student?• What are some possible political implications

of choosing the students you chose? • Leads to the integration• Reflect on the team dynamics

Decision Rules for Access to Advanced TiersDecision Rules for Access to Advanced Tiers (and decision rules for prevention-if we can predict the trajectories , then (and decision rules for prevention-if we can predict the trajectories , then

we can prevent it from happening)we can prevent it from happening)

• Youth has 2 Major ODRs• Youth has 1 Suspension• Youth experiences more than ? minutes out of

instruction • Youth misses more than ? days unexcused

absences• Youth drops GPA by more than ??• Youth – benchmark testing- McIntosh • Youth- incomplete class work/homework• Attendance (look at predictors for drop-out and

school completion)• Admin Referral• Teacher/Staff Referral• Family Referral• Other:

S

ervice

s and In

terventio

ns

are availa

ble as soon as t

he

student d

emonstrates a

need

Screening: Early Warning SystemsScreening: Early Warning Systems • Research is clear that ninth grade is a “make or

break” year. More students fail ninth grade than any other grade in high school, and a disproportionate number of students who are held back in ninth grade subsequently drop out (Herlihy, 2007).

• The most powerful predictors of whether a student will complete high school include course performance and attendance during the first year of high school (Allensworth & Easton, 2005; 2007).

• Therefore, systematic collection of student attendance and course performance data can be used to develop an effective early warning system that can also be tailored to local contexts.

http://betterhighschools.org/ews.asp#EWS1

Relationsh

ip

Critical Features for Implementing Critical Features for Implementing Advanced Tiers of Support: Advanced Tiers of Support:

• Establish decision rules for access to the intervention• Explore data and “look” for students in need**Refrain from grouping students with similar life circumstance

(divorce/bully etc)– Group based on demonstrated need- response to the life

circumstance and the coping skills required• Interventions are linked directly to the SW expectations and/or

academic goals• Interventions are always available to students• Monitor progress of student- (outcome with data in and data out)• Staff are trained, receive ongoing support, and are provided

feedback.

Types of Coaching: Selection and Types of Coaching: Selection and Recruitment for the “Right Fit”Recruitment for the “Right Fit”

• Coaching for Individual Change: focus on skill development, support and performance

feedback (content specific: academic, behavior)

• Coaching for Team/Group Change: focus on collaboration and facilitation, group

dynamics

• Coaching for Systems Change: focus on organizational change

Systems Coach

Support To Leadership

1. Listen, model2. Advocate for School-Wide Support through

data3. Broker Resources to Include EBPs4. Be a “New Pair of Eyes” 5. Provide an Objective View of a Situation6. Lead in the Direction of Sustainability

Skill/Coach for Practitioners

1. Provide Direct Training, recruit next trainer2. Serve as the System Level Interventionist3. Promote Common Language That’s

Productive4. Provide Scaffolding5. Model Active Listening

Facilitator/Communicator

1. Develop Effective Communication Systems2. Facilitate Sharing Different Views and

Perspectives3. Guide Through:

a. Self-Assessment of Efficiencyb. Evaluationc. Needs Assessment d. Use of Datae. Critical Features of Systems and

Programs

Coaching: % Of Time Spent w/ Each Group

Coaching: % Of Time Spent On Each Type Of Coaching

Percentage Of Time Spent On…

Top Small Group Hours

Challenges Challenges

What is a School Climate Specialist? School leadership oppositionStaff buy-inLack of systems structure“B.D.T.R.B. Syndrome” Been Down This Road Before

Involvement of whole staff

School Climate Specialists’ School Visits

Lessons Learned in the School Climate Specialist Role

1. Support May Look Different From School-to-School

1. Expect Successes and Challenges

1. Healthy Debriefing Among Colleagues is Good Practice

1. Pushback from Schools is not Personal

1. Flexibility is Key in Maintaining Healthy Relationships with School Teams

1. Three Schools Seem to Be the Limit for Successful Implementation of EBPs

1. Serve as a Guide, Facilitate not Direct

1. Celebrate Even the Smallest of Successes

1. Remember… You are a Guest in the School

Lessons Learned AboutLessons Learned AboutEvidence-Based ProgramsEvidence-Based Programs

1. Let Schools Work Within their Own Timeline

2. For Some Interventions (e.g., Tier 2 and Tier 3), It Is Okay to

Start Small and Work the Kinks Out

3. Utilize Data To Make Decisions about Evidence-Based Programs

4. Celebrate Even the Smallest Successes

5. Realize that Program Implementation Will Not Take Place the

Day After Training

6. Work With What’s Already in Place To Formalize or Document

EBPs

7. Don’t just do “IT” to say “we do IT.”

Lessons Learned about StakeholdersLessons Learned about Stakeholders

1. Administrator Buy-In is Critical for Success

2. Make Sure Team is Representative of Staff

3. Know Who Has the Power in the School and Work Through Them

4. Gather Student Feedback and Participation

5. For Sustainability, Business/Community Support is Imperative

6. Expect Changes in Team Composition Over Time

7. Recognize school readiness signals in order to advance to next steps

Lessons Learned in Implementation StepsLessons Learned in Implementation Steps

1. Each school is in a different phase-make sure you are also in that phase.

2. Each stakeholder on the team has a different agenda and perspective about needs.

3. Each member of the team will have the “aha” moment at different times.

4. Implementing step 2 before step 1 will sometimes help you have a stronger team. It is okay to go back.

5. Staff may need training in the program before they

can commit and commitment is never assured.

Year 2 Year 2

• State Integration Team• District and Community Team• Community Resource Mapping

– GIS (geographic information system) mapping of the locations of the schools in relation to community-based resources (e.g., libraries, churches, hospitals, community centers) and risks (e.g., alcohol outlets, crime). We are also linking the schools with community level census data (e.g., income of surrounding zip codes).

– This will allow us to examine some macro-level factors related to the survey data and school-based observational data collected in the project.

–   Data will enrich the information available to the schools, as well as the research on community-level correlates of school climate.

Year 2: CapacityYear 2: Capacity

• RENEW• CBITS• School based team expansion• Implementation Briefs• ISF Facilitation Guides

– Funding, Tools, Team– Readiness Checklist for Integration– ISF Consumer Guide

Share Your Thoughts…Questions?Share Your Thoughts…Questions?

Acknowledgements“The Elite Eleven”

Beth Chatfield, Kim Crawford, Lacey Hentz, Wayne Hickman, Christina Jordan, Christina Knepper, Mike Muempfer, Rebecca

Piermattei, Rebecca Philbrick, Morgen Piper, Brian TureckPatti Hershfeldt, Jerry Bloom, Aniket Joshi, Muriel Smoot

Catherine Bradshaw, Katrina DebnamMartha Essenmacher, Mike Ford, Andrea Alexander

“No significant learning occurs without a significant relationship."

Dr. James Comer