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Promoting Positive Behavioral & Mental Health in Schools: Promising Practices from Early Childhood through High Schools Lucille Eber Lise Fox Beth Harn Krista Kutash George Sugai IL PBIS Network University of S. FL University of OR University of S. FL University of CT July 2011 OSEP Project Directors Meeting Washington D.C.

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  • Slide 1
  • Promoting Positive Behavioral & Mental Health in Schools: Promising Practices from Early Childhood through High Schools Lucille Eber Lise Fox Beth Harn Krista Kutash George Sugai IL PBIS Network University of S. FL University of OR University of S. FL University of CT July 2011 OSEP Project Directors Meeting Washington D.C.
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  • Objectives Evidence- based Practices & Systems Implementation Fidelity Implementation Sustainability & Scaling
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  • VIOLENCE PREVENTION Surgeon Generals Report on Youth Violence (2001) Coordinated Social Emotional & Learning (Greenberg et al., 2003) Center for Study & Prevention of Violence (2006) White House Conference on School Violence (2006)
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  • Conceptual Logic! Successful individual student behavior & mental health support is linked to host environments or schools & communities that are effective, efficient, relevant, durable, scalable, & logical for all students (Zins & Ponti, 1990) EffectiveWork EfficientDoable RelevantCultural/contextual DurableLasting ScalableTransferrable LogicalConceptually sound
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  • Positive Behavior & Mental Health
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  • RtI
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  • Consideration of risk & protective factors in redesign of teaching environmentsnot students
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  • 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 Individualized Systems for Students with High-Risk Behavior ~80% of Students ~15% ~5% CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT ALL SOME FEW
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  • Early Triangle (p. 201) Walker, Knitzer, Reid, et al., CDC
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  • All Some Few Continuum of Support for ALL Dec 7, 2007
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  • Continuum of Support for ALL Theora Dec 7, 2007 Science Soc Studies Reading Math Soc skills Basketball Spanish Label behavior & practicenot people
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  • Continuum of Support for ALL: Molcom Dec 7, 2007 Prob Sol. Coop play Adult rel. Anger man. Attend. Peer interac Ind. play Self-assess Label behavior & practicenot people
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  • Detrich, Keyworth, & States (2007). J. Evid.-based Prac. in Sch. Start w/ What Works Focus on Fidelity
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  • Guskey, 1986, p. 59
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  • SYSTEMS PRACTICES DATA Supporting Staff Behavior Supporting Student Behavior OUTCOMES Supporting Social Competence & Academic Achievement Supporting Decision Making Integrated Elements
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  • SWPBS Implementation Blueprint www.pbis.org
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  • Where are you in implementation process? Adapted from Fixsen & Blase, 2005
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  • Algozzine, B., Wang, C., & Violette, A. S. (2011). Reexamining the relationship between academic achievement and social behavior. Journal of Positive Behavioral Interventions, 13, 3-16. Burke, M. D., Hagan-Burke, S., & Sugai, G. (2003). The efficacy of function-based interventions for students with learning disabilities who exhibit escape-maintained problem behavior: Preliminary results from a single case study. Learning Disabilities Quarterly, 26, 15-25. McIntosh, K., Chard, D. J., Boland, J. B., & Horner, R. H. (2006). Demonstration of combined efforts in school-wide academic and behavioral systems and incidence of reading and behavior challenges in early elementary grades. Journal of Positive Behavioral Interventions, 8, 146-154. McIntosh, K., Horner, R. H., Chard, D. J., Dickey, C. R., and Braun, D. H. (2008). Reading skills and function of problem behavior in typical school settings. Journal of Special Education, 42, 131-147. Nelson, J. R., Johnson, A., & Marchand-Martella, N. (1996). Effects of direct instruction, cooperative learning, and independent learning practices on the classroom behavior of students with behavioral disorders: A comparative analysis. Journal of Emotional and Behavioral Disorders, 4, 53-62. Wang, C., & Algozzine, B. (2011). Rethinking the relationship between reading and behavior in early elementary school. Journal of Educational Research, 104, 100-109. Academic-Behavior Connection Viewed as outcomes, achievement and behavior are related; viewed as causes of each other, achievement and behavior are unrelated. In this context, teaching behavior as relentlessly as we teach reading or other academic content is the ultimate act of prevention, promise, and power underlying PBS and other preventive interventions in Americas schools. Algozzine, Wang, & Violette (2011), p. 16.
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  • Bradshaw, C.P., Koth, C.W., Thornton, L.A., & Leaf, P.J. (2009). Altering school climate through school-wide Positive Behavioral Interventions and Supports: Findings from a group-randomized effectiveness trial. Prevention Science, 10(2), 100-115 Bradshaw, C.P., Koth, C.W., Bevans, K.B., Ialongo, N., & Leaf, P.J. (2008). The impact of school-wide Positive Behavioral Interventions and Supports (PBIS) on the organizational health of elementary schools. School Psychology Quarterly, 23(4), 462- 473. Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of School-Wide Positive Behavioral Interventions and Supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12, 133-148. Bradshaw, C.P., Reinke, W. M., Brown, L. D., Bevans, K.B., & Leaf, P.J. (2008). Implementation of school-wide Positive Behavioral Interventions and Supports (PBIS) in elementary schools: Observations from a randomized trial. Education & Treatment of Children, 31, 1-26. Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., & Esperanza, J., (2009). A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Journal of Positive Behavior Interventions, 11, 133-145. Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptionality, 42(8), 1-14. RCT & Group Design PBIS Studies Reduced major disciplinary infractions Improvements in academic achievement Enhanced perception of organizational health & safety Improved school climate Reductions in teacher reported bullying behavior
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  • ~80% of Students ~5% ESTABLISHING CONTINUUM of SWPBS SECONDARY PREVENTION Check in/out Targeted social skills instruction Peer-based supports Social skills club TERTIARY PREVENTION Function-based support Wraparound Person-centered planning PRIMARY PREVENTION Teach SW expectations Proactive SW discipline Positive reinforcement Effective instruction Parent engagement SECONDARY PREVENTION TERTIARY PREVENTION PRIMARY PREVENTION ~15%
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  • Behavior Support Elements Problem Behavior Functional Assessment Intervention & Support Plan Fidelity of Implementation Impact on Behavior & Lifestyle *Response class *Routine analysis *Hypothesis statement *Alternative behaviors *Competing behavior analysis *Contextual fit *Strengths, preferences, & lifestyle outcomes *Evidence-based interventions *Implementation support *Data plan *Continuous improvement *Sustainability plan Team-based Behavior competence
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  • v Promising Practices for Early Childhood
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  • The Context Concerns about increases in childrens challenging behavior Growing awareness of the relationship between social emotional development and school readiness Myriad of approaches to address particular social emotional issues; lacking comprehensive models Reliance on clinical approaches
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  • Pyramid Model Universal Promotion Secondary Prevention Tertiary Intervention
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  • 28 Nurturing and Responsive Relationships Foundation of the pyramid Essential to healthy social development Includes relationships with children, families and team members
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  • 29 High Quality Environments Inclusive early care and education environments Comprehensive system of curriculum, assessment, and program evaluation Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC
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  • 30 Supportive Home Environments Supporting families and other caregivers to promote development within natural routines and environments Providing families and other caregivers with information, support, and new skills
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  • Targeted Social Emotional Supports Self-regulation, expressing and understanding emotions, problem solving, developing social relationships Explicit instruction Increased opportunities for instruction, practice, feedback Family partnerships Progress monitoring and data-based decision-making
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  • 32 Targeted Social Emotional Supports The support and coaching of families to enhance their childs social development within natural environments and activities Self-regulation, expressing and understanding emotions, developing social relationships
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  • 33 Individualized Intensive Interventions Team developed Parents as partners Comprehensive interventions (all environments) Assessment-based (functional assessment) Skill-building
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  • The Pyramid Model: Program-Wide Implementation ALL Levels Require Administrative Support Data-Based Decision Making including screening and progress monitoring Program-Wide Commitment Teacher Training and Technical Assistance (coaching) Well-Defined Procedures Partnerships with Families
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  • Mental Health Framework for the Early Childhood Mental Consultant to build capacity Emphasis on prevention with intensive individualized intervention available Embedded screening for efficient identification and support Comprehensive interventions that focus children and families Seewww.ecmhc.org for resourceswww.ecmhc.org
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  • Outcomes Teacher and parent satisfaction Continual growth in implementation fidelity (practitioners and programs) Decreases in behavior incidents
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  • Experimental Child Outcomes Non-target children Differences between social skills scores for children in intervention versus control classrooms (Cohens d =.46). Lower mean scores for problem behavior Target children Higher mean social skills scores in intervention classrooms (Cohens d =.41). Differences in problem behavior scores Significant differences in frequency of positive social interactions
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  • The non-system of early childhood Early childhood policies and procedures are highly fragmented, with complex and confusing points of entry that are particularly problematic for underserved populations and those with special needs. This lack of an integrative early childhood infrastructure makes it difficult to advance prevention-oriented initiatives for all children and to coordinate services for those with complex problems. (Shonkoff & Phillips, 2000, p.11)
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  • Partnership for Scaling Up Center on the Social and Emotional Foundations for Early Learning www.vanderbilt.edu/csefel/
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  • Primary Partner Associations Division for Early Childhood of the Council for Exceptional Children (DEC) IDEA Infant and Toddler Coordinators Association (ITCA) National Association for Bilingual Education (NABE) National Association of Child Care Resource & Referral Agencies (NACCRRA) National Association for the Education of Young Children (NAEYC) National Association of State Directors of Special Education (NASDSE ) National Association of State Mental Health Program Directors (NASMHPD) National Head Start Association (NHSA) Parent Advocacy Coalition for Educational Rights (PACER) IDEA 619 Consortium
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  • Commitment Unified message Evidence-based practices Comprehensive approach for supporting/promoting the social emotional competence of all children Focus on the enhancement of social competencies rather than the remediation of problems Application to the full range of programs and service settings Affordable, feasible, and acceptable to diverse personnel, families and communities
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  • Changing Practice Training alone is inadequate Coaching is necessary for translation of training to classroom practice Fidelity of implementation focus of coaching Administrative support and systems change necessary for sustained adoption Data driven systems necessary for ensuring targeted program, practitioner, and child outcomes
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  • Capacity Building State Cross Sector Leadership Team Building a system for ongoing training and technical assistance for scaling up the implementation of the model within programs across service systems Master T/TA Cadre Expertise in all aspects of model Will provide training (of additional trainers, coaches, and practitioners), external coaching, guide program-wide implementation, support data collection Demonstration Sites Data System System and procedures for measuring implementation fidelity, outcomes, and using data for decision-making
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  • Promoting Positive Behavioral and Mental Health in Schools: Promising Practices from Early Childhood Through High School Lucille Eber, Statewide Director, IL PBIS Network www.pbisillinois.org [email protected] Supporting Youth at the Secondary Level OSEP Project Directors Conference Washington DC July 19, 2011
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  • Big Ideas Challenges and Context A multi-tiered Systemic Approach Effect of PBIS on existing clinical supports in place in schools and a developing model in IL A developing national model: National SMH and National PBIS Center
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  • Some Big Picture Challenges Low intensity, low fidelity interventions for behavior/emotional needs Habitual use of restrictive settings (and poor outcomes) for youth with disabilities High rate of undiagnosed MH problems (stigma, lack of knowledge, etc) Changing the routines of ineffective practices (systems) that are familiar to systems
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  • Why We Need MH 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
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  • It Takes a System
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  • 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
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  • Core Features of a Response to Intervention (RtI) Approach Investment in prevention Universal Screening Early intervention for students not at benchmark Multi-tiered, prevention-based intervention approach Progress monitoring Use of problem-solving process at all 3-tiers Active use of data for decision-making at all 3-tiers Research-based practices expected at all 3-tiers Individualized interventions commensurate with assessed level of need
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  • Examples of Ineffective Secondary/Tertiary Structures Referrals to Sp. Ed. seen as the intervention FBA seen as required paperwork vs. a needed part of designing an intervention Interventions the system is familiar with vs. ones likely to produce an effect (ex: student sent for insight based counseling at point of misbehavior)
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  • Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems SIMEO Tools: HSC-T, RD-T, EI-T Check-in/ Check-out Individualized Check- In/Check-Out, Groups & Mentoring (ex. CnC) Brief Functional Behavioral Assessment/ Behavior Intervention Planning (FBA/BIP) Complex FBA/BIP Wraparound/RENEW 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 Positive Behavior Interventions & Supports: A Response to Intervention (RtI) Model Illinois PBIS Network, Revised April2011 Adapted from T. Scott, 2004 Tier 2/ Secondary Tier 3/ Tertiary Intervention Assessment
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  • Interconnected Systems Framework paper Examples from the Field Provided by: Colette Lueck, Managing Director, Illinois Children's Mental Health Partnership Lisa Betz, Mental Health and Schools Coordinator, IL Division of MH The IL PBIS Network Team
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  • Community Partners Roles in Teams Participate in all three levels of systems teaming: Universal, Secondary, and Tertiary Facilitate or co-facilitate tertiary teams around individual students Facilitate or co-facilitate small groups with youth who have been identified in need of additional supports
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  • Tier I: Universal/Prevention for All Coordinated 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 Some Coordinated 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 Childrens 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
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  • Tier 1 - Universal Interventions that target the entire population of a school to promote and enhance wellness by increasing pro-social behaviors, emotional wellbeing, skill development, and mental health. This includes school-wide programs that foster safe and caring learning environments that, engage students, are culturally aware, promote social and emotional learning and develop a connection between school, home, and community. Data review should guide the design of Tier 1 strategies such that 80-90% of the students are expected to experience success, decreasing dependence on Tier II or III interventions. The content of Tier 1/Universal approaches should reflect the specific needs of the school population. For example, cognitive behavioral instruction on anger management techniques may be part of a school-wide strategy delivered to the whole population in one school, while it may be considered a Tier 2 intervention, only provided for some students, in another school.
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  • Tier 2 - Secondary Interventions at Tier 2 are scaled-up versions of Tier 1 supports for particular targeted approaches to meet the needs of the roughly 10-15% of students who require more than Tier 1 supports. Typically, this would include interventions that occur early after the onset of an identified concern, as well as target individual students or subgroups of students whose risk of developing mental health concerns is higher than average. Risk factors do not necessarily indicate poor outcomes, but rather refer to statistical predictors that have a theoretical and empirical base, and may solidify a pathway that becomes increasingly difficult to shape towards positive outcomes. Examples include loss of a parent or loved one, or frequent moves resulting in multiple school placements or exposure to violence and trauma. Interventions are implemented through the use of a comprehensive developmental approach that is collaborative, culturally sensitive and geared towards skill development and/or increasing protective factors for students and their families.
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  • Tier 3 - Tertiary Interventions for the roughly 1-5% of individuals who are identified as having the most severe, chronic, or pervasive concerns that may or may not meet diagnostic criteria. Interventions are implemented through the use of a highly individualized, comprehensive and developmental approach that uses a collaborative teaming process in the implementation of culturally aware interventions that reduce risk factors and increase the protective factors of students. Typical Tier 3 examples in schools include complex function-based behavior support plans that address problem behavior at home and school, evidence-based individual and family intervention, and comprehensive wraparound plans that include natural support persons and other community systems to address needs and promote enhanced functioning in multiple life domains of the student and family.
  • Slide 59
  • Old Approach New Approach Each school works out their own plan with Mental Health (MH) agency; A MH counselor is housed in a school building 1 day a week to see students; No data to decide on or monitor interventions; Hoping that interventions are working; but not sure. District has a plan for integrating MH at all buildings (based on community data as well as school data); MH person participates in teams at all 3 tiers; MH person leads small groups based on data; MH person co-facilitates FBA/BIP or wrap individual teams for students. Example 1: A District-Level Re-Design
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  • Example 2: Planning for Transference and Generalization Middle schools SWIS data indicated an increase in aggression/fighting between girls. Community agency had staff trained in the intervention Aggression Replacement Training (ART) and available to lead groups in school. This evidence-based intervention is designed to teach adolescents to understand and replace aggression and antisocial behavior with positive alternatives. The program's three-part approach includes training in Prosocial Skills, Anger Control, and Moral Reasoning. Agency staff worked for nine weeks with students for 6 hours a week; group leaders did not communicate with school staff during implementation.
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  • SWIS Referrals for the girls dropped significantly during group. At close of group there was not a plan for transference of skills (i.e. notifying staff of what behavior to teach/prompt/reinforce). There was an increase in referrals following the group ending. Secondary Systems team reviewed data and regrouped by meeting with ART staff to learn more about what they could do to continue the work started with the intervention. To effect transference and generalization, the team pulled same students into groups lead by school staff with similar direct behavior instruction. Links back to Universal teaching of expectations (Tier 1) is now a component of all SS groups (Tier 2). Example 2: Planning for Transference and Generalization (cont.)
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  • Example #3: Community Clinicians Augment Strategies A school located near an Army base had a disproportionate number of students who had multiple school placements due to frequent moves, students living with one parent and students who were anxious about parents as soldiers stationed away from home. These students collectively received a higher rate of office discipline referrals than other students. The school partnered with mental health staff from the local Army installation, who had developed a program to provide teachers specific skills to address the particular needs students from military families. Teachers were able to generalize those skills to other at risk populations. As a result, office discipline referrals decreased most significantly for those students originally identified as at risk but also for the student body as a whole.
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  • Example #5: Systems Collaboration and Cost Savings A local high school established a mental health team that included a board coalition of mental health providers from the community. Having a large provider pool increased the possibility of providers being able to address the specific needs that the team identified using data, particularly as those needs shifted over time. In one case, students involved with the Juvenile Justice System were mandated to attend an evidence-based aggression management intervention. The intervention was offered at school during lunch and the school could refer other students who were not mandated by the court system, saving both the school and the court system time and resources and assuring that a broader base of students were able to access a needed service. As a result of their efforts, the school mental heath team was able to re- integrate over ten students who were attending an off site school, at a cost savings of over $100,000.
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  • Number of IL PBIS High Schools as of April 2011
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  • LRE Data Trends at the High School Level Significantly higher use of restrictive placements of students with disabilities in most restrictive settings Over 20% in some high schools Drop out rates exacerbate the issue Students with any behavioral/emotional component to disability more likely to be placed and/or drop out .and lots more NOT identified with a disability
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  • How High Schools Are Different Size Expectations of staff Staff is departmentalized More groundwork is needed Teams can become layered Implementation comes more slowly
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  • Theyre not as different as they think they are! The concepts are the same but the practices may look different.
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  • Building-level Team Development Core Team Teaching Acknowledgement Data Communication
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  • SECONDARY Check In Check out (CICO) Training with high school examples TA with only high schools Small Group Interventions (SA/IG) Check & Connect (C&C) University of Minnesota Brief FBA/BIP
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  • TERTIARY Complex FBA/BIP Wrap-Around applying RENEW Two day training SIMEO training Follow up phone TA Follow up TA days
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  • Rehabilitation, Empowerment, Natural Supports, Education and Work {RENEW} J. Malloy and colleagues at UNH Developed in 1996 as the model for a 3-year RSA- funded employment model demonstration project for youth with SED Focus is on community-based, self-determined services and supports Promising results for youth who typically have very poor post-school outcomes (Bullis & Cheney; Eber, Nelson & Miles, 1997; Cheney, Malloy & Hagner, 1998) 71
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  • RENEW Overview RENEW (Rehabilitation, Empowerment, Natural Supports, Education and Work) is an application of wraparound Reflects key principles: person-centered, community and strengths-based, natural supports Focused on student, versus parent engagement (e.g., student-centered teams, student-developed interests)
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  • RENEW Overview The RENEW framework and the practice of mapping are ideal for engaging older students For example, a key element of transition planning, especially for older students, is building in opportunities/activities that the student has identified as important to their personal development
  • Slide 74
  • Promoting Positive Behavioral and Mental Health in Schools: Promising Practices from Early Childhood through High School Office of Special Education Programs (OSEP) Annual Conference July 2011 Washington DC The Mental Health Perspective Krista Kutash, Ph.D. Department of Child & Family Studies University of South Florida 74
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  • Integrating Education and Mental Health Into School-Based Mental Health Historically, difficult to establish effective partnerships For many reasons. 75
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  • Contrasting Perspectives Important Theoretical Influences Education System Behaviorism, Social Learning Theory Mental Health System Behavior Theory, Cognitive Theory, Developmental Psychology, Biological/Genetic Perspective, Psychopharmacology 76
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  • Contrasting Perspectives Focus of Intervention Education System Behavior Management, Skill Development, Academic Improvement Mental Health System Insight, Awareness, Improved Emotional Functioning 77
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  • Education / Mental Health System Improving Social and Adaptive Functioning. Importance of and Need to Increase Availability, Access, and Range of Services Perspectives Perspectives Common Focus 78
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  • What about evidence based practices.? ?? 79
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  • E vidence Based Practices 80
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  • 81 E vidence Based Practices
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  • 82 Effect sizes for emotional functioning, functional impairment, & achievement. Effect Size Program Kutash, K., Duchnowski, A.J., Green, A.L. (in press). School-based mental health programs for students who have emotional disturbances: Academic and social-emotional outcomes. School Mental Health.
  • Slide 83
  • Refocus School-Based Mental Health Services On the Core Foundation of Schools: To Promote Learning 83
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  • The Refocused Role of Mental Health Services Support Teachers: the Primary Change Agents Mental Health Providers Become: Educational Enhancers Serve the Core Function of Schools Promoting Social/Emotional Development, no Longer Tangential 84
  • Slide 85
  • Need to Involve Parents & Families 85
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  • 86 Common Vision Families (FAM) Mental Health (MH) Education (ED) Common Vision Families (FAM) Mental Health (MH) Education (ED) Intensive Students in Special Ed due to Emotional Disturbances ED FBA / PBS MH Assessment FAM ED MH ED FAM MH Intensive Students in Special Ed due to Emotional Disturbances ED FBA / PBS MH Assessment FAM ED MH ED FAM MH Cognitive Behavior Therapy and other EBPs Team Monitors Progress Universal All Students ED PBS MH - Screening FAM ED MH Universal All Students ED PBS MH - Screening FAM ED MH EBPs (PATHS) Selective At-Risk Students ED FBA / PBS MH Assessment FAM ED MH ED MH FAM Selective At-Risk Students ED FBA / PBS MH Assessment FAM ED MH ED MH FAM Group Interventions Team Monitors Progress RtI Implemented in organizations that support and facilitate collaborative, integrated systems of services. Integrated Partnership
  • Slide 87
  • Some Program Models with Organizational Potential for Success 87
  • Slide 88
  • The earmark of a quality program or organization is that it has the capacity to get and use information for continuous improvement and accountability. No program, no matter what it does, is a good program unless it is getting and using data of a variety of sorts, from a variety of places, and in an ongoing way to see if there are ways it can do better. Weiss, 2002 88
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  • 89 Model of Implementation Complexity FIT Does the innovation fit within your organization Complement or Compete? FIT Does the innovation fit within your organization Complement or Compete? CLIMATE Willing to remove obstacles? Are there rewards? Leadership support? Clarity of Goals? CLIMATE Willing to remove obstacles? Are there rewards? Leadership support? Clarity of Goals? IMPLEMENTATION EFFECTIVENESS Can you implement the innovation with accuracy and fidelity? IMPLEMENTATION EFFECTIVENESS Can you implement the innovation with accuracy and fidelity? INNOVATION EFFECTIVENESS Impact of innovation, commitment, and satisfaction INNOVATION EFFECTIVENESS Impact of innovation, commitment, and satisfaction VOLITION Is there capacity and willingness to implement? VOLITION FIDELITY BELIEFS Favorable attitudes toward practice Complexity of innovati on Favorable attitudes toward practice Complexity of innovation FIDELITY BELIEFS Favorable attitudes toward practice Complexity of innovati on Favorable attitudes toward practice Complexity of innovation
  • Slide 90
  • System Integration Strategies: Systems of Care Effective Service Systems Requires A range of services with a community Collaboration between service sectors, organizations, parents and professionals Attention to careful planning Performance measurement Continuous quality improvement Comprehensive Financing Plan Individualized, comprehensive and Culturally Competent services Transformative Leadership 90
  • Slide 91
  • Recently Concluded Study SOC-IS Recently Concluded Study SOC-IS (Surveyed 225 Randomly Selected Counties on Their Level of SOC Implementation) 91
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  • National Levels of Implementation of Systems of Care 75% of the counties surveyed rated themselves as having adequate implementation on 6 or more of the 14 factors associated with Systems of Care 26% of counties surveyed rated them selves as having adequate levels of implementation on 11 of the 14 factors associated with Systems of Care 92
  • Slide 93
  • Implementing Systems of Care 6 Factors that had the highest levels of implementation nationally Systems management approach Leadership Services based a statement of values & principles Family voice and choice Individualized, comprehensive cultural competent treatment A written theory of change for system improvement 2 Factors with the lowest levels of implementation An implementation plan for service system improvement An adequate level of skilled provider network 93
  • Slide 94
  • Systems of Care Information on the Systems of Care slides based on: Kutash K., Greenbaum P., Wang W., Boothroyd R., Friedman R. (2011) Levels of system of care implementation: A national benchmarking study. Journal of Behavioral Health Services and Research, 2011; 38(3). Boothroyd R.A., Greenbaum P.E., Wang W., Kutash K., Friedman R. (2011) Development of a measure to assess the implementation of childrens systems of care: The system of care implementation survey (SOCIS). Journal of Behavioral Health Services and Research, 2011; 38(3). Greenbaum P.E., Wang W., Boothroyd R., Kutash K., Friedman R.M. Multilevel confirmatory factor analysis of the system of care implementation survey (SOCIS) (2011). Journal of Behavioral Health Services and Research, 2011; 38(3). Lunn L.M., Heflinger C.A., Wang W., Greenbaum P.E., Kutash K., Boothroyd R.A., Friedman R.M. (2011). Community characteristics and implementation factors associated with effective systems of care. Journal of Behavioral Health Services and Research, 2011; 38(3). 94
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  • 95 Alice said to the Cheshire Cat: Would you tell me please, which way I ought to go from here? That depends a good deal on where you want to get to, said the Cat. I dont much care where, said Alice. Then it doesnt matter which way you go, said the Cat. it depends a good deal on where you want to get to
  • Slide 96
  • Where do we go from here? Build on strengths of schools Build on strengths of families Focus on learning Improve & build feedback systems Provide services & system coaches and of course . 96
  • Slide 97
  • Fund More Research 97 A written summary of many of the points made in this presentation can be found in the following materials: Atkins, M., Hoagwood, K., Kutash, K., & Seidman, E. (2010) Toward the Integration of Education and Mental Health in Schools. Administration and Policy in Mental Health and Mental Health Services Research, 37, 40-47. Reducing Behavior Problems in the Elementary School Classroom This guide is intended to help elementary school educators as well as school and district administrators develop and implement effective prevention and intervention strategies that promote student behavior. The guide includes concert recommendations and indicates the quality of the evidence that supports them. Additionally, we have described some ways in which each recommendation could be carried out. For each recommendation, we also acknowledge roadblocks to implementation that may be encountered and suggest solutions that have the potential to circumvent the roadblocks. Finally, technical details about the studies that support the recommendations are provided in the Appendix. Download a free copy at: http://ies.ed.gov/pubsearch/pubsinfo.asp?pubid=WWC2008012 School-Based Mental Health: An Empirical Guide for Decision-Makers Krista Kutash, Ph.D., Albert J. Duchnowski, Ph.D., Nancy Lynn, M.S.P.H. This monograph provides a discussion of barriers to school-based services with the intention of improving service effectiveness and capacity. Reviews the history of mental health services supplied in schools, implementation of services and provides an overview of the evidence base for school-based interventions. Includes recommendations for evidence-based mental health services that can be used in schools. Download a free copy at: http://rtckids.fmhi.usf.edu/rtcpubs/study04/http://rtckids.fmhi.usf.edu/rtcpubs/study04/ Or purchase a printed copy for $5.95 at https://fmhi.pro-copy.com/