Integrating School Mental Health and PBIS: Examples at All 3 Tiers

Integrating School Mental Health and PBIS: Examples at All 3 Tiers

Michele Capio, Oak Park School DistrictPam Horn, Elgin School District U-46

Kelly Perales, Community Care Behavioral Health

Agenda

• Describe key features of the Interconnected Systems Framework (ISF)

• Share tools that have been developed and how to use them in practice

• Share examples of early implementation at all three tiers

Connectionsand

Partnerships

• OSEP National PBIS Technical Assistance Center (www.pbis.org)

• Center for School Mental Health (www.csmh.umaryland.edu)

• NASDSE (www.ideapartnership.org)• National COP for SBBH (www.sharedwork.org)

http://www.csmh.umaryland.edu/

http://www.ideapartnership.org/

BIG Ideas…

• How Multi-tiered Systems of Support (MTSS) can enhance mental health in schools

• Installing SMH through MTSS in Schools• The Interconnected Systems Framework (ISF)

SMH +MTSS=ISF

History-Rationale

• Sparse availability of MH providers in schools• Labels and ‘places’ confused with

interventions• Separate delivery systems (Sp.Ed., Mental

health, etc)• Minimal accountability for outcomes for most

vulnerable populations

Why Partnership Are Needed

• 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• Suicide is 4th leading cause of death among

young adults

SMH and PBISCommon Purpose

• Schools supporting/promoting MH of ALL students

• Prevention, early access, interventions commensurate with level of need (vs label)

• School personnel feel confident and competent in identifying and intervening with accuracy and effectiveness

Logic

– Youth with MH needs require multifaceted education/behavior and mental health supports

– The usual systems have not routinely provided a comprehensive, blended system of support.

– Supports need to be provided in a clustered and integrated structure,

– Academic/behavior and mental health supports need to be efficiently blended

Promotion and Prevention

Simple and complex supports require integrated systems with foundation of a school-wide system

• Schools and community serve as protective factor• problem-solving teams with

school/family/youth/community voice• use of data for decision-making (screening/ selection

and monitoring/outcomes)• layers supports from the foundational/universal to the

more complex

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?

Core Features of a Response to Intervention (RtI) Approach

• Investment in prevention, screening and early intervention for students not at “benchmark”

• Multi-tiered intervention approach

• Use of progress monitoring and problem-solving process at all 3-tiers

Core Features of a Response to Intervention (RtI) Approach

• Research-based practices and active use of data for decision-making at all 3-tiers

• Use of progress monitoring and problem-solving process at all 3-tiers

3-Tiered System of Support

Necessary Conversations (Teams)

Check-In Check-Out

Skills Groups

Group w. individual

feature

Complex

FBA/BIP

Problem Solving Team Meeting

Tertiary Systems Team Meeting

Brief

FBA/BIP

Brief FBA/BIP

Wraparound

Secondary Systems Team

Meeting

Plans schoolwide &

classroom supports

Uses process data; determines overall

intervention effectiveness

Standing team; uses FBA/BIP process for one student at a time

Uses process data; determines overall


Rev. 11.19.2012

UniversalTeam

Meeting

Universal Support

Illinois PBIS Network

Tier 1/Universal School-Wide Assessment

School-Wide Prevention Systems

SIMEO Tools: HSC-T, SD-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

Definition of school mental health •Involves partnership between schools and community health/mental health organizations, as guided by families and youth

•Builds on existing school programs, services, and strategies

•Focuses on all students, both general and special education

•Involves a full array of programs, services, and strategies- mental health education and promotion through intensive intervention

(Weist & Paternite, 2006)

“Expanded” School Mental Health

• Full continuum of effective mental health promotion and intervention for ALL students

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

• Collaborating community professionals (augment the work of school-employed staff

The Context

• Over 18,000 schools engaged in implementation of SWPBIS (MTSS ) prevention based system

• Current focus on capacity to scale-up • MTSS as platform to install effective

interventions for youth w/or at-risk of EBD

The Context (cont.)

• Emphasis now on scaling with expansion and connection to other systems – i.e. academic, juvenile justice, mental health, child

welfare, systems of care

• Emphasis on deliberate actions that foster connections w/families & community

Development of ISF

• 2002-2007: Site Development with PBIS Expansion (informal and independent)

• 2005 CoP focus on integration of PBIS and SMH• 2008: ISF White Paper: formal partnership between

PBIS and SMH• 2009- 2013 Monthly calls with implementation sites,

national presentations (from sessions to strands)• 2009-2011 Grant Submissions• June 2012- September 2013 ISF Monograph• Monograph Advisory group

Interconnected Systems Framework paper

(Barrett, Eber and Weist , revised 2009)

Developed through a collaboration of theNational SMH and National PBIS Centers

www.pbis.org http://csmh.umaryland.edu

http://www.pbis.org/

http://csmh.umaryland.edu/

• Define the common goals of SMH and PBIS

• Discuss the advantages of interconnection

• Identify successful local efforts to implement collaborative strategies and cross-initiative efforts

• Define the research, policy, and implementation agendas to take us to the next action level

ISF Monograph DevelopmentJune 2012 – September 2013

ISF Defined– ISF provides structure and process for education and mental

health systems to interact in most effective and efficient way. – ISF is guided by key stakeholders in education and mental health

system who have the authority to reallocate resources, change role and function of staff, and change policy.

– ISF applies strong interdisciplinary, cross-system collaboration.

ISF Defined– ISF uses the tiered prevention logic as the overall

organizer to develop an action plan.– ISF involves cross system problem solving teams that

use data to decide which evidence based practices to implement.

ISF Defined (cont)

– ISF involves ongoing progress monitoring for both fidelity and impact.

– ISF emphasizes active involvement by youth, families, and other school and community stakeholders.

Interconnected Systems Framework

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 Safe & caring learning environments Partnerships : school, home & community Decision making framework guides use of

and best practices that consider unique strengths and challenges of each school community

MH/PBIS: An Expanded Tier One• Universal screening for social, emotional, and behavioral

at-risk indicators• Universal screening for families who may request

assistance for their children• Teaching social skills with evidence-based curricula to all

students• Teaching appropriate emotional regulation and expression

to all students• Teaching behavioral expectations to all students• Mental health professionals are part of the Tier 1 systems

team, providing input and progress monitoring data• Opportunity to review community data and expand Tier 1

intervention options based on data

Interconnected Systems Framework

Tier 2: Early Intervention for Some

Coordinated Systems for Early Detection, Identification, and Response to Mental Health Concerns

Systems Planning Team coordinates referral process, decision rules and progress monitors

Array of services availableCommunication system: staff, families and community Early identification of students at risk for mental health concerns due to specific risk factorsSkill-building at the individual and groups level as well as support groups

Staff and Family training to support skill development across settings

MH/PBIS: An Expanded Tier Two• Mental health/community professionals part of

secondary systems and problem solving teams• Working smarter matrix completed to ensure key

resources are both efficient and effective (i.e., initiatives are aligned and combined such as “bully prevention”, “discipline”, “character education”, “RtI behavior”, etc.)

• Groups co-facilitated by school staff and community partner (example – guidance counselor and community provider clinician)

• Opportunity to expand the continuum of interventions based on data (i.e. trauma informed interventions)

• Out-reach to families for support/interventions

Interconnected Systems FrameworkTier 3: Intensive Interventions for FewIndividual Student and Family Supports

Systems Planning team coordinates decision rules/referrals and progress monitors

Individual team developed to support each student Individual plans have array of interventions/servicesPlans can range from one to multiple life domains System in place for each team

to monitor student progress

MH/PBIS: An Expanded Tier Three

• Mental health professional(s) part of tertiary systems team

• FBA/BIP and/or person-Centered Wraparound plans completed together with school staff and mental health provider for one concise plan, rather than each completing paperwork to be filed

• Quicker access to community-based supports for students and families

Traditional Preferred

• Each school works out their own plan with Mental Health (MH) agency;

• District has a plan for integrating MH at all buildings (based on community data as well as school data);


• A MH counselor is housed in a school building 1 day a week to “see” students;

• MH person participates in teams at all 3 tiers;


• No data to decide on or monitor interventions;

• MH person leads group or individual interventions based on data;

Structure for Developing an ISF: Community Partners

Roles in Teams

• A District/Community leadership that includes families, develops, supports and monitors a plan that includes:

• Community partners participate in all three levels of systems teaming in the building: Universal, Secondary, and Tertiary

Structure for Developing an ISF: Community Partners Roles in Teams (cont.)

• Team of SFC partners review data and design interventions that are evidence-based and can be progress monitored

• MH providers from both school & community develop, facilitate, coordinate and monitor all interventions through one structure

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


Plans SW & Class-wide supports

Uses Process data; determines overall


Standing team with family; uses FBA/BIP process for one youth

at a time



Sept. 1, 2009

UniversalTeam

Universal Support

Family and community Family and

community

Family and community

Community

Using and Expanding the Framework

• Change creates uncertainty and fear• Struggle always precedes growth

Help foster new mental map- framework leads to having people think in different ways

Tools• Tools help manage conversation in smaller groups• Lead to minimizing danger and maximizing reward• Lead to overwhelming sense of purpose

David Rock

Current Tools (in development)

• Dialogue Guides (IDEA partnership)• Implementation Guides (Funding, Team)• Crosswalk of Demo Sites (Data, Systems,

Practices)• Readiness Checklist• Resource Mapping• Consumer Guide for Selecting MH practices

U-46 at a Glance

Enrollment: Total school enrollment 40,57054.8% Low Income97 languages spoken in U-46 homes

Facilities: 40 Elementary Schools (PreK-6)8 Middle Schools (7-8) + 1 Alternative Middle School5 High Schools + 2 Alternative High Schools2 Early Childhood Centers

Communities Served:11 communities3 counties (Cook, DuPage, Kane)

SD U-46 Student ProfileBased on School Report Card 2012

MISSIONMISSION The mission of the U-46 School and Community Alliance is to

create, integrate and leverage existing and new school/community partnerships that develop a full continuum of systematic interventions

based on data. It encompasses three intervention tiers:

•Systems for promoting healthy development and preventing problems

•Systems for responding to problems as soon after onset as is feasible

•Systems for providing intensive care

22 Community Partners 78 providers trained in PBIS/SAIG

Boys and Girls Club of Elgin*Centro de Informacion* Community Crisis Center*Crossroads Kids Club* Easter Seals*Elgin Police Department*

Family Service Association of Greater Elgin Area*Fox Valley Pregnancy Center*Fox Valley

Volunteer Hospice*Girl Scouts of Northern Illinois*Hanover Township Youth and Family

Services*Kenneth Young*Kids’ Hope USA*Renz Center*Streamwood Behavioral Healthcare

System*Taylor Family YMCA*The Y*WAYS*West Ridge Community Church*Youth Leadership

Academy

U-46 School and Community Alliance Work Groups

2009-2012

U-46 School and Community Alliance Work Groups 2012-2013

3-Tiered System of Support Necessary Conversations (Teams)

CICO

SAIG

Group w. individual

feature

Complex

FBA/BIP

Problem Solving Team


Brief

FBA/BIP

Brief FBA/BIP

WRAP


Plans SW & Class-wide supports



Standing team; uses FBA/BIP process for one youth at a time



UniversalTeam

Universal Support

Training

• 2009-2013 Separate training for partners (condensed versions of school training)

• 2011-2013 Community partners attend Team Planning Day with their PBIS Tier 2/3 System Teams

• 2012-current Community partners attend full training with school teams

• Examples: Wraparound, RENEW, and Trauma informed CPI

Tier 1 Network Example

Hanover Township Youth & Family Services

• Elementary (Grades 4-5-6) Open Gym• Middle and High School Healthy Living in Health Classes

Elgin High ExampleTier 1 Examples

Boys & Girls Club (Elgin) •Club Elgin: daily, after school

RENZ •Freshman Transition: prevention model

Tier 2 ExamplesBoys & Girls Club (Elgin)

•SAIG: 2-3 groups, not responding to CICO, DPR card electronically

Family Service Association of Greater Elgin •Group Mentoring: 5 groups, 3-5 girls/group, anger management and conflict resolution

Hanover Township Youth & Family Services•Group Mentoring: 2 groups, daily CICO with counselor•Alternative to Suspension Program: restorative program

Tier 2/Social Academic Instruction Groups (SAIG)

• Coordinated by Elgin High School Counselor• Facilitated by Community Partner• Data: Feedback from Teachers and Students• Groups 6-8 weeks• Student identification based on

teacher/dean/counselor input and lack of response to CICO• Agency partners are active members of

secondary systems team

Elgin High School Weekly Progress Report

NS=No School A=Absent all day NP=No show M=Missing data

Period 1 Period 2

Date

Earn & Give Respect Goal (Stop, think and act before reacting to something)

Hold Yourself Responsible (Stop, think and act before reacting to something)

Safety First Goal (Stop, think and act before reacting to something)

Earn & Give Respect Goal (Stop, think and act before reacting to something)

Hold Yourself Responsible (Stop, think and act before reacting to something)

Safety First Goal (Stop, think and act before reacting to something)

2/6/2012

2/7/2012

2/8/2012

2/9/2012

2/10/2012

Weekly Progress ReportEarn and Give Respect (student will not talk back to staff)

Hold Yourself Responsible (Student will be on time to class)

Safety First (Student will wear ID around neck)

1. I attend school regularly2. I skip ___# of classes each week3. I receive all A’s, B’s, and C’s for grades4. I receive _____# of disciplinary referrals per week5. I feel connected to my school6. I feel respected and important while at school7. I can count on friends for support8. I can count on my family members for support

Pre-test/Post-test

I feel connected to my school

I feel respected & important at school

Next Steps at EHS…

Move from instructional short-term groups to long-term group mentoring with skill instruction embedded in the mentoring

Increase communication between deans/facilitators/staff of the interventions

Align initiativesExplore more intensive interventions for

students with unmet mental health needs

Next Steps for Community Alliance…

Increase trauma focus at all three tiersDirectory of partners/agenciesBlend & coordinate initiatives across districtExpand alternative to suspension Utilize district exemplars as examples for

other schoolsIncrease communication between district

and community partners

Using and Expanding the Framework

• Change creates uncertainty and fear• Struggle always precedes growth

Help foster new mental map- framework leads to having people think in different ways

Tools• Tools help manage conversation in smaller groups• Lead to minimizing danger and maximizing reward• Lead to overwhelming sense of purpose

David Rock

Key features• Systems

– District and building teaming models – Facilitation, technical assistance, coaching– Stakeholder participation and buy-in

• Practices– Mental health and school staff work in an integrated way to

support students across tiers– Using assessment and screening in order to determine which

EBPs to use, progress monitor– One plan for both education and mental health

• Data– Shared decision rules– Used for decision making with all stakeholders at the table – school,

mental health, other child serving systems, family

CrosswalksWhat creates the pathway?

Systems, Data, Practices• Systems:

– Identified need (gaps in services, lack of services)– Identified cost savings– Shift in population (increased poverty, homelessness, health concerns)– Frustration with current condition (restrictive, inefficient, ineffective)– Flexible funding source identified (United Way, Walter Reed, community care, blended)– PBIS foundation (provided both structure and process)– Local “Champions”– Demo sites created opportunity– Received Grant (Systems of Care)– Non profit working with school system for district wide change

• Data: Moving beyond Office Referrals and Suspensions to 360 view that include community data

– hearing data, # of student encounters with law enforcement, calls to crisis centers, instructional time lost for services, use of screeners, behavioral health assessments

• Practices: Broader range: EBP with Trauma focus

Scranton, PAHistory and Time Line

• District and Community Leadership Team – established in 2009-10 school year

• Transformation of mental health services for children/youth and families

• Utilized PBIS Implementer’s Blueprint and Stages of Implementation (Fixen)

• Began in two schools, after reviewing data indicating positive outcomes, then expansion

Scranton, PA“Current Conditions”

• Eleven Elementary Schools (K-5)– 2 implementing ISF at all three tiers– 3 implementing PBIS at tier one and have SMH – 1 implementing PBIS at tier one– 2 will be trained/kick off PBIS this year (1 w/ SMH)

• Three Intermediate Schools (grades 6-8)– 1 implementing PBIS at tier one and has SMH– 2 have SMH and will be trained/kick off PBIS this year

• Two High Schools (grades 9-12)– 1 with SMH and previously implementing PBIS– 1 implementing PBIS at tier one and has SMH

2013-14 School Year

• 20 licensed mental health professionals• 38 bachelor’s level behavioral health workers• Closure of center-based partial hospitalization program• Closure of five school-based partial hospitalization

programs• ROI – less restrictive educational placements, return to

home schools, less restrictive mental health placements, cost savings

• Increased collaboration, communication – improved outcomes

Resource Mapping Definition• Mapping focuses on what communities have to offer

by identifying assets and resources that can be used for building a system

– It is not a "one-shot" drive to create a published list or directory

– It is a catalyst for joint planning and professional development, resource and cost sharing, and performance-based management of programs and services

(National Center on Secondary Education and Transition, 2003)

Resource Mapping: Identifying community resources, assess duplication and build comprehensive, sustainable resources

Identify the geographic community Identify all currently participating organizations Discuss the description of required target population Identify services/programs available• Inventory each agency/organization’s expenditures• Identify funds expended but not fully matched• Discuss spending resources collaboratively• Assess redundancy• Use resource map • Develop and implement plan• Share information and results to ensure support

4/15/2013 - Hershfeldt

1-5% Tier 3-Resources/Supports for a Few

5-15% Tier 2- Resources/Supports for Some

80-90% Tier 1 –Resources/Supports for All

Activity: What’s in Place?

Community-Based Services/Resources and Providers

School-Based Services &Resources

Applying the Logic to Families

80-90%

5-10%

1-5%

Tier 1: Universal InterventionsSelf Assessments: Family Engagement Checklist, Surveys

Skill Building Series Guest Speaker (Topics Vary- Survey Families)

Newsletter, Resource Library , “Shout Outs”

Volunteer Opportunities (DOGS- Dads of Great Students)

Teacher Conferences- Goal Setting, Family Vision, Strengths Discovery

Family Fun Nights throughout the year

School Handbook (Description, Teaching Matrix – promote common language between school and home)

Tier 2: Targeted Group InterventionsSupport Groups (Military Families, Newcomer Group)

Skill Building Sessions (Academic and Behavior)

Tier 3: Intensive, Individual InterventionsFamily Liaison-matched with family, needs matched with community resources

Individual Skill Building Sessions-

Tier 3/Tertiary Interventions 1-5%•1:1 instruction•Increased time•504

1-5% Tier 3/Tertiary Interventions•SBMH, Partial Hospitalization•Alt Ed•FBA/PBISP•Home School Visitor

Tier 2/Secondary Interventions 5-15%•Title I Reading and Math•ERI, RM, RN, etc.•IST

5-15% Tier 2/Secondary Interventions•Counselor groups, lunch bunch•Friendship groups•Behavior Chart/plan•IST•Parenting Classes

Tier 1/Universal Interventions80-90%•Core Curriculum – reading and math•AIMS Web•MAP•PSSAs

80-90% Tier 1/Universal Interventions•Character Education curriculum•Bullying Prevention•SWPBS (some schools)•Act 211 D&A awareness•Counselor classroom lessons•Community Activities•Health Screening

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

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

Tier 3/Tertiary Interventions 1-5%1-5% Tier 3/Tertiary Interventions

•SBBH Team•Outpatient therapy•SB Partial•Guidance – individual support•SAVES/school aged mothers

Tier 2/Secondary Interventions 5-15%5-15% Tier 2/Secondary Interventions

•SAP•Guidance – groups•Community Partners – groups•Resource Officer

Tier 1/Universal Interventions80-90%

80-90% Tier 1/Universal Interventions•SWPBIS•Drug and Alcohol Prevention

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

Resources


Needs

Scranton High School

Building Level Action Plan

Problem Solving Team (individual student)



Universal Systems Team

PRACTICES PRACTICES PRACTICES PRACTICES

Data Decision Rule Data Decision Rule Data Decision Rule Data Decision Rule

UNIVERSAL SYSTEM SECONDARY SYSTEM TERTIARY SYSTEM

73

Annual Fidelity CheckAction Planning

• Benchmarks of Advanced Tiers– Do we have more than one strategy available to

support students who need more?– Do we use data to make decisions?– Are we selecting Evidence-Based Practices?– Do we have the staff and resources to implement

with fidelity?– Are we progress monitoring?

Revisit Resource Map

• Do we have a continuum of interventions and supports?

• Does our systems team include representatives from our community partners?

• Are their gaps that we need filled?• Can we present needs to our district and

community leadership team?

Tier 3/Tertiary Interventions 1-5%•_____________________•_____________________•_____________________

1-5% Tier 3/Tertiary Interventions•___________________________•___________________________•___________________________

Tier 2/Secondary Interventions 5-15%•___________________________•___________________________•___________________________•___________________________•___________________________•___________________________

5-15% Tier 2/Secondary Interventions•____________________________•____________________________•____________________________•____________________________•____________________________•____________________________

Tier 1/Universal Interventions80-90%•________________________•________________________•________________________•________________________•________________________•________________________

80-90% Tier 1/Universal Interventions•____________________________•____________________________•____________________________•____________________________•____________________________

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

Academic Systems Behavioral Systems


Consumer Guide to Selecting Evidenced Based Mental Health Services

(Putnam et al, 2012 in draft)

Main Components• Assessment• Interventions Selection• Intervention Progress Monitoring

Assessment

Intervention Selection

Intervention Progress Monitoring

Use of EBP ToolScranton

AssessmentCurrent Condition• Assessment/Screening

happens upon referral to SMH Team

• SDQ and COS used in addition to progress monitor and track outcomes

Future Planning• Universal Screening• Tie in work that happens in

other processes - SAP


Intervention SelectionCurrent Condition• Clinicians report almost

exclusively selecting interventions that address all nine areas on the tool

• There is not a place for indicated which interventions are selected and whether or not they are identified as EBPs

Future Planning• Combined training for

school-employed and community-employed staff who will be supporting youth/families who need Tier Two and Three interventions that specifically address how to select EBPs that match area assessed/screened


Intervention Progress MonitoringCurrent Condition• Clinicians utilize outcome

tools of COS and SDQ• Not differentiating

implementation fidelity to a particular intervention (TF-CBT)

• Sharing outcome data in aggregate per school annually, not always by student and more frequent

Future Planning• Utilize tools to monitor

fidelity of implementation of intervention

• Share data with systems teams on a more frequent basis and by student for planning purposes, consistently

Trauma Informed Care

• 3 Community Mental Health Provider Agencies employ the SMH staff working across home/school/community

• As part of comprehensive assessment, include a trauma screening– Traumatic Events Screening Inventory (TESI)– UCLA PTSD Index

Trauma Screening Tools

TESI• Used by most clinicians• Free• On our preferred list• 15-item clinician-

administered interview• Variety of potential

traumatic events

UCLA PTSD Index• Requires licensing

agreement for use• On our preferred list• Recommended by TF-CBT• 48-item interview• Assesses a child’s exposure

to 26 types of traumatic events

“Once You Screen, You Must Intervene” K. Lane

• If trauma uncovered in screening/assessment, clinician works with family to determine:– If previously addressed/resolved– If not addressed, yet not currently causing

presenting issues/concerns/problems/symptoms– If not addressed, and contributing to current

concerns

• Clinician selects EBP that is trauma informed

National Child Traumatic Stress Network

• Evidence-based treatment fact sheets– Trauma-Focused Cognitive Behavioral Therapy

(TF-CBT)– Child/youth and family component (+)– Can receive free web-based training (+/-)– Important to have good clinical supervision

“Arianna”

• 13 year old Caucasian female in 7th grade• Adopted at 18 months into a family with two

half-siblings, who were also adopted. • 17 year old sister diagnosed with Asperger’s

Syndrome and Bi-Polar Disorder• 12 year old brother diagnosed with Asperger’s

Syndrome• Moved into area at age 4

“Arianna” continued

• Referred to SMH team due to self-injurious behaviors

• School reported risk of change in educational placement and concern for risk of drop-out

• At the time of referral, Arianna did not have a positive peer group

• Trauma uncovered during screening/assessment

• Clinician utilized TF-CBT

Child Outcomes Survey (COS) Family Functioning:Child Outcomes Survey (COS) Family Functioning:Child XChild X

A large improvement is observed in both domains of family functioning

Child Outcomes Survey (COS) Overall Wellness:Child Outcomes Survey (COS) Overall Wellness:Child XChild X

Overall wellness improves dramatically

“Arianna” today• Attending school with academic success• Participating on the girls basketball team• Reports having improved relationships with a

more positive peer group• Reports having improved relationships with

family members• School reports no risk for change in placement or

drop-out at this time• Arianna told the team, through a drawing, that

they “saved her life”!

School Mental Health

Child Outcomes Survey (COS) Family Functioning:Child Outcomes Survey (COS) Family Functioning:Scranton School DistrictScranton School District

Child Outcomes Survey (COS) Child Functioning: Child Outcomes Survey (COS) Child Functioning: Scranton School DistrictScranton School District

Child Outcomes Survey (COS) Therapeutic Alliance: Child Outcomes Survey (COS) Therapeutic Alliance: Scranton School DistrictScranton School District

Strengths and Difficulties Questionnaire Parent Strengths and Difficulties Questionnaire Parent (SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton (SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton

School DistrictSchool District

Questions?

Documents

Integrating School Mental Health and PBIS: Examples at All 3 Tiers