Integrating SMH/PBIS in Large Urban School Systems

Bob PutnamMay Institute

Raymond Palmer & Helena Rodriguez Jennifer Parmalee New York City Department of Education Onondaga Department of Mental Health

Devon Bandison Mark VinciquerraThe Visiting Nurse Service of New York Syracuse Public Schools

Linda Brown

OCM /BOCES

National PBIS Leadership ForumOctober 19, 2012Chicago, Illinois, Ph.D.

Integrating SMH/PBIS in Large Urban School Systems

Bob PutnamMay Institute

National PBIS Leadership ForumOctober 19, 2012Chicago, Illinois, Ph.D.

School Mental Health Partnership

More than a place for services

4

Context of Urban Schools

Higher rates of Community poverty (U.S. Census Bureau, 2002) Community crime (Sampson et al; 1997, Brooks-

Gunn, 1997) Cultural and racial diversity (U.S. Census Bureau,

2002) Staff turnover (Cuban, 2001; National Commission

on Teaching and American’s Future, 2005) Low performing schools (Williams, 1996) “persistently dangerous” schools (NCLB:20 U.S.C.

7912, 2001)

5

Urban Systems

Urban systems, particularly those with high rates of poverty, face multiple challenges Higher rates of problem behavior

Lower rates of academic readiness for school (Smith et al., 1994) Increased exclusionary disciplinary procedures (Fusarelli, 1999;

Winbinger et al., 2000)

The combination of these factors leads to higher dropout rates (Mayer, 1997; McLoyd, 1998) which places these students back in the community with chronic exposure to violence, drug abuse, and higher mortality rates (Lane et al; 2002)

Need for Effective Mental health Services Almost one in five youths has a MH “condition” (New

Freedom Commission on Mental Health, 2003) and it is reported that about 70% of those get no treatment (Kataoka, Zhang & Wells; 2002).

Only one to two percent of these students are identified by schools as emotionally impaired. Often these identified students have poor outcomes. (National Center for Children in Poverty, 2006)

Interconnected Systems Framework (ISF)

Strategy for interconnection of two systems across multiple tiers

Strong team planning and actions at each tier Full continuum of effective mental health promotion

and intervention for students in general and special education

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

Collaborating community professionals (not outsiders) augment the work of school-employed staff

Eber, Barrett & Weist, 2011

SYST

EMS

PRACTICES

DATASupportingStaff BehaviorSupportingStaff Behavior

SupportingStudent BehaviorSupportingStudent Behavior

OUTCOMES

Supporting Social Competence &Academic Achievement

Supporting Social Competence &Academic Achievement

SupportingDecisionMaking

SupportingDecisionMaking

Emphasize:4 IntegratedElements

Emphasize:4 IntegratedElements

Evidenced Based Practices (EBP)

Children who received evidenced based interventions were functioning better after treatment than more than 75% of children in the control group. These changes often were found to sustain after treatment termination.

Where therapists were able to use their clinical judgment to deliver treatment as they saw fit and in which there was a comparison of their treatment to a control condition little or no changes in treatment outcomes were seen (Weisz, Sandler, Durlak & Anton; 2005).

Evidenced Based Mental Health Treatment

American Psychological Association website http://effectivechildtherapy.com/content/ebp-options-specific-disorders

Evidenced Based Behavioral Practice website funded grant from by the National Institutes of Health http://www.ebbp.org/index.html

Kutash, Duchnowski, & Lynn, School-based mental health: An empirical guide for decision makers. http://rtckids.fmhi.usf.edu/rtcpubs/study04/SBMHfront-TOC.pdf

 

“Organizations get the outcomes they are designed

to deliver”

Aubrey Daniels

Barriers to Evidence-Based Programs in Schools Clinician Systems within a school setting Overall mental health systems

Funding/Resources

Systems to Support the Use of EBP

Many of the school based and community partners have limited expertise.

Without staff competencies and systems (adequate training, ongoing coaching, performance feedback) on their use, these interventions will not maximize their potential benefits to students. (Fixsen, Blasé, Duda, Naoom, & Van Dyke; 2010).

Training alone, even when it is fairly intensive, appears to increase knowledge but has a limited impact on practice (Ganju, 2006).

How to Build Clinical Capacity

Training Exposure Cross training

Coaching and performance feedback

Treatment integrity

Systems within a School Setting

Typical school delivers, on average, 14 separate programs that broadly address social-emotional issues.

Of these programs, however, most were not empirically-based.

There was found no evidence of a systematic deployment of these programs, but rather, they seem to emerge in response to immediate pressures or trends.

(Zins, Weissberg, Wang, & Walberg; 2004)

Evidence-Based “Manualized” interventions (from Sharon Stephan) Intervention/Indicated:

Cognitive Behavioral Intervention for Trauma in Schools, Coping Cat, Trauma Focused CBT, Interpersonal Therapy for Adolescents (IPT-A)

Prevention Selected Coping Power, FRIENDS for Youth/Teens, The Incredible Years, Second Step, SEFEL and DE:CA Strategies and Tools, Strengthening Families Coping Resources Workshops

C

Promotion/UniversalGood Behavior Game, PATHS to PAX, Positive Behavior Interventions and Support, Social and Emotional Foundations of Early Learning (SEFEL), Olweus Bullying Prevention, Toward No Tobacco Use

Weist, 2012

Assessment

Intervention

Mental Health Systems

More flexible funding More emphasis on functional outcomes that both

improve school and community functioning and support families

Early prevention – Accessing mental health services across the tiers

Schools leveraging the access of students to allow creative use of clinicians time

Collaboration between Systems

Valuing the family as partner –wrap around (Eber) Improving effectiveness

Assessment Practices

Training and building capacity

Treatment integrity

Improving efficiency Assess to each others resources and natural resources Focusing on socially valid outcomes for students in

school, home and community

Selecting Mental Health Interventions within a PBIS Approach

Robert Putnam, Susan Barrett, Lucille Eber, Tim Lewis and George Sugai