S YSTEM OF C ARE, S CHOOL M ENTAL H EALTH, & PBIS: H OW D O W E I NTEGRATE FOR B EST O UTCOMES 2014 National PBIS Leadership Forum Session C12 | October

SYSTEM OF CARE, SCHOOL MENTAL HEALTH, & PBIS:

HOW DO WE INTEGRATE FOR BEST

OUTCOMES

2014 National PBIS Leadership Forum

Session C12 | October 29th, 2:15 PM - 3:30 PM

Maximizing Your Session Participation

When Working In Your Team

Consider 4 questions:

– Where are we in our implementation?

– What do I hope to learn?– What did I learn?– What will I do with what I learned?

Where are you in the implementation process?

Adapted from Fixsen & Blase, 2005

• We think we know what we need so we are planning to move forward (evidence-based)

Exploration & Adoption

• Let’s make sure we’re ready to implement (capacity infrastructure)

Installation

• Let’s give it a try & evaluate (demonstration)

Initial Implementation

• That worked, let’s do it for real and implement all tiers across all schools (investment)

• Let’s make it our way of doing business & sustain implementation (institutionalized use)

Full Implementation

Leadership Team Action Planning

Worksheets: StepsSelf-Assessment: Accomplishments & Priorities

Leadership Team Action Planning Worksheet

Session Assignments & Notes: High Priorities

Team Member Note-Taking Worksheet

Action Planning: Enhancements & Improvements

Leadership Team Action Planning Worksheet

SESSION DESCRIPTION

This session will discuss the need, challenges, and strategies for blending related mental health initiatives in schools and communities. State-level experience of active blending of System of Care, School Mental Health, and PBIS will be shared and Directors of the three related centers will share perspectives and dialogue with participants.

MEET OUR PANEL

• Mark Weist, University of South Carolina• James Palmiero, Pennsylvania Training &

Technical Assistance Network• Rob Horner, University of Oregon• Sharon Stephan, University of Maryland• Michelle Zabel, University of Maryland

SESSION OBJECTIVES

• Understand the interconnections between PBIS, school mental health, and System of Care

• Learn how one state is working to blend philosophies through an interconnected framework to support efficient and effective systems at the district and school level

• Learn strategies for blending related mental health initiatives in the community

FOUNDATION

• Stroul, B., & Friedman, R. M. (1986). A system of care for children and adolescents with severe emotional disturbances. Washington DC: Georgetown University Center for Child Development, National Technical Assistance Center for Children’s Mental Health.

• 2010: Updated System of Care Concept and Philosophy: http://gucchdgeorgetown.net/data/documents/SOC_Brief2010.pdf

http://gucchdgeorgetown.net/data/documents/SOC_Brief2010.pdf




DEFINITION OF SYSTEM OF CARE

A System of Care is a spectrum of effective, community-based services and supports for children and youth with or at-risk for mental health or other challenges and their families, that is • organized into a coordinated network, • builds meaningful partnerships with families and

youth, and • addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life.

Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development National Technical Assistance Center for Children’s Mental Health. http://gucchdgeorgetown.net/data/documents/SOC_Brief2010.pdf

CORE VALUES OF SYSTEMS OF CARESystems of care are:1. Family driven and youth guided, with the strengths and needs of the child and family determining the types and mix of services and supports provided.2. Community based, with the locus of services as well as system management resting within a supportive, adaptive infrastructure of structures, processes, and relationships at the community level.3. Culturally and linguistically competent, with agencies, programs, and services that reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of appropriate services and supports and to eliminate disparities in care.

Stroul, B., Blau, G., & Friedman, R. (2010). Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development National Technical Assistance Center for Children’s Mental Health. http://gucchdgeorgetown.net/data/documents/SOC_Brief2010.pdf

CHILDREN’S MENTAL HEALTH INITIATIVE• Led by Child, Adolescent and Family Branch, Center for Mental

Health Services, SAMHSA• Child Adolescent Service System Program (CASSP) – 1984 • Comprehensive Community Mental Health Services Program for

Children and Their Families – 1993 • 252 Awards since Program Inception

FY 2011: 24 Expansion Planning Awards FY 2012: 6 Expansion Planning Awards FY 2012: 16 Expansion Implementation Awards FY 2013: 11 Expansion Planning Awards FY 2013: 15 Expansion Implementation Awards (Off-the Shelf) FY 2014: 9 Expansion Planning and 22 Expansion Implementation Awards

SIGNIFICANTLY IMPROVED OUTCOMES• Improved emotional/behavioral functioning• Reduced high risk behaviors • Enhanced family functioning• Expanded and improved service delivery system• Hundreds of millions of dollars in return on

investmentStroul, B., Pires, S., Boyce, S., Krivelyova, A., & Walrath, C. (2014). Return on investment in systems of care for children with behavioral health challenges. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health

BUT…

More work remains to be done to integrate the work of State and local behavioral health agencies and community organizations with State and local educational authorities and schools.

Fundamental Challenge and Rationale for Building Systems of Care: No one system controls everything. Every system controls something.

Pires, S. 2004. Human Service Collaborative. Washington, D.C.

Tier 1 Tier 2 Tier 3

Mental Health

Education

Tier 1 Tier 2 Tier 3

Mental Health and

Other Youth-Serving

Systems

Education

MEET OUR PANEL



PENNSYLVANIA

• 3 Demonstration Sites – 3 SoC Counties– 3 School Districts Implementing PBIS & SMH

SoC + PBIS = Safe Schools / Healthy Students

PENNSYLVANIA

1) Promoting early childhood social &

emotional learning and development

2) Promoting metal, emotional and behavioral

health

3) Connecting families, schools and communities

4) Preventing behavioral health problems, including

substance abuse

5) Creating safe and violent free schools

1) Promoting early childhood social &

emotional learning and development

2) Promoting metal, emotional and behavioral

health

3) Connecting families, schools and communities

5) Creating safe and violent free schools

PENNSYLVANIA

PA’s Approach to Aligning SoC and PBIS

PENNSYLVANIA PA Community of Practice (CoP) on

School Based Behavioral Health / PBIS State Leadership Team

PBIS Facilitators

Penncrest SD

Northeastern York

SD

Carbon-Lehigh I.U.

#21

Regional PBIS Network


PBIS Co-Directors and

State Coordinators


PENNSYLVANIA PA System of Care (SoC) PartnershipState Leadership Team (SLT)

SoC Staff

Crawford Co. York Co. Lehigh Co.

SoC County

Collaborative

SoC County

Collaborative

PA SoC State Administrative Team

SoC County

Collaborative

PENNSYLVANIA PA Safe Schools – Health Student (SS-HS) Partnership

State Management Team

{PA SoC SLT (Youth, Family & Systems Partners – including but not limited to Education, Public Welfare and Juvenile Justice ) and designees of the

PA CoP on SBBH & SS- HS Core Management Teams*}

SS-HS Project Contractors

Core Management Team*

Crawford Co.

Penncrest SD


York Co.Northeastern York

SD


Lehigh Co. Carbon-

Lehigh I.U. #21

SS-HS Operational

Team

SS-HS Project Director, Co-

Director, Admin. Asst.

SS-HS Project Evaluators

PENNSYLVANIA PA System of Care (SoC) PartnershipState Leadership Team (SLT)

PA Community of Practice (CoP) onSchool Based Behavioral Health (SBBH)

PA Safe Schools – Health Student (SS-HS) PartnershipState Management Team

SoC Staff PBIS Facilitators

SS-HS Project Contractors


Crawford Co.

Penncrest SD



SD


Lehigh Co. Carbon-

Lehigh I.U. #21

SoC County

Collaborative


SoC County

Collaborative




State CoordinatorsSS-HS

Operational Team

SS-HS Project Director, Co-

Director, Admin. Asst.

SS-HS Project Evaluators

SoC County

Collaborative


PENNSYLVANIA PA Safe Schools – Health Student (SS-HS) Partnership

State Management Team

SoC Staff PBIS Facilitators


Crawford Co.

Penncrest SD



SD


Lehigh Co. Carbon-

Lehigh I.U. #21

SoC County

Collaborative


SoC County

Collaborative




State CoordinatorsSS-HS

Operational Team

SoC County

Collaborative


PA System of Care (SoC) PartnershipState Leadership Team (SLT)

PA Community of Practice (CoP) onSchool Based Behavioral Health (SBBH)

PENNSYLVANIA

• Challenges/Barriers– Understanding Theory and Practice• Data, systems and practices

– Language– Organizational Culture– Roles/Responsibilities

PENNSYLVANIA

• Strategies– State and Local Level Leadership Teams – Cross Systems Training and Technical Assistance– Relationship-building – Distributed Leadership– Authentic Engagement • Youth, Families, School and Community

– Data Informed Decision-Making

MEET OUR PANEL



THREE MESSAGES

• Values drive a focus on the “outcomes” and “outcome measures that can unite education, mental health and justice.

• “Multi-tiered Systems of Support” requires a focus FIRST on “core features” and SECOND on “intervention strategies”

• Implementation Science offers guidance for how to align effective strategies in one system of support. – The Integrated Systems Framework is an example.

VALUES

• Values guide Unified commitment

• Values guide selectionOf outcome measures

VALUES

• Child-centered• Inclusive• Individualized• Life-style relevance

MEASURES

• Social Emotional competence• Academic skills• Behavioral self-regulation• Friendships• Activity patterns• Self-determination

PRACTICES CORE FEATURES

Valued Outcomes

Core Features

Effective Practice

Effective Practice

Effective Practice

Effective Practice

Values

Science

TechnologyExamples-------------First Step

FCT

CICO

MST

ACT

PBIS

PRACTICES CORE FEATURES

Valued Outcomes

Core Features

Mental Health Education Social

ScienceJuvenileJustice

Values

Science

TechnologyExamples-------------First Step

FCT

CICO

MST

ACT

PBIS

MULTI-TIERED SYSTEMSCORE FEATURES VERSUS STRATEGIES

Use What Works

Provide Different Levels of Support Intensity

Matched Support Intensity to Student

Need

Measure both “Are doing it?” AND “Is

it working?”

Implementation Science Frameworks

WHO

Teams

WHEN

Stages

HOW

Drivers

HOW

Cycles

WHAT

Interventions

SUMMARY

• The era of the single system, single package, single strategy is over

• Integrated Systems Framework – Guided by Values (Measure what you value)– Guided by Science (Use what works)– Guided by Alignment (Administrative Leadership)

• Build the organizational systems that deliver effective practices

• Focus on fidelity and sustainability as well as impact

MEET OUR PANEL



MEET OUR PANEL



Children’s Behavioral Health: Opportunities for Partnership & Collaboration

Michelle Zabel, MSSDirector, The TA Network

Director & Clinical Instructor, The Institute for Innovation & Implementation, University of Maryland School of Social Work

Content Hubs:• Cultural and Linguistic Competence• Families and Youth• Systems and Finance• Wraparound, Evidence-Based and Promising Clinical Practice,

Services and Supports

The TA Network’s Mission: To develop effective service systems and establish a skilled and well-prepared workforce that can expand and sustain community-based systems of care across the United States to benefit all children and youth with behavioral health needs and their families.

Federal Funding to Support Systems of Care Development

• Child Adolescent Service System Program (CASSP) – 1984

• Comprehensive Community Mental Health Services Program for Children and Their Families (CMHI; SOC Planning and Expansion Grants) – 1993: 252 Awards since Program Inception

• Safe Schools Healthy Students: Jointly funded by the Departments of Education, Justice, and Health & Human Services

• Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health): Public health approach to promoting wellness of children 0-8 through coordination of key child-serving systems and integration of behavioral and physical health services so that children enter school ready to learn.

• Healthy Transitions: Focus on providing services and supports to address serious mental health conditions, co-occurring disorders, and risk for developing serious mental health conditions among youth and young adults ages 16-25

• Project AWARE (Advancing Wellness and Resilience in Education): State and Local Educational Agency Grants for implementation of Mental Health First Aid and Youth Mental Health First Aid

CMHI EXPANSION PLANNING & IMPLEMENTATION AWARDS (2011-2014)

SIGNIFICANTLY IMPROVED OUTCOMES• Improved emotional/behavioral functioning• Reduced high risk behaviors • Enhanced family functioning• Expanded and improved service delivery system• Hundreds of millions of dollars in return on

investmentStroul, B., Pires, S., Boyce, S., Krivelyova, A., & Walrath, C. (2014). Return on investment in systems of care for children with behavioral health challenges. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health

System of care is, first and foremost, a set of values and principles that provides an organizing framework for systems reform on behalf of children, youth and families.

Stroul, B. 2005. Georgetown University. Washington, D.C.

Fundamental Challenge and Rationale for Building Systems of Care: No one system controls everything. Every system controls something.

Pires, S. 2004. Human Service Collaborative. Washington, D.C.

47

1/2 of all lifetime cases of mental illness begin by age 14; 3/4 by age 24 (Kessler, 2006)

It typically takes 6 + years for people to receive treatment after the onset of a mental or substance use disorder (Wang et al., 2005).

44% of children receiving special education services who have emotional disturbances drop out of school, the highest of any category of disability (Wagner, M. 2005).

Substance use impacts families, places families at risk of involvement in the child welfare and criminal justice system (Hinkel, 2011; National Center on Addiction and Substance Abuse at Columbia University, 2010; Kessler, 2007).

EARLY INTERVENTION CAN REDUCE THE IMPACT OF BEHAVIORAL HEALTH PROBLEMS

ADVERSE CHILDHOOD EXPERIENCES & CHILDHOOD TRAUMA

rwjf.org/vulnerablepopulations

CHILDREN’S BEHAVIORAL HEALTH MATTERS

• 13-20% of children & adolescents in the US have a diagnosable mental, emotional or behavioral health disorder & suicide is the 2nd leading cause of death for youth ages 12-17 (Perou, R., Bitsko, R. H., Blumburg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C., . . . Huang, L. N., 2013)

• In 2006, $8.9 billion were spent for the treatment of mental health disorders in children—the highest of any children’s health care expenditures (exceeding asthma and infectious disease) (Soni, 2009)

• In 2007, it was estimated that mental and emotional disorders in children and youth cost $247 billion annually when considering all associated costs, including those from lost productivity, drug and alcohol abuse, crime, and related educational costs (National Research Council & Institute of Medicine, 2009)

50Behavioral Health Accounts for Significant Expenditures Even Among Children

With Chronic Physical Conditions

THE CHANGING LANDSCAPE IN CHILDREN’S BEHAVIORAL HEALTH

• Implementation of the Affordable Care Act and more families gaining health insurance

• More states moving to managed care• Focus on early Intervention at first onset of

Serious Mental Illness/Psychosis• Now Is The Time• Focus on trauma-informed systems

SUPPORT CHILDREN & FAMILIES TO ACCESS HIGH QUALITY & EFFECTIVE SERVICES & INTERVENTIONS• Families have expanded access to health insurance through

Medicaid and private policies• Many states are exploring options for covering additional

prevention and treatment services through their Medicaid State Plans

• Mental Health/Substance Abuse Treatment Parity requires that insurance policies include comparable coverage for behavioral health treatment and somatic health treatment (actual implementation is very challenging!)

• Centers for Medicare & Medicaid Services (CMS) and other federal partners are issuing federal guidance via informational bulletins: http://www.medicaid.gov/Federal-Policy-guidance/federal-policy-guidance.html

http://www.medicaid.gov/Federal-Policy-guidance/federal-policy-guidance.html




PREVENTION & EARLY INTERVENTION WORKS!

• Be a part of Youth Mental Health First Aid implementation in your state (Visit http://www.samhsa.gov/sites/default/files/fy14-grant-awards-nitt.pdf to find out if your state or local educational authority received a grant)

• Access Bullying Prevention Resources: www.stopbullying.gov

http://www.samhsa.gov/sites/default/files/fy14-grant-awards-nitt.pdf

http://www.samhsa.gov/sites/default/files/fy14-grant-awards-nitt.pdf

http://www.stopbullying.gov/

STAY IN TOUCH!• To join the TA Network’s listserv, send an e-mail to

[email protected] (you’ll receive the weekly TA Telegram and periodic TA Telescope as well as occasional announcements from SAMHSA)

• The TA Network is the Children’s Behavioral Health Information Gateway on social media– Like us on Facebook: https://www.facebook.com/CBHinfo– Follow us on Twitter: https://twitter.com/CBHinfo

mailto:[email protected]

https://www.facebook.com/CBHinfo



https://twitter.com/CBHinfo



Documents

S YSTEM OF C ARE, S CHOOL M ENTAL H EALTH, & PBIS: H OW D O W E I NTEGRATE FOR B EST O UTCOMES 2014 National PBIS Leadership Forum Session C12 | October