Interconnected Systems Framework in Pennsylvania

Report
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Gain an understanding of the Interconnected
Systems Framework (ISF)
Gain two examples for how the ISF is
embedded into ongoing school services
◦ Scranton School District, Pennsylvania
◦ Maryland’s Emerging Adult Initiative (formerly
Healthy Transitions Initiative)
Lucille Eber Ed.D.
IL PBIS Network & National PBIS TA Center
[email protected]
www.pbisillinois.org
www.pbis.org
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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
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Emphasis now on scaling with expansion
and connection to other systems
◦ i.e. academic, juvenile justice, mental health,
child welfare, systems of care
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Emphasis on deliberate actions that foster
connections w/families & community
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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
Developed through a collaboration of the
National SMH and National PBIS Centers
www.pbis.org
www.pbis.org http://csmh.umaryland.edu
June 2012 – September 2013
Collaborative effort of the OSEP TA Center of
PBIS, Center for School Mental Health, and
IDEA Partnership (NASDE) bringing together
national-level experts in the SMH and PBIS,
state and district leaders, and selected
personnel from exemplar sites currently
implementing collaborative initiatives.
Publish a monograph that provides a
summary and framework for
interconnection, documents examples of
success, and lays out a research, policy, and
technical assistance agenda for the future.
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One in 5 youth have a MH “condition”
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About 70% of those get no treatment
School is “defacto” MH provider
 JJ system is next level of system default
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Suicide is 4th leading cause of death
among young adults
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT:
What is meant by
“layering”
interventions?
~5%
~15%
Primary Prevention:
School-/ClassroomWide Systems for
All Students,
Staff, & Settings
~80% of Students
Tertiary Prevention:
Specialized
Individualized
Systems for Students
with High-Risk Behavior
Secondary Prevention:
Specialized Group
Systems for Students
with At-Risk Behavior
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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
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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
◦ Kids 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
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
ISF provides structure and process for
education and mental health systems to
interact in most effective and efficient way.
◦ 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.
◦ Applies strong interdisciplinary, cross-system collaboration.
◦ Uses the tiered prevention logic as the overall organizer to
develop an action plan.
◦ Involves cross system problem solving teams that use data to
decide which evidence based practices to implement.
◦ Involves ongoing progress monitoring for both fidelity and
impact.
◦ Emphasizes active involvement by youth, families, and other
school and community stakeholders.
◦ 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.
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Each school works
out their own
plan with Mental
Health (MH)
agency
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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
Interconnected Systems Framework
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
 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
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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 available
 Communication system: staff, families and
community
 Early identification of students 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
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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 Framework
Tier 3: Intensive Interventions for Few
Individual 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/services
 Plans can range from one to
multiple life domains
 System in place for each team
to monitor student progress
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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
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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
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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
Quick Reflection :
What features of the ISF are in place
in your district/community?
1. Mental health providers participate in Tier 1/Universal
Behavior Support Teams, assisting in
selection/design/delivery of behavioral support through
Tier 1/Universal curriculum for all students?
2. Community/mental health partners participate on Tier
2/3 systems teams in tandem with school personnel to
review data , identify students with Tier 2/3 needs and
design interventions?
3. ALL social/emotional/mental health interventions are
monitored through blended teams (school & mental
health personnel) using data?
PBIS: Equity in Education
Making Education Work for All
Integrating School Mental Health Strand:
• Integrating SMH & PBIS: Examples at All 3 Tiers
• Integrating SMH & PBIS: Using Data
• Integrating SMH & PBIS: Selecting Evidence-based
Practices
• Interconnected Systems Framework Monograph:
Lessons from the Field
• Implementing an Interconnected System Framework
in an Urban School System
• Integrating SMH & PBIS at the State Level
• The Changing Role of School-based Clinicians
Kelly Perales
Jessica Leitzel
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Local control for the human services system - 67
counties
◦ Child Welfare
◦ Mental Health
◦ Juvenile Justice
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Local control for education - 500 school districts
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Behavioral health
◦ Funding to County Mental Health Programs
◦ Medicaid Behavioral health – carve out from physical health,
some counties hold the contract
◦ Managed care organizations – 5 in PA
© 2010 Community Care
33
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Pennsylvania has a diverse service delivery system
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Understanding, accessing and obtaining services
is difficult and confusing

Current services are based on diagnoses and
problems rather than building on strengths and
needs, limited focus on prevention
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Services are fragmented
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Limited youth & family participation in many areas
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All systems struggle to serve youth with complex
behavioral health needs, multi-system involvement
and their families
Detention/ RTF
AAA
Partial
Detox
Services
APS
Probation
Court
Mentor
Truanc
y
Psych
Special Ed
Residential
Supports
Counseling
Referral
Intake
Referral
Referral
Eligibility
Case Mgmt.
Intake
Ed. Sys
JJ Sys
MH Sys
Case
Work
Services
Residential
MR Sys
Intake
Supports
Special Ed
Foster
Care
Referral
Intake
CW Sys
Intake
Psychiatrist
th
D&A Sys
TSS/BSC
Therapist.
MCO Sys
Partial
Health Sys
Referral
Referral Case Mgmt..
ER
Hospital.
Intake
TSS/BSC
Mobile T
Intake
Primary
Care
Care Mgmt.
Case Mgmt.
Inpatient
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Established in 2006 through the Bureau of
Special Education (BSE) in the Department
of Education
Membership includes representatives
from the Pennsylvania Departments of
Education, Health, and Public Welfare in
addition to youth serving provider
agencies, managed care organizations,
advocates, and youth and family members
•
•
The primary strategy of the CoP is to support
the scale-up of the Positive Behavior
Interventions and Supports (PBIS) with fidelity
In the past 5 years, the PAPBS network has
expanded its reach to over 400 schools state
wide, with approximately 100 PBIS facilitators
providing regional training and technical
assistance across the multiple tiers of
prevention and intervention
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Systems of Care – Hi Fidelity Wrap Around
Early Childhood – Program Wide and Home
Based Positive Behavior Intervention and
Support
Juvenile Justice – CoP for Transition and
RENEW
Children and Youth – CoP for Transition and
RENEW
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Stakeholder input regarding current BHRS and
children’s service delivery
◦ Families
◦ Educators
◦ County partners – child serving systems
Unique opportunity to partner with Department of
Welfare and OMHSAS
Transformation of children’s services
◦ Partnership with oversight
◦ Stakeholder input
◦ Development of program description template
© 2010 Community Care
40
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Accountable TO the family and FOR the care
Accessible, coordinated, and integrated care
Comprehensive service approach
Increased accountability and communication
Single point of contact for behavioral health
School is “launching pad” for services
delivered in all settings
Youth continue on the team with varying
intensity of service
CLINICAL
CASE
INTERVENTIONS
MANAGEMENT
CASE
CRISIS
INTERVENTION
CONSULTATION
AND TRAINING
for educational
staff
LEARNING
COLLABORATIVE
TECHNICAL
ASSISTANCE
TRAINING
EVIDENCE-BASED
PRACTICES
COACHING
CARE
MANAGEMENT
MODEL FIDELITY
Family and
community
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
3-Tiered System of Support Necessary Conversations
Family and
community
Community
Secondary
Systems Team
Problem Solving
Team
Uses Process data;
determines overall
intervention
effectiveness
Standing team with
family; uses FBA/BIP
process for one youth
at a time
Tertiary
Systems Team
Uses Process data;
determines overall
intervention
effectiveness
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
Sept. 1, 2009
Family and
community
FBA/
BIP
Complex
FBA/BIP
WRAP
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Quarterly meetings
Stakeholder representation – System of Care
Implementer’s blueprint
Systems, data and practices
Scaling and sustainability
Implementation Science - Fixen
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Scranton School
District
Scranton Counseling
Center
Lourdesmont
Friendship House
Community Care
NEIU 19
PaTTAN KOP
Steady increase in enrollment for the past 4
years:
 2011-2012 SY
Total Enrollment = 9,732

Special Education = 1,742
 Free and Reduced Lunch = @67%
 English Language Learners = @ 780
 Process @ 200 internal transfers per month
(going between schools) and @ 100
withdrawals and first time enrollment monthly
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District and Community Leadership Team
Tier Three – School Based Behavioral Support (SBBH)
Teams
Tier One – 2010-11 School
Year
Began meeting during
the 2009-10 school
Willard Elementary
year. Meet on a
quarterly basis.
Follow the PBIS
Bancroft Elementary
Implementation
Blueprint.
Scranton High
Willard Elementary
Bancroft Elementary
Scranton High
Tier Two
Tier One – 2012-13 School Year
Tier Three – 2012-13
School Year
Willard reaches
implementation fidelity at
Isaac Tripp Elementary
Tier One and begins
training for implementation
of Tier Two.
McNichols Plaza Elementary
Willard implements Tier
Two beginning 2011-12
South Scranton
School Year.
Intermediate
Scranton High participates
in RENEW pilot project.
SBBH expands to Kennedy
Elementary, Whittier
Elementary, Plaza
Elementary, SSIS, NEIS, and
WSIS
Tier One – 2013-14
Tier Two – 2013-14
Three more schools to be
trained and implement
Bancroft, SHS, and
Tier One
perhaps more to be
Scott Ross Bully
trained and begin
Prevention to be
implementing Tier Two
implemented
Universal Screening
Tier Three – 2013-14
Additional school
employed and provider
employed staff will be
trained to facilitate
RENEW
SBBH will be scaled to
more schools
3000
Willard Elementary
2840 2840
2500
2000
1460 1460
1500
1380 1380
1000
500
0
Last Year
This Year
Student Minutes
Time Regained
Admin Minutes
1.8
1.6
1.4
1.2
1.0
Improving
0.8
0.6
0.4
0.2
0.0
Change at 3 mos
Not Implementing
Change at 6 mos
Low Fidelity
Change at 9 mos
High Fidelity
1.8
1.6
1.4
1.2
1.0
Improving
0.8
0.6
0.4
0.2
0.0
Change at 3 mos
Not Implementing
Change at 6 mos
Low Fidelity
Change at 9 mos
High Fidelity
1.0
0.5
0.0
Improving
-0.5
Change Q1
Change Q2
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
Not Implementing
Low Fidelity
High Fidelity
1.0
0.5
0.0
Improving
-0.5
Change Q1
Change Q2
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
-4.0
Not Implementing
Low Fidelity
High Fidelity
Formerly known as Healthy Transitions Initiative
(HTI)
 A five year systems change state/community partnership
to create developmentally appropriate and effective youth
guided local systems of care that will improve outcomes
for transitioning youth with mental health and cooccurring disorders in the areas of:
 education,
 employment,
 housing,
 and decrease contacts with juvenile and criminal justice
systems toward a goal of
 Effecting statewide policy change and replication
 Improving the capacity of communities to effectively
serve these youth and young adults
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Seven states have been awarded five-year
cooperative agreements that began in fiscal
year 2009.
These states are:
Maryland
Georgia
Maine
Missouri
Oklahoma
Utah
Wisconsin
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Strengths-based coordinated care to provide
seamless transition into adulthood
Involvement in normative activities including
employment and/or continuing education,
and productive community contribution
Family education, support and
empowerment
Youth
Family
& Young Adult Level
Level
Community/System
Level
Service tunnels – services are largely provided
within segregated service systems, not
integrated across systems; policy, regulations,
eligibility criteria not aligned (i.e., mental health,
juvenile justice, social service/foster care,
education)
Age transition cliffs – services end due to an
increase in age rather than a change in the need
for the service (Child and adolescent mental
health system versus adult mental health system
–differing eligibility criteria, priority population,
service types)
http://www.ncwd-youth.info/resources_&_Publications/mental_health.html
Special Education
(pre K-12)
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IDEA
Services mandated for
qualified students
Schools responsible for
◦ Identification,
◦ Eligibility
◦ Provision of services
Post Secondary
Education/Employment
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Section 504 & ADA
Individuals are responsible for:
◦ Applying for services
◦ Providing appropriate
identification
◦ Asking for reasonable
accommodations in employment
& educational settings

Requirements vary among
agencies
CHILD SYSTEM
ADULT SYSTEM
Education
Child Welfare
Juvenile Justice
Child Mental Health
Criminal Justice
Adult Mental Health
Medicaid
Medicaid
Health Insurance
Health Insurance
Housing
Vocational Rehabilitation
Substance Abuse
Labor
Birth  
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18-21yrs  
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Death
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Collaboration is critical
Necessary to shift locus of power & share
responsibility
Look at communities with micro & macro
perspective & be willing to do things
differently in both perspectives
More Every Day
Youth and young adults 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
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All aspects of the work are guided by youth,
families, school and community stakeholders
with an emphasis on ongoing quality
assessment and improvement.
The functioning of Transition teams is critical
to all efforts, and are emphasized and
supported strongly.
Aligned conceptually and operationally to
promotion of health, mental health and
wellness that increases student’s
participation in programs and activities.
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Promote enhanced collaboration toward
system integration among families, youth and
adult serving agencies, and initiatives that
connect.
Shared Agenda with strong collaborations
moving to partnerships among families,
schools, and mental health and other
community systems.
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Commitment to identify – acknowledge - and
reduce barriers to learning, school, and
community success
Shared agenda to foster commitment
Strong family engagement and empowerment
Shared vision to create and maintain a full
continuum of multi-tiered programs and
services for TAY and their families
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Working Together
Establishing Demonstration Sites
Building Interconnected Systems
Braiding community resources
Community Clinicians Bringing in Augmenting
Strategies
Systems Collaboration and Cost Savings
Highlighted
Planning for Transference and Generalization on
Multiple Levels
◦ Teaching transferable skills to Mutual Benefit

Develop empirically-supported services and supports
which are designed specifically for TAY and which
transcend the age transition cliff (ages 16-25), rather
than retro-fit child and adolescent or adult services to
met the unique needs of transition age youth.

Leverage funding and pool resources across multiple
systems.

Cultivate youth peer support to engage youth in
service and provide natural support.

Anchor TAY initiatives in supported employment and
education – use as a point of entry to other mental
health services.
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Define population
Identify systems and organizations who serve this
population
Seek potential visionary allies in the public mental
health arena
Identify community resources that may have similar
goals
Identify what is working and what is not working
Establish a commitment from stakeholders
Develop a shared vision(i.e. seamless transition for
youth with emotional disabilities)
Make a plan and do it
A new report indicates that young adults (ages 18–25)
taking part in community-based treatment programs
achieve positive outcomes in behavioral and
emotional health, daily life skills, employment,
enrollment in school, and reduced homelessness. This
report by the Substance Abuse and Mental Health
Services Administration (SAMHSA) also shows that
older adolescents and young adults who had
participated in these SAMHSA-supported treatment
programs reported lower levels of substance use
disorders
(SAMHSA Press Office , 5/7/2013, 9:30 AM)
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT:
What is meant by
“layering”
interventions?
~5%
~15%
Primary Prevention:
School-/ClassroomWide Systems for
All Students,
Staff, & Settings
~80% of Students
Tertiary Prevention:
Specialized
Individualized
Systems for Students
with High-Risk Behavior
Secondary Prevention:
Specialized Group
Systems for Students
with At-Risk Behavior
Contact Information:
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Lucille Eber, Illinois PBIS Network ([email protected])
Kelly Perales, CCBH, Pennsylvania ([email protected])
Jessica Leitzel, Scranton S.D., PA ([email protected])
John Coppola, Maryland HTI, ([email protected])
Deanne Unruh, University of Oregon, ([email protected])

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