Integrating School Mental Health and PBIS: Examples at All 3 Tiers Michele Capio, Oak Park School District Pam 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 Connections and 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) 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 PBIS Common 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 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 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 problemsolving 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 problemsolving process at all 3-tiers 3-Tiered System of Support Necessary Conversations (Teams) Universal Team Meeting Plans schoolwide & classroom supports Universal Support Secondary Systems Team Meeting Uses process data; determines overall intervention effectiveness Problem Solving Team Meeting Tertiary Systems Team Meeting Standing team; uses FBA/BIP process for one student at a time Uses process data; determines overall intervention effectiveness Check-In Check-Out Skills Groups Group w. individual feature Brief Complex Wraparound FBA/BIP FBA/BIP Brief FBA/BIP Rev. 11.19.2012 Illinois PBIS Network Positive Behavior Interventions & Supports: A Response to Intervention (RtI) Model Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems Tier 2/ Secondary ODRs, Attendance, Tardies, Grades, DIBELS, etc. Check-in/ Check-out (CICO) Social/Academic Instructional Groups (SAIG) Daily Progress Report (DPR) (Behavior and Academic Goals) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Group Intervention with Individualized Feature (e.g., Check and Connect -CnC and Mentoring) Tier 3/ Tertiary Brief Functional Behavior Assessment/ Behavior Intervention Planning (FBA/BIP) Complex or Multiple-domain FBA/BIP Illinois PBIS Network, Revised October 2009 Adapted from T. Scott, 2004 SIMEO Tools: HSC-T, SD-T, EI-T Wraparound 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 the National SMH and National PBIS Centers www.pbis.org http://csmh.umaryland.edu ISF Monograph Development June 2012 – September 2013 • 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 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 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 MH/PBIS: An Expanded Tier One • Universal screening for social, emotional, and behavioral atrisk 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 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 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 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 • Each school works out their own plan with Mental Health (MH) agency; Preferred • District has a plan for integrating MH at all buildings (based on community data as well as school data); Traditional • A MH counselor is housed in a school building 1 day a week to “see” students; Preferred • MH person participates in teams at all 3 tiers; Traditional • No data to decide on or monitor interventions; Preferred • 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 Family and community Universal Team Plans SW & Class-wide supports Universal Support 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 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 40,570 54.8% Low Income 97 languages spoken in U-46 homes Facilities: 40 Elementary Schools (PreK-6) 8 Middle Schools (7-8) + 1 Alternative Middle School 5 High Schools + 2 Alternative High Schools 2 Early Childhood Centers Communities Served: 11 communities 3 counties (Cook, DuPage, Kane) SD U-46 Student Profile Based on School Report Card 2012 2% 1% Hispanic 50% 7% Caucasian 32% 8% Asian-American 8.3% 50% 32% African-American 6.7% Multi-Race 2.4% Native American 0.5% MISSION 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 # of Agencies U-46 School & Community Alliance Trained Agency Partners 20 10 0 19 19 22 9 # of People Trained U-46 School & Community Alliance Trained Partners 80 70 78 60 50 67 40 30 57 20 10 0 16 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 Operations Tier 2/3 High School Violence Prevention U-46 School and Community Alliance Work Groups 2012-2013 Tier 1 Trauma Informed Care Tier 2 Interventions Tier 3 RENEW/WRAP 3-Tiered System of Support Necessary Conversations (Teams) Universal Team Plans SW & Class-wide supports Universal Support Secondary Systems Team Problem Solving Team Tertiary Systems Team Uses Process data; determines overall intervention effectiveness Standing team; uses FBA/BIP process for one youth at a time Uses Process data; determines overall intervention effectiveness CICO Brief SAIG Group w. individual feature Brief FBA/BIP FBA/ BIP Complex FBA/BIP WRAP 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 Example Tier 1 Examples Boys & Girls Club (Elgin) • Club Elgin: daily, after school RENZ • Freshman Transition: prevention model Tier 2 Examples • • • • Boys & 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 Date 2/6/2012 2/7/2012 2/8/2012 2/9/2012 2/10/2012 A=Absent all day NP=No show Period 1 Period 2 Earn & Give Respect 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) M=Missing data Hold Yourself Responsible (Stop, think and act before reacting to something) Safety First Goal (Stop, think and act before reacting to something) Weekly Progress Report Earn 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) Pre-test/Post-test 1. 2. 3. 4. 5. 6. 7. 8. I attend school regularly I skip ___# of classes each week I receive all A’s, B’s, and C’s for grades I receive _____# of disciplinary referrals per week I feel connected to my school I feel respected and important while at school I can count on friends for support I can count on my family members for support 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 initiatives Explore more intensive interventions for students with unmet mental health needs Next Steps for Community Alliance… Increase trauma focus at all three tiers Directory of partners/agencies Blend & coordinate initiatives across district Expand alternative to suspension Utilize district exemplars as examples for other schools Increase 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 Crosswalks What 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, PA History 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 Activity: What’s in Place? 1-5% Community-Based Services/Resources and Providers Tier 3-Resources/Supports for a Few 5-15% SchoolBased Services & Resources Tier 2- Resources/Supports for Some 80-90% Tier 1 –Resources/Supports for All Applying the Logic to Families Tier 3: Intensive, Individual Interventions Family Liaison-matched with family, needs matched with community resources Individual Skill Building Sessions- 1-5% Tier 2: Targeted Group Interventions Support Groups (Military Families, Newcomer Group) 5-10% Skill Building Sessions (Academic and Behavior) Tier 1: Universal Interventions Self Assessments: Family Engagement Checklist, Surveys Skill Building Series Guest Speaker (Topics Vary- Survey Families) Newsletter, Resource Library , “Shout Outs” 80-90% 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) School-Wide Systems for Student Success: A Response to Intervention (RtI) Model: SUPPORTS Academic Systems Behavioral Systems Tier 3/Tertiary Interventions •1:1 instruction •Increased time •504 1-5% 1-5% 5-15% Tier 2/Secondary Interventions •Title I Reading and Math •ERI, RM, RN, etc. •IST 5-15% 80-90% Tier 1/Universal Interventions80-90% •Core Curriculum – reading and math •AIMS Web •MAP •PSSAs 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 •SBMH, Partial Hospitalization •Alt Ed •FBA/PBISP •Home School Visitor Tier 2/Secondary Interventions •Counselor groups, lunch bunch •Friendship groups •Behavior Chart/plan •IST •Parenting Classes Tier 1/Universal Interventions •Character Education curriculum •Bullying Prevention •SWPBS (some schools) •Act 211 D&A awareness •Counselor classroom lessons •Community Activities •Health Screening Scranton High School School-Wide Systems for Student Success: A Response to Intervention (RtI) Model: Resources Needs Tier 3/Tertiary Interventions Tier 2/Secondary Interventions 1-5% 5-15% 1-5% 5-15% 80-90% Tier 1/Universal Interventions80-90% 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 •SBBH Team •Outpatient therapy •SB Partial •Guidance – individual support •SAVES/school aged mothers Tier 2/Secondary Interventions •SAP •Guidance – groups •Community Partners – groups •Resource Officer Tier 1/Universal Interventions •SWPBIS •Drug and Alcohol Prevention Building Level Action Plan UNIVERSAL SYSTEM SECONDARY SYSTEM TERTIARY SYSTEM Universal Systems Team Secondary Systems Team Problem Solving Team (individual student) Tertiary Systems Team PRACTICES PRACTICES PRACTICES PRACTICES Data Decision Rule Data Decision Rule Data Decision Rule Data Decision Rule 73 Annual Fidelity Check Action 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? School-Wide Systems for Student Success: A Response to Intervention (RtI) Model: SUPPORTS Academic Systems Tier 3/Tertiary Interventions Behavioral Systems 1-5% 1-5% Tier 3/Tertiary Interventions •_____________________ •_____________________ •_____________________ Tier 2/Secondary Interventions •___________________________ •___________________________ •___________________________ •___________________________ •___________________________ •___________________________ Tier 1/Universal Interventions80-90% •________________________ •________________________ •________________________ •________________________ •________________________ •________________________ •___________________________ •___________________________ •___________________________ 5-15% 5-15% Tier 2/Secondary Interventions •____________________________ •____________________________ •____________________________ •____________________________ •____________________________ •____________________________ 80-90% 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 1/Universal Interventions •____________________________ •____________________________ •____________________________ •____________________________ •____________________________ 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 Tool Scranton Assessment Current 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 Use of EBP Tool Scranton Intervention Selection Current 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 Use of EBP Tool Scranton Intervention Progress Monitoring Current Condition • Clinicians utilize outcome tools of COS and SDQ • Not differentiating implementation fidelity to a particular intervention (TFCBT) • 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 clinicianadministered 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 (TFCBT) – 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 X A large improvement is observed in both domains of family functioning Child Outcomes Survey (COS) Overall Wellness: Child 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: Scranton School District 8 7.8 7.6 7.4 7.2 7 6.8 6.6 6.4 6.2 Baseline 3 mo 6 mo 9 mo COS Family Functioning 12 mo 15 mo Child Outcomes Survey (COS) Child Functioning: Scranton School District 8 7.5 7 6.5 6 5.5 5 Baseline 3 mo 6 mo 9 mo COS Child Functioning 12 mo 15 mo Child Outcomes Survey (COS) Therapeutic Alliance: Scranton School District 9.5 9 8.5 8 7.5 7 Baseline 3 mo 6 mo 9 mo COS Therapeutic Alliance 12 mo 15 mo Strengths and Difficulties Questionnaire Parent (SDQ-P) and Teacher (SDQ-T) Total Difficulties: Scranton School District 19 18 17 16 15 14 13 12 11 10 Baseline 3 mo SDQ-P Total Difficulties Score 6 mo 9 mo SDQ-T Total Difficulties Score 12 mo Questions?