School-Based Behavioral Health Diversion -Which Youth and What Services ?

1. School-Based Behavioral Health Diversion -Which Youth and What Services? April 11, 2016 Please take this time to answer the polling questions that appear in the bottom corner of your web browser This webinar’s slides & handouts are available for download from the ‘shared documents’ tab.

2. Housekeeping A recording of this webinar will beposted to http://www.ncmhjj.com/jjtpa/resources/archived-webinars/ and to https://schooljusticepartnership.org/ A question & answer session will be held at the end of the webinar. You may use the ‘chat’ function (please select chat with ‘all panelists’) to submit questions. If you have logistical challenges or questions during this webinar, please notify us by using the ‘chat’ function (select chat with ‘all panelists’). ► Q&A

3. School-Justice Partnership National Resource Center • Supported by the Office of Juvenile Justice and Delinquency Prevention • Led by the National Council of Juvenile and Family Court Judges, with four core partners: • National Center for Mental Health and Juvenile Justice (NCMHJJ) • International Association of Chiefs of Police • National Association of State Boards of Education • The National Child Traumatic Stress Network

4. Webinar Series: Developing Effective School-Based Diversion Programs that Identify and Address Behavioral Health • Recordings at http://www.ncmhjj.com/jjtpa/resources/archived-webinars/

5. Developing an Identification Structure

6. Why Use a Targeted Strategy? • Broader school mental health initiatives are very worthwhile, but may be a more difficult lift • Limited resources call for targeted approaches • Danger in labeling youth as at-risk of juvenile justice involvement – want to avoid net widening • Builds an intentional relationship between the juvenile justice system, schools, and providers

7. How to Define At-Risk of Juvenile Justice Referral • Options from most limited to most expansive: • Youth already under juvenile justice supervision • On probation • On aftercare status • Youth for whom referral to law enforcement is imminent • When is law enforcement called in the school now? • Youth for whom referral to law enforcement is likely • Patterns of escalating behavior • Behavior that was on the cusp of a call to law enforcement • Risk Factors • E.g. truancies, grades, history of juvenile justice involvement • Critical to be able to do this in a research-informed way

8. Dr. Nancy Lever • Associate Professor in the Division of Child and Adolescent Psychiatry at the University of Maryland School of Medicine • Co-Director of the Center for School Mental Health (CSMH)

9. Connecting Students to Behavioral Health Services: Successful Models for Schools Nancy Lever, Ph.D. Associate Professor University of Maryland School of Medicine Co-Director – Center for School Mental Health April 11, 2016

10. Of students who DO receive mental health services, over 75% receive those services in schools (Duchnowski, Kutash, & Friedman, 2002; Power, Eiraldi, Clarke, Mazzuca & Krain, 2005; Rones & Hoagwood, 2000; Wade, Mansour, & Guo, 2008)

11. Best Practices in Comprehensive School Mental Health Center for School Mental Health, 2014

12. Models of Service Delivery • Community-Partnered School Behavioral Health • School-Based Health Centers • School-Linked Mental Health Services

13. Community-Partnered School Behavioral Health • Involves formal partnershipbetween schools and community health/behavioral health organizations, as guided by familiesand youth • Builds on existing school programs, services, and strategies • Focuses on all students, both general and special education • Can involve a full arrayof tiered services - mental health education and promotion through intensive intervention • Prioritizes evidence-based practicesand addresses quality improvement

14. School-Based Health Centers (SBHC) • A SBHC represents a shared commitment between a school and a health care organization to support the health, well-being, and academic success of its students • Schools provide space and access • Local health organizations bring expertise and linkages to services (physical health care, behavioral health, dental, reproductive health, nutrition education, and health promotion) • Can help integrate physical and mental health care SBHA, 2016

15. School-Linked Models • Services are provided off-site in a community program • Ideally schools and programs have MOU/MOA related to referral processes, communication and collaboration, data sharing, crisis management, and other procedures

16. Role of School-Based Staff Who? School-Based Staff includes among others: Educators, Health and Mental Health Providers, Paraprofessionals, Administrators, School Resource Officers What? • Assist with Screening Process • Behavioral health screening tools • Staff nomination • Participate in professional development (e.g., signs, symptoms, typical development, and red flags) • Make referrals as appropriate • Learn about mental health strategies to use with youth to promote wellness and reduce stress • Participate in prevention and intervention activities along with behavioral health providers

18. Direct Referral Process (CSMH & AIR, 2016)

19. Team Referral Process (CSMH & AIR, 2016)

20. The Community-Partnered School Behavioral Health Module Free Training Series and CEUs www.mdbehavioralhealth.com Community-Partnered School Behavioral Health Implementation Modules provides a range of strategies, resources, and tools necessary to establish, maintain, and expand effective student behavioral health programs. MODULE 1: Community-Partnered School Behavioral Health: An Overview MODULE 2: Operations: An Overview of Policies, Practices, and Procedures MODULE 3: Overview of School Language and Policy MODULE 4: Funding Community-Partnered School Behavioral Health MODULE 5: Resource Mapping MODULE 6: Teaming MODULE 7: Evidence-Based Practices and Programs: Identifying and Selecting EBPs MODULE 8: Implementation Science: Lessons for School Behavioral Health MODULE 9: Data Informed Decision Making MODULE 10: School Behavioral Health Teacher Consultation MODULE 11: Psychiatry in Schools MODULE 12: Starting Early: Supporting Social Emotional Development and School Readiness MODULE 13: School Behavioral Health Program Evaluation 101 MODULE 14: 10 Critical Factors to Advance State & District School Behavioral Health MODULE 15: Working with State Leaders to Scale-Up School Behavioral Health

21. Additional Resources Center for School Mental Health http://csmh.umaryland.edu The School Health Assessment and Evaluation (SHAPE) System for school mental health systems https://theshapesystem.com School-Based Health Alliance http://www.sbh4all.org/

22. Dr. Katie Eklund • Assistant Professor in the School Psychology Program at the University of Arizona

23. Screening to Identify Students with Behavioral and Emotional Concerns in Schools Katie Eklund, Ph.D. University of Arizona April 11, 2016

24. Students with emotional and behavioral health concerns have poor school-related and long-term outcomes • Low overall academic achievement • Higher rates of suspension and expulsion • High rates of absenteeism • Highest incidence of contact with juvenile justice system • Low graduation rates • Poor psychosocial outcomes

25. Methods of Early Identification • Teacher referral • Pediatric setting • Problem solving teams • School-based mental health support • Parent referral

26. Teacher Referral and School Identification • Refer-Test-Place models • teachers differ in their ability to work with students • perceptions of “teachability” • teachers not trained to know how problematic behavior must be prior to referral • Children’s behavioral/emotional problems may be under-referred and/or referral is delayed (Lloyd, Kauffman, Landrum, & Roe, 1991; Severson et al., 2007; Tilly, 2008; Walker et al., 2000)

27. Behavioral Health Screening: A Possible Solution • Behavioral health screening can be conducted with students to identify those who are “at risk” of behavioral or emotional concerns -Measures designed to assess internalizing as well as externalizing behaviors

28. Behavioral Health Screening: A Possible Solution • Emerging evidence of ability to predict outcomes • Screener could predict 6 years later which children were involved in mental health, special education, or juvenile justice (Jones et al., 2002) • Goal is to provide early intervention • Short & long-term goals: • decrease academic failure, improve student well-being, improve educators ability to effectively respond to concerns

29. Nuts & Bolts of Screening Screening at-risk students • Why? • Identify students at risk for SEB difficulty • Who? • Teacher, parent, and/or student self-reports • When? • 1-3 times per year (Fall, Winter, and Spring) • Minimum of 4-6 weeks into school year • How? • Many different administrative procedures (depending on the informant)

30. Universal Screening Tools • Systematic Screening Behavioral Disorders (Walker & Severson, 1992) • Student Risk Screening Scale* (Drummond, 1994) • Strengths & Difficulties Questionnaire (Goodman, 2001) • Behavioral and Emotional Screening System* (Kamphaus & Reynolds, 2007) • Social, Academic, and Emotional Behavioral Risk Screener* (Kilgus, Chafouleas, Riley-Tilman, & von der Embse, 2014)

31. Behavioral and Emotional Screening System (BESS; Kamphaus & Reynolds, 2007) PROS Can be cost-prohibitive Time to screen entire classroom/school when sole reliance on teachers CONS • Brief and multi-informant • Assesses key variables • Strong psychometric properties • Scoring software available

32. Student Risk Screening Scale (SRSS) PROS Internalizing scale is still new There are only 7-items so may not capture a wide-range of behaviors Tends to confound academic and behavioral risk CONS • Quick & efficient • Assesses externalizing behaviors • Initial evidence for internalizing behaviors • Free of charge

33. Student Risk Screening Scale(Sample)

34. Social , Academic, and Emotional Behavior Risk Screener (SAEBRS; Kilgus, Chafouleas, Riley-Tillman, & von der Embse, 2014) • Brief, 19-item teacher rating scale • One broad scale and three subscales • Total Behavior (19 items) • Social Behavior (6 items) • Academic Behavior (6 items) • Emotional Behavior (7 items)

35. Social , Academic, and Emotional Behavior Risk Screener (SAEBRS; Kilgus, Chafouleas, Riley-Tillman, & von der Embse, 2014) • Intended for use in surveillance of both protective and risk factors • Subscales = domains of functioning • Items = continuum of behavior • Maladaptive  Adaptive • Items = sample from the universe of item content • Do not represent the entirety of behavior within each domain

36. Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) Total Behavior Social Behavior Academic Behavior Emotional Behavior Externalizing Problems Social Skills Attentional Problems Academic Enablers Internalizing Problems Emotional Competence

37. Social , Academic, and Emotional Behavior Risk Screener (SAEBRS; Kilgus, Chafouleas, Riley-Tillman, & von der Embse, 2014) PRO Can also be somewhat time intensive Need for more research at high school level CONS • Brief (19 items) • Assesses Social, Academic, and Emotional Behavior • Promising evidence, with strong sensitivity and specificity at elementary and middle levels

38. FAST Individual Report

39. Determine the level at which to implement intervention (SEBA Model; Kilgus & Eklund, 2015) Universal Screening School-wide Base Rate < 20%, but Classroom Base Rate ≥ 20% School-wide Base Rate ≥ 20% School-wide Base Rate < 20% & Classroom Base Rate ≤ 20% System Support (Tier 1) Classroom Support (Tier 1) Individual/Small Group Support (Tier 2)

40. Questions? Thoughts? Katie Eklund, Ph.D., NCSP katiereklund@gmail.com

41. Dr. Isaiah Pickens • Assistant Director of Service Systems at the National Center for Child Traumatic Stress

42. WHY TRAUMA MATTERS IN SCHOOLS Isaiah B. pickens, ph.d. Assistant director of service systems National center for child traumatic stress

43. OBJECTIVES • Define trauma, trauma reminders, and traumatic stress reactions. • Identify minimum of 3 impacts of trauma on individual. • Recommend minimum of 2 strategies to minimize impact of psychological trauma.

44. THE IMPORTANCE OF SAFETY • Physical and emotional safety are basic needs we automatically fight to preserve. • Fear is a natural response that promotes self-preservation. • Our experiences shape how we perceive threat and understand strategies for self-preservation. • an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. Photo Credit: http://www.sciseek.com/search/web/fear%20response

45. DISSECTING TRAUMA • Acute traumatic experience versus chronic traumatic experiences • Different people can view the same traumatic experience differently. • Traumatic experiences impact how a person assesses threat and their automatic strategies for self-protection. • Sometimes it limits how a person copes with stress.

46. A CLOSER LOOK ATPROBLEMATIC COPING • Post-Traumatic Stress Disorder (PTSD) is a diagnosis that helps explain reactions to trauma. • Common traumatic stress reactions include: • Intrusive thoughts • Re-experiencing • Avoidance • Negative thoughts & feelings • Dissociation • Hyper/hypo arousal Photo Credit: http://www.catherineleblancmft.com/how-to-reach-optimal-arousal/

47. Building Trust • Trauma can interrupt the process of building trust. • Basic needs may not be met early in life and undermine the development of secure attachment. • The brain becomes hardwired to assess for threat and more automatically uses the “survival brain” instead of the “learning brain”. Photo Credit: http://communityresiliencecookbook.org/your-body-brain/

48. UNDERSTANDING SELF & OTHERS Trauma can undermine the development of a healthy level of autonomy. Individuals may believe they have limited control over their environments. Feelings of worthlessness and hopelessness may arise and become pervasive. Trauma can make it difficult for individuals to identify their feelings or the feelings of others. Constantly having feelings invalidated potentially limits emotional range and understanding. Frequently perceiving threat leads to selective attention that may lead to distorted perceptions of others emotions.

49. STUCK IN THE PAST • Trauma can lead to regressed behavior or underdeveloped skills. • Emotion regulation and executive functioning deficits may make daily functioning difficult and decision making processes problematic. • Attempts to communicate may become frustrating and lead to aggressive behavior.

50. IDENTIFYING TRAUMA • Understanding the 3 E’s (events, experiences, and effects) provide a foundation for identifying the impact of trauma in the classroom. • Events are the traumatic incidents that have happened to youth • Experiences refer to youth responses to traumatic events • Effects refer to functional impairment that may occur related to the trauma but be compounded by other stressors • Changes in behavior • Disproportionate response to stress • Screening instruments are formal tools non-mental health professionals can use to identify trauma. • Child Stress Disorders Checklist – Screening Form • Child Traumatic Screening Questionnaire • Trauma Symptom Checklist for Children • UCLA PTSD Reaction Index