School and Community Collaboration for an Effective Service Delivery System Sandra Keenan Director, Center for Effective Collaboration and Practice American Institutes for Research Washington, DC October 31, 2008
Objectives—Participants will learn: • An overview of school based mental health models nationally that are implementing multiple approaches including PBIS, Safe Schools/Healthy Students and systems of care • Data on improved school and child outcomes from integrated initiatives • Challenges for partnerships between mental health systems and schools and strategies for overcoming these challenges • designing and building sustainable coalitions that support the social, emotional and behavioral supports among multiple systems • Strategies for involving families as partner with schools and mental health systems • Community-specific examples and strategies used to develop partnerships between schools and mental health systems to implement a continuum of school-based mental health services • An integration framework for communities to implement multiple strategies for school-based mental health services
WHAT WE KNOW: To improve the academic success of our children, we must also improve their social success. Academic and social failures are directly related.
What is the level of need for behavioral and emotional support within our schools and communities? • Approximately 20% of our youth exhibit complex problems; 10% have a serious emotional disorder • Only 2% of school age children are identified with serious emotional disorders under special education. • Fewer that 1 in 4 students with significant emotional and behavioral needs are receiving minimally adequate treatment, both in school and the community(Surgeon General’s Report, 2000)
Get lower grades Fail more courses and exams Are held back more often Graduate at lower rates 55% drop out rate Have blame placed on family move from program to program Get arrested more often; almost 50% /1 year and within 5 yrs. over 60% Spend more time in the juvenile justice system Are more frequently placed in restrictive educational environments Children and Youth with Emotional and Behavioral Disorders(2% nationally are identified IEP)
Aspects of School Culture • Time/Day/Month/Year • Personnel • Domain/classroom/school/bus/playground • Context of service delivery…. food/exercise/instruction/transportation/health services/legal/college planning/social network/behavior/rules…..
Most prevalent school discipline problems: • Class disruption • noncompliance • bullying and harassment • fighting/physical aggression • truancy • vandalism • theft • alcohol, tobacco, and other drug use • dropout • suicide
Understanding issues that might relate to behavior (Schools may see this as all one thing…..inappropriate behavior to be dealt with as a discipline issues….) • Developmental • Environmental • History of reinforcement • Related to medical condition • Related to a mental health condition • Cultural(active as well as reactive) • Related to side effects of medication • Related to another disability, such as LD, or Language processing difficulty • Type of instruction and curriculum
INTERNAL SCHOOL TEAM COORDINATION • TEACHER TRAINING/CONSULTATION • POSTIVE BEHAVIORAL SUPPORTS • SOCIAL SKILL INSTRUCTION • INSTRUCTIONAL SUPPORT • INTEGRATED SERVICE COORDINATION • FAMILY CENTERED SYSTEM • SUPPORT FOR PARENT SKILL & INVOLVEMENT • COLLABORATION WHAT’S MISSING? TYPICAL SCHOOL JuvenileCourt JuvenileServices PUPIL SERVICESSCHOOL PSYCHOLOGISTSCHOOL SOCIAL WORK *Special Education Alternative Schools SCHOOL NURSE *STD/Pregnancy Prevention HEALTH SERVICES *Drug/Alcoholand MentalHealthServices SCHOOL SECURITY *Police * ViolencePrevention *Drug & Alcohol Prevention Program Counseling Administration HIGH SCHOOL SCHOOL COUNSELORS *College *Class Schedule *Mentors Teachers and Staff Physical/Health Education SOCIAL SERVICES *SSI *Medicaid *Teen Mother *Pregnancy Counseling Prevention*ChildAbuse/NeglectPrevention Adapted from slide by of National Resource Center for Safe Schools Based upon Dwyer, 1994
School Mental Health Services in US 2002-2003 • Study was conducted of 83,000 schools • 1/5 of students received some mental health services • Major providers in schools= nurses, counselors, school psychologists and social workers • School nurses spent 1/3 time providing MH services • 80% of schools provided MH services, but not part of a formal network of support
School Mental Health Services in US • Most difficult service to deliver: family support services • Most successful strategy: developing positive formal and informal relationships with community partners WHAT A GREAT OPPORTUNITY FOR COLLABORATION AND PARTNERSHIP!
Slides provided by : Sylvia Fisher, Ph.D. Program Director of Evaluation Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse Mental Health Services Administration (SAMHSA) Brigitte Manteuffel, Ph.D. Principal Investigator, CMHI National Evaluation Macro International Inc. National Evaluation Findings: Education Outcomes of Children/Youth with Mental Health Needs Served in Systems of Care
Passamaquoddy Tribe, ME Maine (3 counties) King County, WA Maine (4 counties) New Hampshire (3 regions) Vermont 1 (statewide) Worcester County, MA Sault Ste. Marie Tribe, MI Vermont 2 (statewide) Minnesota (6 counties) Blackfeet Tribe, MT Worcester, MA Clark County, WA Bismarck, Fargo, & Minot, ND Rhode Island 1 (statewide) Montana & Crow Nation Rhode Island 2 (statewide) Multnomah County, OR Albany County, NY Mid-Columbia Region (4 counties), OR Minnesota (4 counties) Monroe County, NY Rhode Island 3 (statewide) Wisconsin (6 counties) Sacred Child Project, ND Bridgeport, CT Clackamas County, OR Southeastern Connecticut Ingham County, MI Erie County, NY Westchester County, NY Lane County, OR Willmar, MN New York, NY Oglalla Sioux Tribe, SD Idaho Detroit, MI Yankton Sioux Tribe, SD Mott Haven, NY Kalamazoo County, MI Northern Arapaho Tribe, WY Burlington County, NJ Cuyahoga County, OH Iowa (10 counties) South Philadelphia, PA Milwaukee, WI United Indian Health Service, CA Allegheny County 1, PA Chicago, IL McHenry County, IL Lake County, IN Allegheny County 2, PA Lyons, Riverside, & Proviso, IL Nebraska (22 counties) Wyoming (statewide) Beaver County, PA Southern Consortium & Stark County, OH Glenn County, CA Delaware (statewide) Butte County, CA Marion County, IN Montgomery County, MD Placer County, CA Baltimore, MD Alexandria, VA St. Joseph, MO Lancaster County, NE Napa & Sonoma Counties, CA Denver area, CO Washington, DC Charleston, WV St. Louis, MO Rural Frontier, UT Northern Kentucky Sacramento County, CA Southeastern Kansas Contra Costa County, CA Edgecombe, Nash, & Pitt Counties, NC Eastern Kentucky St. Charles County, MO San Francisco, CA Colorado (4 counties) Urban Trails, Oakland, CA North Carolina (11 counties) Sedgwick County, KS Clark County, NV North Carolina (11 counties) Nashville, TN Monterey, CA Southwest Missouri Mecklenburg County, NC California 5 (Riverside, San Mateo, Santa Cruz, Solano, & Ventura Counties) Navajo Nation South Carolina (3 counties & Catawba Nation) Maury County, TN Oklahoma (5 counties) Mississippi River Delta area, AR Greenwood, SC Santa Barbara County, CA California Rural Indian Health Board, Inc., CA Birmingham, AL Charleston, SC Los Angeles County, CA Gwinnett & Rockdale Counties, GA Choctaw Nation, OK Pascua Yaqui Tribe, AZ San Diego County, CA Hinds County, MS Las Cruces, NM Pima County, AZ Ft. Worth, TX Mississippi (3 counties) El Paso County, TX Travis County, TX Hillsborough County, FL Harris County, TX Southeastern Louisiana West Palm Beach, FL Sarasota County, FL Broward County, FL Funded Communities Fairbanks Native Association, AK Date Number Wai'anae & Leeward, HI 1993–1994 22 1997–1998 23 1999–2000 22 2002–2004 29 2005–2006 30 Guam Yukon Kuskokwim Delta Region, AK Puerto Rico Honolulu, HI System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their Families Program Funded by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMSHA)
Value-Driven Systems Change Youth Guided Family Driven Individualized Least Restrictive System-of-Care Principles Culturally & Linguistically Competent Community Based Interagency Accessible Collaborative & Coordinated
Collaboration Supports Mental Health Needs of Children/Youth and their Families Schools actively refer children/ youth to systems of care Partnerships grow across grant years Note: 2005-2006 grantees serve more children below age 6; 7 sites only serve only young children. Other includes physical health, substance abuse clinics, family court, early care, among others.
Some School Characteristics of Children/Youth Entering Systems of Care 95% attended school in past 6 months 85% are in regular public school, 15% in alternative/special school, 7.5% in 24-hour restrictive school setting, etc. About 20% were absent 2 or more days per week About 22% were failing 2 or more classes 39% had been suspended from school in past 6 months
Children and Youth Entering Systems of Care: IEPs and Special Education Nearly half have an IEP Most have IEPs for behavioral/emotional problems, among other reasons (see below) 45% of caregivers reported child/youth receipt of special education services
GOOD NEWS…Youth in Systems of Care are Doing Better Regular School Attendance (> 80% of the time) increased from 74% to 81% in 6 months Absences due to behavioral and emotional problems were reduced by 1/5 in 18 months 31% more youth achieved passing grades after 18 months Note: Findings are for youth aged 14-18 years
Changes in School Attendance and Performance 30 Months After Entering Systems of Care (all children and youth) Attendance Performance 20
Fewer Disciplinary ProblemsYouth Ages 14 – 18 Years Suspensions & expulsions were reduced by 1/5 in first 6 months and by 44% in 18 months
Improved Youth (Aged 14-18 Years) Behavior and Emotional Health Behavioral and emotional problems decreased (35% improved at 6 months, 48% at 18 months) Youth involvement with juvenile justice decreased (e.g., arrests fell by 60% at 18 months) Youth became less depressed and less anxious Youth suicide attempts were reduced by half in 6 months
Mental health consumers/youth/families are not in the mental health system – they are in the “de facto system”- schools • Over 52 million children in ~ 100,000 schools in U.S.; 6 million adults working in the schools: 1/5 of U.S. population • Children receive more MH services through schools than any other public system • Student support services/school health programs need greater focus in health and education policy initiatives • Must serve ALL children….. so they can learn in schools.
(MODELS)Promising Practices in Children’s Mental Health,Systems of Care identified six practices integral to success, regarding the use of personnel and service delivery systems: • The use of school-based and school-focused Wraparound services to support learning and transition. • The use of school-based case management. • The use of clinicians or other student-support providers in the schools to work with students, their families, and all members of the school community, including teachers and administrators. • The provision of schoolwide prevention and early intervention programs • The creation of “centers” within the school to provide support to children and youth with emotional and behavioral needs and their families. • The use of family liaisons or advocates to strengthen the role and empowerment of family members in their children’s education
How do these school based mental health models integrate with promotion and prevention models? 3 tiered model of promotion and prevention such as PBS…. Examine what we do for ALL Examine what we do for SOME Examine what we do for a FEW
MODEL OF POSITIVE BEHAVIORAL SUPPORTS High-Risk Students Individual Interventions Intensive Level (FEW) 1-5% At-Risk Students Classroom/Small Group Strategies Targeted Level (SOME) 5-10% All Students School-wide Systems of Support Universal Level( ALL) 80-90%
What SW-PBS is… • Evidenced based practices imbedded in a systems change process • A prevention continuum • A framework for organizing mental health supports and services • Not only “school-wide” but in churches, and community
Critical Features of SW-PBS …. • Team driven process • Instruction of behaviors/social skills • Data-based decision-making • Instruction linked to evaluation • Defines social culture of the school
Academic Systems Behavioral Systems • Intensive, Individual Interventions • Individual Students • Assessment-based • High Intensity • Intensive, Individual Interventions • Individual Students • Assessment-based • Intense, durable procedures • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Targeted Interventions • Some students (at-risk) • High efficiency • Rapid response • Individual or Group • Universal Interventions • All students • Preventive, proactive • Universal Interventions • All settings, all students • Preventive, proactive Designing School-Wide Systems for Student Success 1-5% 1-5% 5-10% 5-10% 80-90% 80-90%
Academic Systems Behavioral Systems • Intensive, Individual Interventions • Individual Students • Assessment-based • High Intensity • Intensive, Individual Interventions • Individual Students • Assessment-based • Intense, durable procedures • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Targeted Interventions • Some students (at-risk) • High efficiency • Rapid response • Individual or Group • Universal Interventions • All students • Preventive, proactive • Universal Interventions • All settings, all students • Preventive, proactive Designing School-Wide Systems for Student Success 1-5% 1-5% 5-10% 5-10% 80-90% 80-90% Is there a value and Commitment to do what is Needed to have child in school Values and commitment to What is necessary to teach Child to read……
Current Implementation School-wide Positive Behavior Support 7,009 schools in 44 states: 152 PreK; 4231 K-6; 1564 6-9; 739 9-12; 324 Alt and JJ settings • Team • Coach • Curriculum emphasizing prevention, teaching, behavioral function • On-going data collection and use of data for active decision-making
Instructional Approach • Focus on teaching social behavior like academic skills (direct instruction) • Emphasis on teaching & encouraging pro-social behavior that competes with development & displays of rule-violating behavior • Ensure effective instructional practices are consistently used school-wide
General Approach to School-wide Data • # referrals per day per month • # referrals by student • # referrals by location • #/kinds of problem behaviors • # problem behaviors by time of day
Stockton School Percent of Students Meeting or Exceeding Standards on ISAT Scores
Steuben School Total OSS Per Year
Steuben School Percent of Students Meeting or Exceeding Standards on ISAT Scores
What Does the Research on PBIS Tell Us? • Increases in instructional time lost to behavioral interferences • Increases in opportunities for academic engagement and academic achievement • Increases prosocial behavior • Enhances school climate for students and adults • Increases the willingness and ability of teachers to work with students with more complex behavior needs Adapted from Sugai and Horner, 2000
PBIS • Aligns schools with System of Care values and reform efforts such as RTI (Response to Intervention) • Changes the lens through which we view our students and their families - “Strengths and Needs” • Creates a school culture and climate where all staff take responsibility for supporting positive student behavior
PBIS also helps schools to • develop less-restrictive, but effective, interventions (IDEA) • achieve improved student outcomes, through partnerships with community-based service providers such as mental health • engage families in powerful partnerships • gain time for instruction, improve student learning • fulfill legal mandates for disabled students
What does SOC and Education look like in communities? Answer is: different…as each community. However, over the last decade, “levels of SOC acculturation have begun to emerge”
Five levels of involvement for schools with mental health: 1.the individual child and family; 2.small group support; 3. school wide support; 4.district wide support; 5. county or state initiatives The first level begins with the individual child and family. Through case management and the family service coordinator, school representatives have been included in team planning and follow-up through the wraparound process. There is usually one staff member from the school where the child attends that becomes part of the process and team.
Level 2 and 3 • Level 2 addresses the needs of a group of children or youth, such as group therapy provided at the school, after school programs, parent support groups or mentoring. • Level 3 occurs through school wide programs that support all children, such as school wide positive behavioral supports and interventions, social skill classroom instruction, mental health provider assigned to the pre-referral team at the school or behavioral support centers.
Level 4 • The fourth level provides district level support through comprehensive programming with support for referral, assessment, various programs options, both in school and in the community, family supports and consistent case management and follow-up.
Level 5 involves county or state initiatives that maintain comprehensive training and technical assistance structures, referral and assessment centers and ongoing policy and funding initiatives. • Throughout all these levels, a strategic plan for the system of care development includes an analysis of the overlap or integration with the strategic plan of the school district as well as the county or state initiatives as well.
Building a System that Cares: The PARK Project, Bridgeport, CT Slides provided by the Park Project
How did PARK build a school-based system of care? • Educate them on who we are and what we do • Align our vision and mission with theirs • Build synergy • Show results
Who We Are: The PARK Project • Vision: Bridgeport children will live in a safe, caring community that nourishes the development of positive mental health. • Mission: To build a system of care in partnership with home, school and community so that children with behavioral and mental health challenges can achieve success.
Who We Are: System of Care is Not… • SOC is not a school reform initiative • SOC is not a way to remove unwanted students • SOC is not a means of isolating children with mental health issues
Build Synergy: How Do “Outsiders” Build Synergy With Schools? • Be a resource to them • What are there needs? • How can you help them? • Give Unconditional respect (cultural competence) • Listen before you advise • Acknowledge their expertise in educating children • Focus on their successes rather than their failures