Integrating School Mental Health and PBIS: Selecting Evidence-based Practices

1. Integrating School Mental Health and PBIS:Selecting Evidence-based Practices Jill Johnson Illinois PBIS Network Sharon Stephan, Ph.D. University of Maryland School of Medicine PBIS Annual Meeting October 10th, 2013

2. Objectives 1. Describe at least two strategies for integrating PBIS and school mental health. 2. Name at least one evidence-based mental health practice at each level of the public health triangle. 3. Describe the difference between evidence-based manualized and modularized mental health interventions.

3. Center for School Mental Health MISSION To strengthen the policies and programs in school mental health to improve learning and promote success for America’s youth • Established in 1995. Federal funding from the Health Resources and services Administration. • Focus on advancing school mental health policy, research, practice, and training. • Shared family-schools-community agenda. • Co-Directors: Sharon Stephan, Ph.D. & Nancy Lever, Ph.D. http://csmh.umaryland.edu, (410) 706-0980

4. Our Team

5. SCHOOL MENTAL HEALTH – A DEFINITION

6. A partnership between schools and community health organizations… Guided by youth and families.

7. Builds on existing school programs, services, and strategies.

8. Focuses on all students… …in both general and special education

9. Includes a full array of programs, services, and strategies

10. 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)

11. Who provides mental health services in schools?

12. Research Supported Interventions Involve…. • Strong training • Fidelity monitoring • Ongoing technical assistance and coaching • Administrative support • Incentives • Intangibles

13. Practice in the Trenches? • Involves NONE of these supports

14. What’s happening on the “front lines”?

15. “Some Good Stuff” • Increasing emphasis on: • Evidence-based (research-supported) Practice (EBP) • Outcomes • Consideration of cultural context in development, implementation and evaluation of EBP • Recognition of the importance of meaningfully partnering with families • Increased emphasis on workforce development of mental health providers and educators

16. Limited control/accountability of providers and services provided Gaps in training, particularly related to schools and evidence-based practice “C.O.W. Therapy” – Crisis of the Week “Some Not-So-Good Stuff”

17. Challenges selecting evidence-based MH practices • School/clinician has not: • assessed specific needs of school/students • identified target outcomes • defined “success” (of interventions) • identified a way to measure intervention fidelity • MH interventions are often not designed for complex issues

18. Activity Think of a current intervention that your district/school/organization uses to address student needs. Answer the following questions regarding said intervention: • Selection of the intervention allows for clear and measureable outcomes YES NO • The intervention provides for generalization YES NO • The implementation of the EBP allows for the assessment of implementation fidelity YES NO

19. Consumer Guide to Selecting Evidenced Based Mental Health ServicesMain Components • Assessment • Interventions Selection • Intervention Progress Monitoring

20. Assessment

21. Intervention Selection

22. Intervention Progress Monitoring

23. Potential Uses of the Tool • To determine needs of a school/agency/community • To determine what EBP may be most effective to address needs • To guide the implementation of an EBP • To reflect on current EBP • Celebrate that components are in place • Action plan on how to include necessary components

24. Who Can Utilize the Tool • Building or District-level teams • Community-level teams • Joint building or district-community teams • Practitioners

25. Illinois ExampleReflecting on Current Evidence-based Practices • District Leadership Team had a concern that interventions utilized by staff were not culturally relevant nor appropriate to address needs • Wanted a non-confrontation way for social workers to reflect on their practices, lack there-of • Tool was used at a School Social Work meeting within the district

26. School Social Work Meeting ResultsMean = 6

29. District Leader Thoughts • Partnership between school and community providers is lacking • Implementation fidelity not addressed • Progress monitoring interventions not done systematically • Self-assessment by social workers may not be accurate • Budget issues • Defensive • Example: They scored themselves 100% on culturally relevant interventions: however, students on intervention were all African-American and at-risk for change of placement

30. District Action Steps • Work towards school-community partnership on Strategic Plan/District Leadership Team • Short-term goal: Quarterly, one community partner invited to school social work meeting • Long-term goal: add community partners back on DLT • Long-term goal: each building collaborate with one community partner; add to tiered team • Add implementation fidelity and evaluation tools to practice • Short term goal: Strickland tools • Offer professional development/support for social workers • Short-term goal: Use Consumer Guide, BAT, ISSET to drive school social work meetings monthly

31. Current trends and Future Directionsin SMH

32. Four Themes in Quality Services Systematic Quality Assessment and Improvement Family Engagement and Empowerment Modular, Evidence-Based Skill Training Implementation Support

33. Quality Assessment and Improvement (QAI) Principles Full continuum from promotion to treatment Committed and energetic staff Developmental and cultural competence Coordinated in the school and connected in the community Emphasize access Tailor to local needs and strengths Emphasize quality and empirical support Active involvement of diverse stakeholders

34. Examples of QAI tools • School Mental Health Quality Assessment Questionnaire (SMH-QAQ) • https://csmh.umaryland.edu • Mental Health Planning and Assessment Template (MHPET) • www.nasbhc.org

35. Effectively Partnering with Families Early focus on engagement, e.g., through candid discussions about past experiences Emphasize empowerment and the potential for improvement Provide pragmatic support Emphasize mutual collaboration See McKay, Hoagwood

36. Results of using these elements

37. Focus on Evidence-Based Practice – “Manualized” and “Modularized” Intervention/Indicated: Cognitive Behavioral Intervention for Trauma in Schools, Coping Cat, Trauma Focused CBT, Interpersonal Therapy for Adolescents (IPT-A) Prevention/Selected: Coping Power, FRIENDS for Youth/Teens, The Incredible Years, Second Step, SEFEL and DECA Strategies and Tools, Strengthening Families Coping Resources Workshops Promotion/Universal: Good Behavior Game, PATHS to PAX, Positive Behavior Interventions and Support, Social and Emotional Foundations of Early Learning (SEFEL), Olweus Bullying Prevention, Toward No Tobacco Use

38. Modularized Interventions – aka “Common Elements” approaches Chorpita, B.F., & Daleiden, E.L. (2007). 2007 Biennial Report: Effective Psychosocial Intervention for Youth with Behavioral and Emotional Needs. Child and Mental Health Division, Hawaii Department of Health (Reviews most important treatment foci for Anxiety, Attention Problems, Autism, Depression, Disruptive Behavior Disorders, Substance Use, and Traumatic Stress)

39. Origins of the “Common Elements” Approach 39

40. Forget it! No one really does this anyway! How will I ever master all these treatment manuals ???

41. Illustration of Common Elements terminology Treatment Family Treatment Protocols Practice Elements From Chorpita & Marder, 2009. UCLA Common Elements Summer Social Work Workshop

42. PracticeWise Resources • www.practicewise.com • Subscription-based resources: • PracticeWise Evidence-Based Services Database (PWEBS) • PracticeWise Practitioner Guides • PracticeWise Clinical Dashboards • Modular Approach to Therapy for Children (MATCH)

46. Example of printable PDF describing practice element: Audience Goals of this practice element Steps for using this practice element

47. Clinical Dashboards • Microsoft Excel based monitoring tool • Tracks achievement of treatment goals or other progress measures on a weekly/session basis • Documents which practice elements were used when • Dashboard can be customized: • Display up to 5 progress measures; • Write-in additional practice elements • Potential uses: • Documenting session activities • Tracking client progress • Clinical supervision

48. Progress Measures Document which practice element was used when

49. Implementation Support Focus on “indigenous” school resources Moving beyond “Train and Hope” Focus on: Interactive and lively teaching Off and on-site coaching, performance assessment and feedback, emotional and administrative support Peer to peer support User friendliness see Dean Fixsen, Karen Blasé, National Implementation Research Network (NIRN)

50. SCHOOL MENTAL HEALTH RESOURCES…