Jill JohnsonIllinois PBIS Network

Sharon Stephan, Ph.D.University of Maryland School of Medicine

PBIS Annual MeetingOctober 10th, 2013

Integrating School Mental Health and PBIS:

Selecting Evidence-based Practices

Objectives1. 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.

Center for School Mental Health

MISSIONTo strengthen the policies and programs in school mental healthto 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

Our Team

SCHOOL MENTAL HEALTH – A DEFINITION

A partnership between schools and community health organizations…

Guided by youth and families.

Builds on existing school programs, services, and strategies.

Focuses on all students…

…in both general and special education

Includes a full array of programs, services, and strategies

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)

Who provides mental health services in schools?

Research Supported Interventions Involve….

• Strong training• Fidelity monitoring• Ongoing technical assistance and coaching• Administrative support• Incentives• Intangibles

Practice in the Trenches?

• Involves NONE of these supports

What’s happening on the “front lines”?

“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

“Some Not-So-Good Stuff”

• 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

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

ActivityThink 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

Consumer Guide to Selecting Evidenced Based Mental Health Services

Main Components

• Assessment• Interventions Selection• Intervention Progress Monitoring

Assessment

Intervention Selection

Intervention Progress Monitoring

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

Who Can Utilize the Tool

• Building or District-level teams• Community-level teams• Joint building or district-community teams• Practitioners

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

School Social Work Meeting ResultsMean = 6

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

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

CURRENT TRENDS AND FUTURE DIRECTIONSIN SMH

Four Themes in Quality Services

• Systematic Quality Assessment and Improvement

• Family Engagement and Empowerment

• Modular, Evidence-Based Skill Training

• Implementation Support

Quality Assessment and Improvement (QAI) Principles

• Emphasize access• Tailor to local needs

and strengths• Emphasize quality and

empirical support• Active involvement of

diverse stakeholders

• Full continuum from promotion to treatment

• Committed and energetic staff

• Developmental and cultural competence

• Coordinated in the school and connected in the community

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

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

Results of using these elements

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

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)

Origins of the “Common Elements” Approach

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How will I ever master all these

treatment manuals ???

Treatment Family

Treatment Protocols

Practice Elements

Illustration of Common Elements terminology

From Chorpita & Marder, 2009. UCLA Common Elements Summer Social Work Workshop

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)

Example of printable PDF describing practice element:

Audience

Goals of this practice element

Steps for

using this

practice element

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

Progress

Measures

Document which practice element was used when

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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)

SCHOOL MENTAL HEALTH RESOURCES…

National Community of Practice on School Behavioral Health

www.sharedwork.org • CSMH and IDEA Partnership

12 practice groups:– Connecting School Mental Health and Positive Behavior Supports– Connecting School Mental Health with Juvenile Justice and Dropout

Prevention– Education: An Essential Component of Systems of Care– Families in Partnership with Schools and Communities– Improving School Mental Health for Youth with Disabilities– Learning the Language: Promoting Effective Ways for interdisciplinary

Collaboration– Psychiatry and Schools– Quality and Evidence-Based Practice– School Mental Health and Culturally Diverse Youth– School Mental Health for Military Families– Social, Emotional, and Mental Health in Schools– Youth Involvement and Leadership

CSMH Annual Conference on Advancing School Mental Health

• 1996 Baltimore• 1997 New Orleans• 1998 Virginia Beach• 1999 Denver• 2000 Atlanta• 2002 Philadelphia• 2003 Portland, OR• 2004 Dallas*

* Launch of National Community of Practiceon School Behavioral Health

• 2005 Cleveland• 2006 Baltimore• 2007 Orlando• 2008 Phoenix• 2009 Minneapolis• 2010 Albuquerque• 2011 Charleston, SC• 2012 Salt Lake City, UT

Mark your calendars for Oct 3-5, 2013 in Crystal City-Arlington, Virginia

JOURNALS School Mental Health

• A Multidisciplinary Research and Practice Journal

• Editor-in-Chief: Steven W. Evans

• International efforts in SMH research, practice, policy and training

• Editor-in-Chief: Mark Weist• Deputy Editor: Sharon Stephan (Editor-

in-Chief, as of January 2014)

Advances in School Mental Health Promotion

Nicole Evangelista, Ph.D.nevangel@psych.umaryland.edu

Center for School Mental HealthUniversity of Maryland, BaltimoreSchool of MedicineDivision of Child and Adolescent Psychiatry737 W. Lombard St. 4th floorBaltimore, Maryland 21201(http://csmh.umaryland.eduEmail: csmh@psych.umaryland.edu Phone: (410) 706-0980

Sharon Stephan, Ph.D.sstephan@psych.umaryland.edu410-706-0941