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RTI Means Behavior Too

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RTI Means Behavior Too Powered By Docstoc
					      Building Bridges for Students
      with Behavioral Health Needs


Colorado Connections for Healthy
            Schools
       February 8 ,2011

  Barb Bieber, Colorado Department of Education
  Denise McHugh, Center for Systems Integration
 Amy Engelman, Colorado Department of Education
Laying the Foundation for
        the Bridge
    The Need
                               Nationally

• 1 in 5 Children have a diagnosable mental illness,
  including substance abuse. (Surgeon General’s
  report, 1999)
• 5% have an extreme functional impairment
• 75% of youth (ages 6-17) did not receive services*
• For the majority, the only mental health services they
  receive is in the schools**
* Katoaka,S et.al., American Journal of Psychiatry, 2002
** Burns, G. et. al., Health Affairs, 1995
                                        In Colorado

• 49,364 children with SED (& 3005 of poverty level)
• 30,839 received services through the mental health
  system.
• 18,525 (38%) children with SED did not receive any
  services to address their mental health needs*
• Too few children in Colorado have health insurance,
  causing Colorado to be ranked 44th nationwide.**
*Population in Need of Mental Health Services, 2009
** 2010 Kids Count in Colorado, Colorado Children’s Campaign
            Students with SIED Have
             Poorest Outcomes

•   Lowest grade point averages
•   Poorest attendance
•   Highest level of drop-out
•   Difficulty holding jobs after school
•   Youth Corrections – 59% of average daily
    population had moderate to severe mental
    health needs.
                     Impact of Untreated Problems:
                      Schools and Behavioral Health

• 2,381 students expelled*
• 71,826 suspensions
• 2,284 students placed in day treatment,
  hospital, or residential programs because
  school districts could not meet their special
  needs in 2008

* for drug and alcohol violations, assaults & weapons & disruptive behavior in 2006-
   2007
           Impact of Untreated Problems:
             Youth Risk Behavior Survey

• 25.4% of Colorado adolescents report
  depression**
• 7.6 % of adolescents report attempting
  suicide**
• 30.6% of adolescents report binge drinking
  causing Colorado to be ranked 41st in the
  country**
** The Colorado Health Foundation – Youth Risk Behavior
  Survey, 2009
                          Mental Health Intervention Is
                            Important from a Student
                                   Perspective

• Research* evidence that promoting social and
  emotional skills plays a critical role in improving
  academic performance:
• 10 % points higher on achievement tests
• Better attendance
• More constructive behavior, less disruptive
• Like school more
• Better grade point averages
“No Emotion Left Behind,” NYT, 2007
          MH Intervention is Important
         from the Teacher’s Perspective

• 1/3 of teachers leave profession within the
  first 4 years due to students with behavior
  problems
• In a poll of AFT teachers, 17 % said they lost 4
  + hours of teacher time per week due to
  disruptive student behavior
• 19% more said they lost 2 to 3 hours
           Bridges that Work in Colorado

• Response to Intervention
• School-wide Positive Behavior Supports
• Building Bridges Grant
           Applying RtI/PBIS

• RtI/PBIS is a comprehensive framework that
  addresses prevention & early intervention
• School systems tend to under-identify
  students with S/E/B problems
• Identification is often delayed until middle
  school or HS
         RtI/PBIS Means Behavior Too

Systemic reform that includes:
• Well-defined, multi-tiered system of supports
• Universal screening for behavior
• Problem Solving Process
• High quality, evidence-based practices
• Progress Monitoring/ assessment
• Family involvement
                                     Behavior and Academics
                                           Are Linked

                             Improvements in student behavior and school
                               climate are related to improvements in
                               academic outcomes.

                                    Fleming et al., 2005; Kellam et al., 1998; McIntosh et al., 2006;
                                    Nelson et al., 2006; Nelson et al., 1996; Wentzel, 1993




Talking points on School-wide Positive Behavior Support & school-based mental health (2006). National Center on
               Positive Behavioral Interventions and Supports, Center on Behavioral Education and Research, University
               of Connecticut, Positive Behavioral Interventions and Support Website:
              http://www.pbis.org/files/gstalkingpoints0107.doc
            PBIS Initiative began in 2002

• Schools face a set of difficult challenges today
       • Multiple expectations (Academic accomplishment,
         Social competence, Safety)
       • Students arrive at school with a wide range of
         academic and behavioral needs.
       • Traditional “get tough” and “zero tolerance”
         approaches are insufficient to address these needs.
• Individual student interventions
       • Effective, but inefficient
• School-wide support systems
       • Establish a positive culture within which both social
         and academic success is more likely
We Are…
Safe
Respectful
Responsible
                                                  Average Suspensions
                                               One Year After PBS Implementation
                              50
                              45
                                                                                     PBS In-School
Average Number (per school)




                              40                                                     Suspensions

                              35
                                                                                     PBS Out-of-School
                              30                                                     Suspensions

                              25
                              20                                                     Colorado In-School
                                                                                     Suspensions
                              15
                              10                                                     Colorado Out-of-
                                                                                     School Suspensions
                              5
                              0
                                   2004-2005       2005-2006             2006-2007

                                                 School Year
      Middle School
Office Discipline Referrals
      Per Day Per 100 Students
Impact of PBIS
             Screening at the
             Universal Level
• A system for screening for S-E & behavioral
  concerns
• Examples of screening information:
  attendance, tardy patterns, discipline
  referrals, health history, suspension incidents
Significant decline in academic grades
Use ESW standards as guidelines
               Universal Mental
              Health Interventions
• Defining and teaching behavioral expectations
• A positive acknowledgement system for
  behaviors
• Social – Emotional Learning, e.g., a universal
  curriculum, such as Life Skills Training for
  substance abuse prevention
• Families are engaged
       Targeted Mental Health
            Interventions
• Standard protocol interventions = small group,
  supplemental supports
• Evidence-based & implemented with fidelity
  Integrity
  Sufficiency
• Strategies to support & encourage academic
  engagement can be a powerful behavioral
  intervention
          Examples of Targeted
        Mental Health Interventions

• Self-monitoring
• Social skills development
• Check-in Check-out Program
• Re-teaching expectations
• Targeted social-emotional curriculum, such as
  Second Steps & Anger Replacement Therapy
• Families included in collaborative problem-
  solving
                 Intensive Interventions


•   A Functional Behavioral Assessment (FBA)
    is used to guide the development of an
    individual Behavior Intervention Plan (BIP)
•   Interventions are usually needed for both
    academics and behavior
•   Includes community collaboration and/or
    wraparound services
•   Families provide support at home.
          Critical Importance
           of Relationships
• Positive school climate and student
  connectedness to school are largely based on
  relationships
• Connectedness is associated with:
   1. School attendance,
   2. Academic performance
   3. Reduced involvement in risk behavior
   4. Reduced drop outs
              PBS Model and Behavioral
                   Health Services
Greater the need – greater
  the need for collaboration
  with:
• Families
• Mental Health/Substance
  Abuse
• Human Services
• Healthcare
• Law Enforcement
• Judicial System
      Institute of Medicine Report

Preventing Mental, Emotional and Behavioral
 Disorders Among Young People: Progress and
                Possibilities

               March, 2009
          Prevention is a Priority

• ½ of all mental illnesses occur by age 14; ¾
  occur before age 24
• Need to refocus the mental health system on
  prevention activities
• Includes training teachers, health and child
  care providers to support the emotional and
  behavioral health of young people.
           Report Reinforces the
               Need for:
• The Public Health Approach used by PBIS
• Integrated strategies
• Using schools as the optimal setting for health
  promotion programs
• A shared agenda, with schools, families &
  community MH working together to build a
  continuum of interventions.
           Building a Bridge Together

Integrated Approach
                  System of Care:
                 Essential Elements

A system of care is a coordinated, integrated
  networking of community-based services and
  supports.
Systems are governed by core values, including:
 Child-centered & strengths based
 Family focused,
 Community-based
 Culturally competent
             System of Care Framework

                  Mental
                  Health        Family
                 Services      Support
     Juvenile
                               Services
     Justice                               DHS/
     Services                              Child
                                          Welfare
                                          Services
Recreation
 Services
                                           Education
                     CHILD &                Services
  Vocational         FAMILY
   Services                             Health
                                       Services
             Substance       Legal
               Abuse        Services
              Services
 Role of the State & Communities:
Building Bridges between Systems
                    Building Bridges:
             Integrated PBS/SOC Approach

• 18 month grant + 1 year extension to 10/14/10
• Build statewide infrastructure to:
   – Support the integration of Positive Behavior
     Interventions & Supports and the System of Care
     (SOC) approaches
   – Improve outcomes of students in Colorado.
• Mesa County is the Demonstration Site
• Schools across the county implementing this
  integrated approach report:
   – Increased collaboration with MH & other agencies
   – Improved outcomes for students
             Bazelon Center for Mental Health Law
          Collaboration with
         Community MH Centers
• 100% of Colorado’s 17 community mental
  health centers have school-based services
• Inconsistent & fragmented funding
• BB Grant: Promote school-based services and
  state policies for increased funding
                      System of Care :
                   Effective in Colorado
Colorado Cornerstone School Outcomes:
• GPA significantly improved within 6 mos. & then
  maintained through 36 mos.
• Significant decrease in In-School Detention from intake
  (42%) through 36-mos (22%).
• Significant decrease in suspensions from intake (48%)
  through 36-mos (22%).
• Expulsions fell from 8.3% to 1.8%.
• Parent satisfaction with child’s school significantly
  improved from intake through 36 mos.
Crossing the Bridge Together
       Building Bridges as a Change Agent


Better outcomes come from:
– Fostering collaborative partnerships with youth
  and families
– Interagency collaboration
– Individualized community-based care
          Seeing Youth & Parents as
                Collaborators
Collaboration involves:
• Shared responsibility
• Shared goals
• Working together

Through:
• Supportive relationships
• Realistic arrangements
• Responsible information exchange
• Flexible, shared approaches to gauging failure or success
               Role of State and
           Local Family Organizations

• Build and train a cadre of knowledgeable, competent
  and passionate youth & family-leaders across the
  state and local communities.

• Train youth and parents to support others who are
  accessing mental health and other services for their
  children.

• Promote policy and system change efforts to ensure
  positive outcomes for youth and their families.

                                                         41
Intensive – Tier 3
 Special efforts for a few youth &
families
Targeted – Tier 2
 Additional supports to boost
 some youth & families
Universal – Tier 1
 Opportunities afforded to
 all youth & families
              Universal Strategies : 1st Tier

•   Create a welcoming environment
•   Solicit youth & family input
•   Provide an orientation
•   Establish ongoing communication
•   Sponsor social activities
           Moving to Solutions

        National                        Building Bridges

                                • PBS & RTI means that families
What makes families feel          should be treated as equal
                                  partners.
       welcome?
                                • Both teachers and families
                                  benefit when youth & parents are
Families feel welcome when        knowledgeable.
    they are treated with
respect and they are viewed     • Youth & parents feel more
                                  comfortable working with
 as partners in helping their     teachers who help and respect
          children.               them.

                                                                  44
 Moving to Solutions cont’d
National         Building Bridges

           • Mesa creating a family
             resource guide for parents
             to navigate the systems.
           • Person centered planning
             will be implemented to help
             families and their children
             during transitions. i.e.
             middle to high school



                                       45
            Targeted Strategies : 2nd Tier


• Connect families with each other.
• Offer families education and training.
• Take advantage of meetings with youth and
  parents.
• Recruit youth and family members to serve on
  advisory groups.
           Moving to Solutions

        National                     Building Bridges
Parents feel welcome when      • Include parents in school in-
                                 services
their school provides          • Educated families feel supported
opportunities for them to        and better connected.
connect with other parents.    • Educated families better able to
                                 express the “Youth & Family
                                 Voice.”
One parent noted that it is    • Promote opportunities for equal
clear the school is reaching     youth/parent partnerships with
                                 schools.
out to parents “when it
                               • Mandate family collaboration in
throws you that rope”.           RTI and PBS.

                                                                47
             Moving to Solutions
          National                   Building Bridges

• Use school in-service        • NAMI -”Parents and Teachers As
                                 Allies” scheduled as an in-service
  training days to increase      for teachers
  mental health awareness         – Addresses stigma on mental
  and evidence-based                  health issues
  practices.                      – Parents not blamed for having
                                      a “bad kid”
• Have every school produce    • Social/Emotional norms adapted
                                 to help in with early intervention
  a brochure that gives
  families information about
  how to specifically access
  mental health services in
  their community
                                                                 48
             Intensive Strategies : 3rd Tier


• Tailor approaches to each family
• Repair relationships between youth, their
  family and the school.
• Hire Family Advocate/Liaison to work with
  families
                 MOVING TO SOLUTIONS

National                     Building Bridges
  Parents feel overwhelmed   • Implement PBIS across the
  and isolated by lack of      district at all levels so that
  information                  Mesa families and children
                               will have a more positive
.                              school experience
                             • Provide staff training to help
                               meet the needs of children
                               with behavioral health
                               issues
                             • Referral protocol between
                               schools with the community
                               mental health center

                                                           50
                        Resource

• Family Driven Care Are We There Yet?
   The road map for system transformation for family members,
   educators, and mental health professionals. May 2007
Albert J. Duchnowski, Ph.D.; Krista Kutash, Ph.D.

Department of Child and Family Studies
Luis de la Parte Florida Mental Health Institute
University of South Florida
http://cfs.fmhi.usf.edu
                                                            51
      Building Bridges for Children’s
            Behavioral Health

   Key Informant
Interview and Focus
   Group Results
    October 2008
                       Recommendations

• Increase training on behavioral health for teachers, principals,
  and other school staff
• Increase awareness of and competence at referring families
• Ensure strength-based strategies such as PBIS are fully
  implemented
• Address barriers to accessing services
• Address bullying and teasing of children and youth with special
  needs.
• Expand family involvement at both the individual case level and
  in the many collaborative efforts in Mesa County.
           Mesa School District’s
            Identified Goals:
• Create a school-wide prevention model that
  integrates services at the universal and targeted
  level.
   – Create mentally healthy classrooms (PBIS)
   – Train teachers on early warning signs
   – Utilize data collected through the RTI process to support
     appropriate mental health referrals
   – Use school mental health professionals to provide support
     though RTI framework
   – Involve families as essential partners
            Sustaining the Bridge

•   Policy
•   Tools
•   Training
•   Partners
•   Resources
             Policy: Social-Emotional
                     Standards
• Initially identified by Mesa SD & endorsed by
  Grant Leadership Team
• Ultimately included in CDE’s recently
  approved Comprehensive Health & PE Stds.
• Explicit standards for “Emotional and Social
  Wellness” and also social skills in “Prevention
  and Risk Management” & “Physical & Personal
  Wellness”
              S-E Competencies Can Be
            Successfully Taught in Schools*

• Improved Academics
  – Improved grades
  – Increased performance on achievement tests
  – Increased graduation rates
• Improved Behavior
  – Improved attendance
  – More commitment & attachment to school
  – Reduced suspensions, expulsions & grade retention

  *Weissberg & Obrien, 2004; Elias, 2006
       Mesa: Why Social Emotional Standards?



• Promote social emotional development of all
  students
• Help to identify those who lag behind &
  present an opportunity for early intervention
• Common language across agencies with
  families
          “Emotional & Social Wellness”
            Third Grade Expectations
• 1. Utilize skills to treat self & others with care
  & respect
• 2. Demonstrate interpersonal communication
  skills to support positive interactions with
  families, peers, and others
• 3. Demonstrate positive social behaviors
  during class
      “Scripts” for Conversations
            with Parents

• “Talking points” for teachers to call parents
  when students are behind in social-emotional
  development or present other behavioral
  challenges
• Aligned with RtI/PBIS
• Response from teachers is extremely positive
           Referral Protocols

• Create a streamlined way for schools to refer
  students and families for behavioral health
  services
• School point person makes referral
• Referral is tracked at CMHC
• Connection is made with the family
• Family permission encouraged to allow cross
  system support for student connecting home,
  school and counselor
              Referral Protocols

• Improved relationship between schools and
  CMHC
• Increased access for students and families to
  CMHC services
• Enhanced ability to work across systems to
  support student & family
  – Goal alignment between home, school, CMHC
  – Incentives & consequences
  – Open communication & real time data
                 Fact Sheets
              Parents & Teachers

• Provide tips for teachers and parents to support
  students in school
• Highlight specific mental health issues, e.g.,
  depression, anxiety, bipolar disorder, conduct
  disorder, OCD, etc.
• Include educational implications & proactive
  instructional strategies
• Available at
  www.cde.state.co.us/cdesped/BuildingBridges.asp
             Training for teachers
            & community partners

Training:
• Mental Health First Aid for families, school staff,
  resource officers, probation officers
• Parents and Teachers as Allies
Lessons Learned:
• Provide 20-30 minute segments for learning
• Identify training available in multiple venues
• Establish booster sessions to reinforce learning
          Mental Health Integration
            Grants in Colorado
• Aurora Community Mental Health Center &
  Cherry Creek School District
• Adams County School Districts along with
  District Attorneys Office
• Pueblo School District
              Steps to Build Bridges
               In your community:

• Raise awareness: use your PBIS data
• Consider focus groups with families and youth for input
• Connect mental health center work with schools / PBIS
• Train parents, school and community partners on
  mental health and substance abuse concerns and
  available resources
• Identify and link to community resources and providers
• Link PBIS with family organizations
                 Resources to
              Support Your Efforts

• Way To Go: School Success for Children with Mental Health
  Care Needs: www.Bazelon.org
• Colorado Department of Education: School-wide Positive
  Behavior Support homepage: www.cde.state.co.us/pbs
• Colorado Department of Education Response to Intervention
  Tools and Resources
  www.cde.state.co.us/RtIToolsResourcesRtI.htm
• The Federation of Families for Children’s Mental Health
  Colorado Chapter www.coloradofederation.org
• The Center for Systems Integration www.csi-policy.org
                Building Bridges
              Contact Information
Barb Bieber, Colorado Department of Education
   303.866.6933; bieber_b@cde.state.co.us.
Denise McHugh, Center for Systems Integration
   303.455.1740; Denise@csi-policy.org.
Margie Grimsley, Federation of Families for Children's Mental
   Health~Colorado Chapter, 303 455-5928,
   (m_grimsley@msn.com)
Kirsten Tyler: Building Bridges Family Representative, Federation
   of Families for Children’s Mental Health Mesa County
   Colorado, kirstentyler@yahoo.com

				
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