pennsylvania’s integration of mental health and positive behavior interventions and supports...
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Pennsylvania’s Integration of Mental Health and Positive Behavior Interventions and Supports (PBIS)
Ron Sudano, Ed.S. NCSP – PA Training and Technical Assistance NetworkKelly Perales, LCSW – Community Care Behavioral Health
A Community of Practice Approach using Social Entrepreneurism to Scale Social Impact
• Community of Practiceo Intentional integration of Mental Health and PBIS
• Social Entrepreneurismo SWPBS to initiate and expand Mental Health Supports
for ALL children and youth
• Innovationo Distributed Leadership & Contributiono Affiliated Networko Tertiary Demonstration Project
Big Ideas
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Communities of Practice:A Conceptual Framework
“Groups of people who share a concern, a set of problems or a passion about a topic, and who deepen their understanding and knowledge of this area by interacting on an ongoing basis.”
(Etienne Wenger, Richard McDermott, William Snyder, A Guide to Managing Knowledge,
Cultivating Communities of Practice, 2002, p. 4)
What is a Community of Practice?
• Based on relationships and natural bonds• Supportive and convening functions enable a collective
intelligence• Share learning at all levels to escalate progress• Create new knowledge grounded in ‘doing’ the work• Reflect a “pull” versus a “push”
Sponsors of the National Community of Practice on School Behavioral Health are the IDEA Partnership funded by OSEP and housed at NASDSE and the Center for School Mental Health funded by HRSA and housed at the University of Maryland.
www.ideapartnership.org
www.sharedwork.org
Communities of Practice:A Variety of Activities
• Problem-solving• Requests for
Information• Seeking
Experience• Reusing Assets• Mapping
Knowledge
• Coordination and Synergy
• Discussing Developments
• Documentation Projects
• Visits• Identifying Gaps
PA State Leadership Team
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• Allegheny County Department of Human Services
• Bureau of Autism Services• Community Care Behavioral Health• Devereux Center for Effective Schools• Disability Rights Network of Pennsylvania• Education Law Center• Juvenile Court Judge’s Commission• Mental Health Association of Pennsylvania• Office of Child Development and Early
Learning• Pennsylvania Community Care Providers• Pennsylvania Department of Education
o Bureau of Special Educationo Division of Student Services and Safe
Schools• Pennsylvania Department of Health
oBureau of Drug and Alcohol Programs
• Pennsylvania Department of Labor and Industry
oOffice of Vocational Rehabilitation• Pennsylvania Department of Public Welfare
oOffice of Mental Health and Substance Abuse Services
• Pennsylvania Governor’s Commission on Children and Families
• Pennsylvania Intermediate Unit (PAIU) Special Education Directors
• Pennsylvania Network for Student Assistance Services
• Pennsylvania Training and Technical Assistance Network (PaTTAN)
• Pennsylvania Youth Leadership Network• Philadelphia Public Citizens for Children and
Youth• Value Behavioral Health• Youth and Family Training Institute
The state leadership team was founded in 2006 and the following departments, agencies and stakeholder groups represent a partial list.
Scaling SWPBSPennsylvania’s Approach
Promoting the entrepreneurial pursuit of social impact
(Adapted from - John Kalafatas: Approaches to Scaling Social Impact)
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The mission of the Pennsylvania Positive Behavior Support Network (PAPBS Network), through training and technical assistance, is to support schools and their family and community partners to create and sustain comprehensive, school-based behavioral health support systems in order to promote the academic, social and emotional well-being of all Pennsylvania’s students. The network’s goal is to ensure that all schools have the necessary technical assistance, collaborative opportunities, and evaluative tools needed to overcome non-academic barriers to learning and achieve competence and confidence in advancing academic, social, and emotional success for all students.
Mission Statement
Scaling Social Impact: The process of increasing positive social impact to better correspond to the magnitude of the identified social need.
John Kalafatas: Approaches to Scaling Social Impact.
http://www.caseatduke.org/knowledge/scalingsocialimpact/frameworks.html
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Definition: What is Scaling Social Impact?
• Increase Quantity and/or Quality of Impact
• Diversify Communities Served
• Diversify Services Offered
• Expand Geographically
• Influence Public
Policy• Establish a Social
Movement
• Change/Create
Markets
Impact through Direct Service Impact through Indirect Influence
• Promote a
Model
MH & SWPBS
Integration
GOALS for
Scaling MH &
SWPBS
STRATEGIES for
Scaling MH & SWPBS
• Organizational Branching and/or Affiliation
• Expanding Organization’s Delivery Capacities (via volunteers, technology, etc.)
• Research & Public Policy Development
• Influencing Public Awareness, Norms or Behaviors
• Direct Advocacy & Lobbying
• Convening Networks
• Technical
Assistance• Knowledge Dissemination
• Partnerships/
Alliances
• Packaging/
LicensingAdapted from: John Kalafatas: Approaches to Scaling Social Impact.
http://www.caseatduke.org/knowledge/scalingsocialimpact/frameworks.html 10
Pennsylvania’s Strategy
Situational Organization Contingencies Capabilities
Labor needs
Start-up Capital
Public Support
Potential Allies
Supportive Public Policy
Staffing
Dispersion of Beneficiaries
Strength of Economic Incentives
Communicating
Alliance-Building
Lobbying
Stimulating Market Forces
Earnings Generation
Replication
PA SCALERS
Scale of
SocialImpact
+ High valence- Low valence
+
-
+
+
-
-
+
Adapted with permission: Bloom, P. N. & Chatterji, A. K. (In press, 2008). Scaling Social Entrepreneurial Impact. Fuqua School of Business, Center for the Advancement of Social Entrepreneurship: Duke University. Retrieved January 18, 2008 from http://www.fuqua.duke.edu/centers/case/knowledge/scalingsocialimpact/articlespapers.html
• Broad representation on State Leadership Team
• Develop evaluation plan from beginning based on interests of stakeholders
• Commitments from central office and building-level administrators
• Ideal: secure commitment from mental health agency to participate at all 3 tiers of support
• Establish leadership infrastructure to roll-out
• Plan for scaling-up
Lessons Learned
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Tertiary DemonstrationProject
Integrating PBIS and Mental Health Services
School Based Behavioral Health (SBBH ) Teams
What is Community Care?
• Non-profit behavioral health managed care organization (BHMCO)
• Public health mission• Transformation of mental health services to
children and families• Affiliated partner in PA PBS Network – have co-
director and coordinator• Partnering with school districts for integration of
services, along with other child serving systems
Goals of SBBH Team Program
• To provide services that are more flexible than traditional services in meeting unique behavioral needs of youth and families
• To provide a behavioral health home for youth and families through availability of care in school, home and community settings as needed
• To improve communication among youth, family, educators, clinicians and other child serving systems
Goals of SBBH Team Program
• To maximize integration of behavioral health services, school intervention programs and family and community resources
• To improve access to service for youth returning to district schools from partial hospitalization, inpatient care, RTF or out of home placement
• To support school staff with training and case specific consultation
How is SBBH different?
• Quicker access to assessment and service
• No requirement for a specific prescription of SBBH hours
• Greater flexibility in types of interventions and intensity of service delivered
• Any team staff can intervene with a youth
How is SBBH different?
• Focus on resiliency concepts, understanding of trauma informed care and structural family therapy
• Increased qualifications for staff - licensure, experience and ongoing training
How is SBBH different?
• Enhanced integration with school interventions via positive behavioral supports
• 24/7 availability for phone crisis response
• Evaluation component is included
Behavioral Health Home Concept
• Increased accountability via clinical home • School is “launching pad” for services that can
be delivered in all settings• Comprehensive service approach• Youth continue on the team with varying
intensity of service
Who Can Receive SBBH Team Services?
• Youth, 5-18 years, and their families• Have a serious emotional or behavioral
disturbance (internalizing or externalizing) • Receive Medical Assistance • Community Care member• School related problems not required• IEP not required• ASD diagnosis on case by case basis
Where and when is service delivered?
• School is the physical location of team
• Services may extend into home and community settings on evenings, weekends and during summers
• 24/7 availability for crisis intervention
SBBH Service Components
• Clinical interventions
• Case management
• Crisis intervention
• Case consultation & training for teachers
Team Composition
• Mental Health Professionals
• Behavioral Health Workers
• Consultant
• Clinical director
SBBH Evaluation Plan
• Assessment of impact of SBBH Team on: Academic performance – grades, attendance,
behavior Child functioning at home/community and
school Family satisfaction Service utilization and cost
SBBH Evaluation Plan
• Child Outcomes Survey (COS) Completed by families monthly and at discharge Measures child functioning and family
perception of treatment process• Strengths and Difficulties Questionnaire (SDQ)
1 page questionnaire with 25 items related to emotional symptoms, conduct, peer problems and prosocial behavior
Completed by families and teachers at admission, quarterly and at discharge
Tertiary Demonstration Project
• Three districts who would have a SBBH Team at the start of the 2009-10 school year were invited to participate
• Logic of having Tier 3 services and beginning Tier 1 in order to build three tiered system
• District/community leadership teams were established that included mental health partners at the table from the beginning
• Districts committed to implementing SWPBS at all three tiers across the district
Current Status
• 2 of 3 districts were trained in Tier 1 and “kicked off” at the start of the 2010-11 school year in those buildings that have SBBH Team
• Use blueprint to develop action plan for other buildings to begin process as well as assess needs for mental health across tiers
• Planning for training and implementation of Tier 2 during this school year in those buildings implementing Tier 1
• Full integration of mental health