COMPREHENSIVE BEHAVIORAL HEALTH SERVICES: USING DATA FOR - - PowerPoint PPT Presentation

Annual Conference of Advancing School Mental Health, Sept 19, 2014 Pittsburgh PA

COMPREHENSIVE BEHAVIORAL HEALTH SERVICES: USING DATA FOR IDENTIFICATION, PARTNERSHIP DEVELOPMENT, AND RESEARCH

ANDRIA AMADOR, CAGS, NCSP & MARY COHEN, PH.D., BOSTON PUBLIC SCHOOLS MELISSA PEARROW, PH.D. & VICTORIA SHEPPARD, M.S. UNIVERSITY OF MASSACHUSETTS BOSTON

¡ Background of project and introduce how needs were identified and addressed through a Comprehensive Behavioral Health Model (CBHM) ¡ Using data to secure support from internal and external stakeholders ¡ Using data to systematically identify needs ¡ Using data for research and partnership development

CONFERENCE OBJECTIVES

— Preschool children with social emotional needs,

expulsion rate 3x higher than children in k-12

— Children with mental health issues:

— Miss up to 22 days in an academic year — Suspension/expulsion rate 3 times higher than those without mental health

needs

— Up to 14 % receive mostly Ds and Fs for grades (in comparison to 7% for all

children with disabilities)

— Mental health disorders contributes to over 10% of high

school dropouts

— Students with behavioral health issues à less school

success

— (Sources: Blackorby et al., 2003; Blackorby, & Cameto, 2004;Breslau et al., 2008; Doll, 1996;

Gilliam, W.S, 2005; Hanchon & Allen, 2013; Wagner et al, 2005)

IMPACT OF MH ISSUES ON ACADEMIC SUCCESS

Andria Amador, CAGS Director of Behavioral Health Services

USING DATA TO SECURE SUPPORT

¡ City with diverse neighborhoods and communities

§ Three school zones § Ten distinct neighborhoods § More than 100 languages spoken by families

¡ More than 120 schools

§ 84 elementary § 18 middle/ junior high school § 34 secondary - 3 exams schools and 1 performing arts schools

¡ Staffing

§ Over 8000 professional staff § 54 School Psychologists, 6 Pupil Adjustment Counselor (SW) & 3 Behavior Specialists

BOSTON PUBLIC SCHOOLS

STUDENTS IN BPS

LOCAL NEED

¡ Local need

§ 1 in 5 children in Boston have experienced at least 1 adverse childhood experience § Marathon Bombing § 60 critical incidents each year

¡ National and State Initiatives (policy, legislation)

§ Safe and Supportive School Legislation § Department of Justice Forum City

¡ Role change of School Psychologist: Change agents

§ CBHM from the ground up § NASP Practice Model

¡ A 2012 report identified the need for mental health services rated as a high priority in the majority of Boston Public Schools ¡ 94% of all respondents reported that on-site mental health support was needed at their school ¡ 66% of schools reported that providing mental health services was a high or highest priority

• f need for their school

Schools at the Hub, Weiss & Siddall, 2012

NEEDS OF STUDENTS AND SCHOOLS

¡ Impetus to create and design this model

§ Expand the role of school psychologists for all domains of practice (NASP Practice Model) § Expanded partnership with Boston Children’s Hospital § Address the needs of the students in Boston § Address inequities in access to services § Respond to state and national initiatives

COMPREHENSIVE BEHAVIORAL HEALTH MODEL (CBHM)

¡ Support from internal stakeholders

§ Administrators § School psychologists § Teachers

¡ Support from external stakeholders

§ Parents § Hospitals § Community mental health agencies § Local officials § University partners

USING DATA TO GARNER SUPPORT

¡ What behavioral health issues have the greatest impact on the students in your school?

KEY STAKEHOLDER INTERVIEWS (N=76)

Issue

Ag Agreement

Social skills/self-regulation 75% Family stress 50% Trauma 47% Bullying 21% Depression 17% Acculturation 14%

¡ Benefits of buy-in articulated to administrators through shared agreements ¡ Principal buy-in: breakfasts, contracts, scheduling… ¡ “Creative resourcing of staff” ¡ Parents and families ¡ Support and capacity building of school psychologists

§ Professional Learning Communities (PLC) § Purchasing new curriculum and training § Efforts to balance proactive and preventive strategies with their responsibilities regarding special education mandates

INTERNAL SUPPORT

¡ Historically, partnerships lacked consistent representation and oversight by district ¡ Inequities in partnerships with schools

§ More than 120 schools in BPS, and only 90 have partnerships with community mental health agencies § Composition of services varies by school and by agency § Vast inequities in services across the district

¡ Need for consistency in identification and treatment

• utcomes

§ No systematic monitoring of progress by agencies § No monitoring of outcomes by district

COMMUNITY PARTNERSHIPS

¡ University Partnerships § Aligned university field work with CBHM needs and supports § Increased number of students § Increased number of hours of service provided by students ¡ Community Partnerships § Formed Partnership with Boston Children’s Hospital § Aligned work with Defending Childhood Initiative § Work closely with other city agencies § Received federal and state grants

OUTCOMES

¡ Mental Health Partners: § District-level staff involvement with the School-Based Mental Health Collaborative § Mandatory training for all mental health providers (over 250) § Created guidelines to clarify roles and expectations of the partnership § Standards of Practice, based on best practices § Memorandum of Agreement (MOA) to create greater equity in access to services for all students

OUTCOMES

Mary Cohen, PhD School Psychologist Extraordinair e

USING DATA TO IDENTIFY NEEDS THROUGH UNIVERSAL SCREENING

UNIVERSAL SCREENING DEFINED

“Universal screening is the systematic

assessment of all children within a given class, grade, school building, or school district, on academic and/or social-emotional indicators that the school personnel and community have agreed are important” (Ikeda, Neessen, & Witt, 2009)

UNIVERSAL SCREENING RATIONALE

¡ Universal screening to identify students at-risk of developing behavior problems offers several advantages:

§ Cost-efficient (less expensive than special education evaluations) § Proactive (identify students who can benefit from extra supports) § Reach students who typically “fly under the radar” (shy, withdrawn students can also experience poor outcomes: academic failure, social ostracism, heightened risk of suicide) § Objective (help address disproportionality issues)

¡ 20% of students in BPS receive Special Education services ¡ Massachusetts has the 2nd highest rate of identification of special needs (12%) in the United States

SPECIAL EDUCATION

SPECIAL EDUCATION CATEGORIES

¡ President’s Commission on Excellence in Special Education (2001) and No Child Left Behind (2001) recommend acade academic ic AND be beha havioral ioral screening ¡ Greater likelihood of alt altering ring ne negat ativ ive lif life tr trajec ectory y associated with early intervention (Patterson, Reid, & Dishion, 1992) ¡ Massachusetts Safe & Supportive Schools le legis islat lation ion requires that schools address the mental health needs of students (passed this summer)

UNIVERSAL SCREENING RATIONALE

Comprehensive Behavioral Health Model Universal Screening Coaching & Consulting Tiered Levels of Intervention Data Collection & Progress Monitoring Collaboration with Mental Health Partners Professional Development Teams Social- Emotional Learning Curriculum CO COMPO MPONE NENT NTS O S OF THE F THE CO COMPR MPREHE HENSI NSIVE BE BEHA HAVIORAL AL HE HEAL ALTH TH MODEL ( MODEL (CB CBHM) HM) – – S SCHOOL LEVEL CHOOL LEVEL

¡ To select universal screening tool (Spring 2012)

§ Six demographically-diverse schools § Samples and examined multiple tools and rated using criteria § Screening team comprised of district administration, school psychologists and interns, and two consultants

¡ Schools selected for Cohort 1 (2012-2013)

§ 10 schools chosen to participate § Represent elementary, middle, and high school § Mental health partnership

PILOT PROJECT

¡ BIMAS

SELECTION OF BIMAS

¡ BIMAS: empirically-based; sensitive to change (excellent for RtI) ¡ Standard and Flex ¡ Big Norm Samples and Good Psychometric Properties ¡ Powerful Web-based Interface ¡ Easy paper and online administration and scoring options ¡ Wide Selection of Informative Web-based Reports

SUMMARY OF BIMAS

TRAIN THE TEACHERS BIMAS I - Introduction and Administration BIMAS II - Interpretation and Data-Based Decision Making BIMAS III - Group Formation and Progress Monitoring

1.

• 1. Sc

Screen eening- g- as a brief screening device to detect students in need of further assessment and to identify their respective areas of strengths and needs 2.

• 2. St

Student Progress Monitoring- To provide feedback about the progress of individual students or clients 3.

• 3. Pr

Progr

• gram E

m Evaluati tion

• n -
• To gather evidence that

intervention services are effective.

HOW THE BIMAS IS USED

BIMAS FORMAT

¡ A multi-informant assessment system § Parent § Teacher § Self (12 -18 yrs old) § Clinician

BIMAS SCALES

Beha Behavi vioral Co Concer ern Sc Scales: es: ¡ Con Conduct ct— anger management problems, bullying behaviors, substance abuse, deviance ¡ Ne Negativ gative Af Affect ct — anxiety, depression ¡ Cogn Cogniti tive/A e/Att tten enti tion

• n — attention, focus, memory,

planning, organization Ad Adaptive Scales: ¡ So Social — social functioning, friendship maintenance, communication ¡ Ac Academic Functioning — academic performance, attendance, ability to follow directions

PROGRESS MONITORING WITH THE BIMAS

¡ Universal Screenings (Tier I) § Use the BIMAS-Standard form § Early Fall § Late Spring § What do we want to know ? § What data a are available ? § System data (classrooms, grades, schools) § Individual data (specific students)

BIMAS SCREENING

¡ October 2014 ¡ May 2015 ¡ Typically done by teacher at the elementary level ¡ At the middle and high school level the staff that knows the students best (e.g., advisory, crew, etc) complete the screener

16 TYPES OF REPORTS

School- wide Class Individual

LOOKING AT THE DATA

CREATING EFFECTIVE TEAMS

TIER ONE TEAM – Universal Supports & Programming for all students PROBLEM-SOLVING TEAM(S) - Look at the students found at-risk

CBHM RECORD OF PROBLEM SOLVING AND PROGRESS MONITORING

BIMAS – GRADE DATA

¡ Boston Latin School ¡ 7th grade students – Self-Report ¡ Collaboration with Peg Dawson on providing tiered levels of intervention for executive functioning skills ¡ Directed by School Psychologist

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BEHAVIORAL CONCERN SCALES – ROBERTO 1ST GRADE STUDENT

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FLEX ITEMS (PROGRESS MONITORING) #2 Control anger #13 Respectful to adults and children #26 Complete assigned work at school

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LA LAYERED ERED CONT ONTINUUM INUUM OF OF SUP UPPORT ORTS

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§ Every ¡student ¡receives ¡ Universal ¡supports ¡ § Some ¡students ¡also ¡receive ¡ Targeted ¡supports ¡ ¡ ¡

¡

§ Few ¡students ¡also ¡receive ¡ Intensive ¡supports ¡

TIER 1 AND 2 INTERVENTIONS

¡ 9/2012 to 6/2013 ü Tier One Intervention-Open Circle Curriculum; two days a week for 15 minutes whole class ¡ 2/2013 to 5/2013 ü Tier 2-Checkin/Check out ¡ 5/2013 to 6/2013 ü Social Skills group

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LIVE DEMONSTRATION OF BIMAS

SU SUCCE CCESS T SS TO D DATE TE

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Progress a

at t the he S Student l level

5 10 15 20 25 30 35 40 2012-2013 2013-2014 Percentage of Students who scored At-risk

CBHM WEBSITE

http://cbhmboston.com ¡ Get and share information and resources ¡ Link to Cohort school’s website ¡ Information for educators & families ¡ Provide content – images, videos, etc. ¡ Announce district trainings

45

Melissa Pearrow, PhD Victoria Sheppard, MS

USING DATA TO SUPPORT PARTNERSHIP DEVELOPMENT: TRAINING AND RESEARCH

¡ Dearth of adequate training opportunities and research on evidence based practices in urban schools and communities ¡ Partnership has been mutually beneficial

§ Advance training of students of multiple programs § Enhance collaboration with Massachusetts Trainers Group § Build capacity and leadership of schools professionals § Increase capacity for examination of evidence-based practices and research

PARTNERSHIP WITH UNIVERSITY

¡ History of relationship between school district and school psychology training program ¡ Issues unique to partnering with urban district and roles of school psychologist ¡ Changes in administrative leadership and expansion of role ¡ Professional relationships outside of training program

CREATING PARTNERSHIP BETWEEN SCHOOL AND UNIVERSITY

¡ Assist in development of CBHM

§ Content support for development § Align graduate training activities with CBHM initiatives § Structures to sustain systems change § Supervise graduate students at specialist and doctoral levels § Role change of school psychologist

UNIVERSITY SUPPORT

¡ Specialist level

§ Full domains of practice § Be involved in school-level change § Working with other students in a building

¡ Doctoral level

§ Be involved in district-level change § Supervision/mentoring experiences § Leadership opportunities

¡ Expanded roles and learning for supervisors – aligning work with NASP Practice Model

FIELD TRAINING OPPORTUNITIES

¡ Supervisors

§ Practicum and internship programs training and resources § Sequenced Training Series (e.g., dissemination) § Professional Learning Communities (PLC) activities (internal)

¡ All Behavioral Health Services staff

§ In-service trainings

TRAINING FOR SCHOOL PROFESSIONALS

¡ Research and evaluation skills

§ Create research team with Children’s Hospital § Logic model - a roadmap for outcomes § Presentations and publications opportunities § Capacity building for staff to conduct research § Program evaluations with service delivery

¡ Create standards for publishing and access to data for research

TO ENHANCE RESEARCH

¡ Research and evaluation skills

§ Create research team with Children’s Hospital § Logic model - a roadmap for outcomes § Presentations and publications opportunities § Capacity building for staff to conduct research § Program evaluations with service delivery

¡ Create standards for publishing and access to data for research

TO ENHANCE RESEARCH

¡ Financial sustainability for partners

§ Explore creative funding alternatives § Maximize existing revenue sources

¡ Develop best practices for service delivery model ¡ Integrate mental health services and partnerships into CBHM ¡ District level data collection and management ¡ Clear district oversight and management of partnerships ¡ Maximize use of community services (CBHI)

ONGOING EFFORTS

¡ BPS, BCH, and UMB

§ Monitor and analyze CBHM outcome data § Build research base

§ Access to student-, school-, and district-level data § Dissemination strategies through presentations and publications

§ Drafted authorship agreement

§ Protects ownership of those who created this work § Honors partnership

RESEARCH COMMITTEE

¡ Examples of issues and strategies for problem solving

§ Universal screening data (BIMAS)

§ Technology problems § Lack of staff understanding/buy-in

§ Professional development evaluations

DATA COLLECTION & CHALLENGES

¡ Andria Amador: aamador@boston.k12.ma.us ¡ Mary Cohen: mcohen@boston.k12.ma.us ¡ Melissa Pearrow: Melissa.Pearrow@umb.edu ¡ Victoria Sheppard: sheppardv@gmail.com

CONTACT INFORMATION