Project One-to-Won School Based Mental Health in the Pocono Mountain School District Presented by: Dr. Mary Beth Gustafson, Deanna Moerer LSW, and Greg.

Project One-to-WonSchool Based Mental Health in the Pocono Mountain School

DistrictPresented by: Dr. Mary Beth Gustafson, Deanna Moerer LSW, and Greg Llewellyn Ed.S

May 18, 2011

Behavioral Health is as important as physical

health to a child’s quality of life and directly impacts

his/her learning and development.

PDE Grant Opportunity

School-Based Behavioral/Mental Health Performance Grant:•Create a model program to address the behavioral/mental health needs of students in grades K-12•Partner with an outside mental health agency – (i.e. Youth Advocate Program (YAP)•Create a three tiered behavior support system•Grant funding for five years

PMSD Demographics

Total Enrollment - 10,689Free/Reduced Lunch - 49.1%Special Education - 22% (increase from 15% in 2008-09)Gifted Education - 2.6%Diversity of Student Body•White – 53.5%• African American – 23.8%•Hispanic – 21.3%English as a Second Language – 400 studentsHomeless – 82 students (increase from 9 in 2009-10)

Transfer Students with Special Needs

• July 1, 2010 to present- 328• Foster – 8• Partial Hospitalization – 4• Alternative Educational Placement – 26• Adjudication - 20

Project One- to- Won

School Based Behavioral Health Program

Mental health is not simply the absence of mental illness; it also

means having the skills necessary to cope

with the challenges of life.

Main Staff

• Behavioral Specialist Consultant• Drug and Alcohol Counselors• Guidance Counselors• Student Assistant Program (SAP)

Coordinator• Project One-to-Won

• Deanna Moerer – Program Coordinator• Lynette Rohan – Social Worker• Beth Fisher – Assistant Program

Coordinator

Goal and Objectives

•Increase attendance rate•Decrease Alternative Education Placements (AEP)•Decrease In-School Suspension/Out of School Suspension•Increase student achievement•Increase Least Restrictive Environment (LRE) percentage•Increase graduation rate•Increase school community involvement

Response to Intervention

5%

BEHAVIORAL SYSTEM

TERTIARY (6 or more discipline referrals)

Targeted Programs•Ind/group Therapy•Community Links Program•Family Check Up Program•Truancy Treatment Planning•Transition Treatment Planning

ACADEMIC SYSTEMS

Resiliency Theory

• Based upon the principle that all people have the ability to overcome adversity to succeed.

• A strengths based model with a focus on providing support and opportunities which promotes success in life.

• Based on research devoted to identifying the protective/risk factors and processes that might account for children’s successful outcomes (Wolin & Wolin, 1993; Glantz & Johnson, 1999; Mastine, 2001).

Risk Factors

IN THE CHILD IN THE FAMILY

Fetal drug/alcohol effects PovertyPremature birth or Large family of 4 or moreDifficult temperament Parent with mental illness Shy temperament Parent with substance abuseNeurological Impairment Parent with criminalityIQ <80 Chronic medical disorder Psychiatric disorder Repeated aggression Substance abuse Delinquency Academic failure

Risk Factors cont.

Family/Experiential

Poor infant attachment to motherLong term absence of caregiver in infancyWitness to extreme conflict and violenceSubstantiated neglectSeparation/divorce/single parentNegative parent-child relationshipSexual abusePhysical abuseRemoval from homeFrequent family movesTeen pregnancy

Protective Factors

Qualities of the Child Family Characteristics

Positive - easy temperament Lives at home Independence as a toddler Warm relationship with High hopes for the future with parentInternal locus of control as a teenagerInterpersonally engagingSense of humorEmpathy  Perceived competencies  IQ>100  Good reader  Gets along with others  Problem solving skills

Referral/Intake Process

• Student Assistance Referral (SAP) - students exhibiting emotional/behavioral concerns.

• BIO/PSYCHO/SOCIAL - An assessment of all the factors relevant to resiliency which allows treatment planning to address ongoing risk factors, identify existing strengths, and build on protective factors.

• Assessment Tools• CHILD BEHAVIOR CHECK LIST-DSMIV

Treatment Planning

Once all intake paperwork has been completed, the following components are available to all students.

Individual/Group TherapyFamily Check UpCommunity LinksTransition Treatment PlanningTruancy

Becca - A Case Study

2009-2010•Attendance 45%•GPA 78•1 ODR 7 OSS•1 close friend•Youth group

2010-2011•Attendance 91%•GPA 95•0 ODR•Drama Club•Talent Show•8 close friends, sleepovers, parties, movies, youth group, typical teenager activities

How did we do this?

Component 1: Intensive Individual Therapy

• Cognitive, Solution Focused, Reality Based Therapy

• Mentoring• Consulting• Crisis Planning

Component 2: Intensive Group Therapy

• Aggression Replacement Training • Full of Ourselves/Girl Talk• Keeping Your Cool • Cool Cat• Coping Cat• Taking Action for Depression• I Can Problem Solve• Second Step• Skillstreaming • Student Bodies (Eating Disorders)

Aggression Replacement Training

• Anger Control• Skillstreaming50 social skills

• Moral Reasoning

Aaron

Penti

COMPONENT 3: FAMILY CHECK-UP

• Enables the therapist to partner with parents on a daily, weekly, monthly basis in school and/or home on a continuous basis.

• Bridges any gaps, creates a positive relationship, increases a positive home/school connection, and engages the parents in the process of their child’s road to mental wellness.

• Identifies barriers interfering with the child’s education and helps parents create and implement behavior support plans in the home.

• Provides a vehicle to inform parents of the child’s progress in all areas.

COMPONENT 4: COMMUNITY LINKS

Links students with after-school activities or in the community to build on their strengths and interests.

Examples:

•Equilibrium

•Pocono Medical Center

Community Links cont.

•Mental Health and Mental Retardation (MHMR) •Provider 50 •Multisystemic Therapy•Psychiatric Outpatient •Family Outpatient Counseling •YMCA •Libraries•Salvation Army•Medical Assistance

Tino

Sean

Component 5: Transition Treatment Planning

Provide continuity of care:

•Transition student in/out of district in timely manner.•Aide in securing services to build a resilient child/family.•Transfer learned coping skills back to district/staff.

COMPONENT 6: TRUANCY PROGRAM

•School Refusal Assessment Scale (SRAS): an evidenced-based scale that identifies the function of a student’s behavior that causes truancy.

•Bio/psycho/social: identifies the barriers that are affecting the child’s ability to attend school.

A significant percentage of truancy occurs when there is an undiagnosed mental health concern such as anxiety (school phobias/panic disorders), depression, paranoia , etc.

School Refusal Assessment Scale

Negative Affectivity - bad feelings related to something at school.Social/Evaluative Situations - difficulties interacting with or performing before others.Attention - child refuses to attend school to spend time with parents/guardians.Tangible Rewards - child misses school to have more fun outside of school.

Truancy Treatment Planning

• Identify the mental health concern (if applicable).• Obtain psychiatric treatment (if applicable).• Teach coping strategies.• Go to the home each morning, work the child

through their challenges, drive them to school and continue to work with them in school until they are stable enough to continue on their own.

• Transfer skills to parent/child.• Include school staff in all stages of planning as

they are integral to achieving success.

Truant Students who received support and services through Project One-to-Won

• 2008-2009 - Attendance rates increased by 19% (based on 3 students).

• 2009-2010 - Attendance rates increased from a baseline of 41% to 85% (based on 5 students).

Component 7: Professional Development

Tier II• Check-In/Check-Out (CICO) • Second Step

Tier III• Looking Beyond the Behavior (Anxiety, Eating

Disorders, ADHD, Bipolar Disorder)• Self Injury: Cutting and Eating Disorders• Understanding Bipolar Disorder in Children• Understanding ADHD in the School Environment• Treating Anxiety Disorders in School

Project One-to-Won 2009-2010 (based on approx. 60 students)

• Office Discipline Referrals - Decreased by 56%

• In-School Suspension - Decreased by 10%

• Out of School Suspension - Decreased by 47%

• Grade Point Averages - Increased by 8%, 90% maintained grade point average, 2% had a lower average

Graduation Rates

• 9 out of 10 TIER III students have graduated.

Tier IIIBuilding the Framework

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011TIER I Researched,

Designed, Planned, Hired Staff, Trained Staff and created Advisory and Steering Committees.

Implemented SWPBS at Clear Run Elementary and Swiftwater Elementary Centers

Tobyhanna & Coolbaugh Elementary Centers plan for SWPBS

Implemented SWPBS at Tobyhanna and Coolbaugh Elementary Centers

Clear Run Intermediate School planned for SWPBS

Implemented Second Step Program in Kindergarten at CREC and SEC

Implemented SWPBS at Clear Run Intermediate

Implemented First Tee in CREC and SEC

Barrett Elementary Center planned for SWPBS

Constructed District Leadership Team

TIER II Pilot Check-in/Check-out at CREC and SEC

Trained guidance counselors to implement Behavior Education Program (CI/CO) and Second Step Program

Implemented Check-in/Check-out at CREC, SEC, TEC & CEC

Implemented Full of Ourselves self-esteem program at Swiftwater Intermediate School (SIS)

Implemented Check-in/Check-out at Clear Run Intermediate School and Swiftwater Intermediate School

• Implemented Full of Ourselves self-esteem program at CRIS

TIER III Project One-to-Won (SOAR Room) 18 studentsIndividual/Group TherapyAggression Replacement TrainingI Can Problem SolveMentor ProgramFamily Check-up ProgramCommunity Links ProgramTruancy Prevention Program

40 StudentsIncreased number of groups for Aggression Replacement Training from one to threeAnalyzed Alt. Ed. PlacementsCreated Individualized Transition Plan template for all students in Out of District PlacementsImplemented Second Step in targeted group settings

60 studentsUtilized the Individualized Transition Plan template for all students in Alt. Ed. PlacementsIncreased number of students receiving individual and group therapies by hiring a Master Level clinician.Implemented Second Step in 4 emotional support classrooms

90 students•Created a Mental Health Core Team•Implemented Aggression Replacement Training, Full of Ourselves and Social Skills groups at CRIS and WHS•Increased Second Step to 2 emotional support classrooms at PEC

Tier I

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Tier I Implemented SWPBS at:•CREC•SEC

Planning stages for SWPBS:•TEC•CEC

Implemented SWPBS at:•CREC•SEC•TEC•CEC

Planning stages for SWPBS•CRIS Implemented Second Step Program in one Kindergarten at SEC

Implemented SWPBS at:•CREC•SEC•TEC•CEC•CRIS

Implemented Second Step Program in all Kindergarten classrooms at CREC and SEC

Implemented First Tee at CREC and SEC.

Implemented SWPBS at:•CREC•SEC•TEC•CEC•CRISPlanning stages for SPWBS:•BEC Implemented Second Step Program in Kindergarten and First Grade at CREC and SEC

Implemented First Tee at CREC and SEC.Create District Leadership Team for SWPBS

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Tier II Piloted Check-in/Check-out: • CREC• SEC

Trained guidance counselors to implement Behavior Education Program (CI/CO) and Second Step Program

Implemented Check-in/Check-out: • CREC• SEC• TEC • CEC

Implemented Full of Ourselves self-esteem program at: •Swiftwater Intermediate School (SIS)

Implemented Check-in/Check-out at:•CREC•SEC•TEC•CEC•CRIS•SIS

Implemented Full of Ourselves self-esteem program at:•Swiftwater Intermediate School (SIS)

Implemented Full of Ourselves self-esteem program at;•Clear Run Int. School (CRIS)

2006-07 2007-2008 2008-2009 2009-2010 2010-2011

Tier III ImplementedProject One-to-Won•Individual Therapy•Group therapy•Family Check-up Program•Community Links Program•Truancy Prevention Program•Mentor Program•Family Therapy•Parenting Classes

Aggression Replacement TrainingI Can Problem Solve

Serves 18 students

ImplementedProject One-to-Won•Individual Therapy•Group therapy•Family Check-up Program•Community Links Program•Truancy Prevention Program

Increased number of groups for Aggression Replacement Training from one to two. Second Step, I Can Problem Solve.

Analyzed Alt. Ed. PlacementsCreated Individualized Transition Plan Template for all students in Alt. Ed. Placements Serves 40 students

ImplementedProject One-to-Won•Ind. Therapy•Group therapy•Family Check-up Program•Community Links Program•Truancy Prevention Program Increased use of the Individualized Transition Plan Template for all students in Alt. Ed. Placements

Increased number of students receiving individual and group therapies by hiring a Master Level clinician. Serves 60 students

ImplementedProject One-to-Won•Ind. Therapy•Group therapy•Family Check-up Program•Community Links Program•Truancy Prevention ProgramIncreased number of students transitioning back to district from Alt. Ed. PlacementsIncreased number of students receiving ind./group therapies.

Created a District Mental Health Core Team

Serves 90 students

Program BenefitInstructional Minutes

CREC Office Discipline Referrals

Referrals 5min 20min 10min

ISS

OSS

5min

5min

6hrs 20min

6hrs 45min

Teacher Student Administrator

Referrals 10 hrs/1hr 39hr/4hr 19hrs/2hrs

ISS 8.5hrs/45min101days/9days 33.5hrs/3hrs

OSS 4.5hrs/15min 55days/3days 41hrs/2hrs

AdministratorStudentTeacher

2007-2008 Pilot Program (18 students)

Referrals 5min 20min 10min

ISS

OSS

5min

5min

6hrs 20min

6hrs 45min

Teacher Student Administrator

Referrals 3.5 hrs/55min 2days/3.6hrs 7hrs/1.8hrs

ISS 5.75hrs/15min69days/3days 3days/1hr

OSS 3.5hrs/2.9hr42days/35days 4 days/3.5days

AdministratorStudentTeacher

2009-2010 ART Group (6 students)

CICO DATA FOR CREC 2008-09

CICO DATA 3 YEARS

LRE Percentages STUDENTS INCLUDED MORE THAN 80% OF THEIR DAY

Increase in LRE for Alex

Increase in LRE for Christian

Increase in LRE for Josephine

Increase in LRE for Latifa

Increase in LRE for Alexis

Cost Benefit

Would you want that program?

If programs and services were provided to students for $7.43 per student per day within the district vs. $69.00 per student per day in an Alternative Educational Placement (AEP)…

Financial Impact

Sustainability and Continuous Improvement

Sustainability and Continuous Improvement

• Develop a District-Wide SWPBS team.• Develop a District-Wide SBBH to:

improve the referral process, communication, and delivery of services to ensure

improve efficiency and effectiveness of the referral process

decrease duplication of services. • Collect and analyze four years of district data • Determine the cost effectiveness of providing

SBBH services within the district.

Moving Forward for 2011-12

•Develop a Needs Assessment•Develop an Action Plan

Identify roles and responsibilitiesImprove the referral processDevelop new forms and formatsDevelop a staff surveyPlan Professional Development Activities for 2011-12 school year

•Develop a system to monitor progress

Sustainability and Continuous Improvement cont.

•Develop consistency of programming and supports among all schools implementing School-Wide SWPBS.•Provide support and resources to the staff and students implementing SWPBS. •Provide on-going communication between and among all schools implementing SWPBS. •Increase collaboration and improve communication with PaTTAN, PDE, and IU 20 in an effort to provide on-going professional development opportunities to the school community related to SBBH/SWPBS.

Resources

• Achenbach, T, Child Behavior Checklist. ASEBA University of Vermont, Burlington Vermont, www.aseba.org.

• Albano, Anne Marie & Kearney, Christopher (2007), When Children Refuse School, A Cognitive-Behavioral Therapy Approach. Oxford University Press: Oxford.

• Goldstein, A , Glick, B & Gibbs, J (1998), Aggression Replacement Training. Research Press: Illinois.

• Crone, Deanne, Hawken, Leanne & Horner, Robert (2004) Behavior Education Program. Guilford Press: New York.

• www.pattan.net

Mary Beth Gustafson, Ed. D. [email protected] Llewellyn, Ed.S [email protected] Moerer, LSW [email protected] Beth Fisher, BS [email protected] Rohan, LSW [email protected]

PaTTAN , PDE, and the IU 20 for

your support.

Thank You!