May is Mental Health Awareness Month. Every year, Mental Health America encourages us all to spend more time educating ourselves about mental illness and strategies for improving our own mental health and wellness. This year’s theme, “Look Around, Look Within,” has us examining our environments and all the ways it affects our mental health.
It turns out, there are a lot of factors at play in my own personal mental health.
- How much sleep happened last night?
- Did I check the news this morning?
- Was the coffee strong enough?
- Has my to-do list increased or decreased since yesterday?
- Do the kids have practice?
- Is there food for dinner in the fridge?
…and then it’s 10:00 am.
My list goes on and on. I bet yours does, too. And here’s the real kicker: Your students’ lists are also lengthy. Like all of us, they come to school with their own set of factors setting the stage for the way they move through our hallways, cafeterias, and classrooms every day.
As I looked around at my environments and looked within at all the ways each context affects how I show up in the next, I wondered whether PBIS teams could account for this in their work. To find that answer, I had to go back to basics.
What is PBIS?
PBIS is a multi-tiered framework to support student behavioral, academic, social, emotional, and mental health. The Center on PBIS tells us there are five building blocks setting up the framework’s foundation:
- Equity
- Systems
- Data
- Practices
- Outcomes
Equity exists at the center. Our priority is for schools to work for all students. The systems are the nuts and bolts of how are school operates — our teams, professional development plans, coaching, all of it. The practices create the support our students need to be successful. Data tell us when things are working, when they’re not, and when we need to start doing something differently. And all of it works together, like a well-oiled machine, to achieve the specific outcomes we know are possible.
These five elements give us a foundation for everything else we want to do. We can leverage this framework to integrate more aspects of our students’ lives into the support we provide, including mental health.
While the definition of PBIS includes improving mental health outcomes, it doesn’t give us specifics for how to do it. It’s a framework, after all, not an initiative — it’s up to us to make it fit within our our context and for our community. For so many schools, that means PBIS teams meets to look at referral, academic, and fidelity data while a separate team monitors the systems, data, practices, and outcomes related to school mental health supports…but it doesn’t have to be that way.
What is the Interconnected Systems Framework?
The Interconnected Systems Framework (ISF) is “a structure and process for blending school mental health resources, training, systems, data, and practices into all levels of a multitiered system of support…to improve outcomes for all children and youth.”1 It leverages those same foundational elements to ensure you include relevant mental health components.
In a recent study, researchers placed 22 schools into one of three groups:2
- PBIS Only: This was the “business-as-usual” group. Schools continued to implement PBIS as they always had.
- PBIS + School Mental Health (SMH):Schools implemented PBIS as usual, and a school mental health (SMH) clinician started working in their building two and a half days a week, but without guidance on how to integrate their work on PBIS teams.
- ISF: These schools also continued to implement PBIS, plus they got the SMH clinician in their building two and a half days a week, and that clinician joined the school’s PBIS team with guidance from an ISF coach on how to do that.
In this study, there were a few statistically significant outcomes that grabbed my attention (emphasis is my own).
- ISF schools delivered more Tier 2 and Tier 3 interventions, and more students benefitted from those supports by the second year than the other schools.
- In those same ISF schools, clinicians provided nearly half of the Tier 2 and Tier 3 support in the second year while only providing around 3% of the interventions in the other schools.
- School psychologists and school counselors attended between 85-90% of team meetings at ISF schools, which is well above their attendance rates at the other schools.
By deliberately including SMH professionals, PBIS teams added another perspective in the problem-solving process, a deeper awareness of how mental health affects student behavior, and access to a wider range of interventions. When we talk about PBIS supporting student mental health outcomes, this is what we mean.
So, how did they do it?
I’m so glad you asked.
How to Integrate School Mental Health in PBIS
Remember the circles above? When you look to integrate anything into your existing framework, you’ve gotta embed it in every circle. These are a few of the systems, data, and practices ISF schools implement that make all the difference.3
Establish a District-Community Leadership Team
In the same way your multi-tiered systems have teams at the state, district, and school levels, the decision to integrate school mental health within your PBIS implementation needs to be made at those same levels. The District Community Leadership Team (DCLT) brings together district-level leadership with community mental health agencies. The DCLT sorts out important decisions related to things like communication, supervision, time allocation, universal screening measures, professional development, goals, and the all-important, ever-present question of funding.
In the case study, the DCLT eliminated a barrier by rewriting policy and reallocating funding so mental health providers could stop worrying about billable hours and start participating in building-level teams to consider referrals, plan intervention, and monitor progress. The collaboration had stalled around questions related to funding. The DCLT had the authority to address the issue.
Add New Members to Your School-level Team
Whether you have one team monitoring implementation across all three tiers or many teams delegated to monitoring specific tiers, you’re going to need to add a mental health provider as a teammate. Currently, your teams probably include:
- School administrator
- Family member
- Classroom teacher
- Student (especially at the high school level)
To capture the knowledge, expertise, and access to mental health outcomes, add any of the following mental health professionals to your schoolwide, Tier 2 or Tier 3 teams:
- School Counselor
- SPED teacher
- Collaborating community mental health clinician
- School psychologist
- School nurse
- School social worker
Use Community Data in Decision Making
Once you’ve added mental health professionals to your team, you open up a new world of data sources to incorporate in your decision-making process. On top of reviewing referral, attendance, academic, and fidelity data, you can add data like:
- Universal screening measures
- # of families accessing crisis support outside of school hours
- # of families experiencing homelessness
- Unemployment rates
- Food insecurity rates
In the study, a school team reviewed information about the number of students requesting to visit the school counselor during the lunch hour. Data showed students felt anxious in the cafeteria because of the longlines, loud noise, and sheer number of students in the space. With this additional piece of information, the team developed a more comprehensive solution that involved both reteaching expectations in the cafeteria and helping students improve their coping skills during stressful times.
Commit to On-going Coaching
When schools have access to a coach, they are more likely to sustain their PBIS implementation over the long haul.4 The same goes when you’re looking to integrate mental health systems, data, and practices into your existing framework. This isn’t easy work. It requires change, both on the part of the existing team as well as the mental health professional you add to it. The learning curve feels steep at times, so why not enlist the help of a guide.
Remember that study where 22 schools divided into three groups and researchers measured the outcomes each experienced after two schoolyears?5 Yes, ISF schools experienced their own set of improvements, but every school in the study saw improvement between the first and second year. Care to take a guess what happened between years 1 and 2? Due to teacher turnover, every team received coaching. Then, on top of that, ISF teams received specific coaching on how to integrate school mental health professionals in their process, which in turn led to the successes we already mentioned. Coaching works! We highly recommend it.
Everyone in your schoolwide community is a whole person with a lot of factors contributing to what you see walking through your hallway every day. If PBIS is a framework you use to support student behavioral, academic, social, emotional, and mental health goals, it’s critically important to find a way to integrate each of these supports into your team’s process. The ISF is a process, backed by research, to leverage the PBIS framework to incorporate school mental health into the systems, practices, data, and outcomes you’re already implementing.
[1] Splett,J. W., Perales, K., Halliday-Boykins, C. A., Gilchrest, C. E., Gibson, N.,& Weist, M. D. (2017). Best practices for teaming and collaboration in the interconnected systems framework. Journal of Applied School Psychology,33(4), 347-368.
[2] Weist, M. D., Splett, J. W., Halliday, C. A., Gage, N. A., Seaman, M. A., Perkins, K.A., ... & Distefano, C. (2022). A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: focus on proximal variables and school discipline. Journal of school psychology, 94,49-65.
[3] Splett,J. W., Perales, K., Halliday-Boykins, C. A., Gilchrest, C. E., Gibson, N.,& Weist, M. D. (2017). Best practices for teaming and collaboration in the interconnected systems framework. Journal of Applied School Psychology,33(4), 347-368.
[4] Mathews,S., McIntosh, K., Frank, J. L., & May, S. L. (2014). Critical features predicting sustained implementation of school-wide positive behavioral interventions and supports. Journal of Positive Behavior Interventions, 16(3),168-178.
[5] Weist,M. D., Splett, J. W., Halliday, C. A., Gage, N. A., Seaman, M. A., Perkins, K.A., ... & Distefano, C. (2022). A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: focus on proximal variables and school discipline. Journal of school psychology, 94,49-65.