Running Head: SCHOOL BASED MENTAL HEALTH REPORT

School Based Mental Health Report

Emporia State University
Senaida Mehmedovic
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School Based Mental Health Report

Introduction
“Research demonstrates that students with good mental health are more successful in
school” (Skalski & Smith, 2006). Schools not only have an ethical duty to ensure that all areas of
educational need being met, but are mandated by laws like No Child Left Behind (NCLB) and
Every Student Succeeds Act (ESSA). Numerous barriers hinder students and families from
receiving the support they need and the provision of mental health services, school-based mental
health services then become an essential component for meeting the needs of all student and
improving the learning of all students (NASP, 2015b). Additionally, school-based mental health
professionals are “specifically trained to provides services in the learning context” and “... are
essential to creating and sustaining safe schools” (NASP, 2006).
School-based mental health often professionals consist of school counselors, school
social workers, and school psychologists; in particular, school psychologists are trained to utilize
the NASP practice model when providing services and are in a unique position to help bridge the
gaps between research and practice (NASP, 2015a). Furthermore, school psychologists are
considered experts in data-based decision making, consultation, and collaboration with strong
foundational knowledge in diversity development, research evaluation, legal practices, and
ethical practices (NASP, 2010) which enables them to become effective change agents.
As a school psychologist intern, at Sunflower Elementary School and Southwest Middle
School, my role in mental health varies based on the setting that I’m in. At the middle school, my
main role is to help the team enhance their data collection procedures and utilize the problem-
solving model—in order to make data-driven decisions. At the elementary school, my role is
similar but I function more as a change agent by [attempting] to bridge the gaps between
research and practice, summarizing relevant research articles during meetings, and guiding the
team to utilize behavior-analytic strategies.
Needs Assessment
For the purpose of this project, the focus will be on Sunflower Elementary school due to
its history of difficulties in addressing behavioral needs as a mental health team (MHT).
Sunflower Elementary currently utilizes the framework develop by Dr. Kathleen Lane at the
University of Kansas, called Comprehensive and Integrated Three-Tired Model of Prevention
(Ci3T). Additional information about Ci3T can be obtained through the website. Within this
framework, there is a primary intervention plan in place as well as a behavior matrix that
provides behavior-specific expectations in a variety of settings. Students are pre-taught these
expectations and receive reinforcement via “BEST bucks” for following the stated expectations.
In addition to the primary interventions, the Ci3T plan providers interventions based on
secondary (Tier 2) and tertiary (Tier 3) needs. The Ci3T plan also requires systematic screening
to be utilized at least three time per year and for interventions to be delivered, based on the
results of the screening. Overall, the Ci3T model utilizes best practices in providing population-
based mental health services laid out by Doll, Cummings, & Chapla, (2008).
According to KSDE’s report card data, Sunflower Elementary has about 45% of the
student population that meets the criteria for “economically disadvantaged”, about 35% of the
population is “non-white”, and about 12% of the population consists of student with disabilities.
An informal interview with the principal suggested that “response to behavior needs”, both in
terms of prevention and intervention, was identified as the biggest need. School-wide data was
inaccessible for the previous year due to the district moving from one platform (Skyward) to
another (Powerschool). It is also important to note that the Speech Language Pathologist (SLP)
left last year, after serving as the SLP for Sunflower for over five years, because she was
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required to respond to “Heart Team” calls and missed multiple therapy sessions [a day] with
students on her caseload. “Heart Team” calls are placed over the intercom and a member of the
MHT is supposed to go to the identified classroom, then attempt to diffuse the situation; this led
to several calls being made throughout the school day, for various students.
The identified area of need is decreasing incidents deemed to be “behavioral crises”,
defined as “aggressive behaviors” based on the Ci3T model. Aggressive behaviors include:
hitting, kicking, biting, punching, throwing items towards someone, self-injurious behaviors,
sexual behaviors, verbal aggression, bullying, and any other behaviors that places the students or
those around them in harm’s way. According to the Ci3T plan, aggressive behaviors are “office
managed” and the MHT is required to respond when requests are made. However, the plan does
not address how to actually respond, when or if the student is able to return, what methods
should be used for de-escalation, what setting is appropriate for response (e.g. does the heart
team member try to address the needs in the classroom, take the student to the office, or attempt
something else?) and how to track the calls being made—aside from the incident reports that are
completed by teachers.
In order to thoroughly identify the problem(s) contributing to the behavioral crises, data
was gathered through observations [by the school psychologist intern] of MHT members
responding to “behavior crises”, anecdotal data from MHT members, and analysis of incident
reports on Powerschool for specific students. The following conclusions were drawn (1) MHT
members were not responding to incidents based possible function, (2) MHT members more
often than not, “resolved” the crisis by taking students to their office to “talk it through”, (3)
MHT members seemingly had students for at least 20 minutes at a time and rarely called for
assistance, even when they themselves were triggered by the student, (4) teachers would provide
very limited information regarding the events that led up to the behavioral crisis, (5) teachers
were failing to utilize corrective feedback methods, outlined in the Ci3T plan, before calling for
MHT assistance, and (6) most importantly, there was zero consistency in responding to
behavioral crises and no method in place to track the frequency or duration of behavioral crises.
Mental Health Services Plan
It seems as though the lack of specificity, lack of understanding and/or application of
basic behavior analytic principles, and a lack of consistency between MHT members when
responding to behavioral crises led to practices that inadvertently reinforced the student’s
behaviors and/or the teachers. To help combat the identified issues, as it pertains to behavioral
crises, a plan was developed to help address the areas of need. The plan is based on “Function
Based Thinking” that helps create responses based on theorized behavioral functions (Hershfeldt,
Rosenberg, & Bradshaw, 2010). Function-based interventions are often more effective in
reducing the frequency of challenging behaviors, when compared to non-function-based
interventions and responses (Ingram, Lewis-Palmer, & Sugai, 2005). In addition to a function-
based approach, the plan was also influenced by the work of Dr. Ross Greene’s Collaborative
and Proactive Solutions (CPS); CPS focuses on recognizing the lagging skills that are
contributing to problem behaviors and providing interventions based on this premise. When the
final version of the plan was presented to the MHT, this was explicitly stated and tied back to the
current Ci3T plan already in place. The intern also created MHT response visuals to help
represent these ideas; please see “Figure 1” in the appendix for the MHT visuals.
Perhaps one of the most important components of the plan, the data collection, was
influenced by input from every member on the MHT and then created by the intern. This
includes the student, the date, day of the week, what happened prior to the behavior that
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necessitated a need for MHT to be called, and the actual behavior observed. The form prompts
the staff member [teacher] that calls for MHT assistance to fill out all of these items before a
MHT member arrives and in turn, serves as visual for staff members to follow. Please see “figure
2” in the appendix for the data sheet.
Following the problem-solving process (Tilly, 2008), an intervention must include a plan
for implementation; part of the implementation process involves training those involved to
implement the plan with fidelity. A Behavior Skills Training (BST) approach is a “well research,
performance and competency-based means of training...” (Parsons, Rollyson, & Reid, 2013, p.4)
and was used by the intern to train the MHT members on responding to behavioral crises. BST
involves (1) providing rationale for the target skills being trained, (2) verbally describing the
steps, (3) providing a written summary of the target skill steps, (4) modeling the target skill, (5)
having the trainee perform the target skill, (6) observing and recording correct responses, and (7)
providing supportive and corrective feedback (Parsons et al., 2013). The target skills were
identified as: behavior-specific praise, planned ignoring, behavior-momentum, and utilizing least
to most prompting. The visuals created by the intern, “Figure 2” in the appendix, were used as
the guide for BST and the BST occurred during the weekly MHT meeting. Additionally, please
see “Figure 4” in the appendix for images of the items in each of the response packets.
Post-implementation
Fidelity of implementation will be monitored by the intern on an intermittent schedule
and negative reinforcement will be utilized in order to increase implementation fidelity
(DiGennaro, Martens, & McIntyre, 2005). Data sheet used to measure fidelity of implementation
is based on Hawkins, Morrison, & Musti-Rao’s (2008) “intervention implementation
worksheet”; please see “Figure 5” in the appendix for the fidelity datasheet developed by the
intern. The response is determined to be implemented with fidelity when MHT members are able
to, independently, implement the behavioral crisis response with at least 90% accuracy.
Additionally, teacher fidelity of implementation will be monitored via permanent product record
and the data collection sheets will be used as the measure. Data will be entered by the intern
weekly, via google survey to quickly and accurately enter the data; the intern will be entering the
data, for now, to ensure that data is being entered. The data collected will be reviewed on a
weekly basis, during MHT meetings, and will be used to determine if target interventions for
certain variables are needed (e.g. grade levels, teachers, commonly occurring problems, etc.).
Reflection
Implementing a coordinated response to behavioral crises ended up being a more difficult
task than originally anticipated. I underestimated the time that it would take to develop the
materials, teach the strategies to the MHT members and teachers, and developing a goal to work
towards when there was very minimal data to work with. Overall, the overarching goal was to
decrease the frequency and duration of MHT members response to behavior crises. The goal was
not meant to be achieved simply through a coordinate response, but also by building capacity for
the MHT members to be change agents and for teachers to follow the Ci3T plan in place with
fidelity. The most difficult part of this project has been teaching colleagues with minimal
understanding of behavior analysis, how to look at and view behavior as a form of
communication and act accordingly. I found that the best way to gain buy-in for implementation,
was to connect the behavior-analytic terminology to concepts they were already familiar with
and work from there. This seemed to be effective and MHT members often thanked me, because
their understanding of behavior consisted of “old-fashioned” behavior modification strategies
that seemed to have a focus on punishment.
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The model for comprehensive and integrated school psychological services (Armistead &
Smallwood, 2014) was utilized to help develop the supports described throughout this report,
specifically as it pertains to school-wide practices that promote learning as well as preventative
and responsive services. While it was not a dubious task to use the model to guide the develop of
response plan, it was difficult to implement the plan developed and to do so with fidelity.
Additionally, it was difficult to provide feedback to MHT members in a way that would not
tarnish the collegial relationship established and make the change more difficult to occur. I was
also well aware of the impacts that my philosophical orientation (cognitive-behavioral and
radical behaviorism heavy) may impact the development of the MHT behavioral crisis plan,
which is why I made sure to gain input from the team members and then translate that into
behavioral terms.
Moving forward, I believe that the team may benefit from additional BST and to practice
this alongside the intern before responding to behavioral crisis on their own. I think that certain
members of the MHT respond more consistently than others and it will be imperative to develop
a plan that will address the varying levels of implementation. Eventually, I would like the team
to be able to apply the MHT response to all situations in which they are involved—not just
behavioral crisis. I would also like to develop a method to gain feedback from the MHT
members in regards to comfort with implementing the plan and have a way for them to
communicate this privately.
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References

Armistead, R. J., & Smallwood, D. L. (2014). The National Association of School Psychologists
Model for Comprehensive and Integrated School Psychological Services. Best practices in
school psychology: Data-based and collaborative decision making, 9-24.

Doll, B., Cummings, J. A., & Chapla, B. A. (2008). Best practices in population-based school
mental health services. Best practices in school psychology V, 4, 1333-1347.

DiGennaro, F. D., Martens, B. K., & McIntyre, L. L. (2005). Increasing treatment integrity
through negative reinforcement: Effects on teacher and student behavior. School Psychology
Review, 34(2).

Hawkins, R. O., Morrison, J. Q., Musti-Rao, S., & Hawkins, J. A. (2008). Treatment Integrity for
Academic Interventions in Real-World Settings. In School Psychology Forum (Vol. 2, No. 3).

Hershfeldt, P. A., Rosenberg, M. S., & Bradshaw, C. P. (2010). Function-based thinking: A

systematic way of thinking about function and its role in changing student behavior
problems. Beyond Behavior, 19(3), 12-21.

Ingram, K., Lewis-Palmer, T., & Sugai, G. (2005). Function-based intervention planning:
Comparing the effectiveness of FBA function-based and non-function-based intervention
plans. Journal of Positive Behavior Interventions, 7(4), 224-36.

National Association of School Psychologists [NASP]. (2010). Model for comprehensive and
integrated school psychological services. Bethesda, MD: Author.

National Association of School Psychologists [NASP]. (2015a). School psychologists: Qualified

health professionals providing child and adolescent mental and behavioral health services
[White paper]. Bethesda, MD: Author.

National Association of School Psychologists [NASP]. (2015b). The importance of mental and
behavioral health services for children and adolescents (Position statement). Bethesda, MD:
Author.

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2013). Teaching practitioners to conduct
behavioral skills training: a pyramidal approach for training multiple human service
staff. Behavior analysis in practice, 6(2), 4-16.

Skalski, A. K., & Smith, M. J. (2006). Responding to the mental health needs of
students. Principal Leadership, 7(1), 12-15.

Tilly, W. D. (2008). The evolution of school psychology to science-based practice: Problem

solving and the three-tiered model. Best practices in school psychology V, 1, 17-36.
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