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Building a trauma-informed community to address adverse childhood experiences

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Building a trauma-informed community to address adverse childhood experiences

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Content Running head: CAPSTONE PAPER Capstone Paper Grand Challenge: Ensuri ng Healthy Development for All Youth Building a Trauma Inform ed Comm unity Michelle M. Webb Doctor of Social Work University of Southern California December 2019 I Running head: CAPSTONE PAPER 2 DEDICATION Dedicated to the memory of my mother, Betty Jane Kolecki-Mersich in appreciation of her unconditional love, grace, support, and resilience. (10/23/32-9/26/16) Running head: CAPSTONE PAPER TABLE OF CONTENTS AREA 1 EXECUTIVE SUMMARY I.Grand Challenge Link- 5 2. Purpose-5 3. Problem Identification-5 4. Project Methodology-6 5. Aims for the Project-7 6. Innovative Step 7-8 AREA 2 CONCEPTUAL FRAMEWORK 1. Statement of Problem-8 2. Literature and Practice Review of Problem and Innovation-8-10 3. Social Significance-10-11 4. Conceptual Framework with Logic Model and Theory of Change 11-14 Area 3 PROBLEM OF PRACTICE AND INNOVATIVE SOLUTIONS I.Proposed Innovation and its effect on the Grand Challenge-14-18 2. Views of Key Stakeholders- 18-19 3. Evidence and Current Context-20-22 4. Comparative Assessment of Other Opportunities-22 5. Innovation Links to Proposed Logic Model and Theory of Change 23-25 AREA 4 PROJECT STRUCTURE AND METHODOLOGY I.Description of Capstone Deliverable/Prototype-26-27 2. Comparative Market Analysis -27-29 3. Project Implementation Methods-29-34 4. Financial Plans and Staging-34-35 5. Project Impact Assessment Methods-35-37 6. Stakeholder Engagement Plan-37-39 7. Communication Strategies and Products-39-41 8. Ethical Considerations-41 AREA 5 CONCLUSIONS, ACTIONS, AND IMPLICATIONS I.Summary of Project Plans 41-42 2. Current Practice Context for Project Conclusions 42-43 3.Project Implications for Practice and Further Actions 43 4.Project Limitations 44 REFERENCES 3 5-8 8-14 14-25 26-41 41-44 45-49 Running head: CAPSTONE PAPER 4 ATTACHMENTS Logic Model 50 Gantt Chart for Implementation 51-55 Three Year Budget for Full Scale Implementation 56 Assessments SAEBRS 57-61 PHQ-9 Adolescent 62 Curriculum Briefs SSET 63-69 CBITS Grades 5-12 70-74 CBITS- Bounce Back for ages 5-11 75-80 Informed Consent Sample 81-82 PROTOTYPE APPLICATION FOR FUNDING Running head: CAPSTONE PAPER AREA 1 EXECUTIVE SUMMARY I.Grand Challenge Link 5 The project addresses the Grand Challenge to Ensure the Healthy Development of All Youth through systemic change, professional development, and increased access to mental health services to address the problem of adverse childhood experiences that effect healthy youth development. 2. Purpose The purpose of this project is to disrupt community norms and programmatic silos via an infrastructure that leverages resources, increases access to mental health services, and creates a human scaffold of relational support to address exposure to adverse childhood experiences (ACEs). The logic model depicted in the attachments identifies outputs related to the number of participants served, number of mental health sessions and number of staff trained in ACE Interface and Youth Mental Health First Aid and the number of youth who are trained in Teen Mental Health First Aid. Anticipated outcomes are improved emotional well-being and improved school discipline. 3. Problem Identification ACEs have been shown to impact health, mental health, social, and behavioral outcomes that compromise healthy youth development. Bucci, (2016) indicates that the exposure to traumatic stress rewires the brain and represents a neurobiological response rather than a behavioral choice that affects, cognition, memory and emotional regulation. Without critical mental health support to guide the development of healthy coping skills, behavioral manifestations in a school setting may affects emotional well-being, school success, and future life trajectories. Running head: CAPSTONE PAPER 6 The project will identify youth who demonstrate exposure to traumatic stress, unhealthy coping behaviors and have unmet mental health needs in efforts to improve emotional well-being. 4. Project Methodology Key community stakeholders including youth have been engaged from the onset in community visioning sessions to support the development of the infrastructure. Youth are also included on the Community Advisory group and will have the opportunity to be trained in Teen Mental Health First Aid and be employed in Peer Mentor positions. Summer professional development in ACE Interface and Youth Mental Health First Aid for fifty staff and community members will be offered annually for those with direct daily contact with youth. Participants will include bus drivers, food service workers, secretaries, and teachers and is intended to build a human scaffold of relational support include those on the frontlines. At the beginning and end of the school year the SAEBRS universal screener will be administered to all students and serve to identify students with unaddressed mental health concerns. Collateral screening will include the Patient Health Questionnaire PHQ-9 Adolescent. Both instruments have demonstrated validity and reliability with the identified demographic groups. Based on assessments, MSW Social Workers will obtain informed parental consent and triage services. Tier 2 services facilitated by BSW Social Workers will include a sample of an estimated 30% of the enrollment peer mentor pairings, and participation in individual and group support and may include the Student Support for Exposure to Trauma {SSET), non-clinical curriculum. In year one the sample size will be an estimated five hundred and ten high school students in grades nine to twelve. Running head: CAPSTONE PAPER 7 Tier 3 services will be facilitated by MSW Social Workers and may include individual and family counseling, participation in the Cognitive Behavior Intervention for Trauma in Schools (CBITS) group curriculum, and wrap-around community support if indicted. Tier 3 services will include a sample of an estimated 10% of the enrollment based on students with the greatest needs. In year one the sample size is estimated to impact one hundred and seventy students at the high school. The Program Director will develop a data monitoring protocol and data analysis to monitor outputs in the number of staff trained, number of Tier 2 and Tier 3 participants, number of units of mental health support service with pre and post intervention assessments to determine impact on outcomes of improved emotional well-being and improved discipline. 5. Aims for the Project The purpose of the project is to address youth exposure to traumatic stress in the absence of mental health supports in effort to improve emotional wellbeing and school discipline. The project will incorporate professional development and school-based mental health services based on identified needs. The project will begin at the high school and be scaled at all levels in the Michigan City Area Schools within three years. Because of the correlation between ACEs and substance use and the high incidence of substance use in families of our students the model will also be incorporated into county wide strategic planning efforts to implement a Trauma Informed Recovery Oriented System of Care. Concurrently the model will become a visible pilot for replication in the state of Indiana via the Indiana School Mental Health Initiative and shared nationally in February 2020 at CADCA's National Leadership Forum. Running head: CAPSTONE PAPER 8 6. Innovative Step Beyond Local Context The project is innovative because it disrupts programmatic silos to create a community infrastructure to address access to mental health services and proactively engages community stakeholders and youth as beneficiaries in the development of the operational design and cross sector implementation. The solution cultivates a human scaffold of support among those with direct contact with youth and disrupts the top down discipline paradigm from punishment to discipline as guidance. The framework is based on socio-ecological theory which demonstrates how the innovation will be scaled from an individual school to additional schools, and then system wide in three years as well as serve as a model for practice and policy in the state of Indiana and the nation. AREA 2 CONCEPTUAL FRAMEWORK 1 .Statement of Problem According to Baffour (2016), adverse childhood experiences, or ACEs effect thirty-five million children in the United States. Research indicates that this exposure affects healthy development and leads to negative health, mental health, social, and behavior outcomes that impact future life trajectories Counts et al (2017). The exposure to traumatic stress during childhood directly impacts the Grand Challenge to ensure the healthy development of all youth and is considered by the former President of the American Pediatric Association, Dr. Robert Block (2013) to be the single most important unaddressed public health risk. Bucci (2016) articulates how this exposure rewires the brain and creates a neurobiological response rather than a behavioral choice affecting emotional regulation, memory, and cognition. Running head: CAPSTONE PAPER 9 2. Literature and Practice Review of Problem and Innovation The exposure to adverse childhood experiences (ACEs) that occur during key periods of child development increase the incidence of physical, mental and behavioral issues later in life were first identified by Anda and Felitti in the landmark ACEs study. In a school environment the exposure to traumatic stress may result in behavioral, social, mental health, or substance abuse issues that may affect the ability to be successful in school. Anda, RF, Felitti VJ, Bremner JD, Walker, JD, Whitfield C, Perry (2006), Webb M. (2018). Collins et al (2010), describes how exposure to adverse childhood experiences is more prevalent in children growing up in urban poverty and the mental health resources essential to overcome the exposure are often inaccessible. Soleimanpour, et al. (2017) corroborates these findings and cites an increased incidence of ACEs and a lack of essential supports available in distressed and communities. The environmental context of the capstone pilot is the culturally diverse, high poverty urban area of Michigan City, Indiana. Located on a federally designated high intensity drug trafficking area (HIDT A) in northwest Indiana, the area served by the Michigan City Area Schools is identified by zip code areas 46360 and 46350. The community ranks last in the state in health behaviors and is identified in the County Needs Index as a medically underserved area with a critical shortage of mental health providers. The project connects with the environmental context and aims to increase capacity for mental health services to address ACEs via interdisciplinary and cross sector collaboration that aligns with Grand Challenge recommendation two. The Robert Wood Johnson County Health ranking report (2018) indicates that twenty-two percent of youth in this community are neither in school nor working and are considered disconnected youth in comparison to the state average of fourteen percent. Unpublished raw data (2019) from the school corporation identify seventy-seven percent of the students as low income Running head: CAPSTONE PAPER 10 based on free and reduced lunch status. Budget cuts within the school system in 2010 resulted in the total elimination of school social workers and resulted in an absence of a safety net for students considered most vulnerable. Trauma-rooted coping responses in a school setting may manifest as behavioral problems and result in exclusionary discipline for those youth who lack access to mental health support. According to Redford and Pritzker (2016), students with high ACE scores may operate on fight or flight mode and demonstrate inappropriate coping responses that affect school success that can be ameliorated by the integration of trauma informed practices. Teasley (nd) articulates the need to overhaul student services practices and the discipline disproportionality of African American students in the Grand Challenge working paper. Hawkins et al. (2015) addresses proactive prevention in universal, selected and indicated programs to address social inequities and behavioral health problems in children. 3. Social Significance A greater percentage of Indiana children (52.3%) have experienced at least one ACE in comparison to the U.S average (47.9%) according to the National Survey on Children's Health (2012). The American Academy of Pediatrics (AAP) indicates the prevalence of mental health problems in over twenty percent of youth and cite school-based programs as a means of improving access to mental health services and ameliorating barriers of provider shortages, stigma, transportation, and costs to parents. The AAP Policy statement on Out of School Suspension and Expulsion (2013) describe the counterproductive effects of out of school suspensions and exclusionary discipline and the failure of school systems to address the causes of behavior problem that may be rooted in trauma. Skiba et al (2014) discusses the impact on African American students and the use of exclusionary Running head: CAPSTONE PAPER 11 discipline that has prompted national dialogue. Expanded school based mental health services have however demonstrated improvement in discipline, suspensions, and attendance as compared to treatment as usual services Ballard et al (2014 ). An estimated 4,371 students enrolled in the school corporation in the 2018-19 school year face a greater incidence of traumatic stress exposure and high ACE scores. Without access to mental health support to address this exposure, emotional regulation is compromised and healthy youth development is impacted. Unpublished raw data internally retrieved and analyzed for the year one pilot site at the high school reflect significant local discipline disparities whereas students of color faced or more than three times the exclusionary discipline in comparison to their white peers. School climate, discipline practices, mental health, and exposure to trauma have not been addressed by the school system prior to the initiation of the capstone in spring 2018. The proposed strategy is consistent with the AAP recommendation for school-based mental health services. The strategy convenes key stakeholders in the development of a community infrastructure to provide mental health support to guide the development of healthy coping skills. The strategy seeks to disrupt programmatic silos and community norms to shift the paradigm from discipline as punishment to discipline as guidance in anticipation of improved emotional well being, improved school discipline, and a reduction in discipline disparities. The multi-tiered strategies included in the implementation plan will be scaled throughout the school corporation within three years increase access to mental health services within the pilot sites for students who have encountered ACEs that compromise their healthy development. It is considered socially significant as it fosters relational support and access to mental health services previously not available to support healthy development and represents a social justice imperative for schools and communities to orchestrate trauma-informed services and healing or otherwise relegate youth who Running head: CAPSTONE PAPER 12 have encountered ACEs to an educational caste system that impacts future health, mental health and social outcomes. 4. Conceptual Framework with Logic Model and Theory of Change The logic model as depicted in the attachment represents a graphic representation of the capstone pilot that will be introduced at the high school in year one, the two middle schools in year two, the eight elementary schools in year three. It is included in the attachments and will continue to be refined to provide a graphic representation of the program's components, inputs, strategies, and expected outcomes to improve the mental health and emotional well-being of students as measured by the SAEBRS universal assessment, PHQ-9 Adolescent, and SSET and CBITS pre post curricular assessments, and improve school climate as measured by school discipline records. At the individual level the theory of change is based on social learning theory, whereas children who have been exposed to ACES may demonstrate emotional dysregulation and poor coping skills however is based on a premise that social behavior can be taught and new behaviors learned. The model also seeks to change behaviors in the relational dynamic among staff and students via professional development in ACEs, and Youth Mental Health First Aid and includes youth as Peer Mentors. Inputs include staffing resources of a contractual Program Administrator, BSW and MSW Social Workers, Social Work interns, Peer Mentors and Professional Development Trainers. Additional internal inputs include office and meeting space, furniture, office equipment, technology, and interdepartmental access to finance human resources, technology, and curriculum departments. External inputs offered as in-kind contributions include funding, resource materials, trainers, meeting space, and service on the community advisory board. Running head: CAPSTONE PAPER 13 Professional Development represents an integral strategy in the development of the human scaffold of support and includes training for fifty staff annually in ACE Interface, and Youth Mental Health First Aid and fifty youth in Teen Mental Health First Aid. During the three-year phasing process, leadership cohorts will attend the year-long Positive School Discipline Institute (PSDI). The PSDI leadership cohort will be responsible to translate trauma informed practices and changes in discipline policies in their respective buildings beginning in year one with the high school, year two at the middle schools, and year three in the elementary schools. Mental Health needs will be assessed through a universal screener assessment administered within the first 4 weeks of the school year and at the end of the school year. Based on the results of the Social Academic and Emotional Behavior Risk Screener (SAEBRS), the MSW Social Workers will obtain informed parental consent and triage service delivery based on identified needs through a Multi-Tiered System of Support (MTSS) framework. Tier 2 services will operate under the auspice of BSW Social Workers and may include Peer Mentor support and utilize the Support for Students Exposed to trauma SSET (non-clinical) group curriculum model to target approximately thirty percent of the enrollment. Pre and post assessments will provide a measure of change. In year one, tier two services will impact an estimated five hundred and ten students at the high school. Tier 3 Intensive services will target an estimated 10% of the enrollment or one hundred and seventy students at the high school level in year one and be facilitated by MSW Social Workers. School-based services for tier 3 will include weekly individual, family sessions and wrap around services utilizing the CBITS for grades five through twelve and the Bounce Back program for younger grades considered developmentally appropriate for younger children. Embedded CBITS pre and post assessments will measure change following the intervention. Running head: CAPSTONE PAPER 14 Outputs for mental health services include: the number of sessions held and the number of student participants receiving services as evidenced by service logs. Outputs for professional development include the number of participants trained in each activity and the percentage of staff in each building who participated in the training. As a result of the mental health supports, student outcomes will include increased knowledge of healthy coping skills, and social-emotional well-being that translates to behavior change and improved school behavior. As a result of the professional development in ACEs and Youth Mental Health First Aid, outcomes for staff include increased knowledge of trauma practices, ability to recognize student mental health concerns, and the ability to demonstrate greater relational behavior with students as evidenced by restorative practices and decreases in school discipline incidents. The theory of change is reflected in a proactive versus reactive model, via the use of assessments that facilitate the deployment of school-based services developed in response to periodic screening data. With informed parental consent, stratified tiers of scaled services will differentiate interventions and build capacity toward improved mental health, social emotional growth, and the development of healthy coping and strategies aimed toward increasing protective factors and decreasing risk factors toward the prevention of substance use. The Theory of Change is also reflected in Social-Ecological Theory included in the attachments and portrays the big picture which identifies the pilot phases and changes in practice at the individual student level, school level, district level, and community level, as well as the intent to innovate and scale the innovation and drive practice and policy at the state and national level. Running head: CAPSTONE PAPER 15 Area 3 Problem of Practice and Innovative Solutions I.Proposed Innovation and its effect on the Grand Challenge Significant bodies of research demonstrate the impact of exposure to adverse childhood experiences (ACEs) and traumatic stress on health, mental health, social, and behavioral outcomes that effect the Grand Challenge to ensure the healthy development of all youth. According to Chaundry and Wimer, childhood poverty is described as a vital indicator of how income and deprivation impact healthy youth development and future life success (2016). Children from low income backgrounds and students of color have been shown to face a greater incidence of exposure to traumatic stress that compromise healthy development Collins et al (2010). In the absence of critical mental health supports, this exposure may translate to unhealthy coping responses and school discipline issues. Soleimanpour, Geierstanger and Brindis (2017) indicate children who reside in low income households or distressed neighborhoods face a greater likelihood of ACEs but do not receive the services and support to ensure their healthy social-emotional development. The disproportionality of discipline of African American students is identified by Teasley (nd) in the Grand Challenge working paper and indicates the need to overhaul student services practice. The proactive power of prevention is addressed by Hawkins et al. (2015) who identifies childhood behavioral health problems and social inequities that can be prevented and indicates the importance of Universal, Selective, and Indicated programs. Mental health services are limited in the identified pilot community of Michigan City, Indiana due to a shortage of mental health providers and programmatic silos exist that without a collaborative infrastructure. Schools however have the primary opportunity to offer prevention and intervention programs and increase access to mental health services according to Ridgard et al Running head: CAPSTONE PAPER 16 (2016). The reach of these disparate services can be exponentially magnified by linkages created within and across systems as articulated in the proposed innovation. The solution contributes to the Grand Challenge to ensure healthy youth development and addresses ACEs through the creation of a community infrastructure of services that disrupts programmatic silos, increases access to mental health services, and shifts the paradigm of discipline as punishment to discipline as guidance. The infrastructure was previously non-existent prior to the initiation of the capstone development. Professional development will help build the district's capacity to provide layers of support among staff and community members that interact directly with youth. The trainings aim to foster understanding of the importance of relationships in understanding adverse childhood experiences in support of trauma-informed interactions. Prior to the start of the school year, stipends will be offered for participation in annual summer professional development for fifty staff members in the evidence based, ACE-Interface trauma- informed curriculum and the Youth Mental Health First Aid certification course. Participants will include bus drivers, food service workers, clerical staff, coaches, and teachers who may be on the front lines in working with students. The training will equip them with understanding the importance of relationships, recognition of mental health concerns and referrals for intervention support. Fifty high school age youth annually will also have the opportunity to participate in two days of paid training during the summer prior to the start of the school year in ACEs and Teen Mental Health First Aid. Teen Mental Health First Aid helps young people identify warning signs among their peers in order to guide peers in seeking access to appropriate help. Youth trainees will then be recruited to serve in paid peer mentor positions during the school year. Running head: CAPSTONE PAPER 17 During the three-year phasing process, school leadership cohorts in the identified pilot sites will participate in monthly meetings in the yearlong the Positive School Discipline Institute and be trained in trauma-informed practices. The school-based leadership cohorts will guide the development of building level improvement plans for the integration of trauma informed restorative justice practices and changes in school discipline policies. The Social, Academic and Emotional Behavioral Risk Screen (SAEBRS) will be administered by school social workers to all students at the beginning and end of the school year as a brief universal screening assessment. The SAEBRS assessment will serve as an initial assessment instrument to identify students based on student mental health needs. Masters level social workers will secure informed parental consent and triage services based on identified needs via a three tier, Multi-Tiered System of Support (MTSS) framework composed of universal, selective, and intensive supports. Collateral assessments when indicated will include the Patient Health Questionnaire PHQ-9 Adolescent, multi-purpose assessment instrument to screen, diagnose, and monitor depression as well as assessments embedded in the SSET and CBITS curriculum. A multi-tiered system of school-based universal, selective, and intensive mental health supports will be phased throughout the school district pilot over the next three years beginning at the high school during the 2019-2020 school year, middle school in 2020-2021, and elementary schools in 2021-22. The innovative supports include youth as peer mentors, and mental health services triaged to create a human scaffold of relationships that disrupts the norm of traditional school guidance counseling and integrates social learning theory to guide the development of healthy coping behaviors. Peer Mentors from similar backgrounds will mentor identified students to reinforce social-emotional skills and resilience in spite of their life circumstances. The addition of grant funded contractual BSW and MSW Social Workers, and Social Work interns from area Running head: CAPSTONE PAPER 18 universities will provide case management, and school-based mental health counseling services in accordance with their licensure to increase access to mental health services and promote enhanced coping, self-discipline, and socio-emotional skill development. Tier one services are those universal supports available for all students and may include restorative practices, school-wide discipline initiatives, or classroom instruction in the Botvin Life Skills, social-emotional curriculum facilitated by the teacher or school counselor. Tier two and tier three services will require informed parental consent based on needs identified in the assessments. Under the auspice of BSW social workers, the Tier two services may include peer mentor pairings, brief behavior interventions, individual counseling and participation in the Support for Students Exposed to trauma (SSET), a ten session, non-clinical curriculum model. Tier two services with target an estimated thirty percent of the enrollment at each level and impact an estimated five hundred and ten high school students in year one. Tier three intensive services will be provided by MSW social workers assigned to serve those students demonstrating greatest need and target an estimated 10% of the enrollment at each level. In year one an estimated one hundred and seventy high school students may access services that include individual and family counseling, participation in the evidence-based, Cognitive Behavior Intervention for Trauma in Schools (CBITS) group curriculum and/or referral to wraparound community services. 2. Views of key stakeholders Capstone research and development became the catalyst for thirteen community visioning sessions that began in the spring of 2018 and included three sessions that specifically targeted middle school and high school age youth who were potential beneficiaries. Over one hundred and twenty stakeholders representing sectors of city government, higher education, business, community- based organizations, mental health providers, funders, youth serving organizations, Running head: CAPSTONE PAPER 19 culturally specific service entities, parents, youth, and the faith community joined as thought partners with school personnel and examined the problem from multiple perspectives. Stakeholders engaged in transparent discussions to strategically analyze the problems and social norms unique to the community and the school system from a configuration, history and actor dynamic. During each of the thirteen visioning sessions, participants analyzed qualitative and quantitative data considered social norms, and confronted the painful facts related to race, disproportionality, and implicit bias. A gap analysis identified provider shortages, limited access to mental health services, the lack of social workers, and limitations in the school corporation's student services program essential to address exposure to traumatic stress. Table talk conversations considered strategies and through a nominal group process, stakeholders identified priorities that were based on best practice research to inform the capstone development, integrate internal and external resources to reach the intended outcomes. Written memorandums of understanding from stakeholder organizations further demonstrate community ownership and pledges of in-kind contributions of $666,000 in time, talent, and resources. Critical stakeholder buy-in was then demonstrated through the formulation of a twenty-one, member Community Advisory group to support implementation, guide adjustments, and secure sustainable resources. With the school system as central to the backbone infrastructure these relationships are depicted as follows: Running head: CAPSTONE PAPER 20 3. Evidence and current context for proposed innovation Principal Investigators, Dr. Robert Anda and Dr. Vincent Felitti are credited with the landmark epidemiological study on Adverse Childhood Experiences sponsored by Kaiser Permanente. The study of over seventeen thousand, predominantly white, middle class, college educated participants provided evidence that adversities and exposure to traumatic stress during critical periods of brain development increased the incidence of physical, mental, social, and behavioral problems later in life. Later studies demonstrated associations with childhood exposure Running head: CAPSTONE PAPER 21 to traumatic stress and the development of unhealthy coping behaviors, negative health and mental health outcomes, substance use, domestic violence, suicidality, PTSD symptoms that effect healthy development. ACEs have historically been addressed reactively in child welfare, juvenile justice and in school discipline. In school settings where exposure to traumatic stress, may manifest as mental health or behavioral issues and reflected in disproportional exclusionary discipline and contribute to the school to prison pipeline. Redford et al (2016) highlights the trauma informed transformational changes of Lincoln high school in Walla Walla Washington and the subject of the documentary, Paper Tigers. Questions of urban replication are addressed by Tum Around for Children, a New York City's, non-profit, address in larger urban whose goal is to translate neuroscience research into classroom practice through professional development and curricula. Turnaround found that the common denominator for children who have experienced ACEs was poverty and have since expanded their efforts in Washington D.C. and Newark, New Jersey. Rossen and Cowan (2013) describe how schools however are uniquely positioned to address the complexity of exposure to traumatic stress on academic achievement, special education service, school discipline, graduations rates and the effect on school success and recommend a continuum of tiered mental health supports available to all students. Runion (2018) identifies a shortage of student support personnel that limit access to school-based services and describes the need for schools to establish a human scaffold and embed trauma-informed strategies into organizational practice. Runion discusses the role that all staff play in addressing AC Es and cites Dr. Bruce Perry of the National Child Traumatic Stress Network who articulates that a safe relationship is the most effective neurobiological intervention in addressing traumatic stress exposure. Running head: CAPSTONE PAPER 22 According to The Children's Policy and Law Initiative of Indiana (CPLI) 2016 Summit Report, there is growing national concern that calls for systemic change and educational reform that include trauma-infonned strategies. House Resolution #443 addresses the need to incorporate trauma infonned practice calls for federal programs and identifies urban school communities that include: Washington, California, Wisconsin, and New York that have demonstrated successful reform. Although eighteen states are considering legislation related to ACEs and trauma-informed professional development, curricula, school-based services, and policy changes have been integrated in other organizations, the capstone is innovative because it proactively engages community stakeholders and youth as beneficiaries in the development of the operational design and cross sector implementation and disrupts the top down discipline paradigm from punishment to discipline as guidance. The Michigan City Area Schools and the Michigan City Community represent a strong opportunity for the implementation of the innovation as evidenced by the organizational, political and financial support. The administrative support is articulated by the Superintendent as indicated in the prototype transmittal letter, in-kind contributions of $666,000 from stakeholder organizations and $338,500 in secured annual funding for the next two years. The innovation will operate under the auspice of the DSW Candidate who has been affiliated with the school system and community for over thirty years. The DSW candidate will serve as Program Director and maintain relationships with stakeholders and funders as part of a contract addendum to her job responsibilities. 4 Comparative assessment of opportunities for innovation According to Nelson, (2018), innovation is defined as advancement, disruption, process, and behavior change. The solution advances access to trauma-infonned mental health services, Running head: CAPSTONE PAPER 23 and disrupt internal and external organizational processes. The proposed solution strategically links professional development, access to service delivery, critical school-based mental health services and mentoring to create a human scaffold of support to facilitate individual and organizational behavior change. Implementation will be scaled districtwide in three years, and piloted at the high school in year one, at the two middle schools in year two, and the eight elementary schools in year three. The innovation will serve as a practice model for state replication and policy change through the Indiana School Mental Health Initiative as well as national replication through the National Child Traumatic Stress Network and the Substance Abuse Mental Health Services Administration. The solution is innovative because it engages youth as potential beneficiaries from the onset as part of the solution and utilizes a peer mentor model to engage youth in a meaningful way as part of the implementation strategy. The innovation further diffuses leadership responsibilities to members of Positive School Discipline cohorts beginning in year one at the high school who will be tasked as in-house trainers to coordinate monthly afterschool staff training on trauma informed skill development, restorative justice, and guiding changes in school discipline practice. Finally, it serves to transform the community perceptions of the school system and how it disrupts a deviant norm to creates relationships that support all children as the predominant norm. 5. Innovative Solution links with the logic model and theory of change The theory of change represents the big picture vison to cultivate community capacity to increase access to mental health support to address the problem of adverse childhood experiences. Michigan City Area Schools represents the backbone in the development of a community infrastructure for trauma informed practice via leveraged resources, and professional development for staff and community members who directly interact with youth. Perry describes a safe relationship as the Running head: CAPSTONE PAPER 24 single most powerful neurobiological intervention in addressing the exposure to traumatic stress and thus the intent is to input professional development to train adults including bus drivers, secretaries, food service workers, coaches, teachers, and youth to understand the power of relationships in helping foster resilience in youth and acquire the skills to identify and intervene in a mental health concern. This training will allow the school corporation to build the human scaffold of relationships and support healing in over four thousand children enrolled in the Michigan City Area Schools who have experienced exposure to traumatic stress that compromises their healthy development. The innovation will be piloted over the next three years in the school system and local community, as a model for replication and to drive state and national policy and practice through the Indiana School Mental Health Initiative, the National Child Traumatic Stress Network, and the Substance Abuse and Mental Health Services Administration. At the state level, the DSW Candidate as Program Director serves as a representative on the Indiana School Mental Health Initiative, provides informational sharing at regional meetings, and will present the innovation to participants from across the state at the February 2020 state conference. The DSW candidate will also present the capstone innovation at the Community Anti Drug Coalition of America's National Leadership Forum in February 2020. The theoretical framework follows a public health approach and embraces components of Social Leaming Theory, whereas at the individual student level based on needs identified in a universal assessment, new learning of healthy coping behavior can be developed with triaged levels of tiered mental health support that provides school-based services to address the void in access to mental health care for youth participants who have been exposed to traumatic stress that may manifest as behavioral issues in the social context of a school setting and the impact oflifelong health and well-being that particularly for children and youth are determined by the opportunities they have. While the Running head: CAPSTONE PAPER 25 Michigan City community represents a microcosm of the challenges experienced in larger urban areas, the capstone innovation has been the catalyst for transparent dialogue with key stakeholders including youth as beneficiaries in designing strategies to address the challenges to mental health access and exposure to traumatic stress exacerbated by poverty that are experienced by our students. One hundred and twenty stakeholder participants included representatives from the following: Community Mental Health Center, Non-Profit Organizations, Social Service Providers, Youth Serving Organizations, Area universities, City Government, Juvenile Probation, Courts, Culturally specific organizations, Faith community, School Administrators, Counselors, Teachers, Parents, and Youth. The DSW Candidate will serve as the Program Director and has the established network of professional relationships at the community, state, and national level to ensure successful implementation and sustainable funding. The innovation has already begun to be incrementally addressed as a result of partial funding and will operate under the leadership of the DSW Candidate who has been affiliated with the school system for over thirty years. The likelihood of success is demonstrated by written memorandums of understanding that demonstrate contributions of time, talent and resources. The level of buy-in from key stakeholders was viewed as critical to funders to secure the financial support for professional development and partial staffing and provides indication of political, operational and fiscal feasibility for successful implementation. The Social-Ecological theory diagram depicts the phases and impact in how the innovation will be scaled. Running head: CAPS TO E PAPER An e ti mated 4.371 MC S youth, grades K-1 2, have unmet mental health need . National Policy Recommendations for Natk~ull Poli~· l • H R. 11 09 IN Dept. of Education Recomm,nd:ihon. , I~ ~1Jm.-, P olo~ State Organization i.clndiana HB 1 ~21 addendum Ifilm Overall impact: Access to Servi es Emotional well- being School Climate Discipline Community 8 Elementary Schools 2 Middle Schools Michigan City High School Individual DSW candidate serves a the Program Director - is currently representative of the Indiana State Mental Health Initiative that focuses on youth mental health in collaboration with Indiana University. Micltigan City, IN Y= 3 2021-2021 YOlr2 2020-2021 Yearl W1 9-2020 i ii ii ii i 26 8 Running head: CAPSTONE PAPER 27 AREA 4 PROJECT STRUCTURE AND METHODOLOGY I.Description of Capstone Deliverable/Prototype The Capstone Prototype included in the attachment was a grant application submitted to the Indiana Department of Mental Health and Addiction (DMHA). Funding was requested in the amount of $200,000 annually for the next two years to support costs associated with professional development that builds staff and community capacity, a portion of the program administration costs, and staffing for implementation with two bachelor level social workers and two master's level social workers as independent contractors. Social work efforts will focus on students identified with the greatest mental health needs and part of an overall school-based mental health and substance abuse prevention continuum. The BSW and MSW Social workers represent the professional knowledge base essential to integrate the Tier 2 and 3 evidence-based trauma informed mental health support based on the assessments. SAMHSA's National Survey on Substance Use and Health (2016), demonstrates the current prevalence of mental illness is higher in Indiana than the nation, and only 41.8% of those receive treatment, whereas only 15.2% of those with an illicit substance use disorder receive care. Without critical support to mitigate the risk factors, poor adaptation to traumatic stress on parental or family functioning has an exponential risk for children who may develop substance use, emotional or, behavioral problems unless prevention efforts are put in place that address the root cause of the problem. In the Michigan City Area Schools over four thousand children are estimated to have been exposed to ACEs and are thus considered at risk. This exposure has been shown in the research to effects healthy and mental health outcomes, healthy youth development and future life trajectories. Running head: CAPSTONE PAPER 28 SAMHSA's strategic prevention framework (SPF) has evolved to assess capacity and plan for shared professional development and embed the foundational pillars of trauma-informed practice and school based mental health access in the development of a human scaffold of relationship support through funding requested from the Indiana Department of Mental Health and Addiction. Funding of this proposal provides the social justice opportunity to utilize evidence-based approaches to provide professional development and integrate a multi-tiered system of support to increase mental health access, and prevent substance abuse in a vulnerable, diverse, and health disparate youth population that are served in the public-school corporation. This funding will address adverse childhood experiences and mental health access particularly as it relates to the prevention of youth substance use. These dollars will support implementation in the initial pilot site at the high school and be leveraged to secure other funding streams to support full scale operationalization over the next three years .. According to SAMHSA, research indicates a strong correlation between exposure to traumatic stress and adverse childhood experiences and risk factors related to substance use. The inability to adapt to traumatic stress impacts early initiation to illicit substances and is considered a coping response that affects schools, families, and juvenile justice systems. Increased exposure to traumatic stress, access to illicit substances, low perception of risk and attitudes toward use are characterized by limited hope and aspirations for many Michigan City youth. 2. Comparative Market Analysis A comparative market and gap analysis for LaPorte County, Indiana revealed information from the Robert Wood Johnson Foundation's County Health Ranking report (2019) that revealed the county ranks ninety- two out of all ninety-two counties in health behavior. Compounding the issue of mental health access is a significant shortage in La Porte County of other community Running head: CAPSTONE PAPER 29 mental health providers that is evident in the ratio of l: 1160 as compared to the state ratio of l :670 as indicated in the Robert Wood Johnson Foundation County Health rankings report (2019). Critical community needs in the geographic zip code areas of 46360 and 46350 served by the Michigan City Area Schools is demonstrated based on national indicators in the community Needs Index from Dignity Health. According to Webb (2018), the Community Needs Index, a planning tool available to communities from Dignity Health denotes the health and structural indicators and severity of health disparities and access to needed resources. Qualitative reports from listening sessions indicate that the shortage of local providers can result in waiting weeks and even months for an appointment for a student for mental health services. Transportation, costs, parent work schedules, lack of health care coverage, and a limited number of providers willing to accept Medicaid reimbursement further exacerbates the problem of access to quality evidence based mental healthcare. In 2010 the school corporation encountered massive budget cuts that led to the elimination of all school social workers available to serve general education students. Mental Health concerns are further compounded in the school corporation by the ratio of school counselors to students of 1 :312, and higher than the 1 :250 ratio recommended by the American School Counselor Association (ASCA). This ratio is exacerbated with an estimated 50% of the counselor's time spent in non-guidance counseling duties or a true ratio based on a time and effort analysis is 1 :624, that include state test administration, building leadership meetings, crisis response and when necessary filling in for the Principal or substituting in classrooms. In consideration of the aforementioned concerns and analysis of the market for the proposed innovation, there are no other options available to youth. Like a Tale of Two Cities the Running head: CAPSTONE PAPER 30 wealthy summer beachfront homes that dot the shores of Lake Michigan are in sharp contrast to the life circumstances where students face greater exposure to traumatic stress. As such, an estimated 4,371 students enrolled in grades K-12 in the school corporation face an increased incidence of exposure to adverse childhood experiences (ACEs) and may not be able to get the support they need to ensure healthy development thus making this proposed innovation a social justice imperative. 3. Project Implementation Methods Project implementation reflects organizational and community support and funding that has been partially secured to address outcomes related to improvements in emotional well-being as measured by the SAEBRS, PHQ-9 Adolescent, and the embedded assessments that are part of the SSET and CBITS group curriculums and improvements in school climate as measured by school discipline records. Outputs include the number of sessions provided by BSW and MSW Social Workers that have increased access to school based mental health support, the number of staff trained and changes in school discipline policies. A key obstacle to implementation includes sustainable funding. Indiana ranks 47 th in the country in funding for education and in 2010 the district was forced due to budget cuts to eliminate social worker positions, thus necessitating the need to secure grant dollars in support of program initiatives and to fulfill the requirements of unfunded state mandates. Although the school system is anticipating a tax referendum in 2020 to support student services, it is acknowledged that there is not a guarantee that a referendum will be passed by voters. From the onset of the capstone development funding and sustainability has been a consideration and through the community visioning sessions have secured written commitments of in-kind contributions and the development of a Community Advisory group that will help support access to sustainable financial Running head: CAPSTONE PAPER 31 resources. In addition, the DSW candidate as Program Director has submitted multiple grant applications as evidenced by the attached prototype to DMHA. Mental health provider shortages also represent a critical obstacle that will be addressed through the use of full time BSW and MSW Social Workers who will be hired as independent contractors at hourly rates higher than the community market rates. Clinical supervision in this community is generally not available because of the time commitment of the clinical supervisor or comes at a significant cost to the prospective licensee. To incentivize these positions, they will also be offered weekly clinical supervision for advanced licensure with the DSW Candidate who is a Licensed Clinical Social Worker (LCSW) and will serve as the Program Director. The mindset of some staff members who subscribe to a punitive discipline philosophy in spite of a child's trauma circumstances represents an additional challenge as they may refuse to change their classroom management practices and may be reflective of implicit bias This will be addressed through participation in professional Development on ACE-Interface curriculum which addresses restorative justice, bias, and trauma-informed practices. In addition, leadership cohorts that include teacher peers will participate in the Positive School Discipline Institute, professional development and curricula resources on implicit bias to increase awareness of how trauma impacts learning and classroom management support that empowers staff with restorative practices. Foundational professional development for administrators, instructional, student services personnel, community members and high school age peer mentors will be offered during the summer months will guide enhanced understanding of the work necessary to change social norms and integrate trauma informed perspective identification and services based on the social emotional needs of students. The provision of training will foster understanding of the importance of relationships and integrate neuroscience research into school and community practice. Unique Running head: CAPSTONE PAPER 32 to this proposal is an intent to train support personnel including bus drivers, food service workers, clerical staff, and high school age youth and also incorporate two days of summer 2019 professional development for all new teaching staff as part of their overall orientation that include certification in the evidence based Youth Mental Health First Aid, and ACE-Interface programs. Peer mentors who have successfully demonstrated the resilience to overcome their own adversities. The SAEBRS, a brief universal assessment will be administered at the beginning and end of the school year to help identify and triage student mental health supports through a three tier, Multi-Tiered System of Support (MTSS) framework composed of universal, strategic, and intensive social-emotional supports in tandem with academic interventions. Collateral assessments will include the PHQ-9 as indicated. Based on assessment results, the MSW Social Worker will triage Tier 2 selected services facilitated by BSW Social Workers, s Social Work Interns and Peer Mentors and Tier 3 Intensive services facilitated by MSW Social Workers. In year one, an estimated 510 high school students who have been identified based on screening assessments and have informed parental consent, will have access to Tier 2 Strategic services. Tier 2 services will be provided by BSW social workers that may include individual counseling, Peer Mentoring, and participation in the evidence-based Student Support for Exposure to Trauma (SSET) ten session curriculum. An estimated 170 students who have been identified based on the universal screening, ancillary assessments and informed parental consent, will have access to Tier 3 Intensive Services facilitated by MSW social workers that may include individual counseling, Peer Mentoring, and participation in the evidence-based Cognitive Behavior Intervention Trauma Support (CBITS). The CBITS curriculum includes ten group sessions, individual sessions, two parent sessions and one teacher session. The aforementioned model will be replicated in the middle schools in year two and in the elementary schools in year three for Running head: CAPSTONE PAPER 33 students in grade 5. Based on the CBITS, the Bounce Back program represents a developmentally appropriate trauma curriculum for students in younger than grade five. At full scale implementation during the 2021-22 school year, Tier 1 Universal prevention support will be available for 5601 students through evidence-based programs facilitated by counselors that include Botvin Life Skills, and Project Alert. Tier 2 services facilitated by BSW Social Workers will target approximately 30% of the enrollment or 1680 students. Tier 3, intensive services will be facilitated by MSW Social Workers and target an estimated 10% of the enrollment or 560 students. Tier 3 services include weekly individual, family sessions and wrap around services utilizing the evidence-based, Cognitive Behavior Intervention for Trauma in Schools (CBITS), and CBITS Bounce Back model for younger students. When indicated, the Screening for Brief Intervention and Referral to Treatment (SBIRT) will be utilized to support referrals to community- based services. The management plan is designed to ensure effective and efficient implementation with sufficient decision-making authority and access to the corporation's Executive leadership team. The program will operate under the auspice of the DSW Candidate/Program Director who works out of central administration offices. The proposed Program Director is an experienced education administrator, who is licensed by the Indiana Health Professions Bureau as a Licensed Clinical Social Worker and is a current DSW candidate orchestrating the development of these efforts. Rather than hire an employee, this individual will provide program administration as a grant funded addendum to their contract for the additional coordination and implementation duties in accordance with established benchmarks and timelines. Duties will include clinical supervision, fiscal management, data collection, internal evaluation, reporting, capacity building, reporting, Running head: CAPSTONE PAPER 34 staff and intern supervision, fidelity, and sustainability planning and as the liaison with the community advisory board. The management plan is designed to ensure effective and efficient implementation for the program reflects in-kind organizational support that includes administrative office space, equipment, supplies, secured record storage, and clerical support at the central school administration building as well as specific expertise from the Curriculum, Business, Technology, Media, and other ancillary departments. Established fiscal management protocols are monitored by the Indiana State Board of Accounts audit process and include approvals of purchase orders expenditures aligned with approved budgeted line items. The school corporation's administrative leadership team meets weekly and this provides a communication and decision-making mechanism among all departments. The Community Advisory Group will meet quarterly to guide the implementation process and evolved from the thirteen community visioning sessions. The group is reflective of the diversity of the community and is composed of twenty-one key stakeholder representatives including community members, providers, staff, parents and youth. Their commitment to serve in this capacity is indicative of the support for the efforts and the willingness to disrupt programmatic silos. The value of their volunteer time is calculated as an in-kind contribution at the established IRS volunteer rate and will be used to support match requirements that may be indicated by funding sources. The advisory group will support efforts as a model for replication and work to sustain and scale efforts throughout the district and state with an intent for the anticipated successful outcomes to drive practice and policy efforts. The following organizational chart depicts the organizational hierarchy and interrelationships between the school corporation and coordinating components as well as the relationship of the Community Advisory group. Running head: CAPSTONE PAPER Grant F unded Pos1 ens Ch.ef Business 1cer Year 1 -1 2 Colege & career C . ector of CU um Progr am Coord nalton Superv1Sor OS· N :1"' e1:t ·.; urs Hioh School Commu Based s rr/ Gr u p 8 HS Counselor 21 members • o nteer 2BSWs 2 Ws 8 Peer Mento,s 2 BSW Lev e l Social Worl<ers 2 M S W Lev e l Social Worl<ers C:·:m:..J -2F": 8 Peer MentolS Worl<ers 4 -ASW Le e l Sooal Worl<ers I " ·.~..1. 3 F: C 'Kl 4. Financial Plans and Staging Worl<ers 8 MSW Level Socia l Worl<ers 35 Established financial practices are governed by the Indiana State Board of Accounts in accordance with generally accepted accounting principles with funds subject to annual financial and program audits. The organization operates under the auspice of an elected Board of School Trustees who approve all monthly expenditures. based on the state budget cycle of July 1, 2019 to June 30, 2020. The identified Year 1 capstone budget is $ 278,784 a pilot at the high school and is. A total budget to implement the program over three years throughout the school corporation of Running head: CAPSTONE PAPER 36 $2,505,2 16 is contained in the attachments. Current enrollment is 5480 students and represents a three year per pupil investment cost of $457 .16 during the full three years of implementation. (Total 3year budget $2,505,216/5480). In relation to unaddressed trauma the lifelong costs of unemployment and costs to society including billions in lost earnings welfare costs and medical and prison expenditures if trauma and mental health needs are unaddressed. Budget for Year 1 Pilot at Michigan City High School Year 1 Budget Year 1 Building a Trauma Informed Community in the Michigan City Area Schools Pilot at Michigan City HS A. Personnel A. Peer mentors $11,520 (8 mentors X $8/hour B. Summer Training Stipends for ACE Interface & Youth X 5hrs/wk. X 36 wks.) Mental Health First Aid 50 @ year B. $30,000 stipends (50 staff X 3 days X 200/day) $10,000 Youth stipends (50 Youth X 2 days X 100/day) C. Fringe- FICA .0765 $2,295 - stipends $765 - Youth stipends $881.28 - mentors D. Travel - E. Equipment in-kind technology $3000@ X 4 = $1 2,000.00 F. Supplies $4,000.00 G. Contracted Services Michigan City HS 2 BSW X1330 X $27 = $71,820.00 2 MSW Xl330 X $41 = $109,060.00 YMHF A Facilitator Fee $800/day X 6 = $4,800.00 YMHFA Teen Training Facilitator Fee $800/day X 4 = $3,200.00 Program Director 450 hrs. X $50 = $22,500.00 H. Other-Space-in-kind $8,000.00 ($2,000(a),vr) Total DMHA Request submitted March 2019 $200,000.00 Total other funding TBD T otal Implementation Year I $278,784.48 5. Project Impact Assessment Methods The project aims to orchestrate a community infrastructure that increases access to mental health support to address outcomes related to the socio emotional development of healthy coping Running head: CAPSTONE PAPER 37 behaviors, improved mental health, and improvements in school discipline. The Program Director will be responsible for internal data collection through the school system's data management system and has the assigned authority to access the information districtwide. Outputs include the number of staff trained and number of students accessing mental health related support services. Assessment methods will address the effectiveness of professional development activities on the outcome of improving school discipline climate and increasing staff understanding ofY outh Mental Health First Aid and ACEs in changing staff relational behavior in their interactions with students as reflected by improvements in school discipline. Evaluation will identify whether there is an attitude and behavior change in the fifty staff members who have participated in the summer professional development prior to the start of the school year as measured by comparisons in the number of staff- initiated discipline referrals between the spring of 2019 and post-training in the fall of 2019. The assessment methods will also identify if the professional development provided for fifty staff members links to a change in the overall numbers of school discipline referrals at the pilot school(s) in the semester following the training, if there are semester comparisons in discipline disparities and changes pre and post intervention in discipline referrals, for ethnic and gender demographic group in the identified pilot site (s). The overarching goal of the innovation is improvement in outcomes in the social emotional development and mental health of students, particularly those who have been exposed to traumatic stress through access to school-based and community services. This will be assessed via pre and post comparisons utilizing the standardized Social Academic, and Emotional Behavior Risk Screener (SAEBRS) assessment, from the beginning and end of the school year, the Patient Health Quesionaire-9 for adolescents, and instruments embedded in the Tier 2, Student Support for Running head: CAPSTONE PAPER 38 Exposure to Trauma (SSET) and Tier 3, Cognitive Behavior Intervention for Trauma in schools curriculum. The findings will be communicated to multiple audiences via multiple channels as identified in the communication plan. Activities that link to favorable outcomes will provide evidence to other urban school systems as to as an effective intervention for unaddressed exposure to traumatic stress and disrupt the negative mental health implications of ACEs through a community infrastructure of leveraged resources, professional development and tiered support Based on proven evidence of effectiveness, it is anticipated that the Capstone may then serve as a practice model for to drive policy and state and national replication. 6. Stakeholder Engagement Plan Thirteen different community visioning sessions during day and evening hours including one bilingually facilitated, invited community engagement "Investing in our most precious natural resource, our children. Investing in our in the development of the project innovation and secured students today creates tomorrow's leaders." Mayor Ron Meer the input of one hundred and twenty stakeholders reflective of the demographics of the community. The visioning sessions provided strong evidence of proof of concept and offered first person accounts of individuals and youth who reside in the community and experience the ramifications of urban poverty. Particularly insightful were the painful dialogues related to disparities among marginalized populations related to race that were further substantiated by the DSW candidate in analysis of exclusionary discipline data in the school system, whereas African American students experienced nearly three times the days in out of school suspensions compared to their white peers. Youth as potential beneficiaries were included in the planning process from the onset in three planning sessions at the middle and high schools and are incorporated in the operational Running head: CAPSTONE PAPER 39 design as peer mentors. Stakeholder participants included: Administrators, teachers, counselors, city government representatives, business leaders, postsecondary representatives, community mental health providers, social service agencies, youth-serving organizations, philanthropic foundations, cultural, and faith organizations, parents, and middle and high school students. Visioning sessions were facilitated by the DSW candidate and included table assignments so that each of the table talk conversations provided diverse stakeholder perspectives in considering the data, engaging in authentic dialogue, analyzing strengths, opportunities, weaknesses, and threats. Participants discussed gaps and provider shortages that limit mental health support to address youth exposure to traumatic stress, weaknesses in the current school counseling program, and disparities in underrepresented subpopulations of students, particular students of color. Participants developed and prioritize strategies via a nominal group process to create a shared vision and common language for a continuum of support to address the mental health and behavioral needs of students who have been exposed to traumatic stress. Participants further identified ways to leverage and braid resources and offered written Memorandums of Understanding indicative of commitments of $666,000 in in-kind support, that demonstrated evidence of community commitment in the pursuit of funding opportunities. These efforts systemically integrated community supported efforts aligned to the proposed project and leveraged Running head: CAPSTONE PAPER 40 internal and external resources to phase the interventions over the next three years beginning in year one at the high school. The nucleus of the Community Advisory group includes youth representative and is reflective of the community demographics evolved from the group of initial stakeholder participants. The advisory group will meet quarterly to review data, make programmatic adjustments, build capacity for sustainability and communicate with other community members on progress in achieving individual, school, and organizational outcomes. 7. Communication Strategies and Products The Program Director will generate capstone communication products including monthly and quarterly reports sharing successes and challenges though multiple communication channels and with multiple relevant audiences. Monthly and quarterly written reports will be shared and discussed with the Community Advisory group and district level Administrators during regularly scheduled meetings. The Community Advisory group will have the opportunity to provide input and make recommendations for program adjustments. The community stakeholders will assist in transferring the information to others in the community in manageable language respective of language and literacy levels of various audiences. The communication plan includes translation of key reports and infographics in a language that all can understand with documents translated into Spanish to accommodate non-English speaking residents. Youth involved in the Community Advisory group will be encouraged to utilize multiple strategies to further disseminate messaging to effectively reach their youth peer groups and to encourage peer participation in Teen Mental Health First Aid training. Youth Advisory representatives will also help to facilitate Public Service Announcements on local radio channels. Running head: CAPSTONE PAPER 41 The hallmark of the capstone communication plan is the embedded priority of Cultural Competence that not only takes into consideration ethnicity, education, culture, language and literacy levels of various demographic groups, but who, what, when, how and why we communicate and visually depict the various ethnic, religious, socio-economic, age, gender, family compositions, and sexual orientations so that the target audience perceives representative inclusivity. Knowing that various community constituent groups may not necessarily represent a traditional family unit or middle- class norms, visual depictions will also include single-parent, multi-ethnic, custodial grandparents, same sex couples, as well as emancipated youth. In recognition that high poverty and non-English speaking stakeholders may have limited technology access an essential part of the communication plan is to customize the communication methodology utilizing multiple means with sensitivity to populations who prefer oral versus written communication. These methods will include traditional media, PSA's and infographic visual materials, social media as well as oral sharing of information by youth, peers, and other respected individuals indigenous to a particular community. Funding sources and the Board of School Trustees will be presented a summative evaluation reports at the conclusion of the school year. Oral presentations made to constituent groups will reflects progress on outcomes during their final monthly public board meeting at the end of the school year. Community members are invited to attend in the public meeting held in the evening on the last Tuesday of the month. Community stakeholder presentations will also be scheduled during daytime hours at the high school and in a centrally located public area accessible by public transportation. The DSW candidate will work to communicate the capstone as a model to address problems of practice through various professional organizations. As a representative of the Indiana Running head: CAPSTONE PAPER 42 School Mental Health Initiative, the Capstone project will be shared with seven hundred school personnel, administrators, and mental health providers at the annual state conference in February 2020. The project Building a Trauma-Informed Community was also recently selected for a February 2020 training presentation at the National Leadership Forum sponsored by SAMHSA and the Community Anti-Drug Coalition of America (CADCA). The Leadership Forum draws over twenty-five hundred participants from throughout the United States as well as some foreign countries. 8. Ethical Considerations The project will be initially implemented m the organization where I serve as an administrator and therefore engagement with an Institutional Review Board is not required. Ethical considerations however also include the need for written informed consent from the parent of guardian as well as implied assent indicative of the willingness of the youth participant in service. Because Social Workers are bound by a Code of Ethics and are mandated to report abuse or neglect, an ethical consideration is that there are times that upon learning of the investigation, the perpetrator who may be a parent may engage in additional abuse and then withdraw informed consent. Confidentiality represents another consideration and as such electronic records are to be maintained in password protected files, and paper copies secured in locked files with restricted access. AREA 5 CONCLUSIONS, ACTIONS, AND IMPLICATIONS I.Summary of Project Plans Running head: CAPSTONE PAPER 43 The Michigan City Area Schools has facilitated the development of an infrastructure that brings together multiple sectors reflective of community in effort to address community challenges, eliminate programmatic silos and address the mental health needs of youth. In light of a shortage of providers, these disparate services through linkages created within and across systems can be magnified exponentially to improve the social-emotional well-being of students in our community. The school system operates on a July 1st to June 30 th fiscal year and has secured in-kind contributions and grant funding to support phased implementation beginning with the 2019-20 school year at the high school and is indicative of a strong opportunity for innovation. In year two training and services will be implemented at the two middle schools, and in year three, the eight elementary schools will be added with the project innovation taken to full scale in three years. Summer professional development in Youth Mental Health First Aid and ACE Interface began in July 2019 with implementation of programs and services to occur in year one at the high school during the 2019-2020 school year and in subsequent years at other levels. A leadership cohort from the high school has been identified and is also scheduled to participate in the yearlong Positive School Discipline Institute that focuses on trauma informed practice during the 2019-20 school year. The SAEBRS, universal assessment administered within the first month of the school year provides an assessment baseline to determine student needs and triage tiered services among BSW and MSW Social Workers. This framework will be replicated in the middle schools in year two and in the elementary schools in year three. Consistent with socio-ecological theory this model will be scaled system wide in three years and begin in the high school in year one, middle schools in year two, elementary schools in year three and serve as a model for state and national replication. 2. Current Practice Context for Project Conclusions Running head: CAPSTONE PAPER 44 ACEs have been shown to impact health, mental health, and social outcomes across the life span. This exposure may alter brain development and lead to unhealthy coping responses that result in school behavioral issues that represent a neurobiological response hardwired into brain development. Children in poverty and children of color have been found to face greater exposure that may lead to the development of poor coping skills behavioral issues and disparities in discipline. In the absence of critical mental health support to guide the socio-emotional development, these children are relegated to an educational caste system that alters future life trajectories and opportunities for success thus perpetuating the intergenerational cycle of ACEs. Schools are ideally positioned to intervene and foster an innovative, trauma informed, human scaffold of mental health supports, and translates the neuroscience research into classroom and community practice and builds on the power of relationships identified as the most powerful neurobiological intervention by Dr. Bruce Perry from the National Child Traumatic Stress Network. 3.Project Implications for Practice and Further Actions The model will be scaled throughout the school system within three years and shared throughout the state of Indiana through the Indiana School Mental Health Initiative list serve as well as presented at the annual School Mental Health state conference in February 2020 and nationally via SAMHSA, CADCA, and USDOE channels as a practice model for scaled replication. Because of the strong predictive relationship between ACES and substance use, the model will be further aligned with the efforts of the LaPorte County Drug Free Partnership coalition to orchestrate and implement a Trauma Informed Recovery Oriented System of Care (TI-ROSC) strategic plan for the community. In addition, the project will be presented as a training at the Running head: CAPSTONE PAPER 45 SAMHSA and CADCA's National Leadership forum in February 2020 in Washington, DC. The event is attended by over twenty-five hundred adults and youth from across the country. 4.Project Limitations Funding, provider shortages, and the use of Social Workers as independent contractors represent obstacles to be addressed in implementation and sustainability represents a critical risk in light of budget constraints in the school system. A SAMHSA funding announcement SM-20- 004 however was recently released for the National Child Traumatic Stress Initiative that provides $600,000 annually for five years without a required match and is being considered for submission of an application. This funding is indicative of a trend to consider program efforts from a trauma informed lens. Relationships with area universities as field placement sites will provide the opportunity to utilize unpaid social work interns and recruit those best suited to work with our population of high-risk students upon graduation, as independent contractors to address provider shortages, at a rate higher than the current market and concurrently receiving weekly supervision toward licensure. The innovation has the organizational, political, and partial financial support n spite of the limitations we are optimistic that the project will demonstrate positive outcomes to provide strong justification for funding and sustainability within the organization. Running head: CAPSTONE PAPER 46 REFERENCES Anda, RF, Felitti VJ, Bremner JD, Walker, JD, Whitfield C, Perry BD, et al. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clinical Neuroscience 2006; 256 (3): (174-86). Ballard, K., Sander, L., & Klimes-Dougan, M. (2014). School-Related and Social-Emotional Outcomes of Providing Mental Health Services in Schools. Community Mental Health Journal, 50(2), 145-149. 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Baltimore, MD: Family Informed Trauma Treatment Center. http://nctsn.org/nccts/nav .do?pid=ctr _rsch _prod_ ar or http://f1ttcenter. umaryland.edu/WhitePaper.aspx. Community Needs Index (2018) by Dignity Health https://www.dignityhealth.org/about- us/community-healtl community-health-programs-and-reports Running head: CAPSTO E PAPER 47 Counts, Gillam Perico, & Egger . (2017). Lemonade for Life: A Pilot Study on a Hope-Infused, Trauma-Informed Approach to Help Families Understand Their Past and Focus on the Future. Children and Youth Services Review, 79, 228-234. Given , M. Genu o, K. Jovaag, A., Willems VanDijk J. (2017). County Health Ranking & Roadmaps: Building a Culture of Health, County by County. University of Wisconsin Population Health Institute. County Health Rankings Key Findings 2017. A Collaboration between University of Wi con in Population Health Institute and the Robert Wood Johnson Foundation. Hanger, Jau Nae, (2016) Leaders Collaborating to Advance Positive School Discipline in Indiana Summit Report and Recommendations, June 30, 2016. Hawkins J. D. Jenson, J. M. DeVylder, J., Catalano R. F., Botvin, G. J., Fraser, M. Bumbarger B. (2016 September). Policy recommendations for meetina the Grand Challenge to Ensure Healthy Development/or All Youth (Grand Challenges for Social Work Initiative Policy Brief o. l). Cleveland, OH: American Academy of Social Work & Social Welfare. Helping Children Cope with Violence: A School-Based Program that Works. (n.d.). RAND Corporation. Retrieved fromhttp://search.proquest.com/docview/1820869168/ https://www.rand.org/health/projects/cbits.html Lamont, J. (2013) American Academy of Pediatrics Council on School Health Out of School Suspensions and Expulsion Policy Statement, Pediatrics 2013;131 ;elO00, DOI: 1 0. l 542/peds.2012-3932 originally published online February 25, 2013. https://www.cahmi.org/project /adver e-childhood-experiences-aces/ National Children's Health urvey 2011-12. Running head: CAPSTONE PAPER Redford, J., Pritzker, K. (2016) Teaching Traumatized Kids. The Atlantic. https://www.theatlantic.com/education/archive/2016/07 /teaching-traumatized kids/490214/ 48 Ridgard, T. J., Laracy, S. D., DuPaul, G. J., Shapiro, E. S., & Power, T. J. (2015). Trauma informed care in schools: A social justice imperative. Bethesda: National Association of School Psychologists. Retrieved from http://libproxy.usc.edu/login?url=https://search proguest-com.libproxy 1 .usc.edu/docview/1731542953?accountid= 14749 Runion, M. (2018). The Infrastructure ofTrauma-Informed Schools Requires a Human Scaffold, Psych Learning Curve, American Psychological Association. http://psychlearningcurve.org/trauma-informed-schools/ Teasley, M., McRoy, R, ,Joyner, M, Armour, M, Gourdine, R., Crewe, S. Kelly, M. Franklin, C., Macheo, P, Jackson, J. Jr., & Fong, R. (n.d.). (2016) Increasing Success for African American Children and Youth (Grand Challenges for Social Work Initiative Working Paper No. 21). Cleveland Ohio: American Academy of Social Work and Social Welfare. Trauma Sensitive Schools, https://traumasensitiveschools.org. Webb, M. (2018) unpublished paper SOWK 706, Michigan City Area Schools (June 2018), unpublished raw data for out of school suspensions internally retrieved June 2018 Webb, M. (2018) unpublished paper SOWK 710, Assignment 1, October 2018. Webb, M. (2018) unpublished internal discipline reports retrieved October 2018. Webb M. (2019) unpublished internal discipline reports retrieved June 2019. Mendelson, Tamar, Tandon, S. Darius, O&Amp;Apos, Brennan, Lindsey, Leaf, Philip J., & Ialongo, Nicholas S. (2015). Brief report: Moving prevention into schools: The Running head: CAPSTONE PAPER impact of a trauma-infonned school-based intervention. Journal of Adolescence, 43, 142-147. 49 Nadeem, E. Jaycox, L. H., Kataoka, S.H., Langley, A.K., & Stein, B.D. (20 11). Going to scale: Experi~nces implementing a school-based trauma intervention. School Psychology Review, 40(4), 549-568. National S urvey of Children's Health. (2011/12) Retrieved from http://www.childhealth data .org https:/ /www .cahmi.org/projects/adverse-childhood-experiences-aces/ National Children's Health Survey 2011-12. Perry, B. D. (2006). The Neuro-sequential Model of Therapeutics: Applying principle of neuroscience to clinical work with traumatized and maltreated children. In N. B. Webb (Ed.), Working with traumatized youth in child w lfare {pp. 27-52 ). New York: The Guilford Press. Perry, B. D., & Hambrick, E. P. (2008). The neuro-sequential model of therapeutics. Reclaiming Children and Youth, 17(3), 38-43. Retrieved from http://libproxy.usc.edu/login?url=https://search-proquest com.libproxy l .usc.edu/docview/2 l 4 l 93 l l 6?accountid= l4749 SAMHSA 2014-2016 National Survey on Drug Use and Health National Maps of Prevalence Estimates, by Sub-state Region, SAMHSA, CBHSQ retrieved from SAMHSA.gov. prevalence estimates. Scala, P. D. (2015). Planning and implementing school-based mental health services: A website resource for school districts Available from ProQuest Central; Dissertations & Running head: CAPSTONE PAPER Theses Full Text; ProQuest Dissertations & Theses Global. (1685409930). Retrieved http://libproxy.usc.edu/login?url=https://search-proguest- com.libproxyl .usc.edu/docview/l 685409930?accountid=l4749. Skiba, R., Chung, C., Trachok, M., Baker, T., Sheya, A., & Hughes, R. (n.d.). Parsing Disciplinary Disproportionality: Contributions of Infraction, Student, and School Characteristics to Out-of-School Suspension and Expulsion. American Educational Research Journal, 51 ( 4 ), 640-670. doi: 10.3102/000283121454 l 670 50 Soleimanpour, Geierstanger, & Brindis. (2017). Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents. Academic Pediatrics, 17(7), S108-Sl 14. Taras, H. (n.d.). School-Based Mental Health Services. Pediatrics, 113(6), 1839-45. doi: 10.1542/peds.113.6.1839 Teicher, M.H, Scars that won't heal: The neurobiology of child abuse, (2002) Scientific American, 286 (3) 54-61. Teicher, M. H., Rabi, K. S., Sheu, Y. B., Seraphin, S. L., Andersen, S. M., Anderson, C., ... Tomoda, A. (2010). Neurobiology of childhood trauma and adversity. In The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic (pp. 112-122). Cambridge University Press. United States Census Bureau https://www.census.gov/guickfacts/fact/table/IN.US/PST045217 (July 1 2017) Webb, M. (2019) unpublished raw data for Free and Reduced lunch internally retrieved June 2019. Running head: CAPSTONE PAPER 51 Trauma Informed Practice Logic Model for Capstone Pilot by Michelle Webb Grand Challenge Ensure the Healthy Development of All Youth. Problem- Exposure to Adverse Childhood Experiences can impact health, mental health, social and behavioral outcomes Vision to create systemic change that increases access to multi-tiered mental health and counseling supports via professional development and a trauma informed human scaffold that translates neuroscience research into school and community practice. Pilot Phasing Michigan City High School- Grades 9-12, Enrollment 1700 in 2019-20, Middle Schools in 2020-21, and Elementary Schools in 2021-22. Theoretical Framework Social Learning Theory and Socio-Ecological Theo_l}I_ . Inputs I Activities I Outputs I Immediate Outcomes I Intermediate I Overall Impact Staffing --+- Universal Screener Program administrator Peer Mentors -+I # of participants served # of sessions BSWs & MSWs Individual & Group Counselors, . Support staff Counseling Peer Mentors SSET- Student exposed to University Interns Trauma 10 sessions Community Advisory CBITS= 15 sessions gr 5-12 City Govt. --+- CBITS Bounce Back 15 Higher Ed United Way Funders Boys & Girls Club Safe Harbor sessions for younger children % of staff trained --+- Increased access to mental health support --+ Outcomes Increased support response to trauma exposure --+- Improved coping skills--+t Improved school behavior --+- Swanson Center Samaritan Center Drug Free Coalition Parents/Youth ACE Interface Curriculum I # of participants who ---+-I Increased knowledge of I Improved Staff & student (8 hours) --+ complete the ACE training - J trauma informed prac~ Relationships --+- Increased knowledge of Improved emotional well being as measured by: SAEBRS- universal screener PHQ-9 Adolescent SSET CBITS Improved school climate as measured by school discipline records Improved qualitative report of support as measured by participant feedback. In-Kind & Financial Training Space- Youth Mental Health First Aid Training (8 hours) --+ Teen Mental Health First Aid (8 hours) # of participants who become certified in YMHFA & Teen Mental Health First Aid the warning signs of --+- Increase early --+ Improvement in #s of mental health concerns identification of mental student access to school Furniture Technology Equipment Funding intervention and referral health concerns. based mental health. --+ ACE Trainers # of participants who ~ Increased # of staff using -+- I Positive School Discipline I complete the Positive restorative practices to Institute (year long) --+ School Discipline Institute Handle discipline Improvements in Discipline policies --+ Improvement in use of trauma informed practice in lieu of exclusionary discipline YMHFATrainers- --+- Planning YEARl YEAR2 YEAR3 YEAR4 YEARS 2018-19 2019-20 2020-21 2021-22 2022-23 2023-24 Research & High Sl·hool +2 Middle +8 Diffuse State Diffuse Planning with Grades 9-12 Schools Elementary of Indiana United ACTIVITY Key Grades 7-8 Schools Dept of States Dept Stakeholders Grades K-5 Education & of Including Department Education Youth of Mental & Health SAMHSA l 2 3 4 l 2 3 4 l 2 3 4 l 2 3 4 Phase l RESEARCH & Planning Spring-Summer 2018-19 Research for Grand Challenge on ACEs for USC DSW program Research & data collection on mental health access, trauma and discipline including breakdowns of gender and ethnic disparities in Michigan City Area Schools Comparative Analysis Research programs that have been implemented elsewhere Planning Visioning Sessions- 13 community visioning sessions with 120 key stakeholders (one bilingually) including parents and youth. Nominal group process to prioritize strategies Secure in-kind Contributions & MOUS Formulate community advisory group Develop proposals funding • Lilly Endowment, • Indiana Dept. of Mental Health & Addiction • Healthcare Foundation of LaPorte • Duneland Foundation • Others TBD i.e. SAMHSA, Department of Education School Climate Transformation grant • Identify, leverage & braid internal & external fu nding PHASE 2 Summer 2019 Notification of funding, hiring, orientation, training & staff/community professional development. Replicate Year 2 & 3. Youth Mental Health First Aid Training Recruit, background checks hire BSW & MSW Social Workers Coordinate/Facilitate Orientation & Training of Social Workers Recruit, background checks hire Youth Peer Mentors Coordinate/Facilitate Orientation & Training of Peer Mentors Verify baseline data for target populations Establish protocol for data management, assessment, and evaluation Operationalize plans for administration of Universal Assessment within 4 weeks of start of school year Re-convene Advisory, review narrative, timeline, tasks, sustainability planning. Establish quarterly program review meeting schedule with Advisory Board Sept 2019, Dec. 2019, Mar. 2020, June 2020 Schedule leadership cohort to attend year-long Positive School Discipline Institute (PSDI) to learn Trauma Informed practice Develop a Sustainability plan and work to build additional capacity Oct-Nov and ongoing Coordinate Community Speaker schedule Counselor Topics Create Professional Development Calendar for Counselors during PLC time Oct - May I and ongoing Advertise Social Work & Peer Mentor positions, interview, criminal background check, hire & conduct orientation. Re-convene Community partners review narrative, timeline, tasks Operationalize MOU's as agreed, Establish program review meeting schedule with Advisory Board. ongoing Finalize subcontracts Phase 3 Social Workers facilitate SAEBRS Universal Assessment in first 30 days of school & EOY Social Workers obtain informed consent & triage mental health services based on assessment BSWs facilitate Student Support for Exposure to Trauma group for Tier 2 students - IO sessions MSWs facilitate Cognitive Behavior Intervention for Trauma in Schools (CB ITS) group for Tier 3 students- 14 sessions Peer Mentor Orientation & Mentee pairings Sept. Peer Mentors meet weekly with assigned mentees Data collection grading period benchmarks Data collection & Quarterly Progress report I 5 1 h of month for distribution to Advisory Board Annual Dec 30, Mar 30, June 30, & Sept 30 quarterly report deadlines. Prepare reports for funding source. Communicate outcomes to stakeholders. Celebrate semester and annual program success ACE Interface Summer Training - 50 annually Teen Mental Health First Aid Summer Training - 50 annually Comunicate Model Statewide IN School Mental Health Initiative - Feb. 2020 & Ongoing Communicate Model Nationally CADCA Nationally Leadership Forum - Feb. 2020 Building a Trauma Year I Year2- Year3 Total line item Informed Community Pilot at Michigan City Michigan City High Michigan City High in Michigan City Area HS School plus 2 Middle School,2 Middle Schools, Schools Schools plus 8 elementary schools A. Personnel- A. Peer mentors $320 A. Peer mentors $960 A. Peer mentors $960 $122,240.00 8. Summer Training (8 mentors X (24 mentors X (24 mentors X Stipends for ACE $8/hour X 5/hrs $8/hour X 5/hrs per $8/hour X 5/hrs per Interface & Youth per week) week) week) Mental Health First 8. $30,000 stipends 8. $30,000 stipends 8. $30,000 stipends Aid 50@year (50 staff X 3 days (50 staff X 3 days (50 staffX 3 days X 200/day) X200/day) X 200/day) $10,000 Youth $10,000 Youth $10,000 Youth stipends (50 Youth stipends (50 Youth stipends (50 Youth X2daysX X2daysX X2 daysX JOO/day) 100/day) 100/day) C. Fringe- FICA .0765 $2,295 - stipends $2,295 - stipends $2,295 - stipends $7,821.36 $765 - Youth stipends $73.44 - mentors $73.44 - mentors $24.48 - mentors D. Travel - - - $0 E. Equipment in-kind technology in-kind in-kind technology $132,000.00 $3000@X4= $3000@ X {4+8) = $3000@X (4+8+16) = $12,000 $36,000 $84,000 F. Supplies $4000 $120000 $28,000 $44,000.00 G. Contracted Services ,\ llchlgun Chy HS MC HS MCHS $2,040,280.00 2 BSW Xl330 X $27 2 BSW X 1330 X$28 = 2 BSW X 1330 X$29 = = $71,820.00 $74,480.00 $77,140.00 2 MSW X1330 X $41 2 MSW X 1330 X$42= 2MSW X 1330 X$43hr = $109,060.00 $111,720.00 = $114,380.00 2 Middle Schools 2 Middle Schools YMHFA Facilitator 4 BSW X 1330 X $27 4 BSW X 1330 X $28hr Fee $800/day X 6 = {m:w hin::)= = $148,960.00 $4,800 $143,640.00 4MSWX 1330X 4 MSW X 1330X $42hr = $223,440.00 YMHFATeen $4 1 @ {new hire) = 8 Elementary Training Facilitator $218,120.00 8 BSW X 1330 X $27 Fee $800/day X 4 = YMHF A Facilitator Fee hr (new hire) = $3,200 $800/day X 6 = $4,800 $287,280.00 YMHF A Teen Training 8MSW X 1330X Program Director Facilitator Fee $800/day $4lhr(new hire)= 450 hours X $50= X4= $3,200 $436,240.00 $22,500 YMHFA Facilitator Fee Program Director $800/day X 6 = $4,800 450 hours X $52.50= YMHF A Teen Training $23,625 Facilitator Fee $800/day X4= $3,200 Program Director 450 X $55.=$24,750 H. Other-Space-in-kind $8000 (2000@yr) $24,000 (2000~ yr) $56,000 (2000@yr) $88,000.00 Total $278,784.48 $694,913.44 $1,531,518.44 $2,505,216.36 Implementation Requ est Assessment Name: Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) Validated Purpose of Assessment Method Screening Diagnostic Progress Monitoring X Overview: The SAEBRS is a brief tool supported by research for use in universal screening for behavioral and emotional risk. The measure falls within a broad class of highly efficient tools, suitable for teacher use in evaluating and rating all students on common behavioral criteria (Severson, Walker, Hope-Doolittle, Kratochwill, & Gresham, 2007). The SAEBRS is designed for use in the K-12 setting. It is grounded within a conceptual model, which states that a student's success in school is not only related to his or her academic achievement, but also success within multiple behavioral domains. Research suggests the SAEBRS may be used to evaluate student functioning in terms of overall general behavior, as assessed by a broad Total Behavior (19 items). Research further suggests the SAEBRS may be used to evaluate student behavior within multiple inter-related narrow domains, as assessed by the Social Behavior (6 items), Academic Behavior (6 items), and Emotional Behavior (7 items) subscales. ____ 1 __ , , Social Behavior I I I Total Behavior I - L - Academic Behavior Brief review of validity and reliability evidence: - I Emotional Behavior To date, three studies have yielded evidence regarding SAEBRS reliability, validity, and diagnostic accuracy, with research conducted across elementary, middle, and high school settings (Kilgus, Chafouleas, & Riley-Tillman, 2013; Kilgus, Eklund, von der Embse, & Taylor, 2014; Kilgus, Sims, von der Embse, & Riley-Tillman, 2014). Please see below for a summary of internal consistency reliability coefficients (Cronbach's alpha), test-retest reliability coefficients (Pearson's r), criterion-related validity coefficients (Pearson's r), and diagnostic accuracy statistics (area under the curve [AUC], sensitivity [SE], specificity [SP]). Statistics either represent the sole statistic or range of statistics collected to date. Overall, initial findings yield support for the use of the SAEBRS in universal screening across the K-12 spectrum. Diagnostic accuracy results are particularly encouraging, with sensitivity and specificity values generally falling within optimal or acceptable ranges (i.e.,.::: .80-.90; Kilgus, Riley-Tillman, Chafouleas, Christ, & Welsh, 2014). Together, these findings suizizest that the SAEBRS might be used to reliably differentiate between at risk and not at risk students, with risk defined through gold standard measures (e.g., Social Skills Improvement System [Gresham & Elliott, 2008]; BASC-2 Behavioral and Emotional Screening System [Kamphaus & Reynolds, 2007]). Reliability Validity Dia1mostic Accuracy Internal Test-Retest Concurrent AUC SE SP Consistency Elementary School Social .89-.94 .79-.90 .90-.96 .81-.97 .83-.86 Academic .90-.92 .69-.86 .83-.94 .79-.91 .84-.85 Emotional .83 .72 .88 .90 .73 Total .93-.93 .61-.93 .95-.97 .89-.93 .81-.93 Middle School Social .93 .85 .96 .93 .85 Academic .92 .88 .95 .91 .83 Emotional .77 .69 .86 .86 .73 Total .94 .94 .99 .95 .92 High School Social .89 .41 Academic .93 .47 Emotional Total .93 .48 Note: Empty cells represent evidence not yet collected to date. Strength and Weakness: Primary strengths of the SAEBRS include its usability and contextual appropriateness, two characteristics identified as crucial in universal screening (Glover & Albers, 2007). • Usability � the SAEBRS is comprised of a small number of items that may be completed in 1-3 minutes for a single student. In addition, given psychometric support for both the SAEBRS broad scale and subscales, schools may choose to only complete those SAEBRS subscales that are relevant to their concerns and decision making. For instance, a school could choose to only rate students on Social Behavior and Emotional Behavior, thus reducing the number of items that must be completed for each student. • Contextual appropriateness � SAEBRS items correspond to categories of behavior found within the literature to be highly relevant to social and academic success in the early childhood, school aged, and adolescent stages of development (DiPema, 2006; Masten et al., 2005; Walker, Irvin, Noell, & Singer, 1992). These include categories of both (a) adaptive behaviors, including social skills, academic enablers, and emotional wellness factors, and (b) maladaptive behaviors, including externalizing behavior, internalizing behavior, and attentional problems. This balance between both adaptive and maladaptive is in accordance with recommendations from recent research, which has suggested that prosocial behavior and problem behavior each uniquely predict student behavioral outcomes, and are thus important in supporting early identification of behavioral and emotional risk (Kwon, Kim, & Sheridan, 2012). A weakness of the SAEBRS pertains to its relative novelty, having only been examined through three studies to date. As such, replications of previous work, as well as new research ( e.g., examination of diagnostic accuracy in high school), is necessary to yield full support for the SAEBRS within universal screening in school settings. Administration Steps: Teachers complete the SAEBRS once for each student in their classroom. Therefore, if 15 students are enrolled in a particular teacher's classroom, the teacher will fill out the SAEBRS 15 times. Once a teacher is ready to rate a student, he/she should complete the SAEBRS subscales deemed by the school to be pertinent to their decision making. To complete each SAEBRS item, the teacher indicates how frequently the student in question has displayed each behavior (as described within each item) during the previous month. The teacher is to ONLY consider the behavior exhibited by the student during the month prior to SAEBRS completion. No other behaviors outside of this time period should be taken into consideration during item completion. It is common for teachers to request a definition of the behaviors represented within each SAEBRS item. For instance, many seek additional clarification regarding what should be considered a 'temper outburst.' However, as part of standard administration, SAEBRS users are not to be provided with such definitions. Rather, teachers are to use their best judgment in considering what actions are representative of each behavior. Materials: Only the SAEBRS form and writing utensil are required for its completion. No other additional materials or resources are necessary. Data coding/sorting/presenting process: Once all ratings have been completed, the user adds the scores within each subscale to yield a summed score. Subscale scores can then be combined to yield the Total Behavior scale score. Summed scores range between 0-18 for Social Behavior and Academic Behavior, 0-21 for Emotional Behavior, and 0-57 for Total Behavior. Please see below for guidelines regarding how each item should be scored, as scoring varies from item to item: Almost Social Behavior Never Sometimes Often Always Arguing 3 2 1 0 Cooperation with peers 0 1 2 3 Temper outbursts 3 2 1 0 Disruptive behavior 3 2 1 0 Polite and socially appropriate ... 0 1 2 3 Impulsiveness 3 2 1 0 Almost Academic Behavior Never Sometimes Often Always Interest in academic topics 0 1 2 3 Preparedness for instruction 0 1 2 3 Production of acceptable work 0 1 2 3 Difficulty working independently 3 2 1 0 Distractedness 3 2 1 0 Academic engagement 0 1 2 3 Almost Emotional Behavior Never Sometimes Often Always Sadness 3 2 1 0 Fearfulness 3 2 1 0 Adaptable to change 0 1 2 3 Positive attitude 0 1 2 3 Worry 3 2 1 0 Difficulty rebounding from setbacks 3 2 1 0 Withdrawal 3 2 1 0 Analysis guidelines: Within each SAEBRS scale and subscale, higher scores are indicative of better student behavior and more appropriate functioning. Although SAEBRS scores can often be used as continuous variables, it is sometimes convenient to classify scores as at risk and not at risk. Using the ranges shown below, subscale and scale scores can be dichotomized in terms of risk categories within the Social Behavior, Academic Behavior, Emotional Behavior, and Total Behavior domains. At Risk Not At Risk Social Behavior 0-12 13-18 Academic Behavior 0-9 10-18 Emotional Behavior 0-17 18-21 Total Behavior 0-36 37-57 How risk should be defined depends on the specific subscale(s) within which a student falls in the at risk range. Please see below for a description of each type of risk: • Risk for Social Behavior Problems - student displays behaviors that limit his/her ability to maintain age appropriate relationships with peers and adults. • Risk for Academic Behavior Problems - student displays behaviors that limit his/her ability to be prepared for, participate in, and benefit from academic instruction. • Risk for Emotional Behavior Problems - student displays actions that limit his/her ability to regulate internal states, adapt to change, and respond to stressful/challenging events. Additional Resources/Suggesting for in-depth training materials: SAEBRS users are referred to works from Kilgus et al. (2014), Kilgus, Eklund, et al. (2014), and Kilgus, Sims, et al. (2014) for more information regarding SAEBRS development, as well as recommendations for how the SAEBRS might be integrated within school-based service delivery models. Users are also referred to various books on the topic of both universal screening (Kettler, Glover, Albers, & Feeney-Kettler, 2013; Lane, Menzies, Oakes, & Kalberg, 2012) and multi-tiered systems of support ( e.g., Riley-Tillman, Burns, & Gibbons, 2013) for information regarding how universal screening might be used to support student social and academic outcomes. References: DiPerna, J.C. (2006). Academic enablers and student achievement: Implications for assessment and intervention services in the schools. Psycholo9y in the Schools, 43, 7-17. Glover, T. A., & Albers, C. A. (2007). Considerations for evaluating universal screening assessments.Journal of School Psycholo9y, 45, 117-135. Gresham, F. M., & Elliott, S. N. (2008). Social skills improvement system: Rating scales. Bloomington, MN: Pearson. Kamphaus, R. W., & Reynolds, C. R. (2007). BASC-2 Behavioral and Emotional Screening System. Minneapolis, MN: Pearson. Kettler, R. J., Glover, T. A., Albers, C. A., & Feeney-Kettler, K. A. (2013). Universal screening in educational settin9s: Evidence-based decision makin9 for schools. Washington, DC: American Psychological Association. Kilgus, S. P., Chafouleas, S. M., & Riley-Tillman, T. C. (2013). Development and initial validation of the Social and Academic Behavior Risk Screener for elementary grades. School Psycholo9y Quarterly, 28, 210-226. Kilgus, S. P., Riley-Tillman, T. C., Chafouleas, S. M., Christ, T. J., & Welsh, M. E. (2014). Direct behavior rating as a school-based behavior universal screener: Replication across sites. Journal of School Psychology, 52, 63-82. Kwon, K., Kim, E., & Sheridan, S. (2012). Behavioral competence and academic functioning among early elementary children with externalizing problems. School Psychology Review, 41, 123-140. Lane, K. L., Menzies, H. M, Oakes, W. P., & Kalberg, J. R. (2012). Systematic screenings of behavior to support instruction: From preschool to high school. New York: Guilford. Masten, A. S., Roisman, G. I., Long, J. D ., Burt, K. B., Obradovic', J., Riley, J. R., ... Tellegen, A. (2005). Developmental cascades: Linking academic achievement and externalizing and internalizing symptoms over 20 years. Developmental Psycholo9y, 41, 733-746. Riley-Tillman, T.C., Burns, M. K., Gibbons, K. (2013). RTI applications, Volume 2: Assessment, design and decision making. New York, NY: The Guilford Press. Severson, H. H., Walker, H. M., Hope-Doolittle, J., Kratochwill, T. R., & Gresham, F. M. (2007). Proactive, early screening to detect behaviorally at-risk students: Issues, approaches, emerging innovations, and professional practices.Journal of School Psychology, 45, 193- 223. Walker, H. M., Irvin, L. K., Noell, J., & Singer, G. H. S. (1992). A construct score approach to the assessment of social competence: Rationale, technological considerations, and anticipated out- comes. Behavior Modification, 16, 448-474. PHQ-9 modified for Adolescents (PHQ-A) Name: ____________ Clinician: __________ Date: __ _ Instructions: How often have you been bothered by each of the following symptoms during the past two weeks? For each symptom put an "X" in the box beneath the answer that best describes how you have been feeling. (0) (1) (2) (3) Not at Several More Nearly all days than every half day the days 1. Feeling down, depressed, irritable, or hopeless? 2. Little interest or pleasure in doing things? 3. Trouble falling asleep, staying asleep, or sleeping too much? 4. Poor aooetite, weight loss, or overeating? 5. Feelinq tired , or havinq little energy? 6. Feeling bad about yourself - or feeling that you are a failure, or that you have let yourself or your family down? 7. Trouble concentrating on things like school work, reading, or watching TV? 8. Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you were moving around a lot more than usual? 9. Thoughts that you would be better off dead, or of hurting yourself in some way? In the past year have you felt depressed or sad most days, even if you felt okay sometimes? � Yes � No If you are experiencing any of the problems on this form, how difficult have these problems made it for you to do your work, take care of things at home or get along with other people? � Not difficult at all � Somewhat difficult � Very difficult � Extremely difficult Has there been a time in the past month when you have had serious thoughts about ending your life? � Yes � No Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt? � Yes � No **If you have had thoughts that you would be better off dead or of hurting yourself in some way, please discuss this with your Health Care Clinician, go to a hospital emergency room or call 911. Office use only: Severity score: ___ _ ------ Modified with permission from the PHQ (Spitzer, Williams & Kroenke, 1999) by J. Johnson (Johnson, 2002) NCTSN - The Nation,11 { hild Traum.11u. S!rP .. ., NNwork SSET: Support for Students Exposed to Trauma: GENERAL INFORMATION Treatment Description Target Population Essential Components School Support for Childhood Trauma Designed for implementation by school teachers or counselors, Support for Students Exposed to Trauma (SSET) is a cognitive-behavioral, skills-based, support group aimed at relieving symptoms of child traumatic stress, anxiety, depression, and functional impairment among middle school children (ages 10-16) who have been exposed to traumatic events. It is used most commonly for children who have experienced or witnessed community, family, or school violence, or who have been involved in natural disasters, accidents, physical abuse, or neglect. It includes 10 lessons in which children learn about common reactions to trauma, practice relaxation, identify maladaptive thinking and learn ways to challenge those thoughts, learn problem solving skills, build social support, and process the traumatic event. Between sessions, children practice the skills they have learned. Developed as an adaptation of the Cognitive-Behavioral Intervention for Trauma in Schools program (CBITS; Stein et al., 2003; Kataoka et al., 2003; Jaycox et al., 2010), SSET contains many of the same therapeutic elements but is designed to be implemented by school staff members without clinical training, with the back-up of a clinician who can help with clinical decision-making related to screening and intervention, provide emergency back-up, and advise on high-risk students. The SSET adaptation of CBITS does not include individual or group imaginal exposure to the traumatic event, and is designed to be more like a school lesson, written in lesson plan format. Schools are one of the natural environments that can support health and mental health. Delivery of mental health programs through schools can overcome logistical barriers (transportation, scheduling) as well as reduce stigma. SSET is designed for children in late elementary school through early high school (ages 10-16) who have experienced events such as witnessing or being a victim of family, school, or community violence, being in a natural or man-made disaster, being in an accident or fire, or being physically abused or Injured, and who are experiencing moderate to severe levels of post-traumatic stress symptoms. SSET was developed and tested in middle schools serving diverse, multicultural, and multilingual students-predominantly Latino, African American, Caucasian, and Asian. It is designed to be used in schools with children from a variety of ethnic and socio economic backgrounds and acculturation levels. SSET includes cognitive-behavioral coping strategies and skills and trauma narrative. Key components: Psychoeducation Relaxation training Cognitive coping Gradual exposure to trauma reminders Trauma narrative Problem Solving Trauma-Informed Interventions I January 2017 SSET: General Information 1 2 NCTSN The N.11ion,1I Child TrJum.HK S1u~\s Nf.'lwork SSET: Support for Students Exposed to Trauma: School Support for Childhood Trauma GENERAL INFORMATION Essential Components continued Clinical & Anecdotal Evidence Parental permission is sought for children to participate. A handout is sent home to parents, followed by screening of students. A screening procedure is recommended for use in the general school population to assist in identifying children who have been exposed to traumatic events and have current moderate to severe post-traumatic stress symptoms, including guidelines for consultation with the back-up clinician to advise on cases in which child abuse is detected or the child discloses intent to harm self or others. A call or in-person meeting with parents/caregivers is recommended at the beginning of treatment to answer questions and review expectations for child and parent involvement. A step by-step guide lesson plan, including scripts and examples for activities, is available for use by the group leader, as well as a workbook with all of the parent letters, handouts, and materials needed for each session. Are you aware of any suggestion/ evidence that this treatment may be harmful? D Yes XJ No D Uncertain Extent to which cultural issues have been described In writings about this Intervention (scale of 1-5 where 1=not at all to 5=all the time). 5 This intervention is being used on the basis of anecdotes and personal communications only (no writings) that suggest its value with this group. D Yes xJ No Are there any anecdotes describing satisfaction with treatment, drop-out rates (e.g., quarterly/annual reports)? XJ Yes j No If YES, please include citation: Jaycox LH, Langley AK, Stein BD, Wong M, Sharma P. Scott M, Schonlau M, Support for Students Exposed to Trauma: A Pilot Study, School Mental Health, 1(2):49-60, 2009 Has this intervention been presented at scientific meetings? [I Yes D No Are there any general writings which describe the components of the intervention or how to administer it? XI Yes D No If YES, please Include citation: Jaycox LH. Kataoka SH, Stein BD, Wong Mand Langley A, Responding to the needs of the community: A stepped care approach to implementing trauma-focused interventions in schools, Report on Emotional and Behavioral Disorders in Youth, 5(4):85-88, 100-103, 2005 Jaycox LH, Langley AK and Dean KL, Support for Students Exposed to Trauma: The SSET Program-Lesson Plans, Worksheets, and Materials, Santa Monica: RAND Corporation, TR-675, 2009. Jaycox LH, Langley AK, Stein BD, Wong M, Sharma P, Scott M, Schonlau M, Support for Students Exposed to Trauma: A Pilot Study, School Mental Health, 1(2):49-60, 2009 The National Child Traumatic Stress Network www.NCTSN.org NCTSN The Notion,11 Child lrJum.lf1l Str~~s Nrtwnrk SSET: Support for Students Exposed to Trauma: GENERAL INFORMATION Cllnlcal & Anecdotal Evidence continued Research Evidence Randomized Controlled Trials Outcomes School Support for Childhood Trauma Has the Intervention been replicated anywhere? XJ Yes :J No Other countries? (please lfst) The intervention has been implemented in Los Angeles, CA; Lawndale, CA; Pittsburgh, PA. Sample Size (N) and Breakdown (by gender, ethnicity, other cultural factors) N=76, 6th and 7th graders (age 11.5, SD=O. 7) of two large middles schools in urban Los Angeles during two school years (2005-6 and 2006-7). Most students were Hispanic (96%). The sample was evenly split in terms of gender (51% female, 49% male) and of lower socioeconomic status, with parents reporting 8th grade education on average and 80% reporting a family income of $25,000 or less. Citation Jaycox LH, Langley AK, Stein BD, Wong M, Sharma P, Scott M, Schonlau M, Support for Students Exposed to Trauma: A Pilot Study, School Mental Health, 1(2):49-60, 2009. This study used a randomized design to compare students who participated in SSET immediately (between baseline and 3-month followup assessment) or on a delayed schedule (between the 3-month and 6-month followup assessments) Process measures & results: 1. Participant satisfaction & attendance Parent satisfaction scores were 4.50 out of 6, indicating that parent satisfaction was between -very good" and "excellent." Student satisfaction was high as well with an average score of 2.52 out of 3, between "mostly true" and "very true." On average, students attended approximately 8 of the 10 lessons. 2. Fidelity of the intervention as delivered by school staff A random subset of audiotapes were rated for fidelity to the manual. The average coverage rating was 2.39 out of 3 with all implementers in the acceptable range of fidelity. The average quality rating was 2.37 out of 3. Participant screening & outcomes measures utilized: 1. Modified Life Experiences Survey (LES; Singer et al., 1995; Singer, Miller, Guo, Slovak, & Frierson, 1998) to assess exposure to violence through direct experience and witnessing of events at home, at school, and in the neighborhood for the purpose of screening children for the program. 2. Child PTSD Symptom Scale (CPSS; Foa, Treadwell, Johnson, & Feeny, 2001), to assess PTSD symptoms for both screening into the program and for use in examining child outcomes over time. Trauma-Informed Interventions I January 2017 SSET: General Information 3 4 NCTSN The NJlion,11 ( hild TrJum.111,· Sir<',~ NC"lwork. SSET: Support for Students Exposed to Trauma: School Support for Childhood Trauma GENERAL INFORMATION Outcomes continued 3. Children's Depression Inventory (CDI; Kovacs, 1981). This 27-item measure assesses children's cognitive, affective and behavioral depressive symptoms 4. Strengths and Difficulties Questionnaire-Parent Report, and Teacher Report (SDQ, Goodman, 1997; Goodman, Meltzer, & Bailey, 1998). Results: Between group effect sizes (ES): Between baseline and the first follow-up, during which the immediate SSET group participated in the lessons, we observed decreases in PTSD (treated ES= -.39, control ES = -.16, difference ES = -.23) and depression (treated ES = -.25, control ES = .07, difference ES = -.32) scores that were more pronounced than in the comparison group. However, changes in parent reported behavior problems were negligible (treated ES = -.39, control E = -.28, difference ES = -.10). Changes in teacher reports showed a small effect size ((Treated ES= .006, control ES= .28, difference ES =-.28), with the immediate intervention group showing slight decreases whereas the delayed intervention group showed slight increases in behavior problems by teacher report. During the time period between the first and second follow-up, when the delayed SSET group participated in the lessons and the immediate group did not, we observed that the immediate SSET group scores stayed about the same, and that there was some decrease in self-reported scores for PTSD and depression as well as parent reported behavior problems in the delayed group Regression Analyses: The regression analysis examining depression and PTSD scores at the first follow up, controlling for scores at baseline, revealed a significant intervention group effect for depression scores (Estimate=0.65; T=-1.99, p=.046) and a non-significant trend for PTSD scores (Estimate = 0.58, T=-1.89, p=.058). These estimates of the intervention effect remained stable with comparable levels of significance when school or group leader were controlled as fixed effects. Neither teacher nor parent reports of behavior problems showed a significant intervention effect (T=-0.19 and T=-1.22, respectively). Subgroup analyses: Among students with higher symptoms at the beginning of the study, intervention effects were more pronounced, with a 10-point reduction in PTSD symptoms, 5-point reduction in depressive symptoms, and 5-point reduction in behavioral problems in the immediate intervention group between baseline and first follow-up assessment, though the delayed intervention group also showed more modest reductions. In contrast, in the low symptoms group, we observed little or no change across time in either group Adverse Events: No adverse reactions to the intervention were noted. Some children disclosed child abuse, which was reported to authorities following school guidelines. Conclusions: Findings support the feasibility, acceptability, and promise of SSET as delivered by school staff for children with traumatic stress. Additional testing is warranted. The National Child Traumatic Stress Network www.NCTSN.org Implementation Requirements & Readiness Training Materials & Requirements Pros & Cons/ Qualitative Impressions Full support of the school principal and administration should be obtained prior to initiating SSET. • A whiteboard or large writing pad and extra copies of the activity worksheets are used for each session. Active parental consent is usually required for participants. A back-up clinician of record is required so as to work with SSET implementers should any students be identified who require more intensive services or who remain symptomatic at the end of the group. SSET is not a crisis intervention. If an entire school is affected by a disaster or violence, it is recommended that school counselors wait at least a month after the trauma before identifying those children in need of SSET. SSET is designed as lesson plans for teachers or school counselors. However, a clinician of record is required to serve as back up to the SSET group leader. One back-up clinician can support SSET implementers at several schools. Training consists of reading background materials and the manual, attending a 1.5- day, in-person training, and then receiving ongoing consultation from a local clinician with expertise in CBT and/or child trauma treatment. Guidelines are provided both in the manual and during the training regarding: consultation with the back-up clinician, protecting student confidentiality, forming groups of children, handling disclosure by students, limiting group leader self-disclosure, and self-care for the group leader, This training also addresses issues related to successful delivery of a mental health program in a school setting. The manual is available at http://www.rand.org/pubs/technical reports/TR675.html • An on-line training course and implementation support materials can be found at www.ssetprogram.org What are the pros of this intervention over others for this specific group (e.g., addresses stigma re. treatment, addresses transportation barriers)? Implementation in schools enables clinicians to reach underserved students who might not otherwise receive mental health care. It also reduces barriers to care such as transportation, and SSET is typically delivered at no cost to the family. Not all schools have on-site clinicians, and so SSET can fill a need by being designed for delivery by non-clinically trained school staff. What are the cons of this intervention over others for this specific group (e.g., length of treatment, difficult to get reimbursement)? Not all students are permitted by parents to participate in screening or intervention in schools. Thus, some students are missed. Some students will need additional treatment above and beyond this early intervention group treatment, so SSET implementers need to work with a clinician to make appropriate referrals after or in parallel to SSET. Other qualitative Impressions: Interviews with parents, students, and educators indicate that the program is well tolerated and that users are generally satisfied. Trauma-Informed Interventions I January 2017 SSET: General Information 5 6 NCTSN The N:ition,11 { hild lrJurn.1!1t Srr<'\'i NC'twnrk SSET: Support for Students Exposed to Trauma: School Support for Childhood Trauma GENERAL INFORMATION Contact Information References Name: Lisa Jaycox, Ph.D. Address: RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202 Phone number: 703413-1100, x5118 Email: jaycox@rand.org Website: www.ssetprogram.org Jaycox LH, Kataoka SH, Stein BD, Wong M and Langley A, Responding to the needs of the community: A stepped care approach to implementing trauma-focused interventions in schools, Report on Emotional and Behavioral Disorders in Youth, 5(4):85-88, 100-103, 2005 Jaycox LH, Langley AK and Dean KL, Support for Students Exposed to Trauma: The SSET Program-Lesson Plans, Worksheets, and Materials, Santa Monica: RAND Corporation, TR-675, 2009. Jaycox LH . Langley AK, Stein BD, Wong M, Sharma P, Scott M, Schonlau M, Support for Students Exposed to Trauma: A Pilot Study, Schoo/ Mental Health, 1(2):49-60, 2009. Kataoka S, Stein 8D, Jaycox LH, Wong M, Escudero P, Tu W, Zaragoza C and Fink A, A school-based mental health program for traumatized Latino immigrant children, Journal of the American Academy of Child and Adolescent Psychiatry, 42(3):311-18, 2003. Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN and Fink A, A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial, Journal of the American Medical Association, 290(5):603-11, 2003. Jaycox LH , Cohen JA, Mannarino AP, Langley AK, Walker DW, Gegenheimer K, Scott M, Schonlau M, Children's mental health care following Hurricane Katrina : A field trial of trauma-focused psychotherapies, Journal of Traumatic Stress, 23(2):223-31, 2010. The National Child Traumatic Stress Network www.NCTSN.org NCT SN Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Treatment Description Target Population Intensity Essential Components CBITS is a skills-based, group intervention that is aimed at relieving symptoms of Post Traumatic Stress Disorder (PTSD), depression, and general anxiety among children exposed to trauma. Children learn skills in relaxation, challenging upsetting thoughts, and social problem solving, and children work on processing traumatic memories and grief. These skills are learned through the use of drawings and through talking in both individual and group settings. Between sessions, children complete assignments and participate in activities that reinforce the skills they've learned. CBITS also includes parent and teacher education sessions. The CBITS program has been used most commonly for children in grades six to nine (ages 10 to 15) who have experienced events such as witnessing or being a victim of violence, being in a natural or man-made disaster, being in an accident or house fire, or being physically abused/injured, and who are suffering from moderate to severe levels of PTSD symptoms. Preliminary versions of the CBITS program have been used in children as young as eight years old. The program consists of 10 group sessions (six to eight children/group) of approximately an hour in length, usually conducted once a week in a school setting. The CBITS intervention has also been delivered in other settings, such as mental health clinics. In addition to the group sessions, participants receive one to three individual sessions, usually held before the exposure exercises. CBITS also includes two parent education sessions and one teacher education session. CBITS teaches six cognitive-behavioral techniques: • Education about reactions to trauma • Relaxation training • Cognitive therapy • Real life exposure • Stress or trauma exposure • Social problem-solving Parental permission is sought for children to participate. A handout is sent home to parents, and a call to parents at the beginning of treatment is used to answer questions and reinforce the ideas in the handout. Between-session activities help Cognitive Behavioral Intervention for Trauma in Schools {CBITS) Trauma Treatment Fact Sheets vers. 1.0, 2004 National Child Traumatic Stress Network www .NCTSNet.org 1 Essential Components Cont'd Assessment Measures Used Outcome Measures Used Training Requirements consolidate skills and allow group members to apply these skills to real life problems. A step-by-step guide to each session, including scripts and examples for use by the group leader, common obstacles and their solutions, and handouts and worksheets for group participants is available. A screening procedure is recommended for use in the general school population to assist in identifying children in need of the program. A brief (less than five-minute) screening instrument has been developed for this purpose, and its use should be followed by an individual meeting with a clinician to confirm the screening results. Participant screening measures utilized: • Life Events Scale to assess the level of exposure to violence • Child PTSD Symptom Scale and the Children's Depression Inventory providing validated cut-offs for scores to indicate clinical levels of PTSD and depression • Pediatric Symptom Checklist completed by parents to assess child functioning Parents and children completed these measures prior to beginning the program, at program completion, and three months after program completion. All children completed the Child PTSD Symptom Scale and the Children's Depression Inventory at the completion of treatment, and parents completed the Pediatric Symptom Checklist at completion of treatment. Program effectiveness has been demonstrated in several studies, including a randomized control trial. Assessment of change in PTSD, depressive symptoms, and child functioning is recommended following CBITS program completion in order to be able to make an informed referral for children who are still symptomatic at the end of the intervention program. It is recommended that someone with clinical mental health training deliver the CBITS program. Depending on the level of pre-existing expertise and the availability of an onsite CBT expert, the recommended training varies. A common training approach is for trainees to read background materials and the manual, watch a training video prior to training, attend a two-day training, and then receive ongoing supervision from a local clinician with expertise in CBT. This training also addresses issues related to successful delivery of a mental health program in a school setting. The order form for the CBITS manual is available on the internet from Sopris West publishers (see below). However, clinician training is also recommended. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Trauma Treatment Fact Sheets vers. 1.0, 2004 National Child Traumatic Stress Network WWW .NCTSNet.org 2 Fidelity Monitoring Procedures Implementation Requirements and Readiness Outcomes/ Evaluation Adaptations for Special Populations or Settings CBITS treatment fidelity may be monitored by having an independent rater watch sessions (live or videotaped) or listen to audiotapes of sessions and rate the adherence to elements in the manual and the quality of the therapeutic approach on the CBITS Fidelity Assessment Measure (the measure used in the CBITS evaluation studies.) Full support of the school principal and administration should be obtained prior to initiating any of the CBITS activities. • Notebooks containing the program handouts should be prepared for participants and extra copies made in case children lose them. • A chalkboard or large writing pad and extra copies of the activity worksheets are used for each session. • Active parental consent is usually required for participants. • Teachers whose students will be impacted by the program are identified and asked to participate in the teacher education program. • Referra l paths should be identified for children who require more intensive services in addition to CBITS or who remain symptomatic at the end of the group. CBITS is not a crisis intervention. If an entire school is affected by a disaster or violence, it is recommended that school counselors wait at least a month after the trauma before identifying those children in need of CBITS. In a randomized controlled study with children from Los Angeles Unified School District (LAUSD}, children in the CBITS intervention group had significantly greater improvement in PTSD and depressive symptoms compared to those on the wait list at a three-month follow-up. Parents of children in the CBITS intervention group also reported significantly improved child functioning compared with children in the wait-list group. The improvements in symptoms and functioning in the CBITS group continued to be seen at a subsequent follow-up at six months. Results from another study showed that those in the CBITS intervention group had significantly fewer self-reported symptoms of PTSD and depression at post-test adjusting for relevant covariates as did children in a comparison group. The CBITS intervention has now been effectively implemented with a wide range of racially and ethnically diverse children. CBITS is currently being used in the general school population in LAUSD, and parent materials of the current version of the CBITS program are available in Spanish as well as English, but the manual is available in English only. Several Network members are currently working to adapt the CBITS intervention for Native American children. During CBITS development, preliminary versions of the CBITS intervention were delivered to recent immigrants who speak primary languages other than English, such as Spanish, Russian, Korean, and Western Armenian. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Trauma Treatment Fact Sheets vers. 1.0, 2004 National Child Traumatic Stress Network www .NCTSNet.org 3 Recent Publications Treatment Developers Contact Information Jaycox, L.H., Stein, B., Kataoka, S., Wong, M., Fink, A., Escudera, P. & Zaragoza, C. (2002). Violence exposure, PTSD, and depressive symptoms among recent immigrant school children. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9 ): 1104-1110. Kataoka, S., Stein, B. D., Jaycox, L. H., Wong, M., Escuerdo, P., Tu, W ., Zaragosa, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311-318. Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., Tu, W., Eliot, M.N., & Fink, A. (2003). A mental health intervention for school children exposed to violence: A randomized controlled trial. JAMA, 290(5), 603-611. Stein, B.D., Elliott, M.N., Tu, W., Jaycox, L.H., Kataoka, S.H., Wong, M., & Fink, A. (2003). "School-based intervention for children exposed to violence": Reply. Journal of the American Medical Association, 290(19): 2542. Stein, B. D., Kataoka, S., Jaycox, L.H., Steiger, E.M., Wong, M., Fink, A., Escudero, P., Zaragoza, C. (2003). The Mental Health for Immigrants Project: Program design and participatory research in the real world. In: M.D. Weist, S. Evans, N. Lever {Eds) Handbook of School Mental Health: Advancing Practice and Research. {pp. 179-190). New York: Kluwer Academic/ Plenum Publishers. Stein, B., Kataoka, S., Jaycox, L., Wong, M., Fink, A., Escudero, P., & Zaragoza, C. (2002). Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: A collaborative research partnership. Journal of Behavioral Health Services and Research, 29(3), 318-326. RAND Corporation, the Los Angeles Unified School District, and UCLA {Lisa Jaycox, Bradley Stein, Marleen Wong, Sheryl Kataoka.) For more information on the CBITS model, contact Marleen Wong {mar1een,wong@1ausd.net) at the LAUSD Community Practice Site, Lisa Jaycox (jaycox@rand.org) or Bradley Stein {stein@rand.org) at the RAND Corporation, or Sheryl Kataoka (skataoka@uc1a.edu) at UCLA. For consultation regarding training opportunities and implementation procedures for this model within the Network, contact Charlene Allred (callred@psych.duhs.duke.edu) at Duke or Cassie Kisiel at UCLA (ckisiel@mednet.ucla.edu). Copies of the treatment manual can be ordered from Sopris West Educational Services (800) 547-6747. www.sopriswest.com. Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Trauma Treatment Fact Sheets vers. 1.0, 2004 National Child Traumatic Stress Network www.NCTSNetorg 4 NCTSN The N.llion,11 Chi Id lrJumJt1t Srrr!>s Ncrwnrk Bounce Back: An Elementary School Intervention for Childhood Trauma GENERAL INFORMATION Treatment Description Target Population Essential Components Bounce Back is a cognitive-behavioral, skills-based, group intervention aimed at relieving symptoms of child traumatic stress, anxiety, depression, and functional impairment among elementary school children (ages 5-11) who have been exposed to traumatic events. Bounce Back is used most commonly for children who have experienced or witnessed community, family, or school violence, or who have been involved in natural disasters, accidents, physical abuse, neglect, or traumatic separation from a loved one due to death, incarceration, deportation, or child welfare detainment. The clinician-led intervention includes 10 group sessions where children learn and practice feelings identification, relaxation, courage thoughts, problem solving and conflict resolution, and build positive activities and social support. It also includes 2-3 individual sessions in which children complete a trauma narrative to process their traumatic memory and grief and share it with a parent/caregiver. Between sessions, children practice the skills they have learned. Bounce Back also includes materials for parent education sessions. Developed as an adaptation for elementary aged students of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) program, Bounce Back contains many of the same therapeutic elements but is designed with added elements and engagement activities and more parental involvement to be developmentally appropriate for 5-11 year olds. Bounce Back is designed to be implemented in schools for children in elementary school grades Kindergarten through 5th grade (ages 5-11) who have experienced events such as witnessing or being a victim of family, school, or community violence, being in a natural or man-made disaster, being in an accident or fire, or being physically abused or injured, and who are experiencing moderate to severe levels of PTSD symptoms. Bounce Back was developed and implemented in schools serving diverse, multicultural, and multilingual students-predominantly Latino, African American, Caucasian, and Asian. It is designed to be used in schools with children from a variety of ethnic and socio-economic backgrounds and acculturation levels. Bounce Back includes cognitive-behavioral coping strategies and skills and trauma narrative. Bounce Back is adapted from CBITS. It contains all of the key elements of CBITS and adds feelings identification, positive activities, and social support. Key components: Psychoeducation Feelings Identification Positive Activities Relaxation Training Cognitive Coping Gradual Exposure for functional Impairment Trauma-Informed Interventions I January 2017 Bounce Back: An Elementary School Intervention for Childhood Trauma 1 2 NCTSN The N,1tion,1I ( hi Id TrJum.1l1l Slr<'~S NC'twnrl,. Bounce Back: An Elementary School Intervention for Childhood Trauma GENERAL INFORMATION Essential Components continued Cllnlcal & Anecdotal Evidence Trauma narrative Social SupporVConnecting with Others Problem Solving/Conflict Resolution With respect to its implementation procedure: Parental permission is sought for children to participate. A handout is sent home to parents, followed by screening of students. A screening procedure is recommended for use in the general school population to assist in identifying children who have been exposed to traumatic events and have current moderate to severe PTSD symptoms. For this age group, we recommend individual screening. A call or in-person meeting with parents/ caregivers is recommended at the beginning of treatment to answer questions and review expectations for child and parent involvement. Developmentally appropriate between-session activities help children (and parents) consolidate skills and allow group members to apply these skills to real life issues. A step-by-step guide to each session, including scripts and examples for activities for various age groups, is available for use by the group leader, as well as a workbook with all of the parent letters, handouts, and materials needed for each session. Are you aware of any suggestion/evidence that this treatment may be harmful? Yes XI No O Uncertain Extent to which cultural issues have been described in writings about this Intervention (scale of 1-5 where 1=not at all to 5=all the time). 5 This Intervention Is being used on the basis of anecdotes and personal communications only (no writings) that suggest its value with this group. 0 Yes XJ No Are there any anecdotes describing satisfaction with treatment, drop-out rates (e.g., quarterly/annual reports)? XJ Yes :J No If YES, please include citation: Langley, Audra K.; Gonzalez, Araceli; Sugar, Catherine A.; Solis, Diana; Jaycox, Lisa (2015). Bounce back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events. Journal of Consulting and Clinical Psychology, 83, 853-865. Has this intervention been presented at scientific meetings? IXJ Yes � No If YES, please include cltation(s) from last five presentations: Langley, A.K., & Jaycox, L.H. (2013, October). An Intervention for Elementary School Children Exposed to Traumatic Events: A Pilot Evaluation of the Bounce Back Program. Symposium presented at the Annual Meetings of the American Academy of Child and Adolescent Psychiatry, Orlando, Fl. Jaycox, L.H., & Langley, A. K. (2015, November). Intervening with Elementary School Children Exposed to Trauma: Effectiveness of a School-based Intervention and Recommendations for Implementation. Symposium presented at the Annual Meetings of the Internationals Society for Traumatic Stress Studies, New Orleans, LA. The National Child Traumatic Stress Network www.NCTSN.org NCTSN The N.,tion.,I Child Tr.1um.11ic Srrc-~s NNwnrk Bounce Back: An Elementary School Intervention for Childhood Trauma GENERAL INFORMATION Cllnlcal & Anecdotal Evidence continued Research Evidence Randomized Controlled Trials Other Research Evidence Outcomes Are there any general writings which describe the components of the Intervention or how to administer it? ii Yes O No Has the Intervention been replicated anywhere? ~ Yes ::J No Other countries? The intervention has been implemented in various parts of the country including, Los Angeles, CA, Chicago, IL, New Orleans, LA, Newtown, CT, Long Island, NY, Oceanside, CA Sample Size (N) and Breakdown (by gender, ethnicity, other cultural factors) N=74, at least 40% of the students were eligible for free or reduced lunch. Participants in the analytic sample were 7 4 students in 1st-5th grade (Mean age: 7 .65 years, SD = 1.36; 50% boys) and were ethnically diverse: 49% Latino, 27% Caucasian, 18% African American, 5% biracial, 1% Asian. Nearly one-quarter (24.3%) of families had a highest household education level of less than high school, 20.3% had at least one caregiver who earned a high school degree, and 55.4% had at least one caregiver who had completed at least some college. Nearly half of the participants (43.3%) had a household income of $40,000 or less, supporting an average of four individuals (Mean = 3.81 individuals, SD = 1.15). Replication study in Cicero. II currently underway Participant screening measures utilized: Citation Langley, A.K., Gonzalez, A., Sugar, C.A., Solis, D., & Jaycox, L. (2015). Bounce back; Effectiveness of an Elementary School-Based Intervention for Multicultural Children Exposed to Traumatic Events. Journal of Consulting and Clinical Psychology, 83(5), 853-865. 1. Modified Traumatic Events Screening Inventory for Children - Brief Form (TESI-C Brief) (Ford et al., 2000), was used at baseline to assess exposure to direct or witnessed trauma via 21 items. This was utilized as a clinical interview with the children. 2. UCLA PTSD Reaction Index to assess current PTSD symptoms. 3. SDQ-Parent and Teacher Versions Parents and children completed these measures prior to beginning the program, at program completion, and three months after program completion. Trauma-Informed Interventions I January 2017 Bounce Back: An Elementary School Intervention for Childhood Trauma 3 4 NCTSN The Na1ion,1I l hild TrJlJm.if,l Strc•\\ NNwnrk Bounce Back: An Elementary School Intervention for Childhood Trauma GENERAL INFORMATION Outcomes continued lmplementatlon Requirements & Readiness Training Materials & Requirements Results: Bounce Back was Implemented with excellent clinician fidelity. On Pre-Post measures, compared to children in the Delayed Intervention group, children who received Bounce Back in the Immediate Intervention group demonstrated significantly greater improvements in parent- and child-reported posttraumatic stress and child reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the Delayed intervention group demonstrated significant improvements In parent- and child-reported posttraumatlc stress, depression, and anxiety symptoms. The Immediate Intervention group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6 month assessment). Conclusions: Findings support the feasibility, acceptability, and effectiveness of the Bounce Back Intervention as delivered by school-based clinicians for children with traumatic stress. Full support of the school principal and administration should be obtained prior to initiating any of the Bounce Back activities. • It is helpful to prepare toolkits containing the program handouts and necessary materials. • A whiteboard or large writing pad and extra copies of the activity worksheets are used for each session. • Active parental consent is usually required for participants. • Teachers whose students will be impacted by the program are identified and asked for input related to group schedules. • Referral paths should be identified for children who require more intensive services in addition to Bounce Back or who remain symptomatic at the end of the group. Bounce Back is not a crisis intervention. If an entire school is affected by a disaster or violence, it is recommended that school counselors wait at least a month after the trauma before identifying those children in need of Bounce Back. It is recommended that a professional with clinical mental health training deliver the Bounce Back program. Depending on the level of pre-existing expertise and the availability of an onsite CBT expert, the recommended training varies. A common training approach is for trainees to read background materials and the manual, attend an in-person two-day training, and then receive ongoing supervision from a local clinician with expertise in CBT and/ or child trauma treatment. This training also addresses issues related to successful delivery of a mental health program in a school setting. The manual and workbook can be obtained from the treatment developer through the training process. Clinician training is recommended. The National Child Traumatic Stress Network www.NCTSN.org Pros & Cons/ Qualltatlve Impressions Contact Information References What are the pros of this Intervention over others for this specific group (e.g., addresses stigma re. treatment, addresses transportation barriers)? Implementation in schools enables clinicians to reach underserved students who might not otherwise receive mental health care. It also reduces barriers to care such as transportation and Bounce Back is typically delivered at no cost to the family. What are the cons of this Intervention over others for this specific group (e.g., length of treatment, difficult to get reimbursement)? Not all students are permitted by parents to participate in screening or intervention in schools. Thus, some students are missed. Some students will need additional treatment above and beyond this early intervention group treatment, so clinicians who deliver Bounce Back also need to link with other services and make appropriate referrals after on in parallel to Bounce Back. Name: Audra Langley, Ph.D. Address: UCLA TIES for Families 1000 veteran Avenue, 2nd Floor, Los Angeles, CA 90095 Phone number: 310 794-2460 Email: alangley@mednet.ucla.edu Website: www.bouncebackprogram.org Gonzalez, A., Monzon. N., Solis, D., Jaycox, L, and Langley, A.K. (2016). Trauma exposure in elementary school children: Description of screening procedures. prevalence of exposure, and posttraumatlc stress symptoms. School Mental Health, 8(1), 77-78. Jaycox L.H .. Cohen J.A., Mannarino A.P., Walker, D.W., Langley A.K., Gegenheimer K.L., •.. & Schonlau M. (2010). Children·s mental health care following Hurricane Katrina : A field trial of trauma-focused psychotherapies. Journal of Traumatic Stress, 23(2), 223-31. Kataoka S.H., Stein 8.0., Jaycox L.H., Wong M., Escudero P., Tu W., •.• & Fink A., (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Ch/Id & Adolescent Psychiatry, 42(3), 311·18. Langley, A.K .. Santiago, C.D .. Rodriguez, A .. & Zelaya, J. (2013). Improving implementation of mental health services for trauma in multicultural elementary schools: Stakeholder perspectives on parent and educator engagement. The Journal of Behavioral Health Services and Research, 40(3), 247-262. Langley, A.K .. Gonzalez, A., Sugar, C.A., Solis, D., & Jaycox, L. (2015). Bounce back; Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events. Journal of Consulting and Clinical Psychology, 83(5), 85~65. Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., Tu, W., Elliott, M.N. & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. Journal of the American Medical Association, 290(5), 603-11. Trauma-Informed Interventions I January 2017 Bounce Back: An Elementary School Intervention for Childhood Trauma 5 [DATE] Dear Parents, [School Name] is fortunate to have a special counseling program for students who have experienced stressful events. We have found that students who have experienced trauma as victims or witnesses often suffer from a unique kind of stress, called traumatic stress. It could show up in the form of your child not wanting to go to school or as difficulties with class work and concentration. We would like your permission to ask your child some questions about whether he or she has experienced or witnessed stressful events. Examples of questions that we will ask your child are "have you been in a serious accident where you could have been badly hurt or could have been killed," "has anyone very close to you been very sick or injured?" In addition, we will ask questions like whether or not your child has been experiencing trouble with falling and staying asleep or is experiencing bad dreams or nightmares due to the experience. These questions will serve to help us determine if the academic and/or social problems your child may be having are due to a stressful event(s) that he or she might have experienced or witnessed. All of the information collected will be used to try to improve your child's emotional well being, his or her academic success and the overall success of the school. If we find that your child has been a victim or witness to a stressful event, we hope to be able to offer some counseling that will help him/her deal with any problems in a constructive way which we hope will improve their grades and attendance. The information that we collect will be kept confidential and will not be a part of your child's school record. If you would like your child to participate and wish to give us permission to ask your child questions related to stressful events, please sign the bottom of this form. If you have any questions related to this program or would like to review a copy of the questions that we will be asking your child please contact me at [contact info]. Thank you for your cooperation and support. Student Name: Date of Birth: ----------- __ I accept __ I do not accept Parent/guardian signature ______________ Date ____ _ [DATE] Dear Parents, [School Name] is fortunate to have a special counseling program for students who have experienced stressful events. We have found that students who have experienced trauma as victims or witnesses often suffer from a unique kind of stress, called traumatic stress. It could show up in the form of your child not wanting to go to school or as difficulties with class work and concentration. Based on a recent screening of students we found that your child meets the eligibility for the program. We would like to offer your child, ___________ a ten week program focused on helping him/her to process the traumatic experience and reduce the traumatic stress. As a part of the program, we will meet 1-2 times with your child individually in addition to the weekly group meetings and schedule two parent meetings to give you any necessary information related to your child's progress and experience in the program. In signing the bottom of this form, you as the parent or guardian are indicating your understanding that information regarding your child and your family will be held in confidence with the exception of situations that may be harmful to the health and safety of others, including yourself and your children. It is your right to accept, refuse, or stop services at any time. If you have any specific questions or need any further assistance, please call [Contact Person] at [Contact Information]. __ I accept I decline services __ I would like to receive a list of referrals to community resources. Child's Name Child's D.0.8. Name of Parent/Guardian Address Home Telephone Worlc/Cell Phone Signature of Parent/Guardian Today's Date _ Please call me, I have a question or concern ______________ _ I PROTOTYPE FUNDING PROPOSAL 2 Executive Summary Problem: A plethora of research have shown the impact of adverse childhood experiences on health, mental health, behavioral and social outcomes and future life trajectories. Children in poverty, who are often youth of color face a greater incidence of exposure. In school settings, ACEs may manifest as behavioral or mental health concerns and result in disproportional discipline reflective of implicit bias. To ensure the healthy development of youth, the DSW candidate identified the problem of adverse childhood experiences (ACEs) and youth exposure to traumatic stress in a high poverty urban community with limited access to mental health resources. Of the 5,601 students enrolled in the school corporation in 2018-19, an estimated 4,371 students face a greater incidence of traumatic stress exposure and high ACE scores. Innovative Solution: The Michigan City Area Schools will create a community infrastructure for trauma informed practice that increases access to a continuum of school based mental health services for youth who have encountered exposure to traumatic stress and have unmet mental health needs. Youth are considered key stakeholders and have been involved from the onset in the development and proposed implementation of the operational design. The infrastructure was non existent prior to the initiation of capstone development and engages school, community, and youth who have successfully overcome adversities to be part of a human scaffold of support. The innovation disrupts programmatic siloes via a community infrastructure and disrupts the norm of discipline as punishment to discipline as guidance. Systemic community changes in organizational practice and relational behavior of staff in the provision of emotional and behavioral support are anticipated, while concurrently providing professional school-based mental health services that ameliorates the problem of access to care. Running head: PROTOTYPE PROPOSAL Prototype Proposal for Funding Building a Trauma Informed Community Michelle Webb, Doctoral Candidate University of Southern California October 8, 2019 March 14, 2019 Ms. Bethany Ecklor Family and Social Services Administration Division of Mental Health and Addiction Bureau of Youth Services Division of Mental Health and Addiction 402 West Washington Street, Room W353 Indianapolis, Indiana 46204 Re: RFF 2019-07 Dear Ms. Ecklar, Administration Building 408 South Carroll Avenue Michigan City, Indiana 46360 (219) 873-2000 The Michigan City Area Schools is pleased to submit an application to the Indiana Department of Mental Health and Addiction for RFF 2019-07, Evidence-Based School Social Services Program in the amount of $200,000. Michigan City Area Schools (MCAS) will address the social problem of adverse childhood experiences (ACEs) as a root cause in the prevention of substance use and the absence of preventative mental health support through professional development, and the use of three Masters level Social Workers in the provision of evidence-based universal, selected and indicated prevention programing. The research demonstrates strong predictive relationships with children who have experienced adverse childhood experiences (ACEs) and substance-related and risk behaviors, as well as negative health, mental health, social and behavioral outcomes. As a medically underserved county, La Porte County experiences a shortage of mental health providers and students who have been exposed to traumatic stress or experience health disparities may have the least access to mental health support. The provision of evidence based professional development and K-12 social work prevention services in all eleven MCAS schools will address this issue and can have far reaching implications for positively impacting future outcomes and the lives of our students. The principle contact is Micki Webb who can be reached at micki.webb@mcas.k12.in.us or 219-873-2000 ext. 8367. Thank you in advance for your consideration. Sincerely, ~~t'un1--w~ 1 Dr. Barbara Eason-Watkins, Superintendent Michigan City Area Schools PROTOTYPE FUNDING PROPOSAL 3 Funding is requested from the Indiana Department of Mental Health and Addiction (DMHA) in the amount of $200,000 annually for the next two years to support costs associated with two bachelor level social workers and two master's level social workers as independent contractors, professional development that builds staff and community capacity, and a portion of the program administration costs. The BSW and MSW Social workers represent the professional knowledge base essential to integrate the Tier 2 and 3 evidence-based trauma-informed mental health support based on the assessments. Social work efforts will focus on students identified with the greatest mental health needs and part of an overall school-based mental health and substance abuse prevention continuum. These dollars will be leveraged to secure other funding streams to support full scale operationalization over the next three years. Full scale implementation in three years totals $1,568,453.84 and represents an equivalent per pupil investment cost of $280.03 To put this in perspective the per pupil expenditure is the approximate equivalent of a new lap top. What this cost does not reflect is the exponential impact of the innovation in relation to unaddressed trauma, and lifelong costs to society if trauma and mental health needs are left unaddressed. PROTOTYPE FUNDING PROPOSAL RESPONDENT INFORMATION l) LEGAL NAME: Michigan City Area Schools 2) Doing Business As (if different than legal name): 3) ADDRESS: 408 S. Carroll Avenue Michigan City, Indiana 46360 County: La Porte 4) ELECTRONIC MAIL ADDRESS: micki.webb@mcas.k12.in.us 5) TELEPHONE: 219-873-2000 6) DIRECTOR NAME/TITLE: Michelle Webb/Program Director 7) CONTACT PERSON: Micki Webb 8) COUNTIES TO SERVED: la Porte (Michigan City Area School boundaries) 9) TAXPAYER IDENTIFICATION NUMBER 1 :35-1100595 10) DUNS Number:069761146 11) Congressional District: Indiana 1st RESPONDENT FACILITY INFORMATION 1) Type of Facility: Private Non-Profit () Other ( X) LEA Public School Corporation 2) Proof of Non-Profit Status - 751(c)(3) CERTIFICATE SIGNATURE OF AUTHORIZED REPRESENTATIVE: To the best of my knowledge and belief, the information in this proposal has been duly authorized by the governing body of the applicant. SIGNATURE: NAME/TITLE: (Typed) Michelle Webb DATE SIGNED: 4 PROTOTYPE FUNDING PROPOSAL 5 1. Eligibility (5) Michigan City Area Schools (MCAS), a public, Pre-K-12, Indiana Local Education Agency (LEA) located in Northwest Indiana is identified as an eligible applicant for $200,000 in annual funding for two years from the Indiana Department of Mental Health and Addiction. This funding will address adverse childhood experiences and mental health access particularly as it relates to the prevention of youth substance use. The MCAS school corporation is located one hour east of Chicago on a federally designated, high intensity drug trafficking (HIDT A) corridor. The school corporation serves an enrollment of 560 l students who reside in the urban and rural geographic area identified by zip codes 46360, and a portion of 46350 within La Porte County, Indiana. The county is ranked 92 of92 counties in health behavior in the 2018 Robert Wood Johnson Foundation County Health Ranking report and is identified as a medically underserved area characterized by a shortage of mental health providers. Census data reflect 25.5% of residents are below the federal poverty guidelines, as compared to the state average of 14. l %. Internal school corporation data demonstrates that 77% of students grades Pre K- 12 are low income based on the United States Department of Agriculture (USDA) Free or reduced lunch eligibility. According to the Indiana Youth Institute Kids Count data center for La Porte County, 21.7% children in the county are considered food insecure as compared to 17.7% of the state (2018). For many of these children, the breakfast and lunch provided by the school system may be their only meals of the day. MCAS has a history of collaborative partnerships and is represented on the governance committee of the local System of Care, the La Porte County Drug Free Partnership coalition, the Continuum of Care "Home Team" Coalition, and a network of social service and government services providers who have been consulted in the development of the proposal. In addition the applicant is a DSW PROTOTYPE FUNDING PROPOSAL 6 candidate, career school administrator, licensed clinical social worker, and a representative on the state Indiana School Mental Health Initiative through which the model program can be replicated and scaled throughout the state. 2. Extent of the need for the proiect (1S) The Substance Abuse and Mental Health Services Administration's (SAMHSA) website describes ACEs as the exposure to traumatic stress that is related to an increase in risk factors for substance misuse, and health and mental health problems across the life span. According to SAMHSA, research indicates a strong correlation between exposure to traumatic stress and adverse childhood experiences and risk factors related to substance use. The inability to adapt to traumatic stress impacts early initiation to illicit substances and is considered a coping response that affects schools, families, and juvenile justice systems. Increased exposure to traumatic stress, access to illicit substances, low perception of risk and attitudes toward use are characterized by limited hope and aspirations for many Michigan City youth. SAMHSA's National Survey on Substance Use and Health (2016), demonstrates the current prevalence of mental illness is higher in Indiana than the nation, and only 41.8% of those receive treatment, whereas only 15.2% of those with an illicit substance use disorder receive care. Without critical support to mitigate the risk factors, poor adaptation to traumatic stress on parental or family functioning has an exponential risk for children who may develop substance use, emotional or, behavioral problems unless prevention efforts are put in place that address the root cause of the problem. In the Michigan City Area Schools over four thousand children are estimated to have been exposed to ACEs and are thus considered at risk. This exposure has been shown in the research to effects healthy and mental health outcomes, healthy youth development and future life trajectories. PROTOTYPE FUNDING PROPOSAL 7 Critical community needs in the geographic zip code areas of 46360 and 46350 served by the Michigan City Area Schools is demonstrated based on national indicators. According to Webb (2018), the Community Needs Index, a planning tool available to communities from Dignity Health denotes the health and structural indicators and severity of health disparities and access to needed resources. Compounding the issue of mental health access is a significant shortage in La Porte County of other community mental health providers that is evident in the ratio of 1: 1170 as compared to the state ratio of 1 :700 as indicated in the Robert Wood Johnson Foundation County Health rankings report (2018). Student Mental Health concerns are further reflected in county data gathered from the Indiana Youth Survey (2016) that demonstrated suicidality higher than state and national averages which identified that 23.1 % of 9 th grade students and 13.2% of 11 th grade students made a plan to commit suicide in the past year. The issue is compounded in the school corporation by the ratio of school counselors to students of 1 :624 that is higher than the American School Counselor Association recommendation of 1 :250. Consistent with the DMHA strategic plan to address the needs ofunderserved populations, the Youth Risk Behavior Survey administered by the Center for Disease Control in 2017 addressed the question of sexuality. The survey evidenced that 8% of secondary high school age students identify as LGBTQ and based on research are 4 times more likely to engage in IV drug usage than their peers and 30% of these high school students have attempted suicide. The research was considered significant and per the CDC study was an indicative of a percent that could be extrapolated in data calculations. As such, an estimated 191 secondary students in grades 7-12 may PROTOTYPE FUNDING PROPOSAL 8 identify as LGBTQ, however because of the stigma associated with sexual orientation, these students may not receive the level of support needed to overcome the exposure to traumatic stress thus exacerbating risk factors and the development of unhealthy coping strategies including substance usage. The availability of school based mental health services however provides accessible, safe, and inclusive support for students who might otherwise have limited access or resources or be stigmatized to seek help. According to the Robert Wood Johnson Foundation County Health Ranking report (2018), the county ranks 92 of 92 Indiana counties in health behaviors. The report identifies twenty-two percent of youth ages sixteen to twenty four are not working or in school and are identified as "disconnected youth" as compared to the state average of fourteen percent. Distressed neighborhoods and urban poverty in Michigan City, Indiana have fostered an environment of generational poverty. Multiple, part-time, service-sector jobs are necessary to meet the most basic needs and some parents may turn a blind eye to the sale or use of substances in their homes. Shuttered manufacturing, economic downturn, and urban flight represent the harsh economic realities of survival for the majority of MCAS students and their families. Soleimanpour (2017) identifies the critical rationale for this proposal as low-income children typically lack access to mental health support to overcome the trauma exposure necessary for healthy emotional development. The state of Indiana ranks 47 th in education funding. Budget shortfalls in the school corporation have previously led to the elimination of all general education social workers in the Michigan City Area Schools, thus leaving MCAS students without access to critical mental health support. Risk screening data for 2017-18 completed by the Open Door Adolescent Health Clinic specific to the proposed pilot at Michigan City High School revealed 370 of 530 risk screens or PROTOTYPE FUNDING PROPOSAL 9 70% were indicative of substance abuse risks and 124 of530 or 23.3% of these were indicative of suicide risks. The need for school based mental health services is further identified by technology alerts within the Michigan City Area Schools. Go Guardian, a software application that monitors student usage of district issued devices around the clock. According to Webb (2019) unpublished internal reports dated Dec 4· 2019 reflect 287 incidents of MCAS students conducting self-harm inquiries indicative of potential suicidal ideation that necessitated crisis screenings and risk assessments. 3. Planning Overview During the initial development of this proposal, the applicant who is a DSW candidate convened and facilitated 13 different face-to face community visioning session meetings including one bilingually translated with over 120 key community stakeholders including parents and youth. The challenge that was issued during the table talk visioning sessions in the pretesting and planning phase was to leverage community resources to break down programmatic siloes to address the mental health and behavioral needs of students who have been exposed to traumatic stress. The focus and goal was to develop a plan to increase access to mental health support services that foster the development of healthy coping skills and create wrap-around systems of support that would translate to changes in school climate. Participants including youth were engaged in the 2018-19 planning process as thought partners and provided input in the preparation of the operational design pursuant to this application. Dialogue occurred related to adverse childhood experiences (ACEs), a gap analysis of community provider shortages, limitations in the current school counseling program, and transparent discussion of the disparities in underrepresented subpopulations of students, particular students of color. Surveys and planning meetings included government officials, social service providers, PROTOTYPE FUNDING PROPOSAL 10 youth-serving organizations, United Way, local philanthropic foundations, all eighteen school counselors, postsecondary representatives from Ivy Tech, Purdue Northwest, Valparaiso, and Indiana Universities, district and school administrators as well as business, cultural, and faith organizations. Three student sessions at the two middle schools and one high school solicited the perspective of youth beneficiaries. Participants analyzed data and resources in efforts to create a shared vision, common language, generate solutions, and identify priorities via a Nominal Group Process to create a comprehensive continuum of support. Problems, goals, challenges, objectives, strategies, outputs, and short and long term outcomes were then mapped to a detailed logic model. The Evidence-Based School Social Services proposal provides the social justice opportunity to utilize evidence based approaches to provide professional development and integrate a multi-tiered system of support to prevent substance abuse and address ACEs via evidence based strategies that address the following goals to: l) improve emotional well-being, resilience and healthy coping responses in students enrolled in the Michigan City Area Schools, 2) improve access to school-based mental health prevention support, 3) prevent/reduce alcohol and illicit drug use, and 4) reduce mental health disparities for historically marginalized student demographic populations. The proposal will be piloted during the 2019-20 school year at the high school. The implementation design leverages internal and external resources to systemically integrate community support aligned to the identified interventions. Written memorandums of understanding reflective of in-kind contributions totaling nearly $666,000 of support provides evidence of community commitment in the submission of the request for funding. A twenty-one member community advisory group that includes youth representation emerged during the PROTOTYPE FUNDING PROPOSAL 11 planning process. The advisory group will meet quarterly and further support data analysis, monitor implementation outcomes, make program adjustments and secure sustainable resources. 4. Plan of Operation (30) The plan of operation utilizes the SAMHSA Strategic Prevention Framework (SPF) on an ongoing basis to assess both internal corporation data as well as epidemiological data for the SAMHSA SPF, Webb 2019 county and work with internal and external stakeholders to engage in data assessment, analysis and planning during community visioning sessions. Embedded in this model is the critical components of cultural competence and sustainability that are considerations from the onset during the visioning sessions. SAMHSA's strategic prevention framework (SPF) has evolved to assess capacity and plan for shared professional development and embed the foundational pillars of trauma-informed practice and school based mental health access in the development of a human scaffold of relationship support through funding requested from the Indiana Department of Mental Health and Addiction. Funding of this proposal provides the social justice opportunity to utilize evidence-based approaches to provide professional development and integrate a multi-tiered system of support to increase mental health access, and prevent substance abuse in a vulnerable, diverse, and health disparate youth population that are served in the public school corporation. The school corporation has maintained a long standing membership with the La Porte County Drug Free Partnership who contribute in-kind resources of prevention materials as well as a small mini grant from local drug interdiction fees to operate the Safe Harbor afterschool Lead & PROTOTYPE FUNDING PROPOSAL 12 Seed Youth Coalitions in our high school middle school aft:erschool programs. The La Porte County Drug Free Partnership (LPCDFP) has worked collaboratively on a variety of school system initiative and MCAS has been able to benefit from their prevention experti econ i tent with their mis ion to prevent and/or reduce substance use. The propo ed model will be piloted with services at the high school in year one and expanded throughout the school corporation within three years Professional development training will cultivate broader under tanding on the power of relation hips as a protective factor as described by Hawkins et al. (2015) that address social inequities that can be prevented in the healthy development of youth. The sy temic integration with other community-based organization depicted in the following diagram ba ed on SAMHS ' Continuum of Care Model that reflect both chool and community service delivery. Samhsa , go ( ubmitted by W ebb 2019) Michigan City Area School ------Local Sy tern of Care PROTOTYPE FUNDING PROPOSAL 13 The program will operate under the direction and coordination of the DSW candidate/applicant who has been affiliated as a central office administrator for over thirty years and will provide the managerial and programmatic oversight. Upon receipt of funding notification, summer professional development will occur prior to the start of the school year. Evidence based training and certification in Youth Mental Health First Aid Program will be provided for all new teaching staff as part of the new teacher orientation and represents a change in organizational practice. Fifty Staff and community members including bus drivers, food service workers, and clerical staff along with fifty high school age youth will also be trained annually in how to respond to a mental health or substance abuse crisis. Professional development will also include trainings in ACEs and a trauma-informed relational framework via the ACE-Interface curriculum developed by Dr. Robert Anda, the Co-Principal investigator of the landmark ACE study. Runion (2018) identifies staff play in creating a human scaffold of support. According to Runion, Dr. Bruce of the National Child Trauma Academy states "there is no more effective neurobiological intervention in addressing ACEs than that of a safe relationship." A leadership cohort from the high school will attend the Positive School Discipline Institute (PSDI) and be trained in trauma informed practice and restorative justice and will be charged with the task of training their peers and working to develop a school specific action plan that changes discipline policies and operational practice. The funding from the Indiana Department of Mental Health and Addiction will fund three social workers hired as independent contractors and offered access to onsite weekly clinical supervision needed for LCSW licensure. Eight high school PROTOTYPE FUNDING PROPOSAL 14 students will also be trained and hired in year one to serve as paid peer mentors for five hours each per week during lunch periods and afterschool hours. Pilot implementation includes professional development in the summer of 2019. At the beginning of the 2019-20 school year, Social Workers will assess student needs and provide triaged mental health and prevention support along a MTSS continuum of Universal, Strategic and Intensive supports. Grading period benchmarks will provide the opportunity for programmatic adjustments and evaluative reporting. School-based mental health services will be triaged for students who have been identified through the SAEBRS universal screener assessment administered at the beginning and end of the school year along a multi-tiered system of support (MTSS) framework. The Patient Health Questionnaire (PHQ-9) standardized assessment and the embedded Student Support for Exposure to Trauma assessment (SSET) and the Cognitive Behavior Intervention for Trauma in Schools checklist (CBITS) instruments will further assess changes in a student's emotional well-being. Anticipated outcomes will reflect the development of healthy coping behaviors, student engagement, improved mental health and emotional well being, and a reduction in discipline disparities among marginalized students who may be underrepresented in access to mental health services. In addition the capstone will support the cultivation of a positive school discipline climate as measured by an overall decrease in discipline referrals per school records. The anticipated outcomes will ultimately provide a model for replication to be taken to scale at the state and national level. This innovation leverages internal school system and external community resources and reframes the role of staff and youth in providing emotionally supportive relationships. The proposal utilizes peer mentors, bus drivers, food service workers, teachers, and other school personnel trained to be a part of a human scaffold of supportive relationships. PROTOTYPE FUNDING PROPOSAL 15 The SAEBRS, a brief universal assessment will be administered at the beginning and end of the school year to help identify and triage student mental health supports through a three tier, Multi-Tiered System of Support (MTSS) framework composed of universal, strategic, and intensive social-emotional supports in tandem with academic interventions. In year one, an estimated 510 high school students who have been identified based on screening assessments and have informed parental consent, will have access to Tier 2 Strategic services. Tier 2 services will be provided by BSW social workers that may include individual counseling, Peer Mentoring, and participation in the evidence-based Student Support for Exposure to Trauma (SSET) ten session curriculum. An estimated 170 students who have been identified based on the universal screening, ancillary assessments and informed parental consent, will have access to Tier 3 Intensive Services facilitated by MSW social workers that may include individual counseling, Peer Mentoring, and participation in the evidence-based Cognitive Behavior Intervention Trauma Support (CBITS). The CBITS curriculum includes ten group sessions, individual sessions, two parent sessions and one teacher session. The aforementioned model will be replicated in the middle schools in year two and in the elementary schools in year three for students in grade 5. Based on the CBITS, the Bounce Back program represents a developmentally appropriate trauma curriculum for students in younger than grade five. At full scale implementation during the 2021-22 school year, Tier l Universal prevention support will be available for 560 l students through evidence-based programs facilitated by counselors that include Botvin Life Skills, and Project Alert. Tier 2 services facilitated by BSW Social Workers will target approximately 30% of the enrollment or 1680 students. Tier 3, intensive services will be facilitated by MSW Social Workers and target an estimated 10% of the enrollment or 560 students. Tier 3 services include weekly individual, family sessions and wrap around PROTOTYPE FUNDING PROPOSAL 16 services utilizing the evidence-based, Cognitive Behavior Intervention for Trauma in Schools (CBITS), and CBITS Bounce Back model for younger students. When indicated, the Screening for Brief Intervention and Referral to Treatment (SBIRT) will be utilized to support referrals to community based services. Key Functionalities The theory of change is reflected in a proactive versus reactive model, via the use of assessments that facilitate the deployment of school-based services developed in response to periodic screening data. With informed parental consent, stratified tiers of scaled services will differentiate interventions and build capacity toward improved mental health, social emotional growth, and the development of healthy coping and strategies aimed toward increasing protective factors and decreasing risk factors toward the prevention of substance use. Foundational professional development for administrators, instructional, student services personnel, community members and high school age peer mentors will be offered during the summer months will guide enhanced understanding of the work necessary to change social norms and integrate trauma informed perspective identification and services based on the social emotional needs of students. The provision of training will foster understanding of the importance of relationships and integrate neuroscience research into school and community practice. Unique to this proposal is an intent to train support personnel including bus drivers, food service workers, clerical staff, and high school age youth and also incorporate two days of summer 2019 professional development for all new teaching staff as part of their overall orientation that include certification in the evidence based Youth Mental Health First Aid, and ACE-Interface programs. Peer mentors who have successfully demonstrated the resilience to overcome their own adversities. PROTOTYPE FUNDING PROPOSAL 17 The efficacy of staff professional development and mental health support on relationships with students will be measured by changes in emotional wellbeing as measured on the PHQ-9, and SSET and CBITS evidence based standardized assessments embedded comparisons in frequency of discipline referrals, school climate, and improvements in student emotional well-being as part of the evaluation plan. Outcomes will be based on quantitative and qualitative data at quarterly and semester grading period benchmarks and will provide the opportunity to make programmatic adjustments throughout the implementation phase. The short and long term benefits to be gained by meeting those needs: Short Term Benefit Lon2 Term Benefit Measurement Instruments Students will have access to school Improved SAEBRS Universal based mental health support Emotional -well-being Assessments PHQ9 Students aware & learn social Improved resilience (Grit) CBITS & SSET curriculum emotional self-management to develop embedded alternative healthy coping strategies Prevent or reduce Countywide INYS data substance use Open Door health clinic reports Drug Free Partnership data Students from marginalized groups Improved student Robert Wood Johnson will have in inclusive, safe access to engagement County Health Ranking school based support to de-stigmatize Improved school discipline Report seeking support School discipline reports Staff will increase awareness of ACEs Decreased disproportional Internally retrieved & impact of trauma & integrate in discipline corporation data at the practice semester and the end of the School Year Staff increase awareness and Improved school recognition of mental health. Attendance/ Achievement PROTOTYPE FUNDING PROPOSAL 18 Evidence of community support for the creation of the infrastructure and willingness to serve on the Community Advisory group is reflected in signed Memorandums of Understanding that are demonstrated in the following table: Contributor with signed In-kind Contribution & demonstrated support at no Value MOU's cost to grant City of Michigan City 50 Promise Scholarships of up to $5000@ annually for $250,000.00 Promise Scholarship MCHS graduates. Advisory Board Michigan City Commission Leadership Training, College Visits to Historically Black $10,000.00 of Social Status of African Colleges, Financial Aid, Scholarship & Parent Information, American Males Advisory Board Swanson Center Community School Based Services - 540 hours of Therapy & 702 $182,520.00 Mental Health Center hours of Case Management Samaritan Counseling Center School Based Therapy Services-up to 360 hours of services $46,800.00 Valparaiso University 2 BSW Interns- 900+ hours. Advisory Board $24,560.00 Purdue University NW Masters in Clinical Counseling Intern - 600 hours @ $14,484.00 $24. 14@ TRIO Talent Search Purdue Talent Search will contribute the following services valued $47,880.00 University Northwest - at $95.00 per hour 14 hrs per week X 36 weeks= $47,880 m MCAS. Eligibility identification, Student support services through one-on-one or group meetings, Academic, Note an estimated 75% of career, and financial information regarding career and MCAS students meet college readiness. Academic and financial assistance for eligibility guidelines for SAT & ACT tests. Financial information regarding the TRIO program support F AFSA, 21 st Century Scholar, and financial literacy, Postsecondary field trips. Parent workshops. Tutoring and mentoring. Dunebrook Family Healthy Families community partner sessions for socio $40,200.00 Advocacy Center emotional support and counseling guidance expectant teens and teen parents. 10 sessions@ month x $335@ x 12. Topical Professional Development workshops for faculty Advisory Board PROTOTYPE FUNDING PROPOSAL 19 United Way of La Porte Facilitate PD Training on "Implicit Bias". Technical $30,000.00 County assistance guidance for sustainability plans. Sponsor fundraiser for positive youth development. Provide summer Kindergarten Countdown Camp to assure social & emotional readiness. Will serve on Community Advisory Board Unity Foundation of LP Media Channel Access, Sustainability Support, Access to $4,000.00 County potential donors, creation of funding portal for online donations. Access to up to $3,000 in special project funding. Will serve on Community Advisory Board Duneland Health Foundation Sustainability Planning. Will serve on Advisory Board $1,000.00 La Porte County Drug Free 30 Youth Mental Health First Aid workbooks $25@= $4,488.00 Partnership $750.Financial support of$1000for Lead & Seed Youth Coalitions at Barker & Krueger Middle Schools. Lead & Seed workbooks & Training costs for evidence based training with certified facilitator $2000. Guest speakers14 hours of @ $24.14= $338 2 Hidden in Plain Sight Interactive Presentations- faculty PD $400. Advisory Board Minority Health Coalition of 200 hours at $24.1 4@of outreach services that address $4,828.00 La Porte County non-cognitive skills and resources to students and families. Safe Harbor/Hours For Ours 217 hours of Peer Mentoring Infrastructure @ $24.14 $5,237.14 hours to coordinate middle school and elementary 8 th grade and 6 th grade volunteer Peer Mentors. Advisory Board Citizens Concerned for the Access to Community Meeting space at the Grace In-kind space Homeless Learning Center Advisory Board for40 Total Community Collective Written Memorandums of Understanding are maintained $665,997.14 Impact Contribution on-file that articulate financial and in-kind contributions and support to assure sustainability and community buy-in beyond the scope of grant dollars. Management Plan The public school system operates under the auspice of an elected School Board who are responsible for the approval of all monthly expenditures in accordance with practices that are established by the State Board of Accounts. State oversight includes fiscal and program audits to PROTOTYPE FUNDING PROPOSAL 20 assure that expenditures are reasonable and align with the intended grant purpose for a budget cycle is from July 1, 2019 through June 30 1 h, 2020. The organizational chart depicts the organizational hierarchy and interrelationships between the school corporation and coordinating components as well as the relationship of the Community Advisory group. The management plan is designed to ensure effective and efficient implementation with sufficient decision making authority and access to the corporation's Executive leadership team. The program will operate under the auspice of the MCAS Curriculum Department's Data and Grant Specialist who works out of central administration offices. The proposed Program Director is an experienced education administrator, who is licensed by the Indiana Health Professions Bureau as a Licensed Clinical Social Worker and is a current DSW candidate orchestrating the development of these efforts. Rather than hire an employee, this individual will provide program administration as a grant funded addendum to their contract for the additional coordination and implementation duties in accordance with established benchmarks and timelines. Duties will include clinical supervision, fiscal management, data collection, internal evaluation, reporting, capacity building, reporting, staff and intern supervision, fidelity, and sustainability planning and as the liaison with the community advisory board. The management plan is designed to ensure effective and efficient implementation for the Program reflects in-kind organizational support that includes administrative office space, equipment, supplies, secured record storage, and clerical support at the central school administration building as well as specific expertise from the Curriculum, Business, Technology, Media, and other ancillary departments. Established fiscal management protocols are monitored by the Indiana State Board of Accounts audit process and include approvals of purchase orders expenditures aligned with approved budgeted line items. The school corporation's administrative PROTOTYPE FUNDING PROPOSAL 21 leadership team meets weekly and this provides a communication and decision making mechanism among all departments. Budget Year 1 Budget Year 1 Building a Trauma Informed Community Pilot at Michigan City HS in the Michigan City Area Schools A. Personnel A. Peer mentors $11,520 (8 mentors X B. Summer Training Stipends for ACE Interface & $8/hour X Shrs/wk. X 36 wks.) Youth Mental Health First Aid 50 @ year 8 . $30,000 stipends (50 staff X 3 days X 200/day) $10,000 Youth stipends (50 Youth X 2 days X 100/day) C. Fringe- FICA .0765 $2,295 - stipends $765 - Youth stipends $881.28 - mentors D. Travel - E. Equipment in-kind technology $3000@ X 4 = $12,000.00 F. Supplies $4,000.00 G. Contracted Services Michigan City HS 2 BSW Xl330 X $27 = $71,820.00 2 MSW Xl330 X $41 = $109,060.00 YMHFA Facilitator Fee $800/day X 6 = $4,800.00 YMHFA Teen Training Facilitator Fee $800/day X 4 = $3,200.00 Program Director 450 hrs. X $50 = $22,500.00 H. Other-S pace-in-kind $8,000.00 ($2,000@yr) Total DMHA Request submitted March 2019 $200,000.00 Total other funding TBD Total Implementation $290,841.28 Request [$20,000 in-kind] Like a Tale of Two Cities the wealthy summer beachfront homes that dot the shores of Lake Michigan are in sharp contrast to the life circumstances where students face greater exposure to traumatic stress. As such, an estimated 4,371 students enrolled in grades K-12 in the school PROTOTYPE FUNDING PROPOSAL 22 corporation face an increased incidence of exposure to adverse childhood experiences (ACEs) and may not be able to get the support they need to ensure healthy development thus making this proposal of paramount importance. Funding from the Indiana Department of Mental Health will address the aforementioned needs beginning with a pilot program at the Michigan City High School and impact 1700 students overall of whom 510 students are estimated in need of Tier 2 interventions and 170 students in need of Tier 3 mental health support. Evaluation Plan (10) The mixed methods evaluation plan will assess the impact of professional development, leveraged resources, and multi-tiered mental health support on creating a community culture of trauma informed practice in the context of the Michigan City Area Schools. The plan aligns with state efforts to meet the social emotional needs of students to ensure the healthy development of all youth and fills a research void for trauma-infonned practices in urban school districts. Additional measures will consider a community health perspective and changes in community outcomes. The 21 member Community Advisory committee will meet at least quarterly to analyze the data collected. As a process for making improvements and/or enhancements to the plan, fonnative data will provide the opportunity to make programmatic adjustments and refine or improve implementation strategies. Summative evaluation will provide qualitative and quantitative data related to the results of the activities and align with grant reporting deadlines. In addition to quantitative and qualitative indicators. Sustainability The Indiana Department of Education has provided the district with short tenn Substance Abuse Cures funding to train staff and purchase prevention materials and the requested DMHA funding would support professional development and the contractual Social Workers. In addition, PROTOTYPE FU NDING PROPOSAL 23 The Healthcare Foundation of La Porte has engaged in a Partners in Prevention Initiative planning process to work with school systems throughout the county to implement evidence based prevention programing via a competitive grant process. Modeled after efforts by the Richard M Fairbanks Foundation in Indianapolis, this funding is planned to support area schools It is our belief that through the DMHA Evidence based School Social Services program we will be able to demonstrate successful outcomes that will be supported in the competitive grant process that will allow the programs to be sustained after the completion of grant assistance. Michigan City Area Schools have a strong history of collaborative partnerships with community based organizations and local foundations that will serve in an advisory capacity and support securing sustainable funding. The recent planning initiative by the Healthcare Foundation of La Porte has identified the prevention of youth substance use as a strategic priority that will create a funding mechanism for the future to continue the identified evidence based programming Formal memorandum of understanding are in place with area universities for the provision of bachelor and masters level interns that will support the continuity of programming. Comparable services are limited or non-existent as a result of barriers related to limited providers, and issues with access related to hours, transportation, and service fees. The MCAS is fortunate to have a strong partnership and is represented on the local System of Care and the Swanson Center Community Mental Health Center who has agreed to provide some school based treatment services as well as the Samaritan Counseling Center who is able to provide a limited number of service hours from organizational fundraisers. With the identified action plan that includes professional development, the aforementioned evidence of community buy-in, and a shared vision in the responsibility of equipping all of our students with positive coping strategies we are optimistic in our ability to sustain program efforts or develop/access comparable services.

Abstract (if available)

Abstract The purpose of the capstone project is to address youth exposure to traumatic stress in the absence of mental health supports in a medically underserved, high poverty, urban community in an effort to improve emotional wellbeing and school discipline. The project will incorporate professional development school-based mental health services, leveraged resources, and community infrastructure. The capstone project addresses the Grand Challenge to Ensure the Healthy Development of All Youth through systemic change, professional development and increased access to mental health services for healthy youth development. The purpose of this project is to disrupt community norms and programmatic silos via an infrastructure that leverages resources, increases access to mental health services and creates a human scaffold of relational support to address exposure to adverse childhood experiences (ACEs). ACEs have been shown to impact health, mental health, social, and behavioral outcomes that compromise healthy youth development. Bucci, (2016) indicates that exposure to traumatic stress rewires the brain and represents a neurobiological response rather than a behavioral choice that affects cognition, memory, and emotional regulation. Without critical mental health support to guide the development of healthy coping skills, behavioral manifestations in a school setting may affect emotional well-being, school success, and future life trajectories. The project will identify youth who demonstrate exposure to traumatic stress, unhealthy coping behaviors and have unmet mental health needs in efforts to improve emotional well-being. Key community stakeholders including youth have been engaged from the onset in community visioning sessions to support the development of the infrastructure. Youth are also included in the Community Advisory group and will have the opportunity to be trained in Teen Mental Health First Aid and be employed in Peer Mentor positions. Summer professional development in ACE Interface and Youth Mental Health First Aid for fifty staff and community members will be offered annually for those with direct daily contact with youth. Participants will include bus drivers, food service workers, secretaries, and teachers and is intended to build a human scaffold of relational support include those on the frontlines. At the beginning and end of the school year, the SAEBRS universal screener will be administered to all students and serve to identify students with unaddressed mental health concerns. The collateral screening will include the Patient Health Questionnaire PHQ-9 Adolescent. Both instruments have demonstrated validity and reliability with the identified demographic groups. Based on assessments, MSW Social Workers will obtain informed parental consent and triage services. Tier 2 services facilitated by BSW Social Workers will include a sample of an estimated 30% of the enrollment peer mentor pairings, and participation in individual and group support and may include the Student Support for Exposure to Trauma (SSET), non-clinical curriculum. In year one the sample size will be an estimated five hundred and ten high school students in grades nine to twelve. Tier 3 services will be facilitated by MSW Social Workers and may include individual and family counseling, participation in the Cognitive Behavior Intervention for Trauma in Schools (CBITS) group curriculum, and wrap-around community support if indicted. Tier 3 services will include a sample of an estimated 10% of the enrollment based on students with the greatest needs. The Program Director will develop a data monitoring protocol and data analysis to monitor outputs in the number of staff trained, number of Tier 2 and Tier 3 participants, number of units of mental health support service with pre and post-intervention assessments to determine the impact on outcomes of improved emotional well-being and improved discipline. Anticipated outcomes are improved emotional well-being and improved school discipline. re of wrap-around support.

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Webb, Michelle Mersich (author)

Core Title Building a trauma-informed community to address adverse childhood experiences

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 12/16/2019

Defense Date 11/21/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Adverse Childhood Experiences (ACEs),community infrastructure,healthy development of all youth,OAI-PMH Harvest,school-based mental health,social-emotional development,trauma-informed practice

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Manderscheid, Ronald (committee chair), Lee, Nani (committee member), Rank, Michael (committee member)

Creator Email mickiwebb@usc.edu,webb837@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-255190

Unique identifier UC11674700

Identifier etd-WebbMichel-8068.pdf (filename),usctheses-c89-255190 (legacy record id)

Legacy Identifier etd-WebbMichel-8068.pdf

Dmrecord 255190

Document Type Capstone project

Rights Webb, Michelle Mersich

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA