NASDSE Satellite Conference Series May 9, 2007 Response

NASDSE Satellite Conference Series May 9, 2007 Response

NASDSE Satellite Conference Series May 9, 2007 Response to Intervention (RtI) Non-Academic Barriers to Achievement-Addressing School-based Mental Health and Positive Behavior Lucille Eber Ed.D Interventions and Supports IL PBIS Network [email protected] Content/Agenda:

Establishing a Framework for Discussion Rationale/Need Comprehensive Approach Impact and Outcome Examples Challenges Next Steps A Framework for Discussion. Non-Academic Barriers to Learning: Social climate

Students availability for instruction School and community Predictable, consistent At school In Class Academic Engagement Family voice/involvement

A Clarification about the concept of Response to Intervention (RtI) RtI currently thought of as only about reading and RtI is a model that applies to both academics and non-academic components of learning Language Clarification Needed? We arent allowed to use term RtI but we say a 3-tiered intervention system School-Wide Systems for Student Success Academic

Systems A Response to Intervention Model Behavioral Systems Tertiary Interventions Individual Students Assessment-based High Intensity Secondary Interventions Some students (at-risk) High efficiency Rapid response Small Group Interventions Some Individualizing Universal Interventions All students Preventive, proactive

1-5% 5-10% 80-90% 1-5% Tertiary Interventions Individual Students Assessment-based Intense, durable procedures 5-10% Secondary Interventions Some students (at-risk) High efficiency Rapid response Small Group Interventions Some Individualizing

80-90% Universal Interventions All settings, all students Preventive, proactive Core Features of any Response to Intervention (RtI) Approach Investment in prevention

Universal Screening Early intervention for students not at benchmark Multi-tiered, prevention-based intervention approach Progress monitoring Individualized interventions commensurate with assessed level of need (at tiers 2 and 3) Use of problem-solving process at all 3-tiers Active use of data for decision-making at all 3-tiers Research-based practices expected at all 3-tiers Rationale/Need. Why Does RTI need to be applied to Components Social/Emotional Over use of restrictive settings (Sp. Ed. As

well as non-Sp.Ed) Disproportionality-over representation of specific population subgroups Lack of structures for fidelity implementation Failure to intervene early with adequate dosage and fidelity increases cost Challenges with Social/Emotional Components of as

RTI Behavior is not always viewed sets of skills that need instruction Transference & generalization structures History of failed implementation Lack of effective Universal systems High rate of Universal responses applied to students who really need access to all 3-tiers Specialized interventions implemented poorly if at all; too low dosage, intensity Need for Universal Implementation

High use of punitive responses without regard to lack of effectiveness (Effective means behavior is not likely to reoccur) Structures/expectations to monitor impact of effect of discipline practices not in place Inconsistency of adult responses to behavior not recognized as factor in outcomes Expectations that effective behavioral approaches are to be used by all not established Where to Begin

Invest in a social culture that is positive, predictable, consistent and safe Define positive behavioral expectations Teach behavioral expectations Acknowledge correct behavior Consistent continuum of consequences for problem behavior Collection and use of data for decision-making Assume more intense supports will be needed for students with more significant support needs.

Examples of Ineffective Secondary/Tertiary structures Referrals to Sp.Ed. seen as the intervention FBA seen as required paperwork vs. a needed part of designing an intervention Interventions the system is familiar with vs. ones likely to produce an effect (ex: student sent for insight based counseling at point of mis behavior)

Challenges with regard to students with Emotional Behavioral Challenges: Low fidelity or low dosage of implementation of interventions Lack of data-based decision making Fragmentation of efforts on behalf of youth Lack of effective behavior practices in schools School environments that are toxic for youth with MH challenges

Key Questions: Is positive behavior support being applied in needed dosage for ALL students? How do we move from expert driven, onestudent at a time, reactive approaches to building capacity within schools to support the behavior of ALL students? Comprehensive Approach The Development of SW-PBS as a Context for Improving Outcomes for Students with or at-risk of EBD ABA

PBS Behavior has a function/purpose Person Centered Planning SW-PBS (PBIS) Enhancement of PCP w/SOC and wraparound Systems changes in Sp.Ed. implementation Positive Behavioral Interventions & Supports PBIS is a research-based systems approach designed to enhance the

capacity of schools to effectively educate all students, including students with challenging social behaviors adopt & sustain the use of effective instructional practices (Lewis & Sugai, 1999; Sugai et al., 1999; Sugai & Horner, 1994, 1999) What SW-PBIS is Evidenced based practices imbedded in a systems change process A process with conceptual foundations in Applied Behavior Analysis (ABA) A prevention continuum that includes wraparound

value-base & practices (person-centered planning) A framework for organizing mental health supports and services Social Competence & Academic Achievement SY ST E TA DA Supporting Staff Behavior MS

OUTCOMES PRACTICES Supporting Student Behavior Supporting Decision Making What SW-PBIS is NOT A curriculum, a packaged program Just about tangible reinforcers

Just about discipline A Special Education Program Just for some students Critical Features of SWPBIS . Team driven process Instruction of behaviors/social skills

Data-based decision-making Instruction linked to evaluation Defines social culture of the school Whats Different A Systems Change Process Goal is to establish host environments that support adoption, sustain use, & expansion of evidence-based practices (Zins & Ponti, 1990) Universal Example

Leadership Team identifies need Lessons taught school-wide (all staff all kids) Response to high frequency of bullying (data) Direct instruction linked to Respect expectation Practice activities in all settings Prompts in settings (i.e. playground, halls, classroom) Recognition of skills being demonstrated

Assessment of outcomes Has bullying decreased? More Time for Learning: Out-of-School Suspensions (OSSs), Springfield Elementary Schools 70 63 Total OSSs 60 50 40 30 20 10

30 30 17 26 14 - 43% - 53% - 59% Harvard Park Addams Feitshans 0

August to October 2004 August to October 2005 Stu d e n ts W h o M e e t o r Ex c e e d Re a d in g Sta n d a rd s o n 3 rd G ra d e ISA T 64 % of students 65 60 58 55 P BIS N o t in P la c e (n =8 4 ) P BIS in P la c e (n =1 1 2 ) S c h o o ls

S c h o o ls factors Risk & protective Comparing School Safety Survey Partial vs. Fully Implementation FY06 100% 80% 60% 40% 20% 0% R isk R a tio P ro te c tiv e R a tio P a rtia l (n =3 7 ) Fu ll 8 0 / 8 0 (n =4 0 )

Does School-wide PBIS increase Schools abilities to effectively educate students with more complex needs? How did a school-wide cool tool emerge from a Wraparound planning process for an individual student? The team decided to develop a school-wide cool tool to teach/shape respectful interactions with adults because: concerns about being able to deliver consistent practice, prompts and reinforcers across all settings at school. concerns that Simon would not be accepting of an individualized approach to teaching the desired behavior the principal stated that Simon wasnt the only student who needed teaching/practice of this behavior Missed Opportunity for Positive Behavior Support?

Kindergartner; tantrums; hurts small animals In principals office by noon daily Waiting to be accepted for MH assessment No FBA/BIP done Although transitions were a known trigger School became immobilized by the setting events (i.e. possible psychiatric disorder) Number of Secondary/Tertiary Interventions Reported - 04-05 Number of Interventions Reported

120 100 80 60 40 20 0 Full Implementation Partial Implementation No-SET Data Level of Implementation Number of schools PBIS Schools Completing School Profile Forms and

Implementing Secondary/Tertiary Interventions Across Four Years 200 180 160 140 120 100 80 60 40 20 0 187 170 151 149 Schools Completing

Profiles # of Schools Reporting Secondary/Teritiary Interventions 2002-2003 2003-2004 2004-2005 2005-2006 Years Number of Students Six Year Comparison of Sparta School District Least Restrictive Environment 140 120 100 80 60 40 20 0

1999-00 2000-01 Monitor 2001-02 2002-03 Resource 2003-04 2004-05 Self contained MARK TWAIN PRIMARY SCHOOL Kankakee, IL DISCIPLINARY REFERRALS FOR CLASSROOM BEHAVIOR thru Feb. 2006 300

268 200 143 150 113 100 3rd Year PBIS 50 71 2nd Year of PBIS

1st Year of PBIS # OF DISCIPLINE REFERRALS 250 15 0 2001-02 2002-03 2003-04 2004-05 2005-06 (TO DATE)




11 FIRST YEAR OF PBIS # OF REFERRALS FOR SPEC ED 14 1 0 2002-03 2003-04 2004-05 2005-06 (TO DATE) ISAT 00-05 MARK TWAIN - % MEETS AND EXCEEDS


45.0% 28.8% 24.4% 23.0% 30.0% 24.0% 40.0% 10.0% 0.0% MATH 2001 2002 2003

2005 20.0% READING 2000 2004 36.0% 42.0% 50.0% 41.5% 48.9% 60.0%

47.0% 58.9% 61.7% 70.0% 72.3% 80.0% 52.6% BEFORE PBIS WRITING Dewey Elementary: 100%

45 40 30 20 10 78% 60% 80% 60% 27 40% 16 20%

5 0 2003-04 0% 2004-05 Students in SPED < 21% of Day Students in SPED 21-60% of Day ISAT Scores IS A T S c o re # Stu d en ts 50 Changes in Least Restrictive Environment

School-wide Positive Behavior Supports A Response to Intervention Model Universal School-Wide Assessment School-Wide Prevention Systems Small group interventions t en Tertiary Multiple settings Multiple Perspectives Multi-Disciplinary Assessment & Analysis

Individualized Interventions In Interviews, Questionnaires, etc. Observations, FBA Group Interventions te rv en t io n Secondary

m ss se As Analyze Student Data (simple) Complex individualized interventions Team-Based Wraparound Interventions (wraparound/PCP) Adapted from T. Scott, 2004 Continuum of Support for Secondary-Tertiary Level Systems

Targeted group interventions (BEP, Check and Connect, social or academic skills groups, tutor/homework clubs, etc) Targeted group with a unique feature for an individual student Individualized function based behavior support plan for a student focused on one specific problem behavior Complex Behavior Support Plan across all settings (ie: home and school) Wraparound Team/Plan: More complex and comprehensive plan; address multiple life domain needs across home, school and community (i.e. basic needs, sense of belonging; MH/medical treatment as well as behavior/academic interventions) Types of Group

Interventions Check in/ Check Out Systems Check and Connect Newcomers Club Homework Study Groups Anger Management Group Other Social Skills Groups Support Groups (divorce, grief, etc) Average ODRs for 12 Check In/Check Out Students Edison Elementary School, Danville CCSD 118 3

Number of ODRs 2.5 2 2.42 76% 1.5 1 0.5 0.58 0 Pre-Intervention Post Intervention

Blending Community & Family Supports for Group Intervention Success Mr. Orlando Thomas and Ian Tatum of Jefferson Middle School, Champaign Community Unit School District 4, initiated T.E.A.M. (Teaching Excellence in Academics through Motivation) for 30 African American male students who accounted for 30% of the total ODRs in 2002-03. After two years, the students reduced their ODRs by 56% (from 482 in 2003-04 to 211 in 2005-06). In 2004-05, five of these students made honor roll. This amount doubled to ten students in 2005-06. TEAM Member ODRs Across Three Years Jefferson Middle School, Champaign CUSD 4 600

56% Number of ODRs 500 400 482 300 200 254 100 211 0

2003-04 (N=30) 2004-05 (N=30) 2005-06 (N=28) Does School-wide PBIS increase schools capacity to catch and respond to MH needs of students sooner? What Do we Know about the Tertiary Level: Requires real talent and skills (Rob Horner) Applies Art (of engagement) and Science (of interventions Needs to happen sooner for many students/families

Gets tougher with each system failure Requires thinking differently with kids and families Is easier in schools proficient with school-wide PBIS Includes system/practice/data components L. Eber 2005 Individualized Teams at the Tertiary Are unique to the individual Level child & family

Meeting Process Blend the familys supports with the school representatives who know the child best Meet frequently Regularly develop & review interventions Facilitator Role Role of bringing team together Role of blending perspectives

Tertiary Level System Components Facilitate/guide an individualized team planning process Family/student/teacher ownership of plan Access full range of school and community support services across life domains Home, school, community settings Individualized academic and behavior interventions are integrated into comprehensive wraparound plans. Wraparound: A SOC Tool Emerged from practitioners struggling to implement SOC (grassroots) Keep/bring youth home

Flexible, creative, non-categorical Natural support networks Community-based Unconditional-Commit to stay the course Let family voice guide service development Non-traditional supports and services Value Base Build on strengths to meet needs Non-judgemental; non-blaming One family-one plan

Increased family/youth voice/choice Increased family independence Support for youth in context of families Support for families in context of community Implementing Wraparound : Key Elements Needed for Success Engaging students, families & teachers Team development & team ownership Ensuring student/family/teacher voice

Getting to real (big) needs Effective interventions Serious use of strengths Natural supports Focus on needs vs. services Monitoring progress & sustaining System support buy-in Whats New in Wraparound? Skill set specificity Focus on intervention design/effectiveness

Integration with school-wide PBS Phases to guide implementation/supervision Data-based decision-making Integrity/fidelity assessment (WIT) Tools to guide teams: Home School Community

Education Information Tool Skill Sets Identifying big needs (quality of life indicators) Student needs to feel others respect him Establish voice/ownership Reframe blame Recognize/prevent teams becoming immobilized by setting events

Getting to interventions that actually work Integrate data-based decision-making into complex process (home-school-community) Four Phases of Wraparound Implementation I. II. III. IV. Team Preparation

- Get people ready to be a team - Complete strengths/needs chats (baseline data) Initial Plan Development - Hold initial planning meetings (integrate data) - Develop a team culture (use data to establish voice) Plan Implementation & Refinement - Hold team meetings to review plans (ongoing data collection and use) - Modify, adapt & adjust team plan (based on data) Plan Completion & Transition - Define good enough (Data-based decision-making) - Unwrap DATA: The BIG Question Can teams use data-based decisionmaking to prioritize needs, design strategies, & monitor progress of the child/family team? more efficient teams, meetings, and plans? less reactive (emotion-based) actions? more strategic actions? more effective outcomes?

longer-term commitment to maintain success? Using Data to Drive Decision Making at The Child and Family Team Supports what we know to be true about a student Sometimes tells us what we did not know about a student Helps to support need for team involvement Helps to support need for family involvement Help to support need for resource allocation

Helps us to our celebrate success Helps us to know when change is necessary and imminent Example of Getting to Strengths and Needs at Baseline Using Data and Voice & Choice Jacob Reasons for Wrap Referral Baseline Poor school attendance Tardiness Refusal to participate in 2nd grade classroom activities. Did work independently in office/partial school days. Previous hospitalization (Bipolar Disorder)

Retention currently repeating 2nd grade year Failing Grades Family Support Needs Jacob Home/School/Community Tool Getting to Strengths & Needs at Baseline Jacob Educational Information Tool Time 3 Roman Using the Data to get to Strengths and Needs 4 Home 4

3.5 3.5 3 3 2.5 2.5 2 2 1.5 1.5

1 1 Baseline Controls Anger 3 months Has friends 6 months Gets along with children School Baseline Controls Anger 3 months Has friends

6 months Gets along with children Results of Implementation of Wraparound within SW-PBS Three year pilot in IL Enhance SOC wraparound approach data-based decision-making as part of wraparound intervention Development of strength-needs data tools Web-based system

Immediate and Sustainable Change Noted in Placement Risk 2 High Risk 1.75 1.78 1.5 1.5 1.3 1.25 Low/No Risk 1 Baseline (n = 19)

Time2 Time 3 School Risk BehaviorsSubstantially Decline for Student Engaged in Wrap Avg # of episodes 4 3.87 2.84 3 2.37 2 O SSs

1.38 1 0.79 0.5 0 Ba seline (n=19) O DRs Time 2 (n=19) Time 3 (n=8) P o sitiv e C la ssro o m Be h a v io r & A c a d e m ic A c h ie v e m e n t Lin k e d 4 Always

2 .8 3 2 .2 1 2 .4 5 2 .8 3 2 2 .1 3 Never 2 .1 9 1 B a se lin e ( n = 2 6 ) Tim e 2 ( n = 2 6 ) C la ssro o m B e h a v io r Fu n c t io n in g

Tim e 3 ( n = 1 2 ) A c a d e m ic A c h ie v e m e n t Challenges at Tertiary Level Requires complex skills Need to find internalizers sooner (SSBD) Data is buried in family/student stories Capacity to stay at the table long enough to effect change Engage key players, Establish voice and ownership Translate stories into data to guide plans

Coaches have to help establish capacity for: Commitment of time Commitment to stay at table Willingness to regroup and be solution-focused No judging or blaming Time for listening to stories Time for venting, validating

Establishing consensus Voice of student/family in prioritizing Establishing ownership Solidifying SecondaryTertiary Implementation: IL Demo sites w/specialized coaching support Example Breakdown training to correspond with full continuum of interventions needed On-line SIMEO system Link to IL State Performance Plan goals: Sp.Ed. Data Interagency Linkage: Community LANs

ICMHP: SBMH integration through PBIS Demos Tertiary Demos District Commitment Designated Buildings/District Staff External Tertiary Coach/Coordinator Continuum of Skill Sets (training, guided learning, practice, coaching, consultation) Commitment to use of Data System

Going beyond ODRs (i.e. SSBD) Self assessment/fidelity SIMEO-Student Outcomes District and Building Progress Tertiary Coaches Allocated Intensive Skill Development Regular District and Building Meetings Secondary/Tertiary Systems being Refined Hard look at data:

Are current interventions working? How are youth with IEPs doing? What does our LRE data look like? Group Intervention Reduces Behavior Problems for Students At-Risk At Jefferson Middle School, Springfield School District 186, 14 of 22 students who began a Check and Connect intervention in 2006-07 due to high rates of office discipline referrals (ODRs) in 2005-06 are showing improvement. Total ODRs from last year to first semester this year dropped significantly for these eight students (from 193 to 26). 8 students received only five or fewer ODRs in the first semester of this year ODRs for Eight Students on Check & Connect Jefferson Middle School, Springfield District 186 Number of ODRs

120 100 80 96.5 73% 60 40 20 26 0 2005-06 Avg per Semester 2006-07 First Semester

Jack Benny Middle School, Waukegan Of 14 students placed on Check and Connect in November 2006, seven students showed progress in only three weeks. These seven students decreased their ODRs from a total of 19 in ten weeks to a total of one ODR after three weeks of the intervention. More Intensive Intervention Avoided? (or A

sets stage student with for fourmore ODRsefficient/productive was not experiencing wraparound?) success with Check and Connect. After individualizing the intervention by allowing her to choose her Check and Connect person, she has received only one ODR, and teachers have observed improvement in her behavior. This students progress will continue to be monitored, to determine if more comprehensive support via w/a approach is needed. Mary Ellen 7th grade student Referred to the Student Assistant Team as a potential WRAP because she had formed a strong attachment to a teacher that interfered with her ability to transition

between classes. The team determined that when Mary Ellen transitioned between classes her anxiety increased because she wanted attention from her teacher. Staff escorts were assigned to her between classes as a safety precaution and to alleviate anxiety of the student and teacher. A staff member was also assigned outside the classroom teachers room. The anxiety continued and the wraparound process was initiated. Mary Ellen Home, School, Community Tool Mary Ellen Home, School, Community Tool Mary Ellen Wraparound Phase One The escort service was gradually faded and Mary Ellens anxiety began to decrease. Mary Ellen met with her counselor, D.D., to set goals (Universal

level intervention). Mary Ellen set the goal: to walk to class by herself. The wrap team plans to meet to address social and recreational needs identified by the family and school via data and conversation. The team has also started to plan ways that Mary Ellen can interact with peers (Trivia game, safety presentation). The family is in the process of completing an outside evaluation.. (possible ASD?). Whats Different for Practitioners (schools)? Data-based decision-making across settings/life domains. Integrated teams with MH and other community partners Natural supports and unique strengths are emphasized in team and plan development. Youth/family access, voice, ownership are critical features.

Plans include supports for adults/family as well as youth. Does School-wide PBIS increase Schools capacity to identify MH needs and reach out to families in a timely manner? Need for MH Integration Age 10 male in BD Class Excellent teacher; good progress Teacher frustrated; cant get him out more

Incidents decrease in frequency but NOT in intensity (hits head on wall; screams hates himself) Needs other supports to deal with past trauma he has experienced? Missed Opportunity for Early Intervening Services? Kindergartener with ADHD (family identified and sought treatment) Teacher can handle her

Psychiatric hospitalization (safety at home) Staff knew triggers & maintaining consequences But no FBA/BIP was done No support to family offered Use of SSBD could have led to interventions? Missed Opportunity Kindergartner; tantrums; hurts small animals In principals office by noon daily Waiting to be accepted for MH assessment No FBA/BIP done Although transitions were a known trigger

School became immobilized by the setting events (i.e. possible psychiatric disorder) Building Capacity for Wraparound in Schools Establish full-continuum of PBIS in schools Identify and train facilitators Train other school personnel about wrap teams Ongoing practice refinement and skill development Review data around outcomes of teams and plans Wraparound Case Study Carlos Reason for Referral Impaired family relationships Impaired peer relationships

Family support needs Mental health needs (depression) Wraparound Case Study Carlos Student Baseline Information Repeated seventh grade General ed classroom 100% of day Failing academics (GPA 0 59%) 6 or more detentions 2 5 in-school suspensions Wraparound Case Study Carlos cont.

Classroom Functioning From three points in time (11/03 06/04) Wraparound Case Study Carlos cont. Strength Sustained at Six Months (11/03 06/04) Works independently Wraparound Case Study Carlos cont. Need Becomes Strength at Six Months (11/03 06/04) Has enough to do (age-appropriate activities) Wraparound Case Study Carlos cont. Strengths Sustained at Six Months (11/03 06/04)

Wraparound Case Study Carlos cont. Ongoing Needs/Six Months (11/03 06/04) Wraparound Case Study Carlos cont. Strengths Gained 2nd Year (11/03 02/05) District and Building Progress Tertiary Coaches Allocated Intensive Skill Development Regular District and Building Meetings

Secondary/tertiary Systems being Refined Hard look at data: Are current interventions working? How are kids with IEPs doing? What does our LRE (EE) data look like? Possible Steps to Move Forward Opportunity for MH integration through School-based Leadership Team System and Data Structures Needed: leadership team is in place

Team looks at range of universal data (not just ODRs) Capacity to get 80-90% of staff consistently implementing inventions MH Integration opportunity at the Universal Level High % of youth come from multiple homeless shelters in the neighborhood High % of kids have experienced

death/violence High % of suicide threats/attempts MH Integration Opportunity at Secondary Screening for MH needs not Level caught via ODRs Use of SSBD Connections with families early on Social skills instruction for at-risk students

More likely to succeed as part of systemic process Cool tools can be scheduled as follow-up to ensure transference and generalization Data to Consider LRE Other places kids are parked

Building and District Level By disability group Alternative settings Rooms w/in the building kids are sent Sub-aggregate groups Sp. Ed. Ethnicity Going Beyond ODRs. Apply RtI process to mental health status

SSBD Teen Screen Other? Engage community partners in a 3-tiered process Explore other data points to consider/pursue Resources: Fixen, et al, 2005.Implementation Research: A Synthesis of the Literature

Kutash et al, 2006. School-based Mental Health: An Empirical Guide for Decision-Makers (Bazelon Center, 2006)Way to Go.School Success for Children with Mental Health Care Needs Freeman, R., Eber, L., Anderson C, Irvin L, Bounds M, Dunlap G, and Horner R. (2006). Building Inclusive School Cultures Using Schoolwide PBS: Designing Effective Individual Support Systems for Students with Significant Disabilities. The Association for Severe Handicaps (TASH) Journal, 3 (10), 4-17. (

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