INTENSIVE LEVEL WRAPAROUND

Day 2

Agenda for Week

Monday Tuesday Wednesday Thursday

Stra

nd

1.  Introductions 2. Wrap & PBIS 3. Tier 2/3 Review 4. Team Visit

1. Universal Screening

2.  FBA/BIP 3. Matching

Interventions 4. Wrap Intro

1.  Engagement 2. Team

Development 3. Big Needs 4. Using Wrap Tools

1.  Planning to Implementation

2.  Evaluating progress

3. Transition 4. Action Steps

Team

Tim

e

Finish Activity #1 BAT School Act Plan

BAT School Act Plan •  Screening •  FBA •  Engagement

BAT School Act Plan

School Act Plan

Today’s Agenda:

• Reminders & Introductions • Universal Screening • Functional Behavior Assessment & Behavior Intervention Planning (FBA/BIP) • Matching Needs & Interventions • Wraparound Phase 1: Engagement • Team Time Planning

Dr. Cath Burns

• Clinical Director Children, Youth and Families Washington County Mental Health • Working with schools and mental health personnel in Washington County • Conducting and providing training in FBA/BIPs • Facilitating wraparound teams

BEST Summer Institute Theme & Vision:

Working Smarter

Not Harder

BEST Expectations Be present

Engage with others

Support each other

Team solutions

(Tiny) Community of Practice

Wraparound Principles in

Action

Working Smarter /

Not Harder

Low-Tech Resources

High-Tech Resources

UNIVERSAL SCREENING

Interventions with an Evidence Base 1.  Advance organizers 2.  Anger Management Skills Training 3.  Behavioral Interventions 4.  Choice 5.  Class Wide Peer Tutoring 6.  Cognitive organizers 7.  Cognitive Restructuring 8.  Cognitive-Behavioral Therapy 9.  Computer-Assisted Instruction 10. Contingency Management 11. Daily Behavior Report Cards 12. Exposure-Based Techniques 13. Family Therapy 14. Functional Assessment 15. Functional Communication Training 16. Integrated Cognitive-Behavioral Therapy 17. Interdependent Group-Oriented Contingency

Management 18. Interpersonal Therapy for Adolescents 19. Milieu Language Teaching 20. Mnemonics 21. Modeling 22. Modified Task Presentation Strategies 23. Moral Motivation Training 24. Multimodal Interventions

25. Multisystemic Therapy 26. Opportunities to respond 27. Pacing 28. Parent Training 29. Peer Mediated Interventions 30. Peer tutoring 31. Peer-Mediated Conflict Resolution and

Negotiation 32. Picture Exchange Communication System 33. Pivotal Response Training 34. Pre-correction 35. Presentation Strategies 36. Problem Solving 37. Procedural prompts and behavioral momentum 38. Replacement Behavior Training 39. Self instruction 40. Self mediated strategies 41. Self monitoring 42. Self-Management 43. Social Skills Training 44. Task Modification 45. Task Selection Strategies 46. Token Economy System 47. Verbal Mediation 48. Video Modeling

Vannest K, Reynolds CR, Kamphaus RW. BASC-2 intervention guide for emotional and behavioral problems. Bloomington, MN: Pearson Assessments; 2009.

Why Universal Screening?

• To find students whose problems are not immediately obvious (internalizers) and identify problems with a high degree of accuracy

• Early identification leads to early intervention

• Schools that implement Universal Screening select interventions based on results of rating scales on the screening tools. This is effective and efficient.

Universally Accepted Types of Screening in School

Readiness

Academic

Vision

Hearing

Dental

Behavior

Why not?

Features of Good Universal Screening

Accurate Cost efficient Acceptable Useful

Aren’t ODRs Enough?

Students with

externalizing problems?

Students with

internalizing problems?

Multi-Stage & Multi-Gate Approach

Stage 3

Stage 2

Stage 1 Universal Screen

Elevated? Screen #2

Elevated? Refer to

team

Not elevated? Done.

Not elevated? Done.

BASC-2 Approach

Vannest (2008) Interventions for Externalizing & Internalizing Behaviors at Tier 2 & Tier 3

Stage 1 Stage 2

Results of screens helped teams choose which interventions to develop, use, or expand (4 schools)

0

5

10

15

20 TES DPE RES TIS

PBIS-NH Approach Stage 1

Systematic Screening for Behavior Disorders • Teachers rank order

students with: • Externalizing problems •  Internalizing problems • Choose top 3

Stage 2 BASC-2 BESS Teacher • Teachers rate those

passed gate 1 • Elevated risk • Extremely elevated risk

Stage 3 Referral to School

Team •  Link with appropriate

intervention

No elevation

No elevation

Exit Exit

Systematic Screener for Behavior Disorders

List Externalizers Rank Order Externalizers

1 Richard Boltax 1 Richard Boltax

2 Cath Burns 2 Jesse Suter

3 Mandy Couturier 3 Sherry Schoenberg

4 Kilie Demar 4 Ernest Hart

5 Ernest Hart 5 Jennifer Repinski

6 Dan Mapes 6 Sherri Nichols

7 Sherri Nichols 7 Dan Mapes

8 Jennifer Repinski 8 Mandy Couturier

9 Sherry Schoenberg 9 Kilie Demar

10 Jesse Suter 10 Cath Burns

1.  Select 10 students 2.  Rank order them 3.  Choose top 3

Student Internalizing Behavior Screener (2010)

Students Nervous Bullied by peers

Seems sad Clings to adults

Total Score

1 Richard Boltax 3 3 3 3 21

2 Cath Burns 0 0 0 0 0

3 Mandy Couturier 0 0 0 0 0

4 Kilie Demar 0 0 0 0 0

5 Ernest Hart 0 0 0 0 0

6 Dan Mapes 0 0 0 0 0

7 Sherri Nichols 0 0 0 0 0

8 Jennifer Repinski 0 0 0 0 0

9 Sherry Schoenberg 0 0 0 0 0

10 Jesse Suter 3 3 3 3 21

1.  Rate each student: 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Frequently 2.  Risk Level: Low (0-3), Moderate (4-8), High (9-21)

Student Risk Screening Scale (1994)

Students Nervous Bullied by peers

Seems sad Clings to adults

Total Score

1 Richard Boltax 3 3 3 3 21

2 Cath Burns 0 0 0 0 0

3 Mandy Couturier 0 0 0 0 0

4 Kilie Demar 0 0 0 0 0

5 Ernest Hart 0 0 0 0 0

6 Dan Mapes 0 0 0 0 0

7 Sherri Nichols 0 0 0 0 0

8 Jennifer Repinski 0 0 0 0 0

9 Sherry Schoenberg 0 0 0 0 0

10 Jesse Suter 3 3 3 3 21

1.  Rate each student: 0 = Never, 1 = Rarely, 2 = Sometimes, 3 = Frequently 2.  Risk Level: Low (0-3), Moderate (4-8), High (9-21)

ACTIVITY # 4 Review all & complete one for your student

•  BASC-2 BESS Teacher Form, •  Systematic Screening for Behavior Disorders, •  Student Risk Screening Scale, •  Student Internalizing Behavior Screener

Screening Tips

• Recommended twice / year (October & February) • Group administration of Stage 1 • Teachers should have known students for at least one month • Review definitions / examples of externalizing and internalizing problems

So pretty simple, right? Well…

• Family’s right to privacy (opt out option) • Clear & efficient systems to support process • Training & TA • Availability of supports • Policy and liability issues • What else?

NH-PBIS Recommended Steps to Readiness

Need identified

Approval secured

Team formed

Supports identified

Policies for other screening

reviewed

Evidence based system

identified

Policies & procedures developed

P&P shared with families

(opt out)

P&P for notifying

families shared

Point of contact for oversight

Point of contact at SU/SD

Resources available

ACTIVITY #5 1.  Review Universal Screening Steps to Readiness 2.  Where’s your school in this process?

Perhaps Step 1 is Workshop M?

Howard Muscott Early Identification of Students at Risk of School Failure Due to Social, Emotional and/or Behavior Problems: Nomination and Activation of Secondary Prevention (Targeted) Behavior Supports within an RTI for Positive Behavioral Interventions and Supports Framework

FBA / BIP

Functional Behavioral Assessment / Behavior Intervention Program (FBA/BIP)

• Foundation of all intensive level interventions

• Behavior support is the redesign of environments, not the redesign of individuals.

• Positive behavior support plans define changes in the behavior of those who will implement the plan. A behavior support plan describes what we will do differently.

FBA “BIG IDEAS” • FBA is a problem solving process – a way to think about behavior systematically. • FBA identifies the events that reliably predict and maintain problem behavior. • Best conducted by teams of educators who are skilled in the process • Those who implement the strategy need to be actively involved in designing it or it probably won’t work!

Trigger Behavior Consequence Function

Levels of FBA (Crone & Horner, 2003)

Full FBA

Brief FBA

Brief FBA

“The FBA that can be done in your head.” • Simple description of the behavior • Antecedents • Consequences • Likely function

FBA Team Process Steps 1.  Collect information

a.  What does the problem look like? b.  What series of events predicts behavior? c.  What is the maintaining consequence of the observable

behavior? d.  Hypothesis statement?

2.  Develop “competing pathways” and replacement behaviors

3.  Develop BIP. 4.  Develop strategies for monitoring & evaluating

implementation of BIP.

ACTIVITY #6 1.  Get into school groups 2.  Prepare brief presentation on student from your

school (Next slide) 3.  Group problem-solving

Consultation Time with Colleagues Discuss the student and the FBA you prepared •  Identify type of FBA you completed: Brief à Full FBA

protocol? •  Recreate the Competing Behavior Pathway on chart paper •  List interventions the team developed • Describe the Behavior Intervention Plan • Describe your plan for evaluating ongoing progress with plan •  List your building’s “Go TO” FBA person •  List questions you have for the group

Review these questions and chart paper with larger group

ACTIVITY #7 Benchmarks for Advanced Tiers (BAT) Tier 3: Assessment & Plan Development

BAT: 46. BIPs are developed by a team of individuals with knowledge in school context, student, and behavioral theory.

A Fully in Place All BIPs developed by such teams

B Partially in Place Some BIPs developed by such teams or some areas

C Not Yet Started BIPs developed by teams expertise in 1 area or less

BAT: 48. BIPs include problem statement with definition of problem behavior, antecedents, and consequences.

A Fully in Place BIPs include all 3

B Partially in Place BIPs include 2, or components inconsistent

C Not Yet Started Problem statements not developed

BAT: 47. Tier 3 includes procedures allowing a continuum of strategies to match student needs.

A Fully in Place Range of Tier 3 supports are available to match needs simple to complex

B Partially in Place Only one Tier 3 process

C Not Yet Started School lacks system for supporting students needing Tier 3

CHOOSING INTERVENTIONS BASED ON DATA

Continuum of Behavior Supports Continuum of Behavior Supports:

New Hampshire’s System of Care and EducationSchool-wide and General Education Classroom Systems for Preventative

I t ti l d B h i M t P tiInstructional and Behavior Management PracticesSystematic Screening

Promote Positive Parent Contact

Array of Evidence Based Group Interventions Addressing

Efficient Systematic Intervention for Students Who Do Not Respond to SW and Classroom Prevention and Response Systems

Array of Evidence-Based Group Interventions Addressing Prevalent Functions of Behavior Available for Students Who

Don’t Respond to SW and Social Contracting

Function-Based Support PlanningMann & Muscott (2007)

School-basedIntensive Supports

pp g(Functional Assessment and Intervention Planning)

Available for SW and Group non-responders

Intensive Linkages to Wrap-NH

Facilitation

Intensive Supports Coordinator

School-basedIntensive Supports

Behavior Support Plans and

Crisis Intervention

Linkages to Community-based

Supports

Linkages to Case Centered Collaboratives

Why We Need MH Partnerships

• One in 5 youth have a MH “condition” • About 70% of those get no treatment • School is “defacto” MH provider • Students with EBD are 2 to 4 grade levels behind in academics. • Best predictor of delinquency and incarceration • Suicide is 4th leading cause of death among young adults

Old Approach à New Approach

• Each school works out their own plan with Mental Health (MH) agency; • A MH counselor is housed in a school building 1 day a week to “see” students; • No data to decide on or monitor interventions; • “Hoping” that interventions are working; but not sure.

• District has a plan for integrating MH at all buildings (based on community data as well as school data); • MH person participates in teams at all 3 levels; • MH person leads small groups based on data; • MH person co-facilitates FBA/BIP or wrap individual teams for students.

Interventions Based on Functions of Behavior

Access Adult Attention/Support:

Check-In/Check-Out

Adult Mentoring Programs

Access Peer Attention/Support:

Social Skills Instruction

Peer Mentoring

Self-Monitoring with Peer Support (function: academic task escape)

Academic Skills Support

Organization/Homework planning support

Homework completion club

Tutoring

Interventions Based on Types of Behavior

0

5

10

15

20 TES DPE RES TIS

Interventions for Aggressive Behaviors

1.  Problem Solving Training 2.  Cognitive Restructuring 3.  Verbal Mediation 4.  Social Skills Training 5.  Peer Mediated Conflict Resolution and Negotiation 6.  Replacement Behavior Training

Interventions for Attention Problems

1.  Contingency Management 2.  Daily Behavior Report Cards 3.  Modified Task-Presentation Strategies 4.  Self-Management 5.  Classwide Peer Tutoring 6.  Computer Assisted Instruction 7.  Multimodal Interventions

Interventions for Anxiety Disorders

1.  Exposure-Based Techniques 2.  Contingency Management 3.  Modeling

4.  Family Therapy 5.  Integrated Cognitive-Behavioral Therapy

Interventions for Depression I.  Cognitive- Behavioral Therapy A. Psychoeducation B. Problem-Solving Skills Training C. Cognitive Restructuring D. Pleasant Activity Planning E. Relaxation Training F. Self- Management Training

G. Family Involvement II. Interpersonal Therapy for Adolescents

Separate Interventions to Individualized Teams

Individualized Team

CICO

Mentor CBT

WHAT KINDS OF STUDENT TEAMS HAVE YOU JOINED?

Individualized Teams at the Intensive Level

• Are unique to an individual child & family • Task facilitator with engaging family and bringing team together • Blend the family’s supports with the school representatives who know the child best • Designed to improve quality of life as defined by the youth/family (i.e., “BIG Needs”) • Meet frequently •  Identify, develop & review interventions

Who Benefits from Intensive Supports?

• Youth with needs across home, school, & community

•  Youth with needs in multiple life domains

•  The adults in youth’s life who are not effectively engaged in comprehensive planning

Targeted/Intensive Level Skill Sets • Understands the conflict cycle and uses de-escalation strategies • Develops FBAs and  BIPs • Uses effective engagement strategies with students, families and teams • Develops targeted interventions that are function-based. • Familiar with academic modifications and accommodations •  Integrates data-based decision-making into comprehensive processes (home-school-community)

WRAPPING BACK TO WRAPAROUND

What is Wraparound?

• Wraparound is a family-driven, team-based process for planning and implementing services and supports.

• Teams create plans that are geared toward meeting the unique needs & strengths of children and youth with complex needs and their families.

• The wraparound team members meet regularly to implement and monitor the plan to ensure its success.

Student

Physical

Family

Safety

Socialization

Cultural Emotional

Education

Job

Legal

Life Domains

Wraparound and PBIS

• The wraparound process is a key component on the continuum of a school-wide system of PBIS.

• Value-base: • Quality of Life; Voice/Ownership

• Data-based Decision-Making: •  Efficient & Effective Actions

Voice to Engagement

• WE have to ask the youth/family how they will know if thing are getting better…

• Family has to define ‘success’ for the team

•  If they define progress/success, as well as strengths and needs, then they are likely to be engaged in the interventions.

Wraparound Principles

Voice & choice

Natural supports Collaboration Community-

based

Culturally Competent Team-based Individualized Strengths-

based

Unconditional Outcomes-based

Four Phases of Wraparound 1. Engagement & Team Preparation •  Orient family, stabilize crises, assess strengths & needs,

form vision, identify team members

2. Planning •  Hold initial meeting(s), orient team, create plan focusing

on “Big Needs”, identify services & supports

3. Implementation •  Hold regular meeting, implement plan, review progress,

revise plan

4. Transition •  Define when vision / goals have been met, “unwrap”

celebration, follow up with familiy

DATA Teams at student, school, & district levels use data on fidelity and progress

for decision making

SYSTEMS District Team, District Coach, & School Teams

monitor resources, evidence based

practices, planning, & implementation

PRACTICES Facilitators lead

collaborative wraparound process plus identify and coordinate

evidence based practices

T3-W Components

T3-W Outcomes SHORT-TERM MID-TERM LONG-TERM

Focus on most important needs

identified by family

Strategies based on strengths

Team cohesiveness & follow-through

Satisfaction and

engagement with wraparound

Experiences of efficacy

and success

Evidence based practices & natural supports are more

effective

Improved access, engagement, and commitment to

services/supports

REDUCTIONS IN: •  School disciplinary

problems • Need for restrictive

placements IMPROVED QUALITY OF LIFE OUTCOMES: • Needs met; team-

identified outcomes achieved •  Improved emotional &

behavioral functioning •  Improved academic

performance (e.g., grades, curriculum based measures) •  Stable living situation •  Supportive

relationships

Increased social supports

Improved self-efficacy

& self-esteem

Increased capacity for coping &

problem-solving

Services & supports are a better fit

Evidence based practices are chosen

based on individualized needs

Better coordination of services

Wraparound is: An ongoing planning process used by:

•  A team of people

•  Who come together

•  Around family strengths/needs

•  To create a unique plan of interventions & supports

•  Based upon a process of unconditional care – no blame, no shame

Wraparound is Not: •  A set of services

•  A one or two time meeting

•  A special education evaluation

•  An individual counselor who links with the family or student

•  Only for families and students we judge as “workable”

•  The presence of flexible funds

QUICK Reflection: Similarities/Differences with your

past experiences/knowledge of wraparound?

ACTIVITY # 8 How is wraparound similar and different from typical service delivery in your school / district? Use worksheet to answer questions

Tier 3 Student Action Plan Illinois PBIS Network

Tier 3/ Student Action Plan & Progress Update

Illinois PBIS Network, 2009 Revised December 2009 1

Purpose: This document is a working record of the team structure and plan of support for each individual student receiving tier-3 support. This document should be shared and updated at every individual student team meeting to ensure that: a) changes and progress are recorded, b) interventions are agreed upon by all team members and c) teams are accountable for ongoing progress monitoring. If information is stated clearly, the plan can also be shared with others who may be supporting this student in the future. Team facilitators are encouraged to document all components clearly. Clarity of actions and decisions (rather than length) makes the written plan useful to the student and his/her team currently as well as in the future. Student: ________________________ School: __________________________ School Contact: _______________________ Grade: _______________________ Age: _________ SIMEO ID#: ___________________________

Student Intervention History

Check interventions that the student has received. Include start date and end date; if not applicable indicate N/A OR data not available-only if intervention has just begun:

Simple Secondary Interventions (CICO)

Social/Academic

Instructional Groups

Simple Secondary Interventions with

Individual Features(CnC)

Brief Function-Based Behavior Plan

Complex/Multiple-Life -Domain FBA/BIP Wraparound Support

Start Date End Date Start Date End Date Start Date End Date Start Date End Date Start Date End Date Start Date End Date

Pre Data Post Data Pre Data Post Data Pre Data Post data Pre Data Post Data Pre Data Post Data Pre Data Pre Data

ACTIVITY #9 TEAM TIME Review Activity #9 Worksheet Student Intervention History Complete during team time today

Team Members Illinois PBIS Network Tier 3/ Student Action Plan & Progress Update

Illinois PBIS Network, 2009 Revised December 2009 3

SECTION 1: Team Development/Sign-In Sheet

Youth/Student: ______________ Parent Guardian: _______________ Facilitators: ______________

Date of 1st Meeting: ________2nd___________3rd______________4th_____________5th_____________

6th____________7th____________8th_____________9th____________ 10th____________ ***set meeting date before ending current meeting***

CONFIDENTIALITY AND ATTENDANCE: I agree to honor the rights and privacy of any persons discussed in this meeting. I agree not to divulge any information regarding any family, person, or agency, which may be referred to in the course of this meeting.

Team members present today: Relationship/Role Team members not present today:

Check here if release of Information have been signed. Yes No

AGENDA for Wraparound Meeting:

Introductions by role First meeting develop mission statement, big need (review) Review strengths, add other strengths Update progress Priorities for today’s meeting Action plan: who, what, by when? Next meeting date

ACTIVITY #10 TEAM TIME Review Activity #10 Worksheet Assessing Team Composition Complete during team time today

Team Time – Day 2

• Complete Benchmarks of Advanced Tiers (BAT) • VTPBiS Action Plan for Intensive Level: Sections H, I, & J • What are your goals and action steps for… • Universal Screening? (Steps to Readiness) •  Improving FBA/BIP process? (BAT) •  Identifying evidence based interventions?

• Activity #9 – Student Intervention History • Activity #10 – AssessingTeam Composition

Step 1: Workshop N

Joy Prior, Christine Kilpatrick, Kathleen Holsopple Collaborating with Families In order to meaningfully include parents and parenting caregivers in activities related to the systems, data and practices that help students achieve both academically and behaviorally, educators need to have an understanding of what does and does not work in assisting and partnering with parents in the educational process.