linking wraparound and consultation: theory and techniques annual convention national association of...
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Linking wraparound and consultation: Theory and
techniques
Annual Convention
National Association of School Psychologists
March 4, 2010
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Presenters
• Jennifer Rose, Tertiary Research and Evaluation Coordinator, Illinois PBIS Network: [email protected]
• Lucille Eber, Statewide Network Director, Illinois PBIS Network: [email protected]
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Session goals• To summarize key issues in children’s mental
health• To review basic concepts associated with
school-based consultation• To present the theory and values base of
wraparound• To share findings from federally-funded
tertiary demonstration project
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Background
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Children’s mental health: statistics
• Children with emotional issues, are underserved– An estimated 21% of youth ages 9-17 have a diagnosable mental
health issue• However, only 6%-25% of these children receive any mental health
services
(U.S. Surgeon General, 1999; Hoagwood & Johnson, 2003)
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Children’s mental health: Statistics
• Children/youth with complex needs require supports across multiple settings encompassing their homes, schools and communities
(Joint Commission on the Mental Health of Children, 1969; President’s Commission on Mental Health, 1978; Stroul & Friedman, 1986; Duchnowski, Kutash, & Friedman, 2002)
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Children’s mental health: Service delivery history
• Over forty years of research documents adverse effect of fragmented service delivery:– Joint Commission on the Mental Health of
Children (1969)– Project on Classification of Exceptional Children
(1975)– Unclaimed Children (1982)
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Children’s mental illness and the issue of accessibility to treatment : Ripped from the
headlines….• “Children in the Mental Health Void Remember the Nebraska law
meant to keep desperate new mothers from abandoning their babies in dumpsters by offering them the possibility of legal drop-off points at safe havens like hospitals? As was widely reported last year, the law neglected to set an age limit for dropped-off children, and eventually led to 36 children mostly between the ages of 13 and 17 being left with state authorities. Most of these children had serious mental health issues. Some were handed over to the state by relatives who had no other way of securing for them the heavy-duty psychiatric care they needed. Seven of the children came from out of state, including one who had been driven 1,000 miles to Lincoln, Neb., from Smyrna, Ga.”
Source: New York Times, February 19, 2009
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Children’s mental health: Impact on learning
• Untreated emotional problems have the potential to create barriers to learning that interfere with the mission of schools to educate all children
Source:Taylor and Adelman (2002)
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Children’s mental health: Role of schools
• Authorization of Education of All Handicapped Children Act (PL 94-142) incorporated provisions for addressing the needs of children with emotional problems (Duchnowski, Kutash, & Friedman, 2002)
• Schools are “de facto” mental health care providers (Burns, 1995)
• School psychologists have a prominent role in service delivery beyond assessment for special education (Foster, Rollefson, Doksum, Noonan, Robinson, & Teich, 2005)
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School-based Consultation
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School-based consultation
• Consultation is widely-recognized as one option for school psychologists to expand service delivery (Zins & Erchul, 2002)– “Gives psychology away” to non-psychologists
(Miller, 1969)– Consultees (e.g., teachers) acquire skills to address
similar issues in the future
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School-based consultation• Key features of consultation:
– Problem-solving approach• Problem Identification• Problem Analysis• Plan Implementation• Plan Evaluation
– In-direct service delivery– Collaborative– Triadic relationship
• consultant-consultee-student
• Theoretical orientation:– Behavioral– Ecological-systems
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School-based consultation• Four consultation models are prevalent in school
psychology training programs:– Behavioral – Mental health– Instructional– Organizational
• Programs tend to use a combination of more than two models
• Majority of instruction focused on theory and best practices in interventions
(La-Hart, Rosenfield, 2005)
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School-based consultation
• However, most school-based consultation models focus on behaviors occurring within the school setting – Lack guidance for addressing behaviors across
multiple settings, or consideration of factors outside of school that may influence in-school behaviors
(Kratochwill, Elliott, & Callan-Stoiber, 2002)
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Consultation: Conjoint Behavioral Consultation (CBC)
• Key features:– Ecological approach that considers influences of multiple
settings and persons upon a student’s behavior– Actively involves teachers, parents and other key people
(e.g., extended family, friends, clergy) in a collaborative intervention planning process
– Attempts to improve relations between home and school– Strives to enhance competencies of client (student) and
consultee (teacher)
(Sheridan, 1997)
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Conjoint-Behavioral Consultation (CBC)
Home School
Supportsystems
•Problem Identification•Problem Analysis•Plan Implementation•Plan Evaluation
Sheridan, 1997
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Wraparound
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Wraparound history• Wraparound practice originated in the 1960’s and gained
ground during the early 1980’s• Developed to meet the needs of families with children/youth
presenting needs across multiple settings (school, home & community) who were at-risk of change in placement– Addressed obstacles to care posed by fragmented service
delivery– Reduced need for psychiatric/residential placements for
children/youth via coordination of community-based care– Empowered parents/caregivers by incorporating family-
centered philosophy of practice
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Wraparound defined
Wraparound is a process for developing family-centered teams and plans that are strength and needs based
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Wraparound: Core values
• Child-centered, family-driven
• Community-based• Culturally
competent
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Wraparound: Key characteristics
• Individualized• Team-based• Collaborative• Unconditional
support• Outcomes-based
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Four Phases of Wraparound Implementation
I. Team Development- Get people ready to be a team- Complete strengths/needs chats
II. Initial Plan Development- Hold initial planning meetings - Develop a team “culture”
III. Plan Implementation & Refinement- Hold team meetings to review plans - Modify, adapt & adjust team plan
IV. Plan Completion & Transition- Define good enough - “Unwrap”
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Wraparound: Theoretical base
• Social-ecological theory (Bronfenbrenner, 1979)
• Social-learning theory (Bandura, 1977)• Systems theory (Munger, 1998)
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Wraparound: Research
• Case studies:– Kaleidoscope Program in Chicago (Cumblad, 1996)– Alaska Youth Initiative (Burchard, Burchard, Sewell, & VanDenBerg, 1993)
• Pre-post test design:– Eber, Osuch, & Redditt, 1996
• Quasi-experimental designs:– Hyde, Burchard, & Woodworth, 1996– Bruns, Rast, Peterson, Walker, & Bosworth, 2006– Anderson, Wright, Kelley, & Kooreman, 2008
• Experimental designs:– Clark, Lee, Prange, & McDonald, 1996– Evans, Armstrong, & Kuppinger, 1996– Clark, Prange, Lee, Stewart, McDonald, & Boyd, 1998– Carney & Buttell, 2003
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Wraparound and Consultation
• Wraparound and consultation share many similar characteristics:– Ecological theoretical base– Team-based– Structured process– Outcomes-based– Incorporates evidence-based interventions
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Wraparound: Differentiated
• Differs from consultation models and even other intensive interventions geared toward families of children with complex needs (e.g., case management, multisystemic therapy, treatment foster care)
– Family versus “expert” focused– Long-term, unconditional support– Emphasis on natural supports
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Wraparound practice
IL-PBIS Tertiary Demonstration Project
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Background• Kansas-Illinois (K-I) Center, a joint research partnership:
– IL-PBIS Network– University of Kansas
• Two primary goals – Illustrate what’s effective with kids and families with the highest need– Build system capacity
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Background
• K-I Center is part of a federally-funded demonstration project located in 4 states– Illinois– Kansas– Oregon– Washington
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Background
• Six school Illinois school districts participated as demonstration models– Three sites were incorporated as part of the
federal grant, three were not• All sites implemented IL-PBIS tertiary model
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Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal School-Wide Assessment
School-Wide Prevention Systems
Tier 2/Secondary
Tier 3/Tertiary
SIMEO Tools: HSC-T, SD-T, EI-T
Small Group Interventions (CICO, SAIG, etc)
In
terv
entio
nAssessm
en
tIllinois PBIS Network, Revised Sept., 2008Adapted from T. Scott, 2004
Group Interventions withIndividualized Focus (CnC, etc)
Simple Individual Interventions(Brief FBA/BIP, Schedule/ Curriculum Changes, etc)
Multiple-Domain FBA/BIP
Wraparound
ODRs, Attendance, Tardies, Grades,
DIBELS, etc.
Daily Progress Report (DPR) (Behavior and Academic Goals)
Competing Behavior Pathway, Functional Assessment Interview,
Scatter Plots, etc.
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Tertiary Level PBIS 1. Systems
Team based problem solving (District, Building @ 3 tiers) Data-based decision making system (SIMEO) Sustainability focus (redefining roles, district data review, etc. )
2. Data Data used for engagement and action planning with team Data tools are strengths/needs based Multiple perspectives and settings captured in data Show small increments of change at team meetings
3. Practices Youth having access to all levels of SWPBS FBA/BIP is essential skill set for implementers Engagement and team development are critical elements Team facilitation is essential skill set (for complex FBA/BIP & wrap) Wraparound process/elements create ownership/context for effective interventions including
FBA/BIP Assess/monitor fidelity with families
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FY 2009 SIMEO Study II: Time 1 and Time 2 Assessment
• 125 students receiving Tertiary Wraparound Intervention within school setting
• Average length of time receiving Tertiary Intervention= 9.1 months
• Baseline assessed within 30 days of team engagement (Student Disposition Tool, Education Information Tool, Home School Community Tool)
• Follow up assessment conducted at Time 2 (on average 3.94 months later)
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FY 2009 Study IIStudent Characteristics
N=125 Students
→ Age: Range in age from 5-15 years; Mean Age-9.95 Years old
→ IEP Identified at Baseline: 38% (47)
→ Primary Disability: ED-16% (20); SLD-11 (9%)
→ Ed Placement: 64% (78) in General Ed Placement 100% of day
→ Risk of Placement Failure: 88% (110) at-risk of failing one or more placements
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At Baseline:
→ Fourteen students (11%) had DCFS Legal Involvement;
→ Twenty-four (19%) had involvement with Probation
→ Twelve (10%) had Community Mental Health Involvement
→ Thirty-six (30%) of the student’s families were receiving Public Aid
FY 2009-Study IIStudent Characteristics
N=125 Students
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N=70
90
546
107 87
319
650
100
200
300
400
500
600
Office DisciplineReferrals
In-School Suspensions Out of SchoolSuspensions
Number of Episodes
Baseline Time 2 N=125
FY 2009-Study II High Risk School Behaviors
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N=70
52
281
56 46
185
3524 41
157
0
50
100
150
200
250
300
Office DisciplineReferrals
In-School Suspensions Out of SchoolSuspensions
Number of Episodes
Baseline Time 2 Time 3 N=70
FY 2009-Study III High Risk School Behaviors
Baseline plus Time 2 and Time 3 Study Cohort
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1.921.76
2.64
2.442.19
1.94
2.14
1.83
1
1.5
2
2.5
3
3.5
4
Baseline Time 2 Time 3
Home School Community N=70
High Risk
No Risk
Minimal Risk
Moderate Risk
FY 2009-Study III Students by Overall Risk of Placement
Baseline plus Time 2 and Time 3
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2.85
2.672.62 2.68
2.872.94
1
1.5
2
2.5
3
3.5
4
Baseline Time 2 Time 3
Need for Additional Academic Assistance* Need for Additional Behavioral Assistance**
N=70
Always
Never
Sometimes
Frequently
FY 2009-Study III Need for Additional Assistance in Classroom
Baseline plus Time 2 and 3 Study Cohort
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2.512.19
2.69
1
2
3
4
Baseline Time 2 Time 3
School Environment N=70
High Strength
High Need
Somewhat Need
Somewhat Strength
FY 2009 Study III: HSC Social Functioning Sub-Scale: Sub-Scale: SchoolSchool
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2.36
2.11
1
2
3
4
Baseline Time 2 Time 3
Home
1.94
N=70
High Strength
High Need
Somewhat Need
Somewhat Strength
FY 2009 Study III: HSC Emotional Functioning Sub-Scale: Home
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Illinois tertiary demonstration project case study:”Latrice”
• Background information– Placement in self-contained ED/BD classroom beginning of
2005-06 school year– History of multiple suspensions and expulsions
• 19 major incidents• One 45-day alternative placement due to assault of staff
– Demonstrated poor academic performance• Standardized test scores reflected “Academic Warning” status
– Moderate-severe risk of change in placement
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Illinois tertiary demonstration project case study:”Latrice”
• Check and connect• Behavior intervention
plan• Mentorship with city
alderwoman
• Reunification with estranged family members
• Juvenile diversion program
• LAN funding– Summer programming– Bike, helmet and lock– Bus passes
Secondary supports Tertiary Supports
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Illinois tertiary demonstration project case study:”Latrice”
• During the course of the Tier 3/ wraparound process, the need for disciplinary actions as a consequence of problem behaviors dramatically decreased
Trends in Latrice's discipline data
20
2
2
25
30
4
0 10 20 30 40
2006-07
2007-08
2008-09
Referrals Suspensions
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Illinois tertiary demonstration project case study:”Latrice”
• Over time, “Latrice” showed an increasing ability to interact appropriately with peers without adult supervision
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Illinois tertiary demonstration project case study:”Latrice”
• With behavioral supports in place, “Latrice” had greater access to the curriculum. As a result, her academic performance improved.
3.6
4.4
6.2
3.7
5.4
6.4
0 5 10
2006-07
2007-08
2008-09
Math grade level
Reading grade level
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Illinois tertiary demonstration project case study:”Latrice”
• Additional outcomes– Mainstreamed into the general education setting
on the basis of her improved behavior and academic performance
– Recognized by the city mayor at the annual Martin Luther King Jr. celebration
– Communication between school and home improved
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Resources• Anton-LaHart, J., & Rosenfield, S. (2004). A survey of preservice consultation training in
school psychology programs. Journal of Educational and Psychological Consultation, 15(1), 41-62.
• Burns, B.J., & Hoagwood, K. (Eds.). (2002). Community Treatment for Youth: Evidence-Based Interventions for Severe Emotional and Behavioral Disorders. New York: Oxford University Press.
• Eber, L., Hyde, K., Rose, J., Breen, K., McDonald, D., Lewandoski, H., (2009). Completing the continuum of schoolwide positive behavior support: Wraparound as a tertiary-level intervention. In Sailor, W., Dunlop, G., Sugai, G., & Horner, R. (Eds.), Handbook of Positive Behavior Support (pp.671-703). New York: Springer.
• Quinn, K.P., & Lee, V. (2007). The wraparound approach for students with emotional and behavioral disorders: Opportunities for school psychologists. Psychology in the Schools, 44(1), 101-111.
• Sheridan, S.M., (1997). Conceptual and empirical bases of conjoint behavioral consultation. School Psychology Quarterly, 12(2), 119-133.
• VanDenBerg, J.E., & Grealish, E.M. (1996). Individualized services and supports through the wraparound process: Philosophy and process. Journal of Child and Family Services,
5 (1), 7-21.