secondary planning day 1 final - positive supports minnesota … · 2020-04-07 · o personal...
TRANSCRIPT
10/25/18
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Secondary Team MeetingYear 4 – Day 1
Morning Agenda
• Review of 2-Day Level 3 Event & Regional Planning
• Review of Secondary (Tier 2) Progress• Discuss How We Will Organize the Next Team
Training Days
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Review of Secondary Teams
Person-Centered Practices & Planning
Organizational Workforce Development
Person-Centered Practices & Planning
Positive Behavior SupportTertiary Stage• In Depth Person-Centered Plans• Integrated Plans (PCP, PBS, Trauma-
informed Therapy)• Teams Monitor Plan Progress
Primary Stage• Universal Person-Centered Strategies• Encourage Self Expression• Self-Determination and Choice Making• Meaningful Participation in the
Community
Secondary Stage• Monitor PCT Action Plans • Additional Quality of Life Strategies• Increase Strategies for Supporting Independence and
Community Involvement• Mental Health and Wellness Interventions
Implementing Multi-Tiered Systems of Support
Positive Behavior Support
Organizational Workforce
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Positive Behavior Support
Universal Stage• Teach and Encourage Communication• Predictable and Proactive Settings• Encourage and Reinforce Social Skills• Consensus-Based Team Focus• Emphasis on Using Data For Decisions
Secondary Stage• Early Intervention and Data Monitoring• Additional Supports for Key Social Skills• Function-Based Decisions• Simple Interventions • Mental Health and Wellness Interventions
Tertiary Stage• Individualized PBS Plans• Integrated with Other Positive Supports (PCP, Trauma-
Informed Care, DBT, Etc.)• Plans Are Monitored- Data-Based Decision Making• Teams Monitor Progress of Each Person
Organizational Workforce Development
Person Centered Practices & Planning
Positive Behavior Support
Implementing Multi-Tiered Systems of Support
Person-Centered Practices & Planning
Organizational Workforce
Organizational Workforce DevelopmentPositive Behavior Support
Universal Stage• Align Policies to Person-Centered Practices• Revise Job Descriptions, and Performance Evaluations• Integrate Person-Centered Practices and PBS With New Orientation and
Ongoing Instruction• Use Data for Decision Making
Secondary Stage• Monitoring and Early Intervention • Training Targeted for Groups• Targeted Strategies to Improve Specific Settings• Simple Problem Solving for Challenging Situations That Occur in More
Than One Situation
Tertiary Stage• Tailor Problem Solving for Specific Problematic Situations • Individualize Training and Mentoring to Address Unique Settings
Where Problems Occur• Improve Supervision and Mentoring for Locations Experiencing
Challenges• Establish Matching/Hiring Tailored to Individualized Plans Organizational Workforce
Implementing Multi-Tiered Systems of Support
Person-Centered Practices & Planning
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Incidents -- IF... FOCUS ON...
£ More than 40% of people in organization have been involved in an incident
£ More than 2.5 incidents per personOrganization-Wide System
£ More than 35% of incidents occur in the community
Community£ More than 60% of incidents come from specific
settings
£ More than 10-15 people are involved in incidents in one setting
Within Specific Settings
£ Less than 10 people involved in 10 or more incidents
£ Less than 10 people continue rate of referrals after secondary strategies are tried
£ Small number of people need more intensive supports
Individualized Supports
Use Data to Identify Where to Spend Your Time as a Team
Incident Reports &Data-based Decision Making
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People: 25
Incidents: 59
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Missing Attendance in Sessions – IF ... FOCUS ON...
£ More than 40% of people involved in mental health services have missed more than 3 sessions Organization-Wide System
£ More than 35% of attendance problems occur in one type of mental health service
Type of Services
£ Less than 10 people involved in 10 or more missed sessions
£ Less than 10 people continue rate missed sessions after secondary strategies are tried
£ Small number of people need more intensive supports
Individualized Supports
Use Data to Identify Where to Spend Your Time as a Team
Attendance & Data-based Decision Making
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People: 25
Incidents: 59
Num
ber o
f Miss
ed S
essio
ns
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Types of Data for Monitoring• Actively Monitor Quality of Life, Progress in
Mental Health Sessions, etc.o Person-Centered Descriptionso Personal Wellness Workbook
• Monitor Information Regularlyo Review Incident Reportso Attendance Patterns in Mental Health Sessions
• Support Plans or Other Documents• Satisfaction and Quality of Life Data
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Three Possible Tier 2 Team Decisions
• Level 1: Secondary Strategies (Quick Hypothesis)
• Level 2: Modify Tier 2 Strategies & Use Simple PBS Plans
• Level 3: Full Functional Behavioral Assessment and PBS Plan
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Last Time We Met
Introducing the Secondary Team to Others• Create the Process for Secondary Support• Share Plan
Discuss What is Needed• Referral Process• Simple Flow Chart• Presentation to Staff/Colleagues• Secondary Problem Solving Tool
Review of Progress
• Setting Up the Secondary Team• Creating Referral Process• Identifying Secondary Strategies– Person-Centered Practices– Positive Behavior Support– Workforce-Related Issues
• Problem-Solving Form for Meetings• Introducing Secondary Team to Staff• Learn More About Evidence-Based Strategies• Share De-Identified Examples of Secondary Team
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Organization-WideTeam
Addresses Universal Systems
Secondary/Tertiary Team
At Secondary Stage Organizations Form Two Teams
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Universal Team• Organization-Wide interventions• Monitor Organization-Wide Data • Implement Universal Strategies
Positive Support Secondary Team Managers• Monitor Personal Description Action Plans• Monitor Incident Reports• Decide What Level of Support Is Needed
– Is an Individual Team Meeting Needed– Can We Implement Secondary Strategies
Positive Support Team– Establish individualized Teams for More Intensive Plans– Monitor Progress of Each Team at Secondary and Tertiary Levels– Problem Solve When Quality of Life or Problem Behaviors Are Not Improving
Regional Team - Discussion• Interagency Team Meetings for Region• Additional Training and Supports• Assist With Referrals for Support
Organizing for Progress Monitoring and Problem Solving
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Secondary Tier Strategies• Minor Quality of Life Issues Needing Attention– Add Quality of Life Assessment– Expand Personal Description Action Plan
• Minor Social Interaction Problems– Simple Function-Based Strategies
• Group Social Skills– Mindfulness Activities– Expressing Emotions
Start With a Personal Description and Action Plan
• Personal Descriptions/Profiles with Action Plans in Place for All People Supported
• Monitor Action Plans for Progress Over Time
• List Individual Data That Can Be Used to Monitor Quality of Life
Flo’s Profile & Plan
What Is Important To Flo:
• Spending time & talking on
the phone with Rikki
(brother) & Ruby (sister).
• Hanging out with
Cheyenne.
• My wheelchair is kept
comfortable.
• Dressing well & feeling
good about my appearance
gives me a good self-
esteem.
• Getting out of the house to
enjoy LOTS of activities!
• Watching sports,
especially my favorite
teams the Twins &
Vikings!
• I enjoy playing with
balloons, having stuffed
animals around &
soft/warm blankets when
relaxing.
• Going to church regularly
and praying before bed
and meals.
• I love listening & singing
to music!
• It’s important to me that I
have choices & that people
listen to me.
• I am VERY social and want
the opportunity to meet
new people.
• Working on arts & crafts.
• Remembering my mom &
keeping her memory alive.
What Is Important For Flo:
• Having thicket in my
liquids for drinking.
• Making sure my
medications are monitored
and managed well.
• A healthy diet.
• Keeping my wheelchair in
working order &
comfortable.
• It’s important for me to be
dressed well so my self-
esteem doesn’t suffer.
• It’s important that I get out
in the community & enjoy a
variety of activities & that
those places are accessible
to me.
• It’s important for me to be
social & get out into the
community to meet new
people.
• It’s important for my
religious practices to be
respected &
accommodated.
• It’s important for me to
have choices, be respected
& feel my voice is being
heard.
• It’s important for me to
have people who will help
me find ways to remember
my mom & her memory.
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Add Simple Secondary Action Plan to Description
Action Planning Form
What needs to be done? How often?
Who is responsible
?
By when?
Jesse will make sure staff are organized and transportation is available on Sundays so Flo can attend church
Available Every Sunday
Jesse
By August16, 2017
Lucy will work with Flo to create a lunch club and help Flo send out invitations
Weekly Starting on August
Flo and Lucy
First invites by August 1, 2017
Jesse will help Flo create a simple invitation to lunch that Flo can share with people in the community
July 24, 2017
Flo and Jesse By August 16, 2017
Jamain will sit down with Flo on Sunday each week and identify a plan for spending time in the community, and share this with Jesse who will make sure transportation and staffing are available
August 13, 2017
Flo and Jamain
July 18, 2017
Rikki and Ruby will work with Flo to create a family collage book during their visits
August to September 6, 2017
Flo, Rikki, and Ruby
October, 2017
Flo will begin looking for a pet by visiting the sanctuary and assessing what kind of animal would be the best fit. Flo and the team will review findings together and take the next step
August to September
Flo and Jamain Review October, 2017
Wellness Self-Management Personal Workbook
http://www.irenegreene.com/wp-content/uploads/WSM_English_Wor
kbook.pdf
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Improving Quality of Life
Quality of Life
SAMHSA 8 Dimensions of Wellnesshttps://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness
Mental Wellnesshttps://mn.gov/dhs/assets/mental-wellness_tcm1053-307677.pdf
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Incident Reports &Data-based Decision Making
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People: 25
Incidents: 59
Attendance in Mental Health Sessions &Data-based Decision Making
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People: 25
Incidents: 59
Num
ber o
f Miss
ed S
essio
ns
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Secondary Team CharacteristicsReferrals to the Team– Automatic From Team Monitoring– Person Requests Referral– Staff Members, Guardians, Family Members Etc.
Make Referral1-2 People Meet Regularly to Monitor4-6 Times Per Month Larger Meeting
Referrals Monitored by 1-2 PeopleAutomatic Referrals• Action Plans from Personal Description Are Not Completed a Month
After Completion Due Date• 4-5 Incident Reports Signals Review• Team Identifies the Key Features for Automatic Referrals
Self-Referrals• Person Requests Referral
Referrals From Others• Staff Members, Guardians/Family, Case Managers
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Purpose of Behavior Support Team• 1-2 people in team review– Are we confident we know why a challenge is occurring?– Is there a secondary strategy that will address the
challenge?– Automatic weekly meetings to review progress
• Review data on all secondary strategies– Review progress each person is making– Decide whether to continue, modify
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Three Possible Team Decisions
• Level 1: Secondary Strategies (Quick Hypothesis)
• Level 2: Modify Tier 2 Strategies & Use Simple PBS Plans
• Level 3: Full Functional Behavioral Assessment and PBS Plan
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Possible Targeted Strategies in the Community
1. Person-Centered & Quality of Life Strategies Related to the Community
2. Social and Behavioral Supports3. Emotional Wellness4. Health and Wellness
Examples of Secondary Strategies• Additional Social and Communication Skills
Training• Strategies for Recognizing Emotions• Problem-Solving Employment Issues• Increase Friendship Skills• Relaxation and Mindfulness Activities• Other Health and Wellness Strategies• Self-Management Strategies
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Activity: What Secondary Strategies are Available?Name of Strategy Who Monitors
StrategyWhat is the Type of
Secondary Strategy?
DATA COLLECTED / MONITORED
Recognizing Emotions Jamain Social Skills Anger Outbursts
Incident Reports
Mindfulness Sessions
Stacey Mental Health Quality of Life Survey
Health and Wellness Class
lucy Health and Wellness
Quality of Life Survey
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RMHC GROUPSMAIN HIBBING BELL
AI GroupBecca Leaders
M 11:00-12:00 Peer Support MICDChristine Claveau
M 9:30-11:30 AMF 12:30-2:30 PM
GLBTA AcceptanceCris Tugnoli
M 4:00-5:00 PM Youth Psychotherapy Stacy Englund/Anna Q
M 3:30-5:00 Women’s GroupLinda Marafiot
M 12:30-2:30 PM
Seeking Safety (PTSD/CD)Kiah Bizal/Anna Quistad
T 10:00-11:00 AM Aggression ManagementAnn Wiedemer
T 9:30-12:00
Wellness GroupSue Kelly
T 12:30-2:30Th 12:30-2:30
ARMHS Stress MgmtBilli Homola
T 9:30-11:30 AM
Men’s GroupEric Hyttinen
W 9:30-11:30 AM
DBTTaylor Draper / Kiah Bizal
W 1:00-3:00 PM IDDT/MICD Group 2Katie Finch
W 10:00-12:00
Pathways to RecoveryEric Hyttinen
W 1:00-2:30 PM Art GroupClient led (Steph Hashey)
W 1:00-2:30 PM Seasonal
IMR – ForensicTim Kresien
W 2:30-4:30 PM Mindfulness in NatureDeb Meyers
W 1:00-4:00 PMSeasonal (starts in May)
AI GroupTaylor Draper
W 3:00-4:00 PM
Meditation/RelaxationDuane Dale
Th 3:00-4:00 Men’s GroupAurora Emmons
Th 10:00-12:00
Women’s DBTBecca Leaders
Th 1:00-3:00 PM Women’s GroupLeah Mornes-Kulcsar
Th 12:30-2:30 PM(currently full)
Women’s GroupLinda Marafiot
Th 12:30-2:30 PM
Art TherapyTaylor Draper / Kiah Bizal
F 9:30-11:00 AM AI GroupSara E / Aurora Emmons
F 10:00-11:00 AM
IDDT/MICD Group 1Katie Finch
F 12:30-2:30
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Do Your Secondary Strategies Address Different Functions
Self-Manage Social Skills Group
Communication Skills
Community
Seeking Staff Attention X X X
Seeking Attention from Friends X X X
Relationship Building X X
Choice of Activities X
Teaching of Social Skills for Work X X X X
Precorrect/ Feedback Prior to Events X X X
Self-Management: Teach New Skills To Replace Challenging Interaction With A More Efficient
And Effective Social Skill
Connect the Self-Management to the Matrix Skills Being Used at the Universal Level
Setting Event
TriggeringEvent OrAntecedent
Problem Behavior
Consequence (What The Child Obtains Or Escapes/Avoids)
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Functional Assessment Pathway
Setting EventTriggeringEvent or
AntecedentProblem Behavior
MaintainingConsequence
THE FUNCTION“Get something”“Get away from
Something”
Goal: Over time all school personnel think about function of behavior on a continuum for • Classroom management• Grade level team problem solving• School-wide tier 1 planning (universal interventions)• Tier 2 interventions for academic and behavior• Tier 3
Function-Based Decision Making Activity for Staff
• Hypothesis Statements
Access Tier 2 Resources Here: https://mnpsp.org/training-materials-cohort-2/
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Strategies for Assessment & Evaluation
Mindfulness Self-Assessmenthttps://ppc.sas.upenn.edu/resources/questionnaires-researchers/mindful-attention-awareness-scale
Difficulties in Emotion Regulationhttp://cairncenter.com/forms/difficultiesinemotionalregulation_scale.pdf
Discuss & Team Share Out• Discuss With Your Team Where Your Are With Tier 2 Implementation
o What is Missing?o What are the Next Steps?
• Can You Share an Example of the How the Tier 2 Process is Working for the Other Teams?
• Do You Have Secondary Strategies Available to Address Different Functions?o What Types are in Place?o How Do You Know They Are Successful?
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Activity: What Secondary Strategies are Available?Name of Strategy
Who Monitors Strategy
What is the Type of
Secondary Strategy?
DATA COLLECTED / MONITORED
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Three Possible Team Decisions
• Level 1: Secondary Strategies (Quick Hypothesis)
• Level 2: Modify Targeted Interventions or Simple PBS Plans
• Level 3: Full FBA and PBS Plan
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Implement Secondary Strategies
Are the Strategies Working?
• Continue with Basic Secondary Strategies
Yes
No, There Are Issues Related to Social Interactions
Use Brief Functional Assessment• Where does the problem behavior occur/not
occur?• Why does the problem behavior keep
happening?
No, There Are Issues Related to Quality of Life
Add Additional Quality of Life Assessment
• What are the barriers to an optimal quality of life?
• What tools are needed to gather more information?
Implement Secondary Strategies
Problem-Solving Tool• Simple Team Problem Solving (Not a Full Planning
Session)• Gather Additional Information to Confirm Hypothesis• How Confident Are You That Your Hypothesis is
Correct?
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Function-Based Decision Making Activity for Staff
• Makayla’s Story
Access Tier 2 Resources Here: https://mnpsp.org/training-materials-cohort-2/
What Steps Are Needed to Address Level 2?
(When Immediate Strategies Didn’t Work)
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Next Steps for Tiers 2/3
• Setting Up the Secondary Team• Creating Referral Process• Identifying Secondary Strategies• Problem-Solving Form for Meetings• Introducing Secondary Team to Staff• Learn More About Evidence-Based Strategies• Share De-Identified Examples of Secondary Team
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Addressing Level 3 Team Decisions
• Level 1: Secondary Strategies (Quick Hypothesis)
• Level 2: Modify Tier 2 Strategies & Use Simple PBS Plans
• Level 3: Full Functional Behavioral Assessment and PBS Plan
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Discussion for This Year
• Simple Functional Assessment Strategies• Introduce Evidence-Based Strategies for Level
2 Problem Solving• Consider Training for Other PBS Facilitators• Link Evidence-Based Strategies to Hypothesis
Statement
Angela Novak Amado, Ph.D.
Friends Connecting people with disabilities and community members
https://rtc.umn.edu/friends
Making Community Connections
MNPSP.ORG• Training Materials • Universal Social Skills
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Preparation of this [presentation/report] was supported, in part, by cooperative agreement JPK%50470 from the Minnesota Department of Human Services. The University of Minnesota undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore necessarily represent official MN DHS policy.