1 MTSS Advanced for Session for School Professionals Maryland School Psychologists’ Association Fall 2018 James McDougal, Psy.D Director, School Psychology Program State University of New York at Oswego BIMAS, Senior Author Jillian Archer, NCSP School Psychologist, Boston Public Schools Trainer: Comprehensive Behavioral Health Model Introducing Jillian Archer, NCSP Background, Experience, one good story
103
Embed
Introducing Jillian Archer, NCSP · 2020. 7. 29. · Jillian Archer, NCSP School Psychologist, Boston Public Schools Trainer: Comprehensive Behavioral Health Model Introducing Jillian
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
MTSS Advanced for Session for
School Professionals
Maryland School Psychologists’ Association Fall 2018
James McDougal, Psy.DDirector, School Psychology ProgramState University of New York at OswegoBIMAS, Senior Author
Jillian Archer, NCSPSchool Psychologist, Boston Public SchoolsTrainer: Comprehensive Behavioral Health Model
Introducing Jillian Archer, NCSP
Background, Experience, one good story
2
McDougal’s StoryFinally Its time to get real about students’ Emotional-
Behavioral Health
• ESSA Emphasizes children's mental health in the schools- title 1 finds for MTSS, funds for safe/health schools
• The New York State Council of School Superintendents statewide survey of its members Children's’ mental health/emotional well-being #1 priority (the daily star.com)
• McDougal’s story (1998)10/1/2018
Schools often struggle with challenging behavior
We tend to …
• react to crisis rather than work on prevention
• Intervene on an individual basis vs a systemic one
• Implement ineffective strategies: punishment, exclusion, counseling, etc.
• get highly frustrated reducing effective problem solving
We could be…..• Working together on prevention/ early
intervention
• Implementing systemic programming and instruction
• Incorporating clear expectations, SEL instruction, reinforcements, and positive supports across settings
• Use data to improve outcomes and reduce frustration
10/1/2018
3
AGENDA
• Common student problems
• ACES/Trauma
• Components of effective school response
• Review of common Screening & PM measures
• Emphasis on DATA: Screening, PM, DBDM
• MTSS Results
• Resources for tiered intervention
10/1/2018
Review of theschool based factors important to student
outcomes
• Literacy
• Attendance
• Grades
• Behavior
Social/Emotional considerations
• Conduct: externalizing
• Mood/emotional regulation: Internalizing
• Cognitive/ concentration: Attention
• Social Skills
• Adaptive Behaviors
10/1/2018
4
The Reading Problem in America
• 1 in 4 children in America grow up without learning how to read.
• Approximately 75% of students identified with reading problems in the third grade are still significantly reading delayed in the 9th grade
• Many students who cannot read proficiently by the end of 4th grade will end up dropping out of school in jail or on welfare.
• Nearly 85% of the juveniles who face trial in the juvenile court system are functionally illiterate. 60% to 87% of all inmates are functionally illiterate
• A significant proportion of students with literacy delays also have problem behavior. Working on either one in isolation is generally ineffective.
EBD students have the poorest outcomes of the “high incident” disability groups.
Drop-out rate over 50%
After school, 40% are unemployed with no additional training/education.
50% are arrested within 5 years of leaving school
Of EBD drop-outs this figure exceeds 70%!!
(e.g., see Quinn & McDougal, 1998)
Internalizing/affect problemsNegative Long Term Outcomes
• Negative affect can significantly diminish social functioning, student well being, grades, attendance, and later life outcomes (employment, relationships)
• Difficulties include anxiety, depression, compulsive/negative thoughts
• This can lead to the ultimate tragedy
• Students with internalizing difficulties are generally under identified and not referred for support
• Teacher referral and/or nomination procedures still under identify.
• Universal screening procedures dramatically improve identification rates to intervene with students who
are suffering.
8
Internalizing/affect problemsNegative Long Term Outcomes
• Students with internalizing difficulties are generally under identified and not referred for support
• Teacher referral and/or nomination procedures still under identify.
• Universal screening procedures dramatically improve identification rates to intervene with students who are suffering.
Negative affect can significantly diminish social functioning, student well being, grades, attendance, and later life outcomes (employment, relationships)
Difficulties include anxiety, depression, compulsive/negative thoughts
This can lead to the ultimate tragedy
Suicide• Nearly 30,000 Americans commit suicide
every year.
• In the U.S., suicide rates are highest during the spring.
• Suicide is the 3rd leading cause of death for 15 to 24-year-olds and 2nd for 24 to 35-year-olds.
• On average, 1 person commits suicide every 16.2 minutes.
• Each suicide intimately affects at least 6 other people.
10/1/2018
9
Summary: Common Behavioral Health Concerns
Externalizing
• Irritable, ODD, BD, CD, ASPD
• Comorbid/ Co-occurring ADHD, LD, thought disorders, and learning problems
• Also significant number with internalizing problems
Internalizing
• Anxiety, OCD and Depressive disorders all have an increased risk for suicide…
• Comorbid with social, learning, and adaptive problems.
Cognitive/ Attention
also related to problems in
learning, conduct, and social skills
Do these concerns exist in Maryland ?
10/1/2018
10
Youth Risk Behavior Surveillance System (YRBSS)conducted by the CDC
• The YRBSS is a national survey, conducted by CDC, provides data representative of 9th through 12th grade students in public and private schools in the United States
• developed in 1990 to monitor health behaviors that contribute markedly to the leading causes of death, disability, and social problems
• surveys are conducted every two years, usually during the spring semester
• From 1991 through 2017, the YRBSS has collected data from more than 4.4 million high school students in more than 1,900 separate surveys
• Available at: https://www.cdc.gov/healthyyouth/data/yrbs/overview.htm
10/1/2018
2017 Youth Risk Behavior Survey:SURVEY SAYS…..
10/1/2018
Overall High school students report:
• 19.0% had been bullied on school property
• 31% students report persistent feelings of hopelessness
In 2017 high school students report that within the last 1-12 months:
• 6-8% carried a weapon in school
• 5-6% carried a gun in school
• 8-12% were threatened/injured with a weapon in school
• 14-16% were bullied
• 8-9% forced to have intercourse
• 28-30% felt hopeless
• 17-19% seriously considered attempting suicide
• 14-15% developed a suicide plan
• Suicide attempt question not asked?
254,000 High School Students in MD
• 18, 000 carried a weapon in school
• 14,000 carried a gun in school
• 25,000 were threatened/injured with a weapon in school
• 38,000 were bullied
• 23,000 forced to have intercourse
• 76,000 felt hopeless
• 45,500 seriously considered attempting suicide
• 38,000 developed a suicide plan
• 17-18,000 will attempt suicide
MD State Report Card, 2016
So in Maryland in high school students within the last 1-12 months:
12
Orienting Activity
Students with social-emotional needs often have challenging
behavior:
• Talk to folks near you about challenging behavior you encounter at school
• What are the top 3 social-emotional/ behavioral concerns students present
10/1/2018
Other Compounding Factors
Factors
• Trauma
• ACES
• Poverty
• Mobility
• Family Community support
• Others
13
Adverse Childhood Experiences and Trauma
What is Trauma?
• For many children, trauma exposure is a common and chronic experience. Chronic trauma exposure during childhood significantly increases the risk for emotional/behavioral disorders and academic failure. Common trauma experienced by children and youth include physical or sexual abuse, neglect, domestic violence, gun violence, and loss of a parent or loved one.
10/1/2018
14
Types of Trauma
• Acute Trauma: Single events, such as a death in the family or a natural disaster that affect an individual.
• Chronic Trauma: Repeated events, such as exposure to violence and assaults to oneself or others around you.
• Complex Trauma: A form of chronic trauma, that is inflicted upon an individual by their caregivers, and the impact that these events have on the individual over time.
10/1/2018
Adverse Childhood Experiences (ACEs)
10/1/2018
The Kaiser study included over 17,000 students beginning in the mid 90’s and concluded that roughly 13% of children encounter 4 or more ACES.
15
How does ACES impact students?
• ACES are strongly linked to negative outcomes for kids and schools, including:
• Academic Failure & School Dropout
• Behavioral Difficulties
• Aggression
• Physical & Mental Illnesses
• School to Prison Pipeline
• Substance Abuse & Opioid Addiction
• Unhealthy Relationships.
• Risk Taking Behaviors
• Suicide
10/1/2018
16
ACE & School Performance
• Traumatized children are:
• 2.5x more likely to fail a grade in school
• score lower on standardized achievement tests
• more likely to have struggles in receptive & expressive language
• suspended & expelled more often
• more frequently placed in special education
Trauma Informed Care
• Asks what happened to you as opposed to what’s wrong with you
• Trauma informed care takes into account past trauma and the resulting coping mechanisms when attempting to understand and treat a student having difficulties.
• trauma-informed systems approaches that aim to shape organizations to be more trauma-sensitive in their work with children and families
• trauma-specific treatment interventions that can be implemented at the individual-level to address trauma and its symptoms.
10/1/2018
17
• Process by which children and adults acquire and effectively apply the knowledge attitudes and skills necessary to
• Understand and manage emotions
• Set and achieve positive goals
• Feel and show empathy for others
• Establish and maintain positive relationships
• Make responsible decisions
What is Social- Emotional Learning?
• Human development domains:
• Social, emotional, cognitive, linguistic, and academic are all central to learning!
• Strengths/ weaknesses in one area impede development in others
• Students learn more and classrooms are more effective when they have the skills and competencies to manage emotions, focus their attention, build and maintain relationships, persevere, and problem solve (David Osher et al. 2016 &
Stephanie M. Jones and Emily J. Doolittle 2017)
Why is SEL important?
18
• Self Awareness
• Self Management
• Social Awareness
• Social Relationships
• Responsible Decision Making
SEL competencies that are important for student success include:
• Recognizing one’s own emotions, thoughts and values AND how they influence behavior
• Identifying emotions
• Recognizing strengths
• Self-confidence
• Self-efficacy
• Ability to accurately assess one’s strengths and limitations
• “Growth mindset”
Self-awareness
19
• Ability to successfully regulate one’s emotions, thoughts, and behaviors in different situations
• Impulse control
• Stress management
• Self-discipline
• Self-motivation
• Organizational skills
• Ability to set and work towards both personal and academic goals
Self-management
• Ability to take perspective of and empathize with others
• Perspective-taking
• Empathy
• Appreciating diversity
• Respect for others
• Recognizing family, school and community supports
• Understanding social and ethical norms for behavior
Social Awareness
20
• Ability to establish and maintain healthy relationships
• Communication
• Clearly
• Listening
• Social engagement
• Cooperating with others
• Resisting inappropriate social pressure
• Relationship-building
• Seek and offer help when needed
• Teamwork
• Negotiating conflict constructively
Relationship Skills
• Ability to make constructive choices about personal behavior and social interactions based on ethical standards, safety concerns, and social norms.
• Identifying problems
• Analyzing situations
• Solving problems
• Evaluating
• Reflecting
• Ethical responsibility
• Realistic evaluation of consequences of your actions as well as the well-being of yourself and others
Responsible decision-making
21
• Development of strong SEL skills increases the likelihood of academic & behavioral success throughout their education
• Competencies provide a foundation for improved student adjustment and academic performance resulting in:
• Increase in positive social behaviors
• Fewer conduct problems
• Less emotional distress
• Improved test scores and grades
• Shown to positively impact student college and career trajectories
How does SEL instruction influence student outcomes?
• SEL impact is long-term
• Up to 18 years later, students exposed to SEL in school continue to do better than peers in displaying positive social behaviors and attitudes, encompass empathetic, teamwork and academic skills
• Fewer conduct problems, less emotional distress, lower drug use.
• Early prosocial skills decrease the likelihood of living in/ being on a waiting list for public housing, having any involvement with police before adulthood (Jones, Greenberg & Crowley 2015)
• Impact on Academics
• Students involved in SEL programs show an 11% point gain in academic achievement
Research
22
Rethinking what we do
• With the implementation of ESSA, social-emotional learning has been given a precedence in schools
• While it may take time to perfect, schools around the country have already put into effect TIC learning environments that help the students and their families build up their skillset to best help them succeed
• Hopefully these approaches will replace schools’ typical responses to student misbehavior
• Punishment
• Exclusion
• Crisis counseling
10/1/2018
Through what lens do you view behavior: What do you see?
• Incorrigible, unwilling, unmotivated, vengeful, mean
• All for the problems listed prior are able to be reliably identified, are best treated early, and effective prevention and treatment options exist for use in the schools.
• Evolution of models for addressing these types of difficulties…….
"No mass disorder afflicting mankind is ever brought under control or eliminated by attempts at treating the individual.“
A Public Health Approach
25
The evolution of 3 tiered models of support
Q: What is the foundation for all effective tiered systems of support?
Think about the Evolution of RTI
• RTI started as a preventative approach targeting LD especially in literacy
• Outcomes of LD students were poor.
• Lack of early identification, intervention, and PM hampered efforts
• CBM research provided the foundation for RTI (screening and PM)
26
RTI/ Tiered models require different kinds of assessment
• Screening and PM vs. mastery an diagnosis
• General Outcome Measures (GOM) evolve during CBM research
• ORF for example is a GOM for overall reading ability
• GOMS are not tied to specific programs or interventions
• Can be used for UA and PM across the 3 tiers and across a range of instructional programs
• GOMs can also help to target areas in need of intervention
RtI and BehaviorNeed for Universal Behavior Screening
• Teachers CAN accurately identify young children at high risk of academic and behavioral problems related to school adjustment with a great deal of accuracy (Taylor et al., 2000).
• Schools ARE the ideal setting for large-scale, broad based mental health screening of children and adolescents (Wu et al., 1999).
• early identification and intervention appear to be the “most powerful course of action for ameliorating life-long problems associated with children at risk for EBD” (Hester et al., 2004)
• Yet Behavioral Health Screening occurs in only 2-3% of Districts across the country.
27
MTSS Measure selection and options
Sexy Statistics for Selecting Measures
GROUP THINK
• We’re mostly psychologists right? Let talk
• What are Important psycho-metric considerations when selecting universal screening and progress monitoring measures?
Roger, your my Valid-tine!
28
Selecting a Universal Screening Measure: Technical Adequacy Considerations
Norms-utility
• sample populations based on census data, includes clinical and typical samples
Reliability-accuracy
• internal consistency
• Test retest
• Inter-scorer
• Validity-meaningful, screening ability
• Content
• Concurrent
• Predictive-Screening Accuracy
Selecting a Universal Screening Measure: Is the measure normed/researched with representative groups?
Norms can tell us..• if the measure is appropriate/ useful for
different groups of students
• How the measure will react to important subgroups e.g., ethnicity, SES
• If the measure culturally biased
• How a student’s performance on the test compares to others in the reference group
• How do students with known difficulties compare to those without
• Norms form the basis for the 2 other important adequacy considerations
If the Measure is Normed: Are the samples adequate?Do they reflect the students in your district?
29
Reliable – not valid Reliable & Valid
Not reliable or
valid
Reliability & Validity-
• Tests can be reliable but not valid
• Yet, unreliable test can never be valid
The accuracy/consistency of scores across items, scales, time, raters, populations, etc.
• Relates to the concept of SEM
• The level of acceptable reliability depends on:• the construct being measured
• the way the test scores will be used
• the method used for estimating reliability
Reliability
30
Validity degree to which a test measures what it
was designed to measure.
Kinds of validity
• Construct- how well a test or tool measures the construct that it was designed to measure (e.g., IQ)
• Content- how well a test measures the domains of behavior for which it is intended (e.g., KBIT vs. WISC)
• Criterion- the relationship between test results and some external variable(s)
Criterion Validity- 2 types• Concurrent Validity – Does the
instrument correlate to another criterion? (e.g., how a screener relates to school grades, ODRs, behavioral health)
• Predictive Validity – Does the instrument predict a criterion in the future (e.g., how well does the screener ID students who will develop problems vs. those that don’t
Behavioral Health Screening:Criterion Validity is very Important
Concurrent Validity
• How well does the measure correlate to other important variables? Attendance, grades, ODRs, emotional well being
• Does the screening technique relate to other measures of behavioral health, and important school and social/behavioral variables
Predictive Validity
• Can the screening technique predict important student outcomes
• How well does the screening technique identify those with risk and those without risk
• Screening: Important considerations-classification stats
• Test-retest reliability range from .59-.67 on 4 scales
• Measures problem behaviors, social and academic competence
• User friendly
Cons
• Subscription based, 10-25 min. to complete, scoring required
• No classification statistics reported
10/1/2018
• Originally designed to be a screening tool for social and emotional behavioral problems of elementary students
• Coined the “gold standard” of behavioral screening
• Identify students at risk for internalizing and externalizing behaviors
• Identifies behaviors that may impede academic and social functioning
• Hopes to lead to earlier intervention
• NOT recommended as a diagnostic tool for Special Education services
Systematic Screening for Behavior Disorders (SSBD) Walker & Severson, 1992
44
• Three stage gated screening process for grades K-9, can be completed in one hour or less
• Stage 1: teacher nominates and rank- orders students
• 10 students (per class) are identified as externalizers
• 10 students (per class) are identified as internalizers
• Top 3 are chosen as students who display these bx’s in each category
• Stage 2: Teacher completes adaptive and maladaptive behavior rating scales on the 3
• Stage 3: Observation of the three students
• Uses a Teacher Nomination system- tends to under identify internalizing students
SSBD Cont’d
• Reliability (.74-.90), Validity-adequate
• Issues with test-retest: Top three listed for externalizing and internalizing behaviors, one month later only 69% of those nominations stayed the same
• Sensitivity, specificity, positive predictive value, negative predictive value validity- not provided
• Requires time to implement all 3 gates. Schools tend to just use gate 1.
Algozzine, B., Wang, C., & Violette, A. S. (2011). Reexamining the relationship between academic achievement and social behavior. Journal of Positive Behavioral Interventions, 13, 3-16.
Burke, M. D., Hagan-Burke, S., & Sugai, G. (2003). The efficacy of function-based interventions for students with learning disabilities who exhibit escape-maintained problem behavior: Preliminary results from a single case study. Learning Disabilities Quarterly, 26, 15-25.
McIntosh, K., Chard, D. J., Boland, J. B., & Horner, R. H. (2006). Demonstration of combined efforts in school-wide academic and behavioral systems and incidence of reading and behavior challenges in early elementary grades. Journal of Positive Behavioral Interventions, 8, 146-154.
McIntosh, K., Horner, R. H., Chard, D. J., Dickey, C. R., and Braun, D. H. (2008). Reading skills and function of problem behavior in typical school settings. Journal of Special Education, 42, 131-147.
Nelson, J. R., Johnson, A., & Marchand-Martella, N. (1996). Effects of direct instruction, cooperative learning, and independent learning practices on the classroom behavior of students with behavioral disorders: A comparative analysis. Journal of Emotional and Behavioral Disorders, 4,53-62.
Wang, C., & Algozzine, B. (2011). Rethinking the relationship between reading and behavior in early elementary school. Journal of Educational Research, 104, 100-109.
Academic-Behavior Connection
49
School Teachers Can Improve Students' Mental Health, Study Finds
• examined 43 studies that evaluated nearly 50,000 students who had received school-based mental health services
• that mental health interventions that were integrated into the regular curriculum were the most effective. These programs typically targeted behavior problems such as aggressiveness and failing to follow directions
9/28/2018
MTSS for Behavior or Delivery of Comprehensive Behavioral Health Services for ALL students
A Comprehensive Behavioral Health Model (CBHM) is a district wide response to the need for behavioral health support for all students in our schools. CBHM is a multi-tiered system designed to give all students access to high-quality behavioral and mental health support.
50
CBHM Outcomes
CO
HO
RT
ON
E
51
CBHM OutcomesC
OH
OR
T O
NE
PROFICIENT
CBHM Outcomes
52
CBHM OutcomesImproved scores on MCAS/PARCC
Increased social skills
Improved School Climate
Increased time on learning
Reductions in suspensions
Reductions in problematic behavior
53
Commonalities between effective models
• Early Screening for identifying students at risk
• Emphasis on tier 1 programming to address needs of all.
• Tiered levels of intervention for matching student need
• A reliance on Data and Data-based decision making to drive implementation
9/27/2018
The Mercedes Benz
54
CBHM at Tier 1
It’s all about the TEAM
55
TIER I PBIS ESSENTIALS• EXPECTATIONS DEFINED1
• EXPECTATIONS TAUGHT2
• REINFORCEMENT SYSTEM3
• CONSEQUENCE SYSTEM4
• DATA SYSTEM5
What is the TFI?• The TFI offers a valid, reliable, and efficient measure of
the extent to which school personnel are applying the core features of school-wide positive behavioral interventions and supports (SWPBIS).
• The TFI is comprised of three sections • Tier I: Universal SWPBIS Features
• Tier II: Targeted SWPBIS Features
• Tier III: Intensive SWPBIS Features
(Algozzine et al., 2014)
56
Why use the TFI?
(Algozzine et al., 2014)
Guide Implementation
Support improved student
outcomes
Enhance the work of PBIS teams
Utilize the most efficient fidelity
measure
57
BEHAVIOR
Trauma
Academic
Difficulties
Peer /Adult
Relationships
Substance
Abuse
….
Universal Screening for CBHM
Twice a year, teachers complete a brief (34 item)
rating scale for each student.
Sample Item:
In the last week, how often did this student appear
comfortable when relating to others?
never / rarely / sometimes / often / very often
58
Work Smarter, Not Harder
Resource Activity: School teams
• Identify all “teams” or meetings that happen in your building
• Identify which “tier” each team is primarily concerned with addressing
• Is there overlap between teams?
• Any recommendations for combining teams?
Resource Activity: Practices
• Identify programs, procedures, and supports for students’ social-emotional, behavioral, and mental health.
• Identify the “tier” that is addressed by each of the practices listed above
• Any recommendations for improving these practices and supports?
59
Resource Mapping Activity
What do you do in your school:
• Talk to folks near you about the programming/ supports you have at each of the 3 tiers
• Are these supports effective? If so indicate the data used to demonstrate effectiveness.
9/28/2018
In the beginning...
So I need to ask every teacher in this building to complete this universal screener for every student twice a year?!?!?!
60
Working to understand the data
Tier 1 Team
61
Purpose
The purpose of Data Based
Decision Making
School teams need to
understand how to use
universal assessment data
to make systematic
decisions about instruction.
Outcomes
The outcomes of Data Based Decision
Making
School teams will become proficient in
identifying the most efficient strategies
that work to create safe and supportive
schools for all students.
62
Process
The process of Data Based Decision
Making
▫ Team Analysis
▫ Team Action Planning
Grow the Green!
● Continuous Improvement
● Developed by schools○ Grade Level Teams
○ Tier 1 Team
● Goals:○ Assessment Literacy & inquiry
cycle
○ Avoid using data as a hammer
○ Help educators/teams reach
consensus & action
Grow the
green
to mellow the
yellow
& stop the
spread
of the
red!
63
Grow the Green!
Step 1. Define the problem
Step 2. Develop a plan
Step 3. Implement the plan
Step 4. Evaluate the progress
64
65
Step 2. Define the problem & develop a plan, continued
Example: Conduct and academic functioning continue to be
opportunities for growth across our school-level data. As a tier 1
team, we have seen improvements with the introduction of our
school-wide reward system (e.g. PRIDE Bucks), but we feel the
next step to support implementation is the introduction of PBIS
lesson plans across the settings of our school.
DATA BASED DECISION MAKING:
Data Review Protocol
66
Step 4. Evaluate the Progress
Review your progress at your team meeting after your end date.
Evaluate the effectiveness of the school strategy by answering the
following questions:.
● Was the implementation plan carried out with fidelity? If not,
state the reason.
● Was the implementation plan effective? Why or Why not?
● Does the data indicate that you need to maintain, decrease or