Supporting students with significant behavioural ... · Dr. Susan Graham-Clay July 21, 2016 ISPA Supporting students with significant behavioural challenges: A team approach

Dr. Susan Graham-Clay July 21, 2016

ISPA

Supporting students with significant behavioural challenges:

A team approach

Student population: 20,000

Schools: 42 Elementary (K-8) 9 High Schools (9-12)

Mental Health Staff: Mental Health Lead Senior Psychologist 3 Psychology Staff Psychology interns 6 School Counsellors – weekly school visits 6 Educational Assistants (itinerant)

Scope of School Psychology Practice

 Consultation – learning, behaviour & social-emotional difficulties

 Psychological Assessment

 Counselling

 Professional Development for staff

 Crisis Response

 System Initiatives (e.g., suicide prevention, equity and inclusion, safe schools, student success)

TOPKID “Teams Organizing Programs for

Kids in Distress” History – 20 years in the making

For elementary students presenting severe patterns of disruptive behaviour and social-emotional distress (“show-stoppers”).

Focused support for the School Team in consultation with Board staff.

A collaborative process used to formulate an intensive support plan for the student.

Process: intake, implementation, discharge and follow-up report with recommendations.

TOPKID

Examples of referral concerns:

Grade 8 male – school refusal, leaves designated location, refuses to obey school rules, swearing in class

Grade 4 male – non-compliant with teacher, tantrums (yelling and screaming), leaves class & hides, disruptive to peers

Grade 4 female – diagnoses of: duplication of chromosome 17, ADHD and LD, aggressive to peers, flight risk, disruptive in class

Grade 1 female – aggressive to peers, in “constant motion”, tells adults what she will/will not do, past Occupational Therapy, paediatrician appointment pending

Grade JK male – poking and touching peers, aggression (hitting & spitting), throwing things across room (shoes, pencils), hiding

Grade SK female – refuses to follow directions, aggressive to peers (hitting/scratching/pushing), flops on floor, knocks over chairs

School Team and Board Team

School team: Principal Classroom Teacher Special Education Resource Teacher Educational Assistant (if applicable)

Board team: Senior Psychologist (manager, clinical support, supervisor) 3 Psychology staff (clinical support) 6 School Counsellors (attend each school weekly) 6 Educational Assistants (itinerant)

Collaborative process & Intensive Support Plan

Collaborative process:

 Regular school team meetings – team focus (teacher not alone)

 Observations: classroom and schoolyard (identify triggers, problem times during the day, functions of behaviour, themes & trends)

 School team dynamics (understand team functioning)

 School Counsellor and EA consult daily. Senior psychologist receives/reviews referrals and provides clinical direction.

Intensive Support Plan:

 Focus on pro-social skill development, data-driven

 Use of evidence-based approaches:

 Collaborative Problem Solving (Ross Greene)

  Applied Behaviour Analysis (ABA)

 Cognitive Behaviour Therapy (CBT)

 Zones of Regulation (Kuypers)

 non-violent crisis response approaches

TOPKID in action

Referral: Referral form outlines:

 Detailed behaviours of concern

 Individual student or shared support?

 Safety concerns

 Supports already in place (e.g. IEP, safety plan, EA support),

 Diagnosis?

 Medication?

 Specialist/community supports in place

 Principal approves and signs TOPKID referral

Implementation:

 Board staff collaborate with school team

  Data collection process (observations, FBA)

 Strategies considered and attempted

 Ongoing daily & weekly consultation and review

Discharge:

 Development of “Personal Support Plan” (summary of successful strategies).

 EA support moves on to next school placement.

 Ongoing monitoring and consultation by School Counsellor continues at school level overseen by Senior Psychologist.

Considerations for Psychology Manager:

Requires ½ to 1 day per week to manage TOPKID program.

Balance competing referrals and determine EA assignments.

Match student needs with EA skill sets.

Weekly communication with school staff re program status.

Focus on independence mindset for student and for staff (not dependence on EA support) – concept of resiliency.

Focus on pro-social skill development – i.e., not just managing behaviours but actively teaching skills.

Provides a framework to bring clinical psychological expertise to our most needy students.

Case Study

Grade 4 female - Lana Diagnoses: LD, ADHD, Genetic duplication (rare)

Wanders, leaves class without permission (safety concern)

Aggressive at recess to peers (hitting, throwing, pushing). Verbally aggressive to staff.

Difficulties with impulsivity, attention, executive functions - especially initiating tasks on own (asks for help constantly).

Runs around room, loud & disruptive in class. Throws things.

Other: Behaviour Plan and IEP already in place, family working with paediatrician, genetic testing, neuropsychology assessment pending (local resource).

TOPKID Service duration: 5 weeks (Jan-Feb/2016)

Goal #1: teach Lana to seek permission from teacher before leaving class (priority safety goal)

Goal #2: executive functions, especially learning to initiate some tasks independently

Implemented a range of intervention strategies focused on direct skills teaching (examples):

Language: First/then statements; 1,2,3 Magic (Phelan); Reinforcement Contingency (“You may when you have done……”); Specific verbal praise; “Does this make the problem bigger or smaller?” (CBT approach)

Visuals: Creation of “Hall Pass”; Social stories (touching); visual schedule (colour-coded work/breaks); Hunger Games tokens for preferred activities

Movement: Specific fidgets (e.g. squish ball, plasticine – keep fingers busy); hand massage; meaningful movement breaks (recycling and delivering attendance folders); throw dice and perform required # reps

Additional Team recommendations:

 Adults interact outside of class only if Lana has her hall pass (i.e. permission to leave), if no pass - alert office

 Use animated voice to convey instructions

 Teach peers to tell Lana they do not like her touching them Ask Lana: “What did you hear _____ say?”

 Adults provide and supervise scissor use

 Preferred seating in classroom close to teacher instruction

 Reduce time Lana spends in line-ups

 Helping role – loves kindergarten duty with adult support

 Will stay in seat if she will be reading aloud (advance prep and have Lana read last)

 Chunk and modify work

Some stats from 2015-2016 school year:

Total # students supported through TOPKID = 54

Total # elementary schools accessing TOPKID = 28 of 42 (67%)

Vast majority of students referred were male (82%)

No EA support prior to TOPKID and no EA support after = 42%

Each EA worked with 9 to 11 students through the year

Program duration:

%

1 - 2 weeks – typically transition back to school in fall 3 - 6 weeks – typical TOPKID program/placement 7 - 9 weeks – occasional longer term for higher needs 10+ weeks – rare (3 students)

Grade distribution of referrals:

Early intervention focus JK-3 (60% of referrals)

TOPKID 20 years – WHY?

Because it works!

Allows responsive psychological support to students with significant needs.

Support comes to school. Adds specialized services to regular classroom programming that often is not adequate to address the needs of these high needs students.

Builds capacity in the system through on-site consultation and training at the school level.

Provides system responsiveness to support new students and to bring needed relief and support to crisis situations.

Provides for system understanding of PD needs (60% referrals JK - grade 3).

ISPA Conference theme

School Psychologists as:

Communicators Collaborators Organizers

Mental Health Advocates