Assessment to Intervention: Implications for School Psychologists Serving Students with Emotional/Behavioral Disorders

1. Assessment to Intervention: Implications for School Psychologists Serving Students with Emotional/Behavioral Disorders Tim Lewis, Ph.D. University of Missouri OSEP Center on Positive Behavioral Intervention & Supports pbis.org

2. Purpose • Identify issues with evaluation for EBD • Propose best practices • yes, more forms • Answer questions • Pre-Correct: Content = my interpretation of law, regulations, & professional literature

3. At Issue • Definition • Regulation Interpretation • Confusion / misinterpretation • Numbers • “Rule out” issues • Current process • Wait/Fail model • Alternatives?

4. Being Sane in Insane Places(Rosenhan, 1973) Study 1 8 pseudo patients called hospital (3 psychologist, 1 psychiatrist, painter, housewife) admissions office complained of hearing voices; "empty," "hollow," "thud," everything else factual. Upon admission cease complaints, behave normally, & write notes Goals: 1 get out on your own 2 convince staff that sane 3 cooperate 4 no abnormal behaviors Results • Pseudo patients never detected • Each diagnosed with "schizophrenia in remission" • Average stay 19 days (7‑52) • 35 of 118 patients suspicious “You’re not crazy. You’re a journalist, or a professor (referring to the continual note taking). You’re checking up on the hospital.”

5. Being Sane in Insane Places(Rosenhan, 1973) Study 2 Staff told pseudo patients to be admitted over next 3 months 193 ratings obtained from staff on patients Results No pseudo patients actually used!!! 41 rated as pseudo patients with “high confidence” 23 “suspect” by one psychiatrist 19 “suspect” by one psychiatrist and one other staff member It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment ‑ the powerlessness, depersonalization, segregation, mortification, and self‑labeling ‑seem undoubtedly counter therapeutic (p. 237).

6. Myth One Using the term “Emotional Disturbance” to replace “Behavior Disorders” necessitates a DSM IV diagnoses

7. IDEA General Definition (3) CHILD WITH A DISABILITY- (A) IN GENERAL- The term 'child with a disability' means a child -- (i) with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance (hereinafter referred to as emotional disturbance), orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities; and (ii) who, by reason thereof, needs special education and related services.

8. IDEA Definition (SED/ED) (i) The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance: (A) An inability to learn which cannot be explained by intellectual, sensory, or health factors; (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers; (C) Inappropriate types of behavior or feelings under normal circumstances; (D) A general pervasive mood of unhappiness or depression; or (E) A tendency to develop physical symptoms or fears associated with personal or school problems. (ii) The term includes children who are schizophrenic. The term does not include children who are socially maladjusted, unless it is determined that they are seriously emotionally disturbed.

9. Missouri Definition “Emotional Disturbance” means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: A. an inability to learn that cannot be explained by intellectual, sensory or health factors; B. an inability to build or maintain satisfactory interpersonal relationships with peers and teachers; C. inappropriate types of behavior or feelings under normal circumstances; D. a general pervasive mood of unhappiness or depression; and, E. a tendency to develop physical symptoms or fears associated with personal or social problems. The term includes schizophrenia, but does not apply to children who are socially maladjusted unless it is determined they have an emotional disturbance.

10. Fact… Bad news • No clear formula • No consensus on Standard instruments • No consensus in the field Good News • Triangulation of data & confidence in professional judgment • Label simply provides access to service

11. Myth Two By changing the regulatory language, those students most in need will get services

12. Numbers • US prevalence = 0.85% (9.7% of all students on IEP K-12) • Estimated prevalence = 5-7% • Implication (5%) = 2,201,943 students who could qualify who might not be receiving services (456,407 EBD on IEP / 53,167,000 students K-12)

13. Designing an Evaluation Process for EBD Multiple Data Points Multi-disciplinary Team

14. Criteria for Initial Determination of Eligibility A child displays an emotional disturbance when: A. through evaluation procedures that must include observation of behavior in different environments, and an in-depth social history the child displays one of the following characteristics: B. 1) an inability to learn that cannot be explained by intellectual, sensory or health factors; 2) an inability to build or maintain satisfactory interpersonal relationships with peers and teachers; 3) inappropriate types of behavior or feelings under normal circumstances; 4) a general pervasive mood of unhappiness or depression; and, 5) a tendency to develop physical symptoms or fears associated with personal or social problems.

15. Criteria for Initial Determination of Eligibility C. the characteristic(s) must have existed to a marked degree and over an extended period of time. In most cases, an extended period of time would be a range from two (2) through nine (9) months depending upon the age of the child and the type of behavior occurring. For example, a shorter duration of disturbance that interrupts the learning process in a younger student might constitute an extended period of time. Difficulties may have occurred prior to the referral for evaluation; and D. the emotional disturbance adversely affects the child’s educational performance. NOTE: Manifestations of an emotional disturbance can be observed along a continuum ranging from normal behavior to severely disordered behavior. Children who experience and demonstrate problems of everyday living and/or those who develop transient symptoms due to a specific crisis or stressful experience are not considered to have an emotional disturbance.

16. Keys… • Direct observation • Social History • 2- 9 month history with behavior (except in extremes) • Impacts Educational Performance • No definition of “marked degree”

17. Educational Performance • Achievement • Grades • Attendance • Participation in school-related activities • Social interactions with peers and adults • Pre-vocational related skills • Informed citizen within community

18. Social History

19. Standard Scales • Behavior Rating Profile (Brown & Hammill) • Child Behavior Checklist (Achenbach & Edelbrock) • Revised Behavior Problem Checklist (Quay et al) • Behavior Assessment Scale for Children (Reynolds & Kamphaus) • Behavior Evaluation Scale (McCarney) • Systematic Screening for Behavior Disorders (Walker & Severson)

20. Social Competence/Social Skills • Social Skills Rating System(Gresham & Elliott) • The Walker-McConnell scale of social competence and school adjustment: A social skills rating scale for teachers.(Walker & McConnell)

21. Interviews • First hand knowledge of child • Repeated measures across multiple sources • Teacher(s) • Parent • Student • Members of community

22. Archival Review • School Archival Records Search(Walker, Block-Pedego, Todis & Severson) • What to look for: • Lack of intervention / non-responsiveness to intervention • Expressed concerns/ within school referrals for assistance • Out-of-school referrals for assistance • Attendance • Achievement • Discipline contacts • Making sense of archival data: • Red Flags (Tobin) • Patterns/ chronicity

23. Archival Review Tobin, T., Sugai, G., & Colvin, G. (2000, May). Using discipline referrals to make decisions. NASSP Bulletin, 84(616), 106-117. Tobin, T. J., & Sugai, G. M. (1999a). Discipline problems, placements, and outcomes for students with serious emotional disturbance. Behavioral Disorders, 24(2), 109-121. Tobin, T. J., & Sugai, G. M. (1999b). Using sixth-grade school records to predict violence, chronic discipline problems, and high school outcomes. Journal of Emotional and Behavioral Disorders, 7(1), 40-53.

24. “Rule Out” Issues • Medical-Health / Cognitive / Other Disability / Acute Stressor / Culture • Inappropriate educational accommodations • Inappropriate behavioral intervention • Social maladjustment

26. How does SM differ from SED? How is SM similar to SED

28. Myth Three We have to identify students the same way we always have

29. Special Education Evaluation Process • Wait & Fail • Largest percentage of students identified @ 2nd -4th grade • Outcomes =

30. If antisocial behavior is not changed by the end of grade 3, it should be treated as a chronic condition much like diabetes. That is, it cannot be cured but managed with the appropriate supports and continuing intervention(Walker, Colvin, & Ramsey, 1995).

31. Re-Thinking the Process • Consensus on data points and process • Focus on prevention/early intervention • Non-response as additional data point • Building Capacity • Continuum of student supports • w/ accompanying adult supports

32. School-wide Positive Behavior Support PBS is a broad range of systemic and individualized strategies for achieving important social and learning outcomes while preventing problem behavior OSEP Center on PBIS

33. School-wide Positive Behavioral Support • Expectations for student behavior are defined by a building based team with all staff input • Effective behavioral support is implemented consistently by staff and administration • Appropriate student behavior is taught • Positive behaviors are publicly acknowledged • Problem behaviors have clear consequences • Student behavior is monitored and staff receive regular feedback • Effective Behavioral Support strategies are implemented at the school-wide, specific setting, classroom, and individualstudent level • Effective Behavioral Support strategies are designed to meet the needs of all students

34. Social Competence & Academic Achievement Positive Behavior Support OUTCOMES Supporting Decision Making Supporting Staff Behavior DATA SYSTEMS PRACTICES Supporting Student Behavior

35. Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT ~5% Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior ~15% Primary Prevention: School-/Classroom- Wide Systems for All Students, Staff, & Settings ~80% of Students

36. Universal Strategies: School-Wide Essential Features • Statement of purpose • Clearly define expected behaviors (Rules) • Procedures for teaching & practicing expected behaviors • Procedures for encouraging expected behaviors • Procedures for discouraging problem behaviors • Procedures for record-keeping and decision making

37. Benton

38. Universal Strategies: Non- Classroom Settings • Identify Setting Specific Behaviors • Develop Teaching Strategies • Develop Practice Opportunities and Consequences • Assess the Physical Characteristics • Establish Setting Routines • Identify Needed Support Structures • Data collection strategies

39. Universal Strategies:Classroom Needed at the classroom level... • Use of school-wide expectations/rules • Effective Classroom Management • Behavior management • Instructional management • Environmental management • Support for teachers who deal with students who display high rates of problem behavior

40. Why build strong universal systems of support? • We can’t “make” students learn or behave • We can create environments to increase the likelihood students learn and behave • Environments that increase the likelihood are guided by a core curriculum and implemented with consistency and fidelity across all learning environments

41. Process for Disseminating Practice SAT Process Teacher Training and Support Targeted Interventions Individual Student Plans SAT Team Administrator Counselor Behavior Specialist STAT Team Core Team/Classrooms Implement AIS Monitor Progress Refer to SAT Core Team Representative SAT Partner Core Team Teachers *Meets Weekly RRKS Team School-Wide Systems Matrix Lesson Plans School-Wide Data Acknowledgement Communication Core Team Representative District PBS Support Building Administrator and Counselors *Meets Monthly

42. Pyramid to Success for All • Office Issues • Bus referrals, Truancy, Chronic offender, Threatening student or adult, Fighting, Refusal to go to or Disruptive in Buddy Room, Sexual harassment, Weapons, Drug/cigarettes/ tobacco/alcohol, Assault – physical or verbal • Teacher Method for handling student behaviors • Referral Form – send student to office with completed form • Process with student before re-entry • Office Method for handling student behaviors • Proactive: RRKS Review, Parent Contact • Corrective: Loss of Privilege, Saturday detention, Opportunity Center, Suspension, etc. Team Issues Repeated minor & major disruptions in multiple classrooms, Throwing things, Hallway/Lockers problems, Attendance, Repeated disrespect to peers or adults, Cheating, Inappropriate to substitute, Insubordination, Chronic Disruptions Method for handling student behaviors Proactive: Parent contact (mandatory), RRKS review, Team conference, Team conference with student, Team conference with Parents, Team conference with Administrator/Counselor, Triage in the AM with the student, Triage at lunch with the student, Team Focus, etc. Corrective:Removal of privilege on team, Recovery Study Hall, Buddy Room, etc. Classroom Teacher Issues Out of seat, Talking to classmates, Talking out, Off-task, Violation of class rules, Inappropriate language, Lack of materials, Gum, Disrespect, Cheating, Tardies, Minor destruction of property Method for handling student behaviors Proactive: Positive call to parents, Use praise, Use Rewards, Daily/Weekly Goal sheets, Proximity to instructor, Provide choices, One-to-One assistance, Pre-correct for transitions/trouble situations, Regular breaks for exercise, Give a job, RRKS Review, Reward lunch with teacher, etc. Corrective: One and only one REDIRECT, RRKS Review, Safe-seat, Buddy Room, Think Sheet, Parent Phone call, Lunch Detention, Recovery Study Hall, Removal of privilege in classroom, etc.

43. Serving Students with EBD All facets of programming should include:  • Systematic, data based interventions • Continuous assessment and monitoring of progress • Provision for practice of new skills • Treatment matched to problem • Multi-component treatment • Programming for transfer & maintenance • Commitment to sustained intervention (Peacock Hill Working Group, 1991)

44. Level of Supports within EBD Programs For All Students, pre-school – Grade 12  Prevention – prior to identification / pre-referral / universal supports for all students – the intent of universal support is three-fold: a) prevention of EBD, b) early intervention for high risk students (across all grade levels), and c) supportive environments for those students identified as EBD. (see www.pbismissouri.org)

45. Level of Supports within EBD Programs Intermittent – Support on an “as needed basis.” Characterized by episodic nature, person not always needing the support(s), or short term supports needed during life span transitions. Intermittent supports may be a high or low-level intensity when provided. Examples Academic • Consult with general education teacher • Specific event accommodations (e.g., test reader, more time, quiet room) Behavior • Targeted social skills • Quiet room • Check in • Self management/monitoring Related Supports • On-call counseling / social worker • Receives meds at school

46. Level of Supports within EBD Programs Limited– An intensity of supports characterized by constancy over time, time limited but not of an intermittent nature, may require fewer staff members and less cost than more intensive levels of support Examples Academic • Consistent accommodations in one or more academic domains (IEP goals) • Regular contact with special educator (scheduled pull out time) Behavior • Targeted social skill IEP goals • FBA- BIP Related Supports • Counseling services on a regular basis (e.g., weekly) • Need for on-going medication monitoring with physician • Social work monitoring • Juvenile officer monitoring

47. Level of Supports within EBD Programs Extensive– Supports characterized by regular involvement (daily) in at least some (work, or home) environments and not time limited (long term). Examples Academic • Special education curriculum or general education curriculum delivered in pull out special education placement for majority of day Behavior • Behavior supports delivered by or with daily support of a special educator • Requires frequent intensive behavior supports outside of typical scheduled activities across the day or school week (e.g., removal from classroom due to behavioral concerns) • Behavior intervention plans reflect implementation by specialized personnel and or specialized strategies Related Supports • Behavior consultant • One-on-one paraprofessional • Daily or multi-modal counseling • Outpatient • Family involvement • Active Community case worker (e.g., social worker, family services, health) • Active juvenile justice involvement • Multiple medications requiring close monitoring

48. Level of Supports within EBD Programs Pervasive - Supports characterized by their constancy, high intensity; provided across environments; potential life sustaining nature. Pervasive supports typically involve more staff members and intrusiveness than do extensive or time limited supports. Examples Academic • Requires highly individual and specialized instruction to benefit within curriculum Behavior • History of requiring in-patient • History of home-bound placement • On-going and intensive behavioral supports implemented by specialized personnel required across the school day • Requires environment with continual monitoring and immediate intervention by specialized personnel Related Supports • Requires intensive mental health services (frequent counseling with access for on-the-spot assistance across the school day) • Medications must be monitored on an on-going basis • Frequent and active involvement with community case workers

49. Research-Based • Related Supports* • Comprehensive case management / wrap around • Family supports/ parent training *limited empirical support

50. Research-Based • Academic • “Effective instruction” (see nwrel.org) • Antecedent / setting modifications • Peer tutoring • Direct Instruction • Self-management targeting academic related skills • Opportunities to Respond