Wraparound as a Tier 3 Intervention for Students with Significant Emotional/Behavioral Challenges

Wraparound as a Tier 3 Intervention for Students with Significant Emotional/Behavioral Challenges Lucille Eber, Illinois PBIS Network www.pbisillinois.org Lucille.Eber@pbisillinois.org Northern CA PBIS Symposium November 18, 2013

Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior SCHOOL-WIDE 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

Layering Supports • As students start with tier 2 interventions and may not be successful, layering additional interventions is important • A student could be in CICO, in SAIG, have a FBA/BIP and also be involved in wrap. • OR, students could start with wrap, then the team/school would make sure the student had access to lower level interventions as a part of the wrap plan • Tier 3 wrap student action plan builds on lower level interventions as a part of the comprehensive wraparound plan

We Know the Practices that Work… Proactive, strength-based; “set kids up” to experience success High rates of consistent, supported instruction; teach/practice/reinforce Predictable and consistent environments Know unique “why?” for each student/problem Contextual fit: Strategic use of natural supports, and settings Careful monitoring of data over time with ongoing revisions to guide incremental improvements in quality of life

The System Features Needed to Support he Effective Practices… • A Team unique to each individual child & family • Blend the family/natural supports with the school representatives who know the child best • A defined Meeting Process • Meet frequently and use data • Develop, implement, review range of interventions • Facilitator Role • Bringing team together • Blending perspectives; guiding consensus • Systematic use of data (strengths and needs)

What is Wraparound? • Wraparound is a process for developing family-centered teams and plans that are strength and needs based • (not deficit based) • across multiple settings and life domains.

A Growing Evidence Base See Bruns and Suter, (2010) largest analysis of wrap research. Key points include: • Investment in wraparound is backed by controlled research. In 2003, there were 3 controlled studies published, in 2010, there are 12 scientifically controlled and over 36 overall outcomes studies, more being published monthly. • Research is showing an association between system, organizational, team fidelity to good outcomes with families. • The wraparound-based RENEW process showing significant outcomes for older, transition-aged youth with or at-risk of EBD.

Individualized Comprehensive Teams/Plans • Who? • Youth with multiple needs across home, school, community • Youth with multiple life domain needs • The adults in youth’s life are not effectively • engaged in comprehensive planning • (i.e. adults not getting along very well) • What? • The development of a very unique, individualized, strength-based team & plan with the youth family that is designed to improve quality of life as defined by the youth/family.

Individualized, Comprehensive Teams/Plans What Do Tertiary Plans include? Supports and interventions across multiple life domains and settings (i.e. behavior support plans, academic interventions, basic living supports, multi-agency strategies, family supports, community supports, etc.) What’s Different? Natural supports and unique strengths are emphasized in team and plan development. Youth/family access, voice, ownership are critical features. Plans include supports for adults/family, as well as youth.

10 Principles of Wraparound • Family Voice and Choice • Team-Based • Natural Supports • Collaboration • Community-Based • NWI standardized the 10 principles in 2004 2008–Revised persistent to unconditional • Culturally-Competent • Individualized • Strengths-Based • Unconditional Care • Outcome-Based

Life Domain Areas to Consider • Physical Needs/Living Situation • Family/Attachment • Safety • Socialization • Cultural/Spiritual • Emotional/Psychological • Health • Educational/Vocational • Legal

Four Phases of Wraparound Implementation • Team Development - Get people ready to be a team - Complete strengths/needs chats (baseline data) • Initial Plan Development - Hold initial planning meetings (integrate data) - Develop a team “culture” (use data to establish voice) • Plan Implementation & Refinement - Hold team meetings to review plans (ongoing data collection and use) - Modify, adapt & adjust team plan (based on data) • Plan Completion & Transition - Define good enough (Data-based decision-making) - “Unwrap”

Implementing Wraparound: Key Elements Needed for Success • Engaging students, families & teachers • Team development & team ownership • Ensuring student/family/teacher voice • Getting to real (big) needs • Effective interventions • Serious use of strengths • Natural supports • Focus on needs vs. services • Monitoring progress & sustaining • System support buy-in

What’s New in Wraparound? • Skill set specificity • Focus on intervention design/effectiveness • Integration with school-wide PBS • Phases to guide implementation/supervision • Data-based decision-making • Integrity/fidelity assessment (WIT) • Tools to guide teams: • Home School Community • Education Information Tool

Data-Based Decision-Making and Wraparound Can wraparound teams use data-based decision-making to prioritize needs, design strategies, & monitor progress of the child/family team? • more efficient teams, meetings, and plans? • less reactive (emotion-based) actions? • more strategic actions? • more effective outcomes? • longer-term commitment to maintain success?

Wraparound Skill Sets • Identifying “big” needs (quality of life indicators) • “Student needs to feel others respect him” • Establish voice/ownership • Reframe blame • Recognize/prevent teams’ becoming immobilized by “setting events” • Getting to interventions that actually work • Integrate data-based decision-making into complex process (home-school-community)

Good needs-based interventions will: • Change the environment around the situation rather than waiting for the person with the unmet need to do the changing • Help build skills for the youth and the youth’s supporters (family, teachers, neighbors, kin, etc.) • Access existing resources when there is fit, avoid existing resources when there is not Patricia Miles, 2002

Needs & Wraparound • Focus on the “why” of a need not the “how” • Needs to feel competent with academic tasks rather than he needs to complete his assignments • Use descriptive terms • To learn, To know, To experience, To feel, To see, To have, To be • Deal with the “big” stuff • Families/youth deserve to know their teams are dealing with their larger challenges • More than one way to meet it • Unlike a goal (John will come to school every day) • Improves quality of life (as defined by family, youth) Adapted from P.Miles,2004

Need Defines why do the action Unifying concept that cuts across all three levels of service Changes infrequently until reports indicate “met need” Service Defines the action Three levels Existing service Intervention Support Frequent changes based on new information Services & Needs are Different P.Miles, 2004

“Needs” Talk in Team Meetings • When a team member disguises a service as a need, i.e. • He needs a special education placement or • The family needs counseling • Ask the team member: • What do you hope will be accomplished through this? • Why do you think this is important to the person? • How will you know when it’s been effective?

Examples of Needs Statements: • The student needs to feel adults and peers respect him. • The student needs to feel happy about being at school. • The parent needs to know her son is getting a fair shake at school. • The student needs to be reassured that he can complete the work.

6th grade student Behavior difficulties and academic failure GPA 1.25 (2nd quarter) 6 ODRs (1st two quarters) 15 Out-of-School Suspensions (safety) Family support needs –history of mobility with plan to move at the end current school year. Student moved nine times since first grade Andy

Why move to Phase I wraparound instead of an FBA around one problem behavior? Discussing problem behaviors would not have motivated family to participate on team. Probably not the first time schools have approached family in this manner (“let’s talk about behavior”) Bigger needs to work on to improve quality of life for youth and family Open-ended conversation and use of wrap data tools helped engage family

The team developed a mission statement: “Andy will be happy and confident in school” Andy

Using Data to Keep the Team Moving“Celebrate Success of current plan”Andy

Andy was happy at school and his mother was pleased with the help that the wrap team provided. Teachers were pleased with the change in Andy. Data is used to then identify “next steps”. Andy

Using Data to Keep the Team Moving “Identify Ongoing Needs & Next Steps”Andy The check and connect intervention and other strategies helped Andy feel better about being at his school. The team identified unmet “needs”. The data is used to engage the team to continue working on a plan. Educational Information Tool

Andy The family expressed that for the first time in their son’s school experience, they felt supported and optimistic. Andy’s mother wants him to continue at this school. Andy’s team will help develop a plan that supports his independence from adults.

Setting Event Challenges • Setting events that seems outside of the “control” of the school may frustrate intervention efforts.

Effective Interventions: Getting to the Setting Event If you are doing wraparound and effectively engage the family, you are more likely to (eventually) get to strategies that address the setting event.

“Ben’s Story… • “Ben” started CICO in September of 2009. He was automatically entered into the intervention when he met the building criteria of having two, level two office discipline referrals. • Behaviors of concern included: disobeying directions, talking out, disrupting others learning, off task, hitting other students, arguing with teacher and students, name calling, cursing to peers and adults. • He averaged a 78% after 6 weeks.

And Then… • A reverse request was given to the teacher where she was asked to identify the next secondary intervention (continued CICO, SAIG, CICO with individual features or mentoring). • The teacher chose for Ben to receive a mentor. • His mentor was chosen from the community partnership ‘G’ elementary has with a local church.

Moving Forward In December, Ben began asking his mother if he could be admitted to the hospital so he “could get better”. He was experiencing anger, thoughts of hurting himself and he was physically aggressive with classmates and peers. He was verbalizing “I can’t control himself.” Ben had three prior psychiatric hospitalizations (before coming to ‘G’ Elementary).

Challenges Ben and Family Were Facing Included… • Single parent family; mom working evenings and overnights. • No contact with biological father and no consistent male role models. • ADHD diagnoses; inconsistent use of prescribed medication. • Limited involvement in community & neighborhood • Limited social relationships at school & home • Stress of moving to different homes.

Child and Family Strengths Ben’s Strengths identified in the first meeting included: “Ben”: Smart, good at math, reading, writing and playing video games Mom: Very organized He’s creative and enjoys drawing cartoons Teacher: writing and math; Family Strengths: Mom consistently takes “Ben” to his mental health appointments. This might include getting the city bus for an hour ride, attending an hour appointment, waiting another 30 minutes for the bus and then riding home and then bringing him to school. Mom is an active participant at the school, follows through with suggestions.

Wrap process builds on lower tiered interventions At the first team meeting family agreed to: Continue CICO Continue mentoring Continue MH services Improved communication with Mental Health FBA to be completed (home and school) Family YMCA (schedule present at LANS for funding)

Other Data…

Questionnaire: SIMEO 2010-Home, School, Community Tool

Rehabilitation, Empowerment, Natural Supports, Education and Work {RENEW}J. Malloy and colleagues at UNH Developed in 1996 as the model for a 3-year RSA-funded employment model demonstration project for youth with “SED” Focus is on community-based, self-determined services and supports Promising results for youth who typically have very poor post-school outcomes (Bullis & Cheney; Eber, Nelson & Miles, 1997; Cheney, Malloy & Hagner, 1998)

RENEW Overview RENEW (Rehabilitation, Empowerment, Natural Supports, Education and Work) is an application of wraparound • Reflects key principles: person-centered, community and strengths-based, natural supports • Focused on student, versus parent engagement (e.g., student-centered teams, student-developed interests)

RENEW Features Self-determination through Personal Futures Planning Individualized Team Development and Wraparound Individualized Education Programming Individualized School-to-Career Planning Naturally Supported Employment Mentoring Sustainable and Positive Social Connections

The RENEW MAPS • History • Who You Are Today • Strengths & Accomplishments • People • What Works and Doesn’t Work (Preferences) • Dreams • Fears, Concerns, Barriers • The Goals • Next Steps • Essential Next Steps and Follow Up (Action Plan)

Mapping Futures Planning Maps uses flip chart paper & markers, a power point projected on a wall, or a Smart board and should include: • Both words and graphics that represent the student and their story • A focal point where everyone on the team can see the Maps being created

K’s History K. was expelled from school in the 9th grade due to behavioral issues at school K. attended Alternative Program for remainder of 9th grade and freshman year. K. started the RENEW process during 2nd semester of her sophomore year. The RENEW process was used to support K. as she began to transition back to WHS, attending 2 periods at WHS and attending the Alternative Program for the remainder of the day.

K’s Maps: Strengths and Accomplishments

K’s Maps : Dreams

K’s Maps: Fears, Barriers and Concerns

Wraparound as a Tier 3 Intervention for Students with Significant Emotional/Behavioral Challenges