Universal Screening for Social-Emotional and Behavioral Difficulties

1. Universal Screening for Social-Emotional and Behavioral Difficulties Delaware PBS Project April 23, 2008 Kathleen Minke

2. Workshop Overview • Background/Rationale for universal screening • Methods for your consideration • Linking identified students to services

3. What Is Universal Screening? • Purpose: to identify youth who have high risk for developing behavioral or mental health problems • Conducted on a schoolwide basis • Typically involves several levels of assessment to avoid over- or under-identification of students

4. Universal Screening for What? • Behavior problems? • Social-emotional problems? • Mental illness? Mental health?

5. Why Should Schools Be Concerned With This? • Fits with the three-tiered model • Fits with RTI

6. Why Should Schools Be Concerned With This? • Children with better social-emotional and behavioral skills do better academically • Children’s academic and social competencies influence each other • When you improve children’s social competence you also make it more likely that they will improve academically • Students are more likely to use services that are offered at school

7. Do Students Need Support? • 2005: Around 2.2 million adolescents (12-17) reported a major depressive episode; nearly 60% received no treatment • Students with significant social-emotional and behavioral needs drop out at a rate twice that of other students • In a given year, around 20% of children and adolescents experience symptoms of mental health problems

8. Facts about Delaware’s Youth • 16.6% carried a weapon in the prior month; 5.4% carried a gun • 4.6% did not go to school because they felt unsafe • 6.2% were threatened or injured on school grounds in prior 12 months • 7.1% attempted suicide; 12.7% seriously considered suicide

9. The Good News…Prevention Works Greenberg et al. (2003): • Programs that developed students’ skills and promoted positive school climates demonstrated improved interpersonal relationships, improved academic achievement, and reductions in problem behaviors (e.g., truancy, substance use, violence) among students (Catalono et al, 2002) • Primary prevention programs in school settings can enhance interpersonal competencies and prevent externalizing and internalizing problems (Durlak & Wells, 1997)

10. “There is a solid and growing empirical base indicating that well-designed, well-implemented, school-based prevention and youth development programming can positively influence a diverse array of social, health, and academic outcomes.” Greenberg et al. (2003)

11. Is My School Ready to Do This? • The school faculty and staff are committed to improving social-emotional and behavioral health among students. • The school and district are committed to “following the data.” • Faculty understand and accept that current referral and support structures in the school may need to change. • The community supports screening for social-emotional and behavioral concerns.

12. Is My School Ready to Do This? • The schoolwide program is working well for 80-85% of students. • The targeted program is working well and the problem-solving process at this level is not overwhelmed. • In-school resources are available to provide interventions. • Effective connections have been established with community support services.

13. Academic and Behavioral Systems Work Together • Intensive Interventions • Individual Students • Assessment-based, function based • Intense, durable procedures • Intensive academic support • School based adult mentors • Intensive social skills training • Individualized function based behavior support plans • Parent training and collaboration • Multi-agency collaboration (wrap around) • Alternatives to suspension and expulsion • Targeted Interventions • Some students (at-risk) • Function-based • Skill development and/or • relationship development • Individual or group • High efficiency • Rapid response 5-10% 10-15% • More detailed social skills training and support • Self-management programs • School-based adult mentors (check-in) • Increased academic support & practice • Alternatives to school suspension • Effective academic support • Teaching social skills • Character development • Teaching school-wide expectations • Active supervision in common areas • Positive reinforcement (tangible and • intangible) for all • Firm fair, corrective discipline • Family-school collaboration efforts • Effective classroom management • School-wide Interventions • All settings, all students • Preventive, proactive All interventions are based on function and progress monitoring data

14. Multiple Gating Procedures • Gate 1: cast a wide net • Teacher report or nomination • Brief parent report • Brief self-report

15. Remember that measurement class?

16. Remember that measurement class? • Sensitivity: • Of those actuallyat risk, what proportion is identified? • Specificity: • Of those actually not at risk, what proportion is identified? • Positive predictive value • Of those identified as at risk, what proportion is correctly identified?

17. Multiple Gating Procedures • Gate 1: cast a wide net • Teacher report or nomination • Brief parent report • Brief self-report • Gate 2: refine the “catch” • Ratings and/or rankings

18. Multiple Gating Procedures • Gate 1: cast a wide net • Teacher report or nomination • Brief parent report • Brief self-report • Gate 2: refine the “catch” • Ratings and/or rankings • Gate 3: identify those most at risk • Observations, interviews, other assessments

19. Then What? • Individualized planning • Intervention • Progress monitoring • Fading of intervention

20. Universal = All? • All kindergartners • All transfers into school • All students during transition year to middle school or high school

21. When to Screen? • If using parent report, at beginning of school year is ok • If using teacher report, wait at least two months • Self-report?

22. What about Informed Consent? • Passive vs. active consent • The trade-off

23. What About Informed Consent? Hatch Amendment (1974) • No student shall be required, as part of any applicable program, to submit to a survey, analysis, or evaluation that reveals information concerning— • (1) political affiliations; • (2) mental and psychological problems potentially embarrassing to the student or his family; • (3) sex behavior and attitudes; • (4) illegal, anti-social, self-incriminating and demeaning behavior; • (5) critical appraisals of other individuals with whom respondents have close family relationships; • (6) legally recognized privileged or analogous relationships, such as those of lawyers, physicians, and ministers; or • (7) income (other than that required by law to determine eligibility for participation in a program or for receiving financial assistance under such program), • without the prior consent of the student (if the student is an adult or emancipated minor), or in the case of an unemancipated minor, without the prior written consent of the parent.

24. What About Informed Consent? • Broad interpretations of the Hatch Amendment (1974); parents seek to restrict activities related to: • Values clarification; moral dilemmas • Religious and moral standards • Death education; Sex education • Drug and alcohol use • Nuclear policy and globalism • Witchcraft, occult, supernatural • Evolution

25. What About Informed Consent? • “Psychological and psychiatric treatment that is designed to affect behavioral, emotional, or attitudinal characteristics of an individual or designed to elicit information about attitudes, habits, traits, opinions, beliefs or feelings of an individual or group.”

26. What about Informed Consent? • Passive consent probably ok for teacher nominations or rankings at Gate 1 and 2; obtain active consent for Gate 3 • Almost always obtain active consent when student or parent report is used • Get consent and screen when parents are physically present at school • Don’t forget the lawyers….

27. Assessing Technical Adequacy • Just because it is published… • School or district level evaluation…

28. Except for a few statistics, everything I learned in graduate school turned out to be wrong. - Jack Bardon

29. Statistics • Please remember to answer in the form of a question…or whatever…. • And, as always, no wagering.

30. Variance is a measure of a. the amount of spread in a set of scores.b. the most frequently occurring score.c. the average score.d. the difficulty level of scores.

31. The statistic that tells you the strength and direction of the relationship between two variables.

32. True or false:If you know that there is an r of .85 between measures of these two variables, you can state with confidence that parent involvement in schooling results in students’ high grades.

33. Which of the following is a more impressive result in a study?A. “the correlation between the variables was significant at the .0001 level.”B. “An effect size of 1.2 was observed in favor of the experimental group.”

34. A self-concept scale was normed in 1968 on 200 children who lived near a university in Colorado. Name at least 3 problems with using this measure in Delaware.

35. A T score has a mean of _____ and a SD of _____ .a. 50; 10b. 50; 50c. 100; 15d. 0; 2

36. Cronbach’s coefficient alpha is a measure ofa. construct validity.b. internal consistency reliability.c. discriminant validity.d. test‑retest reliability.

37. True or False: A low test-rest reliability coefficient always means that the test is poorly constructed.

38. __________ validity is the extent to which the items in a measure represent the domain being assessed.A. ConstructB. FaceC. ContentD. Concurrent

39. Technical Adequacy Summary • Representative norms • Internal consistency reliability • Test-retest reliability • Inter-rater reliability • Predictive validity • Concurrent validity • Construct validity • Content validity

40. Additional Factors to Consider • Acceptability • Appropriateness • Feasibility • Adaptability • Utility • See Glover and Albers (2007)

41. Utility • Are the outcomes useful for guiding intervention? • Does this process improve student outcomes?

42. Cautions • Build support for the program • Provide clearly written, family-friendly information that outlines the benefits of screening • Provide prompt answers and additional information to any parent expressing concern • Provide information about screening outcomes (and effectiveness of programming)

43. Cautions • Gain student assent • Even when parents have provided permission, students must have the freedom to opt out without penalty • Provide student-friendly information about the screening • Encourage family decision-making

44. Cautions • Protect student and family privacy • Educate teachers about confidentiality • Guard against labeling • Screening must lead to effective intervention!

45. Some Examples • Published methods • SSBD • BASC-2/BESS • Build-Your-Own-Screening • Nomination • Delaware Behavior Checklist • Parent or Youth Self-Report

46. Systematic Screening for Behavior Disorders (SSBD) • Walker and Severson (1992) • Published by Sopris West • Cost: $120 (plus $14 per pack of forms) • K-6 • Identifies externalizing and internalizing disorders

47. Systematic Screening for Behavior Disorders (SSBD) • Based on teacher judgment which is reliable and valid but underutilized • Simple procedures at Gates 1 and 2 that: • Take full advantage of teachers’ judgments • Require attention to the full range of potentially problematic behaviors (internalizing and externalizing) • Require systematic attention to all students in a class

48. Systematic Screening for Behavior Disorders (SSBD) • Procedures at Gate 3 that: • Address the two major adjustment areas for children • Teacher-related classroom adjustment • Peer-related social adjustment

49. Systematic Screening for Behavior Disorders (SSBD) • Don’t conduct screening until at least one month into school year; end of October preferred • Don’t rank any student that the teacher has known for less than one month • Screen again in February to pick up new students, missed students, and those whose behavior has changed

50. Systematic Screening for Behavior Disorders (SSBD) • Gate 1 – Step 1: • Study definitions and examples of externalizing and internalizing behavior problems • Gate 1 – Step 2: • Using class roster, select 10 students for EACH of the externalizing and internalizing groups • Gate 1 – Step 3: • Rank order students in each group from most to least according to degree of externalizing or internalizing behavior