Lucille Eber, Statewide Director, IL PBIS Network Partner with OSEP’s National PBIS TA Center www.pbisillinois.org |

1. April 11, 2012 CEC Institute on School-based Mental Health and Positive Behavioral Interventions and Supports (PBIS) School-based Wraparound, School Mental Health and PBIS : Building Systems of Care in Schools & Communities Lucille Eber, Statewide Director, IL PBIS Network Partner with OSEP’s National PBIS TA Center www.pbisillinois.org | Lucille.Eber@pbisillinois.org

2. Why We Need MH Partnerships • One in 5 youth have a MH “condition” • About 70% of those get no treatment • School is “defacto” MH provider • JJ system is next level of system default • 1-2% identified by schools as EBD • Those identified have poor outcomes • Suicide is 4th leading cause of death among young adults

3. The 6-yr PBIS Tier (2)3 demo in IL impacted: • systems and structures • Special Ed/General Ed relationships • roles of school-based clinicians

4. “Big Ideas” for Today • At least twice as many youth need high levels of support for emotional/behavioral needs than currently identified as EBD. • Nationally, youth who are identified as EBD have experienced very poor outcomes. • Behavior support for students with emotional/behavioral challenges is not just a “Special Education” issue. • Prevention-based systems, with capacity to scale-up and provide effective interventions for those youth with or at-risk of EBD are being developed and implemented in schools. • Schools can’t do it alone…partnerships with communities are needed to ensure success.

5. Setting the Stage • 1982 Unclaimed Children (Jane Knitzer) • SOC needed to be seamless continuum, community-based and culturally relevant 1983 CASSP: Technical Assistance plan to develop SOC • 1986 System of Care (Stroul & Freidman) • Called for collaboration & community-based services • Resulted in increments of service development • (i.e. case mgmt, respite, day treatment, in-home supports) • But not a coordinated system or continuum • Did not indicate practices needed for a SOC

6. History (cont.) • 1989-1993 RWJ Projects • 27 states and local communities • introduced managed care • effected state systems in some places (i.e. KY, NC) • 1992-present Comprehensive Community Mental Health Services for Children & Their Families Program • 85 states local tribes & territories • Decrease use of restrictive placements while increasing • access, satisfaction, and youth/family outcomes • Systemic change across systems • Development of state & community structures

7. Wraparound: A SOC Tool • Emerged from practitioners struggling to implement SOC (grassroots) • Keep/bring youth home • Flexible, creative, non-categorical • Natural support networks • Community-based • Unconditional-Commit to “stay the course” • Let family voice guide service development • Non-traditional supports and services

8. 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.

9. Some “Big Picture” Challenges • Low intensity, low fidelity interventions for behavior/emotional needs • Habitual use of restrictive settings (and poor outcomes) for youth with disabilities • High rate of undiagnosed MH problems (stigma, lack of knowledge, etc.) • Changing the routines of ineffective practices (systems) that are “familiar” to systems

10. 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

11. We Know the System Features Needed to Support the 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)

12. Problem Innovative practices do not fare well in old organizational structures and systems Organizational and system changes are essential to successful use of innovations Expect it Plan for it © Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008

13. It Takes a System…

14. 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

15. Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems ODRs, Attendance, Tardies, Grades, DIBELS, etc. Tier 2/Secondary Tier 3/ Tertiary Check-in/ Check-out Intervention Assessment Social/Academic Instructional Groups Daily Progress Report (DPR)(Behavior and Academic Goals) Individualized Check-In/Check-Out, Groups & Mentoring (ex. CnC) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Brief Functional Behavioral Assessment/ Behavior Intervention Planning (FBA/BIP) Illinois PBIS Network, Revised Aug.,2009 Adapted from T. Scott, 2004 Complex FBA/BIP SIMEO Tools: HSC-T, RD-T, EI-T Wraparound

16. More Students Access Tier 2/3 Interventions When Tier 1/ Universal is in Place FY09 School Profile Tool Students Accessing Tier 2/Tier 3 Interventions

17. Who is Tier 3-Wraparound for? • Youth with multiple needs across home, school, community • Youth at-risk for change of placement (youth not responding to current systems/practices) • The adults in youth’s life are not effectively engaged in comprehensive planning (i.e. adults not getting along very well)

18. 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

19. Features of Wraparound • individual students • built upon strengths • voice, priorities of youth and family • based on unique youth and family needs • culturally relevant teams and plans • plans include natural supports • traditional and non-traditional interventions • multiple life domains • unconditional

20. Unique Fit Wraparound plans should be uniquely designed to fit individual students needs as opposed to making a student fit into existing services or a prescribed program.

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

22. Value Base • Build on strengths to meet needs • One family-one plan • Increased parent choice • Increased family independence • Support for youth in context of families • Support for families in context of community • Unconditional: Never give up P. Miles, 2004

23. 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

24. 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?

25. Jacob Poor school attendance Tardiness Refusal to participate in 2nd grade classroom activities. Did work independently in office/partial school days. Previous hospitalization (Bipolar Disorder?) Retention – currently repeating 2nd grade year Failing Grades

26. “Jacob”Home/School/Community ToolGetting to Strengths & Needs at Baseline

27. 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)

28. 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”

29. Establish Family Voice & Ownership Communicate differently… • No blaming, no shaming • Start with strengths • Family’s needs are priority • Listen to their story before the meeting • Validate their perspective

30. Checking for Family Voice & Ownership • Family chooses team members • Team meets when & where family is comfortable • Family (including the youth) feels like it is their meeting and their plan instead of feeling like they are attending a meeting the school or agency is having about them.

31. 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.

32. “Ben’s Story…(multi-tiered support) • “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.

33. 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.

34. 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).

35. And Then… • System criteria is for the systems team to consider wrap around for a student who is at risk for change of placement. • The secondary systems met and decided to contact mom re: starting a wrap around. • Ben was at risk for an out of home placement due to behaviors at home (physical aggression). He was also chosen due to continued office discipline referrals (30 for the year), out of school suspensions (3), and a CICO average of 76%.

36. 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.

37. 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.

38. MISSION STATEMENT: ‘A Happy Home’ The mission statement was developed by the team, Ben and his mom. Ben stated that his hopes were “he would yell less at home so that he would see more smiling from his family.” Mom agreed.

39. First Child & Family Meeting: Initial steps as a result of the first child & family team meeting: Continued CICO Continued mentoring Continued MH services Continue communication with Mental Health FBA to be completed Family access to YMCA (schedule present at LANS for funding)

40. Child & Family Team Meeting Number 2 January 22 Discussed improved behavior at home and school (not in physical fights at school, turning in his work, helping at home) Completed BIP using the FBA (help from the baseline SIMEO data) Planned next meeting and Ben wanted to invite mentor to the next meeting

41. 3rd Child & Family Team Meeting March 5, 2010: Reviewed strengths: celebrating that he walked away from two fights at school (he had never done that before) Team looked at data/ graphs and Ben led the discussion and interpreted the improvements for the group Needs in Ben’s words were that he “still had room to improve”. Ben pointed to areas on the graphs where he said he still needed to work on. Mom was going to bring electric bill so the social worker could continue to get YMCA family membership to address the needs (e.g. to do, social activities)

42. Next Meeting was Scheduled for April 23rd… however: Upon returning from spring break (three weeks-this is a year round school) mom was in the school office and reported she was evicted and needed to begin staying with extended family. Social worker and the parent educator are working to obtain transportation. The parent educator (homeless liaison) is working with the family to obtain stable housing.

43. Other Data…

44. Questionnaire: SIMEO 2010-Home, School, Community Tool

45. Questionnaire: SIMEO 2010-Home, School, Community Tool

46. Questionnaire: SIMEO 2010-Home, School, Community Tool

47. 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)

48. 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)

49. Student Challenges • Failing 2 classes • History of psychiatric hospitalizations • Strained Relationship with family and some teachers. • Feeling accepted at home, school, and community. • Bored and Isolated at home.

50. I Feel Happy/Sad When????