Linking wraparound and consultation: Theory and techniques

1. Linking wraparound and consultation: Theory and techniques Annual Convention National Association of School Psychologists March 4, 2010

2. Presenters • Jennifer Rose, Tertiary Research and Evaluation Coordinator, Illinois PBIS Network: jen.rose@pbisillinois.org • Lucille Eber, Statewide Network Director, Illinois PBIS Network: lucille.eber@pbisillinois.org

3. Session goals • To summarize key issues in children’s mental health • To review basic concepts associated with school-based consultation • To present the theory and values base of wraparound • To share findings from federally-funded tertiary demonstration project

4. Background

5. Children’s mental health: statistics • Children with emotional issues, are underserved • An estimated 21% of youth ages 9-17 have a diagnosable mental health issue • However, only 6%-25% of these children receive any mental health services (U.S. Surgeon General, 1999; Hoagwood & Johnson, 2003)

6. Children’s mental health: Statistics • Children/youth with complex needs require supports across multiple settings encompassing their homes, schools and communities (Joint Commission on the Mental Health of Children, 1969; President’s Commission on Mental Health, 1978; Stroul & Friedman, 1986; Duchnowski, Kutash, & Friedman, 2002)

7. Children’s mental health: Service delivery history • Over forty years of research documents adverse effect of fragmented service delivery: • Joint Commission on the Mental Health of Children (1969) • Project on Classification of Exceptional Children (1975) • Unclaimed Children (1982)

8. Children’s mental illness and the issue of accessibility to treatment : Ripped from the headlines…. • “Children in the Mental Health Void Remember the Nebraska law meant to keep desperate new mothers from abandoning their babies in dumpsters by offering them the possibility of legal drop-off points at safe havens like hospitals? As was widely reported last year, the law neglected to set an age limit for dropped-off children, and eventually led to 36 children mostly between the ages of 13 and 17 being left with state authorities. Most of these children had serious mental health issues. Some were handed over to the state by relatives who had no other way of securing for them the heavy-duty psychiatric care they needed. Seven of the children came from out of state, including one who had been driven 1,000 miles to Lincoln, Neb., from Smyrna, Ga.”Source: New York Times, February 19, 2009

9. Children’s mental health: Impact on learning • Untreated emotional problems have the potential to create barriers to learning that interfere with the mission of schools to educate all children Source:Taylor and Adelman (2002)

10. Children’s mental health: Role of schools • Authorization of Education of All Handicapped Children Act (PL 94-142) incorporated provisions for addressing the needs of children with emotional problems (Duchnowski, Kutash, & Friedman, 2002) • Schools are “de facto” mental health care providers (Burns, 1995) • School psychologists have a prominent role in service delivery beyond assessment for special education (Foster, Rollefson, Doksum, Noonan, Robinson, & Teich, 2005)

11. School-based Consultation

12. School-based consultation • Consultation is widely-recognized as one option for school psychologists to expand service delivery (Zins & Erchul, 2002) • “Gives psychology away” to non-psychologists (Miller, 1969) • Consultees (e.g., teachers) acquire skills to address similar issues in the future

13. School-based consultation • Key features of consultation: • Problem-solving approach • ProblemIdentification • Problem Analysis • Plan Implementation • Plan Evaluation • In-direct service delivery • Collaborative • Triadic relationship • consultant-consultee-student • Theoretical orientation: • Behavioral • Ecological-systems

14. School-based consultation • Four consultation models are prevalent in school psychology training programs: • Behavioral • Mental health • Instructional • Organizational • Programs tend to use a combination of more than two models • Majority of instruction focused on theory and best practices in interventions (La-Hart, Rosenfield, 2005)

15. School-based consultation • However, most school-based consultation models focus on behaviors occurring within the school setting • Lack guidance for addressing behaviors across multiple settings, or consideration of factors outside of school that may influence in-school behaviors (Kratochwill, Elliott, & Callan-Stoiber, 2002)

16. Consultation: Conjoint Behavioral Consultation (CBC) • Key features: • Ecological approach that considers influences of multiple settings and persons upon a student’s behavior • Actively involves teachers, parents and other key people (e.g., extended family, friends, clergy) in a collaborative intervention planning process • Attempts to improve relations between home and school • Strives to enhance competencies of client (student) and consultee (teacher) (Sheridan, 1997)

17. Conjoint-Behavioral Consultation (CBC) • Problem Identification • Problem Analysis • Plan Implementation • Plan Evaluation Home School Support systems Sheridan, 1997

18. Wraparound

19. Wraparound history • Wraparound practice originated in the 1960’s and gained ground during the early 1980’s • Developed to meet the needs of families with children/youth presenting needs across multiple settings (school, home & community) who were at-risk of change in placement • Addressed obstacles to care posed by fragmented service delivery • Reduced need for psychiatric/residential placements for children/youth via coordination of community-based care • Empowered parents/caregivers by incorporating family-centered philosophy of practice

20. Wraparound defined Wraparound is a process for developing family-centered teams and plans that are strength and needs based

21. Wraparound: Core values • Child-centered, family-driven • Community-based • Culturally competent

22. Wraparound: Key characteristics • Individualized • Team-based • Collaborative • Unconditional support • Outcomes-based

23. Four Phases of Wraparound Implementation • Team Development - Get people ready to be a team - Complete strengths/needs chats • Initial Plan Development - Hold initial planning meetings - Develop a team “culture” • Plan Implementation & Refinement - Hold team meetings to review plans - Modify, adapt & adjust team plan • Plan Completion & Transition - Define good enough - “Unwrap”

24. Wraparound: Theoretical base • Social-ecological theory (Bronfenbrenner, 1979) • Social-learning theory (Bandura, 1977) • Systems theory (Munger, 1998)

25. Wraparound: Research • Case studies: • Kaleidoscope Program in Chicago (Cumblad, 1996) • Alaska Youth Initiative (Burchard, Burchard, Sewell, & VanDenBerg, 1993) • Pre-post test design: • Eber, Osuch, & Redditt, 1996 • Quasi-experimental designs: • Hyde, Burchard, & Woodworth, 1996 • Bruns, Rast, Peterson, Walker, & Bosworth, 2006 • Anderson, Wright, Kelley, & Kooreman, 2008 • Experimental designs: • Clark, Lee, Prange, & McDonald, 1996 • Evans, Armstrong, & Kuppinger, 1996 • Clark, Prange, Lee, Stewart, McDonald, & Boyd, 1998 • Carney & Buttell, 2003

26. Wraparound and Consultation • Wraparound and consultation share many similar characteristics: • Ecological theoretical base • Team-based • Structured process • Outcomes-based • Incorporates evidence-based interventions

27. Wraparound: Differentiated • Differs from consultation models and even other intensive interventions geared toward families of children with complex needs (e.g., case management, multisystemic therapy, treatment foster care) • Family versus “expert” focused • Long-term, unconditional support • Emphasis on natural supports

28. Wraparound practice IL-PBIS Tertiary Demonstration Project

29. Background • Kansas-Illinois (K-I) Center, a joint research partnership: • IL-PBIS Network • University of Kansas • Two primary goals • Illustrate what’s effective with kids and families with the highest need • Build system capacity

30. Background • K-I Center is part of a federally-funded demonstration project located in 4 states • Illinois • Kansas • Oregon • Washington

31. Background • Six school Illinois school districts participated as demonstration models • Three sites were incorporated as part of the federal grant, three were not • All sites implemented IL-PBIS tertiary model

32. Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems Assessment Intervention Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model Tier 2/Secondary Tier 3/ Tertiary Small Group Interventions(CICO, SAIG, etc) ODRs, Attendance, Tardies, Grades, DIBELS, etc. Group Interventions with Individualized Focus(CnC, etc) Daily Progress Report (DPR) (Behavior and Academic Goals) Simple Individual Interventions (Brief FBA/BIP, Schedule/ Curriculum Changes, etc) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Multiple-Domain FBA/BIP SIMEO Tools: HSC-T, SD-T, EI-T Wraparound Illinois PBIS Network, Revised Sept., 2008 Adapted from T. Scott, 2004

33. Tertiary Level PBIS 1. Systems • Team based problem solving (District, Building @ 3 tiers) • Data-based decision making system (SIMEO) • Sustainability focus (redefining roles, district data review, etc. ) 2. Data • Data used for engagement and action planning with team • Data tools are strengths/needs based • Multiple perspectives and settings captured in data • Show small increments of change at team meetings 3. Practices • Youth having access to all levels of SWPBS • FBA/BIP is essential skill set for implementers • Engagement and team development are critical elements • Team facilitation is essential skill set (for complex FBA/BIP & wrap) • Wraparound process/elements create ownership/context for effective interventions including FBA/BIP • Assess/monitor fidelity with families

34. FY 2009 SIMEO Study II: Time 1 and Time 2 Assessment • 125 students receiving Tertiary Wraparound Intervention within school setting • Average length of time receiving Tertiary Intervention= 9.1 months • Baseline assessed within 30 days of team engagement (Student Disposition Tool, Education Information Tool, Home School Community Tool) • Follow up assessment conducted at Time 2 (on average 3.94 months later)

35. FY 2009 Study IIStudent Characteristics N=125 Students Age: Range in age from 5-15 years; Mean Age-9.95 Years old IEP Identified at Baseline: 38% (47) Primary Disability: ED-16% (20); SLD-11 (9%) Ed Placement: 64% (78) in General Ed Placement 100% of day Risk of Placement Failure: 88% (110) at-risk of failing one or more placements

36. At Baseline: Fourteen students (11%) had DCFS Legal Involvement; Twenty-four (19%) had involvement with Probation Twelve (10%) had Community Mental Health Involvement Thirty-six (30%) of the student’s families were receiving Public Aid FY 2009-Study IIStudent Characteristics N=125 Students

37. FY 2009-Study II High Risk School Behaviors N=70 N=125

38. FY 2009-Study III High Risk School BehaviorsBaseline plus Time 2 and Time 3 Study Cohort N=70 N=70

39. FY 2009-Study III Students by Overall Risk of PlacementBaseline plus Time 2 and Time 3 High Risk Moderate Risk Minimal Risk No Risk N=70

40. FY 2009-Study III Need for Additional Assistance in ClassroomBaseline plus Time 2 and 3 Study Cohort Always Frequently Sometimes Never N=70

41. FY 2009 Study III: HSC Social FunctioningSub-Scale: School High Strength Somewhat Strength Somewhat Need High Need N=70

42. FY 2009 Study III: HSC Emotional Functioning Sub-Scale: Home High Strength Somewhat Strength Somewhat Need High Need N=70

43. Illinois tertiary demonstration project case study:”Latrice” • Background information • Placement in self-contained ED/BD classroom beginning of 2005-06 school year • History of multiple suspensions and expulsions • 19 major incidents • One 45-day alternative placement due to assault of staff • Demonstrated poor academic performance • Standardized test scores reflected “Academic Warning” status • Moderate-severe risk of change in placement

44. Check and connect Behavior intervention plan Mentorship with city alderwoman Reunification with estranged family members Juvenile diversion program LAN funding Summer programming Bike, helmet and lock Bus passes Illinois tertiary demonstration project case study:”Latrice” Secondary supports TertiarySupports

45. Illinois tertiary demonstration project case study:”Latrice” • During the course of the Tier 3/ wraparound process, the need for disciplinary actions as a consequence of problem behaviors dramatically decreased

46. Illinois tertiary demonstration project case study:”Latrice” • Over time, “Latrice” showed an increasing ability to interact appropriately with peers without adult supervision

47. Illinois tertiary demonstration project case study:”Latrice” • With behavioral supports in place, “Latrice” had greater access to the curriculum. As a result, her academic performance improved.

48. Illinois tertiary demonstration project case study:”Latrice” • Additional outcomes • Mainstreamed into the general education setting on the basis of her improved behavior and academic performance • Recognized by the city mayor at the annual Martin Luther King Jr. celebration • Communication between school and home improved

49. Resources • Anton-LaHart, J., & Rosenfield, S. (2004). A survey of preservice consultation training in school psychology programs. Journal of Educational and Psychological Consultation, 15(1), 41-62. • Burns, B.J., & Hoagwood, K. (Eds.). (2002). Community Treatment for Youth: Evidence-Based Interventions for Severe Emotional and Behavioral Disorders. New York: Oxford University Press. • Eber, L., Hyde, K., Rose, J., Breen, K., McDonald, D., Lewandoski, H., (2009). Completing the continuum of schoolwide positive behavior support: Wraparound as a tertiary-level intervention.In Sailor, W., Dunlop, G., Sugai, G., & Horner, R. (Eds.), Handbook of Positive Behavior Support (pp.671-703). New York: Springer. • Quinn, K.P., & Lee, V. (2007). The wraparound approach for students with emotional and behavioral disorders: Opportunities for school psychologists. Psychology in the Schools, 44(1), 101-111. • Sheridan, S.M., (1997). Conceptual and empirical bases of conjoint behavioral consultation. School Psychology Quarterly, 12(2), 119-133. • VanDenBerg, J.E., & Grealish, E.M. (1996). Individualized services and supports through the wraparound process: Philosophy and process. Journal of Child and Family Services, 5 (1), 7-21.