A PROJECT OF SERESC Developing a Screening Process for Determining Young Children in

Need of Targeted Supports2015 Alaska RTI Conference

January 25, 2015

Howard Muscott, Ed.D, DirectorNH Center for Effective Behavioral Interventions and Supports

Bedford, NH www.nhcebis.seresc.net; 603-206-6891; hmuscott@seresc.net

A PROJECT OF SERESC

Outcomes

1. Understand how Tier 2 supports fit into the 3-Tier PWPBIS as Response to Instruction Framework

2. Identify three pathways for determining risk;3. Develop a form for gathering information from

staff; 4. Develop behavioral indicators and cut scores; &5. Understand how to use a normed systematic

screening assessment.6. To learn about how screening was successfully

used to implement Tiered Interventions in Head Starts

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Agenda

1.Overview of PWPBIS2.Features of Tier 23.Pathways for Determining

Risk4.Teacher Nomination5.Behavioral Indicators6.Normed Screening Tools

and Procedures7.Post Screening Processes

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A Systemic Multi-tiered Approach

“PBIS has allowed me to address problems early before they escalated and became a crisis. The shift from reactive to proactive has been one of the best changes I’ve seen in all my years of consulting in Head Start programs.”

NH Head Start Mental Health Consultant

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Program-wide Positive Behavioral Interventions and Supports

Muscott, Mann & Pomerleau (2008)

PWPBIS is a systematic framework for improving valued social, emotional, behavioral and learning outcomes for young children in early childhood education programs.

PWPBIS uses a broad set of evidence-based systemic and individualized strategies to effectively prevent and respond to challenging problem behavior and collaborate with families.

PWPBIS is a strategic approach in which collaborative teams use effective group processes and data-based decision-making to achieve desired outcomes.

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SYSTEMS

PRACTICES

DATA

SupportingStaff Behavior

SupportingDecisionMaking

SupportingStudent Behavior and Families

Program-wide Positive Behavioral Interventions and Supports Systems

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Program-wide Positive Behavior Supports in Early Childhood Education Programs

Preventative Practices

Building Positive Relationships with Children and Families

Social and Emotional Teaching Strategies

Individualized Strategies

Primary Promotion: High Quality Early Education for All Children

Secondary Prevention: Explicit Instruction for Groups of Children at Risk

Tertiary Intervention: Function-Based Support for Children with Persistent Challenges

Muscott, Mann & Pomerleau (2008) Adapted from the Center on the Social and Educational Foundations for Early

Learning

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Tier 1: Primary Prevention in ECE

Tier 1, primary prevention, is designed to address the whole population in the ECE program

While applied to the entire preschool, the emphasis here is on reaching the approximately 80-90% of young children who do not have serious behavior problems or mental health needs

The purpose of universal strategies is to maximize learning, deter problem behavior, and increase positive peer and adult interactions

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Tier 1: Primary Prevention in ECE

All children should receive sufficient density of positive feedback from their caregivers.

All families should be positively engaged.

Building Positive Relationships with Children and Families

Sources: Shores, Gunter, & Jack, 1993; Brendekamp & Copple, 1997).

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Tier 1: Primary Prevention in ECE

1. Maintain a predictable schedule

2. Minimize and plan effective transitions

3. Provide visual reminders of rules

4. Teach appropriate behavior5. Use positive reinforcement

to promote appropriate behavior

6. Provide choices where appropriate, and

7. Maximize child engagement to minimize problem behaviors.

Preventative Practices

Sources: Laus, Danko, Lawry, Strain, & Smith, 1999; Strain & Hemmeter (1999)

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Tier 2: Secondary Prevention in Early Childhood Education

Tier 2, secondary prevention, is aimed at the roughly 5-10% of young children considered at risk for developing behavioral disorders or mental illness

These students enter school with significant risk factors and are usually unresponsive to universal prevention strategies alone.

The goal of secondary prevention is two-fold: To decrease opportunities in which high-risk

behaviors might be fostered To establish effective and efficient prosocial

repertoires that would increase their responsiveness to primary interventions

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Tier 2: Secondary Prevention in ECE

Explicit instruction in emotional literacy skills, controlling impulses and anger and friendship-making skills is provided to small groups of children.

Research indicates that systematic efforts to promote children’s social competence can have both preventive and remedial effects.

Sources: Fox, Dunlap, Hemmeter, Joseph & Strain, 2003; Webster-Stratton & Reid (2004)

Social & Emotional Teaching Strategies

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Tier 3: Tertiary Interventions

Level 3, tertiary interventions, targets the 1-5% of young children who display persistent challenging symptoms or behaviors

The goal of tertiary interventions is to reduce the frequency, intensity and complexity of a child's maladaptive behavior patterns and provide him/her with suitable, efficient and effective replacement behaviors that will compete with his/her more maladaptive ones.

Tertiary interventions are individualized, assessment-based and designed to meet individual needs.

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Tier 3: Tertiary Interventions Function-based interventions

are developed through the process of functional assessment (FA) and behavior support plans (BSP).

Functional assessment determines why the student exhibits challenging behavior.

BSPs are most effective when developed by a team with family involvement.

Individualized Strategies

Sources: Blair, Umbreit, & Eck, 2000; Dunlap & Fox, 1999; Galensky, Miltenberger, Stricker, & Garlinghouse, 2001; Moes & Frea, 2000; Reeve & Carr, 2000).

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Steps for Addressing Children in Need of Tier 2 Supports

Develop a process for screening/nomination of children who are not responding to Tier 1 behavior supports and may need additional supports

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What is Screening? Salvia & Ysseldyke (1988)

Screening is an initial stage of assessment in which those who may evidence a particular problem are sorted out from among the general population.

Individuals who perform poorly on screening measures as considered “at-risk.”

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Features of Good Universal Screening

Accurate Cost efficient Acceptable Useful

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Why Universal Screening?

To find children whose problems are not immediately obvious and identify problems with a high degree of accuracy

Early identification leads to early intervention

Preschools that implement Universal Screening select interventions based on results of the screening tools. This is effective and efficient.

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Universally Accepted Types of Screening in School

Readiness

Vision

Hearing

DentalBehavior

Why not?

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Why Screen for Behavior Disorders? It’s Costly Not To!

Indicators of problem behaviors are evident in preschoolers and elementary age students

Internalizers are missed with other approachesEarly intervention mattersSchools are the only place where we have

universal accessRecommended by the President’s New Freedom

Commission and Special Education Task Force, Surgeon General, Safe Schools/Healthy Students as an evidenced-based practice

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Minimizing ErrorsEffective Screening Programs

A screening-identification program to be considered effective, it must insure acceptable levels of accuracy, cost efficiency, and consumer acceptance.

Accuracy implies that the screening process provides reliable and valid information for the purposes of making decisions (Hartmann, Roper, & Bradford, 1979).

Cost efficiency means that, relative to the outcomes produced or achieved, the system's implementation does not consume too much professional time.

Acceptance implies that such a system would be adopted by professionals and used repeatedly over time.

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I’m Concerned About A Child What Should I Do?

Screening for Behavior

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Activity 1: Current Supports

Think: Identify your current process for getting help with a student for whom you have behavioral concerns (5 minutes)

Pair Up: Discuss with colleagues next to you (5 minutes)

Share Out: (5 minutes)

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Activation Pathways to Secondary Tier 2 Systems of Behavior Support

Muscott & Mann (2010)

Universal Screening

Using Normed

Systematic Screening

Assessments

Universal Screening Using Local Benchmarks

Behavioral Indicators (+ and -)Instances of Challenging Behavior,

Attendance, Tardiness, Nurse Visits, etc.

Teacher Nomination

Parent Nomination

Secondary Systems Activationthrough Team-based Decision Making Process

Students Are Not Responding to Core Curriculum & Tier 1 Systems

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Teacher Activation to Tier 2 Team

Begins with completion of an activation formForm should be efficient and easy to completeIt should include a reason for requesting

supportsIt should include a quick data summary

including behavioral and academic indicatorsIt could include what has been triedAmount of information should match what’s

necessary to make good decision about potential supports

Consider what forms and information were used with Tier 1 teams

Nomination Form

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Activity 2: Nomination Form

Think: Review the example nomination form. Make suggested edits that might improve the form for use in your early childhood program. (10 minutes)

Pair Up: Discuss with colleagues next to you (5 minutes)

Share Out: (5 minutes)

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Early Identification: Behavioral Indicators and Cut Scores

1. Behavioral indicators of students at risk should be identified

2. Indicators should be practical and related to behavioral risk

3. Data indicators should be easy to collect or already available

4. Cut scores should be determined for time periods that are practical based on program

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Isn’t Challenging Behavior Enough?

Students with

externalizing problems?

Students with

internalizing problems?

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Challenging Behaviors in Early Childhood

1. Physical Aggression2. Verbal Aggression 3. Self-injury4. Property Damage5. Disruption/Tantrum6. Non-compliance7. Social

Withdrawal/Isolation8. Inappropriate

Language9. Running Away10. Unsafe Behaviors

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Defining Challenging Behaviors

Physical Aggression – forceful physical actions directed towards adults/peers that may result in physical contact and injury (e.g., hitting, kicking, spitting, pinching, and throwing objects).

Verbal Aggression – the use of threatening, offensive or intimidating words directed towards an adult/peer (e.g., screaming, name-calling, swearing/ profanity, use of threats).

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Defining Challenging Behaviors

Disruption/Tantrum – an outburst or action that prevents learning or interferes with teaching and persists despite an adult’s request to stop or attempt to provide support.

Non-compliance – refusal to follow a reasonable request, direction or the established routine, which persists after multiple requests and a reasonable amount of time.

Running away – the act of leaving a designated area of supervision or boundary of play without permission and without responding to the requests of an adult to return.

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Tier 2 Behavioral Indicators, Cut Scores and Benchmarking

Periods for ECE ProgramsIndicator November 1 February 1 March 1

Instances of Challenging Behavior

3 or more 3 or more in this timeframe

3 or more this timeframe

Nurse TLC Visits (Non-medical)

4 or more 4 in this timeframe

4 in this timeframe

Absences 3 or more 3 in this timeframe

3 in this timeframe

High Stress Event (Death in immediate family, divorce, domestic violence, etc.)

1 or more 1 in this timeframe

1 in this timeframe

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Behavioral Indicators within Timeframe

Students: 20 Referrals: 25

Office Discipline Referrals (no minors)08/01/2009-10/06/2009

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Activity 3: Behavioral Indicators

Think: 1. Determine a practical time period that aligns with your school calendar. 2. Identify/name 2-3 potential Tier II indicators on the chart. 3. For one indicator, determine the cut score for the initial time period.(10 minutes)

Pair Up: Discuss with colleagues next to you. (5 minutes)

Share Out: (5 minutes)

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Tier 2 Behavioral Indicators, Cut Scores and Benchmarking

Periods for ECE ProgramsIndicator Date Date Date Date

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Features of an Evidence-based Screening Practice

Good psychometric properties Reliability Validity

Screening selects true positives and minimizes false negatives

Multi-source and multi-method assessment and intervention are the most accurate and effective.

Factors associated with long term outcomesEfficient to implementLow costIntervention and services are targeted for the

appropriate child

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Scientifically ValidatedEarly Childhood Assessments

ASQ:SE Screening – Determining the Need for Additional Supports

An easy-to-use, research-validated screening system that helps educators assess children’s social-emotional development

Self-regulation, compliance, communication, adaptive functioning, autonomy, affect, and interactions with people

With the results, professionals can quickly recognize young children at-risk for social or emotional difficulties, identify behaviors of concern to caregivers, and identify any need for further assessment or intervention.

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Devereux Early Childhood Assessment Clinical (DECA-C)

Ages 2-5The DECA-C

assesses both social-emotional strengths (protective factors) and behavioral concerns.

During the past 4 weeks…

62 Items15-20 minutesTeacher and

Parent Versions

Protective Factor Scales (Initiative, Self-control, and Attachment)

Behavioral Concerns Scales (Attention Problems, Aggression, Withdrawal/ Depression, Emotional Control Problems).

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Implementation Procedures

Systematic screenings are recommended twice a year in October and February/March

In preschools, classroom teachers screen students in their class they have known for at least 30 school days Group administration at a faculty

meeting or training is efficient – allow 1 ½ to 2 hours

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Activity 3: Scientifically Based Screening

Pair Up: Discuss feasibility of using a systematic screening process with colleagues next to you. (10 minutes)

Share Out: (5 minutes)

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Ready for School Success - NH

New Hampshire Center for Effective Behavioral Interventions and Supports – Program-Wide Positive Behavioral Interventions and Supports (PW-PBIS)

NH Head Start Programs: Southern NH Services, Inc. (Manchester & Nashua ) & Belknap-Merrimack (Laconia) Head Start Programs

Support for RSS-NH is provided by the U. S. Department of Education Office of Safe and Drug-Free Schools, under the Foundations for Learning Grants Program

READY FOR SCHOOL SUCCESS

NNEE WW HH AAMMPP SS HH II RR EE

A Partnership Between:

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Ready for School Success – NHTHE CHALLENGE

Early childhood educators frequently encounter students who are at risk for school failure because they exhibit challenging behavior or lack the required social-emotional skills for school success.

If not provided with high-quality, effective interventions, many of these students, particularly those with externalizing behaviors, continue onward to experience a negative developmental trajectory through their childhood, adolescent, and adult years.

Despite the overall success of Head Start programs in providing early intervention services to students from low-income households, providing students who are dually at risk with behavior challenges or social-emotional deficits and one or more additional risk associated with Head Start participation factors (e.g., family poverty, developmental delays) with adequate access to evidence-based interventions and supports has remained a major barrier for many young students and their families.

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Ready for School Success – NHOUTCOMES

Improve school readiness of dually at-risk preschoolers attending the Southern New Hampshire Services, Inc. (SNHHS) and Community Action Program Belknap-Merrimack Counties, Inc. Head Start (BMHS) programs

Enhancing child and family access to a linguistically appropriate, culturally competent and sustainable multi-tier continuum of program and community-based social, emotional and behavioral supports (PWPBIS)

Results in measurable gains in student’s emotional, behavioral, and social development and increases in targeted and individualized supports.

A PROJECT OF SERESC

Ready for School Success – NHSCREENING

Ages and Stages Questionnaire: Social Emotional Development (ASQ-SE)

Each fall, the students were screened for risk by both teachers and parents using the ASQ-SE

Fall 2011 indicated 26% (66 of 257) of students at SNHS and 41% (23 of 56) of students at BMHS were screened at risk by either their teachers or parents. Parents generally rated their children as more at risk. For example at BMHS, three times as many children were rated at risk by their parents than their teachers.

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Ready for School Success – NHSUPPORTING Dually-At-RISK

STUDENTS

Dually at risk if (a) qualified for Head Start participation, as indicated by enrollment in one of the participating Head Start locations, and (b) fell within the at-risk range on the ASQ-SE.

The project was very successful in providing additional services to students who were identified as at-risk 88% having received Tier II and/or Tier III

interventions depending on need and response to interventions (Some parents refused services or supports).

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ASQ:SE Results Fall 2010BM-HS DATA

NOW

WHAT?

Total # Children Screened: 56

Total Typical Risk: 35 (62.5%)

Total Elevated: 21 (37.5%)

Elevated Teacher Scores: 6 (11%)

Elevated Parent Scores: 15 (27%)

Elevated in Both: 4 (7%)

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PW-PBIS Big Idea

Data-based decision making requires commitment to a consistent and effective data collection and decision making process to attain positive child and program outcomes

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“Insanity is engaging in the same process over and over, and expecting different outcomes.”

Albert Einstein

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Who should participate in Tier 2 Interventions?

Universal Teaching strategies are geared toward the entire program, and apply to all classrooms

Targeted Group Interventions are for children who are NOT responding to the universal system and require more support to be successful

Includes children either from a classroom or across multiple classrooms that need additional social-emotional support

Tier 2: Secondary Prevention in ECE

Explicit instruction in emotional literacy skills, controlling impulses and anger and friendship-making skills is provided to small groups of children.

Research indicates that systematic efforts to promote children’s social competence can have both preventive and remedial effects.

Sources: Fox, Dunlap, Hemmeter, Joseph & Strain, 2003; Webster-Stratton & Reid (2004)

Social & Emotional Teaching Strategies

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Create Process for Implementing Targeted

Group Interventions

Identify which children need TGI

Identify the primary skill deficitsAssign child to appropriate

intervention based on his/her needs

Identify who will implement the targeted group support

Identify what to teach, where, when, & how

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Dually At Risk Children Reassessed After Social Skills InstructionAges & Stages Questionnaire: Social-Emotional (ASQE –SE) – Teacher Rating Only

Improved; Did Not ImproveTeacher Rating of Skill Improvement

Significantly Improved; Partially Improved; Did Not ImproveCreative Curriculum

Significantly Improved; Did Not Improve

Core Head Start Program &

Monitor ProgressN=20

Children with Elevated Teacher Rating Only (n=4 = 7%)

All 39 Children Nominated for Social Skills Instruction (12 lessons) Receive Social Skills Instruction

Complete Social Skills InstructionDECA Completed

Incident Data Collected

All Head Start Funded Children Screened within 45 Days by Teachers & Parents

Ages & Stages Questionnaire: Social-Emotional (ASQE –SE)(n=59)

READY FOR SCHOOL SUCCESS-NEW HAMPSHIRE 2011-12 BEHAVIOR SUPPORT CONTINUUM FOR DUALLY AT-RISK CHILDREN ATTENDING BELKNAP-MERRIMACK HEAD START AT LACONIA

Children Screened as Dually At Risk (29 of 59 = 49%)Children Without Elevated Teacher or Parent Ratings (30 of 59 =

51%)Ages & Stages Questionnaire: Social-Emotional (ASQE –SE)

Children with Elevated Parent Rating Only (n=15 = 25%)

Children with Elevated Teacher and Parent Ratings (n=10= 17%)

Parents of Dually At Risk Children Nominated for Parent Skills Group(once per week for six weeks)

attend and complete Parent Skills Group

Parents of Dually At Risk Children for Who Complete Parent Skills GroupAssess Skills/Dispositions with Pre-Post Self-Assessment

Parent Stress InventoryParents Rate Their Child Ages & Stages Questionnaire: Social-Emotional

(ASQE –SE)

Dually At Risk Children Who Did Not Respond Nominated for Big Bs Card__ Begin Big B Program Daily in May

Monitor Progress

Teacher Nominations without Elevated Ratings on Either (n=10 =

17%)

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RSS-NH Tiered Interventions

Tier 1 Core Instruction at Head Starts

Tier 2 Continuum Social Skills Group

Instruction Teacher Check Connect

and Expect Parent Education Classes

Tier 3 Individualized Behavior Plans

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RSS-NH: Social Skills InstructionAdapted from Center on Social

Emotional Foundations for Early Learning

One time per week group 30 minutes4-6 children12 lessons in 2011-12 Samples

1 )I was so mad!Goal: To increase emotional literacy; learn to express feelings in healthy ways, to increase problem solving2) How am I feeling?Goal: To increase emotional literacy and to help children begin to understand the mind body connection, increase empathy3) What could you do to help?Goal: To increase problem solving skills, develop theory of mind and sense of altruism, and increase personal responsibility4) What might happen?

Goal: To increase understanding of cause and effect; and problem solving5) Stop light/ solutions kit.

Goal: To teach and practice problems solving steps.

?

1. What is my problem?

3. What would happen if…?Would it be safe? Would it be fair?

How would everyone feel?4. Give it a try!

2. Think, think, think of some solutions

Problem Solving Steps

Frustrated

Embarrassed

Frustrated Sad

Mad

Learning Self Control

Recognizing that anger can interfere with problem solving

Learning how to recognize anger in oneself and others

Learning how to calm downUnderstanding appropriate ways to

express anger

Turtle Technique

Recognize

that you

feel angry.

“Think”

Stop.

Go into shell. Take 3 deep breathes. And think calm, coping thoughts.

Come out of shell when calm and think of a solution.

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Teacher Check, Connect and Expect

Mann and Muscott (2007); Adapted from Cheney (2006)

Teacher Check, Connect and Expect is an efficient, early, & systematic response for students not responding to primary prevention systems of behavior support.

Occurs prior to implementing more sophisticated & less efficient secondary supports.

TCCE is a procedure in which classroom teachers provide higher rates of feedback & attention to ‘at-risk’ students for exhibiting expected classroom behaviors linked to school-wide expectations

TCCE allows for a systematic monitoring of student behavior using data-based decision-making.

Offers an immediate and low effort approach whereby teachers: greet child at the beginning of the day review their behavior on a daily chart based

on classroom schedule & established expectations

provide feedback and encouragement at each checkpoint & the end of the day

Teacher Check, Connect & ExpectMann and Muscott (2007)

The Potential Benefits of Involvement in TCCE

1. Provides increased positive teacher-child contacts before relationship is damaged by repetitious conflict (builds relationship)

2. Provides increased reinforcement to the child for following expectations (builds self-esteem, self-worth)

3. Provides increased home-school communication and partnership (daily feedback to family)

4. Provides an early, effective and efficient response to emerging problem behavior before it becomes chronic and engrained

Potential Benefits of Involvement in Teacher Check Connect Expect

5. Connects logically and easily to program-wide system of behavior support

6. Provides an efficient and measurable assessment of progress that helps determine if interventions are working

7. Provides information that may be useful for identification of predictors of behavior should more supports be needed.

8. Data can be entered in BIRCHIS™

Teacher:_______________ ___

Classroom:______________ ___

Name:_________________ ____

Date:______________ ________

I earned _______ Green Lights

(Optional _______ of 28)

Be Safe Be Kind

Be Careful with Our Things Make it Better

Arrival

Breakfast

Circle

Free Choice/Play

Small Group Activities

Outdoor Play

Lunch

Tomorrow is a new day. I will try again tomorrow.

Updated 10-20-11

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Name:_______________ Today is:_____________

I earned ____ Green Lights

(Optional ____ of 7)

Be Safe

Wait Safely with Adult

Sit Down & Buckle Up

Stay in Seat

Hands and Feet to Self

Quiet Voice

Wait for Bus to Stop

Un- buckle

Tomorrow is a new day. I will try again tomorrow.

Updated 10-20-11

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Ready for School Success – NHPARENT EDUCATION

38 participating parents attended 6-8 week parenting classes (70% or more of classes)

Used the Center on the Social Emotional Foundations for Early Learning curriculum, an empirically validated, widely recognized program

Focused on strengthening parenting competencies and fostering parents’ involvement in children’s school experiences in order to promote children’s academic, social, and emotional competencies and reduce conduct problems

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Ready for School Success – NHPARENT EDUCATION

Care was taken to avoid time-related conflicts that might preclude attendance, such as scheduling the parent training during non-traditional hours to better accommodate working families’ schedules.

Reimbursement was offered for transportation costs (e.g., taxi/bus fare or fuel consumption) to and from the group location.

Language translation services during the skills group were offered to parents whose primary language was not English.

Child-care services or reimbursement were offered to participating parents to cover the parenting skills group scheduled meeting time.

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Ready for School Success – NHChild GAINS

91.4% of the 47 students who were identified as at-risk by teacher ratings exhibited an improvement of 15% or greater on the ASQ-SE.

Additionally, students who exhibited improvement typically exceeded the cut-off point of 15% by a wide margin, with an average improvement of 45.6% in 2010-11, and 57.1% in 2011-12.

By the project’s end, 44.6% of students whose teacher ratings had indicated elevated risk now fell in the typical risk category

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Ready for School Success – NH CHILD GAINS

Incident data on challenging behaviors was collected on 32 at-risk students from the two Head Starts during the winter and spring of school year 2011-12.

Twelve students had no documentable behavioral incidents during the data collection period and as a result were considered successful.

In addition 14 students reduced the number of behavioral incidents by at least 25%. All told, 26 of 32 students were successful in meeting the performance measure.

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Ready for School Success – NHPARENT GAINS

Parent survey responses to the parenting class indicated high levels of satisfaction, with parents reporting increased confidence in their ability to build a positive relationship with their child, to figure out reasons their child acts as he or she does, and to have clear expectations and house rules.

Parents also indicated that they were more likely to actively engage in teaching social skills and to use different strategies to promote positive behavior, and that they would be likely to recommend the training to other parents.

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Ready for School Success – NHPARENTAL STRESS

Parenting Stress Index – Short Form (PSI-SF)

Average decline in total parental stress in parents who participated in the training at Belknap-Merrimack Head Start Pre-test percentile ranking of

75.7% (average raw score, 90.5) Post-test percentile ranking of

53.1% (average raw score, 75.5).

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Ready for School Success – NH

PARENT EDUCATIONParticipation in parent education

programs was associated with improvements in student behavior and development.

8 children at SNHHS identified as at-risk on the ASQ-SE teacher rating scale and whose parents participated in the education programs

Showed an average improvement of 26% in teacher ratings of social emotional development by the conclusion of the education program