Linking wraparound and consultation: Theory and

techniques

Annual Convention

National Association of School Psychologists

March 4, 2010

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

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

Background

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)

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)

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)

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

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)

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)

School-based Consultation

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

School-based consultation• Key features of consultation:

– Problem-solving approach• Problem Identification• Problem Analysis• Plan Implementation• Plan Evaluation

– In-direct service delivery– Collaborative– Triadic relationship

• consultant-consultee-student

• Theoretical orientation:– Behavioral– Ecological-systems

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)

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)

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)

Conjoint-Behavioral Consultation (CBC)

Home School

Supportsystems

•Problem Identification•Problem Analysis•Plan Implementation•Plan Evaluation

Sheridan, 1997

Wraparound

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

Wraparound defined

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

Wraparound: Core values

• Child-centered, family-driven

• Community-based• Culturally

competent

Wraparound: Key characteristics

• Individualized• Team-based• Collaborative• Unconditional

support• Outcomes-based

Four Phases of Wraparound Implementation

I. Team Development- Get people ready to be a team- Complete strengths/needs chats

II. Initial Plan Development- Hold initial planning meetings - Develop a team “culture”

III. Plan Implementation & Refinement- Hold team meetings to review plans - Modify, adapt & adjust team plan

IV. Plan Completion & Transition- Define good enough - “Unwrap”

Wraparound: Theoretical base

• Social-ecological theory (Bronfenbrenner, 1979)

• Social-learning theory (Bandura, 1977)• Systems theory (Munger, 1998)

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

Wraparound and Consultation

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

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

Wraparound practice

IL-PBIS Tertiary Demonstration Project

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

Background

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

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

Positive Behavior Interventions & Supports:

A Response to Intervention (RtI) Model

Tier 1/Universal School-Wide Assessment

School-Wide Prevention Systems

Tier 2/Secondary

Tier 3/Tertiary

SIMEO Tools: HSC-T, SD-T, EI-T

Small Group Interventions (CICO, SAIG, etc)

In

terv

entio

nAssessm

en

tIllinois PBIS Network, Revised Sept., 2008Adapted from T. Scott, 2004

Group Interventions withIndividualized Focus (CnC, etc)

Simple Individual Interventions(Brief FBA/BIP, Schedule/ Curriculum Changes, etc)

Multiple-Domain FBA/BIP

Wraparound

ODRs, Attendance, Tardies, Grades,

DIBELS, etc.

Daily Progress Report (DPR) (Behavior and Academic Goals)

Competing Behavior Pathway, Functional Assessment Interview,

Scatter Plots, etc.

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

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)

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

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

N=70

90

546

107 87

319

650

100

200

300

400

500

600

Office DisciplineReferrals

In-School Suspensions Out of SchoolSuspensions

Number of Episodes

Baseline Time 2 N=125

FY 2009-Study II High Risk School Behaviors

N=70

52

281

56 46

185

3524 41

157

0

50

100

150

200

250

300

Office DisciplineReferrals

In-School Suspensions Out of SchoolSuspensions

Number of Episodes

Baseline Time 2 Time 3 N=70

FY 2009-Study III High Risk School Behaviors

Baseline plus Time 2 and Time 3 Study Cohort

1.921.76

2.64

2.442.19

1.94

2.14

1.83

1

1.5

2

2.5

3

3.5

4

Baseline Time 2 Time 3

Home School Community N=70

High Risk

No Risk

Minimal Risk

Moderate Risk

FY 2009-Study III Students by Overall Risk of Placement

Baseline plus Time 2 and Time 3

2.85

2.672.62 2.68

2.872.94

1

1.5

2

2.5

3

3.5

4

Baseline Time 2 Time 3

Need for Additional Academic Assistance* Need for Additional Behavioral Assistance**

N=70

Always

Never

Sometimes

Frequently

FY 2009-Study III Need for Additional Assistance in Classroom

Baseline plus Time 2 and 3 Study Cohort

2.512.19

2.69

1

2

3

4

Baseline Time 2 Time 3

School Environment N=70

High Strength

High Need

Somewhat Need

Somewhat Strength

FY 2009 Study III: HSC Social Functioning Sub-Scale: Sub-Scale: SchoolSchool

2.36

2.11

1

2

3

4

Baseline Time 2 Time 3

Home

1.94

N=70

High Strength

High Need

Somewhat Need

Somewhat Strength

FY 2009 Study III: HSC Emotional Functioning Sub-Scale: Home

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

Illinois tertiary demonstration project case study:”Latrice”

• 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

Secondary supports Tertiary Supports

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

Trends in Latrice's discipline data

20

2

2

25

30

4

0 10 20 30 40

2006-07

2007-08

2008-09

Referrals Suspensions

Illinois tertiary demonstration project case study:”Latrice”

• Over time, “Latrice” showed an increasing ability to interact appropriately with peers without adult supervision

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.

3.6

4.4

6.2

3.7

5.4

6.4

0 5 10

2006-07

2007-08

2008-09

Math grade level

Reading grade level

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

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.