Implementing PBIS Practices in Alternative Education and Mental Health Settings

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Implementing PBIS Practices in Alternative
Education and Mental Health Settings

• Jeffrey Sprague, Ph.D.
• University of Oregon
• jeffs_at_uoregon.edu

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PBIS and high risk youth

• Outline the challenge of delinquency and mental
  health concerns for high risk youth
• Link PBIS practices to improved delinquency and
  mental health outcomes
• Overview of PBIS in Alt Ed and Mental Health
  settings
• Describe how PBIS practices can be applied in
  these settings
• Describe evidence-based practices
• Describe research on the approach
• Discuss treatment fidelity assessments

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Big Ideas

• SWPBIS is implemented in over 20,000 general
  education schools
• Academic and behavioral benefits
• Implementation is much lower for programs called
  alternative education
• Less is known about what works in alternative
  education
• It is likely that the same structures for
  adopting, implementing and maintaining PBIS
  practices in general education schools are
  effective in alternative education programs if
  the unique features of these environments are
  addressed

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Multi-problem youth

• Exist in every school and community (and always
  will.)
• The challenge varies in intensity and frequency
• Is associated w/ a variety of risk factors (no
  single pathway)
• Presents our greatest public health problem!

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Sobering Statistics

• Students with EBD
• 1-5 account for over 50 of office discipline
  referrals in a given school
• Have an avg. GPA of 1.4
• Absent an avg. of 18 days of school per year
• 50 arrested within 1 year of school ending
• 58 dropout of school
• Of those that dropout, 73 are arrested within 2
  years
• 68 are unemployed up to 5 years after school
• ED girls 8 times more likely to get pregnant
  during teenage years than typically developing
  girls

Special Education Elementary Longitudinal Study
(SEELS, 2003) and National Longitudinal
Transition Study of Special Education Students
(NLTS, 1995 2005)
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Current Landscape of School-Related Behavior
Disorders (2)

• National Trends in the Identification of Students
  with Behavioral Challenges
• (SED sample)
• (Autism sample)
• Approximately 1 of public school population
  served as EBD under auspices of IDEA.
• Special Education can never solve problem
• (a) costs
• (b) legal and bureaucratic barriers

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Universal Screening Methods Using Multiple Gates

• First used by Cronbach in 1940s
• Patterson, Loeber, Dishion (1984) developed a
  three-stage, multiple-gating model to identify
  delinquency-prone youth
• Walker, Severson, Feil (1990, 1995) have
  developed the SSBD and ESP multiple-gating models
  for use in screening BD students in preschool
  through elementary
• (example)

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We Know a Lot About Human Development

• Its never too early, nor too late to nurture and
  support children and youth
• Prevention is the outcome for everyone
• Intervention is how we achieve prevention
• Simple things form the basis for all
  interventions
• Positive, caring interactions
• Monitoring and supervision
• Physical activity
• Multiple points of influence
• What other things do you know of that work?

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How do some children grow up to be challenging?

• Risk factor exposure
• Poverty/low income
• Family Stress
• Abuse or neglect
• Harsh and inconsistent parenting practices
• Community Disorganization
• Deviant peer affiliation
• Academic Failure
• Disability

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Risk Persists

• Exposure to multiple adverse childhood
  experiences predicts increased risk for serious
  life adjustment problems
• Academic failure
• Peer and Teacher Rejection
• Depression
• Emotional and Behavioral Disorders
• Is linked to health and life outcome status
  decades later
• Predicts increased risk of dying from any one of
  the seven leading causes of death in adults
  (Felitti et al 1998)

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Categories of Adverse Childhood Experiences

• recurrent and severe physical abuse (11)
• recurrent and severe emotional abuse (11)
• contact sexual abuse (22)
• growing up in a household with
• an alcoholic or drug-user (25)
• a member being imprisoned (3)
• a mentally ill, chronically depressed, or
  institutionalized member (19)
• the mother being treated violently (12)
• both biological parents not being present (22)
• Source Fellitti et al (http//www.healthpresentati
  ons.org/)

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Death
Where is school on the path to destruction?
Conception
The Impact of Adverse Childhood Experiences
Throughout The Lifespan
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Alternative School ODR Pyramid - Implementation
2005-2006 2006-2007
Jan-May Aug-Mar
21 (6) 8 (6) 25 (2-5) 15 (2-5)
54 (0-1) 76 (0-1)
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Illinois PBIS Juvenile Facility
7.7
10.6
81.7
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• If you always do what you always did, youll
  always get what you always got
• Moms Mably

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Reasons to use Sanctions

• Punish
• Cool off
• Remove unsafe youth
• ????

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• Sanctions may appear to work in the short term
• Removes the youth
• Provides relief to corrections and treatment
  staff members, teachers, peers, administrator(s)
• Some attribute sole responsibility for change to
  the youth /or others (family)

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Do Sanctions Work Without A Balance of Positive
Acknowledgement?

• Detrimental effects on adult-youth relations
• Modeling undesirable problem solving
• Reduced motivation to maintain self-control
• Generates Youth anger
• May result in more problems (Mayer, 1991)
• Truancy, dropout, vandalism, aggression
• Does not teach Weakens academic achievement
• Limited long term effect on behavior or other
  forms of adjustment

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Questions to ask

• How can we make our behavior support process
• Help Youths accept responsibility?
• Place high value on academic engagement and
  achievement?
• Teach alternative ways to behave?
• Focus on restoring the environment and damaged
  social relationships?

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Where to Start

• Conduct Needs Assessment
• Analysis of risk and protective factors of the
  youth
• Analysis of intervention fidelity and treatment
  adherence
• Performance Based Standards
• CPAI
• Fidelity Assessment -- TBA
• Select objective performance measures
• (goals and objectives)
• Select and Implement Evidence-based Practices
• Rigorously and periodically evaluate the programs

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Conduct Needs Assessment

• Incident tracking (Pentamation, excel, JJIS)
• Youth Risk and Protective Factors
• Juvenile records
• Risk/Protect needs assessment
• Behavioral and Emotional Rating Scale (Epstein
  Sharma)
• Program quality and features
• At-risk student services assessment
• Team Implementation Checklist
• ?????
• Youth perception of unit safety and climate
• ?????

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• Intensive academic support
• Intensive social skills teaching
• Individual behavior management plans
• Wrap-around) services
• Community and service learning
• Alternatives to out of school suspension

Targeted/ Intensive (High-risk
Youth) Individual Interventions (3-5)

• Increased academic support and practice
• Increased social skills teaching
• Self-management training and support
• Alternatives to out of school suspension
• Community and service learning

Selected (At-risk Youth) Classroom Small
Group Strategies (10-20 of Youths)
Universal (All Youth) Program-wide,
Culturally Responsive Systems of Support
(75-85 of Youths)

• Effective Academic Supports
• Program wide social skills teaching
• Teaching Program behavior expectations
• Effective unit and classroom management
• Active supervision and monitoring in common areas
• Positive reinforcement systems
• Firm, fair, and corrective response to problem
  behavior
• Community and service learning

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Adaptation of the three-tier PBIS Logic for
Alternative Education Programs
FBA-based behavior support plan with social
skills training to teach appropriate replacement
behaviors.
Default classroom-based interventions and
proactive, classroom interventions.
Alternative Education Programs
Services for students identified as ED and more
intensive services for students identified as CD.
Universal classroom- or school-wide positive
behavior supports.
Source Jolivette, K., McDaniel, S. C., Sprague,
J. R., Swain-Bradway, J. (in press).
General Education Schools
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Intervention Menu Sample
Intervention Intensity Intervention How are Youth Selected to Receive This Intervention?
Targeted/ Intensive (Few) Pathways (Drug and Alcohol), Behavior Risk Plans, Functional Behavioral Assessment, Suicide Precaution Level ?????
Selected (Some) Seeking Safety (Drug and Alcohol), Sex offender treatment, Changing Offender Behavior (Cognitive Restructuring), Aggression Replacement Training, Voices and Talking Circle, Individual Therapy, Minority Services, In Facility Jobs ?????
Universal (All) Intake Assessment Protocol (Risk, Medical, Psychological), Facility Rules, DBT, Fun Friday, Skillstreaming the Adolescent, Point System (Token economy), Recreation, On the spot coaching, Program refusal system, Routines, Invitations to families, Safe Room Protocol, Religious Services, Education, Drug and Alcohol Services, MDT Provided to all youth in the facility/school
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Working smarter matrix
Initiative, Project, Committee Purpose Outcome Target Group Staff Members Involved Facility Imp. Plan?
Treatment Committee
Character Education
Security Committee
Program Spirit Committee
PBIS Facility Team
DBT
Point System
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Initiative, Project, Committee Purpose Outcome Target Group Staff Members Involved Facility Imp. Plan?







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Programs That Reduce Disruption and Delinquency

• Shared values regarding program mission and
  purpose (admin, staff, families, youth)
• Clear expectations for learning and behavior
• Multiple activities designed to promote
  pro-social behavior and connection to local
  Program and community values
• A caring social climate involving collegial
  relationships among adults and Youths
• Youths have valued roles and responsibilities in
  the program

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Our Challenge

• We must enhance our capacity to create sustain
  positive effective discipline practices!
• We know what works, but we often dont do it
  consistently
• Start by creating a positive, inclusive program
  culture Positive Behavior Interventions and
  Supports!

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Positive Behavior Interventions and Supports are.

• What parents, teachers, peers and others do to
  increase student success---the whole village!

Positive Interactions
Negative Interactions
4 1
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PBIS History

• 1960s Application of behavioral methods in
  education and human services (aka behavior
  modification)
• 1980s
• nonaversives backlash against punishments such
  as electric shock, isolation, aversive tastes
• Functional behavioral assessment behavior has a
  purpose (e.g., avoid or approach)
• 1990s Positive Behavior Supports included in
  U.S. federal special education law
• 2000s Extension of PBIS to Juvenile Justice,
  Alternative Education and Residential Mental
  Heath Treatment Facilities

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The core features of PBIS in alternative settings

• Emphasis on prevention (its about the future!)
• Problem behaviors in the facility
• Problem behaviors in the community
• Recidivism
• Adoption of evidence-based practices (especially
  function-based behavior support)
• Development of the systems needed to support and
  sustain effective practices
• Team based planning and implementation
• Coaching!
• Data-based decision making
• Progress monitoring
• Adaptation of the procedures to fit each local
  context

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How are these features different in alternative
settings?

• Staff persons come from very different
  backgrounds with very different assumptions about
  problem behavior
• Security and safety are much more important
• Very high risk population challenging to staff
  members

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Implications

• Make the environment (a) predictable (b)
  consistent, (c) safe, and (d) positive
• Greater need to define and teach behavioral
  expectations
• High need for active instruction on appropriate
  behaviors.
• Because kids already have learned wrong-wayyou
  need multiple trials, and training to fluency
• High potential for peer-based deviancy training
• Focus on contingencies in which all benefit when
  each does well
• Data
• Need additional outcome measures (e.g. incident
  reportsphysical restraint incidents..)
• Extra need for teamwork
• Because environment is high-riskstaff members
  need to work well with each other.
• Staff members need to be able to predict and
  depend on each other

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Goals

• Improved behavior
• Improving educational outcomes
• Creating a safe culture and environment
• Better transition/aftercare supports
• Reducing recidivism/further failure

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(RE)-AIM for PBIS Success

• Reach
• Efficacy
• Adopt
• Implement
• Maintain

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PBIS Adoption Conditions

• Program improvement priority
• Administrator(s) are active leaders and involved!
• Each program has champions
• Training and coaching for the adults
• Use of standardized curriculum and procedures
  (for youth and adults)
• Most adults help implement the program (go with
  the goers)
• All Youths affected and involved (even the tough
  ones)
• System for performance-based feedback (are we
  meeting our outcomes?)

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Implementation Practices

• Train and support a representative team
• Administrator actively leads and facilitates
• Train and support all staff members in the
  facility
• Set time to plan and continuously improve
• Set program wide expectations
• Set a plan to teach expected behavior
• Set a plan to recognize expected behavior and
  actively supervise
• Provide firm but fair behavioral corrections
• Use data (Youth and staff behavior) to make
  decisions and give/seek feedback to/from staff

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Program-Level PBIS Teams

• Team meets monthly
• Continuous assessment of facility progress and
  problems
• Implement discipline systems
• Team provides staff training/coaching across the
  year and is continuously available
• Team gives status report monthly to all staff
• Office Referral patterns and updates
• Successes and Concerns

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Directly teach and review expected behavior
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Recognize and reward expected behavior
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Reward System

• Token Economy
• Continuously assess fidelity
• Look for abuse and coercion (negative side
  effects)
• Share data on effects with staff regularly and
  frequently
• One size fits all or individualized?
• Research suggests that function-based or
  individualized systems are more effective

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When dealing with non-compliance

• Stop and think
• Restate the request (wont do it or cant do it)
• Deliver the penalty or loss of privilege without
  emotion if that is your plan.
• Avoid
• Arguing with the Youth
• Holding a grudge
• Trying to make the Youth feel bad or guilty for
  previous poor choices

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Performance-based feedback

• How often do I get feedback about discipline
  patterns in my program?
• What kind of feedback do I get?
• Incidents/day/week
• Incident by type of behavior
• Incidents Per Youth/week
• Location of incident
• Unit
• Program
• Treatment Groups
• Time of Day/Shift
• Youth
• BL Unit Behavior Ratings
• Of tickets/week
• Grades
• Attendance

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Questions to Drive Data-Based Planning

• How many ODRs occur
• Per day?
• Per week?
• Per month?
• Where do behavior problems occur?
• Location
• Time of day
• Activity
• How are incidents distributed among youth?
• What is the frequency per day of
  administrative/disciplinary segregation?
• How are patterns of disciplinary action
  distributed among youth?

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Referrals per Student
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Pre PBIS
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Alternative Education Program characteristics

• Small class size and small student body
• A personalized school environment
• High expectations for success
• Students feel included in the decision making
  process
• Special teacher training
• Flexible teaching arrangements
• Parent involvement and collaboration
• Effective classroom management
• Transition support.

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Diagram of the Skills for Success Program for
At-risk Students
Universal Supports for All Students

• School Wide Positive Behavior Interventions and
  Supports (PBIS)
• Additional social skills curriculum (e.g., Second
  Step or Steps to Respect Aggressors, Bystanders
  Victims)

Universal Screening Procedures Multi-gated System
Early Identification Systematic School Resource
Planning School-Based Services Adult
Mentoring Academic Tutoring Alternative
Discipline Self-Management Check in/Check
Out Inclusion Support Increased Monitoring in
School Service Learning or Community Service
Family Support Parent Collaboration Resource
Linkage Family Advocacy Solution-focused
Planning
Selective and Tertiary Supports for at-risk
students
Service Coordination Multi-agency
monitoring Individual Service Plan Agency
Linkage Case management
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SFS Results

• Seven Schools
• Three years
• Implementation fidelity
• Student outcomes

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.
97 Implementation Fidelity 99 Combined
Implementation Fidelity by year 3
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Results

• Math LA teachers for 80 students who were
  participating in either the Skills for Success
  Classroom or receiving Mental Health services
  were surveyed. The teachers reported that during
  the last semester
• 62 of the students were more attentive in class
• 68 of the students were behaving better in
  class.
• 75 of the students were getting along better
  with other students.
• The average improvement in these three indicators
  was 68

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Results Skills for Success

• Prior to SFS Math LA grades averaged 0.50
  (D-).
• Both Math LA grades increased 1 full grade
  from D- to C-

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Results Skills for Success

• Absences dropped from an average of almost 7
  per term to below 5 and
• Referrals dropped from an average of almost
  2.5 per term to below 1.

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Skills for Success Study

• 3 year, Treatment-control design
• Treatment
• School Wide PBIS
• Second Step Violence Prevention Curriculum
• Skills for Success
• Control
• School Wide PBIS
• typical treatment for at-risk youth

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Office Referral Juvenile Arrest Data

• Treatment Group
• (n26)
• 81 boys, 19 girls
• 92 white, 18 non-white
• 13 in special education
• 27 previously arrested
• 1 students committed 53 of crimes

• Comparison Group
• (n25)
• 80 boys, 20 girls
• 88 white, 12 non-white
• 40 in special education
• 12 previously arrested
• 1 students committed 50 of crimes

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Juvenile Arrests

• Students in Skills for Success Group
• 10 increase in number of crimes
• -7 decrease in severity of crimes
• Students in Comparison Group
• 264 increase in number of crimes
• 131 increase in severity of crimes

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Juvenile Arrest Rates
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Three case summaries

• Jose school stabilization and support
• Adam school stabilization, support, and family
  collaboration
• Johnny school stabilization, support, family
  collaboration, and multi-agency service
  coordination

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Case Study José

• José is a seventh grade student. Spanish is
  the primary language spoken in his home English
  is considered his second language. José has
  difficulty sitting still and often engages in
  horseplay with other students by pretending to
  choke, hit, or kick them. This sometimes leads to
  fights and is viewed as disruptive by his
  teachers.

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Josés Presenting Problems

• Cultural and language issues
• Frequent discipline referrals for fighting,
  disruptive, and abusive language
• Failing grades
• High rates of aggressive behavior with peers
• Attention problems in class

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Interventions for José

• Adult mentoring
• Daily check-in and check-out
• Intensive social skills training and academic
  support
• Alternative discipline with stronger rewards
• Self-management training and practice
• Bi-lingual communication with family

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Outcomes for José

• Josés grades improved greatly.
• In 6th grade, his overall GPA was 1.25.
• In his first semester of 7th grade, his GPA was
  3.11.
• Attendance
• Satisfactory attendance maintained
• Behavior referrals
• Behavior referrals decreased from 16 referrals in
  6th grade to 3 referrals in 7th grade

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Adam

• Adam is a very bright eighth grade student who
  was referred to the Talented and Gifted (TAG)
  program in elementary school. He lives in a
  single-parent, low-income family. He has no
  friends and is often left at home alone
  sometimes for entire weekends.

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Adams Presenting Problems

• History of bringing weapon to school to threaten
  younger peers
• Disruptive and defiant behavior in classes.
• Not motivated in school
• Often unsupervised after school and during
  weekends
• Moved and frequent changes in household
• Chronic attendance and tardiness

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Interventions for Adam

• Adult mentorship
• Daily Check-in and Check-out system
• Support and coordination with school teachers
• Intensive social skills instruction
• Self-management system with stronger reward
  system for organizing and completing work
• Individual behavior contract for attendance
• Strong partnership with parent
• Vocational experience
• Contingent on school-based goals
• Incentive plan

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Outcomes for Adam

• Improved Grades
• 6th grade, his overall GPA was 1.00.
• 7th grade, his overall GPA was 1.85.
• First semester of 8th grade, 2.63 GPA.
• Decreased Attendance
• 6th grade 92
• 7th grade 79
• 8th grade 89
• No Change in Behavior Referrals
• 6th grade 5 discipline referrals
• 7th grade 7 discipline referrals (1 weapon), 5
  tardy referrals
• 8th grade 7 discipline referrals, 9 tardy
  referrals

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Johnny

• Johnny lives with his mother and older brothers.
  His father is in prison and his brothers are in
  and out of jail. Mom works during the day and is
  frequently gone evenings and nights. Brothers and
  friends party late into the night at Johnnys
  house. Brothers have dropped out of school and
  are unemployed. Drugs and stealing are problems
  for this household.

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Johnnys presenting problems

• Low motivation, poor attendance, and failing
  grades
• Substance abuse issues
• Juvenile court record
• Poor parental supervision, frequent family moves
  and chronic adverse life events
• Aggressive, disruptive behavior resulting in
  numerous referrals and suspensions
• Depression

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Interventions for Johnny

• Adult monitoring and mentorship
• Daily check-in and check-out
• Collaboration and support in regular classrooms
• Family partnership
• Alternative discipline with stronger rewards and
  individualized consequences for behavior
• Intensive social skills training and academic
  support
• Multi-agency coordination with family court

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Outcomes for Johnny

• Multi-agency support for Pete and his family
• Alcohol and drug treatment and monitoring
• Improved Grades
• 6th grade 1.0 GPA
• 7th grade .93 GPA
• 8th grade 2.40 GPA
• Behavior and Discipline Referrals
• Average of 17 discipline referrals for 6th, 7th
  and 8th grades
• Improved Attendance
• 6th grade 67
• 7th grade 76
• 8th grade 74

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Program Wide Positive Behavior Supports

• What can we expect?
• Reductions in discipline problems
• Improved academic achievement
• Deviant peer groups less likely to form
• Prevent the onset, or slow the trajectory of
  alcohol, tobacco and other drug use, and
  delinquency

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Books and resources
Copy of Jeffs PPT here!

• Institute on Violence and Destructive Behavior
• http//uoregon.edu/ivdb/
• Iris Media
• www.lookiris.com
• Best Behavior Building Positive Behavior
  Supports in Schools (Sprague Golly, 2004)
  www.sopriswest.com
• Safe and Healthy Schools Practical Strategies
  (Sprague Walker, 2005) www.guilford.com
• RTI and Behavior A Guide to Integrating
  Behavioral and Academic Supports (Sprague, Cook,
  Browning-Wright Sadler, 2008) www.shoplrp.com
• Metzler, C.W., Biglan, A., Embry, D.D., Sprague,
  J.R., Boles, S.M., Kavanagh, K.A.
  (2008).Improving the well-being of adolescents in
  Oregon. Eugene, OR Center on Early Adolescence,
  Oregon Research Institute. https//www.earlyadoles
  cence.org/system/files/Adolescent_Wellbeing_in_Ore
  gon_Sept22_smallFinal_0.pdf
• LAUSD Foundation Discipline Policy
• http//notebook.lausd.net/portal/page?_pageid33,9
  11578_dadptl_schemaPTL_EP

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