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Cognitive Behavioral Intervention for Trauma in Schools (CBITS) within Chicago Public Schools. Amanda Mohler Mashana L. Smith, Ph.D. Chicago Public Schools Office of Diverse Learners and Student Supports Office of Social & Emotional Learning. AGENDA. Chicago Public Schools at a Glance - PowerPoint PPT Presentation
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Cognitive Behavioral Intervention for
Trauma in Schools (CBITS) within
Chicago Public SchoolsAmanda Mohler
Mashana L. Smith, Ph.D.Chicago Public Schools
Office of Diverse Learners and Student SupportsOffice of Social & Emotional Learning
AGENDA Chicago Public Schools at a Glance
Implementation and Use of MTSS Framework within CPS
History of CBITS within CPS
Training & Supported Implementation
Referral, Screening and Assessment Process
Implementation Fidelity
Evaluation and Outcomes
Challenges & Future Direction for Implementation
Chicago Public Schools at a Glance
Demographics
CPS Elementary64%CPS
High Schools
15%
Con-tract1%
Charter19%
Schools: 658
African Amer-ican40%
Hispanic 46%
White9%
Asian4%
Multi-Racial1%
Hawaiian/Pacific Is-lander
0%
Student Population: 400,545
Demographics Chicago Public Schools (District 299) is the 3rd largest school district
85% of students live at or below the poverty line
91% of students are minority
70% graduation rate (within 4 years)
19% mobility rate
13.3% of students with disabilities
English language learners 16%
Trauma Related Symptomatology among CPS Students
32.5% of CPS students felt sad or hopeless almost every day for 2 weeks or more in a row and stopped usual activities
15.5% of CPS students seriously considered attempting suicide
Implementation and Use of MTSS Framework
within Chicago Public Schools
SOME(Ex: Peer Council, Check In/Check Out)
ALL STUDENTS(Examples: School-wide Expectations, Second Step, Talking Circles)
INDIVIDUALIZED INTERVENTIONSFor students with the highest levels of need, highly-targeted and individualized
behavior strategies provide more intensive intervention and monitoring.
TARGETED SUPPORTSFor at-risk students, classroom-based responses can help de-escalate behavior problems, clinical
group interventions address anger, trauma, and violence; and restorative practices provide students with strategies to resolve conflicts
POSITIVE LEARNING CLIMATESchool climates with positive relationships, clear expectations, and collective
responsibility establish appropriate behaviors as the norm. Respectful, learning-focused, participatory classroom environments with well-managed procedures and
behaviors maximize learning time
SOCIAL AND EMOTIONAL LEARNINGExplicit curricula, along with integrated instructional practices that promote social and
emotional development, teach students how to form positive relationships, make responsible decisions, and set goals. These are critical skills for college and career success.
(Ex. Wraparound,Individualized Counseling)
Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs
FEW
SOME
ALL STUDENTS
INDIVIDUALIZED COUNSELING, FUNCTIONAL BEHAVIOR ASSESSMENT, WRAPAROUND
SMART PROGRAM, REFERRAL TO OUTSIDE RESOURCESALTERNATIVES TO SUSPENSIONS PROGRAM
CHECK IN/CHECK OUT, PEACE CIRCLES, SS GRIN
ANGER COPING/THINK FIRST,CBITS, PEER COUNCILS/JURIES
SCHOOLWIDE EXPECTATIONSCOMMON AREA POLICIES
LESSON PLANSACKNOWLEDGEMENTS
SECOND STEPADVISORY
TALKING CIRCLESMORNING MEETINGS
FEW
Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs
History of CBITSwithin Chicago Public Schools
Identifying a Need for Evidence-Based Interventions within Chicago Public Schools
During a focus group attended by CPS social work and psychology coordinators (Winter, 2006), it was determined that:◦ The majority of referrals for social work services were related
to the experience of trauma or anger/aggression◦ CPS didn’t have a firm understanding of the nature or
effectiveness of services◦ Despite numerous minutes of direct service minutes, students
were not exiting related service delivery, indicating “improvement”
In 2007, CPS collaborated with the University of Florida to review evidence-based interventions (EBIs) designed to address trauma in school-aged populations
◦ Cognitive Behavioral Intervention for Trauma in Schools (CBITS) o LAUSD – Lisa Jaycox
Cognitive Behavioral Intervention for Trauma in Schools (Jaycox, 2004)
Includes 10, one hour cognitive behavioral therapy group sessions
Recommended for students ages 11-15
Skill Areas of the Intervention:◦ Psychoeducation and
Relaxation ◦ Realistic and Helpful Thinking◦ Social Problem Solving
Parent Education
Teacher Education
Planning for the Adoption of CBITS: Identification/Selection of Schools
Community Partners and Funding Mechanisms
Identification/Selection of Schools
ISBE MH ◦ Leadership members or leadership teams had attended
training related to early intervention
◦ Current infrastructure in place relative to preventative or early intervention SEL supports
◦ Indicators of need (disciplinary infractions, OSS, arrest rates, graduation rates)
ISBE MH/Englewood◦ African American 97.82%◦ Ranks 2nd for violent reports◦ 32.3% of households below
poverty level ◦ 34.7% of residents unemployed ◦ 30.3% of residents without high
school diploma SSHS/South Shore ◦ Ranks 12th for violent crime◦ 31.5% households below
poverty level ◦ 17.7% of residents unemployed ◦ 14.9% of residents without high
school diploma
Identification/Selection of Schools
Training and Supported Implementation
Training for Chicago Public School Staff
In 2007, Chicago Public Schools partnered with UCLA Division of Child & Adolescent Psychiatry to train school based clinicians
In 2008, clinical psychologists from Ann & Robert H. Lurie Children’s Hospital Community-Linked Mental Health Services Program partnered with CPS to train clinicians
Training targeted the district’s school social workers, school psychologists, counselors, deans, and community mental health partners
Two day training model offered:◦ History of CBITS◦ Cognitive-Behavioral Theory◦ Education and Relaxation◦ Imaginal Exposure◦ Introduction to Cognitive Therapy
Train the Trainer (TOT) in SY11 (2010-11) to include school-based clinicians
Train the Trainer (TOT) Expansion during Spring, 2011 to include community mental health partners
CPS Training Data (SY08-SY14)
Training began in Fall, 2007
Over 1690 trainees (2007-2014)
350/351 (99.7%) current School Social Workers trained in CBITS
226/228 (99.1%) current School Psychologists trained in CBITS
482/816 (59.1%) current School Counselors have been trained in CBITS
124 community mental health clinicians (2011-2012)
First Year of Implementation 2007-08
Clinicians
(District &
Community
Mental Health Partne
r)
Trainings
Implementation
Anger Coping CBITS0
2
4
6 5
0
First Year of Implementation
2007- 2008
From Training to Implementation: Supported Implementation
EBT CBT Professional Learning Community◦ Clinical Support◦ Fidelity Monitoring◦ Content Review
Co Facilitation◦ Inter-disciplinary◦ Community mental health partners, district clinicians
GOAL: Change practice for the delivery of school based Mental Health services for all students
MTSS Problem Solving Process:(Referral, Screening and Assessment Processes)
Behavioral Health Request for Assistance Form
Teachers observe behavior and attempt evidence-based behavioral strategies in the classroom
If students do not respond, teachers complete a Request for Assistance (RFA) form
The RFA is reviewed by a Behavioral Health Team (also known as CARE Teams)
Additional screening is completed by a member of the BHT
Strengths and Difficulties Questionnaire (SDQ)
Originally developed by Robert Goodman (1997)
Consists of 25 items in five different domains:
1. Conduct2. Hyperactivity3. Externalizing Behavior4. Peer Problems5. Prosocial Behavior
Similar versions for different informants
Trauma Symptom Inventory
Trauma Symptom Inventory
Implementation Fidelity
Chicago Public Schools Implementation Model
Co-facilitation is considered best practice◦ Co-facilitation is encouraged during Year I of implementation◦ Co-facilitation not required during Year II and beyond
New implementers are highly encouraged to attend supported implementation sessions
Co-Facilitation Guidelines
LEAD FACILITATOR
SBC Clinician (Masters level social worker, psychologist, or counselor supervised by a Licensed Mental Health Professional (LMHP) (LCPC, LCSW, PhD, PsyD)
CO-FACILITATOR
Type 73 school based professional (school psychologist, school social worker, school counselor)
Graduate trainees/interns supervised by masters level social worker, psychologist, or counselor
Implementation Data
Metric SY 2013
# of students referred 2815
# of students assigned to CBITS 253
# of students assigned to Anger Coping 1036
Fidelity of Implementation
Facilitators are asked to complete a fidelity monitoring form following each group meeting
Intended to encourage accountability and uphold fidelity
School Name: _______________ Group Name: _______________ Date: __________ HSMP: YES/NO Progress Note: Y/N Attendance: Student
Clinician Attendance and Signature: Clinician Signature: ___________________ Clinician Signature: __________________________ Clinician Signature: ____________________ BTAT Leader Signature: ______________________
Anger Coping Group: Session One Introductions
How well did your group meet each objective?
Session Objective 1 = Not Met
2 Partially
Met
3 = Completely
Met
Comments
Objective 1: GENERAL PURPOSE AND STRUCTURE
1
2
3
Objective 2: GET ACQUAINTED/GROUP COHESION Activities: Pass the ball, paired interviews, group flag, etc.
1
2
3
Objective 3: FOCUS ON INDIVIDUAL PERCEPTUAL PROCESSES Activities: Show DUSO cards and discuss perceptions
1
2
3
Objective 4: POSITIVE FEEDBACK Activity: Compliment Circle
1
2
3
Comments: For Discussion:
Are you able to reach the goals of each lesson? (y/n)
Is there anything that needs to be re-taught? (y/n)
Did you make any adaptations to the content/activities of the curriculum? (y/n)
Evaluation and Outcomes
Assessment Instruments Pre and Post Assessment
◦ Strengths and Difficulties Questionnaire (SDQ)
◦ Trauma Symptom Inventory
All data is entered into a district SharePoint
Scoring and ClassificationSTRENGTHS AND DIFFICULTIES QUESTIONNAIRE
Total Difficulties Score ranges between 0 and 40
16-40 Abnormal
12-15 Borderline
0-11 Normal
TRAUMA SYMPTOM INVENTORY
Scoring
Exposure: One or more exposure
Symptomatology: 14 or more
Pre-Post Analyses
Assessment Time
N Mean CI 95%
Pre
Post
220
220
40.155
37.409
39.088-41.221
36.359-38.459
Limitations of Evaluation
Single method of assessment
Limited understanding of areas of impact◦ No examination of domains with SDQ◦ No examination of domains within the TRRPB
CBITS: A School Psychologist’s
Experience
ExperienceTwo day training (December 2008); Dr. Audra Langley, ULCA Division of Child and Adolescent Psychiatry
Initial implementation in March 2009
6th grade students attending a PK-8th school in Englewood Social-emotional Learning Grant School slated for closure hearing
Community PartnersAnn & Robert H. Lurie Children’s Hospital of Chicago
SGA Youth and Family Services
Children’s Research Triangle (Teacher Education Session)
Referral ProcessTeacher referral
Counselor referral
Group composition
May need to make referrals to outside counseling or alternate intervention
Trauma Symptom Inventory
Preferential to administer individually, read items orally
Refer back to types of trauma student indicated and ask for more information
Establish relationship and gain student assent
Need to guide or reframe in cases of chronic or multiple traumas
Guide student to select an event to work on in group
Types of Traumatic EventsFire
Parent incarceration
Parent/ relative homicide
Peer homicide
Traumatic grief or multiple losses
Witness to community violence
Incentive System Two levels
◦ Group Teamwork incentive
◦ Individual point sheet
Behavior Management Establish group rules
Introduce confidentiality
Co-facilitator roles◦ Content◦ Behavior management
Group Incentive Tracking
Group Incentive Tracking
Individual Incentive
Education and Relaxation
Common reactions to stress or trauma
Write on slips of paper and have students pull and read them
Provide copies of handout and have students highlight them
Allow students to share
Normalize all feelings
Encourage them to share with their families
Relaxation Training Read progressive relaxation script
Consider dimming lights and moving furniture
Play calming music
Cognitive Therapy Teach students the link between thoughts and feelings
Chicken Little example
Hot Seat activity to challenge negative thinking and supply positive alternatives
Fidelity Behavioral Technical Assistance Team meetings
Co-Facilitator reflection
Modifications Consider estimated cognitive and academic functioning
Read material orally
Informally assess need for additional sessions
Consider additional visuals
Challenges Logistics
◦ Space◦ Time allocation
Referral process◦ Screening appropriate referrals◦ Paperwork
Successes Collaboration with other professionals
Internalizing and applying content and techniques
Student and parent feedback
Impact “What I learned is that you can trust people you’re in the group with. The group helps you a lot. It gets the things that are in your mind out and to express what you’re feeling.”
-Seventh grade female
Challenges & Future Direction for the Implementation and Evaluation
of CBITS withinChicago Public Schools
Challenges to Training, Implementation and Evaluation
Training of district personnel to allow for internal training
Allocations for Related Service Providers o 60 minutes per school per week
Use and Ease of Data Collection Platform
Alignment of Assessment Tools with the Intervention
Funding Mechanisms for Community Mental Health Partners
Next Steps for Continuous Improvement
Train ALL counselors, psychologists, social workers, interns and community partners
Improve supported implementation model Differentiate sessions for all levels of experience Increase accessibility and convenience for facilitators
Increase number of groups implemented via increased allocations of clinical related service staff and community mental health partners and availability of Network SEL Specialists
Improve generalization of curriculum to classroom
Strategically align assessment instruments for identification
Support community mental health partners in the identification of external funding mechanisms
Questions?
Chicago Public Schools Office of Social & Emotional Learning
[email protected]://sites.google.com/site/cpspositivebehavior/home