Missouri’s Interagency Statewide Planning Team: Improving Quality of Life for Individuals Across the

Lifespan

Terry Bigby and Diane Feeley Missouri SWPBS/University of Missouri

Julia LePage and Terri Rodgers Missouri DDDRachel Freeman, University of Kansas

Purpose of Presentation• Share the evolution of Schoolwide PBS

(SW-PBS) in Missouri• Describe how the statewide PBIS team

collaborated with professionals in mental health and developmental disabilities to– Form a statewide interagency planning process– Leverage limited funds for PBS across agencies

• Describe the tiered implementation training beginning in the MO Division of Developmental Disabilities (DDD)

MU

SW-PBSTrainers

Schools

1999 Training FormatThe Missouri Department of Elementary

and Secondary Education (DESE) local improvement grants (LIGs) are awarded

to districts to attend trainings throughout the year and during summer

institutes.

Staff from the University of Missouri PBS Center provides the trainers for these

activities.

History of MO SW-PBS

MU

SW-PBSTrainers

Schools

1999 2006

DESE

MO SW-PBSTrainers

in Regional Centers

Schools

MO SW-PBS 2006 - Present

Training Format22 Consultants in 9 regions, 5 Tier 2/3 consultants, state data/web consultant, state

coordinator and MU PBS personnel provide training/technical

assistance on standardized curriculum for multiple levels and stakeholders

ImplementUniversals

Identify Students

Describe Problem

Identify Function

Select & ProvideIntervention

Evaluate Outcomes

Collect & ReviewData

Schoolwide, Nonclassroom and Classroom Systems

Tier 1 implementedwith fidelity?

Tier 1 implementedwith fidelity?

Yes

No

Teacher/ParentNomination

Teacher/ParentNomination

Data Decision Rules

Data Decision Rules

ScreeningInstrumentScreening

Instrument

Teacher and Team collect dataTeacher and Team collect data

Team summarizes dataDescribe problem

Team summarizes dataDescribe problem

Obtain Attention

Obtain Attention

Escape/AvoidTasks

Escape/AvoidTasks

Escape/Avoid

Attention

Escape/Avoid

Attention

Function?Function?

MentoringMentoring Check InCheck OutCheck In

Check OutAcademicSupport(s)AcademicSupport(s)

Small Group

Social Skill

Small Group

Social Skill

EnvironmentalInterventions

EnvironmentalInterventions

FBABIP

Revised 10/12/2011

Current Statistics 2011-12• 700 schools representing 202 districts are active

participants – This is 29% of Missouri schools and 36% of

Missouri districts• Support from MO Department of Elementary &

Secondary Education• Dr. Tim Lewis, an MU professor and co-director of

the OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports, continues to be instrumental in providing ongoing technical assistance and guidance to the Missouri SW-PBS initiative.

Missouri’s Interagency Statewide Collaboration

Challenges of Disconnected System of Service Delivery

• No system to inform schools that other agencies are working with the child and family

• Agencies and schools do not work together to develop one plan with the child and family

• Often agency people feel that they are asked to take sides – parents vs. the school

• School personnel spending 60 - 120 minutes during meetings focusing only on the problems

Challenges of Disconnected System of Service Delivery (Continued…)

• Parents not sharing what it is like at home• Schools expecting parents to do it all - telling

them what to do instead of collaborating around goals and dreams for child

• “Too many words” or with “too much Jargon” because so many different systems are working to provide services to the child and family

Interagency Collaboration

• Started in 2008 • Agencies included:

– Missouri SW-PBS– Department of Elementary and Secondary Education

(DESE)• Office of Quality Schools• Office of Special Education• Missouri Schools for the Severely Disabled

– Department of Mental Health• Division of Developmental Disabilities (DDD)• Comprehensive Psychiatric Services

Leadership Team

FundingVisibility

Policy/Political Support

Training Coaching Evaluation

Active Coordination

Local School Teams/Demonstrations

State-wide Model for SWPBS

Tier 3 Interagency

System

Behavioral Expertise

Adapted From:

Placed Policy With PoliticalSupport and Added Tier 3 Interagency Systems

School Planning

Team

Add a Statewide Problem-solving System to Encourage Interagency Use of PBS Funds

Key Issues Related to Sustainability of Interagency Collaboration

Goal was to avoid common problems associated with interagency meetings and to follow key elements of sustainability & systems change:•Promote priority for a specific practice•Maximize contextual fit•Ensure efficacy of practices•Use data for continuous generation•Avoid over reliance on any one individual

Important Expectations for the Team

• The outcomes of the team process must address each agency’s agenda

• No group slowed down their own progress to wait for another group to “catch up”; instead, every agency proceeded with tasks at their own pace

• Goal was to remain aware of what was happening with training and technical assistance across agencies at all times

First Steps: Assessment and Brainstorming

MU

SW-PBSTrainers

Schools

1999 2006

DESE

MO SW-PBSTrainers

in Regional Centers

Schools

2008

DMH

CPS DDD

Interagency Collaboration – First Steps

Initial Goals of the Team

Work between agencies at the state level and information gleaned from working with schools and human service agencies across the state resulted in the identification of the following goals:• Develop a Common Language• Develop a Common Vision• Develop a Common Training

Develop a Common Vision

What can we start doing?• Focus on quality of life

‒ Start the conversation with the goal, not the problem. All schools and human service agencies must work with families to focus first on prevention – not on reaction

Develop Common Vision

• Improve quality of life across the lifespan• Foster interagency collaboration • Support delivery of evidence-based, outcome-

focused, person-centered services and supports • Share training resources • Increase professionals’ skills in implementing

positive behavior support and person-centered planning

• Leverage limited state funds

Develop a Common Language

• Identify terms we need to understand to facilitate collaborative work with children and families. ‒ Glossary of terms developed that will be used by

schools and human service agencies in Missouri

• Establish ongoing communication between families, agencies and families

Develop a Common Language

Glossary of terms developed that will be used by schools and human service agencies in MO

• Person-Centered Planning– Schools do not commonly use the term, Person-

Centered Planning. Yet, the Person-Centered Plan is the starting point for provision of services through the Division of Developmental Disabilities and Comprehensive Psychiatric Services

• Quality of Life

Develop a Common Language

Establish ongoing communication between families, agencies and schools• Schools and agencies identify one person

within each system to act as the contact.• Add the following to school enrollment

forms: “List other agencies currently working with your child”

Develop a Common Training System & Curriculum

• While MO SW-PBS was designing curriculum and training to develop Tier 2 system of support, collaboration with other state agencies was initiated to prepare for design of Tier 3 system of support.

• Common language incorporated in MO SW-PBS and Division of Developmental Disabilities (DDD) Tier 3 curricula

Develop a Common Training System & Curriculum

Shared Training Opportunities - what do we need to do to make this happen?

• DDD is developing training systems that are modeled after systems developed by MO SW-PBS.– DDD provides training for Behavior Resource Team

members during Monthly Meetings• Behavior Resource Team members attend

the trainings provided to schools by MO SW-PBS consultants.

• Schools and human service agencies will send information to one another about upcoming trainings.

The Assessment Resulted in the Following

• It was common for professionals to know about the interagency teams that were occurring within their own agency

• However, professionals in other agencies were not always aware of these interagency meetings

• The PBS team was curious about the extent to which interagency teams at the local and regional level “overlap”

• How do these teams relate to the SWPBS efforts (RPDCs) and to the BRT supports across the state

Location of RPDCs (SW-PBS Regional Trainers)

Systems of Care Interagency Meetings

Juvenile Justice Meetings

Community Transition Teams (for Students with Developmental Disabilities)

Assessing Overlap of Teams

Defining the Types of Training Needed

Four Levels of Integrated Training

1. Awareness Training in PBS2. Training for Professionals in PBS

(inservice)3. Training Facilitators to lead teams4. Training Experienced leaders who

will provide training in areas 1-3

Layers of Training Are Needed for Different Prevention Tiers

• Tier 1/Universal Interventions/Primary Prevention(Example: Training for teams in systems to create positive environments, teach communication and social skills, and collect data and intervene early)

• Tier 2/Secondary Prevention/Specialized (Example: Trainings for teams to use data for early identification of problem behavior and implementation of interventions that will support groups of individuals)

• Tier 3 or Tertiary Prevention(Example: Trainings for teams to create systems that address chronic and severe problem behavior)

Four Levels of Integrated Training

1. Awareness Training in PBS– Tier 1– Tier 2 – Tier 3

2. Training for Professionals in PBS (Preservice/inservice)

– Tier 1– Tier 2 – Tier 3

3. Training Facilitators to lead teams– Tier 1– Tier 2 – Tier 3

4. Training Experienced leaders who will provide training in areas 1-3

– Tier 1– Tier 2 – Tier 3

MU

SW-PBSTrainers

Schools

1999 2006

DESE

MO SW-PBSTrainers

in Regional Centers

Schools

2011

DMH

CPS DDD

Interagency Collaboration

CommunityMental Health

Community Support

Specialists

RO

BRT

SB40

TransitionCoordinators

First MO Interagency Task Orders

• Create Tertiary Level PBS Curriculum That Can Be Used Across Education, Human Services and Other Agencies

• Expand and Encourage Interagency Collaboration at State, Regional, and Local Levels

• Establish State Level Data-based Decision Making to Evaluate Impact of PBS in Missouri

• Ensure that Universities and Colleges Across Missouri Know About the Interagency Team and Can Access the PBS Curriculum

Two Regional Interagency Pilots • Awareness training in PBS for District team, Agencies in DD,

Mental Health, Families, etc• School-wide PBS tools to assist districts created and

embedded within the statewide training system (this is created with the team but embedded in the SWPBS training systems)

• Assistance in helping regional teams create strategies that will improve PBS planning for individual students within regions– Training– Service Coordination– Communication– Etc.

Additional First MO Interagency Task Orders

• Create 2 Glossy Brochures About the Interagency Efforts for Dissemination

• Gather information from Local, Regional, and Statewide Professionals to Guide Implementation

• Modify a District tier 2 & 3 self assessment checklist that includes interagency planning in addition to other district-level considerations

First MO Interagency Task Orders (Continued)

• Expand Tiered Training Systems in Developmental Disabilities– Medicaid Reimbursement for Organizations to

Implement Tiers 1 & 2 – Tier 3 Can Only Be Facilitated by BCBA Certified

Professionals)– Create a Training System Similar to Statewide PBIS

Products and Outcomes

• Logic model, draft task orders, and mission statement

• Modification of a district self assessment and implementation planning checklist for tiers 2 & 3 that includes interagency collaboration

• Team member audit of a tier 3 interagency training system in Kansas using online modules, onsite classes, mentoring observations, and intervention fidelity

Products and Outcomes (Continued)

• Policy document --how PBS can be implemented from a tiered perspective within the DD system

• Development of a tool similar to the Schoolwide Evaluation Tool (SET) – Agency Systems Supports Evaluation Tool (ASSET)

• Software program designed – “Big Seven” for Agencies – To provide data-based decision making in general

using Incident Reports

Products and Outcomes (Continued)

• Human subjects design outlining a plan for disseminating a qualitative study of interagency collaboration in MO

• First glossy brochure describing the purpose of the Missouri Interagency Statewide Team

• Training materials created for regional team (ie. Kirksville awareness PBS materials), meeting minutes, and perceptions of individuals participating in process thus far

Products and Outcomes (Continued)

• State interagency professionals visited two state schools implementing SW-PBS; during this visit information was gathered about how to begin structuring interviews, focus groups, and tool development

Working Smarter Not Harder

Using Already Existing Developmental Disability Resources to Establish Data, Systems, and Practices for Preventing

Problem Behavior and Increasing Quality of LIfe

Development of Division of Developmental Disabilities (DDD) Tiered Supports Systems

• 1:1 crisis behavior management ineffective and expensive-”focus on putting out fires”

• System wide approach necessary for effectiveness and best use of resources– Modeling after Mo-SW state level systems- “not re-

inventing the wheel”– Person Centered Process – focus on QOL – To implement must have training, coaching, mentoring

and system support

Systems

Data

Practices

Missouri Division of Developmental Disabilities (DDD) Tiered Support Work Structure

MO Division of Developmental Disabilities (DDD) Tiered Supports Practices include:

• 3) Intensive individualized behavior supports-

to be developed and implemented by licensed professionals.

• 2) Specialized strategies for common problem situations; and

• 1) Universal strategies-proactive, preventative, positive teaching based strategies for staff and families to use

Other System Modifications That Support Implementation

• Licensure required for practice of Applied Behavior Analysis (with exemption for IDEA)

• Medicaid Waiver services to fund additional assistance with implementation of model– Behavior Analysis services – for development of

Intensive Individualized supports – Person Centered Strategies Consultation - to

develop, around an individual, implementation of universal strategies that improve quality of life

MO DDD Expected Outcomes

• Development and implementation of universal strategies will:– Advance quality of life outcomes – Improve processes and practices– Support communication and consistency for all

individuals (those served and those supporting) – Reduce occurrences and severity of crisis

situations

Missouri Division of Developmental Disabilities Tiered Supports Model

What? Applied Behavior Analysis

What? Focused teaching strategies

What? Proactive, preventive, positive & teaching based strategies for staff and families to use consistently and continuously

Additional Example of Interagency PBS Awareness Brochure