Tier 2 Interventions: Systems, Practices, Data, and Outcomes

Lori Lynass, Ed.D.NWPBIS Network

www.pbisnetwork.org

Acknowledgments

• Hill Walker, U of O• Doug Cheney, U of WA• Kathleen Lane, Vanderbilt• Clay Cook, U of WA• Jeff Sprague, U of O• Bridget Walker, Seattle U• Wendy Iwaszuk, Beach Center, Kansas• Tricia Hagerty, Highline Public School

Systems, Data, Practices, Outcomes

Cedarhurst Elementary PBIS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005-2006 2012-1013

60% = 233 Students

93% or 632 Students

21% = 80 Students

5% or 36 Students

19% = 73 Students

1% = 8 Students

6+ ODR2-5 ODR0-1 ODR

Building the Airplane While Flying It

Social and Behavioral Support for All Students

Factors that Place Children At-Risk

• Biology/physiology• Socioeconomic status• Family Conflict• Family Composition• Parenting Style

• Lack of health care• Poor nutrition• Frequent moves• Temperament• Academic failure

Mental Health: What Do We Know?

• The most common conditions include– Anxiety (31.9%) – Behavior disorders (19.1%) – Mood disorders (14.3%)– Substance use disorders (11.4%)

• Approximately 40% of individuals meet criteria for multiple disorders.

(Merikangas et al., 2010)

Tier 2 Rationale: Early Intervention is Vital

• Research suggests that there’s a ‘window of opportunity’ ranging between 2-4 years when prevention is critical

Great Smoky Mountains Study: Age Between First Symptom and Initial Diagnosis

Source: O’Connell, Boat, & Warner, 2009

What is a Tier 2 Intervention?• An intervention (or set of interventions)

known by all staff and available for students during the school day

• Interventions that provide additional student support in academic, organizational, and/or social support areas

Tier 2 Interventions(Hawken, Vincent, & Schumann, 2008).

• Assumes a Tier 1 School wide PBIS is in place – SET, BOQ• Involves a problem-solving focused behavior support team• Screening to identify a % of students non responsive to Tier 1• Readily available and easily accessible• Uses efficient, available evidence based practices• Includes data-based progress monitoring & decisions• Have an entry & exit criteria, with non-responders moving to Tier 3

Goal of Tier 2 InterventionsTo Make the Problem Behavior:

• Ineffective• Inefficient • Irrelevant • Unstable

* Some of this occurs through changes to the environment.

Tier 2: Small Group Interventions

–Social Skills Groups (Redefining Counselor Groups)

–Check In/Check Out, Check, Connect & Expect–Executive Functioning Skill Groups–Academic Support Groups–Self-Monitoring

SST13 at SWOSERRC

Why do Targeted Interventions Work?

• Improved structure• Prompts are provided throughout the day for correct behavior.• System for linking student with at least one positive adult.• Student chooses to participate.

• Student is “set up for success”• First contact each morning is positive.• “Blow-out” days are pre-empted.• First contact each class period (or activity period) is positive.

• Increase in contingent feedback• Feedback occurs more often.• Feedback is tied to student behavior.• Inappropriate behavior is less likely to be ignored or rewarded.

Important Notes About Tier 2• Do not lose sight of Tier 1

• Common misperception is that interventions will “fix” the student and the classroom teacher does not need to be an active participant since “specialists” or outside staff are often involved in the intervention

• Successful interventions will require high level of involvement among ALL staff within the school building

The Tier 2 Team

• ENTRY, EVALUATE, EXIT

• Determine & Oversee Referral Process• Review Students Referred• Monitor Implementation Fidelity• Evaluate Outcomes and Make Decisions

– Ongoing Progress Monitoring– Fidelity of Implementation– Social Validity

Outcomes

Systems: To sustain the implementation

Data: For decision making

Practices: Evidenced-based and doable

SWPBS IMPLEMENTATION DRIVERS

Are We Ready for Tier Two?• For Tier Two supports to

be most successful, basic components of Tier One should be in place.

* Check Classrooms• Time must be dedicated

for Tier Two to be implemented.

• Support from staff and admin must be available.

• Professional development must occur.

Is Tier One in Place in the Classrooms?

• Classroom-wide positive expectations taught, encouraged & reinforced and match school-wide expectations

• Teaching classroom routines & cues taught & encouraged• Ratio of 4-5 positive to 1 negative adult-student interaction• Do Staff Agree with and Understand Classroom and Office

Managed Behaviors• Active supervision• Redirections for minor, infrequent behavior errors• Frequent pre-corrections for chronic errors• Effective academic instruction & curriculum

Knowing Function of Behavior to Determine Intervention

“Can’t Do versus Won’t Do”

• Can’t Do or Don’t Know When To Do- Skill Deficit - Performance Deficit - Perception Deficit

• Won’t Do- Function of Behavior

Can’t Do: Skills Building

• Social Skills Groups– Assertion Skills, Anger Management, Friendship

Skills, Empathy Skills• Executive Function Skills Groups

– Organization Skills, Emotional Control, Time Management

• Academic Skills Groups– Context Reading Skills, Math Skills

Three Functions of Behavior

Problem Behavior

Escape/Avoid

Social Activity

Peer Adult

Obtain

Social Activity Tangible

Peer Adult

Automatic

We Also Have To Think Functionally When Choosing Interventions

• “Problem Behaviors” are functional skills• Interventions must consider the purpose of

behavior (from student’s perspective)• Seek a match from intervention menu for the

needs of each individual student

It Starts With The Team

Functions of The Tier 2 Team• ENTRY, EVALUATE, EXIT

• Determine & Oversee Referral Process• Review Students Referred• Monitor Implementation Fidelity• Evaluate Outcomes and Make Decisions

– Ongoing Progress Monitoring– Fidelity of Implementation– Social Validity

3-Tiered System of Support

CICO

SSG

Exec Func Skills

ComplexFBA/BIP

Problem Solving Team

Tertiary Systems Team

Brief FBA/BIP

WRAP

Secondary Systems Team

Plans SW & Class-wide supports

Uses Process data; determines overall

intervention effectiveness

Standing team; uses FBA/BIP process for one youth at a time

Uses Process data; determines overall

intervention effectiveness

Sept. 1, 2009

UniversalTeam

Universal Support

Derby Ridge Elementary Teaming Structure

Special Education Team

Tier 3 Team

Tier Two Team

CORE PBIS Team

Grade Level Teams

Establishing the Tier 2 Team

• May be part of the existing PBIS leadership team.

• May be an extension of the existing PBIS leadership team.

• May be a stand alone team, often these teams look at Tier 2 & 3.* Such a team may already exist in your school -

SIT team, Care team, MDT team.

Tier 2 Team Members

• Tier 2 Coach• PBIS Coordinator• Counselor • Psychologist• Teachers• Administrator• Other Para-professionals

Team Uses Problem Solving Format

• http://www.rsd.edu/teach-learn/response-to-intervention.html– Instructional Support Team Video– Richland School District

(Process Example)

DiscussionTier 2 Team

• What Tier 2 team format might work best for your school?Who would be on your Tier 2 team?

• When could this team meet?• What would need to happen to create a Tier 2

team?

10 Minutes

Establish Entry Criteria

Establish Entry Criteria

• A team agreed process should be established for how students enter Tier 2 programs. Common entry criteria:– Office Referrals– Teacher Nomination - Through Process– Counselor Nomination– Screening Results

How most schools determine student need for services

• Office discipline referrals & Teacher/Staff referrals are commonly used

• Only 2-5% of schools screen all children for mental heath reasons (Romer & McIntosh, 2005)

Office Referral Information

But Who Are We Missing?

How Are We Currently Screening For Social Behavior?

Screening for “At-risk” Students

Screening

• Use of a Validated Screener:– Six-Eight (Oct-Nov) weeks after school begins & in

Spring– At the end of the year if desired (provides

information for planning)– As a new student enters if needed

* Academic Screening Data Also Considered

Choosing A Universal Screener

• Choose a Screener that:1. Is appropriate for its intended use and that is

contextually and developmentally appropriate and sensitive to issue of diversity

2. Has Technical Adequacy3. Useable - efficient, feasible, easy to manage

- Calderella,Young, Richardson & Young, 2008

Systematic Screening for Behavior Disorders (SSBD; Walker & Severson, 1992)

• Originally normed K-6, recently normed for middle and Jr High (Calderella,Young, Richardson & Young, 2008)

• Multiple gating procedures following mental health & PBS model

• Externalizing and Internalizing dimensions• Evidence of efficiency, effectiveness, & cost benefits• Exemplary, evidence-based practice

• US Office of Special Education, Council for Children with Behavior Disorders, National Diffusion Network

Multiple Gating Procedure (Severson et al. 2007)

Teachers Rank Order 3 Ext. & 3 Int. Students

Teachers Rate Top 3 Students on Critical Events, Adaptive & Maladaptive Scales

Gate 1

Gate 2

Pass Gate 1

Classroom & Playground Observations

Gate 3Pass Gate 2

Tier 2,3Intervention

Tier 3 Intervention or Special Ed. Referral

SSBD Screening Internalizing Behaviors

• Examples– Not talking w other children– Acting in a fearful manner– Not participating– Avoiding or withdrawing– Not standing up for one’s self

• Non-examples– Initiating social interactions– Having conversations– Joining in with others

Externalizing Behaviors

• Examples– Displaying aggression – Arguing– Defying the teacher– Being out of seat– Disturbing others

• Non-examples– Cooperating– Sharing– Working on tasks

SSBD: Sample Questions• Critical Events (Behavioral Earthquakes):

– Sets Fires, – Vomits after eating, – Exhibits painful shyness

• Maladaptive Behavior– Requires punishment before s/he will terminate behavior.– Child tests teacher imposed limits.

• Adaptive Behavior– Is considerate of the feelings of others.– Is socially perceptive.

SSBD Differentiates Grads , Non-grads, Comparisons

Graduates Non-Graduates Comparison

SSBD Critical

Events

5.9 (2.8) 5.4 (3.0) 5.2 (2.8)

SSBD Maladaptive 31.2 (10.5) a 37.2 (5.7) b 32.2 (7.8) a

SSBD Adaptive 32.3 (8.0) a 28.0 (4.8) b 30.6 (6.8) a

Student Risk Screening Scale (Drummond, 1994)

• Originally normed at elementary level, recently normed at middle and high school (Lane, Kalberg, Parks, & Carter, 2008)– Classroom teacher evaluates and assigns a

frequency-based, Likert rating to each student in the class in relation to seven behavioral criteria

– Score indicates the level of risk (low, medium, high)• Scores predict both negative academic and behavioral

outcomes• Effective, Efficient and Free

Student Risk Screening Scale (Drummond, 1994)

lies, cheats, sneaks, steals, behavior problems, peer rejections, low achievement, negative attitude, Aggressive.

Rated on a 4-point Likert scale (never, seldom, sometimes, frequently)

SRSS

Student Internalizing Behavior Screener (SIBS, Cook et al. 2008)

• Normed K-12 Grade. Rates on 7 Items:• Nervous or Fearful• Bullied by Peers• Spends Time Alone• Clings to Adults• Withdrawn• Seems Sad or Unhappy• Complains About Being Sick or Hurt

– Rated on a 4-point Likert scale (never, seldom, sometimes, frequently)

BASC- Behavior and Emotional Screening Scale (BESS, Pearson Publications)

• Based on BASC by Reynolds & Kamphaus, 2002• Universal screener with norms for preschool & K-12, • Includes teacher, parent, and self-rating forms grades 3-

12. 3-5 minutes per form. Completed on all students in class.

• Hand scored and scannable forms (in spanish too), ASSIST software available

• Provides comprehensive summary of student scores and teacher ratings across the school

• Assessment of a wide array of behaviors that represent both behavioral problems and strengths, including internalizing problems, externalizing problems, school problems, and adaptive skills.

Sample of BASC-2/BESS Form

Administration & Scoring Criteria

• The BASC-2/BESS uses T-scores to communicate results relative to the average (mean=50)

• Identifiers and percentile ranks are provided for ease of interpretation

• Normal risk level: T-score range 10-60• Elevated risk level: T-score range 61-70• Extremely Elevated risk level: T-score range ≥

71

Screening Activity

10 Minutes

What Are Your Initial Thoughts?What Other Information Might You Seek?If You Have 3 Slots for Tier 2, Whom Do You Serve First?

In Addition to Screening Consider:

• Teacher/Counselor/Parent Request Forms• Office Referral Data• Academic Data• Classroom Minor Data• Attendance

Questions to Consider

• When to do screening?• Who should prepare the forms?• Who should administer the screener?• Who should score them?• When and how should the results be

shared?

We Have Screened, Now What?

• Make Sure You Have A Plan For What to Do Once You Screen..

2009 Bridget Walker, Ph.D.

Sample List of Students Identified Through Schoolwide Screening

How could this information help you determine where your limited support resources should focus?

Bridget Walker, Ph.D.

Monitoring Effectiveness and Fidelity of Tier 2 Interventions

Fidelity Checklist

A good plan implemented poorly…is a bad plan.

Monitoring Progress In Tier 2

• Each Student Should Be Monitored Weekly and Discussed Twice Monthly to Determine :– If they are responding to the intervention– If the intervention is the correct intervention– If the intervention needs to be adjusted– If the student is ready to exit

SWIS-CICO ReportDaily Points Graph

Monitoring Fidelity of Tier 2 Interventions

• Core features of interventions should be adhered to.

• The fidelity of Tier 2 programs should be monitored by the Tier 2 team.

• Look over the Tier 2/3 Tracking Tool and Systems-Response Tool.

Monitoring All Interventions

Tier 2: Summary of The Big Ideas

• Do the easy stuff first (efficiency is a major goal)• Processes are as important as practices• Use of Evidence Based Practices based on Behavioral

Science• Teaming is critical• Administrative support is critical• Data Based Decision Making

Some Students Just Need A Little More Support