Universal Screening/ Teen Screen

1. Universal Screening/Teen Screen PBIS National Forum October 15, 2010

2. Presenters • Jennifer Rose, M.Ed., Tertiary Research & Evaluation Coordinator, Illinois-PBIS Network: jen.rose@pbisillinois.org • Marian Sheridan, Coordinator of School Health & Safety Programs, Fond du Lac School District: SheridanM@fonddulac.k12.wi.us

3. Session Objectives • To identify selection criteria for universal screening tools • To provide a brief overview of two universal screeners • To share Illinois PBIS Network universal screening model and results • To discuss overall rationale for universal screening and the Teen Screen approach

4. Reflection Questions • What, if any, roadblocks to universal screening for behavior exist in your district/school?

5. Potential Roadblocks • Absence of administrative support • Lack of knowledge regarding the process • Fear of ‘labeling’ students • Apprehension regarding parental/guardian response • Concerns regarding cost/time to implement universal screening

6. The BIG Question • What will you do with your students once they have been identified as needing additional supports?

7. Oh my God! What are we going do with all of these kids!

8. Universal Screening: Tool Selection Criteria • Some basic criteria for selecting a screening instrument: • It is technically-valid: • Adequate norms • Recent norms reflecting population to be screened • Reliable • Produces consistent results over time • Valid • Distinguishes between those who do and don’t meet the criterion measured (i.e., students at-risk of internalizing behaviors)

9. Universal Screening: Tool Selection Criteria • Has social validity: • Instrument/screening process is seen as both acceptable and important) • For example, if an instrument is perceived as time-consuming, or the process of universal screening is not deemed as relevant to stakeholders, then results may not be valid and there will be a lack of staff buy-in

10. Universal Screening: Tool Selection Criteria • A note regarding selection criteria…. • A tool may have social validity, however, the critical aspect of screeners is their capacity to consistently and accurately identify individuals in need of support

11. Universal Screening: SSBD • Systematic Screening for Behavior Disorders (Walker & Severson, 1992) for grades 1-6 • Validated by the Program Effectiveness Panel of the U.S. Department of Education • Six research studies confirm the SSBD’s ability to systematically screen and identify students at-risk of developing behavior problems • Universal screening with the SSBD is less costly and time-consuming than traditional referral system (Walker & Severson, 1994) • Inexpensive • Manual= $125, reproducible screening forms= $15 • Quick • Entire screening process can be completed within 45 minutes to 1 hour per classroom

12. Universal Screening: SSBD

13. Universal Screening: SSBD

14. Universal Screening: SSBD

15. Universal Screening: BASC-2/BESS BASC-2/Behavioral and Emotional Screening System (BASC-2/BESS; Kamphaus & Reynolds, 2007) Developed as a school-wide (Universal) screening tool for children in grades Pre-K to 12 Similar to annual vision/hearing screenings Identifiesbehavioral and emotional strengths and weaknesses Externalizing behaviors (e.g., acting out) Internalizing behaviors (e.g., withdrawn) Adaptive skills (e.g., social and self-care skills) Screening process takes about 30-45 minutes per classroom

16. Universal Screening: BASC-2/BESS

17. Universal Screening: IL-PBIS Network Approach • IL-PBIS Network Approach: • Secure district-level commitment to universal behavioral screening • Build capacity for secondary practices (e.g., CICO, CnC, SAIGs) • Identify and train building level staff person to lead and manage universal screening process and data • Provide building level overview • Distribute informational letters to parents/guardians • Conduct universal behavioral screening • Secondary teams meet with universal behavior screening coordinator to review results • Contact parents to obtain permission for intervention • Upon receipt of parent/guardian permission, students are quickly placed into simple secondary-level intervention (e.g., CICO) • Use data to progress monitor students’ response to intervention

18. Universal Screening: Implementation • A note on recommended screening frequency: • Academic screening (e.g., Curriculum Based Measures-CBMs for reading difficulty) typically occurs during fall, winter and spring benchmarking phases • Screening twice annually (in fall and early winter) is optimal for behavioral screening • Screen transfer students • Additional progress monitoring of students identified during fall screening

19. Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model Tier 1/Universal School-Wide Assessment School-Wide Prevention Systems ODRs, Attendance, Tardies, Grades, DIBELS, etc. Tier 2/Secondary Tier 3/ Tertiary Check-in/ Check-out Intervention Assessment Social/Academic Instructional Groups Daily Progress Report (DPR)(Behavior and Academic Goals) Individualized Check-In/Check-Out, Groups & Mentoring (ex. CnC) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Brief Functional Behavioral Assessment/ Behavior Intervention Planning (FBA/BIP) Complex FBA/BIP SIMEO Tools: HSC-T, RD-T, EI-T Wraparound Illinois PBIS Network, Revised August 2009 Adapted from T. Scott, 2004

20. Screening process • Teachers nominate students and complete screening tools

21. Multiple Gating Procedure (Adapted from Severson et al. 2007) Teachers Rank Order then Select Top 3 Students on Each Dimension (Externalizing & Internalizing) Gate 1 Pass Gate 1 Teachers Rate Top 3 Students in Each Dimension (Externalizing & Internalizing) using either SSBD, or BASC-2/BESS Gate 2 Tier 2 Intervention Pass Gate 2

22. Illinois PBIS Network Universal Screening Results: Externalizers 2007-10

23. Illinois PBIS Network Universal Screening Results: Internalizers 2007-10

24. Universal Screening Results: Totals

25. Resources • Glover, T.A., & Albers, C.A. (2007). Considerations for evaluating Instruments for universal screening assessments. Journal of School Psychology, 45, 117-135. doi:10.1016/j.jsp.2006.05.005 • Kamphaus, R.W., & Reynolds, C.R. (2007). BASC-2 Behavioral and Emotional Screening System. Minneapolis, MN: Pearson. • Patterson, G., Reid, J., Dishion, T. (1992). Antisocial Boys. Eugene, OR: Castalia. • Severson, H.H., Walker, H.M., Hope-Doolittle, J., Kratochwill , T.R., & Gresham, F.M. (2007). Proactive, early screening to detect behaviorally at-risk students: Issues, approaches, emerging innovations, and professional practices. Journal of School Psychology, 45, 193-223. doi:10.1016/j.jsp.2006.11.003 • Walker, B., Cheney, D., Stage, S., & Blum, C. (2005). Schoolwide screening and positive behavior supports: Identifying and supporting students at-risk for failure. Journal of Positive Behavior Supports, 7(4), 194-204. Retrieved from http://flagship.luc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true& db=aph&AN=18658082&site=ehost-live • Walker, H.M., & Severson, H.H. (1992). Systematic Screening for Behavior Disorders. Longmont, CO: Sopris West.

26. Implementation of Universal ScreeningFond du Lac TeenScreen ProgramMarian Sheridan

27. Why Screen for Mental Illness and Suicide Risk? • Mental illness is treatable. • There is ample time to intervene before symptoms escalate to a full blown disorder and before a teen turns to suicide. • Screening tools that effectively and accurately identify at-risk teens are available. • Screening more accurately identifies teens with significant mental health problems than school professionals (63% vs. 37%; Scott et al., AJPH 2009). • Most mentally ill and suicidal youth aren’t already being helped. • At-risk adolescents who do not request help on the screening questionnaire are significantly more likely to report suicidal ideation in the preceding three months than those who request help (62% vs. 31%; Husky et al., Child Psychiatry Hum Dev, 2008). • No one else is asking teens about these issues, but they will give us the answers if we ask the questions. • Screening is safe and does not increase distress, depressive symptoms, or suicidal ideation (Gould et al., JAMA 2005). The National Research Council and the Institute of Medicine of the National Academies. (2009).; Anderson 2004; YRBS 2005; U.S. Census 2003

28. History of TeenScreen • TeenScreen developed in 1991 as a result of Dr. David Shaffer’s research on mental illness & suicide in youth • 90% of youth who died by suicide suffered from a treatable mental illness • 65% experience symptoms for at least a year prior to their deaths • This shattered the myth that suicide is a random and unpredictable event in youth • Found there is time to intervene with at risk youth, connect with treatment, • Potential to save lives 1

29. Why Implement TeenScreen? • One in five children has a mental or emotional problem that requires treatment • At least one in 10 may have a serious emotional disturbance that significantly impairs his or her ability to function emotionally, socially or academically • Two-thirds of children needing mental health treatment go without • Children with mental health problems are not “just being children.” Mental health problems can disrupt daily functioning at school, at home and with peers. • Suicide is the second leading cause of death for adolescents in Wisconsin. 1

30. Principles of Quality Screening Programs • Screening must always be voluntary • Approval to conduct screening must be obtained from appropriate leadership • All screening staff must be qualified and trained • Confidentiality must be protected • Parents of identified youth must be informed of the screening results and offered assistance with securing an appointment for further evaluation

31. Prepare Your School to Implement a Universal Screening • Raise awareness and build school/ community support • Choose a staffing model and identify your team • Select your screening population, location, schedule and questionnaire • Develop a referral network and community resource guide

32. Establishing a Strong Foundation for Universal Screening • Administrative Support • School Board Members • Key Stakeholders • Medical Providers • Mental Health Providers • Community Agencies and Organizations • .

33. Educate and Engage School Personnel • Teachers, administrators, and school health and mental health staff can dramatically influence the success of your TeenScreen program. • Inform school personnel of your plans to implement TeenScreen and obtain their support for and commitment to your efforts. • Build working relationships with school personnel. • Present your plans at a faculty meeting and/or department meetings.

34. Seek Advice and Help from School Personnel • Ask school personnel how they think parents will react to screening and how best to reach parents and teens. • Ask for assistance with promoting the program to parents and teens and with distributing and securing the return of parent consent forms. • Help and buy-in is especially critical from the teachers whose classes will be impacted by consent distribution or screening.

35. Educate and Engage Parents • Know your community and share key facts specific to your community with parents to educate them about the need for screening. • Present information about TeenScreen at a school PTA/PTO meetings to raise awareness and build support prior to consent distribution. • Have a TeenScreen information table at parent orientations, registration days or back to school nights. • Make yourself available to answer questions or address concerns about screening . • Present information in a culturally appropriate manner and anticipate how different cultural groups will respond to screening.

36. The Screening Process

37. Principles of Quality Screening Programs • Screening must always be voluntary • Approval to conduct screening must be obtained from appropriate leadership • All screening staff must be qualified and trained • Confidentiality must be protected • Parents of identified youth must be informed of the screening results and offered assistance with securing an appointment for further evaluation

38. Select Your Screening Questionnaire

39. CHS Overview 14-item, 10-minute, self-completion, paper-and-pencil survey for suicide risk Appropriate for 11-18 year-olds 6th grade reading level Trained layperson can administer and score Assesses for symptoms of depression, anxiety, substance abuse, suicide ideation and past attempts Highlights those who might be at risk and screens out those who are not Available in English and Spanish 33% positive rate

40. CHS Sample Question

41. DPS Overview 52-item, 10 minute, self-completion mental health screen Appropriate for 11-18 year-olds Computer-based with spoken questions Trained layperson can administer and score Automatic reporting of screening results English and Spanish versions available 20-33% positive rate

42. The DPS Screens For: • Social Phobia • Generalized Anxiety • Panic attacks • Obsessions and Compulsions • Depression • Suicide ideation (past month) • Suicide attempts (past year) • Alcohol Abuse/ Dependence • Marijuana Abuse/ Dependence • Other Substances Abuse/ Dependence

43. DPS Sample Question In the last 3 months….. Has there been a time when nothing was fun and you just weren’t interested in anything?

44. Developing a Mental Health Referral Network and Community Resource Guide • Key Points: • The Referral Network should include providers for insured and uninsured teens • Develop relationships with providers in your community who: • Evaluate and treat a variety of conditions • Agree to accept your referrals in a timely manner and do not have long wait lists • Are culturally appropriate • The Community Guide should include a variety of resources relevant to parents and their teen • Planning Questions: • Have you contacted mental health providers for your referral network? • Have you identified community resources to enhance your services and provide additional linkages and resources to at-risk teens?

45. Fond du Lac County Data 2002-2008 Over 4,989 students in FDL County have been screened 961 of these students have been identified for being at potential risk of suicide, suffering from mental health problems and received a referral for further evaluation and appropriate treatment.

46. Teen Support for Screening- What Teens Say About TeenScreen - “I feel like someone is paying attention and listening to me.” “I thought it was very helpful, and I finally feel relieved because I’m getting my problems out.” “The interview on the computer was a great way to know how we feel about stuff in our lives. I think it’s a great idea.” “I thought it was insightful because some of these things are not talked about enough.” “I think this is a good way to find out what’s going on with teens these days. Most teens are afraid to talk about their problems because they don’t want other teens to think they are different.”