Universal Screening for Behavior

1. Universal Screening for Behavior Illinois Children’s Mental Health Partnership’s Second Annual School Mental Health Conference June 27, 2012

2. Session Objectives • As a result of attending this presentation, attendees will: • Learn the rationale for universal screening • Acquire information on several evidence based universal screeners • Systematic Screening for Behavior Disorders (SSBD) • BASC-2/BESS • Columbia Health Screen (CHC) • Signs of Suicide (SOS) • Obtain strategies for successful implementation and addressing challenges

3. Universal Screening Defined • “Universal screening is the systematic assessment of allchildren within a given class, grade, school building, or school district, on academic and/or social-emotional indicators that the school personnel and community have agreed are important.” • Source: Ikeda, Neessen, & Witt, 2009

4. Rationale: Student Benefits Associated with Universal Screening • “The Commission found compelling research sponsored by OSEP on emotional and behavioral difficulties indicating that children at risk for these difficulties could also be identified through universal screening and more significant disabilities prevented through classroom-based approaches involving positive discipline and classroom management.” Source: U.S. Department of Education Office of Special Education and Rehabilitative Services. (2002). A New Era: Revitalizing Special Education for Children and Their Families

5. Rationale: Prevalence Rates • How prevalent are emotional disorders among school-age children and youth?

6. “Untreated emotional problems have the potential to create barriersto learning that interfere with the mission of schools to educate all children.” (Adelman & Taylor, 2002) “Without early intervention, children who routinely engage in aggressive, coercive actions, are likely to develop more serious anti-social patterns of behaviors that are resistant to intervention.” (Walker, Ramsey, & Gresham, 2004) Youth who are the victims of bullying and who lack adequate peer supports are vulnerable to mood and anxiety disorders (Deater-Deckard, 2001; Hawker & Boulton, 2000) “Depressive disorders are consistently the most prevalent disorders among adolescent suicide victims (Gould, Greenberg, Velting, & Shaffer, 2003) . Rationale: Poor outcomes associated with delaying intervention

7. 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

8. 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 (CICO) Intervention Assessment Social/Academic Instructional Groups (SAIG) Daily Progress Report (DPR)(Behavior and Academic Goals) Individualized Check-in Check-out (CICO), Groups, & Mentoring Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc. Brief Functional Behavior Assessment/ Behavior Intervention Plan (FBA/BIP) Complex or Multiple-domain FBA/BIP SIMEO Tools: HSC-T, SD-T, EI-T Wraparound/RENEW Illinois PBIS Network, Revised April 2012 Adapted from T. Scott, 2004

9. Illinois PBIS Network Universal Screening Model • The Illinois PBIS Network recommends a ‘multi-gate’ process for implementing universal screening for behavior • Efficient: • Takes approximately one hour, maximum, per classroom to complete process • Less expensive and more timely than special education referral process • Fair: • All students receive consideration for additional supports (gate one) • Reduces bias by using evidence-based instrument containing consistent, criteria to identify students (gate two)

10. Illinois Universal Screening Model Gate 1 Teachers Rank Order then Select Top 3 Students on Each Dimension (Externalizing & Internalizing) Pass Gate 1 Teachers Rate Top 3 Students in Each Dimension (Externalizing & Internalizing) using either SSBD, BASC-2/BESS, or other evidence-based instrument Gate 2 Tier 2 Intervention Pass Gate 2 (Multiple Gating Procedure Adapted from Walker & Severson, 1992)

11. Examples of Externalizing Behaviors: Displaying aggression toward objects or persons Arguing Being out of seat Not complying with teacher instructions or directives Source: Walker and Severson, 1992

12. Examples of Internalizing Behaviors: Not talking with other children Being shy Timid and/or unassertive Avoiding or withdrawing from social situations Not standing up for one’s self Source: Walker and Severson, 1992

13. Teacher ranking form: Externalizers

14. Teacher ranking form: Internalizers

15. Illinois Universal Screening Model: Selected Instruments • 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= $ 131.49 (includes reproducible screening forms) • Quick • Entire screening process can be completed within 45 minutes to 1 hour per classroom

16. Illinois Universal Screening Model: SSBD Administration • Teachers complete Critical EventsIndex checklist for top three internalizers and externalizers • Internalizers with four or more and externalizers with five or more critical events immediately pass gate two and are eligible for simple a secondary intervention (i.e., CICO)

17. Sample of SSBD Critical Events Form

18. Illinois Universal Screening Model: SSBD Administration • Teachers complete the Combined Frequency Index scale for internalizers and externalizers who did not initially pass gate 2 • Students who subsequently pass gate 2 meet the following criteria: • Internalizers with Adaptive scores of ≤41 and Maladaptive scores of ≥; Externalizers with Adapative scores of ≤30 and Maladaptive scores of ≥35

19. Sample of SSBD CFI Form

20. Illinois Universal Screening Model: Selected Instruments BASC-2 Behavioral and Emotional Screening System (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 Identifies behavioral 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)

21. Illinois Universal Screening Model: BASC-2/BESS Administration • Teachers complete scantron forms (‘bubble sheets’) for each student in their class • Or, for top three internalizers and externalizers if using a multi-gate approach • Takes approximately five minutes, or less per student to complete ratings

22. Illinois Universal Screening Model: BASC-2/BESS Sample

23. Illinois Universal Screening Model: BASC-2/BESS Administration • 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

24. Illinois Universal Screening Model: BASC-2/BESS Administration • Students who score within the Elevated, or Extremely Elevated risk levels would be considered as eligible for simple secondary intervention (i.e. CICO)

25. Illinois Universal Screening Model: Implementation Summary • During the 2010-11 school year, 61 Illinois schools screened approximately 28,000 students representing a diverse demographic profile: • White, 32% • Black/African American, 20% • Hispanic/Latino, 38% Source: ISBE 2011 Fall Housing Report

26. Illinois Universal Screening Model: Universal Screening Results

27. Universal Screening: What do implementers think? • The Illinois PBIS Network recently surveyed* staff at 60 Illinois schools regarding their experience with universal screening for behavior (i.e. the IL-PBIS Network model using the SSBD, or BASC-2/BESS instruments) • Respondents (N= 582) were involved with the universal screening process in the 2010-11 and/or 2011-12 school year • Majority (82%) of respondents were teachers • *Preliminary results from a screening tool adapted from Caldarella, P., Wall, D. G., Christensen, L., Hallam, P. R., & Young, B. J. (2010, October). General Educators’ Perceptions of the Systematic Screening for Behavior Disorders (SSBD). Paper presented at the annual Teacher Educators for Children with Behavior Disorders Conference, Tempe, AZ.

28. Universal Screening: What do implementers think? • Key findings: • “Universal screening for behavior is consistent with our school’s mission” (72%) • “Universal screening is appropriate for a variety of children” (64%) • “Universal screening is beneficial for students exhibiting overly introverted, anxious, or depressed behaviors” (58%) • “The amount of time required to complete the universal screening tool was reasonable” (63%)

29. Universal Screening: What do implementers think? • “I believe that universal screening is a beneficial tool for students with difficulties, especially emotional, in that it gives specific data to assist the student.” • “I am so pleased that our school has used this as a means for identifying our students who need interventions.” • “Universal Screening allows for input by a variety of school personnel. This is valuable since different settings create different behaviors in individuals in accord with experiences and comfort levels.”

30. Universal Screening: What do implementers think? • Key areas of concern identified in the survey were: • Timing for executing universal screening • Completing universal screening too early in the year before staff is knows the students in their class(es) • Too much lag time between screening and implementing interventions • Having adequate staff to implement interventions • Lack of effective interventions (especially for internalizers) • Not providing interventions for identified students • Results of universal screening process were not shared with staff

31. Universal screening readiness checklist

32. Universal screening readiness checklist • Build a foundation • Secure district and building-level administrative support for universal screening • Establish universal screening committee consisting of district and building-level administrators, student support personnel, teachers, family and community representatives and assign roles • Clarify goals • Identify purpose of universal screening (e.g., mental health, social skills assessment) • Determine desired outcomes

33. Universal screening readiness checklist • Identify resources and logistics • Identify resources for supporting students identified via screening (in-school and community-based) • Create a timeline for executing screening process including frequency of screening (e.g., once, or multiple times per year?) • Develop budget for materials, staff, etc. • Create administration materials (e.g., power point to share process with staff, parents and community members, consent forms, teacher checklists) • Schedule dates for screening(s) and meetings to share school-wide results

34. Universal screening readiness checklist • Select an evidence-based screening instrument • Use TheStandards for Educational and Psychological Testing, or resources from other professional organization resources (e.g., National Association for School Psychologists; NASP), as guidelines for selecting an appropriate screener

35. Universal screening readiness checklist • Data • Develop data collection and progress monitoring system • Determine systematic process for using results to inform interventions • Plan for sharing screening and progress monitoring results with staff and families

36. Universal Screening: Illinois PBIS Network Current Screening Instruments

37. Universal Screening: Illinois PBIS Network Additional Evidence-Based Screening Instruments

38. Contact Information • Jennifer Rose, Ph.D., Illinois PBIS Network, jen.rose@pbisillinois.org

39. Implementation of Universal ScreeningMental Health America of Illinois’ TeenScreen ProgramCarol Gall, MA Executive Director

40. Who is Mental Health America of Illinois? • *Formerly Mental Health Association in Illinois • Statewide, non-profit organization founded in 1909 – Celebrating over 100-Years of Service in Illinois! • Mission is to promote mental health, work for the prevention of mental illnesses, advocate for fair care and treatment of those suffering from mental and emotional problems. • Engage in public education, prevention, and advocacy. 1

41. 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

42. History of MHAI’s Screening Programs • In 2007, MHAI launched it’s pilot TeenScreen Program at Cameron Elementary School in Humboldt Park • MHAI is now 1 of 900 sites in 43 states to implement the TeenScreen Program, and • 1 of 5 in Illinois • Program expanded to 3 schools in 2011 school year - Cameron Elementary in Humboldt Park, Buckingham Special Education Center in Calumet Heights and Burnham/Anthony Mathematics and Science Academy in South Deering • Majority of students screened are African-American and Latino-American populations; are on Medicaid; live in lower SES communities • In 2009, MHAI began conducting screenings at Oak Lawn Community High School, screening all freshman students utilizing the Signs of Suicide screening tool & incorporating aspects of TeenScreen 1

43. Why Screen for Mental Illness and Suicide Risk? • Mental illnesses are treatable. • Screening tools that effectively and accurately identify at-risk teens are available. • Most mentally ill and suicidal youth aren’t already being helped and are not necessarily asking for help when needed. • http://www.teenscreen.org/library/press-releases/proactive-screening-more-effective-in-identifying-students • No one else is asking teens about these issues, but they will give us the answers if we ask the questions. The National Research Council and the Institute of Medicine of the National Academies. (2009).; Anderson 2004; YRBS 2005; U.S. Census 2003

44. Why Implement Universal Screening? • One in five teens suffers from clinical depression • Each year almost 5,000 teens in the U.S. die by suicide • 80% of youth give clear warning signs before a suicide attempt • For every one youth that dies by suicide, an estimated 100 attempt; compare this to adults – for every one adult that dies by suicide, an estimated 25 attempt • 70% of youth who make a suicide attempt are frequent users of alcohol and/or other drugs 1

45. Why Implement Universal Screening? Child Health Data Lab www.chdl.org/yrbs.htm 1

46. Why Implement Universal Screening? Child Health Data Lab www.chdl.org/yrbs.htm 1

47. Why Implement Universal Screening? Child Health Data Lab www.chdl.org/yrbs.htm 1

48. Why Implement Universal Screening? Child Health Data Lab www.chdl.org/yrbs.htm 1

49. 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 Principles of Quality Screening Programs

50. The TeenScreen Screening Process