Cognitive Behavioral Intervention for Trauma in Schools (CBITS) within Chicago Public Schools

1. 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

2. 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

3. Chicago Public Schools at a Glance

4. Demographics

5. 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%

6. 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

7. Implementation and Use of MTSS Framework within Chicago Public Schools

8. Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs POSITIVE LEARNING CLIMATE School 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 ALL STUDENTS (Examples: School-wide Expectations, Second Step, Talking Circles) SOCIAL AND EMOTIONAL LEARNING Explicit 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. SOME (Ex: Peer Council, Check In/Check Out) TARGETED SUPPORTS For 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 INDIVIDUALIZED INTERVENTIONS For students with the highest levels of need, highly-targeted and individualized behavior strategies provide more intensive intervention and monitoring. FEW (Ex. Wraparound, Individualized Counseling)

9. Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs SCHOOLWIDE EXPECTATIONS COMMON AREA POLICIES LESSON PLANS ACKNOWLEDGEMENTS SECOND STEP ADVISORY TALKING CIRCLES MORNING MEETINGS ALL STUDENTS CHECK IN/CHECK OUT, PEACE CIRCLES, SS GRIN ANGER COPING/THINK FIRST, CBITS, PEER COUNCILS/JURIES SOME INDIVIDUALIZED COUNSELING, FUNCTIONAL BEHAVIOR ASSESSMENT, WRAPAROUND SMART PROGRAM, REFERRAL TO OUTSIDE RESOURCES ALTERNATIVES TO SUSPENSIONS PROGRAM FEW

10. History of CBITSwithin Chicago Public Schools

11. 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) • LAUSD – Lisa Jaycox

12. 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

13. Planning for the Adoption of CBITS: Identification/Selection of SchoolsCommunity Partners and Funding Mechanisms

14. 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)

15. Identification/Selection of Schools • 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

16. Training and Supported Implementation

17. 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

18. 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)

19. First Year of Implementation 2007-08

20. 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

21. MTSS Problem Solving Process:(Referral, Screening and Assessment Processes)

22. 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

23. Strengths and Difficulties Questionnaire (SDQ) • Originally developed by Robert Goodman (1997) • Consists of 25 items in five different domains: • Conduct • Hyperactivity • Externalizing Behavior • Peer Problems • Prosocial Behavior • Similar versions for different informants

24. Trauma Symptom Inventory

25. Trauma Symptom Inventory

26. Implementation Fidelity

27. 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

28. Co-Facilitation Guidelines Lead Facilitator 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 • SBC Clinician (Masters level social worker, psychologist, or counselor supervised by a Licensed Mental Health Professional (LMHP) (LCPC, LCSW, PhD, PsyD)

29. Implementation Data

30. Fidelity of Implementation • Facilitators are asked to complete a fidelity monitoring form following each group meeting • Intended to encourage accountability and uphold fidelity

31. Evaluation and Outcomes

32. Assessment Instruments • Pre and Post Assessment • Strengths and Difficulties Questionnaire (SDQ) • Trauma Symptom Inventory • All data is entered into a district SharePoint

33. Scoring and Classification Strengths and Difficulties Questionnaire Trauma Symptom Inventory Scoring Exposure: One or more exposure Symptomatology: 14 or more • Total Difficulties Score ranges between 0 and 40 • 16-40 Abnormal • 12-15 Borderline • 0-11 Normal

34. Pre-Post Analyses

35. 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

36. CBITS: A School Psychologist’s Experience

37. Experience • Two 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

38. Community Partners • Ann & Robert H. Lurie Children’s Hospital of Chicago • SGA Youth and Family Services • Children’s Research Triangle • (Teacher Education Session)

39. Referral Process • Teacher referral • Counselor referral • Group composition • May need to make referrals to outside counseling or alternate intervention

40. 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

41. Types of Traumatic Events • Fire • Parent incarceration • Parent/ relative homicide • Peer homicide • Traumatic grief or multiple losses • Witness to community violence

42. Incentive System • Two levels • Group Teamwork incentive • Individual point sheet

43. Behavior Management • Establish group rules • Introduce confidentiality • Co-facilitator roles • Content • Behavior management

44. Group Incentive Tracking

45. Group Incentive Tracking

47. Individual Incentive

48. 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

49. Relaxation Training • Read progressive relaxation script • Consider dimming lights and moving furniture • Play calming music

50. Cognitive Therapy • Teach students the link between thoughts and feelings • Chicken Little example • Hot Seat activity to challenge negative thinking and supply positive alternatives