Transcript CARE TEAM DISCUSSION

Building and Sustaining a
School-Based CARE Team
June 27, 2012
Laura Hurwitz, LCSW
Mental Health Consultant
Elizabeth Stranzl, Ed.S
School Psychologist, Harper High School
Today…
1.
2.
3.
4.
5.
Background and History of CARE team
What is a CARE team?
Assessing School Readiness for CARE team
CARE Team Planning Process
CARE Team Implementation
2
Background and
History
of Care Team
The Illinois School Model
Illinois PBIS Network, Revised May 2008. Adapted from "What is school-wide PBS?", OSEP Technical Assistance on Positive Behavioral
Interventions & Supports.
4
Three Tiers
• Tier I - Universal: policies and practices that target the entire population
to promote and enhance wellness by improving social, emotional, and
behavioral skills (e.g., school-wide and classroom programs and activities
that foster safe and caring learning environments that engage students)
• Tier II - Secondary: interventions that target students who have already
evidenced early signs of an identified concern or who are at risk of
developing mental health or behavioral concerns (e.g., groups that
address aggression, exposure to violence)
• Tier III - Tertiary: interventions for the individuals who are identified as
having the most severe, chronic, or pervasive concerns. (e.g., evidencebased individual and family interventions)
5
Social-Emotional Policy, Chicago
Public Schools, 2004
As a result of Illinois Children’s Mental Health
Partnership’s Recommendations, CPS has required all schools
to develop:
• School-wide SEL policies
• Classroom instruction
• Teacher training
• Parent education
• Community partnerships
• Screening, early intervention
• Clinical referral
6
CPS: Behavioral Health
7
History of CARE Team
Implementation at Chicago Public
Schools (CPS)
• 2008 - CARE team model adopted by Office of School
Improvement (OSI) and derived from similar national models
• 2008 - gradually implemented in three low performing (“turn
around”) high schools
• 2010 - expanded CARE teams to additional non ”turnaround” schools using internal violence prevention funding,
under initiative called “Culture of Calm”
• 2011 - CPS uses School Improvement Grant (SIG) dollars
from ISBE to further expand to transformation schools
• 2012 - CPS interested in expanding to more schools
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What is a Care
Team?
CARE Team Definition
The CARE Team is a place for concerned educators to
effectively address the needs and problems of their schools’ atrisk students.
A CARE Team:
Cares about both the individual and the system
Assesses by gathering information, discussing, and planning
Responds by following through with interventions
Evaluates the effectiveness of interventions and determines the
need to reassess
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CARE Team: Mission and
Purpose
• Supports students’ social, emotional, and behavioral needs in
order to maximize learning
• Functions as a web of support for students exhibiting social,
emotional, or behavioral difficulties
• Supports a three-tiered model of mental health
• Assesses student needs, matches them to appropriate
intervention(s)
• Collaborates with other adults to advocate for the student and
monitor their progress
• Intervenes early to prevent escalation of problematic
behaviors and to prevent need for more intensive services
11
CARE Team: Structure and
Services
CARE Teams are school-based groups composed of school
counselors, school social workers, school psychologist,
community mental health provider, and administrators that:
• Come together weekly to collaborate in finding solutions to the
problems of at-risk students and families.
• Deliver three levels of interventions that address students’ social,
emotional, and behavioral needs.
• Facilitate referrals to school and community-based resources to further
support student needs.
• Collaborate with school personnel (e.g., teachers, deans, student advocates)
and community-based organizations to coordinate services and supports.
• Collect, interpret, and report on data to improve quality of services.
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CARE Teams help to link and
coordinate services for students
INSCHOOL
SUSPENSI
ON
PEER JURY
CARE TEAM
HEALTH
SERVICES
COUNSELING
OFFICE
COMMUNITY
MENTAL
HEALTH
AGENCY
RE-ENTRY
SUPPORT
ATTENDAN
CE OFFICE
DISCIPLIN
E OFFICE
MENTOR
S
WEEKLY
ADVISORY
RESTORATI
VE JUSTICE
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CARE Teams utilize best practices to
coordinate cohesive services that benefit
all students
PEER JURY
HEALTH
SERVICES
SBHC
COMMUNITY
MENTAL
HEALTH
AGENCY
IN-SCHOOL
SUSPENSION
CARE TEAM
MENTOR
S
DISCIPLIN
E OFFICE
COUNSELING
OFFICE
RE-ENTRY
SUPPORT
ATTENDANCE
OFFICE
RESTORAT
IVE
JUSTICE
WEEKLY
ADVISORY
14
How do we know
if we’re ready for
a CARE team?
CARE Team Readiness Criteria
• Staff Requirements
• CARE Team Member Responsibilities
• Tier One Structures
• Community Resources
• Support from School Administration
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Staffing: CARE Team Lead
• One or two individuals (existing staff or hired)
• Estimated time commitment (combined): 14-16 hrs/wk
• Qualifications (of at least one lead):
– Type 73
– Masters’ level clinician
• Preferred skills and experience (of at least one lead):
–
–
–
–
–
Leadership skills (e.g. setting agendas, convening meetings)
Clinical skills
Skill in building community partnerships
Strong organizational skills
Interest and ability to gather, enter, manage, and use data to drive
practice
– Interest and experience in training and public speaking
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Staffing: CARE Team Members
• A minimum of three internal staff members (e.g., counselors,
social worker, psychologist, special education case manager)
motivated to be a part of CARE Team
• Counselor, social worker, or psychologist who has previously
been trained on and has implemented Tier II group
interventions (e.g., CBITS and Think First)
• An administrative liaison (e.g., SEL coordinator, Assistant
Principal) committed to providing oversight of CARE Team
• A behavioral health community partner clinician providing
school-based services.
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CARE Team Member
Responsibilities
• Estimated time commitment: approximately 4-6 hours per
week) for CARE team work, including:
– Training
– Technical Assistance
– Ongoing Duties
• attend weekly CARE Team meetings
• deliver interventions
• collect and enter data
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Tier One Structures
• Existence of (or interest in developing) Tier One structures to
help address student social/emotional/behavioral issues such
as:
– Grade level teacher teams (e.g., SLCs) in which teachers meet to
discuss students’ academic and behavioral progress in the classroom
– Student Advisory
– Tier One Restorative Justice initiatives
Community Resources
– Partnerships with community partners who have successfully provided
social, emotional and behavioral health services to the school and
students.
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Support from School
Administration
• School must designate an administrator (e.g. Culture of Calm
Coordinator) to take on the following roles:
– Oversight of the CARE Team
– Supervision of CARE Team members (e.g., meeting attendance,
delegation of CARE Team tasks)
– Liaison to Children's Memorial Hospital consulting team
– Liaison to community providers
• Administrator should integrate CARE Team into school’s
professional development calendar throughout the year to
engage the entire school in the implementation and adoption
of the model
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ACTIVITY
• Instructions:
• Complete “Readiness Assessment” (handout) for your school
or a school with which you are familiar:
• Discussion questions:
– Are we ready? Why? Why not?
– What do we need to do to get ready?
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What is the care
team planning
process?
Building a CARE Team
• Development of a CARE Team includes both an intensive
planning and start-up phase prior to implementation.
• The creation of the CARE Team is an organic process.
• Each school plays an influential role in shaping what this
model becomes by helping to modify and refine the process
over time.
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Role of Consultant
• Consultants work with the school administration and CARE
Team to assist with:
– Aligning CARE Team practices with school’s mission and priorities
– Collaborating with existing school-based teams
– Consulting with staff around implementation and individual case
issues
– Providing professional development on interventions and
strategies
– Collecting and analyzing data about the effectiveness of the
interventions
– Connecting school with existing community and school-based
resources
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Planning and Implementation Timeline
Planning (1-2 months)
•
•
•
•
Meet with school administration
to discuss scope of work and
identify core planning team
Meet with core planning team
(and others as needed) to assess
capacity and needs
Start-up (1-2 months)
•
Develop CARE Team calendar and
meeting schedule
•
Provide or coordinate training for
CARE Team members
•
Meet with core planning team to
review results of assessment.
Solidify roles and responsibilities
of CARE Team Lead and
members
•
Select group interventions.
•
Develop referral, screening,
tracking, and evaluation
protocols
•
•
•
Implementation
•
Provide weekly / bi-weekly
support, review and evaluation of
referral, tracking, and evaluation
practices
•
Support analysis of intervention
effectiveness and student
outcomes
•
Provide recommendations for
process improvements
•
Provide support for ongoing CARE
Team and staff professional
development
•
Provide support on group
interventions
•
Support CARE Team in their roles
related to providing consultation
to teachers
Develop or assemble tools and
materials (e.g., forms, assessment
tools, resource manuals)
Present professional development
session to staff (e.g., “Overview of
CARE Team” and “Impact of Trauma”
at staff)
Create plans with school
departments (discipline,
attendance, restorative justice,
advisory, SLCs) and key community
partners
Convene first CARE Team meeting
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Capacity and Needs
Assessment
• Purpose: to assess what behavioral health services and
supports are already in place at the school.
• How to administer:
–
–
–
–
Identify participants
Guided discussion format
May need 2-3 separate meetings
Allow participants to provide input in writing/email
• Includes questions related to (see handout):
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–
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–
–
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Staffing
Collaboration with School and Community Partners
Clinical procedures and Services
Training
Teachers and School Staff
Data
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Roles and Responsibilities:
Care Team Leadership
• Single or co-facilitation model
• Mapping of core functions (see handout)
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–
–
–
–
–
–
Clinical leadership
Administrative leadership
Liaison with school administration, discipline office, attendance
Liaison to teachers and grade level teams
Coordination of staff professional development
Liaison to consultant
Data management and coordination
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Considerations in Selecting
Group Interventions
• Should match needs of students/school/ community
o
o
o
o
o
•
•
•
•
Number of students referred
Presenting issues of students referred
Time of year/number of Sessions
Age or developmental level of children/youth
Materials and/or space needed
Must demonstrate effectiveness
Facilitators’ training in intervention
Facilitators’ previous experience with intervention
Plan for ongoing support and supervision
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How do we implement
a care team?
Harper High School
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CARE Team Implementation
Components
• Meeting structure and participants
• Collaboration with school staff
• Collaboration with family/community
• Referral and screening process
• Interventions
• Data tracking & progress monitoring
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Harper CARE Team Meeting
Structure and Participants
Weekly meetings : 90 minutes
Pre-set agenda
Clinical note taker
Open vs. closed meeting structure
Meeting topics aligned to CARE team calendar
Closed Meeting Participants
– School Psychologist (Lead)
– 2 school social workers
– 3 school counselors
– Assistant Principal of Student Development
– CMH Consultant
• Open meeting participants: deans, mentors, CBO’s
•
•
•
•
•
•
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Collaboration with School Staff
• Grade level teams
– Pushing IN with training & student updates
– Pulling OUT with CT referrals, students/interventions for follow up
• Disciplinary and attendance staff
• Professional Development to staff
– Overview of CARE Team
– Impact of Trauma on Students and Staff
• Classroom consultation
• Advisory support
34
Collaboration with Family and
Community
• Families
– Consent for services
– Outreach at report card pick up
– Orientation to services and/or curriculum
• School-based Community Partners
– Include in OPEN CARE team meetings
– Referrals to/from CARE team
– Student discussions
• External agencies
– Develop linkages
– Refer for specialized services not available at school
35
Harper High School’s
Referral & Screening Process
Tier I Supports are delivered with fidelity.
Problem-Solving steps are completed within PODS. If problem solving does not produce a behavior change or support
needs exceed what can be provided at Tier 1, the teacher/concerned party completes an RFA.
Give a copy of the RFA to a CARE team member.
Teacher Consultation: Care Team representative meets with the teacher to have teacher complete the SDQ and to
gather additional information about the student.
Student Consultation: Care Team representative meets with the student to administer the MSAI-18 and the CBITS
Trauma Screen and to conduct a semi-structured interview.
Care Team representative reviews RFA, SDQ, and data from student screening with the CARE Team at the
next meeting (up to 2 wks).
Care Team representative responds to RFA with the following options
Consultation/collaboration
conducted with teacher to
improve behavior at Tier 1.
Inclusion in Tier 2
small group.
*obtain parent consent
Inclusion in Tier 3
services.
*obtain parent consent
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Who Gets Referred to CARE
Team?
•
•
•
•
Students with social/emotional issues that are negatively
impacting academic and social functioning at school
Students with problems with anger
Students exposed to trauma
Students at risk or who demonstrate other behavioral
health problems
–
–
–
symptoms of depression or anxiety
substance use
family or peer issues
• See handout
37
CARE Team Interventions
• Tier II Groups
– Manualized, evidence-based (e.g. CBITS, Think First)
• Services emphasize:
–
–
–
–
Skill-building
Normative peer support
Generalization to classroom setting
Address behaviors that impact school performance and
attendance
• Tier III individual services
• Referral for external services as needed
• Crisis intervention
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Tier II Group Interventions
Think First (Anger Coping)
CBITS
Students with a pattern of impulsive and
reactive aggression
Students exposed to traumatic events
demonstrating clinical symptoms
Approximately 15 sessions (12 sessions)
Approximately 10 sessions
Small groups (6-8 students)/(4-6 students)
Small groups (6-8 students)
Target/Skill Areas
• Goal setting
• Increasing locus of control: personal
choice behaviors
• Anger management training: Anger cue
recognition; palliative anger regulation;
Self-instruction in anger regulation
• Social Problem Solving: problem
identification; response generation and
enactment
Target/Skill Areas
• Reduce symptoms of Post Traumatic
Stress Disorder (PTSD), depression, and
anxiety
• Recognition of normative responses to
trauma
• Relaxation
• Processing traumatic memories
• Coping strategies for managing
exposure to associated events
• Social problem-solving
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Steps for Implementing
Interventions
In order to facilitate appropriate referrals, timely
communication, and effective supports to students, the
CARE Team has best practices in place for each of the
following:
1.
2.
3.
4.
5.
6.
7.
8.
Outreach
Referral Process
Screening
Consents
Implement Intervention
Documentation
Progress Monitoring
Post-Intervention Assessment
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Harper Tracking Document
Previous
Interventions Date of CT Appropriate Intervention
Student Name
Grade LBS? Gatekeeper Tried
Review
For CT?
Assigned
John
Doe
10 Yes Stewart
think first
8/15/2011 Yes
tier 3
tier 3
8/8/11 Carter
John
Doe
10
No Stewart
Yes
8/15/2011
tier 3
think first
8/8/11 Fletcher
John
Doe
10
No Stewart
8/22/2011 Yes
weekly check
tier 3
8/8/11 Khan
John
Doe
10 Yes Stranzl
in
8/15/2011 Yes
Stewart
cbits
think first
8/8/11 Garrett
John
Doe
10 Yes
8/15/2011 Yes
Stewart
think
first
tier 3
8/8/11 Farid
John
Doe
10
No
8/22/2011 Yes
Stewart
tier
3
weekly check
8/15/11 Jones
John
Doe
10
No
8/22/2011 Yes
Stewart
tier 3
in
8/15/11 Fletcher
John
Doe
10 Yes
8/22/2011 Yes
tier 3
8/15/11 Whittier
John
Doe
11 Yes Stranzl
8/22/2011 Yes
SW
tier 3
8/15/11 Smith
John
Doe
10
No Sanders
8/22/2011 Yes
think first
weekly check
8/15/11 Kamara
John
Doe
10
No Sanders
8/22/2011
Yes
think first
in
8/15/11 Thuet
John
Doe
12 Yes Stranzl
8/22/2011 Yes
think first
think first
8/15/11 Moore
John
Doe
10
No Stranzl
8/22/2011 Yes
think first
weekly check
8/15/11 Bryant
John
Doe
12
No
8/22/2011 Yes
SW
8/15/11 Bryant
John
Doe
10 Yes Stewart
8/22/2011 Yes
tierin3
check in then
tier2/3 hybrid
weekly check
in
Change of Placement
Group Group Second Third
&
Start End
Review Review Start Date for new
RFA
RFA entered in SDQ
SDQ entered in # of times consent Consent
Date Date Date
Date
intervention
received Sharepoint
received Sharepoint
requested
received
Referral Person Making
Date
Referral
8/8/11 Garrett
Intervention
Facilitator
Stewart
Stewart
Stranzl
Stranzl/Hill
Stewart
Stewart
Stewart
Stranzl
Stewart
Stranzl/Hill
Stranzl
Stranzl/Winfield
Winfield
Stranzl/Winfield
Winfield
Intervention
Consent
Assignment
entered in entered in
Sharepoint Sharepoint
41
Interventions: Documentation,
Progress Monitoring and
Assessment
• Establish a system for monitoring the fidelity of
implementation
– Fidelity monitoring forms
– Group observation template
– Co-facilitation rubric
• Establish a system for reviewing student progress
–
–
–
–
Hint: you may want to incorporate non-clinical data
Harper “BAG” report
Exit criteria for Tier 3
Movement between tiers
• Establish a system for managing student needs postgroup
42
Co-facilitation Rubric
Facilitator 1:
Facilitator 2:
Completed?
BEFORE THE GROUP
Establish a group meeting schedule
Inform students of the group schedule
Inform referring teacher of the student's participation
Obtain parent consent and necessary screening documents
Make sure all screening documents have been entered into OSES Sharepoint
Establish a points system
Decide on your co-facilitation/planning style(when, how)
DURING THE GROUP
Provide feedback to the referring teacher & referring POD
Build the agenda using the manual & supplemental outlines
Create manipulatives/posters when necessary
Copy necessary handouts and checkpoints(OSES Sharepoint)
Plan a group meeting time (if not already set)
Pick up the students
Carry out the agenda
Complete the fidelity monitoring logs @ the end of each group
Record a progress note in HSMP or OSES Sharepoint
Enter a group event in the OSES Sharepoint
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Sample “BAG” Report:
Misconduct
Wk1 Wk2 Wk3 Wk4 Wk5 Wk6 Wk7 Wk8 Wk9 Wk10 Wk11
Wk12
Wk13 Wk14 Wk15 Wk16 Wk17 Wk18 Wk19 Wk20 Wk21 Total
Tier 3
Student A
1
Student B
1
1
2
1
Student C
2
1
1
Student D
1
1
1
6
1
6
1
1
Student E
1
Student F
1
Student G
1
2
Student J
5
1
1
2
1
1
1
2
2
2
1
6
1
1
3
1
1
2
2
1
1
1
1
Student I
1
6
1
1
1
1
1
1
Student H
Total
1
1
1
2
5
2
3
2
2
2
5
1
4 39
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Sample “BAG” Report:
Attendance
Think First 2
Student Name
Brown, Diane
7-Nov
91.00%
18-Nov
87.21%
27-Nov
82.00%
6-Dec
83.33%
12-Dec
81.67%
16-Dec
75.38%
Brown, Gabriel
84.00%
82.65%
72.32%
72.50%
65.91%
62.68%
60.53%
55.95%
Dotson, Dearold
88.00%
85.58%
86.44%
86.51%
87.68%
86.49%
85.44%
85.63%
Jackson, Dominque
78.00%
72.22%
72.95%
73.08%
74.65%
76.32%
75.31%
73.03%
Parker, Felica
92.00%
91.67%
90.98%
91.54%
90.14%
90.13%
88.27%
88.20%
Vaughn, Terrance
97.00%
98.15%
96.72%
96.92%
97.89%
96.71%
96.30%
96.07%
White, Shari
90.00%
91.67%
90.98%
91.54%
91.55%
91.45%
91.98%
91.57%
Edwards, Vinesha
66.00%
68.52%
65.57%
63.85%
63.38%
63.82%
63.58%
65.73%
82%
82%
80.44%
82.41%
81.61%
80.37%
78.93%
79.46
Dukes, Mercedes
92.59%
87.93%
88.52%
87.69%
85.92%
85.53%
85.19%
85.39%
Johnson, Dashay
80.56%
79.31%
77.05%
74.24%
69.01%
67.76%
68.52%
69.10%
Robinson, Dionte
86.00%
83.33%
82.46%
83.61%
85.07%
86.11%
85.06%
82.94%
Walker, Tyiesha
98.15%
98.28%
98.36%
97.69%
97.18%
97.37%
96.30%
95.51%
Mcgoogin, Keanna
98.15%
98.28%
95.90%
96.15%
96.48%
96.71%
96.30%
96.07%
Branch, Arreanna
88.89%
88.79%
88.52%
89.23%
88.73%
89.47%
90.12%
90.45%
Robertson, Donesha
88.78%
87.74%
86.61%
85.00%
84.85%
80.99%
78.95%
80.95%
Ruff, Diamond
91.67%
92.24%
91.80%
92.31%
91.55%
91.45%
90.74%
90.45%
Robinson, Rochel
95.37%
93.97%
94.26%
93.08%
92.96%
92.76%
90.74%
88.20%
Brioso, Giovanny
69.57%
68.52%
68.33%
72.06%
73.75%
75.56%
78.00%
76.72%
GROUP TOTAL
88.97%
88%
87.18%
87.11%
86.55%
86.37%
GROUP TOTAL
Think First 3
14-Jan
28-Jan
70.00% n/a
85.99% 85.58%
45
End of Year Service and
Provider Data
#
#
#
#
#
#
#
#
#
students referred to CARE team
students receiving tier two
students receiving tier three
students referred to school-based community partner
students referred to external provider
students on CARE team receiving special education services
groups
community partners participating in CARE team meetings
community partner staff participating in CARE team meetings
• See handout!
46
Activity
• Who would make up your CARE team?
• How would CARE team interface with other school systems:
grade levels, discipline, attendance?
47
Contact Information
Laura Hurwitz
[email protected]
Elizabeth Stranzl
[email protected]
48