Efficient Wraparound Service Model for Students with Emotional and Behavioral Disorders: A Collaborative Model for School Social Workers and Teachers

Efficient Wraparound Service Model for Students with Emotional and Behavioral Disorders: A... Teachers of students with emotional and behavioral disorders (EBD) face the challenge of managing core academics alongside maladaptive behavior that may be insurmountable without embedded support from mental health professionals (Henderson, Klein, Gonzalez, & Bradley, 2005). Possible providers of mental health support include school social workers as they can directly assist within an EBD self-contained classroom (Frey & George-Nichols, 2003). Teachers of students with EBD and social workers providing classroom-level wraparound individual support within a multitiered system would fall under Tier 3 services. Multitiered systems of support (MTSS) often cover both academics and behavior with the academic side referred to as Response to Intervention and the behavior side Positive Behavior Intervention Supports (PBIS). The commonality across both academic and behavior sides is the range from Tier 1 (least individualized), designed to improve all student outcomes, to Tier 3 (most individualized and most support). Based on our practitioner experiences, the primary purpose of this article is to suggest ways school social workers can provide supports through wraparound services (Painter, 2012) and collaborate with teachers (Eber, 2003). A case scenario  appendix (with pseudonyms) connected to the content of this Practice Highlights is provided as an additional resource for practitioners. Wraparound Services within Tier 3 Wraparound programming is a process by which a supportive team is formed to work together to develop, monitor, and update the support plan until success is achieved (Shepherd & Linn, 2015). This team includes the teacher, social worker, identified support staff, and the student’s family. The wraparound approach to programming includes four distinctive phases (Eber, 2003; Eber et al., 2009). Based on the research by Eber (2003), these four phases consistently include all key players as integral parts of the planning, development, and monitoring. Phase 1 includes meeting with the family to develop the working team that will monitor the students’ progress. During Phase 2 teachers and school social workers collaborate on completing mental health assessments, functional behavior assessments (FBAs), provide suggestions for individualized supports, provide more intensive interventions based on the student’s needs, and link the student and family to needed services. FBA is a systematic method of assessing the purpose of a problem behavior to guide interventions (Cooper, Heron, & Heward, 2007) within Tier 3 of MTSS (Shepherd & Linn, 2015). FBAs include both indirect (that is, interviews of the parent, student, and teacher; review of records; and so on) and direct assessments (that is, classroom observations). Sample observation sheets, FBA forms, and data tracking forms can be found at http://www.pbisworld.com/data-tracking/ free of charge. In addition, supporting tip sheets and training materials can be found at http://iseesam.com/content/teachall/text/behavior/LRBI.htm. Phase 3 includes identification of appropriate evidence-based interventions, plans for the implementation, and plans for data collection for progress monitoring. In this phase, the school social worker relies on his or her therapeutic and consultative training to assist the team with appropriate intervention identification. Examples of intensive individualized interventions should include both behavioral interventions in response to the data gathered from the FBAs and student-centered therapeutic interventions (Frey & George-Nichols, 2003). Student-centered therapeutic interventions can include cognitive–behavioral therapy (CBT) and trauma-focused cognitive–behavioral therapy (TFCBT). These supportive interventions take place during the academic day by a trained school social worker across settings. CBT is a goal-oriented problem-solving intervention that focuses on changing the thoughts and beliefs associated with challenging behaviors (Herzig-Anderson, Colognori, Fox, Stewart, & Warner, 2012), and it is combined with more explicit behavior interventions. TFCBT is an evidence-based strategy proven to be effective for students who have experienced single, multiple, or complex traumatic events (Fitzgerald & Cohen, 2012). Helpful tools and evidence-based interventions can be found at http://www.pbisworld.com/. The final phase of the wraparound process is Phase 4: plan completion and transition. This phase includes moving toward least restrictive supports and interventions that are more reflective of the natural environment while continuing the data collection and monitoring of student progress (information about the four key phases of this process is available from the Midwest PBIS Network [n.d.]). Evaluating Wraparound Effective wraparound services are built on designing and planning integrity checks throughout the four phases. Thus, wraparound must include ongoing monitoring in terms of data collection on efficacy, integrity, and continuity of care within the community. Literature suggests that data collection timelines are planned and that results are used to drive decision making and future planning (Shepherd & Linn, 2015). MTSS evaluation tools and PBIS assessments to guide schools with monitoring wraparound within their schools can be found at http://www.pbis.org/evaluation/evaluation-tools. An additional source link (Midwest PBIS Network, n.d.) provides fidelity checklist for wraparound services. Conclusion Managing behaviors for students with EBD in a self-contained classroom can be challenging; thus, it is essential to provide team-based support at Tier 3. However, if teachers and school social workers collaborate, students with EBD can receive mental health, social–emotional, behavioral, and academic supports within Tier 3. Because interventions should include individualized behavior plans, counseling services, linkage to additional services outside of the school system, case management, and additional parental supports, collaboration is essential between teachers and social workers. References Cooper, J. O., Heron, T. E., & Heward, W. L. ( 2007). Applied behavior analysis  ( 2nd ed.). Upper Saddle River, NJ: Pearson. Eber, L. ( 2003). The art and science of wraparound: Completing the continuum of schoolwide behavioral support . Bloomington: Forum on Education at Indiana University. Eber, L., Hyde, K., Rose, J., Breen, K., McDonald, D., & Lewandowski, H. ( 2009). Completing the continuum of schoolwide positive behavior support: Wraparound as a tertiary-level intervention. In W. Sailor, G. Dunlop, & G. Sugai (Eds.), Handbook of positive behavior support  (pp. 671– 703). New York: Springer. Google Scholar CrossRef Search ADS   Fitzgerald, M., & Cohen, J. ( 2012). Trauma-focused cognitive behavior therapy for school psychologists. Journal of Applied School Psychology,  28, 294– 315. Google Scholar CrossRef Search ADS   Frey, A., & George-Nichols, N. ( 2003). Intervention practices for students with emotional and behavioral disorders: Using research to inform school social work practice. Children & Schools,  25, 97– 104. Google Scholar CrossRef Search ADS   Henderson, K., Klein, S., Gonzalez, P., & Bradley, R. ( 2005). Teachers of children with emotional disturbance: A national look at preparation, teaching conditions, and practices. Behavioral Disorders,  31( 1), 6– 17. Herzig-Anderson, K., Colognori, D., Fox, J. K., Stewart, C. E., & Warner, C. M. ( 2012). School-based anxiety treatments for children and adolescents. Child and Adolescent Psychiatry,  21, 655– 668. Google Scholar CrossRef Search ADS   Midwest PBIS Network. (n.d.). Wraparound. Retrieved from http://www.midwestpbis.org/materials/wraparound Painter, K. ( 2012). Outcomes for youth with severe emotional disturbance: A repeated measures longitudinal study of a wraparound approach of service delivery in systems of care. Child and Youth Care Forum,  41, 407– 425. Google Scholar CrossRef Search ADS   Shepherd, T. L., & Linn, D. ( 2015). Behavior and classroom management in the multicultural classroom: Proactive, active, and reactive strategies . Los Angeles: Sage Publications. Google Scholar CrossRef Search ADS   Appendix: A Case Vignette Marcus, an eight-year-old male student in second grade, was referred for wraparound supports because of frequent office referrals and suspensions resulting from self-injurious behavior (SIB). His SIB included banging his head on the desk or the wall and poking his hand with a sharpened pencil. Marcus had a previous diagnosis from a primary care physician of attention-deficit/hyperactivity disorder (ADHD) and was taking a stimulant-based medication. At the beginning of the year, Marcus was not receiving any counseling services. The mother disclosed in a parent–teacher conference a family history of bipolar disorder and mood disorders, and she was interested in pursuing additional assessments to rule out such diagnoses. In a previous psychoeducational assessment, Marcus was deemed eligible for emotional and behavior disorder diagnosi and was placed in a self-contained classroom for additional supports. Because of the severity of his SIB behaviors and lack of improvements with Tier 1 and 2 interventions, the support team met to determine the next steps. Previous interventions included corrective feedback, calm-down time within and outside of the classroom, and visits to the guidance counselor’s office. The SIB was so concerning that during one episode, crisis intervention was contacted and recommended intensive outpatient counseling, but these services unfortunately did not take place. The support team (administrator, special education teacher, general education teacher, parent, school psychologist, and school social worker) convened and reviewed academic and behavioral data. Marcus’s academic performance was found to be within average range, but SIB was on an increasing trend. Thus, a team decision was made to look at comprehensive wraparound and social–emotional approaches. To support the student, functional behavior assessments, a behavior intervention plan, and a comprehensive mental and behavioral health assessment were determined to be the best next steps. Indirect and direct assessment procedures hypothesized an escape-maintained function. The mental health assessment revealed that Marcus did have a mood disorder, and the current ADHD stimulant-based medications may have been exacerbating his aggression, anger, and self-injury. As a key component to service delivery, the school social worker assisted the parent with identifying a local community mental health agency to address the medication management issues and shared the needed information with the agency after securing the parent’s permission. Because of the wraparound programming, Marcus received a continuum of care across school and community and began showing marked improvement. Based on his success, the team then initiated a plan to start inclusion-based (within the K–12 school) services for Marcus. © 2017 National Association of Social Workers http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Children & Schools Oxford University Press

Efficient Wraparound Service Model for Students with Emotional and Behavioral Disorders: A Collaborative Model for School Social Workers and Teachers

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Publisher
Oxford University Press
Copyright
© 2017 National Association of Social Workers
ISSN
1532-8759
eISSN
1545-682X
D.O.I.
10.1093/cs/cdx030
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Abstract

Teachers of students with emotional and behavioral disorders (EBD) face the challenge of managing core academics alongside maladaptive behavior that may be insurmountable without embedded support from mental health professionals (Henderson, Klein, Gonzalez, & Bradley, 2005). Possible providers of mental health support include school social workers as they can directly assist within an EBD self-contained classroom (Frey & George-Nichols, 2003). Teachers of students with EBD and social workers providing classroom-level wraparound individual support within a multitiered system would fall under Tier 3 services. Multitiered systems of support (MTSS) often cover both academics and behavior with the academic side referred to as Response to Intervention and the behavior side Positive Behavior Intervention Supports (PBIS). The commonality across both academic and behavior sides is the range from Tier 1 (least individualized), designed to improve all student outcomes, to Tier 3 (most individualized and most support). Based on our practitioner experiences, the primary purpose of this article is to suggest ways school social workers can provide supports through wraparound services (Painter, 2012) and collaborate with teachers (Eber, 2003). A case scenario  appendix (with pseudonyms) connected to the content of this Practice Highlights is provided as an additional resource for practitioners. Wraparound Services within Tier 3 Wraparound programming is a process by which a supportive team is formed to work together to develop, monitor, and update the support plan until success is achieved (Shepherd & Linn, 2015). This team includes the teacher, social worker, identified support staff, and the student’s family. The wraparound approach to programming includes four distinctive phases (Eber, 2003; Eber et al., 2009). Based on the research by Eber (2003), these four phases consistently include all key players as integral parts of the planning, development, and monitoring. Phase 1 includes meeting with the family to develop the working team that will monitor the students’ progress. During Phase 2 teachers and school social workers collaborate on completing mental health assessments, functional behavior assessments (FBAs), provide suggestions for individualized supports, provide more intensive interventions based on the student’s needs, and link the student and family to needed services. FBA is a systematic method of assessing the purpose of a problem behavior to guide interventions (Cooper, Heron, & Heward, 2007) within Tier 3 of MTSS (Shepherd & Linn, 2015). FBAs include both indirect (that is, interviews of the parent, student, and teacher; review of records; and so on) and direct assessments (that is, classroom observations). Sample observation sheets, FBA forms, and data tracking forms can be found at http://www.pbisworld.com/data-tracking/ free of charge. In addition, supporting tip sheets and training materials can be found at http://iseesam.com/content/teachall/text/behavior/LRBI.htm. Phase 3 includes identification of appropriate evidence-based interventions, plans for the implementation, and plans for data collection for progress monitoring. In this phase, the school social worker relies on his or her therapeutic and consultative training to assist the team with appropriate intervention identification. Examples of intensive individualized interventions should include both behavioral interventions in response to the data gathered from the FBAs and student-centered therapeutic interventions (Frey & George-Nichols, 2003). Student-centered therapeutic interventions can include cognitive–behavioral therapy (CBT) and trauma-focused cognitive–behavioral therapy (TFCBT). These supportive interventions take place during the academic day by a trained school social worker across settings. CBT is a goal-oriented problem-solving intervention that focuses on changing the thoughts and beliefs associated with challenging behaviors (Herzig-Anderson, Colognori, Fox, Stewart, & Warner, 2012), and it is combined with more explicit behavior interventions. TFCBT is an evidence-based strategy proven to be effective for students who have experienced single, multiple, or complex traumatic events (Fitzgerald & Cohen, 2012). Helpful tools and evidence-based interventions can be found at http://www.pbisworld.com/. The final phase of the wraparound process is Phase 4: plan completion and transition. This phase includes moving toward least restrictive supports and interventions that are more reflective of the natural environment while continuing the data collection and monitoring of student progress (information about the four key phases of this process is available from the Midwest PBIS Network [n.d.]). Evaluating Wraparound Effective wraparound services are built on designing and planning integrity checks throughout the four phases. Thus, wraparound must include ongoing monitoring in terms of data collection on efficacy, integrity, and continuity of care within the community. Literature suggests that data collection timelines are planned and that results are used to drive decision making and future planning (Shepherd & Linn, 2015). MTSS evaluation tools and PBIS assessments to guide schools with monitoring wraparound within their schools can be found at http://www.pbis.org/evaluation/evaluation-tools. An additional source link (Midwest PBIS Network, n.d.) provides fidelity checklist for wraparound services. Conclusion Managing behaviors for students with EBD in a self-contained classroom can be challenging; thus, it is essential to provide team-based support at Tier 3. However, if teachers and school social workers collaborate, students with EBD can receive mental health, social–emotional, behavioral, and academic supports within Tier 3. Because interventions should include individualized behavior plans, counseling services, linkage to additional services outside of the school system, case management, and additional parental supports, collaboration is essential between teachers and social workers. References Cooper, J. O., Heron, T. E., & Heward, W. L. ( 2007). Applied behavior analysis  ( 2nd ed.). Upper Saddle River, NJ: Pearson. Eber, L. ( 2003). The art and science of wraparound: Completing the continuum of schoolwide behavioral support . Bloomington: Forum on Education at Indiana University. Eber, L., Hyde, K., Rose, J., Breen, K., McDonald, D., & Lewandowski, H. ( 2009). Completing the continuum of schoolwide positive behavior support: Wraparound as a tertiary-level intervention. In W. Sailor, G. Dunlop, & G. Sugai (Eds.), Handbook of positive behavior support  (pp. 671– 703). New York: Springer. Google Scholar CrossRef Search ADS   Fitzgerald, M., & Cohen, J. ( 2012). Trauma-focused cognitive behavior therapy for school psychologists. Journal of Applied School Psychology,  28, 294– 315. Google Scholar CrossRef Search ADS   Frey, A., & George-Nichols, N. ( 2003). Intervention practices for students with emotional and behavioral disorders: Using research to inform school social work practice. Children & Schools,  25, 97– 104. Google Scholar CrossRef Search ADS   Henderson, K., Klein, S., Gonzalez, P., & Bradley, R. ( 2005). Teachers of children with emotional disturbance: A national look at preparation, teaching conditions, and practices. Behavioral Disorders,  31( 1), 6– 17. Herzig-Anderson, K., Colognori, D., Fox, J. K., Stewart, C. E., & Warner, C. M. ( 2012). School-based anxiety treatments for children and adolescents. Child and Adolescent Psychiatry,  21, 655– 668. Google Scholar CrossRef Search ADS   Midwest PBIS Network. (n.d.). Wraparound. Retrieved from http://www.midwestpbis.org/materials/wraparound Painter, K. ( 2012). Outcomes for youth with severe emotional disturbance: A repeated measures longitudinal study of a wraparound approach of service delivery in systems of care. Child and Youth Care Forum,  41, 407– 425. Google Scholar CrossRef Search ADS   Shepherd, T. L., & Linn, D. ( 2015). Behavior and classroom management in the multicultural classroom: Proactive, active, and reactive strategies . Los Angeles: Sage Publications. Google Scholar CrossRef Search ADS   Appendix: A Case Vignette Marcus, an eight-year-old male student in second grade, was referred for wraparound supports because of frequent office referrals and suspensions resulting from self-injurious behavior (SIB). His SIB included banging his head on the desk or the wall and poking his hand with a sharpened pencil. Marcus had a previous diagnosis from a primary care physician of attention-deficit/hyperactivity disorder (ADHD) and was taking a stimulant-based medication. At the beginning of the year, Marcus was not receiving any counseling services. The mother disclosed in a parent–teacher conference a family history of bipolar disorder and mood disorders, and she was interested in pursuing additional assessments to rule out such diagnoses. In a previous psychoeducational assessment, Marcus was deemed eligible for emotional and behavior disorder diagnosi and was placed in a self-contained classroom for additional supports. Because of the severity of his SIB behaviors and lack of improvements with Tier 1 and 2 interventions, the support team met to determine the next steps. Previous interventions included corrective feedback, calm-down time within and outside of the classroom, and visits to the guidance counselor’s office. The SIB was so concerning that during one episode, crisis intervention was contacted and recommended intensive outpatient counseling, but these services unfortunately did not take place. The support team (administrator, special education teacher, general education teacher, parent, school psychologist, and school social worker) convened and reviewed academic and behavioral data. Marcus’s academic performance was found to be within average range, but SIB was on an increasing trend. Thus, a team decision was made to look at comprehensive wraparound and social–emotional approaches. To support the student, functional behavior assessments, a behavior intervention plan, and a comprehensive mental and behavioral health assessment were determined to be the best next steps. Indirect and direct assessment procedures hypothesized an escape-maintained function. The mental health assessment revealed that Marcus did have a mood disorder, and the current ADHD stimulant-based medications may have been exacerbating his aggression, anger, and self-injury. As a key component to service delivery, the school social worker assisted the parent with identifying a local community mental health agency to address the medication management issues and shared the needed information with the agency after securing the parent’s permission. Because of the wraparound programming, Marcus received a continuum of care across school and community and began showing marked improvement. Based on his success, the team then initiated a plan to start inclusion-based (within the K–12 school) services for Marcus. © 2017 National Association of Social Workers

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Children & SchoolsOxford University Press

Published: Jan 1, 2018

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