implementation of positive behavioral interventions & supports (pbis) in a children’s...
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Implementation of Positive Behavioral Interventions & Supports (PBIS) in a Children’s Residential Mental Health Treatment Program Veronica P. Arellano, O&E Manager Andrew Pane, Milieu Activities Therapist. Georgetown Training Institute Conference Orlando, FL July 2006. - PowerPoint PPT PresentationTRANSCRIPT
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Implementation of Positive Implementation of Positive Behavioral Interventions & Behavioral Interventions &
Supports (PBIS)Supports (PBIS)
in a Children’s Residentialin a Children’s Residential
Mental Health Treatment ProgramMental Health Treatment ProgramVeronica P. Arellano, O&E ManagerVeronica P. Arellano, O&E Manager
Andrew Pane, Milieu Activities Therapist Andrew Pane, Milieu Activities Therapist
Georgetown Training Institute ConferenceGeorgetown Training Institute Conference
Orlando, FLOrlando, FL
July 2006July 2006
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Context and Reasoning for ChangeContext and Reasoning for Change To achieve improved To achieve improved
outcomesoutcomes Poor outcomes cited Poor outcomes cited
nationally for residential nationally for residential services services
High cost of services, in High cost of services, in context of diminishing context of diminishing resourcesresources
Effectiveness of community Effectiveness of community based servicesbased services
Focus on permanency and Focus on permanency and the effect foster care has the effect foster care has had on severing family had on severing family connectionsconnections
To implement evidence To implement evidence based services including based services including PBIS, TF-CBT, and Parent PBIS, TF-CBT, and Parent Management TrainingManagement Training
To utilize residential services To utilize residential services as an intervention, not a as an intervention, not a placementplacement
To increase youth and family To increase youth and family connections and sustainable connections and sustainable community supportscommunity supports
To ensure consistent To ensure consistent implementation of a implementation of a strength based, needs strength based, needs driven, family centered, driven, family centered, individualized and culturally individualized and culturally relevant philosophy relevant philosophy in all in all aspects of careaspects of care
To partner with families and To partner with families and ensure family involvement in ensure family involvement in all aspects of careall aspects of care
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Phases Change ProcessPhases Change Process
Phase 1 - Data Phase 1 - Data GatheringGathering
Focus groups with Focus groups with families and childrenfamilies and children
Staff questionnairesStaff questionnaires Customer questionnairesCustomer questionnaires Reviewed 7 years of Reviewed 7 years of
internal datainternal data Literature review of Literature review of
Evidence-Based Evidence-Based PracticesPractices
Benchmarking other Benchmarking other residential programsresidential programs
Attendance at “Best Attendance at “Best Practices” conferencesPractices” conferences
Phase 2 – Phase 2 – ImplementationImplementation
Implemented PBISImplemented PBIS Family FindingFamily Finding Family Inclusion Family Inclusion
Practices and Practices and ProceduresProcedures
Community Based Community Based PracticesPractices
Switch to Mental Health Switch to Mental Health Model vs. Day TX.Model vs. Day TX.
Developed Transitional Developed Transitional ServicesServices
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Residential Services Residential Services DescriptionDescription
4 RCL (Rate Classification Level) 14 cottages, 4 RCL (Rate Classification Level) 14 cottages, capacity of up to 10 children capacity of up to 10 children
Two units for children ages 6-12 yearsTwo units for children ages 6-12 years Two units for youth ages 12-18 yearsTwo units for youth ages 12-18 years 3 are co-ed and 1 is all male3 are co-ed and 1 is all male
Array of ServicesArray of Services
Comprehensive Comprehensive assessment of all life assessment of all life domainsdomains
Family TherapyFamily Therapy Individual TherapyIndividual Therapy Intensive case Intensive case
management and linkage management and linkage to community activitiesto community activities
Nursing servicesNursing services Psychiatric Assessment Psychiatric Assessment
and Treatmentand Treatment
Psycho educational Psycho educational and and psychotherapeutic psychotherapeutic groups Academic groups Academic support support
Family FindingFamily Finding Family Partner Family Partner
ServicesServices Medical/Dental Medical/Dental
Assessment and Assessment and LinkageLinkage
Recreational, Music Recreational, Music and Art Therapy and Art Therapy
Therapeutic milieu Therapeutic milieu based on PBIS based on PBIS principlesprinciples
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Youth CharacteristicsYouth Characteristics
ResidentialResidential
GenderGender MaleMale 59%59%
LanguageLanguage EnglishEnglish 95%95%
EthnicityEthnicity African AmericanAfrican American 13%13%
CaucasianCaucasian 30%30%
Latin AmericanLatin American 46%46%
OtherOther 12%12%
Age at EntryAge at Entry 13 to 18 Years Old13 to 18 Years Old 54%54%
% of Out-of-Home % of Out-of-Home PlacementsPlacements
3 or More3 or More 79%79%
CAFAS at EntryCAFAS at Entry Severe (140 and Higher)Severe (140 and Higher) 69%69%
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Youth CharacteristicsYouth Characteristics(cont.)(cont.)
ResidentiResidentialal
History of History of AbuseAbuse
PhysicalPhysical YesYes 64%64%
SexualSexual YesYes 40%40%
Drug/AlcoholDrug/Alcohol YesYes 77%77%
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Why PBIS?Why PBIS?
Evidence in schools that approach creates pro social Evidence in schools that approach creates pro social positive environmentspositive environments
Alignment with agency philosophyAlignment with agency philosophy
Goodness of fit: congruent with behavioral approach Goodness of fit: congruent with behavioral approach already utilizedalready utilized
Focus on increasing quality of life, achieving broad Focus on increasing quality of life, achieving broad goals and supporting portable skillsgoals and supporting portable skills
Use of a proactive and educative approach to support Use of a proactive and educative approach to support elimination of “control based” interventions including elimination of “control based” interventions including restraintsrestraints
Eber, Sugai, Smith, & Scott (2002); Scott & Eber (2003 a & b) Eber, Sugai, Smith, & Scott (2002); Scott & Eber (2003 a & b)
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PBIS Implementation PBIS Implementation StrategiesStrategies
PBIS Overview Training for all staffPBIS Overview Training for all staff
Hired a Consultant who observed each cottage to understand Hired a Consultant who observed each cottage to understand current operations and provided 3 8-hourcurrent operations and provided 3 8-hour trainingstrainings on Functional on Functional Behavioral Assessment and Behavior Support PlansBehavioral Assessment and Behavior Support Plans
Developed an implementation work teamDeveloped an implementation work team
Developed a “Support team”Developed a “Support team”
Developed behavior and cottage management systemDeveloped behavior and cottage management system
Reviewed past point and level system, developed new systems Reviewed past point and level system, developed new systems based on values matrixbased on values matrix
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Living Situation at Exit
0%
20%
40%
60%
80%
100%
Pre-EBP Post-EBP Pre-EBP Post-EBP Pre-EBP Post-EBP Pre-EBP Post-EBP
Willow Sequoia Penn East Ruth Mallery
Home Foster Family More Restrictive Other
1010
Reason for Discharge
0%
20%
40%
60%
80%
100%
Pre-EBP Post-EBP Pre-EBP Post-EBP Pre-EBP Post-EBP Pre-EBP Post-EBP
Willow Sequoia Penn East Ruth Mallery
Planned Discharge Tx Goals Not Met Neutral Missing Information
1111
Average Number of Restraints Per Month
0
86
01
12
9
3
0
24
68
1012
14
Willow Sequoia Penn East Ruth MalleryAvg
. Num
ber
of R
estr
aint
s
Pre-EBP Post-EBP
1212
Average Number of Assaultive Behaviors Per Month
0
8 7
32
16
11
5
0
5
10
15
20
Willow Sequoia Penn East Ruth MalleryAvg
. Num
ber
of A
ssau
ltive
B
ehav
iors
Pre-EBP Post-EBP
1313
Facilitative FactorsFacilitative Factors Agency and PBIS philosophy alignmentAgency and PBIS philosophy alignment Sponsorship and resources from managementSponsorship and resources from management
Open to concerns and seeing resistance as helping to inform the change Open to concerns and seeing resistance as helping to inform the change processprocess
Acknowledging staff and celebrating successesAcknowledging staff and celebrating successes
Outcome and Evaluations DepartmentOutcome and Evaluations Department Data management practicesData management practices Using electronic record to gather and report dataUsing electronic record to gather and report data
Use of change methodology and quality improvement techniquesUse of change methodology and quality improvement techniques Clearly delegating tasks to specific people with timelinesClearly delegating tasks to specific people with timelines
PBIS Trainer/consultant became familiar with program, built PBIS Trainer/consultant became familiar with program, built relationship with staff and maintained on-going support for relationship with staff and maintained on-going support for implementation.implementation.
Resource binders and booksResource binders and books
Developing Program Procedures to support implementationDeveloping Program Procedures to support implementation Structuring discussions of BSP in team meetingsStructuring discussions of BSP in team meetings Development of a “Support Team” and an Operations work teamDevelopment of a “Support Team” and an Operations work team Building PBIS job expectations into staff evaluationsBuilding PBIS job expectations into staff evaluations
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ChallengesChallenges Implementing significant change while caring for children 24-7Implementing significant change while caring for children 24-7
Deciding what practices to discontinue to make room for new practicesDeciding what practices to discontinue to make room for new practices
Development of a sustainability planDevelopment of a sustainability plan
Considering multi-systemic needs and regulations, particularly in terms of Considering multi-systemic needs and regulations, particularly in terms of documentationdocumentation
Maintaining focus and prioritizing PBIS implementation with multiple other Maintaining focus and prioritizing PBIS implementation with multiple other demandsdemands
Learning curve on how to utilize data to inform practiceLearning curve on how to utilize data to inform practice
Establishing consistency and accountability across three shifts, 20 staff and Establishing consistency and accountability across three shifts, 20 staff and registryregistry
Overcoming agency culture “flavor of the day”Overcoming agency culture “flavor of the day”
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ReferencesReferences
Scott, T.M. & Eber, L. (2003). Functional Scott, T.M. & Eber, L. (2003). Functional Assessment and Wraparound as Systemic Assessment and Wraparound as Systemic School Processes: Primary, Secondary, and School Processes: Primary, Secondary, and Tertiary Systems Examples. Tertiary Systems Examples. Journal of Journal of Positive Behavior Interventions, Vol 5 (Positive Behavior Interventions, Vol 5 (3), 3), pp 131-143.pp 131-143.
Eber, L., Sugai, G., Smith, AC.R., & Scott, Eber, L., Sugai, G., Smith, AC.R., & Scott, T.M.T.M.
(2002). Wraparound and Positive Behavioral (2002). Wraparound and Positive Behavioral Interventions and Supports in the Schools. Interventions and Supports in the Schools. Journal of Emotional and Behavioral Journal of Emotional and Behavioral Disorders, Vol Disorders, Vol 10 (3), pp 171-180.10 (3), pp 171-180.