secondary planning day 1 final - positive supports minnesota … · 2020-04-07 · o personal...

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Secondary Team MeetingYear 4 – Day 1

Morning Agenda

• Review of 2-Day Level 3 Event & Regional Planning

• Review of Secondary (Tier 2) Progress• Discuss How We Will Organize the Next Team

Training Days

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Review of Secondary Teams

Person-Centered Practices & Planning

Organizational Workforce Development


Positive Behavior SupportTertiary Stage• In Depth Person-Centered Plans• Integrated Plans (PCP, PBS, Trauma-

informed Therapy)• Teams Monitor Plan Progress

Primary Stage• Universal Person-Centered Strategies• Encourage Self Expression• Self-Determination and Choice Making• Meaningful Participation in the

Community

Secondary Stage• Monitor PCT Action Plans • Additional Quality of Life Strategies• Increase Strategies for Supporting Independence and

Community Involvement• Mental Health and Wellness Interventions

Implementing Multi-Tiered Systems of Support

Positive Behavior Support

Organizational Workforce

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Universal Stage• Teach and Encourage Communication• Predictable and Proactive Settings• Encourage and Reinforce Social Skills• Consensus-Based Team Focus• Emphasis on Using Data For Decisions

Secondary Stage• Early Intervention and Data Monitoring• Additional Supports for Key Social Skills• Function-Based Decisions• Simple Interventions • Mental Health and Wellness Interventions

Tertiary Stage• Individualized PBS Plans• Integrated with Other Positive Supports (PCP, Trauma-

Informed Care, DBT, Etc.)• Plans Are Monitored- Data-Based Decision Making• Teams Monitor Progress of Each Person

Organizational Workforce Development

Person Centered Practices & Planning




Organizational Workforce

Organizational Workforce DevelopmentPositive Behavior Support

Universal Stage• Align Policies to Person-Centered Practices• Revise Job Descriptions, and Performance Evaluations• Integrate Person-Centered Practices and PBS With New Orientation and

Ongoing Instruction• Use Data for Decision Making

Secondary Stage• Monitoring and Early Intervention • Training Targeted for Groups• Targeted Strategies to Improve Specific Settings• Simple Problem Solving for Challenging Situations That Occur in More

Than One Situation

Tertiary Stage• Tailor Problem Solving for Specific Problematic Situations • Individualize Training and Mentoring to Address Unique Settings

Where Problems Occur• Improve Supervision and Mentoring for Locations Experiencing

Challenges• Establish Matching/Hiring Tailored to Individualized Plans Organizational Workforce



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Incidents -- IF... FOCUS ON...

£ More than 40% of people in organization have been involved in an incident

£ More than 2.5 incidents per personOrganization-Wide System

£ More than 35% of incidents occur in the community

Community£ More than 60% of incidents come from specific

settings

£ More than 10-15 people are involved in incidents in one setting

Within Specific Settings

£ Less than 10 people involved in 10 or more incidents

£ Less than 10 people continue rate of referrals after secondary strategies are tried

£ Small number of people need more intensive supports

Individualized Supports

Use Data to Identify Where to Spend Your Time as a Team

Incident Reports &Data-based Decision Making

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People: 25

Incidents: 59

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Missing Attendance in Sessions – IF ... FOCUS ON...

£ More than 40% of people involved in mental health services have missed more than 3 sessions Organization-Wide System

£ More than 35% of attendance problems occur in one type of mental health service

Type of Services

£ Less than 10 people involved in 10 or more missed sessions

£ Less than 10 people continue rate missed sessions after secondary strategies are tried

£ Small number of people need more intensive supports

Individualized Supports

Use Data to Identify Where to Spend Your Time as a Team

Attendance & Data-based Decision Making

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People: 25

Incidents: 59

Num

ber o

f Miss

ed S

essio

ns

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Types of Data for Monitoring• Actively Monitor Quality of Life, Progress in

Mental Health Sessions, etc.o Person-Centered Descriptionso Personal Wellness Workbook

• Monitor Information Regularlyo Review Incident Reportso Attendance Patterns in Mental Health Sessions

• Support Plans or Other Documents• Satisfaction and Quality of Life Data

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Three Possible Tier 2 Team Decisions

• Level 1: Secondary Strategies (Quick Hypothesis)

• Level 2: Modify Tier 2 Strategies & Use Simple PBS Plans

• Level 3: Full Functional Behavioral Assessment and PBS Plan

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Last Time We Met

Introducing the Secondary Team to Others• Create the Process for Secondary Support• Share Plan

Discuss What is Needed• Referral Process• Simple Flow Chart• Presentation to Staff/Colleagues• Secondary Problem Solving Tool

Review of Progress

• Setting Up the Secondary Team• Creating Referral Process• Identifying Secondary Strategies– Person-Centered Practices– Positive Behavior Support– Workforce-Related Issues

• Problem-Solving Form for Meetings• Introducing Secondary Team to Staff• Learn More About Evidence-Based Strategies• Share De-Identified Examples of Secondary Team

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Organization-WideTeam

Addresses Universal Systems

Secondary/Tertiary Team

At Secondary Stage Organizations Form Two Teams

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Universal Team• Organization-Wide interventions• Monitor Organization-Wide Data • Implement Universal Strategies

Positive Support Secondary Team Managers• Monitor Personal Description Action Plans• Monitor Incident Reports• Decide What Level of Support Is Needed

– Is an Individual Team Meeting Needed– Can We Implement Secondary Strategies

Positive Support Team– Establish individualized Teams for More Intensive Plans– Monitor Progress of Each Team at Secondary and Tertiary Levels– Problem Solve When Quality of Life or Problem Behaviors Are Not Improving

Regional Team - Discussion• Interagency Team Meetings for Region• Additional Training and Supports• Assist With Referrals for Support

Organizing for Progress Monitoring and Problem Solving

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Secondary Tier Strategies• Minor Quality of Life Issues Needing Attention– Add Quality of Life Assessment– Expand Personal Description Action Plan

• Minor Social Interaction Problems– Simple Function-Based Strategies

• Group Social Skills– Mindfulness Activities– Expressing Emotions

Start With a Personal Description and Action Plan

• Personal Descriptions/Profiles with Action Plans in Place for All People Supported

• Monitor Action Plans for Progress Over Time

• List Individual Data That Can Be Used to Monitor Quality of Life

Flo’s Profile & Plan

What Is Important To Flo:

• Spending time & talking on

the phone with Rikki

(brother) & Ruby (sister).

• Hanging out with

Cheyenne.

• My wheelchair is kept

comfortable.

• Dressing well & feeling

good about my appearance

gives me a good self-

esteem.

• Getting out of the house to

enjoy LOTS of activities!

• Watching sports,

especially my favorite

teams the Twins &

Vikings!

• I enjoy playing with

balloons, having stuffed

animals around &

soft/warm blankets when

relaxing.

• Going to church regularly

and praying before bed

and meals.

• I love listening & singing

to music!

• It’s important to me that I

have choices & that people

listen to me.

• I am VERY social and want

the opportunity to meet

new people.

• Working on arts & crafts.

• Remembering my mom &

keeping her memory alive.

What Is Important For Flo:

• Having thicket in my

liquids for drinking.

• Making sure my

medications are monitored

and managed well.

• A healthy diet.

• Keeping my wheelchair in

working order &

comfortable.

• It’s important for me to be

dressed well so my self-

esteem doesn’t suffer.

• It’s important that I get out

in the community & enjoy a

variety of activities & that

those places are accessible

to me.

• It’s important for me to be

social & get out into the

community to meet new

people.

• It’s important for my

religious practices to be

respected &

accommodated.

• It’s important for me to

have choices, be respected

& feel my voice is being

heard.

• It’s important for me to

have people who will help

me find ways to remember

my mom & her memory.

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Add Simple Secondary Action Plan to Description

Action Planning Form

What needs to be done? How often?

Who is responsible

?

By when?

Jesse will make sure staff are organized and transportation is available on Sundays so Flo can attend church

Available Every Sunday

Jesse

By August16, 2017

Lucy will work with Flo to create a lunch club and help Flo send out invitations

Weekly Starting on August

Flo and Lucy

First invites by August 1, 2017

Jesse will help Flo create a simple invitation to lunch that Flo can share with people in the community

July 24, 2017

Flo and Jesse By August 16, 2017

Jamain will sit down with Flo on Sunday each week and identify a plan for spending time in the community, and share this with Jesse who will make sure transportation and staffing are available

August 13, 2017

Flo and Jamain

July 18, 2017

Rikki and Ruby will work with Flo to create a family collage book during their visits

August to September 6, 2017

Flo, Rikki, and Ruby

October, 2017

Flo will begin looking for a pet by visiting the sanctuary and assessing what kind of animal would be the best fit. Flo and the team will review findings together and take the next step

August to September

Flo and Jamain Review October, 2017

Wellness Self-Management Personal Workbook

http://www.irenegreene.com/wp-content/uploads/WSM_English_Wor

kbook.pdf

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Improving Quality of Life

Quality of Life

SAMHSA 8 Dimensions of Wellnesshttps://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness

Mental Wellnesshttps://mn.gov/dhs/assets/mental-wellness_tcm1053-307677.pdf

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Incident Reports &Data-based Decision Making

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People: 25

Incidents: 59

Attendance in Mental Health Sessions &Data-based Decision Making

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People: 25

Incidents: 59

Num

ber o

f Miss

ed S

essio

ns

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Secondary Team CharacteristicsReferrals to the Team– Automatic From Team Monitoring– Person Requests Referral– Staff Members, Guardians, Family Members Etc.

Make Referral1-2 People Meet Regularly to Monitor4-6 Times Per Month Larger Meeting

Referrals Monitored by 1-2 PeopleAutomatic Referrals• Action Plans from Personal Description Are Not Completed a Month

After Completion Due Date• 4-5 Incident Reports Signals Review• Team Identifies the Key Features for Automatic Referrals

Self-Referrals• Person Requests Referral

Referrals From Others• Staff Members, Guardians/Family, Case Managers

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Purpose of Behavior Support Team• 1-2 people in team review– Are we confident we know why a challenge is occurring?– Is there a secondary strategy that will address the

challenge?– Automatic weekly meetings to review progress

• Review data on all secondary strategies– Review progress each person is making– Decide whether to continue, modify

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Three Possible Team Decisions




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Possible Targeted Strategies in the Community

1. Person-Centered & Quality of Life Strategies Related to the Community

2. Social and Behavioral Supports3. Emotional Wellness4. Health and Wellness

Examples of Secondary Strategies• Additional Social and Communication Skills

Training• Strategies for Recognizing Emotions• Problem-Solving Employment Issues• Increase Friendship Skills• Relaxation and Mindfulness Activities• Other Health and Wellness Strategies• Self-Management Strategies

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Activity: What Secondary Strategies are Available?Name of Strategy Who Monitors

StrategyWhat is the Type of

Secondary Strategy?

DATA COLLECTED / MONITORED

Recognizing Emotions Jamain Social Skills Anger Outbursts

Incident Reports

Mindfulness Sessions

Stacey Mental Health Quality of Life Survey

Health and Wellness Class

lucy Health and Wellness

Quality of Life Survey

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RMHC GROUPSMAIN HIBBING BELL

AI GroupBecca Leaders

M 11:00-12:00 Peer Support MICDChristine Claveau

M 9:30-11:30 AMF 12:30-2:30 PM

GLBTA AcceptanceCris Tugnoli

M 4:00-5:00 PM Youth Psychotherapy Stacy Englund/Anna Q

M 3:30-5:00 Women’s GroupLinda Marafiot

M 12:30-2:30 PM

Seeking Safety (PTSD/CD)Kiah Bizal/Anna Quistad

T 10:00-11:00 AM Aggression ManagementAnn Wiedemer

T 9:30-12:00

Wellness GroupSue Kelly

T 12:30-2:30Th 12:30-2:30

ARMHS Stress MgmtBilli Homola

T 9:30-11:30 AM

Men’s GroupEric Hyttinen

W 9:30-11:30 AM

DBTTaylor Draper / Kiah Bizal

W 1:00-3:00 PM IDDT/MICD Group 2Katie Finch

W 10:00-12:00

Pathways to RecoveryEric Hyttinen

W 1:00-2:30 PM Art GroupClient led (Steph Hashey)

W 1:00-2:30 PM Seasonal

IMR – ForensicTim Kresien

W 2:30-4:30 PM Mindfulness in NatureDeb Meyers

W 1:00-4:00 PMSeasonal (starts in May)

AI GroupTaylor Draper

W 3:00-4:00 PM

Meditation/RelaxationDuane Dale

Th 3:00-4:00 Men’s GroupAurora Emmons

Th 10:00-12:00

Women’s DBTBecca Leaders

Th 1:00-3:00 PM Women’s GroupLeah Mornes-Kulcsar

Th 12:30-2:30 PM(currently full)

Women’s GroupLinda Marafiot

Th 12:30-2:30 PM

Art TherapyTaylor Draper / Kiah Bizal

F 9:30-11:00 AM AI GroupSara E / Aurora Emmons

F 10:00-11:00 AM

IDDT/MICD Group 1Katie Finch

F 12:30-2:30

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Do Your Secondary Strategies Address Different Functions

Self-Manage Social Skills Group

Communication Skills

Community

Seeking Staff Attention X X X

Seeking Attention from Friends X X X

Relationship Building X X

Choice of Activities X

Teaching of Social Skills for Work X X X X

Precorrect/ Feedback Prior to Events X X X

Self-Management: Teach New Skills To Replace Challenging Interaction With A More Efficient

And Effective Social Skill

Connect the Self-Management to the Matrix Skills Being Used at the Universal Level

Setting Event

TriggeringEvent OrAntecedent

Problem Behavior

Consequence (What The Child Obtains Or Escapes/Avoids)

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Functional Assessment Pathway

Setting EventTriggeringEvent or

AntecedentProblem Behavior

MaintainingConsequence

THE FUNCTION“Get something”“Get away from

Something”

Goal: Over time all school personnel think about function of behavior on a continuum for • Classroom management• Grade level team problem solving• School-wide tier 1 planning (universal interventions)• Tier 2 interventions for academic and behavior• Tier 3

Function-Based Decision Making Activity for Staff

• Hypothesis Statements

Access Tier 2 Resources Here: https://mnpsp.org/training-materials-cohort-2/

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Strategies for Assessment & Evaluation

Mindfulness Self-Assessmenthttps://ppc.sas.upenn.edu/resources/questionnaires-researchers/mindful-attention-awareness-scale

Difficulties in Emotion Regulationhttp://cairncenter.com/forms/difficultiesinemotionalregulation_scale.pdf

Discuss & Team Share Out• Discuss With Your Team Where Your Are With Tier 2 Implementation

o What is Missing?o What are the Next Steps?

• Can You Share an Example of the How the Tier 2 Process is Working for the Other Teams?

• Do You Have Secondary Strategies Available to Address Different Functions?o What Types are in Place?o How Do You Know They Are Successful?

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Activity: What Secondary Strategies are Available?Name of Strategy

Who Monitors Strategy

What is the Type of

Secondary Strategy?

DATA COLLECTED / MONITORED

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Three Possible Team Decisions


• Level 2: Modify Targeted Interventions or Simple PBS Plans

• Level 3: Full FBA and PBS Plan

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Implement Secondary Strategies

Are the Strategies Working?

• Continue with Basic Secondary Strategies

Yes

No, There Are Issues Related to Social Interactions

Use Brief Functional Assessment• Where does the problem behavior occur/not

occur?• Why does the problem behavior keep

happening?

No, There Are Issues Related to Quality of Life

Add Additional Quality of Life Assessment

• What are the barriers to an optimal quality of life?

• What tools are needed to gather more information?

Implement Secondary Strategies

Problem-Solving Tool• Simple Team Problem Solving (Not a Full Planning

Session)• Gather Additional Information to Confirm Hypothesis• How Confident Are You That Your Hypothesis is

Correct?

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Function-Based Decision Making Activity for Staff

• Makayla’s Story

Access Tier 2 Resources Here: https://mnpsp.org/training-materials-cohort-2/

What Steps Are Needed to Address Level 2?

(When Immediate Strategies Didn’t Work)

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Next Steps for Tiers 2/3

• Setting Up the Secondary Team• Creating Referral Process• Identifying Secondary Strategies• Problem-Solving Form for Meetings• Introducing Secondary Team to Staff• Learn More About Evidence-Based Strategies• Share De-Identified Examples of Secondary Team

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Addressing Level 3 Team Decisions




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Discussion for This Year

• Simple Functional Assessment Strategies• Introduce Evidence-Based Strategies for Level

2 Problem Solving• Consider Training for Other PBS Facilitators• Link Evidence-Based Strategies to Hypothesis

Statement

Angela Novak Amado, Ph.D.

Friends Connecting people with disabilities and community members

https://rtc.umn.edu/friends

Making Community Connections

MNPSP.ORG• Training Materials • Universal Social Skills

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Preparation of this [presentation/report] was supported, in part, by cooperative agreement JPK%50470 from the Minnesota Department of Human Services. The University of Minnesota undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore necessarily represent official MN DHS policy.