Dr. Susan Graham-Clay July 21, 2016
ISPA
Supporting students with significant behavioural challenges:
A team approach
Student population: 20,000
Schools: 42 Elementary (K-8) 9 High Schools (9-12)
Mental Health Staff: Mental Health Lead Senior Psychologist 3 Psychology Staff Psychology interns 6 School Counsellors – weekly school visits 6 Educational Assistants (itinerant)
Scope of School Psychology Practice
Consultation – learning, behaviour & social-emotional difficulties
Psychological Assessment
Counselling
Professional Development for staff
Crisis Response
System Initiatives (e.g., suicide prevention, equity and inclusion, safe schools, student success)
TOPKID “Teams Organizing Programs for
Kids in Distress” History – 20 years in the making
For elementary students presenting severe patterns of disruptive behaviour and social-emotional distress (“show-stoppers”).
Focused support for the School Team in consultation with Board staff.
A collaborative process used to formulate an intensive support plan for the student.
Process: intake, implementation, discharge and follow-up report with recommendations.
TOPKID
Examples of referral concerns:
Grade 8 male – school refusal, leaves designated location, refuses to obey school rules, swearing in class
Grade 4 male – non-compliant with teacher, tantrums (yelling and screaming), leaves class & hides, disruptive to peers
Grade 4 female – diagnoses of: duplication of chromosome 17, ADHD and LD, aggressive to peers, flight risk, disruptive in class
Grade 1 female – aggressive to peers, in “constant motion”, tells adults what she will/will not do, past Occupational Therapy, paediatrician appointment pending
Grade JK male – poking and touching peers, aggression (hitting & spitting), throwing things across room (shoes, pencils), hiding
Grade SK female – refuses to follow directions, aggressive to peers (hitting/scratching/pushing), flops on floor, knocks over chairs
School Team and Board Team
School team: Principal Classroom Teacher Special Education Resource Teacher Educational Assistant (if applicable)
Board team: Senior Psychologist (manager, clinical support, supervisor) 3 Psychology staff (clinical support) 6 School Counsellors (attend each school weekly) 6 Educational Assistants (itinerant)
Collaborative process & Intensive Support Plan
Collaborative process:
Regular school team meetings – team focus (teacher not alone)
Observations: classroom and schoolyard (identify triggers, problem times during the day, functions of behaviour, themes & trends)
School team dynamics (understand team functioning)
School Counsellor and EA consult daily. Senior psychologist receives/reviews referrals and provides clinical direction.
Intensive Support Plan:
Focus on pro-social skill development, data-driven
Use of evidence-based approaches:
Collaborative Problem Solving (Ross Greene)
Applied Behaviour Analysis (ABA)
Cognitive Behaviour Therapy (CBT)
Zones of Regulation (Kuypers)
non-violent crisis response approaches
TOPKID in action
Referral: Referral form outlines:
Detailed behaviours of concern
Individual student or shared support?
Safety concerns
Supports already in place (e.g. IEP, safety plan, EA support),
Diagnosis?
Medication?
Specialist/community supports in place
Principal approves and signs TOPKID referral
Implementation:
Board staff collaborate with school team
Data collection process (observations, FBA)
Strategies considered and attempted
Ongoing daily & weekly consultation and review
Discharge:
Development of “Personal Support Plan” (summary of successful strategies).
EA support moves on to next school placement.
Ongoing monitoring and consultation by School Counsellor continues at school level overseen by Senior Psychologist.
Considerations for Psychology Manager:
Requires ½ to 1 day per week to manage TOPKID program.
Balance competing referrals and determine EA assignments.
Match student needs with EA skill sets.
Weekly communication with school staff re program status.
Focus on independence mindset for student and for staff (not dependence on EA support) – concept of resiliency.
Focus on pro-social skill development – i.e., not just managing behaviours but actively teaching skills.
Provides a framework to bring clinical psychological expertise to our most needy students.
Case Study
Grade 4 female - Lana Diagnoses: LD, ADHD, Genetic duplication (rare)
Wanders, leaves class without permission (safety concern)
Aggressive at recess to peers (hitting, throwing, pushing). Verbally aggressive to staff.
Difficulties with impulsivity, attention, executive functions - especially initiating tasks on own (asks for help constantly).
Runs around room, loud & disruptive in class. Throws things.
Other: Behaviour Plan and IEP already in place, family working with paediatrician, genetic testing, neuropsychology assessment pending (local resource).
TOPKID Service duration: 5 weeks (Jan-Feb/2016)
Goal #1: teach Lana to seek permission from teacher before leaving class (priority safety goal)
Goal #2: executive functions, especially learning to initiate some tasks independently
Implemented a range of intervention strategies focused on direct skills teaching (examples):
Language: First/then statements; 1,2,3 Magic (Phelan); Reinforcement Contingency (“You may when you have done……”); Specific verbal praise; “Does this make the problem bigger or smaller?” (CBT approach)
Visuals: Creation of “Hall Pass”; Social stories (touching); visual schedule (colour-coded work/breaks); Hunger Games tokens for preferred activities
Movement: Specific fidgets (e.g. squish ball, plasticine – keep fingers busy); hand massage; meaningful movement breaks (recycling and delivering attendance folders); throw dice and perform required # reps
Additional Team recommendations:
Adults interact outside of class only if Lana has her hall pass (i.e. permission to leave), if no pass - alert office
Use animated voice to convey instructions
Teach peers to tell Lana they do not like her touching them Ask Lana: “What did you hear _____ say?”
Adults provide and supervise scissor use
Preferred seating in classroom close to teacher instruction
Reduce time Lana spends in line-ups
Helping role – loves kindergarten duty with adult support
Will stay in seat if she will be reading aloud (advance prep and have Lana read last)
Chunk and modify work
Some stats from 2015-2016 school year:
Total # students supported through TOPKID = 54
Total # elementary schools accessing TOPKID = 28 of 42 (67%)
Vast majority of students referred were male (82%)
No EA support prior to TOPKID and no EA support after = 42%
Each EA worked with 9 to 11 students through the year
Program duration:
%
1 - 2 weeks – typically transition back to school in fall 3 - 6 weeks – typical TOPKID program/placement 7 - 9 weeks – occasional longer term for higher needs 10+ weeks – rare (3 students)
TOPKID 20 years – WHY?
Because it works!
Allows responsive psychological support to students with significant needs.
Support comes to school. Adds specialized services to regular classroom programming that often is not adequate to address the needs of these high needs students.
Builds capacity in the system through on-site consultation and training at the school level.
Provides system responsiveness to support new students and to bring needed relief and support to crisis situations.
Provides for system understanding of PD needs (60% referrals JK - grade 3).