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Cognitive Behavioral Intervention for Trauma in Schools (CBITS) within Chicago Public Schools Amanda Mohler Mashana L. Smith, Ph.D. Chicago Public Schools.

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Presentation on theme: "Cognitive Behavioral Intervention for Trauma in Schools (CBITS) within Chicago Public Schools Amanda Mohler Mashana L. Smith, Ph.D. Chicago Public Schools."— Presentation transcript:

1 Cognitive Behavioral Intervention for Trauma in Schools (CBITS) within Chicago Public Schools Amanda Mohler Mashana L. Smith, Ph.D. Chicago Public Schools Office of Diverse Learners and Student Supports Office of Social & Emotional Learning

2 AGENDA Chicago Public Schools at a Glance Implementation and Use of MTSS Framework within CPS History of CBITS within CPS Training & Supported Implementation Referral, Screening and Assessment Process Implementation Fidelity Evaluation and Outcomes Challenges & Future Direction for Implementation

3 Chicago Public Schools at a Glance

4 Demographics

5 Chicago Public Schools (District 299) is the 3rd largest school district 85% of students live at or below the poverty line 91% of students are minority 70% graduation rate (within 4 years) 19% mobility rate 13.3% of students with disabilities English language learners 16%

6 Trauma Related Symptomatology among CPS Students 32.5% of CPS students felt sad or hopeless almost every day for 2 weeks or more in a row and stopped usual activities 15.5% of CPS students seriously considered attempting suicide

7 Implementation and Use of MTSS Framework within Chicago Public Schools

8 SOME (Ex: Peer Council, Check In/Check Out) ALL STUDENTS (Examples: School- wide Expectations, Second Step, Talking Circles) INDIVIDUALIZED INTERVENTIONS For students with the highest levels of need, highly-targeted and individualized behavior strategies provide more intensive intervention and monitoring. TARGETED SUPPORTS For at-risk students, classroom-based responses can help de-escalate behavior problems, clinical group interventions address anger, trauma, and violence; and restorative practices provide students with strategies to resolve conflicts POSITIVE LEARNING CLIMATE School climates with positive relationships, clear expectations, and collective responsibility establish appropriate behaviors as the norm. Respectful, learning- focused, participatory classroom environments with well-managed procedures and behaviors maximize learning time SOCIAL AND EMOTIONAL LEARNING Explicit curricula, along with integrated instructional practices that promote social and emotional development, teach students how to form positive relationships, make responsible decisions, and set goals. These are critical skills for college and career success. (Ex. Wraparound, Individualized Counseling) Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs FEW


10 History of CBITS within Chicago Public Schools

11 Identifying a Need for Evidence-Based Interventions within Chicago Public Schools During a focus group attended by CPS social work and psychology coordinators (Winter, 2006), it was determined that: ◦ The majority of referrals for social work services were related to the experience of trauma or anger/aggression ◦ CPS didn’t have a firm understanding of the nature or effectiveness of services ◦ Despite numerous minutes of direct service minutes, students were not exiting related service delivery, indicating “improvement” In 2007, CPS collaborated with the University of Florida to review evidence-based interventions (EBIs) designed to address trauma in school-aged populations ◦ Cognitive Behavioral Intervention for Trauma in Schools (CBITS) o LAUSD – Lisa Jaycox

12 Cognitive Behavioral Intervention for Trauma in Schools (Jaycox, 2004) Includes 10, one hour cognitive behavioral therapy group sessions Recommended for students ages 11-15 Skill Areas of the Intervention: ◦ Psychoeducation and Relaxation ◦ Realistic and Helpful Thinking ◦ Social Problem Solving Parent Education Teacher Education

13 Planning for the Adoption of CBITS: Identification/Selection of Schools Community Partners and Funding Mechanisms

14 Identification/ Selection of Schools ISBE MH ◦ Leadership members or leadership teams had attended training related to early intervention ◦ Current infrastructure in place relative to preventative or early intervention SEL supports ◦ Indicators of need (disciplinary infractions, OSS, arrest rates, graduation rates)

15 ISBE MH/Englewood ◦ African American 97.82% ◦ Ranks 2 nd for violent reports ◦ 32.3% of households below poverty level ◦ 34.7% of residents unemployed ◦ 30.3% of residents without high school diploma SSHS/South Shore ◦ Ranks 12 th for violent crime ◦ 31.5% households below poverty level ◦ 17.7% of residents unemployed ◦ 14.9% of residents without high school diploma Identification/ Selection of Schools

16 Training and Supported Implementation

17 Training for Chicago Public School Staff  In 2007, Chicago Public Schools partnered with UCLA Division of Child & Adolescent Psychiatry to train school based clinicians  In 2008, clinical psychologists from Ann & Robert H. Lurie Children’s Hospital Community- Linked Mental Health Services Program partnered with CPS to train clinicians Training targeted the district’s school social workers, school psychologists, counselors, deans, and community mental health partners Two day training model offered: ◦ History of CBITS ◦ Cognitive-Behavioral Theory ◦ Education and Relaxation ◦ Imaginal Exposure ◦ Introduction to Cognitive Therapy Train the Trainer (TOT) in SY11 (2010-11) to include school-based clinicians Train the Trainer (TOT) Expansion during Spring, 2011 to include community mental health partners

18 CPS Training Data (SY08-SY14) Training began in Fall, 2007 Over 1690 trainees (2007-2014) 350/351 (99.7%) current School Social Workers trained in CBITS 226/228 (99.1%) current School Psychologists trained in CBITS 482/816 (59.1%) current School Counselors have been trained in CBITS 124 community mental health clinicians (2011-2012)

19 First Year of Implementation 2007-08 Clinicians (District & Community Mental Health Partner) TrainingsImplementation

20 From Training to Implementation: Supported Implementation EBT CBT Professional Learning Community ◦ Clinical Support ◦ Fidelity Monitoring ◦ Content Review Co Facilitation ◦ Inter-disciplinary ◦ Community mental health partners, district clinicians GOAL: Change practice for the delivery of school based Mental Health services for all students

21 MTSS Problem Solving Process: (Referral, Screening and Assessment Processes)

22 Behavioral Health Request for Assistance Form Teachers observe behavior and attempt evidence-based behavioral strategies in the classroom If students do not respond, teachers complete a Request for Assistance (RFA) form The RFA is reviewed by a Behavioral Health Team (also known as CARE Teams) Additional screening is completed by a member of the BHT

23 Strengths and Difficulties Questionnaire (SDQ) Originally developed by Robert Goodman (1997) Consists of 25 items in five different domains: 1.Conduct 2.Hyperactivity 3.Externalizing Behavior 4.Peer Problems 5.Prosocial Behavior Similar versions for different informants

24 Trauma Symptom Inventory


26 Implementation Fidelity

27 Chicago Public Schools Implementation Model Co-facilitation is considered best practice ◦ Co-facilitation is encouraged during Year I of implementation ◦ Co-facilitation not required during Year II and beyond New implementers are highly encouraged to attend supported implementation sessions

28 Co-Facilitation Guidelines LEAD FACILITATOR SBC Clinician (Masters level social worker, psychologist, or counselor supervised by a Licensed Mental Health Professional (LMHP) (LCPC, LCSW, PhD, PsyD) CO-FACILITATOR Type 73 school based professional (school psychologist, school social worker, school counselor) Graduate trainees/interns supervised by masters level social worker, psychologist, or counselor

29 Implementation Data MetricSY 2013 # of students referred2815 # of students assigned to CBITS253 # of students assigned to Anger Coping1036

30 Fidelity of Implementation  Facilitators are asked to complete a fidelity monitoring form following each group meeting  Intended to encourage accountability and uphold fidelity

31 Evaluation and Outcomes

32 Assessment Instruments Pre and Post Assessment ◦ Strengths and Difficulties Questionnaire (SDQ) ◦ Trauma Symptom Inventory All data is entered into a district SharePoint

33 Scoring and Classification STRENGTHS AND DIFFICULTIES QUESTIONNAIRE Total Difficulties Score ranges between 0 and 40 16-40 Abnormal 12-15 Borderline 0-11 Normal TRAUMA SYMPTOM INVENTORY Scoring Exposure: One or more exposure Symptomatology: 14 or more

34 Pre-Post Analyses Assessment Time NMeanCI 95% Pre Post 220 40.155 37.409 39.088-41.221 36.359-38.459

35 Limitations of Evaluation Single method of assessment Limited understanding of areas of impact ◦ No examination of domains with SDQ ◦ No examination of domains within the TRRPB

36 CBITS: A School Psychologist’s Experience

37 Experience  Two day training (December 2008); Dr. Audra Langley, ULCA Division of Child and Adolescent Psychiatry  Initial implementation in March 2009  6 th grade students attending a PK-8 th school in Englewood  Social-emotional Learning Grant  School slated for closure hearing

38 Community Partners  Ann & Robert H. Lurie Children’s Hospital of Chicago  SGA Youth and Family Services  Children’s Research Triangle  (Teacher Education Session)

39 Referral Process  Teacher referral  Counselor referral  Group composition  May need to make referrals to outside counseling or alternate intervention

40 Trauma Symptom Inventory  Preferential to administer individually, read items orally  Refer back to types of trauma student indicated and ask for more information  Establish relationship and gain student assent  Need to guide or reframe in cases of chronic or multiple traumas  Guide student to select an event to work on in group

41 Types of Traumatic Events  Fire  Parent incarceration  Parent/ relative homicide  Peer homicide  Traumatic grief or multiple losses  Witness to community violence

42 Incentive System Two levels ◦ Group Teamwork incentive ◦ Individual point sheet

43 Behavior Management Establish group rules Introduce confidentiality Co-facilitator roles ◦ Content ◦ Behavior management

44 Group Incentive Tracking



47 Individual Incentive

48 Education and Relaxation Common reactions to stress or trauma Write on slips of paper and have students pull and read them Provide copies of handout and have students highlight them Allow students to share Normalize all feelings Encourage them to share with their families

49 Relaxation Training Read progressive relaxation script Consider dimming lights and moving furniture Play calming music

50 Cognitive Therapy Teach students the link between thoughts and feelings Chicken Little example Hot Seat activity to challenge negative thinking and supply positive alternatives

51 Fidelity Behavioral Technical Assistance Team meetings Co-Facilitator reflection

52 Modifications Consider estimated cognitive and academic functioning Read material orally Informally assess need for additional sessions Consider additional visuals

53 Challenges Logistics ◦ Space ◦ Time allocation Referral process ◦ Screening appropriate referrals ◦ Paperwork

54 Successes Collaboration with other professionals Internalizing and applying content and techniques Student and parent feedback

55 Impact “What I learned is that you can trust people you’re in the group with. The group helps you a lot. It gets the things that are in your mind out and to express what you’re feeling.” -Seventh grade female

56 Challenges & Future Direction for the Implementation and Evaluation of CBITS within Chicago Public Schools

57 Challenges to Training, Implementation and Evaluation Training of district personnel to allow for internal training Allocations for Related Service Providers o 60 minutes per school per week Use and Ease of Data Collection Platform Alignment of Assessment Tools with the Intervention Funding Mechanisms for Community Mental Health Partners

58 Next Steps for Continuous Improvement  Train ALL counselors, psychologists, social workers, interns and community partners  Improve supported implementation model  Differentiate sessions for all levels of experience  Increase accessibility and convenience for facilitators  Increase number of groups implemented via increased allocations of clinical related service staff and community mental health partners and availability of Network SEL Specialists  Improve generalization of curriculum to classroom  Strategically align assessment instruments for identification  Support community mental health partners in the identification of external funding mechanisms

59 Questions?

60 Chicago Public Schools Office of Social & Emotional Learning

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