1. Building Fluency with Tier 3 Wraparound
National PBIS Leadership Forum
Hyatt Regency O’Hare, Rosemont, IL
October 9, 2009
Session E-4
Lucille Eber, Statewide Director, IL PBIS Network
Susan Bruce, Iowa Department of Education
Becky Halbur, East Sac Schools
Julie Nadrchal, Prairie Lakes Area Education Agency

2. Individualized Teams at the Tertiary Level
Are unique to the individual child & family
Blend the family’s supports with the school representatives who know the child best
Meeting Process
Meet frequently
Regularly develop & review interventions
Facilitator Role
Role of bringing team together
Role of blending perspectives

3. Individualized Comprehensive Teams/Plans
Who?
Youth with multiple needs across home, school, community
Youth with multiple life domain needs
The adults in youth’s life are not effectively
engaged in comprehensive planning
(i.e. adults not getting along very well)
What?
The development of a very unique, individualized, strength-based team & plan with the youth and family that is designed to improve quality of life as defined by the youth/family.

4. Individualized, Comprehensive Teams/Plans
What Do Tertiary Plans include?
Supports and interventions across multiple life domains and settings (i.e. behavior support plans, academic interventions, basic living supports, multi-agency strategies, family supports, community supports, etc.)
What’s Different?
Natural supports and unique strengths are emphasized in team and plan development. Youth/family access, voice, ownership are critical features. Plans include supports for adults/family, as well as youth.

5. What is Wraparound?
Wraparound is a tool (e.g. a process) used to implement interagency systems of care in achieving better outcomes for youth and their families.
The wraparound process is similar to person-centered planning, the individualized Positive Behavior Support (PBS) planning process.

6. What is Wraparound?
Wraparound is a process for developing family-centered teams and plans that are strength and needs based
(not deficit based)
across multiple settings and life domains.
Wraparound plans include natural supports, are culturally relevant, practical and realistic.

7. Implementing Wraparound: Key Elements Needed for Success
Engaging students, families & teachers
Team development & team ownership
Ensuring student/family/teacher voice
Getting to real (big) needs
Effective interventions
Serious use of strengths
Natural supports
Focus on needs vs. services
Monitoring progress & sustaining
System support buy-in

8. What’s New in Wraparound?
Skill set specificity
Focus on intervention design/effectiveness
Integration with school-wide PBS
Phases to guide implementation/supervision
Data-based decision-making
Integrity/fidelity assessment (WIT)
Tools to guide teams:
Home School Community
Education Information Tool

9. Wraparound Skill Sets
Identifying “big” needs (quality of life indicators)
“Student needs to feel others respect him”
Establish voice/ownership
Reframe blame
Recognize/prevent teams’ becoming immobilized by “setting events”
Getting to interventions that actually work
Integrate data-based decision-making into complex process (home-school-community)

10. Four Phases of Wraparound Implementation
Team Preparation
- Get people ready to be a team
- Complete strengths/needs chats (baseline data)
Initial Plan Development
- Hold initial planning meetings (integrate data)
- Develop a team “culture” (use data to establish voice)
Plan Implementation & Refinement
- Hold team meetings to review plans (ongoing data collection and use)
- Modify, adapt & adjust team plan (based on data)
Plan Completion & Transition
- Define good enough (Data-based decision- making)
- “Unwrap”

11. Scenario for Activity 5
You are at a coach’s network meeting and the following questions are asked?
How do we know if were supposed to do complex fba/bip or wraparound?
Follow up Questions?
So what is the difference between big need and function?
How do I go about assessing/determining what a student (and/or family)’s “ big needs” are?

12. Deciding Which Tertiary Level Intervention is Most Appropriate
Complex FBA/BIP (T200):
Brief FBA/BIP was not successful
AND
NONE of Wraparound criteria are present
Wraparound (T300+):
Youth with multiple needs across home, school, community & life domains
Youth at-risk for change of placement
The adults in youth’s life are not effectively engaged in comprehensive planning (i.e. adults not getting along well)

13. Function
The purpose/reason for demonstrating a specific type of behavior within a specific context/routine.
Specific behaviors have been strengthened by consistent reinforcement.
Family voice is not necessary to identify function of behavior in the school setting.
Once Function is correctly identified, putting a plan in place can produce rapid behavior change. This can be accomplished in a single meeting.
Big Need
The underlying reason preventing successful experiences/interactions in multiple settings/contexts/routines
When a big quality of life need is unmet, it impacts perception/judgment, often resulting in chronic problem behavior.
Family voice is necessary to identify the Big Need for the school setting.
Once Big Need is identified, it takes a while to achieve and involves action planning across multiple life domains. Meeting the big need always involves multiple Child & Family Team meetings.

14. Function
Function is identified through structured interviews focusing on the problem behavior, antecedents, consequences, and setting events
Focus is on developing function-based support plan (replacement behavior, antecedent, consequence, and setting event supports).
When achieved, situations improve for the youth or those engaged with the youth on a regular basis (e.g., the family, the teacher).
Big Need
Big needs are identified through open-ended conversation and use of SIMEO tools with those engaged with the youth on a regular basis.
Big Need statements motivate a family to participate on the team (know we are working on something ‘bigger’ than specific behaviors).
If met, the need will improve quality of life for the youth or those engaged with the youth on a regular basis (e.g., the family, the teacher).

15. Big Need: “Andy needs to feel like he belongs at school”
School Behaviors: Aggressive with peers, excessive absences/tardies, history of academic failure
Other indicators: Family frequently relocated, lack of home school communication, community support needs
Starting with FBA would not have been an effective approach—why?
Discussing problem behaviors would not have motivated family to participate on team.
Probably not the first time schools have approached family in this manner (“let’s talk about behavior”)
Open-ended conversation and use of SIMEO tools helped engage family
Bigger needs to work on to improve quality of life for youth and family

16. Scenario for Activity 6
You are at a coach’s network meeting and the following questions are asked:
What if the family or teacher does not want to engage in wraparound?
Follow up Questions:
How do I use the SIMEO tools to engage them? To keep the team going?
Wraparound seems really hard, why should we spend so much time?

17. Why Do Wraparound???

18. Points to Remember: Engaging Families
Apply RtI to Family Engagement: don’t keep doing what hasn’t worked up
If engagement didn’t happen, how would you change your approach to effectively engage?
Professionals don’t get to choose or judge how families raise their kids.
Always start with a conversation (not a meeting) with the family, getting their trust and permission before talking with others.

19. Points to Remember: Engaging Professionals
Apply RtI to Teacher Engagement: don’t keep doing what hasn’t worked.
Just like we do for kids and families, recognize teacher strengths and needs. Teacher voice in the plan will ensure better outcomes.
Always start with a conversation (don’t hand off data tools). Teachers need to be prepared for the wrap meeting and kept “in the loop”.
Use data to bring teacher and family together.
“Kept in the looP” – sometimes we focus so much on the family ,that the teacher can start to feel “out of the loop” of information. Facilitators don’t need to share “everything” about the family with teachers, but, checking in with teachers and keeping them up to date on general info. will keep them connected to the plan. 19

20. Using Data to Drive Decision-Making with Wraparound
More efficient teams, meetings and plans
Less reactive (emotion-based) actions
More strategic actions
More effective outcomes
Longer-term commitment to maintain success

21. Wraparound: Data-based decision-making
Baseline Data -
Enhances the initial conversations with family and team members.
Creates more efficient team meetings.
Takes the emotion out of team meetings.
Gives us a starting point for planning.
Helps us plan across all environments – Home, School and Community
How have you used baseline data?

22. Using Data and Voice & Choice
Wraparound Case Study “Ozzie” cont. Getting to Strengths and Needs at Baseline
Using Data and Voice & Choice
                                             
Ozzie the twister kid 22

23. Wraparound: Data-based decision-making Follow-up Data (Time2, Time 3…)
Helps us CELEBRATE progress
Shows us small increments of progress that can be missed.
Helps us progress monitor – remember, if the plan is not working, re-work the plan!
Helps us get buy-in from staff, administration, and skeptical team members.
How have you used follow-up data?

24. Transition Planning for “Jacob” Using Data to get buy-in from the new team

25. Becky Halbur, MS School Counselor Internal PBIS Coach East Sac County Elementary Schools Julie Nadrchal, LISW School Social Worker External PBIS Coach Prairie Lakes Area Education Agency

26. What we learned… PBS in Iowa
We needed to beef up our tier 2 interventions
Implemented Check In Check Out
Implemented Check and Connect
Tier 3 Team Developed
PBS in Iowa – in Iowa we were missing the “I”. Our focus was the ‘universal supports’. A lot of schools (including our district), were missing the interventions. I tried different interventions on my own, but they didn’t work as well as I hoped. I was missing the data, didn’t have the tools to use to gather data, and didn’t have the right kind of conversations with families.
Then the training opportunity came: wraparound.
Implemented Tier 2: After first training – studied CICO, CNC, social skills groups. Implemented CICO.
Implemented Tier 3: We are developing our Tier 3. We are learning about how to involve the whole school system. We are at the point when we are recognizing when a family has big needs and needs to move quickly in the system up to wraparound. The system is more fluid – moving from Tier 1 and can move up to Tier 3 if needed.
Example: We had a new family move into our district. After a couple of weeks of school, it was determine this family needed more then Tier 1 & Tier 2. They are now a wraparound family. As a PBIS school, we can move in quickly with students and families. 26

27. What we learned… The power of Phase 1: Initial conversation
“Cinder” family …listening to the story
Identifying strengths through soft data
When we prove that we heard the parent, they will listen to us.
What was different about wraparound
Moving from the expert model to Voice and Choice of the family.
Importance of listening to the family’s story is very powerfully.
We had to prove that we heard them and understood them before they will listen to us.
Story of Tyce – when we were able to talk to mom about not rescuing him; she listened to us about a different approach of parenting. She listened since we had that relationship built up.
Parenting CD’s in the truck on the road
Gathering the family’s strength through soft data. This was a Big learning: it is ok to listen to their story. As you listen, you gather the hard data but also the family’s story which is powerful when you help the family and the staff develop a plan. A good example of soft data we were able to gather was the mother of Tyce had a history of abuse when she was growing up which affects her parenting style today. Deep empathy – understanding where she is coming from.
That’s what is Different with wraparound: Moving from expert model to where the parent has a “voice”. As a school, we tell the families what to do. Which doesn’t do any good for us if the family isn’t engaged. Wraparound, the family feels they are the expert and it’s their voice which gives them ownership. The families once engaged, we can provide more suggestions that is well received:
Example Love & Logic – parent’s skills 27

28. What we learned… Re-engagement is sometimes necessary
Mental Health Advocate for Sherrie
Everyone needs to leave the meeting with a job
Everyone’s job needs to be connected with the big need
Mental Health Advocate
Wraparound facilitates partnership between agencies, school, and family
 Need to keep in mind, wraparound is fluid process where you may be at Phase 2 but you need to move back to Phase 1.
Begin with the story of Sherrie: The family became wraparound family after her mental health hospitalize. The mental health advocate assigned to Sherrie, was very demanding, & not very trusting towards the school. We had one conversation with her before the wrap meeting. At the first wrap meeting, she wrote notes under the table, did not add input at the meeting, and was not assigned a job at the end.
Phone Consultant – with Lucille over the phone – Lucille talked about re-engagement is sometimes necessary. We needed to re-engaged the mental health advocate. Also we shared information with Lucille that mom didn’t like how Sherrie acted after her visits with mental health advocate; Sherrie was being disrespectful towards mom. We held a meeting with just mom and the mental health advocate and it went very well. At the next wrap team meeting, the advocate was participating and left the meeting with an assigned job. Mom felt things were going better with Sherrie and the respect issue.
Need to be fluid and keep connecting the activities of each team member with the Big Need.
Big Learning: the wraparound process helps facilitate communication – when I was a community mental health therapist, I rarely talked to the school. I did my work in isolation and so did the school. This process – bridges the community agencies with the schools. All team members are working on the same “big need”. 28

29. What we learned… The power of data Using the HSC tool
Using SIMEO data at a team meeting
The power of co-facilitators
The power of Data: At our site visit from the state’s training team, the family that was interview commented that they really liked that “everything was the table”. They could see what were the strengths and needs of their child and could see growth.
Also by putting down the data and input on the Behavior Pathway, the family/team saw how everything fitted to together. Gave the team areas to focus on.
The data ties everything together:
Starts with strengths
Focus on the need
Look at the data
Look solution base
HSC is an important tool: it gives you the hard data but also the soft data. It starts the conversations that can bring out the family’s story and the need.
Using SIMEO: It was trial and error of what to use. At the first meeting we had, we had the strengths and needs on one chart and then the second meeting we broke it into one chart of strengths and one chart of needs.
Big Learning: Co-facilitate: We feel using two facilitators from different backgrounds, school counselor and social worker, has been very helpful. 29

30. SIMEO Strength Data on HSC Tool
EMOTIONAL FUNCTIONING: Feels that he/she belongs
Rating Period - Home
Baseline
1= High Need 4 = High Strength 3
Knows when to ask for help 2
BEHAVIORAL: Seeks attention in appropriate ways
CULTURAL/SPIRITUAL: Feels accepted
Time 2 4
Rating Period - School 1
Rating Period - Community
Strengths:
At the second meeting we celebrated the improvements we made: Sherrie felt safe at school which was a ‘big need’. 30

31. SIMEO Needs Data on HSC Tool
Student Has life/survival skills
Rating Period - Home
Baseline
1 = High Need 4 = High Strength 2
SOCIAL RELATIONSHIPS: Respects adults in authority 3
Responds emotionally like other youth 1
Time 2 4
Rating Period - School
Rating Period - Community
Needs
One area of concern mom had was respecting adults at home/community. As we already discussed, mom felt Sherrie was not being respectfully after meeting with the mental health advocate. So this was an area we monitored. Another area was life survival skills – since she had problems with coping with stress in the past, this was an area we were monitoring.
Big Learning
What you graph will depend on the conversation you have with the family. 31

32. We’re still learning… Need to have a systems approach
Understanding and using the behavior pathway
Blake’s story
Tier 2 and Tier 3 teams meeting monthly
Systems: We are using a system approach at the elementary level. We are trying to have the system more fluid – having the ability for a student/family move from tier 1 to tier 3 quickly.
Challenge - Big Learning's moving to one building with a strong Tier 2 & 3 base to the next with Tier 1:
Story about Jacob – elementary has the tier 2 in place and the next bldg. does not have tier 2 in place. There was some mis-communication. What was not completed, was the consensus of the behavior pathway: it is so important for the team to understand the importance of working with the pathway to get the intervention that will work.
Challenge: The challenge will be how to move the tier 1, 2, & 3 to the other systems in our district. Such as at the middle school, the middle school has universal systems of Tier 1 only and the high school has not establish the universal systems of Tier 1.
Big learning: The teams need to meet on a regular basis. We have teams at tier 2 and tier 3: this year we are meeting on a regular basis. 32

33. Iowa’s Project LINCS
What’s working

34. Implementation Evaluation
Sites visits
3 to 4 hours
Interviews
School team
Parents/caregivers
Students
Parent Informed Consent Document

35. Visit format Case Study/Focus Group Iowa DE group and Full Wrap Team
Interviews occurring simultaneously
One team interviewed student and reviewed student materials
One team interviewed parent and reviewed team notebook /materials
DE Team discussion
Focus Group and exit briefing 35

36. Interview Case Study Questions School Staff
What about the implementation is working?
What about the implementation is not working?
What do you need to improve the implementation of wraparound?
What do you view as the indication of greatest success to date?

37. In regard to the wraparound training and materials:
What do you see as most valuable?
What do you see as least valuable?
What access does the wraparound team have to community mental health services?
In regard to services provided to your student:
What community resources were utilized prior to the implementation of wraparound?
What community resources are now being utilized?

38. What did we find out from the school staff?
Good things
Not so good
Develop relationships
HSC Tool - initiating conversations
SIMEO user friendly
TA – DE and Lucille
Strength based
Positive change in parent attitude
Increased use of community resources
Student success
Getting all to attend meetings
Conference calls with other schools
Communication with community resources
Use of all the forms

39. Parent Interview
What supports, services or activities are working well for your child?
What supports, services or activities are not working well for your child?
What do you think your school needs to improve supports, services or activities for your child?
This school year, what do you view as the indication of your child’s greatest success?

40. What access do you and your child have to community mental health services?
In regard to services provided to your child:
What community resources were used prior to the implementation of wraparound?
What community resources are now being used with the implementation of wraparound?

41. What did we find out from parents?
Good things
Not so good
Team working together toward same goal
Feel like a valuable, equal member
Strength based
Additional supports (therapists, CICO) and resources
Child’s success is obvious

42. Student Interview What at school is working well for you?
What is not working well for you?
What do you think the school needs to do to improve your success at school?
This school year, what do you feel has been your greatest success?
What new supports or people have you decided to work with?

43. What did we find out from students?
Good things
Not so good
Teachers support behavior plans
Like CICO
More friends
Help with personal issues
Less angry
Mom and dad are more helpful
Feel good about doing better
CICO can be embarrassing
Peers behaviors don’t change

44. Overall Themes
Wraparound was positive for school, parents and students and resulted in a new way to work together.
Enhanced relationships and increased trust.
Increased communication, improved transitions and decreased duplication of work involved.
Greatest indicator of successful implementation was student success.
Strength based focus and increase of effective strategies put in place to help student succeed.