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Universal Screening Teen Screen


									Universal Screening/
Teen Screen

    PBIS National Forum
    October 15, 2010

   Jennifer Rose, M.Ed., Tertiary Research &
    Evaluation Coordinator, Illinois-PBIS
   Marian Sheridan, Coordinator of School
    Health & Safety Programs, Fond du Lac
    School District:
Session Objectives

   To identify selection criteria for universal
    screening tools
   To provide a brief overview of two universal
   To share Illinois PBIS Network universal
    screening model and results
   To discuss overall rationale for universal
    screening and the Teen Screen approach
Reflection Questions
   What, if any, roadblocks to universal
    screening for behavior exist in your
Potential Roadblocks
    Absence of administrative support
    Lack of knowledge regarding the process
    Fear of ‘labeling’ students
    Apprehension regarding parental/guardian
    Concerns regarding cost/time to implement
     universal screening
The BIG Question

   What will you do with your students once they
    have been identified as needing additional
  Oh my
God! What
  are we
 going do
 with all of
these kids!
    Universal Screening: Tool Selection
   Some basic criteria for selecting a screening
       It is technically-valid:
           Adequate norms
               Recent norms reflecting population to be screened
           Reliable
               Produces consistent results over time
           Valid
               Distinguishes between those who do and don’t meet
                the criterion measured (i.e., students at-risk of
                internalizing behaviors)
Universal Screening: Tool Selection
    Has social validity:
        Instrument/screening process is seen as both
         acceptable and important)
            For example, if an instrument is perceived as time-
             consuming, or the process of universal screening is not
             deemed as relevant to stakeholders, then results may not
             be valid and there will be a lack of staff buy-in
Universal Screening: Tool Selection
   A note regarding selection criteria….
       A tool may have social validity, however, the
        critical aspect of screeners is their capacity to
        consistently and accurately identify individuals in
        need of support
Universal Screening: SSBD
   Systematic Screening for Behavior Disorders
    (Walker & Severson, 1992) for grades 1-6
       Validated by the Program Effectiveness Panel of the U.S. Department of
       Six research studies confirm the SSBD’s ability to systematically screen
        and identify students at-risk of developing behavior problems
       Universal screening with the SSBD is less costly and time-consuming
        than traditional referral system (Walker & Severson, 1994)
       Inexpensive
           Manual= $125, reproducible screening forms= $15
       Quick
           Entire screening process can be completed within 45 minutes to
            1 hour per classroom
Universal Screening: SSBD
Universal Screening: SSBD
Universal Screening: SSBD
Universal Screening: BASC-2/BESS
   BASC-2/Behavioral and Emotional Screening
    System (BASC-2/BESS; Kamphaus & Reynolds,
       Developed as a school-wide (Universal) screening tool
        for children in grades Pre-K to 12
           Similar to annual vision/hearing screenings
       Identifies behavioral and emotional strengths and
         Externalizing behaviors (e.g., acting out)

         Internalizing behaviors (e.g., withdrawn)

         Adaptive skills (e.g., social and self-care skills)

       Screening process takes about 30-45 minutes per
Universal Screening: BASC-2/BESS
Universal Screening: IL-PBIS Network
   IL-PBIS Network Approach:
       Secure district-level commitment to universal behavioral screening
       Build capacity for secondary practices (e.g., CICO, CnC, SAIGs)
       Identify and train building level staff person to lead and manage universal
        screening process and data
       Provide building level overview
       Distribute informational letters to parents/guardians
       Conduct universal behavioral screening
       Secondary teams meet with universal behavior screening coordinator to
        review results
        Contact parents to obtain permission for intervention
       Upon receipt of parent/guardian permission, students are quickly placed
        into simple secondary-level intervention (e.g., CICO)
       Use data to progress monitor students’ response to intervention
Universal Screening: Implementation

   A note on recommended screening frequency:
       Academic screening (e.g., Curriculum Based Measures-
        CBMs for reading difficulty) typically occurs during fall,
        winter and spring benchmarking phases
       Screening twice annually (in fall and early winter) is
        optimal for behavioral screening
           Screen transfer students
           Additional progress monitoring of students identified during fall
    Positive Behavior Interventions & Supports:
      A Response to Intervention (RtI) Model

                                   Tier 1/Universal
                                School-Wide Assessment
                             School-Wide Prevention Systems

                                         Tier 2/
    ODRs,                                                                   Check-in/
 Attendance,                                                               Check-out
Tardies, Grades,
      DIBELS, etc.
                                                                    Instructional Groups
      Daily Progress
        Report (DPR)
             (Behavior and
                                                               Individualized Check-
               Academic Goals)             Tier 3/             In/Check-Out, Groups &
                                                               Mentoring (ex. CnC)
         Competing Behavior               Tertiary
          Pathway, Functional                            Brief Functional Behavioral Assessment/
           Assessment Interview,                         Behavior Intervention Planning (FBA/BIP)
                 Scatter Plots, etc.
                                                     Complex FBA/BIP
                           SIMEO Tools:
                           HSC-T, RD-T, EI-T     Wraparound
                                                                        Illinois PBIS Network, Revised August 2009
                                                                        Adapted from T. Scott, 2004
Screening process

   Teachers nominate
    students and complete
    screening tools
         Multiple Gating Procedure
            (Adapted from Severson et al. 2007)

Gate 1             Teachers Rank Order
                then Select Top 3 Students
                    on Each Dimension
               (Externalizing & Internalizing)

                        Pass Gate 1

Gate 2             Teachers Rate Top 3
                Students in Each Dimension
               (Externalizing & Internalizing)
               using either SSBD, or BASC-

                                                     Tier 2
                      Pass Gate 2                 Intervention
Illinois PBIS Network Universal Screening Results:
 Students identified as % of enrollment in grades







                                                           SY 2007-08 (N=18)   SY 2008-09 (N=30)   SY 2009-10 (N=42)
Illinois PBIS Network Universal Screening Results:
 Students identified as % of enrollment in grades



                                                    3.6%                            3.5%






                                                           SY 2007-08 (N=18)   SY 2008-09 (N=30)   SY 2009-10 (N=42)
Universal Screening Results: Totals
  Students identified as % of enrollment in grades

                                                     9.0%                                                     8.2%

                                                     6.0%     5.5%

                                                                        4.0%      3.7% 3.5%
                                                     4.0%                                     3.3%




                                                             Externalizers Internalizers                   Total
                                                              SY 2007-08 (N=18)   SY 2008-09 (N=30)   SY 2009-10 (N=42)
   Glover, T.A., & Albers, C.A. (2007). Considerations for evaluating Instruments
           for universal screening assessments. Journal of School Psychology, 45, 117-135.
   Kamphaus, R.W., & Reynolds, C.R. (2007). BASC-2 Behavioral and Emotional
           Screening System. Minneapolis, MN: Pearson.
   Patterson, G., Reid, J., Dishion, T. (1992). Antisocial Boys. Eugene, OR:
   Severson, H.H., Walker, H.M., Hope-Doolittle, J., Kratochwill , T.R., & Gresham, F.M.
           (2007). Proactive, early screening to detect behaviorally at-risk students: Issues,
           approaches, emerging innovations, and professional practices. Journal of School
           Psychology, 45, 193-223. doi:10.1016/j.jsp.2006.11.003
   Walker, B., Cheney, D., Stage, S., & Blum, C. (2005). Schoolwide screening and positive
           behavior supports: Identifying and supporting students at-risk for failure. Journal of
           Positive Behavior Supports, 7(4), 194-204. Retrieved from
   Walker, H.M., & Severson, H.H. (1992). Systematic Screening for Behavior Disorders.
           Longmont, CO: Sopris West.
Implementation of Universal Screening

  Fond du Lac TeenScreen Program

          Marian Sheridan
Why Screen for Mental Illness and Suicide
  • Mental illness is treatable.
           •    There is ample time to intervene before symptoms escalate to a full blown disorder and
                before a teen turns to suicide.

  • Screening tools that effectively and accurately identify at-risk teens are available.
           •    Screening more accurately identifies teens with significant mental health problems than
                school professionals (63% vs. 37%; Scott et al., AJPH 2009).

  • Most mentally ill and suicidal youth aren’t already being helped.
           •    At-risk adolescents who do not request help on the screening questionnaire are
                significantly more likely to report suicidal ideation in the preceding three months than
                those who request help (62% vs. 31%; Husky et al., Child Psychiatry Hum Dev, 2008).

  • No one else is asking teens about these issues, but they will give us the answers if we
    ask the questions.
           •    Screening is safe and does not increase distress, depressive symptoms, or suicidal
                ideation (Gould et al., JAMA 2005).

The National Research Council and the Institute of Medicine of the National Academies. (2009).; Anderson 2004; YRBS 2005; U.S. Census 2003
                  History of TeenScreen
    • TeenScreen developed in 1991 as a result of Dr. David Shaffer’s research on
     mental illness & suicide in youth

    • 90% of youth who died by suicide suffered from a treatable mental illness

    •65% experience symptoms for at least a year prior to their deaths

    •This shattered the myth that suicide is a random and unpredictable event in

    •Found there is time to intervene with at risk youth, connect with treatment,
    Potential to save lives

Why Implement TeenScreen?

    One in five children has a mental or emotional problem that
    requires treatment

    At least one in 10 may have a serious emotional disturbance
    that significantly impairs his or her ability to function emotionally,
     socially or academically

    Two-thirds of children needing mental health treatment go without

    Children with mental health problems are not “just being
    children.” Mental health problems can disrupt daily functioning
     at school, at home and with peers.

    Suicide is the second leading cause of death for adolescents
    in Wisconsin.

Principles of Quality Screening Programs

    Screening must always be voluntary
    Approval to conduct screening must be obtained from
     appropriate leadership
    All screening staff must be qualified and trained
    Confidentiality must be protected
    Parents of identified youth must be informed of the
     screening results and offered assistance with securing an
     appointment for further evaluation
Prepare Your School to Implement a
Universal Screening
 • Raise awareness and build school/ community
 • Choose a staffing model and identify your team
 • Select your screening population, location,
   schedule and questionnaire
 • Develop a referral network and community
   resource guide
Establishing a Strong Foundation for
Universal Screening
  • Administrative Support

  • School Board Members

  • Key Stakeholders
    • Medical Providers
    • Mental Health Providers
    • Community Agencies and Organizations

Educate and Engage School Personnel

  • Teachers, administrators, and school health and mental health
    staff can dramatically influence the success of your TeenScreen
  • Inform school personnel of your plans to implement
    TeenScreen and obtain their support for and commitment to
    your efforts.
  • Build working relationships with school personnel.
  • Present your plans at a faculty meeting and/or department
Seek Advice and Help from School Personnel

  • Ask school personnel how they think parents will react to
    screening and how best to reach parents and teens.
  • Ask for assistance with promoting the program to parents and
    teens and with distributing and securing the return of parent
    consent forms.
  • Help and buy-in is especially critical from the teachers whose
    classes will be impacted by consent distribution or screening.
Educate and Engage Parents

  • Know your community and share key facts specific to your
    community with parents to educate them about the need for
  • Present information about TeenScreen at a school PTA/PTO
    meetings to raise awareness and build support prior to consent
  • Have a TeenScreen information table at parent orientations,
    registration days or back to school nights.
  • Make yourself available to answer questions or address
    concerns about screening .
  • Present information in a culturally appropriate manner and
    anticipate how different cultural groups will respond to
The Screening Process
Principles of Quality Screening Programs

 •   Screening must always be voluntary
 •   Approval to conduct screening must be obtained from
     appropriate leadership
 •   All screening staff must be qualified and trained
 •   Confidentiality must be protected
 •   Parents of identified youth must be informed of the screening
     results and offered assistance with securing an appointment for
     further evaluation
Select Your Screening Questionnaire
CHS Overview
  •   14-item, 10-minute, self-completion, paper-and-pencil
      survey for suicide risk
  •   Appropriate for 11-18 year-olds
  •   6th grade reading level
  •   Trained layperson can administer and score
  •   Assesses for symptoms of depression, anxiety, substance
      abuse, suicide ideation and past attempts
  •   Highlights those who might be at risk and screens out those
      who are not
  •   Available in English and Spanish
  •   33% positive rate
CHS Sample Question
DPS Overview

 •   52-item, 10 minute, self-completion mental
     health screen

 •   Appropriate for 11-18 year-olds

 •   Computer-based with spoken questions

 •   Trained layperson can administer and score

 •   Automatic reporting of screening results

 •   English and Spanish versions available

 •   20-33% positive rate
The DPS Screens For:
 • Social Phobia
 • Generalized Anxiety
 • Panic attacks
 • Obsessions and Compulsions
 • Depression
        Suicide ideation (past month)
        Suicide attempts (past year)
 • Alcohol Abuse/ Dependence
 • Marijuana Abuse/ Dependence
 • Other Substances Abuse/ Dependence
DPS Sample Question

In the last 3 months…..
Has there been a time when nothing was fun and
you just weren’t interested in anything?
Developing a Mental Health Referral
Network and Community Resource Guide
 Key Points:
        The Referral Network should include providers for insured and uninsured
        Develop relationships with providers in your community who:
             Evaluate and treat a variety of conditions
             Agree to accept your referrals in a timely manner and do not have
             long wait lists
             Are culturally appropriate
        The Community Guide should include a variety of resources relevant to
         parents and their teen
 Planning Questions:
    1.   Have you contacted mental health providers for your referral network?

    2.   Have you identified community resources to enhance your services and provide
         additional linkages and resources to at-risk teens?
Fond du Lac County Data 2002-2008

Over 4,989 students in FDL County have been screened

961 of these students have been identified for being at
potential risk of suicide, suffering from mental health
problems and received a referral for further evaluation and
appropriate treatment.
        Teen Support for Screening
    - What Teens Say About TeenScreen -

“I feel like someone is paying attention and listening to

“I thought it was very helpful, and I finally feel relieved
because I’m getting my problems out.”

“The interview on the computer was a great way to know
how we feel about stuff in our lives. I think it’s a great

“I thought it was insightful because some of these things
are not talked about enough.”

“I think this is a good way to find out what’s going on
with teens these days. Most teens are afraid to talk about
their problems because they don’t want other teens to
think they are different.”

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