1. Tier 2 Interventions: Systems, Practices, Data, and Outcomes
Lori Lynass, Ed.D.
NWPBIS Network

2. Acknowledgments Hill Walker, U of O Doug Cheney, U of WA
Kathleen Lane, Vanderbilt
Clay Cook, U of WA
Jeff Sprague, U of O
Bridget Walker, Seattle U
Wendy Iwaszuk, Beach Center, Kansas
Tricia Hagerty, Highline Public School

3. Systems, Data, Practices, Outcomes3

4. Cedarhurst Elementary PBIS

5. Building the Airplane While Flying It
Social and Behavioral Support
for All Students

6. Factors that Place Children At-Risk
Biology/physiology
Socioeconomic status
Family Conflict
Family Composition
Parenting Style
Lack of health care
Poor nutrition
Frequent moves
Temperament
Academic failure

7. Mental Health: What Do We Know?
The most common conditions include
Anxiety (31.9%)
Behavior disorders (19.1%)
Mood disorders (14.3%)
Substance use disorders (11.4%)
Approximately 40% of individuals meet criteria for multiple disorders.
(Merikangas et al., 2010)

8. Tier 2 Rationale: Early Intervention is Vital
Research suggests that there’s a ‘window of opportunity’ ranging between 2-4 years when prevention is critical
Great Smoky Mountains Study: Age Between First Symptom and Initial Diagnosis
Original source: Costello, E.J., Angold, A., Burns, B.J., Stangl, D.K., Tweed, D.L, Erkanli, A., and Worthman, C.M. (1996). The Great Smoky Mountains Study of Youth: Goals, Design, Methods, and the Prevalence of DSM-III-R Disorders. Unpublished manuscript, Developmental Epidemiology Program, Duke University Medical Center, Durham, NC, and the Department of Anthropology, Emory University, Atlanta, GA.
Source: O’Connell, Boat, & Warner, 2009

9. What is a Tier 2 Intervention?
An intervention (or set of interventions) known by all staff and available for students during the school day
Interventions that provide additional student support in academic, organizational, and/or social support areas

10. Tier 2 Interventions (Hawken, Vincent, & Schumann, 2008).
Assumes a Tier 1 School wide PBIS is in place – SET, BOQ
Involves a problem-solving focused behavior support team
Screening to identify a % of students non responsive to Tier 1
Readily available and easily accessible
Uses efficient, available evidence based practices
Includes data-based progress monitoring & decisions
Have an entry & exit criteria, with non-responders moving to Tier 3 10

11. Goal of Tier 2 Interventions
To Make the Problem Behavior:
Ineffective
Inefficient
Irrelevant
Unstable
* Some of this occurs through changes to the environment. 11

12. Tier 2: Small Group Interventions
Social Skills Groups (Redefining Counselor Groups)
Check In/Check Out, Check,
Connect & Expect
Executive Functioning Skill Groups
Academic Support Groups
Self-Monitoring

13. Why do Targeted Interventions Work?
Improved structure
Prompts are provided throughout the day for correct behavior.
System for linking student with at least one positive adult.
Student chooses to participate.
Student is “set up for success”
First contact each morning is positive.
“Blow-out” days are pre-empted.
First contact each class period (or activity period) is positive.
Increase in contingent feedback
Feedback occurs more often.
Feedback is tied to student behavior.
Inappropriate behavior is less likely to be ignored or rewarded.
SST13 at SWOSERRC
SST13 at SWOSERRC

14. Important Notes About Tier 2
Important Notes About Tier 2
Do not lose sight of Tier 1
Common misperception is that interventions will “fix” the student and the classroom teacher does not need to be an active participant since “specialists” or outside staff are often involved in the intervention
Successful interventions will require high level of involvement among ALL staff within the school building
SST13 at SWOSERRC

15. The Tier 2 Team ENTRY, EVALUATE, EXIT
Determine & Oversee Referral Process
Review Students Referred
Monitor Implementation Fidelity
Evaluate Outcomes and Make Decisions
Ongoing Progress Monitoring
Fidelity of Implementation
Social Validity

16. SWPBS IMPLEMENTATION DRIVERS
Data: For decision making
Systems: To sustain
the implementation
Practices: Evidenced-based and doable
Outcomes

17. Are We Ready for Tier Two?
For Tier Two supports to be most successful, basic components of Tier One should be in place.
* Check Classrooms
Time must be dedicated for Tier Two to be implemented.
Support from staff and admin must be available.
Professional development must occur.

18. Is Tier One in Place in the Classrooms?
Classroom-wide positive expectations taught, encouraged & reinforced and match school-wide expectations
Teaching classroom routines & cues taught & encouraged
Ratio of 4-5 positive to 1 negative adult-student interaction
Do Staff Agree with and Understand Classroom and Office Managed Behaviors
Active supervision
Redirections for minor, infrequent behavior errors
Frequent pre-corrections for chronic errors
Effective academic instruction & curriculum

19. Knowing Function of Behavior to Determine Intervention

20. “Can’t Do versus Won’t Do”
Can’t Do or Don’t Know When To Do
- Skill Deficit
- Performance Deficit
- Perception Deficit
Won’t Do
- Function of Behavior

21. Can’t Do: Skills Building
Social Skills Groups
Assertion Skills, Anger Management, Friendship Skills, Empathy Skills
Executive Function Skills Groups
Organization Skills, Emotional Control, Time Management
Academic Skills Groups
Context Reading Skills, Math Skills

22. Three Functions of Behavior
Problem Behavior
Escape/Avoid
Social
Activity
Peer
Adult
Obtain
Tangible
Automatic

23. We Also Have To Think Functionally When Choosing Interventions
“Problem Behaviors” are functional skills
Interventions must consider the purpose of behavior (from student’s perspective)
Seek a match from intervention menu for the needs of each individual student

24. It Starts With The Team

25. Functions of The Tier 2 Team
ENTRY, EVALUATE, EXIT
Determine & Oversee Referral Process
Review Students Referred
Monitor Implementation Fidelity
Evaluate Outcomes and Make Decisions
Ongoing Progress Monitoring
Fidelity of Implementation
Social Validity

26. 3-Tiered System of Support Secondary Systems Team
Universal Team
Secondary Systems Team
Problem Solving Team
Tertiary Systems Team
Uses Process data; determines overall intervention effectiveness
Uses Process data; determines overall intervention effectiveness
Plans SW & Class-wide supports
Standing team; uses FBA/BIP process for one youth at a time
CICO
Universal Support
Brief
FBA/BIP
SSG
Complex
FBA/BIP
WRAP
Exec Func Skills
Sept. 1, 2009 26 26

27. Derby Ridge Elementary Teaming Structure
Special Education Team
Tier 3 Team
Tier Two Team
CORE PBIS Team
Grade Level Teams

28. Establishing the Tier 2 Team
May be part of the existing PBIS leadership team.
May be an extension of the existing PBIS leadership team.
May be a stand alone team, often these teams look at Tier 2 & 3.
* Such a team may already exist in your school - SIT team, Care team, MDT team.

29. Tier 2 Team Members Tier 2 Coach PBIS Coordinator Counselor
Psychologist
Teachers
Administrator
Other Para-professionals

30. Team Uses Problem Solving Format
Instructional Support Team Video
Richland School District (Process Example)

31. Discussion Tier 2 Team
10 Minutes
What Tier 2 team format might work best for your school?
Who would be on your Tier 2 team?
When could this team meet?
What would need to happen to create a Tier 2 team?

32. Establish Entry Criteria

33. Establish Entry Criteria
A team agreed process should be established for how students enter Tier 2 programs. Common entry criteria:
Office Referrals
Teacher Nomination - Through Process
Counselor Nomination
Screening Results

34. How most schools determine student need for services
Office discipline referrals & Teacher/Staff referrals are commonly used
Only 2-5% of schools screen all children for mental heath reasons (Romer & McIntosh, 2005)

35. Office Referral Information
But Who Are We Missing?

36. How Are We Currently Screening For Social Behavior?

37. Screening for “At-risk” Students37

38. Screening Use of a Validated Screener:
Six-Eight (Oct-Nov) weeks after school begins & in Spring
At the end of the year if desired (provides information for planning)
As a new student enters if needed
* Academic Screening Data Also Considered

39. Choosing A Universal Screener
Choose a Screener that:
Is appropriate for its intended use and that is contextually and developmentally appropriate and sensitive to issue of diversity
Has Technical Adequacy
Useable - efficient, feasible, easy to manage
- Calderella,Young, Richardson & Young, 2008

40. Systematic Screening for Behavior Disorders (SSBD; Walker & Severson, 1992)
Originally normed K-6, recently normed for middle and Jr High (Calderella,Young, Richardson & Young, 2008)
Multiple gating procedures following mental health & PBS model
Externalizing and Internalizing dimensions
Evidence of efficiency, effectiveness, & cost benefits
Exemplary, evidence-based practice
US Office of Special Education, Council for Children with Behavior Disorders, National Diffusion Network

41. Multiple Gating Procedure (Severson et al. 2007)
Teachers Rank Order 3 Ext. & 3 Int. Students
Gate 1
Pass Gate 1
Teachers Rate Top 3 Students on Critical Events, Adaptive & Maladaptive Scales
Gate 2
Tier 2,3
Intervention
Pass Gate 2
Gate 3
Classroom & Playground Observations
Tier 3 Intervention or Special Ed. Referral

42. SSBD Screening Internalizing Behaviors Externalizing Behaviors
Examples
Not talking w other children
Acting in a fearful manner
Not participating
Avoiding or withdrawing
Not standing up for one’s self
Non-examples
Initiating social interactions
Having conversations
Joining in with others
Examples
Displaying aggression
Arguing
Defying the teacher
Being out of seat
Disturbing others
Non-examples
Cooperating
Sharing
Working on tasks

43. SSBD: Sample Questions
Critical Events (Behavioral Earthquakes):
Sets Fires,
Vomits after eating,
Exhibits painful shyness
Maladaptive Behavior
Requires punishment before s/he will terminate behavior.
Child tests teacher imposed limits.
Adaptive Behavior
Is considerate of the feelings of others.
Is socially perceptive.

44. SSBD Differentiates Grads , Non-grads, Comparisons
Graduates
Non-Graduates
Comparison
SSBD Critical Events
5.9 (2.8)
5.4 (3.0)
5.2 (2.8)
SSBD Maladaptive
31.2 (10.5) a
37.2 (5.7) b
32.2 (7.8) a
SSBD Adaptive
32.3 (8.0) a
28.0 (4.8) b
30.6 (6.8) a

45. Student Risk Screening Scale (Drummond, 1994)
Originally normed at elementary level, recently normed at middle and high school (Lane, Kalberg, Parks, & Carter, 2008)
Classroom teacher evaluates and assigns a frequency-based, Likert rating to each student in the class in relation to seven behavioral criteria
Score indicates the level of risk (low, medium, high)
Scores predict both negative academic and behavioral outcomes
Effective, Efficient and Free 45 45

46. Student Risk Screening Scale (Drummond, 1994)
lies,
cheats,
sneaks,
steals,
behavior problems,
peer rejections,
low achievement,
negative attitude,
Aggressive.
Rated on a 4-point Likert scale (never, seldom, sometimes, frequently)

47. SRSS

48. Student Internalizing Behavior Screener (SIBS, Cook et al. 2008)
Normed K-12 Grade. Rates on 7 Items:
Nervous or Fearful
Bullied by Peers
Spends Time Alone
Clings to Adults
Withdrawn
Seems Sad or Unhappy
Complains About Being Sick or Hurt
Rated on a 4-point Likert scale (never, seldom, sometimes, frequently)

49. BASC- Behavior and Emotional Screening Scale (BESS, Pearson Publications)
Based on BASC by Reynolds & Kamphaus, 2002
Universal screener with norms for preschool & K-12,
Includes teacher, parent, and self-rating forms grades minutes per form. Completed on all students in class.
Hand scored and scannable forms (in spanish too), ASSIST software available
Provides comprehensive summary of student scores and teacher ratings across the school
Assessment of a wide array of behaviors that represent both behavioral problems and strengths, including internalizing problems, externalizing problems, school problems, and adaptive skills. 49 49

50. Sample of BASC-2/BESS Form

51. Administration & Scoring Criteria
The BASC-2/BESS uses T-scores to communicate results relative to the average (mean=50)
Identifiers and percentile ranks are provided for ease of interpretation
Normal risk level: T-score range 10-60
Elevated risk level: T-score range 61-70
Extremely Elevated risk level: T-score range ≥ 71

52. 10 Minutes
Screening Activity

53. What Are Your Initial Thoughts?
What Other Information Might You Seek?
If You Have 3 Slots for Tier 2, Whom Do You Serve First?

54. In Addition to Screening Consider:
Teacher/Counselor/Parent Request Forms
Office Referral Data
Academic Data
Classroom Minor Data
Attendance

55. Questions to Consider When to do screening?
Who should prepare the forms?
Who should administer the screener?
Who should score them?
When and how should the results be shared? 55

56. We Have Screened, Now What?
Make Sure You Have A Plan For What to Do Once You Screen..

57.  2009 Bridget Walker, Ph.D. 57 57

58. Sample List of Students Identified Through Schoolwide Screening
How could this information help you determine where your limited support resources should focus?
Bridget Walker, Ph.D. 58 58

59. Monitoring Effectiveness and Fidelity of Tier 2 Interventions
A good plan implemented poorly…
is a bad plan.
Monitoring Effectiveness and Fidelity of Tier 2 Interventions
Fidelity Checklist

60. Monitoring Progress In Tier 2
Each Student Should Be Monitored Weekly and Discussed Twice Monthly to Determine :
If they are responding to the intervention
If the intervention is the correct intervention
If the intervention needs to be adjusted
If the student is ready to exit

61. SWIS-CICO Report Daily Points Graph

64. Monitoring Fidelity of Tier 2 Interventions
Core features of interventions should be adhered to.
The fidelity of Tier 2 programs should be monitored by the Tier 2 team.
Look over the Tier 2/3 Tracking Tool and Systems-Response Tool.

65. Monitoring All Interventions

66. Tier 2: Summary of The Big Ideas
Do the easy stuff first (efficiency is a major goal)
Processes are as important as practices
Use of Evidence Based Practices based on Behavioral Science
Teaming is critical
Administrative support is critical
Data Based Decision Making

67. Some Students Just Need A Little More Support