Tag: behavior

Mental Health Education and Support at School can be Critical

Posted on by Nicol Walsh

A Brief Overview

  • Alarming statistics indicate the pandemic worsened many behavioral health outcomes for young people. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.
  • President Joe Biden issued a Fact Sheet about the nation’s mental health crisis on March 1, 2022, as part of his State of the Union message. This article includes some of what the president shared about youth impacts.
  • Washington State’s 2021 Healthy Youth Survey confirms that children and youth are struggling to maintain well-being.
  • These outcomes make adolescence a critical time for mental health promotion, early identification and intervention. Read on for information and resources.
  • The emotional well-being of students may be served through Multi-Tiered Systems of Support (MTSS), which provide a structure for schools to provide education and supports related to student well-being schoolwide.
  • Students with high levels of need may access mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA).

Full Article

Alarming statistics indicate that children and young people are in crisis. Governor Jay Inslee issued an emergency proclamation for children’s mental health on March 14, 2021. Data from Washington’s 2021 Healthy Youth Survey confirm the distressing trends:

Seven out of ten students in tenth grade report feeling nervous, anxious, on edge, or cannot stop worrying. Eight percent said they tried suicide within the past year. Almost 40 percent said their feelings were disturbing enough to interrupt their regular activities, and more than 10 percent of students said they didn’t have anyone to talk to about their feelings. According to the Centers for Disease Control and Prevention (CDC), only about half of young people who need behavioral health services get them.

According to the 2021 statewide survey, students with disabilities struggle more than most. Also over-represented are girls, students from lower income households, and students whose gender or sexuality is non-binary. Non-binary refers to more than two things; it’s a term often used when discussing people who identify as Lesbian, Gay, Bi-sexual, Transgender, Queer, or questioning (LGBTQ+). LGBTQ+ youth can seek crisis help and more from The Trevor Project.

“Reports of our children suffering with mental health issues are a worrisome public health concern,” said Umair A. Shah, MD, MPH, Washington’s Secretary of Health. “Mental health is a part of our children’s overall health and well-being. It is imperative that we all continue to work together to fully support the whole child by providing information and access to behavioral health resources to youth and the trusted adults in their lives.”

Concerns are nationwide. On March 1, 2022, President Joe Biden issued a Fact Sheet stating that grief, trauma, and physical isolation during the past two years have driven Americans to a breaking point:

“Our youth have been particularly impacted as losses from COVID and disruptions in routines and relationships have led to increased social isolation, anxiety, and learning loss.  More than half of parents express concern over their children’s mental well-being. An early study has found that students are about five months behind in math and four months behind in reading, compared with students prior to the pandemic.

“In 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40 percent from 2009. Emergency department visits for attempted suicide have risen 51 percent among adolescent girls.”

Mental Health support to students is a statewide priority

Recognizing the unmet needs, Washington State’s 2022 legislature passed a variety of bills to increase support to children and youth with behavioral health conditions. Here are a few examples:

  • HB 1664: Provides funding and incentives for schools to increase numbers of staff who provide physical, social, and emotional support to students. Schools are responsible to report to the state how these funds were used for hiring staff that directly support students and not something else.
  • HB 1800: Requires Health Care Authority (HCA) to build and maintain a website (“parent portal”) to help families seek out behavioral health services. Also supports growth and training requirements for behavioral health ombuds serving youth through the Office of Behavioral Health Consumer Advocacy.
  • HB 1834: Establishes a student absence from school for mental health reasons as an excused absence.
  • HB 1890: Creates an advisory group under the Children and Youth Behavioral Health Work Group (CYBHWG) to build a strategic plan for children, youth transitioning to adulthood, and their caregivers. Also establishes a $200/day stipend (up to 6 meetings per year) for members of the CYBHWG with lived experience who are not attending in a paid professional capacity.

TIP: Family caregivers can get involved in advocacy work!

Here’s another TIP: Families can ask their school who is on site to support students with their mental health needs. Some school districts seek support from an Educational Service District (ESD) to meet student behavioral health needs, so families can also ask whether ESD supports are available. Some ESDs are licensed as behavioral health providers—just ask.

What is MTSS, and why learn this acronym to ask the school about it?

A priority for agencies involved in statewide work is implementation of Multi-Tiered Systems of Support (MTSS). Through MTSS, schools support well-being for all students and offer higher levels of support based on student need. Social Emotional Learning (SEL) is key to MTSS, which creates a structure for positive behavioral supports and trauma-informed interventions.

The Office of Superintendent of Public Instruction (OSPI) is the state educational agency for Washington schools. In its 2021 budget, OSPI prioritized MTSS as part of a plan to Empower all Schools to Support the Whole Child. In January, 2021, OSPI was awarded a five-year, $5.3 million grant from the U.S. Department of Education help districts implement MTSS. As a local control state, Washington districts determine their own specific policies and procedures.

TIP: Families can ask school and district staff to describe their MTSS work and how students are receiving support through the various levels/tiers.

Special Education is one pathway for more help

Students may access mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). Appropriate support can be especially critical for these students: According to the U.S. Office of Special Education Programs (OSEP), students eligible for school-based services under the ED category are twice as likely to drop out of high school before graduating.

How a student is supported in their life planning could have an impact. PAVE provides a toolkit of information about how to support a student in their preparations for graduation and beyond: School to Adulthood: Transition Planning Toolkit for High School, Life, and Work.

Note that a student with a mental health condition might qualify for an Individualized Education Program (IEP) under the category of Other Health Impairment (OHI), which captures needs related to various medical diagnoses. Other categories that often overlap with behavioral health are Autism and Traumatic Brain Injury (TBI). IEP eligibility categories are described in the Washington Administrative Codes (WAC 392-172A-01035).

In Washington State, the ED category is referred to as Emotional Behavioral Disability (EBD). If the student’s behavioral health is impaired to a degree that the student is struggling to access school, and the student needs Specially Designed Instruction (SDI), then the student may be eligible for an IEP. Keep in mind that academic subjects are only a part of learning in school: Social Emotional Learning (SEL) is part of the core curriculum. 

An educational evaluation determines whether a student has a disability that significantly impacts access to school and whether Specially Designed Instruction (SDI) and related services are needed for the student to receive a Free Appropriate Public Education (FAPE). FAPE is the entitlement of a student eligible for special education services. An IEP team determines how FAPE/educational services are provided to an individual student.

Behavioral health counseling can be part of an IEP

Counseling can be written into an IEP as a related service. When included in a student’s IEP as educationally necessary for FAPE, a school district is responsible to provide and fund those services. School districts can receive reimbursement for most of the cost of behavioral health services for students who are covered by Medicaid and on an IEP. The Health Care Authority provides information about school-based health services for students who are covered by Medicaid and on an IEP.

A student with a mental health condition who doesn’t qualify for an IEP might be eligible for a Section 504 Plan. A disability that impairs a major life activity triggers Section 504 protections, which include the right to appropriate and individualized accommodations at school. Section 504 is an aspect of the Rehabilitation Act of 1973, a Civil Rights law that protects against disability discrimination. Students with IEPs and 504 plans are protected by Section 504 rights.

Behavioral Health encompasses a wide range of disability conditions, including those related to substance use disorder, that impact a person’s ability to manage behavior. Sometimes students with behavioral health disabilities bump into disciplinary issues at school. Students with identified disabilities have protections in the disciplinary process: PAVE provides a detailed article about student and family rights related to school discipline.

Placement options for students who struggle with behavior

IEP teams determine the program and placement for a student. In accordance with federal law (IDEA), students have a right to FAPE in the Least Restrictive Environment (LRE) to the maximum extent appropriate. That means educational services and supports are designed to help students access their general education classroom and curriculum first. If the student is unable to make meaningful progress there because of their individual circumstances and disability condition, then the IEP team considers more restrictive placement options. See PAVE’s article: Special Education is a Service, Not a Place.

If general education is not working, the IEP team is responsible to consider all placement options to find the right fit. There is not a requirement to rule out every “less restrictive” option before choosing a placement that the team agrees will best serve the student’s needs.

Sometimes the IEP team, which includes family, will determine that in order to receive FAPE a student needs to be placed in a Day Treatment or Residential school. OSPI maintains a list of Non-Public Agencies that districts might pay to support the educational needs of a student. Districts may also consider schools that are not listed. Washington State has almost no residential options for students. Schools almost always send students to other states when residential placement is needed.

On May 23, 2022, a Washington affiliate of National Public Radio (KUOW) provided a report about the lack of residential programs in the state and the challenges for families whose students go out of state for residential education: Washington is sending youth in crisis to out-of-state boarding schools; taxpayers pick up the tab.

Residential placement may be necessary because educational needs cannot be served unless medical needs are fully supported. School districts may be responsible in those situations to pay for a residential placement. A precedent-setting court ruling in 2017 was Edmonds v. A.T. The parents of a student with behavioral disabilities filed due process against the Edmonds School District for reimbursement of residential education. The administrative law judge ruled that the district must pay for the residential services because “students cannot be separated from their disabilities.”

Strategies and safety measures for families and teachers

The Healthy Youth Survey is conducted every other year and was delayed from 2020 to 2021 because of the pandemic. Over the years, results are shared along with tips for families and schools. Here are a few considerations built from various data points within the survey:

Hopeful students:

  • Are more interested in schoolwork: Is there a way to make every day at school more connected to what a child cares about?
  • See people who can help: Who are the adults at school that a student can trust and go to for encouragement or guidance?
  • Believe that school is relevant to life: Who is helping the student connect what they are learning now to who they want to become?
  • Are academically successful: Are supports in place to provide adequate help so the student can succeed in learning? Evidence-based instructional strategies are key when students struggle in reading, writing, or math because of learning disabilities, for example.

TIP: Make sure these four topics are part of a school/family discussion when a student is struggling with emotional well-being or behavior that may be impacted by hopelessness.

A 2018 handout includes tips for parents and other adults who support teens who feel anxious or depressed:

  • Bond with them: Unconditional love includes clear statements that you value them, and your actions show you want to stay involved in their lives.
  • Talk with teens about their feelings and show you care. Listen to their point of view. Suicidal thinking often comes from a wish to end psychological pain.
  • Help teens learn effective coping strategies and resiliency skills to deal with stress, expectations of others, relationship problems, and challenging life events.
  • Have an evening as a family where everyone creates their own mental health safety plan.
  • Learn about warning signs and where to get help
  • Ask: “Are you thinking about suicide?” Don’t be afraid that talking about it will give them the idea. If you’ve observed any warning signs, chances are they’re already thinking about it.
  • If you own a firearm, keep it secured where a teen could not access it.
  • Lock up medications children shouldn’t have access to.

A press for school-based services and mental health literacy

Advocacy for direct school-based mental health services and education about mental health topics comes from the University of Washington’s SMART Center. SMART stands for School Mental Health Assessment Research and Training. The SMART center in 2020 provided a report: The Case for School Mental Health. The document includes state and national data that strongly indicate school-based behavioral health services are effective:

“Increased access to mental health services and supports in schools is vital to improving the physical and psychological safety of our students and schools, as well as academic performance and problem-solving skills. Availability of comprehensive school mental health promotes a school culture in which students feel safe to report safety concerns, which is proven to be among the most effective school safety strategies.”

The SMART Center in partnership with the non-profit Chad’s Legacy Project in 2021 established an online Student/Youth Mental Health Literacy Library. Intended for staff at middle and high schools, the library provides resources to help schools choose curricula for mental health education on topics that include Social Emotional Learning, Substance Use Disorder, and Suicide Prevention.

Goals of mental health literacy are:

  • Understanding how to foster and maintain good mental health
  • Understanding mental disorders and their treatments
  • Decreasing Stigma
  • Understanding how to seek help effectively for self and others

TIP: Families can direct their schools to this resource to support development or growth of a mental health education program.

For information, help during a crisis, emotional support, and referrals:  

  • Suicide Prevention Lifeline (1-800-273-TALK): After July 16, 2022, call 988
  • Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor
  • Trevor Project Lifeline (LGBTQ) (1-866-488-7386)
  • The Washington Recovery Help Line (1-866-789-1511)
  • TeenLink (1-866-833-6546; 6pm-10pm PST)
  • Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide

Further information on mental health and suicide:  

Family Support

  • PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.
  • A Facebook group called Healthy Minds Healthy Futures provides a place to connect with other families.
  • Family caregivers can request support and training from COPE (Center of Parent Excellence), which offers support group meetings and direct help from lead parent support specialists as part of a statewide program called A Common Voice.
  • Washington State Community Connectors (WSCC) sponsors an annual family training weekend, manages an SUD Family Navigator training, and offers ways for families to share their experiences and support one another. With passage of HB 1800 in 2022, WSCC is working with the Health Care Authority to build a statewide website to help families navigate behavioral health services.
  • Family, Youth, and System Partner Round Table (FYSPRT) is a statewide hub for family networking and emotional support. Some regions have distinct groups for young people.

Behavior and School: How to Participate in the FBA/BIP Process

Posted on by Nicol Walsh

This 2-part training has information about how to support a child’s behavior at school. When behavior gets in the way of learning, schools are responsible to figure out what the child is trying to communicate and to teach the child what to do instead.

PAVE’s accessible, fillable worksheet goes with the videos to help with behavior planning.

The process of figuring out why a child is acting out is called a Functional Behavioral Assessment—FBA for short. The first video in this 2-part series is about the FBA process.

A Behavior Intervention Plan—BIP for short—is a working document that the school and family build together and review regularly to make sure the child is supported with positive reinforcement and encouragement for meeting behavioral expectations. The second video in this 2-part series is about BIP development.

PAVE provides a Sample Letter to Request a Functional Behavioral Assessment to help families formally ask the school to assess their child’s behavior and consider how to thoughtfully build a behavior support plan.

Schools are guided by the state to use best practices when evaluating and serving students with special needs. The Office of Superintendent of Public Instruction (OSPI) is the state educational agency in Washington State. OSPI’s website is k12.wa.us. A page called Model Forms for Services to Students in Special Education has links to downloadable forms schools use to develop IEPs, Section 504 Plans, and more.

Here are links to OSPI’s model forms for:

After you view the video, please take a quick moment to complete our survey. Your feedback is valuable!

Adolescent Health Care Act Provides Options for Families Seeking Mental Health and Substance Use Help for Young People Resistant to Treatment

Posted on by Nicol Walsh

A Brief Overview

  • The Adolescent Behavioral Health Care Access Act, passed into law by the Washington Legislature in 2019, gives parents and providers more leverage in treating a young person who will not or cannot independently seek medical help for a behavioral health condition.
  • The Washington State Health Care Authority (HCA) hosts website links with information about the law, which allows Family Initiated Treatment (FIT). The landing page includes an email address: hcafamilyinitiatedtreatment@hca.wa.gov.
  • Access to FIT is a topic of the state’s Children and Youth Behavioral Health Work Group. CYBHWG supports several sub-work groups, including one focused on school-based services and suicide prevention. Information about group membership, public meetings, resources, events and training is available on the HCA website.
  • If a person ages 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys. This website link includes access to a referral form.

Full Article

Getting mental health help for a youth in crisis can be complicated, frustrating, and frightening.

Mental Health America ranks states based on the incidence of mental illness and access to services. The 2022 youth rankings list Washington 39th in the nation. Various measures indicate a high prevalence of major depression, substance use disorder, and/or emotional disturbance as a category of disability on the Individualized Education Program (IEP). Barriers to treatment consider insurance as well as availability of services.  

Sometimes a barrier to treatment involves a complicated balance of youth autonomy and parental responsibility. The most severe psychiatric conditions often include a symptom called anosognosia, which blocks the brain’s ability to see the impairment or understand why professional help could be of benefit. In youth whose brains are still forming, symptoms that impact insight and choice-making are particularly problematic.

New Journeys is an option when psychosis is present

Sometimes anosognosia co-occurs with psychosis, which indicates a person has lost touch with reality. Delusions and hallucinations may be present. If a person is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys: This link provides access to information for clients and families and includes an online referral form.

Causes of psychosis are the subject of ongoing research, but some theories suspect the brain is trying to make sense out of a world that does not make sense. Synapses fire errantly, and the brain tries to organize them into stories to calm itself. Synaptic loops get built during these firestorms of neural activity, and the stories that emerge become reality to the person whose brain is narrating the experience, even if they are untrue or grounded in false perceptions. Choice-making in the empirical world is often compromised.

Family education about psychosis is an aspect of New Journeys, which is for youth and adults ages 15-40 who have experienced psychotic symptoms for more than or equal to 1 week and less than or equal to 2 years. Staff from the University of the Washington contribute support to the state’s New Journeys program, which is offered in various but not all regions of the state.

University staff also support a program called Psychosis REACH, which provides evidence-based skill-building for relatives and friends of individuals with psychotic disorders. The practices are based in cognitive behavioral therapy (CBT). The program’s website includes information about training opportunities and resources.

Age of Consent in Washington is 13

In Washington State, the age of medical consent is 13. That means that a person 13-17 years old can independently seek medical treatment, without the consent or knowledge of parents.

Age of consent laws also have meant that Washington youth could say no to behavioral health treatment, regardless of whether parents and providers agreed that such treatment was necessary to protect the safety and well-being of the adolescent. Exceptions are made when there is a threat of imminent danger or grave disability due to psychiatric deterioration. Read on for more information about involuntary treatment/commitment.

The Adolescent Behavioral Health Care Access Act, passed by the Washington legislature in 2019, gives parents and providers more leverage when a young person is struggling with behavioral health and does not independently engage with treatment. The law allows parents/caregivers to bring a youth, ages 13-17, to a provider for evaluation without requiring consent from the youth.

The law includes elements introduced by the state Senate and House of Representatives, which originally titled the bill as HB 1874. In 2020, passage of HB 2883 added residential treatment as an additional option under Family Initiated Treatment (FIT).

The law does not limit an adolescent’s ability to initiate treatment on their own.

Parents have felt shut out of their teenager’s care

A January 8, 2020, article in Crosscut profiles several families impacted by the new law. “Until the new law,” the article states, “parents often were shut out of their teenager’s care and treatment plans and couldn’t push a teen toward necessary outpatient or inpatient care without their consent.”

Passage of FIT marks a win for the Children and Youth Behavioral Health Work Group, which studied and reviewed recommendations from a stakeholder advisory group authorized by the 2018 legislature. Final language in the law was impacted by family members, youth, clinicians, hospital staff and many others who met dozens of times.

“Parent” is broadly defined, and information sharing is more open

Under the law, the definition of parent is expanded to include a wide range of family caregivers, guardians and others who have authority to initiate treatment. The Revised Code of Washington (RCW 9A.72.085) provides standards for “subscribing to an unsworn statement” that can apply to a caregiver initiating treatment. 

The law enables providers to share information with parents without an adolescent’s consent, if the provider determines that information sharing with family is in the best interests of the adolescent patient. A list of information-sharing guidelines is included below.

Note that parents retain the right to make medical decisions for children younger than 13, and adults 18 and older are responsible for medical decision-making if there is no guardianship.

In accordance with RCW 71.34.375, providers are required to provide notice to parents of all available treatment options, including Family Initiated Treatment. The state Health Care Authority provides a fact sheet to clarify those requirements.

Family-Initiated Treatment (FIT)

The FIT law allows a parent/caregiver to escort their adolescent child to certain licensed behavioral health facilities and request that a professional person examine the adolescent to determine whether treatment is medically necessary. That treatment might include outpatient, inpatient, or residential care.

According to the Health Care Authority (HCA), FIT is not a guarantee of immediate services, and no provider is obligated to provide services under FIT. Each provider has processes, procedures, and requirements pertaining to evaluation and admission to services. However, the only reason for not providing services cannot be the youth’s lack of consent (RCW 71.34.600).

If a facility covered by this law does not have a professional person available to perform the examination, the facility is not required to make staff available on demand. Additionally, if the professional determines the adolescent needs in-patient treatment but the facility does not have a bed available, the facility is not required to make a bed available. Included are those facilities that house children and youth under the Children’s Long-term Inpatient Program (CLIP). CLIP beds are generally subject to a waiting list and a multi-step referral process.

According to staff at Washington’s Health Care Authority, staffing shortages and other limitations within the behavioral health system have slowed implementation of the law. Families are encouraged to contact providers before taking an adolescent to a facility to determine if the provider has the capacity or ability to perform an assessment.

FIT in a community setting

If medical necessity is found by an outpatient provider who evaluates a young person brought into care through FIT, the provider is limited to 12 sessions over 3 months to attempt to work with the adolescent. If the young person still refuses to engage with treatment, then the period of Family-Initiated Treatment with that provider ends. The family at that point could seek treatment elsewhere.

State laws continue to encourage autonomy for young people, despite recognition that family involvement is important. According to the Revised Code of Washington (RCW 71.34.010):

 “Mental health and chemical dependency professionals shall guard against needless hospitalization and deprivations of liberty, enable treatment decisions to be made in response to clinical needs in accordance with sound professional judgment, and encourage the use of voluntary services. Mental health and chemical dependency professionals shall, whenever clinically appropriate, offer less restrictive alternatives to inpatient treatment. Additionally, all mental health care and treatment providers shall assure that minors’ parents are given an opportunity to participate in the treatment decisions for their minor children.”

For children and youth eligible for Apple Health, Wraparound with Intensive Services (WISe) is Washington’s most intensive outpatient treatment. PAVE provides an article: WISe Provides Team-Based Services for Washington Youth with Severe Behavioral Health Disorders.

The Health Care Authority (HCA) maintains a website page with information about WISe in multiple languages. Families can discuss their options for FIT with WISe staff and HCA leadership.

FIT in a hospital setting

An inpatient or residential facility can detain the adolescent under Family-Initiated Treatment (FIT) if medically necessary for a mental health condition. In these settings, FIT may last up to 30 days. Then the adolescent must be discharged, unless:

  • they agree to stay voluntarily, or
  • a designated crisis responder (DCR) initiates involuntary commitment proceedings

What is required for involuntary treatment?

The Involuntary Treatment Act (ITA) can apply to persons of any age who are determined to be gravely disabled or at imminent risk of harm to self, others, or property. Under Ricky’s Law, community members of any age who are a danger or gravely disabled due to a drug or alcohol problem may be involuntarily detained to a secure withdrawal management and stabilization facility—also known as secure detox.

For substance use disorder treatment, due to Federal Privacy Laws, a parent/caregiver can only provide consent for an assessment. The youth would have to consent to the results of the assessment being shared with their parent/caregiver and volunteer for ongoing treatment if it is deemed medically necessary.

Guidance for Information Sharing

Federal law, 42 CFR Part 2, restricts information sharing related to substance use, and clinicians cannot share that information without a patient’s written consent, regardless of whether the substance use co-occurs with mental illness.

Providers have discretion in determining what information about mental health diagnoses and treatment is clinically appropriate to share with parents of an adolescent 13-17. A provider retains discretion in withholding information from family/caregivers to protect an adolescent’s well-being. In general, however, the Adolescent Behavioral Healthcare Access Act encourages sharing information to support collaboration between the clinical setting and home. Specifically, providers and families are encouraged to discuss:

  • Diagnosis
  • Treatment Plan and Progress
  • Recommended medications, including risks, benefits, side effects, typical efficacy, dosages, and schedule
  • Education about the child’s mental health condition
  • Referrals to community resources
  • Coaching on parenting or behavioral management strategies
  • Crisis prevention planning and safety planning

To support family caregiving for individuals of all ages, the Washington State Hospital Association provides general guidance about exceptions to federal confidentiality laws (HIPAA): Permitted disclosures of mental health information and substance use disorder information without patient consent.

Family Support

For individualized, non-emergency support, please click Get Help and someone from PAVE will contact you. Family Voices of Washington, PAVE’s Family-to-Family Health Information Center, is another place for information and resources.

In addition to PAVE, here are places for family support:

  • COPE (Center of Parent Excellence) offers support group meetings and direct help from lead parent support specialists as part of a statewide program called A Common Voice.
  • Family, Youth, and System Partner Round Table (FYSPRT). Regional groups are a hub for family networking and emotional support. Some have distinct groups for young people.
  • Washington State Community Connectors (WSCC) sponsors an annual family training weekend, manages an SUD Family Navigator training, and offers ways for families to share their experiences and support one another. With passage of HB 1800 in 2022, WSCC is working with the Health Care Authority to build a statewide website (Parent Portal) to help families navigate behavioral health services.
  • Healthy Minds Healthy Futures is an informal network of family caregivers on Facebook. The group advocated for Family Initiated Treatment (FIT) and is part of the work to build the Parent Portal website.

Additional Resources

The  Health Care Authority (HCA) provides a range of information about behavioral health services for children and youth, including this downloadable resource: Parent’s Guide to Family Initiated Treatment.

Families can direct specific questions to: hcafamilyinitiatedtreatment@hca.wa.gov. Please note that this business email is not intended for crisis response.

An agency called CaseText organizes links related to Family Initiated Treatment for direct access to various statutes.

WISe Provides Team-Based Services for Washington Youth with Severe Behavioral Health Disorders

Posted on by Nicol Walsh

A Brief Overview

  • WISe behavioral healthcare teams serve children and youth 20 or younger whose conditions are too severe to benefit appropriately from regular visits to a community clinician and/or therapist.
  • To qualify for WISe, the young person must be eligible for Apple Health, which is the public health program for Washington State. WAC 182-505-0210 describes Apple Health eligibility standards.
  • WISe was created as a response to the T.R. et al. lawsuit, settled in 2013.
  • Different agencies manage WISe programs in various regions of the state. The Health Care Authority manages a downloadable list of WISe agencies, organized by county. Families can contact their area agency by calling the phone number on this referral list.
  • Read on for various places families might seek solidarity and support. One option is Family, Youth, and System Partner Round Table (FYSPRT), which is a network of groups that meet to discuss what’s working/not working in behavioral healthcare systems in their communities.

Full Article

Children and youth with intensive needs related to behavioral health may be eligible for services from a statewide program called WISe–Wraparound with Intensive Services. A WISe team includes various clinical and professional staff and certified peers, who may support the emotional needs of family members.  

WISe services are provided in the community—outpatient—for children and youth 20 or younger who are eligible for public insurance, called Apple Health in Washington State. To be assigned to a WISe team, the young person must demonstrate a need for services that are more intensive than what is provided from regular visits to a community clinician and/or therapist.

What does behavioral health mean?

Behavioral health is a broad term describing services for people with conditions based in the brain that impact their behavior. Bipolar disorder, schizophrenia, and substance use disorder (SUD) are examples of severe behavioral health conditions impacting some adults and young people.

Other childhood conditions are many and varied, and not everyone uses the same terms for the same symptoms. The Child Mind Institute is a place for information about childhood symptoms, diagnoses, and options for treatment and support.

Some developmental conditions, such as autism, are considered behavioral health conditions when symptoms have a significant impact on behavior. A person with a complicated behavioral health condition may have impacts in multiple areas and may be given a “dual diagnosis.”

Who is eligible for WISe services?

WISe services are for children and youth until their 21st birthday. WISe is only approved if the patient has used other, less intensive therapies, with little to no improvement.  Once approved for services, a young person may spend time on an “interest list,” receiving limited support, before a full team is formed to serve them.

The young person is evaluated with a Child and Adolescent Needs and Strengths (CANS) intensive mental health screening tool, called the CANS-SCREEN.

Five core areas are evaluated:

  1. Life functioning
  2. Behavioral and emotional needs
  3. Risk behaviors
  4. Caregiver resources and needs
  5. Diagnosis and prognosis

According to the CANS-SCREEN, “The care provider, along with the child/youth and family as well as other stakeholders, gives a number rating to each of these items. These ratings help the provider, child/youth and family understand where intensive or immediate action is most needed, and also where a child/youth has assets that could be a major part of the treatment or service plan.”

WISe requires public health insurance eligibility

In addition to meeting criteria based on their symptoms, a young person must be eligible for Apple Health, which is the name for public health insurance in Washington State. The Washington Administrative Code (WAC 182-505-0210) describes Apple Health eligibility standards for children.

Apple Health is most often administered by Managed Care Organizations (MCOs). In 2022, plans are provided by Amerigroup, Community Health Plan of Washington (CHPW), Coordinated Care, Molina, and United Healthcare. Families can request case management from their MCO to help them navigate and understand healthcare options available to them.

An MCO care coordinator/case manager commonly is the person who refers a young person into WISe, although referrals also can be made by the family, a provider, a county health agency, or someone else with knowledge of the circumstances.

Different agencies manage WISe programs in various regions of the state. The Health Care Authority manages a downloadable list of WISe agencies, organized by county. Families can contact their area agency by calling the phone number on this referral list.

Who is on the WISe team?

Team members include:

  • Natural supports (family, friends, religious leaders…)
  • A Care Coordinator (who oversees clinical aspects of the case)
  • Therapist
  • Professionals (clinicians/prescriber if needed, Child Protective Services, probation officers and others who are relevant)
  • Certified peer support specialist
  • Others upon request (youth peer, school staff…)

The clinical group creates a Team Vision Statement, explaining what they plan to achieve and how they will accomplish it through collaborative work. The family also creates a Vision Statement, showing what strengths they would like to build in their family and what tools they need to make their goals possible.

WISe requires family engagement

The time commitment for WISe is significant. Clinicians engage with the whole household on topics related to school, health, work, relationships, home organization, and more.

WISe publishes data about its service delivery. According to January 2021 Service Intensity Estimates, an average family spends 10 or more hours per week engaged with WISe services. This could be much higher, especially in the beginning. Parents/Caregivers are offered therapy sessions and opportunities to engage with parent peers. 

WISe clinicians are responsible to integrate their work to fit with a family’s schedule, often seeking creative ways to tuck sessions into already busy days. For example, a clinician describes a day when they picked up a child at school and conducted a session in the car while driving the child to their next activity. After work, parent met with the clinician while the adults watched the child swim.

Family experiences with WISe are varied. Some say WISe created a critical turning point that enabled family survival. Others cite high staff turnover as a barrier to ideal therapeutic outcomes. The program is most effective with buy-in from the young person and their caregivers and when services are provided to match family needs and schedules.

Does my child have to agree to WISe services?

WISe is a voluntary program. Families may be able to motivate their child to participate by getting services started through Family Initiated Treatment (FIT). FIT was established as a pathway to treatment for youth 13-17 when Washington passed the Adolescent Behavioral Health Care Access Act in 2019. A parent/caregiver can initiate outpatient services to attempt to get the youth to engage. If after 12 visits (within 3 months) the youth is still unwilling to engage with the treatment, the family must end services. They have the option to engage a different provider to try FIT again.

What if WISe isn’t enough?

The WISe program is the most intensive outpatient program that the state offers. If services don’t seem to be working, the family might check the WISe Service Delivery, Policy, Procedure and Resource Manual to see whether there is more the program could be doing. The family also might check if the child could get additional services from another agency to complement the work with WISe. For example, service providers from a special education program at school or from the Developmental Disabilities Administration (DDA) can collaborate with a WISe team.

If a child needs inpatient services, they may be eligible for a referral into the Children’s Long-term Inpatient Program (CLIP). Children placed on a waiting list for CLIP often receive ongoing services from WISe. PAVE provides an article: Children’s Long-Term Inpatient Program (CLIP) Provides Residential Psychiatric Treatment.

History, Advocacy, and Family Support

WISe was created as a response to the T.R. et al. lawsuit, settled in 2013. The class-action lawsuit named ten plaintiffs who were denied treatment for schizophrenia, depression, bipolar disorder, and other serious psychiatric conditions. Most were institutionalized repeatedly and for extended periods, despite recommendations by therapists and case workers that they return home and receive services in their homes and local communities.

Disability Rights Washington (DRW) provided attorney support for the settlement of the T.R. et al. lawsuit. DRW is monitoring current issues related to children being underserved through WISe and encourages families with concerns to contact attorney Susan Kas: susank@dr-wa.org.

Another result of the legal settlement was a statewide network of stakeholders who meet regularly to discuss what works/doesn’t work within the behavioral health system for youth. That network is called Family, Youth, and System Partner Round Table (FYSPRT). Regional FYSPRTs report to a statewide FYSPRT to share input for system improvement. Regional groups are a hub for family networking and emotional support in addition to serving as a place to engage with community health providers, insurance case managers, and other professionals. Some FYSPRTs have distinct groups for young people to meet and support one another. Many FYSPRT groups use online meeting platforms due to the pandemic.

Another place for families engaged in behavioral health services to network is Washington State Community Connections (WSCC), which sponsors an annual family training weekend, manages an SUD Family Navigator training, and offers a variety of ways for families to share their experiences and support one another. WSCC in 2022 is engaged in work to help build a statewide website to help families navigate behavioral health services across systems. Stay tuned!

Families can get direct support from A Common Voice, a statewide non-profit staffed with Parent Support Specialists who have lived experience parenting a child with challenging behavioral health conditions. The program offers virtual support groups and 1:1 help. A Common Voice is part of the Center of Parent Excellence (COPE), managed by the state’s Health Care Authority. The COPE project website provides a schedule of support group meetings and contact information for regional lead parent support specialists.

An informal place to connect with other families is a Facebook group called Healthy Minds Healthy Futures. Advocates in this group initiated work for an interactive website for parents and are engaged in a push for HB 1800 to expand behavioral health services for minors statewide.

Families wanting to advocate for system change can participate in meetings of the Children and Youth Behavioral Health Work Group (CYBHWG). The work group was created in 2016 by the Legislature (HB 2439) to promote system improvement. CYBHWG supports several advisory groups, including one for Student Behavioral Health and Suicide Prevention. The work groups include representatives from the Legislature, state agencies, health care providers, tribal governments, community health services, and other organizations, as well as parents of children and youth who have received services. Meetings include opportunities for public comment. Meeting schedules and reports are posted on the Health Care Authority (HCA) website.

Parity laws, thoughtful language, stopping stigma

Keep in mind that a healthy mind is part of a healthy body, and U.S. laws protect parity for all illness conditions. Despite those protections, discrimination and stigma are commonly discussed within behavioral healthcare systems. Here are a few tips and considerations to help reduce stigma:

  • All behaviors start in the brain, so an impairment that impacts the brain is going to affect behavior. Some behaviors are not a person’s fault; that’s why they need treatment, support, and services.
  • Specific person-first language can help reduce stigma. For example, instead of calling someone bipolar or schizophrenic, say they are a person with bipolar disorder or schizophrenia.
  • An exception to person-first language is in the autism community, which has collectively agreed to use the term “autistic” to describe someone on the spectrum.
  • Saying that someone has “behavioral health,” or “mental health” does not describe their condition or what they need help with. Everyone has mental health! A better choice is to describe the condition/concern and the need for help: “This youth’s schizophrenia is impacting every aspect of life, and they need a range of services and treatments to recover and move forward with their life plans.”
  • A person who dies from suicide did not commit a crime, so the word “commit” is inappropriate to use when discussing suicide.

For additional information on related topics, including areas where behavioral health impacts school, see PAVE’s article: Mental Health Education and Support at School can be Critical

How to Navigate School for Youth with Mental Health Concerns

Posted on by Nicol Walsh

Staff from PAVE’s Parent Training and Information (PTI) program provided a workshop as part of the statewide virtual conference hosted by NAMI Washington October 16, 2021.

This recorded training provides a general overview of student rights in education. Some information is specific to students impacted by mental health conditions.

The formal content begins about four minutes into the video and ends at about 46 minutes.

Here are a few examples of topics addressed:

  • Does my student have the right to be evaluated for special education if they refuse to go to school because of anxiety?
  • What accommodations are reasonable to ask for?
  • What services might be possible for my student who struggles with emotional regulation?
  • Can counseling be a related service?
  • Are there protections for a student because of suicidal thoughts or attempts?
  • What support is available for a student with a disability condition who isn’t prepared for adulthood because high school got interrupted by the pandemic?

Additional information about mental health education and services at school, the overall layout of youth behavioral health in Washington State, and where to find family support is included in a PAVE article: Mental Health Education and Support at School can be Critical.

To seek education, training, and support from the National Alliance on Mental illness, look for a virtual training or information about a local affiliate near you, listed on the NAMI WA website.

One place to access behavioral health services for children and youth anywhere in Washington is through the Seattle Children’s Hospital Mental Health Referral Service: 833-303-5437, Monday-Friday, 8 a.m. to 5 p.m.

Families and young people can reach out for individualized assistance from PAVE’s Parent Training and Information (PTI) staff at PAVE. Click Get Help or call 800-572-7368.

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Social Emotional Learning, Part 3: Tools for Regulation and Resiliency

Posted on by Nicol Walsh

A Brief Overview

  • Children who are taught self-regulation are more resilient and learn better in academics and more. This article describes a few practical tools and techniques that are aspects of Social Emotional Learning (SEL).
  • “Kids do well if they can,” says Ross W. Greene, a child psychologist and author. In a short YouTube video, Greene says, “The biggest favor you can do a challenging kid is to finally, at long last, be the person who figures out what’s getting in his way.”
  • PAVE provides additional articles about Social Emotional Learning.
  • Washington’s Office of Superintendent of Public Instruction (OSPI) provides SEL learning activities for families and educators. OSPI also provides free online SEL training, links to information about SEL state learning standards, and more on the Social and Emotional Learning page of its website: k12.wa.us.

Full Article

When children act out at school, what does the teacher do? The answer depends on the discipline policies of the school, but research indicates that suspending and expelling students is ineffective for improving behavior and can cause harm (NIH.gov).

Social Emotional Learning (SEL) in schools marks a shift toward education that promotes self-regulation, resiliency, problem-solving skills, and more. “Kids do well if they can,” says Ross W. Greene, who explains his statement in a short YouTube video. Greene is a clinical child psychologist and author of the books The Explosive Child, Lost at School, Lost & Found, and Raising Human Beings.

By accepting the logic that kids do well if they can, adults shift away from believing that kids behave only if they “want to” and allows for problem-solving, Greene says: “The biggest favor you can do a challenging kid is to finally, at long last, be the person who figures out what’s getting in the way [of doing well].”

Behavior is communication: “Get curious, not furious”

Adults can consider behavior as a form of communication and seek to understand the function of the behavior. One educator refers to this approach as “Getting Curious (Not Furious) With Students.” In the article, posted to Edutopia.org June 29, 2016, Rebecca Alber says, “When teachers get curious instead of furious, they don’t take the student’s behavior personally, and they don’t act on anger. They respond to student behaviors rather than react to them.”

Alber lists the primary benefits to schools when they promote SEL and trauma-informed approaches to discipline:

  • Improved student academic achievement
  • Less student absences, detentions, and suspensions
  • Reduction of stress for staff and students and less bullying and harassment
  • Improved teacher sense of job satisfaction and safety

Tip: Request a Functional Behavior Assessment

A Functional Behavioral Assessment (FBA) may be necessary in circumstances where behavior consistently impedes learning. Schools can use FBA data to build an individualized Behavior Intervention Plan (BIP). A BIP may support an Individualized Education Program (IEP) or could be a stand-alone plan for any student.

When using positive behavior support strategies, adults can avoid judging behavior with labels such as bad, non-compliant, defiant, uncooperative, etc. Researchers have found that those labels often refer to adult perception and frustration about what is happening more than they explain what a child may be trying to express.

Family caregivers might read through a student’s Individualized Education Program (IEP), a behavior plan, disciplinary referrals, or other notes from the school to notice what type of language is being used to describe what’s happening. Requesting a meeting to discuss an FBA and/or strategy for SEL skill-building is an option.

Raw moments are opportunities to teach from the heart

Heather T. Forbes, author of Help for Billy, is among professionals designing new ways to help children cope and learn. Emotional instruction is crucial, argues Forbes, whose website, Beyond Consequences, shares Trauma-Informed Solutions for parents, schools, and other professionals.

“It is in the moments when your child or student is most ‘raw’ and the most dysregulated [out of control],” Forbes writes, “that you are being presented with an opportunity to create change and healing. It takes interacting from not just a new perspective but from an entirely new paradigm centered in the heart.”

In an article, Teaching Trauma in the Classroom, Forbes concludes: “These children’s issues are not behavioral. They are regulatory. Working at the level of regulation, relationship, and emotional safety addresses more deeply critical forces within these children that go far beyond the exchanges of language, choices, stars and sticker charts.”

Regulation starts in the brain

SEL supports are informed by brain science. OSPI provides a free downloadable handbook, The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success. Included in Chapter One is a list of the brain regions affected by trauma. Understanding the amygdala as a center for fear, for example, can be critical for designing strategies to manage meltdowns. “Overstimulation of the amygdala…activates fear centers in the brain and results in behaviors consistent with anxiety, hyperarousal and hypervigilance,” the page informs.

Writing for Edutopia, Rebecca Alber recommends that teachers learn to understand and recognize impacts of trauma and to understand that apparent refusal to comply might actually be a trauma-based response.

“When we ask students to do high-level tasks, such as problem solving or design thinking,” Alber says, “it’s nearly impossible if they are in a triggered state of fight, flight, or freeze. This trauma state may look like defiance or anger, and we may perceive this refusal as choice, but it is not necessarily so.”

Use Your Words

Some teachers are turning directly to scientists for advice. Dan Siegel, a well-known neurobiologist and author, offers tips through his agency, Mindsight. Mindsight teaches how to “name and tame” emotions to keep from getting overwhelmed. For example, Siegel suggests learning the difference between these two sentences:

  1. I am sad.
  2. I feel sad.

The first statement “is a kind of limited self-definition,” Siegel argues, while the second statement “suggests the ability to recognize and acknowledge a feeling, without being consumed by it.”

Encourage rather than simply praise

Word choice can be critical in trauma-informed instruction. Jody McVittie, a pediatrician who started Sound Discipline, based in Seattle, gives workshops for parents and teachers. She talks about the difference between praise and encouragement in a training called Building Resiliency. Instead of saying “Great Job,” which can trigger an emotional response but may not reinforce learning, a teacher or parent might say instead:

  • “I noticed that you wrote all of the letters of your name on the line and it was really easy to read.”
  • “I appreciate that you asked some insightful questions during our discussion about the Constitution today.”
  • “I know you can write a creative description of the book you read.”

The more specific the encouragement, McVittie says, the more the student will be encouraged to keep working on that expected behavior. Another of McVittie’s key concepts is “connection before correction” to help teachers create helpful relationships with students. An example she uses in her trainings:

A teenaged student tossed a soda can from across the room during class. A trauma-trained teacher pointed to the hallway, and the boy joined her there. Instead of directing him to the office, the teacher explained that she really enjoyed having him in class. She said that he contributed valuable questions. Then she asked why he thought he was in the hallway. He said it was because he threw the soda can. She asked, “What’s your plan?” His answer included apologies and decision-making about how to avoid the mistake again.

This story certainly could have ended differently, and McVittie encourages educators and parents to avoid a “Dignity Double-Bind,” where children experience shame instead of problem-solving:

“Make the child think,” she says, “by showing respect instead of giving orders to obey.”

A Self-Regulation Strategy for Right Now

Sometimes grace starts with self-care. Following is a breathing practice you can use right now to help your nervous system regulate. If you prefer, you can watch a short video from PAVE that demonstrates this technique: Stop and Settle with Five-Fingers Breath.

You will be breathing evenly as you trace the outline of your hand, giving your eyes and your mind something to focus on while you control your breath.

  • Hold up one hand, with your palm facing you.
  • Place the first finger of your other hand onto the bottom of your thumb.
  • As you breathe in, slide your finger up to the top of your thumb.
  • Breathing out, slide your finger into the valley between your thumb and first finger.
  • Breathing in, slide up your first finger. Breathing out, slide down the other side.
  • Continue following your breath up and down all your fingers.
  • When you breathe out down the outside edge of your pinkie, continue to exhale until you reach your elbow.
  • Notice how you feel. Allow your breath to find a natural pattern.

Now that you’ve learned this technique, you can share it with other family members!

State Standards Guide Social Emotional Learning for all Ages and Abilities

Posted on by Nicol Walsh

A Brief Overview

  • Social Emotional Learning (SEL) is a lifelong process through which children and adults effectively manage emotions, reach toward goals, experience empathy, maintain positive relationships, and make responsible decisions.
  • In school, all students participate in SEL as part of Multi-Tiered Systems of Support (MTSS). Specific SEL instruction can also be part of a student’s Individualized Education Program (IEP).
  • Washington State adopted formal Social Emotional Learning Standards January 1, 2020. The Office of Superintendent of Public Instruction (OSPI) provides an SEL website page with resources for educators, families, and community members.
  • A 12-page SEL equity brief focuses specifically on issues of equity as they relate to race, culture, and economic status.
  • A state law that took effect June 11, 2020, further compels work related to SEL. HB 2816, which was inspired and supported by activist parents, requires the Washington State School Directors’ Association (WSSDA) to develop a model policy “for nurturing a positive social and emotional school and classroom climate.”

Full Article

A child’s ability to understand, communicate, and manage emotions is critical to learning. So are skills that enable a child to socialize, self-motivate, empathize, and work collaboratively. Schools call this area of education Social Emotional Learning (SEL).

SEL is not just for children. According to the Collaborative for Academic, Social, and Emotional Learning (CASEL), “SEL is the process through which children and adults understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.”

Students with disabilities may qualify for Specially Designed Instruction (SDI) in social and/or emotional areas of learning as part of an Individualized Education Program (IEP). Eligibility for SDI is determined through evaluation, and schools use various instruments to assess whether a student has a disability affecting social or emotional skills to an extent that education is significantly impacted. If so, the student’s IEP will support learning in those social/emotional areas, and goal-monitoring will track skill growth.

Students with IEPs are not the only ones who receive SEL instruction, however. Schools may use curricula to promote emotional understanding, social stories, mindfulness programs, communication circles or other strategies as part of Multi-Tiered Systems of Support (MTSS). MTSS is a framework for improving school-wide social, emotional, and cultural climate. Schools that adopt an MTSS framework deliver SEL to all students (Tier 1) and generally offer Tier 2 and Tier 3 programming to targeted groups or individual students.

Parenting Tip: Ask whether your school uses an MTSS framework

Family caregivers can ask school staff and administrators whether the district operates within an MTSS framework.

  • If the answer is no, ask how school climate is addressed and how SEL is integrated into school-wide programming.
  • If the answer is yes, ask what SEL instruction looks like in the general education classroom (Tier 1) and how specialized lessons are provided to students with higher levels of need (Tiers 2-3). Note that a student who does not qualify for an IEP could demonstrate the need for social/emotional instruction beyond what is provided to most students. Family caregivers can ask for detail about how the school’s MTSS system supports any specific student.

State adopts six SEL standards

Washington State adopted formal Social Emotional Learning Standards January 1, 2020. The Office of Superintendent of Public Instruction (OSPI), which provides guidance to all public and non-public educational agencies in the state, provides an SEL website page with resources for educators, families, and community members. Included is a link to the official letter in which State Superintendent Chris Reykdal adopted the standards, and a collection of resources to support SEL implementation and to further understanding about how families and communities can participate.

A primary document is the 24-page Social Emotional Learning Standards, Benchmarks, and Indicators, which defines the six SEL learning standards and various benchmarks under each. An extensive chart offers practical guidance for assessing each standard for students in Early Elementary, Late Elementary, Middle School, and High School/Adult. The SEL learning standards include:

  1. SELF-AWARENESS – Individuals have the ability to identify their emotions, personal assets, areas for growth, and potential external resources and supports.
  2. SELF-MANAGEMENT – Individuals have the ability to regulate emotions, thoughts, and behaviors.
  3. SELF-EFFICACY – Individuals have the ability to motivate themselves, persevere, and see themselves as capable.
  4. SOCIAL AWARENESS – Individuals have the ability to take the perspective of and empathize with others from diverse backgrounds and cultures.
  5. SOCIAL MANAGEMENT – Individuals have the ability to make safe and constructive choices about personal behavior and social interactions.
  6. SOCIAL ENGAGEMENT – Individuals have the ability to consider others and show a desire to contribute to the well-being of the school and community.

Developmental milestones are charted with a variety of statements that might demonstrate the skill or disposition within an age range.  

  • For example, a late elementary age student might show self-awareness this way: “I can identify and describe physical symptoms and thoughts related to my emotions and feelings (e.g., hot, shoulders tight).”
  • A middle-school student might demonstrate self-efficacy this way: “I can identify specific human and civil rights and freedoms to which everyone is entitled and can understand how to advocate for myself in healthy ways.”

Tip for Parents: Promote SEL at home

Included on the SEL website page is a list of learning activities for families and educators. The eight-page guide includes links to videos, websites, and ready-to-use resources to encourage positive behavior support and helpful communication at home and at school.  Resources are sorted by age and marked to indicate whether they are best suited for family caregivers, teachers, or both.

  • For example, parents of children K-5 might want to click on SEL Games to Play With Your Child to find a resource from Understood.org. One game, Starfish and Tornadoes, helps kids notice how much energy they are feeling inside and when they might need to use their calming skills or ask for help from a trusted adult.
  • A suggestion for grades 5-12 is to Practice Loving-Kindness for Someone you Care About. That exercise from Greater Good in Education provides adaptations for students with disabilities and suggests ways to make the project culturally responsive.

Another document accessible through OSPI’s website is a three-page guide for parents and families, which includes resource linkages to free online training, parenting cue cards with quick answers to typical concerns, and access to other websites with tools and advice specific for various stages of child development. Also included are tips to promote SEL at home by encouraging a child to:

  • Identify and name their emotions, feelings, and thoughts.
  • Identify positive and negative consequences of actions.
  • Demonstrate the ability to follow routines and generate ideas to solve problems.
  • Create a goal and track progress toward achieving that goal.
  • Identify feelings expressed by others.
  • Identify ways that people and groups are similar and different.
  • Demonstrate attentive listening skills without distraction.
  • Identify and take steps to resolve interpersonal conflicts in constructive ways.
  • Demonstrate a sense of community responsibility

SEL guidance supports equity and inclusion

  • Principles listed throughout the state SEL guidance include:
  • Equity: Each child receives what he or she needs to develop his or her full potential.
  • Cultural responsiveness: Culture is viewed as a resource for learning, not a barrier.
  • Universal design: Learning differences are planned for and accommodated.
  • Trauma-informed: Knowledge of the effects of trauma is integrated into policy and practice.

State guidance that describes the SEL standards and benchmarks includes this statement: “Social emotional learning (SEL) happens over the course of a day, a lifetime, and in every setting in which students and adults spend their time.… Effectively supporting social emotional development in schools requires collaboration among families and communities. It also involves building adult capacity to support a school climate and culture that recognizes, respects, and supports differences in abilities, experiences, and ethnic and cultural differences, and celebrates diversity.”

A 12-page SEL equity brief focuses specifically on issues of equity as they relate to race, culture, and economic status. “A white, middle-class model of self that values independence dominates schools,” the brief states. “Students of color and students in low-income communities often experience ‘cultural mismatch’ in education settings that expect forms of expression and participation not aligned with their culture.

“Without explicit attention to equity and cultural diversity, prevalent SEL frameworks, models, and curricula may not adequately reflect the diverse worldviews of students and families.”

Parenting Tip: Attend your local school board meeting to influence decisions

The state’s SEL implementation guide is intended for local districts to use in developing their own school- or community-specific plan to meet the needs of all learners. Because Washington is a local control state, each district is responsible for policy development.

Families have the option of making public comment at meetings to share thoughts or concerns. School board meetings are required monthly and must follow the state’s Open Public Meetings Act (Chapter 42.30 in the Revised Code of Washington). Families can reach out to their local district for information about how and when school boards meet. The Washington State School Directors’ Association provides a guidebook about the rules for Open Public Meetings. The rules apply in any meeting space or platform.

HB 2816 promotes positive school climate

A state law that took effect June 11, 2020, further compels work related to SEL. HB 2816, which was inspired and supported by activist parents, requires the Washington State School Directors’ Association (WSSDA) to develop a model policy “for nurturing a positive social and emotional school and classroom climate.”

The model policy and procedures for its implementation includes specific elements to “recognize the important role that students’ families play in collaborating with the school and school district in creating, maintaining, and nurturing a positive social and emotional school and classroom climate.” In addition, districts “must provide information to the parents and guardians of enrolled students regarding students’ rights to a free public education, regardless of immigration status or religious beliefs; and school districts must provide meaningful access to this information for families with limited English proficiency.”

In accordance with HB 2816, the WSSDA website will post the model policy and procedure by March 1, 2021. School districts are responsible to incorporate the guidance by the beginning of the 2021-22 school year: “School districts may periodically review policies and procedures for consistency with updated versions of the model policy for nurturing a positive social and emotional school and classroom climate.”

SEL is linked to research about Adverse Childhood Experiences

A national movement to incorporate Social Emotional Learning (SEL) is informed by knowledge that trauma profoundly impacts educational outcomes. In the late 1990s, the Centers for Disease Control and Prevention released its first report about Adverse Childhood Experiences (ACEs). Dr. Vincent Felitti, then the CDC’s chief of preventive medicine, boldly proclaimed childhood trauma a national health crisis. The report led to development of an ACEs survey, which scores a person’s likelihood of suffering lifelong physical and mental health impairments resulting from trauma. An ACEs score of 4, the study found, makes a child 32 times more likely to have behavior problems at school.

The data inspired researchers and educators to seek new ways to help children cope so they can manage themselves at school—and in life. A variety of new evidence-based practices were developed to support childhood resiliency. The National Research Council issued this statement in 2012: “There is broad agreement that today’s schools must offer more than academic instruction to prepare students for life and work.”

The 2015 Washington State Legislature directed OSPI to convene an SEL Benchmarks workgroup, and Senate Bill 6620 in 2016 authorized development of a free online training module in SEL for school staff. The bill states that, “In order to foster a school climate that promotes safety and security, school district staff should receive proper training in developing students’ social and emotional skills.” Development of the state SEL Standards furthers that work.

Parenting tip: Work on your own SEL skills

Family caregivers play an important role in fostering SEL by working on their own self-regulation skills. The Collaborative for Academic, Social, and Emotional Learning (CASEL) provides a wide array of resources, including some related to stressors from COVID-19. “We need to pay close attention to our own social emotional needs in order to be the community of adults who best serve our young people,” CASEL advises. “Practice continued self-care strategies, including eating healthy, getting enough sleep, exercising, and finding time to take breaks.” CASEL provides a checklist to reframe your thinking, including ideas about “all-or-nothing” or overgeneralization, for example.

PAVE provides a series of short mindfulness videos for all ages and abilities and offers additional mindfulness and parenting ideas in an article, Stay Home Help: Get Organized, Feel Big Feelings, Breathe.

Parents are a child’s primary SEL teachers

Family caregivers can help foster SEL skills by collaborating with the school. OSPI’s guidance includes this statement: “Parents and families are a child’s first teachers of SEL. As children grow, parents and families continue to support the social emotional lives of their children in the home.”

Here are a few questions parents might ask school staff to collaborate on SEL skill development:

  • How are you helping my child learn from mistakes?
  • If behavior is keeping my child from learning, what skill is lacking?
  • What is a best-practice strategy for teaching the skill that my child needs to learn?
  • Do you have a tool for understanding and regulating emotions that we can use at home also?
  • How is my child learning to “name and tame” emotions? (Dan Siegel, neurobiologist and author of Mindsight, suggests that recognizing and naming a feeling gives a person power to regulate the emotion.)
  • What positive reinforcement is being provided when my child demonstrates a new skill? How are those positive reinforcers tracked through data collection?
  • What is the plan to help my child calm down when dysregulation makes problem-solving inaccessible?
  • Would a Functional Behavior Assessment help us understand what my child is trying to communicate through this unexpected behavior?
  • Can we collaborate to develop a Behavior Intervention Plan so that we are using the same cues and language to support expected behavior?
  • What adult at the school is a “champion” for my child? (Dr. Bruce Perry, whose research supports trauma-informed initiatives, says, “Relationships are the agents of change and the most powerful therapy is human love.”)

Isolation and Restraint Practices Attract Media Attention

Posted on by Nicol Walsh

Disability Rights Washington (DRW) has published a video about school use of isolation and restraint. The video, which is posted to YouTube, was produced by DRW’s media program called Rooted in Rights. DRW is a private non-profit organization with a mission to advance the dignity, equality, and self-determination of people with disabilities. The agency is staffed with attorneys who pursue justice on matters related to human and legal rights.

In Washington State, isolation and restraint may be used if “reasonably necessary to control spontaneous behavior that poses an imminent likelihood of serious harm,” as defined in the Revised Code of Washington (RCW 70.96B.010). The isolation/restraint ends when the imminent likelihood of harm has passed. These practices are considered emergency responses and not disciplinary actions.

The Office of Superintendent of Public Instruction (OSPI) describes specific reporting requirements for schools to inform parents and the state about isolation and restraint incidents.

PAVE’s website, wapave.org, provides several articles that include information about isolation and restraint practices. Articles also describe ways to incorporate positive behavior supports into school programs to reduce the need for emergency response. An article titled, Ideas and Resources to Support Your Child’s Behavior at School, is a place to start.

Another option to research information on the topic is to type the word “Behavior” into the search bar at wapave.org to find additional articles. A comprehensive article about policies related to discipline is titled, What Parents Need to Know when Disability Impacts Behavior and Discipline at School.

Educators and policy makers generally agree that an evidence-based method to keep everyone safe and learning at school is to incorporate Positive Behavior Interventions and Supports (PBIS) into a school-wide program that focuses on a healthy school climate. PBIS is described in several of PAVE’s articles, including one contributed by University of Washington researcher Kelcey Schmitz: Positive Behavioral Interventions & Supports (PBIS) in Schools.

Implementation of PBIS varies widely across the state. Parents can ask their school district administrators about whether a PBIS framework is being used within the district.

 

 

Ideas and Resources to Support Your Child’s Behavior at School

Posted on by Nicol Walsh

A Brief Overview

  • Behavior specialists generally agree that difficult behaviors arise from unmet needs. How adults respond is critical if a child is going to learn new ways to communicate.
  • Humans spend about 80 percent of their brain energy trying to belong. This can explain a lot when a child with a disability feels isolated or unwanted and starts to act out.
  • Positive Behavior Interventions and Supports (PBIS) is a framework that a growing number of schools nationwide are using to improve school climate, which refers to the way a school feels to students and staff.
  • Members of the U.S. Congress discussed PBIS on February 27, 2019, when a committee heard public testimony regarding a bill that would regulate use of isolation and restraint in public schools. Positive behavior interventions are considered “protective” by behavior experts, and there is evidence that isolation and restraint cause trauma.
  • Read on for questions families can consider when they are trying to understand what’s happening with a child and how to intervene for the best outcomes.

Full Article

Families and teachers often struggle to figure out what to do when a child’s behavior at school is getting in the way of learning.  How adults respond to unexpected behavior can impact whether an incident leads down a path of worsening problems or toward improved learning. Parents can help by understanding as much as possible about what the child might be trying to communicate or overcome.

“Difficult behaviors result from unmet needs,” says David Pitonyak, PhD, an educational consultant, author and public speaker who specializes in behavior supports for children with disabilities. Pitonyak speaks nationally and provides a variety of online tools to help families and educators.

One example is a free, online presentation, “All Behavior is Meaning-full.” In it, Pitonyak includes a list of what might be missing when an unmet need leads to a behavior incident:

  • Meaningful relationships
  • A sense of safety and well-being
  • Power
  • Things to look forward to
  • A sense of value and self-worth
  • Relevant skills and knowledge

“Supporting a person requires us to get to know the person as a complicated human being influenced by a complex personal history,” Pitonyak says. “While it is tempting to look for a quick fix, which usually means attacking the person and his or her behavior, suppressing behavior without understanding something about the life the person is living is disrespectful and counterproductive….

“Our challenge is to find out what the person needs so that we can be more supportive.”

A running theme in Pitonyak’s work is that adults need to strengthen their own social and emotional skills in order to effectively help children. He often quotes another specialist in the field, Jean Clark: “A person’s needs are best met by people whose needs are met.” In other words, parents and teachers need to practice self-care and regulate their own behaviors and emotions to provide the best examples to children. Read on for a check-list that adults can use to develop their own skills while they help children.

A brain’s biggest job is to belong

Pitonyak is among specialists who believe that children act out because they feel misunderstood, devalued, lonely or powerless. Other growing themes are the importance of belonging and the human need to contribute meaningfully to a social group. Neuroscientists have found that humans spend about 80 percent of their brain energy trying to belong. This can explain a lot when a child with a disability feels isolated or unwanted and starts to act out.

Parents can use these concepts in a variety of ways to participate in their child’s educational program. Here are examples of questions to ask in any meeting with a school:

  • Who are the adults at school that my child trusts?
  • Does my child have special jobs or responsibilities, so he/she feels important at school?
  • Is someone regularly checking in with my child to see what’s going on?
  • How are positive behavior skills being taught and reinforced?

Positive Behavior Interventions and Supports (PBIS) is a framework that a growing number of schools nationwide are using to improve “school climate,” which refers to the way a school feels to its students and staff.

Schools that embrace PBIS generally create programs to help all students participate in well-being and then offer more targeted social, emotional and behavioral help to students who struggle the most. These different levels of intervention are called Multi-Tiered Systems of Support (MTSS). According to the federal PBIS website, “PBIS improves social, emotional and academic outcomes for all students, including students with disabilities and students from underrepresented groups.”

Information about federal guidelines and programs related to PBIS and MTSS are available online from the U.S. Department of Education’s Office of Special Education Programs (OSEP) and the Office of Elementary and Secondary Education (OESE). PAVE provides an article about PBIS, with parenting tips by Kelcey Schmitz, a longtime MTSS expert who previously worked for OSPI and now is part of the University of Washington’s School of Medicine and the School Mental Health Assessment, Research, & Training (SMART) Center.

PBIS is a protective strategy

The United States Congressional Committee on Education and Labor received training about PBIS on February 27, 2019, when they heard public testimony (YouTube video): Classrooms in Crisis: Examining the Inappropriate Use of Seclusion and Restraint Practices. Congress is considering legislation that would create a federal standard on accepted practice, accountability and training for teachers who might use isolation or restraint in an emergency.

National Public Radio reported about isolation and restraint in a June 5, 2019, broadcast that included personal comments from two families in Vancouver, Washington.

The State of Washington allows isolation and restraint by trained school staff if a student’s behavior poses an imminent threat of serious bodily harm. PAVE’s comprehensive article about discipline at school includes more information and resources about isolation and restraint, which is described by state law as an emergency response and not a form of disciplinary action.

Among those who provided public testimony for the U.S. Congress was George Sugai, PhD, professor of special education at the University of Connecticut who was a key developer of the PBIS framework. At the public hearing, Sugai spoke about the reduction in trauma among schools who embrace PBIS. He said teachers report more positive feelings toward their work and that students show more progress toward specific educational goals. “PBIS is a protective strategy,” he said.

The behavior itself holds the clues about what to do next

Sugai, who holds a Master of Arts and a PhD in special education from the University of Washington, spoke about understanding a child’s unmet needs. “We have to understand what children are communicating through their behavior,” he said. “The behavior itself holds the clues about what to do next.”

Washington’s Office of Superintendent of Public Instruction (OSPI), which oversees the state’s school districts, has a variety of programs underway to address school climate and improve staff training in Social Emotional Learning, equity in student discipline and development of Compassionate Schools. The state encourages use of a Behavior Intervention Plan (BIP), which promotes positive support and skill-building for expected school behavior. The plan is to prevent the need for disciplinary action or emergency response. A BIP is developed with data collected through a Functional Behavior Analysis (FBA), which is a best-practice tool for schools to figure out what help a student with challenging behavior might need. OSPI’s website includes examples of the FBA and BIP in its Model Forms.

OSPI’s family and community liaison, Scott Raub, partnered with a special services director from the Puget Sound’s Educational Service District 121 to create a slide presentation about isolation and restraint that is available as a free, downloadable PDF. The document is titled, Stop Using Restraint and Isolation: An Evolution or a REVOLUTION? The presentation includes specific guidance for school staff to use a Behavior Intervention Plan (BIP) as a strategy for managing behavior. A flow chart shows how early intervention might diffuse a situation to allow a student to remain in a more regulated state and stay in class. The document also provides detail about recent OSPI rulings about isolation and restraint raised through the Citizen’s Complaint process.

In accordance with the Revised Code of Washington (RCW 28A.600.485), “Restraint or isolation of any student is permitted only when reasonably necessary to control spontaneous behavior that poses an imminent likelihood of serious harm. Restraint or isolation must be closely monitored to prevent harm to the student, and must be discontinued as soon as the likelihood of serious harm has dissipated. Each school district shall adopt a policy providing for the least amount of restraint or isolation appropriate to protect the safety of students and staff under such circumstances.”

In the slide presentation, designed for schools and publicly available, OSPI provides detail about what “imminent likelihood of serious harm” can look like and provides direct guidance to staff, including these statements:

  • Emergency Response Protocols are NOT a substitute for BIPs.
  • BIPs must be updated as part of student’s annual IEP [review].
  • The time to end isolation and restraint is as soon as the likelihood of serious harm has dissipated; this is not equivalent to waiting until the student has calmed.

A state workgroup to study Social Emotional Learning (SEL) in October 2016 proposed a set of Standards and Benchmarks to help school staff identify how best to help children who struggle with their behavior, social skills and emotional regulation. The group established six standards with specific benchmarks. A report from that workgroup includes a chart of the standards (Page 3). Families can share this information with schools when trying to identify what’s happening with a child and what interventions might help.

Below is a brief overview of those SEL standards and a few questions parents can bring to the table. In each target area, parents can ask what school staff are doing to help. This check-list also can be a good starting-point for adults who want to work on their own emotional regulation and coping strategies.

1. Self-Awareness

  • Can the student identify and understand emotions?
  • What is the student good at or interested in?
  • How are family, school and community agencies helping as a team?

2.Self-Management

  • Can the student express emotions and manage stress constructively?
  • What problem-solving skills are in place or need to be learned?

3. Self-Efficacy (self-motivated/seeing self as capable)

  • Can the student understand and work toward a goal?
  • Can the student show problem-solving skills?
  • Can the student request what he/she needs?

4. Social Awareness

  • Can the student recognize another person’s emotions?
  • Can the student show respect for others who are different?
  • Can the student accept another cultural perspective?

5. Social Management

  • Does the student have ways to communicate?
  • Can the student take steps to resolve conflicts with other people?
  • Does the student have constructive relationships with a variety of people?

6. Social Engagement

  • Does the student feel responsibility as part of a community?
  • Can the student work with others to achieve a goal?
  • Does the student contribute productively and recognize his/her contribution?

Additional Resources

PAVE provides a series of three articles with more information and resources about Social Emotional Learning (SEL).

Many parents struggle in their communications with the school when a child’s specific disability and its impact on behavior is not well understood. A place to research specific disabilities related to mental health, such as Oppositional Defiance Disorder (ODD), Attention Deficit Hyperactivity Disorder (ADHD) or Disruptive Mood Dysregulation Disorder (DMDD) is the Child Mind Institute.

A resource for better understanding how children might behave in response to trauma or Adverse Childhood Experiences (ACEs) is the Children’s Health Foundation.

An agency called GoZen offers an online article about Eight Ways a Child’s Anxiety Shows up at Something Else. Included in the list: difficulty sleeping, anger, defiance, lack of focus, avoidance, negativity, over-planning and “chandeliering,” which refers to a full-blown tantrum that seemingly comes out of nowhere. In addition to its free online articles, GoZen provides fee-based programs on resilience.

A Supreme Court Ruling Could Impact Your Child’s IEP

Posted on by Nicol Walsh

A Brief Overview

  • The parents of a child named Endrew F argued that their son with a disability deserved more from his public school. They appealed their case all the way to the Supreme Court, and the ruling in their favor could mean more robust rights for all children with Individualized Education Programs (IEPs).
  • The implications of this unanimous decision are reverberating through schools and agencies that oversee special education. Read on to learn how you can participate in important conversations about these uplifted standards.
  • Learn key phrases from this ruling to help you be a proactive member of your child’s IEP team. The U.S. Department of Education has an important guidance document that includes some of this language: For example, a school must offer an IEP “to enable a child to make progress appropriate in light of the child’s circumstances.” The court additionally emphasized the requirement that “every child should have the chance to meet challenging objectives.”
  • This article and the included resource links can help you understand the Endrew F ruling and how you might use this information in advocating for your child’s rights.

Full Article

Endrew F (Drew) is a student with autism, ADHD and challenging behaviors. His disabilities impact his academic and functional skills, including his ability to effectively communicate about his emotions and needs. He attended a public elementary school in Douglas County, Colorado, and qualified for special education with an Individualized Education Program (IEP). His parents moved him to a private school in fourth grade, arguing that:

  1. Drew did not make measurable progress on the goals set in his past IEPs, and
  2. The IEP did not address Drew’s escalating behavior problems.

Drew had more success at the private school, and his parents filed a Due Process complaint with the Colorado Department of Education in 2012. They requested reimbursement for the private school tuition on the basis that the public school had failed to provide access to a Free Appropriate Public Education (FAPE), which is a cornerstone of the Individuals with Disabilities Education Act (IDEA), the federal law that governs special education.

The parents argued, and lost, at the state, district and circuit court levels. These lower courts ruled that because Drew had made at least some progress toward his IEP goals, then the school had met its obligation to provide FAPE. Wrightslaw is one source for more detail about the case and its history.

The family filed an appeal with the Supreme Court of the United States (SCOTUS), and on March 22, 2017, the court ruled in their favor. The ruling, which took effect immediately, ended a discrepancy in circuit courts across the country by determining that a trivial amount of progress (“merely more than de minimis”) is insufficient to satisfy a student’s right to FAPE. In order to meet its “substantive obligation under the IDEA,” the court stated, “a school must offer an IEP that is reasonably calculated to enable a child to make progress appropriate in light of the child’s circumstances.”

Since then, a variety of agencies have been analyzing the court’s unanimous ruling and creating guidance documents to help schools and families understand the implications of this case. On April 9, 2018, The Office of Special Education Programs (OSEP) provided a two-hour webinar with speakers from various education fields to discuss the ruling and its broad-sweeping impact on schools and families. Parents need to understand this case, the experts agree, because family voices are critical to raising the level of expectation.

High expectations are a theme in discussions about the ruling. Some other emerging themes:

  • Parents/guardians are the first and most important lifelong teachers of their children. They, therefore, need to be fully welcomed and heard as key collaborators in the process.
  • IEP teams need to assure relevance when writing appropriately ambitious IEP goals for lifelong learning and success in varied environments. Goals toward narrowly defined academic “mastery” often miss this opportunity to create flexible learners.
  • State academic standards should be noted at the IEP table, but challenging objectives are to be individualized, not “one size fits all” or based in goals generated by computer data programs.
  • Educational benefit is determined on an individual basis, and standards for measurement must be varied and rigorous to ensure meaningful progress.
  • An IEP with the same goals year-after-year does not meet the standard of FAPE.

The Statewide Parent Advocacy Network (SPAN) issued a summary of the Endrew F ruling that includes a list of “Roles and Responsibilities” for professionals and families. “This new standard will require a prospective judgment by school officials that will be informed not only by the expertise of school officials, but also by the input of the child’s parents and guardians,” SPAN stated in this overview document.

Understood, a consortium of non-profit agencies committed to providing information on attention and learning problems in children ages 3-21, developed a free, downloadable Endrew F Advocacy Toolkit that provides a four-page handout of Talking Points and a four-page IEP Worksheet to assist parents in using principles from the Endrew F ruling in their own advocacy. For example, the court’s ruling included the words “appropriately ambitious” as a requirement for IEP goals. The worksheet offers a place where a parent can record a list of areas that they feel a child’s goals might not be ambitious enough. The worksheet then suggests a script for a parent to use at an IEP meeting:

“I know that my child’s goals should be appropriately ambitious. Even if my child is behind in academics, the IEP goals should aim to help my child catch up. When can we look at present level of performance and put services and supports in place, so we can set goals that allow my child to meet the same standards as his peers?”

The National Center for Parent Leadership, Advocacy, and Community Empowerment (National PLACE) offered a Webinar to explain how the ruling provides families with a new advocacy tool. PLACE, a membership organization whose website is named “Parents at the Table,” has made available some resource documents, including a Power Point with a set of slides titled: “What Parents Can Do.” For example, PLACE suggests that parents prepare questions for an IEP meeting using key phrases pulled directly from the Supreme Court’s ruling. Here are some sample questions:

  • Has the team carefully considered my child’s potential for growth?
  • Have we considered whether my child is on track to achieve or exceed grade-level proficiency?
  • Are the goals appropriately ambitious, with sufficiently challenging objectives?
  • How is the IEP reasonably calculated to enable my child to make progress appropriate in light of his circumstances?

PLACE emphasizes that parents should not accept an IEP with the same goals and objectives from year to year, indicators that a child has failed to make meaningful progress. And, using language directly from the SCOTUS ruling, PLACE encourages parents to hold schools accountable for a child’s progress by requesting a “cogent and responsive explanation” for decisions about goals and progress measurements.

Diana Autin, an attorney and executive director of National PLACE, uses the webinar platform to review foundational principles of the IDEA, re-authorized by Congress in 2004, to set a stage for understanding new guidelines related to the SCOTUS ruling. “It’s important to note that Endrew F can’t be understood or defined or used without it being within the context of the IEP requirements of IDEA,” she says.

Autin shares the PLACE webinar platform with Michael Yudin, former assistant secretary at the U.S. Department of Education and a longtime national leader in disability rights. Yudin points to key language in the ruling that clarifies earlier Department of Education guidance documents that he helped develop. The heart of IDEA, he says, is specially designed instruction that helps students reach goals that are “ambitious but achievable” and in alignment with grade-level content standards. “Specially designed instruction is adapting as appropriate to the needs of the child,” Yudin says, “so that the content, methodology and the delivery of instruction are appropriate to ensure access to the general curriculum so that the child can meet the educational standards that apply to all children.”

Inclusion sometimes requires access to specially designed instruction in Social-Emotional Learning (SEL), and the Endrew F decision reinforces the IDEA’s requirement for necessary behavioral interventions and supports, Yudin says. “This guidance clearly states that failure to consider and provide those needed behavioral supports and interventions through the IEP is in fact likely to result in a denial of FAPE.”

The child at the heart of this landmark case, Drew, struggled with phobias and had behaviors that included screaming, climbing over furniture and occasionally running from school. According to the PLACE webinar: “His parents believed that his progress had stalled and that the strategies used to address his behaviors were insufficient to allow him to learn.” Behavior interventions at the private school chosen by Drew’s parents helped, and his access to learning improved. In considering all aspects of the case, including a lack of suitable behavior interventions, the Supreme Court ruled that the public school had denied Drew access to FAPE.

A child “must be afforded the opportunity for significant learning,” the court stated. And individualized supports and programming must provide for more than “de minimis,” or trivial, progress to meet the standard of FAPE. “For children with disabilities, receiving instruction that aims so low would be tantamount to sitting idly,” the court wrote, “…awaiting the time when they were old enough to drop out.”

The ruling in Endrew F has brought new emphasis to existing policy related to discipline and behavior. On August 1, 2016, the U.S. Department of Education issued a Dear Colleague guidance document to establish clarity about the IDEA’s requirements for behavioral assessments and interventions. “Recent data on short-term disciplinary removals from the current placement strongly suggest that many children with disabilities may not be receiving appropriate behavioral interventions and supports, and other strategies, in their IEPs,” the document states. “In light of research about the detrimental impacts of disciplinary removals… the Department is issuing this guidance to clarify that schools, charter schools, and educational programs in juvenile correctional facilities must provide appropriate behavioral supports to children with disabilities who require such supports in order to receive FAPE and placement in the least restrictive environment (LRE).”

The Office of Special Education Programs (OSEP) offered a summary of policy that included this statement: “Parents may want to request an IEP Team meeting following disciplinary removal or changes in the child’s behavior that impede the child’s learning or that of others, as these likely indicate that the IEP may not be properly addressing the child’s behavioral needs or is not being properly implemented.”

For further information about the Endrew F decision and its implications, refer to the following resources:

The Center for Parent Information and Resources/Parent Center Hub

National PLACE/Parents at the Table

Wrightslaw

Understood Endrew F Advocacy Toolkit

SCOTUSblog

SPAN Parent Advocacy Network

OSEP IDEAs that Work

 

 

 

Positive Behavioral Interventions & Supports (PBIS) in Schools

Posted on by Nicol Walsh

By Kelcey Schmitz, MSEd
Center for Strong Schools
University of Washington Tacoma

We wouldn’t exclude, humiliate or send a child home for making an academic error.

However, when it comes to misbehavior, a typical response has been to punish or wait until the behavior escalates or occurs at a high rate or intensity before intervening. But this is changing. The direction of discipline is moving from reactive, punitive and exclusive measures to more positive, proactive and preventative approaches.

According to the National Technical Assistance Center on Positive Behavioral Interventions and Support (PBIS) (www.pbis.org), over 21,000 schools (elementary, middle, high) across the nation are implementing PBIS. As a result of using the same methods for teaching academics to students for behavior, schools report a decrease in problem behavior, an increase in instructional time, an increase in perception of safety, more positive school and classroom environments and an increase in student achievement. Taking an instructional approach to behavior is much better than waiting for problems to occur.

Positive Behavioral Interventions and Supports (PBIS)

PBIS offers an alternative to traditional discipline methods. Evidence shows that harsh and punitive responses do not change behavior for the long term and may even contribute to the erosion of relationships between students and adults. Creating a positive climate and culture contributes to parents, students and staff feeling happier about the school environment and strengthening the bond between teachers, students, and families

PBIS is a framework schools use to organize behavior supports for students. Much like the public health model, PBIS emphasizes prevention instead of waiting for problems to happen. The practices and programs range in intensity and duration depending on the level of behavior.

Just like many health issues and diseases are preventable, there are many ways adults can prevent student problem behaviors.  Many students will respond to Tier 1 prevention strategies.  In fact, we expect 80% of students to be successful in Tier 1. Twenty percent of students will need additional support in the form of Tier 2 and Tier 3 supports.

Tier 1

To effectively implement PBIS, schools identify a team that is representative of the staff in the building to learn the steps. This team, with frequent input from their colleagues, students and families, create a school wide (Tier 1) PBIS plan. The first step the team takes is to establish 3-5 positively stated expectations or pillars. Some common expectations are “be responsible”, “be respectful”, “be kind” and “be safe.”

Next, they identify a few “hotspots” throughout the school where misbehavior happens frequently. For example, teams may conclude that the hallways, cafeteria or playground are good places to start. They generally pick two locations to get “quick wins.” Lesson plans, or “cool tools”, are developed expected behaviors for each setting are explicitly taught to students. Students are taught what being respectful looks and sounds like in the classroom and non-classroom settings and then are provided opportunities practice.

Every adult that interacts with students (i.e. nutrition services, transportation, custodians, teachers, para-educators) are trained on the specific effective practices. This way, no matter where students are, they are getting consistent, predictable and positive messages.

Students are acknowledged with specific positive feedback for showing the appropriate behavior.  Positive feedback is an essential component of PBIS. Some schools pair feedback with a ticket and students can turn in their tickets for drawings or save them up and spend them at a school store or exchange them for things like school dances, VIP seating at an assembly or a front of the lunch line pass. It is most effective that for every corrective statement, four positive statements must be given. This is referred to as the 4:1 ratio.

Another essential element of PBIS is using data to make decisions. Instead of being driven by tradition, emotions, or convenience to staff, regularly collected data is summarized and reviewed by teams. The types of data teams review include office discipline referrals, suspensions, expulsions, attendance, grades and even school nurse referrals. Office discipline referrals can give teams more detailed information about the problem behavior happening in school. This is called looking at the “Big 5” data (how often, where, when, why and by whom). Drilling down allows precise problem identification and more effective problem solving. It is one thing to say “the sixth grade boys are unruly” – but much more actionable if we can create a statement with the specific information such as “between 2:00 p.m. and 2:30 p.m. in the west hallway the sixth grade boys are using inappropriate language 15 – 20 times a day, motivated by peer attention.” Now the team can brainstorms solutions.

Regular review of data allows teams to identify problems early, before they become chronic. It is much easier to address a low-level behavior than behaviors that have been practiced over time.

It is expected that schools will take 2-4 years to fully implement their Tier 1 PBIS plan. Once a strong foundation is in place, the school begins to work on supports for students in need of more than what Tier 1 supports have to offer. In many cases, school teams are guided through the steps of the PBIS implementation process by an expert in the field either within their district or outside the district.

Tier 2 and Tier 3

Just like with academics, some students will need more instructional support for social behavior skills. Advanced tiers (Tier 2 and Tier 3) offer students more practice and feedback. Students with mild to moderate problem behaviors such as being off task, talking out, difficulty getting along with others, or not following directions are good candidates for Tier 2 supports. Some examples are the Behavior Education Program, a modification of Check-in/Check-out, social skills instruction, and homework club. A few students will still need very intensive support, or Tier 3, for chronic challenging behavior. Tier 3 supports include a functional behavior assessment and behavior intervention plan and may involve a wraparound or person-centered plan, as well. A professional with substantial behavioral expertise often provides the Tier 3 supports and services.

Get Involved

Ask your school if they have a PBIS plan. A fully implemented plan involves family input and involvement and there are many other ways you can support PBIS.  For example, families can use the same expectations and apply them to home settings such as morning, homework and bedtime routines. The common language and an instructional approach to behavior provide the much-needed consistency, predictability and positivity kids need across all learning, living and leisure settings.

Find more information:

Office of Special Education Programs Technical Assistance Center for PBIS

Positive Behavior Supports: Continuing the model at home and in the community

Posted on by Nicol Walsh

By: Dr. Vanessa Tucker, PhD., BCBA-D

What is Positive Behavior Support?

Positive Behavior Support (PBS) is a special education initiative that informs school districts, schools and classrooms regarding prevention and intervention practices designed to teach and reinforce pro-social behaviors. Behavior supports, as we parents well know, do not end at the schoolhouse door. Interfering behaviors can and do continue to manifest themselves in other settings and present a real and present challenge to parents and caregivers raising children with special needs.

The field of PBS is built on the premise of universal interventions that are designed to teach behaviors that prevent negative or challenging ones from occurring. These universal interventions, or Tier I, are effective for most children, but approximately 15 to 20% will need something much more intense in order to experience success. These children require what are known as Tier II and Tier III Interventions. Tier II interventions are designed to address the 15% who need more focused interventions. These may be temporary or may be needed on an ongoing basis. A small number of children (approximately 5%) will require intensive interventions, or Tier III, designed to support the most challenging behaviors. As a parent, you may find that problematic behaviors are a top priority for you due to your child’s unique needs. Parents can benefit from applying the same basic system of PBS in the home and community in order to mitigate the presence of interfering behaviors as well as teaching and reinforcing acceptable replacements. The focus of this brief article will be on prevention tactics that parents and caregivers can implement in the home and community.

Prevention as Intervention

Challenging or interfering behaviors occur for a wide variety of reasons. In many cases a communication breakdown is the “culprit.” In other words, children who have communication delays often resort to behaviors we don’t want in order to let us know what they do want! Children may also engage in challenging behavior due to stress, fatigue, unmet needs for attention, or because they have learned a habit that “works” for them. For example, the child may engage in mild to moderate aggression toward a parent when they first arrive at home as a means of accessing attention. This is problematic as the child inevitably is reinforced for these behaviors when the parent provides the designed attention. The first order of business in PBS is to teach and reinforce behaviors and/or to change our own practices as a means of prevention. In addition, it is strongly recommended that you work with your school team and utilize the Functional Behavior Assessment (FBA) and Positive Behavior Intervention Plan (PBIP) to guide your interventions at home. Pay close attention to the described “function” or reason(s) why your child engages in challenging behaviors. You’ll want to plan your interventions based upon those hypothesized functions. For example, if your child’s aggression is due to escape from unwanted tasks, you’ll want to find ways to help him escape (e.g. ask for a break) successfully. Remember that whatever you select as an intervention should be acceptable to you and your family.

In order to be efficient, you will want to analyze the various times, areas and places where challenging behaviors are most likely to occur. Create a simple matrix of your activities and rate your child’s behaviors as (a) non-problematic, (b) somewhat problematic, or (c) very problematic. Target those areas that are “very problematic” first. Decide what could be creating or maintaining the problematic behavior. Is your child in need of communication supports? Does he understand what is expected of him? Does she need more visuals in order to do what you want? Is her need for attention being met in ways that are unacceptable? Are there sibling issues? Tackling the most difficult areas first will bolster your ability to dive into the smaller issues later and may actually address them inadvertently through your interventions with the bigger ones.

The following table (Table 1.0) presents a list of general recommendations and justifications for prevention of challenging behaviors at home or in the community.

Table 1.0 Tactics for Prevention of Challenging Behaviors

Tactic Rationale Example
Non-Contingent Reinforcement/Planned Attention Your child may need your attention and will engage in whatever behavior necessary to obtain it. You want your child to obtain your attention without having to engage in mild to moderate behaviors to receive it. When you come home spend the first 10 or so minutes with your child before you check email, answer the phone or do anything else. Plan this and stick with it. Give your child (or children) your undivided attention before you do anything else.
Schedules-Visuals and/or Written Your child may need the same structural supports that they use in the school setting in order to predict what is coming, what is done, and what is expected of them. They may not be able to predict these things as successfully if given with verbal prompts only. Create and use schedules with visuals or words for family routines. This might include an activity schedule for evening activities, for a bathing routine or a trip to the store. Rely on your school staff for support in this area. They can assist you to build and use these systems.
Transition Schedules and Objects Your child may need more information than you require in order to successfully understand and navigate transitions. You may need to provide him with more information about what is coming and what will happen. Challenging behaviors may result from a breakdown in understanding what is coming or what is expected. Create a transition schedule such as a white board with icons and/or line drawings. Some children benefit from a basic checklist that they can “check off” as they go. Others need a transition object (e.g. a teddy bear, or something else that is comforting) in order to successfully navigate transitions.
Demand-free time after school All children are tired to some degree or another after school. For some children, the social demands of school have left them with very little in the “tank” at the end of the day. Behaviors may occur because the child needs rest from social and other demands. Consider providing 30 minutes or more of demand-free time (e.g. no homework) after school. Pair this with a timer and allow the child to engage in something that is soothing, restful and relaxing. Don’t pair this with their favorite and most reinforcing activity-save that for after they complete what you want later in the evening, especially if that involves homework or chores. Engage them in a schedule with demands (homework and chores, etc.) after a period of rest.
Homework and Chores A child may balk at the idea of homework and/or chores, which are regular expectations of most parents after school. You may find that children engage in a lot of challenging behavior around these two areas. Consider the rest time after school as the first line of defense. Then, consider using a visual system that breaks down what they have to do, how long they have to do it, and when they are finished. Break things into smaller pieces (called “chunking”) and consider pairing with breaks in between each piece. Show visuals of what you expect the finished product to be. For example, what does a clean bathroom look like? Show each part in a picture format.
Token System Your child may not be particularly motivated to engage in things that are outside of his/her interest area. Challenging behaviors may occur despite your efforts to provide visual structure and break things into smaller pieces. She may need a more tangible way to motivate her to comply with what you want. Consider adding in a token system designed to provide reinforcement for desired behaviors. If possible, mirror the ones used at school if they are effective in motivating the child to comply. Creating a “First, then” procedure allows the child to see that after they do what you want, they will get something that they want. For example, “first clean bathroom, then 20 minutes of iPad” is a reasonable expectation. Provide tokens (stickers on a chart, poker chips on a velcro board) for each step of the bathroom clean up. Make sure you follow through with the earned reinforcer once they’ve complied.

Summary

Challenging behaviors in the home and community are never easy for parents or caregivers to address. Working with your school team, you can come up with ways to support your child so that they understand what you want and have the tools to engage in replacement behaviors that are acceptable to everyone. Many children with disabilities benefit from the same basic principles of PBS that are used in schools. A focus on prevention can decrease stress, increase compliance and teach replacements that lead to better behavior in all settings.

The school wants to use Aversive Intervention, what do I do?

Posted on by Nicol Walsh

What is aversive intervention?

Washington Administrative Code (WAC) Section 392-172A-03120 sets out the following:

Aversive interventions means the systematic use of stimuli or other treatment which a student is known to find unpleasant for the purpose of discouraging undesirable behavior on the part of the student. The term does not include the use of reasonable force, restraint, or other treatment to control unpredicted spontaneous behavior which poses one of the following dangers:

(a) A clear and present danger of serious harm to the student or another person.

(b) A clear and present danger of serious harm to property.

(c) A clear and present danger of seriously disrupting the educational process.

This WAC section also states that “aversive interventions, to the extent permitted, shall only be used as a last resort. Positive behavioral supports interventions shall be used by the school district and described in the indivi-dualized education program prior to the determination that the use of aversive intervention is a necessary part of the student’s program.” More simply put, using an aversive intervention plan must be a last resort measure and positive behavioral supports interventions must be used and described in the IEP prior to determining that aversive intervention is a necessary part of the student’s program.

Requirements for Implementing Aversive Interventions

If an IEP team is considering the use of an aversive intervention because positive behavior support interventions have not worked in discouraging undesirable behavior on the part of the student, the team must follow WAC 392-172A-03135.  (http://apps.leg.wa.gov/wac/default.aspx?cite=392-172A-03135)

What do I need to know?

All students with Aversive Plans MUST have Behavior Intervention Plans as part of their IEP that have all of the above elements. Again, “aversive interventions” means the systematic use of stimuli or other treatment which a student is known to find unpleasant for the purpose of discouraging undesirable behavior on the part of the student. As such, Aversive Plans should not be focused on responding to unpredicted spontaneous behavior and should instead be focused on why the team believes an aversive measure is an appropriate tool to use to help a student meet a specific behavior objective and how the tool will be used.

Requirements for Monitoring Aversive Interventions

As set forth above, WAC 392-172A-03135(1)(h) requires that at least every three months when school is in session, the effect of the use of aversive interventions be reviewed. Each case manager insures that data is collected regarding the use of aversive interventions for this periodic review for each student on their caseload on the following schedule:

Preschool and elementary: with trimester progress reporting

Secondary: by 12/1, 2/1, 5/1

If changes need to be made to the current aversive intervention plan, those must be done through an IEP amendment, complete with all required paperwork. If no changes are necessary then the case manager completes a prior written notice documenting this review that is sent to parents and central files for the legal file.

The PAVE Parent Training and Information Program may include information on State or Federal laws regarding the rights of individuals with disabilities. While this is provided to inform or make one aware of these rights, legal definitions, or laws/regulations, it is not providing legal representation or legal advice. The recipient understands that this is information is to educate them not to provide them with legal representation.