Making Response to Intervention More Accessible

I always have such great conversations and idea-bouncing with my email buddy, a school psychologist in Ohio. She emailed me today with a question/query/frustration that I'm sure TONS of us, including myself deal with: teacher push-back and reluctance to adopt the Response to Intervention (RTI) model. Here's some of what she had to say:

"Myself and another psych in the district are trying to create a framework and/or standard protocol model for the RtI process... [T]here is a great deal of talk about the resistance we are facing in developing an intervention framework... My frustration is trying to foster teacher buy in.... I want to move towards identifying students area of weakness, developing a student specific goal and then selecting the appropriate intervention for said deficit... Right now, the IAT type meetings {student support team meetings, I imagine} we have involve the teacher complaining, the Interv. Spec. doing a small reading group and DIBELS and in 4-6 weeks saying no progress-evaluate. UGH!"

Agreed, agreed, 100%! With RTI now the legal requirement for eligibility, the mode into special education is going to be changing a lot, potentially without a lot of support to the people who have to do and/or monitor the interventions: the teachers! No wonder they fight back... they don't have the support, training, time, or understanding of the model in order to implement RTI the way it's "supposed" to be done. It's much easier to stand by the old "test and place" or "discrepancy" models, which are not as fair to the child as RTI is.

My district is huge and there's no guidelines or mandates about how RTI should be done or what it's expected to look like, only that we have to be doing it. We have no specific intervention building staff, and some of our reading/math support staff don't work with the kids, only coach the teachers. We do have a lot of tutors come in from local colleges, and are putting before and after school tutoring/homework help in place, but it's hard to monitor.

I try to be basic with RTI for my teachers, and think about it more like differentiation than a separate intervention... I think people get scared by the term "intervention." What I've found in requiring academic RTI data is that teachers are doing way more differentiation than you and they realize, and when you're trying to scrounge things together, many things can be recorded as intervention. For instance: pre-teaching vocab, re-teaching lessons, shortened assignments, reduced items per page, graphic organizers/outlines, visual aids (i.e. a reminder card on the desk of steps for writing a paragraph), specially spaced lined paper, practice writing sight words in sentences, math manipulatives (tiles, cubes, counters, charts), etc. These are things teachers typically do in a classroom, but if only a few kids are getting it, it's an intervention. Sure, there are bigger things too, like special tutoring, small groups, individual pull-out, etc, but those are often too cumbersome, time-consuming, and disruptive for teachers to wrap their heads around.

My biggest obstacle is getting good, sold, appropriate data. I can get beautiful narratives and excellent information to fill into Individualized Education Plans (IEPs), but if I don't have the numbers, it's less than useful. We use the Dynamic Indicators of Basic Early Literacy Skills (DIBELs) pretty extensively for reading assessment. Every kiddo gets a quarterly progress monitoring, and those who are at the strategic (1 year behind) or intensive (2+ years behind) level get monitoring much more often. Usually, I have to rely on DIBELs and reading program lesson tests (pre- and post-) for my data. What I found from past experiences is that you don't have to have nationally normed, well-known sources of data for it to be useful and meaningful. Using things like the Dolch word lists, Fry's high frequency words, and other DIBELs measures aside from Oral Reading Fluency (ORF) are useful too [Letter Naming Fluency (LNF), Initial Sound Fluency (ISF), Nonsense Word Fluency (NWF), and Phonemic Segmentation Fluency (PSF) are good for the little kiddos, especially to measure decoding interventions].

In short, I try to remember that teachers are limited in their time, resources, and ability to conduct interventions. Make it as simple yet effective as possible for them and give them easy data tracking ideas. Meet them where they are. Remind them of all the differentiation they actually do, and find away to quantify it.

Readers, please share how your school/district manages RTI! How do you get teachers to "buy in"? What do you do to help/field/alleviate their frustrations? What sources of data have you found to be easy yet effective to implement?

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And in This Corner...

Since it was requested by a follower of my Facebook page, I shall recount the tale of the time I broke up my first fist fight. You'd think this would've happened long ago knowing the potential my building has for insanity, but no, it was today. At 3:30, on a Friday. (Side note: doesn't everything insane seem to happen on a Friday after 3:00?)

K came down to my office at the end of the day because she had a bad interaction with a peer during specials. Kudos to her for removing herself from the situation, first off. She said she needed to cool down, so we went on a walk to collect my kiddos' Check-in, Check-out scores for the day. She said that the peer was bothering her and "running his mouth," but she didn't want to fight him and get suspended anymore. Second Kudos... good decision, girlfriend. Insert me reciting my "keep your hands to yourself" mantra and giving her a pep talk. K has shown good decision-making skills in the past, but has a hot mess temper. Save this for future reference.

We made a few stops, got a few high fives from some younger kiddos, and made our way to her classroom. K participates in the backpack program through the local Food Bank, so she needed to grab her things for dismissal and go pick up her backpack, since it's Friday. Upon entering the room, the proverbial switch flipped and all hell broke loose. Someone had thrown everything out of K's desk and left it scattered all over the floor. She was convinced that the peer she had issues with earlier had done it. (Side note: if you were the class's substitute teacher today, and knew that K was having an "off" day, you wouldn't have tried to save yourself and the kids from the coming onslaught by cleaning the mess up? Apparently not.)

Insert rather colorful, imaginative, and overall impressive cursing from K's glossy lips. I swear, this girl was coming up with good ones. My favorite was the comments about the peer's sexuality and the heavily repeated "n***** p***y b****." Third Kudos for creativity, which is inappropriate on my part. The substitute started instigating her behavior from her position at the front of the room (which she never moved from during the entire ordeal), which was totally helpful. As K got in the other boy's face and I tried to intervene, another kid actually got up out of his seat at the front of the room, grinning, and found a better vantage point to watch what might ensue. Fourth kudos to him for being ballsy, though I looked at him and monotoned, "Not a good idea."

I physically herded K to the doorway of the classroom, trying to get her to get her things from her locker, get her to her backpack, and get out of there. For a glimmer of a moment, I thought we had diverted the crisis. It was short-lived. One bazinga of a comment came from the other boy from inside the room, and K kicked off her shoes. (Side note: loss of shoes is the best indicator that you know it's about to go down... and the tiny voice in my head said, "Oh s***, it's on.")

I grabbed K around the chest to hold her back, but damn, that chick was strong and kept after the boy (who was like, 6 ft. tall by the way). Halfway through the struggle, as I was getting punched/clawed in the holding arm and screamed obscenities in both ears, I realized a few things:

1. Kids come out of the freakin' woodwork when there's a fight. I swear I looked over and saw kindergarteners and first graders watching, who are on the other side of the school and down a floor.
2. Today was a bad day to wear boots that need the rubber grippy nub on the heel replaced. I almost bit it and had visions of being trampled by pre-teens.
3. It's pretty ironic that I was writing a Functional Behavior Assessment (FBA) for K this morning, thinking how she probably wouldn't need a Behavior Intervention Plan (BIP) because her behavior is managed well by her teacher and the structure of the classroom.

Two teachers from next door came over to help, one grabbed K and pulled her out of the mess and down the hall, and the other shooed the onlookers back to their classrooms to pack up (Side note: they continued to creep in the hallway). K needed to be held, struggling, for about five minutes until she could calm down and stop calling the boy a "f****** p***y b****" and saying she was going to break his face. The principal came up, spoke to both kids, and I dragged K to her bus.

Needless to say, I didn't finished my Check-in, Check-out for the afternoon. Happy Friday!

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My Lunch Buddy is on "Vacation"

You may remember my Michael Jackson-loving, big dreamer blog star, H. A quick recap for our viewers at home: H is diagnosed with Asperger Syndrome and exhibits "classic" symptoms: rote, bookish speech (and hilarious one-liners), poor peer social interactions and a preference for being with adults, resistance to changes in routine, and extreme negative reactions to overstimulating (loud, noisy, busy, overpopulated) environments.

H was a case I looked at due to our ongoing state review, but was one we had already planned to reevaluate. H was receiving Integrated Co-Teaching (ICT) services within the general education classroom. When she moved up to first grade, she began having an extremely difficult time maintaining herself in the large classroom, and would shut down for hours at a time when overwhelmed. She would cry, sob, refuse to do work, and “ramble” incoherently. She also was refusing to go into the lunchroom, saying she is “scared” of the noise. She was unable to calm herself independently, a teacher is generally needed to do so, or removal from the overstimulating environment. Crying/shutting down episodes typically happened 2-3 times per half an hour period, and the crying lasted for up to 30 minutes afterwards.

H's special education teacher started interventions at the beginning of the year. Here's a quick list, none of which made a significant impact on her behavior, as little change occurred in her shutting down:

-planned breaks following periods of appropriate work.

-pulled into small groups within the class, to isolate her from the whole class.

-attempts to console, soothe, and calm her within the classroom (almost always had to be removed due to the disruption and intensity).

-given headphones to wear within the classroom to help her block out some of the noise of the other children. 

-lunch in my office, outside of the overstimulating lunch room (always a hoot).

-individual counseling on coping, calming down, and problem-solving skills at least 3x/week.

As a result of the reevaluation, we decided to move H to a classroom specifically for students with Autism. It proved to be a fantastic move that all of the Committee on Special Education (CSE) was pleased with (including H, who was reportedly needing "a vacation" from our school). The self-contained classes for students with Autism in our district not only target the academic needs of these students, but also do intense social, problem-solving, and coping skill training. The kiddos get to socialize with students "like them" within a controlled setting, teaching them age-appropriate interactions and helping them to overcome social and emotional deficits inherent in the disorder. They also learn more appropriate ways to cope with frustrations, changes in routine, and other upsets, as the "default" coping mechanism for many students with Autism is to cry/shut down, self-stimulate, or in extreme cases, self-injure (bite, scratch, or head-bang). 

H is reportedly doing great over at her new school, and while I will miss my daily lunch buddy and her fantastic (if inadvertent) humor, she's in a much more appropriate educational setting. Enjoy your "vacation," H!

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Best Musings of 2011

In taking inspiration from Dr. Branstetter over at Notes from the School Psychologist, I decided to debut my first "best of" showcase. 2011 was a big year for me: my first full year as an employed school psychologist. There was tons on learning and laughs, of which there will continue to be many more of. Here are highlights of the year, as measured by most viewed, most comments, or my personal favorite:

January -- A post about The Semantics of Stigma associated with "mental retardation" vs. "intellectual disability."

February -- A case study about a kiddo who moved from an Integrated Co-Teaching classroom to a 6:1+1. (and a bonus update on how he settled in!)

March -- The Cross Country Team, a post about "runners," or kids who leave the classroom during instruction and roam/run the school building. This post gets a huge amount of hits for the graphic, not the content. Alas!

April/May/June -- A compilation of the 8-week anger management/social skills group that I co-facilitated during the spring in the 5th grade 6:1+1 class. All boys, all shenanigans.

July -- I didn't have any posts in July... :(

August -- E=mc... huh?, a case study about a kiddo with a nonverbal learning disability. And because I couldn't choose (and slacked in July), a playful reflection post linking my shoe collection to key events in my career.

September -- A post about Jamie Nabozny and the documentary "Bullied," which every one should order and use because it's FREE! I'll reiterate again: "Bullying: Confront it. Report it. End it."

October -- A post about interview questions I was asked when I was interviewing for positions after grad school. I'm so glad that this post has been helpful to those just starting out!

November -- An important post about the current New York mandate relief proposal to remove psychologists from the CSE. Speak up, advocate for yourself and your colleagues, and make everyone know the importance of psychologists in the schools.

December -- If you missed it the first time, a good laugh for the holidays, with inappropriate Christmas carols for those who work in mental health.

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Multiply Disabled, Doubly Blessed

Earlier this month, we had a Committee on Special Education (CSE) meeting on a rather tough case. X, a kindergarten student, was referred by his foster mom/aunt and his doctor due to suspected developmental delays. I had to blog about X and his CSE referral, since cases like his don't come around very often. Here's a list of notable things in X's social history, shortened for brevity:

Facial features of children with Fetal Alcohol Syndrome

-heavily exposed to alcohol and marijuana in utero. Recently diagnosed with Fetal Alcohol Syndrome. (also exhibits facial features)

-traumatic brain injury at 6-months (suspected that biological mother dropped him, cracking his skull).

-no medical care after first well-visit after birth.

-significant history of malnutrition (often left to fend for himself to eat, which led to injuries as he attempted to cook for himself; currently, hoarding food and pica-like behaviors of eating inedible objects).

-not toilet trained (a requirement for attending kindergarten in my district--he was asked not to return to school until he was toilet trained, because he was having accidents throughout the day).

-much smaller than is typical for his age--looks about 3 years old when he's 5-years, 7-months.

-speech concerns (articulation, voice tone and quality, expressive and receptive language deficits).

-underdeveloped fine motor abilities (shoe tying, writing, cutting; also sensory concerns).

-removed from biological mom's care 6-months ago due to severe neglect; living with his aunt.

-no exposure to school or age-appropriate social interactions prior to entering kindergarten this year.

During testing with me, X exhibited no spontaneous conversation, and when he did speak, it was in a whisper (I must've driven him nuts asking him to repeat himself so much because I couldn't hear him!). His sentences were no more than three words and he would gesture or point rather than speak at times. Throughout our time together, he exhibited flat affect and appeared lethargic. He was slow to respond to many assessment tasks. He rarely smiled or responded appropriately when I tried to make him laugh (I probably am not funny).

Lots of assessments were done, to get a full picture of X's developmental levels. Speech/language and occupational therapy evaluations were indicative of significant delays, so he qualified to receive those related services. My cognitive testing was in the borderline intellectually disabled range, as was standardized academic testing (i.e. standard scores in the 70 range). Behavioral rating scales were also completed by X's teacher, which indicated high levels of atypical or "strange" behaviors and moderate hyperactivity and attention problems. Adaptive behavior was also delayed, with daily living skills (self-care skills) and socialization were the lowest areas.

Standard scores within the 70 range across all areas (cognitive, academic, adaptive behavior) would in most cases lead to a classification of Intellectually Disabled. However, I recommended a classification of Multiple Disabilities. What are the criteria for this disability, in New York State?

Multiple disabilities means concomitant impairments..., the combination of which cause such severe educational needs that they cannot be accommodated in a special education program solely for one of the impairments. The term does not include deaf-blindness. [Part 200.1(zz 8)]

Due to his pervasive level of delays and needs, and concurrent head trauma and Fetal Alcohol Syndrome, Multiple Disabilities was a more appropriate classification for X. After the New Year, we are going to look into an agency self-contained classroom for him to be placed in. This setting will meet not only his educational needs, but also his daily living, self-care, and toileting.

So with all these hurdles to overcome, why is X "doubly blessed?" Because of his foster mother and aunt. She is working so hard to support him and provide him with the nurturing environment that he has lacked for the last five years. He is receiving routine medical care, nutritious food, an education, and most importantly, love and social interaction. She has advocated for him in ways that most people would find difficult, starting first by taking him in when she has other children of her own, and by initiating the special education referral that will get him the support he needs. I am confident that X will quickly catch up to where he needs to be with her care and appropriate educational services.

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Holiday Wishes for Mental Health Professionals

Just got this in an email through my district's psychologist email group and I simply had to share. Happy holidays everyone! Expect a couple good case study posts next week from the comfort of my couch. :)

Christmas Carols for the Psychiatrically Challenged:

Schizophrenia--Do You Hear What I Hear?
Multiple Personality Disorder--We Three Queens Disoriented Are
Amnesia--I Don't Know if I'll Be Home for Christmas
Narcissistic--Hark The Herald Angels Sing About Me
Manic--Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Buses and Trucks and Trees and Fire Hydrants and
Paranoid--Santa Claus is Coming to Get Me
Personality Disorder--You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll Tell You Why
Borderline Personality Disorder--Thoughts of Roasting on an Open Fire
Obsessive Compulsive Disorder-- Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells,Jingle Bells
Agoraphobia--I Heard the Bells on Christmas Day But Wouldn't Leave My House
Autistic--Jingle Bell Rock and Rock and Rock
Senile Dementia--Walking in a Winter Wonderland Miles From My House in My Slippers and Robe
Oppositional Defiant Disorder--I Saw Mommy Kissing Santa Claus So I Burned Down the House
Social Anxiety Disorder--Have Yourself a Merry Little Christmas While I Sit Here and Hyperventilate

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Backpack! Backpack! Backpack! Backpack!

(name the obscure children's TV show reference)

I just found Marie's blog over at the South Carolina Counselor Cafe as she posted on my Facebook page, and in looking back through her entries, I found a great reference for helping families faced with poverty and homelessness.

As I've mentioned many a time, my school is high poverty, low SES. We have about 99% of the students receiving free and reduced lunches. At the district level, we find that many of our students do not have enough to eat. As such, we have a breakfast program where every morning, the students are provided with a breakfast pack and milk. I always make sure to have extra breakfasts in my office. Why? Well, if there's a kid having a behavioral fit before 10:00am, there's a pretty good chance they haven't eaten breakfast (and in some cases, since lunch at school the previous day). The first thing I ask when kids are having meltdowns in the morning is whether or not they had breakfast--not "what did you do?" or "what happened?"

A tangential story for a moment. Last winter, we had a terrible snowy day (which never happens in Western NY, right? ha). All the surrounding districts were closed, but not ours. Why you may ask? It was a Friday, and the rumor was that the superintendent kept school open so that the students would get breakfast and lunch in school Friday, and wouldn't have to go three days without food over a long weekend.

This year, we have a new partnership with the local food bank. This was sought out through the community service providers that are housed in my building. Every Friday, the food bank provides backpacks full of nutritious food for our students to take home over the weekend. We have over 50 families participating! It's such a wonderful program and has so many great benefits. Aside from giving families food for the weekend, the backpack program is also designed to increase school attendance. There's nothing like seeing all the little munchkins tearing down the hallway on the way to the bus with their yellow backpacks bouncing on their backs. I'm so glad we have the opportunity to provide for these students!

If you work in a high poverty area, or have a student population that is significant for homelessness, contact your local food bank or soup kitchen and see if they also partner with schools to provide for students. You never know what you might find out.

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What Do Basketball and Social Skills Have in Common?

One of the big problems with working in an urban area is the lack of enrichment activities for the students. We have no music program aside from one semester per year of general music (although our new music teacher rocks and is trying to expose the kids to more), we have no clubs or activities aside from a fall cross-country team and a winter basketball team, and we have a very limited art class, which is also only for a semester. My principal is trying hard to get the kids out on field trips to local colleges, the theatre, and to see the city orchestra, and she's bringing in a lot of before and after school tutoring programs.

Our gym... go green team!

Today, I stayed after school not to write IEPs or reports (as is the norm lately with the program review I'm wading through), but to go to the boys' basketball game! Some of my 7th and 8th grade friends have been trying to get me to go, so since today was their last home game, I couldn't pass it up. It was a blast! The boys lost by 2 points, but they played hard and enjoyed themselves.

The benefits of extracurricular activities, especially sports, is so incredible for kids. Not only do they learn routines, expectations, rules, and how to follow directions, they increase their social skills. Kids learn about turn-taking and sharing, good sportsmanship, how to deal with upsets and challenging situations, friendship skills, leadership, and problem-solving skills. Research has also shown a positive correlation between participation in sports and academic achievement. Hmm... sounds like all of the "desired behaviors" I write on my Behavior Intervention Plans (BIPs)!

Watching the boys working together, congratulating one another, and cheering each other on was fantastic. The majority of the team is self-contained special ed. students from the 15:1 classes in junior high, who need some social skills training, so this is an excellent opportunity for them. I wish that we had more sports teams for our school. Maybe it would keep me from having to write so many BIPs! ;)

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