Cognitive Behavioral Intervention for

Trauma in Schools (CBITS) within

Chicago Public SchoolsAmanda Mohler

Mashana L. Smith, Ph.D.Chicago Public Schools

Office of Diverse Learners and Student SupportsOffice of Social & Emotional Learning

AGENDA Chicago Public Schools at a Glance

Implementation and Use of MTSS Framework within CPS

History of CBITS within CPS

Training & Supported Implementation

Referral, Screening and Assessment Process

Implementation Fidelity

Evaluation and Outcomes

Challenges & Future Direction for Implementation

Chicago Public Schools at a Glance

Demographics

CPS Elementary64%CPS

High Schools

15%

Con-tract1%

Charter19%

Schools: 658

African Amer-ican40%

Hispanic 46%

White9%

Asian4%

Multi-Racial1%

Hawaiian/Pacific Is-lander

0%

Student Population: 400,545

Demographics Chicago Public Schools (District 299) is the 3rd largest school district

85% of students live at or below the poverty line

91% of students are minority

70% graduation rate (within 4 years)

19% mobility rate

13.3% of students with disabilities

English language learners 16%

Trauma Related Symptomatology among CPS Students

32.5% of CPS students felt sad or hopeless almost every day for 2 weeks or more in a row and stopped usual activities

15.5% of CPS students seriously considered attempting suicide

Implementation and Use of MTSS Framework

within Chicago Public Schools

SOME(Ex: Peer Council, Check In/Check Out)

ALL STUDENTS(Examples: School-wide Expectations, Second Step, Talking Circles)

INDIVIDUALIZED INTERVENTIONSFor students with the highest levels of need, highly-targeted and individualized

behavior strategies provide more intensive intervention and monitoring.

TARGETED SUPPORTSFor at-risk students, classroom-based responses can help de-escalate behavior problems, clinical

group interventions address anger, trauma, and violence; and restorative practices provide students with strategies to resolve conflicts

POSITIVE LEARNING CLIMATESchool climates with positive relationships, clear expectations, and collective

responsibility establish appropriate behaviors as the norm. Respectful, learning-focused, participatory classroom environments with well-managed procedures and

behaviors maximize learning time

SOCIAL AND EMOTIONAL LEARNINGExplicit curricula, along with integrated instructional practices that promote social and

emotional development, teach students how to form positive relationships, make responsible decisions, and set goals. These are critical skills for college and career success.

(Ex. Wraparound,Individualized Counseling)

Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs

FEW

SOME

ALL STUDENTS

INDIVIDUALIZED COUNSELING, FUNCTIONAL BEHAVIOR ASSESSMENT, WRAPAROUND

SMART PROGRAM, REFERRAL TO OUTSIDE RESOURCESALTERNATIVES TO SUSPENSIONS PROGRAM

CHECK IN/CHECK OUT, PEACE CIRCLES, SS GRIN

ANGER COPING/THINK FIRST,CBITS, PEER COUNCILS/JURIES

SCHOOLWIDE EXPECTATIONSCOMMON AREA POLICIES

LESSON PLANSACKNOWLEDGEMENTS

SECOND STEPADVISORY

TALKING CIRCLESMORNING MEETINGS

FEW

Multi-Tiered Systems of Support for Social, Emotional, & Behavioral Needs

History of CBITSwithin Chicago Public Schools

Identifying a Need for Evidence-Based Interventions within Chicago Public Schools

During a focus group attended by CPS social work and psychology coordinators (Winter, 2006), it was determined that:◦ The majority of referrals for social work services were related

to the experience of trauma or anger/aggression◦ CPS didn’t have a firm understanding of the nature or

effectiveness of services◦ Despite numerous minutes of direct service minutes, students

were not exiting related service delivery, indicating “improvement”

In 2007, CPS collaborated with the University of Florida to review evidence-based interventions (EBIs) designed to address trauma in school-aged populations

◦ Cognitive Behavioral Intervention for Trauma in Schools (CBITS) o LAUSD – Lisa Jaycox

Cognitive Behavioral Intervention for Trauma in Schools (Jaycox, 2004)

Includes 10, one hour cognitive behavioral therapy group sessions

Recommended for students ages 11-15

Skill Areas of the Intervention:◦ Psychoeducation and

Relaxation ◦ Realistic and Helpful Thinking◦ Social Problem Solving

Parent Education

Teacher Education

Planning for the Adoption of CBITS: Identification/Selection of Schools

Community Partners and Funding Mechanisms

Identification/Selection of Schools

ISBE MH ◦ Leadership members or leadership teams had attended

training related to early intervention

◦ Current infrastructure in place relative to preventative or early intervention SEL supports

◦ Indicators of need (disciplinary infractions, OSS, arrest rates, graduation rates)

ISBE MH/Englewood◦ African American 97.82%◦ Ranks 2nd for violent reports◦ 32.3% of households below

poverty level ◦ 34.7% of residents unemployed ◦ 30.3% of residents without high

school diploma SSHS/South Shore ◦ Ranks 12th for violent crime◦ 31.5% households below

poverty level ◦ 17.7% of residents unemployed ◦ 14.9% of residents without high

school diploma

Identification/Selection of Schools

Training and Supported Implementation

Training for Chicago Public School Staff

In 2007, Chicago Public Schools partnered with UCLA Division of Child & Adolescent Psychiatry to train school based clinicians

In 2008, clinical psychologists from Ann & Robert H. Lurie Children’s Hospital Community-Linked Mental Health Services Program partnered with CPS to train clinicians

Training targeted the district’s school social workers, school psychologists, counselors, deans, and community mental health partners

Two day training model offered:◦ History of CBITS◦ Cognitive-Behavioral Theory◦ Education and Relaxation◦ Imaginal Exposure◦ Introduction to Cognitive Therapy

Train the Trainer (TOT) in SY11 (2010-11) to include school-based clinicians

Train the Trainer (TOT) Expansion during Spring, 2011 to include community mental health partners

CPS Training Data (SY08-SY14)

Training began in Fall, 2007

Over 1690 trainees (2007-2014)

350/351 (99.7%) current School Social Workers trained in CBITS

226/228 (99.1%) current School Psychologists trained in CBITS

482/816 (59.1%) current School Counselors have been trained in CBITS

124 community mental health clinicians (2011-2012)

First Year of Implementation 2007-08

Clinicians

(District &

Community

Mental Health Partne

r)

Trainings

Implementation

Anger Coping CBITS0

2

4

6 5

0

First Year of Implementation

2007- 2008

From Training to Implementation: Supported Implementation

EBT CBT Professional Learning Community◦ Clinical Support◦ Fidelity Monitoring◦ Content Review

Co Facilitation◦ Inter-disciplinary◦ Community mental health partners, district clinicians

GOAL: Change practice for the delivery of school based Mental Health services for all students

MTSS Problem Solving Process:(Referral, Screening and Assessment Processes)

Behavioral Health Request for Assistance Form

Teachers observe behavior and attempt evidence-based behavioral strategies in the classroom

If students do not respond, teachers complete a Request for Assistance (RFA) form

The RFA is reviewed by a Behavioral Health Team (also known as CARE Teams)

Additional screening is completed by a member of the BHT

Strengths and Difficulties Questionnaire (SDQ)

Originally developed by Robert Goodman (1997)

Consists of 25 items in five different domains:

1. Conduct2. Hyperactivity3. Externalizing Behavior4. Peer Problems5. Prosocial Behavior

Similar versions for different informants

Trauma Symptom Inventory

Trauma Symptom Inventory

Implementation Fidelity

Chicago Public Schools Implementation Model

Co-facilitation is considered best practice◦ Co-facilitation is encouraged during Year I of implementation◦ Co-facilitation not required during Year II and beyond

New implementers are highly encouraged to attend supported implementation sessions

Co-Facilitation Guidelines

LEAD FACILITATOR

SBC Clinician (Masters level social worker, psychologist, or counselor supervised by a Licensed Mental Health Professional (LMHP) (LCPC, LCSW, PhD, PsyD)

CO-FACILITATOR

Type 73 school based professional (school psychologist, school social worker, school counselor)

Graduate trainees/interns supervised by masters level social worker, psychologist, or counselor

Implementation Data

Metric SY 2013

# of students referred 2815

# of students assigned to CBITS 253

# of students assigned to Anger Coping 1036

Fidelity of Implementation

Facilitators are asked to complete a fidelity monitoring form following each group meeting

Intended to encourage accountability and uphold fidelity

School Name: _______________ Group Name: _______________ Date: __________ HSMP: YES/NO Progress Note: Y/N Attendance: Student

Clinician Attendance and Signature: Clinician Signature: ___________________ Clinician Signature: __________________________ Clinician Signature: ____________________ BTAT Leader Signature: ______________________

Anger Coping Group: Session One Introductions

How well did your group meet each objective?

Session Objective 1 = Not Met

2 Partially

Met

3 = Completely

Met

Comments

Objective 1: GENERAL PURPOSE AND STRUCTURE

1

2

3

Objective 2: GET ACQUAINTED/GROUP COHESION Activities: Pass the ball, paired interviews, group flag, etc.

1

2

3

Objective 3: FOCUS ON INDIVIDUAL PERCEPTUAL PROCESSES Activities: Show DUSO cards and discuss perceptions

1

2

3

Objective 4: POSITIVE FEEDBACK Activity: Compliment Circle

1

2

3

Comments: For Discussion:

Are you able to reach the goals of each lesson? (y/n)

Is there anything that needs to be re-taught? (y/n)

Did you make any adaptations to the content/activities of the curriculum? (y/n)

Evaluation and Outcomes

Assessment Instruments Pre and Post Assessment

◦ Strengths and Difficulties Questionnaire (SDQ)

◦ Trauma Symptom Inventory

All data is entered into a district SharePoint

Scoring and ClassificationSTRENGTHS AND DIFFICULTIES QUESTIONNAIRE

Total Difficulties Score ranges between 0 and 40

16-40 Abnormal

12-15 Borderline

0-11 Normal

TRAUMA SYMPTOM INVENTORY

Scoring

Exposure: One or more exposure

Symptomatology: 14 or more

Pre-Post Analyses

Assessment Time

N Mean CI 95%

Pre

Post

220

220

40.155

37.409

39.088-41.221

36.359-38.459

Limitations of Evaluation

Single method of assessment

Limited understanding of areas of impact◦ No examination of domains with SDQ◦ No examination of domains within the TRRPB

CBITS: A School Psychologist’s

Experience

ExperienceTwo day training (December 2008); Dr. Audra Langley, ULCA Division of Child and Adolescent Psychiatry

Initial implementation in March 2009

6th grade students attending a PK-8th school in Englewood Social-emotional Learning Grant School slated for closure hearing

Community PartnersAnn & Robert H. Lurie Children’s Hospital of Chicago

SGA Youth and Family Services

Children’s Research Triangle (Teacher Education Session)

Referral ProcessTeacher referral

Counselor referral

Group composition

May need to make referrals to outside counseling or alternate intervention

Trauma Symptom Inventory

Preferential to administer individually, read items orally

Refer back to types of trauma student indicated and ask for more information

Establish relationship and gain student assent

Need to guide or reframe in cases of chronic or multiple traumas

Guide student to select an event to work on in group

Types of Traumatic EventsFire

Parent incarceration

Parent/ relative homicide

Peer homicide

Traumatic grief or multiple losses

Witness to community violence

Incentive System Two levels

◦ Group Teamwork incentive

◦ Individual point sheet

Behavior Management Establish group rules

Introduce confidentiality

Co-facilitator roles◦ Content◦ Behavior management

Group Incentive Tracking

Group Incentive Tracking

Individual Incentive

Education and Relaxation

Common reactions to stress or trauma

Write on slips of paper and have students pull and read them 

Provide copies of handout and have students highlight them

Allow students to share

Normalize all feelings

Encourage them to share with their families

Relaxation Training Read progressive relaxation script

Consider dimming lights and moving furniture

Play calming music

Cognitive Therapy Teach students the link between thoughts and feelings

Chicken Little example

Hot Seat activity to challenge negative thinking and supply positive alternatives

Fidelity Behavioral Technical Assistance Team meetings

Co-Facilitator reflection

Modifications Consider estimated cognitive and academic functioning

Read material orally

Informally assess need for additional sessions

Consider additional visuals

Challenges Logistics

◦ Space◦ Time allocation

Referral process◦ Screening appropriate referrals◦ Paperwork

Successes Collaboration with other professionals

Internalizing and applying content and techniques

Student and parent feedback

Impact “What I learned is that you can trust people you’re in the group with. The group helps you a lot. It gets the things that are in your mind out and to express what you’re feeling.”

-Seventh grade female

Challenges & Future Direction for the Implementation and Evaluation

of CBITS withinChicago Public Schools

Challenges to Training, Implementation and Evaluation

Training of district personnel to allow for internal training

Allocations for Related Service Providers o 60 minutes per school per week

Use and Ease of Data Collection Platform

Alignment of Assessment Tools with the Intervention

Funding Mechanisms for Community Mental Health Partners

Next Steps for Continuous Improvement

Train ALL counselors, psychologists, social workers, interns and community partners

Improve supported implementation model Differentiate sessions for all levels of experience Increase accessibility and convenience for facilitators

Increase number of groups implemented via increased allocations of clinical related service staff and community mental health partners and availability of Network SEL Specialists

Improve generalization of curriculum to classroom

Strategically align assessment instruments for identification

Support community mental health partners in the identification of external funding mechanisms

Questions?

Chicago Public Schools Office of Social & Emotional Learning

osel@cps.eduhttps://sites.google.com/site/cpspositivebehavior/home