Interhab 2013 - Kansas Mental Health Positive Behavior Support

POSITIVE BEHAVIOR SUPPORT IN KANSAS:
PAST, PRESENT, FUTURE
Matt Enyart, Kris Matthews, Cherie Blanchat
University of Kansas
OBJECTIVES
• Meeting the QOL needs of Kansans
• Positive Behavior Support Role and Definition
• Building on Kansas Experience and Strengths
• Positive Behavior Support Systems and Services
• Future of Positive Behavior Support Policies,
Systems, and Services in Kansas
• Kansas Mental Health Positive Behavior Support
Project
IMPROVING
QUALITY OF LIFE
BEHAVIOR &
QUALITY OF LIFE
PWB
SD
MWB
PD
INDIVIDUAL
SI
QOL DOMAINS
PWB: Personal Well-Being
PD: Personal Development
SI: Social Inclusion
EWB: Emotional Well-Being
IPR: Inter-Personal
Relationships
R: Rights
MWB: Material Well-Being
SD: Self-Determination
R
EWB
IPR
All behaviors, no matter how
strange or maladaptive, serve a
purpose.
COMMUNITY SUPPORTS
GOVERNMENT
AND POLICIES
RESEARCH
&
ADVOCACY
• MEDICAID SERVICES
• REGULATIONS
• QUALITY OVERSIGHT
ORGANIZATIONS
& COMMUNITIES
• FUNDING
• RESOURCES
• PROFESSIONALS
INDIVIDUALS &
FAMILIES
• IMPLEMENTATION
• QOL IMPACT
• DOABILITY
POSITIVE BEHAVIOR
SUPPORT IMPACT
INDIVIDUALS
KANSAS
KANSAS
COMMUNITIES
SERVICE
ORGANIZATION
INDIVIDUALS
INDIVIDUALS
STATE WIDE
COMMUNITY &
ORGANIZATION WIDE
INDIVIDUALS
POSITIVE BEHAVIOR SUPPORT IMPLEMENTATION
OUTCOMES
Supporting
Decision
Making
Supporting
Staff Behavior
PRACTICES
Supporting
Individual Behavior
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LAYERED PBS SUPPORTS FOR HOME &
COMMUNITY SUPPORT RECIPIENTS
INDIVIDUALIZED
TARGETED
UNIVERSAL
POSITIVE BEHAVIOR
SUPPORT
WHAT’S IN A NAME?
PBS=Positive
Behavior Support
KIPBS=Kansas
Institute for Positive
Behavior Support
APBS=Association
of Positive Behavior
Support
SWPBS=Schoolwide Positive
Behavior Support
PBIS=Positive
Behavior
Interventions and
Support
EBS=Effective
Behavior Supports
PBES=Positive
Behavior and
Employment
Support
PBSS=Positive
Behavior Sexuality
Support
Pyramid Model=
Early Childhood
Positive Behavior
Support
11
Quality of
Life
Positive
Behavior
Support
Emphasizes
Personcentered
Planning
Evidence
Based
Practices
12
PBS TIMELINE
Science of Behavior
Applied Behavior
Analysis
1960s
Institution
Abuse/Neglect
Punishment
Research
1970s
M. ENYART PBSS TRAINING 10/11/11
Community Access
Human Rights
Normalization
Movement
1980s
Behavior Science
Expanded to Real
World
FBA/QOL
Prevention
1980s
PBS Developed
Intensive Research
Inclusive
Movement
Quality of Life
1990s
Social Science
SWPBS
CMS Program
Foster Care
States/Feds
2000s
Schools
Mental
Health
Elder Care
Family
Homes
I/DD
Settings
Positive
Behavior
Support
Early
Childhood
Supported
Employment
Individuals
Juvenile
Justice
Transition
Schmitz, 2011
14
KANSAS STAKEHOLDERS & SUPPORT SYSTEMS
Frail and
Elderly
Technical
Assistance
Developmental
Disability
Traumatic Brain
Injury
Seriously
Emotionally
Disturbed
Physical
Disability
Autism
15
POSITIVE BEHAVIOR SUPPORT
INTEGRATION OF:
-Valued outcomes
-Behavioral and biomedical science
-Validated procedures -Systems change
WITH THE GOAL OF:
-Enhancing quality of life
-Preventing problem behavior
PBS requires our teams and those supporting individuals to change
their behavior
16
POSITIVE BEHAVIOR SUPPORT
• Three tiered proactive and preventative
approach to discipline
• Enhance Quality of Life
• Decrease Problem behavior
• Builds Positive Relationships
• Encourages Positive Behavior
17
KIPBS TRAINING SYSTEM AND CAPACITY
BUILDING
Community-wide Behavior
Support Systems
School-wide
Behavior Systems
1-5%
Intensive, Individual
Interventions
5-10%
* Children with intense needs
* Assessment-based
• High Intensity
80-90%
• Appropriate for professionals across
agencies and systems
Adapted from Sugai, 2002
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POSITIVE BEHAVIORAL SUPPORT MODEL
Collaborative Team
Functional
Behavior
Assessment
Person Centered
Planning
Teach New
Change the
Environment
Skills
Change the System
Repeat the Process
Offer Crisis
Support
Assess and
Revise the
Plan
Molly Dellinger-Wray, Virginia Commonwealth University
BUILDING ON
KANSAS HISTORY &
STRENGTHS
KANSAS HAS BEEN A LEADER IN QUALITY OF
LIFE AND POSITIVE BEHAVIOR SUPPORT
• Applied Behavior Analysis and
Evidence Based Practices
• School-wide Positive Behavior
Support
• Self-Determination and Family
Driven Supports
• Wrap-around and Person-Centered
Planning
• Community Reform Acts
• System Transformation Quality of
Life, Person-Centered Planning, and
Challenging Behavior Studies
22
CHALLENGES BASED ON STUDY FINDINGS…
Challenging Behavior Study Interview and Focus Group
Total Combined Secondary Code Frequency
Lack of
Training/Skill
J
255
I
System Barriers
17
H
253
Secondary Codes
G
50
F
Fragmentation/Collaboration
17
E
8
D
65
C
Lack of Resources
3
B
20
A
Over-emphasis on Paperwork
1
0
50
100
150
Frequency of Code Occurrence
200
250
300
23
PBS-Kansas: Enhancing Systems to Improve
Quality of Life for All Kansans
PBS-Kansas was established in 2005 as an APBS Network
and continues to be a loosely affiliated group of individuals
interested in networking and supporting the expansion of
positive behavior support (PBS) across the state.
EXAMPLES PBS-KANSAS ACTIVITIES
Action Planning
Statewide
Networking
Standards and
Evaluation
Presentations in
the Community
Website and
Marketing
Studies: Quality of Life,
Challenging Behavior,
Person-Centered Planning
25
EVOLUTION OF PBS
SYSTEMS AND
SERVICES
KANSAS INSTITUTE FOR POSITIVE BEHAVIOR
SUPPORT: INDIVIDUAL PBS PLAN
TRAINING SYSTEM
• Project Initiated in 2001
• Medicaid Director initiated PBS project
• Training program match with KU (federal fiscal participation)
• Statewide match for reimbursement
• Kansas State Plan includes PBS
• Children who are Medicaid eligible (physical health screen)
27
OVER 100 PROFESSIONALS TRAINED
REPRESENTING…
• Intellectual/Developmental Disability Services
• Mental Health
• Children and Family Services
• Education
• Independent Contractors
• District Tertiary Trainers in School-wide Positive Behavior
Support (SWPBS)
• Juvenile Justice
28
29
4,000
(TOTAL DONATED HOURS)
LOCATIONS WHERE KAN-BE HEALTHY ELIGIBLE
CHILDREN HAVE RECEIVED PC-PBS SERVICES
DEMOGRAPHICS
70% Male
30% Female
16% African
American
9% Hispanic
69% Caucasian
5% Asian
DEMOGRAPHICS
9 years old
33% PDD
Spectrum
18% No
Diagnosis
33% I/DD
18% MH
or Other
FOR MORE INFORMATION ON TERTIARY
SUPPORTS
The Kansas Institute for Positive Behavior
Support
www.kipbs.org
•Free Training and Certification Program
for Professionals who work with
individuals with challenging behavior
•Over 100 Individuals have been trained
•10 Online Modules free to all Kansans
•KIPBS Toolbox features tools and
assessments
34
KS I/DD Challenging Behavior Workgroup
Schools
Mental
Health
Aging
Family
Homes
PBS KS Website, Resources, and
Standards
Work
Positive
Behavior
Support
I/DD
Settings
Foster
Care
KIPBS and KMHPBS Statewide
Training System
KS Quality Oversight Workgroup and
Critical Incident Data
KS Innovative Stakeholders with PBS
Awareness and Tertiary Skills
Early
Childhood
Juvenile
Justice
Transition
KS State Leadership PBS Investment and
Community Outreach
SW-PBS and Technical Assistance Support
Networks
Increasing PBS Awareness and
Fidelity of Implementation Across
Kansas
Awareness of
Core PBS
Components
Utilize PBS
Examples to
Increase
Investment
in PBS
Develop
Standards
and Support
Specific PBS
Initiatives
Collaboration
Across
Human
Service
Providers
Website
PBS Kansas
Events
Products
Networking
and
Awareness
Activities
www.pbskansas.org
Fast Facts
• PBS-Kansas Meets 6 Times/Year
• Approximately 20 Members Attend
• 2 Distance Sites
• 2 Co-Facilitators Lead Meetings
• More than 100 PBS Kansas Members
PBS Standards
Workgroup
Formed
2010
Standards
Developed from
APBS Standards
& PBS Research
2011
Standards
Finalized and
Modules
Developed
2012
KANSAS INTENSIVE POSITIVE BEHAVIOR
SUPPORT STANDARDS
 Module I: Foundations of Positive Behavior Support
 Module II: Collaboration & Team Building
 Module III: Basic Principles of Behavior
 Module IV: Data-based Decision Making
 Module V: Comprehensive Person-centered Planning and
Functional Behavioral Assessments
 Module VI: Development and Implementation of Comprehensive,
Multi-Element Behavior Support Plans
FUTURE OF
POLICIES, SYSTEMS,
AND SERVICES
CHECKING THE RADAR…
INITIAL COLLABORATION WITH OTHER
SYSTEMS & OPPORTUNITIES FOR GROWTH
Community
Mental Health
System
PBS Training
Intellectual &
Developmental
Statewide
PlanningDisability
&
System
System
QMS Training
Schools and
other Community
Stakeholder
Systems
43
LONG-TERM GOAL:
COLLABORATION WITH OTHER SYSTEMS
Community
Mental Health
System
Statewide
Planning &
Sustainable
System
Intellectual &
Developmental
Disability
System
Schools and
other
Community
Stakeholder
Systems
44
REVISED KIPBS TRAINING AND CERTIFICATION
PROJECT
October 11, 2012
SYSTEMS
CASE
STUDIES
DIVERSITY
TIME
IMPETUS
FOR
CHANGE
ONLINE
PROPOSED CHANGES
• Migrate Course to Blackboard
• 10 eLearning Modules
• Field Based Activities: Two Classes Per Month (one adobe/one onsite)
• Recorded sessions and asynchronous learning material
• One Mock Case Study (gets completed during module work)
• One Live Case Study (with Mentor Observations)
• New Evaluation Measures
• Celebrations at Mid-Term and Final
KANSAS MENTAL
HEALTH POSITIVE
BEHAVIOR SUPPORT
PROJECT
The Kansas Mental Health Positive Behavior Support Project
University of Kansas
Dole Human Development Building
1000 Sunnyside Dr. Room 1052
Lawrence, Kansas. 66045
For More Information Contact: Matt Enyart at menyart@ku.edu
KANSAS ADVISORY BOARD
Members
Jane Adams
Jeff Butrick
Richard Cagan
Randy Callstrom
Erika Dvorske
Shelly Harris
Brian Hastings
Wes Jones
Marla Lira
Pam McDiffett
Dawn Miller
Holly Myers
Renee Patrick
James Roberson
Amy Trachta
Rosemary Tuggle
Nick Wood
Julie Vogel
Organization
Director, Keys for Networking, Inc.
Kansas Juvenile Justice Authority
Director, NAMI Kansas, Inc.
CBS Director, Wyandot Mental Health Center
President, United Way of Douglas County
Assistant Director, High Plains Educational Cooperative
Principal, Youthville Alternative School/PRTF
Mental Health Center of East Central Kansas
CBS Director, Area Mental Health Center
Consumer Affairs-Children and Families, University of Kansas
MTSS Coordinator, Shawnee Mission School District
Assistant Director, Douglas County Youth Services
Director, Parsons Dual Diagnosis Outreach Center
Assistant Director, KVC-Wheatland PRTF
PRTF PBS Grant Officer, KDADS
CBS Director, Family Service and Guidance Center
Systems Advocacy Change Coordinator, Disability Rights Center
CBS Director, Spring River Mental Health and Wellness, Inc.
NATIONAL ADVISORY BOARD
Members
Susan Barrett
Catherine Bradshaw
Al Duchnowski
Mark Durand
Steve Goodman
Meme Heineman
Julia LePage
Joe Lucyshyn
Gene McConnachie
Beth Morrison
Tim Moore
Lori Newcomer
Robert Putnam
Terri Rodgers
Thea Scott
Claudia Vincent
Organization
Maryland Positive Behavioral Interventions & Support (PBIS)
Johns Hopkins-Bloomberg School of Public Health
University of South Florida
University of South Florida
Michigan Positive Behavioral Interventions & Support (PBIS)
University of South Florida
Missouri Department of Mental Health
University of British Columbia
Washington State Division of Developmental Disabilities
University of Minnesota
University of West Virginia
University of Missouri
May Institute
Missouri Department of Mental Health
Missouri Department of Education
University of Oregon
KEY FEATURES
Collaborative
Funded Initiative
Sustainable
Voluntary
Free Training &
Resources
PROJECT FUNDING
CMS
$2,947,405
Home &
Community
18 Months
Medicaid
AREAS OF FOCUS
• Training and Technical Assistance to
Community Mental Health Centers (CMHCs)
• Training and Technical Assistance to
Psychiatric Residential Treatment Facilities
(PRTFs)
• Support the Transition Process for Children
Receiving Services Through the CBA PRTF
grant to the Serious Emotional Disturbance
(SED) Waiver
MENTAL HEALTH SERVICES IN KANSAS
• 26 Community Mental Health Centers
• 7 Psychiatric Residential Facilities
• Kansas Home and Community Based Supports (HCBS) Serious
Emotional Disturbance (SED) Waiver
• 3,985 children served in FY11
• Currently no waiting list
• Wraparound Facilitation, Independent Living/Skill Building
Services, Parent Support and Training, Short Term Respite
Care, Professional Resource Family Care, and Attendant Care
Awareness Level
Webinars
Workshops
Intermediate Skill
Building
Team-based Action Planning
Targeted trainings for Key
Staff
Regional
Interagency
Meetings
PBS Case Demonstrations
Regional SOC Meetings
Intensive
PBS
Training
CONTINUUM OF TECHNICAL ASSISTANCE FOR CMHCS
•
Level 1: Awareness Level Trainings
• Webinars Introducing Main Concepts Related to Mental Health and Positive
Behavior Support
• Conferences Held Regionally for Centers and the Community
•
Level 2: Intermediate Team and Individual Skill Building
• Team-based Training to Conduct Organizational Self-assessment and Action
Planning
• Skill-building Trainings for Professionals Already Introduced to PBS Concepts
• Online Webinars and Onsite Training for a Small Number of Professionals
• Goal: Create a Positive and Supportive Organizational Context in Each Center
to Support MH Professionals Participating in the KIPBS Training
CONTINUUM OF TECHNICAL ASSISTANCE (CONT.)
•
Level 3: Regional Interagency Team Planning
• Regional Team Action Planning (2-3 meetings)
• KMHPBS Staff and MH professional (Applied Case Study Demonstration)
• Recommendations for the Statewide Team
• Connection to Statewide Cadre Trainer
•
Level 4: KIPBS Intensive Training
• At Least One Professional is Required to Participate in Order to Access Training
• 6 Months
• One Case Study
• Approximately 26-28 Professionals Can Participate Annually
PLEASE VISIT WWW.KMHPBS.ORG
IMPROVING QUALITY OF LIFE
BY INCREASING PBS
CAPACITY IN KANSAS
KS I/DD Challenging Behavior Workgroup
Schools
Mental
Health
Aging
Family
Homes
PBS KS Website, Resources, and
Standards
Work
Positive
Behavior
Support
I/DD
Settings
Foster
Care
KIPBS and KMHPBS Statewide
Training System
KS Quality Oversight Workgroup and
Critical Incident Data
KS Innovative Stakeholders with PBS
Awareness and Tertiary Skills
Early
Childhood
Juvenile
Justice
Transition
KS State Leadership PBS Investment and
Community Outreach
SW-PBS and Technical Assistance Support
Networks
COMMUNITY SUPPORTS
GOVERNMENT
AND POLICIES
RESEARCH
&
ADVOCACY
• MEDICAID SERVICES
• REGULATIONS
• QUALITY OVERSIGHT
ORGANIZATIONS
& COMMUNITIES
• FUNDING
• RESOURCES
• PROFESSIONALS
INDIVIDUALS &
FAMILIES
• IMPLEMENTATION
• QOL IMPACT
• DOABILITY
POSITIVE BEHAVIOR
SUPPORT IMPACT
INDIVIDUALS
KANSAS
KANSAS
COMMUNITIES
SERVICE
ORGANIZATION
INDIVIDUALS
INDIVIDUALS
STATE WIDE
COMMUNITY &
ORGANIZATION WIDE
INDIVIDUALS
QUESTIONS
• www.pbskansas.org
• www.kipbs.org
www.kmhpbs.org
• www.swpbs.org
• www.tasn.org
• http://www.beachcenter.org/
• www.kansasmtss.org
66
CONTACT INFORMATION
Matt J. Enyart
menyart@ku.edu
Kris Matthews
krismat@ku.edu
Cherie Blanchat
cherie@ku.edu
THANK YOU!