Universal Screening/
Teen Screen
PBIS National Forum
October 15, 2010
Presenters


Jennifer Rose, M.Ed., Tertiary Research &
Evaluation Coordinator, Illinois-PBIS
Network: jen.rose@pbisillinois.org
Marian Sheridan, Coordinator of School
Health & Safety Programs, Fond du Lac
School District:
SheridanM@fonddulac.k12.wi.us
Session Objectives




To identify selection criteria for universal
screening tools
To provide a brief overview of two universal
screeners
To share Illinois PBIS Network universal
screening model and results
To discuss overall rationale for universal
screening and the Teen Screen approach
Reflection Questions

What, if any, roadblocks to universal
screening for behavior exist in your
district/school?
Potential Roadblocks





Absence of administrative support
Lack of knowledge regarding the process
Fear of ‘labeling’ students
Apprehension regarding parental/guardian
response
Concerns regarding cost/time to implement
universal screening
The BIG Question

What will you do with your students once they
have been identified as needing additional
supports?
Oh my
God! What
are we
going do
with all of
these kids!
Universal Screening: Tool Selection
Criteria

Some basic criteria for selecting a screening
instrument:

It is technically-valid:

Adequate norms


Reliable


Recent norms reflecting population to be screened
Produces consistent results over time
Valid

Distinguishes between those who do and don’t meet
the criterion measured (i.e., students at-risk of
internalizing behaviors)
Universal Screening: Tool Selection
Criteria

Has social validity:

Instrument/screening process is seen as both
acceptable and important)

For example, if an instrument is perceived as timeconsuming, or the process of universal screening is not
deemed as relevant to stakeholders, then results may not
be valid and there will be a lack of staff buy-in
Universal Screening: Tool Selection
Criteria

A note regarding selection criteria….

A tool may have social validity, however, the
critical aspect of screeners is their capacity to
consistently and accurately identify individuals in
need of support
Universal Screening: SSBD

Systematic Screening for Behavior Disorders
(Walker & Severson, 1992) for grades 1-6




Validated by the Program Effectiveness Panel of the U.S. Department of
Education
Six research studies confirm the SSBD’s ability to systematically screen
and identify students at-risk of developing behavior problems
Universal screening with the SSBD is less costly and time-consuming
than traditional referral system (Walker & Severson, 1994)
Inexpensive


Manual= $125, reproducible screening forms= $15
Quick

Entire screening process can be completed within 45 minutes to
1 hour per classroom
Universal Screening: SSBD
Universal Screening: SSBD
Universal Screening: SSBD
Universal Screening: BASC-2/BESS

BASC-2/Behavioral and Emotional Screening
System (BASC-2/BESS; Kamphaus & Reynolds,
2007)

Developed as a school-wide (Universal) screening tool
for children in grades Pre-K to 12



Similar to annual vision/hearing screenings
Identifies behavioral and emotional strengths and
weaknesses
 Externalizing behaviors (e.g., acting out)
 Internalizing behaviors (e.g., withdrawn)
 Adaptive skills (e.g., social and self-care skills)
Screening process takes about 30-45 minutes per
classroom
Universal Screening: BASC-2/BESS
Universal Screening: IL-PBIS Network
Approach

IL-PBIS Network Approach:










Secure district-level commitment to universal behavioral screening
Build capacity for secondary practices (e.g., CICO, CnC, SAIGs)
Identify and train building level staff person to lead and manage universal
screening process and data
Provide building level overview
Distribute informational letters to parents/guardians
Conduct universal behavioral screening
Secondary teams meet with universal behavior screening coordinator to
review results
Contact parents to obtain permission for intervention
Upon receipt of parent/guardian permission, students are quickly placed
into simple secondary-level intervention (e.g., CICO)
Use data to progress monitor students’ response to intervention
Universal Screening: Implementation

A note on recommended screening frequency:


Academic screening (e.g., Curriculum Based MeasuresCBMs for reading difficulty) typically occurs during fall,
winter and spring benchmarking phases
Screening twice annually (in fall and early winter) is
optimal for behavioral screening


Screen transfer students
Additional progress monitoring of students identified during fall
screening
Positive Behavior Interventions & Supports:
A Response to Intervention (RtI) Model
Tier 1/Universal
School-Wide Assessment
School-Wide Prevention Systems
Tier 2/
Secondary
ODRs,
Attendance,
Tardies, Grades,
DIBELS, etc.
Check-in/
Check-out
Social/Academic
Instructional Groups
Daily Progress
Report (DPR)
(Behavior and
Academic Goals)
Competing Behavior
Pathway, Functional
Assessment Interview,
Scatter Plots, etc.
Individualized CheckIn/Check-Out, Groups &
Mentoring (ex. CnC)
Tier 3/
Tertiary
Brief Functional Behavioral Assessment/
Behavior Intervention Planning (FBA/BIP)
Complex FBA/BIP
SIMEO Tools:
HSC-T, RD-T, EI-T
Wraparound
Illinois PBIS Network, Revised August 2009
Adapted from T. Scott, 2004
Screening process

Teachers nominate
students and complete
screening tools
Multiple Gating Procedure
(Adapted from Severson et al. 2007)
Gate 1
Teachers Rank Order
then Select Top 3 Students
on Each Dimension
(Externalizing & Internalizing)
Pass Gate 1
Gate 2
Teachers Rate Top 3
Students in Each Dimension
(Externalizing & Internalizing)
using either SSBD, or BASC2/BESS
Pass Gate 2
Tier 2
Intervention
Students identified as % of enrollment in grades
screened
Illinois PBIS Network Universal Screening Results:
Externalizers
2007-10
6.0%
5.5%
4.7%
5.0%
4.0%
4.0%
3.0%
2.0%
1.0%
0.0%
SY 2007-08 (N=18)
SY 2008-09 (N=30)
SY 2009-10 (N=42)
Students identified as % of enrollment in grades
screened
Illinois PBIS Network Universal Screening Results:
Internalizers
2007-10
3.8%
3.7%
3.7%
3.5%
3.6%
3.5%
3.4%
3.3%
3.3%
3.2%
3.1%
SY 2007-08 (N=18)
SY 2008-09 (N=30)
SY 2009-10 (N=42)
Students identified as % of enrollment in grades
screened
Universal Screening Results: Totals
10.0%
9.2%
9.0%
8.2%
8.0%
7.3%
7.0%
6.0%
5.0%
4.0%
5.5%
4.7%
4.0%
3.7% 3.5%
3.3%
3.0%
2.0%
1.0%
0.0%
Externalizers Internalizers
SY 2007-08 (N=18)
SY 2008-09 (N=30)
Total
SY 2009-10 (N=42)
Resources

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Glover, T.A., & Albers, C.A. (2007). Considerations for evaluating Instruments
for universal screening assessments. Journal of School Psychology, 45, 117-135.
doi:10.1016/j.jsp.2006.05.005
Kamphaus, R.W., & Reynolds, C.R. (2007). BASC-2 Behavioral and Emotional
Screening System. Minneapolis, MN: Pearson.
Patterson, G., Reid, J., Dishion, T. (1992). Antisocial Boys. Eugene, OR:
Castalia.
Severson, H.H., Walker, H.M., Hope-Doolittle, J., Kratochwill , T.R., & Gresham, F.M.
(2007). Proactive, early screening to detect behaviorally at-risk students: Issues,
approaches, emerging innovations, and professional practices. Journal of School
Psychology, 45, 193-223. doi:10.1016/j.jsp.2006.11.003
Walker, B., Cheney, D., Stage, S., & Blum, C. (2005). Schoolwide screening and positive
behavior supports: Identifying and supporting students at-risk for failure. Journal of
Positive Behavior Supports, 7(4), 194-204. Retrieved from
http://flagship.luc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&
db=aph&AN=18658082&site=ehost-live
Walker, H.M., & Severson, H.H. (1992). Systematic Screening for Behavior Disorders.
Longmont, CO: Sopris West.
Implementation of Universal Screening
Fond du Lac TeenScreen Program
Marian Sheridan
Why Screen for Mental Illness and Suicide
Risk?
• Mental illness is treatable.
•
There is ample time to intervene before symptoms escalate to a full blown disorder and
before a teen turns to suicide.
• Screening tools that effectively and accurately identify at-risk teens are available.
•
Screening more accurately identifies teens with significant mental health problems than
school professionals (63% vs. 37%; Scott et al., AJPH 2009).
• Most mentally ill and suicidal youth aren’t already being helped.
•
At-risk adolescents who do not request help on the screening questionnaire are
significantly more likely to report suicidal ideation in the preceding three months than
those who request help (62% vs. 31%; Husky et al., Child Psychiatry Hum Dev, 2008).
• No one else is asking teens about these issues, but they will give us the answers if we
ask the questions.
•
Screening is safe and does not increase distress, depressive symptoms, or suicidal
ideation (Gould et al., JAMA 2005).
The National Research Council and the Institute of Medicine of the National Academies. (2009).; Anderson 2004; YRBS 2005; U.S. Census 2003
History of TeenScreen
• TeenScreen developed in 1991 as a result of Dr. David Shaffer’s research on
mental illness & suicide in youth
• 90% of youth who died by suicide suffered from a treatable mental illness
•65% experience symptoms for at least a year prior to their deaths
•This shattered the myth that suicide is a random and unpredictable event in
youth
•Found there is time to intervene with at risk youth, connect with treatment,
Potential to save lives
1
Why Implement TeenScreen?
One in five children has a mental or emotional problem that
requires treatment
At least one in 10 may have a serious emotional disturbance
that significantly impairs his or her ability to function emotionally,
socially or academically
Two-thirds of children needing mental health treatment go without
Children with mental health problems are not “just being
children.” Mental health problems can disrupt daily functioning
at school, at home and with peers.
Suicide is the second leading cause of death for adolescents
in Wisconsin.
1
Principles of Quality Screening Programs

Screening must always be voluntary

Approval to conduct screening must be obtained from
appropriate leadership

All screening staff must be qualified and trained

Confidentiality must be protected

Parents of identified youth must be informed of the
screening results and offered assistance with securing an
appointment for further evaluation
Prepare Your School to Implement a
Universal Screening
• Raise awareness and build school/ community
support
• Choose a staffing model and identify your team
• Select your screening population, location,
schedule and questionnaire
• Develop a referral network and community
resource guide
Establishing a Strong Foundation for
Universal Screening
• Administrative Support
• School Board Members
• Key Stakeholders
• Medical Providers
• Mental Health Providers
• Community Agencies and Organizations
•.
Educate and Engage School Personnel
• Teachers, administrators, and school health and mental health
staff can dramatically influence the success of your TeenScreen
program.
• Inform school personnel of your plans to implement
TeenScreen and obtain their support for and commitment to
your efforts.
• Build working relationships with school personnel.
• Present your plans at a faculty meeting and/or department
meetings.
Seek Advice and Help from School Personnel
• Ask school personnel how they think parents will react to
screening and how best to reach parents and teens.
• Ask for assistance with promoting the program to parents and
teens and with distributing and securing the return of parent
consent forms.
• Help and buy-in is especially critical from the teachers whose
classes will be impacted by consent distribution or screening.
Educate and Engage Parents
• Know your community and share key facts specific to your
community with parents to educate them about the need for
screening.
• Present information about TeenScreen at a school PTA/PTO
meetings to raise awareness and build support prior to consent
distribution.
• Have a TeenScreen information table at parent orientations,
registration days or back to school nights.
• Make yourself available to answer questions or address
concerns about screening .
• Present information in a culturally appropriate manner and
anticipate how different cultural groups will respond to
screening.
The Screening Process
Principles of Quality Screening Programs
•
Screening must always be voluntary
•
Approval to conduct screening must be obtained from
appropriate leadership
•
All screening staff must be qualified and trained
•
Confidentiality must be protected
•
Parents of identified youth must be informed of the screening
results and offered assistance with securing an appointment for
further evaluation
Select Your Screening Questionnaire
CHS Overview
•
14-item, 10-minute, self-completion, paper-and-pencil
survey for suicide risk
•
Appropriate for 11-18 year-olds
•
6th grade reading level
•
Trained layperson can administer and score
•
Assesses for symptoms of depression, anxiety, substance
abuse, suicide ideation and past attempts
•
Highlights those who might be at risk and screens out those
who are not
•
Available in English and Spanish
•
33% positive rate
CHS Sample Question
DPS Overview
•
52-item, 10 minute, self-completion mental
health screen
•
Appropriate for 11-18 year-olds
•
Computer-based with spoken questions
•
Trained layperson can administer and score
•
Automatic reporting of screening results
•
English and Spanish versions available
•
20-33% positive rate
The DPS Screens For:
Social Phobia
Generalized Anxiety
Panic attacks
Obsessions and Compulsions
Depression
 Suicide ideation (past month)
 Suicide attempts (past year)
• Alcohol Abuse/ Dependence
• Marijuana Abuse/ Dependence
• Other Substances Abuse/ Dependence
•
•
•
•
•
DPS Sample Question
In the last 3 months…..
Has there been a time when nothing was fun and
you just weren’t interested in anything?
Developing a Mental Health Referral
Network and Community Resource Guide
Key Points:

The Referral Network should include providers for insured and uninsured
teens

Develop relationships with providers in your community who:

Evaluate and treat a variety of conditions

Agree to accept your referrals in a timely manner and do not have
long wait lists

Are culturally appropriate
The Community Guide should include a variety of resources relevant to
parents and their teen

Planning Questions:
1.
Have you contacted mental health providers for your referral network?
2.
Have you identified community resources to enhance your services and provide
additional linkages and resources to at-risk teens?
Fond du Lac County Data 2002-2008
Over 4,989 students in FDL County have been screened
961 of these students have been identified for being at
potential risk of suicide, suffering from mental health
problems and received a referral for further evaluation and
appropriate treatment.
Teen Support for Screening
- What Teens Say About TeenScreen “I feel like someone is paying attention and listening to
me.”
“I thought it was very helpful, and I finally feel relieved
because I’m getting my problems out.”
“The interview on the computer was a great way to know
how we feel about stuff in our lives. I think it’s a great
idea.”
“I thought it was insightful because some of these things
are not talked about enough.”
“I think this is a good way to find out what’s going on
with teens these days. Most teens are afraid to talk about
their problems because they don’t want other teens to
think they are different.”