Applying PBS to a Statewide Service System: Special Focus on Tier 2 - - PowerPoint PPT Presentation

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Applying PBS to a Statewide Service System: Special Focus on Tier 2 - - PowerPoint PPT Presentation

Oct 21, 2022 303 likes •661 views

Applying PBS to a Statewide Service System: Special Focus on Tier 2 Rhiannon Evans, MS, BCBA, LBA Teresa Rodgers, PhD, BCBA-D, LBA Missouri Department of Mental Health Division of Developmental Disabilities What we know 4 out of 10 people are

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Applying PBS to a Statewide Service System: Special Focus on Tier 2

Rhiannon Evans, MS, BCBA, LBA Teresa Rodgers, PhD, BCBA-D, LBA Missouri Department of Mental Health Division of Developmental Disabilities

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What we know

4 out of 10 people are at risk of or are experiencing behavioral crisis 85% of residential providers need support to predict, prevent, and reduce behavioral crisis We spend a lot of resources reacting to crisis!

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Common Approaches

  • Increased medications
  • Added Staffing
  • Law Enforcement
  • Hospitalizations
  • Provider forced moves
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What we know

Implementation science: we must work toward sustainability Behavioral science: achievable goals are made up of small steps Wide-spread problems: we must address at a systems level

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Missouri Tiered Supports: Our Systems Approach

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What is MO Tiered Supports?

A state sponsored consultation process Focused on helping organizations develop systems to support positive practices for improved services

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Essential Elements

  • Common values
  • Active leadership
  • Action planning
  • Team problem-

solving

  • Professional peer

mentorship

  • Systems of

reinforcement

  • Competency training
  • Frequent feedback
  • Ongoing assessment

& monitoring

  • Evidence-based

decision making

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What do we do?

Define Analyze Coach Evaluate

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How’s it add up?

What We Do What You Do A Good Life

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Tier 1 Universal Strategies

  • Assessment (ASSET)
  • Data analysis
  • Training
  • Action-plan
  • Regular review and onsite coaching
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Tools of Choice

  • PBS competency based course
  • Helps people build relationships
  • Helps families stay together
  • Free to Tiered Agencies & Family members
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What’s the data say?

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36 50 52 45 60 75

10 20 30 40 50 60 70 80

Low Moderate High ASSET SCORE LEVEL OF INVOLVEMENT

Change in implementation of universal strategies based on level of involvement in MO Tiered Supports

Baseline Post Tiered Supports

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$- $50,000 $100,000 $150,000 non tiered low implementers moderate implementers high implementers

Cost of Review Level of Implementation

Cost to Review Severe Behavioral Incidents by Implementation Level FY17-FY19 FY17 FY18 FY19

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Why do we need Tier 2 & 3?

40% of people need support beyond Tier 1 85% of providers need additional support

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Tier 2 Prevention Strategies

  • Data analytics
  • Assessment (T-SSET)
  • Problem-solving
  • Targeted interventions
  • Training
  • Action-plan
  • Review and coaching
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Tier 2 Prevention Strategies

Problem:

  • Large groups of people with 1:1 and 2:1 staffing

Targeted Intervention:

  • Enhanced staffing review process
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Tier 2 Prevention Strategies

Problem:

  • Providers with over 70% of population needing Tier 2 & 3 level support

Targeted Interventions:

  • Provider Support Committee
  • Enhanced Tier 1
  • Frequent check ins with Statewide Tiered Supports Team
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Tier 2 Prevention Strategies

Problem:

  • Behavior Support Plans are missing essential elements

Targeted Intervention:

  • Behavior Analysis Mentorship Program
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Tier 2 Prevention Strategies

Problem:

  • Unplanned reactive strategies commonly used

Targeted Intervention:

  • Safety crisis plan training
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What’s the data say?

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59% 63% 33% 29% 9% 8%

0% 10% 20% 30% 40% 50% 60% 70%

FY20Q1 FY20Q2 % of population

Quarter Population by Tier Across Quarters

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257 268 255 224

200 210 220 230 240 250 260 270 280

FY19Q3 FY19Q4 FY20Q1 FY20Q2

# OF PROVIDERS FISCAL QUARTER

The number of residential providers needing Tier 2 support

Begin Tier 2 Planning & Pilot Implementation

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2 3 4

1 2 3 4

October November December January February

# OF SEVERE INCIDENTS

Severe Incidents at Agency Implementing Targeted Interventions

Internal Coaching Began in December

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Tier 3 Intensive Strategies

  • Data analytics– Identifying high risk individuals
  • Problem-solving system– (BSRC)
  • Action-plan
  • Intensive interventions
  • Review and coaching
  • Training
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Behavior Support Review Committee

  • Committee of volunteer LBAs
  • Meet twice monthly
  • Whole team encouraged to attend
  • Review BSPs
  • Provide consultation
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What do providers say?

90% of people participating in MO Tiered Supports say there has been a

positive shift in their organization

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Next Steps

  • Echo to improve skills of broader audience
  • Value based purchasing
  • Tools of Choice hybrid course
  • Build Tier 2 team
  • Real-time data
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RHI EVANS, MS, BCBA, LBA Statewide Targeted Prevention Coordinator Rhiannon.Evans2@dmh.mo.gov

Q&A

TERESA RODGERS, PHD, BCBA-D, LBA Chief Behavior Analyst Teresa.Rodgers@dmh.mo.gov