Elementary Level T3 Support System

 

Elementary T3 Overview

 

The Elementary Level T3 (or Tier 3) Support System a model of support for students with chronic or episodic mental and behavioral health needs that interfere with daily school functioning and access to the general curricula. The goal of this model is to provide target students with multidisciplinary emotional, behavioral, social, and academic support in the context of specialized instruction and in-class help.

 

Students will receive a combination of individual therapeutic interventions; specific in-class support for academic functioning; and specialized group instruction regarding social skills, emotional regulation, self-reflection, and coping skills for school-based stressors. Students will also receive necessary behavioral assessment and intervention planning.

 

The goal of this model is to foster skills development in the areas of emotion regulation, academic resiliency, and socialization. By doing so, the intention is to decrease “out of class time” due to symptom interference, and increase each student’s ability to receive academic instruction. Supports are provided in a clinically-informed, trauma-sensitive environment with evidence-based methodologies. 

 

Components of the Elementary T3 Support System

Component

Description

Direct Emotional/Behavioral Support

 

As each student enters T3, an assessment and outline of strengths and skills deficits will be done to inform the student’s goals [Appendix C]. 

 

Behavioral Supports:

 

  • Assessment/Planning: T3 staff will facilitate behavioral data collection and the design of Behavioral Intervention Plans (BIPs) for students with maladaptive externalizing symptoms. 

 

  • General Setting Support: T3 staff will coach general building staff on how to appropriately support a given student’s needs, how to respond to behavioral escalations, and how to implement BIPs.

 

Emotional Supports:

 

  • Planned/Scheduled Therapeutic Support: These times will be used to provide individual and group therapeutic interventions as well as individual goal setting and progress monitoring.

 

  • Unscheduled Support Time: These times include non-crisis emotional escalation that is contributing to reduced functionality and interventions for social/relational disruptions as they arise.

 

  • Crisis Intervention: T3 staff will provide crisis interventions for emotional escalations, both regarding internalizing symptoms and externalizing symptoms. In the case of the latter, when crises occur outside the T3 space, the goal will be for the student to use the T3 space to de-escalate, with the intention of preserving dignity and increasing their sense of safety and comfort, and then transition back into the general setting. 

 

Physiological Support:

 

  • Environmental Considerations: The design of the T3 space will specifically regard sensory processing needs, have sensory-based de-escalation opportunities available, and have ‘carve-out’ personal areas accessible to student who need a defined, available personal space to feel safe.

 

  • Individual Monitoring: Students with applicable needs may have access to technology that facilitated physiological measurement and cueing (i.e. biofeedback technology). 

 

 

Curriculum Modules

 

T3 students will be supported via several layers of instruction featuring evidence-based interventions [Appendix A].

 

Base Instruction: This level of instruction is for all T3 students and tied directly to entrance criteria, which all students will have in common. For example, instruction will feature curricula related to social and emotional awareness, regulation, and resiliency. 

 

Specific Modules: This secondary level of instruction relates to a student’s specific need areas and features briefer, targeted therapeutic interventions (i.e. anxiety management, coping with trauma, social skills training, etc.). 

 

Academic Coordination

 

Academic coordination includes a customized combination of academic support and communication with a student’s teachers to modify assignments and/or secure direct teacher support as needed.

 

T3 staff will work with general staff to best support each student in their classrooms, receiving instruction alongside their peers. During periods in which T3 students require extended time in the T3 space, staff will work with teachers to create an academic plan relevant to the student’s needs. 

 

Data Collection

 

 

Tracking student progress will include several methods of direct and indirect behavioral and emotional assessment, and both quantitative and qualitative methods:

 

Quantitative Methods Examples:

 

  • Tracking of absences/tardies/dismissals

 

  • Academic performance

 

  • Unscheduled out of class time, including use of the T3 space and other spaces for mental and behavioral health needs (i.e. nursing visit for somatic complaints, staff assisted unscheduled breaks)

 

  • Pre/Mid/Post assessments of student functioning, such as validated parent, teacher, and self-report scales for screening and progress monitoring [Appendix B]

 

Qualitative Methods Examples:

 

  • Student interview and self-report, such as feelings logs, coping skills logs, self-assessment of strengths and need areas

 

  • Observational data of the nature and frequency of behavioral prevalence 

 

  • T3 Staff completed progress monitoring rubrics 

 

Family Engagement

 

Goal Setting: As a student enters T3, staff will meet with the student’s parents to outline goals and describe how the student will be supported.

 

  • T3 staff may work with families to obtain relevant biopsychosocial history, determine cultural considerations, and shape the needs assessment process. 

 

  • T3 staff will join with parents to outline the trajectory of interventions, explain proposed methods of interventions, and review curricula.

 

Communication Planning: When a student enters T3, staff will design a communication plan with the student’s parent(s)/guardian(s):

 

  • Identifying the preferred mode of communication (i.e. call, email)

 

  • Identifying the type and frequency of routine communications (the default will be a weekly email initiated by T3 staff with information and progress and other updates, sent to the student’s parent). 

 

  • Identifying a method of urgent communication.

 

Care Coordination

 

Care coordination includes the identification of and collaboration with school staff (i.e. teachers, specialists, admin), as well as outside providers:

 

The care coordination process will include:

 

  • Identification of team members at the school who need to be informed of the student’s needs.

 

  • Identification of supports outside of school:
    1. therapeutic/healthcare related supports
    2. familial resources/relationships
    3. Social/peer relationships

 

  • Identification of gaps (i.e. supports outside of school that are needed but not in place)

 

  • Identification of action steps for care coordination and who will follow through with those steps

 

 

Student Profiles, Entry Criteria, and Procedures

Student Profile: 

The T3 level of support is designed for students who routinely exhibit emotional/behavioral/social challenges in the school environment that contribute to a history of interference accessing instruction. T3 support is also meant to address students who are returning to school after a period of time participating in an outside mental health intervention (i.e. psychiatric hospitalization). There may be variance in regards to symptom etiology, such primary psychosocial stressors (i.e. trauma history) or neurodevelopmental needs (i.e. executive dysfunction, high functioning autism without intellectual impairment), and there may be variance in how symptoms are expressed, such as behavioral meltdowns, eloping, or school avoidance. However, students should exhibit 1) struggles with emotional registration and regulation and 2) low academic resiliency for tolerating the school setting and/or tolerating task demands in the school setting. 

Entry Criteria:

The determination of entry into the T3 Support System is made by each elementary school’s Mental Health Intervention Team (MHIT), which is comprised of the building’s mental and behavioral health staff alongside building/district administration. 

Specific criteria:

  • The student has a presentation of routinely problematic symptoms, demonstrated by chronic dysfunction and interference regarding receiving instruction.

 

  • There is evidence of prior increasingly intensive interventions that have not been effective. For example, the student should have gone through the building’s IST/CST process, yielding interventions attempted for a period of time. 

 

  • The student’s issues appear due to regulatory dysfunction and low resiliency for stressors related to the academic environment and/or task demands.

 

Alternate criteria:

  • The student has returned to school after a period of absence due to receipt of outside mental and behavioral health interventions (i.e. psychiatric hospitalization).

 

Procedures:

The following procedures reflect the process of referring a student, organizing a student’s supports, and tracking student progress.

Referral: Building staff may refer a student for T3 support by completing the brief referral form and submitting it to the Mental Health Intervention Team (MHIT). T3 should not be discussed as an option with parents or students by anyone other than T3 staff, and after a student is referred, reviewed, and deemed appropriate. The MHIT will meet at several set times each month, and meetings will include a review of referrals, determinations of appropriateness of fit, and recommendations for students not deemed an appropriate fit. 

Entry Meeting: The following section outlines the format of the entry meeting once a student enters T3. The entry meeting should include T3 staff, additional APS staff as appropriate, and the student’s parent(s)/guardians(s). 

  1. Introductions and T3 description, including methods of support, curricula, etc.

 

  1. Identifying available information:
    1. Detailing of the student’s history and current symptom presentation
    2. Documenting school-based supports (i.e. T3 staff/disciplines/roles)
    3. Documenting non-school supports (i.e. outside providers, community supports, family/peer supports)

 

  1. Completing/Reviewing the student’s needs assessment focusing on functional areas that require skills development.

 

  1. Draft a support plan with goals related to needs areas and the manner in which specified needs will be addressed, either by T3 related supports of adjacent supports (i.e. a student’s pragmatic language deficits may be addressed through an IEP service versus within T3).

 

  1. Share expectations:

 

  1. Expectations the student and parent(s)/guardian(s) can have of T3:
    1. T3 staff will work with the student with respect, and will communicate positive hopes for student outcomes.
    2. T3 staff will provide emotional and behavioral supports, academic coordination, family communication, and engagement with professionals outside the school (with consent).

 

  1. Expectations of the student:
    1. The student will work towards the goals and access T3 when planned and as needed
    2. The student will come to school every day, barring typical reasons not to, in order to access supports for school success
    3. The student will communicate questions and concerns at school so they can be addressed effectively.

 

  1. Expectations of the parent(s)/guardian(s):
    1. The parent(s)/guardian(s) will work to make sure the student comes to school daily on time 
    2. If the student needs to be late or absent, the parent(s)/guardian(s) will communicate directly with T3 staff to share challenges
    3. Parent(s)/guardian(s) will be willing to reciprocally communicate with T3 staff, such as receiving/providing updates about the student.
    4. The parent(s)/guardian(s) will consent to allow T3 staff and outside providers to communicate, in conversation and in writing, to coordinate care to benefit the student (i.e. outpatient therapist, pediatrician, psychopharmacologist, representative from a care facility).

Exiting T3: T3 staff/building staff will arrange an exit meeting, and include parent(s)/guardian(s) when a student meets the following criteria:

  • Documented and observed improvements in self-regulation, moods, and emotional functioning.
  • Increased comfort level in larger settings, such as the classroom, as evidenced by student report, teacher report, behavioral data, and time receiving instruction.
  • No recent hospitalization or other significant regression (i.e. serious behavioral incident, statements of self-harm/aggression, eloping with concurrent safety concerns)
  • Maintenance of safe and expected behavior in the general classroom setting with the implementation of needed accommodations.

Students who have exited the formal use of T3 level supports may still maintain a less intense support plan that permits them access to predetermined therapeutic resources associated with T3. For example, a student may have a plan to check in with T3 staff to start the day, meet with T3 staff at a set time each week, etc., if it would facilitate maintenance of the progress made when in T3.

 

T3 Staffing and Responsibilities

 

The T3 team is comprised of a school psychologist, special education teacher, and social work staff all of whom provide direct service and interventions for students. The team is additionally supported by a Board Certified Behavior Analyst (BCBA), a Registered Behavior Technician (RBT), and nursing staff. 

 

T3 support is also provided by building administration (Principal, Assistant Principal), district administration (APS Clinical Director, Social Work Coordinator), and other Student Support staff (i.e. ETF). 

 

Staff

Primary Function

Secondary Function

Psychologist

 

  • Behavior assessment/planning
  • T3 Data Oversight
  • Design of curriculum/module based instruction
  • Crisis assessment

 

  • Delivery of base curricula
  • Delivery of targeted intervention modules
  • Organize family updates, coordination

SPED Teacher

 

  • Targeted in-class support
  • Work tracking
  • Teacher support/coaching
  • Academic modification

 

  • Preview/review academic content 
  • Oversee setting-based accommodations 

Social Worker

 

  • Individual therapeutic support
  • Group-based therapeutic support
  • Crisis assessment
  • Delivery of targeted modules
  • Community outreach and care coordination

BCBA

 

  • Behavioral assessment and planning
  • FBA/FA oversight
  • Supervision of RBTs
  • Oversight of behavioral data collection
  • Teacher consultation and environmental observation
  • Advise whole-class reinforcement systems

RBT

 

  • BIP implementation
  • Behavioral data collection
  • Support for transitions

 

  • Implement in-class system of supportive prompting with prompt fading

Nurse

 

  • Interventions for physiological symptoms
  • Crisis triage for internalizing symptoms
  • Alternative de-escalation space (internalizing symptoms)

 

 

  

 

APENDIX A

 

Example Curricula / Therapeutic Modules

 

 

Base Curricula

Description

 

Second Step

 

 

General SEL curriculum with a full year’s scope and sequence .

Zones of Regulation

 

The Zones of Regulation is a framework and easy-to-use curriculum for teaching students strategies for emotional and sensory self-management. Rooted in cognitive behavioral therapy, The Zones approach uses four colors to help students identify how they are feeling in the moment given their emotions and level of alertness as well as guide them to strategies to support regulation. By understanding how to notice their body’s signals, detect triggers, read social context and consider how their behavior impact those around them, students learn improved emotional control, sensory regulation, self-awareness, and problem-solving abilities.

 

Check In / Check Out (CICO)

 

Check-In/Check-Out (CICO) can give students a boost and allow them to meet behavioral goals using a PBIS format. Check-In/Check-Out intervention forms can be customized to reflect behaviors that need additional focus. Teachers provide feedback to the student on these behaviors throughout the day.

Reasons to use CICO in your PBIS implementation:

  • Provides structure in a student’s day
  • Creates accountability
  • Provides teacher feedback to student and parents
  • Creates internal motivation
  • Improves student behavior
  • Increases academic success
  • Creates a stronger home-school connection

 

APS Student Skills

 

Lucie’s skills-developed based behavioral support model.

 

 

Therapeutic Modules

Description

 

Bounce Back/CBITS

 

 

Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is a school-based group intervention (for grades 5-12) that has been shown to reduce PTSD and depression symptoms and psychosocial dysfunction in children who have experienced trauma.  Bounce Back is an adaptation of the CBITS model for elementary school students (grades K-5).

 

Coping Cat CBT

 

The Coping Cat program is a CBT manual-based and comprehensive treatment program for children from 7 to 13 years old with separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, and/or related anxiety disorders.

 

The goals of the treatment are three-fold:[4]

  • the child learns to recognize, experience, and cope with anxiety
  • the child learns to manage their level of anxiety
  • the child learns to master developmentally appropriate, challenging, and difficult tasks

 

MATCH-ADTC

 

MATCH-ADTC (Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems) is an evidence-based treatment designed for children ages 6 - 15. Unlike most treatment approaches that focus on single disorders, MATCH is designed to treat four common behavioral health concerns among children, including anxiety, depression, posttraumatic stress, and behavior problems. 

 

MATCH is comprised of 33 modules (e.g., praise, rewards, etc.) representing treatment components that are frequently included in cognitive behavioral therapy (CBT) protocols for depression, anxiety including post-traumatic stress, and behavioral parent training for disruptive behavior. Based on the child's primary concern, treatment is sequentially organized and flexible in order to tailor treatment to each child's specific characteristics and needs. 

 

 

 

 

APPENDIX B

 

Potential Screening / Progress Monitoring Systems

 

Tool

Notes

SSIS SEL (Student Skills Intervention System, Social-Emotional Learning Edition)

  • teacher, parent, self-report rating scales with computer scoring
  • has ready-made, full class curricula outlines
  • has ready-made screening/progress monitoring scales (individual student to full class, by skills area)

DESSA System (Devereux Student Strengths Assessment)

  • teacher report
  • software-based administration and data analysis
  • mini screening form with 4 variants for brief progress monitoring
  • full survey form for pre-post

BIMAS-2 (Behavioral Intervention and Monitoring System, 2nd Ed.)

  • paper or software-based administration and logging
  • emphasis on behavioral data
  •  

 


APPENDIX C: Student Needs Area Assessment Template

 


Appendix C Template