Achieving the Least Restrictive School Environment for All Students

What if we improve the behavior of our most vulnerable students such that all children are educated in the least restrictive environment?

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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

Colin was 13 and on the autism spectrum. He went to an inpatient psychiatric facility following long-term aggressive behavior and harmful self-injury. Most facilities don’t have the proper training to handle problem behavior, so kids like Colin are sent away to residential facilities. However, they can be helped with the right resources and clinical treatments, but those are limited. The Intensive Behavior Treatment Services program at CCCD was founded to fill this treatment gap in our region.

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)

Website

http://www.cccdinc.org/services/ibts/ibts_index.html

Location: Where is your organization headquartered? [State]

  • Connecticut

Location: Where is your organization headquartered? [City]

Milford

Location: Where is your project primarily creating impact? [State]

  • Connecticut

Location: Where is your project primarily creating impact? [City]

Milford, CT, New Haven, CT, West Haven CT, Bridgeport, CT, Fairfield, CT, Darien, CT, Weston, CT, Pound Ridge, NY

Problem: What problem is this project trying to address?

Children with ASD often exhibit problem behavior, including self-injury (that can result in tissue damage, loss of vision, and brain injuries) and/or physical aggression. This can lead to placement in a residential facility, which may be problematic due to the high cost, restrictive environment, and emotional impact of removing a child from the home. IBTS can treat these behaviors at a lower cost and keep kids at home and in their communities.

Due to privacy issues and the sensitivity associated with the nature of the services provided, we are unable to include any photographs or videos depicting service delivery.

Like any problem of social significance, a solution requires at least a two-pronged approach: (1) confront/treat the existing problem itself (i.e., improve the behavior of the student) and (2) educate relevant stakeholders in order to effectively manage the current problem and/or prevent the problem from maintaining or recurring. The Intensive Behavior Treatment Services program at CCCD recognizes the importance (and inter-dependence) of both prongs, and therefore is set up to address both. A significant body of research in the fields of applied behavior analysis as well as behavioral psychology have demonstrated that the majority of problem behaviors displayed by persons with ASD and other intellectual and developmental disabilities are sensitive to variables and conditions of the environment. And to a lesser degree these behaviors are sensitive to only internal (nonsocial and non-environmental) variables. This holds true for self-injurious behaviors as well. With this understanding, clinicians with expertise in this area have the skills and technology to assess these behaviors and determine which social and environmental variables are evoking and maintaining these behaviors. The assessment process, often referred to as functional behavior assessment, is a tiered set of procedures that incorporates interviews, direct observation as well as experimental analysis of the targeted behaviors. When done correctly, this process yields concrete information about why a given behavior is occurring. This information is then used to develop an individualized treatment plan. Behavioral treatments focus on teaching alternative appropriate behaviors that produce the same desired outcome as the problem behavior, while discontinuing the desired consequence following the problem behavior. For example, if it is learned through assessment that a child engages in self-injurious behaviors in order to get attention from caregivers, this child can be taught to appropriately request attention using a communication response that is easy for them to emit (e.g., vocal, sign, picture exchange, or using a voice-output device). The leadership and staff at the IBTS program have the expertise and resources to perform these assessments, and to develop and evaluate these treatments. The potential benefits to the child (and family) are numerous and extend beyond simply decreasing problem behavior and increasing appropriate/adaptive behavior. For example, children who are no longer displaying these behaviors can more easily go into the community and participate in community activities. This affords them the opportunity to socialize with peers and be exposed the opportunities associated with social interactions.  This may also increase the likelihood that these children can be more active participants in their own education. With less time “managing” problem behavior, teachers can use this time to teach.

Is your model focused on any of the following traditionally underserved communities?

  • Children who are differently abled
  • Low-income communities

Does your model work within any of the following sectors?

  • Child and Family Services
  • Education
  • Mental Health

Year Founded

2016

Project Stage

  • Growth (the pilot has already launched and is starting to expand)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

An 8-year-old boy with Autism and an intellectual disability was referred for treatment of aggression directed at caregivers and tantrum behavior in the home, community and school. His mother reported that aggression and tantrums occurred during transitions, believing that he couldn’t control it. An analysis of his behavior demonstrated that these behaviors functioned to gain/regain access to preferred or ongoing activities. Treatment focused on teaching him to appropriately request access to preferred items and teaching him when his requests would and would not be honored. His family was taught to apply the intervention and his mother was taught how to train school staff. At discharge no incidents of aggression or tantrums were reported.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

Because this program is new, no measurable impact is evident to date. However, the director of IBTS has an established career of developing clinical programs serving individuals with developmental disabilities who display problem behavior. He has served as director of less-intensive models of service providing similar services. In 2015, this director provided direct service to 16 patients and families yielding outcomes similar to the example above. A significant impact is anticipated. Measurement of the impact may be based on individual behavior improvement, the number of families served, and/or the social and financial implications treatments have permitting keeping students in the least restrictive environments. These measures are not mutually exclusive and we anticipate an impact in all. Further, a meaningful change in one family’s life is also represents a sufficient impact.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • $250k - $500k

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Our services can be paid out-of-pocket or through contracts between IBTS and individual school districts that are invested in ensuring appropriate educational placements for their students. We are also working with 3rd party payers to develop contracts that will allow families to use their private insurance to obtain our services. We are negotiating billing/reimbursement rates with these companies to become an in-network provider.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

The procedures and expertise offered by IBTS are not unique in-and-of themselves. What is unique is the intensity and setting where our services are being offered. Patients at IBTS receive up to 20 hours of treatment services per week in an outpatient community-based clinic. This level of service is currently only offered in inpatient hospitals (e.g., the Neurobehavioral Unit at the Kennedy Krieger Institute in Baltimore, MD) and/or residential services (e.g., the New England Center for Children in Southborough, MA). Prior to the starting IBTS Connecticut families had few out-of-state options.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

A major shift over the last decade is the education and understanding of individual differences of students. Students with disabilities are not hidden from their peers. These peers are taught about individual differences and tolerance. We now see students with and without disabilities educated in the same classroom. We see both groups participating in social and leisure activities together. Today we see students organizing clubs designed to help their developmentally disabled peers (e.g., Best Buddies ©). I think that teaching, sharing and equal participation sets the stage for further change.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email

Evaluation results

3 evaluations so far

1. Relevance: Does this project seem to help children (ages 0 to 12 years) develop a strong sense of self, belonging, and purpose?

5 - Yes, this is great! The project lays out a strong, compelling case for how its model nurtures children’s wellbeing. - 33.3%

4 - It seems like a good fit, and the model talks explicitly about children’s wellbeing. - 66.7%

3 - I think so. The project seems related to children’s wellbeing, but the logic is vague. - 0%

2 - Not sure. The project doesn’t have much to do with wellbeing, or it doesn’t give enough information. - 0%

1 - Nope, this project definitely doesn’t fit the challenge brief (e.g., It doesn’t help kids younger than 12, isn’t in the U.S., etc.) - 0%

2. Innovation: Does this project tackle children’s wellbeing from a new angle?

5 - I loved this! The project describes a novel model that addresses important cultural or systemic barriers. - 0%

4 - This is pretty cool. The project is addressing an important problem in a new or compelling way. - 66.7%

3 - I feel like there’s something there, but I want more details about what makes it distinctive. - 0%

2 - It’s a good project, but I’ve seen others like it before. - 33.3%

1 - It was confusing or hard to tell what it made it different. - 0%

3. Social Impact: What is this project’s potential for creating positive social impact?

5 - Lots of potential. This project is achieving impressive results, and it’s growing quickly. It could absolutely inspire changes in the ways we approach caring for kids nationally, across sectors (e.g. childcare, healthcare, education). - 0%

4 - Pretty good potential. This project demonstrates significant positive impact so far, and it could scale regionally or nationally one day and fundamentally change how a system operates (e.g. childcare, healthcare, education). - 0%

3 - Budding potential. This project is creating local impact, but it would take a few adjustments before it could scale. - 66.7%

2 - Some potential. This project demonstrates some initial positive impact, but it would require major changes before it could scale. - 0%

1 - Limited potential. This project has great intentions, but it looks like it does not include key drivers of a shift towards children’s wellbeing. - 33.3%

4. Overall, how do you feel about this idea?

5 - This idea rocked my world. It’s awesome! - 0%

4 - This idea seems really exciting. With a little more polishing, it’d be among my favorites. - 0%

3 - I think the idea is great, but it needs some work before it moves onto the next round. - 50%

2 - I liked it fine but preferred others. - 50%

1 - It didn’t make my heart beat faster. Needs significant revisions. - 0%

5. Offer some feedback. Where should this participant spend some time revising?

DEFINING THE PROBLEM. Make sure to articulate the root causes or main barriers of the social issue your project addresses. (Founding Story, Problem, Solution). - 0%

CLARITY OF MODEL. Make sure to mention (a.) the beneficiary, b) the main activities, and c) how those activities drive social impact. Keep it streamlined! - 0%

MARKETPLACE. Make sure to research other players in this space and articulate how this project is different. I didn’t get a complete sense of how this project compares to others. - 100%

IMPACT POTENTIAL. Make sure to use specific numbers to describe what your project has achieved so far! And consider how you might scale the model or its insights, through partnerships, trainings, or franchising. - 100%

WRITING STYLE. Try to stay concise and make it vivid. Avoid jargon. - 0%

Nothing stands out! I thought it was great. - 0%

2 comments

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Photo of Christy Beighe-Byrne
Team

ITBS offers an unique approach to keeping children in general education settings as opposed to placing children with special needs, specifically Aspergers/Autism, in private residential institutions. I liked the idea that the agency is seeking to offer training to the parents and support people. I would suggest that this agency do some research on expanding the training to actual educators versus just expecting the parent to teach the teacher. School funding might support sending special education and support staff to training.

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