APSY 513 Assignment 4 Systems Level Situational Analysis Name: John Laing Topic of Inquiry: Improving Outcomes for

Children by Closing the Gaps in Systems of Care Date: June 26, 2009 1. Description of Inquiry Situation Students with emotional/behavioural problems (conduct problems) are often seen as the most challenging students for teachers to manage (Jordan, 2007). Students displaying such behaviours struggle in and out of the classroom. Although classroom interventions may prove useful, support from outside the classroom must be considered as well. For students with such deficits to be successful in the classroom, interventions must be across settings and involve multiple support systems. Children with conduct problems seem to experience improved outcomes when several support systems are in place. It is important that each system work together to provide congruent interventions across settings for the child and their family. 2. Clarification of Inquiry and Guiding Questions As a Family Support Counsellor for a community agency I often see gaps in service delivery. Many times the families I work with feel confused about how many services/professionals are involved and feel torn about which ones may be effective and which ones may not be. Families are often overwhelmed by going to copious meetings and appointments, held independently, at specific agencies i.e., school, hospital, social services etc. Most children and their families involved with the Child Welfare System struggle in other areas of their lives as well. To improve outcomes for children with severe emotional and behavioural disorders many areas of their lives need support. In my experience there has been very little opportunity for all the stakeholders to collaborate in order to develop one congruent plan that satisfies all areas of need in the childs life. This seems due to each system having their own set of policies and procedures independent from one another. By working independently from one another agencies create artificial silos in which families must operate. Navigation through each silo can be stressful and confusing for families and may not produce the best outcomes for children with severe conduct problems. Collaboration within an agency is important for providing appropriate interventions for children, however, interagency collaboration may be important for providing appropriate support in other areas of the childs life. Providing support in other areas of the familys life decreases risk factors associated with childhood conduct problems, thus increasing their chance for success in school. Using the Situational Analysis Framework I will review the literature pertaining to collaboration between all stakeholders including: parents, school personnel, the student, and community agencies. In doing so, I hope to answer the following two questions. Does interagency collaboration improve outcomes for students with severe emotional and

behavioural deficits? And, what framework could be useful for ensuring collaboration between all stakeholders involved in the childs life? 3. Background and Plan for Inquiry Many students with conduct problems enter the school system ill prepared for school. Children that are socially maladjusted struggle with social relationships and academic achievement. Preschool children who exhibit conduct problems are at-risk for peer and teacher rejection, being removed from inclusive classrooms, health concerns, drug and alcohol abuse, school failure and dropout and dependency on social services (Mclaren & Nelson, 2009). Children who are exposed to poverty-related risk issues prior to entering the school system are more likely to exhibit conduct problems. Intervention programs targeted at children from low SES homes aim to improve a childs school readiness. School readiness involves emotional selfregulation, social competence and family/school involvement (Webster-Stratton, Reid & Stoolmiller, 2008). Webster-Stratton et al. (2008) evaluated the effectiveness of the Incredible Years Teacher and Child Training Programs in high risk schools. These programs were part of a universal prevention program for children in Head Start Programs. The program provided a social and emotional school curriculum, trained teachers in effective classroom management skills and promoted parent-school involvement. Along with improving school readiness, such programs aim to prevent conduct problems. The absence of conduct problems plays a vital role in social adjustment and academic success (Webster-Stratton et al., 2008). According to Webster-Stratton et al. (2008), these programs appeared effective in improving the childs school readiness, preventing conduct problems and lead to future academic success. Information regarding the need for collaboration among all stakeholders was obtained by a literature review and by speaking with parents and professionals involved in the Child Welfare System and Special Education. Specifically, a literature review was done to gather information about the effectiveness and need for collaboration between agencies and families to improve outcomes for children with emotional and behavioural exceptionalities. Furthermore, conversations were had with teachers, social workers, therapists, counsellors and parents about the need for sustained support in other areas of a childs life. Frequently, those interviewed expressed concern about the discontinuity between services and stated the need for one comprehensive intervention plan developed by all parties involved in the childs life. A literature review was deemed appropriate as an information gathering method to ensure perceived benefits of interagency collaboration was supported in the research. Interviews were conducted to gather information from several different sources with differing perspectives about the childs and familys needs.
4. Dimensions of the Situation

For the purpose of this inquiry the following dimensions will be examined: The importance of congruent interventions across settings; Involving teachers in the treatment process appears to have greater effects on treatment outcomes because it targets more than one risk domain and improves generalization of treatments across settings (Mackenzie, 2007). Treating only one risk domain (parenting interaction) decreases generalization of treatment outcomes across settings. Along with

negative parenting interactions, negative academic and social school experiences contribute to conduct problems (Webster-Stratton, Reid & Hammond, 2004). Working collaboratively, parents and teachers can support childrens learning at home and develop congruent homeschool behaviour plans that can have positive effects on childrens academic, social and emotional development (Webster-Stratton et al., 2008). Sometimes families require support in their home to develop appropriate coping strategies and interventions to manage a child with conduct problems. Support is often provided through community agencies such as childrens services or the hospital. Therefore, congruent service planning and collaboration is important. The Silo effect; The silo effect is caused by the development of separate child welfare, juvenile justice, education, housing, mental health, public health, addictions and other service models (VanDenBerg, 2006). Children at-risk for conduct problems are more likely to come from families experiencing difficulties in more than one of these areas. These systems often do not interact with one another and can create multiple and competing service plans for the families they serve (VanDenBerg, 2006). Having incongruent service plans can cause families to be overwhelmed with professionals demands. All parties involved in the interview process agreed that too many professionals involved creates confusion and often produces feelings of hopelessness for the families. A collaborative model of care; Parents, teachers and other professionals recognized the need for collaboration, however, very few examples of interagency collaboration were ever cited. All parties seemed to agree on the necessity, but no formal framework existed to ensure collaboration. The wraparound process is a way to improve the lives of children and families who have complex needs. Services and supports are community-based and family-centered. Planning, services, and supports cut across traditional agency boundaries through multi-agency involvement and funding (VanDenBerg & Grealish, 1998). The wraparound process seeks to support families by meeting the many needs of the families, therefore, reducing risk factors leading to conduct problems in children. 5. Analysis of the Situation School settings are the key to early intervention strategies for children with conduct problems. Schools can target students at-risk based on neighbourhood or school risk factors (Brotman, Kingston, Bat-Chava, Caldwell & Calzada, 2008). Recent research has focused on making programs more appealing, relevant, and accessible to families who are less likely to have access to quality services and are less likely to use traditional programs (Mackenzie, 2007). Because schools provide universal access to children and families, families may feel less stigmatized by early intervention facilitated by the school. Instructing teachers on effective strategies to use in family intervention is paramount in school-based prevention interventions. According to Slough and McMahon (2008), interventions targeting a single risk dimension have not proven effective for youth with conduct problems. Identifying conduct problems early, targeting multiple risk domains and using a long-term perspective gives children with conduct problems the best chance for social and academic success (Slough & McMahon,

2008). However, providing support in other areas of the childs life is unrealistic for schools to provide on their own. Communities offer alternative therapies and supportive environments that can increase protective factors for children at-risk for conduct problems (Dettmer, Thurston, Knackendoffel & Dyck, 2009). The premise of the wraparound process is that meeting the needs of the child and their family will result in an improved life (VanDenBerg, 2006). The integration process of wraparound is used by communities to support children with complex needs and their families by developing individualised plans of care. The wraparound system is guided by a family centered team and is individualized based on the childs/familys needs and is not service driven (VanDenBerg, 2006). Furthermore, the family are vital members of the team and have ownership of the plan. Planning sessions do not occur without the familys involvement. The individualized plan for intervention is developed by a wraparound team consisting of all stakeholders involved in the childs life i.e., teachers, counsellors, family, friends, the child etc (VanDenBerg, 2006). Children who display conduct problems at an early age are more likely to have continued conduct problems later in life (McMahon et al., 2006). Patterson, Capaldi and Bank refer to children with early onset conduct problems as early-starters (as cited in McMahon, Wells & Kotler, p. 147). Early-starters tend to display conduct problems during the preschool years and their problems get progressively worse as they reach grade school. Because early starters have a poor prognosis it is important for early intervention. Without early intervention behavioural problems may become crystallized by age 8, leading to social and academic deficits; therefore, Intervention prior to age 8 seems to have the best result for social and academic achievement (Webster-Stratton et al., 2004). Gill, Hyde, Shaw, Dishion and Wilson (2008) evaluated the effectiveness of early intervention for a child displaying early-starter characteristics. Gill et al. (2008) found the Family Check-Up, a family-based and ecological prevention intervention for children at risk for problem behaviours, lead to clinically meaningful improvements in the childs conduct problems. The Family Check-Up was an intervention utilized prior to the school years and had positive long-term effects on the childs conduct problems. It is important for collaboration with schools in these cases to ensure school staff creates a consistent environment that optimizes the childs success by creating congruent interventions and expectations. Systems of Care have evolved over the past 25 years. Few families in need can have all their needs met by one System of Care. Child welfare, juvenile justice, schools, mental health, and others must work together to ensure that at-risk students` and their family`s needs are being met effectively and efficiently. Yet, frequently little actual collaboration or integration exists between systems. In addition, most systems realize that they cannot do their mission without the participation of the broader community. Therefore, many systems of care efforts should include participants from other community agencies (VanDenBerg, 2006). Children with conduct problems do better when several risk domains are targeted and when interventions are generalized across settings. Due to multiple contributing factors of conduct problems a multisystem approach must be utilized in order to target all the risk domains. With this approach artificial silos are created causing incongruent service plans that are often confusing for families causing more stress. Although multisystem intervention is necessary to target the multiple factors involved with the development of conduct problems, a system of

care is necessary to ensure service plans are appropriate, consistent, and congruent, therefore, meeting all the needs of the child and their family. This can only be done through interagency collaboration. Collaboration is necessary to produce positive outcomes for families and will create a system of care, therefore, reducing the silo effect. The difficulty with interagency collaboration is that at the end of the day each agency makes their own decision and work within their own policies and procedures. 6. Guiding Principles for Improvement Children with conduct problems are very difficult for teachers to manage. Improving outcomes for children displaying conduct problems requires intervention and support across several of the childs life domains. No one agency can provide all the support necessary to intervene in several areas of the childs life, therefore, multisystem involvement is important. However, it is imperative that each system work together to ensure all the childs needs are being met. For effective collaboration to be possible standard practices need to be developed, documented, implemented and monitored (Bradley, 2005). A standard service delivery system must be established in order to provide support in all areas of the familys life and so outcomes can be evaluated. Bruner (1991) stated that, interagency collaboration must involve joint development and agreement to a set of common goals, shared responsibility for achieving the goals and relying on the expertise of each collaborator (as cited in Dettmer et al., 2009, p. 377). Also, coordinated care is important to improve service delivery to families of children with conduct problems. A mandated policy of interagency collaboration may be the only way to effectively implement a wraparound policy. Furthermore, it is important to understand practical strategies that can enhance the effectiveness of collaboration between agencies (Dettmer et al., 2009). 7. Improvement Plan A mandated law may be the most effective way to ensure interagency collaboration. Mandating collaboration ensures all stakeholders are informed about the childs needs and work together to create a system of care. Vermont developed a state wide model of individualized care. The principles of the Vermont Child and Adolescent Service System Program included family centered services and interagency collaboration (Bradley, 2005). Interagency case planning, review and problem resolution were based on the belief that children should receive services in the least restrictive environment possible (Bradley, 2005). The passage of Vermonts Act 264 into law mandated interagency coordination and collaboration (Bradley, 2005). According to Bradley (2005) 12 Local Interagency Teams are mandated to include Social Services, Mental Health, Special Education and a parent. Other people involved in the childs life are also invited to the team. This team provides multidisciplinary decision-making in cases where the treatment team is unable to develop or implement a coordinated community-based plan for services (Bradley, 2005). Also, special education services included support staff or mental health staff, from other agencies, on-site to provide support for students needing more intensive emotional or behavioural supports (Bradley, 2005). Prior to the passage of Act 264 only 27% of respondents who were asked about interagency collaboration responded by saying agencies usually collaborate with one another. However, after the passage of Act 264 83% of respondents said that agencies usually collaborate on case reviews (Bradley, 2005). According to Bradley (2005) referrals to Local Interagency Teams

decreased by 65% after the passage of Act 264 suggesting that collaboration and problem resolution have increased as a result of Vermonts system development. Other positive outcomes included: individualized care proved to be cost-effective; children were maintained in community-based programs; decreases in negative behaviours; decreases in restrictiveness of living environments; decreases in restrictiveness of school placement and interagency collaboration improved (Bradley, 2005). Consultants must understand how to work together with different service agencies and different professional cultures (Dettmer et el., 2009). According to Dettmer et al. (2009) Communities in Schools provides links between community resources such as health care, mental health, teachers, parents, and volunteers on behalf of children. To effectively develop coordinated care for children treatment team meetings may be useful. Treatment team meetings help agencies better understand their roles and to cooperate in service delivery (Bradley, 2005). To create effective treatment team meetings formal, systematic and high quality training must be provided. Dettmer et al. (2009) outlined 8 steps for organizing and managing collaborative interagency projects: convene a group; assess student and community needs; establish purposes and priorities; study effective ways of working together; plan the project; implement the plan; assess the results; and sustain the achievement. Interagency collaboration requires patience and new perspectives about supporting children with diverse learning needs. Interagency collaboration creates several environments for learning and establishes diversity of experiences for students with special needs (Dettmer et al., 2009). Furthermore, interagency collaboration can provide support to a greater number of areas of the childs life, therefore, positive outcomes will be longer-term, consistent and communitydeveloped (Dettmer et al., 2009). Dettmer et al. (2009) provided the following suggestions for how agencies can study ways of efficiently working together: cross-train in each others procedures and norms; build a sense of community; obtain and maintain high levels of support at all organizational levels; develop joint procedures and eliminate conflicting ones; write policies that encourage integrated services and interagency collaboration; work to develop trust; clearly define the decisionmaking process; and ensure the collaborative process is democratic. 8. Outcomes I believe interagency collaboration is a difficult process that must be dictated by policy. However, a mandated policy will not create effective collaboration between agencies if techniques for collaboration are not developed. Each agency must begin to develop a culture whereby their employees are submerged in collaborative language and practice. I believe that interagency collaboration and the development of one comprehensive service plan will reduce stress in families and improve outcomes for children with special needs. Outcomes should be measured at each level of implementation to ensure effective collaboration. For example, clinical measures can be used to measure a childs success while receiving interventions prescribed through collaboration. Also, the rate in which collaboration occurs across settings should be measured by policy makers and program providers to ensure policies are being followed. 9. Review and Reflection of the Inquiry Process

I felt it was important to keep this situational analysis broad based and not focus on a specific detail regarding collaboration in the school system. Due to the relatively short length of this situational analysis I did not focus on a specific strategy for improved interagency collaboration. Rather, I inquired about the need for a mandated policy that outlines procedures for interagency collaboration. Discussing specific details was beyond the scope of this paper, however, any one of the suggestions for improving collaboration could have been an inquiry project in and of themselves. Due to my own professional practice, I felt it was important to learn about interagency collaboration and the need for a unified policy. When speaking with professionals involved in working with children with special needs it seems to be a common consensus that collaboration is important, however, it is done only on occasion. Although I have attended many collaborative meetings they do not consistently involve all of the stakeholders and seldom do they involve the child. I felt it was best for my professional development to inquire about the need for interagency collaboration and not focus on specific tactics that could be used in the school system, as I do not work in a school setting. Also, I focused on providing support for children with conduct problems because it helped provide a clear direction for my topic of inquiry. I work primarily with children with conduct problems and see the need for collaboration between agencies; however, interagency collaboration should be standard practice for all children with special needs. Because I work with children with conduct problems I felt it was important to inquire about how interagency collaboration can best support the children I work with. Having the opportunity to conduct a situational analysis about specific techniques used within a school setting to improve collaboration would improve my professional development. I would gain more knowledge about the school systems professional culture, norms, standards and nomenclature. Gaining a further understanding of other agencies would allow for better collaboration because an understanding of differing perspectives would be gained. This situational analysis was time consuming and difficult to complete, however, it was worthwhile for my understanding of interagency collaboration and my professional development. This report relied heavily on research of the literature and could have been enhanced by including more formal interviews with professionals in different fields of special education. References Bradley, J. (2005). The Deinstitutionalization of Children: An Evaluation of The Efficacy of Wraparound Services (Doctoral dissertation, Widener University, 2005). Institute for Graduate Clinical Psychology. Brotman, L. M., Kingston, S., Bat-Chava, Y., Caldwell, M. B., & Calzada, E. J. (2008). Training School Personnel to Facilitate a Family Intervention to Prevent Conduct Problems. Early Education & Development, 19(4), 622-642.

Dettmer, P., Thurston, L., Knackendoffel, A., & Dyck, N. (2009). Collaboration, Consultation, and Teamwork for Students with Special Needs. New Jersey: Pearson. Gill, A. M., Hyde, L.W., Shaw, D. S., Dishion, T. J., & Wilson, M. N. (2008). The Family CheckUp in Early Childhood: A Case Study of Intervention Process and Change. Journal of Clinical Child & Adolescent Psychology, 37(4), 893-904. Jordan, A. (2007). Introduction to Inclusive Education. Mississauga, ON, Canada: John Wiley and Sons. Mackenzie, E. P. (2007). Improving Treatment Outcomes for Oppositional Defiant Disorder in Young Children. Journal of Early and Intensive Behaviour Intervention, 4(2), 500-510. McMahon, R. J., Wells, K. C., & Kotler, J. S. (2006). Conduct Problems. In Mash, E. J., & Barkley, R. A. (3rd ed.), Treatment of Childhood Disorders (pp. 137-268). New York: The Guilford Press. Slough, N. M., & McMahon, R. J. (2008). Preventing Serious Conduct Problems in School-Age Youth: The Fast Track Program. Cognitive and Behavioral Practice, 15 317. VanDenBerg, J. (2006). Systems of Care and the Child and Family Team Process. Retrieved June 12, 2009 from: http://www.pccyfs.org/dpw_ocyfs/High-FidelityWraparound/PYFI_Orientation(Vandenberg)_112007.pdf VanDenBerg, J. & Grealish, M. (1998). The Wraparound Process. Wraparound Process Manual. Webster-Stratton, C., Reid, J. M., & Hammond, M. (2004). Treating Children with Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training. Journal of Clinical Child and Adolescent Psychology, 33(1), 105-124. Webster-Stratton, C., Reid, J. M., & Stollmiller, M. (2008). Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training

Programs in high-risk schools. Journal of Child Psychology and Psychiatry, 49(5), 471 488.