A Sample Integrated Treatment/Education Plan For A Student Who Requires Coordinated Multisystem Services

1. Identifying Information

Name: Tim
Birth Date: 87/10/21
Age: 10yr 5mos
Date of Plan: 98/3/17
Parent/Guardian: North by Northwest Child and Family
                              Temporary Guardian Joe and Susan Smith; Foster Parents as of October 1, 1997
School: Central
Grade: 4 (Grade 1 repeated)

Background Information

2. Description of Concerning Emotional/Behavioural Problems

(Specify the student's behavioural/emotional problems, how they endanger self/others, the problem's persistence over time, and their pervasiveness in the student's environment at home, at school, and in the community.)

Tim's behaviour can be quite extreme when someone gets in his way or when he is upset.  His actions at these times are not particularly rational and some of his behaviours endanger others or himself.  A few samples of these types of behaviours are given in the following table.  Overall, there have been 24 documented examples of such behaviours since September of this year.  Most involve an attack (one quick hit or push) and then escape (running out of the room or building).  However, a couple of incidents have resulted in intense fights when people did not back down.  If restrained at these times, it can take many hours for Tim to deescalate.

School	Home
Held a young girl by the throat when she got in his way	Fought with his brother during an arranged visit and threatened to knife him
Pushed a paraprofessional when she stood in front of him while he was trying to leave the classroom during recess (he was to stay in at recess), he used sufficient force to cause her to lose her balance	Ran out of the house and stayed away most of the night – never indicated where he was
Hit a paraprofessional seated in front of him in the back with his fist, this was without apparent reason and he used sufficient force to cause the para to leave the room in pain	Was found on the roof of the house one night when he had been grounded, was trying to get out (the house is two stories)
Threw a book at the teacher when he was having trouble with assignment	Has damaged his room and some of his own things when upset
Ran out in front of a car during recess (was chasing a ball)	Youth Emergency Crisis Stabilization Team has been called into the home twice in the last two months
Hit another child on the calf with a stick causing bruises when angry with him for scoring a winning goal on his team	Tim has had difficulties in school since kindergarten, and some difficulties were reported in daycare.  Child and Family Services has been involved since he was two and has been his legal guardian at various times since then.

 

Coping Strategies and Patterns

When Tim is intent on doing something and someone tries to get him to stop, Tim usually ignores the person and continues what he is doing. It appears to matter little if the person is a peer or an adult, although Tim does appear to respond more positively to young children when they try interrupting him. If the person becomes more demanding, Tim (on a good day) will stop what he is doing but will stop loudly. For example, if he is to stop working on his mathematics and begin language arts, he may slam his book closed and loudly state "I’m closing it". At home, if asked to turn the TV off to come for supper, he will make loud statements about "this stupid house" or "who wants to eat the stupid meal anyway". On a bad day at school, Tim may simply refuse to recognize the adult or get up and leave the room, usually quite loudly with some comment such as "I don’t have to work in this stupid place". Twice when teachers have tried to stop Tim from leaving the room by standing in front of him, the result was physical. At home he may begin calling everyone names and, if they don’t retreat, leave the home saying "I don’t have to live in this stupid place " and may damage something on the way out.

Tim will work quietly and intently on a task when he knows exactly what to do and has a high chance of success. He does not appear to be bothered by the fact that the task is repetitive. In fact he appears to take comfort in familiar tasks. This is particularly noticeable when Tim is agitated. On good days he may offer to help his foster mother with a chore. He may lose interest after a while but, if the task is short, he will complete it and seems quite pleased with himself. This is one of the few times he will accept praise if gently given. He likes hanging around playgrounds where there are younger children and will sometimes help a child who needs a swing or spin. However, he did get into trouble a few times when he intervened in a situation where a larger child was bullying a smaller one.

3. Development and Function of Student's Emotional/Behavioural Problems

(This section details the developmental context in which the child learned the current emotional/behavioural coping style. The team summarizes those relevant events, including experiences with caregivers, family dynamics, trauma, and any significant occurrences that may account for the student's present coping style and the factors that maintain and drive present behaviours.)

Tim has been moved around a great deal. His birth family moved many times for various reasons and he has had four foster placements since entering school. There are still some unresolved issues and his father has threatened to take him from school when difficulties arise at school even though his father is not to have unsupervised contact with Tim. Tim has seen and possibly experienced extreme violence from a trusted adult and will, when he feels cornered or unfairly treated, strike out although his first response is to withdraw or run.

Tim's birth parents have failed to follow through on various commitments, creating extreme emotional reactions. This is particularly noticeable when they fail to show up for a planned visit. Tim takes a great deal of time getting ready to meet with his parents. When it is evident that they are not coming, Tim initially is very quiet and uncommunicative.  Later, he gets into an argument over simple issues and will sometimes destroy things, particularly things he values. Tim is also very stressed leading up to court cases and will become confrontational and defiant over simple requests when a court case is nearing.

During early life, Tim sometimes went without food or adult supervision. He needed to learn to fend for himself and his brother. He can be very self-reliant and may not always trust adults to come through for him or meet his basic needs, including nurturance. This creates conflict when adults want him to "wait" for meals or trips to the mall or theatre. Tim becomes quite anxious and agitated while waiting for positive events and may do something that causes the event to be cancelled.

Through much of his early life, Tim survived through his own wit, skill, and determination. He is highly self-reliant and has limited experience in meeting the needs or requests of others. He has learned to take care of his own needs and his brother's needs. He does not connect with adults easily. He is also very vulnerable to failure. This may tie in with a sense of shame, a feeling that there is something basically wrong with him. After all, he is the one who cannot live at home. When most vulnerable, he becomes agitated when faced with a difficult task and may give up easily. If any corrections are attempted, he may react in an extreme manner. Many people have given up on him in the past and it is not a surprise if someone gives up on him now.

4. Diagnostic Information

(Summarizes formal diagnostic information completed to date by school clinicians, social services and health personnel, identifying critical factors to be considered in developing the multisystem (Circle of Care) plan and Individual Education Plan.)

Dr. Jeff, a psychiatrist, has made a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), predominately hyperactive type with some symptoms consistent with Oppositional Defiant Disorder. There has also been some discussion as to whether Tim's behaviour is truly related to ADHD or to an underlying depression or anxiety. The school psychologist has reported elevated scales on the BASC in both anxiety and depression. A diagnosis of depression would fit with some of Tim’s statements. However, the depression could be more situational than clinical. He certainly seems more "down" and defeated when his parents don’t show for visitations or when court cases regarding custody are near.

A trial of Ritalin has been given. On good days the Ritalin seems to help Tim control his impulsive behaviours. On bad days, it has little impact. Although the medication will be continued and monitored by home and school, it is clear that additional interventions will be required.

Weschler Intelligence Scale for Children indicates that Tim’s underlying thinking skills and conceptual understanding are appropriate for his age group. His nonverbal skills are in the high average range and his verbal skills are in the high end of the low average range. The results compare Tim with students at the same age level. He would be at the low end of the normal range if he were compared with other students in the classroom. Nevertheless, Tim may need help with some verbal concepts. He may become confused if instructions are only given verbally, but he will benefit from a teaching style that demonstrates and models expectations when a task is given.

Current Levels of Performance

5a. Summary of School Performance

(Pertinent information that gives direction for educational programming.)

Tim's reading is delayed by two years (based on grade level). However, his comprehension is quite good when he is familiar with the subject matter. His sight words and analytical skills are quite weak (Grade 1.5). He sounds out the initial letters in a word and then guesses at the remainder of the word. Tim may use the basic shape of the word when making a final selection, but his main tool is context. Since he is quite good at using context once he understands the story, we can develop basic sight skills through reading words in context rather than in isolation if we insure that background knowledge is accessed or developed. Analysis can be systematically taught from the words he knows within a story.

Tim's arithmetic skills are fairly strong. He has good understanding of mathematical concepts and fairly good addition and subtraction skills. His multiplication facts are weak, which also affects his division skills. Practise in this area would help. Tim could use a calculator or multiplication table when working on problems. There are effective computer programs designed to help students memorize rote mathematical facts. A program that visually displays the question and answer together and does not show incorrect answers would be most effective for a student like Tim with strong visual skills.

Although Tim’s writing appears quite messy, his fine motor control is good. He has some trouble with punctuation but responds well when asked to edit material for capitals and periods. Commas are a little weak but Tim is not alone in this area. The major problem appears to be in spelling. He is very capable of developing story lines when using pictures to represent the story. The pictures are quite detailed and the sequencing is appropriate. His story telling is detailed and the language is appropriate if he knows that he will not be asked to write the story. Once he knows that he will be asked to write the story, his vocabulary becomes more elementary and his flow of ideas more stilted. He appears to be selecting vocabulary from the bank of words he can spell and this limits the selection of words and ruins the flow of thought. Thus his writing appears to be at the grade one level while his capability to develop stories is near his grade level.

When spelling, Tim tends to sound out words. This is not his strength nor is he very successful at it. However, the limited success he has experienced has come from this approach and Tim will not give up using this approach without a great deal of support and success. Initial indications suggest that Tim’s spelling could be improved using the Ves Thomas approach, which is highly visual. This could become part of a whole class strategy when introducing new vocabulary. An individualized program will also be needed since Tim has many gaps in his spelling and needs to relearn critical primary vocabulary.

5b. Summary of Home and Community Performance

(Pertinent information that gives direction for home and community programming.)

Tim’s foster parents are prepared to continue fostering him and his present Family Services social worker will continue to provide support. Tim relates well to the Family Service worker and will discuss feelings with her about family and issues around court cases and family visits. He says little about his foster home. On good days he will help around the home and has begun to take responsibility for some chores. He still gets very upset with disciplinary action and will sometimes damage the Smith’s property. However, he will also damage his most valued possessions at these times. This is particularly true when court cases are near or when the family fails to show up for visits. His only ongoing contact with family is an uncle (mother’s brother). He seems to enjoy visits with his uncle and likes to help out in his uncle's shop. He often comes back from these visits in a very positive mood.

Tim has expressed desires and fears about returning home to the social worker. This ambivalence is consistent with his parents’ actions. They desire to have Tim return home but miss critical meetings that would enable them to prepare their household for his return. He appears comfortable with the school psychologist but restricts his discussions to school issues. However, he has given some indication that he can think through his behaviour if given time to settle down.

Summary of Needs

(With EBD children this includes three critical programming needs.)

System Needs

• All children, including Tim, need to be safe in the school.
• There must be an alternative to school for Tim when he is highly unmanageable in school and risks the safety of other students.
• Foster parents need to insure that valuables in their home are not damaged, particularly those that are difficult to replace.
• Foster parents need to know that when Tim leaves home in anger, there are supports to help find him and help him find a way to return unharmed.

Learning Needs

Social:

• Tim needs to develop a sense of trust in trustworthy adults.
• Tim needs to find an more acceptable ways to deal with feelings of shame.
• Tim needs to realise that there is a connection between what he does and positive things that happen.
• Tim needs to begin to see himself as a competent learner.
• Tim needs to learn new social skills and develop positive friendships.

Academic:

• Tim needs to have an opportunity to learn using his strengths (e.g., visual skills).
• Tim needs to have an opportunity to learn in low-risk, highly supportive learning environments that challenge him but provide him with the tools for success in advance.
• Tim needs to have an opportunity to perform positively in front of his peers, so they begin to see him as a competent learner (in turn he may begin to see himself this way).
• Tim needs to be given a safe opportunity to develop missing skills in a way that respects his underlying sense of shame.

Personal / Emotional Needs

• Tim needs to needs to know that his environment is safe and predictable.
• Tim needs to know that basic needs such as food are housing will be available.
• Tim needs high support and preparation when new tasks are to be faced.
• Tim needs low stress times to get himself (feelings, fears, anxieties) under control.
• Tim needs the opportunity to talk to an involved adult before and after parental visits.
• Tim needs the opportunity to use his "helping" talents with young children and adults.

Student Specific Outcomes

(May 31, 1999 is the target date for Tim to meet these outcomes. The team will review progress in each of these areas throughout the school year.)

Emotional / Behavioural Outcomes (These outcomes should be met by mid-May [some gains may be lost in June when school activities become less predictable].)

1) Regarding Safety Issues

• Tim will remain within the school most school days and improve his attendance by 10%.
• Tim will remain in the classroom for most the school day (6 out of 7 classes) and reduce the number of classroom suspensions by 25%.
• Tim will go outside at noon recess and take part in student activities without harming other students.

2) Regarding Trust Issues

• Tim will be able to follow directions given by his foster parent(s) and do what is requested without major argument, two out of three times.
• Tim will be able to follow directions given by the classroom teacher without argument two out of three times.
• Tim will be able to go to the office when asked without argument.
• Tim will ask for help when having difficulty with a task (at home or at school).

3) Regarding Friendship Issues

• Tim will have at least two people who he plays with during free time who become involved with him both at home and at school
• Tim will receive or make at least two phone calls a week to "friends"

4) Regarding Basic Needs

• Tim will take food from the kitchen as he needs without hoarding it in his room.
• Tim will wait until recess for a snack without asking for one.

Educational Outcomes (These outcomes should be met by the end of June.)

1) Grade Level Learning

Tim will be able to meet the grade four educational outcomes in all the core subject areas with a score of 60% [the possible exception is Language Arts].

2) Filling Gaps in English Language Arts

Tim will demonstrate progress in formal testing of at least one year in written language and two years in reading.

Tim will demonstrate success in written language and in reading in the classroom by attempting to write responses and stories and by using his reading skills to access information in the content areas.

Methods, Materials and Strategies Identification of Safety, Shared-Service and Educational Goals

6. Multisystem Education and Treatment Plans

(The purpose of this section is to identify Shared Service Goals that will coordinate the implementation of the Multisystem Service Plan to address the student's critical social learning and personal needs and the system's safety needs.)

6a. Safety Goals (goals that address system’s needs):

• provide alternative placements for times when Tim is at risk of injuring others or himself
• create crisis response supports for the Smiths when Tim puts himself in jeopardy
• reduce damage to the Smith’s valuables

6b. Shared-Service Goals (goals that address personal/emotional and learning needs):

• create a predictable and consistent environment with few changes, to help Tim develop a sense of trust (learning need) and safety (personal/emotional need)
• create opportunities for Tim to have low-stress times (personal/emotional need) and more control (personal/emotional need) when he is most vulnerable to emotional stress<
• create an environment where some basic needs such as food (personal/emotional need) can be met and where Tim can learn to wait for some needs to be met (learning need)
• create opportunities where completion of work is rewarded (learning need) and where Tim can begin to see himself as a competent learner in new situations (personal/emotional and learning need)
• create opportunities where Tim can learn new social skills (learning need) and possibly develop friendships (learning need)

6c. Educational Goals:

• create a classroom environment where students with a variety of learning styles, including Tim’s visual learning style, can successfully learn and present information in the class
• introduce adaptive strategies in the core subject areas to help Tim meet curricular goals in these subject areas
• develop direct teaching strategies and programs that will help Tim fill the academic gaps in ELA and mathematics

7. Multisystem Education and Treatment Plans

(Specifies the service plans developed by the multisystem team to address the educational and shared service goals.  The plans include specific strategies that will be implemented in each of the child's living/learning environments and identifies the services provided to support the child and caregivers by each member of the team.)

7a. Safety Plan (Designed to address Safety Goals)

7b. Circle of Care Treatment Plan (Designed to co-ordinate the activities of all service systems around the Shared-Service Goals)

7c. Educational Plan (Designed to implement teaching strategies to address Educational Goals)

Click above to see attached intervention plans

8. Case Management Process

(This section explains how the plans identified above will be managed and co-ordinated.)

Ruth, the caseworker with Child and Family Services, will manage the community part of the program and insure that resources are available to Tim and the Smiths. She will convene meetings with parents and outside professionals as needed. She will also arrange for additional home supports if they become necessary.

Mary-Sue, the resource teacher, will manage the school part of the plan to insure that resources are in place and that strategies are successfully implemented. She will chair school-based meetings to address educational concerns and provide training and direct support where necessary.

The full team will meet monthly until it is felt that the program is progressing successfully. Communication around the program will go directly to the appropriate case manager, who will resolve problems at their own level or call a meeting of the full team if necessary.

9. Implementation Costs

(Detail the school division/district costs of implementing the school component of the multisystem education/treatment plan.)