PBIS PG-Interconnected Systems Framework

Report
Understanding the Interconnected
Systems Framework (ISF) for
Integrating Mental Health Supports
in Schools
January 28, 2013
A National Community of Practice (COP);
www.sharedwork.org
• IDEA Partnership (www.ideapartnership.org)
providing support
• 22 professional organizations and 16 states
• 12 practice groups
• Opportunities for dialogue and collaboration
• Advancing multi-scale learning
2
Our goal today:
• Describe the Interconnected Systems
Framework (ISF)
• Clarify the features of School-Wide Positive
Behavior Interventions and Supports (SWPBIS)
School Mental Health (SMH) in the context of
the ISF
• Describe emerging examples of ISF
Poll Question #1
History-Rationale
• Sparse availability of MH providers in schools
• Labels and ‘places’ confused with
interventions
• Separate delivery systems (Sp.Ed., Mental
health, etc)
• Minimal accountability for outcomes for most
vulnerable populations
Why Partnership Are Needed
• One in 5 youth have a MH “condition”
• About 70% of those get no treatment
• School is “defacto” MH provider
• JJ system is next level of system default
• Suicide is 4th leading cause of death among
young adults
Interconnected Systems Framework
paper
(Barrett, Eber and Weist , revised 2009)
Developed through a collaboration of the
National SMH and National PBIS Centers
www.pbis.org
www.pbis.org http://csmh.umaryland.edu
ISF Monograph Development
June 2012 – September 2013
• Define the common goals of SMH and PBIS
• Discuss the advantages of interconnection
• Identify successful local efforts to implement
collaborative strategies and cross-initiative efforts
• Define the research, policy, and implementation
agendas to take us to the next action level
SMH and PBIS
Common Purpose
• Schools supporting/promoting MH of ALL
students
• Prevention, early access, interventions
commensurate with level of need (vs label)
• School personnel feel confident and
competent in identifying and intervening with
accuracy and effectiveness
Logic
– Youth with MH needs require multifaceted
education/behavior and mental health supports
– The usual systems have not routinely provided a
comprehensive, blended system of support.
– Supports need to be provided in a clustered and
integrated structure,
– Academic/behavior and mental health supports
need to be efficiently blended
Promotion and Prevention
Simple and complex supports require integrated
systems with foundation of a school-wide system
• Schools and community serve as protective factor
• problem-solving teams with
school/family/youth/community voice
• use of data for decision-making (screening/ selection
and monitoring/outcomes)
• layers supports from the foundational/universal to the
more complex
School-Wide Systems for Student Success: A Response to
Intervention (RtI) Model
Academic Systems
Behavioral Systems
Tier 3/Tertiary Interventions
1-5%
1-5%
Tier 3/Tertiary Interventions
•Individual students
•Assessment-based
•Intense, durable procedures
•Individual students
•Assessment-based
•High intensity
Tier 2/Secondary Interventions
5-15%
•Some students (at-risk)
•High efficiency
•Rapid response
•Small group interventions
• Some individualizing
Tier 1/Universal Interventions 80-90%
•All students
•Preventive, proactive
Illinois PBIS Network, Revised May 15, 2008.
Adapted from “What is school-wide PBS?”
OSEP Technical Assistance Center on Positive
Behavioral Interventions and Supports.
Accessed at http://pbis.org/schoolwide.htm
5-15%
Tier 2/Secondary Interventions
•Some students (at-risk)
•High efficiency
•Rapid response
•Small group interventions
•Some individualizing
80-90%
Tier 1/Universal Interventions
•All settings, all students
•Preventive, proactive
Positive Behavior Intervention and Support
(www.pbis.org)
• Decision making framework to guide selection
and implementation of best practices for
improving academic /behavioral functioning
• Data-based, measurable outcomes, evidencebased practices, systems to support effective
implementation
Core Features of a Response to
Intervention (RtI) Approach
• Investment in prevention, screening and
early intervention for students not at
“benchmark”
• Multi-tiered intervention approach
• Use of progress monitoring and problemsolving process at all 3-tiers
Core Features of a Response to
Intervention (RtI) Approach
• Research-based practices and active use
of data for decision-making at all 3-tiers
• Use of progress monitoring and problemsolving process at all 3-tiers
SCHOOL-WIDE
POSITIVE BEHAVIOR
SUPPORT:
What is meant by
“layering”
interventions?
~5%
~15%
Primary Prevention:
School-/ClassroomWide Systems for
All Students,
Staff, & Settings
~80% of Students
Tertiary Prevention:
Specialized
Individualized
Systems for Students
with High-Risk Behavior
Secondary Prevention:
Specialized Group
Systems for Students
with At-Risk Behavior
Components of SWPBIS
1.
2.
3.
4.
5.
3-5 agreed upon common expectations
Positive statement of purpose
Clear and positive expectations for behavior
Procedures for teaching expected behavior
Continuum of consistent procedures for
encouraging expected behavior
6. Continuum of consistent procedures for
discouraging inappropriate behavior
7. Procedures for on-going monitoring and
evaluation
Definition of school mental health
•Involves partnership between schools and
community health/mental health organizations, as
guided by families and youth
•Builds on existing school programs, services, and
strategies
•Focuses on all students, both general and special
education
•Involves a full array of programs, services, and
strategies- mental health education and promotion
through intensive intervention
(Weist & Paternite, 2006)
“Expanded” School
Mental Health
• Full continuum of effective mental health promotion and
intervention for ALL students
• Reflecting a “shared agenda” involving school-family-community
partnerships
• Collaborating community professionals (augment the work of
school-employed staff
SMH at Tier One
• Universal screening for social, emotional, and
behavioral at-risk indicators
• Teaching social skills with evidence-based
curricula to all students
• Teaching appropriate emotional regulation and
expression to all students
• Teaching behavioral expectations to all students
• Mental health professionals are part of the Tier
One systems team, providing input and progress
monitoring data
SMH at Tier Two
• Mental health professionals part of secondary
systems and problem solving teams
• Working smarter matrix completed to ensure key
resources are both efficient and effective (i.e.,
initiatives are aligned and combined such as
“bully prevention”, “discipline”, “character
education”, “RtI behavior”, etc.)
• Groups co-facilitated by school staff and
community partner (example – guidance
counselor and community provider clinician)
SMH at Tier Three
• Mental health professional part of tertiary
systems team
• FBA/BIP completed together with school staff
and mental health provider for one concise
plan, rather than each completing paperwork
to be filed
The Context
• Over 18,000 schools engaged in
implementation of SWPBIS (MTSS )
prevention based system
• Current focus on capacity to scale-up
• MTSS as platform to install effective
interventions for youth w/or at-risk of EBD
The Context (cont.)
• Emphasis now on scaling with expansion and
connection to other systems
– i.e. academic, juvenile justice, mental health, child welfare,
systems of care
• Emphasis on deliberate actions that foster
connections w/families & community
BIG Ideas…
• How Multi-tiered Systems of Support (MTSS)
can enhance mental health in schools
• Installing SMH through MTSS in Schools
• The Interconnected Systems Framework (ISF)
SMH +MTSS=ISF
Development of ISF
• 2002-2007: Site Development with PBIS Expansion
(informal and independent)
• 2005 CoP focus on integration of PBIS and SMH
• 2008: ISF White Paper: formal partnership between
PBIS and SMH
• 2009- 2013 Monthly calls with implementation sites,
national presentations (from sessions to strands)
• 2009-2011 Grant Submissions
• June 2012- September 2013 ISF Monograph
• Monograph Advisory group
ISF Defined
– ISF provides structure and process for education and mental
health systems to interact in most effective and efficient way.
– ISF is guided by key stakeholders in education and mental health
system who have the authority to reallocate resources, change
role and function of staff, and change policy.
– ISF applies strong interdisciplinary, cross-system collaboration.
ISF Defined
– ISF uses the tiered prevention logic as the overall
organizer to develop an action plan.
– ISF involves cross system problem solving teams that
use data to decide which evidence based practices to
implement.
ISF Defined (cont)
– ISF involves ongoing progress monitoring for both fidelity and
impact.
– ISF emphasizes active involvement by youth, families, and
other school and community stakeholders.
Structure for Developing an ISF:
Community Partners Roles in Teams
• A District/Community leadership that includes families,
develops, supports and monitors a plan that includes:
• Community partners participate in all three levels of systems
teaming: Universal, Secondary, and Tertiary
• Team of SFC partners review data and design interventions
that are evidence-based and can be progress monitored
• MH providers form both school and community develop,
facilitate, coordinate and monitor all interventions through
one structure
Traditional
• Each school works
out their own plan
with Mental
Health (MH)
agency;
 Preferred
• District has a plan
for integrating MH
at all buildings
(based on
community data as
well as school data);
Traditional
• A MH counselor
is housed in a
school building 1
day a week to
“see” students;
 Preferred
• MH person
participates in
teams at all 3 tiers;
Traditional
• No data to
decide on or
monitor
interventions;
 Preferred
• MH person leads
group or individual
interventions based
on data;
Poll Question #2
Structure for Developing an ISF:
Community Partners
Roles in Teams
• A District/Community leadership that includes
families, develops, supports and monitors a
plan that includes:
• Community partners participate in all three
levels of systems teaming in the building:
Universal, Secondary, and Tertiary
Structure for Developing an ISF:
Community Partners Roles in Teams (cont.)
• Team of SFC partners review data and design
interventions that are evidence-based and can
be progress monitored
• MH providers from both school & community
develop, facilitate, coordinate and monitor all
interventions through one structure
3-Tiered System of Support
Necessary Conversations (Teams)
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Secondary
Systems Team
Problem Solving
Team
Tertiary Systems
Team
Uses Process data;
determines overall
intervention
effectiveness
Standing team; uses
FBA/BIP process for
one youth at a time
Uses Process data;
determines overall
intervention
effectiveness
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
FBA/
BIP
Complex
FBA/BIP
WRAP
3-Tiered System of Support Necessary Conversations
Family and
community
Universal
Team
Plans SW &
Class-wide
supports
Universal
Support
Family and
community
Community
Secondary
Systems Team
Problem Solving
Team
Uses Process data;
determines overall
intervention
effectiveness
Standing team with
family; uses FBA/BIP
process for one youth
at a time
Tertiary
Systems Team
Uses Process data;
determines overall
intervention
effectiveness
CICO
Brief
SAIG
Group w.
individual
feature
Brief
FBA/BIP
Sept. 1, 2009
Family and
community
FBA/
BIP
Complex
FBA/BIP
WRAP
Tier I: Universal/Prevention for All
Coordinated Systems, Data, Practices for Promoting Healthy Social
and Emotional Development for ALL Students
 School Improvement team gives
priority to social and emotional
health
 Mental Health skill development for
students, staff, families and
communities
 Social Emotional Learning curricula
for all students
 Safe & caring learning environments
 Partnerships between school, home
and the community
 Decision making framework used to
guide and implement best practices
that consider unique strengths and
challenges of each school community
School Improvement Team Gives
Priority
– Community mental health staff (Director and Program
Coordinator) with the assistance of the PBIS TAC set up
meetings with key school administrators (Principal, AP’s) to
introduce SPARCS to them
• Follow-up meetings periodically to deal with larger
system issues
– PowerPoint presentation of key program features
presented to admins, school social workers, school
psychologist and counselors
• Shifting of school-based staff roles/responsibilities
discussed
Tier I: Universal/Prevention for All
Coordinated Systems, Data, Practices for Promoting Healthy Social
and Emotional Development for ALL Students
 School Improvement team gives
priority to social and emotional
health
 Mental Health skill development for
students, staff, families and
communities
 Social Emotional Learning curricula
for all students
 Safe & caring learning environments
 Partnerships between school, home
and the community
 Decision making framework used to
guide and implement best practices
that consider unique strengths and
challenges of each school community
Partnerships Between Home, School &
Community
School-Community Partner Information Sheet
Tier I: Universal/Prevention for All
Coordinated Systems, Data, Practices for Promoting Healthy Social
and Emotional Development for ALL Students
 School Improvement team gives
priority to social and emotional
health
 Mental Health skill development for
students, staff, families and
communities
 Social Emotional Learning curricula
for all students
 Safe & caring learning environments
 Partnerships between school, home
and the community
 Decision making framework used to
guide and implement best practices
that consider unique strengths and
challenges of each school community
Determine Strengths and Needs
• At the building level
– Admin team was meeting weekly and looking at the data
to determine needs
• Gaps were identified – mental health
– Administrators, Community Elements Director for Youth
Services and PBIS TAC met to determine intervention to
meet needs and continued meeting every few weeks to set
up system features
• Secondary Systems Team was formed
Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification,
and Response to Mental Health Concerns






Systems Planning Team identified to
coordinate referral process, decision
rules and progress monitor impact
of intervention
Array of services available
Communication system for staff,
families and community
Early identification of students who
may be at risk for mental health
concerns due to specific risk factors
Skill-building at the individual and
groups level as well as support
groups
Staff and Family training to support
skill development across settings
Systems Planning Team
• Secondary Systems Team meetings
– Meeting twice a month
• to talk through systems response
• to work through system implementation issues
• to build rapport and relationships between service
providers
• to communicate and implement with fidelity
Coordinated Referral Process with
Decision Rules
• Data-based Decision Rules for Entrance
– At Centennial, students are referred for SPARCS
because they are freshman/freshman status and
• They have been through two tier two interventions and
have not responded
• They are READY (alternative school) students
transitioning back to Centennial**
• They have had multiple SASS contacts
• Meet criteria for trauma experience as screened using
the TESI-SR (Traumatic Events Screening Inventory-Self Report)
** READY, Juvenile Detention & MH providers also providing across the community
Monitor the Impact of the Intervention
Tier Two Tracking Tool- SY2012
Tier 2 Intervention Tracking Tool
School Name: Centennial High School
Skill Building Group
Number of
Students
Number of
Participatin Students
Interventions g
Responding
August
1
1
September
13
11
October
16
12
November
38
17
December
18
14
January
24
17
February
5
5
March
8
7
April
10
4
May
1
1
June
0
0
Total
134
89
66%
Total School Population as of October 1: 1386
Intensive Skill Building Group
Number of
Students
Participating
Number of
Students
Responding
0
1
5
0
4
7
3
2
3
0
0
25
44%
Check-in Check-out
Number of
Students
Participating
0
0
2
0
2
2
0
2
3
0
0
11
Teacher/Student Mediation
Number of
Students
Responding
0
4
14
7
6
9
3
2
0
0
0
45
69%
0
3
8
5
6
6
2
1
0
0
0
31
Number of
Students
Participating
Number of
Students
Responding
0
3
4
4
3
3
5
5
6
0
0
33
84%
Total
0
2
2
2
3
3
5
5
6
0
0
28
Total
Respo
nding
1
21
39
49
31
43
16
17
19
1
0
237
1
16
24
24
25
28
12
15
13
1
0
159
69%
Responding to Skill Building Group: Individual student does not receive a discipline referral for the same infraction within four weeks of completing the group.
Responding to Intensive Skill Building Group: Individual student does not receive a discipline referral for the same infraction within four weeks of completing th
Responding to Check-in Check-out (CICO): Individual student does not receive a discipline referral for eight weeks after beginning CICO.
Responding to Teacher/Student Mediation: Individual student does not receive another discipline referral from the same teacher after Teacher/Student Mediatio
Outcomes
School Data – Office Discipline Referrals
ODR Comparison 14 Weeks Before Intervention and 14 Weeks on Intervention
Number of ODRs
37%
Reduction
Overall
23%↓
25%↓
ODR Total 14 Weeks Before Intervention
ODR Total 14 Weeks On Intervention
45%↓
66%↓
100%↑
Students
Outcomes
School Data – In-School and Out-of-School Suspension
Total Number
ISS and OSS 14 Weeks Before vs 14 Weeks During Intervention for
Group
Before
After
23%↓
25% ↓
Offenses
Student Feedback
Student Survey Results
1=strongly agree 2=disagree 3= don’t know 4=agree 5=strongly agree
Skills were helpful to me:
a) Mindfulness
3.8
b) Self-sooth/distract 4.4
c) LET ‘M GO
4.0
d) MAKE A LINK
4.2
Have used skills outside
of group
4.4
Student Feedback Continued
• What was the best part of group?
“It helped me to make better choices and not get
into trouble”
“That you can talk about stress level and feelings”
“It allowed me to share”
“It helped me to identify my sources of anger”
“I liked that it had structure, that we had a lesson
plan that we followed and I liked the handbook”
“Food”
Tier 3: Intensive Interventions for Few
Individual Student and Family Supports
• Systems Planning team coordinates
decision rules/referrals for this level of
service and progress monitors
• Individual team developed to support
each student
• Individual plans may have array of
interventions/services
• Plans can range from one to multiple
life domains
• System in place for each team to
monitor student progress
Accountable Clinical Home
•
•
•
•
•
•
Accountable TO the family and FOR the care
Accessible, coordinated, and integrated care
Comprehensive service approach
Increased accountability and communication
Single point of contact for behavioral health
School is “launching pad” for services delivered
in all settings
• Youth continue on the team with varying
intensity of service
SBBH Service Components
CLINICAL
CASE
INTERVENTIONS
MANAGEMENT
CASE
CRISIS
INTERVENTION
CONSULTATION AND
TRAINING
for educational staff
District and Community Leadership
Team
•
•
•
•
•
Quarterly meetings
Stakeholder representation – System of Care
Implementer’s blueprint
Systems, data and practices
Scaling and sustainability
Time Line
School Year
Activity
2008-09
•Community Care engaged district through ICSP regarding SBBH
Team
2009-10
•SBBH Team begins work within district – September 2009
•District and Community Leadership Team is established, district
commitment signed, tertiary demonstration project begins – spring
2010
2010-11
•Tier One SWPBIS is fully implemented with kickoff at the start of
the school year
•Tier Two training begins in the spring of 2011 with some
implementation
2011-12
•All three tiers are being implemented at both elementary schools
•Montrose Junior High receives Tier One training in fall, with “soft”
kickoff in January 2012
•Discussion of SBBH Team model expanding into Junior and Senior
High
Scranton School District
Year One
2009-10
Year Two
2010-11
Year Three
2011-12
Year Four
2012-13
Year Five
2013-14
Year Six
2014-15
District and Community Leadership Team established.
District commits to implementing SWPBIS with fidelity across the district.
SBBH Teams begin implementation at Frances Willard Elementary, George Bancroft Elementary, and Scranton High. A Tier Three support.
Frances Willard Elementary, George
Bancroft Elementary, and Scranton High
all receive training to implement Tier
One SWPBIS.
Frances Willard Elementary, George Bancroft Elementary, and Scranton High all implement Tier One SWPBIS.
Frances Willard Elementary reaches implementation fidelity.
Frances Willard Elementary receives training for implementation of Tier Two and
begins implementation.
Frances Willard Elementary implements three tiers of Interconnected Systems Framework.
Isaac Tripp Elementary, McNichols Plaza
Elementary, and South Scranton
Intermediate all receive training to
implement Tier One SWPBIS.
Isaac Tripp Elementary, McNichols Plaza Elementary, and South Scranton
Intermediate all implement Tier One SWPBIS.
George Bancroft Elementary and Scranton High receive training for implementation of Tier Two and begin implementation
Scranton High receives training and begins implementation of RENEW.
SBBH Teams begin implementation at Northeast Intermediate, John F. Kennedy Elementary, McNichols Plaza Elementary, and
John G. Whittier Elementary.
John F. Kennedy Elementary, John G.
Whittier Elementary, and Northeast
Intermediate all receive training to
implement Tier One SWPBIS.
John F. Kennedy Elementary, John G.
Whittier Elementary, and Northeast
Intermediate all implement Tier One
SWPBIS.
Key features
• Systems
– District and building teaming models
– Facilitation, technical assistance, coaching
– Stakeholder participation and buy-in
• Practices
– Mental health and school staff work in an integrated way to
support students across tiers
– Using assessment and screening in order to determine which
EBPs to use, progress monitor
– One plan for both education and mental health
• Data
– Shared decision rules
– Used for decision making with all stakeholders at the table – school,
mental health, other child serving systems, family
Outcomes
Change in Family Functioning
1.8
1.6
1.4
1.2
1.0
Improving
0.8
0.6
0.4
0.2
0.0
Change at 3 mos
Not Implementing
Change at 6 mos
Low Fidelity
Change at 9 mos
High Fidelity
Outcomes
Change in Child Functioning
1.8
1.6
1.4
1.2
1.0
Improving
0.8
0.6
0.4
0.2
0.0
Change at 3 mos
Not Implementing
Change at 6 mos
Low Fidelity
Change at 9 mos
High Fidelity
Outcomes – SDQ-P
Change in Difficulties Score
1.0
0.5
0.0
Improving
-0.5
Change Q1
Change Q2
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
Not Implementing
Low Fidelity
High Fidelity
Outcomes – SDQ-T
Change in Difficulties Score
1.0
0.5
0.0
Improving
-0.5
Change Q1
Change Q2
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
-4.0
Not Implementing
Low Fidelity
High Fidelity
The Smith Family
• Jason was referred to the SBBH Team in November. He
is a seven-year-old first grader who was having
difficulty coming to school and being separated from
his mother.
• When he was four, Jason and his family were in a car
accident in a rural area. The members of the family
were taken to different hospitals and Jason did not
know where his mom was or if she was okay.
• Every day, since the first day of school, Jason’s mom
would bring him into the school and the school staff
would literally have to peel Jason off of his mother and
hold him so she could leave.
The Smith Family cont.
• Once referred to the team, they were immediately able
to work with Jason and his family to create strategies
to help him separate more smoothly.
• Jason found the SBBH Team office/room a safe place to
be. His mother also spent time there to help create a
nice transition area.
• After the Holiday break, Jason began riding the bus for
the fist time, accompanied by one of the BHWs from
the team.
• Soon, Jason was able to ride the bus on his own,
increasing his confidence and allowing him some relief
from his anxiety.
Child Outcomes Survey (COS) Family Functioning:
Child X
10
9
7
6
5
4
3
2
1
Solve Problems
Shared Decisions
2/21/12
2/7/12
1/24/12
1/10/12
12/27/11
12/13/11
0
11/29/11
Level of Success
8
Child Outcomes Survey (COS) Child Functioning and
Therapeutic Inventory: Child X
10
9
8
6
5
4
3
2
1
TASKS
ave inventory
2/21/12
SCHOOL
2/7/12
PEERS
1/24/12
1/10/12
FAMILY
12/27/11
12/13/11
0
11/29/11
Level of Success
7
Child Outcomes Survey (COS) Overall Wellness:
Child X
14
12
10
6
4
2
2/21/12
2/7/12
1/24/12
1/10/12
12/27/11
12/13/11
0
11/29/11
Days
8
Strength and Difficulties-Parent Report: Child X
10.00
9.00
Subscale Score
8.00
7.00
6.00
5.00
4.00
3.00
2.00
1.00
0.00
11/1/11
Emotional Symptoms
Peer Problems
2/1/12
Conduct Problems
ProSocial
Hyperactivity
Strength and Difficulties-Teacher Report: Child X
10
9
Subscale Score
8
7
6
5
4
3
2
1
0
11/1/11
Emotional Symptoms
Peer Problems
2/1/12
Conduct Problems
ProSocial
Hyperactivity
Lessons Learned
•
•
•
•
Return on investment
Funding efficiency
Scaling and sustaining SBBH Teams – size
Community “politics”
Interconnected Systems Framework
Tier I: Universal/Prevention for All
Coordinated Systems, Data, Practices for
Promoting Healthy Social and Emotional Development
for ALL Students
 School Improvement team gives priority to
social and emotional health
 Mental Health skill development for
students, staff/, families and communities
 Social Emotional Learning curricula for all
Safe & caring learning environments
 Partnerships : school, home & community
 Decision making framework guides use of
and best practices that consider unique
strengths and challenges of each school
community
Interconnected Systems Framework
Tier 2: Early Intervention for Some
Coordinated Systems for Early Detection, Identification,
and Response to Mental Health Concerns
 Systems Planning Team coordinates referral
process, decision rules and progress monitors
 Array of services available
 Communication system: staff, families and
community
 Early identification of students at risk for
mental health concerns due to specific
risk factors
 Skill-building at the individual and groups
level as well as support groups
 Staff and Family training to support skill
development across settings
Interconnected Systems Framework
Tier 3: Intensive Interventions for Few
Individual Student and Family Supports
 Systems Planning team
coordinates decision
rules/referrals and progress
monitors
 Individual team developed to
support each student
 Individual plans have array of
interventions/services
 Plans can range from one to
multiple life domains
 System in place for each team
to monitor student progress
For More Information:
• www.sharedwork.org
• www.pbis.org

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