The “RYSE Program”: Intensive school-related clinical services that work U.S. Department of...

The “RYSE Program”:The “RYSE Program”:Intensive school-relatedIntensive school-related

clinical services that clinical services that workwork

U.S. Department of EducationU.S. Department of Education

Thursday, April 19, 2007, 12:00-1:00Thursday, April 19, 2007, 12:00-1:00

Paul Block, Ph.D., Co-DirectorPaul Block, Ph.D., Co-DirectorPsychological CentersPsychological Centers

Four years laterFour years later

11/30/2002- series of meetings with 11/30/2002- series of meetings with impressive, helpful representatives of impressive, helpful representatives of U.S. Department of EducationU.S. Department of Education

Result: Conviction that the RYSE Result: Conviction that the RYSE model was different from anything model was different from anything we’ve been able to findwe’ve been able to find

Now: 4 years of inconsistent Now: 4 years of inconsistent experience, looking forward to more experience, looking forward to more feedbackfeedback

Fundamental error of school-Fundamental error of school-based services for children based services for children

whose psychological/emotional whose psychological/emotional problems interfere with their problems interfere with their

learning:learning:

Focus on the relationship between Focus on the relationship between psychological/emotional problems psychological/emotional problems and learningand learning

Psychological CentersPsychological Centers

Developed in response to frustration Developed in response to frustration withwith– a lack of community-focus in academic a lack of community-focus in academic

psychological settings but psychological settings but – lack of commitment to state of the art lack of commitment to state of the art

quality in community-focused settings in quality in community-focused settings in which we’d workedwhich we’d worked


Program development process:Program development process:– Identify critical community needs, gaps in Identify critical community needs, gaps in

services, gaps in the quality necessary to reach services, gaps in the quality necessary to reach desired effects, gaps in accessdesired effects, gaps in access

– Determine scientific foundations for best Determine scientific foundations for best approaches to addressing these needsapproaches to addressing these needs

– Because Psychological Centers has no obligation Because Psychological Centers has no obligation to serve any individuals or group, we can seek to serve any individuals or group, we can seek funding to offer best approaches rather than funding to offer best approaches rather than having to take available funding and doing the having to take available funding and doing the best possible with itbest possible with it


Flexibility to adapt services to community Flexibility to adapt services to community needs and preferences:needs and preferences:– No board (just argument between 2 partners)No board (just argument between 2 partners)– No licensing requirementsNo licensing requirements– No accreditationNo accreditation

Resources devoted instead toResources devoted instead to– StaffStaff– clinically-driven quality assuranceclinically-driven quality assurance– sliding scale servicessliding scale services– flexibility to bring services to where people and flexibility to bring services to where people and

needs already areneeds already are

Chariho Regional School Chariho Regional School DistrictDistrict

3 towns (chronic issues)3 towns (chronic issues)– Relatively rural and isolated from the rest of the Relatively rural and isolated from the rest of the

state (1 hour away)state (1 hour away)– Main collaborative program: “Comprehensive Main collaborative program: “Comprehensive

Alternative Program”Alternative Program”– A “comprehensive, integrated, community school A “comprehensive, integrated, community school

model, alternative to out of district placementmodel, alternative to out of district placement– Still referred to as a “clinical day program” though Still referred to as a “clinical day program” though

not solely clinical, solely day, or even solely a not solely clinical, solely day, or even solely a “program”“program”

– Current bond initiative for district buildings Current bond initiative for district buildings including a (cheaper) permanent building for RYSE, including a (cheaper) permanent building for RYSE, inc. the ALPinc. the ALP

Chariho Regional School Chariho Regional School DistrictDistrict

Initial RYSE success led to expansion to Initial RYSE success led to expansion to add small “At-Risk” and Autism Spectrum add small “At-Risk” and Autism Spectrum Disorders programs, district-wide Disorders programs, district-wide consultation, and on-site outpatient consultation, and on-site outpatient services through a rental agreementservices through a rental agreement

Currently proposing a 3-year renewal for Currently proposing a 3-year renewal for all three programsall three programs

School board and community members School board and community members have questions about RYSE and about the have questions about RYSE and about the building bond proposal building bond proposal

RYSE- The historyRYSE- The history Psychological consultation about Psychological consultation about

management of students’ behavioral and management of students’ behavioral and clinical needsclinical needs

District staffs’ frustration with out of district District staffs’ frustration with out of district day programs for SED and severely day programs for SED and severely behaviorally disruptive youth:behaviorally disruptive youth:– Questionable educational qualityQuestionable educational quality– Questionable quality of clinical servicesQuestionable quality of clinical services– Black hole placementsBlack hole placements– Lack of information, coordination, joint planningLack of information, coordination, joint planning– Extremely expensive placementsExtremely expensive placements– Final straw: restraints resulting in broken bones- Final straw: restraints resulting in broken bones-

““not required to follow RI DOE restraint not required to follow RI DOE restraint standards”standards”

RYSE- The ModelRYSE- The Model

OverviewOverview Start with Multisystemic Therapy (MST)Start with Multisystemic Therapy (MST)

– Most evidence for effectiveness addressing seriously Most evidence for effectiveness addressing seriously disruptive behavior (including acute and critically disruptive behavior (including acute and critically dangerous psychiatric conditions)dangerous psychiatric conditions)

High quality special education services High quality special education services following the district’s standards-based following the district’s standards-based curriculumcurriculum– Tailored to the educational needs of the populationTailored to the educational needs of the population– Not only addressing the factors leading to behavioral Not only addressing the factors leading to behavioral

problems but offering rewarding positive alternativesproblems but offering rewarding positive alternatives


Overview (cont.)Overview (cont.) IntegrationIntegration

– One teamOne team– multiple viewpointsmultiple viewpoints– complimentary strengthscomplimentary strengths– supporting each other supporting each other – most important, vs. coordination or case most important, vs. coordination or case

management of services:management of services:Unified decision makingUnified decision making

““RYSE Method” RYSE Method” (paraphrased)(paraphrased)

Jointly developed:Jointly developed:– Formulation targeting school-focused goals (determining Formulation targeting school-focused goals (determining

the biggest barrier to progress)the biggest barrier to progress)– Integrated educational/clinical planIntegrated educational/clinical plan– Concrete intervention steps to persuade (not convince) Concrete intervention steps to persuade (not convince)

relevant parties to perform targeted behaviors. This relevant parties to perform targeted behaviors. This includes mutually determined understanding includes mutually determined understanding of how many contacts of what sort and format will be of how many contacts of what sort and format will be

needed needed to do what specific interventions are necessary to get what to do what specific interventions are necessary to get what

movement started and to keep progress goingmovement started and to keep progress going– This is the time for presentation of clinical judgment, This is the time for presentation of clinical judgment,

argument about approachargument about approach

Interventions implemented as described, based on Interventions implemented as described, based on explicit rationaleexplicit rationale

““RYSE Method” RYSE Method” (paraphrased)(paraphrased)

(cont.)(cont.) Interventions monitored for adherence and outcomesInterventions monitored for adherence and outcomes

– Daily check-insDaily check-ins– Joint home visits to observe & consultJoint home visits to observe & consult– Notes organized around formulation, plan, steps, outcomesNotes organized around formulation, plan, steps, outcomes

Results reported to the teamResults reported to the team– Jointly developed next stepsJointly developed next steps– This is the time, again, for presentation of clinical judgment, argument about This is the time, again, for presentation of clinical judgment, argument about

approachapproach

NotesNotes:: Interactions (inc. pattern of contacts) and interventions are focused on Interactions (inc. pattern of contacts) and interventions are focused on

formulated targets and steps as agreed/describedformulated targets and steps as agreed/described

Interventions are action-oriented, designed to persuade performance of Interventions are action-oriented, designed to persuade performance of specific behaviors that have been formulated to be necessary to reach the specific behaviors that have been formulated to be necessary to reach the formulated intermediate goals (understanding or acceptance of need to formulated intermediate goals (understanding or acceptance of need to take actions are unnecessary, even if potentially helpful, and thus are take actions are unnecessary, even if potentially helpful, and thus are secondary goals; enactment of targeted actions is the goal and focus)secondary goals; enactment of targeted actions is the goal and focus)

Supervision is focused on supporting and monitoring implementation of Supervision is focused on supporting and monitoring implementation of steps as describedsteps as described


Overview (cont.)Overview (cont.) Unlike any therapeutic classroom, clinical school Unlike any therapeutic classroom, clinical school

program, or school-based service we’ve found:program, or school-based service we’ve found:– Clinical team works to address ALL systems involved Clinical team works to address ALL systems involved

with youths’ problematic behaviorwith youths’ problematic behavior– Family, peers, neighborhood, community organizations Family, peers, neighborhood, community organizations

such as churches, sports teams, child-centered activities such as churches, sports teams, child-centered activities and agencies, police, courts, DCYF, etc.and agencies, police, courts, DCYF, etc.

– In all settings and at all times (24/7/365) as needed to In all settings and at all times (24/7/365) as needed to have the desired effectshave the desired effects

– Especially with family- monitoring, control, parental Especially with family- monitoring, control, parental mental health and substance abuse, and family issues mental health and substance abuse, and family issues affecting children’s problemsaffecting children’s problems

Back to the premise:Back to the premise:

Fundamental error of school-based services Fundamental error of school-based services for children whose psychological/emotional for children whose psychological/emotional problems interfere with their learning:problems interfere with their learning:

Focus on the relationship between Focus on the relationship between psychological/emotional problems and psychological/emotional problems and learninglearning

The new premise:The new premise:

To have the necessary effect on psychological To have the necessary effect on psychological and emotional problems preventing access to and emotional problems preventing access to appropriate education, services cannot be appropriate education, services cannot be focused on functioning in schoolfocused on functioning in school

To be successful, services To be successful, services mustmust focus on focus on– all of the reasons for these problemsall of the reasons for these problems– across all systemsacross all systems– especially those at home and in the community especially those at home and in the community

which have the greatest effect on the problems which have the greatest effect on the problems that have to change for students to be able to that have to change for students to be able to learnlearn


Examples we like to give #1:Examples we like to give #1:– Youth doesn’t come to school, clinical Youth doesn’t come to school, clinical

staff have the only relationship that staff have the only relationship that could help him/her decide to attend could help him/her decide to attend (with adequate individual clinical (with adequate individual clinical intervention)intervention)

– Such intervention would not lead to Such intervention would not lead to sustainable change in the factors sustainable change in the factors leading to the youth’s truancyleading to the youth’s truancy


Examples we like to give #2:Examples we like to give #2:– Youths’ serious outbursts in classroom Youths’ serious outbursts in classroom

disrupt the class, interfere with educational disrupt the class, interfere with educational programming and their own learningprogramming and their own learning

– The clinician is called in, consults with the The clinician is called in, consults with the teacher and behavior management teacher and behavior management assistant, understands the factors causing assistant, understands the factors causing the outburst, and…the outburst, and…

– Says, “I got it,” and runs Says, “I got it,” and runs outout of the of the classroom to call the parents or visit the classroom to call the parents or visit the homehome

Details of the RYSE modelDetails of the RYSE model

Educational Services- Intervention Educational Services- Intervention targetstargets– School correlates of School correlates of

behavior/educational problemsbehavior/educational problems:: Low achievementLow achievement DropoutDropout Low commitment to educationLow commitment to education Unfavorable school featuresUnfavorable school features

– Poor structurePoor structure– Large class sizesLarge class sizes– Inadequate educational approach for population Inadequate educational approach for population

(inc. special education services)(inc. special education services)– Lack of access to resourcesLack of access to resources


Educational approach:Educational approach:– An individualized standards-based An individualized standards-based

application of the Chariho curriculumapplication of the Chariho curriculum– Project-Based Learning Project-Based Learning – Vocational Preparation Vocational Preparation – Work-Based Learning and Work Study Work-Based Learning and Work Study

Programs Programs – Weekly community-based service-Weekly community-based service-

learning and community servicelearning and community service


Educational approach:Educational approach:– Extended school day and extended Extended school day and extended

school year educational programmingschool year educational programming– Small, structured classrooms Small, structured classrooms – Positive behavioral programmingPositive behavioral programming– Case management services Case management services – An integrated and coordinated clinical An integrated and coordinated clinical

and educational team for each student and educational team for each student – High school transition plans for post-High school transition plans for post-

school planningschool planning


Educational approach- Behavioral Educational approach- Behavioral programprogram– Point and level systemPoint and level system– Positive behavioral supportsPositive behavioral supports– Structure and environmental Structure and environmental

managementmanagement– Positive optionsPositive options– Clinically driven managementClinically driven management– Clinically focused managementClinically focused management

Details of the RYSE modelDetails of the RYSE model Clinical approach- 1. Alternative approachesClinical approach- 1. Alternative approaches

– Traditional services occur in “un-natural” settings Traditional services occur in “un-natural” settings and thus generalize poorly back to youths’ real livesand thus generalize poorly back to youths’ real lives

– Most traditional interventions focus on the individual Most traditional interventions focus on the individual level and insufficiently on the main factors leading level and insufficiently on the main factors leading to behavioral and educational problemsto behavioral and educational problems

– Out of district placements, residential centers, Out of district placements, residential centers, hospitals, and other un-natural placements have hospitals, and other un-natural placements have little if any evidence of sustainable benefits little if any evidence of sustainable benefits (requiring transitions back to the natural setting (requiring transitions back to the natural setting without the supports that enabled success in without the supports that enabled success in placement)placement)

– Traditional service providers often do not have Traditional service providers often do not have expertise in the known causes or effective expertise in the known causes or effective interventions for significant psychological and interventions for significant psychological and emotional problemsemotional problems


Clinical approach- 2. Intervention targetsClinical approach- 2. Intervention targets– YouthYouth: low verbal skills, positive attitude about : low verbal skills, positive attitude about

negative behavior, psychiatric disordersnegative behavior, psychiatric disorders– FamilyFamily: inadequate parental monitoring, : inadequate parental monitoring,

ineffective discipline (control), low warmth, ineffective discipline (control), low warmth, parental problems (substance abuse, negative parental problems (substance abuse, negative attitudes and behaviors, psychiatric disorders)attitudes and behaviors, psychiatric disorders)

– PeersPeers: association with deviant peers, poor : association with deviant peers, poor relationship skillsrelationship skills

– Neighborhood/CommunityNeighborhood/Community: high mobility, : high mobility, criminal subculture, low availability of support criminal subculture, low availability of support (church, neighbors, etc.)(church, neighbors, etc.)


Clinical approach- 2. Intervention Clinical approach- 2. Intervention targetstargets– Not school-based community mental Not school-based community mental

health serviceshealth services– Services as necessary to decrease the Services as necessary to decrease the

effects of psychological and emotional effects of psychological and emotional problems on learningproblems on learning


Clinical approach- 3. Intervention detailsClinical approach- 3. Intervention details– YouthYouth: individual treatment for psychiatric and : individual treatment for psychiatric and

interpersonal problems as central to ability to interpersonal problems as central to ability to functionfunction

– FamilyFamily: parent engagement (motivational : parent engagement (motivational enhancement), parent training, enhancement), parent training, consulting/coaching/support, family therapy, consulting/coaching/support, family therapy, parent substance abuse and psychiatric treatment, parent substance abuse and psychiatric treatment, case management and resource developmentcase management and resource development

– PeersPeers: removal from deviant peer groups, : removal from deviant peer groups, engagement with positive peer activitiesengagement with positive peer activities

– Neighborhood/CommunityNeighborhood/Community: identification and : identification and connection with local supportsconnection with local supports

Clinical teamClinical team Up to 29 students (inc. 45 day Up to 29 students (inc. 45 day

assessments)assessments) Doctoral Psychologist Clinical DirectorDoctoral Psychologist Clinical Director 3 Masters level clinicians3 Masters level clinicians 1 service learning coordinator/case 1 service learning coordinator/case

managermanager Part time psychiatristPart time psychiatrist Agency consultation (inc. specialty Agency consultation (inc. specialty

psychological evaluations and psychological evaluations and consultation) and oversightconsultation) and oversight


Clinical approach- 3. Intervention Clinical approach- 3. Intervention detailsdetails

– MST decreases behavioral problems, MST decreases behavioral problems, improves long term pro-social improves long term pro-social adjustment and outcomes, decreases adjustment and outcomes, decreases out of home placements, reduces out of home placements, reduces recidivism for legal problems and recidivism for legal problems and psychiatric hospitalizationspsychiatric hospitalizations

– Often perceived as “like <other Often perceived as “like <other programs>”programs>”

Distinguishing characteristics of MST:

Focus on factors found in scientific research to cause target problems, as relevant for each youth and family– Vs. focus on factors identified as important by individual

clinicians (usual practices)

Use of interventions that have been proven effective for addressing identified targets– Vs. use of interventions based on “treatment as usual”

(usual practices)

Ongoing training and consultation from international experts in severe childhood behavioral disorders (who themselves receive ongoing training, consultation, and feedback from independent evaluation regarding their support for community providers)– Vs. ongoing training and supervision by local program

directors (usual practices)

Distinguishing characteristics of MST:

Direct, independent measurement of interventions actually used in treatment interactions– Vs. reliance on clinician (and family) report of interventions

actually used in treatment interactions (usual practices)

Independent measurement of outcomes including post-treatment evaluation of maintenance of gains– Vs. no outcome evaluation, or pre-post evaluation

implemented by treatment personnel (usual practices)

Multiple controlled trials proving greater effectiveness than alternatives, and evaluations from community-based application in 30 states and several countries proving success at achieving real world desired outcomes– Vs. no scientific evidence of effectiveness, especially

compared to alternatives (usual practices)

Scientifically supported services Services as usual

Scientific foundation

Multiple controlled trials proving greater effectiveness than alternatives

Limited scientific evidence, especially compared to alternatives

Relevance Evaluations of success at achieving real world outcomes in community-based applications

Limited evidence of effectiveness in real world settings, especially compared to alternatives

Focus Factors found in scientific research to cause target problems, as relevant for each youth and family

Factors identified as important by individual clinicians

Interventions Proven effective for addressing identified targets

Based on clinical expertise and “treatment as usual”

Clinician role Developing sustainability through empowerment of youths’ caregivers with necessary skills and resources

Provision of interventions that directly affect disruptive teenagers’ problem behaviors and dysfunction

Training and supervision

By experts in relevant clinical science By program supervisors with relevant clinical experience

Monitoring interventions

Direct, independent measurement of interventions actually used

Reliance on clinician (and family) report of interventions actually used

Outcome measurement

Independent measurement including post-treatment maintenance of gains

Pre-post evaluation implemented by treatment personnel

RYSE vs. MSTRYSE vs. MST

Services provided as long as students Services provided as long as students need assistance to succeed in schoolneed assistance to succeed in school

IEP driven services require parental IEP driven services require parental consentconsent

Focus on any psychological/emotional Focus on any psychological/emotional factors affecting educational successfactors affecting educational success

Services provided in and offered Services provided in and offered through school (inc. resulting through school (inc. resulting relationship and expectations)relationship and expectations)


Increased case loads (9 or 10, vs. 5-6)Increased case loads (9 or 10, vs. 5-6) Increased need for and focus on alliance Increased need for and focus on alliance

and engagementand engagement Closer collaboration with educational staff Closer collaboration with educational staff

and integration with educational servicesand integration with educational services Less external pressure to comply/succeedLess external pressure to comply/succeed Greater need to focus on educational Greater need to focus on educational

outcomes and school behavioroutcomes and school behavior

RYSE vs. MSTRYSE vs. MST Similar focus on factors at all levels and in all Similar focus on factors at all levels and in all

systems formulated to be driving problemssystems formulated to be driving problems Similar flexible availability when, where, and Similar flexible availability when, where, and

as needed at that pointas needed at that point Similar focus on sustainable, real-world Similar focus on sustainable, real-world

outcomesoutcomes Similar commitment to do whatever it takesSimilar commitment to do whatever it takes Similar intensity and urgency of services Similar intensity and urgency of services

addressing problems in time to prevent addressing problems in time to prevent negative consequencesnegative consequences


Both differ significantly from typical Both differ significantly from typical therapy or treatment services:therapy or treatment services:– Focus on mutually defined goals, translated Focus on mutually defined goals, translated

into specific immediate goals to be metinto specific immediate goals to be met– Focus on whatever is currently driving Focus on whatever is currently driving

targetstargets– Focus on caregivers or other key members Focus on caregivers or other key members

of youths’ lives taking specific actions of youths’ lives taking specific actions required to achieve immediate goalsrequired to achieve immediate goals

RYSE vs. MSTRYSE vs. MST Unlike therapy focus on engagement in a process Unlike therapy focus on engagement in a process

of becoming ready to do what is necessary to of becoming ready to do what is necessary to achieve targeted improvementsachieve targeted improvements

Intervening aggressively to effect changes in Intervening aggressively to effect changes in behavior now that are necessary to reach behavior now that are necessary to reach immediate goals nowimmediate goals now– Building on strengthsBuilding on strengths– Addressing barriers (pushing through them, not working Addressing barriers (pushing through them, not working

them through)them through)– Intensity sufficient to reach immediate goals as Intensity sufficient to reach immediate goals as

necessarynecessary– Contact and intervention format tailored to what will be Contact and intervention format tailored to what will be

needed to effect needed change as quickly as neededneeded to effect needed change as quickly as needed

RYSE OutcomesRYSE Outcomes

Clinical results:Clinical results:– 21 students (30%) moved out of district21 students (30%) moved out of district– 3 students (4%) were residentially placed 3 students (4%) were residentially placed

by DCYFby DCYF– 3 students (4%) were residentially placed 3 students (4%) were residentially placed

by Family Courtby Family Court– No students have been remanded to the No students have been remanded to the

RI Training School for Youth (juvenile RI Training School for Youth (juvenile detention)detention)

– We identified 5 students (7%) arrested We identified 5 students (7%) arrested during enrollment at RYSEduring enrollment at RYSE

RYSE OutcomesRYSE Outcomes Educational results: behavior at school Educational results: behavior at school

(is it risky to have these children on campus?)(is it risky to have these children on campus?)– 86-89% daily attendance86-89% daily attendance– Only 2 students have been brought to the school Only 2 students have been brought to the school

committee for disciplinary reasons in 4 years (vs. committee for disciplinary reasons in 4 years (vs. 20-25/year for High School)20-25/year for High School)

– No instances of drugs or weapons within the school No instances of drugs or weapons within the school and only one on campusand only one on campus

– No physical alterations between students and staff; No physical alterations between students and staff; only two minor physical altercations between only two minor physical altercations between studentsstudents

– No disciplinary removals from regular district No disciplinary removals from regular district transportationtransportation

– No incidents at sports, dance, or other No incidents at sports, dance, or other extracurricular activitiesextracurricular activities

RYSE OutcomesRYSE Outcomes

Educational results: Educational results: (can these students learn?)(can these students learn?)– 96% of all students have earned the grades 96% of all students have earned the grades

and credits to be promoted to next gradeand credits to be promoted to next grade– 25% of students have completed one or 25% of students have completed one or

more classes within the Middle School, High more classes within the Middle School, High School, or regional Career and Tech CenterSchool, or regional Career and Tech Center

– 86% of eligible students recouped lost 86% of eligible students recouped lost credits to regain appropriate academic credits to regain appropriate academic standingstanding

– 5 of 69 students (7%) dropped out prior to 5 of 69 students (7%) dropped out prior to graduation, 2 of whom left for full time jobsgraduation, 2 of whom left for full time jobs

RYSE OutcomesRYSE Outcomes Educational results: Educational results:

(can these students succeed?)(can these students succeed?)– 92% graduation rate (11/12 eligible)92% graduation rate (11/12 eligible)

Only RI school in 2006 to be listed as having 100% Only RI school in 2006 to be listed as having 100% graduation rategraduation rate

– Post-graduation successPost-graduation success 3 enrolled in or accepted to college, 1 in adult education 3 enrolled in or accepted to college, 1 in adult education

and vocational apprenticeshipand vocational apprenticeship 4 with full time employment, 1 business owner4 with full time employment, 1 business owner 2 receiving adult mental health services for SPMI2 receiving adult mental health services for SPMI

– 2007: 4 seniors, all expected to graduate2007: 4 seniors, all expected to graduate 1 accepted to college, 2 applying, 1 seeking employment1 accepted to college, 2 applying, 1 seeking employment

RYSE OutcomesRYSE Outcomes Educational results: Educational results:

(Does this educational model work?)(Does this educational model work?)– All Chariho’s schools, including RYSE meet All Chariho’s schools, including RYSE meet

standards as “High Performing”standards as “High Performing”

– RYSE is Chariho’s only school that is High RYSE is Chariho’s only school that is High Performing “with Regents Commendation”Performing “with Regents Commendation”

Note that this is the only clinical school program in the Note that this is the only clinical school program in the state reporting results independentlystate reporting results independently

Note that private clinical program students’ test scores Note that private clinical program students’ test scores are reported out of the home districtare reported out of the home district

Note that this is the only clinical school program in the Note that this is the only clinical school program in the state that is required to have highly qualified teachersstate that is required to have highly qualified teachers

ConclusionConclusion It is necessary to move beyond the fundamental It is necessary to move beyond the fundamental

error of school-based services for children whose error of school-based services for children whose psychological/emotional problems interfere with psychological/emotional problems interfere with their learningtheir learning

Services can have the desired effect on Services can have the desired effect on psychological and emotional problems to enable psychological and emotional problems to enable access to appropriate educationaccess to appropriate education

Services that focus onServices that focus on– all of the reasons for these problems across all systemsall of the reasons for these problems across all systems– especially those at home and in the community which especially those at home and in the community which

have the greatest effect on the problems that have to have the greatest effect on the problems that have to change for students to be able to learnchange for students to be able to learn

– WILL lead to improved outcomes, both during school WILL lead to improved outcomes, both during school years and into later lifeyears and into later life

Contact information:Contact information:

Paul Block, Ph.D.Paul Block, Ph.D.Director, Psychological CentersDirector, Psychological Centers765 Allens Avenue765 Allens AvenueProvidence, RI 02905Providence, RI 02905(401) 490-8935(401) 490-8935

[email protected]@[email protected]@PCRI.US

Don’t stop yet!

The question I’m waiting forThe question I’m waiting for

Anything can be done with enough Anything can be done with enough resources. Is this approach resources. Is this approach affordable?affordable?

The answer I was waiting to The answer I was waiting to givegive

We have saved the district at least We have saved the district at least between $200-300,000 every year, between $200-300,000 every year, and could save somewhat more.and could save somewhat more.

This not only works, but it’s This not only works, but it’s affordable.affordable.

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