When students are struggling with health conditions, educators can respond with multi-tiered systems of support (MTSS) to help their students succeed under difficult circumstances. Join us for the continuation of our Health Barriers to Learning series with guests Ashley Pitts and Emily McCracken of the Colquitt County School District.

Ashley Pitts and Emily McCracken in Classroom Conversations

When students are struggling with health conditions, educators can respond with multi-tiered systems of support (MTSS) to help their students succeed under difficult circumstances. Join us for the continuation of our Health Barriers to Learning series with guests Ashley Pitts and Emily McCracken of the Colquitt County School District.

TRANSCRIPT

 

Ashley Mengwasser: Hi there. Welcome to Classroom Conversations, the platform for Georgia's teachers. Hope you're enjoying season six content so far. I'm Ashley Mengwasser, your host and educator super fan. If you're new to what we do here, Classroom Conversations is a joint production of your two statewide teacher support systems, the Georgia Department of Education and Georgia Public Broadcasting. Right now I'm sitting in the studio at GPB in Midtown Atlanta, champing at the bit to introduce a new series, For the Health of It. This season, we're presenting a handful of helpful episodes about health barriers to learning. There can be many facing our students. And trust me, they're critical. Unaddressed vision or hearing problems, dental pain, persistent hunger, language development, uncontrolled asthma, lead exposure, even behavioral and mental health problem. Just think of one student with just a single one of these barriers. Hold them in your mind's eye. Georgia DOE says that when left undetected or unaddressed health barriers to learning, interfere with that student's ability to learn. And it can stymie physical, emotional, and cognitive development in the student. Once you've seen a student battle one of these health barriers, rectifying the situation can start to feel personal for teachers. But how do you do that? Whatever the health barrier to learning, how do educators address barriers in the classroom to ensure their students are successful? The answer is our topic today. Integrated MTSS, multi-tiered system of supports. This prevention and response framework helps meet the needs of the whole child health included. Just take it from my expert guests. Ashley Pitts is whole child support specialist at Doerun elementary school and she is on a mission alongside Emily McCracken, classroom special education teacher. On today's episode, these two educators will demonstrate using their masterful talents, how true whole child supports result in amazing student outcomes. That sounded a bit like a magic act. The amazing Wallendas. And here they are from Colquitt County School District, Ashley Pitts and Emily McCracken. Welcome ladies.

Ashley Pitts: Thank you. Glad to be here.

Ashley Mengwasser: How are you?

Ashley Pitts: Good.

Emily McCracken: Good.

Ashley Mengwasser: Good. What was that drive from Colquitt County to here in Midtown?

Ashley Pitts: About three and a half hours.

Ashley Mengwasser: Yeah. I appreciate you guys making the drive and I'm glad you're doing well. I don't think I've ever hosted an episode where both of my educator guests own campers. Is that a club you have to be a part of? I'm not sure. Fill me in Emily.

Emily McCracken: It is. It's a club.

Ashley Mengwasser: It is. Where do you get your membership card? Not at Costco.

Emily McCracken: Just from us. We hold all the member cards ourselves.

Ashley Mengwasser: Okay, well please let a sister in. I don't know a single person in Georgia with a camper now. I know too.

Emily McCracken: Wow.

Ashley Mengwasser: Thanks for coming to the show and expanding my horizons. Give us a sense of what grades you work with and your roles at Doerun. Ashley, you first?

Ashley Pitts: Sure. I work pre-K through fifth grade and my role is the whole child support specialist.

Ashley Mengwasser: Supporting the whole child. What does that mean?

Ashley Pitts: So, supporting the whole child is looking at if a child needs any supports, whether it be educational or developmental, behavioral, social, emotional or seeing if there are any health barriers and helping to address those as well. And then giving the child those support so they can be successful in all areas, not just academically.

Ashley Mengwasser: I can't wait to see what that looks like today. And Emily, tell us about your role as classroom special education teacher.

Emily McCracken: This year I am supporting kindergarten and first grade.

Ashley Mengwasser: And how long have you been in this role?

Emily McCracken: Just this year?

Ashley Mengwasser: Brand new. What made you transition to special education?

Emily McCracken: This is not my first time in special education. I taught ninth grade English special education and ninth grade English regular education. Then I moved to fifth grade where I taught math, science and social studies, and then I moved to second grade where I taught everything.

Ashley Mengwasser: So, you're going backwards chronologically.

Emily McCracken: Yes. And now I'm in kindergarten and first. All right. Well thank you for being with us today. Ashley. How does a whole child support specialist compare to other roles? I'm thinking of a behavior support specialist or a behavior interventionist. How's it different?

Ashley Pitts: Right. That's a great question. I began this journey as a behavior interventionist and as a behavior interventionist, I would seek to solve students' behavioral issues or behavioral problems. And a lot of times that was with specific supports, which were behavioral. Needs-based, behavioral supports. It may be something we call check-in, check out where a student would check in with an adult each day and then go throughout their day and see how they're doing with the rules. And then the end of the day they would check out with the same adult.

Ashley Mengwasser: I like that. Check-in, check out.

Ashley Pitts: Right. And so that supports the child's needs for monitoring themselves behaviorally. And that's really what we did with behavior. But when we look at the framework for the whole child support, when I dig down, I find more specific needs. So if they do have a deficit in oral care or they have oral issues, it's my job to work with parents and we have a dental bus that comes to the school.

Ashley Mengwasser: A dental bus.

Ashley Pitts: A dental bus. And they take all kinds of insurance including state-provided insurance.

Ashley Mengwasser: Oh my gosh.

Ashley Pitts: So, we hook that up with a parent so the students can get their teeth cleaned at the school without the parents having to be there. So we're breaking those barriers as far as transportation and costs, those sorts of things. But also I have students that come to my classroom every day and brush their teeth in the morning.

Ashley Mengwasser: Look at that.

Ashley Pitts: So, it is more than just seeing the behavior but digging down more into root causes. And there are many root causes, not just oral issues. There may be sensory issues. I won a grant and created a sensory room at our school. And so we give specific sensory supports for children who need those. As a whole child support specialist, I look at all of those health barriers that you talked about earlier. And we do screeners. I work with our school nurse, I work with the teachers, I work with the social worker and we have some community partnerships as well. Not only looking at their behavioral needs and trying to make sure they follow the rules, but also just supporting them as individuals.

Ashley Mengwasser: Yeah. As individual learners. And you said whole child. I love this phrase, we'll get into this in a second. But you were talking to me about how behavior, it's a symptom of something deeper. So you're trying to get to the root cause. Love the dental bus. I often joke that I would rather go to the dentist than the grocery store. I love going to the dentist.

Ashley Pitts: Not us.

Ashley Mengwasser: I'm a weirdo. So to know that there's a dental bus option for kids sounds very exciting to me. But one of the things you guys told me when we first met was about how many times you will see a concerning behavior or a student will be missing a learning target. And then when you do dig deep, you see that there could be a health barrier at play here. So you're trying, like you said, Ashley, to get to that root cause. A case in point, Emily, you had a story I'd love for you to share with our audience. It was a couple of years ago when you were a classroom teacher and you said before you knew about whole child, here's an example of what was happening. Can you take us through that?

Emily McCracken: I can. So I had a student who would steal lunchboxes. And when asked why he stole the lunchbox, it's because he was hungry. He wasn't stealing it to be mean. He was stealing it to feel a need that he had. And then I worked with Ashley and we created a system where he had a little card on my desk and then he needed a snack. He would go get the card. He didn't have to say anything to me. I saw him taking the card. He would go to Ms. Ashley, he would get a snack, he would come back to class. So he did not have to steal a lunchbox. And then we worked with the school counselor and she has a program where there's some local churches and other people in the community that will donate food to the school. And she sends home a backpack. It's a weekend backpack food bag. And we got him one of those so he would be able to have food at home when he didn't have it to meet those needs as well.

Ashley Mengwasser: So, you were seeing a concerning behavior, but punishment wouldn't have worked because it wasn't really a behavioral issue, it was a health barrier issue.

Emily McCracken: Yes.

Ashley Mengwasser: It was hunger. We're going to get into this deeper and I'm really fascinated by it.

Ashley Pitts: I'm going to just add something to that if I could.

Ashley Mengwasser: Yeah.

Ashley Pitts: The same student when you talk about punishment, wouldn't work, the student also, he didn't have adequate housing and so he wasn't getting the sleep in the rest that he needed. So he would actually do things to get in trouble and he'd go to the office and while he waited to see the principal, he would take a nap.

Ashley Mengwasser: He could rest.

Ashley Pitts: He took a nap.

Emily McCracken: One time, he just got up, crossed the classroom, said something to another student and looked at me and said, "I'm going to the office now."

Ashley Mengwasser: Oh, he sent himself to the office.

Emily McCracken: Yeah. So he could take a nap. I'm like, "You can't get written up to take a nap. We got to work something out. We can't do that."

Ashley Mengwasser: Because you're right, these are real needs that have to be met before students can learn. Well, I mentioned earlier that watching a student like this struggle with health barrier to learning can feel very personal for teachers. You're invested in their success, but for each of you, it is personal largely because you've dealt with this in your own life. So Ashley, talk to us first about Oliver and your connection to whole child support personally.

Ashley Pitts: Absolutely. Oliver is my son who's eight years old, and Oliver has an autoimmune condition called Pandas, which is pediatric autoimmune disorder with neurological symptoms associated with strep. So a lot of times we think about strep with strep throat, but sometimes people get scarlet fever, which is when strep gets into the epidermis.

Ashley Mengwasser: Oh, that's caused by strep.

Ashley Pitts: That's caused by strep.

Ashley Mengwasser: My dad had that when I was little.

Ashley Pitts: Yeah.

Ashley Mengwasser: Wow.

Ashley Pitts: So that's strep induced. And rheumatic fever is when the heart becomes inflamed and it's also caused by strep. And Pandas is when strep causes inflammation in the brain and it targets a specific part of the brain that controls our fight and flight and also decision making and impulse control. And so students or children with Pandas have trouble with impulses, have trouble with fight or flight, and there's an onslaught of symptoms, but it is an acute syndrome. So it happens quickly.

Ashley Mengwasser: Really.

Ashley Pitts: They get strep and then maybe two days later they're a completely different child. And that happened to my son when he was five. And it was like we didn't know who this child was and he was having panic attacks that really looked like aggression. He had developed OCD overnight. And when those compulsions were not fulfilled or he wasn't able to feel them ... One was hand washing, he would have a panic attack that seemed aggressive. He would throw things or he would hit people. But it was because he was not being able to fulfill the compulsion. And as a behavior specialist at the time or behavior interventionist, it was deeply personal because I wasn't able to help my child even though I could help so many other children. But what didn't understand that I do now is that Pandas is a medical problem and instead of having mental health supports in place, he needed medical interventions. And his medical interventions include long-term antibiotics, long-term antivirals, and he got a plasma infusion to help support his immune system and now he's doing really well. But there was no amount of behavior supports or mental health medications or stimulants.

Ashley Mengwasser: That was going to help him.

Ashley Pitts: Nothing would've helped him because it was truly, he had inflammation in his brain, and it was a medical cause.

Ashley Mengwasser: It was a medical cause. Thanks for talking about Oliver and Emily, one of your own sons has faced a health barrier in his life. Would you like to share about that?

Emily McCracken: He has. So my son, he failed the hearing test at school and we went to the doctor and they did hear a test on him and they were like, "Ah, he's fine. He can hear." But he would constantly, if he was listening to the radio, say, "Can you turn it up? I can't hear it." If he was watching TV, he'd be like, "Can you turn it up? I can't hear it." I'm like, "A child doesn't ask you to turn things up just for no reason." So I requested from the doctor that we go to the ENT. The ENT checked his ears, he said, "They look good. They're clean." So he sent us to the audiologist and she tested his ears. She even went around the ear because you can hear through the bone and tested the bone and he wasn't hearing everything. So she says it's nerve damage. She said but it's not really a nerve, that's just what they call it. So it's not vibrating correctly so he doesn't hear everything. So that's how he got hearing aids. But not because the doctor said he needed them, because I requested that we go because it still wasn't right.

Ashley Mengwasser: Yeah. Yeah. And I think it's important to point out a lot of parents might not notice some of these behaviors at home. It might take them being in a learning environment where they're asked to achieve and they're asked to focus and some of these other things and feel emotionally challenged by being with their peers that this might arise. So we really are looking at our schools and at our teachers to raise the red flag if something is wrong here. I do think we need a definition here before we move forward though, about what the whole child approach is because it does seem to be a bit of a buzzword these days. So can we just get in a sentence, Ashley, what does whole child approach mean to you?

Ashley Pitts: To me, whole child approach means that you are digging into all the needs of the child to see specifically what barriers they have and how you can support them.

Ashley Mengwasser: Very nice. Anything to add Emily to that?

Emily McCracken: I think it's more than looking at their academics. It's looking at like she said, those barriers. What is causing them to be behind in academics or behavior or emotionally or socially? What is causing it, not what is the problem?

Ashley Mengwasser: Yes. Good point. Get to the root. I wonder if there's a whole adult approach because I feel like there can definitely be some things that I need to feel supported before I'm successful professionally. For me it's a clean house. Little secret to you guys. I don't like my house to look like anyone lives there. I want to cook like a staged home all the time. Until my house is clean and I've revved up my vacuum cleaner I cannot focus on work. Another thing that I learned about ... I learned all this in college. We had this great exercise called the resistances to work worksheet. It's like what do you have to have done before you can focus on work? And for me it was having a clean environment, vacuuming, not being hangry because who can work on an empty stomach?

Emily McCracken: Me too. Me too.

Ashley Mengwasser: Yeah, exactly. Like your lunchbox thief there. And I also learned if there's any emotional unrest in my day, if I'm in odds with a family member or a friend, I have to resolve it first. Otherwise, I'm preoccupied with that situation. So just wondering, for you two as adults yourselves, what would be part of your whole adult approach? What do you need before you can achieve professionally in your schools?

Ashley Pitts: I think this is a great question and I think it's so interesting because as adults oftentimes we don't even know the answer to that.

Ashley Mengwasser: Good point.

Ashley Pitts: And so, when I think about our students, it's our job to dig down and help them figure that out. Personally, I think the last four years I've really been exploring that question through my own mental health and therapy and seeing those types of things. For me, I think I need to feel safe emotionally and physically. I need to feel safe in my environment and I need to feel that the ones who I'm close to are safe. I need to know that my children are safe, that my husband is safe. If I'm working with students, I need to know that they are safe. I need to know that I'm providing a safe environment for them as well. The clean thing doesn't really bother me.

Ashley Mengwasser: Good for you.

Ashley Pitts: I do like organization. I do like things to be organized, but if there's a mess that's not really going to bother me. But Emily May have something different to say about that one.

Ashley Mengwasser: I'm very curious what she's going to say. Emily, your turn.

Emily McCracken: I need things to be clean and organized or I can't function. I had to vacuum and mop my house before I came.

Ashley Mengwasser: You get it. Yeah.

Emily McCracken: I do.

Ashley Mengwasser: So, you could achieve here today.

Emily McCracken: Yes.

Ashley Mengwasser: And your success is directly linked to that vacuum cleaner.

Emily McCracken: I'm going to be thinking about how the house is dirty while I'm not there.

Ashley Mengwasser: Exactly. Anything else?

Emily McCracken: I need to feel like if I have something that I can't solve or I need help that there's people there that will support me and work with me.

Ashley Mengwasser: Collaborators.

Emily McCracken: Yes.

Ashley Mengwasser: The whole adult approach. Worth exploring I think. Speaking of whole adults, I'm curious who you guys are outside of your classroom. I know Ashley, you've got district teacher of the year under your belt.

Ashley Pitts: I do.

Ashley Mengwasser: In your past. And you also call yourself ... I didn't know these two things could go together, but a people pleaser and a percussionist. Please explain

Ashley Pitts: People pleaser percussionist. I am a recovering people pleaser.

Ashley Mengwasser: I like it.

Ashley Pitts: A recovering people pleaser. I try to be proud of myself now more than make others proud of me. I work towards fulfilling my own desires and needs to be proud of myself more than others' desires and needs. But percussionist, I am a therapeutic drumming instructor.

Ashley Mengwasser: Wow. What kind of drums?

Ashley Pitts: We use djembe and dununs. We use traditional West African drums.

Ashley Mengwasser: How does that work?

Ashley Pitts: I have been trained through a program called TDI, which is Therapeutic Drumming Instruction. I'm going to throw a name out. Mr. Tom Harris runs TDI. He's had lots of trainings, but we have been trained in our district to do therapeutic drumming with our students. And it has really shown ... They have done a lot of research behind the regulation that not only the rhythms can cause the regulation, but also drumming, the vibrations cause your brain to create alpha brain waves, which are the best brain waves because they give you a sense of calm but also focus. And when we think about not just students, but anyone, usually calm, you're not very focused. You may think calm is relaxed and chilled out, but calm and focused is where we really want to ... That's the best place to be for learning. So you're in a calm state, but you're also very focused and you're able to do it.

Ashley Mengwasser: Alert.

Ashley Pitts: Yes. Alert but not highly alert.

Ashley Mengwasser: Right. Right. Because that would be anxiety.

Ashley Pitts: Right.

Ashley Mengwasser: Got a little too far the other way. So are you just walking around the school with your drums? Like here comes Mrs. Pitts?

Ashley Pitts: No. I run intervention groups with drummers. Some of our most challenging behaviors in schools are from students who are dysregulated. They're nervous system are dysregulated, whether it be a problem such as a diagnosed problem or whether it be trauma, whether it just be they had a bad morning. The dysregulation is what's going to cause them to be disruptive in class. It's going to cause them to not be engaged. And so first thing in the morning, every day of the week I get to do 30 to 45 minutes of drumming, which is very helpful for me as well because I get my alpha brainwaves on fleek during that time.

Ashley Mengwasser: I'm glad on fleek is still alive. I was wondering the other day.

Ashley Pitts: It's really not. I'm just that old. So we drum every day. Those are our students with the most challenging behavior. And we really notice a difference in the classroom on days they're able to drum versus days they're not able to drum. And Ms. McCracken can really speak to that because she was a homeroom teacher of some students with some pretty intense needs when we first started the program. So she had students that were my first cohort of drummers.

Ashley Mengwasser: Who doesn't love a rhythm section? Tell me about this, how this worked your classroom.

Emily McCracken: So back then she did not get them every day. She would only get them one or maybe two times a week. And the days where she did get them, we actually achieved work. We were able to focus. You could tell learning was going on. There was an outcome. On days she didn't get them, we probably ended up in the office.

Ashley Mengwasser: Yeah. Gotcha.

Ashley Pitts: She had several elopers, and it really got to where instead of you couldn't find them or we had to shut down the school or find help, they would run to my classroom and they would come and they would even advocate for their self and say, "I need to drum a little while."

Ashley Mengwasser: Wow.

Ashley Pitts: So even as children, they can see, or they can sense that difference and know and begin to self-advocate for what they need.

Ashley Mengwasser: Excellent. That's incredible. They're helping themselves regulate.

Ashley Pitts: Absolutely.

Ashley Mengwasser: That's a beautiful story. Another thing about you personally Ashley, like me, you're a Halloween gal, but Emily over here is most looking forward to Christmas.

Emily McCracken: I am.

Ashley Mengwasser: Tell us about your personal life Emily. When I first asked what you like to do for fun, you said, "Wow. You've clearly never been to South Georgia."

Emily McCracken: That's why we have campers so we can get out of South Georgia.

Ashley Mengwasser: Exactly. Talk to me about some of your interests.

Emily McCracken: We do like to go camping. As a family we like to come up to the mountains where there's coolness and no gnats.

Ashley Mengwasser: Yes. No gnats.

Emily McCracken: Yes.

Ashley Mengwasser: No gnat Georgia.

Emily McCracken: That's something my boys enjoy too. We're very active in our church.

Ashley Mengwasser: Yeah. And you're using your special education training there.

Emily McCracken: I am. So I am would say I do what Ashley does at church, but I don't actually have a class. I'm there to support kindergarten through second grade when they have behavior needs or they have a student that they don't know what to do with. So I had one student who wouldn't go into whole group and I was like, "I think it's too loud. I don't think he enjoys that sensory input." So we ordered him some noise-canceling headphones and the next week when he put them on, he was able to go in the whole group because he was not so overstimulated by all the children and the singing and the dancing and the noise.

Ashley Mengwasser: Yes. There you go. One thing you guys are teaching me about this approach is that it's really curiosity, not criticism.

Ashley Pitts: Absolutely.

Ashley Mengwasser: That you're trying to do that data gathering and that information gathering. Another thing you said that I find hilarious, Emily, is that you're big readers at home and you like to limit TV use.

Emily McCracken: Yes.

Ashley Mengwasser: What's your rationale?

Emily McCracken: Because my oldest son does have ADHD, and it just overstimulates him and then he becomes emotionally dysregulated and that becomes his hyper fixation. But he is a big reader. He does love to read. So taking away his book is more punishment to him than taking away the TV.

Ashley Mengwasser: Look at you. Good parenting. Good parenting 101. But you definitely get things McCracken in your household.

Emily McCracken: Yes.

Ashley Mengwasser: Emily McCracken. Okay. Let's talk about integrated MTSS, which is why we're all here today. Before we examine the way that we can use integrated MTSS to address health barriers to learning can one of you give us some background on the purpose of the framework and the tiers? MTSS. How many tiers are there?

Emily McCracken: There are three. MTSS is a multi-tier system of support. They call it a pyramid. And it used to have four tiers, but now it's three tiers and it's a pyramid because you have academics, social, emotional, behavioral. They're different sides of the pyramid.

Ashley Mengwasser: Oh, different faces.

Emily McCracken: Yes. And they all come together to make a whole child. And so you may be on the tier one in behavior, you may be the best behaved student in the school, but socially and emotionally you're in a tier three-

Ashley Mengwasser: On the other side.

Emily McCracken: Because you have some unsolved issues that need support.

Ashley Mengwasser: Intervention. Yes.

Emily McCracken: So you may be on different tiers, on different spaces of the pyramid.

Ashley Pitts: And then maybe you are in tier two for academics. But we can also think about it as a three braid rope. And the three parts are behavior, academic, social emotional. And we take those three braids and we intertwine them and create one rope, which is the whole child.

Emily McCracken: At tier one of the pyramid. That's your primary level of prevention. That's your instruction, that's your core curriculum, be it academics, be it social emotional, be it behavioral, kids don't know what they don't know. They don't know that they're social emotional, they just know something's not right and they need help with it. That's every kid across the board. And then tier two is the secondary level of prevention. That's where an intervention comes in. Maybe they need some help. Like Ms. Ashley was saying, they may get it in the classroom in a small group, they may get it during PE, they may get it from the nurse just depending on what that is. They may get a food bag from the counselor or the social worker. And then tier three, that's where your highest level of support is. That's where your intensive interventions are coming in.

Ashley Mengwasser: You told me that we are an MTSS system in your school system. What does that mean?

Ashley Pitts: That means that we have a guaranteed and viable curriculum at tier one and every student receives that guaranteed and viable curriculum. And at tier two we have data-driven and research-based interventions to help students who need a little more support. You will see these interventions being given in the classroom in a small group setting. They're not pulled out of the classroom. Tier three support would be a small group setting, but maybe it's out of the classroom in an intervention room or for me, we do it a lot of times in the drumming room.

Ashley Mengwasser: Of course.

Ashley Pitts: You may also see some one-on-one support given at tier three. But as a system, as a district, we maintain those same interventions from school to school. We do have a lot of migrant population in our district and this is really important because if they're receiving something at our school and they move to the other side of the county, they can continue receiving those things that work for them because as a school system, we maintain those same products or those same curriculums.

Ashley Mengwasser: Nice. And let's take just for an example, a health barrier like asthma, something respiratory. Tell us about how your school's multi-tiered system of supports framework has evolved over the years to meet the needs of students at the base level. I know you told me that there are certain things that come standard in your school and that are not in your school in order to protect those students.

Ashley Pitts: Right. Absolutely. When we think about those levels of support, we want to give all students a base level that is most supportive to everyone. So if we think about asthma, the first thing you think may be an inhaler. A student needs inhalers. However, those same students, they need a smoke-free environment. And so we're giving that to all the students. They need an environment that's clean and has minimal or limited dust or extra particles.

Ashley Mengwasser: Allergens.

Ashley Pitts: Allergens. So we don't have any carpet in our school.

Ashley Mengwasser: None.

Ashley Pitts: No carpet in our school. And there's a schedule that's maintained by our maintenance crew that they're changing the air conditioner filters on a specific schedule. So these are all things that are at the tier one level, it supports every single student, but that's also going to support those students with asthma or maybe even prevent those that are on the edge of having asthma.

Ashley Mengwasser: Very good example. Anything else you would like to add, Emily, about how we might see some specific baseline offering in your school system that helps with MTSS?

Emily McCracken: It's also encouraged not to use smells.

Ashley Mengwasser: Oh yeah.

Emily McCracken: Because that can set off the ... Even kids with allergies if they're allergic to the smells, but also the kids with asthma and some kids just don't like the smell. That's like a tier one across the system. You're not supposed to use smells. They're not supposed to use cleaning products that have smells just to help with that.

Ashley Mengwasser: The chemical scents.

Emily McCracken: Yes.

Ashley Mengwasser: How has your own perception and understanding of MTSS evolved over time?

Emily McCracken: When I first started as a teacher, we just did our own, oh, these kids are behind, we need to have a meeting with the parents. Let them know they're behind. You let administration know. We had some documentation that we kept up with, but it was very ... Teachers took care of it. It wasn't like a school focus.

Ashley Mengwasser: System wide.

Emily McCracken: Yes.

Ashley Mengwasser: That's one big change. What about for you, Ashley?

Ashley Pitts: Absolutely. I agree with her. I taught first grade for five years, third grade for six years. And it was very much, I took care of the in my four walls. And now we look at our students are our students, like the students in third grade are also, my students. They're also Ms. McCracken students. They are the fifth grade teacher students, the pre-K teacher students, the custodian students, the nurses students. So we really take ownership of all students learning. And when I say learning, I don't just mean academically, I mean socially, emotionally, behaviorally, the whole child we look at.

Ashley Mengwasser: Whole child.

Ashley Pitts: The whole child. And when we think about those supports as well, it was very silo like health was taught in PE. If you were sick you would go to the nurse. But now the nurses is coming into our classrooms. The nurse is at open house and she's talking to parents about asthma education and oral health. She's just more integrated.

Ashley Mengwasser: It's a teaching opportunity.

Ashley Pitts: Absolutely. And so we take more responsibility for all of the students together and we're just able to do better work because everyone has their own areas of interest and their own areas of expertise. And you can't get that when you're siloed just one adult to 20 children.

Ashley Mengwasser: Yes. It's a whole new way of thinking for the whole child. I love it. And asthma was just one example, but you have all been digging very deep into health barriers to learning and development at your school. How are you embedding this knowledge into your current practices? Do you have other examples for us?

Ashley Pitts: If I have a student referred to ... If we do a baseline and they show that they're academically low in one area or if I have a student who the teacher refers for behavior interventions, I have a complete screening process where we screen every one of those children who may have been flagged for needing some support. Whether it be social emotional, academic, behavioral. And so we look at all the health barriers of learning. We have a screener for language and our speech teacher screens them for language and speech. Even if it's behaviors the nurse screens them for hearing and vision. She does an oral investigation of their mouth. And if there's any problems, she connects them with healthcare providers. She calls their parents, connects them with healthcare providers. We call and speak to the parents about food insecurities and about their living conditions. And then we're able to offer supports like Ms. McCracken had spoken about earlier. We have our weekend backpack program. And what I really love about the weekend backpack program to go off on a tangent, is we're not sending them home with gummies and cereal bars, but we're sending them home with actual ... It is processed food, but it is actual food. So maybe it's like canned beanie weenies, but it's actual food that they can prepare themselves or maybe it's microwavable mac and cheese. I was thinking of mac and cheese. Or granola bars, things that can provide some nutrition and also just really fill their bellies up. So, we scream for that as well. And then our counselor may or may not meet with them based on just the things that we've observed to check for certain things like anxiety, depression, and then our counselor will call home. We're a team, but we all have our own roles. And then we work with parents, we work with students. And then in tandem, my job is that I will give them those behavioral supports at the exact same time. So if they're referred for a behavior, we're going to check all of these other things I just mentioned, all those barriers to health. And then I'm going to maybe put them in a drumming intervention if they are dysregulated. Or if we notice they're having trouble making friends, I'm going to put them in a social emotional intervention where I'm teaching them those social skills. So it really works in tandem instead of siloed. And I don't wait to find out if they have a vision problem before I start working with them on their behaviors.

Ashley Mengwasser: There you go. So that evaluation is very illuminating it sounds like. And any other ways you're embedding this knowledge into your current classroom practices?

Emily McCracken: When I'm going in, because I now go in and I push into classrooms, and I don't have my own classroom. But when I had my own classroom, just taking into account, okay, why is this child, this student doing this? You didn't do this yesterday, now we're having some issues. What could be the root of this issue? Did you sleep? Are you nervous? Are you anxious? Do you need something to eat? I feel like 20% of the problems can be solved by we need something to eat.

Ashley Mengwasser: Yeah. Good point. As I was saying earlier. Hanger.

Emily McCracken: It could be more than that. My own children get hangry.

Ashley Mengwasser: Of course, what has been the difference in using integrated MTSS?

Ashley Pitts: We have made a lot more progress much quicker with our students. So we're moving those students. When we talk about those tiers, tier three being the most support tier, one being the least-

Ashley Mengwasser: The baseline.

Ashley Pitts: The baseline that they're receiving the same amount of support as their peers or that means they're on grade level. So we're seeing that we're able to move students down the tier. So we're able to remove some of those extra supports and get them on grade level with their peers quickly when we are finding root problems such as oral needs or vision needs or hearing needs. So we think about, there's a large number ... I can't tell you the percentage, but there's a percentage of students statewide that are in behavioral needs, like behavioral interventions, but they also have cavities. And so if your teeth are hurting or maybe you didn't get any sleep because your teeth are hurting or maybe you're hungry because you can't eat because your teeth are hurting you're going to be more likely to misbehave.

Ashley Mengwasser: Yes. It makes me think of The Princess and the Pea with just that pea in the mattress. You could have some small little grievance that you haven't identified yet that could really be the root cause of all this stuff, which I think is fascinating. I want to explore some use cases of what this looks like. So while protecting students' personal information, can you share a couple of stories about how this work has impacted your classrooms?

Emily McCracken: I had a student who had some complex medical needs, and I noticed that they weren't learning at the same rate as the peers. And they were very frustrated and they didn't want to be there and they were ripping up paper and they would put their head down and they were crying. The behavior was starting to come over this. So we got Ashley involved, we got the school nurse involved, the counselor, the social worker, we had the principals, we got a translator because the parents didn't speak English. And we all came together and we had a meeting and come to find out there were some side effects from the medication that was causing some of her needs. I see. So we worked together and we just established a plan so that if she needed a nap, she could go take a nap during the day. If she needed a snack they always had water at their desk in case they need it. But I allowed any student, when you're thirsty, just drink your water.

Ashley Mengwasser: But the point is whatever additional supports that student needed they received.

Emily McCracken: The student was allowed to take a break. Just if the student was becoming overwhelmed and felt the need, they could go take a nap or they could just go take a break out of the room where they had an opportunity to come back together. We talked with the doctors. The parent gave the nurse permission to talk to the doctors to find out some of the side effects. We were able to set up a plan and the student became happy again. The student wanted to be there when the student knew that they were supported. And the student was afraid to speak up and talk about it so the student just internalized it all. So once the student knew that we were on the student's side, they became happy. Help me out Ms. Ashley.

Ashley Pitts: Yeah. That was a major concern from the parents was the child was crying every day when they got home and crying every day before school. They didn't want to come to school because they knew they were not learning at the same rate as their peers. They were feeling very anxious. And once we established this plan, it was like a whole new child. And it was because the child did suffer short-term memory loss because of the medication they were on. And in the mornings we had a support person pre-teach her what Ms. McCracken was going to be teaching during the day.

Emily McCracken: And review what we did the day before.

Ashley Pitts: My favorite intervention I think was nap time. I got them each day for a 20-minute nap. And after that they were ready to go. They were ready to be in class, they were alert, their needs were met. And it was so refreshing to see that we were able to dig down and we found a medical need that was causing these behaviors. And even though we're not a medical facility, none of us are medical personnel, we were still able to meet those needs at the school so that the child could continue learning and be successful and happy.

Ashley Mengwasser: And be happy.

Emily McCracken: And through the MTSS process we were able to write up a plan to travel with that child. So when they moved to the next grade and they were no longer in my class, they still got the same supports.

Ashley Mengwasser: Handed off to their next teacher. Yeah. And partnering with families is a really big piece of what you just described. So what practical strategies do you use to build that partnership with family members?

Ashley Pitts: Anytime that I am referred a student, I like to immediately make a connection with the family. But even before that, our school as a whole works really hard to partner with parents. Even before school starts, every teacher calls every child's parent two or three days before school starts and just says, "I'm so excited to have so-and-so in my class. We can't wait to see you." And then open house, it's like a big party. So they go to their child's classroom, they meet their teacher, and then in a separate location in the school, we have a family event where they're able to make things, create things with their children, and then we pass those things back to the teachers. They're able to hang them on the walls. So we're bringing the family creations into the classroom. But also we use that time to ... That's when our nurses educating them about oral care. And our PE teacher is there talking about how to meet physical needs at home. And we're able to make those connections then so that when issues may arise, we're able to already have a relationship with the parents so that when we call meeting, it's not so scary. And we work really hard to make our connections with parents positive.

Ashley Mengwasser: Yes.

Ashley Pitts: And parents, they're always like, "Oh, thank you so much." Anytime I call a parent, I say, "Hi. This is Ms. Ashley from Doerun Elementary. Everything's fine. Your daughter's fine, your son's fine." And they're always like, "Oh, thank you so much. As soon as I see this number, I'm so afraid." But I've done it so much now and I have these relationships, the parents are like, "I know Ms. Ashley. What do you need?" And usually, even if they are in trouble, I say, "Hey, this is what happened today, this is our plan moving forward. This is how we're going to prevent this next time. This is what we're going to do to learn from these mistakes." And the parents are excited to get on board with that because they see it as a partnership. And I've even had parents who I've met with, and we have a plan for challenging behaviors. And there's been many times parents have been moved to tears and have said, "I've never had a teacher or a school say your kid's in trouble, but here's the plan that we can prevent it next time or these are the things we're going to do to teach them the right way to express their emotions or handle these situations."

Ashley Mengwasser: Yeah. A lot of what I'm hearing, just to synthesize our discussion today, is about bridge-building, having relationships, discussing the health barriers upfront, assessing, knowing what they are, and then responsiveness. Responding to the student with those supports, which I think is a beautiful thing. So could you help leave our audience with, given your insider information, vast experience in drumming and other things, what would you impart in terms of quick pointers to help teachers intervene confidently in scenarios where there is a health barrier?

Ashley Pitts: I would say the first thing is to make a partnership with your school nurse, your school social worker, and your administrator. If the administration in the building does not support the initiative, the initiative will fail. So having the partnership across the school is absolutely imperative. And then also partnering with the parents in a positive way. And like you said, upfront saying, "These are the things that have been identified that may be barriers and we're going to check to see if some of those things are affecting your child." We're being proactive and not reactive.

Ashley Mengwasser: That's right. You're integrating MTSS for the whole child.

Emily McCracken: I think teachers should also keep in mind; most students are not coming in the classroom to cause a problem. They're trying to communicate something and they don't know how to do it. So figuring out what they're trying to communicate, why the behavior is occurring instead of just punishing the behavior would be a big takeaway.

Ashley Mengwasser: That is a big takeaway. Thank you, Ashley and Emily. We appreciate it. You've left us feeling integrated, supported, and dare I say whole, so thank you for your help today. We really appreciate it. Before I go, may I offer you a piece of interactivity to look at the student health data in your district. Georgia DOE has a tool for that. Google the Georgia Insights whole child health dashboard. The whole child health dashboard is an interesting reference with two purposes. First, it provides educators and those who work with students with relevant health outcomes data for their communities. And second, it challenges educators and those who work with students to use this health outcomes data so that you can factor health-related prevention and intervention activities into tiered support processes in your work. Just select your county to view the results and ranking information is also included to simply compare your county against the rest of Georgia. This episode is but the first of our health barriers to learning series. So stick around. We have a wealth of health information coming your way this season. It's always a pleasure being your happy, healthy host. I'm Ashley. Join us next week for another eye-opening Classroom Conversations. Goodbye for now. Funding for Classroom Conversations is made possible through the School Climate Transformation Grant.