Teacher Driven Individualized Behavior Supports: Are They ...

Identification and Progress Monitoring at Tier 3: Prevent-Teach-Reinforce Presented at 2008 National Forum for Implementation of School-Wide Positive Behavior Supports Rose Iovannone, Ph.D. [email protected] Kathy Christiansen, MS [email protected] University of South Florida Objectives Participants will:

Describe a model of individualized behavior support Identify factors that may contribute to effectiveness of PTR The ProblemEvidence-Based Tertiary supports (i.e., individualized PBS, Tier 3 behavior supports) Evidence-base exists Research method used primarily single subject Limited rigorous, randomized control trials to evaluate effectiveness

The Problem - In Authentic Schools Ingredients Child is the problem - fix him/her Absence of uniform policies & practices Form-driven versus process-driven Expert versus collaborative approach

Contextual fit not always considered Limited support/follow-up/training for teacher provided Result Many BIPs do not get implemented Behavior problems persist Individualized PBS (Tertiary) For high-risk students: History of severe problem behaviors

Demonstrated resistance to intervention An intensive system of support is needed ~5% ~15% ~ 80% of Students What is PTR?

Research project funded by U.S. Department of Education, Institute of Education Science (2004-2008) University of South Florida3 school districts University of Colorado, Denver2 school districts Purpose: Investigate effectiveness of PTR process vs. business as usual Randomized control trial

200 students (100 treatment/100 comparison) Theoretical Framework Principles of applied behavior analysis Operant learning theory Positive Behavior Supportfoundation Intervention consists of three core components:

Prevent Teach Reinforce Team/teacher driven process Participants Students in K-8th grade General or Special Education

Behavioral difficulties All cognitive levels All disabilities Intensity disruption to the learning environment Frequency minimum of 1 time per week Duration minimum 6 months Teachers volunteered & nominated 1-3 students Top externalizers

Systematic Screening for Behavior Disorders (SSBD) Process Prevent-Teach-Reinforce (PTR) Five steps: Team development30 minutes if applicable Goal setting30-45 minutes PTR assessment30-60 minutes PTR intervention45-90 minutes Coaching support (up to 12 hours)

Evaluation30-40 minutes Each team assigned PTR consultant (from project) Teams receive manual and assigned activities to be completed in each step. Preliminary Data Results Student Demographics by Disability Disability N %

20 8.2 Deaf 1 .4 Developmental Delay 6 2.4 Emotional Disturbance

31 12.7 Mental Retardation 19 7.8 Multiple Disabilities 4 1.6 OHI (not ADD/ADHD)

2 .8 OHI (ADD/ADHD) 8 3.3 Specific Learning Disability 21 8.6 Speech/Language Disability

8 3.3 Visual Impairment 1 .4 General Education 116 47.3 TOTAL

237 Autism Student Description Grade Level K 1 2 3 4 5 6 7 8 N

34 53 53 41 30 16 7 8 3 % 13.9 21.6 21.6 16.7 12.2 6.5 2.9

3.3 1.2 77 150 31.4 61.2 45 200 18.4 81.6 Lunch Status Regular Free/Reduced

Gender Female Male The PTR Process Step 1: Form a Team Identify members and their roles Teacher, special area teachers Behavior specialist/school psychologist Family members, paraprofessionals,

Step 1: Team Building Ensuring a Successful Team Review the status of the team Work styles inventory Teaming survey Use a collaborative process

Teacher and facilitator relationship Consensus making method Case Study 1: Mike 9-year-old male Autism diagnosis Self-contained autism classroom Nonverbaluses AAT (signs, voice output devices such as Dynamite, and pictures to communicate) 1 teacher, 2 aides, and 6 students Results of teaming information indicate a great team that meets regularly to brainstorm Case Study 2: Jeff Male Second grade general ed. student

Retained once Premature birth SSBD Scores: Stage 2: 8 Critical Events Adaptive Behavior Score = 33 Maladaptive Behavior Score = 32 Teacher/Classroom Team: Two teachers

Current second grade teacher Second grade teacher from previous year Seventeen students Teacher experience4 years at same school Teaming Results Team respected each other, worked together Met consistently for planning purposes Strong communicators and problem solvers Sharing of roles and responsibilities Active parental participation encouraged Step 2: Goal Setting

Identify team consensus on: Academic behavior Social behavior Problem behavior Develop and begin baseline data collection Setting Goals: Mike Pre-Test Behavior Rating Scale

Reliability Perceptual rating Behavior recorded at least once daily May be specific to a setting, activity, time of day May be whole day May be combination of both Use anchors on a scale of 1-5

Determining the Anchors on the BRS Behavior can be measured using Frequency (times per day) Duration (hours, minutes, seconds) Intensity (how hard, how loud, bruise, etc.) Percent of day Percent of occurrence Percent of opportunity

BRS Preliminary Reliability (Psychometric) Results Variable Mean SD Pearsons T PB1 3.98 1.35 S PB1

3.99 1.33 T PB2 3.97 1.35 S PB2 3.84 1.33 T AB1

3.01 1.39 S AB1 3.08 1.37 T AB2 3.22 1.35 S AB2

3.70 1.57 .83* .77* .66* .77* T = Teacher rating; S = PTR data collector rating; PB = Problem behavior; AB = Appropriate behavior * P < .01 BRS Preliminary Reliability Results Kappa Scores Behavior Type

Unweighted/ Standard Error Linear Weighting/ Standard Error Quadratic/ Standard Error Problem .38/.08 .66/.06 .83/nc

Appropriate .24/.08 .40/.08 .53/.14 Step 3: Assessment Checklist format:

Antecedents or Triggers (Prevent) Function(s) of the problem behaviors (Teach) Consequences following the problem behaviors (Reinforce) Assists team to link function of behavior to intervention plan Appropriate Inappropriate When. Student will. As a result Mike is asked to complete nonpreferred task (Reading, Math), stop preferred activity or transition to

nonpreferred activity, fix an error, or when teacher attending to other students scream and hit Mike is able to gain attention and delay the transition/activity Mike is asked to complete nonpreferred task (Reading, Math), stop preferred activity or transition to nonpreferred activity, fix an error, or when teacher attending to other students express his frustrations appropriately

Mike is able to delay the transition/activity complete the assigned task Mike is able to gain attention Jeff Case Study: Hypothesis Step 4: Intervention Team ranks top three intervention strategies in each of the PTR components Multi-component intervention that teacher states s/he can implement

Prevent Teach Reinforce Implementation plan Case Study Mike: PTR Intervention Plan Prevent Strategies Environmental

Support Specific Strategy steps A wait card will be placed on Mikes desk to assist him in remembering to wait his turn. 1. Prior to group work, tell Mike, Remember, when it is someone elses turn, you sit quietly and wait, while pointing to his card. 2. If Mike calls out, point to his visual to remind him what to do. 3. Use a verbal prompt if the point prompt does not work. Environmental Support Mikes visual schedule will be modified to detail the number of and type of activities he is to complete during non-preferred activities. For example, if math involves listening to a lesson, doing a hands-on activity, and completing a worksheet, his visual schedule will list each activity under math using either a picture of the type of activity or using numbers

that correspond to a number on the worksheet. 1. Prior to the start of the activity, Mike should review the visual schedule. 2. As Mike completes an activity, he should X off the activity. Prevent Strategies Curricular Modification Specific Strategy steps Mike will be given an easy, independent activity, such as a worksheet, to complete upon transitioning to a non-preferred activity or an activity that requires him to wait, such as group activities Teach Strategies

Replacement Behavior Specific Strategy Steps Mike will be taught to use his Dynamite to express his need to calm down. 1. Mikes device will be programmed to say I need to calm down. 2. Prior to transitioning to a non-preferred activity or at the end of a preferred activity, remind Mike that if you start to get mad, you can choose to calm down. 3. As soon as Mike starts to get upset, prompt him to use his device. 4. Once Mike communicates I need to calm down, present him with the choice board of calming strategies and ask him, What do you want? 5. As soon as he is calm, praise him. 6. Allow Mike to engage in his choice until he is calm for 1-minute. 7. If Mike does not return to his area, then start having a fun time in that area with those students present

Teach Strategies SelfManagement Specific Strategy Steps Mike will be taught to independently use his calming strategies. 1. A tracking sheet with smiley faces and sad faces will be given to Mike at the start of each day. 2. Role-play with Mike about when he needs to make the choice to calm down. 3. Practice completing the tracking sheet. 4. Set and review the daily goal for using the calming strategies. 5. Prompt Mike to complete the tracking sheet if needed Reinforce Strategies

Replacement Behavior Specific Strategy Steps Anytime Mike says I need to calm down, his choice board should be given. 1. Praise Mike for communicating (thank you for telling me.) 2. Provide his choice board. 3. Allow him to calm for 1 minute 4. Praise him as soon as he is quiet 5. Praise him for returning to the group SelfManagement Anytime Mike scores his behavior, attention should be given. Waiting

Mike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule. 1. When Mike marks his tracking sheet, praise him for doing so. 2. At the end of the day, review the sheet with Mike. 3. Talk about the sad faces. 4. Provide his reward if his goal is met. Reinforce Strategies Transition Specific Strategy Steps Mike will earn stars during Reading Centers if he transitions and completes his work without screaming. 1. A social story will be reviewed prior to Reading Centers to remind Mike

that he can earn a star if he comes to centers and works. 2. At the end of each reading center, an adult will review Mikes behavior with him and ask him if he earned his stars. 3. Provide his stars if earned. 4. During the teachers group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group. 5. Allow Mike to participate in his chosen activity if he earned his stars. Jeff: Intervention Checklist Results Case Study Jeff: PTR Intervention Plan Prevent Strategies Description Choice-Making Using a choice matrix, decide upon the choice that will be offered to

Jeff each day with his writing assignment. The following choices will be rotated: (a) Withinwriting tool to use (pen/pencil), color notebook paper, color of eraser, topic; (b) Whopeer for writing partner; (c) WhereRobins room, round table, desk; (d) Whenpart now, part later, whole task now Steps: 1.Right before giving the writing assignment to Jeff, decide upon the choice to be offered. 2.Once the choice is determined, present it to Jeff by saying, What do you want to use for writing today? The pen or the pencil? 3.Praise Jeff for making the choiceThank you for making a choice. and honor the choice JeffIntervention Plan Prevent Strategies Description

Environmental Support Visual Timer: Set a visual timer for the amount of time agreed upon with Jeff to complete the writing assignment. Steps: 1. Discuss the goal for completing the writing assignment. Say, I think you can complete the assignment in ___ minutes. What do you think? 2. Set the timer by saying, Jeff, lets see if you can beat the timer. Today, you have ___ minutes (time from step 1) to complete the writing. Ready, set, go. JeffIntervention Plan Teach

Strategies Description Pro-academic Replacement Behavior Academic Engagement Jeff will be taught how to remain engaged on a writing assignment. Engagement is defined as: working on a task without disrupting by raising hand to speak, keeping pencil upright, and letting neighbors work. Steps: 1. Divide Jeffs writing task into 3 major sectionsstarter, details, conclusion

2. Tell Jeff that for each section completed, he earns a dot that he should place in the envelope hanging at the side of his desk. 3. Inform him that he can use the dots later to get out of work and to get special rewards for himself and the rest of the class. 4. Review his self-management checklist/dot total sheet with Jeff. Review each section of the writing assignment (step 1), his goal (time for completion), and academic engaged behaviors. 5. On Monday, a weekly goal should be discussed and set. JeffIntervention Plan Reinforce Strategies Description

Reinforce Proacademic Replacement Behavior Academic Engagement Jeff will be reinforced for academic engagement and meeting his daily goal with allowable/earned escape represented by the dots. Jeff can use his dots to get out of doing work/problems during independent work times. Steps: 1. At the end of the writing period or when Jeff completes his writing (whichever event occurs first), review Jeffs self-management checklist. 2. For each behavior on the checklist, discuss with Jeff whether he

performed the activity. If yes, place a check in the box. If no, place an x in the box. For each check, Jeff should be given a dot. When reviewing, say, Jeff, did you write a starter sentence? Did you stay on task? Did you meet your goal? When giving dots, say Jeff, how many checks do you have today? How many dots do you earn? 3. Jeff uses dots by sticking it over a problem/question he doesnt want to do and showing the teacher when he uses a dot. He can escape as long as he has dots in his envelope. 4. If Jeff uses a dot to get out of work, immediately say You used a dot to get out of ____. You earned it! 5. If Jeff meets his weekly goal, he can go to his brothers kindergarten class and read a book to them. JeffIntervention Plan Reinforce

Strategies Description Group Contingency (Modified) If Jeff meets his daily (time) goal for completing his writing assignment within the time agreed upon, the class earns a bonus letter toward the mystery reinforcer of the week. When Jeff earns the class this letter, the class provides attention to Jeff by thanking him and celebrating (clapping hands, saying Yeah. Steps: 1. After reviewing Jeffs self-management sheet, ask him, Did you meet your goal today?

2. If yes, You did meet your goal. Lets tell the class theyve earned a letter for the mystery reinforcer. 3. Tell the class, Jeff met his goal today. We get another letter on the board. 4. Prompt the class to thank Jeff (if they havent done so spontaneously). 5. If no, You worked hard and tried. Youll do it tomorrow! Coaching of Interventions Training of teacher

Assistance in classroom 1 to 2 hours 80% accuracy on all strategies Up to 12 hours Fidelity measures recorded 80% implementation terminates assistance in classroom

Task Analysis of Intervention Discuss Q&A Verbal Role-play Observe Feedback Case Study Mike: Training PREVENT Environmental Support 1. Mini schedule of group & center time available 2. Schedule reviewed prior to task 3. Schedule reviewed & items crossed off TEACH Replacement Behavior 1. Remind to use DynaVox prior to transition 2. Provided choice board and honored choice REINFORCE Replacement Behavior

1. Verbally or gesturally acknowledge ASAP 2. Allowed to cool off for 1-minute TOTAL (# Yes/ # Total) Fidelity Score ( .00 1.00) Training Review Yes No Yes No Yes

No Yes No Yes No Yes No Yes No

Yes No Yes No Yes No Yes No Yes

No Yes No Yes No Case Study Mike: Fidelity Interventions Environmental Support 1) Mini schedule of center & group available 2) Mini schedule reviewed prior to start of centers 3) Items crossed off as completed

Adherence Quality Mini schedule Mini schedule present present & reviewed at least either prior to or after activities completed Replacement BehaviorFunctional 1) Reminded student to use DynaVox prior to transition & when student engaged in warning signs 2) Choice board given 3) Choice honored Teacher

reminded student prior to transition or behavior Reinforce Replacement Behavior Teacher 1) Teacher immediately recognized student recognized for using DynaVox (within 15 s) student 2) Allowed to calm down for at least 1-minute Teacher reminded student prior to at least 2 of 3 transitions & all

behavior Teacher immediately (within 15 seconds) recognized student and allowed student to calm down Mike Post-test Video Coaching Checklist Example: Jeff Example of FidelityJeff Number of Fidelity Measures Teacher N %age 1

3 2.3 2 28 23.8 3 37 28.5 4

36 27.7 5 17 13.1 6 8 6.2 7

1 .8 Total 130 Mean # of measures per teacher 3.5 Step 5: Evaluation Data-based decision-making

Identifying what is working; what is not and WHY Expanding into other routines Generalization Continuing team meetings Planning time Cohesiveness 1 is a lot of screaming, 5 is no screaming 10-May 7-May

2-May 27-Apr 24-Apr 19-Apr 16-Apr 11-Apr Baseline 4-Apr 30-Mar

27-Mar 15-Mar 12-Mar 2-Mar 26-Feb 21-Feb 15-Feb 7-Feb 5-Feb

31-Jan 26-Jan 23-Jan 18-Jan 11-Jan 8-Jan 3-Jan 5 12-Dec

7-Dec 14-Dec Rating Step 5: Evaluation - Mike Screaming Intervention 4 3 Definition Changed

2 1 Step 5: Evaluation - Mike Hitting 5 Intervention Baseline Rating 4 3

2 1 1 is a lot of hitting, 5 is no hitting -D e 7- c D 12 ec -D e 3- c Ja 8- n J

11 an -J a 18 n -J 23 an -J 26 an -J 31 an -J a 5- n Fe 7- b F 15 eb -F

21 eb -F 26 eb -F e 2- b M 12 ar -M 15 ar -M 27 ar -M 30 ar -M a 4- r A

11 pr -A 16 pr -A 19 pr -A 24 pr -A 27 pr -A 2- pr M a 7- y M 10 ay -M ay

14 Rating Step 5: Evaluation - Mike Expression of Frustration 5 Baseline Intervention 4 3 2

1 1 is a little appropriate expression, 5 is a lot of appropriate expression Step 5: Evaluation - Mike Transition to Nonpreferred 5 Baseline Intervention Rating 4 3

2 1 1 is inappropriate transition, 5 is super appropriate transition Step 5: Evaluation Other Outcome Data Measure Baseline Post-test Change SSRS-PB

123 112 -11 SSRS-SS 87 102 +15 AET .34

.57 +23 Jeff Data Step 5: Evaluation Other Outcome Data for Jeff Measure Baseline Post-test Change SSRS-PB

127 113 -14 SSRS-SS 85 92 +7 AET .52

.82 +.30 Wrap Up: What We Have Learned Teachers like the process Teachers identify coaching/support and collaboration as key features Teachers do not continue the process without support Systemic change may be necessary for tertiary supports to happen How to Make PTR Work in Your School Process is the key

Creative resource reallocation may be necessary to find the time Things to consider Tertiary team Identification/Nomination process Data-based decision making Facilitator Set-up of meetings for efficient results For copies of Forms

[email protected] or [email protected]usf.edu Manual will be published by Brookesanticipated date Summer 09 Two journal articles in 2009 Journal of Positive Behavior Interventions (Jeff will be described)

Journal of Emotional Behavioral Disorders Next steps: Training school-based behavior consultants to do process http://ies.ed.gov/ncee/wwc/ Questions?

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