1. START EBP Summer Institute 2011
WELCOME

2. Agenda Day One Day Two Setting the “stage”
Spotlighting evidence based practice
Act I: Horizon Elementary
Act II: Clawson Middle School
Day Two
Act III: Holt High School
A script for implementing EBP
Practice with your crew

3. The START EBP Implementation Project…
is the culmination of many years of work supporting the implementation of evidence based practices in schools along with the recent collaborative partnership project with the National Professional Development Center on Autism Spectrum Disorders from Our aim is to train and support school building teams to create student IEP goals that best reflect the needs of the student and match those goals to evidence based practices that will help the students and team meet those goals.

4. This chart shows the breakdown of the dependent variables (i. e
This chart shows the breakdown of the dependent variables (i.e., target behaviors) by domain, as used in the studies making up the evidence base for the practices.. The gray boxes indicate that a study that made the evidence-base targeted a skill or behavior in a particular domain. . .
With this information, we utilize what we know about the learner and our own professional expertise to make a decision about the most appropriate EBP to choose. 4

5. How do families and professionals learn about practices for individuals with ASD

6. Families & professionals are seeking information about autism treatment
If you type in the words “autism and treatment” in Google you get:
17,800,000 results in .09 seconds

7. We have warnings for many things in our society

10. But there is not a good warning system to let families and professionals know when intervention practices that haven’t been thoroughly studied are being promoted
Elephant Therapy!

11. Currently not enough evidence…
Injection of immunological substances
Vitamin therapy
Hormone therapy
Facilitated communication
Biofeedback
Hyperbaric oxygen chamber therapy
Auditory integration
Massage of the scalp
Prism lenses
Complex rhythmic drumming
Electromagnetic therapy
Holding therapy
Dolphin therapy

12. When families seek treatment for a child diagnosed with cancer or diabetes, they aren’t given a long list of interventions that someone somewhere believes to be effective, and told to choose from that list on their own; they can usually expect to be informed about treatments that are based on sound scientific research. Why do we settle for less when the diagnosis is ASD?
Retrieved from asatonline.org (2011)

13. So many treatments, so much information

14. Problem: People may want to “try everything”
A “try everything” mindset leads one to believe that treatment of autism is based upon the quantity of interventions, as opposed to the quality of interventions
Celiberti et al., The Road Less Traveled: Charting a Clear Course for Autism Treatment ( ) (p. 5)

15. Problem: Choosing non-evidence based interventions
Primum non nocere: FIRST DO NO HARM
Example: Facilitated Communication – Potentially Harmful Therapy
Lilienfeld, S. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2,

16. Problem: Choosing non-evidence based interventions
Time, money, energy that is NOT directed toward evidence-based intervention

17. Solution
Teach people to be good consumers of information through understanding the scientific process… yes, really.
Teach people to collect data in a rigorous way and control for confounding variables.
If you don’t partner with families and providers, they will proceed without you. Its better to work with them (S. Harris, years ago)

18. Understanding and Using Evidence Based Practices

19. What are EBPs all about?
All students in public education should have access to scientifically based practices (NCLB, 2001).

20. What is scientifically based research?
You must have reliable evidence that a program or practice works. NCLB requires experimental studies that are similar to the medical model of research used by scientists. These studies require many steps to prove strong evidence of effectiveness.
Well designed studies that use random samples of the population
Trials must also include a random “control group” for comparison
Valid and reliable outcome measures
Data on long-term outcomes
Trials in more than one site of implementation

21. Using EBPs in Schools
What are examples of universal EBP practices for all students?
Behavioral expectations
Evidence based approaches to teaching reading
What is the environmental context for all students attending school?
General education curriculum, instruction, social interaction, transitions

22. 3-Tiered Model of Support23
3-Tiered Model of Support
Few
Some
Universal EBPs
TIER 1
All

23. When to Use EBPs Specific to Students with ASD
Specific EBPs for students with ASD are deficit driven and based on the student’s lack of progress. Deficits and lack of progress become IEP goals.
Students aren’t making progress in…
Academic learning
Socialization
Communication
Behavior expectations

24. 3-Tiered Model of Support Targeted and Intensive EBPs Intervention23
3-Tiered Model of Support
Few
Targeted and Intensive EBPs Intervention
TIER 2 & 3
Some
Universal EBPs
TIER 1
All

25. EBPs Specific to Students with ASD (and other students?)
What are examples of targeted or intensive practices?
Self-management systems
Video modeling
Discrete trial teaching
PECS
Functional communication training (FCT)

26. Finding information about Practices that are Evidence-Based

27. The National Professional Development Center on ASD
The National Professional Development Center on Autism Spectrum Disorders is a multi-university center to promote the use of evidence-based practice for children and adolescents with autism spectrum disorders.

28. National Standards Project
"In a field rife with fads, pseudoscience, and popular, yet unproven, interventions, the findings of the National Standards Project are a welcome and much-needed counterbalance to much of the hyperbole for both professionals and families." Peter Gerhardt, Ed.D.

29. The Association for Science in Autism Treatment
ASAT is a not-for-profit organization of parents and professionals committed to improving the education, treatment, and care of people with autism. Since autism was first identified, there has been a long history of failed treatments and fads, levied on vulnerable individuals as well as on their families. Since ASAT was established in 1998, it has been our goal to work toward adopting higher standards of accountability for the care, education and treatment of all individuals with autism.
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30. The START EBP Implementation Project is easy as 1-2-3-4
To make it easier to remember the steps of the project, just remember “ ”
1building
2 target students
3 IEP goals per target student
4 Evidence Based Practices (EBPs) to address the IEP goals

31. Presentation Script for 3 Groups
Description of the student
Developing the GAS goals from the IEP
Selecting the EBP
Implementation Plan & Process
Ongoing Review & Adjustments
Expansion to other students

32. What you need to know about the GAS before we start…

33. Expanding Children’s IEP Goals through the Goal Attainment Scale (GAS)
Goal Attainment Scale (GAS) is designed to document progress on IEP goals, objective, and benchmark.
Provides a summative rating to evaluate outcomes for students

34. Somewhat less than expected
Much less than expected
Present level of performance
Somewhat less than expected
Progress toward goal
Expected level of outcome
Annual Goal
Somewhat more than expected
Exceeds annual goal
Much more than expected
Far exceeds annual goal
Dan is inconsistently performing job tasks. He needs verbal, gesture and visual prompting to complete a task.
Given a 5-step vocational task and visual supports, Dan will complete 3/5 steps independently over 3 consecutive probe days.
Given 2 different 5-step vocational tasks and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.
Given 3 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.
Given any familiar 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

35. Description of Scaling
Consists of a five point range of performance for students:
Much less than expected (present level)
Somewhat less than expected
Expected level of outcome (annual goal)
Somewhat more than expected
Much more than expected

36. Day Two: Afternoon

37. The START EBP Implementation Project is easy as 1-2-3-4
To make it easier to remember the steps of the project, just remember “ ”
1building
2 target students
3 IEP goals per target student
4 Evidence Based Practices (EBPs) to address the IEP goals

38. A script for implementing evidence based practices
Review Checklist
Discuss Building and Student Selection

39. Writing, Implementing, and Monitoring Goals

40. Writing Measurable Goals:
Formula for Success
Condition--Under what condition and using what support should the skill be demonstrated?
Behavior—Use verbs to describe behavior
What competency / skill should change?
Observable behavior
Criteria— Describes level of mastery such as much or how well the behavior is demonstrated

41. Writing Measurable Goals
Condition—Circumstances the student will need in order to perform the expected skill (when, where, with whom, type of activity, with what support, etc.)
When given a verbal request
During transition periods
During a social conversation
During class discussions
When shown a three choices
When prompted (specify type and # )
When given a check schedule card
When prompted (specify type and #) to a visual schedule
Using peers / peer to peer support
Using a choice modification strategy
During lunch (math, science, etc)

42. Writing Measurable Goals
Behavior—Use verbs to describe behavior
Choose / select
Raise hand
Remain in seat / area
Answer questions
Request
Locate / find
Put on / Take off
Respond to (describe)
Complete task
Transition to next activity
Look at
Wait to be called on
Ask for help
Ask a peer
Follow direction

43. Writing Measurable Goals
Criteria— Describes level of mastery such as much or how well the behavior is demonstrated
9 out of 10 opportunities
6 items
75% accuracy
Increase by 10%
3 times a day
On 9 consecutive attempts
For 15 minutes at a time
Within 5 minutes
4 times weekly
3 out of 5 days
4 class periods

44. Examples
Marci will have improved functional communication skills for indicating wants and needs.
Marci will use a system of words, pictures, gestures to indicate basic wants and needs during classroom activities. (8 of 10 trials)
Marci will use a picture schedule to follow daily classroom routines with minimal prompting. (8 of 10 trials)
Marci will use a system of words, pictures, gestures to participate in conversational routines with peers. (8 of 10 trials)

45. Examples
Chris will improve his social communication skills in the classroom setting.
Chris will raise his hand when he needs assistance or wants to share important information. (90% of time)
Chris will ask for help and accept teacher response when he doesn’t understand something. (80% of time)
With gestural prompts from peers and adults, Chris will limit conversational ideas appropriate to the setting. (90% of time)

46. Goal Attainment Scaling
Much More than Expected
More than Expected
Annual Goal
Benchmark
Present Level 46 46

47. Expanding Children’s IEP Goals through the Goal Attainment Scale (GAS)
Goal Attainment Scale (GAS) is designed to document progress on IEP goals, objective, and benchmark.
Provides a summative rating to evaluate outcomes for students

48. Prior to Developing GAS
Review student’s IEP Goals with teacher/parents
Identify 3 priority goals for each target student
must be observable and measurable
must be agreed on by family and team
Collect data on present level of performance

49. Description of Scaling
Consists of a five point range of performance for students:
Much less than expected (present level)
Somewhat less than expected (benchmark)
Expected level of outcome (annual goal)
Somewhat more than expected
Much more than expected

50. GAS Levels Second: Identify the current level
First: Write the annual goal

51. Ways to Modify Goals to Create Levels

52. Ways to Change Criteria
Changing People
No adults (-2)
Familiar adult (-1)
Unfamiliar adult (0)
With one peer (+1)
Across multiple peers (+2)
Changing Prompt Level
Physical prompt (-2)
Gestural prompt (-1)
Verbal prompt (0)
Visual prompt (+1)
Independent (+2)
Changing Setting
One setting in school (-1)
Two settings in school (0)
2 school settings plus 1 community setting (+2)

53. Measurement of Goal Progress
Measurement can be collected:
Within a class period
Across days
During a 15-min probe
By specific number of opportunities given

54. Examples

55. Jon Jon is a preschool student with autism
Jon’s annual goal reads, “When entering the classroom in the morning and with a visual prompt Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.”
The classroom team took data prior to the meeting for everyday for two weeks and determined that Jon never greets peers or professionals

56. When he enters class, Jon does not greet his peers or teaching staff.-2
Much less than expected
(Present Level of Performance) -1
Somewhat less than expected
(Progress toward goal)
Expected level of outcome
(Annual Goal) +1
Somewhat more than expected
(Exceeds annual goal) +2
Much more than expected
(Far exceeds annual goal)
When he enters class, Jon does not greet his peers or teaching staff.
When entering the classroom in the morning and with a verbal prompt and picture cue , Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for a week
When entering the classroom in the morning and with a visual prompt, Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.
When entering the classroom in the morning without a prompt, Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.
When entering school in the morning and without a prompt, Jon will greet at least two peers by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.

57. Dan Dan is a high school school student with autism
Dan’s annual goal reads, “Given 2 different 5-step vocational tasks and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.”
The classroom team took data prior to the meeting for three days a week for two weeks and determined that Dan is inconsistently performing job tasks. He never completes steps to tasks independently, needing frequent verbal, gesture and visual prompting.

58. -2
Much less than expected
(Present Level of Performance) -1
Somewhat less than expected
(Progress toward goal)
Expected level of outcome
(Annual Goal) +1
Somewhat more than expected
(Exceeds annual goal) +2
Much more than expected
(Far exceeds annual goal)
Dan is inconsistently performing job tasks. He needs verbal, gesture and visual prompting to complete a task.
Given a 5-step vocational task and visual supports, Dan will complete 3/5 steps independently over 3 consecutive probe days.
Given 2 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.
Given 3 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.
Given any familiar 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

59. Sam
Sam is an 5th grade student with autism who is included in a general education classroom for most of the day.
Sam’s annual goal reads, “When presented with a conversational attempt from a peer support student, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days.”
A paraprofessional in the general education classroom took data for 5 days prior to the meeting. Peers initiated with Sam over 30 times, but Sam would just smile or laugh instead of responding verbally.

60. -2
Much less than expected
(Present Level of Performance) -1
Somewhat less than expected
(Progress toward goal)
Expected level of outcome
(Annual Goal) +1
Somewhat more than expected
(Exceeds annual goal) +2
Much more than expected
(Far exceeds annual goal)
When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 0% of opportunities over 3 consecutive days across 3 different peers.
When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 40% of opportunities over 3 consecutive days.
When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days.
When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days across 3 different peers.
When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days across 3 different peers in 2 different settings.

61. Jack Jack is a high school student with autism
Jack’s annual goal reads, “When arriving at school, Jack will walk to the classroom with verbal and visual prompts 4 out of 5 days for 3 consecutive weeks.”
The classroom team took data prior to the meeting for everyday for two weeks and determined that Jack dropped, refused to get up, and had to be lifted into a wheelchair and wheeled to the classroom 9 out of the 10 days.

62. -2
Much less than expected
(Present Level of Performance) -1
Somewhat less than expected
(Progress toward goal)
Expected level of outcome
(Annual Goal) +1
Somewhat more than expected
(Exceeds annual goal) +2
Much more than expected
(Far exceeds annual goal)
Jack drops to the ground upon arrival and during various times throughout the day. When arriving at school, Jack has to be lifted into a wheelchair and wheeled to the classroom 9/10 days.
When arriving at school, Jack will walk to the classroom with verbal and visual prompts 2 out of 5 days for three consecutive weeks.
When arriving at school, Jack will walk to the classroom with verbal and visual prompts 4 out of 5 days for three consecutive weeks.
When arriving at school, Jack will walk to the classroom independently 4 out of 5 days for three consecutive weeks.
Throughout the school day, Jack will walk through the school building independently 4 out of 5 days for three consecutive weeks.

63. GAS Goal Chart for Monitoring

64. A script for implementing evidence based practices
Practice Writing GAS Goals
GAS Template

66. Choosing and Combining EBPs

67. When you are choosing EBPs:
Think about the context
Does the EBP make sense for that environment?
Think about the student
Characteristics & Interests
Strengths & Needs
Think about the future
Will it promote independence and socialization
Will it lead to sustained learning or behavior change

68. Choosing EBPs: Guidelines for Individualizing

69. Student Characteristics
Choosing EBPs
Student Characteristics
EBP s to Consider
If your student likes or learns best from repetition
Discrete trial teaching
Video modeling

70. Student Characteristics
Choosing EBPs
Student Characteristics
EBP s to Consider
If your student likes or learns best from visual strategies
Visual supports
Video modeling
PECS
Social narratives

71. Student Characteristics
Choosing EBPs
Student Characteristics
EBP s to Consider
If your student needs to improve independent skills
Self-management
Prompting
Structured work
systems
Video modeling

72. Student Characteristics
Choosing EBPs
Student Characteristics
EBP s to Consider
If your student has significant challenging behavior
Antecedent-based
interventions
Functional
communication
training
Functional behavior
assessment

73. Student Characteristics
Choosing EBPs
Student Characteristics
EBP s to Consider
If your student does not have an effective communication system
Functional
communication training
Speech generating
devices/VOCA
PECS

74. Combining EBPs EBPs are NOT usually used in isolation…
Self-management requires reinforcement
Video modeling may require prompting
FCT requires FBA
Professionals should be prepared to understand and implement a combination of EBPs

75. A script for implementing evidence based practices
Review and Discussion of EBPs