Presentation on theme: "Advanced Behavior Interventions"— Presentation transcript:
1Advanced Behavior Interventions Rose Iovannone, Ph.D., BCBA-D
2Agenda Technically Adequate FBAs/BIPs Refresher of PTR Linking hypotheses with behavior interventionsBehavior interventions
3Objectives Participants will: Develop a task analyzed behavior intervention plan that is linked to a FBA hypothesis that includes:A prevention interventionA replacement skillA functional equivalent reinforcerComplete a coaching checklist for training others to implement the planComplete a fidelity measureIdentify key coaching/consultation skills
5Core Components of Technically Adequate FBAs/BIPs Input sought from multiple sourcesProblem behavior that is focus of FBA identified and clearly definedBaseline data indicate target behavior is a problemAntecedents that predict problem behavior clearly identified/describedSetting events considered and (if applicable) clearly identified/describedAntecedents that predict absence of problem behavior clearly identified/describesConsequences (responses of others) immediately after problem behavior identified and describedHypothesis developed from FBA data and includes antecedents, setting events (if applicable), behavior, and functionFunction is one recognized and identified by “leaders” in the fieldSocial reinforcement—e.g., obtain/get attention, tangibles, activities, sensoryNegative reinforcement—e.g., escape/avoid/delay/terminate attention, tangibles, activities, sensory
6Core Components of Technically Adequate FBAs/BIPs Developed relatively soon after FBA (e.g. within 30 days)FBA hypothesis is included or referenced on BIPMinimum of one antecedent strategy:IncludedLinked to FBA hypothesis (when)Described in enough detail to pass “stranger test”Minimum of one teach strategy:Linked to FBA hypothesis (functional equivalence or incompatible behavior)Minimum of one reinforce strategy:Linked to FBA hypothesis (functional equivalence provided)Strategy included to no longer reinforce problem behavior (change maintaining responses)Need for crisis plan considered and described in detail (if applicable) and linked to hypothesisEvaluation plan described in detailFidelity plan described in detail
8What is Prevent-Teach-Reinforce (PTR)? Research project funded by U.S. Department of Education, Institute of Education SciencesUniversity of South FloridaThree central Florida school districtsUniversity of Colorado, DenverTwo Colorado school districtsPurposes:Answer the call for rigorous researchEvaluate effectiveness of PTR vs. “services as usual” using randomized controlled trialEvaluate effectiveness of “standardized “ approach
9Prevent-Teach-Reinforce: PTR Intervention teams given manual and assigned PTR consultantFive step process (aligned with problem solving process):TeamingGoal Setting (Identification of Problem)Functional Assessment (Problem Analysis)Intervention (Intervention Implementation)Coaching and fidelityEvaluation (Monitoring and Evaluation of RtI)
10Step 1: Teaming Teaming: A collaborative process Purpose: Members Person with knowledge of student (e.g., Classroom teacher, instructional assistant, parent)Someone with expertise in functional assessment, behavioral principles (PTR consultant, school-based consultant)Someone with knowledge of context (e.g., administrator or designeePurpose:Evaluate strengths and weaknesses of team functioningOutline roles and responsibilitiesDetermine a consensus-making process
12What Determines Success? Analysis of outcomes of 800+ consultation cases involving elementary studentsProblem identification = 43%Problem analysis & plan development = 31%Goal attainment occurred in 97% of cases in which a plan was implemented“consultants successful in identifying problems were almost invariably able to solve those problems”Bergan and Tombari (1976) studied over 800 consultation cases (children in grades K – 3 referred for psych services), found that in only 43% and 31% of cases referred for help were problem identification and analysis (i.e., culmination in development of a plan to implement) stages, respectively, successfully met. In 97% of cases in which a plan was able to be developed and implemented, the pre-determined outcome level was established (i.e., goal attainment was reached).Also important… what contributed to completion of the problem identification stage?- largely, consultant skills, particularly the (a) flexibility of the psychologist in applying psychological principles (i.e., in selecting interventions) and (b) index of message control.Take away points:Thus, we need to put efforts up front and successfully do problem analysis (what are factors that make problem occur) and goal setting.Need intensive training in effective consultation skills, because when a psychologist lacked skills or was inefficient, s/he was likely to select a course of action beside problem id, including testing, SPED referrals, move to another school, referral to other mental health agencyStudy details: “interviewing skills” of consultant assessed by transcribing problem id and problem analysis interviews by psychologists/consultants; interviews were then coded for message content, message process, and message control. Yielded 4 measures of interviewing skills: (a) relevancy of interview content to problem id and analysis, (b) content focus… staying on topic, (c) psychologist verbal processes- using more specification, summarization, and validation utterances, and (d) message control- asking more questions to elicit information or action on the part of the teacher.Problem-solving measures: case-reporting forms were used to assess the presence or absence of phases in the problem-solving process… stages that were coded: problem identification, plan implementation, problem solution- if the goal identified in problem ID was achievedBergan & Tombari, 1976
13Step 2: Goal Setting Purpose: Targeted Areas: Identify behaviors of greatest concern to the team and possible replacement behaviors (teach)Prioritize and operationalize behaviors targeted for interventionDevelop teacher friendly baseline data collection systemTargeted Areas:Problem behaviorsSocial skillsAcademic behaviors
14Step 2: Data Collection System Behavior Rating Scale – BRS (cf., Kohler & Strain, 1992)Direct Behavior Rating (DBR)—Hybrid assessment combining features of systematic direct observations and rating scalesEfficient and feasible for teacher useProvides data for decisionsPrioritized and defined behaviors measuredRequires minimum of 1 appropriate and 1 inappropriate behavior
15Case Study- Mike: Behavior Rating Scale Screaming9+ times7-8 times5-6 times3-4 times0-2 times54321Hitting8+ times6-7 times4-5 times2-3 times0-1 timesExpressing Frustration40%+30-40%20-30%10-20%0-10%Transition to Non-preferredWhimper or squealLouder than indoor voiceOutdoor play voiceLouder than outdoor playEar penetrating01/15
17Step 3: PTR Functional Assessment PTR Assessment (FBA)Checklist formatPrevent = antecedentsTeach = function, possible replacementsReinforce = consequences, possible reinforcersOne form completed for each problem behavior by each team memberInformation leads to hypothesis
18Learned Functions of Behaviors GET (Positive Reinforcement)ObtainActivities, people, tasks, tangibles, sensory, pain attenuationGET OUT OF (Negative R)Escape/Avoid/DelayActivities, people, tasks, tangibles, sensory, pain
19Step 3: Case Study – Mike Hypotheses When….he willAs a result…Mike is asked to complete non-preferred tasks (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher is attending to other studentsscream and hitMike is able to gain attention and delay the transition/activityMike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher attending to other studentsexpress his frustrations appropriatelycomplete the assigned taskMike is able to delay the transition/activityMike is able to gain attentionInappropriateAppropriate
21Behavior Intervention Plan Development: Essential Features Behavior interventions selectedTeam/teacher provides description on how interventions will look in classroom settingFacilitator guides the team/teacher by using ABA principles to develop most effective intervention that matches the team/teacher contextEach intervention selected is described in detail by task-analyzing steps, providing scripts, describing adult behaviors, NOT student behaviorsAfter plan developed, time is scheduled to train the team/teacher the strategies prior to implementationPlans for training students and other relevant individualsSupport provided once plan is implemented
22How to Link Hypothesis Statements to Behavior Interventions The hypothesis statements link to behavior interventions by:Modifying the antecedent(s) identified,Teaching alternative appropriate behaviors to get the same payoff,Providing alternative ways of responding to the appropriate and problem behavior (including crisis management)
23Hypothesis LinkWhen Jeff is presented with demands to start non-preferred academic tasks, specifically independent writing, he will become disengaged and walk around the room, talk to and touch peers, put his head down without initiating writing. As a result, he gets to avoid/delay the non-preferred task..PreventTeacher request to start the non-preferred taskBehaviorDisengaged-walk around room, bother peers,ReinforceAvoid/delay non-preferred taskSetting EventNone identified
24Rule #1You should not develop a plan to decrease the problem behavior without first identifying the alternative, desired behaviors the person should perform instead of the problem behavior (O’Neill)
25Rule #2Use the functional equivalence reinforcement (i.e., escape and/or obtain) identified in the hypothesis in your behavior support plan.Only use artificial reinforcement (e.g., tangibles) if the functional equivalence is not enough.
26Rule #3Develop an intervention to modify the trigger (prevention information) so that the problem behavior is no longer necessary.
27The Three I’s IRRELEVANT INEFFECTIVE INEFFICIENT Function-Based Support Plans will be effective whenIRRELEVANTA prevention intervention that modifies the context so that the problem behavior is no longer necessary to perform is included.INEFFECTIVEThe replacement behavior serves the same function (obtains the same outcome) as the problem behavior - if it doesn’t work, the student won’t do it.INEFFICIENTThe replacement behavior works at least as quickly and easily as the problem behavior - if it works but is harder to perform, the student won’t do it.
28Jeff-matching hypothesis to interventions Setting EventsNONEPrevention TriggeringAntecedentsRequest to do a non-preferred task = writingProblemBehaviorDisengagedMaintainingConsequences ReinforceESCAPE!!!Replacement Behavior)equivalent or incompatible)Engage in TaskModify triggerChoicesEnvironmental support
29Step 4: Writing the Intervention Plan Task analyze each step of the planNOT— “give student choices”YES— Prior to the start of independent reading, tell the student “we have 2 worksheets today” (show worksheets). “Which worksheet would you like to do first?”If teachers do not know how to do it, they will not implement the strategy.
33ChoicesIndividual selects preference from among 2 or more valid optionsReduces likelihood of exhibition of escape and avoidance behaviors associated with demandsChoice strategies: (adapted from Fredda Brown)Between tasksWithin tasksWhereWhenPerson(s)RejectionTermination
34Choice Making Steps to Build Intervention Step 1: Determine the context (antecedent) identified in the hypothesisStep 2: Determine choice options (from 7 categories) that can be presented during specified contextStep 3: Select the choice options that will be offeredStep 4: Decide how the choice options will be presented to the student (when, who, how)Step 5: Decide response to student after making choiceStep 6: Decide how to release to choice
35Environmental Supports Used when hypothesis (when part) suggests that visual cues/organizational tools or external reminders may make context/antecedent less aversiveExamples of environmental supports for anyoneTraffic signsMicrosoft Outlook, tools, remindersRestaurant menusTo do listsEvery app you can think ofExamples of environmental supports for studentsVisual checklistsReminders of reinforcementVisual cuesTimersVisual mnemonicsCommunication toolsSchedules
36Environmental Support Steps Step 1: Determine nature of antecedent and type of environmental support that may work bestStep 2: Develop the environmental supportStep 3: Determine how to use environmental support (when, who, how to present)Step 4: Teach student use of environmental support
37Jeff: PTR Intervention Plan Prevent Prevent StrategiesDescriptionChoice-MakingUsing 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) Within—writing tool to use (pen/pencil), color notebook paper, color of eraser, topic; (b) Who—peer for writing partner; (c) Where—Robin’s room, round table, desk; (d) When—part now, part later, whole task nowSteps:Right before giving the writing assignment to Jeff, decide upon the choice to be offered.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?”Praise Jeff for making the choice—”Thank you for making a choice.” and honor the choice
39Jeff—Intervention Plan Prevent Prevent StrategiesDescriptionEnvironmental SupportVisual Timer: Set a visual timer for the amount of time agreed upon with Jeff to complete the writing assignment.Steps:Discuss the goal for completing the writing assignment. Say, “I think you can complete the assignment in ___ minutes. What do you think?”Set the timer by saying, “Jeff, let’s see if you can beat the timer. Today, you have ___ minutes (time from step 1) to complete the writing. Ready, set, go.”
40ActivityIn your group/team, develop a prevention intervention for the following hypothesis.When requested to transition from a preferred to a non-preferred activity, Joe will start calling the adults and peers names and use cuss words. As a result, he (a) avoids/delays the transition and (b) gets responses/attention from both adults and peers.StepsIdentify the antecedent/prevention informationReview the prevention interventionsDecide upon one interventionDevelop a step-by-step plan for implementationBe prepared to share
43Replacement Behaviors Replacement behaviors are what we want the student to do instead of the problemEffective replacement behavior must:1. Be incompatible with the problem.2. Serve the same function as the problem.PROBLEMFUNCTIONREPLACEMENT
44Replacement BehaviorTeaches more appropriate, but equally effective, means of getting reinforcer (escape/obtain)Must be:Socially validSimpleEfficientLikely to be reinforced by others in student’s life
45Considerations When Teaching Replacement Behaviors Identify alternative behavior as easy for student to do as challenging behavior (efficiency)Consider the replacement behavior is a skill or performance deficitDirectly teach student new behavior including how and when to useMake sure all other’s in student’s environment are consistent in teaching the replacement behavior.
46Replacement Behaviors Incompatible replacement (sample)EngagementIndependent task completionRaise handAppropriate social interactionsAppropriate commentingCommunicative replacementReject offer of undesired item or eventRequest alternative activityRequest assistanceRequest breakRequest work check
47Teaching “Request a Break” First, determine the point in which the problem behavior occurs after presentation of the antecedentDeliver the prompt for using the replacement behavior (e.g., “I need a break”) just prior to above point of time.Release student to break immediately after correct response exhibited and provide verbal reinforcement for using replacement behavior
48Request a Break, continued Provide inducement to get back to taskFade prompt graduallyEvaluate need for tolerance for delay cue (time delay for escape)
49Teach Incompatible Behavior Raise handStep 1: Determine if skills is a performance or skill deficitIf skill deficit, break down behavior into discrete steps and determine steps student needs to acquireIf performance deficit, reinforcement part of intervention will be extremely importantStep 2: Teach student when to use new behavior and what will happen when they use new behaviorExamples and nonexamplesOpportunity to practice with feedbackDetermine prompting required until skill is acquiredStep 3: Determine how skill will be generalized/maintained
50Jeff— Teach Intervention Plan Teach StrategiesDescriptionIncompatible Replacement Behavior—Academic EngagementJeff 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:Divide Jeff’s writing task into 3 major sections—starter, details, conclusionTell Jeff that for each section completed, he earns a “dot” that he should place in the envelope hanging at the side of his desk.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.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.On Monday, a weekly goal should be discussed and set.
52ActivityIn your group/team, develop a teach intervention for the following hypothesis.When requested to transition from a preferred to a non-preferred activity, Joe will start calling the adults and peers names and use cuss words. As a result, he (a) avoids/delays the transition and (b) gets responses/attention from both adults and peers.StepsIdentify the problem behaviorIdentify the functionAgree upon a replacement behavior (functional equivalent or incompatible)Review the teach interventionsDecide upon one interventionDevelop a step-by-step plan for implementationBe prepared to share
55Reinforcement Four rules (Terry Scott) Use the least amount that is necessary to get the replacement behaviorUse the natural reinforcement (i.e., function)Be consistent and immediate in delivering the reinforcer-establish a routineTeach the student how he/she will get the reinforcement
56Jeff—Reinforce Intervention Plan Reinforce StrategiesDescriptionReinforce Pro-academic Replacement Behavior—Academic EngagementJeff 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:At the end of the writing period or when Jeff completes his writing (whichever event occurs first), review Jeff’s self-management checklist.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?”Jeff uses dots by sticking it over a problem/question he doesn’t want to do and showing the teacher when he uses a dot. He can escape as long as he has dots in his envelope.If Jeff uses a dot to get out of work, immediately say “You used a dot to get out of ____. You earned it!”If Jeff meets his weekly goal, he can go to his brother’s kindergarten class and read a book to them.
57Jeff—Reinforce Intervention Plan Reinforce StrategiesDescriptionGroup 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:After reviewing Jeff’s self-management sheet, ask him, “Did you meet your goal today?”If yes, “You did meet your goal. Let’s tell the class they’ve earned a letter for the mystery reinforcer.”Tell the class, “Jeff met his goal today. We get another letter on the board.”Prompt the class to thank Jeff (if they haven’t done so spontaneously).If no, “You worked hard and tried. You’ll do it tomorrow!”
58ActivityIn your group/team, develop a reinforce intervention for the following hypothesis.When requested to transition from a preferred to a non-preferred activity, Joe will start calling the adults and peers names and use cuss words. As a result, he (a) avoids/delays the transition and (b) gets responses/attention from both adults and peers.StepsIdentify the function.Determine how the function (outcome) can be delivered as an interventionReview the reinforce interventionsDecide upon one interventionDevelop a step-by-step plan for implementationBe prepared to share
60Coaching StepsCore components of each behavior intervention strategy listed on coaching/fidelity form.Primary adult behaviors (physical or verbal actions) & materialsIf applicable, student behaviors included.During coaching session, facilitator gives teacher behavior intervention plan and coaching form.Facilitator introduces coaching form,e.g., “We’re going to go over the steps of the behavior plan strategies to make sure they are still making sense to you and are things that can be done by you in your classroom. If there is anything that you feel isn’t going to work, we can make changes today.”
61Coaching Steps Several methods for coaching the teacher. Can choose one method, combination of two, or all threeDiscussion—facilitator asks teacher to verbally describe (in his or her own words) each of the interventions.Ensures teacher describes each step of the interventionTeacher can refer to coaching form to cue core stepsQ & A—facilitator asks teacher questions about strategies.For example, choice-making “When are you going to offer the choices to X?”; “What kind of choices will you offer X?”; etc.Role Play (preferred method)-facilitator plays role of student and asks teacher to perform plan steps as they would with student.
62Coaching StepsCheck ‘Y’ or ‘N’ whether teacher demonstrated competence with plan stepsRemediation: For any step teacher did not demonstrate correctly or skipped,Review step with teacherProvide another opportunity for teacher to demonstrate competenceIf successful, coaching session finishedIf unsuccessful, choose from the following:Provide more opportunities to review and practice stepAsk teacher what features make step difficult and adapt to make feasibleSelect different intervention checked on PTR intervention Checklist that matches hypothesis.Schedule another meeting to develop new interventionSchedule another coaching session
63Coaching Steps Successful training: Decide who else needs to be trained (e.g., student, other school staff, parent)Try to be there when teacher trains student or offer to train studentDetermine start date of intervention planCan choose to implement the intervention in phases.Prevent first, then teach/reinforceTeach/reinforce first, the preventTraining checklist can be used as fidelity measure rather than developing separate checklist
66Jeff Coaching Plan (Sample) Intervention StepsYNPREVENT 1: PROVIDING CHOICESPresented valid choice to Jeff immediately after writing assignment presentedPraised Jeff for making choiceHonored choice within 1 minute after selectionimplementedPREVENT 2: ENVIRONMENTAL SUPPORT/TIMERNegotiated time limit with Jeff immediately after choice and prior to release to taskSet time limit on visual timerPlaced visual timer on Jeff’s deskTEACH: ACADEMIC ENGAGEMENTBroke Jeff’s writing task into 3 parts and reviewedWrote 3 parts onto self-management planReviewed academic engagement behaviors with JeffReviewed with Jeff how to complete dot checklist
67ActivityDevelop a coaching/fidelity plan for your behavior interventionBe prepared to shareDiscuss how you would collect data on response to intervention (Behavior Rating Scale, other)
69PTR Publications PTR Manual Journal Articles Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C., Prevent-Teach-Reinforce: The School-Based Model of Individualized Positive Behavior Support. Baltimore: Paul H. Brookes.Journal ArticlesIovannone, R., Greenbaum, P., Wei, W., Kincaid, D., Dunlap, G., & Strain, P. (2009). Randomized controlled trial of a tertiary behavior intervention for students with problem behaviors: Preliminary outcomes. Journal of Emotional and Behavioral Disorders, 17,Dunlap, G., Iovannone, R., Wilson, K., Strain, P., & Kincaid, D. (2010). Prevent-Teach-Reinforce: A standardized model of school-based behavioral intervention. Journal of Positive Behavior Interventions, 12, 9-22Strain, P. S., Wilson, K., & Dunlap, G. (2011). Prevent-Teach-Reinforce: Addressing problem behaviors of students with autism in general education classroom. Behavior Disorders, 36,Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (in revision). Reliability of the Individualized Behavior Rating Scale-Strategy for Teachers (IBRS-ST): A Progress Monitoring Tool. Manuscript submitted for publication.Sears, K. M., Blair, K. S. C., Crosland, K., & Iovannone, R. (in press). Using the Prevent-Teach-Reinforce model with families of young children with ASD. Journal of Autism and Developmental Disabilities.