Presentation on theme: "Prevent-Teach-Reinforce Model: A Tier 3 Behavior Intervention Process Rose Iovannone, Ph.D., BCBA-D Don Kincaid, Ed.D., BCBA"— Presentation transcript:
Prevent-Teach-Reinforce Model: A Tier 3 Behavior Intervention Process Rose Iovannone, Ph.D., BCBA-D email@example.com Don Kincaid, Ed.D., BCBA firstname.lastname@example.org The contents of this training were developed under grant H324P04003 from the Department of Education
Agenda AM PTR Overview Step 1—Teaming Step 2—Goal Setting Step 3—PTR Assessment PM Step 4a—PTR Intervention Plan Step 4b—Coaching/Fidelity Step 5—Evaluation Questions/Wrap-up Next Steps
Objectives Participants will: Describe the 5-step PTR Tier 3 support model Identify the critical components that enhance the success of Tier 3 supports Apply the principles of the PTR process to a case study Determine how the PTR process is applicable within their setting
Tier 3 Function-Based Behavior Interventions in Schools Current Issues Absence of uniform policies & practices Form versus a process Expert driven versus collaborative effort Occasionally contextual fit considered Limited support/follow-up/training for teacher provided Teachers may not be the personnel to facilitate FBAs in schools Increased focus on school psychologists (Scott & Kamps, 2007) and other school-based behavioral consultants or “coaches”
What is Prevent-Teach-Reinforce (PTR)? Research project funded by U.S. Department of Education, Institute of Education Sciences University of South Florida Three central Florida school districts University of Colorado, Denver Two Colorado school districts Purposes: Answer the call for rigorous research Evaluate effectiveness of PTR vs. “services as usual” using randomized controlled trial Evaluate effectiveness of “standardized “ approach
Participants 200+ students—100 treatment, 100 comparison K-8 th grade General and Special Education All cognitive levels All disabilities Teacher-nominated top externalizers Systematic Screening for Behavior Disorders (SSBD) Behavioral difficulties Duration– minimum 6 months Frequency— minimum of 1 time per week Intensity– disruption to the learning environment
Prevent-Teach-Reinforce: PTR Intervention teams given manual and assigned PTR consultant Five step process (aligned with problem solving process): Teaming Goal Setting (Identification of Problem) Functional Assessment (Problem Analysis) Intervention (Intervention Implementation) Coaching and fidelity Evaluation (Monitoring and Evaluation of RtI)
Outcomes Student Outcomes: Treatment and control group comparison resulted in significant differences (p <.001; moderate effect sizes (.44 to.55) Intervention students: Social Skills Rating System (SSRS): Problem Behavior scores decreased SSRS: Social Skills scores increased Academic Engaged Time scores increased
Step 1: Teaming Teaming: A collaborative process 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 designee)
Step 1: Teaming Purpose: Evaluate strengths and weaknesses of team functioning Outline roles and responsibilities Determine a consensus-making process
Step 1: Teaming Forms for creating an effective cohesive team Classroom Team Survey (pg. 18 book; pg. 2-3 blank) Classroom Team Survey Teacher Work-Style Survey (pg. 19 book; pg. 4 blank) Teacher Work-Style Survey Paraeducator Work-Style Survey (pg. 20 book; pg. 5 blank) Paraeducator Work-Style Survey PTR Work-Style Comparison Sheet (used by facilitator) (pg. 21 book; pg. 6 blank) PTR Work-Style Comparison Sheet (used by facilitator) Purposes: To identify potential issues enhancing and impeding effective intervention implementation
Step 1: Teaming Facilitation Tips Avoid direct confrontation or “fixing” issues Purpose is for team to recognize potential issues that enhance and inhibit problem solving process Less talk, more listening and facilitating Provide visual summary of results to each team member Ask them to review the results and reflect Ask for their ideas, reactions, input Facilitate the discussion
Step 1: Teaming Case Study Mike 9-year-old male ESE Classification: Autism Placement: Self-contained, autism classroom with 6 students (wide age range) Nonverbal: Uses signs, Dynamite, pictures to communicate Team: Teacher and two aides, PTR Consultant
Step 1: Teaming Activity Instructions Get with a “team” Review the work-style survey responses (page 3) and the teaming survey (pages 4-5) from Mike’s teamwork-style survey responses Identify potential issues that may impact how the team functions Discuss how you would facilitate a discussion with the team about the issues
Step 1: Discussion What do you need in order to facilitate Step 1? How will you use this step? What forms will you be using?
What Determines Success? Analysis of outcomes of 800+ consultation cases involving elementary students Problem 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 & Tombari, 1976
Step 2: Goal Setting Purpose: Identify behaviors of greatest concern to the team and possible replacement behaviors (teach) Prioritize and operationalize behaviors targeted for intervention Develop teacher friendly baseline data collection system Targeted Areas: Problem behaviors Social skills Academic behaviors
Step 2: Goal Setting (pg. 7-9 blank forms; pg. 38 book) BehaviorSocialAcademic Broad GoalBroad outcomes desired (what is the overall goal to be achieved in each category)? Short-Term Goal: Behavior to Decrease Inappropriate behaviors preventing student from achieving long-term goals (current problem behaviors/deficits) Short-Term Goal: Behavior to Increase Skills to be taught to replace inappropriate behaviors (skills to replace problem behaviors that will achieve broad goal)
Case Study—Step 2: Goal Setting Decrease Increase Broad Mike will communicate his wants and needs appropriately Mike will interact with peers appropriately Mike will comply with non-preferred activities and requests Mike will decrease screaming, hitting, and getting out of his seat Mike will decrease hitting, screaming at, and bossing his peers Mike will decrease screaming and hitting Mike will ask for a break or for attention when needed Mike will initiate peer interactions using his Dynamite Mike will engage in non- preferred activities and communicate his frustration using his Dynamite or an appropriate tone Behavior Social Academic
Step 2: Data Collection System Behavior Rating Scale Behavior Rating Scale – BRS (pg. 10 blank forms; pg. 39 book) Direct Behavior Rating (DBR)—Hybrid assessment combining features of systematic direct observations and rating scales Efficient and feasible for teacher use Provides data for decisions Prioritized and defined behaviors measured Requires minimum of 1 appropriate and 1 inappropriate behavior
Step 2: Behavior Rating Scale (BRS) Behavior recorded at least once each day Specific time period/routine Whole day Combination of both Anchors –scale of 1-5 Measure options: Frequency Duration Intensity Percentage of opportunities
BRS Guiding Questions In which routine(s) will you be rating the behavior? What would be the easiest way to track the behavior? How often it occurs? How long it lasts? How intense it is? What is your estimate of the behavior happening on a typical day? Problem behavior = 4 Appropriate behavior = 2 What would the behavior look like on a great day? Problem behavior = 1 Appropriate behavior = 5
Case Study - Mike: Operational Definitions Problem behaviors Screaming—loud, high pitched noise heard outside the classroom Hitting—anytime Mike touches peers or adults with an open hand, fist, foot, or object while screaming or protesting Replacement/Appropriate Behaviors Express frustration appropriately using Dynamite, pictures, or signs to ask for a break or attention Transition to non-preferred activities: Moving to non- preferred activity and engaging with appropriate verbal expression
Case Study- Mike: Behavior Rating Scale Behavior Screaming9+ times 7-8 times 5-6 times 3-4 times 0-2 times 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 Hitting8+ times 6-7 times 4-5 times 2-3 times 0-1 times 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 Expressing Frustration 40%+ 30-40% 20-30% 10-20% 0-10% 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 Transition to Non-preferred Whimper or squeal Louder than indoor voice Outdoor play voice Louder than outdoor play Ear penetrating 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 5432154321 01/15
Other Uses of BRS Systemic data tracking method for Tier 3 Sample system created by: Cindy Anderson School district in Florida
Secondary Level Modifications Teams with 3 or more members Select one team member who will be the primary interventionist Behavior identification and BRS development will be focused on that person’s situation Other team members provide input/support If desired, other team members can record BRS data in their settings—rating descriptions can stay the same or minor modifications can be made Each row of BRS can represent a different teacher OR Each teacher can keep own BRS Consultant/coach collects all BRS ratings at specified times
Step 2a Activity: Developing a Behavior Rating Scale (BRS)
Setting up a Behavior Rating Scale One volunteer Identify a behavior of concern As a group, walk through the steps to set up the scale Step 2: BRS Group Activity
Step 2 Activity Instructions Watch the video of Paris Identify one problem behavior With your team, agree upon an operational definition of the behavior Write it on the goal form, second row (decrease) What would you target as a replacement behavior? Clearly define the behavior and write it on the third row (increase).
Activity (page 7 Activity Packet)page 7 Activity Packet In your teams, identify one student you know with serious problem behaviors. As a team, identify one behavior you would like decrease for this student Define it in clear, measurable terms Identify a behavior you would like to see increase that may replace the problem behavior Define it in clear, measurable terms
Facilitation Tips Have team members submit the goal setting table as homework Have a visual that summarizes all of the input Do not reword input—wait until meeting to have team provide clarification If step is conducted during problem solving meeting, use group processes to ensure all team members participate Use post-it notes or index cards and provide several to each team member Use 2 minute thinking time, have team members write input on notes/cards Use round robin to get input from all
Step 2: Discussion What do you need in order to facilitate Step 2? How will you implement this step?
Step 3: Functional behavior assessment Analyze the Problem
Given 60 seconds, use 4 straight lines to connect all of the dots without lifting your pen (Page 8 Activities)Page 8
Step 3: PTR Functional Assessment PTR Assessment (FBA) (pp. 56-61 book; 9-13 activity; 12-16 blank forms) PTR Assessment (FBA) Checklist format Prevent = antecedents Teach = function, possible replacements Reinforce = consequences, possible reinforcers One form completed for each problem behavior by each team member Information leads to hypothesis
Step 3: Prevent Section (First 2 pages of Assessment)Prevent Section Read the questions Be prepared to discuss the questions in this section
Step 3: Activity (pages 9-10 Activity packet) Practice using this section with regard to a student you know.
Step 3: Teach Section Read and discuss the questions in this section
Step 3: Activity (Pages 11-12 Activity Packet) Practice using the Teach section with regard to a student you know.
Step 3: Reinforce Section Read and discuss the questions in this section
Step 3: Activity (Page 13 Activity Packet) Practice using the Reinforce section with regard to a student you know.
Step 3: PTR Assessment Table ( pg. 18 blank forms, pg. 62 book)PTR Assessment Table Used by consultant to summarize all information from PTR Assessment Responses organized and categorized Information requiring clarification listed Draft hypotheses developed Draft hypotheses “Cheat sheet” (page 17 blank forms; page 16 Activity Packet)
Learned Functions of Behaviors GET Obtain Activities, people, tasks, tangibles, sensory, pain attenuation GET OUT OF Escape/Avoid/Delay Activities, people, tasks, tangibles, sensory, pain
Step 3: Case Study – Mike Assessment Summary Table of Problem Behavior Prevention DataTeach DataReinforce Data Non-preferred task Reading, Math Other students upset/mad Teacher attending to others Transition Preferred to non-preferred Change in schedule Denied item, told no, or to fix something Gain attention Peers, adults Delay Access to items Redirected Reprimanded Calm/soothe Personal space Later must complete task Loss of or delay in reinforcement Screaming, Hitting
Step 3: Case Study – Mike Assessment of Appropriate Behavior Prevention DataTeach DataReinforce Data Independent work One-on-one attention Specials Peer interaction Getting attention Raising hand Sharing attention Conversation skills Taking turns Waiting Self-management Asking for break Expressing emotions Treasure box Movie Attention Helping teacher Going to media center Going outside Walk Food Prosocial
Step 3: Developing the Hypothesis When….Student will….As a result… Inappropriate Behavior Appropriate Behavior Prevention data = antecedents or triggers Teach data = replacement behavior and possible function Reinforce data = function and reinforcers
Step 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 students scream and hitMike is able to gain attention and delay the transition/activity Mike 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 students express his frustrations appropriately complete the assigned task Mike is able to delay the transition/activity Mike is able to gain attention Inappropriate Appropriate
Facilitation Tips Team members complete for homework During meeting, use as an interview During meeting, give each team member 15 minutes to complete. Give 15 minute break to allow time for facilitator/coach to synthesize information in Assessment Organization Table Secondary: May want to change forced choice options to make appropriate for secondary environments
Step 3 Activity: Paris Activity Packet Pages 14-15
Step 3: Activity Instructions Review the PTR Assessment Summary for Paris (on page 14) Develop a problem behavior and appropriate behavior hypothesis (use form on page 15) Feel free to use the cheat sheet (page 16) Be ready to share
Step 3: Activity (Page 17 Activity Packet) Practice using the PTR Assessment Organization Table to organize your PTR Assessment information you completed on the child you know and develop a draft hypothesis. Use the ‘cheat sheet’ on page 16 to assist.cheat sheet’
Step 3: Discussion What do you need in order to facilitate Step 3? How will you implement this step?
Step 4: PTR Behavior Intervention Plan Implement Behavior Interventions
Step 4: Behavior Intervention Plan Team selects interventions from each component (P-T- R) (pg. 19 blank forms; pg. 102 book; page 20 blank forms secondary version) Team selects interventions from each component (P-T- R) Detailed behavior plan developed (template pp. 23-24 blank forms; pp. 104-105 book) Consultant provides training and on-site assistance with plan implementation Implementation fidelity evaluated
Step 4: Using the Intervention Checklist Record each team member’s rank on the checklist (pp. 21-22 blank forms; pg. 103 book)checklist Develop a list of preferred interventions Mean of ratings Interventions rank ordered #1 Number of people selecting specific intervention *Be sure to make note of interventions ranked highest/selected by teacher
Case Study: Tips on Linking Interventions to Hypothesis Prior to selecting interventions, “guidelines” provided to participants Prevention strategies should: Get Mike attention more often Modifying non-preferred tasks Changing what happens when he makes a mistake Signaling end of preferred activity Teach strategies should address: How to get attention/assistance How to get break/delay appropriately Reinforce strategies should: Give Mike attention/help Give Mike break/delay
Step 4: Intervention Checklist Summary Discuss interventions selected by the team Team gains consensus on the interventions to be implemented PTR consultant ensures interventions: Agree with hypothesis Can be done in the classroom
Step 4: Writing the Intervention Plan Task analyze each step of the plan NOT— “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.
Prevent Strategies Specific Strategy steps Environmental Support A wait card will be placed on Mike’s desk to assist him in remembering to wait his turn. 1. Prior to group work, tell Mike, “Remember, when it is someone else’s 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. Step 4: Case Study – Mike’s BIP
Prevent Strategies Specific Strategy steps Environmental Support Mike’s 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. Mike’s Intervention Plan
Prevent Strategies Specific Strategy steps Curricular Modification 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 Specific Strategy Steps Replacement Behavior Mike will be taught to use his voice output device to express his need to calm down. Steps: 1. Mike’s 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, say “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 (hierarchy—hand-over-hand, gesture, verbal). 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 (e.g., “You made a good choice.”. 6. Allow Mike to engage in his choice until he is calm for 1- minute. 7. If Mike does not want to leave his choice, then start becoming animated with students in the non-preferred activity.
Teach Strategies Specific Strategy Steps Self- Management 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 Specific Strategy Steps Replacement Behavior Anytime Mike “says” “I need to calm down”, his choice board should be given. 1. Praise Mike for communicating (“thank you for telling me what you need.”) 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 Self- Management Anytime Mike scores his behavior, attention should be given. 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. WaitingMike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule.
Reinforce Strategies Specific Strategy Steps TransitionMike 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 Mike’s behavior with him and ask him if he earned his stars. 3. Provide his stars if earned. 4. During the teacher’s 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.
Discuss PTR Intervention Plan How is the PTR intervention plan and level of detail different from current BIPs? How will the level of detail make a difference in implementation and effectiveness?
Step 4 Activity: Paris Intervention Plan Activity Packet Page 18
Step 4 Paris: Activity Instructions Look at your hypothesis developed for Paris. Identify one or two prevent, teach, and reinforce strategies you might want to try with Paris One for each component (prevent/teach/reinforce) For the Teach strategy, make certain one behavior you are teaching is a replacement behavior. Develop the specific steps (task analysis) of the TEACH replacement behavior intervention for Paris (page 18).
Step 4: Coaching Support- Teacher Training on BIP Provide opportunity to practice the plan with the teacher (team) without the students present (30-90 minutes) Role play, Q & A, Discuss Evaluate teacher accuracy on each step prior to teacher implementing plan with student Coaching Checklist used by PTR for training evaluation (pp. 25-26 blank forms; pg. 106 book). Coaching Checklist
Step 4: In-Class Support Provide support to teacher in implementation Be present on first day of implementation Determine when to debrief Measure fidelity Discuss and modify if necessary
Step 4: Intervention Fidelity Measure teacher implementation of plan (pg. 107 book) PTR—Two fidelity measures Adherence—did they do it? What is the most important part of intervention to be implemented to ensure intervention happens? Quality—did they do it correctly? What are all the parts that need to be implemented completely and correctly?
Teacher Fidelity Self- Assessments Daily Fidelity Self-Check (sample pg. 27 blank forms) Daily Fidelity Self-Check Teacher has major steps of intervention Provides them with nonintrusive prompts Weekly Fidelity Self-Check (pg. 29 blank forms) Weekly Fidelity Self-Check Aligned with Behavior Rating Scale Can be used with Excel SpreadsheetExcel Spreadsheet
Activity 4b: Coaching/Fidelity Pg. 19 Activity Packet Develop a fidelity measure for the replacement behavior intervention your team developed for Paris
Step 4: Facilitation Tips Secondary—modify menu of interventions to include those appropriate for middle/high school Teams can select interventions for homework or can select during team meeting Focus on one routine, class, subject for developing intervention If meeting time is limited, break up strategies: One meeting, focus on full development of Prevent, next meeting develop Teach/Reinforce OR First concentrate on Teach/Reinforce; next meeting develop Prevent. Fidelity measurements can be done once or twice a week rather than daily One form can be used for training and fidelity Use technology (video, Skype, Wiki, Facebook) to provide support to teachers
Activity (page 24-25 Activity Packet)page 24-25 Activity Packet Brainstorm ideas on possible prevent, teach, and reinforce interventions that would be appropriate for your student’s hypothesis Begin to task analyze the interventions
Step 4: Discussion What do you need in order to facilitate Step 4? How will you implement this step?
Step 5: Evaluation Is it working? BRS and/or other data measures Is it being implemented consistently and accurately? Fidelity ratings Are more data needed? Does the plan need to be modified or expanded? How can the team maintain the interventions?
Step 5: Evaluation Mike Outcome Data MeasureBaselinePost-testChange SSRS-PB123112-11 SSRS-SS87102+15 AET.34.57+23
Social Validity Social Validity (pp. 30-31 blank forms; pp. 120-121 book) Social validity—Acceptance and effectiveness of intervention Highly correlated with intervention implementation and maintenance Provides data on functionality of intervention’ Can be a pre-post measure
Teacher-Consultant Alliance Teacher-Consultant Alliance (page 32 blank forms) Provides data on relationship between facilitator (e.g., school-based behavior consultant) and implementer of interventions (e.g., teacher) Can be used as pre-post test measure Provides core behaviors valued in consultant/teacher relationship High correlation with teacher willingness to implement interventions
Step 5 Activity Instructions Review the graphs and outcome data for Paris (Pages 20-23 in activity packet)in activity packet As a team, what decisions would you make? Continue with intervention Modify or change intervention Gather more data Other???? Justify your responses.
Step 5: Facilitation Tips When fading interventions, do so systematically. Consider Multi-tiered System of Supports (access to Tiers 1 and 2) Make all decisions on data ALWAYS review fidelity data ALWAYS review BRS data (or other child outcomes) Have decision rules (e.g.,3 consecutive data points at or above goal line, fidelity score necessary to consider adequate implementation, etc.) Remind team this is a dynamic process and behavior is never “fixed”.
Step 5: Discussion What do you need in order to facilitate Step 5? How will you implement this step? How will you use the BRS or other evaluation measures to make data-based decisions?
Review PTR Process Five-step team-based process Teacher/team driven Prescriptive/manualized process Support provided to teacher/team to implement interventions Every intervention plan includes 3 components Prevent Teach Reinforce Plans are task analyzed
References Manual Dunlap, G., Iovannone, R., English, C., Kincaid, D., Wilson, K., Christiansen, K., & Strain, P. (2010). Prevent-Teach-Reinforce: A school-based model of individualized positive behavior support. Baltimore:Paul H. Brookes Journal articles Iovannone, 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, 213- 225. 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, 9-22 Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (in review). Reliability of the Individualized Behavior Rating Scale-Strategy for Teachers (IBRS-ST): A Progress Monitoring Tool. Manuscript submitted for publication. Next steps: Facilitating schools to scale up Training key school staff and team members to do process