Presentation on theme: "Prevent-Teach-Reinforce Model: A Tier 3 Behavior Intervention Process"— Presentation transcript:
1 Prevent-Teach-Reinforce Model: A Tier 3 Behavior Intervention Process Rose Iovannone, Ph.D., BCBA-DUniversity of South FloridaThe contents of this training were developed under grant H324P04003 from the Department of Education
3 Objectives Participants will: Describe the 5-step PTR Tier 3 support modelIdentify the critical components that enhance the success of Tier 3 supportsApply the principles of the PTR process to a case studyDetermine how the PTR process is applicable within their setting
4 Tier 3 Function-Based Behavior Interventions in Schools Current IssuesAbsence of uniform policies & practicesForm versus a processExpert driven versus collaborative effortOccasionally contextual fit consideredLimited support/follow-up/training for teacher providedTeachers may not be the personnel to facilitate FBAs in schoolsIncreased focus on school psychologists (Scott & Kamps, 2007) and other school-based behavioral consultants or “coaches”
5 What 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 “ approachSame steps, same procedures, all plans with 3 components (prevent, teach, reinforce)
6 Where is PTR in a Multi-tiered System of Supports (MTSS)?
7 Primary Research Questions Is the PTR model more effective in decreasing severe problem behaviors than ‘services as usual’? (services as usual defined as the typical behavior services/supports that would be provided within the school setting).Does the PTR model improve the academic performance and pro-social interactions of students with severe problem behaviors?
8 Participants 200+ students—100 treatment, 100 comparison K-8th grade General and Special EducationAll cognitive levelsAll disabilitiesTeacher-nominated top externalizersSystematic Screening for Behavior Disorders (SSBD)Behavioral difficultiesDuration– minimum 6 monthsFrequency— minimum of 1 time per weekIntensity– disruption to the learning environment
9 Prevent-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)
18 Making PTR More Efficient Two primary meetings to get to interventionMeeting 1Step 1 (optional): TeamingStep 2: Identify the problem/Goal SettingDefine the behaviors to be targeted for FBA (behaviors to be decreased)Define the behaviors targeted for increase (potential replacement behaviors)Set up Individualized Behavior Rating Scale—team collects baseline data prior to meeting 2Step 3: Analyze the problem/PTR AssessmentConduct FBA with team (interview or have team complete form in minutes)Complete FBA organization table and develop hypothesis or summary statementGet consensus
19 Making PTR More Efficient Meeting 2 (in perfect world, scheduled one week after meeting 1)Team has been collecting baseline data on IBRSTREMEMBER TO REVIEW IT AT MEETINGStep 4: Develop and Implement Intervention/PTR Intervention PlanTeam comes to consensus on 3 primary intervention:One prevent (modifies the context in the hypothesis)One new skill to teach (functional replacement or physically incompatible behavior)One to reinforce (reinforce new replacement behavior so that it will be repeated, one to follow problem behavior so that the behavior no longer gets the outcomes (function)Task analyze the strategies with the teacher so that it fits the contextSchedule a separate time to coach/train the teacher (30 min.)Plan fidelity measures (observation, self-assessment)Teachers continue to take IBRST data every day (draw vertical line down column showing date intervention begins).
20 Making PTR More Efficient Meeting 3—Step 5-EvaluateReview data including (a) student outcomes-IBRST; (b) teacher outcomes-FidelityMake decisions on next steps based on data
22 Step 1: Teaming (Before the Process is Started) Teaming: A collaborative processDetermine relevant team membersSuggestions—3 levels of knowledge represented:MembersPerson 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)
23 Teaming: Considerations Purpose:Evaluate strengths and weaknesses of team functioningOutline roles and responsibilitiesDetermine a consensus-making processRationaleThe “team” is implementing the interventionGreater buy-in correlated with collaborative processes
25 Teaming (PTR Style) Optional forms Best used for situations in which the team may not be collaborating effectivelyForms for creating an effective cohesive teamClassroom Team SurveyTeacher Work-Style SurveyParaeducator Work-Style SurveyPTR Work-Style Comparison Sheet (used by facilitator)Purposes: To identify potential issues enhancing and impeding effective intervention implementation
26 Collaborative Facilitation Tips Take off the “expert” hatAvoid direct confrontation or “fixing” issuesPurpose is for team to recognize potential issues that enhance and inhibit problem solving processLess talk, more listening and facilitatingProvide visual summary while facilitating—allow reflection and discussion by teamAsk them to review the results and reflectAsk for their ideas, reactions, inputFacilitate the discussionGuide them to use “science” in making decisions
27 Problem Solving Process = Identify the problem Step 2-Goal SettingProblem Solving Process = Identify the problem
28 What 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
29 Goal SettingPurpose:Identify behaviors of greatest concern to the team and possible replacement behaviors (teach)Prioritize and operationalize behaviorsDevelop teacher friendly baseline data collection systemTargeted Areas:Problem behaviorsSocial skillsAcademic behaviors
30 Step 2: Goal Setting Behavior Social Academic Broad Goal Broad outcomes desired(what is the overall goal to be achieved in each category)?Short-Term Goal: Behavior to DecreaseInappropriate behaviors preventing student from achieving long-term goals(current problem behaviors/deficits)Short-Term Goal: Behavior to IncreaseSkills to be taught to replace inappropriate behaviors (skills to replace problem behaviors that will achieve broad goal)
32 Case Study Mike 9-year-old male ESE Classification: Autism Placement: Self-contained, autism classroom with 6 studentsNonverbal: Uses signs, Dynamite, pictures to communicateTeam: Teacher and two aides, PTR Consultant
33 Mike Baseline VideoIdentify broad goals, behaviors to be decreased, and behaviors to be increased
34 Case Study—Step 2: Goal Setting BehaviorSocialAcademicMike will communicate his wants and needs appropriatelyMike will interact with peers appropriatelyMike will comply with non-preferred activities and requestsMike will decrease screaming, hitting, and getting out of his seatMike will decrease hitting, screaming at, and bossing his peersMike will decrease screaming and hittingMike will ask for a break or for attention when neededMike will initiate peer interactions using his DynamiteMike will engage in non-preferred activities and communicate his frustration using his Dynamite or an appropriate toneDecreaseIncreaseBroad
35 Step 2: Progress Monitoring System Individualized Behavior Rating Scale Tool – IBRSTDirect 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
36 IBRST Behavior recorded at least once each day Specific time period/routineWhole dayCombination of bothAnchors –scale of 1-5Measure options:FrequencyDurationIntensityPercentage of opportunities
37 IBRST Guiding Questions In which routine(s) or over what time period 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?
38 IBRST Guiding Questions What is your estimate of the behavior occurrence on a bad day?Problem behavior = 4Appropriate behavior = 2What would the behavior look like on a fantastic day?Problem behavior = 1Appropriate behavior = 5Anchor/rating—standardized ranksProblem behavior: 5 = Terrible day; 4 = Bad day; 3 = So-so day; 2 = Good day; 1 = Fantastic dayAppropriate behavior: 5 = Fantastic day; 4 = Good day; 3 = So-so day; 2 = Bad day; 1 = Terrible day
39 Case Study - Mike: Operational Definitions Problem behaviorsScreaming—loud, high pitched noise heard outside the classroomHitting—anytime Mike touches peers or adults with an open hand, fist, foot, or object while screaming or protestingReplacement/Appropriate BehaviorsExpress frustration appropriately using Dynamite, pictures, or signs to ask for a break or attentionTransition to non-preferred activities: Moving to non-preferred activity and engaging with appropriate verbal expression, volume, and pitch.
40 Case 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
42 Other Uses of IBRST in MTSS Systemic data tracking method for Tier 3Sample system created by:Cindy AndersonSchool district in FloridaState behavior database in Florida (Tier 3 coming soon)
43 Secondary Level Modifications Teams with 3 or more membersSelect one team member who will be the primary interventionistBehavior identification and BRS development will be focused on that person’s situationOther team members provide input/supportIf desired, other team members can record BRS data in their settings—rating descriptions can stay the same or minor modifications can be madeEach row of BRS can represent a different teacher OREach teacher can keep own BRSConsultant/coach collects all BRS ratings at specified times
44 Facilitation TipsHave team members submit the goal setting table as homeworkHave a visual that summarizes all of the inputDo not reword input—wait until meeting to have team provide clarificationIf step is conducted during problem solving meeting, use group processes to ensure all team members participateUse post-it notes or index cards and provide several to each team memberUse 2 minute thinking time, have team members write input on notes/cardsUse round robin to get input from all
45 Troubleshooting IBRST Data Collection Decide upon a method of prompts to remind teachers/team to:Rate the behaviors on the IBRST daily (or frequency determined by the team)Have data ready for analysis at ALL meetings related to the student and the planIdentify a key person (who likes Excel or other spreadsheet/data chart software) who can transfer the scores into a graphToo many behaviors identifiedAsk teachers/team if they could select one problem behavior that, if reduced, would make each day at least 50% better for everyone (student, school, family)Defining behaviorsIf teachers/team have difficult time using words to define the define the behavior, ask them to demonstrate the student doing the behavior. Write down the motor movements, verbal communication, other key features that define the behavior.
46 Practice Time Setting up a behavior rating scale One volunteer Identify a behavior of concernAs a group, walk through the steps to set up the scale
49 Step 2 Activity Instructions Form a teamWatch the video of ParisIdentify one problem behaviorWith your team, agree upon an operational definition of the behaviorWrite it on the goal form under problem behaviorWhat would you target as a replacement behavior? How would you define the behavior?
51 Step 3: Analyze the Problem/PTR Functional Behavior Assessment
52 Functional Behavioral Assessment Definition:“ A process whereby informed hypothesis statements are developed about relationships between events in the environment and the occurrence of a student’s challenging behavior.”Johnson & Dunlap, 1993
53 Given 60 seconds, use 4 straight lines to connect all of the dots without lifting your pen
56 Step 3: PTR Assessment (FBA) - Problem Analysis PTR Assessment (FBA) ChecklistPrevent: Antecedents/triggers of problem behaviorTeach: Function(s) of problem behavior, possible replacement behaviorsReinforce: Consequences associated with problem behavior, possible reinforcersAssessment form completed by each team memberFacilitator summarizes input and develops draft hypothesisTeam reaches consensus5656
57 Learned Functions of Behaviors GETObtainActivities, people, tasks, tangibles, sensory, pain attenuationGET OUT OF/AWAY FROMEscape/Avoid/DelayActivities, people, tasks, tangibles, sensory, pain
59 Are Power, Control, Jealousy, Revenge Functions? Iovannone, Anderson, & Scott, In Review (Beyond Behavior)
60 Completing the PTR Assessment Organization Table
61 Step 3: Case Study – Mike Assessment Summary Table of Problem Behavior Prevention DataTeach DataReinforce DataNon-preferred taskReading, MathOther students upset/madTeacher attending to othersTransitionPreferred tonon-preferredChange in scheduleDenied item, told no, or tofix somethingGain attentionPeers, adultsDelayAccess to itemsRedirectedReprimandedCalm/soothePersonal spaceLater mustcomplete taskLoss of or delay inreinforcementScreaming, Hitting
62 Step 3: Case Study – Mike Assessment of Appropriate Behavior Prevention DataTeach DataReinforce DataIndependent workOne-on-oneattentionSpecialsPeer interactionGetting attentionRaising handSharing attentionConversation skillsTaking turnsWaitingSelf-managementAsking for breakExpressing emotionsTreasure boxMovieAttentionHelping teacherGoing to mediacenterGoing outsideWalkFoodProsocial
63 Step 3: Developing the Hypothesis When….Student will….As a result…Inappropriate BehaviorAppropriate BehaviorPrevention data = antecedents or triggersTeach data = replacement behavior and possible functionReinforce data = function and reinforcers
64 Mike’s Hypotheses When…. he will As a result… Inappropriate Mike is (a) asked to complete non-preferred tasks (Reading, Math), stop a preferred activity or transition to a non-preferred activity, or fix an error, or(b) when the teacher is attending to other students,scream and hit.Mike is able to (a) delay the transition or non-preferred activity and(b) get attention from teachers and peersMike is (a) asked to a complete non-preferred task (Reading, Math), stop a preferred activity or transition to a non-preferred activity, or fix an error, or(a) express his frustration appropriately.(b) Transition from preferred to non-preferred tasksInappropriateAppropriate64
65 Case Study: Tips on Linking Interventions to Hypothesis Prevention strategies should:Get Mike attention more oftenModifying non-preferred tasksChanging what happens when he makes a mistakeSignaling end of preferred activityTeach strategies should address:How to get attention/assistanceHow to get break/delay appropriatelyReinforce strategies should:Give Mike attention/helpGive Mike break/delay
66 Facilitation Tips Team members complete for homework During meeting, use as an interviewDuring 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 TableSecondary: May want to change forced choice options to make appropriate for secondary environments (although very few words need to be changed)Family version of PTR Assessment availableCategorizing/aligning: Ensure that your pathway/table is aligned (e.g., triggers are categorized, function is identified for each set of triggers)
67 Troubleshooting Team select all options/boxes after question Ask them to select the top 3-5 that they have 100% confidence is related to the behavior occurrenceExample—Prevent Question 4 almost all boxes selectedSay to the team, “If I came into your classroom tomorrow and would give you $1 million to make Sarah’s behavior happen, which of these would you do first to get the money? Second? Third?Not sure of functionFirst, separate antecedents/triggers by categories (e.g., triggers related to demands to do non-preferred tasks, triggers related to peer interactions, etc.).Ask team what function seems to best fit with these categories (e.g., non-preferred tasks—is behavior’s purpose to delay/escape the non-preferred task or to get attention)If not sure between escape/attention, probe the team furtherFor example, if the child was doing a preferred activity, would the behavior still occur? If yes, it may be attention. If no, it may be escape.
69 Step 3: Activity Instructions Review the PTR Assessment Summary for ParisDevelop a problem behavior hypothesisIf ambitious, develop a replacement behavior hypothesis.
70 Step 4: PTR Intervention Plan Developing and implementing an intervention
71 Behavior Intervention Plan Team selects interventions from each component (P-T-R)Detailed behavior plan developedConsultant provides training and on-site assistance with plan implementationImplementation fidelity evaluated
72 Coming to Consensus on Interventions Record each team member’s rank on the checklistDevelop a list of preferred interventionsMean of ratingsInterventions rank ordered #1Number of people selecting specific intervention*Be sure to make note of interventions ranked highest/selected by teacher
73 Coming to Consensus on Interventions Discuss interventions selected by the teamTeam gains consensus on the interventions to be implementedPTR consultant ensures interventions:Agree with hypothesisCan be done in the classroom
74 Writing the Intervention Plan Task analyze each step of the planNon-Example: Give student choicesExample:Prior to the start of independent reading, tell the student, “We have 2 worksheets today.”Show student both worksheetsSay, “Which worksheet would you like to do first?”Teachers need to know exactly what to do or the intervention may not be implemented as intended.74
75 Step 4: Case Study – Mike’s BIP Prevent StrategiesSpecific Strategy stepsEnvironmental SupportA 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.
76 Mike’s Intervention Plan Prevent StrategiesSpecific Strategy stepsEnvironmental SupportMike’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.
77 Mike’s Intervention Plan Prevent StrategiesSpecific Strategy stepsCurricular ModificationMike 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
78 Mike’s Intervention Plan Teach StrategiesSpecific StepsReplacement Behavior:Appropriately express his need to calm downMike will be taught to use his Dynamite to express his need to calm down.1. Mike’s device will be programmed to say “I need to calmdown.”2. Prior to transitioning to a non-preferred activity or at the endof a preferred activity, remind Mike, “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 hisdevice.4. Once Mike communicates “I need to calm down”, present himwith 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-min.7. If Mike does not return to his area, then start having a fun timein that area with those students present
79 Specific Strategy Steps Teach StrategiesSpecific Strategy StepsSelf-ManagementMike 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
80 Mike’s Intervention Plan Reinforce StrategiesSpecific StepsReplacement Behavior:Appropriately express his need to calm downWhenever Mike ‘says’, “I need to calm down”, give him the choice board.1. Praise Mike for communicating: “Thank you for telling me what youneed.”2. Provide the choice board.3. Allow him to calm for 1 minute4. Praise him as soon as he is quiet5. Praise him for returning to the groupSelf-ManagementAnytime 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.80
81 Specific Strategy Steps Reinforce StrategiesSpecific Strategy StepsTransitionMike will earn stars during Reading Centers if he transitions and completes his work without screaming.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.At the end of each reading center, an adult will review Mike’s behavior with him and ask him if he earned his stars.Provide his stars if earned.During the teacher’s group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group.Allow Mike to participate in his chosen activity if he earned his stars.
84 Intervention Plan Group Activity With your team:Review Paris’ PTR Assessment data and the hypothesis you developed.Identify a replacement behavior to be taught to Paris.Develop a task analysis of the intervention.PTR Activity Packet8484
86 Teacher Training Teacher and Staff Training Initial training with no students presentminutesModel, Role Play, Q & A, DiscussionCoaching ChecklistUsed by PTR Consultant for training evaluationEvaluate teacher accuracy on each step prior to implementation with studentComfort and competence measured
88 Step 4: In-Class Support Provide support to teacher in implementationBe present on first day of implementationDetermine when to debriefMeasure fidelityDiscuss and modify if necessary
89 Step 4: Intervention Fidelity Measure teacher implementation of planPTR Research—2 fidelity measuresAdherence—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?
91 Revised Method for Fidelity Title = PTR Plan AssessmentNo longer look at adherence and qualityYes/No checklistCan be used as a self-assessment or external observationCan use the training checklist as the fidelity measure or use the PTR Plan Assessment as the training checklist (rather than have 2 forms)Fidelity ideally should be collected daily; at a minimum, once a weekAll evaluation meetings after intervention implemented should review both the IBRST and the Plan Assessment data (Fidelity)
92 PTR Plan Self-Assessment Example for Mike Intervention TypeFidelityImpact1 = none; 5 = greatEnvironmental SupportMini schedule present and availableMini schedule reviewed prior to activityMike prompted to cross off items as completedY/N/NAReplacement Behavior—FunctionalVoice output device present and availablePrompted Mike to use voice output device to request, “I need to calm down”Prompted Mike to choose his calm down activityReinforce Replacement Behavior—FunctionalTeacher responded to Mike’s request for “I need to calm down” with verbal praise (flat affect)Teacher granted Mike his choice and provided verbal praise (flat affect)
93 Step 4: Training/Fidelity Checklist Case Study - Paris Group Activity:Look at the task analysis for Paris’ replacement behaviorsSlide 74 - group developedSlide 79 - ‘raising hand’Select the core strategies you would include on a coaching/training and fidelity measure93
95 Step 4: Facilitation Tips Secondary—modify menu of interventions to include those appropriate for middle/high schoolTeams can select interventions for homework or can select during team meetingFocus on one routine, class, subject for developing intervention
96 Step 4: Facilitation Tips If meeting time is limited, break up strategies:One meeting, focus on full development of Prevent, next meeting develop Teach/Reinforce ORFirst concentrate on Teach/Reinforce; next meeting develop Prevent.Fidelity measurements can be done once or twice a week rather than dailyOne form can be used for training and fidelityUse technology (video, Skype, Wiki, Facebook) to provide support to teachers
97 Step 4: Facilitation Tips Fidelity observations and coaching sessions should NEVER be used as teacher evaluation toolsFidelity and training are coaching supportsTrust is essential for coaching and fidelity to work as intended
99 Step 5: Evaluation Progress Monitoring Data-Based Problem-SolvingWhat is working? What is not working?What changes need to be made?Is more data needed? (additional data collection measures)Implementation Fidelity DataIs the plan being implemented consistently and accurately?Student outcome dataIs the problem behavior decreasing? Is the replacement behavior increasing?Expanding the planRoutines, times of dayGeneralize across settings and/or staffFadingContinue team meetingsData review and planningNext stepsTeam cohesion
100 Steps for Evaluating Outcomes Make sure you have both fidelity measures (self and/or observation scores) AND student outcomes (Behavior Rating Scale measures)Decision rulesWhat constitutes adequate fidelity? 80%, 70%, something else?What constitutes adequate student progress? (e.g., 3 or more consecutive ratings at or above goal line?)
101 Primary DecisionsIf Fidelity scores are inadequate, determine the reasons (intervention too difficult, not feasible, not described adequately….)Retrain/coach the teacher/implementerModify the interventions so that they are feasible, simplerSelect different interventions that match the hypothesisStudent outcomes (decision contingent upon outcome trend)Maintain interventionIntensify interventionModify interventionFade intervention componentsShape behavior outcomes to become closer approximations of desired behaviorExpand the intervention (additional people, additional settings or routines)Conduct another FBA if hypothesis is suspect, team has new data, or context has changed
102 POSITIVE BEHAVIOR CHANGE BRS data indicate positive trends toward desired goalsGood fidelity implementation scoresNext StepsExtensionExtend the scope of the BIPGeneralizationSettingsAdditional routinesMultiple classesAcross entire dayInterventionistsSchool staffMultiple service providersFamilyShapingIncrease desired goal responsesFading ReinforcersReduce type and/or amount of reinforcement providedDelayed GratificationIncrease time intervals within reinforcement scheduleIntermittent ScheduleProvide reinforcers at irregular intervalsSelf-ManagementShift control for behavior monitoring from teacher to student
103 Increase in Problem Behavior BRS data indicate a trend/movement away from desired goalsFBA VariablesAppropriate function determined?Interventions match function?Appropriate replacement behaviordetermined and skills taught?Low Fidelity VariablesStrategies implemented as designed?Strategies implemented daily?All setting events addressed?Reinforcers provided as designated?Training and Technical AssistanceAdditional training outside classroomModeling of strategies with studentIncrease technical assistance in classroom (observation/feedback)BIP Variables:Interventions difficult to implement?Insufficient planning/prep time?Insufficient time to implement?Lack of resources?BIP StrategiesModify current interventionsSelect alternative strategiesDetermine appropriate reinforcersReinforcers readily available
110 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 dataALWAYS review fidelity dataALWAYS 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.)Consider using Excel or other graphing tools to visually show behavior ratings and fidelity scoresRemind team this is a dynamic process and behavior is never “fixed”.
115 Step 5: Evaluation Mike Outcome Data MeasureBaselinePost-testChangeSSRS-PB123112-11SSRS-SS87102+15AET.34.57+23
116 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 dataALWAYS review fidelity dataALWAYS 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”.
117 PTR Summary Preliminary outcomes suggest PTR is effective Implemented in wide variety of settings with diverse studentsTeachersLike the processGave the PTR model high social validityIdentify coaching and collaboration as key featuresDo not continue the process without supportTools not as important as the processEssential skills for effective team facilitationKnowledge of applied behavior analysis and positive behavior supportCollaborative consultationUsing data to make decisionsEffective problem-solving skillsImplementation of effective Tier 3 supports may require systemic change
118 PTR 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 press). Reliability of the Individualized Behavior Rating Scale-Strategy for Teachers (IBRS-ST): A Progress Monitoring Tool. Assessment for Effective Intervention..Sears, K. M., Blair, K. S. C., Iovannone, R. & Crosland, K., (in press). Using the Prevent-Teach-Reinforce model with families of young children with ASD. Journal of Autism and Developmental Disabilities.