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P REVENT -T EACH -R EINFORCE (PTR): A N E FFICACIOUS T IER 3 BEHAVIOR INTERVENTION Presented at the 2010 PBIS Leadership Forum Chicago, IL Rose Iovannone,

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Presentation on theme: "P REVENT -T EACH -R EINFORCE (PTR): A N E FFICACIOUS T IER 3 BEHAVIOR INTERVENTION Presented at the 2010 PBIS Leadership Forum Chicago, IL Rose Iovannone,"— Presentation transcript:

1 P REVENT -T EACH -R EINFORCE (PTR): A N E FFICACIOUS T IER 3 BEHAVIOR INTERVENTION Presented at the 2010 PBIS Leadership Forum Chicago, IL Rose Iovannone, Ph.D., BCBA-D University of South Florida The contents of this training were developed under grant H324P04003 from the Department of Education.

2 O BJECTIVES Participants will: Describe the 5-step PTR Tier 3 support model Identify the critical components that enhance the success of Tier 3 behavior supports Discuss application at district level

3 A GENDA Rationale and conceptual foundation Research method/outcomes Overview of PTR process Suggestions for district-wide application

4 T IER 3 F UNCTION -B ASED B EHAVIOR I NTERVENTIONS IN S CHOOLS 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 Result--limited impact on student behavior

5 W HAT IS P REVENT -T EACH -R EINFORCE (PTR)? Research project funded by U.S. Department of Education University of South Florida University of Colorado, Denver Evaluate effectiveness of PTR process vs. “business as usual” Randomized controlled trial Intervention “Package” ONE ‘P’revent; ONE ‘T’each; ONE ‘R’einforce Based on ABA principles and individual Positive Behavior Support

6 W HAT IS P REVENT -T EACH -R EINFORCE (PTR)? Primary Research Questions: Is the PTR intervention more effective than control conditions (‘business as usual’) in decreasing severe problem behaviors and increasing pro-social and academic skills of students? Repeated measures—baseline, post-test, follow-up Social Skills Rating System (SSRS)-Problem Behavior and Social Skills subscales Academic Engaged Time (AET)

7 P ARTICIPANTS K-8th grade Behavioral difficulties Intensity– disruption to the learning environment Frequency— minimum of 1 time per week Duration– minimum 6 months General or Special Education All cognitive levels All disabilities Teachers volunteered & nominated 1-3 students Top externalizers Systematic Screening for Behavior Disorders (SSBD)

8 P ROCESS Standardized Individual Positive Behavior Support approach Intervention teams provided manual, assignments, homework Five step process aligned with problem solving facilitated by PTR Consultant Team Development Goal Setting Assessment Intervention and Coaching Evaluation

9 O UTCOMES OF PTR P ROCESS

10 S TUDENT D EMOGRAPHICS BY P RIMARY D ISABILITY DisabilityN Percent Autism259.8 Developmental Delay52.0 Emotional Disturbance Mental Retardation Multiple Disabilities41.6 OHI (not ADD/ADHD)1.4 OHI (ADD/ADHD)83.1 Specific Learning Disability207.8 Speech/Language Disability103.9 Visual Impairment2.8 General Education TOTAL 245

11 S TUDENT D ESCRIPTION Grade Level K N % Lunch Status Regular Free/Reduced Gender Female Male

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13 Cross-Over Treatment Results p <.01 d =.64

14 T EACHER O UTCOMES Fidelity Majority of teachers achieved.80 Mean # coaching/training sessions = 3.5 Prevention higher than Teach and Reinforce Social Validity Modified Teacher Acceptability Rating Form (TARF; Reimers & Wacker, 1988)—15 items 5-point Likert Scale 124 teachers Overall—4.16 (.52) Willingness to carry out plan—4.80 (0.42) Like the procedures—4.46 (0.64)

15 PTR: T HE P ROCESS

16 S TEP 1: TEAMING Purpose: Evaluate strengths and weaknesses of team functioning Outline roles and responsibilities Determine a consensus-making process Members (desired 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) Tools Work style survey Teacher and Teacher Assistant Teaming survey

17 S TEP 2: G OAL S ETTING Purpose: Identify behaviors of greatest concern to the team and possible replacement behaviors (teach) Prioritize and operationalize behaviors Develop teacher friendly baseline data collection system Targeted Areas: Problem behaviors Social skills Academic behaviors

18 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

19 S TEP 2: D ATA C OLLECTION S YSTEM Behavior Rating Scale 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

20 C ASE S TUDY - M IKE : O PERATIONAL D EFINITIONS 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

21 Case Study- Mike: Behavior Rating Scale Behavior Screaming9+ times 7-8 times 5-6 times 3-4 times 0-2 times Hitting8+ times 6-7 times 4-5 times 2-3 times 0-1 times Expressing Frustration 40% % 20-30% 10-20% 0-10% Transition to Non-preferred Whimper or squeal Louder than indoor voice Outdoor play voice Louder than outdoor play Ear penetrating Date

22 BRS P SYCHOMETRICS (P RELIMINARY ) Kappa coefficients of: Problem Behavior 1 (n = 105):.82 Problem Behavior 2 (n = 90) :.77 Appropriate Behavior 1 (n = 103):.65 Appropriate Behavior 2 (n = 56):.76

23 S TEP 3: PTR A SSESSMENT (FBA) PTR Assessment (FBA) Each team member independently answers a series of questions related to: Observed antecedents/triggers of problem behaviors Functions of the problem behaviors Consequences ordinarily associated with the problem behaviors PTR facilitator summarizes input and develops draft hypothesis Team reaches consensus

24 S TEP 3: C ASE S TUDY – M IKE A SSESSMENT S UMMARY T ABLE OF P ROBLEM B EHAVIOR 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

25 S TEP 3: C ASE S TUDY – M IKE A SSESSMENT OF A PPROPRIATE B EHAVIOR 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

26 S TEP 3: C ASE S TUDY – M IKE H YPOTHESES 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

27 S TEP 4: B EHAVIOR I NTERVENTION P LAN Team selects interventions from each component (P-T-R) Detailed behavior plan developed Consultant provides training and on- site assistance with plan implementation Implementation fidelity evaluated

28 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

29 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

30 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 30

31 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.

32 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

33 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.

34 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.

35 S TEP 4: PTR I NTERVENTION C OACHING / FIDELITY Provide training to practice the plan without student (30-90 min.) PTR Consultant present first day of implementation with student Provide support in the classroom Model the plan Provide feedback Discuss need for modifications if applicable

36 Case Study: Sample Coaching Checklist/Fidelity for Mike

37 S TEP 5: E VALUATION Is it working? Daily ratings of behavior Continuous progress monitoring BRS Other data collection forms Is it being implemented consistently and accurately? Fidelity ratings Do we need more data? Does the plan need to be modified or expanded? Plan for generalization and maintenance

38 Step 5: Mike Evaluation

39 Step 5: Evaluation

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41 S TEP 5: E VALUATION

42 42 S TEP 5: E VALUATION M IKE O UTCOME D ATA MeasureBaselinePost-testChange SSRS-PB SSRS-SS AET

43 R EVIEW PTR P ROCESS Five-step team-based process Teacher/team driven Support provided to teacher/team to implement interventions Mean number of days for PTR process = 71

44 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, 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

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46 A PPLICATION OF TIER 3 DISTRICT LEVEL

47 S TEP 1: A SSESS C URRENT S TATUS

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53 PBS T EAM S TRUCTURE Goals: Teams to support all students (general ed. and ESE) throughout tiered (levels) continuum of support System for monitoring outcomes at all levels Access to technical assistance Link between all three tiers of behavior support Link between school, home, community

54 PBS T EAM S TRUCTURE IN A S CHOOL SWPBS team—for all students (gen. ed. & ESE) Monitor implementation of universal intervention Monitor school-wide data Guide implementation of new initiatives, braid with SWPBS Tier 3 PBS team—“Standing team”—for all students (gen. ed. & ESE) Progress monitor students in targeted and intensive interventions Guide intervention selection for students selected for IPBS Student-focused teams—“Ad hoc” for all students (gen. ed. & ESE) Conduct FBAs and build support plans

55 T IER 3 B EHAVIOR S UPPORT IN A S CHOOL : T EAM O PTION “Ad-hoc” team—student focused (both gen. ed. & ESE)  Responsibilities of team (problem solving process) Conduct FBA Build function-based support plan Provide coaching/support to teacher to implement interventions Collect and review fidelity and student outcome data Make decisions based on data  Membership—Three levels of knowledge represented Someone with expertise in FBA and function-based intervention plans (school psychologists, CABAs, BCBAs, behavior specialists, counselors, social workers……) Someone with knowledge of the student and his or her behaviors (Teacher(s), aides, parents, students) Someone with knowledge of the context in which the support plan will be implemented (administrators or designees)

56 T IER 3 PROCESS — CONSISTENT AND FEASIBLE

57 M ULTIPLE L EVELS OF T IER 3 (FBA) Brief FBA FBA/BIP developed in one meeting (60 minutes or less) Best used for high frequency/low intensity behaviors (e.g., noncompliance, minor disruptions, etc.) Example: Brief PTR, ERASE Comprehensive FBA More complex FBA/BIP procedure May take 2 or more meetings or one lengthy meeting (>1 hour) Best used for chronic, durable, intense behaviors Example: PTR

58 M ULTIPLE L EVELS OF T IER 3 Wraparound Involves multiple agencies Support plan includes practices that may go beyond scope of school Best used for students with mental health issues and/or complex life events

59 D ATA T RACKING —T IER 3 Systemic Data Tracking Examples Florida School Districts Monroe Martin University of Oregon

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63 Q UESTIONS ?

64 F OR COPIES OF FORMS, E - MAIL :


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