Presentation on theme: "Presented at the 2010 PBIS Leadership Forum Chicago, IL"— Presentation transcript:
1 Prevent-Teach-Reinforce (PTR): An Efficacious Tier 3 behavior intervention Presented at the 2010 PBIS Leadership ForumChicago, ILRose Iovannone, Ph.D., BCBA-DUniversity of South FloridaThe contents of this training were developed under grant H324P04003 from the Department of Education.
2 Objectives Participants will: Describe the 5-step PTR Tier 3 support modelIdentify the critical components that enhance the success of Tier 3 behavior supportsDiscuss application at district level
3 Agenda Rationale and conceptual foundation Research method/outcomes Overview of PTR processSuggestions for district-wide application
4 Tier 3 Function-Based Behavior Interventions in Schools IssuesAbsence of uniform policies & practicesForm versus a processExpert driven versus collaborative effortOccasionally contextual fit consideredLimited support/follow-up/training for teacher providedResult--limited impact on student behavior
5 What is Prevent-Teach-Reinforce (PTR)? Research project funded by U.S. Department of EducationUniversity of South FloridaUniversity of Colorado, DenverEvaluate effectiveness of PTR process vs. “business as usual”Randomized controlled trialIntervention “Package”ONE ‘P’revent; ONE ‘T’each; ONE ‘R’einforceBased on ABA principles and individual Positive Behavior Support
6 What is Prevent-Teach-Reinforce (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-upSocial Skills Rating System (SSRS)-Problem Behavior and Social Skills subscalesAcademic Engaged Time (AET)6
7 Participants K-8th grade Behavioral difficulties Intensity– disruption to the learning environmentFrequency— minimum of 1 time per weekDuration– minimum 6 monthsGeneral or Special EducationAll cognitive levelsAll disabilitiesTeachers volunteered & nominated 1-3 studentsTop externalizersSystematic Screening for Behavior Disorders (SSBD)
8 Process Standardized Individual Positive Behavior Support approach Intervention teams provided manual, assignments, homeworkFive step process aligned with problem solving facilitated by PTR ConsultantTeam DevelopmentGoal SettingAssessmentIntervention and CoachingEvaluationBRCs and NBRCC Overview8
16 Step 1: teaming Purpose: Members (desired Tools Evaluate strengths and weaknesses of team functioningOutline roles and responsibilitiesDetermine a consensus-making processMembers (desiredPerson 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)ToolsWork style surveyTeacher and Teacher AssistantTeaming survey
17 Step 2: Goal Setting Purpose: Targeted Areas: 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
18 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
19 Step 2: Data Collection System Behavior Rating ScaleDirect 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
20 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
21 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 penetratingDate
23 Step 3: PTR Assessment (FBA) Each team member independently answers a series of questions related to:Observed antecedents/triggers of problem behaviorsFunctions of the problem behaviorsConsequences ordinarily associated with the problem behaviorsPTR facilitator summarizes input and develops draft hypothesisTeam reaches consensus
24 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
25 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
26 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 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
27 Step 4: 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
28 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.
29 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.
30 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
31 Specific Strategy Steps Teach StrategiesSpecific Strategy StepsReplacement BehaviorMike will be taught to use his voice output device to express his need to calm down.Steps:Mike’s device will be programmed to say “I need to calm down.”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.”As soon as Mike starts to get upset, prompt him to use his device (hierarchy—hand-over-hand, gesture, verbal).Once Mike communicates “I need to calm down”, present him with the choice board of calming strategies and ask him, “What do you want?”As soon as he is calm, praise him (e.g., “You made a good choice.”.Allow Mike to engage in his choice until he is calm for 1-minute.If Mike does not want to leave his choice, then start becoming animated with students in the non-preferred activity.
32 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
33 Specific Strategy Steps Reinforce StrategiesSpecific Strategy StepsReplacement BehaviorAnytime Mike “says” “I need to calm down”, his choice board should be given.Praise Mike for communicating (“thank you for telling me what you need.”)Provide his choice board.Allow him to calm for 1 minutePraise him as soon as he is quietPraise him for returning to the groupSelf-ManagementAnytime Mike scores his behavior, attention should be given.When Mike marks his tracking sheet, praise him for doing so.At the end of the day, review the sheet with Mike.Talk about the sad faces.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 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.
35 Step 4: PTR Intervention Coaching/fidelity Provide training to practice the plan without student (30-90 min.)PTR Consultant present first day of implementation with studentProvide support in the classroomModel the planProvide feedbackDiscuss need for modifications if applicable
36 Case Study: Sample Coaching Checklist/Fidelity for Mike
37 Step 5: Evaluation Is it working? Daily ratings of behaviorContinuous progress monitoringBRSOther data collection formsIs it being implemented consistently and accurately?Fidelity ratingsDo we need more data?Does the plan need to be modified or expanded?Plan for generalization and maintenance
42 Step 5: Evaluation Mike Outcome Data MeasureBaselinePost-testChangeSSRS-PB123112-11SSRS-SS87102+15AET.34.57+23
43 Review PTR Process Five-step team-based process Teacher/team driven Support provided to teacher/team to implement interventionsMean number of days for PTR process = 71
44 References Manual Journal articles Next steps: 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. BrookesJournal 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, 9-22Iovannone, 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 upTraining key school staff and team members to do process
53 PBS Team Structure Goals: Teams to support all students (general ed. and ESE) throughout tiered (levels) continuum of supportSystem for monitoring outcomes at all levelsAccess to technical assistanceLink between all three tiers of behavior supportLink between school, home, community53
54 PBS Team Structure in a School SWPBS team—for all students (gen. ed. & ESE)Monitor implementation of universal interventionMonitor school-wide dataGuide implementation of new initiatives, braid with SWPBSTier 3 PBS team—“Standing team”—for all students (gen. ed. & ESE)Progress monitor students in targeted and intensive interventionsGuide intervention selection for students selected for IPBSStudent-focused teams—“Ad hoc” for all students (gen. ed. & ESE)Conduct FBAs and build support plans
55 Tier 3 Behavior Support in a School: Team Option “Ad-hoc” team—student focused (both gen. ed. & ESE)Responsibilities of team (problem solving process)Conduct FBABuild function-based support planProvide coaching/support to teacher to implement interventionsCollect and review fidelity and student outcome dataMake decisions based on dataMembership—Three levels of knowledge representedSomeone 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)55
57 Multiple Levels of Tier 3 (FBA) Brief FBAFBA/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, ERASEComprehensive FBAMore complex FBA/BIP procedureMay take 2 or more meetings or one lengthy meeting (>1 hour)Best used for chronic, durable, intense behaviorsExample: PTR
58 Multiple Levels of Tier 3 WraparoundInvolves multiple agenciesSupport plan includes practices that may go beyond scope of schoolBest used for students with mental health issues and/or complex life events
59 Data Tracking—Tier 3 Systemic Data Tracking Examples Florida School DistrictsMonroeMartinUniversity of Oregon