Module 7—Field Based Activity Developing & Implementing a Fidelity Checklist Rationale and importance of the Fidelity Checklist Developing the Fidelity Checklist Sample Fidelity Checklist for Function- Based Interventions Fidelity Checklist Implementation Issues

Rationale and Importance of Checklist We conduct fidelity & reliability observations to ensure that interventions are being implemented as described in the PC-PBS Plan and discussed with the team, and that data are being accurately collected In order to ensure that interventions are implemented as described in the plan, the KIPBS facilitator conducts fidelity observations on a regular basis. If fidelity of intervention procedures is inadequate, KIPBS facilitator must discuss problematic aspects of the interventions with parents/ caregivers. Further training is then conducted on selected procedures or, if the procedures are too difficult to implement, they are modified. New team members (for ex., if a new staff person is hired or if a volunteer starts working with individual) or team members who are involved fewer hours per week with the focus person (e.g., a working parent of a young child being supported at home by other parent) may need more in-depth training regarding implementation of interventions (fidelity) and data collection (reliability).

Rationale and Importance of Checklist (continued) All team members should complete the Self-Assessment of Contextual Fit Survey. If survey results do NOT indicate that all primary implementers are (1) aware of the plan’s requirements, (2) feel comfortable implementing the plan, (3) feel confident they have adequate resources to implement the plan, and (4) believe the plan is in the focus person’s best interests, then the KIPBS facilitator needs to discuss and revise, and/or re-train specific team members on selected procedures that were viewed as problematic. If/when intervention fidelity cannot be assessed formally by KIPBS facilitator due to scheduling conflicts, he/she should discuss with parent/ caregiver how other team members, who were not able to be observed, are doing with implementing the interventions described in the plan. If/when the KIPBS facilitator must informally review other team members’ performance (vs. using direction observation), the facilitator should refer to the Fidelity Checklist that is being used to collect formal fidelity of implementation data. If the informal discussion suggests that the team member(s) may NOT be implementing the plan with adequate fidelity (according to Fidelity Checklist responses), then additional training needs to be scheduled.

Developing the Fidelity Checklist Fidelity Checklist should be developed based on the specific function- based interventions listed in Part 2 of the PC-PBS Plan--Interventions and Supports: Function-based Interventions Best way to develop a comprehensive and accurate Fidelity Checklist is to link checklist items directly back to the Competing Behaviors Diagram (CBD) and the four-column intervention table that immediately follows the CBD; i.e., Setting Event Interventions, Antecedent Interventions, Teaching New Skills & Replacement Behaviors/Related Social-Communication Skills, and Consequence Interventions. Organize the Fidelity Checklist such that each component of the checklist can be rated, as well as an overall score across all four components. The following example illustrates how to develop a simple yet comprehensive Fidelity Checklist.

Setting Event Awake at night; difficulty sleeping; lack of predictability in schedule Antecedent Demand/ request by a parent or other adult Desired Behavior Complete task given without complaint or delay Problem Behavior Noncompliance, Tantrum Replacement Behavior Appropriately ask to do task in 2 minutes (delay doing task). Maintaining Consequence Escape from task or delay doing task Maintaining Consequence Move to next task that is more preferred Competing Behavior Diagram Escape Maintained Behaviors

Function Based Intervention Strategies – Summary Escape Maintained Behaviors Setting Event Interventions Antecedent Interventions Teaching New SkillsConsequence Interventions Develop a daily schedule with choices built into it. Provide choice system for tasks (Ex. “Carter you can do _____ or _____”.) Have consistent bedtime routine and sleep time in order to help eliminate sleep issues. Give Carter the option to do task now or in 2 minutes. Give a contingency with every task. (Ex. “Carter, when you finish putting away the dishes you can go outside and play for 15 minutes”.) Prompt and teach Carter to ask for a 2 minute delay in responding to request to do a task Teach Carter to use his words/ choose to do task now or in two minutes. Prompt or remind Carter that he can ask using a variation of “2 minutes” after an adult has given him an instruction. This will be faded over time but initially prompted each time an instruction is given. Praise Carter for doing task immediately after being instructed to and without protest. Give him a quarter as part of motivation system which can be exchanged for preferred items, such as a football, going out to eat, etc. Praise Carter for using his words appropriately when asking if he can do task in two minutes; remind him that he can earn quarters for doing things immediately after being asked. Follow through with the instruction if problem behavior occurs in isolation or paired with the request for two minutes. Do not let Carter out of the task. If tantrum behavior occurs, utilize extinction (planned ignoring) and require him to do the task after the tantrum is over.

Setting Event No adult supervision; Awake in the night; Difficulty sleeping Antecedent Item taken away or denied access to item by a peer or sibling Problem Behavior Aggression Desired Behavior Appropriately ask peer/sibling for item…and then wait (tolerate a non-immediate response); or ask an adult for assistance, if problem continues to occur. Replacement Behavior Requesting assistance from an adult (“___, will you help me please?”) to get item he wants, if asking peer/sibling does not work. Maintaining Consequence Gain access to item or activity. May be paired with reinforcement for waiting (if appropriate) and using words to communicate needs and feelings by parent. Maintaining Consequence Gain (immediate) access to item or activity he wants Competing Behavior Diagram Tangible Maintained Behaviors

Function Based Intervention Strategies – Summary Tangible Maintained Behaviors Setting Event Interventions Antecedent Interventions Teaching New SkillsConsequence Interventions Go over choices and strategies for dealing with asking for items in social situations. Develop a daily schedule with choices built into it. Include when certain preferred items/ activities can be played with and by whom. Develop family rules about siblings’ rooms and belongings. Have a consistent bedtime routine and sleep time in order to eliminate sleep issues. Provide reminders every ten minutes to share and take turns while playing. Remind Carter to use his words, if he wants an item or if he wants to get something back if/when someone takes it. Teach Carter to ask for assistance in gaining the item he wants by using the phrase “____will you help me please?” Teach Carter to communicate his needs. Teach Carter to: 1. Ask sibling to return toy. 2. Ask sibling to leave his room. 3. Ignore behavior of others and walk away. Praise for using appropriate communication phrase and help Carter (even if you feel it is “tattling”). Allow access to preferred item/ activity, if at all possible. Give quarters for using the targeted appropriate communication phrase. Do not allow Carter access to the item if he has aggressed towards another person.

Sample Fidelity Checklist for Function-Based Interventions Setting Event InterventionsCheck if/when observed OR indicate N/A if Not Applicable 1. Parent uses a daily schedule with choice(s) built into it 2. Daily schedule indicates when certain preferred items/ activities can be played with and by whom 3. Parent uses a choice system for tasks to increase Carter’s control over what he does and when 4. Parent reviews with Carter his choices and specific strategies he can use to ask for items in social situations 5. Family rules have been developed (and are being taught and reinforced) regarding siblings’ rooms and belongings 6. Parent maintains consistent bedtime routine and bedtime in order to help with sleep issues Total Checkmarks for Setting Event Interventions = Setting Event Intervention Fidelity = (Total checkmarks/Total # interventions to be observed) X 100 =

Antecedent Interventions Check if/when observed OR indicate N/A if Not Applicable 1.Parent gives a contingency with every task; e.g., “Carter, when you finish putting away the dishes, you can go outside for 15 minutes.” 2. Parent provides reminders every 10 minutes to share and take turns while playing (if routine/activity provides opportunity to observe this intervention) 3. Parent gives Carter the option to do task now or in 2 minutes (specifically addresses escape-maintained behavior, such as non- compliance or tantrums) 4. Parent reminds Carter to use his words if he wants an item or to get something back, if someone takes it (specifically addresses tangible- maintained behavior, such as aggression) Total Checkmarks for Antecedent Interventions = Antecedent Intervention Fidelity = (Total checkmarks/Total # interventions to be observed) X 100 =

Replacement Behavior & Related Social/Communication Skill Interventions Check if/when observed OR indicate N/A. if Not Applicable 1. Parent prompts and teaches Carter to ask for a delay from requests. 2. Parent teaches Carter to use his words/choose to do task now or in 2 minutes. 3. Parent prompts or reminds Carter that he can ask for a delay using a variation of “2 minutes” after an adult has given him an instruction. 4. Parent teaches Carter to ask for assistance in gaining the item he wants by using the phrase “____, will you help me please?” 5. Parent teaches Carter to communicate his needs during routines or in situations that provide such teaching & learning opportunities 6. Parent teaches Carter to (1) ask sibling to return toy; (2) ask sibling to leave his room; and/or (3) ignore behavior of others & walk away (depending on routines observed) Total Checkmarks for Replacement Behavior Interventions = Replacement Behavior Intervention Fidelity = (Total checkmarks/Total # interventions to be observed) X 100 =

Consequence Interventions Check if/when observed OR indicate N/A. if Not Applicable 1.Parent praises Carter for doing tasks immediately after being instructed and without protest 1.Parent gives Carter a quarter (as part of motivation system which can be exchanged for preferred items, such as a football, going out to eat, etc.) 1.Parent praises Carter for using his words appropriately when he asks to do task in 2 mins. and reminds him that he can earn quarters for doing things immediately after being asked 1.Parent praises Carter for using appropriate communication phrase and helps him (even if he seems to be “tattling”). Parent allows access to preferred item/ activity, if at all possible 1.Parent follows through with the instruction, if problem behavior occurs in isolation or paired with the request for 2 minutes. Parent does not let Carter out of the task 1.If tantrum behavior occurs in order to escape/avoid a task, parent utilizes extinction (planned ignoring) and requires Carter to do the task after the tantrum is over 1.If aggression occurs to gain access to item, parent does not allow Carter access to the item Total Checkmarks for Consequence Interventions = Consequence Intervention Fidelity = (Total checkmarks/Total # interventions to be observed) X 100 = SUMMARY: Fidelity for All Function-Based Interventions Total Checkmarks for All Function-Based Interventions = (Sum up ALL checkmarks for Setting Event, Antecedent, Replacement Behavior & Consequence Interventions) Function-Based Intervention Fidelity = (Total checkmarks/Total # interventions observed across 4 checklists) X 100 =

Fidelity Checklist Implementation Issues Intervention fidelity should be assessed for all function-based intervention components of the PC-PBS Plan: (1)setting event interventions; (2)antecedent interventions; (3)teaching replacement behaviors & other related social-communication skills; and (4)consequence interventions. Fidelity of intervention procedures should be equal to or greater than 90% for each team member. Ideally, intervention fidelity should be 90% or higher for EACH of the four function-based intervention components, as well as across ALL intervention components; i.e., a 90%-90% rule. However, we do not require this but rather propose it as a goal for KIPBS students-in-training to aim for. Following an intervention fidelity observation, KIPBS facilitator should discuss and practice function-based intervention components that parent (team member) did not implement with complete fidelity; i.e. there were X instances, early during program implementation, when no reinforcement was given when the focus individual asked his parent for help accessing an item.