1. Implementation Plans & Treatment Fidelity
Chris Borgmeier, PhD
Portland State University

2. Who should attend FBA meetings?
Behavior Specialist (often School Psych or SpEd)
Principal
Teachers who work with student
Both Gen Ed & SpEd
Other staff who work closely with the student
Parent
Student (if old enough – team decision)
An FBA meeting for an IEP student is an IEP meeting, so all required attendees must be present

3. FBA Team members

4. Embedding Function-Based Support into School Teams – Leah Benazzi, 2005
Participants
School-based teams
Behavior specialists with knowledge of behavior theory
Participants developed behavior support plans (BSPs) based on description of students
Teams without a behavior specialist
Behavior specialist without the team
Teams and the behavior specialist together
All BSPs were evaluated for technical adequacy and contextual fit

5. Results
BSPs developed by behavior specialists alone, rated low on contextual fit
BSPs developed by teams alone, rated low on technical adequacy
Only BSPs developed by the team working with a behavior specialist rated high on both technical adequacy and contextual fit.

6. FBA Process -- Meetings
Day 
Next 2 wks
Day 
Next 2 wks
Day 
Ongoing 
Initial FBA meeting
Team disburses and gathers functional assessment data
FBA/BSP meeting - team reconvenes to review assessment information & develop behavior plan
Team implements behavior plan & collects data
Behavior Plan Review - Team reconvenes to look at data to Review effectiveness and implementation of behavior plan
Continue to implement behavior plan or changes as needed
Review Meeting - Reconvene as needed depending on success of behavior plan

7. Supports that enable accurate & durable implementation of interventions
Ensure contextual fit
Organize adult responsibilities, tasks, etc.
Embed interventions in IEP
Establish effective, efficient, & relevant school-wide behavior support systems

8. Support Plan Design Ensure Contextual Fit
Implementers involved in design of plan
Plan consistent with values of implementers
Plan consistent with skills of implementers
Plan consistent with resources of implementers
Plan consistent with administrative structure
Plan perceived as (a) likely to be effective and (b) in the best interest of the focus individual

9. Implementation Implementation Plan (Who will do what, when?)
Schedule prep activities (e.g. communication system development)
Schedule teaching times/curriculum
Schedule data system design/use
Schedule on-going times for assessment

10. Implementation Plan: Fidelity of Implementation

12. Example Joe: Implementation Plan
3/7
2/20
2/26
Mrs. S
Ms. T- couns.
Mrs. S & Mr. J-aide
Explain new behavior plan to Joe and get agreement to cooperate
Teach Joe to raise hand and ask to go to back of room
Provide Joe with easier math work
Extra math tutoring
Evaluation Decision .
Review Date
By When
Person
Tasks

13. Preparing Staff for Implementation
Who is implementing each part of the intervention?
How do staff implement it? (Requires specific instruction & modeling)
When should it be implemented?
What if it’s not working (Back-up/crisis plans)?
Why should this work?
When will we meet again to review the plan and implementation?

14. BSP Review Meeting
Make sure to review each step on implementation plan at Follow-up BSP meeting
Problem Solve around treatment fidelity
If we’re not implementing the plan with fidelity, we cannot evaluate if the plan is successful or not

16. Intervention Cases Treatment Fidelity
Noell et al, 1997
Jones et al, 1997
Codding et al, 2005

17. Noell et al. (1997) 3 Elementary School teachers in public schools
Ms. Wynn – 3rd grade – referred female student for mathematics
Ms. Milton – taught talented & gifted – referred 3rd grade male for mathematics
Ms. Gill – 3rd grade male – assistance w/ reading
all expressed concerns with inconsistent work and intermittent noncompliance w/ teacher instructions

18. Treatment Integrity - Measures
# of treatment steps teachers implemented
permanent product data collected to reduce reactivity to observation
intervention designed so completion of each treatment step would produce a permanent product

19. Phases of Implementation Support
Consultation Only
explained individual child assessment results to teacher -w/ rationale, how to implement intervention, provided data collection forms & explained an assistant would collect all materials related to intervention each day
no further contact w/ consultant
Daily Performance Feedback
consultant met with teacher each morning before school for 3 to 5 minutes
presented student performance data & teacher intervention implementation data to the teacher on a graph
consultant id’d specific treatment steps missed & discussed importance of steps. discussed how to improve implementation & praised treatment steps completed accurately
Maintenance
told consultant would not be returning for morning feedback meetings, but data collection would continue & teacher asked to continue using intervention

21. Results & Discussion
All 3 teachers initially exhibited high levels of treatment integrity over first 2-4 days w/ decelerating trend to follow
Introduction of performance feedback = increased treatment integrity
Moderate to high levels of treatment integrity were only maintained when performance feedback was provided to teachers regarding intervention implementation and student outcomes

22. Jones, Wickstrom,& Friman (1997).
School-based behavioral consultation is “a good talk spoiled”
Typical interaction:
consultant and teacher discussing a student’s inappropriate behavior, which can be very rewarding
Often, however, the student problem behavior is attributed to the “inappropriate” behavior of the teacher, and the consultant recommends a “new” response instead.
Often this new response requires greater effort than ignoring the consultant’s suggestions.

23. Students & Teachers Joan (12) white female in Lang. Arts class
Ms D 9 yrs. teaching
Behaviors: excessive off task behavior related to touching objects, pulling her own hair, & biting nails
Bob (11)African American male in Reading class
Ms W (1 yr. teaching)
Behaviors: problem following instructions, aggression and throwing objects
Joe (11) white male in summer reading class
Ms. Bean ( 20 yrs. teaching)
Behaviors: spent great deal of time arguing w/ peers, getting out of his seat, playing w/ objects & making irrelevant comments
all 3 student reside in specialized Treatment Program at Boys Town for youth w/ severe behavioral difficulties

24. Intervention
Provide more frequent positive attention to students for expected behavior
Provide praise, approval statements & a mark on child’s daily note card
Provide positive feedback to student at least once every two minutes for on-task behavior & ignore students “passive” off-task behavior

27. Mean Levels of Treatment Integrity (% of 2 min. intervals w/ pos
Mean Levels of Treatment Integrity (% of 2 min. intervals w/ pos. consequence issued by teacher, contingent on student on-task behavior)
Ms D
Ms B
Ms W
Baseline
0-11
(4%)
0-13
(3%)
Consultation Alone
22-56 (37%)
0-21
(9%)
0-50 (22%)
Performance Feedback
57-100
(83%)
45-75 (60%)
(66%)

28. Results/ Discussion
Simply asking a teacher to implement consequences may result in inadequate level of integrity
Even w/ daily performance feedback – overall mean of treatement integrity did not exceed 83% for any of the teachers
Study makes salient the difficult nature of assisting teachers in the delivery of treatments w/ a high level of integrity

29. Implementing Behavior Support Plans Performance Feedback Codding, et al. (2005)
Private school for students w/ brain injury years old
Data collected on 5 teacher-student dyads
Percentage of antecedent & consequences components of the intervention implemented as written
All teachers received formal training in implementing behavior support plan

30. Phases of Implementation Support
Baseline – Observer completed integrity data sheet w/o knowledge of observation
Intervention – performance feedback was implemented after stable or decreasing performance in baseline was demonstrated
on same day as each observation, experimenter spent an average of 12 minutes w/ target teacher outside of classroom
Feedback included – praise for components followed as written & constructive feedback for components not followed consistently (reviewed components & explained how component should have been implemented)

33. Findings
Results of performance feedback were maintained for up to 15 weeks
Treatment integrity was assessed using direct observation
Performance feedback was provided every other week rather than daily or weekly and on the same day that the observation occurred
Performance feedback resulted in greater percentages of both antecedent & consequence components correctly implementing for 4 of 5 teachers

34. Codding et al. (2005)
“We suspect that periodic collection of treatment integrity data and subsequent performance feedback are necessary for high rates of intervention integrity to persist.”

35. Beyond Talking -- Feedback
Make sure to train staff how to implement
Modeling/Role Playing the intervention is best method of instruction
People won’t implement it if they don’t understand how to do it, or if it’s not working because they doing the intervention incorrectly
Frequent follow-up & check-in
Linking w/ permanent product to turn in can be helpful
Example – point sheet w/ regular interval ratings (way of tracking teacher feedback to student)
Example – daily Intervention checklist for teacher to self check implementation of plan
check-ins/reminders paired with periodic visits/observations are good