Lead Presenter: Shelley Clarke

Family and School Collaboration At Tier III: An Illustration of A PTR/PBS Intervention
Lead Presenter: Shelley Clarke Exemplars: Jodi Panepinto & Kristy L. Jones Key Words: Family, Classroom, FBA/BIP Shelley Introductions presentation will share team’s experience in completing the a TIER 3 intervention using the PTR process to assist Noah a middle school student who was having difficulties during his morning when he was getting ready for school at home and then the transition and arrival to class. Co-presenters and core team members Jodi – Parent of Noah Kristy –ESE Director of middle school, Desiree Mahiquez School districts BCBA behavioral consultation team National PBIS Leadership Forum: September 28-29th, 2017, Chicago Illinois

ICEI Services: Interdisciplinary approach collaborative
The mission of ICEI is to provide specialized services to school-aged students with serious and complex behavioral issues that are interfering with daily school activities and/or quality of life. Services: Interdisciplinary approach collaborative Completion of diagnostic and evaluation testing Behavior support services provided for referred students age 3-22 ICEI Interdisciplinary Center for Evaluation and Intervention Shelley funded by the Fl-DOE to demonstrate and promote an interdisciplinary approach to promoting …. = Encourage and recruit individuals from other areas of expertise to contribute their knowledge regarding specific children and cases that our BCBAs and Evaluation professionals encounter. Our services within the community are two- fold. We provide behavior supports in the form of collaborative teaming when school and district submit referral requests for behavior supports for individual students. We also provide diagnostic and consultation services to children and families delivered by our clinical psychologist on staff as well as those interdisciplinary professionals when appropriate.

Behavior Support Services of ICEI
Provide school/family teams with guidance and facilitation to complete the Prevent-Teach-Reinforce (PTR) process in order to address: Student challenging behavior Enhancement of Skills Improved Quality of Life Shelley -Our goals in regards to providing behavior supports are to facilitate and teach the PTR process to collaborative school teams in an effort -Address challenging behavior through collaboration with families and schools to not just reduce problem behavior but also boost and enhance the quality of life of the student and those around him or her. And that might look light increase the occasion for diverse leisure activities, friendships, preferences and providing supports for these new and empowering opportunities. .

Prevent-Teach-Reinforce A School Based Model of PBS
Individualized Tier 3 FBR/BIP Process Fosters a collaborative team Builds in facilitation of PTR and coaching supports Protocols for teacher and family friendly behavior data collection Protocols for measuring fidelity of implementation Strong focus on teaching prosocial replacement behaviors

P-T-R Formula for Success
Effective and Socially Valid Practices + Effective Implementation Methods Implementation Supports Meaningful Outcomes Practices are essential, but in addition we needed to consider implementation more carefully and focus our technical assistance and training in a manner that would optimize implementation success Fixsen & Blase, 2012

Steps of Prevent-Teach-Reinforce Model
1. Establish a collaborative team 2. Identify information about child and team Long Term Goals/Short Term Goals Behaviors of Concern/Behaviors to increase Data Collection/Implementation Supports 3. Functional Behavioral Assessment 4. Select PTR Strategies, Develop and Implement Plan with Supports 5. Record Progress and Fidelity, Monitor outcomes Shelley The model is based on the well-established procedures of positive behavior support, but is designed to help teachers and others to complete the systematic approach of assessment and intervention strategies with a high level of fidelity, leading to improved effectiveness. PTR model is a process for use in home and education settings, and consists of teaming and goal setting, practical data collection, a functional behavioral assessment, intervention planning that includes coaching and implementation. In addition, progress is recorded in an easy to compete systematic manner, along with ensuring the intervention is being implemented as intended or with fidelity.

Establish Collaborative Team
Family Partnerships Team Expectations Supports for PTR Process Strategies to Identify and Respond to Individual Child Needs Consistent Team Communication Data Decision-Making Examining Implementation and Outcomes

Working Together as a Collaborative Team
Facilitating referral and PTR process Establish team: Who to include Core Team Extended Team Establishing methods for team communication Kristy- uniqueness of case Necessary to figure out way to communicate with all members of the team to be efficient cant and effective example monthly meetings, weekly , texting, sharing information between home and school environment supplemental information with different data collection techniques and supports

Essential Components of PTR Team
Family Involvement All perspectives valued Team established goals Equity of task distribution Consensus decision-making Ongoing problem-solving Identify and recognize each person’s resources, talents, and skills Encourage risk taking and creativity ShelleyTeams Family critical component/valuable resource of child/interventions consistent with family values create the best fit (acceptable, doable, effective and sustainable All valued, est goals, everyone invested to spilt up responsibilities and tasks, decision making and problem solving strengths creativity think outside the box

PTR Team Decision Making
Provide a visual context that allows everyone to follow and contribute Identify goals Identify target behaviors Determine data to collect Determine how to track direct observations Interviews Summarize patterns from data and interviews Develop hypothesis statements Team development and implementation of interventions Shelley -Identify goals short and long term -Identify target behaviors- consensus across team, make sure we are looking at the same behaviors -Determine data to be collected (setting event table- due to complaints of being ill or lack of sleep, etc./ due to Noah’s setting and nature and comfort level unable to complete typical observations at home in morning) -How to track direct observations (team agreement and buy in who / when / how will we collect data) -Interviews (formal and informal from stakeholders across home and school environments about conditions under which behaviors and most and least likely) -Summarize Patterns found in data and information collected trough interviews -Developed hypothesis statements based on summary (used these to guide development of interventions) -Team preferences on development and implementation of interventions *We completed all steps without directly impacting on Noah's daily routines

Home-School PTR Collaborative Team: Four Questions to Consider
1. What does the collaborative team hope to learn and accomplish? 2. What can each team member contribute and learn from the process ? 3. What will the team and each member do with the information gathered and knowledge learned? 4. Where are we in the PTR process? Shelley The 4 questions we consider through out the PTR process as a team are fluid and reflected upon through out the steps of process Where are we What do we want to accomplish and learn How and what can each team member contribute What will the team do with the information gathered.

Collaborative Team Action Planning
Assessment: Accomplishments and identified priorities in PTR process Team Meetings and Notes: Develop consensus for team’s priorities, communication, visual displays, summaries Action Planning Interventions and Implementation Supports PTR Process Data Collection Develop and Implement Intervention Coaching, Support, Feedback Enhancements and Improvements Outcomes of collaboration for PTR Process, Intervention, Home, School Shelley Collaborative Team Action Planning Assessment – team priorities, successes Team Meetings and Notes- maintain up-to-date information across team members (Home-Jodi School-Kristy) Action Planning Interventions and Implementation Supports0 How do we gather information what it means, how do we start

Functional Assessment Process
Process used to determine the purpose (function) of behavior Why is it important for us to know the function of behavior? So we can understand why the behavior is occurring To find an appropriate replacement behavior To identify what skills to teach To develop the best behavior support plan Shelley Gathering and summarizing information gathered from interviews direct observation team feedback and record review

PTR Intervention Components
Prevention Strategies makes challenging behavior unnecessary Teach-Skill Building Strategies replace challenging behavior with new skills Reinforcement Strategies modify responses to challenging and appropriate behavior Shelley PTR focuses on team and implementer preference of intervention strategies to use related to the function of behavior. With the PTR supports a strategy is selected from each of the 3 components

Implementation Supports
Person-centered, collaborative behavior support plan development Provide modeling and coaching for accurate implementation of strategies during target routines and activities Exchange of supportive/constructive feedback Data collection Ongoing evaluation, monitoring, collaboration Shelley\ IS are those activates during the PTR process that promote development of doable and feasible interventions supported by respecting the student and team preferences and interests, modeling and coaching provide feedback data collection to see if interventions are making a difference in behavior and then ongoing monitoring and collaboration once formal facilitation and coaching is faded out

Where are you (team) in the implementation process
Where are you (team) in the implementation process? Adapted from Fixsen & Blasé, 2005 Exploration & Adoption Establish collaborative team (both core and extended), moving forward with evidence-based practices Installation and Completion of PTR Assessment Build capacity, facilitate process, determine goals, target behavior, routines, data collection, FBA, behavior function Initial Implementation Develop intervention (PTR) strategies, identify resources needed, collaborative task agenda, provide implementation supports Full Implementation Implement formal behavior support plan, ensure fidelity, sustain implementation, support and feedback, review data, what works, what doesn’t Shelley EXPLORATION AND ADOPTION Collaborative team guided to -Establish core and extended team -Share the PTR process and accommodate the individual culture and priorities of team INSTALLATION -Work together to complete each step, goals target behavior routines, data collection. FBA hypotheses INITIAL IMPLEMENTATION Develop strategies, id resources, task agenda, responsibilities, provide implementation supports FULL IMPLEASEMENTATION Create Formal BSP, ensure fidelity, support and feedback, review data, what works what doesn’t, tweak plan -Identify goals short and long term -Identify target behaviors- consensus across team, make sure we are looking at the same behaviors -Determine data to be collected (setting event table- due to complaints of being ill or lack of sleep, etc./ due to Noah’s setting and nature and comfort level unable to complete typical observations at home in morning) -How to track direct observations (team agreement and buy in who / when / how will we collect data) -Interviews (formal and informal from stakeholders across home and school environments about conditions under which behaviors and most and least likely) -Summarize Patterns found in data and information collected trough interviews -Developed hypothesis statements based on summary (used these to guide development of interventions) -Team preferences on development and implementation of interventions *We completed all steps without directly impacting on Noah's daily routines

Getting to know Noah at home and school
Jodi Kirsty

Meet Noah Age: 13 at time of intervention
Family: Mom, Dad, Brother, Sister School: 7th grade at time of intervention Strengths/Interests: piano, amusement parks, xBox, computer games, history, science Diagnoses: Autism, Generalized Anxiety Disorder, ADHD Not properly diagnosed until 5th grade Jodi

Noah’s Issues of Concern
Challenges: extreme anxiety toward school and schoolwork Problem Behavior: aggression, shutting down, defiance, dependence in everyday routines Difficult Activity: Getting ready for school, leaving house, getting out of car at school, going to class 5 Subroutines identified as part of home routine Jodi (subroutines: get up, breakfast, teeth, get dressed, go to car)

Status in Beginning Target Behavior Modified day schedule
Previous FBA conducted Previous strategies Kristy Work – not able to do anymore without assistance

Morning Routine – Home to School Goals
1. Wake up/get out of bed 2. Eat breakfast 3. Brush teeth (with assist) 4. Deodorant/get dressed (independently with prompt) 5. Play xBox or iPad (stay awake and out of bed) 6. Walk to car (independently) 7. Get in/stay in car (independently) 8. Get out of car on own at school (independently) Prior to Intervention: Little independence Would not get out of bed/would get back into bed Would not get dressed on own Would not walk to/get in/get out of car Jodi describe what the morning was like the steps identified and what if looked like and described difficulties??

Goals Broad/ Long-term Goals Short-term Goals
Improve daily living skills Pass classes Graduate middle school Short-term Goals Get ready for school without noncompliance or aggression Cooperate appropriately in a reasonable amount of time Transition from car into school Get to first period on time Jodi/Kristy?

Target Behaviors Behaviors to decrease Behaviors to increase
Noncompliance (not following directions, physical resistance, verbal aggression, property destruction) Physical Aggression Behaviors to increase Completing morning subroutines Get up, breakfast, teeth, get dressed, go to car Completing entry to school subroutines Get out of the car, walk to building, enter building, walk to class Follow steps of subroutines with minimal assistance or independently and in timely manner Jodi/Kristy? Home: 5 subroutines- get up, breakfast, teeth, get dressed, go to car School: 4: Get out of car, walk to into building, sign in, go to class Behaviors to decrease: Noncompliance: Not following directives; gripping the car/ door, clenching jaw down on toothbrush; verbal aggression- yelling, screaming, name calling, verbal threats; property destruction Physical Aggression in the form of kicking, hitting, biting, spitting, punching others Rating scale will target escalation of challenging behaviors related to Not Following Directions across morning routine and entry to school

Data Collection Individualized Behavior Rating Scale Tool (IBRST)
(Iovannone, Greenbaum, Wang, Kincaid, & Dunlap, 2014) Home to School Entry into School Home Settings Events Table Interviews Shelley

Behavior Rating Scale (IBRST)
Daily Rating of Problem and Replacement Behaviors: Home Subroutines Problem Behavior Replacement Behavior Shelley- Daily Rating Problem and Replacement Behavior (IBRST) 5 Subroutines PTR suggests using an individualized behavior rating tool (IBRST; Iovannone, Greenbaum, Wang, Kincaid, & Dunlap, 2014) that utilizes a direct observation method that is easy to use, efficient, and accepted by teachers. The IBRST uses a 5-point Likert-type scale that allows the teachers to progress monitor the behaviors targeted through both baseline and intervention. The IBRST is developed by guiding the teacher to (a) operationally define each target behavior being monitored; (b) select the most appropriate measurement type (e.g., frequency, %, etc.) that would best estimate the occurrence of the target behaviors; and (c) establish the behavior occurrence or range for each Likert point. The IBRST was designed to make daily progress monitoring feasible for teachers. When using the IBRST for progress monitoring, the teacher merely circles the rating that best represents the day/routine for behavior occurrence at the end of the specified measurement period. For problem behaviors, rating scale point 5 represents a very bad day for the behavior occurrence, a 4 represents a typical bad day, a 3 represents a so-so day, a 2 represents a good day, and a 1 represents a great day. For appropriate behaviors, the scale is reversed with a 5 representing a great day and a 1 representing a very bad day. Problem Behavior: Not Following Directions (Resistant/Noncooperative) Replacement Behavior: Complete Morning Subroutines Independently 5 = Did Not Follow Directions during any subroutine = Completed all subroutines independently and in timely manner 4= Did Not Follow Directions across most of subroutines = Completed most of subroutines independently and in timely manner 3= Did Not Follow Directions across half of subroutines = Completed half of subroutines independently and in a timely manner 2= Did Not Follow Directions across a few subroutines 2= Completed a few subroutines independently and in a timely manner 1= Followed Directions across all subroutines = Completed zero subroutines independently in a timely manner *Aggression is identified as any single or a combination of behaviors listed and highlighted on goals page

Behavior Rating Scale (IBRST)
Daily Rating of Problem and Replacement Behaviors: Entry to School shelley Daily Rating Problem and Replacement Behavior (IBRST) 5 Subroutines

Home Setting Events Table
Identify events that occur at another time that may increase the likelihood of challenging behavior Shelley Jodi- Identifies events that occurs at another time that increases the likelihood the child will have challenging behavior.

Interviews Structured interviews
PTR Interview (Dunlap et al, 2010) Functional Assessment Interview (O’Neill et al, 1997) Identify when target behavior is most and least likely to occur Identify patterns and possible skill deficits Determine best guesses about purpose/function Shelley 10 individuals were interviewed about Noah’s behaviors; answers were complied into a chart to analyze for patterns When target behavior is most likely and least likely to occur: activities, circumstances, people Helps to identify patterns: possible skill deficit, how is behavior responded to Determine best guesses about purpose/function ABC Model Antecedent: What happened prior to the problem behavior? What was the person doing? Who else was there? Behavior problem: Describe the problem behavior How long did it last? How intense? Consequence/Reaction: What happened in response to the problem behavior? Who responded? What was said or done?

FBA Information Gathering Summary: High Association with Problem Behavior
Behaviors most likely to occur: Time of Day- morning, arrival time, evening Activities- getting ready for school, grooming activities, transitions, entry into school, going to 1st period, homework, getting ready for bed Specific Circumstances- requested to start task, change in schedule, end of preferred activity, start of non-preferred activity, parent attending to siblings, close proximity to particular people (mom, ese specialist, etc.) Other Setting Events- illness, fatigue/sleep deprivation, conflict at home Consequences that typically occur after behaviors: Attention: assistance given, verbal redirect, negotiation/ debate, physical prompt, calming or soothing interactions Avoid/Escape: delay or avoid activity (e.g., misses class) Shelley-Gain attention from adults: specifically *Mom- N will interact and negotiate debate; challenge, continue back and forth interactions accompanied by escalation in behavior.

FBA Information Gathering Summary: Low Association with Problem Behavior
Behaviors least likely to occur: Time of Day- weekends, lunch, between classes, dismissal Activities- free time, playing video games, using ipad/ computer, reading, legos, individual time with preferred adult, helping a teacher People- cousin, preferred teachers Shelley/Jodi? Least likely

FBA Information Gathering Summary: Skills to reduce the likelihood of problem behavior
Request attention appropriately Wait for reinforcement Recognize need for help/ ask for help Request a break Make choices Use graphic organizers and visual supports Self-management Shelley skill deficits

Hypotheses Statements: Functions of Target Behavior
Attention Based: Noah will display problem behavior when he is in close proximity to particular people (Mom, Dad, Brother, ESE Director). Escape/Avoidance Based: Noah will display problem behavior when there is a change in schedule or an unpredictable situation. Shelley Multiple functions of behavior

PTR Support Plan – based on hypothesis statements
Prevention Strategies- Modify the environment and/or provide additional supports that prevents challenging behavior from occurring (makes it unnecessary) Replacement Skills - Skills to teach throughout the day to replace the problem behavior Responses - What adults will do when the problem behavior occurs Shelley 3 components of plan

Behavior Support Plan Strategies Selected
Prevention Strategies Introduce components that make challenging behavior unnecessary Teaching Strategies New or alternative skills taught to promote routine completion in a timely and independent manner Reinforcement Strategies Modify Consequences or responses to behavior (both challenging and appropriate) Xx Provide Choices: Provide choices of preferred people, tasks, or activities. Self-monitoring: Teach steps needed to complete routine and promote increased independence. Discontinue reinforcement of challenging behavior: Minimize eye contact, verbal interactions, redirect to expected behavior. Escalation = leave area. After 2 minutes provide him with verbal prompt of what he can do to obtain adult attention. Pair up with preferred peer: Provide peer support and role model for Noah. Transition Supports: Provide a visual schedule to assist with predictability. Teach skills for obtain attention from others appropriately: (request help, assistance) Provide noncontingent attention: Increase amount of praise and interactions when Noah is displaying appropriate behavior. Environmental Supports: Arrive at school at lower crowd time. Change drop off point at school. Modify school schedule. Teach skills for how to wait appropriately: Promotes independence and gaining attention from others. Positive reinforcers for routine completion: Provide Noah with access to preferred people and activities at school and home continent on appropriate completion of routine per day and week. Provide Helper Job: Provides opportunity to be with preferred adult and preferred activity. Teach time management skills: Help Noah to learn how to organize time and materials to assist with predictability and routine completion. Provide Shelley go through table Setting Events: Lack of sleep, headache, stomach ache, fatigue, mood impairment

Examples of Intervention Materials:
Morning Visual Schedule and Choice Chart Self Monitoring and Reinforcement Chart Kristy jodi

Implementation Supports completed by core members of team
Coaching Scripts Review Fidelity Conducted across home and school All Presenters Range of folks who were directly and indirectly involved with interventions and support plan – Had to be cognizant of others such as front office staff who sometimes filled out rating scale and those in Noah’s environment to be aware of behavior support plan by providing additional information, and sometimes coaching to respond to Noah including other family members.

Script for Instructions and Responses to Appropriate and Challenging Behavior
When an instruction is presented: Make sure the instruction is short, clear and concise. Make sure it is presented as a demand and not in the form of a question, or as a choice. Make sure that if Noah protests makes a noise or says “no” to ignore. Praise briefly using verbal or nonverbal gesture (nodding head, “great job”) When Appropriate Behavior occurs: • Provide Specific Descriptive Feedback and Praise (in small increments) Provide physical affection or gestures (high fives, pat on back, hug, thumbs up, ) • Provide opportunities to do preferred activities When negative verbal statements are displayed: If Noah complains, debates, attempts to negotiate or makes derogatory statements DO NOT RESPOND. IGNORE and do not respond verbally or nonverbally (body language becomes tense or emotional) so he will learn these interactions do not foster response. Once the negative verbal behavior subsides, encourage conversation with Noah about a topic that is preferred and does not relate to his previous statements. Provide praise or acknowledge him briefly within the social interaction. If Noah does not respond to interaction that is okay. Terminate interaction so he does not feel pressured to continue conversation. Try again at another time. If Noah does not follow directions or does not respond to instruction within 10 seconds: Restate the instruction, and prompt him that if he needs help you will help him, and provide him with model of how to gain attention or assistance appropriately (example “If you need help Noah, just say -I need help”) if he does not respond move away from area. After 1 monitor return repeat instruction and if he continues to not follow directions- let him know that you are now going to complete step. During the time you are completing step without Noah’s full cooperation- only provide minimal attention. Kristy Script used to assist in coaching teachers review prior to class

Monitoring and evaluating outcomes
Shelley

Impact on Home Morning Routines
Getting Up/Breakfast improved, quicker to get out of bed ADLs remained dependent but less resistance Leaving house: walked on own to car Lessons Learned: Incentives were KEY! (candies in car, reward of going out for dinner with mom)…need to adjust and have new ideas Mom and dad knowing what to say and how to say it during subroutines, and when NOT to say it Jodi

Impact on School Morning Routines
Amount of “tardy” days greatly reduced All teachers involved in larger school team, became familiar with strategies and individualized for specific classroom activities Improved behavior allowed increase access and opportunity to interact with peers and adults Kristy others

Impact on Noah’s and Family’s Quality of Life
Daily morning meltdowns -> Rare morning meltdown 1 parent able to drive alone in car on way to school Reduced amount of time spent dropping off at school (preferred drop off spot/teacher/class was crucial) Extracurricular activities: piano, karate Jodi

Fading Supports How to maintain strategies without formal facilitation
Monitoring progress Revisiting behavior support plan when events and situations change How to teach and coach others in behavior support plan All presenters

PTR Team Reflections and Feedback
Status following formal PTR process Successes Barriers Challenges Individual Perspectives SHOULD WE UPDATE THIS?? Jodi and Kristy current status- No aggression for the remainder of school year during drop-off. No tardies this year. Goes to extended first period class as opposed to sitting in office, Modified plan over time still include strategies of preferred and high interest activities and people, Expressing positive statements about others now. This process required rapport, open communication listening, flexibility, and most important listening to Noah through comments and or behavior.

Thank you! Questions? Comments?
Contact person: Shelley Clarke: All Presenters

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San Diego, California Pre-Conference Workshops: MARCH 28
Save the date, March 28 – 31, 2018 for the… Pre-Conference Workshops: MARCH 28 Skill-Building Workshops: MARCH 31 Breakout Sessions Networking Posters Exhibits San Diego, California Manchester Grand Hyatt San Diego, One Market Place For more information, go to: conference.apbs.org

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