1. Advanced Behavior Interventions
Rose Iovannone, Ph.D., BCBA-D

2. Agenda Technically Adequate FBAs/BIPs Refresher of PTR
Linking hypotheses with behavior interventions
Behavior interventions

3. Objectives Participants will:
Develop a task analyzed behavior intervention plan that is linked to a FBA hypothesis that includes:
A prevention intervention
A replacement skill
A functional equivalent reinforcer
Complete a coaching checklist for training others to implement the plan
Complete a fidelity measure
Identify key coaching/consultation skills

4. Technically adequate fba/bipS
ESSENTIAL COMPONENTS
Technically adequate fba/bipS

5. Core Components of Technically Adequate FBAs/BIPs
Input sought from multiple sources
Problem behavior that is focus of FBA identified and clearly defined
Baseline data indicate target behavior is a problem
Antecedents that predict problem behavior clearly identified/described
Setting events considered and (if applicable) clearly identified/described
Antecedents that predict absence of problem behavior clearly identified/describes
Consequences (responses of others) immediately after problem behavior identified and described
Hypothesis developed from FBA data and includes antecedents, setting events (if applicable), behavior, and function
Function is one recognized and identified by “leaders” in the field
Social reinforcement—e.g., obtain/get attention, tangibles, activities, sensory
Negative reinforcement—e.g., escape/avoid/delay/terminate attention, tangibles, activities, sensory

6. Core Components of Technically Adequate FBAs/BIPs
Developed relatively soon after FBA (e.g. within 30 days)
FBA hypothesis is included or referenced on BIP
Minimum of one antecedent strategy:
Included
Linked to FBA hypothesis (when)
Described in enough detail to pass “stranger test”
Minimum of one teach strategy:
Linked to FBA hypothesis (functional equivalence or incompatible behavior)
Minimum of one reinforce strategy:
Linked to FBA hypothesis (functional equivalence provided)
Strategy included to no longer reinforce problem behavior (change maintaining responses)
Need for crisis plan considered and described in detail (if applicable) and linked to hypothesis
Evaluation plan described in detail
Fidelity plan described in detail

7. PTR—Refresher

8. What is Prevent-Teach-Reinforce (PTR)?
Research project funded by U.S. Department of Education, Institute of Education Sciences
University of South Florida
Three central Florida school districts
University of Colorado, Denver
Two Colorado school districts
Purposes:
Answer the call for rigorous research
Evaluate effectiveness of PTR vs. “services as usual” using randomized controlled trial
Evaluate effectiveness of “standardized “ approach

9. Prevent-Teach-Reinforce: PTR
Intervention teams given manual and assigned PTR consultant
Five step process (aligned with problem solving process):
Teaming
Goal Setting (Identification of Problem)
Functional Assessment (Problem Analysis)
Intervention (Intervention Implementation)
Coaching and fidelity
Evaluation (Monitoring and Evaluation of RtI)

10. Step 1: Teaming Teaming: A collaborative process Purpose: Members
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
Purpose:
Evaluate strengths and weaknesses of team functioning
Outline roles and responsibilities
Determine a consensus-making process

11. Step 2-Goal Setting
Identify the problem

12. What Determines Success?
Analysis of outcomes of 800+ consultation cases involving elementary students
Problem identification = 43%
Problem analysis & plan development = 31%
Goal attainment occurred in 97% of cases in which a plan was implemented
“consultants successful in identifying problems were almost invariably able to solve those problems”
Bergan and Tombari (1976) studied over 800 consultation cases (children in grades K – 3 referred for psych services), found that in only 43% and 31% of cases referred for help were problem identification and analysis (i.e., culmination in development of a plan to implement) stages, respectively, successfully met. In 97% of cases in which a plan was able to be developed and implemented, the pre-determined outcome level was established (i.e., goal attainment was reached).
Also important… what contributed to completion of the problem identification stage?- largely, consultant skills, particularly the (a) flexibility of the psychologist in applying psychological principles (i.e., in selecting interventions) and (b) index of message control.
Take away points:
Thus, we need to put efforts up front and successfully do problem analysis (what are factors that make problem occur) and goal setting.
Need intensive training in effective consultation skills, because when a psychologist lacked skills or was inefficient, s/he was likely to select a course of action beside problem id, including testing, SPED referrals, move to another school, referral to other mental health agency
Study details: “interviewing skills” of consultant assessed by transcribing problem id and problem analysis interviews by psychologists/consultants; interviews were then coded for message content, message process, and message control. Yielded 4 measures of interviewing skills: (a) relevancy of interview content to problem id and analysis, (b) content focus… staying on topic, (c) psychologist verbal processes- using more specification, summarization, and validation utterances, and (d) message control- asking more questions to elicit information or action on the part of the teacher.
Problem-solving measures: case-reporting forms were used to assess the presence or absence of phases in the problem-solving process… stages that were coded: problem identification, plan implementation, problem solution- if the goal identified in problem ID was achieved
Bergan & Tombari, 1976

13. Step 2: Goal Setting Purpose: Targeted Areas:
Identify behaviors of greatest concern to the team and possible replacement behaviors (teach)
Prioritize and operationalize behaviors targeted for intervention
Develop teacher friendly baseline data collection system
Targeted Areas:
Problem behaviors
Social skills
Academic behaviors

14. Step 2: Data Collection System
Behavior Rating Scale – BRS (cf., Kohler & Strain, 1992)
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

15. Case Study- Mike: Behavior Rating Scale
Screaming
9+ times
7-8 times
5-6 times
3-4 times
0-2 times 5 4 3 2 1
Hitting
8+ times
6-7 times
4-5 times
2-3 times
0-1 times
Expressing Frustration
40%+
30-40%
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
01/15

16. Step 3: Functional behavior assessment
Analyze the Problem
Step 3: Functional behavior assessment

17. Step 3: PTR Functional Assessment
PTR Assessment (FBA)
Checklist format
Prevent = antecedents
Teach = function, possible replacements
Reinforce = consequences, possible reinforcers
One form completed for each problem behavior by each team member
Information leads to hypothesis

18. Learned Functions of Behaviors
GET (Positive Reinforcement)
Obtain
Activities, people, tasks, tangibles, sensory, pain attenuation
GET OUT OF (Negative R)
Escape/Avoid/Delay
Activities, people, tasks, tangibles, sensory, pain

19. Step 3: Case Study – Mike Hypotheses
When….
he will
As 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 hit
Mike 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

20. Step 4 Behavior Interventions

21. Behavior Intervention Plan Development: Essential Features
Behavior interventions selected
Team/teacher provides description on how interventions will look in classroom setting
Facilitator guides the team/teacher by using ABA principles to develop most effective intervention that matches the team/teacher context
Each intervention selected is described in detail by task-analyzing steps, providing scripts, describing adult behaviors, NOT student behaviors
After plan developed, time is scheduled to train the team/teacher the strategies prior to implementation
Plans for training students and other relevant individuals
Support provided once plan is implemented

22. How to Link Hypothesis Statements to Behavior Interventions
The hypothesis statements link to behavior interventions by:
Modifying the antecedent(s) identified,
Teaching alternative appropriate behaviors to get the same payoff,
Providing alternative ways of responding to the appropriate and problem behavior (including crisis management)

23. Hypothesis Link
When Jeff is presented with demands to start non-preferred academic tasks, specifically independent writing, he will become disengaged and walk around the room, talk to and touch peers, put his head down without initiating writing. As a result, he gets to avoid/delay the non-preferred task. .
Prevent
Teacher request to start the non-preferred task
Behavior
Disengaged-walk around room, bother peers,
Reinforce
Avoid/delay non-preferred task
Setting Event
None identified

24. Rule #1
You should not develop a plan to decrease the problem behavior without first identifying the alternative, desired behaviors the person should perform instead of the problem behavior (O’Neill)

25. Rule #2
Use the functional equivalence reinforcement (i.e., escape and/or obtain) identified in the hypothesis in your behavior support plan.
Only use artificial reinforcement (e.g., tangibles) if the functional equivalence is not enough.

26. Rule #3
Develop an intervention to modify the trigger (prevention information) so that the problem behavior is no longer necessary.

27. The Three I’s IRRELEVANT INEFFECTIVE INEFFICIENT
Function-Based Support Plans will be effective when
IRRELEVANT
A prevention intervention that modifies the context so that the problem behavior is no longer necessary to perform is included.
INEFFECTIVE
The replacement behavior serves the same function (obtains the same outcome) as the problem behavior - if it doesn’t work, the student won’t do it.
INEFFICIENT
The replacement behavior works at least as quickly and easily as the problem behavior - if it works but is harder to perform, the student won’t do it.

28. Jeff-matching hypothesis to interventions
Setting Events
NONE
Prevention Triggering
Antecedents
Request to do a non-preferred task = writing
Problem
Behavior
Disengaged
Maintaining
Consequences Reinforce
ESCAPE!!!
Replacement Behavior
)equivalent or incompatible)
Engage in Task
Modify trigger
Choices
Environmental support

29. Step 4: Writing the Intervention Plan
Task analyze each step of the plan
NOT— “give student choices”
YES— Prior to the start of independent reading, tell the student “we have 2 worksheets today” (show worksheets). “Which worksheet would you like to do first?”
If teachers do not know how to do it, they will not implement the strategy.

30. Prevention Interventions

31. PTR Prevention Strategies
Providing Choices
Transition Supports
Environmental Supports
Curricular Modification
Adult-Verbal Behavior
Classroom Management
Increase Noncontingent Reinforcement
Setting Event Modification
Opportunity for Prosocial Behavior
Peer Modeling or Peer Reinforcement

32. Prevention Intervention: Choice-Making

33. Choices
Individual selects preference from among 2 or more valid options
Reduces likelihood of exhibition of escape and avoidance behaviors associated with demands
Choice strategies: (adapted from Fredda Brown)
Between tasks
Within tasks
Where
When
Person(s)
Rejection
Termination

34. Choice Making Steps to Build Intervention
Step 1: Determine the context (antecedent) identified in the hypothesis
Step 2: Determine choice options (from 7 categories) that can be presented during specified context
Step 3: Select the choice options that will be offered
Step 4: Decide how the choice options will be presented to the student (when, who, how)
Step 5: Decide response to student after making choice
Step 6: Decide how to release to choice

35. Environmental Supports Used when hypothesis (when part) suggests that visual cues/organizational tools or external reminders may make context/antecedent less aversive
Examples of environmental supports for anyone
Traffic signs
Microsoft Outlook, tools, reminders
Restaurant menus
To do lists
Every app you can think of
Examples of environmental supports for students
Visual checklists
Reminders of reinforcement
Visual cues
Timers
Visual mnemonics
Communication tools
Schedules

36. Environmental Support Steps
Step 1: Determine nature of antecedent and type of environmental support that may work best
Step 2: Develop the environmental support
Step 3: Determine how to use environmental support (when, who, how to present)
Step 4: Teach student use of environmental support

37. Jeff: PTR Intervention Plan Prevent
Prevent Strategies
Description
Choice-Making
Using a choice matrix, decide upon the choice that will be offered to Jeff each day with his writing assignment. The following choices will be rotated: (a) Within—writing tool to use (pen/pencil), color notebook paper, color of eraser, topic; (b) Who—peer for writing partner; (c) Where—Robin’s room, round table, desk; (d) When—part now, part later, whole task now
Steps:
Right before giving the writing assignment to Jeff, decide upon the choice to be offered.
Once the choice is determined, present it to Jeff by saying, “What do you want to use for writing today? The pen or the pencil?”
Praise Jeff for making the choice—”Thank you for making a choice.” and honor the choice

39. Jeff—Intervention Plan Prevent
Prevent Strategies
Description
Environmental Support
Visual Timer: Set a visual timer for the amount of time agreed upon with Jeff to complete the writing assignment.
Steps:
Discuss the goal for completing the writing assignment. Say, “I think you can complete the assignment in ___ minutes. What do you think?”
Set the timer by saying, “Jeff, let’s see if you can beat the timer. Today, you have ___ minutes (time from step 1) to complete the writing. Ready, set, go.”

40. Activity
In your group/team, develop a prevention intervention for the following hypothesis.
When requested to transition from a preferred to a non-preferred activity, Joe will start calling the adults and peers names and use cuss words. As a result, he (a) avoids/delays the transition and (b) gets responses/attention from both adults and peers.
Steps
Identify the antecedent/prevention information
Review the prevention interventions
Decide upon one intervention
Develop a step-by-step plan for implementation
Be prepared to share

41. Sharing Time

42. Teach Interventions

43. Replacement Behaviors
Replacement behaviors are what we want the student to do instead of the problem
Effective replacement behavior must:
1. Be incompatible with the problem.
2. Serve the same function as the problem.
PROBLEM
FUNCTION
REPLACEMENT

44. Replacement Behavior
Teaches more appropriate, but equally effective, means of getting reinforcer (escape/obtain)
Must be:
Socially valid
Simple
Efficient
Likely to be reinforced by others in student’s life

45. Considerations When Teaching Replacement Behaviors
Identify alternative behavior as easy for student to do as challenging behavior (efficiency)
Consider the replacement behavior is a skill or performance deficit
Directly teach student new behavior including how and when to use
Make sure all other’s in student’s environment are consistent in teaching the replacement behavior.

46. Replacement Behaviors
Incompatible replacement (sample)
Engagement
Independent task completion
Raise hand
Appropriate social interactions
Appropriate commenting
Communicative replacement
Reject offer of undesired item or event
Request alternative activity
Request assistance
Request break
Request work check

47. Teaching “Request a Break”
First, determine the point in which the problem behavior occurs after presentation of the antecedent
Deliver the prompt for using the replacement behavior (e.g., “I need a break”) just prior to above point of time.
Release student to break immediately after correct response exhibited and provide verbal reinforcement for using replacement behavior

48. Request a Break, continued
Provide inducement to get back to task
Fade prompt gradually
Evaluate need for tolerance for delay cue (time delay for escape)

49. Teach Incompatible Behavior
Raise hand
Step 1: Determine if skills is a performance or skill deficit
If skill deficit, break down behavior into discrete steps and determine steps student needs to acquire
If performance deficit, reinforcement part of intervention will be extremely important
Step 2: Teach student when to use new behavior and what will happen when they use new behavior
Examples and nonexamples
Opportunity to practice with feedback
Determine prompting required until skill is acquired
Step 3: Determine how skill will be generalized/maintained

50. Jeff— Teach Intervention Plan
Teach Strategies
Description
Incompatible Replacement Behavior—Academic Engagement
Jeff will be taught how to remain engaged on a writing assignment. Engagement is defined as: working on a task without disrupting by raising hand to speak, keeping pencil upright, and letting neighbors work.
Steps:
Divide Jeff’s writing task into 3 major sections—starter, details, conclusion
Tell Jeff that for each section completed, he earns a “dot” that he should place in the envelope hanging at the side of his desk.
Inform him that he can use the dots later to get out of work and to get special rewards for himself and the rest of the class.
Review his self-management checklist/dot total sheet with Jeff. Review each section of the writing assignment (step 1), his goal (time for completion), and academic engaged behaviors.
On Monday, a weekly goal should be discussed and set.

52. Activity
In your group/team, develop a teach intervention for the following hypothesis.
When requested to transition from a preferred to a non-preferred activity, Joe will start calling the adults and peers names and use cuss words. As a result, he (a) avoids/delays the transition and (b) gets responses/attention from both adults and peers.
Steps
Identify the problem behavior
Identify the function
Agree upon a replacement behavior (functional equivalent or incompatible)
Review the teach interventions
Decide upon one intervention
Develop a step-by-step plan for implementation
Be prepared to share

53. Sharing Time

54. Reinforce Interventions

55. Reinforcement Four rules (Terry Scott)
Use the least amount that is necessary to get the replacement behavior
Use the natural reinforcement (i.e., function)
Be consistent and immediate in delivering the reinforcer-establish a routine
Teach the student how he/she will get the reinforcement

56. Jeff—Reinforce Intervention Plan
Reinforce Strategies
Description
Reinforce Pro-academic Replacement Behavior—Academic Engagement
Jeff will be reinforced for academic engagement and meeting his daily goal with allowable/earned escape represented by the dots. Jeff can use his dots to get out of doing work/problems during independent work times.
Steps:
At the end of the writing period or when Jeff completes his writing (whichever event occurs first), review Jeff’s self-management checklist.
For each behavior on the checklist, discuss with Jeff whether he performed the activity. If yes, place a check in the box. If no, place an “x” in the box. For each check, Jeff should be given a dot. When reviewing, say, “Jeff, did you write a starter sentence?”… Did you stay on task? Did you meet your goal?” When giving dots, say “Jeff, how many checks do you have today? How many dots do you earn?”
Jeff uses dots by sticking it over a problem/question he doesn’t want to do and showing the teacher when he uses a dot. He can escape as long as he has dots in his envelope.
If Jeff uses a dot to get out of work, immediately say “You used a dot to get out of ____. You earned it!”
If Jeff meets his weekly goal, he can go to his brother’s kindergarten class and read a book to them.

57. Jeff—Reinforce Intervention Plan
Reinforce Strategies
Description
Group Contingency (Modified)
If Jeff meets his daily (time) goal for completing his writing assignment within the time agreed upon, the class earns a bonus letter toward the mystery reinforcer of the week. When Jeff earns the class this letter, the class provides attention to Jeff by thanking him and celebrating (clapping hands, saying “Yeah”.
Steps:
After reviewing Jeff’s self-management sheet, ask him, “Did you meet your goal today?”
If yes, “You did meet your goal. Let’s tell the class they’ve earned a letter for the mystery reinforcer.”
Tell the class, “Jeff met his goal today. We get another letter on the board.”
Prompt the class to thank Jeff (if they haven’t done so spontaneously).
If no, “You worked hard and tried. You’ll do it tomorrow!”

58. Activity
In your group/team, develop a reinforce intervention for the following hypothesis.
When requested to transition from a preferred to a non-preferred activity, Joe will start calling the adults and peers names and use cuss words. As a result, he (a) avoids/delays the transition and (b) gets responses/attention from both adults and peers.
Steps
Identify the function.
Determine how the function (outcome) can be delivered as an intervention
Review the reinforce interventions
Decide upon one intervention
Develop a step-by-step plan for implementation
Be prepared to share

59. Sharing Time

60. Coaching Steps
Core components of each behavior intervention strategy listed on coaching/fidelity form.
Primary adult behaviors (physical or verbal actions) & materials
If applicable, student behaviors included.
During coaching session, facilitator gives teacher behavior intervention plan and coaching form.
Facilitator introduces coaching form,
e.g., “We’re going to go over the steps of the behavior plan strategies to make sure they are still making sense to you and are things that can be done by you in your classroom. If there is anything that you feel isn’t going to work, we can make changes today.”

61. Coaching Steps Several methods for coaching the teacher.
Can choose one method, combination of two, or all three
Discussion—facilitator asks teacher to verbally describe (in his or her own words) each of the interventions.
Ensures teacher describes each step of the intervention
Teacher can refer to coaching form to cue core steps
Q & A—facilitator asks teacher questions about strategies.
For example, choice-making “When are you going to offer the choices to X?”; “What kind of choices will you offer X?”; etc.
Role Play (preferred method)-facilitator plays role of student and asks teacher to perform plan steps as they would with student.

62. Coaching Steps
Check ‘Y’ or ‘N’ whether teacher demonstrated competence with plan steps
Remediation: For any step teacher did not demonstrate correctly or skipped,
Review step with teacher
Provide another opportunity for teacher to demonstrate competence
If successful, coaching session finished
If unsuccessful, choose from the following:
Provide more opportunities to review and practice step
Ask teacher what features make step difficult and adapt to make feasible
Select different intervention checked on PTR intervention Checklist that matches hypothesis.
Schedule another meeting to develop new intervention
Schedule another coaching session

63. Coaching Steps Successful training:
Decide who else needs to be trained (e.g., student, other school staff, parent)
Try to be there when teacher trains student or offer to train student
Determine start date of intervention plan
Can choose to implement the intervention in phases.
Prevent first, then teach/reinforce
Teach/reinforce first, the prevent
Training checklist can be used as fidelity measure rather than developing separate checklist

65. Jeff Example

66. Jeff Coaching Plan (Sample)
Intervention Steps Y N
PREVENT 1: PROVIDING CHOICES
Presented valid choice to Jeff immediately after writing assignment presented
Praised Jeff for making choice
Honored choice within 1 minute after selection
implemented
PREVENT 2: ENVIRONMENTAL SUPPORT/TIMER
Negotiated time limit with Jeff immediately after choice and prior to release to task
Set time limit on visual timer
Placed visual timer on Jeff’s desk
TEACH: ACADEMIC ENGAGEMENT
Broke Jeff’s writing task into 3 parts and reviewed
Wrote 3 parts onto self-management plan
Reviewed academic engagement behaviors with Jeff
Reviewed with Jeff how to complete dot checklist

67. Activity
Develop a coaching/fidelity plan for your behavior intervention
Be prepared to share
Discuss how you would collect data on response to intervention (Behavior Rating Scale, other)

68. Questions?

69. PTR Publications PTR Manual Journal Articles
Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C., Prevent-Teach-Reinforce: The 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
Strain, P. S., Wilson, K., & Dunlap, G. (2011). Prevent-Teach-Reinforce: Addressing problem behaviors of students with autism in general education classroom. Behavior Disorders, 36,
Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (in revision). Reliability of the Individualized Behavior Rating Scale-Strategy for Teachers (IBRS-ST): A Progress Monitoring Tool.  Manuscript submitted for publication.
Sears, K. M., Blair, K. S. C., Crosland, K., & Iovannone, R. (in press). Using the Prevent-Teach-Reinforce model with families of young children with ASD. Journal of Autism and Developmental Disabilities.