Developed under grant H324P04003 from the Department of Education. Team Driven Tertiary Process: The...
-
Upload
nickolas-perry -
Category
Documents
-
view
216 -
download
0
Transcript of Developed under grant H324P04003 from the Department of Education. Team Driven Tertiary Process: The...
Developed under grant H324P04003 from the Department of Education.
Team Driven Tertiary Process: The Prevent-Teach-Reinforce
Model
Rose Iovannone, [email protected]
Carie English, [email protected]
University of South Florida
Acknowledgements
USF1. Don Kincaid
2. Kathy Christiansen
3. Sarah Donadio
4. Glen Dunlap
UCD1. Kelly Wilson
2. Patricia Oliver
3. Ted Bovey
4. Edy Purcell
5. Phil Strain
Objectives
Participants will:1. Describe an individual positive behavior
support process for use in the classroom
2. List factors impacting the effectiveness of an individual behavior support process
Individualized PBS (Tertiary)
For high-risk students:
– History of severe problem behaviors
– Demonstrated resistance to intervention
– An intensive system of support is needed
~15%
~ 80% of Students
~5%
Conceptualizing an Array of PBS Supports
Scott, 2001
Universal/Primary School-Wide Assessment
School-Wide Prevention SystemsClassroom Interventions
Targeted/
Secondary
Tertiary (Intensive)
AnalyzeStudent Data
Interviews,
Questionnaires, etc.
Observations and ABC Analysis
Multi-Disciplinary Assessment & Analysis
Simple Student Interventions (ERASE)
Group Interventions
Complex Individualized Interventions (PTR)
Team-Based Wraparound Interventions
Inte
rven
tionAssessm
ent
Tertiary Supports in Schools
Traditional process:1. Specialist/expert-driven
1. Complete an observation
2. Write a support plan
3. Call me if you have questions
Often contextual fit ignored
Limited support/follow-up/training provided
Prevent Teach Reinforce Process
Team driven process1. Goals, assessment, intervention plan
Support provided by facilitator1. Direct observation
2. Training and classroom implementation assistance
Contextual fit1. Greater buy-in and likelihood of
implementation
Prevent-Teach-Reinforce Model
Funded by US Dept. of Education/ Institute of Educational Sciences
Randomized control group design
Two sites—USF and UCD1. Three school districts central Florida2. Two school districts Colorado
Compare prescriptive, simple model to “business as usual”
Sample 200 students
1. 100 treatment; 100 wait-list control
Any student in K-8 grades who exhibit problem behavior
Problem behavior criteria1. Minimum 5 critical events indicated on Systematic
Screening for Behavior Disorders (SSBD)
2. Behaviors disruptive, durable (6 months), chronic (at least 1 time a week)
*USF site only
Sample Data MeasuresRepeated measures at student level
– Problem behaviors, social skills, academicsMediator and moderators at multiple levels:
– Student– Teacher/Classroom– System
ProcessStandardized approach Five step process facilitated by PTR Consultant
1. Team Development 2. Goal Setting 3. Assessment 4. Intervention
1. Coaching—up to 12 hours
5. Evaluation Manual including information and forms
Preliminary Data Results
Student Demographics by Ethnicity and Gender
Ethnicity N %age
American Indian 3 1.3
Asian 2 .9
Black 42 18.7
Hispanic 64 28.4
Other 7 3.0
White 112 49.8
Gender
Female 43 19.1
Male 182 80.9
Student Demographics by Primary DisabilityDisability N %
Autism 25 9.8
Developmental Delay 5 2.0
Emotional Disturbance 38 14.9
Mental Retardation 28 11.0
Multiple Disabilities 4 1.6
OHI (not ADD/ADHD) 1 .4
OHI (ADD/ADHD) 8 3.1
Specific Learning Disability 20 7.8
Speech/Language Disability 10 3.9
Visual Impairment 2 .8
General Education 99 38.8
Unknown 15 5.9
TOTAL 255
SSRS Social Skills
707274767880828486
Baseline Post-test Follow-up
Time Interval
Treatment n =107
Control n=90
d = .57
p < .000
Follow-up N 29/17
SSRS Problem Behavior
108110112114116118120122124126
Baseline Post-test Follow-up
Interval
Pro
ble
m B
eh
av
ior
Treatment N=69
ComparisonN=47
Follow-up N(16/9)
p < .000
d = .48
Academic Engaged Time
0.4
0.5
0.6
0.7
0.8
Baseline Post-test Follow-up
Treatment n=110
Control n=84
p = <.01d = .43
NBRCC Report 10-10-07
PTR Intervention more effective in:– Increasing social skills and decreasing
problem behaviors with students having most severe behaviors (measured by SSBD Maladaptive Behavior Scale)
– Increasing social skills and decreasing problem behaviors of males
NBRCC Report 10-10-07
Teachers participating in PTR indicated:– High social validity
– 98% liked PTR– 91% felt PTR reasonable
– High alliance (relationship) with consultant– Overall mean = 4.8 (SD = 0.45)
– Consultant is approachable
– Consultant and I trust one another
– Overall, consultant has shown sincere desire to understand and improve the situation
Social Validity Comparison USF—Sample Items
Item Pre Post
Like procedures 3.2 4.4
Acceptable 3.6 4.3
Teach appropriate behavior 3.5 4.3
Fit into existing routine 3.8 4.3
Total Social Validity Score 3.8 4.3
Fidelity
Most teams reaching 80% fidelity and maintaining into post-test
Quality scores lower than adherence scores
1. Part of the plan implemented although not entirely as plan written
The Process: A Case Study Example
Step 1: Team Development
Members and roles identified1. Teacher
2. Behavior specialist/school psychologist
3. Family members, paraprofessionals, special area teachers
Work styles inventory
Teaming survey
Case Study—Step 1: Team Building
Mike is a 9-year-old male in a self-contained autism classroom
Nonverbal—uses signs, Dynamite, and pictures to communicate
1 teacher, 2 aides, and 6 students
Case Study—Step 1: Team Building
Teacher-- Ms. Wonderful Aides
Ms. Needs Help Ms. Also Needs Help
Facilitator—PTR Consultant Results of teaming information indicate a
great team that meets regularly to brainstorm
Step 2: Goal Setting
Identify team consensus on:1. Academic behavior
2. Social behavior
3. Problem behavior
4. Appropriate behavior
Develop and begin baseline data collection
Case Study—Step 2: Goal SettingD
ecre
ase
Incr
ease
Bro
ad
Mike will communicate his wants and needs appropriately
Mike will interact with peers appropriately
Mike will comply with nonpreferred activities and requests
Mike will decrease screaming, hitting, and getting out of his seat
Mike will decrease hitting, screaming at, and bossing his peers
Mike will decrease screaming and hitting
Mike will ask for a break or for attention when needed
Mike will initiate peer interactions using his Dynamite
Mike will engage in nonpreferred activities and communicate his frustration using his Dynamite or an appropriate tone
Behavior Social Academic
Case Study: Operational Definitions of Problem and Replacement
Behaviors
Screaming—loud, high pitched noise heard outside the classroom
Hitting—anytime Mike touches peers or adults with an open hand, fist, foot, or object while screaming or protesting
Expressing Frustration—using Dynamite, pictures, or signs to ask for a break or attention
Transition to nonpreferred activities—moving to nonpreferred activity and engaging with appropriate
verbal expression (screaming level)
Case Study: Behavior Rating Scale With Anchors
Behavior Date
Screaming 9+ times7-8 times5-6 times3-4 times0-2 times
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
Hitting 8+ times6-7 times4-5 times2-3 times
0-1 times
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
Expressing Frustration
40%+30-40%20-30%10-20%
0-10%
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
Transition to Nonpreferred
Whimper or squealLouder than indoor voice
Outdoor play voiceLouder than outdoor play
Ear penetrating
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
54321
Step 3: Assessment
Checklist format:1. Antecedents or Triggers (Prevent)
2. Function(s) of the problem behaviors (Teach)
3. Consequences following the problem behaviors (Reinforce)
Assists team to link function of behavior to intervention plan
Case Study—Step 3: PTR AssessmentProblem Behavior
Prevention Data Teach Data Reinforce Data
Non-preferred task
1.Reading, Math
Transition
1.Preferred to
non-preferred
1.Change in schedule
Denied item, told no, or to fix
something
Other students upset/mad
Teacher attending to others
Gain attention
1.Peers, adults
Delay
Access to items
Redirected
Reprimanded
Calm/soothe
Personal
space
Later must
complete task
Loses/delays
reinforcers
Scr
eam
ing,
Hitt
ing
Case Study—Step 3: PTR AssessmentAppropriate Behavior
Prevention Data Teach Data Reinforce Data
Independent work
One-on-one
attention
Specials
Peer interaction
Getting attention
Raising hand
Sharing attention
Conversation skills
Taking turns
Waiting
Self-management
Asking for break
Expressing emotions
Treasure box
Movie
Attention
Helping teacher
Going to media
center
Going outside
Walk
Food
Pro
soci
al
Step 3: PTR Assessment—Developing the Hypothesis
When…. Student will….
As a result…
Inappropriate Behavior
Appropriate Behavior
Prevention data = antecedents or triggers
Teach data = replacement behavior and possible function
Reinforce data = function and reinforcers
Case Study—Step 3: PTR Assessment Possible HypothesesWhen…. Student will…. As a result…
Mike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to nonpreferred activity, fix an error, or when teacher 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
Inap
prop
riate
App
ropr
iate
Case Study: Tips on Linking Interventions to Hypothesis
Prevention strategies must address:1. Getting Mike attention more often2. Changing non-preferred task
1. Particular student2. How it is done (format)
3. Changing what happens when he makes a mistake1. Do part of it (rather than all of it) over2. Allow him to find what is wrong3. Provide social story
4. Signaling end of preferred activity
Teach strategies must address:1. How to get attention/assistance2. How to get break/delay appropriately
Reinforce strategies must address:1. Giving Mike attention/help2. Giving Mike break/delay
Step 4: InterventionTeam ranks top three intervention strategies in each of the PTR components
Multi-component intervention that teacher states s/he can implement
1. Prevent
2. Teach
3. Reinforce
Implementation plan
Case Study: Tips on Linking Interventions to Hypothesis
Prevention strategies must address:1. Giving Paris attention more often
2. Changing non-preferred task1. Presentation (how it is given to Paris; how it looks)
2. Content (embedding preferences)
3. Changing environment surrounding independent work time
Teach strategies must address:1. How to get attention appropriately
2. How to get a delay appropriately
3. How to access preferred item appropriately
Reinforce strategies must address:1. Giving Paris attention/help
2. Giving Paris a delay
3. Giving Paris access to preferred activities
Prevent Strategies
Specific Strategy steps
Environmental Support
A 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.
Environmental Support
Mike’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.
Case Study—Step 4: PTR Intervention
Prevent Strategies
Specific Strategy steps
Curricular Modification
Mike 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
Teach Strategies
Specific Strategy Steps
Replacement Behavior
Mike will be taught to use his Dynamite to express his need to calm down.
1. Mike’s device will be programmed to say “I need to calm down.”2. Prior to transitioning to a non-preferred activity or at the end of a preferred activity, remind Mike that “if you start to get mad, you can choose to calm down.”3. As soon as Mike starts to get upset, prompt him to use his device.4. Once Mike communicates “I need to calm down”, present him with the choice board of calming strategies and ask him, “What do you want?”5. As soon as he is calm, praise him. 6. Allow Mike to engage in his choice until he is calm for 1-minute.7. If Mike does not return to his area, then start having a fun time in that area with those students present
Teach Strategies
Specific Strategy Steps
Self-Management
Mike 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
Reinforce Strategies
Specific Strategy Steps
Replacement Behavior
Anytime Mike “says” “I need to calm down”, his choice board should be given.
1. Praise Mike for communicating (“thank you for telling me.”)2. Provide his choice board.3. Allow him to calm for 1 minute4. Praise him as soon as he is quiet5. Praise him for returning to the group
Self-Management
Anytime Mike scores his behavior, attention should be given.
1. When Mike marks his tracking sheet, praise him for doing so.2. At the end of the day, review the sheet with Mike.3. Talk about the sad faces.4. Provide his reward if his goal is met.
Waiting Mike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule.
Reinforce Strategies
Specific Strategy Steps
Transition Mike will earn stars during Reading Centers if he transitions and completes his work without screaming.
1. 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.2. At the end of each reading center, an adult will review Mike’s behavior with him and ask him if he earned his stars. 3. Provide his stars if earned.4. During the teacher’s group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group.5. Allow Mike to participate in his chosen activity if he earned his stars.
Coaching of Interventions
Training of teacher1. 1 to 2 hours2. 80% accuracy on all strategies
Assistance in classroom1. Up to 12 hours
Fidelity measures recorded1. 80% implementation terminates
assistance in classroom
Case Study: Training
Task Analysis of Intervention Dis
cuss
Q
& A
V
erb
al
Rol
e-p
lay
Ob
serv
e F
eed
bac
k
Training
Review
PREVENT – Environmental Support 1. Mini schedule of group & center time available Yes No Yes No
2. Schedule reviewed prior to task Yes No Yes No
3. Schedule reviewed & items crossed off Yes No Yes No
TEACH – Replacement Behavior
1. Remind to use DynaVox prior to transition Yes No Yes No
2. Provided choice board and honored choice Yes No Yes No
REINFORCE –Replacement Behavior
1. Verbally or gesturally acknowledge ASAP Yes No Yes No
2. Allowed to cool off for 1-minute Yes No Yes No
TOTAL (# Yes/ # Total) Fidelity Score ( .00 – 1.00)
Case Study: Fidelity
Interventions Adherence Quality Environmental Support 1) Mini schedule of center & group available 2) Mini schedule reviewed prior to start of
centers 3) Items crossed off as completed
Mini schedule present
Mini schedule present & reviewed at least either prior to or after activities completed
Replacement Behavior—Functional 1) Reminded student to use DynaVox prior to
transition & when student engaged in warning signs
2) Choice board given 3) Choice honored
Teacher reminded student prior to transition or behavior
Teacher reminded student prior to at least 2 of 3 transitions & all behavior
Reinforce Replacement Behavior 1) Teacher immediately recognized student
for using DynaVox (within 15 s) 2) Allowed to calm down for at least 1-minute
Teacher recognized student
Teacher immediately (within 15 seconds) recognized student and allowed student to calm down
Step 5: Evaluation
Data-based decision-making1. Identifying what is working; what is not and
WHY
Expanding into other routines
Generalization
Continuing team meetings1. Planning time
2. Cohesiveness
Screaming
1
2
3
4
5
14-D
ec
7-D
ec
12-D
ec
3-Ja
n
8-Ja
n
11-J
an
18-J
an
23-J
an
26-J
an
31-J
an
5-F
eb
7-F
eb
15-F
eb
21-F
eb
26-F
eb
2-M
ar
12-M
ar
15-M
ar
27-M
ar
30-M
ar
4-A
pr
11-A
pr
16-A
pr
19-A
pr
24-A
pr
27-A
pr
2-M
ay
7-M
ay
10-M
ay
Rat
ing
BaselineIntervention
Definition Changed
Step 5: Evaluation
1 is a lot of screaming, 5 is no screaming
Hitting
1
2
3
4
5
Ra
tin
g
BaselineIntervention
Step 5: Evaluation
1 is a lot of hitting, 5 is no hitting
Step 5: Evaluation Expression of Frustration
1
2
3
4
5
14-D
ec
7-Dec
12-D
ec
3-Ja
n8-
Jan
11-J
an
18-J
an
23-J
an
26-J
an
31-J
an
5-Feb
7-Feb
15-F
eb
21-F
eb
26-F
eb
2-M
ar
12-M
ar
15-M
ar
27-M
ar
30-M
ar
4-Apr
11-A
pr
16-A
pr
19-A
pr
24-A
pr
27-A
pr
2-M
ay
7-M
ay
10-M
ay
Rat
ing
BaselineIntervention
1 is a little appropriate expression, 5 is a lot of appropriate expression
Transition to Nonpreffered
1
2
3
4
5
Rat
ing
BaselineIntervention
Step 5: Evaluation
1 is inappropriate transition, 5 is super appropriate transition
Step 5: Evaluation Other Outcome Data
Measure Baseline Post-test Change
SSRS-PB 123 112 -11
SSRS-SS 87 102 +15
AET .34 .57 +23
Wrap Up:What We Have Learned
PTR process may not be enough for all students
Some need wraparound
Not all students need PTR3-tiered model of individual support
Teachers report the coaching piece and collaborative process to be keys
How to Make PTR Work in Your School
Steps are the key components not how your organize themMust create a system that will work for your school or even each studentThings to consider
1. Tertiary team2. Identification/Nomination process3. Facilitator 4. Set-up of meetings for efficient results
Organizing the PTR Process
Is Team Building needed?1. Small team, team works well together, no
paraprofessional
If small team or no paraprofessional, skip and start with Goal Setting
If well functioning team, combine with Goal Setting
Organizing the PTR Process
Few problem behaviors or all in same response class?
1. Same antecedents &/or function2. Small team
Combine Assessment with Intervention DevelopmentCondense the steps to meet the needs of your school
Final Thoughts: System Changes
Process may require more time up front but less time overall
1. Must provide assistance in the classroom until desired outcomes achieved
2. Will pay off in the end
Teams more likely to implement the plan1. Ownership
2. Fits the class and the student
3. Continued contact
Questions?