MAY 21, 2014 JENNIFER PEREZ, MSW, BCBA ALEXIS SOMERS, MA, BCBA Behavior Management.
Making Behavior Interventions HappenMaking Behavior Interventions Happen Real strategies for...
Transcript of Making Behavior Interventions HappenMaking Behavior Interventions Happen Real strategies for...
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MakingBehaviorInterventionsHappenRealstrategiesforsupportingimplementation
AustinH.Johnson,PhD,BCBAAssistantProfessor,GraduateSchoolofEducationUniversityofCalifornia,Riverside
PENT Forum 2019 www.pent.ca.gov
Section 2: Strategies Slide 1
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AboutmeBA:UniversityofArizonaMA:UniversityofConnecticutPhD:UniversityofConnecticut
BCBA&LicensedPsychologist UCRiverside AssistantProfessor SchoolPsychologyprogram
Research Observationally‐basedbehaviorassessment Researchtopracticegapinschoolsettings Effectivepracticesinbehaviorintervention
PENT Forum 2019 www.pent.ca.gov
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Conflictofintereststatement
Dr.JohnsoniscurrentlyrevisingaGuilfordtextonschool‐basedbehaviorassessment,uponwhichhewillreceiveroyalties.
PENT Forum 2019 www.pent.ca.gov
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Whatisimplementation?
Weassumethatifwetellsomeonetodosomething,they’lldoit.Whywouldn’tthey?Becausebehaviorchangeisreallyreallyhard. Butifpeopledon’tchange,theninterventionsdon’thappen,andpatients/clients/studentscannotbenefitfrominterventionsthattheydonotreceive.
PENT Forum 2019 www.pent.ca.gov
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Whatisimplementation?
HowmanypeoplemadeaNewYear’sresolutionthispastyear? Howmanypeoplekeptit?
PENT Forum 2019 www.pent.ca.gov
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Thisisnotan“education”problem.
(Fleming,Nguyen,Afful,Carroll,&Woods,2018)
PENT Forum 2019 www.pent.ca.gov
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Thisisnotan“education”problem.
Spreadofmostinfectionsinhospitalscanbestoppedwithonesimplepractice Onaverage,healthcareworkerscleantheirhandslessthan50%ofthetimestheyshouldHospital‐basedinfectionswerealeadingcauseofdeathin2011,cost$40billion/year
(Gawande,2004;Rosenberg,2011;CDC,2018)
PENT Forum 2019 www.pent.ca.gov
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Thisisahumanproblem.We’veknownitfornearlytwocenturies!1847:we’respreadingpuerperalfever,sowashyourhandsbeforedeliveringababy!
ByDay10,mostimplementersarenotdeliveringtheinterventionasintendedWhetherit’sacademicorbehavioral,individualorgroup,atschoolorinhomeorinthecommunity
Interventionnotdeliveredas
intended
Studentdoesnot“respond”tointervention
Moreintensive,morerestrictiveinterventionsorplacements
(Dufrene etal.,2012;Gilbertson,Willt,Singletary,VanDerHeyden,2007;Sundman‐Wheat,Bradley‐Klug,&Ogg,2012,Fallon,Collier‐Meek,Sanetti,Feinberg,&Kratochwill,2016;Jeffrey,McCurdy,
Ewing,&Polis,2009;Mouzakitus,Codding,Tryon,2015;Sanetti,Collier‐Meek,Long,Byron,
&Kratochwill,2015)
PENT Forum 2019 www.pent.ca.gov
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So,whatdowedo?
2001:PeterPronovostCritical‐carespecialistatJohnsHopkinsFocusedonfixingoneproblem:infectionswheninsertingcatheterlinesFive‐stepchecklist
1. Washhandswithsoap2. Cleanpatient’sskinwithchlorhexidineantiseptic3. Putsteriledrapesoverentirepatient4. Wearsterilemask,hat,gown,andgloves5. Putsteriledressingovercathetersiteafterwards
(Gawande,2007)
PENT Forum 2019 www.pent.ca.gov
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So,whatdowedo?
Pronovost persuadesadministratorstoauthorizenursestostopdoctorsiftheysawanystepsskippedNeededtomakethisexplicit:“manynursesaren’tsurewhetherthisistheirplace,orwhetheragivenstepisworthaconfrontation.”
Lineinfectionrate:2001:11%2002:0% Prevented43infections,8deaths,saved$2m
(Gawande,2007;Pronovost etal.,2006)
PENT Forum 2019 www.pent.ca.gov
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So,whatdowedo?
Howdoyoumakebehaviorchangehappen?HelppeoplerememberwhattodoOperationalizeitintodiscretestepsPutpreventionandresponsestrategiesintoplacetomakesurethatitcanandwillhappen
(Gawande,2007)
PENT Forum 2019 www.pent.ca.gov
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There’snoone‐size‐fits‐allapproach
Buttheseare principleswecanuseregardlessofthe IntensityofthebehaviorStakesofdecisions Ourjobistodecidehowsimple orhowelaboratethesesystemsshouldbeforthecasethatwe’reworkingwith
PENT Forum 2019 www.pent.ca.gov
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Ourplanfortoday
1. Designingausablebehaviorsupportplan2. Buildingtreatmentfidelityassessmentintoyour
behaviorsupportplan3. Workingwithimplementersbeforeitbreaksdown4. Supportingimplementersafteritdoesbreakdown
PENT Forum 2019 www.pent.ca.gov
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1.DesigningausablebehaviorsupportplanAKA:“peopleusePinterestbecauseit’sprettyandit’sthere”
PENT Forum 2019 www.pent.ca.gov
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Peoplewillproblem‐solveontheirown
“IfoundthiscoolthingonPinterest…”
PENT Forum 2019 www.pent.ca.gov
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Somakeourplaneasytoreadanduse
WecannotexpectimplementerstoreadfullparagraphsorpagethroughBIPsEspeciallywhenrespondingtobehavior! Practice#1– WritequickguidetoBIPusingO’Neilletal.’s(2015)format Practice#2– CreateaquickguideBasedonsameprinciplesasPronovost’s checklistsMakethestepseasytoseeandunderstand
PENT Forum 2019 www.pent.ca.gov
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Practice#1– MaketheBIPreadable
Antecedent
Presentedwithmulti‐stepmathproblem
Behavior
Cries(tearsonface,loudyelling)
Consequence
Escapetask
SettingEvent
Fightonbus
Prevent
Strategy1Strategy2…
Replace
Strategy1Strategy2…
Respond
Strategy1Strategy2…
Prevent
Strategy1Strategy2…
PENT Forum 2019 www.pent.ca.gov
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Desired Behavior Consequence/Function
Setting Event Antecedent Problem Behavior Consequence/Function
Alternative Behavior
Prevent (SE) Prevent (A) Teach/Replace (B) Respond (C)
PENT Forum 2019 www.pent.ca.gov
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Practice#2– Makethestepsvisible
CreateaQuickGuide(“cheatsheet”)! TwosectionsAntecedentstrategies[whatshouldIbethinkingaboutallthetime?]Consequencestrategies[howIrespondwhenIseepositiveornegativebehavior?whatiftheyescalate?]
PENT Forum 2019 www.pent.ca.gov
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(Mostly)AntecedentstrategiesBehavior Intervention Plan Quick Guide
DURING: STAFF SHOULD: BY:
Beginning of day Check in with J
Providing brief, positive attention Determining rewards and filling in activities for day Reminding of consequences for disruptive behavior Not providing attention for inappropriate materials in bag
Academic tasks
Prepare Giving J a choice of activities. Interspersing easy and hard problems.
Engage Providing specific, positive praise throughout task. Using active and rapid exchanges. Using transition warnings.
Respond Ignoring off‐topic comments. Engaging in current task with directive or question.
Finish Providing specific, positive praise at end of task.
Throughout day Specific praise “You did a great job on that math worksheet, J” Positive prompts “Alright buddy, let’s start getting ready for recess” Nonverbal cues Smiles, thumbs‐up, high‐fives
IF STUDENT: THEN STAFF SHOULD: EXAMPLE/NOTES:PENT Forum 2019 www.pent.ca.gov
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Consequencestrategiesandcrisisplan
, p, g
IF STUDENT: THEN STAFF SHOULD: EXAMPLE/NOTES:
Raises hand Completes work Has hands to self Has feet to self Uses appropriate language
Immediately, catch him being good by: Calling on him Providing specific praise Reminding him of progress to goal
At end of activity, provide points by: Marking point on chart at end of period Providing specific praise
Ex: “Thanks for raising your hand, J!” *5:1 pos. to neg. statements
Ex: “I loved the way you raised your hand when Mrs. Garza asked that question. Since you had appropriate hands and feet and voice, you earned 3 minutes!”
Starts to be mildly disruptive
Ignore behavior No eye contact, neutral face
Praise students engaging in positive behavior Give positive praise as soon as he does any appropriate behavior
Ex: J starts to tap on his desk. Ignore. “I love the way that Jason and Vanessa are raising their hand and waiting to be called on!” J stops tapping at any point. “J, great job using quiet hands!”
Continues to be disruptive
Prompt to use replacement behavior Remind him about point sheet
Ex: “J, remember that I need to see quiet hands and feet to give you minutes at the end of this activity.”
Escalates to severe problem behavior
Escort to a quiet work space Set timer for 5 minutes Monitor quietly Provide easy worksheets
At end of time, remind of goals and return to class
Ex: “You didn’t earn your minutes because you walked around the room yelling, which isn’t using a respectful voice, feet, or hands. If you can keep your hands and feet to yourself, and use a respectful voice, you can earn your minutes for the next activity!”
PENT Forum 2019 www.pent.ca.gov
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Whatabouttoughkids?
Integratethecrisisplanintothequickguide Considerintegratingdatacollectionaswell! Lesspaperwork=moretimesupportingthekid
PENT Forum 2019 www.pent.ca.gov
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DATE:
When A does not use any off‐topic verbalizations for 20 minutes, 8:30 9:30 10:30 11:30 12:30 1:30 2:301 Provide specific praise & a ticket.
When A uses an off‐topic verbalization (e.g., “Is my hair longer today?”)… 8:30 9:30 10:30 11:30 12:30 1:30 2:30Staff will provide… Details After staff response…
Back on task : ticket
Continues : see below
Back on task/break : ticket
Continues : see below
Requests break : take break + ticket
Continues : indicate consequence on sheet
4If at any time, behavior becomes unsafe.
"A, you're not being safe. We're going to go to the cooldown area."
Escort to cooldown area.
When in cooldown area… 8:30 9:30 10:30 11:30 12:30 1:30 2:30Staff will…
1 Set timer for 5 minutes2 Point to “I’m ready” checklist.3 At end of timer, ask if A is "acting ready."4 Escort A to class.
Spontaneously requested breakOn‐task comments
3Verbal redirection, provide break or state alternative.
"A, that still isn't appropriate. You can either take a break right now, or you can finish your activity during free time."
Calm voice and bodyIn space with feet on floor
“I’m ready”Flashcard or spelling
Give stop sign with hand. Firm and neutral.
Nonverbal redirection
1
2Verbal redirection and prompt break.
"A, that's isn't an appropriate question to ask right now. Do you want to take a break?"
PENT Forum 2019 www.pent.ca.gov
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2.BuildingtreatmentfidelityassessmentintobehaviorsupportAKA:“yeah,it’saboutcollectingevenmoredata,butIpromiseit’sworthit!”
PENT Forum 2019 www.pent.ca.gov
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Seriously,whydothis?
(Burns & Gibbons, 2008)
1. Problem Identification
2. Problem Analysis
3. Plan Development4. Plan Implementation
5. Plan Evaluation
ReviseModify
IntensifyWith Expanding Support
PENT Forum 2019 www.pent.ca.gov
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Seriously,whydothis?
(Burns & Gibbons, 2008)
1. Problem Identification
2. Problem Analysis
3. Plan Development4. Plan Implementation
5. Plan Evaluation
ReviseModify
IntensifyWith Expanding Support
PENT Forum 2019 www.pent.ca.gov
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Studentoutcomes
Improving Continuecurrentpractice(orconsiderfading)
Worsening Changeintervention
(Collier‐Meek,Fallon,Sanetti,&Maggin,2013)
“Awesome!"
PENT Forum 2019 www.pent.ca.gov
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Studentoutcomes
Improving Continuecurrentpractice(orconsiderfading)
Worsening Changeintervention
(Collier‐Meek,Fallon,Sanetti,&Maggin,2013)
“Well,wetried,andit’snotworking.It’stimetostarttalkingabout
[insertmorerestrictiveenvironmenthere].”
Butwereweactuallydoingwhatwesaidwewoulddo?Asoftenaswesaidwe’ddoit?Withsufficientquality?
PENT Forum 2019 www.pent.ca.gov
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Implementation
Atorabovecriterion BelowcriterionStudentoutcomes
Improving Continuecurrentpractice(orconsiderfading) Determineunknownissue
Worsening Changeintervention Provideperformancefeedback
(Collier‐Meek,Fallon,Sanetti,&Maggin,2013)
PENT Forum 2019 www.pent.ca.gov
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Consultationorevaluation?
“Let’stakedataonthestudent!”= “Let’stakedataontheteacher/para/aide!”= Butwait!It’sjustconsultationskills It’sthedifferencebetween “Here’stheplan,seeyouintwoweeks.” “Iwanttomakesurethisplanworksforyou.So,here’sachecklistyoucanusetotrackwhatpartsyou’reabletodo,andwhatpartsaren’tworkingforyouandyourclassroom.Let’smeetbackuptomorrowandseewhatpartsworkedandwhatpartsdidn’t.”
PENT Forum 2019 www.pent.ca.gov
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Whatshouldwemeasure?
TreatmentintegrityAdherence:whetherstepsweredeliveredQuality:howwell eachstepwasdeliveredExposure:howmuchoforhowlong thetreatmentwasprovided (andProgramDifferentiation…)
Complexityshouldbedrivenbycaseintensity!Adherenceisstillthemaingameintown
Quality
Exposure
Adherence
(Schulte,Easton,&Parker,2009)
PENT Forum 2019 www.pent.ca.gov
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• Interventionfidelity1. Adherence:whether stepwasdelivered2. Quality:howwell thestepwasdelivered3. Exposure:howlong thestepwasdeliveredfor
https://cbitsprogram.org/forms
☐ Adherence☐ Quality☐ Exposure
PENT Forum 2019 www.pent.ca.gov
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Behavior Intervention Plan (Token Economy) Intervention Fidelity Form
Week of: ____________________________
During… Staff will… Monday Tuesday Wednesday Thursday Friday
Checkmark
Morning meeting
Provide positive attention Determine rewards, fill activities Remind of consequences Removed materials silently (or n/a)
Throughout morning
Catch him being good Provide points after each activity with specific feedback and praise
AM reward Provide reward time
Throughout afternoon
Catch him being good Provide points after each activity with specific feedback and praise
PM reward Provide reward time
If student… Staff will… Monday Tuesday Wednesday Thursday Friday
Tally
Continues to be disruptive
After ignoring and praising other students, prompt to use replacement behavior and remind him of point sheet
Needs to leave the room
Escort to quiet work space Set timer for 5 minutes Provide easy worksheets At end of timer, return to class
PENT Forum 2019 www.pent.ca.gov
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Improving Relationships & Results: Building Family School PartnershipsMathematics Strategies Module
Integrity Checklist
Treatment Integrity Measure for Explicit Timing:
Steps to follow: Yes or No Response: Materials
1. Stopwatch or watch with a second hand 2. Kitchen timer with bell 3. Sets of math worksheets with 100 basic math problems on the front of the
sheet stapled together into a packet
4. Pencil Procedure
1. Set the kitchen timer with an amount of work time (15, 20, or 30 minutes) 2. Inform the student that the timer is set for an amount of work time. Inform
them that you will also be timing them with a stopwatch in 1 minute intervals.
3. At the beginning of each timing say “Pencils up, ready, begin!” 4. At the end of the 1 minute interval say “Stop” and have the student draw a
line after the last problem answered. Repeat the procedure throughout the set time interval for the work period
5. When the kitchen timer rings, announce that the work period is over. Evaluation
1. Calculate the average number of correct problems per minute by counting the total number of problems correct for the period and divide them by the number of 1 minute intervals
2. Compare the average number correct per minute over time to evaluate if the student is becoming more fluent (faster)
3. Have the student complete this activity 3‐5 times per week
11Count the total number of “yeses” from the yes/no column. Divide this number by the total number of possible “yeses” (i.e. 13) and multiply that number by 100 for a percentage of treatment integrity.
# of “yeses” X 100 = %
13
13X 100 = ____%
#____ of “yeses”
PENT Forum 2019 www.pent.ca.gov
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AHJ March 2018 Based on form from: https://my.vanderbilt.edu/specialeducationinduction/files/2013/07/Tip‐Sheet‐Check‐In‐Check‐Out.pdf
Hawkins Mad Scientists! ::: CICO form
Name: ________________________________ Today’s goal: __________________________
Date: ________________________________ Student signature: ______________________
Check In
Pen/Pencil Paper Agenda Parent signature ________________________________
Mentor Initials
Expectation Period 1 Period 2 Period 3 Period 4 Period 5 Period 6 Period 7
Be safe 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0
Be responsible 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0
Be respectful 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0
Work completion 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0 2 1 0
Total
Teacher initials
Student initials
WOW! comments
0 = Did not meet expectation 1 = Sometimes met expectation 2 = Always met expectation
Daily point total _______ / 56 = ________ x 100 = ___________ (Daily Point %)
Parent signature: ________________________________________________________________
Parent wows: ___________________________________________________________________
______________________________________________________________________________
Check Out
Form copied Agenda % calculated Homework
________________________________ Mentor Initials
PENT Forum 2019 www.pent.ca.gov
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CICO Checklist for Ms. Hamilton Week of ______________
Day Did I…
Score the sheet? Provide specific praise? Provide specific feedback? Monday
Tuesday
Wednesday
Thursday
Friday
� � �� � �� �
� � �� � �
n/a (great day!)
2/8/18
PENT Forum 2019 www.pent.ca.gov
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3.WorkingwithimplementersbeforeitbreaksdownAKA:“anounceofpreventionisworthapoundofaspirin”
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Weneedtoberealistic
Interventionsareadapted inpractice Interventionsthathavecontextualfitaremorelikelytobeimplemented Adaptedinterventionscanstillwork! So,planfortheinevitableandimportant!
“We can thus say now with confidence that some measure ofadaptation is inevitable and that for curriculum developersto oppose it categorically, even for the best of conceptual orempirical reasons,would appear to be futile.”
(Durlak &DuPre,2008)
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Implementationplanning
Planhasbeendrafted(theBIPexists) Ideally,planwasdraftedwithabundantstakeholderinputwithaneyetowardsimplementation Butwhatifit’sforasecondarystudent?Lotsofteachersandeducatorswhowedidn’ttalkto So,nowweneedtofigureoutWhatmodificationsneedtobemadetotheplanWhatresourceswe’llneed,andifwecangetthemWhatbarrierstoimplementationexistHowwe’lladdressthosebarriers
PENT Forum 2019 www.pent.ca.gov
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ActionandCopingPlanning
1. Whatmodificationsneedtobemadetotheplan2. Whatresourceswe’llneed,andifwecangetthem
1. Whatbarrierstoimplementationexist2. Howwe’lladdressthosebarriers
BasedonresultsfromPRIMEProject MultiplestudiestosupporteffectivenessofthisframeworkWithparentsandteachers Foracademicandbehavioralinterventions
(Fallon,Collier‐Meek,Sanetti,Feinberg,&Kratochwill,2016;Sanetti &Collier‐Meek,2015;Sanetti,Collier‐Meek,Long,Byron,&Kratochwill,2015;Sanetti,Collier‐Meek,Long,Kim,&Kratochwill,2014;Sanetti,Williamson,Long,&Kratochwill,2017)
ACTIONPLAN
COPINGPLAN
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Howdoyoudothis?
Withameeting!(…hooray…)SitdownwiththestakeholdersActionPlanTaskanalyzeinterventionintodiscretesteps IdentifyresourcesneededforeachstepCopingplanDiscussforeseeablebarrierstoimplementationDiscussstrategiestosupportimplementation
Monitoroutcomes,modify,check‐in,discuss,andreviseonanongoingbasis
PENT Forum 2019 www.pent.ca.gov
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4.Supportingimplementersafteritdoesbreakdown
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Welp,it’snothappening
Implementation
Atorabovecriterion Belowcriterion
Studentoutcomes
Improving Continuecurrentpractice(orconsiderfading) Determineunknownissue
Worsening Changeintervention Provideperformancefeedback
(Collier‐Meek,Fallon,Sanetti,&Maggin,2013)
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Welp,it’snothappening
Implementation
Atorabovecriterion Belowcriterion
Studentoutcomes
Improving Continuecurrentpractice(orconsiderfading) Determineunknownissue
Worsening Changeintervention Provideperformancefeedback
(Collier‐Meek,Fallon,Sanetti,&Maggin,2013)
PENT Forum 2019 www.pent.ca.gov
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Performancefeedback
SomanystudiesexaminingitseffectontreatmentintegrityandstudentoutcomesMeetsWhatWorksClearinghousestandardsforanevidence‐basedpractice!Whenitcomestoevidence‐basedimplementationsupportstrategies,performancefeedbackisthemostwell‐researched
(Fallon,Collier‐Meek,Maggin,Sanetti,&Johnson,2015)
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Whatisit?
“Informationthatisprovidedtoanindividualorgroupaboutthequantityorqualityoftheirbehaviorthatprovidesinformationabouthowwelltheyaredoing” “capturing,summarizing,andpresentingdatatoteachersregardingtheirplanimplementation”
(Noell &Gansle,2014)
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Performancefeedback
ShowingdatatoapersonandreviewingitwiththemcanbeeffectiveonitsownCanembedwithothertrainingmethods LogisticsBriefmeetings(5to15min)Ongoing (daily,weekly,as‐needed)Needgraphs ofdata
(Noell &Gansle,2014;Fallonetal.,2016)
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Doingit
1. Ask implementerabout Interventionfidelity Studentoutcomes
2. Reviewfidelity datawithgraphs3. Reviewoutcome dataandgoalprogress4. Reviewandpractice stepsasnecessary5. Followup!
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OfthosestudiesthatfoundPFtobeeffective…
Typeoffeedback 97%providedverbalfeedback 69%providedgraphicTIfeedback 69%reviewedstudentdata 62%includedproblem‐solvingtosupportimplementation Less‐oftenusedweregoal‐setting(17%),reinforcementproceduresforadult(17.5%)
Frequencyoffeedback Variedgreatly(28%daily,21%weekly,7%onlywhenTIfellbelowacriterion)
Whenfeedbackwasprovidedrelativetointervention Sameday(21%),oneortwodaysafter(24%)
Studentcharacteristics 73%werewithkidsreceivingspedservices,27%withgened only
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Superiortoothermethods
Resultsofrandomizedtrial
Consultationfollow‐upsBriefweeklyinterviewWeeklyinterviewwithcommitmenttoimplementPerformancefeedbackMeteverydayuntilat100%integrity,theneveryotherday,thenweekly
(Noell etal.,2005)
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That’ssomuch
Yes,butrealistically:“Theliteraturesuggeststhatconsultingwithteachers,designing aninterventiontheyseemacceptable,providingmaterialsnecessaryfortheintervention,discussing theimportanceofinterventionimplementation,andtrainingteacherstoimplementtheinterventionarefrequentlyinsufficienttosupportlong‐term[implementation]” (Noell &Gansle,2014)
PENT Forum 2019 www.pent.ca.gov
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Howtodoit? Canoccurinthecontextof:One‐on‐oneconsultationPros:EasierforyoutoinfluencehowthisgoesCons:Dependingontherelationship,mightbedifficulttodoPFeffectively
EmbeddedintoaProblem‐SolvingTeamPros:Lessduplicationofresources,mayameliorateconcernsaboutevaluativerolesCons:Mayexacerbatetensionsindatacollection(havetoreportoutonmydatatoallthesepeople…)
(Duhon,Mesmer,Gregerson,&Witt,2009)
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Wrappingup
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Supportingimplementation1. Designthematerialstobeused,nottobefiled “Writeitlikeyouwantsomeonetoreadit”
2. Takeimplementationdata,butmakesurethedataworkforyouandthecase “WhatquestionamItryingtoanswer?”
3. Berealisticandplanforadaptations4. Ifandwhenitfails,usethosedatayou’retakingto
implementPF:asimple,evidence‐basedpracticeforsupportingimplementation
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Wrappingup
Doesn’tseemlikemuch?Prettystraight‐forwardstuff? Iagree!That’swhyit’sgreat! Thisstuffisnotcomplex. Butit’sevidence‐based! Andittakestimeandeffort.
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Wrappingup
“Thesestepsareno‐brainers;theyhavebeenknownandtaughtforyears.Soitseemedsillytomakeachecklistjustforthem.Still,Pronovost askedthenursesinhisI.C.U.toobservethedoctorsforamonthastheyputlinesintopatients,andrecordhowoftentheycompletedeachstep.Inmorethanathirdofpatients,theyskippedatleastone.” (Gawande,2007)
Interventionnotdeliveredas
intended
Studentdoesnot“respond”tointervention
Moreintensive,morerestrictiveinterventionsorplacements
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Nextsteps
Researchersneedtogivepractitionersthetoolstheyneed toimplementthepracticesthattheystudy
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Thankyou!
Wanttopartnerondevelopingusable,evidence‐basedbehaviorinterventionmaterials?Otherideas?Contactme!
Email:[email protected] Phone:951‐827‐5958 Twitter:@johnsonaustinhWeb:www.ahjohnson.com
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