Students with Complex Needs (Elementary)...Provide high 5’s, thumbs up, “great job” or other...

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Students with Complex Needs (Elementary)

START Conference 2018

A case example of implementing an interconnected system of supports

Introductions & Outcomes

• Introductions:• Presenters• Team• Audience

•Outcomes:

• Learn from our successes and our mistakes• Use case study to demonstrate systems

development for complex students• Demonstrate interconnectedness of the systems• Share ways of creating and improving

implementation fidelity systems

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OUR INSPIRATION

CSI (Comprehensive Student Inquiry)

• RELEVANT History: • Eligibility, Health, Development• Past & Current Programming (planned restriction end last year)• Other Situational Variables

• Environmental: • District restructure; classroom is a double science lab

• Default Perceptions (Human Nature):• Child has “___”• Parent is “___”• We can’t do “___”

• Direct Observation / Interaction: • FBA-Informed (ABC) Direct Observation• Schedule Matrix Observation• Baseline Data (Engagement, Independence, Social Interaction,

Communication, Behaviors)• Universal Supports Fidelity (CETA)• Preferred Interests• Interaction Inquiry (Integrated Observations)

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The Schedule Matrix• Uses

• Observation• Plan Development• Implementation Fidelity

• Other Columns• Current Target Student Comparison

(broad domains)• Implementation Fidelity of Current

Supports & Strategies

• Raegan’s schedule matrix

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Data Review• Proposed Variables:

• New environment and peers• Lack of clear expectations• Lack of implementation fidelity of universal supports• Heightened anxiety (based on level of manic darting and

difficult attending)• Need to access preferred activities (logo shirts, music)

• Baseline:• Engagement in Curriculum (0%)• Eloping: Attempts 8-10+x per 30 min (depending on variables)• Grabbing at Others’ Shirts with logos (100% when logo present

unless prompted not to; with prompts, 4/5X still attempted)• Repetitive Language (90% time, 10+ repeated questions)• Private Behavior (100% -- 90% when cognitively engaged)

Review of Universal SupportsUse the CETA

(START page search bar CETA then click assessment and data tools)

• Visual Schedule & Supports

• Peer to Peer Support

• Curriculum Differentiation to Improve Engagement

• Functional Communication

• Positive Behavior Support (Sr)• Individual Preventative Strategies including using

preferred interests• Teaching Alternative Behaviors including break• Reinforcing (at least 5 to 1) Alternative Behaviors• Response Scripts for Challenging Behavior

• Intentional Adult Support

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Development & Implementation of Individual Supports

• Raegan’s Supports:

• Schedule Matrix• Used to outline when IEP goals addressed• Used to outline where / when supports are in place• Used as implementation fidelity checks

• Visual Schedule / Self Management System

• Scripts and Protocols including Fidelity Checklists

• Academic Support & Differentiation

• Peer to Peer

• Home / School Communication

• Data Collection and Review• Progress (daily data collection)• Implementation Fidelity (scripts & schedule matrix)

WRITE IT DOWN!!

White boardPost its

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• Peer to Peer



Foundation Engagement ScriptTeach how to be a student

During large group instruction: Have peer(s) or additional adult translate gen ed

teacher’s instructions (step by step), expectations, core discussion points, answers peers are providing, etc. on a white board, post it, paper, etc. This will help keep <student> oriented to key information in the environment.

If the teacher is asking for peers to respond, visually prompt <student> to “raise your hand” and wait for the teacher to call on him/her. Write down the correct answer (on a post it,

white board, etc.) so <student> doesn’t have to generate a correct answer (even if you know he/she knows the answer).

Once the teacher calls on <student>, visually prompt <student> to read the answer out loud and then provide a high 5 or thumbs up for a “great job.” This will help <student> learn what it means to be a student and engage with the class.

• ICF (Implemented

Consistently with Fidelity)

• IBI (Implemented but

Inconsistently and/or

without Fidelity)

• NI (Not Implemented)

• NO (No Opportunity for

Implementation)

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Foundation Engagement ScriptTeach how to be a student

During small group / independent instruction: Have selected peers sit near <student> and do the

expected work in order to model what <student> is expected to be doing.

Visually prompt <student> to do what his/her peers are doing.

Differentiate all work to a level <student> can do it independently.

Provide high 5’s, thumbs up, “great job” or other feedback as <student> interacts with assignments (right or wrong). Engagement is what is important, not always correctness.

To ensure correctness, differentiate work to a level <student> will get the answer correct <errorless learning>.

• ICF (Implemented

Consistently with Fidelity)

• IBI (Implemented but

Inconsistently and/or

without Fidelity)

• NI (Not Implemented)

• NO (No Opportunity for

Implementation)

Foundation Dis-Engagement Script• Establish # Opportunities to Attempt to Re-engage

• Attempted Steps (based on function):• Re-direct to Task (check your schedule)• Provide Help• Differentiate to a Lower Demand• Offer Choices with the Activity• Use “ONE MORE”• Offer Schedule / Break Choice

If <student> is not engaged, visually prompt <student> to complete a very specific task in the activity and/or differentiate the expectation to lower demand AND increase the use of the Sr script.

If this is not successful, offer a choice within the activity. Examples include “you do one, I do one,” “do you want to do the first ½ or the 2nd ½” etc.

If this is not successful, use the One More Script. If the student does not respond to the Engagement Script or strategies in the Disengagement

Script, visually give the prompt “One More then Choice Time” and be specific about what “one more” <student> is expected to do. Make this “one more” VERY limited in demand.

If <student> completes the “one more”, use the Sr Script and offer visual choices for a brief choice time (5 minutes or less). Design choice options in advance. After choice time, return to the Engagement and Disengagement Scripts and continue as is needed to maintain engagement.

If <student> does not respond to “one more,” follow the Schedule/Break Script. If these 3 steps are not successful, utilize the Schedule / Break Script

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Incredible 5-Point Scale

Level of Escalation What the Student Says and Does

5—AggressionPhysical aggression toward self/others

4—AngerVerbal aggression, including threats of physical harm

3—AgitationNoticeable increase or change in behavior

2—AnxietySlight change in behavior

1—GreenAppropriate behavior and following expectations

Adapted from Kari Dunn Buron & Mitzi Curtis

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Script using a Scale

Level 1 Engagement

Level 2 Anxiety

Level 3 Agitation

Level 4 Anger

Level 5 Aggression

Level 6 Recovery

What the staff says and does

What the student says and does

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BREAK: Implementation Issues

•PURPOSE of BREAK• Time w/out demands• De-escalate

•GUIDELINES:• Activities / Choices Result in De-escalation• Benign in Reinforcing Value / NOT Highly Preferred• Student Initiated – Staff Prompted (TEACH)• Break Procedures

SCHEDULE

BREAK Choice Time

VS.

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Schedule / Break ProtocolIf the Engagement and Disengagement Scripts aren’t working (3 attempts or greater

than 5 minutes), say “schedule or break” and use two visuals, one in each hand to

offer the choices. If Raegan says schedule, return to the expected task and use the

One More script as soon as needed to keep her engaged.

If she says “break,” follow break protocol.

If she says nothing or says schedule but continues the challenging behaviors say “it’s

time for a break” and follow break protocol.

Break Protocol Example:If student chooses break or break is directed, direct to the break area and once in the area,

disengage from all interaction.

Do not respond to any questions, comments, discussion or anything. Ignore all attempts!!

After 30 seconds, say and show “schedule or break.”

If <student> chooses break, disengage again for 15 seconds and offer the choice again every

15 seconds.

Default is break so when she doesn’t choose schedule or break or tries to engage in a

discussion, say “you have chosen break” and follow the break protocol.

If she tries to leave, even if it is within the 15 seconds, prompt “schedule or break.”

If she chooses schedule, write down the expectations (mini‐schedule) for returning to

schedule and ask if she is clear about the expectations. If so, go on to the schedule.

If she chooses break, say “break is here until you are ready for schedule.”

Other Scripts to Address Specific Behaviors

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• Peer to Peer



Academic SupportDifferentiation of Curriculum

•Purpose of Differentiation•Enhance Engagement•Promote Independence•Create Opportunities for Sr

•Differentiation Output Hierarchy:•Open Ended Questions•Visual Organization Strategies•Closed Strategies•Choice Strategies•Yes / No Strategies

http://www.gvsu.edu/autismcenter/differentiated-output-hierarchy-136.htm

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The Binders to Support Academics

•Writing•Science•Social studies•Reading•Math•Speech

Strategies for Work Accommodations

• Use the First, Then writing checklist• Encourage seated behavior within the classroom to complete assignments• Use the writing organizer as a checklist when working to complete 3 sentences for an

assignment. Raegan can verbally dictate information in order to complete the organizer. • Give Raegan a choice to print or typewrite information from the organizer• To complete the activity have Raegan read her work aloud • Complete the checklist as you move through the writing task

• IPad Apps for typing/work completion• Snaptype• Dreamwriter

• Typing at word level:• Write word on a sticky note• Write singular word on a white board

• Verbal prompting: • Single letter through dictation for spelling• Single letter using the letter sound through dictation

• Activity Examples: labeling a picture (science/social studies), completing a worksheet with singular responses through Snaptype

• Typing at sentence level:• Present the whole sentence in handwritten format on a whiteboard• Present the sentence, broken down by words on sticky notes to then be presented at word level• Use a writing organizer to provide a visual expectation/checklist to complete work

• Collect writing samples in folders on the IPad and print as you are able to save work samples within this binder under the Writing Samples tab

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Speech

Gym

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• Peer to Peer



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Her links are amazing…







• Peer to Peer



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• Peer to Peer



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Implementation Variables

•Script Fidelity Checks

•Roles & Responsibilities (sharing of tasks)

•Team Meetings

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Raegan’s Successes• Increased Time in General Education (with peers / access & exposure to curriculum)

• Baseline: 20-30 min daily• Current: Majority of every class period

• Decrease in eloping and running in the hallway• Baseline: 8-10+ times in a 30 minute period• Current: Avg 2-3 times daily; With significant changes to routine, more eloping but still far fewer

• Increased on task behavior, engagement in activities, appropriate use of classroom tools and materials

• Baseline: 0%• Current: Avg 50-70% depending on day/routine change

• Decrease in repetitive comments/questions• Baseline: 90% of conversations were 10+ repeated questions• Current: Avg 3-4 times per day with less than 4 repetitions of a question (increases with change)

• Private behavior eliminated• Baseline: 90-100% of the time• Current 0%

• Decrease in grabbing at shirts/logos• Baseline: 100% when logos present• Current: 1 in 5 times but stops with prompt/redirection

• Increase in appropriate/reciprocal communication with adults and peers• Did not collect baseline• Initiates and responds to others 80-90% of attempts; Demonstrating a sense of humor

Other Successes

- No more discussion about a more restrictive placement

- Current teachers are feeling confident about transition to 4th grade

- Academic skill gains

- Increase in positive social interactions with peers and adults

- Attended school music concert- Going to special Olympics with a peer support- Tolerating change/new people in her class- Singing the National Anthem at sporting events

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One of her FAVS: The National Anthem

https://www.facebook.com/jamie.honoway/vide

os/909159152592044/

Raegan asked for bagpipes for Christmas… her parents came through big time

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Next steps…

•Continue to look at level of differentiation for each subject- make sure we are challenging her

• Increase amount of work output•Plan to strategically fade prompts (physical, proximal, verbal, gestural.. All roads lead to visual )

• Increase independence with routines and work completion

•Continue to foster peer relationships•Continue to explore extracurricular opportunities

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