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Team Driven Tertiary Process: The Prevent-Teach-Reinforce Model

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Team Driven Tertiary Process: The Prevent-Teach-Reinforce Model Rose Iovannone, Ph.D. iovannone_at_fmhi.usf.edu Carie English, Ph.D. cenglish_at_fmhi.usf.edu – PowerPoint PPT presentation

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Title: Team Driven Tertiary Process: The Prevent-Teach-Reinforce Model


1
Team Driven Tertiary Process The
Prevent-Teach-Reinforce Model
  • Rose Iovannone, Ph.D.
  • iovannone_at_fmhi.usf.edu
  • Carie English, Ph.D.
  • cenglish_at_fmhi.usf.edu
  • University of South Florida

2
Acknowledgements
  • USF
  • Don Kincaid
  • Kathy Christiansen
  • Sarah Donadio
  • Glen Dunlap
  • UCD
  • Kelly Wilson
  • Patricia Oliver
  • Ted Bovey
  • Edy Purcell
  • Phil Strain

3
Objectives
  • Participants will
  • Describe an individual positive behavior support
    process for use in the classroom
  • List factors impacting the effectiveness of an
    individual behavior support process

4
Individualized PBS (Tertiary)
  • For high-risk students
  • History of severe problem behaviors
  • Demonstrated resistance to intervention
  • An intensive system of support is needed

5
15
80 of Students
5
Conceptualizing an Array of PBS Supports




Universal/Primary School-Wide AssessmentSchool-W
ide Prevention Systems Classroom Interventions

  • Targeted/
  • Secondary
  • Tertiary (Intensive)


Group Interventions
AnalyzeStudent Data
Assessment
Interviews, Questionnaires, etc.
Simple Student Interventions (ERASE)
Intervention
Observations and ABC Analysis
Complex Individualized Interventions
(PTR)
Team-Based Wraparound Interventions
Multi-Disciplinary Assessment Analysis
Scott, 2001
6
Tertiary Supports in Schools
  • Traditional process
  • Specialist/expert-driven
  • Complete an observation
  • Write a support plan
  • Call me if you have questions
  • Often contextual fit ignored
  • Limited support/follow-up/training provided

7
Prevent Teach Reinforce Process
  • Team driven process
  • Goals, assessment, intervention plan
  • Support provided by facilitator
  • Direct observation
  • Training and classroom implementation assistance
  • Contextual fit
  • Greater buy-in and likelihood of implementation

8
Prevent-Teach-Reinforce Model
  • Funded by US Dept. of Education/ Institute of
    Educational Sciences
  • Randomized control group design
  • Two sitesUSF and UCD
  • Three school districts central Florida
  • Two school districts Colorado
  • Compare prescriptive, simple model to business
    as usual

9
Sample
  • 200 students
  • 100 treatment 100 wait-list control
  • Any student in K-8 grades who exhibit problem
    behavior
  • Problem behavior criteria
  • Minimum 5 critical events indicated on Systematic
    Screening for Behavior Disorders (SSBD)
  • Behaviors disruptive, durable (6 months), chronic
    (at least 1 time a week)

10
Sample Data Measures
  • Repeated measures at student level
  • Problem behaviors, social skills, academics
  • Mediator and moderators at multiple levels
  • Student
  • Teacher/Classroom
  • System

11
Process
  • Standardized approach
  • Five step process facilitated by PTR Consultant
  • Team Development
  • Goal Setting
  • Assessment
  • Intervention
  • Coachingup to 12 hours
  • Evaluation
  • Manual including information and forms

12
Preliminary Data Results
13
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 Gender Gender
Female 43 19.1
Male 182 80.9
14
Student Demographics by Primary Disability
Disability 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 255 255
15
d .57
Follow-up N 29/17
p lt .000
16
d .48
p lt .000
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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

19
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

20
Social Validity Comparison USFSample 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
21
Fidelity
  • Most teams reaching 80 fidelity and maintaining
    into post-test
  • Quality scores lower than adherence scores
  • Part of the plan implemented although not
    entirely as plan written

22
The Process A Case Study Example
23
Step 1 Team Development
  • Members and roles identified
  • Teacher
  • Behavior specialist/school psychologist
  • Family members, paraprofessionals, special area
    teachers
  • Work styles inventory
  • Teaming survey

24
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Case StudyStep 1 Team Building
  • Mike is a 9-year-old male in a self-contained
    autism classroom
  • Nonverbaluses signs, Dynamite, and pictures to
    communicate
  • 1 teacher, 2 aides, and 6 students

26
Case StudyStep 1 Team Building
  • Teacher-- Ms. Wonderful
  • Aides
  • Ms. Needs Help
  • Ms. Also Needs Help
  • FacilitatorPTR Consultant
  • Results of teaming information indicate a great
    team that meets regularly to brainstorm

27
Step 2 Goal Setting
  • Identify team consensus on
  • Academic behavior
  • Social behavior
  • Problem behavior
  • Appropriate behavior
  • Develop and begin baseline data collection

28
Case StudyStep 2 Goal Setting
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
29
Case Study Operational Definitions of Problem
and Replacement Behaviors
  • Screamingloud, high pitched noise heard outside
    the classroom
  • Hittinganytime Mike touches peers or adults with
    an open hand, fist, foot, or object while
    screaming or protesting
  • Expressing Frustrationusing Dynamite, pictures,
    or signs to ask for a break or attention
  • Transition to nonpreferred activitiesmoving to
    nonpreferred activity and engaging with
    appropriate verbal expression (screaming level)

30
Case Study Behavior Rating Scale With
Anchors
Behavior Date
Screaming 9 times 7-8 times 5-6 times 3-4 times 0-2 times 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Hitting 8 times 6-7 times 4-5 times 2-3 times 0-1 times 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Expressing Frustration 40 30-40 20-30 10-20 0-10 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1
Transition to Nonpreferred Whimper or squeal Louder than indoor voice Outdoor play voice Louder than outdoor play Ear penetrating 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1

31
Step 3 Assessment
  • Checklist format
  • Antecedents or Triggers (Prevent)
  • Function(s) of the problem behaviors (Teach)
  • Consequences following the problem behaviors
    (Reinforce)
  • Assists team to link function of behavior to
    intervention plan

32
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Case StudyStep 3 PTR AssessmentProblem Behavior
Prevention Data Teach Data Reinforce Data
Non-preferred task Reading, Math Transition Preferred to non-preferred Change in schedule Denied item, told no, or to fix something Other students upset/mad Teacher attending to others Gain attention Peers, adults Delay Access to items Redirected Reprimanded Calm/soothe Personal space Later must complete task Loses/delays reinforcers
Screaming, Hitting
38
Case StudyStep 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
Prosocial
39
Step 3 PTR AssessmentDeveloping 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

40
Case StudyStep 3 PTR Assessment Possible
Hypotheses
When. 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
Inappropriate
Appropriate
41
Case Study Tips on Linking Interventions to
Hypothesis
  • Prevention strategies must address
  • Getting Mike attention more often
  • Changing non-preferred task
  • Particular student
  • How it is done (format)
  • Changing what happens when he makes a mistake
  • Do part of it (rather than all of it) over
  • Allow him to find what is wrong
  • Provide social story
  • Signaling end of preferred activity
  • Teach strategies must address
  • How to get attention/assistance
  • How to get break/delay appropriately
  • Reinforce strategies must address
  • Giving Mike attention/help
  • Giving Mike break/delay

42
Step 4 Intervention
  • Team ranks top three intervention strategies in
    each of the PTR components
  • Multi-component intervention that teacher states
    s/he can implement
  • Prevent
  • Teach
  • Reinforce
  • Implementation plan

43
Case Study Tips on Linking Interventions to
Hypothesis
  • Prevention strategies must address
  • Giving Paris attention more often
  • Changing non-preferred task
  • Presentation (how it is given to Paris how it
    looks)
  • Content (embedding preferences)
  • Changing environment surrounding independent work
    time
  • Teach strategies must address
  • How to get attention appropriately
  • How to get a delay appropriately
  • How to access preferred item appropriately
  • Reinforce strategies must address
  • Giving Paris attention/help
  • Giving Paris a delay
  • Giving Paris access to preferred activities

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Case StudyStep 4 PTR Intervention
Prevent Strategies Specific Strategy steps
Environmental Support A wait card will be placed on Mikes desk to assist him in remembering to wait his turn. 1. Prior to group work, tell Mike, Remember, when it is someone elses 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 Mikes 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.
46
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
47
Teach Strategies Specific Strategy Steps
Replacement Behavior Mike will be taught to use his Dynamite to express his need to calm down. 1. Mikes 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
48
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
49
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 minute 4. Praise him as soon as he is quiet 5. 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.
50
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 Mikes behavior with him and ask him if he earned his stars. 3. Provide his stars if earned. 4. During the teachers 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.
51
Coaching of Interventions
  • Training of teacher
  • 1 to 2 hours
  • 80 accuracy on all strategies
  • Assistance in classroom
  • Up to 12 hours
  • Fidelity measures recorded
  • 80 implementation terminates assistance in
    classroom

52
Case Study Training
53
Case Study Fidelity
54
Step 5 Evaluation
  • Data-based decision-making
  • Identifying what is working what is not and WHY
  • Expanding into other routines
  • Generalization
  • Continuing team meetings
  • Planning time
  • Cohesiveness

55
Step 5 Evaluation
1 is a lot of screaming, 5 is no screaming
56
Step 5 Evaluation
1 is a lot of hitting, 5 is no hitting
57
Step 5 Evaluation
1 is a little appropriate expression, 5 is a lot
of appropriate expression
58
Step 5 Evaluation
1 is inappropriate transition, 5 is super
appropriate transition
59
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
60
Wrap UpWhat We Have Learned
  • PTR process may not be enough for all students
  • Some need wraparound
  • Not all students need PTR
  • 3-tiered model of individual support
  • Teachers report the coaching piece and
    collaborative process to be keys

61
How to Make PTR Work in Your School
  • Steps are the key components not how your
    organize them
  • Must create a system that will work for your
    school or even each student
  • Things to consider
  • Tertiary team
  • Identification/Nomination process
  • Facilitator
  • Set-up of meetings for efficient results

62
Organizing the PTR Process
  • Is Team Building needed?
  • 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

63
Organizing the PTR Process
  • Few problem behaviors or all in same response
    class?
  • Same antecedents /or function
  • Small team
  • Combine Assessment with Intervention Development
  • Condense the steps to meet the needs of your
    school

64
Final Thoughts System Changes
  • Process may require more time up front but less
    time overall
  • Must provide assistance in the classroom until
    desired outcomes achieved
  • Will pay off in the end
  • Teams more likely to implement the plan
  • Ownership
  • Fits the class and the student
  • Continued contact

65
Questions?
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