P REVENT -T EACH -R EINFORCE (PTR): A N E FFICACIOUS T IER 3 BEHAVIOR INTERVENTION Presented at the...
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Transcript of P REVENT -T EACH -R EINFORCE (PTR): A N E FFICACIOUS T IER 3 BEHAVIOR INTERVENTION Presented at the...
PREVENT-TEACH-REINFORCE (PTR): AN EFFICACIOUS TIER 3 BEHAVIOR INTERVENTION
Presented at the 2010 PBIS Leadership ForumChicago, IL
Rose Iovannone, Ph.D., BCBA-DUniversity of South [email protected]
813-974-1696
The contents of this training were developed under grant H324P04003 from the Department of Education.
OBJECTIVES
Participants will: Describe the 5-step PTR Tier 3 support model Identify the critical components that enhance the
success of Tier 3 behavior supports Discuss application at district level
AGENDA
Rationale and conceptual foundation Research method/outcomes Overview of PTR process Suggestions for district-wide application
TIER 3 FUNCTION-BASED BEHAVIOR INTERVENTIONS IN SCHOOLS
Issues Absence of uniform policies & practices Form versus a process Expert driven versus collaborative effort Occasionally contextual fit considered Limited support/follow-up/training for teacher
provided Result--limited impact on student behavior
WHAT IS PREVENT-TEACH-REINFORCE (PTR)?
Research project funded by U.S. Department of Education University of South Florida University of Colorado, Denver
Evaluate effectiveness of PTR process vs. “business as usual” Randomized controlled trial Intervention “Package”
ONE ‘P’revent; ONE ‘T’each; ONE ‘R’einforce Based on ABA principles and individual Positive
Behavior Support
WHAT IS PREVENT-TEACH-REINFORCE (PTR)?
Primary Research Questions: Is the PTR intervention more effective than
control conditions (‘business as usual’) in decreasing severe problem behaviors and increasing pro-social and academic skills of students? Repeated measures—baseline, post-test, follow-up
Social Skills Rating System (SSRS)-Problem Behavior and Social Skills subscales
Academic Engaged Time (AET)
PARTICIPANTS K-8th grade Behavioral difficulties
Intensity– disruption to the learning environment
Frequency— minimum of 1 time per weekDuration– minimum 6 months
General or Special EducationAll cognitive levelsAll disabilities
Teachers volunteered & nominated 1-3 studentsTop externalizersSystematic Screening for Behavior
Disorders (SSBD)
PROCESS
Standardized Individual Positive Behavior Support approach
Intervention teams provided manual, assignments, homework
Five step process aligned with problem solving facilitated by PTR Consultant Team Development Goal Setting Assessment Intervention and Coaching Evaluation
OUTCOMES OF PTR PROCESS
STUDENT DEMOGRAPHICS BY PRIMARY DISABILITY
Disability N Percent
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
TOTAL 245
STUDENT DESCRIPTIONGrade Level
K12345678
N345353413016
783
%13.921.621.616.712.2
6.52.93.31.2
Lunch StatusRegularFree/Reduced
77150
31.461.2
GenderFemaleMale
45200
18.481.6
Baseline Post-test0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
AET
Treatment n = 126
Control n=98
Time Interval
AE
T r
atio
p<..01g = .51
Cross-Over Treatment Results
Baseline Post-test76
78
80
82
84
86
88
90Social Skills
Social Skills
p <.01d = .85
Baseline Post-test110
112
114
116
118
120
122
124
Problem Behavior
Problem Behavior
p <.00d = 1.03
Baseline Post-test0
10
20
30
40
50
60
AET
AET
p <.01d = .64
TEACHER OUTCOMES
Fidelity Majority of teachers achieved .80 Mean # coaching/training sessions = 3.5 Prevention higher than Teach and Reinforce
Social Validity Modified Teacher Acceptability Rating Form
(TARF; Reimers & Wacker, 1988)—15 items 5-point Likert Scale 124 teachers Overall—4.16 (.52)
Willingness to carry out plan—4.80 (0.42) Like the procedures—4.46 (0.64)
PTR: THE PROCESS
STEP 1: TEAMING Purpose:
Evaluate strengths and weaknesses of team functioning Outline roles and responsibilities Determine a consensus-making process
Members (desired 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)
Tools Work style survey
Teacher and Teacher Assistant Teaming survey
STEP 2: GOAL SETTING
Purpose: Identify behaviors of greatest concern to the
team and possible replacement behaviors (teach)
Prioritize and operationalize behaviors Develop teacher friendly baseline data collection
system Targeted Areas:
Problem behaviors Social skills Academic behaviors
Case Study—Step 2: Goal Setting
Dec
reas
e
Incr
ease
B
road
Mike will communicate his wants and needs appropriately
Mike will interact with peers appropriately
Mike will comply with non-preferred 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 non-preferred activities and communicate his frustration using his Dynamite or an appropriate tone
Behavior Social Academic
STEP 2: DATA COLLECTION SYSTEM
Behavior Rating Scale 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
CASE STUDY - MIKE: OPERATIONAL DEFINITIONS
Problem 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
Replacement/Appropriate Behaviors Express frustration appropriately using
Dynamite, pictures, or signs to ask for a break or attention
Transition to non-preferred activities: Moving to non-preferred activity and engaging with appropriate verbal expression
Case Study- Mike: Behavior Rating Scale Behavior
Screaming 9+ times7-8 times5-6 times3-4 times0-2 times
54321
54321
54321
54321
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Hitting 8+ times6-7 times4-5 times2-3 times0-1 times
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Expressing Frustration
40%+30-40%20-30%10-20%0-10%
54321
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Transition to Non-preferred
Whimper or squealLouder than indoor voice
Outdoor play voiceLouder than outdoor play
Ear penetrating
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Dat
e
BRS PSYCHOMETRICS (PRELIMINARY)
Kappa coefficients of: Problem Behavior 1 (n = 105): .82 Problem Behavior 2 (n = 90) : .77 Appropriate Behavior 1 (n = 103): .65 Appropriate Behavior 2 (n = 56): .76
STEP 3: PTR ASSESSMENT (FBA)
PTR Assessment (FBA) Each team member independently answers a
series of questions related to: Observed antecedents/triggers of problem behaviors Functions of the problem behaviors Consequences ordinarily associated with the problem
behaviors PTR facilitator summarizes input and develops
draft hypothesis Team reaches consensus
STEP 3: CASE STUDY – MIKEASSESSMENT SUMMARY TABLE OF PROBLEM BEHAVIOR
Prevention Data Teach Data Reinforce Data
Non-preferred taskReading, Math
Other students upset/madTeacher attending to othersTransition
Preferred to non-preferredChange in schedule
Denied item, told no, or to fix something
Gain attentionPeers, adults
Delay
Access to items
RedirectedReprimandedCalm/soothe
Personal spaceLater must complete task
Loss of or delay in reinforcement
Scr
eam
ing,
Hitt
ing
STEP 3: CASE STUDY – MIKEASSESSMENT OF APPROPRIATE BEHAVIOR
Prevention Data Teach Data Reinforce Data
Independent workOne-on-one attentionSpecials
Peer interactionGetting attentionRaising handSharing attentionConversation skillsTaking turnsWaitingSelf-managementAsking for breakExpressing emotions
Treasure boxMovieAttentionHelping teacherGoing to media centerGoing outsideWalkFood
Pro
soci
al
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
Ina
pp
rop
riat
eA
ppr
op
riate
STEP 4: BEHAVIOR INTERVENTION PLAN
Team selects interventions from each component (P-T-R)
Detailed behavior plan developedConsultant provides training and
on-site assistance with plan implementation
Implementation fidelity evaluated
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.
Step 4: Case Study – Mike’s BIP
Prevent Strategies
Specific Strategy steps
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.
Mike’s Intervention Plan
Mike’s Intervention Plan
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
30
Teach Strategies
Specific Strategy Steps
Replacement Behavior
Mike will be taught to use his voice output device to express his need to calm down.Steps: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, say “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 (hierarchy—hand-over-hand, gesture, verbal).
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 (e.g., “You made a good choice.”.
6. Allow Mike to engage in his choice until he is calm for 1-minute.
7. If Mike does not want to leave his choice, then start becoming animated with students in the non-preferred activity.
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
what you need.”)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.
STEP 4: PTR INTERVENTION COACHING/FIDELITY
Provide training to practice the plan without student (30-90 min.)
PTR Consultant present first day of implementation with student
Provide support in the classroom Model the plan Provide feedback Discuss need for modifications if applicable
Case Study: Sample Coaching Checklist/Fidelity for Mike
Task Analysis of Intervention D
iscu
ss
Q &
A
Ver
bal
R
ole-
pla
y O
bse
rve
Fee
db
ack
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 Dynamite 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)
STEP 5: EVALUATION
Is it working? Daily ratings of behavior Continuous progress monitoring
BRS Other data collection forms
Is it being implemented consistently and accurately? Fidelity ratings
Do we need more data? Does the plan need to be modified or
expanded? Plan for generalization and maintenance
Screaming
1
2
3
4
5
14-D
ec
8-Dec
15-D
ec
8-Ja
n
12-J
an
22-J
an
26-J
an
1-Feb .
15-F
eb
22-F
eb
1-M
ar
12-M
ar
16-M
ar
29-M
ar
4-Apr
12-A
pr
18-A
pr
24-A
pr
30-A
pr
4-M
ay
10-M
ay
Rat
ing
BaselineIntervention
Definition Changed
Step 5: Mike Evaluation
Hitting
1
2
3
4
5
14-D
ec
8-Dec
15-D
ec
8-Ja
n
12-J
an
22-J
an
26-J
an
1-Feb .
15-F
eb
22-F
eb1-
Mar
12-M
ar
16-M
ar
29-M
ar
4-Apr
12-A
pr
18-A
pr
24-A
pr
30-A
pr
4-M
ay
10-M
ay
Rat
ing
BaselineIntervention
Step 5: Evaluation
Step 5: Evaluation
Expression of Frustration
1
2
3
4
5
Rat
ing
BaselineIntervention
1
2
3
4
5
Rat
ing
Transition to Non-Preferred
BaselineIntervention
STEP 5: EVALUATION
42
STEP 5: EVALUATION MIKE OUTCOME DATA
Measure Baseline Post-test Change
SSRS-PB 123 112 -11
SSRS-SS 87 102 +15
AET .34 .57 +23
REVIEW PTR PROCESS
Five-step team-based process Teacher/team driven Support provided to teacher/team to
implement interventions Mean number of days for PTR process = 71
References• Manual
• Dunlap, G., Iovannone, R., English, C., Kincaid, D., Wilson, K., Christiansen, K., & Strain, P. (2010). Prevent-Teach-Reinforce: A 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, 213-225.
• 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
• Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (in review). Reliability of the Individualized Behavior Rating Scale-Strategy for Teachers (IBRS-ST): A Progress Monitoring Tool. Manuscript submitted for publication.
• Next steps:• Facilitating schools to scale up• Training key school staff and team members to do process
APPLICATION OF TIER 3 DISTRICT LEVEL
STEP 1: ASSESS CURRENT STATUS
PBS TEAM STRUCTURE
Goals: Teams to support all students (general ed. and
ESE) throughout tiered (levels) continuum of support
System for monitoring outcomes at all levels Access to technical assistance Link between all three tiers of behavior support Link between school, home, community
PBS TEAM STRUCTURE IN A SCHOOL SWPBS team—for all students (gen. ed. &
ESE) Monitor implementation of universal intervention Monitor school-wide data Guide implementation of new initiatives, braid
with SWPBS Tier 3 PBS team—“Standing team”—for all
students (gen. ed. & ESE) Progress monitor students in targeted and
intensive interventions Guide intervention selection for students
selected for IPBS Student-focused teams—“Ad hoc” for all
students (gen. ed. & ESE) Conduct FBAs and build support plans
TIER 3 BEHAVIOR SUPPORT IN A SCHOOL: TEAM OPTION
“Ad-hoc” team—student focused (both gen. ed. & ESE) Responsibilities of team (problem solving process)
Conduct FBA Build function-based support plan Provide coaching/support to teacher to implement interventions Collect and review fidelity and student outcome data Make decisions based on data
Membership—Three levels of knowledge represented Someone with expertise in FBA and function-based intervention
plans (school psychologists, CABAs, BCBAs, behavior specialists, counselors, social workers……)
Someone with knowledge of the student and his or her behaviors (Teacher(s), aides, parents, students)
Someone with knowledge of the context in which the support plan will be implemented (administrators or designees)
TIER 3 PROCESS—CONSISTENT AND FEASIBLE
MULTIPLE LEVELS OF TIER 3 (FBA)
Brief FBA FBA/BIP developed in one meeting (60 minutes
or less) Best used for high frequency/low intensity
behaviors (e.g., noncompliance, minor disruptions, etc.) Example: Brief PTR, ERASE
Comprehensive FBA More complex FBA/BIP procedure May take 2 or more meetings or one lengthy
meeting (>1 hour) Best used for chronic, durable, intense
behaviors Example: PTR
MULTIPLE LEVELS OF TIER 3
Wraparound Involves multiple agencies Support plan includes practices that may go
beyond scope of school Best used for students with mental health issues
and/or complex life events
DATA TRACKING—TIER 3
Systemic Data Tracking Examples Florida School Districts
Monroe Martin University of Oregon
QUESTIONS?