Effective Programs Based on Outcome Data

1. Effective Programs Based on Outcome Data Topic #6 ED 553: Assessing Effective Treatments for Children with Autism

2. What are “Data”? • “Data are the quantitative results of deliberate, planned, and usually controlled observation.” (Johnston & Pennypacker, 1980) (Translation: These are the values of what we’ve measured!)

3. What are Data? (cont’d) • Quantitative • behavioral observations are translated into numbers • Deliberate • data and IOA are collected carefully • Planned • decisions to collect data are made before the observation session • Controlled • data are collected under same conditions each time

4. Why Collect Data? • Monitor child’s progress within programs • Monitor child’s progress across programs • Required by funding agency • Empirical evidence to demonstrate progress to funding agencies • Used to make curriculum decisions • Used to verify effectiveness of specific teaching procedures for a specific child

5. Data: Types to Collect • Acquisition data • Fluency data • Generalization data • Maintenance data • Inter-observer Agreement (IOA) data

6. Data Collection: Frequency • “Testing” and “teaching” are different procedures • Collect data at an interval that matches acquisition speed

7. Data Collection: Procedures • Data should reflect conditions under which you want the terminal performance • Select a measurement procedure that is appropriate for your response definition • Only collect the amount of data that you will graph and use

9. Why TeachMotivational Systems? • Contingency management • Management of stereotypy • Increasing skill acquisition leads to intrinsic motivation • Communication

10. Types of Motivational Systems • Direct snacks and preferred activities • Token economies • choice • behavioral chains • Edibles in a cup • Behavioral contract • DRO (Differential Reinforcement of “Other” behavior)

11. Maximizing Teaching Opportunities • Every opportunity for teaching should be used! • Increase social opportunities and language opportunities during rewards and preferred activities • Skills should be taught in sets

12. Components of Comprehensive School-Based ABA Program • INDIVIDUALIZED SKILL ASSESSMENT AND GOAL SELECTION(Bondy, 1996; Jacobson, 2001) • First several weeks after child enters program • Skills assessed in all domains: gross- and fine-motor skills, academics, pre-requisite learning skills, self-help, independence, receptive and expressive language, non-productive behavior that interferes with learning, and leisure skills • Updated on a continual basis • Goals selected by parents, teacher, speech therapist, occupational therapist, and school psychologist

13. More Components of Comprehensive School-Based ABA Program • INDIVIDUALIZED TEACHING PROGRAMS(McClannahan & Krantz, 2001; Smith, Donahoe & Davis, 2001) • Operational definition, Measurement procedure, Discriminative Stimuli, Teaching Procedures (e.g., activity schedules, video modeling, peer tutoring, audio modeling, small group instruction, discrete trial instruction, incidental teaching) Generalization, Maintenance, IOA, specific teaching sets • 30-40 individualized teaching programs will be written based on the above criteria for all skill domains for each child. • Approximately 90% of each child’s individualized programs are language-based programs. • Programs that are child initiated, that promote generalization across multiple staff, or that need rapid skill acquisition are taught by all instructors • Programs that have complex fading procedures, involve initial acquisition of discrimination or involve shaping procedures are initially taught by one instructor and then generalized to all instructors.

14. More Components of Comprehensive School-Based ABA Program • INDIVIDUALIZED CURRICULUM(Bondy, 1996; Taylor & McDonough, 1996; McClannahan & Krantz, 2001; Smith, Donahoe, & Davis, 2001) • Curriculum is based on general preschool curriculum broken down into multiple steps • All curriculum written by the teachers and the consultant • Skills are taught in a systematic fashion (mastering pre-requisite skills before being introduced to more complex skills) • Examples of general packaged curriculum that can be used and possibly modified are Edmark Reading, Distar Language, MacMillan Math, Sensible Pencil, Learn to Cut • Almost all curriculum materials are specifically made for a particular child

15. More Components of Comprehensive School-Based ABA Program • INDIVIDUALIZED DATA COLLECTION ASSESSING PROGRESS OF EACH SKILL(McClannahan & Krantz, 2001; Jacobson, 2001) • Ongoing monitoring of skill acquisition • Data are collected on every program approximately once a week (some programs more frequently, some programs less frequently depending on a child’s skill acquisition) • Accountability!

16. More Components of Comprehensive School-Based ABA Program • ON-GOING HANDS-ON STAFF TRAINING (Bondy, 1996; Jacobson, 2001; Smith, Donahoe & Davis, 2001; McClannahan & Krantz, 2001) • No one is ever fully trained in ABA, training will be ongoing and provided by a classroom teacher and/or consultant • WORKSHOP TRAINING(Jacobson, 2001, Bondy, 1996; Smith, Donahoe & Davis, 2001; McClannahan & Krantz, 2001) • Twice a month all staff members participate in workshop trainings in the principles of ABA and other relevant topics related to teaching children with autism

17. More Components of Comprehensive School-Based ABA Program • SCHOOL VISITS(McClannahan & Krantz, 2001; Jacobson, 2001; Bondy, 1996) • Weekly school visits in which parents will receive training in teaching their child various skills • During school visits parents access to child’s data notebook and can monitor progress • Workshop training several times per year

18. More Components of Comprehensive School-Based ABA Program • HOME VISITS(McClannahan & Krantz, 2001; Smith, Donahoe & Davis, 2001; Bondy, 1996) • Home visits provided at least monthly by classroom teacher, instructional aide, and/or consultant • Child’s progress will be reviewed • Training provided in areas specific to home (e.g., going to dentist, doctor, mall, grocery store; eating; sleeping; leisure skills; language skills)

19. More Components of Comprehensive School-Based ABA Program • RELATED SERVICES: • Many ABA techniques shown to be effective for increasing and improving language and communication in children with autism (e.g., activity schedules, audio modeling, video modeling, PECS) (Skinner, 1957; Lovaas, 1977, 1987; McGee, Krantz, & McClannahan, 1985; Sundberg & Partington, 1998; McClannahan & Krantz, 1999; New York State Department of Health, 1999; Bondy & Frost, 1994; Fenske, Krantz, & McClannahan, 2001; Rappaport, 2001; Reeve, Reeve, Poulson, & Buffington-Townsend, manuscript in preparation). • When teaching children with autism, related services have been shown to be maximally effective when delivered using the principles of ABA (Jacobson, 2000; Smith, 1993; New York State Department of Health, 1999; Bondy, 1996; Romanczyk, Lockshin,& Matey, 2001; Meyer, Taylor, Levin, & Fisher, 2001).

20. More Components of Comprehensive School-Based ABA Program • Evaluation of Program Effectiveness (McClannahan & Krantz, 2004) • Engagement with Activities with Other Persons • Opportunities to Respond • Behavior-Descriptive Praise • Relationship Building • Children’s Hygiene and Personal Appearance • Social Competence • Inappropriate Behavior • Family Participation in Intervention

21. Direct Care Team Membership • Consultant/Director • Is responsible for no more than 10 children and staff members • Provides supervision for teacher • Helps teacher develop goals and objectives for each child • Helps teacher develop data management system to evaluate effectiveness of each child’s program • Provides direction for the development of curriculum • Trains teacher in effective individualized teaching procedures • Provides frequent hands-on training to all instructional staff • Provides workshop training for all team members • Periodically accompanies teacher and/or instructional aide on home visits • Consults with and brings in other doctoral level professionals in the field when necessary

22. Direct Care Team Membership • Teacher/Trainers • Enrollment in BCBA-approved program and certified in special ed • Develops individualized programs for each child • Manages all data collection systems to ensure program effectiveness for each child • Creates individualized curriculum to accompany each program for each child • Provides hands-on training to instructional aides and the implementation of individualized programs for each child • Provides hands-on training to parents and any person that frequently interacts with the child • Teaches each child

23. Direct Care Team Membership • Instructional Aides • Training in applied behavior analysis (ABA) and autism • Continually receives hands-on training • Teaches all children in the classroom rotating approximately every half hour • Serve as data analyst for one child • Prepares individualized curriculum for one specific child • May be selected by consultant and teacher to provide home visits and training on home staff

24. Direct Care Team Membership • Parents • Active participation in at least annual home and school selection of goals and objectives for their child • Receives hands-on training in how to effectively keep their child engaged in productive activity at home and in the community, increase child’s direction following skills, and maximize their child’s use of language at home and/or whatever other area parent requests training in • Receives workshop training in specific areas of applied behavior analysis

25. PCDIFounded in 1970 • Structure and Context • Includes early intervention, preschool and school, services to families, community=based, family style group homes, and career development and supported employment programs for adults. • 3 dissemination sites: SHLI, IEA, NYCLI • Diagnosis and Assessment • Diagnosis of autism by DSM IV and direct observation of using PCDI’s own assessment methods. Skills or skill deficits are unrelated to program legibility. • Staffing and Administration • Bachelor’s or master’s degrees in psych or ed. Doctoral students participate in interns • Early intervention 1:1; school program 1:1.5 • All behavior analysts, no related services • Executive Directors, Director, trainer, Special ed teacher, aides • Staff training consists of preservice workshops; monthly workshops; and hands-on training throughout employment

26. PCDIFounded in 1970 • Curriculum • More than 600 individualized programs in community participation; expressive.receptive language, handwriting, leisure skills, motor/verbal imitation; peer interaction, physical education, reading, self care, social skills. • Some are based on commercially available curricula: Edmark, Sensible Pencil, other are based on their own published research. • Children rotate across all staff members in the classroom and across activity areas and rooms • Teaching procedures: discrete trial, incidental teaching, activity schedules, script/script fading, video/audio modeling, peer interaction, small group • 30 individualized program per year per child • All children are taught vocal language; only 1-2 students in their 30 years of operation needed an augmentative communication system • No related services –all skills are taught by behavior analysts • @weekly data collection on skill acquisition and generalization

27. PCDI-Founded in 1970 • Integration • Prerequisites for transition include: • 1. exhibiting sustained engagement with learning and leisure materials • 2. systematically following adults instructions • 3. responding favorably to delayed reinforcement • 4. displaying generalized responses • 5. low levels of disruptive behavior • When these pre-requisites are met, children are systematically transitioned to regular ed settings; always attending both programs at once and gradually transitioning from PCDI to the regular ed setting. • Follow up services are offered • Community integration and peer modeling are used with all children • Use of Aversives • Disruptive behavior is addressed through differential reinforcing more productive behavior • Severe problems that do not respond to positive reinforcement procedures are treated with other procedures such as response cost, time out and facial screens may be used

28. PCDI-Founded in 1970 • Family Involvement • Weekly home visits • Goals are set for home • Parents are taught to teach children in school setting first and then at home -Parents collect data • Parents also have monthly school visits in which they spend the entire day at PCDI with their child • Outcome • Out of 41 children who entered the program before 60 months of age, 8 are enrolled in preschool or early intervention programs, 14 have made transitions to publish schools and 19 are enrolled at PCDI • Most students did not achieve basal scores on PPVT • Percentage of students who make successful transitions varies from 42%-62%. • Extensive Program Assessment • Written protocol for assessing training and staff • Notebook reviews by outside consultant • All consumers are surveyed on quality of service e.g., child study teams, parents, staff members

29. The Douglas School -1989 • Structure and Context • DDDC founded 28 years ago has 4 divisions: the original Douglass School, Douglass Outreach, the Division of Adult and Transitions Services, and the Division of Research and Training. • Preschool has 3 classes, proper class (1:1, 25 hrs per week 10-15 at home with parent); small group preschool (2:1) small wonders class (integrated class) • Diagnosis and Assessment • Diagnosis of autism or PDD-NOS by DSM IV and CARS • Staffing and Administration • Executive director, director, division director, Supervisor of education, coordinator of speech and language, Special ed teachers, aides, ST, OT, PT, APE, home programmers, grad students • Yearly in-services, ongoing-hands-on training, attendance at COSAC, yearly conference

30. The Douglas School -1989 • Curriculum • Individualized teaching procedures • Speech-language services • Teacher made curriculum materials • Commercially made curriculum; Levine’s Great beginning for early language training, ploudre’s CLAS preschool, Earlly’s AIMS pre-reading, Edmark Reading, PACE-Match program, Sensible Pencils, PECS, First Words, IGS curriculum by ROmanczyk • Trial by trial data collection

31. The Douglas School -1989 • Integration • Careful progression of skills from basic compliance, self control, attention to task, learning senility to others, ability to maintain oneself in a group • transition process consists of sometimes having the child attend both programs; other they prepare the student by simulating the transition environment at school • follow up services are offered • Use of Aversives • Rich schedules of reinforcement for productive behavior • Functional alternate response training • For severe behavior problems, other procedures are used such as removal of attention ,brief exclusionary, time out, overcorrection

32. The Douglas School -1989 • Family Involvement • Twice a month home visits • Parents are taught to teach children at home • Parents have monthly clinics in which they can observe their child in class for 30 minutes and then discuss the observation with team members • Discussion groups for parents and siblings • Parent meetings four times a year • Outcome • 13 children who began teacher at 48 months 10 were in regular ed classes. These children had a mean IQ of 78at intake • 14 started at 50 months 13 were in special ed classes • Children who entered the program with Iqs in the normal range (80) were more likely to transition than those with lower IQ (48)

33. Alpine Learning Group -1989 • Structure and Context • Provides services for 25039 learner4s ages 3-21. • Diagnosis and Assessment • Diagnosis of autism, Vineland, PPVT, IQ • Staffing and Administration • 3 directors, 1 head teacher, Teacher (certified), instructor (bachelor’s) • 1:1 in preschool • No related service providers • 40 hour yearly pre-service • Research meetings are held twice a month • Comprehensive annual employee performance evaluation is conducted with all staff –use PCDI’s evaluation protocol

34. Alpine Learning Group -1989 • Curriculum • 600 individualized programs in the areas of attending, community, expressive language, fine/gross motor, handwriting, imitation, leisure, pre-academic, reading, receptive language, science, self-care, socialization, social studies, work studies • Classes of 2-4 children; learning periods are 30-45 minutes, most preschool programs are taught by all instructors • Use some published curriculum such as Edmark, explode the code, starting comprehension, manual of exercises for expressive reasoning, Continental press mathematics, Reader Rabbit, Words and Concepts II. • Trial by trial data collection • Monthly clinics with director of educational programming

35. Alpine Learning Group -1989 • Integration • Pre-requisites: receptive and expressive language skills, minimal disruptive behavior. • Supported inclusion program after pre-requisites have been met –gradually transition for Alpine to general education –follow up services are provided • Peer modeling for all children • Use of Aversives • Functional assessment and alternate behaviors are taught • Extinction, DRO, DRL, response cost

36. Alpine Learning Group -1989 • Family Involvement • Weekly home visits during first 6 months of enrollment –doctoral level clinical director • Twice per month thereafter by home programmer • Participation in didactic parent training course • Parents are required to teach their children at home and collect data • Lecture series is offered to extended family members • Sibling education and support group • 3 hours of observation per month –open door policy • Mandatory monthly meetings • Outcome • 26 preschoolers -7 transitioned to public school (27%) • Average age of enrollment was 3.11 and remained for at least 24 months