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

1. Team Driven Tertiary Process: The Prevent-Teach-Reinforce Model Rose Iovannone, Ph.D. iovannone@fmhi.usf.edu Carie English, Ph.D. cenglish@fmhi.usf.edu University of South Florida Developed under grant H324P04003 from the Department of Education.

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

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. For high-risk students: History of severe problem behaviors Demonstrated resistance to intervention An intensive system of support is needed Individualized PBS (Tertiary) ~5% ~15% ~ 80% of Students

5. Conceptualizing an Array of PBS Supports Universal/Primary School-Wide AssessmentSchool-Wide 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 sites—USF 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 *USF site only

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

12. Preliminary Data Results

13. Student Demographics by Ethnicity and Gender

14. Student Demographics by Primary Disability

15. d = .57 Follow-up N 29/17 p < .000

16. d = .48 p < .000

18. 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 USF—Sample Items

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

25. Case Study—Step 1: Team Building • Mike is a 9-year-old male in a self-contained autism classroom • Nonverbal—uses signs, Dynamite, and pictures to communicate • 1 teacher, 2 aides, and 6 students

26. Case Study—Step 1: Team Building • Teacher-- Ms. Wonderful • Aides • Ms. Needs Help • Ms. Also Needs Help • Facilitator—PTR 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. Social Behavior Academic Broad Decrease Increase Case Study—Step 2: Goal Setting

29. Case Study: Operational Definitions of Problem and Replacement 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 • Expressing Frustration—using Dynamite, pictures, or signs to ask for a break or attention • Transition to nonpreferred activities—moving to nonpreferred activity and engaging with appropriate verbal expression (screaming level)

30. Case Study: Behavior Rating Scale With Anchors

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

37. Case Study—Step 3: PTR AssessmentProblem Behavior Screaming, Hitting

38. Case Study—Step 3: PTR AssessmentAppropriate Behavior Prosocial

39. Step 3: PTR Assessment—Developing the Hypothesis • Prevention data = antecedents or triggers • Teach data = replacement behavior and possible function • Reinforce data = function and reinforcers

40. Case Study—Step 3: PTR Assessment Possible Hypotheses 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

45. Case Study—Step 4: PTR Intervention