Behavioral Research in Supervision and Training

1. Behavioral Research in Supervision and Training Presented By: Heather Lewis, M.S.W., Ed.S.,BCBA Missouri Licensed Behavior Analyst heatherlynnlewis@hotmail.com

2. Objectives Define importance of treatment integrity with evidence-based practices Identify evidence-based staff training and supervision procedures

3. A Successful (and Efficient) Behavior Plan Requires A good assessment Review of relevant history Analysis of the function of the behavior Data collection that helps determine function as well as other trends in the challenging behavior A good plan Based on research that supports the practice Accurate implementation of the plan Do you actually do what you SAY you�re doing on paper.

4. Do you need a specialist? What training does your staff have? Consider training in FBA alone: An entire semester-long course Can your staff develop and analyze data collection procedures? Does your staff know common evidence-based intervention strategies and their pros and cons.

5. BACB Task List: Content Area 10�Systems Support Use competency-based training for persons who are responsible for carrying out behavioral assessment and behavior change procedures. Use effective performance monitoring and reinforcement systems. Design and use systems for monitoring procedural integrity. Establish support for behavior analysis services from persons directly and indirectly involved with these services. Secure the support of others to maintain the clients� behavioral repertoires in their natural settings. Provide behavior analysis services in collaboration with others who support and/or provide services to one�s clients.

6. Relevance of supervision and training IDEA: mandated functional assessment Greater acceptance and use of ABA-based procedures Google: 10,700,000 results when searching �Applied Behavior Analysis� Missouri: First Steps, school-based behavior consultants on staff, licensure of behavior analysts in 2011

7. Relevance of supervision and training Educators and expert pool not large enough to meet service needs of children with autism (Simpson, 2004) Many behaviorally difficulties with other children beyond those with diagnosis with autism that need behavioral support to be effective.

8. Educators and expert pool not large enough to meet service needs of children 135 BCaBAs and BCBAs combined in Missouri Many educators do not have specialized training in behavior analysis, but are responsible for designing both an FBA and developing a behavior support plan as well as implementing it and training others to implement it. CDC: 1 in every 110 children are diagnosed with autism CDC: 1 in 20 children between the ages of 4 and 17 has been identified (by their parents) as having difficulties behaviorally, academically, or socially (Simpson, Bloom, Cohen, Blumberg, & Bourdon, 2005).

9. Relevance of Supervision and Training Indirect service model (Noell et al., 2000) Teachers, parent, staff are treatment agents Many teachers have not received formal training to conduct an FBA (Scott et al., 2004) Often direct instruction is implemented by support staff (Warren et. al., 1986)

10. Providing behavioral support and training for students is educationally relevant and must be done well When a student can�t read, we teach them. When a student can�t understand math concepts, we teach them. What do we do when a student can�t behave? Or can only do so for a short time? (obtained from http://www.slideshare.net/iastate_pbis/session-1-behavior-expectations-rules-power-point)

11. Supervision and Training Required at assessment and development of behavior plan, but once a good behavior plan is written, what do we do to ensure treatment integrity?

12. Bernice is a teacher in a Special Education Classroom serving 12 students on her caseload. George is a student who has a medical diagnosis of ADHD, which his parents have decided not to treat medicinally. Even with current supports, George exhibits many inappropriate behaviors in his third grade classroom, including verbal aggression (threatening to hurt others), distracting others (leaving his seat, refusing to sit down), talking when the teacher is trying to explain directions, and destroying his papers and books on a daily basis. The teacher has observed George in the past be very successful in the classroom, so the teacher sits down with her staff�they decide that George acts out because of difficult, long work tasks (escape-maintained behavior) and difficulty sitting (sensory-based escape).

13. As a result, the team writes up a behavior plan that includes: A timer so he can see when the work task will end. Breaking up longer work tasks into smaller chunks. Allowing fidget toys and opportunities to move freely in the classroom. A token system where he receives a token for work completion after each subject

14. After a week, the fidget is missing from the box. The paraprofessional assumes it was pulled for a reason, so when she doesn�t find it, they stop using it. The timer gets thrown one day and breaks. The person working with him provides a verbal reminder when work will end (forgetting that George is a very visual student) and the timer is not replaced. After three weeks and no data collection, a new para joins the team, and since she�s seen George have a good day, she knows he can complete an entire worksheet, there�s no need to break it up. Everyone forgets about the tokens, but someone usually remembers about twice a day (but they catch up what they�ve forgotten ) 6 weeks later, George has a meltdown. Why? There was a behavior plan with evidence-based strategies!

15. Treatment Integrity The degree to which a treatment plan is implemented as it is written (Gresham, 1989) A primary determinate in the success of educational programs (Detrich, 1999) Research indicates that different levels of treatment integrity results in different levels of behavior change (Gansle & McMahon, 1997)

16. Issues in Treatment Integrity Greater research base for treatment than ensuring use (Noell et al., 2000) Procedural integrity highly controlled during study Efficacy of evidence-based models relies on accuracy of implementation Example: Direct Instruction and Project Follow Through

17. Evidence-Based Supervision Strategies Training Supervision/consultation

18. Evidence-Based Supervision Strategies Training packages recommended vs. single strategy Instruction, feedback, rehearsal, & modeling (Sarokoff & Sturmey, 2004) Use of both antecedent (instruction, demonstration) and consequent conditions are important to package (Harschik et al., 1989, as obtained from Bolton, 2005)

19. Evidence-Based Supervision Strategies Training Packages, cont. Direct training techniques reflect higher treatment integrity than indirect (Sterling-Turner et al., 2001) Verbal and video instruction, practice, feedback and on the job feedback (Parsons & Reid, 1995; Iwata et al., 1982)

20. Training Components Instruction Clear, measurable objectives Modeling Model necessary components during instruction Rehearsal: practice until 90-100% accuracy maintained before discontinuing training Feedback: visual displays, verbal praise, further explanation

21. Training Guidelines Develop package to include multiple instructional modalities Develop criteria for training completion Knowledge-based criteria Application: Role play, natural environment Determine follow-up consultation with trainees

22. Evidence-Based Supervision Strategies: Enhancing treatment integrity Ways to measure treatment integrity: Direct methods Observation Indirect methods Self reports Questionnaires Behavior rating scales (Gresham, 1989)

23. Research-supported steps for completing observations Make sure that the components in the intervention are clearly defined. Make sure to have a way to measure both occurrence and nonoccurrence of the components in the intervention. Make sure to use percentages to measure the treatment integrity of each person implementing the plan. Gresham (1989)

24. Follow-up Feedback: Maintaining the Integrity of the Plan FBA Visual Supports in place for on-going reminders from training Written review of all components of plan. Make sure that the components in the intervention are clearly defined. Make sure to have a way to measure both occurrence and nonoccurrence of the components in the intervention. Make sure to use percentages to measure the treatment integrity of each person implementing the plan. -(Gresham, 1989) General classroom-based modifications Checklist: Allows for reminders as well as provide feedback

25. Follow-up Feedback: Maintaining the Integrity of the Plan The involvement of the principal has been shown to increase the teacher�s likelihood of implementing the intervention (Gilat & Sulzer-Azaroff, 1994) Providing adequate teacher training prior to implementation is one method that may decrease the affects of plan related variables on implementation (Kratochwill & Bergan, 1990)

26. Follow-up Feedback: Maintaining the Integrity of the Plan Intensive Behavior Intervention Classrooms Annual program evaluation: Lengthy review and scoring Upon completion, set up goals and plot short and long-term goals on calendar Review quarterly and adjust as needed Weekly/Bi-weekly loose feedback of core program components Have link to program eval report and example form that I useHave link to program eval report and example form that I use

27. Evidence-Based Supervision Strategies: Enhancing treatment integrity Follow-Up Consultation: Research examining treatment implementation reflects amount and type of follow-up consultation directly affects the degree to which programs are implemented following training (Noel et al., 2000; Reid & Parsons, 2000) Frequency of follow-up Initial training is on-going, supervision can fade out some, but when supervision is removed completely, integrity deiminishes. When integrity is <80%, weekly feedback and training has demonstrated improvement to better implementation of plan. (Mortensen and Witt, 1998) Use of feedback during follow-up is vital to the success of the behavior intervention plan

28. Evidence-Based Training and Supervision Strategies �Teachers are the key. When teaching is an art, a good teacher is an accident. When teaching is a science, good teaching can be replicated by many professionals in a reliable fashion.� (Greer, 1994a, 2002)