Conjoint Behavioral Consultation

1. Conjoint Behavioral Consultation The Future of School Psychology Task Force on Family-School PartnershipsSusan Sheridan, Michelle Swanger-Gagne, Kathryn Woods, Kathryn Black, Jennifer Burt, S. Andrew Garbacz, Ashley Taylor University of Nebraska-Lincoln

2. Conjoint Behavioral Consultation • A structured, indirect form of service delivery in which teachers and parents are brought together to collaboratively identify and address students’ needs (Sheridan et al., 1996; Sheridan & Kratochwill, 1992). • Extension of the traditional behavioral consultation model that serves parents and teachers at the same time. • Interview stages are the same as in that of behavioral consultation, except that stages are conducted in a simultaneous (rather than parallel) manner. • Parents and teachers collaborate to: • Address the academic, behavioral, and social concerns of a child • Monitor a child’s behavior • Design an intervention • Rated by parents and teachers as the most acceptable consultation approach for academic, behavioral, and social-emotional problems when compared with teacher consultation models (Freer & Watson, 1999).

4. Process Goals of CBC • Improve communication and knowledge about child and family. • Increase commitments to educational goals. • Address problems across, rather than within, settings. • Promote shared ownership for need identification and solution. • Promote greater conceptualization of a need. • Increase the diversity of expertise and resources available.

5. Process Goals of CBC (continued) • Establish and strengthen home-school partnerships; enhance the family-school relationship. • Refers to a mutual effort toward a shared goal. • Contains the philosophy, attitude, and belief that both families and educators are essential for children’s progress in school. • Working together to promote the academic and social development of students.

6. Outcomes Goals of CBC • Obtain comprehensive and functional data over extended temporal and contextual bases. • Identify potential setting events that are temporally or contextually distal to target. • Improve skills and knowledge of all parties. • Establish consistent programming across settings. • Monitor behavioral contrast and side effects systematically via cross-setting treatment agents. • Develop skills and competencies for future conjoint problem solving. • Enhance generalization and maintenance of treatment effects.

7. Stages of CBC • Preconsultation • Conjoint Needs Identification • Conjoint Needs Analysis • Conjoint Plan Implementation • Conjoint Needs Evaluation See PC Handout 3

8. Preconsultation • Important process of communication, relationship building, cohesion begins well before formal consultation stages and continues throughout! • Opportunities for inviting participation and sharing information should be seized whenever possible • Use initial contacts to ensure that participants know what to expect (and what not to expect) in consultation See Pre-CBC Handouts 1 - 3

9. Conjoint Needs Identification: Initiating Formal Consultation • Standard consultation forms outline specific objectives of the CNII • Use agenda for participants to keep them informed of the process and meeting objectives (see CNII Handout 1) See CNII Handouts 2 and 3 for structured CNII forms

10. CNII: Child’s Strengths/Assets • Strengths, abilities, or other positive features of the client • Can also include things that the client likes, which can be used in reinforcement programs • Examples: • “What are some of Jamie’s strengths?” • “What are some things Kevin does well?”

11. CNII: Behavior Specification/Needs Identification • Elicit behavioral descriptions of client functioning • Focus is on specific behaviors of the client in terms that can be understood by an independent observer • Ask for as many examples of the problem behavior as possible • Careful specification is essential to identify the precise problem, direct the focus of an intervention, and monitor progress • Assist consultee focus on a specific target problem by asking for a priority • For example, “What is causing you the most concern?” or “Which of these behaviors is most problematic for Joey?”

12. Guidelines for Target Selection • Focus on building a client’s skill repertoire, rather than simply extinguishing behaviors • Prioritize urgent or dangerous behaviors if they pose serious risk or invoke serious consequences • Select a target that leads to the best treatment outcome (treatment validity, generalization) -- HOW?? Always:

13. Guidelines for Target Selection • Identifying a response chain and target first behavior of the chain • Selecting behaviors that will likely generalize to other behaviors (e.g., work completion with generalization to on-task or accuracy) • Organizing behaviors in terms of their topographical or functional properties • Prioritizing behaviors that have general utility and that the environment will likely maintain (e.g., social skills) • Changing the “easiest” behavior to encourage further treatment efforts • Changing behaviors that are most irritating to or preferred by the consultees Consider:

14. Operationalizing the Target Behavior • Operational Definition: • A precise description of the behavior of concern to the consultee • Criteria • Objective: observable characteristics of behavior; must be countable and measurable • Clear: unambiguous, specific, reliable; should be explainable to others & should not require interpretation on the part of an observer • Complete: describes what is included and excluded; leaves little to judgement of observer • It is often helpful to include information about situations/conditions where/when the behavior occurs • SUMMARIZE & VALIDATE TARGET BEHAVIOR -- WRITE IT DOWN!!!

15. Case Example: Prioritizing &Operationalizing Target Behaviors Parent and teacher describe the following concerns about 8 year old Pedro: • talks out/talks back • fights, argues, complains • fails to complete assignments/tasks • uses obscene language • doesn’t get along with other kids/siblings • doesn’t pay attention to lectures or instructions • tardy for school As a consultant, how would you go about helping consultees prioritize and operationalize a target behavior in the case of Pedro??

16. CNII: Behavior Setting • A precise description of the specific settings in which the problem behavior occurs at home and at school • Specific within-school and within-home settings important to prioritize • Ask for as many examples of problem settings as possible • In academic areas, this may include subject areas and not just physical environment • Assist consultees prioritize problem settings by asking which setting is causing the most difficult

17. CNII: Antecedent Conditions • A tentative delineation of events that precede the client’s behavior • Ask for information regarding what happens before the problem behavior occurs • Setting events: Antecedents that are removed in time or place from the target behavior, but that bear a functional relationship to its occurrence

18. CNII: Sequential Conditions • Situational /ecological variables or events occurring when the behavior occurs • Environmental (contextual) conditions in operation when the problem behavior occurs • Pattern or trend of antecedent and/or consequent conditions across a series of occasions • Examples: • Time of day • Day of week • Class period or common situations • Expectations of child (e.g., task demands) • Sequence of events • Curricular or instructional variables

19. Ecological Assessment & Existing Conditions • Curricular assessment: What is taught • Instructional assessment: How it is taught • Variables to assess include materials, teaching format, assignments, daily routine, student grouping, evaluation and feedback procedures, homework

20. CNII: Consequent Conditions • A tentative delineation of events that follow the client’s behavior • Ask for information regarding what happens after the problem behavior occurs • Setting events: Consequences that are removed in time or place from the target behavior, but which are related to its occurrence • Examples: Being removed from the class, staying in from recess • SUMMARIZE & VALIDATE CONDITIONS SURROUNDING BEHAVIOR

21. CNII: Behavior Strength • Attain a tentative estimate of the frequency or duration of a problem behavior • Level of incidence that is to be focused on • Examples: • Frequency • Duration • Latency • Intensity • SUMMARIZE & VALIDATE BEHAVIOR & BEHAVIOR STRENGTH

22. CNII: Goal Statement • Assist consultee generate an acceptable or appropriate level of the behavior • Examples • “How often would Patrick have to turn in his work in order to get along OK?” • “How much time could Sally take to respond to your request?” • “What would be an acceptable amount of talking out in class?”

23. CNII: Existing Procedures • Procedures or rules in force which are external to the child and behavior • Questions regarding approach to teaching or parenting • Examples: • “How long are Stacy and the others doing seatwork?” • “What are the playground rules?” • “How do you currently handle Paul’s talking back?” • “How are instructions/directions given to Anna?” 276849837 -85875764

24. CNII: Data Collection • Rationale provided to set the stage for data collection (why) • Examples: “It would be very helpful to observe Sam in the lunchroom and see exactly how often he throws his food. This will help us understand... make comparisons later...” • Specific data collection procedures discussed • Common observation procedures include event, duration, interval, momentary time sample, latency • Permanent product measures easy, useful • Procedures must be appropriate for the target behavior, and continued throughout consultation • Provide a form on which consultees can collect data, if possible See CNII Handout 4 forexample

25. BehavioralAssessment • Data collected must have high treatment utility and be relevant to treatment • Direct assessments will lead to meaningful treatments if they promote greater understanding of a behavior • On-going and repeated measurement, rather than pre/post assessment only, is required • Multi-source, multi-method multi-setting assessment strategies are used along the direct >>> indirect continuum • Multi-source: Collect information from teacher, parent(s), peers, self, others • Multi-method: Collect information using different methods, such as rating scales, interviews, observations • Multi-setting: Collect information across settings of home and school, and other relevant settings as appropriate (e.g., classroom, playground, lunchroom, library, etc.)

26. Tips for Data Collection • Keep it simple! • Clearly define what is to be recorded • Match the data collection procedure to the target behavior • Consider retrospective baseline data when applicable • Graph the data to monitor progress • Record data that have a range (i.e., not simply “yes/no”

27. Practical, Direct Data Collection Procedures • Permanent Products • Direct Observation • Performance-Based Assessment • Curriculum-Based Measurement • Self-Monitoring

28. Permanent Product • Concrete evidence of a student’s behavior taken from an existing source • Examples: • Percent of homework assignments completed • Number of worksheets completed in a subject area • Number of pages read • Number of problems attempted/completed/accurate • Organization of work on a page

29. Direct Observation • Measurement of discrete behaviors while they are occurring • Examples: • On task/off task • Disruptive behavior • Out of seat • Talking out • Initiating conversations • Compliance with commands

30. Direct Observations • How to… • Low frequency behaviors: • Frequency counts using golf counter, pennies, tallies on wristband • How to… • High frequency behaviors: • Identify intervals that are easy to monitor • Consider momentary time sampling procedure

31. Performance-Based Assessment • Use of rating scales to record behaviors over time periods, based on a Likert scale • Examples: • Aggression • Oppositional behavior • Active participation in activities

32. Curriculum-Based Measurement • The use of standardized short-duration fluency measures of basic, any testing strategy that uses a student’s curriculum to monitor progress and as the basis for decision-making • Examples: • Reading fluency and accuracy • Math digits correct • Spelling correct words

33. Self-Monitoring • An observation technique wherein students are responsible for recording their own behaviors • Examples: • On-task behaviors • Following instructions • Beginning work on time • Completing chores/tasks • Cognitive events such as using self-control, problem solving, experiencing depressive symptomotology

34. Goal Attainment Scaling • A rating on a 5-point scale (from -2 to +2) based on the degree to which a student’s performance is approximating a predetermined goal • Somewhere between a direct and subjective measurement system • Examples: • Work completion • Accuracy on academic tasks • Compliance • Using self control • Social skill development

35. CNII: Data Collection • Specify the target response to record, the kind of measure, and procedures for recording (what, when, where, how) • SUMMARIZE & VALIDATE RECORDING PROCEDURES • Establish date to begin data collection

36. CNII: Closing • Establish date of next appointment • Date, time, place • Closing Salutation: • “Bye! Good luck!” • “I’ll check back in a few days to see how things are going.” • “Call me if you have questions or problems!”

37. Conjoint Needs Analysis Interview: Opening the Interview • Use agenda for participants to keep them informed of the process and meeting objectives (See CNAI Handout 1) • General Statement re: Data and Problem • Make a general statement to orient consultee toward data • Questions or Statement about Behavior Strength • Questions and statements about specific data, behaviors, and patterns • Statement determining representativeness of the data See CNAI Handouts 2 and 3 for structured CNAI forms

38. CNAI: Conditions/Functional Analysis • Underlying assumptions of behavior: Behavior is contextually defined • Behaviors arise in relation to environmental events; i.e., both the consequences that maintain them and the setting events/antecedents that precede them • The context, and not the form of the behavior, determines how a behavior is perceived (i.e., its appropriateness) • Why is this important to understand in consultation?

39. CNAI: Conditions/Functional Analysis • Adequate functional analysis may highlight important functions of a behavior (i.e., lead to functional hypotheses) or pinpoint environmental events (i.e., lead to contextual hypotheses) that impact or maintain the target behavior • “Functions” refer to the function that a behavior serves for an individual, and are often related to environmental conditions that reinforce its occurrence (i.e., motivate a person to engage in the behavior) • Examples include attention, escape, avoidance, others • It is critically important to conduct a careful conditions/functional analysis to accurately generate hypotheses and develop meaningful interventions

40. Primary Outcomes of the Functional Assessment Process • A clear description of the problem behaviors, including classes or sequences of behaviors that frequently occur together • Identification of events, times, and situations that predict when the problem behaviors will and will not occur • Identification of the consequences that maintain the problem behaviors (i.e., what functions the behaviors appear to serve for the person)

41. Primary Outcomes of the Functional Assessment Process • Development of one or more summary statements or hypotheses that describe specific behaviors, a specific type of situation in which they occur, and the outcomes or reinforcers maintaining them in that situation • Collection of direct observation data that support the summary statements that have been developed

42. CNAI: Conditions/Contextual Analysis • Antecedents, Consequences, Sequential/Ecological conditions are explored in relation to the specific data collected by consultees • What happened before, after, and during the occurrence of the target behavior? • What things may have triggered or maintained a behavior? • What patterns were present that may be related to the occurrence of a target behavior? • Trends across settings (e.g., home and school) are investigated; cross-setting conditions and setting events are highlighted when appropriate • Are there common things that happen across settings that trigger or maintain a behavior? • Do events occurring in one setting precipitate, trigger, or predict a behavior in another setting?

43. Conditions Analysis: Summary • Environmental variables can function as discriminative stimulifor behaviors, as consequencesthat maintain behavior, and as stimuli that elicit behavior • Environment covariation can reflect a causal relationship, so it is important to identify environmental sources of behavioral variance • Ask: “to what extent do target behaviors demonstrate covariation with environmental events, and can these controlling environmental stimuli be targeted for modification?”

44. CNAI: Skills Analysis • Often what appears to be “behavior” problems are in reality related to skill (vs. performance) deficits • Can’t do vs. won’t do (i.e., skill vs. will) • Skills analyses are important when the target behavior concerns skills to be mastered • Steps of skills analyses: • Identify target skill that should be present • Break the skill down into component parts • Assess the client’s ability to perform each component • Determine the uppermost level at which the client can perform • Develop an intervention starting at this point

45. CNAI: Hypothesis Generation • Can be based on the function, context, or skills/deficits surrounding the behavior • Hypotheses addressing function are based on an examination of the consequences that are presumed to maintain the behavior • Contextual hypotheses are based on an analysis of the settings or events wherein a behavior is likely to occur • Skills hypotheses are based on the identification of deficits in the child’s behavioral repertoire

46. CNAI: Interpretation/Hypothesis Statement • Consultant elicits consultee’s perception regarding the purpose, function, or “causes” of the behavior • Careful (strategic) questioning and summaries prior to this point in the process should assist consultees in forming appropriate hypotheses • More appropriate interpretations should be provided by the consultant when necessary • Interpretation should be based on the conditions/skills/functional analyses (behaviorally- or environmentally-based, rather than following a medical model) • Provides an important link between assessment and intervention!

47. Case Example During independent work time, Servio daydreams and fails to complete any math worksheet problems. When his teacher tells him to get to work, he argues that he is working, and sometimes writes down random answers. The teacher requires students to bring uncompleted or incorrect work home. At home, Servio’s mother works the night shift and leaves the house at 7:00. She tries to get him to do his homework before leaving, but he spends his time watching TV, fighting with his younger brother, and arguing with his mother. Servio leaves to catch the bus before his mother gets home from work. Upon returning to school, he doesn’t turn in his worksheet and gets a “0” in the gradebook. • What are some possible target behaviors in this case? • What are some possible antecedents, consequences, and sequential conditions in this case? (Contextual analysis) • What are some possible functions of his behaviors? (Functional analysis) • What are some important areas to explore during the conditions analysis?

48. CNAI: Plan Strategies • Focus on identifying: • Ways to change the context • Ways to prevent the problem behavior • Ways to increase expected behavior or teach a replacement behavior • What should happen when the problem behavior occurs • What should happen when the desired behavior or replacement behavior occurs

49. CNAI: Plan Strategies • Consultant and consultee establish general strategies and specific tactics that might be used in treatment implementation • Strategies should be related to the hypothesis/interpretation statement • May use brainstorming techniques • SUMMARIZE & VALIDATE PLAN • Use form and write it down! See CNAI Handouts 4 - 7

50. Other Considerations When Designing Intervention Programs • Diagnosis • Target Behavior Characteristics • Intervention Variables • Consultee Variables • Intervention History