E16-The Prevent-Teach-Reinforce FBA/BIP Model for Middle & High School Students

1. E16-The Prevent-Teach-Reinforce FBA/BIP Model for Middle & High School Students Rose Iovannone, Ph.D., BCBA-D iovannone@usf.edu 813-974-1696 Key Words: Tier III, FBA/BIP The contents of this training were developed under grant H324P04003 from the Department of Education

2. Agenda • Overview of PTR and secondary FBA/BIP practices • PTR Process • Step 1-Teaming/goal setting/progress monitoring • Step 2 Functional assessment • Step 3a-Behavior intervention plan • Step 3b-Coaching/Fidelity • Step 4-Monitoring and making data-based decisions

3. Objectives • Participants will: • Describe the 4-step PTR FBA process • Identify the critical components that enhance the success PTR • Demonstrate implementation of PTR with case studies

4. Maximizing Your Session Participation When Working In Your Team • Consider 4 questions: • Where are we in our implementation? • What do I hope to learn? • What did I learn? • What will I do with what I learned?

5. Where are you in the implementation process?Adapted from Fixsen & Blase, 2005

6. Leadership Team Action Planning Worksheets: Steps • Self-Assessment: Accomplishments & Priorities Leadership Team Action Planning Worksheet • Session Assignments & Notes: High Priorities Team Member Note-Taking Worksheet • Action Planning: Enhancements & Improvements Leadership Team Action Planning Worksheet

7. Who is Here? Why are you Here?

8. FBA/BIPs and Secondary Schools—The Issues • FBA/BIPs have compelling empirical support • Used infrequently in secondary schools • Punitive strategies increase in use in middle schools (Vincent et al. 2012)--ODRs • In high school, increase in use of exclusionary discipline methods (suspension/expulsion; Flannery et al. 2013) • Secondary issues: • Teachers see more students-lack of relationship • Teaming practices are different in secondary schools compared to elementary • Stakeholders express student issues more complex-FBA/BIPs may not address the multitude of problems

9. FBA/BIPs in Secondary Schools-Rationale • We consider FBA/BIPs to be a first-line core Tier 3 behavioral support in secondary schools • FBA/BIP not intended to address every concern • Pivotal impact of decreasing externalizing problem behaviors: • Increased engagement (for target student and peers; Lannie & McCurdy, 2007) • Increased time for academic instruction (Walker et al. 2003) • Long-term decrease in high risk behaviors (physical aggression, carrying of weapons; Martinez et al. 2016) • Reduction of absenteeism (De Pry & Sugai, 2002) • Reduction of drop-out rates (Noltemeyer et al. 2015) • Addresses key concern of secondary teachers-problem behaviors • 76% middle/high school teachers reported reduction of behavior problems would enhance ability to teach (Public Agenda, 2004) • Considered a complementary approach integrated with empirically supported therapeutic interventions for other concerns

10. What is Prevent-Teach-Reinforce (PTR)? • Research project funded by U.S. Department of Education, Institute of Education Sciences • University of South Florida • Three central Florida school districts • University of Colorado, Denver • Two Colorado school districts • Purposes: • Answer the call for rigorous research • Evaluate effectiveness of PTR vs. “services as usual” using randomized controlled trial • Evaluate effectiveness of “standardized “ approach • Aims of the model • Make available tools that are parsimonious-easy for team/teachers to use • Use language that is not technical-easy to understand terms • Use a collaborative approach-not an expert model • Have consensual team-based processes built within each step • Provides ongoing support to teacher/team for implementation and making data-based decisions

12. Where is PTR in a Multi-tiered System of Supports (MTSS)?

13. Student-Centered Team • coach • Members who know student • Member who know school/district

14. Considerations for Selecting coach • Characteristics to consider when selecting individual(s): • In a flexible position that allows him/her to support others (for example, it may be hard for a teacher to be a coach unless his/her position is one that does not require 100% of time in a classroom • Has significant behavioral training background or has extensive experience in applying behavioral principles • Has experience collaborating with others • Has excellent interpersonal skills • Is respected by other professionals in school building/district

15. Research Support for PTR

16. Participants in Original PTR RCT • 245 students enrolled—randomly assigned to treatment or comparison • K-8th grade • General and Special Education • All cognitive levels • All disabilities • Teacher-nominated top externalizers • Systematic Screening for Behavior Disorders (SSBD)

17. Student Demographics by Primary Disability

18. Student Description

19. Student Outcomes • Students receiving PTR, compared to students who received services as usual, significantly improved (p < .001) • Their social skills and problem behaviors (measured by the Social Skills Rating Scale-SSRS) • Their academic engaged time (AET) as measured by direct observations during 15 minute independent work time routine • Effect sizes were moderate (as predicted-given that the comparison group were still getting some sort of ”treatment”)

20. Teacher Outcomes • Fidelity • Majority of teachers achieved .80 • 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

21. Other Research

22. Research in PTR • Second randomized controlled trial • Young children (3 years to 6 years of age) • Several single subject studies • General education • Autism • Child care settings • Families • High school students with emotional disorders

23. Research Outcomes • RCT-Students receiving PTR significantly improved social skills, problem behaviors and academic engagement compared to those who received services as usual (SAU) • Single subject—multiple baseline designs showed PTR improved the dependent variable in all studies • Teachers implemented the interventions with high (e.g., 80% or greater) fidelity • Teachers (and students) found PTR to be socially valid

25. The PTR Process

26. Step 1: Goal Setting • Purpose: • Identify behaviors of greatest concern to the team and possible replacement behaviors (teach) • Prioritize and operationalize behaviors targeted for intervention • Develop teacher friendly baseline data collection system • Secondary school procedures • Core team and extended team • Select one team member who will be the primary interventionist • Behavior identification and progress monitoring tool be focused for that team member • Other team members provide input/support to behaviors, definitions, progress monitoring and throughout the process

27. Meets less frequently • Provide input and support to teacher implementing intervention • Make broader data-based decisions (tiered support needs, expanding/generalizing plan Extended Team Student Other teachers Referring Teacher Other Staff Family Coach Core Team • Meets frequently with coach • Is the focus of the what, where, how • Is the recipient of direct active coaching • Makes immediate data-based decisions about plan Coach Referring Teacher Student

28. Note About Student Involvement • Each student case is unique • In general, student input is gathered by an adult trusted by the student • Not typically included in the actual meeting

29. Collaborative Process • NOT coach telling the team the behaviors to target • INSTEAD coach guides the team to consensus on behaviors to be targeted

33. Step 1: Progress Monitoring System • Individualized Behavior Rating Scale Tool – IBRST • 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

34. IBRST Inter-rater Reliability (Iovannone, Greebaum, Wang, Kincaid, & Dunlap, 2014) • 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

35. Agreement of IBRST and Direct Observation • In recent multiple baseline study, • Problem Behavior-74% of ratings in exact agreement, 16% within one scaled score • Appropriate Behavior-75% exact agreement, 14% within one scaled score. • Cohen’s Kappa = 0.70 (p<0.001) Barnes, Iovannone, Blair, Crosland, & Peshak-George, (in review).

36. Sample Middle/High School Goals and IBRSTS

37. Step 2: PTR Functional Behavior Assessment Analyze the Problem

38. Step 2: PTR Assessment (FBA) Problem Analysis • PTR Assessment (FBA) • Prevent: Antecedents/triggers of problem behavior • Teach: Function(s) of problem behavior, possible replacement behaviors • Reinforce: Consequences associated with problem behavior, possible reinforcers • Assessment checklist completed by each team member • coach summarizes input on Assessment Summary Table and develops draft hypothesis • Team reaches consensus • coach has conducted at least ONE direct observation of student and context prior to this step 38

39. Several Versions of PTR Assessment • Secondary Version • Teacher versions • Student versions • Each relevant team member completes a PTR Assessment for targeted behavior(s) to be decreased • Student is interviewed • Coach conducts at least one observation

40. Learned Functions of Behaviors • GET • Obtain • Activities, people, tasks, tangibles, sensory, pain attenuation • GET OUT OF • Escape/Avoid/Delay • Activities, people, tasks, tangibles, sensory, pain

41. NAME THAT FUNCTION!

44. Are Power, Control, Jealousy, Revenge Functions? Iovannone, Anderson, & Scott, 2013

45. Completing the PTR Assessment Organization Table

46. Sample Middle/High School Hypothesis Statements

47. Step 3: PTR Intervention Plan Developing and implementing an intervention

48. “The problem is not that people resist change, but they resist being changed.” Michael Kim, Founder and CEO of Habit Design

49. Behavior Intervention Plan Development: Essential Features • Behavior interventions selected by team from PTR Menu • coach guides the team/teacher by using ABA principles to develop most effective intervention that matches the team/teacher context • Team/teacher provides description on how interventions will look in classroom setting • Each intervention selected is described in detail by task-analyzing steps, providing scripts, describing adult behaviors, NOT student behaviors • After plan developed, time is scheduled to train the team/teacher the strategies prior to implementation • Plans for training students and other relevant individuals • Support provided once plan is implemented