Designing and Delivering Intensive Intervention in Behavior

1. Designing and Delivering Intensive Intervention in Behavior • Name • Position • January 2014

2. Today’s Agenda • Introduction • Review of previous NCII modules • Training goals • Examples of evidenced-based interventions (EBIs) • Summary

3. A Bird’s-Eye View of Data-Based Individualization

4. Learning Objectives • Relate assessment to function. • Select EBIs that align with the functions of behavior. • Link assessment and progress monitoring. • Connect data with the selected EBI.

5. Designing and Delivering Intensive Intervention Tying It All Together!

6. Another Way of Thinking About It • Design and implement interventions carefully but quickly. • Collect data in a highly feasible manner. • Establish a consistent manner of data analysis that is efficient and easy for anyone to do. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

7. Part 1 Relating Assessment to Function

8. Relating Assessment to Function • A review of Functional Behavior Assessment (FBA) • Definition of FBA: • FBA is a process for identifying the events that reliably predict and maintain problem behavior. • Function refers to the purpose of behavior.

9. Relating Assessment to Function Assessment (in FBA): Need to quickly select the likely reason for the behavior. • Time is a precious commodity. Educators need to be efficient when problem solving. • Under many circumstances, the most efficient thing to do is to test the easiest hypothesis first, implement an intervention, monitor, and then evaluate the outcomes. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

10. Common Reasons Why Students Misbehave • A student has not learned the behavior. • Inappropriate behavior removes a student from what he or she does not want to do (escape). • Inappropriate behavior gets a student something (typically attention). • A student has not had to do the behavior in that way before. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

11. Start With a Reasonable Hypothesis • If starting with a reasonable hypothesis fails to improve student performance, then something progressively more time intensive can be attempted until the probable cause of failure is identified. • Note: Easier solutions are more likely to be implemented consistently, whereas solutions that are more time consuming or technically difficult for teachers and support personnel are less likely to be implemented correctly (Gresham, 1989). Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

12. Importance of Identifying Function First • Identify the hypothesized function of behavior and then select the intervention. • Selecting an intervention with the appropriate level of rigor based on the problem is essential. • After the intervention is selected, the analysis phase can begin. It is only in the analysis phase where a team will find out if the assessment phase was successful. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

13. Part 2 Selecting Evidence-Based Interventions That Align With the Functions of Behavior

14. Selecting Evidence-Based Interventions EBIs are treatments that have proven effective through rigorous outcome evaluations. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

15. The History of Evidence-Based Interventions Across Professions • Medicineand clinical and counseling psychology • Lots of discussion and debate about the pros and cons of an EBI approach • Field agreement with a deep understanding of EBI • Education and school psychology • Very little discussion (if any) about whether we should use EBI • Field agreement with no real understanding of EBI Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

16. The History of Evidence-Based Interventions (Handout 1)

17. What Are Evidence-Based Interventions in Schools? • Tier I: Whole-school best practices • Tier II: Functionally related small- group practices • Tier III: Individually functionally based practices Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

18. Selecting Evidence-Based Interventions That Align With Function • Why is it important to pick the “right” EBI for each case if they are all evidence based? • There are important limitations in EBI that we like to call the “fine print,” which are important to understand to effectively use this technology. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

19. Fine Print I: Tiers 2 and 3 • EBIs are validated for a specific purpose with a specific population. • Implication: EBIs are useful only for a range of problems and, as such, must be paired up with the right situation. “A hammer is an effective tool but not with a screw.” Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

20. Fine Print II • Evidence-based Tier 3 interventions assume implementation integrity. • Implications • Changing parts of an intervention, while typical, can invalidate an EBI. • How can an intervention be changed—frequency, materials,target, style, and so on? Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

21. Fine Print III • EBIs are typically validated with large-group research or a series of small-group studies. • Implications • EBIs have been documented as likely effective, not surely effective. • Even the most effective interventions are often ineffective with a specific case. • As such, you cannot assume an EBI will work for every student in every situation. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

22. Implications of Evidence-Based Interventions • A list of EBIs is just a good place to start, but even if selected carefully, they may not be effective. • Additional steps are necessary. • Need to select EBIs that make sense for the current case. • Need to implement EBIs with integrity. • Need to collect outcome data—progress and outcomes. • Need to evaluate the effectiveness in some manner to see if it worked and make adaptations as necessary. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

23. A Bird’s-Eye View of Data-Based Individualization

24. Decoding the Terminology: EBI and DBI

25. What Should Tier 3 Intervention Plans Include? • What the intervention will look like (i.e., steps or procedures) • What materials and/or resources are needed and whether these are available within existing resources • Roles and responsibilities with respect to intervention implementation (i.e., who will be responsible for running the intervention and preparing materials) Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

26. What Should Tier 3 Intervention Plans Include? • The intervention schedule (i.e., how often, for how long, and at what times in the day) • Context(i.e., where and with whom) • How the intervention and its outcomes will be monitored (i.e., what measures, by whom, and on what schedule) and analyzed (i.e., compared to what criterion). Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

27. Considerations for Tier 3 Interventions: The “How” • When considering an intensive intervention, teams are asked to consider what they think are the most likely reasons for the problem behavior. • Once selected, these hypothesized reasons are then used to select interventions. • If there is more than one likely reason selected, try rank ordering from most to least likely. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

28. Considerations for Tier 3 Interventions: The “How” • Selected interventions should be customized to the student with care so as to not alter the function. • Change the icing, not the core ingredients. For example, although praise is often suggested in reinforcement-based interventions, other reinforcements can be used if praise does not act in a reinforcing manner for the target student. That being said, you cannot remove the reinforcement fully from such an intervention. • Implement. • Collect outcome data. • Analyze. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

29. Considerations for Tier 3 Interventions: The “How” The true documentation that an intervention is evidence based for a specific case occurs only when there areoutcome data indicating a change in the target behavior. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

30. Common Reasons Why Students Misbehave • A student has not learned the behavior. • Inappropriate behavior removes a student from what he or she does not want to do (escape). • Inappropriate behavior gets a student something (typically attention). • A student has not had to do the behavior in that way before. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

31. Selecting Evidenced-Based Interventions That Align With Function • NCII does not endorse any of the interventions presented in this training. We would like to acknowledge that these examples were selected for training and illustrative purposes and in large part because they are commonly used in tiered systems and have an intriguing evidence base. • However, NCII, through its Technical Review Committee (TRC), has not yet validated any of the strategies or interventions listed in this training. It is planning to review interventions in the next several years to provide endorsed options.

32. Examples of Evidence-Based Interventions • Check In Check Out (CICO) • Non-contingent reinforcement (NCR): attention seeking • Antecedent modification: escape • Instructional match: prerequisite skill or ability Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

33. Check In Check Out • An empirically supported strategy for reducing problem behavior • Relatively quick and easy; provides structure • Increases positive adult contact • Excellent intervention when the function of behavior is attention seeking • Also useful for students who escape because they do not want to do a task if teach praise is more reinforcing than the task is punishing. Source: Michigan’s Integrated Behavior and Learning Support Initiative (http://miblsi.cenmi.org)/

34. Elements of Check In Check Out • Focus on teaching • Check-in check-out system • Daily classroom report card • Home-school partnership • Collaborative team-based process Source: Michigan’s Integrated Behavior and Learning Support Initiative (http://miblsi.cenmi.org)/

35. For Whom Should Check In Check Out Be Used? • Students engaging in externalizing behaviors • Less than 15 percent of students • Students with multiple referrals (two to five major referrals) • Students who receive several minor referrals • Students who receive referrals in multiple settings • Students who find adult attention rewarding or reinforcing Source: Michigan’s Integrated Behavior and Learning Support Initiative (http://miblsi.cenmi.org)/

36. The Benefits of Check In Check Out • On a daily basis, there are increased structure, feedback, and adult support. • There are daily home and school communications and collaborations. • Data are collected, reviewed, and used to make decisions about the intervention success (or lack there of). Source: Michigan’s Integrated Behavior and Learning Support Initiative (http://miblsi.cenmi.org)/

37. Source: Michigan’s Integrated Behavior and Learning Support Initiative (http://miblsi.cenmi.org)/

38. Non-contingent Reinforcement Photo Credit: http://www.flickr.com/photos/familymwr/4919451795/; http://creativecommons.org/licenses/by/2.0/deed.en

39. What Is Non-contingent Reinforcement? NCR is a powerful method to reduce attention-seeking problem behavior. NCR involves giving a student access to a reinforcer frequently enough so that he or she is no longer motivated to exhibit disruptive behavior to obtain that same reinforcer (e.g., saturate the environment with the reinforcer beforethe behavior occurs). Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

40. An Example of Non-contingent Reinforcement • Example: A student wants teacher attention and calls out or engages in disruptive behaviors to get attention consistently during a group activity, such as art or story time. • Possible solution: The teacher will provide appropriate attention prior to the student “asking” for attention with the “problem behavior” (e.g., have the student sit with the teacher while she is reading a book to the class).

41. Critical Components for Success • You need to identify the reinforcer for the problem behavior. NCR will not work if you do not know the function of the disruptive behavior. • The problem behavior must be attention seeking. • You need a schedule for NCR delivery that minimizes problem behavior. • NCR is most effective with a heavy dose of reinforcement early in the day. • You must ignore problem behavior after the schedule is initiated. • You should fade the process as problem behavior declines but make sure the student does not reengage in behavior by fading too quickly. • Slowly reduce the amount of NCR given. Note: NCR is good teaching practice, so it should never be “stopped.”

42. Antecedent Modification The “Great Escape” Photo credit: http://www.flickr.com/photos/edenpictures/2969677793/; http://creativecommons.org/licenses/by/2.0/ Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

43. What Is Antecedent Modification? • The student does not have to do something when he or she exhibits the problem behavior. • The problem behavior is “working” for the student by allowing him or her to escape something that he or she does not want to do. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

44. An Example of Antecedent Modification • Example: A student wants to escape a non-preferred activity, such as mathematics or physical education. Every time the teacher announces the start of a specific activity, the student starts engaging in disruptive behaviors (e.g., runs away, shouts out, pretends to sleep). • Possible solutions: • Minimize the need for the escape by making the target activity less punishing! • Alter antecedents to increase task engagement, appropriate behaviors, and general success (e.g., preteaching, offering choice, and modeling).

45. Critical Components for Success • Positive reinforcement (e.g., praise) for engaging in the activity • Reinforce appropriate behaviors in shorter intervals initially (e.g., change the schedule of reinforcement or task demand) Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

46. Instructional Match Photo credit: http://www.flickr.com/photos/charlottel/154443920/; http://www.flickr.com/photos/dno1967b/8703319368/; http://creativecommons.org/licenses/by/2.0/

47. What Is Instructional Match? • Escape behavior related to academic tasks that are simply “too hard.” • For example, a student might not be successful because the instructional materials are too difficult, or he or she may not have the prerequisite skills. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

48. Characteristics of Instructional Match • There is a mismatch between student skill and the level of difficulty of the task: the assessment of a student’s current instructional level is inaccuratein some way (e.g., knowledge, difficulty, pace, and/or level). • Students who are failing academically are frustrated and often act out!

49. Examples of Instructional Match Examples: • Doing addition problems without being able to count • Journal writing without being able to form two- or three-word sentences • Drawing without fine motor skills, such as pencil grip • Running without proper gait (e.g., can walk only on tippy toes) Possible Solutions: • Preteach content or skill. • Reduce the difficulty of the task. • Break down tasks into smaller, more manageable subtasks. • Use curriculum-based measurement (CBM) to determine the appropriate instructional level. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

50. Critical Components for Success • Must be able to accurately assess a student’s current level of ability and implement a curriculum and teaching materials that are appropriate to the student’s instructional level. • Must match task demands with current skill levels to ensure success. • Differentiate instruction whenever possible and appropriate. Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/