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START EBP Summer Institute 2011. WELCOME . Agenda. Day One Setting the “stage” Spotlighting evidence based practice Act I: Horizon Elementary Act II: Clawson Middle School Day Two Act III: Holt High School A script for implementing EBP Practice with your crew.

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agenda
Agenda

Day One

  • Setting the “stage”
  • Spotlighting evidence based practice
  • Act I: Horizon Elementary
  • Act II: Clawson Middle School

Day Two

  • Act III: Holt High School
  • A script for implementing EBP
  • Practice with your crew
the start ebp implementation project
The START EBP Implementation Project…

is the culmination of many years of work supporting the implementation of evidence based practices in schools along with the recent collaborative partnership project with the National Professional Development Center on Autism Spectrum Disorders from 2009-2011. Our aim is to train and support school building teams to create student IEP goals that best reflect the needs of the student and match those goals to evidence based practices that will help the students and team meet those goals.

families professionals are seeking information about autism treatment
Families & professionals are seeking information about autism treatment
  • If you type in the words “autism and treatment” in Google you get:

17,800,000 results in .09 seconds

slide10

But there is not a good warning system to let families and professionals know when intervention practices that haven’t been thoroughly studied are being promoted

Elephant Therapy!

currently not enough evidence
Currently not enough evidence…
  • Injection of immunological substances
  • Vitamin therapy
  • Hormone therapy
  • Facilitated communication
  • Biofeedback
  • Hyperbaric oxygen chamber therapy
  • Auditory integration
  • Massage of the scalp
  • Prism lenses
  • Complex rhythmic drumming
  • Electromagnetic therapy
  • Holding therapy
  • Dolphin therapy
slide12

When families seek treatment for a child diagnosed with cancer or diabetes, they aren’t given a long list of interventions that someone somewhere believes to be effective, and told to choose from that list on their own; they can usually expect to be informed about treatments that are based on sound scientific research. Why do we settle for less when the diagnosis is ASD?

Retrieved from asatonline.org (2011)

problem people may want to try everything
Problem: People may want to “try everything”
  • A “try everything” mindset leads one to believe that treatment of autism is based upon the quantity of interventions, as opposed to the quality of interventions
  • Celiberti et al., The Road Less Traveled: Charting a Clear Course for Autism Treatment (http://www.researchautism.org/uploads/roadless.pdf ) (p. 5)
problem choosing non evidence based interventions
Problem:Choosing non-evidence based interventions
  • Primum non nocere: FIRST DO NO HARM
  • Example: Facilitated Communication – Potentially Harmful Therapy
      • Lilienfeld, S. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70.
problem choosing non evidence based interventions16
Problem:Choosing non-evidence based interventions
  • Time, money, energy that is NOT directed toward evidence-based intervention
solution
Solution
  • Teach people to be good consumers of information through understanding the scientific process… yes, really.
  • Teach people to collect data in a rigorous way and control for confounding variables.
  • If you don’t partner with families and providers, they will proceed without you. Its better to work with them (S. Harris, years ago)
what are ebps all about
What are EBPs all about?

All students in public education should have access to scientifically based practices (NCLB, 2001).

what is scientifically based research
What is scientifically based research?

You must have reliable evidence that a program or practice works. NCLB requires experimental studies that are similar to the medical model of research used by scientists. These studies require many steps to prove strong evidence of effectiveness.

  • Well designed studies that use random samples of the population
  • Trials must also include a random “control group” for comparison
  • Valid and reliable outcome measures
  • Data on long-term outcomes
  • Trials in more than one site of implementation
using ebps in schools
Using EBPs in Schools
  • What are examples of universal EBP practices for all students?
    • Behavioral expectations
    • Evidence based approaches to teaching reading
  • What is the environmental context for all students attending school?
    • General education curriculum, instruction, social interaction, transitions
slide22

23

3-Tiered Model of Support

Few

Some

Universal EBPs

TIER 1

All

when to use ebps specific to students with asd
When to Use EBPs Specific to Students with ASD

Specific EBPs for students with ASD are deficit driven and based on the student’s lack of progress. Deficits and lack of progress become IEP goals.

Students aren’t making progress in…

  • Academic learning
  • Socialization
  • Communication
  • Behavior expectations
slide24

23

3-Tiered Model of Support

Few

Targeted and Intensive EBPs Intervention

TIER 2 & 3

Some

Universal EBPs

TIER 1

All

ebps specific to students with asd and other students
EBPs Specific to Students with ASD (and other students?)
  • What are examples of targeted or intensive practices?
    • Self-management systems
    • Video modeling
    • Discrete trial teaching
    • PECS
    • Functional communication training (FCT)
the national professional development center on asd
The National Professional Development Center on ASD
  • The National Professional Development Center on Autism Spectrum Disorders is a multi-university center to promote the use of evidence-based practice for children and adolescents with autism spectrum disorders.

http://autismpdc.fpg.unc.edu/content/evidence-based-practices

national standards project
National Standards Project
  • "In a field rife with fads, pseudoscience, and popular, yet unproven, interventions, the findings of the National Standards Project are a welcome and much-needed counterbalance to much of the hyperbole for both professionals and families." --- Peter Gerhardt, Ed.D.

http://www.nationalautismcenter.org/

the association for science in autism treatment
The Association for Science in Autism Treatment

ASAT is a not-for-profit organization of parents and professionals committed to improving the education, treatment, and care of people with autism. Since autism was first identified, there has been a long history of failed treatments and fads, levied on vulnerable individuals as well as on their families. Since ASAT was established in 1998, it has been our goal to work toward adopting higher standards of accountability for the care, education and treatment of all individuals with autism.

http://www.asatonline.org/intervention/treatments_desc.htm

the start ebp implementation project is easy as 1 2 3 4
The START EBP Implementation Project is easy as 1-2-3-4

To make it easier to remember the steps of the project, just remember “1-2-3-4.”

  • 1building
  • 2 target students
  • 3IEP goals per target student
  • 4Evidence Based Practices (EBPs) to address the IEP goals
presentation script for 3 groups
Presentation Script for 3 Groups
  • Description of the student
  • Developing the GAS goals from the IEP
  • Selecting the EBP
  • Implementation Plan & Process
  • Ongoing Review & Adjustments
  • Expansion to other students
expanding children s iep goals through the goal attainment scale gas
Expanding Children’s IEP Goals through the Goal Attainment Scale (GAS)

Goal Attainment Scale (GAS) is designed to document progress on IEP goals, objective, and benchmark.

Provides a summative rating to evaluate outcomes for students

slide34

Dan is inconsistently performing job tasks. He needs verbal, gesture and visual prompting to complete a task.

Given a 5-step vocational task and visual supports, Dan will complete 3/5 steps independently over 3 consecutive probe days.

Given 2 different 5-step vocational tasks and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

Given 3 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

Given any familiar 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

description of scaling
Description of Scaling

Consists of a five point range of performance for students:

Much less than expected(present level)

Somewhat less than expected

Expected level of outcome (annual goal)

Somewhat more than expected

Much more than expected

the start ebp implementation project is easy as 1 2 3 437
The START EBP Implementation Project is easy as 1-2-3-4

To make it easier to remember the steps of the project, just remember “1-2-3-4.”

  • 1building
  • 2 target students
  • 3IEP goals per target student
  • 4Evidence Based Practices (EBPs) to address the IEP goals
a script for implementing evidence based practices

A script for implementing evidence based practices

Review Checklist

Discuss Building and Student Selection

slide40

Writing Measurable Goals:

Formula for Success

  • Condition--Under what condition and using what support should the skill be demonstrated?
  • Behavior—Use verbs to describe behavior
    • What competency / skill should change?
    • Observable behavior
  • Criteria— Describes level of mastery such as much or how well the behavior is demonstrated
writing measurable goals
Writing Measurable Goals
  • Condition—Circumstances the student will need in order to perform the expected skill (when, where, with whom, type of activity, with what support, etc.)
    • When given a verbal request
    • During transition periods
    • During a social conversation
    • During class discussions
    • When shown a three choices
    • When prompted (specify type and # )
    • When given a check schedule card
    • When prompted (specify type and #) to a visual schedule
    • Using peers / peer to peer support
    • Using a choice modification strategy
    • During lunch (math, science, etc)
writing measurable goals42
Writing Measurable Goals

Behavior—Use verbs to describe behavior

  • Choose / select
  • Raise hand
  • Remain in seat / area
  • Answer questions
  • Request
  • Locate / find
  • Put on / Take off
  • Respond to (describe)
  • Complete task
  • Transition to next activity
  • Look at
  • Wait to be called on
  • Ask for help
  • Ask a peer
  • Follow direction
writing measurable goals43
Writing Measurable Goals

Criteria— Describes level of mastery such as much or how well the behavior is demonstrated

  • 9 out of 10 opportunities
  • 6 items
  • 75% accuracy
  • Increase by 10%
  • 3 times a day
  • On 9 consecutive attempts
  • For 15 minutes at a time
  • Within 5 minutes
  • 4 times weekly
  • 3 out of 5 days
  • 4 class periods
examples
Examples
  • Marci will have improved functional communication skills for indicating wants and needs.
    • Marci will use a system of words, pictures, gestures to indicate basic wants and needs during classroom activities. (8 of 10 trials)
    • Marci will use a picture schedule to follow daily classroom routines with minimal prompting. (8 of 10 trials)
    • Marci will use a system of words, pictures, gestures to participate in conversational routines with peers. (8 of 10 trials)
examples45
Examples
  • Chris will improve his social communication skills in the classroom setting.
    • Chris will raise his hand when he needs assistance or wants to share important information. (90% of time)
    • Chris will ask for help and accept teacher response when he doesn’t understand something. (80% of time)
    • With gestural prompts from peers and adults, Chris will limit conversational ideas appropriate to the setting. (90% of time)
goal attainment scaling

Goal Attainment Scaling

Much More than Expected

More than Expected

Annual Goal

Benchmark

Present Level

expanding children s iep goals through the goal attainment scale gas47
Expanding Children’s IEP Goals through the Goal Attainment Scale (GAS)

Goal Attainment Scale (GAS) is designed to document progress on IEP goals, objective, and benchmark.

Provides a summative rating to evaluate outcomes for students

prior to developing gas
Prior to Developing GAS
  • Review student’s IEP Goals with teacher/parents
  • Identify 3 priority goals for each target student
    • must be observable and measurable
    • must be agreed on by family and team
  • Collect data on present level of performance
description of scaling49
Description of Scaling

Consists of a five point range of performance for students:

Much less than expected(present level)

Somewhat less than expected (benchmark)

Expected level of outcome (annual goal)

Somewhat more than expected

Much more than expected

ways to change criteria
Ways to Change Criteria

Changing Prompt Level

  • Physical prompt (-2)
  • Gestural prompt (-1)
  • Verbal prompt (0)
  • Visual prompt (+1)
  • Independent (+2)

Changing Setting

  • One setting in school (-1)
  • Two settings in school (0)
  • 2 school settings plus 1 community setting (+2)

Changing People

  • No adults (-2)
  • Familiar adult (-1)
  • Unfamiliar adult (0)
  • With one peer (+1)
  • Across multiplepeers (+2)
measurement of goal progress
Measurement of Goal Progress
  • Measurement can be collected:
    • Within a class period
    • Across days
    • During a 15-min probe
    • By specific number of opportunities given
slide55
Jon
    • Jon is a preschool student with autism
    • Jon’s annual goal reads, “When entering the classroom in the morning and with a visual prompt Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.”
  • The classroom team took data prior to the meeting for everyday for two weeks and determined that Jon never greets peers or professionals
slide56

When he enters class, Jon does not greet his peers or teaching staff.

When entering the classroom in the morning and with a verbal prompt and picture cue , Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for a week

When entering the classroom in the morning and with a visual prompt, Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.

When entering the classroom in the morning without a prompt, Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.

When entering school in the morning and without a prompt, Jon will greet at least two peers by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.

slide57
Dan
    • Dan is a high school school student with autism
    • Dan’s annual goal reads, “Given 2 different 5-step vocational tasks and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.”
  • The classroom team took data prior to the meeting for three days a week for two weeks and determined that Dan is inconsistently performing job tasks. He never completes steps to tasks independently, needing frequent verbal, gesture and visual prompting.
slide58

Dan is inconsistently performing job tasks. He needs verbal, gesture and visual prompting to complete a task.

Given a 5-step vocational task and visual supports, Dan will complete 3/5 steps independently over 3 consecutive probe days.

Given 2 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

Given 3 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

Given any familiar 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

slide59
Sam
    • Sam is an 5th grade student with autism who is included in a general education classroom for most of the day.
    • Sam’s annual goal reads, “When presented with a conversational attempt from a peer support student, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days.”
  • A paraprofessional in the general education classroom took data for 5 days prior to the meeting. Peers initiated with Sam over 30 times, but Sam would just smile or laugh instead of responding verbally.
slide60

When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 0% of opportunities over 3 consecutive days across 3 different peers.

When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 40% of opportunities over 3 consecutive days.

When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days.

When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days across 3 different peers.

When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days across 3 different peers in 2 different settings.

slide61
Jack
    • Jack is a high school student with autism
    • Jack’s annual goal reads, “When arriving at school, Jack will walk to the classroom with verbal and visual prompts 4 out of 5 days for 3 consecutive weeks.”
  • The classroom team took data prior to the meeting for everyday for two weeks and determined that Jack dropped, refused to get up, and had to be lifted into a wheelchair and wheeled to the classroom 9 out of the 10 days.
slide62

Jack drops to the ground upon arrival and during various times throughout the day. When arriving at school, Jack has to be lifted into a wheelchair and wheeled to the classroom 9/10 days.

When arriving at school, Jack will walk to the classroom with verbal and visual prompts 2 out of 5 days for three consecutive weeks.

When arriving at school, Jack will walk to the classroom with verbal and visual prompts 4 out of 5 days for three consecutive weeks.

When arriving at school, Jack will walk to the classroom independently 4 out of 5 days for three consecutive weeks.

Throughout the school day, Jack will walk through the school building independently 4 out of 5 days for three consecutive weeks.

a script for implementing evidence based practices64

A script for implementing evidence based practices

Practice Writing GAS Goals

GAS Template

when you are choosing ebps
When you are choosing EBPs:
  • Think about the context
    • Does the EBP make sense for that environment?
  • Think about the student
    • Characteristics & Interests
    • Strengths & Needs
  • Think about the future
    • Will it promote independence and socialization
    • Will it lead to sustained learning or behavior change
combining ebps
Combining EBPs
  • EBPs are NOT usually used in isolation…
    • Self-management requires reinforcement
    • Video modeling may require prompting
    • FCT requires FBA
  • Professionals should be prepared to understand and implement a combination of EBPs