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Secondary Prevention: Targeted Interventions Christine McGrath Davis, Ph.D.
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Secondary Prevention: Targeted Interventions Christine McGrath Davis, Ph.D.

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  1. Secondary Prevention: Targeted Interventions Christine McGrath Davis, Ph.D. The May Institute, Inc. SERC Training Middletown, CT 6 September, 2005

  2. Overview • Discuss prevention efforts • Define the features and purpose of “targeted interventions” • Describe targeted approaches • Present research examining these approaches • Provide examples • Review targeted team process

  3. The Challenge • Students come to school without skills to respond to instructional and behavioral expectations (Sprague, Sugai & Walker, 1998) • Teachers report that “uncivil” behavior is increasing and is a threat to effective learning (Skiba and Peterson, 2000) • Students who display severe problem behavior at-risk for segregated placements (Reichle, 1990)

  4. The Challenge • Exclusion and punishment are the most common responses to severe problem behavior in schools (Lane & Murakami, 1987; Patterson, Reid & Dishon, 1992) • Exclusion and punishment are ineffective at producing long-term reduction in problem behavior (Costenbader & Markson, 1998; Walker et al., 1996)

  5. The Challenge • Punishing problem behaviors, without a proactive support system is associated with increases in: • aggression • vandalism • truancy • dropping out (Mayer, 1995; Mayer & Sulzar-Azaroff, 1991)

  6. The Response • Need a prevention focus • “Schools that are safe, effective, and controlled are not accidents” (Sugai, Sprague, Horner & Walker, 2000) • Need to build school capacity to support all students • Need a continuum of behavior support • Level and intensity of intervention matches severity of problem behavior

  7. Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT 1-5% Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior 5-10% Primary Prevention: School-/Classroom- Wide Systems for All Students, Staff, & Settings 80 - 90% of Students

  8. Designing School-Wide Systems for Student Success Academic Systems Behavioral Systems • Intensive, Individual Interventions • Individual students • Assessment-based • High Intensity • Intensive, Individual Interventions • Individual students • Assessment-based • High Intensity 1-5% 1-5% 5-10% 5-10% • Targeted Group Interventions • Some students (at-risk) • Rapid Response • Targeted Group Interventions • Some students (at-risk) • Rapid Response 80-90% 80-90% • Universal Interventions • All settings, all students • Preventative, proactive • Universal Interventions • All settings, all students • Preventative, proactive Sugai, Horner & Gresham (2002)

  9. Individualized, Function-Based Behavior Support Plans • Intensive Academic Support • School-based Adult Mentors • Intensive Social Skills Training • Parent Training and Collaboration • Multi-Agency Collaboration (Wrap-Around) • Alternatives to Suspension and Expulsion Intensive (High Risk Students) Individual Interventions 1% - 5% of Students Targeted (At-Risk Students) Individual & Small Group Strategies 5% - 10% of Students • Intensive Social Skills Training and Support • Self-Management Programs • School-Based Adult Mentors (Check-In) • Increased Academic Support and Practice • Alternatives to School Suspension Universal (All Students) School-Wide Systems of Support 80% - 90% of Students • Effective Academic Support • Teaching Social Skills • Teaching School-Wide • Expectations • Active Supervision & Monitoring • in Common Areas • Positive Reinforcement for All • Firm, Fair, Corrective Discipline • Effective Classroom Management

  10. Discipline is… • The actions parents and teachers take to increase student success (Charles, 1980). Prevention Rules, Routines, Arrangements Reaction Positive and Negative Consequences Scott (2005)

  11. Positive Behavioral Interventions & Supports Supporting Decision Making Supporting Staff Behavior DATA SYSTEMS PRACTICES Supporting Student Behavior

  12. Emphasis on Prevention • Primary • Reduce new cases of problem behavior • Secondary • Reduce current cases of problem behavior • Tertiary • Reduce complications, intensity, severity of current cases

  13. Secondary Prevention • AKA: • Targeted Interventions • Selected Interventions • Yellow Interventions

  14. Targeted Interventions:Key Features • Screening and Identification • Functional Assessment • Intervention / Implementation • Evaluation

  15. Screening & Identification • Routine review of individual student data • Efficient teacher referral system • Parent referral • Screening tools • Assessment of risk factors

  16. Early Identification / Intervention:Who needs targeted interventions? • Academic Support • Dynamic Indicators of Basic Early Literacy Skills (DIBELS) • • Curriculum Based Measurement (CBM) •

  17. Early Identification / Intervention:Who needs targeted interventions? • Behavioral Support • Systematic Screener for Behavior Disorders (SSBD) (Walker & Severson, 1990) • Office Discipline Referrals • Behavioral Incident Reports • Request for Assistance

  18. Identify Students in Need of Support: A Multiple Gate Approach: • A Multiple Gate Approach is an efficient method for quickly identifying students who might be in need of additional academic and social supports. • Usually employs three “gates” • 1. Teacher rating of externalizing and internalizing behaviors. • 2. Records review, including attendance, academic performance, behavior reports. • 3. Direct observations of class by trained professional (e.g. school psych, social worker, counselor, etc..) • Parent Interview & Discussion • 1. Meet with parents and discuss opportunity for their child to a participate in a program that will offer additional supports. • 2. Support may include academic tutoring, study skills, social development, organizational support, etc..

  19. Identify Students in Need of Support: School Data • Summarize Office Discipline Referral data • School-Wide Information System (SWIS) • Spreadsheet Program (e.g. Excel) • Develop a referral process • All staff trained on process • Differentiate behavior handled in classroom vs. office & Major vs. Minor rule infractions • Support referral by teacher, staff, or parent

  20. Efficient Request for Assistance • Process includes description of: • the problem behavior, • the problem context or setting, • previously attempted interventions and their outcomes, and • the kind of assistance being requested (e.g., assessment, intervention planning) Todd, Horner, Sugai & Colvin (1999)

  21. Assessment • Functional assessment that includes analysis of academic, social, and behavioral features of the student’s education. • Curriculum revision is examined to determine the extent to which • student educational responding is occurring and • student educational success is occurring. • Focus is on assessment and remediation, not “diagnosis and placement.” FACTS

  22. Intervention & Implementation Proactive:What environmental adjustments will be used to make the student’s problem behavior unnecessary? Educative:What behaviors (skills) will be taught to replace or meet the same function as the student’s problem behavior and improve his/her ability to function more effectively? Functional:How will consequences be managed to insure the student receives reinforcers for positive, and not problem behavior?

  23. Evaluation • Measurable student outcomes • Formative & Summative questions developed • System to track students in targeted groups • Regular review and modification • Involve all key stakeholders

  24. Targeted Interventions: Critical Features • Intervention is continuously available • Rapid access to intervention (72 hr) • Very low effort by teachers • Consistent with school-wide expectations • Implemented by all staff/faculty in a school • Flexible intervention that is function-based • Adequate resources (admin, team) • weekly meeting, plus 10 hours a week • Student chooses to participate • Continuous monitoring for decision-making

  25. Why do Targeted Interventions Work? • Improved structure • Prompts are provided throughout the day for correct behavior. • System for linking student with at least one positive adult. • Student chooses to participate. • Student is “set up for success” • First contact each morning is positive. • “Blow-out” days are pre-empted. • First contact each class period (or activity period) is positive. • Increase in contingent feedback • Feedback occurs more often. • Feedback is tied to student behavior. • Inappropriate behavior is less likely to be ignored or rewarded.

  26. Why do Targeted Interventions Work? • Program can be applied in all school locations • Classroom, playground, cafeteria (anywhere there is a supervisor) • Elevated reward for appropriate behavior • Adult and peer attention delivered each target period • Adult attention (and tangible) delivered at end of day • Linking behavior support and academic support • For academic-based, escape-maintained problem behavior incorporate academic support • Linking school and home support • Provide format for positive student/parent contact • Program is organized to morph into a self-management system • Increased options for making choices • Increased ability to self-monitor performance/progress

  27. Examples of Targeted Interventions • Academic Support • Family Support and Parent Management Training • Behavioral Contracting • The Behavior Education Program (BEP) • Check and Connect • Newcomer’s Club • Social Skills Training • Mentoring

  28. First Step to Success (Walker, Kavanaugh, Golly, Stiller, Severson & Feil, 1995)

  29. First Step to Success • Appropriate for at-risk Kindergarten / 1st Grade Students • Primary goals: • Divert antisocial behavior • Develop competencies needed to build effective behavioral adjustment

  30. First Step to Success • Targets three social agents having greatest influence on child: (Reid, 1993) • Parents / caregivers • Teachers • Peers • Three Modules: • Universal screening to detect at-risk students • School-based intervention • Home-based intervention

  31. Overview of First Step Program Components • Universal Screening Module • Evaluate each Kindergarten student in relation to behavioral indicators of emerging antisocial behavior patterns • Identify Kindergarten students who show elevated risk status and could benefit from early intervention • School Intervention Module • 30 successful program days • Three phases • Consultant (Days 1-5) • Teacher (Days 6-20) • Maintenance (Days 21-30) • Home Intervention Module • Enable parents to build child’s skills/competencies in 6 areas: • Communication and Sharing in School • Cooperation • Limits Setting • Problem Solving • Friendship Making • Development of Confidence

  32. First Step to Success: Outcomes • Longitudinal results indicated students in First Step Intervention displayed: • Increased academic engaged time (AET) • Decreased aggressive behaviors (within the normative range) (CBCL Aggression Subscale) Walker, Kavanaugh, Stiller, Golly, Severson & Feil (1998)

  33. Targeted Group Supports • For those students who exhibit difficulties despite proactive school-wide prevention efforts • Likely to be student with both academic & behavioral challenges • Approximately 10% of school population

  34. Behavior Education Program (BEP) Crone, Horner & Hawken (2004)

  35. Elements of the BEP • Organization/Structure • Identification/Referral • Contract/Agreement • Basic BEP Cycle • Functional Assessment • Design of Support • Data Collection and Decision Making

  36. Organization and Structure • BEP Coordinator • Chair BEP meetings, faculty contact, improvement • BEP Specialist • Check-in, check-out, meeting, data entry, graphs • Together (Coordinator + Specialist) = 10 hours/wk • BEP Team Meeting 45 min per week • Coordinator, Specialist, Sped faculty, Related Services • All staff commitment and training • Simple data collection and reporting system

  37. BEP Plan Weekly BEP Meeting 9 Week Graph Sent Morning Check-In Program Update Daily Teacher Evaluation Home Check-In EXIT Afternoon Check-In BEP Cycle Crone, Horner & Hawken (2004)

  38. What each student experiences at start of his or her school day: • Greeted (positive, personal, glad to see you) • Scanned (ready to go to class?) • Readiness check (books, pencils, etc?) • Gets piece of paper (prompt for positive interaction)

  39. Daily Progress Report

  40. APPROPRIATE Low-level problem behavior (not severe) 3-7 referrals Behavior occurs across multiple locations Examples talking out minor disruption work completion INAPPROPRIATE Serious or violent behaviors/ infractions Extreme chronic behavior (8-10+ referrals) Require more individualized support FBA-BIP Wrap Around Services Functional Assessment:Who can benefit from a BEP?

  41. Daily Data Used for Decision Making

  42. Daily Data Used for Decision Making

  43. Conduct Brief Functional Assessment Is the behavior maintained by peer attention? Is the behavior maintained by escape from social interaction? Is the behavior related to lack of academic skills? Escape Motivated BEP Reduce adult interaction Use escape as a reinforcer • BEP + Academic Support • Increase academic support Peer Motivated BEP Allow student to earn reinforcers to share with peers Crone, Horner & Hawken (2004)

  44. Importance of Functional Assessment in BEP

  45. Weekly BEP Features • Summarize weekly data for each BEP student • Print graphs from excel file • Prioritize BEP students • BEP coordinator should choose about 5 students of concern to prioritize for BEP meetings • Make data-based decisions • Award reinforcers • Discuss new candidates for the BEP • Assign tasks (develop action plan)

  46. Quarterly BEP Features • Provide feedback to teachers and staff and to the students and their families • Acknowledge the right of parents, staff, and students to be informed about their school or their child • Maintain interest and involvement • Recognize and encourage accomplishments • Point out needed areas of improvement (new goals) and achieve collaboration in meeting those goals

  47. Check-in / Check-out Program H.U.G. Program (Hello, Update, Good-bye) (Tigard-Tualatin School District, Oregon) Bethel School District (Eugene, OR)