Prevent-Teach-Reinforce: A Teacher Validated Function-Based Intervention

1. Prevent-Teach-Reinforce: A Teacher Validated Function-Based Intervention Presented by: Rose Iovannone, Ph.D., BCBA

2. Tier 3 Function-Based Behavior Interventions in Schools Issues Absence of uniform policies & practices Form versus a process Expert driven versus collaborative effort Occasionally contextual fit considered Limited support/follow-up/training for teacher provided

3. What is Prevent-Teach-Reinforce (PTR)? Research project funded by U.S. Department of Education University of South Florida University of Colorado, Denver Evaluate effectiveness of PTR process vs. �business as usual� Randomized controlled trial Intervention �Package� ONE �P�revent; ONE �T�each; ONE �R�einforce Based on ABA principles and individual Positive Behavior Support

4. What is Prevent-Teach-Reinforce (PTR)? Primary Research Questions: Is the PTR intervention more effective than control conditions (�business as usual�) in decreasing severe problem behaviors of students? Social Skills Rating System�Problem Behavior Scale (repeated measures�3 time intervals) Does the PTR intervention improve the academic and pro-social performance and participation of students with severe problem behaviors? Social Skills Rating System (SSRS)�Social Skills Scale (repeated measures�3 time intervals) Academic Engaged Time (AET)�(repeated measures; two 15 minute observations of student during independent work time, 3 time intervals)

5. Who is Participating? Florida Schools Three central Florida school districts Colorado Public Schools Two Colorado school districts 200 students in sample 100 treatment 100 wait-list comparison

6. Participants K-7th grade Behavioral difficulties Intensity� disruption to the learning environment Frequency� minimum of 1 time per week Duration� minimum 6 months General or Special Education All cognitive levels All disabilities Teachers volunteered & nominated 1-3 students Top externalizers Systematic Screening for Behavior Disorders (SSBD)

7. Process Standardized Individual Positive Behavior Support approach Intervention teams provided manual, assignments, homework Five step process facilitated by PTR Consultant Team Development Goal Setting Assessment Intervention and Coaching Evaluation

8. Preliminary Outcomes of PTR Process

9. Student Demographics by Disability

10. Student Description

14. Social Validity Modified Teacher Acceptability Rating Form (TARF; Reimers & Wacker, 1988)�15 items 5-point Likert Scale 1 (most unacceptable) 5 (most acceptable) 124 teachers Overall�4.16 (.52) Willingness to carry out plan�4.80 (0.42) Like the procedures�4.46 (0.64)

15. PTR: The Process

16. Step 1: Team Building Team Development Include relevant stakeholders Team Collaboration�enhancers and inhibitors Tools Chapter 1 Work style survey Teaming survey

19. Case Study�Step 1: Team Building Mike is a 9-year-old male in a self-contained autism classroom Nonverbal�uses signs, Dynamite, and pictures to communicate 1 teacher, 2 aides, and 6 students Team included teacher, aides, PTR facilitator

20. Step 2: Overview Goal Setting Team: Engages in a process of identifying problem behavior and possible replacement behaviors to target three areas: Academic Social Behavior Defines short term goals in operational and measurable terms Prioritizes short term goals and develops a baseline data collection system

21. Mike�Baseline

23. Step 2: Identify Baseline Data Collection System Baseline data gathering Identify minimum one problem behavior and one appropriate behavior Operationally define all targeted behaviors Develop Behavior Rating Scale

24. Using the Behavior Rating Scale (BRS) Perceptual rating Behavior recorded at least once daily May be specific to a setting, activity, time of day May be whole day May be combination of both Use anchors on a scale of 1-5

25. Determining the Anchors on the BRS Behavior can be measured using Frequency (times per day) Duration (hours, minutes, seconds) Intensity (how hard, how loud, bruise, etc.) Percent of day Percent of occurrence Percent of opportunity

26. Case Study: Operational Definitions of Problem and Replacement Behaviors Screaming�loud, high pitched noise heard outside the classroom Hitting�anytime Mike touches peers or adults with an open hand, fist, foot, or object while screaming or protesting Expressing Frustration�using Dynamite, pictures, or signs to ask for a break or attention Transition to nonpreferred activities�moving to nonpreferred activity and engaging with appropriate verbal expression (screaming level)

28. Kappa Scores

29. Step 3: Functional Behavior Assessment Process

30. Step 3: PTR Assessment (FBA) PTR Assessment (FBA) Each team member independently answers a series of questions related to: Observed antecedents/triggers of problem behaviors Functions of the problem behaviors Consequences ordinarily associated with the problem behaviors Synthesized input leads logically to development of three intervention components (prevent, teach, reinforce) PTR facilitator develops draft hypothesis and presents to team for consensus

36. Case Study�Step 3: PTR AssessmentProblem Behavior

37. Case Study�Step 3: PTR AssessmentAppropriate Behavior

38. Case Study�Step 3: PTR Assessment Possible Hypotheses

39. Step 4: Designing a Behavior Intervention Plan

40. Step 4: PTR Intervention Team selects appropriate interventions for each component (prevent-teach-reinforce) from a menu of options Behavior intervention plan developed Consultant provides training and on-site assistance for final interventions agreed upon Fidelity of implementation measured

42. Step 4: PTR Intervention Writing the Intervention Plan Task analyze each step of the plan NOT� �give student choices� YES� �at start of reading, tell student �we have 2 worksheets today (show worksheets). Which worksheet would you like to do first?�� If teachers do not know how to do it, they will not implement the strategy

43. Case Study�Step 4: PTR Intervention

49. Step 4: PTR Intervention Teacher Training on BIP Provide training to practice the plan without student Ask the team questions to ensure understanding Have team role-play steps Obtain 80% accuracy prior to teacher implementing plan with student

50. Case Study: Training

51. Coaching Video

52. Step 4: PTR Intervention In-Class Coaching Provide up to 12 hours in the classroom Model the plan Provide feedback Discuss need for modifications if applicable

53. Step 4: PTR Intervention Fidelity Adherence�did they do it? What is the most important part of intervention to be implemented to ensure intervention happens? Quality�did they do it correctly? What are all the parts that need to be implemented completely and correctly?

54. Case Study: Fidelity

55. Case Study: Post-Intervention Video

56. Step 5: Evaluation Is it working? Daily ratings of behavior Continuous progress monitoring BRS Other data collection forms Is it being implemented consistently and accurately? Fidelity ratings Do we need more data? Does the plan need to be modified or expanded? Plan for generalization and maintenance

57. Step 5: Evaluation Case Study: Data

58. Step 5: Evaluation

59. Step 5: Evaluation

60. Step 5: Evaluation

61. Step 5: Evaluation

62. Step 5: Evaluation Other Outcome Data

63. Review PTR Process Five-step team-based process Meetings last 30-120 minutes Training of teacher in BIP In-class coaching provided Most teams in study completed PTR process within 71 days

64. Next Steps Making process more efficient Three meetings Prior to first meeting�form team Meeting 1�Steps 2 & 3 Meeting 2�Step 4, schedule coaching and first day of implementation Meeting 3�Step 5 Analysis of P-T-R categories relation to behavior change

65. News and Noteworthy iovannone@fmhi.usf.edu Manual will be published by Brookes (Fall 2009?) Two journal articles in 2009 Journal of Positive Behavior Interventions�Case study Journal of Emotional Behavioral Disorders�Preliminary outcomes Next steps: Facilitating schools to scale up Training key school staff and team members to do process

66. Questions?