prevent-teach-reinforce model: a tier 3 behavior intervention process

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Prevent-Teach-Reinforce Model: A Tier 3 Behavior Intervention Process. Rose Iovannone, Ph.D., BCBA-D University of South Florida iovannone@usf.edu 813-974-1696. The contents of this training were developed under grant H324P04003 from the Department of Education. Agenda. AM PTR Overview - PowerPoint PPT Presentation

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Individual Student Training

Prevent-Teach-Reinforce Model: A Tier 3 Behavior Intervention ProcessRose Iovannone, Ph.D., BCBA-DUniversity of South Floridaiovannone@usf.edu813-974-1696

The contents of this training were developed under grant H324P04003 from the Department of Education

AgendaAMPTR OverviewStep 1TeamingStep 2Goal SettingStep 3PTR AssessmentPMStep 4aPTR Intervention PlanStep 4bCoaching/FidelityStep 5EvaluationSummary/QuestionsObjectivesParticipants will:Describe the 5-step PTR Tier 3 support modelIdentify the critical components that enhance the success of Tier 3 supportsApply the principles of the PTR process to a case studyDetermine how the PTR process is applicable within their setting

3Tier 3 Function-Based Behavior Interventions in SchoolsCurrent IssuesAbsence of uniform policies & practices Form versus a process Expert driven versus collaborative effortOccasionally contextual fit consideredLimited support/follow-up/training for teacher providedTeachers may not be the personnel to facilitate FBAs in schoolsIncreased focus on school psychologists (Scott & Kamps, 2007) and other school-based behavioral consultants or coaches

4What is Prevent-Teach-Reinforce (PTR)?Research project funded by U.S. Department of Education, Institute of Education SciencesUniversity of South Florida Three central Florida school districtsUniversity of Colorado, DenverTwo Colorado school districts

Purposes:Answer the call for rigorous researchEvaluate effectiveness of PTR vs. services as usual using randomized controlled trialEvaluate effectiveness of standardized approachSame steps, same procedures, all plans with 3 components (prevent, teach, reinforce)

5Where is PTR in a Multi-tiered System of Supports (MTSS)?

Primary Research Questions Is the PTR model more effective in decreasing severe problem behaviors than services as usual? (services as usual defined as the typical behavior services/supports that would be provided within the school setting).

Does the PTR model improve the academic performance and pro-social interactions of students with severe problem behaviors?

Participants200+ students100 treatment, 100 comparison

K-8th grade

General and Special EducationAll cognitive levelsAll disabilities

Teacher-nominated top externalizersSystematic Screening for Behavior Disorders (SSBD)

Behavioral difficultiesDuration minimum 6 monthsFrequency minimum of 1 time per weekIntensity disruption to the learning environment

8Prevent-Teach-Reinforce: PTRIntervention teams given manual and assigned PTR consultant

Five step process (aligned with problem solving process):TeamingGoal Setting (Identification of Problem)Functional Assessment (Problem Analysis)Intervention (Intervention Implementation)Coaching and fidelityEvaluation (Monitoring and Evaluation of RtI)910PTR Preliminary Outcomes

10Student Demographics by Primary DisabilityDisabilityN PercentAutism259.8Developmental Delay52.0Emotional Disturbance3814.9Mental Retardation2811.0Multiple Disabilities41.6OHI (not ADD/ADHD)1.4OHI (ADD/ADHD)83.1Specific Learning Disability207.8Speech/Language Disability103.9Visual Impairment2.8General Education9938.8TOTAL 245 1111Student DescriptionGrade LevelK12345678N345353413016783%13.921.621.616.712.26.52.93.31.2Lunch StatusRegularFree/Reduced7715031.461.2GenderFemaleMale4520018.481.6

Randomized Controlled Trial ResultsWait-List Control to Treatment Results

Teacher OutcomesFidelityMajority of teachers achieved .80Mean # coaching/training sessions = 3.5Prevention higher than Teach and Reinforce

Social ValidityModified Teacher Acceptability Rating Form (TARF; Reimers & Wacker, 1988)15 items5-point Likert Scale124 teachersOverall4.16 (.52)Willingness to carry out plan4.80 (0.42)Like the procedures4.46 (0.64)

AllianceTeachers rated PTR consultants highly (4.80 mean)Highesttrust, follow-through, collaborative

Follow-Up Six Months after Intervention:

Social skills and problem behavior outcomes sustaining

Academic Engaged Time (AET) not sustainedSignificant difference from post-test to follow-up

The PTR Process

Making PTR More EfficientTwo primary meetings to get to intervention

Meeting 1Step 1 (optional): TeamingStep 2: Identify the problem/Goal SettingDefine the behaviors to be targeted for FBA (behaviors to be decreased)Define the behaviors targeted for increase (potential replacement behaviors)Set up Individualized Behavior Rating Scaleteam collects baseline data prior to meeting 2Step 3: Analyze the problem/PTR AssessmentConduct FBA with team (interview or have team complete form in 15-20 minutes)Complete FBA organization table and develop hypothesis or summary statementGet consensusMaking PTR More EfficientMeeting 2 (in perfect world, scheduled one week after meeting 1)Team has been collecting baseline data on IBRST

REMEMBER TO REVIEW IT AT MEETING

Step 4: Develop and Implement Intervention/PTR Intervention PlanTeam comes to consensus on 3 primary intervention:One prevent (modifies the context in the hypothesis)One new skill to teach (functional replacement or physically incompatible behavior)One to reinforce (reinforce new replacement behavior so that it will be repeated, one to follow problem behavior so that the behavior no longer gets the outcomes (function)Task analyze the strategies with the teacher so that it fits the contextSchedule a separate time to coach/train the teacher (30 min.)Plan fidelity measures (observation, self-assessment)Teachers continue to take IBRST data every day (draw vertical line down column showing date intervention begins).Making PTR More EfficientMeeting 3Step 5-Evaluate

Review data including (a) student outcomes-IBRST; (b) teacher outcomes-Fidelity

Make decisions on next steps based on dataThe PTR Process5-stepsProblem SolvingStep 1: Teaming (Before the Process is Started) Teaming: A collaborative process

Determine relevant team members

Suggestions3 levels of knowledge represented:Members Person with knowledge of student (e.g., Classroom teacher, instructional assistant, parent)Someone with expertise in functional assessment, behavioral principles (PTR consultant, school-based consultant)Someone with knowledge of context (e.g., administrator or designee)

22Teaming: ConsiderationsPurpose:Evaluate strengths and weaknesses of team functioningOutline roles and responsibilitiesDetermine a consensus-making processRationaleThe team is implementing the interventionGreater buy-in correlated with collaborative processes

Collaboration ActivityTeaming (PTR Style)Optional forms

Best used for situations in which the team may not be collaborating effectively

Forms for creating an effective cohesive teamClassroom Team SurveyTeacher Work-Style SurveyParaeducator Work-Style SurveyPTR Work-Style Comparison Sheet (used by facilitator)

Purposes: To identify potential issues enhancing and impeding effective intervention implementationCollaborative Facilitation TipsTake off the expert hat

Avoid direct confrontation or fixing issuesPurpose is for team to recognize potential issues that enhance and inhibit problem solving process

Less talk, more listening and facilitating

Provide visual summary while facilitatingallow reflection and discussion by teamAsk them to review the results and reflectAsk for their ideas, reactions, inputFacilitate the discussionGuide them to use science in making decisions

Step 2-Goal SettingProblem Solving Process = Identify the problemWhat Determines Success?Analysis of outcomes of 800+ consultation cases involving elementary students

Problem identification = 43%

Problem analysis & plan development = 31%

Goal attainment occurred in 97% of cases in which a plan was implemented

consultants successful in identifying problems were almost invariably able to solve those problemsBergan & Tombari, 197628Bergan and Tombari (1976) studied over 800 consultation cases (children in grades K 3 referred for psych services), found that in only 43% and 31% of cases referred for help were problem identification and analysis (i.e., culmination in development of a plan to implement) stages, respectively, successfully met. In 97% of cases in which a plan was able to be developed and implemented, the pre-determined outcome level was established (i.e., goal attainment was reached).

Also important what contributed to completion of the problem identification stage?- largely, consultant skills, particularly the (a) flexibility of the psychologist in applying psychological principles (i.e., in selecting interventions) and (b) index of message control.

Take away points:Thus, we need to put efforts up front and successfully do problem analysis (what are factors that make problem occur) and goal setting.Need intensive training in effective consultation skills, because when a psychologist lacked skills or was inefficient, s/he was likely to select a course of action beside problem id, including testing, SPED referrals, move to another school, referral to other mental health agency

Study details: interviewing skills of consultant assessed by transcribing problem id and problem analysis interviews by psychologists/consultants; interviews were then coded for message content, message process, and message control. Yielded 4 measures of interviewing skills: (a) relevancy of interview content to problem id and analysis, (b) content focus staying on topic, (c) psychologist verbal processes- using more specification, summarization, and validation utterances, and (d) message control- asking more questions to elicit information or action on the part of the teacher.

Problem-solving measures: ca

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