Developed under grant H324P04003 from the Department of Education.

Team Driven Tertiary Process: The Prevent-Teach-Reinforce

Model

Rose Iovannone, Ph.D.iovannone@fmhi.usf.edu

Carie English, Ph.D.cenglish@fmhi.usf.edu

University of South Florida

Acknowledgements

USF1. Don Kincaid

2. Kathy Christiansen

3. Sarah Donadio

4. Glen Dunlap

UCD1. Kelly Wilson

2. Patricia Oliver

3. Ted Bovey

4. Edy Purcell

5. Phil Strain

Objectives

Participants will:1. Describe an individual positive behavior

support process for use in the classroom

2. List factors impacting the effectiveness of an individual behavior support process

Individualized PBS (Tertiary)

For high-risk students:

– History of severe problem behaviors

– Demonstrated resistance to intervention

– An intensive system of support is needed

~15%

~ 80% of Students

~5%

Conceptualizing an Array of PBS Supports

Scott, 2001

Universal/Primary School-Wide Assessment

School-Wide Prevention SystemsClassroom Interventions

Targeted/

Secondary

Tertiary (Intensive)

AnalyzeStudent Data

Interviews,

Questionnaires, etc.

Observations and ABC Analysis

Multi-Disciplinary Assessment & Analysis

Simple Student Interventions (ERASE)

Group Interventions

Complex Individualized Interventions (PTR)

Team-Based Wraparound Interventions

Inte

rven

tionAssessm

ent

Tertiary Supports in Schools

Traditional process:1. Specialist/expert-driven

1. Complete an observation

2. Write a support plan

3. Call me if you have questions

Often contextual fit ignored

Limited support/follow-up/training provided

Prevent Teach Reinforce Process

Team driven process1. Goals, assessment, intervention plan

Support provided by facilitator1. Direct observation

2. Training and classroom implementation assistance

Contextual fit1. Greater buy-in and likelihood of

implementation

Prevent-Teach-Reinforce Model

Funded by US Dept. of Education/ Institute of Educational Sciences

Randomized control group design

Two sites—USF and UCD1. Three school districts central Florida2. Two school districts Colorado

Compare prescriptive, simple model to “business as usual”

Sample 200 students

1. 100 treatment; 100 wait-list control

Any student in K-8 grades who exhibit problem behavior

Problem behavior criteria1. Minimum 5 critical events indicated on Systematic

Screening for Behavior Disorders (SSBD)

2. Behaviors disruptive, durable (6 months), chronic (at least 1 time a week)

*USF site only

Sample Data MeasuresRepeated measures at student level

– Problem behaviors, social skills, academicsMediator and moderators at multiple levels:

– Student– Teacher/Classroom– System

ProcessStandardized approach Five step process facilitated by PTR Consultant

1. Team Development 2. Goal Setting 3. Assessment 4. Intervention

1. Coaching—up to 12 hours

5. Evaluation Manual including information and forms

Preliminary Data Results

Student Demographics by Ethnicity and Gender

Ethnicity N %age

American Indian 3 1.3

Asian 2 .9

Black 42 18.7

Hispanic 64 28.4

Other 7 3.0

White 112 49.8

Gender

Female 43 19.1

Male 182 80.9

Student Demographics by Primary DisabilityDisability N %

Autism 25 9.8

Developmental Delay 5 2.0

Emotional Disturbance 38 14.9

Mental Retardation 28 11.0

Multiple Disabilities 4 1.6

OHI (not ADD/ADHD) 1 .4

OHI (ADD/ADHD) 8 3.1

Specific Learning Disability 20 7.8

Speech/Language Disability 10 3.9

Visual Impairment 2 .8

General Education 99 38.8

Unknown 15 5.9

TOTAL 255

SSRS Social Skills

707274767880828486

Baseline Post-test Follow-up

Time Interval

Treatment n =107

Control n=90

d = .57

p < .000

Follow-up N 29/17

SSRS Problem Behavior

108110112114116118120122124126

Baseline Post-test Follow-up

Interval

Pro

ble

m B

eh

av

ior

Treatment N=69

ComparisonN=47

Follow-up N(16/9)

p < .000

d = .48

Academic Engaged Time

0.4

0.5

0.6

0.7

0.8

Baseline Post-test Follow-up

Treatment n=110

Control n=84

p = <.01d = .43

NBRCC Report 10-10-07

PTR Intervention more effective in:– Increasing social skills and decreasing

problem behaviors with students having most severe behaviors (measured by SSBD Maladaptive Behavior Scale)

– Increasing social skills and decreasing problem behaviors of males

NBRCC Report 10-10-07

Teachers participating in PTR indicated:– High social validity

– 98% liked PTR– 91% felt PTR reasonable

– High alliance (relationship) with consultant– Overall mean = 4.8 (SD = 0.45)

– Consultant is approachable

– Consultant and I trust one another

– Overall, consultant has shown sincere desire to understand and improve the situation

Social Validity Comparison USF—Sample Items

Item Pre Post

Like procedures 3.2 4.4

Acceptable 3.6 4.3

Teach appropriate behavior 3.5 4.3

Fit into existing routine 3.8 4.3

Total Social Validity Score 3.8 4.3

Fidelity

Most teams reaching 80% fidelity and maintaining into post-test

Quality scores lower than adherence scores

1. Part of the plan implemented although not entirely as plan written

The Process: A Case Study Example

Step 1: Team Development

Members and roles identified1. Teacher

2. Behavior specialist/school psychologist

3. Family members, paraprofessionals, special area teachers

Work styles inventory

Teaming survey

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

Case Study—Step 1: Team Building

Teacher-- Ms. Wonderful Aides

Ms. Needs Help Ms. Also Needs Help

Facilitator—PTR Consultant Results of teaming information indicate a

great team that meets regularly to brainstorm

Step 2: Goal Setting

Identify team consensus on:1. Academic behavior

2. Social behavior

3. Problem behavior

4. Appropriate behavior

Develop and begin baseline data collection

Case Study—Step 2: Goal SettingD

ecre

ase

Incr

ease

Bro

ad

Mike will communicate his wants and needs appropriately

Mike will interact with peers appropriately

Mike will comply with nonpreferred activities and requests

Mike will decrease screaming, hitting, and getting out of his seat

Mike will decrease hitting, screaming at, and bossing his peers

Mike will decrease screaming and hitting

Mike will ask for a break or for attention when needed

Mike will initiate peer interactions using his Dynamite

Mike will engage in nonpreferred activities and communicate his frustration using his Dynamite or an appropriate tone

Behavior Social Academic

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)

Case Study: Behavior Rating Scale With Anchors

Behavior Date

Screaming 9+ times7-8 times5-6 times3-4 times0-2 times

54321

54321

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Hitting 8+ times6-7 times4-5 times2-3 times

0-1 times

54321

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54321

54321

54321

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54321

Expressing Frustration

40%+30-40%20-30%10-20%

0-10%

54321

54321

54321

54321

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54321

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Transition to Nonpreferred

Whimper or squealLouder than indoor voice

Outdoor play voiceLouder than outdoor play

Ear penetrating

54321

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Step 3: Assessment

Checklist format:1. Antecedents or Triggers (Prevent)

2. Function(s) of the problem behaviors (Teach)

3. Consequences following the problem behaviors (Reinforce)

Assists team to link function of behavior to intervention plan

Case Study—Step 3: PTR AssessmentProblem Behavior

Prevention Data Teach Data Reinforce Data

Non-preferred task

1.Reading, Math

Transition

1.Preferred to

non-preferred

1.Change in schedule

Denied item, told no, or to fix

something

Other students upset/mad

Teacher attending to others

Gain attention

1.Peers, adults

Delay

Access to items

Redirected

Reprimanded

Calm/soothe

Personal

space

Later must

complete task

Loses/delays

reinforcers

Scr

eam

ing,

Hitt

ing

Case Study—Step 3: PTR AssessmentAppropriate Behavior

Prevention Data Teach Data Reinforce Data

Independent work

One-on-one

attention

Specials

Peer interaction

Getting attention

Raising hand

Sharing attention

Conversation skills

Taking turns

Waiting

Self-management

Asking for break

Expressing emotions

Treasure box

Movie

Attention

Helping teacher

Going to media

center

Going outside

Walk

Food

Pro

soci

al

Step 3: PTR Assessment—Developing the Hypothesis

When…. Student will….

As a result…

Inappropriate Behavior

Appropriate Behavior

Prevention data = antecedents or triggers

Teach data = replacement behavior and possible function

Reinforce data = function and reinforcers

Case Study—Step 3: PTR Assessment Possible HypothesesWhen…. Student will…. As a result…

Mike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to nonpreferred activity, fix an error, or when teacher attending to other students

scream and hit Mike is able to gain attention and delay the transition/activity

Mike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher attending to other students

express his frustrations appropriately

complete the assigned task

Mike is able to delay the transition/activity

Mike is able to gain attention

Inap

prop

riate

App

ropr

iate

Case Study: Tips on Linking Interventions to Hypothesis

Prevention strategies must address:1. Getting Mike attention more often2. Changing non-preferred task

1. Particular student2. How it is done (format)

3. Changing what happens when he makes a mistake1. Do part of it (rather than all of it) over2. Allow him to find what is wrong3. Provide social story

4. Signaling end of preferred activity

Teach strategies must address:1. How to get attention/assistance2. How to get break/delay appropriately

Reinforce strategies must address:1. Giving Mike attention/help2. Giving Mike break/delay

Step 4: InterventionTeam ranks top three intervention strategies in each of the PTR components

Multi-component intervention that teacher states s/he can implement

1. Prevent

2. Teach

3. Reinforce

Implementation plan

Case Study: Tips on Linking Interventions to Hypothesis

Prevention strategies must address:1. Giving Paris attention more often

2. Changing non-preferred task1. Presentation (how it is given to Paris; how it looks)

2. Content (embedding preferences)

3. Changing environment surrounding independent work time

Teach strategies must address:1. How to get attention appropriately

2. How to get a delay appropriately

3. How to access preferred item appropriately

Reinforce strategies must address:1. Giving Paris attention/help

2. Giving Paris a delay

3. Giving Paris access to preferred activities

Prevent Strategies

Specific Strategy steps

Environmental Support

A wait card will be placed on Mike’s desk to assist him in remembering to wait his turn.

1. Prior to group work, tell Mike, “Remember, when it is someone else’s turn, you sit quietly and wait,” while pointing to his card.2. If Mike calls out, point to his visual to remind him what to do. 3. Use a verbal prompt if the point prompt does not work.

Environmental Support

Mike’s visual schedule will be modified to detail the number of and type of activities he is to complete during non-preferred activities. For example, if math involves listening to a lesson, doing a hands-on activity, and completing a worksheet, his visual schedule will list each activity under math using either a picture of the type of activity or using numbers that correspond to a number on the worksheet.

1. Prior to the start of the activity, Mike should review the visual schedule.2. As Mike completes an activity, he should X off the activity.

Case Study—Step 4: PTR Intervention

Prevent Strategies

Specific Strategy steps

Curricular Modification

Mike will be given an easy, independent activity, such as a worksheet, to complete upon transitioning to a non-preferred activity or an activity that requires him to wait, such as group activities

Teach Strategies

Specific Strategy Steps

Replacement Behavior

Mike will be taught to use his Dynamite to express his need to calm down.

1. Mike’s device will be programmed to say “I need to calm down.”2. Prior to transitioning to a non-preferred activity or at the end of a preferred activity, remind Mike that “if you start to get mad, you can choose to calm down.”3. As soon as Mike starts to get upset, prompt him to use his device.4. Once Mike communicates “I need to calm down”, present him with the choice board of calming strategies and ask him, “What do you want?”5. As soon as he is calm, praise him. 6. Allow Mike to engage in his choice until he is calm for 1-minute.7. If Mike does not return to his area, then start having a fun time in that area with those students present

Teach Strategies

Specific Strategy Steps

Self-Management

Mike will be taught to independently use his calming strategies.

1. A tracking sheet with smiley faces and sad faces will be given to Mike at the start of each day.2. Role-play with Mike about when he needs to make the choice to calm down.3. Practice completing the tracking sheet.4. Set and review the daily goal for using the calming strategies. 5. Prompt Mike to complete the tracking sheet if needed

Reinforce Strategies

Specific Strategy Steps

Replacement Behavior

Anytime Mike “says” “I need to calm down”, his choice board should be given.

1. Praise Mike for communicating (“thank you for telling me.”)2. Provide his choice board.3. Allow him to calm for 1 minute4. Praise him as soon as he is quiet5. Praise him for returning to the group

Self-Management

Anytime Mike scores his behavior, attention should be given.

1. When Mike marks his tracking sheet, praise him for doing so.2. At the end of the day, review the sheet with Mike.3. Talk about the sad faces.4. Provide his reward if his goal is met.

Waiting Mike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule.

Reinforce Strategies

Specific Strategy Steps

Transition Mike will earn stars during Reading Centers if he transitions and completes his work without screaming.

1. A social story will be reviewed prior to Reading Centers to remind Mike that he can earn a star if he comes to centers and works.2. At the end of each reading center, an adult will review Mike’s behavior with him and ask him if he earned his stars. 3. Provide his stars if earned.4. During the teacher’s group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group.5. Allow Mike to participate in his chosen activity if he earned his stars.

Coaching of Interventions

Training of teacher1. 1 to 2 hours2. 80% accuracy on all strategies

Assistance in classroom1. Up to 12 hours

Fidelity measures recorded1. 80% implementation terminates

assistance in classroom

Case Study: Training

Task Analysis of Intervention Dis

cuss

Q

& A

V

erb

al

Rol

e-p

lay

Ob

serv

e F

eed

bac

k

Training

Review

PREVENT – Environmental Support 1. Mini schedule of group & center time available Yes No Yes No

2. Schedule reviewed prior to task Yes No Yes No

3. Schedule reviewed & items crossed off Yes No Yes No

TEACH – Replacement Behavior

1. Remind to use DynaVox prior to transition Yes No Yes No

2. Provided choice board and honored choice Yes No Yes No

REINFORCE –Replacement Behavior

1. Verbally or gesturally acknowledge ASAP Yes No Yes No

2. Allowed to cool off for 1-minute Yes No Yes No

TOTAL (# Yes/ # Total) Fidelity Score ( .00 – 1.00)

Case Study: Fidelity

Interventions Adherence Quality Environmental Support 1) Mini schedule of center & group available 2) Mini schedule reviewed prior to start of

centers 3) Items crossed off as completed

Mini schedule present

Mini schedule present & reviewed at least either prior to or after activities completed

Replacement Behavior—Functional 1) Reminded student to use DynaVox prior to

transition & when student engaged in warning signs

2) Choice board given 3) Choice honored

Teacher reminded student prior to transition or behavior

Teacher reminded student prior to at least 2 of 3 transitions & all behavior

Reinforce Replacement Behavior 1) Teacher immediately recognized student

for using DynaVox (within 15 s) 2) Allowed to calm down for at least 1-minute

Teacher recognized student

Teacher immediately (within 15 seconds) recognized student and allowed student to calm down

Step 5: Evaluation

Data-based decision-making1. Identifying what is working; what is not and

WHY

Expanding into other routines

Generalization

Continuing team meetings1. Planning time

2. Cohesiveness

Screaming

1

2

3

4

5

14-D

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BaselineIntervention

Definition Changed

Step 5: Evaluation

1 is a lot of screaming, 5 is no screaming

Hitting

1

2

3

4

5

Ra

tin

g

BaselineIntervention

Step 5: Evaluation

1 is a lot of hitting, 5 is no hitting

Step 5: Evaluation Expression of Frustration

1

2

3

4

5

14-D

ec

7-Dec

12-D

ec

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n8-

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ay

Rat

ing

BaselineIntervention

1 is a little appropriate expression, 5 is a lot of appropriate expression

Transition to Nonpreffered

1

2

3

4

5

Rat

ing

BaselineIntervention

Step 5: Evaluation

1 is inappropriate transition, 5 is super appropriate transition

Step 5: Evaluation Other Outcome Data

Measure Baseline Post-test Change

SSRS-PB 123 112 -11

SSRS-SS 87 102 +15

AET .34 .57 +23

Wrap Up:What We Have Learned

PTR process may not be enough for all students

Some need wraparound

Not all students need PTR3-tiered model of individual support

Teachers report the coaching piece and collaborative process to be keys

How to Make PTR Work in Your School

Steps are the key components not how your organize themMust create a system that will work for your school or even each studentThings to consider

1. Tertiary team2. Identification/Nomination process3. Facilitator 4. Set-up of meetings for efficient results

Organizing the PTR Process

Is Team Building needed?1. Small team, team works well together, no

paraprofessional

If small team or no paraprofessional, skip and start with Goal Setting

If well functioning team, combine with Goal Setting

Organizing the PTR Process

Few problem behaviors or all in same response class?

1. Same antecedents &/or function2. Small team

Combine Assessment with Intervention DevelopmentCondense the steps to meet the needs of your school

Final Thoughts: System Changes

Process may require more time up front but less time overall

1. Must provide assistance in the classroom until desired outcomes achieved

2. Will pay off in the end

Teams more likely to implement the plan1. Ownership

2. Fits the class and the student

3. Continued contact

Questions?