Advanced Behavior Interventions

Report
Advanced Behavior
Interventions
Rose Iovannone, Ph.D., BCBA-D
[email protected]
813-974-1696
Agenda
• Technically Adequate FBAs/BIPs
• Refresher of PTR
• Linking hypotheses with behavior
interventions
• Behavior interventions
Objectives
• Participants will:
– Develop a task analyzed behavior intervention plan
that is linked to a FBA hypothesis that includes:
• A prevention intervention
• A replacement skill
• A functional equivalent reinforcer
– Complete a coaching checklist for training others to
implement the plan
– Complete a fidelity measure
– Identify key coaching/consultation skills
ESSENTIAL COMPONENTS
TECHNICALLY ADEQUATE FBA/BIPS
Core Components of Technically
Adequate FBAs/BIPs
• FBA
–
–
–
–
–
–
Input sought from multiple sources
Problem behavior that is focus of FBA identified and clearly defined
Baseline data indicate target behavior is a problem
Antecedents that predict problem behavior clearly identified/described
Setting events considered and (if applicable) clearly identified/described
Antecedents that predict absence of problem behavior clearly
identified/describes
– Consequences (responses of others) immediately after problem behavior
identified and described
– Hypothesis developed from FBA data and includes antecedents, setting events
(if applicable), behavior, and function
– Function is one recognized and identified by “leaders” in the field
• Social reinforcement—e.g., obtain/get attention, tangibles, activities, sensory
• Negative reinforcement—e.g., escape/avoid/delay/terminate attention, tangibles,
activities, sensory
Core Components of Technically
Adequate FBAs/BIPs
•
BIP
– Developed relatively soon after FBA (e.g. within 30 days)
– FBA hypothesis is included or referenced on BIP
– Minimum of one antecedent strategy:
•
•
•
Included
Linked to FBA hypothesis (when)
Described in enough detail to pass “stranger test”
– Minimum of one teach strategy:
•
•
•
Included
Linked to FBA hypothesis (functional equivalence or incompatible behavior)
Described in enough detail to pass “stranger test”
– Minimum of one reinforce strategy:
•
•
•
–
–
–
–
Included
Linked to FBA hypothesis (functional equivalence provided)
Described in enough detail to pass “stranger test”
Strategy included to no longer reinforce problem behavior (change maintaining responses)
Need for crisis plan considered and described in detail (if applicable) and linked to hypothesis
Evaluation plan described in detail
Fidelity plan described in detail
PTR—REFRESHER
What is Prevent-Teach-Reinforce
(PTR)?
• Research project funded by U.S. Department of
Education, Institute of Education Sciences
– University of South Florida
• Three central Florida school districts
– University of Colorado, Denver
• Two Colorado school districts
• Purposes:
– Answer the call for rigorous research
– Evaluate effectiveness of PTR vs. “services as usual”
using randomized controlled trial
– Evaluate effectiveness of “standardized “ approach
Prevent-Teach-Reinforce: PTR
• Intervention teams given manual and assigned PTR
consultant
• Five step process (aligned with problem solving
process):
–
–
–
–
Teaming
Goal Setting (Identification of Problem)
Functional Assessment (Problem Analysis)
Intervention (Intervention Implementation)
• Coaching and fidelity
– Evaluation (Monitoring and Evaluation of RtI)
Step 1: Teaming
• Teaming: A collaborative process
– 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
• Purpose:
– Evaluate strengths and weaknesses of team functioning
– Outline roles and responsibilities
– Determine a consensus-making process
Step 2-Goal Setting
Identify the problem
What 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
Bergan & Tombari, 1976
problems”
Step 2: Goal Setting
• Purpose:
– Identify behaviors of greatest concern to the team and
possible replacement behaviors (teach)
– Prioritize and operationalize behaviors targeted for
intervention
– Develop teacher friendly baseline data collection
system
• Targeted Areas:
– Problem behaviors
– Social skills
– Academic behaviors
Step 2: Data Collection System
• Behavior Rating Scale – BRS (cf., Kohler &
Strain, 1992)
– Direct Behavior Rating (DBR)—Hybrid assessment
combining features of systematic direct
observations and rating scales
– Efficient and feasible for teacher use
– Provides data for decisions
– Prioritized and defined behaviors measured
– Requires minimum of 1 appropriate and 1
inappropriate behavior
01/15
Case Study- Mike: Behavior Rating Scale
Behavior
Screaming
9+ times
7-8 times
5-6 times
3-4 times
0-2 times
5
4
3
2
1
5
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Hitting
8+ times
6-7 times
4-5 times
2-3 times
0-1 times
5
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Expressing
Frustration
40%+
30-40%
20-30%
10-20%
0-10%
5
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Transition to
Non-preferred
Whimper or squeal
Louder than indoor voice
Outdoor play voice
Louder than outdoor play
Ear penetrating
5
4
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2
1
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Analyze the Problem
STEP 3:
FUNCTIONAL BEHAVIOR ASSESSMENT
Step 3: PTR Functional Assessment
• PTR Assessment (FBA)
– Checklist format
• Prevent = antecedents
• Teach = function, possible replacements
• Reinforce = consequences, possible reinforcers
– One form completed for each problem behavior
by each team member
– Information leads to hypothesis
Learned Functions of Behaviors
• GET (Positive Reinforcement)
– Obtain
• Activities, people, tasks,
tangibles, sensory, pain
attenuation
• GET OUT OF (Negative R)
– Escape/Avoid/Delay
• Activities, people, tasks,
tangibles, sensory, pain
Step 3: Case Study – Mike Hypotheses
Appropriate
Inappropriate
When….
he will
As a result…
Mike is asked to complete nonscream and hit
preferred tasks (Reading, Math),
stop preferred activity or transition
to non-preferred activity, fix an
error, or when teacher is attending
to other students
Mike is able to
gain attention and
delay the
transition/activity
Mike is asked to complete nonpreferred 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
Mike is able to
delay the
transition/activity
complete the
assigned task
Mike is able to
gain attention
STEP 4 BEHAVIOR INTERVENTIONS
Behavior Intervention Plan
Development: Essential Features
• Behavior interventions selected
• Team/teacher provides description on how interventions
will look in classroom setting
• Facilitator guides the team/teacher by using ABA principles
to develop most effective intervention that matches the
team/teacher context
• Each intervention selected is described in detail by taskanalyzing steps, providing scripts, describing adult
behaviors, NOT student behaviors
• After plan developed, time is scheduled to train the
team/teacher the strategies prior to implementation
• Plans for training students and other relevant individuals
• Support provided once plan is implemented
How to Link Hypothesis Statements to
Behavior Interventions
The hypothesis statements link to behavior
interventions by:
– Modifying the antecedent(s) identified,
Teaching alternative appropriate behaviors to
get the same payoff,
Providing alternative ways of responding to
the appropriate and problem behavior
(including crisis management)
Hypothesis Link
When Jeff is presented with demands to start non-preferred
.
academic
tasks, specifically independent writing, he will
become disengaged and walk around the room, talk to and
touch peers, put his head down without initiating writing. As a
result, he gets to avoid/delay the non-preferred task.
Setting Event
None identified
Prevent
Teacher
request to
start the nonpreferred task
Behavior
Disengaged-walk
around room,
bother peers,
Reinforce
Avoid/delay nonpreferred task
Rule #1
• You should not develop a plan to decrease the
problem behavior without first identifying the
alternative, desired behaviors the person
should perform instead of the problem
behavior (O’Neill)
Rule #2
• Use the functional equivalence reinforcement
(i.e., escape and/or obtain) identified in the
hypothesis in your behavior support plan.
• Only use artificial reinforcement (e.g.,
tangibles) if the functional equivalence is not
enough.
Rule #3
• Develop an intervention to modify the trigger
(prevention information) so that the problem
behavior is no longer necessary.
The Three I’s
Function-Based Support Plans will be effective when
A prevention intervention that modifies the context so
that the problem behavior is no longer necessary to
perform is included.
The replacement behavior serves the same function
(obtains the same outcome) as the problem behavior - if
it doesn’t work, the student won’t do it.
The replacement behavior works at least as quickly and
easily as the problem behavior - if it works but is harder
to perform, the student won’t do it.
Jeff-matching hypothesis to
interventions
Setting Events
NONE
Prevention
Triggering
Antecedents
Request to do a
non-preferred
task = writing
Problem
Behavior
Disengaged
ESCAPE!!!
Replacement
Behavior
Modify trigger
Choices
Environmental
support
Maintaining
Consequences
Reinforce
)equivalent or
incompatible)
Engage in Task
Step 4: Writing the Intervention Plan
• Task analyze each step of the plan
– NOT— “give student choices”
– YES— Prior to the start of independent reading,
tell the 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.
Prevention Interventions
PTR Prevention Strategies
• Providing Choices
• Transition Supports
• Environmental
Supports
• Curricular Modification
• Adult-Verbal Behavior
• Classroom Management
• Increase Noncontingent
Reinforcement
• Setting Event
Modification
• Opportunity for
Prosocial Behavior
• Peer Modeling or Peer
Reinforcement
Prevention Intervention:
Choice-Making
Choices
• Individual selects preference from among 2 or more valid
options
• Reduces likelihood of exhibition of escape and avoidance
behaviors associated with demands
• Choice strategies: (adapted from Fredda Brown)
–
–
–
–
–
–
–
Between tasks
Within tasks
Where
When
Person(s)
Rejection
Termination
Choice Making Steps to Build
Intervention
• Step 1: Determine the context (antecedent) identified
in the hypothesis
• Step 2: Determine choice options (from 7 categories)
that can be presented during specified context
• Step 3: Select the choice options that will be offered
• Step 4: Decide how the choice options will be
presented to the student (when, who, how)
• Step 5: Decide response to student after making choice
• Step 6: Decide how to release to choice
Environmental Supports
Used when hypothesis (when part) suggests that visual cues/organizational
tools or external reminders may make context/antecedent less aversive
•
Examples of environmental supports for
anyone
–
–
–
–
–
Traffic signs
Microsoft Outlook, tools, reminders
Restaurant menus
To do lists
Every app you can think of
•
Examples of environmental supports for
students
–
–
–
–
–
–
–
Visual checklists
Reminders of reinforcement
Visual cues
Timers
Visual mnemonics
Communication tools
Schedules
Environmental Support Steps
• Step 1: Determine nature of antecedent and
type of environmental support that may work
best
• Step 2: Develop the environmental support
• Step 3: Determine how to use environmental
support (when, who, how to present)
• Step 4: Teach student use of environmental
support
Jeff: PTR Intervention Plan Prevent
Prevent
Strategies
Description
Choice-Making Using a choice matrix, decide upon the choice that will be offered to
Jeff each day with his writing assignment. The following choices will
be rotated: (a) Within—writing tool to use (pen/pencil), color
notebook paper, color of eraser, topic; (b) Who—peer for writing
partner; (c) Where—Robin’s room, round table, desk; (d) When—
part now, part later, whole task now
Steps:
1.Right before giving the writing assignment to Jeff, decide upon the
choice to be offered.
2.Once the choice is determined, present it to Jeff by saying, “What
do you want to use for writing today? The pen or the pencil?”
3.Praise Jeff for making the choice—”Thank you for making a
choice.” and honor the choice
Jeff—Intervention Plan Prevent
Prevent
Strategies
Description
Environmental
Support
Visual Timer: Set a visual timer for the amount of time agreed upon
with Jeff to complete the writing assignment.
Steps:
1.
Discuss the goal for completing the writing assignment. Say, “I
think you can complete the assignment in ___ minutes. What
do you think?”
2.
Set the timer by saying, “Jeff, let’s see if you can beat the timer.
Today, you have ___ minutes (time from step 1) to complete the
writing. Ready, set, go.”
Activity
• In your group/team, develop a prevention intervention for
the following hypothesis.
• When requested to transition from a preferred to a nonpreferred activity, Joe will start calling the adults and peers
names and use cuss words. As a result, he (a) avoids/delays
the transition and (b) gets responses/attention from both
adults and peers.
• Steps
–
–
–
–
–
Identify the antecedent/prevention information
Review the prevention interventions
Decide upon one intervention
Develop a step-by-step plan for implementation
Be prepared to share
Sharing Time
TEACH INTERVENTIONS
Replacement Behaviors
Replacement behaviors are what we want the
student to do instead of the problem
Effective replacement behavior must:
1. Be incompatible with the problem.
2. Serve the same function as the problem.
PROBLEM
FUNCTION
REPLACEMENT
Replacement Behavior
• Teaches more appropriate, but equally
effective, means of getting reinforcer
(escape/obtain)
• Must be:
– Socially valid
– Simple
– Efficient
– Likely to be reinforced by others in student’s life
Considerations When Teaching
Replacement Behaviors
• Identify alternative behavior as easy for student
to do as challenging behavior (efficiency)
• Consider the replacement behavior is a skill or
performance deficit
• Directly teach student new behavior including
how and when to use
• Make sure all other’s in student’s environment
are consistent in teaching the replacement
behavior.
Replacement Behaviors
Incompatible replacement
Communicative replacement
(sample)
• Reject offer of undesired • Engagement
item or event
• Independent task
• Request alternative
completion
activity
• Raise hand
• Request assistance
• Appropriate social
• Request break
interactions
• Request work check
• Appropriate
commenting
Teaching “Request a Break”
• First, determine the point in which the
problem behavior occurs after presentation of
the antecedent
• Deliver the prompt for using the replacement
behavior (e.g., “I need a break”) just prior to
above point of time.
• Release student to break immediately after
correct response exhibited and provide verbal
reinforcement for using replacement behavior
Request a Break, continued
• Provide inducement to get back to task
• Fade prompt gradually
• Evaluate need for tolerance for delay cue
(time delay for escape)
Teach Incompatible Behavior
• Raise hand
– Step 1: Determine if skills is a performance or skill deficit
• If skill deficit, break down behavior into discrete steps and
determine steps student needs to acquire
• If performance deficit, reinforcement part of intervention will be
extremely important
– Step 2: Teach student when to use new behavior and what
will happen when they use new behavior
• Examples and nonexamples
• Opportunity to practice with feedback
• Determine prompting required until skill is acquired
– Step 3: Determine how skill will be
generalized/maintained
Jeff— Teach Intervention Plan
Teach
Strategies
Description
Incompatible
Replacement
Behavior—
Academic
Engagement
Jeff will be taught how to remain engaged on a writing assignment.
Engagement is defined as: working on a task without disrupting
by raising hand to speak, keeping pencil upright, and letting
neighbors work.
Steps:
1.
Divide Jeff’s writing task into 3 major sections—starter, details,
conclusion
2.
Tell Jeff that for each section completed, he earns a “dot” that
he should place in the envelope hanging at the side of his desk.
3.
Inform him that he can use the dots later to get out of work and
to get special rewards for himself and the rest of the class.
4.
Review his self-management checklist/dot total sheet with Jeff.
Review each section of the writing assignment (step 1), his goal
(time for completion), and academic engaged behaviors.
5.
On Monday, a weekly goal should be discussed and set.
Activity
• In your group/team, develop a teach intervention for the following
hypothesis.
• When requested to transition from a preferred to a non-preferred
activity, Joe will start calling the adults and peers names and use
cuss words. As a result, he (a) avoids/delays the transition and (b)
gets responses/attention from both adults and peers.
• Steps
– Identify the problem behavior
– Identify the function
– Agree upon a replacement behavior (functional equivalent or
incompatible)
– Review the teach interventions
– Decide upon one intervention
– Develop a step-by-step plan for implementation
– Be prepared to share
Sharing Time
REINFORCE INTERVENTIONS
Reinforcement
• Four rules (Terry Scott)
– Use the least amount that is necessary to get the
replacement behavior
– Use the natural reinforcement (i.e., function)
– Be consistent and immediate in delivering the
reinforcer-establish a routine
– Teach the student how he/she will get the
reinforcement
Jeff—Reinforce Intervention Plan
Reinforce
Strategies
Description
Reinforce Proacademic
Replacement
Behavior—
Academic
Engagement
Jeff will be reinforced for academic engagement and meeting his daily goal
with allowable/earned escape represented by the dots. Jeff can use
his dots to get out of doing work/problems during independent work
times.
Steps:
1.
At the end of the writing period or when Jeff completes his writing
(whichever event occurs first), review Jeff’s self-management
checklist.
2.
For each behavior on the checklist, discuss with Jeff whether he
performed the activity. If yes, place a check in the box. If no, place
an “x” in the box. For each check, Jeff should be given a dot. When
reviewing, say, “Jeff, did you write a starter sentence?”… Did you
stay on task? Did you meet your goal?” When giving dots, say “Jeff,
how many checks do you have today? How many dots do you earn?”
3.
Jeff uses dots by sticking it over a problem/question he doesn’t want
to do and showing the teacher when he uses a dot. He can escape
as long as he has dots in his envelope.
4.
If Jeff uses a dot to get out of work, immediately say “You used a dot
to get out of ____. You earned it!”
5.
If Jeff meets his weekly goal, he can go to his brother’s kindergarten
class and read a book to them.
Jeff—Reinforce Intervention Plan
Reinforce
Strategies
Description
Group
Contingency
(Modified)
If Jeff meets his daily (time) goal for completing his writing
assignment within the time agreed upon, the class earns a
bonus letter toward the mystery reinforcer of the week. When
Jeff earns the class this letter, the class provides attention to
Jeff by thanking him and celebrating (clapping hands, saying
“Yeah”.
Steps:
1.
After reviewing Jeff’s self-management sheet, ask him, “Did you
meet your goal today?”
2.
If yes, “You did meet your goal. Let’s tell the class they’ve
earned a letter for the mystery reinforcer.”
3.
Tell the class, “Jeff met his goal today. We get another letter on
the board.”
4.
Prompt the class to thank Jeff (if they haven’t done so
spontaneously).
5.
If no, “You worked hard and tried. You’ll do it tomorrow!”
Activity
• In your group/team, develop a reinforce intervention for the
following hypothesis.
• When requested to transition from a preferred to a non-preferred
activity, Joe will start calling the adults and peers names and use
cuss words. As a result, he (a) avoids/delays the transition and (b)
gets responses/attention from both adults and peers.
• Steps
– Identify the function.
– Determine how the function (outcome) can be delivered as an
intervention
– Review the reinforce interventions
– Decide upon one intervention
– Develop a step-by-step plan for implementation
– Be prepared to share
Sharing Time
Coaching Steps
• Core components of each behavior intervention
strategy listed on coaching/fidelity form.
– Primary adult behaviors (physical or verbal actions) &
materials
– If applicable, student behaviors included.
• During coaching session, facilitator gives teacher
behavior intervention plan and coaching form.
• Facilitator introduces coaching form,
– e.g., “We’re going to go over the steps of the behavior plan
strategies to make sure they are still making sense to you
and are things that can be done by you in your classroom.
If there is anything that you feel isn’t going to work, we
can make changes today.”
Coaching Steps
• Several methods for coaching the teacher.
• Can choose one method, combination of two, or all
three
– Discussion—facilitator asks teacher to verbally describe (in
his or her own words) each of the interventions.
• Ensures teacher describes each step of the intervention
• Teacher can refer to coaching form to cue core steps
– Q & A—facilitator asks teacher questions about strategies.
• For example, choice-making “When are you going to offer the
choices to X?”; “What kind of choices will you offer X?”; etc.
– Role Play (preferred method)-facilitator plays role of
student and asks teacher to perform plan steps as they
would with student.
Coaching Steps
• Check ‘Y’ or ‘N’ whether teacher demonstrated competence with
plan steps
• Remediation: For any step teacher did not demonstrate correctly
or skipped,
–
–
–
–
Review step with teacher
Provide another opportunity for teacher to demonstrate competence
If successful, coaching session finished
If unsuccessful, choose from the following:
• Provide more opportunities to review and practice step
• Ask teacher what features make step difficult and adapt to make feasible
• Select different intervention checked on PTR intervention Checklist that
matches hypothesis.
– Schedule another meeting to develop new intervention
– Schedule another coaching session
Coaching Steps
• Successful training:
– Decide who else needs to be trained (e.g., student,
other school staff, parent)
– Try to be there when teacher trains student or offer to
train student
• Determine start date of intervention plan
– Can choose to implement the intervention in phases.
• Prevent first, then teach/reinforce
• Teach/reinforce first, the prevent
• Training checklist can be used as fidelity measure
rather than developing separate checklist
Jeff Example
Jeff Coaching Plan (Sample)
Intervention Steps
Y
PREVENT 1: PROVIDING CHOICES
1. Presented valid choice to Jeff immediately after writing
assignment presented
2. Praised Jeff for making choice
3. Honored choice within 1 minute after selection
implemented
PREVENT 2: ENVIRONMENTAL SUPPORT/TIMER
1. Negotiated time limit with Jeff immediately after choice
and prior to release to task
2. Set time limit on visual timer
3. Placed visual timer on Jeff’s desk
implemented
TEACH: ACADEMIC ENGAGEMENT
implemented
1.
2.
3.
4.
Broke Jeff’s writing task into 3 parts and reviewed
Wrote 3 parts onto self-management plan
Reviewed academic engagement behaviors with Jeff
Reviewed with Jeff how to complete dot checklist
N
Activity
• Develop a coaching/fidelity plan for your
behavior intervention
• Be prepared to share
• Discuss how you would collect data on
response to intervention (Behavior Rating
Scale, other)
Questions?
PTR Publications
PTR Manual
Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C.,
2010. Prevent-Teach-Reinforce: The School-Based Model of Individualized Positive
Behavior Support. Baltimore: Paul H. Brookes.
Journal Articles
Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., Dunlap, G., & Strain, P. (2009).
Randomized controlled trial of a tertiary behavior intervention for students with
problem behaviors: Preliminary outcomes. Journal of Emotional and Behavioral
Disorders, 17, 213-225.
Dunlap, G., Iovannone, R., Wilson, K., Strain, P., & Kincaid, D. (2010). Prevent-TeachReinforce: A standardized model of school-based behavioral intervention. Journal of
Positive Behavior Interventions, 12, 9-22
Strain, P. S., Wilson, K., & Dunlap, G. (2011). Prevent-Teach-Reinforce: Addressing problem
behaviors of students with autism in general education classroom. Behavior Disorders,
36, 160-171.
Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (in revision). Reliability of
the Individualized Behavior Rating Scale-Strategy for Teachers (IBRS-ST): A Progress
Monitoring Tool. Manuscript submitted for publication.
Sears, K. M., Blair, K. S. C., Crosland, K., & Iovannone, R. (in press). Using the PreventTeach-Reinforce model with families of young children with ASD. Journal of Autism and
Developmental Disabilities.

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