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 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Hitting 8+ times 6-7 times 4-5 times 2-3 times 0-1 times 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Expressing Frustration 40%+ 30-40% 20-30% 10-20% 0-10% 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Transition to Non-preferred Whimper or squeal Louder than indoor voice Outdoor play voice Louder than outdoor play Ear penetrating 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 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.