Designing and Delivering Intensive Intervention in Behavior

Designing and Delivering Intensive Intervention in Behavior

NamePositionJanuary 2014

Introduction Review of previous NCII modules Training goals Examples of evidenced-based interventions (EBIs) Summary

Today’s Agenda

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A Bird’s-Eye View of

Data-Based Individualization

1. Relate assessment to function.2. Select EBIs that align with the functions of behavior.3. Link assessment and progress monitoring. 4. Connect data with the selected EBI.

Learning Objectives

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1. Identification

of Hypothesized

Function

2. Selection of Relevant Intervention Based on Function

3. Assessment

and Monitoring

4. Analysis Focusing on

Both Effectiveness and Function

If

Neces

sary

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Designing and Delivering Intensive

Intervention

Tying It All Together!

Design and implement interventions carefully but quickly. Collect data in a highly feasible manner. Establish a consistent manner of data analysis that is

efficient and easy for anyone to do.

Another Way of Thinking About It

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Source: Evidence Based Intervention Network (http://ebi.missouri.edu)/

Part 1Relating Assessment to Function

A review of Functional Behavior Assessment (FBA)

Definition of FBA: • FBA is a process for identifying the events that reliably

predict and maintain problem behavior.• Function refers to the purpose of behavior.

Relating Assessment to Function

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Assessment (in FBA): Need to quickly select the likely reason for the behavior. Time is a precious commodity. Educators need to be

efficient when problem solving. Under many circumstances, the most efficient thing to do is

to test the easiest hypothesis first, implement an intervention, monitor, and then evaluate the outcomes.

Relating Assessment to Function

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A student has not learned the behavior. Inappropriate behavior removes a student from what he or

she does not want to do (escape). Inappropriate behavior gets a student something (typically

attention). A student has not had to do the behavior in that way

before.

Common Reasons Why Students Misbehave

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If starting with a reasonable hypothesis fails to improve student performance, then something progressively more time intensive can be attempted until the probable cause of failure is identified.

Note: Easier solutions are more likely to be implemented consistently, whereas solutions that are more time consuming or technically difficult for teachers and support personnel are less likely to be implemented correctly (Gresham, 1989).

Start With a Reasonable Hypothesis

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Identify the hypothesized function of behavior and then select the intervention.

Selecting an intervention with the appropriate level of rigor based on the problem is essential.

After the intervention is selected, the analysis phase can begin. It is only in the analysis phase where a team will find out if the assessment phase was successful.

Importance of Identifying Function First

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Part 2Selecting Evidence-Based Interventions That

Align With the Functions of Behavior

EBIs are treatments that have proven effective through rigorous outcome evaluations.

Selecting Evidence-Based Interventions

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Medicine and clinical and counseling psychology• Lots of discussion and debate about the pros and cons of an

EBI approach• Field agreement with a deep understanding of EBI

Education and school psychology• Very little discussion (if any) about whether we should use

EBI• Field agreement with no real understanding of EBI

The History of Evidence-Based Interventions Across Professions

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Tier 3Example: HIV drug cocktails

Tier 2Examples: pass out condoms in school and health clinics; needle exchange programs

Tier 1Examples: educational programs, national

level of awareness—HIV conferences

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The History of Evidence-Based Interventions (Handout 1)

Tier I: Whole-school best practices Tier II: Functionally related small-

group practices Tier III: Individually functionally

based practices

What Are Evidence-Based Interventions in Schools?

Tier 3 (5 percent) Functionally based

Tier 2 (15 percent)Functionally related small

groups and individuals

Tier 1 (80 percent)Evidence-based

curricula

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Why is it important to pick the “right” EBI for each case if they are all evidence based?

There are important limitations in EBI that we like to call the “fine print,” which are important to understand to effectively use this technology.

Selecting Evidence-Based Interventions That Align With Function

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EBIs are validated for a specific purpose with a specific population.

Implication: EBIs are useful only for a range of problems and, as such, must be paired up with the right situation.

“A hammer is an effective tool but not with a screw.”

Fine Print I: Tiers 2 and 3

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• Evidence-based Tier 3 interventions assume implementation integrity.

Implications• Changing parts of an intervention, while typical, can invalidate

an EBI.• How can an intervention be changed—frequency, materials,

target, style, and so on?

Fine Print II

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EBIs are typically validated with large-group research or a series of small-group studies.

Implications• EBIs have been documented as likely effective, not surely

effective.• Even the most effective interventions are often ineffective with a

specific case.• As such, you cannot assume an EBI will work for every student

in every situation.

Fine Print III

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A list of EBIs is just a good place to start, but even if selected carefully, they may not be effective.

Additional steps are necessary.• Need to select EBIs that make sense for the current case.• Need to implement EBIs with integrity.• Need to collect outcome data—progress and outcomes.• Need to evaluate the effectiveness in some manner to see if it worked and

make adaptations as necessary.

Implications of Evidence-Based Interventions

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A Bird’s-Eye View of

Data-Based Individualization

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Decoding the Terminology: EBI and DBI

What the intervention will look like (i.e., steps or procedures)

What materials and/or resources are needed and whether these are available within existing resources

Roles and responsibilities with respect to intervention implementation (i.e., who will be responsible for running the intervention and preparing materials)

What Should Tier 3 Intervention Plans Include?

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The intervention schedule (i.e., how often, for how long, and at what times in the day)

Context (i.e., where and with whom) How the intervention and its outcomes will be monitored

(i.e., what measures, by whom, and on what schedule) and analyzed (i.e., compared to what criterion).

What Should Tier 3 Intervention Plans Include?

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When considering an intensive intervention, teams are asked to consider what they think are the most likely reasons for the problem behavior.

Once selected, these hypothesized reasons are then used to select interventions.

If there is more than one likely reason selected, try rank ordering from most to least likely.

Considerations for Tier 3 Interventions: The “How”

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Selected interventions should be customized to the student with care so as to not alter the function.• Change the icing, not the core ingredients. For example, although praise

is often suggested in reinforcement-based interventions, other reinforcements can be used if praise does not act in a reinforcing manner for the target student. That being said, you cannot remove the reinforcement fully from such an intervention.

Implement. Collect outcome data. Analyze.


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The true documentation that an intervention is evidence based for a specific case occurs only when there are outcome data indicating a change in the target behavior.


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A student has not learned the behavior. Inappropriate behavior removes a student from what he or

she does not want to do (escape). Inappropriate behavior gets a student something (typically

attention). A student has not had to do the behavior in that way

before.

Common Reasons Why Students Misbehave

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NCII does not endorse any of the interventions presented in this training. We would like to acknowledge that these examples were selected for training and illustrative purposes and in large part because they are commonly used in tiered systems and have an intriguing evidence base.

However, NCII, through its Technical Review Committee (TRC), has not yet validated any of the strategies or interventions listed in this training. It is planning to review interventions in the next several years to provide endorsed options.

Selecting Evidenced-Based Interventions That Align With Function

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Check In Check Out (CICO) Non-contingent reinforcement (NCR): attention seeking Antecedent modification: escape Instructional match: prerequisite skill or ability

Examples of Evidence-Based Interventions

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An empirically supported strategy for reducing problem behavior

Relatively quick and easy; provides structure Increases positive adult contact

• Excellent intervention when the function of behavior is attention seeking• Also useful for students who escape because they do not want to do a

task if teach praise is more reinforcing than the task is punishing.

Check In Check Out

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Source: Michigan’s Integrated Behavior and Learning Support Initiative (http://miblsi.cenmi.org)/

Focus on teaching Check-in check-out system Daily classroom report card Home-school partnership Collaborative team-based process

Elements of Check In Check Out

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Students engaging in externalizing behaviors Less than 15 percent of students Students with multiple referrals (two to five major referrals) Students who receive several minor referrals Students who receive referrals in multiple settings Students who find adult attention rewarding or reinforcing

For Whom Should Check In Check Out Be Used?

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On a daily basis, there are increased structure, feedback, and adult support.

There are daily home and school communications and collaborations.

Data are collected, reviewed, and used to make decisions about the intervention success (or lack there of).

The Benefits of Check In Check Out

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Non-contingent Reinforcement

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Photo Credit: http://www.flickr.com/photos/familymwr/4919451795/; http://creativecommons.org/licenses/by/2.0/deed.en

http://www.flickr.com/photos/familymwr/4919451795/



NCR is a powerful method to reduce attention-seeking problem behavior. NCR involves giving a student access to a reinforcer frequently enough so that he or she is no longer motivated to exhibit disruptive behavior to obtain that same reinforcer (e.g., saturate the environment with the reinforcer before the behavior occurs).

What Is Non-contingent Reinforcement?

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Example: A student wants teacher attention and calls out or engages in disruptive behaviors to get attention consistently during a group activity, such as art or story time.

Possible solution: The teacher will provide appropriate attention prior to the student “asking” for attention with the “problem behavior” (e.g., have the student sit with the teacher while she is reading a book to the class).

An Example of Non-contingent Reinforcement

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You need to identify the reinforcer for the problem behavior. NCR will not work if you do not know the function of the disruptive behavior.• The problem behavior must be attention seeking.

You need a schedule for NCR delivery that minimizes problem behavior.• NCR is most effective with a heavy dose of reinforcement early in the day.

You must ignore problem behavior after the schedule is initiated. You should fade the process as problem behavior declines but make

sure the student does not reengage in behavior by fading too quickly.• Slowly reduce the amount of NCR given. Note: NCR is good teaching

practice, so it should never be “stopped.”

Critical Components for Success

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Antecedent Modification

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Photo credit: http://www.flickr.com/photos/edenpictures/2969677793/; http://creativecommons.org/licenses/by/2.0/

The “Great Escape”

http://www.flickr.com/photos/edenpictures/2969677793/

http://www.flickr.com/photos/edenpictures/2969677793/

The student does not have to do something when he or she exhibits the problem behavior.

The problem behavior is “working” for the student by allowing him or her to escape something that he or she does not want to do.

What Is Antecedent Modification?

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Example: A student wants to escape a non-preferred activity, such as mathematics or physical education. Every time the teacher announces the start of a specific activity, the student starts engaging in disruptive behaviors (e.g., runs away, shouts out, pretends to sleep).

Possible solutions:• Minimize the need for the escape by making the target activity less

punishing!• Alter antecedents to increase task engagement, appropriate behaviors, and

general success (e.g., preteaching, offering choice, and modeling).

An Example of Antecedent Modification

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Positive reinforcement (e.g., praise) for engaging in the activity

Reinforce appropriate behaviors in shorter intervals initially (e.g., change the schedule of reinforcement or task demand)


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Instructional Match

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Photo credit: http://www.flickr.com/photos/charlottel/154443920/; http://www.flickr.com/photos/dno1967b/8703319368/; http://creativecommons.org/licenses/by/2.0/

http://www.flickr.com/photos/charlottel/154443920/



http://www.flickr.com/photos/dno1967b/8703319368/

http://www.flickr.com/photos/dno1967b/8703319368/

• Escape behavior related to academic tasks that are simply “too hard.”

• For example, a student might not be successful because the instructional materials are too difficult, or he or she may not have the prerequisite skills.

What Is Instructional Match?

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There is a mismatch between student skill and the level of difficulty of the task: the assessment of a student’s current instructional level is inaccurate in some way (e.g., knowledge, difficulty, pace, and/or level).

Students who are failing academically are frustrated and often act out!

Characteristics of Instructional Match

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Examples: Doing addition problems without

being able to count Journal writing without being able to

form two- or three-word sentences Drawing without fine motor skills,

such as pencil grip Running without proper gait (e.g.,

can walk only on tippy toes)

Possible Solutions: Preteach content or skill. Reduce the difficulty of the task. Break down tasks into smaller, more

manageable subtasks. Use curriculum-based measurement

(CBM) to determine the appropriate instructional level.

Examples of Instructional Match

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Must be able to accurately assess a student’s current level of ability and implement a curriculum and teaching materials that are appropriate to the student’s instructional level.

Must match task demands with current skill levels to ensure success.

Differentiate instruction whenever possible and appropriate.

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Underestimate performance and

behavior problems

Low motivation, expectations,

perceived control, and confidence

Repeated failure plus

generalization of failure

Learned helplessness

response style

Focus on limitations and weaknesses

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Source: Seligman & Maier (1967)

Learned Helplessness Studies

Part IIILinking Assessment and Monitoring

Determine the plan and who is responsible for execution at each step.

Identify training and resources. Monitor the plan. Use a cycle of support.

Implementing and Monitoring Outcomes

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Teaching Coaching and feedback Scripts for adults to follow Data collection Follow-up support meetings Follow-up data evaluation

Plan for Integrity of Implementation

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Evaluate the effects of interventions, comparing baseline data to data during intervention. Is your plan working?

If your plan is not working, consider some reasons why it might not be working. What changes are needed in your plan? Make those changes.

Monitor the Plan: Five Considerations

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If your plan is working, consider what you will do next. Will you simplify the plan to make it more efficient? Will you fade, change, or terminate your interventions?

Continue to implement your interventions until you feel they are no longer needed or working.

After terminating the plan, continue to collect data to determine whether any positive effects are maintained following plan termination.

Monitor the Plan: Five Considerations

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Were the goals of the support plan achieved? Was implementation done consistently and with integrity? Is more assessment needed? How should the plan be modified?

Data-Based Decisions

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Part IVConnecting Data With the Evidence-Based

Intervention Selected

Target Behavior

Questionnaire

Checklist

Anecdotal Report

Direct Observation

Connecting Data With the Selected Evidence-Based Intervention

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Direct Behavior Rating

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Comparing Non-intervention and Intervention Patterns: Example 1

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1. What is an EBI?2. What are some of the reasons why it is important to align EBIs

and the function of behavior?3. What are the four EBIs we mentioned today and can you give

a quick description of them?4. Bonus question: Can you describe the components of the DBI

process and where EBIs fit in? (Hint: Think of all the NCII trainings.)

Quick Review

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Direct behavior ratings. (2010). Storrs, CT: University of Connecticut. Retrieved from http://www.directbehaviorratings.com/cms/

Gresham, F. M. (1989). Assessment of treatment integrity in school consultation and prereferral intervention. School Psychology Review, 18, 37–50.

Michigan Department of Education. (n.d.). Michigan’s integrated behavior and learning support initiative. Lansing, MI: Author. Retrieved from http://miblsi.cenmi.org/

National Center on Intensive Intervention. (2013). Data-based individualization: A framework for intensive intervention. Washington, DC: Author. Retrieved from http://www.intensiveintervention.org/sites/default/files/DBI%20a%20Framework%20for%20Intensive%20Intervention.pdf

References

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http://www.directbehaviorratings.com/cms/

http://www.directbehaviorratings.com/cms/

http://miblsi.cenmi.org/

http://miblsi.cenmi.org/

http://www.intensiveintervention.org/sites/default/files/DBI%20a%20Framework%20for%20Intensive%20Intervention.pdf




School of Psychology at Mizzou. (2011). Evidence Based Intervention Network. Columbia, MO: University of Missouri. Retrieved from http://ebi.missouri.edu

Seligman, M. E. P., & Maier, S. F. (1967). Failure to escape traumatic shock. Journal of Experimental Psychology, 74(1). Retrieved from http://psych.hanover.edu/classes/learning/papers/seligman%20maier%201967.pdf

References

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http://ebi.missouri.edu/

http://ebi.missouri.edu/

http://psych.hanover.edu/classes/learning/papers/seligman%20maier%201967.pdf

http://psych.hanover.edu/classes/learning/papers/seligman%20maier%201967.pdf

This presentation was produced under the U.S. Department of Education, Office of Special Education Programs, Award No. H326Q110005. Celia Rosenquist serves as the project officer. The views expressed herein do not necessarily represent the positions or polices of the U.S. Department of Education. No official endorsement by the U.S. Department of Education of any product, commodity, service or enterprise mentioned in this website is intended or should be inferred.

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Designing and Delivering Intensive Intervention in Behavior