Interventions for Externalizing and Internalizing behaviors at Tier 2 and Tier 3

Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.

Interventions for Externalizing and Internalizing behaviors at Tier 2

and Tier 3

Kimberly J. Vannest, PhD


Overview

Evidence based interventions are critical at all levels of a response to intervention model. Best practices in a general education classroom can prevent learning and behavior problems while serving as a protective and resiliency factor for children who have characteristics of risk. For students demonstrating learning or behavior problems that place them at risk, evidence based interventions serve to ameliorate and potentially mediate further exacerbation of problems.


This presentation will:

Provide a description of a multi tier model for context with suggested timelines and procedures

Present a list of applicable interventions at each of the three levels in RTI (for behavior).

Provide the essential steps for highlighted interventions so that participants may leave the session with methods for application.


Vannest, K.J. (2009) [email protected]


PROVIDE A DESCRIPTION OF A MULTI TIER MODEL FOR CONTEXT WITH SUGGESTED TIMELINES AND PROCEDURES


Three tier preventive intervention classification system


First, lets all get on the same page. There are multiple names for a 3-tier model

Medical Model

Primary Secondary Tertiary

Positive Behavioral Supports

Universal Targeted Individual


September & OctoberUniversal Best Practices

Teach explicit school wide expectations

Reinforce new pro-social skills 1:1

Reinforce pro-social behaviors on a fixed or intermittent schedule

Use data to evaluate practices

Conduct universal screening to determine elevated levels of risk

Killer academic programming


November & DecemberTargeted Interventions

Target the problem Consider externalizing vs. internalizing types of risk Consider specific differences ex. attention problems or

aggression problems (i.e. one is neurological, the other is not likely)

Identify resources & Train for needs Implement Measure teacher fidelity, Measure student progress


January & February Individual Interventions

Monitor ongoing

progress

noyes

New intervention or individualized programming

Making Progress ?


Suggested timeline Review August – September

Prep teachers and parents, send notices, review school rules for consensus

Teach school rules to students, use school rules to guide universal programs

October Screen school population @ week 6 (Behavior Emotional Screening

System) Review risk list Determine number of students to serve

October-November Notify & consent parents Conduct assessments to identify problem type (BASC-2) Consider coordinating reading or academic screening and behavioral risk

notification November-December

Use targeted interventions (Intervention Guide & Classroom Guides) Use resource mapped interventions

January-February, March-May as appropriate Use targeted interventions (Intervention Guide & Classroom Guides) Use resource mapped interventions Consider specialized services based on diagnostic assessment, structured

background interview, direct observation and FBA

Vannest, K.J. (2009)


Screening & Resource allocation

We have an inefficient reactive rather than proactive approach.

The community costs for treatment of chronic conditions, juvenile justice, adult incarceration, restorative justice, loss to family and work force contributions far exceeds the cost of screening and early intervention.

Our current system of service identification depends on parent and teacher referral Idiosyncratic, externalizing behavior problem-focused method of either unknown or poor validity.

Schools screen for other types of problems including vision, hearing, speech, academic problems associated with specific learning disabilities, and developmental delay but not for emotional and behavior problems.


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Classroom Snapshot


Things I hear:“ we are too busy with academic RTI

to worry about behavior”


If 20% of our student population is struggling with social

emotional, behavioral issues – academics will be affected.

A reciprocal relationship exists between achievement and behavior.

Academic performance is inversely related to problem behavior that begins early in a child’s development (Brier, 1995;

McEvoy & Welker, 2000).


What's the significance of students with problem behaviors?

There is evidence to show that young children with challenging behavior are more likely to experience: expulsion from preschool programs at 3.2 times the rate of K-12

students (Gilliam, 2005) early and persistent peer rejection (Coie & Dodge, 1998); mostly punitive contacts with teachers (Strain et al., 1983); family interaction patterns that are unpleasant for all participants

(Patterson & Fleishman, 1979); school failure & negative achievement trajectory (Kazdin, 1993;

Lipsey & Derzon, 1998; Patterson & Fleishman, 1979; Tremblay, 2000; Wahler & Dumas, 1986),

high risk of fatal accidents, substance abuse, divorce, unemployment, psychiatric illness, and early death (Coie & Dodge, 1998; Kazdin, 1985).

Adult lives characterized by violence, abuse loneliness & anxiety (McCord, 1978; Olweus, 1991)



What are the positive outcomes expected from early intervention?

Decreased risk of withdrawal, aggression, non-compliance, and disruption (Strain & Timm, 2001).

Treatment impact on fears, phobias, depression, anxiety, hyperactivity, conduct, and obsessive-compulsive disorders.

Positive peer relationships including understanding of friendship, cooperation, and sharing (Denham & Burton, 1996).

Increased self-control, self-monitoring, and self-correction and improved social-emotional health (Webster-Stratton, 1990).

Academic success (Walker et al., 1998). Reduced risk for teen pregnancy, juvenile delinquency, and

special education placement (Strain & Timm, 2001).

www.challengingbehavior.orgVannest, K.J. (2009) [email protected]

Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.18

System for Managing Behavioral and Emotional Problems

Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.19

Group: Roster Report

In a Roster report, students are listed according to whatever level is chosen; in this case, the district level was chosen, and results are sorted within each school in the district

Results can be sorted alphabetically (student name), or by classification level (either ascending or descending)

Classification Key that lists elevation levels


Methodology A multi-year research review

study by Vannest, Reynolds & Kamphaus, 2008

Inclusion criteria -Any research articles that were experimental or quasi-experimental in design and demonstrated positive effects which could be attributed to the intervention.

Studies sorted by the type of problem behavior for which the intervention was designed. Of the thousands of studies reviewed, 40 distinct interventions are listed here today.


Example annotation

Robinson, P. W., Newby, T. J., & Ganzell, S. L. (1981). A token system for a class of underachieving hyperactive children. Journal of Applied Behavior Analysis, 14(3), 307–315.

This study investigated the efficacy of a token economy reinforcement

system on the reading achievement of a large group of children with hyperactivity and low reading ability. Eighteen third-grade males identified as hyperactive and performing below grade reading level participated. Tokens were awarded for learning a reading unit or teaching a unit to another student and were redeemed for time spent playing a video game or pinball. Students completed nine times as many reading assignments during the token-economy condition as during the reversal period, when the tokens were removed (p < .05). Students also passed more standardized level tests required by district during the token-economy condition.



PRESENT A LIST OF APPLICABLE INTERVENTIONS AT EACH OF THE THREE LEVELS IN RTI (FOR BEHAVIOR).


Interventions with Evidence


Using intervention across tiers is partially about

resources and skills

Universal Targeted Individual

Problem Solving Self-Management

x x x

Cognitive Restructuring

x x

Verbal Mediation x x

Social Skills Training

x x x

Peer-Mediated Conflict Resolution and Negotiation

x x x


PROVIDE THE ESSENTIAL STEPS FOR HIGHLIGHTED INTERVENTIONS SO THAT PARTICIPANTS MAY LEAVE THE SESSION WITH METHODS FOR APPLICATION.


Intervention categorization Interventions are organized according to

the most common behavior problem clusters found in a nationally represented sample of nearly 4000 teachers and parents across the United States.

Students, schools, teachers and parents were matched for all demographic variables.


Intervention categorization

Behavior and emotional categories include: Academic Problems Adaptability Aggression Anxiety Attention Problems Conduct Problems Depression Functional Communication Hyperactivity Leadership/Social Skills


Interventions for Aggressive Behaviors

1. Problem Solving Training2. Cognitive Restructuring3. Verbal Mediation4. Social Skills Training5. Peer Mediated Conflict Resolution and

Negotiation6. Replacement Behavior Training


Interventions for Conduct Problems

1. Token Economy Systems2. Interdependent Group-Oriented Contingency

Management3. Anger Management Skills Training4. Problem-Solving Training5. Social Skills Training6. Moral Motivation Training7. Parent Training8. Multimodal Interventions9. Multisystematic Therapy


Interventions for Hyperactive Behaviors

1. Functional Assessment2. Contingency Management3. Parent Training 4. Self- Management5. Task Modification6. Multimodal Interventions


Interventions for Attention Problems

1. Contingency Management2. Daily Behavior Report Cards3. Modified Task-Presentation Strategies4. Self-Management5. Classwide Peer Tutoring6. Computer Assisted Instruction7. Multimodal Interventions


Academic Problem Interventions

1. Mediated Interventions•Focus on effective teaching

2. Peer Mediated Interventions•Focus on peers helping peers

3. Self-Mediated Interventions•Focus on student regulating learning


Interventions for Anxiety Disorders

1. Exposure-Based Techniques

2. Contingency Management

3. Modeling

4. Family Therapy

5. Integrated Cognitive-Behavioral Therapy


Interventions for Depression

I. Cognitive- Behavioral TherapyA. PsychoeducationB. Problem-Solving Skills TrainingC. Cognitive RestructuringD. Pleasant Activity PlanningE. Relaxation TrainingF. Self- Management Training

G. Family InvolvementII. Interpersonal Therapy for Adolescents


Interventions for Somatization Disorders

1. Behavioral Interventions

2. Multimodal Cognitive-Behavioral Therapy


Interventions for Problems with Adaptability

1. Functional Behavior Assessment2. Precorrection3. Procedural Prompts and

Behavioral Momentum4. Self Management Training5. Cognitive Behavior Management


Interventions for Problems Functional Communication

1. Functional Communication Training

2. Picture Exchange Communication System

3. Video Modeling

4. Milieu Language Teaching

5. Pivotal Response Training


Social Skills Defined

Definition: Children who exhibit strong social and interpersonal skills and demonstrates positive relationships with others without significant maladaptive behaviors (Bierman, Miller, & Stabb, 1987).

Etiology: Children who demonstrate characteristics of emotional and behavior disorders, autism spectrum disorders, and ADHD demonstrate deficits in social skills (Bellini et. al., 2007, Forness & Knitzer, 1992).

Prevalence: 18-20% of teachers report deficits in social skills in the classroom setting (Reynolds, Kamphaus, 2004).

Outcomes: Positive, everyday experiences with their parents are fundamental to

children’s developing social skills. Children whose parents frequently play with them have more advanced social

skills and get along better with peers. Children who have a hard time getting along with others in the preschool

years are more likely to experience later academic difficulties.


Social Skills Training

Teaching prosocial concepts to children to function successfully in social environments across all settings. Basic Elements of Social Skills Training

1. Teaching the skill and talking about the problem area or weakness

2. Modeling the skill through active demonstration3. Practicing the skill in a controlled environment while receiving

feedback4. Generalizing the skill by practicing it in new environment


Context of our current research

Universal Screening Brief assessment to determine problem type The “10 minute” meeting

Discuss intervention selection NOT problem admiration ½ day School wide training in most common

interventions Follow up coaching in classrooms Electronic daily behavior report cards

Example problem assessment report

Primary Improvement Areas Secondary Improvement Areas Adaptive Skill StrengthsHyperactivity Aggression None

Anxiety Conduct ProblemsAttention


Case Example of Elmer

Elmer’s scores on Hyperactivity, Anxiety, and Attention Problems fall in the clinically significant range, and probably should be considered among the first behavioral issues to resolve.

Note that Elmer also had scores on Aggression and Conduct Problems that are areas of concern. Interventions for these areas are not provided in this report. However, these areas may require additional follow up

Example: Hyperactivity Functional Assessment Contingency Management Parent Training Self-Management Task Modification Mulitmodal Interventions


Assistance for expert decision making

Our current models involve resource mapping, but we may consider the match between problem type and

intervention rather than a generic intervention or an overly engineered or prescribed one

Look at supports available to Elmer at home or in the community

Look at capacity and resources of the school.

Also consider the barriers in the related settings.

For example:

A functional assessment to determine specific antecedent and consequence manipulations may be

beyond the scope of the available time and resources of the school and classroom.

Contingency management may not seem like the type of intervention suggestion that would work with a

particular teacher personality.

Parent training likewise may not be a “best fit”.

However self-management works well for Elmer’s age, the school, the classroom and your time use. So

you might then engage in a treatment plan that includes or starts with self-management.


Parent Tip Sheets


Tools for Partnership


Multiple steps and examples


Communication with Caregivers


Teacher Training -

If leadership teams decide to use an intervention as a tier two support. The school should be trained. Small teacher groups Use conference or prep time Train in a 30 minute block with a competency check Use scenarios appropriate for your school i.e. your own

student examples.


Effective Training

What do we know about getting teacher training content to “stick” Requires modeling Requires performance feedback Requires praise for change For any new behavior consider…

Praise for attempting something new Coaching and contingencies


Improving practice

Step by step instructions for all the interventions listed here are excerpted from the Intervention Guide which lists the evidence-base for each intervention and provides procedures, directions and consideration for use in schools. (Vannest, Reynolds & Kamphaus)


Our Schools face very real challenges within our student population Both externalizing and internalizing conditions

I’m optimistic that our schools make a tremendous difference in the lives of our students and their families.

They are, or have the potential to be everything that is good about our communities and our collective culture. Self-determination, empowerment, freedom, and

achievement.


Conclusions Although the need for services is

tremendous the available resources in our professional literature are also strong

The cost for inefficient or ineffective practices is too high Teacher attrition Poor student outcomes Community and societal costs

Effective practices do improve school & student outcomes.


Documents

Interventions for Externalizing and Internalizing behaviors at Tier 2 and Tier 3