Advanced Behavior Interventions Rose Iovannone, Ph.D., BCBA-D iovannone@usf.edu 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

Technically adequate fba/bipS ESSENTIAL COMPONENTS Technically adequate fba/bipS

Core Components of Technically Adequate FBAs/BIPs 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 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: Linked to FBA hypothesis (functional equivalence or incompatible behavior) Minimum of one reinforce strategy: Linked to FBA hypothesis (functional equivalence provided) 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 Purpose: 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 problems” Bergan and Tombari (1976) studied over 800 consultation cases (children in grades K – 3 referred for psych services), found that in only 43% and 31% of cases referred for help were problem identification and analysis (i.e., culmination in development of a plan to implement) stages, respectively, successfully met. In 97% of cases in which a plan was able to be developed and implemented, the pre-determined outcome level was established (i.e., goal attainment was reached). Also important… what contributed to completion of the problem identification stage?- largely, consultant skills, particularly the (a) flexibility of the psychologist in applying psychological principles (i.e., in selecting interventions) and (b) index of message control. Take away points: Thus, we need to put efforts up front and successfully do problem analysis (what are factors that make problem occur) and goal setting. Need intensive training in effective consultation skills, because when a psychologist lacked skills or was inefficient, s/he was likely to select a course of action beside problem id, including testing, SPED referrals, move to another school, referral to other mental health agency Study details: “interviewing skills” of consultant assessed by transcribing problem id and problem analysis interviews by psychologists/consultants; interviews were then coded for message content, message process, and message control. Yielded 4 measures of interviewing skills: (a) relevancy of interview content to problem id and analysis, (b) content focus… staying on topic, (c) psychologist verbal processes- using more specification, summarization, and validation utterances, and (d) message control- asking more questions to elicit information or action on the part of the teacher. Problem-solving measures: case-reporting forms were used to assess the presence or absence of phases in the problem-solving process… stages that were coded: problem identification, plan implementation, problem solution- if the goal identified in problem ID was achieved Bergan & Tombari, 1976

Step 2: Goal Setting Purpose: Targeted Areas: 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

Case Study- Mike: Behavior Rating Scale Screaming 9+ times 7-8 times 5-6 times 3-4 times 0-2 times 5 4 3 2 1 Hitting 8+ times 6-7 times 4-5 times 2-3 times 0-1 times Expressing Frustration 40%+ 30-40% 20-30% 10-20% 0-10% Transition to Non-preferred Whimper or squeal Louder than indoor voice Outdoor play voice Louder than outdoor play Ear penetrating 01/15

Step 3: Functional behavior assessment 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 When…. he will As a result… Mike is asked to complete non-preferred tasks (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher is 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 Inappropriate Appropriate

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 task-analyzing 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. . Prevent Teacher request to start the non-preferred task Behavior Disengaged-walk around room, bother peers, Reinforce Avoid/delay non-preferred task Setting Event None identified

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 IRRELEVANT INEFFECTIVE INEFFICIENT Function-Based Support Plans will be effective when IRRELEVANT A prevention intervention that modifies the context so that the problem behavior is no longer necessary to perform is included. INEFFECTIVE 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. INEFFICIENT 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 Maintaining Consequences Reinforce ESCAPE!!! Replacement Behavior )equivalent or incompatible) Engage in Task Modify trigger Choices Environmental support

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: Right before giving the writing assignment to Jeff, decide upon the choice to be offered. 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?” 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: Discuss the goal for completing the writing assignment. Say, “I think you can complete the assignment in ___ minutes. What do you think?” 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 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 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 (sample) Engagement Independent task completion Raise hand Appropriate social interactions Appropriate commenting Communicative replacement Reject offer of undesired item or event Request alternative activity Request assistance Request break Request work check

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: Divide Jeff’s writing task into 3 major sections—starter, details, conclusion 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. 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. 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. 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 Pro-academic 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: At the end of the writing period or when Jeff completes his writing (whichever event occurs first), review Jeff’s self-management checklist. 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?” 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. If Jeff uses a dot to get out of work, immediately say “You used a dot to get out of ____. You earned it!” 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: After reviewing Jeff’s self-management sheet, ask him, “Did you meet your goal today?” If yes, “You did meet your goal. Let’s tell the class they’ve earned a letter for the mystery reinforcer.” Tell the class, “Jeff met his goal today. We get another letter on the board.” Prompt the class to thank Jeff (if they haven’t done so spontaneously). 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 N PREVENT 1: PROVIDING CHOICES Presented valid choice to Jeff immediately after writing assignment presented Praised Jeff for making choice Honored choice within 1 minute after selection implemented PREVENT 2: ENVIRONMENTAL SUPPORT/TIMER Negotiated time limit with Jeff immediately after choice and prior to release to task Set time limit on visual timer Placed visual timer on Jeff’s desk TEACH: ACADEMIC ENGAGEMENT 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

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 Journal Articles 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-Teach-Reinforce: 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 Prevent-Teach-Reinforce model with families of young children with ASD. Journal of Autism and Developmental Disabilities.