START EBP Summer Institute 2011 WELCOME

Agenda Day One Day Two Setting the “stage” Spotlighting evidence based practice Act I: Horizon Elementary Act II: Clawson Middle School Day Two Act III: Holt High School A script for implementing EBP Practice with your crew

The START EBP Implementation Project… is the culmination of many years of work supporting the implementation of evidence based practices in schools along with the recent collaborative partnership project with the National Professional Development Center on Autism Spectrum Disorders from 2009- 2011. Our aim is to train and support school building teams to create student IEP goals that best reflect the needs of the student and match those goals to evidence based practices that will help the students and team meet those goals.

This chart shows the breakdown of the dependent variables (i. e This chart shows the breakdown of the dependent variables (i.e., target behaviors) by domain, as used in the studies making up the evidence base for the practices.. The gray boxes indicate that a study that made the evidence-base targeted a skill or behavior in a particular domain. . . With this information, we utilize what we know about the learner and our own professional expertise to make a decision about the most appropriate EBP to choose. 4

How do families and professionals learn about practices for individuals with ASD

Families & professionals are seeking information about autism treatment If you type in the words “autism and treatment” in Google you get: 17,800,000 results in .09 seconds

We have warnings for many things in our society

But there is not a good warning system to let families and professionals know when intervention practices that haven’t been thoroughly studied are being promoted Elephant Therapy!

Currently not enough evidence… Injection of immunological substances Vitamin therapy Hormone therapy Facilitated communication Biofeedback Hyperbaric oxygen chamber therapy Auditory integration Massage of the scalp Prism lenses Complex rhythmic drumming Electromagnetic therapy Holding therapy Dolphin therapy

When families seek treatment for a child diagnosed with cancer or diabetes, they aren’t given a long list of interventions that someone somewhere believes to be effective, and told to choose from that list on their own; they can usually expect to be informed about treatments that are based on sound scientific research. Why do we settle for less when the diagnosis is ASD? Retrieved from asatonline.org (2011)

So many treatments, so much information

Problem: People may want to “try everything” A “try everything” mindset leads one to believe that treatment of autism is based upon the quantity of interventions, as opposed to the quality of interventions Celiberti et al., The Road Less Traveled: Charting a Clear Course for Autism Treatment (http://www.researchautism.org/uploads/roadless.pdf ) (p. 5)

Problem: Choosing non-evidence based interventions Primum non nocere: FIRST DO NO HARM Example: Facilitated Communication – Potentially Harmful Therapy Lilienfeld, S. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70.

Problem: Choosing non-evidence based interventions Time, money, energy that is NOT directed toward evidence-based intervention

Solution Teach people to be good consumers of information through understanding the scientific process… yes, really. Teach people to collect data in a rigorous way and control for confounding variables. If you don’t partner with families and providers, they will proceed without you. Its better to work with them (S. Harris, years ago)

Understanding and Using Evidence Based Practices

What are EBPs all about? All students in public education should have access to scientifically based practices (NCLB, 2001).

What is scientifically based research? You must have reliable evidence that a program or practice works. NCLB requires experimental studies that are similar to the medical model of research used by scientists. These studies require many steps to prove strong evidence of effectiveness. Well designed studies that use random samples of the population Trials must also include a random “control group” for comparison Valid and reliable outcome measures Data on long-term outcomes Trials in more than one site of implementation

Using EBPs in Schools What are examples of universal EBP practices for all students? Behavioral expectations Evidence based approaches to teaching reading What is the environmental context for all students attending school? General education curriculum, instruction, social interaction, transitions

3-Tiered Model of Support 23 3-Tiered Model of Support Few Some Universal EBPs TIER 1 All

When to Use EBPs Specific to Students with ASD Specific EBPs for students with ASD are deficit driven and based on the student’s lack of progress. Deficits and lack of progress become IEP goals. Students aren’t making progress in… Academic learning Socialization Communication Behavior expectations

3-Tiered Model of Support Targeted and Intensive EBPs Intervention 23 3-Tiered Model of Support Few Targeted and Intensive EBPs Intervention TIER 2 & 3 Some Universal EBPs TIER 1 All

EBPs Specific to Students with ASD (and other students?) What are examples of targeted or intensive practices? Self-management systems Video modeling Discrete trial teaching PECS Functional communication training (FCT)

Finding information about Practices that are Evidence-Based

The National Professional Development Center on ASD The National Professional Development Center on Autism Spectrum Disorders is a multi-university center to promote the use of evidence-based practice for children and adolescents with autism spectrum disorders. http://autismpdc.fpg.unc.edu/content/evidence-based-practices

National Standards Project "In a field rife with fads, pseudoscience, and popular, yet unproven, interventions, the findings of the National Standards Project are a welcome and much-needed counterbalance to much of the hyperbole for both professionals and families." --- Peter Gerhardt, Ed.D. http://www.nationalautismcenter.org/

The Association for Science in Autism Treatment ASAT is a not-for-profit organization of parents and professionals committed to improving the education, treatment, and care of people with autism. Since autism was first identified, there has been a long history of failed treatments and fads, levied on vulnerable individuals as well as on their families. Since ASAT was established in 1998, it has been our goal to work toward adopting higher standards of accountability for the care, education and treatment of all individuals with autism. http://www.asatonline.org/intervention/treatments_d esc.htm

The START EBP Implementation Project is easy as 1-2-3-4 To make it easier to remember the steps of the project, just remember “1-2-3-4.” 1building 2 target students 3 IEP goals per target student 4 Evidence Based Practices (EBPs) to address the IEP goals

Presentation Script for 3 Groups Description of the student Developing the GAS goals from the IEP Selecting the EBP Implementation Plan & Process Ongoing Review & Adjustments Expansion to other students

What you need to know about the GAS before we start…

Expanding Children’s IEP Goals through the Goal Attainment Scale (GAS) Goal Attainment Scale (GAS) is designed to document progress on IEP goals, objective, and benchmark. Provides a summative rating to evaluate outcomes for students

Somewhat less than expected Much less than expected Present level of performance Somewhat less than expected Progress toward goal Expected level of outcome Annual Goal Somewhat more than expected Exceeds annual goal Much more than expected Far exceeds annual goal Dan is inconsistently performing job tasks. He needs verbal, gesture and visual prompting to complete a task. Given a 5-step vocational task and visual supports, Dan will complete 3/5 steps independently over 3 consecutive probe days. Given 2 different 5-step vocational tasks and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days. Given 3 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days. Given any familiar 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

Description of Scaling Consists of a five point range of performance for students: Much less than expected (present level) Somewhat less than expected Expected level of outcome (annual goal) Somewhat more than expected Much more than expected

Day Two: Afternoon

The START EBP Implementation Project is easy as 1-2-3-4 To make it easier to remember the steps of the project, just remember “1-2-3-4.” 1building 2 target students 3 IEP goals per target student 4 Evidence Based Practices (EBPs) to address the IEP goals

A script for implementing evidence based practices Review Checklist Discuss Building and Student Selection

Writing, Implementing, and Monitoring Goals

Writing Measurable Goals: Formula for Success Condition--Under what condition and using what support should the skill be demonstrated? Behavior—Use verbs to describe behavior What competency / skill should change? Observable behavior Criteria— Describes level of mastery such as much or how well the behavior is demonstrated

Writing Measurable Goals Condition—Circumstances the student will need in order to perform the expected skill (when, where, with whom, type of activity, with what support, etc.) When given a verbal request During transition periods During a social conversation During class discussions When shown a three choices When prompted (specify type and # ) When given a check schedule card When prompted (specify type and #) to a visual schedule Using peers / peer to peer support Using a choice modification strategy During lunch (math, science, etc)

Writing Measurable Goals Behavior—Use verbs to describe behavior Choose / select Raise hand Remain in seat / area Answer questions Request Locate / find Put on / Take off Respond to (describe) Complete task Transition to next activity Look at Wait to be called on Ask for help Ask a peer Follow direction

Writing Measurable Goals Criteria— Describes level of mastery such as much or how well the behavior is demonstrated 9 out of 10 opportunities 6 items 75% accuracy Increase by 10% 3 times a day On 9 consecutive attempts For 15 minutes at a time Within 5 minutes 4 times weekly 3 out of 5 days 4 class periods

Examples Marci will have improved functional communication skills for indicating wants and needs. Marci will use a system of words, pictures, gestures to indicate basic wants and needs during classroom activities. (8 of 10 trials) Marci will use a picture schedule to follow daily classroom routines with minimal prompting. (8 of 10 trials) Marci will use a system of words, pictures, gestures to participate in conversational routines with peers. (8 of 10 trials)

Examples Chris will improve his social communication skills in the classroom setting. Chris will raise his hand when he needs assistance or wants to share important information. (90% of time) Chris will ask for help and accept teacher response when he doesn’t understand something. (80% of time) With gestural prompts from peers and adults, Chris will limit conversational ideas appropriate to the setting. (90% of time)

Goal Attainment Scaling Much More than Expected More than Expected Annual Goal Benchmark Present Level 46 46

Expanding Children’s IEP Goals through the Goal Attainment Scale (GAS) Goal Attainment Scale (GAS) is designed to document progress on IEP goals, objective, and benchmark. Provides a summative rating to evaluate outcomes for students

Prior to Developing GAS Review student’s IEP Goals with teacher/parents Identify 3 priority goals for each target student must be observable and measurable must be agreed on by family and team Collect data on present level of performance

Description of Scaling Consists of a five point range of performance for students: Much less than expected (present level) Somewhat less than expected (benchmark) Expected level of outcome (annual goal) Somewhat more than expected Much more than expected

GAS Levels Second: Identify the current level First: Write the annual goal

Ways to Modify Goals to Create Levels

Ways to Change Criteria Changing People No adults (-2) Familiar adult (-1) Unfamiliar adult (0) With one peer (+1) Across multiple peers (+2) Changing Prompt Level Physical prompt (-2) Gestural prompt (-1) Verbal prompt (0) Visual prompt (+1) Independent (+2) Changing Setting One setting in school (-1) Two settings in school (0) 2 school settings plus 1 community setting (+2)

Measurement of Goal Progress Measurement can be collected: Within a class period Across days During a 15-min probe By specific number of opportunities given

Examples

Jon Jon is a preschool student with autism Jon’s annual goal reads, “When entering the classroom in the morning and with a visual prompt Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.” The classroom team took data prior to the meeting for everyday for two weeks and determined that Jon never greets peers or professionals

When he enters class, Jon does not greet his peers or teaching staff. -2 Much less than expected (Present Level of Performance) -1 Somewhat less than expected (Progress toward goal) Expected level of outcome (Annual Goal) +1 Somewhat more than expected (Exceeds annual goal) +2 Much more than expected (Far exceeds annual goal) When he enters class, Jon does not greet his peers or teaching staff. When entering the classroom in the morning and with a verbal prompt and picture cue , Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for a week When entering the classroom in the morning and with a visual prompt, Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks. When entering the classroom in the morning without a prompt, Jon will greet at least one peer by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks. When entering school in the morning and without a prompt, Jon will greet at least two peers by saying “hi” or waving for 4/5 mornings for 2 consecutive weeks.

Dan Dan is a high school school student with autism Dan’s annual goal reads, “Given 2 different 5-step vocational tasks and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.” The classroom team took data prior to the meeting for three days a week for two weeks and determined that Dan is inconsistently performing job tasks. He never completes steps to tasks independently, needing frequent verbal, gesture and visual prompting.

-2 Much less than expected (Present Level of Performance) -1 Somewhat less than expected (Progress toward goal) Expected level of outcome (Annual Goal) +1 Somewhat more than expected (Exceeds annual goal) +2 Much more than expected (Far exceeds annual goal) Dan is inconsistently performing job tasks. He needs verbal, gesture and visual prompting to complete a task. Given a 5-step vocational task and visual supports, Dan will complete 3/5 steps independently over 3 consecutive probe days. Given 2 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days. Given 3 different 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days. Given any familiar 5-step vocational task and visual supports, Dan will complete 4/5 steps independently over 3 consecutive probe days.

Sam Sam is an 5th grade student with autism who is included in a general education classroom for most of the day. Sam’s annual goal reads, “When presented with a conversational attempt from a peer support student, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days.” A paraprofessional in the general education classroom took data for 5 days prior to the meeting. Peers initiated with Sam over 30 times, but Sam would just smile or laugh instead of responding verbally.

-2 Much less than expected (Present Level of Performance) -1 Somewhat less than expected (Progress toward goal) Expected level of outcome (Annual Goal) +1 Somewhat more than expected (Exceeds annual goal) +2 Much more than expected (Far exceeds annual goal) When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 0% of opportunities over 3 consecutive days across 3 different peers. When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 40% of opportunities over 3 consecutive days. When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days. When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days across 3 different peers. When presented with a conversational attempt from a peer, Sam will respond and then continue the conversation by asking a follow-up question for 80% of opportunities over 3 consecutive days across 3 different peers in 2 different settings.

Jack Jack is a high school student with autism Jack’s annual goal reads, “When arriving at school, Jack will walk to the classroom with verbal and visual prompts 4 out of 5 days for 3 consecutive weeks.” The classroom team took data prior to the meeting for everyday for two weeks and determined that Jack dropped, refused to get up, and had to be lifted into a wheelchair and wheeled to the classroom 9 out of the 10 days.

-2 Much less than expected (Present Level of Performance) -1 Somewhat less than expected (Progress toward goal) Expected level of outcome (Annual Goal) +1 Somewhat more than expected (Exceeds annual goal) +2 Much more than expected (Far exceeds annual goal) Jack drops to the ground upon arrival and during various times throughout the day. When arriving at school, Jack has to be lifted into a wheelchair and wheeled to the classroom 9/10 days. When arriving at school, Jack will walk to the classroom with verbal and visual prompts 2 out of 5 days for three consecutive weeks. When arriving at school, Jack will walk to the classroom with verbal and visual prompts 4 out of 5 days for three consecutive weeks. When arriving at school, Jack will walk to the classroom independently 4 out of 5 days for three consecutive weeks. Throughout the school day, Jack will walk through the school building independently 4 out of 5 days for three consecutive weeks.

GAS Goal Chart for Monitoring

A script for implementing evidence based practices Practice Writing GAS Goals GAS Template

Choosing and Combining EBPs

When you are choosing EBPs: Think about the context Does the EBP make sense for that environment? Think about the student Characteristics & Interests Strengths & Needs Think about the future Will it promote independence and socialization Will it lead to sustained learning or behavior change

Choosing EBPs: Guidelines for Individualizing

Student Characteristics Choosing EBPs Student Characteristics EBP s to Consider If your student likes or learns best from repetition Discrete trial teaching Video modeling

Student Characteristics Choosing EBPs Student Characteristics EBP s to Consider If your student likes or learns best from visual strategies Visual supports Video modeling PECS Social narratives

Student Characteristics Choosing EBPs Student Characteristics EBP s to Consider If your student needs to improve independent skills Self-management Prompting Structured work systems Video modeling

Student Characteristics Choosing EBPs Student Characteristics EBP s to Consider If your student has significant challenging behavior Antecedent-based interventions Functional communication training Functional behavior assessment

Student Characteristics Choosing EBPs Student Characteristics EBP s to Consider If your student does not have an effective communication system Functional communication training Speech generating devices/VOCA PECS

Combining EBPs EBPs are NOT usually used in isolation… Self-management requires reinforcement Video modeling may require prompting FCT requires FBA Professionals should be prepared to understand and implement a combination of EBPs

A script for implementing evidence based practices Review and Discussion of EBPs