Evidence-Based Practices to Reduce Challenging Behavior Lise Fox, Ph.D. University of South Florida 1

Session Discussion Critical importance for developing systems to support teacher implementation of evidence-based practices Adoption of a promotion, prevention, intervention model Identifying evidence-based practices for early educators 2

National Centers - Resources Center on the Social and Emotional Foundations for Early Learning (CSEFEL) www.vanderbilt.edu/csefel Technical Assistance Center on Social Emotional Intervention (TACSEI) www.challengingbehavior.org 3

Key Messages High quality caregiving + high quality environments ≠ No challenging behavior Addressing challenging behavior = Promoting the development of social competence We have evidence-based practices; but we need practitioners and systems to implement those practices with fidelity

Impact & Prevalence

An estimated 9 to 13% of American children and adolescents between ages nine to 17 have serious diagnosable emotional or behavioral health disorders resulting in substantial to extreme impairment. (Friedman, 2002)

More than half of students with SED drop out of grades 9-12, the highest rate for all disability categories. (U.S. Department of Education, 2002; 2006) At 2 years post high school, 58% of youth have been arrested at least once and 42% are on probation or parole. (NLTS2, 2005). Students with ED reported use of alcohol (54%), illegal drug use (36%), marijuana use (33%), and smoking (53%) at rates higher than all other disability categories (NLTS2, 2008)

Over 15% of all students with disabilities (6-21) are taking psychotropic medications (USDOE, 2005) About 1/3 of all adolescent students with disabilities have been suspended or expelled (USDOE, 2005)

It begins early...

Campbell (1995) estimated that approximately 10-15% of all typically developing preschool children have chronic mild to moderate levels of behavior problems. Children who are poor are much more likely to develop behavior problems with prevalence rates that approach 30% (Qi & Kaiser, 2003).

Children who are identified as hard to manage at ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., 1990).

Early Predictors Temperamental Difficulties Early Aggression Language Difficulties Noncompliance

Family Factors Maternal Depression Harsh Parenting Stressful Family Life Events Low Social Support Family Instability

Depression Hurts Children of mothers who were depressed in their infancy are more likely to be delayed Children of depressed mothers are at increased risk for behavior problems, depression, and mood disorders in adolescence D

Sobering Facts

The correlation between preschool-age aggression and aggression at age 10 is higher than that for IQ. (Kazdin, 1995)

Early appearing aggressive behaviors are the best predictor of juvenile gang membership and violence. (Reid, 1993)

When aggressive and antisocial behavior has persisted to age 9, further intervention has a poor chance of success. (Dodge, 1993)

Young Children with Challenging Behavior: Are rejected by peers Receive less positive feedback Do worse in school Are less likely to be successful in kindergarten

Preschool children are three times more likely to be “expelled” than children in grades K-12 (Gilliam, 2005)

(Hemmeter, Santos, & Ostrosky, 2004) Faculty in higher education early childhood programs report that their graduates are least likely to be prepared to work with children with persistently challenging behavior (Hemmeter, Santos, & Ostrosky, 2004)

(Kataoka, Zhang, & Wells, 2002) Of the young children who need mental health services, it has been estimated that fewer than 10% receive services for these difficulties. (Kataoka, Zhang, & Wells, 2002)

There are evidence-based practices that are effective in changing this developmental trajectory…the problem is not what to do, but rests in ensuring access to intervention and support (Kazdin & Whitley, 2006)

The Pyramid Model The Pyramid Model provides guidance for early childhood special education and early intervention personnel, early educators, families, and other professionals on the evidence-based practices associated with promoting young children’s healthy social and emotional development and social relationships. This brief presentation provides an introduction to the Pyramid Model.

Pyramid Model Tertiary Intervention Secondary Prevention Universal The inspiration for the Pyramid Model comes from the public health model of promotion, prevention, and intervention. Similar to the public health model, we describe the need for universal, secondary, and tertiary interventions. At the universal level we include the practices needed to ensure the promotion of the social emotional development of all children. At the next level, the prevention level includes the provision of targeted supports to children at risk of challenging behavior. Finally, the tertiary level of the pyramid describes the need to provide individualized and intensive interventions to the very small number of children with persistent challenges Universal Promotion

Nurturing and Responsive Relationships Foundation of the pyramid Essential to healthy social development Includes relationships with children, families and team members In the Pyramid Model, we place the provision of nurturing and responsive relationships with children, families, and colleagues as the foundation for all other practices and the universal conditions that are necessary for social competence promotion and behavior guidance. The focus on relationships puts primary importance on the caregiver or teacher engaging in responsive and positive interactions with children and the development of partnerships with families. Moreover, it includes the critical importance of collaboration and teaming that is essential to the provision of a high quality early childhood programs or the provision of early intervention services in natural environments. In their early years, children exist within a web of relationships among parents, teachers, other caring adults in their lives and eventually, peers. This web supplies the context within which healthy social emotional growth and the capacity to form strong affirmative relationships with adults and peers develop. The relationships level of the pyramid model includes practices such as: actively supporting children’s engagement; embedding instruction within children’s routine, planned, and play activities; responding to children’s conversations; promoting the communicative attempts of children with language delays and disabilities; and providing encouragement to promote skill learning and development. When providing support to very young children and their families within early intervention programs, this level of the pyramid includes developing strong collaborative partnerships with families and other caregivers, providing support to caregivers in responding to the infant and toddler’s needs, and guiding caregivers in establishing responsive and nurturing interactions that will promote the child’s social and emotional development.

Relationships

High Quality Environments Inclusive early care and education environments Comprehensive system of curriculum, assessment, and program evaluation Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC 30

Reviewing Rules

Transitions

Circle Time – Universal Design Adult Support From: www.headstartinclusion.org 33

Circle Time – Universal Design Peer Support From: www.headstartinclusion.org

Circle Time – Universal Design Child Preference Special Equipment From: www.headstartinclusion.org

Circle Time – Universal Design Environmental Support From: www.headstartinclusion.org

Circle Time Special Equipment

Circle Time Child Preference From: www.headstartinclusion.org

Circle Time Invisible Support From: www.headstartinclusion.org

Circle Time Simplify the Activity From: www.headstartinclusion.org

Targeted Social Emotional Supports Self-regulation, expressing and understanding emotions, problem solving, developing social relationships Explicit instruction Increased opportunities for instruction, practice, feedback Family partnerships Progress monitoring and data-based decision-making 42

Friendship Skills Gives suggestions (play organizers) Shares toys and other materials Takes turns (reciprocity) Is helpful Gives compliments Understands how and when to give an apology Begins to empathize 43

Book Nooks www.vanderbilt.edu/csefel On Monday When it Rained Glad Monster Sad Monster Hands Are Not for Hitting

Feeling Wheel & Feeling Dice

Turtle Technique Recognize that you “Think” Stop. feel angry. Go into shell. Take 3 deep breaths and think calm, coping thoughts. Come out of shell when calm and think of a solution.

Problem Solving Steps Would it be safe? Would it be fair? How would everyone feel? 47

The Solution Kit 48

Secondary – Skill Instruction Identify target skill Identify learning opportunities and seek to maximize the number of learning trials Select procedure for teaching e.g., least to most, most to least, incidental teaching procedure, peer support, modeling, visual prompts Track child progress

Individualized Intensive Interventions Comprehensive interventions Assessment-based Skill-building Partnerships with families Progress monitoring and data-based decision-making . 51

Positive Behavior Support Convene a team Conduct functional assessment Identify hypotheses Develop behavior support plan for all relevant environments The process begins with convening the team that will develop and implement the child’s support plan. At the center of the team is the family and child’s teacher or other primary caregivers. The PBS process begins with functional assessment to gain a better understanding of the factors that are related to the child’s engagement in challenging behavior. Functional assessment ends with the development of hypotheses about the functions of the child’s challenging behavior by the team. These hypotheses are used for the development of a behavior support plan. The behavior support plan includes prevention strategies to address the triggers of challenging behavior; replacement skills that are alternatives to the challenging behavior; and strategies that ensure challenging behavior is not reinforced or maintained. The behavior support plan is designed to address home, community, and classroom routines where challenging behavior is occurring. In this process, the team also considers supports to the family and strategies to address broader ecological factors that affect the family and their support of the child.

About Tim 4 years old Only child First preschool experience Strengths – very smart, loves books, engages well with adults Challenging Behaviors - Aggression, Verbal threats, Destroys other children’s products, Damages toys intentionally Significant risk of Preschool Expulsion

Before PBS

Develop Plan Team of individuals who know him best – teacher, parents, paraprofessional, assistant director Behavior consultant guided the process Focused on understanding the purpose of Tim’s challenging behavior - importance of gathering information Developed a comprehensive plan that includes: Strategies for preventing his challenging behavior New skills Adult responses Classroom team and family implement and monitor plan outcomes

Hypotheses Tim engaged in challenging behavior to: initiate social interactions enter into play get access to particular toys get teacher or peer attention

Behavior Support Plan Prevention Strategies Social story to describe behaviors that were expected during center play and outdoor activities Review of social story prior to center time Priming to remember skills to use Visual prompt to remember skills to use

Created for Tim by Lisa Grant & Rochelle Lentini I Can Be a SUPER FRIEND! SUPER FRIEND Created for Tim by Lisa Grant & Rochelle Lentini 2002

I like talking and playing with my friends at school.

Sometimes, I want to play with what my friends are playing with. When I play, I sometimes feel like taking toys, using mean words, or hitting and kicking. My Friends get sad or mad when I hit, kick, use mean words, or take toys.

I can say, “Can I play with that toy?” or “Can I play with you?”. If I want to join in play, I need to join nicely or ask to play with my friends’ toys. Can I play with you? I can say, “Can I play with that toy?” or “Can I play with you?”.

I can join my friends and play nicely. I can take turns. I can go with the flow. I can stop, think, and do.

I CAN BE A SUPER FRIEND I can join my friends and play nicely. ________ I can take turns nicely. ________ I can go with the flow. ________ I can stop, think, and do. ________ DATE: ___________

Tim’s Plan (cont.) Instructional Strategies Social skills instruction of each new skill (role play and story review) Self-management system for new skills

Tim’s Plan (cont.) New Responses Attention to child who was assaulted Prevent access to toy or activity Review with Tim after incident has been resolved

Tim – with PBS

“If a child doesn’t know how to read, we teach.” “If a child doesn’t know how to swim, we teach.” “If a child doesn’t know how to multiply, we teach.” “If a child doesn’t know how to drive, we teach.” “If a child doesn’t know how to behave, we… … teach?… punish?” KEY CONCEPTS: 67 67

Pyramid Model Evidence-Based Practices that Promote the Social Emotional Development of All Children Tertiary Intervention Secondary Prevention The inspiration for the Pyramid Model comes from the public health model of promotion, prevention, and intervention. Similar to the public health model, we describe the need for universal, secondary, and tertiary interventions. At the universal level we include the practices needed to ensure the promotion of the social emotional development of all children. At the next level, the prevention level includes the provision of targeted supports to children at risk of challenging behavior. Finally, the tertiary level of the pyramid describes the need to provide individualized and intensive interventions to the very small number of children with persistent challenges Universal Promotion 68

Assess your teaching How skilled are you at…. Developing strong teaming relationships? Developing parent partnerships? Creating classroom environments that support the active engagement of all children? Teaching social emotional skills intentionally to all children? Teaching social emotional skills with sufficient intensity to individual children who are at-risk of challenging behavior?

Assess your Program Does your program… Have a system for screening children for social emotional delays? Ensure that children at-risk of challenging behavior receive intentional instruction and support that leads to outcomes? Use data to make decisions about how to support children effectively?

Assess your program Does your program… Have a system for ensuring that children with persistent challenging behaviors receive intensive, individualized support? Offer teachers individualized professional development (training and coaching) to provide evidence-based approaches?

National Centers - Resources Center on the Social and Emotional Foundations for Early Learning (CSEFEL) www.vanderbilt.edu/csefel Technical Assistance Center on Social Emotional Intervention (TACSEI) www.challengingbehavior.org 72