Evidenced Based Practices for Children and Youth with ASD

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National Professional Development Center on Autism Spectrum Disorders A multi-university center to promote the use of evidence- based practices for children and adolescents with ASD

NPDC Sites FPG Child Development Institute, University of North Carolina at Chapel Hill; PI: Sam Odom and Ann Cox Waisman Center, University of Wisconsin- Madison  PIs: Len Abbeduto and Linda Tuchman-Ginsberg M.I.N.D. Institute, University of California at Davis; PI: Sally J. Rogers

Goals of the NPDC Promote optimal learning for preschoolers, elementary and secondary students with ASD and support for their families through use of evidence-based practices (EBP) Increase state capacity to implement EBPs in early identification, intervention, and education Increase the number of highly qualified personnel serving children with ASD through sustainable technical assistance and professional development

5 year project: total number of states: 12 Work with each state for 2 years  Year 1 : master content and process, working with NPDC staff  Year 2 : begin training additional state personnel with NPDC staff support  Years 3+ : state continues activities NPDC and State Involvement Cohort 1 Cohort 2 Cohort 3

Who Is Involved? State Interagency Planning Group School Site Teams NPDC team Training teams for school sites Families Children Admin School com

What Does NPDC Provide? EPB Content Development Technical Assistance Evaluation Professional Development

Content Development Goal: to translate information about evidence-based practices from research into practical resources for service providers

Define criteria for “evidence” Identify evidence-based practices in lit Define how to do them Content Development

Web-based Module Contents Pre-Test/Post-Test Contextual Information Step by Step Instructions Case Examples Video Examples Implementation Check List Evidence-Base Resources

Collaboration with OCALI and NATTAP for Module Development AIM

Content Development Project Website Assessment Instruments Autism Program Environment Rating Scale (APERS) Autism Evidence-Based Practices Self Inventory Fidelity Implementation Checklists (BRIEFS) Web-based Modules: How to do each EBP Online Course Autism 101 Products

What Does NPDC Provide? EPB Content Development Technical Assistance Evaluation Professional Development

Definition: “Structured teaching and learning experiences that are formalized and designed to support the acquisition of professional knowledge, skills and dispositions and applied in practice.” National Professional Development Center on Inclusion, 2007 Professional Development

Goals: Provide training to state professional development providers Provide training activities to practitioners in participating states Support school sites that model evidence-based practices

Professional Development To those on the model site teams, local training teams, and state training team: Online introductory course on ASD All materials: APERS, GAS, EBP training modules, BRIEFS Intensive Summer Training TA support for model sites and local training teams 2 years of training, technical assistance

Intensive Summer Institute Professional Development 1. Increase knowledge of EBP 2. Identify elements of high quality programs 3. Build networking, collaboration and skills of members of state autism training team 4. Develop plans for model sites and for dissemination across state

National Professional Development Center on ASD Content Development Technical Assistance Evaluation Professional Development

NPDC Collaboration with State Partners Goals: Develop outreach program Provide ongoing site-based training Establish a network of professional development sites, trainees, and national consultants

NPDC Collaboration with State Partners Begins with Support for Strategic Planning Activities State Interagency Planning Group stakeholders NPDC Staff Liaison person Provides Support to Local Training Teams Provides Year 1 Training Provides consultation and TA during Year 1 -2 Supports the team during Year 2 Training Team takes over training Year 3 and after Provides Support to Model Site personnel Provides Year 1 Training Provides consultation/TA during Years 1-2 Supports them with Year 2 Training Team takes over Year 3 and after

What Does NPDC Provide? EPB Content Development Technical Assistance Evaluation Professional Development

Evaluation: Goals: Assist trainees in establishing a system for implementing EBP Collect follow-up data on use of evidence-based practices, practitioner skills, and child and family outcomes

Evaluation Content Professional Development Technical Assistance Outcomes Child Family Practitioner Systems

Who has GAS?

Goal Attainment Scaling Summarizing progress on IEP objectives

Acknowledgements Dr. Sam Odom, PI of the NPDC, Frank Porter Graham Center, UNC - Chapel Hill

Problem Child MC – age 4 years – has 9 IEP goals in 5 developmental domains that involve 4 benchmarks each. End of year IEP meeting – mother asks, “Overall, how much progress did he make on his plan this year?” How can the classroom teacher easily summarize?

Problem School District has added additional funds to support all 36 students in inclusive education in High Point middle school in some general ed classes. At end of year, asks Resource Teacher for summary of progress of these 36 children so that they can compare progress of included children to progress of center based children at the other middle school in district. How can the Resource Teacher easily summarize progress of the 36 students?

An answer? Goal Attainment Scaling

Goal Attainment Scaling (GAS) What is it?  A method for measuring amount of progress made on a goal, objective, or benchmark.  Content free  Allows progress to be easily summarized across multiple goals or students  Not a substitute for objective measurement or progress – it’s a supplement

Description of GAS Care provider establishes goals/benchmarks/ objectives that are measured on a continuum.  After getting his work, James will independently complete all 15 steps on the bicycle brake assembly task 90% of the time when working in the bike shop.  At start of each class, Sasha will turn in her completed homework assignment in biology class on time 85% of days in a one month period.  Julia will use 10 different words spontaneously during free play activity with typical peers.

Goal Attainment Scaling Baseline level Expected outcome = 0 Less than expected = -1 Much less than expected = -2 More than expected = +1 Much more than expected = +2

How to Develop a GAS Select learning objective. Identify the current – baseline - level of performance. Identify the expected level at end of teaching period. Generate the additional outcome points on the scale. Examine progress using the GAS when you evaluate learning according to your benchmarks on a regularly designated schedule (monthly, bimonthly). Summarize the child’s or group’s overall progress at the end of the year by averaging the final GAS score.

GAS Data for NPDC target students 2009 Individual goals of approx 30 students

Level Of Attainment Goal 1Goal 2Goal 3 Much less than expected -2 Somewhat less than expected.. Expected level of outcome 0 Somewhat more than expected +1 Much more than expected +2 Comments Use this form for the activity

Activity: Shaping the behavior of those we love Use the form in your packet Identify a behavior you would like to see increase – write a measurable objective for this for six months from now – BE REALISTIC! Write the current baseline level of this behavior Describe a much better than expected outcome(+2) Identify a much worse than expected outcome (-2) Identify the midpoints

Sharing

Student Goal Attainment Scaling Form Example Level of Attainment Goal 1: Identify need to reduce anxiety in classroom settings Goal 2: Follow schedules of leisure activities independently Goal 3: Initiate verbal interaction with peers to join an activity Much less than expected -2 UU always requires visual teacher prompts to leave the area when anxious and to use a visual story to regain composure. UU engages in internet use for every leisure break, ignoring a schedule of daily leisure activity choices. UU exhibits anxious behavior when near a peer, joining only when visually prompted in 5 of 10 opportunities. Somewhat less than expected UU independently goes to appropriate area in the classroom when anxious and uses a visual story to regain composure 50% of the time during a two-week interval. UU complies with allowed internet use on the leisure activity schedule on 4 of 10 days and chooses other leisure activities from his schedule. When visually prompted, UU will always join peer in desired activity. Expected level of outcome 0 UU independently goes to an appropriate area at school when anxious and uses a visual story to regain composure 90% of the time during a two-week interval UU complies with allowed internet use on the leisure activity schedule on 8 of 10 days and chooses other leisure activities from his schedule. UU, verbally, will initiate interaction with peers to join an activity in 4 of 10 opportunities without prompting. Somewhat more than expected +1 UU verbally states “I need a break” when anxious without prompts and takes a walk to look at his visual story, returning to scheduled activity without disruption 3 times a week for 2 months. UU complies with allowed internet use at home on 5 of 10 days. UU, verbally, will initiate interaction with peers to join an activity in 8 of 10 opportunities without prompting. Much more than expected +2 UU uses strategies (stress ball or fidgit) to reduce anxiety in the classroom and stay focused on scheduled activity 3 times a week for 2 months. UU creates and follows a weekly internet use schedule at school and at home with 80% fidelity for 2 months. UU will invite a peer to play a computer game during computer time at school without prompts in 2 of 4 opportunities..

Is this extra work? NO –  benchmarks are already written  assessments will occur as already planned  Additional benchmarks can carry over into next year ?? YES BUT–  Adding higher benchmarks is easy! Just increase the criterion – 85% vs 95%, 2 times an hour vs. 4 times an hour, doing with a peer vs with 3 peers, doing X in snacktime vs. in snacktime and circle.  generating the above goal points allows you to reflect more growth  Process may result in more focused teaching ??

Break and small group activity Identify one crucial IEP goal/objective for one target student Go through the GAS process as a group Write it out on the form Think about how this will influence your teaching with that student

Evidence-Based Practices: What’s the fuss all about?

As a consumer - Your doctor suggests surgery to you as the first approach for a non-lie threatening chronic condition. What is your response? Your first grade daughter Marci has been struggling with reading. She doesn’t yet reliably associate letters with sounds. The teacher wants to use a sight word approach due to Marci’s excellent memory. What is your response?

Evidence Based Practices What does it mean? It’s been tested and found to be effective Why does it matter?  It’s the law  It’s the most efficient way to teach  Most efficient way to learn  Better chance of success

Evidence Based Practices (EBP) If there is no evidence, does it mean the practice is ineffective? If the child progresses, isn’t that evidence of effectiveness? What are the risks of using practices that are not evidence based?

NPDC Definition of EBP The teaching practice has been tested and found to be effective in: (1)Two randomized or other well-controlled (quasi- experimental design) studies. AND/ OR (2) Five single-subject design studies conducted by at least three different researchers

What has to be considered when applying an EBP? Fidelity! Medicine  Condition  Patient  Drug/procedure  Dosage  How administered  Measure of efficacy  When to change approaches Education/intervention  Content/behavior  Student  Teaching approach  How much time daily  Specific procedures  Data collection and examination  When to change approaches

Efficacy vs. Effectiveness Efficacy is the systematic evaluation of whether a treatment works Effectiveness is the extent to which the treatment works in natural settings – “real world” applications Clinical utility is the applicability, feasibility, acceptability, and usefulness of the intervention in a specific setting

Utility of EBP’s Some EBP’s may have a strong evidence base but be less useful in educational settings. Use professional judgment to determine what is most feasible and applicable to your unique context / student.

NPDC Tools to Help with EPB Implementation APERS EBP Inventory Briefs and Modules

Examples APERS – EBPs in place in the classroom EBP Inventory – Your own learning goals Briefs and Modules – EBPs for individual learning objectives

Choosing an evidence-based practice for a student Ask: What is our goal/objective targeting? Consider the specific IEP goals and related objectives Ask: What are our options? Look at the domain that the specific goal relates

Next, make a decision based on: The skills being taught Your professional wisdom The learner’s learning style The learner’s temperament The learner’s interests and motivators Supports already in place History of what has and hasn’t worked

IEP Application Goal - Communication Goal: Sam will improve expressive communication skills across the school day. Related Objective: When he sees a preferred object, Sam will request a desired item during snack and/or free choice time three times per day for two consecutive weeks.

Sam is in an inclusive kindergarten setting. Sam does not like talking to most people and he is difficult to understand. Last year’s IEP efforts to increase his use of speech using differential reinforcement and naturalistic approaches were not successful. Sam is already using pictures for a visual schedule at school. One of Sam’s classmates uses PECS, and Sam is interested in the pictures.

How do we decide which EBP to use? Ask: What is the goal targeting? Expressive Language Ask: What are the options?

IEP Application Goals – BEHAVIOR/COMMUNICATION Goal: Rosita will improve communication skills. Related objective: When Rosita shows distress during learning tasks, she will use words, not self injury to request a break or assistance 85% of opportunities over two consecutive weeks.

Let’s say we know this… Through the FBA process, the team determined that Rosita was head banging and self biting during lengthy teaching interactions to end the interaction. Rosita does have oral language, but tends to not talk very much. Rosita is interested in print and can read simple words and short sentences. Rosita enjoys peer interaction more than adult interaction.

How do we decide which EBP to use? Ask: What is our objective targeting? Expressive Language/Pragmatics Behavior Ask: What are our options?

Choosing an EPB to teach a skill involves: The skills being taught Your professional wisdom The learner’s learning style The learner’s temperament The learner’s interests and motivators Supports already in place History of what has and hasn’t worked

Integrating EBP’s Few practices are ever really used in isolation. Prompting and reinforcement, for example, are used in almost all of the other practices. Task analysis, too, is used prior to teaching skills through video modeling, visual supports, etc. Teams are encouraged, through coaching and mentoring, to explore the overlap of practices.

Integrating EBP’s Examples: Video modeling can be used to teach a self- management system. (model site example : ) A social narrative can be written to explain the routine of a social skills training group. A speech generating device may be used by a learner in the context of a peer-mediated intervention.

Integrating EBP’s The understanding required to use practices concurrently, while still being mindful of fidelity of implementation, is an important component in the development of skillful teachers and practitioners.

Teaching Flowchart Review the Brief & Module ID the EBP Design the data system Gather baseline data Develop the teaching plan; inform and train others Implement plan & data collection system; review often ID IEP goal and standard Break down into teachable steps

Don’t tell me I have to keep data! Developing helpful data systems

Why is data critical for EBP use? Collection of performance data tells us: What should we be teaching? Is our instruction successful? Is the student making progress? Do we need to change the teaching plan? Is it time to introduce a new skill?

The many ways to measure learning Event recording: frequency counts,% Latency recording: time elapsed Did it happen at all? Yes-no For chains: number of independent steps Assessing steps before independence: levels of prompts, precision (for shaping) Once skills are mastered: thinning reinforcement schedules, generalization to other skills, settings, environs, partners

Assessing progress Don’t start the new practice until you have baseline data!!!  Assess skill a few times in your current way of teaching first; to determine the baseline rate Summarize data immediately to make it useful: rates, percents, simple graphs

Note the stopping Points! Sherer and Schreibman 2005 Goal: Child will verbalize to request objects

Goal involving a sequence When instructed to wash his hands verbally or on picture schedule, Hal will go to bathroom and complete 85% or more of the steps of handwashing independently 90% of requests.

Daily Data chart for sequences How to summarize? 7 levels ; 14% each; Steps IndepMinimal PPartial PFull P Turns on water Wets hands soaps rinses Turns off water Dries hands Turns off lite, leaves

Daily Data chart for sequences How to summarize? Weights: I=3, MP=2, PP=1, FP=0 Steps IndepMinimal PPartial PFull P Turns on water 3 Wets hands 3 soaps 2 rinses 0 Turns off water 1 Dries hands 2 Turns off lite, leaves 1

Take home points EBPs represent the most effective teaching practices in ed science Start with these, as written Pick them carefully, by student age, setting, and content area Get baseline data before you begin a new practice or implement a change!! Measure as you go – don’t continue ineffective teaching Assume students will progress when well taught

Relationship between EBP and State Standards Standard defines content – skills to be learned EBP defines teaching practice – the teaching procedures used to teach the skill EBP is not about curriculum ! Content From standards EBPLearning! + =

Academics & Cognition BehaviorCommunicationPlaySocialTransition Evidence-Based Practices ECEC ELEL MHMH ECEC ELEL MHMH ECEC ELEL MHMH ECEC ELEL MHMH ECEC ELEL MHMH ECEC ELEL MHMH 1. Antecedent-based Interventions 2. Computer Assisted Instruction 3. Differential Reinforcement 4. Discrete Trial Training 5. Extinction 6. Functional Behavioral Assessment 7. Functional Communication Training 8. Naturalistic Interventions 9. Parent Implemented Interventions 10. Peer Mediated instruction 11. Picture Exchange Com. System 12. Pivotal Response Training 13. Prompting 14. Reinforcement 15. Response Interruption/Redirection 16. Self-Management 17. Social Narratives 18. Social Skills Groups 19. Speech Generating Devices 20. Structured Work Systems 21. Task analysis 22. Time delay 23. Video Modeling 24. Visual Supports

NPDC Tools to Help with EPB Implementation APERS: EBPs in place in the classroom EBP Inventory: Your own learning goals Briefs and Modules: EBPs for individual learning objectives

IAPG, NPDC and State Partners will develop: 6 dispersed demo sites Local training teams to support sites Statewide survey to identify EBP needs Merged NPDC training info and State content (standards, best practices) Unified state TA network and content

Outcomes NPDC materials will contribute to systematic approach for state NPDC process will help increase number of well trained para and professionals NPDC + IAPG will increase amount, quality and consistency of training in the state

Let’s Take A Look At The Briefs Available at: START Website: Briefs