1. Workshop: Prevention and Amelioration of Disproportionality in Special Education June 13, 2011 Daniel J. Reschly Vanderbilt University dan.reschly@vanderbilt.edu 615-708-7910 Reschly Disproportionality1

2. Solutions to Significant Disproportionality Understanding current legal requirements Prevention, especially improving reading –~50% of 4 th grade black students read below basic; inexcusable! Teach Reading and Math effectively!! Eligibility determination procedures and decision making –Focus on RTI and needs, consider alternatives to sp ed –Implement rigorous identification criteria Intensive interventions and special education exit for ~20% to 40% Implement RTI in sp ed –Torgesen et al. studies Overview 2Reschly Disproportionality

3. Irony of Disproportionate Representation Special Education for SWD with Mild Disabilities (LD, Mild MR, ED) – Individualized educational programs with related services as needed, based on individual evaluation – Significantly greater expenditures – Greater parent involvement – Mandated annual review – Procedural safeguards 3Reschly Disproportionality

4. Irony of Disproportionate Representation cont. Why is disproportionate representation unacceptable? Overrepresentation per se? Consider Head Start and Title I Assumptions about special education – Stigma – Poor outcomes – Limited curriculum and career options – Often segregated programs (Mild MR & ED) Differences in sp ed: Suburbs vs Cities 4Reschly Disproportionality

5. Constructive Policies and Practices Based On Understanding legal requirements Appropriate statistical analyses Reasonable criteria to define “significant disproportionality” Prevention in general education Early identification-Early intervention Non-discrimination in evaluation and placement Ensuring special education effectiveness 5Reschly Disproportionality

6. Reschly Interpretation: Centrality of Outcomes: Judge Peckham commenting on the 1979 Trial Opinion ban on IQ tests, “… clearly limited to the use of IQ tests in the assessment and placement of African- American students in dead end programs such as MMR.” (Crawford and Larry P., 1992, p. 15). 6Reschly Disproportionality

7. Reschly (1979) Interpretation Confirmed: Centrality of Outcomes: “ Despite the Defendants’ attempts to characterize the court’s 1979 order as a referendum on the discriminatory nature of IQ testing, this court’s review of the decision reveals that the decision was largely concerned with the harm to African-American children resulting from improper placement in dead- end educational programs.” (Crawford and Larry P., 1992, p.23).” 7Reschly Disproportionality

8. Traditional EHA/IDEA Legal Requirements re: Nondiscrimination Process – §300.304 Assessments and other evaluation materials used to assess a child under this part— – (i) Are selected and administered so as not to be discriminatory on a racial or cultural basis; – Plus extensive additional requirements in the Evaluations and Re-evaluations section – Process focus 8Reschly Disproportionality

9. Problems with Non-discrimination Regulations 1975 to 1997, 2004 No definition of discrimination Focus on assessment procedures (less on decision making) Assumption that non-discrimination can be prevented through reforms in assessment, classification, and placement Attempted to resolve group representation issues through individual mechanisms Improved assessment for all, but little overall effect on minority over-representation 9Reschly Disproportionality

10. Disproportionality IDEA 2004, 2006 §300.173 Overidentification and disproportionality. The State must have in effect, consistent with the purposes of this part and with section 618(d) of the Act, policies and procedures designed to prevent the inappropriate overidentification or disproportionate representation by race and ethnicity of children as children with disabilities, including children with disabilities with a particular impairment described in §300.8. 10Reschly Disproportionality

11. IDEA 2004, 2006 re: 34 CFR 300.646 Disproportionality (a) General. Each State …… shall provide for the collection and examination of data to determine if significant disproportionality based on race is occurring in the State …… ‑ (1) The identification of children as children with disabilities, including the identification of children as children with disabilities in accordance with a particular impairment described in section 602(3) of the Act; and THAT IS, CATEGORY (2) The placement in particular educational settings of these children. THAT IS, LRE Profile (3) Incidence, duration, and type of disciplinary actions, including suspension and expulsion 11Reschly Disproportionality

12. Disproportionality By Category 13 Categories of Disability at 34 C.F.R. 300.8 Greatest concern about MR, ED, LD, OHI, and Sp/L Significant disproportionality triggers policies and procedures reviews 12Reschly Disproportionality

13. Disproportionality by LRE Option Official Federal Placement Options re: Time Outside General Education – ≤20 % Full-time General Education – 21% to 60% Part-time Special Education – >60% Full-time Special Education – Public or Private Separate Setting – Public or Private Residential – Home or Hospital 13Reschly Disproportionality

14. IDEA 2004, 2006 re: 34 CFR 300.646 Disproportionality, cont. (b) Review and revision of policies, practices, and procedures. In the case of a determination of significant disproportionality with respect to the identification of children as children with disabilities, or the placement in particular educational settings of these children,….., the State ….. shall provide for the review and, if appropriate revision of the policies, procedures, and practices used in the identification or placement to ensure that the policies, procedures, and practices comply with the requirements of Part B of the Act. 14Reschly Disproportionality

15. IDEA 2004, 2006 re: 34 CFR 300.646 Disproportionality, cont. Require any LEA identified under Section 618(d)(1) to reserve the maximum amount of funds under Section 613(f) to provide comprehensive coordinated early intervening services to serve children in the LEA, particularly children in those groups that were significantly overidentified under Section 618(d)(1); and Require the LEA to publicly report on the revision of policies, practices, and procedures described under Section 618(d)(1)(A). Focused monitoring---Disproportionality listed as one of a small number of areas 15Reschly Disproportionality

16. Early Intervening Services § 300.226 Early intervening services. – LEA can use 15% of federal IDEA funds to support prevention and early identification-treatment – Purpose: minimize over-identification and unnecessary sp ed referrals – Provide academic and behavioral supports – Supports professional development and provision of interventions including early literacy instruction – Significant Disproportionality? Must spend 15% of the IDEA monies on prevention and early identification/early treatment in general education 16Reschly Disproportionality

17. District Policy EIS Funds and Programs 1.Responses

18. Summary: Legal Requirements Nondiscrimination in eligibility determination and placement still required (see PEDE 34 CFR 300. Added requirements regarding results (consistent with results focus of NCLB) Applications to both category and placement option (≤20%, 21%-60%, >60%, etc.), and disciplinary actions Emphasis on prevention and early id/early tmt Mandatory revision of policies and procedures if significant disproportionality exists 18Reschly Disproportionality

19. Part II: What Constitutes “Significant” Disproportionality Over- and Under-representation? What statistical analysis? What criteria – Numerical guidelines? – Criteria varying by context? – Improvement criteria? Revisions in policies and practices? 19Reschly Disproportionality

20. Disproportionality: Magnitude of the Phenomenon 17% of U.S. students are black 35% of students in the sp ed category of MR are black What percent of black students are diagnosed as MR and put in sp ed?? Choose an answer 2%; 4%; 17%; 35%; 50%; 70% 20Reschly Disproportionality

21. What Statistic for Disproportionality? Risk: Percent of total group in sp ed category – 100 white in MR out of 2000 white students in the student population, 100÷2000=5% – Risk=5% Composition: Percent of sp ed category by each group – Total of 150 students in MR – White composition of MR, 100 ÷ 150=67% 21Reschly Disproportionality

22. Illustration of Risk and Composition Consider gender and teaching Composition of educators by gender is heavily female, >80% “Risk” of being an educator for women is <1% Likewise with racial/ethnic group and special education representation – Composition sometimes appears large – Risk is relatively small 22Reschly Disproportionality

23. Comparing Risk Statistics Across Groups Relative Risk, ratio of two risk indices Useful for determining the severity of disproportionality Two methods – Risk of minority group to risk of white group – Risk of each group compared to the combined risk of the other groups See calculation exercises 23Reschly Disproportionality

24. Disproportionality Impressions Composition: African students constitute 17% of the US student population, but 35% of the US MR population is African American. Risk: Approximately 2.5% of African American students are classified as MR. The rate for white students is 1.1% The relative risk for MR for African American and white students is 2.5%÷1.1%=2.27 African American students are approximately 2.3 times more likely to be in MR than white students 24Reschly Disproportionality

25. Advantages/Disadvantages of Risk Statistics Accurate impressions of the actual proportions of minority students in sp ed Directly comparable across groups Equally useful regardless of whether the minority group is a large or small proportion of the overall population Used in determining relative risk index “Minimizes” the problem according to some 25Reschly Disproportionality

26. Advantages/Disadvantages of Composition Statistics Dramatizes the problem, draws attention Cannot be compared directly across groups Always has to be interpreted in relation to population composition Usually misinterpreted, producing widespread distortions and confusion about sp ed disproportionality Supports stereotypes of minority children, suggesting that a high proportion or even a majority have disabilities and are in sp ed Media favorite 26Reschly Disproportionality

27. N RiskRel Risk Am/Ind91,49214.3%1.6 A-PI131,0994.7%0.5 Black1,231,92212.4%1.5 Hispanic1,034,1378.5%0.9 White3,498,0078.6%0.9 Total5,986,6579.1% Risk and Relative Risk All Disabilities Age 6-21 2006-2007 Year N is the number of students with disabilities age 6-21 The denominator is the estimated total population age 6-21 27Reschly Disproportionality

28. High Incidence = Speech/language, SLD, MR and ED Low Incidence = The remaining 9 IDEA categories Disproportionality Occurs In High Incidence Disabilities Reschly Disproportionality28

29. Criteria for Significant Disproportionality No precise numerical guidelines (Grutter and Gratz Supreme Court Cases) Reschly Tenative Guidelines: – Relative Risk of (RR) 1.0 to 1.2 acceptable – RR of 1.2 to 1.5 moderate, questionable, more study – RR of 1.5-2.0 Clearly significant – RR > 2.0 Highly significant, nearly certain scrutiny 29Reschly Disproportionality

30. IDEA on Meaning of Significant IDEA Comments on Regulations (2006) “With respect to the definition of significant disproportionality, each State has the discretion to define the term for the LEAs and for the State in general.” See a technical assistance paper at: http://www.ideadata.org/docs/Disproportionality%20Tec hnical%20Assistance%20Guide.pdf 30Reschly Disproportionality

31. Prevalence and Disproportionality in SEAs and LEAs Enormous variations across SEAs Enormous variations across LEAs within a state Variations are not easily explained Failures to explain prevalence variations in LD and ED 31Reschly Disproportionality

32. Disproportionality Conclusions 1.Disproportionality is an international issue 2.Minority overrepresentation contributes about 0.25% to national disability prevalence in the US, i.e., to “overidentification” 3.African-American overrepresentation a.MR affecting 2.6% of Af-Am.; 2.6 x b.ED affecting 1.6% of Af.-Am.; 1.6 x 32Reschly Disproportionality

33. Disproportionality Conclusions cont. 4.Native Am. Indian overrepresentation of in SLD affecting 7.3%; 1.2 x 5.Little disproportionality in Other Sp Ed Categories 6.Hispanic Students Slightly Underrepresented Nationally 7.Asian Pacific Islander Students Markedly Underrepresented nationally 33Reschly Disproportionality

34. Disproportionality Conclusions cont. 8.Varied Patterns for All Groups; Hispanic and Asian students overrepresented in some states and local schools 9.Minority students overrepresented in sp ed have > educational and behavioral needs than non-minority students at referral, placement, and re-evaluation 10.Changes in assessment and evaluation procedures did not affect disproportionality 34Reschly Disproportionality

35. Part III: Causes of Disproportionality National Academy of Sciences/National Research Council Panel Report – http://www.nap.edu/catalog/10128.html http://www.nap.edu/catalog/10128.html Donovan, M. S., & Cross, C. T. (2002). Minority students in special and gifted education. Washington, DC: National Academy Press. 35Reschly Disproportionality

36. Causes of Overrepresentation Biological factors Social factors General education experiences Special education system 36Reschly Disproportionality

37. Biological Bases-Yes Poverty associated with greater exposure to pre- and post-natal toxins (lead, alcohol, tobacco); more premature births, poorer health care, micronutrient deficiencies (iron) and poorer overall nutrition. Do Biological Factors Contribute? 37Reschly Disproportionality

38. Many More Black Children are Born at Low Birthweight 38Reschly Disproportionality

39. Do Social Factors Contribute Social Bases-Yes – Less supportive environments for language and cognitive development; poorer preparation for reading and academic achievement generally, less direct teaching Substantial Difference Exist at Kindergarten 39Reschly Disproportionality

40. Disadvantaged Children Are Less Well Prepared for Schooling Percent first time kindergartners by print familiarity scores 0 skills3 skills 40Reschly Disproportionality

41. Disadvantaged Children Are Less Well Prepared for Schooling Percent first time kindergartners. Teacher ratings of anti- social behavior. Fight with Others Never Often 41Reschly Disproportionality

42. 42Reschly Disproportionality

43. Do Schooling Differences Contribute to Disproportionality? Differences in Resources in Schools with High and Low Income Students Differences in Teacher Education, Experience, and Training in High and Low In Low Income Schools, Greater Need for Highly Systematic Instruction and Strong Classroom Organization/Behavior Mgmt Kellam research re: classroom management 43Reschly Disproportionality

44. Role of Special Education Referral and Assessment Complex Evidence-No Clear Conclusions Simulations Suggest Teacher Biases Studies of Referred Students –Minority students, especially Black students, have greater needs compared to other students Studies of Students in MR, LD, and ED –Minority students have greater needs Tentative Conclusion: Greater Deficits Required for Minority Students to be Referred and Placed 44Reschly Disproportionality

45. 45Reschly Disproportionality

46. 46Reschly Disproportionality

47. Prevention of Disproportionate Representation NRC Panel Report Major Conclusion “ There is substantial evidence with regard to both behavior and achievement that early identification and intervention is more effective than later identification and intervention.” Executive Summary, p. 5 47Reschly Disproportionality

48. Universal Screening and Prevention “ There is substantial evidence with regard to both behavior and achievement that early identification and intervention is more effective than later identification and intervention.” Nat’l Academy Report on Disproportionality p. 5 “If antisocial behavior is not changed by the end of grade 3, it should be treated as a chronic condition much like diabetes. That is, it cannot be cured, but managed with the appropriate supports and continuing intervention.” (Walker et al., 1995, p. 6) 48Reschly Disproportionality

49. Snow re reading (slightly paraphrased)  Reading intervention with a 2nd grader is like changing the direction on a speedboat, with a 5th grader it is like changing the direction of an oil tanker. (Ed Week May 13, 2009, p.11 49Reschly Disproportionality

50. Benchmark=25 Reschly Disproportionality50

51. Benchmark=25 Reschly Disproportionality51

52. Benchmark=35 Reschly Disproportionality52

53. Benchmark Instruction Matters!! Reschly Disproportionality53

54. Centrality of Teachers and Teacher Preparation  Teacher effects are significant, especially for at-risk students and students with disabilities. Tennessee Value Added Assessment System: Three years of highly effective teachers overcome effects of low socioeconomic status Teacher qualifications (e.g., degree level) have trivial effects Teacher practices have large effects. Research-based teaching practices exist but are not taught in most teacher preparation programs.  Improved teacher preparation and professional development are prerequisites to improved achievement. 54Reschly Disproportionality

55. Universal Screening Results Assess success of instructional program – Percent of students at or above benchmarks – If necessary, examine curriculum, instruction, or both Identify students below benchmarks – Interventions within general education classroom – Assess progress and consider need for more intensive interventions at Tier II 55Reschly Disproportionality

56. Universal Screening Academics 1.Current District Practices 1.Classrooms? 2.Individual Students?

57. Universal Screening cont. What could be done?

58. What Works? Research Foundations from Meta-Analysis TreatmentEffect Size  Applied Behavior Analysis.+ 1.00  Formative evaluation: CBM+ Graphing+Decision Rules+ Reinf.+ 1.00  Explicit Instruction and PS +.70 to 1.50  Comprehension Strategies +1.00  Math Interventions +.60 to 1.10  Writing Interventions +.50 to.85  Matching instruction to learning styles??0.00  Note, these effect sizes are stable across cultural groups 58Reschly Disproportionality

59. 59 General Instructional Principle Instruction at student’s knowledge/skill level Principle of Prior Knowledge and Completeness of Instruction Lower Prior Knowledge Higher Prior Knowledge Needs Complete, Explicit Systematic Can Profit from Incomplete Implicit Less Structured 59Reschly Disproportionality

60. Direct, Explicit Teacher Directed Instruction, http://rea.mpls.k12.mn.us/BEAT_THE_ODDS_- _Kindergarten_Teachers.html http://rea.mpls.k12.mn.us/BEAT_THE_ODDS_- _Kindergarten_Teachers.html Teach all elements of the task Break task into components—as far as needed How explicit? Explicit enough for the student to make good progress – Teacher Models Skill, using multiple examples and non-examples – Teacher and student perform task together – Student performs task with feedback – Student independently practices task to automaticity – Integrate skills with prior skills and competencies See YouTube Direct Instruction videos 60Reschly Disproportionality

61. Scientifically-based Instruction in Reading  Reading Curricula content-Snow et al, 1998  Phonemic Awareness Phonics  FluencyVocabulary  Comprehension PLUS  Direct, systematic instruction  Universal screening and formative evaluation  Problem of teacher preparation  VU-TQ Center Innovation configurations, reading, classroom behavior, inclusive services, learning strategies (Reschly, et al., 2007) 61Reschly Disproportionality

62. 62 Reschly RTI62Reschly RTI62 Math Panel Report Key Findings www.ed.gov/mathpanel  Conceptual understanding, computational and procedural fluency, and problem solving skills are equally important and mutually reinforce each other.  Students should develop immediate recall of arithmetic facts to free the “working memory” for solving more complex problems.  Teachers' regular use of formative assessments can improve student learning in mathematics.  Explicit instruction for students who struggle with math is effective in increasing student learning.  Teachers should understand how to provide clear models for solving a problem type using an array of examples, offer opportunities for extensive practice, encourage students to “think aloud,” and give specific feedback.

63. Instruction and Curriculum Practices Current Practices in your district – Curricular Content (national panel reports) – Direct and explicit instruction?

64. Tier I: Screening for Behavior Problems Early indications of later serious behavior problems appear by age 3-5 Early identification-treatment more effective than later interventions, especially with aggression Behavior referrals often occur too late for maximum effect of interventions Identification as ED and Sp Ed placement most often occur at age 10, 11, or older when interventions are less effective and more resistant

65. Tier 1 Screening Procedures Proactive rather than reactive Multiple respondents and settings Earlier is better – i.e. preschool or kindergarten Include multiple measures after initial teacher nominations/rankings – Direct observations, record reviews, parent ratings, other sources Kauffman, 2005

66. Systematic Screening for Behavior Disorders (SSBD) Walker, H. M., & Severson, H. H. (1992). Systematic Screening of Behavior Disorders (SSBD). Longmont, CO: Sopris West. Multiple “gating” procedure – Externalizing vs. internalizing Identifying at-risk students grades 1-6 Every child is screened in general education Child must have been in classroom a minimum of 30 days to be screened Walker & Severson, 1992

67. Do behavior problems contribute to disproportionality in Iowa? Behavior Issues

68. Do behavior problems contribute to disproportionality in Iowa? cont. Universal Screening? Positive Behavior Supports P-6 Positive Behavior 6-12 Sprick Safe and Civil Schools Individual interventions

69. Principles of Strong Classroom Organization and Management Engaging instruction Structuring the environment Monitoring behavior and academic engagement Classroom rules and behavioral routines Encourage and reinforce appropriate behavior Behavior reduction strategies Oliver, R. M., & Reschly, D. J. (2007). Improving student outcomes in general and special education: Effective classroom management. Washington, DC: Learning Point Associates, National Comprehensive Center for Teacher Quality. http://www.tqsource.org/topics/effectiveClassroomManagement. pdf http://www.tqsource.org/topics/effectiveClassroomManagement. pdf 69Reschly Behavior

70. Tier I: Behavior: Classroom Organization and Behavior Management  Kellam, Baltimore Schools Students randomly assigned to 1 st grade teachers, then classroom was the unit of analysis Classrooms observed during first 9 wks., high rates of disruptive behavior and aggression, large differences across classrooms Classrooms randomly assigned to,  Experimental condition: Good Behavior Game (Barrish, et al, 1969; Sulzer-Azaroff & Mayer, 1991) vs.  Control condition of in-service on general curriculum issues 70Reschly Behavior

71. Kellam Research: Classroom Organization and Management  Good Behavior Game (Barrish, et al., 1969) Group contingency Two groups formed into teams Define rules and positive behaviors Teams compete for positive consequences Team with highest rate of appropriate behaviors earn “rewards”  Lining up first, Help teacher pick-up classroom, free time, etc. 71Reschly Behavior

72. Kellam Research: Effects of Good Behavior Game Were Statistically Significant Aggression and disruptive behavior continued in control classrooms Marked reduction in experimental condition Experimental classrooms had higher academic productivity and achievement Aggressive students in both conditions followed through 6 th grade and first grade classroom effects persisted First grade experience sets academic and behavioral trajectory 72Reschly Behavior

73. Academic Interventions (Vaughn et al., 2003 Exceptional Children) Goals: Move performance to benchmark trajectories and, If needed, consider more intensive interventions Example of Tier II academic intervention – Small group, N=4-5, pull out, similar needs – 30 to 35 minutes per day in addition to classroom instruction – Progress monitoring weekly or semi-weekly – Individual time series analysis graph – 10 to 20 weeks of instruction – 5-component reading interventions, with emphasis on weak components 73Reschly Disproportionality

74. Individual Progress Monitoring Essential at Tier II and Tier III Frequency? At least weekly using CBM Formative Evaluation – Graph with goals – Progress in relation to goals – Decision Rules to guide changes in instruction or to raise goal. 2 or 3 data points above or below goal leads to changes 74Reschly Disproportionality

75. Egbert’s Time Series Analysis Graphs  Egbert is in February of Grade 1  Main problem is low reading based on universal screening measure in January  He has some interfering behaviors including mild levels of disruptive behavior and inattention in the classroom  Decision to place in general education Tier II small group reading intervention  30 to 40 minutes daily, group of 3-5 students  Weekly progress monitoring with an individual graph using Oral Reading Fluency 75Reschly Disproportionality

76. Weeks Words Correct Per Minute Graph Current Status February Grade 1 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Benchmark=24 Egbert=11 76Reschly Disproportionality

77. Weeks Words Correct Per Minute Determine Goal: Class=1.5 wd growth per week; Egbert Goal: 2 wd growth per week 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Bchm=24 Egbert=11 Benchmark Line Egbert goal line Bchm=54 77Reschly Disproportionality

78. Weeks Words Correct Per Minute Monitor Egbert’s Progress Relative to Goal 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Bchm=24 Egbert Results Benchmark Line Egbert goal line Egbert Results Bchm=54 78Reschly Disproportionality

79. Weeks Words Correct Per Minute Formative Evaluation: Change Intervention 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Bchm24 Egbert results Benchmark Egbert goal line Change Intervention Bchm=54 79Reschly Disproportionality

80. Weeks Words Correct Per Minute Continue Intervention and Monitor Progress 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Bnch=24 Egbert Results Benchmark Egbert goal line Change Intervention Bchm=54 80Reschly Disproportionality

81. Weeks Words Correct Per Minute Raise Goal to 2.5 WCM Growth 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Bnch=24 Egbert results Benchmark Egbert goal line Change Intervention Change Goal New Goal Line Bchm=54 81Reschly Disproportionality

82. Weeks Words Correct Per Minute Continue Intervention and Monitor Progress 0 1 2 3 4 5 6 7 8 9 10 12 14 16 18 20 Bchmrk=24 Benchmark Egbert results Change Intervention Fade Tier II Bchm=54 82Reschly Disproportionality

83. Review of Sp Ed Case Files State of WA for a court case Randomly selected 900 sp ed students – 10 districts represented – All students were in sp ed for at least 12 months – Case files varied from 50 to 1100 pages – Evaluated IEPs using checklist for required components and evidence of formative evaluation – How many graphs?? 83Reschly Disproportionality

84. Review of Sp Ed Case Files cont. Results – Little evidence of systematic, direct instruction or of – Behavior Interventions using problem solving – Assessment and formative evaluation was nearly non-existent (11 of 870 cases had graphs) – Lots of test protocols documenting weaknesses – Little evidence of positive outcomes, that is, benefits of special education are largely undocumented in high incidence. No assessment of progress 84Reschly Disproportionality

85. Progress Monitoring and Formative Evaluation District Practices Recall effect sizes of PM and FE Current practices in your district? – CBM use in general education? – CBM use in special education? – Time series analysis graphs?

86. Barriers to Improved Results Implementation of what we know: 20 year gap Treatment fidelity-interventions implemented as designed – Universal problem – Medicine, law, education, business – Example, Given a prescription for a medication, what proportion of us take the medication exactly as directed? – Self regulation procedures Checklists and intervention protocols are critical to closing implementation gaps 86Reschly Behavior

87. Gawande, A. (2009). The Checklist Manifesto: How to Get Things Right. New York: MacMillan. 87Reschly Behavior

88. Gawande’s Checklist Manifesto Checklists: Force function, that is, remind us to do routine behaviors that are essential to accomplishing complex tasks Many examples – Aviation checklists – Medicine-routine administration of pediatric immunizations – Medicine-surgery procedures (infection, bleeding, anesthesia) 88Reschly Behavior

89. Gawande’s Checklist Manifesto cont. Central line insertion in medicine: Tube to a major vein Routine Procedure known and taught for years Infection rates too high—lead to enormous negative consequences Checklist developed that reduced infection rates by 66% – Wash hands thoroughly with anti-bacterial soap – Clean patient’s skin with chlorhexidine antiseptic – Sterile drapes over the patient – Wear mask, hat, sterile gown, gloves – Put sterile dressing over the insertion site 89Reschly Behavior

90. Gawande’s Checklist Manifesto cont. Surgery checklist-international study involving wide range of hospitals Three checklists regarding routine behaviors – Seven item checklist before anesthesia – Seven item checklist prior to incision – Five item checklist at the conclusion of the surgery Outcomes? Significant decrease in surgical complications 90Reschly Behavior

91. Acceptance of Checklists by Professionals Mixed, often negative reactions: Reasons??? Survey of Gawande’s participants was generally positive – Lower for surgeons, higher for nurses – 50% to 70% depending on specialty endorsed continued use – Question? If you were the surgical patient, would you want the checklist used? – Answer: 94% said yes Checklists work, but acceptance is mixed 91Reschly Behavior

92. Some things do not make sense 92Reschly Behavior

93. Characteristics of Good Checklists Brief Critical behaviors that, if not done, lead to negative outcomes Simple direct statements that cue critical behaviors Efficient regarding time Effective in improving outcomes 93Reschly Behavior

94. Improved Disproportionality Prevention and Early Intervention Summaries-What do you want to do?

95. Reschly95 Enough Already: Time for me to sit down!! Royal Kiss? Grace van Cutsem Not Impressed