1. Evidence-Based Practices to Reduce Challenging Behavior Lise Fox, Ph.D. University of South Florida1

2. 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

3. National Centers - Resources
Center on the Social and Emotional Foundations for Early Learning
(CSEFEL)
Technical Assistance Center on Social Emotional Intervention (TACSEI) 3

4. 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

5. Impact
&
Prevalence

6. 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)

7. 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)

8. 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)

9. It begins
early...

10. 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).

11. 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).

12. Early Predictors
Temperamental Difficulties
Early Aggression
Language Difficulties
Noncompliance

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

14. 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

15. Sobering
Facts

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

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

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

19. 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

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

21. (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)

22. (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)

23. 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)

24. 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.

25. 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

27. 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.

28. Relationships

30. 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

31. Reviewing Rules

32. Transitions

33. Circle Time – Universal Design
Adult Support
From: 33

34. Circle Time – Universal Design
Peer Support
From:

35. Circle Time – Universal Design
Child Preference
Special Equipment
From:

36. Circle Time – Universal Design
Environmental Support
From:

37. Circle Time
Special Equipment

38. Circle Time
Child Preference
From:

39. Circle Time
Invisible Support
From:

40. Circle Time
Simplify the Activity
From:

42. 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

43. 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

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

45. Feeling Wheel & Feeling Dice

46. 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.

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

48. The Solution Kit 48

49. 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

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

52. 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.

53. 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

54. Before PBS

55. 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

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

57. 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

58. 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

59. I like talking and playing
with my friends
at school.

60. 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.

61. 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?”.

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

63. 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: ___________

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

65. 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

66. Tim – with PBS

67. “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

68. 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

69. 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?

70. 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?

71. 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?

72. National Centers - Resources
Center on the Social and Emotional Foundations for Early Learning
(CSEFEL)
Technical Assistance Center on Social Emotional Intervention (TACSEI) 72