1. Team Driven Tertiary Process: The Prevent-Teach-Reinforce Model
Rose Iovannone, Ph.D.
Carie English, Ph.D.
University of South Florida
Developed under grant H324P04003 from the Department of Education.

2. Acknowledgements USF UCD Don Kincaid Kathy Christiansen Sarah Donadio
Glen Dunlap
UCD
Kelly Wilson
Patricia Oliver
Ted Bovey
Edy Purcell
Phil Strain

3. Objectives Participants will:
Describe an individual positive behavior support process for use in the classroom
List factors impacting the effectiveness of an individual behavior support process

4. Individualized PBS (Tertiary)
For high-risk students:
History of severe problem behaviors
Demonstrated resistance to intervention
An intensive system of support is needed
~5%
~15%
Students who are at the top of the triangle need more intensive, individualized supports. These students are not or have not responded to other supports in your school. Not all students at the top of the triangle will need an individual behavior support plan. Many will benefit from a targeted group intervention. Those who do not, however, need additional support. Many of these students are classified as EH, ED, SED, etc… These are the students with the most frequent and/or most severe problem behavior.
~ 80% of Students

5. Conceptualizing an Array of PBS Supports
Universal/Primary
School-Wide Assessment School-Wide Prevention Systems
Classroom Interventions
Targeted/
Secondary
Tertiary (Intensive)
Group Interventions
Analyze Student Data
Assessment
Interviews, Questionnaires, etc.
Simple Student Interventions (ERASE)
Intervention
Observations and ABC Analysis
Complex Individualized Interventions (PTR)
Team-Based Wraparound Interventions
Multi-Disciplinary Assessment & Analysis
Scott, 2001

6. Tertiary Supports in Schools
Traditional process:
Specialist/expert-driven
Complete an observation
Write a support plan
Call me if you have questions
Often contextual fit ignored
Limited support/follow-up/training provided

7. Prevent Teach Reinforce Process
Team driven process
Goals, assessment, intervention plan
Support provided by facilitator
Direct observation
Training and classroom implementation assistance
Contextual fit
Greater buy-in and likelihood of implementation

8. Prevent-Teach-Reinforce Model
Funded by US Dept. of Education/ Institute of Educational Sciences
Randomized control group design
Two sites—USF and UCD
Three school districts central Florida
Two school districts Colorado
Compare prescriptive, simple model to “business as usual”

9. Sample
200 students
100 treatment; 100 wait-list control
Any student in K-8 grades who exhibit problem behavior
Problem behavior criteria
Minimum 5 critical events indicated on Systematic Screening for Behavior Disorders (SSBD)
Behaviors disruptive, durable (6 months), chronic (at least 1 time a week)

10. Sample Data Measures Repeated measures at student level
Problem behaviors, social skills, academics
Mediator and moderators at multiple levels:
Student
Teacher/Classroom
System
*USF site only

11. Process Standardized approach
Five step process facilitated by PTR Consultant
Team Development
Goal Setting
Assessment
Intervention
Coaching—up to 12 hours
Evaluation
Manual including information and forms

12. Preliminary Data Results

13. Student Demographics by Ethnicity and Gender
%age
American Indian 3
1.3
Asian 2 .9
Black 42
18.7
Hispanic 64
28.4
Other 7
3.0
White
112
49.8
Gender
Female 43
19.1
Male
182
80.9

14. Student Demographics by Primary Disability%
Autism 25
9.8
Developmental Delay 5
2.0
Emotional Disturbance 38
14.9
Mental Retardation 28
11.0
Multiple Disabilities 4
1.6
OHI (not ADD/ADHD) 1 .4
OHI (ADD/ADHD) 8
3.1
Specific Learning Disability 20
7.8
Speech/Language Disability 10
3.9
Visual Impairment 2 .8
General Education 99
38.8
Unknown 15
5.9
TOTAL
255

15. d = .57
Follow-up N 29/17
p < .000

16. d = .48
p < .000

18. NBRCC Report 10-10-07 PTR Intervention more effective in:
Increasing social skills and decreasing problem behaviors with students having most severe behaviors (measured by SSBD Maladaptive Behavior Scale)
Increasing social skills and decreasing problem behaviors of males

19. NBRCC Report 10-10-07 Teachers participating in PTR indicated:
High social validity
98% liked PTR
91% felt PTR reasonable
High alliance (relationship) with consultant
Overall mean = 4.8 (SD = 0.45)
Consultant is approachable
Consultant and I trust one another
Overall, consultant has shown sincere desire to understand and improve the situation

20. Social Validity Comparison USF—Sample Items
Pre
Post
Like procedures
3.2
4.4
Acceptable
3.6
4.3
Teach appropriate behavior
3.5
Fit into existing routine
3.8
Total Social Validity Score

21. Fidelity
Most teams reaching 80% fidelity and maintaining into post-test
Quality scores lower than adherence scores
Part of the plan implemented although not entirely as plan written

22. The Process: A Case Study Example

23. Step 1: Team Development
Members and roles identified
Teacher
Behavior specialist/school psychologist
Family members, paraprofessionals, special area teachers
Work styles inventory
Teaming survey

25. Case Study—Step 1: Team Building
Mike is a 9-year-old male in a self-contained autism classroom
Nonverbal—uses signs, Dynamite, and pictures to communicate
1 teacher, 2 aides, and 6 students

26. Case Study—Step 1: Team Building
Teacher-- Ms. Wonderful
Aides
Ms. Needs Help
Ms. Also Needs Help
Facilitator—PTR Consultant
Results of teaming information indicate a great team that meets regularly to brainstorm

27. Step 2: Goal Setting Identify team consensus on:
Academic behavior
Social behavior
Problem behavior
Appropriate behavior
Develop and begin baseline data collection

28. Case Study—Step 2: Goal Setting
Behavior
Social
Academic
Decrease
Increase
Broad
Mike will communicate his wants and needs appropriately
Mike will interact with peers appropriately
Mike will comply with nonpreferred activities and requests
Mike will decrease screaming, hitting, and getting out of his seat
Mike will decrease hitting, screaming at, and bossing his peers
Mike will decrease screaming and hitting
Mike will ask for a break or for attention when needed
Mike will initiate peer interactions using his Dynamite
Mike will engage in nonpreferred activities and communicate his frustration using his Dynamite or an appropriate tone

29. Case Study: Operational Definitions of Problem and Replacement Behaviors
Screaming—loud, high pitched noise heard outside the classroom
Hitting—anytime Mike touches peers or adults with an open hand, fist, foot, or object while screaming or protesting
Expressing Frustration—using Dynamite, pictures, or signs to ask for a break or attention
Transition to nonpreferred activities—moving to nonpreferred activity and engaging with appropriate verbal expression (screaming level)

30. Case Study: Behavior Rating Scale With Anchors
Date
Screaming
9+ times
7-8 times
5-6 times
3-4 times
0-2 times 5 4 3 2 1
Hitting
8+ times
6-7 times
4-5 times
2-3 times
0-1 times
Expressing Frustration
40%+
30-40%
20-30%
10-20%
0-10%
Transition to Nonpreferred
Whimper or squeal
Louder than indoor voice
Outdoor play voice
Louder than outdoor play
Ear penetrating

31. Step 3: Assessment Checklist format:
Antecedents or Triggers (Prevent)
Function(s) of the problem behaviors (Teach)
Consequences following the problem behaviors (Reinforce)
Assists team to link function of behavior to intervention plan

37. Case Study—Step 3: PTR Assessment Problem Behavior
Prevention Data
Teach Data
Reinforce Data
Non-preferred task
Reading, Math
Transition
Preferred to
non-preferred
Change in schedule
Denied item, told no, or to fix
something
Other students upset/mad
Teacher attending to others
Gain attention
Peers, adults
Delay
Access to items
Redirected
Reprimanded
Calm/soothe
Personal
space
Later must
complete task
Loses/delays
reinforcers
Screaming, Hitting

38. Case Study—Step 3: PTR Assessment Appropriate Behavior
Prevention Data
Teach Data
Reinforce Data
Independent work
One-on-one
attention
Specials
Peer interaction
Getting attention
Raising hand
Sharing attention
Conversation skills
Taking turns
Waiting
Self-management
Asking for break
Expressing emotions
Treasure box
Movie
Attention
Helping teacher
Going to media
center
Going outside
Walk
Food
Prosocial

39. Step 3: PTR Assessment—Developing the Hypothesis
When….
Student will….
As a result…
Inappropriate Behavior
Appropriate Behavior
Prevention data = antecedents or triggers
Teach data = replacement behavior and possible function
Reinforce data = function and reinforcers

40. Case Study—Step 3: PTR Assessment Possible Hypotheses
When….
Student will….
As a result…
Mike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to nonpreferred activity, fix an error, or when teacher attending to other students
scream and hit
Mike is able to gain attention and delay the transition/activity
Mike is asked to complete non-preferred task (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher attending to other students
express his frustrations appropriately
complete the assigned task
Mike is able to delay the transition/activity
Mike is able to gain attention
Inappropriate
Appropriate

41. Case Study: Tips on Linking Interventions to Hypothesis
Prevention strategies must address:
Getting Mike attention more often
Changing non-preferred task
Particular student
How it is done (format)
Changing what happens when he makes a mistake
Do part of it (rather than all of it) over
Allow him to find what is wrong
Provide social story
Signaling end of preferred activity
Teach strategies must address:
How to get attention/assistance
How to get break/delay appropriately
Reinforce strategies must address:
Giving Mike attention/help
Giving Mike break/delay

42. Step 4: Intervention
Team ranks top three intervention strategies in each of the PTR components
Multi-component intervention that teacher states s/he can implement
Prevent
Teach
Reinforce
Implementation plan

43. Case Study: Tips on Linking Interventions to Hypothesis
Prevention strategies must address:
Giving Paris attention more often
Changing non-preferred task
Presentation (how it is given to Paris; how it looks)
Content (embedding preferences)
Changing environment surrounding independent work time
Teach strategies must address:
How to get attention appropriately
How to get a delay appropriately
How to access preferred item appropriately
Reinforce strategies must address:
Giving Paris attention/help
Giving Paris a delay
Giving Paris access to preferred activities

45. Case Study—Step 4: PTR Intervention
Prevent Strategies
Specific Strategy steps
Environmental Support
A wait card will be placed on Mike’s desk to assist him in remembering to wait his turn.
1. Prior to group work, tell Mike, “Remember, when it is someone else’s turn, you sit quietly and wait,” while pointing to his card.
2. If Mike calls out, point to his visual to remind him what to do.
3. Use a verbal prompt if the point prompt does not work.
Mike’s visual schedule will be modified to detail the number of and type of activities he is to complete during non-preferred activities. For example, if math involves listening to a lesson, doing a hands-on activity, and completing a worksheet, his visual schedule will list each activity under math using either a picture of the type of activity or using numbers that correspond to a number on the worksheet.
1. Prior to the start of the activity, Mike should review the visual schedule.
2. As Mike completes an activity, he should X off the activity.

46. Specific Strategy steps
Prevent Strategies
Specific Strategy steps
Curricular Modification
Mike will be given an easy, independent activity, such as a worksheet, to complete upon transitioning to a non-preferred activity or an activity that requires him to wait, such as group activities

47. Specific Strategy Steps
Teach Strategies
Specific Strategy Steps
Replacement Behavior
Mike will be taught to use his Dynamite to express his need to calm down.
1. Mike’s device will be programmed to say “I need to calm down.”
2. Prior to transitioning to a non-preferred activity or at the end of a preferred activity, remind Mike that “if you start to get mad, you can choose to calm down.”
3. As soon as Mike starts to get upset, prompt him to use his device.
4. Once Mike communicates “I need to calm down”, present him with the choice board of calming strategies and ask him, “What do you want?”
5. As soon as he is calm, praise him.
6. Allow Mike to engage in his choice until he is calm for 1-minute.
7. If Mike does not return to his area, then start having a fun time in that area with those students present

48. Specific Strategy Steps
Teach Strategies
Specific Strategy Steps
Self-Management
Mike will be taught to independently use his calming strategies.
1. A tracking sheet with smiley faces and sad faces will be given to Mike at the start of each day.
2. Role-play with Mike about when he needs to make the choice to calm down.
3. Practice completing the tracking sheet.
4. Set and review the daily goal for using the calming strategies.
5. Prompt Mike to complete the tracking sheet if needed

49. Specific Strategy Steps
Reinforce Strategies
Specific Strategy Steps
Replacement Behavior
Anytime Mike “says” “I need to calm down”, his choice board should be given.
1. Praise Mike for communicating (“thank you for telling me.”)
2. Provide his choice board.
3. Allow him to calm for 1 minute
4. Praise him as soon as he is quiet
5. Praise him for returning to the group
Self-Management
Anytime Mike scores his behavior, attention should be given.
1. When Mike marks his tracking sheet, praise him for doing so.
2. At the end of the day, review the sheet with Mike.
3. Talk about the sad faces.
4. Provide his reward if his goal is met.
Waiting
Mike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule.

50. Specific Strategy Steps
Reinforce Strategies
Specific Strategy Steps
Transition
Mike will earn stars during Reading Centers if he transitions and completes his work without screaming.
1. A social story will be reviewed prior to Reading Centers to remind Mike that he can earn a star if he comes to centers and works.
2. At the end of each reading center, an adult will review Mike’s behavior with him and ask him if he earned his stars.
3. Provide his stars if earned.
4. During the teacher’s group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group.
5. Allow Mike to participate in his chosen activity if he earned his stars.

51. Coaching of Interventions
Training of teacher
1 to 2 hours
80% accuracy on all strategies
Assistance in classroom
Up to 12 hours
Fidelity measures recorded
80% implementation terminates assistance in classroom

52. Case Study: Training

53. Case Study: Fidelity

54. Step 5: Evaluation Data-based decision-making
Identifying what is working; what is not and WHY
Expanding into other routines
Generalization
Continuing team meetings
Planning time
Cohesiveness

55. Step 5: Evaluation
1 is a lot of screaming, 5 is no screaming

56. Step 5: Evaluation
1 is a lot of hitting, 5 is no hitting

57. Step 5: Evaluation
1 is a little appropriate expression, 5 is a lot of appropriate expression

58. Step 5: Evaluation
1 is inappropriate transition, 5 is super appropriate transition

59. Step 5: Evaluation Other Outcome Data
Measure
Baseline
Post-test
Change
SSRS-PB
123
112
-11
SSRS-SS 87
102
+15
AET
.34
.57
+23

60. Wrap Up: What We Have Learned
PTR process may not be enough for all students
Some need wraparound
Not all students need PTR
3-tiered model of individual support
Teachers report the coaching piece and collaborative process to be keys

61. How to Make PTR Work in Your School
Steps are the key components not how your organize them
Must create a system that will work for your school or even each student
Things to consider
Tertiary team
Identification/Nomination process
Facilitator
Set-up of meetings for efficient results

62. Organizing the PTR Process
Is Team Building needed?
Small team, team works well together, no paraprofessional
If small team or no paraprofessional, skip and start with Goal Setting
If well functioning team, combine with Goal Setting

63. Organizing the PTR Process
Few problem behaviors or all in same response class?
Same antecedents &/or function
Small team
Combine Assessment with Intervention Development
Condense the steps to meet the needs of your school

64. Final Thoughts: System Changes
Process may require more time up front but less time overall
Must provide assistance in the classroom until desired outcomes achieved
Will pay off in the end
Teams more likely to implement the plan
Ownership
Fits the class and the student
Continued contact

65. Questions?