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Slide1
Prevent-Teach-Reinforce (PTR): An Evidence-Based Functional Behavior Assessment/Behavior Intervention Process for Students Needing Tier 3 Supports
Rose Iovannone, Ph.D., BCBA-D
iovannone@usf.edu813-974-1696
The contents of this training were developed under grant H324P04003 from the Department of Education
Slide2AgendaOverview PTRPTR ProcessStep 1-Teaming/goal setting/progress monitoringStep 2 Functional assessmentStep 3a-Behavior intervention plan
Step 3b-Coaching/FidelityStep 4-Monitoring and making data-based decisionsNext steps
Slide3ObjectivesParticipants will:Describe the 4-step PTR Tier 3 support modelIdentify the critical components that enhance the success of Tier 3 supportsDetermine how the PTR process is applicable within their setting
Slide4Prevent-Teach-ReinforceThe Model
Slide5What is Prevent-Teach-Reinforce (PTR)?Research project funded by U.S. Department of Education, Institute of Education SciencesUniversity of South Florida Three central Florida school districtsUniversity of Colorado, Denver
Two Colorado school districtsPurposes:Answer the call for rigorous researchEvaluate effectiveness of PTR vs.
“services as usual” using randomized controlled trialEvaluate effectiveness of “standardized “ approach
Slide6Where is PTR in a Multi-tiered System of Supports (MTSS)?
Slide7Participants in PTR 245 students—100 treatment, 100 comparisonK-8th gradeGeneral and Special Education
All cognitive levelsAll disabilitiesTeacher-nominated top externalizers
Systematic Screening for Behavior Disorders (SSBD)Behavioral difficultiesDuration– minimum 6 monthsFrequency— minimum of 1 time per weekIntensity– disruption to the learning environment
Slide8PTR Preliminary Outcomes
Slide9Student Demographics by Primary Disability
Disability
N
Percent
Autism25
9.8
Developmental Delay
5
2.0
Emotional Disturbance
38
14.9
Intellectual Disability
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
TOTAL
245
Slide10Student Description
Grade Level
K
1
2345678
N
34
53
53
41
30
16
7
8
3
%
13.9
21.6
21.6
16.7
12.2
6.5
2.9
3.3
1.2
Lunch Status
Regular
Free/Reduced
77
150
31.4
61.2
Gender
Female
Male
45
200
18.4
81.6
Slide11Randomized Controlled Trial Results
Slide12Wait-List Control to Treatment Results
Slide13Teacher OutcomesFidelityMajority of teachers achieved .80Mean # coaching/training sessions = 3.5Prevention higher than Teach and Reinforce
Social ValidityModified Teacher Acceptability Rating Form (TARF; Reimers & Wacker, 1988)—15 items5-point Likert Scale124 teachers
Overall—4.16 (.52)Willingness to carry out plan—4.80 (0.42)Like the procedures—4.46 (0.64)AllianceTeachers rated PTR consultants highly (4.80 mean)Highest—trust, follow-through, collaborative
Slide14Other Research
Slide15Research in PTRTwo randomized controlled trialsOriginal for kindergarten through grade 8 (5 years to ~ 14 years of age)Young children (3 years to 6 years of age)Several single subject studies
General educationAutismChild care settingsFamiliesHigh school students with emotional disorders
Slide16Research OutcomesRCT-Students receiving PTR significantly improved social skills, problem behaviors and academic engagement compared to those who received services as usual (SAU)Single subject—multiple baseline designs showed PTR improved the dependent variable in all studiesTeachers implemented the interventions with high (e.g., 80% or greater) fidelity
Teachers found PTR to be socially valid
Slide17Sullivan, Crosland, Iovannone, 2016
PTR High School EBDDirect Observation
Slide18Sullivan, Crosland, Iovannone, 2016
PTR High School EBDTeacher IBRST Ratings
Slide19Barnes,
Iovannone, Blair, Crosland, & George, 2016
An Evaluation of the Prevent-Teach-Reinforce Model in a General Education Setting
Slide20Kulikowski
, Blair, Iovannone
, & Crosland, 2015An Evaluation of the Prevent-Teach-Reinforce (PTR) Model
in a Community Preschool Classroom
Slide21The PTR Process
Slide22PTR Model
Student-Centered Team
FacilitatorMember(s) who know studentMember(s) who know school/district
Start here
Slide23Teaming (Before the Process is Started) Teaming: A collaborative processDetermine relevant team membersSuggestions—3 levels of knowledge represented:Members
Person with knowledge of student (e.g., Classroom teacher, instructional assistant, parent)Facilitator—Someone with knowledge of functional assessment, behavioral principles (PTR consultant, school-based consultant)Someone with knowledge of context (e.g., administrator or designee)
Slide24Collaboration Activity-
p. 3 Activity Packet
Slide25Teaming (PTR Style)Optional forms Best used for situations in which the team may not be collaborating effectively
Forms for creating an effective cohesive teamClassroom Team Survey (
68-69)Teacher Work-Style Survey (70)Paraeducator Work-Style Survey (71)PTR Work-Style Comparison Sheet
(72-used by facilitator) Purposes: To identify potential issues enhancing and impeding effective intervention implementation
Slide26Step 1-Goal SettingIdentify the problem
Slide27Step 1: Goal SettingPurpose: Identify behaviors of greatest concern to the team and possible replacement behaviors (teach)Prioritize and operationalize behaviors targeted for interventionDevelop teacher friendly baseline data collection system
Areas that can be targeted:Problem behaviorsSocial skillsAcademic behaviorsDifferent options/versions in
PTR Tools handout (11-19)
Slide28Slide29Slide30Slide31Case Study 1Mike9-year-old maleESE Classification: AutismPlacement: Self-contained, autism classroom with 6 students
Nonverbal: Uses signs, Dynamite, pictures to communicate Team: Teacher and two aides, PTR Consultant
Slide32Mike’s Team-Goal Setting
BEHAVIORS TO DECREASE
Target Behavior:ScreamingHitting
Getting out of seatBossing peersOperational Definition:Loud, high pitched noise heard outside the classroom
Touching peers or adults with open hand, fist, foot, or object while screamingBEHAVIORS TO INCREASETarget Behavior:Transition from preferred to non-preferred activitiesExpress frustration using his communicationAsk for a break or attentionInitiate peer interactions using communicationOperational Definition:Moving to non-preferred activity and engaging in communication at inside voice volume and pitchUse communication (voice output device, signs, pictures) to request a break or attention
Slide33Case Study 2-Jeff General EducationRetained second graderClass had 19 studentsTeam included two co-teachers
both with their own second grade classrooms
Slide34Jeff’s Behaviors
BEHAVIORS TO DECREASE
Target Behavior:Disruptive behaviors
Negative commentsOperational Definition:Tapping pencil, making loud comments without raising hand, tapping person seated near him, getting out of seat to sharpen pencil without permission.BEHAVIORS TO INCREASE
Target Behavior:On-task behaviorIndependent work completionInteract with peers at appropriate timesOperational Definition:Actively participating in group instruction by raising hand to speak and looking at teacher; during independent work, keeping pencil moving on paper in a way that gets task completed, letting neighbors work, raising hand to ask for help(this is part of on-task behavior-was measured by %age of assignments completed)
Slide35Step 1: Progress Monitoring SystemIndividualized Behavior Rating Scale Tool – IBRST Direct Behavior Rating (DBR)—Hybrid assessment combining features of systematic direct observations and rating scalesEfficient and feasible for teacher use
Provides data for decisionsPrioritized and defined behaviors measuredRequires minimum of 1 appropriate and 1 inappropriate behavior
Slide36Components of IBRSTScale—5 point foundationCan be flexible and add or subtract Likert scale pointsCan be creative and use columns/rows for different time periods/people, etc.Key—Vital for teacher Definition of behavior
Directions—over what time period of day will they be rating the behavior? What do each of the anchor points represent as perceptual estimates?PracticeAfter setting up, ask teacher to rate student
’s behavior from earlier in the day or previous dayAdjust if necessary
Slide37Defining Behaviors
NonexamplesGrabs
Hits Examples
Grabs clothing of peers by pinching and bunching fabric with his fistHits peers and adults on their bodies by slapping with hand (moderate intensity), pinching flesh with fingers (leaves mark), punching by making a fist with hand and making contact with peer/adult bodies
Slide38Case Study 1- Mike: Behavior Rating Scale
Behavior
Screaming
9+ times
7-8 times
5-6 times
3-4 times
0-2 times
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
Hitting
8+ times
6-7 times
4-5 times
2-3 times
0-1 times
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
54321543215432154321543215432154321Expressing Frustration40%+30-40%20-30%10-20%0-10%543215432154321543215432154321543215432154321543215432154321Transition to Non-preferredWhimper or squealLouder than indoor voiceOutdoor play voiceLouder than outdoor playEar penetrating543215432154321543215432154321543215432154321543215432154321
01/15
Slide39IBRST—Key for MikeScreaming: Loud, high-pitched noise heard outside the classroom. Rate your perception of Mike’s screaming episodes over the entire day. 5 = Terrible day; 4 = Typical bad day; 3 = So-So day; 2 = Good day; 1 = Fantastic day.
Hitting: Touching peers or adults with open hand, fist, foot, or object while screaming. Rate your perception of Mike’s hitting episodes over the entire day.
5 = Terrible day; 4 = Typical bad day; 3 = So-So day; 2 = Good day; 1 = Fantastic day.Expressing frustration: Using communication (voice output device, signs, pictures) to request a break or attention. Rate your perception of the percentage of opportunities Mike used appropriate communication 5 = Fantastic day; 4 = Good day; 3 = So-so day; 2 = Typical bad day; 1 = Terrible dayTransition to non-preferred:
Moving to non-preferred activity and engaging in communication at inside voice volume and pitch. Rate your perception of the overall intensity of Mike’s transitioning behaviors. 5 = Fantastic day; 4 = Good day; 3 = So-so day; 2 = Typical bad day; 1 = Terrible day
Slide40Slide41IBRST Inter-rater Reliability (Iovannone, Greebaum, Wang, Kincaid, & Dunlap, 2014)Kappa coefficients of:
Problem Behavior 1 (n = 105): .82Problem Behavior 2 (n = 90) : .77
Appropriate Behavior 1 (n = 103): .65Appropriate Behavior 2 (n = 56): .76
Slide42Agreement of IBRST and Direct ObservationIn recent multiple baseline study, Problem Behavior-74% of ratings in exact agreement, 16% within one scaled scoreAppropriate Behavior-75% exact agreement, 14% within one scaled score.
Cohen’s Kappa = 0.70 (p<0.001)Barnes, Iovannone, Blair, Crosland, & Peshak-George, (in review).
Slide43Secondary Level ModificationsTeams with 3 or more membersSelect one team member who will be the primary interventionistBehavior identification and IBRST development will be focused on that person’s situation
Other team members provide input/supportIf desired, other team members can record IBRST data in their settings—rating descriptions can stay the same or minor modifications can be madeEach row of BRS can represent a different teacher OR
Each teacher can keep own IBRSTFacilitator collects all IBRST ratings at specified times
Slide44Variations of the Individualized Behavior Rating Scale Tool (IBRST)
Slide45Slide46Slide47Slide48Slide49Slide50Slide51Slide52Facilitation TipsHave team members submit the goal setting table as homeworkHave a visual that summarizes all of the inputDo not reword input—wait until meeting to have team provide clarificationIf step is conducted during problem solving meeting, use group processes to ensure all team members participate
Use post-it notes or index cards and provide several to each team memberUse 2 minute thinking time, have team members write input on notes/cardsUse round robin to get input from all
Slide53TroubleshootingIBRST Data CollectionDecide upon a method of prompts to remind teachers/team to:Rate the behaviors on the IBRST daily (or frequency determined by the team)Have data ready for analysis at ALL meetings related to the student and the plan
Identify a key person (who likes Excel or other spreadsheet/data chart software) who can transfer the scores into a graphToo many behaviors identifiedAsk teachers/team if they could select one problem behavior that, if reduced, would make each day at least 50% better for everyone (student, school, family)
Defining behaviorsIf teachers/team have difficult time using words to define the define the behavior, ask them to demonstrate the student doing the behavior. Write down the motor movements, verbal communication, other key features that define the behavior.
Slide54Practice TimeSetting up a behavior rating scale
One volunteerIdentify a behavior of concern
As a group, walk through the steps to set up the scale
Slide55Behavior
Ratings
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
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3
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1
5
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2
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1
5
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2
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3
2154321543215432154321Key:
Slide56Activity—Step 1
Slide57Step 1 Activity 2b InstructionsPage 4 of ACTIVITY PACKETWatch the video of ParisIdentify one problem behaviorWith your team, agree upon an operational definition of the behavior
Write it on the goal form under problem behaviorWhat would you target as a replacement behavior?Define the behavior in measurable/observable terms
Slide58ParisFirst grade student in general educationTeam included teacher, school psychologist, guidance counselor, and special education coordinatorSchool was considering referring Paris for special education eligibility assessment due to behavior problems
Slide59Step 2: Functional behavior assessmentAnalyze the Problem
Slide60Given 60 seconds, use 4 straight lines to connect all of the dots without lifting your pen (
PAGE 7 ACTIVITY
)
Slide61A box to think outside of:
Slide62Step 2: PTR Assessment (FBA) Problem AnalysisPTR Assessment (FBA) Prevent: Antecedents/triggers of problem behaviorTeach: Function(s) of problem behavior, possible replacement behaviors
Reinforce: Consequences associated with problem behavior, possible reinforcersAssessment form completed by each team member Facilitator summarizes input on Assessment Summary Table and develops draft hypothesis
Team reaches consensusFacilitator has conducted at least ONE direct observation of student and context prior to this step
62
Slide63Several Versions of PTR AssessmentElementary Version (pp. 20-25)Secondary Version (pp. 26-32; 33-38)
Student Version (pp. 39-44, 45-49)
Slide64Learned Functions of BehaviorsGETObtainActivities, people, tasks, tangibles, sensory, pain attenuation GET OUT OF
Escape/Avoid/DelayActivities, people, tasks, tangibles, sensory, pain
Slide65NAME THAT FUNCTION!
Slide66Are Power, Control, Jealousy, Revenge Functions?
Iovannone, Anderson, & Scott, 2013
Slide67Completing the PTR Assessment Organization Table
Slide68Step 2: Case Study – MikeAssessment Summary Table of Problem Behavior
Antecedent/Prevention Data
Teach/Function Data
Consequences/ Reinforce Data
Non-preferred tasks
Reading, Math—when in a group
Told to fix an error
Other students upset/mad
Teacher attending to others
Transition
Preferred (one-one) to
non-preferred (group reading/math)
Change in schedule
Denied item, told no,
Gain attention
Peers, adults
Delay
Access to items
Redirected
Reprimanded
Calm/soothe
Personal space
Later must
complete task
Loss of or delay in
reinforcement
Screaming, Hitting
Slide69Step 2: Case Study – MikeAssessment Summary Table of Absence of Problem Behavior
Antecedent/ 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
Absence of Screaming, HItting
Slide70Mike’s Hypotheses
When….
he will
As a result…
1. Mike is (a) asked to complete non-preferred tasks in small groups (Reading, Math), stop a preferred one-one activity or transition to a non-preferred group activity, or fix an error, or
2. When the teacher is attending to other students,
scream and hit.
scream and hit
Mike (a) delays the transition or non-preferred activity and (b) gets attention from teachers and peers
Mike gets attention from teachers and peers
1. Mike is (a) asked to complete non-preferred tasks in small groups (Reading, Math), stop a preferred one-one activity or transition to a non-preferred group activity, or fix an error, or
2. When the teacher is attending to other students,
(a) express his frustration appropriately and (b) transition from preferred to non-preferred tasks
Ask for attention
Mike (a) delays the transition or non-preferred activity and (b) gets attention from teachers and peers
Mike gets attention from teachers and peers
Inappropriate
Appropriate
Slide71Slide72Jeff’s Hypothesis
When….
he will
As a result…
Jeff is presented with demands to start non-preferred academic tasks, specifically independent writing,
Walk around the room, talk to and touch peers, put his head down, tap his pencil, and not initiate writing
He avoids/delays non-preferred tasks
Jeff is presented with demands to start non-preferred academic tasks, specifically independent writing
Be academically engaged and independently complete tasks within the time assigned
He avoids/delays non-preferred tasks
Inappropriate
Appropriate
Slide73Step 2 Activity: Paris
Slide74Step 2: Activity InstructionsPage 20-21 ACTIVITY PACKETReview the PTR Assessment Summary for Paris (page 20)Develop a problem behavior and appropriate behavior hypothesis (page 21)
Feel free to use the cheat sheet (page 22)Be ready to share
Slide75Facilitation TipsTeam members complete for homeworkDuring meeting, use as an interviewDuring meeting, give each team member 15 minutes to complete. Give 15 minute break to allow time for facilitator/coach to synthesize information in Assessment Organization TableSecondary: May want to change forced choice options to make appropriate for secondary environments (although very few words need to be changed)
Family version of PTR Assessment availableCategorizing/aligning: Ensure that your pathway/table is aligned (e.g., triggers are categorized, function is identified for each set of triggers)
Slide76TroubleshootingTeam select all options/boxes after questionAsk them to select the top 3-5 that they have 100% confidence is related to the behavior occurrenceExample—Prevent Question 4 almost all boxes selectedSay to the team,
“If I came into your classroom tomorrow and would give you $1 million to make Sarah’s behavior happen, which of these would you do first to get the money? Second? Third?Not sure of function
First, separate antecedents/triggers by categories (e.g., triggers related to demands to do non-preferred tasks, triggers related to peer interactions, etc.). Ask team what function seems to best fit with these categories (e.g., non-preferred tasks—is behavior’s purpose to delay/escape the non-preferred task or to get attention)If not sure between escape/attention, probe the team furtherFor example, if the child was doing a preferred activity, would the behavior still occur? If yes, it may be attention. If no, it may be escape.
Slide77Step 3: PTR Intervention PlanDeveloping and implementing an intervention
Slide78“The problem is not that people resist change, but they resist being changed.”Michael Kim, Founder and CEO of Habit Design
Slide79Behavior Intervention Plan Development: Essential FeaturesBehavior interventions selected by team from PTR MenuTeam/teacher provides description on how interventions will look in classroom settingFacilitator guides the team/teacher by using ABA principles to develop most effective intervention that matches the team/teacher context
Each intervention selected is described in detail by task-analyzing steps, providing scripts, describing adult behaviors, NOT student behaviorsAfter plan developed, time is scheduled to train the team/teacher the strategies prior to implementationPlans for training students and other relevant individuals
Support provided once plan is implemented
Slide80Slide81Slide82Slide83Replacement BehaviorsFunctional Equivalent vs. Alternate SkillFunctional Equivalent (examples)
Escape functionsAsk for a breakAsk to waitAsk to terminateAccess attention functionsAsk for attention
Ask for a hugAccess specific object or activityAsk for an objectAsk for a specific activityAlternate Skill (examples)Raise hand for help or answering questions/participation
Independently complete workAppropriately transition from point a to point bBe academically engagedInitiate social interactionsMake appropriate social comments
Slide84Linking Hypothesis to Interventions
When Michael is: (a) required to transition from non-preferred to preferred activities, within and outside of the classroom, when corrected or told to stop/wait during transitions
PREVENTION INTERVENTION:
What intervention will modify the
transition request, correction, reprimand so that it is no longer a trigger?
Slide85Linking Hypothesis to Interventions
He/She will scream (behavior)
What do we want the student to do instead of screaming? What is the replacement behavior/skill to be taught to the student?
Slide86Linking Hypothesis to Interventions
He/She will scream (behavior)
What do we want the student to do instead of screaming? What is the replacement behavior/skill to be taught to the student?
Slide87Linking Hypothesis to Interventions
As a result, he/she (a) escapes/avoids/delays the transition from a non-preferred to a preferred activity and protest the transition
How will we make sure that the replacement behavior gets the same outcome as did the problem behavior (e.g., escape)?
Slide88Writing the Intervention PlanTask analyze each step of the planNon-Example: Give student choicesExample: Prior to the start of independent reading, tell the student, “
We have 2 worksheets today.” Show student both worksheetsSay, “
Which worksheet would you like to do first?”Teachers need to know exactly what to do or the intervention may not be implemented as intended.
Slide89Which One Will More Likely be Consistently Implemented?Provide choices of where to sit
Provide Choices: The teacher will provide Don with a choice immediately after assigning him independent work in class. Choice options are: (a) materials to use for assignment; choice of leadership activities; (b) where to sit; (c) who to do the assignment with
Steps for Provide Choices:Immediately after giving the class the independent math assignment, go over to Don and present him with a choice option.When presenting him with a choice, say “Don, where do you want to sit? X or X?”
After Don makes his choice, say, “Thanks for making a great choice” and release him to his choice.
BIP-Prevention StrategiesBIP-Prevention Strategies
OR
Slide90Prevent Strategies
Specific Strategy steps
Environmental Support
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.
Environmental Support Steps:
Each week, an adult will review Mike’s schedule and activities and ensure that the visual schedule matches the activities.
Before a non-preferred activity, the teacher will review the visual schedule with Mike and the tasks he will do by reviewing the visual schedule and pointing to each task while describing it.
After reviewing the schedule, the teacher will ask Mike some questions to make sure he knows the order of activities.
The teacher will remind Mike that after he finishes each activity, he will put an X over it to show it is finished.
After Mike completes each activity, the teacher (initially) will prompt Mike to place an X over the activity on his schedule.
Mike
’
s Intervention Plan
Slide91Mike’s Intervention Plan
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.
Curricular modification steps:
At the beginning of each week, the teacher will identify the transitions that would be appropriate for the curricular modification strategy.
Immediately after the transition signal for the specified transitions, the teacher will say
“
Mike, how about doing this __ first before going to __?
”
Wait for Mike to complete the activity. During this time, provide minimum attention (e.g., limited talking, eye contact)
At the end of the activity, prompt Mike to transition (if he does not transition) or prompt him to use his replacement behavior (
I need to calm down).
91
Slide92Mike’s Intervention Plan
Teach Strategies
Specific Steps
Replacement Behavior:
Appropriately express his need to calm down
Mike will be taught to use his Dynamite to express his need to calm down.
Replacement Behavior Steps:
An adult will
program Mike’s AAT device to say
“
I need to calm
down.
”
A choice board will be built into the device by identifying 3-4 options from which Mike can select as his activity to calm down and identifying buttons to represent those choices.
One minute before transitioning from a preferred to a non-preferred activity or at the end of a preferred activity (if the timer has not gone off), the teacher/adult will remind Mike to use his replacement behavior.
“
Remember, If you start to get mad when you go to X,
you can tell us you need to calm down.
”
At the first sign of Mike beginning his screaming behavior (initial squeal), redirect Mike to use his replacement behavior by prompting him (most-to-least hierarchy) while saying
“What do you need?”
For example, initially the teacher will use physical prompting (hand-over-hand) to guide Mike in telling the adults that he needs to calm down.
Once Mike communicates
“
I need to calm down
”
,
present
him with the choice board of calming strategies and
ask
him,
“
What do you want?
”
As soon
as he is calm, praise him by saying
“
thank you for telling us what you need to calm down.
”
.
Allow
Mike to engage in his choice until he is calm for 1-min.
If Mike does not return to his area, then start having a fun time in that area with those students present
Slide93Reinforce Strategies
Specific Steps
Replacement Behavior:
Appropriately express his need to calm down
Whenever Mike
‘
says
’
,
“
I need to calm down
”
, give him the choice board, praise him for using his communication, and release him to his choice.
Immediately after Mike indicates he needs to calm down, ask him
“What do you want?”
while showing the choices.
Immediately after Mike makes his choice, say
“
Thank you for telling us what you
need.
”
Depending upon his choice, release him or provide him with the selection.
When he makes his transition, praise him (with a warm tone) for returning to the group; “thank you for coming over.”
Discontinue reinforcing problem behavior
Minimal attention will be provided to Mike when he is calming down and when he is starting to scream.
Steps:
As soon as Mike begins to show signs for screaming, the adult will immediately prompt Mike to say he needs to calm down by presenting the device and saying
“What do you need?”.
If necessary, provide physical or partial physical prompting to have Mike say what he needs.
Immediately after Mike says “I need to calm down”, present the choice board and ask him “What do you want?”.
Provide positive praise for Mike saying what he needs,
“thank you for telling us what you need.”
Allow him to engage in his choice for one minute.
Mike
’
s Intervention Plan
Slide94Jeff: PTR Intervention Plan Prevent
Prevent Strategies
Description
Choice-Making
Using a choice matrix, decide upon the choice that will be offered to Jeff each day with his writing assignment. The following choices will be rotated: (a) Within—writing tool to use (pen/pencil), color notebook paper, color of eraser, topic; (b) Who—peer for writing partner; (c) Where—Robin’s room, round table, desk; (d) When—part now, part later, whole task nowSteps:Right before giving the writing assignment to Jeff
, decide upon the choice to be offered.
Once the choice is determined, present it to Jeff by saying, “
What do you want to use for writing today? The pen or the pencil?
”
Praise Jeff for making the choice—”Thank you for making a choice.” and
honor the choice
Slide95Slide96Jeff—Intervention Plan Prevent
Prevent Strategies
Description
Environmental Support
Visual Timer: Set a visual timer for the amount of time agreed upon with Jeff to complete the writing assignment.Steps:At the beginning of the writing period and while reviewing Jeff’s self-management writing chart for the day, and before providing Jeff a choice, either call Jeff to the teacher’s desk or go over to Jeff.
Discuss the goal for completing the writing assignment. Say, “I think you can complete the assignment in ___ minutes. What do you think?”
Set the timer by saying, “Jeff, let’s see if you can beat the timer. Today, you have ___ minutes (time from step 1) to complete the writing. Ready, set, go.”
Slide97Jeff— Teach Intervention Plan
Teach Strategies
Description
Incompatible Replacement Behavior—Academic Engagement
Jeff will be taught how to remain engaged on a writing assignment. Engagement is defined as: working on a task without disrupting by raising hand to speak, keeping pencil upright, and letting neighbors workSteps:Each day, divide Jeff’s writing task into 3 major sections—starter, details, conclusion
Initially, tell Jeff that for each section completed, he earns a “dot” that he should place in the envelope hanging at the side of his desk.
Inform him that he can use the dots later to get out of work and to get special rewards for himself and the rest of the class.
Each day after giving the writing assignment to Jeff, review his self-management checklist/dot total sheet. Review each section of the writing assignment (step 1), his goal (time for completion), and the academic engaged behaviors.
On Monday, a weekly goal should be discussed and set.
Immediately after reviewing Jeff’s goals and expected behaviors, provide him a choice and set the timer.
Slide98Slide99Jeff—Reinforce Intervention Plan
Reinforce Strategies
Description
Reinforce Pro-academic Replacement Behavior—Academic Engagement
Jeff will be reinforced for academic engagement and meeting his daily goal with allowable/earned escape represented by the dots. Jeff can use his dots to get out of doing work/problems during independent work times.Steps:At the end of the writing period or when Jeff completes his writing (whichever event occurs first), review Jeff’s self-management checklist.
For each behavior on the checklist, discuss with Jeff whether he performed the activity. If yes, place a check in the box. If no, place an “x” in the box. For each check, Jeff should be given a dot. When reviewing, say, “Jeff, did you write a starter sentence?”… Did you stay on task? Did you meet your goal?” When giving dots, say “Jeff, how many checks do you have today? How many dots do you earn?”
Jeff uses dots by sticking it over a problem/question he doesn’t want to do and showing the teacher when he uses a dot. He can escape as long as he has dots in his envelope.
If Jeff uses a dot to get out of work, immediately say “You used a dot to get out of ____. You earned it!”
If Jeff meets his weekly goal, he can go to his brother’s kindergarten class and read a book to them.
Slide100Jeff—Reinforce Intervention Plan
Reinforce Strategies
Description
Group Contingency (Modified)
If Jeff meets his daily (time) goal for completing his writing assignment within the time agreed upon, the class earns a bonus letter toward the mystery reinforcer of the week. When Jeff earns the class this letter, the class provides attention to Jeff by thanking him and celebrating (clapping hands, saying “Yeah”.Steps:
After reviewing Jeff’s self-management sheet, ask him, “Did you meet your goal today?”
If yes, “You did meet your goal. Let’s tell the class they’ve earned a letter for the mystery reinforcer.”
Tell the class, “Jeff met his goal today. We get another letter on the board.”
Prompt the class to thank Jeff (if they haven’t done so spontaneously).
If no, “You worked hard and tried. You’ll do it tomorrow!”
Slide101Jeff—Reinforce Intervention Plan
Reinforce Strategies
Description
Discontinue reinforcement of problem behavior
If Jeff gets disruptive (disengaged) during academic tasks, redirect him to his replacement behavior.Steps:At the first sign of Jeff starting to get disengaged, calmly walk over to Jeff and gesture to his self-management chart by pointing to it. Provide no or minimal verbal comments.
If Jeff continues to be disengaged, calmly redirect him to use one of his dots (if he has any) to escape. Say “Jeff, it looks as if you need to use one of your dots to get out of some work.”
If Jeff continues to be disengaged and doesn’t use one of his dots, walk over to his desk, pick out one of his dots out of his envelope, and say “It looks as if you need to use one of your dots to get out of some work. Where should I put the dot?”
Continue to use dots if Jeff continues to be disengaged.
If all of the dots are used, calmly remind Jeff how he will earn dots to get out of work.
Slide102Switching Activities
Michael’s Story
Slide103High School Examples
Slide104Plans for High School Students with E/BDDCDSNC
Slide105Slide106Step 3 Activity: Paris Intervention Plan
Slide107Step 3 Paris: Activity InstructionsPAGE 24 OF ACTIVITY PACKETLook at your hypothesis developed for Paris.Identify one or two prevent, teach, and reinforce strategies you might want to try with Paris
One for each component (prevent/teach/reinforce)For the Teach strategy, make certain one behavior you are teaching is a replacement behavior.Develop the specific steps (task analysis) of the replacement behavior intervention for Paris
Slide108Additional ConsiderationsWhen developing the behavior intervention plan, ask the team how they will do the following:Pre-teach the student the planPrompts they will need to use in the initial stagesFading prompts
Slide109Coaching/Fidelity
Slide110Teacher CoachingTeacher and Staff TrainingInitial training with no students present 30 -90 minutesModel, Role Play, Q & A, Discussion
Coaching/Fidelity Checklist (page 60-63 Tools Handout Packet)Used by PTR Consultant for training evaluation Evaluate teacher accuracy on each step prior to implementation with student
Comfort and competence measuredCan also be used as fidelity measure after intervention is implemented
Slide111Coaching StepsCore components of each behavior intervention strategy listed on coaching/fidelity form. (alternative form)Primary adult behaviors (physical or verbal actions) & materials If applicable, student behaviors included. During coaching session, facilitator gives teacher behavior intervention plan and coaching form.
Facilitator introduces coaching form, e.g., “We’re going to go over the steps of the behavior plan strategies to make sure they are still making sense to you and are things that can be done by you in your classroom. If there is anything that you feel isn’t going to work, we can make changes today.”
Slide112Coaching StepsSeveral methods for coaching the teacher.Can choose one method, combination of two, or all threeDiscussion—facilitator asks teacher to verbally describe (in his or her own words) each of the interventions. Ensures teacher describes each step of the interventionTeacher can refer to coaching form to cue core steps
Q & A—facilitator asks teacher questions about strategies. For example, choice-making “When are you going to offer the choices to X?”; “What kind of choices will you offer X?”; etc.Role Play (preferred method)-facilitator plays role of student and asks teacher to perform plan steps as they would with student.
Slide113Coaching StepsCheck ‘Y’ or ‘N’ whether teacher demonstrated competence with plan stepsRemediation: For any step teacher did not demonstrate correctly or skipped,Review step with teacherProvide another opportunity for teacher to demonstrate competenceIf successful, coaching session finished
If unsuccessful, choose from the following: Provide more opportunities to review and practice stepAsk teacher what features make step difficult and adapt to make feasible Select different intervention checked on PTR intervention Checklist that matches hypothesis.
Schedule another meeting to develop new intervention Schedule another coaching session
Slide114Coaching StepsSuccessful training: Decide who else needs to be trained (e.g., student, other school staff, parent)Try to be there when teacher trains student or offer to train studentDetermine start date of intervention planCan choose to implement the intervention in phases.
Prevent first, then teach/reinforceTeach/reinforce first, the preventTraining checklist can be used as fidelity measure rather than developing separate checklist
Slide115Mike: Coaching/Fidelity
Slide116Jeff Coaching/Fidelity Plan
Slide117Step 3: In-Class Support Provide support to teacher in implementationBe present on first day of implementationDetermine when to debriefMeasure fidelity
Discuss and modify if necessary
Slide118Step 3: Training/Fidelity ChecklistCase Study - ParisGroup Activity: Look at the task analysis for Paris’ replacement behaviors
Select the core strategies you would include on a coaching/training and fidelity measure
118
Slide119Paris’ Fidelity Checklist
119
Teach Intervention Strategy
Fidelity
Replacement Behavior:
Y/N/NA
Slide120Step 3: Facilitation TipsTeams can select interventions for homework or can select during team meetingFocus on one routine, class, subject for developing interventionMake sure the facilitator is asking guiding questions-allow the teacher to describe how the intervention will be in their classroom
Slide121Step 3: Facilitation TipsIf meeting time is limited, break up strategies:One meeting, focus on full development of Prevent, next meeting develop Teach/Reinforce ORFirst concentrate on Teach/Reinforce; next meeting develop Prevent.Fidelity measurements can be done once or twice a week rather than daily
One form can be used for training and fidelity
Slide122Step 3: Facilitation TipsUse technology (video, Skype, Wiki, Facebook) to provide support to teachersFidelity observations and coaching sessions should NEVER be used as teacher evaluation toolsFidelity and training are coaching supportsTrust is essential for coaching and fidelity to work as intended
Slide123Step 4: Progress Monitoring
Slide124Step 4: Evaluation Progress MonitoringData-Based Problem-SolvingWhat is working? What is not working?What changes need to be made?
Is more data needed? (additional data collection measures)Implementation Fidelity DataIs the plan being implemented consistently and accurately?Student outcome data
Is the problem behavior decreasing? Is the replacement behavior increasing?Expanding the planRoutines, times of dayGeneralize across settings and/or staff
Slide125Steps for Evaluating OutcomesMake sure you have both fidelity measures (self and/or observation scores) AND student outcomes (IBRST measures)Decision rulesWhat constitutes adequate fidelity? 80%, 70%, something else?What constitutes adequate student progress? (e.g., 3 or more consecutive ratings at or above goal line?)
Slide126Primary DecisionsIf Fidelity scores are inadequate, determine the reasons (intervention too difficult, not feasible, not described adequately….)
Retrain/coach the teacher/implementerModify the interventions so that they are feasible, simplerSelect different interventions that match the hypothesis If student outcomes are in the right direction (decision contingent upon outcome trend)
Maintain interventionModify interventionFade intervention componentsShape behavior outcomes to become closer approximations of desired behaviorExpand the intervention (additional people, additional settings or routines)
Slide127Primary DecisionsIf student outcomes are remaining flat or data are showing that behavior problems are increasing and fidelity scores are adequate:Intensify interventionModify interventionConduct another FBA if hypothesis is suspect, team has new data, or context has changed
Conduct a functional analysisExpand team to include other experts
Slide128Slide129Step 5: Mike Evaluation
Intervention changed
Slide130Step 5: Evaluation
Slide131Step 5: Evaluation
Slide132Step 5: Evaluation
Slide133Jeff Data
Slide134Review PTR ProcessFour-step team-based process Teacher/team drivenStandardized/manualized processSupport provided to teacher/team to implement interventionsEvery intervention plan includes 3 componentsPrevent
TeachReinforcePlans are task analyzed
Slide135PTR PublicationsPTR ManualsDunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C., 2010. Prevent-Teach-Reinforce: The school-based model of individualized positive behavior support. Baltimore, MD: Paul H. Brookes. (Second edition coming soon)
Dunlap, G., Wilson, K., Strain, P., & Lee, J. K. (2013). Prevent-Teach-Reinforce for young children: The early childhood model of individualized positive behavior support. Baltimore, MD: Paul H. Brookes.Journal ArticlesBarnes, S., Iovannone, R., Blair, K. S. W., Crosland, K., &
Peshak-George, H. (under review). An evaluation of the Prevent-Teach-Reinforce model within a multi-tiered intervention system. Journal of Positive Behavior Interventions.DeJager, B. W., & Filter, K. J. (2015). Effects of Prevent-Teach-Reinforce on academic engagement and disruptive behavior. Journal of Applied School Psychology, 31, 369-391.Dunlap, G., Iovannone, R., Wilson, K., Kincaid, D., & Strain, P. (2010). Prevent-Teach-Reinforce: A standardized model of school-based intervention. Journal of Positive Behavior Interventions, 12, 9-22.Dunlap, G., Lee, J. K., Joseph, J. D., & Strain, P. (2015). A model for increasing the fidelity and effectiveness of interventions for challenging behaviors: Prevent-Teach-Reinforce for young children. Infants & Young Children, 28, 3-17.
Iovannone, R., Anderson, C. M., & Scott, T. M. (2013). Power and control: Useful functions or explanatory fictions? Beyond Behavior, Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (2014). Interrater agreement of the Individualized Behavior Rating Scale Tool. Assessment for Effective Intervention, 39, 195-207.Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., Dunlap, G., & Strain, P. (2009). Randomized controlled trial of a tertiary behavior intervention for students with problem behaviors: Preliminary outcomes. Journal of Emotional and Behavioral Disorders, 17, 213-225.Kulikowski
, L. L., Blair, K. S. C., Iovannone, R., & Crosland (2015). An evaluation of the Prevent-Teach-Reinforce (PTR) model in a community preschool classroom. Journal of Behavior Analysis and Supports, 2, 1-22.Sears, K. M., Blair, K. S. C., Iovannone, R. & Crosland, K. (2013). Using the Prevent-Teach-Reinforce model with families of young children with ASD. Journal of Autism and Developmental Disorders, 43, 1005-1016. doi:10.1007/s10803-012-1646-1.Strain, P. S., Wilson, K., & Dunlap, G. (2011). Prevent-Teach-Reinforce: Addressing problem behaviors of students with autism in general education classroom. Behavior Disorders, 36, 160-171.
Slide136Questions?