Identification and Progress
Monitoring at Tier 3:
Prevent-Teach-Reinforce
Presented at 2008 National Forum for Implementation of School-Wide
Positive Behavior Supports
Rose Iovannone, Ph.D.
iovannone@fmhi.usf.edu
Kathy Christiansen, MS
kchristiansen@fmhi.usf.edu
University of South Florida
Objectives

Participants will:


Describe a model of individualized behavior support
Identify factors that may contribute to effectiveness of
PTR
The Problem—Evidence-Based

Tertiary supports (i.e., individualized PBS, Tier 3
behavior supports)



Evidence-base exists
Research method used primarily single subject
Limited rigorous, randomized control trials to evaluate
effectiveness
The Problem - In Authentic
Schools

Ingredients







Child is the problem - “fix him/her”
Absence of uniform policies & practices
Form-driven versus process-driven
“Expert” versus collaborative approach
Contextual fit not always considered
Limited support/follow-up/training for teacher provided
Result


Many BIPs do not get implemented
Behavior problems persist
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%
~ 80% of Students
What is PTR?

Research project funded by U.S. Department of Education, Institute
of Education Science (2004-2008)



University of South Florida—3 school districts
University of Colorado, Denver—2 school districts
Purpose: Investigate effectiveness of PTR process vs. “business as
usual”


Randomized control trial
200 students (100 treatment/100 comparison)
Theoretical Framework

Principles of applied behavior analysis

Operant learning theory
Positive Behavior Support—foundation
 Intervention consists of three core components:





Prevent
Teach
Reinforce
Team/teacher driven process
Participants
Students in K-8th grade

General or Special Education



Behavioral difficulties




All cognitive levels
All disabilities
Intensity– disruption to the learning environment
Frequency— minimum of 1 time per week
Duration– minimum 6 months
Teachers volunteered & nominated 1-3 students


Top externalizers
Systematic Screening for Behavior Disorders (SSBD)
Process

Prevent-Teach-Reinforce (PTR)

Five steps:




Team development—30 minutes if applicable
Goal setting—30-45 minutes
PTR assessment—30-60 minutes
PTR intervention—45-90 minutes
 Coaching support (up to 12 hours)



Evaluation—30-40 minutes
Each team assigned PTR consultant (from project)
Teams receive manual and assigned activities to be
completed in each step.
Preliminary Data
Results
Student Demographics by Disability
Disability
N
%
20
8.2
Deaf
1
.4
Developmental Delay
6
2.4
Emotional Disturbance
31
12.7
Mental Retardation
19
7.8
Multiple Disabilities
4
1.6
OHI (not ADD/ADHD)
2
.8
OHI (ADD/ADHD)
8
3.3
Specific Learning Disability
21
8.6
Speech/Language Disability
8
3.3
Visual Impairment
1
.4
General Education
116
47.3
TOTAL
237
Autism
Student Description
Grade Level
K
1
2
3
4
5
6
7
8
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
77
150
31.4
61.2
45
200
18.4
81.6
Lunch Status
Regular
Free/Reduced
Gender
Female
Male
The PTR Process
Step 1: Form a Team

Identify members and their roles



Teacher, special area teachers
Behavior specialist/school psychologist
Family members, paraprofessionals,
Step 1: Team Building—
Ensuring a Successful Team

Review the status of the team



Work styles inventory
Teaming survey
Use a collaborative process


Teacher and facilitator relationship
Consensus making method
Case Study 1: Mike
9-year-old male
 Autism diagnosis
 Self-contained autism classroom
 Nonverbal—uses AAT (signs, voice output
devices such as Dynamite, and pictures to
communicate)
 1 teacher, 2 aides, and 6 students
 Results of teaming information indicate a great
team that meets regularly to brainstorm

Case Study 2: Jeff
Male
 Second grade general ed. student
 Retained once
 Premature birth
 SSBD Scores:




Stage 2: 8 Critical Events
Adaptive Behavior Score = 33
Maladaptive Behavior Score = 32
Teacher/Classroom

Team: Two teachers


Current second grade teacher
Second grade teacher from previous year
Seventeen students
 Teacher experience—4 years at same school

Teaming Results
Team respected each other, worked together
 Met consistently for planning purposes
 Strong communicators and problem solvers
 Sharing of roles and responsibilities
 Active parental participation encouraged

Step 2: Goal Setting

Identify team consensus on:




Academic behavior
Social behavior
Problem behavior
Develop and begin baseline data collection
Setting Goals: Mike Pre-Test
Behavior Rating Scale—
Reliability


Perceptual rating
Behavior recorded at least once daily




May be specific to a setting, activity, time of day
May be whole day
May be combination of both
Use anchors on a scale of 1-5
Determining the Anchors
on the BRS

Behavior can be measured using






Frequency (times per day)
Duration (hours, minutes, seconds)
Intensity (how hard, how loud, bruise, etc.)
Percent of day
Percent of occurrence
Percent of opportunity
BRS Preliminary Reliability
(Psychometric) Results
Variable
T PB1
S PB1
T PB2
S PB2
T AB1
S AB1
T AB2
S AB2
Mean
SD
3.98
3.99
3.97
3.84
3.01
3.08
3.22
3.70
Pearson’s
1.35
.83*
1.33
1.35
1.33
1.39
1.37
1.35
.77*
.66*
.77*
1.57
T = Teacher rating; S = PTR data collector rating; PB = Problem behavior; AB =
Appropriate behavior
* P < .01
BRS Preliminary Reliability
Results—Kappa Scores
Behavior Type
Unweighted/
Standard Error
Linear
Weighting/
Standard Error
Quadratic/
Standard Error
Problem
.38/.08
.66/.06
.83/nc
Appropriate
.24/.08
.40/.08
.53/.14
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
Appropriate Inappropriate
When….
Student will….
As a result…
Mike is asked to complete nonpreferred 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 nonpreferred task (Reading, Math), stop
preferred activity or transition to nonpreferred activity, fix an error, or when
teacher attending to other students
express his
frustrations
appropriately
Mike is able to
delay the
transition/activity
complete the
assigned task
Mike is able to
gain attention
Jeff Case Study: Hypothesis
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
Case Study Mike: PTR Intervention Plan
Prevent Strategies
Environmental
Support
Specific Strategy steps
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.
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.
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.
Prevent
Strategies
Curricular
Modification
Specific Strategy steps
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
Teach
Strategies
Replacement
Behavior
Specific Strategy Steps
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
Teach Strategies
SelfManagement
Specific Strategy Steps
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
Reinforce
Strategies
Replacement
Behavior
Specific Strategy Steps
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
SelfManagement
Anytime Mike scores his behavior, attention should be given.
Waiting
Mike will earn a skittle paired with attention if he waits. This will be faded
to an intermittent schedule.
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.
Reinforce
Strategies
Transition
Specific Strategy Steps
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.
Jeff: Intervention Checklist Results
Case Study Jeff: PTR Intervention Plan
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 now
Steps:
1.Right before giving the writing assignment to Jeff, decide upon the
choice to be offered.
2.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?”
3.Praise Jeff for making the choice—”Thank you for making a
choice.” and honor the choice
Jeff—Intervention Plan
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:
1.
Discuss the goal for completing the writing assignment. Say, “I
think you can complete the assignment in ___ minutes. What
do you think?”
2.
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.”
Jeff—Intervention Plan
Teach
Strategies
Description
Pro-academic
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 work.
Steps:
1.
Divide Jeff’s writing task into 3 major sections—starter, details,
conclusion
2.
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.
3.
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.
4.
Review his self-management checklist/dot total sheet with Jeff.
Review each section of the writing assignment (step 1), his goal
(time for completion), and academic engaged behaviors.
5.
On Monday, a weekly goal should be discussed and set.
Jeff—Intervention Plan
Reinforce
Strategies
Description
Reinforce Proacademic
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:
1.
At the end of the writing period or when Jeff completes his writing
(whichever event occurs first), review Jeff’s self-management
checklist.
2.
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?”
3.
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.
4.
If Jeff uses a dot to get out of work, immediately say “You used a dot
to get out of ____. You earned it!”
5.
If Jeff meets his weekly goal, he can go to his brother’s kindergarten
class and read a book to them.
Jeff—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:
1.
After reviewing Jeff’s self-management sheet, ask him, “Did you
meet your goal today?”
2.
If yes, “You did meet your goal. Let’s tell the class they’ve
earned a letter for the mystery reinforcer.”
3.
Tell the class, “Jeff met his goal today. We get another letter on
the board.”
4.
Prompt the class to thank Jeff (if they haven’t done so
spontaneously).
5.
If no, “You worked hard and tried. You’ll do it tomorrow!”
Coaching of Interventions

Training of teacher



Assistance in classroom


1 to 2 hours
80% accuracy on all strategies
Up to 12 hours
Fidelity measures recorded

80% implementation terminates assistance in
classroom
Task Analysis of Intervention
Discuss
Q&A
Verbal
Role-play
Observe
Feedback
Case Study Mike: Training
PREVENT – Environmental Support
1. Mini schedule of group & center time available
2. Schedule reviewed prior to task
3. Schedule reviewed & items crossed off
TEACH – Replacement Behavior
1. Remind to use DynaVox prior to transition
2. Provided choice board and honored choice
REINFORCE –Replacement Behavior
1. Verbally or gesturally acknowledge ASAP
2. Allowed to cool off for 1-minute
TOTAL (# Yes/ # Total)
Fidelity Score ( .00 – 1.00)
Training
Review
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Case Study Mike: Fidelity
Interventions
Environmental Support
1) Mini schedule of center & group available
2) Mini schedule reviewed prior to start of
centers
3) Items crossed off as completed
Adherence
Quality
Mini schedule Mini schedule
present
present & reviewed
at least either prior to
or after activities
completed
Replacement Behavior—Functional
1) Reminded student to use DynaVox prior to
transition & when student engaged in
warning signs
2) Choice board given
3) Choice honored
Teacher
reminded
student prior
to transition or
behavior
Reinforce Replacement Behavior
Teacher
1) Teacher immediately recognized student
recognized
for using DynaVox
(within 15 s)
student
2) Allowed to calm down for at least 1-minute
Teacher reminded
student prior to at
least 2 of 3
transitions & all
behavior
Teacher immediately
(within 15 seconds)
recognized student
and allowed student
to calm down
Mike Post-test Video
Coaching Checklist Example: Jeff
Example of Fidelity—Jeff
Teacher N %age
Number of Fidelity Measures
1
3
2.3
2
28
23.8
3
37
28.5
4
36
27.7
5
17
13.1
6
8
6.2
7
1
.8
Total
130
Mean # of measures per teacher
3.5
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
1 is a lot of screaming, 5 is no screaming
10-May
7-May
2-May
27-Apr
24-Apr
19-Apr
16-Apr
11-Apr
Baseline
4-Apr
30-Mar
27-Mar
15-Mar
12-Mar
2-Mar
26-Feb
21-Feb
15-Feb
7-Feb
5-Feb
31-Jan
26-Jan
23-Jan
18-Jan
11-Jan
8-Jan
3-Jan
12-Dec
7-Dec
14-Dec
Rating
Step 5: Evaluation - Mike
Screaming
Intervention
5
4
3
Definition
Changed
2
1
Rating
5
15 .
-F
e
22 b
-F
eb
1M
12 ar
-M
16 ar
-M
29 ar
-M
ar
4Ap
12 r
-A
p
18 r
-A
p
24 r
-A
p
30 r
-A
p
4- r
M
10 ay
-M
ay
14
-D
ec
8D
15 ec
-D
ec
8Ja
12 n
-J
a
22 n
-J
a
26 n
-J
an
1Fe
b
Step 5: Evaluation - Mike
Hitting
Baseline
Intervention
4
3
2
1
1 is a lot of hitting, 5 is no hitting
-D
e
7- c
D
12 ec
-D
e
3- c
Ja
8- n
J
11 an
-J
a
18 n
-J
23 an
-J
26 an
-J
31 an
-J
a
5- n
Fe
7- b
F
15 eb
-F
21 eb
-F
26 eb
-F
e
2- b
M
12 ar
-M
15 ar
-M
27 ar
-M
30 ar
-M
a
4- r
A
11 pr
-A
16 pr
-A
19 pr
-A
24 pr
-A
27 pr
-A
2- pr
M
a
7- y
M
10 ay
-M
ay
14
Rating
Step 5: Evaluation - Mike
Expression of Frustration
5
Baseline
Intervention
4
3
2
1
1 is a little appropriate expression, 5 is a lot of appropriate expression
Rating
5
Baseline
15 .
-F
22 eb
-F
eb
1M
12 ar
-M
16 ar
-M
29 ar
-M
a
4- r
Ap
12 r
-A
18 pr
-A
p
24 r
-A
30 pr
-A
p
4- r
M
10 ay
-M
ay
14
-D
e
8- c
D
15 ec
-D
ec
8Ja
12 n
-J
a
22 n
-J
a
26 n
-J
a
1- n
Fe
b
Step 5: Evaluation - Mike
Transition to Nonpreferred
Intervention
4
3
2
1
1 is inappropriate transition, 5 is super appropriate transition
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
Jeff Data
Step 5: Evaluation
Other Outcome Data for Jeff
Measure
Baseline
Post-test
Change
SSRS-PB
127
113
-14
SSRS-SS
85
92
+7
AET
.52
.82
+.30
Wrap Up:
What We Have Learned
Teachers like the process
 Teachers identify coaching/support and
collaboration as key features
 Teachers do not continue the process without
support
 Systemic change may be necessary for tertiary
supports to happen

How to Make PTR Work
in Your School
Process is the key
 Creative resource reallocation may be
necessary to find the time
 Things to consider






Tertiary team
Identification/Nomination process
Data-based decision making
Facilitator
Set-up of meetings for efficient results
For copies of Forms




iovannone@fmhi.usf.edu or
kchritiansen@fmhi.usf.edu
Manual will be published by Brookes—anticipated date—
Summer 09
Two journal articles in 2009



Journal of Positive Behavior Interventions (Jeff will be described)
Journal of Emotional Behavioral Disorders
Next steps:

Training school-based behavior consultants to do process
http://ies.ed.gov/ncee/wwc/
Questions?