Triage Model
Numerous strategies are available for increasing the effectiveness and efficiency of
school teams charged with Tier 3 problem solving through FBAs and BIPs. One
strategy is careful identification of behavior challenges that may be successfully
addressed by low to moderate intensity FBAs and BIPs versus those that may
require higher intensity FBAs and BIPs, including those that may require support
from professionals with advanced training. This identification process may be
referred to as a triage approach.
Triage Model
In the response to intervention (RTI) model, when a student’s behavior has been
unresponsive to Tier 1 and Tier 2 supports, the school problem-solving team may
add intensive, individualized Tier 3 supports to address the student’s needs.
In an extension of the RTI model, when a Tier 3 intervention (i.e., BIP) has been
based on an FBA and has been implemented with sufficient intensity for a
reasonable duration and with high integrity, the school problem-solving team may
determine that the results are less than desired. The team then has several options
available, such as:
 Conduct a more thorough FBA.
 Modify the BIP.
 Seek support from a professional with advanced training in FBA and BIP.
 Add or intensify resources to support full implementation of the intervention
plan.
However, prior to, or in the very early stages of problem solving, teams may
determine that a student is experiencing very severe or significant behavioral,
social-emotional, or academic problems and may then triage the student to expedite
immediate intensive and individualized Tier 3 interventions with little or no prior
contact with Tier 1 or 2 level interventions.
School teams can supplement existing universal screening procedures at Tier 1 (e.g.,
office discipline referrals, minor infraction reports) and screening at Tier 2 (e.g.,
teacher nominations) with triage procedures. Teams can then make better informed
decisions about when to expedite an FBA and BIP. Teams can also decide when an
FBA and BIP should be supported by professionals with advanced training. Factors
that may impact related decisions are described in Appendix 1.
Appendix 1:
Triage Procedures
The problem solving team may decide to expedite an FBA and BIP, revise an existing FBA and
BIP, and/or to decide to seek support from a professional with advanced training when:

A student is experiencing very severe or significant academic, behavioral, or
social-emotional problems even though there may have been little or no prior contact with
Tier 1 or 2 interventions.

A student’s behavior has been unresponsive to Tier 1 and Tier 2 supports.

A Tier 3 intervention (i.e., BIP) has been based on an FBA and has been implemented with
sufficient intensity for a reasonable duration and with high integrity, and the behavior
change is less than desired.
Additional factors may impact related decisions by the problem solving team (and can be added to
existing Tier 1 and 2 screening procedures):
•
There is current or proposed use of:
– Frequent
removals from the classroom for disciplinary purposes that result in
loss of instructional time (e.g., trips to the main office, in-school or out-of-school
suspension)
– Highly
restrictive reactive strategies or crisis management strategies (e.g.,
restraint or seclusion)
– Procedures
that may be considered by some to be unusual, coercive, or punitive
(e.g., water mist, social reprimands, restricted access to meals, frequent or prolonged
exclusionary time out)
– Procedures
that may be considered by some to be controversial (e.g., weighted
vests, Facilitated Communication, other therapies or treatments for which the
evidence of scientific research support has been questioned)
– Protective
devices or equipment to prevent harm or injury as a result of behaviors
(e.g., helmet for headbanging, gloves for hand mouthing), including items that may
limit normal sensation or movement, or affect social inclusion
•
There is a history of high risk and/or unusual behaviors (e.g., severe self-injury, PICA,
aerophagia, trichotillomania, polydipsia)
•
•
•
•
•
•
The student has a history of severe behavior problems (e.g., aggression) and is transferring
from a more restrictive school setting to a less restrictive setting (e.g., from an
out-of-state intensive treatment residential program to a neighborhood school)
The student has a history of severe behavior problems that have resulted in police contact
and/or Baker Acts
Multiple problem behaviors have been identified and/or the current hypotheses
regarding the function(s) of the problem behavior(s) are unclear (e.g., team members
have conflicting opinions; the team has tentatively identified: multiple antecedents and/or
functions, multiple behaviors with the same function, a behavior chain)
There is a possible need for systematic functional analysis (FA) methods (i.e., controlled
applications of procedures to test hypotheses and select the most effective intervention)
There is a possible need for functional communication training (e.g., limited language
repertoire, need for effective replacement behaviors)
Other factors may include:
– Parent request for support from a behavior analyst
– Parent
dissatisfaction, formal complaint, mediation hearing, attorney or advocate
involvement, litigation
– Need
for coordination with external agencies or private behavior analysts
working with the student in home, community, and agency settings
– Need
for coordination of wrap-around supports (e.g., therapeutic interventions,
medication management)