PREVENT-TEACH-REINFORCE (PTR):
AN EFFICACIOUS TIER 3 BEHAVIOR
INTERVENTION
Presented at the 2010 PBIS Leadership Forum
Chicago, IL
Rose Iovannone, Ph.D., BCBA-D
University of South Florida
iovannone@fmhi.usf.edu
813-974-1696
The contents of this training were developed under grant H324P04003 from the Department of Education.
OBJECTIVES

Participants will:
Describe the 5-step PTR Tier 3 support model
 Identify the critical components that enhance the
success of Tier 3 behavior supports
 Discuss application at district level

AGENDA
Rationale and conceptual foundation
 Research method/outcomes
 Overview of PTR process
 Suggestions for district-wide application

TIER 3 FUNCTION-BASED BEHAVIOR
INTERVENTIONS IN SCHOOLS
Issues






Absence of uniform policies & practices
Form versus a process
Expert driven versus collaborative effort
Occasionally contextual fit considered
Limited support/follow-up/training for teacher
provided
Result--limited impact on student behavior
WHAT IS PREVENT-TEACH-REINFORCE
(PTR)?

Research project funded by U.S. Department of
Education



University of South Florida
University of Colorado, Denver
Evaluate effectiveness of PTR process vs.
“business as usual”


Randomized controlled trial
Intervention “Package”
 ONE ‘P’revent; ONE ‘T’each; ONE ‘R’einforce
 Based on ABA principles and individual Positive
Behavior Support
WHAT IS PREVENT-TEACH-REINFORCE
(PTR)?

Primary Research Questions:

Is the PTR intervention more effective than control
conditions (‘business as usual’) in decreasing severe
problem behaviors and increasing pro-social and
academic skills of students?

Repeated measures—baseline, post-test, follow-up
 Social Skills Rating System (SSRS)-Problem Behavior
and Social Skills subscales
 Academic Engaged Time (AET)
PARTICIPANTS
 K-8th grade
 Behavioral difficulties
 Intensity– disruption to


the learning
environment
Frequency— minimum of 1 time per week
Duration– minimum 6 months
 General or Special Education
 All cognitive levels
 All disabilities
 Teachers volunteered & nominated
students


1-3
Top externalizers
Systematic Screening for Behavior Disorders
(SSBD)
PROCESS
Standardized Individual Positive Behavior
Support approach
 Intervention teams provided manual,
assignments, homework
 Five step process aligned with problem solving
facilitated by PTR Consultant






Team Development
Goal Setting
Assessment
Intervention and Coaching
Evaluation
OUTCOMES OF PTR PROCESS
STUDENT DEMOGRAPHICS BY PRIMARY DISABILITY
Disability
Autism
N
Percent
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
2
.8
99
245
38.8
Visual Impairment
General Education
TOTAL
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
AET
0.7
AET ratio
0.6
Treatment n =
126
0.5
Control n=98
0.4
0.3
p<..01
g = .51
0.2
0.1
0
Baseline
Post-test
Time Interval
Cross-Over Treatment Results
Social Skills
90
88
86
84
82
Social Skills
80
p <.01
d = .85
78
76
AET
60
50
Baseline
Post-test
40
30
AET
20
Problem Behavior
124
10
122
0
p <.01
d = .64
Baseline
120
118
Problem Behavior
116
114
p <.00
d = 1.03
112
110
Baseline
Post-test
Post-test
TEACHER OUTCOMES

Fidelity
Majority of teachers achieved .80
 Mean # coaching/training sessions = 3.5
 Prevention higher than Teach and Reinforce


Social Validity
Modified Teacher Acceptability Rating Form (TARF;
Reimers & Wacker, 1988)—15 items
 5-point Likert Scale
 124 teachers
 Overall—4.16 (.52)

Willingness to carry out plan—4.80 (0.42)
 Like the procedures—4.46 (0.64)

PTR: THE PROCESS
STEP 1:

Purpose:




TEAMING
Evaluate strengths and weaknesses of team functioning
Outline roles and responsibilities
Determine a consensus-making process
Members (desired
Person with knowledge of student (e.g., Classroom teacher,
instructional assistant, parent)
 Someone with expertise in functional assessment,
behavioral principles (PTR consultant, school-based
consultant)
 Someone with knowledge of context (e.g., administrator or
designee)


Tools

Work style survey


Teacher and Teacher Assistant
Teaming survey
STEP 2:
GOAL SETTING

Purpose:
Identify behaviors of greatest concern to the team
and possible replacement behaviors (teach)
 Prioritize and operationalize behaviors
 Develop teacher friendly baseline data collection
system


Targeted Areas:
Problem behaviors
 Social skills
 Academic behaviors

Case Study—Step 2: Goal Setting
Increase
Decrease
Broad
Behavior
Social
Academic
Mike will communicate his Mike will interact with
wants and needs
peers appropriately
appropriately
Mike will comply with
non-preferred 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
STEP 2: DATA COLLECTION SYSTEM

Behavior Rating Scale





Direct Behavior Rating (DBR)—Hybrid assessment
combining features of systematic direct observations
and rating scales
Efficient and feasible for teacher use
Provides data for decisions
Prioritized and defined behaviors measured
Requires minimum of 1 appropriate and 1 inappropriate
behavior
CASE STUDY - MIKE: OPERATIONAL
DEFINITIONS

Problem 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


Replacement/Appropriate Behaviors
Express frustration appropriately using Dynamite,
pictures, or signs to ask for a break or attention
 Transition to non-preferred activities: Moving to nonpreferred activity and engaging with appropriate
verbal expression

Date
Case Study- 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
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
Expressing
Frustration
40%+
30-40%
20-30%
10-20%
0-10%
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
Transition to
Non-preferred
Whimper or squeal
Louder than indoor voice
Outdoor play voice
Louder than outdoor play
Ear penetrating
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
BRS PSYCHOMETRICS (PRELIMINARY)

Kappa coefficients of:
Problem Behavior 1 (n = 105): .82
 Problem Behavior 2 (n = 90) : .77
 Appropriate Behavior 1 (n = 103): .65
 Appropriate Behavior 2 (n = 56): .76

STEP 3: PTR ASSESSMENT
(FBA)

PTR Assessment (FBA)

Each team member independently answers a series of
questions related to:
Observed antecedents/triggers of problem behaviors
 Functions of the problem behaviors
 Consequences ordinarily associated with the problem
behaviors

PTR facilitator summarizes input and develops draft
hypothesis
 Team reaches consensus

STEP 3: CASE STUDY – MIKE
ASSESSMENT SUMMARY TABLE OF PROBLEM
BEHAVIOR
Prevention Data
Screaming, Hitting
Non-preferred task
Reading,
Math
 Other students upset/mad
Teacher attending to others
Transition
Preferred to
non-preferred
Change in schedule
Denied item, told no, or to
fix something
Teach Data
Gain attention
Reinforce Data
Redirected
Peers,
Reprimanded
adults
Calm/soothe
Delay
Personal space
Later must
complete task
Access to items
Loss of or delay in
reinforcement
STEP 3: CASE STUDY – MIKE
ASSESSMENT OF APPROPRIATE BEHAVIOR
Prosocial
Prevention Data
Teach Data
Reinforce Data
Independent work
Peer interaction
Treasure box
One-on-one
Getting attention
Movie
attention
Specials
Raising hand
Attention
Sharing attention
Helping teacher
Conversation skills
Going to media
Taking turns
center
Going outside
Walk
Food
Waiting
Self-management
Asking for break
Expressing
emotions
STEP 3: CASE STUDY – MIKE HYPOTHESES
Appropriate
Inappropriate
When….
he will
As a result…
Mike is asked to complete nonscream and hit
preferred tasks (Reading, Math),
stop preferred activity or transition
to non-preferred activity, fix an
error, or when teacher is attending
to other students
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 non-preferred 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
STEP 4: BEHAVIOR INTERVENTION PLAN
 Team
selects interventions from
each component (P-T-R)
 Detailed behavior plan developed
 Consultant provides training and onsite assistance with plan
implementation
 Implementation fidelity evaluated
Step 4: Case Study – Mike’s BIP
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.
Mike’s Intervention Plan
Prevent
Strategies
Environmental
Support
Specific Strategy steps
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.
Mike’s Intervention Plan
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
30
Teach
Strategies
Replacement
Behavior
Specific Strategy Steps
Mike will be taught to use his voice output device to
express his need to calm down.
Steps:
1.
2.
3.
4.
5.
6.
7.
Mike’s device will be programmed to say “I need to calm
down.”
Prior to transitioning to a non-preferred activity or at the end
of a preferred activity, say “If you start to get mad, you can
choose to calm down.”
As soon as Mike starts to get upset, prompt him to use his
device (hierarchy—hand-over-hand, gesture, verbal).
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 (e.g., “You made a good
choice.”.
Allow Mike to engage in his choice until he is calm for 1minute.
If Mike does not want to leave his choice, then start
becoming animated with students in the non-preferred
activity.
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
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
what you need.”)
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.
1.
2.
3.
4.
Waiting
When Mike marks his tracking sheet, praise him for
doing so.
At the end of the day, review the sheet with Mike.
Talk about the sad faces.
Provide his reward if his goal is met.
Mike will earn a skittle paired with attention if he waits. This
will be faded to an intermittent schedule.
Reinforce
Strategies
Specific Strategy Steps
Transition Mike will earn stars during Reading Centers if he
transitions and completes his work without screaming.
1.
2.
3.
4.
5.
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.
At the end of each reading center, an adult will review
Mike’s behavior with him and ask him if he earned his
stars.
Provide his stars if earned.
During the teacher’s group, Mike can earn 2 stars: 1 for
transitioning to the group and 1 for working during
group.
Allow Mike to participate in his chosen activity if he
earned his stars.
STEP 4: PTR INTERVENTION
COACHING/FIDELITY
Provide training to practice the plan without
student (30-90 min.)
 PTR Consultant present first day of
implementation with student
 Provide support in the classroom

Model the plan
 Provide feedback
 Discuss need for modifications if applicable

Task Analysis of Intervention
Discuss
Q&A
Verbal
Role-play
Observe
Feedback
Case Study: Sample Coaching
Checklist/Fidelity for Mike
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 Dynamite 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
STEP 5: EVALUATION

Is it working?
Daily ratings of behavior
 Continuous progress monitoring

BRS
 Other data collection forms


Is it being implemented consistently and
accurately?

Fidelity ratings
Do we need more data?
 Does the plan need to be modified or expanded?
 Plan for generalization and maintenance

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Step 5: Mike Evaluation
Screaming
Baseline
Intervention
4
Definition
Changed
3
2
1
Step 5: Evaluation
Hitting
Intervention
Baseline
5
Rating
4
3
2
1
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Rating
Step 5: Evaluation
Expression of Frustration
5
Baseline
Intervention
4
3
2
1
STEP 5: EVALUATION
Transition to Non-Preferred
Baseline
5
Rating
4
3
2
1
Intervention
STEP 5: EVALUATION
MIKE OUTCOME DATA
Measure
Baseline
Post-test
Change
SSRS-PB
123
112
-11
SSRS-SS
87
102
+15
AET
.34
.57
+23
42
REVIEW PTR PROCESS
Five-step team-based process
 Teacher/team driven
 Support provided to teacher/team to implement
interventions
 Mean number of days for PTR process = 71

References
• Manual
• Dunlap, G., Iovannone, R., English, C., Kincaid, D., Wilson, K., Christiansen,
K., & Strain, P. (2010). Prevent-Teach-Reinforce: A school-based model of
individualized positive behavior support. Baltimore:Paul H. Brookes
• Journal articles
• 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.
• Dunlap, G., Iovannone, R., Wilson, K., Strain, P., & Kincaid, D. (2010).
Prevent-Teach-Reinforce: A standardized model of school-based behavioral
intervention. Journal of Positive Behavior Interventions, 12, 9-22
• Iovannone, R., Greenbaum, P., Wei, W., Kincaid, D., & Dunlap, G. (in review).
Reliability of the Individualized Behavior Rating Scale-Strategy for Teachers
(IBRS-ST): A Progress Monitoring Tool. Manuscript submitted for publication.
• Next steps:
• Facilitating schools to scale up
• Training key school staff and team members to do process
APPLICATION OF TIER 3
DISTRICT LEVEL
STEP 1: ASSESS
CURRENT STATUS
PBS TEAM STRUCTURE

Goals:





Teams to support all students (general ed. and ESE)
throughout tiered (levels) continuum of support
System for monitoring outcomes at all levels
Access to technical assistance
Link between all three tiers of behavior support
Link between school, home, community
PBS TEAM STRUCTURE IN A SCHOOL

SWPBS team—for all students (gen. ed. & ESE)




Monitor implementation of universal intervention
Monitor school-wide data
Guide implementation of new initiatives, braid with
SWPBS
Tier 3 PBS team—“Standing team”—for all
students (gen. ed. & ESE)
Progress monitor students in targeted and intensive
interventions
 Guide intervention selection for students selected for
IPBS


Student-focused teams—“Ad hoc” for all students
(gen. ed. & ESE)

Conduct FBAs and build support plans
TIER 3 BEHAVIOR SUPPORT IN A SCHOOL:
TEAM OPTION

“Ad-hoc” team—student focused (both gen. ed. & ESE)

Responsibilities of team (problem solving process)






Conduct FBA
Build function-based support plan
Provide coaching/support to teacher to implement interventions
Collect and review fidelity and student outcome data
Make decisions based on data
Membership—Three levels of knowledge represented



Someone with expertise in FBA and function-based intervention plans
(school psychologists, CABAs, BCBAs, behavior specialists, counselors,
social workers……)
Someone with knowledge of the student and his or her behaviors
(Teacher(s), aides, parents, students)
Someone with knowledge of the context in which the support plan will
be implemented (administrators or designees)
TIER 3 PROCESS—CONSISTENT AND FEASIBLE
MULTIPLE LEVELS OF TIER 3 (FBA)
 Brief
FBA
FBA/BIP developed in one meeting (60 minutes or
less)
 Best used for high frequency/low intensity
behaviors (e.g., noncompliance, minor disruptions,
etc.)


Example: Brief PTR, ERASE
 Comprehensive
FBA
More complex FBA/BIP procedure
 May take 2 or more meetings or one lengthy
meeting (>1 hour)
 Best used for chronic, durable, intense behaviors


Example: PTR
MULTIPLE LEVELS OF TIER 3

Wraparound
Involves multiple agencies
 Support plan includes practices that may go beyond
scope of school
 Best used for students with mental health issues
and/or complex life events

DATA TRACKING—TIER 3

Systemic Data Tracking Examples

Florida School Districts
Monroe
 Martin
 University of Oregon

QUESTIONS?
FOR COPIES OF FORMS, E-MAIL:
iovannone@usf.edu