Tier II Interventions - MSPA

Tier II Interventions - MSPA

Intervention Programming from Beginning to End: Matching, Mapping, Monitoring, and Meeting Clayton R. Cook, PhD Associate Professor Core Faculty School Psychology Institute for Translational Research in Childrens Mental Health College of Education & Human Development University of Minnesota University of Minnesota The Plan for this Presentation Discuss how IM4 fits within a multi-tiered system of support (MTSS) and supports

educators to deliver evidence-based interventions for students who need additional support Describe each of the key steps of the IM4 process that enables effective intervention programming from beginning to end Discuss Tier 2 and 3 interventions that can be tailored to students based on a root cause 2 Welcome to IM4 , a problemsolving system that coordinates intervention programming from beginning to end for students with social, emotional, and behavioral needs. What makes a behavior a problem? 4 Review of MTSS Basics

MTSS is the operating system programs / practices / policies can all be run within it A continuous improvement framework for incrementally improving the selection and delivery of supports to ensure that all students receive the supports they need to be successful Equity-based, needs driven framework 5 Purpose of Tier 1 1.Prevent problems from emerging 2.Promote/ enhance/ optimize success

3.Provide a solid foundation that enable interventions to work better 6 ALL Students Receive Supports to Prevent and Promote How does a student go from Tier 1 to Tier 2 or 3? Proactive detection of students who may be in need of intervention Use of existing data capturing warning indicators (kitchen sink) Universal and/or targeted screening Structured Teacher

Nomination 7 Existing Social, Emotional, and Behavior Screening Tools Free screening tools Student Risk Screening Scale (Externalizing & Internalizing) Brief Externalizing and Internalizing Screener for Youth (BEISY) Youth Internalizing & Externalizing Problem Screeners (YIPS & YEP) Strengths and Difficulties Questionnaire (SDQ) Commercially available screening tools Social, Academic, Emotional Behavior Risk Screener (SAEBRS; FBL) Systematic Screener for Behavioral Disorders (SSBD) Behavior and Emotional Screening Scale (BASC) Social Skills Improvement System Screener (SSIS-S)

DESSA-Mini How does a student go from Tier 1 to Tier 2? Site Intervention Team reviews detection data to: First, rule-in or ruleout students who need additional intervention Second, for students who are ruled-in, initiate a formal intervention process (e.g., IM4) 9 What is Tier 2? 10 to 20% of all students who: Have socially, emotionally and/or behaviorally needs that necessitate intervention

above Tier 1 alone Quick and efficient o Limited assessment data and minimal expertise needed to select an appropriate intervention for the student 10 Tier 2 is a protocol/process/system Tier 2 is a coordinated process that we wrap around a child not just an intervention Proactively detecting students who need intervention Matching students to intervention

Gathering baseline data Implementing the intervention Monitoring progress 11Meeting Tier 2 problem-solving process Step 1: Identify and define the main problem/concern/need Step 4: Evaluate whether the plan worked Step 2: Determine why the problem is happening to generate solutions Step 3: Develop and implement a plan

What intervention does the student need to address the hypothesized root cause underlying the problem? Who is responsible? A multi-disciplinary team is responsible for the generating and implementing the solution How to organize this process? Problem-solving team that is activated for students who are detected as having a need that goes above and beyond Tier 1 alone Formal process of selecting, planning, delivering, and monitoring of the impact of interventions Match, map, monitor, and meet

Intervention Programming from Beginning to End: Intervention Match, Map, Monitor and Meet (IM4) Match Match the student to the most precise and appropriate intervention Map Map out who is implementing core components of the intervention to increase the fidelity with which the intervention is implemented Monitor Gather baseline data and begin monitoring student response to the intervention and

intervention fidelity Meet 15 Meet as a team to review data and make a data-driven decision 1 6 Match Match the student to the most precise and appropriate intervention 17

Problem-Solving Process Step 1: Identify & define the problem Step 4: Implement the intervention with fidelity and determine whether it was effective Step 2: Determine why the problem is happening (i.e., root cause analysis) Step 3: Select an intervention to

address the problem 18 Student Intervention Matching System Root Cause Analysis Theoretically-informed, data-driven approach to determine the hypothesized root cause that explains why the problem is happening Linking root cause to intervention o root cause must be amenable to intervention (malleable/

alterable) so it can be linked to a precise intervention that educators have 19 ability/control over to Why a menu of evidence-based interventions? Students with social, emotional and behavioral problems are a heterogeneous group of students One-size-fits-all approach to intervention results in lackluster outcomes Matching students to the most precise intervention requires having a menu of

options to select from 20 Acquisition-Performance Deficit Paradigm A problem or difficulty will always be observed when (1) a person lacks or does not possess a skill or given set of behaviors ACQUISITION DEFICIT (Cant do) (2) A person is not OR properly supported or motivated to exhibit the skills or behaviors they do possess

PERFORMANCE DEFICIT and expectations (Wont do) to meet the demands of a given performance setting (e.g., classroom). 21 Acquisition vs. Performance Descriptor Acquisition Deficit Performance Deficit Explanation of the problem

Problem occurs because the student does not possess the requisite skills/behaviors to meet the demands or expectations of the environment Problem occurs because the student is insufficiently supported or motivated by the environment to exhibit the skills/behaviors they possess Student deficit Student lacks a skill/behavior that is necessary to meet the social or academic demands of the environment Student is not properly motivated and/or

supported to utilize skills/behaviors they already possess Type of problem Cant Do Problem (Skill) Wont Do Problem (Will) Focus of the intervention Instructional intervention that focuses on teaching the student lagging skills or behaviors to effectively meet the demands from the environment Intervention that is embedded in the

environment that prompts, encourages, and motivates student to use skills/behaviors he or she already possesses 22 Categories of Interventions IDENTIFY and DEFINE the main problem of concern Analyze WHY the problem is happening 23 Acquisition Deficit (Cant Do Problem)

Performance Deficit (Wont Do Problem) Intervention designed to teach student lagging social, emotional regulation, or executive skills to meet demands from the environment Intervention designed to encourage and motivate the student use the behavior or skills the student is fully capable of exhibiting Student Intervention Matching System Student Intervention

Step 1: Problem Iden fica on Matching - Form Step 2: Performance vs. Skill Deficit Dis nc on Student iden fied as in need of addi onal support via screening, teacher referral or extant data Problem and context in which it occurs defined Performance Deficit Acquisi on Deficit Student Interven on Matching System Step 3: Matching to Interven on

Emo onal Regula on Behavioral Regula on Anxiety Anger Trauma Social Skills e.g., Coping Cat e.g., Coping Power

e.g., CBITS e.g., SISS-IS A en on/ Impulse Control e.g., Selfmonitoring Avoidance of academic work Adult A en on insufficient opportunity interact w/ peers Home

Support Access to rewards Class Pass Interven on Check in/ Check out Posi ve Peer Report SchoolHome Note Behavioral Contract MENU OF INTERVENTIONS 24

Tier 2 Menu of Supports Targeted/ Intensive (A FEW students) Individual Interventions (3-5%) Selected (SOME Students) Small Group or Individual Strategies (10-25% of students) Universal (ALL Students) School/classwide, Culturally Relevant Systems of Support (75-90% of students) 25

Tier 2 Menu: Performance-based Interventions Behavioral contract Self monitoring School-home note system Structured, mentor-based program Class Pass Intervention Goal setting with problem solving Acquisition-based Interventions Small group socialemotional skills Social skills Executive functioning Emotion regulation Example Evidence-based Performance- and Acquisition-Based Tier 2 Interventions Performance-based Intervention

Acquisition-based Intervention Structured School-based Traditional social skills training Mentoring e.g., Check in/Check out Behavior contracting Class Pass Intervention Self-monitoring School-home note system Emotion Regulation Anxiety Anger Trauma Executive functioning Organization Impulse control Attention regulation

26 Performance-Based Intervention Behavior Contract Process of negotiating an agreement between staff and a student so each party receives some benefit or payoff Teacher benefits by improved student behavior Student benefits by earning something based on good behavior Components of behavioral contract: Description of the desired behaviors Goal statement specifying by when, what behavior, and under what conditions payoff will be earned Identification of the privileges, rewards, or desired social experiences to be earned (i.e., The Pay-Off) Signatures from all parties involved Teacher precorrects and prompts student on daily basis using the behavior contract 27

Behavior Contract: Student Characteristics Designed for students who respond well to school-based incentives or contingent access o Eager to earn rewards, special privileges, and/or recognition from others Students who dislike particular academic subjects and could benefit from receiving extrinsic reinforcement (i.e., pay-off) Students who could benefit from receiving precorrection and prompting 28 Behavior Contract: Active Ingredients 1. Negotiated agreement or brokered deal to increase student buy-in 2. Focus on positive behaviors teachers want to see in the classroom (i.e., those behaviors that are incompatible

with problem behavior) 3. Positive reinforcement for meeting goal 4. Teacher follows up with daily pre-correction and prompting Pulling out the contract and reminding the student of the behavior and reward to be earned At the first warning signs of problem behavior, prompting the student 29 Difference Between Effective and Ineffective Behavior Contracts Negotiated agreement Non-negotiated Describes what the Describes what the student should do Provides a goal

statement Outlines what the student will earn as a reward for meeting goal Teacher uses contract to precorrect and prompt behavior EFFECTIVE BEHAVIOR CONTRACT 30 student is doing wrong Provides no goal statement Outlines how the student will be punished if problem behavior

continues No other adult follow through with the contract INEFFECTIVE BEHAVIOR CONTRACT Performance-Based Intervention Daily Structured Mentoring (e.g., Check-in/ Check-out) Assignment of a mentor who provides unconditional positive regard and bookends support on the front- and back-end of each day Avoid a person who has a dual relationship with the student (e.g., mentor and the teacher) Active ingredients of behavior change: Behavioral momentum (i.e., getting the day off to a good start) Precorrection (i.e., cutting problems off before they start)

Performance feedback (i.e., letting the student know how s/ he is doing) Positive reinforcement (i.e., recognizing and rewarding the student) Goal specification and attainment (i.e., increasing students 31 motivation and awareness of behavior) Simple vs. Structured Mentoring Mentor meets with the child infrequently Mentor is there to be a positive role model with limited to no precorrection Often no target behaviors identified to address

Can handle significantly more students SIMPLE MENTORING 32 Mentor meets with the child on a daily basis In addition to positive relationship, mentor precorrects problem behavior Daily ratings of specific targets behaviors Limitations with regard to the number of students a school can DAILY STRUCTURED handle MENTORING

Mentor-Based Support Basic Sequence of Structured Mentoring Deliver consequences at home based on behavior at school Provide encouragement for a better day tomorrow Parent Check In upon arrival home Morning check in with mentor Positive greeting Deliver praise/reward Provide nonjudgmental

feedback End of day check out with mentor 3 3 Positive greeting Check for school readiness Cutoff problems before Reminder of expected behaviors Talk about reward to be

earned Give student monitoring chart Teacher evaluation and ongoing feedback Teacher monitoring Prompts to engage in expected behavior Reminder of reward to be earned Mentor-Based Support: Student Characteristics Students who respond well to adult attention Students who could benefit from having a positive adult role model outside of the home Students who could benefit from receiving daily encouragement and feedback to improve behavior and school performance

Students who have been involved with negative interactions with teachers and administrators (punitive discipline) 34 Mentor-Based Support: Active Ingredients 1. Assignment of an adult mentor who the student likes or doesnt mind meeting with 2. Unconditional positive regard (mentor does not get involved with discipline) 3. Daily contact with the student in the morning and afternoon Encouragement, precorrecting problems, feedback 4. Progress monitoring form to serve as a basis for performance-based feedback 5. Positive reinforcement for improved behavior Praise, public recognition, access to desired privileges/ rewards 35

Performance-Based Intervention Self-Monitoring Intervention designed to increase self-management by prompting the student to self-reflect and self-record specific behaviors on a chart/form Two main components: o Self-reflection (reflection of behavior over a certain amount of time) o Self-recording (marking down on the chart whether behavior met or did not meet expectations) Teacher performs periodic honesty checks 36 Self-Monitoring: Student Characteristics Students who needs constant prompts and reminders to stay on track Students who experience difficulties with

self-management / regulation Students who exhibit relatively frequent rates of problem behavior Students who could benefit from reminders or prompts to stay on task and engage in desired, expected behaviors 37 Self-Monitoring: Active Ingredients 1. Identification of behaviors to self-reflect upon and self-record on a chart 2. Development of a self-monitoring chart that the students uses to record his/her behavior 3. Device or natural break that prompts the student to self-reflect and self-record behavior 4. Train the student (tell-show-do) 5. Positive reinforcement component attached to selfmonitoring chart (increases the value or meaning of self-reflection and recording) 6. Teacher conducts periodic honesty check 38

Self-Monitoring Technology 39 40 Performance-Based Intervention School-Home Note System Intervention designed to improve the communication and consistency of practices between school and home environments Involves training parents to act upon a school behavioral note by delivering consequences at home consistent with their childs behavior at school Two-way communication - Parents can share information with school about outside stressors that may be impacting student behavior at school 41

School-Home Note Decision Tree DAILY BEHAVIORAL GOAL YES - GOAL MET NO - GOAL UNMET PARENT RESPONSE CELEBRATE YOUR CHILDS SUCCESS (positively reinforce) 42 ENCOURAGE YOUR CHILD TO HAVE A BETTER DAY TOMORROW (effective discipline) Consequences Delivered by Parents

Celebrating the childs success to recognize and acknowledge behavioral goal being met Access to daily home-based privileges o Computer time, video games, talking on the phone, staying up later, hanging out with friends, TV time Access to a reward or desired experiences o Buy-out of chore, money, invite friend over, play outside, after dinner dessert, playing with toys, etc. Behavior specific praise and positive recognition 43 Consequences Delivered by Parents Encouraging a better day tomorrow (effective discipline to teach) Loss of daily privileges o Removal of TV time, computer, video games, playing

outside, talking on the phone, or anything else that is considered to be fun Task-based grounding o Have the child perform chores that are outside of typical responsibilities o Grounded until the chore or chores are completed Collaborative problem-solving o Debrief about the barriers and create mutually 44 agreeable plan to overcome barrier to meet behavioral goal 4 5 School-Home Note: Student Characteristics

Students whose parents are open and willing to join forces with the school to improve the students performance in school Students who are unaffected by typical school-based disciplinary consequences Students whose parents could benefit from learning skills Students who could benefit from consistency across school and home environments 46 School-Home Note: Active Ingredients 1. Development of a school-home note that captures student behavior and communicates whether behavioral goal was met Student behavior section, teacher communication section, parent response to note section, parent communication section, & signatures 2. Brief parent training that consists of teaching parents how to translate the information on the school-home note into

effective parenting strategies Goal met = celebrating success Goal unmet = encouraging a better day tomorrow 3. Ensuring that parents are receiving the note & following through 47 Performance-Based Intervention Name: ________________ CLASS PASS Class Pass Intervention Time: __________ Where to?: ___________________ Intervention designed for students who escapedInitial: __________ motivated disruptive classroom behavior Students are given class passes and taught how to appropriately request a break by issuing a

class pass Students can choose to hold on to the class passes to exchange them for a more preferred item, activity, or privilege It works because students: Exercise choice by requesting a break with class pass Dual motivational contingencies (break from work and contingent access to preferred experience) 48 CPI Implementation Steps 1. Meet with the student to teach them the CPI and how to appropriately request a break using the class pass 2. Identify a spot where the student can break and engage in a preferred activity for 3 7 minutes (this depends on how long staff are willing to accept) 3. Determine the rewards and/or privileges that can be earned by saving the class passes (make it such that the more passes means the better the reward and/or privilege) 4. Give the student a predetermined amount of class passes

(anywhere from 3 to 5) 5. When implementing the CPI, provide prompts to the student to use the class pass if you see him beginning to engage in problem behavior 6. Monitor and track the effectiveness of the intervention 7. Give the student feedback about how he is doing 49 Class Pass Intervention: Student Characteristics Students who engage in classroom behavior problems only when presented with academic work Students whose classroom behavior is hypothesized to be escape-motivated Students who have a low tolerance for engaging in academic work Students who are more likely to remain ontask when provided with choice 50 Class Pass Intervention:

Active Ingredients 1. 2. 3. 4. 51 Develop the actual class passes to be used Determine the number of class passes and length of time the student can break for Identify the location for the break (desk, in the classroom, outside of the classroom) Identify the items, privileges, or activities that can be earned and the number of class passes needed for each one Example of a Class Pass FRONT BACK Guidelines for Class Pass:

# ______ PASS CLASS Name: ________________ Time: __________ Where to?: ___________________ Initial: __________ Reward for a saved pass: ___________________________ If you use the pass 1. Choose a time when you need to step out of the class. 2. Fill out one of your passes. 3. Show pass to teacher. 4. Walk to ____________________. 5. Have adult where you

walked initial pass on your way back to class. 6. Enter class quietly. 7. Join classroom activity. If you save the pass Earn a reward!!!!!!! 52 Acquisition-Based Interventions EMOTIONAL REGULATION/COPING Anger Anxiety Trauma Stress/Depression BEHAVIORAL REGULATION Social Skills Executive Functioning 53 Example evidence-based curriculum

EMOTIONAL REGULATION Anger o Anger replacement training; Coping Power Anxiety o FRIENDS, Coping Cat, Coping with Stress Trauma o Bounce Back, Cognitive Behavior Intervention for Trauma in Schools Stress/Depression o Coping with Depression, Penn Resilience Program, Teaching Kids to Cope BEHAVIORAL REGULATION Social Skills o Skillstreaming, Social Skills Improvement System Executive Functioning o Homework, Organization, and Planning Skills 54 55

Map Map out who is implementing core components of the intervention to increase the fidelity with which the intervention is implemented 5 6 Mapping out a Plan (MAP) Focusing on the Active Ingredients Delivering an effective intervention is like a good cooking recipe that involves combining multiple ingredients to produce a yummy product An ingredient is a component of a product that helps achieve its desired

outcome Single ingredients are necessary but insufficient alone to produce the desired outcome 57 = IMPLEMENTATION MAP Intervention Selected: Performance-Based Intervention Check in/Check Out Intervention Facilitator: School Counselor Mark Cook

Active Ingredients of Intervention: Assignment of an adult mentor who the student likes and is willing to meet with Mentor provides unconditional positive regard and encouragement to the student (mentor does not get involved with discipline) Mentor checks in with the student in the morning on a daily basis to pre-correct problems, make sure the child is ready for the day, and engage in positive interaction/conversation Mentor checks out with the student in the afternoon on a daily basis to connect with the student, provide feedback and reinforcement, and offer advice and encouragement Point sheet was completed by teachers to serve as a basis for monitoring progress and providing performance-based feedback Student receives positive reinforcement for improved behavior (such as, praise, public recognition, access to desired

privileges/rewards) If willing and able, parents are included and provided with daily point sheet to support their childs behavior in the home. Dates: Baseline Data Collection: Date: Oct. 14, 2016 Whos responsible: Teacher (Sandy Holmes) Whos Responsible? Initials:_______ Initials:_______ Initials:_______ Initials:_______ Initials:_______ Initials:_______ Initials:_______

Intervention Start Date: Date: Oct. 18, 2016 Meeting to Review Data Date: Date: Nov. 2, 2016 5 9 Gather baseline data and begin monitoring student response to the intervention and fidelity of implementation 60

85 80 70 85 75 70 Student Progress Data 80 GOAL Date Date Date

Date Date Date Date Date Date Date Date Date Date Date

Date Median Baseline Baseline #3 Baseline #2 60 Baseline #1 Monitor 90 80 70 60 50 40

30 20 10 0 Aim Line Progress Monitoring Graph Advantages of Direct Behavior Rating Brief and valid Behaviors are explicitly defined and measure captures a key dimension of behavior (frequency, duration, intensity) Ratings are pre-set so students and adults can easily monitor behavior DBR is defensible, flexible, repeatable, and efficient Direct Behavior Rating Scale Example: http://dbr.education.uconn.edu/ 61

62 63 Monitoring Intervention Fidelity 64 Fidelity Rating Date 10/18 10/24 10/31 11/6 + +

+ + Mentor provided unconditional positive regard and encouragement to the student (mentor does not get involved with discipline) + + + - Mentor checked in with the student in the morning on a daily basis to pre-correct problems, make sure the child is ready for the day, and engage in positive conversation with the student +

+ + - Mentor checked out with the student in the afternoon on a daily basis to connect with the student, provide feedback and reinforcement, and offer advice and encouragement + - - - Point sheet was completed by teachers to serve as a basis for monitoring progress and providing

performance-based feedback + - + - Student received positive reinforcement for improved behavior (such as, praise, public recognition, access to desired privileges/rewards) + + + -

N/A N/A N/A N/A Active Ingredient Assignment of an adult mentor who the student likes and is willing to meet with If willing and able, parents were included and provided with daily point sheet to support their childs behavior in the home. 65 66 Meet Meet as a team to review

data (graphed progress monitoring depicting student response and estimates of fidelity of implementation) and make timely and relevant datadriven decisions 67 Meeting Phase Structured Teaming to Drive Data-Driven Actions Schedule meeting prior to beginning the implementation of the intervention Gather data while the intervention is being implemented Prepare data to be consumed by team to drive a decision Assign roles and create a structured agenda to ensure the meeting runs efficiently 68 Meeting to Make a Data-Driven

PROGRESS MONITORING FIDELITY DATA 69 Positive Response Insufficient Response Adequate Fidelity Inadequate Fidelity Maintain or Exit Maintain Intervention, Begin Fading Intervention, or Exit Student Progress Improve Fidelity or Exit

Improve fidelity of Implementation, Exit student (i.e., false positive) Change Intervention Select a different intervention, Consider a more intensive intervention Improve Fidelity Improve Fidelity of Implementation http://itr.umn.edu/ im4education.com [email protected] @ClayCook_PhD


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