Embedded Intervention: Addressing Children’s Goals in Daily Activities

Amy M. Casey

Center for Child Development

Vanderbilt University Medical Center

What is Embedded Intervention?

A recommended approach for addressing the individualized goals of children with disabilities in their natural environments

Why is This Important?

PracticalLearn new skills in context where

they’ll be used Multiple learning opportunities Classroom membership Independence Engagement

What is Engagement?

Participation, being active, being involved, playing, on-task behavior, learning

Engagement is the amount of time that children spend involved with the environment (adults, peers, or materials) in a way that is appropriate given their age, abilities, and surroundings.

The Importance of Engagement

Improving engagement leads to positive change in children’sBehaviorInteractions with othersThinking and reasoning skills

Engagement in Children With Disabilities Compared to typically-developing

peers, children with disabilities spendMore time passively nonengagedLess time interactively engaged with

adultsLess time attentionally engaged with

peersLess time in master-level engagement

with materials

Levels of Engagement

Level 1: NonengagementUnoccupied behavior

• Crying• Whining• Aggression• Wandering aimlessly• Staring blankly• Needless waiting

Levels of Engagement

Level 2: Casual AttentionScanning the environmentAttending to a range of things instead

of paying attention to one object or person

Level 3: Undifferentiated BehaviorRepetitive actions or vocalizationsSimple, low-level play

Levels of Engagement

Level 4: Focused AttentionIntent watching or listeningLimited motor activity

Level 5: Differentiated BehaviorActive interaction with the

environmentPlayingParticipating in routines

Levels of Engagement

Level 6: Constructive BehaviorMaterialsMaking, creating, or building somethingIntentionality

Level 7: Encoded BehaviorSocialUsing context-bound, understandable

language

Levels of Engagement

Level 8: Symbolic BehaviorPretend playTalking about someone/something that is

not present Level 9: Persistence

Problem solvingChallengeChanging strategies or using the same

strategy repeatedly

Engagement Continuum

Unsophisticated

Sophisticated

Nonengaged

Casual Attention

Undifferentiated

Focused Attention

Differentiated

Constructive

Encoded

Symbolic

Persistence

LEVELS

Develo

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Ways to Focus on Engagement

Room arrangement/materials Fun activities Zone defense scheduling Incidental teaching

Room Arrangement

Break up the middle of the roomCreates 4 zonesPrevents wandering, running laps

Scatter centers throughout zones instead of lining them up on wallsMost nonengagement occurs in wide

open spaces

Materials Quantity

Enough toys for everyoneMatching toys to encourage parallel play

QualityAt or slightly above skill level

AccessibilityOn low shelves

VarietySwap toys/activities on regular schedule

Activities

Fun and exciting!! Interesting things to do and talk about Focus on process and skill

development (not final product) Focus on promoting independence,

social relationships, and engagement

Zone Defense Scheduling

Method for organizing adults Creates environment in which

engagement is the focus

ZDS Basics

Man-to-man defense: assignment to a specific player/child

Zone defense: assignment to an area of the court/classroom

The ZDS prevents teachers from chasing specific children around the classroom

ZDS Roles

One adult is assigned to the scheduled child activity and is focused on child engagement

One adult is in charge of extra classroom tasks, such as cleaning up, preparing the next activity, changing diapers, taking phone calls, helping a child who needs individual assistance, etc.

ZDS Transitions

During transitions between activities, one adult is at the old zone and one adult is at the new zoneChildren can transition at their own

paceChildren can begin the new activity as

soon as they arrive at the zone

Example 2-Person ZDS

Time Person 1 Person 2

8:00-8:15 Arrival Set Up

8:15-8:30 Set Up Story

8:30-8:45 Free Play Set Up

8:45-9:00 Set Up Circle

9:00-9:15 Small Toys Set up

9:15-9:30 Set Up Centers

9:30-9:45 Set Up Centers

9:45-10:00 Snack Set Up

10:00-10:45 Set UpBathroom and Outside/Hallway

10:45-11:00 Music Set Up

11:00-11:15 Set Up Art

Incidental Teaching

What to do when you’re the adult assigned to focus on the ongoing activity and child engagement

Method for basing interactions on a child’s interest in order to elaborate on existing engagement

Steps for Incidental Teaching

1. Arrange the environment

2. Catch the child engaged

3. Approach the child

4. Elicit elaboration of existing engagement

5. Provide reinforcement

1. Arrange the Environment

ProvideAccessible materialsPreferred toysA defined spaceSufficient quantitiesOpportunities for peer interaction

2. Catch the Child Engaged

In any routine or activity With peers or materials

3. Approach the Child

Think about the child’s level of engagementWhat are you aiming for? A higher level

of engagement? If so, which one? Consider the child’s learning style

Is it better to interact with the child? Is it better to sit near him and engage in parallel play? Is it better to encourage a peer to approach him?

4. Elicit Elaboration of Existing Engagement

Options areMore engagement (continue the

behavior for a longer amount of time)Higher engagement (use more

sophisticated behavior)Skill development (work toward a

developmental goal)

5. Provide Reinforcement

Natural reinforcementThe activity or outcome appeals to the

child’s interests and intrinsic motivation

Verbal reinforcementBe specific

Tangibles

Using Incidental Teaching

Incidental teaching comes naturally to most teachers, but it can always be used more oftenOur research shows that rates of

incidental teaching are low before awareness training; after training teachers are able to increase their rates of incidental teaching to changing criterion levels

Classroom Modifications

Modify the environmentCreate opportunities for engagement

• Ensure that activities are appealing and have a variety of materials available

Sabotage is not necessarily a bad thing• Example: Set out all needed

materials except for one, requiring children to ask for the missing item or problem solve

How would you address his goal to use word approximations?

Classroom Modifications

Modify the task demandsAsk the child to do something that is

slightly above his current skill level (and provide as few prompts as possible) to encourage higher engagement

Ask the child to do something that is slightly below his current skill level (and provide reinforcement) to encourage more engagement

How would you encourage higher engagement?

Classroom Modifications

Modify your expectationsRather than focusing on the goal of the

activity, focus on one of the child’s goalsExample: Maggie’s goal is to use words

to request items or help. During art, do not focus on getting Maggie to make the expected product. Instead, focus on providing multiple opportunities for her to request materials.

Classroom Modifications

Use multiple routines to address the same goal

Create opportunities for peer interactionExample: Have peers without

disabilities use a buddy system to help a child with disabilities take his coat off after playing outside

How would you encourage more engagement?

Is It Working?

Measure class-wide engagement with the Engagement Check II

Measure an individual child’s engagement with the Scale for Teachers’ Assessment of Routines Engagement (STARE)

Engagement Check II

Method for teachers to determine percentage of children engaged during activities

Engagement Check II(McWilliam, 1999)

IntervalNumberPresent

NumberNonengaged

NumberEngaged

PercentEngaged

1

2

3

4

5

6

7

8

9

10

Engagement Check II Procedure Every 5 minutes, count and record

The number of children who are nonengaged

The total number of children present At the end of the observation, calculate

The number of children who were engaged in each interval

The percentage of children engaged across the session

STARE

Method for teachers to document their impressions of an individual child’s engagement in each classroom routine

Helps teachers determineWith whom or what the child was

engagedComplexity of child’s engagement

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Directions: Observe the child for 10 minutes in each of the following routines. First, rate the amount of time the child is engaged with adults, peers, and materials. Second, rate the complexity of the child’s engagement. There is space to add additional or alternate routines at the end of the scale.

Arrival Almost none of the time

Little of the time

Half of the time

Much of the time

Almost all of the time

With Adults 1 2 3 4 5

With Peers 1 2 3 4 5

With Materials 1 2 3 4 5

Complexity* Nonengaged

1

Unsophisticated

2 Average

3

Advanced

4

Sophisticated

5

STARE Procedure

Observe child in routine Rate amount of time spent with adults,

peers, and materialsCan rate high in more than one

Rate complexity of engagementHow the child spent the majority of his

or her time (not the highest level observed)

Other Strategies for Embedding

Prompts Time delay Reinforcement Peer-mediated strategies

Prompts

Something the teacher does before the child responds

They increase the likelihood that a child will respond in a certain way

TypesPhysicalVerbalGestural

Time Delay

Wait time Allows the child to respond

independently before the teacher provides support

Reinforcement

Reinforcers = things (words, activities) that follow a behavior

Reinforcers are what teachers do immediately after the child’s behavior or response

Positive Reinforcement

Positive reinforcement – something that follows a specific response and increases the likelihood that the response will happen againExample: Child asks for ball and

teacher gives it to him.Example: Child puts coat on and

teacher says, “Wow – you zipped your coat!” and puts a star on her chart.

Differential Reinforcement of Other Behavior Catch the child displaying a desired

behavior (doing something good) and let him or her know about it

Use this when you’re trying to decrease a challenging behavior by providing positive reinforcement for replacement (incompatible) behaviorExample: For a child who flits from one

activity to another, provide feedback when the child stays at an activity and plays

Peer-Mediated Strategies

Peer management Peer modeling Peer tutoring

Tips for Embedding

Use multiple routines to address the same goal When goals are functional, they will naturally

occur in multiple routines The Examination of the Implementation of

Embedded Intervention through Observation (EIEIO) can be used to assess the frequency with which goals are addressed

Examination of the Implementation of Embedded Intervention, through Observation (EIEIO)

Center: Class: Teacher: Child: Date: Observer: Goals 15-Minute Blocks of Observation

(Record the name of the routine in which the child with disabilities was participating for each 15-minute block of observation)

Routine: Routine: Routine: Routine:

List high priority goals (check all that are addressed in each 15-minute block of observation)

C W A Notes C W A Notes C W A Notes C W A Notes

C= Could the goal be addressed? W= Was the goal addressed? A= Was the goal addressed appropriately? Appropriately: Developmentally appropriate, individually appropriate, normalization principles, relevant to what others are doing, doable by teaching staff, contextually appropriate.

Tips for Embedding

Plan when (during which routines) specific goals will be targeted and who is responsible Higher priority goals (as decided by the

family) should be planned to occur in more routines

The Intervention Matrix can be used as a one-page summary of intervention priorities and planned implementation times

The Intervention Matrix

Child:_______________________________________ ID:_____________________ From:________to________

* T= Teacher; F= Family; SC= Service Coordinator SE SLP PT OT

Priority #

*Person Respon-

sible

Objective Arrival Free Play

Meals Struc-tured

Activity

Circle Music Art Out-doors

Transi-tions

Nap Per-sonal

Hygiene

Home

Summary

Focus on engagement by Arranging your classroom to promote

participation Providing interesting materials and fun

activities Organizing the adults in the classroom Using incidental teaching

Consult with service providers to identify the most useful strategies for embedding intervention into daily routines

For Additional Information

Contact Amy Casey at amy.m.casey@vanderbilt.edu615-936-3986

Visit our websiteswww.IndividualizingInclusion.us www.VanderbiltImprovingEngagement.us www.vanderbiltchildrens.com/engagementclassroom