multimodal intervention fn..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,&...

10
!"#$% '()*+,-#$% ./0,#1"230 4$,)*()$,#"$ ," 5*)()$, 6)30,-73*)89::"7#3,)2 4$;)7,#"$: "#$%&' ()*+,-./ 01) 2#*3)* %'3,$,40*%0#* #2 01) 5)$0)*4 2#* 6)',-%*) %$' 6)',-%,' 7)*8,-)4/ #$-) %4.)' 9:*%$ ;)$*,./ -1,)2 )<)-=0,8) #2 &)%*$,$> %$' ,$$#8%0,#$ ,$ ?:$.:@,$> 5#=$0A/ 7+)')$/ 1#+ 1,4 -#=$0A +%4 %-1,)8,$> +#*&'B&)%',$> *)4=&04 ,$ 0#0%& 1)%&01 4A40)3 @)*2#*3%$-)C ;)$*,. 0#&' 1,3D E;)*)F4 01) 4)-*)0D G) '# )8)*A01,$>CH UMF Corporation 4709 Golf Road Suite 300-A Skokie, IL 60076 • 847-920-0370 October 2012 " #$% &'()'(*+,'- ./,+0 1*)0(

Upload: others

Post on 11-Apr-2020

5 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

!!!

!

!

!

!"#$%&'()*+,-#$%&

./0,#1"230&4$,)*()$,#"$&,"&5*)()$,&

6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!

!

!

!

!

!

"#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4!

2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4/!#$-)!%4.)'!9:*%$!

;)$*,./!-1,)2!)<)-=0,8)!#2!&)%*$,$>!%$'!,$$#8%0,#$!,$!

?:$.:@,$>!5#=$0A/!7+)')$/!1#+!1,4!-#=$0A!+%4!%-1,)8,$>!

+#*&'B&)%',$>!*)4=&04!,$!0#0%&!1)%&01!4A40)3!@)*2#*3%$-)C!

;)$*,.!0#&'!1,3D!E;)*)F4!01)!4)-*)0D!G)!'#!)8)*A01,$>CH!!

!!

!

!

!

!

!

UMF Corporation 4709 Golf Road Suite 300-A Skokie, IL 60076 • 847-920-0370 October 2012

"!#$%!&'()'(*+,'-!./,+0!1*)0(!!

Page 2: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page 2

!

!

!<4=>&'?'@AB64=>C&

.DEB4.<!9E&4=B'@?'=B4<=&

4=B@<!DFB4<=&

304),+0!4'50!06,70-80!'9!)(':(044!;!5<8/!'9!,+!*!(04<=+!'9!:'60(-50-+!)*>50-+!,-,+,*+,604!;!

,-908+,'-4!*8?<,(07!7<(,-:!*!/'4),+*=!4+*>!(05*,-!+/0!4'<(80!'9!5'4+!)(060-+*@=0!/*(5!+'!)*+,0-+4A!B,+/!706*4+*+,-:!09908+4!'-!)0(4'-*=!=,604A!+/0!

-*+,'-*=!08'-'5>A!*-7!/'4),+*=!(0)<+*+,'-4!*-7!9,-*-8,*=!4<4+*,-*@,=,+>C!!&

"88'(7,-:!+'!+/0!&0-+0(4!9'(!3,40*40!&'-+('=!*-7!1(060-+,'-!D&3&EA!*@'<+!F!,-!060(>!2G!,-)*+,0-+4!:0+4!,-908+07!7<(,-:!*!/'4),+*=!4+*>A!*-7!HHAGGG!

)0')=0!7,0!0*8/!>0*(!*4!*!(04<=+A!5*I,-:!/0*=+/8*(0J*44'8,*+07!,-908+,'-4!DK"L4E!+/0!9'<(+/J=0*7,-:!8*<40!'9!70*+/!,-!+/0!#-,+07!

M+*+04CF!!!K"L4!=0*7!+'!='-:0(!/'4),+*=,N*+,'-4O!*!(080-+!

*-*=>4,4!@>!#$%!&'()C!04+,5*+04!+/*+!+/040!,-908+,'-4!*88'<-+07!9'(!5'(0!+/*-!2P!5,==,'-!*77,+,'-*=!/'4),+*=!)*+,0-+!7*>4!*--<*==>C!Q/0!

4+<7>!0R+(*)'=*+07!7*+*!9('5!*!2GG2!&3&!(0)'(+!*-7!*!2GFG!(0)'(+!9('5!+/0!10--4>=6*-,*!30)*(+50-+!'9!1<@=,8!K0*=+/A!+/0!'-=>!

:'60(-50-+*=!0-+,+>!+/*+!/*4!8'-4,4+0-+=>!+(*8I07!*==!K"L4C2!

!3<(,-:!+/'40!='-:0(!/'4),+*=!4+*>4A!*-!,-908+07!)*+,0-+!(0?<,(04!:(0*+0(!<40!'9!,-+0-4,60!8*(0A!

7,*:-'4+,8!,5*:,-:!*-7!-0B0(!*-+,@,'+,84!+/*+!8'4+!*+!=0*4+!9'<(!+,504!*4!5<8/!*4!8'-60-+,'-*=!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!F!I40,3%0,$>!;)%&01!5%*)BJ44#-,%0)'!K$2)-0,#$4!%$'!")%014!,$!LC7C!

;#4@,0%&4/!MNNMA!&0-+0(4!9'(!3,40*40!&'-+('=!*-7!1(060-+,'-!

2!K0*=+/8*(0J"44'8,*+07!L-908+,'-4!DK"LE!,-!10--4>=6*-,*!K'4),+*=4S!2GFG!T0)'(+A!10--4>=6*-,*!30)*(+50-+!'9!1<@=,8!K0*=+/!

7(<:4C!U'!B'-70(!*!2GGH!&3&!(0)'(+!04+,5*+07!+/*+!K"L4!*88'<-+!9'(!VWG!@,==,'-!,-!0R8044!

/0*=+/8*(0!8'4+4!0*8/!>0*(A!B,+/!+/0!*60(*:0!,-908+,'-!8'4+,-:!*!/'4),+*=!V2GAGGG!+'!V2XAGGG!+'!+(0*+CY!3<0!+'!/0*=+/!(09'(5A!5<8/!'9!+/*+!,4!-'B!

<-(0,5@<(407!0R)0-40CW!!!K0*=+/8*(0!9*8,=,+,04!*(0!@(007,-:!:('<-74!9'(!*-!

*((*>!'9!,-908+,'<4!7,40*404!8*<407!@>!50+/,8,==,-J(04,4+*-+!M+*)/>='8'88<4!*<(0<4!D$TM"EA!6*-8'5>8,-J(04,4+*-+!0-+0('8'88<4!DZT[EA!

"8,-0+'@*8+0(!@*<5*--,,A!&='4+(,7,<5!7,99,8,=0!D&C!7,99,8,=0EA!-'('6,(<4A!,-9=<0-N*!6,(<4!*-7!4060(0!*8<+0!(04),(*+'(>!4>-7('50C!Q/040!,-908+,'-4!

(04<=+!9('5!@*8+0(,*A!9<-:,!*-7!6,(<404!+/*+!7B0==!,-!+/0!/'4),+*=!0-6,('-50-+!;!'9+0-!9'(!5'-+/4!;!,-!7<4+!*-7!'-!9=''(4A!@07(*,=4A!+0=0)/'-04A!8*==!

@<++'-4A!8<(+*,-4!*-7!'+/0(!4<(9*804C!Q/0!5*\'(,+>!'9!K"L4!*(0!<(,-*(>!+(*8+!,-908+,'-4A!4<(:,8*=!4,+0!,-908+,'-4A!@=''74+(0*5!,-908+,'-4!

*-7!)-0<5'-,*C!!!

Q/040!,-908+,'-4!/*60!7060=')07!(04,4+*-80!+'!*-+,@,'+,84A!*!(04<=+!'9!708*704!'9!B0==J,-+0-+,'-07!'60(<40!@>!)/>4,8,*-4!*-7!'+/0(!

)(048(,@0(4!+/*+!/*4!/*7!+/0!09908+!'9!40=08+,-:!4+(*,-4!'9!@*8+0(,*!+/*+!*(0!*@=0!+'!06*70!+/0!704,(07!I,==,-:!*8+,'-!'9!+/0!7(<:4C!L-!FHPWA!2!

)0(80-+!'9!4+*)/!,-908+,'-4!B0(0!$TM"C!]>!2GGWA!+/*+!-<5@0(!,-8(0*407!+'!^W!)0(80-+CX!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Y!O1)!",*)-0!6)',-%&!5#404!#2!;)%&01-%*)BJ44#-,%0)'!K$2)-0,#$4!,$!

LC7C!;#4@,0%&4!%$'!01)!()$)2,04!#2!P*)8)$0,#$A!&0-+0(4!9'(!3,40*40!&'-+('=!*-7!1(060-+,'-A!$*(8/!2GGH!

W!O1)!Q,$%$-,%&!K3@%-0!#2!J$0,R,#0,-!S)4,40%$-)A!_',-+!&'55,44,'-!T04'<(804!D'-=,-0E!

G&H$0+/,8,==,-JT04,4+*-+!70%@1A&#-#--=4!J=*)=4S!"!10(6*4,60!1*+/':0-!K,:/=,:/+4!+/0!U007!9'(!U0B!"-+,5,8('@,*=!3060=')50-+A`!T%&)!?#=*$%&!#2!(,#&#>A!%$'!6)',-,$)/!30805@0(!2GFGO!aYDWES!22Y;2YY!

Page 3: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page Y

!"!(04<=+!'9!*-+,@,'+,8!(04,4+*-80!,4!5*(I07=>!/,:/0(!

5'(@,7,+>!*-7!5'(+*=,+>!*5'-:!+/'40!B/'!8'-+(*8+!*-!,-908+,'-C!%'(!0R*5)=0A!*!4+<7>!'9!)*+,0-+4!B,+/!7(<:J(04,4+*-+!"8,-0@*8+0(!

@*<5*--,,!;!*!@*8+0(,<5!+/*+!8*-!8*<40!4060(0!)-0<5'-,*!*-7!,-908+,'-4!'9!+/0!<(,-*(>!+(*8+!*-7!@=''74+(0*5!;!9'<-7!YGJ7*>!5'(+*=,+>!(*+04!+/*+!

B0(0!5'(0!+/*-!+B,80!*4!/,:/!*4!)*+,0-+4!B,+/!4+(*,-4!+/*+!8'<=7!@0!+(0*+07!B,+/!8'-60-+,'-*=!*-+,@,'+,84C!Q/,4!050(:,-:!+/(0*+!,-!/'4),+*=4!/*4!

*!4+<--,-:!Xa!)0(80-+!5'(+*=,+>!(*+0C!

T040*(8/!4/'B4!+/*+!-0*(=>!+/(00!?<*(+0(4!'9!)*+,0-+4b!(''54!*(0!8'-+*5,-*+07!B,+/!$TM"!*-7!ZT[C!"!FHHP!4+<7>!9'<-7!+/*+!W2!)0(80-+!'9!

)0(4'--0=!B/'!/*7!/*7!-'!7,(08+!8'-+*8+!B,+/!,-908+07!)*+,0-+4!/*7!8'-+*5,-*+07!+/0,(!:='604!B,+/!$TM"!50(0=>!@>!+'<8/,-:!/'4),+*=!(''5!

4<(9*804C^!!!1(')0(!/*-7!/>:,0-0A!8,+07!@>!5*->!*4!+/0!5'4+!

,5)'(+*-+!4'=<+,'-!+'!-'4'8'5,*=!,-908+,'-4A!,4!'-=>!5'70(*+0=>!09908+,60C!L9!@*8+0(,*!*-7!6,(<404!

*(0!-'+!0=,5,-*+07!9('5!+/0!/'4),+*=!0-6,('-50-+A!/*-74!?<,8I=>!@08'50!8'-+*5,-*+07!*:*,-C!

1*+,0-+4!8*-!8'-+(*8+!*-!K"L!+/('<:/'<+!+/0!8>8=0!'9!8*(0C!Q/0>!8*-!:0+!,+!9('5!*-!,-\08+,'-!,-!+/0!

[TA!*!)/>4,8,*-c4!B0==J50*-,-:!+'<8/!'9!*!)*+,0-+c4!/*-7A!*!@(<4/!B,+/!*!8'-+*5,-*+07!:'B-!7<(,-:!*!4<(:,8*=!)('807<(0!'(!,5)(')0(!

/*-7=,-:!'9!*!<(,-*(>!8*+/0+0(!,-!*!)*+,0-+c4!(''5C!

K'4),+*=!(''54!*(0!6,4,+07!@>!*!7,NN>,-:!*((*>!'9!

)0')=0A!9('5!-<(404!+'!507,8*=!+08/-,8,*-4!+'!/'<40I00),-:!+'!5*,-+0-*-80!B'(I0(4!+'!9*5,=>!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!^!d[-6,('-50-+*=!&'-+*5,-*+,'-!3<0!+'!$0+/,8,==,-JT04,4+*-+!M+*)/>='8'88<4!*<(0<4S!1'44,@=0!L-908+,'-!&'-+('=!L5)=,8*+,'-4A`!K$2)-0,#$!5#$0*#&!%$'!;#4@,0%&!I@,')3,#&#>A/!M0)+05@0(!FHHP!

!

*-7!9(,0-74C!1('+'8'=4!9'=='B07!@>!4'50!507,8*=!)0(4'--0=!*(0!-'+!'9+0-!9'=='B07!@>!'+/0(4C!!

.,+/!+/0!0?<,6*=0-+!'9!*!\<5@'!\0+c4!B'(+/!'9!)0')=0!7>,-:!0*8/!7*>!9('5!K"L4A!+/,4!8'-+*:,'-!

,-!'<(!-*+,'-c4!/'4),+*=4!,4!*!-*+,'-*=!050(:0-8>C!"!:('B,-:!*((*>!'9!06,70-80J@*407!(040*(8/!9,-74!+/*+!@(0*I,-:!+/0!d8/*,-!'9!,-908+,'-`!(0?<,(04!

+/0!I,-7!'9!*))('*8/!7048(,@07!*@'60!@>!ef(*-!K0-(,I!;!*!5<=+,5'7*=!d7'!060(>+/,-:`!*))('*8/!=07!@>!B0==J(04'<(807!*-7!80(+,9,07!,-908+,'-!

8'-+('=!)('9044,'-*=4!@*8I07!@>!+/0!*8+,60!4<))'(+!'9!/'4),+*=!=0*70(4/,)C!Q/,4!)*)0(!7048(,@04!4<8/!*-!,-+0(60-+,'-C!

>"()*$1)$,&97,#"$&

&

"4!*!(04<=+!'9!/0*=+/!(09'(5!*-7!0*(=,0(!=*B4A!+/0!&0-+0(4!9'(!$07,8*(0!*-7!$07,8*,7!M0(6,804!

D&$ME!/*4!,44<07!(0:<=*+,'-4!+/*+!/*60!4+'))07!$07,8*(0!)*>50-+!9'(!5*->!K"L4A!,-8=<7,-:!8*+/0+0(J*44'8,*+07!<(,-*(>!+(*8+!,-908+,'-O!

6*48<=*(!8*+/0+0(J*44'8,*+07!,-908+,'-O!*-7!4<(:,8*=!4,+0!,-908+,'-4!9'=='B,-:!8'('-*(>!*(+0(>!@>)*44!:(*9+4A!@*(,*+(,8!4<(:0(>!*-7!'(+/')07,8!

)('807<(04C!&$M!/*4!+/0!(,:/+!+'!0R+0-7!+/,4!)'=,8>!+'!'+/0(!,-908+,'-4C!&!

Q/0!$07,8*(0!(<=04!B,==!4''-!*5'<-+!+'!d7'<@=0!\0')*(7>C`!M+*(+,-:!'-!g8+C!FA!2GFYA!K"L4!B,==!@08'50!*!9*8+'(!,-!70+0(5,-,-:!/'4),+*=!48'(04!

<-70(!+/0!K'4),+*=!L-)*+,0-+!Z*=<0J@*407!1<(8/*4,-:!1(':(*5A!,-!B/,8/!<)!+'!2!)0(80-+!'9!)*>50-+!,4!*+!(,4IC!

!$07,8*,7!B,==!4''-!9'=='B!4<,+C!M+*(+,-:!_<=>!FA!2GF2A!4+*+04!*(0!(0?<,(07!+'!,5)=050-+!-'-J

)*>50-+!)'=,804!9'(!/0*=+/8*(0J*44'8,*+07!8'-7,+,'-4C!Q/0!&$M!(<=0!40+4!$07,8*(0!)'=,8>!*4!+/0!@*40=,-0A!*=='B,-:!4+*+04!4'50!9=0R,@,=,+>!+'!

5*I0!*77,+,'-*=!8'-7,+,'-4!4<@\08+!+'!+/0!)'=,8>C!!

Page 4: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page W

Q/0!)*>50-+!,5)=,8*+,'-4!*(0!)0(/*)4!060-!5'(0!7*<-+,-:!B/0-!,+!8'504!+'!(0*75,44,'-4C!K'4),+*=!

(0*75,44,'-4!*-7!K"L4!*(0!4+('-:=>!8'((0=*+07A!*88'(7,-:!+'!*!4+<7>!)<@=,4/07!,-!+/0!_<-0!2GF2!,44<0!'9!+/0!\'<(-*=!K$2)-0,#$!5#$0*#&!%$'!;#4@,0%&!

I@,')3,#&#>AA!B/,8/!9'<-7!+/*+!)*+,0-+4!B,+/!$TM"A!ZT[A!'(!&C!7,99,8,=0!5'(0!+/*-!Wa!/'<(4!*9+0(!*75,44,'-!+'!+/0!/'4),+*=!B0(0!^G!)0(80-+!

5'(0!=,I0=>!+'!@0!(0*75,++07!B,+/,-!YG!7*>4!+/*-!)*+,0-+4!B,+/'<+!K"L4C!!

[9908+,60!g8+C!FA!2GF2A!/'4),+*=4!B,+/!'@40(607!(0*75,44,'-!(*+04!0R8007,-:!+/0!0R)08+07!=060=!

B,==!@0!4<@\08+!+'!*!F!)0(80-+!)*>50-+!='44!'9!*==!$07,8*(0!)*>50-+A!*!)0-*=+>!+/*+!B,==!(,40!+'!Y!)0(80-+!@>!9,48*=!>0*(!2GFXC!!!!

&

I"1)&5*"%*)::&

&

U'-)*>50-+!)'=,8,04!9'(!K"L4!/*60!)<4/07!/'4),+*=4!+'!,-8(0*40!4<(60,==*-80!*-7!)(060-+,'-!099'(+4A!*!4+<7>!,-!+/0!$*>!2GF2!,44<0!'9!+/0!

J3)*,-%!?#=*$%&!#2!K$2)-0,#$!5#$0*#&!9'<-7CP!K*(6*(7!1,=:(,5!K0*=+/!&*(0!L-4+,+<+0!*-7!K*(6*(7!$07,8*=!M8/''=&(040*(8/0(4!4<(60>07!/0*7!

,-908+,'-!'99,8,*=4!;!8*==07!d)(060-+,'-,4+4`!;!*+!5'(0!+/*-!YGG!#CMC!/'4),+*=4C!%'<(!'<+!'9!9,60!(04)'-70-+4!(0)'(+07!,-8(0*407!9'8<4!'-!K"L4!

8'60(07!@>!+/0!2GGa!)'=,8>A!-'+,-:!*!)*(+,8<=*(=>!4+('-:!9'8<4!'-!8*+/0+0(J*44'8,*+07!<(,-*(>!+(*8+!,-908+,'-4C!&

L-!)*(+,8<=*(S!!

• PF!)0(80-+!'9!+/0!)(060-+,'-,4+4!90=+!+/*+!4+*99!505@0(4!(05'60!<(,-*(>!8*+/0+0(4!5'(0!?<,8I=>!+/*-!@09'(0C!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!P!d10(80,607!,5)*8+!'9!+/0!$07,8*(0!)'=,8>!+'!*7\<4+!)*>50-+!9'(!

/0*=+/!8*(0J*44'8,*+07!,-908+,'-4A`!J3)*,-%$!?#=*$%&!#2!K$2)-0,#$!

5#$0*#&/&$*>!2GF2!

• XG!)0(80-+!90=+!+/*+!4+*99!505@0(4!(05'60!80-+(*=!60-'<4!8*+/0+0(4!5'(0!

?<,8I=>C!• X^!)0(80-+!(0)'(+07!,-8(0*407!<40!'9!

*-+,40)+,8J8'-+*,-,-:!7(044,-:4!9'(!80-+(*=!

60-'<4!8*+/0+0(4C!!

304),+0!+/0!,-8(0*407!*++0-+,'-!+'!K"L4!9'=='B,-:!

+/0!-'-)*>50-+!)'=,8>A!'-=>!FX!)0(80-+!'9!)(060-+,'-,4+4!(0)'(+07!*-!,-8(0*40!,-!9<-7,-:!9'(!,-908+,'-!8'-+('=C!K'B060(A!^P!)0(80-+!(0)'(+07!

:(0*+0(!/'4),+*=!8'==*@'(*+,'-!+/('<:/!,-+0(7,48,)=,-*(>!+0*54!+'!(07<80!K"L!(*+04C!!

Q/,4!B'(I!5*>!@0!/*6,-:!*-!,-8(050-+*=!,5)*8+C!"!2GF2!(0)'(+!@>!+/0!&3&!+/*+!9'<-7!+/*+!9'(!K"L4!4<@\08+!+'!(0)'(+,-:!,-!+/0!U*+,'-*=!K0*=+/8*(0!

M*90+>!U0+B'(I!,-!8*=0-7*(!>0*(!2GFGA!+/0(0!B*4!*!YY!)0(80-+!(07<8+,'-!,-!80-+(*=!=,-0J*44'8,*+07!@=''74+(0*5!,-908+,'-4A!*-!Fa!)0(80-+!7(')!,-!

$TM"!*-7!*!P!)0(80-+!(07<8+,'-!,-!8*+/0+0(J*44'8,*+07!<(,-*(>!+(*8+!,-908+,'-4!+/('<:/'<+!/'4),+*=4Ca!Q/0!(0)'(+A!/'B060(A!,4!=,5,+07!+'!

+/'40!,-908+,'-4A!*-7!'+/0(!,-908+,'-4!*))0*(!+'!@0!'-!+/0!(,40C!%'(!0R*5)=0A!,-908+,'-!(*+04!9'(!&C!

7,99,8,=0A!*!4060(0!:*4+(',-+04+,-*=!,-908+,'-A!/*60!8=,5@07!+'!/,4+'(,8!/,:/4A!*-7!FWAGGG!"50(,8*-4!-'B!7,0!9('5!,+!060(>!>0*(C!

!

B6'&.DEB4.<!9E&955@<9F6&

"!(06,0B!'9!8<((0-+!=,+0(*+<(0!*-7!

(08'550-7*+,'-4!9('5!+/0!&3&A!+/0!_',-+!&'55,44,'-!*-7!=0*7,-:!,-908+,'-!8'-+('=!)('9044,'-*=4!4<::04+4!+/*+!*!8'5)(0/0-4,60!

*))('*8/!+'!8'5)(0/0-4,60!,-908+,'-!8'-+('=!4/'<=7!,-8=<70S!

• "!707,8*+07!,-908+,'-!8'-+('=!+0*5!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!a!U*+,'-*=!*-7!M+*+0!K0*=+/8*(0J*44'8,*+07!L-908+,'-4!M+*-7*(7,N07!L-908+,'-!T*+,'!T0)'(+A!&0-+0(4!9'(!3,40*40!&'-+('=!*-7!1(060-+,'-A!2GF2!D'-=,-0E!

!

Page 5: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page X

• T,4I!*4404450-+!

• "8+,60!4<(60,==*-80!

• L4'=*+,'-!)(08*<+,'-4!

• K*-7!/>:,0-0!

• [9908+,60!0-6,('-50-+*=!8=0*-,-:!

• [7<8*+,'-!*-7!+(*,-,-:!

• "-+,@,'+,8!4+0B*(74/,)!!!

L-!*->!,-908+,'-!)(060-+,'-!5'7*=,+>A!+/0!4<))'(+!'9!+')!=0*70(4/,)!*-7!,-4+,+<+,'-*=!9=0R,@,=,+>!*(0!-08044*(>!+'!*8/,060!4<88044A!*-7!4<4+*,-*@,=,+>!

(0?<,(04!*-!'-:',-:!'(:*-,N*+,'-*=!099'(+C!!

9&!)2#73,)2&4$;)7,#"$&F"$,*"0&B)31&

!&(0*+,-:!*-!,-908+,'-!8'-+('=!70)*(+50-+!'(!

'99,80!,4!*-!0R*5)=0!'9!*-!'<-80!'9!)('+08+,'-!@0,-:!B'(+/!*!)'<-7!'9!8<(0C!!!

"!2GGP!4+<7>!0R*5,-07!,-908+,'-!8'-+('=!@<7:0+4!,-!2a!8'55<-,+>!/'4),+*=4!,-!+/0!M'<+/0*4+0(-!#-,+07!M+*+04C!Q/0!4+<7>!8,+07!*!507,*-!

70)*(+50-+*=!@<7:0+!'9!VF2HAGGGA!,-8=<7,-:!VFGGAGGG!9'(!/'4),+*=4!<-70(!22G!@074!*-7!V2F2AGGG!9'(!'60(!22G!@074C!%'(!=*(:0(!+0(+,*(>!

8*(0!/'4),+*=4!'60(!XGG!@074A!+/0!*--<*=!,-908+,'-!8'-+('=!'99,80!@<7:0+!,4!VYXGAGGG!+'!VXGGAGGGCH! &'-+(*4+!+/*+!B,+/!+/0!*60(*:0!*--<*=!8'4+!'9!+(0*+,-:!K"L4!*+!*!/'4),+*=A!B/,8/!(<-4!WC^!+,504!:(0*+0(!+/*-!+>),8*=!,-908+,'-!8'-+('=!@<7:0+4A!

*88'(7,-:!+'!*!(0)'(+!@>!+/0!_',-+!&'55,44,'-C!!!

]*(@*(*!T<440==A!TUA!$1KA!7,(08+'(!'9!,-908+,'-!8'-+('=!*+!]*)+,4+!K0*=+/!,-!$,*5,A!+'=7!;)%&01U)%')*4!5*:*N,-0!+/*+!'-0!'9!+/0!@04+!

+/,-:4!*!/'4),+*=!8*-!7'!+'!,5)('60!,-908+,'-!8'-+('=!5'-,+'(,-:!,4!+'!/,(0!*!80(+,9,07!,-908+,'-!)(060-+,'-!'99,8,*=A!*4!4/0!,4C!"!(080-+!4+<7>!,-!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!H!"-70(4'-!3CA!0+!*=CS!#-70(J(04'<(807!/'4),+*=!,-908+,'-!8'-+('=!*-7!

)(060-+,'-!)(':(*54S!10-->!B,40A!)'<-7!9''=,4/h!?#=*$%&!#2!K$2)-0,#$!5#$0*#&!%$'!;#4@,0%&!I@,')3,#&#>AA!_<=>!2GGPC!

&*=,9'(-,*!4/'B07!+/*+!'-=>!aH!'9!FPW!8'-+('=!7,(08+'(4A!*@'<+!/*=9A!B0(0!80(+,9,07!,-!,-908+,'-!

8'-+('=C!

"!4+<7>!)<@=,4/07!,-!+/0!$*(8/!2GF2!,44<0!'9!+/0!J3)*,-%!?#=*$%&!#2!K$2)-0,#$!5#$0*#&!9'<-7!+/*+!/'4),+*=4!B/'40!,-908+,'-!)(060-+,'-!*-7!8'-+('=!

)(':(*54!*(0!=07!@>!*!7,(08+'(!B/'!,4!@'*(7!80(+,9,07!,-!,-908+,'-!)(060-+,'-!*-7!8'-+('=!/*60!4,:-,9,8*-+=>!='B0(!(*+04!'9!$TM"!+/*-!+/'40!+/*+!

*(0-c+!=07!@>!4<8/!*!)('9044,'-*=CFG!!

Q/0!&0(+,9,8*+,'-!,-!L-908+,'-!1(060-+,'-!*-7!&'-+('=!8(070-+,*=!,4!*75,-,4+0(07!@>!+/0!&0(+,9,8*+,'-!]'*(7!'9!L-908+,'-!&'-+('=!*-7!

[),705,'=':>C!$'4+!80(+,9,07!,-908+,'-!8'-+('=!=0*70(4!*(0!-<(404A!@<+!+/0!8*+0:'(>!*=4'!,-8=<704!5,8('@,'=':,4+4!*-7!)/>4,8,*-4C!&0(+,9,8*+,'-!

(0?<,(04!<)!+'!+B'!>0*(4!'9!+(*,-,-:C!!

T<440==!04+,5*+04!+/*+!'-=>!*@'<+!'-0J+/,(7!'9!/'4),+*=4!-*+,'-B,70!/*60!80(+,9,07!,-908+,'-!)(060-+,'-!'99,8,*=4C!

@#:J&9::)::1)$,&

"!9,(4+!4+0)!9'(!*!/'4),+*=!=0*70(!,4!+'!70+0(5,-0!

+/0!48')0!'9!+/0!)('@=05S!./0(0!*(0!+/0!)*+/':0-4!*-7!,-!B/*+!?<*-+,+>!*-7!+>)0h!K'B!5*->!)*+,0-+4!*(0!8*((,0(4!'(!/*60!,-908+,'-4h!3,7!

+/0>!@(,-:!+/05!,-+'!+/0!/'4),+*=h!g-0!B*>!+'!9,-7!+/0!+(<0!,-8,70-80!(*+0!,4!+'!<40!8/*(+J*@4+(*8+07!7*+*!+'A!9'(!0R*5)=0A!*44044!40(,'<4!

,-908+,'-!B,+/!ZT[!'60(!*!+/(00J5'-+/!)0(,'7C!&'5),=,-:!*-7!)('5<=:*+,-:!(0)'(+4!+/*+!+(*8I!,-908+,'-4!@>!<-,+!*-7!+>)0!'60(!+,50!8*-!,-9'(5!

,5)('6050-+!099'(+4C&

!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

KL&H&0(+,9,8*+,'-!,-!,-908+,'-!8'-+('=!5*++0(4S!L5)*8+!'9!,-908+,'-!

8'-+('=!70)*(+50-+!8/*(*8+0(,4+,84!*-7!)'=,8,04!'-!(*+04!'9!5<=+,7(<:J(04,4+*-+!,-908+,'-4A`!J3)*,-%$!?#=*$%&!#2!K$2)-0,#$!

5#$0*#&A!$*(8/!2GF2!

Page 6: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page ^

"!408'-7!,4!+'!/0*7!'<+!,-+'!+/0!/'4),+*=!+'!*44044!8'-+*5,-*+,'-!=060=4C!i*(0-!$*(+,-A!$1KA!TUA!

7,(08+'(!'9!,-908+,'-!)(060-+,'-!*+!"76'8*+0!&/(,4+!$07,8*=!&0-+0(!,-!g*I!j*B-A!L==CA!B('+0!,-!+/0!_*-<*(>!2GF2!,44<0!'9!+/0!J3)*,-%$!?#=*$%&!#2!

K$2)-0,#$!5#$0*#&!+/*+!/0(!/'4),+*=!5'-,+'(4!/'4),+*=!4<(9*804!9'(!*70-'4,-0!+(,)/'4)/*+0A!B/,8/!8*-!@0!,-7,8*+'(!'9!6,*@=0!=,6,-:!80==4CFF!M+*99!

*=4'!50*4<(0!8'='->J9'(5,-:!<-,+4!'9!7,40*40!'(:*-,454!'-!0-6,('-50-+*=!4<(9*804A!*!8'4+=>!@<+!(0=,*@=0!06,70-80!@*407!)(*8+,80C!

!!

97,#()&I/*()#003$7)&

!

1*+,0-+4!8*-!@0!8*((,0(4!'9!7(<:J(04,4+*-+!'(:*-,454!060-!,-!+/0!*@40-80!'9!4>5)+'54!'9!,-908+,'-C!L-!9*8+A!8*((,0(4!)=*>!*!8(,+,8*=!('=0!,-!+/0!

4)(0*7!'9!,-908+,'-4!,-!/'4),+*=4C!%'(!060(>!'-0!)*+,0-+!I-'B-!+'!@0!8'='-,N07!'(!,-908+07!B,+/!$TM"A!ZT[!'(!&C!7,99,8,=0A!+/0(0!*(0!+/(00!+'!9,60!

)*+,0-+4!'-!+/0!4*50!<-,+!B,+/!<-70+08+07!8'='-,N*+,'-!@>!+/0!(04,4+*-+!4)08,04C!!

"8+,60!4<(60,==*-80!,-6'=604!8'==08+,-:!4)08,50-4!9('5!)*+,0-+4!(0:*(7=044!'9!B/0+/0(!+/0>!/*60!4,:-4!'(!4>5)+'54!'9!,-908+,'-C!Q/,4!+>),8*==>!

,-6'=604!4B*@@,-:!7,990(0-+!@'7>!4,+04!70)0-7,-:!'-!+/0!'(:*-,45!'9!,-+0(04+C!MB*@!4)08,50-4!*(0!+/0-!4<@5,++07!+'!+/0!5,8('@,'=':>!=*@'(*+'(>!

*-7!<-70(:'!'-0!'(!5'(0!8<=+<(0J!'(!5'=08<=*(J@*407!+04+4!+'!70+08+!+/0!)(040-80!'9!(0=06*-+!'(:*-,454C!1*+,0-+4!9'<-7!+'!@0!8'='-,N07!B,+/!*-!

'(:*-,45!*(0!+/0-!)=*807!,-!,4'=*+,'-!(''54!*-7!5*>!*=4'!@0!+(0*+07!B,+/!4>4+05,8!'(!+'),8*=!*-+,@,'+,8!*:0-+4!,-!*-!*++05)+!+'!708'='-,N0!

+/05C!!

Q/0!7*+*!'-!+/0!099,8*8>!'9!+/,4!4'=<+,'-!*(0!5,R07C!L5)=050-+*+,'-!'9!*!<-,60(4*=!*8+,60!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!FF!d"4I,-:!+/0!T,:/+!k<04+,'-4!e<,704!M'=<+,'-4!+'!L5)('6,-:!

&=0*-=,-044A`!K$2)-0,#$!5#$0*#&!O#'%AA!_*-C!YGA!2GF2!

4<(60,==*-80!9'(!*==!-0B=>!*75,++07!)*+,0-+4!=07!+'!*-!aG!)0(80-+!(07<8+,'-!,-!$TM"!@=''74+(0*5!

,-908+,'-4!*8('44!+/(00!$,7B04+0(-!/'4),+*=4A!*88'(7,-:!+'!(040*(8/!)<@=,4/07!,-!+/0!$*(8/!FaA!2GGa!07,+,'-!'9!+/0!J$$%&4!#2!K$0)*$%&!6)',-,$)CF2!

!K'B060(A!*!2GFF!$*>'!&=,-,8!4+<7>!'9!Fa!L&#4!*+!5*\'(!*8*705,8!507,8*=!80-+0(4!*('<-7!+/0!

8'<-+(>!8*50!+'!*!-0*(=>!'))'4,+0!8'-8=<4,'-CFY!Q/0!*-*=>4,4!'9!*8+,60!4<(60,==*-80!9'(!L&#!)*+,0-+4!9'<-7!+'!@0!8*((,0(4!'9!$TM"!'(!ZT[!*-7!+/0!<40!

'9!@*((,0(!)(08*<+,'-4!D:='604!*-7!:'B-4E!@>!/0*=+/8*(0!)('6,70(4!9'<-7!-'!7,990(0-80!,-!+/0!9(0?<0-8>!'9!-0B!8'='-,N*+,'-!'(!,-908+,'-!060-+4!

B/0-!8'5)*(,-:!,-+0(60-+,'-!L&#4!+'!8'-+('=!L&#4C!!

Q/0!(040*(8/0(4!4<::04+07!+/*+!@0++0(!*7/0(0-80!+'!,4'=*+,'-!)(08*<+,'-4!,4!,5)'(+*-+A!@<+!5*>!-007!+'!@0!8'5)=050-+07!@>!,-+0(60-+,'-4!+/*+!

(07<80!8'='-,N*+,'-!'-!@'7>!4,+04!*-7!,5)('607!0-6,('-50-+*=!8=0*-,-:C!

!

4:"03,#"$&5*)73/,#"$:&

L-908+07!)*+,0-+4!*(0!+/0!)(,5*(>!4'<(80!9'(!+/0!4)(0*7!'9!K"L4!,-!/'4),+*=4C!L+!,4!8'-4,70(07!*!4+*-7*(7!'9!8*(0!+'!)=*80!*==!/'4),+*=,N07!)*+,0-+4!

9'<-7!+'!@0!8'='-,N07!'(!,-908+07!B,+/!$TM"A!ZT[A!&C!7,99,8,=0!*-7!'+/0(!@*8+0(,*!<-70(!8'-+*8+!)(08*<+,'-4C!M+<7,04!/*60!4/'B-!+/*+!)*+,0-+4!

8'='-,N07!B,+/!*-!'(:*-,45!B/'!*(0!)=*807!,-!8'-+*8+!,4'=*+,'-!*(0!5<8/!=044!=,I0=>!+'!+(*-45,+!+/040!)*+/':0-4!+'!'+/0(!/'4),+*=,N07!)*+,0-+4C!

"+!4'50!9*8,=,+,04A!7(')=0+!)(08*<+,'-4!5*>!*=4'!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!F2!d#-,60(4*=!4<(60,==*-80!9'(!50+/,8,==,-J(04,4+*-+!M+*)/>='8'88<4!

*<(0<4!,-!+/(00!*99,=,*+07!/'4),+*=4A`!J$$%&4!#2!K$0)*$%&!6)',-,$)A!$*(8/!FaA!2GGaC!

!FY!dL-+0(60-+,'-!+'!T07<80!Q(*-45,44,'-!'9!T04,4+*-+!]*8+0(,*!,-!

L-+0-4,60!&*(0A`!V)+!I$>&%$'!?#=*$%&!#2!6)',-,$)A!")(,=!FWA!2GFF!!

!

Page 7: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page P

@0!*))=,07!,9!+/0!)*+,0-+!/*4!*-!,-908+,'-!,-!+/0!(04),(*+'(>!+(*8+C!!

!"88'(7,-:!+'!*!2GGW!(0)'(+!@>!*!+0*5!9('5!M,5'-!%(*40(!#-,60(4,+>A!,-!Z*-8'<60(A!]C&CA!60-+,=*+,'-!

,4!*=4'!8(,+,8*=!,-!+/0!8'-+('=!'9!*,(@'(-0!)*+/':0-4!9'(!)('+08+,60!,4'=*+,'-FWC!Q/0!5'6050-+!'9!*,(!(0=*+,60!+'!*7\*80-+!*(0*4!5<4+!

@0!)'4,+,60!*-7!9'(!,-908+,'<4!,4'=*+,'-A!,+!5<4+!@0!-0:*+,60C!L-!)*(+,8<=*(A!)*+,0-+4!4<4)08+07!'9!/*6,-:!*-!*,(@'(-0!,-908+,'<4!7,40*40!4/'<=7!@0!

)=*807!,-!-0:*+,60!)(044<(0!(''54!+/*+!(080,60!-<50('<4!*,(!8/*-:04!)0(!/'<(C!3<(,-:!*-!'<+@(0*I!'9!*,(@'(-0!,-908+,'-A!B/'=0!<-,+4!'9!

4,-:=0!(''54!5*>!-007!+'!@0!8'-60(+07!+'!-0:*+,60!)(044<(0!(''54!,-!'(70(!+'!5,-,5,N0!+(*-490(!+'!'+/0(!)*(+4!'9!+/0!/'4),+*=C!!

"=+/'<:/!+/0!4+*-7*(74!9'(!,4'=*+,'-!)(08*<+,'-4!

*(0!9*,(=>!4+(*,:/+9'(B*(7A!4+<7,04!4/'B!+/*+!+/0!,5)=050-+*+,'-!'9!+/,4!@*4,8!50*4<(0!(05*,-4!*!8/*==0-:0!*+!5*->!,-4+,+<+,'-4C!M,5,=*(!+'!)''(!

8'5)=,*-80!B,+/!/*-7!/>:,0-0!4+*-7*(74A!5<8/!/*4!@00-!B(,++0-!*@'<+!+/0!9*,=<(0!'9!/0*=+/8*(0!

B'(I0(4!+'!5*I0!<40!'9!*))(')(,*+0!)('+08+,60!0?<,)50-+!+'!)(060-+!+/0!+(*-45,44,'-!'9!7(<:!(04,4+*-+!'(:*-,454C!

!!

63$2&6+%#)$)&

!"4!8*(0:,60(4!5<4+!+'<8/!)*+,0-+4!*-7!<40!

,-6*4,60!706,804!'-!+/05A!+/0!(,4I!'9!4)(0*7,-:!7(<:J(04,4+*-+!'(:*-,454!6,*!<-8=0*-!/*-74!,4-c+!/*(7!+'!9*+/'5C!1(')0(!/*-7!/>:,0-0!,4!'9+0-!

8*==07!+/0!4,-:=0!5'4+!,5)'(+*-+!+''=!+'!)(060-+!+(*-45,44,'-!'9!K"L4C!$'4+!/'4),+*=4!/*60!*7')+07!4'50!9'(5!'9!5'-,+'(,-:!)(':(*5A!B,+/!

=,5,+07!09908+,60-044C!M'50!/'4),+*=4!/*60!(04'(+07!+'!(0=>,-:!'-!)*+,0-+4!+'!8'-9('-+!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!FW!T0)'(+S!Q/0!#40!'9!M,-:=0!1*+,0-+!T''54!60(4<4!$<=+,)=0!

g88<)*-8>!T''54!,-!"8<+0!&*(0![-6,('-50-+4!D'-=,-0EC!

7'8+'(4!*-7!-<(404!*@'<+!,5)(')0(!/*-7!/>:,0-0C!

!!"=8'/'=J@*407A!B*+0(=044!/*-7!/>:,0-0!)('7<8+4!*(0!5'(0!@*8+0(,8,7*=!+/*-!4'*)!*-7!B*+0(A!

09908+,60=>!(07<80!+/0!-007!9'(!4,-I4A!*-7!:(0*+=>!(07<80!+/0!*5'<-+!'9!+,50!(0?<,(07!+'!09908+,60=>!7,4,-908+!/*-74C!$*->!/'4),+*=4!*(0!)=*8,-:!

7,4)0-40(4!'<+4,70!*-7!,-4,70!)*+,0-+!(''54C!!!"!5<=+,80-+0(!4+<7>!)<@=,4/07!,-!+/0!J3)*,-%$!

?#=*$%&!#2!6)',-%&!W=%&,0A!,-!2GGH!'9!/*-7!/>:,0-0!,-!)(060-+,-:!/0*=+/8*(0J*44'8,*+07!,-908+,'-4!9'<-7!+/*+!060-!B,+/!+/0!5'4+!,-+0-40!

,-+0(60-+,'-4A!8'5)=,*-80!(05*,-07!*+!'(!@0='B!XG!)0(80-+A!060-!,-!,-+0-4,60!8*(0!<-,+4A!+/0!5'4+!6<=-0(*@=0!)=*804!9'(!,-908+,'-CFX!

./>!B'-c+!5'(0!/0*=+/8*(0!B'(I0(4!B*4/!+/0,(!/*-74!,-!*88'(7*-80!B,+/!)'=,8>h!dM,5)=>!)<+A!

5*->!)0(4'--0=!7'-c+!(0*=,N0!B/0-!+/0>!/*60!:0(54!'-!+/0,(!/*-74!@08*<40!+/0>!<-70(04+,5*+0!+(*-45,44,'-!9('5!6*(,'<4!

4<(9*804A`!"76'8*+0!&/(,4+!$07,8*=!&0-+0(c4!$*(+,-!B(,+04C!Q/0!)('@=05!,4!*!(04<=+!'9!

/<-7(074!'9!<-8'-48,'<4!*8+,'-4C!g-0!0R*5)=0!,4!<4,-:!*!/*==B*>!/*-7!4*-,+,N0(A!+/0-!<4,-:!*!@*(0!/*-7!+'!')0-!*!)*+,0-+!(''5!7''(A!+/0-!4/*I,-:!

/*-74!B,+/!+/0!)*+,0-+C!

!!

'$(#*"$1)$,30&F0)3$#$%&

!

U'!/*-7!/>:,0-0!)(':(*5!B,==!@0!09908+,60!,9!)*+,0-+!(''54!(05*,-!8'-+*5,-*+07!B,+/!*!5<=+,+<70!'9!)*+/':0-4C!M,:-,9,8*-+!

,5)('6050-+4!,-!7,4,-908+,'-!8=0*-,-:!8*-!@0!*8/,0607!,-!5'4+!/'4),+*=4!B,+/'<+!*!4<@4+*-+,*=!*7707!9,48*=!8'55,+50-+!+/('<:/!+/0!<40!'9!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!FX!dK*-7!K>:,0-0!&'5)=,*-80!T*+04!,-!+/0!#-,+07!M+*+04l"!g-0J

m0*(!$<=+,80-+0(!&'==*@'(*+,'-!#4,-:!1('7<8+nZ'=<50!#4*:0!$0*4<(050-+!*-7!%007@*8IA`!J3)*,-%$!?#=*$%&!#2!6)',-%&!W=%&,0AA!$*>n_<-0!2GGH!

Page 8: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page a

06,70-80J@*407!)(*8+,804!*-7!)(')0(=>!+(*,-07!*-7!(0B*(707!0-6,('-50-+*=!40(6,804!4+*99C!!

!3<(,-:!+/0!)*4+!4060(*=!>0*(4A!-0B!4+*-7*(74!*-7!(0:<=*+,'-4!/*60!050(:07!+'!/0=)!,5)('60!

0-6,('-50-+*=!/>:,0-0!,-!/0*=+/8*(0!40++,-:4C!L-!2GGYA!+/0!&3&c4!9=,')&,$)4!2#*!I$8,*#$3)$0%&!

K$2)-0,#$!5#$0*#&!,$!;)%&01-%*)!Q%-,&,0,)4B

I$8,*#$3)$0%&!7=*2%-)4!(08'550-707!+/*+!/'4),+*=4!8=0*-!*-7!7,4,-908+!*==!oo/,:/J+'<8/!4<(9*804C`F^!L-!2GGP!&$M!,44<07!*-!,-+0()(0+*+,60!

:<,70=,-0!9'(!,+4!,-908+,'-!8'-+('=!4+*-7*(7A!(0?<,(,-:!+/*+!/'4),+*=4c!,-908+,'-!)(060-+,'-!*-7!8'-+('=!)(':(*54!oo5<4+!,-8=<70!*))(')(,*+0!

5'-,+'(,-:!'9!/'<40I00),-:!*8+,6,+,04!+'!0-4<(0!+/*+!+/0!/'4),+*=!5*,-+*,-4!*!4*-,+*(>!0-6,('-50-+Ccc!!

!Q/0!"44'8,*+,'-!9'(!+/0!K0*=+/8*(0![-6,('-50-+c4!P*%-0,-)!9=,'%$-)!2#*!;)%&01-%*)!I$8,*#$3)$0%&!

5&)%$,$>!(08'550-74!+/*+!+'!0-4<(0!8'-4,4+0-+!?<*=,+>!'9!8=0*-,-:!*-7!*70?<*+0!4+*99,-:!

(04'<(804!9'(!,-908+,'-!)(060-+,'-A!*!+'+*=!9*8,=,+>!8=0*-,-:!4+*-7*(7!4/'<=7!@0!*:(007!<)'-!,-!*76*-80!@>!0-6,('-50-+*=!40(6,804A!,-908+,'-!

8'-+('=A!*-7!')0(*+,'-4!'(!*75,-,4+(*+,60!5*-*:050-+C!]>!9'=='B,-:!*==!'9!+/0!(08'550-707!4+0)4A!8=0*-,-:!*-!'88<),07!

)*+,0-+!(''5!4/'<=7!+*I0!*))('R,5*+0=>!2XJYG!5,-<+04C!"!d+0(5,-*=!8=0*-`!*9+0(!*!)*+,0-+!,4!7,48/*(:07!'(!+(*-490((07!(0?<,(04!WGJWX!5,-<+04C!

!#-9'(+<-*+0=>A!*!2GFF!4<(60>!@>!#$%!&'()C!'9!0-6,('-50-+*=!40(6,804!5*-*:0(4!9'<-7!+/*+!

+/0,(!70)*(+50-+4!B0(0A!'-!*60(*:0A!4/'(+!@>!9,60!+'!-,-0!9<==J+,50!05)='>004C!$*-*:0(4!4*,7!+/*+!704),+0!/'4),+*=!0R)*-4,'-4A!0R)*-707!40(6,804A!

,-8(0*407!)*+,0-+!*75,44,'-4!*-7!4/'(+0(!=0-:+/4!'9!4+*>!D8(0*+,-:!5'(0!(''5!+<(-'60(EA!5*->!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!F^!9=,')&,$)4!2#*!I$8,*#$3)$0%&!K$2)-0,#$!5#$0*#&!,$!;)%&01B5%*)!

Q%-,&,0,)4A!&0-+0(4!9'(!3,40*40!&'-+('=!*-7!1(060-+,'-!D'-=,-0E!

!

/'4),+*=4!/*60!9'<-7!/'<40I00),-:!*-!0*4>!50*-4!'9!@<7:0+J8<++,-:A!=0*6,-:!/'<40I00)0(4!

+'!4,5)=>!7<5)!+/0!+(*4/!*-7!5'60!'-!+'!+/0!-0R+!(''5C!

[60-!B/0-!+/0!(''5!,4!8=0*-07A!+/0!B('-:!8=0*-,-:!5*+0(,*=4!*(0!'9+0-!05)='>07C!Q/0![-6,('-50-+*=!1('+08+,'-!":0-8>!4*,7!,-!_<-0!

2GGH!+/*+!*))('R,5*+0=>!'-0J+/,(7!'9!Y2X!(0:,4+0(07!/'4),+*=!7,4,-908+*-+4!*-7!Y^!'9!+/0!P2!+<@0(8<='8,704!+04+07!+/<4!9*(!<-70(!,+4!

"-+,5,8('@,*=!Q04+,-:!1(':(*5!9*,=07!+'!500+!,+4!4+*-7*(74!9'(!09908+,60-044!*:*,-4+!@*8+0(,*C!

Q/0!5'4+!8'55'-!7,4,-908+*-+!<407!,-!/'4),+*=4!,4!?<*+0(-*(>!*55'-,<5C!./0-!<407!,-!8'-\<-8+,'-!B,+/!8'++'-!4+(,-:!5')4A!+/0!4'=<+,'-!

,4!(0-70(07!,-09908+,60C!&'++'-!*-7!'+/0(!'(:*-,8!5*++0(!@,-7!*-7!,-*8+,6*+0!d?<*+A`!(0-70(,-:!,+!(0=*+,60=>!,-09908+,60!<-=044!<407!,-!=*(:0!

*5'<-+4C!"!4+(,-:!5')!(0<407!,-!+/0!-0R+!(''5!4,5)=>!*,74!+/0!4)(0*7!'9!@*8+0(,*C!

"!4+<7>!@>!$*>'!&=,-,8!(040*(8/0(4A!)<@=,4/07!,-!+/0!M0)+05@0(!2GFG!07,+,'-!'9!K$2)-0,#$!5#$0*#&!

O#'%A/!9'<-7!+/*+!8'-4,4+0-+!7*,=>!8=0*-,-:!'9!*==!/,:/J+'<8/!4<(9*804!B,+/!*!4)'(0JI,==,-:!@=0*8/!7,4,-908+*-+!8='+/!9'(!*==!)*+,0-+4!'-!<-,+4!B,+/!

/,:/!0-705,8!(*+04!'9!&C!7,99,8,=0!,-908+,'-!*=5'4+!0=,5,-*+07!+/0!)('@=05CFP!!

$,8('9,@0(!+08/-'=':>!,4!4,:-,9,8*-+=>!,5)('6,-:!8=0*-,-:!*-7!708'-+*5,-*+,'-!8*)*8,+>!@08*<40!9,@0(4!*(0!4)=,+!*-7!9'(5!*!I-,++07!9*@(,8!+/*+!

*=='B4!WG!+,504!5'(0!4<(9*80!*(0*!8'60(*:0!+/*-!8'++'-!9,@0(!*-7!8/05,8*==>!@'-74!B,+/!@=0*8/C!"44<5,-:!*!/'4),+*=!,4!<4,-:!4+(,-:!5')4!*-7!

8/*-:,-:!4'=<+,'-!060(>!+/(00!(''54A!+/0!<40!'9!5,8('9,@0(!8=0*-,-:!4<(9*804!8*-!(07<80!B*+0(!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!FP!d&=0*-,-:!L-+0(60-+,'-!&<+4!&C!7,99,8,=0!"8?<,4,+,'-!T*+04!@>!g-0JQ/,(7A`!K$2)-0,#$!5#$0*#&!O#'%AA!M0)+C!PA!2GFG!!

!

Page 9: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page H

<4*:0!@>!HW!)0(80-+!*-7!8/05,8*=!<40!@>!5'(0!+/*-!PW!)0(80-+C!

T'40=*-7!&'55<-,+>!K'4),+*=!,-!&/,8*:'!(07<807!,+4!(*+0!'9!&C!7,99,8,=0!,-908+,'-!'-!4<(:,8*=!<-,+4!+'!

N0('!B,+/,-!4,R!5'-+/4!'9!(0)=*8,-:!8'++'-!4+(,-:!5')4!B,+/!*!4>4+05!'9!8/='(,-0!4+*@=0A!8'='(J8'707!5,8('9,@0(!8='+/4!*-7!5')4!*-7!*!4'7,<5!

/>)'8/='(,+0!4'=<+,'-!*4!(08'550-707!@>!+/0!&3&C!T'40=*-7c4!0-6,('-50-+*=!40(6,804!4+*99!505@0(4!*=4'!(0)=*80!+/0!5,8('9,@0(!B,)04!*9+0(!

0*8/!(''5!8=0*-,-:C!!&

'2/73,#"$&3$2&B*3#$#$%&

!

[9908+,60!0-6,('-50-+*=!8=0*-,-:!*-7!/*-7!

/>:,0-0!(0?<,(0!0R+0-4,60!07<8*+,'-C!%'(!0R*5)=0A!+/0!)(':(*5!*+!T'40=*-7!,-8=<707!8'5)(0/0-4,60!+(*,-,-:!'9!*==!0-6,('-50-+*=!

40(6,804!4+*99C!

Q(*,-,-:!4+*(+4!@>!,5)(044,-:!<)'-!4+*99!+/*+!,-908+,'-!)(060-+,'-!,4!*-!'(:*-,N*+,'-*=!)(,'(,+>C!%'(!0R*5)=0A!4+<7,04!/*60!4/'B-!+/*+!9*8,=,+,04!

B,+/!B0==J04+*@=,4/07!8<=+<(04!'9!4*90+>!=07!@>!*-!*8+,60=>!0-:*:07!40-,'(!=0*70(4/,)!*(0!*@=0!+'!*8/,060!*-7!5*,-+*,-!/,:/!/*-7!/>:,0-0!

*7/0(0-80!(*+04C!g-0!@04+!)(*8+,80!,4!/*6,-:!+/0!8/,09!0R08<+,60!'(!8/,09!507,8*=!'99,80(!('<-7!'-!)*+,0-+4!*-7!+*I0!0*8/!'))'(+<-,+>!+'!B*4/!

/*-74!,-!)=*,-!4,:/+!'9!4+*99C!"-'+/0(!,4!9'(!+/0!&[g!+'!6'8*==>!)('5'+0!/*-7!/>:,0-0!*-7!,+4!=,-I!+'!='B0(!,-908+,'-4!*+!060(>!'))'(+<-,+>C!$'4+!

/0*=+/!8*(0!B'(I0(4!@0=,060!+/*+!/*-7!/>:,0-0!,4!,5)'(+*-+A!@<+!+/0>!'9+0-!9*,=!+'!*))(08,*+0!/'B!7(*5*+,8!*-!09908+!,+!8*-!/*60!'-!,-4+,+<+,'-*=!

(*+04!'9!,-908+,'-C!

j0*70(4!4/'<=7!*))=>!@04+!)(*8+,804!9'(!09908+,60!,-908+,'-!)(060-+,'-A!,-J40(6,80!07<8*+,'-!*-7!

09908+,60!/>:,0-0!5*-*:050-+!,-!)*+,0-+!(''54!*-7!*==!'+/0(!*(0*4!'9!+/0!/'4),+*=C!

"+!#-,60(4,+>!'9!&/,8*:'!K'4),+*=4A!*==!WXG!505@0(4!'9!+/0!0-6,('-50-+*=!40(6,804!

70)*(+50-+!B0(0!+(*,-07!,-!2GGH!+'!*))=>!*!8<4+'5,N07A!8'='(J8'707!4>4+05!+'!704,:-*+0!060(>+/,-:!9('5!')0(*+,-:J(''5J4)08,9,8!

)('7<8+4!+'!8'='(J8'707!B,)0(4!*-7!9=*+!5')4!9'(!<40!,-!@*+/(''54A!)*+,0-+!(''54!*-7!'+/0(!*(0*4C!&'='(J8'7,-:!,4!*=4'!<407!+'!,-7,8*+0!B/,8/!B,)0(4!

*(0!+'!@0!<407!B0+!'(!7(>C!

Q0*5!=0*70(4!)('6,707!,-)<+!,-+'!+/0!-0B!4>4+05!*-7!B0(0!,-4+(<50-+*=!,-!8*((>,-:!,+!'<+C!]*407!'-!+/0,(!,-)<+A!*77,+,'-*=!+(*,-,-:A!,-8=<7,-:!'-0J

'-J'-0!4044,'-4!*-7!:('<)!)(040-+*+,'-4A!B*4!<-70(+*I0-C!

&

9$,#M#",#7&I,)N3*2:-#O&

&

Q/0!<40!'9!*-+,@,'+,84A!060-!B/0-!8=,-,8*==>!

*))(')(,*+0A!)('5'+04!+/0!*76*-80!'9!5<=+,7(<:!(04,4+*-+!'(:*-,454!,-!+/0!/0*=+/8*(0!0-6,('-50-+C!L-!+/0!/'4),+*=!40++,-:A!,+!/*4!@00-!

04+,5*+07!+/*+!*4!5<8/!*4!XG!)0(80-+!'9!*-+,@,'+,8!<40!,4!<--08044*(>C!"4!B,+/!'+/0(!5'7*=,+,04A!)(')0(!<40!'9!*-+,@,'+,84!+*I04!*-!

'(:*-,N*+,'-*=!8'55,+50-+C!!"-+,@,'+,8!4+0B*(74/,)!,4!7048(,@07!@>!+/0!_',-+!

&'55,44,'-!*4!*!5<=+,4>4+05!+0*5!*))('*8/!+/*+!,-6'=604!=,5,+,-:!,-*))(')(,*+0!<40!'9!*-+,@,'+,8!*:0-+4!B/,=0!')+,5,N,-:!+/0!40=08+,'-A!7'40A!

7<(*+,'-A!*-7!('<+0!'9!+/0(*)>!B,+/!+/0!5'4+!*))(')(,*+0!7(<:!9'(!+/0!)*+,0-+c4!8'-7,+,'-C!L-4+,+<+,'-4!+/*+!,5)=050-+!*-+,@,'+,8!

4+0B*(74/,)!)(':(*54!8'55'-=>!(07<80!*-+,@,'+,8!<40!@0+B00-!22!)0(80-+!*-7!Y^!)0(80-+CFa!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Fa!$3Tg!Q''=I,+A!_',-+!&'55,44,'-!T04'<(804!D'-=,-0E!

!

Page 10: Multimodal Intervention FN..../0,#1"230&4$,)*()$,#"$&,"&5*)()$,& 6)30,-73*)89::"7#3,)2&4$;)7,#"$:&!!!!! "#$%&'!()*+,-./!01)!2#*3)*!%'3,$,40*%0#*!#2!01)!5)$0)*4! 2#*!6)',-%*)!%$'!6)',-%,'!7)*8,-)4

The Multimodal Approach Page FG

M'50!/'4),+*=4!)('6,70!*-!*-+,@,'+,8!:<,70=,-04!@''I=0+!+/*+!,4!)<@=,4/07!*--<*==>!*-7!

7,4405,-*+07!+'!*==!'9!+/0!507,8*=!4+*99A!,-8=<7,-:!(04,70-+!/'<40!4+*99A!4+<70-+4!*-7!'+/0(!8=,-,8*=!+(*,-004C!Q/0!/*-7@''IA!B/,8/!8*-!9,+!,-!*!=*@!

8'*+!)'8I0+A!,4!*!4<55*(>!'9!+/0!:<,70=,-04!9'(!05),(,8!+(0*+50-+!'9!4'50!'9!+/0!5'4+!8'55'-!

8'-7,+,'-4!+/*+!+/0!8=,-,8,*-!,4!=,I0=>!+'!0-8'<-+0(C!!

!

F<=FEDI4<=&

e'60(-50-+!)*>50-+!(09'(54!*-7!+/0!(,4,-:!8'4+4!'9!8*(0!,-!+/0!#-,+07!M+*+04!*(0!)<++,-:!)(044<(0!'-!+/0!

/0*=+/!4>4+05!+'!4+05!+/0!(,4,-:!+,70!'9!/0*=+/8*(0J*44'8,*+07!,-908+,'-4C!Q/'<:/!+/0(0!,4!4'50!06,70-80!'9!)(':(044A!8=0*(=>!5<8/!5'(0!-0074!+'!@0!7'-0C!$*->A!,9!-'+!5'4+A!K"L4!*(0!)(060-+*@=0!+/('<:/!+/0!I,-74!'9!099'(+4!7048(,@07!,-!+/,4!)*)0(C!

M060(*=!'9!+/0!,-+0(60-+,'-4!8'50!*+!=,++=0!0R+(*!8'4+!+'!/'4),+*=4C!1(')0(!07<8*+,'-!*-7!=0*70(4/,)!*8+,'-!

8*-!,5)('60!/*-7JB*4/,-:C!$*,-+*,-,-:!*!4<99,8,0-+!0-6,('-50-+!40(6,804!4+*99A!+(*,-,-:!+/05!,-!)(')0(!)('807<(04!*-7!)('6,7,-:!+/05!B,+/!8=0*-,-:!5*+0(,*=4!+/*+!*8+<*==>!(05'60!*-7!8'-+*,-!)*+/':0-4!8'4+4!=,++=0!5'(0!+/*-!,4!8<((0-+=>!4)0-+!'-!/'<40I00),-:C!"-7!>0+!(0)'(+4!9,-7!+/*+!(''5!8=0*-,-:!/*4!@00-!

4*8(,9,807!+'!@<7:0+!8<++,-:!,-!5*->!'(:*-,N*+,'-4C!

%0B!*8+,'-4!,-!*!/'4),+*=!8*((>!4<8/!*-!'@6,'<4!(0+<(-!'-!,-604+50-+!*4!,-908+,'-!8'-+('=C!.,+/'<+!(0,5@<(4050-+A!+/0!/'4),+*=!,4!*@4'(@,-:!*-!*60(*:0!'9!5'(0!+/*-!V2GAGGG!,-!*7707!8'4+4!)0(!8*(0!0),4'70!,-6'=6,-:!*-!K"LC!"77,-:!,-!+/0!K"L!)0-*=+,04!<-70(!6*=<0J@*407!)<(8/*4,-:!*-7!0R8044!(0*75,44,'-4A!*-7!

+/0!9,-*-8,*=!8*40!9'(!+*I,-:!*8+,'-!,4!8=0*(C!

M0++,-:!8'4+!*4,70A!8'-+('==,-:!,-908+,'-4!,4!+/0!(,:/+!+/,-:!+'!7'!9'(!)*+,0-+4C!.,+/!5<=+,7(<:!(04,4+*-+!'(:*-,454!:*,-,-:!:('<-7!'-!*6*,=*@=0!*-+,@,'+,84A!+/0!8<((0-+!04+,5*+07!(*+0!'9!,-908+,'-!'9!('<:/=>!9,60!)0(80-+!'9!*==!)*+,0-+4!5*>!@0!:('B,-:A!060-!B,+/!(0)'(+07!*76*-804!'-!*!90B!,-908+,'-4C!M*6,-:!)*+,0-+4!

*-7!+/0,(!='607!'-04!9('5!4<8/!-007=044!4<990(,-:!4/'<=7!@0!*!+')!)(,'(,+>!9'(!*==!/0*=+/8*(0!)('6,70(4C!!