The Role of Intensive Support within School-wide PBIS

Rob Horner

University of Oregon

Main Messages

Applied Behavior Analysis is a compelling and effective technology for assessing and changing behavior.

In combination with medical and organizational variables we can use behavior analysis to both change behavior and improve quality of life.

Getting behavior analysis implemented with (a) fidelity, (b) breadth, and (c) sustainability remains a major challenge.

Hill Walker’s multi-tiered prevention model, Dean Fixsen’s implementation logic, and George Sugai’s integration of practices into an implementation “framework” are worthy of consideration.

Goals

Define core features of a “Three-Tiered” Framework for intervention

Emphasize the core role of intensive supports within the three-tiered prevention framework

Propose elements of a research agenda for enhancing implementation of function-based behavior support

Three CE Questions summarized in last slide

Three-tiered approach

Hill Walker’s introduction of multi-tiered prevention, drawn from community mental health. (Walker et. al,1996)

Primary prevention Evidence-based, efficient, all

Secondary prevention Standardized, targeted, some

Tertiary prevention Individualized, intensive, few

School-wide Positive Behavioral Interventions and Supports (PBIS)

Build a continuum of supports that begins with the whole school and extends to intensive, wraparound support for individual students and their families.

Implement effective practices with the systems needed for high fidelity and sustainability

What is School-wide Positive Behavior Intervention and Support?

School-wide PBIS is: A framework for establishing the social culture and intensive,

individual behavioral supports needed for a school to be an effective learning environment for all students.

Evidence-based features of SWPBIS Prevention Define and teach positive social expectations Acknowledge positive behavior Arrange consistent consequences for problem behavior On-going collection and use of data for decision-making Continuum of intensive, individual intervention supports. Implementation of the systems that support effective practices

Bradshaw, C.P., Koth, C.W., Thornton, L.A., & Leaf, P.J. (2009). Altering school climate through school-wide Positive Behavioral Interventions and Supports: Findings from a group-randomized effectiveness trial. Prevention Science, 10(2), 100-115

Bradshaw, C.P., Koth, C.W., Bevans, K.B., Ialongo, N., & Leaf, P.J. (2008). The impact of school-wide Positive Behavioral Interventions and Supports (PBIS) on the organizational health of elementary schools. School Psychology Quarterly, 23(4), 462-473.

Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of School-Wide Positive Behavioral Interventions and Supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12, 133-148.

Bradshaw, C.P., Reinke, W. M., Brown, L. D., Bevans, K.B., & Leaf, P.J. (2008). Implementation of school-wide Positive Behavioral Interventions and Supports (PBIS) in elementary schools: Observations from a randomized trial. Education & Treatment of Children, 31, 1-26.

Horner, R., Sugai, G., Smolkowski, K., Eber, L., Nakasato, J., Todd, A., & Esperanza, J., (2009). A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. Journal of Positive Behavior Interventions, 11, 133-145.

Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptionality, 42(8), 1-14.

Randomized Controlled Trials Examining PBIS

• Reduced major disciplinary infractions

• Improvements in academic achievement

• Enhanced perception of organizational health &

safety• Improved school climate• Reductions in teacher’s reports of bullying

behavior

The Effects of School-wide PBS within a Randomized

Control Effectiveness Trial

Rob Horner, George Sugai, Keith Smolkowski, Lucille Eber, Jean Nakasato, Anne Todd,

Jody Esperansa

OSEP TA Center on Positive Behavior Support

www.pbis.orgIn press in the Journal of Positive Behavior Intervention

Randomized Controlled Trial(Preliminary Findings)

Assessment Time Period Group T 1 T 2 T 3

Treatment (N = 30) O X O O

Control/Delay (N = 30) O O X O

(T = time (by year), O = observation, X = implementation of SWPBS training)

Results: With training by regular state trainers, schools are able to implement

SWPBS to criterion.Implementation of SWPBS

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

T1 T2 T3

Mean

SE

T S

co

res

Initial (N = 33) Delayed (N = 28)

Random coefficients analysis: p <.0001; d = 1.78

Initial

Training

Delay

Training

* *

Results: Perceived Social Risk Factors decreased when SWPBS was implemented with fidelity.

Perceived Risk Factor Score from School Safety Survey

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

T1 T2 T3

Mean

Sch

oo

l S

afe

ty S

urv

ey R

isk S

co

res Initial (N = 24) Delay (N = 19)

Random coefficients analysis p = .0154; d = -.86

* *

Results: The percentage of 3rd graders meeting the state reading standard increased with SWPBS

implementation

Percentage of 3rd Graders meeting State Reading Standard

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

T1 T2 T3Perc

en

tag

e o

f 3rd

Gra

ders

meeti

ng

sta

te r

ead

ing

sta

nd

ard

Initial (N = 33) Delay ( N= 28)

N.S. p = .032; d = .58

* *

Schools adopting SWPBIS by year

00 01 02 03 04 05 06 07 08 09 2010 20110

2000

4000

6000

8000

10000

12000

14000

16000

14,325 Schools Adopting

School-wide PBIS

Alab

ama

Alas

ka

Ariz

ona

Arka

nsas

Calif

orni

a

Colo

rado

*

Conn

ectic

ut

Del

awar

e

Flor

ida*

Geo

rgia

Haw

aii

Idah

o

Illin

ois

Indi

ana

Iow

a*

Kans

as*

Kent

ucky

Loui

sian

a*

Mai

ne

Mar

ylan

d*

Mas

sach

usett

s

Mic

higa

n

Min

neso

ta

Mis

siss

ippi

Mis

sour

i*

Mon

tana

*

Neb

rask

a

Nev

ada

New

Ham

pshi

re

New

Jers

ey*

New

Mex

ico

New

Yor

k

Nor

th C

arol

ina*

Nor

th D

akot

a*

Ohi

o

Okl

ahom

a

Ore

gon*

Penn

sylv

ania

Rhod

e Is

land

Sout

h Ca

rolin

a*

Sout

h D

akot

a

Tenn

esse

e

Texa

s

Uta

h*

Verm

ont

Virg

inia

Was

hing

ton

Stat

e

Was

hing

ton

DC

Wes

t Vir

gini

a

Wis

cons

in

Wyo

min

g

0

200

400

600

800

1000

1200

1400

1600

Schools use SWPBIS (Feb, 2011)11 states with over 500

schools

3 states with over 1000 schools

Illinois

Texas

Florida

Extension of Walker’s Logicto School-Wide PBIS

Primary Prevention: Tier I Define, teach, monitor, reward behavioral expectations Consistent continuum of consequences Data collected and used for decision-making

Secondary Prevention: Tier II First Step to Success Check-in/ Check-out Check and Connect

Tertiary Prevention: Tier III Function-based support Wraparound Tertiary Supports:

High Intensity Applied Behavior Analysis with medical, behavioral, educational, community mental health

Primary Prevention is the foundation for effective and sustained implementation of more intensive behavior support** Eber** Dishion & Fosco

Analysis of “weak and non-responders”

The Effectiveness of Intervention Strategies

Based on Functional Behavioral Assessment.

Kimberly L. Ingram,

Teri Lewis-Palmer and George Sugai

University of Oregon,

Making Function-based Support more Accessible

Practices with Systems Team Time Data Structure

Team Composition Bennazi et al.,

The Role of Behavior Specialists in the Development of Function-

based Behavior Support Plans

Benazzi, L., Horner, R., & Good, R.

University of Oregon

Three knowledge areas needed for a behavior support plan

Behavior Support Plan

Knowledge about The Student

Knowledge aboutThe Setting

Knowledge about Behavioral Theory

Mean Expert Ratings of Technical Soundness

0

2

4

6

8

10

12

14

16

Team Alone Team + Spec Spec Alone

Me

an

Te

ch

nic

al S

ou

nd

ne

ss

Results: Technical AdequacyMean Expert Rating (6-18)

* Team alone plans were statistically different from plans that included behavior specialist.*Team + Specialist and Specialist Alone were not statistically significantly different.

Mean Team Ratings of Contextual Fit

70

72

74

76

78

80

82

84

86

88

90

Team Alone Team +Spec Spec Alone

Me

an

Co

nte

xtu

al F

it

Results: Contextual FitMean Team Rating (0-100)

* Specialist Alone plans were statistically different from plans that included team members.* Team Alone and Team + Specialist plans were not statistically significantly different

Mean Rank of Implementation Prefernce

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Team Alone Team +Spec Spec Alone

Me

an

Ra

nk

Sc

ore

Results: Mean Team RankTeam Preference (1-3) (inverse)

* Specialist Alone plans statistically different from plans that included team members.* Team Alone and Team + Specialist plans were not statistically significantly different

Making Function-based Support more Accessible

Functional Behavioral Assessment as a common practice in schools Sheldon Loman Kathleen Strickland-Cohen

Providing the data systems to match behavioral technology Individual Student Information System Measure fidelity as well as impact

An Examination of the Efficacy of a Practical Functional Behavioral Assessment Training

Model for Personnel in Schools

Sheldon Loman, Ph.D.Portland State University

andRobert H. Horner, Ph.D.

University of Oregon2011

Practical FBA

Basic FBA:

Single Response Class:

Behaviors and Maintaining Functions are Easily Defined and Identified

Complex FBA:

Single or Multiple Response Classes:

Behaviors and Maintaining Functions Vary, and are not Easily Defined and/or Identified

Study Design

Teach Practical FBA to 12 typical school personnel Document their mastery of content

Typical School Personnel Conduct FBA with typical students under typical conditions

Functional Analysis conducted to test the accuracy of the Practical FBA.

Comparison of Summary Statements Generated from Interviews

9 out of 10 of the summary statements hypothesized by the FACTS interviews with teachers were

confirmed via direct observation 10 out of 10 FBA Summary Statements based on

FACTS + Direct Observation were confirmed via Functional Analysis.

Results: Phase 3

Implementation and ABA

We know more about what to do, than about how to get what we know in place.

Organizational behavior analysis, and Implementation Science need to become more dominant elements in our research agenda.

© Fixsen & Blase, 2008

Performance Assessment (Fidelity)

Coaching

Training

Selection

Systems Intervention

Facilitative Administration

Decision Support Data System

Integrated & Compensatory

Compe

tenc

y D

river

s

Compe

tenc

y D

river

s Organization D

rivers

Organization D

rivers

LeadershipLeadership

Adaptive Technical

Successful Student Outcomes

Program/Initiative/Framework (e.g. RtI)

Main Messages

Intensive Applied Behavior Analysis is an integral part of SWPBIS We know more about what Intensive Support looks like than we do about how to get it in

place in typical school and community settings.

---------------------------------------------------------------------------- Implementation of School-wide Systems (policy, team operating procedures, data systems,

school-wide expectations) will enhance the implementation and impact of high intensity supports.

The construct of “function-based support” needs to be applied to all three tiers of intervention supports.

Need for more systematic analysis of “weak and non-responders”

Typical school personnel are able to conduct “basic” FBA Teams will use FBA information well only if they have a member who is knowledgeable

about behavioral theory. Achieving the policy goal of making schools more effective with a wider range of students

will require making ABA more accessible across the educational system.

Toward a Functional Research Agenda

Document necessary and sufficient conditions for implementing technically competent behavior analysis in applied settings.

Assess the effects of organizational systems on the quality of behavior analysis implementation… at all three tiers?

Assess if conducting “basic” FBAs improves the efficiency of effective behavior analysis implementation?

Use analysis of weak and non-responders to guide enhancements in standard behavior analysis procedures?

Behavior Support Elements

Problem Behavior

Functional Beh. Assessment

Content of Support Plan

Fidelity of Implementation

Impact on Behavior and Lifestyle

*Team*Specialist

*Hypothesis statement*Competing Behavior Analysis *Contextual Fit

*Implementation Plan

*Technical Adequacy

Summary

What Tiers of Support within SWPBIS? Primary Prevention, Secondary Prevention, Tertiary Prevention

What competencies needed on a team building BSP? Knowledge about (a) Setting, (b) Individual, (c)Behavioral Theory

Measures needed in assessment of Intensive Support? Outcome/Impact measures of student behavior Fidelity measures of quality of implementation