Transcript BASC™-2 Interventions

Interventions for Externalizing and
Internalizing behaviors at Tier 2
and Tier 3
Kimberly J. Vannest, PhD
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.
Overview

Evidence based interventions are critical at all levels of a
response to intervention model. Best practices in a general
education classroom can prevent learning and behavior problems
while serving as a protective and resiliency factor for children who
have characteristics of risk. For students demonstrating learning or
behavior problems that place them at risk, evidence based
interventions serve to ameliorate and potentially mediate
further exacerbation of problems.
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This presentation will:
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Provide a description of a multi tier model for
context with suggested timelines and
procedures
Present a list of applicable interventions at
each of the three levels in RTI (for behavior).
Provide the essential steps for highlighted
interventions so that participants may leave
the session with methods for application.
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.
Vannest, K.J. (2009)
[email protected]
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.
PROVIDE A DESCRIPTION OF
A MULTI TIER MODEL FOR
CONTEXT WITH SUGGESTED
TIMELINES AND
PROCEDURES
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Three tier preventive intervention
classification system
Tertiary Prevention – reduces
negative impact of an already
established disease by
restoring function and
reducing disease related
complications.
Secondary Prevention - aimed at early
disease detection to increase
opportunities for intervention to
prevent progression of disease and
emergence of symptoms
Primary Prevention – avoids the development of the
“disease”
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First, lets all get on the same
page. There are multiple
names for a 3-tier model
Medical Model
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Primary
Secondary
Tertiary
Positive Behavioral
Supports
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Universal
Targeted
Individual
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September & October
Universal Best Practices
Teach explicit school wide expectations
Reinforce new pro-social skills 1:1
Reinforce pro-social behaviors on a fixed or
intermittent schedule
Use data to evaluate practices
Conduct universal screening to determine
elevated levels of risk
Killer academic programming
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November & December
Targeted Interventions
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Target the problem
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Consider externalizing vs. internalizing types of risk
Consider specific differences ex. attention problems
or aggression problems (i.e. one is neurological, the
other is not likely)
Identify resources & Train for needs
Implement
Measure teacher fidelity, Measure student
progress
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January & February
Individual Interventions
Making Progress ?
yes
no
Monitor ongoing
progress
New intervention or
individualized
programming
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Suggested timeline Review
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August – September
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October
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Notify & consent parents
Conduct assessments to identify problem type (BASC-2)
Consider coordinating reading or academic screening and behavioral risk
notification
November-December
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Screen school population @ week 6 (Behavior Emotional Screening
System)
Review risk list
Determine number of students to serve
October-November
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Prep teachers and parents, send notices, review school rules
for consensus
Teach school rules to students, use school rules to guide
universal programs
Use targeted interventions (Intervention Guide & Classroom Guides)
Use resource mapped interventions
January-February, March-May as appropriate
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Use targeted interventions (Intervention Guide & Classroom Guides)
Use resource mapped interventions
Consider specialized services based on diagnostic assessment, structured
background interview, direct observation and FBA
Vannest, K.J. (2009)
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Screening & Resource
allocation
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We have an inefficient reactive rather than proactive
approach.
The community costs for treatment of chronic conditions,
juvenile justice, adult incarceration, restorative justice, loss
to family and work force contributions far exceeds the cost
of screening and early intervention.
Our current system of service identification depends on
parent and teacher referral
Idiosyncratic, externalizing behavior problem-focused method of
either unknown or poor validity.

Schools
screen for other types of problems including vision,
hearing, speech, academic problems associated with specific
learning disabilities, and developmental delay but not for
emotional and behavior problems.
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Student
Student
Student
Student
Student
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Student
Student
Student
Student
Student
Student
Student
Student
Student
Student
Student
Classroom Snapshot
Things I hear:

“ we are too busy with academic RTI
to worry about behavior”
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If 20% of our student population
is struggling with social
emotional, behavioral issues –
academics will be affected.
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80
70
60
Academic
Achievement
50
40
Problem
Behaviors
30
20
10
0
1st 2nd 3rd
Qtr Qtr Qtr
4th
Qtr

A reciprocal relationship
exists between
achievement and
behavior.
Academic performance
is inversely related to
problem behavior that
begins early in a child’s
development (Brier, 1995;
McEvoy & Welker, 2000).
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What's the significance of students with
problem behaviors?

There is evidence to show that young children with challenging
behavior are more likely to experience:
 expulsion from preschool programs at 3.2 times the rate of K-12
students (Gilliam, 2005)
 early and persistent peer rejection (Coie & Dodge, 1998);
 mostly punitive contacts with teachers (Strain et al., 1983);
 family interaction patterns that are unpleasant for all participants
(Patterson & Fleishman, 1979);
 school failure & negative achievement trajectory (Kazdin, 1993;
Lipsey & Derzon, 1998; Patterson & Fleishman, 1979; Tremblay,
2000; Wahler & Dumas, 1986),
 high risk of fatal accidents, substance abuse, divorce,
unemployment, psychiatric illness, and early death (Coie & Dodge,
1998; Kazdin, 1985).
 Adult lives characterized by violence, abuse loneliness & anxiety
(McCord, 1978; Olweus, 1991)
Vannest, K.J. (2009)
[email protected]
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.
What are the positive outcomes
expected from early intervention?
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Decreased risk of withdrawal, aggression, non-compliance, and
disruption (Strain & Timm, 2001).
Treatment impact on fears, phobias, depression, anxiety,
hyperactivity, conduct, and obsessive-compulsive disorders.
Positive peer relationships including understanding of friendship,
cooperation, and sharing (Denham & Burton, 1996).
Increased self-control, self-monitoring, and self-correction and
improved social-emotional health (Webster-Stratton, 1990).
Academic success (Walker et al., 1998).
Reduced risk for teen pregnancy, juvenile delinquency, and
special education placement (Strain & Timm, 2001).
www.challengingbehavior.org
Vannest, K.J. (2009)
[email protected]
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.
System for Managing Behavioral and
Emotional Problems
18
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Group: Roster Report
Classification Key
that lists elevation
levels
In a Roster report,
students are listed
according to
whatever level is
chosen; in this
case, the district
level was chosen,
and results are
sorted within each
school in the
district
Results can be
sorted
alphabetically
(student name), or
by classification
level (either
ascending or
descending)
19
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Methodology
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A multi-year research review
study by Vannest, Reynolds &
Kamphaus, 2008
Inclusion criteria -Any research
articles that were experimental or
quasi-experimental in design and
demonstrated positive effects
which could be attributed to the
intervention.
Studies sorted by the type of
problem behavior for which the
intervention was designed. Of
the thousands of studies
reviewed, 40 distinct
interventions are listed here
today.
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Example annotation

Robinson, P. W., Newby, T. J., & Ganzell, S. L. (1981). A token
system for a class of underachieving hyperactive children. Journal
of Applied Behavior Analysis, 14(3), 307–315.

This study investigated the efficacy of a token economy reinforcement
system on the reading achievement of a large group of children with
hyperactivity and low reading ability. Eighteen third-grade males
identified as hyperactive and performing below grade reading level
participated. Tokens were awarded for learning a reading unit or
teaching a unit to another student and were redeemed for time spent
playing a video game or pinball. Students completed nine times as
many reading assignments during the token-economy condition as
during the reversal period, when the tokens were removed (p < .05).
Students also passed more standardized level tests required by district
during the token-economy condition.
Vannest, K.J. (2009)
[email protected]
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.
PRESENT A LIST OF
APPLICABLE INTERVENTIONS
AT EACH OF THE THREE
LEVELS IN RTI (FOR
BEHAVIOR).
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Interventions with
Evidence
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25.
Advance organizers
Anger Management Skills Training
Behavioral Interventions
Choice
Class Wide Peer Tutoring
Cognitive organizers
Cognitive Restructuring
Cognitive-Behavioral Therapy
Computer-Assisted Instruction
Contingency Management
Daily Behavior Report Cards
Exposure-Based Techniques
Family Therapy
Functional Assessment
Functional Communication Training
Integrated Cognitive-Behavioral Therapy
Interdependent Group-Oriented Contingency
Management
Interpersonal Therapy for Adolescents
Milieu Language Teaching
Mnemonics
Modeling
Modified Task Presentation Strategies
Moral Motivation Training
Multimodal Interventions
Multisystemic Therapy
26.
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Opportunities to respond
Pacing
Parent Training
Peer Mediated Interventions
Peer tutoring
Peer-Mediated Conflict Resolution and Negotiation
Picture Exchange Communication System
Pivotal Response Training
Precorrection
Presentation Strategies
Problem Solving
Procedural prompts and behavioral momentum
Replacement Behavior Training
Self instruction
Self mediated strategies
Self monitoring
Self-Management
Social Skills Training
Task Modification
Task Selection Strategies
Token Economy System
Verbal Mediation
Video Modeling
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Using intervention across
tiers is partially about
resources and skills
Universal
Targeted
Individual
x
x
x
Cognitive
Restructuring
x
x
Verbal Mediation
x
x
Problem Solving
SelfManagement
Social Skills
Training
x
x
x
Peer-Mediated
Conflict
Resolution
and
Negotiation
x
x
x
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PROVIDE THE ESSENTIAL
STEPS FOR HIGHLIGHTED
INTERVENTIONS SO THAT
PARTICIPANTS MAY LEAVE
THE SESSION WITH METHODS
FOR APPLICATION.
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Intervention categorization
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Interventions are organized according to
the most common behavior problem
clusters found in a nationally represented
sample of nearly 4000 teachers and
parents across the United States.
Students, schools, teachers and parents
were matched for all demographic
variables.
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Intervention categorization
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Behavior and emotional categories include:
 Academic Problems
 Adaptability
 Aggression
 Anxiety
 Attention Problems
 Conduct Problems
 Depression
 Functional Communication
 Hyperactivity
 Leadership/Social Skills
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Interventions for Aggressive
Behaviors
1.
2.
3.
4.
5.
6.
Problem Solving Training
Cognitive Restructuring
Verbal Mediation
Social Skills Training
Peer Mediated Conflict Resolution and
Negotiation
Replacement Behavior Training
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Interventions for Conduct Problems
1.
2.
3.
4.
5.
6.
7.
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9.
Token Economy Systems
Interdependent Group-Oriented Contingency
Management
Anger Management Skills Training
Problem-Solving Training
Social Skills Training
Moral Motivation Training
Parent Training
Multimodal Interventions
Multisystematic Therapy
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Interventions for Hyperactive
Behaviors
1.
2.
3.
4.
5.
6.
Functional Assessment
Contingency Management
Parent Training
Self- Management
Task Modification
Multimodal Interventions
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Interventions for Attention Problems
1.
2.
3.
4.
5.
6.
7.
Contingency Management
Daily Behavior Report Cards
Modified Task-Presentation Strategies
Self-Management
Classwide Peer Tutoring
Computer Assisted Instruction
Multimodal Interventions
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Academic Problem Interventions
1.
Mediated Interventions
•Focus on effective teaching
2. Peer Mediated Interventions
•Focus on peers helping peers
3. Self-Mediated Interventions
•Focus on student regulating learning
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Interventions for Anxiety
Disorders
1.
2.
3.
4.
5.
Exposure-Based Techniques
Contingency Management
Modeling
Family Therapy
Integrated Cognitive-Behavioral Therapy
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Interventions for Depression
Cognitive- Behavioral Therapy
A. Psychoeducation
B. Problem-Solving Skills Training
C. Cognitive Restructuring
D. Pleasant Activity Planning
E. Relaxation Training
F. Self- Management Training
G. Family Involvement
II. Interpersonal Therapy for Adolescents
I.
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Interventions for Somatization
Disorders
1.
2.
Behavioral Interventions
Multimodal Cognitive-Behavioral Therapy
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Interventions for Problems with
Adaptability
1.
2.
3.
4.
5.
Functional Behavior Assessment
Precorrection
Procedural Prompts and
Behavioral Momentum
Self Management Training
Cognitive Behavior Management
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Interventions for Problems Functional
Communication
1.
2.
3.
4.
5.
Functional Communication Training
Picture Exchange Communication
System
Video Modeling
Milieu Language Teaching
Pivotal Response Training
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Social Skills Defined
Definition: Children who exhibit strong social and interpersonal skills and
demonstrates positive relationships with others without significant
maladaptive behaviors (Bierman, Miller, & Stabb, 1987).
Etiology: Children who demonstrate characteristics of emotional and behavior
disorders, autism spectrum disorders, and ADHD demonstrate deficits in
social skills (Bellini et. al., 2007, Forness & Knitzer, 1992).
Prevalence: 18-20% of teachers report deficits in social skills in the classroom
setting (Reynolds, Kamphaus, 2004).
Outcomes:
 Positive, everyday experiences with their parents are fundamental to
children’s developing social skills.
 Children whose parents frequently play with them have more advanced social
skills and get along better with peers.
 Children who have a hard time getting along with others in the preschool
years are more likely to experience later academic difficulties.
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Social Skills Training
Teaching prosocial concepts to children to function successfully
in social environments across all settings.
Basic Elements of Social Skills Training
1. Teaching the skill and talking about the problem area or
weakness
2. Modeling the skill through active demonstration
3. Practicing the skill in a controlled environment while receiving
feedback
4. Generalizing the skill by practicing it in new environment
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Context of our current
research
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Universal Screening
Brief assessment to determine problem type
The “10 minute” meeting
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Discuss intervention selection NOT problem admiration
½ day School wide training in most common
interventions
Follow up coaching in classrooms
Electronic daily behavior report cards
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Example problem assessment report
Primary Improvement Areas
Hyperactivity
Anxiety
Attention
Secondary Improvement Areas
Aggression
Conduct Problems
Adaptive Skill Strengths
None
Case Example of Elmer
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Elmer’s scores on Hyperactivity, Anxiety, and Attention Problems fall in
the clinically significant range, and probably should be considered
among the first behavioral issues to resolve.
Note that Elmer also had scores on Aggression and Conduct Problems
that are areas of concern. Interventions for these areas are not
provided in this report. However, these areas may require additional
follow up
Example: Hyperactivity
 Functional Assessment
 Contingency Management
 Parent Training
 Self-Management
 Task Modification
 Mulitmodal Interventions
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Assistance for expert decision
making
Our current models involve resource mapping, but we may consider the match between problem
type and intervention rather than a generic intervention or an overly engineered or prescribed
one

Look at supports available to Elmer at home or in the community
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Look at capacity and resources of the school.
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Also consider the barriers in the related settings.
For example:
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A functional assessment to determine specific antecedent and consequence manipulations may
be beyond the scope of the available time and resources of the school and classroom.

Contingency management may not seem like the type of intervention suggestion that would work
with a particular teacher personality.

Parent training likewise may not be a “best fit”.
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However self-management works well for Elmer’s age, the school, the classroom and your time
use. So you might then engage in a treatment plan that includes or starts with self-management.
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Parent Tip Sheets
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Tools for
Partnership
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Multiple
steps and
examples
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Communication with
Caregivers
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Teacher Training 
If leadership teams decide to use an
intervention as a tier two support. The school
should be trained.
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Small teacher groups
Use conference or prep time
Train in a 30 minute block with a competency
check
Use scenarios appropriate for your school i.e.
your own student examples.
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Effective Training

What do we know about getting teacher
training content to “stick”
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Requires modeling
Requires performance feedback
Requires praise for change
For any new behavior consider…
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Praise for attempting something new
Coaching and contingencies
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Improving practice

Step by step instructions for all the
interventions listed here are excerpted from
the Intervention Guide which lists the
evidence-base for each intervention and
provides procedures, directions and
consideration for use in schools. (Vannest,
Reynolds & Kamphaus)
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
Our Schools face very real
challenges within our student
population
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Both externalizing and internalizing conditions
I’m optimistic that our schools make a
tremendous difference in the lives of our
students and their families.
They are, or have the potential to be
everything that is good about our communities
and our collective culture.

Self-determination, empowerment, freedom, and
achievement.
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Conclusions
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Although the need for services is
tremendous the available resources in our
professional literature are also strong
The cost for inefficient or ineffective practices is
too high
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Teacher attrition
Poor student outcomes
Community and societal costs
Effective practices do improve school & student
outcomes.
Vannest, K.J. (2009)
[email protected]
Copyright © 2008 Pearson Education, Inc. or its affiliates. All rights reserved.