Transcript Conjoint Problem Identification Interview

Conjoint Behavioral
Consultation
The Future of School Psychology Task
Force on Family-School Partnerships
Susan Sheridan, Michelle Swanger-Gagne, Kathryn
Woods, Kathryn Black, Jennifer Burt, S. Andrew
Garbacz, Ashley Taylor
University of Nebraska-Lincoln
Conjoint Behavioral Consultation




A structured, indirect form of service delivery in which teachers and
parents are brought together to collaboratively identify and address
students’ needs (Sheridan et al., 1996; Sheridan & Kratochwill, 1992).
Extension of the traditional behavioral consultation model that
serves parents and teachers at the same time.
Interview stages are the same as in that of behavioral consultation,
except that stages are conducted in a simultaneous (rather than
parallel) manner.
Parents and teachers collaborate to:




Address the academic, behavioral, and social concerns of a child
Monitor a child’s behavior
Design an intervention
Rated by parents and teachers as the most acceptable consultation
approach for academic, behavioral, and social-emotional problems
when compared with teacher consultation models (Freer & Watson, 1999).
Process Goals of CBC

Improve communication and knowledge about child and family.

Increase commitments to educational goals.

Address problems across, rather than within, settings.

Promote shared ownership for need identification and solution.

Promote greater conceptualization of a need.

Increase the diversity of expertise and resources available.
Process Goals of CBC
(continued)

Establish and strengthen home-school partnerships;
enhance the family-school relationship.
 Refers to a mutual effort toward a shared goal.
 Contains the philosophy, attitude, and belief that
both families and educators are essential for
children’s progress in school.
 Working together to promote the academic and
social development of students.
Outcomes Goals of CBC







Obtain comprehensive and functional data over
extended temporal and contextual bases.
Identify potential setting events that are temporally or
contextually distal to target.
Improve skills and knowledge of all parties.
Establish consistent programming across settings.
Monitor behavioral contrast and side effects
systematically via cross-setting treatment agents.
Develop skills and competencies for future conjoint
problem solving.
Enhance generalization and maintenance of treatment
effects.
Stages of CBC
Preconsultation
 Conjoint Needs Identification
 Conjoint Needs Analysis
 Conjoint Plan Implementation
 Conjoint Needs Evaluation

See PC Handout 3
Preconsultation



Important process of communication, relationship
building, cohesion begins well before formal
consultation stages and continues throughout!
Opportunities for inviting participation and sharing
information should be seized whenever possible
Use initial contacts to ensure that participants know
what to expect (and what not to expect) in consultation
See Pre-CBC Handouts 1 - 3
Conjoint Needs Identification:
Initiating Formal Consultation


Standard consultation forms outline specific
objectives of the CNII
Use agenda for participants to keep them
informed of the process and meeting
objectives (see CNII Handout 1)
See CNII Handouts 2 and 3 for structured CNII forms
CNII: Child’s Strengths/Assets



Strengths, abilities, or other positive features of
the client
Can also include things that the client likes,
which can be used in reinforcement programs
Examples:
“What are some of Jamie’s strengths?”
 “What are some things Kevin does well?”

CNII: Behavior Specification/
Needs Identification

Elicit behavioral descriptions of client functioning


Ask for as many examples of the problem behavior as
possible


Focus is on specific behaviors of the client in terms that can be
understood by an independent observer
Careful specification is essential to identify the precise problem,
direct the focus of an intervention, and monitor progress
Assist consultee focus on a specific target problem by
asking for a priority

For example, “What is causing you the most concern?” or
“Which of these behaviors is most problematic for Joey?”
Guidelines for Target Selection
Always:



Focus on building a client’s skill repertoire,
rather than simply extinguishing behaviors
Prioritize urgent or dangerous behaviors if they
pose serious risk or invoke serious
consequences
Select a target that leads to the best treatment
outcome (treatment validity, generalization) -HOW??
Guidelines for Target Selection
Consider:






Identifying a response chain and target first behavior of the
chain
Selecting behaviors that will likely generalize to other behaviors
(e.g., work completion with generalization to on-task or
accuracy)
Organizing behaviors in terms of their topographical or
functional properties
Prioritizing behaviors that have general utility and that the
environment will likely maintain (e.g., social skills)
Changing the “easiest” behavior to encourage further treatment
efforts
Changing behaviors that are most irritating to or preferred by
the consultees
Operationalizing the Target
Behavior

Operational Definition:


Criteria





A precise description of the behavior of concern to the consultee
Objective: observable characteristics of behavior; must be countable
and measurable
Clear: unambiguous, specific, reliable; should be explainable to
others & should not require interpretation on the part of an observer
Complete: describes what is included and excluded; leaves little to
judgement of observer
It is often helpful to include information about
situations/conditions where/when the behavior occurs
SUMMARIZE & VALIDATE TARGET BEHAVIOR -WRITE IT DOWN!!!
Case Example: Prioritizing &
Operationalizing Target Behaviors
Parent and teacher describe the following concerns
about 8 year old Pedro:
talks out/talks back

fights, argues, complains

fails to complete assignments/tasks

uses obscene language

doesn’t get along with other kids/siblings

doesn’t pay attention to lectures or instructions

tardy for school
As a consultant, how would you go about helping consultees
prioritize and operationalize a target behavior in the case
of Pedro??

CNII: Behavior Setting

A precise description of the specific settings in which the
problem behavior occurs at home and at school




Specific within-school and within-home settings important to
prioritize
Ask for as many examples of problem settings as possible
In academic areas, this may include subject areas and not
just physical environment
Assist consultees prioritize problem settings by asking
which setting is causing the most difficult
CNII: Antecedent Conditions



A tentative delineation of events that
precede the client’s behavior
Ask for information regarding what happens
before the problem behavior occurs
Setting events: Antecedents that are
removed in time or place from the target
behavior, but that bear a functional
relationship to its occurrence
CNII: Sequential Conditions




Situational /ecological variables or events occurring when the
behavior occurs
Environmental (contextual) conditions in operation when the
problem behavior occurs
Pattern or trend of antecedent and/or consequent conditions
across a series of occasions
Examples:






Time of day
Day of week
Class period or common situations
Expectations of child (e.g., task demands)
Sequence of events
Curricular or instructional variables
Ecological Assessment &
Existing Conditions
Curricular
assessment: What is taught
Instructional assessment: How it is taught
Variables to assess include materials,
teaching format, assignments, daily routine,
student grouping, evaluation and feedback
procedures, homework
CNII: Consequent Conditions
A
tentative delineation of events that follow the
client’s behavior
 Ask for information regarding what happens after
the problem behavior occurs
 Setting events: Consequences that are removed in
time or place from the target behavior, but which are
related to its occurrence
 Examples: Being removed from the class, staying in
from recess
 SUMMARIZE & VALIDATE CONDITIONS
SURROUNDING BEHAVIOR
CNII: Behavior Strength



Attain a tentative estimate of the frequency or duration
of a problem behavior
Level of incidence that is to be focused on
Examples:





Frequency
Duration
Latency
Intensity
SUMMARIZE & VALIDATE BEHAVIOR &
BEHAVIOR STRENGTH
CNII: Goal Statement


Assist consultee generate an acceptable or
appropriate level of the behavior
Examples
“How often would Patrick have to turn in his work
in order to get along OK?”
 “How much time could Sally take to respond to
your request?”
 “What would be an acceptable amount of talking
out in class?”

CNII: Existing Procedures



Procedures or rules in force which are
external to the child and behavior
Questions regarding approach to
teaching or parenting
Examples:




“How long are Stacy and the others doing
seatwork?”
“What are the playground rules?”
“How do you currently handle Paul’s
talking back?”
“How are instructions/directions given to
Anna?”
276849837
-85875764
CNII: Data Collection

Rationale provided to set the stage for data collection (why)


Examples: “It would be very helpful to observe Sam in the
lunchroom and see exactly how often he throws his food. This
will help us understand... make comparisons later...”
Specific data collection procedures discussed




Common observation procedures include event, duration,
interval, momentary time sample, latency
Permanent product measures easy, useful
Procedures must be appropriate for the target behavior, and
continued throughout consultation
Provide a form on which consultees can collect data, if possible
See CNII Handout 4 for example
Behavioral Assessment
 Data collected must have high treatment utility and be relevant to
treatment
 Direct assessments will lead to meaningful treatments if they promote greater
understanding of a behavior
 On-going and repeated measurement, rather than pre/post
assessment only, is required
 Multi-source, multi-method multi-setting assessment strategies are
used along the direct >>> indirect continuum
 Multi-source: Collect information from teacher, parent(s), peers, self, others
 Multi-method: Collect information using different methods, such as rating
scales, interviews, observations
 Multi-setting: Collect information across settings of home and school, and
other relevant settings as appropriate (e.g., classroom, playground,
lunchroom, library, etc.)
Tips for Data Collection






Keep it simple!
Clearly define what is to be recorded
Match the data collection procedure to the
target behavior
Consider retrospective baseline data when
applicable
Graph the data to monitor progress
Record data that have a range (i.e., not simply
“yes/no”
Practical, Direct Data Collection
Procedures





Permanent Products
Direct Observation
Performance-Based Assessment
Curriculum-Based Measurement
Self-Monitoring
Permanent Product


Concrete evidence of a student’s behavior taken from
an existing source
Examples:





Percent of homework assignments completed
Number of worksheets completed in a subject area
Number of pages read
Number of problems attempted/completed/accurate
Organization of work on a page
Direct Observation


Measurement of discrete behaviors while they
are occurring
Examples:
On task/off task
 Disruptive behavior
 Out of seat
 Talking out
 Initiating conversations
 Compliance with commands

Direct Observations

How to…
Low frequency behaviors:
 Frequency counts using golf counter, pennies, tallies
on wristband


How to…
High frequency behaviors:
 Identify intervals that are easy to monitor
 Consider momentary time sampling procedure

Performance-Based Assessment


Use of rating scales to record behaviors over
time periods, based on a Likert scale
Examples:
Aggression
 Oppositional behavior
 Active participation in activities

Curriculum-Based Measurement


The use of standardized short-duration fluency
measures of basic, any testing strategy that uses
a student’s curriculum to monitor progress and
as the basis for decision-making
Examples:
Reading fluency and accuracy
 Math digits correct
 Spelling correct words

Self-Monitoring


An observation technique wherein students are
responsible for recording their own behaviors
Examples:
On-task behaviors
 Following instructions
 Beginning work on time
 Completing chores/tasks
 Cognitive events such as using self-control, problem
solving, experiencing depressive symptomotology

Goal Attainment Scaling

A rating on a 5-point scale (from -2 to +2) based on the
degree to which a student’s performance is
approximating a predetermined goal


Somewhere between a direct and subjective measurement
system
Examples:





Work completion
Accuracy on academic tasks
Compliance
Using self control
Social skill development
CNII: Data Collection



Specify the target response to record,
the kind of measure, and procedures for
recording (what, when, where, how)
SUMMARIZE & VALIDATE
RECORDING PROCEDURES
Establish date to begin data collection
CNII: Closing

Establish date of next appointment


Date, time, place
Closing Salutation:
“Bye! Good luck!”
 “I’ll check back in a few days to see how things are
going.”
 “Call me if you have questions or problems!”

Conjoint Needs Analysis Interview:
Opening the Interview


Use agenda for participants to keep them informed of
the process and meeting objectives (See CNAI Handout 1)
General Statement re: Data and Problem


Make a general statement to orient consultee toward data
Questions or Statement about Behavior Strength


Questions and statements about specific data, behaviors, and
patterns
Statement determining representativeness of the data
See CNAI Handouts 2 and 3 for structured CNAI forms
CNAI: Conditions/Functional
Analysis

Underlying assumptions of behavior:
Behavior is contextually defined
Behaviors arise in relation to environmental events;
i.e., both the consequences that maintain them and the
setting events/antecedents that precede them
 The context, and not the form of the behavior,
determines how a behavior is perceived (i.e., its
appropriateness)


Why is this important to understand in
consultation?
CNAI: Conditions/Functional
Analysis

Adequate functional analysis may highlight
important functions of a behavior (i.e., lead to
functional hypotheses) or pinpoint environmental
events (i.e., lead to contextual hypotheses) that
impact or maintain the target behavior



“Functions” refer to the function that a behavior serves
for an individual, and are often related to environmental
conditions that reinforce its occurrence (i.e., motivate a
person to engage in the behavior)
Examples include attention, escape, avoidance, others
It is critically important to conduct a careful
conditions/functional analysis to accurately generate
hypotheses and develop meaningful interventions
Primary Outcomes of the
Functional Assessment Process



A clear description of the problem behaviors,
including classes or sequences of behaviors that
frequently occur together
Identification of events, times, and situations that
predict when the problem behaviors will and will
not occur
Identification of the consequences that maintain the
problem behaviors (i.e., what functions the
behaviors appear to serve for the person)
Primary Outcomes of the
Functional Assessment Process


Development of one or more summary
statements or hypotheses that describe specific
behaviors, a specific type of situation in which
they occur, and the outcomes or reinforcers
maintaining them in that situation
Collection of direct observation data that
support the summary statements that have been
developed
CNAI: Conditions/Contextual
Analysis
 Antecedents, Consequences, Sequential/Ecological conditions are
explored in relation to the specific data collected by consultees



What happened before, after, and during the occurrence of the target
behavior?
What things may have triggered or maintained a behavior?
What patterns were present that may be related to the occurrence of a
target behavior?
 Trends across settings (e.g., home and school) are investigated;
cross-setting conditions and setting events are highlighted when
appropriate


Are there common things that happen across settings that trigger or
maintain a behavior?
Do events occurring in one setting precipitate, trigger, or predict a behavior
in another setting?
Conditions Analysis: Summary
Environmental variables can function as discriminative
stimuli for behaviors, as consequences that maintain
behavior, and as stimuli that elicit behavior
 Environment covariation can reflect a causal
relationship, so it is important to identify
environmental sources of behavioral variance
 Ask: “to what extent do target behaviors demonstrate
covariation with environmental events, and can these
controlling environmental stimuli be targeted for
modification?”

CNAI: Skills Analysis

Often what appears to be “behavior” problems
are in reality related to skill (vs. performance)
deficits



Can’t do vs. won’t do (i.e., skill vs. will)
Skills analyses are important when the target
behavior concerns skills to be mastered
Steps of skills analyses:





Identify target skill that should be present
Break the skill down into component parts
Assess the client’s ability to perform each component
Determine the uppermost level at which the client
can perform
Develop an intervention starting at this point
CNAI: Hypothesis Generation




Can be based on the function, context, or skills/deficits
surrounding the behavior
Hypotheses addressing function are based on an
examination of the consequences that are presumed to
maintain the behavior
Contextual hypotheses are based on an analysis of the
settings or events wherein a behavior is likely to occur
Skills hypotheses are based on the identification of
deficits in the child’s behavioral repertoire
CNAI: Interpretation/Hypothesis
Statement

Consultant elicits consultee’s perception regarding the
purpose, function, or “causes” of the behavior




Careful (strategic) questioning and summaries prior to this point in
the process should assist consultees in forming appropriate
hypotheses
More appropriate interpretations should be provided by the
consultant when necessary
Interpretation should be based on the
conditions/skills/functional analyses (behaviorally- or
environmentally-based, rather than following a medical
model)
Provides an important link between assessment and
intervention!
Case Example
During independent work time, Servio daydreams and fails to complete any
math worksheet problems. When his teacher tells him to get to work,
he argues that he is working, and sometimes writes down random
answers. The teacher requires students to bring uncompleted or
incorrect work home. At home, Servio’s mother works the night shift
and leaves the house at 7:00. She tries to get him to do his homework
before leaving, but he spends his time watching TV, fighting with his
younger brother, and arguing with his mother. Servio leaves to catch
the bus before his mother gets home from work. Upon returning to
school, he doesn’t turn in his worksheet and gets a “0” in the
gradebook.
 What are some possible target behaviors in this case?
 What are some possible antecedents, consequences, and sequential conditions in this
case? (Contextual analysis)
 What are some possible functions of his behaviors? (Functional analysis)
 What are some important areas to explore during the conditions analysis?
CNAI: Plan Strategies

Focus on identifying:
Ways to change the context
 Ways to prevent the problem behavior
 Ways to increase expected behavior or teach a
replacement behavior
 What should happen when the problem behavior
occurs
 What should happen when the desired behavior
or replacement behavior occurs

CNAI: Plan Strategies





Consultant and consultee establish general
strategies and specific tactics that might be used in
treatment implementation
Strategies should be related to the
hypothesis/interpretation statement
May use brainstorming techniques
SUMMARIZE & VALIDATE PLAN
Use form and write it down!
See CNAI Handouts 4 - 7
Other Considerations When
Designing Intervention Programs
Diagnosis
 Target Behavior Characteristics
 Intervention Variables
 Consultee Variables
 Intervention History

Interventions That Influence
Antecedents of Problem Behavior






Alter schedule of activities;
Adapt curriculum or task-specific aspects of
instruction;
Vary size of instructional groupings;
Provide special directions regarding
instruction;
Introduce pre-corrective strategies before
problems occur;
Teach students rules.
Factors That Influence Success
of Consequence Components of
a Behavioral Intervention Plan



Length of reinforcement interval;
Program reinforcers;
Reinforcement variables.
Factors Influencing Acceptability
of Intervention

Consistent with teacher and parent beliefs
and values
Does not require too much effort or time
Does not exceed the skill level of the teacher
or parent (with support)
Is unobtrusive

Holds promise of effectiveness!



Escape-Motivated Behavior



Description: Student need to escape from an aversive
situation.
Examples: difficult, irrelevant lengthy or ambiguous
assignment; undesirable group placement; negative peer or
adult interaction.
Intervention Options:
 Instruction in signal responses
Attention-Seeking Behavior



Description: Unmet student need for attention, coupled
with perception that attention is unlikely to occur.
Examples: call outs, swearing, yelling at classmate or
teacher; tantrum or noncompliance with adult request.
Intervention Options:
 Non-contingent attention
Strategies to Support Positive
Behavior Changes





Social/environmental re-engineering;
Cognitive mediation and self-management;
Periodic “booster” training;
Advocacy training;
Accept “just noticeable difference.”
CNAI: Closing

Continue data collection procedures
 Important that data collection continue in the
same manner (time, setting, procedure) as
collected during baseline!
Establish next appointment
 Closing salutation

Conjoint Plan Evaluation
Interview

Use agenda for participants to keep them
informed of the process and meeting objectives
(See CPEI Handout 1)

Review data collected by consultees; chart or
graph the data prior to the meeting if at all
possible
See CPEI Handouts 2 and 3 for structured CPEI forms
Treatment Evaluation

The data gathering activity that allows the
consultant to determine:



What progress the client is making
The overall success of an intervention
The overall success of services
Treatment Evaluation as Feedback
Feedback is provided to consultant and
consultees throughout the course of
consultation
 Evaluation allows for immediate modification
of the treatment plan, if necessary
 Evaluation/feedback can suggest information
about the adequacy of treatment
implementation (integrity and strength)

Requirements of ‘Best Practices’
in Treatment Evaluation
Take systematic, relevant, and repeated measures
of the target behavior
 Specify treatments in such a way that they can be
replicated
 Determine whether treatments are actually
benefiting the client
 Use appropriate design elements (time-series
methodology) to demonstrate and replicate
meaningful outcomes/effects

Evaluating the Intervention
Remember:
 Techniques making up the intervention must
be completely identified and described
 Written summaries/manuals are helpful
 Specification enhances treatment integrity and
allows for empirical investigation of the
treatment program
 Careful specification is critical for replication
purposes
Establishing the Degree of
Variability
Sources of Variability:
 Measurement procedures/measurement error
 Extraneous variables/outside influences
 Treatment program (the good kind of variability!)
Remember:
 The influences of measurement error and extraneous
variables must be sufficiently limited or clear to enable
a reasonable statement about the effects of the
treatment
What to Do if Data are
Excessively Variable


Wait and see if patterns become clearer; variability may
be temporary
Analyze the sources of variability




Explore possible effects due to measurement error
Identify possible extraneous variables
Attempt to control all possible extraneous variables
Examine the temporal unit of analysis (e.g., daily vs.
weekly data sets). Some detail may be lost, but “Part of
good clinical skill seems to involve knowing when to ignore
individual trees in order to see the forest” (Hayes & Nelson, 1986, p.
439).
Improving Consultation Cases
 Use
objective (e.g., frequency counts), rather
than subjective data
 Collect data continuously throughout all
phases of case study (baseline, treatment,
follow up)
 Collect historical data; effects of treatment
are more convincing if problems are
chronic and intractable
Improving Consultation Cases



Consider repeating procedures over a number
of cases to replicate the effects
Include diverse subjects in replication
attempts to assess breadth of intervention
Standardize assessment and treatment
procedures, including consultation
procedures
For example, by using structured interview forms and standard
intervention programs, the details of “what” was done (and
“how”) becomes clear
Improving Consultation Cases

Assess treatment integrity to ensure that the intervention
was implemented correctly



Assess clinical meaningfulness of outcomes through
social validation procedures





This allows for immediate revisions or attention
Only when interventions are implemented appropriately can
effects of the intervention be determined
Treatment acceptability
Perceptions of effectiveness of interventions
Subjective measures of outcomes
Degree to which consultation goals were met
Assess generalization and follow up
Improving Consultation Cases

Formalize procedures for analyzing case data
Level changes from baseline to treatment
 Immediacy effects
 Overlap in data points across phases
 Within phase variability
 Trend in baseline and treatment (see Tawney & Gast)


Use formal design structure when possible:
ABAB (reversal design)
 A/B/B+C/A (multi-element design with reversal)
 Multiple baseline designs

Assessing Client Outcomes

Direct Observations
 Consultees
can collect data daily, but keep
procedures simple! (see consultation record)
 Use permanent product data if appropriate
 Include independent observations when
possible (e.g., weekly)
 Include procedures for improving case studies
(Galloway & Sheridan, 1994; Kratochwill, 1985)
Assessing Client Outcomes

Goal Attainment Scaling
Provides a method for quantifying parents’ and
teachers’ reports of treatment progress with
regard to a target behavior and consultation goal
 Ratings are made on a 5-point scale from +2 to 2 (+2=behavioral goal fully met; +1=behavioral
goal partially met; 0=no progress toward goal; 1=behavior somewhat worse; -2=behavior
significantly worse)
 Assess periodically (e.g., weekly) throughout
treatment

Assessing Client Outcomes

Rating Scales & Questionnaires
 Include
pre- and post- standardized checklists
as they relate to your case (e.g., SSRS,
Conners’ Questionnaires, etc.)
 Include Problem Behavior Questionnaire
during problem identification/analysis to
obtain information about the function of the
target behavior
Problem Behavior Questionnaire



15-item scale completed by teachers
Responses based on the degree to which an
event is likely to be observed relative to a
problem behavior
Five functional areas assessed: access to peer
attention, access to teacher attention,
escape/avoidance of peer attention,
escape/avoidance of teacher attention, setting
events
Problem Behavior Questionnaire



Scores plotted on the PBQ Profile
Items marked 3 or above are considered
potential hypotheses for the problem behavior;
if 2 or more items within one area are rated 3 or
above, a primary hypothesis is suggested
Authors suggest that interventions should focus
on teaching the student an alternative behavior
that serves the same function as the problem
behavior
Assessing Client Outcomes

Social Validity
 Include
social comparison and subjective
evaluation data (Kazdin, 1977)

Treatment Acceptability
 Include
Child Intervention Rating Profile
(Witt & Elliott)