What is an Evidence Based Intervention? Choosing and ...

What is an Evidence Based Intervention? Choosing and ...

What Is an EvidenceBased Behavior Intervention? Choosing and Implementing Behavior Interventions That Work Dr. Chris Riley Tillman, University of Missouri Dr. Allison Gandhi, National Center on Intensive Intervention June 11, 2014 A note about questions Please type questions related to technical issues in the Chat box. Please type questions related to webinar content in the Q&A box. In Todays Webinar Framing the need for evidence-based interventions (EBIs) National Center on Intensive Intervention (NCII) Behavior Interventions Tools Chart Selecting appropriate EBIs Examples of EBIs Relevant resources 3 Behavior Intervention Challenges The Current Dilemma for Educational Professionals More cases Higher levels of accountability And traditional methods assume there is lots of time

4 Selecting Interventions Quickly: The Reasonable Hypothesis Time is a precious commodity. Efficient approach Test easiest hypothesis first. Implement intervention. Monitor and evaluate outcomes. If approach fails, attempt something more progressive. 5 NCIIs Approach: Data-Based Individualization (DBI) 1. Secondary intervention program, delivered with greater intensity 2. Progress monitoring 3. Informal diagnostic assessment 4. Adaptation 5. Continuous progress monitoring with adaptations occurring as needed to ensure adequate progress 6 Adapting Behavior Interventions Intensify current intervention. Appropriate when the current intervention is yielding some progress but slowly.

Change to a new intervention. Appropriate when the current intervention is yielding little or no progress. Pre-intervention After intervention change 7 Selecting EBIs for Behavior 1. Identification of Hypothesized Function 4. Analysis Focusing on Both Effectiveness and Function 2. Selection of Relevant Intervention Based on Function 3. Assessment

and Monitoring 8 NCII Tools Chart on Behavioral Interventions 9 Implementation Table Study Quality Intervention Study Study Type Participants Design Fidelity of Measures Implementation Targeted Measures Broader Kamps, Conklin, & Wills (in press) Single Case

Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group

Single Case Class-Wide FunctionRelated Intervention Teams Schmidt (s) Study Citation Study Quality Intervention Study Study Type Participants Design

Fidelity of Measures Implementation Targeted Measures Broader Kamps, Conklin, & Wills (in press) Single Case Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case

Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group Single Case Class-Wide FunctionRelated Intervention Teams Schmidt (s)

11 Study Quality: Participants Study Quality Intervention Study Study Type Participants Design Fidelity of Measures Implementation Targeted Measures Broader Kamps, Conklin, & Wills (in press) Single Case

Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group Participants Class-Wide FunctionRelated Intervention Teams

Do the students in the study exhibit intensive social, emotional or behavioral challenges? Schmidt (s) Full Bubble: Single Case Evidence is convincing that participants currently exhibit intensive social, emotional, or behavioral challenges (e.g. ED label, alternative school/classroom, nonresponder, etc.) Half Bubble: Evidence is partially convincing that participants currently exhibit intensive social, emotional, or behavioral challenges (e.g. ED label, alternative school/classroom, non-responder, etc.) Empty Bubble: Evidence is unconvincing that participants currently exhibit intensive social, emotional, or behavioral challenges (e.g. ED label, alternative school/classroom, non-responder, etc.). 12

Study Quality: Design Study Quality Intervention Study Design (Group Design) Study Type Does the study design allow us to conclude that the intervention program, rather than Kamps, extraneous variables, was responsible for theConklin, results? & Wills (in Single press) Case Random assignment was used. At pretreatment, program and control groups were not statistically significantly different; and had a mean standardized difference that fell within 0.25 SD on measures used as covariates or on pretest measures also used as outcomes. Program and control groups were demographically comparable Full Bubble: Kamps, Wills, Heitzman-Powell, at pretreatment. There was no attrition bias1. Unit of analysis matched randomCase Single Szoke, Hobohm,

& Culey (2011) dependency assignment (controlling for variance associated with potential at higher levels of the unit of randomization is permitted, e.g., for randomizing at the student Class-Wide Functionlevel, controlling for variance at the classroom level) Related Intervention Teams Random assignment was used, but other conditions for full & bubble not met; Wills, Kamps, Fleming, Miller, OR Half Bubble: Empty Bubble: Hansen (draft paper) Group Random assignment was not used, but a strong quasi-experimental design was used. At pretreatment, program and control groups were not statistically significantly

different and had a mean standardized difference that fell within 0.25 SD on measures central to the study (i.e., pretest measures also used as outcomes), and outcomes were analyzed to adjust and Case control Schmidt (s)for pretreatment differences. Program Single groups were demographically comparable at pretreatment. There was no attrition bias. Unit of analysis matched assignment strategy. Fidelity of Measures Implementation Targeted Measures Broader Participants Design

Empty Bubble: Fails full and half bubble. Design (Single Subject Design) Does the study design allow us to evaluate experimental control?

Full Bubble: The study includes three data points or sufficient number to document a stable performance within that phase. There is the opportunity for at least three demonstrations of experimental control.* Half Bubble: The study includes one or two data points within a phase. There is the opportunity for two demonstrations of experimental control. Or, the study is a non-concurrent multiple baseline design. Empty Bubble: Fails full and half bubble. 13 Study Quality: Fidelity of Implementation Study Quality Intervention Study Kamps, Conklin, & Wills (in press) Study Type Single Case Fidelity of Implementation (Group Design) Kamps, Wills, Heitzman-Powell, Single Case

Szoke, Hobohm, & Culey (2011) Fidelity of Measures Implementation Targeted Design

Was it clear that the intervention program was implemented as it is designed to be used? Class-Wide FunctionRelated Intervention TeamsMeasurement of fidelity of implementation was conducted adequately* and observed with adequate agreement (e.g., between .8 and 1.0) or permanent Wills, Kamps,intercoder Fleming, Miller, & Group Full Bubble: product, levels of fidelity indicate that the intervention program was implemented Hansenand (draft paper) as intended (e.g., a reasonable average across multiple measures, or 75% or above

for a single measure). Schmidt (s)of fidelity of implementation Singlewas Case Measurement conducted adequately and observed with adequate intercoder agreement (e.g., between .8 and 1.0) or permanent product, but levels of fidelity are moderate (e.g., an average below 60% across multiple measures, 60%-75% for a single measure); Half Bubble: Measures Broader Participants OR Levels of fidelity indicate that the intervention program was implemented as intended (e.g., a reasonable average across multiple measures, or 75% or above for a single measure), but measurement of fidelity of implementation either was not conducted adequately or was not observed with adequate intercoder agreement or permanent product. Empty Bubble: Fails full and half bubble. 14 Study Quality: Measures Study Quality Intervention

Study Measures Kamps, Conklin, & Wills (in (Group Design) press) Study Type

Single Case Broader Outcome Measures Kamps, Wills, Heitzman-Powell, Single Case & Culey (2011)Measure(s) assess outcomes not directly Measure(s)Szoke, directlyHobohm, assess behaviors targeted by the intervention. Empirical targeted by the intervention. Empirical Class-Wide Functionevidence evidence (e.g., psychometrics, interRelated Intervention Teams (e.g., psychometrics, interobserver agreement) of the

quality of agreement) of the quality of Wills, Kamps, Fleming, Miller, &observerGroup Full Bubble: each targeted measure was provided each related measure was provided for Hansen (draft paper) for the current sample and results are adequate (e.g., IOA between .8 and 1.0 for all measures). Schmidt (s) Measures Broader Design Were the study measures accurate and important? Targeted Outcome Measures Fidelity of Measures Implementation Targeted Participants

the current sample and results are adequate (e.g., IOA between .8 and 1.0 for all measures). Single Case Half Bubble: Measure(s) directly assess behaviors targeted by the intervention. Empirical evidence (e.g., psychometrics, interobserver agreement) of the quality of most or all targeted measure was provided for the current sample, but results were adequate only for some measures or were marginally acceptable. Measure(s) assess outcomes not directly targeted by the intervention. Empirical evidence (e.g., psychometrics, interobserver agreement) of the quality of most or all related measures was provided for the current sample, but results were adequate only for some measures or were marginally acceptable. Empty Bubble: Fails full and half bubble. Fails full and half bubble. Dash:

No targeted measures used in the study. No broader measures used in the study. 15 Pop-Up Data: Participants Study Quality Intervention Study Study Type Participants Design Fidelity of Measures Implementation Targeted Measures Broader Kamps, Conklin, & Wills (in press) Single Case

Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group

Single Case Class-Wide FunctionRelated Intervention Teams Schmidt (s) 16 Pop-Up Data: Design Study Quality Intervention Study Study Type Participants Design

Fidelity of Measures Implementation Targeted Measures Broader Kamps, Conklin, & Wills (in press) Single Case Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case

Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group Single Case Class-Wide FunctionRelated Intervention Teams Schmidt (s)

17 Pop-Up Data: Fidelity of Implementation Study Quality Intervention Study Study Type Participants Design Fidelity of Measures Implementation Targeted Measures Broader Kamps, Conklin, & Wills (in press) Single Case

Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group Single Case

Class-Wide FunctionRelated Intervention Teams Schmidt (s) 18 Pop-Up Data: Measures Study Quality Intervention Study Study Type Participants Design Fidelity of Measures Implementation Targeted Measures

Broader Kamps, Conklin, & Wills (in press) Single Case Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Wills, Kamps, Fleming, Miller, & Hansen (draft paper)

Group Single Case Class-Wide FunctionRelated Intervention Teams Schmidt (s) 19 Study Results Study Results Mean ES Targeted

Intervention Study Study Type Analysis Measure ES - Visual (Single-Case Broader Designs) Disaggregated Outcome Data Available for Demographic Subgroups Kamps, Conklin, & Wills (in press) Single Case n/a n/a n/a Kamps, Wills, Heitzman-Powell,

Szoke, Hobohm, & Culey (2011) Single Case n/a n/a n/a Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 0.93* n/a No Single Case n/a n/a

n/a Class-Wide FunctionRelated Intervention Teams Schmidt (s) 20 Study Results: Effect Size Study Results Mean ES Targeted Intervention Study Study Type Analysis Measure ES - Visual (Single-Case Broader Designs) Disaggregated Outcome Data Available for Demographic Subgroups Kamps, Conklin, & Wills (in press)

Single Case n/a n/a n/a Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case n/a n/a n/a Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 0.93* n/a

No Single Case n/a n/a n/a Class-Wide FunctionRelated Intervention Teams Schmidt (s) 21 Study Results: Visual Analysis Study Results Mean ES Targeted Intervention Study Study Type Analysis Measure ES - Visual (Single-Case Broader

Designs) Disaggregated Outcome Data Available for Demographic Subgroups Kamps, Conklin, & Wills (in press) Single Case n/a n/a n/a Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case n/a n/a n/a

Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 0.93* n/a No Single Case n/a n/a n/a Class-Wide FunctionRelated Intervention Teams Schmidt (s) 22 Effect Size Pop-Up Study Results Mean ES Targeted

Intervention Study Study Type Analysis Measure ES - Visual (Single-Case Broader Designs) Disaggregated Outcome Data Available for Demographic Subgroups Kamps, Conklin, & Wills (in press) Single Case n/a n/a n/a Kamps, Wills, Heitzman-Powell,

Szoke, Hobohm, & Culey (2011) Single Case n/a n/a n/a Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 0.93* n/a No Single Case n/a n/a

n/a Class-Wide FunctionRelated Intervention Teams Schmidt (s) 23 Visual Analysis Pop-Up Study Results Mean ES Targeted Intervention Study Study Type Analysis Measure ES - Visual (Single-Case Broader Designs) Disaggregated Outcome Data Available for Demographic Subgroups Kamps, Conklin, & Wills (in press)

Single Case n/a n/a n/a Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case n/a n/a n/a Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 0.93* n/a

No Single Case n/a n/a n/a Class-Wide FunctionRelated Intervention Teams Schmidt (s) 24 Program Information Program Information Intervention Study Study Type Target Behavior(s) Delivery Fidelity of

Implementation Checklist Available Minimum Interventionist Requirements Kamps, Conklin, & Wills (in press) Single Case Externalizing Small groups (n = 3-25), Classrooms Yes Paraprofessional 48 hours of training Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Externalizing Small groups

(n = 3-25), Classrooms Yes Paraprofessional 48 hours of training Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group Externalizing Small groups (n = 3-25), Classrooms Yes Paraprofessional 48 hours of training Single Case Externalizing Small groups (n = 3-25), Classrooms

Yes Paraprofessional 48 hours of training Class-Wide FunctionRelated Intervention Teams Schmidt (s) 25 Program Information Pop-Up Data Program Information Intervention Study Study Type Target Behavior(s) Delivery Fidelity of Implementation Checklist Available Minimum Interventionist

Requirements Kamps, Conklin, & Wills (in press) Single Case Externalizing Small groups (n = 3-25), Classrooms Yes Paraprofessional 48 hours of training Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case Externalizing Small groups (n = 3-25), Classrooms Yes Paraprofessional

48 hours of training Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group Externalizing Small groups (n = 3-25), Classrooms Yes Paraprofessional 48 hours of training Single Case Externalizing Small groups (n = 3-25), Classrooms Yes Paraprofessional 48 hours of training

Class-Wide FunctionRelated Intervention Teams Schmidt (s) 26 Additional Research Additional Research Intervention Study Study Type Additional Research Studies Intervention Reviewed by on the Intervention What Works Clearinghouse Kamps, Conklin, & Wills (in press) Single Case 1 Study No Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case 1 Study

No Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 1 Study No Single Case 1 Study No Class-Wide FunctionRelated Intervention Teams Schmidt (s) 27 Additional Research Pop-Up Data Additional Research Intervention Study Study Type Additional Research Studies Intervention Reviewed by

on the Intervention What Works Clearinghouse Kamps, Conklin, & Wills (in press) Single Case 1 Study No Kamps, Wills, Heitzman-Powell, Szoke, Hobohm, & Culey (2011) Single Case 1 Study No Wills, Kamps, Fleming, Miller, & Hansen (draft paper) Group 1 Study No Single Case 1 Study

No Class-Wide FunctionRelated Intervention Teams Schmidt (s) 28 NCII Tools Chart: Cautions The tools chart is not an exhaustive list of behavioral interventions. All submitted products are reviewed and results posted; in other words, not all interventions on the chart have positive reviews! When reviewing and selecting EBIs, consider your population and the function of the behavior you are addressing. The tools chart is not intended to solve all your problems. However, it is a good place to start. 29 What Are EBIs in Schools? Tier 1Whole-school best practices Tier 2Functionally related small-group practices Tier 3Individually and functionally based EBI NOTE: EBIs are very different things in Tiers 1 and 2 than Tier 3! This is a critical and not wellunderstood issue. Tier 3 (5%)

Functionally Based EBI Tier 2 (15%) Functionally Related SmallGroup and Individual EBI Tier 1 (80%) Evidence-Based Curricula 30 Tiers 2 and 3EBI Fine Print I EBIs are validated for a specific purpose with a specific population. Implication EBIs are only useful for a range of problems and, as such, must be paired up with the right situation. A hammer is an effective tool, but not with a screw. 31 Tiers 2 and 3EBI Fine Print II EBIs assume implementation integrity. Implication Changing parts of an intervention, while typical, can invalidate the EBI. Ways to change an intervention Frequency Materials Target Style

32 Tiers 2 and 3EBI Fine Print III EBIs are typically validated with large-group research or a series of small-group studies. Implication EBIs have been documented as likely effective, not surely effective. Even the most effective interventions are often ineffective with a specific case. As such, you cannot assume an EBI will always work. 33 Implications of the Fine Print A list of EBIs is just a nice place to start. Additional needed steps Select the EBI that makes sense for the current case. Implement the EBI with integrity. Evaluate the effectiveness in some manner to see if it worked. 34 General Goal of Intervention Selection Make a sound decision quickly.

Try the selected intervention. Evaluate the intervention. Recycle or escalate if necessary. 35 Functional EBI Selection With or Extended Analysis Practical Functional Assessment and Analysis 36 Lets Talk About Functional Assessment What does this term refer to? What does this look like in practice? What happened to the analysis? 37 School-Based Functional Assessment in 2012 A high-incidence approach Flexible rather than prescriptive Focused on intervention effectiveness rather than functional documentation Multi-function Followed by functional analysis rather than done in

isolation 38 Common Reasons Why Students Misbehave Class-wide problems exist. Students have not learned the proper behavior. Inappropriate behavior removes students from what they do not want to do (escape). Inappropriate behavior gets students something (typically attention). They have not had to do the behavior in that way before. 39 Selecting EBIs That Align With Function Examples Good Behavior Game Check In Check Out (CICO) Non-contingent reinforcement (NCR)attention seeking Antecedent modificationescape Instructional matchprerequisite or skill/ability http://miblsi.cenmi.org/ 40 Class-wide Problems Sometimes multiple children in the classroom are exhibiting similar behavior problems. Solution: A class-wide behavior intervention! EBI Network Intervention: Good Behavior Game

http://ebi.missouri.edu/wp-content/uploads/2011/09/Good-BehaviorGame.pdf 41 Selecting EBIs That Align With Function What is CICO? Empirically supported strategy for reducing problem behavior Relatively quick and easy; provides structure Increases positive adult contact Excellent intervention when function of behavior is attention seeking Also useful for kids who escape because they do not want to do a task if teacher praise is more reinforcing than the task is punishing http://miblsi.cenmi.org/ 42 Selecting EBIs That Align With Function Who is CICO for? Engages in externalizing behaviors Less than 15 percent of students Students with multiple referrals (two to five majors) Students who receive several minor referrals Students who receive referrals in multiple settings Students who find adult attention rewarding http://miblsi.cenmi.org/ 43 http://miblsi.cenmi.org/

44 Selecting EBIs That Align With Function Non-contingent reinforcement (NCR) 45 Selecting EBIs That Align With Function Brief description of NCR Giving students access to a reinforcer frequently enough that they are no longer motivated to exhibit disruptive behavior to obtain that same reinforcer For example, saturate the environment with the reinforcer BEFORE the behavior occurs. ebi.missouri.edu 46 Selecting EBIs That Align With Function Example: Student wants teacher attention and calls out or engages in disruptive behaviors to get attention consistently during a group activity such as art or story time. Possible Solution: Teacher provides appropriate attention prior to the child asking for attention with the problem behavior, such as having the student sit with the teacher while she is reading the book.

47 Selecting EBIs That Align With Function Antecedent modification http://ebi.missouri.edu/ 48 Selecting EBIs That Align With Function Brief description of antecedent modification Students do not have to do something when they exhibit the problem behavior. The problem behavior is working for students by allowing them to escape something they do not want to do. http://ebi.missouri.edu/ 49 Selecting EBIs That Align With Function Example Student wants to escape a non-preferred activity, such as mathematics or gym. Every time the teacher announces the start of the specific activity, the student starts engaging in disruptive behaviors (e.g., runs away, shouts out, pretends to sleep). Possible Solutions Minimize need for the escape by making the target activity less punishing! Alter antecedents to increase task engagement, appropriate behaviors, and

general success. For example, preteaching, offering choices, and modeling http://ebi.missouri.edu/ 50 Selecting EBIs That Align With Function Instructional Match 51 Selecting EBIs That Align With Function Brief description and function Escape behavior related to academic tasks that are simply too hard Instructional materials are too difficult. Child may not have the prerequisite skills. Children who are failing academically are frustrated and often act out! http://ebi.missouri.edu/ 52 Selecting EBIs That Align With Function Examples Addition mathematics problems without being able to count Journal writing without being able to form two- or three-word

sentences Drawing without fine motor skills, such as pencil grip Running without proper gait Possible Solutions Preteach content or skill. Reduce the task difficulty. Break down tasks into smaller, more manageable subtasks. Administer a curriculum-based assessment or measurement to determine the appropriate instructional level. Can only walk on tippy toes http://ebi.missouri.edu/ 53 NCII Tools Chart 54 The Evidence Based Intervention (EBI) Network http://ebi.missouri.edu/ 55 EBI Network Created and maintained by the University of Missouri, Indiana

University, and East Carolina University school psychology programs. Presents EBI associated with the five common reasons for academic and social behavior problems each year. 56 EBI Network Main Page 57 EBI Network Academic Interventions Page 58 EBI Network Behavioral Interventions Page 59 EBI Network Sample Intervention Brief 60 EBI Network Sample Intervention Modeling YouTube Video 61 Additional Resources DBI Training Modules

Using Functional Behavior Assessment for Diagnostic Assessment in Behavior http://www.intensiveintervention.org/resource/using-fba-diagnostic-assessme nt-behavior-dbi-training-series-module-6 Designing and Delivering Intensive Intervention in Behavior http://www.intensiveintervention.org/resource/designing-and-delivering-inten sive-intervention-behavior-dbi-training-series-module-8 62 Additional Resources Ask the Expert Videos http://www.intensiveintervention.org/resources/ask-the-expert Dr. Chris Riley-TillmanHow does the use of evidence-based practices and the approach to instruction and intervention change as behavior or academic issues become more severe? Dr. Lee KernWhy is it important for schools to focus on intensive behavioral interventions? 63 Questions? Allison Gandhi [email protected] Chris Riley-Tillman [email protected] 1000 Thomas Jefferson St. NW Washington, DC 20009 www.intensiveintervention.org [email protected]

Although permission to redistribute this webinar is not necessary, the citation should be: National Center on Intensive Intervention. (2014). What is an EvidenceBased Behavior Intervention? Choosing and Implementing Behavior Interventions That Work. Washington, DC: U.S. Department of Education, Office of Special Education Programs, National Center on Intensive Intervention. 65 NCII Disclaimer This presentation was produced under the U.S. Department of Education, Office of Special Education Programs, Award No. H326Q110005. Celia Rosenquist serves as the project officer. The views expressed herein do not necessarily represent the positions or polices of the U.S. Department of Education. No official endorsement by the U.S. Department of Education of any product, commodity, service, or enterprise mentioned in this website is intended or should be inferred. 66

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