1. Tier 3 Development and Implementation in
Adult Services
Justin Kelly, M.A., Melissa Strout, M.A., Undrea Cato-Steele, M.Ed., BCBA and
Michelle Graham-Freeman, M.Ed., BCBA
May Institute Adult Services, Eastern Mass.
Results
www.mayinstitute.org
Introduction
The Eastern Mass Adult Services Tier 3 team
was developed in January 2016, and consists of:
the center’s Vice President, Director of Clinical
Services, Residential Directors, Day Program
Directors, Assistant Clinical Directors, Assistant
Residential Directors, and Quality Improvement
Coordinator. The meeting is facilitated by The
May Institute’s PBIS Coordinator.
High risk individuals and those formerly on Level
2 Behavior Support Plans were added to the Tier
3 discussion and data review, and monitored for
response to intervention(s).
Outside of monthly meetings, the clinical team
reviews the data recurrently and discusses new
cases to be added, as well as targeted
interventions/ BSP revisions (for review by the
larger, Tier 3 Team). Each team member has
the opportunity at the conclusion of the monthly
meeting to make suggestions for additional
individuals to be reviewed. This process has
increased communication amongst the team,
and ensured quality service delivery.
Information discussed, and treatment changes/
recommendations are brought back to the site
level and reviewed with the team.
Implementation is consistently reviewed by the
clinical team for treatment integrity.
Emass Tier 3
-10 Individuals
- 5 males, 5 females
- Age Range: 22 to 58
- Primary Diagnoses: ASD and Intellectual
Disability
- All attend and/ or live in May Institute Day
Programs and Residential Group Homes
- Primary Behaviors of Individuals reviewed:
Aggression, Property Destruction, Elopement,
Self-Injurious Behavior
Results
-Those who are classified as “responders” average approx. 48% per month
-Tier 3 meetings have proven beneficial in terms of offering a quick analysis of high risk
behaviors.
- Reviews have promoted quicker response turn-around and oversight of “non-responders”
by all team members.
-The Tier 3 Team continues remains mindful of those responding to intervention;
completing regular integrity checks to insure their ongoing stability and staff consistency
-The team also determines criteria for removal for those individuals who have shown to be
consistent “responders”.