RTI: An Intervention-Based Approach to Identification and Treatment of EBD Frank M. Gresham, Ph.D. Louisiana State Univers...
Some Issues in ED Determination <ul><li>Students with emotional/behavioral challenges unserved/underserved </li></ul><ul><...
Let’s Play the Logic Game <ul><li>Frank is socially maladjusted. </li></ul><ul><li>Frank therefore cannot be emotionally d...
Some Numbers 27 th  Annual Report to Congress (2005) CA (6-21 yrs.) US (6-21 yrs.) ED SLD MR CA under-identifies (under-se...
Prevalence Rate Relative to Population CA US ED SLD MR 0.29% 0.72% 4.11% 4.33% 0.44% 0.90%
The Real Culprit IDEIA Definition <ul><li>Chronicity  (“Long period of time”) </li></ul><ul><li>Severity  (“To a marked de...
Social Maladjustment Exclusion Clause <ul><li>Conceptually illogical </li></ul><ul><li>Over 20 published articles question...
RTI:  Provision of high-quality interventions matched to student need, frequent progress monitoring to guide decisions abo...
NASP Position Statement on ED <ul><li>“ ED is more than a transient, expected response to stressors in the child’s or yout...
What is Scientifically-Based Knowledge? <ul><li>Scientifically-based knowledge involves the application of rigorous, syste...
What Are Some Evidence-Based Behavioral Interventions? <ul><li>Group Contingencies (Good Behavior Game) </li></ul><ul><li>...
Evidence-Based Treatments for DSM Categories ( Journal of Clinical Child and Adolescent Psychology  (2008),  37 , pp. 1-30...
Fundamental Principles of RTI <ul><li>Intensity of intervention matched to degree of unresponsiveness </li></ul><ul><li>Mo...
Advantages of RTI <ul><li>Early identification of learning/behavior problems  </li></ul><ul><li>Conceptualizes learning/be...
Comparison of Traditional & RTI Assumptions <ul><li>Indirect measurement </li></ul><ul><li>Within-child focus </li></ul><u...
What You  Won’t  See in a RTI Assessment <ul><li>“ Draw-a-Something” Measures  </li></ul><ul><li>Apperception Tests  </li>...
Problem-Solving Logic in RTI <ul><li>What is the problem? </li></ul><ul><ul><li>Discrepancy between expected & current lev...
Assessment Principles in RTI <ul><li>Purposes of Assessment </li></ul><ul><ul><li>Referral </li></ul></ul><ul><ul><li>Scre...
Basic Principles of Screening for EBD in Schools <ul><li>Similar logic to other fields (e.g., medicine) </li></ul><ul><ul>...
A Useful Behavior Screening Tool: Systematic Screening for Behavior Disorders Walker & Severson (1990) <ul><li>Multiple Ga...
SSBD (continued) <ul><li>Gate 1 </li></ul><ul><ul><li>Teachers rank order class on internalizing & externalizing behavior ...
Decision Rules for SSBD Screening At Risk Not At Risk Risk Indicator Present Risk Indicator Absent Accuracy=Correct Decisi...
Another Useful Screening Tool: Student Risk Screening Scale  (Drummond, 1993) Steals Lie, Cheat Bx Prob. Peer Reject Low A...
3-Tier Model of RTI Intervention <ul><li>Universal Intervention </li></ul><ul><ul><li>All students </li></ul></ul><ul><ul>...
Types of RTI <ul><li>Preventive RTI </li></ul><ul><ul><li>Universal prevention (“primary prevention”) </li></ul></ul><ul><...
Multi-Tier Social Skills Interventions Social Skills Improvement System (Gresham & Elliott, 2008) <ul><li>Classwide Interv...
Classwide Intervention Program (continued) <ul><li>6-Step Instructional  Sequence </li></ul><ul><ul><li>Tell (Coaching) </...
SSIS  Intervention Guide Tier 2 Selected Intervention <ul><li>Designed for weak responders to CIP </li></ul><ul><li>Teache...
FBA Replacement Behavior Training Tier 3 Intensive Intervention <ul><li>Designed for weak responders to Tier 2 Interventio...
FBA Replacement Behavior Training (continued) <ul><li>Intervention Strategies  </li></ul><ul><ul><li>Antecedent Strategies...
Responsiveness to Intervention Model     Degree of Unresponsiveness to Intervention LOW HIGH HIGH Intensity of treatment L...
Classification of RTI Outcomes Outcome Status Inadequate Responder Adequate Responder Accuracy=Correct Decisions Relative ...
Measurement of Responsiveness Standards & Procedures <ul><li>Academics (CBM) </li></ul><ul><ul><li>Norms </li></ul></ul><u...
Brief Behavior Rating Scale (Weekly) Difficulty paying attention  Never  Sometimes  Often  Almost Always Difficulty organi...
Treatment Integrity An Essential Component of RTI <ul><li>Extent to which intervention is implemented as planned </li></ul...
Treatment Integrity & Behavior Change Adequate Behavior Change Inadequate Behavior Change Implemented As Planned Not Imple...
Ways of Expressing Integrity <ul><li>Percentage of intervention steps implemented </li></ul><ul><li>Intervention manual  <...
Some RTI References <ul><li>Gresham, F.M. (2002). Responsiveness to intervention: An alternative approach to the identific...
T H A N K  Y O U Questions? Laizzez le bon temps rouler !
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RTI: An Intervention-Based Approach to Delivering Services to Students At-Risk for Emotional and Behavioral Disorders

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Frank Gresham, Ph.D. Louisiana State University
RTI: An Intervention-Based Approach to Delivering Services to Students At-Risk for Emotional and Behavioral Disorders. Almost 20% of school-age students could qualify for a mental health diagnosis, however less than 1% of these students are served in schools as emotionally disturbed. Students with these emotional and behavioral challenges are therefore either unserved or underserved in American schools. Most of these children experience a number of difficulties in the development and maintenance of satisfactory interpersonal relationships with peers and teachers. This presentation focuses on the development and implementation of multiple tiers of social skills instructional interventions that are evidence-based and effective. Issues of screening, assessment, and program evaluation are discussed.

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RTI: An Intervention-Based Approach to Delivering Services to Students At-Risk for Emotional and Behavioral Disorders

  1. 1. RTI: An Intervention-Based Approach to Identification and Treatment of EBD Frank M. Gresham, Ph.D. Louisiana State University [email_address]
  2. 2. Some Issues in ED Determination <ul><li>Students with emotional/behavioral challenges unserved/underserved </li></ul><ul><li>Students often create chaotic classroom or school environments </li></ul><ul><li>Prevalence rate for ED projected @ 2% but always has been <1% </li></ul><ul><li>ED shows greatest state variability than any of 13 disability groups </li></ul><ul><li>ED definition: </li></ul><ul><ul><li>Vague </li></ul></ul><ul><ul><li>Confusing </li></ul></ul><ul><ul><li>Contradictory (bordering on the oxymoronic) * </li></ul></ul><ul><li>Estimates suggest that 20% of kids in schools need mental health services </li></ul><ul><li>Schools often believe they are not responsible for mental health services </li></ul><ul><li>Schools often see conduct problems as responsibility other agencies </li></ul><ul><li>“ The term does not include children who are socially maladjusted, unless it is determined that they are seriously emotionally disturbed.” </li></ul>
  3. 3. Let’s Play the Logic Game <ul><li>Frank is socially maladjusted. </li></ul><ul><li>Frank therefore cannot be emotionally disturbed. </li></ul><ul><li>Frank is determined to be emotionally disturbed. </li></ul><ul><li>Frank is both socially maladjusted & emotionally disturbed. </li></ul><ul><li>??????? </li></ul>
  4. 4. Some Numbers 27 th Annual Report to Congress (2005) CA (6-21 yrs.) US (6-21 yrs.) ED SLD MR CA under-identifies (under-serves???) ED and MR and overserves SLD relative to US average 4.4% 8.0% 54.4% 47.4% 5.2% 9.6%
  5. 5. Prevalence Rate Relative to Population CA US ED SLD MR 0.29% 0.72% 4.11% 4.33% 0.44% 0.90%
  6. 6. The Real Culprit IDEIA Definition <ul><li>Chronicity (“Long period of time”) </li></ul><ul><li>Severity (“To a marked degree”) </li></ul><ul><li>Outcome (“Adversely affects educational performance”) </li></ul><ul><li>Characteristics </li></ul><ul><ul><li>Inability to learn </li></ul></ul><ul><ul><li>Inability to build or maintain satisfactory interpersonal relationships </li></ul></ul><ul><ul><li>Inappropriate types of behavior under normal circumstances </li></ul></ul><ul><ul><li>General pervasive mood of unhappiness or depression </li></ul></ul><ul><ul><li>Tendency to develop physical symptoms or fears associated with personal or school problems </li></ul></ul><ul><ul><li>Does not include social maladjustment, unless student is ED (???) </li></ul></ul>
  7. 7. Social Maladjustment Exclusion Clause <ul><li>Conceptually illogical </li></ul><ul><li>Over 20 published articles question and refute its existence </li></ul><ul><li>IDEIA statute provides no definition of SM </li></ul><ul><li>IDEIA regulations provide not guidelines for distinguishing SM from ED </li></ul><ul><li>About ½ of the states ignore social maladjustment exclusion </li></ul><ul><li>Many psychological disorders are co-morbid </li></ul><ul><ul><li>Conduct Disorder + Depression </li></ul></ul><ul><ul><li>Oppositional Defiant Disorder + ADHD </li></ul></ul><ul><ul><li>Conduct Disorder + ADHD </li></ul></ul><ul><ul><li>“ A youngster cannot be socially maladjusted by any credible interpretation of the term without exhibiting one or more of the five characteristics to a marked degree and over a long period of time.” (Kauffman, 1997, p. 28) </li></ul></ul>
  8. 8. RTI: Provision of high-quality interventions matched to student need, frequent progress monitoring to guide decisions about changes in interventions, and using student data to guide important educational decisions.* <ul><li>High-Quality Instruction/Intervention </li></ul><ul><ul><li>Matched to student need </li></ul></ul><ul><ul><li>Scientifically-based </li></ul></ul><ul><ul><li>Individually-based </li></ul></ul><ul><li>Learning Rate and Level of Performance </li></ul><ul><ul><li>Rate=Growth over time compared to peers </li></ul></ul><ul><ul><li>Level=Relative standing on dimension of achievement/behavior </li></ul></ul><ul><ul><li>Data-based decision making (decisions based on student data) </li></ul></ul><ul><li>Important Educational Decisions </li></ul><ul><ul><li>Based on individual response </li></ul></ul><ul><ul><li>Across multiple tiers of intervention </li></ul></ul><ul><ul><li>Decisions made about </li></ul></ul><ul><ul><ul><li>Intensity of intervention </li></ul></ul></ul><ul><ul><ul><li>Special education eligibility </li></ul></ul></ul><ul><ul><ul><li>Exiting special education </li></ul></ul></ul>* National Association of State Directors of Special Education (2005)
  9. 9. NASP Position Statement on ED <ul><li>“ ED is more than a transient, expected response to stressors in the child’s or youth’s environment and would persist even with individualized interventions.” </li></ul><ul><li>“ No single diagnosis should be used to deny services to students. The impact of the behavior on the student’s educational progress must be the guiding principle for identification.” * </li></ul><ul><li>“ Persistence: The extent to which difficulties have continued despite the use of well-planned, empirically-based and individualized intervention strategies provided within the least restrictive environment. </li></ul>*Social Maladjustment Exclusion Clause
  10. 10. What is Scientifically-Based Knowledge? <ul><li>Scientifically-based knowledge involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to educational activities and programs </li></ul><ul><li>Scientifically-based knowledge is: </li></ul><ul><ul><li>Objective </li></ul></ul><ul><ul><li>Involves direct measurement </li></ul></ul><ul><ul><li>Reliable and valid </li></ul></ul><ul><ul><li>Based on high quality experimental design </li></ul></ul><ul><ul><li>Rules out alternative explanations </li></ul></ul><ul><ul><li>High sensitivity (high true positive rates) </li></ul></ul><ul><ul><li>High specificity (high true negative rates) </li></ul></ul><ul><li>Pseudoscience (4 out of 5 dentists recommend Crest) </li></ul><ul><li>Nonscience (My kid learned to read with Whole Language) </li></ul><ul><li>Nonsense (A child cannot be ED if he/she is socially maladjusted) </li></ul>
  11. 11. What Are Some Evidence-Based Behavioral Interventions? <ul><li>Group Contingencies (Good Behavior Game) </li></ul><ul><li>Token/Point Systems ( with response cost component) </li></ul><ul><li>Replacement Behavior Training (teaching functionally equivalent behaviors) </li></ul><ul><li>Differential Reinforcement (DRO/DRA/DRI/DRL) </li></ul><ul><li>Antecedent-Based </li></ul><ul><ul><li>Choice (preferred activities) </li></ul></ul><ul><ul><li>Task interspersal </li></ul></ul><ul><ul><li>Modification of task difficulty </li></ul></ul><ul><ul><li>Precorrection </li></ul></ul><ul><li>Classroom-Based Behavioral Consultation </li></ul><ul><li>Performance Feedback (teachers’ integrity) </li></ul><ul><li>Self-Monitoring </li></ul>
  12. 12. Evidence-Based Treatments for DSM Categories ( Journal of Clinical Child and Adolescent Psychology (2008), 37 , pp. 1-301) <ul><li>Disruptive Behavior Disorders (CD/ODD) </li></ul><ul><ul><li>Anger Control Training (CBM-based intervention) </li></ul></ul><ul><ul><li>Behavioral Parent Training </li></ul></ul><ul><ul><li>First Steps to Success (classroom-based behavioral intervention) </li></ul></ul><ul><ul><li>Multisystemic Therapy (family/community-based treatment) </li></ul></ul><ul><li>ADHD </li></ul><ul><ul><li>Behavioral Parent Training </li></ul></ul><ul><ul><li>Behavioral Classroom Management </li></ul></ul><ul><li>Anxiety Disorders </li></ul><ul><ul><li>Individual Cognitive Behavior Therapy </li></ul></ul><ul><ul><li>Group Cognitive Behavior Therapy </li></ul></ul><ul><ul><li>Exposure-Based Therapies (specific fears/phobias) </li></ul></ul><ul><li>Depression </li></ul><ul><ul><li>Cognitive Behavior Therapy (Individual) </li></ul></ul><ul><ul><li>Cognitive Behavior Therapy (Group) </li></ul></ul>
  13. 13. Fundamental Principles of RTI <ul><li>Intensity of intervention matched to degree of unresponsiveness </li></ul><ul><li>Movement through tiers based on inadequate response </li></ul><ul><li>Decisions regarding movement based data from multiple sources </li></ul><ul><li>Increasing body of data collected to inform decision-making </li></ul><ul><li>Change in intervention considered only after inadequate response </li></ul><ul><li>Intervention delivery approaches </li></ul><ul><ul><li>Problem solving (consultation) </li></ul></ul><ul><ul><li>Standard protocol </li></ul></ul>
  14. 14. Advantages of RTI <ul><li>Early identification of learning/behavior problems </li></ul><ul><li>Conceptualizes learning/behavior problems from risk rather than deficit model </li></ul><ul><li>Reduction of identification biases (overrepresentation) </li></ul><ul><li>Strong focus on student outcomes </li></ul><ul><ul><li>Measures & domains based on relationships to child outcomes </li></ul></ul><ul><ul><li>Documents relationships to positive child outcomes </li></ul></ul><ul><ul><li>Emphasizes direct measurement of achievement, behavior, & the instructional environment </li></ul></ul><ul><ul><li>Focuses on measurable and changeable aspects of instructional environment </li></ul></ul><ul><ul><li>Identifies ABT students ( Ain’t Been Taught ) </li></ul></ul>
  15. 15. Comparison of Traditional & RTI Assumptions <ul><li>Indirect measurement </li></ul><ul><li>Within-child focus </li></ul><ul><li>Nomothetic (groups) </li></ul><ul><li>Moderate-high inference </li></ul><ul><li>Behavioral stability </li></ul><ul><li>Static, 1-shot assessment </li></ul><ul><li>Lack of treatment validity </li></ul><ul><li>Direct measurement </li></ul><ul><li>Environmental focus </li></ul><ul><li>Idiographic (individual) </li></ul><ul><li>Low inference </li></ul><ul><li>Behavioral variability </li></ul><ul><li>Continuous progress monitoring </li></ul><ul><li>Treatment validity </li></ul>Traditional RTI
  16. 16. What You Won’t See in a RTI Assessment <ul><li>“ Draw-a-Something” Measures </li></ul><ul><li>Apperception Tests </li></ul><ul><li>Rorschach Test </li></ul><ul><li>MMPI </li></ul><ul><li>WHY? </li></ul><ul><ul><li>Because none of the above are directly related to child outcomes and are not useful in either planning interventions or progress monitoring the effects of interventions. </li></ul></ul><ul><ul><li>This type of information is superfluous to data-based decision making in RTI </li></ul></ul><ul><ul><li>Almost all are technically inadequate based on the Test Standards </li></ul></ul>
  17. 17. Problem-Solving Logic in RTI <ul><li>What is the problem? </li></ul><ul><ul><li>Discrepancy between expected & current levels of performance </li></ul></ul><ul><ul><li>100% homework completion expected but only 20% completed </li></ul></ul><ul><ul><li>Problems can be defined differently by different individuals </li></ul></ul><ul><li>Why is the problem happening? </li></ul><ul><ul><li>Can’ do </li></ul></ul><ul><ul><li>Won’t do </li></ul></ul><ul><ul><li>Low inference </li></ul></ul><ul><li>What should be done about it? </li></ul><ul><ul><li>Antecedent strategies </li></ul></ul><ul><ul><li>Consequent strategies </li></ul></ul><ul><ul><li>Instructional strategies </li></ul></ul><ul><li>Did it work? </li></ul><ul><ul><li>Data-based decision making </li></ul></ul><ul><ul><li>Benchmarks </li></ul></ul><ul><ul><li>Social validation </li></ul></ul>
  18. 18. Assessment Principles in RTI <ul><li>Purposes of Assessment </li></ul><ul><ul><li>Referral </li></ul></ul><ul><ul><li>Screening </li></ul></ul><ul><ul><li>Classification </li></ul></ul><ul><ul><li>Intervention planning </li></ul></ul><ul><ul><li>Continuous progress monitoring </li></ul></ul><ul><ul><li>Program evaluation </li></ul></ul><ul><li>Types of Assessment Data </li></ul><ul><ul><li>Direct observations of behavior </li></ul></ul><ul><ul><li>Permanent products </li></ul></ul><ul><ul><li>Behavior ratings </li></ul></ul><ul><ul><li>Daily Behavior Reports </li></ul></ul><ul><li>Assessment Principles </li></ul><ul><ul><li>Problem Solving </li></ul></ul><ul><ul><li>Low Inference </li></ul></ul><ul><ul><li>Functional Assessment </li></ul></ul><ul><ul><li>Multiple Operationalism </li></ul></ul><ul><ul><li>Assessment Quality </li></ul></ul><ul><ul><li>Social Validity </li></ul></ul>
  19. 19. Basic Principles of Screening for EBD in Schools <ul><li>Similar logic to other fields (e.g., medicine) </li></ul><ul><ul><li>PSA tests </li></ul></ul><ul><ul><li>PAP smears </li></ul></ul><ul><ul><li>Mammograms </li></ul></ul><ul><li>Instruments must be technically sound </li></ul><ul><ul><li>Low false negative rates </li></ul></ul><ul><ul><li>Low false positive rates (willing to tolerate higher) </li></ul></ul><ul><ul><li>Stable prediction over time </li></ul></ul><ul><ul><li>Cost beneficial (benefits outweigh costs) </li></ul></ul><ul><li>Brief </li></ul><ul><li>Research based </li></ul><ul><li>Easily understood & applied </li></ul>
  20. 20. A Useful Behavior Screening Tool: Systematic Screening for Behavior Disorders Walker & Severson (1990) <ul><li>Multiple Gating Procedure </li></ul><ul><li>Grades 1-6 </li></ul><ul><li>Combination of 3 Assessment Procedures </li></ul><ul><ul><li>Teacher nominations- Gate 1 </li></ul></ul><ul><ul><li>Teacher rating scales – Gate 2 </li></ul></ul><ul><ul><li>Direct observations (classroom & playground)- Gate 3 </li></ul></ul><ul><li>Nationally standardized ( n =4500) </li></ul><ul><li>Normative data </li></ul><ul><li>Extensive reliability & validity data </li></ul><ul><li>Early Screening Project (ages 3-5 years) </li></ul>Published by Sopris West, Longmont, CO
  21. 21. SSBD (continued) <ul><li>Gate 1 </li></ul><ul><ul><li>Teachers rank order class on internalizing & externalizing behavior </li></ul></ul><ul><ul><li>Teacher select top 3 ranks for internalizing & externalizing behavior </li></ul></ul><ul><li>Internalizing : Defined as overcontrolled behavior pattern characterized by social withdrawal, anxiety, and lacking self-confidence </li></ul><ul><li>Externalizing : Defined as an undercontrolled behavior pattern characterized by aggression, bullying, noncompliance, and impulsivity </li></ul><ul><li>Gate 2 </li></ul><ul><ul><li>Teachers ratings & CEI checklist </li></ul></ul><ul><ul><li>Exceed normative criteria; move to next gate </li></ul></ul><ul><li>Gate 3 </li></ul><ul><ul><li>Direct observation in classroom & playground </li></ul></ul><ul><ul><li>Exceed normative criteria; move to intervention phase </li></ul></ul>
  22. 22. Decision Rules for SSBD Screening At Risk Not At Risk Risk Indicator Present Risk Indicator Absent Accuracy=Correct Decisions/All Decisions A+D/A+B+C+D A Accurate Prediction SENSITIVITY B False Positive C False Negative D Accurate Prediction SPECIFICITY
  23. 23. Another Useful Screening Tool: Student Risk Screening Scale (Drummond, 1993) Steals Lie, Cheat Bx Prob. Peer Reject Low Ach Neg. Att. Agg Beh. Total O-Never; 1-Occasionally; 2-Sometimes; 3-Frequently 9-21 High Risk 4-8 Moderate Risk 0-3 Low Risk Frank 1 1 3 2 3 3 3 16 Clay 1 1 0 1 2 1 0 6 Jill 0 0 1 1 1 0 1 4 Luke 2 2 2 2 3 2 3 16 Matt 1 1 0 1 1 1 1 6
  24. 24. 3-Tier Model of RTI Intervention <ul><li>Universal Intervention </li></ul><ul><ul><li>All students </li></ul></ul><ul><ul><li>Schoolwide or classwide </li></ul></ul><ul><ul><li>Examples (reading curriculum, school discipline procedures) </li></ul></ul><ul><ul><li>80-85% will respond </li></ul></ul><ul><li>Selected Interventions </li></ul><ul><ul><li>Classroom strategies </li></ul></ul><ul><ul><li>Small group strategies </li></ul></ul><ul><ul><li>Consultation-based interventions </li></ul></ul><ul><ul><li>About 7-10% of students </li></ul></ul><ul><li>Intensive Interventions </li></ul><ul><ul><li>Individualized interventions </li></ul></ul><ul><ul><li>Intense & powerful (FBA-based interventions) </li></ul></ul><ul><ul><li>3-5% of students </li></ul></ul>
  25. 25. Types of RTI <ul><li>Preventive RTI </li></ul><ul><ul><li>Universal prevention (“primary prevention”) </li></ul></ul><ul><ul><li>Universal screening (2-3 times per year) </li></ul></ul><ul><li>Reactive RTI </li></ul><ul><ul><li>Selected interventions (“secondary prevention”) </li></ul></ul><ul><ul><li>Replaces refer-test-place model for ED </li></ul></ul><ul><li>SPED Eligibility RTI </li></ul><ul><ul><li>Intensive interventions (“tertiary prevention”) </li></ul></ul><ul><ul><li>“ Disability” versus “Need” decisions </li></ul></ul>
  26. 26. Multi-Tier Social Skills Interventions Social Skills Improvement System (Gresham & Elliott, 2008) <ul><li>Classwide Intervention Program (CIP) Tier 1 Universal Intervention </li></ul><ul><ul><li>Provides general education teachers with a structured efficient way to integrate opportunities 10 most important social skills for school success </li></ul></ul><ul><ul><li>CIP has 3 levels </li></ul></ul><ul><ul><ul><li>Preschool/Kindergarten </li></ul></ul></ul><ul><ul><ul><li>Early Elementary (Grades 1-3) </li></ul></ul></ul><ul><ul><ul><li>Late Elementary/Middle (Grades 4-6) </li></ul></ul></ul><ul><ul><li>Top 10 Social Skills (based on responses of over 800 teachers rating over 100 social skills: 0-Not important, 1-Important, 2-Critical) </li></ul></ul><ul><ul><ul><li>Listens to others </li></ul></ul></ul><ul><ul><ul><li>Follows directions </li></ul></ul></ul><ul><ul><ul><li>Follows classroom rules </li></ul></ul></ul><ul><ul><ul><li>Ignores peer distractions </li></ul></ul></ul><ul><ul><ul><li>Asks for help </li></ul></ul></ul><ul><ul><ul><li>Takes turns in conversations </li></ul></ul></ul><ul><ul><ul><li>Cooperates with others </li></ul></ul></ul><ul><ul><ul><li>Controls temper in conflict situations </li></ul></ul></ul><ul><ul><ul><li>Acts responsibly with others </li></ul></ul></ul><ul><ul><ul><li>Shows kindness to others </li></ul></ul></ul>
  27. 27. Classwide Intervention Program (continued) <ul><li>6-Step Instructional Sequence </li></ul><ul><ul><li>Tell (Coaching) </li></ul></ul><ul><ul><li>Show (Modeling) </li></ul></ul><ul><ul><li>Do (Behavioral Rehearsal) </li></ul></ul><ul><ul><li>Practice </li></ul></ul><ul><ul><li>Monitor Progress </li></ul></ul><ul><ul><li>Generalize </li></ul></ul><ul><li>3 lesson per week, 25 minutes per lesson X 10 weeks </li></ul><ul><li>Progress Monitoring Tools </li></ul><ul><li>Treatment Integrity Checks </li></ul>
  28. 28. SSIS Intervention Guide Tier 2 Selected Intervention <ul><li>Designed for weak responders to CIP </li></ul><ul><li>Teaches social skills across 6 domains </li></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Cooperation </li></ul></ul><ul><ul><li>Assertion </li></ul></ul><ul><ul><li>Responsibility </li></ul></ul><ul><ul><li>Empathy </li></ul></ul><ul><ul><li>Self-Control </li></ul></ul><ul><li>Delivered in small pullout group setting (4-6 children) </li></ul><ul><li>2 sessions per week, 45 minutes per session X 15 weeks </li></ul><ul><li>Teaches 20 social skills </li></ul><ul><ul><li>Top 10 retaught </li></ul></ul><ul><ul><li>10 “keystone behaviors” also taught </li></ul></ul><ul><li>Distinguishes acquisition from performance deficits </li></ul>
  29. 29. FBA Replacement Behavior Training Tier 3 Intensive Intervention <ul><li>Designed for weak responders to Tier 2 Intervention Guide </li></ul><ul><li>Identifies competing problem behaviors using SSIS-Rating Scales </li></ul><ul><li>Behaviors receiving rating of 2 (Very Often) or 3 (Almost Always) targeted to replacement </li></ul><ul><li>Descriptive FBA conducted to identify function of competing problem behaviors </li></ul><ul><li>Social skills replacement behaviors serving same function selected as target of intervention </li></ul><ul><li>FBA process </li></ul><ul><ul><li>Records review </li></ul></ul><ul><ul><li>FBA interviews (teacher, student, parent) </li></ul></ul><ul><ul><li>Systematic direct observations </li></ul></ul><ul><ul><li>Behavior ratings </li></ul></ul><ul><ul><li>Daily behavior reports </li></ul></ul>
  30. 30. FBA Replacement Behavior Training (continued) <ul><li>Intervention Strategies </li></ul><ul><ul><li>Antecedent Strategies </li></ul></ul><ul><ul><ul><li>Precorrection </li></ul></ul></ul><ul><ul><ul><li>Prompts </li></ul></ul></ul><ul><ul><ul><li>Check and connect </li></ul></ul></ul><ul><ul><ul><li>Altering schedule of activities </li></ul></ul></ul><ul><ul><ul><li>Choice </li></ul></ul></ul><ul><ul><ul><li>Task modification </li></ul></ul></ul><ul><ul><ul><li>Task interspersal </li></ul></ul></ul><ul><ul><ul><li>Providing frequent breaks </li></ul></ul></ul><ul><ul><li>Consequent Strategies </li></ul></ul><ul><ul><ul><li>Differential reinforcement (DRO, DRI, DRA) </li></ul></ul></ul><ul><ul><ul><li>Response cost </li></ul></ul></ul><ul><ul><ul><li>Noncontingent reinforcement (NCR) </li></ul></ul></ul><ul><ul><ul><li>Behavioral contracting </li></ul></ul></ul><ul><ul><ul><li>School-home notes </li></ul></ul></ul>
  31. 31. Responsiveness to Intervention Model     Degree of Unresponsiveness to Intervention LOW HIGH HIGH Intensity of treatment Level I Universal Interventions Level II Selected Interventions Level III Intensive Interventions Level IV Special Education IEP Determination
  32. 32. Classification of RTI Outcomes Outcome Status Inadequate Responder Adequate Responder Accuracy=Correct Decisions Relative to All Decisions A+D/A+B+C+D Requires More Intense Services A True Positive SENSITIVITY B False Positive Does Not Require More Intense Services C False Negative D True Negative SPECIFICITY
  33. 33. Measurement of Responsiveness Standards & Procedures <ul><li>Academics (CBM) </li></ul><ul><ul><li>Norms </li></ul></ul><ul><ul><li>Benchmark criteria </li></ul></ul><ul><ul><li>Growth criteria </li></ul></ul><ul><li>Behavior </li></ul><ul><ul><li>Direct observations </li></ul></ul><ul><ul><li>Behavior ratings scales </li></ul></ul><ul><ul><li>Daily behavior reports </li></ul></ul><ul><ul><li>Brief, focused behavior rating scales (weekly) </li></ul></ul><ul><ul><li>Permanent products & progress monitoring </li></ul></ul><ul><li>Solutions </li></ul><ul><ul><li>Social validation (peer comparisons & subjective judgments) </li></ul></ul><ul><ul><li>Visual analysis of graphed data </li></ul></ul><ul><ul><li>Effect size estimates </li></ul></ul>
  34. 34. Brief Behavior Rating Scale (Weekly) Difficulty paying attention Never Sometimes Often Almost Always Difficulty organizing tasks Never Sometimes Often Almost Always Fidgets with hands or feet Never Sometimes Often Almost Always Blurts out answers Never Sometimes Often Almost Always Interrupts/intrudes on others Never Sometimes Often Almost Always
  35. 35. Treatment Integrity An Essential Component of RTI <ul><li>Extent to which intervention is implemented as planned </li></ul><ul><li>Deviations from integrity compromises effectiveness </li></ul><ul><li>Teacher-implemented interventions high-risk for integrity lapses </li></ul><ul><li>Integrity can be measured by: </li></ul><ul><ul><li>Direct observations of implementation </li></ul></ul><ul><ul><li>Permanent products </li></ul></ul><ul><ul><li>Self-reports (not recommended) </li></ul></ul><ul><li>Treatment integrity can be improved by: </li></ul><ul><ul><li>Specific performance feedback on implementation </li></ul></ul><ul><ul><li>Contingency management </li></ul></ul><ul><ul><li>Modeling of intervention implementation </li></ul></ul>
  36. 36. Treatment Integrity & Behavior Change Adequate Behavior Change Inadequate Behavior Change Implemented As Planned Not Implemented As Planned High Integrity Expected High Integrity Wrong Treatment Poor Functional Analysis Low Integrity Changed treatment Other unknown variables Low Integrity Expected
  37. 37. Ways of Expressing Integrity <ul><li>Percentage of intervention steps implemented </li></ul><ul><li>Intervention manual </li></ul><ul><li>Rating of intervention implementation </li></ul><ul><li>Permanent products of intervention </li></ul><ul><li>Task analysis of intervention </li></ul>
  38. 38. Some RTI References <ul><li>Gresham, F.M. (2002). Responsiveness to intervention: An alternative approach to the identification of learning disabilities. In R. Bradley, L. Danielson, & D. Hallahan (Eds.), Learning disabilities: Research to practice (pp. 467-519). Mahwah, NJ: Lawrence Erlbaum. </li></ul><ul><li>Gresham, F.M. (2006). Response to intervention. In G. Bear & K. Minke (Eds.), Children’s needs-III (pp. 439-451) . Bethesda, MD: National Association of School Psychologists. </li></ul><ul><li>Gresham, F.M. Response to intervention: An alternative means of identifying students as emotionally disturbed. Education and Treatment of Children, 28, 328-344. </li></ul><ul><li>Gresham, F.M. (2004). Current status and future directions of school-based behavioral interventions. School Psychology Review, 33, 326-343. </li></ul><ul><li>Gresham, F.M. (2005). Response to intervention (RTI): An alternative means of identifying students as emotionally disturbed. Education and Treatment of Children, 28, 328-344. </li></ul><ul><li>Gresham, F.M. (2007). Best practices in diagnosis. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology-V . Bethesda, MD: National Association of School Psychologists. </li></ul><ul><li>Brown-Chidsey, R., & Steege, M. (2005). Response to intervention: Principles for effective practice. New York: Guilford Press. </li></ul><ul><li>National Association of State Directors of Special Education (2005). Response to intervention: Policy considerations and implementation. Alexandria, VA: Author. </li></ul><ul><li>Jimmerson, S., Burns, M., & VanDerHeyden, A. (Eds.) (2007). Handbook of response to intervention . New York: Springer. </li></ul><ul><li>Glover, T., DiPerma, J., & Vaughn, S. (Eds.) (2007). Special series on service delivery systems for response to intervention: Considerations for research and practice. School Psychology Review, 36 (4), 526-646. </li></ul><ul><li>Silverman, W., & Hinshaw, S. (Eds.) (2008). The second special issue on evidence-based psychosocial treatments for children and adolescents: A 10-year update. Journal of Clinical Child and Adolescent Psychology, 37, 1-301. </li></ul>
  39. 39. T H A N K Y O U Questions? Laizzez le bon temps rouler !

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