Evidence Based Practices to Reduce Challenging Behavior

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Evidence Based Practices to Reduce Challenging Behavior
Lise Fox
Opening Minds Conference of the Chicago Metro AEYC
Presented January 28, 2010
Description: What are the essential characteristics and support structures that programs and practitioners need in place to be evidence based practitioners? How can you promote social development in preschool children with and without disabilities? Learn about best practices, where they come from, and the approaches you can take to change children's challenging behavior.

Published in: Education, Health & Medicine

Evidence Based Practices to Reduce Challenging Behavior

  1. 1. Evidence-Based Practices to Reduce Challenging Behavior Lise Fox, Ph.D. University of South Florida
  2. 2. Session Discussion <ul><li>Critical importance for developing systems to support teacher implementation of evidence-based practices </li></ul><ul><li>Adoption of a promotion, prevention, intervention model </li></ul><ul><li>Identifying evidence-based practices for early educators </li></ul>
  3. 3. National Centers - Resources <ul><li>Center on the Social and Emotional Foundations for Early Learning </li></ul><ul><li>(CSEFEL) </li></ul><ul><li>www.vanderbilt.edu/csefel </li></ul><ul><ul><li>Technical Assistance Center on Social Emotional Intervention (TACSEI) </li></ul></ul><ul><ul><li>www.challengingbehavior.org </li></ul></ul>
  4. 4. Key Messages <ul><li>High quality caregiving + high quality environments ≠ No challenging behavior </li></ul><ul><li>Addressing challenging behavior = Promoting the development of social competence </li></ul><ul><li>We have evidence-based practices; but we need practitioners and systems to implement those practices with fidelity </li></ul>
  5. 5. Impact & Prevalence
  6. 6. An estimated 9 to 13% of American children and adolescents between ages nine to 17 have serious diagnosable emotional or behavioral health disorders resulting in substantial to extreme impairment. (Friedman, 2002)
  7. 7. <ul><li>More than half of students with SED drop out of grades 9-12, the highest rate for all disability categories. </li></ul><ul><li>(U.S. Department of Education, 2002; 2006) </li></ul><ul><li>At 2 years post high school, 58% of youth have been arrested at least once and 42% are on probation or parole. (NLTS2, 2005). </li></ul><ul><li>Students with ED reported use of alcohol (54%), illegal drug use (36%), marijuana use (33%), and smoking (53%) at rates higher than all other disability categories (NLTS2, 2008) </li></ul>
  8. 8. Over 15% of all students with disabilities (6-21) are taking psychotropic medications (USDOE, 2005) About 1/3 of all adolescent students with disabilities have been suspended or expelled (USDOE, 2005)
  9. 9. It begins early...
  10. 10. <ul><li>Campbell (1995) estimated that approximately 10-15% of all typically developing preschool children have </li></ul><ul><li>chronic mild to moderate levels of </li></ul><ul><li>behavior problems. </li></ul><ul><li>Children who are poor are much more likely to develop behavior problems with prevalence rates that approach 30% (Qi & Kaiser, 2003). </li></ul>
  11. 11. <ul><li>Children who are identified as hard to manage at ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., 1990). </li></ul>
  12. 12. <ul><li>Early Predictors </li></ul><ul><li>Temperamental Difficulties </li></ul><ul><li>Early Aggression </li></ul><ul><li>Language Difficulties </li></ul><ul><li>Noncompliance </li></ul>
  13. 13. <ul><li>Family Factors </li></ul><ul><li>Maternal Depression </li></ul><ul><li>Harsh Parenting </li></ul><ul><li>Stressful Family Life Events </li></ul><ul><li>Low Social Support </li></ul><ul><li>Family Instability </li></ul>
  14. 14. Depression Hurts <ul><li>D </li></ul><ul><li>Children of mothers who were depressed in their infancy are more likely to be delayed </li></ul><ul><li>Children of depressed mothers are at increased risk for behavior problems, depression, and mood disorders in adolescence </li></ul>
  15. 15. Sobering Facts
  16. 16. <ul><li>The correlation between preschool-age aggression and aggression at age 10 is higher than that for IQ. (Kazdin, 1995) </li></ul>
  17. 17. <ul><li>Early appearing aggressive behaviors are the best predictor of juvenile gang membership </li></ul><ul><li>and violence. </li></ul><ul><li>(Reid, 1993) </li></ul>
  18. 18. <ul><li>When aggressive and antisocial behavior has persisted to age 9, further intervention has a poor chance of success. </li></ul><ul><li>(Dodge, 1993) </li></ul>
  19. 19. <ul><li>Young Children with Challenging Behavior: </li></ul><ul><li>Are rejected by peers </li></ul><ul><li>Receive less positive feedback </li></ul><ul><li>Do worse in school </li></ul><ul><li>Are less likely to be successful in kindergarten </li></ul>
  20. 20. <ul><li>Preschool children are three times more likely to be “expelled” than children in grades K-12 </li></ul><ul><li>(Gilliam, 2005) </li></ul>
  21. 21. <ul><li>Faculty in higher education early childhood programs report that their graduates are least likely to be prepared to work with children with persistently challenging behavior </li></ul><ul><li>(Hemmeter, Santos, & Ostrosky, 2004) </li></ul>
  22. 22. <ul><li>Of the young children who need mental health services, it has been estimated that fewer than 10% receive services for these difficulties. </li></ul><ul><li>(Kataoka, Zhang, & Wells, 2002) </li></ul>
  23. 23. <ul><li>There are evidence-based practices that are effective in changing this developmental trajectory…the problem is not what to do, but rests in ensuring access to intervention and support (Kazdin & Whitley, 2006) </li></ul>
  24. 24. The Pyramid Model
  25. 25. Pyramid Model Universal Promotion Secondary Prevention Tertiary Intervention
  26. 27. Nurturing and Responsive Relationships <ul><li>Foundation of the pyramid </li></ul><ul><li>Essential to healthy social development </li></ul><ul><li>Includes relationships with children, families and team members </li></ul>
  27. 28. Relationships
  28. 30. High Quality Environments <ul><li>Inclusive early care and education environments </li></ul><ul><li>Comprehensive system of curriculum, assessment, and program evaluation </li></ul><ul><li>Environmental design, instructional materials, scheduling, child guidance, and teacher interactions that meet high quality practices as described by NAEYC and DEC </li></ul>
  29. 31. Reviewing Rules
  30. 32. Transitions
  31. 33. Circle Time – Universal Design Adult Support From: www.headstartinclusion.org
  32. 34. Circle Time – Universal Design Peer Support From: www.headstartinclusion.org
  33. 35. Circle Time – Universal Design Child Preference Special Equipment From: www.headstartinclusion.org
  34. 36. Circle Time – Universal Design Environmental Support From: www.headstartinclusion.org
  35. 37. Circle Time Special Equipment
  36. 38. Circle Time Child Preference From: www.headstartinclusion.org
  37. 39. Circle Time Invisible Support From: www.headstartinclusion.org
  38. 40. Circle Time Simplify the Activity From: www.headstartinclusion.org
  39. 42. Targeted Social Emotional Supports <ul><li>Self-regulation, expressing and understanding emotions, problem solving, developing social relationships </li></ul><ul><li>Explicit instruction </li></ul><ul><li>Increased opportunities for instruction, practice, feedback </li></ul><ul><li>Family partnerships </li></ul><ul><li>Progress monitoring and data-based decision-making </li></ul>
  40. 43. Friendship Skills <ul><li>Gives suggestions (play organizers) </li></ul><ul><li>Shares toys and other materials </li></ul><ul><li>Takes turns (reciprocity) </li></ul><ul><li>Is helpful </li></ul><ul><li>Gives compliments </li></ul><ul><li>Understands how and when to give an apology </li></ul><ul><li>Begins to empathize </li></ul>
  41. 44. Book Nooks www.vanderbilt.edu/csefel On Monday When it Rained Glad Monster Sad Monster Hands Are Not for Hitting
  42. 45. Feeling Wheel & Feeling Dice
  43. 46. Turtle Technique Recognize that you feel angry. “ Think” Stop. Go into shell. Take 3 deep breaths and think calm, coping thoughts. Come out of shell when calm and think of a solution.
  44. 47. Would it be safe? Would it be fair? How would everyone feel? Problem Solving Steps Step 2
  45. 48. The Solution Kit
  46. 49. Secondary – Skill Instruction <ul><li>Identify target skill </li></ul><ul><li>Identify learning opportunities and seek to maximize the number of learning trials </li></ul><ul><li>Select procedure for teaching </li></ul><ul><ul><li>e.g., least to most, most to least, incidental teaching procedure, peer support, modeling, visual prompts </li></ul></ul><ul><li>Track child progress </li></ul>
  47. 51. Individualized Intensive Interventions <ul><li>Comprehensive interventions </li></ul><ul><li>Assessment-based </li></ul><ul><li>Skill-building </li></ul><ul><li>Partnerships with families </li></ul><ul><li>Progress monitoring and data-based decision-making </li></ul>
  48. 52. Positive Behavior Support <ul><li>Convene a team </li></ul><ul><li>Conduct functional assessment </li></ul><ul><li>Identify hypotheses </li></ul><ul><li>Develop behavior support plan for all relevant environments </li></ul>
  49. 53. <ul><li>4 years old </li></ul><ul><li>Only child </li></ul><ul><li>First preschool experience </li></ul><ul><li>Strengths – very smart, loves books, engages well with adults </li></ul><ul><li>Challenging Behaviors - Aggression, Verbal threats, Destroys other children’s products, Damages toys intentionally </li></ul><ul><li>Significant risk of Preschool Expulsion </li></ul>About Tim
  50. 54. Before PBS
  51. 55. <ul><li>Team of individuals who know him best – teacher, parents, paraprofessional, assistant director </li></ul><ul><li>Behavior consultant guided the process </li></ul><ul><li>Focused on understanding the purpose of Tim’s challenging behavior - importance of gathering information </li></ul><ul><li>Developed a comprehensive plan that includes: </li></ul><ul><ul><li>Strategies for preventing his challenging behavior </li></ul></ul><ul><ul><li>New skills </li></ul></ul><ul><ul><li>Adult responses </li></ul></ul><ul><li>Classroom team and family implement and monitor plan outcomes </li></ul>Develop Plan
  52. 56. Hypotheses <ul><li>Tim engaged in challenging behavior to: </li></ul><ul><li>initiate social interactions </li></ul><ul><li>enter into play </li></ul><ul><li>get access to particular toys </li></ul><ul><li>get teacher or peer attention </li></ul>
  53. 57. Behavior Support Plan <ul><li>Prevention Strategies </li></ul><ul><ul><li>Social story to describe behaviors that were expected during center play and outdoor activities </li></ul></ul><ul><ul><li>Review of social story prior to center time </li></ul></ul><ul><ul><li>Priming to remember skills to use </li></ul></ul><ul><ul><li>Visual prompt to remember skills to use </li></ul></ul>
  54. 58. I Can Be a SUPER FRIEND! Created for Tim by Lisa Grant & Rochelle Lentini 2002 SUPER FRIEND
  55. 59. I like talking and playing with my friends at school.
  56. 60. My Friends get sad or mad when I hit, kick, use mean words, or take toys. Sometimes, I want to play with what my friends are playing with. When I play, I sometimes feel like taking toys, using mean words, or hitting and kicking.
  57. 61. If I want to join in play, I need to join nicely or ask to play with my friends’ toys. I can say, “Can I play with that toy?” or “Can I play with you?”. Can I play with you?
  58. 62. I can join my friends and play nicely. I can take turns. I can go with the flow. I can stop, think, and do.
  59. 63. I CAN BE A SUPER FRIEND I can join my friends and play nicely. ________ I can take turns nicely. ________ I can go with the flow. ________ I can stop, think, and do. ________ DATE: ___________
  60. 64. Tim’s Plan (cont.) <ul><li>Instructional Strategies </li></ul><ul><ul><li>Social skills instruction of each new skill (role play and story review) </li></ul></ul><ul><ul><li>Self-management system for new skills </li></ul></ul>
  61. 65. Tim’s Plan (cont.) <ul><li>New Responses </li></ul><ul><ul><li>Attention to child who was assaulted </li></ul></ul><ul><ul><li>Prevent access to toy or activity </li></ul></ul><ul><ul><li>Review with Tim after incident has been resolved </li></ul></ul>
  62. 66. Tim – with PBS
  63. 67. “ If a child doesn’t know how to read, we teach .” “ If a child doesn’t know how to swim, we teach .” “ If a child doesn’t know how to multiply, we teach .” “ If a child doesn’t know how to drive, we teach.” “ If a child doesn’t know how to behave, we… … teach?… punish?”
  64. 68. Pyramid Model Universal Promotion Secondary Prevention Tertiary Intervention Evidence-Based Practices that Promote the Social Emotional Development of All Children
  65. 69. Assess your teaching <ul><li>How skilled are you at…. </li></ul><ul><ul><li>Developing strong teaming relationships? </li></ul></ul><ul><ul><li>Developing parent partnerships ? </li></ul></ul><ul><ul><li>Creating classroom environments that support the active engagement of all children? </li></ul></ul><ul><ul><li>Teaching social emotional skills intentionally to all children? </li></ul></ul><ul><ul><li>Teaching social emotional skills with sufficient intensity to individual children who are at-risk of challenging behavior? </li></ul></ul>
  66. 70. Assess your Program <ul><li>Does your program… </li></ul><ul><li>Have a system for screening children for social emotional delays? </li></ul><ul><li>Ensure that children at-risk of challenging behavior receive intentional instruction and support that leads to outcomes? </li></ul><ul><li>Use data to make decisions about how to support children effectively? </li></ul>
  67. 71. Assess your program <ul><li>Does your program… </li></ul><ul><li>Have a system for ensuring that children with persistent challenging behaviors receive intensive, individualized support? </li></ul><ul><li>Offer teachers individualized professional development (training and coaching) to provide evidence-based approaches? </li></ul>
  68. 72. National Centers - Resources <ul><li>Center on the Social and Emotional Foundations for Early Learning </li></ul><ul><li>(CSEFEL) </li></ul><ul><li>www.vanderbilt.edu/csefel </li></ul><ul><ul><li>Technical Assistance Center on Social Emotional Intervention (TACSEI) </li></ul></ul><ul><ul><li>www.challengingbehavior.org </li></ul></ul>

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