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An evaluation of the prevent-teach-reinforce (ptr) model in a community preschool setting
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by Laura Kulikowski.
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b University of South Florida,
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Thesis (MA)--University of South Florida, 2010.
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ABSTRACT: This study evaluated the use of the Prevent-Teach-Reinforce (PTR) model with two four-year-old children in a community preschool classroom. A multiple baseline design across activities was used to assess the teacher implementation of the behavior intervention strategies developed during the PTR team process and the changes in child problem behavior and engagement. Additional measures associated with the outcomes, such as researcher procedural integrity and social validity were assessed. The results suggest that the team of teachers were able to implement the PTR intervention with fidelity, which resulted in a decrease in the children's problem behavior and an increase in their engagement. The PTR process was deemed feasible and acceptable by the teaching staff, and that the child behavioral outcomes were evaluated as acceptable by nave observers.
Advisor: Kwang-Sun Blair, Ph.D.
x Child & Family Studies
t USF Electronic Theses and Dissertations.
An E valuation of the Prevent Teach Reinforce (PTR) Model in a Community Preschool Setting by Laura L. Kulikowski A thesis s ubmitted in partial f ulfillment of the r equirements for the degree of Master of Arts Department of Child and Family Stu dies College of Behavior and Community Sciences University of South Florida Major Advisor: Kwang Sun Blair, Ph D Rose Iovanonne, Ph.D. Kimberly Crosland, Ph.D. Date of Approval: October 18, 2010 Keywords: feasibility early childhood, PTR, PBS, ch allenging behavior Copyright 2010, Laura L. Kulikowski
i Table of Contents List of Tables iii List of Figures iv Abstract v I ntroduction 1 Prevent Teach Reinforce (PTR) 5 Method 8 Participants and Setting 8 Child Participants 8 Teacher Participants 9 Setting 9 Materials and Equipment 11 Measures 11 Teacher Implementation Fidelity 11 Child Behavior 12 Social Validity 13 Integrity of PTR Process 14 Interobserver Agreement 15 Experimental Design and Procedures 1 7 Teaming and Goal Setting 17 Baseline Data Collection 19 Assessment and Intervention Planning 19 Intervention Implementation 22 Generalization 23 Evaluation 23 Results 24 Teacher Implementation Fidelity 26 Child Behavior 26 Generalization 27 Social Validity 27 Discussion 30
ii References 35 Appendices 41 Appendix 1 Teacher Work Style Survey 42 Appendix 2 Paraeducator Work Style Survey 43 Appendix 3 Work Style Score Comparison Sheet 44 Appendix 4 Developing Short Term Goals 45 Append ix 5 Child Behavior Data Sheet 47 Appendix 6 Functional Behavior Assessment 48 Appendix 7 Hypothesis Development Form 53 Appendix 8 PTR Checklist Intervention Checklist 54 Appendix 9 PTR Teacher Implementation Checklist 58 Appendix 10 Fidelity of PTR Implementation Checklist 59 Appendix 11 PTR Self Evaluation : Social Validity 60 Appendix 12 Novel Rater Evaluation: Social Validity 62
iii List of Tables Table 1: Mean Percent of Interobserver Agreement 16 Table 2: Social Validity Questionnaire Results for Teachers 28
iv List of Figures Figure 1. Percentage of intervals for child target behaviors and percentage of teacher implementation fidelity across experimental phases routines, and children 25
v Abstract Th is study evaluate d the use of the Prevent Teach Reinforce (PTR) model with two four year old children in a community preschool classroom A multiple baseline design across activities w as used to assess the teacher implementation of the behavior intervention strategies dev eloped during the PTR team process and the changes in child problem beh avior and engagement Additional measures associated with the outcomes, such as researcher procedural integrity and social validity were assessed The results suggest that the team of teacher s w ere able to implement the PTR intervention w ith fidelity, which resulted in a decrease in the children's problem behavior and an increase in their engagement. The PTR process was deemed feasible and acceptable by the teaching staff, and that th e child behavioral outcomes were evaluated as acceptable by nave observers.
1 Introduction Challenging behaviors are being noticed in young children at alarming rates. Between 7% and 25% of preschool aged children are qualifying for a diagnosis of oppositional defiant disorder (Conroy, Dunlap, Clarke, & Alter 2005). If these young children do not receive early intervention, they are at greater risk for more severe psychiatric diagnoses, school failure, drug/alcohol abuse, and criminal activities (Coie & Dodge, 1998; Kazdin, 1993; Olweus, 1991; Tremblay, 2000). The literature consistently indicates that early appearing problem behavior in young children is the single best predictor of delinquency in adolescence, gang membership, and adult incarce ration (Dishion, French, & Patterson, 1995; Reid, 1993). Young children who have persistent challenging behavior have been found to receive limited instruction and have few opportunities for learning from peers (Arnold et al., 2006). Given the consequences of challenging behavior in young children, it is imperative to prepare early childhood educators to address the children's behavioral difficulties in their programs. It is estimated that 67% of young children in the United States receive services in cente r based programs (Innes, Denton, & West, 2001). Behavioral intervention using Positive Behavior Support (PBS) as a framework has been used with preschool aged children as an effective approach for assisting families, educators, and other caregivers for ad dressing challenging behavior and teaching appropriate replacement behaviors of children in early childhood settings (Blair,
2 Umbreit, & Bos, 1999; Blair, Umbreit, Dunlap, & Jung, 2007; Duda, Dunlap, Fox, Lentini, & Clarke, 2004). Positive behavior support (PBS) is often defined as a collaborative process of developing individualized behavior support for children who have persistent problem behaviors PBS is a multistep approach to developing effective function based interventions to reduce problem behavior and increase appropriate behaviors (Dunlap et al., 2000) PBS gives priority to social validity and provision of child support in natural daily routines (Carr et al., 2002) The PBS multistep approach includes developing a team that will often consist of p arents, teachers, paraprofessionals, administrators support professionals, and a behavioral consultant. The consultant facilitates the meetings guide s the team members to determin e their roles with the target children train s the team members on the PBS process and provide s coaching as necessary during implementation of intervention (Dunlap, Hieneman, Knoster, Fox, Anderson, & Albin, 2000 ) The PBS steps include a functional assessment and hypothesis development During a functional assessment struct ured interviews with parents and teachers and direct observation s of child interactions with adults and peers in the context of natural routines are conducted to develop an understanding of the target child's challenging behavior The functional assessmen t data is reviewed to hypothesize the function s of the child's behavior (O'Neill et al, 1997) Once hypothesized functions are determined team members collaborate to develop a behavior support plan or intervention strategies best suited to reduce the pro blem behavior and increase alternative or desired behavior. The final step within the PBS model is to continually monitor the implementation of intervention and determine if
3 alterations are necessary. At this point an evaluation can be made on the part o f those involved as to the intervention's effectiveness and suitability to the specific situation Although studies on PBS with young children served in community early childhood programs are relatively few, results of the studies suggest that the PBS in tervention could successfully be implemented by early childhood educators in collaboration with behavioral consultants, result in a reduction in the children's challenging behavior, increase in engagement in the activities and other appropriate behavior, a nd promote generalization of intervention to non targeted routines (Blair et al., 1999; Blair, Fox, & Lentini, 2010; Duda et al., 2004; Stormont, Smith, & Lewis, 2007 ). As it relates to social validity, w hen designing procedures that are to be implemented in a classroom setting Mueller, Edwards, and Trahant (2003) indicate that there is a preference for procedures that are easy to implement and have minimal disruption in ongoing instruction. They suggested that w hen there are different effective interventio n strategies available the teachers often pick those based on their personal preference and or how their classroom currently functions. Teachers experience burnout tying to meet classroom demands with too little support (Brouweres & Tomic, 2000), and as a result they might be unwilling to implement a new approach or intervention unless they receive support in the process of developing and implementing the intervention (Woolfolk, Rosoff, & Hoy, 1990). Furthermore, teachers may not always be able to implem ent the intervention with fidelity and generalize the intervention procedures to non trained routines or activities (Hundert, 2007; Scheeler, 2006). In short, there is a need for studies to develop a feasible and acceptable behavioral intervention model t hat can be implemented in early childhood settings.
4 Although the PBS approach using the multi step process shows promise it would be difficult for professionals to implement t he complex collaborative process of assessment and intervention in early childho od settings without practical tools. In a review of a published PBS training manual Kincaid and his colleagues (2006) concluded that the content of the manual provided general behavioral information, but did not include all the information needed to prov ide best practices. The manual failed to provide a clear picture of a complete PBS process, and it was concluded that it would be difficult for practitioners and trainers to use the manual in implementing the PBS process that requires collaborative team b uilding, problem solving process, and develop comprehensive supports. Recent literature on the use of function based intervention in schools has found that behavior supports for students with severe problem behaviors often show problems in the following a reas (Iovannone et al., 2009): (a) logical connections between FA data and behavior support strategies; (b) clear definitions of target behaviors; (c) accurate hypotheses; (d) identification of replacement behavior; (e) measurement of teacher fidelity; (f) teacher input to the process; and (g) follow up and evaluation. The literature indicates that current training efforts are not showing success in building the necessary skills of professionals for implementation of function based intervention. The curren t issues with the manualized intervention in schools have significant implications for adapting the function based intervention or PBS model for early childhood settings. Within and across early childhood settings, there is a great deal of variability in program quality, training and qualification of teachers, and resources available to support the intervention model (Fox & Hemmeter, 2009). This implies that
5 the application of function based or PBS intervention model should be focused on developing standa rdized procedures and materials that are feasible for use by professionals to address the diverse needs of early childhood settings. Prevent Teach Reinforce The Prevent Teach Reinforce (PTR) model is similar to the PBS model in that it also includes a mul tistep process focusing on function based intervention and team collaboration (Dunlap et al., 2009). The PTR model is a standardized school based consultation model that has been tested in the k indergarten thru 8 th grade population by assisting teacher i mplementation of interventions with students who demonstrate problem behavior and behavioral and social skills outcomes for students ( Iovannone et al., 2009 ). In addition, there is some evidence that this approach may be used as an effective process for c hildren within the preschool aged population (Blair et al, 1999; Blair et al., 2007; Blair et al., 2010) The theoretical and conceptual foundation of the PTR model is aligned with the principles of applied behavior analysis (Carr et al., 2002) and indivi dualized PBS (Dunlap & Carr, 2007; Sugai & Horner, 2002). The behavior support plans developed through the PTR process consist of antecedent manipulation (Prevent), teaching strategies for replacing problem behavior (Teach), and consequence manipulations (Reinforce). The model uses a five step process (i.e., teaming, goal setting, assessment, intervention including training and coaching, and evaluation) that uses a systematic collaborative approach that helps teachers develop and implement the interventio n with the assistance of behavioral consultants and a manual. In a recent publication the authors describe the process in which school based teams design and implement individualized behavior support plans for students with
6 severe behavioral challenges (D unlap et al., 2010). PTR is currently in the process of being evaluated at two school districts for efficacy, the authors suggest that the preliminary data indicate a significant difference in those students assigned to a comparison group and those partic ipating in PTR (Dunlap et al., 2010). While the authors have developed this effective standardized method for assisting schools, grades kindergarten thru 8 th in developing behavioral interventions, it is necessary to adapt and evaluate the PTR model for use with preschool aged children e xhibiting challenging behavior. It is unclear from the school based efficacy trials whether the same individualized, team based process will hold true for preschool settings in which younger children are served and early childhood educators have substantially lower levels of training and support than do teachers in elementary schools (Granger & Marx, 1992). PTR includes many steps that the PBS model also incorporates including teaming, behavioral assessments, interventio n implementation and evaluation of that implementation. While the approaches of function based intervention and PBS process have been used with preschool aged children and in preschool settings effectively, future research should evaluate the application of the PTR process for its feasibility in early childhood settings. Therefore, the purpose of this study wa s to explore the feasibility of implementing the adapted PTR intervention model in an early childhood program Specifically, the study address ed th e following research questions: 1. Can the early childhood educators implement the behavior support strategies with fidelity and generalize those skills to another student ?
7 2. Will the target behaviors of the children improve when the teachers implement the beha vior support strategies with fidelity? 3. Will the PTR process be viewed as feasible and acceptable by program staff, and the child outcome be viewed as acceptable by nave observers?
8 Method Participant and Setting The participants in the study includ ed two children of preschool age served in a community preschool classroom and their lead and assistant teachers The classroom teachers and center director nominated specific students based on the severity of their challenging behaviors, and each of the children had been exhibiting these challenging behaviors for longer than six months. The children's parents also expressed c oncerns relating to their readiness for a kindergarten program. Child P articipants Mandy was a 4 year old girl who ha d attended the program for approximately two years. She live d at home with her biological parents and two sisters at the time of the study. S he was the middle child. She was a typically developing child who ha d no known diagnoses No communication or developmental delays ha d been noted for this participant. However, Mandy frequently spen t time by herself and did not engage in classroom activities with peers S he raise d her voice, yell ed at both teachers and peers, and hit peers. Michelle was a 4 year old girl, who ha d attended the preschool program for approximately two years. She live d at home with her biological parents and older sister. She was also a typically developing child ha ving no known diagnosis Her communication and other developmental skills were co nsidered normal Michelle was a
9 very active child and had difficulty staying in her assigned seat, keeping her hands to herself (e.g. hitting peers), and yell ing at peers and teachers. Teacher P articipants The children s lead and assistant teachers part icipated in the study. The lead teacher, Danielle, was a 31 year old female. She recently completed her four year degree in elementary education at a local university. Her primary internship experience included first and second grade classrooms. She had been with this preschool program for less than eight months. This placement was Danielle's first position post graduation from her collegiate program. She had received no specific training on behavior management or classroom management strategies. Durin g initial classroom visits, it was observed that her classroom did not follow a consistent schedule, and she did not use any form of consistent classroom management strategies. Danielle terminated her position at the school toward the end of the study. Th e assistant teacher Tanya was a 19 year old female with a high school education. She ha d been an assistant teacher for over one year and with this particular preschool for five months. Tanya had not received any specific training on classroom management strategies but had expressed interest in receiving the required training to earn her Child Development Associate (CDA) certification. Her prior work experience ha d been a 1 1 homecare aide for a teenaged child with a n a utism spectrum disorder. Setting T he study took place in a private community preschool that use d the HighReach Learning curriculum The HighReach Learning curriculum incorporates the latest research on early childhood, including Piaget's Constructivist Theory, Bruner's Theory of Discovery Learning, Bergen's Theory of Play, active exploration, and the most current the National Association for the Education of Young Children ( NAEYC )
10 Developmentally Appropriate Practice Guidelines HighReach Learning intends to create a balanced, innovative, and interest driven curriculum for children birth to five ("HighReach Learning", 2010). The total number of children served in the participating children's classroom ranged from 8 11. As the school did not require attendance the number of children fluctuat ed depending on the day. The typical classroom schedule included planned group activities, outdoor play, lunch, quiet time, and free play. The study took pl ace in the children's three classroom routines or activities: out side play, transition, and group ti me in which the teachers had great difficulty in gaining the student's attention. The classroom (25ft x 25ft) contained long connecting tables chairs, and learning centers (e.g., home living, science, reading, and writing) The outdoor playground (60ft x 20ft) contain ed one large swing set, two play houses, a tunnel bicycles, and a variety of age appropriate toys. The outside play routine was conducted in the outdoor play yard. Typical activities the children were invited to participate in include d a r ed light/green light running game, riding wheeled toys (e.g. tricycles), and interacting with the playground equipment, which included a wooden jungle gym, house, and a train tunnel. The children were encouraged to play on the playground and interact with their peers for 15 20 minutes twice per day once in the morning and once in the afternoon. This study targeted the morning play time. Children were expected to share, take turns with toys, and wait their turn without the teacher's assistance Transiti on from outside play to group time was also targeted for intervention, which lasted approximately 10 minutes. During transition, the children were expected to
11 line up. No instructions or activities were provided to the children during this routine. The te achers would repeatedly say "line up or call the children by name Typical activities during group time include d playing games (e.g. UNO, matching), reading books, and interacting with specific materials from the curriculum (e.g. oranges senses). The typical group activity time lasted approximately 10 minutes. The lead teacher would lead the group time while the assistant provided assistance by helping the children with activities. Occasionally the assistant teacher would lead the activities. The teac hers' classroom management consisted of using verbal reprimands, time outs, and depriving privileges. Materials and Equipment A PTR working manual was used to fac ilitate the PTR process and was provided to each team member involved. This working manual included all forms, excluding the behavior rating scales, from the published Prevent Teach Reinforce instruction manual by Dunlap et al. ( 2009). A digital video camera was used during baseline and inte rvention sessions to record teacher implementation of i ntervention and target behaviors of students. A digital voice recorder was used to record the team meetings to assess the procedural integrity of the PTR process. A task analysis checklist of the meeting components was developed and a research assistant recorded the occurrence or nonoccurrence of each step. Measures Teacher Implementation F idelity To assess the degree to which the teachers implemented the selected intervention strategies with integrity, a task analysis was developed for intervention f or each activity, and data were collected on the percentage of
12 step s completed correctly. Data were collected on the steps t hat could be heard or observed during actual implementation during the sessions. Seventy five percent of all sessions in each acti vity were video recorded. Observers complete d a checklist of the relevant steps by reviewing the video recordings. Observers use d t he checklist to see if the teachers used prevention strategies (e.g., use of clear verbal statement of what the children we re expected to do, prompts with clear specific language and calm tone of voice, positive phrasing, frequent positive comments), teaching strategies (e.g., use of script stories), and reinforcement strategies (e.g., contingent praise for alternative behavio r and redirection or extinction for problem behavior) during each routine or activity. A total of 12 steps (3 5 steps for each strategy) were developed (see Appendix 9 for PTR T eacher Implementation C hecklist developed for Mandy ) to measure the teacher imp lementation fidelity Child B ehavior All b aseline an d intervention sessions were video recorded and analyzed to determine the percentage of intervals of the target children's problem behaviors and engagement in the routines or activities. A 10 s partial i nterval recording system was used to collect data on child behavior. The behaviors were operationally defined during the goal setting as part of the first step of the PTR process. For Mandy p roblem behavior was defined as any occurrenc e of the following: (a) walking away from a planned activity (greater than 2 feet); (b) screaming or yelling which can be heard from 10 feet away ; and (c) hitting or attempt to hit her peers Mandy's engagement behavior was defined as (a) staying within 2 feet of the designa ted activity area ; (b) using a conversational tone of voice ; (c) respecting the personal space (2ft circle) of her peers; and (c) focusing eyes on the teacher or work materials when the
13 teacher provides instructions ( see Appendix 5 for a sample target chil d data sheet). Definition s of Michelle's target problem behavior and engagement were the same as those of Mandy's except one extra topography of problem behavior: demanding excessive adult attention (more than 2 times per activity) by repeatedly saying th e teacher's name, pulling at the teachers arms, or embracing/hugging the teachers ( see Appendix 5 for a sample target child data sheet). Social V alidity Measures of social validity were taken by giving the two teacher participants a 15 item questionnaire about their experience perception of acceptance and effectiveness in the PTR process following the termination of the intervention phase. The form was based on a five point Likert type scale, which was adapted from the Treatment Acceptability Rating Form Revised (TARF R; Reimers & W acker, 1988) and designed to rate their acceptability of the PTR intervention from 1 to 5, with counterbalanced questions (i.e. for some questions 1 indicates acceptability and 5 indicates an unacceptable score). The evaluation form was provided to each teacher and completed individually to avoid any crossover discussion (See Appendix 12 for the Self Evaluation Form) In addition to the social validity assessment by the teachers, the social validity of the PTR intervention was also assessed by two novel observers: one father of two children, one of whom was a 4 year old boy and one female early childhood educator who was unfamilia r with the target children. The father did not have any experience receiving parenting or behavior t raining. The teacher had been working at another community preschool in the area and had not received any training on classroom management or behavioral training. They were asked to view videotaped sessions of the
14 target child ren and teaching staff during baseline and interve ntion conditions and then complete a rating scale based on their impressions of the teacher's and target children's behaviors. Se ssions from baseline and intervention were shown in random order. Two four minute segments from baseline and two four minute segments from intervention were randomly selected to review. The researcher explain ed the rating scale s to the individuals and specified who the target child wa s. After viewing each videot aped session the individual then complete d a ra ting scale about acceptability of the child and teacher behaviors. The rating scale consisted of six items, rated on a 5 point scale (see Appendix 13 for nave observer social validation rating form). Integrity of PTR P rocess To assess the degree to w hich the components of the PTR process were implemented with integrity as planned, data were collected by two independent data collectors on the implementation of PTR steps Each session of the researcher with team members and teachers was audio recorded. Observers use d the PTR integrity checklist (see Appendix 10 for procedural integrity check list ) to see if the researcher addressed all steps necessary during each team meeting During the first team meeting the researcher was to provide a welcome state ment, introduction of the team members, provide an overview of the process with meeting goals, use and explain the teaming worksheets and explain the baseline data process and timeline. During second meeting the researcher was to use and explain the funct ional behavior assessment checklist and summary table, review the baseline data and hypothesis and finally to use and explain the PTR intervention checklist. During the third meeting the researcher and team were to develop the intervention plan, made and explained the training checklist and took fidelity of the teacher's implementation. During
15 the final meeting the researcher was to discuss the intervention data and request teachers to complet e the social validity measures. Percentage of procedural integ rity was computed by dividing the number of steps addressed by the total number of steps in each session. The results indicated that the researcher completed all steps at 100% during each meeting. Interobserver A greement Interobserver agreements (IOAs) we re assessed for implementation fidelity, child target behaviors, and procedural integrity measures. IOA for implementation f idelity was conducted for 35 % of the sessions. IOA was measured by having tw o observers independently watch the video recorded sess i ons and record if the teachers were using each of the intervention steps or the child target behavior occurred during each interval Both observers were master's students in the Applied Behavior Analysis P rogram. An agreement of the occurrence of a n inte rvention step was defined as both observers recording that the step was either not completed (no) or completed (yes) during the activity IOA was calculated by dividing the number of agreements by the number of agreements plus disagr eements and multiplyin g by 100. The mean IOA for teacher implementation fidelity was 100%. IOA for children's target behaviors was calculated for 35% of baseline and intervention sessions. To conduct IOA two observers (researcher and a graduate student in the ABA master's pr ogram) independently view ed videos of target child ren's interactions with adult and peers for occurrences of the target behaviors. An agreement of the occurre nce of a target behavior was defined as both observers recording that a target behavior occurred within the same interval. IOA was calculated by dividing the
16 number of agreements by the number of agreements plus disagr eements and multiplying by 100. IOA for teacher implementation fidelity was an average of 100%. IOA for child behaviors was an avera ge of 91.23% (range of 75 to 100%). Table 1 shows the IOAs across phases, participants, and target behaviors. Table 1. Mean percent of interobserver agreement Mandy Michelle Phases Lead Teacher Assistant Teacher PB EB PB EB Baseline 100 100 98 (93 100) 98 (93 100) 93 (75 100) 93 (75 100) Intervention 100 100 100 100 100 100 Note Mean (ra nge). PB: problem behavior and EB: Engagement behavior IOA for measures of procedural integrity was also conducted for 100% of the sessions. IOA was measur ed by having two observers independently listen to the audio recorded sessions and record if each PTR step occurred during meetings Agreement and disagreement over the occurrence of a PTR component in each step was scored. IOA was calculated by dividing the number of agreements by the number of agreements plus disagreements and multiplying by 100. IOA for researcher procedural integrity was 100%.
17 Experimental Design and Procedures A concurrent m ultiple baseline design across activities (e.g., group time, playground, transitions) with an assessment of teacher generalization of intervention strategies to another child was used to assess the PTR intervention's effect on the teacher and child target behaviors (Kazdin, 1982). Baseline data on the challen ging behaviors that each target child exhibited as well as data on the target child's engagement behaviors were gathered until levels of these behaviors stabilize d The team building, goal setting, functional assessment, intervention development and impl ementation and th en the final evaluation were completed over the course of this study Teaming and Goal Setting An initial meeting was conducted to implement the PTR Steps 1 and 2 (Teaming and Goal Setting), which lasted approximately 34 minutes. Befor e the initial team meeting, the researcher made three classroom visits to gather initial information on the current classroom practice and target children's behavior. During these observations it was noted that the classroom did not follow specific schedu les, the teachers were both new to the classroom and had not worked together for very long and many of the children in this class could have benefitted from individual behavior interventions or overall better classroom management strategies.
18 At the meeti ng the PTR intervention team for Mandy was formed. Man d y' s team included both of her classroom teachers and the researcher. During this meeting, the researcher provided an overview of the PTR process, an explanation of the materials provided from the publi shed PTR manual. The teachers completed Work Style Survey and the goal setting form in collaboration with team members and then participated in a discussion of the timeline for baseline data collection and the next PTR steps to be implemented was conducted The lead teacher completed a work style survey (see Appendix 1 for the Teacher Work Style Survey), which provided information on her work beliefs and information on how and what she expects from paraeducators. The assistant teacher completed the parae ducator work style survey (see Appendix 2 for the Paraeducator Work Style Survey). A review of both educators' answers was conducted (see Appendix 3 for compiled answer sheet). The purpose of completing these work style surveys was to help the team member s develop a communication regarding their work styles. Both teachers participated in a discussion regarding areas they had in common including their preference for a written work schedule, both preferred explicit directions, and taking on challenges. They also discussed their differences, which include morning vs. afternoon person, beliefs on the flexibility of a work schedule, and preferences on touching other's things. The team completed the goal setting form for Mandy's broad behavioral and engagement g oals and were clearly defined so that each goal was observable, measurable and would provide the most impact in the child's life (see Appendix 4 for the completed Goal Setting Form for Mandy ). During this time, the teachers were also encouraged to
19 develop goals for Michelle. The teacher's broad goals for both children included that they would actively participate in all scheduled activities. The goals for decrease include d walking away from a planned activity and decrease placing demands on, yelling, hitti ng, or touching her peers. In order to decrease these challenging behaviors the teachers determined that the children should stay within 2 feet of the designated activity area, use a conversational tone of voice, eyes would be focused on the teacher and/o r work materials, and they would respect the personal space (2ft circle) of their peers. Baseline Data C ollection Following the initial meeting, b aseline data on the teacher implementation of steps within behavior support strategies and target children's problem behavior and engagement were gathered across routines until the levels of these behaviors showed an increasing/decreasing trend or became stable Baseline sessions consist ed of usual activities (i.e. group time, transitions, and playground) and in structional procedures. Whenever a child engages in problem behavior, the teachers continued with their current management strategies (i.e. call the child's name, yell, reprimand or time out). Baseline data was collected daily, 5 10 minutes in duration (a n average time for each routine). Duration of data collection during transition routine occasionally lasted less than 10 minutes. Assessment and Intervention P lanning During the second team meeting the team members participated in the PTR Step 3 (Assess ment) and Step 4 (Intervention Planning). The meeting lasted approximately one hour (35 minutes for assessment and 25 minutes for intervention planning). They complet ed the functional assessment forms (FBA), and developed hypotheses based on
20 their finding s The FBA provided situations or circumstances that increase the occurrence of challenging behaviors during the targeted three routines or activities. Based on the FBA results, t he teachers hypothesized that when the teachers placed demands and/or the act ivity requ ired interactions with peers Mandy would engage in problem behavior to delay demands or to get attention from both her peers and teachers During group and play time, Mandy often engaged in off task behavior and aggression which resulted in tea cher reprimand. When teachers demanded Mandy to complete tasks during group time and transition, her prolonged problem behavior delayed the task demands. It was found that the classroom teachers rarely provided positive reinforcement contingent upon Mandy' s engagement in appropriate engagement and interaction ( S ee Appendix 6 for the Functi onal Behavior Assessment Forms and Appendix 7 for the Hypothesis Development Forms ) Upon the completion of the assessment, the team participated in the PTR Step 4 ( Inte rvention Planning). They selected strategies from each of the Prevent Teach Reinforce menus Although providing choices and curricular modifications were discussed, t he strategies selected by the teachers focused on adult verbal behavior (e.g., use of clea r verbal statement of what the children were expected to do, prompts with clear specific language and calm tone of voice, positive phrasing, and frequent positive comments ). The strategies were perceived as being easy to implement and would accommodate the competing demands on teaching staff, considering recourses available to implement the plan A total of four steps were developed within the prevention component: (1) preparing the child for activity for transition by providing a clear statement of what th ey were expected to; (2) going over to the child a nd provide verbal
21 prompt to init iate the activity or routine, using clear language; (3) reminding the child of the routine expectations using positive phrasing; and (4) providing frequent positive comments on the child's engagement in the activities or routine (see PTR T eacher Implementation C hecklist in Appendix 9 for specific definitions of each step). The teachers selected the use of script stories for teach component of intervention in collaboration w ith the researcher. They determined that the use of script stories would be an easy way to teach the skills they wan ted them to learn. F our dif ferent script stories were used which focused on teaching personal space, how to ask for help, talking about emo tions, and following rules in school. The stories were to be read daily to students at the beginning of group activity time, and the teachers prompted individual children to use the skills learned through the stories during each target routine. The teacher s required a prompt by the researcher via cell phone text to read the stories daily. A total of five steps were developed for the social script strategy: (1) read ing the first story, (2) ask ing the children if there were any questions, (3) review ing a sec ond story, (4) ask ing the children if there were any questions, and (5) thank ing the children for reading the stories together. Data were included in the group routine scores. Finally, the reinforcement intervention selected was to increase the ratio of positive to negative responses and withdraw reinforcement for problem behavior During the selection the teachers recognized that they rarely made positive comments to the children including Mandy during any of the daily routines. Three steps were devel oped for the reinforcement component: (1) providing verbal complement upon the child's engagement and initiation or attempt to comply with directions; (2) reminding of class rules or routine expectations upon the child's attempts to use the problem behavio r; and
22 (3) being calm, temporally withholding the activity or attention while ignoring problem behavior. Intervention I mplementation The researcher provide d a 45 minute training to teachers (including written instructions, modeling, rehearsal and feed back) on the specific skills selected in the intervention. The length of the training was determined by the interventions selected and the steps determined through the task analysis. If a teacher did not show they could implement the intervention procedu res with greater than 80% accuracy during their first two sessions an additional coaching session would have been provided, however this was not necessary during this study Both the lead and assistant teachers participated in implementing the interventio n strategies. As shown in the graphical data in Results, the lead teacher implemented the intervention during the first target routine, outside play. The staff were able to implement the intervention during the outside play routine in only two sessions du e to the heat and possible risks to the children. Implementation of the intervention by the lead teacher was discontinued toward the end of intervention phase due to termination of her employment at the program. Data on the lead teacher implementation fi delity during transition and group times and during the generalization sessions were collected in only one session. During the intervention phase, the researcher provided feedback on the teachers' implementation of intervention steps and reviewed child pro gress data with the teachers on a daily basis after each routine. The researcher provided them with a checklist of strategies displayed correctly or missed during that routine. The feedback meetings were approximately 5 minutes.
23 Generalization Upon c ompletion of each PTR step, the teachers were encouraged to implement the PTR process with non target child, Michelle. They defined Michelle's target behaviors, assessed Michelle's behavior using the functional assessment checklist provided and developed hypotheses, and developed and implemented intervention strategies. The teachers chose group time as the target routine for Michelle. As described in the target behaviors and intervention development sections, the behavioral goals and intervention strategi es developed for Michelle were almost the same as those developed for Mandy due to the similar problem behaviors and their functions. The researcher reviewed the hypotheses and strategies developed for Michelle by the teachers, but did not provide any coac hing or feedback to the teachers during intervention. Generalization data were collected throughout the experimental phases to investigate teachers' use of the intervention strategies with Michelle. Evaluation After each teacher was able to implement the selected interventions with 80% or greater accuracy and th e children's behavior's trend was in the desired direc tion, the researcher fade d all feedback The team members he ld a final meeting for implementing the PTR Step 5 to revi ew the intervention results and make decisions about future steps. The teachers also completed social validity forms at that time The meeting lasted less than 10 minutes.
24 Results Figure 1 presents data on the use of P T R strategies by teachers across target routines for child participant Mandy and generalization assessment with Michelle in one routine During baseline sessions, teachers only used a few of the P T R intervention strategies after receiving training on the strategies they increased their use of PTR strategi es to above 80% across all activities with Mandy and effectively used the selected strategies with Michelle The data shows that Mandy's challenging behavior was consistently at high levels and engagement at low levels during baseline, and upon interventi on those behaviors clearly reversed. Michelle's challenging behaviors were variable during baseline and upon intervention her engagement increased and challenging behaviors decreased. Th e data show evidence that teachers generalized their use of P T R stra tegies to the untrained child in a group routine
25 Figure 1. Percentage of intervals for child target behaviors and percentage of teacher implementation fidelity across experimental phases
26 Teacher Implementation F idelity During baseline the t eachers' use of intervention steps averaged 16.7% in the outside play routine. During intervention the average use of the intervention steps increased to 83%. During the transition routine the teachers used 26.4% (range of 0 to 33%) of the steps in baseli ne. During intervention their implementation of the steps increased to 83%. During the group routine the teachers used an average of 26.1% (range 16.7 to 50%) of the intervention steps in baseline. The average use of the intervention steps increased to 95 % (range 83 to 100%) during intervention. Child Behavior During baseline Mandy's challenging behavior averaged 70.5% (range of 66 to 75%) of intervals while engagement was 29% (range of 25 to 33%) during the outside play routine. During the intervent ion phase her challenging behavior immediately decreased to 0% and her engagement increased to 100% of intervals. During baseline the Mandy's challenging behavior averaged 77.4% (range of 28.6 to 100%) of intervals while engagement was 22.5% (range of 0 t o 71.4%) during the transitions routine. During the intervention phase her challenging behavior decreased to 0% and her engagement increased to 10% of intervals. During the group time, Mandy's challenging behavior averaged 58.3% (range of 10 to 100%) of i ntervals while engagement was 41.6% (range of 0 to 90%) in baseline. During the intervention phase her challenging behavior decreased to 1% (range of 0 to 4%) and her engagement increased to 96.3% (range of 96 to 100%) of intervals. Mandy's problem behavi or was virtually terminated in all target routines as soon as the intervention was implemented and remained stable throughout the
27 intervention sessions. Her engagement behavior showed a marked increase in the levels and was stable across sessions. Generali zation Generalization data showed that during group activities, both teachers implemented the intervention with fidelity for Michelle. As shown in Figure 1, the teachers used 25% (range of 0 to 50%) of the intervention strategies in baseline, and their use of strategies increased to an average of 82% (range of 64 to 100%) in intervention during the group routine. Michelle's challenging behavior was 42.8% (range of 15 to 76%) of intervals during baseline. However, her problem behavior decreased to 3.6% ( range of 0 to 11%) during intervention. Her engagement behaviors increased from 55.6% (range of 23 to 84%) during baseline to 96.3% (range of 89 to x100%) during intervention Social V alidity During the last team meeting the teachers were asked to comp lete a social validity questionnaire. The ratings on the social validity rating scale by the two teachers showed that the levels of teacher acceptability of the intervention were high. The overall ratings of acceptability and satisfaction with the PTR in tervention process were relatively high, with a mean of 3.7 (range = 3 5) by lead teacher and 4.5 (range = 3 5) by assistant teacher. The ratings by the assistant teacher were higher than the ratings by the lead teacher. As shown in Table 2 Both teachers responded that they were very willing to carry out the behavior plan and change the routines in order to carry out the plan. Both teachers responded neutrally to there being disadvantages to following the plan and their observing any undesirable side effec ts as a result of the behavior plan. The lead teacher
28 responded that the behavior plan was somewhat effective in reducing problem behaviors, she was somewhat likely to continue implementation of the procedures, the interventions were somewhat effective in teaching the child appropriate behaviors, and that the goal of the intervention somewhat fit with the team's goal for improvement of the child's behavior. The assistant teacher felt more strongly in the positive sense for each of the lead teacher's respo nses. Table 2 Social validity questionnaire results for teachers Head Teacher Assistant Teacher 1. Given the child's behavior problems, how acceptable did you find the PTR behavior plan? 5 5 2. How willing were you to carry out this behavior plan? 5 5 3. To what extent were there disadvantages to following the behavior plan? 3 3 4. How much time was needed each day for you to carry out the behavior plan? 3 4 5. To what extent do you think the behavior plan was effective in reducing problem behav iors? 4 5 6. Do you feel that following this plan will result in permanent improvements in the child's behavior? 3 5 *7. How disruptive was it to carry out the behavior plan? 3 4 8. How much did/do you like the procedures used in the behavior plan? 3 5 9. How likely is it that you will continue to implement the procedures in the plan after this research is terminated? 4 5 10. To what extent did you observe undesirable side effects as a result of the behavior plan? 3 3 11. How much discomfort did the child experience during the behavior plan? 3 4
29 12. How willing were you to change routines in order to carry out the behavior plan? 5 5 13. How well did carrying out the plan fit into your current routines? 4 5 14. How effective was the intervention in terms of teaching the child appropriate behavior? 4 5 15. How well did the goal of the intervention fit with the team's goal for improvement of the child's behavior? 4 5 Note: *Reverse score items (i.e., 2 becomes 4) The social validity ratings by n ave observers (a father of a preschool aged child and an early childhood educator) showed that both nave observers rated the participating children's behaviors as relatively being unacceptable and the teachers appeared to be having a difficult time in th e routines. However, they responded that during intervention the children's behaviors were relatively acceptable and the teachers appeared to be comfortable in the routine, and that the children were participating in the routine appropriately. The parent also felt that the teachers were comfortable, using practical procedures, and their strategies appeared to be working. Overall ratings by the teacher were 1.6 for transition and 2.5 for outside play in baseline, the ratings were 3.6 for transition and 5. 0 for outside play in intervention. The ratings by the parent were 2.5 for both routines in baseline and 3.6 for transition and 4.7 for outside play in intervention.
30 Discussion The purpose of this study was to examine the feasibility of implementing t he PTR intervention with two preschool aged children in a local community preschool classroom. As anticipated this study provided the expected results. The teachers of the participating children were able to implement the PTR intervention with fidelity, w hich resulted in improvement in the target children's target engagement and problem behaviors. The PTR process was evaluated as feasible and acceptable by the teachers, and that the child behavioral outcomes and teacher's use of the strategies were evalua ted as acceptable by nave observers. In addition, there was some evidence that the teachers generalized the PTR intervention to an additional child (Michelle), creating the collateral effects of intervention with the Michelle. Both Mandy and Michelle wer e able to successfully engage in activities, following teacher directions; significant changes in their behavior over time were noticeable. The data from this study have extended the current PTR evaluation by Dunlap et al. (2010) in elementary schools by using the PTR process with preschool aged children. This study allowed for application and evaluation of the PTR model in a preschool setting. The findings from the current study support the use of function based intervention and Positive Behavior Suppor t (PBS) in the community early childhood settings ( Blair et al., 1999; Blair et al., 2010; Duda et al., 2004 ; McLaren & Nelson,
31 2009). During baseline, it was noted that the participating teachers rarely implemented the intervention strategies but did demo nstrate high levels of implementation of the multi component intervention strategies. A variable that affects the process and outcome of function based or PBS intervention is the teacher skills required to conduct functional behavioral assessment (FBA) and design and implement multi component intervention strategies (Conroy et al., 2007; Conroy, Clark, Fox, & Gable, 2000), which are the key components of PTR intervention. Prior literature suggested that even the school based consultants had difficulty link ing FBA to intervention (Conroy et al., 2007; Van Acker, 2005). Considering the early childhood educators in community early childhood settings have substantially lower levels of training and support to address challenging behavior in young children (Hemme ter, Fox, Jack, & Broyles, 2007), this study suggests that it is essential to provide training to early childhood educators in the process of selecting appropriate prevention, teaching, and reinforce strategies based on FBA results (Blair et al., 1999; 201 0; Schepis, Ownbey, Parsons, & Reid, 2000). In this study, it was emphasized to provide the teaching staff with training and coaching during intervention as a critical element to enhance teacher skills and to ensure teacher implementation fidelity as well as generalization (Blair et al., 2010; Casey & McWillam, 2008). An encouraging result of the study was the successful implementation of the intervention by both teachers who served the participating children in the classroom. Their consistent implementat ion of the intervention across target routines resulted in significant improvement of the children's target behaviors. Their active involvement in all aspects of the PTR process to address the children's challenging behavior contributed
32 to immediate change in the children's behavior. However, toward the end of study, the lead teacher who had more training background and teaching experience left the program in pursuit of a position in a public school setting. The program director also resigned her position t o assume a teaching role in the public school system. Both children in this study were subjected to many staff changes in their eight months prior to the study and that continued throughout the course of the study. Considering the high staff turn over an d limited resources in community early childhood settings to implement interventions, this study suggests that the behavior support team develop intervention steps that are effective and easily implementable by early childhood educators who have diverse tr aining backgrounds. When the intervention steps are easy to implement, the new staff will be able to implement the intervention without extensive training. The teachers in the study selected interventions that they indicated were the easiest to implement i ncluding the use of clear specific instructions and increasing their levels of reinforcement for the children's appropriate behavior. Prior to the interventions teacher would call the children by name but not provide them with direction after they gained a ttention from the child and they also spent a great deal of time focused on the challenging behaviors and little attention to the appropriate behaviors. However, it is important to recognize that while every function of both children's challenging behavio r was not specifically addressed, the teachers were still able to select intervention strategies that worked in this case. For example, one of the functions of Mandy's problem behavior was found to be delaying task demands, but the strategies of modifying tasks to reduce task demands or providing negative reinforcement contingent upon completion of task were not included in the intervention strategies.
33 Although the researcher or another behavior analyst might not initially select the intervention strategie s chosen by the teachers, the strategies selected by the teachers were valued, considering they were the persons implementing the strategies. To ensure successful implementation of intervention strategies, it was considered important to select strategies t hat would encourage teacher buy in. While this study appears effective for the two students and teachers it is not without its l imitations First, the study was conducted in a private preschool setting and the parents did not participate as part of the t eam. Often we find that children in daycare settings do not have attendance requirements like that of the school system and parents may not be able to take time off of work to participate in five meetings. Second, we were unable to obtain maintenance and follow up data due to time constraints. Both Mandy and Michelle had a variety of absences during the summer program, which resulted in the limited data collection during intervention across routines. Intervention phases should have been extended in order to collect more data to show the maintenance of the PTR intervention without the researcher involvement. In addition, follow up data could have been collected to demonstrate long term outcomes of the intervention. Third, due to the absences, including a complete replication across routines with Michelle was not possible to assess teacher generalization. Another possibility for inclusion in future studies would be the use of technology to include parents in the PTR process. With online video ability and telephone communication, each of the team meetings conducted in this study could have easily included parents.
34 In summary, the results of the present study provide positive results that early childhood teachers in a community preschool setting can impleme nt the PTR model with children of preschool age. This extension of the original PTR evaluation is promising, not only because it adds to the use of PTR, but also because it is an effective way for teachers to learn how to help young children in their clas srooms.
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42 Appendix 1 Teacher Work Style Survey Directions: Circle the number that ind icates your level of agreement / disagreement with each statement. Disagree Agree 1. I supervise paraeducators closely. 1 2 3 4 5 N/A 2. I like a flexible work schedule. ................................ ................................ ..... 1 2 3 4 5 N/A 3. I let paraeducators know exactly what is expected. ................................ ........ 1 2 3 4 5 N/A 4. I provide (or at least determine) all the materials that will be used 1 2 3 4 5 N/A 5. I provide a written work schedule. ................................ ................................ .. 1 2 3 4 5 N/A 6. I expect the paraeducator to think ahead to the next task. .............................. 1 2 3 4 5 N/A 7. I determine the instructional methods that will be used 1 2 3 4 5 N/A 8. I encourage the paraeducator to try new activities independently. 1 2 3 4 5 N/A 9. I give explicit directions for each task 1 2 3 4 5 N/A 10. I always do several things at one time. 1 2 3 4 5 N/A 11. I like working with paraeducators that willingly take on new challenges 1 2 3 4 5 N/A 12. I like taking care of details. 1 2 3 4 5 N/A 13. I req uire the paraeducator to be very punctual 1 2 3 4 5 N/A 14. I like to get frequent feedback on how I can improve as a supervisor 1 2 3 4 5 N/A 15. I like to bring problems out in the open 1 2 3 4 5 N/A 16. I like to give freq uent performance feedback to the paraeducator 1 2 3 4 5 N/A 17. I like to discuss activities that do not go well 1 2 3 4 5 N/A 18. I like working with other adults 1 2 3 4 5 N/A 19. I encourage paraeducators to think for thems elves 1 2 3 4 5 N/A 20. I am a morning person 1 2 3 4 5 N/A 21. I speak slowly and softly 1 2 3 4 5 N/A 22. I work best alone with little immediate interaction 1 2 3 4 5 N/A 23. I need a quiet place to work without d istractions 1 2 3 4 5 N/A 24. I prefer that no one else touches my things 1 2 3 4 5 N/A 25. I prefer to work from a written plan 1 2 3 4 5 N/A
43 Appendix 2 Paraeducator Work Style Survey Directions : Circle the number that indi cates your level of agreement / disagreement with each statement. Disagree Agree 1. I like to be supervised closely. ................................ ........................... 1 2 3 4 5 N/A 2. I like a flexible work schedule..... ................................ ...................... 1 2 3 4 5 N/A 3. I like to know exactly what is expec ted. ................................ ............ 1 2 3 4 5 N/A 4. I prefer to decide which materials to use ................................ ........... 1 2 3 4 5 N/A 5. I like having a written work schedule ................................ ................ 1 2 3 4 5 N/A 6. I need time to think ahead on the next task. ................................ ....... 1 2 3 4 5 N/A 7. I like to deter mine the instructional methods I use ............................ 1 2 3 4 5 N/A 8. I like to try new activities independently. ................................ .......... 1 2 3 4 5 N/A 9. I like to be told how to do each task ................................ .................. 1 2 3 4 5 N/A 10. I like to do several things at one time. ................................ ............. 1 2 3 4 5 N/A 11. I like to take on challenges and new situations. ............................... 1 2 3 4 5 N/A 12. I like taking care of details. ................................ .............................. 1 2 3 4 5 N/A 13. I like to be very punctual ................................ ................................ 1 2 3 4 5 N/A 14. I like to give frequent feedback on how I prefer to be supervised ... 1 2 3 4 5 N/A 15. I like to bring problems out in the open ................................ ........... 1 2 3 4 5 N/A 16. I like to get frequent feedback on my performance ......................... 1 2 3 4 5 N/A 17. I like to discuss when activities do not go well ............................... 1 2 3 4 5 N/A 18. I like working with other adults ................................ ....................... 1 2 3 4 5 N/A 19. I like to think things through for myself ................................ .......... 1 2 3 4 5 N/A 20. I am a morning person ................................ ................................ ..... 1 2 3 4 5 N/A 21. I like to speak slowly and softly ................................ ...................... 1 2 3 4 5 N/A 22. I like to work alone with little immediate interaction ...................... 1 2 3 4 5 N/A 23. I need a quiet place to work without distractions ............................ 1 2 3 4 5 N/A 24. I prefer that no one else touches my things ................................ ..... 1 2 3 4 5 N/A 25. I prefer to work from a w ritten plan ................................ ................ 1 2 3 4 5 N/A
44 Appendix 3 Work Style Score Comparison Sheet Disagree Agree Item Content Disagree Agree 1 2 3 4 5 N/A . ..1. Closeness of supervision ................................ ......................... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 2. Flexibility of work schedule. ................................ ..... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . ..3. Preciseness of expectations. ................................ ...... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 4. Decisions on which ma terials to use ......................... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 5. Written work schedule ................................ ............... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . .6. Time to think ahead on the next task. ........................ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . .7. Decisions on instructional methods .......................... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . .8. Trying new activities independently. ........................ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . .9. Specifyin g how to do each task ................................ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 10. Doing several things at one time. ............................. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 11. Taking on challenges ................................ .............. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 12. Taking care of details. ................................ .............. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 13. Punctuality ................................ ................................ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 14. Giving /getting feedback on supervision .................. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 15. Dealing with problems out in the open .................... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 16. Giving / getting frequent feedback ........................... 1 2 3 4 5 N/A 1 2 3 4 5 N /A. . . . . . 17. Discussing activities that do not go well .................. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 18. Working with other adults ................................ ........ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 19. Thinking things th rough for myself .......................... 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . .20. I am a morning person ................................ ............. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 21. Speak slowly and softly ................................ ............ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 22. Working alone little interaction ............................. 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 23. Quiet place to work / no distractions ........................ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 24. Touching others' thi ngs ................................ ............ 1 2 3 4 5 N/A 1 2 3 4 5 N/A. . . . . . 25. Working from a written plan ................................ .... 1 2 3 4 5 N/A
45 Appendix 4 Developing Short Term Goals Short Term Goals for __ M andy __________ Behavioral Social Academic Mandy will actively participate in all scheduled activities appropriately. Mandy will interact with peers in an appropriate manner. Academic goals have not been specified for Mandy during this project. Mandy will decrease her walking away from a planned activity and yelling. Mandy will decrease placing demands on, yelling, hitting, or touching her peers. NA Mandy will stay within 2 feet of the designated activity area, use a conversational tone of voice, and eyes focused on the teacher and/or work materials. Mandy will increase use of a conversational tone of voice, respecting the personal space (2ft circle) of her peers. NA Decrease Decrease Increase Decrease Broad Goals
46 Developing Short Term Goals Short Term Goals for __ M ichelle __________ Behavioral Social Academic Michelle will actively participate in all scheduled activities appropriately. Michelle will interact with peers in an appropriate manner. Academic goals h ave not been specified for Michelle during this project. Michelle will decrease her walking away from a planned activity and yelling. Michelle will decrease placing demands on, yelling, hitting, or touching her peers and demanding excessive adult a ttention (more than 2 times per activity). NA Michelle will stay within 2 feet of the designated activity area, use a conversational tone of voice, and eyes focused on the teacher and/or work materials. Michelle will increase use of a convers ational tone of voice, respecting the personal space (2ft circle) of her peers, and request attention from adults only 1 time per activity. NA Decrease Decrease Increase Decrease Broad Goals
47 Appendix 5 Child Behavior Data Sheet Child Behavior I nterval Recording Sheet Child's Name ______ ____ Date __________ Observer's Name __________ Behavior __________ Activity __________ Start Time ___ Stop Time ____ Total Time ________ (Code: + occurrence; nonoccurrence) 1min 2 min 3 min 10 10 10 10 10 10" 10 10 10" 10" 10" 10" 10 10 10" 10" 10" 10" 4 min 5 min 6 min 10 10 10 10 10 10" 10 10 10" 10" 10" 10" 10 10 10" 10" 10" 10" 7 min 8 min 9 min 10 10 10 10 10 10" 10 10 10" 10" 10" 10" 10 10 10" 10" 10" 1 0" 10 min 10 10 10 10 10 10" Number of Occurrences __ ____ Percentage of Occurrences _______% Overall IOA _________% Nonoccurrence IOA ____ ____% Number of Nonoccurrences __________ Percentage of Nonoccurrences _____ _____% Occurrence IOA ________
48 Appendix 6 FUNCTIONAL BEHAVIOR ASSESSMENT Directions: Your team selected both problem behavior(s) and pro social or academic behaviors to be targeted for the PTR Intervention. The behaviors targeted were written in me asurable terms. Complete one PTR Assessment form for each problem behavior targeted (not the pro social or academic behaviors). Answer each PTR assessment question by selecting or writing the response(s) that best describe events related to the problem behavior specified. The responses you provide will give your team valuable information to help understand the circumstances contributing to the problem behavior and will lead to selecting more effective PTR interventions. PTR ASSESSMENT: Prevent Compon ent 1a. Are there times of the school day when problem behavior is most likely to occur? If yes, what are they? ___ Morning ___ Afternoon ___ Before meals ___ During meals ___ After meals ___ Arrival ___ Dismissal Other:_ ______ _______________________________ __________________________ 1b. Are there times of the school day when problem behavior is least likely to occur? If yes, what are they? ___ Morning ___ Afternoon ___ Before meals ___ During meals ___ After mea ls ___ Arrival ___ Dismissal Other : ___________________________ _____________ ______________________ 2a. Are there specific activities when problem behavior is very likely to occur? If yes, what are they? ___ Reading/LA ___ Independent work ___ One on one ___ Free time ___ Worksheets, seatwork ___ Writing ___ Small group work ___ Computer ___ Peer/cooperative work ___ Math ___ Large group work ___ Recess ___ Centers ___ Specials (specify) __________ ___ Scie nce ___ Riding the bus ___ Lunch ___ Discussions/Q&A ___ Transitions (specify) ________________ Other: ___ _____________________________ _________ ______________________ 2b. Are there specific activities that cooperative and prosocial behavior is ve ry likely to occur? What are they?
49 ___ Reading/LA ___ Independent work ___ One on one ___ Free time ___ Worksheets, seatwork ___ Writing ___ Small group work ___ Computer ___ Peer/cooperative work ___ Math ___ Large group w ork ___ Recess ___ Centers ___ Specials (specify) _________ ___ Science ___ Riding the bus ___ Lunch ___ Discussions/Q&A ___ Transitions (specify) ________________ Ot her: ________________________ ____________________ __________________ 3a. Are there specific classmates or adults whose proximity is associated with a high likelihood of problem behavior? If so, who are they? ___ Peers ___ Teacher(s) ___ Paraprofessional(s) ___ Other school staff Specify:________________ Specify: ____ ____________ Specify: ________________ Specify_________________ ___ Bus driver ___ Parent ___ Other family member (Specify)__________ Other: ________________________ ___________________ ___________________ 3b. Are there specific classmates or adults wh ose proximity is associated with a high likelihood of cooperative and prosocial behavior? If so, who are they? ___ Peers ___ Teacher(s) ___ Paraprofessional(s) ___ Other school staff Specify:_________________ Specify: ________________ Specify: ______ ___________ Specify: _________________ ___ Bus driver ___ Parent ___ Other family member (Specify) ______________ Other: ________________________________ _____________________ ____________ 4. Are there specific circumstances that are associated with a high likelihood of problem behavior? ___ Request to start task ___ Being told work is wrong ___ Reprimand or correction ___ Told "no" ___ Seated near specific peer ___ Peer teasing or comments ___ Change in schedule ___ Task to o difficult ___ Task too long ___ Task is boring ___ Task is repetitive (same task daily) ___ Novel task ___ Transition ___ End of preferred activity ___ Removal of preferred item ___ Start of non preferred activity ___ Student is alone ___ Unstructured time ___ Down' time (no task specified) ___ Teacher is attending to other students Other : ________________ _________________ _________________________ __ 5. Are there conditions in the phy sical environment that are associated with a high likelihood of problem behavior? For example, too warm or too cold, too crowded, too much noise, too chaotic, weather conditions.
50 ___ Yes (specify) ______________ ______________________________ __________ ___________ ___ No 6. Are there circumstances unrelated to the school setting that occur on some days and not other days that may make problem behavior more likely? ___ Illness ___ Allergies ___ Physical condition ___ Hormones or menstru al cycle ___ No medication ___ Change in medication ___ Hunger ___ Parties or social event ___ Change in diet ___ Drug/alcohol abuse ___ Bus conflict ___ Fatigue ___ Change in routine ___ Parent not home ___ Home conflict ___ Sleep deprivation ___ Stayed with non custodial parent Other: ______________________________________ _______________________ Any other comments not addressed in the Prevent Component : PTR ASSESSMENTS: Teach Component 1. Does the problem behavior seem to be exhibited in order to gain attention from peers ? ___ Yes List the specific peers: _____________________________________________________ ___ No 2. Does the problem behavior seem to be exhibited in order to gain attention from adults ? If so, are there part icular adults whose attention is solicited? ___ Yes List the specific adults: _____________________________________________________ ___ No 3. Does the problem behavior seem to be exhibited in order to obtain objects (toys or games, materials, food ) from peers or adults? ___ Yes List the specific objects: _______ _______________________________ ______________ ___ No 4. Does the problem behavior seem to be exhibited in order to delay a transition from a preferred activity to a non preferred activity? ___ Yes List the specific transitions: ____________________________ _____________________ ___ No 5. Does the problem behavior seem to be exhibited in order to terminate or dela y a non preferred (difficult, boring, repetitive) task or activi ty? ___ Yes List the specific non preferred tasks or activities ____________________________ _____ ___ No
51 6. Does the problem behavior seem to be exhibited in order to get away from a nonpreferred classmate or adult? ___ Yes List the specifi c peers or adults _______________________________ ________________ ___ No 7. What social skills(s) could the student learn in order to reduce the likelihood of the problem behavior occurring in the future? ___ Peer interaction ___ Play skills ___ Gett ing attention appropriately ___ Joint or shared attention ___ Sharing objects ___ Sharing attention ___ Conversation skills ___ Making pro social statements ___ Taking turns ___ Losing gracefully ___ Waiting for reinforcement ___ Accepting differences Oth ers: ________________________________ ____________________________ 8. What problem solving skill(s) could the student learn in order to reduce the likelihood of the problem behavior occurring in the future? ___ Recognizing need for help ___ Asking for help ___ Using visual supports to work independently ___ Ignoring peers ___ Graphic organizers ___ Note taking strategies ___ Assignment management ___ Working with a peer ___ Move ahead to easier items then go back to difficult items ___ Staying engaged ___ Working independently ___ Making an outline ___ Self management ___ Making choices from several appropriate options Others: _____________________________ ______________________________ 9. What communication skill(s) could the student learn in order to reduce the likelihood of the problem behavior occurring in the future? ___ Asking for a break ___ Expressing emotions (frustration, anger, hurt) ___ Requesting information ___ Raising hand for attention ___ Requesti ng wants ___ Rejecting ___ Active listening ___ Asking for help ___ Commenting ___ Responding to others Others: _____ ________________________ ______________________________ Any other comments not addressed in the Teach Component: PTR ASSESSMENT: Rein force Component 1. What consequence(s) usually follow the student's problem behavior ? ___ Sent to time out ___ Chair time out ___ Head down ___ Sent to office ___ Sent home ___ Gave personal space ___ Sent to behavior specialist /counselor ___ Assistance given ___ Verbal redirect ___ Delay in activity ___ Verbal reprimand ___ Stated rules ___ Physical prompt ___ Peer reaction ___ Physical restraint
52 ___ Calming/soothing ___ Activity changed ___ Activity terminated ___ Removal of reinforcers ___ Natur al consequences (Specify) ___________________ Other:___________________ ____________________________________________ 2. Does the student enjoy praise from teachers and other school staff? Does the student enjoy praise from some teachers more t han others? ___ Yes List specific people _____________ _________________________ ___________________ ___ No 3. What is the likelihood of the student's appropriate behavior (e.g., on task behavior; cooperation; successful performance) resulting in acknowl edgment or praise from teachers or other school staff? ___ Very likely ___ Sometimes ___ Seldom ___ Never 4. What is the likelihood of the student's problem behavior resulting in acknowledgment (e.g., reprimands, corrections) from teachers or other school staff? ___ Very likely ___ Sometimes ___ Seldom ___ Never 5. What school related items and activities are most enjoyable to the student? What items or activities could serve as special rewards? ___ Social interaction with adults ___ Social interaction with peers ___ Playing a game ___ Helping teacher ___ Line leader ___ Going to media center ___ Sensory activity (specify ) ____________________ ___ Music ___ Puzzles ___ Going outside ___ Going for a walk ___ Reading ___ Extra PE time ___ Extra free time ___ Art activity ___ Computer ___ Video games ___ Watching TV/video ___ Objects (Specify ) ______________________________ _______________________ ___ Food (Specify) __________________ ____________ ______________________ Other(s):______ _______________________ _____________________ _______ Any other comments not addressed in the Reinforce Component:
53 Appendix 7 HYPOTHESIS DEVELOPMENT FORM Prevent Teach Reinforce Assessment Information Student: __ Mandy_ _____ ___ Date:_____ 8/2010 _________ _______ Prevention Data Teaching Data Reinforcement Data Demands Peer cooperative work Recess Transitions Certain teachers present Attention from adults Delay transition Terminate or delay task Recognize need for help Sta y engaged Expressing emotions Chair time out Calming/soothing Assistance given Verbal reprimand Possible Hypotheses for Problem and Appropriate Behavior When. She will.. As a result, he/she Demands are placed When peer cooperative work When tra nsitions occur Cry, yell, walk away, hit peers Gets attention from adults, delay in activity, and attention from peers HYPOTHESIS DEVELOPMENT FORM Prevent Teach Reinforce Assessment Information Student: __ Michelle _____ ___ Date:_____ 8/2010 ___________ _____ Prevention Data Teaching Data Reinforcement Data Demands Large/small group work Independent work Attention from adults Delay transition Terminate or delay task Get attention appropriately Stay engaged Working inde pendently Sent to time out Delay in activity Physical prompt Removal of reinforcers Assistance given Verbal reprimand Activity changed/terminated Possible Hypotheses for Problem and Appropriate Behavior When. She will.. As a result, he/she Dem ands are placed Or is required to work Cry, yell, walk away, hit peers Gets attention from adults, delay in activity, and attention from peers
54 Appendix 8 Prevent Teach Reinforce Interventions Checklist Instructions Instructions: Review your hyp othesis statement. 1) Select the interventions that match the information in your hypotheses. Please select at least two interventions but no more than four in each category (prevent, teach, reinforce). The asterisked interventions are required and must be selected. 2) Rank order the selected interventions by placing a "1" in the box next to the most highly preferred, a "2" next to the second highest preferred, etc. Example Hypothesis: When presented with a demand involving a non preferred and difficu lt task, Joey will scream loudly to avoid the task and to get assistance. Prevention Teach Reinforce 1 Providing choices 1 *Replacement behaviors (functional or desired) 2 *Reinforce replacement behavior (functional or desired) Tr ansition supports 2 Specific academic skills Increase noncontingent reinforcement 3 Environmental supports Problem solving strategies 1 Discontinue reinforcement of problem behavior 2 Curricular modifications General coping strategies Grou p contingencies (peers, teachers)
55 PTR Interventions Checklist Student: _____ _________ ____________ Date:_______ Behavior:_______________ Completed by:____________ Hypothesis:_____________________________________________________________ ________ ______ ______________________ ____________________________________ ____________________________________________ ___________________________ Prevention Interventions Teaching Interventions Reinforcement Interventions Providing Choices **Replacement Behavior Fun ctional Desired or Pro Social **Reinforce Replacement Behavior Functional Desired or Pro Social Transition Supports Specific Academic Skills Increase Non Contingent Reinforcement Environmental Supports Problem Solving Strategies Discontinue Reinforcement of Problem Behavior Curricular Modification (eliminating triggers) General Coping Strategies Group Contingencies (peer, teacher) Adult Verbal Behavior (just be nice) Specific Social Skills Increase Ratio of + to Responses Classroom Management Teacher Pleasing Behaviors Home to School Reinforcement System Setting Event Modification Learning Skills Strategies Establish Crisis Intervention Opportunity for Pro Social Behavior (peer support) Self Management (self monitoring) Peer Modeling Delayed Grati fication Independent Responding Increased Engaged Time **All asterisked interventions need to be selected and included in the student's PTR Intervention Plan
56 Intervention Plan St udent: Mandy _______ Teacher: ____________________ H ypothesi s: When demands are placed on Mandy or she is required to participate in a group activity or transitions, she will exhibit challenging behaviors in order to gain access to attention from her peers and teachers and will also delay the task. PREVENT Inter ventions Intervention Type Specific Strategy Needed/Who Prevent: Adult Verbal Behavior The teachers will use a calm tone of voice, use clear specific language, use positive phrasing, and increase comments instead of demands only. All teachers TEACH Interventions Intervention Type Specific Strategy Needed/Who Teach: desired or pro social Specific Social Skills The teachers will use script stories to discuss the specific social skills of asking for help and the use of appropriate emotions. All teachers and peers REINFORCE Interventions Intervention Type Specific Strategy Needed/Who Reinforce: Functional Increase ratio of + to responses The teachers will increase their use of positive comments and reinforcing comments to the Mandy and will use the ratio of 4:1. All teachers
57 Intervention Plan St udent: Michelle _______ Teacher: ____________________ H ypothesis: When demands are placed on Michelle or she is required to participate in a group activity or transitions, she w ill exhibit challenging behaviors in order to gain access to attention from her peers and teachers and will also delay the task. PREVENT Interventions Intervention Type Specific Strategy Needed/Who Prevent: Adult Verbal Behavior The teachers will use a calm tone of voice, use clear specific language, use positive phrasing, and increase comments instead of demands only. All teachers TEACH Interventions Intervention Type Specific Strategy Needed/Who Teach: desired or pro social Specific Soci al Skills The teachers will use script stories to discuss the specific social skills of respecting personal space and how to follow rules. All teachers and peers REINFORCE Interventions Intervention Type Specific Strategy Needed/Who Reinforce: Func tional Increase ratio of + to responses The teachers will increase their use of positive comments and r einforcing comments to the Michelle and will use the ratio of 4:1. All teachers
58 Appendix 9 PTR Teacher Implementation Checklist Date of Training: ____________________________ S tudent: ___ Mandy _________________ Teacher/Teacher Assistant: ___________________ C onsultant: __ LK _________________ Task Analysis of Intervention Did the Implementer Complete the step? PREVEN T 1. Prepare the child for activity or transition by providing a clear verbal statement of what they where expected to do (transition line up, hands on hips, bubble in mouth) (group sit in this seat, use your paper, draw a picture of "x") (playground choose an activity to play with Susie, let me know if you need help) Yes No 2. Go over to the child and provide verbal prompt to initiate the activity or routine using clear language (e.g., "First, clean up, then play") and calm tone of voic e. Yes No 3. Remind the child of the routine expectations using positive phrasing (e.g., "Use quiet voices" rather than "Don't yell") Yes No TEACH 1 Time Daily 1. Review the "asking for help" story Yes No 2 Ask M andy if she has any questions Yes No 3. Review the emotions story Yes No 4. Ask Mandy if she has any questions Yes No 5. Thank Mandy for reading the stories together Yes No REINFORCE 1. Upon the child's engagement, initiation or attempt to comply with directions, provide verbal complements. Yes No 2. If the child attempts to use the problem behavior to obtain toys from a peer or refuses to follow directions, remind of class rules or routine e xpectations and provide alternatives; praise for choosing an alternative. Yes No 3. If the child continues to engage in the problem behavior, be calm about the problem behavior; temporally withhold the activity or attention while ignoring probl em behavior. Yes No
59 Appendix 10 Fidelity of PTR Steps Implementation Checklist Date of Meeting: ____________________ S tudent: ____________________ Teacher /Teacher Assistant: ____ ________ C onsultant: ___________________ Interventions : Prevent Teach Reinforcer Instructions: (1) Place an x' in each cell that coincides with the activities completed during the meeting (e.g., discussion, rol e play, etc.) (2) Answer yes or no if the consultant effectively demonstrates each step of the int ervention. (3) Obtain integrity score. Task Analysis of PTR Meetings Researcher Conducted Task Meeting 1 1. Welcome and introduction of team Yes No 2. Overview of process and meeting goals Yes No 3. Explains and uses teaming worksheets Yes No 4. Explains and sets time for baseline data Yes No Meeting 2 1. Explains and uses FBA checklist Yes No 2. Explains and uses FBA summary table Yes No 3. Goes over baseline data and hypothesis Yes No 4. Explains and uses PTR intervention checklist Yes No 5. Develops Intervention plan Yes No 6. Makes and explains training checklist Yes No 8. Takes fidelity of implementation data Yes No Meeting 3 1. Discusses intervention data Yes No 2. Explains and uses self evaluation social validity measure Yes No Total Number of Correct Steps Percentage of Correct Steps
60 Appendix 11 PTR Self Evaluation: Social Validity Directions: Please score each item by circling the number that best indicates how you feel about the PTR intervention(s). 1. Given the child's behavior problems, how acceptable did you find the PTR behavior plan? __________1___________2_ ___________3____ ________4____________5____ Not acceptable Neutral Very acceptable 2. How willing were you to carry out this behavior p lan? __________1___________2______ ______3____________4____ ________5____ Not willing Neutral Very willing 3. To what extent were there disadvantages to following the behavior plan? __________1____________2_____ ______3____ ________4_ ___________5____ No disa dvantages Neutral Many disadvantages 4. How much time was needed each day for you to carry out the behavior plan? ______ __1____________2__ ____ _____3____ ________4____________5______ Little time Some time Much time 5. To what extent do you think the behavior plan was effective in reducing problem behaviors? _________1____________2_______ ____3____ ________4____________5____ Not effe ctive Somewhat effective Very effective 6. Do you feel that following this pla n will result in permanent improvements in the child's behavior? __ ________1____________2________ ___3____ ________4____________5____ Unlikely Possibly Very likely 7. How disruptive was it to carry out the behavior plan? __________1 ___________2________ ___3____________4________ ____5____ Not at all disrupti ve Slightly disruptive Very disruptive 8. How much did/do you like the procedures used in the behavior plan? __________1____________2_____ ______3____ ________4_________ ___5____
61 9. How likely is it that you will continue to implement the procedures in the plan after this research is terminated? __________1__________ __2_____ ______3____ ________4____________5____ Unlik ely Somewhat Likely Very likely 10. To what exten t did you observe undesirable side effects as a result of the behavior plan? __________1____________2______ _____3____ ________4____________5____ No side effects Neutral Definite side effects 11. How much discomfort did the child experience during the beh avior plan? ________1____________2________ ___3____ ________4____________5_____ Little discomfort Some discomfort Significant discomfort 12. How willing were you to change routines in order to carry out the behavior plan? __________1____________2______ ____3____________ 4____________5____ Not willing Somewhat willing Very willing 13. How well did carrying out the plan fit into your current routines? __________1____________2____ __ _____3____ ________4____________5____ Not at all Somewhat Very well 14. How effective was the intervention in terms of teaching the child appropriate behavior? __________1 ____________2________ ___3___ _________4____________5___ Not effective Somewhat effective Very effective 15. How well did the goal of the interventio n fit with the team's goal for improvement of the child's behavior? __________1____________2___ ____ ____3____ ________4____________5____ Not at all Somewhat Very well Other comments: _____________________________________________________ ____________ _______
62 Appendix 12 Novel Rater Evaluation: Social Validity Directions: Please score each item by circling the number that indicates how you feel about the teacher and child behavior. 1. The child's behavior is acceptable in this routine. ____1______ ______2____ ______3____ ________4____________5________ No Somewhat Yes 2. The child is participating in the routine appropriately. ____1____________2____ ______3____ ________4____________5________ No Somewhat Yes 3. The child appears comfortable with how the routine is going. ____1____________2____ ______3____ ________4____________5________ No Somewhat Yes 4. T he strategies used by the teacher (s) are w orking in this routine. ____1____________2____ ______3____ ________4____________5________ No Somewhat Yes 5. The teacher appears comfortable with how the routine is going. ____1____________2____ ______3____ ________4_____ _______5________ No Somewhat Yes 6. The strategies used by the teacher are practical for preschoolers ____1____________2____ ______3__ __________4____________5______ __ No Somewhat Yes