D-10 Autism Spectrum Disorder: Across the Tiers

Presenters:  Robert  Putnam,  May  Ins2tute  &  Na2onal  Au2sm  Center    

Kathy  Gould,  Illinois  Au2sm  Partnership,  Easterseals  serving  Chicagoland  and  Rockford  

   Key  Words:  Au-sm,  Applied  Evalua-on,  Special  Educa-on  

 

           

Key  Words:  Applied  Evalua-on,  Assessment,  Training  

Maximizing  Your  Session  Par-cipa-on  

When  Working  In  Your  Team  

Consider  4  ques-ons:        

–  Where  are  we  in  our  implementa-on?  –  What  do  I  hope  to  learn?  –  What  did  I  learn?  –  What  will  I  do  with  what  I  learned?  

Where  are  you  in  the  implementa-on  process?  

 Adapted  from  Fixsen  &  Blase,  2005  

• We  think  we  know  what  we  need  so  we  are  planning  to  move  forward  (evidence-­‐based)  

Explora-on  &  Adop-on  

•  Let’s  make  sure  we’re  ready  to  implement  (capacity  infrastructure)  

Installa-on  

•  Let’s  give  it  a  try  &  evaluate  (demonstra-on)  

Ini-al  Implementa-on  

•  That  worked,  let’s  do  it  for  real  and  implement  all  -ers  across  all  schools  (investment)  

•  Let’s  make  it  our  way  of  doing  business  &  sustain  implementa-on  (ins-tu-onalized  use)  

Full  Implementa-on  

Leadership Team Action Planning Worksheets: Steps

Self-­‐Assessment:  Accomplishments  &  Priori2es  

Leadership  Team  Ac-on  Planning  Worksheet  

Session  Assignments  &  Notes:  High  Priori2es  

Team  Member  Note-­‐Taking  Worksheet  

Ac-on  Planning:  Enhancements  &  Improvements  

Leadership  Team  Ac-on  Planning  Worksheet  

Advance  Organizer  

•  Brief  review  of  evidence-­‐based  prac-ces  with  ASD  

•  Prac-ces,  systems,  and  data  of  a  three-­‐-ered  approach  to  serving  students  with  au-sm  spectrum  disorder  

•   Implementa-on  and  evalua-on  of  these  prac-ces  within  a  three-­‐-ered  approach  in  two  states  

•  Heterogeneity  

•  Drama-cally  increased  prevalence  

•  High  risk  of  problem  behaviors  

•  Presence  of  massive  amounts  of  informa-on  and    misinforma-on  

 regarding  effec-ve  prac-ces  (e.g.,  via  internet)  

•  Tedious  li-ga-on  

ASD  and  Special  Challenges    for  Schools  

• Need  for  specialized  services  and    supports  §  structure  §  precise  &  highly    systema-c  instruc-onal  procedures    §  sophis-cated  educa-on  communica-on  and  social  skills  

interven-ons  

• Essen-ally  ALL  students  with  ASD  require  ter-ary  supports,    though  this  need  can  be  mi-gated  with  effec-ve  universal  and    secondary  supports  

• Need  exists  across  all  levels  of  func-oning,  all  ages,  all  placements  

ASD  and  Special  Challenges    for  Schools  

ASD  Prevalence  • Between  2000  to  2008,  au-sm  prevalence  has  grown  from  1  in  150    Children  to  1  in  68  from  the  year  2000  un-l  2012.  (Center  for      Disease  Control,  2012)      • Between  1998  to  2010,  the  number  of  6  to  21  year  old  children  receiving    services  for  an  ASD  in  public  special  educa-on  programs  across  the  na-on    increased  from  54,064  to  370,011.  

~80% of Students

~15%

~5%

CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT

ALL  

SOME  

FEW  

What    Supports    are  needed  for    ALL  Students  with  ASD?  

What    Supports    are  needed  for    SOME  Students  with  ASD?  

What    Supports    are  needed  for    A  FEW  Students  with  ASD?  

PRACTICES  

Supporting staff behavior:

“How

things are done.”

Supporting decision making:

“How

decisions are made.”

Supporting Student Behavior: “How staff interact with students.”

   OUTCOMES  

Social Competence &Academic Achievement:

PRACTICES Supporting Students

•  What practices should be Universal, Secondary and Tertiary

•  Select and individualize practices for students at each tier

•  Determine effectiveness

PRACTICES Supporting

Students with ASD

     All  Students  with  ASD  need:  

•  Social/Communica-on  Supports  and  Behavior  Supports  to  be  successful  in  school  

 •  Level  of  support  needed  varies  (skill  scader)  

•  Level  of  intensity  matched  to  level  of  need  

•  Must  individualize  interven-on  AND  intensity  of  interven-on  

•  How  do  you  determine  what  is  needed?    •  Data-­‐based  method  for  evalua-ng  the  effec-veness  of  interven-on  

PRACTICES

Evidence  Based  Prac9ces  for    students  with  ASD  

Na-onal  Standards  Project    2015    Na-onal  Au-sm  Center  www.na-onalau-smcenter.org  

 Na-onal  Professional  Development  Center  for  Au-sm  Spectrum  Disorders    2014    

Evidence-­‐Based  Prac-ces  |  Au-sm  PDC  hdp://au-smpdc.fpg.unc.edu/evidence-­‐based-­‐prac-ces  

 

Evidence  Based  Prac-ces  Matrix  

 Na-onal  Standards  Project    

 National Autism Center

•  Phase 2 completed April 2015 •  Comprehensive treatment packages •  14 Established interventions (age

0-21) •  18 Emerging interventions (age 0-21) •  Target skills to increase or behaviors to

decrease National Standards Project, Phase 2 National Standards Report 2 2015

NSP  1  and  2  

•  Largest  review  of  research  for  individuals  with  ASD  

•  Over  1000  studies  •  All  reviews  found  interven9ons  based  on  ABA  have  record  of  effec9veness  

•  Must  be  incorporated  into  an  individually  developed,  well-­‐designed  program  

NSP2 Established Practices

•  Behavioral  Interven-ons  •  Cogni-ve  Behavioral  Interven-on  Package  

•  Comprehensive  Behavior  Treatment  for  Young  Children  

•  Language  Training  (produc-on)  

•  Modeling  •  Natural  Teaching  Strategies  

   •  Parent  Training  •  Peer  Training  Package  •  Pivotal  Response  Training  

•  Schedules  •  Scrip-ng  •  Self-­‐Management  •  Social  Skills  Package  •  Story-­‐  Based  Interven-on  

Na-onal  Professional  Development  Center  on  Au-sm  Spectrum  Disorders  

•  Updated  findings  2014  •  Iden-fied  27  EBP  (focused  interven-ons)  •  Every  iden-fied  prac-ce  is  not  necessarily  appropriate  for  every  learner  

•  Prac-ce  is  most  effec-ve  when  carefully  matched  to  a  learner’s  specific  needs  and  characteris-cs.  

 Na-onal  Professional  Development  Center  on  ASD  -­‐  2014  

Easter Seals Metropolitan Chicago- Illinois Autism Partnership

Summer 2016

NPDC EBP 2014 •  Antecedent-­‐  Based  Interven-on  

•  Cogni-ve  Behavior  Interven-on  

•  Computer  Aided  Instruc-on  

•  Differen-al  Reinforcement  

•  Discrete  Trial  Training  

•  Exercise  •  Ex-nc-on  

•  Func-onal  Behavior  Assessment  

•  Func-onal  Communica-on  Training  

•  Modeling  •  Naturalis-c  Interven-ons  

•  Parent  Implemented  Interven-on  

•  Peer  Mediated  Interven-on  

Summer 2016

NPDC EBP 2014 (cont.) •  Picture  Exchange  Communica-on  

•  Pivotal  Response  Training  

•  Promp-ng  •  Response  •  Interrup-on/Redirec-on  •  Reinforcement  •  Scrip-ng  

•  Self-­‐Management  •  Structured  Work  Systems*  

•  Social  Narra-ves  •  Social  Skills  Training    •  Structured  Play  Groups  •  Task  Analysis  •  Time  Delay  •  Video  Modeling  •  Visual  Supports  

http://afirm.fpg.unc.edu

Selec-ng  EBP  

 Consider  -­‐  Age  of  student  -­‐  Environment/Semng  -­‐  Individual  characteris-cs  -­‐  Skills  to  be  taught  -­‐  Capacity  to  implement    -­‐  Include  families  -­‐  Involve  the  individual  

with  ASD  

 Non-­‐examples  •  Pick  a  package  and  go  with  it  

•  Do  what  feels  right  •  This  is  what  we  have  staff  trained  in  

•  Parents  are  asking  for  this  

 

Autism Spectrum Disorders: Guide to Evidence-based Practice

Missouri Guidelines Autism Initiative

Evidence  Based  Prac9ce  

Professional  Exper9se  

Individual  Characteris9cs  

Best  Available  Research  

Evidence  Based  Prac9ce  

Massachuseds  Suppor-ng  Decision  Making  

 Quality  Indicators  of  Effec-ve  Supports  

May  Ins-tute  

 • Instruc9on  in  Areas  Related  to  Core  Deficits  of  Au9sm  • Curriculum  and  Instruc9on—Academics  and  Specials  (e.g.,  reading,  math,  art)  • Communica9on  and  Interac9on  • Behavior  Supports  • System  and  Infrastructure  • Rela9onships  and  Interac9on  (staff)  

 

DATA

DATA

Massachusetts Supporting Decision Making

Quality Indicators of Effective Supports May Institute

•  Tier  I  efforts  are  focused  on  ensuring  that  standards  are  met  for  all  students  and  systems  are  in  place  for  those  standards  to  con-nue  over  -me.  

•  Self-­‐Assess  the  level  at  which  the  standard  is  in  place  

•  Priori-ze  based  on  the  assessment              Target  items  for  Tier  1    Quality  Indicators  of  Effec-ve  Supports    

SYSTEMS

Massachusetts Supporting Staff Behavior

     Systems/infrastructure  

•  Leadership  Team  includes  an  administrator  and  at  least  one  person  with  exper-se  in  the  following  areas:  applied  behavior  analysis  

•  Leadership  team  meets  monthly    •  Leadership  teams  uses  data  to  make  decisions    •  School  policies  and  procedures  emphasize  evidenced  based  prac-ces    

•  Classroom Observation Feedback •  Self-assessment of Quality Indicators

•  Interview Walk Through

DATA

Illinois

Supporting Decision Making

DATA Illinois  Data  Tools

Classroom Observation Feedback Assesses Evidenced based class wide practices

–  Access to evidenced based communication interventions –  Access to evidenced based social skills interventions –  Academic and behavioral supports as needed

DATA Illinois  Classroom Observation Feedback Form

•  Used with staff after training in the classroom

•  Used to assess implementation of critical components at classroom level

•  Action plan for higher implementation and problem solve barriers to implementation

 •  Observation Form

Illinois  Self-­‐Assessment  Survey    of  Quality  Indicators  

 District/Building

Learning Environment Instructional Activity Curriculum and Data

Survey  results  are  summarized  and  used  for:  –  annual  ac-on  planning  and  priori-zing,  –  awareness  building  of  staff,  –  Compared  to  direct  measures  –  Assessment  of  change  over  -me    Self  Assessment  Survey  

DATA

•  Determine  if  quality  indicators  are  in  place  for  students  with  ASD  by  observing  and  interviewing  

•  Evaluate  overall  on-­‐going  implementa-on  •  Compare  with  Self-­‐Assessments  and  Classroom  Observa-ons  •  Assist  in  ac-on  planning  and  design  and  revision  of  

programming  and  supports  for  schools  and  their  students  with  ASD  

 Interview  Walkthrough  

Illinois Interview Walkthrough (IIW)

DATA

SYSTEMS

Illinois Supporting Staff Behavior

Illinois  Explora-on  

•  Gain  commitment  and  administra9ve  approval  for    implementa9on  

 •  Select  team  members  for  training    •  Arrange  for  staff  to  par-cipate  in  coaching  mee-ngs  and  

summits  during  the  school  year  

•  Administra-ve  support  for  problem  solving  of  barriers  iden-fied  by  team  

SYSTEMS

Illinois  Installa-on  

   •  Convening  monthly  team  mee-ngs  with  IAP  Coach    •  Alloca-on  of  funds  to  support  this  work  

SYSTEMS

SYSTEMS Illinois  Implementa-on  

       District  Administrators  discuss  ASD  data  with  the  purpose  of  developing,  monitoring,  and  revising  an  ac-on  plan  to  facilitate  the  educa-on  of  students  with  ASD.  

   District  Administrators  discuss  at  least  annually  the  data  results  of  for  the  purpose  of  increasing  the  effec-veness  of  the  district’s  supports  and  services  for  students  with  ASD.  

•  Get  Administra-ve  (district  level)  commitment  upfront  (administra-ve  overview)  

•  Provide  team  member  recommenda-ons  and  Coach  job  descrip-on  

•  Provide  coaches  training  and  mentoring  

•  Implementa-on  over  -me  (3-­‐5  years)  

Illinois    Lessons  Learned  

Intensive  (Tier  3)  Supports  

•  High  risk    •  Individualized  strategies,  interven-ons,  and  prac-ces  

•  Intensive  teaching,  acknowledgement,  and  correc-on  procedures  

•  Frequent  monitoring  and  data  analysis,  and  treatment  integrity  

FEW  

Tier  3  System  

•  Purpose:  To  provide  a  venue  for  teams  to  systema-cally  analyze  behavioral  data,  make  decisions  based  on  those  data,  and  monitor  individuals’  progress  

•  Objec9ve:  To  find  the  simplest  solu-on  that  will  make  the  biggest  change  in  the  behavior  problem  

Criteria  for  Placement  in  Tier  3  

•  The  individual  has  required  2  or  more  physical  holds  within  a  24-­‐hour  period  or  over  a  30  day  period  to  insure  their  safety  or  that  of  others  

or    •  The  individual  has  engaged  in  behaviors  that  are  dangerous  

to  themselves  or  others  on  a  regular  basis,  not  necessarily  requiring  physical  holds.  

•  The  individual  has  had  long  standing  behavior  problems  which  has  not  been  responsive  to  current  interven-ons  

•  The  most  frequently  recorded  behavior  problems  are  aggression,  self-­‐injury,  elopement,  and  property  destruc-on.  

Systems  Team    vs.    Individual  Team  

•  Systems  Team    – Brief  data  review  of  all  students  in  Tier  3  

– Has    administra-ve  par-cipa-on    

– Behavioral  exper-se    – Other  exper-se  e.g.;  nursing,  speech    

– Reviews  on  a  ongoing  basis  systems  treatment  integrity  

•  Individual  team    –  Focused  on  one  student    

–  Review  of  data  of  one  student’s  performance    

–  Behavioral  exper-se    –  Team  includes  staff  working  with  the  student  

–  Family  and/or  significant  others  involved    

Team  Ini-ated  Problem  Solving  (TIPS)    

 (hdps://www.pbis.org/training/-ps)    – Emphasis  on  efficient  team  mee-ngs  using  data  to  inform  decision  making  

– Having  appropriate  team  members  present    •  Administrator  •  Senior  Behavior  Analyst  •  Educator    •  Other  Clinical  Staff    

– Review  of  current  data    – Determine  an  ac-on  plan  

Tier  3  Team  System  Mee-ngs  

•  Each  person  is  discussed  during  the  mee-ng  for  no  more  than  2  or  3  minutes.  

•  Graphs  of  the  daily  frequency  of  no  more  than  3  of  their  most  challenging  behaviors    over  the  past  60  days  are  reviewed.  

•  Determine  current  trends  by  using  trend  line  and/or  mean  frequency  per  day  of  behavior  •  Decreasing  trend/Behavior  improving  (+)  •  About  the  same/No  change  in  behavior  (0)  •  Increasing  trend/Behavior  not  improving  (-­‐)  

•  Decisions  are  made  as  to  what  should  be  done  to  address  the  problem  behaviors  that  are  not  improving  •  Develop  an  ac-on  plan  

Tier  3  Systems  Team  

•  Administrator/resource  &  opera-onal  exper-se    

•  Behavioral  exper-se  •  Clinical  staff  •  Program  staff  

Tier  3  Prac-ces:  BSP  

•  Preven-on  Strategies  – Antecedent  interven-ons  – Teaching  procedures  – Environmental  design  – Communica-on  style  

•  Consequence  Strategies  – Posi-ve  acknowledgement  &  reinforcement  procedures  

TFI Tier 3 Data

Tier  3  System  

•  Purpose:  To  provide  a  venue  for  teams  to  systema-cally  analyze  behavioral  data,  make  decisions  based  on  those  data,  and  monitor  individuals’  progress  

•  Goal:  To  prevent  problem  behaviors  by  using  data  based  decision  making.  

•  Objec9ve:  To  find  the  simplest  solu-on  that  will  make  the  biggest  change  in  the  behavior  problem  

Are  interven-ons  implemented  with  fidelity?  

Overall,  are  individuals’  behavior  improving,  staying  the  same,  or  

gemng  worse?  Have  they  acquired  skills?  

Decreasing  Trend  (+)  

0

2

4

6

8

10

12

10/1

/14

10/3

/14

10/5

/14

10/7

/14

10/9

/14

10/1

1/14

10/1

3/14

10/1

5/14

10/1

7/14

10/1

9/14

10/2

1/14

10/2

3/14

10/2

5/14

10/2

7/14

10/2

9/14

10/3

1/14

11/2

/14

11/4

/14

11/6

/14

11/8

/14

11/1

0/14

11/1

2/14

11/1

4/14

11/1

6/14

11/1

8/14

11/2

0/14

11/2

2/14

11/2

4/14

11/2

6/14

11/2

8/14

11/3

0/14

Pica Attempts

Flat/No  Change-­‐(0)  

Increasing  Trend  (-­‐)  

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

10/1/14 10/8/14 10/15/14 10/22/14 10/29/14 11/5/14 11/12/14 11/19/14 11/26/14

Elopement

Elopement DH

Linear (Elopement DH)

Data  Based  Decision  Making    Modifica9on:  Some  change  needs  to  be  made  •  FBA  •  Preference  

assessment  •  Medical    •  Treatment  

integrity    Monitor:  Con-nue  to  observe  for  change    

 Tier  3  Ini9a9ve  

 • 20  individuals    • 4  females,  16  males    • All  are  diagnosed  with  ASD  • 14  have  addi-onal  diagnoses  including  Down  Syndrome,  PTSD,  TBI,  and  Schizoaffec-ve  Disorder  

• All  adend  and/or  live  in  May  Ins-tute  day  and  residen-al  programs  

0%  

43%  46%  

66%   68%  

0%  

10%  

20%  

30%  

40%  

50%  

60%  

70%  

80%  

90%  

100%  

Q4  2014   Q1  2015   Q2  2015   Q3  2015   Q4  2015  

Tiered  Fidelity  Inventory  -­‐  Tier  3  Total  Implementa9on  Score  

Goal:  80%  

0%  

10%  

20%  

30%  

40%  

50%  

60%  

70%  

80%  

90%  

100%  

Sept-­‐Oct  2014   Sept-­‐Oct  2015  

29%  

50%  

55%  

37%  

16%   13%  

Percent  of  Individuals  Responding  to  Tier  3  Interven9on  

Non-­‐Responder  

Par-al  Responder  

Responder  

Eliminated   Reduced  by  90%    

69%  decrease  

26  

8  

0  

5  

10  

15  

20  

25  

30  

14-­‐Oct   15-­‐Oct  

Total  Protec9ve  Holds  October  2014  vs.  October  2015  

Building  Tier  3  Systems    

•  Build  representa-ve  teams  –  Leadership  &  oversight  –  Accountability  –  Resources  &  support  

•  Create  or  streamline  data  collec-on  systems    –  Data  based  decision  making  –  Monitoring  effec-veness  of  systems  and  prac-ces  

•  U-lize  evidence  based  prac-ces  –  Systema-ze  current  prac-ces  

•  Determine  each  individual’s  level  of  support  –  Universal,  targeted,  intensive  –  Iden-fy  risk  

Challenges  for  Schools  

•  Knowledge  and  fluency  in  the  EBP    •  How  to  individualize  and  combine  prac-ces  •  Take  data  –  Document  progress  •  Create  an  ongoing  plan  for  systems  change,  maintenance  and  sustainability  

•  Work  with  a  TEAM  -­‐  engagement  of  families      

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