Term
Problem Solving RTI
(Tier 2 interventions) |
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Definition
•consultation context, more behavior mod at tier 2 but at tier 3 more Behavior analytic
–Problem Identification (What is the problem?)
–Problem Analysis (Why is it occurring?)
–Plan Design/Implementation (How can we change it?)
–Plan Evaluation (Was it effective?) |
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Term
Standard Protocol RTI
(Tier 3 interventions) |
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Definition
can be for both academic and behavior
–Manualized treatment
–Specific procedures
–Integrity checks- you have to know how well the intervention is working
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Term
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Definition
•Preventive RTI
•Universal prevention (primary prevention)
•Universal screening (3 times per year)
•Multiple gating procedures
•Reactive RTI
–Selected interventions (secondary prevention)
–Replaces refer-test-place approach
–Moves from assessment-oriented to intervention-oriented practices
•Eligibility RTI
–Most intense
–Used to make eligibility decisions
–Districts can’t use both RTI and discrepancy, you have to pick one as a district
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Term
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Definition
•An ounce of prevention is worth a pound of cure”
•Involves systematic screening of entire school population
•Screening should take place 3 times per year
•Early identification leads to better outcomes
•Efficient & practical means of screening available
•Similar logic used in medicine:
–PAP smears
–PSA tests
–Mammograms |
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Term
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Definition
•Interventions directly linked to assessment information
•Intensity of intervention matched to degree of unresponsiveness
•Student response to intervention directly measured
•Increasing body of data collected as student moves through tiers
•Integrity of intervention directly measured
•Generalization & maintenance of behavior change evaluated |
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Term
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Definition
•Interventions directly linked to assessment information
•Intensity of intervention matched to degree of unresponsiveness
•Student response to intervention directly measured
•Increasing body of data collected as student moves through tiers
•Integrity of intervention directly measured
•Generalization & maintenance of behavior change evaluated |
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Term
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Definition
•Used to make “high stakes” decisions
–Eligibility for special education
–Referral to other agencies (mental health)
•Part of special education law in U.S.
•IDEIA (2004)
•Can be used instead of IQ-achievement discrepancy for SLD
•Used in many states for ED eligibility determination
•Similar logic to triage in hospitals
–General hospital admission
–Step-up unit
–Intensive care |
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Term
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Definition
–Screening Test:
–Diagnostic Test:
–Treatment Decision Test:
–Monitoring Test: |
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Term
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Definition
| A test in search of a disease. Example: PSA test in search of prostate cancer |
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Term
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Definition
–: A test for a disease. Example: Biopsy of lump on breast for breast cancer
– |
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Term
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Definition
| Test designed to guide treatment decisions: Example: Cholesterol panel results used to prescribe statin drugs |
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Term
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Definition
| Test to help track progress of a disease or treatment regimen: Example: Blood pressure monitoring for patients with hypertension |
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Term
Advantages & Disadvantages of Screening
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Definition
•Advantages
–Early detection of problems—more effective intervention outcomes
•Disadvantages
–Cost & use of resources for most who do not need intervention
–Adverse anxiety or discomfort
–Unnecessary investigation of false positive results
–False sense of security in false negative results
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Term
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Definition
•False Positive Error: Indicator is present but condition is absent:
–Example: Pregnancy test is positive but individual is not pregnant
–Example: Person diagnosed as SLD but is MR (false positive for SLD)
•False Negative Error: Indicator is absent but the condition is present:
– Example: PSA test is negative but individual has prostate cancer
–Example: Person diagnosed as SLD but it MR (false negative for MR)
•Borderline Test: One with a result but it may not be clearly answer the question: It is not negative, but it is not positive enough to justify treatment
–Example: Borderline hypertension (136/84 blood pressure)
–Example: Person has IQ of 72
–Example: Beck Depression Index 65 |
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Term
| Antecedent Probability & Identification |
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Definition
•Diagnostic & prognostic statements can be based on actuarial data (base rates)
–All you need is the base rate
•Test must improve identification over base rates
•Problems with many tests
–Base rates not reported
–Restrictive samples & small samples
–Lack of cross-validation
–Lack of clarity concerning population to be identified
–Results reported in terms of statistical significance (p<.05) rather than # correct decisions |
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Term
| Examples of Base Rate Information |
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Definition
•Base rate of reading problems in a school is 80%
–A reading test predicts reading problems with 79% accuracy
–Reading test is worthless relative to base rate information
•Base rate of bullying in a school is 20%
–A rating scale identifies bullying in 19% of school population
–Rating scale is worthless relative to base rate information
•Base rate of LEAP failure in 3rd grade is 15%
–CBM measure predicts a 16% LEAP failure rate
–CBM measure is worthless relative to base rate information
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Term
| What are Base Rates based on? |
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Definition
•Base rates based on Bayesian statistics or logic
•Bayesian statistics use 2 types of probability
–Prior or antecedent probability (probability before data are collected)
–Posterior probability (probability after data are collected)
•Traditional statistics use only prior probability (p<.05)
•Bayesian statistics or logic used in Decision Theory
•Probability of event changed based on accumulation of additional information
•Example: Courts use Bayesian logic to establish guild or innocence beyond a reasonable doubt using accumulation of admissible evidence |
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Term
| 5 Criteria for Screening Tools |
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Definition
•Brief (No more than 10 items)
•Research based (Based on sound empirical evidence)
•Easily understood (Scoring, administration, self-explanatory)
•Valid (Accurate in identifying at-risk students)
•Powerful (Efficient in identifying at-risk students who might benefit from intervention) |
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Term
| Conceptualization of Screening |
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Definition
•Screening as titration
–Gradually adjusting dose of medication
–All students tested
–Those scoring below cut point candidates for more intense interventions
–Decision to change intervention based on progress monitoring data
•Screening as triage
–Sort individuals based on need
–Immediate alignment with any of 3 tiers based on scores
–Services at any tier provided base on need
•Fast track individuals to Tiers 2 or 3
•Do not have to go through all tiers |
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Term
| Evaluation Framework for Screening Tools |
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Definition
•Accessibility
–Cost to administer
–Feasibility
–Acceptability to stakeholders
–Infrastructure for data management
•Reliability
–Internal consistency
–Test-retest stability
–Alternate form
–Interrater
•Construct Validity
–Content
–Internal structure
–Relations to other variables (predictive/concurrent/postdictive)
•Consequential Validity- sammessick
–Treatment utility (treatment validity)
–Schoolwide behavior records (e.g., ODRs)
–SPED placement rates
–Stakeholders opinions
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Term
| Conditional Probability Indices |
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Definition
•Reflects dichotomous nature of predictor & criterion (present/not present)
•4 possible outcomes (true positive/false positive & true negative/false negative)
•5 indices of accuracy
–Sensitivity (SEN)-true positive
–Specificity (SPE)-true negative
–Positive predictive value (PPV)
–Negative predictive value (NPV)
–Base rate (BR)
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Term
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Definition
•Sensitivity: Likelihood of correct identification of a problem
•Specificity: Likelihood of correct identification of absence of a problem
•PPV: Likelihood that person identified is one that has the problem
•NPV: Likelihood that student not identified is one who does not have the problem
•BR: Total number persons identified by criterion divided by total sample size
•Hit rate: True positives + true negatives divided by total sample size
•Phi coefficient (shared variance between predictor & criterion)expressed as a dichotomy related to chi-square
ROC analysis (plot of sensitivity rate against false positive rate to determine optimal cut score)-receiver operating analysis, this tells you how good your test is |
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Term
Decision Rules for Screening |
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Definition
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Term
Screening Example:
Hypothetical School of 500 Students |
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Definition
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Term
Office Discipline Referrals (ODRs):
A Simple, Efficient Screening Tool |
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Definition
•Initiated by classroom teachers for behavioral infractions
–Teacher defiance
–Insubordination
–Bullying, harassment
–School rule violations
•Majority of ODRs accounted for by 10% of school population
•Elementary-school students: 0-1 ODRs each school year
•Middle-school students: 3.5 ODRs each school year
•Typical antisocial student: 10 or more ODRs
•10 or more ODRs: Chronic Discipline Problem |
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Term
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Definition
•Specific categories
–Behavior
–Location
–Time
•Estimates rate of specific behaviors
•Indicators of student behavior problems (e.g., externalizing)
•Efficient form of data collection
•Indicator of school climate |
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Term
ODRs:
How to collect and use them in decision-making |
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Definition
•For elementary school, select students with 3 or more ODRs
•For middle school students, select students with 6 or more ODRs
•Categorize main reasons for ODRs:
–Teacher defiance
–Breaking school rules (specify)
–Bullying, harassment
–Chronic tardiness
•Implement a Positive Behavior Support (PBS) program in schools
•For chronic discipline problems, implement Tier 2 or Tier 3 interventions |
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Term
Screening Example
Depression |
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Definition
•Depression refers to people that feel sad much of the time. People like this often lose of interest in activities or friends, feel that they are worthlessness, have trouble sleeping, have changes in their appetite, and don’t feel good about themselves.
•Rate the following items on the scale below:
– 1-Not like me; 2-A little like me; 3-Somewhat like me; 4-Like me; 5-A lot like me
–I feel sad
–I have little interest in school activities
–I feel worthless as a person
–I have trouble sleeping
–I have little interest in eating
–Scores: Range from 5-25
–Cut Score: 1.65 standard deviations above school mean (will identify 5% of population)
•Administer to entire school population 3 times per year
•Next steps: Administer diagnostic test for depression (CDI, BDI, etc.) |
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Term
| Student Internalizer Behavior Screener |
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Definition
•Internalizers often overlooked in schools
•Most screeners focus on externalizing behaviors
•Participants: 1357 in Grades 1-5 (50% male/female)
•55 teachers completed ratings
•Internal consistency: .80; Test-retest: .75 (Fall/Winter)
•Scale validated against Teacher Rating Form Internalizing scale (r=.82)
•Optimal cutoff score: 8 (86% Sensitivity; 1% False Positive) |
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Term
Next Steps
What do we do with Kristin and Natalie? |
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Definition
•Both girls screened positive for possible anxiety & depression
•Lisa appears to be more severe based on teacher ratings
•Administer diagnostic tests
–Teacher Rating Form or BASC-Teacher
–CBCL or BASC-Parent
–Social Skills Improvement System (teacher-parent-student)
–Revised Manifest Anxiety Scale (RCMAS)
–Children’s Depression Inventory (CDI)
–Interviews (teacher, parent, student)
–Record review
•Treatment planning
–Do we have enough information?
–If not, what do we need? |
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Term
| Intervention Considerations for Kristin & Natalie |
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Definition
•Individual CBT; Individual CBT with parents (anxiety)
•Group CBT with or without parents (anxiety)
•The Coping Cat (anxiety)
•Social Effectiveness Training (social phobia)
•CBT group, CBT child only (depression)
•CBT group (depression; adolescent only)
•Penn Prevention Program (depression)
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Term
Externalizing Behavior Screener:
Some Technical Adequacy Data |
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Definition
•Student Risk Screening Scale (SRSS; Drummond, 1994)
•7 items (see next slide) summed to yield Total Score
•Elementary school study (N=2588 students; 53% males; 47% females)
•Internal consistency α=.81; Test-retest r=.73 (F-W; F-S; W-S)
•Externalizers: Sensitivity = .95; Specificity=.95
•Internalizers: Sensitivity=.78; Specificity=.72
•Replicated in middle school (N=500) & high school (N=674) populations |
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Term
Next Steps
What do we do with Frank and George? |
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Definition
•Both boys screened positive for possible Conduct Disorder
•Both boys equally at-risk based on teacher ratings
•Administer diagnostic tests:
–Teacher Rating Form or BASC-Teacher
–Child Behavior Checklist or BASC-Parent
–Youth Self-Report or BASC-Student
–Social Skills Improvement System (teacher-parent-student)
–Interviews (teacher-parent-student)
–Record review
•Treatment planning
–Do we have enough information?
–If not, what do we need?
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Term
| Intervention Considerations for Frank & George |
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Definition
•Anger Control Training
•Incredible Years-Parent and Child
•Classroom Management with Teacher Consultation
•Problem Solving Skills Training |
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Term
Continuous Progress Monitoring
An Essential Aspect of Data-Based Decision Making |
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Definition
•Curriculum Based Measurement (CBM) well-established progress monitoring tool
•CBM useful because:
–Technically adequate (reliability & validity)
–Sensitive to short-term changes in academic performance
–Time efficient for frequent progress monitoring (1-2 times per week)
–Example: DIBLES and AIMs WEB
•No CBM analogue for social behavior or mental health issues
•Progress monitoring for these issues important because:
–Is rate of progress during intervention acceptable?
–Who is not responding to the intervention & to what degree?
–Use data to change or modify intervention
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Term
“Clinimetrics”
An Example from Medicine |
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Definition
•Psychometric approaches ignore sensitivity to change (strive for opposite: test-retest reliability or stability)
•Practitioners interested in measuring several attributes with few “items”
•APGAR score comprised of 5 “items” taken at birth & 5 minutes later
–Heart rate
–Respiratory effort
–Reflex irritability
–Muscle tone
–Skin color
•Rated on 0, 1, 2 scale and summed for Total Score
•“Items” not correlated with each other nor correlated with total score
•All items reflect newborn’s survivability & current health status
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Term
Brief Behavior Rating Scales (BBRs)
Promising Progress Monitoring Tools |
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Definition
•BBRs used in ADHD to assess response to stimulant medication
•IOWA Conners Teacher Rating Scale
–5 core symptoms of ADHD
–5 core symptoms of Oppositional Defiant Disorder (ODD)
•Developing General Outcome Measures (GOM)
–Technically adequate (reliability & validity)
–Sensitive to short-term changes in performance
–Administered repeatedly over time (1-2 times per week)
–Reflects general or overall performance
–Easily administered with minimal rater training required
–Not intervention dependent |
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Term
GOM for Social Behavior
An example using the Social Skills Rating System |
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Definition
•Identified 12 change sensitive items from SSRS-Teacher
–Responds appropriately when hit or pushed
–Follows your directions
–Disturbs ongoing activities
–Ignores peer distractions
–Overall classroom behavior
–Is easily distracted
–Cooperates with peers
–Argues with others
–Gives compliments to peers
–Joins ongoing activity or group
–Volunteers to help peers
–Accepts peers ideas for activity |
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Term
| BBRs Can Be Developed for Other Areas |
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Definition
•Depression
–Items from Children’s Depression Inventory
–Items from the Beck Depression Inventory
•Anxiety
–Items from the Revised Children’s Manifest Anxiety Scale (RCMAS)
–Items from the Multidimensional Anxiety Scale for Children (MASC)
•Conduct Problems
–Items from Teacher Rating Form
–Items from Behavioral Assessment System for Children (BASC)
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Term
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Definition
•Anxiety
–Irritability
–Concentration problems
–Fatigue
–Excessive worrying
•Depression
–Depressed mood
–Fatigue
–Eating problems
–Feelings of worthlessness
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