Integrating Academic and Behavior Supports Within an RtI Framework, Part 4: Tertiary Supports
Systems initiatives with the greatest impact use data to guide the allocation of resources (Kotter, 1995). Nowhere is this more important than for tertiary supports. Students who do not respond to the previously provided tiers of support (to goal attainment) may require the most intense level of assessment and intervention. The personnel involved in ameliorating intensive student instructional barriers have the most highly specialized skill sets. Therefore, school teams must find the most effective and efficient allocation processes for academic and behavioral support resources.
Interventions at the tertiary level address multiple issues that have an impact on student success. For students who "cannot" perform an academic or behavioral skill due to a deficit, specific academic remediation or teaching of replacement behaviors (or in combination) may be required. For students who "will not" use adaptive academic or behavioral skills due to specific antecedent or consequence factors (e.g., function), an investigation is conducted to determine the reason for this motivation deficit (VanDerHeyden & Witt, 2008). Additional analysis may include an investigation into student and family quality of life (Turnbull et al., 2002).
Critical core components of tertiary supports include functional behavior assessment, functional academic assessment (Witt, Daly, & Noell, 2000), comprehensive team-based approaches, connecting academic and behavioral supports, interventions grounded in assessments that may include altering the environment and instruction, teaching needed skills, decreasing the efficiency of problem behaviors, use of safety or negative consequences as needed, increasing behavioral expertise, and use of ongoing data collection for problem solving (Center on Positive Behavioral Interventions and Supports, 2007). Additional tertiary supports may include person-centered planning to address intensive quality of life needs (e.g., wraparound, futures planning; Cheney, Malloy, & Hager, 1998; Eber, Sugai, Smith, & Scott, 2002; Kincaid, 1996). Family involvement also may increase at this level. The participation of the family in selecting areas for academic and behavioral improvement can encourage effective problem solving and increase the ability of teams to maintain a preventative orientation (Esler, Godber, & Christenson, 2008).
Effective and Reliable Integration Assessment
Whether or not a student has an individualized education program (IEP), developing a core treatment plan in three domains may be useful. Assessment and supports would include academic issues, behavioral supports, and quality of life treatments. Teams would review previously collected secondary data (e.g., progress monitoring). Additional data would be collected in the area of student performance deficits. For instance, student performance may be assessed using direct measurement (e.g., curriculum-based measurement of academic skills; Shinn, 1989). Behavioral assessments can include record reviews, interviewers, observations, and check lists designed to be synthesized into a comprehensive hypothesis statement regarding the student’s target behaviors (Roberts, Marshall, Nelson, & Albers, 2001). Other assessments may include interviews and self-reports regarding quality of life issues in the areas of advocacy, emotional well being, health, environmental well being, productivity, and social well being (Poston et al., 2003).
Assessing quality of life is crucial, as it can influence both academic and behavior performance. If a child has limited support outside of the school environment, there may be barriers in the development of understanding social cues and increasing academic skills through practice at home. There also may be an increase the likelihood that students will use problem behavior to get their needs met.
Hart and Risley (1995) found differences in levels of affirmative positive feedback for infants to range from 20% to 80% for children from 13 to 18 months of age. These early experiences can profoundly affect later interactions. Within this study, children who at 13–18 months had received negative feedback during 80% of interactions with caregivers gave negative feedback to family members during 80% of interactions by age 3.
Some students may have limited phonemic awareness due to lack of exposure to linguistic interactions through caregivers and play (Sindelar, Lane, Pullen, & Hudson, 2002). As early as age 3, children may have established their patterns in vocabulary, amount of talking, and style of interaction. If the amount and the variety of interactions have a limited range, it may require thousands of hours of intervention to address vocabulary deficits (Hart & Risley, 1995). As stated, a deficit in quality of life from an early age may have an impact on both academic and behavioral outcomes (Poston et al., 2003).
Intervention becomes far more proximal at the tertiary level. For instance, if an academic intervention such as repeated readings is utilized, the student repeats the practice of the section until reaching a research validated fluency criterion (Sindelar et al., 2002). These data can be charted to monitor progress and for additional self-motivation for students.
The development of the treatment plan (e.g., behavioral intervention plan, instructional planning) involves a consideration of the reason (function) of the student's presenting issue. If the student cannot perform the skill, an intensive remediation plan is needed. If the student possesses the requisite skills but does not use them reliably, the support plan must include an environmental arrangement that promotes success (VanDerHeyden & Witt, 2008).
Traditional academic support plans are based on direct assessments, assessment of expected skills, and creating a link between assessment data and intervention (VanDerHeyden & Witt, 2008). Traditional behavioral and quality of life intervention plans often utilize a competing pathway analysis (O’Neill et al., 1997). Within this process, the summary statement of the function of the target behavior is expressed in terms of a) setting events, b) antecedent triggers, c) description of the target behavior(s), d) a description of the maintaining consequence for the problem behavior, e) a description of the desired behavior, f) a description of an alternative behavior that would lead to the same function as the problem behavior, and g) a description of the functional outcome for the desired behavior (e.g., improved grades). Interventions associated with competing pathway analysis address four major components (setting event supports, antecedent interventions, teaching new behaviors, consequence strategies), each of which is designed to lead to the desired behavior. The pathway process may be used to integrate academic, behavioral, and quality of life interventions.
The following section provides examples of how academic, behavioral, and quality of life interventions can be combined into a pathway for treatment. These examples may provide illustration; however, they do not provide an exhaustive list of evidence-based supports.
Setting Event Strategies
Interventions that address setting event issues may come in the form of academic remediation, reducing perceived need for problem behavior, or addressing a basic quality of life need. Behaviorally, setting event supports might include the use of noncontingent reinforcement to decrease the reinforcing properties of negative adult attention for students' inappropriate behavior. In terms of quality of life, an intervention may focus on a domain that directly addresses problem behavior (e.g., a student sleeping in class because the student does not have a bed at home; Edmonson & Turnbull, 2002). In some cases, it may be efficient to address the problem behavior at this level if a basic need is not being met (e.g., access to food or shelter; Chandler & Dahlquist, 2006; Edmonson & Turnbull, 2002). Further, parents also can provide supports with specific interventions at home (e.g., reinforcing error correction procedures; Esler, Godber, & Christenson, 2008).
In terms of antecedent manipulations, the difficulty of tasks can be manipulated to match the student's instructional level (Lee, Sugai, & Horner, 1999). Adaptations in either the level (modifying) or providing accommodations through scaffolding (e.g., advanced organizers, peer tutoring) can be provided to increase success and decrease frustration. Further, students can be provided with prompts to engage in alternative behaviors that have been previously taught (Scott & Nelson, 1999).
For remediation of any skill (academic or behavior), treatments must include high-quality instruction. High-quality instruction a) focuses on critical, functional skills; b) uses explicit teaching; c) is carefully sequenced; c) emphasizes the use of conspicuous strategies; d) uses scaffolding to promote student success; e) utilizes prior knowledge; and f) provides regular opportunities for practice (Kame'enui & Carnine, 2002). Both academic and behavior intervention may involve mixed instructional methods, including one-on-one tutoring or small-group instruction, with a systematic instructional pedagogy (Institute for Education Sciences, 2009).
Students can be taught behaviors that serve the functional equivalent of their problem behavior (Chandler & Dahlquist, 2006; Scott & Nelson, 1999). For instance, students can learn to request assistance or to escape from a frustrating activity. Students also can be taught to solicit attention appropriately. Students can be taught to self-monitor progress and determine if changes in problem-solving orientation regarding particular assignment would be needed. Choice making also can be an appropriate intervention, including allowing students to decide how to complete an assignment.
Consequence strategies for a support plan can include providing a preferred outcome, such as access to adult or peer attention, access to a preferred object, or escape from a frustrating task (e.g., understimulating, overstimulating), for use of appropriate academic or behavioral skills (Dunlap, Foster-Johnson, Clarke, Kern, & Childs, 1995). Outcomes should be as functional as possible. For instance, the outcome of completing a task that required improving reading fluency should lead to access to the student being able to read preferred content. Outcomes of a social nature can increase the functionality of a consequence strategy. For instance, allowing students to participate in a classwide debate as an alternative to a quiz may decrease the level of academic frustration and lead to increased socialization.
The model described in this article can be conceptualized as a series of processes. A major question for practitioners and researchers alike is to identify how much effort is required and at what point a team makes the transition from one level to the next. Each team should be aligned in such a way that each group can identify their responsibilities, keep the other groups informed, and know when to move supports up or down the triangle. The implementation of separate tertiary academic and behavioral support systems, independent of each other, has clear drawbacks.
Blood and Neel (2007) discussed the implementation of behavioral assessment and intervention. In their study, they found an instance in which 23 students had existing behavior intervention plans (BIPs) but did not have a functional assessment included in their file. BIPs not grounded in data may not be effective or may even cause harm (Filter & Horner, 2009; Ingram, Lewis-Palmer, & Sugai, 2005; Newcomer & Lewis, 2004). Additionally, the BIPs in the identified case study files included primarily a list of possible reinforcers, as well as a series of negative reactionary consequences for undesired behaviors (Blood & Neel, 2007). There was limited information about other intervention strategies, including prevention or teaching strategies.
There are concerns about the use of tertiary academic interventions without monitoring individual response, particularly once students begin receiving special education supports and services. It is critical that school teams measure the effectiveness of interventions, even evidence-based interventions, for every student (Kratochwill & Shernoff, 2004). By integrating both models, it is hoped that some of these concerns, including the overwhelming nature of multiple initiatives, can be addressed.
Moving up the Triangle
As the magnitude of academic and behavior problems increases, so too do the resources, environmental structures, and use of data needed to address the problems. Figure 1 provides an illustration of the relationship between problem intensity and the increased level of resources required to address them.
Figure 1: Comparing Magnitude of Needs and Resource Intensity
Supporting students at the tertiary level places many demands on school systems. An important tactic to improve efficacy at the tertiary (and secondary) level is ensuring that strategies at the universal and secondary levels are implemented with fidelity prior to referral at the tertiary level. The Illinois Positive Behavior Interventions & Supports Network reported on the number of identified interventions per school by level of implementation of positive behavior supports. During the 2007–2008 academic year, 162 schools reported implementing secondary and tertiary interventions on their annual report. Of the 162 schools reporting secondary and tertiary interventions, 138 of these schools were at full implementation for universal supports as measured by the School-wide Evaluation Tool (Horner et al., 2004). Fifty-six schools who reported secondary or tertiary level interventions had not reached full implementation (Eber, Lewandowski, Hyde, & Phillips, 2008). There may be a relationship between increased level of universal implementation and a school team’s ability to provide secondary and tertiary level interventions. This involves the appropriate identification and placement into the secondary supports based on specific student need. By taking these steps, fewer students may be referred to the tertiary support level, but those students may be more legitimately identified as being in need of intensive supports. As students progress in age, it may be that addressing intensive academic, behavioral, and quality of life needs becomes increasingly challenging (Walker & Sprague, 1999). Evidence-based systems must be available to address skill deficits in basic skills and content areas, and at major transition points (e.g., moving from elementary to middle school and middle school to high school).
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