http://. evidenced based practices for children and youth with asd

http://www.youtube.com/watch?v=RTEPx0B2HgA

Evidenced Based Practices for Children and Youth with ASD

Michigan Students with an ASD Eligibility Label

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National Professional Development Center on Autism Spectrum Disorders

A multi-university center to promote

the use of evidence-based practices for

children and adolescents with

ASD

NPDC Sites

• FPG Child Development Institute, University of North Carolina at Chapel Hill; PI: Sam Odom and Ann Cox

• Waisman Center, University of Wisconsin- Madison PIs: Len Abbeduto and Linda Tuchman-Ginsberg

• M.I.N.D. Institute, University of California at Davis; PI: Sally J. Rogers

www.fpg.unc.edu/~autismPDC

Goals of the NPDC

• Promote optimal learning for preschoolers, elementary and secondary students with ASD and support for their families through use of evidence-based practices (EBP)

• Increase state capacity to implement EBPs in early identification, intervention, and education

• Increase the number of highly qualified personnel serving children with ASD through sustainable technical assistance and professional development

• 5 year project: total number of states: 12

• Work with each state for 2 years Year 1 : master content and process, working with

NPDC staff Year 2 : begin training additional state personnel with

NPDC staff support Years 3+ : state continues activities

NPDC and State Involvement

Cohort 1

Cohort 2

Cohort 3

Who Is Involved?

State Interagency

Planning Group

School Site Teams

NPDC team

Training teamsfor school sites

FamiliesChildrenAdmin

School com

What Does NPDC Provide?

EPB Content Development

Technical Assistance Evaluation

Professional Development

Content Development

Goal: to translate information about evidence-based practices from research into practical resources for service providers

Define criteria for “evidence”

Identify evidence-based practices in lit

Define how to do them

Content Development

Web-based Module Contents

• Pre-Test/Post-Test• Contextual Information• Step by Step Instructions• Case Examples• Video Examples• Implementation Check

List• Evidence-Base• Resources

Collaboration with OCALI and NATTAP for Module Development

• AIM

http://autisminternetmodules.org/index.php

Content Development

•Project Website•Assessment Instruments

•Autism Program Environment Rating Scale (APERS)•Autism Evidence-Based Practices Self Inventory•Fidelity Implementation Checklists (BRIEFS)

•Web-based Modules: How to do each EBP •Online Course Autism 101

Products

What Does NPDC Provide?

EPB Content Development

Technical Assistance Evaluation

Professional Development

Professional Development

Goals:Provide training to state professional development providersProvide training activities to practitioners in participating statesSupport school sites that model evidence-based practices

Professional Development

•To those on the model site teams, local training teams, and state training team:

•Online introductory course on ASD•All materials: APERS, GAS, EBP training modules, BRIEFS•Intensive Summer Training•TA support for model sites and local training teams•2 years of training, technical assistance

Intensive Summer Institute

Professional Development

1. Increase knowledge of EBP2. Identify elements of high quality programs3. Build networking, collaboration and skills of members of state autism training team4. Develop plans for model sites and for dissemination across state

National Professional Development Center on ASD

Content Development

Technical Assistance Evaluation

Professional Development

NPDC Collaborationwith State Partners

Goals: Develop outreach program Provide ongoing site-based

training Establish a network of professional development sites, trainees, and national consultants

NPDC Collaborationwith State Partners

Begins with Support for Strategic Planning Activities

State Interagency Planning Group stakeholdersNPDC StaffLiaison person

Provides Support to Local Training TeamsProvides Year 1 TrainingProvides consultation and TA during Year 1 -2Supports the team during Year 2 TrainingTeam takes over training Year 3 and after

Provides Support to Model Site personnelProvides Year 1 TrainingProvides consultation/TA during Years 1-2Supports them with Year 2 TrainingTeam takes over Year 3 and after

What Does NPDC Provide?

EPB Content Development

Technical Assistance Evaluation

Professional Development

Evaluation: Goals:Assist trainees in establishing a system for implementing EBPCollect follow-up data on use of evidence-based practices, practitioner skills, and child and family outcomes

Evaluation

•Content•Professional Development•Technical Assistance•Outcomes

•Child•Family•Practitioner•Systems

Who has GAS?

Goal Attainment Scaling

Summarizing progress on IEP objectives

Acknowledgements

• Dr. Sam Odom, PI of the NPDC, Frank Porter Graham Center, UNC - Chapel Hill

Problem• Child MC – age 4 years – has 9 IEP goals in 5

developmental domains that involve 4 benchmarks each.

• End of year IEP meeting – mother asks, “Overall, how much progress did he make on his plan this year?”

• How can the classroom

teacher easily summarize?

Problem• School District has added additional funds to

support all 36 students in inclusive education in High Point middle school in some general ed classes.

• At end of year, asks Resource Teacher for summary of progress of these 36 children so that they can compare progress of included children to progress of center based children at the other middle school in district.

• How can the Resource Teacher easily summarize progress of the 36 students?

An answer?

Goal Attainment ScalingGoal Attainment Scaling

Goal Attainment Scaling (GAS)

• What is it? A method for measuring amount of progress made

on a goal, objective, or benchmark.

Content free

Allows progress to be easily summarized across multiple goals or students

Not a substitute for objective measurement or progress – it’s a supplement

Description of GAS

• Care provider establishes goals/benchmarks/ objectives that are measured on a continuum. After getting his work, James will independently

complete all 15 steps on the bicycle brake assembly task 90% of the time when working in the bike shop.

At start of each class, Sasha will turn in her completed homework assignment in biology class on time 85% of days in a one month period.

Julia will use 10 different words spontaneously during free play activity with typical peers.

Goal Attainment Scaling

Baseline level

Expected outcome = 0

Less than expected = -1

Much less than expected = -2

More than expected = +1

Much more than expected = +2

How to Develop a GAS • Select learning objective.

• Identify the current – baseline - level of performance.

• Identify the expected level at end of teaching period.

• Generate the additional outcome points on the scale.

• Examine progress using the GAS when you evaluate learning according to your benchmarks on a regularly designated schedule (monthly, bimonthly).

• Summarize the child’s or group’s overall progress at the end of the year by averaging the final GAS score.

GAS Data for NPDC target students 2009

Individual goals of approx 30 students

Level Of

Attainment

Goal 1 Goal 2 Goal 3

Much less than expected

-2

Somewhat less than expected

-1

. .

Expected level of outcome

0

Somewhat more than expected

+1

Much more than expected

+2

Comments

Use this form for the activity

Activity: Shaping the behavior of those we love

• Use the form in your packet

• Identify a behavior you would like to see increase – write a measurable objective for this for six months from now – BE REALISTIC!

• Write the current baseline level of this behavior

• Describe a much better than expected outcome(+2)

• Identify a much worse than expected outcome (-2)

• Identify the midpoints

Sharing

Student Goal Attainment Scaling FormExample

Level of

Attainment

Goal 1:Identify need to reduce anxiety in classroom

settings

Goal 2:Follow schedules of leisure

activities independently

Goal 3:Initiate verbal interaction with

peers to join an activity

Much less than expected

-2

UU always requires visual teacher prompts to leave the area when anxious and to use a visual story to regain composure.

UU engages in internet use for every leisure break, ignoring a schedule of daily leisure activity choices.

UU exhibits anxious behavior when near a peer, joining only when visually prompted in 5 of 10 opportunities.

Somewhat less than expected

-1

UU independently goes to appropriate area in the classroom when anxious and uses a visual story to regain composure 50% of the time during a two-week interval.

UU complies with allowed internet use on the leisure activity schedule on 4 of 10 days and chooses other leisure activities from his schedule.

When visually prompted, UU will always join peer in desired activity.

Expected level of outcome

0

UU independently goes to an appropriate area at school when anxious and uses a visual story to regain composure 90% of the time during a two-week interval

UU complies with allowed internet use on the leisure activity schedule on 8 of 10 days and chooses other leisure activities from his schedule.

UU, verbally, will initiate interaction with peers to join an activity in 4 of 10 opportunities without prompting.

Somewhat more than expected

+1

UU verbally states “I need a break” when anxious without prompts and takes a walk to look at his visual story, returning to scheduled activity without disruption 3 times a week for 2 months.

UU complies with allowed internet use at home on 5 of 10 days.

UU, verbally, will initiate interaction with peers to join an activity in 8 of 10 opportunities without prompting.

Much more than expected

+2

UU uses strategies (stress ball or fidgit) to reduce anxiety in the classroom and stay focused on scheduled activity 3 times a week for 2 months.

UU creates and follows a weekly internet use schedule at school and at home with 80% fidelity for 2 months.

UU will invite a peer to play a computer game during computer time at school without prompts in 2 of 4 opportunities..

Is this extra work?• NO –

benchmarks are already written assessments will occur as already planned Additional benchmarks can carry over into next year ?

• YES BUT– Adding higher benchmarks is easy! Just increase the criterion –

85% vs 95%, 2 times an hour vs. 4 times an hour, doing with a peer vs with 3 peers, doing X in snacktime vs. in snacktime and circle.

generating the above goal points allows you to reflect more growth

Process may result in more focused teaching ?

Break and small group activity

• Identify one crucial IEP goal/objective for one target student

• Go through the GAS process as a group

• Write it out on the form

• Think about how this will influence your teaching with that student

Evidence-Based Practices:

What’s the fuss all about?

As a consumer - • Your doctor suggests surgery to you as the first

approach for a non-lie threatening chronic condition. What is your response?

• Your first grade daughter Marci has been struggling with reading. She doesn’t yet reliably associate letters with sounds. The teacher wants to use a sight word approach due to Marci’s excellent memory. What is your response?

Evidence Based Practices• What does it mean?

• It’s been tested and found to be effective

• Why does it matter? It’s the law It’s the most efficient way to teach Most efficient way to learn Better chance of success

Evidence Based Practices (EBP)

• If there is no evidence, does it mean the practice is ineffective?

• If the child progresses, isn’t that evidence of effectiveness?

• What are the risks of using practices that are not evidence based?

NPDC Definition of EBP• The teaching practice has been tested and found to be

effective in:

(1)Two randomized or other well-controlled (quasi-experimental design) studies.

AND/ OR

(2) Five single-subject design studies conducted by at least three different researchers

What has to be considered when applying an EBP? Fidelity!

• Medicine Condition Patient Drug/procedure Dosage How administered Measure of efficacy When to change

approaches

• Education/intervention Content/behavior Student Teaching approach How much time daily Specific procedures Data collection and

examination When to change

approaches

Efficacy vs. Effectiveness• Efficacy is the systematic evaluation of

whether a treatment works

• Effectiveness is the extent to which the treatment works in natural settings – “real world” applications

• Clinical utility is the applicability, feasibility, acceptability, and usefulness of the intervention in a specific setting

Utility of EBP’s

• Some EBP’s may have a strong evidence base but be less useful in educational settings.

• Use professional judgment to determine what is most feasible and applicable to your unique context / student.

NPDC Tools to Help with EPB Implementation

APERS

EBP Inventory

Briefs and Modules

Examples

APERS – EBPs in place in the classroom

EBP Inventory – Your own learning goals

Briefs and Modules – EBPs for individual learning objectives

Choosing an evidence-based practice for a student

Ask: What is our goal/objective targeting?

• Consider the specific IEP goals and related objectives

Ask: What are our options?

• Look at the domain that the specific goal relates

Next, make a decision based on:

• The skills being taught• Your professional wisdom• The learner’s learning style• The learner’s temperament• The learner’s interests and motivators• Supports already in place• History of what has and hasn’t worked

IEP Application Goal - Communication

Goal: Sam will improve expressive communication skills across the school day.

Related Objective:When he sees a preferred object, Sam will request a desired item during snack and/or free choice time three times per day for two consecutive weeks.

• Sam is in an inclusive kindergarten setting.• Sam does not like talking to most people and

he is difficult to understand.• Last year’s IEP efforts to increase his use of

speech using differential reinforcement and naturalistic approaches were not successful.

• Sam is already using pictures for a visual schedule at school.

• One of Sam’s classmates uses PECS, and Sam is interested in the pictures.

How do we decide which EBP to use?

Ask: What is the goal targeting?

• Expressive Language

Ask: What are the options?

IEP Application Goals – BEHAVIOR/COMMUNICATION

Goal: Rosita will improve

communication skills.

Related objective:When Rosita shows distress

during learning tasks, she will use words, not self injury to request a break or assistance 85% of opportunities over two consecutive weeks.

Let’s say we know this…• Through the FBA process, the team

determined that Rosita was head banging and self biting during lengthy teaching interactions to end the interaction.

• Rosita does have oral language, but tends to not talk very much.

• Rosita is interested in print and can read simple words and short sentences.

• Rosita enjoys peer interaction more than adult interaction.

How do we decide which EBP to use?

Ask: What is our objective targeting?

• Expressive Language/Pragmatics

• Behavior

Ask: What are our options?

Choosing an EPB to teach a skill involves:

• The skills being taught• Your professional wisdom• The learner’s learning style• The learner’s temperament• The learner’s interests and motivators• Supports already in place• History of what has and hasn’t worked

Integrating EBP’s• Few practices are ever really used in isolation.

• Prompting and reinforcement, for example, are used in almost all of the other practices.

• Task analysis, too, is used prior to teaching skills through video modeling, visual supports, etc.

• Teams are encouraged, through coaching and mentoring, to explore the overlap of practices.

Integrating EBP’sExamples:• Video modeling can be used to teach a self-

management system. (model site example : )

• A social narrative can be written to explain the routine of a social skills training group.

• A speech generating device may be used by a learner in the context of a peer-mediated intervention.

Integrating EBP’s

• The understanding required to use practices concurrently, while still being mindful of fidelity of implementation, is an important component in the development of skillful teachers and practitioners.

Teaching Flowchart

Review the Brief & Module

ID the EBP

Design the data system

Gather baseline data

Develop the teaching plan; inform and train others

Implement plan & data collection system; review often

ID IEP goal and standard

Break down into teachable steps

Don’t tell me I have to keep data!

Developing helpful data systems

Why is data critical for EBP use?

• Collection of performance data tells us:

• What should we be teaching?

• Is our instruction successful?

• Is the student making progress?

• Do we need to change the teaching plan?

• Is it time to introduce a new skill?

The many ways to measure learning

• Event recording: frequency counts,%%• Latency recording: time elapsed• Did it happen at all? Yes-no• For chains: number of independent steps • Assessing steps before independence:

levels of prompts, precision (for shaping)• Once skills are mastered: thinning

reinforcement schedules, generalization to other skills, settings, environs, partners

Assessing progress

• Don’t start the new practice until you have baseline data!!! Assess skill a few times in your current way of

teaching first; to determine the baseline rate

• Summarize data immediately to make it useful: rates, percents, simple graphs

Note the stoppingPoints!

Sherer and Schreibman 2005

Goal: Child will verbalizeto requestobjects

Goal involving a sequence

• When instructed to wash his hands verbally or on picture schedule, Hal will go to bathroom and complete 85% or more of the steps of handwashing independently 90% of requests.

Daily Data chart for sequencesHow to summarize? 7 levels; 14% each;

Steps Indep Minimal P Partial P Full P

Turns on water

Wets hands

soaps

rinses

Turns off water

Dries hands

Turns off lite, leaves

Daily Data chart for sequencesHow to summarize? Weights: I=3, MP=2, PP=1, FP=0

Steps Indep Minimal P Partial P Full P

Turns on water

3

Wets hands 3soaps 2rinses 0Turns off water

1

Dries hands 2

Turns off lite, leaves

1

Take home points• EBPs represent the most effective teaching practices

in ed science

• Start with these, as written

• Pick them carefully, by student age, setting, and content area

• Get baseline data before you begin a new practice or implement a change!!

• Measure as you go – don’t continue ineffective teaching

• Assume students will progress when well taught

Relationship between EBP and State Standards

• Standard defines content – skills to be learned

• EBP defines teaching practice – the teaching procedures used to teach the skill

• EBP is not about curriculum !

Content From standards EBP Learning!+ =

Academics & Cognition

Behavior Communication Play Social Transition

Evidence-Based Practices EC

EL

MH

EC

EL

MH

EC

EL

MH

EC

EL

MH

EC

EL

MH

EC

EL

MH

1. Antecedent-based Interventions2. Computer Assisted Instruction3. Differential Reinforcement4. Discrete Trial Training5. Extinction6. Functional Behavioral Assessment7. Functional Communication Training8. Naturalistic Interventions9. Parent Implemented Interventions10. Peer Mediated instruction11. Picture Exchange Com. System12. Pivotal Response Training13. Prompting14. Reinforcement15. Response Interruption/Redirection16. Self-Management17. Social Narratives18. Social Skills Groups19. Speech Generating Devices 20. Structured Work Systems21. Task analysis 22. Time delay23. Video Modeling24. Visual Supports

NPDC Tools to Help with EPB Implementation

APERS: EBPs in place in the classroom

EBP Inventory: Your own learning goals

Briefs and Modules: EBPs for individual learning objectives

IAPG, NPDC and State Partners will develop:

• 6 dispersed demo sites

• Local training teams to support sites

• Statewide survey to identify EBP needs

• Merged NPDC training info and State content (standards, best practices)

• Unified state TA network and content

Outcomes

• NPDC materials will contribute to systematic approach for state

• NPDC process will help increase number of well trained para and professionals

• NPDC + IAPG will increase amount, quality and consistency of training in the state

Let’s Take A Look At The Briefs

• Available at:

http://autismpdc.fpg.unc.edu/content/briefs

• START Website:

http://www.gvsu.edu/autismcenter

• Briefs