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