In Tier 1, we talked about providing interventions and supports to all students. In Tier 2, we have been talking about providing targeted interventions to students who demonstrate certain behaviors that put them at-risk for needing more intensive support.

So far, you have designed interventions for students with internalizing and externalizing behaviors.

This week we are going to talk about how you can use evidence-based strategies to help students “manage” behaviors in your groups. We are also going to talk about how to monitor students’ progress through two different evidence-based systems: Check-In and Check-Out (CICO) and Self-Monitoring.

So, you’ve reviewed the files for the students on your caseload and you’ve planned the perfect group. You’ve thought about:

• The title of the group

• People responsible for facilitating the group

• The purpose of the group and the rationale

• The location where the group will take place

• The steps needed to carry out the group

• The materials that will be needed

• The questions that you will ask to guide process, generalization, and application

• Homework related to the group

But…during the implementation of the group, things get a little bit out of control.

The students in your group start exhibiting the behaviors that they’ve grown accustomed to using as a coping mechanism.

How you respond to the students’ behaviors have far reaching implications for the maintenance (or recurrent use) of the behaviors - with you, as well as in other settings (Henricsson & Rydell, 2004).

In some circles responding to students’ behaviors is called “management”. You might even hear teachers talk about “classroom management”.

In a nutshell, “management” is how the adult interprets the student’s behavior and responds. Some classrooms (and groups) have very strict management protocols, while other are appear to be a little more willing to respond to the students’ needs on a case by case basis. While there are some general rules of thumb for responding to different types of students’ behaviors, your understanding of what the behavior means is key to you finding a truly effective response.

Functional behavior assessment (FBA) is the systematic way many teams use to determine the cause or function of a student’s behavior (Chandler & Dahlquist, 2002). The FBA helps teams understand why a student engages in challenging behavior, when and where the challenging behaviors are like to take place, and under what environmental conditions the student will be the most successful. This is not If this process sounds to you very much like the OT process of dynamic performance analysis, I agree! Occupational therapy practitioners are very good at functional behavior assessment. Unfortunately, many OT practitioners only participate in FBAs when the team believes that the student has an underlying sensory concern (Murray-Slutsky & Paris, 2005).

Think back to the radio broadcast of Harper High School. So much of the kids behavior was determined by the environment – both social and physical. Occupational Therapy practitioners are trained to focus on occupation in the context of environment. So much behavior can be understood when considered in context. Children learn to do “what works” for them. It is a powerful feeling when something they do helps them feel safer, or better, or helps them get something they want or need. It is often the power of that feeling that leads to kids repeating that behavior.

As previously stated, FBAs are often conducted within the context of a team. However, if you are working with groups of students by yourself, you can apply the FBA principles. Applying the FBA principles will help you to develop solutions that address the root cause or function of the student’s behavior and help you to avoid even more challenging behaviors.

In order to conduct FBAs, you first have to wholly believe in two guiding principles. The first one is the most important for helping us to understand children. It is that ALL behavior serves a function. All of it!! Even repetitive behaviors by children with the most severe cases of autism, such as hand flapping, string flicking, and rocking all have a purpose. To frame this behavior as “self-stimulatory” (often called “self-stimming” or “stimming”) is to degrade the child and his or her desire to communicate and participate in this world.

The second guiding principle often proposed by FBA enthusiasts is that all behavior is supported by the current environmental conditions. Put simply, it is the idea that we can help to change students’ challenging behaviors by changing the environment. But, since we are OTs and understand the complex interactions and relationships between the Person-Environment-Occupation factors, I’d like you to take this view a step further. We should consider how the environment, as well as factors related to the occupation, and potential skill deficits can also support the continued use of certain behaviors. Now, take some time to learn more about FBA through the IRIS module, which includes short helpful videos and handouts. It can be accessed with the link below. Please page through so that you can access the following pages: Challenge, Initial Thoughts, Perspectives & Resources, Wrap Up (Assessment is Optional)

http://iris.peabody.vanderbilt.edu/module/fba/#content.

As you know, children with externalizing behaviors direct their feelings outward and children with internalizing behavior direct their feelings inward. However, remember that all of these challenging behaviors serve a function and are based on some need that has gone unmet. Also, remember that some of the students you will work with will have a limited behavioral repertoire. That is, a child with externalizing might knock over his chair when he is angry about having to do a worksheet that is too difficult for him (function: expressing need for assistance) AND when he feels excluded from a peer group (function: to gain attention). A child with internalizing behaviors may use withdraw or isolation for the same 2 functions.

The same behavior can mean something different at different times. Further, a children with internalizing and externalizing behaviors often engage in different challenging behaviors, but for the same purpose (e.g., to get attention, to avoid something, to get something, etc...).

When working with children with challenging behaviors, please remember that your goal is to teach them what to do instead of the challenging behavior. Again, consider the teens at Harper High School. Not only have they learned what behaviors keep them safe or meet their emotional needs in that situation, they have not learned alternative behaviors that will be more effective in the long run. In psychology helping people develop new, more effective behaviors is called “replacement behavior”. Replacement behaviors are best taught in the settings they will be used. However, groups with other kids, provide an excellent opportunity to practice and reinforce new behaviors. Groups can also give us, as leaders and providers, an opportunity to consider how we might be reinforcing challenging behaviors through our own actions or in the way we set up the environment, or even through the occupation or activity that we present

Retrieved from : TOT 2: Implementing Tier II Assessment and Intervention (2019)

Check-In/Check-Out (CICO)

Check-In/Check-Out (CICO) has been used in schools for some time as part of a package of positive behavior intervention supports. It is a system for providing students with ongoing feedback and support. It has been found to be particularly effective for students who are at-risk of needing more intensive support (Todd, Campbell, Meyer, & Horner, 2008). CICO is based on a daily report card that is focused on the student’s behaviors and performance in different settings and throughout the school day. Behavior report cards have been widely used since the 1980s (e.g., Davies & McLaughlin, 1989). Behavior report cards have several things in common:

• They provide the student with structure and prompts to help him get through the day

• They offer adults an opportunity to provide the student with written feedback which can be shared with the student’s family and other team members

• They provide the student with a visual reminder about his goals for the day

• They help the team collect data on the student’s performance (Todd, Campbell, Meyer, & Horner, 2008).

For an example of behavior report cards, do a google image or pinterest search or click on this link for a few: https://www.pinterest.com/explore/daily-behavior-report/

When behavior report cards are incorporated into CICO, they are available to every member of the school staff on a continuous basis.

Great video resource on Check in/Check out that will help you see how it works

https://www.facebook.com/edutopia/videos/10156366303429917/

Commonly, a student will receive his report card at Check-In.

Check-In typically occurs in the morning and is monitored by the school staff. The purpose of Check-In is to help students start the day off on the right foot.

Many of the reports of Check-In procedures in the literature focus on individual meetings with students (Simonsen, Myers, & Briere, 2011).

Here’s an example of what Check-In looks like from Green Meadow Elementary School in Michigan

Check-in 8:35 - 8:50

• Holly gets off the bus, has breakfast, goes to class and then to Check & Connect in Mrs. Coleman’s office. (off the library)

• If anyone else is with Mrs. Coleman, Holly knows to take a seat at the table just outside of Mrs. C.’s office. Everyone is met with alone.

• Holly’s turn! She receives a copy of her checksheet for the day.

• Every goal is gone over every morning. A reminder that the goal for the day is 80% or better.

• Daily Questions: Are these reasonable? Are they doable? Can you do it? ♣

• Questions that vary depending on student:

• Did you have breakfast?

• Did you get enough sleep?

• Did you take your medicine?

• Are you ready for the day or do you still need a little time?

• Okay! Off you go with “High 5s”, smiles, jokes, hugs, and an “I can do it” attitude!!

Check-Out typically occurs at the end of the day. It is generally a time for a student to meet with an adult to review his or her performance at the end of the day.

Here’s an example of what Check-Out looks like from Green Meadow Elementary School in Michigan

Check-Out 3:30 - 3:35

• Holly leaves class and reports to Mrs. Coleman’s office.

• Again, she waits her turn so that she can have one-on-one time.

• When it’s her turn, her daily points are totaled - Mrs. Coleman guides her to calculate her own percentage for the day.

• Once the percentage is determined, Mrs. Coleman and Holly discuss and celebrate her successes.

• If her score is 80% or better, Holly picks a sticker or a pencil.

• If Holly has 80% or better, daily, for a week, Holly chooses from her reward list.

• Mrs. Coleman sends her on her way with a positive feeling about her day and her accomplishments.

(CICO example taken from: http://miblsi.cenmi.org/MiBLSiModel/Implementation/ElementarySchools/TierIISupports/Behavior/TargetBehaviorInterventions/CheckInCheckOut.aspx)

The following links are two video examples of CICO programs:

https://www.youtube.com/watch?v=AKwMbLNl_zI&list=PLWNv7Hm-wkwzUdRZjqnny-JxjDuCLlH7E

https://www.youtube.com/watch?v=aAEEMlvPivY&index=2&list=PLWNv7Hm-wkwzUdRZjqnny-JxjDuCLlH7E

For more resources and information about Check-In (and Check-Out) go to: http://www.pbisworld.com/tier-2/check-in-check-out-cico/

This is an excellent resource.

Retrieved from : TOT 2: Implementing Tier II Assessment and Intervention (2019)