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Implementing a Tier 2 Behavioral Intervention in a Therapeutic Alternative High School Program

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Title: Implementing a Tier 2 Behavioral Intervention in a Therapeutic Alternative High School Program
Language: English
Authors: Fallon, Lindsay M., Feinberg, Adam B.
Source: Preventing School Failure. 2017 61(3):189-197.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 9
Publication Date: 2017
Document Type: Journal Articles
Reports - Research
Education Level: High Schools
Secondary Education
Descriptors: Behavior Modification, Intervention, High Schools, Nontraditional Education, Positive Behavior Supports, Emotional Disturbances, High School Students, Program Effectiveness, Fidelity, Validity
DOI: 10.1080/1045988X.2016.1254083
ISSN: 1045-988X
Abstract: The research base for Check-in, Check-out (CICO), a targeted behavioral intervention within a schoolwide positive behavioral interventions and supports framework, is growing. However, little has been written about its application in therapeutic alternative programs. To extend the literature base, the current article describes a study conducted using an applied multiple baseline single-case research design involving three students with emotional disabilities enrolled in a therapeutic alternative education program. Overall, results indicate that improvements in the three participants' targeted behaviors were noted following intervention. Treatment fidelity and social validity data indicate that CICO steps were implemented as intended and were perceived as acceptable, understandable, and feasible. Implications for research and practice are described.
Abstractor: As Provided
Number of References: 16
Entry Date: 2017
Accession Number: EJ1141448
Database: ERIC
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  Value: <anid>AN0123075190;psf01jul.17;2019Mar15.12:12;v2.2.500</anid> <title id="AN0123075190-1">Implementing a Tier 2 behavioral intervention in a therapeutic alternative high school program. </title> <p>The research base for Check-in, Check-out (CICO), a targeted behavioral intervention within a schoolwide positive behavioral interventions and supports framework, is growing. However, little has been written about its application in therapeutic alternative programs. To extend the literature base, the current article describes a study conducted using an applied multiple baseline single-case research design involving three students with emotional disabilities enrolled in a therapeutic alternative education program. Overall, results indicate that improvements in the three participants' targeted behaviors were noted following intervention. Treatment fidelity and social validity data indicate that CICO steps were implemented as intended and were perceived as acceptable, understandable, and feasible. Implications for research and practice are described.</p> <p>Keywords: Alternative education; behavioral interventions; targeted support</p> <p>The U.S. Department of Education ([<reflink idref="bib16" id="ref1">16</reflink>]) defined alternative education settings as schools or programs that address the unique needs of students by providing a nontraditional approach to education. Many of the nearly 1.3% of students in the United States educated in alternative programs were placed in these more restrictive settings due to displays of unsafe behavior (e.g., physical aggression, possession of weapons), chronic truancy, and/or continued academic failure (Carver, Lewis, & Tice, [<reflink idref="bib3" id="ref2">3</reflink>]). Furthermore, it is often the case that an emotional disability may prevent sustained academic and behavioral success in traditional school settings (Flower, McDaniel, & Jolivette, [<reflink idref="bib5" id="ref3">5</reflink>]), resulting in the need for increased behavioral and academic supports. Alternative education settings vary, yet common features of such programs may include (a) a small number of enrolled students, (b) a low student-to-staff ratio, (c) an emphasis on explicit social skills instruction, (d) access to mentorship, (e) a structured yet flexible approach to academic and behavior support, and (f) an intensive data collection system to track individual student progress (Flower et al., [<reflink idref="bib5" id="ref4">5</reflink>]; Gelbar, Jaffery, Stein, & Cymbala, [<reflink idref="bib6" id="ref5">6</reflink>]). Alternative school educators are encouraged to use positive, proactive strategies to promote student success (Simonsen & Sugai, [<reflink idref="bib15" id="ref6">15</reflink>]).</p> <p>One empirically supported framework to design supportive, predictable educational environments is schoolwide positive behavioral interventions and supports (PBIS; Horner, Sugai, & Anderson, [<reflink idref="bib9" id="ref7">9</reflink>]). Schools that implement PBIS with fidelity have uniform behavior support practices and systems (informed by review of relevant data and outcomes) organized into multiple tiers. Tier 1 supports are universal efforts aimed at promoting displays of prosocial behavior for all students in a school (e.g., development of schoolwide expectations, reinforcement, and consequence systems) whereas Tier 2 (e.g., small group) and Tier 3 (e.g., individual) interventions are more intensive, often reserved for those who need targeted and individualized behavioral support, respectively (Horner et al., [<reflink idref="bib9" id="ref8">9</reflink>]).</p> <p>Commonly, Tier 3 interventions involve individualized and/or wraparound supports that involve conducting a functional behavior assessment and the development of a corresponding behavior support plan, yet Tier 2 supports may take a variety of forms (Horner et al., [<reflink idref="bib9" id="ref9">9</reflink>]). One frequently used Tier 2 strategy is Check-In, Check-Out (CICO; see Hawken, O'Neill, and MacLeod ([<reflink idref="bib7" id="ref10">7</reflink>]) for a description of a standard CICO procedure). Core components of CICO include (a) student check-ins with an adult at the beginning of the day to review behavioral expectations and goals, (b) adults providing feedback to the student throughout the day via behavior ratings on a daily point card, and (c) student check-outs with an adult at the end of the day to review progress toward goals. Students might also have the opportunity to earn rewards for meeting predetermined goals on their point sheets and/or reinforcement linked to daily progress with parents at home (see Simonsen, Myers, & Briere, [<reflink idref="bib14" id="ref11">14</reflink>] for a detailed example of a CICO procedure). Similar to other Tier 2 interventions, CICO is meant to be an efficient, effective means of providing targeted behavioral support to students within a multitiered framework (Anderson & Borgmeier, [<reflink idref="bib1" id="ref12">1</reflink>]).</p> <p>There is emerging research support to adapt a tiered framework logic for implementation in alternative education settings. Specifically, Simonsen and Sugai ([<reflink idref="bib15" id="ref13">15</reflink>]) suggested that in alternative education settings, all students may benefit from a schoolwide recognition system (e.g., point sheet) used to (a) provide explicit, frequent feedback about the demonstration of social skills; (b) actively monitor engagement and behavior; and (c) inform the delivery of systematic, functionally relevant reinforcement for appropriate behavior. Theoretically, when such a system is used as universal (i.e., Tier 1) practice, a Tier 2 intervention for nonresponders might use the universal point sheet system as a foundation upon which to provide additional mentoring, individualized goal setting, and check-ins with preferred adults (i.e., adults who students typically seek for attention). Preliminary studies include one recently published by Gelbar and colleagues ([<reflink idref="bib6" id="ref14">6</reflink>]), wherein the authors demonstrated the benefits of intensive staff training and enhanced, function-based Tier 1 strategies (e.g., providing cues to distressed or agitated students to take a break) to reduce both students' disruptive behavior as well as staff's use of student restraint and seclusion in an alternative setting. Their efforts illuminate the need for research to support these recommendations for both universal and targeted supports in alternative educational environments.</p> <p>The purpose of the current multiple baseline single-case design study was to extend the literature base by evaluating the use of an adapted version of CICO with three students with emotional disabilities enrolled in a therapeutic alternative education program. The adapted CICO procedure built upon the program's existing Tier 1 point system but included additional features commonly found in other CICO programs, as well as two unique features. Daily check-ins and check-outs as well as access to a tangible reward for meeting a predetermined behavioral goal were the two common features, while the unique features added were guided by recommendations for alternative settings made by Simonsen and Sugai ([<reflink idref="bib15" id="ref15">15</reflink>]): student goal setting and choice of adult for CICO interactions. Specifically, the study attempted to answer the following question: Will the use of an adapted CICO procedure increase and stabilize the percentage of points students earn for target behaviors tracked on Tier 1 point sheets?</p> <hd id="AN0123075190-2">Method</hd> <p></p> <hd id="AN0123075190-3">Participants and setting</hd> <p>Three high school students participated in this multiple baseline study: (a) Jared, a 14-year-old multiracial male; (b) Carlos, a 15-year-old Hispanic male; and (c) Joey, a 14-year-old multiracial male. All student participants had a diagnosed mood disorder (e.g., bipolar disorder) and received special education supports for an emotional disability as designated on their Individualized Education Programs. Student participants received grade-level instruction, but had difficulty regulating classroom behavior and received referrals to the office for exhibiting inappropriate language, noncompliance, disruption, and leaving the classroom. Also, the three participants were not in the same classes throughout the day and none had previously received a formal Tier 2 behavioral intervention.</p> <p>In addition, the school's clinical director, Darlene, participated in the study. Darlene was a trained social worker with a master's degree and four years of professional experience. The study took place in a therapeutic alternative education program (Grades 7–12) for students with acute emotional disabilities situated on the top floor of a large public high school in the northeastern United States. During the study, the program housed 8 teachers and 30 students. The typical class size was ≤6 students. Students enrolled took core classes with others in the program on the top floor, but electives (e.g., carpentry shop) with the general high school population downstairs.</p> <p>With the support of an external consultant (second author; doctoral-level school psychologist), staff in the program developed a comprehensive Tier 1 schoolwide PBIS plan over the course of a three-day training as part of a district PBIS initiative three years prior to the study. Once the Tier 1 plan was implemented, the overall <emph>Benchmarks of Quality</emph> (Kincaid, Childs, & George, [<reflink idref="bib10" id="ref16">10</reflink>]) scores, a fidelity tool for measuring PBIS practices, ranged from 81%–93% in Years 1–3. Due to the therapeutic nature of the program, the devised Tier 1 system included tracking all students' progress toward exhibiting four program-wide expectations with a daily point sheet.</p> <hd id="AN0123075190-4">Dependent variable</hd> <p>Students could earn a quarter of a point for exhibiting each of the following four expectations across eight class periods (i.e., earning up to eight points per day): (a) arrive to class on time, (b) complete assigned work, (c) use appropriate language, and (d) follow teachers' instruction. Percentage of points earned each day served as the dependent variable in the current study. When point sheets were developed and launched in Year 1 of schoolwide PBIS implementation, a comprehensive training was conducted to promote reliable and valid teacher ratings. Although teacher ratings were guided by teacher perceptions of students' behavior, trends in points assigned were aligned with trends in office discipline referral (ODR) data. For the current study, an additional dependent variable included the calculation of the average ODR per day for each of the three students during both the baseline and intervention phases. Comparison of the averages was done to determine if there was a reduction in ODRs after students engaged in the adapted CICO procedure.</p> <hd id="AN0123075190-5">Design and procedures</hd> <p></p> <hd id="AN0123075190-6">Recruitment</hd> <p>The clinical director sought assistance from an external consultant (first author; doctoral-level school psychologist) to design and implement a targeted behavioral intervention for students in need of additional support within the school via a multiple baseline single-subject design. Darlene and the consultant reviewed daily point sheets and ODR data and nominated three students to participate due to concerns about responsiveness to the Tier 1 point sheet system. Specifically, the three identified students had demonstrated variability in percentage of points earned for specific target behaviors. This variability was concerning to Darlene, but was not perceived to be so concerning that intensive, individualized support seemed warranted (e.g., fewer than 50% of points earned each day).</p> <hd id="AN0123075190-7">Brief functional assessment</hd> <p>Results from previous studies have demonstrated that CICO can be effective for students whose misbehavior functions to access attention (Hawken et al., [<reflink idref="bib7" id="ref17">7</reflink>]). As such, additional data were collected and reviewed to confirm that, in the current study, CICO was an appropriate intervention strategy for the three student participants. The consultant conducted a brief semistructured functional interview (Functional Assessment Checklist for Teachers and Staff [FACTS]; March et al., [<reflink idref="bib12" id="ref18">12</reflink>]) with Darlene to determine a hypothesized function of student participants' misbehavior. That is, Darlene was asked to provide details about when, how long, and in what context student participants typically misbehaved. Results of the interview and review of ODR data lead the consultant to hypothesize that the three students were exhibiting misbehavior maintained by adult attention: (a) Jared would <emph>not follow teacher instructions</emph> to obtain negative attention from teachers, (b) Carlos <emph>would miss or leave class</emph> to visit preferred staff (e.g., clinical director, security guard), and (c) Joey would <emph>use inappropriate language</emph> in class to obtain negative attention from teachers. Identified misbehaviors informed the selection of a target behavior for each of the three students. Each student's target behavior was linked to the program-wide expectations tracked on the Tier 1 point sheet (i.e., Jared's was <emph>follow teachers' instruction</emph>; Carlos' was <emph>arrive to class on time</emph>, and Joey's was <emph>use appropriate language</emph>). As such, once Darlene obtained parent consent and student assent to participate, a Tier 2 CICO intervention was implemented to address the hypothesized function for the three individual students.</p> <hd id="AN0123075190-8">Baseline</hd> <p>During baseline, Tier 1 supports were in place. As a therapeutic alternative education program, Tier 1 supports included a system in which all enrolled students carried point sheets to each class every day. The same point sheet was used for a week (i.e., from Friday until the following Thursday). Teachers ended each class approximately two minutes before the transition bell to assign points for the four program-wide expected behaviors. Also, as points were assigned to each student individually, teachers gave students verbal feedback and behavior-specific praise linked to students' progress toward exhibiting expected behaviors. Although teachers provided this verbal praise at the end of each day's class period, there was no formal feedback (check-in) when point sheets were distributed at the beginning of the week nor when turned in at the end of the week. Each Thursday afternoon, Darlene aggregated points and would determine the program's five "top earners" who would receive a special breakfast with her on Friday morning. The program's Tier 1 reinforcement system relied on point sheet data to determine top earners and participation in monthly field trips.</p> <hd id="AN0123075190-9">CICO</hd> <p>In addition to Tier 1 supports, the intervention phase included participant goal setting with Darlene related to specific target behaviors. Darlene worked to set goals with (a) Jared to improve his displays of <emph>following teacher directions</emph>, (b) Carlos <emph>to arrive to class on time and stay the entire class period</emph>, and (c) Joey to <emph>use appropriate language</emph>. She informed each of the three students that if ≥80% of possible points were earned in a day, a tangible reward (e.g., bag of chips) would be provided before the student left school for the day. The three students chose Darlene to check in with in the morning and at lunch time in addition to checking out with students at the end of each school day (i.e., identified her from a short list of support staff as their preferred adult). Participants' entry into the intervention phase was staggered. Once the first participant demonstrated a decreasing trend for three consecutive days during baseline, then he was introduced into intervention phase. The second and third student participant entered the intervention phase a week and two weeks after the first participant, respectively. This was to accommodate Darlene's request to complete the study before spring vacation.</p> <p>Teachers were made aware of the three students' participation in the CICO intervention but were not informed of when goal setting and check-ins with Darlene began (so as to minimize the likelihood of bias when providing ratings). Darlene used a 12-step checklist to self-report fidelity with the CICO procedures she completed with each student, each day.</p> <hd id="AN0123075190-10">Procedural fidelity</hd> <p>The procedural fidelity checklist included the following steps: (a) locate the student to conduct a check-in before school; (b) ask the student how his night and morning was; (c) ensure the student had materials for morning classes (e.g., a pencil); (d) remind the student of expectations, goal, and chance to earn reward at the end of the day; (e) locate the student to conduct a check-in at lunch; (f) ask the student how the rest of morning was; (g) ensure the student had materials for afternoon classes; (h) remind the student of expectations, goal, and chance to earn reward at the end of the day; (i) locate the student and check out before dismissal; (j) praise the student for points earned; (k) talk about areas for improvement the next day, if necessary; and (l) deliver reward, if earned. If a student was present, Darlene provided all check-ins and there was no reported barrier to her completing the process. If a student was absent, the procedure was not implemented for the student that day.</p> <hd id="AN0123075190-11">Social validity</hd> <p>Darlene completed the Usage Rating Profile—Intervention Revised (URP-IR; Chafouleas, Briesch, Neugebauer, & Riley-Tillman, [<reflink idref="bib4" id="ref19">4</reflink>]) to gather information about her perception of the CICO intervention. Items on URP-IR aim to reliably assess the acceptability (Cronbach's alpha [α] =.96), understanding (α =.90), and feasibility (α =.85) of implementing a school-based intervention by having the participant rate the extent to which she agrees or disagrees with statements such as "This intervention is a good way to handle the child's behavior problem" using a six-point Likert scale (1 = <emph>strongly disagree</emph> to 6 = <emph>strongly agree</emph>).</p> <hd id="AN0123075190-12">Data analysis</hd> <p>Review of results included visual analysis of changes to the level, trend, and variability of data across phases (Kratochwill et al., [<reflink idref="bib11" id="ref20">11</reflink>]) as well as effect size calculations. Specifically, Standard Mean Difference (SMD; Busk & Serlin, [<reflink idref="bib2" id="ref21">2</reflink>]) was calculated due to its use of all data and tendency not to be overly influenced by outliers. To derive estimates of SMD, the mean of the intervention phase was subtracted from the mean of baseline then divided by the standard deviation of baseline. Interpretation of SMD estimates was used to evaluate changes in percentage of points earned from baseline to intervention. In addition, TauU was calculated due to (a) its consistency with single-case logic and visual analysis, (b) the control it provides for both within-phase trend and serial dependency of the data, and (c) its suitability for small data sets (see Parker, Vannest, Davis, & Sauber, [<reflink idref="bib13" id="ref22">13</reflink>] for a complete description of TauU). To derive an estimate of TauU, overlapping data were subtracted from nonoverlapping data. The TauU estimate was used to evaluate the overall change from baseline to intervention for points earned for target behaviors across participants.</p> <hd id="AN0123075190-13">Results and discussion</hd> <p>Average total student point sheet data are displayed in Table 1. Overall, Jared's average total points earned on the daily point sheet increased from baseline (<emph>M</emph> = 77.1, <emph>SD</emph> = 16.9) to intervention (<emph>M</emph> = 88.0, <emph>SD</emph> = 9.3; SMD = 0.6). Also, Carlos demonstrated an increase in average total points earned from baseline (<emph>M</emph> = 88.4, <emph>SD</emph> = 11.9) to intervention (<emph>M</emph> = 93.1, <emph>SD</emph> = 7.3; SMD = 0.4). For Joey, a slightly larger increase in average total points from baseline (<emph>M</emph> = 86.3, <emph>SD</emph> = 8.2) to intervention (<emph>M</emph> = 95.0, <emph>SD</emph> = 5.2; SMD = 1.1) was observed. Across participants, average total points earned increased from baseline (<emph>M</emph> = 83.9, <emph>SD</emph> = 12.3) to intervention (<emph>M</emph> = 92.0, <emph>SD</emph> = 7.3; SMD = 0.7).</p> <p>Table 1. Mean, standard deviation, and effect size calculations for average points assigned to participants.</p> <p> <ephtml> <table><thead><tr><td /><td>Student</td><td /></tr><tr><td /><td>Jared</td><td>Carlos</td><td>Joey</td><td>Total</td></tr></thead><tbody><tr><td>Expectations</td></tr><tr><td>Arrived to class on time and stay the entire class period</td></tr><tr><td> <italic>M<sub>B</sub> (SD<sub>B</sub>)<sup>1</sup></italic></td><td char=".">78.8 (18.8)</td><td char="."><bold>82.6 (18.2)<sup>4</sup></bold></td><td char=".">91.3 (10.3)</td><td char=".">84.2 (15.7)</td></tr><tr><td> <italic>M<sub>I</sub> (SD<sub>I</sub>)<sup>2</sup></italic></td><td char=".">90.5 (12.1)</td><td char="."><bold>94.8 (7.3)</bold></td><td char=".">93.9 (9.5)</td><td char=".">93.1 (9.6)</td></tr><tr><td> SMD<sup>3</sup></td><td char=".">0.62</td><td char="."><bold>0.67</bold></td><td char=".">0.25</td><td char=".">.56</td></tr><tr><td>Completed assigned work</td></tr><tr><td> <italic>M<sub>B</sub> (SD<sub>B</sub>)<sup>1</sup></italic></td><td char=".">86.5 (21.9)</td><td char=".">86.9 (16.9)</td><td char=".">91.9 (10.9)</td><td char=".">88.4 (16.6)</td></tr><tr><td> <italic>M<sub>I</sub> (SD<sub>I</sub>)<sup>2</sup></italic></td><td char=".">93.2 (11.5)</td><td char=".">88.0 (17.1)</td><td>100 (0)</td><td char=".">93.7 (9.5)</td></tr><tr><td> SMD<sup>3</sup></td><td char=".">0.31</td><td char=".">0.07</td><td char=".">0.74</td><td char=".">.32</td></tr><tr><td>Used appropriate language</td></tr><tr><td> <italic>M<sub>B</sub> (SD<sub>B</sub>)<sup>1</sup></italic></td><td char=".">72.7 (20.0)</td><td char=".">94.1 (10.5)</td><td char="."><bold>78.0 (14.8)</bold></td><td char=".">81.6 (15.1)</td></tr><tr><td> <italic>M<sub>I</sub> (SD<sub>I</sub>)<sup>2</sup></italic></td><td char=".">87.4 (10.5)</td><td char=".">98.5 (5.0)</td><td char="."><bold>97.6 (5.8)</bold></td><td char=".">94.5 (7.1)</td></tr><tr><td> SMD<sup>3</sup></td><td char=".">0.74</td><td char=".">0.42</td><td char="."><bold>1.32</bold></td><td char=".">.85</td></tr><tr><td>Followed instructions from teacher</td></tr><tr><td> <italic>M<sub>B</sub> (SD<sub>B</sub>)<sup>1</sup></italic></td><td char="."><bold>70.4 (17.1)</bold></td><td char=".">89.9 (12.8)</td><td char=".">84.0 (14.1)</td><td char=".">81.4 (14.7)</td></tr><tr><td> <italic>M<sub>I</sub> (SD<sub>I</sub>)<sup>2</sup></italic></td><td char="."><bold>81.2 (9.2)</bold></td><td char=".">91.1 (10.4)</td><td char=".">88.3 (20.4)</td><td char=".">86.9 (13.3)</td></tr><tr><td> SMD<sup>3</sup></td><td char="."><bold>0.63</bold></td><td char=".">0.09</td><td char=".">0.30</td><td char=".">0.37</td></tr><tr><td>Total points</td></tr><tr><td> <italic>M<sub>B</sub> (SD<sub>B</sub>)<sup>1</sup></italic></td><td char=".">77.1 (16.9)</td><td char=".">88.4 (11.9)</td><td char=".">86.3 (8.2)</td><td char=".">83.9 (12.3)</td></tr><tr><td> <italic>M<sub>I</sub> (SD<sub>I</sub>)<sup>2</sup></italic></td><td char=".">88.0 (9.3)</td><td char=".">93.1 (7.3)</td><td char=".">95.0 (5.2)</td><td char=".">92.0 (7.3)</td></tr><tr><td> SMD<sup>3</sup></td><td char=".">0.64</td><td char=".">0.39</td><td char=".">1.06</td><td char=".">0.66</td></tr><tr><td>TauU</td><td /><td /><td /><td char=".">.518</td></tr></tbody></table> </ephtml> </p> <p>2 <sups>1</sups><emph>M</emph><bold><emph><subs>B</subs></emph></bold> (<emph>SD</emph><bold><emph><subs>B</subs></emph></bold><emph>)</emph> = Mean (standard deviation) for baseline; <sups>2</sups><emph>M</emph><bold><emph><subs>I</subs></emph></bold><emph>(SD</emph><bold><emph><subs>I</subs></emph></bold><emph>)</emph> = Mean (standard deviation) for intervention; <sups>3</sups>SMD = <emph>(M<subs>I</subs> – M<subs>B</subs></emph>) / <emph>SD<subs>B</subs>;</emph><sups>4</sups>Bold values reflect student's target behavior during goal setting.</p> <p>Figure 1 displays points earned for target behaviors specifically. For Jared, baseline data demonstrated an increasing trend but were highly variable (<emph>M</emph> = 70.4, <emph>SD</emph> = 17.1) compared to the stability of data and increase in level observed in the intervention phase (<emph>M</emph> = 81.2, <emph>SD</emph> = 9.2; SMD = 0.6). A similar pattern of increased stability of data and level was also observed for Carlos from baseline (<emph>M</emph> = 82.6, <emph>SD</emph> = 18.2) to intervention (<emph>M</emph> = 94.8, <emph>SD</emph> = 7.3; SMD = 0.67) and Joey from baseline (<emph>M</emph> = 78.0, <emph>SD</emph> = 14.8) to intervention (<emph>M</emph> = 97.6, <emph>SD</emph> = 5.8; SMD = 1.32).</p> <p>Graph: Figure 1. Percentage of points earned for target behavior by date. Note. There were school closings on 2/13, 3/18, and 3/19. February school break occurred from 2/15–2/23. In addition, Jared was absent on 2/26, 3/3, 3/4, 3/6, 3/13, 3/17, 3/20, 3/31, and 4/8. Carlos was absent on 2/10, 2/13, 2/14, 2/24, 3/27, 4/3, and 4/9. Joey was absent on 2/27, 3/10, 3/31, and 4/2.</p> <p>The TauU effect size indicated a moderate (51.8%) increase in points provided for target behaviors for all three participants from baseline to the intervention phase. Also, from baseline to intervention, a small increase in percentage of days for which ≥80% of total points were earned and a small decrease in average office discipline referrals per day was observed (see Table 2). Last, Darlene self-reported her consistent implementation of the CICO procedure (100% fidelity across participants for the duration of the study) and rated it to be acceptable (<emph>M</emph> = 4.9; <emph>SD</emph> = 0.9), understandable (<emph>M</emph> = 5.7; SD = 0.6), and feasible (<emph>M</emph> = 4.8; <emph>SD</emph> = 0.4) on the URP-IR.</p> <p>Table 2. Percentage of days goal was met and mean office discipline referral by phase.</p> <p> <ephtml> <table><thead><tr><td /><td><bold>Student</bold></td></tr><tr><td /><td>Jared</td><td>Carlos</td><td>Joey</td></tr></thead><tbody><tr><td>Percentage of days ≥80% possible daily points were earned</td></tr><tr><td> Baseline</td><td char=".">73.3</td><td char=".">83.3</td><td char=".">73.1</td></tr><tr><td> Intervention</td><td char=".">81.3</td><td char=".">85.7</td><td>100</td></tr><tr><td>Mean office discipline referral per day</td></tr><tr><td> M<bold><sub>B</sub></bold></td><td char=".">.66</td><td char=".">.05</td><td char=".">.46</td></tr><tr><td> M<bold><sub>I</sub></bold></td><td char=".">.44</td><td char=".">.00</td><td char=".">.38</td></tr></tbody></table> </ephtml> </p> <p>In contrast to traditional academic settings, students with emotional disabilities may have more success in therapeutic alternative education programs due to increased access to support and mentorship (Flower et al., [<reflink idref="bib5" id="ref23">5</reflink>]). Support and mentorship may be integrated into the implementation of schoolwide PBIS, a framework wherein the delivery of effective practices is structured to be functionally relevant, data-based, and efficient. In alternative education settings, a PBIS approach might include relatively intensive support strategies and data collection at Tier 1 (e.g., use of a point sheet with all students; Simonsen & Sugai, [<reflink idref="bib15" id="ref24">15</reflink>]) while Tier 2 strategies might offer even more comprehensive support (e.g., providing features of CICO such as individualized goal setting and frequent check-ins with preferred adults).</p> <p>The purpose of the current study was to determine if an adapted CICO procedure would increase and stabilize daily percentage of points earned for three students enrolled in a therapeutic alternative education program. Overall, results from this preliminary study indicated that with CICO (i.e., check-ins, goal setting, and offering a small reward at the end of the day), a small to moderate increase in percentage of total points earned across the day as well as a moderate improvement in target behaviors occurred across the three participants. In addition, a small reduction in the number of average office discipline referrals by day occurred from baseline to interventions for all three students. Darlene reported that the intervention was acceptable, feasible, and understood, and self-reported that the intervention was implemented with 100% procedural fidelity each day across the three students.</p> <p>As with most preliminary studies in an applied setting, there are limitations to consider when interpreting results. First, the consultant's review of students' point sheet data corroborated Darlene's self-report ratings of procedural fidelity. However, although the current study aimed to build upon the school's existing data collection system's efficiency, future replications of this study might use more rigorous data collection methods (such as direct observation) for student behavior, teachers' ratings, and Darlene's check-ins. Using direct observation would also allow for calculating inter-observer agreement and assess multiple dimensions of procedural fidelity (e.g., adherence, quality). Furthermore, Darlene's ratings of social validity were high and that may be related to her initial interest in receiving assistance to develop and implement a Tier 2 intervention at the school. In future replications of the study, it would be valuable to collect social validity data from teachers, too, as teachers might have different perspectives about the acceptability and feasibility of the current procedure.</p> <p>Second, as program-wide Tier 1 supports were in place at the start of the study, no data were gathered during a true baseline (i.e., in the absence of any behavioral supports). However, despite receiving universal support, review of point sheet and functional interview data indicated that students identified for participation were in need of a targeted support to improve behaviors identified. Third, in the present study, limited time (i.e., the start of spring break) resulted in the end of the CICO procedure without a process of thinning reinforcement or transitioning students to a self-management plan in place of participation in CICO (Hawken et al., [<reflink idref="bib7" id="ref25">7</reflink>]). Practitioners who engage in a similar procedure as the one used in the current study may want and should be encouraged to establish exit criteria for disengaging with CICO so as not to abruptly terminate the support. Also, researchers may want to extend data collection to determine the extent to which behavior change sustains over time. This would facilitate the analysis of maintenance as well as initial effects, strengthening the external validity of the study (Horner et al., [<reflink idref="bib8" id="ref26">8</reflink>]).</p> <p>Fourth, financial resources resulted in the clinical director, Darlene, selecting a reward to offer to students. In subsequent research and practice replications, conducting a brief preference assessment or offering students a choice with a reward menu could increase students' motivation to meet their predetermined daily goal. Fifth, a traditional CICO program often includes a home component during which parents provide feedback and reinforce progress made at school during the day. Darlene communicated limited family involvement in the students' school progress for the study's three participants. Therefore, parents were not included in the intervention implemented in the current study. Actively involving parents in future replications would provide students with more comprehensive wraparound support.</p> <p>In addition, it is important to consider that the existing (i.e., prestudy) Tier 1 reinforcement system tied to the weekly point sheet was provided to only five students each week (i.e., breakfast), was delayed (i.e., nothing was given daily but rather weekly or monthly), and not individualized (i.e., was not based on student preference, was the same for everyone, did not include choice). The adapted CICO Tier 2 strategy was moderately effective, but it is unclear exactly why. It may have been due to the access to individualized attention throughout the day from Darlene, the addition of a goal-setting component, or the availability of a daily reward. To evaluate these possibilities, future research designs might include a component analysis to determine if features of this adapted CICO procedure are differentially effective for students in therapeutic alternative education programs.</p> <p>In sum, results from this preliminary study indicate initial evidence that the delivery of Tier 2 supports in therapeutic alternative education settings may lead to improved behavioral outcomes, but more research is needed. Practitioners in the field may want to consider what implications the current study results could have on their current data-collection practices and behavior management systems when developing and implementing efficient, targeted behavioral supports to those not responding to the universal interventions already in place in their respective alternative education environments.</p> <hd id="AN0123075190-14">Notes on contributors</hd> <p> <emph>Lindsay M. Fallon</emph> is an assistant professor in school psychology at the University of Massachusetts Boston. Her research interests include assessment and promotion of treatment fidelity, specifically for interventions implemented by school staff and family members to support youth behavior.</p> <p> <emph>Adam B. Feinberg</emph> is an assistant research professor at the University of Connecticut and the director of the Northeast PBIS Network. His research and clinical interests include the development and implementation of multitier systems of supports in schools and districts, with a focus on developing and supporting coaching knowledge, skills, and networks.</p> <ref id="AN0123075190-15"> <title> References </title> <blist> <bibl id="bib1" idref="ref12" type="bt">1</bibl> <bibtext> Anderson, C. M., & Borgmeier, C. (2010). Tier II interventions within the framework of school-wide positive behavior support: Essential features for design, implementation, and maintenance. Behavior Analysis in Practice, 3, 33–45.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref21" type="bt">2</bibl> <bibtext> Busk, P. L., & Serlin, R. C. (1992). Meta-analysis for single-case research. In T. R. Kratochwill & J. R. Levin (Eds.), Single-case research design and analysis (pp. 187–212). Hillsdale, NJ: Lawrence Erlbaum.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref2" type="bt">3</bibl> <bibtext> Carver, P. R., Lewis, L., & Tice, P. (2010). Alternative schools and programs for public school students at risk of educational failure: 2007–08 (NCES 2010–026). Washington, DC:U.S. Department of Education, National Center for Education Statistics.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref19" type="bt">4</bibl> <bibtext> Chafouleas, S. M., Briesch, A. M., Neugebauer, S. R., & Riley-Tillman, T. C. (2011). Usage Rating Profile–Intervention (Revised). Storrs, CT: University of Connecticut.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref3" type="bt">5</bibl> <bibtext> Flower, A., McDaniel, S. C., & Jolivette, K. (2011). A literature review of research quality and effective practices in alternative education settings. Education and Treatment of Children, 34, 489–510. doi:10.1353/etc.2011.0038</bibtext> </blist> <blist> <bibl id="bib6" idref="ref5" type="bt">6</bibl> <bibtext> Gelbar, N. W., Jaffery, R, Stein, R., & Cymbala, H. (2015). Case study on the implementation of school-wide positive behavioral interventions and supports in an alternative educational setting. Journal of Educational and Psychological Consultation, 25, 1–27. doi:10.1080/10474412.2014.929958</bibtext> </blist> <blist> <bibl id="bib7" idref="ref10" type="bt">7</bibl> <bibtext> Hawken, L. S., O'Neill, R. E., & MacLeod, K. S. (2011). An investigation of the impact of function of problem behavior on effectiveness of the Behavior Education Program (BEP). Education and Treatment of Children, 34, 551–574. doi:10.1353/etc.2011.0031</bibtext> </blist> <blist> <bibl id="bib8" idref="ref26" type="bt">8</bibl> <bibtext> Horner, R., Carr, E., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject design research to identify evidence-based practice in special education. Exceptional Children, 71, 165–179. doi:10.1177/001440290507100203</bibtext> </blist> <blist> <bibl id="bib9" idref="ref7" type="bt">9</bibl> <bibtext> Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the evidence base for school-wide positive behavior support. Focus on Exceptional Children, 42, 1–14.</bibtext> </blist> <blist> <bibtext> Kincaid, D., Childs, K., & George, H. (2010). School-wide benchmarks of quality (Revised). Unpublished instrument. Tampa, FL: University of South Florida.</bibtext> </blist> <blist> <bibtext> Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M & Shadish, W. R. (2010). Single-case designs technical documentation. Retrieved from What Works Clearinghouse website: <ulink href="http://ies.ed.gov/ncee/wwc/pdf/wwc%5fscd.pdf">http://ies.ed.gov/ncee/wwc/pdf/wwc%5fscd.pdf</ulink>.</bibtext> </blist> <blist> <bibtext> March, R., Lewis-Palmer, L., Brown, D., Crone, D., Todd, A. W., & Carr, E. (2000). Functional assessment checklist for teachers and staff (FACTS). Eugene, OR: University of Oregon.</bibtext> </blist> <blist> <bibtext> Parker, R. I., Vannest, K. J., Davis, J. L., & Sauber, S. B. (2010). Combining non-overlap and trend for single case research: TauU. Behavior Therapy, 42, 284–299. doi:10.1016/j.beth.2010.08.006</bibtext> </blist> <blist> <bibtext> Simonsen, B., Myers, D., & Briere, D. E. (2011). Comparing a behavioral check-in/check-out (CICO) intervention with standard practice in an urban middle school using an experimental group design. Journal of Positive Behavior Interventions, 13, 31–48. doi:10.1177/1098300709359026</bibtext> </blist> <blist> <bibtext> Simonsen, B., & Sugai, G. (2013). PBIS in alternative education settings: Positive support for youth with high-risk behavior. Education and Treatment of Children, 36, 3–14. doi:10.1353/etc.2013.0030</bibtext> </blist> <blist> <bibtext> U.S. Department of Education, National Center for Educational Statistics. (2002). Characteristics of the 100 largest public elementary and secondary school districts in the United States: 2000–01 (NCES 2002-351). Washington, DC: Author.</bibtext> </blist> </ref> <aug> <p>By Lindsay M. Fallon and Adam B. Feinberg</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib16" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib15" firstref="ref6"></nolink> <nolink nlid="nl3" bibid="bib14" firstref="ref11"></nolink> <nolink nlid="nl4" bibid="bib10" firstref="ref16"></nolink> <nolink nlid="nl5" bibid="bib12" firstref="ref18"></nolink> <nolink nlid="nl6" bibid="bib11" firstref="ref20"></nolink> <nolink nlid="nl7" bibid="bib13" firstref="ref22"></nolink>
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  Data: The research base for Check-in, Check-out (CICO), a targeted behavioral intervention within a schoolwide positive behavioral interventions and supports framework, is growing. However, little has been written about its application in therapeutic alternative programs. To extend the literature base, the current article describes a study conducted using an applied multiple baseline single-case research design involving three students with emotional disabilities enrolled in a therapeutic alternative education program. Overall, results indicate that improvements in the three participants' targeted behaviors were noted following intervention. Treatment fidelity and social validity data indicate that CICO steps were implemented as intended and were perceived as acceptable, understandable, and feasible. Implications for research and practice are described.
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