Using ABA to Improve Treatment Integrity in Schools

BBP182 Treatment Integrity

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Behavioural Psycology

For evidence-based interventions to be effective for students they must be consistently implemented, however, many teachers struggle with treatment integrity and require support. Although many implementation support strategies are research based, there is little empirical guidance about the types of treatment integrity, implementers, and contexts these strategies are best suited to address. To facilitate the data-driven identification of implementation supports, treatment integrity and the implementation context could be evaluated through an applied behavior analysis (ABA) lens. That is, teachers’ engagement in intervention implementation or competing behaviors could be considered to be occasioned by antecedents (e.g., prompts, setting) and maintained by consequences (e.g., escape intervention, access to attention). This article describes the conceptualization of treatment integrity within an antecedent-behavior-consequence framework. The current land- scape and limitations of school-based treatment integrity research are reviewed and the application of ABA technology to address implementer behavior is described. Further, the article provides practical strategies for how school psychologists might apply this conceptualization to support teachers. A case study is provided to illustrate associated research-based strategies. Last, implications and limitations are described. C? 2017 Wiley Periodicals, Inc.

Numerous task forces within professional organizations (e.g., American Psychological Association, Council for Exceptional Children), and government agencies (U.S. Department of Education, National Research Council) have developed criteria for research quality, facilitated systematic reviews of the extant literature, and identified evidence-based intervention practices (e.g., American Psychological Association Task Force on Evidence-Based Practice, What Works Clearinghouse). Others have focused on dissemination of such practices to the field (National Guideline Clearinghouse, Promising Practices Network). Likewise, significant advances have been made with regard to development, evaluation, and validation of formative measures of student outcomes In many ways, these developments have simplified clinical decision making and progress monitoring by school psychologists, and thus have increased the likelihood for high-quality intervention delivery and evaluation in schools (DiGennaro Reed, Hirst, & Howard, 2014).

The availability of these resources, however, does not imply that educators will implement the evidence-based interventions with adequate treatment integrity over time. Treatment integrity refers to the degree to which an intervention is implemented as planned (Gresham, 1989). When an intervention is not consistently and accurately implemented across time, an evidence-based intervention may have minimal to no impact on student outcomes.

Applied Behaviour Analysis

Applied behavior analysis (ABA) is the scientific study of socially significant behavior with a focus on discovering environmental variables that reliably explain behavior (Cooper, Heron, & Heward, 2007; Skinner, 1953). A primary advantage of adopting an ABA approach is the notion that behavior can be changed by systematically altering environmental conditions. More specifically, behavior change based on ABA seeks to explain a behavior by understanding the environmental condition(s) or stimulus change(s) that precede and follow it. The environmental conditions or stimuli that precede a behavior in close temporal proximity are referred to as antecedents. These environmental conditions or stimuli may or may not occasion, or serve as a cue for, the behavior of interest. The environmental conditions or stimuli that follow the behavior of interest are referred to as consequences. Some consequences have a significant influence on likelihood of the behavior of interest occurring again in the future whereas others have minimal influence on future behavior.

Data from behavioral assessment approaches (e.g., direct observations, questionnaires, checklists, and interviews) are analyzed to develop hypotheses about the temporal relationship of the environmental conditions and stimuli that evoke a behavior and the consequences that maintain it (see Figure 1). These hypotheses are used to inform development of an intervention plan that is focused on removing contingencies maintaining problematic behavior and replacing them with functionally equivalent contingencies that reinforce appropriate and adaptive behaviors.

Application of ABA for Intervention Implementers

Treatment integrity and the implementation environment could be analyzed through ABA principles to identify functionally relevant intervention implementation supports that are appropriate, efficient, and effective for varied implementers in schools (DiGennaro, Martens, & McIntyre, 2005; DiGennaro et al., 2014; Iwata, Bailey, Brown, Foshee, & Alpern, 1976). That is, a teacher’s engagement in intervention implementation or competing behaviors could be considered to be evoked by antecedents (e.g., prompts, setting) and maintained by consequences (e.g., escape negative student behavior, access to positive feedback).

For instance, a teacher might be more likely to engage in intervention implementation (target behavior) when she has visual reminders to do so (stimulus prompt) and praise from her colleagues contingent on high levels of treatment integrity (positive reinforcement). In another case, a teacher might be more likely to send a student engaging in disruptive behavior to the office (competing behavior), rather than implementing the intervention (target behavior) during difficult instructional content (motivating operation) when doing so results in easier delivery of instructional content (positive reinforcement) and not having to manage challenging student behavior (negative reinforcement) for the rest of the class period.

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