Tier two interventions implemented within the context of a tiered prevention framework

The purpose of this article is to systematically review the existing research base for Tier 2 small group intervention studies conducted within a tiered prevention framework.. Use of a t

Tier Two Interventions Implemented within the

Context of a Tiered Prevention Framework

Barbara S Mitchell, Melissa Stormont, and Nicholas A Gage

University of Missouri

ABSTRACT: Despite a growing body of evidence demonstrating the value of Tier 1 and Tier 3 interventions, significantly less is known about Tier 2 level treatments when they are added within the context of a tiered continuum of support The purpose of this article is to systematically review the existing research base for Tier 2 small group intervention studies conducted within a tiered prevention framework Results indicated that few studies documented fidelity of Tier I implementation prior to the addition of Tier 2 interventions Methods for identifying students to receive Tier 2 supports varied across investigations, but included teacher nomination, use of student data, and/or screening score results More than half of the reviewed studies demonstrated use of the Behavior Intervention Program: Check-in/Check-out (BEP/CICO), although social skill instructional groups and academic instructional groups were also employed as Tier 2 interventions Overall, positive results for reducing problem behavior were reported In addition, school-based personnel implemented the Tier 2 intervention in nearly half of the investigations Among studies that reported measures of social validity teacher and student perceptions of the treatments were largely positive Implications for future research are evaluated using criteria from the Society for Prevention Research (Flay et al., 2005).

• A substantial number of children and

adolescents have or are at risk for developing

emotional and behavioral disorders (EBD)

(National Research Council and Institute of

Medicine [NRC & IOM|, 2009; Van

Land-eghem & Hess, 2005) Outcomes for students

experiencing EBD are very poor and include

drop out, incarceration, homelessness,

psy-chopathology, diminished functioning,

inabil-ity to find and maintain employment, and

problems developing healthy interpersonal

relationships (Lehr, Johnson, Bremer, Cosió,

& Thompson, 2004; NRC & lOM, 2009)

Unfortunately, although signs of EBD can be

detected at an early age, many children and

youth who experience symptoms and disorder

are often inadequately supported, delayed in

accessing services, or receive no treatment at

all (NRC & lOM, 2009)

In response to the growing concern for

students who experience EBD, a number of

practices have shown evidence for preventing,

treating, and/or reducing symptoms Use of a

tiered intervention framework such as

School-Wide Positive Behavior Support (SWPBS) is

one promising avenue for delivering

school-based prevention efforts Derived from a

public health disease prevention model

(Gor-don, 1983), SWPBS is the application of a

three-tiered continuum of supports for students

in school settings (Lewis & Sugai, 1999; Sugai

et al., 2000; Walker et al., 1996) SWPBS is asystematic approach to plan, develop, andprovide primary prevention to all students (Tier1); specialized group or targeted support tosome students who may be at risk foracademic and/or behavioral problems (Tier2); and intensive, individualized support for asmall percentage of students who alreadyexhibit patterns of chronic and persistentfailure (Tier 3) (Sugai & Horner, 2008)

The purpose for delivering Tier 1 supports

to all students is to reduce new cases ofproblem behavior and/or academic failure(Lewis & Sugai, 1999; Sugai et al., 2000; Sugai

& Horner, 2008) Specific to behavioraloutcomes Tier 1 prevention componentsinclude clearly identified expectations andrules that are specifically taught to students, asystematic process for acknowledging appro-priate behavior, and consistent reteaching andresponse for inappropriate behavior (Lewis &Sugai, 1999; Sugai et al., 2000) Thesepractices are embedded throughout instructionacross classroom and nonclassroom settings.The vast majority of students, approximately80%, respond to this level of support A largebody of evidence shows that these features can

be implemented by school personnel (Colvin,Kameenui, & Sugai, 1993; Lewis, Sugai, &Colvin, 1998); these practices are effective inreducing office discipline referrals, school

suspensions, and problem behaviors (Colvin,

Sugai, Good, & Lee, 1997; Lewis, Colvin, &

Sugai, 2000; Lewis et al., 1998); and

improve-ments in student behavior and perceptions of

school safety are associated with increased

academic outcomes (Bradshaw, Koth, Bevans,

lalongo, & Leaf, 2008; Bradshaw, Mitchell, &

Leaf, 2010; Horner et al., 2009)

In addition to the research outcomes for

Tier 1 supports, a number of studies also

demonstrate the effectiveness of

function-based, individualized planning that is

charac-teristic of Tier 3 interventions (Fairbanks, Sugai,

Guardino, & Lathrop, 2007; Ingram,

Lewis-Palmer, & Sugai, 2005; March & Horner, 2002;

Todd, Horner, & Sugai, 1999) Tier 3 support

typically involves the use of functional

behav-ioral assessment (FBA) and/or functional

anal-ysis results to determine patterns across setting

event, antecedent, and maintaining

conse-quence conditions of problem behavior

Infor-mation from a FBA is then used to develop

individualized intervention plans for students

School, family, and community agencies may

also collaborate to coordinate intervention

planning and efforts At the Tier 3 level, the

goal is to reduce the severity and intensity of

existing cases of chronic behavior and/or

academic failure (Sugai et al., 2010) Due to

the high level of technical expertise and the

extensive amount of resources required Tier 3

support is generally reserved for a small number

of children, approximately 5%, who

demon-strate persistent failure or serious, violent, and

dangerous types of behavior, and/or when Tier

1 and Tier 2 interventions are determined to be

inadequate (Sugai et al., 2010)

Tier 2 is identified as specialized group or

targeted systems designed for students

consid-ered at risk The goal at this level is to reduce

current cases of problem behavior and/or

academic failure to prevent student problems

from escalating to an intensity that requires

individualized planning (Sugai et al., 2010)

Hallmark characteristics of Tier 2 include

rapid access to intervention that is

continu-ously available, low-effort teacher

implemen-tation facilitated by a team-based approach,

and frequent monitoring of progress to

deter-mine the effectiveness of the intervention and/

or need for further support (Mclntosh,

Camp-bell, Carter, & Dickey, 2009; Sugai et al.,

2010) An estimated 10-15% of a school's

population may potentially be identified as

at-risk, so the need for interventions that are both

effective and efficient is pressing

Specific to students with EBD, it isestimated that currently only 25% of childrenwho have these disorders are actually iden-tified and served in schools, and this typical-

ly occurs after the opportunity for Tier 1 andTier 2 prevention has long passed (Kauffman,2005) The systematic use of tiered modelsfor intervention is a way to serve theseindividuals before their problems are exac-erbated Although extensive research hasbeen conducted for both Tier 1 and Tier 3supports, less is known about the level of Tier

1 implementation prior to adding mental supports, the feasibility of Tier 2implementation by typical school personnel,and the perceived value in relation to timeand effort when Tier 2 supports are provided

supple-as part of a prevention framework (Mclntosh

et al., 2009)

A wide range of interventions is highlighted

as potentially beneficial for at-risk children andyouth Recommended Tier 2 interventions haveincluded: The Behavior Education Program,which includes a daily check-in/check-out with

an adult at school (BEP/CICO); First Step toSuccess, which is a school- and home-basedintervention for primary level children; Checkand Connect, a drop-out prevention and men-toring program; social skill instructional groups;and academic supports (Sugai et al., 2010).Although many evidence-based interventionsare available to support individuals who havebehavior problems, the details and logistics ofproviding Tier 2 intervention within a tieredframework have not been clearly articulated inthe literature (Campbell & Anderson, 2008;Mclntosh et al., 2009; Sugai & Horner, 2008) Anumber of issues remain in question

The purpose of this review is to explore theexisting research base for Tier 2 group interven-tion studies conducted within the framework of

a tiered continuum of supports Group tions are specifically selected as an area ofinterest because they hold potential for effec-tively serving a number of students in the samefashion, and may demonstrate efficient use oflimited resources Emphasis on studies conduct-

interven-ed within a tierinterven-ed model is also an importantdistinction A number of investigations alreadydemonstrate positive outcomes for use of smallgroup supports provided in isolation, but less isknown about how these interventions can beused within a framework of tiered intervention(Campbell & Anderson, 2008; Mclntosh et al.,2009; Sugai & Horner, 2008) Specific researchquestions for this review include:

1 To what extent has integrity of Tier 1

implementation been assessed prior to the

addition of Tier 2 interventions among

studies in the existing research base?

2 What are the characteristics of students

who have participated in Tier 2 group

interventions and how was identification

for these additional supports determined?

3 What outcomes are most often targeted,

which types of group interventions have

been implemented, and what effects do

they show within a tiered framework?

4 Have school-based teams demonstrated

capacity to implement and sustain Tier 2

interventions, or have these efforts largely

been conducted by research personnel?

5 Have Tier 2 interventions rated by

school-based personnel as socially valid (i.e.,

important, effective, and feasible)?

Method

The following strategies were used to

complete a comprehensive search for

pub-lished studies of interventions provided as Tier

2 level supports within a tiered prevention

framework: (1) database search, (2) journal

review, (3) application of inclusion criteria,

and (4) ancestral review Use of these

tech-niques led to an initial pool of 67 possible

studies These steps and processes are

de-scribed in detail in the following sections

Database Search

First, a search was conducted using two

databases, the Education Resources Information

Center (ERIC) and PsyclNFO with the following

terms: check-in/check-out, effective behavior

support, positive behavior support, school-wide

positive behavior support, and the behavior

education program Because the phrase "positive

behavior support" located the greatest number of

entries in both databases it was then used as a key

word combined with each of the following

additional terms: at-risk students, behavior

change, behavior problems, behavior

modifica-tion, benchmarking, check-in/check-out, early

intervention, high-risk students, identification,

intervention, outcomes of education, outcomes

of treatment, prediction, prevention, program

effectiveness, referral, response to intervention,

screening instruments, screening tests, secondary

intervention, small group intervention, targeted

intervention, teacher nomination, the behavior

education program, and tier two intervention.Using these procedures, 41 potential articlesfrom the ERIC database and 11 additional articlesfrom the PsyclNFO search were located

Journal Review

Second, an examination of ten reviewed journals that frequently publisharticles about SWPBS, prevention, and specialeducation was conducted In most cases, eachjournal was reviewed from 1984 or theearliest published volume through the mostcurrent edition This year was identifiedbecause a three-tiered support continuumwas first established as a disease preventionmodel in the early eighties (Gordon, 1983)and shortly after, the tiered prevention modelwas applied to social behavior in schoolsettings (Walker et al., 1996) Five experts inthe area of EBD and/or SWPBS nominatedjournals that were likely to publish work inthe subject of Tier 2 intervention Each of theselected experts has worked and published inthe area of special education and positivebehavior supports for a number of yearswithin a research university Based on expertrecommendations the following journals were

peer-included in this search: Behavioral Disorders, Education and Treatment of Children, Excep- tional Children, Journal of Behavioral Educa- tion, Journal of Emotional and Behavioral Disorders, Journal of Positive Behavior Inter- ventions, Psychology in the Schools, Remedi-

al and Special Education, School Psychology Quarterly, and School Psychology Review.

For two of the selected journals the searchyears were modified based on the availability

of volumes School Psychology Quarterly was reviewed from 2001-2009 and Education and Treatment of Children was examined from

1989-2009 Using this procedure, another 15articles were identified

Application of Inclusion Criteria

Each of the initial 67 articles located werethen reviewed according to the followinginclusionary criteria: (a) an intervention studypublished in a peer-reviewed journal; (b)explicit statement within text of the article thatthe study was conducted in a setting imple-menting one of the following: SWPBS, a tieredprevention model that includes social behav-ior, a continuum of supports, or a systems-based response to intervention approach; (c)

the independent variable described in the

study was a supplemental (i.e Tier 2) group

intervention applied to a selected set of

students, in which two or more students

received the same intervention rather than

individualized planning; (d) participants were

determined to be at risk by one or more

criteria, such as teacher nomination, results of

a screening instrument, office discipline

refer-ral data, and/or direct observation data; and

(e) results of the study examined a social or

behavioral outcome such as change in

dis-ruptive behavior, office discipline referral

rates (ODR), peer relationships, and/or social

skill competency Studies that primarily

ex-amined academic outcomes such as increased

writing performance, phonological

aware-ness, or college entrance exam scores were

included if they met the first four criteria and

adhered to the fifth criteria by also reporting

some type of social or behavioral outcome

Studies that reported academic outcomes

alone, even if conducted within SWPBS, a

three-tiered model of support, or a Response

to Intervention (Rtl) approach, were not

considered for this review (e.g., Kamps &

Greenwood, 2005; Lane et al., 2008; Lane,

Robertson-Kalberg, Mofield, Wehby, & Parks,

2009) In addition, articles reporting outcomes

of a class-wide or grade level intervention

were also excluded (e.g., Mclntosh, Chard,

Boland, & Horner, 2006; Nelson, Martella, &

Marchand-Martel la, 2002; Todd, Haugen,

Anderson, & Spriggs, 2002)

To ensure that inclusion criteria were well

defined and studies were accurately accepted

or disqualified, a second reviewer was used

To complete this process, each of the studies

located by the previously described methods

were given to a second reviewer with specific

experience and expertise in SWPBS who

completed an independent review of potential

studies After independent review, the two

reviewers developed a comprehensive list of

studies that met all inclusion criteria In the

case of disagreement, the publication was

reexamined and discussed until consensus

was reached or communication with an author

verified a decision

Ancestral Review

Einally, two reviewers also conducted a

search of references listed in each of the

accepted studies No additional studies were

located using this technique

Excluded Studies

A number of studies considered for tance were disqualified and warrant specificmention to provide additional clarity about thenature and type of work that is included Eorexample First Step to Success is a targetedintervention program for young children ex-hibiting antisocial or aberrant behavior with arobust evidence base of single-subject, quasi-experimental, and random-clinical trial re-search (Walker et al., 1998; Walker et al.,2009) First Step to Success consists of threemodules (screening, school intervention, andparent intervention) designed to be usedtogether to identify students with emergingbehavioral and social concerns, and to im-prove social adjustment and academic perfor-mance through coordinated support fromparents, teachers, and peers (Sprague &Perkins, 2009; Walker et al., 1997) However,the program utilizes its own screening modulefor student identification; therefore, to date,the literature base has not investigated imple-mentation within a tiered model, such asSWPBS, which was an inclusion criterion forthis study

accep-Second, literature supporting Check andConnect, a mentoring and dropout preventionprogram was also examined and consideredfor acceptance but is not included in thisreview Studies of Check and Connect havebeen completed among students with disabil-ities at both the elementary and secondarylevels and show outcomes for improvingattendance rates and engagement in school.Although many investigations of Check andConnect met one or more of the inclusioncriteria, there were no reports that indicated ordescribed this intervention as provided within

a tiered prevention framework; thus thesestudies were excluded

Finally, two studies of BFP/CICO werealso determined ineligible for this review(March & Horner, 2002; Hawken & Horner,2003) March and Horner (2002) designed atwo part investigation to examine the effects

of BEP/CICO for 24 middle school studentsand then used FBA results to modify theintervention for three students who did notdemonstrate initial success Later, Hawkenand Horner (2003) examined the effects ofBEP/CICO on problem behavior and academ-

ic engagement among four students (Hawken

& Horner, 2003) Although both studiesshowed positive outcomes for use of theBEP/CICO intervention, neither included an

explicit statement that these supports were

provided within a SWPBS continuum or a

tiered prevention framework, thus they were

not included for review

Results

From the multi-method search, a total of

13 studies met all inclusion criteria and are

reported in this review The studies range in

date of publication from the earliest in 2002

to the most recent in 2009 Among the 13

studies reviewed, a total of three different

research methods were utilized: seven studies

incorporated exclusive use of single subject

designs, five studies were quasi-experimental,

and one was a descriptive case study (see

Table /).

Tier 1 Level of Implementation

To date, a number of published studies

speak to the effectiveness of Tier 1 behavioral

supports and provide details for how to

employ these techniques In addition,

specif-ically within the context of SWPBS, a number

of research-validated instruments and tools

are available to help assess integrity of

implementation, monitor progress toward

school-wide goals, and evaluate outcomes

of Tier 1 prevention efforts Examples of such

instruments include The Team

Implementa-tion Checklist (TIC; Sugai, Horner, &

Lewis-Palmer, 2009), The School Safety Survey

(SSS; Sprague, Colvin, & Irvin, 2002), The

Effective Behavior Support/Self Assessment

Survey (EBS/SAS; Sugai, Horner, & Todd,

2000), and The Benchmarks of Quality (BoQ;

Cohen, Kinkaid, & Childs, 2007) However,

The School-wide Evaluation Tool (SET;

Horner et al., 2004) is perhaps the most well

known metric for assessing Tier 1

implemen-tation and was developed specifically as a

research tool

Among the studies included for review,

only a disappointing few gave documentation

of their Tier 1 efforts, either by describing

specific features in place or by a measure of

implementation fidelity such as the numerous

instruments listed above In the four studies

that did provide SET results, overall

imple-mentation of Tier 1 prior to the addition of Tier

2 was high, ranging from a mean of 80-100%

of features in place (Fairbanks et al., 2007;

Hawken et al., 2007; Mclntosh et al., 2009;

Todd et al., 2008; see Table 1).

Identification of Tier 2 Participants

Table 1 provides a brief description of

participant demographic characteristics Use

of a systematic process to identify studentswho require additional intervention is of vitalimportance within a tiered continuum ofsupport As such, it is imperative to know

how these students were identified Methods

for identifying student participants variedacross the 13 studies reviewed In general,student identification for participation wasbased on one or a combination of thefollowing: (a) nomination process in which aclassroom teacher, a parent, or a problemsolving team identified the student as at-risk;(b) use of student data—typically officediscipline referral information—to indicatethat the student was unresponsive to the Tier

1 prevention efforts or to a Tier 2 intervention;

or (c) use of behavioral screening scoreresults

Nomination Process

Among studies that identified studentsthrough a nomination process, the referralwas based on perception of need in mostexamples For example, Campbell and Ander-son (2008) reported on two students who werereferred to the school's problem solving team

by a classroom teacher because of disruptiveand noncompliant behavior Similarly,McCurdy, Kunsch, and Reibstein (2007) doc-umented use of a prereferral intervention teamnomination process Participants were includ-

ed based on demonstration of behavioraldifficulties in the classroom and/or existence

of a behavior plan Mclntosh and colleagues(2009) accepted students nominated by teach-ers because of classroom problem behaviorand perceived lack of responsiveness to theTier 1 prevention efforts Fairbanks and col-leagues (2007) also incorporated a teachernomination process to identify students Par-ticipants in this study were referred based onincreasing office referrals and problem behav-ior in the classroom, but neither the number ofreferrals nor the level of classroom problemwere defined Finally, the investigation com-pleted by Todd, Campbell, Meyer, and Horner(2008) identified student candidates through amulti-informant process, which included ad-ministrator nomination, teacher verification ofproblem behavior, parental consent, andstudent willingness to participate in the inter-vention

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Student Data

None of the 13 studies reviewed relied

exclusively on use of student data alone to

determine participation in a Tier 2 intervention

Among studies that included use of student

data, office discipline referral (ODR)

informa-tion was relied upon most heavily Several

authors provided a specific number of ODR as

criteria for participation For example, five or

more ODR was cited as part of an identification

process in one study (Hawken, 2006), and two

or more ODR was considered in another

investigation (Hawken, MacLeod, & Rawlings,

2007) Robertson and Lane (2007) provided

perhaps the most specific use of student data by

combining one or more disciplinary referrals

within the first four months of school, additional

indicators of grade point average less than or

equal to 2.7, and a screening score

demon-strating moderate or high risk Filteretal (2007)

reported outcomes for students from three

different schools buteach school developed its

own identification process These processes

were not specified other than that a behavior

support team submitted student candidates

based on office referral data as part of the

decision-making process Finally, Lane et al

(2002) used school academic data combined

with screening score results as an identification

process In this study, students performing in the

bottom third of their class in terms of literacy

skills and receiving a score of four or higher

using the Student Risk Screening Scale (SRSS;

Drummond, 1993) were considered to be

candidates who would benefit from

interven-tion

Screening Score Results

Results from use of a behavioral screening

instrument were used in three studies Lane et

al (2003) included student participants who

were identified by classroom teachers using

scores from the SRSS (Drummond, 1993) A

criterion for inclusion in the intervention was a

total raw score of 9 or more after the

school-wide prevention plan was implemented for

three months In the second example,

Cresh-am Bao Van, and Cook (2006), used a

multigated procedure after school-wide

uni-versal prevention efforts were provided to all

students In stage one, teachers identified and

rank ordered 10 students who fit a provided

definition for social skill problems Stage two

considered student scores on the Social Skills

Rating System (SSRS; Gresham & Elliott, 1990)

and the Critical Events Index (CEI) of theSystematic Screening for Behavior Disorders(SSBD; Walker & Severson, 1990) Finally,stage three identified students with social skillacquisition deficits as determined by SSRSsocial skill and problem behavior scores In themost recent example Marchant et al (2007)also used the SSBD (Walker & Severson,1990) As part of the SWPBS process allstudents in the participating school werescreened In this example, students identifiedwith internalizing concerns who scored in thehigh-risk range during the direct observationstage of the SSBD were also assessed using theInternalizing Symptoms Scale for Children(ISSC; Merrell & Walters, 1998) or the Pre-school and Kindergarten Behavior Scales,Second Edition (PKBS-2; Merrell, 2002)

Target Outcomes, Intervention Types and Effects Shown

Outcomes Targeted

The majority of studies (12 out of 13)measured behavioral outcomes alone How-ever, Lane et al (2002) examined bothbehavioral and academic indicators Amongthe investigations of behavioral outcomes

alone, measurement of problem behavior was

included in 10 of the 13 studies (Campbell &Anderson, 2008; Fairbanks et al., 2007; Filter

et al., 2007; Cresham et al., 2006; Hawken,2006; Hawken et al., 2007; Lane et al., 2003;Lane et al., 2002; Mclntosh et al., 2009; &Todd et al., 2008) Within those 10 studies,definitions of problem behavior varied Six ofthe 10 studies identified specific parametersfor problem behavior, which frequently in-cluded: non-compliance, disruption, negativephysical or verbal interaction, out of seat, off-task, and talking out Three of the 10 studiesdefined problem behavior by rate of officediscipline referral (Filter et al., 2007; Hawken

et al., 2007; Hawken, 2006) One studydefined problem behavior in terms of ODRand behavior ratings using the BehavioralSymptoms Index (BSI) component of theBehavior Assessment Scale for Children 2(BASC-2; Mclntosh et al., 2009)

Within the group of 10 studies that

mea-sured problem behavior, two authors also included secondary measures to examine ap- propriate behavior (Lane et al., 2003; Mclntosh

et al., 2009) Lane et al (2003) measuredacademic engaged time (AET) as defined byamount of time spent doing one or more of the

following: looking at or attending to the teacher

or instructional materials, engaged in or

com-pleting a required activity, and seeking

assis-tance in an appropriate manner While

Mcln-tosh et al (2009) included a measure of

prosocial behaviors through use of the BASC-2

Teacher Report Scale Form, which considers

adaptability, social skills, leadership, study

skills, and functional communication

Among the 13 studies reviewed, three

investigations measured appropriate behavior

alone Marchant et al (2007) examined rates

of effective communication and appropriate

peer play in a playground setting McCurdy et

al (2007) considered percentage of daily

points earned in a BEP/CICO program as the

dependent variable Robertson and Lane

(2007) examined post-treatment scores for

knowledge and use of study skills and conflict

resolution skills

Interventions and Effects

In terms of the specific interventions used,

the 13 studies reviewed fall across three

distinct intervention categories: (a) The

Behav-ior Education Program: Check-in/Check-out

(BEP/CICO), (b) social skill instructional

groups, and (c) academic instructional groups

Eight of the 13 studies report outcomes and

effects of BEP/CICO (Campbell & Anderson,

2008; Fairbanks et al., 2007; Filter et al., 2007;

Hawken, 2006; Hawken et al., 2007;

McCurdy et al., 2007; Mclntosh et al., 2009;

Todd et al., 2008) Beyond the BEP/CICO

literature, four studies used a social skill

instructional intervention (Gresham et al.,

2006; Lane et al., 2003; Marchant et al.,

2007; Robertson & Lane, 2007) Finally, one

author reported a small group literacy

instruc-tion interveninstruc-tion and examined both the

academic and behavioral outcomes after

treatment (Lane et al., 2002) Among the

studies reviewed, 12 reported positive results

which included decreases in observation of

problem behavior or office discipline referral

rates, and/or an increase in academic

engage-ment, increases in use and/or rating of social

skills, or an increase in academic skill

The Behavior Education Program:

Check-in/Check-out (BEP/CICO) Among eight reports

of the BEP/CICO intervention, five studies

followed a standard treatment protocol for

delivery of the support (Filter et al., 2007;

Hawken, 2006; Hawken et al., 2007;

McCurdy et al., 2007; Todd et al., 2008) A

standard treatment of BEP/CICO includes thefollowing five components: (a) daily check-in,(b) feedback from classroom teachers atregular intervals throughout the day, (c) dailycheck-out, (d) data collection with progressmonitoring, and (e) parent feedback (Hawken

& Horner, 2003) Within the five studies thatdelivered a standard version of BEP/CICO,there were a total of 53 participants Of those,approximately 70% demonstrated positiveoutcomes that included a decrease in ODR(Filter et al., 2007; Hawken, 2006; Hawken etal., 2007), a decrease in percentage ofintervals engaged in problem behavior (Todd

et al., 2008), or a percentage of daily pointsearned averaging 80 percent or higher(McCurdy et al., 2007)

In a different investigation, Mclntosh andcolleagues (2009) also provided a standardBEP/CICO treatment with an additional 34participants, but examined results according togroup rather than by individual student Thepurpose was to identify effects of BEP/CICO forstudents with attention-maintained behavior(n = 18) versus students with escape-motivatedbehavior (n = 16) Outcomes showed statisti-cally significant reductions in problem behaviorratings and ODR rates, and a statisticallysignificant increase in prosocial behaviorrating for participants with attention-main-tained behaviors Results for the escape-motivated group were not statistically signifi-cant on any measure

Fairbanks and colleagues (2007) alsodemonstrated positive results for BEP/CICO

In this study, a cohort of 10 students received astandard treatment of BEP/CICO and resultswere monitored A unique aspect of theinvestigation was the report of outcomes inrelation to typically developed classmates.Four of the 10 students who received inter-vention demonstrated decreases in problembehavior that were near to or below the level

of an observed peer

Last, Campbell and Anderson (2008) alsodemonstrated use of a distinct feature as asupplement to the BEP/CICO treatment Thisinvestigation reported the addition of anincentive that allowed access to peer attentionwas sufficient for increasing the success of twoparticipants who initially showed low levels ofresponsiveness to the standard group interven-tion Study participants were permitted to sitwith a preferred peer during lunch and tocheck-out with a preferred peer at the end ofthe day Using the function-based adaptation