Academic journal article Education & Treatment of Children

A Treatment Integrity Analysis of Function-Based Intervention

Academic journal article Education & Treatment of Children

A Treatment Integrity Analysis of Function-Based Intervention

Article excerpt

Abstract

This study examined whether direct, interval-by-interval measures of treatment integrity would make it possible to distinguish whether equivocal intervention results could be attributed to the intervention itself, or to poor implementation. Josh, an eight-year-old 3rd grader, performed at or slightly above his peers' academically, yet engaged in problem behaviors (yelling, throwing objects, slamming his desk into a peer's desk) on a daily basis. A functional behavioral assessment (FBA) identified these behaviors were maintained by gaining attention (positive reinforcement) and escaping from certain assignments (negative reinforcement). A function-based intervention was then developed, tested, and implemented during ongoing activities in the classroom. On-task behavior occurred throughout more than 91% of the intervals when the intervention was implemented correctly, compared to only 9% when it was implemented incorrectly. Positive treatment acceptability ratings were obtained from both Josh and his teacher, even though she continued to implement inconsistently throughout the study. Implications for both research and practice are presented.

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Although treatment integrity is a key quality indicator in intervention research (Gersten et al., 2005; Horner et al., 2005), it has important implications for practitioners as well. Treatment integrity is the degree to which an intervention is implemented as described and intended and is not due to extraneous factors unrelated to an intervention (Billingsley, White, & Munson, 1980; Gresham, 1989; Peterson, Homer, & Wonderlich, 1982). If researchers fail to document treatment integrity, they cannot legitimately claim that an intervention was responsible for observed changes in behavior. Practitioners face the same predicament because, without objective data on intervention implementation, they may abandon effective interventions that appear ineffective because they were implemented poorly or inconsistently. Treatment integrity is therefore concerned with both the accuracy and consistency with which intervention procedures are implemented.

The area of function-based intervention for challenging behaviors offers a good example of how lapses in treatment integrity may compromise the interpretation of intervention outcomes. Function-based interventions are developed based on a prior identification of the antecedent conditions that set the occasion for a problem behavior and of the consequences that reinforce it. Resulting interventions aim to improve the antecedent conditions, withhold or minimize reinforcement when problem behavior occurs, and provide reinforcement for more desirable, alternative behaviors (Sugai et al., 2000; Umbreit, Ferro, Liaupsin, & Lane, 2007). Reviewers of this research (Conroy, Dunlap, Clarke, & Alter, 2005; Fox & Gable, 2004; Fox, Conroy, & Heckaman, 1998; Heckaman, Conroy, Fox, & Chait, 2000, Sasso, Conroy, Stichter, & Fox, 2001) have repeatedly concluded that function-based interventions produce verifiable improvements in behavior when they are implemented with integrity.

The purpose of this study was to examine whether a comprehensive, direct measure of treatment integrity would make it possible to determine whether equivocal intervention results could be attributed to the intervention itself, or to poor implementation. This information would be very helpful to interventionists by enabling them to determine quickly whether they needed to focus their efforts on revising and improving the intervention, or on helping staff to implement the intervention with greater integrity. The study was conducted in two phases. A descriptive functional behavioral assessment (FBA) was conducted in Phase 1. In Phase 2, an intervention was systematically constructed, tested through brief reversal conditions, and then implemented during naturally occurring activities and routines in the classroom. …

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