Tertiary Prevention is aimed at preventing an emotional or behavior problem from overwhelming the individual.
PBIS has been used to support the behavioral adaptation of students with a wide range of characteristics, including developmental disabilities, autism, emotional and behavioral disorders, and even students with no diagnostic label.
Tier 3 Supports are tailored to an individual’s specific needs and circumstances and are comprehensive. These supports require professional collaborations. The interventions seek to increase the individual’s adaptive skills.
Tier 3 Supports require the establishment of a comprehensive Tier 3 Team, which includes the student, family, a behavioral specialist, and other individuals who have expertise in areas related to the student’s needs. Tertiary Prevention allows teams to vary features of the process (e.g., data collection tools used, breadth of information gathered, specificity and number of hypotheses generated, extent of the behavioral support plan, and degree of monitoring) to provide the most individualized behavior support possible.
When should a program of Tertiary Prevention be implemented and who should be involved?
Mandates provided by educational and human services agencies define conditions in which individual systems should be used to address concerns related to behavior.
For example, with a student with a disability, IDEA requires that a functional behavioral assessment (FBA) be completed and a behavioral intervention plan (BIP) be implemented when disciplinary sanctions result in extended periods (i.e., the first removal beyond 10 cumulative days and every change in placement) in which a student is removed from an environment or suspended (34 C.F.R. 300.520 (b) (c)).
Individual systems of support are warranted in other circumstances as well, especially when problem behavior is interfering with educational progress.
Use of data to make decisions
Tertiary Prevention involves conducting a Functional Behavioral Assessment (FBA), which is then utilized to develop a Behavior Intervention Plan (BIP) that consists of:
1. Instruction on how to utilize an appropriate replacement behavior instead of using the inappropriate behavior
2. Rearrangement or manipulation of the environment to prevent setting events and antecedents from eliciting inappropriate behaviors
3. Rearrangement or manipulation of the environment to encourage the use of the appropriate replacement behavior
4. Procedures for responding to appropriate and inappropriate behavior
5. Procedures for monitoring, evaluating, and reassessing of the plan as necessary
In some cases, the plan may also include emergency procedures to ensure safety and rapid de-escalation of severe episodes or major ecological changes such as changes in school placement.
Tertiary Prevention interventions are implemented through a flexible, but systematic, process of functional behavioral assessment and behavioral intervention planning.
The following outline illustrates the general practices that are utilized:
I. Identify goals of intervention. Based on the available information, the team identifies the specific concern and goals:
· what the student is doing that is problematic (observable behaviors)
· to what extent (e.g., frequency) these behaviors are occurring
· what broad goals the team hopes to achieve through intervention
II. Gather relevant information. Members of the behavioral support team gather information through a variety of sources:
· review of existing records
· interviews of support providers
· direct observation of patterns, antecedents, contexts, and consequences
III. Develop summary statements. The team uses the information to create statements that describe relationship between the student’s behaviors of concern and aspects of the environments. These statements include:
· when, where, and with whom the behavior is most/least likely to occur
· what happens following the behavior (what they get or avoid)
· other variables that appear to be affecting the person’s behavior
IV. Generate behavioral support plan. A plan is developed, based on the summary statements, to address the behavioral concerns and fit within the environments in which it will be used. The behavioral support plan includes:
· adjustments to the environment that reduce the likelihood of the problem
· teaching replacement skills and building general competencies
· consequences to promote positive behaviors and deter problems
· a crisis management plan (if needed)
V. Implement and monitor outcomes. The team works together to ensure that the plan is implemented with consistency and is effective in achieving the identified goals:
· the team identifies the training and resources needed, determines who is responsible for monitoring implementation, evaluating outcomes and making adjustments in the plan