Examples of Research-Based Processes and Interventions



Massachusetts Department of Elementary and Secondary EducationExamples of Research-Based Processes and Interventions for More Intensive Student SupportThe COVID-19 pandemic and extended school closure is likely to contribute to greater mental health symptoms and increased vulnerability to stress. Some students may have experienced skills regression as familiar and predictable structures and routines disappeared. Others have been exposed to stressors during the closure, including financial, housing, or food insecurity, increased family conflict, and illness or death of family members. These challenges, and resulting social-emotional difficulties, are likely to impact both students who have been previously identified as exhibiting behavioral or social-emotional skill deficits as well as those who have historically responded well to Tier One/Universal Supports.Schools will therefore benefit from implementing effective and efficient processes for Tier 2-3 service implementation. Effective services are those that directly meet student needs. Efficient processes are proactive, occurring before the problem behavior is exhibited. The following are examples of such services and processes, and considerations for implementation.Check In/Check OutCheck In/Check Out (CICO) is a structured process that can be flexibly applied to support skill development within a variety of interventions. It provides the student an opportunity to connect with an identified school staff member to set behavioral goals, review desired target behaviors, assess emotional well-being, and monitor school performance. It is most effective for students who are reinforced by adult attention. The following modifications may be considered to adapt the CICO model to school re-opening contingencies:In-person--Consider push-in small group CICO structures to reach more students and limit student exposure to other areas of the buildingRemote-- Students in remote learning are likely to benefit from continued adult attention as well as support to set goals and structure their learning when at home. Consider using technology (e.g. VoiceThread, FlipGrid) to provide CICO to students without needing to set up virtual meetings for each studentPromoting In-Class Self-Regulation BehaviorTraditional behavior response protocols emphasize providing social-emotional support outside of the learning environment. Mitigating the risk of infection, however, requires limiting student movement throughout a school building during the day. This indicates that there is a need for additional systems and strategies for helping students manage frustration and utilize coping skills within their learning environment. The following approaches may be considered to support self-regulation for students in the classroomProvide each student with a collection of self-regulation strategies that can be utilized at their deskUtilize non-verbal emotional communication tools to help teacher understand students who require coping skill use to stay regulated and engaged in learningUtilize behavior data to identify behavioral “hot spots” and proactively place mental health personnel in those locations to provide additional support and supervisionUtilize mental health personnel to coach teachers on implementing de-escalation techniques. This will likely require some initial counselor modeling at firstFamily Engagement/CollaborationSkills targeted for remediation in a Tier 2 intervention will likely improve functioning across all environments, not simply the classroom. To support this skill generalization, it is always important to engage families in the process. This may include psychoeducation, shared reinforcement strategies, and possible opportunities for home skills practice. Such collaboration is especially important given the possibility of hybrid learning models or intermittent school closure if/when Covid-19 rates increase. The following recommendations should be considered to improve family engagement with Tier 2 intervention:Provide concrete examples for when and how a student will utilize learned skill at homeProvide concrete strategies for how parent can support skill development at homeEncourage student to write/verbalize their own explanation for the skill that they have learnedUtilize behavior contracts for the student to agree to specific skills practice when at homeIf possible, share skills learned in Tier 2 intervention with community-based providers working with the student/familyReinforcement PlansExtrinsic reinforcement is important in increasing the likelihood of desired behaviors. This is because the student’s prior unexpected behavior developed because a.) the student had the skills to do it and b.) it was reinforced by their environment. The following recommendations are presented to develop effective reinforcement plans to support students returning to school:Increase frequency and intensity of reinforcement, especially if the student is in a hybrid learning environment. It will be more challenging to shape adaptive behaviors in an inconsistent learning environmentUtilize self-monitoring reinforcement systems whenever possible to help maintain the plan at both school and homeProvide access to reinforcement each day as students are likely to miss more school days due to hybrid learning and minor physical symptoms that may be related to Covid-19 infection (e.g. sore throat, headache, stuffy nose) Share reinforcement plans with parents/guardians along with concrete strategies for how the system can be modified for the home settingEffective Tier 2 InterventionsTier 2 interventions should be short-term, but intensive and include several core elements. First, there must be an opportunity to explicitly teach skills in a non-threatening learning environment. Second, the student must have chances to review and practice newly taught skills. Third, the student’s teachers must have guidance for how to effectively preview, prompt, and reinforce these new skills in the environment where they are most needed. Finally, there must be a progress monitoring component to ensure that the student has responded to the intervention. The following recommendations are presented to ensure that students receive appropriate Tier 2 intervention.Safety Protocol InterventionThere are a variety of factors that may impact a student’s ability to comply with newly implemented measures designed to mitigate the risk of infection. This could include anything from difficulties following multi-step instructions, poor self-monitoring, sensory processing differences, or different political or cultural beliefs related to the virus. Disciplinary responses to failure to follow safety measures are unlikely to increase future compliance. A Tier 2 intervention may focus on the following approach:Education on the rationale for why specific safety measures have been implementedAdditional instruction on effective hygiene practices, such as hand washing, taking on/off masks, etc.Reinforcement plans to increase self-monitoring capacity related to social distancing or abstaining from touching nose, mouth, eyesAdditional practice with safety-related routines, such as hallway transitionsCollaborative problem solving discussions to develop a plan to address possible underlying reasons for why a safety measure is not being followed (e.g. mask is uncomfortable)Self-Regulation InterventionLearning is a cognitive and emotional exercise. Students must learn how to manage distress when tackling new concepts, making mistakes, or responding to performance feedback. Without self-regulation strategies, students may engage in a range of behaviors to escape the classroom environment and may need additional instruction and practice in order to be able to access their coping skills. A Tier 2 self-regulation intervention may include:Psychoeducation on the adaptive purpose of emotionInstruction to identify physiological symptoms the student struggles to tolerate Exposure to a range of strategies to ameliorate physiological symptoms Regular practice of strategies when calmInstruction on effective communicative scripts to alert teacher of the need to utilize self-regulation strategiesDevelop a self-regulation toolkit that includes skills the student has identified as effective Instruction on effective cognitive coping strategiesDevelop a hierarchy of situations that elicit negative emotionExpose student to these situations to provide opportunity for skill use Anxiety Management InterventionThe uncertainty experienced as a result of the pandemic and school closure has been a breeding ground for anxiety symptoms. This uncertainty is likely to continue for our students who will return to school environments and routines that are quite different from what they are accustomed to. The following strategies are presented to support effective Tier 2 intervention for anxiety symptoms:Provide opportunities for students identified with anxiety to tour the school and learn about the safety protocol prior to official school re-openingDisseminate concrete student drop off protocols for students at risk for separation anxietyEngage in proactive family engagement for students with a history of anxiety-related attendance issues to help families develop and practice wake-up routines to prepare the student for the school yearProvide psychoeducation on role of anxiety as the body’s alarm systemProvide explicit instruction on identifying physiological anxiety symptomsSupport student in determining whether an anxiety alarm is a “true” or “false” alarmProvide explicit instruction in anxiety reduction strategies, such as deep breathing, progressive muscle relaxation, and meditationDevelop a hierarchy of anxiety provoking situationsSupport gradual exposure to anxiety provoking situations to allow student to face and overcome physiological distress related to anxietyCritical Incident ResponseAs we prepare for our return to school, we can anticipate circumstances in the lives of students or staff that would be in the category of Critical Incident Response, whether or not related to the pandemic, including illness/death of a family member, serious injury/accident, psychiatric crisis/suicide. No matter what precipitates the concern, response to a critical incident may be challenged and modified by COVID-19 restrictions, but are most effective when guided by the foundations of best practice in emergency management:Health and Safety are the first priorityWe are guided by legal guidelines of confidentiality, and the wishes of the individuals involved regarding privacy. General procedures include:Designating one point of contact for any staff or family outreach. If circumstances cross schools, the respective principals will share information with each other and determine who is the best single point of contact, who willreach out, connect, and verify any relevant details needed to understand the situationdetermine (when appropriate) what information can be shared and with whom, and assess the level of support or follow up that is needed/desiredMobilizing the school (or District) Crisis Team when appropriateMaintain an up-to-date contact list for Crisis Team members, particularly for outreach that is needed in the evening, weekends, or when school is not in sessionIn a significant critical event, such as serious accident or death, when the scope of the issue exceeds school resources, utilize community-based crisis response partners to develop support or tele-support plansWhen a situation involves threat of harm to self or others, include first responder partners as needed.Whether or not the situation requires Crisis Team deployment, identify the various networks of students, staff and members of the community who have been impacted and the nature of their connection to the situation when determining and planning the appropriate response. This is done to make sure that we are not overlooking any possible connections/needsUse after-action analysis to determine ways to improve future responses. ................
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