Providing Access to School-Wide Positive Behavioral Interventions and Supports for Students with Significant Cognitive Disabilities
Patricia McDaid, M. Kathleen Strickland-Cohen, Virginia Walker, Lyndsey Aiono Conradi
Positive Behavior Support (PBS) is an evidence-based approach used to design inclusive environments and prevent and decrease challenging behavior (Kincaid et al., 2016). PBS was first described in the 1980s as a person-centered and effective way to improve life outcomes and reduce challenging behavior for people with significant disabilities. It was developed as an alternative to commonly used punishment-based interventions. Over time, PBS expanded into a broader system that can support all the students in a school or district, including students with significant cognitive disabilities. School-wide Positive Behavioral Interventions and Supports (PBIS) is a three-tiered system now used in schools across the U.S. and is often combined with a three-tiered system of academic support to form a comprehensive Multi-tiered System of Support (MTSS).
PBIS is designed to support all students. However, many students with significant cognitive disabilities, especially those served in self-contained special education settings, do not always receive the full range of support within PBIS (Walker et al., 2018). This Brief discusses ways to design PBIS systems that are accessible to all students. It describes the importance of including all students in PBIS structures and gives practical strategies to help schools achieve this goal. It ends with the story of a student who benefited from full access to his school’s PBIS system.
Continuum of Practices within a PBIS Framework
Schools use a PBIS framework to develop a continuum of practices that supports students’ social, emotional, and behavioral growth. A representative school leadership team, which includes and engages students and families, develops and contextualizes the specific practices for each school. In Tier 1 PBIS, supports typically include selecting, defining, and teaching all students three to five positive behavioral expectations and how to demonstrate them. For example, the expectation of “Responsibility” in the cafeteria may mean throwing away your trash. In the hallway, it might refer to getting to class on time. On the playground, it could mean taking care of the environment. These setting-specific definitions are posted around the school and referred to throughout the day. School personnel acknowledge students when they meet the expectations. Staff may also use various skill-building and supportive strategies for responding to and redirecting challenging behavior when it occurs.
Tier 2 PBIS practices are used with students who need support beyond that offered by Tier 1 alone. In Tier 2, classroom environments are observed to see what may be creating barriers to student success. Check-in/Check-out (CICO) is a common and effective Tier 2 PBIS intervention (Hawken et al., 2015). CICO provides students with adult “check-ins” at the beginning of the day and “check-outs” at the end of the day. Students receive specific and positive feedback, support, and encouragement to meet their behavioral goals. CICO can be used with any number of students and is relatively simple to implement. Schools often adopt a menu of Tier 2 interventions, which they select based on data that indicate a match with student need.
Tier 3 PBIS provides individualized behavior intervention for students who need additional support to benefit from Tiers 1 and 2. Tier 3 support uses functional behavioral assessment to create function-based behavior support plans for students with significant, ongoing, and complex behavioral needs. Student-specific teams may also consider additional supports, coordinated in Tier 3 through a wraparound or person-centered planning process.
The goal of PBIS is to provide a continuum of social, emotional, and behavioral support to all students. However, some misperceptions prevent PBIS from being fully accessible to all. First, PBIS is often misunderstood as a general education system that does not include students with disabilities served outside of general education classrooms. This misunderstanding and persistent exclusionary placement practices can result in students with significant cognitive disabilities not having full access to all tiers of PBIS. Another assumption—that students with significant cognitive disabilities “automatically” require Tier 3 behavior support—also creates barriers to full PBIS access. This assumption can lead to a determination that students with significant cognitive disabilities are not likely to benefit from Tier 1 and 2 supports. Students are then prevented from being included in programs and supports at those tiers (Simonsen et al., 2020). As a result, these students often miss out on the social, emotional, behavioral, and academic benefits of accessing all three tiers of PBIS on an ongoing basis.
Importance of Including Each and Every Student in PBIS
The intent of PBIS is to support all students within a fully inclusive framework (Horner et al., 2017). Students with significant cognitive disabilities typically spend most of the day in separate, special education settings (Kleinert et al., 2015). As a result, they may have limited or no access to the school-wide aspects of PBIS. By promoting greater access to inclusive settings and ensuring that PBIS is available to every student no matter their placement, schools can provide students with significant cognitive disabilities increased opportunities to participate in and benefit from behavior supports available to their peers without disabilities (Loman et al., 2018; Walker et al., 2018).
There are a variety of reasons to include students with significant cognitive disabilities in all aspects of PBIS. First, not all students who require intensive, individualized (Tier 3) academic support also need the same level of behavior support. Even those students who do require Tier 3 behavior support can also benefit from school-wide behavior support practices. For example, all students, including those with significant cognitive disabilities, can benefit from Tier 1 practices such as predictable classroom routines, clearly defined behavioral expectations, increased prompts for positive behavior, and more positive feedback than corrective feedback (Simonsen et al., 2020). Consistent access to these types of support at Tier 1 can prevent some students with significant cognitive disabilities from needing more targeted or intensive behavioral interventions and can help foster inclusion of students who have more intensive behavior support needs.
Second, all students, including students with significant cognitive disabilities, benefit when their Tier 3 behavior supports correspond to the school-wide system. For example, school-wide reward systems provide increased opportunities for positive reinforcement for specific appropriate behaviors in various school environments and from a variety of adults. This consistency across settings can help students with significant cognitive disabilities generalize these behaviors more easily and increase the likelihood they will be successful in general education classrooms. The story provided later in this Brief provides an example of how this can look.
A third reason to include students with significant cognitive disabilities in all tiers of PBIS is that PBIS has consistently been shown to reduce schools’ use of detention, restraint, and seclusion (Grasley-Boy et al., 2019; Lee & Gage, 2020). Although students with disabilities make up only about 12% of total school enrollment in the U.S., they experience more than half of all suspensions, restraints, and seclusions (Office of Civil Rights, 2018). A critical feature of PBIS is developing a school-wide and instructional approach to discipline, focused on teaching and prompting expected behavior and redirecting challenging behavior. This type of approach can limit the overuse of traditional exclusionary discipline consequences.
Finally, by defining and explicitly teaching school-wide expectations, PBIS offers the opportunity to build more inclusive school cultures. By intentionally and meaningfully including students with significant cognitive disabilities in all aspects of PBIS, schools can demonstrate commitment to inclusion. They can also foster understanding and acceptance of differences and help to ensure all students, including those with disabilities, are treated with dignity and respect by all staff and peers.
Practical Strategies for Including Each and Every Student in PBIS
There are school-wide, classroom-wide, and student-specific strategies to provide all students with access to PBIS. Four keys to providing access to all PBIS tiers for students with significant cognitive disabilities include:
Special education teachers are often not involved in their schools’ PBIS teams (Shuster et al., 2017). Including special education teachers and other school personnel who support students with significant cognitive disabilities (e.g., paraprofessional, speech-language pathologist, assistive technology specialist, behavior analyst) in these collaborative teams is essential. These individuals have expertise that can support the development, implementation, and monitoring of effective PBIS supports that are accessible to all students.
Joint Professional Development
Special education personnel should be included in all PBIS professional development and training activities. Joint training ensures that allschool members have the information to provide behavior support across all tiers of PBIS for all students. In addition, when PBIS training includes information on how students with significant cognitive disabilities can participate in PBIS, access to appropriate and meaningful PBIS support in inclusive school-wide settings is likely to improve (Kurth & Zagona, 2018).
Universal Design for Learning
Walker and Loman (2021) recommended that schools consider the principles of UDL to meet the needs of all students participating in PBIS, including those with significant cognitive disabilities. Supports designed with UDL principles in mind provide students with multiple means of engagement, representation, and action and expression (CAST, 2018). Table 1 provides examples of applying UDL to each element of PBIS.
In addition, embedding evidence-based educational practices that address the needs of students with significant cognitive disabilities into the teaching of school-wide expectations can increase student success. These practices include peer-mediated supports, systematic instruction, and visual supports (Browder et al., 2014; Hume et al., 2021). For example, adding visual supports (e.g., photos) to posters displaying school-wide expectations and setting-specific definitions will benefit students with significant cognitive disabilities. This may also help others, including English learners and students who are not yet fluent readers. Other strategies include offering students choices and using familiar instructional materials and interventions (e.g., first-then board, social narratives). In addition, breaking down routines and procedures into smaller, accessible chunks (task analysis) and increasing practice opportunities are important to support student learning.
Tier 2 support may also need to be adapted using a UDL approach. CICO uses a daily progress report (DPR) card to monitor and reward school-wide or individual behavior goals. It has five steps: (1) check in with an adult and review DPR and daily goals, (2) receive teacher feedback throughout the day, (3) check out with an adult and receive encouragement, (4) take DPR home for guardians to sign and reward appropriate behavior, and (5) return DPR to school (Hawken et al., 2015). Possible adaptations that may support individuals with significant cognitive disabilities include:
Table 1. Application of Universal Design for Learning to Elements of PBIS
Linking Tier 3 with School-wide Supports.
Two strategies can be used to link components of PBIS to students’ individualized behavior support plans. First, incorporate the language used in Tier 1 school-wide expectations into Tier 3 behavior goals. Second, include the Tier 1 school-wide acknowledgment system (e.g., tokens) into the student’s individualized reward system. For example, an individual goal to ask for a break can be linked to the PBIS expectation “Be responsible.” This language could be incorporated into verbal praise in the following way, “Nice asking for a break. You are being responsible.” In addition, the student’s token board could be redesigned to use PBIS tokens in place of stars or coins.
The Big Take-away
The goal of PBIS is to create an inclusive school-wide culture that promotes and supports positive social, emotional, behavioral, and academic outcomes for all students. Providing meaningful access to all tiers of PBIS to students with significant cognitive disabilities increases their membership in the school community while also leading to improved outcomes.
Quinn is an 8th grader who attends a rural K-12 school. His IEP identifies him as a student with multiple disabilities, including a significant cognitive disability. Quinn is a friendly and outgoing young man with extensive support needs. He communicates using an augmentative and alternative communication (AAC) device and enjoys interacting with friends. His device allows him to interact socially, request items and activities, and appropriately refuse to participate in activities. Quinn accesses 8th-grade general education standards using specially designed instruction and adapted materials. He has a history of challenging behavior that includes lying down, yelling, throwing materials, pushing, and hitting. Challenging behavior occurs during transitions or when he is asked to complete non-preferred tasks and activities. He has had an individualized behavior support plan for the past several years. In addition, his school had been implementing PBIS for four years. Still, he has not been provided with access to the Tier 1 or Tier 2 behavior supports used by his grade-level peers.
Before Access to PBIS
Quinn’s IEP indicated he was included in general education classrooms for approximately 50% of the school day, with the remaining 50% in a special education classroom. Unfortunately, when staff felt he was having a “bad day,” Quinn frequently remained in the special education classroom for the entire day.
Providing Quinn with Access to PBIS
The school’s PBIS expectations of Respect, Responsibility, and Cooperation provided the base for Quinn’s access to the school-wide system. In addition to his individualized behavior support plan (which included a daily visual schedule and advance notice of transitions), he was explicitly taught the specific behaviors needed to demonstrate the school-wide expectations across all areas of the school. He was rewarded when he demonstrated those behaviors. Visual supports were added to posters displaying expectations in all common areas. They were used to remind Quinn what he needed to do before entering a specific area (e.g., hallway). Quinn surprised everyone with his ability to demonstrate these skills.
All of Quinn’s peers and teachers knew the behavioral expectations and could remind and reward him throughout the day. Because he already had strong peer relationships, reminders and praise from his classmates motivated him to use his new skills. Quinn’s individualized behavior support plan was also modified to use the same language, prompts, and rewards as the school-wide system. He appeared to like that his behavior plan was not all that different from the other students’ plans, and he did not mind receiving the additional reminders he needed to be successful.
After Access to PBIS
Although Quinn’s challenging behavior is not completely gone, it decreased dramatically. In general education classes, staff feel more able to support him. He enjoys being with his friends and is more engaged in educational activities than in the special education classroom. Quinn’s communication and social skills have also improved. This has helped him to build stronger relationships with his friends and teachers. Over time, he has consistently increased his participation and learning in general education classes alongside his peers.
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TIES Center Brief #10, July 2022