Barriers to Behavior Intervention: Improving Behavioral Support Through Pyramidal Training On Treatment Fidelity Methodologies

Background: Individuals with autism spectrum disorders often present with significant challenging behavior that interferes substantially with access to educational services and quality of life for their families.  Comprehensive and evidence-based assessment and intervention strategies are well understood; however, it can be difficult to ensure interventions are implemented with fidelity by educators, caregivers, and treatment providers.  This is especially the case in public school settings where a scarcity of technical resources, staff training, and human resources compromise implementation.  Well-crafted interventions that are not supported by appropriate implementation can fail to achieve socially meaningful outcomes for the client and, further, may result in increases in maladaptive behavior due to inconsistent use of therapeutic protocols. 

Objectives: This paper will present a process for systematically addressing barriers to implementation of behavior support plans within educational settings in order to ensure maximal therapeutic effect of these plans.  The data reviewed will demonstrate the positive impact of applying a pyramidal training model with school teams to establish a stable procedure for monitoring treatment fidelity on plan implementation as well as plan effectiveness. 

Methods: All participants underwent functional assessment procedures and were supported by behavior support plans derived directly from assessment data.  To address the presence of ongoing challenging behavior a protocol was introduced to instruct the educational team on maintaining implementation fidelity.  A pyramidal training model was implemented with the educational team to establish a consistent and proactive process for observation and performance feedback.  Data were collected on lead educator proficiency with implementing fidelity monitoring as well as the behavior support plan implementation fidelity of all team members.  The data on implementation fidelity were reviewed for co-variation with levels of challenging behavior to assess associated therapeutic effects of this process. 

Results: The implementation of the pyramidal training model resulted in significant improvements in educational teams’ abilities to reliably implement behavior support plans.  The lead educators were able to demonstrate proficiency with executing treatment monitoring and offering performance feedback to team members.  The successful acquisition of this treatment fidelity model by the educational teams was associated with positive therapeutic effects of the behavior support plans for the students.  For example, in one setting the initial levels of implementation fidelity fell at 68% and following the application of the fidelity monitoring protocol fidelity was measured at 92%.  Levels of challenging behavior decreased substantially to near zero as implementation fidelity rose.

Conclusions: School staff should be trained to utilize treatment fidelity monitoring as an essential component of effective behavior support plan implementation.  Without appropriate fidelity monitoring procedures, clients may fail to experience the therapeutic effect of appropriately developed behavior support plans.  Further, fidelity monitoring procedures provide important information for evaluating plan effectiveness as without these an intervention may be judged as ineffective when, in fact, it would result in substantial behavior change if implemented correctly.  Educational teams must possess not only the ability to assess and develop interventions, but additionally to train all team members on protocol use and monitor maintenance of correct implementation.