Triage Model
Numerous strategies are available for increasing the effectiveness and efficiency of school teams charged with Tier 3 problem solving through FBAs and BIPs. One strategy is careful identification of behavior challenges that may be successfully addressed by low to moderate intensity FBAs and BIPs versus those that may require higher intensity FBAs and BIPs, including those that may require support from professionals with advanced training. This identification process may be referred to as a triage approach.
Triage Model
In the response to intervention (RTI) model, when a student’s behavior has been unresponsive to Tier 1 and Tier 2 supports, the school problem-solving team may add intensive, individualized Tier 3 supports to address the student’s needs.
In an extension of the RTI model, when a Tier 3 intervention (i.e., BIP) has been based on an FBA and has been implemented with sufficient intensity for a reasonable duration and with high integrity, the school problem-solving team may determine that the results are less than desired. The team then has several options available, such as:
· Conduct a more thorough FBA.
· Modify the BIP.
· Seek support from a professional with advanced training in FBA and BIP.
· Add or intensify resources to support full implementation of the intervention plan.
However, prior to, or in the very early stages of problem solving, teams may determine that a student is experiencing very severe or significant behavioral, social-emotional, or academic problems and may then triage the student to expedite immediate intensive and individualized Tier 3 interventions with little or no prior contact with Tier 1 or 2 level interventions.
School teams can supplement existing universal screening procedures at Tier 1 (e.g., office discipline referrals, minor infraction reports) and screening at Tier 2 (e.g., teacher nominations) with triage procedures. Teams can then make better informed decisions about when to expedite an FBA and BIP. Teams can also decide when an FBA and BIP should be supported by professionals with advanced training. Factors that may impact related decisions are described in Appendix 1.
Appendix 1:
Triage Procedures
The problem solving team may decide to expedite an FBA and BIP, revise an existing FBA and BIP, and/or to decide to seek support from a professional with advanced training when:
· A student is experiencing very severe or significant academic, behavioral, or social-emotional problems even though there may have been little or no prior contact with Tier 1 or 2 interventions.
· A student’s behavior has been unresponsive to Tier 1 and Tier 2 supports.
· A Tier 3 intervention (i.e., BIP) has been based on an FBA and has been implemented with sufficient intensity for a reasonable duration and with high integrity, and the behavior change is less than desired.
Additional factors may impact related decisions by the problem solving team (and can be added to existing Tier 1 and 2 screening procedures):
• There is current or proposed use of:
– Frequent removals from the classroom for disciplinary purposes that result in loss of instructional time (e.g., trips to the main office, in-school or out-of-school suspension)
– Highly restrictive reactive strategies or crisis management strategies (e.g., restraint or seclusion)
– Procedures that may be considered by some to be unusual, coercive, or punitive (e.g., water mist, social reprimands, restricted access to meals, frequent or prolonged exclusionary time out)
– Procedures that may be considered by some to be controversial (e.g., weighted vests, Facilitated Communication, other therapies or treatments for which the evidence of scientific research support has been questioned)
– Protective devices or equipment to prevent harm or injury as a result of behaviors (e.g., helmet for headbanging, gloves for hand mouthing), including items that may limit normal sensation or movement, or affect social inclusion
• There is a history of high risk and/or unusual behaviors (e.g., severe self-injury, PICA, aerophagia, trichotillomania, polydipsia)
• The student has a history of severe behavior problems (e.g., aggression) and is transferring from a more restrictive school setting to a less restrictive setting (e.g., from an out-of-state intensive treatment residential program to a neighborhood school)
• The student has a history of severe behavior problems that have resulted in police contact and/or Baker Acts
• Multiple problem behaviors have been identified and/or the current hypotheses regarding the function(s) of the problem behavior(s) are unclear (e.g., team members have conflicting opinions; the team has tentatively identified: multiple antecedents and/or functions, multiple behaviors with the same function, a behavior chain)
• There is a possible need for systematic functional analysis (FA) methods (i.e., controlled applications of procedures to test hypotheses and select the most effective intervention)
• There is a possible need for functional communication training (e.g., limited language repertoire, need for effective replacement behaviors)
• Other factors may include: