How is Tertiary Prevention implemented?

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 steps of the process.
I. Identify goals of intervention.
Based on the available information, the team identifies the specific concerns and goals:

1. what the student is doing that is problematic (observable behaviors).
2. to what extent (e.g., frequency) these behaviors are occurring.
3. 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:

1. review of existing records.
2. interviews of support providers.
3. direct observation of patterns, antecedents, contexts, and consequences.

III. Develop summary statements.
The team uses the information to create statements that describe relationships between the student’s behaviors of concern and aspects of the environments. These statements include:

1. when, where, and with whom the behavior is most/least likely to occur.
2. what happens following the behavior (what they get or avoid).
3. 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 (for students who have IEPs this may also serve as the Behavior Intervention Plan (BIP) includes:

1. adjustments to the environment that reduce the likelihood of problem.
2. teaching replacement skills and building general competencies.
3. consequences to promote positive behaviors and deter problems.
4. 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, evaluates outcomes (via continued data collection), and communicates periodically, making adjustments in the plan, as needed.

How should goals for Tertiary Prevention be determined?

Individualized positive behavior support focuses not only on decreasing specific behaviors of concern, but also building adaptive (and replacement) skills, and improving the individual’s overall quality of life. Goals should be based on a positive, long-term vision for the student developed with input from the student, the student’s family, and the support team. An excellent mechanism for determining broad goals for behavioral intervention is person-centered planning.
Person-centered planning (PCP) is a process for learning about an student’s preferred lifestyle. It involves creating goals that will assist students in achieving their preferred lifestyle within a collaborative team context. Most PCP plans are created with the goal of:

• increasing participation and presence in the school and community;
• gaining and maintaining significant relationships;
• expressing and making choices;
• experiencing respect and living a dignified life; and
• developing personal skills and areas of expertise.

How do we know when an individual plan is effective?

Effective tertiary interventions produce measurable changes in behavior and improvements in a student’s quality of life (e.g., participation in integrated activities, improved social relationships, independence and self-sufficiency). Individual BIPs include objective methods for evaluating these outcomes, and determining adjustments that might be warranted when progress does not occur within a reasonable time frame.