The distance support model was introduced the week immediately following school closure in the county. We are currently serving 24 students who were previously receiving support via an NPA in a public school placement. Each student served by the NPA’s distance support model has a current IEP and an attached behavior intervention plan that addresses one or more behavioral excesses. Students’ IEPs prescribed services including, but not limited to, behavior intervention implementation (BII) and BCBA-level supervision. Students’ IEPs mandated BII support for the duration of their school day, as well as BCBA supervision ranging from 90 to 360 min per week. Students are eligible for special education services under a variety of different educational categories, including autism, intellectual disability, emotional disturbance, and other health impairments. Students range in grade from 1st to 10th and in age from 6 to 16 years. A majority of the students are placed in a general education setting and receive 80% or more of their services in that setting. The remaining students are placed in special day classrooms.
During the initial week of the distance support model, interventionists worked from one clinical location. The model was introduced at a single clinical site (i.e., as opposed to clinicians’ private homes) to support rapid problem resolution by BCBAs particularly with respect to administrative and technology-related items on the end of the student’s caregiver or the interventionist. To maintain safety at the clinical site, an extensive list of safety precautions was put in place, including solitary entry across multiple building entrances, social distancing, repeated and deep sanitization of the site during and following sessions, and storage of shoes and personal items prior to entry into the building. Interventionists worked from independent distance support stations located 10–20 ft from one another, and problem resolution by BCBAs was primarily conducted via videoconferencing and on-site observations and equipment checks. Following 5 days of site-based distance support and the passing of a procedural check related to access to secure workstations, interventionists were transitioned to providing the distance support sessions from their homes. Since this time, additional interventionists have been trained to support students in the distance support model, and this training has been conducted successfully using digital platforms and has not required working from a uniform location.
Each interventionist’s workstation was equipped with a device that included an electronic data-tracking application (e.g., Catalyst), as well as applications for virtual meeting platforms and Google Classroom. Students accessed distance support sessions using a Chromebook, many of which were provided by their district, and/or a handheld device such as an iPad or Kindle. Interventionists and students had secure Wi-Fi connections.
During the initial week of school closure, students were not provided with educational services at the discretion of the school districts. According to the California Department of Education, if a district closes its schools, in this case, to slow or stop the spread of COVID-19, and does not provide any educational services to the general student population, it is not required to provide services to students with disabilities during that same period of time. During this first week, the NPA examined students’ IEPs to determine the means by which IEP goals could be addressed via BII and BCBA services to the “fullest extent possible.” This analysis was used to create the general framework underlying the distance support model. This week was also utilized to meet repeatedly with special education administrators to discuss the proposed model, advocate for the implementation of services, and plan for the initiation of service.
Following approval by school district administrators, BCBAs employed by both the school district and NPA contacted the parent(s) of each student assigned to their caseload and conducted an open-ended interview that included questions related to the student’s response to academic work presented by the parent and the behavioral challenges the student presented during these times (for students already assigned). Parents were also asked about what educational and/or behavioral supports they felt would be beneficial during the school closure. Interview data were summarized and shared with the Special Education Local Planning Area Director and Special Education Directors in an attempt to secure support for the distance support model.
A follow-up meeting was conducted with most parents via phone or Zoom, during which the BCBA conducted an open-ended functional assessment interview (Hanley, Jin, Vanselow, & Hanratty, 2014) related to the undesirable behaviors the parent reported to observe, particularly during academic work periods. Parents were provided with an electronic survey related to their ability to access technology, including access to equipment and the Internet; their ability and preferences related to virtual platforms for meetings and sessions; and the space available for the student to complete work and participate in distance learning sessions. Following the initiation of support sessions, parents and students were surveyed to learn more about how they were doing in the context of school closures and their specific needs and requests (see Appendices A and B). Data obtained through these methods were utilized to further build out the model for distance support.
BCBA program preparation
The BCBA supervising the student’s services examined the student’s IEP goals with a focus on those goals for which the BCBA served as the responsible party. These goals tended to focus on behavior reduction and the acquisition of positive replacement skills, including, but not limited to, appropriate mands for assistance, breaks, and attention; following multiple-step instructions; turn taking; waiting; reciprocal communication; attending to a speaker; task initiation; social problem solving; goal setting; and planning. The majority of students were placed in general education classrooms, and, therefore, opportunities to work on positive replacement skills most often occurred in the context of naturally occurring opportunities throughout the school day. The conditions of the distance model afforded the opportunity to target these skills in a more contrived preparation, allowing for repeated presentations within a single session. BCBAs conducted a brief assessment of the student’s prerequisite skills required for distance support (see Appendix C). BCBAs completed needed programming for how these skills would be addressed in an individualized distance support session, and targets and measurement parameters were programmed into the student’s digital tracking application. The BCBA made modifications to reinforcement, prompting, and behavior intervention protocols to allow for implementation under the conditions of the distance support model and customized distance intervention sessions to meet the needs of the individual student.
BI training in distance support intervention strategies
Student–interventionist pairings were made such that almost all students designated to receive services through the distance support model had been previously supported by their assigned interventionist in their educational placement. This ensured that rapport and instructional control had already been established. Given that the distance model involved conditions that varied greatly from the previous conditions, interventionists were provided with supplementary training in rapport building, prompting, and reinforcement under the conditions associated with the distance model. Interventionists received training and supervision via the BCBA during distance support sessions at a minimum of once weekly. Overlap support was provided by the BCBA, who joined the virtual session. Immediate feedback to the interventionist was provided using the chat function during the session, and delayed feedback was provided via a performance checklist specific to distance support sessions. Additionally, interventionists participated in weekly training via a virtual meeting platform. It was determined that ongoing training and support at a high rate were essential during the initial weeks of the model to allow for rapid problem resolution and adjustments in procedures given the novelty of the model and the continuously evolving conditions under which it was introduced.
Distance support intervention sessions
A general session structure for distance support sessions was developed and further individualized as needed. Sessions were designed to be up to 3 hr in duration, 5 days weekly. Session durations and frequencies were then individualized to meet students’ service needs. Ongoing analysis of student data was conducted to determine if adjustments in service levels should be made. The general session structure involved the following: (a) a brief period of rapport building; (b) a 30-s positive statement timing (Calkin and Pennypacker, 2003) during which the student was asked to state positive things about him- or herself, the work he or she did, and/or things that made the student feel happy, joyful, or more confident, followed by the student conducting a positive statement timing for the BI; (c) structured teaching targeting one to two positive replacement skills; (d) a check-in concerning academic work in progress or academic support needs; (e) support toward the completion of required academic work; and (f) a more natural condition under which to target behavior reduction and replacement skill goals (see Appendix D).
The session structure was further differentiated at the level of the student. For some students, and particularly those at the secondary-education level, academic work was completed during a significant portion of the session with the BI’s support. For other students, a greater portion of the session consisted of structured teaching on replacement skills. Interventionists were given access to the student’s Google Classrooms and other instructional platforms utilized by the student’s teacher to assist with task completion and submission. At times, interventionists provided support to students during virtual sessions with other service providers, including speech therapists, occupational therapists, and/or resource specialists. During these sessions, the interventionist facilitated student participation via the implementation of behavior and reinforcement protocols. For example, interventionists might prompt the student to attend, respond to questions, or emit target replacement behaviors and might provide reinforcement via a token economy or with subtle social reinforcers including a smile, thumbs-up, or comments through the chat feature. For some students, peer and/or small-group sessions were introduced to target social or peer-related goals, as well as to allow for opportunities for skill development and generalization under conditions more closely matched to those on school campuses (Appendix E).
BCBA supervision and parental support
In addition to providing training and conducting overlaps with the interventionists to ensure treatment integrity with respect to individual student protocols and programming, the BCBA overseeing each student’s distance support intervention was responsible for acquisition programming related to IEP goals managed by the BCBA, as well as data-based modifications related to the student’s behavior intervention and reinforcement protocols. The BCBA also guided and oversaw communication between the parent and interventionist, as well as the interventionist and the student’s teacher, case manager, and/or special service providers, related to academic assignments and tasks provided to the student. This is not dissimilar to the role the BCBA maintained prior to school closure; however, the variance in the two models of service delivery did require that the BCBA modify protocols to accommodate for delivery under the conditions of the distance model. The BCBA must also assess the antecedent and consequential events associated with challenging behaviors reported by the parent and/or observed during distance support sessions and make changes to the behavior intervention plan as needed given potentially different maintaining contingencies (i.e., functions) across school and home settings.
Results from parent interviews and surveys were utilized to develop brief, video-based modules related to reported concerns and specific support requests. Video content was developed and delivered by BCBAs, and included developing a student workstation, creating a routine and schedule for instructional activities, prompting hierarchies, building and sustaining rapport, positive reinforcement for desirable behaviors, shaping requests for breaks and assistance, and antecedent strategies to address undesirable behaviors. These videos were very brief (i.e., 5–10 min) and allowed parents to access information and strategies related to areas they had requested with the ability to do so at a time workable for them. In addition to providing parents with access to video-based modules, the student’s supervising BCBA conducted weekly parent check-ins to address student-specific needs and challenges. Parent check-in meetings focused heavily on antecedent manipulations designed to reduce undesirable behavior during distance support sessions.