Intervention - Oral Comps - Alyssa Joy

SELECTING AN INTERVENTION 

The MAP clinical decision-making framework indicates that evidence driving a decision for an intervention should be as follows:  

General Services Research: Evidence-Based Treatments & Research 

Case-Specific Historical Information: Client’s Personal Experiences; Past Treatments 

• Presenting Problems: What is the data telling you about the problem? What is the family telling you? 

• Client Characteristics (e.g., age, gender, race, etc.) 

• Priority of Concerns  

• Cultural Considerations 

• Feasibility/Acceptability/Accessibility 

Causal Mechanisms Research: Evidence About the Causes of Disorders 

Local Aggregate Evidence: Local Evidence; What Works for Kids in Certain Contexts 

HOW COULD “EVIDENCE BASED” INTERVENTIONS OR ASSESSMENTS EXACERBATE SOCIAL INJUSTICE IN THE PSYCHOLOGICAL SERVICE SYSTEMS? 

The scientific evidence is mostly normed on white populations, so it affects the impact of the help we are providing to minoritized groups… 

• Even if a sample is nationally representative, the underrepresented groups, the average effect size will not tell you how it’s benefitted 

• For whom is the evidence based on??? 

• We have no clue if an intervention is helpful or harmful for other populations… 

Evidence-based interventions may be seen as a “claim of superiority” 

Devalues indigenous helping community practices… 

 

Cultural attunements

additions or modifications that are intended to boost engagement and retention of subcultural group members. They involve changes to increase reach and engagement, but they do not modify core treatment components. SURFACE LEVEL! (i.e., when you tune an instrument, you are not changing the instrument, you are only making tweaks!) 

• Employing bilingual and bicultural materials and staff 

• Translating materials 

• Incorporating culturally familiar formats & activities  

• Delivering the intervention in group settings 

• Siting the intervention in safe locations familiar to participants 

• Providing hands-on or fun activities 

• Including role models of the same race or ethnicity 

SURFACE-LEVEL!!!! 

• Tune an instrument; not changing an instrument, only making tweaks 

cultural adaptations

• Modifies the core components of the intervention to reflect cultural differences that can be targeted or tailored. CORE COMPONENTS!  

• Incorporating cultural values in intervention design or implementation 

• Involving the family or support groups in interventions 

• Adjusting the materials to the literacy level of participants 

• 5 Step Model

5 step model for cultural adaptations

Gathering Information: Acceptability; Feasibility; Literature Review

Preliminary design: Pilot Study

Preliminary testing: Evaluating Difficulties for Staff & Participants

Refinement: Editing based on preliminary testing

Final Trial: Full Trial to Test Efficacy

Gathering Information - 5 Step Model - Cultural Adaptation

Acceptability; Feasibility; Literature Review 

• In the initial effectiveness/efficacy trail of the intervention, what was the cultural make-up of the population?  

When do conditions justify a cultural adaptation?  

• Differences in acceptability/feasibility between cultures?  

• Differences in outcomes between cultures?  

• Do core components target culturally defined mechanisms of change?  

What treatment elements should be modified when cultural adaptation is justified?  

Search the literature for evidence of group differences to determine whether previous applications of an evidence-based intervention show deficient engagement & whether there are sizable mismatches between the features of the original efficacy research  

preliminary design - 5 step model - cultural adaptation

Pilot Study  

• Train staff for preliminary version of adaptation  

• Use case studies or pilot studies for first version testing  

preliminary testing - 5 step model - cultural adaptation

Evaluating Difficulties for Staff & Participants 

• Implementation difficulties 

• Difficulties with content or activities 

• Satisfaction with treatment…including cultural features 

• Suggestions for improvement  

refinement - 5 step model - cultural adaptation

Editing Based on Preliminary Testing 

• Integrate feedback to revise the intervention 

• Check exclusion of initial components/mechanisms with cultural modifications  

final trial - 5 step model - cultural adaptation

Full Trial to Test Efficacy of revised intervention to determine if it leads to desired effect 

how can cultural adaptations be targeted?

This is a deductive approach, which includes prior modifications based on expectations for cultural groups. 

Makes assumptions & changes before implementing the intervention in anticipation of needs & preferences  

Assumes homogeneity of individuals within the culture; one single adapted intervention will be adequate to serve members of this group

E.g., You might change the program curriculum for a particular demographic group to include culturally relevant examples. This allows for customization for groups but does not include within-group variances.

E.g., If you know the new population you are implementing a mentoring program with will be primarily Latin youth, then you may make assumptions and changes before implementing the intervention in anticipation of their needs and preferences…such as hiring translators to translate materials, removing certain modules that appear to not fit Latin culture, etc. 

how can cultural adaptations be tailored?

• This is an inductive approach, which creates a structure for anticipating and responding to individual differences within expected cultures  

• Occurs in response to particular events/information from consultees (e.g., incorporating spirituality into the intervention after learning that this is a value of the family) 

• E.g., Modifying treatment materials for one individual in your intervention group based on information collected during an intake interview…such as integrating themes of spirituality if they note this as a main value 

• E.g., Based on a person’s age, prior mammogram status, or inclination to religion, you may provide someone with a particular pamphlet. This is what social media advertisements do. There is opportunity for individualization; however, it may be considered manipulative… 

• Use an empowerment evaluation to allow the emic culture to steer the ship! 

WHAT WOULD YOU SAY TO PEOPLE WHO ARE SKEPTICAL OF ADAPTING THE INTERVENTION? Be able to address straw-man arguments against the adaptation of evidence-based programs (e.g., it could compromise the fidelity) 

• People who think that adaptations are harmful are assuming that they are made thoughtlessly and carelessly. However, those who are adapting interventions are often experts in the populations they are working with. They do not make adaptations carelessly… 

• Some may be concerned that intervention may be less potent or watered down on core components which would cause less change…HOWEVER, while some might think that making cultural adaptations negatively impacts implementation fidelity, existing research indicates that interventions are more effective when they are adapted 

• Number of adaptations and effect size have a linear relationship! 

• The vast majority of adaptations are to periphery materials which are not central to the intervention. Of those changes which are made to core components, the majority are additions, not subtractions from material.  

• ALSO, it might also be unethical to implement an intervention that you know is inconsistent with a client’s cultural beliefs/values & adaptations make interventions more accessible  

WHAT INDICATORS DO WE EVALUATE TO DETERMINE IF A MODIFICATION/ADAPTATION WAS SUCCESSFUL OR UNSUCCESSFUL? WHY DO WE MODIFY INTERVENTIONS TO ACCOMMODATE CULTURES? 

• Intervention Accessibility  

• Intervention Acceptability 

• Intervention Dosage 

• Intervention Effectiveness 

CONCERNS SURROUNDING UNNECESSARY OR POTENTIALLY HARMFUL TREATMENT ADAPTATIONS 

Some adaptations are low risk, high reward. Whereas other adaptation are high risk with unknown rewards… 

While existing research indicates that adaptations increase effect sizes, we have limited studies.

Due to a lack of replication, there is some concern that adaptation panacea has grown and will compromise services for underrepresented population 

EFFICACY VS. EFFECTIVENESS 

Efficacy: Can an intervention work under ideal circumstances?  

• Ideal being defined as the conditions that one can generalize results from a controlled evaluation  

• Does not mean optimal… 

Effectiveness: Does an intervention work in regular clinical practice and/or routine implementation?  

INSTRUCTIONAL HIERARCHY (ACADEMIC INTERVENTIONS) 

Why is a student having difficulty with reading comprehension?  

Acquisition/Accuracy: the student is able to complete the skill accurately, but is not yet fluent  

• Is the student reading the words accurately? Do they know the correct meaning of the words?  

Fluency: the student is able to complete the skill quickly & accurately 

• Is the student reading the words quickly & accurately?  

Generalization: the student is able to complete the skill quickly & accurately, and is able to use the skill across different settings & situations  

• Is the student able to read the words embedded in passages?  

Adaptation: the student is able to modify and adapt the skill to fit new situations & settings  

• Is the student able to read novel words in new situations & figure out the meaning of the words? 

MASTERY LEARNING VS. CURRENT EDUCATIONAL SYSTEM 

Mastery learning is learning that ensures that each student masters each part of the curriculum before progressing and moving on to the next one by providing formative feedback.  

Our current educational system does not employ mastery learning, and quickly progresses through content even if students did not master prerequisite knowledge.  

• This approach sets students up to fail as their foundation of knowledge is not stable before trying to build up higher levels of knowledge.  

• Higher levels of knowledge will collapse or may not even be able to be built… 

DALY’S HYPOTHESES FOR ACADEMIC DEFICITS & CORRESPONDING INTERVENTIONS 

• they do not want to do it

• they have not spent enough time doing it

• they have not had enough help to do it

• they have not had to do it in that way before

• it is too hard

daly’s hypothesis: they do not want to do it (student lacks motivation)

Increase interest in curricular activities… 

• Provide incentives for using the skill 

• Teach the skill in the context of using the skill  

• Provide choices of activities  

Daly’s hypothesis: they have not spent enough time doing it (insufficient active student responding

Increase active student responding… 

• Estimate the current rate of active responding & increase the rate during allocated time 

daly’s hypothesis: they have not had enough help to do it

insufficient prompting & feedback for active responding; poor accuracy; poor fluency; lack of generalization to natural settings and/or to other materials/settings

how to target insufficient prompting & feedback (daly’s hypothesis)?

• Implement response cards 

• Encourage choral responding  

• Provide flash cards with praise & error correction  

how to target poor accuracy in target skills (daly’s hypothesis)?

Increase modeling & error correction 

• Read passages to the student 

• Use cover-copy-compare 

• Have student repeatedly practice correct response in context of errors 

how to target poor fluency in target skills (daly’s hypothesis)?

Increase practice, drills, & incentives 

• Have the student repeatedly read the passages 

• Offer incentives for beating the student’s last score 

how to target lack of generalization (daly’s hypothesis)?

• Teach multiple examples of use of the skill  

• Teach use of the skill in the natural setting  

• Capture natural incentives 

• Teach self-monitoring  

daly’s hypothesis: they have not had to do it in that way before

instructional demands do not promote mastery of the curricular objective

Change instructional materials to match the curricular objective… 

daly’s hypothesis: it is too hard

• (student’s skill level is poorly matched to the difficulty of the instructional materials)  

• Increase student responding using better matched instructional materials to the level of understanding the student is at… 

CRITIQUES 

Does not explain why a child is poorly matched with the difficulty of the materials… 

• Maybe there is a cognitive component for why the material is too hard?  

Daly’s recommendation is to lower the instructional materials to the child’s level 

• Interventions may be different based on the underlying reason for why someone is having difficulty or it is too hard for them.  

• E.g.,  a child with ADHD who is struggling to complete an assignment may have very different educational needs than a child with a LD in reading. But Daly would treat these the same way… 

 

FUNDAMENTAL SKILLS OR CONTEXTUAL FACTORS THAT MAY HELP PARENTS SUPPORT ACADEMIC INTERVENTION SERVICES 

Fundamental Skills  

• Make a Context Conducive for Learning 

• Remove Distractions; Increase Proximity 

• Maintain Eye Contact  

• Remain Quiet & Calm  

• Give One Instruction at a Time  

• Requests! Not Don’ts!  

• Prompt in a Calm & Direct Manner 

• Keep Things Positive  

Contextual Factors  

• Access to School-Based Services  

VALUE & IMPORTANCE OF NONBEHAVIORAL CONSTRUCTS (ACADEMIC INTERVENTIONS) 

important to academic instruction and acquisition of academic skills

Self-Efficacy: A student’s belief about their capacity to perform mathematics is one of the most important things about mathematics development.  

Self-Fulfilling Prophecy: Teacher perceptions of a child’s abilities directly shapes student performance  

Motivation: Even behaviorists (e.g., Daley) recognize that motivation is important (e.g., “they don’t want to do it”)  

Academic Mindsets, Attitudes, & Beliefs: Interventions that target academic mindsets, attitudes, and beliefs can lead to improved academic outcomes through changes in student disposition toward academic work and increased academic effort. 

• Student academic mindsets drive academic perseverance and, therefore, academic behaviors, such as attending class, paying attention in class, completing homework, and studying. 

• Growth vs. Fixed-Ability Mindsets  

• Students who have a growth mindset have more reason to believe that their performance can improve with effort.  

• In contrast, students who hold a fixed-ability mindset are more likely to engage in performance avoidance.  

EFFECTIVE CLASSROOM MANAGEMENT STRATEGIES 

Be organized! 

• Crowded & cluttered classrooms create environments of disorder & disruption 

Minimize distance from all students  

• The closer a student is to the teacher, the easier it is for the teacher to manage behavior 

Set expectations as globally stated rules of conduct 

Set rules as behavioral definitions that define the expectations 

Provide consistent behavioral routines 

• Predictable  

• Structured 

• Well-defined 

Implement pre-corrections 

• Statements that prompt the correct response before an opportunity  

Engage in active supervision  

• Proximity + Performance Feedback  

• You need to be close to a child & when they behave, provide feedback  

Provide noncontingent interactions 

Provide OtR (opportunities to respond)

Provide contingent behavior specific praise 

Provide group contingencies & token economies 

Implement behavior contracts 

Respond to inappropriate behavior  

• Planned ignoring  

• Explicit reprimands 

• Differential reinforcement  

• Response cost & time out 

Classroom check-up (consultation) Steps

Assess Classroom (Problem Identification) 

Provide Feedback (Problem Analysis) 

Develop Menu of Options (Problem Analysis) 

Choose Interventions (Plan Implementation) 

Action Planning & Encourage Teacher Self-Monitoring (Plan Implementation) 

Provide Ongoing Monitoring (Plan Evaluation) 

What goes into assessing the classroom (problem identification) in consultation classroom checkup?

• Teacher Interview  

• Classroom Ecology Checklist  

• 10 & 5-Minute Observation Forms 

• Overall Classroom Rating Form  

What goes into providing feedback (problem analysis) for classroom check-up (consultation)?

Summarize Objective Data from Observations  

• Mean Rate of OtR 

• Mean % of Student Accuracy 

• Mean Rate of Classroom Disruptions 

• Mean Rate of Praise 

• Mean Rate of Reprimands 

• Ratio of Positive-to-Negative Interactions 

• Number of Behavior-Specific Praise Statements to General Praise 

• Number of Explicit Reprimands vs. Critical Harshness 

Conceptualize the Problem 

• What is the most necessary need?  

• What resources are minimally sufficient to produce an impact on this need?  

Provide Objective Feedback  

• Classroom Check-Up Feedback Form  

• Present Strengths & Areas of Concern  

• Provide specific data!  

Elicit Change Talk

What goes into action planning for classroom checkup consultation?

Develop SMART GOALS  

• Specific  

• Measurable 

• Attainable 

• Realistic 

• Timely 

What improves fidelity to recommendations for classroom checkup consultation?

• Monitoring 

• Antecedent and consequence strategies 

• Consequence strategies work best, feedback that is consistent from the behavior 

• Feedback and monitoring 

What factors would you consider when choosing an intervention? (classroom checkup consultation)

• Feasibility/acceptability/accessibility 

• Presenting problem 

• Priority of concerns 

• Client characteristics 

• Cultural considerations 

Evidence based assessment or intervention for a young child vs. teenager? 

• Consider the client’s current levels 

• Need for visuals/activities vs. conversation/learning 

• Ability to access the information 

*How would you tell a parent they are the target of an intervention vs. the child? 

• Summarize and reflect what the parent is currently experiencing 

• Creating the environment for the child  

• Based on where your child is right now - xyz 

Interventions for populations of differing cultural backgrounds

Open and receptive during interview to understand the populations background and values

Research the cultural background to gain a better understanding and learn about already adapted interventions

Seek consultations from an experienced clinician in this background or cultural adaptation to understand the appropriate interventions and risk/benefits of the changes

Speaking a second language

Test selection: is there a disability or is there an inability to access appropriate instruction?

Be aware of the schools/district's resources and access to appropriate instruction

Test sensitivity

Be able to address straw-man arguments against the adaptation of evidence-based programs (e.g. it could compromise the fidelity).

straw-man argument: someone misrepresents or oversimplifies a position to make it easier

Example: If you adapt an evidence-based program, you're no longer doing the actual program. It won’t work if you change anything

Adaptation doesn’t mean throwing out the evidence, it means adjusting the delivery to better fit the students, context, or culture while maintaining the program’s core components

Researchers are often experts in the population they are adapting, and adaptations actually increases effect sizes because of increased effectiveness of the intervention for the population

Be able to describe legitimate concerns surrounding unnecessary or potentially harmful treatment adaptations.

Some adaptations are low risk, high reward. Whereas other adaptation are high risk with unknown rewards.

Due to a lack of replication and limited studies, there is some concern that “adaptation panacea” has grown and will compromise services for underrepresented population

Be able to describe how racism has impacted access to psychological services and have specific examples of systems that perpetuate inequalities in health and education. 

Major areas: assessment, testing, interventions, higher ed being a white institution, health care and medical services also being white institutions, and the inequalities for discipline for Black & Latinx boys. review below and see individual flashcards.

Scientific research and evidence in primarily normed with majority white populations that can impact how we can support minoritized groups

Testing, evaluations, interventions have all been studied with primarily white samples – so from who the evidence is based has been influenced by racism

Even if a sample is nationally representative, the underrepresented groups, the average effect size will not tell you how it’s benefitted

Evidence-based interventions may be seen as a “claim of superiority” and devalues indigenous helping community practice or practices out of the norm that are beneficial to minoritized groups

The field is trying to diversify and as a result likely underserved minority populations as well as a lack of representation of diverse therapists, perpetuated by things like higher ed being a white institution

Leads to a cycle of minoritized groups less likely to receive services, therefore less likely to have diverse therapists and vice versa (something we can do on our end)

Health care and medical services also experiencing the same thing – also the cost of health care in the united states can contribute to this, with low income communities with less access

systemic inequities through funding disparities, biased disciplinary practices, and curricular omissions that marginalize non-dominant perspectives, reinforcing cycles of academic disengagement and opportunity gaps.

Minority students, particularly Black & Latinx boys, are much more likely to be disciplined for minor behavioral infractions, often resulting in suspension or expulsion from school.

Schools are much more likely to escalate disciplinary issues to the juvenile justice system for these students, as well…putting them in contact with the criminal justice system at an early age

Black students are suspected 3x more than White students

how have testing, evaluations, and intervention been affected by racism?

Scientific research and evidence in primarily normed with majority white populations that can impact how we can support minoritized groups

Even if a sample is nationally representative, the underrepresented groups, the average effect size will not tell you how it’s benefitted

Evidence-based interventions may be seen as a “claim of superiority” and devalues indigenous helping community practice or practices out of the norm that are beneficial to minoritized groups

how are systems and organizations impacted by racism?

The field is trying to diversify and as a result likely underserved minority populations as well as a lack of representation of diverse therapists, perpetuated by things like higher ed being a white institution

Leads to a cycle of minoritized groups less likely to receive services, therefore less likely to have diverse therapists and vice versa (something we can do on our end)

Health care and medical services also experiencing the same thing – also the cost of health care in the united states can contribute to this, with low income communities with less access

systemic inequities through funding disparities, biased disciplinary practices, and curricular omissions that marginalize non-dominant perspectives, reinforcing cycles of academic disengagement and opportunity gaps.

how are school discipline systems impacted by racism?

Minority students, particularly Black & Latinx boys, are much more likely to be disciplined for minor behavioral infractions, often resulting in suspension or expulsion from school.

Schools are much more likely to escalate disciplinary issues to the juvenile justice system for these students, as well…putting them in contact with the criminal justice system at an early age

Black students are suspected 3x more than White students

How does systemic racism influence the socialization of young people?

Systemic racism shapes the environment, expectations, and opportunities of young people

Socialization: how young people understand themselves and others, often reinforcing stereotypes and limiting cross-cultural understanding

Example: students of color often seeing portrayals of people who look like them in textbooks, movies, or the news

Example: stereotype that black males are perceived as violent and more threatening, thus authority figures treating them more harshly

How does systemic racism influence the learning of young people?

Learning: impacts quality of education, resources, and amount of support for youth that impacts their academic achievement

Example: More funding for schools in predominantly white or affluent communities

Systemic inequities through funding disparities, biased disciplinary practices, and curricular omissions that marginalize non-dominant perspectives, reinforcing cycles of academic disengagement and opportunity gaps.

school-to-prison pipeline - racially minoritized students face disproportionate punitive measures, fostering alienation and increased risk for long-term socioeconomic disadvantage.

How does systemic racism impact the mental health of young people?

chronic exposure to racism can lead to trauma, stress, and feelings of isolation

Example: microaggressions or witnessing of racisms can lead to depression and anxiety

Example: increased youth mental health concerns when there are leess culturally competent mental health providers available

What are structural barriers that young people face as a result of racism?

Structural barriers: stigma, lack of cultural competencee, SES contraints that often preclude access to services

What are overall needs for change in the field of psychology when it comes to racism?

Overall we need a multilevel approach to integrate policy reform, culturally responsive education, and accessible services (mental health) to mitigate disparities and promote resilience

Fidelity

Define: faithful and consistent implementation of a process, program, or intervention exactly as it was designed or intended

What improves fidelity?

• Monitoring

• Antecedents and Consequences strategies

  • Consequences strategies work best because it is feedback that is consistent with the behavior

• Feedback

How might your approach to intervention with disruptive behavior change from early childhood to later adolescence?

Difference that my impact what intervention is used on children vs late adolescence

• Developmental stage

• Social context – role of others

• Autonomy – choice ability

• Communication – language/conversation modem or style

Early childhood

• More structure: consistencies and routines

• Skill building: learning self-regulation

• Adult guided: rely heavily on modeling and observation

• Immediate feedback: rewards are closely tied to desired behavior

Late adolescence

• Relationship building focus on repairing relationships and restorative practices

• Collaborative problem solving: they want autonomy and independence

• Goal setting: own values to guide solutions and change

Intervention Logic

Prevent: (Antecedent) change what comes before the behavior

Teach: (Behavior) focus on behavioral skills training

Reinforce: (Consequence) reinforce expected behavior & ignore problem behavior

Be able to identify a biological basis of behavior and explain its relevance to therapy, trauma, behavior management, etc. Take a look at Siegel’s hand model.

Biological basis of behavior: thoughts, emotions, and behaviors are deeply rooted in the structure and function of the nervous system, as well as in genetic and biochemical processes; biological substrates contribute to cognition and behavior but also reinforces the necessity of a biopsychosocial model. know the limbic system. see individual flash cards.

how does the limbic system relate to behavior?

involved in emotion regulation, memory processing, and threat detection

Amygdala: fight or flight

Hippocampus: memory formation

Prefrontal Cortex: executive functioning

When the system is under stress or dysregulation, the amygdala often becomes hyperactive, leading to heightened fear responses, while the prefrontal cortex may be underactive, making it harder to regulate emotions or behavior

How is the biological basis of behavior relevant to therapy?

Trauma informed therapy: works to calm the overactive amygdala and reintegrate traumatic memories

CBT: strengthens the prefrontal cortex’s ability to regulate negative thoughts and behaviors

How does the biological basis of behavior relate to trauma

impacts brain development, leading to difficulties with memory, emotional regulation, and attention

tailor interventions to support healing

How does the biological basis of behavior relate to behavior management.

challenging behaviors are often neurologically driven

Behavior support plans rooted in neuroscience and interventions that support their nervous system

Why do students underachieve?

Daly’s hypothesis:

they don’t want to achieve

they haven’t spent enough time practicing

they have not had to do it in a particular way

it is too hard

other reasons (teacher skills, classroom routine/ambiance/distractions, internal conditions/mental health concerns)