case study 1 tommy

Case Study 1 – Tommy (Elementary/Middle School)

Case Study 1 – Tommy (Elementary/Middle School)

Background Information Tommy is an 10 year-old boy who enjoys baseball, swimming, and baking. He does not like art activities or large crowds. Tommy has a good sense of humor but he can be irritable. He is fearful around new people and may become quiet and more reserved in those situations. His parents and teachers talk him through exposure to new people. Tommy is highly verbal and speaks in sentences. Tommy is above grade level in reading. He enjoys reading, and his favorite book is the Percy Jackson Lightning Thief. According to Tommy, he dislikes writing. Most of his writing is simple sentences with a great deal of grammatical errors and little detail. He also struggles with math, in which he is approximately 2 grade levels below. He has recently learned how to pitch left handed. Tommy has a medical diagnosis of childhood-onset bipolar disorder and an educational classification of severe emotional and behavioral disorder. He takes medication for bipolar disorder on a daily basis. He is currently on a new medication. Tommy has a new baby brother who is 5 months old.

Target Behavior Tommy has been increasingly disruptive the past few months. He has verbal outbursts and pushes classroom materials onto the floor after being given an academic task during quiet work time. His verbal outbursts include yelling that he is not doing the assignment, telling a student to shut up, using profanity, and calling student’s names. His teachers do feel that they spend about an hour per day dealing with the behavior, and they usually respond to Tommy’s behavior by scolding him or by initiating an office referral.

School Classroom Environment Tommy attends a regular K-5 public elementary school. Tommy is new to the school. Tommy is in the 5th grade. There are 19 students in his homeroom classroom. Tommy has 2 segments in a resource SPED class with 5 other students. Tommy also has 1 co-teaching segment for math. His teacher is very organized and structured. She is loving and understanding with regards to Tommy’s needs.

Previous Interventions Tommy has attended your school for two months now. Initially, he seemed to acclimate to the the new school well. However, things have gotten more difficult for him lately. Tommy’s teacher set up some rewards for him to earn if he does not engage in the disruptive behavior. His behavior has not improved and it has been difficult for his team to identify “why” he is engaging in the behavior. There is not consensus among his team that the rewards are the appropriate intervention for his disruptive behavior. His team agreed that they should conduct an FBA and develop a BIP.

TARGET BEHAVIOR Student:

Target Behavior One:

Describe what the student is physically doing that is interfering with his or her learning or the learning of others? Be Specific.

Give an example of the target behavior and desired behavior.

Is the target behavior measurable? How would you measure the behavior?

Use the information above to define Target Behavior One. Be concise and specific so anyone could recognize the target behavior when observing the student.

Target Behavior Two:

Use the information above to define Target Behavior Two. Be concise and specific so anyone could recognize the target behavior when observing the student.

Target Behavior Three:

Use the information above to define Target Behavior Three. Be concise and specific so anyone could recognize the target behavior when observing the student.

Tommy TARGET BEHAVIOR Student:

Verbal Outbursts: Tommy has negative verbal outbursts towards adults and peers which include yelling, name calling, and profanity.

Give an example of the target behavior and desired behavior. Verbal outbursts: Tommy yells at the teacher that he will complete the given assignment or shut up to peers, calls students names such as stupid, and uses profanity towards others. Desired behavior: Tommy speaking and participating in class in a positive manner‐ using a quiet voice, positive, appropriate words.

Is the target behavior measurable? How would you measure the behavior? The number of verbal outbursts.

Tommy engages in the behavior of negative verbal outbursts. These negative verbal outbursts include yelling at peers and adults, name calling, and using profanity. This does not include talking during class time in a positive manner (even when talking when he is not supposed to).

Physical class disruption: Tommy engages is physically disruptive behaviors. He pushes papers onto the floor and throws classroom materials. Give an example of the target behavior and desired behavior. Physical class disruption: Throwing classroom materials across the room. Pushing books and papers onto the floor. Desired behavior‐ In the classroom utilizing the classroom materials in an appropriate manner‐ using them for the intended use.

Is the target behavior measurable? How would you measure the behavior? The number of times he throws, pushes off the desk, or interacts with classroom materials in a destructive manner.

Physical class disruption‐ Tommy engages in physically disruptive behaviors. This looks like throwing classroom materials across the room and pushing books and papers onto the floor. This does not include moving his materials around in an angry manner, but any action which causes the materials to no longer be in his presence or makes the materials unusable.

Case Study 1: Activity 2

ABC Behavior Checklist Activity

Record the following information on the ABC Behavior Checklist.

Context or Activities: Student Reaction: A. Group – small Stopped B. Individual Time Continued C. Reading Intensified D. Math E. Spelling F. Lunch G. Social Studies H. Recess I. Science J. Writing

Antecedents: A. Transition B. Denied Access C. Instruction/Directive D. New Task E. Teacher Attention to Other F. Told NO G. Choice Given H. Redirection I. Routine Task

Consequence/Outcome: A. Choice Given B. Redirection C. Discussion of Behavior D. Personal Space Given E. Changed Activity F. Peer Attention G. Verbal Reprimand H. Physical Prompt I. Time Out J. Removal from Class

ABC Behavior Checklist Student: Date: Time start: Time End: Context or Activity Antecedent Event Consequence / Outcome Student Reaction What is the student doing? What happened IMMEDIATELY Identified Target Behaviors What happens IMMEDIATELY What was the student’s Fill in the students before the target behavior occurs? after the behavior occurs? response to the consequence? schedule. □ A. □ A. □ A. Transition □ A. □ A. Definition: □ B. □ B. Denied Access □ B. □ B. □ C. □ C. Instructive/directive □ C. □ C. □ B. □ D. □ D. New Task Definition: □ D. □ E. □ E. Teacher attention to other □ E. □ F. □ F. Told no □ F.

□ G. □ G. Physical Prompt □ G.

□ H. □ H. Setting Events: What type of □ H. class/situation- SPED/REG. Number of students, etc. □ I. □ I. □ I.

□ J. □ J. □ J.

IMPORTANT**CHECK ONLY ONE BOX IN EACH IMPORTANT**CHECK ONLY ONE BOX IN EACH COLUMN** COLUMN** ABC Behavior Checklist Student: Date: Time start: Time End: Context or Activity Antecedent Event Consequence / Outcome Student Reaction What is the student doing? What happened IMMEDIATELY Identified Target Behaviors What happens IMMEDIATELY What was the student’s Fill in the students before the target behavior occurs? after the behavior occurs? response to the consequence? schedule. □ A. □ A. □ A. Transition □ A. □ A. Definition: □ B. □ B. Denied Access □ B. □ B. □ C. □ C. Instructive/directive □ C. □ C. □ B. □ D. □ D. New Task Definition: □ D. □ E. □ E. Teacher attention to other □ E. □ F. □ F. Told no □ F.

Adapted from ABC Data Sheets at www.behaviordoctor.org

ABC Behavior Checklist- Case Study 1_Activity 2 Answer Key Student: Tommy Date: Time start: Time End: Context or Activity Antecedent Event Consequence / Outcome Student Reaction What is the student doing? What happened IMMEDIATELY Identified Target Behaviors What happens IMMEDIATELY What was the student’s Fill in the students before the target behavior occurs? after the behavior occurs? response to the consequence? schedule. □ A. Verbal Aggression Definition: Tommy engages in the behavior of negative verbal outbursts. These negative verbal outbursts include yelling at peers and adults, name □ A. Group-Small □ A. Transition □ A. Choice given □ A. Stopped calling, and using profanity. This does not include talking during class time in a positive manner (even when talking when he is not supposed to).

□ B. Individual Time □ B. Denied Access □ B. Redirection □ B. Continued □ C. Reading □ C. Instructive/directive □ B. Physical Class Disruption □ C. Discussion of the Behavior □ C. Intensified □ D. Math □ D. New Task Definition: Tommy engages in □ D. Personal Space Given physically disruptive behaviors. This looks like throwing classroom materials across the room and pushing books and papers onto the floor. This does not include □ E. Spelling □ E. Teacher attention to other moving his materials around in an □ E. Changed Activity angry manner, but any action which causes the materials to no longer be in his presence or makes the materials unusable.

□ F. Lunch □ F. Told no □ F. Peer Attention

□ G. Social Studies □ G. Choice Given □ G. Verbal Reprimand

□ H. Recess □ H. Redirection Setting Events: What type of □ H. Physical Prompt class/situation- SPED/REG. Number of students, etc. □ I. Science □ I. Routine Task □ I. Time Out

□ J. Check-out □ J. □ J. Removal from class

Alpine (GNETS)

FUNCTIONAL BEHAVIORAL ASSESSMENT Date:

Student Name: School/Grade: DOB: Case Manager:

Data Source: FBA Parent Questionnaire IEP Psychological Student Observation /Report (if applicable) Observation Setting & Environment Checklist FBA Staff Questionnaire Student Survey Other:

Student Profile (Utilize the IEP, Psychological, Student Observation/Report, FBA Staff Questionnaire): Student Strengths:

Student Weaknesses:

Previous Interventions (Describe previous interventions):

Setting & Environmental Factors (Psychological, Student Observation/Report, FBA Staff Questionnaire, Observation Setting & Environment Checklist, FBA Parent Questionnaire, Classroom Description): Describe the current school/classroom environment:

Describe any significant external factors (Psychological, FBA Parent Questionnaire):

Antecedent (A)-Behavior (B)-Consequence(C): Analyze each target behavior (utilize FBA ABC Report, Target Behavior Form).

Target Behavior One: (B) Define the behavior: (Target Behavior Form)

(B) Frequency of Behaviors/Behaviors Per Day: When is the problem behavior most likely to occur? (times of day and days of the week)

(B) Frequency of Behaviors/Behaviors Per Day: When is the problem behavior least likely to occur? (times of day and days of the week)

(A) Context: Within what settings/activities does this behavior occur most often?

(A)Antecedent: What event/activities seem to be triggering the target behavior?

(C) Student Reaction: How are the current interventions/consequences impacting the target behavior?

(C) Consequences: What consequence is used most often with the target behavior?

Identify and describe any patterns in the data.

Function: Attention Escape/Avoidance Sensory Tangibles/Activities CONSEQUENCE

which Hypothesis typically leads to CONTEXT TRIGGERING the TARGET BEHAVIOR ANTECEDENTS student FUNCTION (What is the During when and gives/ function of the target behavior?) provides the student

Target Behavior Two: (B) Define the behavior: (Target Behavior Form)

Target Behavior Three: (B) Define the behavior: (Target Behavior Form)

School: SAMPLE Student: Grade: 5 School year: 2012 through 2013 Tommy Sample Teacher: Mrs. Smith Assessment period: Monday, March 04, 2013 Report prepared by: Mr. Jones The purpose of this assessment is to determine the function of 2 target behaviors: Verbal Aggression; Physical Class Disruption. Tommy was observed over a period of 9 school days. School was in session from 8:00 until 3:00. FREQUENCY OF BEHAVIORS Each bar in the graph below represents the number of behaviors observed in each 30 minute time segment during this assessment period. Frequency by Time of Day 2.5 Most Active Times of Day 2 % of Total # of 1.5 Activity Events 1 9:30 AM 13% 2 0.5 10:00 AM 13% 2

10:30 AM 13% 2

2:30 PM 13% 2

3:00 PM 3:00 7:00 AM 7:00 AM 8:00 AM 9:00 PM 1:00 PM 2:00 PM 4:00 PM 5:00

6:00 AM 6:00 8:00 AM 7% 1

10:00 AM 10:00 AM 11:00 PM 12:00 8:30 AM 7% 1

BEHAVIORS PER DAY Tommy was assessed a total of 9 days. Average Number of Behaviors per Day Overall # of Number of: Mondays 2 6 incidents Tuesdays 2 6 Behavior A 9 3 Behavior B Wednesdays 2 4 2 2 2 6 Thursdays 2 Behavior C 0 2 Fridays 1 Total 15 0 EVENT DURATION The assessment period covered a total of 63:0 hours:min. Behaviors were charted 2:24 hr/min. This was 4% of the assessment period.

Event Duration hr:min Behavior A 1:42 71% Verbal Aggression Verbal Aggression

Physical Class Behavior B 0:42 29% Disruption Physical Class Disruption 0 Behavior C 0:00 0% 0

0:00 0:28 0:57 1:26 1:55 2:24 2:52 OVERALL: 2:24 hr:min STUDENT REACTION (How student reacted to staff intervention/consequences) A = Stopped. B = Continued 100% C = Intensified. 75%

25% A, 33% B, 33% C, 33% A, 83% B, 17% C, 0% A, 0% B, 0% C, 0% 0% BEHAVIORS: Verbal Aggression Physical Class Disruption 0

www.behaviordoctor.org program written by Denise Wilson

Tommy Sample page 2 Monday, March 04, 2013 Context is the setting or activity that is A 7% Group Small B 7% Individual Time happening when a behavioral incident C 0% Reading occurrs. D 40% Math E 7% Spelling 10 Context Frequency F 13% Lunch G 7% Social Studies H 0% Recess 5 I 0% Science J 20% Check-out K 0% 0 L 0% A B C D E F G H I J K L Context (Setting)/Behavior Interaction : 5

0 BEHAVIORS: A: Verbal Aggression B: Physical Class Disruption C:

A 20% Transition Antecedent is the trigger, the event B 0% Denied access that started the behavioral incident. C 20% Instruction/Directive D 13% New Task E 13% Tchr attn to other 4 Antecedent Events F 7% Told NO G 7% Choice given H 7% Redirection 2 I 13% Routine task J 0% K 0% 0 L 0% A B C D E F G H I J K L Antecedent/Behavior Interaction: 5

A 0% Choice given Consequence describes what B 0% Redirection to task happened as the result of a C 13% Discussion of the behavior behavior. D 7% Personal space given E 13% Changed activity 6 Consequence Events F 0% Peer Attention 5 G 27% Verbal reprimand 4 H 0% Physical prompt 3 I 7% Time Out 2 J 33% Removal from class 1 K 0% 0 L 0% A B C D E F G H I J K L

Consequence/Behavior Interaction 10

0 behaviors: A: Verbal Aggression B: Physical Class Disruption C:

Student Reaction to Consequence - # of Times Behavior Stopped 10

0 A B C D E F G H I J K L

www.behaviordoctor.org program written by Denise Wilson Tommy TARGET BEHAVIOR Student:

Case Study 1 Activity 4 Answer Key

Student Name: Tommy School/Grade: 5th DOB: Case Manager:

Data Source: FBA Parent Questionnaire IEP Psychological Student Observation/Report (if applicable) Observation Setting & Environment Checklist FBA Staff Questionnaire Student Survey Other:

Tommy has strengths in reading. He is an above average reader, and enjoys fictional books. He also has a good sense of humor and is highly verbal, speaking in sentences. Tommy is athletic and enjoys sports.

Tommy has a weakness in math and writing. According to Tommy, writing is his least favorite subject. He is approximately 2 grade levels below in math. He exhibits some anxiety and is fearful around new people and large groups.

A reward system has been put in place for Tommy. He is able to earn rewards for engaging in appropriate behaviors.

Tommy attends a regular K-5 public elementary school. Tommy is new to the school. Tommy is in the 5th grade. There are 19 students in his homeroom classroom. Tommy has 2 segments in a resource SPED class with 5 other students. Tommy also has 1 co-teaching segment for math. His teacher is very organized and structured. She is loving and understanding with regards to Tommy’s needs.

Tommy takes medication on a daily basis. He is currently on a new medication. He also has a new baby brother, which may be impacting his sleep habits. In addition to this, he experiences a great deal of anxiety in large crowds and with new people. This may be of significance due to the fact that he is at a new school.

Target Behavior One: (B) Define the behavior: (Target Behavior Form) Tommy engages in the behavior of negative verbal outbursts. These negative verbal outbursts include yelling at peers and adults, name calling, and using profanity. This does not include talking during class time in a positive manner (even when talking when he is not supposed to). (B) Frequency of Behaviors/Behaviors Per Day: When is the problem behavior most likely to occur? (times of day and days of the week) Verbal outbursts are most likely to occur on Mondays in the morning between 9:30-10:30 AM and the afternoon at 2:30 PM. (B) Frequency of Behaviors/Behaviors Per Day: When is the problem behavior least likely to occur? (times of day and days of the week) Verbal outbursts are least likely to occur between 11:30AM-1:00PM mid-week.

(A)Context: Within what settings/activities does this behavior occur most often? Verbal outbursts happen most often in math and check-out.

(A)Antecedent: What event/activities seem to be triggering the target behavior? Transition events and routine tasks during math and check-out seem to be triggering the verbal outbursts.

(C) Student Reaction: How are the current interventions/consequences impacting the target behavior? No interventions/consequence are having a significant or consistent impact on the behavior. (C) Consequences: What consequence is used most often with the target behavior? Verbal reprimand was used most often, but did not cause the behavior to stop. Discussion of behavior was also used. Identify and describe any patterns in the data. Overall behavior issues seem to be when first gets to school, and when it is time to go home. This could be indicative of a home issue. It could also be reflective of a medication issue (medication getting into his system and wearing off). Math seems to be the major time that he is having issues, which is also a weakness for him. Function: Attention Escape/Avoidance Sensory Tangibles/Activities CONSEQUENCE

which a verbal reprimand or typically leads discussion of the behavior to Hypothesis CONTEXT TRIGGERING the TARGET BEHAVIOR ANTECEDENTS student FUNCTION (What is the During when And function of the target behavior?) Math and check-out doing a routine task engages in verbal gives/ & transitioning provides outbursts the attention student

Target Behavior Two: (B) Define the behavior: (Target Behavior Form) Physical class disruption- Tommy engages in physically disruptive behaviors. This looks like throwing classroom materials across the room and pushing books and papers onto the floor. This does not include moving his materials around in an angry manner, but any action which causes the materials to no longer be in his presence or makes the materials unusable. (B) Frequency of Behaviors/Behaviors Per Day: When is the problem behavior most likely to occur? (times of day and days of the week) See above.

(B) Frequency of Behaviors/Behaviors Per Day: When is the problem behavior least likely to occur? (times of day and days of the week) See above.

(A)Context: Within what settings/activities does this behavior occur most often? Physical class disruption occurs most often during math.

An instruction or a directive seem to be triggering the physical class disruptions.

He normally stops the physical class disruption when the consequence occurs. (C) Consequences: What consequence is used most often with the target behavior?

The consequence used most often is removal from class.

removal from class which typically leads Hypothesis to CONTEXT TRIGGERING the TARGET BEHAVIOR ANTECEDENTS student FUNCTION (What is the During when and gives function of the target behavior?) Math given an instruction engages in physically /provides or directive disruptive behaviors the student an escape (Use the FBA Report, Alpine FBA Form, Antecedent Interventions Chart, & Reinforcement Chart.) REINFORCERS & CONSEQUENCES CONSEQUENCE

which ANTECEDENT INTERVENTIONS BEHAVIOR typically leads Hypothesis to CONTEXT TRIGGERING TARGET BEHAVIOR

ANTECEDENTS the And FUNCTION (What is the During when student gives/ function of the target behavior?) provides the student

Modify the context and/or the triggering events in a way that leaves the FUNCTION of DESIRED ALTERNATIVE INDIVIDUALIZED the target behavior BEHAVIOR unnecessary. REINFORCERS MODIFIED (Modify adult behaviors- Reinforces desired/acceptable alternative behaviors) ANTECEDENT MODIFICATIONS

ACCEPTABLE ALTERNATIVE BEHAVIOR

CONSEQUENCE MODIFIED (Modify adult behaviors-decreases the BEHAVIOR SKILLS Target Behavior & accounts for TEACHING function.)

Adapted from Competing Pathways at www.behaviordoctor.org Case Study 1 Activity 4 Answer Key

removal from class which typically leads Hypothesis to CONTEXT TRIGGERING the TARGET BEHAVIOR ANTECEDENTS student FUNCTION (What is the During when and gives function of the target behavior?) Math given an instruction engages in physically /provides or directive disruptive behaviors the student an escape (Use the FBA Report, Alpine FBA Form, Antecedent Interventions Chart, & Reinforcement Chart.)

REINFORCERS & CONSEQUENCES CONSEQUENCE

which Removal from class ANTECEDENT INTERVENTIONS BEHAVIOR typically leads Hypothesis to CONTEXT TRIGGERING TARGET BEHAVIOR

ANTECEDENTS the And FUNCTION (What is the During when student gives/ function of the target behavior?) Math Instruction/Directive Physical class disruption provides the Escape student

Modify the context and/or the triggering events in a way that leaves the FUNCTION of DESIRED ALTERNATIVE INDIVIDUALIZED the target behavior BEHAVIOR unnecessary. REINFORCERS MODIFIED (Modify adult behaviors- Reinforces Participate in math class and desired/acceptable alternative use materials appropriately behaviors) ANTECEDENT MODIFICATIONS 1.Preferred Activity

1.Provide math remediation. ACCEPTABLE 2.Differentiated instruction on his level. ALTERNATIVE BEHAVIOR

3. Choice of math activity‐ menu. Tommy will be given a break from math when he asks for 4. Pair preferred activity (reading, athletic activity, baking) with it. math activity. CONSEQUENCE MODIFIED (Modify adult behaviors-decreases the BEHAVIOR SKILLS Target Behavior & accounts for TEACHING function.)

1.Steps for participating 1.Extra math during in math. appropriately recess/free time

2. Steps for asking for a break

Adapted from Competing Pathways at www.behaviordoctor.org ALPINE BEHAVIORAL INTERVENTION PLAN Student Name: Grade: Date of Plan: Date of Plan Review:

I. Target Behaviors and II. Functional III. Antecedent Intervention Strategies (Positive IV. Reinforcers and Consequences V. Progress Definitions (Copy from the Behavioral Behavioral Interventions and Supports) Monitoring of BIP FBA.) Assessment and What data? What Identified Function A. Context & B. Alternative A. Individualized B. Consequences progress monitoring tool? Who will collect the data? of the Target Antecedent Behaviors/Behavior Reinforcers for Target Behavior (Hypothesis Modifications Skills Training Behavior from the FBA) 1.

ALPINE BEHAVIORAL INTERVENTION PLAN Crisis Plan:

How will an emergency situation or behavior crisis be handled? (Define possible scenarios, including the use of in‐school or out‐of‐school suspension, or aversive techniques, as appropriate)

Code of Conduct: (To be considered for grades 6‐12 and others as appropriate.)

‰ ‰ A. The student has the capacity to understand school rules as outlined in the Code of Student Conduct. ‰ ‰ B. The student has the capacity to follow school rules as outlined in the Code of Student Conduct.

(Complete if response to A or B is No.)

The student cannot be expected to comply, by reason of the student’s disability, with the following rules in the Code of Student Conduct:

(Use the FBA Report, Alpine FBA Form, Antecedent Interventions Chart, & Reinforcement Chart.) REINFORCERS & CONSEQUENCES CONSEQUENCE

Adapted from Competing Pathways at www.behaviordoctor.org ALPINE BEHAVIORAL INTERVENTION PLAN 5 Student Name: Tommy Grade: Date of Plan: Today Date of Plan Review: 1/1/13

I. Target Behaviors and II. Functional III. Antecedent Intervention Strategies (Positive IV. Reinforcers and Consequences V. Progress Definitions (Copy from the Behavioral Behavioral Interventions and Supports) Monitoring of BIP FBA.) Assessment and What data? What Identified Function A. Context & B. Alternative A. Individualized B. Consequences progress monitoring tool? Who will collect the data? of the Target Antecedent Behaviors/Behavior Reinforcers for Target Behavior (Hypothesis Modifications Skills Training Behavior from the FBA) 1. Physical class disruption‐ During Math when given 1.Provide math remediation. Desired Alternative: 1.Preferred Activity 1.Extra math during # of physical class Tommy engages in physically an instructive or directive, Participate in math class recess/free time disruptions (teacher) disruptive behaviors. This Tommy physically disrupts 2.Differentiated instruction and use materials looks like throwing classroom the class which typically on his level. appropriately # of times he asks for materials across the room and leads to removal from the break (teacher) pushing books and papers class and provides him an 3. Choice of math activity‐ onto the floor. This does not escape. menu. Acceptable Alternative: include moving his materials Tommy will be given a # of times he around in an angry manner, 4. Pair preferred activity break from math when he participates in math (reading, athletic activity, but any action which causes asks for it. appropriately (teacher) baking) with math activity. the materials to no longer be in his presence or makes the 1.Steps for participating materials unusable. in math appropriately

Crisis Plan:

Tommy continues to physically disrupt class in the same day and the behavior is escalating. Tommy destroys materials or hurts someone.

1) Intensive Intervention

2) In‐school suspension

ALPINE BEHAVIORAL INTERVENTION PLAN 3) Out of school suspension

4) Law enforcement involvement

x ‰ A. The student has the capacity to understand school rules as outlined in the Code of Student Conduct. x ‰ B. The student has the capacity to follow school rules as outlined in the Code of Student Conduct.

Pardon Our Interruption

As you were browsing something about your browser made us think you were a bot. There are a few reasons this might happen:

• You've disabled JavaScript in your web browser.
• You're a power user moving through this website with super-human speed.
• You've disabled cookies in your web browser.
• A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this support article .

To regain access, please make sure that cookies and JavaScript are enabled before reloading the page.

Please enable JavaScript.

Coggle requires JavaScript to display documents.

Positive Behavior Intervention Supports - Case Study I (Tier 1…

• Case Study - TOMMY Tommy is an 10 year-old boy who enjoys baseball, swimming, and baking. He does not like art activities or large crowds. Tommy has a good sense of humor but he can be irritable. He is fearful around new people and may become quiet and more reserved in those situations. Tommy has been increasingly disruptive the past few months. He has verbal outbursts and pushes classroom materials onto the floor after being given an academic task during quiet work time. His verbal outbursts include yelling that he is not doing the assignment, telling a student to shut up, using profanity, and calling student’s names. His teachers do feel that they spend about an hour per day dealing with the behavior, and they usually respond to Tommy’s behavior by scolding him or by initiating an office referral. ommy attends a regular K-5 public elementary school. Tommy is new to the school. Tommy is in the 5th grade. There are 19 students in his homeroom classroom.Tommy has attended your school for two months now. Initially, he seemed to acclimate to the the new school well. However, things have gotten more difficult for him lately.
• The student may:
• Speak out of turn, blurt out
• Make inappropriate or humorous comments at inappropriate times
• Try to engage others while they are working
• Drop things, laugh, or makes noises on purpose
• Claim to not know what is going on
• Bother other students
• Out of seat, walking around class, getting drinks, sharpening pencil, etc
• Over socializing
• Asking frequent and obvious questions
• Find fault with everything others say
• Tier I Interventions for Disruptive
• Before you start, a few important points:
• Try multiple interventions
• Each intervention should be tried for a minimum of 4 weeks, & more than 1 intervention may be implemented at the same time
• Collect and track specific data on each intervention tried & its effect
• If your data indicates no progress after a minimum of 6 months, you may consider moving to tier 2 interventions
• Interventions:
• Acknowledging positive behavior
• Avoid power struggles
• Frequent home contact
• Praise when cooperative and well behaved
• Praise when on task
• Redirection
• Speak with student in hallway
• Start Commands
• Take a break
• Talk to parent
• Teach conflict resolution skills
• Teach coping skills
• Teach relationship skills
• Teach relaxation techniques
• Teach social skills
• Use calm neutral tone
• Use a Calm Neutral Tone - not knowing the parenting style of his caregivers, he may not be use to being respected or spoken to calmly. This works well because it can be done in class in front of the other students without embarrassment.
• Redirection - This works for elementary age classes because sometimes students just need help to redirect their frustration on a positive activity and to be engaged in something constructive.
• Speak with Student in Hallway - This works well when he is being very disruptive because it removes him from the environment, stresses the importance as he is moved from his normal location, and also does not create more negative attention he may be seeking by going away from the other students.
• Alternatives To Suspension
• Behavior Contract
• Behavior Intervention Plan (BIP)
• Structured Breaks
• Check In Check Out (CICO)
• Classroom Management Support
• Counselor Referral
• Daily Behavior Form
• Forced Choice Reinforcement Survey
• Functional Behavior Assessment (FBA)
• Individual & Visual Schedules
• Non-Verbal Cues & Signals
• Organizational Tools
• Peer Tutoring
• Response To Intervention (RTI)
• Reward System
• Self Monitoring
• Sensory Tools
• Social Stories
• Teach Conflict Resolution Skills
• Teach Coping Skills
• Teach Relationship Skills
• Teach Relaxation Techniques
• Teach Social Skills
• The Praise Game
• Reward System - provides student with positive feedback, increases motivation, and creates incentive
• Behavior Meetings
• Collaboration With Student’s Physician And/Or Mental Health Provider
• No Passing Time
• Seclusion & Restraint
• Sexuality, Sexually Inappropriate, Sexualized Behaviors
• Time Out (Structured Time Out)
• Behavior Intervention Plan - Involves teachers, support staff, the student, and parents actively, increases support around student, helps teachers across rooms/subjects
• Teach Coping Skills - at a basic level the student may not be equipped with the skills necessary to provide the behavior we are seeking as teachers. This would empower the student and help student be more assertive in his own plan for behavior changes.
• Resources: Free Printable Behavior Charts. (n.d.) Retrieved from https://www.freeprintablebehaviorcharts.com/behaviorcharts3-10.htm Live School. (n.d.) Retrieved from https://pbisdata.whyliveschool.com/?utm_version=LP&utm_campaign=pbis-organic Student Self-Assessment. (n.d.) Teacher Vision. Retrieved from https://www.teachervision.com/student-self-assessment-1?downloadpdf=print Learning Styles Survey. (n.d.) Studyguide. Retrieved from http://www.studyguide.org/learning_styles.htm
• Tier 1 Tracking Systems for Tommy will be -
• Behavior Charts https://www.freeprintablebehaviorcharts.com/behaviorcharts3-10.htm
• Self Monitoring Assessment Sheet
• Live School Platform for Tracking Behavior Points and Awards
• Heather Nenadovich
• Student Self-Assessment
• Time Out Log
• Student Learning Style Survey
• PBISWorld.com Behavior & Intervention Tracking Form (For Microsoft Excel Software)
• Antecedent Behavioral Consequence Log
• District Behavior Intervention Team/Behavior Specialist Student Referral Form

• Health Science

Case Study #1: Tommy

Related documents.

Add this document to collection(s)

You can add this document to your study collection(s)

Add this document to saved

You can add this document to your saved list

Suggest us how to improve StudyLib

(For complaints, use another form )

Input it if you want to receive answer

• Search Menu
• Sign in through your institution
• Computer Science
• Earth Sciences
• Information Science
• Life Sciences
• Materials Science
• Science Policy
• Advance Access
• Special Topics
• Author Guidelines
• Submission Site
• Open Access Options
• Self-Archiving Policy
• About National Science Review
• Editorial Board
• Advertising and Corporate Services
• Journals Career Network
• Dispatch Dates
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Powerful qtl mapping and favorable allele mining in an all-in-one population: a case study of heading date.

These authors equally contributed to this work

• Article contents
• Figures & tables
• Supplementary Data

Pengfei Wang, Ying Yang, Daoyang Li, Zhichao Yu, Bo zhang, Xiangchun Zhou, Lizhong Xiong, Jianwei Zhang, Yongzhong Xing, Powerful QTL mapping and favorable allele mining in an all-in-one population: a case study of heading date, National Science Review , 2024;, nwae222, https://doi.org/10.1093/nsr/nwae222

• Permissions Icon Permissions

The multiparent advanced generation intercross (MAGIC) population is characterized with great potentials in power and resolution of QTL mapping, but SNP-based GWAS does not fully play its potential. In this study, a MAGIC population of 1021 lines was developed from four Xian and four Geng varieties from 5 subgroups of rice. A total of 44,000 genes showed functional polymorphisms among eight parents, including frameshift variations or premature stop codon variations, which provides the potential to map almost all genes of the MAGIC population. Principal component analysis results showed that the MAGIC population had a weak population structure. A high-density bin map of 24,414 bins was constructed. Segregation distortion occurred in the regions possessing the genes underlying genetic incompatibility and gamete development. SNP-based association analysis and bin-based linkage analysis identified 25 significant loci and 47 QTLs for heading date, including 14 known heading date genes. The mapping resolution of genes is dependent on genetic effects with offset distances of less than 55 kb for major effect genes and less than 123 kb for moderate effect genes. Four causal variants and noncoding structure variants were identified to be associated with heading date. Three to four types of alleles with strong, intermediate, weak, and no genetic effects were identified from eight parents, providing flexibility for the improvement of rice heading date. In most cases, japonica rice carries weak alleles, and indica rice carries strong alleles and nonfunctional alleles. These results confirmed that the MAGIC population provides the exceptional opportunity to detect QTLs, and its use is encouraged for mapping genes and mining favorable alleles for breeding.

Author notes

Email alerts

Citing articles via.

• Recommend to Your Librarian

Affiliations

• Online ISSN 2053-714X
• Print ISSN 2095-5138
• Copyright © 2024 China Science Publishing & Media Ltd. (Science Press)
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

HHS Announces Cost Savings for 64 Prescription Drugs Thanks to the Medicare Rebate Program Established by the Biden-Harris Administration’s Lower Cost Prescription Drug Law

Under President Biden’s Inflation Reduction Act, some people with Medicare will pay less for some Part B drugs if the drug’s price increased faster than the rate of inflation.

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), today announced that some Medicare enrollees will pay less for 64 drugs available through Medicare Part B. The drugs will have a lowered Part B coinsurance rate from July 1, 2024 – September 30, 2024, since each drug company raised prices faster than the rate of inflation.  Over 750,000 people with Medicare use these drugs annually, which treat conditions such as osteoporosis, cancer, and infections. White House Domestic Policy Advisor Neera Tanden will announce the cost savings on these life-saving drugs in a keynote address on the Biden-Harris Administration’s focus on lowering costs today at the Center for American Progress.

“Without the Inflation Reduction Act, seniors were completely exposed to Big Pharma’s price hikes. Not anymore. Thanks to President Biden and the new Medicare inflation rebate program, seniors are protected and benefitting from lower Part B drug costs,” said White House Domestic Policy Advisor Neera Tanden. “The Biden-Harris Administration will continue fighting to bring down the cost of health care and prescription drugs for all Americans.”

“President Biden’s Medicare prescription drug rebate program is putting money back in the pockets of seniors and people with disabilities, said HHS Secretary Xavier Becerra. “President Biden made lowering prescription drug costs for Americans a top priority, and he is delivering on that promise. Our work is not complete, and we will continue to fight for lower health care costs for all Americans.”

Please find soundbites from HHS’ Chief Competition Officer, Stacy Sanders, here .

Because of President Biden’s lower cost prescription drug law, the Inflation Reduction Act, which established the Medicare Prescription Drug Inflation Rebate Program, some people with Medicare who use these drugs during this time period may save between $1 and $4,593 per day.

“Everyone should be able to afford their medication, and the Inflation Reduction Act continues to deliver on this goal to improve affordability,” said CMS Administrator Chiquita Brooks-LaSure. “Discouraging drug companies from price increases above the rate of inflation is a key part of this effort, and CMS continues to implement the law to bring savings to people with Medicare.”

Padcev, a medication used to treat advanced bladder cancer, is an example of a prescription drug with a price that has increased faster than the rate of inflation every quarter since the Medicare Part B inflation rebate program went into effect, resulting in lowered Part B coinsurances for seniors and others with Medicare. A beneficiary taking Padcev as part of their cancer treatment may have saved as much as $1,181 from April 1, 2023 through March 31, 2024, depending on their coverage and course of treatment. Another example, Crysvita, treats a rare genetic disorder that causes impaired growth, muscle weakness, and bone pain. A beneficiary taking Crysvita may have saved as much as $765 from July 1, 2023 through March 31, 2024 depending on their coverage and course of treatment.

The Medicare Prescription Drug Inflation Rebate Program is just one of the Inflation Reduction Act’s prescription drug provisions aimed at lowering drug costs. In addition to this program, the law expanded eligibility for full benefits under the Low-Income Subsidy program (LIS or “Extra Help”) under Medicare Part D at the beginning of this year. Nearly 300,000 people with low and modest incomes are now benefiting from the program’s expansion. A comprehensive public education campaign is underway to reach the more than three million people who are likely eligible for the program but not yet enrolled.

In addition, as of January 1, 2024, some people enrolled in Medicare Part D who have high drug costs have their annual out-of-pocket costs capped at about $3,500. In 2025, all people with Medicare Part D will benefit from a $2,000 cap on annual out-of-pocket prescription drug costs.

The Inflation Reduction Act requires drug companies to pay rebates to Medicare when prices increase faster than the rate of inflation for certain drugs. CMS intends to begin invoicing prescription drug companies for rebates owed to Medicare no later than fall 2025. The rebate amounts paid by drug companies will be deposited in the Federal Supplementary Medical Insurance Trust Fund, which will help ensure the long-term sustainability of the Medicare program for future generations.

For more information on the Medicare Prescription Drug Inflation Rebate Program visit, https://www.cms.gov/inflation-reduction-act-and-medicare/inflation-rebates-medicare

To view the fact sheet on the 64 Part B drugs with a coinsurance reduction for the quarter July 1, 2024 – September 30, 2024, visit, https://www.cms.gov/files/document/reduced-coinsurance-certain-part-b-rebatable-drugs-july-1-september-30-2024.pdf

More information and helpful resources about the Inflation Reduction Act and how it is helping to lower costs for people with Medicare can be found at LowerDrugCosts.gov .

Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases

Subscribe to RSS

Receive latest updates

Related News Releases

Hhs publishes first round of inflation reduction act case studies on health sector climate investments, hhs releases new data showing over 10 million people with medicare received a free vaccine because of the president’s inflation reduction act; releases draft guidance for the second cycle of medicare drug price negotiation program, biden-harris administration furthers medicare drug price negotiations, releases new data on how the president’s historic law lowers health care costs for women, media inquiries.

For general media inquiries, please contact  [email protected] .

• Election 2024
• Entertainment
• Newsletters
• Photography
• Personal Finance
• AP Investigations
• AP Buyline Personal Finance
• AP Buyline Shopping
• Press Releases
• Israel-Hamas War
• Russia-Ukraine War
• Global elections
• Asia Pacific
• Latin America
• Middle East
• Election Results
• Delegate Tracker
• AP & Elections
• Auto Racing
• 2024 Paris Olympic Games
• Movie reviews
• Book reviews
• Financial Markets
• Business Highlights
• Financial wellness
• Artificial Intelligence
• Social Media

Things to know about the gender-affirming care case as the Supreme Court prepares to weigh in

FILE - A flag supporting LGBTQ+ rights decorates a desk on the Democratic side of the Kansas House of Representatives during a debate, March 28, 2023, at the Statehouse in Topeka, Kan. The U.S. Supreme Court agreed Monday to consider whether a Tennessee ban on gender-affirming care for minors is constitutional. (AP Photo/John Hanna, File)

• Copy Link copied

The U.S. Supreme Court said Monday that it will hear arguments on the constitutionality of state bans on gender-affirming care for transgender minors.

The issue has emerged as a big one in the past few years. While transgender people have gained more visibility and acceptance in many respects, half the states have pushed back with laws banning certain health care services for transgender kids.

Things to know about the issue:

What is gender-affirming care?

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth.

The services are offered to treat gender dysphoria, the unease a person may have because their assigned gender and gender identity don’t match. The condition has been linked to depression and suicidal thoughts.

Gender-affirming care encompasses counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes. Those for transgender men cause periods to stop, increase facial and body hair, and deepen voices, among others. The hormones used by transgender women can have effects such as slowing growth of body and facial hair and increasing breast growth.

Gender-affirming care can also include surgery, including operations to transform genitals and chests. These surgeries are rarely offered to minors .

What laws are states passing?

Over the past three years, 26 Republican-controlled states have passed laws restricting gender-affirming care for minors. Most of the laws ban puberty blockers, hormone treatment and surgery for those under 18. Some include provisions that allow those already receiving treatment to continue.

The laws also make exceptions for gender-affirming treatments that are not part of a gender transition, such as medications to stop breast growth in boys and excessive facial hair in girls.

One of the laws — in Arkansas — was nixed by a federal court and is not being enforced.

Meanwhile, at least 14 Democratic-controlled states have adopted laws intended to protect access to gender-affirming care.

The gender-affirming care legislation is a major part of a broader set of laws and policies that has emerged in Republican-controlled states that rein in rights of transgender people. Other policies, adopted in the name of protecting women and girls, bar transgender people from school bathrooms and sports competitions that align with their gender.

What have courts said so far?

Most of the bans have faced court challenges, and most are not very far along in the legal pipeline yet.

The law in Arkansas is the only one to have been struck down entirely, but the state has asked a federal appeals court to reverse that ruling.

The 6th U.S. Circuit Court of Appeals, one step below the Supreme Court, last year ruled that Kentucky and Tennessee can continue to enforce their bans amid legal challenges. The high court has agreed to hear the Tennessee case in the term that starts later this year.

The U.S. Supreme Court in April ruled that Idaho can enforce its ban while litigation over it proceeds. A lower court had put it on hold.

What does the medical community think?

Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed the bans and said that gender-affirming treatments can be medically necessary and are supported by evidence.

But around the world, medical experts and government health officials are not in lockstep. Some European countries in recent years have warned about overdiagnosis of gender dysphoria.

In England, the state-funded National Health Service commissioned a review of gender identity services for children and adolescents, appointing retired pediatrician Dr. Hilary Cass to lead the effort. The final version of the Cass Review , published in April, found “no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

England’s health service stopped prescribing puberty blockers to children with gender dysphoria outside of a research setting, following recommendations from Cass’ interim report.

The World Professional Association for Transgender Health and its U.S. affiliate issued a statement in May saying they’re deeply concerned about the process, content and consequences of the review, saying it “deprives young trans and gender diverse people of the high-quality care they deserve and causes immense distress and harm to both young patients and their families.”

We've detected unusual activity from your computer network

To continue, please click the box below to let us know you're not a robot.

Why did this happen?

Please make sure your browser supports JavaScript and cookies and that you are not blocking them from loading. For more information you can review our Terms of Service and Cookie Policy .

For inquiries related to this message please contact our support team and provide the reference ID below.

Pardon Our Interruption

As you were browsing something about your browser made us think you were a bot. There are a few reasons this might happen:

• You've disabled JavaScript in your web browser.
• You're a power user moving through this website with super-human speed.
• You've disabled cookies in your web browser.
• A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this support article .

To regain access, please make sure that cookies and JavaScript are enabled before reloading the page.