Behavioral Interventions

Behav. Intervent. 29: 145156 (2014)

Published online 26 February 2014 in Wiley Online Library
(wileyonlinelibrary.com) DOI: 10.1002/bin.1382

IMPROVING INTERVENTION INTEGRITY OF DIRECTSERVICE PRACTITIONERS THROUGH PERFORMANCE

FEEDBACK AND PROBLEM SOLVING
CONSULTATION
Lisa Minor, Melanie DuBard and James K. Luiselli*
May Institute, Randolph, MA 02368, USA

The purpose of this study was to improve intervention integrity of behavior support plan implementation
by teachers at a specialized school. During the rst phase of a multiple baseline design, performance
feedback was given to the teachers during (correction) and immediately following (praise) classroom
observations. In a second phase, the teachers received problem solving consultation that addressed
behavior support plan misapplication and respective procedural modications. Only one of the three
teachers demonstrated improved intervention integrity with performance feedback, whereas problem
solving consultation produced uniform improvement. We discuss these ndings and implications for
intervention integrity assessment and research. Copyright 2014 John Wiley & Sons, Ltd.

Intervention integrity refers to how accurately practitioners implement instructional

and behavior support procedures in educational and clinical settings (DiGennaro Reed
& Codding, 2011; Gresham et al., 1993). Typically, intervention integrity is measured
by (i) observing staff when they are expected to follow written protocols, (ii) recording
their application of prescribed procedures, and (iii) deriving an overall intervention
integrity score (Vollmer, Roane, Ringdahl, & Marcus, 1999). Assessing intervention
integrity is critical because it provides in vivo practitioner training that allows supervisory personnel to document, reinforce, and correct performance (Reid & Parsons,
1995). Also, without intervention integrity assessment, it is not possible to verify
whether ineffective outcomes are due to the procedures themselves or inaccurate
implementation (McIntyre, Gresham, DiGennaro, & Reed, 2007).
Research reveals that high intervention integrity is associated with better intervention effects (Fiske, 2008; Noell, Gresham, & Gansle, 2002; Vollmer et al., 1999;
Wilder, Atwell, & Wine, 2006). Of note, performance feedback (PF) appears to be
*Correspondence to: James K. Luiselli, May Institute, 41 Pacella Park, Drive, Randolph, MA 02368, USA. E-mail:
jluiselli@mayinstitute.org
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L. Minor et al.

particularly effective in improving intervention integrity by care providers (Solomon,

Klein, & Politylo, 2012). Broadly dened, PF is the process of informing practitioners
about their implementation of intervention plans. Typically, the person delivering PF
(i) reinforces accurately implemented procedures and (ii) corrects procedures that
were implemented inaccurately. Most studies suggest that immediate PF is effective
(Codding, Feinberg, Dunn, & Pace, 2005), and indeed, practitioners seem to prefer
feedback that is provided contiguous to being observed (Reid & Parsons, 1996).
However, Solomon et al. (2012) proposed that immediate and same-day PF may be
only slightly better than feedback given a week later. Other options include giving
feedback to practitioners individually or in groups (Noell, Witt, La Fleur, Mortensen,
Rainer, & LeVelle, 2000), using written, oral, or graphic formats (Sanetti, Luiselli, &
Handler, 2007), and incorporating behavioral rehearsal (DiGennaro, Martens, &
McIntyre, 2005). In summary, although PF can improve intervention integrity of
educational and clinical practitioners, there are different methods to achieve this
objective and not all methods are consistently effective.
The purpose of the present study was to improve implementation of behavior
support plans (BSPs) by direct-service providers implementing educational objectives.
Specically, we measured intervention integrity during a baseline (no feedback) phase,
followed by a PF phase and a subsequent phase that combined PF with problem solving
consultation (PSC). In line with previous research, our objectives were to evaluate the
singular and combined effects of integrity enhancing procedures. Additionally, we
report results with practitioners who had relatively good intervention integrity before
receiving feedback and the addition of PSC to boost their performance.

METHOD
Participants and Setting
The participants were three teacherstudent dyads at a private school for children
and youth with autism and related developmental disabilities. The school provided
special education and intervention services according to an applied behavior analysis
(ABA) service model. Each classroom in the school had 67 students and 34
teachers. The students attended school for 6 h on weekdays.
The teacher in dyad-1 was Mr. Smith, who was enrolled in a graduate program in
applied behavior analysis and had been employed at the school for 2 years. His
student, Colin, was a 20-year-old male with a diagnosis of autism. In dyad-2,
Ms. Harris was enrolled in a special education graduate program and had been
employed at the school for 2 years. Her student was Kevin, a 20-year-old male with
a diagnosis of autism. The teacher in dyad-3 was Mr. Stadler, who had an
Copyright 2014 John Wiley & Sons, Ltd.

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Intervention integrity

undergraduate degree and been employed at the school for 1 year. His student, Jonah,
was 20 years old and had a diagnosis of pervasive developmental disorder - not
otherwise specied (PDD-NOS). All three teachers had received pre-service training
at the school on basic principles and applications of ABA as well as direct supervision in implementing instructional and behavior support procedures.
The three teacherstudent dyads comprised a single classroom at the school. A fourth
teacher and three other students, who were only occasionally present in the classroom,
were not involved in the study. All of the students followed activity schedules according
to a vocational and functional life skills curriculum. The classroom teachers instructed
13 students at a time in small groups. All learning objectives and teaching procedures
were derived from each students Individualized Educational Program (IEP).
The rst author served as a consultant to the classroom. She worked with the teachers
in developing instructional and intervention procedures, conducting assessments, and
assisting students. Throughout the study, she was present in the classroom from 2 to
3 h each day.

Materials
Behavior Support Plans
Each student in the study had a BSP that included general antecedent procedures, individually prescribed antecedent procedures, and individually prescribed consequence
procedures for specic problem behaviors such as aggression, noncompliance, and
property destruction. The BSPs had operational denitions of target behaviors, descriptions of all intervention procedures, and accompanying frequency recording forms that
teachers lled out during the 6-h school day. As shown in Table 1, each student had
approximately the same number of procedures within the general antecedent, individually prescribed antecedent, and individually prescribed consequence categories.
Senior clinical staff at the school wrote the BSPs based on functional behavioral
assessments (Cipani & Schock, 2011) of the students. Teachers were expected to
implement these plans throughout the school day. It should be noted that although
the teachers were assigned to a specic student during the study, they at times were
Table 1. Number of general antecedent, individual antecedent, and individual consequence procedures
comprising each students behavior support plan.
Student
Colin
Kevin
Jonah

General antecedent

Individual antecedent

Individual consequence

6
5
6

4
3
4

7
6
8

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L. Minor et al.

required to implement the BSPs of the other students. However, the reported intervention integrity data from the study were only recorded for the designated
teacherstudent dyads. All of the BSPs had been written and approved preceding
the study.

Intervention Integrity Form

We designed an intervention integrity form that was adapted from Codding et al.
(2005). The form listed 1721 components that corresponded to (i) general antecedent
procedures, (ii) behavior-specic antecedent procedures, (iii) behavior-specic
consequence procedures, and (iv) data recording procedures in each students BSP.
Consistent with the form created by Codding et al., Each component consisted of
specic behaviors that teachers were instructed to engage in, either as a result of
the activity a student was required to perform or in response to students behavior
(p. 207). A component was rated as implemented accurately if the teachers
implemented it as written in the BSP every time target behaviors occurred or when
a situation required an antecedent manipulation. A rating of implemented inaccurately
was given if the teachers did not implement, sometimes implemented, or implemented
a portion of the component as written in the BSP. A third rating, no opportunity,
referred to situations where the teachers could not implement BSP components
because target behaviors did not occur or antecedent conditions were not present.

Measurement
Using the intervention integrity form, the senior author conducted a 30-min
classroom observation of each teacherstudent dyad on a separate day each week.
During observation, the teachers interacted with their assigned student and usually
12 other students on various skills and learning objectives. For example, the students
received communication, pre-academic, vocational, and leisure skills instruction
according to the goals specied in their IEP. Accordingly, the instructional activities
during the 30-min classroom observation varied with each student.
When observation concluded, the data recorded on the form were computed to
yield an intervention integrity percentage. The percentage metric was calculated by
dividing the number of BSP components with implemented accurately ratings by
the number of BSP procedures with implemented accurately and implemented
inaccurately ratings and multiplying by 100. Throughout the study, the average
percentages of BSP procedures that the teachers had opportunities to implement were
50% for Mr. Smith-Colin, 59% for Ms. Harris-Kevin, and 38% for Mr. Stadler-Jonah.
There were no observations in which the teachers had opportunities to implement
every procedure that comprised a students BSP.
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Interobserver Agreement
To assess interobserver agreement (IOA), a second individual conducted classroom
observation simultaneously but independently with the senior author during 14% of
days that were distributed across the three teacherstudent dyads. An agreement was
recorded when both observers rated implementation of BSP procedures identically
(implemented accurately or implemented inaccurately). Average IOA (agreements
divided by agreements plus disagreements 100) was 96.5% (range, 94100%).

Experimental Design and Procedures

Procedures were implemented in a multiple baseline design across teacherstudent
dyads. We changed phases with the teacherstudent dyads based on visual inspection
and stability of data in preceding phases.

Initial Teacher Training

One week preceding the study, the rst author conducted a training session with
the teachers using a semi-structured format in which she distributed each students
BSP, described the respective procedures, and answered questions. The senior author
also informed the teachers that she would be observing them periodically and giving
feedback about BSP implementation. The teachers retained copies of the BSPs and
were able to refer to them throughout the study.

Baseline
Following initial teacher training, the rst author initiated classroom observations.
Under baseline conditions, she did not interact with the teachers or students while
observing. At the end of the school day, the rst author praised the teachers (e.g.,
You did a nice job keeping students on-task today.) but did not give them feedback
about implementing the BSPs. During baseline, there were no instances of serious
aggressive or destructive behavior that required emergency intervention or procedural
changes to a students BSP.

Performance Feedback
During classroom observations, the rst author made a corrective statement to
teachers when they implemented a BSP procedure inaccurately, for example,
Remember, you have to shut the closet door to prevent Colin from taking food.
Whenever possible, this feedback was delivered to the teachers as soon as the rst
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L. Minor et al.

author observed misapplication of a BSP component or when the teachers were

between activities. Only corrective statements were delivered during observation to
minimize distraction to the teacher and students. Approximately 30 min following
observation, the rst author provided additional PF to the teachers by commenting
generally about BSP implementation and describing two examples, with accompanying praise, of procedures that were implemented accurately. These feedback
interactions lasted approximately 5 min.

Performance Feedback and Problem Solving Consultation

Identical to the PF phase, the rst author continued to deliver immediate correction
and delayed praise to the teachers during and following classroom observations, respectively. One additional procedure, the visual display (line graph) of each teachers
intervention integrity data, was included in the post-observation PF.
The PSC phase of the study was introduced following the last observation in the
PF phase. During an initial PSC meeting, the rst author met individually with each
teacher (2030 min) and reviewed intervention integrity results that had been documented in baseline and PF phases. Next, they discussed inaccurately implemented
BSP procedures, potential barriers to implementation, and how to resolve them.
The teachers were encouraged to offer solutions that would improve intervention
integrity with their assigned student including revisions to the BSP as well as general
classroom modications. If teachers were not able to generate solutions, the rst
author suggested alternatives based on her classroom observations. These exchanges
also had teachers weigh the potential advantages and disadvantages of revised BSP
procedures before implementing them with their assigned students. Any procedural
modications were made to the BSPs. If a teachers intervention integrity dropped
below 90%, the rst author conducted another PSC meeting to further address implementation barriers and corrective strategies.

RESULTS
Figure 1 shows the intervention integrity percentage scores for Mr. Smith (top
panel), Ms. Harris (middle panel), and Mr. Stadler (bottom panel). In baseline,
Mr. Smith had relatively high and stable intervention integrity, averaging 86.3%.
With PF, his average intervention integrity was 88.8%. The addition of PSC
increased intervention integrity to an average of 96.6%. Throughout the study,
Mr. Smith implemented three specic procedures in Colins BSP inaccurately. He
implemented all three BSP procedures inaccurately during baseline, two of the three
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Intervention integrity

Intervention Integrity Percentage Intervention Integrity Percentage Intervention Intergrity Pecentage

Baseline

PF

PF +PSC

100
90
80
70
Problem-solving meetings

60
50
40
30
20

Mr. Smith

10
0
100
90
80
70
60
50

Problem-solving meetings

40
30
20

Ms Harris

10
0
100
90
80
70
60

Probllemsolving
meeting

50
40
30
20

Mr.Stadler

10
0
0

10

11

12

13

14

15

Days
Figure 1. Intervention integrity percentage scores for Mr. Smith, Ms. Harris, and Mr. Stadler during
baseline, performance feedback (PF), and PF plus problem solving consultation (PF + PSC) phases.

BSP procedures inaccurately during the IPF phase, and one of the three BSP procedures inaccurately during the IPF + PSC phase.
For Ms. Harris, intervention integrity averaged 66.2% during baseline. There was
an increase with PF to an average of 76.5%. Her intervention integrity improved
further with PSC, averaging 92.3%. Ms. Harris implemented six specic procedures
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in Kevins BSP inaccurately throughout the study. All six BSP procedures were
implemented inaccurately during baseline, three of the six BSP procedures inaccurately during the IPF phase, and two of the six BSP procedures inaccurately during
the IPF + PSC phase.
Finally, intervention integrity for Mr. Stadler averaged 73.6% in baseline. There
was reduced variability in the PF phase with an average of 87.5%. His intervention
integrity increased to 100% with the addition of PSC. Mr. Stadler implemented ve
specic procedures in Jonahs BSP inaccurately throughout the study. All ve BSP
procedures were implemented inaccurately during baseline, one of the ve BSP
procedures inaccurately during the IPF phase, and none of the ve BSP procedures
inaccurately during the IPF + PSC phase.

DISCUSSION
We found that PF did not improve intervention integrity for two of three teacher
student dyads but was effective with the third teacherstudent dyad. Signicantly, all
three teachers had better intervention integrity when they received PSC. These results
suggest that intervention integrity by direct-service providers may be inuenced by
different types and combinations of PF. Furthermore, the effects of PSC were consistent with teachers who had relatively high (Mr. Smith) and moderate (Ms. Harris and
Mr. Stadler) levels of intervention integrity before receiving PF. Thus, by conclusion
of the study, all of the teachers had consistently fewer BSP implementation errors
with their students.
A noteworthy point was the relatively high intervention integrity under baseline
conditions. This may be inuenced by the level of training each instructor had
received prior to the intervention analysis; all of the teachers had undergraduate
degrees, and two of them were enrolled in graduate school programs. This amount
of educational and vocational expertise may explain their baseline performance.
Further research is required to determine whether teachers with less formal training
would respond similarly.
Additionally, the study was conducted with all of the teachers in the same classroomthis situation could also have inuenced intervention integrity. However,
the data presented in Figure 1 show that each teacherstudent dyad was not
inuenced by the sequentially introduced phases that were in effect with the other
teacherstudent dyads. Some of the factors that may have contributed to independence within phases and across the teacherstudent dyads include the different
combination of procedures in each students BSP and the familiar presence of the
consultant in the classroom. Finally, although the teachers may have reacted to the
rst author observing and recording data, Codding, Livanis, Pace, and Vaca (2008)
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found that intervention integrity of classroom teachers was not affected differently by
the presence and absence of observers. Again, visibility of the rst author in the
classroom likely obviated possible reactivity.
The positive results from PSC differed among the three teachers. Mr. Smith, for
example, required two consultation meetings before his intervention integrity
increased and stabilized at 90% for the remainder of the PF + PSC phase. It should
be pointed out that these results may have been attributable to a ceiling effect that
was evident in the preceding phases. Ms. Harris, on the other hand, had an initial
positive response to PSC, which gradually decreased and required a second meeting to boost her performance once again. Mr. Stadler also improved his
intervention integrity with PSC, achieving 100%, notwithstanding that these data
were recorded during only two classroom observations. We emphasize that the
focus of PSC was asking the teachers to identify barriers to BSP implementation
and recommend possible solutions with supportive advice from the consultant.
For example, the consultation sessions claried and modied BSPs by introducing
procedures such as posting visual reminders in the classroom, revising instructional
prompting procedures, changing a students activity schedule, and conducting a
preference assessment to identify more potent reinforcement. Moreover, these
sessions highlighted specic areas for further staff training. Therefore, in contrast
to PF alone, PSC produced procedural changes to already existing BSPs. Although
few studies have done so (Noell et al., 2000), having practitioners help design
and revise BSPs may be a motivational strategy to improve their intervention
integrity.
Some aspects of the intervention integrity training procedures should be discussed
further. As noted previously, PF featured immediate correction of implementation
errors and delayed behavior-contingent praise. We reasoned that immediate correction was necessary to prevent potential problems that could occur if the teachers
were allowed to apply BSP procedures inaccurately. The praise component of PF
was delayed to avoid further interruption to teachers and students. Certainly, the
teachers may have reacted differently if the consultant provided both correction and
praise at the same time.
With regard to PSC, we acknowledge that it included many procedures that were
not identical among teachers. For example, the process of having teachers discuss
and propose barriers to implementation produced several changes to BSPs that
affected general classroom organization and instructional methods. Although we
cannot quantify all of these modications across the teacherstudent dyads, PSC
may have resulted in more effective BSPs, which, in turn, was associated with
improved intervention integrity. The 2030 min per PSC meeting was purposefully
variable to afford teachers ample time to address implementation concerns and
remedies with the consultant.
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Finally, and as alluded to earlier, there were varying trends in intervention integrity
among the three teacherstudent dyads within and across experimental phases. The
data for Mr. Smith did not change appreciably until the nal 4 days of the study when
he achieved 100% intervention integrity. Ms. Harris, on the other hand, had a
gradually increasing trend in her intervention integrity percentage during baseline,
which stabilized in the PF phase, then increased to a higher level with PSC. The most
pronounced changes in intervention integrity occurred with Mr. Stadlerhis
improvement was associated with the introduction on PF and subsequently PSC.
Because of classroom stafng changes, we were unable to measure intervention
integrity following the study (Codding et al., 2005; Mortenson & Witt, 1998).
However, poor maintenance might be resolved by re-implementing intervention
integrity assessments and, if needed, scheduling additional consultation that
addresses BSP procedures. Ideally, it would be desirable to establish high levels of
intervention integrity that can then be sustained while systematically reducing
frequency of assessments and consultation meetings (Noell et al., 2000; Noell
et al., 2005). Another limitation is that many of the BSP consequence components
were not observed in the study because the students did not emit specic target
responses. More frequent occurrence of these responses might have impacted BSP
implementation and intervention integrity. One additional constraint is that the study
did not evaluate if improved intervention integrity was associated with students
achieving instructional objectives and having fewer problem behaviors. Lastly,
scheduling constraints among school personnel limited the percentage of days we
were able to assess IOA.
In summary, our ndings support previous research suggesting that a combination
of methods improves intervention integrity more than PF alone (DiGennaro et al.,
2005; Noell et al., 2002). Furthermore, we found that brief PSC may be an effective
strategy to augment conventional intervention integrity assessment. Although we did
not include formal social validity assessment (Wolf, 1978), anecdotally, the teachers
remarked positively about the PF and PSC they received. Of course, practitioner
acceptability and satisfaction should be considered when judging the success of
supervisory and staff training models within educational and clinical settings
(Luiselli, 2013, 2014). Additional direction for future research would be analyzing
differential effects of PF procedures (reinforcement and correction) on overall intervention integrity as well as antecedent and consequence procedures specically.

ACKNOWLEDGEMENTS
This study was conducted at the May Center School for Autism and Developmental
Disabilities, Randolph, Massachusetts. We thank the teachers and students for their participation.
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