Tiered Systems of Adaptive Supports and the Individualization of Intervention: Merging Developmental Cascades and Correlated Constraints Perspectives

2020 ◽  
pp. 106342662095765
Author(s):  
Thomas W. Farmer ◽  
Karen L. Bierman ◽  
Cristin M. Hall ◽  
Debbie S. Brooks ◽  
David L. Lee
Keyword(s):  
Evidence Based ◽  
Tier 2 ◽  
Research Strategies ◽  
Long Term Outcomes ◽  
Developmental System ◽  
Introductory Article ◽  
General Classroom ◽  
Tier 1 ◽  
Tier 3

Although tremendous advances have been made in the development of evidence-based services and strategies to prevent and treat emotional and behavioral disorders (EBDs) in children, often such programs may be necessary but not sufficient to address the circumstances and needs of a specific student. The purpose of this introductory article and this broader special issue on the adaptation and individualization of evidence-based approaches for students with EBD is to consider innovations for tailoring multifactored interventions within tiered systems of support. In this article, we discuss potential ways that current tiered models may be strengthened using information and research strategies from developmental science to more rigorously link intervention to long-term outcomes of youth. We center this discussion on the concepts of developmental cascades and correlated constraints. We then present Tiered Systems of Adaptive Supports (TSAS) as a framework that is developmentally informed to guide individualized intervention. In this model, Tier 1 focuses on adapting general classroom strategies to support the routine daily functioning of all students; Tier 2 focuses on preventing the negative reorganization of a student’s developmental system; and Tier 3 focuses on promoting the positive reorganization of a student’s developmental system.

Multitiered Systems of Supports, Response to Intervention, and Positive Behavioral Interventions and Supports

2021 ◽  
pp. 107-117
Author(s):  
Samantha Bates ◽  
LaShonda Linnen ◽  
Stephanie Columbia ◽  
Dawn Anderson-Butcher
Keyword(s):  
Response To Intervention ◽  
Social Workers ◽  
Behavioral Interventions ◽  
Evidence Based ◽  
Tier 2 ◽  
Students At Risk ◽  
Positive Behavioral Interventions ◽  
School Based ◽  
Tier 1 ◽  
Tier 3

This chapter covers the Response to Intervention framework, Positive Behavioral Interventions and Supports, and multitiered systems of supports (MTSS). The Response to Intervention framework is a central step in implementing a successful MTSS framework. MTSS delivers school-based supports across three tiers: tier 1 (universal), tier 2 (targeted), and tier 3 (individualized). The MTSS framework is a resource that enables schools to use data not only to identify students at risk for poor learning outcomes but also to monitor student progress and deliver evidence-based interventions. The chapter provides examples of ways social workers can maximize the utility of these models and school teams to improve student outcomes.

Optimal Timing for Launching Installation of Tier 2 and 3 Systems of School-Wide Positive Behavioral Interventions and Supports

2021 ◽  
pp. 109830072199608
Author(s):  
Angus Kittelman ◽  
Sterett H. Mercer ◽  
Kent McIntosh ◽  
Robert Hoselton
Keyword(s):  
Longitudinal Study ◽  
Behavioral Interventions ◽  
Structural Equation ◽  
Equation Modeling ◽  
Optimal Timing ◽  
First Year ◽  
Tier 2 ◽  
Positive Behavioral Interventions ◽  
Tier 1 ◽  
Tier 3

The purpose of this longitudinal study was to examine patterns in implementation of Tier 2 and 3 school-wide positive behavioral interventions and supports (SWPBIS) systems to identify timings of installation that led to higher implementation of advanced tiers. Extant data from 776 schools in 27 states reporting on the first 3 years of Tier 2 implementation and 359 schools in 23 states reporting on the first year of Tier 3 implementation were analyzed. Using structural equation modeling, we found that higher Tier 1 implementation predicted subsequent Tier 2 and Tier 3 implementation. In addition, waiting 2 or 3 years after initial Tier 1 implementation to launch Tier 2 systems predicted higher initial Tier 2 implementation (compared with implementing the next year). Finally, we found that launching Tier 3 systems after Tier 2 systems, compared with launching both tiers simultaneously, predicted higher Tier 2 implementation in the second and third year, so long as Tier 3 systems were launched within 3 years of Tier 2 systems. These findings provide empirical guidance for when to launch Tier 2 and 3 systems; however, we emphasize that delays in launching advanced systems should not equate to delays in more intensive supports for students.

scholarly journals Global Inland Capture and Culture Finfisheries Follow Different Trends When Evaluated by the Human Development Index

2021 ◽  
Vol 13 (15) ◽  
pp. 8420
Author(s):  
Peter W. Sorensen ◽  
Maria Lourdes D. Palomares
Keyword(s):  
Socioeconomic Factors ◽  
Human Development ◽  
Human Development Index ◽  
Developed Countries ◽  
Global Scale ◽  
Tier 2 ◽  
Development Index ◽  
Tier 1 ◽  
Catch Reconstruction ◽  
Tier 3

To assess whether and how socioeconomic factors might be influencing global freshwater finfisheries, inland fishery data reported to the FAO between 1950 and 2015 were grouped by capture and culture, country human development index, plotted, and compared. We found that while capture inland finfishes have greatly increased on a global scale, this trend is being driven almost entirely by poorly developed (Tier-3) countries which also identify only 17% of their catch. In contrast, capture finfisheries have recently plateaued in moderately-developed (Tier-2) countries which are also identifying 16% of their catch but are dominated by a single country, China. In contrast, reported capture finfisheries are declining in well-developed (Tier-1) countries which identify nearly all (78%) of their fishes. Simultaneously, aquacultural activity has been increasing rapidly in both Tier-2 and Tier-3 countries, but only slowly in Tier-1 countries; remarkably, nearly all cultured species are being identified by all tier groups. These distinctly different trends suggest that socioeconomic factors influence how countries report and conduct capture finfisheries. Reported rapid increases in capture fisheries are worrisome in poorly developed countries because they cannot be explained and thus these fisheries cannot be managed meaningfully even though they depend on them for food. Our descriptive, proof-of-concept study suggests that socioeconomic factors should be considered in future, more sophisticated efforts to understand global freshwater fisheries which might include catch reconstruction.

Incorporation of plasma-based next-generation sequencing to improve guideline-concordant molecular testing in patients with newly diagnosed metastatic nonsquamous non-small cell lung cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 14-14
Author(s):  
Charu Aggarwal ◽  
Melina Elpi Marmarelis ◽  
Wei-Ting Hwang ◽  
Dylan G. Scholes ◽  
Aditi Puri Singh ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Change ◽  
Molecular Testing ◽  
Tier 2 ◽  
Newly Diagnosed ◽  
Next Generation ◽  
First Line ◽  
Tier 1 ◽  
Tier 3 ◽  
The Impact

14 Background: Current NCCN guidelines recommend comprehensive molecular profiling for all newly diagnosed patients with metastatic non-squamous NSCLC to enable the delivery of personalized medicine. We have previously demonstrated that incorporation of plasma based next-generation gene sequencing (NGS) improves detection of clinically actionable mutations in patients with advanced NSCLC (Aggarwal et al, JAMA Oncology, 2018). To increase rates of comprehensive molecular testing at our institution, we adapted our clinical practice to include concurrent use of plasma (P) and tissue (T) based NGS upon initial diagnosis. P NGS testing was performed using a commercial 74 gene assay. We analyzed the impact of this practice change on guideline concordant molecular testing at our institution. Methods: A retrospective cohort study of patients with newly diagnosed metastatic non-squamous NSCLC following the implementation of this practice change in 12/2018 was performed. Tiers of NCCN guideline concordant testing were defined, Tier 1: complete EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, Tier 2: included above, but with incomplete NTRK testing, Tier 3: > 2 genes tested, Tier 4: single gene testing, Tier 5: no testing. Proportion of patients with comprehensive molecular testing by modality (T NGS vs. T+P NGS) were compared using one-sided Fisher’s exact test. Results: Between 01/2019, and 12/2019, 170 patients with newly diagnosed metastatic non-Sq NSCLC were treated at our institution. Overall, 98.2% (167/170) patients underwent molecular testing, Tier 1: n = 100 (59%), Tier 2: n = 39 (23%), Tier 3/4: n = 28 (16.5%), Tier 5: n = 3 (2%). Amongst these patients, 43.1% (72/167) were tested with T NGS alone, 8% (15/167) with P NGS alone, and 47.9% (80/167) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS: 95.7% (79/80) compared to T alone: 62.5% (45/72), p < 0.0005. Prior to the initiation of first line treatment, 72.4% (123/170) patients underwent molecular testing, Tier 1: n = 73 (59%), Tier 2: n = 27 (22%) and Tier 3/4: n = 23 (18%). Amongst these, 39% (48/123) were tested with T NGS alone, 7% (9/123) with P NGS alone and 53.6% (66/123) with T+P NGS. A higher proportion of patients underwent comprehensive molecular testing (Tiers 1+2) using T+P NGS, 100% (66/66) compared to 52% (25/48) with T NGS alone (p < 0.0005). Conclusions: Incorporation of concurrent T+P NGS testing in treatment naïve metastatic non-Sq NSCLC significantly increased the proportion of patients undergoing guideline concordant molecular testing, including prior to initiation of first-line therapy at our institution. Concurrent T+P NGS should be adopted into institutional pathways and routine clinical practice.

Evidence-Based Cognitive Rehabilitation for People With Multiple Sclerosis: A Systematic Review

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512520385p1-7512520385p1
Author(s):  
Yu-Chih Chen ◽  
Szu-Wei Chen ◽  
Britney Ferri
Keyword(s):  
Processing Speed ◽  
Cognitive Skills ◽  
Cognitive Rehabilitation ◽  
Evidence Based ◽  
Long Term Outcomes ◽  
Noninvasive Brain Stimulation ◽  
Future Studies ◽  
Cognitive Improvement ◽  
Computer Based

Abstract Date Presented 04/22/21 Computer-based programs, conventional cognitive rehabilitation, neurologic music therapy, and noninvasive brain stimulation are effective in improving memory and learning, processing speed, language, executive function, or general cognitive skills. However, the retention of treatment effects and the generalizability of the cognitive improvement to the daily occupations are not clear. Including a predetermined single outcome, functional and long-term outcomes are needed in future studies. Primary Author and Speaker: Yu-Chih Chen Contributing Authors: Nicole Gerhardt, Christina Calhoun Thielen, Winnie Dunn, and Mary Jane Mulcahey

scholarly journals Initial Experience in Predicting the Risk of Hospitalization of 496 Outpatients with COVID-19 Using a Telemedicine Risk Assessment Tool

2020 ◽  
Author(s):  
James B O'Keefe ◽  
Elizabeth J Tong ◽  
Thomas H Taylor ◽  
Ghazala D Datoo O'Keefe ◽  
David C Tong
Keyword(s):  
Risk Assessment ◽  
Assessment Tool ◽  
Cox Regression ◽  
Risk Assessment Tool ◽  
Individual Risk ◽  
Tier 2 ◽  
Tier 1 ◽  
Risk Patients ◽  
Tier 3

Objective: To determine whether a risk prediction tool developed and implemented in March 2020 accurately predicts subsequent hospitalizations. Design: Retrospective cohort study, enrollment from March 24 to May 26, 2020 with follow-up calls until hospitalization or clinical improvement (final calls until June 19, 2020) Setting: Single center telemedicine program managing outpatients from a large medical system in Atlanta, Georgia Participants: 496 patients with laboratory-confirmed COVID-19 in isolation at home. Exclusion criteria included: (1) hospitalization prior to telemedicine program enrollment, (2) immediate discharge with no follow-up calls due to resolution. Exposure: Acute COVID-19 illness Main Outcome and Measures: Hospitalization was the outcome. Days to hospitalization was the metric. Survival analysis using Cox regression was used to determine factors associated with hospitalization. Results: The risk-assessment rubric assigned 496 outpatients to risk tiers as follows: Tier 1, 237 (47.8%); Tier 2, 185 (37.3%); Tier 3, 74 (14.9%). Subsequent hospitalizations numbered 3 (1%), 15 (7%), and 17 (23%) and for Tiers 1-3, respectively. From a Cox regression model with age ≥ 60, gender, and self-reported obesity as covariates, the adjusted hazard ratios using Tier 1 as reference were: Tier 2 HR=3.74 (95% CI, 1.06-13.27; P=0.041); Tier 3 HR=10.87 (95% CI, 3.09-38.27; P<0.001). Tier was the strongest predictor of time to hospitalization. Conclusions and Relevance: A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified both low-risk and high-risk patients with better performance than individual risk factors alone. This approach may be appropriate for optimum allocation of resources.

Transactional theory and research on emotions and coping

1987 ◽  
Vol 1 (3) ◽  
pp. 141-169 ◽  
Author(s):  
Richard S. Lazarus ◽  
Susan Folkman
Keyword(s):  
Final Section ◽  
Cognitive Appraisal ◽  
Relational Theory ◽  
Methodological Issues ◽  
Research Strategies ◽  
Long Term Outcomes ◽  
Short Term ◽  
And Coping ◽  
Dynamic Interplay

In this article we examine the fundamental premises of our cognitive‐relational theory of emotion and coping and assess our progress in examining them through 10 years of programmatic empirical research. Our discussion involves the metatheoretical topics of transaction and relationship, process, and emotion as a system. The person‐environment relationship is mediated by two key processess: cognitive appraisal and coping. We evaluate the findings of our research on these processes, their dynamic interplay, their antecedents, and their short‐term and long‐term outcomes. In the final section we highlight major substantive and methodological issues that need to be addressed. These include issues surrounding the theory and measurement of appraisal, functional and dysfunctional coping, causal inference, microanalytic vs macroanalytic research strategies, objective vs subjective approaches and confounding, and the problem of method variance.

SFBT Within the Tier 2 Framework

2017 ◽  
Author(s):  
Michael S. Kelly ◽  
Johnny S. Kim ◽  
Cynthia Franklin
Keyword(s):  
Classroom Climate ◽  
Tier 2 ◽  
Social Emotional ◽  
Prevention Services ◽  
Coaching Intervention ◽  
Tier 1 ◽  
American Schools ◽  
Tier 2 Intervention ◽  
Tier 3 ◽  
Teacher Coaching

The educational policy changes of the past 20 years have increased the focus on the provision of prevention services within schools, both for individual students and for social-emotional programming delivered in their classroom. Whether characterized as Response to Intervention (RTI), Positive Behavior Intervention and Supports (PBIS), or Multi-Tiered Systems of Supports (MTSS), the focus on a 3-tier framework of universal (Tier 1), selective (Tier 2) and indicated (Tier 3) has become one of the largest evidence-based framework ever scaled up within American schools, with over 19,000 schools across all 50 states having implemented PBIS by this writing. This chapter focuses on an example of a SFBT Tier 2 intervention, the Working on What Works (WOWW) teacher coaching intervention, that strives to create a better classroom climate for teachers and their students.

Response to Intervention

2020 ◽  
Author(s):  
Evelyn S. Johnson
Keyword(s):  
Response To Intervention ◽  
General Education ◽  
Progress Monitoring ◽  
Instructional Program ◽  
Evidence Based ◽  
Tier 2 ◽  
Academic Challenges ◽  
Essential Components ◽  
Tier 1 ◽  
Tier 2 Intervention

Response to intervention (RTI) is a framework that can help ensure the academic strengths and needs of students are met effectively and efficiently. Patterned on a public health model of prevention, the focus of RTI is on preventing and intervening for academic challenges through a system of increasingly intensive supports, where the least intensive but most effective option is the most desirable. RTI models consist of the key essential components of effective inclusive instruction, universal screening, progress monitoring, data-based instructional decision-making, tiered levels of evidence-based and culturally responsive interventions, and fidelity of implementation. When the RTI framework is well implemented, most students are successful in the general education environment. In the general education classroom, teachers provide quality core, or Tier 1, instruction for all students. Even with high-quality instruction, however, not all students will be successful. Between 10 and 15% of the student population will likely need more intensive academic support at some point during their schooling, typically referred to as Tier 2 intervention. Tier 2 provides a system of evidence-based intervention, designed to meet the needs of most students at risk for poor academic outcomes. Tier 2 interventions are meant to be short in duration, focused on improving skill deficits that interfere with students’ success, and comprised of systematic approaches to providing student support. For some students whose needs cannot be met through Tier 1 or 2 instruction, an even more intensive level of intervention will be required. Tier 3 consists of specially designed interventions to support the needs of students who require a more individualized, intensive instructional program. Through this multi-leveled prevention system, the RTI framework provides supports to students that are appropriate to their needs within an environment of equity, efficiency, and accountability. With a well-structured, rigorous implementation of RTI, schooling becomes much more fluid and responsive to meet student needs.

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