The effects of a targeted intervention to reduce problem behaviors: elementary school implementation of check in-check out.(Report)

Behavior support in schools is increasingly viewed as a three-tier prevention effort in which universal interventions are used for primary prevention, targeted interventions are used for secondary prevention, and intensive interventions are used for tertiary prevention. A growing body of research has demonstrated the effectiveness of targeted interventions in decreasing the frequency of problem behaviors. The Check In-Check Out Program (CICO) is becoming a recognized targeted intervention. The present study examines if there is a functional relation between the implementation of CICO and a reduction in problem behaviors. Results indicate that implementation of CICO with four elementary school-age boys was functionally related to a reduction in problem behavior. Clinical and conceptual implications of these results, methodological limitations, and future research directions are reviewed.

Keywords: check in-check out; behavior education program; targeted intervention; secondary intervention; check and connect; school-wide interventions; challenging behaviors; elementary school students

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School-wide positive behavior support (SWPBS) is a systems-level approach to building the social culture and behavioral supports needed for schools to be effective learning environments for all students. The approach builds on the three-tiered community health prevention model proposed by Walker et al. (1996), with (a) universal behavior support systems for all students, (b) secondary or targeted levels of support for students at risk of succeeding without additional support, and (c) tertiary support that includes function-based support for individualized, intensive interventions. Schoolwide PBS is a well-documented strategy for establishing a positive school culture at the universal level (Horner, Sugai, Todd, & Lewis-Palmer, 2005; Walker et al., 1996). To date, research has emphasized the impact of universal and intensive interventions (Nelson, Martella, & Marchand-Martella, 2002; Metzler, Biglan, & Rusby, 2001; Todd, Horner, Sugai, & Sprague, 1999; Todd, Horner, Sugai, & Colvin, 1999; Walker et al., 1996). Recently, however, the value of targeted interventions has gained more attention as educators search for highly efficient strategies for preventing and addressing problem behavior (Crone, Horner, & Hawken, 2003; Fairbanks, Sugai, Guardino, & Lathrop, in press; Filter et al., in press; Hawken & Horner, 2003; Lewis & Sugai, 1999; March & Horner, 2002).

Targeted interventions may include strategies such as social skills training, check in-check out systems, First Step to Success, peer mentors, or homework clubs (Crone et al., 2003; Hawken & Horner, 2003; Lewis & Sugai, 1999; Nelson and Carr, 1996; Walker, Severson, & Feil, 1998). Targeted interventions are designed to provide efficient behavior support for students at risk of more intense problem behavior. Three elements have been identified as key to effective, targeted interventions: organizational systems, intervention practices, and data use (Horner et al., 2005). System variables include team based planning, data-driven decisions, a program plan known by all staff, program availability for implementation at any time, and the the inclusion of a regular home-school communication exchange in the program. Practices for targeted interventions include teaching the student the skills, teaching the student when to use the skills, teaching the student the routine for using the targeted intervention, teaching the home report routine, and teaching the banking and shopping routine. Data variables include individual student progress data, fidelity data on use of the program, and summary data of program use overall. Each of these elements (system variables, practices, and data) work in concert to meet the defined outcomes for developing, implementing, and monitoring targeted interventions.

The check in-check out (CICO) approach to targeted behavior support is based on a simple strategy for increasing ongoing structure and feedback for at-risk students. The elements of CICO systems have been used in schools for many years (Blechman, Taylor, & Schrader, 1981; Burkwist, Mabee, & McLaughlin, 1987; Chafouleas, McDougal, Riley-Tillman, Panahon, & Hilt, 2005; Chafouleas, Riley-Tillman, & McDougal, 2002; Condon & Tobin, 2001; Fairchild, 1983; Galloway & Sheridan, 1994; Schumaker, Hovell, & Sherman, 1977; Stein, 1999; Struckoff, McLaughlin, & Bialozor, 1987).

The tactic for increasing structure and feedback in the CICO approach revolves around the use of a behavior report card. Behavior report cards have appeared in the literature since the 1980s with documented success (Davies & McLaughlin, 1989; Dougherty & Dougherty, 1977; Crone et al., 2003; Hawken & Horner, 2003). Depending on the structure of the behavior report card, it can provide (a) structure and prompts that students need through the day, (b) adult written feedback through the day, (c) visual reminders of personal goals for the day, (d) data collection, and (e) communication between adults at school and home.

To fit the definition of a targeted intervention, the CICO system needs to be continuously available to staff, students, and families and include a plan for instruction of the system and skills needed for the student using the CICO system. CICO systems typically include increased monitoring and feedback to students about their behavior, positive reinforcement of desirable behavior, and a home-school component (Davies & McLaughlin, 1989; Dougherty & Dougherty, 1977; Hawken & Horner, 2003). Students check in with school personnel in the morning, receive feedback throughout the day, and then check out with school personnel before they leave. Typically, the child earns points to receive some form of daily reinforcer. CICO systems have documented success (Condon & Tobin, 2001; Davies & McLaughlin, 1989; Dougherty & Dougherty, 1977; Hawken & Horner, 2003; Fairchild, 1983; Schumaker, et al., 1977; Stein, 1999), especially for children who engage in problem behaviors maintained by adult attention (March & Horner, 2002).

The present study examines the effect of the CICO program when implemented by typical school personnel under typical school conditions with one kindergartener, one first grader, one second grader and one third grader. The specific research question was, "Is there a functional relation between implementation of check in-check out and reduction in the frequency of problem behaviors?"

Method

Setting

The study took place in a rural elementary school (Grades K-5) of 472 students located in the Pacific Northwest. The school provided two instructional options for students: English instruction only, or half-day English and half-day Spanish. There were 217 students in the English-only section and 255 students in the Spanish immersion section of the school. As measured by the School-Wide Evaluation Tool (Horner et al., 2004), the school had an average overall implementation mean score of 97% for the past three school years, indicating that primary prevention elements of schoolwide …