Check incheck out effects on students with emotional and behavioral disorders with attention or escape maintained behavior in a residential facility

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Check In/Check Out: Effects on Students
with Emotional and Behavioral Disorders
with Attention- or Escape-Maintained
Behavior in a Residential Facility
a

b

b

Nicole Cain Swoszowski , Kristine Jolivette , Laura D. Fredrick &
L. Juane Heflin
a

b

The University of Alabama

b

Georgia State University
Published online: 20 Jul 2012.

To cite this article: Nicole Cain Swoszowski , Kristine Jolivette , Laura D. Fredrick & L. Juane
Heflin (2012) Check In/Check Out: Effects on Students with Emotional and Behavioral Disorders with
Attention- or Escape-Maintained Behavior in a Residential Facility, Exceptionality: A Special Education
Journal, 20:3, 163-178, DOI: 10.1080/09362835.2012.694613
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Exceptionality, 20:163–178, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 0936-2835 print/1532-7035 online
DOI: 10.1080/09362835.2012.694613

Check In/Check Out: Effects on Students with
Emotional and Behavioral Disorders with
Attention- or Escape-Maintained Behavior
in a Residential Facility
Nicole Cain Swoszowski
The University of Alabama

Kristine Jolivette, Laura D. Fredrick, and L. Juane Heflin
Georgia State University

Check In/Check Out (CICO) is a secondary tier intervention for those students who are not
responsive to universal tier, school-wide positive behavioral interventions and supports. The present
study extended the implementation of CICO to six students with emotional and behavioral disorders
in a residential facility whose behaviors were maintained by either attention or escape. Results of
a nonconcurrent multiple baseline across participants design indicate that the mean percentage of
problem behavior improved for two of three students with attention-maintained behavior and two
of three students with escape-maintained behavior. Future directions and limitations of the research
are addressed.

Students with emotional and behavioral disorders (E/BD) demonstrate maladaptive behaviors
that may affect social and academic performance and may then lead to the isolation of students
with E/BD from their same age peers (Coutinho, 1986). Students with E/BD are the most likely
of all disability groups to require supports in alternative education (AE) settings. According
to the National Center on Education Statistics (NCES, 2001), 33% to 75% of students served

in alternative school settings have an E/BD eligibility. Tobin and Sprague (2000) cited several
effective practices for AE settings including highly structured classroom management, an
emphasis on positive-behavior management, the inclusion of adult mentors at the school,
the inclusion of function-based assessment, and social-skills instruction. A research-based
framework that incorporates these noted effective practices is positive behavioral interventions
and supports (PBIS; Flower, McDaniel, & Jolivette, 2011).
Correspondence should be addressed to Nicole Cain Swoszowski, Department of Special Education and Multiple
Abilities Program, The University of Alabama, Box 870232, Tuscaloosa, AL 35487. E-mail:

163


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PBIS is a three-tier proactive and preventative framework (Sugai & Horner, 2002) based
on the theory of behaviorism and the principles of applied behavior analysis, which involves the fundamentals of conditioning behavior through the modification of antecedents
and consequences (Dunlap, 2006; Sugai & Horner, 2002). Researchers have evaluated the
effectiveness of universal and tertiary tier PBIS interventions within typical school settings but
have not evaluated secondary tier interventions as thoroughly (Hawken, Adolphson, Macleod,
& Schumann, 2009). There is a need for further evaluation of secondary tier interventions
to meet effectively the needs of those students who require more targeted supports than are
available at the universal level, such as students with E/BD. Secondary tier interventions also
are critical to prevent the need for resource intensive individualized supports at the tertiary
tier (Horner, Sugai, Todd, & Lewis-Palmer, 2005; Sugai & Horner, 2002). Secondary tier
interventions are noted as being (a) designed in combination with school-wide expectations;
(b) adapted to address the function of behavior, when needed; and (c) implemented quickly

and efficiently as multiple students can be addressed at one time, and the intervention can be
implemented quickly using materials and personnel already available in the school environment
(Hawken et al., 2009). One such secondary tier intervention is Check In/Check Out (CICO),
which may be appropriate for students with E/BD who require support beyond the universal
tier.
CICO originated as the Behavior Education Plan (BEP; Hawken & Horner, 2003; Hawken,
MacLeod, & Rawlings, 2007; March & Horner, 2002) and is based on the fundamentals of a
daily report card. The use of daily report cards is noted as a reliable means for accurately documenting student behavior as well as for providing behavioral feedback to students (Chafouleas,
McDougal, Riley-Tillman, Panahon, & Hilt, 2005; Riley-Tillman, Chafouleas, Briesh, & Eckert,
2008). Students are typically chosen for CICO based on nonresponsiveness to universal, schoolwide PBIS as indicated by discipline referrals. Two to five office discipline referrals (ODRs)
within a school year is a recommended criterion for secondary tier referral (Crone, Horner,
& Hawken, 2004; Horner et al., 2005); however, some CICO studies have included students
based on general problem behaviors or administrator/teacher recommendations (Campbell &
Anderson, 2008; Fairbanks, Sugai, Guardino, & Lathrop, 2007; Filter et al., 2007; Hawken
& Horner, 2003; Hawken et al., 2007; March & Horner, 2002; Todd, Campbell, Meyer, &
Horner, 2008). When CICO is implemented, a student is paired with an adult mentor (CICO
facilitator) to encourage positive, appropriate behavior throughout the school day. Students
complete a 5-step CICO cycle including check in with the facilitator at the beginning of the
school day to set behavior goals for the day and check out with the facilitator at the end of
the day to determine if daily goals were met. During the school day, the student’s behavioral
performance is assessed per class period by each teacher. In addition, the student takes the
CICO point sheet home to discuss daily behavior with parents to provide collaboration and
planned communication between the school and home environments.
The presence of the CICO facilitator and adult in the home environment provide adult
attention within the 5-step CICO cycle, thus leading researchers (March & Horner, 2002;
McIntosh, Campbell, Carter, & Dickey, 2009) to hypothesize that function of behavior may
relate to student responsiveness to CICO especially for students with adult-attention-maintained
behavior who may be more likely to respond to CICO. To assess function, researchers conduct
functional behavior assessments (FBAs) to determine the antecedents that precede or predict
behavior and the consequences that follow or maintain behavior, with function in two pri-

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mary categories: (a) to gain (attention, tangible, sensory stimulation), and (b) to escape/avoid
(demand, attention, sensory stimulation) (Iwata, Dorsey, Slifer, Bauman, & Richman, 1982;
Maag, 2004; Sugai, Lewis-Palmer, & Hagan-Burke, 1999). Four CICO studies have included
an FBA as part of the initial CICO intervention phase (Campbell & Anderson, 2008; March
& Horner, 2002; McIntosh et al., 2009; Simonsen, Myers, & Briere, 2010) but with mixed
approaches: (a) March and Horner (2002) conducted the Functional Assessment Checklist
for Teachers and Staff (FACTS; March et al., 2000) interview after the CICO intervention
period ended, (b) Campbell and Anderson (2008) used both the FACTS and brief observation
to determine peer-attention–maintained behavior for two students prior to intervention for
reading and during intervention for math, (c) McIntosh and colleagues (2009) assessed function
using the FACTS interview one to five days before beginning intervention, and (d) Simonsen
and associates (2010) administered FACTS interviews prior to intervention as a descriptive
measure, not to determine responsiveness by function. To date, no studies have assessed
function a priori for nomination purposes using an FBA protocol including archival record
reviews, teacher interviews, and classroom observations to determine the relationships between
antecedents, behavior, and consequences to identify either escape-maintained or attentionmaintained behavior. While the use of an a priori FBA approach as part of the nomination
process may appear in direct contrast with the resource efficient benefits of secondary tier
interventions noted previously, interviews alone are not a recommended approach (Horner,
Albin, Sprague, & Todd, 1999; O’Neill et al., 1997) and the thorough evaluation of function for
research purposes to scientifically evaluate the likelihood of response per function is a necessary
contribution to the CICO research literature. Without the addition of a priori assessment of
function, it is not possible to determine the accurate assessment of function of inappropriate

behavior without the impact of the intervention potentially confounding the results of the FBA
as function can change throughout an intervention period over time (March & Horner, 2002).
Of the nine published empirical CICO studies and the two conceptual CICO papers, as
identified through a literature search, researchers have evaluated the effectiveness of CICO
across traditional elementary (Campbell & Anderson, 2008; Fairbanks et al., 2007; Filter et al.,
2007; Hawken et al., 2007; McIntosh et al., 2009; Todd et al., 2008) and middle school settings
(Hawken & Horner, 2003; March & Horner, 2002; Simonsen et al., 2010) with 136 students
(94 males, 23 females; gender not reported by Filter et al., 2007) in Kindergarten through
ninth grade. Of the 136 total participants, 11 received services through special education;
3 with learning disabilities and 8 with a disability that was not specified. A majority of
students exposed to CICO have demonstrated decreases in problem behavior as evidenced
by (a) mean changes in percentage of intervals with problem behavior (Campbell & Anderson,
2008; Fairbanks et al., 2007; Hawken & Horner, 2003; Todd et al., 2008), (b) decreases in
ODRs and/or discipline contact (Filter et al., 2007; Hawken et al., 2007; March & Horner, 2002;
McIntosh et al., 2009), (c) decreases in problem behavior ratings (McIntosh et al., 2009), and
(d) increases in academic engagement (Hawken & Horner, 2003). To assist in the generalization
of the effects of CICO beyond the current 9 studies, it is critical to include (a) students with
disabilities (e.g., those with E/BD), (b) settings outside typical schools (e.g., AE settings: day
treatment, residential, juvenile justice), and (c) a priori FBAs as part of the nomination process.
In this study, researchers extended the 5-step CICO intervention to students with E/BD in an
AE setting, a residential facility, with problem behavior maintained by adult attention or escape
from demands with function assessed a priori. The research questions were: (a) What effect


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does CICO have on the attention-maintained problem behavior of students with E/BD? (b) What
effect does CICO have on the escape-maintained problem behavior of students with E/BD?

(c) Is the attention-maintained problem behavior of students with E/BD affected differently by
CICO than the escape-maintained problem behavior of students with E/BD?

METHOD

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Participants
Six students in grades 6 through 9 participated: three with problem behavior maintained by adult
attention (Tyrone, Leo, Daniel) and three with problem behavior maintained by escape from demands (Kevin, Natalie, Nathan). The students participated if they (a) received two to five office
discipline referrals (ODRs) since the beginning of the school year prior to baseline, (b) lived
at the residential facility, (c) had a primary eligibility of E/BD, (d) demonstrated inappropriate
behavior maintained by either attention (from adults) or escape (from demands) per the a priori
FBA, (e) were in grades 6 through 12, and (f) provided informed consent. Researchers used the
school-wide information system database (SWIS; May et al., 2000) to determine the number
of ODRs students received prior to baseline. Throughout baseline and intervention condition,
it was observed that teachers were writing ODRs for minor discipline infractions (e.g., use
of profanity, putting head down on desk) inconsistent with school procedures. Researchers
discussed this with the facility administrator, and even after the administrator conducted a
retraining session regarding ODR referrals no observable improvements were observed to the
referral process (i.e., inconsistencies between practice and procedure). Therefore, ODRs were
used for inclusion criteria only. Refer to Table 1 for student demographics.
Three teachers, three housing supervisors, and three housing staff served as CICO facilitators.
Each student was paired with one CICO facilitator (a teacher) for the school component of
CICO and a housing facilitator (either a housing staff or supervisor depending on shift) for
the home component. See Table 2 for facilitator demographics. See Table 3 for facilitator
assignments.

Setting
The study took place at an urban residential facility for students with E/BD in first through

twelfth grades. The maximum capacity of this facility is 74 students. Classes typically include
5 to 8 students, a teacher, and a behavior specialist to assist with behavioral issues on an as
needed basis. The school is structured as a typical public school but also provides housing for
students on campus. The classroom environments are like traditional school classrooms, and
instruction is consistent with that in traditional school settings with curricula linked to the State
performance standards. School-wide universal PBIS has been in place for three years and both
school and housing staff have been trained to implement universal PBIS. Fidelity of universal
PBIS was assessed using the School-Wide Evaluation Tool (SET; Sugai, Lewis-Palmer, Todd
& Horner, 2001) twice each year of universal implementation and all obtained scores exceeded
the minimum 80/80.


167

12
14
12
15
14
13

Tyrone
Leo
Daniel
Kevin
Nathan
Natalie

6
9

7
9
7
8

Grade

M
M
M
M
M
F

Gender
African American
Caucasian
Caucasian
Caucasian
Caucasian
Caucasian

Race/Ethnicity
Low
Low
Low
Low
Low
Low

SES
4
3
5
3
5
5

No. of ODRS at
Identification
Parental Custody
DFCS
DFCS
Parental Custody
DFCS
Parental Custody

Referral Source
22
36
43
37
39
6

months
months
months
months
months

months

Length of Stay
Prior to Study

2,
1,
1,
1,
1,
1,

3,
4,
2,
3,
2,
4,

4,
7
3,
6
5,
6,

6
7

7

7

Challenging
Behaviors

Attention
Attention
Attention
Escape
Escape
Escape

Function

Note. SES: students in the alternative education setting are considered in state custody. All students’ income falls in the range of low SES, and students are
eligible for free and reduced lunch; DFCS D Department of Family and Children Services; Challenging behaviors, per SWIS database: 1 D noncompliance, 2 D
destruction of property, 3 D physical aggression, 4 D inappropriate vocalizations, 5 D elopement, 6 D sleeping, 7 D disruption.

Age

Name

TABLE 1
Participant Demographics

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TABLE 2
Facilitator Demographics

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Name
Shannon
Luke
Katie
Ronald
Maria
Larry
Jennifer
Andrew
Marcy

Title/Location

Gender

Race/Ethnicity

Highest
Degree

Years of
Experience

Age

Teacher/School
Teacher/School
Teacher/School
Supervisor/Unit
Staff/Unit
Supervisor/Unit
Staff/Unit
Supervisor/Unit
Staff/Unit

Female
Male
Female
Male
Female
Male
Female
Male
Female

Caucasian
Caucasian
Caucasian
African American
African American
African American
Caucasian

African American
Caucasian

Bachelors
Bachelors
Bachelors
Bachelors
Bachelors
Bachelors
Bachelors
Bachelors
Bachelors

10
10
2
6
6
2
2
4
1

37
37
29
39
34
52
31

35
29

Materials
The materials used in this study included a daily CICO point card (referred to as a STAR point
chart), the FACTS (March et al., 2000), and a fidelity checklist.
Functional Behavior Assessment
Researchers conducted an FBA a priori according to the steps suggested by Sugai, LewisPalmer, and Hagan-Burke (1999). First, we analyzed information from ODR referrals. Second,
the two teachers who had the most daily contact with the students completed FACTS interviews.
During the FACTS interviews, the teachers indicated the behavior deemed most problematic for
each student and described in detail the topography of the behavior. In addition, teachers ranked
students’ problematic environments from most to least based on their experiences with the
students and on the locations noted on ODRs. Third, the researchers operationally defined the
target problem behavior for each student based on the descriptions of the behavior provided (see
Table 4). Fourth, we formed hypothesis statements based on the FBA data. Fifth, researchers
conducted 3 direct observations in the classrooms rated as most problematic and to confirm
if (a) the behavioral operational definition was accurate, and (b) the hypothesis statement was
supported by the antecedent-behavior-consequence (A-B-C) data collected.

TABLE 3
Facilitator Assignment
Student

School Facilitator

Housing Facilitator

Tyrone
Leo
Daniel

Kevin
Nathan
Natalie

Shannon
Shannon
Katie
Luke
Katie
Luke

Ronald
Maria
Larry
Jennifer
Andrew
Marcy


CHECK IN/CHECK OUT

169

TABLE 4
Definitions

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Name

Behavior

Tyrone

Disruption

Leo

Noncompliance

Daniel

Disruption

Kevin

Noncompliance

Nathan

Noncompliance

Natalie

Noncompliance

Definition
Speaking or making vocalizations without first gaining permission to speak from an
adult and/or without being engaged in conversation by an adult during classroom
instruction, independent work times, and during transitions—this can include use of

profanity and verbal insults toward teachers and peers
Verbally refusing to complete an assignment or to follow a request/demand, putting
head down on desk and/or closing eyes for more than 5 consecutive seconds, failing
to respond to or follow through with an assignment, a request, or a demand for
more than 5 consecutive seconds
Leaving designated area and/or moving around classroom; speaking or making
vocalizations without first gaining permission to speak from an adult—this can
include the use of profanity and verbal insults toward teachers and peers and noises
such as singing. Also included is intentional coughing and banging hands on desk
top or stomping feet on floor
Putting head down on desk and/or closing eyes for more than 5 consecutive seconds,
failing to respond to or follow through with an assignment, a request, or a demand
for more than 5 consecutive seconds
Putting head down on desk and/or closing eyes for more than 5 seconds, failing to
respond to or follow through with an assignment, a request, or a demand for more
than 5 consecutive seconds
Verbally refusing to complete an assignment or to follow a request/demand, putting
head down on desk and/or closing eyes for more than 5 consecutive seconds, failing
to respond to or follow through with an assignment, a request, or a demand for
more than 5 consecutive seconds

Dependent Variables and Data Collection
The dependent variable was percentage of intervals with problem behavior.
Percentage of intervals with problem behavior. Researchers documented the percentage
of intervals with problem behavior using a 10-second partial interval recording system for
20-minute direct observations. The target problem behavior observed was individualized per
student and observed in the most problematic classroom four times per week. See Table 4
for a description of target problem behavior per student. Observers wore an MP3 player with
headphones on a splitter for all observations. Researchers calculated the percentage of intervals
with target problem behavior by dividing the total number of intervals in which the problem

behavior occurred by the total number of intervals in the session, and multiplying by 100%.

Facilitator Training
All school staff serving as CICO facilitators attended a two-hour training session on the
implementation procedures of CICO. They were trained on the dialogue to have with students
each morning/afternoon, to complete the daily CICO point card (i.e., the STAR point chart),
and to complete a checklist as a means to guide them through the intervention steps. At the


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conclusion of the training, the facilitators role-played the procedure for both check in and check
out until they reached 100% fidelity using a variety of scenarios.
Housing facilitators attended a separate one-hour training (i.e., unit supervisor, housing
staff, school administrator). We scheduled this session separately from the school training to
accommodate staff scheduling patterns and the session was shorter in duration as only one step
of the five-step cycle was discussed. Housing staff were instructed on how to follow a checklist
as a guide for providing feedback to students and signing the CICO point chart each afternoon.
At the conclusion of the training they role-played the procedure for providing feedback and
signing the STAR point chart to 100% fidelity using a variety of scenarios.
All sixth through ninth grade teachers participated in a one-hour training on how to award
points for the daily CICO point card. The training included a demonstration of how to complete
the CICO point card per class period and examples and nonexamples of when students would
earn a 0, 1, or 2 on the CICO point card.
Research Design
A nonconcurrent multiple baseline across participants design was used (Kazdin, 1982; Kennedy,

2005) for both attention- and escape-maintained behavior so that responsiveness to the intervention by function could be assessed as students were identified for possible inclusion throughout
the semester. Researchers chose a nonconcurrent multiple baseline as this design is noted for
flexibility as participants can be added to intervention as they are identified given the transient
nature of the student population within AE settings.
Independent Variable
The independent variable was check in/check out. The baseline and intervention phases are
described next.
Baseline. Researchers conducted direct observation of the percentage of intervals with
problem behavior. School personnel continued implementation of the facility-wide PBIS (FWPBIS) universal tier supports where students were taught, modeled, and reinforced (e.g., given
STAR coupon) for engaging in the 4 facility-wide rules (i.e., show respect, take responsibility,
accept adult directions, and respond appropriately) throughout the baseline phase. On a weekly
basis, students could exchange their STAR coupons for items and/or privileges in the school
store.
CICO intervention phase. Facility-wide PBIS from baseline remained in effect during
intervention. Prior to implementing CICO, researchers randomly assigned each student a CICO
facilitator with the pairing constant throughout. See Table 3 for facilitator assignments. CICO
facilitators implemented the 5-step CICO intervention daily using the following steps: First,
the students met individually with their CICO facilitator in the facilitator’s classroom prior to
homeroom to set STAR point goals for the day as well as to receive their daily STAR point
chart. The STAR point chart provided a visual representation of the students’ daily schedules
and a place for the teachers to rate students’ daily behavior by class period in accordance with


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171

the PBIS behavioral expectations (i.e., show respect, take responsibility, accept adult feedback,

and respond appropriately). The point goal for each student was 80% of possible points as
suggested by Crone and colleagues (2004). All students received their own copy of the form;
however, the forms were the same across students as is consistent with the tier two, targeted
supports, design. Second, the students took the STAR point chart from class to class. The
students gave the STAR point chart to the teacher at the beginning of each class period and
collected it at the end of the period with both verbal and written feedback from the teacher
indicating whether they scored a 0, 1, or 2 for the period. A score of 0 indicated that the
student was dismissed from the classroom and required intervention. A score of 1 indicated the
student was good overall but did receive warnings for behavior, and a score of 2 indicated the
student demonstrated behavior consistent with the school rules and did not require warnings
from the teacher. Third, 15 minutes prior to dismissal from school each day, each student
met individually in the facilitator’s classroom with his or her school CICO facilitator again
to discuss behavior for the entire school day and by class as well as to discuss all STAR
chart points received. The students received verbal praise for scores of 2 (e.g., “Nice job in
math today. You scored 2s on all STAR rules.”) and the CICO facilitator and student discussed
behavior strategies to address scores of 0 or 1 to improve behavior for the next school day. For
example, if a student earned a 1 in math, the facilitator and student discussed what happened
in math. If, for example, the student reported he or she threw his or her paper on the floor
because the math assignment was viewed as difficult, the facilitator would ask what he or
she could do differently next time, and would suggest asking for a break from the task at
hand to regain behavioral control. The students received a STAR coupon when they met their
STAR chart point goal (as was agreed upon during check in). A STAR coupon is part of
FW-PBIS and is awarded to students when they engage in any of the four positive, appropriate
behaviors. Fourth, students took their STAR point chart to their housing CICO facilitator. When
the students entered the house at the end of the school day, each student presented his or her
housing CICO facilitator with his/her STAR point chart. The housing facilitator reviewed the
STAR point chart with the student, praised him or her for areas of strengths (i.e., scores of 2),
discussed areas for improvement (i.e., scores of 0 or 1), ended the discussion on a positive note,
signed the form, and placed the STAR point chart in the student’s folder. Fifth, the students
returned the STAR point chart to their school CICO facilitator during check in the following

school morning. A bonus STAR coupon was given for returning the signed STAR point chart.
Then, steps 1 through 5 were repeated.
Fidelity
To ensure accurate implementation of the CICO intervention, researchers assessed fidelity for
25% of the 5-step CICO cycle sessions using a 14-item fidelity checklist. Researchers calculated
fidelity by dividing the total number of observed steps by the total number of expected steps and
multiplying by 100%. The percentage for each student was: Tyrone, 93.57% (range, 85.71%
to 100%); Leo, 95% (range, 85.71% to 100%); Daniel, 98.98% (range, 92.85% to 100%);
Kevin, 95.45% (range, 85.71% to 100%); Natalie, 95.71% (range, 92.85% to 100%); and
Nathan, 98.98% (92.85% to 100%). A second observer conducted observations for 20% of
the fidelity checks to determine interobserver agreement of fidelity. Researchers used point-bypoint agreement to calculate interobserver agreement of fidelity by dividing the total number


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of agreements by the total number of agreements plus disagreements and multiplying by 100%
(Kennedy, 2005). Interobserver agreement was 100% for Leo, Kevin, and Natalie; and 93.57%
(range, 92.86% to 100%) for Tyrone; 96.43% (range, 92.86% to 100%) for Daniel; and 92.86%
(range, 85.71% to 100%) for Nathan.

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Interobserver Agreement
Researchers measured interobserver agreement for the percentage of intervals with problem
behavior during 25% or more of observation sessions. We calculated agreement using the
point-by-point agreement formula by dividing the total number of agreements by the total
number of agreements plus disagreements and multiplying by 100% (Kennedy, 2005).
For Tyrone, IOA was conducted for 27.20% of total sessions with IOA at 99.17% (range,

95% to 100%) for disruption; for Leo, IOA was conducted for 25.45% of total sessions with
IOA at 99.94% (range, 99.16% to 100%) for noncompliance; for Daniel, IOA was conducted
for 28.13% of total sessions with IOA at 100% for disruption; for Kevin, IOA was conducted
for 28.30% of total sessions with IOA at 99.62% (range, 98.33% to 100%) for noncompliance;
for Natalie, IOA was conducted for 26% of total sessions with IOA at 99.86% (range, 99.16%
to 100%) for noncompliance; and for Nathan, IOA was conducted for 27.02% of total sessions
with IOA at 100% for noncompliance.

RESULTS
Attention-Maintained Behavior
Figure 1 represents the percentage of intervals with problem behavior for students with problem
behavior maintained by adult attention, and Table 5 illustrates mean baseline and intervention
percentages of intervals with problem behavior as well as percentage of nonoverlapping data
points. Two of three students with problem behavior maintained by adult attention responded
positively to CICO as indicated by mean changes in problem behavior. Although Tyrone
demonstrated a 46.12% decrease in intervals with problem behavior, he also demonstrated
much variability in responding; meaning the effect of CICO on the percentage of intervals
with problem behavior for Tyrone is inconclusive. While Leo also demonstrated variability in
responding, the percentage of change for Leo indicated positive responding.
Escape-Maintained Behavior
Figure 2 represents the percentage of intervals with problem behavior for students with problem
behavior maintained by escape from demand, and Table 5 illustrates mean baseline and intervention percentages of intervals with problem behavior as well as percentage of nonoverlapping
data points. Two of three students with problem behavior maintained by escape from demands
responded positively to CICO as indicated by mean changes in problem behavior. Although
Kevin demonstrated a 22.11% decrease in intervals with problem behavior, he also demonstrated
much variability in responding; meaning the effect of CICO on the percentage of intervals with
problem behavior for Kevin is inconclusive.


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FIGURE 1

173

Percentage of intervals with problem behavior for students with attention-maintained behavior.

TABLE 5
Individual Behavior Results
Student

Behavior

Tyrone

Disruption

Leo

Noncompliance

Daniel

Disruption

Kevin

Noncompliance

Nathan

Noncompliance

Natalie

Noncompliance

Baseline Mean1

Intervention Mean1

Percent Change

PND 2

25.41% (range, 12.5%
to 43.33%)
100.00%

13.69% (range, .83%
to 42.5%)
37.05% (range, 0%
to 99.17%)
12.42% (range, 0%
to 50%)
47.98% (range, 0%
to 100%)
17.32% (range, 0%

to 100%)
16.50% (range, 1.67%
to 30.83%)

46.12% decrease

57.50%

62.95% decrease

100.00%

75.02% decrease

95.24%

22.11% decrease

38.89%

68.51% decrease

82.60%

79.40% decrease

100.00%

49.72% (range, 35%
to 65.83%)

61.60% (range, 25%
to 95.83%)
55.00% (range, 28.33%
to 80.83%)
80.10% (range, 43.33%
to 100%)

1 Mean: The baseline and intervention means reported reflect the mean for percentage of intervals with problem
behavior.
2 PND D percentage of nonoverlapping data.


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FIGURE 2 Percentage of intervals with problem behavior for students with escape-maintained behavior.

DISCUSSION
In this study, we evaluated the effects of the 5-step CICO intervention on the problem behavior
of six students with E/BD in an AE setting. Four of six students positively responded as
indicated by mean changes in problem behavior, regardless of function, but the results for
Tyrone and Kevin are inconclusive as there was much variability in their data. The current
study extended the CICO literature base by addressing multiple limitations cited in previous
studies. These extensions include: (a) conducting a priori FBAs, and (b) selecting students (i.e.,
with E/BD) and a setting (i.e., residential) not previously studied. Implications of results in
relation to function as well as limitations will be discussed along with future research directions.
Researchers hypothesized throughout the CICO literature that students with attention-maintained behavior may be more responsive to CICO than students with escape-maintained behavior (Crone et al., 2004; March & Horner, 2002; McIntosh et al., 2009). Results of this

study demonstrate that students with attention- and escape-maintained behavior both responded
positively to CICO. A possible explanation is that the intervention did provide minimal escape
from demands for students in this setting. Students were allowed to meet individually with
the CICO facilitator at the start of the day and prior to returning to the housing unit in the


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afternoon. It may be that students were motivated by this contact as it delayed the start of
their morning work prior to school and therapy session, chores, and/or homework time after
school, providing a brief, temporary escape from demands. Another possible explanation is that
students receiving support in a 24-hour/7-day per week facility may have fewer opportunities
for one-on-one interactions with adults than students in traditional settings, and therefore, even
for students with escape-maintained behaviors, the one-on-one adult attention embedded in
CICO was reinforcing.

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Limitations
The present study was not without limitations; therefore, the results must be considered in light
of the noted limitations.
First, the data of several students were variable and unstable. Tyrone’s data were variable
through baseline and intervention. Baseline observations indicated low levels of problem behavior for Tyrone, which continued into intervention. Therefore, small changes in the percentage
of intervals with problem behavior impacted mean changes in problem behavior. Additionally,
variability in responding may be related to contextual factors in the residential setting including
both the school and housing unit and across school, housing, and therapeutic staff. Steps
were not taken to control for contextual factors (e.g., appropriateness of level of curriculum/
instruction, method of instruction).

Second, two function-related limitations were possible. The relationship between the student
and CICO facilitator was neither evaluated nor controlled for other than two students were
randomly paired with each mentor. Therefore, it is unknown if the relationship between mentor
and facilitator may have impacted student responsiveness to CICO, regardless of function. Also,
researchers did not adapt the CICO cycle to match function in this study as their goal was to
evaluate the impact of traditional CICO on the problem behavior of students with a disability
and in a setting not previously evaluated.
Third, two setting events within the AE setting may have influenced student’s school behavior. Student behavior on the unit may have negatively influenced school behavior and school
attendance for several students, especially those students demonstrating problem behavior
maintained by escape from demands. Natalie refused to attend school for first period and
fifth period due to consequences of her inappropriate unit behavior. Staff reported that Natalie
often engaged in negative verbal exchanges (e.g., provocation) before school or during lunch
on the unit with her peers, and at times, peers responded with a threat (e.g., “I will get you at
school”). By not attending these class periods, the entire CICO cycle could not be implemented
and consistent feedback on the CICO point sheet was limited. These inappropriate behaviors
occurred during baseline to such a level that she was moved to a more restrictive setting within
the residential facility known as Emergency and Security (E&S) for 37 days. In addition,
Kevin frequently refused to get out of bed in the morning. This behavior increased at times
when Kevin was scheduled for a home visit (e.g., sessions 40 through 45). Additionally, visits
from caseworkers and families may have negatively affected student behavior. For example, the
morning of Session 19, Nathan’s case manager told him he may be moving to another facility.
Also, Nathan continued to display a high percentage of problem behavior the following two
days. When asked why he was having such difficulty, he stated that he was being moved to
another facility and his behavior did not matter anymore since, “all the papers are already


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signed.” In addition, on Session 26, after meeting with his therapist, Nathan displayed a high
percentage of problem behavior when he entered the classroom.

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Future Areas for CICO Research
When considering the results of the current study as well as the extensions to the current
CICO literature base, future areas for research must be addressed. Replication of CICO with
students with E/BD as well as in AE settings is warranted as the sample size in this study
was small (N D 6). With replication with students with E/BD, researchers should evaluate
the relationship between pre-assessment data including percentage of intervals with problem
behavior to determine inclusion criterion for students with E/BD. While it is expected students
with E/BD may demonstrate higher rates of problem behavior than their nondisabled peers and
still warrant secondary tier interventions, currently there is not an agreed upon criterion for
CICO referral for this population. Future researchers also should investigate the relationship
between student and facilitator, and should seek to determine the effect of this relationship on
responsiveness to CICO. Researchers might consider evaluating the impact of facilitator choice
on students’ response to CICO. Researchers also should evaluate adaptations to the CICO cycle
to address potential setting events as discussed previously. For example, it may be beneficial
for students in AE settings to have more frequent check-ins and check-outs including check
in before school, check out before lunch, check in prior to returning to school after lunch,
check out at the end of the school day, and an additional check-in for students after they have
interacted with family or therapeutic staff. In addition, the CICO cycle could be adapted by
researchers so that students are referred by their teachers for an additional conversation with
their CICO facilitator if they are observed demonstrating behavior that is inconsistent with the
expected, appropriate FW-PBIS behaviors. Future researchers also may include adaptations to
the CICO environment. For example, for those students having difficulty coming to school, it
may be beneficial to have check-ins completed on the unit as opposed to at school, and the
evaluation of behaviors on the unit could be incorporated into feedback as part of the CICO
cycle. For those students engaging in behavior that disrupts the CICO cycle, a discussion of

the behaviors contributing to the consistent completion of the CICO cycle by the student and
facilitator may be necessary. For example, the facilitator could discuss the consequences of
provoking peers with Natalie and could discuss more appropriate ways to interact with peers
and respond to conflicts. Also, another secondary tier intervention such as a social skills club
may be appropriate for students like Natalie. Furthermore, it may be valuable for researchers
to evaluate function-based adaptations to the five-step CICO cycle such as providing students
with escape-maintained behavior escape as part of the reinforcement component or by adding
discussions of function-specific replacement behaviors to the check in and check out cycle.

CONCLUSION
This study is a first step at analyzing the effect of CICO on the problem behaviors of students
with E/BD with attention-maintained or escape-maintained behavior who were not responsive
to universal school-wide PBIS in a residential setting. Positive behavioral interventions and
supports have been implemented with much success across traditional school environments,


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and the extension to AE settings such as the residential setting addressed in this study is much
needed to address the social and academic problem behaviors of students within these settings.
Students in AE settings may benefit from the three tiers of positive behavioral supports, similar
to the interventions provided across these tiers in typical schools. Further research evaluating
PBIS across the tiers in AE settings is needed as well as CICO with a priori FBAs across
settings, participants, and age groups as well as replication of this study for AE settings.

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