Overview of Secondary Prevention

Positive behavior support is an application of a behaviorally-based systems approach to enhance the capacity of schools, families, and communities to design effective environments that improve the fit or link between research-validated practices and the environments in which teaching and learning occurs. Attention is focused on creating and sustaining primary (school-wide), secondary (targeted group or simple individual plans), and tertiary (individual) systems of support that improve lifestyle results (personal, health, social, family, work, recreation) for all children and youth by making problem behavior less effective, efficient, and relevant, and desired behavior more functional.

What is Secondary Prevention? What differentiates secondary (individual) intervention from other systems of positive behavior support? When should a program of Secondary Prevention be implemented and who should be involved? How can we effectively address the needs of individuals within group environments? How are targeted group interventions implemented? How do we know when a Secondary Prevention intervention plan is effective?

Example of Secondary Prevention

Power Point presentation describing specific Secondary Prevention strategies.

What is Secondary Prevention?

Secondary Prevention is designed to provide intensive or targeted interventions to support students who are not responding to Primary Prevention efforts. Interventions within Secondary Prevention are more intensive since a smaller number of students within the yellow part of the triangle are at risk for engaging in more serious problem behavior and need a little more support. Common Secondary Prevention practices involve small groups of students or simple individualized intervention strategies. Secondary Prevention is designed for use in schools where there are more students needing behavior support than can be supported via intensive and individual tertiary support, and for students who are at risk of chronic problem behavior, but for whom high intensity interventions are not essential. Secondary prevention often involves targeted group interventions with ten or more students participating. Targeted interventions are an important part of the continuum of behavior support needed in schools, and there is a growing literature documenting that targeted interventions can be implemented by typical school personnel, with positive effects on up to 67% of referred students. Targeted interventions also are recommended as an approach for identifying students in need of more intensive, individualized interventions. Specific Secondary Prevention interventions include practices such as “social skills club,” “check in/check out” and the Behavior Education Plan.

Individual PBS plans at the Secondary Prevention level involve a simple assessment to identify the function a problem behavior serves (Functional Behavioral Assessment or FBA) and a support plan comprised of individualized, assessment-based intervention strategies that include a range of options such as: (1) teaching the student to use new skills as a replacement for problem behaviors, (2) rearranging the environment so that problems can be prevented and desirable behaviors can be encouraged, and (3) monitoring, evaluating, and reassessing this simple plan over time.

What differentiates Secondary Prevention from other systems of positive behavior support?

The main difference between secondary and other levels of positive behavior support is the focus on supporting students at risk for more serious problem behavior. Secondary Prevention addresses the needs of students who require more support than is available for all students (i.e., Primary Prevention) and less support than is available for individual students who need flexible, focused, personalized interventions (tertiary prevention). This means that Secondary Prevention allows teams to select features of the process (e.g., types of programs or interventions, data collection tools used, information gathered, and degree of monitoring) to provide more focused behavior support to students with behavior needs that do not require intensive, individualized plans.

When should a program of Secondary Prevention be implemented and who should be involved?

Decisions to implement Secondary Prevention interventions are usually grounded in records of student behavior compiled by classroom teachers or other professionals. In some schools, students with two or more office referrals are considered eligible for secondary, targeted behavior support. The decision to use Secondary Prevention is typically made by the school’s planning team and behavior support team. Secondary Prevention is most effective when approached as a collaborative (rather than expert-driven) process. With individual plans, support teams including the student’s family, educators, and/or other direct service providers should be involved in assessment and intervention. It is also helpful to include people who have specific expertise in intervention programs being considered. In general, support teams should include people who know the student best, have a vested interest in positive outcomes, represent the range of environments in which the student participates, and have access to resources needed for support.

How can we effectively address the needs of individuals within group environments?

Individual systems and other levels of positive behavior support are complementary in that well-structured group applications (e.g., classroom management systems) provide a foundation for effective individualized support. Often, the need for individual systems is minimized by these broader systems; however, some students require a greater degree of individualization and support. It may be necessary to adapt features of group applications (e.g., physical arrangement, routines, types of rewards) to meet the needs of individual students within certain settings.

How are targeted group interventions implemented?

Targeted group interventions are implemented through a flexible, but systematic, process. Key features of Secondary Prevention interventions include:

1. Continuous availability.
2. Rapid access (72 hr).
3. Very low effort by teachers.
4. Consistent with school-wide expectations.
5. Implemented by all staff/faculty in a school.
6. Flexible intervention based on assessment.
7. Functional assessment.
8. Adequate resources (admin, team), weekly meeting, plus 10 hours a week.
9. Student chooses to participate.
10. Continuous monitoring of student behavior for decision-making.

How do we know when a secondary intervention plan is effective?

Effective secondary interventions produce measurable changes in behavior and improvements in a student’s quality of life (e.g., participation in integrated activities, improved social relationships, independence and self-sufficiency). Direct observations and frequent monitoring of progress are widely-used methods for evaluating these outcomes, and determining adjustments that might be warranted when progress does not occur within a reasonable time frame.