Online Briefs & Learning Modules for Evidence-Based Treatment Strategies

The National Professional Development Center on Autism Spectrum Disorders holds an impressive wealth of information and resources for evidence-based practices for children with autism. We wanted to share their website as a resource to both parents and providers, since evidence-based strategies are so important in devising a home or school-based program for students with ASD. Specifically, we found the online learning and training modules by the NPDC on ASD to be extremely useful and – even better – accessible to anyone online.

For the following evidence-based practices (EBP), the NPDC on ASD has developed briefs with the following components:

  • Overview of the practice
  • Step-by-step instructions for implementation
  • Checklist to document the degree of implementation
  • References that support the efficacy of the practice

Each brief package comes in downloadable PDF formats for easy saving and printing. Some practices also come with downloadable data collection sheets and supplemental materials for teachers to use.

EBP Briefs 1

Additional resources provided by the NPDC on ASD include Learning Modules to accommodate children in early intervention (birth to 3 years).  The 10 Learning Modules touch upon:

  1. Discrete Trial Training (DTT)
  2. Functional Communication Training (FCT)
  3. Naturalistic Intervention
  4. Parent-Implemented Intervention
  5. Picture Exchange Communication System (PECS)
  6. Pivotal Response Training (PRT)
  7. Prompting
  8. Reinforcement
  9. Structured Work Systems
  10. Time Delay

Each module includes a pre-assessment, objectives, an overview of the evidence-based practice, detailed information about the use of the EBP, step-by-step instructions for implementing the practice, case studies, a summary, a post-assessment, frequently asked questions, and references at the end.

EBP Briefs 2

For more information on the NPDC, visit their website at www.autismpdc.fpg.unc.edu

Pick of the Week: NEW! Executive Function Curriculum Books

How can you help kids with autism be flexible, get organized, and work toward goals – not just in school but in everyday life? It’s all about executive function. This week, we’re offering 15% off* our newest books on teaching executive function: Unstuck & On Target: An Executive Function Curriculum and Solving Executive Function Challenges. Just use our promo code EXECFXN at check out to redeem these savings!

Unstuck_and_On_TargetThese practical resources for parents, teachers, and therapists help high-functioning students with autism improve on these critical skills.

Unstuck & On Target! is a robust classroom-based curriculum book that will help educators and service providers teach these executive function skills to high-functioning students with autism through ready-to-use lessons that promote cognitive and behavioral flexibility. This curriculum gives clear instructions, materials lists, modifications for each lesson, and intervention tips to reinforce lessons throughout the school day. Topics touched upon include flexibility vocabulary, coping strategies, setting goals, and flexibility in friendship, all introduced and reinforced with evidence-based lessons. Lessons will target specific skills, free up the instructor’s time, fit easily into any curriculum, ensure generalization to strengthen home-school connection, and best of all, make learning fun and engaging for students in the classroom.

Unstuck & On Target! also comes with an accompanying CD-ROM that contains printable game cards, student worksheets, and other materials for each lesson. The curriculum is targeted for students with cognitive ability and language skills ages 8-11.

Solving_Executive_Function_ChallengesSolving Executive Function Challenges is a strategy guide that offers teachers and caretakers various ways to teach EF skills, including setting and achieving goals and being flexible, as well as ideas for accommodations and actions to address common problems (e.g. keeping positive, avoiding overload, coping, etc.).

To be used with or without the robust curriculum Unstuck and On Target!, this strategy guide aims to show how to embed executive function instruction in everyday scenarios with specific examples, samples IEP goals, and scripts and worksheets that break down tasks into manageable chunks. This guide is appropriate for learners in grades K–8.

Don’t forget – you can save 15%* this week only on these new executive function books by applying promo code EXECFXN at check out!

*Offer is valid until 11:59pm EDT on October 7th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Guest Article: “Promoting Socialization in Children with Autism Through Play” by Julie Russell

We’re so pleased to bring you this guest post by Julie Russell, Educational Director at the Brooklyn Autism Center (BAC). BAC is a not-for-profit ABA school serving children aged 5–21. Here, Julie describes specific, simple strategies for promoting socialization in children on the spectrum.

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Promoting Socialization in Children with Autism Through Play
by Julie Russell, Brooklyn Autism Center

Socialization – defined as a continuing process where an individual acquires a personal identity and learns the norms, values, behavior, and appropriate skills – is a vital part of life. It is also a particularly difficult skill for individuals with autism. Children with autism often struggle with initiating conversation, requesting information, making contextual comments, and listening and responding to others. These difficulties can interfere with the development of friendships for children on the spectrum.

The best way to improve socialization in children with autism is to emphasize play. There are several strategies to teach play skills to children on the spectrum that can help them improve socialization and develop friendships.

One method of teaching socialization is to condition the typically-developing peer as a reinforcer by pairing the peer with items and activities that are reinforcing for the child with Autism. The peer can give the child with Autism a preferred edible or join in on a preferred activity for the child with autism. If Ben’s (the child with autism) favorite edible is Twizzlers and his preferred activity is completing a puzzle, Adam (his typically developing peer) can offer Ben a Twizzler and join in on completing the puzzle. The typically developing peer is then associated with both the preferred edible and the preferred activity, making Adam a reinforcer for Ben.

This method is a great way to make the peer more desirable for the child with autism. The items or activities used for conditioning should only consist of items/activities that the child with autism already enjoys. When trying to introduce a new item or activity to the child with autism, peers should not be included right away. Trying to teach how to play with the item and the peer simultaneously can be confusing and over-stimulating for the child with autism. The child with autism should first be taught how to play appropriately with the age-appropriate activity during individual instruction, and then the peer can be included in the activity once mastery of the activity has been demonstrated.

Another way to promote socialization is to engage the child with autism in cooperative games, or any activity that requires interaction where each child has a role that is needed in order to complete the activity. This way, the motivation to engage with the typically developing peer will be higher. When teaching the child with autism how to play cooperative games, such as board games, you can include teaching skills that target turn taking and sharing. Children with autism (or any child) may have difficulties with giving up preferred items/activities, so these may be challenging skills to teach. In order to teach these skills with success, begin by having the child with autism share and take turns with non-preferred items/activities, then gradually fade in more highly preferred items to take turns and share.

Evidence-based practices such as social stories, peer modeling, and video modeling are also excellent methods to promote socialization in children with autism. Reading social stories and watching “expert” peers interact will allow children with autism to view and understand appropriate behavior before interacting with a new peer or practicing skills such as turn-taking, requesting information, and listening and responding to others.

All of the above methods of promoting socialization are used in Brooklyn Autism Center’s after school program BAC Friends, which pairs our students with typically developing peers from neighboring elementary and middle schools. We also provide additional opportunities for our students to practice peer socialization (along with academic work) during our reverse inclusion program with Hannah Senesh Community Day School. These methods combined with enthusiastic peers have helped our students improve their socialization skills and develop meaningful friendships.

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WRITTEN BY JULIE RUSSELL, MS, BCBA

Julie holds an M.S. in Applied Behavior Analysis from Simmons College in Boston, Massachusetts and received her BCBA in 2009. She has over 10 years of experience working with children with autism and related developmental differences in centers, schools, school districts and home-based programs. Julie received her supervision hours for board certification in behavior analysis by Dr. Nathan Blenkush, Ph.D., BCBA from JRC in Boston, Massachusetts. She was a Clinical Supervisor at ACES (Center for Applied Behavior Analysis) in San Diego California and Clinical Supervisor at the ELIJA School in Levittown, NY before joining the Brooklyn Autism Center as Educational Director.

Pick of the Week: “Classifying with Seasons” Fun Deck – Teach time concepts with match-up games and more

Classifying with SeasonsWinter, Spring, Summer, or Fall… What happens in each season and what do you need for it? With the changing season and cooler days, we thought it was the perfect time to share our newly added Classifying with Seasons Fun Deck as our Pick this week. The Classifying with Seasons Fun Deck contains 13 illustrated cards for each season, depicting holidays, activities, clothing, and weather that might occur. This week, take 15% off* your set of Classifying with Seasons by entering our code CLASSIFY at check out!

Use the Classifying with Seasons Fun Deck to teach time concepts, categorizing, and more. These cards come in a sturdy tin, and make great match-up games, as well as conversation and story starters.

Fall Examples

This week only, don’t forget to save 15%* on your deck of the Classifying with Seasons cards by entering promo code CLASSIFY at check out!

*Offer is valid until 11:59pm EDT on September 30th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

States Begin to Include ABA Coverage

It looks like progress is being made on getting treatments such as ABA covered by insurance. Disability Scoop is reporting that states are finally starting to include coverage of treatments like Applied Behavior Analysis for children with autism under Medicaid. This means that states must cover services consistent with the categories defined by Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). This includes Applied Behavior Analysis, speech and occupational therapies, and other personal care services.

Read the full article here.

Has anyone in CA, NV, and CT had success with getting services like ABA covered?

 

 

 

Simplifying the Science: Parent-Conducted Toilet Training for Kids with Autism

For many of the families I work with, toilet training their child with autism becomes a long, painful process. I typically recommend the Rapid Toilet Training (RTT) protocol developed by Azrin & Foxx (1971) but many parents struggle to maintain implementation without the presence of a behavior therapist or toilet training specialist. And while Azrin & Foxx’s results have been replicated in other studies, RTT has primarily been used in educational and outpatient settings, and the amount of time it has taken to complete toilet training has been longer than in the initial study.

This is why I was especially excited to come across the study by Kroeger & Sorensen (2010) about “A parent training model for toilet training children with autism,” which is based on Azrin & Foxx’s initial study with some key modifications. This study focuses on parent-conducted toilet training in the home and was completed with two children with autism.

As mentioned in previous blog posts, the best interventions usually are multi-pronged approaches. This is no different. While there are multiple steps involved, it’s important to recognize that one of these children was fully toilet trained in 4 days, and the other in 11 days. Both children maintained toilet training skills when researchers checked in at 2 weeks, 6 months, and 3 years. Setting aside a few days or a couple of weeks to complete this intensive protocol may be intimidating at first, but achieving similar results as the two children in the study has a huge impact on the life of your child and the entire family.

Prior to starting the intervention, they received medical consent and clearance from the children’s attending developmental pediatricians. They then performed a preference assessment (the RAISD) to determine reinforcers. The study then states that “The families were asked to restrict the children’s access to these reinforcers for a minimum of 3 days prior to implementing the intensive training treatment protocol.”

The intensive toilet training program had 5 components:

Increased fluids: In consultation with a pediatrician, the study states that “parents were instructed to increase the children’s access to fluids for 3 days prior to implementing the training.” This increase in fluid intake continued until 6:00 PM on the first day of training.

Toilet scheduled sitting: Since the protocol was completed in the privacy of the children’s homes, the children were able to remain undressed from the waist down while being toilet trained. The children were continuously seated on the toilet, then able to leave the toilet for voiding in the toilet, or for brief “stretching” breaks. As they achieved higher frequency of appropriate voiding in the toilet, the amount of time spent on the toilet decreased and the amount of time escaping the toilet increased. (The schedule for fading out time seated on the toilet is detailed in Table 1 of the study.) Also, while seated on the toilet, the child was able to play with preferred items, but not the most preferred items.

Reinforcement for continent voids: According to the study, “If the child successfully voided while on a scheduled sit, they were provided immediate reinforcement (primary edible reinforcement and planned escape to a preferred activity). If the child self-initiated a void while on a break, he was provided immediate reinforcement and a new break time was begun after the self-initiated break.”

Redirection for accidents: When accidents occur, a neutral verbal redirection was provided, such as “We go pee on the toilet” and then the child was physically redirected back to the toilet. Once they were on the toilet, a scheduled sit was begun.

Chair scheduled sitting: Once the child began to experience success with voiding on the toilet, a chair was placed next to the toilet. During scheduled sits, the child would sit on the chair. If he began to void on the chair, the study states that he “was provided with the least intrusive, minimal, physical prompt. When he independently moved from the chair to the toilet to void three consecutive times, the chair was systematically moved away from the toilet in 2-feet increments.”

The study goes into further detail on each of these five components, as well as how to generalize the skill and how parents were trained in the protocol. The study made modifications to the Azrin & Foxx study to make it easier to apply in the home setting for parents, and it removed any form of punishment.

While this is a comprehensive toilet training program that requires a high level of time and attention from the parents, it is set up to help parents achieve results in a relatively short period of time.

The study states, “Parents of incontinent children with developmental disabilities report higher personal stress and distress likely related to the toileting problems presented by their children than parents of toilet trained children with developmental disabilities. It could be deduced then that continence training not only increases associated hygiene factors and access to activities and placements, but also increases the quality of life for the parents by reducing stress and subsequently for other family members such as siblings as corollary recipients of the distress” (Macias et al., 2006).

The potential to improve the quality of life for both your child with autism and your entire family is worth the challenge of implementing this protocol.

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Pilot Study Finds that Parent-led Early Intervention Can Reduce Autism Symptoms in Babies

Autism symptoms can display in babies as young as 6 months old. A new pilot study at the UC Davis MIND Institute found that parents could reduce symptoms of autism in babies under 12 months by using intervention treatments in the home as detailed in the Early Denver Start Model.

As reported in a recent Huffington Post article, the study involved parents and their babies between 7 and 15 months of age in a 12 week-long treatment conducted by parents in home-like environments. The treatment was based on the Early Denver Start Model and revolved around parent-child interactions, such as bathing, feeding, playing, and reading. Four comparison groups were also included: Those who were at a higher risk for autism because of an affected sibling; those who were at low risk; those who had developed autism by age 3; and those with early symptoms who received treatment at a later age.

At the start of the study, all babies displayed early signs of autism, such as low interest in interactions and repetitive behaviors, which increased by around 9 months. However, by 18 to 36 months of age, the children in the treatment group produced lower autism severity scores than the comparison groups who did not go through the treatment.

The Huffington Post article “Pilot Intervention Eliminates Autism Symptoms In Babies” highlights the importance of early intervention in autism treatment. While this research is highly preliminary, the findings show that therapy and early intervention are key factors in treating infants and children with early signs of autism, and possibly in reducing them altogether. This study offers hope for parents and professionals in helping their children succeed with more tools and resources for the earliest stages of autism.

Read more about the pilot study on Huffington Post here.

Pick of the Week: “The Asperkid’s Secret Book of Social Rules” – A teen’s guide to not-so-obvious social codes

It’s not easy for any teen or tween to fit in, but it can be especially tough for Asperkids. Jennifer O’Toole knows this first-hand, and has written a book she only wishes she had when she was a teen with Asperger Syndrome.

This week only, save 15%* on The Asperkid’s (Secret) Book of Social Rules by entering promo code ASPERKID at check out!

In The Asperkid’s (Secret) Book of Social Rules, O’Toole doesn’t offer advice on what Asperkids should not do, but on what they should do with witty and wise insights into baffling social codes. With helpful tips, practice scenarios, checklists, and quizzes, Asperkids will learn how to:

  • Thank people, apologize, and offer compliments
  • Build and maintain genuine friendships and how to deal with bullying
  • Actively listen and have a meaningful conversation
  • Step back and see the “big picture” instead of focusing on the details
  • Make a correction and let go of the need to be right

With over 30 social rules and logical explanations, this illustrated handbook offers information that tweens and teens can truly digest. And having been there herself, the author shares her experience and points out the potential pitfalls with humor and sensitivity.

Don’t forget to save 15%* on The Asperkid’s (Secret) Book of Social Rules this week by using our promo code ASPERKID at checkout!

*Offer is valid until 11:59pm EDT on September 16th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Simplifying the Science: Are You Giving Your Student Enough Freedom?

One of my favorite research papers was published in the Journal of Applied Behavior Analysis in 1990 by Diane J. Bannerman, Jan B. Sheldon, James A. Sherman, and Alan E. Harchik. The title is Balancing the Right to Habilitation with the Right to Personal Liberties: The Rights of People with Developmental Disabilities to Eat Too Many Doughnuts and Take a Nap. It’s an in-depth look at the level of control practitioners can exert over the individuals they serve, and the implications of that control.

It’s important to consider the ethical implications of requiring the individuals we work with to complete specified exercises at scheduled times, eat a healthy diet for all meals, and limit TV. I have seen situations in which the practitioner is holding the individual with developmental disabilities to a higher standard than they hold themselves! Most of you reading this can probably quickly rattle off the name of the last TV show you “binge-watched” or the delicious ice cream you enjoyed too much of.

So how do we teach making appropriate choices to individuals with developmental disabilities without denying the personal freedoms we all value?

One quote from the paper states, “Not only do people strive for freedom in a broad sense they also enjoy making simple choices, such as whether to engage in unproductive, though harmless, activities, like watching sitcoms on television, eating too many doughnuts, taking time off from work, or taking a nap before dinner.” In an effort to teach our learners independent skills, we often neglect to teach meaningful decision-making that reflects the types of decisions neurotypical adults make every day. Since the paper was originally published, there has been more work done on promoting decision-making skills for learners with developmental disabilities, but the issues described in the paper are still relevant today.

Here are a few key considerations described:

  • We need to consider client preference when creating daily schedules, goals, and access to preferred activities.
  • A client’s refusal to participate in an activity may not be a failure to teach appropriately but an expression of preference.
  • It is important for practitioners to teach choice-making. The paper states, “Many people require teaching to help them discover their own preferences and learn to make responsible choices.” We should consider this as an essential step towards promoting independence in our clients.
  • Inflexible schedules for clients can sometimes be obstacles to opportunities for choice-making.

The paper goes on to cite multiple research articles and laws for both sides of the argument about the right to choice for those with developmental disabilities. You can read the full text here.  Overall, I consider this article to be essential reading for anyone working with clients with disabilities. It provides a lot of information to support its final conclusion that “all people have the right to eat too many doughnuts and take a nap” and we have the responsibility to teach clients how to exercise such freedoms.

WRITTEN BY SAM BLANCO, msed, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

On the Need for Crisis Intervention Training: A Guest Article by Bobby Newman, PhD, BCBA

Last week, we discussed a comprehensive checklist for parents in placing their children in the right school environment. Service providers in special education programs play a vital role in students’ daily lives at school and are expected to understand certain protocols when behavioral difficulties arise. We couldn’t think of a more appropriate article than that of Bobby Newman, PhD, BCBA to shed light on this need for crisis intervention training in order to ensure the best learning environment for students.

On the Need for Crisis Intervention Training
by Bobby Newman, PhD, BCBA-D

It was one of those moments in life that seemed scripted. A colleague and I were being given a tour of a public school, a prospective placement for a student of my colleagues. The student in question had a history of aggressive behavior towards staff and bolting from the classroom towards the street. How such physical crises were going to be addressed was thus a major concern of mine. I asked the tour guide, the principal of the school, how such matters were handled and whether staff were formally trained in any crisis intervention philosophy and techniques. She informed me that they were not, but that there were “informal things that staff had taught one another.”

As if on cue, at that very moment a student came sprinting past us, with a staff member in pursuit. The staff member reached out and grabbed the sprinting student by the back of the collar, effectively stopping him by choking him with his shirt. My usual flimsy professionalism couldn’t survive this seemingly scripted moment, not to mention the loud choking noise, and I asked, “Is that one of the things staff have shown each other?”

Further questioning revealed that when students had serious outbursts, 911 was called. My mind went to Chicago where in 2012, police were called to the home of a child with autism during a behavioral crisis with tragic results. Very little else needed to be known to determine that the student’s parents would never agree to this school placement, and I couldn’t say that I blamed them.

Crisis intervention is one of those very sensitive issues in the field of developmental disabilities. There are people who want to ban the physical portion of crisis intervention training, either due to liability concerns or perhaps due to abuse concerns. I will agree that the potential for abuse exists if staff are allowed to put their hands on students/consumers. I will argue, however, that the possibility of abuse is much greater if we do not train and if we do not have formalized systems in place, or at least for mass exclusions of people from less restrictive settings due to the inability to maintain them there safely in such environments. Let me develop my argument:

  • Due to the nature of some developmental disabilities (e.g., difficulty in developing communication skills or sensory defensiveness), behavior that is not typical of same age peers can occur.
  • This behavior may sometimes take forms that can be dangerous to the person engaging in them (e.g., running into hazards or self-injurious behavior) or dangerous to those around them (e.g., aggression towards others or environmentally dangerous behavior such as object destruction).
  • At such times, we may be facing a “crisis,” when injury to self or others is imminent and probable and “crisis intervention” (verbal and possibly eventually physical) may be necessary to keep everyone physically safe. The guiding idea behind crisis intervention is to keep everyone safe. This includes the person engaging in the behavior, peers, and staff.

I wish to emphasize that a crisis is NOT an everyday occurrence. A crisis should not be routine, it should arise as a relatively infrequent occurrence that needs to be dealt with via crisis intervention protocols at that moment. I wish to distinguish crisis intervention from “behavior treatment plans,” which must be in place for behavior we often see from the individual in question. If you’re doing crisis intervention frequently, then this a matter for discussion of alterations to behavior management plans or resource allocation/availability. Crisis intervention is not a consequence meant to change the probability of behavior via a punishment contingency, and any physical interventions where one must put their hands on a student should be a last resort.

Even with this caveat in place, some would make the argument that crisis intervention training should not be provided, that it gives staff permission to be overly physical with students. While I will grant such a possibility exists, as I always tell my ethics classes, the argument about what you are not willing to do is not enough. One must be prepare to answer, “and then what?” Suppose staff were not trained. When a crisis occurred, they would be left with “doing the best they can” or otherwise improvising in the moment. Given this set of circumstances, staff would respond in their own ways to crises and injuries and abuse become probable, not just possible, as staff panic or lash out with whatever self-defense techniques they can think of or act in keeping with a faulty knowledge of body mechanics or physical hazards (witness the “choke stop” described above).

To summarize, the implications of the “do not train” argument are:

  • I know there will be crises due to the behavioral history and repertoires of the students in the program
  • I’m concerned about liability or staff becoming heavy-handed, so I’d rather not train people to safely deal with the crisis, I’d rather trust to their natural impulses or an “unofficial” policy/procedure that has grown up within the program.

What must be appreciated is that good crisis intervention training systems are based on sound behavioral principles, providing the supports the individual needs, rather than on controlling the behavior of the individual physically. The vast majority of crisis intervention training is based upon preventative measures that aim to teach the individual self-control and alternate behaviors, and to create settings that are not likely to create crises in the first place, rather than sheer physical intervention. Should a physical intervention be needed, safety is a foremost concern. Techniques are performed in such a way as to attempt to minimize injury. No technique, for example, is meant to cause pain, is meant to scare, uses impact for behavior control, or moves a limb beyond its normal range of motion.

To sum up the basic argument:

  • We know behavioral crises that can lead to serious injury may occur
  • If we do not train people, we are trusting the staff member’s individual reactions or “unofficial policy’ that cannot be traced or analyzed as it is unofficial.
  • If we do train people, however, we can create standards of conduct and accountability and we can aim at program design that avoids the need for physical intervention.

This seems to me to be our best bet for creating programs that are humane, not emotionally reactive, and encourage the development of effective problem solving strategies that rely on behavioral interventions, rather than relying on physical intervention by staff to keep everyone safe. This seems to me to be most consistent with ethical practice of Applied Behavior Analysis.

About the Author

Bobby Newman is a doctoral level Board Certified Behavior Analyst and Licensed Psychologist. Bobby is the first author on twelve books and has published over two dozen articles in professional journals, as well as numerous popular magazine articles and has hosted two series of radio call-in shows. Bobby is the Past-President of the Association for Science in Autism Treatment and the New York State Association for Behavior Analysis. A popular speaker, Bobby also provides direct treatment, staff training and consultation around the world, and has been honored for this work by several parents and professional groups. Bobby is a SCIP-R (Strategies for Crisis Intervention and Prevention, Revised) instructor and has published a manual to accompany crisis intervention training (Gentle Redirection of Aggressive and Destructive Behavior). In addition to his other clinical work, Bobby teaches non-violent crisis intervention philosophy and techniques for schools, agencies and families.