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Educational Philosphy

The SCERTS Model and Evidence Based Practice

© 2010 by Barry M. Prizant, Amy M. Wetherby, Emily Rubin, & Amy C. Laurent. All rights reserved.

The SCERTS Model is a comprehensive, multidisciplinary, educational approach for individuals with ASD and related disabilities. SCERTS provides a scope and sequence of developmentally grounded goals and objectives, as well as a framework and specific guidance for selecting evidence-based strategies or elements of practice to meet these goals and objectives. The result is a comprehensive program for supporting children and their families that focuses on meaningful, authentic progress within everyday routines at school, home, and in the community.

 

How are the goals and objectives within the SCERTS curriculum informed by evidence?

The scope and sequence of the goals and objectives that are targeted in the SCERTS curriculum is based upon published, peer reviewed longitudinal group research studies that document that these developmental achievements are predictive of gains in social communication, language and socioemotional development, adaptive functioning, academic achievement, and later vocational success. Furthermore, the highest priorities chosen for a child’s program are based on parent as well as professional input as part of a systematic assessment process. Thus, the goals and objectives within the SCERTS Model are functional and meaningful in a child’s life, provide the foundation for social and emotional competence, and are informed by evidence and draw from large group and longitudinal studies that show correlations with these abilities. That is, progress in SCERTS Model goals and objectives is most likely to have a broad ranging impact in the most critical areas of development for individuals with ASD.

 

How are the learning support strategies within the SCERTS model informed by evidence?

The SCERTS model provides a framework for educational teams and families to select interpersonal and learning supports that are evidence-based for their effectiveness in supporting progress in the most critical domains for individuals with ASD, i.e., Social Communication and Emotional Regulation. Furthermore, specific guidance is provided for individualizing supports to accommodate the unique strengths and needs of a child and the priorities and preferences of the family. Practice in the SCERTS Model is informed by findings from published efficacy research studies (both group treatment and single case designs) in the fields of applied behavior analysis (ABA), developmental psychology, speech-language pathology, special education, neurodevelopmental science, occupational therapy, and mental health. For a summary of these studies, please refer to Table 1 of this document.

What is the quality of evidence of the research that has been integrated into the SCERTS framework?

The SCERTS model incorporates evidence-based practices consistent with the recommendations of the National Research Council (NRC, 2001) of the National Academy of Sciences. These recommendations were derived from its review of educational treatments for children with ASD and more current research.

Social Communication, Emotional Regulation and Transactional Support, and the goals and objectives in the curriculum are based on a large number of group treatment and single case design studies that examine specific intervention strategies that are incorporated in the SCERTS model. SCERTS also is informed by descriptive group studies that document core deficits of ASD as well as significant predictors of outcome for individuals with ASD. Chapter 6 of The SCERTS Manual is devoted to discussing how The SCERTS Model is consistent with current evidence-based practice guidelines.

Using a framework adapted from Kazdin (2003) and Smith et al. (2007), we have developed two tables to summarize research studies that support the validity of focusing on the domains of the SCERTS model. Peer-reviewed research may vary as to level of evidence provided, therefore, it is important to consider the quality of research evidence when developing “standards” of practice. The SCERTS collaborators have considered research according to the following levels of evidence, with I being the highest and IV being the lowest:

I. True experimental group treatment designs with randomized clinical trials to document group treatment effects under controlled conditions.
II. Quasi-experimental group treatment designs to demonstrate the feasibility of implementing the model and document group treatment effects.
III. Single-case experimental treatment designs to examine specific intervention strategies that are incorporated in the SCERTS model.
IV. Case-control cross-sectional or longitudinal descriptive group research designs that document core deficits of ASD or significant predictors of outcome for individuals with ASD that are targeted in the SCERTS model.

Table 1 consists of a matrix with the 4 levels of evidence and 3 domains of the SCERTS model—Social Communication, Emotional Regulation, and Transactional Support—and lists references for each level. Table 2 provides an alphabetical listing of the complete references, the level of research evidence, and the SCERTS domains and components supported by each reference.

Where does the SCERTS Model, as a comprehensive educational program, fit within the current landscape of approaches informed by evidence and evidence-based practice?

Methods for evaluating treatment efficacy generally emphasize evidence derived from empirical research methodology that has addressed internal and external validity and generalization of findings (American Psychological Association, 2000; Lonigan, Elbert & Johnson, 1998). As evident in Table 1, there is great depth within the treatment efficacy literature related to focused or specific intervention strategies, or strategies that aim to either reduce challenges associated with ASD or improve specific skills. Learning strategies within the SCERTS Model are informed by this body of evidence.

Comprehensive educational models, such as the SCERTS Model, focus on a broad scope of skills, aimed at improving an individual’s overall course of functioning, long-term outcomes and quality of life. A comprehensive model should be strongly grounded in evidence derived from research on more focused intervention strategies and longitudinal studies informing targeted goals and objectives. Evidence-based practice also relies on well-controlled, randomized control group studies in order to justify whether a particular comprehensive model is more effective than others.

To date, only a few carefully controlled experimental designs involving comprehensive educational programs for children with ASD have been conducted. On the basis of a contemporary review of comprehensive approaches for children with ASD, Prizant and Wetherby (1998) made the following conclusions that were also supported in the review of educational and treatment research in ASD conducted by the national panel of experts appointed by the National Academy of Sciences (NRC, 2001), and remain relevant today:

  1. Research has supported the effectiveness of a range of approaches that differ in underlying philosophy and practice (e.g., developmental and behavioral).

  2. No evidence exists that any one approach is more effective than any other.

  3. Not all children with ASD have benefited to the same degree from a specific approach and even the most positive outcomes are in the range of about 50% of children across different studies utilizing very different approaches.

These conclusions remain accurate and relevant at the time of this writing. Furthermore, of those published randomized control group studies of comprehensive approaches, none have been conducted with school-aged children and none which have been conducted in “real world,” public school settings, relying instead on the unique conditions of laboratory settings (National Standards Report, 2009). This was a primary impetus for developing the SCERTS Model, as the framework was designed to be implemented in “real-world” settings. The focus is on enabling families, service providers, and members of the community to effectively implement strategies, informed by experimental evidence, in the real world activities and settings where individuals with ASD live and learn.

How is the SCERTS Model consistent with recommendations of National Research Council (2001), National Standards Project (2009) and other guidelines for evidence-based practice?

The National Research Council (2001) of the National Academy of Sciences identified a number of critical features that were a result of the convergence of evidence available. The SCERTS Model was designed, in part, to directly address the recommendations of this committee. These characteristics of effective interventions include:

  1. Entry into intervention services as early as possible

  2. Active engagement in intensive instruction for at least 25 hours a week, 12 months a year

  3. Repeated, planned teaching opportunities with sufficient, daily individualized attention

  4. Systematically planned developmentally appropriate activities aimed toward identified objectives

  5. Inclusion of a family component

  6. Mechanisms for ongoing program evaluation of a child’s progress, with adjustments in programming at least every 3 months

  7. Specialized instruction in settings in which ongoing interactions occur with typically developing children to the extent that it leads to the specified educational goals

The NRC Committee (NRC, 2001) went on to identify six instructional priorities, and practice in the SCERTS Model is consistent with these priorities. These priorities include:

Priority #1: Functional, spontaneous communication
Priority #2: Social instruction in various settings
Priority #3: Teaching of play skills (i.e., appropriate use of toys and play with peers)
Priority #4: Instruction leading to generalization in natural contexts
Priority #5: Positive approaches to address problem behaviors
Priority #6: Functional academic skills when appropriate

Finally, the NRC also recommended that educational approaches should address the core challenges faced by children with ASD, and that meaningful outcome measures must address the following two areas:

  1. Gains in initiation of spontaneous communication in functional activities.

  2. Generalization of gains across activities, interactants (adults and peers), and environments.

The SCERTS model addresses these recommendations in the following ways:

  1. Priority goals are established to address the core challenges of ASD, building on a child’s capacity to initiate communication with a presymbolic and/or symbolic communication system, and to regulate attention, arousal and emotion.

  2. Individualized intervention is provided based on a child’s strengths and weaknesses and is guided by research in child development and developmentally appropriate practices.

  3. The SCERTS Model incorporates intervention strategies derived from empirically-supported practices of developmental social-pragmatic and contemporary behavioral approaches.

  4. Generalization is addressed through transactional supports and progress is measured in functional activities with a variety of partners across a variety of settings.

The National Standards Project (2009) also identified numerous “established” and “emerging” interventions that may be incorporated as strategies or elements of practice as part of a SCERTS Model program.

What research is currently being conducted using the SCERTS Model?

In the relatively short time since the publication of the SCERTS Model manuals, a number of large group research initiatives have been launched, and small sample studies are becoming available. Currently, large group experimental longitudinal research is in progress to specifically address the efficacy of the SCERTS Model as a comprehensive treatment program in early intervention populations under a grant funded by the National Institute of Mental Health and Autism Speaks. A federally funded, large, randomized controlled trial is also underway to document the efficacy of the SCERTS Model in public school settings from Kindergarten through 2nd grade.

 

What is the best way to stay current on The SCERTS Model and Evidence-Based Practice?

The official SCERTS website, www.SCERTS.com, includes a “Research Corner” that is designed to provide researchers, practitioners and parents with the most up-to-date information on research with the SCERTS Model. This document will be updated periodically, and each new version will supersede prior versions.

 

References

Kazdin, A. (2003). Research Design in Clinical Psychology (4th edition). Boston: Allyn & Bacon.

National Research Council (2001). Educating children with autism. Washington, DC: National Academy Press.

National Standards Project (2009). National standards report on autism interventions. Randolph, MA: National Autism Center.

Prizant, B.M., & Wetherby, A.M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19(4), 329-353.

Prizant, B.M., Wetherby, A.M., Rubin, E., Laurent, A.C., & Rydell, P. (2006). The SCERTS Model: A Comprehensive Educational Approach for Children with Autism Spectrum Disorders. Baltimore, MD: Paul H. Brookes Publishing.

Smith, T., Scahill, L., Dawson, G., Guthrie, D., Lord, C., Odom, S., Rogers, S., & Wagner, A. (2007). Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders, 37, 354-366.

  

Developmental Therapy-Developmental Teaching 

SOCIAL-EMOTIONAL COMPETENCE

  • Healthy Emotional Development

  • Materials & Activities

  • Decoding Behavior

  • Behavior Management

Basic Beliefs:

Program elements and adult attitudes which foster healthy child and adolescent development in troubled children and youth

 

Belief 1: FOCUS ON STRENGTHS

A strength-based view of behavior fosters self-esteem and encourages behaviors that are healthy and typical. Experiences with peers that bring satisfaction and success strengthen a young person’s identity as one who can succeed, and so promote identification with all that is considered normal rather than encouraging identification as “bad”.

 

Belief 2: FOLLOW DEVELOPMENTAL GUIDELINES

The normal process of social, emotional, and behavioral development follows a predictable and orderly fashion. However, biological make-up and previous experiences with people contribute to the uniqueness of each child’s journey along this developmental path. A program can be truly effective in promoting growth by being sensitive to the individuality of each child within the pattern of typical development.

 

Belief 3: PROVIDE PLEASURE AND SUCCESS

Constructive changes occur when acceptable behavior and relationships bring personally satisfying results. A young person’s willingness to try new behaviors results from significant, pleasurable past experiences. The program must provide a way for young people to have these kinds of experiences in order for them to be motivated to learn.

Belief 4: MAKE EXPERIENCES RELEVANT

Learning results from events that have emotional and cultural meaning. It then spreads to all areas of a young person’s life. Programs must relate to the young person’s world outside of the program setting. The skills learned in the program must produce satisfying results in personal, real-life situations.

Adapted from Wood, M.M. et al. (1996) Developmental Therapy-Developmental Teaching-fostering social emotional competence in children and youth, Austin, TX: ProEd.

DEVELOPMENTAL THERAPY

A cornerstone of PLC’s behavior management system is Developmental Therapy (Developmental Therapy – Developmental Teaching by Mary Wood, Karen Davis, Faye Swindle and Constance Quirk, Pro-Ed Publishers, 3rd Edition, 1996). Developmental Therapy believes that effective behavior management requires that adults clearly and consistently convey achievable expectations to children. In order to do so, teacher’s behaviors, management strategies, and the type and length of activities chosen are matched to the student’s current social-emotional developmental stage. In this way the teaching staff can meet the child’s current needs and help enable the child to move to a higher emotionally intact, more socially aware, more independent stage. This growth corresponds to increased behavioral control. The developmental therapy management strategies chosen are therefore fluid; changing in response to a child’s emotional growth.

The following description of the various developmental stages depicts the concept of changing behavior management strategies in conjunction with a child’s developmental growth. This fluidity is a basic concept behind developmental therapy.

Stage One

In stage one, a child is often extremely impulsive and disorganized, lacks social awareness, has difficulty problem solving conflicts and may have a variety of self-stimulatory and aggressive behaviors. The child needs to learn how to respond to his/her environment with pleasure by learning to act on the environment appropriately, through the use of his/her sensory and motor modalities. The child also needs to gain trust in consistently acting adults who are nurturing and guide/mobilize him to respond to materials appropriately.

Frequently used behavior management strategies for stage one students include:
positive feedback and praise, motivating materials, high classroom structure, physical redirection, controlled teaching vocabulary, reflection (commenting on child’s actions), physical proximity to adults, physical guidance/physically manipulating a student through an activity to teach a new skill or behavior and physically restraining/holding the student in an emergency in order to prevent injury to self or others.

Stage Two

In stage two, the child is learning self-assertion which is often expressed in negative and sometimes aggressive ways, unaware that his/her own actions are a cause of anything. What he/she wants justifies his/her actions and consequently they often test limits. The child’s increased self and social awareness from stage one is often manifested by the development of a fear of failure in which he/she is afraid to make mistakes and may be afraid to attempt new tasks. The child needs to learn how to respond to his/her environment with success by learning to assert himself/herself appropriately, learning about self control, and learning the appropriate ways to achieve adult approval and praise.

The teaching staff provide predictable points of reference by guiding appropriate exploration while holding limits, solving problems, and ensuring success for the child.

Frequently used behavior management strategies for stage two include:
positive feedback and praise, motivating with materials, high classroom structure, verbal redirection, reflection of feelings, verbal interaction between lead and support staff, physical proximity and physical intervention become less intrusive compared to stage one because the child understands more language and is more socially aware.
(Consequently the overall aim is to move from physical to more verbal management strategies compared to stage one), and removal from the group (time out inside the classroom – which may entail therapeutically physically restraining/holding the child to prevent him/her from hurting themselves or others during a crisis.)

Stage Three

In stage three, a child becomes self-protective and “explains away” anything that he/she finds difficult or doesn’t want to do (“that’s stupid”, “I hate this”). The child is socially aware and actively aware of others enough to tattle on peers and boast of his accomplishments. The child needs to learn successful group participation: assimilating social values such as fairness and friendship. The teaching staff is fair but strong, keeping all students in line while recognizing the individual. Adults help the child develop the idea that there are consequences to his/her behavior.

Frequently used behavior management strategies in stage three include:
positive feedback and praise to the individual and often about the group as a whole, motivating materials, classroom structure is less intense, verbal redirection, reflection of feelings and interpretations of those feelings, verbal interactions between the lead and support staff, rules, physical proximity and physical intervention are used infrequently usually during a crisis, and removal from the room (a temporary aide for remobilizing appropriate behavior in a crisis situation – this may entail therapeutically physically holding the child to help meet his/her needs when in a highly anxious state to prevent him/her from hurting themselves or others.)