A cluster randomized trial to evaluate external support for the implementation of positive behavioral interventions and supports by school personnel

Implementation Science

George Sugai³  Jaclyn Cacia¹  Zuleyha Cidav⁴  Thomas Power²  Abbas F Jawad²  Jennifer Mautone¹  Muniya Khanna¹  Barry McCurdy⁵  Ricardo Eiraldi² 

[1] Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, 3440 Market St, Philadelphia, PA 19104-3306, USA;Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA 19104-4319, USA;Center for Behavioral Education and Research, Department of Educational Psychology, University of Connecticut, 249 Glenbroook Road Unit 2064, Storrs, CT 06269-2064, USA;Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104-3371, USA;Devereux Center for Effective Schools, The Devereux Foundation, 2012 Renaissance Blvd, King of Prussia, PA 19406, USA

关键词: School-wide positive behavioral interventions and supports;    Urban schools;    Behavioral health;    Mental health services disparities;    Fidelity;    Sustainability;    Implementation;   

Others  :  810499
DOI  :  10.1186/1748-5908-9-12

 received in 2013-08-03, accepted in 2014-01-03,  发布年份 2014

【 摘 要 】

Background

Urban schools lag behind non-urban schools in attending to the behavioral health needs of their students. This is especially evident with regard to the level of use of evidence-based interventions with school children. Increased used of evidence-based interventions in urban schools would contribute to reducing mental health services disparities in low-income communities. School-wide positive behavioral interventions and supports (SWPBIS) is a service delivery framework that can be used to deliver universal preventive interventions and evidence-based behavioral health treatments, such as group cognitive behavioral therapy. In this article, we describe our ongoing research on creating internal capacity for program implementation. We also examine the cost-effectiveness and resulting school climate when two different levels of external support are provided to personnel as they implement a two-tier SWPBIS program.

Methods/Design

The study follows six K – 8 schools in the School District of Philadelphia randomly assigned to consultation support or consultation-plus-coaching support. Participants are: approximately 48 leadership team members, 180 school staff and 3,900 students in Tier 1, and 12 counselors, and 306 child participants in Tier 2. Children who meet inclusion criteria for Tier 2 will participate in group cognitive behavioral therapy for externalizing or anxiety disorders. The study has three phases, baseline/training, implementation, and sustainability. We will measure implementation outcomes, service outcomes, child outcomes, and cost.

Discussion

Findings from this study will provide evidence as to the appropriateness of school-wide prevention and treatment service delivery models for addressing services disparities in schools. The effectiveness and cost-effectiveness analyses of the two levels of training and consultation should help urban school districts and policymakers with the planning and deployment of cost-effective strategies for the implementation of evidence-based interventions for some of the most common behavioral health problems in school children.

Trial registration

ClinicalTrials.gov identifier: NCT01941069

【 授权许可】

   
2014 Eiraldi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Goodman SH, et al.: Representativeness of clinical samples of youths with mental disorders: a preliminary population-based study. J Abnorm Psychol 1997, 106(1):3-14.
• [2]Burns BJ, et al.: Children’s mental health service use across service sectors. Health Aff (Millwood) 1995, 14(3):147-59.
• [3]Kataoka SH, Zhang L, Wells KB: Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. Am J Psychiatry 2002, 159:1548-1555.
• [4]Pumariega AJ, Rogers K, Rothe E: Culturally competent systems of care for children’s mental health: advances and challenges. Community Ment Health J 2005, 41(5):539-55.
• [5]Eiraldi RB, et al.: Service Utilization among ethnic minority children with ADHD: a model of help-seeking behavior. Adm Policy Ment Health 2006, 33(5):607-22.
• [6]Verhulst FC, van der Ende J: Factors associated with child mental health service use in the community. J Am Acad Child Adolesc Psychiatry 1997, 36(7):901-9.
• [7]Woodward AM, Dwinell AD, Arons BS: Barriers to mental health care for Hispanic Americans: A literature review and discussion. J Ment Health Adm 1992, 19:224-236.
• [8]Owens PL, et al.: Barriers to children’s mental health services. J Am Acad Child Adolesc Psychiatry 2002, 41(6):731-8.
• [9]Flisher AJ, et al.: Correlates of unmet need for mental health services by children and adolescents. Psychol Med 1997, 27(5):1145-54.
• [10]Eiraldi R, Mazzuca LB: Factors affecting utilization of mental health services by low-income Latino children: A model of parental help-seeking behavior. In Child Poverty in America Today: Health and Medical Care. Edited by Maume AADJ. Westport, CT: Praeger; 2007:74-92.
• [11]Sink CA, Igelman CN: Anxiety disorders. In Educator’s Guide to Mental Health Issues in the Classroom. Edited by Kline FM, Silver LB. Baltimore, MD: Paul H. Brookes; 2004.
• [12]Rones M, Hoagwood K: School-based mental health services: a research review. Clin Child Fam Psychol Rev 2000, 3(4):223-41.
• [13]Taras HL: School-based mental health services. Pediatrics 2004, 113(6):1839-45.
• [14]McKay MM, McCadam K, Gonzales J: Addressing barriers to mental health services for inner-city children and their caretaker. Community Ment Health J 1996, 32(4):353-361.
• [15]Nabors LA, Reynolds MW: Overcoming challenges in outcome evaluations of school mental health programs. J Sch Health 2000, 70:206-209.
• [16]Weist MD: Challenges and opportunities in expanded school mental health. Clin Psychol Rev 1999, 19:131-135.
• [17]Greenberg MT, Domitrovich C, Bumbarger B: The prevention of mental disorders in school-aged children: Current state of the field. Prevention and Treatment. Prev & Treat 2001, 4:1.
• [18]Hintze JM: Interventions for Fears and Anxiety Problems. In Interventions for Academic and Behavior Problems II: Preventive and Remedial Approaches. Edited by Shinn MR, Walker HM, Stoner G. Bethesda, MD: NASP Publications; 2002:939-959.
• [19]Cappella E, et al.: Enhancing schools’ capacity to support children in poverty: an ecological model of school-based mental health services. Adm Policy Ment Health 2008, 35(5):395-409.
• [20]Atkins MS, et al.: School-based mental health services for children living in high poverty urban communities. Adm Policy Ment Health 2006, 33(2):146-59.
• [21]Nock MK, et al.: Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry 2007, 48(7):703-13.
• [22]Nock MK, et al.: Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychol Med 2006, 36(5):699-710.
• [23]Yoshikawa H, Knitzer J: Lessons from the field: Head Start mental health strategies to meet changing needs. New York: National Center for Children in Poverty; 1997.
• [24]Reid J: Prevention of conduct disorder before and after school entry: Relating interventions to developmental findings. Dev Psychopathol 1993, 5:243-262.
• [25]Furlong MJ, Morrison GM, Jimerson SR: Externalizing behaviors of aggression and violence and the school context. In Handbook of research in emotional and behavioral disorders. Edited by Rutherford RBJr, Quinn MM, Mathur SR. dew York: Guilford; 2007:243-261.
• [26]Ma L, et al.: Academic competence for adolescents who bully and who are bullied: Findings from the 4-H study of positive youth development. J Early Adolesc 2009, 29:862-897.
• [27]Frick PJ: Conduct disorders and severe antisocial behavior. New York: Plenum; 1998.
• [28]Miller-Johnson S, et al.: Relationship between childhood peer rejection and aggression and adolescent delinquency severity and type among African American youth. J Emotional and Behav Disord 1999, 7:137-146.
• [29]Moffitt TE, Caspi A: Childhool predictors differentiate life-course persistent and adolescence-limited pathways among males and females. Dev Psychopathol 2001, 13:355-375.
• [30]Patterson GR, Yoeger K: Developmental models for delinquent behavior. In Mental disorder and crime. Edited by Hodgins S. Thousand Oaks, CA: Sage; 1993.
• [31]Canino G, et al.: The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Arch Gen Psychiatry 2004, 61(1):85-93.
• [32]Costello EJ, et al.: Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 2003, 60(8):837-44.
• [33]Greco L, Morris T: Factors influencing the link between social anxiety and peer acceptance: Contributions of social skills and close friendships during middle childhood. Behav Ther 2005, 36:197-205.
• [34]Strauss CC, et al.: The association between social withdrawal and internalizing problems of children. J Abnorm Child Psychol 1986, 14(4):525-35.
• [35]Van Amerigen M, Manicini C, Farvolden P: The impact of anxiety disorders on educational achievement. J Anxiety Disord 2003, 17:561-571.
• [36]Kearney CA, Bensaheb A: Assessing Anxiety Disorders in Children and Adolescents. In The clinical assessment of children and adolescents: a practitioner’s handbook. Edited by Smith S, Handler L. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 2007:467-483.
• [37]Kearney CA, Albano AM: The functional profiles of school refusal behavior diagnostic aspects. Behav Modif 2004, 28(1):147-61.
• [38]Beidel DC: Social phobia and overanxious disorder in school-age children. J Am Acad Child Adolesc Psychiatry 1991, 30(4):545-52.
• [39]Feehan M, McGee R, Williams SM: Mental health disorders from age 15 to age 18 years. J Am Acad Child Adolesc Psychiatry 1993, 32(6):1118-26.
• [40]Bell-Dolan D, Brazeal TJ: Separation anxiety disorder, overanxious disorder, and school refusal. Child Adolesc Psychiatr Clin N Am 1993, 2:563-580.
• [41]Pine DS, Grun J: Anxiety disorders. Edited by Walsh TB. Washington, DC: American Psychiatric Press; 1998. [Child psychopharmacology, Volume 17]
• [42]Gould RA, et al.: Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clin Psychol: Sci Pract 1997, 4:291-306.
• [43]Gould RA, et al.: Cognitive-behavioral and pharmacological treatment of generalized anxiety disorder: A preliminary meta-analysis. Behav Ther 1997, 28:285-305.
• [44]Pina AA, Silverman WK: Clinical phenomenology, somatic symptoms, and distress in Hispanic/Latino and European American youths with anxiety disorders. J Clin Child Adolesc Psychol 2004, 33(2):227-36.
• [45]Costello EJ, et al.: The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry 1996, 53(12):1129-36.
• [46]Angold A, et al.: Psychiatric disorder, impairment, and service use in rural African American and white youth. Arch Gen Psychiatry 2002, 59(10):893-901.
• [47]Fitzpatrick KM, Boldizar JP: The prevalence and consequences of exposure to violence among African-American youth. J Am Acad Child Adolesc Psychiatry 1993, 32(2):424-30.
• [48]Barrett SB, Bradshaw CP, Lewis-Palmer T: Maryland statewide PBIS initiative: systems, evaluation, and next steps. J Posit Behav Interv 2008, 10(2):105-114.
• [49]Lewis TJ, Sugai G: Effective behavior support: a systems approach to proactive schoolwide management. Focus on Except Child 1999, 31(6):1.
• [50]Horner RH, et al.: A randomized, wait-list controlled effectiveness trial assessing school-wide positive behavior support in elementary schools. J Posit Behav Interv 2009, 11(3):133-144.
• [51]Bradshaw CP, et al.: Altering school climate through school-wide Positive Behavioral Interventions and Supports: findings from a group-randomized effectiveness trial. Prev Sci 2009, 10(2):100-15.
• [52]Bradshaw CP, Waasdorp TE, Leaf PJ: Effects of school-wide positive behavioral interventions and supports on child behavior problems. Pediatrics 2012, 130(5):e1136-45.
• [53]Bradshaw CP, Mitchell MM, Leaf PJ: Examining the effects of schoolwide positive behavioral interventions and supports on student outcomes. J Posit Behav Interv 2010, 12(3):133-148.
• [54]Waasdorp TE, Bradshaw CP, Leaf PJ: The impact of schoolwide positive behavioral interventions and supports on bullying and peer rejection: a randomized controlled effectiveness trial. Arch Pediatr Adolesc Med 2012, 166(2):149-56.
• [55]Lochman J, Wells K, Lenhart L: Coping Power Child Group Program: Facilitator Guide. New York: Oxford University Press; 2008.
• [56]Lochman JE, Wells KC: The coping power program for preadolescent aggressive boys and their parents: outcome effects at the 1-year follow-up. J Consult Clin Psychol 2004, 72(4):571-8.
• [57]Lochman JE: Effects of different treatment lengths in cognitive behavioral interventions with aggressive boys. Child Psychiatry Hum Dev 1985, 16:45-56.
• [58]Lochman J, Curry J: Effects of social problem solving training and self-instruction training with aggressive boys. J Clin Child Psychol 1986, 15:159-164.
• [59]Barrett P: Friends for Life: Group leaders’ manual for children. Sydney, Australia: Pathways Health and Research Centre, Australia; 2008.
• [60]Briesch AM, Hagermoser Sanetti LM, Briesch JM: Reducing the prevalence of anxiety in children and adolescents: an evaluation of the evidence base for the FRIENDS for life program. Sch Ment Health 2010, 2:155-165.
• [61]Pahl KM, Barrett PM: Interventions for anxiety disorders in children using group cognitive-behavioral therapy with family involvement. In Evidence-Based Psychotherapies for Children and Adolescents. Edited by Weisz JR, Kazdin AE. New York: The Guilford Press; 2010:61-79.
• [62]Barrett P, et al.: Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up. J Consult Clin Psychol 2001, 69(1):135-41.
• [63]Shortt AL, Barrett PM, Fox TL: Evaluating the FRIENDS program: A cognitive-behavioral group treatment for anxious children and their parents. J Clin Child Psychol 2001, 30(4):525-35.
• [64]Sugai G, Horner RH, Gresham F: Behaviorally effective school environments. In Interventions for academic and behavior problems 2: Preventative and remedial approaches. Edited by Shinn MR, Walker HM, Stoner G. Bethesda, MD: National Association of School Psychologists; 2002:315-350.
• [65]Ginsburg GS, Drake KL: School-based treatment for anxious african-american adolescents: a controlled pilot study. J Am Acad Child Adolesc Psychiatry 2002, 41(7):768-75.
• [66]Ginsburg GS, et al.: Transporting CBT for childhood anxiety disorders into inner-city schools-based mental health clinics. Cogn Behav Pract 2008, 15:148-158.
• [67]Stein BD, et al.: A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. Jama 2003, 290(5):603-11.
• [68]Lochman JE, et al.: Dissemination of the Coping Power program: importance of intensity of counselor training. J Consult Clin Psychol 2009, 77(3):397-409.
• [69]Warren J, et al.: Urban applications of the school-wide positive behavior support: Critical issues and lessons learned. J Posit Behav Interv 2003, 5(2):80-91.
• [70]Scott TM: A schoolwide example of positive behavioral support. J Posit Behav Interv 2001, 3(2):88-94.
• [71]Kutash K, Duchnowski AJ, Lynn N: School-based mental health: An empirical guide for decision-makers. Tampa, FL: University of South Florida, The Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies, Research and Training Center for Children’s Mental Health; 2006.
• [72]Strein W, Hoagwood K, Cohn A: School psychology: A public health perspective I. Prevention, populations, and systems change. J Sch Psychol 2003, 41:23-38.
• [73]Weist MD: Fulfilling the promise of school-based mental health: moving toward a Public Mental Health Promotion approach. J Abnorm Child Psychol 2005, 33(6):735-41.
• [74]Proctor EK, et al.: Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health 2009, 36(1):24-34.
• [75]Proctor EK, et al.: Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011, 38:65-76.
• [76]Elashoff JD: nQuery advisor® 6.0. Sangus, MA: Statistical Solutions; 1995-2005.
• [77]Goodman R, et al.: Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 2000, 177:534-539.
• [78]Shaffer D, et al.: NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 2000, 39(1):28-38.
• [79]Guy W: Clinical Global Impression scale(CGI), in ECDEU Assessment Manual for Psychopharmacology Revised. Rockville, MD: U.S. Department of Health, Education, and Welfare; 1976:217-222.
• [80]Walker HM, Severson HH: Systematic Screening for Behavior Disorders (SSBD). Second edition. Longmont, CO: Sopris West; 1992.
• [81]Irvin LK, et al.: Validity of office discipline referral measures as indices of school-wide behavioral status and effects of school-wide behavioral interventions. J Posit Behav Interv 2004, 6:131-147.
• [82]Food Research and Action Center: Food Hardship in America - 2010 Data for the Nation, States, 100 MSAs, and Every Congressional District. Washington, DC: Food Research and Action Center; 2010. http://frac.org/new-data-reveal-extent-of-hunger-in-every-corner-of-the-us/ webcite
• [83]Martin JL, et al.: Moving evidence-based practices into everyday clinical care settings: Addressing challenges associated with pathways to treatment, child characteristics, and structure of treatment. Emotional Behav Disord in Youth 2007, 7:5-21.
• [84]Beidas RS, Kendall PC: Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol (New York) 2010, 17(1):1-30.
• [85]Sugai G, et al.: School-wide Positive Behavior Support Team Training Manual. University of Oregon: College of Education; 2005.
• [86]Sugai G, et al.: School-wide Positive Behavior Support Team Training Manual. Eugene, OR: University of Oregon College of Education; 2005.
• [87]Horner RH, et al.: Schoolwide positive behavior support, in Individualized supports for students with problem behaviors: Designing positive behavior plans. Edited by Bambara LM, Kern L. New York: Guilford; 2005:359-390.
• [88]Stumpf RE, Higa-McMillan CK, Chorpita BF: Implementation of evidence-based services for youth: assessing provider knowledge. Behav Modif 2009, 33(1):48-65.
• [89]Goodman R, Scott S: Comparing the strengths and difficulties questionnaire and the child behavior checklist: Is small beautiful? J Abnorm Child Psychol 1999, 27(1):17-24.
• [90]Goodman R: Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 2001, 40(11):1337-45.
• [91]Elliot D, Mihalic S: Issues in disseminating and replicating effective prevention programs. Prev Sci 2004, 5:47-53.
• [92]Forgatch MS, Patterson GR, DeGarmo DS: Evaluating fidelity: predictive validity for a measure of competent adherence to the Oregon model of parent management training. Behav Ther 2005, 36(1):3-13.
• [93]Cloitre M, et al.: Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder. J Consult Clin Psychol 2004, 72(3):411-6.
• [94]Hogue A, et al.: Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. J Consult Clin Psychol 2006, 74(1):121-9.
• [95]Huey SJ Jr, et al.: Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. J Am Acad Child Adolesc Psychiatry 2004, 43(2):183-90.
• [96]Horner RH, et al.: The School-Wide Evaluation Tool (SET): A research instrument for assessing school-wide positive behavior support. J Posit Behav Interv 2004, 6:3-12.
• [97]Scott T, Barrett S: Using staff and student time engaged in disciplinary procedures to evaluate the impact of school-wide PBS. J Posit Behav Interv 2004, 6:21-27.
• [98]Ervin RA, et al.: Merging research and practice agendas to address reading and behavior school-wide. Sch Psychol Rev 2006, 35(2):198-223.
• [99]McCausland SG, Hales LW, Reinhardtsen JM: CREST: Technical Report. Vancouver, WA: Educational Service District 112; 1997.
• [100]Horwitz SM, et al.: Reliability of the services assessment for children and adolescents. Psychiatr Serv 2001, 52(8):1088-94.
• [101]Canino G, et al.: Methodological challenges in assessing children’s mental health services utilization. Ment Health Serv Res 2002, 4(2):97-107.
• [102]Shaffer D, et al.: The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry 1996, 35(7):865-77.
• [103]Causey D, Dubow E: Development of self-report coping measure for elementary school children. J Clin Child Psychol 1992, 21(1):47-59.
• [104]Achenbach T, Rescorla L: Manual for the ASEBA School-Age Forms & Profiles: An Integrated System of Multi-informant Assessment. Burlington, VT: University of Vermont, Research Center for Children Youth & Families; 2001.
• [105]March JS: Manual for the Multidimensional Anxiety Scale for Children-2nd Edition (MASC 2). North Tonawanda, NY: MHS; 2012.
• [106]Kovacs M: CDI 2: Children’s Depression Inventory 2nd Edition. North Tonawanda, NY: Multi-Health Systems, Inc.; 2011.
• [107]DuPaul GJ, Rapport M, Perriello L: Teacher ratings of academic skills: the development of the academic performance rating scale. Sch Psychol Rev 1991, 20(2):284-300.
• [108]Shaffer D, et al.: A children’s global assessment scale (CGAS). Arch Gen Psychiatry 1983, 40(11):1228-31.
• [109]Lochman JE: Cognitive-behavioral intervention with aggressive boys: three-year follow-up and preventive effects. J Consult Clin Psychol 1992, 60(3):426-32.
• [110]Laird NM, Ware JH: Random-effects models for longitudinal data. Biometrics 1982, 38(4):963-974.
• [111]Liang KW, Zeger SL: Longitudinal data analyses using generalized linear models. Biometrika 1986, 73:13-22.
• [112]Zeger SL, Liang KY: Longitudinal data analysis for dicrete and continuous outcomes. Biometrics 1986, 42(1):121-130.
• [113]SAS/STAT: SAS/STAT® 9.2 User’s Guide. Cary, NC: SAS Institute Inc; 2002–2008.
• [114]Detsky AS: A clinician’s guide to cost-effectiveness analysis. Ann Intern Med 1990, 113(2):147-154.
• [115]Blonigen BA, et al.: Application of economic analysis to school-wide positive behavioral support (SWPBS) programs. J Posit Behav Interv 2008, 10(1):5-19.
• [116]Glasser BG, Strauss AL: The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine; 1967.
• [117]Barrett PM, et al.: Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: an evaluation of the friends program. J Clin Child Adolesc Psychol 2006, 35(3):403-11.