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Center for Adolescent Research in the Schools (CARS)
Research with Secondary Age Students with Emotional and
Behavioral Problems
Lee Kern, Steve Evans, and Tim Lewis
Today
• Brief overview of CARS• Description of intervention development and
refinement process
Center for Adolescent Research in the Schools
• Funded for five years by Institute of Education Sciences (IES)
• Focus: secondary age students with intensive social, emotional, and behavioral problems
Core Collaborators/Sites• Lee Kern, Ph.D., Principal Investigator, Lehigh University• Steven Evans, Ph.D., Co-Principal Investigator, Ohio University• Tim Lewis, Ph.D., Co-Principal Investigator, University of
Missouri• Deborah Kamps, Ph.D., Juniper Gardens Children’s Project,
University of Kansas• Carl Paternite, Ph.D., Miami University of Ohio• Terry Scott, Ph.D., University of Louisville• Mark Weist, Ph.D., University of Maryland• Paras Mehta, Ph.D., TIMES, University of Houston
(design/statistical consultation, data analysis)• Howard Stevenson, Ph.D., Zewelanji Serpell, Ph.D.,
Charlayne Hayling, Ph.D., Consultants
Overview of CARS ActivitiesMajor Study• Years 1-2: Develop and refine intervention
package with small sample of students (n=38, 3 states)
• Year 3: Evaluate and refine intervention package with larger sample of students (n= 60, 6 states)
• Years 4-5: Evaluate efficacy of intervention with large sample of students (n=530, 6 states)
Supplemental Studies• Years 1-5: Conduct supplemental research
studies in core areas relevant to students with emotional and behavioral problems
Goals of Intervention Development and Refinement Process
• Determine effectiveness• Assess feasibility• Identify proximal and distal measures to
assess intervention outcomes• Identify interventionists• Evaluate integrity of implementation• Determine training/coaching
necessary for high integrity
Phase I:Initial Intervention Development
• Determined core needs of population• Identified potentially effective interventions
– Literature reviews– Included interventions developed by CARS research team and others
• Effective with different populations or age groups
• Spent time talking to and observing school staff• Solicited input from local stakeholders
– Community Development Groups
Building Child Capacity
Enhancing School Capacity
Increasing Family and Community Supports
Conceptual Framework
Phase I: Community Development Groups
• Representatives from a variety of stakeholder groups – e.g., administrators, teachers, school psychologists,
behavior specialists, counselors, parents, social workers, mental health workers
• Purpose– Provide information to assist with intervention
developmentInitial meeting• Pressing issues of secondary students with EBD• Interventions they believe are essential and/or effective with secondary EBD students
– Will continue yearly meetings
Community Development GroupFeedback from Initial Meeting: Issues
• Issues among students with EBD– Responding to Mental Health needs (e.g.,
depression)“Interventions we have tried don’t have long-term effects”
“Teachers don’t know how to access community mental health services, so students don’t get interventions”
“Many students don’t have MH coverage for outside services”
“There are too many barriers to students trying to access mental health services”
Refining Mental Health Interventions
Mental Health Needs
• Effective interventions
• Accessible, affordable for students
Intervention Selection
• Evidence-based
• Provided at school
Phase II:Preparation for Implementation
• Develop and test assessment model– Need for classroom-based interventions– Need for student mental health interventions
• Collect data prior to implementation regarding acceptability and feasibility
• Resource mapping: Who is best positioned to implement intervention?– Models of SpEd delivery– Mental health interventions
YES YES
3Does
student show signs
of withdrawal, irritability, negativity
or sad mood?
Choosing Mental Health Interventions
1.2 Obtain relevant school records to assess impairment
(e.g., office referrals)
Given the Information Gathered…
2.1 The C.A.T. Project
16 Session Program
Group or Individual
3.1 Coping with Stress program
15 Session Program
Group or Individual
2Does
student show
signs of anxiety or
worry?
4.1 Interpersonal Skills Group
28 thirty minute Session Program
Group
5.1 Referral to Special Education Teacher for classroom management
or Teacher-Student communication
concerns, and/or the development of an
FBA/BIP
6Prioritize
Intervention
6.1 PRIORITY: Rank problems based on how
much they are impairing school &
academic functioning
6.2 FEASIBILITY: Indicate whether each of the interventions can be feasibly provided
6.3 ACCEPTABILITY: Indicate whether the student, teachers and/or parents are willing to participate
1.3 Conduct Observations
7Implement
the Intervention
5.2 De-Escalation Techniques
6.4 Record list of interventions that are feasible and acceptable
in order or priority ranking
YES YES
1.4 Consult with CARS MH consultant
Family Interventions
1What is the Problem?
1.1 Gather teacher, parent and self
report of difficulties related to
impairment at school
5Does
student disrupt
class, argue, or display
other difficult to
manage behaviors?
7.1 Begin with the feasible intervention with the
highest clinical priority and proceed
through entire intervention
4Does student show signs of
poor social skills,
frequent conflict or
poor problem
solving skills?
2 – 5 Interpretation
7.2 Measure outcomes and use data to
inform modifications
to interventions
Mental Health(Data: Feasibility and Acceptability)
Resource MappingAssessment of School Services Interview: Staff
STAFF MEMBER DEGREE POTENTIAL MH TIME SPENT
Assistant Principal MA, Curr & Instr -Parent Support Groups-Individual Counseling
1 hr/monthAs needed
School Psychologist Ph.D., Sch Counseling -Group Counseling: Peer Conflict-Individual Counseling-Consultation w/Parents
As neededAs needed1 hr/week
Senior Counselor MA, Sch Counseling -Individual Counseling-Parent Ed
1-2 hrs/weekAs needed
Freshman Counselor MA, Sch Counseling -Individual Counseling 20 hrs/week
School Counselor MA, Sch Counseling -Social Skills Knitting Group-Individual Counseling
1 ½ hrs/week28 hrs/week
Security Coordinator Associate -Individual Counseling-Home Visits
As needed4-5 hrs/week
Graduation Coach MA, Literature -Social Skills Knitting Group-Individual Counseling-Open Office Parent Ed
1 ½ hrs/week2 hrs/weekAs needed
Transition Specialist MA, SpEd -Individual Counseling 1 hr/week
School Nurse MA, Health Ed -Parent Support Group-Individual Counseling
2 hrs/month2-3 hrs/week
Social Worker MA, Soc Work -Parent Ed-Individual Counseling
1-2 hrs/week1 hr/week
Resource Mapping:
ACTIVITY TOTAL TIME SPENT (EXCLUDES “AS NEEDED”)
Individual Counseling 53-56+ hours/week
Group Counseling 1 ½ hours/week
Parent Related Activities 5-6 hours/week
RESOURCE MAPPING“Are you aware of any staff or resources at the school which might be utilized to a greater degree to implement mental
health interventions?”
Other Available Resources
STAFF MEMBER OTHER STAFF
Assistant Principal Officer Snyder, Social Worker
School Psychologist Social Worker, Intervention Specialists
Senior Counselor School Counselor, ESL Aides
Freshman Counselor School Nurse
School Counselor Social Worker, Other Counselors
Security Coordinator Officer Snyder
Graduation Coach New to School
Transition Specialist Social Worker, School Counselor
School Nurse
Social Worker Nurse, Graduation Coach, Counselor
Phase III: Implementation and Feedback
• Brief training on intervention• Direct observation
– Teacher behavior, student behavior, classroom context– Treatment fidelity
• Informal feedback from school staff, students, parents– Revisions needed to interventions
• Review of training logs– Document amount and type of coaching
• Cross-site weekly CARS team meeting calls (Class, MH)– Discuss status of intervention implementation– Describe implementation challenges– Describe variations made to interventions
Increasing Positive Interactions
DataDirect Observation:• Infrequent praise• High rates of negative
feedbackTX Integrity:• Low integrity
Intervention Refinement• Intervention acceptable,
feasible, easy to understand
• Difficulty remembering to provide positive feedback
Seems that it is difficult to both teach, naturally deliver praise.
Teacher requested an opportunity to observe CARS facilitators model the intervention procedures.
Training Log
Teacher did not meet integrity criteria
Notes from Training Log
Problem Solving Process: Modeling and In-Vivo Feedback
PHASE IV: Data-Based Refinement
• Pre- and post-intervention assessments– Do measures reflect change from beginning to end of academic year?
– Which measures are most sensitive to change?
• Consumer feedback
SIRF-Teacher
SIRF-Teacher
“Changes in student performance consist of a higher percentage of : on-task behavior, students remaining in their area, decrease in swearing, more positive interactions and an increase in followed teacher prompts.”
PHASE V: Further Refinement Based on Expanded and More
Divergent Sample
• Implementation in three additional states• Inclusion of more diverse sample
– School size– School characteristics– Models of special education service delivery