Today

1. 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

2. Today • Brief overview of CARS • Description of intervention development and refinement process

3. 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

4. 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

5. Overview of CARS Activities Major 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

6. 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

7. 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

8. Enhancing School Capacity Building Child Capacity Increasing Family and Community Supports Conceptual Framework

9. 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 development Initial meeting • Pressing issues of secondary students with EBD • Interventions they believe are essential and/or effective with secondary EBD students • Will continue yearly meetings

10. 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”

11. Refining Mental Health Interventions Mental Health Needs • Effective interventions • Accessible, affordable for students Intervention Selection • Evidence-based • Provided at school

12. 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

13. Choosing Mental Health Interventions 2 – 5 Interpretation 1 What is the Problem? Given the Information Gathered… 6 Prioritize Intervention 2 Does student show signs of anxiety or worry? 5 Does student disrupt class, argue, or display other difficult to manage behaviors? 3 Does student show signs of withdrawal, irritability, negativity or sad mood? 4 Does student show signs of poor social skills, frequent conflict or poor problem solving skills? 7 Implement the Intervention 1.1 Gather teacher, parent and self report of difficulties related to impairment at school 6.1 PRIORITY: Rank problems based on how much they are impairing school & academic functioning 7.1 Begin with the feasible intervention with the highest clinical priority and proceed through entire intervention 6.2 FEASIBILITY: Indicate whether each of the interventions can be feasibly provided 1.2 Obtain relevant school records to assess impairment (e.g., office referrals) YES YES YES YES 6.3 ACCEPTABILITY: Indicate whether the student, teachers and/or parents are willing to participate 1.3 Conduct Observations 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 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 7.2 Measure outcomes and use data to inform modifications to interventions 6.4 Record list of interventions that are feasible and acceptable in order or priority ranking 1.4 Consult with CARS MH consultant 5.2 De-Escalation Techniques Family Interventions

14. Mental Health(Data: Feasibility and Acceptability)

15. Resource Mapping

16. Resource Mapping:

17. 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?”

18. 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

19. Increasing Positive Interactions Data Direct Observation: • Infrequent praise • High rates of negative feedback TX Integrity: • Low integrity Intervention Refinement • Intervention acceptable, feasible, easy to understand • Difficulty remembering to provide positive feedback

20. Training Log Seems that it is difficult to both teach, naturally deliver praise. Teacher requested an opportunity to observe CARS facilitators model the intervention procedures.

21. Teacher did not meet integrity criteria Notes from Training Log Problem Solving Process: Modeling and In-Vivo Feedback

22. 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

23. SIRF-Teacher

24. 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.”

25. 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