Project REACH: Interventions for Severe Emotional and Behavioral Challenges

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Project REACH Interventions for Severe Emotional
and Behavioral Challenges

• Frank M. Gresham, Lee Kern,
• Alexandra Hilt-Panahon, Kristin Starosta,
• and Anuja Divatia

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• National Center for Students with Intensive
  Social, Emotional, and Behavioral Needs
• www.lehigh.edu/projectreach

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Project Overview

• Frank M. Gresham
• Louisiana State University

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About Project REACH

• National Center
• Funded by the Office of Special Education
  Programs
• Collaborating Sites Lehigh University,
  University of California-Riverside

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Purpose of Project REACH

• Literature review to identify best and promising
  practices
• Replicate best practice
• Experimentally evaluate promising practices
• Longitudinal study following students across 4
  years
• Implement interventions
• Determine role of risk factors
• Enhance collaboration across systems of care

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Literature Syntheses Topics

• Risk Factors
• Class-wide behavior management
• Self-management
• Choice
• Behavioral Momentum/Task Interspersal
• Reinforcement
• Parent Education
• Internalizing Interventions
• Social Skills
• Collaboration

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Literature SynthesesEnd Products

• 1) Tips for Teachers
• Website
• Permanent Products
• 2) Tips for Parents
• Website
• Permanent Product
• 3) Publications
• 4) Presentations

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About the Longitudinal Analysis

• Four-year longitudinal study
• Delayed treatment design
• Longitudinal analysis of assessment-based
  interventions
• Determine relationship between child, family, and
  environmental variables, risk factors, and
  intervention practices that relate to student
  outcomes
• Identify strategies to enhance collaboration
  across systems of care
• Ascertain barriers to adoption and utilization of
  effective practices

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Participation Selection

• Classroom teachers asked to nominate students
  with most intensive needs
• Internalizing
• Externalizing
• Administrators nominated students with most
  intensive needs in out of district placements

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Evaluation of Outcomes

• Student behavior
• Social Skills Rating System (yearly)
• Behavior Assessment System for Children (yearly)
• Direct observation (quarterly)
• Permanent records (discipline records,
  attendance, retention, office referrals)
• Student Academics
• Curriculum-based measurement (quarterly)
• Report Cards (quarterly)
• Integrity of interventions
• Direct observation (monthly)
• Consumer satisfaction
• Treatment Evaluation Rating Form
  (post-intervention)

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Current Participating Students

• N112
• 63 from Pennsylvania,
• 49 from California
• Age K-9th grade at enrollment
• Characteristics exhibit externalizing or
  internalizing behavior problems
• Students with the most intensive needs

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Grade at Enrollment

• Elementary (K-6th) 62
• Secondary (7th-10th) 50
• Most students referred between 7th and 9th grade

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Demographic Data Grade
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Demographic Data Gender
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Demographic Data Ethnicity
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Demographic Data Educational Setting
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Problem Behaviors

• Externalizing
• Aggression fighting, assaultive behavior,
  profanity
• Disruptive defiance, noncompliance
• Off-task talking, disruptive
• Internalizing
• Selective mutism
• Depression
• Anxiety

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Demographic Data Problem Behavior
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Recruitment and Retention Challenges

• Significant movement of students
• Change of placement (e.g. special ed, alternative
  settings)
• Suspension, expulsion, incarceration
• Family transience

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Recruitment and Retention Challenges

• Attrition
• School drop out (n6)
• Moved (n6)
• Parental removal (n4)
• Incarceration (n2)

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Challenges to intervention implementation and
integrity

• Systems do not support intervention efforts
• Reactive system
• Teacher burnout
• Teacher resistance to interventions
• Poor implementation fidelity

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Challenges to intervention implementation and
integrity

• Severe problem behavior
• Insufficient supports available
• Difficulty competing with events outside of
  school (drugs, gang affiliation, etc.)
• History of negative outcomes
• Poor outlook on life
• Family challenges

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Risk Factor Data
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Classwide Analysis

• Alexandra Hilt-Panahon
• Lehigh University

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Barriers to Longitudinal Study

• Class-wide behavior problems
• Individualized interventions ineffective or
  inefficient
• Evaluate at both programmatic and individual
  levels

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What works?

• Consistent Behavior Management Approach
• Consistent expectations
• Rewards for positive behavior
• Consequences for negative behaviors
• Focus on academic success
• Instruction matched to students ability
• High levels of student engagement
• Focus on teaching pro-social behaviors
• provide opportunities for positive social
  interactions

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General Observations

• Programs tend to focus on responding to problem
  behavior
• Minimal time spent on academic activities
• Low levels of positive social interaction among
  students and adults
• Infrequent student compliance and engagement

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Current Focus

• Collect general information to determine what is
  happening across classrooms of enrolled
  participants
• Implement class-wide interventions when
  necessary, prior to individualized interventions
• Conduct assessments to identify within classroom
  problems
• Address specific teacher-identified issues

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Classroom ObservationsGeneral Information

• N 67 Classrooms
• 41 EBD
• 9 Learning Support
• 17 General Education

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Classroom ObservationsProcedures

• Observations conducted during academics
• Observation duration 30 minutes
• Each student in class observed for 1 minute
• Observation rotated around all students in class
• When all students in class observed, another
  rotation initiated

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Classroom ObservationsData Collection

• Activity Type
• Instructional activities
• Whole class instruction
• Small group instruction
• Small group cooperative learning
• Independent seatwork (no assistance)
• 11
• Non-instructional activities
• Waiting
• Transitions
• Non-academic small and large group activities
• Freetime

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Classroom ObservationsData Collection

• Engagement
• Student meets expectations of the activity.
  Follows teacher instructions and behaves in
  accordance with class rules and expectations
• Disruptive behavior
• Behaviors or statements that are derogatory,
  demeaning, or disruptive to learning. Do not pose
  danger
• Destructive behavior
• Behaviors that are threatening, destructive,
  and/or pose immediate danger to student, peers,
  teachers, or property

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Results Activity Type
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Results Activity TypeNonacademic
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Results Engagement by Activity-EBD
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Independent Seatwork
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Summary

• Structure of EBD classrooms similar to General
  Education
• Most of time spent in class-wide instruction and
  independent seatwork without assistance
• Teachers spending least amount of time in
  activities with highest student engagement (one
  to one instruction, small group activities)
• Nonacademic activities in EBD classrooms twice
  that of GenEd or LS
• Not addressing specific needs of these children
  at a programmatic level

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Possible Explanations

• Blame placed on child/family
• Perception that nothing will work
• Lack of teacher training
• Behavior management
• Academic individualization

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Possible Explanations

• Systemic structure not in place to offer supports
  to students
• Absence of on-going support for in-service
  teachers
• Lack of collaboration
• between school-based and family-based services
• Service providing agencies

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Individualized Interventions Outcomes and
Challenges

• Lee Kern
• Lehigh University

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Background

• Limited school-based research with internalizing
  problems
• Little functional assessment or assessment-based
  intervention research on internalizing disorders

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Case Study ISelective Mutism

• PARTICIPANT DEMOGRAPHICS
• Beatrice
• 7th grade
• Hispanic
• Target behavior Selective mutism
• Diagnosis Emotional and Behavioral Disorder
• Learning support classroom, Public Middle School

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Functional Assessment Procedures

• Parent Interview
• Teacher Interviews (present and previous)
• School Psychologist Interview
• Student Interview
• Direct observations in classroom

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Sample Interview Responses

In which situations would it be easiest to talk?
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Sample Interview Responses

• In which classes do you want to speak in the
  most?
• Most Math
• Reading Enrichment/Reading
• Social Studies/Science
• Gym
• Cooking
• Least Art

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Summary of Assessment

• Teachers did not require verbal responses
• Beatrice interacted with others, just not
  verbally
• Beatrice had preferences regarding components of
  intervention to facilitate verbal interaction

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Behavior Function Hypotheses

• When a response from Beatrice is required,
  teachers provide nonverbal means of responding,
  in order to obtain a response and/or allow her to
  escape vocal responses

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Link Between Intervention and Student Input

• Beatrice wanted to talk to the teacher
• Intervention began with teacher delivered
  questions
• Beatrice wanted to talk in Math, Reading, Social
  Studies/Science
• Intervention implemented in those classes
• Beatrice wanted to know that she would
• Warning as to the number of questions to be asked
  be asked a question
• Beatrice did not want to know the specific
  questions she would be asked
• Was not informed of question content

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Intervention Components

• Questions regularly posed by teacher
• Questions reframed to generate verbal responses
• Notification of number of questions prior to
  class
• Gradually increased number of questions asked

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Behavioral Response Definitions

• Independent verbal response
• was defined as a voiced response, audible from a
  distance of 5 meters, which occurred within 30 s
  following a teacher question.

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Beatrice Math
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Beatrice Reading
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Beatrice Science
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Treatment Integrity

• Math 86 (range, 50-100)
• Reading 89 (range, 33-100)
• Science 77 (range, 50-100)

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Case Study IIAnxiety-Related Problems

• Participant Characteristics
• Carl
• 8 years old
• Third grade
• Caucasian
• General Education Classroom
• Mother diagnosed with social anxiety
• Older sister diagnosed with generalized anxiety

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Target Behavior

• Referred to Project REACH for anxiety-related
  behaviors
• History of encopresis
• Frequent self-report of feeling sick
• Difficulties paying attention, eye darting

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Purpose of Study

• To identify issues causing anxiety
• To develop an intervention to reduce anxiety and
  related problems

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Assessments

• Teacher Interview
• Parent Interview
• Student Interview
• Student Emotion Thermometer
• Direct Observations

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Results of Assessment

• Teacher and parent reports indicated anxiety
  related behaviors occurred first 2 months of
  school year
• Direct observations conducted in late October
  indicated no symptoms of anxiety
• Carl reported that he felt sick to his stomach at
  beginning of school year leaving the classroom
  made him feel better
• Feelings thermometer
• Scale of 1-10 associated with feelings of anxiety
• Carl asked to rate feelings of anxiety associated
  with a variety of activities

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Specific Transition Related Issues

• New teachers
• New activities
• Navigating building
• New staff members

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Hypothesis Developed

• When initially transitioning to a new
  environment, Carl feels anxious and exhibits
  problem behaviors to escape the new setting
• Specific issues related to transition identified
• Going to new school
• New teachers
• New activities
• Navigating through school building
• New adults

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Intervention Components

• Individual school tour during summer (prior to
  transitioning to new school)
• Familiarized with building, classrooms
• Met school staff
• Mother engaged in positive discussion about new
  school (cognitive restructuring)
• Met teacher prior to classes, invited to
  teachers home during first weeks of school

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Behavior ProblemsFirst 4 weeks of school year

• No incidents of encopresis first 4 weeks of
  school year
• No requests to leave classroom

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Summary

• Internalizing problems may benefit from
  functional assessment information
• Assessment may necessarily include student in the
  case of internalizing problems
• Intervention can be formulated around student
  preferences

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Project REACH

• www.lehigh.edu/projectreach