RANDOMIZED CONTROLLED TRIAL

During Years 1-3 of our project (July 2008-June 2011), we developed a comprehensive intervention package for secondary students with emotional and behavioral problems.  The intervention package was evaluated in eight high schools in five states (Kansas, Missouri, Ohio Pennsylvania, and South Carolina). Data were collected from teachers, students, parents, and mental health providers on outcomes, acceptability, and feasibility.  In addition, implementation fidelity data were collected.  Interventions were revised and refined based on the feedback.  We currently have a comprehensive intervention package that we will be testing in a randomized controlled trial during the 2011-2012 and 2012-2013 school years.

Fifty-four schools are participating in the randomized controlled trial in Kansas, Missouri, Ohio, Pennsylvania, and South Carolina.  In each school, approximately 12 students will be followed to evaluate the effectiveness and broad applicability of the intervention package.  Students include both those identified as having an emotional or behavioral disorder and general education students experiencing social, emotional, and/or behavioral problems.

The intervention package is designed to address the comprehensive needs of secondary age students with social, emotional, and/or behavioral problems.  Thus, the intervention package has numerous components.  Interventions focus on addressing student social, emotional, behavioral, and academic needs; improving classroom structure and supports; and enhancing family functioning.  Assessments were designed to identify the specific interventions needed to fully support each student.  Below is a brief description of our intervention components.

Check & Connect
A mentoring program designed to promote student engagement and competence, and provide support for academic and behavioral needs through systematic monitoring of risk indicators (e.g., attendance, grades, behavior referrals), regular brief meetings, and problem solving with students.  All CARS target students receive Check & Connect. All students will receive this intervention.

Expectations
Expectations, or rules, clearly communicate the expected behavior of students in a classroom, creating safe and effective learning environments. This intervention will be implemented in classrooms when indicated.

Routines
Routines are a set of clear behaviors required of students in a classroom. They create structure and predictability for the students, assist with transitions, and encourage expected students behaviors. Taken together, routines increase the likelihood of student success.  Routines will be implemented in classrooms when indicated.

Opportunities to Respond (OTR)
The opportunities to respond intervention is a collection of instructional strategies designed to increase student engagement and decrease opportunities for students to engage in inappropriate behavior by increasing the number of opportunities to respond (OTR) the teacher provides to the group of students.  Teachers can increase OTR’s by using guided notes, response cards, computer assisted instruction, or classwide peer tutoring.  OTR interventions will be implemented in classrooms when students are not highly engaged.

Increasing Positive Student-Teacher Interactions
There is a strong connection between the amount of teacher acknowledgment of positive student behavior (academic and social) and the likelihood of continued student positive behavior. As an intervention, positive teacher-student interactions refers to the degree to which teachers' provide positive feedback in the form of praise, gestures, or other forms that clearly signal to the student that he or she is being successful. Teachers should use a variety of praise statements, provide praise as immediately as possible following an appropriate behavior, and be specific with regard to what behavior is being praised. This intervention will be implemented in classrooms where student-teacher interactions are predominantly negative.

De-escalation
De-escalation strategies help teachers identify stages of the Acting Out Cycle, and provide teachers with techniques to reduce negative interactions with students who exhibit internalizing and externalizing challenging behaviors. This will be implemented with students who have behavioral outbursts.

Accommodations
A guided process to help determine appropriate accommodations matched to student academic and/or behavioral needs in order to increase student access to the general education curriculum. Accommodations will be implemented for students who need struggle with academics.

Organization Skills
The organization skills intervention is designed to teach students to manage time effectively, to keep track of necessary materials, and to submit completed assignments.  Three interventions are included: (a) to increase effective time management and organization through use of a daily planner, (b) to increase submission of completed assignments by tracking missing assignments, and (c) to organize his/her binder, book bag, and locker using the organization checklist.  These interventions will be implemented with students who have difficulties with organization.
 
Study Skills
Improving student study skills and habits can promote student success on tests and quizzes, which can in turn enhance school/curricular engagement.  Students are introduced to three  proven techniques that will help them monitor learning, develop retention skills, study content effectively, and utilize test time efficiently (i.e., flash cards, strategic studying, and test-taking strategies). Study skills will be used with students who do not perform well on homework and tests.

Cognitive Behavioral Therapy for Anxiety
Sometimes students experience anxiety that interferes with their ability to perform well in school.  Students with anxiety will receive an empirically supported, cognitive-behavioral program for treating anxiety in adolescents.  Skill building sessions are followed by exposure tasks to practice coping skills in typical settings.

Cognitive Behavioral Therapy for Mood Problems
Many adolescents have mood difficulties that result in feelings of irritability, sadness, and disinterest in school and other activities.  Students with these feelings may be at risk for depression.  Cognitive behavioral therapy will be used to help students manage these feelings. During sessions students are taught how to improve their mood through cognitive therapy techniques as well as behavioral activation.

Interpersonal Skills
Interacting with peers and adults appropriately can be challenging for high school students.  Students will receive a group-based cognitive-behavioral program for addressing social difficulties in youth.  Skill-building is followed by practice with in-vivo feedback, and discussions about application.  Students learn to identify social consequences of their behavior and improve their ability to get along with others.  Mastery of social goals is achieved through coaching from a mental health provider. 

Parent Education
Parent education groups focus on management of adolescent behavior in the home.  During sessions parents learn about the symptoms and associated difficulties of emotional and behavioral disorders, behavioral concepts, and the process of behavioral contracting. Parents learn strategies to improve interactions with their adolescent, including identifying the coercive behavior cycle, using problem-solving communication, and strengthening the connection between behavior and consequences. 

Self-Management
This intervention helps students monitor and manage their own behavior in classrooms and other school settings. Students learn to view their behavior from the perspective of another and modify their actions to achieve success with their classwork and classroom behavior.