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Lawson GM, Owens JS, Mandell DS, Tavlin S, Rufe S, Lyon AR, Eiraldi R, Power TJ. Implementation resources to support teachers' use of behavioral classroom interventions: protocol of a randomized pilot trial. Pilot Feasibility Stud 2023; 9:151. [PMID: 37626422 PMCID: PMC10463490 DOI: 10.1186/s40814-023-01381-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. METHODS We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student-teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. DISCUSSION If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. TRIAL REGISTRATION This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Philadelphia, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Steven Rufe
- Rufe Educational Consulting, LLC, Schwenksville, PA, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Thomas J Power
- Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Cruz CM, Dukpa C, Vanderburg JL, Rauniyar AK, Giri P, Bhattarai S, Thapa A, Hampanda K, Gaynes BN, Lamb MM, Matergia M. Teacher, caregiver, and student acceptability of teachers delivering task-shifted mental health care to students in Darjeeling, India: a mixed methods pilot study. DISCOVER MENTAL HEALTH 2022; 2:21. [PMID: 36341156 PMCID: PMC9622553 DOI: 10.1007/s44192-022-00024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Background The acceptability of teachers delivering task-shifted mental health care to their school-aged students is understudied. Here, we evaluate teachers', students', and caregivers' acceptability of Tealeaf (Teachers Leading the Frontlines), an alternative system of care in which teachers are trained and supervised to deliver transdiagnostic, non-manualized task-shifted care to their students. Methods In a 2019 single-arm, mixed methods, pragmatic acceptability pilot study in Darjeeling, India, 13 teachers delivered task-shifted child mental health care to 26 students in need. Teachers delivered care through using a transdiagnostic, non-manualized therapy modality, "education as mental health therapy" (Ed-MH). Measured with validated scales, teachers' and students' acceptability were compared after teacher training (PRE) and at the end of intervention (POST) using paired t tests. Teachers (n = 7), students (n = 7), and caregivers (n = 7) completed semi-structured interviews POST. Results Teachers' quantitative measures indicated moderate acceptability PRE and POST and did not change PRE to POST. Children's measures showed acceptability PRE and POST but decreased PRE to POST. Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers' ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out. Conclusion Teachers, caregivers, and children found teacher delivering task-shifted care acceptable, a key factor in care adoption and sustainability, though interviewed children were unaware of receiving care.Trial registration The trial was registered on January 01, 2018 with Clinical Trials Registry-India (CTRI), Reg. No. CTRI/2018/01/011471, Ref. No. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27. Supplementary Information The online version contains supplementary material available at 10.1007/s44192-022-00024-z.
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Affiliation(s)
- Christina M. Cruz
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599 USA ,grid.10698.360000000122483208School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC USA
| | - Choden Dukpa
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India
| | - Juliana L. Vanderburg
- grid.10698.360000000122483208School Psychology Program, University of North Carolina at Chapel Hill School of Education, Chapel Hill, NC USA
| | - Abhishek K. Rauniyar
- grid.414594.90000 0004 0401 9614Department of Epidemiology, Colorado School of Public Health, Aurora, CO USA
| | - Priscilla Giri
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India
| | | | - Arpana Thapa
- Darjeeling Ladenla Road Prerna, Darjeeling, West Bengal India
| | - Karen Hampanda
- grid.414594.90000 0004 0401 9614Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA ,grid.430503.10000 0001 0703 675XDepartment of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Bradley N. Gaynes
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599 USA ,grid.10698.360000000122483208Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, MacNider Bldg. Suite 304, CB#7160, 333 S. Columbia St., Chapel Hill, NC 27599 USA
| | - Molly M. Lamb
- grid.414594.90000 0004 0401 9614Department of Epidemiology, Colorado School of Public Health, Aurora, CO USA ,grid.414594.90000 0004 0401 9614Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA
| | - Michael Matergia
- grid.414594.90000 0004 0401 9614Center for Global Health, Colorado School of Public Health, 131999 E. Montview Blvd., Suite 310, Mail Box A090, Aurora, CO USA ,Broadleaf Health and Education Alliance, Stroudsburg, PA USA
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Vanderburg JL, Dukpa C, Rauniyar AK, Giri P, Bhattarai S, Thapa A, Gaynes BN, Hampanda K, Lamb MM, Matergia M, Cruz CM. Exploring Mental Health and Academic Outcomes of Children Receiving Non-manualized, Transdiagnostic, Task-Shifted Mental Health Care From Their Teachers in a Low-and-Middle Income Country. Front Pediatr 2022; 10:807178. [PMID: 35386261 PMCID: PMC8979063 DOI: 10.3389/fped.2022.807178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022] Open
Abstract
A majority of children worldwide who face mental health difficulties, especially in low-and-middle income countries, remain undiagnosed and untreated. This deficit roots in part from a lack of trained professionals qualified to provide care. Task-shifting the provision of treatment to teachers, individuals with consistent access to children, can reduce the care gap. The current study investigated whether the implementation of a pilot trial of Tealeaf-Mansik Swastha (Teachers Leading the Frontlines-Mental Health; "Tealeaf") was associated with improvements in child mental health and academic outcomes. Tealeaf is a transdiagnostic, non-manualized, task-shifting intervention in which teachers identify students in need of mental health care and then provide task-shifted care for them using an emerging, novel therapy modality, "education as mental health therapy" (Ed-MH). Pre-post standardized quantitative measures focused on child mental health status and academics. The measures were completed by multiple raters and compared to determine whether changes occurred. Results indicated that primary teacher raters observed significant improvements in child mental health symptoms overall, while secondary teacher raters and caregivers noted improvement for certain diagnostic categories. Caregivers observed on average a decreased impact of their children's mental health symptoms on their children's lives. Academically, math scores significantly improved while reading trended toward significance. Preliminary evidence overall supports the viability of Tealeaf and Ed-MH for positively impacting child mental health and academics. Future directions include the implementation of a formalized, randomized-controlled trial to strengthen preliminary outcomes.
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Affiliation(s)
- Juliana L Vanderburg
- School Psychology Program, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Choden Dukpa
- Darjeeling Ladenla Road Prerna, Darjeeling, India
| | - Abhishek K Rauniyar
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | | | | | - Arpana Thapa
- Darjeeling Ladenla Road Prerna, Darjeeling, India
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karen Hampanda
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Molly M Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States.,Center for Global Health, Colorado School of Public Health, Aurora, CO, United States
| | - Michael Matergia
- Center for Global Health, Colorado School of Public Health, Aurora, CO, United States.,Broadleaf Health and Education Alliance, Stroudsburg, PA, United States
| | - Christina M Cruz
- School Psychology Program, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Outcomes of School-Home Intervention for Attention and Behavior Problems: Teacher Adherence Matters. SCHOOL MENTAL HEALTH 2021; 12:703-715. [PMID: 34589157 DOI: 10.1007/s12310-020-09378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study evaluated the effects of teacher adherence to behavioral treatment on student outcomes. Eighty-four children (ages 7-11) completed a 12-week, collaborative school-home behavioral intervention designed for youth with significant attention-deficit/hyperactivity disorder symptoms and impairment. Teacher adherence was assessed via school mental health provider (SMHP) ratings and Daily Report Card (DRC) implementation. Pre- and post-treatment outcomes included parent and teacher ratings of organizational skills and problem behaviors, observational measures of classroom task engagement and off task behaviors and report card standard grades. Using multi-level models to account for clustering by school, teacher adherence rated by SMHPs predicted improvement across teacher- and parent-rated organizational skills, parent-rated problem behaviors, and classroom observations of task engagement and off-task behavior. Higher rates of DRC implementation only predicted improvements in parent-rated organizational skills; percentage of days parents signed the DRC only predicted teacher-rated improvement in organizational skills. Post-hoc analyses indicated that teacher adherence and child success with academic targets on the DRC during the first month predicted parent-rated improvement in organizational skills. These results suggest that teacher adherence, particularly when rated by SMHPs, is an important predictor of positive treatment outcomes across both school and home settings. Future research is needed to better understand methods for measuring and optimizing teacher adherence to classroom behavioral interventions.
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Mixed-Method Examination of Latinx Teachers' Perceptions of Daily Behavioral Report Card Interventions to Support Students with ADHD. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:29-43. [PMID: 33977337 DOI: 10.1007/s10488-021-01140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 10/21/2022]
Abstract
Daily behavioral report cards (DRC) are an efficacious intervention for children with ADHD, yet there is little information on Latinx teachers' perceptions about ADHD and preferences related to behavioral treatment. The purpose of the current study was to examine the feasibility and acceptability of behavioral consultation with Latinx teachers and students, with a particular focus on the DRC. Participants (n = 23) included elementary school teachers (100% Hispanic/Latinx, 96% female) working with predominantly Hispanic/Latinx students. We leveraged a convergent, mixed-method design to evaluate feasibility, acceptability, as well as several potentially associated factors (i.e., perceptual, practical/logistical, individual, and cultural factors). Quantitative and qualitative measures and analyses were guided by the Consolidated Framework for Intervention Research. We found that Latinx teachers' Daily Report Card (DRC) completion rates (80%) were comparable to previous studies with predominantly non-Latinx white teachers and students. Quantitative indicators of acceptability were also similar to the prior literature. Few variables were associated with DRC completion rates, with the exception of teacher self-report of stress and satisfaction, which were both positively associated with completion rates. Qualitative findings expanded quantitative trends; thematic analyses revealed two overarching themes, that (1) teachers' attitudes toward behavioral interventions matter a great deal, and that (2) teachers' perceived behavioral control over DRC implementation depends a lot on the environment. Findings highlight the importance of stakeholders' perspectives, including teachers, in translating research to practice in real world settings.
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Kurian J, Murray DW, Kuhn L, LaForett DR. Examining frequency and modality of parent engagement in an elementary school mental health intervention. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2021. [DOI: 10.1080/15377903.2021.1911896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jennifer Kurian
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, North Carolina
| | - Desiree W. Murray
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, North Carolina
- Child Trends, Inc, Chapel Hill, North Carolina
| | - Laura Kuhn
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, North Carolina
| | - Doré R. LaForett
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, North Carolina
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Girio-Herrera E, Egan TE, Owens JS, Evans SW, Coles EK, Holdaway AS, Mixon CS, Kassab HD. Teacher Ratings of Acceptability of a Daily Report Card Intervention Prior to and During Implementation: Relations to Implementation Integrity and Student Outcomes. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-020-09400-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Iznardo M, Rogers MA, Volpe RJ, Labelle PR, Robaey P. The Effectiveness of Daily Behavior Report Cards for Children With ADHD: A Meta-Analysis. J Atten Disord 2020; 24:1623-1636. [PMID: 29135352 DOI: 10.1177/1087054717734646] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This meta-analysis examined group-design studies investigating the effectiveness of Daily Behavior Report Cards (DBRC) as a school-based intervention to manage the classroom behavior of students with ADHD. Methods: A search of three article databases (PsycINFO, ERIC and Medline) identified seven group design evaluations of DBRC interventions. This meta-analysis included a total of 272 participants, with an average age of 7.9 years old. Three of the studies compared a control group to a treatment group with randomized group assignment, one study compared a control group to three treatment groups, two studies compared pre-and post-treatment scores in the same group, and one study compared pre-and post-treatment results of two intervention groups without random assignment. Dependent measures for these studies were teacher ratings (n = 5) and systematic direct observation of student academic and social behaviour (n = 2). Standardized mean differences (Hedge's g) were calculated to obtain a pooled effect size using fixed effects. Results: DBRCs were associated with reductions teacher-rated ADHD symptoms, with a Hedge's g of 0.36 (95% CI: 0.12-0.60, z=2.93, p ≤ .005) with low heterogeneity (Q-value: 2.40, I2 = 0.00). This result excluded two studies that used observational coding instead of standardized tests to evaluate the effects of the intervention. A moderator analysis indicated that the effect size for systematic direct observation was large (Hedge's G = 1.05[95% CI: 0.66-1.44, z=5.25, p ≤ .00]), with very high heterogeneity (Q-value: 46.34, I2: 93.53). A second moderator analysis found differences in the effects of DBRCs for comorbid externalizing symptoms with an overall effect size of 0.34 (95%CI: -0.04-0.72, z=1.76 p =0.08) with high heterogeneity (Q-value: 3.98, I2: 74.85). Conclusions: DBRCs effectively reduce the frequency and severity of ADHD symptoms in classroom settings. Additionally, they have a significant effect on co-occuring externalizing behaviors. It appears that systematic direct observation may be a more sensitive measure of treatment effects compared to teacher ratings of ADHD symptoms.
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Holdaway AS, Hustus CL, Owens JS, Evans SW, Coles EK, Egan TE, Himawan L, Zoromski AK, Dawson AE, Mixon CS. Incremental Benefits of a Daily Report Card Over Time for Youth with Disruptive Behavior: Replication and Extension. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09375-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Owens JS, Margherio SM, Lee M, Evans SW, Crowley DM, Coles EK, Mixon CS. Cost-effectiveness of Consultation for a Daily Report Card Intervention: Comparing In-Person and Online Implementation Strategies. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2020. [DOI: 10.1080/10474412.2020.1759428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Smith TE, Holmes SR, Sheridan SM, Cooper JM, Bloomfield BS, Preast JL. The Effects of Consultation-based Family-school Engagement on Student and Parent Outcomes: A Meta-analysis. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2020. [DOI: 10.1080/10474412.2020.1749062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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DuPaul GJ, Eckert TL, Vilardo B. The Effects of School-Based Interventions for Attention Deficit Hyperactivity Disorder: A Meta-Analysis 1996–2010. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2012.12087496] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Smith TE, Sheridan SM, Kim EM, Park S, Beretvas SN. The Effects of Family-School Partnership Interventions on Academic and Social-Emotional Functioning: a Meta-Analysis Exploring What Works for Whom. EDUCATIONAL PSYCHOLOGY REVIEW 2019. [DOI: 10.1007/s10648-019-09509-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evaluating a Short Form of the Academic Competence Evaluation Scales: Expanded Examination of Psychometric Properties. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09347-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zhou Q, Dufrene BA, Mercer SH, Olmi DJ, Tingstom DH. Parent‐implemented reading interventions within a response to intervention framework. PSYCHOLOGY IN THE SCHOOLS 2019. [DOI: 10.1002/pits.22251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Qi Zhou
- Department of Business and Public ServiceGordon State CollegeBarnesville Georgia
| | - Brad A. Dufrene
- School of PsychologyThe University of Southern MississippiHattiesburg Mississippi
| | - Sterett H. Mercer
- Educational and Counselling Psychology, and Special EducationUniversity of British ColumbiaVancouver British Columbia Canada
| | - D. Joe Olmi
- School of PsychologyThe University of Southern MississippiHattiesburg Mississippi
| | - Daniel H. Tingstom
- School of PsychologyThe University of Southern MississippiHattiesburg Mississippi
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O’Farrell P, Kinsella W. Research exploring parents’, teachers’ and educational psychologists’ perceptions of consultation in a changing Irish context. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2018. [DOI: 10.1080/02667363.2018.1461612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- P. O’Farrell
- School of Policy and Practice, Dublin City University , Dublin, Ireland
| | - W. Kinsella
- School of Education, University College Dublin , Ireland
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The efficacy of conjoint behavioral consultation in the home setting: Outcomes and mechanisms in rural communities. J Sch Psychol 2017. [PMID: 28646977 DOI: 10.1016/j.jsp.2017.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study reports the results of a randomized controlled trial examining the effect of Conjoint Behavioral Consultation (CBC), a family-school partnership intervention, on children's behaviors, parents' skills, and parent-teacher relationships in rural community and town settings. Participants were 267 children, 267 parents, and 152 teachers in 45 Midwestern schools. Using an Intent to Treat approach and data analyzed within a multilevel modeling framework, CBC yielded promising results for some but not all outcomes. Specifically, children participating in CBC experienced decreases in daily reports of aggressiveness, noncompliance, and temper tantrums; and increases in parent-reported adaptive skills and social skills at a significantly greater pace than those in a control group. Other outcomes (e.g., parent reports of internalizing and externalizing behaviors) suggested a nonsignificant effect at post-test. CBC parents reported using more effective parenting strategies, gaining more competence in their problem-solving practices, and feeling more efficacious for helping their child succeed in school than parents in the control group. Parents participating in CBC also reported significant improvements in the parent-teacher relationship, and the parent-teacher relationship mediated the effect of CBC on children's adaptive skills. Implications for practice in rural communities, study limitations, and directions for future research are discussed.
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Sheridan SM, Witte AL, Holmes SR, Coutts MJ, Dent AL, Kunz GM, Wu C. A randomized trial examining the effects of Conjoint Behavioral Consultation in rural schools: Student outcomes and the mediating role of the teacher–parent relationship. J Sch Psychol 2017; 61:33-53. [DOI: 10.1016/j.jsp.2016.12.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/10/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Richardson M, Moore DA, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, Whear R, Newlove-Delgado TV, Logan S, Morris C, Taylor E, Cooper P, Stein K, Garside R, Ford TJ. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2016; 19:1-470. [PMID: 26129788 DOI: 10.3310/hta19450] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by age-inappropriate levels of inattention, impulsivity and hyperactivity. School can be particularly challenging for children with ADHD. Few reviews have considered non-pharmacological interventions in school settings. OBJECTIVES To assess the effectiveness of non-pharmacological interventions delivered in school settings for pupils with, or at risk of, ADHD and to explore the factors that may enhance, or limit, their delivery. DATA SOURCES Twenty electronic databases (including PsycINFO, MEDLINE, EMBASE, Education Resources Information Centre, The Cochrane Library and Education Research Complete) were searched from 1980 to February-August 2013. Three separate searches were conducted for four systematic reviews; they were supplemented with forward and backwards citation chasing, website searching, author recommendations and hand-searches of key journals. REVIEW METHODS The systematic reviews focused on (1) the effectiveness of school-based interventions for children with or at risk of ADHD; (2) quantitative research that explores attitudes towards school-based non-pharmacological interventions for pupils with ADHD; (3) qualitative research investigating the attitudes and experiences of children, teachers, parents and others using ADHD interventions in school settings; and (4) qualitative research exploring the experience of ADHD in school among pupils, their parents and teachers more generally. Methods of synthesis included a random-effects meta-analysis, meta-regression and narrative synthesis for review 1, narrative synthesis for review 2 and meta-ethnography and thematic analysis for reviews 3 and 4. RESULTS For review 1, 54 controlled trials met the inclusion criteria. For the 36 meta-analysed randomised controlled trials, beneficial effects (p < 0.05) were observed for several symptom and scholastic outcomes. Mean weighted effect sizes ranged from very small (d + < 0.20) to large (d + ≥ 0.80), but substantial heterogeneity in effect size estimates across studies was reported. Moderator analyses were not able to clarify which intervention features were linked with effectiveness. For review 2, 28 included studies revealed that educators' attitudes towards interventions ranged in positivity. Most interventions were rated positively or neutrally across different studies. The only intervention that consistently recorded positive attitudes from educators was daily report cards. For review 3, 33 studies met the inclusion criteria. Key findings included tensions regarding the preferred format of interventions, particularly how structured interventions were and the extent to which they are tailored to the child with ADHD. There were mixed views about the impact of interventions, although it was clear that interventions both influence and are influenced by the relationships held by children with ADHD and participants' attitudes towards school and ADHD. For review 4, 34 studies met the inclusion criteria. Key findings included the importance of causal attributions that teachers, parents and pupils made about ADHD symptoms, the decisions teachers made about treatment, the self-perceptions pupils developed about themselves, the role of the classroom environment and stigma in aggravating ADHD symptoms, and the significant barrier to treatment posed by the common presence of conflict in relationships between pupils-teachers, parents-teachers and pupils-peers in relation to ADHD. An overarching synthesis of the four reviews highlighted the importance of the context affecting interventions. It suggested that ADHD psychoeducation and relationship-building skills are potential implications for interventions. LIMITATIONS The breadth of both interventions and outcomes in the reviewed studies presented a challenge for categorisation, analysis and interpretation in reviews 1-3. Across reviews, relatively few studies were conducted in the UK, limiting the applicability of findings to UK education. In reviews 1 and 2, the poor methodological quality of some included studies was identified as a barrier to establishing effectiveness or comparing attitudes. In review 3 the descriptive analysis used by the majority of studies constrained theorising during synthesis. Studies in review 4 lacked detail regarding important issues like gender, pupil maturity and school level. CONCLUSION Findings suggest some beneficial effects of non-pharmacological interventions for ADHD used in school settings, but substantial heterogeneity in effect sizes was seen across studies. The qualitative reviews demonstrate the importance of the context in which interventions are used. Future work should consider more rigorous evaluation of interventions, as well as focus on what works, for whom and in which contexts. Gaps in current research present opportunities for the development and testing of standardised tools to describe interventions, agreement on gold-standard outcome measures assessing ADHD behaviour and testing a range of potential moderators alongside intervention trials. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Ruth Gwernan-Jones
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson-Coon
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Obioha Ukoumunne
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Rebecca Whear
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Tamsin V Newlove-Delgado
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Stuart Logan
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Christopher Morris
- Peninsula Cerebra Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | - Eric Taylor
- Institute of Psychiatry, King's College London, London, UK
| | - Paul Cooper
- Centre for Special Educational Needs and Inclusive Education (CSENIE), Hong Kong Institute of Education, Hong Kong, China
| | - Ken Stein
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
| | - Tamsin J Ford
- Child Health Group, University of Exeter Medical School, Exeter, UK
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Ohmstede TJ, Yetter G. Implementing Conjoint Behavioral Consultation for African American Children from a Low-SES, Urban Setting. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2014. [DOI: 10.1080/10474412.2014.929959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gormley MJ, Dupaul GJ. TEACHER-TO-TEACHER CONSULTATION: FACILITATING CONSISTENT AND EFFECTIVE INTERVENTION ACROSS GRADE LEVELS FOR STUDENTS WITH ADHD. PSYCHOLOGY IN THE SCHOOLS 2014. [DOI: 10.1002/pits.21803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Villodas MT, McBurnett K, Kaiser N, Rooney M, Pfiffner LJ. Additive effects of parent adherence on social and behavioral outcomes of a collaborative school-home behavioral intervention for ADHD. Child Psychiatry Hum Dev 2014; 45:348-60. [PMID: 24043560 PMCID: PMC4808053 DOI: 10.1007/s10578-013-0405-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study evaluated the impact of the Collaborative Life Skills Program (CLS), a novel school-home psychosocial intervention, on social and behavioral impairments among children with attention and behavior problems. Fifty-seven ethnically/racially diverse children (70 % boys) with attention and/or behavior problems in the second through fifth grades participated in a pilot study. Ten school-based mental health professionals were trained and then implemented the intervention at their respective schools. Children significantly improved from pre- to post-treatment on parent, teacher, and report card ratings of children's social and behavioral functioning. Treatment improvements were consistent for children with and without co-occurring disruptive behavior problems. The impact of the intervention was enhanced when parents used the intervention strategies more regularly, according to both clinicians' and parents' reports. Findings support the emphasis of CLS on coordinating intervention strategies across contexts to facilitate the generalization of treatment-related improvements in social and behavioral functioning.
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Collier-Meek MA, Sanetti LMH. Assessment of Consultation and Intervention Implementation: A Review of Conjoint Behavioral Consultation Studies. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2014. [DOI: 10.1080/10474412.2014.870482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vujnovic R, Fabiano GA, Pariseau ME, Naylor J. Parameters of Adherence to a Yearlong Daily Report Card Intervention for Students With Attention-Deficit/Hyperactivity Disorder. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2013. [DOI: 10.1080/10474412.2013.785182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Owens JS, Holdaway AS, Zoromski AK, Evans SW, Himawan LK, Girio-Herrera E, Murphy CE. Incremental benefits of a daily report card intervention over time for youth with disruptive behavior. Behav Ther 2012; 43:848-61. [PMID: 23046786 DOI: 10.1016/j.beth.2012.02.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 01/30/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
This study examined the percentage of children who respond positively to a daily report card (DRC) intervention and the extent to which students achieve incremental benefits with each month of intervention in a general education classroom. Participants were 66 children (87% male) with attention-deficit hyperactivity disorder or disruptive behavior problems who were enrolled in a school-based intervention program in rural, low-income school districts in a Midwest state. The DRC was implemented by each child's teacher, who received consultation from a graduate student clinician, school district counselor, or school district social worker. A latent class analysis using growth-mixture modeling identified two classes of response patterns (i.e., significant improvement and significant decline). Results indicated that 72% of the sample had all of their target behaviors classified as improved, 8% had all of their targets classified as declining, and 20% had one target behavior in each class. To examine the monthly incremental benefit of the DRC, individual effect sizes were calculated. Results for the overall sample indicated that most children experience a benefit of large magnitude (.78) within the first month, with continued incremental benefits through Month 4. The differential pattern of effect sizes for the group of improvers and the group of decliners offer data to determine when and if the DRC should be discontinued and an alternative strategy attempted. Evidence-based guidelines for practical implementation of the DRC are discussed.
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Murray DW, Rabiner DL, Hardy KK. Teacher management practices for first graders with attention problems. J Atten Disord 2011; 15:638-45. [PMID: 20837985 DOI: 10.1177/1087054710378234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine whether teacher reports of accommodations and interventions for inattentive first graders are consistent with best practice guidelines. METHOD A total of 36 teachers completed the Teacher Management Questionnaire (TMQ) for 92 students in five predominantly low-income, minority schools. The TMQ is a newly developed measure designed to assess the frequency with which teachers implement a variety of accommodations and interventions with individual students. Additional teacher and student background data were collected on the inattentive sample, including behavior ratings and academic testing. RESULTS Teachers reported variable implementation of different management strategies, with more frequent use of class-wide structure and organizational interventions, and less frequent assignment modifications and individual behavior plans. Greater use of some strategies was reported for inattentive students and those with additional risk characteristics such as oppositional behavior and school-based referrals. CONCLUSION Teachers appear to differentiate some management strategies based on the presence of attention problems, although their self-reported implementation is not well aligned with best practice guidelines.
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Teachers’ Reported Use of Instructional and Behavior Management Practices for Students with Behavior Problems: Relationship to Role and Level of Training in ADHD. CHILD & YOUTH CARE FORUM 2010. [DOI: 10.1007/s10566-010-9130-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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