Journal of Emotional and Behavioral Disorders recent issues

Introduction to This Special Issue: Implementing Evidence-Based Interventions in Elementary Schools for Students With and at Risk for Severe Behavior Disorders

Buckley, J. A. — Wed, 18 Nov 2009 09:31:41 PST

A Randomized Controlled Trial of the First Step to Success Early Intervention: Demonstration of Program Efficacy Outcomes in a Diverse, Urban School District

Wed, 18 Nov 2009 09:31:41 PST

This article reports on a randomized controlled trial of the First Step to Success early intervention that was conducted over a 4-year period in Albuquerque Public Schools. First Step is a selected intervention for students in Grades 1 through 3 with externalizing behavior problems, and it addresses secondary prevention goals and objectives. It consists of three modular components (screening, school intervention, parent training); lasts approximately 3 months; and is initially set up, delivered, and coordinated by a behavioral coach (e.g., school counselor, behavior specialist, social worker). Project Year 1 of this efficacy trial was devoted to gearing-up activities (e.g., hiring, training, planning, logistical arrangements); Years 2 and 3 each involved implementing First Step with approximately 100 behaviorally at-risk students. Students, teachers, and classrooms were randomly assigned to either intervention or usual care comparison conditions. Year 4 activities focused on conducting long-term, follow-up assessments and implementing sustainability procedures to preserve achieved gains. Pre-post teacher and parent ratings of student behavior and social skills showed moderately robust effect sizes, ranging from .54 to .87, that favored the intervention group. Direct measures of academic performance (oral reading fluency, letter—word identification) were not sensitive to the intervention. The implications and limitations of the study are discussed.

Randomized Controlled Trial of the Prevent-- Teach--Reinforce (PTR) Tertiary Intervention for Students With Problem Behaviors: Preliminary Outcomes

Iovannone, R., Greenbaum, P. E., Wang, W., Kincaid, D., Dunlap, G., Strain, P. — Wed, 18 Nov 2009 09:31:41 PST

Although there is literature supporting the effectiveness of tertiary behavioral supports, the majority of the studies have been conducted with single-subject designs. The Prevent—Teach—Reinforce (PTR) model is a standardized model of a school-based tertiary intervention. This study reports initial results from a randomized controlled trial to compare whether the PTR model, as implemented by typical school personnel, is more effective than interventions typically used (i.e., services as usual). To date, 245 students in Grades K-8 have been enrolled in the study, and preliminary results show that students who received the PTR intervention had significantly higher social skills and academic engaged time and significantly lower problem behavior when compared with students who received services as usual. Teachers gave high social validity ratings to the intervention. Implications for widescale school adoption are discussed.

A 2-Year Outcome Study of the Check, Connect, and Expect Intervention for Students At Risk for Severe Behavior Problems

Cheney, D. A., Stage, S. A., Hawken, L. S., Lynass, L., Mielenz, C., Waugh, M. — Wed, 18 Nov 2009 09:31:41 PST

Two hundred seven students in Grades 1 through 5 who were at risk for severe behavior problems participated in a 2-year study of the effects of the Check, Connect, and Expect (CCE) program. The CCE program combined the essential intervention procedures of the Check & Connect Program and the Behavior Education Program . A stratified random sample of students based on school assignment was used to compare the outcomes of 121 CCE program students with 86 comparison students. Sixty percent of the CCE students (n = 73) graduated from the program and 40% (n = 48) did not. Linear growth analyses of eight different outcome measures found that three standardized problem behavior measures significantly decreased to normative levels for CCE graduates. Social skills and academic measures did not significantly change over time. The discussion focuses on the comparative efficacy of CCE as a targeted intervention for students at risk for severe behavior problems.

The National Behavior Research Coordination Center: Coordinating Research and Implementation of Evidence-Based School Interventions for Children With Serious Behavior Problems

Wagner, M. M., Sumi, W. C., Woodbridge, M. W., Javitz, H. S., Thornton, S. P. — Wed, 18 Nov 2009 09:31:41 PST

In implementing its Behavior Research Initiative, the U.S. Department of Education funded four Behavior Research Centers, each to test the efficacy of a separate intervention to improve the behavior of elementary school students with or at risk for serious behavior problems. The initiative also established the National Behavior Research Coordination Center to conduct a cross-site evaluation of the four behavior interventions. The authors describe how the Department of Education’s structuring of the initiative helped avoid many of the shortcomings of earlier federal cross-site demonstration programs and highlight the contributions a research coordination center can make to the quality of research conducted and to the knowledge produced across individual demonstrations.

In Memoriam: Jane Knitzer

Kutash, K. — Mon, 10 Aug 2009 10:30:41 PDT

In Memoriam: Patricia Sitlington

Cheney, D. — Mon, 10 Aug 2009 10:30:41 PDT

Returning Home in Systems of Care: Rates, Predictors, and Stability

Farmer, E. M. Z., Southerland, D., Mustillo, S. A., Burns, B. J. — Mon, 10 Aug 2009 10:30:41 PDT

Recent work suggests that out-of-home placements continue to be relatively common for youth with mental health problems, even within systems of care. The current work examines rates and predictors of movement back home and stability of reunifications. During the focal period, 1,778 youths experienced out-of-home placements; 61% moved back home, and 22% of those reunited were placed out of home again. Race was related to likelihood of reunification and instability: American Indian youth were least likely to return home, whereas Hispanic youth were at increased risk of unstable reunifications. Older youth and boys were more likely to return home, whereas youth from families with higher incomes were slightly more likely to be placed out of home but also most likely to be stably reunited. Higher (i.e., worse) total Child Behavior Checklist score was related to moving back home, whereas decreased strengths and more child-level risk factors predicted instability of reunification.

Measuring the Restrictiveness of Living Environments for Children and Youth: Reconceptualizing Restriction

Mon, 10 Aug 2009 10:30:41 PDT

The Restrictiveness of Living Environment Scale has long been the primary way to conceptualize the "restrictiveness" of a child’s living situation. However, changes in systems of care and other factors have created a need to revisit how restrictiveness is conceptualized and measured. A measure was created to assess an environment’s level of restrictiveness and form the basis for empirically created general environment types. The measure was refined using expert review, cognitive interviewing, and pilot testing. Over 1,000 child organizations and older youth were invited to participate, with responses completed for 446 youth. The sample was reduced to 313 because of a large response from one setting. Cluster analysis produced a four-cluster solution suggesting low, moderate, elevated, and high restrictiveness for a simplified general environment typology. The data also suggest overlap among clusters and that settings with the same names can vary. Limitations are described, and plans for how the measure will be further developed are outlined.

The Changing Mental Health Needs of Youth Admitted to Residential Group Home Care: Comparing Mental Health Status at Admission in 1995 and 2004

Mon, 10 Aug 2009 10:30:41 PDT

Youth entering residential care possess significant emotional and behavioral needs; yet, it is uncertain whether these needs have remained constant or are changing over time. This study examined mental health variables from the admission files of 1,047 youth entering residential group home care in 1995 and 2004. Sequential logistical regression analyses revealed that the mental health needs of youth admitted in 2004 were greater than those for youth in 1995 with regard to having multiple psychiatric diagnoses, being prescribed two or more psychotropic medications, and using alcohol or drugs. As such, these analyses should be replicated in other group homes as well as in other placement settings within the system of care.

Mental Health and Special Education Services at School Entry for Children Who Were Involved With the Child Welfare System as Infants

Ringeisen, H., Casanueva, C., Cross, T. P., Urato, M. — Mon, 10 Aug 2009 10:30:41 PDT

This study examines mental health and special education needs and service use at school entry among children involved in maltreatment investigations as infants. Data are from the National Survey of Child and Adolescent Well-Being, a national probability study of 5,501 children investigated for maltreatment. The study sample comprised 959 children who were infants at baseline and 5 to 6 years old at the last follow-up. Half had behavioral or cognitive needs at entry to school. About a quarter received outpatient mental health or special education services. Logistic regression showed that compared to children residing with biological parents, adopted and foster children were more likely to receive mental health services, and children adopted or in kinship care were more likely to receive educational services. Increased monitoring of behavioral and cognitive needs of infants reported for maltreatment may facilitate their access to services and ease the transition to school.

Kindergarten Predictors of Recurring Externalizing and Internalizing Psychopathology in the Third and Fifth Grades

Morgan, P. L., Farkas, G., Qiong Wu, — Tue, 05 May 2009 11:37:01 PDT

This study evaluated the extent to which a range of risk factors (e.g., gender, race/ethnicity, low socioeconomic status) predicted kindergarten children's likelihood of later displaying recurring psychopathology. It used multilevel logistic regression to analyze teacher ratings of frequent and recurring externalizing and internalizing problem behaviors in a longitudinal sample of 4,674 children participating in the Early Childhood Longitudinal Study—Kindergarten Cohort, 1998—1999. Results indicated that those most at risk of displaying externalizing problem behaviors in both the third and fifth grade are those entering school already displaying high levels of these behaviors, as well as those displaying low reading readiness. Hispanics are at reduced risk of such problem behaviors. Those most at risk of displaying internalizing behavior problems in the third and fifth grades are those entering kindergarten with such problems and those displaying inattention and other learning-related behavior problems. Asian children are at reduced risk of recurring internalizing behavior problems. Females and children from higher SES families are at reduced risk for both types of psychopathology.

Assessing the Relationships Among Delinquent Male Students' Disruptive and Violent Behavior and Staff's Proactive and Reactive Behavior in a Secure Residential Treatment Center

Rozalski, M., Drasgow, E., Drasgow, F., Yell, M. — Tue, 05 May 2009 11:37:01 PDT

The purpose of this study was to examine the relationships among students' disruptive and violent behavior and staff's use of proactive and reactive strategies in a secure residential treatment center serving delinquent adolescent males. One hundred hours of observational data were collected, and linear regression models were used to explore the degree to which students' behavior and staff's behavior predict violence. Results indicate that a moderate to strong relationship exists between students' disruptive and violent behavior, although these relationships vary across settings within the facility. Data suggest that these locations differ in staff coverage, staff's use of proactive strategies, focal activity, and behavioral expectations, thus accounting for differences in the strengths of the relationships. Further analyses reveal that regardless of location, students' disruptive behavior is the best predictor of students' violent behavior.

A Comparison of Systematic Screening Tools for Emotional and Behavioral Disorders

Tue, 05 May 2009 11:37:01 PDT

Early identification of students who might develop emotional and behavioral disorders (EBD) is essential in preventing negative outcomes. Systematic screening tools are available for identifying elementary-age students with EBD, including the Systematic Screening for Behavior Disorders (SSBD) and the Student Risk Screening Scale (SRSS). The SSBD is considered the gold standard for systematic EBD screening. The brevity of the SRSS is often favored with respect to resource allocation. The authors evaluated the concurrent validity of the SRSS to predict SSBD results when used to detect school children with externalizing or internalizing behavior concerns. Between low- and high-risk categories, the SRSS had excellent accuracy for predicting both externalizing (95%) and internalizing (93%) problems on the SSBD. Sensitivity (94%) and specificity (95%) were both excellent for externalizing behavior, but for internalizing behavior, sensitivity was lower (44%), while specificity was excellent (95%). Receiver-operating characteristic analysis also suggested that the SRSS was more accurate for detecting externalizing than internalizing behaviors. Limitations and future directions are offered.

School-Based Cognitive-Behavioral Therapy for Adolescent Depression: A Benchmarking Study

Shirk, S. R., Kaplinski, H., Gudmundsen, G. — Tue, 05 May 2009 11:37:01 PDT

The current study evaluated cognitive-behavioral therapy (CBT) for adolescent depression delivered in health clinics and counseling centers in four high schools. Outcomes were benchmarked to results from prior efficacy trials. Fifty adolescents diagnosed with depressive disorders were treated by eight doctoral-level psychologists who followed a manual-guided, 12-session, individual CBT protocol. Referred adolescents presented with high rates of comorbidity, traumatic experiences, and prior suicide attempts. Posttreatment response to school-based CBT (64%) was comparable to results obtained in efficacy trials. On average, symptom reduction in this school-based study was similar to prior efficacy trials, exceeded results from an efficacy trial using the original manual, and exceeded results from a prior school-based CBT trial. Examination of predictors of symptom change and treatment response showed that life stress, trauma history, and depressive symptom severity were negatively associated with outcomes. Results suggest that school-based CBT is a relatively robust treatment for adolescent depression across gender, age, and ethnic groups as well as for adolescents with varied patterns of comorbidity.

Factor-Analytic and Individualized Approaches to Constructing Brief Measures of ADHD Behaviors

Volpe, R. J., Gadow, K. D., Blom-Hoffman, J., Feinberg, A. B. — Tue, 05 May 2009 11:37:01 PDT

Two studies were performed to examine a factor-analytic and an individualized approach to creating short progress-monitoring measures from the longer ADHD-Symptom Checklist-4 (ADHD-SC4). In Study 1, teacher ratings on items of the ADHD:Inattentive (IA) and ADHD:Hyperactive-Impulsive (HI) scales of the ADHD-SC4 were factor analyzed in a normative data sample of 493 students aged 5 to 12 years. Items with the highest factor loadings were then selected to create abbreviated IA and HI scales for Study 2. In Study 2, the psychometric characteristics of two shortened progress-monitoring measures (factor derived and individualized) and the original IA and HI scales of the ADHD-SC4 were examined in a sample of 26 students aged 4 to 17 years in a medication titration study involving baseline and three doses of methylphenidate. The results indicated comparable psychometric properties across the original and abbreviated versions of the IA and HI scales.

Understanding Racial/Ethnic Disparities in Youth Mental Health Services: Do Disparities Vary by Problem Type?

Gudino, O. G., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L. — Tue, 10 Feb 2009 11:10:15 PST

The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youth's symptoms and functional impairment during an initial interview. Specialty and school-based mental health service use during the subsequent 2 years was assessed prospectively. Greater disparities in mental health service receipt were evident for internalizing problems, with non-Hispanic White youth more likely to receive services in response to internalizing symptoms than minority youth. Fewer disparities in rates of unmet need emerged for externalizing problems, but minority youth were more likely to have need for externalizing problems met and African American youth were particularly likely to receive services in response to such problems. Findings highlight the importance of considering problem type when examining racial disparities in mental health services and underscore concerns about the responsiveness of mental health services for minority youth with internalizing disorders.

Emotional and Behavioral Problems Reported in Child Welfare Over 3 Years

McCrae, J. S. — Tue, 10 Feb 2009 11:10:15 PST

Child welfare agencies are required to provide services that ensure that children receive adequate mental health care. This study provides a comprehensive view of the emotional and behavioral problems of children who are referred to child welfare services, using nationally representative data. Bivariate analyses compare rates by child demographics, and conditional probability tables present changes in clinical status. Results show that 62% of children have at least one clinical-level score over 3 years. Rates are highest at baseline. Posttraumatic stress most frequently improves, whereas thought, attention, and aggressive/ delinquent behavior problems are most persistent. Sexualized behavior is more common among White and Hispanic children, and boys are reported with more internalizing problems than do girls. Targeted services are needed for young children who experience posttraumatic stress, as is treatment for attention problems that accounts for both biological and environmental components. Distinguishing the effects of age, environment, and assessment methods on boys' internalizing problems is also critical.

Development and Standardization of a Test to Measure the Emotional and Behavioral Strengths of Preschool Children

Epstein, M. H., Synhorst, L. L., Cress, C. J., Allen, E. A. — Tue, 10 Feb 2009 11:10:15 PST

The purpose of the present study was to document the development and standardization of the Preschool Behavioral and Emotional Rating Scale and to examine its factor structure, internal consistency, and criterion validity. Data from a nationally representative sample (N = 1,471) of preschool children with and without disabilities were collected. An exploratory factor analysis identified four factors: Emotional Regulation, School Readiness, Social Confidence, and Family Involvement. The subscales and total instrument appear remarkably stable and consistent (.838 to .983). Age differences across 3-, 4-, and 5-year olds were small in magnitude, although girls were rated as possessing significantly more strengths than boys. Preschool children with disabilities were seen as having less emotional and behavioral strength than their peers without disabilities. The limitations and future research needs are discussed.

Depression Among Alumni of Foster Care: Decreasing Rates Through Improvement of Experiences in Care

Tue, 10 Feb 2009 11:10:16 PST

The Northwest Foster Care Alumni Study examined the relation between experiences in foster care and depression among young adults who spent at least a year in foster care as adolescents. Results indicate that preparation for leaving foster care, nurturing supports from the foster family, school stability, access to tutoring, access to therapeutic service and support, and a shorter and more stable placement history were associated with a lower probability of depression in young adulthood. Results provide evidence that suggest ways to improve practice to decrease rates of depression among alumni of care.

Risk Factors Linking Maternal Depressed Mood to Growth in Adolescent Substance Use

Cortes, R. C., Fleming, C. B., Mason, W. A., Catalano, R. F. — Tue, 10 Feb 2009 11:10:16 PST

Maternal depression has been implicated in the development of adolescent substance use. Conceptualizing depression as a continuum, the aims of this study are to (a) understand the relationship between maternal depressed mood and risk factors associated with adolescent substance use; (b) understand the relationship between maternal depressed mood and level and growth in adolescent alcohol, cigarette, and marijuana use assessed at multiple time points during adolescence; and (c) examine the unique and relative contribution of maternal depressed mood after taking into account contextual risk factors related to adolescent substance use. Participants are 792 children and their mothers. Latent growth modeling is used with adolescent alcohol, cigarette, and marijuana use treated as ordinal variables. Child depressive phenomena and child antisocial behavior partially explain the relationship between maternal depressed mood and adolescent alcohol and cigarette use. Mothers' own substance use does not contribute to level or change in adolescent substance use after other risk factors are considered.