Addressing the Needs of Students With Social,Emotional,and Behavioral Problems

Positive Supports

Aside from the occasional development that revolutionizes institutions like education, system change is measured and cautious. Indeed, schools operate much as they did several centuries ago. One exception, however, is the relatively recent focus on positive approaches to behavior support (e.g., Bradshaw, Mitchell, & Leaf, 2010; Horner et al., 2009). Regardless of the specific variation (e.g., school-wide positive behavior support [SWPBS]), the associated ideology has transformed the way we approach problem behavior. The emphasis on prevention, instruction, and acknowledgment of appropriate behavior represents a fundamental change in the way we manage behavior (Carr et al., 2002). This movement has allowed us to understand that punishment will not improve the behavior of students who have ongoing and intransigent problems.

The number of schools implementing SWPBS is rapidly growing, currently reaching approximately 20,000 (R. H. Horner, personal communication, March 14, 2014). This suggests that educators are embracing the concept of positive approaches. Still, we must work to assure that positive supports reach all students, particularly those with EBDs as research suggests that there are many ways that teachers respond more negatively toward inappropriate behaviors exhibited by students with ongoing behavioral issues than to similar behaviors of their peers without such issues (Skinner & Belmont, 1993). In addition, these efforts need to target early intervention, so that appropriate supports are activated when problems first emerge. Finally, supports need to seamlessly follow students throughout their school career (e.g., Lane, Oakes, Carter, & Messenger, in press).

The concept of positive approaches to behavior support and associated practices must begin with pre-service teacher training. As we found in a survey evaluating the content of elementary teacher training programs, among a random sample of colleges/universities in the United States almost half offer no courses whatsoever in behavior management (State et al., 2011). This is unfortunate as teachers have long-reported difficulties managing student behavior as a primary concern contributing to attrition from the field (Billingsley, 2004). Training, however, needs to go beyond basic classroom management and include other areas essential to student well-being, such as identifying mental health disorders, improving quality of life, and futures planning.

In addition, in-service training on behavior management and positive support needs to be available to fill the gaps educators self-identify and those found in the course of supervision. Related approaches found to improve teacher performance also must become a regular part of education. These include mentoring for new teachers and ongoing coaching and performance feedback. Furthermore, a vast number of instructional modules, materials, and intervention strategies are easily accessible via the Internet. Administrators need to assure that these are available and accessed by educators. Once we fully engage in preventive and instructive strategies, as well as focusing on the strengths of students with EBDs, I believe that we will begin to see the improvements that have so long evaded us.

Mentoring and Relationship Building

Another important yet not so new advance is attention to adult–student relationships. Educators continue to overlook the importance of building rapport and developing a relationship with students. Recent changes in education, such as reduced funding, resulting in increased class size and the focus on academic achievement to the detriment of social and emotional development have contributed to this neglect. Research has illustrated important outcomes, both behavioral and academic, that can be achieved through positive student–teacher rapport and interactions as well as formal adult–student mentoring. For instance, large-scale studies have demonstrated that mentoring and/or a close teacher–student bond is associated with a variety of favorable outcomes, including higher academic achievement, fewer disciplinary problems, reduced rates of school dropout, and improved relationships with peers and adults other than the mentor (e.g., Chan et al., 2013; Crosnoe, Johnson, & Elder, 2012).

I believe that sustained mentoring, perhaps alone but particularly when it is linked to specific interventions identified through the mentoring process, has the potential to significantly improve student outcomes. Structured mentoring programs, such as Check & Connect (Anderson, Christenson, Sinclair, & Lehr, 2004), offer systematic procedures for school-based implementation to track and respond to indicators of risk. Again, such mentoring needs to begin in the early school years when signs of emotional and behavioral problems emerge and continue uninterrupted through high school graduation.

Fidelity and Adaptations

The final concept that I believe is critical to progress in the area of EBD pertains to the way we implement interventions. As noted, I am fairly well convinced that we have a repertoire of interventions that could successfully reduce the fundamental issues of many students with EBDs. One failure, however, is with treatment fidelity, or the extent to which those interventions are implemented as designed. It is my experience that many (if not most) interventions fail to show treatment effects because they were not fully or accurately implemented.

Treatment fidelity, although not a new concept, has received renewed attention in recent years (Hagermoser Sanetti & Kratochwill, 2013; Lane, Bocian, MacMillan, & Gresham, 2004). Much of the current work has focused on expanding the definition of fidelity beyond simply measuring provider implementation. For example, the Treatment Fidelity Workgroup for the National Institutes of Health (NIH) Behavior Change Consortium (Bellg et al., 2004) expanded our notion of treatment fidelity to include (a) increasing attention to study design (i.e., assuring that a study is designed so that intervention reflects theoretical foundations, hypotheses can be adequately tested, and potential confounds are reduced), (b) enhancing provider training (i.e., fully training interventionists to deliver the intervention), (c) establishing processes to assure that intervention is delivered as intended, (d) enhancing receipt of intervention (i.e., assuring that students understand and are able to use the skills taught), and (e) increasing the enactment of intervention skills (i.e., increasing the opportunity for students to perform skills in real-life settings). This broadened conceptualization draws our attention to additional dimensions of provider training and receipt of the intervention from the perspective of the student.

Systems must devote ongoing resources to assure that they are assessing broadened aspects of intervention implementation. The movement toward evidence-based practice is encouraging, but needs to be accompanied by fidelity checks to be fully realized. Fidelity monitoring needs to occur soon after intervention is implemented to assure initial understanding, and occur on an ongoing basis to address the potential of periodic lapses. Although measuring treatment fidelity requires a substantial resource commitment, the long-term economic and scientific costs of failing to do so are far greater.

It is also important that adaptive intervention models accompany this increased attention to treatment fidelity. Educators often rely on both their experience with interventions and their knowledge of a student to modify a particular intervention. Indeed, flexible adaptation that is responsive to characteristics of the setting, teacher/educator, and student increases the likelihood of both intervention implementation and intervention effectiveness. This process, however, generally relies on trial and error. Explicit guidelines can greatly assist educators while significantly improving student outcomes.

Recent intervention applications in the field of public health have demonstrated that explicit decision rules and menus of options can facilitate and enhance the adaptation process (Collins, Murphy, & Bierman, 2004; Lei, Nahum-Shani, Lynch, Oslin, & Murphy, 2012). This adaptive intervention framework involves decisions that are made dictating which intervention is initially chosen and when and how the intervention is adapted. The decisions are based on factors associated with context and responsiveness, including (a) student characteristics, (b) student progress after receiving a specific adaptation, and (c) interventionist preference and other related variables (e.g., likelihood of adherence to an adaptation). That is, specific variables (e.g., severity of student behavior, teacher preference) dictate which intervention or interventions should be selected from the start. After intervention is implemented, a number of other variables (e.g., student responsiveness at selected time points, treatment fidelity) guide when and how to adapt the intervention. Thus, when applying the adaptive intervention framework, educators vary different aspects of the standard intervention protocol, depending on the needs of the individual and the context in which intervention is implemented. As evidence is gathered to delineate and support the critical variables for decision-making with respect to behavior problems, the need to rely on teacher/educator judgment will be reduced, while intervention individualization and precision can become standard (e.g., Wehby & Kern, 2014).

Finally, we need to fully understand, document, and formulize adaptations to interventions that are matched to student and educator needs. This will both increase effectiveness and also respond to the individual preference and style of each educator. Furthermore, we will benefit by reducing or eliminating the need to rely on trial and error as well as educator judgment, practices that have led to little success. Increasing our understanding of intervention flexibility and improving precision in measuring whether implementation falls within acceptable bounds are likely to increase both accuracy of implementation and acceptability.