Co-Principal Investigator: Joseph Wehby (Vanderbilt University)

Purpose: The purpose of this project is to develop an Adaptive Intervention Framework (AIF) that will facilitate the systematic identification and modification of Tier 2 interventions within the context of a multi-tiered system of behavior support. Multi-tiered systems of support (e.g., Response to Intervention) frequently used in schools provide the framework for addressing the academic and behavioral needs of students with problem behavior. These systems comprise integrated layers of prevention/intervention that systematically increase in intensity. However, schools most commonly implement only the first level (Tier 1) systematically. Educators are ill-equipped on how best to modify, intensify, or adapt interventions to meet the individualized needs of students who need higher intensity interventions. To address this need, this project will create the AIF to guide educators in selection and adaptation of Tier 2 interventions for students with mild to moderate behavior problems.

Project Activities: A series of iterative research activities will be completed over a 3-year period to develop AIF and examine its feasibility in elementary schools. The team will develop and test the AIF around three Tier 2 interventions. Two are well-known Tier 2 behavioral interventions (Check In Check Out, or CICO, and social skills interventions). A third intervention will be identified based on Year 1 research activities. In Year 1, the team will initially develop AIF through literature reviews of relevant intervention research for CICO and social skills interventions, and conduct observations in schools across the country that are implementing a comprehensive system of interventions to identify an additional commonly used Tier 2 intervention. In addition, the team will conduct focus groups with regional Community Development Team members (e.g., teachers, behavior specialists, administrators, parents). In Year 2, the team will implement AIF with a small group of teachers and their students and gather data and feedback that will allow the team to make revisions to AIF. In Year 3, the team will conduct a small randomized trial to compare a commonly implemented Tier 2 intervention (CICO) implemented within AIF to CICO using standard protocols to evaluate the impact of AIF on students' behaviors and academic performance. In addition, the team will conduct two single-case design studies testing the AIF with social skills interventions and the third Tier 2 intervention identified based on school visits in Year 1.

Products: The products of this project include a fully developed intervention framework, AIF, as well as peer-reviewed publications and presentations.

Structured Abstract

Setting: This study will take place in elementary schools in Pennsylvania and Tennessee.

Sample: In Year 1, five schools at each site will participate for site visits and observations. In Year 2, one elementary school at each site will participate. For both Years 1 and 2, all students who are not responding to standard Tier 2 interventions (estimated to be 7–14 students per school) and their teachers will participate. For the pilot study, four schools at each site will participate, including approximately 90 students in need of Tier 2 interventions and their teachers. Of these, 82 students will be assigned to the randomized trial and the remainder will participate in the single-case studies.

Intervention: AIF varies different aspects of a standard intervention based on the needs of the individual and includes four elements. First, the team will develop critical factors that may interact with an intervention, and may include information such as: a) response patterns to the Tier 1 intervention, b) identification of student characteristics that might predict responsiveness, and c) function of problem behavior. The second element, adaptations, is the identification of potential intervention options related to each of the identified critical factors. These modifications might involve dosage and intensity, but would also include content modifications to the initial intervention protocol (e.g., adding a brief academic review to CICO mentoring sessions). Third, tailoring variables will be selected to help determine when an intervention should be modified and which modification is best suited for an individual. Finally, a sequence of decision rules will be developed. Decision rules use tailoring variables to lead to one or more intervention adaptations.

Research Design and Methods: The team will use an iterative process in Years 1 and 2 to develop AIF. In Year 1, the team will initially develop AIF through literature reviews of relevant intervention research for two commonly implemented Tier 2 interventions (CICO and social skills interventions) as well as a third Tier 2 intervention that the team will identify via observations in schools. The team will conduct observations in schools that are implementing a comprehensive system of interventions to obtain information on common interventions (other than CICO and social skills interventions) school staff are implementing, determine whether and what type of intervention adaptations schools have implemented and have found to be effective, assess what decisions practitioners render critical for intervention selection, determine what data school staff believe are most helpful for decision making and how and when clinical judgment is used, and understand systemic issues school staff perceive as barriers to implementation. The team will also solicit feedback from Community Development Team members. In Year 2, the team will implement AIF with a small group of teachers and their students using the three Tier 2 interventions (CICO, social skills interventions, and additional Tier 2 intervention identified during school visits in Year 1). The team will gather data and feedback to make revisions to AIF. In Year 3, the team will conduct a small randomized trial to compare CICO using AIF with CICO implemented using standard protocols to evaluate the impact of AIF on students' behaviors and academic performance. In addition, the team will conduct two single-case studies (ABAB or multiple baseline designs) testing the AIF with social skills interventions and the third Tier 2 intervention identified though school observations in Year 1.

Control Condition: In the control condition for the randomized trial, CICO will be implemented following CICO standard procedures (without AIF).

Key Measures: The Benchmarks of Quality will be used to measure the degree to which schools are implementing tiered intervention systems to determine school readiness for Tier 2 intervention. To evaluate student outcomes and responsiveness to intervention, the team will administer the Daily Behavior Report, conduct direct observations of student and staff behavior, and use curriculum-based measures to assess student academic progress. The team will also collect student outcome data on office disciplinary referrals and report card grades. In addition, the researchers will collect usability and feasibility data throughout the study.

Data Analytic Strategy: Qualitative and descriptive data analysis techniques will be used for data gathered in Years 1 and 2. Descriptive analyses of intervention fidelity and integrity will also be conducted. Data from the Year 3 randomized pilot study will be analyzed through an analysis of variance with effect sizes computed (Cohen's d) to determine the strength of the difference. For single-subject studies, the researchers will use visual analysis and two methods to determine effect size, one parametric (e.g. HLM) and one non-parametric (e.g. Percent of All Non-Overlapping Data).