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IES Grant

Title: Advancing Equity in the Implementation of Comprehensive Behavioral Health Supports for Youth with or At Risk for Disabilities
Center: NCSER Year: 2023
Principal Investigator: Fallon, Lindsay Awardee: University of Massachusetts, Boston
Program: Social, Emotional, and Behavioral Competence      [Program Details]
Award Period: 4 years (09/012023 – 08/31/2027) Award Amount: $1,999,991
Type: Development and Innovation Award Number: R324A230139

Co-Principal Investigators: Daniels, Brian; La Salle-Finley, Tamika; Greif Green, Jennifer

Purpose: The purpose of this project is to develop Advancing Equity (AE), a training and coaching intervention to center equity in the design and implementation of Tier 1 supports within multi-tiered systems of support (MTSS) for social-emotional-behavioral (SEB) health across elementary and secondary schools. Students' SEB functioning is inextricably linked to academic success and lifelong outcomes. Support for SEB functioning for racially and ethnically minoritized students with or at risk for disabilities should be culturally relevant to maximize effectiveness. To address this need, the research team will develop and pilot the AE intervention in a large urban school district The pilot test aims to determine whether AE leads to stronger implementation of culturally responsive behavioral health practices and lower observed SEB risk for youth in schools. Ultimately, AE aims to reduce referrals to special education for youth historically overrepresented in categories such as emotional disturbance/impairment.

Project Activities: The research team will use information gathered from focus groups and systematic reviews to iteratively develop the AE intervention and associated training materials. AE will undergo a series of feasibility studies before ultimately being tested for promise in an underpowered randomized controlled trail (RCT) pilot study.

Products: The expected products include a fully developed intervention and associated training materials. The project will also result in peer-reviewed publications and presentations as well as additional dissemination products that reach education vested partners such as practitioners and policymakers.

Structured Abstract

Setting: This research will take place in elementary and secondary schools implementing the SEB MTSS framework (Comprehensive Behavioral Health Model) currently used within a large urban school district in Massachusetts.

Sample: In Year 1, 10 teachers, 10 students, and 10 family members will participate in focus groups. In Year 2, 10 teachers from 15 schools (150 total) will participate in a feasibility trial of the AE staff training modules. In Year 3, school-based staff serving on four Tier 1 teams and four teachers will participate in a feasibility trail of the team coaching protocol and observation and feedback form, respectively. In Year 4, school-based staff from 10 schools will participate in the pilot study of the complete the AE intervention. Teachers recruited for the activities described above may be any age, race/ethnicity, gender, and have any number of years of experience. Teachers may also teach any grade level but must be the primary teacher in the classroom.

Intervention: AE is a training and coaching intervention to center equity in the design and implementation of Tier 1 of MTSS for SEB health. AE is designed to support a multidisciplinary MTSS team including administrators, grade level teachers, support staff, family members, and students. The team coaching protocol will support teams in the following: planning and running monthly meetings, engaging in an equity audit to set annual goals, gathering data, involving students and families in the design and implementation process, and engaging in action planning to foster productivity between meetings. AE will consist of four components: (a) team coaching protocol, (b) series of online staff training modules, (c) observation and feedback form, and (d) procedural fidelity inventory. Staff training modules will provide brief, interactive instruction for school staff. These trainings will include direct training on key components of Tier 1 with an explicit equity focus and a series of interactive vignettes to practice implementation virtually before use in the classroom.

Research Design and Methods: In year 1, the research team will conduct several qualitative focus groups with students, teachers, and caregivers to understand perspectives on universal Tier 1 supports that center equity in MTSS. This will be followed by a systematic review of Tier 1 implementation and coaching for equity to understand the evidence base of the supports identified. In years 2 and 3, project personnel will create AE and its associated training materials based on data gathered in the first year. They will conduct a feasibility field trial with teachers in year 2, collecting data pre- and post-intervention, and two additional feasibility studies in year 3 using single-case design with four Tier 1 teams and four teachers, respectively. Finally, in year 4, an underpowered randomized controlled trial (RCT), with schools randomly assigned to condition, will be conducted on the complete AE intervention to evaluate its promise for improving racially and ethnically minoritized students' SEB functioning.

Control Condition: School staff and students within the control condition will receive the school's usual Tier 1 supports without the AE intervention.

Key Measures: The key student outcome measure is the Behavior Intervention Monitoring Assessment System-2, a measure of social, emotional, and behavioral functioning in youth. The project will also include the Tiered Fidelity Inventory, a measure for schoolwide behavioral health support implementation, and additional researcher-developed measures of fidelity, including an observation and feedback form and procedural fidelity inventory developed for the project.

Data Analytic Strategy: In year 1, thematic analyses will identify themes from focus groups. Themes and strategies identified will be compared to the results of a systematic review of the literature related to equity and Tier 1 implementation. Both sources of data will inform the development of AE. For the group design feasibility trial in year 2, data will be analyzed with a paired samples t-test. For the single-case design studies in year 3, data will be analyzed via visual analysis and effect size estimates. For the RCT in year 4, data will be analyzed using multi-level modeling.

Cost Analysis: Costs for AE will be calculated based on the ingredients method using CostOut. Calculations will focus on incremental costs by differentiating between Tier 1 intervention alone and Tier 1 plus AE.