Co-Principal Investigator:  Weist, Mark D.

Purpose: The purpose of this efficacy study is to evaluate the impact of an enhanced version of the Interconnected Systems Framework (ISFE) on elementary school-based team functioning, including use of evidence-based practices and student emotional, behavioral, and academic functioning. The original ISF model was designed to improve the depth and quality of mental health services delivered within multi-tiered systems of support by integrating Positive Behavioral Interventions and Supports (PBIS) and school mental health (SMH) efforts to provide a continuum of high-quality services for students. Preliminary findings from a prior efficacy study show that the ISF improved team functioning and increased identification and services for students in need, particularly among youth of color, when compared to the other two conditions. Moreover, the ISF led to improvements in student social, emotional, and behavioral functioning. The proposed study builds on these findings by testing an enhanced version of the ISF designed to advance the model by adding/modifying several core components intended to further increase the impacts for youth with significant emotional and behavioral problems and reduce inequities in discipline and student service delivery.

Project Activities: In this project, the research team will examine the efficacy of ISFE with a randomized controlled trial (RCT) with schools randomized to ISFE or the PBIS+SMH control condition (where PBIS and SMH efforts are co-located but not integrated) using a randomized block design based on proportion of students of color and degree of implementation of PBIS practices . Baseline data will be collected on a cohort of students in third grade, and that cohort will be followed from third to sixth grade, with intervention occurring in fourth and fifth grades and follow-up assessment in sixth grade.

Products:  This project will result in evidence of the efficacy of ISFE for elementary school team functioning and student social, emotional, and behavioral functioning, as well as information about the cost and cost-effectiveness of the program. The project will also result in a final dataset to be shared, peer-reviewed publications and presentations, and additional dissemination products that reach education stakeholders such as practitioners and policymakers.

Structured Abstract

Setting: The study will take place in 16 elementary schools, including 8 urban and suburban/rural schools in eastern North Carolina and 8 suburban/rural schools in western South Carolina.

Population/Sample:  Approximately 1,216 students who enter the study in third grade will participate. The researchers plan to recruit approximately 80 students per school in NC and 72 students per school in SC. Approximately 144 teachers will participate each year of the study (576 total).

Intervention: The ISF leverages the strengths of PBIS and SMH to improve the quality of services within the three tiers of MTSS by providing specific guidance on their systematic interconnection. The ISF includes a district-community leadership team (DCLT), memoranda of agreement between schools and mental health providers; community-based clinicians integrated into MTSS teams; universal social, emotional, and behavioral screening; team and intervention fidelity monitoring; and district-level communities of practice. The ISFE model tested in this research study will have seven enhancements: (1) consistent meetings of the DCLT, which will include education, mental health, other youth-serving systems, and family/youth leaders; (2) clear agreements indicating parameters for an effective MTSS and community MH clinician involvement in the ISFE/MTSS team; (3) improved team meeting procedures and data-based decision making with consistent use of the Team-Initiated Problem Solving (TIPS) program to facilitate comprehensive and efficient data review, decision-making, and follow through; (4) improved progress monitoring and fidelity monitoring of Tier 2 and Tier 3 interventions; (5) improved data-based decision making; (6) general enhancements to screening and measurement, including measures that have stronger psychometric properties; and (7) increased focus on, and better assessment of, student achievement, attendance, tardiness, grades, and discipline outcomes.

Research Design and Methods: This study will use a randomized controlled trial with schools randomized to treatment or control conditions using a randomized block design based on proportion of students of color and degree of implementation of PBIS practice. In Year 1, the research team will collect baseline data for a cohort of third grade students from all participating schools and then block randomize the schools to experimental conditions. In Years 2 and 3, the schools will provide either the ISFE or PBIS+SMH conditions during the participants' fourth and fifth grade years. In Year 4, the research team will conduct one follow-up assessment during the participants' sixth grade year.

Control Condition:  Schools in the comparison condition will be provided the resources to implement PBIS and SMH (PBIS+SMH) but without guidance on integrating the services.

Key Measures:  Key measures include the Tiered Fidelity Inventory, the ISF Inventory, and the Universal Fidelity Tool to measure school-based teaming quality, identification of student need, and delivery of evidence-based practices. The Intervention Receipt Form (IRF) will be used to measure interventions students received and their quality. Student behavior and academic functioning will be measured with the Behavior Intervention Monitoring Assessment System-2 (BIMIAS-2) and students will also complete a student self-report measure of internalizing symptoms. The research team will also collect school-level achievement data (i-Ready) and school records to examine academic and behavioral functioning.

Data Analytic Strategy: The study will investigate the effects of ISFE as compared to PBIS+SMH using multilevel models with random effects for schools and time to examine differences over time between conditions. The team will employ multilevel models (MLMs) with random effects for schools and time to examine differences between conditions over time. Continuous outcomes will be analyzed using linear MLMs, and categorical outcomes will be analyzed using generalized MLMs with appropriate link functions.

Cost/Cost Effectiveness: Costs associated with the intervention as well as economic cost data will be calculated using the CostOut platform. The research team will combine the economic benefits and costs to derive cost-effectiveness ratios.