Co-Principal Investigators: Sheridan, Susan; Yoon, HyeonJin; Mims, Pamela; Hale, Kimberly

Purpose: The purpose of this project is to test the efficacy of Conjoint Behavioral Consultation (CBC) delivered via distance technology (tele-CBC) in rural Appalachian elementary schools. Students with social-behavioral problems are at high risk of developing long-term, pervasive behavioral and academic problems. CBC is an intervention that allows for individuation of parent- and teacher-delivered behavior plans that are grounded in ecological-behavioral theory, supported by empirical evidence, and implemented across multiple settings such as home and school. CBC has been shown to improve rural students' behaviors when consultants travel long distances to deliver services; however, the use of itinerant consultants makes traditional delivery of CBC costly, inflexible, and unsustainable. Tele-CBC, wherein a consultant uses tele-communications (such as video conferencing services) to deliver CBC remotely, provides solutions to barriers facing rural communities such as limited resources and poor access to specialists. Evaluation of tele-CBC is needed to ascertain its ability to address the social-behavioral needs of rural students.

Project Activities: To test the efficacy of tele-CBC, elementary schools in rural Appalachia will be randomly assigned to either the intervention condition or the typical business-as-usual classroom service model across four cohorts. Researchers will also conduct fidelity and cost analyses to provide essential information about intervention core components and the utility of the intervention in resource-strapped educational settings.

Products: The products of this project include evidence of the efficacy of the tele-CBC intervention as well as peer-reviewed publications, published reports and presentations, descriptions of the intervention, public access to virtual CBC consultant training, and online implementation tools. The project will also result in a final dataset to be shared and information on the intervention's cost effectiveness.

Structured Abstract

Setting: The study will take place in rural Appalachian elementary schools in Tennessee and Virginia.

Sample: The sample participating in this study will include 186 kindergarten through sixth grade students and their parents and teachers. The students in this study will have or be at risk of developing serious emotional disturbance (SED).

Intervention: The intervention, tele-CBC,unites the evidence-based CBC intervention with tele-consultation, thereby allowing access via remote telecommunication. Tele-CBC is a collaborative family-school partnership intervention that promotes prosocial and academic outcomes for students with or at risk of developing SED. In tele-CBC, parents and teachers meet in person (usually at the school) and the tele-CBC consultant joins them from a remote location using distance technology. Tele-CBC uses a sequential, data-based, progress monitoring approach until behavioral skills are firmly established. It is guided by a consultant using collaborative problem solving with parents and teachers. The tele-CBC intervention is implemented for 8 weeks.

Research Design and Methods: A four-cohort randomized controlled trial will be used to evaluate the effects of tele-CBC on rural students, parents, and teachers over the course of 4 years. Rating scale and observational measures will be used to assess student social-behavioral outcomes across home and school as well as parent/guardian and teacher relationships, problem-solving, and behavioral strategy use.

Control Condition: Participants in the business-as-usual control condition will receive typical services currently available through the school or district for students with behavioral concerns.

Key Measures: Researchers will use parent and teacher ratings captured by the Behavior Assessment Scale for Children-3, Social Skills Improvement System, Parent Daily Reports, and school-based observations to assess student behavior outcomes. The Parent–Teacher Relationship Scale will be used to measure parent-teacher relationships. The Competence in Problem Solving Scale will be used to measure teacher problem-solving skills. Behavioral strategy use will be assessed with the Alabama Parenting Questionnaire, Parent Practices Inventory, Teacher Strategies Questionnaire and direct observation of teacher practices. Moderation measures will include child and family risk measured by demographic surveys and the BASC-3 Behavior and Emotional Screening System, parent attitudes about help seeking captured by the Self-Stigma of Seeking Help Scale, and technology acceptance measured by the Technology Acceptance Model Instrument–Fast Form. Parent and teacher ratings of tele-CBC acceptability and consultant effectiveness will be assessed with the Behavioral Intervention Rating Scale and Consultant Evaluation Form.

Data Analytic Strategy: The effects of tele-CBC on student, parent, and teacher outcomes will be assessed using analysis of covariance with maximum likelihood estimation. Structural equation modeling will be applied to test whether pre-post improvements in the parent-teacher relationship and parent-teacher practices are mediators of the effect of tele-CBC on student outcomes and to examine whether intervention effects are moderated by child and family factors.

Cost Analysis: The ingredients approach will be used to develop a cost worksheet and record costs for personnel, implementation resources, and opportunity costs associated with delivery of tele-CBC. A cost-effectiveness ratio will be computed to understand the cost required to obtain a single extra unit of effectiveness.

Related IES Projects: Evaluation of Efficacy of CBC for Addressing Disruptive Behaviors of Children at Risk for Academic Failure (R305F050284);  A Randomized Trial of Conjoint Behavioral Consultation (CBC) in Rural Educational Settings: Efficacy for Elementary Students With Disruptive Behavior (R324A100115); A Randomized Trial of Conjoint Behavioral Consultation (CBC) with Latino Students: A Replication Study (R324A160017)