Purpose: Students with the most severe behavior problems often have multiple risk factors outside of the school setting; for example, their families may be overwhelmed by severe stress from factors such as drug and alcohol abuse, family dysfunction, marital discord, and unemployment. There are existing intervention programs that target young children with significant behavioral problems that may have some degree of impact on improving their behavior, but these are generally not sufficient to substantially decrease the most challenging forms of severe behavior. These students and their families require interventions which are characterized by a comprehensive community-based approach, in addition to components that foster collaboration and communication between home and school settings.

First Step to Success (FS) was designed as a collaborative home and school early intervention to assist at-risk school-age children in having a positive beginning in their school careers. The First Step program has been shown to successfully improve the behavior of these students, but on the whole, the program does not sufficiently address the myriad of problems that affect the lives of students with the most severe behavior problems and with multiple risk factors outside of school. To address this need, the research team will develop the Enhanced First Steps to Success (EFS) intervention, which includes more intensive family intervention and case management processes.

Project Activities: The research team will develop the enhanced intervention program including process measures to guide implementation efforts for the enhanced components and fidelity measures to assess the treatment integrity for implementation of the enhanced components. The team will also develop training materials for related services personnel to implement the program. The intervention development will occur in two stages. In stage 1, the research team will conduct advisory meetings with local and national experts in the field and hold focus group discussions with key participants and interventionists to discuss the initial draft of the intervention activities and training guidelines. The program will then be implemented with 10 students to also explore feasibility and usability of the program. Based on the feedback received from stage 1, the program will be revised and implemented with approximately 40 students during stage 2 (20 students per year for two years). At the end of each year in stage 2, the advisory group will be convened to discuss the data collected and the program will be revised as appropriate.

Products: This project will result in a fully developed Enhanced First Step to Success program with accompanying program guidelines, and evidence of the potential of this program to improve student outcomes.

Structured Abstract

Setting: This project will take place in three public elementary schools in Kentucky. Participating schools have at least one self-contained classroom for students identified with Emotional Disturbances (ED), and also serve students with ED in regular classrooms or resource rooms.

Population: The project will involve related services personnel who will deliver the intervention (e.g., social workers, school psychologists). Participating teachers will include teachers who teach self-contained classrooms for students with Emotional Disturbances as well as resource room teachers for students in grades 1-3. Students will be screened with the Systematic Screening for Behavior Disorders; up to three eligible students per classroom will be invited to participate. Advisory group members include school administrators, teachers, parents/caregivers, and mental health agency personnel.

Intervention: The original First Step to Success program consists of three components that include: universal screening with the Systematic Screening for Behavior Disorders to identify students with behavior problems, a classroom intervention, and the parent education component. For the Enhanced First Step to Success program, the original components of the program remain, but the parent component is enhanced with the addition of two additional approaches (described below). In the First Step program, a trained behavior coach works with each participating student and his or her classroom peers, teacher, and parents for approximately 50 to 60 hours, typically over a 3-month period. The coach teaches the student appropriate social skills and behaviors in the classroom and on the playground; then, over time, the classroom teacher takes over full implementation with coach support.

The parent education component, called HomeBase, consists of a series of six weekly lessons designed to enable parents and caregivers to build child competencies and skills in six areas that affect school adjustment and performance: (1) Sharing School; (2) Cooperation; (3) Limit-Setting; (4) Problem-Solving; (5) Friendship-Making; and (6) Developing Confidence. HomeBase contains lessons, instructional guidelines, and parent-child games and activities for directly teaching these skills. The Enhanced First Step version will incorporate the Family Check-up program and case management processes within the parent component. The Family Check-up uses various methods to increase parent engagement, promote more consistent use of parent management practices, and increase parent involvement in care giving for their child. Case management is based on the assumption that access to high quality community services and supports are often difficult for families to access, and therefore will help families integrate service delivery across systems.

Research Design and Methods: The research team will measure key outcomes related to the usability, feasibility, and potential impact of Enhanced First Step through an iterative research and evaluation plan that involves two stages. During Stage 1, initial drafts of the structural framework, training protocols, manuals, process measures, and fidelity measures will be developed and tested through a case study research design. During this process, project researchers will also conduct advisory meetings with local and national experts in the field and hold focus group discussions with key participants and interventionists. Following this initial implementation and information collection effort, all study protocols will be refined to reflect the gathered information. In stage 2, a within-subjects pretest posttest design will be used to assess the intervention.

Control Condition: N/A

Key Measures: The Systematic Screening for Behavior Disorders will be used as a screening measure. A variety of measures will be used throughout the study, including the Stages of Change Readiness and Treatment Eagerness Scale, the Parenting Ladder, the Parenting Stress Index, and the Home Observations for Measurement of the Environment Inventory to measure parenting and the home environment, and the Social Skills Rating Scale to examine child outcomes. The above mentioned parent measures are also considered to be mediators of child outcomes (e.g., improvement in parenting). Fidelity will be measured by examining home and school monitoring logs, coaches’ time and activity logs, and by using an implementation fidelity checklist. Social validity measures will include the Intervention Attitude Inventory, adapted from the Therapy Attitude Inventory, and a structured qualitative interview.

Data Analytic Strategy: Descriptive statistics and analysis of content and themes from the case studies and focus group meetings will be used in stage 1 to determine initial usability and feasibility of the program perceived by all key participants (teachers, related service providers, parents). Data management and data reduction will be supported by the use of ATLAS-ti text analysis software. In stage 2, a within-subjects pre-post study will be used to assess the promise of the intervention for improving child outcomes. Researchers will also calculate the percentage of children who move from the clinical range at pretest to within the normative functioning range on behavioral scales and calculate the Reliable Change Index. An important element of consumer satisfaction is represented by attrition or dosage estimates so the research team will descriptively report attrition and dosage. The team will also examine inter-rater reliability of implementation fidelity checklists.

Products and Publications

Book

Frey, A.J., Walker, H.M., Seeley, J.R., Lee, J., Small, J.W., Golly, A., and Feil, E.G. (2013). Tertiary First Step to Success Resource Manual. Louisville, KY: University of Louisville. Retrieved from http://firststeptosuccess.org/. Full text

Book chapter

Lee, J., Frey, A.J., Walker, H.M., Golly, A., Seeley, J.R, Small, J.W., and Feil, E.G (2014). Motivational Interviewing in Support of Teacher Behavior Change. In E. McNamara (Ed.), Motivational Interviewing With Children and Young People II: Issues and Further Applications (pp. 83–102). United Kingdom: Positive Behaviour Management.

Reinke, W., Frey, A.J. Herman, K.C., and Thompson, C.V. (2014). Improving Engagement and Implementation of Interventions for Children With Emotional and Behavioral Disorders in Home and School Settings. In H. Walker, and F. Gresham (Eds.), Handbook of Evidence-Based Practices for Students Having Emotional and Behavioral Disorders (pp. 432–445). New York: Guilford Press.

Walker, H.M., Severson, H., Seeley, J., Feil, E., Small, J., Golly, A., Frey, A., Lee, J., Sumi, W.C., Woodbridge, M., Wagner, M., and Forness, S. (2014). The Evidence Base of the First Step to Success Early Intervention for Preventing Emerging Antisocial Behavior Patterns. In H.M. Walker, and F.M. Gresham (Eds.), Handbook of Evidence-Based Practices for Emotional and Behavioral Disorders: Applications in Schools (pp. 518–537). New York: Guilford.

Journal article, monograph, or newsletter

Frey, A.J., Alverez, M.E., and Sabatino, C.A. (2013). Consultation to Improve Treatment Integrity. Children and Schools, 35(1): 3–8. doi:10.1093/cs/cds037

Frey, A.J., Cloud, R.N., Lee, J., Small, J. Seeley, J., Feil, E., Walker, H.W., and Golly, A. (2011). The Promise of Motivational Interviewing in School Mental Health. School Mental Health, 3(1): 1–12. doi:10.1007/s12310–010–9048–z

Frey, A.J., Lee, J., Small, J.W., Seeley, J.R., Walker, H.M., and Feil, E.G. (2013). Transporting Motivational Interviewing to School Settings to Improve the Engagement and Fidelity of Tier 2 Interventions. Journal of Applied School Psychology, 29(2): 183–202. doi:10.1080/15377903.2013.778774

Frey, A.J., Lee, J., Small, J.W., Seeley, J.R., Walker, H.M., and Feil, E.G. (2013). The Motivational Interviewing Navigation Guide: A Process for Enhancing Teachers' Motivation to Adopt and Implement School-Based Interventions. Advances in School Mental Health Promotion, 6(3): 158–173. doi:10.1080/1754730X.2013.804334

Frey, A.J., Sims, K., and Alverez, M.E. (2013). Motivational Interviewing and School Social Work. Children and Schools, 35: 67–70. doi:10.1093/cs/cdt004

Frey, A.J., Small, J.W., Lee, J., Walker, H.M., Seeley, J.R., Feil, E,G., and Golly, A. (2014). Expanding the Range of the First Step to Success Intervention: Tertiary-Level Support for Teachers and Families. Early Childhood Research Quarterly, 30: 1–11. doi:10.1016/j.ecresq.2014.05.002

Lee, J., Frey, A.J., Herman, K., and Reinke, W. (2014). Motivational Interviewing as a Framework to Guide School-Based Coaching. Advances in School Mental Health Promotion, 7(4): 225–239. Full text

Lee, J., Frey, A.J., Herman, K., and Reinke, W. (2014). Motivational Enhancement Career Intervention for Youth With Disabilities. Advances in School Mental Health Promotion, 7(4): 225–239. doi:10.1080/1754730X.2014.949061 Full text

Small, J.W., Lee, J., Frey, A.J, Seeley, J.R, and Walker, H.M. (2014). The Development of Instruments to Measure Motivational Interviewing Skill Acquisition for School-Based Personnel. Advances in School Mental Health Promotion, 7(4): 240–254. doi:10.1080/1754730X.2014.949063

Nongovernment report, issue brief, or practice guide

Frey, A.J., Walker, H.M., Seeley, J.R., Lee, J., Small, J.W., Golly, A., and Feil, E.G. (2013). First Step Classroom Check-Up Resource Manual. Louisville, KY: University of Louisville. Full text

Lee, J., Frey, A.J., and Small, J.W. (2013). The Video Assessment of Simulated Encounters – School-Based Applications. Cincinnati, OH: University of Cincinnati.

Lee, J., Small, J.W., and Frey, A.J. (2013). Written Assessment of Simulated Encounters- School-Based Application. Cincinnati, OH: University of Cincinnati.