Project Activities
Each year of this randomized controlled study, teacher-student-parent triads were randomly assigned to one of four conditions: (1) hB only, (2) FSN only, (3) FSN + hB, and (4) usual care to assess the efficacy of hB – as a stand-alone intervention and in conjunction with FSN – for improving social-emotional and behavioral outcomes for young children with severe challenging behaviors across home and school settings.
Structured Abstract
Setting
The research took place in 100 urban and suburban elementary schools in Kentucky and Indiana.
Sample
A total of 379 students with or at risk for developing severe behavior disorders in kindergarten through third grade, as well as their teachers and parents, participated in this study. Seventy-one percent of participating students were eligible for reduced-price meals at school, and students who met inclusion criteria were primarily male (74%) and either Black (52%) or White (37%).
First Step Next (FSN) is an established teacher- and child-focused intervention that consists of three major program tasks, generally carried out over a 2-month period: social skills instruction, green card game, and home-school connection. During social skills instruction, a behavioral coach helps the focus student develop problem-solving skills and improve self-regulation through delivery of Super Student Skills. During the green card game, a color-coded card functions as a tool for the teacher to provide subtle but direct and immediate nonverbal feedback that encourages continued use of the Super Student Skills or encourages the child to stop, think, and change their behavior from inappropriate to appropriate. The child receives points for meeting daily criteria for positive behavior that are exchanged for reinforcers provided by the parents at home, and classmates also share in a group activity reinforcer at school, if the child meets criteria. The green card game is easily integrated into daily lessons and classroom activities. For the home-school connection (homeBase; hB), caregivers receive daily feedback in the form of a note or phone call from the FSN coach and materials focused on promoting positive parenting strategies. hB consists of three to six 60-minute home visits delivered over several months by a trained coach. During the hB sessions, parents are encouraged to modify their parenting practices consistent with universal principles of positive behavior support. The intervention is delivered within a multistep process for increasing parents’ intrinsic motivation to adopt these principles. During each step (i.e., engage in values discovery; assess current practices; share performance feedback; offer extended consultation, education, and support), the coach uses motivational interviewing to guide and strengthen the parent’s or caregivers’ engagement with and commitment to behavior change. hB was initially developed as a home component to the original First Step intervention; however, when the intervention underwent a redesign in 2015 and named FSN, the original home component was eliminated. homeBase became an independent intervention that could be delivered alone or as a supplement to any teacher- or child-focused intervention.
Research design and methods
This comparative efficacy study examined the effects of FSN alone, hB alone, and FSN + hB, compared to one another and to a business-as-usual control condition. Participating teacher–student dyads were randomly assigned to condition. Baseline data collection was completed prior to randomization and outcome assessments were conducted immediately after completion of the intervention as well as 6 months post intervention.
Control condition
Participants in the usual care condition received instruction and services typically provided by the elementary schools.
Key measures
Child outcome measures of behavior included the Social Skills Improvement System (SSiS-RS) and the Child Behavior Checklist. Child academic outcomes included the SSiS-RS Academic Competence subscale, and Academic Engaged Time. Moderator measures included teacher demographics, family reports on student and family demographics, services received, and parent/family stressors. A variety of measures were used to assess coach–parent relationship quality and coach–teacher relationship quality.
Data analytic strategy
A linear regression model was used to analyze each continuous outcome, and logistic regression models were used with categorial outcomes. Hedges’ g was used as a measure of effect size. Intervention costs were estimated using an activities-based ingredients method. Incremental Cost Effectiveness Ratios (ICER) were estimated as incremental costs divided by incremental gain in students who responded to intervention.
Cost analysis strategy
Intervention costs were estimated using an activities-based ingredients method, which entailed collecting data about the amount and unit price of resources used in the intervention. For the cost-effectiveness analysis, response to intervention was defined as movement from the borderline range into the normative range or from the clinical range into the borderline or normative range at post-intervention. Incremental effectiveness of (a) FSN compared to control or (b) combined FSN + hB compared to control was estimated as the difference in the proportion of students who responded to the intervention compared to the proportion of controls exhibiting such movement from pre- to post-intervention. Incremental Cost Effectiveness Ratios (ICER) were estimated as incremental costs divided by incremental gain in students who responded to intervention.
Key outcomes
The main findings of this project, as reported by the principal investigator, were as follows:
- Students who participated in FSN only or FSN+hB showed greater improvements in pro-social and academic engaged time and reductions in problem behavior compared to students in hB only or usual care.
- Impacts of participating in the hB only condition were limited. Participation led to reductions in problem behavior only in the school setting, with greatest reductions seen for students who initially had the most significant behavior needs (e.g., ADHD).
- The hB intervention was promising as a supplement to FSN. Students who particiapted in FSN + hB showed the greatest improvements teacher-student conflict, pro-social behavior, problem behavior, and academic engagement.
- The combined intervention (FSN + hB ) was cost effective. The value added from the combined intervention, in terms of student response, more than offsets the cost.
People and institutions involved
IES program contact(s)
Project contributors
Products and publications
Study registration:
Publications:
ERIC Citations: Find available citations in ERIC for this award here.
Select publications:
Kuklinski, M., Small, J.W., Frey, A.J., Bills, K., & Forness, S.R. (2022). Comprehensive Cost Effectiveness of a school- and home-based interventions for Elementary School students with Disruptive Behavior Disorders. Journal of Emotional and Behavioral Disorders. doi.org/10.1177/10634266221120521
Frey, A.J., Small, J.W., Walker, H.M, Mitchell, B., Seeley, J.R., Feil, E.G., Lee, J., & Forness, S.R. (2022). First Step Next: A synthesis of replication randomized controlled trials from 2009-2011. Remedial and Special Education. https://doi.org/10.1177/07419325211068
Frey, A.J., Small, J.W., Seeley, J.R., Walker, H.M., Feil, E.G., H.M, Lee, J. Cohen Lissman, D., Crosby, S., & Forness, S.R. (2022). First Step Next and homeBase: A comparative efficacy study of children with disruptive behavior. Exceptional Children, 88(2), 205-222 doi.org/10.1177/00144029211062588
Small, J., Frey, A., Lee, J. Seeley, J.R., Scott, T.M, & Sibley, M.H. (2021). Fidelity of motivational interviewing in school-based intervention and research. Prevention Science, 22, 712-712. doi/10.1007/s11121-020-01167-7
Frey, A.J, Small, J.W., Lee, J., Crosby, S., Seeley, J.R, Forness, S., & Walker, H.M. (2019). homeBase: Participation, engagement, alliance, and social validity of a motivational parenting intervention. Children & Schools, 41(4), 221-228. http://doi.org/10.1093/cs/cdz016
Available data:
A permanent record of the study methodology, codebook, and underlying data can be accessed at: https://www.openicpsr.org/openicpsr/project/145801/version/V1/view
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