Project Activities
The research team will use information from focus groups, structured stakeholder interviews, an expert advisory board, and a family council to develop STAY and associated training materials. They will conduct a feasibility study and then test STAY's promise of efficacy in an underpowered randomized controlled trial pilot study.
Structured Abstract
Setting
The research will take place in elementary and middle schools in three Florida public school districts.
Sample
Focus groups during initial development include youth between the ages of 12 to 17 with school refusal behaviors, school-based behavioral health personnel (SBBH), and caregivers of children/youth with school refusal behaviors. A total of 9 focus groups will be conducted (3 in each district), representing a total of 18 students, 18 SBBHs, and 18 caregivers. For feasibility testing, 8 SBBH and 16 students (2 per SBBH) with or at risk for autism, emotional disturbance, learning disabilities, or other health-impaired and their caregivers will participate. The sample for the pilot study will consist of 40 SBBHs and 80 students (2 per SBBH) with or at risk for disabilities (same categories as the feasibility study) and their caregivers.
Intervention
STAY provides an individually tailored intervention that combines cognitive behavior therapy strategies with a functional behavioral assessment of the school refusal behavior. The intervention is embedded within a stepped-care delivery model that provides the most effective and least resource-intensive treatment as the first-line approach for all students. Students who do not respond are "stepped up" to a more intensive approach. Decision-making guidelines will determine when to step up to subsequent treatment or to step down and end treatment. Step 1 will be a tailored approach delivered via telehealth by an SBBH during two weekly sessions over 4 weeks, followed by monthly boosters. Students who do not respond to step 1 will receive the step 2 individually tailored, face-to-face intervention for 10–12 weeks. Step 2 will be comprehensive, with increased involvement from youth, parents, and school personnel. STAY is intended to have the breadth, depth, and tailored flexibility to be used with diverse students, settings, and contexts.
Research design and methods
In the initial development phase, the research team will conduct qualitative focus groups and structured interviews with students, caregivers, and SBBH staff. A mixed-method design will be used for the feasibility test, including a pre/post design. SBBHs will co-implement STAY with a research project-based coach for the first student case. For the second student case, SBBHs will implement STAY independently with support from the research project-based coach. In addition, the research team will conduct qualitative interviews with participating SBBHs and collect feedback from an expert advisory board (comprised of three national experts in research on school refusal behaviors, functional behavioral analysis, and cognitive behavior interventions) and a family council (consisting of diverse caregivers of children across a variety of grade levels and with a wide variety of experiences related to disability). For the pilot study, SBBHs will be randomized to the intervention or control condition. A multilevel modeling strategy will be used, with children nested within SBBHs.
Control condition
SBBH assigned to the control group will implement their usual interventions to support students with school-refusal behaviors. At the end of the study, they will receive training and study materials for STAY.
Key measures
: The feasibility of STAY will be measured with the Usage Rating Profile -Intervention completed by the caregiver, SBBH, and student. A researcher-developed checklist of implementation fidelity will be used to monitor research coach fidelity during co-facilitation, and SBBHs will complete self-assessments of fidelity for each intervention session. The school will report student attendance rates, and student engagement over time will be measured using Direct Behavior Rating and student- and teacher-report on Engagement vs. Disaffection with Learning rating scales. Anxiety and depression symptoms will be assessed with the Revised Children's Anxiety and Depression Scale, internalizing and externalizing behaviors using the Brief Problem Monitor, and student sense of coping with school situations using the Self-Efficacy Questionnaire for School Situations.
Data analytic strategy
Focus group data will be analyzed qualitatively to identify common themes. Feasibility testing will primarily use analysis of covariance (ANCOVA) to measure changes between pre-and post-intervention. The pilot study will conduct a multilevel, between-subjects ANCOVA to examine the promise of the intervention. Further basic exploratory analyses will examine the characteristics (disability category and function of school refusal behavior) of responders and non-responders to the two-stepped approach.
Cost analysis strategy
Cost analysis will use an ingredients methodology and incremental cost-effectiveness ratios.
Products and publications
Products: This project's primary products include a fully developed STAY program and program manuals to address school-refusal behaviors in students with or at risk for disabilities. It will also result in peer-reviewed publications, presentations, and dissemination products that will reach educators, policymakers, and families.
ERIC Citations: Find available citations for this award in ERIC here.
Supplemental information
Co-Principal Investigator: Salloum, Alison; Crosland, Kim; Suldo, Shannon
Questions about this project?
To answer additional questions about this project or provide feedback, please contact the program officer.