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Treatment integrity and child outcomes: Conjoint behavioral consultation in an urban setting with clients of ethnic minority status

Dissertation
Author: Tammi Jean Beckman
Abstract:
Scope and Method of Study. Home and school represent two of the most powerful influences in children's lives. Research indicates that students benefit when there is a collaborative relationship between families and educators (Clark & Fiedler, 2003). Conjoint Behavioral Consultation (CBC) is one model that attempts to develop effective partnerships and collaborative relationships between parents and educators (Christenson & Sheridan, 2001). Thus, the purpose of this study was to investigate the effectiveness of CBC in an urban setting with clients of ethnic minority status when addressing externalizing behavior concerns that are present at home and school. In addition, procedural and treatment integrity of the consultation and intervention processes were assessed. Lastly, the acceptability of the CBC model and the interventions derived from the model were investigated. Participants in this study consisted of three sets of caregivers and teachers within an urban school district in southern Louisiana. Participants were asked to complete rating scales related to their behavior concerns, participate in CBC meetings, collect behavior data on an ongoing basis, implement the intervention that was created within the CBC process, and finally to complete rating scales related to the acceptability of the intervention and consultation process. Findings and Conclusions. Based on the data collected in this study, there is evidence that the application of consultation is an effective model of service delivery in an urban school setting with clients of ethnic minority status. The effectiveness, integrity, and acceptability of the behavioral interventions implemented within the context of CBC in the home setting were inconsistent in most cases and nonexistent in three of the cases that were dropped due to lack of initial participation and response to the consultant. Thus, indicating CBC, in its original form, may be more difficult to effectively implement when working with caregivers and families living in situations of high stress due to environmental factors, i.e. setting, SES, family composition. Although acceptability ratings of the teachers and caregivers included in this study were relatively high, treatment integrity, which according to previous research, may be a more direct measure of treatment acceptability were only in the moderate range with some specific areas in the low range.

v TABLE OF CONTENTS

Chapter Page

I. INTRODUCTION ......................................................................................................1

Introduction to the Research ....................................................................................1 Purpose of the Study ................................................................................................7

II. REVIEW OF LITERATURE....................................................................................8

Introduction ..............................................................................................................8 Challenging Behaviors .............................................................................................9 Behavioral Consultation.........................................................................................10 School Characteristics Related to Behavior ...........................................................11 Empirically Supported Behavioral Interventions...................................................14 Home-School Partnership ......................................................................................16 Treatment Integrity ................................................................................................17 Conjoint Behavioral Consultation..........................................................................20 Family Characteristics Related to Behavior ..........................................................24 Family Characteristics Related to Treatment .........................................................26 Conjoint Behavioral Consultation with Minority Clients.....……………………..27 Purpose of the Study……………………………………………………………...28 Hypotheses………………………………………………………………………..29

III. METHODOLOGY ................................................................................................31

Participants .............................................................................................................31 Selection Criteria ...................................................................................................32 Instruments .............................................................................................................33 Procedures ..............................................................................................................38 Experimental Design ..............................................................................................41 Analysis..................................................................................................................42

vi Chapter Page

IV. RESULTS ..............................................................................................................46

Purpose of the Study ..............................................................................................46 Case Descriptions...................................................................................................46 Case 1 .....................................................................................................................47 Case 2 .....................................................................................................................53 Case 3 .....................................................................................................................59 Procedural and Treatment Integrity .......................................................................65 Treatment Acceptability.........................................................................................66 Summary of Findings .............................................................................................68

V. DISCUSSION ........................................................................................................75

Discussion of Results .............................................................................................75 Strengths and Limitations ......................................................................................81 Implications for Practice ........................................................................................85 Directions for Future Research ..............................................................................87

REFERENCES ............................................................................................................89

APPENDICES ...........................................................................................................104

vii LIST OF TABLES

Table Page

1. Summary of Case Descriptions .............................................................................46 2. Case 1 Teacher & Caregiver Ratings on the Ext. Scale of the BASC II ..............50 3. Case 1 Descriptive Statistics for Observation Ratings in Home and School ........51 4. Case 2 Teacher & Caregiver Ratings on the Ext. Scale of the BASC II ..............56 5. Case 2 Descriptive Statistics for Observation Ratings in Home and School ........57 6. Case 3 Teacher & Caregiver Ratings on the Ext. Scale of the BASC II ..............62 7. Case 3 Descriptive Statistics for Observation Ratings in Home and School ........63 8. Summary of Caregivers’ and Teachers’ Treatment Integrity ...............................66 9. Summary of Caregivers’ and Teachers’ BIRS and CEF Scores ...........................67

viii

LIST OF FIGURES

Figure Page

1 Case 1 Caregiver & Teacher Observation Record of the Frequency of Target Behaviors Across the Baseline and Intervention Phases .............................................52

2 Case 2 Caregiver & Teacher Observation Recordings of the Frequency of Target Behaviors Exhibited Across the Baseline and Intervention Phases .............................58

3 Case 3 Caregiver & Teacher Observation Recordings of the Frequency of Target Behaviors Exhibited Across the Baseline and Intervention Phases .............................64

4 Data Observed for Target Behaviors of All Three Cases in the School Setting ......70

5 Data Observed for Target Behaviors of All Three Cases in the Home Setting .......72

1 CHAPTER I

INTRODUCTION

Approximately 14%-20% of the children in the general population are reported to exhibit challenging behaviors in the home and/or school setting (Brandenburg, Friedman, & Silver, 1990; Reichle et al., 1996). Challenging behavior in children has been defined as behaviors that involve acts that result in injury to self or others, damage physical surroundings, interfere with skill acquisition, or that isolate the child (Doss & Reichle, 1991; Reichle et al., 1996). Research has indicated that challenging behavior in young children is not typically outgrown, but actually has a high potential for getting worse over time (Kazdin, 1993). Current estimates of the number of children exhibiting challenging behaviors and knowledge of the prognosis for these behavior concerns provides strong evidence for the need for parents and teachers to understand and implement effective behavior management strategies. Many children with academic, social, behavioral, and/or emotional concerns do not receive the services they need. Approximately 70% of the children in need of mental health services in the United States do not receive them (U.S. Congress OTA, 1991). Family characteristics and logistical barriers often prevent families from accessing and maintaining services for their children. For many children, the school setting is the sole provider for mental health services (Burns et al., 2004). Thus, delivering intervention

2 services through a model that encompasses home-school collaboration appears to be the most effective way to meet the needs of children and families who are involved in the educational system. Many of the same behavioral intervention services offered through community-based programs can be provided through behavioral consultation within the educational system. Many of the most effective and widely used behavioral interventions for children with behavior problem are based on the principles of social learning theory and behavior modification (Maughan, Christiansen, Jenson, Olympia, & Clark, 2005). These programs are based on the assumption that children’s appropriate and inappropriate behaviors are maintained by social agents in their environment (Maughan et al., 2005). Some of the most effective treatments that have been reported in the literature for behaviorally challenging children include the following key components: (1) early and sustained interventions, (2) focus on the home and school environments, and (3) consistent efforts to diminish negative behavior while teaching and supporting more adaptive social behaviors (Reid & Patterson, 1991; Short & Shapiro, 1993; Webster-Stratton, 1993). Some of the most common behavior management strategies used in the school setting that have received research support for being effective when dealing with challenging behavior include token economies, rewards, response cost, and curriculum modifications (Abramowitz & O’Leary, 1991; DuPaul & Stoner, 1994). The school-home note is another intervention that has been shown to increase appropriate behaviors and decrease inappropriate behaviors exhibited by children in the classroom (Kelley, 1990). School-home notes promote communication and shared responsibility between the parents, teachers and students. Research has supported the school-home note as being an

3 effective intervention for managing challenging behavior exhibited by children who range in age from preschool through high school (Schumaker, Hovell, & Sherman, 1977; McCain & Kelley, 1993). The school-home note may not only be effective in dealing with the child’s behavior, but may also encourage collaboration between the school and home settings. Home and school represent two of the most powerful influences in children’s lives. School-aged children spend almost all of their time either in the home or school setting where the parents and school personnel are primarily responsible for their behavior. Therefore, building the relationship between these two settings (home and school) is of utmost importance when setting goals to address a child’s educational and behavioral needs. Research indicates that students benefit when there is a collaborative relationship between families and educators (Clark & Fiedler, 2003). Reviews of the parent involvement literature suggest that active parent involvement is a key factor in a child’s success at school. Specifically, it has been reported that active parent participation is related to factors such as increased student achievement and fewer discipline problems in the classroom and at home (Christenson, 1995; Christenson, Rounds, & Franklin, 1992). Specific features of strong home – school partnerships include (a) a belief in a shared responsibility for educating and socializing children, (b) an emphasis on the quality of interactions among the families and school personnel, and (c) a focus on mutually identifying solutions that support learning and adjustment (Sheridan, Eagle, Cowan, & Mickleson, 2001). Gains in student performance are greatest when interventions focus on the reciprocal relationship between home and school rather than focusing only on the

4 classroom or home environment. Positive interactions between parents and school personnel that are based on a common interest enhance the likelihood that behavioral interventions will be effective (Clark & Fiedler, 2003). The following discussion provides a clearly identified process for incorporating all of the key factors that lead to a student’s success in a behavioral consultation model. Conjoint Behavioral Consultation (CBC) is a conceptual and practical extension of a traditional approach to Behavioral Consultation (BC). CBC is “a structured, indirect form of service delivery, in which parents and teachers are joined to work together to address the academic, social, or behavioral needs of an individual for whom both parties bear some responsibility.” (Sheridan & Kratochwill, 1992, p. 122) One of the primary features of CBC is that the parents and teachers are joint consultees who monitor the effects of daily events on children’s behavior. CBC attempts to develop effective partnerships and collaborative relationships between parents and educators (Christenson & Sheridan, 2001). CBC has two major theoretical bases: ecological-systems theory (Bronfenbrenner, 1979) and behavioral theory. CBC fits into the ecological systems theory in that it recognizes that children function within and across various systems in their environments. The two primary systems in a child’s life are home and school. Thus, when working with children, it is important to focus on the primary settings that influence that child’s behaviors. Primary components of CBC that reflect the behavioral theory include the understanding that children’s behaviors are a function of the environment in which they occur, a strong focus on identifying and changing observable behaviors, and using

5 evidence-based techniques to change behavior (Sheridan et al., 1996). Behavioral theory is present throughout all four stages of the CBC process. Specifically, the active involvement of the teacher and parent, the identification of an observable behavior in the Problem Identification stage, data collection on the target behavior throughout all four stages, and using evidence-based techniques to change behavior during the Treatment Implementation stage. The stages of CBC are extensions of the same four stages involved in BC but they also involve the caregiver component. The first stage of CBC is the Conjoint Problem Identification (CPI) stage. The CPI interview is conducted by the consultant with the teacher and caregiver in order to identify and prioritize concerns, determine the contextual factors that contribute to the behavior in both settings, and to define a treatment goal and progress monitoring procedures to examine progress. The second stage, Conjoint Problem Analysis (CPA) consists of another interview conducted by the consultant with the teacher and caregiver to evaluate baseline data, reevaluate the original treatment goal, and design an intervention plan. Immediately following the CPA stage is the Conjoint Treatment Implementation (CTI) stage, which consist of the teacher and caregiver implementing and monitoring the intervention that was developed during the CPA interview. The final stage is the Conjoint Treatment Evaluation (CTE) stage. The CTE stage involves a final interview by the consultant with the teacher and caregiver to evaluate the intervention effectiveness and address maintenance and generalization issues. (Appendix J contains the CPI, CPA and CTE objective checklists). Research has indicated that CBC is an effective and acceptable model of service delivery for teachers and parents addressing the emotional, social, behavioral and

6 academic needs of students (Sheridan, 1997; Sheridan, Eagle, Cowan, & Mickelson, 2001). Several small-N studies have found CBC to be effective in changing client behavior, i.e. social withdrawal, failure to complete homework assignments, disruptive play behaviors in children with ADHD, and nighttime fears (e.g. Auster, Feeney-Kettler, & Kratochwill, 2006; Sheridan & Colton, 1994; Kratochwill & Sheridan, 1990; Weiner, Sheridan, & Jensen, 1998). A large scale study conducted by Sheridan, Eagle, Cowan, & Mickelson (2001) also indicated that CBC was an efficacious and acceptable model of service delivery. Although there is support for the effectiveness and acceptability of CBC, most of the studies have been conducted with children and families of majority who come from middle-class families. According to Sheridan (2000), there is no empirical base supporting the use of CBC in multicultural situations or when one or more participants represents diversity. The first investigation of CBC with minority clients was part of a large scale study examining the effectiveness and acceptability of the CBC process with children who represented various forms of diversity, i.e. ethnicity, socioeconomic status, family composition, maternal education level, and language spoken in the home (Sheridan, Eagle, Doll, 2006). The results of the study conducted by Sheridan et al. (2006) indicated CBC was an effective and acceptable model of service delivery for children representing diversity. Some limitations of the included a small number of children with specific diverse characteristics and subjective measures of diversity indicators that relied only on parent report. There is limited research on the effectiveness of the CBC model with clients of minority. In addition, to this researcher’s knowledge, there are no studies that examine

7 the effectiveness and acceptability of the CBC model with clients of ethnic minority status, low socioeconomic status in an urban setting in the Southeastern part of the United States. Purpose of this Study This study proposed to extend the CBC literature to working with families and teachers of minority status in an urban school district. The present study investigated several possible outcomes for implementing an empirically supported intervention within the context of CBC for children exhibiting externalizing behavior concerns in the school and home settings. First, this study examined the extent to which the behavioral intervention implemented in the context of CBC was effective in reducing the frequency of the targeted externalizing behaviors exhibited by the child at school. Second, this study examined the extent to which the behavioral intervention implemented in the context of CBC was effective in reducing the frequency of the targeted externalizing behaviors exhibited by the child at home. Third, this investigation examined the level of procedural and treatment integrity for the consultees’ participation and implementation of the behavioral intervention, when carried out in the context of CBC. Finally, this study identified the degree to which the CBC model was an acceptable form of service delivery when working with ethnic minority families and teachers in a low-SES urban school district.

8 CHAPTER II

REVIEW OF LITERATURE

The following review of literature provides strong evidence for the importance of maintaining a collaborative relationship between families and school personnel when working with school-age children. This chapter will provide an overview of behavior difficulties experienced by many school aged children, the Behavioral Consultation model often used to address behavior problems in the school and home setting and school characteristic that are related to the development and management of a child’s behavior. This chapter will also identify common empirically supported behavioral interventions and how a strong home-school partnership and high levels of treatment integrity can enhance behavioral interventions. Finally, this chapter will discuss the Conjoint Behavioral Consultation (CBC) model and some of the specific reasons why the parent component of this behavioral consultation model is important and the lack of research conducted using the CBC model with clients of minority status. The purpose of the study as well as the research questions and hypotheses for the current study will be outlined in this chapter. Approximately 70% of the children in need of mental health services in the United States do not receive them (U.S. Congress OTA, 1991). Family characteristics and logistical barriers often prevent families from accessing and maintaining services for their

9 children. For many children, the school setting is the sole provider for mental health services (Burns et al., 2004). Thus, delivering services through a model that encompasses home-school collaboration appears to be the most effective way to meet the needs of children and families who are involved in the educational system. Challenging Behavior Challenging behavior in children has been defined as behaviors that involve acts that result in injury to self or others, damage physical surroundings, interfere with skill acquisition, or that isolate the child (Doss & Reichle, 1991; Reichle et al., 1996). A significant increase in the numbers of children exhibiting these types of behaviors has occurred; with prevalence rates noted around 14%-20% for typical or at-risk children and 13%-30% for children with developmental disabilities (Brandenburg, Friedman, & Silver, 1990; Reichle et al., 1996). Research has indicated that challenging behavior in young children is not typically outgrown, but actually has a high potential for getting worse over time (Kazdin, 1993). Current estimates of the number of children exhibiting challenging behaviors and knowledge of the prognosis for these behavior concerns provides strong evidence for the need for parents and teachers to implement empirically supported behavioral interventions. Research has shown that behavior problems in children are developed and maintained within their natural environment (Patterson, 1982). Social agents, most often parents, who provide cues and consequences for a child’s behavior, play a major role in determining the rates of children’s appropriate and inappropriate behaviors (Miller 1975; Strand, 2000). Integrating our understanding of how children learn with our understanding of societal roles and family dynamics has resulted in strong support for

10 implementing empirically supported interventions that require the involvement of the ‘change agents’ in the child’s environment, i.e. teacher, caregiver (Pehrson & Robinson, 1990). Behavioral Consultation The Behavioral Consultation (BC) model was presented by Bergan, 1977 and Kratochwill & Bergan, 1978 as an indirect form of service delivery that involves providing psychological and educational support to a client, i.e. student through a consultee, i.e. teacher who works directly with the client. This method of service delivery can be much more cost effective than direct service delivery because it allows a school psychologist to impact more children than he or she could serve through direct service (Sheridan, Kratochwill, & Bergan, 1996). The two primary goals of BC are (1) to provide a method for positively impacting a child’s presenting problem and (2) to improve the skills of the consultee (Elliot & Sheridan, 1992; Kratochwill & Bergan, 1990). Specific features of BC include: indirect form of service delivery, problem-solving focus, and the development of a collegial relationship between the consultant and consultee (Elliot & Sheridan, 1992). BC is based on the behavior modification theory which involves objective data collection throughout the process in order to measure treatment success. This model plays particular attention to the acceptability and effectiveness of an intervention as well as the skills and resources of the consultee. The problem solving process of BC occurs throughout four stages. The first stage of BC is known as the Problem Identification (PI) stage. The PI interview involves objectively defining the academic or behavioral concerns of the conslutee and developing

11 a plan for how the consultee will measure baseline performance on the target behavior (Kratochwill & Bergan, 1978). The second stage of BC is Problem Analysis (PA). PA involves validating the problem, identifying possible variables that might facilitate the problem solution, and devising a plan to solve the problem (Kratochwill & Bergan, 1978). The third stage, Treatment Implementation (TI) involves the consultees implementation of the intervention that was designed during the PA stage in the natural environment (Kratochwill & Bergan, 1978). Finally, the last stage of BC is the Treatment Evaluation (TE) stage. TE consists of evaluating the data collected during the consultation and intervention process to see if the intervention was successful. Discussion of the steps necessary to maintain the positive results is also part of the TE stage (Kratochwill & Bergan, 1978). Empirical Support for BC. BC has received a substantial amount of empirical support for being an effective model of service delivery in the school setting (Gresham & Kendell, 1987; Medway, 1979; Sheridan, Welch, & Orme, 1996). Gutkin (1980) found that the BC process not only had an effect of child behaviors, but it also improved the skills of the teachers. Kratochwill, Elliot & Busse (1995) reported that BC had a positive impact on a wide range of problems exhibited by children in the school setting. BC typically involves the consultant and teacher consultee, however there has also been research conducted that supports the use of behavioral parent consultation as an effective method of changing child behavior in the home setting (Doll & Kratochwill, 1992; Gmeinder & Kratochwill, 1998; Rotto & Kratochwill, 1994). School Characteristics Related to Development and Management of Child Behavior

12 Externalizing behaviors present at an early age tend to persist through the early elementary years (Campbell & Ewing, 1990; Egeland, Kalkoske, Gottesman, & Erickson, 1990; Keenan, Shaw, Delliquadri, Giovanelli, & Walsh, 1998). Children’s social behaviors are often influenced and maintained by the structure and interactions within their environment. Therefore, it is important to take a look at the school variables that may be related to the social behaviors a child learns and/or continues to exhibit. A recent push for including children with special needs in the general education setting has created debate about the pros and cons of inclusive education. Inclusive Education. Inclusive education attempts to integrate the general and special education systems into one to meet the special needs of all children (Skrtic, 1991). Inclusive education involves meeting the needs of children with disabilities, to the maximum extent possible, within a general education classroom of same-age peers with the necessary supports available for both the student and teacher. Some of the common barriers schools face when attempting to implement inclusive education effectively include (a) teaching methods which focus on the middle range of academic achievement, (b) different perceptions and expectations about inclusion, (c) inadequate preparation of teachers to work in inclusive settings, (d) confusion about roles and responsibilities, (e) resistance from some special educators, and (f) lack of coordinated, long-term professional development (Clark et al., 1999; Evans & Lunt, 2002; Rouse & Florian, 1996). The practice of inclusive education brings all students together into one classroom. If this practice is not done with the appropriate amount of support, it could make it difficult for the teacher to interact effectively with the students in his/her classroom.

13 Teachers working in schools that practice full inclusion as a model of service delivery for students with disabilities may have additional responsibilities that take up a significant amount of time. Research continues to indicate that teachers in inclusive settings are not sufficiently trained to meet the needs of diverse learners or students with disabilities in mainstream classrooms (Kavale & Forness, 2000). Teachers in inclusive settings with children in the general education that are exhibiting academic and behavior concerns may spend much of their time attempting to develop lesson plans and interventions plans that will meet the diverse needs of all the students in his/her classroom. Teacher Involvement. Most general education teachers have received little or no training in behavior management procedures and report a lack of preparedness in working with children with behavior problems (Heflin & Bullock, 1999; Scruggs & Mastropieri, 1996). The lack of training in behavior management procedures can make it very difficult for a teacher to manage the class effectively, especially if there are children in the classroom who exhibit challenging behaviors. Teachers often work with the school psychologist who serves as the consultant in order to assist them in developing and implementing behavioral intervention plans to help manage the behavior of the entire class or the behavior of a particular student. The lack of knowledge and experience a teacher has dealing with children who exhibit challenging behavior may not only have an effect on the teacher and particular student, but also the other students in the classroom. Specific school experiences that could be affected by challenging behavior that is not managed appropriately within the classroom include: negative social interactions, a disrupted learning environment, and

14 minimal peer social interaction. These negative experiences that impact everyone in the school setting can be minimized with the implementation of consistent, empirically supported behavior management strategies. Empirically Supported Behavior Interventions Many of the most effective and widely used behavioral interventions for children with behavior problem are based on the principles of social learning theory and behavior modification (Maughan et al., 2005). These programs are based on the assumption that children’s appropriate and inappropriate behaviors are maintained by social agents in their environment (Maughan et al., 2005). Some of the most effective treatments that have been reported in the literature for behaviorally challenging children include the following key components: (1) early and sustained interventions, (2) focus on the home and school environments, and (3) consistent efforts to diminish negative behavior while teaching and supporting more adaptive social behaviors (Reid & Patterson, 1991; Short & Shapiro, 1993; Webster-Stratton, 1993). Some of the most common classroom management strategies that have received research support for being effective when dealing with challenging behavior in the classroom are token economies, rewards, response cost, and curriculum modifications (Abramowitz & O’Leary, 1991; DuPaul & Stoner, 1994). The school-home note is another intervention that has been shown to increase appropriate behaviors and decrease inappropriate behaviors exhibited by children in the classroom (Kelley, 1990). School- home notes promote communication and shared responsibility between the parents, teachers and students. Research has supported the school-home note as being an effective intervention for managing challenging behavior exhibited by children who range in age

15 from preschool through high school (Schumaker, Hovell, & Sherman, 1977; McCain & Kelley, 1993). Jurbergs, Palcic, and Kelley (2007) conducted a study to evaluate the effectiveness of school-home notes for increasing academic productivity and on-task behavior of low-income, African American children diagnosed with attention-deficit hyperactivity disorder (ADHD). The findings of Jurbergs and colleagues (2007) study demonstrated that school-home notes were effective in increasing on-task rates and accurate classwork completion for six disadvantaged students. This study also concluded that school-home notes with and without response cost were equally effective, however, parents and teachers preferred the note with the response cost component (Jurbergs et al., 2007). Results of this study suggest that a school-home note can be successfully implemented by low-income families (Jurbergs et al., 2007). The positive findings of the use of a school-home note with families of minority encourages future use of the school- home note not only to increase the appropriate behaviors of the child, but also to enhance levels of parental involvement which has been shown to have several positive effects on a child’s educational success. The literature in child psychology is replete with investigations showing positive relationships between appropriate child behavior and parental use of positive reinforcement contingencies (e.g., verbal praise, physical expression, adult presence); appropriate parental commands; consistent consequences for children’s inappropriate behavior (e.g., time out and response cost); and parental consistency (Dore & Lee, 1999; Marion, 1983). Parents who behave predictably and respond appropriately to their children influence them to behave in more socially acceptable ways (Strand, 2001).

16 Additional research on the effectiveness of interventions used to address challenging behaviors also show strong support for the use of incentives to increase positive behaviors and the use of aversives to decrease the occurrence of negative behavior (Bergan, 1990; Martens & Muller, 1990). Behavioral interventions will be most effective when the primary components of effective interventions are implemented consistently across the child’s primary settings. Home-School Partnership Home and school represent two of the most powerful influences in children’s lives (Christenson & Conoley, 1992). School-aged children spend a significant amount of time in the educational setting where school personnel are primarily responsible for their behavior. Therefore, building the relationship between a child’s primary settings (home and school) is of utmost importance when setting goals to address a child’s educational and behavioral needs. Research indicates that students benefit when there is a collaborative relationship between families and educators (Clark & Fiedler, 2003). Reviews of the parent involvement literature suggest that active parent involvement is a key factor in a child’s success at school. Specifically, it has been reported that active parent participation is related to factors such as increased student achievement and fewer discipline problems in the classroom and at home (Christenson, 1995; Christenson, Rounds, & Franklin, 1992). Specific features of strong home – school partnerships include (a) a belief in a shared responsibility for educating and socializing children, (b) an emphasis on the quality of interactions among the families and school personnel, and (c) a focus on mutually identifying solutions that support learning and adjustment (Sheridan, Eagle, Cowan, & Mickleson, 2001).

17 Gains in student performance are greatest when interventions focus on the reciprocal relationship between home and school rather than focusing only on the classroom or home environment (Christenson & Christenson, 1998). Positive interactions between parents and school personnel that are based on a common interest enhance the likelihood that behavioral interventions will be effective (Clark & Fiedler, 2003). Another factor that plays an important part in the effectiveness of a behavioral intervention involves the intervention being implemented as intended, i.e. treatment integrity. Treatment Integrity Treatment integrity refers to the degree to which the independent variable is manipulated as intended (Gresham, 1997; Gresham, Gansle, & Noell, 1993; Yeaton & Sechrest, 1981). Armstrong, Ehrhardt, Cool, & Pollen (1997) indicated that treatment integrity is a key component in outcome-based research because it helps the readers evaluate the practical and scientific importance of the results, allows for replication of the study, and allows for future investigators to expand on the procedures that were used. In many studies, treatment integrity data has been linked to behavioral outcomes (Sterling- Turner, Watson, & Moore, 2002; Noell, Gresham, & Gansle, 2002). Even though an obvious need for monitoring and reporting treatment integrity data in outcome-based research has been suggested, a meta-analysis of studies conducted between January, 1995 and August, 1999 indicated only about 50% of the articles mentioned how integrity was monitored and only about 18.5% actually reported numerical data on how integrity was monitored (Gresham, Macmillan, Beebe-Frankenberger, & Bocian, 2000).

Full document contains 142 pages
Abstract: Scope and Method of Study. Home and school represent two of the most powerful influences in children's lives. Research indicates that students benefit when there is a collaborative relationship between families and educators (Clark & Fiedler, 2003). Conjoint Behavioral Consultation (CBC) is one model that attempts to develop effective partnerships and collaborative relationships between parents and educators (Christenson & Sheridan, 2001). Thus, the purpose of this study was to investigate the effectiveness of CBC in an urban setting with clients of ethnic minority status when addressing externalizing behavior concerns that are present at home and school. In addition, procedural and treatment integrity of the consultation and intervention processes were assessed. Lastly, the acceptability of the CBC model and the interventions derived from the model were investigated. Participants in this study consisted of three sets of caregivers and teachers within an urban school district in southern Louisiana. Participants were asked to complete rating scales related to their behavior concerns, participate in CBC meetings, collect behavior data on an ongoing basis, implement the intervention that was created within the CBC process, and finally to complete rating scales related to the acceptability of the intervention and consultation process. Findings and Conclusions. Based on the data collected in this study, there is evidence that the application of consultation is an effective model of service delivery in an urban school setting with clients of ethnic minority status. The effectiveness, integrity, and acceptability of the behavioral interventions implemented within the context of CBC in the home setting were inconsistent in most cases and nonexistent in three of the cases that were dropped due to lack of initial participation and response to the consultant. Thus, indicating CBC, in its original form, may be more difficult to effectively implement when working with caregivers and families living in situations of high stress due to environmental factors, i.e. setting, SES, family composition. Although acceptability ratings of the teachers and caregivers included in this study were relatively high, treatment integrity, which according to previous research, may be a more direct measure of treatment acceptability were only in the moderate range with some specific areas in the low range.