Treatment Utility of Universal Screening for Behavioral Risk: A Manipulated Assessment Study

In recent years, schools have started implementing preventive practices such as universal screening. Yet, researchers have not evaluated the extent to which universal screening contributes to academic and behavioral outcomes. The purpose of this study was to evaluate the treatment utility of universal screening for behavioral risk. Student participants were randomly assigned to two groups, corresponding to a different method of identification (office discipline referrals and universal screening). Participants identified as at risk, based on their office discipline referral data or universal screening data, and selected for intervention, received a Tier 2 intervention. Data were analyzed using a fixed-effects regression model. Analyses identified no statistically significantly differences between the two groups with regard to various academic and behavioral outcomes, suggesting universal screening did not contribute to changes in student functioning.     

Implementation of Universal Behavioral Health Screening in a University Health Setting

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62 % female) accessing a university health center. Each semester, 9–13 % of students screened positive for depression, 2.5–3 % for suicidal ideation, and 33–38 % for alcohol misuse, while 10 % wanted help with smoking cessation and 12–13 % with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.     

A universal behavioral screener linked to personalized classroom interventions: Psychometric characteristics in a large sample of German schoolchildren

The current study represents the first psychometric evaluation of an American English into German translation of a school-based universal screening measure designed to assess academic and disruptive behavior problems. This initial study examines the factor structure and diagnostic accuracy of the newly translated measure in a large sample of 1009 German schoolchildren attending grades 1–6 in Western Germany. Confirmatory factor analysis supported a two-factor model for both male- and female- students. Configural invariance was supported between male- and female-samples. However scalar invariance was not supported, with higher thresholds for ratings of female students. Results of receiver operating characteristic (ROC) curve analyses were indicative of good to excellent diagnostic accuracy with areas under the curve ranging from 0.89 to 0.93. Optimal cut-off scores were 10, 5, and 13 for the Academic Productivity/Disorganization, Oppositional/Disruptive, and the Total Problems Composite scores of the Integrated System Teacher Rating Form respectively. This initial study of the newly translated measure supports further investigations into its utility for universal screening in German speaking schools.     

Bayesian Causal Mediation Analysis for Group Randomized Designs with Homogeneous and Heterogeneous Effects: Simulation and Case Study

A fully Bayesian approach to causal mediation analysis for group-randomized designs is presented. A unique contribution of this article is the combination of Bayesian inferential methods with G-computation to address the problem of heterogeneous treatment or mediator effects. A detailed simulation study shows that this approach has excellent frequentist properties, particularly in the case of small sample sizes with accurate informative priors. The simulation study also demonstrates that the proposed approach can take into account heterogeneous treatment or mediator effects without bias. A case study using data from a school-based randomized intervention designed to increase parent social capital leading to improved behavioral and academic outcomes in children is offered to illustrate the Bayesian approach to causal mediation in group-randomized designs.     

How a cognitive psychologist came to seek universal laws

My early fascination with geometry and physics and, later, with perception and imagination inspired a hope that fundamental phenomena of psychology, like those of physics, might approximate universal laws. Ensuing research led me to the following candidates, formulated in terms of distances along shortest paths in abstract representational spaces: Generalization probability decreases exponentially and discrimination time reciprocally with distance. Time to determine the identity of shapes and, provisionally, relation between musical tones or keys increases linearly with distance. Invariance of the laws is achieved by constructing the representational spaces from psychological rather than physical data (using multidimensional scaling) and from considerations of geometry, group theory, and symmetry. Universality of the laws is suggested by their behavioral approximation in cognitively advanced species and by theoretical considerations of optimality. Just possibly, not only physics but also psychology can aspire to laws that ultimately reflect mathematical constraints, such as those of group theory and symmetry, and, so, are both universal and nonarbitrary.     

Systematic Screening for Behavior in K–12 Settings as Regular School Practice: Practical Considerations and Recommendations

There is a priority for schools to address students' social and emotional needs as is done for academic learning. Tiered models of prevention provide a framework for teaching social skills and behavioral expectations, as well as academics, with positive, proactive, evidence-based practices. Central to responding to students' needs is accurate measurement of their performance. Systematic screening for behavior addresses this need. Specific screening tools are presented with brief evidence for their use. Then practical considerations and recommendations are offered for school leadership teams as they plan for using systematic behavior screening as a regular school practice. The study was framed within tiered models of prevention; however, screening practices may be used outside of tiered models provided structures are in place for responding to student needs when detected. Content is offered to guide school leadership teams as they undertake systematic behavior screening efforts.     

School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome

This article examines the effectiveness of an evidence-based behavioral treatment package for children with inattentive and disruptive behavior problems when delivered in the context of a school-based mental health program. Child symptomatology and functioning are assessed in a treatment group (n = 30) and a waitlist control group (n = 12) across multiple time points (fall, winter, and spring). Treatment includes a daily report card procedure, year-long teacher consultation, and parenting sessions. According to the parent report, treated children show marked reductions in hyperactive and impulsive, oppositional or defiant and aggressive behavior, and marked improvement in peer relationships. Teachers observe treatment-related group differences in inattention, academic functioning, and the student-teacher relationship. Feasibility and acceptability data have implications for transporting evidence-based treatments to community settings and for integrating mental health services into the culture of the school community.     

Mindfulness Based Interventions for Youth

Application of mindfulness based interventions for youth is growing exponentially within clinical and educational settings. Proponents emphasize benefits in reduction of a wide range of psychopathology including internalizing and externalizing disorders, as well as enhancement of functioning and skills in attentional focus and concentration, emotion regulation, social and academic performance, adaptive coping, frustration tolerance, self-control, and self-esteem. Findings to date are encouraging, though research design reflects the nascent nature of the field and continues to be insufficient to confirm treatment efficacy or mechanisms of change. This article is aimed at providing the clinical practitioner with a review of the current state of the field with regard to application of mindfulness for youth, placing it in context of the broader history of the CBT movement. Specifically mindfulness based stress reduction, mindfulness based cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavior therapy treatments for youth are critically reviewed, and mindfulness as a technique and as a unifying mechanism of action in “third-wave” youth psychotherapies discussed. Developmental considerations are highlighted, and the application of mindfulness as a universal preventative health measure versus tertiary treatment intervention examined, with consideration for future directions.     

Early identification of mental health problems in schools: The status of instrumentation

When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. Finally, a range of approaches to early identification in schools as well as some of the broader ethical and practical issues related to the integration of these strategies into a school-wide continuum of services are presented.     

Longitudinal relations among school context,school-based parent involvement,and academic achievement of Chinese American children in immigrant families

Immigrant families face multiple barriers to engaging with children's schools. Yet, school-based parent involvement has been associated with academic and behavioral benefits for children of immigrant families. Although past research has examined links between family contextual factors and parent involvement, less is known about the links between school contextual factors and parent involvement in immigrant families. Identifying socio-cultural barriers to parent involvement across home and school contexts can inform culturally competent family engagement interventions serving immigrant families. In a two-wave (1.5 years apart) longitudinal study of a community-based sample of Chinese American children (N = 210, beginning age = 5.8–9.1 years) attending over 80 schools in a metropolitan area, we assessed school-based parent involvement behaviors and parent involvement-related psychological processes (i.e., parent-teacher relationship quality, parents' endorsement of schools, teachers' perceptions of parents) using parent and teacher report. First, results indicated that significant positive associations were found between school-based parent involvement behaviors and parent involvement-related psychological processes (rs = 0.36–0.53). Next, multi-level modeling was conducted to test concurrent relations of Wave 1 school contextual factors to all four parent involvement constructs (controlling for family-level factors), as well as testing the prospective relations of parent involvement at Wave 1 to children's academic achievement at Wave 2. Student body diversity of schools was negatively associated with school-based parent involvement (rs = −0.18, −0.17), parent-rated parent-teacher relationship quality (r = −0.18), and parents' endorsement of schools (r = −0.36). The concentration of Asian students at schools and schoolwide achievement were negatively associated with teachers' perceptions of parents (rs = −0.18, −0.20). However, neither school contextual factors nor school-based parent involvement at Wave 1 uniquely predicted children's academic achievement at Wave 2. Implications of findings for understanding and addressing barriers to engaging Chinese American immigrant families in their children's schools are discussed.     

The efficacy of a universal school-based program to prevent adolescent depression

Evaluated whether a universal school-based program, designed to prevent depression in adolescents, could be effectively implemented within the constraints of the school environment. Participants were 260 Year 9 secondary school students. Students completed measures of depressive symptoms and hopelessness and were then assigned to 1 of 3 groups: (a) Resourceful Adolescent Program-Adolescents (RAP-A), an 11-session school-based resilience building program, as part of the school curriculum; (b) Resourceful Adolescent Program-Family (RAP-F), the same program as in RAP-A, but in which each student's parents were also invited to participate in a 3-session parent program; and (c) Adolescent Watch, a comparison group in which adolescents simply completed the measures. The program was implemented with a high recruitment (88%), low attrition rate (5.8%), and satisfactory adherence to program protocol. Adolescents in either of the RAP programs reported significantly lower levels of depressive symptomatology and hopelessness at post-intervention and 10-month follow-up, compared with those in the comparison group. Adolescents also reported high satisfaction with the program. The study provides evidence for the efficacy of a school-based universal program designed to prevent depression in adolescence.     

Introduction to the Special Issue: The Influence of Cultural and Linguistic Variables on Student Behavior and Academic Performance

Although focus on linguistic and cultural variables in education has been a priority at the federal level, few empirical papers reporting experimental analyses of the influence of these variables have been published. The goal of this special issue is to highlight recent experimental analyses of cultural or linguistic variables on student behavior or academic performance and to illustrate the challenges in translating an applied behavior analytic approach across languages and cultures. The special issue is comprised of studies that address three issues relevant to behavioral education: (1) comparative effects of providing academic instruction or addressing challenging behavior of children with intellectual and developmental disorders in English or their home language of Spanish, (2) delivering effective instructional practices with students from diverse racial and cultural groups, and (3) considerations regarding the translation of applied behavior analysis in education for adoption in a different language and culture.     

Differential Item Functioning of the Emotional and Behavioral Screener for Caucasian and African American Elementary School Students

The present study examined the psychometric properties of a universal screening instrument called the Emotional and Behavioral Screener (EBS), which is designed to identify students exhibiting emotional and behavioral problems. The primary purposes of this study were to assess the measurement invariance of EBS items between Caucasian and African-American students and to assess the impact of differential item functioning (DIF) on EBS scores. The sample consisted of 946 elementary students from throughout the U.S. The findings suggested that EBS items exhibited small to negligible levels of DIF, and that DIF did not significantly impact EBS scores. The results supported the EBS as universal screening instrument that is fair in measuring the emotional and behavioral risk of elementary students. Research limitations and implications for school professionals are discussed.     

Direct behavior rating as a school-based behavior universal screener: Replication across sites

The purpose of this study was to evaluate the utility of Direct Behavior Rating Single Item Scale (DBR–SIS) targets of disruptive, engaged, and respectful behavior within school-based universal screening. Participants included 31 first-, 25 fourth-, and 23 seventh-grade teachers and their 1108 students, sampled from 13 schools across three geographic locations (northeast, southeast, and midwest). Each teacher rated approximately 15 of their students across three measures, including DBR–SIS, the Behavioral and Emotional Screening System (Kamphaus & Reynolds, 2007), and the Student Risk Screening Scale (Drummond, 1994). Moderate to high bivariate correlations and area under the curve statistics supported concurrent validity and diagnostic accuracy of DBR–SIS. Receiver operating characteristic curve analyses indicated that although respectful behavior cut scores recommended for screening remained constant across grade levels, cut scores varied for disruptive behavior and academic engaged behavior. Specific cut scores for first grade included 2 or less for disruptive behavior, 7 or greater for academically engaged behavior, and 9 or greater for respectful behavior. In fourth and seventh grades, cut scores changed to 1 or less for disruptive behavior and 8 or greater for academically engaged behavior, and remained the same for respectful behavior. Findings indicated that disruptive behavior was particularly appropriate for use in screening at first grade, whereas academically engaged behavior was most appropriate at both fourth and seventh grades. Each set of cut scores was associated with acceptable sensitivity (.79–.87), specificity (.71–.82), and negative predictive power (.94–.96), but low positive predictive power (.43–.44). DBR–SIS multiple gating procedures, through which students were only considered at risk overall if they exceeded cut scores on 2 or more DBR–SIS targets, were also determined acceptable in first and seventh grades, as the use of both disruptive behavior and academically engaged behavior in defining risk yielded acceptable conditional probability indices. Overall, the current findings are consistent with previous research, yielding further support for the DBR–SIS as a universal screener. Limitations, implications for practice, and directions for future research are discussed.     

The cultural moral right to a basic minimum of accessible health care

(1) The conception of a cultural moral right is useful in capturing the social-moral realities that underlie debate about universal health care. In asserting such rights, individuals make claims above and beyond their legal rights, but those claims are based on the society's existing commitments and moral culture. In the United States such a right to accessible basic health care is generated by various empirical social facts, primarily the conjunction of the legal requirement of access to emergency care with widely held principles about unfair free riding and just sharing of costs between well and ill. The right can get expressed in social policy through either single-payer or mandated insurance. (2) The same elements that generate this right provide modest assistance in determining its content, the structure and scope of a basic minimum of care. They justify limits on patient cost sharing, require comparative effectiveness, and make cost considerations relevant. They shed light on the status of expensive, marginally life extending, last-chance therapies, as well as life support for PVS patients. They are of less assistance in settling contentious debates about screening for breast and prostate cancer and treatments for infertility and erectile dysfunction, but even there they establish a useful framework for discussion. Scarcity of resources need not be a leading conceptual consideration in discerning a basic minimum. More important are the societal elements that generate the cultural moral right to a basic minimum.     

Violence Exposure and PTSD: The Role of English Language Fluency in Latino Youth

Although Latinos have been a rapidly growing population in the US, little is known about how mental health symptoms may present in Latino children especially in the context of those living in poverty and exposed to violence. We explored the level of violence exposure and trauma symptoms in Latino youth and the relationship of these factors with English language fluency. During 2000–2002, 1,601, Latino students from seven middle schools participated in a school-based screening to identify students with exposure to community violence and symptoms of Posttraumatic Stress Disorder (PTSD). The students completed a self-report instrument, in either Spanish or English, that combined a modified version of the Life Events Scale and the Child PTSD Symptom Scale (CPSS). Bivariate analyses and multivariate regression models showed that youth with higher English language fluency reported greater violence exposure and PTSD symptoms than those with lower fluency. No difference was found in functioning by English language fluency. English language fluency appears to be related to violence exposure and PTSD symptoms in these Latino youth. We discuss the importance of school-based programs especially designed to serve Latino students of varying English language fluency.     

Changing knowledge and attitudes about skin cancer risk factors in adolescents.

We examined knowledge, attitudes, and behaviors related to skin cancer, sun exposure, sunscreen use, and use of tanning booths in 903 female and 800 male adolescents. The effectiveness of a brief, school-based intervention designed to increase teens' knowledge and preventive attitudes about skin cancer was also evaluated. Females, older students, and those with high-risk skin types were most likely to use sunscreen and to take precautions. However, overall level of protection was low. Intentions to take precautions were associated with levels of perceived susceptibility to skin cancer, attitudes about the benefits of sun exposure, skin type, and sex. Beyond intentions, sunscreen use was associated with perceived susceptibility and skin type. The one-session, school-based intervention significantly increased knowledge and perceived susceptibility to skin cancer but not behavioral intentions.     

School-based applications of the wraparound process: Early results on service provision and student outcomes

The application of a school-based wraparound approach presents different challenges, perspectives, and knowledge from those seen in mental health or child welfare settings. For the past three years, the La Grange Area Department of Special Education's Wraparound Project has been implementing a school-based individualized service network that is now being integrated into the larger local and state special education, mental health, and social service systems. We present school-based applications of wraparound for students with emotional and behavioral disabilities, including the community and system context, program application, evaluation process and preliminary results. Students who were identified through self-contained special education classrooms were compared to students who were identified from various other school and mental health settings. Students from the school-based program were less clinically involved than students identified from other settings. Service provision differed between program groups and by out-of-home experiences. Finally, the use of wraparound approaches across a variety of educational settings to prevent out-of-school and out-of-home care are discussed.     

To Have–or Not to Have–Another Child: Family Planning Attitudes,Intentions, and Behavior1

Two hundred eighty-two respondents, representing 141 married couples with either one child (N= 71 couples) or two children (N= 70 couples), were interviewed about their considerations and intentions regarding whether or not to have another child. Reports of their actual subsequent family planning behavior were obtained 12 months later via a mailed questionnaire. The data was gathered and analyzed according to Fishbein's attitude-behavior model which stipulates that the individual's actual behavior is a function of one's behavioral intention. This intention, in turn, is determined by two multiple factors: (a) the individual's beliefs about the consequences of performing the behavior multiplied by his/her evaluation of those consequences, and (b) one's normative beliefs multiplied by one's motivation to comply with the perceived norms. The results provided substantial support for the model; both behavioral intention and actual behavior were successfully predicted from the attitudinal and normative components of the model. It was also shown that the behavioral intention mediates the relationship between the model's attitudinal and normative components and actual behavior.