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Epidemiologic research suggests a gap between prevalence estimates of students with emotional or behavioral problems and the actual number of students identified under the federal category of emotional disturbance (ED). To better understand issues related to the identification gap, we investigated the academic and behavioral functioning, school-based services, frequency of discipline incidents, and predictors of labels among 626 secondary age students referred for participation in a larger study due to emotional and behavioral difficulties. Students with special education labels (i.e., ED, specific learning disability [SLD], other health impairment [OHI]) were compared to those who did not have a school label. Analyses indicated that there were no significant differences between groups on standardized measures of emotional and behavioral functioning. Academic performance was the only distinction, with students with learning disabilities scoring significantly lower in reading and math than students with other disability types or without disabilities. Students without an ED label received significantly fewer services whereas students with an ED label received significantly higher rates of disciplinary actions. Finally, demographic data examined did not differentially predict receipt of a label.

Students with emotional and behavioral problems have poor academic and behavioral outcomes, both short- and long-term. Psychotropic medications are commonly used as an intervention with this population and their use has increased significantly. This study investigated adolescent and family variables associated with medication use among high school students with elevated emotional and behavioral problems, including those with a label of emotional and behavioral disorders. Participants included 548 adolescents from a larger randomized controlled trial, 184 (33.6%) of whom were receiving medication. Hierarchical linear modeling revealed that special education status, externalizing and internalizing behavior symptoms and participant race were significant student predictors of medication use. Parenting stress, family structure, positive parenting, and poor monitoring were significant family predictors of participants' medication use. These findings have implications for current practices in schools pertaining to screening and access to interventions as well as future research focused on the parent and student decision making process for choice of interventions.

U.S. federal policy recommends college and career readiness (CCR) programs to ensure students are prepared for postsecondary life. CCR programs may be particularly important for students with, or at risk of, emotional behavior disorders (EBD) who experience poor school and postschool outcomes. This literature review examined CCR programs for secondary-age students with, or at risk of, EBD. After a systematic search, 14 articles were identified that met the inclusion criteria. Although all studies resulted in favorable outcomes in some areas, outcomes were not universally positive. Furthermore, the evaluation of study quality indicated the need for increased research rigor. The findings suggest additional research is needed to identify effective CCR components and ascertain specific intervention outcomes that can be expected. Limitations and implications for research and practice are described.

Despite a high dropout rate and poor educational and posteducational outcomes, limited evidence-based practices have been validated with students at the high school level who have emotional and behavioral problems. The purpose of this study was to evaluate the impact of a multitreatment, assessment-based intervention package. Participants were 647 high-school-age students with both emotional/behavioral problems and impairment in school functioning. Using a randomized controlled trial, the intervention group showed significantly fewer disruptions, measured using direct observation. No significant differences were found in directly observed engagement or on standardized measures. However, in general, interventions were implemented with low frequency. Dosage effects were examined for classroom interventions and a social skills intervention (Interpersonal Skills Group [ISG]). Results indicated a dosage effect for ISG, reflected in standardized measures. Although implementation was low, teachers and staff rated practices that they implemented highly favorably.

This document provides recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the use of seclusion in schools. It updates the CCBD's position on this topic first published in 2009 and includes (a) key definitions, (b) a summary of problems with the use of seclusion, (c) strategies to eliminate the use of seclusion, (d) a summary of law and policy related to seclusion, (e) a summary of research on seclusion, (f) a declaration of principles, and (g) recommendations regarding the elimination of seclusion in educational settings. A parallel document provides recommendations related to the use of physical restraint procedures in educational settings, which is often associated with the use of seclusion procedures.

One successful approach for proactively reducing problem behavior is the use of a multitiered system of supports (MTSS). MTSS is usually comprised of three tiers, with an increasing intensity of support at each tier to meet student needs. Tier 1 includes preventive strategies staff implement with all students. Typically, Tier 2 behavioral interventions are intended for students with frequent distracting or disruptive behavior problems. Interventions for Tier 2 are typically provided in small-group format and are standardized so they require minimal time and resources on the part of the classroom teacher. However, students who do not respond sufficiently to Tiers 1 and 2 require Tier 3 supports, which are intensive and individualized interventions. Researchers and practitioners have begun to consider whether Tier 2 interventions can be modified to increase their effectiveness. In this article, the authors describe how to adapt social skills instruction (SSI), a common Tier 2 intervention, to increase its effectiveness.

Student views of treatment acceptability of an intervention is important but still is neither regularly assessed nor studied beyond non-behavioral interventions. Furthermore, assessment of treatment acceptability across time is almost never considered. Using data from a longitudinal, randomized controlled trial, we examined variables that predicted students' treatment acceptability of Check & Connect, a mentoring intervention with promise for promoting school engagement. A series of multiple regressions with multiple imputations revealed that students' treatment acceptability ratings in Year 1 significantly predicted Year 2 ratings. Other variables examined, including dosage, change in mentor, and student and mentor characteristics, were not significant in predicting students' treatment acceptability ratings in Year 2. Implications for using treatment acceptability to facilitate buy-in and further replications are discussed.

Check-in check-out (CICO) is a widely implemented program aimed at increasing prosocial behavior. Aligned with the logic of Tier 2 supports, CICO has a standard protocol meant to be implemented in a standardized fashion across all students. However, as CICO is not effective for all at-risk students, it is quite common to find researchers implementing adapted versions of CICO. The purpose of this review was to explore the types of, rationale for, and timing of adaptations made to CICO. Results showed that 71% of studies using CICO made adaptations to core components. While most of these adaptations were made at the onset of treatment, we found little evidence to suggest researchers had a systematic process for selecting adaptations. As schools continue to seek the most efficient and effective means to provide behavior supports to students, adaptive intervention planning is an important process to consider.

This document, from the Council for Exceptional Children, Division of Emotional and Behavioral Health (DEBH), provides clear and compelling support for the abolishment of solitary confinement with incarcerated youth and young adults in juvenile and adult correctional facilities. This is the first position statement from DEBH on the topic, and the information includes (a) a definition of solitary confinement, (b) discussion of its use, (c) an explanation of the impacts of solitary confinement on youth, (d) identification of systemic issues that perpetuate the use of solitary confinement, (e) an examination of U.S. laws concerning the use of solitary confinement, (f) a declaration of principles, and (g) recommendations for policy and practice.

In this article, we follow up on recommendations from the Division for Emotional and Behavioral Health (DEBH) for providing school mental health (SMH) services by offering additional implementation suggestions for teachers and school staff. We highlight the need for and urgency of SMH services, particularly during and after the pandemic, and also consider broad issues that interfere with the success of SMH. We then provide a number of specific recommendations for integrating the delivery of SMH services within a tiered system of supports that are intended to empower school staff to move toward implementation. Last, we address how effective implementation can be facilitated by strong administrative support along with capacity building.

Accommodations are intended to address student academic and behavioral deficits by reducing obstacles that impede learning and accurately measuring skills. There is limited research, however, pertaining to the types of accommodations students receive and their selection, particularly among those with emotional and behavioral problems. This is a significant concern for secondary age students who spend the majority of their day in regular education settings and must participate in high-stakes testing. We examined types of accommodations provided to 222 secondary students with emotional and behavioral problems, their use (i.e., classroom or standardized assessments), and variables related to their selection. Analyses indicated (a) students received a wide array of accommodations with some differences depending on disability type, (b) more accommodations were provided in the classroom than on standardized testing, (c) few demographic variables were associated with type or number of accommodations, and (d) with a single exception, academic and behavioral functioning did not explain type of accommodation received. The findings suggest that accommodation selection is highly imprecise and point to the critical need for further research in this area.

School engagement is an important predictor of graduation. One strategy to enhance student engagement is mentoring. Check & Connect is a structured mentoring program that has resulted in favorable outcomes for many students, including those with emotional and behavioral disorders. Effectiveness, however, depends on the quality of the mentor-mentee relationship. Although research has examined factors that increase relationship effectiveness, findings have been inconsistent. We explored the perceptions and correspondence of 166 high school students (i.e., mentees) with social, emotional, and/or behavioral challenges and their mentors about the mentoring relationship and variables that contribute to relationship quality. Results indicated that mentors and mentees rated the relationship favorably and their ratings correlated moderately. Mentor and mentee variables examined (gender, ethnicity/race, age) were not significant predictors of relationship quality; however, specific topics discussed during mentoring sessions for mentors (family, friends) and mentees (school, future plans) were significantly related to their perceptions of relationship quality.

English learners (ELs) with reading disabilities (RDs) have been among the lowest performers on academic achievement tests that assess vocabulary. To meet academic demands and prepare for college or careers, ELs with RDs clearly need support in terms of vocabulary acquisition; however, relevant research is scarce. This study investigated the effects of the CLUES strategy, a generative vocabulary strategy, on the ability of students to analyze and define unknown science terms relating to biology. The study further evaluated students' ability to maintain vocabulary gains over time and to generalize the CLUES strategy. The results showed that participants benefited from the use of the CLUES approach to define novel science terms and maintain their ability to use this strategy over time. The participants themselves generally expressed satisfaction with the CLUES strategy and recommended it to their peers.

The Division for Emotional and Behavioral Health (DEBH; Formerly Council for Children with Behavioral Disorders, CCBD) put forward a position paper with recommendations for the use of physical restraint procedures in educational settings. In addition to providing relevant background regarding the use of restraint, the position paper set forth a Declaration of Principles and offered specific recommendations for its use. The current paper follows up on CCBD's position paper, elaborating on the specific recommendations as they pertain to practitioners and administrators who serve children with behavioral challenges.

Teaching parents to serve as interventionists for their children is a common approach to enhance child learning. Research demonstrates that parents are able to implement evidence-based interventions with high integrity; however, there is limited research indicating the extent to which parents are able to maintain skills. We taught parents of two children, ages 10 and 11, to implement three positive behavior support skills: praise, choice making, and setting expectations. Using a multiple baseline across skills design, parents demonstrated criterion level use of all three skills; however, only one skill for one parent maintained. We then taught parents to self-monitor the use of skills that did not maintain. Following self-monitoring, parents demonstrated immediate increases in strategy implementation. In addition, both children demonstrated significant increases in engagement and decreases in problem behavior. Social validity results indicated high acceptability by both parents.

Mental health service utilization research is needed for students who are likely to receive school mental health services, yet little research exists for adolescents experiencing emotional/behavioral problems and school impairment. This study addressed this gap using secondary data analyses conducted on baseline data from a large trial testing school-based interventions for high school students (n = 647) experiencing emotional/behavioral problems and school impairment. Analyses examined the number and type (community-based or school-based psychosocial, inpatient, pharmacological treatment) of services used, and sociodemographics associated with services. Sixty-nine percent had received at least one service for their emotional/behavioral problems prior to the study, with nearly half of those having only received a single service. Community-based psychosocial and pharmacological treatments were most common. White adolescents and those in special education were more likely to have received services, particularly community-based and pharmacological treatment. On average, adolescents had not received any services until early adolescence. Findings add to increasing literature on the current status of service use among adolescents with emotional/behavioral problems and the potential for schools to increase access for those in need.

The most efficacious psychosocial intervention for reducing attention-deficit/hyperactivity disorder (ADHD) symptoms in young children is behavioral parent training (BPT). Potential benefits are hindered by limited accessibility, low session attendance, and poor implementation of prescribed strategies. As a result, only approximately half of families with young children with ADHD receive BPT. We describe an innovative approach for reducing barriers to BPT access. Specifically, we invoked an iterative, 5-step process of intervention development and revision to modify an existing face-to-face BPT program and develop an online version. Results indicated that the revised program and online versions (a) increased parent engagement with BPT, (b) enhanced accessibility, (c) produced favorable parent acceptability and feasibility ratings, and (d) resulted in improved child outcomes.

Functional assessment and functional analysis are processes that have been applied successfully in work with people who have developmental disabilities, but they have been used rarely with students who experience emotional or behavioral disorders. In the present study, five students in elementary school programs for severe emotional disturbance participated in a comprehensive functional assessment process designed to yield a useful understanding of their desirable and undesirable behaviors. Interviews, record reviews, and direct classroom observations led to the development of individualized hypotheses regarding relationships between classroom events and the occurrence of target behaviors. Subsequently, direct manipulations (i.e., functional analyses) were conducted to test each of the hypotheses in the context of regularly-occurring classroom activities. These analyses demonstrate important influences that certain classroom variables can exert over individual student's behavior. The process and results are discussed with regard to the need for improved methods for understanding student responding, and the benefits that functional assessment can offer programs of educational and behavioral support. [This is the third in a series of three classic article reprints celebrating the rich history of impactful scholarship published in Behavioral Disorders in the 1970s, 1980s, and 1990s. For the original, "Functional Analysis of Classroom Variables for Students with Emotional and Behavioral Disorders," see EJ470666.]

Over the last decade, there has been increased interest in measuring life satisfaction among children and adolescents as an indicator of broad well-being and happiness. Although limited, existing research with students with social, emotional, and behavioral (SEB) problems indicates they experience lower life satisfaction compared with their nondisabled peers. We evaluated life satisfaction ratings by 553 high school students with SEB problems and examined those ratings relative to their academic, mental health, and behavioral outcomes as well as demographic characteristics. In addition, we examined stability of life satisfaction reports over time. Overall, students reported "medium" satisfaction with life, except in the School domain, which was rated least favorably. Higher life satisfaction reports significantly correlated with lower anxiety, depression, and behavior problems, as well as higher reading and math achievement. Differences were found based on gender and ethnicity, with female and Hispanic/Latino students reporting lower satisfaction in certain life domains compared with their counterparts. Finally, self-reported life satisfaction showed variability across time.

Little is known about the feasibility and acceptability of interventions designed to address the needs of high school students with emotional and behavioral challenges and adopted by their teachers. In this study, 336 general and special education teachers rated classwide interventions (e.g., expectations, routines, positive student-teacher interactions [PSTI]) and individual student interventions (e.g., study skills, organizational skills) in terms of priority, feasibility, and acceptability before implementation. Teachers who implemented the interventions rated their acceptability post-implementation. Results indicated that acceptability ratings varied across interventions, and it appeared that teachers rated interventions that required the least amount of time to implement (e.g., PSTI) most acceptable and those that required the most time for implementation (e.g., study skills) least acceptable. Lack of time, perceived lack of effectiveness, and poor environmental fit were often cited as reasons for lack of feasibility. Regression analyses revealed that teacher characteristics (e.g., years of experience) and type of intervention (e.g., classwide vs. individualized) contributed to teacher ratings of intervention acceptability. Implications for future research and practice are discussed.

This document provides policy recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the use of physical restraint procedures in educational settings. It includes (a) an introduction with definitions of terminology; (b) a discussion of the problems with the use of physical restraint, policy on this topic, and the lack of research; (c) a Declaration of Principles; and (d) Recommendations Regarding the Use of Physical Restraint in educational settings. Although the policy recommendations in this document pertain to the United States, we believe the principles and nonpolicy recommendations are equally applicable to other countries.

Within a three-tiered intervention framework, such as School-Wide Positive Behavioral Interventions and Supports, Tier 2 interventions were initially conceived as employing a standard protocol across all at-risk students. Research and practice, however, suggests advantages to adapting interventions so they are tailored to individual student needs. In this literature review, we examined adaptations to social skills training (SST). We identified 19 studies that implemented SST within a tiered framework, eight of which made adaptations. Across the studies, nine different types of adaptations were made. All studies made multiple simultaneous adaptations with the 156 participants, which resulted in uniformly favorable outcomes. Most studies made adaptations at the study onset and the rationale for making the adaptations varied. Studies varied in the number of Quality Indicators present. This review indicates that adaptations may improve the effectiveness of Tier 2 interventions; however, additional research is needed to provide further evidence of the effectiveness of individual adaptations and to identifying procedures for selecting adaptations matched to student need.

Emotional Disturbance (ED) is one category under which a student can be evaluated and determined eligible to receive special education and related services. Students who experience ED are at greater risk for a host of negative long-term outcomes that include poor social, behavioral, and academic achievement in school, which in turn may impact graduation and postsecondary outcomes. In this article, we provide historical context and current data to highlight contemporary issues surrounding the needs and education of students with ED. Specifically, we present child-count data and descriptions of students that are currently served in the ED category. We provide information about the frequency and types of disciplinary events students with ED experience and discuss associated secondary and postsecondary outcomes. We summarize positive achievements and continued challenges within the field. Finally, derived from the ongoing unmet needs of students with and at risk for ED, we recommend (a) revision of the current Individuals with Disabilities Education Improvement Act terminology and eligibility criteria to a more comprehensive education-based definition; (b) regular universal screening for signs of social, emotional, and/or behavioral problems; (c) use of multitiered systems of support that offer preventive interventions to address the social, emotional, and behavioral needs of all students, particularly when they first emerge; and (d) integrated delivery models that allow greater access to related services to enhance the benefits of special education for students with ED.

Multi-tiered systems of support are frequently used in school settings because of their efficiency and effectiveness (McIntosh & Goodman, 2016). The rationale for multi-tiered systems of support is to provide early and systematic intervention to all students with increasing intensity of intervention provided as needed (Sugai & Horner, 2009). These systems generally offer three levels of support in which Tier 1 is applied with all students in a school, Tier 2 is used with about 15% of students who are at risk for more serious concerns, and Tier 3 is reserved for 3-5% of the school population with the most serious academic or behavior problems. Tier 2 supports have been defined as interventions that are standardized across students and are quickly and continuously available (Hawken, Adolphson, MacLeod, & Schumann, 2009). One common Tier 2 intervention is Check In/Check Out (CICO). As with all Tier 2 interventions, CICO is designed to reduce mild problem behavior and increase academic engagement (Crone, Hawken, & Horner, 2010). Although Tier 2 support was initially conceptualized as employing standardized intervention protocols for ease of implementation, researchers and practitioners have begun to make adaptations to standard protocols to increase their effectiveness (e.g., Boyd & Anderson, 2013; Kilgus, Fallon, & Feinberg, 2016; Melius, Swoszowski, & Siders, 2015). Adaptations are changes to core components of the standard protocol (Majeika et al., in press). These changes require a problem solving process to tailor a program so that it is better aligned with student needs. After providing an overview of CICO, this article addresses how adaptations can be beneficial, how they have been made, and when they should be made. Additionally, it discusses ways to adapt CICO, modifying the intensity or dosage of CICO, and individualizing components to meet students' needs. Classroom case studies and steps to fading CICO are also described.

Although it is known some youth access mental health services more readily than others, most service use studies used variable-centric approaches that produced heterogeneous groups and results that require parents and educators to understand diagnostic categories. Person-centered approaches group youth with similar patterns of behavioral and mental health concerns and thus are more homogenous and comparable to the presentation of behavioral and mental health problems noticed by parents and educators, who most typically facilitate access to care for those youth in need. We examined the behavioral and mental health symptom profiles, demographic characteristics and service use histories of youth referred for intervention in a multi-state, randomized controlled trial intervening in severe emotional/behavioral problems (n = 647; Kern et al. in Educ Treat Child 34(4):593-617, 2011). Latent profile analysis of parent-reported hyperactivity, aggression, and conduct, and adolescent-reported anxiety and depression on a broadband measure of student emotional and behavioral functioning was conducted. Model fit indices and theoretical interpretation supported five latent profiles; Class 1 showed severe externalizing behavior problems (7.18%, n = 45), Class 2 showed normative behaviors (37.78%, n = 237), Class 3 showed elevated internalizing behavior problems (12.76%, n = 80), Class 4 showed elevated externalizing behavior problems (33.01%, n = 207), and Class 5 showed elevated internalizing and externalizing behavior problems (9.25%, n = 58). We detected demographic and service use history difference between these profiles using multinomial logistic regression. Findings are discussed in relation to improving children's mental health services, including universal screening, training emphasizing recognition and concern for internalizing behavior problems, and increased availability of mental health professionals in school settings.

In the 25 years since the publication of the article reprinted in this issue of "Behavioral Disorders", a tremendous amount of research and opinion has been published on the topics of functional analysis, functional assessment, and assessment-based interventions. In this commentary, we reflect on the context in which our original work was conducted and briefly consider changes that have occurred and challenges that remain.

The field of positive behavior support (PBS) has expanded and evolved significantly since the first issue of "Journal of Positive Behavior Interventions" ("JPBI") was published. To ascertain how evolution of the field was reflected in the research, we examined trends in empirical studies published in "JPBI" since its inception. We coded 217 articles published between 1999 and 2016 that included data-based assessment or data-based intervention practices for key variables pertinent to potential trends in PBS. Analyses revealed increases across the publication period in studies that (a) included participants at risk for behavioral difficulties, (b) implemented interventions in general education settings, (c) utilized clinicians/experimenters as intervention agents, and (d) focused on adult skills as the intervention target. Findings are discussed in the context of the expansion of school-wide positive behavior interventions and support.

This document provides administrative recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the need for school-based mental health services (SBMHS) in schools (Kern et al., 2017). It includes (1) an introduction, (2) key considerations for successful SBMHS, and (3) recommendations regarding local, state, and federal administrative guidelines.

Disproportionality persists with regard to the labeling of students with emotional and behavioral disorders (EBD). A blending of critical race theory and disability studies, or DisCrit, provides a framework to examine disproportionality. In this article, a DisCrit mindset is applied to examine how racism and ableism intersect to disproportionately marginalize children of color. A critique of assessment practices, as well as the EBD definition, from a DisCrit perspective is offered to strengthen approaches for equity. We end with recommendations for educational practices and policies and suggest areas for future research. [ABSTRACT FROM AUTHOR]

Within the context of a multi-tiered framework for behavior support, intervention intensification is warranted when a Tier II intervention fails to adequately address a targeted behavior. A traditional approach to intensification is to shift from standardized supports at Tier II to individualized and more resource-intensive supports at Tier III. Recent conceptualizations, however, reflect the use of a process-oriented, adaptive approach in which a continuum of responsive intensifications connects the framework's tiers. Adaptive intervention design relies on the identification of critical factors to inform responsive adaptations to a standard treatment protocol. This study examined the distinct and relative influence of adaptations to Check-In/Check-Out (CICO), a targeted intervention, informed by two critical factors—behavioral function and teachers' use of behavior-specific praise. Results indicated that, relative to traditional CICO, CICO adapted to address behavioral function was less effective in producing differentiated levels of disruptive behavior. However, CICO adapted to strengthen a teaching practice—the delivery of behavior-specific praise—was effective in producing differentiated levels of disruptive behavior relative to the standard treatment protocol. Additional research on treatment adaptations informed by behavioral function and evidence-based teacher practices is needed to evaluate whether the variables may serve as critical factors within an adaptive approach to building treatment intensity at Tier II. [ABSTRACT FROM AUTHOR]

Mental illness is a major public health concern with significant social cost. Symptoms of mental health problems generally emerge during the school-age years. Although effective interventions are available to decelerate or eliminate incipient concerns, they are rarely accessible to youth. Evidence suggests that school-based mental health services (SBMHS) have the highest likelihood of reaching youth in need. In this paper, the authors and the Council for Children with Behavior Disorders present a foundation for future policy recommendations relative to the need for SBMHS and recommendations for implementation.

Positive behavior support (PBS) has been a dynamic and growing enterprise for more than 25 years. During this period, PBS has expanded applications across a wide range of populations and multiple levels of implementation. As a result, there have been understandable inconsistencies and confusion regarding the definition of PBS. In this essay, we offer an updated and unified definition. We provide a brief historical perspective and describe a process for developing a proposed definition. We also discuss the rationale for key elements of the definition.