Do Children with Multiple Patterns of Problem Behavior Improve? The Effectiveness of an Intensive Bio-Behaviorally Oriented School-Based Behavioral Health Program

Over the last thirty years, children's behavioral health services in the school have witnessed drastic progress. Over this time, medications for mental health problems have improved. In addition, empirically validated treatments, most of which have come from behavioral psychology, have made their way into Best Practice guidelines for the treatment of children with emotional and behavioral disorders. In 1999, the U.S. Surgeon General reported on many of these practices and suggested their use to enhance treatment outcomes for children. The President's New Freedom Commission on Mental Health (2003) suggested the need for evidence-based practices to become a regular part of behavioral health care practice and suggested setting up and evaluating the effectiveness of such practices in demonstration projects. In addition, in the 2003-year school year, Children Crisis Treatment Center participated in a new school based program, which focused on the treatment of children with emotional and behavioral disorders in the school. Twenty-four children entered into the program over the course of the first year. Each child received a functional behavioral assessment and an individualized behavioral intervention plan. The treatments in these plans represented evidence based, best practices such as contingency management procedures like token systems with response cost, behavioral skills training, and problem solving training. The system functioned as a revolving entry program providing behavioral consultation to teachers, behavior therapy to children and direct care support to implement non-technical behavioral interventions. Of the eleven staff in the program, three had a masters' degree in counseling or a related field, who served as both behavior therapists and behavioral consultants to the teachers. Seven staff had bachelors degree in psychology related fields and one-year experience. Bachelor level staff provided direct care to the children on a rotating basis across the children's school day. The program never had more than twenty-two children at any one time. The pre-post scores represent the scores at the child's entrance and exits from the program, or entrance to the end of the school year. The average length of time represented in these scores for a child in the program was approximately 6 months. Of the original group, 18 received pre-post scores on the Achenbach: Teacher Report Form. One child's pre-post scoring pattern was in the normal range for both instruments, so we excluded his scores from the analysis. This paper represents an outcome analysis of the effectiveness of this program. Using the Jacobson and Truax's (1997) reliable change index score, we rated large behavioral response classes (or what some would refer to as psychiatric symptoms) to determine if clinically significant improvement resulted from the program. Using these measures, enhanced functioning occurred for twelve out of seventeen scores or 70% of the children. In addition, five out of the 17 or approximately 30% showed enough improvement to score as partially recovered. (Contains 1 table.)