a meta-analysis of the definition, features, and effects of secondary prevention interventions...

A Meta-Analysis of the Definition, Features, and Effects of Secondary Prevention Interventions

Pei-Yu Chen& Carol Ann Davis

University of Washington

Presentation Outline

Why do we focus on SWPBS secondary prevention intervention?

What is SWPBS secondary prevention intervention? Definitions and Key features

How does the existing evidence reflect the key features of SWPBS secondary prevention?

What do we know about the secondary prevention intervention?

What are questions about secondary prevention intervention still left not answered?

A brief review of SWPBS model

Source: PBIS websitehttp://www.pbis.org/schoolwide.htm

Why do we focus on SWPBS secondary prevention intervention? More than 50 studies evaluated the effects of

SWPBS primary intervention (Horner & Sugai, 2007).

decreased incidents of office discipline referral improved students’ perception of school safety and

academic outcomes

The effects of secondary and tertiary prevention interventions within the SWPBS model remained less clear to the researchers (McCurdy et al., 2007).

might be a result of the lack of consensus on core elements of secondary intervention as a field

Reviewing the SWPBS secondary prevention intervention Investigated the definition and key elements

of SWPBS secondary prevention intervention

Applied the key elements as evaluating criteria to examine existing secondary prevention studies

What is SWPBS secondary prevention intervention? Researchers have agreed that SWPBS

secondary prevention intervention is: for students who are not responding to primary

prevention interventions

for students who are at risk for developing serious and chronic behavioral problems

for small groups or individual student

Key elements of SWPBS secondary prevention intervention

using systematic feedback, building connection with key adults

at school, increasing collaboration among

school staff, home, and community, implementing a reward system, making ecological or curricula

modifications, providing ample practice

opportunities to increase social and academic competence

early screening for intervention continuously available services

rapid access to intervention, requiring low teacher efforts, being implemented by school staff, interventions consistent with school

expectations, applying flexible interventions based

on assessment, conducting Functional Assessment, providing students choices to

participate in the intervention, devoting adequate school

resources, continuously monitoring students’

progress

• A wide range of core elements of secondary prevention are proposed by researchers (Baker, 2005, Korb, 2006, Hawken & O’Neill, 2006,

PBIS website, 2008, Scott et al., 2002, Sugai & Horner, 2007), including

Key elements (continued.)

Applied the key elements proposed by PBIS website to further examine existing evidence

PBIS secondary intervention key elements

→ continuously available services→ rapid access to intervention,→ requiring low teacher efforts,→ being implemented by school staff,→ interventions consistent with school

expectations, → applying flexible interventions based on

assessment,→ conducting Functional Assessment, → providing students choices to participate

in the intervention,→ devoting adequate school resources, → continuously monitoring students’

progress

Great variability among researchers about what defines a secondary intervention

Method

Recruiting studies:

Peer-reviewed empirical studies

Education Resources Information Center (ERIC) and PsycINFO database

Hand-search articles identified through the initial searches

Combination of descriptors:

secondary intervention secondary prevention targeted intervention school-wide PBS (SWPBS) academic intervention tutoring positive behavior support small group intervention social skill instruction conflict resolution skills social skill club check and connect Behavior Education Program

Inclusion criteria: Published between 1995 to 2007

Included empirical data to verify the efficacy of an intervention

Conducted in school settings

Included behavioral and/or academic performance as outcome measures

38 studies were identified through the search process

Studies were categorized into 6 types of interventions

self-determination (BEP/CICO/Check and Connect) (n=11), social skills training (n=5), reading interventions (n=7), environmental adjustments (n=1), behavioral interventions (n=1), multi-component interventions (n=13)

combine social skills training and another type of the above-mentioned interventions

The 38 articles were divided into two groups within the SWPBS context out of the SWPBS context

Inclusion criteria of the “in SWPBS context” studies: studies self-identified as secondary prevention

interventions, and/or a description of primary intervention in the study

settings

Half of the studies (n=19) were conducted within the context of SWPBS.

Studies conducted out of the SWPBS context were also included in the review to support the efficacy of the intervention To evaluate whether the intervention is an

evidence-based practice

Data analysis

Each type of secondary intervention is analyzed by

The extent to which the key elements is addressed across studies

Number of studies within and out of SWPBS context

Design of the studies

Number of replication across subjects, researchers, and settings

Results

“Within SWPBS context” Self-Determination (BEP/CICO/ Check & Connect) studies and key elements

PBIS Key Elements of Secondary Intervention

(n=6)

Addressed by # of studies (n=?)

continuously available services 3

rapid access to intervention 0

requiring low teacher efforts 2

being implemented by school staff 6

interventions consistent with school expectations 5

applying flexible interventions based on assessment 1

conducting Functional Assessment 1

providing students choices to participate in the intervention 3

devoting adequate school resources 3

continuously monitoring students’ progress 6

Self-Determination (BEP/CICO/Check and Connect) (n=11)

# of studies Design # of replication across subjects

# of replication across researcher

Out of context

(n= 5)

Case study (n=1) Grade K-2

(n=4) 4 groups-Anderson, Christenson, & Sinclair et al. (1998-2005)-Fairbanks et al. (2007)-Hawken & Horner et al. (2003-2007)-McCurdy et al. (2007)

Single subject design (n=5)

Grade 3-5

(n=5)Non-randomized group (n=4)Within

context (n=6)

Grade 6↑

(n=5)Randomized groups (n=3)

So, what do we learn about Self-determination (BEP/CICO & Check and Connect)?

APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

well-established probably efficacious

at least 2 well-conducted groups-design studies by different investigators, or

2 well-constructed group-design studies conducted by the same investigators, or

more than 9 single-subject design studies to support the positive effects of the intervention

more than 3 but less than 9 single-subject design studies

a treatment manual used for the intervention preferred


Sample characteristics clearly specified

Sample characteristics clearly specified

Christenson, & Sinclair et al. (1998-2005)

“Within SWPBS context” Social Skills Training studies and key elements


(n=2)












• social skills training (n=5)



Out of context

(n= 3)


(n=2) 4 groups of researchers -Boxer et al. (2005)-Lo et al. (2002)-Miller, Lane, & Wehby et al. (2003 & 2005)-Gresham et al. (2006)


Grade 3-5


context (n=2)

Grade 6↑


• 1/5 study is conducted in a self-contained classroom for students with disabilities

So, what do we learn about Social Skills Training studies?


probably efficacious Meet criteria


more than 3 but less than 9 single-subject design studies support the effect of the intervention

✔


Sample characteristics clearly specified ✔

“Within SWPBS context” Reading Intervention studies and key elements


(n=2)












Reading Interventions (n=7)



Out of context

(n= 5)


(n=3)

5 groups of researchers

-Kamps et al. (2003)-Locke& Fuchs (1995)-Scott & Shearer-Lingo (2002)-Strong, Lane, & Wehby et al. (2002, 2004, 2005)-Staubitz et al. (2005)


Grade 3-5

(n=2)Non-randomized group (n=1)

Within context (n=2)

Grade 6↑


• 2/7 studies are conducted in self-contained classrooms

• 1/7 study is conducted in a resource room

So, what do we learn about Reading Intervention studies?





✔



Behavioral interventions (n=1)# of studies Design # of replication

across subjects# of replication

across researcher

Out of context

(n= 1)


(n=0)

1 group of researchers

-Lohrmann & Talerico (2004)

(implemented group contingency to reduce problem behaviors)


Grade 3-5


context (n=0)

Grade 6↑


So, what do we learn about Behavioral Intervention studies?







“Within SWPBS context” Environmental Adjustment studies and key elements


(n=1)












Environmental Arrangement (n=1)



Out of context

(n= 0)


(n=0)

1 group of researchers

-Kern, Bambara, & Fogt (2002)

(class-wide curricula modification)


Grade 3-5


context (n=1)

Grade 6↑


• The study is conducted in a self-contained EBD classroom

So, what do we learn about Environmental Adjustment studies?







“Within SWPBS context” Multi-component Intervention studies and key elements


(n=8)












Multi-component interventions (n=13)

# of studies

Design # of replication across subjects


Out of context

(n= 5)

Case study (n=1)

Grade K-2

(n=10)

8 groups of researchers

-Anderson et al. (2006)-Cavell& Hughes (2000)-Ervin et al. (2007)-Lane & Menzies (1999, 2003)-Lewis, Sugai, & Colvin (1998)-Golly, Walker, & Stiller et al. (1998)-Kamps, Kravis, et al. (1999, 2000, 2002)-Plumer (2005)

Single subject design (n=2) Grade 3-5


context (n=8)

Grade 6↑


So, what do we learn about Multi-component interventions?


well-established Meet criteria

at least 2 well-conducted groups-design studies by different investigators, or ✔more than 9 single-subject design studies to support the positive effects of the intervention



Combination of the interventions

Combination of the interventions # of studies

Social

skills +training

Academic intervention 4

Academic & Behavioral intervention 2

Behavioral intervention 1

Behavioral & Self-determination 1

Environmental Adjustments 1

Family Consultation 3

Academic intervention & Family Consultation

1

If we look at each sub-type of intervention separately, more studies are needed to support the efficacy of each sub-type multi-component intervention.

Overall, what do we know about the secondary prevention intervention?

Small number of studies are conducted within the context of SWPBS. More studies are needed to support the efficacy of each

type of SWPBS secondary prevention interventions

Three key elements listed on the PBIS website are addressed by most of the “within SWPBS context” intervention, including

requiring low teacher efforts interventions consistent with school expectations continuously monitoring students’ progress

Discussion

What are the questions about secondary prevention intervention still left not answered? Most of the interventions did not address 7/10

of the key elements. Whether schools could apply these elements as criteria to select secondary intervention is unknown.

What makes an intervention a secondary intervention?

The difference between secondary and tertiary prevention intervention remain blurred. Functional Assessment Small group and individual interventions

Long-term effects of the interventions are uncertain as a result of brief intervention phases.

This may be a call to researchers or authors to more carefully describe the context under which the intervention is being conducted.


continuously available services

rapid access to intervention

requiring low teacher efforts*

being implemented by school staff * (some not all)

interventions consistent with school expectations

applying flexible interventions based on assessment

conducting Functional Assessment * (brief)

providing students choices to participate in the intervention

devoting adequate school resources

continuously monitoring students’ progress *

providing ample practice opportunities to increase social and academic competence

Thank you

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a meta-analysis of the definition, features, and effects of secondary prevention interventions...

Documents

school staff

school expectations

key adults

interventions consistent

flexible interventions

field slide

students choices

adequate school resources