Children With Serious Emotional Disturbance (cont’d)

In the approach, the specific needs of the student are determined, an intervention plan is developed to meet the student’s needs, and the student’s progress is monitored. If sufficient progress is not made, the intervention’s intensity is increased or modified until progress is made.⁶ This tiered framework, then, involves activities from prevention to early intervention to more intensive treatments and ongoing assessments. This approach allows schools to identify students who are struggling early and provide appropriate instructional interventions. This benefits all students, not just those eligible for special education services, because schools using must implement evidence-based instruction to all students in the general education classroom, screen students early to identify those at risk for learning disabilities, and monitor progress of all at-risk students.² As of March 2008, 60 percent of districts had begun adopting an approach.⁷

One major concern about is that it is a process that takes place over several years with new teachers and new approaches each year. This could potentially delay full evaluations and the identification of those requiring special education services.²
One example of an , codified by IDEA as a best practice, is the Schoolwide Positive Behavioral Support (PBS), or Positive Behavior Intervention and Supports (PBIS), a systematic framework to improve educational and social outcomes for all students, where educators implement a multitiered continuum of evidence-based strategies to increase appropriate social behavior, ranging from prevention for all students to highly individualized supports for those students who need it. Assessments and ongoing review of the data are used to develop strategies that can be implemented with fidelity across all school staff members. PBIS focuses on the positive social skills that students should be engaged in rather than the traditional negative view of infractions and their consequences. Students learn prosocial skills and receive opportunities to practice them and receive positive feedback.^{5, 6, 7, 8}

Sugai and Horner (2008⁹) state that intensive individualized emotional and behavioral interventions will work better when they are part of a comprehensive continuum of behavior support. When effective instruction and classroom management practices are in place for all students, there are more opportunities and capacity to provide more specialized, intensive interventions for students who need them. There are three tiers of support intensity.
Tier 1
This tier establishes the social behavioral curriculum that applies to all students across all school settings. Here, problem behaviors are identified and replaced with prosocial behavior. This leads to positively stated behavioral expectations or “rules,” which are often taught even before students have had the opportunity to make mistakes. Students are reinforced for appropriate behavior and corrected for inappropriate behavior. Data are collected to monitor the impact of the curriculum.^{5, 6, 8}

Tier 2
The attention here is on those students who need further assistance in meeting behavioral expectations but do not necessarily display intense or chronic behavioral problems. This tier remains linked to schoolwide expectations and includes alterations in classroom management or instructional delivery. Students receive more intensive social skills instruction, provided in smaller, more focused groups, and other types of assistance to help them practice the desired behaviors, such as self-management or mentoring interventions, checking in and out with an adult each day, and bringing a “behavior report card” to each teacher.^{5, 6, 8}

Tier 3
Tier 3 offers the most intensive level of supports, with a concentration on individualized behavior support plans for students who have not completely benefited from supports at Tier 2 to best fit each student’s unique needs. However, unlike traditional individualized support, in this tier there is still a connection and linkage to the universal system, and it extends beyond special education to all students who require higher-intensity supports.^{5, 6, 8}

Research shows that PBIS is associated with a reduction in office discipline referrals and in- and out-of-school suspensions and expulsions, improved social emotional skills, improved organizational efficiency, improved academic outcomes, improved perception of safety, and reduced incidents of bullying.⁸

Future Directions
The education and mental health fields need to continue to adopt, integrate, and scale up evidence-based programs and practices and document their effectiveness, including both initial effects and sustained effects. They should conduct demonstrations and replications to show the range of contexts in which these programs and practices are effective and the types of adaptations that might be needed for different contexts. Schoolwide PBS can be successful only when we not only consider short-lived gains in schools but also build local capacity that leads to systems that last for decades at all levels (individual student, classroom, school, district, and state).⁹

One thing we have learned is that best practices tend not to be followed. Educators usually receive information and training, but that rarely leads to significant and sustained change in practices. The research-to-practice gap will be bridged only if educators get the professional development necessary to learn new practices and skills, along with the ongoing feedback and technical assistance to support their progress toward implementing these best practices.⁵

References
¹Child Mind Institute. (2015). Children’s mental health report. New York, N.Y.: Author.
²L. Aron & P. Loprest. (2012). Disability and the education system. The Future of Children, 22(1), 97–122.
³Center for Parent Information & Resources. (2017, April 9). Ten basic steps in special education. Newark, N.J.: Author.
⁴U.S. Department of Education, National Center for Education Statistics. (2016). Fast facts. Digest of Education Statistics, 2015 (NCES 2016–014). Washington, D.C.: Author.
⁵T. J. Lewis, S. E. Jones, R. H. Horner, & G. Sugai. (2010). Schoolwide positive behavior support and students with emotional/behavioral disorders: Implications for prevention, identification, and intervention. Exceptionality, 18(2), 82–93.
⁶R. Bradley, J. Doolittle, & R. Bartolotta. (2008). Building on the data and adding to the discussion: The experiences and outcomes of students with emotional disturbance. Journal of Behavioral Education, 17(1), 4–23.
⁷M. S. Atkins, K. E. Hoagwood, K. Kutash, & E. Seidman. (2010). Toward the integration of education and mental health in schools. Administration and Policy in Mental Health and Mental Health Services Research, 37(1–2), 40–47.
⁸R. H. Horner & G. Sugai. (2015). Schoolwide PBIS: An example of applied behavior analysis implemented at a scale of social importance. Behavior Analysis in Practice, 8(1), 80–85.
⁹G. Sugai & R. H. Horner. (2008). What we know and need to know about preventing problem behavior in schools. Exceptionality, 16(2), 67–77.