ERIC ED581239: Expanding the Range of the First Step to Success Intervention: Tertiary-Level Support for Children, Teachers, and Families

2015·0.36 MB·English

by  ERIC

EarlyChildhoodResearchQuarterly30(2015)1–11

ContentslistsavailableatScienceDirect

Early Childhood Research Quarterly

Expanding the range of the First Step to Success intervention:

Tertiary-level support for children, teachers, and families

AndyJ.Freya,∗,JasonW.Smallb,JonLeec,HillM.Walkerd,JohnR.Seeleyb,

EdwardG.Feilb,AnnemeikeGollyb

aUniversityofLouisville,KentSchoolofSocialWork,PattersonHall,Louisville,KY40292,USA
bOregonRe sea rchInstitu te,17 15Fra nk linBou levard ,Eugene,O R97 403-1983, US A
cUnivers ityofCinc innati,Sc hoolo fEducat ion,2610M cMicken Cir cle,Teachers CollegeSuite615,Cincinnati,OH45221,USA
dUniversity of Oregon,12 65Univ er sityofOreg on,Eu gene,OR9 7403- 1265,USA

a r t i c l e i n f o a b s t r a c t

Articlehistory: Thisstudypresentsthefindingsofaquasi-experimentalfeasibilitystudyexaminingtheTertiaryFirstStep
Receiv ed19April2013 inter ventio n,anen han cedvers ion oftheFirstSteptoS uccessear lyinte rventionp rogr am.Tert iary First
RAeccceepivteedd i2n1 r Mevaisye 2d0 f1o4rm 19 March 2014 Step was deve lop ed to enga ge famil ies mo re eff ectiv ely and infl uence and improve parenting practice s for
childrenhavingchallengingbehavior.Process(fidelity,dosage,andsocialvalidity)andoutcomedatawere
Availableonline5June2014
collectedforallparticipantsintheTertiaryFirstStepcondition(N=33).Parent-andteacher-reported

outcomeswerecollectedforthecomparisoncondition(N=22).Processdatasuggesttheinterventionwas
Keywords:
implementedwithfidelity,andthatteachers,parents,andcoachesperceivedtheinterventionassocially
Challengingbehavior
valid.ThisstudypresentsthefirstempiricalexaminationoftheTertiaryFristStepvariation.Theoutcomes
Socialemotionaldevelopment
HInotemrve evnistiiotantion pourotcvoidmee csoomnpseollciinagl- ebveihdaevnicoer atlhiantd tihcee sT,edreticarreya Fsiinrsgt pSrteopb lienmterbveehnatvioionr ,isa nprdoimmipsirnogv ifnogr iamcapdreomviincge sntguadgeendt

time.
PublishedbyElsevierInc.

Introduction affiliationwithdisruptivepeergroups,juveniledelinquency,tru-

ancy,andschooldropout(Patterson,Reid,&Dishion,1992;Reid,

Successfullynavigatingthesocialandbehavioralexpectations 1993).

of today’s schools and classrooms is a challenging undertaking Intervening early in the school careers of these children is

for young children. This task requires the acquisition of a series importantandhasbeenthefocusofimmenseeffortonthepart

of social-behavioral competencies including the ability to self- ofpublic,private,andnationalsystemsofeducationandresearch.

regulate, initiate positive interactions with teachers and peers, SincetheintroductionoftheResponsetoInterventionframework

attend to instruction, and engage in academic tasks (Walker, (Batscheetal.,2005),theseeffortshavebeencategorizedbasedon

Ramsey,&Gresham,2004).Childrenwhoareunsuccessfulinmeet- achild’seducationalandsocialneedsatthreelevels:(a)univer-

ingtheseexpectationsoftenexperienceteacherandpeerrejection salsupport(primaryprevention),(b)targetedsupport(secondary

and have less than satisfactory teacher and peer relationships prevention)and(c)intensive,individualizedsupport(tertiarypre-

(Kegan,1990).Unfortunately,therehasbeenasharpincreaseinthe vention).Thisapproach,withitsorigininthepublichealthfield,

incidenceofchildrenwhobegintheirschoolcareersunabletonavi- emerged as a model to address health concerns and evolved in

gatetheseexpectations(McCabe,Hernandez,Lara,&Brooks-Gunn, thedirectionofpublicschoolapplicationandsubsequentlyearly

2000). Children, whose serious school adjustment and behav- education.Inacomprehensivereviewandanalysisofmorethan

ior problems persist, are at risk for school social and emotional 2000articlespublishedbetween1990and2006onschool-based,

failure and detrimental outcomes later in life including possible mentalhealthinterventionsforat-riskstudents,Hoagwoodetal.

(2007) identified 64 methodologically rigorous studies for inclu-

sion. Of these, 24 examined both educational and mental health

outcomes,andonly15ofthesestudiesshowedapositiveimpacton
∗ Corresponding author. Tel.: [phone]; fax: [phone]. bothoutco mes .Oft he re maini ng15,1 1includ ed homea ndscho ol
E-mailaddresses:[email protected](A.J.Frey),[email protected](J.W.Small),
componentswithafocusonengagingandcoordinatingtheefforts
ljeoeh4njsn@@oUriC.oMrgAI(LJ..RU.CS.EeeDlUey ()J,. eLdefe@),o hrwi.oarlgke([email protected])n,[email protected] o(Hn..Med. uW(Aal.kGeor)ll,y). ofparentsan dtea c hers.H oa gwoodan dh erassociates also noted

http://dx.doi.org/10.1016/j.ecresq.2014.05.002
0885-2006/PublishedbyElsevierInc.
2 A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11

thatschoolinterventionsjudgedaseffectiveforstudentsrequir- in Canada, Australia, the Netherlands, and Turkey. First Step has

ing tertiary-level prevention strategies contain a well-designed alsobeensuccessfullyimplementedwithAmericanIndian,African

andintensivefamilycomponenttodeliverthenecessarystrength American, and Native Hawaiian students. In 2013, the First Step

anddosagelevelstoimpactsubstantivelyschooloutcomesaswell program was certified as a promising practice after a review

as address the focus on student’s social, emotional, and mental by the What Works Clearinghouse of the Institute for Education

health problems. In addition to including a family component, Sciences.

theempiricalliteratureadvocatesforinterventionsthataresuffi- Walkeretal.(2014)notedthatstudentshavingthemostsevere

cientlyflexibletoberesponsivetotheuniquesituationsandneeds impairments have highly variable and sometimes unsatisfactory

offamiliesrequiringintensive,individualizedsupport.Hoagwood responses to the First Step program. Additionally, this review

etal.’sreviewincludedeffectivesecondarypreventionprograms demonstratesthattheinterventionconsistentlyhaslessdramatic

suchasTheIncredibleYears(Reid,Webster-Stratton,&Hammond, impactonbehaviorinthehomethantheschoolsetting.Onepos-

2003;Webster-Stratton,Reid,&Hammond,2004)andFirstStep sibleexplanationforthefindingofinconsistentresultswithmore

toSuccess(Walkeretal.,1997),butdidnotincludeanyprograms severechildrenisthatthehomeBasecomponentofFirstStepdoes

designed to address the complex needs of children and families notprovideasimilarintensityordosageoftheFirstStepinterven-

requiringtertiarylevelsupport. tioninthesetting,astheschoolcomponentdoesforthestudentin

FirstSteptoSuccessisanearlyinterventionprogramdesigned theclassroom.Anotherexplanationmaybethatthefamilycom-

forat-riskelementaryschoolchildrenintheprimarygrades(K-3) ponenthasnotbeensuccessfulatengagingandfosteringparental

whoshowclearsignsofemergingexternalizingbehaviorpatterns motivationtochangetheirparentingpracticessoastopositively

includingaggressiontowardothers,oppositional-defiantbehavior, impactchildoutcomes.

tantrums,ruleinfractions,andconfrontationswithpeersandadults Inaclassicstudyofparentnoncompliancewithinmentalhealth

(Walkeretal.,1997).Thebehaviorallyat-riskstudentisthepri- settings,PattersonandForgatch(1985)demonstratedthatthera-

maryfocusoftheFirstSteptoSuccessprogram;however,teachers, pists’effortstochangeparentalbehaviorthroughdirectteaching

peers,andparentsarecrucialinterventionagentswhoseparticipa- elicitedimmediateparentnoncompliance,whereaseffortstosup-

tionisunderthedirectionandsupervisionofatrainedFirstStep port parents decreased the likelihood of their noncompliance.

behavioralcoach.Thisprofessionalisfrequentlyarelatedservice Patterson and Chamberlain (1994) have systematically studied

provider(e.g.,schoolsocialworker,schoolcounselor,schoolpsy- parental resistance, and concluded that parental motivation to

chologist,behavioralspecialists,specialeducator),andhasoverall change is a critical yet often neglected ingredient in improving

responsibilityforcoordinatingtheintervention. parentingpractices.Thus,theneedforschoolmentalhealthinter-

The First Step intervention was developed through a model ventionsthatincludeahomecomponentandattendcarefullyto

developmentgrant(1992–1996)fromtheU.S.OfficeofSpecialEdu- parentengagement,motivation,andfollowthroughissubstantial.

cationProgramsandwasacooperativeeffortbetweeninvestigators Infact,theimportanceofengagingfamiliesisrecognizedasoneof

at the University of Oregon, the Oregon Social Learning Center, eightthemesrequiringsystematicattentioninorderforthefieldof

and the Oregon Research Institute. In the past two decades, the schoolmentalhealthtoadvance(Weist,Lever,Bradshaw,&Owens,

FirstStepprogramhasbeenthefocusofalargenumberoffederal 2014).

andstate-fundedgrantstosupportarangeofresearchactivities Over the past four years, developers of the First Step inter-

centeringonitsinitialvalidation,replication,efficacy,andeffec- vention have been engaged in an iterative development process

tiveness.Thesegrantshavealsosupportedexaminingtheuseof tocreateenhancementstotheprogramthatextendtherangeof

theprogramwithstudentsexhibitingelevatedADHDsymptoma- theintervention.TwomanualizedenhancementsoftheFirstStep

tology(Seeleyetal.,2009)andotherstudentsubpopulations(Feil intervention were developed through this process. The first, the

etal.,2014;Frey,Small,etal.,2013).Arecentlyreleasedoverview TertiaryFirstStepResourceManual,isdescribedinthemethods

oftheevidencebasefortheFirstSteptoSuccessEarlyIntervention section(Frey,Walker,etal.,2013c).Thesecond,theFirstStepClass-

programsummarizesresearcheffortsandempiricaloutcomesthat roomCheck-upResourceManual(Frey,Walker,etal.,2013d)can

documenttheprogramasbothefficaciousandeffective(Walker beimplementedflexiblyatthesecondaryandtertiaryprogramlev-

et al., 2014). The efficacy of the First Step intervention has been els,asastand-aloneintervention,orasoneofseveralcomponents

replicatedrepeatedly(Loman,Rodriguez,&Horner,2010;Walker of a yet-to-be-developed universal program variation within an

et al., 1998; Walker et al., 2009). Overall, this body of empirical overarchingFirstStepSystemofSupport.

evidencedemonstratedtheFirstStepinterventionissociallyvalid, ThismanuscriptreportsaninitialempiricalstudyoftheFirst

canbeimplementedwithfidelity,andisassociatedwithdecreases Stepprogram’stertiary-leveladaptationformoreseverelyinvolved

inproblembehavior,increasesinsocialcompetency,andimprove- students. This adapted program variation differs from the orig-

mentsinacademicallyengagedtime.AdescriptionoftheFirstStep inal First Step in that it is designed for tertiary level students

program’scompleteresearchanddevelopmenthistoryalongwith and includes (a) a new, more intensive home component (Ter-

itsevidence-baseiscontainedinWalkeretal.(2012).Thiscom- tiaryhomeBase),(b)screeningproceduresthatrequirebehavioral

prehensivedescriptionalsohasappendicescontainingrespectively impairmentinbothhomeandschoolsettings,and(c)modifications

(1)alistingofkeyFirstStepjournalandchapterpublicationsand totheschoolcomponentnecessaryforsuccessfulimplementation

(2) compilations of recommended lists of early interventions for withtertiary-levelstudents.

behaviorallyat-riskchildren(inwhichFirstStepwasincluded)that The purpose of this article is to report the feasibility and

wereassembledandbroadlydisseminatedbyfederalagenciesand potential impact of the Tertiary First Step intervention. Specif-

advocacygroups. ically, we examined a number of process variables associated

A mixture of experimental, quasi-experimental, and replica- with these program enhancements, such as fidelity of imple-

tiondesigns,involvinggrouprandomizedandsinglecaseresearch mentation, dosage, and satisfaction. Further, we examined the

methods, have been used to establish the First Step evidence extent to which participation in the intervention was associated

base. First Step has been the focus of three randomized con- withreductionsinparentaldistressandimprovementsinparent-

trolled trials to date—two of which were efficacy trials and one ingefficacy,children’ssocialcompetency,andacademicengaged

that was a national effectiveness study of the program’s effects time. Finally, we examined the associations between our pro-

involvingfivesitesacrosstheU.S.and286participantsingrades cessandoutcomevariablesfortheschoolandhomecomponents,

K-3. The First Step program has been implemented successfully respectively.
A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11 3

Method reviewanddiscussionofpreviouslylearnedskillsasneeded.The

specific homeBase skills taught are: communication and sharing,

Participants cooperation, limit setting, problem solving, friendship making, and

self-confidence.Parentsareprovidedwithamanualcontainingall

Thirty-three families from Kentucky and Indiana participated theinformation,guidelines,andaccompanyingmaterialsneededto

intheclassroomandhomecomponentsoftheTertiaryFirstStep implementhomeBase.Thesematerialsprovideausefulreference

feasibility study and 22 additional families completed baseline forparentsandthecoachduringandfollowingimplementationof

and post-intervention measures as part of a quasi-experimental, theFirstStepprogram.Thecoachprovidessupport,supervision,

comparison group. Children participating in Tertiary First Step andtroubleshootingofanyproblemsandissuesthatariseduring

were from K-3 classrooms, ranged in age from 5 to 9 years old and following the program’s implementation, while serving as a

(M=6.8years,SD=1.3),andwerepredominantlymale(79%).The communicationbridgebetweentheparentandschool.

majority of students receiving Tertiary First Step qualified for TertiaryFirstStep.Michie,vanStralen,andWest(2011)have

free or reduced lunch (75%) and one third of participating chil- developed a framework for intervention designers that places a

dren received special education services. Roughly one-third of premiumonparticipantmotivation.Theseauthorsnotethatmany

participatingchildrenlivedintwo-parenthouseholdswhenthey interventiondesignersdevelopnewinterventionswithoutrelying

completedbaselinedata,accordingtoparentselfreport.Priorto on a framework to guide and rationalize the creation of various

recruitment,theuniversity-affiliatedandschool-affiliatedinstitu- components, in part because useful frameworks do not exist. In

tionalreviewboardsapprovedthestudy. responsetothisneed,theycreatedtheBehaviorChangeWheelto

provideabasisfordesigninginterventions.Thebehaviorsystem

Intervention inthisframeworkiscomprisedofthreecomponentsthatinteract

dramaticallytoinfluencebehaviorchangeattheindividuallevel:

First Step to Success. First Step consists of three modular capability,opportunity,andmotivation.Capability,whichincludes

components designed to work together (though each can be knowledgeandskills,involvestheindividual’spsychologicaland

implementedasastand-aloneprocedure).Theseare(1)universal physiologicalcapacitytoalterthebehaviorchangetarget.Oppor-

screeningandidentification,(2)schoolcomponent,and(3)home tunity is comprised of factors that are external to the individual

component. thatpromptbehaviorormakeitpossible.Motivationisdefinedas

TheschoolcomponentofFirstStepwasdevelopedbyHopsand allofthe“brainprocessesthatenergizeanddirectbehavior”(p.4).

Walker(1988).Theprogrambeginswitha20-minutedailyimple- Michieetal.suggestthatagiveninterventionmightchangeonly

mentationperiodthatisgraduallyextendedtotheentireschool oneormoreofthesecomponents,andthataninitialtaskofinter-

day.Initially,thecoach,incloseproximitytothetargetchild,moni- ventiondevelopersistoconsiderwhatthebehaviortargetofthe

torsherorhisclassroombehaviorusingthegreenorredcard.The intervention is, and what components of the system need to be

coachawardspointsifthechild’sbehaviorisappropriate,basedon addressedtoachievethedesiredgoals.

anintervalsystem.Whenthedailyperformancecriterionof80% Theimportanceofparentalmotivationhasledtoanincreasein

ormoreoftheavailablepointsismet,abriefrewardingactivity collaborativeapproachesforcaregiversofstudentswithchalleng-

involving the target child and peers is made available immedi- ing behavior (Frey et al., 2011; Smith, Dishion, Shaw, & Wilson,

atelyandadailyhomenotealsocommunicatestheresultsofthe 2013; Smith, Handler, & Nash, 2010; Smith, Wolf, Handler, &

gametotheparents.Parentsthenprovidepositivereinforcement Nash, 2009). Recent efforts in this context have adopted strate-

withanindividualactivityorrewardimmediatelywhenthechild gies from motivational interviewing. Motivational interviewing

returnshome.Ifthecriterionisn’tmet,thatprogramdayisthen is a burgeoning approach to more effectively influence parents’

repeatedand/orthechildisrecycledtoanearlier,successfullycom- engagementandbehaviorchange.MillerandRollnick(2012)define

pletedprogramdaybeforeproceeding.Theschoolcomponentof motivationalinterviewingas“acollaborative,goal-orientedstyle

FirstSteprequires30programdaysforsuccessfulcompletion.The of communication with particular attention to the language of
coac hpha se(progr am days1–1 0)ist he responsibil ityofaFirstS tep ch ange” and go on to s ay “...it is designed to stre ngthen p er-

behavioral coach, who coordinates the implementation process. sonalmotivationforandcommitmenttoaspecificgoalbyeliciting

Theteacherphase(programdays10–20)isoperatedbytheteacher and exploring the person’s own reasons for change within an

whoassumescontroloftheprogram’soperationonprogramdaysix atmosphereofacceptanceandcompassion”(p.29).Motivational

butwithclosesupervisionandsupportfromthecoach.Itisduring interviewingisbasedonthebeliefthathowonetalksaboutchange

theteacherphasethattheprogramisgraduallyextendedtoinclude isrelatedtohowtheyact.Simplystated,themoreonetalksaboutor

theentireschoolday.Themaintenancephaselastsfromprogram arguesforchange,themorelikelyitisheorshewillchange.Con-

day21to30afterwhichtheformalschoolinterventionends.In versely,themoreoneverbalizesreasonsagainstchange,theless

thisphase,thetargetchildisrewardedprimarilywithpraiseand likelyheorsheistochange.Motivationalinterviewing,therefore,

expressionsofapprovalorrecognitionfromtheteacherandpeers isanapproachthathelpsacceleratethechangeprocess“byliter-

atschoolandtheparentsathome.Anattemptismadeduringthis allytalkingoneselfintochange”(p.168).Developingasupportive

phasetoreducethechild’sdependenceontheprogrambysubsti- environment/relationship and evoking change talk, or any self-

tutingadultrecognitionforpoints,reducingtheamountofdaily expressedlanguagethatisanargumentforchangeiscriticalinthe

feedbackgiven,andmakingoccasionalrewardscontingentupon facilitationofmotivationalinterviewing.Theevidenceformotiva-

exemplaryperformance. tionalinterviewingprovidescompellingverificationforthenotion

Afterthetransitiontotheteacherphase,thecoach’sfocusturns thatthetherapistcaninfluenceclients’expressionofchangetalk

from school to home. The coach invites the focus student’s par- andthatthereisarelationshipbetweenchangetalkandbehavior

entstoparticipateinhomeBase,whichinvolveslearninghowto (Forgatch&Patterson,1985;Glynn&Moyers,2010;Miller,Yahne,

teach school success skills at home and to collaborate with the Moyers,Martinez,&Pirritano,2004;Moyers&Martin,2006).

teacherandcoachtofacilitatethetransferanddemonstrationof Nock and Kazdin (2005) pioneered the application of moti-

these skills at school. Over a six-to-eight-week period, parents vational interviewing in the context of parenting with their

meet weekly with the First Step coach, usually in their home, ParentEnhancementIntervention,amodelthatassessescaregiver

andparticipateinhomeBaseviareading,discussion,role-play,and perception of readiness and that attempts to improve parental

demonstrations. Each week’s meeting focuses on one skill with engagement and adherence (i.e., attendance). Additionally, The
4 A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11

Family Check-up, which is part of the multi-component EcoFIT intervention activities is provided in Table 1. Tertiary homeBase

intervention,includesthreebrief,family-centeredsessionstomoti- typicallyincludestwotofivehomevisitsdesignedtoincreasetheir

vatecaregiverstochangeparentingpracticesanduseintervention motivation and capacity to implement effective parenting prac-

services addressing their specific needs (Dishion & Stormshak, tices.TheTertiaryFirstSteptoSuccessResourceManualprovides

2007). detailedsupportforinterventionists(Frey,Walkeretal.,2013c).

Tertiary First Step includes three components of First Step Recruitment and screening. Project staff recruited teachers

that have been enhanced for children with extremely challeng- acrosstwocohortstoparticipateinafeasibilitystudyoftheTer-

ingbehaviorwhorequiretertiary-levelpreventionstrategies.The tiaryFirstSteptoSuccessintervention.Weusedatwo-stepprocess

first includes screening procedures for identifying appropriate incorporatingteacherandparentreporttoidentifystudentseligi-

participants. The second is very similar to the original school ble for inclusion in the study. At step 1, teachers completed the

component, but includes modifications often necessary for suc- firsttwostagesoftheSystematicScreeningforBehaviorDisorders

cessfulimplementationwithtertiary-levelstudents.Examplesof (SSBD; Walker & Severson, 1990). At stage 1, teachers identified

schoolcomponentmodificationsinclude:(1)completionofafunc- fivestudentswithintheirclassroomswhowereatelevatedriskfor

tionalbehavioralassessment;(2)increasedcoach–teachercontact; externalizing behavior problems. At stage 2, teachers completed

(3)participationincurrentservicecoordinationeffortsinternally briefbehaviorratingscalesforeachofthestudentsidentifiedat

within the school and with external service providers; and (4) stage1.Stage2datawereusedto(a)identifythestudentswhomet

reductionstothelengthoftheFirstStepprogram(intotalnum- SSBDcriteria,(b)rankorderstudentswithinclassroomsinterms

ber of days). Finally, Tertiary homeBase, the home component, ofseverity,and(c)targetthehighestrankedstudentineachclass-

is an adaptation of motivational interviewing. Since the Tertiary room.Atsteptwo,wecollectedtheexternalizingscaleoftheChild

homeBasecomponentrepresentstheprimaryenhancementtothe BehaviorChecklist(CBCL;Achenbach,1991)fromtheparentsofthe

tertiaryFirstStepvariation,italoneisdescribedbelow.Thisstudy highestrankedstudenttoverifythechild’sbehavioralstatusacross

presentsthefirstempiricalexaminationoftheTertiaryFristStep schoolandhomesettings.Ifthestudentmetcriteriaontheparent-

variation. reportedCBCL(TScore>60),werecruitedthefamilytoparticipate

TertiaryhomeBase.TertiaryhomeBaseaddressesallthreecom- inthestudy.Thus,foreachclassroom,thehighestrankedstudent

ponentsofMichieetal.’s(2011)BehaviorChangeWheel.Capability whometSSBDscreeningcriteriaandCBCLscreeningcriteriawere

isaddressedbyincludingcontentconsistentwiththetheoretical eligibletoparticipateinthestudy.Ifthehighest-rankedstudenton

and empirical literature concerning family management prac- theSSBDdidnotmeetCBCLcriteria,werepeatedtheprocesswith

ticesandthedevelopmentofchildrenwithchallengingbehavior thenexthighestrankstudentintheclassroom.Thefirststepofthe

describedintheintroduction.DuringtheTertiaryhomeBaseinter- screeningprocess(SSBD)isconsistentwiththescreeningproce-

vention,parentsareencouragedtomodifytheirparentingpractices duresfortheoriginalFirstStepintervention.However,requiring

consistentwithoneormoreofthefiveuniversalprinciplesofposi- parentstodocumentsubstantialimpairmentinthehomesetting

tivebehaviorsupportthatarecentraltotheFirstStepintervention: isuniquetothetertiaryapplication.Weprovidedteachers$20to

(1)establishclearexpectations;(2)directlyteachtheexpectations; completethescreeningprocess.

(3) reinforce the display of expectations; (4) minimize attention We recruited teachers for the Tertiary First Step intervention

forminorinappropriatebehaviors;and(5)establishclearconse- acrosstwocohortsduringthe2010–2011and2011–2012school

quencesforunacceptablebehavior(Sprague&Golly,2013). years.Participatingteacherswerefromtenelementaryschoolsin

AddressingthemotivationcomponentoftheBehaviorChange KentuckyandIndiana.Seventyof78consentedK-3teachers(90%)

WheelwasaprimaryfocusofourTertiaryhomeBasedevelopment participatedinSSBDscreening,completingstages1and2for268

efforts. Because no existing processes, models, or frameworks, students. Of the 70 teachers completing screening, 33 (47%) had

based on the motivational interviewing approach, were avail- an eligible consented student who participated in the study and

able to inform a detailed procedural write up for its application received the intervention. For the remaining teachers, we were

across home and school settings, our efforts to adapt motiva- unabletoidentify(n=14)orobtainconsentforastudentwhomet

tionalinterviewingforthispurposeresultedinthedevelopmentof fullinclusioncriteria(n=23).

theMotivationalInterviewingNavigationGuide.TheMotivational Researchstaffrecruitedteachersforaquasi-experimentalcom-

Interviewing Navigation Guide is a process for increasing intrin- parison group during the 2011–2012 school year to examine

sicmotivationtoadoptandimplementanevidence-basedpractice between-subject effects and control for potential history effects.

with integrity, applicable to both school and home settings. The Comparison-group teachers were not recruited from the same

fivestepsinclude:(1)engageinvaluesdiscovery;(2)assesscur- schoolsastheexperimental-groupteachers.Weutilizedthesame

rentpractices;(3)shareperformancefeedback;(4)offerextended screening and inclusion criteria for the comparison classrooms.

consultation,education&support;and(5)provideclosure(Frey, Thirty teachers completed SSBD gates 1 and 2 for 149 students.

Lee,etal.,2013a;Frey,Lee,etal.,2013b;Leeetal.,inpress).Itis Twenty-sixofthe30classrooms(86.7%)hadatleastonestudent

thisconceptualizationthatwasinfusedintotheTertiaryhomeBase who met SSBD eligibility criteria. Twenty-two students met full

interventionprocedurestoincreaseparents’motivationtochange inclusion criteria (i.e., SSBD and CBCL criteria described above).

theirbehavior. Fortheremainingeightclassrooms,studentsdidnotmeetinclu-

ThemotivationalcomponentisaddressedateachoftheMoti- sion criteria (n=4) or project staff were unable to recruit the

vational Interviewing Navigation Guide steps; it is attended to family to participate (n=4). Students and families in the quasi-

constantly during steps 1 and 2, and as needed in steps 3 and experimentalcomparisongroupmayhavebeenreceivingschool-

4.Thecapabilityofthecaregiver,primarilyparentingknowledge orcommunity-basedinterventionandsupportservices,butdidnot

andskills,isaddressedinsteps3and4.Opportunityisaddressed receiveinterventionsupportfromourresearchteampriortothe

throughouttheinterventionsinceitoccursinthehome,andspecif- collectionofposttestdata.Theywereofferedahome-basedcon-

ically in step 4 with creation of a behavior change plan which sultationfollowingthecollectionofposttestdata.

individualizes the application of new knowledge and skills to Trainingandsupport.Participatingcoacheswereemployeesof

address routines or family tasks that parents have identified as theUniversityofLouisville.AllthreecoacheshadMastersDegrees:

important, needing attention, and consistent with their values. oneineducation,oneinsocialwork,andoneinschoolcounseling.

Alternatively,parentscanchoosetocompleteanyofthesixorig- Priortothestudy,thethreecoacheshadnopreviousexperience

inal homeBase skill-focused curricular topics. A summary of the with motivational interviewing. All three received three days of
A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11 5

Table1

SummaryoftheTertiaryhomeBaseinterventionactivities.

MINGStep#andtitle(duration) Description

Step1EngageinValuesDiscovery(60minutes) ThemainpurposeofthisstepoftheMINGistolearnaboutthefamilythroughan

ecologicalassessment,anddiscovertheparent’svalues,goals,andhopesfortheir

children’sfutureusingavaluesdiscoveryactivity.

Step2AssessCurrentPractices(60minutes) Successfullycompletedtheuniversalprinciplesinterviewandobservationalprotocol

associatedwiththisstepoftheMINGallowthecoachtolearnaboutexistingparenting

practicesthatareconsistentwith–orpotentiallyinconflictwith–theuniversalprinciples.

ThisinformationisusedtostructuretheprovisionofperformancefeedbackinStep3.

Step3SharePerformanceFeedback(60minutes) Step3oftheMINGisusedtoprovideperformancefeedback.Thedebriefinginterviewis

structuredtoencouragetheparenttoreflectontheirimplementationoftheuniversal

principles,andifnecessary,increasetheextenttowhichtheybelieveimplementingthe

principlesisimportant.Attheendoftheinterview,parentsaregiventheoptionofending

theconsultationrelationshiporreplicatingSteps2and3afterhavingarticulatedspecific

goalsforimprovement.

Step4ExtendedConsultation,Education,andSupport(60minutes) Duringthis(optional)stepoftheprocess,thecoachandparentnegotiatethespecificsofa

behaviorchangeplan.Oncethespecificsaredecideduponandstep4iscompleted,the

coachmaydeemitappropriatetotakeaneducationalstance,morefreelyofferingadvice

andteachingskillsthroughconsultation,ordirecteducation.Werecommendeducational

strategiesincludingmodeling,role-playing,pre-correctingforimplementationproblems

byexploringbarrierstoimplementation,andthemoreMIfocusedstrategyof

Elicit-Provide-Elicit(EPE).Iftheparentchoosestoparticipateinthisaspectofthe

intervention,Steps2&3arerepeatedinordertoprovidecontinuingsupportfor

parent-establishedgoals.

Step5Closure(60minutes) Whetheraparentselectsclosureduetohighconfidenceintheirabilitytochangeontheir

ownorduetolowmotivation,stepsshouldbetakentoinsurethattherelationshipendson

apositivenoteandthattheparentleaveswithtoolstheymaychoosetouseinthefuture.

pre-interventiontrainingandayearofongoingprofessionaldevel- the participant. Direct observation data (described below) were

opmentsupportlearninghowtoapplymotivationalinterviewing collected at baseline and post-intervention for all students par-

skillswithinthecontextofourinterventionprotocols.Theirpre- ticipating in Tertiary First Step but were not collected for the

interventiontrainingwasprovidedbyasubstanceabuseclinician comparisongroupduetotimeandbudgetaryconstraints.

withexpertiseinmotivationalinterviewingandprofessionaldevel-

opmentinvolvedweeklysupervisionsessionsoverthefirstyearof Fidelity

implementation. As part of their professional development, they

were required to obtain audio recordings of their interactions A20-itemimplementationfidelitychecklistwasusedtoeval-
with teachers and parent s. Thes e recording s w ere a nalyzed and uate the fide lity of implemen tation for the s choo l com po nent.
proce ssed in the c ontext o f grou p supervisi on. Fr ey, Lee, e t al. This obse rver-com pl etedmeasureass esse sthe extent towhichthe
(2013a)pr ovi des adetaile dd escript ionofthetrai ningp roce dur es, coac h and teacher adher e to imp lementa tion guide lin es for the
aswella scoache s’ proficien cyapplying m otiv ationali nterviewing schoo lcom ponento ftheFi rst Stepprogram.For eachquest ion, the
wi thpa re nts. observ erindicates (a )wh ethe rthe compon ent wasi mplemen ted
Te achers participating in the Tertiary First Step intervention and(b)th equality ofi mplemen tatio n.Adherenc eite msarescored
receiveda3- hourtraining de scrib ingthei nterv ention procedures. dich oto mou sly (i.e ., yes or no) and q uality item s are sco red on
Coaches as sistedt heteach erswithth es choolcompo nentimple- a 5-point scale (0= very po or, . 25=p oor, .50 =okay , .75 =good , to
mentatio n. 1 .0=excel lent). Adh e renc e sco res w ere c alcu la ted a s th e propo r-
Data collection. Prior to beginning the intervention, parents tion ofprocedu rescorrect lyimpl emen ted.Anobs erv erc ollected
andteac hersparticip ating in TertiaryFi rstS tepcompleted abase- thefi de litydataon threeocc asions:onced urin gthecoa chphase
line question nairecontaini ng demogra phic ando utcomeme a sures. and twiced uring th eteac herphase. Adhe renceto 80 %orm oreof
Atp ost-interventi on,particip antscomplet edt woquest ionnaires: obse rvedp rogram com ponent srepre sentsadequ ate adh ere ncean d
on e containing outco me measure s and anot her containing pro- qualityra tingsof.7 5–.90repres entadequa televelso fimplemen ta-
cess measures addressin g program sat isfaction and barrie rs to tionqua lity.W eu sedthe datafrom thefidelit ycheck li sttocompute
part icipation. T eachers and parents from the co mpa rison gro up adhe rencea ndi mple men tatio nqua lity scores .Measure so fteacher
completedan outcomeq uest ionnaire ateac htim epointbutd idnot andcoach impl ementationqual ityrepr esentth emeanq ua lityrat-
completep roc essmeas uresgiventhat th eydi dn’tr eceiv eth ein ter- ing across theobservedpro gramc omponent s.W ealso calcula ted
vention. F or the compariso n gro up, b asel ine an d post mea sures ove ralladh ere nceandq ualityme asures(i.e.,th em ean ofthetwo
werecol lecte dro ughly60day sapartt oapprox imat ethew indowof implem enters)acr ossb oththe coachand teac her .
time between baseline an dpo st-inte rv entionforth ein terventio n

group.Teachersandparentsfromtheinterventiongroupandcom-
Dosage

parisongroupreceived$50forcompletingaquestionnaireateach

timepoint(i.e.,$100forcompletingbaselineandpost-intervention
The monitoring log, completed by the coach and teacher, is

packets).Forparticipantsreceivingtheintervention,coachesdis-
usedtorecordthefocusstudent’sdailyparticipationintheschool

tributedquestionnairestoparentsandteachers.Forparticipants
component. Upon completion of the intervention, it provides a

inthecomparisongroup,projectstaffdistributedquestionnaires.
summaryofthetotalnumberofprogramdayscompleted,thenum-

Participants returned completed questionnaires via mail using a
ber of program recycle days, and a summary of the points and

postage-paidenvelopedistributedwiththequestionnaireor,when
rewardsearneddailybythechild.Inaccordancewithotherstudies

needed,projectstafforthecoachcollectedthequestionnairefrom
oftheFirstStepprogram(Sumietal.,2013;Walkeretal.,2009),
6 A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11

wecalculatedclassroomdosageastheproportionofprogramdays ABI and MBI are 12-item (˛=.88) and 11-item (˛=.86) scales,

deliveredoutofthepossible30availabledays. respectively, that assess a student’s adaptive and maladaptive

A checklist was also completed by the coach to measure the behavioraladjustmentswithinteractionswithteachersandpeers.

dosageforthehomecomponent.Thischecklistrequiredcoaches Itemsarescoredona5-pointratingscalerangingfromnevertofre-

to document the number of the steps of the Tertiary homeBase quently.TheSSBDisnationallynormed,hasexcellentpsychometric

interventioncompleted.Dosagewascalculatedasapercentageof properties, and has been used in a number of research studies

stepscompleted. (Seeleyetal.,2009;Severson,Walker,Hope-Doolittle,Kratochwill,

&Gresham,2007;Walkeretal.,2009).Rawscalescoreswerecom-

Socialvalidity putedforeachmeasurewithhigherscoresontheABIindicating

betterlevelsofadaptivefunctioningandhigherscoresontheMBI

Socialvalidityitemsforallinformantswerescoredonafive- indicatinghigherlevelsofmaladaptivefunctioning.

point Likert scale from strongly disagree to strongly agree. Parent Observation outcome measures. Project staff collected Aca-

reportincluded12itemsthatassessusability,support,andeffec- demicEngagedTime(AET)datausingadirect-observationmeasure
tivenes softhep rog ramin the home setting.C oefficient alph a(˛), (three 20-minu teob servat ions ),ons e paratedaysatbase lineand

ameasureofinternalconsistencyreliability,is.93forthe12-item, again at post-intervention (Walker & Severson, 1990). For each

parent-reported satisfaction scale. Subsequent coefficient alphas timepoint,wecomputedthemeanpercentofAETacrossthethree

reportedbelowforsocialvalidityandoutcomemeasuresareesti- observations. AET is an estimate of the amount of time a stu-

mated from sample data collected for this study. Teacher report dent spends engaged in academic activities and is an important

includeda13-itemscaleassessingsatisfactionwiththeschoolcom- indicatorofastudent’sacademicsuccessandadjustmenttoclass-
ponent ( ˛ =.93). T he co ach also completed a 6-it em satisfa ction roomexp ec ta tions.We collected inter-ra ter reliabilityfo r1 5%of
scale(˛ =. 84 )pe rtain ingto thec ompatibilit ya ndeffe ctivenessof collec ted AET obser vati ons at ba seline and at post int erv entio n.
the c las sr oom componen t, and six items (˛= .90) addressing t he Theintra -clas scorrelationa ss essingint er-ra te rrelia bilityforthe

compatibilityandeffectivenessofthehomecomponentsofthepro- AETwasexcellentatbaseline(ICC[3,1]=.98)andpost-intervention

gram(i.e.,TertiaryhomeBase).Foreachmeasure,wecalculateda (ICC[3,1]=.94).

meanratingacrossitems. ThePeerSocialBehavior(PSB)codingsystemwasalsorecorded.

ThePSBisapartial-intervalobservationprocedureusedtorecord

Outcomes thepercentageofintervalsthetargetstudentisengagedinpos-

itive and negative interactions with peers in unstructured or

Parent outcomes. Parental distress and parenting efficacy semi-structuredsettings(Walker&Severson,1990).Projectstaff

servedasproximaloutcomes,andweremeasuredatbaselineand conductedthree20-minuteobservationsatbaselineandthreeat

post-intervention.TheparentaldistresssubscaleoftheParenting post-intervention on separate days using an adapted version of

Stress Index – Short Form (PSI-SF; Abidin, 1995) determines the the instrument. Over the 20-minute session, observers recorded

distress a parent is experiencing in his or her role as a parent atone-minuteintervalswhetherthestudentwasengagedinpos-

and expresses the distress as a function of personal factors that itivesocialengagement,negativesocialengagement,parallelplay,

are directly related to parenting. The subscale includes 12 items or was playing alone. For each time point, we aggregated data
(˛= .92) sco red on a 5 -point ratin g sc ale. Tota l raw sco res range fro m th e three observ atio n sess ions and ca lcul ated the pe rcent

from 12 to 60 with higher scores indicating increased levels of of positive and negative engagement by dividing the number

parentaldistress. of positive engagement intervals and the number of negative

TheParentingLadder(NCPResearch,2000)measuresparent- engagementintervalsbythetotalnumberofintervalsobserved.

reportedself-efficacyforparenting.TheParentingLadderconsists We collected inter-rater reliability data for 15% of baseline and
of 6-item s (˛=.91). Par ents rate c onfi dence in their p arenting pos t-interven tionobserva tions.The intra -cla sscor rel ationfor pos-

knowledgeandabilitiesona7-pointratingscalerangingfromlow itive interactions was excellent at baseline (ICC[3,1]=.97) and

to high. Total raw scores range from 0 to 42 with higher scores acceptableatpost-intervention(ICC[3,1]=.86).Fornegativeinter-

indicatinghigherlevelsofperceivedself-efficacy. actions,theintra-classcorrelationwasalsoacceptableatbaseline

Teacher-andparent-reportedoutcomemeasures.TheSocial (ICC[3,1]=.89)andpost-intervention(ICC[3,1]=.91).

SkillsImprovementSystemRatingScales(SSiS;Gresham&Elliott,

2008) is a multi-informant assessment tool that measures (a) Statisticalanalyses

socialbehaviorsthatfacilitatepositiveinteractionswithpeers,tea-

chers, siblings, and parents, (b) problem behaviors that impede We examined between-subject and within-subject effects on

theacquisitionofsocialskills,and(c)generalacademicfunction- teacher and parent-reported outcome measures. To evaluate

ing. The teacher-completed version of the measure includes 46 between-subject effects, we estimated a series of covariate-
soci al sk ills items (˛=.90), 30 prob lem be havior ite ms (˛=.7 4), adjusted regressi on mod els u sing Mplus 6 .0 stati stic al software
and7 acade micco mp et ence ite ms(˛=.9 6).Thepa rent-co mp l eted (Muthèn &Muthèn, 1998–2 010).F orthe regr essionmod els,each
vers io n include s 46 social s kills it em s (˛= .93) , and 33 problem outcome w as regre ssed on a d icho tom ous variab le indic ating
behavio r items ( ˛= .82). It ems a re rate d o n a 4 -poin t f requency intervent iong roup(1=E FSg ro up,0=compar isongrou p)andone

scale (Never, Seldom, Often, and Almost Always). Academic com- covariate, the baseline value of the outcome. Preliminary mod-
peten ce item s, score d on a 5- point s cale from lowest 1 0% to elsinclude dan interacti onter m( i.e.,i nterventio ngroup×ba seline

middle40%tohighest10%,assessthestudent’sreadingandmath valueoftheoutcome)totestthattheslopesoftheregressionlines

skills, motivation, cognitive functioning, and parental support wereequivalentforeachgroup.Ifnon-significant,theinteraction

relative to his or her classmates. We converted raw scores to termwasremovedfromthemodel.

standardscoresusinggender-specificnormativedatafromtheSSiS Forthecomparisongroup,onlyparent-andteacher-reported

manual. outcomeswerecollected.Inturn,fortheinterventiongroup,we

TheSSBDCombinedFrequencyIndexwascollectedatscreening, alsoexaminedwithin-subjecteffectsforourobservationmeasures

baseline,andpost-intervention.Thisindex,partoftheSSBDstage- andprimaryteacher-andparent-reportedoutcomes.Weexamined

2ratingscales(Walker&Severson,1990),includestheAdaptive within-subjecteffectsinananalysisofvariance(ANOVA)frame-

BehaviorIndex(ABI)andMaladaptiveBehaviorIndex(MBI).The workusingthegenerallinearmodel(GLM)procedureinSPSS19.
A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11 7

For the between-subject analysis, we report Hedges’ g as a implemented 96% (range=64–100%) and teachers implemented

measure of effect size. The What Works Clearinghouse (WWC) 90%(range=63–100%)oftheschoolcomponent.Implementation

recommendsHedges’gasthepreferredmeasureofeffectsizefor qualitywasexcellentduringthecoachphase(.96;range=.90–1.00)

continuousoutcomes.Hedges’g,thestandardizedmeandifference, andgoodduringtheteacherphase(.84;range=.61–1.00).

iscalculatedbytakingthedifferencebetweenthemeanoutcome

ofeachgroupanddividingitbythepooledwithin-groupstandard Dosage

deviation(WWC,2011).Effectsizesof.2areconsideredsmall,.5

areconsideredmediumand.8areconsideredlargeeffects.Forthe Students received, on average, 78% (SD=28%) of the requi-

within-subjectanalysis,wereportpartialpoint-biserialrasamea- siteprogramdaysfortheschoolcomponent.Twenty-fiveparents

sureofeffectsize(Rosnow&Rosenthal,2008).Effectsizesof.14, (76%) completed 75% or more of the steps of the home compo-

.36,and.51areconsideredsmall,medium,andlarge,respectively, nent as described in Table 1. Seven parents completed two or

forthepartialr(Cohen,1988). fewerstepsandwereconsiderednon-completers.Ofthe25par-

WealsoreporttheWWC(2011)improvementindexasamea- entswhocompletedtherequiredcomponents,14(60%)committed

sureofpracticalsignificance.Tocalculatetheimprovementindex, toanddevelopedachangeplan,andmost(87%)ofthoseparents

we(a)convertedeacheffectsizeestimatetoaCohen’sU3index implementedit.Sevenfamilieswerereferredforcommunity-based

using a standard normal distribution z-score table and (b) sub- mental resources to receive on-going, additional support for the

tractedtheU3indexfrom50%,thepercentilerankofanaverage child or family, based on coach discretion. Eight parents (24%)

studentinthecomparisongroup.TheWWCimprovementindex ended their participation in the program before the formal invi-

representstheexpectedchangeinpercentilerankforanaverage tationforclosurewasoffered.

studentinthecomparisonsampleifthatstudenthadreceivedthe

TertiaryFirstStepintervention. Socialvalidity

Finally,toexamineassociationsbetweentheseprocessmeas-

ures and change in parent and child outcomes, we specified Parents’responsestothesatisfactionquestionnairerangedfrom

covariate-adjustedregressionmodels.Weregressedpostinterven- 3.2to5.0withmeanscoresof4.6(SD=0.5)onthe12-itemscale.

tionoutcomesonthebaselinevalueoftheoutcomemeasureand Item-level means were above 4.0 on all items. The lowest mean

theprocessmeasureofinterest.Weanticipatedthatprocessmeas- ratingwasinresponsetoaquestionaskingwhethertheprogram

ures specific to the classroom component of the program would hadapositiveeffectontherestofthefamily(M[SD]=4.3[0.8])and

have the strongest associations with school-based or teacher- thehighestmeanratingwasinresponsetoaquestionaboutthe

reportedstudentoutcomesandthatprocessmeasuresspecificto goalsoftheprogrambeingclearlyexplained(M[SD]=4.8[0.4]).Our

thehomecomponentwouldhavethestrongestassociationswith coaches reported satisfaction that can be classified as moderate

parentoutcomesandparent-reportedstudentoutcomes.Thus,we overall(M=3.73,SD=0.74).

examinedwhetherdose,adherence,andimplementationquality

oftheschoolcomponentwereassociatedwithchangeinteacher- Outcomes

reportedprosocialbehavior(i.e.,ABIandSSiSsocialskills),problem

behavior(i.e.,MBIandSSiSproblembehavior),andacademiccom- Baselineequivalence.Studentswhoreceivedthetertiaryver-

petence(i.e.,SSiSacademiccompetence,andAET).Forthehome sionoftheFirstStepinterventiondidnotdiffersignificantlyfrom

component, we examined whether parent-reported satisfaction, thecomparisongrouponbaselinebehavioralandacademicout-

coach-reportedparentcompliance,anddosewereassociatedwith comemeasuresandmoststudent,parent,andteacherdemographic

improvementsinparentingefficacy,reductionsinparentaldistress, characteristics. Table 2 contains a summary of student demo-

andchangesinparent-reportedprosocialandproblembehavioras graphic and behavioral characteristics for each group. The two

reportedontheSSiS. groupsdifferedonlyonthenumberofAfricanAmericanstudents

inthecomparisonsampleascomparedtotheTertiaryFirstStep

condition(68%vs.39%,respectively).
Missingdata

Although there were no statistically significant differences

betweenthegroupswithrespecttoparentdemographiccharacter-
We used the full information maximum likelihood (FIML)

istics,therewereadisproportionatenumberofAfricanAmerican
estimator in MPlus 6.0 to address missing data in the covariate-

parentsinthecomparisongroup(61%)ascomparedtotheinterven-
adjustedregressionmodels.FIML,astate-of-the-arttechniquefor

tiongroup(42%).Otherparentdemographiccharacteristicswere
handlingmissingdata,usesallavailabledatatocalculateunbiased

comparableacrossthegroups.Parentsintheinterventioncondition
parameterestimatesandstandarderrors(Schafer&Graham,2002).

hadameanageof38years(SD=10.4),wereprimarilyfemale(88%),
We included seven auxiliary variables in the models (i.e., child’s

andwerepredominantlythebiologicaloradoptivemotherofthe
SSBDrank,child’sgender,parent’scurrentmaritalstatus,parent’s

participatingstudent(81%).Nearly30%reportedhavinganAsso-
education level, estimated annual household income, number of

ciate’sdegreeorhigherandthemajoritywerecurrentlyemployed
children in the parent’s household, and teacher-reported num-

(61%).Approximately36%ofparticipatingstudentslivedintwo-
ber of years teaching) as potential correlates of missingness in

parenthouseholds.Parentsinthecomparisongrouphadamean
ordertoimprovetheaccuracyofFIMLestimation.Potentialcor-

ageof35years(SD=9.2),werepredominantlyfemale(96%),and
relatesofmissingnessincreasestatisticalpower,reducebias,and

werethebiologicaloradoptivemotherofthestudent(82%).Thirty-
improvetheplausibilityofthemissingatrandomassumptionwith-

two percent had an Associate’s degree or higher and 68% were
out altering the interpretation of parameter estimates (Collins,

employed.Roughly32%ofstudentsinthecomparisongrouplived
Schafer,&Kam,2001;Enders,2010).

inatwo-parenthousehold.

Results Therewerenodifferencesonteachercharacteristicsbetween

thetwogroups.AllteachersparticipatingintheTertiaryFirstStep

Fidelity interventionreportedbeingtheleadteacheroftheclassroom.The

majoritywerefemale(93.3%)andhalfreportedhavingaMaster’s

During coach and teacher phases of the school component, degree or higher. Teachers reported having worked in the field

Tertiary First Step program adherence was excellent. Coaches for an average of 14.1 years (SD=8.8) and had taught students
8 A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11

Table2

Baselineequivalenceofstudentdemographicandbehavioralcharacteristics.

Total(n=55) Comparison(n=22) TertiaryFS(n=33) Teststatistic p-Value

Demographiccharacteristic

Age,M(SD) 7.0(1.2) 7.3(1.1) 6.8(1.3) 1.53 .133

Percentfemale 20.0 18.2 21.2 0.08 .783

PercentAfricanAmerican 50.9 68.2 39.4 4.38 .036

PercentCaucasian 36.4 22.7 45.5 2.95 .086

Percentfree/reducedlunch 82.2 90.5 75.0 1.84 .176

PercentIEP 25.5 13.6 33.3 2.70 .100

Screeningmeasures

SSBDstage2rank 2.78 .249

Percentranked1st 69.1 59.1 75.8

Percentranked2nd 23.6 27.3 21.2

Percentranked3rd 7.3 13.6 3.0

PercentinclinicalrangeonCBCLexternalizingscale 88.9 85.7 90.9 0.35 .554

CriticalEventsIndex,M(SD) 8.1(3.2) 8.5(3.1) 7.8(3.2) 0.90 .370

AdaptiveBehaviorIndex,M(SD) 29.6(6.3) 30.5(7.0) 29.0(5.8) 0.85 .401

MaladaptiveBehaviorIndex,M(SD) 38.2(6.9) 39.7(6.3) 37.1(7.1) 1.39 .170

Notes:SSBD,SystematicScreeningforBehaviorDisorders;CBCL,ChildBehaviorChecklist.

whoreceivespecialeducationservicesforanaverageof11years topostintervention(M[SD]=35.2[17.1])andnegativeinteractions

(SD=9.1). withpeersdecreasedfrom4.3(SD=4.1)to1.7(SD=1.9).

Attritionandmissingdata.FortheTertiaryFirstStepgroup, Fortheparentingmeasures,meanscoresontheparentaldis-

datawereavailablefor94%ofteachersand94%ofparentsatbase- tresssubscaledecreasedfrom26.7(SD=10.8)atbaselineto24.0

line.Atpost-intervention,32teachers(97%)and28parents(88%) (SD=8.9)atpost-test.TheFtestforthewithin-subjectsANOVAwas

returned a questionnaire. For the comparison group, data were not statistically significant (F[1,27]=3.51, p=.072) and the effect

available for all 22 teachers and parents at baseline, all teachers sizewassmall(partialr=.34).Meanscoresonparentingefficacy

at post intervention, and 19 parents (86%) at post intervention. increased from 4.60 (SD=1.10) at baseline to 5.00 (SD=0.80) at

Students with complete assessment data from the comparison posttest.Theeffectsizeforincreasesinparentalefficacywas.41

group did not differ from those with a missing assessment. Ter- (medium),andthedifferencesfrombaselinetopost-testweresta-

tiary First Step students with complete data across time points tisticallysignificant(F[1,27]=5.53,p=.026).

andinformantsdidnotdiffersignificantlyfromthosewithmissing Fortheparent-andteacher-reportedoutcomes,within-subject

assessments on student demographics, student behavioral char- partialreffectsizeswere.57,.66,and.74forteacher-reportedABI,

acteristics, or parent characteristics. The two groups did differ, SSiSsocialskills,andparent-reportedSSiSsocialskills,respectively,

however, on the number of years the teacher had been working withinthepro-socialdomain.Fortheproblembehaviordomain,

inthefield.Theteachersofstudentswithcompletedatahadbeen effect sizes were .70 and .65 for teacher-reported MBI and SSiS

workinginthefieldlongerthantheteachersofstudentswithmiss- problembehavior,and.79forparent-reportedSSiSproblembehav-

ingdata(15.6years[SD=9.0]ascomparedto7.7years[SD=4.1], ior.

respectively). Practicalsignificance.Themeanimprovementindexscorefor

Between-subjectresults.Resultsfromthecovariate-adjusted outcomes in the pro-social behavior domain was +28 percentile

regression models as well as baseline and post-test intervention points(i.e.,ifanaveragecontrolstudentreceivedtheEFSinterven-

meansandstandarddeviationsfortheTertiaryFirstStepandcom- tion,wecouldanticipateameanimprovementof28%onpro-social

parisonconditionsarepresentedinTable3.Forthethreeteacher- outcomes).Theimprovementindexforteacher-reportedadaptive

andparent-reportedoutcomesinthepro-socialbehaviordomain, behaviorwas+31percentilepointsand+37percentilepointsfor

students who received the tertiary version of First Step had sta- social skills. The improvement index for parent-reported social

tisticallysignificantimprovementinadaptivebehaviorandsocial skills(+14.8percentilepoints)wasmoremodest.Fortheproblem

skills at post-test as compared to students in the comparison behaviordomain,meanimprovementacrossthethreeoutcomes

sample. Hedges’ g effect sizes for the three pro-social outcomes was+33percentilepoints.Teacher-reportedproblembehaviorout-

ranged.36–1.11.Studentswhoparticipatedintheinterventionalso comesrangedfrom+34to+38percentilepointsformaladaptive

had statistically significant reductions in maladaptive and prob- andproblembehavior,respectively.Parent-reportedimprovement

lembehaviorsacrossbothschoolandhomesettings.TheHedges’g inproblembehaviorscalewas+28percentilepoints.Therewere

effectsizesfortheteacher-andparent-reportedproblembehaviors positiveimprovementsacrossallprimaryoutcomesandsettings.
range dfrom − .77 to−1.17 .Th erewerenostat isticallys ignificant Meanim provementint hehom es ettingw as+34perc enti lepoints

changesinstudentacademiccompetenceaftercompletionofthe and mean improvement in the home setting was +21 percentile

intervention(Hedges’g=.19). points.

Within-subject results. We also examined within-subject Process-outcomeanalysis.Fortheschooloutcomes,dosewas

effects for our observation measures, parenting measures, and associated with improvements in teacher-reported social skills

primary teacher- and parent-reported outcomes. Within-subject (t=2.60, p=.009) and reductions in teacher-reported problem
effectsiz esforth eaca demicdomainw ere.25for academiccom- be h avior (t = −3.49 ,p< .001).Forao ne standarddeviation increase

petence (F[1,29]=1.80, p=.190) and .82 for AET (F[1,32]=62.17, indose,post-intervention,teacher-reportedsocialskillsincreased

p<.001). After receiving the intervention, student AET improved by.31standarddeviationsandteacher-reportedproblembehavior

onaveragefrom59%(SD=17%)to75%(SD=16%).Effectsforthe decreasedby.40standarddeviations.Therewerenostatistically

PSBobservationdatawereinthemediumtolargerange.Theeffect significantassociationsbetweendoseandtheotheroutcomemeas-

sizeforpositiveinteractions(F[1,30]=6.04,p=.020)was.42and.53 ures. As well, there were no statistically-significant associations

fornegativeinteractions(F[1,30]=11.59,p=.002).Positiveinter- between school-based or teacher-reported outcomes and adher-

actions with peers increased from baseline (M[SD]=27.3[16.5]) enceorqualityofimplementationoftheschoolcomponent.
A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11 9

Table3

Baselineandpost-interventionmeansandstandarddeviationforoutcomemeasuresandcovariate-adjustedregressionresults.

Domain/measure Comparison(n=22) TertiaryFS(n=33) Conditioneffect Effectsize

Baseline Post-intervention Baseline Post-intervention t p-Value Hedge’sg

M(SD) M(SD) MAdj M(SD) M(SD) MAdj
Pro-socialbehavior

SSBD-ABI 29.5(6.2) 29.5(7.1) 30.6 32.3(5.8) 39.2(9.7) 38.4 3.60 <.001 .89

SSiS-SS-Teacher 76.1(8.8) 75.4(9.2) 76.0 77.7(9.7) 91.7(14.3) 89.8 4.55 <.001 1.11

SSiS-SS-Parent 73.9(21.7) 78.9(21.0) 80.1 77.2(13.8) 88.1(17.4) 87.0 2.18 .029 .36

ProblemBehavior
SSBD-M BI 37.6(6.1) 37.7(5.8) 37.4 36.6(5.7) 28.1(9.1) 28.2 −4.79 <.001 −1.17
SSiS-PB-Te acher 133.0 (11.0 ) 134.0 (12.0 ) 133.7 132.4 (11.8 ) 118.5 (16.2 ) 119.4 −4.15 < .001 −.98
SSiS-PB-Parent 129.1 (21.6) 126.8 (19.9) 128.0 129.9 (10.1) 116.7 (12.8) 115.6 −3.39 .001 −.77

AcademicCompetence

SSiS-AC-Teacher 89.3(17.9) 88.0(16.9) 87.9 89.0(15.3) 91.0(13.9) 90.9 1.54 .125 .19

Notes:SSBD,SystematicScreeningforBehaviorDisorders;SSiS,SocialSkillsImprovementSystemRatingScales;SS,SocialSkills;MBI,MaladaptiveBehaviorIndex;PB,

ProblemBehavior;AC,AcademicCompetence.

For the home component, parent satisfaction was associated Process data demonstrated the interventions were delivered

with improvements in parent-reported social skills on the SSiS withfidelity.Althoughthisisnotsurprisingfortheschoolcompo-

(t=2.48, p=.013). For a one standard deviation increase in par- nent,giventheminormodificationstothisaspectoftheprogram

entsatisfactionatpost-intervention,parent-reportedsocialskills at the tertiary level, it is noteworthy since this study repre-

increased by .30 standard deviations. There were no statistically sents the first systematic application of the Tertiary homeBase

significant associations among parent satisfaction and the other intervention.Further,coaches,parents,andteachersallreported

home-based outcome measures. Coach-reported parent compli- moderate to high levels of satisfaction with the revised home

ance was negatively associated with parent efficacy. For a one component. For the school component process-outcome analy-

standarddeviationincreaseinparentcompliance,parentefficacy sis,dosagewasassociatedwithimprovementsinteacher-reported
decreased by .40 s tandard dev iations (t=−2.81, p =.005) . Parent soc ial skill s an d reduction s in problem behav io r, but adherence

compliance was not significantly associated with the other out- and quality were not. For the home component, parent satisfac-

comemeasures.Therewerenostatisticallysignificantassociations tion was associated with parent-reported social skills, but none

amongdoseofthehomecomponentandthehome-basedoutcome of the other home-based outcomes. Given the small sample and

measures. highlevelsofadherenceandimplementationqualityacrosstea-

chers and coaches, we suspect that limited variability may be

Discussion contributing to the lack of association among fidelity and out-

comemeasures.Parentcomplianceanddosagewerenotassociated

TertiaryFirstStepprovidesapotentiallyeffective,manualized withparentingefficacyorparentaldistress.Again,giventhesmall
interventio nopt ionfo raddress in gtheneeds ofanincr easingnum- samp le size, th ese rela tio nships m ust be interpr eted w ith cau-
ber of childr en wh o a re entering sch ool re qu iri ng tertiary level tion.Th eana lysis,h owever,does provi de amodelfor exam ining
sup por tforbeh avior prob lems(Mc Cabee tal.,2000; Walker etal., ther elati onshipbe tweenpro cessv ariables a ndoutc om esinfuture
2004).T he program meetsthe criteriaf or effe ctive interven tio ns rese arch.
to imp act education al and me ntal hea lth outcome s for children In addition to providing support for the notion that these
wi thchalle ngingbehav iorp rovided byHoa gwoodeta l.(2 007)and enhan cements to theFirstSt epinterv enti ona reprom ising when
Patte rsonandCh amberlai n(1994). Spe cifically,it in clu desaf am- implementedw ith chi ldren who requiretertia ry-l evelsuppo rt,this
ily compo nent that is respo nsive to unique situ a tions and n eeds studyextends the literatur etos upport theuseofam otivatio nal
off amiliesrequ iring in tensive,ter tiar y-level support,an dpr ovides interv iewinga ppro achinsch oo l-basedin ter vent ion r esearch(Frey
fle xible,ye tmanuali zedproced uresthatadd resspare ntal motiva- etal.,2011;H erman,R ein ke,Frey,&Sh epard,2014 ;Reinke, Frey,
tiontoe nga geintheint erventionp roces sandfa cilitatech angein He rm an,&T hompson ,2014) .This a pproachc ontinu estoap pear
their ow nbeha vi or. worthyo ff utureresear ch.

Thisstudybuildsontwodecadesofefficacy,effectiveness,and

replicationresearchrelatedtotheFirstStepintervention(Walker Limitations

et al., 2014) by providing preliminary evidence that the newly

createdvariationfortertiarylevelstudentsispromisingforimprov- There are a number of limitations related to these findings.

ingimportanteducationaloutcomessuchassocialskills,problem Theprimarylimitationisthatourdesignfailstocontrolforsev-

behavior, and academic engaged time. The consistency noted in eral threats to internal validity. Specifically, while the addition

outcomes across multiple domains, measures, and informants is of a comparison group increases confidence that the impressive

astrengthofthisevaluation,andcontributessubstantiallytoour gains in teacher- and parent-reported social skills and problem

assertionthattheseFirstStepenhancementsappearpromisingfor behaviors were the result of participation in the Tertiary First

improvingeducationallyrelevantoutcomes.Itisimportanttonote Stepintervention,thelackofrandomizationlimitsourabilityto

thisistheonlyFirstStepstudyinwhichthestudents’behavioral rule out selection bias, and to some extent, history as possible

impairments were identified in home and school settings prior threats to internal validity. Our sample size also prohibited us

tobaselineassessments.Theimprovementsinacademicengaged from conducting a post hoc analysis on the families that com-

timeisperhapstheoutcomethatwillbeofthemostinterestto pletedtwoorfewerstepsofTertiaryhomeBase(N=7),sothatwe

teachersandadministratorsandwasthemostpowerfuloutcome mightbeabletoidentifypatternsoffamiliesforwhomwewere

associatedwithourwithin-subjectanalysis.Unfortunately,onlya unsuccessful at engaging. Additionally, while severity baseline

smalleffectsizewasobservedforacademiccompetenceasassessed scoresforchildrenintheinterventionandcomparisongroupwere

bytheSSiS. similar, more children in the intervention group were receiving
10 A.J.Freyetal./EarlyChildhoodResearchQuarterly30(2015)1–11

specialeducationsupportthroughtheschoolsystem.Additionally, Authornote

observationaldata were not collectedfor the comparisongroup.

Thus,historyandmaturationremainpossibleexplanationsforthe AnInstituteofEducationSciences,USDepartmentofEducation

changesobservedfrombaselinetoposttestwithintheintervention grant(R324A090237)totheUniversityofLouisvillewasutilizedas

group. partialsupportforthedevelopmentofthismanuscript.Theopin-

Our study design also prohibits us from isolating the specific ionsexpressedarethoseoftheauthorsanddonotrepresentviews

benefits the Tertiary First Step program may have had over the of the Institute or the US Department of Education. We would

originalFirstStepintervention,orforidentifyingtherelativecon- also like to thank our partners in Jefferson County Public School

tributionsofthehomeandschoolcomponents.Wehavenowayof (Louisville,KY)system.

knowingiftheeffectsizesforourmainoutcomeswouldhavebeen

as large had we implemented the original intervention with the
AppendixA. Supplementarydata
samesampleofchildren.Itisimportanttonotethattheteacher-

reportedeffectsizesareslightlymorerobustthantheyhavebeen
Supplementary data associated with this article can be
inpreviousFirstStepstudiesemployingsimilardesigns(Walker
found,intheonlineversion,athttp://dx.doi.org/10.1016/j.ecresq.
etal.,1998,2009).Thisfindingisparticularlyimpressivegiventhat
2014.05.002.
thesamplerecruitedissubstantiallymoreatriskthanhasbeenthe

caseinpreviousstudies,andthatpreviousfindinghavebeenmore
varia bl eforchil drenat thet ertia rylevel. Oursam ple sizei salso References

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