(p. 269) Classroom-Based Services for Adolescents With Mental Health Needs
Providing classroom-based services to address the mental health needs of adolescents poses a number of challenges. First, although teachers at the secondary level are highly skilled in their respective content areas, few have parallel expertise in addressing their students’ behavioral and mental health issues. Second, the structure of secondary settings, whereby teacher instruction is limited to a single content area, offers limited time with each student. This often provides insufficient time for teachers to become adequately acquainted with students and identify those who may be in need of additional supports. Unfortunately, universal screening remains extraordinarily unusual, particularly at the secondary level (Caldarella, Young, Richardson, Young, & Young, 2008). Third, we have found that teachers frequently view adolescence as a time when independence is expected, and they are reluctant to afford the supports that would greatly improve students’ outcomes. Finally, the nature of many of the behavioral challenges common among adolescents, such as tardiness and truancy, can be frustrating and counterproductive, especially when teachers have made gallant efforts to assist those in need.
At the same time, the secondary school years are particularly important, representing the margins of adulthood, when success or failure paves the way for the future. For instance, high school completion is associated with a number of benefits, including higher employment rates and greater wages (U.S. Bureau of Labor Statistics, 2012). Conversely, high school dropout is associated with numerous detrimental outcomes, such as earning less yearly income, increased arrest rates, (p. 270) and chronic reliance on public assistance, compared to those who completed high school (Gasper, DeLuca, & Estacion, 2012).
There are many reasons why schools, and classrooms in particular, are ideally suited for the delivery of interventions that address mental health concerns. Because students spend a majority of their day in school, there are many opportunities to provide interventions. Further, among all of the staff in any given school, teachers have the most regular and consistent contact with students. This renders the potential for consistent intervention delivery both plausible and potentially consequential. In addition, student academic growth is intimately tied with domains of student mental health (e.g., social and emotional development), with positive growth in mental health impacting academic performance, and vice versa (Sameroff & Rosenblum, 2006).
Fortunately, there are a number of interventions teachers can readily implement in their classrooms that require limited expertise in the fields of behavioral and mental health, yet have a significant impact on student behavior. Importantly, research supports teacher effectiveness with respect to intervention delivery for students’ emotional and behavior problems and also substantiates the manageability of such interventions in classrooms (Franklin, Kim, Ryan, Kelly, & Montgomery, 2012). In this chapter, we describe a tiered model of prevention and intervention in the classroom that is efficient and cost-effective. In addition, we detail specific interventions with solid or emerging evidence for effectiveness in secondary settings.
Rationale for a Tiered Model of Intervention
A tiered model of intervention, initially applied in the public health field, has now been widely used in schools in the form of school-wide positive behavioral support (SWPBS; Horner, Sugai, & Anderson, 2010). The model focuses on prevention and intervention through universal, secondary, and tertiary support, as dictated by student need. The strength of this system of service delivery is that it allows professionals to provide a full range of services, with the appropriate intensity matched to the level of need exhibited by each student. Furthermore, intervention at the universal tier is aimed at all students, thereby preventing the majority of behavior problems.
We recommend the same conceptual framework for individual classrooms as an efficient and effective way for teachers to both prevent emotional and behavioral problems from emerging and reduce the severity and impact of existing student problems. Tier I focuses on class-wide procedures that promote a safe and welcoming environment with clear expectations and structure. Tier II is aimed at preventing low-level problem behavior and can be used with specific individuals, groups, or, at times, an entire class of students. Finally, Tier III involves individualized and intensive interventions for students with the most serious needs. Beyond addressing the behavioral and mental health needs of secondary students, the interventions associated with this approach represent best practice in (p. 271) classroom instruction and foster a healthy and productive relationship between teacher and student.
We recommend that teachers introduce a tiered framework at the start of the school year or semester. This assures that students become familiar with classroom expectations and routines early on, and little time is wasted addressing problems that may have been prevented. Further, those students with greater intervention needs can be more readily identified. However, it is never too late to start. Introduction of a tiered model at any time in the school year, when implemented correctly, will improve the classroom atmosphere and can reduce emotional and behavioral problems. In the remainder of this chapter we describe specific classroom interventions organized within a three-tiered framework. We first provide a rationale for each intervention strategy, followed by specific implementation procedures. We then describe the existing research to support effectiveness of the intervention.
Tier I Intervention: Class-Wide Practices
Tier I interventions are class-wide or universal practices that benefit all students. In addition, they represent best practice with respect to classroom organization and structure and maximize instructional time. The procedures can be easily integrated into the daily classroom routine. When class-wide procedures are solidly in place, fewer resources are needed for Tier II and III interventions and students with more intensive needs can be more easily and accurately identified. We describe four simple universal class-wide strategies below.
Students spend the majority of their school day in the classroom setting. Unfortunately, most teachers receive limited, if any, formal preservice coursework in the area of behavior management (State, Kern, Starosta, & Mukherjee, 2011). Even in schools with school-wide positive behavior support in place, teachers may struggle adapting and applying universal expectations in their classrooms. Classroom expectations create a supportive environment where students feel comfortable and safe, which is essential for promoting academic growth and mental health. Expectations help students remember what they need to be doing in order to be successful. Furthermore, clear expectations can reduce stress and anxiety among students with internalizing problems by providing consistency and predictability.
Classroom expectations are unique to the teacher and subject matter, and they tell students what behaviors are desired in the classroom. Students will remember the expectations if there are no more than five (three to five is recommended). Effective classroom expectations should be positively stated, explaining to students what to do rather than what not to do. For example, “Students will arrive to (p. 272) class before the bell” is an instructive expectation, rather than “Students should not be late to class.” Additionally, expectations should be observable and measureable. This means that expectations should leave little room for interpretation, even to new students with limited classroom exposure. For instance, asking students to “Be polite” could be interpreted in many ways, whereas the expectation to “Use materials as intended” is much more specific. Box 13.1 shows an example of expectations in a high school chemistry class.
For expectations to be effective, they need to be accompanied by consequences. It is most important that consequences follow appropriate behavior so that students are encouraged and reinforced for doing what is expected. When teachers let students know that they are meeting expectations, desired behavior is likely to increase. In addition, focusing on appropriate behavior and complementing students creates a positive classroom climate.
Praise is commonly used as a consequence for appropriate behavior in classroom settings. A useful way to quantify praise and balance it with the use of reprimands is the concept of “reinforcement ratio,” which compares the number of positive teacher comments (praise) with the number of corrections or reprimands. The minimum ratio of positive to negative statements is 3:1 (Sprick, 1981, 1985); however some have recommended ratios as high as 10:1 (Nafpaktitis, Mayer, & Butterworth, 1985). Although there have been no published studies experimentally evaluating the specific ratio that is most effective for producing positive behavior, descriptive and correlational research indicates there are fewer behavior problems in classrooms with a high amount of positive statements and a low amount of negative feedback (e.g., Hall, Panyan, Rabon, & Broden,1968; Merrett, & Wheldall, 1992; Shores, Gunter, & Jack, 1993). Some adolescents prefer a discreet form of praise (Elwell & Tiberio, 1994), which can be delivered with a written note, gesture (smile, nod, high-five), or quiet compliment. Examples of other positive consequences include extra points for participation, free time at the end of the period, lunch with a teacher, reduced homework or free homework pass, listening to music while working, and computer time.
(p. 273) Predetermined consequences also need to be in place for failing to adhere to the class-wide expectations. These must be clear and consistently delivered in order to discourage inappropriate classroom deportment. Examples include corrective feedback, loss of participation points, a phone call home, or an after-school conference.
It is important for students to fully understand the expectations and accompanying consequences, and teachers must provide such instruction. This can involve simply reviewing the specific behaviors associated with each expectation, along with the consequences. In classrooms with students who have difficulty following the expectations, this instruction may need to be repeated regularly (e.g., daily, weekly). The use of role-play with examples and non-examples is also an effective method of instruction.
There is a substantial amount of research indicating that providing clear expectations, instruction, and reinforcement for prosocial behavior has many benefits, including improvements in student behavior. For example, Klem and Connell (2004) found that student perception of these elements helps create a successful classroom environment. Students reported feeling engaged in school when they perceived that the learning environment was structured with high, clear, and fair expectations. Further, research on teacher aspirational expectations indicates that positive expectations lead to an increase in academic performance, whereas negative expectations have been associated with academic difficulties (Tyler & Boelter, 2008). Furthermore, Wentzel, Baker, and Russell (2012) found that adolescents’ social and academic engagement was related to the extent that they believed their teachers and peers expected them to succeed.
In a study by Elwell and Tiberio (1994), 279 students between 7th and 12th grade reported feeling favorably toward teacher praise. Although all students generally liked receiving teacher praise, there were differences in how it was perceived among various grades, with 7th, 8th, 11th, and 12th graders reporting liking public praise whereas 9th and 10th graders reported preferring it more privately. Furthermore, Daniel, Duncan, and Harpole (2013) found that both public and private praise were effective in increasing on-task behaviors of high school students in the classroom, and in decreasing disruptive behaviors.
Improving Student-Teacher Interactions
A second class-wide strategy to prevent problem behavior is to engage in caring, positive, and supportive student-teacher interactions. Teachers can create a positive classroom community through their interactions with students. This occurs when teacher are accepting of individual differences, are friendly, and take the time to build a positive rapport with each student. There are simple strategies that are meaningful to students and set the classroom tone. These include addressing students by name, greeting them at the door when they enter the classroom, and smiling often. Moreover, talking with students about their interests or concerns demonstrates that teachers care about them beyond their performance in (p. 274) the classroom. This can be accomplished by asking a student what is troubling her or making it a point to acknowledge student success (e.g., grades, sports, other extracurricular activities).
Research shows that student-teacher interactions can help improve student outcomes, both academically and behaviorally, especially if they result in good student-teacher relationships. Improved teacher outcomes have been noted as well, such as reductions in work stress (Roorda, Koomen, Split, & Oort, 2011). Specific aspects of the interactions may be particularly important. For example, Anderman, Andrzejewski, and Allen (2011) surveyed 2,864 students in Grades 9–12 to determine how high school teachers can create motivating and engaging classroom environments. Three core themes emerged: (a) being supportive and understanding, (b) building and maintaining rapport, and (c) managing the classroom.
A central quality of self-determination is the perception of choice (Reeve, Nix, & Hamm, 2003). Choice is defined as the act of selecting or making a decision when faced with two or more possibilities. Offering choices can be used as a class-wide strategy to promote elevated levels of interest and attention and provide a sense of control, purpose, and competence. Furthermore, adulthood is a time when making choices is required, and providing adolescents with such opportunities prepares them to make effective choices as adults.
Teachers can embed choice in many ways without altering an assignment. For example, students may select the materials used to complete a task, their daily seating assignment, or their partner for a cooperative learning activity. Other choice options include allowing students to select the order of task completion or the medium for work completion (e.g., writing an essay by hand or on the computer). Broader types of choices include selecting the topic they would like to research or write about, or creating questions that the class will answer the following day.
Kern, Bambara, and Fogt (2002) illustrated the success of class-wide choice in a middle school classroom by allowing students to select the topical unit of study, how they would complete activities (e.g., on the computer, with a partner), and with whom they would work. The intervention resulted in higher levels of student engagement and a reduction in disruptive behavior. Research has also shown that choice can promote effort and persistence with tasks. For example, Carey, DeMartini, Prince, Luteran, and Carey (2013) demonstrated that when choice was provided to adolescents, their productivity and engagement increased.
Good Behavior Game
The Good Behavior Game is a class-wide intervention that promotes on-task behaviors and helps minimize undesired behaviors (Barrish, Saunders, & Wolf, (p. 275) 1969). This strategy reinforces students who demonstrate desired behaviors during instructional times. The Institute of Medicine report Preventing Mental, Emotional, and Behavioral Disorders Among Young People (National Research Council, 2009) stated that this strategy was one of the most influential prevention approaches that teachers can implement. We recommend this program, in conjunction with the approaches described above, for classrooms that are particularly challenging.
To implement the Good Behavior Game, the teacher typically divides the class into two groups that compete against each other for teacher recognition of target prosocial behaviors (Kellam et al., 2008). The original version used a response-cost paradigm in which students received “demerits” for breaking a publically posted classroom rule. We recommend a newer version in which the teams can earn bonus points to offset demerits (Rathvon, 2008).
Setting up this program involves four steps. The first step is to identify times or activities that are particularly problematic, and when the game would be beneficial (e.g., during teacher lecture when students tend to be inattentive). Next, the teacher or class operationally defines the behaviors that will result in a demerit (e.g., calling out or speaking without teacher permission) and behaviors that will earn a merit (e.g., encouraging a peer). Step three involves choosing how often students will be rewarded (e.g., daily, weekly) and the criteria for receiving the reward. If the team has earned fewer demerits than a preselected goal, students on the team will earn the reward; however, demerits can be eliminated by earning merits (e.g., every five merits erases one demerit). Merits and demerits can be monitored with tallies on the board or cards given to the students, which are collected and counted at the end of the period. Teachers should consider reinforcers that are a natural fit in the classroom context. The fourth step is to introduce the game by explaining the procedures and informing students of their teams (two or more).
Kellam and colleagues (2008) conducted a longitudinal study of first and second graders, who were randomly assigned to either the Good Behavior Game, an intervention aimed at academic achievement, or a control group. Positive outcomes among the group of students who engaged in the Good Behavior Game included lower rates of smoking, drinking and other substance use, antisocial behavior (violence and criminal behavior) and suicidal thoughts and increased service use for problems. These outcomes were maintained more than 12 years after intervention implementation. This research on the Good Behavior Game suggests it may have long-term benefits in multiple areas of the student lives.
Research on the Good Behavior Game has largely focused on positive effects for younger, elementary-age children. A study by Kleinman and Saigh (2011), however, was conducted in a multiethnic, New York City public high school in a ninth-grade classroom. The rate of all targeted disruptive behaviors decreased during intervention, and those reductions were maintained during follow-up. Further, social validity data indicated that (a) 100% of students felt they learned more when the GBG was implemented, b) 89% reported improvement in peer behavior, and (d) 66% reported improvement in their own personal conduct. This study provides evidence that the Good Behavior Game is a promising intervention for adolescents.
(p. 276) Tier II: Prevention With Selected Strategies
Unlike Tier I interventions, which are delivered to all students in a classroom, Tier II strategies target just a few students in any given classroom. In other words, most of the students in a classroom should respond to Tier I strategies, when they are consistently delivered as designed. But those few who are not responsive will need additional support. Because Tier II interventions require individualization, they take more effort than Tier I interventions. At the same time, they can be implemented without gathering the assessment information required by Tier III. We describe three Tier II interventions that are age-appropriate for secondary students and benefit from research supporting their effectiveness.
Individual Goal Setting
Goal setting is a relatively simple intervention strategy that is particularly well suited to Tier II, because it can be easily individualized to address specific student needs. Goal setting is defined as student participation in planning a future goal, followed by self-evaluation of performance. Typically, goal setting involves evaluating what the student is presently able to achieve and determining what he or she would like to achieve in a preset length of time (e.g., a few days, weeks, a semester). The goal can involve increasing a behavior (homework completion, skill practice) or decreasing an undesired behavior (tardy to class, inappropriate social interactions). It is important to consider behavior changes that will be most meaningful and will positively impact the student’s life. For instance, consider a high school senior who has difficulty completing class assignments, as well as social skills related to appropriate interactions with peers. Because gains in social skills could positively impact the student in all areas of his life (i.e., school, work, community), it may have a more meaningful effect for the student to establish a goal to increase positive interactions. Conversely, for a student experiencing difficulty getting along with just a few peers, but also with organization that results in a lack of turned-in classroom assignments and failing grades, organization might be a more meaningful goal, because failing grades would have a significant overall impact on the student’s life.
Although teachers can establish goals for their students, we have seen that the outcomes appear more effective when goals are identified in collaboration with the student, particularly at the secondary level. The first step in goal setting is to determine a goal to be achieved (e.g. minutes on-task, assignments completed, kind acts), a time frame, and a reward if the goal is achieved within the designated time period. Sometimes rewards can be naturally occurring, as in the case of a student passing a test or class; however, students at Tier II often benefit from additional rewards, since they have a tendency not to be successful in school.
Goal Attainment Scaling (GAS; see Figure 13.1) is an effective and easy tool to monitor and record progress toward goal completion. Typically, GAS has five indicators of possible outcomes, ordered from least to most desirable. At regular (p. 277) times, the teacher rates the student’s progress in attaining his or her goal (Sheridan & Kratochwill, 2007). For example, to decrease Seth’s interrupting, a goal may be that he will speak only with people who are not already engaged in conversation, or he will wait until his teacher or peers have completed a conversation. Because baseline data indicate he interrupts an average of five times during an academic period, a goal of no more than two interruptions might be initially established. Seth’s teacher monitors progress toward his goal at the end of each class period, and he earns rewards if he receives a 1 or a 2. GAS provides a more detailed measure of goal progress than simply indicating whether or not a goal was attained.
Measuring goals can also be further enhanced by providing data-based feedback to students about their progress toward meeting their goals. Research indicates that when students receive positive feedback regarding their goals, they are more likely to set higher goals and to achieve their goals (provided the goals are perceived as attainable) (Krenn, Würth, & Hergovich, 2013). As such, teachers and students should make goals that are both challenging and attainable. Feedback should be specific, positive, and constructive to encourage student growth. Outcomes can also be embedded into ongoing procedures, such as grades. For example, points earned for assignment completion can be used to determine a student’s participation grade. Finally, feedback can be provided through multiple formats, including written in a note, discussed in a brief conference, or tracked using other progress monitoring formats.
Research supports the effectiveness of goal setting for secondary students by making behavior change explicit and providing for continuous progress monitoring toward each goal (Codding & Smyth, 2008). Locke and Latham (2006) demonstrated that as goals become more specific, they are more likely to be accomplished. In addition, research suggests that goal setting may be most effective for tasks that are low in difficulty, with goals are specific, clear, and reachable (Krenn, Würth & Hergovich, 2013).
Self-management procedures are highly adaptable to address a wide range of behaviors, including decreasing problem behaviors and increasing appropriate behaviors. (p. 278) Self-management procedures teach students to take responsibility for their actions, which places fewer intervention demands on teachers (Cole, 1992). The process involves observing and documenting occurrences of one’s own behavior.
The first step in beginning a self-management program is to determine the targeted behavior and developing a measurable definition. The definition should clarify what the behavior looks like, making it distinguishable from other behaviors. Forms should then be created for the student to monitor his or her behavior (see Figure 13.2 for an example). Behavior can be monitored using yes-no responses or using rating scales (e.g., 1 = none of the period, 2 = some of the period, 3 = all of the period). Certain behaviors are better monitored with yes-no responses (e.g., “I completed my homework,” “I was seated in my desk when the bell rang”) while others may be more suited for scaling (e.g., “I worked well with my peers”). In addition, behavior can be monitored at different time intervals, depending on (a) the frequency of the behavior (i.e., higher frequency behaviors may require shorter monitoring intervals), (b) the time interval across which the student is able to accurately evaluate whether behavior occurred, and (c) the ability of the student to control his or her behavior (poor self-control requires shorter intervals). The student then needs to be taught to identify and monitor the target behavior by providing examples and non-examples of the behavior and practicing how occurrences will be coded. It may be necessary to allow time for practice with ongoing teacher support before the student begins to independently self-manage. This generally involves the teacher simultaneously monitoring occurrences of the student’s behaviors, determining the extent to which those evaluations match with the student’s evaluations, and providing feedback. (p. 279) When the student is reasonably accurate, he or she is ready to self-manage independently.
An abundance of research supports the effectiveness of self-management to improve the behavior of secondary students. For example, Snyder and Bambara (1997) assessed the effects of implementing a self-management with adolescent students with learning disabilities in both regular and special education classrooms. Following intervention, off-task behavior was reduced and students generalized targeted skills (working on the assigned task and following classroom rules) across settings. In a study by Dalton, Martella, and Marchand-Martella (1999), self-management was used with secondary students with poor academic performance who also displayed disruptive behaviors, were unprepared for class, and failed to turn in assignments. Behavior improvements were observed, including reductions in off-task behavior and increases in appropriate behaviors and the improvement generalized across subject areas.
Check In/Check Out
Check In/Check Out is an intervention strategy that provides students with daily monitoring and adult feedback beyond what the typical student would receive (Campbell & Anderson, 2011; Hawken & Horner, 2003). Teachers could consider using Check In/Check Out for a variety of student behavior problems, such as failing to complete work, poor organization skills, or difficulty focusing and paying attention.
Check In/Check Out is implemented in the following manner: First, target behaviors are identified and listed on a tracking form with accompanying behavior ratings (e.g., Campbell & Anderson, 2011; Hawken & Horner, 2003; see Figure 13.2). An adult “checks in” with the student upon arrival at school. This might be the student’s homeroom teacher or another designated adult. During this morning check in, the adult checks the parent-signed tracking form from the previous day (see below). In addition, the student and adult make sure the student is prepared for the day (e.g., has needed materials) and the adult provides reminders or a review of behavioral expectations, along with encouragement and supportive comments (e.g., “It’s nice to see you here today,” “I’m so happy that you brought your tracker back with a signature”). At the end of each class period, the student brings his or her tracking form to the classroom teacher, who rates the student’s behavior and provides brief feedback. At the end of the day, the designated adult reviews the points earned, sets goals with the student, and provides acknowledgement and encouragement (e.g., “You’re really working hard,” “I’m so proud of you for meeting your goal!). Each night the student takes the tracker home for his or her parent or guardian to review and sign.
Research on Check In/Check Out has found the intervention to be effective for reducing problematic behavior (e.g., disruptions, disrespect, disorganization, work completion, impulsive behaviors) and increasing prosocial behavior, including academic engagement. For example, Toms (2013) found that high school (p. 280) students who participated in Check In/Check Out showed improvements in their grades and decreases in school disciplinary problems. Additionally, Swoszowski, Jolivette, Fredrick, and Heflin (2012) found that Check In/Check Out helped to reduce escape-maintained behaviors (e.g. not completing work, head down) as well as other problems exhibited by adolescents in a residential treatment facility.
Tier 3: Targeted Individualized Interventions
Students who fall in Tier III have not responded to interventions at Tiers I and II. These few students have intensive support needs and require much more complex interventions than those described above. To identify appropriate interventions and supports, an assessment-based approach is best practice, because of its long and successful track record in the school setting for guiding the selection of intervention and mental health services (e.g., Bambara & Kern, 2005). Because the needs of students at Tier III are usually complex, a support team with one or more individuals who have expertise in social, emotional, and behavioral problems usually develops intervention at this tier. For this reason, we will not detail Tier III intervention, but instead provide a brief overview of the process.
Assessment-Based Intervention Development
Because of the complex needs of adolescents with intensive behavior problems, we recommend assessment to evaluate both academic and classroom performance as well as mental health/social issues. Academic/classroom assessments should examine broad competencies, including organization and study skills. More specific skills that should be considered include attention and academic strengths and needs. In the area of mental health, assessments should determine whether a student is at-risk for major mental health disorders, including depression and anxiety. In addition, the assessment should identify any documented occurrences of behavioral outbursts. Finally, potential social skills deficits should be considered. Each of these areas of assessment should link directly to specific interventions. This multidimensional approach to assessment and intervention identification leads to a comprehensive multicomponent intervention plan. Kern and colleagues (2014) describe a comprehensive approach to assessment-based intervention for secondary students, developed by the Center for Adolescent Research in Schools (CARS). In addition, many of the chapters in this volume describe components of assessment-based intervention.
In the previous sections, we described a tiered system of intervention to match the level of support with student need. Accommodations offer another opportunity (p. 281) to facilitate learning. Accommodations, when implemented correctly, may potentially be the cornerstone of student success with the academic curriculum. That is, appropriate accommodations have the potential to make a difference in whether a student succeeds or fails.
The goal of accommodations is to remove barriers to learning and full participation, thereby offering students equal access to the curriculum, including course content and activities, similar to that afforded to their nondisabled peers. This is particularly important for students with emotional and behavioral disorders (EBDs) at the secondary level, because most spend at least some time in general education classrooms (Wagner et al., 2006). Furthermore, the majority of students with EBDs do not meet minimum standards on statewide assessments in core academic areas, suggesting the need to assure the validity of information derived from those assessment (e.g., Temple-Harvey & Vannest, 2012).
First and foremost, it is important to understand the exact meaning of accommodations, particularly since educators often confuse both the term and its practical applications. Accommodations are changes to some aspect of instructional delivery or student participation that does not substantially alter the curriculum or associated expectations (Thompson, Morse, Sharpe, & Hall, 2005). Importantly, accommodations are designed to maintain the academic standards required of students without disabilities while mediating the impact of the student’s disability (Harrison, Bunford, Evans, & Owens, 2013). Stated in terms evoked by previous researchers, the goal is to “level the playing field.”
Accommodations fall into four broad categories (Christensen, Braam, Scullin & Thurlow, 2011). These include presentation, response, timing/scheduling, and setting (Thompson et al., 2005). Presentation accommodations are those that modify the way in which material is presented. Some examples include reading directions, questions, or passages aloud; repeating or clarifying directions; providing visual cues; and providing prompts or encouragement. Response accommodations are those that change the manner in which students provide responses. Examples are using a scribe, responding via computer or other machine, writing in a test booklet, or using a tape recorder. Timing accommodations change some aspect of test timing or the way in which time is organized. Extended time and administration at a time most advantageous for a student are examples. Scheduling accommodations include breaks, assessments administered during multiple sessions or days, and flexible scheduling. Finally, setting accommodations change the location or environment where the assignment, test, or activity may be completed. Examples include reducing the number of students present in the environment (one, small group), providing a carrel or separate room (e.g., special education classroom), modifying seat location or teacher proximity, or minimizing environmental distractions.
The potential benefit of accommodations has not been realized for two primary reasons. First, there is inadequate research to support the effectiveness of accommodations, particularly for students with emotional and behavioral problems. In a recent, comprehensive review of accommodations, Harrison and colleagues (2013) concluded that research provides little evidence of the effectiveness of any approved accommodation for students with behavioral concerns.
(p. 282) The second is that accommodations are not often judiciously selected, nor do they necessarily align with student need. This concern is supported by research indicating that teachers report being unsure about how to provide accommodations and may be willing only to offer class-wide accommodations that do not risk disruption to their classroom routine (e.g., Polloway, Epstein, & Bursuck, 2003). In spite of these limitations, we believe that accommodations have the potential to make a significant difference in student outcomes. Therefore, we offer several recommendations for their selection and implementation.
First, it is critical that accommodations are individualized and linked to each student’s specific deficits and skills. Accommodations should not be selected based on disability label, ease of implementation, or teacher preference. Teachers (in conjunction with the support team) should self-assess the manner in which they select accommodations to assure that they are not the result of the aforementioned processes. Unfortunately, there is an absence of models and procedures to guide teacher selection of accommodations. Until additional guidance is available, we recommend that teachers first determine the student’s specific skill deficits and skill strengths. Second, they should identify an accommodation that addresses the deficit and capitalizes on the student’s strengths. For example, if a student has difficulty reading instructions but has good oral comprehension, reading instructions orally would address her deficit and allow her to rely on a strength. Finally, teachers should closely evaluate whether the accommodation is actually providing a “differential boost” or compensating for the student’s deficit such that his or her understanding, assignments, and test scores are improving.
Second, as noted above, the effect of accommodations should be evaluated on an ongoing basis. This means that teachers must periodically and regularly determine whether the accommodation is continuing to assist the student to demonstrate his or her skills. If the accommodation is not benefitting the student, the teacher must determine whether it needs to be changed or is no longer necessary and can be either faded or discontinued.
A third guideline is to assure that accommodations are applied to both daily academic classwork as well as testing. It is common for teachers to provide accommodations only for standardized tests and/or classroom tests. However, if a student needs testing accommodations, he or she almost always also needs the same accommodations to fully perform academically. An advantage of regularly providing academic accommodations is that it provides the teacher frequent opportunities to evaluate their effectiveness.
Barriers and Solutions to Implementation
In spite of extensive research and promise, classroom-based interventions for students with mental health needs are still not widely implemented in secondary settings Schaughency & Ervin (2006). There are several reasons for this, which can be broadly divided into the categories of teacher-specific barriers and external (p. 283) systemic barriers (Han & Weiss, 2005). Both categories of barriers need to be addressed to fully meet the promise of classroom-based mental health. In the remaining paragraphs, we outline specific barriers and offer suggestions for overcoming these barriers.
Teacher Barriers and Recommendations
Barriers specific to teachers fall in several distinct areas, including resistance to mental health programs, acceptability of interventions, knowledge and training, and teacher burnout and stress. Teacher resistance often stems from the belief that schools are not a place to address mental health concerns, or that it is the teacher’s role to do so. As such, many teachers believe that their central role is academic education, and that mental health activities should be handled by mental health professionals in mental health facilities (Reinke, Stormont, Herman, Puri, & Goel, 2011). This is unfortunate for several reasons. First, teacher interactions have an impact on student mental health (Adelman & Taylor, 2000). Moreover, research has established a close relationship between academics and social, emotional, and physical health (Suldo & Shaffer, 2008). Therefore, addressing mental health concerns is likely to improve academic performance. Finally, among students who receive mental health services, the vast majority occur in school settings (Burns et al., 1997). Thus, schools are best positioned, and perhaps ethically obligated, to provide such services.
We believe that if teachers begin to implement interventions such as those described in this chapter, and in a tiered fashion, it will yield significant rewards, including improvements in class climate, student motivation, peer and adult interactions, and academic performance. A tiered approach to intervention is efficient in that it will eliminate low-level concerns, allowing teachers more time and energy on students with greater needs.
Another teacher-related barrier to classroom mental health is acceptability of interventions, which reflects a larger problem within the field of mental health. Even if teachers are motivated and willing to implement classroom mental health programs, many interventions are designed for clinical settings and do not offer a good fit in the classroom (Han & Weiss, 2005). Further compounding the acceptability problem is a lack of knowledge of interventions and insufficient training among teachers. Consequently, teachers do not have the skills to understand how interventions can be adapted or modified for their students and the classroom (Han & Weiss, 2005).
We recommend continuing to expand the emerging research, further demonstrating that simple and ecologically aligned classroom interventions can prevent and reduce mental health problems. In addition, we believe it is imperative that all teachers receive sufficient training, both pre- and in-service, to assure they can skillfully implement best practices in their classrooms to address the whole student. Such training is likely to interact with teacher acceptability of interventions, subdue anxiety, and raise teacher’s self-efficacy (McCormick, Ayres, & Beechey 2006).
(p. 284) The final teacher-specific barrier is teacher burnout and stress, which can be attributed to many variables, including work overload and insufficient training to address students’ social, emotional, and mental health concerns. An unfortunate cycle can result. Specifically, research has shown that high levels of teacher stress and burnout lead to reduced ability to implement interventions, lower morale, and high rates of staff turnover (Evers, Brouwers, & Tomic, 2002).
Fortunately, research has shown that teacher stress and burnout can be reduced through the use of directed stress management and supports (e.g., brief stress-management intervention), which also improves teacher self-efficacy (Van Dick & Wagner, 2001; Biglan, Layton, Jones, Hankins, & Rusby, 2013). Furthermore, teachers report feeling better, having higher levels of job satisfaction, and improved quality of life following stress-reduction programs (Leung, Chiang, Chui, Mak, & Wong, 2010).
We recommend teachers invest in a personal plan for stress management, including program participation. Again, we also recommend that teachers evaluate their skill at behavior and mental health management and obtain additional training, if needed. Further, we suggest that teacher preparation programs carefully evaluate their curriculum to ensure preservice teachers receive sufficient training to support students with social, emotional, and behavioral needs.
Systems Barriers and Potential Solutions
In addition to teacher-specific barriers, several institutional and systemic barriers can impede the adoption and successful implementation of classroom-based behavioral and mental health interventions. As previously mentioned, lack of teacher training can be caused by the system barrier of lack of opportunity. Other barriers include inadequate performance feedback, limited resources, and lack of flexibility and adaptability (Han & Weiss, 2005).
With respect to lack of training and supports, administrators play a key role in arranging for essential training as well as continued supervision with performance feedback (Han & Weiss, 2005). Moreover, administrators serve as gatekeepers for school-based interventions and programs and distribute funds toward practice (Hallinger & Heck, 1996). As such, it is critical that administrators are educated about the value and importance of classroom-based interventions and arrange for adequate training and resources.
Finally, lack of flexibility and adaptability can prove to be a significant systemic barrier. Flexibility within the school refers to the degree to which the system allows for modifications in plans and resources to provide needed supports, such as classroom-based and individual interventions to address emotional and behavioral needs. This may be partly attributed to the fact that schools have not traditionally focused on student mental health. We recommend capacity-building initiatives to allow for satisfactory levels of supports for mental health interventions, initiatives, and programs.
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