The demand for preventive and easily implemented interventions to address the needs of children with significant behavioral challenges in general education settings is well-documented. First Step to Success is an evidenced-based program to address challenging behavior in preschool and elementary-school settings with a 20-year history of successful implementation (Walker et al., 1997; Walker et al., 2014b). A revision of the intervention, called First Step Next (Walker et al., 2015), was designed to (1) standardize the program components across preschool and elementary settings; (2) make the program more user friendly for implementers, including parents; and (3) increase the program’s efficacy by adding new components and updating existing ones. The current study used a mixed-method approach to compare process data collected from a previous efficacy trial of the original preschool version of First Step (Feil et al., 2014) to the revised version (First Step Next; Feil et al., 2020). Overall procedural fidelity ratings were high for both program variations. Further, alliance and satisfaction ratings, as per parent- and teacher-report, were acceptable, although there were some divergent findings between parent and teacher perspectives at the item level. This study provides support for the feasibility of successfully implementing First Step Next with young children and their families in preschool settings.

Early intervention efforts have been effective in reducing disruptive behaviors and the probability of poor developmental outcomes. Early interventions include common practice elements to improve social functioning and decrease problem behaviors that disrupt the teaching-learning process. The First Step Next intervention has been well validated across early childhood and early elementary settings. In the present article, we provide a best-evidence synthesis of five randomized controlled replication studies between 2009 and 2021. Collectively, these studies show the intervention has resulted in small to large effect sizes and statistically significant improvements, compared with students randomized to control conditions, on multiple indicators of prosocial and problem behavior. The current synthesis focuses on a range of outcomes across elementary and preschool populations, as well as implementation fidelity and social validity ratings, to help school professionals in determining whether First Step Next might be useful in their efforts to support students at risk of school failure.

This study examines the cost effectiveness of two interventions for disruptive behavior problems: First Step Next (FSN), a school-based intervention, and a multicomponent intervention that combined FSN with a home-based intervention, homeBase (hB). Analyses were based on findings from a large-scale comparative efficacy trial in the United States (Frey et al., 2022). Intervention costs were estimated using an activities-based ingredients method (Levin & McEwan, 2001). For each disruptive behavior examined (attention-deficit/hyperactivity disorder [ADHD], conduct disorder [CD], and comorbid ADHD and CD), we defined intervention response as movement from the clinical range into the borderline or normative range or from the borderline range into the normative range at post-intervention. Comparative cost-effectiveness analyses involved calculating incremental cost-effectiveness ratios (ICERs), which showed that the combined intervention was always more cost effective. Improvement in comorbid ADHD and CD was the costliest to achieve, followed by CD, and then ADHD. Sensitivity analyses showed that FSN + hB had a high probability of being cost effective across a range of estimates, indicating stakeholder willingness to pay to reduce disruptive behavior problems. This study expands the literature by estimating the costs of implementing a school-based intervention alone or alongside a home-based intervention with elementary students and comparing their cost effectiveness.

Disruptive behavior disorders in childhood are increasingly pervasive and associated with numerous, negative long-term outcomes. The current study examined whether adding a brief, home-visitation intervention to an existing, multi-component (child and teacher) intervention, would improve social-emotional and behavioral outcomes for young children with challenging behavior in home and school settings who required intensive support. A total of 379 teacher-parent-student triads were screened for elevated levels of behavioral risk in school and home settings and then randomly assigned to school only intervention (i.e., teacher and student components), home only intervention (i.e., parent), both combined, or business-as-usual control conditions. We examined baseline and posttest outcomes across prosocial behavior, problem behavior, and academic domains. The results demonstrated substantial support for the teacher and child-focused condition and combined conditions, and modest support for the parent-focused condition. The study advances the literature by increasing the knowledge base related to these interventions implemented alone and in combination.

While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141-$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages.

This chapter describes how consulting child psychiatrists and psychologists can best assist school teams who are evaluating students for serious emotionally disturbed (SED) placement. It presents a consultation model that is largely based on how child psychiatrists and psychologists routinely assess children and their families. The chapter reviews results from an extensive study of objective characteristics of SED students, which identified important distinguishing variables: serious global dys-function, complex diagnostic pictures, and family stressors such as abuse and parental psychiatric illness. The treatment of SED students leaves much to be desired, particularly in regard to collaboration between educators and mental health professionals. The procedure is based on the comprehensive evaluation of a new child and family, which is typically practiced by child psychiatrists and psychologists. The diagnostic issue of conduct disorder in SED students is complex, indicating that much of the debate to exclude conduct disorder may be oversimplified.

Children with autism spectrum disorder (ASD) tend to receive several related services during their early school years. In this study, we followed 70 preschoolers with ASD and used parent reports to document the intensity of these services over a 4-year period, in relation to children's outcomes in three domains. While behavioral difficulties improved, social skills and adaptive abilities in children with ASD tended to remain impaired across development. We found that very young children with ASD received behavioral services regardless of need and overall standardized measures of behavioral difficulties showed improvement over 4 years. Further, over time. behavioral services were correlated to children's needs. Standardized measures of social skills improved significantly but scores remained impaired and services specific to this skill area were few. Adaptive abilities remained significantly impaired however, and adaptive services were very few, with little relationship to abilities over time.

Preschoolers with elevated anxiety symptoms are at high risk not only of developing more severe mental health disorders in later life but are also apt to respond more poorly to intervention if they present with comorbid disruptive behavior. Because early signs of anxiety disorders may not be recognized as such in preschool settings, many children selected for Tier 2 interventions that target externalizing problem behaviors may also have co-occurring anxiety symptoms and disorders. The First Step to Success intervention has recently been adapted for preschoolers with externalizing behaviors and was found to be efficacious in a randomized controlled trial. The current report examines effects of the First Step intervention on a subsample of 38 preschoolers with comorbid anxiety symptoms. Compared to usual-care controls, preschoolers who were assigned to the First Step intervention demonstrated medium-to-large effects in reducing externalizing behavior and improving social functioning outcomes, but had small effects for reductions in internalizing behaviors. Implications for intervening with preschoolers at risk of comorbid disruptive and anxiety behaviors are discussed.

Preschool children with Autism Spectrum Disorder (ASD) may not always be recognized as such during their early years, but some of their behavioral problems may nonetheless prompt a referral for behavioral intervention. Whether such an intervention brings any benefit has not been well studied. We identified a subsample of 34 preschool children at risk for autism spectrum disorder from a large randomized controlled trial (N = 126) of the First Step to Success program. Children at risk of developing ASD demonstrated significant improvements on seven of 11 outcome measures and on a responder analyses based on symptom severity. Process and fidelity measures also suggested that First Step was both feasible and socially acceptable. Implications for early intervention for children at risk of developing ASD are discussed.

This study evaluated the efficacy of the Preschool First Step (PFS) to Success early intervention for children at risk for attention deficit hyperactivity disorder (ADHD). PFS is a targeted intervention for children 3-5 years old with externalizing behavior problems and addresses secondary prevention goals and objectives. As part of a larger multisite, randomized controlled trial, the efficacy of the PFS program was evaluated on a subsample of 45 children who also had elevated comorbid ADHD symptoms as rated by parents and teachers. The PFS program was found to produce significantly higher social skills, and significantly fewer behavior problems across a variety of teacher- and parent-reported measures at postintervention. Effect sizes for teacher- reported effects were large across a variety of social competency indicators, including those specific to ADHD. Effect sizes for parent-reported social skills and problem behaviors were medium. Although not specifically designed for preschoolers at risk for comorbid ADHD, this generic behavioral intervention appeared to be successful for this population. Implications and limitations of the study are discussed.

This article is focused on the initial development and trial testing of a brief teacher rating tool that can be used for universal screening and tracking of instructionally relevant forms of student social behavior over time. A 12-item scale is described in which teachers make judgments about student performance on a skills-based rather than a frequency-based rating dimension. We believe teachers are expert judges of student skill levels in social behaviors and academic enablers that are of critical importance to school success (i.e., enhanced social-behavioral adjustment and academic performance) as opposed to frequency- or rate-based estimates that are less essential to a teacher's instruction and management of the classroom. The Elementary Social Behavior Assessment (ESBA) asks teachers to judge each student's performance regarding evaluative criteria based on their teaching and management of the classroom. Case-study illustrations of the universal screening and tracking functions of the ESBA are provided.

The field of early intervention is currently faced with the challenge of reducing the prevalence of antisocial behavior in children. Longitudinal outcomes research indicates that increased antisocial behavior and impairments in social competence skills during the preschool years often serve as harbingers of future adjustment problems in a number of domains including mental health, interpersonal relations, and academic achievement. This article reports the results of a cross-site randomized controlled trial, in which 128 preschool children with challenging behaviors were assigned to either a Preschool First Step to Success (PFS) intervention (i.e., experimental) or a usual-care (i.e., control) group. Regression analyses indicated that children assigned to the Preschool First Step intervention had significantly higher social skills, and significantly fewer behavior problems, across a variety of teacher- and parent-reported measures at postintervention. Effect sizes for teacher-reported effects ranged from medium to large across a variety of social competency indicators; effect sizes for parent-reported social skills and problem behaviors were small to medium, respectively. These results suggest that the preschool adaptation of the First Step intervention program provides early intervention participants, staff, and professionals with a viable intervention option to address emerging antisocial behavior and externalizing behavior disorders prior to school entry.

This article presents a collaborative study conducted in a large urban school district, in which the authors surveyed 55 clinicians within the special education system, with a focus on the mental health services provided to students whowere receiving related-services counseling as a mandated component of their individualized education plan. Participating clinicians reported on their own characteristics, the services they provided, and the work environment. Results suggest that the services provided varied substantially among clinicians in terms of the types of treatments provided, intervention format, and treatment duration. Indicators of high-quality services (manual use, parent involvement, care coordination, and standardized assessments) also varied. Clinicians with specialized training, younger and less experienced clinicians, and clinicians working in cooperative climates with less role overload, reported engaging in a higher quality of care of students within special education. These findings have implications for improving quality of care within special education.

In this chapter, we examined issues related to research design and research management as applied to scientific research conducted in applied school settings. In terms of research design, randomized controlled trials (RCTs) have an important role to play in advancing a scientific agenda for school-based research. However, given their enormous cost and complexity, it is important to carefully time their implementation in the development cycle. We suggested that the use of RCTs is most appropriate in the later stages of the development cycle when the focus is on demonstrating the efficacy and/or effectiveness of an intervention and establishing its generalizability under the real world conditions of schooling. We also recommended establishing a hierarchy of evidence for an intervention that involves implementing a cost-efficient mix of single case, quasi-experimental, and true experimental designs where appropriate and feasible. In examining issues related to the management of research and the implementation of a knowledge development agenda for schools, it has become apparent that treatment integrity is a keystone variable. We discussed the importance of treatment integrity, with attention to the impact on internal and external validity. Finally, we offered practical considerations to support high-quality, respectful school-based inquiry.

OBJECTIVE: To describe a tiered approach to identifying and addressing developmental and health concerns among low-income preschool children in Head Start.METHODS: Analytic sample consisted of 3- to 5-year-old Head Start students (n = 1171) from 14 centers in Los Angeles County serving predominantly Latino families during 2008-2009. All Head Start students were screened for developmental and health concerns and assigned to 1 of 3 tiers of intervention need: Tier 1 children needed only the usual Head Start curriculum, Tier 2 children needed targeted interventions (excluding special education), and Tier 3 students received special education services. Logistic regressions were used to analyze predictors of each tier, with screening results and socio-demographic variables as covariates.RESULTS: Sixty-nine percent of children were in Tier 1, 25% in Tier 2, and 6% in Tier 3. Tier 2 children most commonly needed mental health services and were less likely than those in Tier 1 to be from primarily English-speaking homes (odds ratio = 0.6, P < .01). Tier 3 children were significantly less likely to be female than Tier 2 children (odds ratio = 0.4, P < .05).CONCLUSIONS: More than one-quarter of low-income children not in special education may need targeted interventions, particularly mental health services. Although Head Start agencies are required to identify and address these needs, many other early education and clinical settings do not. Establishing screening and intervention guidelines for this intermediate-risk group represents a key policy gap for the child health and education systems.