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Question
Question: How effective is the ‘school-wide positive behavioural interventions and supports’ (SWPBIS) prevention strategy in reducing behaviour problems in school children?
Patients: 12 344 elementary school children in kindergarten, first or second grade at participating schools when the study started (52.9% students, 46.1% Caucasian, 45.1% African American; 49.4% received free school meals and 12.9% special education services). Schools were matched on selected baseline characteristics, for example, enrolment. Children entering the school during the programme were entered into the study, and children who left the school were not followed up.
Setting: 37 public elementary schools, USA; recruitment dates not stated.
Intervention: The SWPBIS programme or wait list control. The SWPBIS applies social learning, behavioural learning and organisational principles across all students in the school in a consistent manner. Clear expectations of behaviour are taught to students and staff. Staff implementing SWPBIS (5–6 staff members per school) attended a 2-day initial training session and a 2-day booster session each year. Monthly support and assistance were provided to each school by trained behaviour support coaches. Comparison schools delayed implementing SWPBIS for 4 years.
Outcomes: The primary classroom teacher rated each child with the teacher observation of classroom adaptation—checklist (TOCA-C) to measure behavioural problems, prosocial behaviour, concentration problems, social-emotional functioning using a six-point Likert scale (1=never, 6=almost always). Data were recorded using TOCA-C at baseline and then each year for 4 years. Analyses took into account child characteristics (eg, gender, race, receipt of school meals and special education), clustering and school characteristics (eg, enrolment and student to teacher ratio).
Patient follow-up: 100% for schools, 91.4% for children at 4 years.
Methods
Design: Cluster randomised controlled trial (schools were the unit of randomisation).
Allocation: Not stated.
Blinding: Unblinded.
Follow-up period: 4 years.
Main results
Twenty-one schools (n=7,241) were randomised to SWPBIS and 16 schools to the control group (n=5594). At follow-up, SWPBIS reduced disruptive behaviour compared with the comparison (p<0.05, effect size (ES)=0.12). At follow-up, compared with the control, SWPBIS also reduced concentration problems (p<0.05, ES=0.08), improved emotion regulation (p<0.05, ES=−0.11), and improved prosocial behaviour (p<0.05, ES=−0.17). Analyses for interaction effects suggested that SWPBIS had the greatest effect on children who were in kindergarten when the intervention began for both emotion regulation (p<0.05) and prosocial behaviour (p<0.01). No other significant interactions were identified. At follow-up, SWPBIS also reduced office discipline referrals compared with the comparison (adjusted OR 0.67, 95% CI 0.57 to 0.79, p<0.001). There was a significant interaction with gender in this analysis, with an effect seen in girls but not in boys.
Conclusions
SWPBIS reduces behaviour problems and improves emotional regulation and prosocial behaviour in elementary school children over a 4-year period.
Abstracted from
Commentary
This School-Wide Positive Behaviour Support (SWPBS) study is innovative in that findings are based on a large-scale randomised trial in 37 elementary schools. High-quality training from the developers of the programme was provided, and fidelity ratings indicated high levels of implementation. An important contribution is that data are reported at the student level over multiple years. Teachers’ perceptions indicated improved emotional regulation and prosocial behaviours, fewer concentration problems, disruptive behaviours including aggression and office referrals for their students in SWPBS schools compared with students in non-SWPBS schools. These findings of improved teacher-rated behaviours may add credibility and should result in increased willingness of future teachers to implement SWPBS.1
Special precautions are necessary, however, for replication in new schools. First, implementation was supported at state and local levels. Similar findings may only be replicable with state-wide positive behaviour support models and in schools with sufficient resources for the teachers, including behavioural specialists, to support interventions. The present study also only reported a measure of ‘fidelity’ for tier 1 procedures. No information of tiers 2 and 3 interventions for the most at risk students was provided, yet these are the most likely students to have problems with emotion regulation and classroom-disruptive behaviours. Additional documentation of interventions beyond universal support is needed for practitioners.2 Analyses also indicated subgroups of students showing better outcomes. Girls in SWPBS schools had lower frequencies of office referrals than girls in comparison schools, but boys did not. Effects were also strongest for students who began SWPBS in kindergarten. Clearly, the benefits are great for the continued widespread adoption of SWPBS. The findings from Bradshaw and colleagues’ study provide important new evidence indicating that teachers view their students as much better socially and behaviourally as a result of their participation in SWPBS.
Footnotes
Sources of funding: Grants from Centers for Disease Control and Prevention, National Institute of Mental Health, Institute of Education Sciences; National Institutes of Health.
Footnotes
Competing interests None.