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A Meta-Analysis of the Definition, Features, and Effects of Secondary Prevention Interventions

A Meta-Analysis of the Definition, Features, and Effects of Secondary Prevention Interventions. Pei-Yu Chen& Carol Ann Davis University of Washington. Presentation Outline. Why do we focus on SWPBS secondary prevention intervention? What is SWPBS secondary prevention intervention?

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A Meta-Analysis of the Definition, Features, and Effects of Secondary Prevention Interventions

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  1. A Meta-Analysis of the Definition, Features, and Effects of Secondary Prevention Interventions Pei-Yu Chen& Carol Ann Davis University of Washington

  2. Presentation Outline • Why do we focus on SWPBS secondary prevention intervention? • What is SWPBS secondary prevention intervention? • Definitions and Key features • How does the existing evidence reflect the key features of SWPBS secondary prevention? • What do we know about the secondary prevention intervention? • What are questions about secondary prevention intervention still left not answered?

  3. A brief review of SWPBS model Source: PBIS website http://www.pbis.org/schoolwide.htm

  4. Why do we focus on SWPBS secondary prevention intervention? • More than 50 studies evaluated the effects of SWPBS primary intervention (Horner & Sugai, 2007). • decreased incidents of office discipline referral • improved students’ perception of school safety and academic outcomes • The effects of secondary and tertiary prevention interventions within the SWPBS model remained less clear to the researchers (McCurdy et al., 2007). • might be a result of the lack of consensus on core elements of secondary intervention as a field

  5. Reviewing the SWPBS secondary prevention intervention • Investigated the definition and key elements of SWPBS secondary prevention intervention • Applied the key elements as evaluating criteria to examine existing secondary prevention studies

  6. What is SWPBS secondary prevention intervention? • Researchers have agreed that SWPBS secondary prevention intervention is: • for students who are not responding to primary prevention interventions • for students who are at risk for developing serious and chronicbehavioral problems • for small groups or individualstudent

  7. using systematic feedback, building connection with key adults at school, increasing collaboration among school staff, home, and community, implementing a reward system, making ecological or curricula modifications, providing ample practice opportunities to increase social and academic competence early screening for intervention continuously available services rapid access to intervention, requiring low teacher efforts, being implemented by school staff, interventions consistent with school expectations, applying flexible interventions based on assessment, conducting Functional Assessment, providing students choices to participate in the intervention, devoting adequate school resources, continuously monitoring students’ progress Key elements of SWPBS secondary prevention intervention • A wide range of core elements of secondary prevention are proposed by researchers (Baker, 2005, Korb, 2006, Hawken & O’Neill, 2006, PBIS website, 2008, Scott et al., 2002, Sugai & Horner, 2007), including

  8. Applied the key elements proposed by PBIS website to further examine existing evidence PBIS secondary intervention key elements continuously available services rapid access to intervention, requiring low teacher efforts, being implemented by school staff, interventions consistent with school expectations, applying flexible interventions based on assessment, conducting Functional Assessment, providing students choices to participate in the intervention, devoting adequate school resources, continuously monitoring students’ progress Key elements (continued.) Great variability among researchers about what defines a secondary intervention

  9. Method

  10. Recruiting studies: • Peer-reviewed empirical studies • Education Resources Information Center (ERIC) and PsycINFO database • Hand-search articles identified through the initial searches • Combination of descriptors: • secondary intervention • secondary prevention • targeted intervention • school-wide PBS (SWPBS) • academic intervention • tutoring • positive behavior support • small group intervention • social skill instruction • conflict resolution skills • social skill club • check and connect • Behavior Education Program

  11. Inclusion criteria: • Published between 1995 to 2007 • Included empirical data to verify the efficacy of an intervention • Conducted in school settings • Included behavioral and/or academic performance as outcome measures

  12. 38 studies were identified through the search process • Studies were categorized into 6 types of interventions • self-determination (BEP/CICO/Check and Connect) (n=11), • social skills training (n=5), • reading interventions (n=7), • environmental adjustments (n=1), • behavioral interventions (n=1), • multi-component interventions (n=13) • combine social skills training and another type of the above-mentioned interventions

  13. The 38 articles were divided into two groups • within the SWPBS context • out of the SWPBS context • Inclusion criteria of the “in SWPBS context” studies: • studies self-identified as secondary prevention interventions, and/or • a description of primary intervention in the study settings

  14. Half of the studies (n=19) were conducted within the context of SWPBS. • Studies conducted out of the SWPBS context were also included in the review to support the efficacy of the intervention • To evaluate whether the intervention is an evidence-based practice

  15. Data analysis • Each type of secondary intervention is analyzed by • The extent to which the key elements is addressed across studies • Number of studies within and out of SWPBS context • Design of the studies • Number of replication across subjects, researchers, and settings

  16. Results

  17. “Within SWPBS context”Self-Determination (BEP/CICO/ Check & Connect) studies and key elements

  18. Self-Determination(BEP/CICO/Check and Connect) (n=11)

  19. So, what do we learn about Self-determination (BEP/CICO & Check and Connect)? Christenson, & Sinclair et al. (1998-2005) APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

  20. “Within SWPBS context”Social Skills Training studies and key elements

  21. social skills training (n=5) • 1/5 study is conducted in a self-contained classroom for students with disabilities

  22. So, what do we learn about Social Skills Training studies? APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

  23. “Within SWPBS context”Reading Intervention studies and key elements

  24. Reading Interventions (n=7) • 2/7 studies are conducted in self-contained classrooms • 1/7 study is conducted in a resource room

  25. So, what do we learn about Reading Intervention studies? APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

  26. Behavioral interventions (n=1)

  27. So, what do we learn about Behavioral Intervention studies? APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

  28. “Within SWPBS context”Environmental Adjustment studies and key elements

  29. Environmental Arrangement (n=1) • The study is conducted in a self-contained EBD classroom

  30. So, what do we learn about Environmental Adjustment studies? APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

  31. “Within SWPBS context” Multi-component Intervention studies and key elements

  32. Multi-component interventions (n=13)

  33. So, what do we learn about Multi-component interventions? APA guideline of evidence-based practice (Lonigan, Elbert, & Johnson 1998)

  34. Combination of the interventions • If we look at each sub-type of intervention separately, more studies are needed to support the efficacy of each sub-type multi-component intervention.

  35. Overall, what do we know about the secondary prevention intervention? • Small number of studies are conducted within the context of SWPBS. • More studies are needed to support the efficacy of each type of SWPBS secondary prevention interventions • Three key elements listed on the PBIS website are addressed by most of the “within SWPBS context” intervention, including • requiring low teacher efforts • interventions consistent with school expectations • continuously monitoring students’ progress

  36. Discussion

  37. What are the questions about secondary prevention intervention still left not answered? • Most of the interventions did not address 7/10 of the key elements. Whether schools could apply these elements as criteria to select secondary intervention is unknown. • What makes an intervention a secondary intervention?

  38. The difference between secondary and tertiary prevention intervention remain blurred. • Functional Assessment • Small group and individual interventions • Long-term effects of the interventions are uncertain as a result of brief intervention phases.

  39. This may be a call to researchers or authors to more carefully describe the context under which the intervention is being conducted.

  40. Thank you Questions and Feedback cadavis1@u.washington.edu

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