Office Referrals Research Articles

The Richard E. Shores TECBD Strand on Research in Emotional-Behavioral Disorders 2010

Some 20 years ago, a friend and colleague, Dr. Richard E. Shores, began a presentation strand at the Annual Teacher - Educators of Children with Behavioral Disorders Conference that was dedicated to show-casing and promoting research on issues related to children and youth with emotional-behavioral disorders. Dick was an early and highly influential contributor to the field of Special Education, playing many important roles but none more so than that of researcher. Even in the role of teacher-trainer, Dick was a very strong proponent of empirically based practices. He was, one might say, data-driven and he expected the same of others. Indeed, not only was Dick a major contributor to understanding the behavior and learning issues of EBD students through his own research, his influence has been equally and lastingly felt through mentoring of his students and colleagues, and their research. The Shores Research Strand at TECBD is one of those enduring contributions. It is not easy to do research in EBD. There have been and continue to be issues around the definition and characteristics, identification, varying prevalence estimates, settings in which EBD students are best served, as well as how the behavior and learning of EBD students can or should be measured and analyzed. These issue can and do pose considerable challenges to the researcher. Yet, given that EBD students are often the least well understood and some of the most problematic students with whom teachers, therapists and parents interact, the need for scientific analyses and empirically informed practices is paramount. Thus, the purpose of the Shores Research Strand was and remains two-fold: to honor and, reinforce those who pursue applied research with EBD children and youth, and by doing so, hopefully encourage others to pursue such research. Following Dick's retirement, several of us who were influenced by him felt it was important to continue his efforts and for the last few years we have coordinated the strand. Following Dick's lead we have sought to have both prominent and developing researchers share their research along a variety of specific topics. Too, we have sought presenters that might either provide very systematic, clearly delineated analyses as well as those that might bring to light new and intriguing findings. A signal aspect of this strand is that the presentations occur successively throughout a day. The sessions are capped by a discussion session in which a panel of established researchers in EBD react to the papers and the issues they raise and the attendees at the day's sessions are highly encouraged to engage in the discussion. Though it occurs late in the day this discussion is always well attended and the participation by presenters, discussants and audience is vigorous and enlightening. The papers in this year's special Shores Strand section of Education and Treatment of Children are good examples of the diversity of topics, analyses, and perspectives on EBD as well as research approaches and stages of research. For example, the paper by Alter, Brown and Pyle reports on a much-needed area of educational research with EBD students, a strategy-based intervention to increase the math word problem solving. Academically-related behavioral problems are common among students with EBD. As Alter and colleagues note, there is a relative paucity of math teaching research for this population and their study provides an excellent example of the use of single-subject methodology to begin to address this need and the basis for systematic replication. Though addressing a different topic, Hawken's paper describes a point in EBD research in which an empirically validated and well-established intervention, the Behavior Education Program (or Check-in Check-out) is systematically analyzed in terms of how its effects may be altered by the function of students' challenging behaviors. Although the study's outcomes were somewhat mixed regarding how assessed behavior function operated, the study did replicate BEP's overall reductive on student office referrals and BEP received positive social validity ratings. …

Office Discipline and Student Behavior: Does Race Matter?

Previous research has consistently found a relationship between student race and discipline. For example, African Americans are more likely than whites to be sent to the office or suspended. However, much of this work is limited by a lack of student behavior and school‐level variables. This study examined the effect of student race on office referrals in 45 elementary schools while controlling for ratings of student behavior and using a fixed effects model to remove school‐level influences. The results indicate that African American students are significantly more likely to be referred to the office than other racial groups. Neither student behavior nor school‐level factors are sufficient to explain this relationship; however, these factors do dampen the effect of race on discipline, suggesting that previous work has reported inflated coefficients. Given the historical association between exclusionary school discipline and later negative life outcomes, this issue warrants increased attention. Implications and directions for future research are discussed.

Patterns in Office Referral Data by Grade, Race/Ethnicity and Gender.

Research supports that office referral data is useful in informing programmatic decisions and in planning interventions such as Positive Behavior Interventions and Supports (PBIS). Knowledge of the different patterns of office referrals may facilitate the development of interventions that are targeted to specific groups of students. This study examines patterns in office referrals within an urban district by gender, race/ethnicity and grade. Findings reveal that there are clear differences by grade that appear to be related to developmental level, with greater numbers of referrals for aggression in younger students (grades K-8), greater numbers of referrals for disrespectful behavior in middle school students (grades 7-8), and greater numbers of referrals for attendance problems in high school students. There were also gender differences in the rate and type of referrals, with significantly more referrals for boys' delinquent and aggressive behavior than girls, which may relate to how schools define unacceptable behavior and the method used to collect this data. Finally, there were differences by race/ethnicity, in that there were significantly more referrals for African American/black students than Hispanic students, which suggest that schools need to consider students' racial/ethnic background in the development of behavioral expectations.

Examining the Challenges of Recruiting Women Into a Cardiac Rehabilitation Clinical Trial

To examine the challenges of recruiting women for a 5-year cardiac rehabilitation randomized clinical trial; the aims of the study were to describe the range of recruitment sources, examine the myriad of factors contributing to ineligibility and nonparticipation of women during protocol screening, and discuss the challenges of enrolling women in the trial. The Women's-Only Phase II Cardiac Rehabilitation program used an experimental design with 2 treatment groups. Eligible participants included women who were (1) diagnosed with a myocardial infarction or stable angina or had undergone coronary revascularization within the last 12 months; (2) able to read, write, and speak English; and (3) older than 21 years. Responses to multiple recruitment strategies including automatic hospital referrals, physician office referrals, mass mailings, media advertisements, and community outreach are described. Reasons for ineligibility and nonparticipation in the trial are explored. Automatic hospital order was the largest source of referral (n = 1,367, 81%) accounting for the highest enrollment rate of women (n = 184, 73%). The barriers to enrollment into the cardiac rehabilitation clinical trial included patient-oriented, provider-oriented, and programmatic factors. Of the referral sources, 52% were screened ineligible for provider-oriented reasons, 31% were ineligible due to patient-oriented factors, and 17.4% were linked to the study protocol. Study nonparticipation of those eligible (73.8%) was largely associated with patient-oriented factors (65.2%), with far less due to provider-related factors (4%) or study-related factors (3.4%). Standing hospital orders facilitated enrollment to the cardiac rehabilitation clinical trial, yet women failed to participate predominantly due to significant patient-oriented biopsychosocial barriers.

The Implementation of Positive Behavioral Support in an Elementary School: Processes, Procedures, and Outcomes

This article presents the processes and outcomes of a year of School-Wide Positive Behavior Support in a North Texas elementary school serving kindergarten through grade 3 students. Included is a description of a school treatment package that incorporated components such as facilitation of the teaming process, a lottery-type system of intermittent reinforcement, mystery motivators, and recognition assemblies, all targeted at increased student compliance with school rules. Positive outcomes included: (a) a reduction in the number of office referrals; (b) reduced frequency of rules-based violations on the part of students; (c) reduced use of punitive consequences such as time-outs, written reprimands, and student conferences on the part of the faculty and administration; and (d) an increase in scores on a state-mandated academic achievement assessment administered to grade 3 students.

Evaluation of a School-based Mentoring Program for At-Risk Middle School Youth

This study investigated the impact of a school-based mentoring program on at-risk students' office referrals, unexcused absences, and school attitude. Students who participated in the mentoring program had statistically significant reductions in office referrals and statistically significant improvements in school attitude. Based on an analysis of mentor interview responses and log entries, mentors were divided into “viewed positively” mentors and “questioned-impact” mentors. Viewed positively mentors reported fewer office referrals, met more consistently with mentees, reported more relaxed mentoring sessions, and shared food and played games more often with their mentees than “questioned-impact” mentors. The results of the study are discussed in terms of the available research on school-based mentoring. In addition, suggestions for future research are provided.

Demography of Problem Behavior in Elementary Schools

The complex mix of systematic and unsystematic discipline that characterizes most schools creates heightened potential for variation and violation in school and classroom behavior. The challenge of maintaining order intensifies with teachers' concerns about the growing inclusion of students with emotional and behavioral problems in general education classrooms and the general levels of diversity common in America's schools. Little is known about the demography (i.e., who, what, where, when, how) of behavior requiring attention from administrators and other professionals in elementary schools. The need for comprehensive and continuous monitoring of what goes on in schools within the context of increasing appropriate behavior and reducing inappropriate behavior is clear. In this research, we investigated the extent of variation in problem behavior at the school and classroom level. We evaluated office referrals, reasons for removing students from the classroom for discipline, and consistency of reasons for office referrals in schools using different recording systems. Rates of referral differed greatly among teachers within schools and a small group of students accounted for most of the documented behavior problems. The results have implications for efforts to improve academic and behavior instruction in elementary classrooms, which we discuss.

Making Schools Safe

The purpose of this investigation was to study how an intervention decreased violence, and created and maintained a positive school environment, and safe school building. Also, this investigation considered how an intervention impacted student learning and academic progress, and positive and appropriate student relating and problem solving among peers and with adults. A school-wide, prosocial behavior management system, The Project ACHIEVE Social Skills Program (Knoff, 2000), was used and the value of the program was determined using behavioral, observational, self-report, quantitative, and qualitative measures. Participants in the study were all school personnel, students in grades 3-6, and their parents/guardians in an elementary public school in an ethnically diverse school district. A similar elementary school in the district provided some comparison data. Pre- and post-intervention data suggested that the school-wide intervention was effective in improving prosocial behavior, in increasing students' appropriate and positive behavioral choices, in decreasing student disruptiveness in classrooms and common areas, and in decreasing disciplinary office referrals and suspensions. Implications of this field-based study are discussed in terms of applied school practice.

A Rational Emotive Behavioral Approach to Improve Anger Management and Reduce Office Referrals in Middle School Children

Sixteen seventh and eighth graders previously identified as having behavioral problems earned significantly higher post-test scores on a test of REBT concepts immediately after participation in a Rational Emotive Behavioral Therapy (REBT) training program, and this knowledge was retained after an 8-week follow-up period (p < .01). Additionally, the 7th graders' post-test scores were significantly higher than the pre-test scores of the 8th graders (who served as a waiting control group). Although the number of office referrals did not decrease sufficiently to produce a statistically significant reduction from baseline to intervention or from baseline to follow-up, moderate to large effect sizes were found. Participants' level of rational thinking and (stated) action were evaluated through written responses to anger-inducing scenarios; rationality of stated actions increased and rationality of thinking increased for the 7th graders and decreased for the 8th graders. Children were successful in acquiring REBT-based principles, and to some extent, in applying these to reduce aggressive behavior. Recommendations for school psychologists in using a rational emotive behavioral approach with middle school Students are provided.

Whole‐school positive behaviour support: effects on student discipline problems and academic performance

Many students attending public schools exhibit discipline problems such as disruptive classroom behaviour, vandalism, bullying, and violence. Establishing effective discipline practices is critical to ensure academic success and to provide a safe learning environment. In this article, we describe the effects of whole‐school positive behaviour support on discipline problems and academic outcomes of students enrolled in an urban elementary school. The whole‐school model was designed through technical assistance consultation with teachers that emphasized: (1) improving instructional methods; (2) formulating behavioural expectations; (3) increasing classroom activity engagement; (4) reinforcing positive performance; and (5) monitoring efficacy through data‐based evaluation. As compared to a pre‐intervention phase, the whole‐school intervention was associated with decreased discipline problems (office referrals and school suspensions) over the course of several academic years. Student academic performance, as measured by standardized tests of reading and mathematics skills, improved contemporaneously with intervention. Issues related to whole‐school approaches to student discipline and the contributions of positive behaviour support are discussed.

An Analysis of Leadership Teams' Perceptions of Positive Behavior Support and the Outcomes of Typically Developing and At-Risk Students in Their Schools

Positive behavioral supports (PBS) have been receiving increased visibility and use in schools nationally. In the state of Washington, schoolwide and individualized positive behavioral supports were recommended as a model for schools by the state agencies of education and human service in 1999. Since then, four demonstration schools have been implementing schoolwide PBS strategies and supports targeted to reach the needs of all students in the school. In this article, we report school-level changes as assessed by leadership teams in the school, along with student-level changes in social skills and problem behaviors. Results are reported on a sample of 68 typically developing students and 56 students who were considered at risk of developing emotional or behavioral problems. Results suggest that the schools made consistent progress from 1999-2002 in implementing the schoolwide PBS model and that students' social skills improved while their problem behaviors decreased. In addition, social skills and behavior problems were found to be related to the number of office referrals students received. Finally, student referrals to prereferral and multidisciplinary team meetings were at or below expected levels, and less than 25% of at-risk students were identified for special education services.

Using Office Referral Records in School Violence Research

SUMMARY Perhaps the most “naturally occurring” data on school misbehavior and aggression are school discipline data, including office referrals, suspensions, and expulsion data. These data constitute the most common markers of school discipline status available on school campuses. There is, however, very little information available in professional or research literature about the reliability and validity of office referrals. This article examines the sources of error that enter into the collection and use of office referrals. Despite these sources of errors, this article documents the importance of considering how office referral data provide information about how discipline systems are functioning on a school campus. Guidelines are provided for utilizing disciplinary data for school safety and school policy planning.

Breaking the cycle of office referrals and suspensions: defensive management

This paper focuses on a strategy—Defensive Management—designed to assist teachers to better manage non‐compliance and defiance in the classroom, with the ultimate goal of reducing disciplinary referrals and flow‐on suspensions and exclusions from school. Non‐compliance and defiance are behaviours that teachers find particularly challenging and, traditionally, teachers have responded provocatively and often unsuccessfully when faced with instances of such behaviour. Drawing on an analogy with Defensive Driving, two groups of teachers (pre‐service and primary) were introduced to a strategy developed to help them avoid unproductive conflict (collisions) with students and the harm that such encounters typically result in. The findings of an exploratory study on the use of Defensive Management are reported.

Evaluating student discipline practices in a public school through behavioral assessment of office referrals.

Office discipline referrals are a common practice in public schools to address students' problem behaviors. The authors report two descriptive studies in a public elementary-middle school to illustrate frequency of office referrals as an evaluative data source. Study I was a behavioral assessment of office referrals to determine the types of discipline problems confronting school personnel and the distribution of referrals among teachers, students, and grade level. In Study II, a fifth-grade class that had the most office referrals in the school received whole-class and individual-student interventions that produced a decrease in the number of referrals. These findings support use of office referrals as a readily available index by which to identify school discipline problems, design interventions, and evaluate outcome.

Employing Descriptive Functional Assessment Methods to Assess Low-Rate, High-Intensity Behaviors

Low-rate, high-intensity behaviors, such as aggression and violence, are not uncommon in school settings. This study evaluated the utility of descriptive methods (e.g., record reviews, interviews) of functional assessment in documenting behavior function for low-rate, high-intensity behaviors. The participant, a 13-year-old boy with ADHD, exhibited low rates of aggression toward peers in school. A comprehensive record review of archival data sources (i.e., office referrals, previous school records) indicated aggression was more likely to occur during unstructured activities (e.g., recess), primarily following negative peer approaches (e.g., teasing, name-calling, or physical aggression). Descriptive information and observations led to the development and selection of potential intervention strategies. Direct observational data indicated that the peer buddy intervention was effective in reducing the number of inappropriate responses to negative peer approaches, as well as the number of aggressive incidents. Implications for utilizing descriptive data to document predictor variables and maintaining variables for low-rate, high-intensity behaviors are discussed.

The Color of Discipline: Sources of Racial and Gender Disproportionality in School Punishment

The disproportionate discipline of African-American students has been extensively documented; yet the reasons for those disparities are less well understood. Drawing upon one year of middle-school disciplinary data for an urban school district, we explored three of the most commonly offered hypotheses for disproportionate discipline based on gender, race, and socioeconomic status. Racial and gender disparities in office referrals, suspensions, and expulsions were somewhat more robust than socioeconomic differences. Both racial and gender differences remained when controlling for socioeconomic status. Finally, although evidence emerged that boys engage more frequently in a broad range of disruptive behavior, there were no similar findings for race. Rather, there appeared to be a differential pattern of treatment, originating at the classroom level, wherein African-American students are referred to the office for infractions that are more subjective in interpretation. Implications for teacher training and structural reform are explored.

Predicting violence from school misbehavior: Promises and perils

AbstractThis article considers the issue of predicting violence committed by students on school campuses through the use of school discipline indices such as office referrals, suspensions, and expulsions. The existing research on incidents of school discipline markers is reviewed as well as sources of variation due to student characteristics and classroom or school‐wide practices. Challenges in making accurate predictions about future behavior at school are outlined. © 2001 John Wiley &amp; Sons, Inc.

The effectiveness of peer mediation in a low-SES rural elementary school

Thirty 6th-8th-grade students were trained to serve as mediators for peers in conflict. Student mediators were taught conflict resolution and mediation techniques from the Conflict Resolution Unlimited (1995) manual. Mediation was available to students school-wide (N = 798); disputants were given the option to go to mediation or to the principal for resolutions. Mediators' responses to written tests indicated increased knowledge of mediation skills after training, which was maintained at 6-week follow-up. During the 6 weeks following training, 32 of 34 mediations resulted in satisfactory conflict resolution. School-wide suspensions decreased during the intervention year, as compared to 3 years of baseline data. In addition, mediators' own office referrals were lower than a randomly selected matched control group. Further, mediators' current referrals were lower than in the previous year, while there was no such change for the control group. Results and process variables of the implementation are discussed. © 2000 John Wiley & Sons, Inc.

Elective Neurosurgical Office Consultations: How Well Are Patients Informed?

A prospective study was performed on elective neurosurgical office referrals to one neurosurgeon at the Toronto Hospital from September 1988 to May 1996. Patient level of information was tested using the chisquare test on the study population of 2,017 patients grouped according to the type of referring doctor and regional category of diagnosis. There was a statistically significant difference in the degree of knowledge of referred patients according to the type of referring doctor (p < 0.008). In addition there was statistical significance found in the difference in degree of knowledge among patients referred with the various regional categories of disease (p < 0.008). Patients referred by family physicians are not as informed as to the nature of their neurosurgical referral as those referred by neurologists and other specialists. Furthermore, patients with an intracranial diagnosis had a greater level of knowledge about their referral than those patients referred for spinal, peripheral nerve or other diagnoses.

Compiling School Base Rates for Disruptive Behaviors from Student Disciplinary Referral Data

Teacher-completed incident reports are commonly generated at most public schools when a student is sent to the principal's office for disciplinary reasons, resulting in an archival record of student office referrals. Incident reports offer several advantages for compiling base rates of disruptive behaviors: They use a standardized format for data collection, are usually completed close to the time of the student's behavioral infraction, and contain teacher-reported information about student behavior that can easily be compiled into building base rates. However, disciplinary reports can reflect teacher bias in recording student behaviors, differing levels of teacher tolerance of disruptive student behaviors, and the absence of independent, objective verification of disruptive student behaviors. An extended case study is provided in which student disciplinary office referrals are analyzed across a 3-year period at two elementary schools in an urban school district. The results of the analysis indicate both a stable rate of disciplinary referral of student subgroups in both schools across school years and a high and stable rate of recidivism, or re-referral, for individual students within a school year. Information from the case example suggests that, despite their limitations, disciplinary referrals can be compiled into a database that provides the school consultant with useful information about emerging patterns of difficulty in student-teacher interactions.