Positive Behavior Support Research Articles

Training and Technical Assistance Increase the Fidelity of Implementation of a Universal Prevention Initiative in Rural Schools: Results from a 3-Year Cluster-Randomized Trial.

The need for well-implemented evidence-based interventions (EBIs) for the prevention of behavioral issues among children and adolescents is substantial. In rural areas, the need often matches or surpasses that of urban areas. Schools have a wide reach for prevention-focused EBIs. However, implementation in rural schools is often hindered by limited resources and capacity. Rural School Support Strategies (RS3) are a bundle of implementation supports that address implementation challenges in rural settings. They include providing additional leadership and coaching training, individualized technical assistance (mostly virtual), and monthly meetings of a virtual learning collaborative. A cluster-randomized Hybrid Type 3 implementation-effectiveness trial tested RS3 for implementing school-wide positive behavioral interventions and supports (PBIS), a universal prevention approach to improving student behavior, academic outcomes, and school climate. Forty rural schools received a multi-day training on PBIS each summer for 3years. Half were randomized to also receive RS3 support. Linear and logistic regression models examined the effect of treatment condition and dosage of support on implementation fidelity for Tier 1 (universal) PBIS. Condition and dosage (number of hours) of support increased the odds of schools achieving the 70% threshold for adequate implementation fidelity. In the first year, the higher dosage of technical assistance events increased the likelihood of schools reaching fidelity, whereas later in the trial, the higher dosage of attendance at the virtual learning collaborative sessions yielded significant improvements in fidelity. Implications for accelerating the implementation of universal prevention initiatives in schools-particularly in rural settings-are discussed. This study was prospectively registered on ClinicalTrials.gov (NCT03736395), on November 9, 2018.

Using Student Voice to Improve Schoolwide PBIS Implementation in Secondary Schools

Implementation of a culturally responsive positive behavioral interventions and supports (PBIS) framework is associated with positive outcomes for secondary students when implemented schoolwide. Yet, educators often report more implementation challenges in secondary school as compared to elementary school settings. Difficulties obtaining student buy-in may make PBIS implementation more challenging. Secondary student input on school climate and discipline systems could be an integral source of information for educators who are working to establish more effective behavioral support systems. Using authentic student voice data from an example secondary school, the authors provide a research-based approach to amplifying student voice and increasing student involvement in culturally responsive PBIS.

Special Education Teacher Preparation in PBIS for Students With Extensive Support Needs

ABSTRACTSchool‐wide positive behavioral interventions and supports (PBIS) is a multi‐tiered system of supports that promotes a safe and equitable school environment by supporting the social, emotional, and behavioral needs of all students, including those with extensive support needs (ESN). Research suggests not all students with ESN access and meaningfully participate in all aspects of PBIS, in part due to teachers' misconceptions and negative beliefs concerning the involvement of students with ESN in PBIS. In response to calls for research focused on teacher preparation in this area, we conducted an exploratory survey study of 34 course instructors in undergraduate and graduate teacher preparation programs that prepare special education teachers of students with ESN with a specific focus on universal, Tier 1 PBIS. Instructors at the undergraduate and graduate levels reported addressing a wide range of content focused largely on knowledge acquisition, with fewer reports of course activities involving skill development and practice‐based applications. Overall, instructors viewed the inclusion of content focused on PBIS for students with ESN as important. We present detailed findings, implications for special education teacher preparation programs, and directions for future research extending this line of inquiry.

Improving quality of support and staff culture in a supported living service: a practice example of tier 1 positive behaviour support

Purpose This paper aims to describe the approach taken to identify areas for development and to enhance positive practice, in line with a preventative tier 1 positive behaviour support (PBS) approach. The work was conducted within a supported living service, where 10 individuals with a learning disability reside. Design/methodology/approach The intervention was provided through a dedicated behavioural clinical specialist role over nine months. An initial assessment included measures evaluating PBS, active support and staff culture. Narrative themes were also noted from discussions with staff to deepen the understanding of informal staff culture. Together, this informed a programme of work guided by the setting of both individual and service-wide goals. Input included practice leadership, staff training, review of PBS plans and delivery of case workshops. Assessments were then repeated to evaluate the work completed. Findings There were indications of improvements in staff culture and practice following the intervention. Originality/value This practice example may be useful for other organisations to consider when thinking about how to use resources effectively to improve people’s quality of life and implement tier 1 of PBS provision.

Which is the more effective management strategy for irritability and challenging behaviour in autism, medication or psychosocial interventions?

Purpose The purpose of this study is to critically analyse the current research around the impact of management strategies on challenging behaviour in autism. Design/methodology/approach Mixed method analysis. Findings Seven studies were included for discussion. The author found significant heterogeneity in the outcome measures of all the studies and was unable to provide a meta-analysis. The results showed that psychosocial interventions offer the most promise in terms of safety and efficacy. The author was unable to explain what part of their intervention had the most significant effect. Antipsychotic interventions demonstrated the most robust methodologies and therefore, the results are more reliable. Research limitations/implications These studies provide valuable evidence for UK guidelines and suggest that lower doses of medication do not have a therapeutic effect on patients. Furthermore, these studies do not use psychosocial interventions alongside medication reduction, which may have proven valuable to help the author’s understanding of the different management strategies for treating challenging behaviour in autism. Thus, this literature review recommends further studies in the reduction of medication alongside psychosocial interventions with a larger number of participants recruited from a diverse range of backgrounds. Practical implications Gerrard et al. (2019) hope that positive behavioural support will become standard practice for specialist teams following the results of their findings and conclude that in the absence of effective management strategies, there is a greater likelihood of the re-introduction of medication. Admittedly, they do not understand what components of their intervention had the greatest significance on the results and identify this as a limitation of the study. In the single case study by Lee, Rhodes and Gerrard (2019), they claim that medication reduction and discontinuation can be successful if the rate of titration reduction is slowed down. This may offer some insight into the success of the strategy by Gerrard et al. (2019). Social implications Bishop-Fitzpatrick et al. (2013) state that the researchers in their systematic reviews used “creative techniques” to address the core deficits of autism (p. 7). It can be argued that psychosocial interventions are highly individualized, making them difficult to implement in practice and are ungeneralizable. For this purpose, the reduction of medication cannot be implemented consistently as it is not clear what strategies are effective. Originality/value This is the author’s own work, and to the best of the author’s knowledge, it does not infringe upon anyone’s copyright and that any ideas, techniques or any other material are fully acknowledged in accordance with the Harvard referencing guidelines.

Commentary on “Improving quality of support and staff culture in supported living: a practice example of tier one positive behaviour support”

Purpose This commentary aims to explore the theme of Tier 1 support within the UK context and abroad by the associated article by Hardiman and Harding (2025; this issue). Design/methodology/approach This commentary considers the literature regarding high-quality support as a Tier 1 approach within positive behaviour support (PBS) model in the UK and abroad. It also considers potential infrastructure that services could use to develop and sustain high-quality support. Findings This commentary highlights how the UK may be guided by the framework of school-wide PBS in the USA to inform the implementation of system-wide PBS in UK contexts. Originality/value This commentary explores how system-wide PBS can be applied.

The SHIELD Framework: Advancing Strength-Based Resilience Strategies to Combat Bullying and Cyberbullying in Youth.

Bullying and cyberbullying are critical global issues that significantly affect the mental health and behavioral well-being of youth. This article explores the complex challenges posed by these forms of aggression and introduces a strength-based model for health and mental health professionals to address these issues with impacted youth holistically. Grounded within findings from a scoping review of the literature, the SHIELD framework emphasizes Strengths, Healing, Interventions, Empowerment, Learning, and Development, offering a comprehensive approach for identifying and supporting youth impacted by bullying and cyberbullying. SHIELD emphasizes collaboration among health professionals, schools, families, and communities. By integrating empirical evidence and best practices from school-based approaches to bullying prevention, such as Positive Behavioral Interventions and Support (PBIS) and Social and Emotional Learning (SEL), this framework provides a roadmap for creating safer, more inclusive environments for youth while prioritizing their mental health and overall well-being in the face of bullying and cyberbullying. A case study illustrates the framework's practical application and future directions are proposed to guide further empirical investigation and stimulate innovative approaches to addressing the complexities of bullying and cyberbullying.

Challenging behaviour, activity, and participation following acquired brain injury: a scoping review of interventions delivered by allied health professionals.

Background This scoping review aimed to identify literature describing allied health interventions used to address challenging behaviour for adults with an acquired brain injury (ABI) living in community settings and identify the impact of these interventions on outcomes across the domains of behaviour, activity, and participation. Methods The Polyglot Search Translator for scoping reviews guided the search of six databases: (1) Ovid Medline®, (2) EmCARE (Ovid), (3) CINAHL Complete, (4) Embase (Ovid), (5) Scopus, and (6) Cochrane Library to identify literature published between 1990 and 2023. Results Of the 1748 records screened, 16 articles met the inclusion criteria. Studies commonly described therapeutic, least restrictive approaches to challenging behaviour founded on a positive behaviour support framework. Interventions were individualised, combining multiple elements to effect change in the environment, behaviour of the people providing support, and/or skills and behaviour of the person with ABI. Although most studies reported clinical gains from intervention, study designs used a range of methods and either single cases or mixed populations. Conclusions The findings of this review suggest that allied health interventions have the potential to reduce challenging behaviour experienced by people with ABI. However, further research addressing the impact of interventions on activity and participation is required to inform clinical practice and improve long-term outcomes.

Using Positive Behavioural Support to Curb Truancy and Improve the Academic Performance of Basic Seven Learners at Public Basic Schools in the Asokore Community of Ghana’s Eastern Region

Using Positive Behavioural Support to Curb Truancy and Improve the Academic Performance of Basic Seven Learners at Public Basic Schools in the Asokore Community of Ghana’s Eastern Region

MTSS implementation in residential and day habilitation settings: A scoping review.

Although Multi-Tiered Systems of Support (MTSS) has been used in schools, its success has prompted recommendations for its adoption in group home and day habilitation settings. This scoping review examines the literature on implementing MTSS in group home and day habilitation settings for individuals with intellectual and developmental disabilities. Of the 15 studies reviewed, most focused on Positive Behavior Interventions and Supports (PBIS) rather than a comprehensive MTSS framework, raising questions about the alignment of interventions with the three-tiered structure of MTSS. Additionally, PBIS in these settings appears restricted to an individualized approach to minimizing behavior instead of the comprehensive framework used in schools. Benefits of implementing PBIS include a reduction in challenging behavior, decreased use of restrictive interventions, and staff-related advantages such as improved organization and reduced turnover. Challenges are noted in time and resource constraints. Suggestions for implementing MTSS in residential and day habilitation settings are provided.

One is Good, but are Two Really Better? Outcomes for Dual versus Individual Attendees in a Behavioral Parent-Training Program for Caregivers of Young Children

ABSTRACT Background The Helping Our Toddlers, Developing Our Children’s Skills (HOT DOCS) BPMT program utilizes positive behavior support principles to help caregivers of children birth-5 years address early childhood disruptive behaviors and common developmental challenges experienced by many young children. Objective The present study examined whether there were differences in child outcomes, attendance rates, homework completion rates, levels of caregiver stress, and treatment satisfaction for individual versus dual caregiver participation in the HOT DOCS BPMT. Method Using a quasi-experimental design, caregivers of children ages 0–5 years were assigned to two non-equivalent groups: individual attendee (n = 141) and dual attendee (n = 123). Independent samples t-tests were utilized to compare means between individual and dual attendee groups for number of sessions attended and homework completion. Paired samples t-tests were calculated to compare means between individual and dual attendee groups on HOT DOCS program outcomes, including child behavior, parenting stress, and treatment satisfaction. Results There were no significant differences in outcomes between individual and dual attendee groups. Child behavior outcomes, parenting stress, treatment satisfaction, attendance, and homework completion were similar across both groups. Conclusions Individual caregiver engagement in the HOT DOCS BPMT program might be sufficiently potent to result in desirable outcomes. Future directions should include examining family structure and treatment modality on BPMT outcomes, maintenance of intervention gains, and perceived child behavior outcomes of BPMT non-attending caregivers.

Cultural adaptation of positive behavioral interventions and supports tier 1 in a Chinese elementary school.

Research has shown the positive effects of positive behavioral interventions and supports (PBIS) on student outcomes. Despite its effectiveness, there is limited research on the cultural adaptation of PBIS in other cultures, especially in Asia. Based on cultural adaptation frameworks, the current case study reports the cultural adaptation and implementation process of PBIS Tier 1 in a Chinese elementary school, including the steps and strategies in its engagement, design, and implementation. Using multiple questionnaires, we also examined the pre- and postintervention differences in students' emotional and behavioral problems, their perceptions of school climate, and important factors related to academic engagement. Mainly, students' prosocial behaviors, emotional symptoms, and their interpersonal relationships with teachers and peers improved. However, there was also an increase in hyperactivity/inattention and conduct problems. Limitations and future directions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Correction: A Discussion of Positive Behavior Support and Applied Behavior Analysis in the Context of Autism Spectrum Disorder in the UK and Ireland

Correction: A Discussion of Positive Behavior Support and Applied Behavior Analysis in the Context of Autism Spectrum Disorder in the UK and Ireland

Conceptual review: The application of attachment theory to adult intellectual disability

Attachment theory provides a framework to understand the importance of carer relationships, and how these relationships influence wellbeing throughout life. Individuals with an Intellectual Disability (ID) are at increased risk of poor wellbeing, and attempt to get support for this from carers, who play an important ongoing role in their lives. Literature suggests that individuals with ID are less likely to develop positive attachment relationships, with poor attachment relationships linked to poor wellbeing. Despite important questions around how attachment theory is understood in the diverse ID population, interventions to foster positive attachments have been highlighted in the hope to support adults with ID. This conceptual review discusses Cognitive Analytic Therapy (CAT) contextual re-formulation, a relationally focused Positive Behaviour Support (PBS) framework and video-feedback interventions. It is recognised that the evidence-base for attachment-informed interventions in this context is in its infancy and further research is necessary to understand their applicability for this population. The application of attachment theory to the adult ID population and how attachment-informed interventions can support caring relationships in this context is explored in this review.

The Role Of Mental Health Education In Mitigating Pandemic-Related Psychological Distress In Children

Children with pre-existing conditions, such as ADHD and anxiety, are particularly vulnerable to the mental health consequences of the pandemic. Disruptions to routine and social interactions have exacerbated their symptoms, leading to increased stress and depression. This article examines the role of mental health education in schools as a critical tool for mitigating these challenges. Mental health education equips children with essential stress-management skills through evidence-based interventions such as coping skills training, emotional regulation practices, and resilience-building. The article features case studies that detail the effectiveness of programs like the Los Angeles Unified School District's teletherapy initiative, which provided virtual mental health support to over a million students, significantly reducing stress and anxiety levels during the pandemic. Programs such as the Comprehensive School Mental Health Systems (CSMHS) employ a multitiered approach, addressing prevention, early intervention, and support for severe mental health concerns in collaboration with community health professionals. The Positive Behavioral Interventions and Supports (PBIS) framework also highlights successful integration into U.S. school systems, ensuring a supportive environment through behavioral reinforcement and targeted mental health education

An evaluation of a multidisciplinary care planning tool for people with intellectual disabilities and behaviours of concern.

Multidisciplinary care planning for people with intellectual disabilities who engage in behaviours of concern (BoC) is challenging and complex. Effective collaborative understanding and action planning across all stakeholders is essential. Cornwall's Adult Community Learning Disability Team developed a care planning tool (Connect Behaviour) using contemporary evidence and best practice. Connect Behaviour is designed to facilitate care planning by collaborative and enhanced shared understanding and is also available as an interactive web-based tool. To evaluate Connect behaviour using stakeholders' experiences. Family members, care providers, advocates, social workers and professionals who had attended meetings guided by the Connect Behaviour care planning tool in a 3-month period were interviewed about their experiences of those meetings. This was interpreted using inductive thematic analysis. Of 71 individuals identified as meeting this criterion of inclusion 61 were contactable and 27 consented to participation. These participants consisted of 17 health professionals, two parents, two social workers, three advocates, two positive behaviour support advisors within care providers, and one manager of a local care provider. The thematic analysis of participant views of connect behaviour generated five superordinate themes of 'pragmatic', 'enabling', 'validation of effort', 'perceived lack of flexibility' and 'areas for development'. Further inquiry of themes highlighted subthemes of Connect Behaviour being 'sensible', 'practical', 'collaborative', 'holistic' and 'action'. Conversely, some perceived a lack of flexibility in the care planning tool. Future areas for development were also identified in the data. Changes were recommended to increase the tool accessibility for people with intellectual disabilities, support stakeholders understanding of the tool, and consider utility for other clinical scenarios. The evaluation established general feedback to continue to use the Connect Behaviour as a care planning tool. The benefits of Connect Behaviour in comparison to other care planning frameworks needs to be understood.

(Internalising) challenging behaviours and trauma-informed Positive Behavioural Interventions and Supports (PBIS)

ABSTRACT Notwithstanding their empirically validated credentials and social justice orientations, a mono-dimensional approach to Positive Behavioural Interventions and Supports (PBIS) cannot singlehandedly meet the unique needs of minoritised children and young people who have experienced acute, cumulative, or complex traumas. Experiences of trauma have been empirically proven to have a debilitating effect on minoritised children’s learning and socio-emotional functioning. This causal effect necessitates the development of trauma-informed multitiered models of intervention to mitigate the adverse effects of trauma and to support these students’ behaviour and learning. The article discusses the necessity of developing trauma-informed and intersectionality-based PBIS, while providing some insights into how trauma-informed education and care should be incorporated in PBIS planning and implementation strategies at the school and community levels. These analytical insights complement earlier work on promoting an ecological/interactional approach to understanding students’ developmental trajectories and their impact on academic and social behaviours, as well as more recent equity-focused PBIS approaches to improving equity in school discipline.

Intensifying Tier 1 Classroom Positive Behavioral Interventions and Supports Practices to Support Students With Disabilities: A Pilot Study

Without effective support, students with disabilities experience more exclusionary discipline and benefit less from classroom instruction. Students with disabilities can benefit when teachers implement key classroom positive behavioral interventions and supports (PBIS) practices (e.g., prompts, opportunities to respond, and specific praise), but many teachers need additional professional development (PD) to implement with sufficient intensity to support students with disabilities. In this pilot study, we explored whether teachers’ intensified implementation of key practices improved academic engagement of students with disabilities. Three elementary teachers and three students with disabilities participated in an experimental multiple-baseline design. Following baseline, each teacher participated in targeted PD for each practice. Two teachers consistently self-managed their intensive implementation and their students’ engagement increased; one teacher did not consistently self-manage her implementation, and her student’s engagement decreased. These data provide an initial proof of concept for this approach; however, additional research is needed to document a functional relation.

Development of an Interprofessional Education Project in Dentistry Based on the Positive Behavior Support Theory: Pilot Curriculum Development and Validation Study.

Effective interprofessional education (IPE) can facilitate teamwork between dentists and dental technicians, thereby enabling the efficient provision of high-quality dental care. This study aimed to design and assess an IPE module named Project 35, which was offered to dental and dental technology students early in their undergraduate training as a precursor to a more comprehensive IPE curriculum in dentistry and dental technology. Leveraging positive behavior support (PBS) theory, Project 35 was devised as an innovation and entrepreneurship educational training framework. It used project-based learning to cultivate teamwork skills and to promote the professional development of dental and dental technology students. The pilot study was designed to present the IPE module and preliminarily assess its validity. In survey 1, which was conducted immediately after the course, the dental and dental technology students' self-reported skill acquisition and attitudes were assessed and compared. Survey 2, conducted 1 year after the course, focused on the comparative benefits of Project 35 training for dental technology students versus an untrained group. A total of 66 students, including 36 dental students and 30 dental technology students who had undertaken the training, were recruited. Project 35 training improved teamwork skills for students in both disciplines comparably, and the students recognized the training as highly valuable and effective. The mean values for all items indicating skills improvement of students ranged from 4.13 (SD 0.797) to 4.63 (SD 0.495) for dental students and from 4.13 (SD 0.869) to 4.74 (SD 0.619) for dental technology students. Among the dental technology students, the trained group showed greater independent and innovative approaches and was more optimistic about the future of the profession than the nontrained group (P<.05). Despite the small sample size, the validity of the Project 35 training system was evident, and the success of our pilot study provides a sound basis for the future development of IPE in clinical dental and dental technology education programs.

Examining Immediate and Sustained Effects of Check-In/Check-Out in Finnish Elementary Schools

Check-in/Check-out (CICO) behavioral support has been implemented in Finnish School-Wide Positive Behavior Interventions and Support (SWPBIS) schools to cater to students who require personalized behavior support beyond the universal level. Previous studies have demonstrated the effectiveness of CICO as a behavioral support method. However, further research is needed to investigate its effectiveness in a larger sample and to analyze the timeline for behavioral change. This study focused on 51 elementary school students in Finland, assessing their behavior at baseline and during the CICO intervention phase using two data collection methods: the Daily Report Card (DRC) and the School Situation Questionnaire (SSQ). Nonlinear growth modeling was employed to examine the effects of the intervention. The results indicated that CICO yielded significant positive effects on behavior within 1 week of initiating support. After the outcomes stabilized, the behavior change remained stable beyond the first week of the intervention. These effects were detected in both the target behavior measured with DRC and the problem behavior measured with SSQ. These findings suggest that CICO interventions produce rapid and sustained changes in behavior. Further, the effects of CICO were observed in various settings within the school environment, indicating distal outcomes.