School-based Behavioral Intervention Research Articles

Design for a cluster randomized controlled trial to evaluate the effects of the CATCH Healthy Smiles school-based oral health promotion intervention among elementary school children

BackgroundThe top two oral diseases (tooth decay and gum disease) are preventable, yet dental caries is the most common childhood disease with 68% of children entering kindergarten having tooth decay. CATCH Healthy Smiles is a coordinated school health program to prevent cavities for students in kindergarten, 1st, and 2nd grade, and is based on the framework of Coordinated Approach to Child Health (CATCH), an evidence-based coordinated school health program. CATCH has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in incorporating the factors surrounding children, in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, ethnically diverse children. The aim of this paper is to describe the design of the CATCH Healthy Smiles CRCT to determine the effectiveness of an oral health school-based behavioral intervention in reducing incidence of dental caries among children. MethodsIn this CRCT, 30 schools serving low-income, ethnically-diverse children in greater Houston area are recruited and randomized into intervention and comparison groups. From which, 1020 kindergarten children (n = 510 children from 15 schools for each group) will be recruited and followed through 2nd grade. The intervention consists of four components (classroom curriculum, toothbrushing routine, family outreach, and schoolwide coordinated activities) will be implemented for three years in the intervention schools, whereas the control schools will be offered free trainings and materials to implement a sun safety curriculum in the meantime. Outcome evaluation will be conducted at four time points throughout the study period, each consists of three components: dental assessment, child anthropometric measures, and parent survey. The dental assessment will use International Caries Detection and Assessment System (ICDAS) to measures the primary outcome of this study: incidence of dental caries in primary teeth as measured at the tooth surface level (dfs). The parent self-report survey measures secondary outcomes of this study, such as oral health related behavioral and psychosocial factors. A modified crude caries increment (mCCI) will be used to calculate the primary outcome of the CATCH Healthy Smiles CRCT, and a two-tailed test of the null hypothesis will be conducted to evaluate the intervention effect, while considering between- and within-cluster variances through computing the weighted-average of the mCCI ratios by cluster. ConclusionIf found to be effective, a platform for scalability, sustainability and dissemination of CATCH already exists, and opens a new line of research in school oral health. Clinical trials identifierAt ClinicalTrials.gov - NCT04632667.

School-Based Strategies to Improve Acceptance of Healthier Foods and Dietary Patterns in Middle and Junior High School Students: A Rapid Review

ObjectivesTo conduct a rapid review addressing the question: What is the effect of school-based strategies that aim to improve acceptance of healthier foods and dietary patterns in children and adolescents on dietary intake and dietary intake-related behaviors? Results are presented for middle and junior high school (MS) only.MethodsWe conducted a literature search (2000–2020) and dual-screened the results using pre-defined inclusion criteria. We extracted data, assessed risk of bias, qualitatively synthesized evidence to develop conclusion statements, and graded the strength of evidence.ResultsFifty-seven articles (54 randomized controlled trials [RCTs]) were included, examining teaching/educational interventions (32 articles), behavioral/environmental interventions (14 articles), and interventions combining education with behavioral/environmental strategies (“combined”; 14 articles). Curriculum-based nutrition education tended to improve dietary intake (particularly overall diet quality and vegetables), but evidence was insufficient for other educational interventions. Behavioral/environmental interventions tended to improve in-school food choices, but evidence on intake was limited due to inconsistency. Combined interventions tended to improve food choices and intake, particularly fruit, vegetables, and lower nutritional quality foods/beverages. Few studies directly compared combined interventions to use of either strategy alone but suggested a benefit of combined interventions.ConclusionsModerate evidence from this rapid review indicates that in MS students: curriculum-based nutrition education improves dietary intake (particularly overall dietary quality and vegetable intake); school-based behavioral and environmental interventions beneficially affect in-school food and beverage selection; and school-based interventions that combine educational and environmental strategies targeting promotion and increased availability of nutrient dense foods and beverages improve food purchasing behaviors and dietary intake, particularly for fruit, vegetables, and foods and beverages of lower nutritional quality.Funding SourcesUSDA, Food and Nutrition Service, Office of Policy Support, Special Nutrition Research and Analysis Division.

School-Based Strategies to Improve Acceptance of Healthier Foods and Dietary Patterns in Elementary School Students: A Rapid Review

ObjectivesTo conduct a rapid review addressing the question: What is the effect of school-based strategies that aim to improve acceptance of healthier foods and dietary patterns in children and adolescents on dietary intake and dietary intake-related behaviors? Results are presented for elementary school children only.MethodsWe conducted a literature search (2000–2020) and dual-screened the results using pre-defined inclusion and exclusion criteria. We extracted data, assessed risk of bias, qualitatively synthesized the evidence to develop conclusion statements, and graded the strength of the evidence.ResultsOne-hundred-six articles (97 randomized controlled trials [RCTs]) were included, examining educational interventions (56 articles [50 RCTs]), behavioral and environmental interventions (32 articles [30 RCTs]), and interventions that combined educational strategies with behavioral and environmental strategies (20 articles [17 RCTs]). Curriculum-based nutrition education tended to improve food and beverage intake, particularly fruit; a few interventions reduced sodium intake. Some studies found that playing educational games for several weeks improved dietary intake, and brief educational books and videos tended to improve immediate food choice. Behavioral and environmental interventions tended to improve in-school food and beverage selection, particularly fruit, vegetables, and milk; many improved in-school food and beverage intake. Interventions that combined educational strategies with behavioral and environmental strategies tended to improve food and beverage intake, particularly fruit.ConclusionsModerate evidence from this rapid review indicates that in elementary school children: curriculum-based nutrition education improves food and beverage intake (particularly fruit); school-based behavioral and environmental interventions improve in-school food and beverage selection (including fruit, vegetables, and milk) and in-school vegetable intake; and school-based interventions that combine educational strategies with behavioral and environmental strategies improve intake of food and beverages, particularly fruit.Funding SourcesUSDA, Food and Nutrition Service, Office of Policy Support, Special Nutrition Research and Analysis Division.

Effectiveness of school-based behavioural interventions to improve children's oral health by reducing sugar intake and promoting oral hygiene: A rapid review of randomised controlled trials.

To evaluate evidence of the effectiveness of school-based behavioural interventions to improve the oral health of children aged 3-18 years in a rapid review of randomised controlled trials (RCTs). Three independent reviewers searched MEDLINE, EMBASE, Web of Science and other sources between January 2000 and December 2020 for eligible published and unpublished studies in English and extracted data. Primary outcomes were caries increment, plaque levels, gingival health, reported frequency and/or amount of free sugars intake and oral hygiene behaviour. Risk of bias was assessed using the Cochrane criteria. Eight cluster RCTs met the inclusion criteria and had substantial heterogeneity. Three trials assessed caries increment and one found significant reductions in the intervention group. Another trial found similar benefits, but these were limited to children from high socioeconomic groups. The third trial found an increase in dental caries in the intervention group. Three studies reported significant reductions in plaque scores and improvements in gingival health with modest effects. Interventions delivered by peers (at adolescence) or with parents' involvement (at pre-adolescence) showed significant reductions in plaque scores compared to those delivered by dentists or teachers only. Most interventions showed significant improvements in self-reported behaviours. There is limited evidence of clinical benefit to dental health from school-based behavioural interventions. There is a need to conduct well-designed trials of behavioural interventions that are theory-derived and include environmental elements (e.g. supervised toothbrushing). Future trials would benefit from cost-effectiveness analysis and assessment of interventions' effect on oral health inequalities amongst children.

The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review

Sedentary behaviours are highly associated with obesity and other important health outcomes in adolescence. This paper reviews screen time and its role within school-based behavioural interventions targeting adolescents between the years 2007 and 2019. A systematic literature review following PRISMA guidelines was conducted across five major databases to identify interventions targeting screen time—in addition to TV/DVD viewing. The review identified a total of 30 papers analysing 15 studies across 16 countries aiming at addressing reduction of recreational screen time (internet use and gaming) in addition to television/DVD viewing. All of the interventions focused exclusively on behaviour change, targeting in the majority both reduction of sedentary behaviours along with strategies to increase physical activity levels. A mix of intervention effects were found in the reviewed studies. Findings suggest aiming only for reduction in time spent on screen-based behaviour within interventions could be a limited strategy in ameliorating excessive screen use, if not targeted, in parallel, with strategies to address other developmental, contextual and motivational factors that are key components in driving the occurrence and maintenance of adolescent online behaviours. Additionally, it raises the need for a differential treatment and assessment of each online activity within the interventions due to the heterogeneity of the construct of screen time. Recommendations for enhancing the effectiveness of school-based sedentary behaviour interventions and implications for public policy are discussed.

The association between excessive screen-time behaviors and insufficient sleep among adolescents: Findings from the 2017 youth risk behavior surveillance system

Although studies have examined the association between television viewing and poor sleep quality, few studies have considered the association between excessive screen-time behaviors and insufficient sleep among adolescents drawing on a large nationally representative sample. The objective of this study was to examine the association between excessive screen-time behaviors and insufficient sleep among adolescents. Data for this study came from the 2017 Youth Risk Behavior Survey. A sample of 14,603 adolescents aged 14–18 years (51.5% female) was analyzed using logistic regression with insufficient sleep as the outcome variable and excessive screen-time behaviors as the main explanatory variable. Of the 14,603 adolescents, almost three out of four (74.8%) had less than 8 h of sleep on an average school night, and about 43% engaged in excessive screen-time behaviors on an average school day. Controlling for all other predictors, odds were 1.34 times higher for adolescents who engaged in excessive screen-time behaviors to have insufficient sleep when compared to adolescents who did not engage in excessive screen-time behaviors (AOR = 1.34, p < .001, 95% CI = 1.22–1.48). School-based behavior interventions that focus on reduction in excessive screen-time and sedentary behaviors might be beneficial in reducing excessive screen-time behaviors and consequently improve sleep quality among adolescents.

School-based behavioral intervention to reduce the habit of smokeless tobacco and betel quid use in high-risk youth in Karachi: A randomized controlled trial.

There have been recent surges in the use of smokeless tobacco (SLT) and betel quid (BQ) chew among adolescents in South East Asian countries, with an increase, on average, of 7% to 15% between 2004 and 2013, necessitating interventional investigations to modify this behavior. The current intervention was aimed towards changing adolescents’ perceptions regarding the harmful effects of SLT and BQ use and encouraging them to quit. This randomized control trial involved 2140 adolescents from 26 private and public-sector schools in Karachi, Pakistan. After randomization, 1185 individuals were placed in the intervention group and administered a behavior changing intervention (BCI), while 955 individuals constituted the control group. A generalized estimating equation was employed to measure differences in repeated measures for both groups. The beta coefficients were reported after adjusting the covariates with the 95% confidence interval, and the p-value was considered significant at <0.050. Cohen’s d was employed to report the effect size of the intervention. The BCI resulted in a 0.176-unit (95% CI 0.078–0.274, p-value <0.001) increase in knowledge scores regarding the health hazards of SLT and BQ, a 0.141-unit (95% CI 0.090–0.192, p-value <0.001) increase in use perception scores, and a 0.067-unit (95% CI 0.006–0.129, p-value 0.031) increase in quit perception scores in the intervention group compared with those in the control group. A knowledge related module (p-value 0.024) and quit preparation module (p-value 0.005) were found to be helpful by adolescents in either changing their perceptions regarding SLT and/or BQ chew use or in quitting. The role of BCI is promising in improving adolescents’ knowledge and changing their perceptions in a positive manner regarding their harmful SLT and BQ use. Convincing results may be achieved if interventions are tailored, with an emphasis on the identification of the products that are used by adolescents in addition to highlighting their ill effects and how students may manage to quit them. If included in the schools’ curricula, this BCI method may help in developing schools that are free of SLT and BQ use.Trial registration: ClinicalTrials.gov NCT03488095.

Transition to school for children with autism spectrum disorder: A systematic review.

AIMTo identify factors that promote a positive start to school for children with autism spectrum disorder (ASD).METHODSWeb of Science, MEDLINE, Scopus, and PsychINFO searches were conducted to identify literature published after 1991 and relevant to school transition processes in children with ASD. Twenty studies were deemed eligible for inclusion. These studies evaluated a range of factors including school readiness, parent and teacher perspectives on transition practices, characteristics of children with ASD that are associated with successful transition to school and the impact of school based intervention programs.RESULTSA review of these studies showed that children with ASD are less school ready emotionally than their peers and those children with ASD appear to have more externalising behaviours and self-regulation difficulties that affect their school engagement and their relationships with their teachers. There was a paucity of research looking at interventions targeting school readiness. However, school-based behavioural interventions appear to improve cognitive, language and daily living skills, but have less impact on socialisation and peer inclusion.CONCLUSIONChildren with ASD face more challenges transitioning to school, particularly with social interaction. Further development and implementation of specific school-based interventions is needed in order to assist children with autism to maximise their success in starting school.

Child characteristics associated with outcome for children with autism in a school-based behavioral intervention.

This study examined the extent to which clinical and demographic characteristics predicted outcome for children with autism spectrum disorder. Participants included 152 students with autism spectrum disorder in 53 kindergarten-through-second-grade autism support classrooms in a large urban public school district. Associations between child characteristics (including age, language ability, autism severity, social skills, adaptive behavior, co-occurring psychological symptoms, and restrictive and repetitive behavior) and outcome, as measured by changes in cognitive ability following one academic year of an intervention standardized across the sample were evaluated using linear regression with random effects for classroom. While several scales and subscales had statistically significant bivariate associations with outcome, in adjusted analysis, only age and the presence of symptoms associated with social anxiety, such as social avoidance and social fearfulness, as measured through the Child Symptom Inventory-4, were associated with differences in outcome. The findings regarding the role of social anxiety are new and have important implications for treatment. Disentangling the construct of social anxiety to differentiate between social fearfulness and social motivation has important implications for shifting the focus of early treatment for children with autism spectrum disorder.

The Reporting of Core Program Components: An Overlooked Barrier for Moving Research Into Practice

The successful implementation of school-based behavioral interventions requires school personnel to be competent with program content and procedures. An unfortunate trend within school-based behavioral intervention research is that the core intervention components and implementation features are often not fully described. Without clear descriptions of these critical elements, it is difficult for school personnel to successfully identify, adopt, and implement research-based programs. The practical implications that study reporting has on the integration of research into practice is illustrated in the present study through a systematic review of a widely researched anxiety prevention program. Results indicated that study authors often did not provide sufficient detail on the intervention components used and whether those components were implemented with sufficient levels of treatment fidelity. Moreover, the supports used to facilitate the implementation of the intervention varied widely across studies. These findings are discussed in relation to evidence suggesting that descriptions of the independent variable are important for identifying the mechanisms of adult and student behavior change while reports of implementation features are needed to ensure school personnel are able to consider the feasibility of implementing research-based programs within applied settings. The authors conclude by describing implications for both research and practice.

A cluster randomized trial to evaluate the efficacy of a school-based behavioral intervention for health promotion among children aged 3 to 5.

BackgroundThe onset of inadequate behaviors leading to the development of risk factors for chronic diseases is known to occur early in life. An effective program for health promotion should therefore focus on children and their environment, as the starting point for behavior development. The overarching objective of the Program SI! (Salud Integral - Comprehensive Health) is to intervene at the school level, to establish and develop life-lasting habits that will help preserving health during adulthood. The Program SI! comprises five consecutive subprograms according to the five stages of education in Spain, the first being in preschoolers. This study aims to evaluate the efficacy of Program SI! to establish and improve lifestyle behaviors in children (preschoolers aged 3–5 years), their parents, and teachers, and also improving the school environment. A secondary objective is to evaluate improvements in cardiovascular health-related markers (anthropometric parameters, blood pressure, and dietary and physical activity patterns) in these same children.Methods/design24 public schools from the city of Madrid (Spain) were allocated through stratified randomization to intervention or control. The intervention schools follow the Program SI!, which provides didactic units, emotions cards, healthy tips, and online resources. The intervention schools integrate the Program SI! into their scholar curriculum organized in four complete weeks during each academic year during the 3 years of preschool education. Control schools follow their normal curriculum. Primary outcomes are 1-year, and 3-year changes from baseline of scores for knowledge, attitudes, and habits (KAH) of children, their parents and teachers in regards to a healthy lifestyle. Secondary outcomes are 1-year, and 3-year changes from baseline in clinical and anthropometric parameters of children.DiscussionThe Program SI! is a long-term health promotion program starting in 3 years old. It incorporates the traditional areas of intervention (diet and physical activity), introducing additional components such as knowledge of the human body and management of emotions to achieve a comprehensive intervention. The Program SI! is designed to be an effective, sustainable health promotion program for the adoption of healthy behaviors from early in life.Trial registrationTrial registration number: NCT01579708

Limited evidence available for the impact of school-based behavioural interventions on oral health

The Cochrane Oral Health Group's Trials Register, and Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, PsycINFO, Current Controlled Trials, ClinicalTrials.gov, Web of Science and Dissertations and Theses via Proquest databases were searched. A number of relevant journals, (Acta Odontologica Scandinavica, ASDC Journal of Dentistry for Children, British Dental Journal, Caries Research, Community Dental Health, Community Dentistry and Oral Epidemiology, Journal of the American Dental Association, Journal of Dental Research, Journal of Public Health Dentistry, Swedish Dental Journal, International Journal of Paediatric Dentistry) not already searched as part of the Cochrane Journal Handsearching Programme were handsearched. There were no restrictions regarding language or date of publication. Randomised controlled trials (RCTs) where randomisation occured at the level of the group (cluster by school and/or class) or individual children were included. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention. Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. A qualitative synthesis was conducted. Four studies involving a total of 2302 children were included. One study was at unclear risk of bias and three were at high risk of bias. The studies were heterogeneous in both intervention and outcome measures and also suffered from poor reporting. Only one included study reported caries development as an outcome. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution. All three studies that reported plaque outcomes found statistically significant reduction in plaque in the intervention groups, but due to differences in plaque reporting between studies these could not be combined. Two of these studies included an active home component where parents were given tasks relating to the school oral health programme (games and homework), to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge. Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.

Primary school-based behavioural interventions for preventing caries

Dental caries is one of the most common global childhood diseases and is, for the most part, entirely preventable. Good oral health is dependent on the establishment of the key behaviours of toothbrushing with fluoride toothpaste and controlling sugar snacking. Primary schools provide a potential setting in which these behavioural interventions can support children to develop independent and habitual healthy behaviours. To assess the clinical effects of school-based interventions aimed at changing behaviour related to toothbrushing habits and the frequency of consumption of cariogenic food and drink in children (4 to 12 year olds) for caries prevention. We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 18 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via OVID (1948 to 18 October 2012), EMBASE via OVID (1980 to 18 October 2012), CINAHL via EBSCO (1981 to 18 October 2012) and PsycINFO via OVID (1950 to 18 October 2012). Ongoing trials were searched for using Current Controlled Trials (to 18 October 2012) and ClinicalTrials.gov (to 18 October 2012). Conference proceedings were searched for using ZETOC (1993 to 18 October 2012) and Web of Science (1990 to 18 October 2012). We searched for thesis abstracts using the Proquest Dissertations and Theses database (1950 to 18 October 2012). There were no restrictions regarding language or date of publication. Non-English language papers were included and translated in full by native speakers. Randomised controlled trials of behavioural interventions in primary schools (children aged 4 to 12 years at baseline) were selected. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention. Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. Relevant statistical information was assessed by a statistician subsequently. All included studies contact authors were emailed for copies of intervention materials. Additionally, three attempts were made to contact study authors to clarify missing information. We included four studies involving 2302 children. One study was at unclear risk of bias and three were at high risk of bias. Included studies reported heterogeneity in both the intervention design and outcome measures used; this made statistical comparison difficult. Additionally this review is limited by poor reporting of intervention procedure and design. Several BCTs were identified in the trials: these included information around the consequences of twice daily brushing and controlling sugar snacking; information on consequences of adverse behaviour and instruction and demonstration regarding skill development of relevant oral health behaviours.Only one included study reported the primary outcome of development of caries. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution.Although no meta-analysis was performed with respect to plaque outcomes (due to differences in plaque reporting between studies), the three studies which reported plaque outcomes all found a statistically significant reduction in plaque in the intervention groups with respect to plaque outcomes. Two of these trials involved an 'active' home component where parents were given tasks relating to the school oral health programme (games and homework) to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge. Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.

A school-based behavioral intervention program demonstrates improvement in individual student behavior

A school-based behavioral intervention program demonstrates improvement in individual student behavior

AN ECONOMIC MODEL OF SCHOOL-BASED BEHAVIORAL INTERVENTIONS TO PREVENT SEXUALLY TRANSMITTED INFECTIONS

Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people. We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs. The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively. School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

Children’s views about obesity, body size, shape and weight; Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions; Intervention strategies that support self-care activities:

Children’s views about obesity, body size, shape and weight; Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions; Intervention strategies that support self-care activities:

Attention to Treatment Fidelity in Social Work Outcomes: A Review of the Literature from the 1990s

Effective social work research on psychosocial outcomes is likely to depend not only on quality of research designs, but also on treatment fidelity. Treatment fidelity refers to whether a specific treatment or intervention is implemented as planned (Gresham, 1996; Hogue, Liddle, & Rowe, 1996). Components of treatment fidelity include treatment adherence and competence. Adherence refers to the degree to which a practitioner uses techniques and approaches prescribed by an intervention, whereas competence refers to the level of skill with which a practitioner delivers the intervention (Waltz, Addis, Koerner, & Jacobson, 1993). Strategies to enhance treatment fidelity might include developing treatment manuals, protocols, or both for practitioners who deliver the intervention, training practitioners in the intervention methods, supervising practitioners as they deliver the intervention, and making observational checks (in vivo, audio, or video) to ensure that the intervention is being implemented as intended (Moncher & Prinz, 1991). Bellig and his colleagues (2004) noted that many of these strategies are well-known but are not consistently used in intervention research on health behaviors. Rosen and his colleagues (1999) stressed that in order for social work research to inform practice and add to the social work knowledge base, interventions must be empirically denotable and sufficiently detailed to ensure the integrity of implementation and future replication. For that reason, enhancing and verifying treatment fidelity as part of research has the potential to increase strong and valid comparisons of replicable treatments. In addition, it has been argued that a critical reason for assessing and enhancing treatment fidelity is to increase the internal validity or confidence that observed differences or lack thereof in outcome studies are due to the intervention and not other variables (Barber, Foltz, Crits-Christoph, & Chittams, 2004; Moncher & Prinz, 1991). Because of its importance, treatment fidelity, according to experts in other fields, should be a standard part of any evaluation (Bellig et al., 2004; Perepletchikova & Kazdin, 2005); however, little attention has been given to treatment fidelity in social work research. In the past, treatment fidelity in studies of school-based behavioral interventions (Gresham, Gansle, Noell, Cohen, & Rosenblum, 1993); clinical psychology, behavioral therapy, psychiatry, marital and family therapy (Moncher & Prinz, 1991); and child treatment (Gresham, Gansle, & Noell, 1993) spanning a decade have been examined. In general, the findings suggest the trend that outcome studies were more likely to use strategies to enhance treatment fidelity than to measure the extent of treatment fidelity. For example, Gresham, Gansle, and Noell (1993) found that only 16% of 168 articles reviewed specifically measured and reported treatment fidelity, whereas as little as 6% of the 359 studies reviewed by Moncher and Prinz (1991) did the same. In addition, conflicting information has been found on the relationship between treatment fidelity and outcomes. In their review of studies addressing treatment fidelity, Perepletchikova and Kazdin (2005) noted that although some research indicates that decreased fidelity is related to a decrease in the likelihood of significant change in the dependent variables, other research partially supports this or indicates therapeutic change without therapeutic fidelity. Unlike the mentioned psychology and education literature, little attention has been given to treatment fidelity in social work research on psychosocial outcomes. In an effort of fill this gap, this study reviews a decade of social work research on psychosocial outcomes to see how treatment fidelity is addressed and to understand the relationship of treatment fidelity to outcomes. METHOD Six prominent social work journals were selected for this review for two reasons. …

An overview of “The Active by Choice Today” (ACT) trial for increasing physical activity

Background Although school-based behavioral interventions for increasing physical activity (PA) in children and adolescents have been conducted, little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days. The overall goal of the “Active by Choice Today” (ACT) trial is to expand the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents (low socioeconmic status, minorities) during their middle school years. Design and setting An overview of the ACT study design, theoretical framework, process evaluation, and primary hypotheses is presented. The trial involves twenty-four middle schools (1560 6th graders) in South Carolina that are randomly assigned to one of two after-school programs (motivational and life skills intervention, or general health education). Intervention The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA. The intervention targets skill development for PA outside of program days and the after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) is designed to positively impact cognitive mediators (self-efficacy, perceived competence), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Main hypotheses/outcomes It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA (based on 7-day accelerometry estimates) at post-intervention as compared to the general health education program. Conclusions Implications of this innovative school-based trial are discussed.

Current Status and Future Directions of School-Based Behavioral Interventions

This article describes current status and future directions for school-based behavioral interventions. The article is centered on four themes that are considered critical for future research and practice in school-based behavioral intervention work. First, the article argues for conceptualizing interventions based on intensity level and purpose (universal, selected, and target/intensive interventions). Second, response to intervention approach should be used as the basis for changing, modifying, or intensifying interventions. Third, evidence-based practices should be used for selecting and evaluating interventions. Fourth, social validation of behavioral interventions should be used to establish the clinical or applied significance of target behavior selection and to document the social importance of effects. Contributions of functional behavioral assessment in designing and implementing behavioral interventions are examined. Future directions for research and practice in behavioral interventions in schools are considered.

Current Perspectives on School-Based Behavioral Interventions: Introduction to the Mini-Series

Emotional and behavioral problems of students in the classroom have been rated as a major concern for teachers, administrators, and the public (Hardman & Smith, 2003; Macciomei, 1999). Without effective behavior management, a positive and productive classroom environment is impossible to achieve. The most effective model for producing behavior change and preventing the development of maladaptive behavior is the behavioral model (Wielkiewicz, 1995). In addition, behavioral approaches have been found to be very effective in developing effective instructional strategies. However, resistance to the use of behavioral procedures in the classroom has come from a variety of sources and some individuals have been particularly harsh in their criticism of the use of positive reinforcement (e.g., Kohn, 1993). In spite of this, teachers continually request training in behavior and classroom management techniques (Maag, 1999, 2001). The school psychologist is at the forefront of providing assistance to teachers in the development of effective practices to both prevent and remediate behavior and academic problems in the classroom. We must ask where we stand as a profession with regard to providing these essential services. What has been empirically validated as effective in the classroom and in what areas are additional research needed? These are fundamental questions for the field of school psychology. It is therefore the intent of this mini-series to provide an overview of current perspectives on behavioral interventions in schools. Integrating theory and research, the articles in this mini-series address the need for both thought-provoking analysis and a summary of best practices as they relate to school-based behavioral procedures. In the first article, Frank M. Gresham (2004) sets the tone for the mini-series by providing an overview of the current status and future directions of school-based behavioral interventions. Dr. Gresham has spent a career providing provocative analyses of major issues facing the field and his examination of school-based behavioral interventions is both thought-provoking and insightful. The article focuses on four themes he considers essential for future research and practice in school-based behavioral interventions. The first theme is that the intensity of an intervention should be matched to the severity of the behavior problem exhibited by the individual. The second theme discusses the idea of response to intervention (RTI) as a fundamental principle in behavioral interventions. The third theme questions the role of functional behavioral assessment (FBA) in designing interventions and presents evidence that the costbenefit of conducting an extensive FBA is not positive. The final theme involves the role of social validation in selecting target behaviors, designing acceptable interventions that will be implemented with integrity, and in documenting socially important outcomes. Angeleque Akin-Little and colleagues (Akin-Little, Eckert, Lovett, & Little, 2004) address the issue of the effects of extrinsic reinforcement on the construct of intrinsic motivation. Popular media, cognitive researchers, and many teacher education programs suggest that classroom use of reinforcement is detrimental to children's motivation. After a comprehensive review and analysis of research in this area, including conflicting meta-analyses, Akin-Little et al. conclude that these accusations are not founded in data. In addition, the article offers school psychologists specific recommendations on the appropriate use of reinforcement programs in educational settings. Joseph Witt, Amanda VanDerHeyden, and Donna Gilbertson (2004) provide a consultative framework for school psychologists in responding to concerns about school-based behavior problems. Drawing on their own research, they offer a model that can help school psychologists in identifying and resolving problems one may encounter with classroombased behavioral interventions. …