Explain Strategies for De-escalation

Essential components of school-based intervention for students with emotional and behavioral disorders: An integration of research and practice

Daniel D. French

Cooperative Educational Services, Trumbull, CT, USA

ABSTRACT Despite over 50 years of research and discussion concerning school-based interventions for stu- dents with emotional and behavioral disorders (EBD), a discernible consensus regarding the core elements of intervention for this student population remains elusive. This discordance is seen by many as an obstacle to the proper design, dissemination, and implementation of effective prac- tice, and has been attributed to the vast number of interventions available, the complexities asso- ciated with the numerous interactive variables involved in their implementation, and the research to practice gap. The present article blends experiential knowledge with relevant literature in a dis- cussion of essential components of school-based intervention for students with EBD from the per- spective of a practitioner.

KEYWORDS EBD; emotional and behavioral disorders; special education

Students with emotional and behavioral disorders (EBD) are arguably among the most challenging students facing today’s educators. The difficulties presented by this student popula- tion have been well-documented for decades (Hewett, 1968; Hobbs, 1982; Redl & Wineman, 1951; Steinberg, Knitzer, & Zabel, 1992) including and up to the present time (Conroy, 2016; Farmer, Reinke, & Brooks, 2014). Within this exten- sive body of literature is an abundance of knowledge con- cerning the magnitude of the problem (Bradley, Doolittle, & Bartolotta, 2008; Kauffman & Landrum, 2009; Knitzer, Steinberg, & Fliesch, 1990) as well as the numerous inter- ventions available to effectively meet the academic and behavioral needs of these students in a school setting (Gage et al., 2010; Lewis, Hudson, Richter, & Johnson, 2004; Peacock Hill Working Group, 1991; Reitz, 1994). Almost 25 years ago, Reitz commented on the breadth of this know- ledge base when he wrote: “There currently exists a dizzying array of theoretical models, general program types, and indi- vidual services or interventions that one could pick from in developing an effective, comprehensive classroom program for students with emotional and behavioral problems” (p. 312). Commentary from more recent research suggests the field continues to have ample information about effective practices for students with EBD (Conroy, 2016; Maggin, Robertson, Oliver, Hollo, & Moore Partin, 2010; Walker, Clancy, Tsai, & Cheney, 2013).

However, despite the obvious benefits of this vast body of literature, it appears that its enormity, coupled with the diffi- culties involved in the successful application of this know- ledge to a myriad of real-life circumstances (Conroy, Stichter, Daunic, & Haydon, 2008), have hindered the professional community’s efforts to arrive at a consensus regarding the

most important components of effective school-based inter- vention for this student population (Peacock Hill Working Group, 1991; Simpson, Peterson, & Smith, 2011). As Simpson et al. (2011) note, establishing accordance among professio- nals on this matter is a necessary first step in the develop- ment of consistent and effective practice: “First there is a need for professionals in the field to identify agreed-upon indispensable and fundamental elements and features of effective programs for children and youth with EBD” (p. 232). The value of determining the essential components of evidence-based practices for students with EBD was also dis- cussed recently by Farmer et al. (2014) in the context of the applicability of interventions to “real world” (p. 72) settings. These authors accentuated the importance of identifying the essential components of evidence-based practices while simul- taneously focusing on their fidelity and the feasibility of their implementation in specific settings.

Over the past three decades, numerous researchers have attempted to narrow the focus of the literature by identifying those interventions believed to be the most efficacious or vital to the process of educating students with EBD. The Peacock Hill Working Group (1991), Landrum, Tankersley, and Kauffman (2003), Lewis et al. (2004), Neel, Cessna, Borock, and Bechard (2003), Gage et al. (2010), and Simpson et al. (2011) represent some of the more prominent contributions to this effort. Their achievements have illuminated many of the central issues on which researchers and practitioners must focus to establish and maintain effective school programing for students with EBD. However, although the sum total of these efforts is laudable, identification of the core program components required for effective intervention with this stu- dent population remains elusive.

CONTACT Daniel D. French [email protected] Cooperative Educational Services, 25 Oakview Drive, Trumbull, CT 06611, USA. � 2019 Taylor & Francis Group, LLC

PREVENTING SCHOOL FAILURE: ALTERNATIVE EDUCATION FOR CHILDREN AND YOUTH 2019, VOL. 63, NO. 4, 369–381 https://doi.org/10.1080/1045988X.2019.1619510

The reasons for this appear to be twofold: First, the rec- ommendations from these authors, albeit considerably pared from the entire body of available literature, continue to be numerous and varied making it difficult for practitioners to decide upon the truly fundamental components when con- structing a school model for this student population. Second, the complexities and interconnections involved in the implementation of these components render their mere identification ineffective without the additional specificity and insight required to successfully navigate these obstacles. Maggin, Wehby, Farmer, and Brooks (2016) discussed the problem of complexity in the context of “correlated con- straints” (p. 127) as well as in the assertion that effective interventions for students with EBD must be multidimen- sional and flexible in order to respond to the multivariate, interrelated nature of the numerous issues involved.

This concern was also addressed by Walker et al. (2013), who commented that published lists of recommended inter- ventions can provide some direction and structure to practi- tioners, but also advised that additional steps will ultimately be required for these interventions to be effectively incorpo- rated into meaningful practice. Moreover, Simpson et al. (2011) noted that broad descriptions of program compo- nents may not provide adequate specificity to be sufficiently instructive and called for expansion and clarification of the key elements of an effective and scientifically based practi- tioner model.

The research to practice gap that has vexed special educa- tion for many years (Boardman, Arguelles, Vaughn, Hughes, & Klingner, 2005; Gage et al., 2010; Greenwood & Abbott, 2001; Maggin et al., 2010; Walker et al., 2013) is germane to this ongoing struggle to achieve the professional consensus Simpson et al. (2011) and Farmer et al. (2014) deem neces- sary, insofar as consensus will most likely remain elusive if researchers and practitioners fail to see eye to eye on this issue. Although evidence-based practices are paramount to successful programing for students with EBD (Cook, Cook, & Tankersley, 2013; Gage et al., 2010; Lewis et al. 2004), the prioritization of these practices may not be well-suited to empirical analysis due to the complexities that arise from the interdependence of numerous strategies that are often implemented simultaneously in real-life, dynamic, nonexper- imental conditions.

This concern was raised by Gage et al. (2010) in their discussion of multicomponent intervention when they noted “current research efforts have not captured the potential and promise of incorporated, multisystemic, comprehensive treatment options” (p. 298). Similarly, Conroy et al. (2008) offer an extensive discussion of the many complex, dynamic variables that often undermine the internal and external val- idity of classroom intervention research for students with EBD. They included the observations that classroom-based research often lacks social validity (i.e., usefulness, feasibil- ity) and that teachers involved in classroom-based interven- tion research frequently do not use the interventions being investigated following the conclusion of the study for this reason.

In light of these challenges, the process of establishing the relative value of school-based interventions for students with EBD may benefit from the contributions of experienced practitioners who have had opportunities to observe differ- ent combinations of strategies in relation to a multitude of relevant variables (e.g., experience level of teachers, severity of student psychopathology, interpersonal skills of teachers, fidelity of implementation). Conroy (2016) commented on this issue noting the tendency for research pertaining to stu- dents with EBD to be “top-down” (p. 192), meaning that it is often approached from the perspective of the researchers. She advocated for increased collaboration between research- ers and practitioners and noted the importance of the over- all contexts within which interventions occur that may not be identified in studies targeting a specific intervention.

Simpson et al. (2011) also discussed the limitations of sci- entific analysis when confronting certain aspects of the com- plex world of special education and presumably the numerous judgments that must be made pertaining to the nuanced and constantly changing variables of human behav- ior. Accordingly, they emphasized the importance of logical judgment, common sense and professional “experience- based opinions” (p. 233) in the education of EBD students. Furthermore, in their discussion of the research-to-practice gap, Maggin et al. (2010) highlighted the importance of practitioner contributions for the integration of research, policy, and practice. These authors proposed that cooper- ation among researchers, policy makers, and practitioners “can result in a reciprocal, interactive relationship between science and practice” (Maggin et al., 2010, p. 310) and that practitioners would “provide feedback on the feasibility and acceptability of research and policy initiatives” (Maggin et al., 2010, p. 315) regarding interventions for students with EBD. Finally, Lewis et al. (2004) advised that reducing the research to practice gap was ultimately the responsibility of both researchers and practitioners.

In consideration of the recurring efforts to identify essen- tial components of school-based intervention for students with EBD, as well as the appeals for increased contributions from practitioners, the following discussion integrates exist- ing research and prominent literature with experiential learning derived from the iterative process routinely applied by practitioners in the course of our work with students in schools. Principally, the purpose of this article is to fuse “top-down” and “bottom-up” knowledge toward a consensus view of what constitutes core elements of school programing for students with EBD. The article’s content is intended to offer ample specificity to be beneficial to practitioners while simultaneously providing researchers a pragmatic perspective on the prioritization of the myriad of strategies and issues involved in the education of students with EBD.

Introductory suppositions

Prior to a discussion of the central elements involved in the establishment of effective school programing for students with EBD, it is necessary to present four critical observations about the task. Awareness of these fundamental truths is

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essential to the process as they permeate all aspects of suc- cessful programing for this student population, and if over- looked, can easily undermine the entire process or diminish the efficacy of otherwise sound strategies.

Recognition of the challenge

The problems presented by this student population are severe and the task of providing effective intervention for these students equally difficult. Although this observation appears well-established (Center & Callaway, 1999; Neel, 2006; Redl & Wineman, 1951; Steinberg & Knitzer, 1992), its implications for the very human, day to day interactions involved in the intervention process are easily lost in the often impalpable, exclusively cerebral context of scientific lit- erature. Successful intervention for EBD students can only occur with a full appreciation for the magnitude of the chal- lenge and the level of emotional fortitude and resolve required by those involved in the intervention process. Students with EBD include children and adolescents with severe trauma histories, untreated psychopathology, and long-standing, ingrained patterns of antisocial behaviors borne of a complex array of both constitutional and envir- onmental influences (Cullinan, 2007; Redl & Wineman, 1951). Common behaviors exhibited by this student popula- tion include noncompliance, verbal and physical aggression, self-injury, elopement, and a wide range of disruptive behav- iors (Cullinan, 2007; Kauffman & Landrum, 2009).

Even under the best of circumstances, student progress may be slow and often fraught with periods of emotional and/or behavioral upheaval. Furthermore, transient environ- mental and/or familial stressors can easily exacerbate this already severe symptomatology to levels beyond that which can be safely managed in a school setting. Although the severity of these symptoms may vary as a function of the child’s particular profile and the extent to which the child’s emotional, behavioral and academic needs are matched with the appropriate educational and mental health supports, it is apparent that the overall challenges inherent to this student population are quite formidable and most certainly contrib- ute to the poor outcomes that have been attributed to these students for many years (Smith, Katsiyannis, & Ryan, 2011; Steinberg & Knitzer, 1992).

Accordingly, the task of establishing effective school- based intervention for students with such profound, com- plex, and refractory disabilities is daunting. Teachers will contend with highly disruptive and, at times, aggressive behaviors. School administrators must anticipate damage to the building (e.g., a hole in the wall), calls for emergency services to transport students to the hospital for psychiatric evaluation, frequent behavioral incidents on transportation vehicles, and an array of both transient and substantive threats (Cornell, Sheras, Gregory, & Fan, 2009). School social workers and school psychologists must be prepared to assess the risk of suicide, make reports to child protective services, and provide frequent counseling support to stu- dents and families in acute emotional distress—while also remaining focused on the goal of academic progress and

attaining the documentation and achievement standards of the Every Student Succeeds Act (ESSA, 2015). The high stress and attrition rates found among teachers of EBD stu- dents (Adera & Bullock, 2010; Center & Callaway, 1999) are testament to the magnitude of this challenge and underscore the necessity of having highly skilled and committed teach- ers as a foundation to effective programing (Simpson et al., 2011).

Effective intervention requires specialized training

Understanding the magnitude of the challenge involved with educating students with EBD generates a second fundamen- tal truth—intervention for this student population requires a specialized knowledge base and skillset (Conroy, 2016; Lewis et al., 2004; Neel, 2006). However, teacher knowledge about effective practices appears to be quite low. Research indi- cates that special education teacher preparation programs place little emphasis on classroom management (Oliver & Reschly, 2017) and in-service training for teachers of stu- dents with EBD is minimal (Wagner et al., 2006). Furthermore, many authors have reported that the use of evidence-based practices for this student population does not occur with any regularity (Conroy, 2016; Landrum et al., 2003; Peacock Hill Working Group, 1991; Simpson et al., 2011) despite the existence of a large body of scientific evidence demonstrating the effectiveness of these practices (Cook et al., 2013; Lewis et al., 2004).

Numerous explanations have been offered for this short- coming, including a lack of treatment fidelity (Landrum et al., 2003), insufficient input from practitioners (Conroy, 2016), blaming students with EBD for their unresponsive- ness to traditional mechanisms of controlling behavior such as punishment (Peacock Hill Working Group, 1991), a fail- ure to evaluate program interventions for their effectiveness (Walker et al., 2013), a belief among practitioners that spe- cific evidence-based practices are not applicable or relevant to their classrooms (Boardman et al., 2005; Farmer et al., 2014), and a lack of consensus regarding best practice (Peacock Hill Working Group, 1991; Simpson et al., 2011).

Although each of these explanations undoubtedly bears a degree of truth, ultimately the responsibility for facilitating effective programing for students with EBD rests with edu- cational leaders (i.e., superintendents, principals, directors of special education) because they set the agenda, influence cul- ture, allocate resources, prioritize goals, and are tasked with ensuring that their employees are prepared to meet those goals. Yet, due to the specialized nature of interventions for students with EBD and the rarity in which these interven- tions actually occur in practice, educational leaders may not have the experience or knowledge necessary to lead their staff in the implementation of effective practice. This is pre- cisely the impetus behind Maggin et al. (2010) having rec- ommended that policymakers at all levels (i.e., local, state, and federal) have familiarity with the treatment needs of this student population.

However, given the mounting demands on educational leaders to facilitate the instruction of a generation of

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students with increasingly diverse needs, it may be unrealis- tic to require these leaders to be well-versed in the complex interventions required for students with EBD. Nevertheless, it is critical that educational leaders recognize the level of expertise and resources necessary to meet this challenge and facilitate the process of acquiring adequate support for their staff. Reitz (1994) discussed this issue noting the necessity of acquiring ongoing supervision and training from knowledge- able professionals in the implementation of interventions for students with EBD. He accentuated the need for long-term administrative commitment to the process as well as the identification of a core group of staff members who would receive the proper training and be primarily responsible for the implementation of the appropriate strategies. Reitz also cautioned that successful implementation will require a min- imum of two to three years to develop—a point that sheds light on the magnitude and complexity of the challenge.

The importance of ongoing training is shared by others (Conroy & Sutherland, 2012; Farmer et al., 2014). For example, Farmer et al. discussed four different intervention models for students with EBD based upon sustained support from knowledgeable professionals that go beyond the trad- itional isolated workshop format. The Peacock Hill Working Group (1991) also touted a consultant driven program in their discussion of successful program models for students with EBD and, of course, the national movement toward school-wide positive behavior support (SWPBS) utilizes a consultant-based model in its implementation (Sugai & Horner, 2006).

Interpersonal skills of the teacher

A third premise underlying effective intervention for stu- dents with EBD pertains to the relational skills of the profes- sionals who work directly with this student population. A staff member’s interpersonal presentation may be the lynch- pin to the entire process of effecting meaningful change for students with EBD because interventions for students with EBD occur in an interpersonal context (e.g., praise, repri- mands, redirection) as do the majority of the problematic behaviors exhibited by these students (e.g., aggression, non- compliance, withdrawal). In fact, the very nature of EBD is interpersonal impairment (Landrum et al., 2003). As such, problematic student behaviors are frequently precipitated or triggered by interpersonal interactions between the student and teacher and can easily escalate in both intensity and duration as a function of the manner in which the teacher interacts with the student.

This is especially important in light of the proclivity for many students with EBD to exhibit behavioral difficulties in response to minor stressors (Cullinan, 2007) and to perceive rejection (Redl & Wineman, 1951) or ill-intent where none exists (Hinshaw & Anderson, 1996; Hobbs, 1966). The teacher’s interpersonal presentation, particularly his or her ability to communicate with a nonjudgmental, warm, and steady demeanor, absent any hint of annoyance or rejection, can be influential in steering a potentially problematic

interaction with a student toward a mutually satisfying con- clusion free of any conflict.

Furthermore, the teacher’s interpersonal presentation is critical to successful intervention as it is the primary vehicle through which trusting relationships are forged with stu- dents—relationships that eventually become a central medium through which students with EBD learn self-con- trol, empathy, self-respect, and numerous prosocial behav- iors. The seminal works of Hobbs (1966), Redl and Wineman (1951), and Bowlby (1988) should provide ample justification for this claim. Also, more recently, Simpson et al. (2011) endorsed this assertion in their article outlining the critical components of programing for students with EBD when they wrote “Programs and interventions for stu- dents with EBD are only as effective as the individuals who apply them and are inextricably aligned with relationships between teachers and learners” (p. 232).

Research in the area of student-teacher relationships and teacher characteristics has produced relevant findings to the present discussion. For example, Hamre and Pianta (2001) found a connection between the quality of student-teacher relationships in kindergarten and academic and behavioral outcomes through eighth grade such that better performance was associated with more positive relationships. Also, in a study that surveyed professionals with knowledge about stu- dents with EBD, teacher traits including sensitivity, persist- ence, enthusiasm and remaining calm were rated highest in importance (Cullinan, Epstein, & Schultz, 1986).

Similarly, Prather-Jones (2011) interviewed teachers of students with EBD and found that “having the ability not to take students’ actions and vocalizations personally” (p. 184) and being flexible were believed to be key characteristics needed to teach students with EBD. Prather-Jones also expressed the importance of recruiting candidates who have the appropriate personality for the job. Lastly, and remark- ably still relevant, 60 years ago Mackie, Kvaraceus, and Williams (1957) reported that experienced professionals of students with EBD believed that emotional stability, warmth, and the ability to tolerate extreme behaviors were important personality traits for professionals to possess when working with this student population.

Avoid over-Reliance on punishment strategies

A fourth and final supposition underlying effective interven- tion pertains to the widely held belief that students with EBD willfully engage in problematic behaviors and therefore “deserve” punishment to hold them “accountable.” The Peacock Hill Working Group (1991) discussed this miscon- ception over 25 years ago as a factor contributing to poor programing for students with EBD and it remains relevant today. Inaccurate and counterproductive, this belief deters professionals from viewing the child’s behavior through a lens of compassion and tolerance. On the contrary, students with EBD provoke feelings of anger and frustration from teachers (Avramidis, Bayliss, & Burden, 2000) and are often viewed as willfully obstinate, unreasonable, immature, annoying, and subsequently not deserving of our

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compassion or our tolerance – a conceptualization that lends itself to the use of punishment as a primary means of attempting to alter their behavior (Cassady, 2011). Despite the popularity of contributions from authors such as Ross Greene (Green, 1998), who has written extensively about the complex and very real nature of the emotional, behavioral, and cognitive symptomatology of children with EBD, there appears to be a natural inclination for both laypeople and professionals to view the misbehavior of these students as being well within their conscious control.

Because this belief can impact the attitudes, judgments, and ultimately the behavior of those working directly with this student population, it is necessary that it be countered with an opposing viewpoint more conducive to the imple- mentation of positive interventions. Thus, it is essential to cultivate and promote a more sophisticated understanding of a student’s capacity for self-control that incorporates the complex and variable relationship between immediate envir- onmental demands, interference from emotional content, innate dispositional tendencies, and the refractory nature of longstanding, ingrained behavior patterns.

Absent a sustained effort to promote a learned perspec- tive about the nature of the disability and the subsequent need to minimize the use of punishment strategies, in con- junction with the often slow progress of students with EBD and the concomitant frustration experienced by teachers, there is considerable risk for an overreliance on punishment strategies to emerge. For a review of the well-established potential side-effects and problems associated with the use of punishment see Cooper, Heron, and Heward (2007), Skiba & Rausch (2006), and Sugai et al. (2000).

Summary

Successful intervention for students with EBD requires rec- ognition that symptoms exhibited by these students are often quite severe, resistant to conventional school-based intervention, taxing on the staff members working directly with the students, and require a specialized approach to intervention that must include on-going supervision from knowledgeable professionals and the full commitment and support of the organization’s leadership. Furthermore, the very nature of the disability for students with EBD is inter- personal. As such, effective intervention requires teachers, paraprofessionals, clinical staff members and administrators who possess the ability to form positive relationships with students and avert eliciting problematic behavioral responses from students by consistently presenting themselves in a calm, steady, and nonjudgmental manner. Finally, there is a natural tendency to view students with EBD as having more conscious control over their problematic behaviors than is actually warranted. This belief can readily lead to an overre- liance on punishment strategies that have the potential to be counterproductive. Effective intervention requires ongoing efforts to offset this tendency by promoting a more sophisti- cated understanding of this student population and a more tolerant and positive approach to intervention. In short, blaming the student for his/her continued misbehavior is

not a productive exercise (A. L. Reitz, personal communica- tion, November 9, 2010).

Essential strategies

Prior to an examination of the essential components of effective intervention for students with EBD, it is necessary to acknowledge the heterogeneity of this student population with regard to the etiology, nature, severity, and chronicity of symptoms. As such, no single intervention strategy, or set of strategies, will be sufficient to address the needs of all stu- dents having an EBD classification. However, the following evidence-based strategies retain wide support in the fields of psychology and special education and are presented here as core interventions for students with EBD from the perspec- tive of the author’s considerable experience implementing evidence-based strategies in a special education school designed specifically for this student population. As previ- ously stated, the intent is to merge empirical evidence with practical application or experiential knowledge. It is also presupposed that functional behavioral assessment and data- driven decision making will accompany these interventions as standard practice for the purpose of adapting strategies to the particular needs of individual students and determining the effectiveness of specific interventions in specific circumstances.

Behavioral expectations, monitoring, and positive reinforcement

The process of providing students with clearly defined expectations for behavior, monitoring their behavior, and delivering reinforcement in response to the performance of the behavior is the bedrock of classroom management for students with EBD. Numerous authors have accentuated the necessity of this particular aspect of classroom management (Lewis et al., 2004; Reitz, 1994; Simonsen, Fairbanks, Briesch, Myers, & Sugai, 2008; Simonsen, Jeffrey-Pearsall, Sugai, & McCurdy, 2011; Simpson et al., 2011), however, the primacy of this intervention cannot be understated. To be successful, this process must be relentlessly applied due to the highly persistent and refractory nature of the behavioral difficulties exhibited by students with EBD (Landrum et al., 2003; Patterson, Reid, & Dishion, 1992; Simpson et al., 2011). Consistent with the manner described by Sugai et al. (2010) regarding the use of School Wide Positive Behavioral Supports (SWPBS), this approach requires that behavioral expectations are posted and frequently reviewed and that teachers routinely state these expectations throughout the course of the school day. This intervention strategy effect- ively promotes prosocial behaviors and eliminates unstruc- tured time, which is a sufficient condition for students with EBD to engage in a myriad of disruptive behaviors (Maag, 2004).

Positive reinforcement following the performance of desired behaviors is delivered most efficiently in the form of verbal praise. The Peacock Hill Working Group (1991), Landrum et al. (2003), and Lewis et al. (2004) each included

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this particular strategy in their respective discussions of the essential elements of school intervention for students with EBD. When consistently applied, contingent praise in response to desired behaviors has been demonstrated to have a positive impact on student behavior (Alberto & Troutman, 2013; Conroy, Sutherland, Snyder, Al-Hendawi, & Vo, 2009; Sutherland, 2000).

Positive reinforcement is also delivered effectively through the use of group contingencies (Maggin, Pustejovsky, & Johnson, 2017; Simonsen et al., 2008). This strategy is particularly effective when linked to behaviors that are critical to the development of a positive classroom culture. For example, teaching students to raise their hands during lessons through the use of group contingency con- tracts contributes to the establishment of a structured and orderly classroom environment. Although there is scant research on this topic, it appears to be standard practice in classroom management because once established as a norm, hand-raising serves as an inhibitor to impulsive or otherwise poorly controlled student verbalizations that disrupt the class and become antecedents for further disrup- tive behaviors.

Group contingencies that target desired peer interactions such as helpful behaviors, kind statements, and the absence of antagonistic behaviors also help to create desired social norms that, once established, serve as a powerful influence on the behavior of the group (Myers & Dewall, 2016). Although not explicitly in the context of group contingen- cies, Farmer et al. (2014) discussed the importance of the social ecology of the classroom and emphasized the value of the teacher’s active involvement in shaping the peer culture toward desired norms. A simple group contract in which a specific behavior is targeted for reinforcement once a prede- termined cumulative frequency is achieved by the group is an efficient way to implement this strategy.

The delivery of positive reinforcement through the struc- ture of a contingency management system (i.e., token econ- omy, point-level system) has also been effective in programs for students with EBD (Kerr & Nelson, 2006; Reitz, 1994). These systems have the potential to provide teachers with predictable, consistent, and objective methods for dispensing positive consequences in response to desired behaviors. However, it is also important to note that they can be implemented in a manner inconsistent with best practice (Maggin, Chafouleas, Goddard, & Johnson, 2011). Although a thorough discussion of contingency management systems is beyond the scope of this article due to the multitude of ways they can be designed and the level of specificity required to ensure their proper implementation (Ivy, Meindl, Overley, & Robson, 2017), it is important to note that any system of this kind should be used in a manner that provides students with high rates of positive reinforce- ment for desired behaviors and minimizes the use of response-cost strategies.

One final note regarding the use of positive reinforce- ment is its value as a behavioral reduction strategy. Targeting problematic behaviors through the use of differen- tial reinforcement (e.g., DRO, DRL) is also a standard

practice in classroom behavior management (Alberto & Troutman, 2013; Simonsen & Myers, 2015), and can con- tribute substantially to the development of a prosocial class- room environment for students with EBD by reducing or eliminating behaviors that are particularly detrimental (e.g., physical aggression, antagonizing peers).

Structure and predictability

It is universally recognized that classrooms for students with EBD require significant structure and predictability (Maag, 2004; Reitz, 1994; Simpson et al., 2011). Students with EBD benefit from this approach, in part, because it minimizes opportunities for disruptive behavior and provides a sense of security for students (Jones, 1993). Common examples of this include clearly stated rules, consistent routines, familiar daily schedules (Reitz, 1994), and a high frequency of teacher directed activities (Simonsen et al., 2008) in which expectations for student behavior are explicit (Reitz, 1994).

Additional elements of “structure” include an orderly classroom wherein teachers are well-prepared for lesson activities, necessary materials are ready to go, and down- time is minimal. Students with EBD do not respond well to even brief periods of time when expectations for behavior are vague, open-ended, or without explicit directions from the teacher. This includes free-time activities and transition times. For example, students benefit from having free-time periods with clearly delineated behavioral choices and struc- tured transitions (e.g., sitting quietly for 15 seconds prior to the start of a new activity). These simple routines bring order to the class numerous times throughout the day and help establish self-regulatory behaviors.

Academic engagement

The poor academic achievement of students with EBD and its origins are well-established (Knitzer et al., 1990; Nelson, Benner, Lane, & Smith, 2004). Among the most obvious causes for this deficiency is the limited student engagement that results from the interference of emotional, behavioral, and learning impairments characteristic of this student population (Kauffman & Landrum, 2009). As such, strategies to increase academic engagement are paramount to the intervention process and equally as important as the imple- mentation of behavior management strategies (Simpson et al. 2011). Perhaps Reitz (1994) said it best when he wrote “No behavioral system, no matter how sophisticated or well implemented, will effectively manage the behavior of stu- dents who are not engaged in productive and meaningful work” (p. 315).

Although the literature is replete with instructional strategies demonstrated to be effective in engaging students with EBD and/or recommended for use with them (Greenwood, 1991; Landrum et al., 2003; Lewis et al., 2004; Rosenberg, Wilson, Maheady, & Sindelar, 2004; Sutherland & Wehby, 2001), only a few strategies appear to be preeminent in the literature. These include providing students with frequent opportunities to respond to academic questions (OTR; Haydon et al., 2010),

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teacher praise (Moore Partin, Robertson, Maggin, Oliver, & Wehby, 2009; Reitz, 1994), and opportunities for individual and small group instruction (Maggin, Wehby, Moore Partin, Robertson, & Oliver, 2011). Providing students with ample opportunities to experience success has also been noted as a critical factor for this student population (Simpson et al., 2011).

However, irrespective of the specific strategies being uti- lized, the presentation of stimulating, fun, and relevant les- sons that are readily understood by students and from which students experience a sense of accomplishment is paramount to the process. Given the attraction of modern technology, lessons presented via smartboards, iPads or other interactive technologies are also helpful in this regard (Lirenman & Wideen, 2016). Undoubtedly, students with EBD have experienced failure and are often quick to become frustrated and disinterested. Lessons that are difficult to fol- low, too demanding, or simply fail to hold the attention of reluctant learners are likely to fail for this reason. This is further evidence as to the importance of an enthusiastic, personable, and compassionate teacher on a student’s engagement in the learning process.

Ironically, academic engagement of students with EBD will also be achieved by affording students ample time each day for nonacademic activities that provide respite from cognitive tasks requiring sustained mental effort (Council on School Health, 2013). This is especially important for stu- dents burdened by familial stressors, psychiatric impairment (e.g., depression), and/or constitutional tendencies toward inattention, hyperactivity, or impulsivity as any of these add- itional encumbrances can easily topple a child’s ability to cope successfully with rigorous academic demands. In fact, for many students with EBD, the task demands inherent to a standard school day can function as a trigger for problem- atic behaviors (Alberto & Troutman, 2013). Therefore, it is essential that cognitive demands placed on students be appropriate to their capacity to tolerate them, and that breaks from tasks requiring sustained concentration and/or sedentary activity occur at higher rates than is typical for their nondisabled peers. Opportunities for recess and struc- tured free time, or play, have long been recognized as important components of the school day for this purpose (Ginsberg, 2007) and are appropriate to the needs of stu- dents with EBD outlined here.

Social skills instruction

It has long been understood that students with EBD have significant impairments in social skills (Gresham, 2002; Kauffman & Landrum, 2009). Accordingly, numerous authors have advocated for the inclusion of social skills instruction as a core feature of school-based intervention for students with EBD and have referenced the efficacy of vari- ous social skills instructional strategies in the process (Gresham, 2015; Lewis et al., 2004, Peacock Hill Working Group, 1991; Simpson et al., 2011). However, despite con- sensus for the necessity of these strategies, meta-analytic studies have shown only modest effect sizes regarding increases in social competencies resulting from social skills

instruction for students with EBD (Gresham, 2015; Lloyd, Forness, & Kavale, 1998; Maag, 2006), suggesting that the specific manner of implementation as well as population variables may impact the relative efficacy of these interven- tions. The maintenance and generalizability of these skills has also been poor for students with EBD (Gresham, 2015). Moreover, Gresham (2015) reported that most of the studies in the past 10 years have focused on Tier 1 and Tier 2 inter- ventions with little to no research addressing Tier 3 inter- ventions for students with EBD.

Packaged curricula such as “Skill Streaming” (McGinnis, 2011) and the “Social Skills Intervention Guide” (Gresham & Elliott, 2008) are popular, yet may have limited sustained impact by themselves. Landrum et al. (2003) suggested that prepackaged, generic social skills curricula may not be effective in isolation and supported implementation strat- egies that provide opportunities for students to interact with other students and teachers in the natural environment of the classroom. The authors of a longitudinal study investi- gating the impact of a classroom-wide social-emotional learning program (PATHS) on the behavior of 2,937 chil- dren in first, second, and third grades appear to have come to a similar conclusion when they wrote “… program impact may be the greatest when teachers generalize support for curriculum-based skills during the day and build a healthy classroom atmosphere that support children’s use and internalization of skills” (Conduct Problems Prevention Research Group, 2010, p. 5).

Given the absence of a clearly established methodology for the sustained improvement of social skills in students with EBD, as well as the concern that their social impair- ments are quite resistant to intervention (Kauffman & Landrum, 2009), the utilization of both evidence-based strat- egies and natural opportunities for practice during the school day appears optimal. Moving forward, Gresham (2015) suggested that replacement behavior training (RBT; Maag, 2005) may merit further study as a strategy for teach- ing social skills to students with EBD and experiential evi- dence suggests that immersing students in a classroom culture wherein staff members consistently demonstrate a variety of social skills (e.g., expressing frustration appropri- ately), which are also targeted for reinforcement, may assist with the maintenance and generalizability of acquired social skills. The consistent display of prosocial behaviors by school personnel also contributes to the development of a positive classroom atmosphere which is an important aspect of effective intervention for students with EBD ( Simpson et al., 2011, Skiba & Rausch, 2006).

Emotional regulation strategies

Students with EBD invariably struggle to adequately regulate their emotions – this is a defining feature of the impairment (Cullinan, 2007). They become disproportionately frustrated, agitated, saddened, or angry in response to a wide range of environmental stimuli and have difficulty calming themselves once strong emotions are activated (Shaw, Stringaris, Nigg, & Leibenluft, 2014; Zeman, Cassano, Perry-Parrish, & Stegall,

PREVENTING SCHOOL FAILURE: ALTERNATIVE EDUCATION FOR CHILDREN AND YOUTH 375

2006). Many students with EBD also have constitutional vul- nerabilities (e.g., hyperarousal, hyperactivity, emotional vola- tility, sensory needs), which predispose them to emotional dysregulation (Barnes, Vogel, Beck, Schoenfeld, & Owen, 2008; Kauffman & Landrum, 2009). Whether arising from environmental and/or internal sources, emotional dysregula- tion in students with EBD often results in behaviors that interfere with their ability to attend, focus, and engage in productive activity. Moreover, intense emotional activation can produce severe dysregulation, which may lead to the onset of highly disruptive and/or aggressive behaviors. Thus, strategies aimed at assisting students with emotional regula- tion appear to be critical to the intervention process.

The term, “emotional regulation” includes a wide range of multifaceted processes related to one’s overall ability to identify and modulate his or her emotional state (Gross, 2008; Tolin, 2016). A sizeable amount of scientific literature has addressed this rather broad construct (Gross & Thompson, 2007; Koole, 2009) and not surprisingly, numer- ous definitions encompassing various aspects and interpreta- tions of the construct have been offered (e.g., Gross, 2008; Mennin, 2006; Tolin, 2016). Nevertheless, the following def- inition from Cicchetti, Ganiban, and Barnett (as cited in Prizant, Wetherby, Rubin, & Laurent, 2003) is provided here for its simplicity and relevance to intervention for students with EBD. They defined emotional regulation as “the intra and extra organismic factors by which emotional arousal is redirected, controlled, modulated and modified to enable an individual to function adaptively” (Prizant et al., 2003, p. 304).

By virtue of the wide-ranging and complex nature of the topic, strategies for targeting various aspects of emotional regulation abound, as do the ways in which these strategies are conceptualized. For example, Gross (2008, p. 500) dis- cussed “intrinsic” and “extrinsic” emotion regulation proc- esses – referring to self-regulation and regulation achieved through the assistance of another person, respectively. Similarly, Tronick (1989), described “self-regulatory behav- iors,” (p. 117) referring to strategies that are self-initiated, and “mutual regulation,” (p. 118) referring to strategies that occur through social interaction. Gross (2008) also discussed “antecedent-focused” (p. 501) strategies designed to be pro- active and “response-focused” (p. 501) strategies that are ini- tiated once emotional dysregulation begins. The landscape is further complicated by whether the particular emotional regulation mechanism falls within a cognitive, social, physio- logical, behavioral, or experiential framework—or multiple domains simultaneously (Gross).

Notwithstanding conceptual and taxonomic entangle- ments, the value of effective interventions in this realm seems obvious, prompting numerous authors to advocate for the use of a variety of different strategies. For example, Smith et al. (2017) recently reported using a comprehensive self-regulation curriculum (I Control) designed to teach middle-school students with EBD various skills associated with emotional regulation. The curriculum included goal- setting, identifying emotions, recognizing differences in emotional intensities, identifying triggers for dysregulation,

shifting attention to pleasant stimuli, cognitive reframing, and deep breathing. Results indicated that students taught the I Control curriculum evidenced improvement in emo- tional control and reduction in externalizing behaviors as measured by teacher and student report measures.

Mindfulness training, which appears to be increasing in popularity as a treatment for anxiety related disorders (Buchholz, 2015), has also been shown to improve focus and reduce anxiety in adolescents with EBD (Malow & Austin, 2016). Furthermore, interventions emanating from the field of occupational therapy have been used with a variety of student populations. These interventions include weighted vests, therabands, pushups, music, chewing gum, and the use of sound-canceling ear covers (Schulken, 2010). Similarly, relaxation breaks, taking walks, yoga, fidget toys, and the use of a quiet area have been recommended by the American Occupational Therapy Association (2012) for reducing stress/anxiety in children and youth in schools. Finally, packaged curricula such as “Superflex” (Madrigal & Winner, 2008) and “Zones of Regulation” (Kuypers, 2011) are widely available and provide an array of cognitive-behav- ioral strategies for use with school children.

In addition to the largely self-regulatory and preventative strategies discussed, students with EBD will invariably exhibit escalating or severe dysregulation manifested by tem- per tantrums or other intense emotional displays requiring staff members to immediately assist with de-escalation (i.e., response-focused, extrinsic or mutual regulation strategies). These interpersonal supports include displaying an appropri- ate emotional tone and facial expression, controlling the vol- ume and rate of speech, using simple and comforting language, appropriate physical proximity, and providing dir- ection that is neither overly directive or controlling, nor lacking in structure or clarity of expectations (Crisis Prevention Institute, 2018; Prizant et al., 2003). Assistance from an adult may also involve empathic statements, remov- ing stressful stimuli, suggesting a self-regulatory strategy (e.g., providing use of an iPad), and inviting a discussion about the source of the distress (French & Wojcicki, 2018).

Due to the refractory nature of the emotional volatility common to students with EBD, in conjunction with the many stressors inherent to a school setting, the need for both proactive (antecedent-focused) and reactive (response- focused) emotional regulation strategies may be consider- able. Furthermore, because the acquisition of self-regulatory strategies will likely take time, staff members working with this student population may be frequently required to assist students with emotional and behavioral de-escalation.

Response-cost and time-out

As discussed, positive reinforcement strategies are preferred prodigiously over the use of punishment for students with EBD (Green, 1998; Simpson et al., 2011; Sugai et al., 2000). That being said, there is support for the use of specific pun- ishment strategies in certain circumstances. For example, Conroy & Sutherland (2012) advocated for the judicious use of response-cost strategies for students with EBD in

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response to disruptive or dangerous behavior. Similarly, Reitz (1994) accentuated the need for time-out procedures in response to escalating, severe or dangerous behaviors, and Landrum et al. (2003) viewed the necessity of response-cost and time-out procedures for reducing problem behaviors analogous to the need for reinforcement strategies to increase desired behaviors. Landrum et al. (2003) also com- mented that the often longstanding nature of problematic behaviors exhibited by students with EBD necessitates the use of response-cost and time-out strategies—suggesting that reinforcement strategies alone are insufficient in some cases. Last, Simonsen et al. (2008) included both response-cost and time-out strategies in their overview of evidence-based strat- egies for classroom management. Synthesizing research with practice, several points of emphasis and precautions regard- ing their use are provided here.

Response-cost In a school setting, response-cost typically involves the tem- porary removal or partial removal of preferred activities and privileges subsequent to any number of misbehaviors. However, due to the proclivity for many students with EBD to exhibit a high frequency of minor misbehaviors, and con- sistent with the recommendations of Reitz (1994), response- cost procedures should be reserved for only those behaviors that are highly disruptive or dangerous (e.g., physical aggres- sion, threats, harsh ridicule directed at a peer). Implemented in this manner, its use aligns with a humanistic approach to treatment and guards against an overemployment of puni- tive strategies. Furthermore, the emotional volatility com- mon to students with EBD predispose them to negative emotional reactions—a well-known potential side effect asso- ciated with punishment procedures (Cooper et al., 2007). Restricting the use of response-cost procedures in this man- ner reduces the risk of provoking severe emotional reactions that may lead to escalating behavior.

Time-out Essentially, time-out procedures vary as a function of their restrictiveness and location (Costenbader & Reading-Brown, 1995). Non-exclusion time-out typically occurs within the classroom while exclusion time-out involves removing the student from the activity area or from the classroom to the hallway or another room designed for this purpose (Alberto & Troutman, 2013; Cooper et al., 2007). Time-outs that occur within the classroom or activity area have been shown to be effective for a variety of mild misbehaviors (Ryan, Sanders, Katsiyannis, & Yell, 2007). However, the success of in-class time-out procedures is predicated on the child being capable of demonstrating the self-control necessary to com- plete the procedure. Should a child be noncompliant with the procedure, continue to exhibit the problematic behavior that prompted the use of the procedure or engage in a highly disruptive behavior, an in class time-out procedure would be ineffective.

Considering the propensity for students with EBD to exhibit severe behaviors and emotional dyscontrol, the need

for time-out procedures outside the classroom may be high for some students. As such, exclusionary time-outs become a critical component of intervention for students with EBD because the procedure interrupts the problematic behavior and provides an opportunity for the child to regroup in a location more conducive to regaining behavioral control (e.g., a location away from other students), and because removing the child helps to cultivate and maintain the integ- rity of a productive and safe classroom atmosphere. If the child was to remain in the classroom while continuing to engage in severe behaviors, the immediate effect would be detrimental to the other students and a gradual erosion of desired behavioral norms within the classroom is likely to occur. Kaiser & Rasminsky (2009) discussed this issue in terms of eliminating a stimulating audience for the misbe- having child and Visser, Kunnen and Van Geert (2010) expressed similar concerns regarding peer contagion having a negative influence on the development of aggression in elementary school children in special education classes.

Time-out from reinforcement involves removing the opportunity for positive reinforcement for a specified time (Cooper et al., 2007). In its purist form, its success is predi- cated on the absence of any positive reinforcement received by the child during the procedure – including reinforcement from engaging in self-stimulation (Cooper et al., 2007) and attention from the teacher (Alberto & Troutman, 2013). However, with the drift toward more positive approaches to classroom management occurring over the past two decades (Simpson et al., 2011; Sugai et al., 2000) and an increased interest in understanding behavior problems from an emo- tional regulation paradigm, this rather strict view of the intervention may be changing.

For example, from the parenting skills literature, Siegal and Bryson (2016) argued that the traditional use of time- out often serves to punish, humiliate, and anger the child. They discuss the child’s misbehavior in terms of emotional dysregulation and suggest adults assist the child in the emo- tional regulation process by talking with and comforting the child when necessary during the time-out process. Similarly, Nelson, Tamborski, and Ainge (2016) advocate for a “positive time-out” (p. 108) procedure in which adults offer stimuli conducive to self-regulation such as music, toys, books, and stuffed animals.

These authors argue that assisting the child in self-regula- tion interrupts the misbehavior without being punitive and develops the child’s capacity for self-control. This positive, self-regulatory approach to time-out is also embraced by the Responsive Classroom model, which emphasizes social-emo- tional learning in the educational process (Responsive Classroom, 2014). In this model, time-out procedures involve teaching deep breathing strategies and visualization techniques as well as providing students with puzzles for distraction and stress balls for tension release. Although research on this topic appears to be lacking, the use of self and mutual regulatory strategies during exclusion time-out procedures for students with EBD may be a worth- while pursuit.

PREVENTING SCHOOL FAILURE: ALTERNATIVE EDUCATION FOR CHILDREN AND YOUTH 377

Crisis intervention

Despite wholehearted, comprehensive, and sophisticated efforts to implement positive behavioral supports and de- escalation strategies for the purpose of minimizing the likeli- hood of severe behaviors, students will sometimes exhibit behaviors dangerous to themselves and/or others (Simonsen, Sugai, Freeman, Kern, & Hampton, 2014), and students with EBD will be particularly disposed to do so (French & Wojcicki, 2018; Reitz, 1994). In these instances, it will be necessary to implement crisis intervention strategies for the purpose of securing the safety of the child as well as other students and school personnel. As such, programing for stu- dents with EBD must anticipate the need for emergency procedures (i.e., restraint) by having staff members fully trained and capable of safely intervening when the need arises. Nonetheless, prevention efforts should remain para- mount, emergency procedures should only be used when absolutely necessary, and they should be used only in accordance with the recommendations from prominent national organizations such as the Council for Children with Behavioral Disorders (2009), the Council for Exceptional Children (2009), and the U.S. Department of Education (2012) as well as state and federal law.

Parent collaboration

Parental involvement in a child’s education has long been linked to the child’s success in school (Henderson & Mapp, 2002). As such, schools customarily make efforts to engage parents through a variety of mechanisms including parent open-house meetings, notes home, and invitations to special events. However, for parents of students with EBD, the development of a positive parent-school relationship is often a more challenging process. Parents of students with EBD have reported feeling blamed by school personnel for their child’s difficulties and teachers of students with EBD have perceived parents as defensive in response to phone calls from school personnel regarding the child’s misbehavior (Buchanan & Clark, 2017). Parents of students with EBD experience high levels of stress, and in some cases, depres- sion as a result of their child’s difficulties (Pollio, McClendon, North, Reid, & Jonson-Reid, 2005). Moreover, because the prognosis and course of intervention for stu- dents with EBD will undoubtedly vary as a function of the severity and nature of the symptoms, age of onset, etiology, familial circumstances, and the quality and scope of inter- vention (Mash & Dozois, 1996; Walker, Colvin, & Ramsey, 1995), some students will respond quickly and favorably to comprehensive school-based intervention, and for others the process will be slow and onerous or highly variable. Parents of children who are not immediately responsive are vulner- able to frustration and skepticism – both of which have the potential to derail the parent’s support for the educational program which, in turn, decreases the likelihood of a suc- cessful outcome for the child.

In light of these challenges, school-based programing for students with EBD will benefit from having a mechanism for cultivating and sustaining a collaborative and trusting

relationship with parents. School psychologists and school social workers are well-suited for this role as their training typically includes insights regarding the nature of students with disabilities and their families. Maintaining consistent contact with parents regarding their child’s progress, while simultaneously being cautious not to contribute to parent stress levels is essential to the process. This often requires empathy for parental perspectives, providing parents with numerous examples of their child’s strengths and accom- plishments, being nonjudgmental and compassionate, and gradually instructing parents about the process of interven- tion. For students with more severe impairments for whom progress may be slow and/or variable, it is particularly important that a positive, trusting relationship be developed with the parents in order to maintain a united and coordi- nated approach to intervention.

Concluding remarks

Considerable discussion has transpired for well over 50 years regarding the composition of effective school-based inter- vention for students with EBD. Although there appears to be some accord among authors who have addressed this topic, the emergence of a clear consensus has been hindered by the enormity of the EBD intervention landscape, the complexities associated with the application of multiple, interrelated strategies to a myriad of real world situations, and discrepancies between empirical and practical perspec- tives. Nevertheless, achieving a consensus among researchers and practitioners will be important to optimize training efforts, direct resources, and advance best practice in schools.

Toward this end, prominent literature was presented and augmented by observations and insights derived from the author’s familiarity with the implementation of evidence- based interventions with this student population. The incorporation of clinical expertise into a discussion of best practice in this manner is common practice in the field of clinical psychology where interpreting research through the lens of clinical expertise is actually a core component of the putative definition of evidence-based practice (Spring, 2007; Tolin, 2014). Employing this process, four fundamental con- siderations and eight essential strategies derived from research and filtered through the lens of an experienced practitioner were presented. A manageable number of inter- vention strategies were selected from a practitioner’s per- spective regarding the relative importance of these strategies and ample specificity was provided to facilitate practical application. This discussion was undertaken in hopes of reducing the research to practice gap and perhaps moving the field closer to a consensus view regarding essential com- ponents of school-based intervention for students with EBD.

Notes on contributor

Daniel D. French is the Unit Director for the Emotional Disabilities Unit at Cooperative Educational Services in Trumbull, Connecticut. His current research interests are

378 D. D. FRENCH

school-based interventions for students with emotional and behavioral disabilities and the use of restraint and seclusion in the school setting.

ORCID

Daniel D. French http://orcid.org/0000-0001-6850-756X

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