Center for Adolescent Research in the Schools (CARS) 

Research with Secondary Age Students with Emotional and 

Behavioral Problems

Lee Kern, Steve Evans, and Tim Lewis

Today

• Brief overview of CARS• Description of intervention development and 

refinement process

Center for Adolescent Research in the Schools

• Funded for five years by Institute of Education Sciences (IES)

• Focus: secondary age students with intensive social, emotional, and behavioral problems

Core Collaborators/Sites• Lee Kern, Ph.D., Principal Investigator, Lehigh University• Steven Evans, Ph.D., Co-Principal Investigator, Ohio University• Tim Lewis, Ph.D., Co-Principal Investigator, University of 

Missouri• Deborah Kamps, Ph.D., Juniper Gardens Children’s Project, 

University of Kansas• Carl Paternite, Ph.D., Miami University of Ohio• Terry Scott, Ph.D., University of Louisville• Mark Weist, Ph.D., University of Maryland• Paras Mehta, Ph.D., TIMES, University of Houston 

(design/statistical consultation, data analysis)• Howard Stevenson, Ph.D., Zewelanji Serpell, Ph.D.,

Charlayne Hayling, Ph.D., Consultants

Overview of CARS ActivitiesMajor Study• Years 1-2: Develop and refine intervention 

package with small sample of students (n=38, 3 states)

• Year 3: Evaluate and refine intervention package with larger sample of students (n= 60, 6 states)

• Years 4-5: Evaluate efficacy of intervention with large sample of students (n=530, 6 states)

Supplemental Studies• Years 1-5: Conduct supplemental research 

studies in core areas relevant to students with emotional and behavioral problems

Goals of Intervention Development and Refinement Process

• Determine effectiveness• Assess feasibility• Identify proximal and distal measures to 

assess intervention outcomes• Identify interventionists• Evaluate integrity of implementation• Determine training/coaching

necessary for high integrity

Phase I:Initial Intervention Development

• Determined core needs of population• Identified potentially effective interventions

– Literature reviews– Included interventions developed by CARS research team and others

• Effective with different populations or age groups

• Spent time talking to and observing school staff• Solicited input from local stakeholders

– Community Development Groups

Building Child Capacity

Enhancing School Capacity

Increasing Family and Community Supports

Conceptual Framework

Phase I: Community Development Groups

• Representatives from a variety of stakeholder groups – e.g., administrators, teachers, school psychologists, 

behavior specialists, counselors, parents, social workers, mental health workers

• Purpose– Provide information to assist with intervention 

developmentInitial meeting• Pressing issues of secondary students with EBD• Interventions they believe are essential and/or effective with secondary EBD students 

– Will continue yearly meetings

Community Development GroupFeedback from Initial Meeting: Issues

• Issues among students with EBD– Responding to Mental Health needs (e.g.,

depression)“Interventions we have tried don’t have long-term effects”

“Teachers don’t know how to access community mental health services, so students don’t get interventions”

“Many students don’t have MH coverage for outside services”

“There are too many barriers to students trying to access mental health services”

Refining Mental Health Interventions

Mental Health Needs

• Effective interventions

• Accessible, affordable for students

Intervention Selection

• Evidence-based

• Provided at school

Phase II:Preparation for Implementation

• Develop and test assessment model– Need for classroom-based interventions– Need for student mental health interventions

• Collect data prior to implementation regarding acceptability and feasibility

• Resource mapping: Who is best positioned to implement intervention?– Models of SpEd delivery– Mental health interventions 

YES YES

3Does

student show signs

of withdrawal, irritability, negativity

or sad mood?

Choosing Mental Health Interventions

1.2 Obtain relevant school records to assess impairment 

(e.g., office referrals)

Given the Information Gathered…

2.1 The C.A.T. Project

16 Session Program

Group or Individual

3.1 Coping with Stress program

15 Session Program

Group or Individual 

2Does

student show

signs of anxiety or

worry?

4.1 Interpersonal Skills Group

28 thirty minute Session Program

Group

5.1 Referral to Special Education Teacher for classroom management 

or Teacher-Student communication 

concerns, and/or the development of an 

FBA/BIP

6Prioritize

Intervention

6.1 PRIORITY: Rank problems based on how 

much they are impairing school & 

academic functioning

6.2 FEASIBILITY: Indicate whether each of the interventions can be feasibly provided

6.3 ACCEPTABILITY:  Indicate whether the student, teachers and/or parents are willing to participate

1.3 Conduct Observations

7Implement

the Intervention

5.2 De-Escalation Techniques

6.4 Record list of interventions that are feasible and acceptable 

in order or priority ranking

YES YES

1.4 Consult with CARS MH consultant

Family Interventions  

1What is the Problem?

1.1 Gather teacher, parent and self 

report of difficulties related to 

impairment at school

5Does

student disrupt

class, argue, or display

other difficult to

manage behaviors?

7.1 Begin with the   feasible intervention with the 

highest clinical priority and proceed 

through entire intervention

4Does student show signs of

poor social skills,

frequent conflict or

poor problem

solving skills?

2 – 5 Interpretation

7.2 Measure outcomes and use data to 

inform modifications 

to interventions

Mental Health(Data: Feasibility and Acceptability)

Resource MappingAssessment of School Services Interview: Staff

STAFF MEMBER DEGREE POTENTIAL MH TIME SPENT

Assistant Principal MA, Curr & Instr -Parent Support Groups-Individual Counseling

1 hr/monthAs needed

School Psychologist Ph.D., Sch Counseling -Group Counseling: Peer Conflict-Individual Counseling-Consultation w/Parents

As neededAs needed1 hr/week

Senior Counselor MA, Sch Counseling -Individual Counseling-Parent Ed

1-2 hrs/weekAs needed

Freshman Counselor MA, Sch Counseling -Individual Counseling 20 hrs/week

School Counselor MA, Sch Counseling -Social Skills Knitting Group-Individual Counseling

1 ½ hrs/week28 hrs/week

Security Coordinator Associate -Individual Counseling-Home Visits

As needed4-5 hrs/week

Graduation Coach MA, Literature -Social Skills Knitting Group-Individual Counseling-Open Office Parent Ed

1 ½ hrs/week2 hrs/weekAs needed

Transition Specialist MA, SpEd -Individual Counseling 1 hr/week

School Nurse MA, Health Ed -Parent Support Group-Individual Counseling

2 hrs/month2-3 hrs/week

Social Worker MA, Soc Work -Parent Ed-Individual Counseling

1-2 hrs/week1 hr/week

Resource Mapping:

ACTIVITY TOTAL TIME SPENT (EXCLUDES “AS NEEDED”)

Individual Counseling 53-56+ hours/week

Group Counseling 1 ½  hours/week

Parent Related Activities 5-6 hours/week

RESOURCE MAPPING“Are you aware of any staff or resources at the school which might be utilized to a greater degree to implement mental 

health interventions?”

Other Available Resources

STAFF MEMBER OTHER STAFF

Assistant Principal Officer Snyder, Social Worker

School Psychologist Social Worker, Intervention Specialists

Senior Counselor School Counselor, ESL Aides

Freshman Counselor School Nurse

School Counselor Social Worker, Other Counselors

Security Coordinator Officer Snyder

Graduation Coach New to School

Transition Specialist Social Worker, School Counselor

School Nurse

Social Worker Nurse, Graduation Coach, Counselor

Phase III: Implementation and Feedback

• Brief training on intervention• Direct observation

– Teacher behavior, student behavior, classroom context– Treatment fidelity 

• Informal feedback from school staff, students, parents– Revisions needed to interventions

• Review of training logs– Document amount and type of coaching 

• Cross-site weekly CARS team meeting calls (Class, MH)– Discuss status of intervention implementation– Describe implementation challenges– Describe variations made to interventions 

Increasing Positive Interactions

DataDirect Observation:• Infrequent praise• High rates of negative 

feedbackTX Integrity:• Low integrity

Intervention Refinement• Intervention acceptable, 

feasible, easy to understand

• Difficulty remembering to provide positive feedback

Seems that it is difficult to both teach, naturally deliver praise.

Teacher requested an opportunity to observe CARS facilitators model the intervention procedures.

Training Log

Teacher did not meet integrity criteria

Notes from Training Log

Problem Solving Process: Modeling and In-Vivo Feedback

PHASE IV: Data-Based Refinement

• Pre- and post-intervention assessments– Do measures reflect change from beginning to end of academic year?

– Which measures are most sensitive to change? 

• Consumer feedback

SIRF-Teacher

SIRF-Teacher

“Changes in student performance consist of a higher percentage of : on-task behavior, students remaining in their area, decrease in swearing, more positive interactions and an increase in followed teacher prompts.”

PHASE V: Further Refinement Based on Expanded and More 

Divergent Sample

• Implementation in three additional states• Inclusion of more diverse sample

– School size– School characteristics– Models of special education service delivery