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ORIGINAL PAPER Optimistic Teaching: Improving the Capacity for Teachers to Reduce Young Children’s Challenging Behavior Elizabeth A. Steed V. Mark Durand Published online: 28 June 2012 Ó Springer Science + Business Media, LLC 2012 Abstract This pilot study compared the differential impact of two professional development interventions to improve preschool teachers’ use of positive behavioral interventions and supports (PBIS) and decrease young children’s social emotional difficulties. Teachers were randomly assigned to one of two coaching interventions conducted over the course of one academic year. Teachers received either Optimistic Teaching, an approach com- bining traditional coaching in PBIS with a cognitive- behavioral component to address teachers’ self-efficacy, or traditional PBIS coaching. Teachers in the Optimistic Teaching condition implemented significantly more PBIS skills related to teaching children social skills and involv- ing families in their children’s social emotional develop- ment when compared to teachers who were exposed to traditional PBIS coaching alone. Teachers in the Optimistic Teaching condition reported significantly fewer children with serious social emotional difficulties post-intervention. Teachers’ experience and self-reported self-efficacy were analyzed for their influence on teachers’ post-intervention use of PBIS skills. The results are discussed in light of how future professional development efforts might address preschool teachers’ motivation to adopt new practices such as PBIS. Keywords Positive behavioral interventions and supports Á Self-efficacy Á Preschool Á Challenging behavior Early childhood educators cite children’s challenging behavior as their primary concern for ongoing professional development (Alkon, Ramler, & MacLennan, 2003; Arnold, McWilliams, & Arnold, 1998; Joseph & Strain, 2003). One of the issues contributing to teachers’ need for support is the rising number of young children who engage in challenging behaviors in daycare, Head Start, and other early learning environments (Brauner & Stephens, 2006). Estimates indicate that approximately 10–25 % of pre- school-aged children engage in challenging behaviors, such as hitting, biting, and kicking that warrant concern (Strain, Joseph, & Hemmeter, 2009; Lavigne et al., 1996). These numbers are higher for young children with disabilities such as autism spectrum disorders (ASD) (e.g., 70 %; Strain et al., 2009) and children at risk due to poverty (e.g., 22–39 %; Qi & Kaiser, 2003). In the absence of effective interventions to reduce challenging behaviors and teach socially appropriate behaviors, these young children may be at risk for long-term social and academic difficulties (e.g., Patterson, Reid, & Dishion, 1992; Ramey & Ramey, 1998). Fortunately, there is emerging consensus that positive behavioral interventions and support (PBIS) is a promising evidence-based practice to reduce and prevent challenging behavior (Horner, Sugai, & Anderson, 2010). PBIS includes a range of environmental supports, instructional practices, and systems changes that result in important academic and social outcomes for children. The primary purpose of PBIS as it is applied in early childhood settings is to reduce young children’s challenging behaviors and improve their social emotional functioning (Fox & Hemmeter, 2009). The first level of the PBIS framework for early child- hood settings involves universal support for all children in the form of high-quality teaching environments and posi- tive social relationships (Fox & Hemmeter, 2009). Exam- ples of specific strategies at this level of support include E. A. Steed (&) Department of Educational Psychology and Special Education, Georgia State University, P.O. Box 3979, Atlanta, GA 30302-3979, USA e-mail: [email protected] V. M. Durand University of South Florida, St. Petersburg, FL, USA 123 School Mental Health (2013) 5:15–24 DOI 10.1007/s12310-012-9084-y

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ORIGINAL PAPER

Optimistic Teaching: Improving the Capacity for Teachersto Reduce Young Children’s Challenging Behavior

Elizabeth A. Steed • V. Mark Durand

Published online: 28 June 2012

� Springer Science + Business Media, LLC 2012

Abstract This pilot study compared the differential

impact of two professional development interventions to

improve preschool teachers’ use of positive behavioral

interventions and supports (PBIS) and decrease young

children’s social emotional difficulties. Teachers were

randomly assigned to one of two coaching interventions

conducted over the course of one academic year. Teachers

received either Optimistic Teaching, an approach com-

bining traditional coaching in PBIS with a cognitive-

behavioral component to address teachers’ self-efficacy, or

traditional PBIS coaching. Teachers in the Optimistic

Teaching condition implemented significantly more PBIS

skills related to teaching children social skills and involv-

ing families in their children’s social emotional develop-

ment when compared to teachers who were exposed to

traditional PBIS coaching alone. Teachers in the Optimistic

Teaching condition reported significantly fewer children

with serious social emotional difficulties post-intervention.

Teachers’ experience and self-reported self-efficacy were

analyzed for their influence on teachers’ post-intervention

use of PBIS skills. The results are discussed in light of how

future professional development efforts might address

preschool teachers’ motivation to adopt new practices such

as PBIS.

Keywords Positive behavioral interventions and supports �Self-efficacy � Preschool � Challenging behavior

Early childhood educators cite children’s challenging

behavior as their primary concern for ongoing professional

development (Alkon, Ramler, & MacLennan, 2003;

Arnold, McWilliams, & Arnold, 1998; Joseph & Strain,

2003). One of the issues contributing to teachers’ need for

support is the rising number of young children who engage

in challenging behaviors in daycare, Head Start, and other

early learning environments (Brauner & Stephens, 2006).

Estimates indicate that approximately 10–25 % of pre-

school-aged children engage in challenging behaviors, such

as hitting, biting, and kicking that warrant concern (Strain,

Joseph, & Hemmeter, 2009; Lavigne et al., 1996). These

numbers are higher for young children with disabilities such

as autism spectrum disorders (ASD) (e.g., 70 %; Strain

et al., 2009) and children at risk due to poverty (e.g.,

22–39 %; Qi & Kaiser, 2003). In the absence of effective

interventions to reduce challenging behaviors and teach

socially appropriate behaviors, these young children may be

at risk for long-term social and academic difficulties (e.g.,

Patterson, Reid, & Dishion, 1992; Ramey & Ramey, 1998).

Fortunately, there is emerging consensus that positive

behavioral interventions and support (PBIS) is a promising

evidence-based practice to reduce and prevent challenging

behavior (Horner, Sugai, & Anderson, 2010). PBIS includes

a range of environmental supports, instructional practices,

and systems changes that result in important academic and

social outcomes for children. The primary purpose of PBIS

as it is applied in early childhood settings is to reduce young

children’s challenging behaviors and improve their social

emotional functioning (Fox & Hemmeter, 2009).

The first level of the PBIS framework for early child-

hood settings involves universal support for all children in

the form of high-quality teaching environments and posi-

tive social relationships (Fox & Hemmeter, 2009). Exam-

ples of specific strategies at this level of support include

E. A. Steed (&)

Department of Educational Psychology and Special Education,

Georgia State University, P.O. Box 3979, Atlanta,

GA 30302-3979, USA

e-mail: [email protected]

V. M. Durand

University of South Florida, St. Petersburg, FL, USA

123

School Mental Health (2013) 5:15–24

DOI 10.1007/s12310-012-9084-y

establishing and teaching program-wide rules and expec-

tations, using specific verbal praise, and providing children

with predictable routines and expected transitions

throughout their day (Stormont, Lewis, & Beckner, 2005).

At the secondary level of PBIS, targeted social skills

strategies are implemented with small groups of children

who are at risk for social emotional difficulties (Joseph &

Strain, 2003). Finally, function-based interventions are

provided for the few children (e.g., 1–5 %) who demon-

strate severe and/or chronic challenging behavior at the

tertiary level of PBIS (Lewis & Sugai, 1999).

Initial research indicates that PBIS may be successfully

applied to early childhood settings. Studies have demon-

strated that preschool teachers are responsive to professional

development efforts to improve their use of universal PBIS

strategies (e.g., Benedict, Horner, & Squires, 2007; Carter &

Van Norman, 2010; Stormont, Covington-Smith, & Lewis,

2007). Research has also demonstrated that early childhood

educators can effectively implement individualized and

function-based PBIS interventions to reduce young chil-

dren’s challenging behavior (e.g., Blair, Fox, & Lentini,

2010; Wood, Ferro, Umbreit, & Liaupsin, 2011). Although

training and coaching in PBIS may be effective in providing

some teachers with an array of knowledge and skills, many

teachers may not consistently implement recommended

practices following training (e.g., Van Acker, Boreson,

Gable, & Potterton, 2005). The challenge for early childhood

programs is no longer just access to evidence-based practices

and professional development but now includes the imple-

mentation and sustainability of these interventions with

fidelity (Webster-Stratton & Herman, 2010). The use of

evidence-based practices such as PBIS is most often com-

promised by low adherence to the curriculum’s protocol,

inadequate resources, and poor support, planning, and

training of teachers (Fixsen, Naoom, Blase, Friedman, &

Wallace, 2005).

There are a growing number of studies suggesting that

some teachers have difficulties with the adoption and sus-

tainability of this evidence-based practice (e.g., Benedict

et al., 2007; Blair et al., 2010; Fox, Hemmeter, Snyder,

Binder, & Clarke, 2011). Unfortunately, much of the lit-

erature on teachers’ professional development has down-

played barriers to treatment and adoption of recommended

practices. When teacher adherence is addressed, it is often

evaluated relative to factors such as teachers’ level of

education or treatment group (e.g., Knoche, Sheridan,

Edwards, & Osborn, 2010). However, most interventions

fail because the professional development did not ade-

quately address teachers’ motivation to adopt new practices

(Tschannen-Moran & McMaster, 2009).

Recent literature has indicated that teacher self-efficacy

may be crucial to understanding why some teachers do not

adopt PBIS (e.g., Kelm & McIntosh, 2012; Ross & Horner,

2006). Teacher self-efficacy has been defined as the belief

in one’s own ability to accomplish desired outcomes, affect

others’ behavior, and impact their success or failure

(Bandura, 1977). Tschannen-Moran, Woolfolk, and Hoy

(1998) identify two processes that may influence teachers’

self-efficacy in specific contexts: teachers’ analysis of the

teaching task and its context and teachers’ assessment of

personal teaching competence. This model proposes that

teacher self-efficacy evolves as teachers encounter new

teaching tasks that prompt them to reevaluate their personal

teaching competence. A teacher’s sense of self-efficacy

becomes fairly stable over time (Tschannen-Moran et al.,

1998). However, a new intervention, such as PBIS, will

cause a teacher to reevaluate his or her teaching compe-

tence in light of the requirements of the new initiative.

Early childhood teachers have reported feeling unpre-

pared to manage young children’s challenging behavior

and support their social emotional competence (Arnold

et al., 1998). And, a survey of newly graduated teacher

educators revealed that they did not feel like they had

adequate information to implement strategies associated

with PBIS (Hemmeter, Santos, & Ostrosky, 2008). Low

efficacy preschool teachers are more likely to have

depressed and/or angry emotional reactions to the chal-

lenging behavior of young children with disabilities

(Ruble, Usher, & McGrew, 2011). Further, preschool

teachers who are stressed due to classroom conditions are

more likely than their colleagues to expel children for

challenging behavior (Gilliam & Shabar, 2006).

This growing research base around teacher efficacy and

PBIS indicates that it may be crucial to address teachers’ self-

efficacy as part of PBIS professional development efforts. The

purpose of this pilot study was to compare the impact of PBIS

coaching that also addressed teachers’ self-efficacy (Opti-

mistic Teaching) to a more traditional PBIS coaching

approach (PBIS) with preschool teachers. The following

research questions were investigated in the pilot study:

1)What was the differential impact of Optimistic Teaching

versus traditional PBIS coaching on teachers’ use of PBIS

skills? 2) What was the differential impact of Optimistic

Teaching versus traditional PBIS coaching on children’s

social emotional competence? 3) What was the relationship

between teachers’ years of experience and self-efficacy and

their use of PBIS skills? 4) How did teachers view the effec-

tiveness and supportiveness of the coaching interventions?

Method

Participants

The pilot study was conducted in 17 pre-kindergarten

classrooms in a suburban county in a Southeastern state

16 School Mental Health (2013) 5:15–24

123

with 21 participating teachers and 350 participating chil-

dren. All of the classrooms provided pre-kindergarten

services as part of the state public pre-kindergarten pro-

gram to children who turned four prior to September 1 of

that year. Six classrooms accepted childcare subsidies. The

17 classrooms were part of 6 different early childhood

programs that provided childcare services to young chil-

dren from infancy through 6 years of age. One program

had 6 participating classrooms. Another program had 3

participating classrooms. Three other programs each had

two classrooms participate. Two programs had one par-

ticipating classroom. Although programs differed in pro-

gram philosophy (e.g., two programs identified themselves

as Montessori schools), all participating classrooms were

part of the state-funded pre-kindergarten system and

therefore were required to conduct similar standards-based

assessments and provide age-appropriate content, class-

room routines and schedules, and opportunities for col-

laboration with families.

Characteristics of teachers (n = 21) and children

(n = 350) in participating classrooms are presented in

Table 1. There were no significant differences between the

groups of teachers, and the only difference between the

groups of students was that more children with English as a

second language were included in the PBIS group. Chil-

dren with special needs were included in the classrooms

(2 %) and had a range of disabilities including autism

spectrum disorders. Two school psychology doctoral stu-

dents provided coaching to participating teachers. Each

coach had a Master’s degree and was enrolled in a doctoral

program in school psychology. Coaches had advanced

training in providing consultative services in school set-

tings and expertise in PBIS.

Design and Intervention

A randomized group experiment was used with randomi-

zation occurring at the classroom level. Each of the 17

classrooms was randomly assigned to either the Optimistic

Teaching or traditional PBIS group prior to intervention

using a random numbers table. All participating teachers

received eight individual coaching sessions, lasting

approximately 40 min in their teaching location (e.g.,

classroom or meeting room at their center). All teachers,

regardless of their assignment to the Optimistic Teaching

or traditional PBIS group, received information about

PBIS that was organized around eight topics (described in

Table 2). Each topic was covered during each of the

8 weeks of the coaching.

For teachers in the Optimistic Teaching condition, a

cognitive-behavioral intervention component was inte-

grated into each PBIS coaching session. This was an

adaptation of an approach used with families of children

with disabilities and challenging behaviors by Durand

(2011), Durand & Hieneman, 2008). The cognitive-

behavioral intervention used in this pilot study addressed

teachers’ attitudes toward their work, self-talk and associ-

ated feelings about children’s challenging behavior, and

their optimism to positively impact children’s develop-

ment. Coaches spent time during each coaching visit with

teachers in the Optimistic Teaching group asking questions

related to teachers’ attitudes, feelings, and beliefs about

what they were learning about PBIS. For example, during

the first session that focused on introductions and goal

setting, the coach would help all teachers identify prob-

lematic situations in the classroom. However, the coach

would extend this discussion for teachers in the Optimistic

Teaching condition to also ask the teacher to identify

Table 1 Characteristics of teachers and children in participating

classrooms

Total

(n = 21)

Intervention groups

Optimistic

Teaching

(n = 9)

PBIS

(n = 12)

Teachers (n) 21 9 12

Average years of experience 7.25 9.52 5.55

Average years at center 2.81 3.08 2.62

Education

High school degree 4.8 % 11.1 % 0 %

Associate’s degree 19.0 % 11.1 % 25.0 %

Bachelor’s degree 71.4 % 66.7 % 75.0 %

Graduate degree 4.8 % 11.1 % 0 %

Race/ethnicity

White 76.2 % 77.78 % 75.0 %

African-American/black 9.5 % 11.1 % 8.3 %

Latino/Hispanic 4.8 % 0 % 8.3 %

Asian/Pacific Islander 9.5 % 11.1 % 8.3 %

Native American 0 % 0 % 0 %

Biracial/multiracial 0 % 0 % 0 %

Children (n) 350 163 187

Male 51.6 % 53.2 % 50.9 %

Race/ethnicity

White 51.7 % 58.3 % 45.8 %

African-American/Black 18.6 % 17.0 % 20.0 %

Latino/Hispanic 8.8 % 5.5 % 11.9 %

Asian/Pacific Islander 12.0 % 7.9 % 15.6 %

Native American 0.6 % 0.6 % 0.5 %

Biracial/multiracial 7.7 % 9.1 % 6.5 %

English as a second

language

17.4 % 12.1 %* 22.1 %

Individualized education

program

2 % 2.4 % 1.6 %

* p \ .05

School Mental Health (2013) 5:15–24 17

123

self-talk and feelings the teacher experiences during these

problem times in the classroom. The teacher might identify

self-talk during a child’s tantrum as, ‘‘Here he goes again.

Forget about anyone learning anything today. The whole

day is a waste’’ with related feelings of frustration and

defeat. Coaches addressed these negative feelings directly

with teachers participating in the Optimistic Teaching

condition. They asked teachers to reflect on the impact of

negative feelings on their behavior and interactions with

children, encouraged them to consider and share alternative

self-talk (e.g., ‘‘He’s having a tantrum. Even though this is

tough, it will end and the day will get better’’) to replace

the negative statements, and practice using the alternative

self-talk in role play scenarios. In another example, the

coaches would discuss how it is important to understand

that children’s behavior is communication during the

fourth coaching session with all teachers. But, the coaches

would extend this conversation with teachers in the Opti-

mistic Teaching condition to also identify teachers’

assumptions about why children engaged in challenging

behavior, their attributions of these behaviors (e.g., was it

mostly influenced by the child’s temperament, home

environment, or something else?), and their feelings of

either optimism or pessimism regarding their role in

affecting change. In order to make each coaching session

equal in time, coaches spent additional time talking about

PBIS content related to each session’s topic with teachers

in the traditional PBIS group.

Coaches followed standard protocols for each coaching

condition (Optimistic Teaching versus PBIS). Teachers in

the Optimistic Teaching group participated in 8.38

(SD = .52, range 8–9) coaching sessions lasting an average

of 42.60 (SD = 5.88, range 36–50) minutes. Teachers in the

PBIS group participated in 8.11 (SD = .33, range 8–9)

coaching sessions lasting an average of 38.04 (SD = 4.59,

range 31–47) minutes. Coaches provided information rela-

ted to each of the eight topics outlined for coaching sessions

to all teachers and provided written feedback to teachers on

coaching logs following each session. Written feedback

included observations of teacher–child interactions and

feedback on their use of PBIS skills. Goals included on the

coaching logs were determined jointly through discussion

between the coach and teacher.

Measures

The following measures were completed in the fall, prior to

commencing coaching in each classroom and in the spring,

after the teachers had finished their last coaching session.

Use of PBIS Strategies

An independent data collector who was blind to treatment

group observed teachers’ implementation of PBIS strate-

gies and conducted teacher interviews in participating

classrooms using the Teaching Pyramid Observation Tool

Table 2 Weekly coaching topics and goals

Week Topic Goals

1 Introduction and goal setting • To introduce an overview of positive behavior interventions and support

• To identify current concerns, priorities, and goals for the classroom

2 Defining and teaching classroom

rules

• To learn how to establish classroom rules

• To learn how to develop lesson plans to teach classroom rules

• To develop a teaching matrix

3 Preventing and responding to

challenging behaviors

• To learn prevention strategies to avoid challenging behavior

• To learn strategies for responding to challenging behavior

4 Understanding children’s challenging

behavior

• To understand how children’s challenging behavior is communication

• To learn how to observe and record children’s behavior through observations, interviews, and

assessments

5 Creating and putting the behavior

support plan in place

• To learn the essential components of a behavior support plan

• To design a behavior support plan for a student

6 Teaching social and emotional skills • To learn evidence-based strategies to teach friendship skills, social skills, emotional literacy,

and problem solving in large and small groups with strategies such as modeling and role

playing

7 Collaborating with families • To discuss common issues when collaborating with families

• To talk about ways to communicate with families about young children’s social emotional

development

8 Monitoring and wrap-up • To make a plan to monitor your implementation of positive behavior interventions and support

over time

• To reflect on the coaching experience and say good-bye

18 School Mental Health (2013) 5:15–24

123

(Hemmeter, Fox, & Snyder, 2008). The TPOT includes 38

items; 7 environmental items, 15 items that focus on key

instructional practices (with 118 indicators), and 16 binary

indicators of classroom practices or issues that are detri-

mental to effective behavior interventions called ‘‘red

flags.’’ The TPOT assessment was designed specifically for

preschool classrooms and measures teachers’ implemen-

tation of PBIS at each level of the Teaching Pyramid

Model (Hemmeter, Ostrosky, & Fox, 2006). The levels of

the Teaching Pyramid Model include nurturing and

responsive relationships, high-quality supportive environ-

ments, social emotional teaching strategies, and individu-

alized interventions (Hemmeter et al., 2006). Item scores

related to the 118 indicators of 15 effective teaching

practices and ‘‘red flags’’ were used for analyses in this

study. TPOT scores reflect both teacher report (subjective)

and evaluator observation (objective) of PBIS practices.

There is initial documentation regarding the psycho-

metric properties of the TPOT (Fox et al., 2011). For

example, a generalizability theory study demonstrated

minimal error variance (i.e., 5 %) that could be attributed

to context and raters. The generalizability coefficient for

TPOT scores was .97. Further, TPOT scores were posi-

tively correlated with a widely used classroom assessment

tool the Classroom Assessment Scoring System (CLASS;

Pianta, La Paro, & Hamre, 2008) that measures emotional

support, classroom organization, and instructional support

in early childhood settings (Fox et al., 2011).

Children’s Social Emotional Competence

Children’s social emotional competence was assessed

through teacher report of one subscale on the System

Performance Screening Guide (SSiS-PSG; Elliott &

Gresham, 2007). The SSiS-PSG is a classroom-wide

screening tool wherein teachers rate each child in the class-

room on a Likert scale regarding his or her social, motiva-

tional, and academic skills. Teachers in this study were

instructed to rate children from 1 to 4 (1 = lowest and

4 = highest) on only one of the subscales, Prosocial

Behavior. A rating of 1 indicates that the child has limited

communication or cooperation skills, extreme difficulty ini-

tiating conversations or interacting in an age-appropriate

manner, and poor self-control or little or no concern for

others. A rating of 2 indicates that the child demonstrates

frequent difficulties in communication or cooperation with

others, some difficulty initiating conversations or interacting

with others, and limited self-control or little concern for

others. Children with ratings of 1 or 2 are not making ade-

quate progress in their current educational environment and

are candidates for more intensive instruction or intervention

(e.g., secondary targeted social emotional supports). Children

with ratings of 3 or 4 are doing well with their social skills

and display few to no challenging behaviors in school.

Teacher Self-Efficacy

Teacher attitudes were assessed before and after interven-

tion by measuring teachers’ perceptions of their ability to

manage children’s behavior with the 24-item long-form

version of the TSES (Teachers’ Sense of Efficacy Scale,

Tschannen-Moran & Woolfolk Hoy, 1998, 2001). Each

teacher completed the TSES by responding with a circled

response from 1 to 9 (‘‘nothing’’ to a ‘‘great deal’’) to the

question ‘‘How much can you do?’’ for various questions

related to teaching. Examples included ‘‘How much can

you do to get through to the most difficult students?’’ or

‘‘How much can you do to calm a student who is disruptive

and noisy?’’ The TSES instrument has subscales regarding

teachers’ efficacy regarding student engagement, instruc-

tional strategies, and classroom management. A total score

was used in this study. The TSES has been compared to

other teacher self-efficacy scales, such as the RAND

measure (Armor et al., 1976). It has small to moderate

significant correlations (GTE r = .18 and PTE r = .53,

p \ .01) and strong internal consistency scores.

Teachers’ Perception of Coaching

An electronic social validity questionnaire was emailed to

teachers at the conclusion of all coaching sessions to

determine teachers’ perspectives about the effectiveness of

the coaching intervention. The questionnaire was devel-

oped specifically for this project and was administered

using Survey Monkey. There were 10 questions that asked

teachers to rate how strongly they agreed on a 6-point

Likert scale (1 = Strongly Disagree, 6 = Strongly Agree).

There were two additional multiple response questions

asking teachers to note what was most valuable about the

coaching experience and components to improve.

Data Analyses

A series of univariate ANOVAs were conducted on

observational, teacher, and self-report data to compare the

samples of teachers in each group. As expected, there were

no significant differences across teachers in the Optimistic

Teaching and PBIS groups on any outcome measures at

pre-intervention, indicating that the two groups were well

matched prior to intervention. One-way ANOVAs were

conducted to analyze the differential impact of the inter-

vention on post-intervention teacher and child outcomes

and to analyze the differential impact of teachers’ years of

experience and self-efficacy on their use of post-interven-

tion PBIS strategies.

School Mental Health (2013) 5:15–24 19

123

Results

Teachers’ Use of PBIS

ANOVA results of group differences indicated that teachers

who participated in Optimistic Teaching made more

improvements on some items on the TPOT when compared

to teachers who participated in the traditional PBIS

coaching condition. Specifically, teachers in the Optimistic

Teaching coaching group improved on TPOT items related

to teaching social skills [F (1, 15) = 9.101, p = .009] and

involving families in their children’s social emotional

development [F (1, 15) = 13.901, p = .002]. (see Table 3).

Children’s Social Emotional Competence

Analyses of group differences in children’s social emo-

tional competence after intervention revealed that there

were significantly more children with serious social emo-

tional difficulties in classrooms whose teachers received

traditional PBIS coaching when compared to classrooms

whose teachers received Optimistic Teaching [F (1, 15) =

4.987, p = .041] (see Table 4).

Teachers’ Years of Experience and Self-Efficacy

Teachers’ use of PBIS was compared for teachers who dif-

fered in their years of experience and reports of their teaching

self-efficacy. Participating teachers were divided into two

groups. Group one (‘‘high adopters’’) included new (less than

8 years) teachers with high self-efficacy (fall TSES average

score of 8 or above) and experienced teachers (8 or more

years) with lower self-efficacy (fall TSES average score less

than 8). This group of 10 teachers was expected to be more

receptive to adopting a new intervention such as PBIS.

Group two (‘‘low adopters’’) included new teachers with

low self-efficacy and experienced teachers with high self-

efficacy. This group of 7 teachers was expected to be less

receptive to adopting PBIS, using the Gregoire (2003) model

of teacher conceptual change.

Prior to coaching in either PBIS or Optimistic Teaching,

‘‘high adopter’’ teachers implemented significantly more

PBIS practices related to teaching children to express their

emotions when compared to ‘‘low adopter’’ teachers [F (1,

15) = 4.419, p = .049]. This was the only significant pre-

intervention group difference between ‘‘high adopters’’ and

‘‘low adopters.’’ After intervention, ‘‘high adopter’’ teach-

ers implemented significantly more PBIS practices related

to using consistent schedules and routines [F (1, 15) =

4.704, p = .043], strategies to respond to children’s prob-

lem behavior [F (1, 15) = 7.195, p = .015], teaching

children to express emotions [F (1, 15) = 8.221, p =

.010], and supporting friendship skills [F (1, 15) = 7.708,

p = .021] when compared to ‘‘low adopter’’ teachers (see

Table 5).

Teachers’ Perception of Coaching

Eight of 21 (38 %) teachers from both coaching conditions

responded to the electronic social validity questionnaire

asking them to provide input about the coaching experi-

ence. The majority of teachers strongly agreed to

Table 3 Means and standard

deviations of pre and post-test

classroom percentages of

teaching pyramid observation

tool practices by intervention

(n = 17)

* p \ .05

Measure and variable Optimistic Teaching (n = 8) PBIS group (n = 9)

Pre-test Post-test Pre-test Post-test

Schedules and routines 84.55 (18.68) 78.47 (14.88) 83.80 (11.05) 72.07 (20.80)

Transitions 65.63 (17.36) 67.19 (13.26) 59.72 (27.08) 66.67 (17.68)

Supportive conversations 90.69 (8.84) 76.11 (20.28) 89.14 (10.86) 80.49 (19.49)

Children’s engagement 98.61 (3.93) 91.49 (11.56) 92.59 (14.70) 91.36 (12.14)

Teaching behavioral expectations 45.24 (34.50) 58.04 (19.80) 30.95 (34.81) 58.20 (26.91)

Providing directions 85.42 (16.52) 87.50 (11.79) 81.48 (21.15) 81.48 (28.19)

Problem behavior 78.75 (40.16) 56.25 (30.21) 77.78 (39.30) 52.22 (33.83)

Teaching social skills 10.94 (16.95) 25.00* (14.94) 9.72 (10.42) 15.28 (17.43)

Teaching to express emotions 56.25 (29.88) 75.00 (43.07) 52.78 (15.02) 55.56 (30.69)

Teaching problem solving 21.25 (18.08) 17.50 (25.50) 13.33 (16.58) 22.22 (20.48)

Supporting friendship skills 29.17 (16.73) 43.06 (21.77) 23.46 (11.71) 27.16 (21.60)

Children with problem behavior 0 (0) 0 (0) 0 (0) 0 (0)

Communication with families 73.43 (4.42) 73.44 (4.42) 72.22 (5.51) 75.00 (0)

Involving families 14.29 (15.27) 26.79 * (19.37) 4.76 (10.10) 14.29 (15.97)

Collaborative teaming 70 (10.69) 60.00 (10.69) 71.11 (10.54) 62.22 (6.67)

Red flags (Tally; highernumber = more problematic)

3.91 (5.73) 11.72 (15.82) 9.72 (12.15) 8.33 (13.62)

20 School Mental Health (2013) 5:15–24

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statements about the coaching experience as supportive and

helpful. For example, 62.5 % of respondents strongly

agreed to the statement, ‘‘I generally enjoyed my coaching

experience’’ and 75 % strongly agreed to the statement, ‘‘I

would recommend participation in this study to a friend or

colleague.’’ Teachers noted that learning new strategies for

preventing challenging behavior and learning new strate-

gies for teaching social emotional skills were the most

valuable aspects of the coaching experience.

Discussion

Teachers’ Use of PBIS

Results of the pilot study suggest that the Optimistic

Teaching intervention was more effective than traditional

PBIS coaching alone in improving specific PBIS skills

related to teaching social skills and involving families.

These two skill areas are two of the most underutilized

aspects of PBIS and most resistant to teacher change. For

example, Fox et al. (2011) noted that preschool teachers

who participated in intensive coaching in PBIS continued

to demonstrate the lowest rates of implementation in the

area of teaching social skills. Others (e.g., Steed & Roach,

2011) have noted preschool teachers’ low implementation

of involving families in their children’s social emotional

development.

It is possible that the cognitive-behavioral aspects of the

professional development intervention used for teachers in

the Optimistic Teaching condition allowed these teachers

to engage in the conceptual change required to adopt a new

and more rigorous way of teaching social skills and inter-

acting with families (i.e., addressing social emotional

Table 4 Means and standard deviations of teachers’ pre and post-test ratings of children’s social functioning on the SSIS-PSG

Measure and variable Optimistic Teaching (n = 8) PBIS group (n = 9)

Pre-test Post-test Pre-test Post-test

Percentage of children in the classroom with above average

social emotional functioning

52.44 (25.59) 34.57 (19.03) 46.51 (26.96) 35.12 (27.60)

Percentage of children in the classroom with average

social emotional functioning

34.33 (25.79) 51.16 (20.67) 23.46 (13.15) 41.93 (20.64)

Percentage of children in the classroom with below average

social emotional functioning

9.89 (8.37) 13.14 (5.78) 21.07 (13.78) 16.93 (12.30)

Percentage of children in the classroom with serious

social emotional difficulties

3.33 (6.61) 1.14 (2.26) 8.97 (8.82) 6.01* (6.11)

* p \ .05

Table 5 Means and standard

deviations of pre and post-test

percentages of classroom

teaching pyramid observation

tool practices by self-efficacy

group (n = 17)

* p \ .05, ** p \ .01

Measure and variable High adopters (n = 10) Low adopters (n = 7)

Pre-test Post-test Pre-test Post-test

Schedules and routines 85.90 (15.27) 79.81* (14.32) 79.49 (13.45) 64.24 (18.48)

Transitions 65.39 (17.79) 69.23 (13.13) 67.19 (32.00) 67.44 (18.94)

Supportive conversations 91.71 (8.97) 82.05 (18.04) 86.44 (11.25) 69.46 (19.20)

Children’s engagement 99.15 (3.08) 93.91 (9.81) 91.67 (15.43) 86.17 (14.18)

Teaching behavioral expectations 43.22 (35.84) 55.13 (24.28) 22.32 (24.87) 67.80 (16.63)

Providing directions 87.18 (13.87) 91.03 (11.00) 81.17 (22.60) 74.88 (26.68)

Problem behavior 86.92 (32.50) 63.08* (28.69) 50.00 (49.00) 32.50 (18.32)

Teaching social skills 8.65 (14.78) 23.08 (15.18) 14.19 (7.99) 11.06 (17.07)

Teaching children to express emotions 57.69* (23.68) 73.08** (28.34) 36.00 (21.67) 33.00 (25.35)

Teaching problem solving 17.69 (17.87) 20.77 (22.90) 15.00 (16.04) 15.00 (22.68)

Supporting friendship skills 27.35 (15.46) 40.17* (22.47) 22.11 (8.36) 16.58 (10.24)

Children with problem behavior 0 (0) 0 (0) 0 (0) 0 (0)

Communication with families 72.12 (5.48) 74.04 (3.47) 75.00 (0) 75.00 (0)

Involving families 10.99 (14.47) 23.08 (18.93) 7.04 (7.52) 14.23 (10.88)

Collaborative teaming 70.77 (10.38) 61.54 (9.87) 72.50 (10.35) 60.00 (0)

Red flags (Tally; highernumber = more problematic)

0.77 (1.01) 1.15 (2.15) 2.25 (2.63) 2.00 (1.93)

School Mental Health (2013) 5:15–24 21

123

issues with families, rather than just academic participation

and adaptive functioning). Certain PBIS tasks may elicit

more negative beliefs about their difficulty and/or teachers’

ability to implement them. It is possible that a coaching

intervention that addresses these negative thoughts and

beliefs will be more effective than interventions that focus

on content alone.

The differential adoption of more challenging behavior

management skills was observed in a related study that

compared a parenting intervention with a cognitive-

behavioral component to a more standard therapeutic

approach for parents with children who engaged in chal-

lenging behavior (Durand, 2011; Durand et al., in press).

These researchers found that parents who participated in

the cognitive-behavioral training (Positive Family Inter-

vention) used more effective parenting strategies and had

higher expectations for their children’s behavior (e.g.,

putting toys away on his own, sitting at the dinner table

with the rest of the family) while parents who participated

in the traditional PBIS training used avoidance strategies

(e.g., picking up the child’s toys themselves or allowing the

child to watch TV while eating dinner) to decrease the

likelihood of their children exhibiting challenging behavior

(Durand, 2011). The parenting intervention that intention-

ally addressed parents’ thoughts and feelings about difficult

family routines and child behavior may have been more

effective at supporting the parents to proactively work

through these difficult situations with their children. Par-

ents who did not receive this cognitive-behavioral com-

ponent may have continued to have negative thoughts and

feelings that more heavily influenced their avoidance of

active parenting strategies during difficult family routines.

Children’s Social Emotional Competence

Teachers involved in the Optimistic Teaching condition

reported significantly fewer children in their classroom

with serious social emotional difficulties after intervention

when compared to teachers in the traditional PBIS group.

There are several possible explanations for this significant

group difference. One is that there was indeed an unplan-

ned difference in the makeup of children with social and

behavioral issues in the two groups of participating

teachers. However, this is unlikely due to the randomiza-

tion of classrooms into intervention groups and the lack of

significant group differences pre-intervention. Another

explanation is that teachers in the Optimistic Teaching

condition changed how they perceived and reported chil-

dren’s challenging behavior post-intervention. If these

teachers viewed themselves as more competent to manage

challenging behaviors after participation in the Optimistic

Teaching coaching sessions, they may have been less likely

to define their students’ challenging behavior as ‘‘serious.’’

Teachers also reported fewer children in the classroom

with above average social emotional functioning at the

post-test. While the decrease was not statistically signifi-

cant, this result is concerning. It is possible that partici-

pating preschool teachers used different expectations by

which to rate children’s social emotional functioning at the

end of the school year compared to the beginning of the

year. Teachers may have tended to rate more children in

the average, rather than the above average category, given

higher expectations for independence, peer interaction, and

problem solving at the end of the school year.

Teachers’ Years of Experience and Self-Efficacy

The other key finding involved the relationship between

teachers’ years of experience, their self-efficacy ratings,

and their implementation of PBIS strategies post-inter-

vention. We found that inexperienced teachers with high

self-efficacy or experienced teachers with low self-efficacy

(‘‘high adopters’’) made significant improvements in their

use of certain PBIS strategies when compared to experi-

enced teachers with high self-efficacy or inexperienced

teachers with low self-efficacy (‘‘low adopters’’). High

adopters implemented significantly more indicators asso-

ciated with having predictable schedules and routines,

teaching children to express emotions, and supporting

children’s friendship skills. These findings lend support to

Gregoire’s (2003) theory that teachers use their experience

and their perception of available resources and their own

competence to form an opinion about a new intervention

and whether or not they will adopt it. Other research has

also found a difference in how experienced and novice

teachers form their self-efficacy beliefs and make decisions

about the adoption of a new teaching task (e.g., Tschannen-

Moran & Hoy, 2007). Novice teachers have been found to

rely most heavily on verbal persuasion and input from

others (e.g., a supervisor or coach) to inform their per-

ceptions of their own teaching and whether or not they are

capable of performing a new task. Experienced teachers are

more likely to be informed by their own mastery experi-

ences than contextual variables, given their more lengthy

teaching history (Tschannen-Moran & Hoy, 2007). These

differences potentially mediated the observed differences

in the two groups of teachers that were divided by expe-

rience and self-efficacy.

It is important to note that self-efficacy is a motivational

construct that is measured through self-report and is not an

indicator of actual teaching competence. This is especially

relevant in light of some of the noted decreases in teachers’

PBIS skills from baseline to post-intervention using the

TPOT measure. Fox et al. (2011) also used the TPOT to

assess teachers’ adoption of PBIS strategies and noted

decreases in several PBIS skills after coaching. The

22 School Mental Health (2013) 5:15–24

123

researchers surmised that these unexpected results may

have been related to changes in teachers’ self-report of

PBIS practices, rather than actual decreases in the use of

PBIS practices. The TPOT uses teacher interviews to

inform some of the indicator ratings. It is possible that

many preschool teachers are not adequately prepared to

answer interview questions about their use of PBIS skills at

baseline, when they have received very little training in

PBIS. A teacher may have reflected on her teaching prac-

tices during the coaching process and then reported more

accurately what she was not implementing during post-

intervention data collection.

Limitations

There were several limitations of this pilot study. The

sample was representative of the racial makeup and edu-

cational level of early childhood teachers in the suburban

area in which the classrooms and preschool programs were

located. However, the sample may not be representative of

other geographical regions in the United States or rural/

urban areas. A larger study that encompasses a more varied

geographical region would be ideal for future research.

Future researchers should also obtain additional informa-

tion about children’s specific disabilities and their history,

typography, and/or function of challenging behaviors. It is

possible that the Optimistic Teaching approach is more

effective with children with certain disabilities or types of

challenging behaviors (e.g., escape maintained).

The intervention used was fairly brief, including 8

coaching sessions across one academic year for each par-

ticipating teacher. This may explain the lack of compre-

hensive post-intervention effects on teacher and child

outcomes. No studies have yet documented the appropriate

dosage and schedule for effective PBIS coaching of pre-

school teachers. However, other researchers in this area

have provided more coaching sessions (e.g., 10–14) over a

shorter amount of time (two coaching sessions per week;

Fox et al., 2011). The Optimistic Teaching and PBIS

coaching interventions provided as part of this study may

have been more effective if they were provided more

intensively and/or over a longer period of time.

Conclusions

This study provides preliminary evidence of the potential

impact of a coaching intervention that addresses preschool

teachers’ self-efficacy to improve their use of PBIS skills.

Cognitive-behavioral interventions have been utilized

in other realms of therapy and psychological support,

including similar approaches to working with families who

have children with disabilities and challenging behavior

(e.g., Durand, 2011; Durand, Hieneman, Clarke, & Zona,

2009). However, Optimistic Teaching is a novel applica-

tion of a cognitive-behavioral intervention to support PBIS

coaching for early childhood teachers. Addressing teach-

ers’ self-efficacy explicitly as part of coaching efforts to

reduce children’s challenging behavior may prove to be a

key ingredient in reaching teachers who are unlikely to

adopt a new intervention such as PBIS. Future researchers

should continue to develop the Optimistic Teaching

approach in terms of content and instructions for delivery

so that it may be used by others who provide technical

assistance to preschool teachers related to young children’s

challenging behavior.

Acknowledgments This research was supported in part by an

internal grant from Georgia State University.

References

Alkon, A., Ramler, M., & MacLennan, K. (2003). Evaluation of

mental health consultation in child care centers. Early ChildhoodEducation Journal, 31, 91–99.

Armor, D., Conroy-Oseguera, P., Cox, M., King, N., McDonnell, L.,

Pascal, A. (1976). Analysis of the school preferred readingprograms in selected Los Angeles minority schools. Report No.

R-2007-LAUSD. Santa Monica, CA: Rand Corporation.

Arnold, D. H., McWilliams, L., & Arnold, E. H. (1998). Teacher

discipline and child misbehavior in day care: Untangling

causality with correlational data. Developmental Psychology,34, 276–287.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of

behavioral change. Psychological Review, 84, 191–215.

Benedict, E. A., Horner, R. H., & Squires, J. K. (2007). Assessment

and implementation of positive behavior support in preschools.

Topics in Early Childhood Special Education, 27, 174–192.

Blair, K. S., Fox, L., & Lentini, R. (2010). Positive behavior support

for young children with developmental and behavioral chal-

lenges: An evaluation of generalization. Topics in EarlyChildhood Special Education, 30, 68–79.

Brauner, C. B., & Stephens, C. B. (2006). Estimating the prevalence

of early childhood serious emotional/behavioral disorders:

Challenges and recommendations. Public Health Reports, 121,

303–310.

Carter, D. R., & Van Norman, R. K. (2010). Class-wide positive

behavior support in preschool: Improving teacher implementa-

tion through consultation. Early Childhood Education Journal,38, 279–288.

Durand, V. M. (2011). Optimistic parenting: Hope and help for youand your challenging child. Baltimore: Paul H. Brookes.

Durand, V. M., & Hieneman, M. (2008). Helping parents withchallenging children: Positive family intervention, facilitator’sguide. New York: Oxford University Press.

Durand, V. M., Hieneman, M., Clarke, S., & Zona, M. (2009).

Optimistic parenting: Hope and help for parents with challenging

children. In W. Sailor, G. Dunlap, G. Sugai, & R. H. Horner

(Eds.), Handbook of positive behavior support (pp. 233–256).

New York: Springer.

Durand, V. M., Hieneman, M., Clarke, S., Wang, M., & Rinaldi, M.

(in press). Positive family intervention for severe challenging

School Mental Health (2013) 5:15–24 23

123

behavior I: A multi-site randomized clinical trial. Journal ofPositive Behavior Interventions.

Elliott, S. N., & Gresham, F. M. (2007). SSiS performance screeningguide. Minneapolis: NCS Pearson, Inc.

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., &

Wallace, F. (2005). Implementation research: A synthesis of theliterature (Vol. FMHI Publication #231). Tampa: University of

South Florida: The National Implementation Research Network.

Fox, L., & Hemmeter, M. L. (2009). A program-wide model for

supporting social emotional development and addressing chal-

lenging behavior in early childhood settings. In W. Sailor, G.

Dunlap, G. Sugai, & R. Horner (Eds.), Handbook of positivebehavior support (pp. 177–202). New York: Springer.

Fox, L., Hemmeter, M. L., Snyder, P., Binder, D. P., & Clarke, S.

(2011). Coaching early childhood special educators to imple-

ment a comprehensive model for promoting young children’s

social competence. Topics in Early Childhood Special Educa-tion, 31, 178–192.

Gilliam, W., & Shabar, G. (2006). Preschool and child care expulsion

and suspension rates and predictors in one state. Infants andYoung Children, 19, 228–245.

Gregoire, M. (2003). Is it a challenge or a threat? A dual process

model of teachers’ cognition and appraisal processes during

conceptual change. Educational Psychology Review, 15, 147–

179.

Hemmeter, M. L., Fox, L., & Snyder, P. (2008a). Teaching pyramidobservation tool—Research edition. Nashville: Unpublished

assessment instrument, Vanderbilt University.

Hemmeter, M. L., Ostrosky, M., & Fox, L. (2006). Social and

emotional foundations for early learning: A conceptual model

for intervention. School Psychology Review, 35, 583–601.

Hemmeter, M. L., Santos, R., & Ostrosky, M. (2008b). A national

survey of higher education programs: Preparing early childhood

educators to address social emotional development and chal-

lenging behavior. Journal of Early Intervention, 30, 321–340.

Horner, R. H., Sugai, G., & Anderson, C. M. (2010). Examining the

evidence base for school-wide positive behavior support. Focuson Exceptional Children, 42, 1–14.

Joseph, G. E., & Strain, P. S. (2003). Comprehensive evidence-based

social-emotional curricula for young children: An analysis of

efficacious adoption potential. Topics in Early ChildhoodSpecial Education, 23, 65–76.

Kelm, J. L., & McIntosh, K. (2012). Effects of school-wide positive

behavior support on teacher self-efficacy. Psychology in theSchools, 49, 137–147.

Knoche, L. L., Sheridan, S. M., Edwards, C. P., & Osborn, A. Q.

(2010). Implementation of a relationship-based school readiness

intervention: A multidimensional approach to fidelity measure-

ment for early childhood. Early Childhood Research Quarterly,25, 299–313.

Lavigne, J. V., Gibbons, R. D., Christoffel, K. K., Arend, R.,

Rosenbaum, D., Binns, H., et al. (1996). Prevalence rates and

correlates of psychiatric disorders among preschool children.

Journal of the America Academy of Child and AdolescentPsychiatry, 35, 204–214.

Lewis, T. J., & Sugai, G. (1999). Effective behavior support: A

systems approach to proactive school wide management. Focuson Exceptional Children, 31, 1–24.

Patterson, G. R., Reid, J., & Dishion, T. (1992). Antisocial boys.

Eugene: Castalia Press.

Pianta, R. C., La Paro, K., & Hamre, B. (2008). Classroomassessment scoring system—PreK (CLASS). Baltimore: Paul H.

Brookes.

Qi, C. H., & Kaiser, A. P. (2003). Behavior problems of preschool

children from low- income families: Review of the literature.

Topics in Early Childhood Special Education, 23, 188–217.

Ramey, C. T., & Ramey, S. L. (1998). Early intervention and early

experience. American Psychology, 53, 109–120.

Ross, S., & Horner, R. H. (2006). Teacher outcomes of school-wide

positive behavior support. Teaching Exceptional Children Plus,

3. Retrieved March 26, 2012 from http://journals.cec.sped.

org/tecplus/vol3/iss6/art6/.

Ruble, L. A., Usher, E. L., & McGrew, J. (2011). Special education

and students with autism: Preliminary investigation of teacher

self-efficacy and its sources. Focus on Autism and OtherDevelopmental Disabilities, 26, 67–74.

Steed, E. A., & Roach, A. (2011, March). Assessing positive behavior

support in childcare centers. Presentation conducted at the

Association for Positive Behavior Support’s 8th International

Conference on Positive Behavior Support. Denver, CO.

Stormont, M., Covington-Smith, S., & Lewis, T. J. (2007). Teacher

implementation of precorrection and praise statements in Head Start

classrooms as a component of program-wide positive behavioral

support. Journal of Behavioral Education, 16, 280–290.

Stormont, M., Lewis, T. J., & Beckner, R. (2005). Positive behavior

support systems: Applying key features in preschool settings.

Teaching Exceptional Children, 37, 29–42.

Strain, P. S., Joseph, G. E., & Hemmeter, M. L. (2009). Adminis-trative practices that support fidelity implementation of thepyramid model. Technical Assistance Center on Social Emo-

tional Interventions, University of South Florida.

Tschannen-Moran, M., & Hoy, A. (2007). The differential anteced-

ents of self-efficacy beliefs of novice and experienced teachers.

Teaching and Teacher Education, 23, 944–956.

Tschannen-Moran, M., Hoy, A., & Hoy, W. (1998). Teacher efficacy:

Its meaning and measure. Review of Educational Research, 68,

202–248.

Tschannen-Moran, M., & McMaster, P. (2009). Sources of self-

efficacy: Four professional development formats and their

relationship to self-efficacy and implementation of a new

teaching strategy. Elementary School Journal, 110, 228–248.

Tschannen-Moran, M., & Woolfolk Hoy, A. (2001). Teacher efficacy:

Capturing an elusive construct. Teaching and Teacher Educa-tion, 17, 783–805.

Van Acker, R., Boreson, L., Gable, R. A., & Potterton, T. (2005). Are

we on the right course? Lessons learned about current FBA/BIP

practices in schools. Journal of Behavioral Education, 14,

35–56.

Webster-Stratton, C., & Herman, K. C. (2010). Disseminating

incredible years series early-intervention programs: Integrating

and sustaining services between school and home. Psychology inthe Schools, 47, 36–54.

Wood, B. K., Ferro, J. B., Umbreit, J., & Liaupsin, C. J. (2011).

Challenging behavior of young children through systematic

function-based intervention. Topics in Early Childhood SpecialEducation, 30, 221–232.

24 School Mental Health (2013) 5:15–24

123