The Importance of Teacher Adherence in School-Home Interventions for Attention and Behavior Problems

This week we will be discussing a study in which authors Meza, Friedman, Dvorsky, Kass, Chabbra, and Pfifner aimed to evaluate the effects of teacher adherence to behavioral treatment on student outcomes. This article, titled “Outcomes of School-Home Interventions for Attention and Behavior Problems: Teacher Adherence Matters” was published in the Journal of School Mental Health in June of 2020.

Why did they do it?

There is a large body of research that supports the efficacy of school-based behavioral interventions for the reduction of adverse symptoms that accompany early-onset mental health disorders such as attention-deficit/hyperactivity disorder (ADHD). Some of these strategies include teacher-implemented, classroom management practices such as classroom management and contingency management programs (e.g., frequent labeled praise, reward and/or response cost-based contingency management programs). As explained by the authors, one of the most widely used and researched variations of contingency management is the daily report card (DRC), which involves teachers providing ratings on predetermined student behaviors targeted for improvement. While these programs have been shown to reduce functional and behavioral impairment in many children and adolescents with ADHD, not all children are equally responsive to these types of interventions. 

The authors explain that while teacher adherence has been previously identified as playing a significant role in ADHD-related treatment outcomes, only a select few studies have directly examined the impact of this potentially critical variable. In order to fill this gap in the literature, the authors of the current study aimed to examine the role of teacher adherence to a school–home intervention (Collaborative Life Skills, CLS) for children with ADHD-related behaviors and impairment. CLS combines classroom management/daily report cards, parent training, and child skills training, and has previously demonstrated positive treatment effects. 

How did they do it?

For this study, the authors used data from a larger randomized control trial of school-home collaborative behavioral interventions for children. For this intervention program, children aged 7–11 years old attending 27 schools (N = 6 students per school) from an urban public school district were randomly assigned to a school–home intervention (Collaborative Life Skills, CLS; N = 14 schools) or services as usual (N = 13 schools). For the current study, only data from students assigned to the CLS group were included in analyses. 

The CLS program was delivered by school mental health providers (SMHP) and was comprised of three primary components: a classroom component, which consisted of a school-home DRC and teacher consultation regarding classroom management and homework planning; a student component, which consisted of nine weekly group sessions that took place during school hours; and a parent component, which consisted of ten weekly, 60-min behavioral parent management training groups designed to teach parents contingency management skills. 

What did they find?

The authors provide detailed explanations of their analyses in the full article. For the purpose of this review, we only briefly highlight the key findings. Overall, SMHP ratings of teacher’s adherence to the CLS school component predicted improvement across teacher and parent-rated organizational skills, parent-rated problem behaviors, and classroom observations of task engagement and off-task behavior. Teacher adherence did not, however, predict improvements on report card grades. 

Many teachers (54.7%) reported having little to no experience using DRCs, and teacher experience with these types of programs was correlated with DRC use, but not associated with SMHP ratings of adherence. As the authors highlight, the association between teacher experience with school-home report cards and DRC implementation is consistent with prior studies demonstrating teacher knowledge has a positive impact on student success outcomes.  

What does it all mean (our take)?

Intervening on child behavior problems is a highly complex task that requires coordination between schools and parents. It’s this simple fact that makes treating children so difficult - instead of relying on a single person to deliver an intervention, we rely on a collective group of individuals to each play their part. The continued building of systems, using technology, to link these treatment teams together will likely help lessen the burden for teachers while also improving outcomes for children. 

We thank the authors of this article for demonstrating the important role of teacher adherence in acquiring gains in student interventions. Teachers are under such immense pressure, with growing class sizes and depleting resources, to support not just the academic success of their students but also their behavioral success. For this - we thank all teachers for everything that they do, and are hopeful that the field will continue building systems to support their efforts in doing everything they can to positively impact each child whom they might teach.