Early Identification Of Behavioral And Emotional Problems .

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89Early Identification of Behavioral and EmotionalProblems in Youth: Universal screening versusTeacher-Referral IdentificationKatie Eklund, Tyler L. Renshaw, Erin Dowdy, Shane R. Jimerson,Shelley R. Hart, Camille N. Jones, and James EarhartUniversity of California, Santa BarbaraUniversal screening is one strategy to enhance the early identification of behavioral and emotional problems among youth. Although it appears to be effective, it is unclear if universalscreening is more or less effective than current teacher referral practices. Thus, the purpose ofthis study was to compare the effectiveness of a teacher-rated, universal screener and typicalteacher-referral methods in identifying youth at risk for emotional and behavioral problems.Results indicated that of the 24 students identified as at-risk by the universal screening measure, only 11 were previously identified through current teacher referral practices – highlightingthe potential benefit of universal screening to enhance early identification. Furthermore, resultsindicated that academic achievement and student engagement outcomes were significantly correlated with at-risk status by identification method. The strengths and limitations of this study,as well as implications for practice, are discussed.A significant number of children are at-risk for or are currently experiencing emotional and behavioral problems (Ringel & Sturm, 2001; United States Public Health Service, 2000). The consequencesfor schools are clear such that emotional and behavioral problems have been well-documented to besignificant barriers to learning (Catalano, Haggerty, Osterle, Fleming, & Hawkins, 2004). Children withan early onset of behavior problems are at elevated risk for academic failure, peer rejection, substanceabuse, and delinquency (Reinke, Herman, Petras, & Ialongo, 2008). Furthermore, national longitudinalstudies show that more than half of the students identified with emotional or behavioral problems dropout of school, 75% achieve below expected grade levels in reading, and 97% achieve below expectedgrade levels in math (Bradley, Doolittle, & Bartolotta, 2008). Such findings overwhelmingly indicatethat emotional and behavioral problems are associated with deleterious outcomes in youth.Despite a significant number of students experiencing emotional and behavioral problems, the majority of these students remain unidentified and consequently untreated (Ringel & Sturm, 2001; UnitedStates Public Health Service, 2000). This is detrimental to student outcomes, considering that the longera child’s emotional and behavioral problems go unidentified and untreated, the more stable his or hermaladaptive trajectory is likely to be (Gottlieb, 1991). Early identification via screening is particularlyimportant as it could help trigger early intervention, resulting in a disruption of the maladaptive trajectory. Research has also documented that recognition of a mental health problem increases the likelihoodthat children and their parents will seek help for that problem (Cauce, et al., 2002). In this way, universalscreening efforts may ultimately lead to early intervention for students’ current problems as well as prevention of future problems.Within the school setting there is emerging evidence that early identification, combined with earlyand comprehensive prevention and intervention, can decrease the likelihood of academic failure andfuture life difficulties (Lane & Menzies, 2003; Walker & Shinn, 2002). Thus, as schools aim to serve allstudents regardless of risk level, through both special and general education supports, early identification via screening is a means for increasing the likelihood that more students are healthy, thriving, andprogressing toward optimal development. Just as the fields of medicine and public health have repeatCorrespondence may be sent to Katie Eklund, UCSB, GGSE, CCSP, Santa Barbara, CA 93106-9490 ore-mail: [email protected] or [email protected] OFOF CONTENTSCONTENTS

90The California School Psychologist, 2009, Vol. 14edly demonstrated the potential of early identification and intervention to prevent and alleviate diseaseand sickness (Fox, Halpern, & Forsyth, 2008), the fields of psychology and education are beginning todemonstrate that using a similar approach within schools can do the same for children’s emotional andbehavioral problems. Indeed, there is growing evidence that school-based screening can alter deleteriousdevelopmental trajectories and enhance positive outcomes (Report of the Alliance for School MentalHealth, 2005).A key feature of early identification is a focus on assessments that are useful for identifying progressive levels of risk among all students, not only among those with profound difficulties or problems(Glover & Albers, 2007). However, current methods of early identification vary widely, with many stillfocused solely on identifying students at the highest level of need. Such methods include teacher referral,parent referral for assessment and services at school or through primary care settings, youth self-referral,and universal screening. This study compares a common method for early identification-teacher referralto what may be a more underused and novel method universal screening.traditional teacher ReferralGiven that children spend countless hours at school, teachers are an invaluable resource for referringstudents in need of behavioral, emotional, and academic intervention. General education teachers arethe primary link between students exhibiting problematic behavior and receiving access to school-basedservices. However, contemporary research indicates that teachers do not refer students based on behaviorproblems at the same rate as other academic concerns (Walker, Nishioka, Zeller, Severson, & Feil, 2000).In addition, many teachers perceive children’s emotional and behavioral problems as someone else’s responsibility (Severson, Walker, Hope-Doolittle, Kratochwill, & Gresham, 2007) – possibly contributingto lower referral rates. Furthermore, previous studies have found a significant time lag between initialsymptoms and referral to services by teachers (Duncan, Forness, & Hartsough, 1995). In general, suchfindings suggest that teacher referral may not be the most effective method of early identification. Thus,the effectiveness of alternative early identification methods, like universal screening, warrants furtherexamination.Universal screeningSchool-based universal screening is conducted with all students in a given classroom, school, ordistrict, to identify those at risk of academic failure and/or behavioral difficulties and may thereforebenefit from intervention (e.g., Severson & Walker, 2002). This approach toward early identification allows for the provision of evidence-based prevention and early intervention services delivered through amulti-tiered intervention approach (Kratochwill, Albers, & Shernoff, 2004). It is recommended that thismulti-tiered approach be accomplished via a multi-gated screening strategy. However, what remains tobe resolved is whether the information obtained at each gate adds significantly to the prediction equation, justifying the additional time and resources required. In addition, key concerns regarding universalscreening have been raised including the overidentification of students in need of school-based and community mental health services, as well as the potential need for multi-informant assessments of youth’sbehavioral problems (Levitt, Saka, Romanelli, & Hoagwood, 2007). Thus, further exploration is neededregarding the utility and feasibility of universal screening within schools.Current studyThe purpose of this study was to evaluate the ability of a universal screening measure to identifystudents who might otherwise go undetected through a traditional identification paradigm (i.e., teacherreferral for special education, child study team, or other school-based service provisions). Utilizing datafrom a cohort of third- and fourth-grade students, the differences between students referred and not referred for evaluation or intervention based on the different referral systems was examined. Specifically,the aims of this study were twofold:TABLETABLE OFOF CONTENTSCONTENTS

Early Identification91(1) Explore the differences between students identified as at-risk for behavioral and emotional difficulties by a universal screening measure compared to those identified via teacher referral.(2) Examine the relationship of students’ academic achievement and engagement indicators to resultsfrom the early-identification method (i.e., universal screening or teacher referral outcomes).MetHoDParticipantsParticipants were 26 third-graders and 22 fourth-graders from two elementary schools in a suburbancommunity, within the same school district, located on California’s central coast. During the 2008-2009school year, the total enrollment of one school was 286 students, and the total enrollment of the other was421 students. During that time, the demographic make up of both schools was comparable, with approximately 73% of students identifying as Hispanic or Latino, 18% as White, and 9% as other or multipleethnic groups. Approximately 68% of the students were classified as socioeconomically disadvantaged,40% as English language learners, and 14% as students with disabilities. Using class-wide data collection procedures, the demographics of the participants in the present study (N 48) were representativeof the student population in these schools.MeasuresBASC-2 Behavioral and Emotional Screening System (BESS), Teacher Form. The BESS teacherform (child/adolescent version) is a screening instrument used to identify behavioral and emotionalstrengths and weaknesses of students in grades K-12 (Kamphaus & Reynolds, 2007). It assesses a widerange of behavioral problems and strengths, such as internalizing and externalizing problems, schoolproblems, and adaptive skills. It is designed to be completed in 5 minutes or less. Respondents rate eachitem on a 4-point scale—never, sometimes, often, or almost always. The sum of the items generates atotal T-score with high scores reflecting more problems. Scores of 20-60 suggests a “normal” level ofrisk; 61-70 suggests an “elevated” level of risk; and 71 or higher suggests an “extremely elevated” levelof risk. The BESS was normed with a sample of 12,350 teacher, parents, and students, collected from233 cities in 40 states. Results from the norming process indicated that the psychometric properties of theBESS (across all forms) are generally acceptable, having good split-half reliability (.90-.96), test-retestreliability (.80-.91), inter-rater reliability (.71-.83), sensitivity (.44-82), and specificity (.90-.97). Furthermore, the measure has demonstrated acceptable convergent validity with the Achenbach System ofEmpirically Based Assessment (.71-.77), Conner’s Rating Scales (.51-.78), Vineland Adaptive BehaviorScales (.32-.69), Children’s Depression Inventory (.51), and the Revised Children’s Manifest AnxietyScale (.55; Kamphaus & Reynolds, 2007).Report Cards. Student report cards include academic and student engagement indicators, as gradedby their teachers. The academic indicators comprised 6 total subject areas— Listening, Reading, Writing, Math, History, and Science—and corresponded to California state educational standards. Each indicator was graded on a scale of 1-4 (1 has difficulty with standard, 2 approaches standard, 3 meetsand applies standard, 4 exceeds standard), indicating teachers’ perceptions of students’ present levelsof achievement. For the purposes of this study, each subject area was conceptualized as a sub-composite,making up a total Academic Achievement composite. A behavioral engagement indicator accompaniedeach subject area, wherein the teachers graded the amount of “effort” students exhibited in meetingacademic standards, using the same grading scale. Because these engagement indicators were unidimensional and few in number, they were summed into a total Engagement composite for the purposesof this study.Traditional Teacher Referral Data. Additional data was collected on each student to determine whichstudents had previously been identified by teachers as being at-risk and needing additional behavioral oremotional evaluation or intervention. Noted indicators included: (a) referral to the school’s child studyteam, (b) testing for special education eligibility, (c) receipt of current special education services, and (d)receipt of other, non-special-education interventions (e.g., general-education counseling or classroomTABLETABLE OFOF CONTENTSCONTENTS

92The California School Psychologist, 2009, Vol. 14environment alterations). These indicators were combined as dichotomous variables and students wereclassified as either “at-risk” or “normal” based on teacher referral for services.ProceduresDuring the first quarter of the school year, the BESS teacher form was completed for all third-gradestudents attending one school and for all fourth-grade students attending the other school. For each grade,screening outcomes indicated that the majority of students were in the “normal” range, several studentswere in the “elevated” range, and relatively few students were in the “extremely elevated” range. Thus,for the purposes of this study, students receiving the latter two classifications were grouped together,resulting in dichotomized risk-level classification outcomes: “normal” (T scores 20-60) or “at-risk” (Tscores 61 and above). Screening results indicated that 20 third-graders and 13 fourth-graders had BESSoutcomes in the “at-risk” range. In an attempt to create matched groups, the 13 “at-risk” third-graderswere selected to participate in the study, matched with a random selection of 13 “normal” third-graders.A random selection of 13 “at-risk” fourth-graders was then conducted, matched with a random selectionof 13 “normal” fourth-graders. Dur