Academic journal article School Psychology Review

Determining the Presence of a Problem: Comparing Two Approaches for Detecting Youth Behavioral Risk

Academic journal article School Psychology Review

Determining the Presence of a Problem: Comparing Two Approaches for Detecting Youth Behavioral Risk

Article excerpt

Awareness that a significant number of children have both unidentified and untreated behavioral and emotional problems (Mills et al., 2006) has necessitated a change in service delivery. Traditionally, school psychology has operated under refer-test-place models, in which only the students at the highest level of need receive services (Cash & Nealis, 2004). In this model, teachers are primarily responsible for identifying "problems" and school psychologists conduct assessments to determine special education eligibility. This teacher-referral system to determine the presence of a behavioral "problem" is flawed for numerous reasons, including: (a) many teachers do not receive specific training about what to look for or how problematic behavior should be prior to a referral; (b) teachers differ in their ability to work with struggling students, thus referring at different rates; and (c) some students are not identified efficiently or effectively (Tilly, 2008).

Because of the known inadequacies of this service delivery approach, multitier models utilizing a problem-solving approach have been recommended as a means to identify and serve all students in need (Tilly, 2008). Although a variety of problem-solving approaches exist, many share common features, including a focus on universal, systematic screening and assessment to determine the presence of problems (Schwanz & Barbour, 2005). Although screening does not diminish the need for teachers to assist in the problem identification stage, structured teacher rating forms completed for all students can provide a more systematic way for teachers to identify at-risk students. In fact, evidence suggests that brief teacher rating scales structure teachers' qualitative perceptions in effective ways that increase screening accuracy (Eklund et al., 2009). Thus, teachers, when provided with a methodology to structure their ratings, hold promise as practical and accurate screeners, providing information about a variety of child problems including attention, conduct, learning, mood, or other school adjustment problems (August, Ostrander, & Bloomquist, 1992; Flanagan, Bierman, & Kam, 2003; Lochman & The Conduct Problems Prevention Research Group, 1995). A shift in service delivery focusing on the systematic screening of all students, using teachers as primary informants, has the potential to transform school-based mental health services (Dowdy, Ritchey, & Kamphaus, 2010).

The "conclusion that universal screening must become a part of business as usual in our schools" (Tilly, 2008, p. 31) is supported by strong evidence that a variety of behavioral and emotional problems are childhood risk factors for poor school outcomes, including academic underachievement, absenteeism, special education placement, suspensions and expulsions, and school dropout (Bradley, Doolittle, & Bartolotta, 2008). However, screening has still not experienced widespread adoption and use, with estimates suggesting that only 2% of schools screen all children for mental health problems (Romer & McIntosh, 2005). In particular, the failure of its adoption may be in part from the impracticality and shortcomings of many current "screening" instruments. For example, the length of screening measures remains a fundamental barrier to widespread adoption and use. Screeners often include many items (e.g., Bracken School Readiness Assessment--88 items; Bracken, 2002), making these instruments impractical for widespread use because of the time and resources needed to assess hundreds, if not thousands, of children in school districts (Flanagan et al., 2003). Similarly, multigate systems that include various levels of assessment requiring teacher training, teacher nominations, rating scale completion, and direct classroom observations, among other requirements, may be expensive in terms of time and effort for school personnel. However, multigate systems have been shown to reduce costs through efficient and accurate identification (Hill, Lochman, Coie, Greenberg & The Conduct Problems Prevention Research Group, 2004), suggesting that the challenge is how to accomplish multiple gates with little time, training, and personnel resources. …

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