Academic journal article School Psychology Review

Test Driving Interventions to Increase Treatment Integrity and Student Outcomes

Academic journal article School Psychology Review

Test Driving Interventions to Increase Treatment Integrity and Student Outcomes

Article excerpt

Behavioral consultation has been shown to be effective in assisting teachers in meeting the needs of students with challenging behaviors (Bergan & Kratochwill, 1990; Wilkinson, 2003). When used by a school psychologist, this model of consultation consists of the consultant (i.e., the school psychologist) working with a consultee (i.e., the teacher) through a sequential process to select, implement, and evaluate the effect of an intervention. Although behavioral consultation can lead to the successful implementation of an intervention and remediation of the identified behavior problem, some teachers demonstrate resistance to this type of consultation (Wickstrom, Jones, LaFleur, & Witt, 1998; Gonzalez, Nelson, Gutkin, & Shwery, 2004).

Teachers occasionally have difficulty with treatment integrity, or the degree to which an intervention is implemented as intended (Gresham, 1989; Peterson, Homer, & Wonderlich, 1982), during the plan implementation phase of behavioral consultation. For a variety of reasons, teachers may implement the intervention poorly or not at all (Hagermoser Sanetti & Kratochwill, 2009). This is troubling considering the link between low levels of treatment integrity and reduced student outcomes (DiGennaro, 2007; Noell, Gresham, & Gansle, 2002). Witt and Elliott (1985) proposed a model that hypothesizes that degree of teacher implementation is determined by treatment acceptability. In turn, treatment integrity influences the extent to which the treatment will likely produce desired effects, which then affects how acceptable the implementer finds the treatment.

The first component in Witt and Elliott's (1985) model, treatment acceptability, has received considerable attention in the literature, because of the high premium placed on socially valid interventions that address students' problem behaviors in education (Walker, Ramsay, & Gresham, 2004). Wolf (1978) introduced the concept of social validity, which he described as a subjective measure of an intervention that takes into consideration the consumer's judgment of the "social significance of the goals..., the social appropriateness of the procedures," and "the social importance of the effects" (p. 207). Kazdin (1980) extended Wolf's notion of social validity into a term he called treatment acceptability. According to Kazdin (1980), treatment acceptability refers to an "evaluation of whether treatment is appropriate for the problem, whether treatment is fair, reasonable, and intrusive, and whether treatment meets with conventional notions about what a treatment should be" (p. 259). In a school setting, where teachers are asked to implement many of the behavioral interventions, treatment acceptability is an important construct to take into consideration, because adoption and effective implementation of an intervention involves more than the consultant's assurance that an intervention will produce results (Noell & Witt, 1999). Although treatment acceptability has been hypothesized to be an important facet of intervention implementation, other factors such as treatment complexity, time required to implement treatment, available resources, and the number of treatment agents and materials needed may all influence the degree to which an intervention is implemented as intended (Gresham, 1989). In this way, even the most effective treatments may not be adopted or implemented with fidelity if they are not viewed as acceptable or if there are competing contingencies in the environment.

Allinder and Oates (1997) successfully demonstrated how treatment acceptability can affect treatment use and treatment effectiveness by showing that teachers who found curriculum-based measurement highly acceptable conducted more probes with their students than did teachers who found it less acceptable. Further, they found that students who were assessed by teachers who viewed it as highly acceptable showed improved outcomes over students who were assessed by teachers who did not find it acceptable (effect size = 1. …

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