School psychology: a public health framework: III. Managing disruptive behavior in schools: the value of a public health and evidence-based perspective

School psychology: a public health framework

III. Managing disruptive behavior in schools:

the value of a public health and

evidence-based perspective

Lisa Hunter

Columbia University, 1051 Riverside Drive Unit 78, New York, NY 10032, USA

Abstract

Schools typically adopt individualistic approaches to address disruptive behavior and meet the

needs of students with disruptive behavior disorders (DBD) [i.e., Attention Deficit Hyperactivity

Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD)]. These

approaches are often not the most effective and have a limited impact on overall school climate. This

article emphasizes the value of an evidence-based and public health perspective in managing

disruptive behavior. Information about comprehensive school-based programs and classroom

management techniques for disruptive behavior disorders is presented and the important role school

psychologists can play in implementing these programs discussed.

D 2002 Society for the Study of School Psychology. Published by Elsevier Science Ltd. All rights

reserved.

Keywords: Disruptive behavior; Public health; Evidence-based perspective

Disruptive behavior disorders (i.e., Attention Deficit Hyperactivity Disorder, Opposi-

tional Defiant Disorder, and Conduct Disorder) are among the most prevalent and stable

child psychiatric disorders (Costello, 1989). Attention Deficit Hyperactivity Disorder

(ADHD) is characterized by symptoms of inattention, motor hyperactivity, and impulsivity.

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are characterized by

antisocial behavior. The disruptive behavior disorders (DBD) are serious psychiatric

disorders and when left untreated can adversely affect the lives of children. ‘‘Children

who exhibit early disruptive behaviors, including inattention, hyperactivity, impulsivity and

0022-4405/02/$ - see front matter D 2002 Society for the Study of School Psychology. Published by Elsevier

Science Ltd. All rights reserved.

doi:10.1016/S0022-4405(02)00143-7

E-mail address: [email protected] (L. Hunter).

Journal of School Psychology

41 (2003) 39–59

aggressiveness, may be at heightened risk for the development of antisocial behavior,

substance abuse, and school dropout in later years’’ (Braswell et al., 1997, p. 197).

Given the symptoms associated with DBD, it is not surprising that children diagnosed

with these disorders typically experience difficulty in school. Often, the adherence to

structure and compliance with rules required in school settings taxes these students’

abilities and leads to extreme frustration. When faced with students suffering from DBD,

teachers also experience frustration as they struggle to manage disruptive behavior and

fulfill their primary responsibility—teaching.

Generally speaking, schools tend to address disruptive behavior in an individualized

way. Management of students with disruptive behavior ‘‘appears to be a collection of

procedures and practices for specific problem behaviors occurring in specific situations

with little continuity across behaviors, settings, time of day, or program implementation’’

(Walker, Greenwood, & Terry, 1994, p. 233). These students are often handled on a case-

by-case basis and their school success is highly dependent on the individual skill,

commitment, and advocacy of school staff, clinicians, and parents. The role of school

psychologists in the care of these students is typically limited to testing.

A lack of educator-friendly information about effective school/classroom interventions

for DBD makes it difficult for schools to adopt comprehensive approaches to these

disorders. Failure to appreciate the applicability of a public health perspective to the

management of DBD in schools also contributes to the continued use of individualistic

approaches to this problem. These approaches are neither time nor cost-efficient and

underutilize existing school resources like school psychologists and teachers.

Strein, Hoagwood, and Cohn (2003) makes a strong case for adopting a public health

perspective in school psychology. Hoagwood and Johnson (2003) also speak to the

value of this perspective and the importance of learning how evidence-based practices

can be effectively implemented in school settings. The public health perspective

emphasizes prevention and focuses on strengthening positive behavior. This perspective

is a clear departure from the individual, problem-focused perspective that primarily

characterizes school psychology today. Although the public health model of school

psychology is appealing, applying this model to schools and school psychologist can be

challenging. Strein et al. (p. 21) aptly points out that the shift to a public health

perspective in school psychology ‘‘will not come quickly or easily,’’ but encourages the

process to begin.

Using the management of disruptive behavior disorders as an example, this article

will examine how knowledge about evidence-based interventions and a public health

perspective can be applied to the work of schools and school psychologists. The article

begins with a description of a three-tiered model of school-wide discipline strategies

(Walker et al., 1996) that applies the public health perspective to student behavior.

Next, information about comprehensive school-based programs and classroom techni-

ques for DBD is presented. Selected programs are described in detail with an emphasis

on the important role of teachers and the potential role of school psychologists in

implementing these programs. The article ends with a discussion of factors that

influence teachers’ use of interventions and the implications, for schools and school

psychologists, of applying an evidence-based and public health perspective to the

management of DBD.

L. Hunter / Journal of School Psychology 41 (2003) 39–5940

The three-tiered model of school-wide discipline strategies

In order to facilitate the implementation of comprehensive, public health approaches to

DBD in schools, school psychologists must first appreciate the applicability of a public

health model in schools. Walker et al.’s (1996) three-tiered model of school-wide discipline

strategies perfectly captures the relevance of a public health perspective for schools. The

model, illustrated in Fig. 1, suggests that the majority of students in a school (80%) do not

have serious problem behaviors. A smaller percentage (15%) is at-risk for problem

behaviors and only 5% actually display intense problem behaviors. Given this distribution

of problem behaviors in a school setting, the model endorses a whole school approach that

includes universal (primary prevention), selected (secondary prevention), and indicated

(tertiary prevention) interventions.

Universal interventions are for all students in a school setting and help prevent students

from developing serious problem behaviors. Selected interventions are for students at-risk

for developing problem behaviors. These interventions provide more intensive services

than universal interventions in an attempt to decrease the chances that a student at-risk for

the development of an externalizing behavior disorder will actually develop the disorder.

Lastly, indicated interventions are for the small percentage of students in a school with

intense problem behaviors (e.g., diagnosed disruptive behavior disorders). These inter-

ventions help stabilize and manage children in a way that is conducive to learning.

As Fig. 1 illustrates, universal interventions are the foundation of the three-tiered

model. Universal interventions enhance the overall climate of a school and serve a

screening and identification function. That is, students who do not respond to universal

Fig. 1. Three-tiered model for school-wide discipline strategies (Walker et al., 1996).

L. Hunter / Journal of School Psychology 41 (2003) 39–59 41

interventions are candidates for selected and possibly indicated interventions. In order for

the Walker et al. (1996) model to work effectively, all three levels of the model (i.e.,

universal, selected, and indicated interventions) must be carefully coordinated and

supported by the majority (75–80%) of school staff. This model is supported by the work

of Adelman and Taylor (1999, p. 150) who advocate for a ‘‘full continuum of prevention

and corrective programs that are integrated with each other and with instruction.’’

By understanding the Walker et al. (1996) model school psychologists will be able to

advocate for a public health approach to disruptive behavior in schools. In order to

facilitate the implementation of such an approach, however, school psychologists must

also arm themselves with accurate information about effective comprehensive school-

based programs and techniques for disruptive behavior. Such information is essential for

bridging the research to practice gap that characterizes school-based mental health services

today.

Comprehensive school-based programs for disruptive behavior disorders

Table 1 summarizes information about 22 comprehensive school-based programs for

disruptive behavior. These programs were identified as part of a critical review of effective

school-based interventions for DBD (Hunter, 2002). Programs were selected for the review

through an extensive search of on-line databases (e.g., PsychInfo, ERIC, Medline, etc.) for

articles published between 1980 and 2001. In addition to searching these databases,

requests for information about school-based programs for disruptive behavior disorders

were posted on educational and psychological list serves (i.e., Society for Community

Research and Action and the Collaborative to Advance Social and Emotional Learning).

Lastly, the reference lists of any articles found through the database searches or list serve

postings were carefully reviewed for additional, relevant programs.

In order to be included in the review, programs had to: (1) target at least one level of the

Walker et al. (1996) three-tiered model, (2) involve teachers in program implementation,

(3) report evaluation results, and (4) address the needs of children with disruptive behavior

disorders. These programs were categorized as promising, with potential, or poor based on

the extent to which they met the evaluation criteria below and reported positive findings:

1. Randomized, quasi-experimental or multiple baseline research design

2. Control group

3. Use of multi-method outcome measure

4. Pre- and post findings

5. At least 6-month assessment of follow-up

6. Manual detailing program components

These criteria represent a compilation of standards for efficacious/effective programs

established and used by various researchers (e.g., Chambless & Hollon, 1998; Greenberg,

Domitrovich, & Bumbarger, 2001; Rones & Hoagwood, 2000). Programs meeting all six of

the above criteria and reporting positive findings were categorized as promising programs.

Programs reporting positive findings without meeting all of the evaluation criteria or


programs with mixed findings were categorized as programs with potential. Lastly,

programs that failed to report significant positive findings regardless of whether or not

they met all the evaluation criteria were categorized as poor.

It is important to note that several excellent reviews in areas related to the topic of this

article have been published in recent years. Previous reviews of intervention programs for

children have focused on evidence-based mental health services in schools (Hoagwood &

Erwin, 1997; Rones & Hoagwood, 2000); prevention programs (Durlack & Wells, 1997;

Greenberg et al., 2001; Leff, Power, Manz, Costigan, & Nabors, 2001); and ADHD

specific interventions (e.g., DuPaul & Eckert, 1998; Fiore & Becker, 1994; Pelham &

Gnagy, 1999). All of these reviews have contributed significantly to the knowledge base

on effective intervention programs for children. Although the review informing this

article shares some characteristics of past reviews, it is unique in its focus on school-

based interventions for DBD that involve teachers and emphasize a public health

perspective.

Table 1 categorizes the programs meeting inclusion criteria for the review as: Programs

for Typical Disruptive Behavior, Attention Deficit Hyperactivity Disorder, and Conduct

Disorder (no programs specifically targeting Oppositional Defiant Disorder were found, but

many of the programs for typical disruptive behavior target symptoms associated with Op-

positional Defiant Disorder). For each listed program, the table provides information about

program content, the type of intervention, the level of teacher involvement, evaluation

results, and evaluation criteria. A detailed description of each program listed in Table 1 is

beyond the scope of this paper, but selected programs are described more fully in the next

section.

Description of selected programs

Programs for typical disruptive behavior

The term typical disruptive behavior is used to characterize problematic behavior such

as aggression, non-compliance, etc., that demands attention from school staff, but is not

severe enough to merit a psychiatric diagnosis. The review identified 14 prevention

programs targeting typical disruptive behavior. These programs, summarized in Table 1,

are likely to benefit all students regardless of whether or not they are diagnosed with DBD

by enhancing the learning environment of schools.

Among the programs for typical disruptive behavior summarized in Table 1, Positive

Behavioral Interventions and Supports (PBIS) is an intervention that captures the public

health perspective particularly well. PBIS refers to a ‘‘team-based, comprehensive, and

proactive system for facilitating and maintaining student success across settings’’ (Scott,

2001, p. 88). It is a data-driven process that targets multiple school systems (i.e., school-

wide, classroom, nonclassroom, and individual) and emphasizes intervention across the

prevention spectrum (universal, selected, and indicated). PBIS embraces the public health

focus on prevention and the promotion of positive behavior.

The PBIS process as conceptualized by Horner, Sugai, Lewis-Palmer, & Todd (2001)

often begins with the identification, teaching, and reinforcement of school-wide behavioral

expectations. This universal, school-wide intervention helps reduce the overall incidence

of disruptive behavior and fosters a positive school climate. Students who continue to


Table 1

Comprehensive school-based programs for disruptive behavior disorders

Program Description Type of

interventionaTeacher

involvementbEvaluation results Evaluation

criteria metc


Classroom-Centered

and Family-School

Partnership

Interventions

Ialongo et al. (1999)

PROMISING

The CC intervention combines

group social problem solving

training and the GBG. The FSP

intervention provides parent

training and emphasizes

parent– teacher communication.

Universal HIGH Significantly fewer teacher-rated

problem behaviors for children in

CC group. Modest FSP effects.

Sample Population: 86.8%

African American, 13.2% White

1, 2, 3, 4, 5, 6

Grade level: 1st grade

Classwide Peer

Tutoring

Delquardi,

Greenwood,

Stretton,

and Hall (1983)

A reciprocal peer-tutoring method

designed to help students master

specific academic material.

Grade level: elementary school

Universal HIGH DuPaul et al. (1998) found

increases in on-task behavior and

academic gains when in use.

Sample population: 74% White,

16% Hispanic, and 10% African

American

1, 3, 4, 5, 6

POTENTIAL

First Steps to Success

Walker, Severson,

Feil, Stiller, and

Golly (1998)

Identifies students at-risk for

antisocial behavior and then

provides them with classroom

and home-based interventions.

Selected MEDIUM Strong treatment effects. 80% of

gains maintained during first grade.

Sample population: ??

1, 2, 3, 4, 5, 6

PROMISING Grade level: kindergarten

Good Behavior Game

Dolan et al. (1993)

Team-based classroom behavior

management strategy.

Universal HIGH Significant impact on behavior as

rated by teachers.

1, 2, 3, 4, 5, 6

PROMISING Grade level.: 1st grade Sample population: 64% African

American, 29% White, 7% other

L.Hunter

/JournalofSchoolPsych

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Montreal Longitudinal

Study Tremblay,

Pagani-Kurtz,

Masse, Vitaro,

and Pihl (1995)

Provides home-based parent

training and school-based social

skills training to at-risk boys.

Grade level: K—8 year olds

Selected LOW Mixed results. Positive impact

during elementary school

disappeared by age 15.

Sample population: Kindergarten

native Canadian boys.

1, 2, 3, 4, 5, 6

POTENTIAL

Multicomponent

Competence

Enhancement

Intervention

Braswell et al. (1997)

POOR

Child, parent, and teacher

components focusing on social

problem solving, behavior

management, and classroom

management, respectively.

Grade level: 1st –4th grade

Selected MEDIUM No significant differences between

children receiving MCEI and those

in the control and comparison

conditions.

Sample population: Mostly White.

Less than 5% minority.

1, 2, 3, 4

School-Wide Intervention

Program Nelson (1996)

POTENTIAL

Focuses on modifying the

organization of disruptive school

areas (e.g., cafeteria), implementing

common classroom management

techniques, and providing services

to identified students.

Universal

Indicated

HIGH Decreases in disciplinary actions

and higher academic ratings for

schools/students exposed to

intervention.

Sample population: 18% minority.

75% free lunch

1, 2, 3, 4


Positive Behavioral

Interventions

and Supports

Sugai and

Horner (2001)

Systemic and individualized strategies

for promoting social and learning

outcomes while preventing problem

behaviors.

Grade level: all school ages

Universal

Selected

Indicated

HIGH Promising preliminary results from

implementation in 500 schools.

Sample population: ??

4, 5

POTENTIAL

Promoting Alternative

Thinking Strategies

Kusche and

Greenberg (1994)

PROMISING

Teacher-delivered social competence

curriculum for elementary

school children.

Grade level: pre-K—5th grade

Universal HIGH Significant differences in

aggression and peer relations

for PATHS classrooms.

Sample population: 49% minority,

mainly African American

(CPPRG, 1999 study)

1, 2, 3, 4, 6

(continued on next page)

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Table 1 (continued)




criteria metc


PrimeTime

Hughes and

Cavell (1999)

POOR

Provides parent and teacher

consultation, therapeutic mentoring,

and problem-solving skills training.

Grade level: school-aged children

Selected MEDIUM No significant differences between

intervention and control group.

Sample population: 55% African-

American, 29% White, 16% Hispanic

1, 3, 4, 5, 6

Project ACHIEVE

Knoff and

Batsche (1995)

PROMISING

School reform program focused

strategic planning, staff development,

consultation, behavioral interventions,

parent support, and more.

Grade level: pre-K—5th grade

Selected

Universal

HIGH Significant reductions in special

education and discipline referrals

for ACHIEVE schools.


38% African American, 19% other.

87% free/reduced lunch

1, 2, 3, 4, 5, 6

Seattle Social

Development

Project

Hawkins, Von Cleve,

and Catalano (1991),

Hawkins, Catalano,

Kosterman, Abbott,

and Hill (1999)

Multicomponent intervention for

elementary school children that

combines teacher training, parent

education, and social competence

training for children.


Universal HIGH Participation in program associated

with significant positive effects

through age 18.


26% African American, 22% Asian,

5% Native American, 3% other

1, 2, 3, 4, 5, 6

PROMISING

Second Step

Grossman et al.

(1997)

Teacher-delivered curriculum that

addresses empathy, social problem

solving and anger management.

Universal HIGH Decrease physical aggression for

Second Step students.

Sample population: Mostly White

1, 2, 3, 4, 5, 6

PROMISING Grade level: pre-K—9th grade

Tri-Ministry Study

Boyle et al. (1999)

POOR

Evaluated the effects of a class-wide

social skills program, a partner-

reading program or a combined

program.

Grade level: K—3rd grade

Universal HIGH ‘‘Small and sporadic’’ effects

attributed to the intervention.

Sample population: Canadian

elementary school children

(up to grade 3)

1, 2, 3, 4, 5, 6

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Programs for attention deficit hyperactivity disorder

Challenging Horizons

Program

Evans, Axelrod,

and Axelrod (2001)

After-school treatment program.

Grade level: middle school

Indicated LOW Promising pilot study results

Sample population: Adolescents

with ADHD.

3, 4

POTENTIAL

LU-CCAADD

Shapiro, DuPaul,

Bradley, and

Bailey (1996)

Three-level consultation program

for middle school staff.


personnel

Universal

Selected

MEDIUM Increases in teacher knowledge of

ADHD. High levels of satisfaction.

Sample population: 96.5% White

4, 6

POTENTIAL

Multicomponent CBT

Intervention

Bloomquist, August,

and Ostrander (1991)

POOR

Provides problem-solving groups

to identified children. Facilitates

class-wide problem-solving skills

training through teacher training

and offers support/education

groups to parents.

Selected MEDIUM Minimal support for program’s

efficacy.

Sample population: 95% White

1, 2, 3, 4, 5, 6


PARD

Williams, Horn,

Daley, & Nader (1993)

POTENTIAL

Coordinates services for low-income

children with ADHD.

Grade level: information not

provided

Indicated LOW 60–70% of students showed

improvement after enrollment

in program.

Sample population: Low SES.

Predominantly White and

African-American

3, 4

RALLY Program

(ADHD Component)

Noam et al. (1996)

POTENTIAL

Offers a range of services to

adolescents based on

their level of need.


Universal

Selected

Indicated

MEDIUM Promising results from pilot study

of entire program.

Sample population: 41% African

American, 26% Asian,

19% Hispanic and 14% White

3, 4, 5, 6

(continued on next page)

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School-Based Day

Treatment Program

Swanson (1992)

POTENTIAL

Intensive day treatment program

modeled after Pelham’s Summer

Treatment Program for ADHD.


Indicated MEDIUM Program has not been subject to a

controlled evaluation, but behavioral

aspects evaluated by Barkley et al.

(2000). Positive findings.

1, 2, 3, 4, 5

(Barkley et al.,

2000)

Sample population: Disruptive

preschool and kindergarten children.

Programs for conduct disorder

FAST Track

Conduct Problems

Prevention Research

Group (1992)

PROMISING

Comprehensive program

combining parent training,

case management, social

skills training, academic

tutoring and

teacher-delivered classroom

intervention.

Selected MEDIUM Greater behavioral improvement,

as rated by parents and teachers,

for intervention group students.

Sample population: 51% African-

American, 47% European American,

2% other ethnicity

1, 2, 3, 4, 5, 6


LIFT

Reid et al. (1999)

PROMISING

Focuses on the instruction and

practice of social skills for students,

parent training, and parent/teacher

communication.

Universal LOW Less playground aggression and

more favorable teacher ratings for

intervention group students.

Sample population: 11% minority

1, 2, 3, 4, 5, 6


a Universal interventions are for all students in a school, independent of risk status. Selected interventions target students identified as at-risk for the development of

problem behaviors. Indicated interventions are for students with intense or diagnosed problem behaviors.b HIGH teacher involvement refers to programs in which teachers deliver the main components of the intervention. Programs in which teacher involvement is

significant, but not primary are characterized as MEDIUM teacher involvement. LOW teacher involvement refers to program with minimal teacher involvement.c Numbers listed refer to the following criteria used to assess the quality of the evaluation results: 1 =Randomized, quasi-experimental or multiple baseline research

design; 2 = Inclusion of control group; 3 =Use of multi-method outcome measures; 4 = Pre- and post findings; 5 =At least 6-month follow-up assessment; 6 =Manual.

Table 1 (continued)




criteria metc


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display disruptive behavior despite universal intervention may require more intensive

selected or indicated interventions.

Through the PBIS process, schools are encouraged to form a problem solving team

devoted to addressing the needs of students who require more than universal intervention.

At the selected level, this team uses functional assessment to identify appropriate

interventions for a student’s problem behavior. At the indicated level, the PBIS process

encourages wraparound planning to meet the needs of individual students across settings.

Although the concepts behind PBIS are not new, its implementation as described here is.

To date, universal aspects of PBIS (i.e., school-wide behavioral expectations) have been

implemented in approximately 500 schools nationwide. Preliminary results indicate that

PBIS leads to significant reductions in office discipline referrals, reductions in the rates of

problem behaviors in common school areas (e.g., cafeteria, hallways, etc.), and improved

academic engagement and performance (Horner et al., 2001). For example, the High Five

Program, a school-wide PBIS intervention implemented in an Oregon middle school, led to

a 47% drop in office discipline referrals after 1 year (Taylor-Greene & Kartub, 2000). After

5 years, the initial number of discipline referrals was down by 68%.

In order to succeed, PBIS requires a high level of administrative support and staff

involvement. School psychologists adopting a public health model of service delivery could

play a vital role in facilitating every level of PBIS implementation. At the universal level,

school psychologists, with their knowledge of basic behavioral principles, could assist

schools in identifying, teaching and reinforcing school-wide behavioral expectations. At the

selected level, school psychologists could serve on a school team devoted to identifying and

meeting the needs of at-risk students through functional assessment. Lastly, at the indicated

level of PBIS, school psychologist could function as they traditionally do by completing

assessments and providing services for individual students.

PBIS is a good example of a school-based intervention for DBD that embraces the public

health model and has growing evidence in support of its effectiveness. As a result of being

specifically mentioned in the 1997 Reauthorization of the Individuals with Disabilities

Education Act (IDEA), there has been a renewed emphasis on implementing PBIS in

schools (Bradley, 2001). School psychologists able to shift their focus from the individual

to the whole school could be of tremendous value in assisting schools interested in

implementing PBIS.


As Table 1 indicates, the review identified six programs specifically targeting ADHD.

One program, Responsive Advocacy for Learning and Life in Youth (RALLY), is similar to

PBIS in its focus on universal, selected, and indicated prevention.

RALLY is a school-based program for at-risk adolescents. The program represents

collaboration between Boston Public Schools, McLean Hospital/Harvard Medical School,

Harvard Graduate School of Education, and community organizations (e.g., YMCA, Boys

and Girls Club). Although the program seeks to meet the academic and psychosocial needs

of all at-risk students, it also has an ADHD-specific component. This component will be

described in detail here.

As a whole, RALLYemphasizes supportive adult–child relationships and the prevention

of chronic mental health problems and school failure. It is ‘‘theoretically grounded in the


concept that supportive relationships can provide the opportunity to develop resilience in

at-risk children and youth’’ (Noam, Winner, Rhein, & Molad, 1996, p. 36). Prevention

practitioners, a new professional role the program has evolved, are an integral component of

RALLY. These individuals are responsible for building relationships with children; serving

as a liaison between children, their parents, the school, and the community; and providing

academic support in the classroom (Noam et al., 1996). Prevention practitioners spend two

days a week in an assigned classroom. They are charged with meeting the educational,

mental health, and health needs of all the children they are assigned to, regardless of the

child’s risk status.

RALLYpractitioners work within a ‘‘Three Tier Model’’ of service delivery. This model,

akin to the public health view of prevention (i.e., universal, selected and indicated),

includes a high intensity, scanning, and inclusive tier (Noam, Warner, & Van Dyken, in

press). The ADHD component of RALLY attempts to address concentration problems,

distractibility, and disorganization at all tiers in order to create a learning environment

beneficial to all students.

Tier One (High Intensity) of the RALLY ADHD component is an indicated level

intervention for students with the disorder. Prevention practitioners working with Tier One

ADHD students make sure that these students are connected to a physician so that

medication, if indicated, can be started and monitored. Practitioners also help ADHD

students with organizational skills and develop consistent plans with teachers. Practitioners

serve as bridges between outside services and the classroom and school life of children.

Tier Two (Scanning Intervention) is a selected intervention for students who show early

warning signs of ADHD. Tier Two activities include screening for ADHD symptoms in

various school settings and providing parents with information about the disorder. Lastly,

Tier Three ADHD components are universal in nature and include teacher training in

classroom management strategies, assistance in organization skills for all students, and

various after school activities to support student academic and social success.

The ADHD component has been a part of RALLY for three years. Although this

component of the program has not been formally evaluated, results from initial evaluations

of the entire RALLY program have been promising. Qualitative data in the form of

interviews with children, teachers, and administrators participating in the program have

been very positive indicating high satisfaction with the program (Noam, personal

communication, November 8, 2001). As for quantitative data, children who have received

a high degree of intervention through RALLY (i.e., Tier One students) have shown

decreases in truancy and increases in school attachment and time spent on homework

(Noam, 1996). The program also reports effectiveness in linking students to outside

services. The developers of the program are presently seeking funding to evaluate the

program in a controlled study.

RALLY embraces a public health philosophy by emphasizing a school-wide approach

that promotes prevention at three different levels. Since RALLY relies predominantly on

prevention practitioners to deliver the various components of the program, a school

psychologist’s role in a RALLY school would be to primarily serve as a consultant and

added support to the prevention practitioners. School psychologists could assist prevention

practitioners in school-wide screening for ADHD and coach teachers in classroom

management strategies. For Tier One students, school psychologists could perform their


more traditional role of providing individual assessment and intervention for students

believed to have ADHD.

Programs for conduct disorder

Two programs, Fast Track and Linking the Interests of Families and Teachers (LIFT),

specifically targeting Conduct Disorder were identified through the review. Both of these

programs are summarized in Table 1. Strein et al. (2003, this issue) describes Fast Track in

more detail. LIFT is described here.

LIFT is a school-based prevention program for Conduct Disorder. Unlike RALLY and

PBIS, LIFT only provides intervention at the universal level. The program targets antece-

dents of Conduct Disorder in home and school settings (Reid, Eddy, Fetrow, & Stoolmiller,

1999). LIFT staff members implement the school component of the program over 10 weeks

in twenty 1-h sessions. These sessions include instruction on specific social skills, practice of

these skills in large and small groups, free play on the playground, and daily rewards.

The parent component of LIFT is delivered through six weekly group sessions that focus

on effective discipline and parenting skills. In addition to these sessions, parents are

encouraged to speak regularly with their child’s teacher through the LIFT line, a phone and

answering machine in each teacher’s classroom.

Results of a randomized clinical trail of LIFT indicated that students receiving the

intervention had more favorable outcomes in the areas of playground behavior and teacher

ratings than children in the control group (Reid et al., 1999). Program satisfaction was high

for both teachers and parents (Reid et al., 1999).

LIFT does not require as much teacher or school psychologist involvement as some of

the other programs described in this article. Trained LIFT staff members deliver the bulk of

the program and teacher involvement is limited to maintaining phone contact with parents.

Nevertheless, school psychologists working in schools interested in implementing LIFT

could assist in important ways. For example, school psychologists could help staff members

deliver the student sessions of the program and develop methods for facilitating application

of skills learned during these sessions throughout the school year. School psychologists

could also consult with teachers about ways of assisting students who do not respond to the

universal components of LIFT.

Summary

LIFT, RALLY, and PBIS are all examples of comprehensive school-based programs for

DBD that embody a public health and evidence-based perspective. RALLY and PBIS are

particularly good examples of the application of a public health perspective in schools. Both

of these programs provide intervention across the prevention spectrum. As such they target

all students in a school, not just students with a DBD.

In addition to LIFT, RALLY, and PBIS, the review informing this article identified 19

other programs that embodied a public health perspective by focusing on at least one level of

prevention (i.e., universal, selected, or indicated), involved teachers in program implemen-

tation, reported evaluation results, and addressed the needs of students with DBD.As Table 1

indicates, the majority of these programsmet evaluation criteria for a promising program or a

program with potential. Only four programs were categorized as poor.


Table 1 provides valuable information to schools and school psychologists seeking to

apply a public health and evidence-based perspective to the management of disruptive

behavior. School psychologists can play an important role in helping schools to implement

any of the programs listed in Table 1. Depending on the program, this role may involve

providing consultation or more direct services. In order to adopt either of these roles and

facilitate the implementation of comprehensive school-based programs for DBD, however,

school psychologists will have to reconceptualize their function.

Classroom management techniques for disruptive behavior disorders

A public health conceptualization of school psychology will allow school psychologists

to play pivotal roles in assisting schools with the implementation of the comprehensive

programs summarized in Table 1. Schools, however, can be slow or resistant to implement-

ing these types of programs and school psychologists may first have to convince schools of

the need for a given program. In making the shift to a public health perspective, school

psychologists may prefer to start small by helping individual classroom teachers implement

classroom behavioral management techniques that in the spirit of public health prevent or

minimize disruptive behavior in the classroom and can be tailored to improve the classroom

behavior of students with DBD.

Table 2 summarizes classroom behavioral management techniques for disruptive

behavior disorders. Complete descriptions of these techniques are beyond the scope of

this paper, but more detailed descriptions can be found in the references cited in the table.

These techniques are often a part of the comprehensive programs described previously, but

they are also used independently to prevent or minimize disruptive behaviors in a

classroom. Although there is ‘‘no formula for the instant resolution of problem behavior’’

(Glass, 1992, p. 33), the techniques described in Table 2 all have demonstrated some

effectiveness.

Most of the classroom behavioral management techniques summarized in Table 2 have

been successfully used with ADHD children. These techniques are also applicable to

children with CD and ODD as well as children without a disruptive behavior diagnosis. In

fact, these techniques are ‘‘helpful for most children and are reflective of good teaching in

general’’ (Mulligan, 2001, p.26).

Classroom behavioral management techniques are generally less expensive and

complicated to implement than some of the comprehensive programs described

previously. Teachers implementing these techniques, however, still require adequate

training and consultation in order to use the techniques successfully. School psychol-

ogists can provide this training and consultation if they expand their role in the

school.

Teacher use of interventions

In their expanded role, school psychologist will have to do a lot of work with teachers

in order to assist them in implementing the programs and techniques described in Tables 1


and 2. Getting teachers to implement new programs or techniques is hard work. Knowledge

of the factors that influence teachers’ use of an intervention will assist school psychologist

in this challenging task.

Not surprisingly, teachers are more likely to implement interventions they deem

acceptable (Hall & Didier, 1987). Research (Elliott, 1988; Elliott, Witt, Galvin, & Peterson,

1984; Power, Hess, & Bennett, 1995) shows that teachers prefer positive interventions (e.g.,

praise, rewards, etc.) more than negative interventions (time out, response cost, etc.). The

amount of time an intervention requires also greatly influences its acceptability for teachers.

Generally speaking, teachers prefer interventions that require less time (Elliott et al., 1984;

Power et al., 1995; Witt, 1986). Given the pressures placed on teachers’ time, it makes sense

that they would prefer time-efficient interventions.

Although teachers may state a preference for less time consuming interventions, such

interventions are not necessarily the most enduring. For example, Commins and Elias

(1991) found that ‘‘ambitious and demanding’’ interventions are more likely to be

institutionalized than simplistic interventions. These interventions ‘‘ultimately are seen

as more valued and useful because they require such effort’’ (Commins & Elias, 1991, p.

213).

Unfortunately, the efficacy or effectiveness of an intervention does not necessarily

influence teachers’ views of its acceptability. Martens, Peterson, Witt, and Cirone (1986,

p. 213) report that classroom teachers are ‘‘often resistant’’ to using interventions with

demonstrated efficacy and ‘‘opt for alternative strategies with which they are more

familiar or which they perceive as more convenient.’’ Witt (1986, p. 39) states,

‘‘Whether teachers have data supporting the effectiveness of one treatment or another

is probably not nearly as important as whether they think a particular treatment is

effective.’’

A study by Johnson and Pugach (1990) supports the views of Martens et al. (1986) and

Witt (1986). The study surveyed 233 elementary school teachers about their views on

acceptability of 57 classroom interventions. Follow up interviews were conducted with

some of the teachers to discuss the rationale for their ratings. Interestingly, some strategies

with empirical support were given low acceptability ratings.

Since the effectiveness of an intervention alone is not enough to guarantee its use by

teachers, it is important to consider other factors when implementing school-based

interventions. The compatibility of an intervention with a teacher’s teaching style, beliefs,

capacities, and expectations is an essential factor to assess (Greene, 1995). Such an

assessment allows for some matching between an intervention and a teacher’s preferences.

‘‘Intervention models or strategies congruent with educators’ beliefs may be more widely

used and effectively implemented than are counter belief strategies because educators may

be more committed to the successful implementation of interventions compatible with their

beliefs’’ (Short & Short, 1989, p. 31).

Given the myriad of factors that influence teachers’ acceptance and use of interventions,

schools, school psychologists, and others interested in implementing some of the programs

and classroom management techniques described in Tables 1 and 2 must proceed thought-

fully as they decide which interventions to implement. Involving teachers in the decision-

making process and securing their buy-in will maximize the potential success of an

intervention.


Table 2

Classroom behaviour management techniques

Technique Description Studies Findings

Attention

Training System

A battery-operated electronic device that administers positive

and negative feedback using a response – cost paradigm.

The device, placed on a child’s desk and operated by a

teacher, awards points for on-task behavior and subtracts

points for off-task behavior.

DuPaul, Guevremont,

and Barkley (1992)

Improvements in on-task behavior and

decreases in ADHD-related behaviors

when ATS in use. Larger gains when

used in conjunction with Ritalin

Choice Making For certain periods during the school day, students are allowed

to choose from a menu of academic activities. Students are

also allowed to choose the type of reinforcement they receive.

Dunlap et al. (1994) Greater task engagement and lower rates

disruptive behavior during choice making

condition.

Computer Assisted

Instruction

The use of computers to enhance learning by highlighting

essential material, using multiple sensory modalities,

chunking material, and/or providing immediate feedback.

Review by DuPaul

and Eckert (1998)

Two studies conducted had methodological

limitations. Some suggestion that CAI

increases attending behavior.

Contingency

Management

A general term for a range of procedures used to manage a

child’s behavior. Token reinforcement programs, contingency

contracting, response cost and time-out are all examples

of contingency management procedures

Review by DuPaul

and Eckert (1998)

Various contingency management

procedures have been associated with

positive behavioral outcomes for children

with ADHD.

Functional

Assessment

‘‘A broad set of procedures that includes interviews, direct

observation of the problem behaviors and environmental events,

and systematic manipulation of environmental events to examine

the functional relationship between the problem behaviors and

environmental events’’ (DuPaul et al., 1997, p. 373).

DuPaul, Eckert, and

McGoey (1997),

Ervin, DuPaul, Kern,

and Friman (1998),

Ervin et al. (2000)

Interventions implemented following

functional assessment led increases in

on task behavior.

Self Management A variety of interventions designed to increase the self-control

of students with disruptive behavior problems. Self-monitoring,

self-reinforcement, and self-instruction are all examples of

self-management interventions.

Christie, Hiss, and

Lozanoff (1984), Hoff

and DuPaul (1998),

Shapiro, DuPaul, and

Bradley-Klug (1998)

Review by DuPaul

and Eckert (1998)

Decreases in inattentive behavior and

increases in on-task behavior.

Strategy Training Teaching students the specific procedures or strategies required

to meet the demands of a given academic situation. Notetaking

interventions are an example of a type of strategy training.

Evans, Pelham, and

Grudberg (1995)

Short term gains in academic

performance and on-task behavior.

Moderate effect size for notetaking

intervention (Evans et al., 1995).

Task and Instructional

Modification

Task modification refers to revisions made to the curriculum or

aspects of the curriculum in an attempt to meet the needs of

students. Instructional modification refers to changes in the

content or delivery of instruction.

Review by DuPaul

and Eckert (1998)

Certain task and instructional modification

strategies have been associated with positive

academic and behavioral outcomes.

L.Hunter


ology41(2003)39–59

54

Conclusion

Disruptive student behavior is a serious problem in schools that diverts time and

attention away from teaching. Unfortunately, schools are not particularly well equipped to

deal with this behavior especially when it is associated with a psychiatric diagnosis of

ADHD, CD, or ODD. Schools tend to address disruptive behavior on a case-by-case basis

and overlook the benefits of more comprehensive approaches to the problem.

By adopting a public health and evidence-based perspective to the management of

disruptive behavior, schools will increase the likelihood of having a real impact on this

problem. A public health perspective emphasizes prevention, the promotion of positive

behavior, and community. An evidence-based perspective emphasizes the use of inter-

ventions that have demonstrated some level of effectiveness in real world settings.

Applying these perspectives to the management of disruptive behavior requires identifying

and implementing prevention-focused programs that have been shown to work.

This article identified a number of school-based programs and classroom techniques for

disruptive behavior that embrace a public health perspective and have demonstrated some

effectiveness. Although this information is valuable, it alone will not facilitate the

implementation of these programs in schools. In order to adopt any of these programs,

schools will need active encouragement and assistance from individuals knowledgeable

about school systems and program implementation.

School psychologists can play a vital role in facilitating the implementation effective,

public health-type programs for DBD. They can serve as an advocate for the public health

perspective in schools, a resource for information about specific programs, and an active

assistant in the implementation of programs by providing consultation or direct services. In

order to adopt these roles, school psychologists will have to shift their focus from the

individual to the whole school as proposed by Strein et al. (2003, this issue). To

successfully adopt these roles, school psychologists will also have to expand their knowl-

edge base by familiarizing themselves with the applicability of the public health model to

schools, learning more about effective programs and techniques, and developing strong

consultation skills.

Given their current focus on conducting individual assessments of children, facilitating

the implementation of effective programs for DBDmay seem like a daunting task for school

psychologists. School psychologists should not feel that the responsibility for implementing

effective DBD programs rests solely on their shoulders. School administrators and teachers

also play a vital role in this process. School psychologists, however, do play a unique role in

schools and can be instrumental in driving the process if they adopt a public health

perspective. Although this will be challenging, it will also be extremely rewarding and

allow school psychologists to influence the lives of all children in a school, not just those

who are being considered for special education services, and actively interact with teachers.

Acknowledgements

Research contributing to this article was supported by a grant from the Klingenstein

Third Generation Foundation.


References

Adelman, H. S., & Taylor, L. (1999). Mental health in schools and system restructuring. Community Psychology

Review, 19, 137–163.

Barkley, R. A., Shelton, T. L., Crosswait, C., Moorehouse, M., Fletcher, K., Barrett, S., Jenkins, L., & Metevia, L.

(2000). Multi-method psycho-educational intervention for preschool children with disruptive behavior: pre-

liminary results at post-treatment. Journal of Child Psychology and Psychiatry and Allied Disciplines, 41(3),

319–332.

Bloomquist, M. L., August, G. J., & Ostrander, R. (1991). Effects of a school-based cognitive-behavioral

intervention for ADHD children. Journal of Abnormal Child Psychology, 19, 591–605.

Boyle, M. H., Cunningham, C. E., Heale, J., Hundert, J., McDonald, J., Offord, D. R., & Racine, Y. (1999).

Helping children adjust—a tri-ministry study: I. Evaluation methodology. Journal of Child Psychology and

Psychiatry, 40, 1051–1060.

Bradley, M. R. (2001). Preface: Positive behavior supports research to practice. Beyond, 3–4.

Braswell, L., August, G. J., Bloomquist, M. L., Realmuto, G. M., Skare, S. S., & Crosby, R. D. (1997). School-

based secondary prevention for children with disruptive behavior: Initial outcomes. Journal of Abnormal

Child Psychology, 25, 197–208.

Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and

Clinical Psychology, 66, 7–18.

Christie, D. J., Hiss, M., & Lozanoff, B. (1984). Modification of inattentive classroom behavior: Hyperactive

children’s use of self-recording with teacher guidance. Behavior Modification, 8, 391–406.

Commins, W. W., & Elias, M. J. (1991). Institutionalization of mental health programs in organizational contexts:

The case of elementary schools. Journal of Community Psychology, 19, 207–220.

Conduct Problems Prevention Research Group (1992). A developmental and clinical model for the prevention of

Conduct Disorder: The FAST track program. Development and Psychopathology, 4, 227–509.

Conduct Problems Prevention Research Group (1999). Initial impact of the fast track prevention trial for conduct

problems: II. Classroom effects. Journal of Consulting and Clinical Psychology, 67, 648–657.

Costello, E. (1989). Developments in child psychiatric epidemiology. American Journal of Community Psychol-

ogy, 5, 1–22.

Delquadri, J., Greenwood, C. R., Stretton, K., & Hall, R. V. (1983). The peer tutoring game: A classroom

procedure for increasing opportunity to respond and spelling performance. Education and Treatment of

Children, 6, 225–239.

Dolan, L. J., Kellam, S. G., Brown, C. H., Werthamer-Larsson, L., Rebok, G. W., Mayer, L. S., Laudolff, J.,

Turkkan, J. S., Ford, C., & Wheeler, L. (1993). The short-term impact of two classroom-based prevention

interventions on aggressive and shy behaviors and poor achievement. Journal of Applied Developmental

Psychology, 14, 317–345.

Dunlap, G., dePercei, M., Clarke, S., Wilson, D., Wright, S., White, R., & Gomez, A. (1994). Choice making to

promote adaptive behavior for students with emotional and behavioral challenges. Journal of Applied Be-

havior Analysis, 27, 505–518.

DuPaul, G. J., & Eckert, T. L. (1998). Academic interventions for students with attention-deficit/hyperactivity

disorder: A review of the literature. Reading and Writing Quarterly: Overcoming Learning Difficulties, 14,

59–82.

DuPaul, G. J., Eckert, T. L., & McGoey, K. E. (1997). Interventions for students with attention-deficit/hyper-

activity disorder: One size does not fit all. School Psychology Review, 26, 369–381.

DuPaul, G. J., Ervin, R. A., Hook, C. L., & McGoey, K. E. (1998). Peer tutoring for children with attention deficit

hyperactivity disorders: effects on classroom behavior and academic performance. Journal of Applied Be-

havior Analysis, 31, 579–592.

DuPaul, G. J., Guevremont, D. C., & Barkley, R. A. (1992). Behavioral treatment of attention-deficit hyper-

activity disorder in the classroom the use of the attention training system. Behavior Modification, 16,

204–225.

Durlack, J. A., & Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents:

A meta-analytic review. American Journal of Community Psychology, 25, 115–152.

Elliott, S. N. (1988). Acceptability of behavioral treatments: Review of variables that influence treatment selec-

tion. Professional Psychology: Research and Practice, 19, 68–80.


Elliott, S. N., Witt, J. C., Galvin, G. A., & Peterson, R. (1984). Acceptability of positive and reductive behavioral

interventions: Factors that influence teachers’ decisions. Journal of School Psychology, 22, 353–360.

Ervin, R. A., DuPaul, G. J., Kern, L., & Friman, P. C. (1998). Classroom-based functional and adjunctive

assessments: Proactive approaches to intervention selection for adolescents with Attention Deficit Hyper-

activity Disorder. Journal of Applied Behavior Analysis, 31, 65–78.

Ervin, R. A., Kern, L., Clarke, S., DuPaul, G. J., Dunlap, G., & Friman, P. C. (2000). Evaluating assessment-

based intervention strategies for students with ADHD and comorbid disorders within the natural classroom

context. Behavioral Disorders, 25, 344–358.

Evans, S. W., Axelrod, J. L., & Axelrod, J. M. (2001). Efficacy of a school-based treatment program for middle

school youth with ADHD: Pilot data. Submitted for publication.

Evans, S. W., Pelham, W., & Grudberg, M. V. (1995). The efficacy of notetaking to improve behavior and

comprehension of adolescents with Attention Deficit Hyperactivity Disorder. Exceptionality, 5, 1–17.

Fiore, T. A., & Becker, E. A. (1994). Promising classroom interventions for students with attention deficit

disorders. Special education programs (ED/OSERS), Washington, DC (pp. 1–215).

Glass, R. M. (1992). Classroom management strategies for students with behavior disorders. In L. G. Cohen, et

al. (Eds.), Children with exceptional needs in regular classrooms. Aspects of learning (pp. 11–36). Wash-

ington, DC: National Education Association.

Greenberg, M. T., Domitrovich, C., & Bumbarger, B. (2001). The prevention of mental disorders in school-aged

children: Current state of the field. Prevention and Treatment, 4 (Article 1).

Greene, R. W. (1995). Students with ADHD in school classrooms: Teacher factors related to compatibility,

assessment, and intervention. School Psychology Review, 24, 81–93.

Grossman, D. C., Neckerman, H. J., Koepsell, T. D., Liu, P. Y., Asher, K. N., Beland, K., Frey, K., & Rivara, F. P.

(1997). Effectiveness of a violence prevention curriculum among children in elementary school: A random-

ized controlled trial. Journal of the American Medical Association, 277, 1605–1611.

Hall, C. W., & Didier, E. (1987). Acceptability and utilization of frequently-cited intervention strategies. Psy-

chology in the Schools, 24, 153–161.

Hawkins, J. D., Catalano, R. F., Kosterman, R., Abbott, R., & Hill, K. G. (1999). Preventing adolescent health-

risk behaviors by strengthening protection during childhood. Archives of Pediatric and Adolescent Medicine,

153, 226–235.

Hawkins, J. D., Von Cleve, E., & Catalano, R. F. (1991). Reducing early childhood aggression: Results of a primary

prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 208–217.

Hoagwood, K., & Erwin, H. D. (1997). Effectiveness of school-based mental health services for children: A 10-

year research review. Journal of Child and Family Studies, 6, 435–451.

Hoagwood, K., & Johnson, J. (2003). School psychology: A public health framework I. From evidence-based

practices to evidence-based policies. Journal of School Psychology, 41, 3–19.

Hoff, K. E., & DuPaul, G. J. (1998). Reducing disruptive behavior in general education classrooms: The use of

self-management strategies. School Psychology Review, 27, 290–303.

Horner, R. H., Sugai, G., Lewis-Palmer, T., & Todd, A. W. (2001). Teaching school-wide behavioral expect-

ations. Report on Emotional and Behavioral Disorders in Youth, 1(4), 77–79, 93–96.

Hughes, J. N., & Cavell, T. A. (1999). School-based interventions for aggressive children: PrimeTime as a

case in point. In S. W. Russ, & T. H. Ollendick (Eds.), Handbook of psychotherapies with children and

families: Issues in clinical child psychology (pp. 419–446). New York: Kluwer Academic Publishing/

Plenum.

Hunter, L. (2002). School-based interventions for attention deficit and disruptive behavior disorders: A critical

review. Unpublished manuscript.

Ialongo, N. S., Werthamer, L., Kellam, S. G., Brown, C. H., Wang, S., & Lin, Y. (1999). Proximal impact of two

first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and

antisocial behavior. American Journal of Community Psychology, 27, 599–641.

Johnson, L. J., & Pugach, M. C. (1990). Classroom teachers’ views of intervention strategies for learning and

behavior problems: Which are reasonable and how frequently are they used? Journal of Special Education, 24,

69–84.

Knoff, H. M., & Batsche, G. M. (1995). Project achieve: Analyzing a school reform process for at-risk and

underachieving students. School Psychology Review, 24, 579–603.


Kusche, C. A., & Greenberg, M. T. (1994). The PATHS curriculum. Seattle, WA: Developmental Research and

Programs.

Leff, S. S., Power, T. J., Manz, P. H., Costigan, T. E., & Nabors, L. A. (2001). School-based aggression

prevention programs for young children: Current status and implications for violence prevention. School

Psychology Review, 30, 344–362.

Martens, B. K., Peterson, R. L., Witt, J. C., & Cirone, S. (1986). Teacher perceptions of school-based inter-

ventions. Exceptional Children, 53, 213–223.

Mulligan, S. (2001). Classroom strategies used by teachers of students with Attention Deficit Hyperactivity

Disorder. Physical and Occupational Therapy in Pediatrics, 20, 25–44.

Nelson, J. R. (1996). Designing schools to meet the needs of students who exhibit disruptive behavior. Journal of

Emotional and Behavioral Disorders, 4, 147–161.

Noam, G. G., Warner, L. A., & VanDyken, L. (in press). Beyond the rhetoric of ‘‘zero tolerance’’ long term

solutions for at-risk youth. In R. J. Skiba, & G. G. Noam (Eds.), Zero Tolerance: Rhetoric vs. Reality.

Noam, G. G., Winner, K., Rhein, A., & Molad, B. (1996). The Harvard rally program and the prevention

practitioner: Comprehensive, school-based intervention to support resiliency in At-Risk adolescents. Journal

of Child and Youth Care Work, 11, 32–47.

Pelham Jr., W. E., & Gnagy, E. M. (1999). Psychosocial and combined treatments for ADHD.Mental Retardation

and Developmental Disabilities Research Review, 5, 225–236.

Power, T. J., Hess, L. E., & Bennett, D. S. (1995). The acceptability of interventions for attention-deficit hyper-

activity disorder among elementary and middle school teachers.Developmental and Behavioral Pediatrics, 16,

238–243.

Reid, J. B., Eddy, J. M., Fetrow, R. A., & Stoolmiller, M. (1999). Description and immediate impacts of a

preventive intervention for conduct Problems. American Journal of Community Psychology, 27, 483–517.

Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and

Family Psychology Review, 3, 223–241.

Scott, T. M. (2001). A schoolwide example of positive behavioral support. Journal of Positive Behavior Inter-

ventions, 3(2), 88–94.

Shapiro, E. S., DuPaul, G. J., Bradley, K. L., & Bailey, L. T. (1996). A school-based consultation program for

service delivery to middle school students with attention-deficit/hyperactivity Disorder. Journal of Emotional

and Behavioral Disorders, 4, 73–81.

Shapiro, E. S., DuPaul, G. J., & Bradley-Klug, K. L. (1998). Self-Management as a strategy to improve the

classroom behavior of adolescents with ADHD. Journal of Learning Disabilities, 31, 545–555.

Short, R. J., & Short, P. M. (1989). Teacher beliefs, perceptions of behavior problems, and intervention prefer-

ences. Journal of Social Studies Research, 13, 28–33.

Strein, W., Hoagwood, K., & Cohn, A. (2003). School psychology: A public health perspective. Journal of

School Psychology, 41, 83–90 (this issue).

Sugai, G., & Horner, R. (2001). School climate and discipline: Going to scale. A framing paper for the national

summit on the shared implementation of IDEA.

Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine: KC.

Taylor-Greene, S. J., & Kartub, D. T. (2000). Durable implementation of school-wide behavior support: The high

five program. Journal of Positive Behavior Interventions, 2, 233–235.

Tremblay, R. E., Pagani-Kurtz, L., Masse, L. C., Vitaro, F., & Pihl, R. O. (1995). A bimodal preventive

intervention for disruptive kindergarten boys: Its impact through mid-adolescence. Journal of Consulting

and Clinical Psychology, 63, 560–568.

Walker, D., Greenwood, C. R., & Terry, B. (1994). Management of classroom disruptive behavior and

academic performance problems. In L. W. Craighead, & E. W. Craighead (Eds.), Cognitive and behav-

ioral interventions: An empirical approach to mental health problems ( pp. 215–234). Boston: Allyn and

Bacon.

Walker, H. M., Horner, R. H., Sugai, G., Bullis, M., Sprague, J. R., Bricker, D., & Kaufman, M. J. (1996).

Integrated approaches to preventing antisocial behavior patterns among school-age children and youth.

Journal of Emotional and Behavioral Disorders, 4, 193–256.

Walker, H. M., Severson, H. H., Feil, E. G., Stiller, B., & Golly, A. (1998). First steps to success: Intervening at

the point of school entry to prevent antisocial behavior patterns. Psychology in the Schools, 35, 259–269.


Williams, R. A., Horn, S., Daley, S. P., & Nader, P. R. (1993). Evaluation of access to care and medical and

behavioral outcomes in a school-based intervention program for attention-deficit hyperactivity disorder.

Journal of School Health, 63, 294–297.

Witt, J. C. (1986). Teachers’ resistance to the use of school-based interventions. Journal of School Psychology,

24, 37–44.


Documents

School psychology: a public health framework: III. Managing disruptive behavior in schools: the value of a public health and evidence-based perspective